BIOLOGY 
 LIBRARY 
 
LECTURES ON 
 
 MILITARY SANITATION 
 
 AND MANAGEMENT 
 OF THE 
 
 SANITARY SERVICE 
 
 ARMY SERVICE SCHOOLS 
 
 FIELD SERVICE AND CORRESPONDENCE SCHOOL 
 FOR MEDICAL OFFICERS 
 
 Fort Leaven worth: 
 ARMY SERVICE SCHOOLS PRESS 
 
 1917 
 
Lecture 
 
 
 MILITARY HYGIENE 
 
 HYGIENE is the science which deals with the 
 preservation of the health. Its existence de- 
 pends on past scientific discoveries. Sanitation is 
 the method which is adopted to carry out the prin- 
 ciples of hygiene. Sanitary methods may differ, but 
 yet be effective, in the same way that many prob- 
 lems in geometry may be solved by different meth- 
 ods. Sanitation, therefore, is the application of 
 scientific discoveries to prevent disease. "Military 
 sanitation" should be used instead of the words "mi- 
 litary hygiene" as hygiene covers all principles to 
 insure health and application of these principles in 
 the military service is the method of dealing with 
 men living under conditions somewhat foreign to 
 those that civilziation has caused to exist. 
 
 A medical officer has many duties to perform. 
 There is hardly anything pertaining to a soldier that 
 he is not in some way required to make recommenda- 
 tions or act on his own initiative, but his principal 
 duty in time of war is to initiate the proper sanitary 
 measures, and without your intelligent help as offi- 
 cers he will not be entirely successful. The greatest 
 achievements towards military efficiency in our ar- 
 my, so far, have been accomplished by the medical 
 corps by scientific discoveries and their application, 
 and the officer who is now in command of men, and 
 who does not give this subject the proper attention 
 must necessarily be a failure. 
 
 In all the wars that history records (possibly 
 with the exceptions of the Russo-Japanese war, and 
 3 
 
) . - . -4-, 
 
 the present disturbance abroad) much more disa- 
 bility and many more deaths have resulted from 
 disease than from wounds. The failures of armies 
 on account of preventable diseases are not few. 
 Arnold in 1775 was unsuccessful because small-pox 
 and dysentery incapacitated the command. " In 1802, 
 15,000 of Napoleon's army perished in Santo Do- 
 mingo of yellow fever and other preventable tropical 
 diseases. The British in the Crimea lost twenty- 
 five times more men from disease than from wounds. 
 In the Spanish- American war there were seven times 
 more deaths from sickness than was caused by the 
 enemy. During the Balkan wars cholera in the Bul- 
 garian army, and typhus fever in Servia during the 
 present war greatly influenced the results of the 
 attack in the former, and the defense of the latter. 
 
 The Selection of Recruits 
 
 It is quite evident to you, as common sense 
 teaches, that it is desirable to have men accepted in 
 the Army who are the best physical specimens, and 
 also men somewhat intelligent and mentally alert. 
 In a small army when men desire to enlist in great 
 numbers this selection can be made ; but there are so 
 many men who have slight imperfections that this 
 degree of perfection will never be reached when a 
 great number of men are called out for active ser- 
 vice. 
 
 At the present time War Department Orders 
 prescribe certain requirements regarding height, 
 weight, chest measurements, age, hearing and vision 
 for recruits, and no departure can be made from 
 these requirments without special authority from 
 The Adjutant General of the Army. Past experi- 
 ence has shown that it is not desirable to accept men 
 who are outside of the limits set forth in the rules 
 
for the examination of recruits. Besides good phy- 
 sique, the soldier should be of good character and 
 habits, mentally alert, with fair education and of 
 normal temperament. 
 
 In time of peace, heretofore, the number of men 
 rejected for enlistment were three or four to one 
 accepted. 
 
 During the recent mustering into the United 
 States service of the National Guard (militia) great 
 pressure was brought to bear on the War Depart- 
 ment to accept officers, especially, who had been re- 
 jected physically. An attempt was made to main- 
 tain the standard of the regular army in regard to 
 the National Guard, but it was found to be impos- 
 sible, yet most of the physically unfit were elim- 
 inated. During war, and the longer that war contin- 
 ues, the physical standard must necessarily be low- 
 ered, in order to obtain men. 
 
 System of Examination. Up to 1907 the phy- 
 sical examinations were made largely by civilian 
 physicians, employed under contract, at recruiting 
 station in cities. Under this system great losses of 
 men occurred as a result of disabilities discovered 
 after the recruit had been sworn in. At the same 
 time the government spent much money for the 
 transportation and' clothing of these defectives, 
 while company commanders became dissatisfied on 
 account of the poor quality of the material sent them. 
 As a result of these undesirable features a system 
 has been developed whereby line officers make a 
 careful preliminary examination at their recruiting 
 stations, and forward likely candidates to depots. 
 At the latter points army medical efficers examine 
 these candidates, weed out the defective ones, and 
 enlist those qualified. The Surgeon General reports 
 that "the present recruiting system operates in a 
 
highly satisfactory manner and furnishes to the 
 army recruits of far better quality than when they 
 were examined under the former system/' 
 
 Principal Defects. The physical deficiencies 
 which cause the greatest number of rejections for 
 our army are: venereal diseases, heart abnormali- 
 ties, defective vision or hearing, foot deformities, 
 and poor physique. While it is not to be expected 
 that line officers on recruiting duty shall be able to 
 detect obscure affections of the internal organs, 
 there are many grosser defects which are readily 
 apparent to them. Such are: deformities, skin 
 eruptions, pallor, emaciation, inebriety, venereal dis- 
 ease, defective development of parts, lice, dirty per- 
 son, rupture, piles, stiff joints, varicose veins, flat 
 feet, indecent tattooing, etc. Furthermore, internal 
 disease may be suspected from shortness of breath, 
 a thumping heart, dimness of vision, or irregular 
 pulse following moderate exertion. 
 
 Character. The character of the applicant 
 should be determined as accurately as possible. He 
 may satisfy all the physical requirements, but when 
 the recruiting officer asks himself the question: 
 "Would I be willing to have this man in my com- 
 pany?" there is often a decided negative. And 
 this test is a useful one to apply with respect to the 
 intelligence of the applicant, his knowledge of Eng- 
 lish, and his general appearance. The moral qual- 
 ifications may be guessed from his features and s*aze 
 (open, frank or averted), his manner (direct or fur- 
 tive and hang-dog), his person and clothing (clean 
 or dirty). He may present the well-known appear- 
 ance of a drunkard or tramp. Drug habits may be 
 indicated by numerous marks of the hypodermic 
 needle or very contracted pupils. A marked dis- 
 proportion of features or limbs may be indications 
 
of degeneracy, or his body may be much tatooed, 
 some of the subjects being of an obscene or other- 
 wise offensive nature. 
 
 Mental and Nervous Condition. The men- 
 tal and nervous condition is important. A nervous 
 shifty, or excitable manner ; wandering attention ; 
 defective memory; inability to give prompt or di- 
 rect replies to questions; sudden, jerky movements, 
 will frequently indicate an unstable nervous sys- 
 tem or defective mentality. 
 
 Age. Youth is a serious physical defect. We 
 sometimes read the erroneous statement that the 
 Civil War was fought by boys, but in that war, 
 as in all those of history, undeveloped, immature 
 youths succumbed to the fatigues and privations of 
 campaign in vastly greater proportion than grown 
 men. Prior to the age of twenty-one the bones are 
 not fully formed, the muscles lack endurance, and 
 the heart is unduly susceptible to overstrain. On 
 the other hand, men over thirty, unless they have 
 led an active, alert life, are apt to be muscle-bound 
 and mentally slow. The limits of age for our service 
 are, in time of peace, eighteen to thirty-five. It is 
 therefore, to be seen that minors may be legally ac- 
 ceted in spite of the knowledge that great com- 
 manders have, for centuries past, protested against 
 the recruitment of boys for their armies. From a 
 physiologic standpoint the truly desirable minimum 
 is not less than twenty years. 
 
 Height, Weight, Chest. In the absence of ac- 
 tual diseased conditions, the physical attributes 
 which chiefly determine the acceptance or rejection 
 of an applicant for enlistment are the height, the 
 weight, and the chest measurements. In normal in- 
 dividuals these bear a fairly definite relation to each 
 other, which relation is set down in official tables. 
 
8 
 
 Men whose chest circumference, at rest, is below 32 
 inches, should not be accepted, for such a chest has 
 not sufficient air capacity. The present minimum 
 of height is 5 feet 1 inch. The question of height 
 is not quite so important now as in the days of 
 shock action. Other things being relatively equal, 
 the smaller man is generally quicker in his move- 
 ments and has more endurance. In these days of 
 specialism we might well accept vigorous men who 
 are a little shorter that the present requirement for 
 special service, thus releasing others of standard 
 height for the fighting line. With respect to weight, 
 men of the "wiry" type may be accepted when they 
 are but a few pounds under the standard, but the 
 mistake must not be made of confusing these with 
 cases of defective or arrested development. In 
 these latter, deficiency in weight, pallor, flabby mus- 
 cles, a flat chest, sloping shoulders, and generally 
 poor physique denote a feeble constitution. 
 
 Records. It is essential, for the protection of 
 the government, that careful records be made: (a) 
 of all departures from the normal, including minor 
 ones which are not considered disqualifying, and (b) 
 of means of identification. The first is needed as a 
 defense against unjust claims for pension. The sec- 
 ond leads to the detection of criminals, deserters, 
 bounty jumpers, and dishonorably discharged men 
 who enlist fraudulently. 
 
 Depots. Owing to the widespread derivation 
 of recruits, depots for their collection and training 
 are frequently afflicted with one or more kinds of 
 contagious diseases, brought by some who have con- 
 tracted them elsewhere. It has sometimes happened 
 that measles, mumps, or some other communicable 
 disease has developed in parties of men sent from 
 depots, during the trip or shortly after arrival at 
 
9 
 
 their destination. Army posts have thus been fre- 
 quently infected, while the health of the traveling 
 public has been endangered. If, therefore, such a 
 disease exists at depots, the men who have been ex- 
 posed to contagion should be isolated, in separate 
 squads, until the period of incubation of that par- 
 ticular disease is past. If a case develops in any 
 one squad, none but members of that squad have 
 been exposed to it and the others may safely be for- 
 warded. A similar procedure is advisable in carnps. 
 Vaccination. One of the first requirements 
 after the enlistment of a man is to have him vac- 
 cinated against smallpox and typhoid fever. This 
 is a very important procedure, looking to his future 
 health and that of the army. 
 
 Personal Hygiene 
 
 Nature and Importance. Personal hygiene 
 means preservation of health by attention to the care 
 of the body. It is obvious that such care is essen- 
 tial to keep the physical character of the soldier up 
 to the proper standard. Napoleon is reported to 
 have said: "The most important quality of the 
 soldier is his ability to support fatigue and privation ; 
 physical courage is only second." Whether or not 
 this be true, it must be apparent to any thinking 
 individual that personal merits, including courage, 
 are of little avail to the military man if he has not 
 bodily vigor. 
 
 Formation of Correct Habits. Military ef- 
 ficiency in an individual, then, rests upon certain con- 
 siderations, chief among which are health, strength, 
 and activity. To secure and keep these qualities it 
 is essential for every man to form such habits as ex- 
 perience has shown to benecessary. These habits 
 are: personal cleanliness; regulation of diet; avoid- 
 
10 
 
 ance of execesses (particularly in eating, drinking, 
 and sexual matters) ; wearing suitable clothing; 
 keeping the bodily processes at work (kidneys, bow- 
 els, skin) ; taking sufficient exercise, preferably in 
 the open air ; devoting a proper part of each day to 
 rest of the body and mind, with recreation for the 
 latter ; maintaining the surroundings in which one 
 lives, in a cleanly state. 
 
 Personal Cleanliness. The maintenance of per- 
 sonal cleanliness is even more necessary in the 
 military service than in civil life. This is due in 
 part to the violent exercises required of the soldier, 
 with the resultant dirt and sweat, but especially be- 
 cause so many live together within a small space. 
 
 Baths and Bathing. The most important re- 
 quirement to insure cleanliness is bathing. Baths 
 are necessary partly to rid the skin of external im- 
 purities, but chiefly to keep open the pores, which 
 are the mouths of the sweat-glands, whose product 
 carries away large amounts of waste and poisonous 
 matters from the blood. Each man has a prefer- 
 ence for a certain temperature of the water in which 
 he takes his bath ; this varies from freezing to hot. 
 A cold bath is stimulating and is to be preferred for 
 a vigorous man, provided he "reacts" well and feels a 
 glow on emerging from the bath and rubbing down. 
 The cold bath is not suited to elderly men nor to 
 those whose circulation is poor. The proper time 
 for cold bathing is on arising in the morning, not at 
 bedtime, as sometimes indulged in. 
 
 It is worthy of mention that the practice of cold 
 bathing often breaks up the habit of "taking cold," 
 to which certain people are liable. 
 
 Hot and warm baths are soothing and best re- 
 move surface dirt; they are grateful means of re- 
 
11 
 
 ducing muscular soreness after exertion, and will 
 often induce sleep in a restless, wakeful person. 
 
 The most desirable means of bathing is perhaps 
 in a tub in which the whole body may be immersed ; 
 in default of this and particularly in barracks, the 
 shower-bath is very satisfactory. If means for com- 
 plete bathing are not available, careful attention 
 should, in any event, be given to the daily cleansing 
 of the armpits, crotch and feet, as well as the hands 
 and face. The hands should be washed after defeca- 
 tion and urination, lest they convey disease germs. 
 The nails must be well kept and clean. On the 
 march, if no water is available, a vigorous "dry rub" 
 with a coarse towel will be found refreshing as well 
 as cleansing. The scalp should be washed at least 
 once or twice a month and should be stimulated 
 daily by brisk rubbing with a brush or the fingers. 
 
 Care of the Teeth. Every man should own a 
 good tooth brush and use it with a tooth powder or 
 mild antiseptic (listerine for instance) at least twice 
 a day. If no tooth powder is available, wood ashes 
 or wood charcoal make efficient substitutes. 
 
 Clothing. Since clothing (especially the un- 
 derwear) when soiled w r ith sweat and dust is irrita- 
 ting to the skin and gives off disagreeable odors, it 
 is necessary to keep this as clean as the body. The 
 soldier cannot keep his person clean if his garments 
 are filthy. Therefore, whenever possible, the soiled 
 clothing should be washed (and with soap if it can 
 be had). If the articles are of wool, they should be 
 washed in tepid water and dried without wringing. 
 On the march a man should have two suits of under- 
 clothes to wear on alternate days, thus ensuring 
 cleanliness if the garments are regularly washed. If, 
 
 at the end of the day's march, water is not available 
 
 i 
 
12 
 
 for this purpose, the garments should be dried, then 
 beaten or well rubbed, and hung up in the air. 
 
 Skin Diseases. In campaign, skin diseases due 
 to animal parasites especially lice and the itch mite 
 usually make their appearance and cause much dis- 
 gust and discomfort. They must be watched for 
 and report of their presence promptly made to the 
 medical officer. 
 
 Diet. In the soldier's life the diet is, of course, 
 regulated as far as possible by the authorities, who 
 design and issue the ration and train the cooks by 
 whom the articles composing it are prepared. In 
 campaign, military considerations may necessitate 
 cutting away from the base of supply, so that sol- 
 diers are obliged to live on the resources of the coun- 
 try in which they are operating or even to subsist 
 for a few days upon the emergency ration. Every 
 soldier should be required to learn how to prepare 
 his individual field ration, since the necessity for this 
 frequently occurs in field service. 
 
 The character of the food taken should vary in 
 accordance with the coonditions of bodily vigor, oc- 
 cupation, climate, and food values. A vigorous man, 
 doing heavy work, requires more nourishment than 
 one of delicate physique following a sedentary pur- 
 suit. Climate is an important factor. Men serving 
 in Alaska need a large amount of fats to serve as 
 fuel in maintenance of the temperature balance. 
 Those on duty in the Philippines require a largo 
 proportion of sugars and starches. 
 
 Dietary Don'ts. A few general dietary prin- 
 ciples follow, which may perhaps best be expressed 
 in the form of prohibitions : 
 
 Don't eat hurriedly. 
 
 Don't swallow a morsel till it is thoroughly 
 broken up and mixed with the saliva by chewing. 
 
13 
 
 Don't overload your stomach, but get up from 
 the table feeling that you could eat a little more 
 with .relish. 
 
 Don't eat unripe or overripe fruit. 
 
 Don't eat anything, while away from camp or 
 barracks, whose materials or mode of preparation 
 may seem questionable. 
 
 Don't bring worry or a "grouch" to the table 
 with you. 
 
 Excess in Eating. Overeating gives rise to 
 biliousness and other forms of dyspepsia and over- 
 loads the body tissues with waste matters. These 
 wastes are irritant substances and are just as likely 
 as alcohol to cause kidney disease, gout, obesity, and 
 hardening of the arteries. Beefy, overfed men are 
 especially liable to apoplexy. 
 
 Excess in drinking means, to us all, overuse of 
 drinks containing alcohol in some form. You will 
 learn that the great majority of violations of dis- 
 cipline, trials by courts-martial, and subsequent 
 punishment in our army result from this particular 
 excess. Habitual indulgence in alcohol brings, as 
 certain rewards, a host of physical and mental ail- 
 ments. Besides weakening men physically, alcohol 
 tampers with their will power and makes them less 
 trustworthy even when sober. 
 
 Sexual Indulgence. It is the popular idea that 
 a young man must exercise the sexual function 
 to some extent in order that he may retain his vigor. 
 This belief is not founded on fact, for the sexual act 
 is not necessary to preserve the health or powers of 
 a man. Not only is this true, but it is equally true 
 that sexual indulgence by young unmarried men is 
 responsible for an immense amount of disease and 
 suffering. This disease and suffering is borne not 
 only by the men themselves, but, in a large propor- 
 
14 
 
 tiori of cases, by the innocent women whom they 
 afterward marry and by their children. The wives 
 may be, and often are, infected years after an ap- 
 parent cure has resulted and the children are* born 
 diseased. 
 
 Clothing. The prime purpose for which cloth- 
 ing is worn (other than that of decency) is to 
 afford protection to the body against extremes of 
 cold and heat. The materials used should, therefore, 
 be such as to conserve the natural warmth of the 
 body or to allow it to escape freely, in accordance 
 with weather conditions. Clothing should not be 
 permitted to interfere with the circulation of the 
 blood, nor with the normal movements of the body. 
 
 Excretory Function. Our bodies, in the work 
 their various parts must perform, manufacture cer- 
 tain waste products which we call excretions. Now 
 it is evident that if we do not get rid of these sub- 
 stances, they will clog up the body or even act as 
 poisons. Nature has, therefore, designed certain 
 avenues of escape for these excretions, and the chief 
 of these are the skin, the kidneys, the bowels, and 
 the lungs. The importance of the skin has already 
 been dwelt upon. The kidneys can best be kept in 
 good condition by drinking plenty of water (at least 
 6 or 8 glasses a day), which flushes these organs 
 and dilutes the solid impurities of the urine. Con- 
 stipation induces a variety of uncomfortable con- 
 ditions, among which piles, headache, the state often 
 called "biliousness," and mental depression are fre- 
 quent. Therefore, remember to keep your bowels 
 open. 
 
 Lungs. The lungs are an important avenue of 
 escape for certain waste products, chief of which is 
 carbon dioxide. The ventilation of living rooms 
 thus becomes desirable to dilute or cary off these 
 
15 
 
 wastes, to renew that most vital element, oxygen, 
 and to prevent overheating, and undue moisture of 
 the atmosphere, which latter are important factors 
 tending to the diminution of vitality. The germs of 
 diseases which affect the respiratory tract are 
 throw r n off into the air and are likely to be breathed 
 by healthy individuals, who are thus in turn infected. 
 "Colds" result more often from overheated, poorly 
 ventilated rooms than as the result of drafts and 
 chilling. Such colds are often contagious. The 
 transmission of tuberculosis and such acute infec- 
 tious diseases as measles, scarlet fever, influenza, 
 and whooping cough is favored by poor ventilation. 
 
 Exercise. A sufficient amount of exercise to 
 maintain health is ordinarily provided by military 
 drills and other dfities requiring active movement. 
 Nevertheless, the physical condition is further im- 
 proved, muscular size and strength greatly increased, 
 and the mental outlook rendered more cheerful by 
 athletic exercises, whether in the open air or the 
 gymnasium. A proper appreciation of the benefits of 
 physical exercise may be gained by a mental com- 
 parison between the rugged condition of a man who 
 exercises regularly, and the poorly developed mus- 
 cles and sallow skin of another who has some oc- 
 cupation which keeps him indoors at work of a light 
 sort. The improvement is brought about by the 
 increased activity not merely of the muscles, but of 
 every part of the body, including the heart, lungs, 
 skin, digestive apparatus, etc. Like all good things, 
 however, exercise may be overdone; excessive ra- 
 pidity or irregularity of the heart's action and 
 labored breathing are warnings to stop and rest. 
 Soldiers in campaign especially immature boys who 
 are somtimes enlisted are very liable to heart strain 
 and an "irritable" condition of that organ. 
 
-16- 
 
 Arteries. "A man is as old as his arteries," 
 and some men grow old in this respect much sooner 
 than the average, so care must be taken to suit the 
 exercise to their condition. 
 
 The amount and kind of exercise best suited to 
 each must be determined, as these vary widely in 
 different individuals. There are men who require 
 the equivalent of a brisk 15 mile daily walk to keep 
 in a satisfactory physical state, while the ordinary 
 occupation of others suffices to maintain them in 
 excellent health. 
 
 Rest. For the repair of damaged tissues and 
 the relief of fatigue, a certain amount of rest for 
 both mind and body is necessary. Different people 
 vary considerably in their requirements, but it may 
 be set down as a fair average that eight hours of 
 sleep in each twenty-four hours are needed to keep 
 the faculties at their best. In addition, work of any 
 sort, physical or mental, must be intermitted by 
 brief period of relaxation. Mental overwork is very 
 common in these days of complex civilization, and 
 exhaustion of the nervous system (neurasthenia) 
 takes a long time for its recovery. 
 
 Recreation. The risk of overtaxing the mind 
 is greatly lessened by measures of recreation, which 
 may take any proper form most agreeable to the in- 
 dividual. The cultivation of a fad is of especial 
 value. The habit of worry, of "crossing bridges 
 before one comes to them," must be avoided. Fits 
 of "the blues," if yielded to, tend to increase in num- 
 ber and length and finally to unfit one for work. 
 In garrison, on transports, and particularly in winter 
 camps during war time, we must make provision for 
 measures of recreation. These are essential to pro- 
 mote cheerfulness and contentment, and to lessen the 
 tendency to abuse of alcohol and tobacco, gambling, 
 
17 
 
 and perversion of the generative function. Enter- 
 tainments of all sorts, but more particularly those 
 participated in by the men themselves, competitions 
 and contests, reading rooms, and opportunities for 
 following and learning mechanical trades must be 
 provided. 
 
 Cleanliness of Surroundings. It is not suffi- 
 cient merely to keep our bodies in a state of cleanli- 
 ness by the measures previously outlined. We must 
 also keep our surroundings the house and grounds 
 in which we live well "policed," as the expression 
 goes in our military service. It is self-evident that 
 where people live especially where many people 
 are congregated in a small space there much dirt 
 will collect. This refers not so much to earthly 
 particles as to the so-called organic materials which 
 are derived from animal and vegetable sources. 
 Under this head fall the body discharges, refuse 
 from the kitchen, decaying flowers and weeds, cigar 
 stubs, floor and stable sweepings, and the like. 
 These must be received in vessels specially kept for 
 them and frequently removed, or they give off foul 
 odors, pollute the ground, attract hosts of flies, and 
 act as breeding places for the germs of disease. 
 
 Preventable Diseases 
 
 In the first place, the fact must be recognized 
 that there are no diseases peculiar to soldiers. There 
 is not, by reason of their occupation or mode of life, 
 any abnormal physical condition engendered which 
 has not its counterpart among civilians. On the 
 other hand, there are certain departures from a 
 state of health to which soldiers are especially liable 
 because of their work and environment. Newly 
 raised troops and recruits generally have the highest 
 
18 
 
 disease rates. Old soldiers are inured to service and 
 have learned how to care for themselves. 
 
 Dependency of Soldiers. "The men who corn-- 
 pose an army are drawn from civil life, in which each 
 individual has, to a greater or less extent, independ- 
 ent control of his time, choice of occupation, selec- 
 tion of food and dwelling place, and general sanitary 
 care. -After enlistment, soldiers lose most of this 
 independence ; they are housed, clothed, fed, and ex- 
 ercised under regulations which it is beyond their 
 power to amend ; they are moved from one point to 
 another, differing perhaps very widely in climatic 
 and other conditions, under orders which they may 
 not presume to question ; their hours for sleep, meals, 
 work, and recreation are fixed for them without con- 
 sultation with them or without regard to individual 
 or communal preference/'* (Harrington.) 
 
 Inexperienced Soldiers. In our military sys- 
 tem the absolute dependence on the will or neglect of 
 a superior is especially prone to result in disease 
 conditions, because of the ignorance and inexperience 
 of militia and volunteers suddenly called into active 
 service. The officers have little or no knowledge of 
 the care of troops, while the men exhibit a reckless- 
 ness and disregard for the laws of health perculiarly 
 national. The American volunteer, unless firmly 
 commanded, displays the utmost indifference to the 
 ordinary rules of decency. He deposits his excre- 
 ment where he happens to be ; he drinks of any liquid 
 he encounters which may be dignified by the name of 
 water; he throws his wastes indiscriminately upon 
 the camp ground, heedless of the fact that putre- 
 factive changes will shortly make them offensive; 
 he gleefully seeks opportunities for alcoholic and 
 sexual excesses ; and, in defense of his heaven-born 
 liberties, he often declines to mend his ways because 
 
19 
 
 he enlisted to fight and not to perform menial occu- 
 pations. The necessity on the part of line officers 
 for familiarity with the preventable diseases to 
 which the soldier is liable and with the fundamental 
 sanitary principles necessary for their prevention 
 thus becomes apparent. 
 
 Venereal Disease. Of all the ills from which 
 the soldier suffers, those consequent upon venery 
 affect his effciency to the greatest extent. Our ar- 
 my is made up mainly of young, unmarried men, 
 freed from the moral restraints of home, often with- 
 out opportunity for association with decent women 
 and susceptible, to the suggestion of the vicious. 
 There must be some outlet for their surplus energies. 
 They visit places of amusement, many of which are 
 maintained with the sole object of pandering to vice, 
 where strong liquor and the advances of lewd wonjen 
 combine to break down such moral defenses as they 
 may possess. Unless prevented by legal enactment 
 the lowest kinds of "dives" cluster round the en- 
 trances to army posts. The soldier has a right to 
 his amusements and we must strive to furnish such 
 as will attract him more than evil resorts ; to secure 
 the passage of laws preventing the establishment of 
 low brothels at our gates ; and to build up the moral 
 stamina of our men by education. 
 
 Statistics show that at least a third of all women 
 who give their bodies for immoral purposes are suf- 
 fering from some form of veneral disease. This in- 
 cludes not merely the professional prostitute, but 
 the chorus girl, "saleslady," or mill hand, who, to 
 satisfy her love for finery or for other reasons, may 
 eke out a scanty income by occasional lapses from 
 virtue. It is a medical axiom that every prostitute 
 becomes infected with syphilis inside of two or three 
 
20 
 
 years. It is, therefore, easy to see that the risks of 
 contagion are very great. 
 
 The American people have, until recently, shun- 
 ned public discussion of venereal matters through 
 what may now seem to have been mistaken pru- 
 dery. A great movement has lately been instituted, 
 through the American Association for Sex Hygiene 
 and allied societies, looking to the awakening of the 
 public conscience and the moral education of the 
 youth of the land. 
 
 Prevalence in the Army. Venereal infec- 
 tions are responsible for an enonjious amount of 
 sickness in the army vastly more than any other 
 cause and constitute the most important health 
 problem with which we have to deal. There are 
 constantly on the sick report from this cause a num- 
 ber of men which more than equals the strength of 
 a regiment of infantry. Our army has the unenvia- 
 ble distinction of having a much greater amount of 
 sickness of this nature than any foreign army. 
 Moreover, since the Spanish- American War the ratio 
 of such cases has rapidly increased, until it is now 
 twice as much as in 1898. The situation must, 
 therefore, be fairly faced and every effort put forth 
 to determine the causes for the prevalence of ven- 
 ereal diseases and to devise measures for their pre- 
 vention. 
 
 That the army has a greater percentage of such 
 disease than has an equal number of vigorous young 
 unmarried men drawn from like source in civil life 
 is not believed. Such infections cause the largest 
 proportion of rejections of applicants for enlistment. 
 They honeycomb our social structure. In point of 
 prevalence they vastly outnumber all other infectious 
 diseases, both acute and chronic, combined. 
 
21 
 
 Causes. These are not far to seek. In the first 
 place, sexual desire is implanted in man as a compel- 
 ling factor for the perpetuation of the race. This 
 desire is strong, especially when, by previous exer- 
 cise of the function, the habit has been formed. 
 Next, the demand for partners in the sexual rela- 
 tion has always created a supply, and prostitution is 
 as ancient as history. Of late this supply has been 
 elevated to the dignity (?) of a business, and a 
 hideous traffic, with an intricate system for procur- 
 ing young girls and suborning those who legally 
 should prevent such traffic, is now strongly en- 
 trenched. 
 
 Preventive Measures. How, then, shall we 
 set about to minimize, as far as possible, the inci- 
 dence and effects of these loathsome diseases, largely 
 dependent, as they are, upon causes inherent in the 
 nature of mankind? From a sanitary standpoint 
 is is plain that we must apply the ordinary prin- 
 ciples of sanitation. That is, we must recognize 
 their contagious character and apply such preven- 
 tive measures as are effective in other transmissible 
 diseases. The most important measure of this char- 
 acter is the isolation of infected individuals until the 
 danger of transmission is past. In the army we can 
 and do control our infected soldiers, but the women 
 from whom their disabilities were derived, as well 
 as infected male civilians, are still at large to spread 
 the contagion further. It is obvious, therefore, 
 that, if we hope for success, sentimentalism and pru- 
 dery must give way, and that diseased public women 
 must be admitted to hospitals or otherwise placed 
 under restraint till the infectious stage of the disease 
 is over. For the diseased male, it should be made 
 a crime knowingly to spread a venereal disease. 
 
22 
 
 Education. The measures above outlined do 
 not conform with the yet uneducated public feeling 
 that it is immoral openly to recognize diseases of 
 this class and their chief transmitter, the prosti- 
 tute. On the other hand, the measures themselves 
 are certainly not immoral, while they are practical. 
 On the moral side, the campaign of education already 
 begun should be extended and a flood of light poured 
 upon the subject, that all may clearly understand 
 sex matters, the dangers as well as the immorality 
 of illicit intercourse and the methods of spread of 
 diseases transmitted thereby. With such education, 
 the veil of ignorance, misinformation, and prudery 
 will be lifted and the tendency to secret vices among 
 children will be lessened. Havard says truly. "It 
 is in the conscience of the young man that prophy- 
 laxis should begin/' The knowledge of sexual mat- 
 ters acquired by a child is from bad sources and of a 
 perverted kind. Such knowledge, secretly acquired 
 and brooded over in secret, hastens the awakening of 
 sexual feeling and leads to vice. 
 
 Action by the War Department. Our War 
 Department has acted with courage and vigor in 
 attacking this problem. Orders were issued in 1912 
 directing procedures as follows: 
 
 I. That physical inspections of enlisted men 
 should be made twice each month for the detection of 
 venereal disease. 
 
 II. That any soldier who exposes himself to in- 
 fection shall report for cleansing and preventive 
 treatment immediately upon return to camp or garri- 
 son. 
 
 III. That any soldier who fails to so report, if 
 found to be suffering from a venereal infection, shall 
 be brought to trial by court martial for neglect of 
 duty. 
 
23 
 
 IV. That men so diseased shall be confined 
 strictly to the limits of the post during the infectious 
 stages of the disease. 
 
 V. That all officers serving with troops shall do 
 their utmost to encourage healthful exercises and 
 physical recreation and to supply opportunities for 
 cleanly social and interesting mental occupations for 
 the men under their command. 
 
 VI. That company and medical officers shall 
 take advantage of favorable opportunities to point 
 out the misery and disaster which follow upon moral 
 uncleanliness and the fact that venereal disease is 
 never a trivial affair. 
 
 Action by Congress. Congress, too, has taken 
 a decided stand, by an enactment providing that no 
 officer or enlisted man who shall be absent from 
 duty on account of disease resulting from his own 
 intemperate use of drugs, or alcoholic liquors, or 
 other misconduct, shall receive pay for the period of 
 such absence. 
 
 It will be seen from the foregoing that the army 
 now has an excellent plan for the discouragement of 
 vice and the control of disease resulting therefrom. 
 It is, however, in the highest degree desirable to keep 
 the men away from more evil influences, and it is 
 notorious that the saloon, prostitution, and profes- 
 sional gambling go hand in hand. The close rela- 
 tion between alcoholic excess and sexual indulgence 
 is an interesting fact. A man's passions are in- 
 flamed by liquor, his will power and his judgment are 
 alike weakened, and he yields to conditions which 
 in his sober moments might be positively offensive 
 to him. 
 
 Syphilis. There are three kinds of venereal 
 disease. The most serious to man is, perhaps, 
 syphilis (sometimes called the "pox," and referred 
 
24 
 
 to in the newspaper advertisements of charlatans 
 as "blood disease")- This is due to a very active, 
 corkscrew-shaped protozoal germ. Its first appar- 
 ent result is an open sore at the point of infection. 
 This sore, known as a hard chancre, does not appear 
 for several weeks after exposure, but is then very 
 resistant to treatment and remains for a month or 
 more. The body is soon infected throughout, and 
 symptoms of this condition appear most often in 
 the form of skin eruptions and glandular swellings. 
 
 Syphilis is an infection of the entire system and 
 its manifestations are practically innumerable. We 
 may expect it to appear in any conceivable form, and 
 where a chronic case of disease is obscure, tests 
 often reveal its presence. Certain of these mani- 
 festations may (and do) appear many years after 
 the disease was contracted. Among these are pare- 
 sis (softening of the brain) and locomotor ataxia. 
 
 Syphilis is extremely difficult to cure, and, in a 
 certain proportion of cases, never is cured. The new 
 remedy "606" or salvarsan is still in the experi- 
 mental stage, but it is at least certain that its use 
 is not followed by permanent recovery, and that the 
 older and more prolonged forms of treatment must 
 still be employed. Syphilis is the disease which is 
 so often transmitted to the children "even unto the 
 third and fourth generation," as the Good Book in- 
 forms us as well as to the wife. It may be trans- 
 mitted to others not only by sexual contact, but also 
 by means of articles (such as towels, eating and 
 drinking utensils, a comrade's pipe) used in common. 
 Cases also are frequently met which have been inno- 
 cently acquired through kissing, surgical or dental 
 operations, the ministrations of a nurse, and numer- 
 ous other blameless ways. 
 
25 
 
 The danger of transmission of the disease from 
 father to child (hereditary syphilis) is very con- 
 siderable. Many children are born dead ; others die 
 soon after birth ; still others (who, though diseased, 
 may survive) show characteristic deformities or 
 unmistakable syphilitic lesions. 
 
 Marriage. "Marriage of a syphilitic is per- 
 missible only after five years, during the last two 
 of which he has been without symptoms and without 
 treatment" (Keyes). 
 
 Gonorrhea, or "clap," is the result of infection 
 with the bacterial germ known as the gonococcus, 
 and is characterized by a profuse purulent discharge 
 from the affected part. This is usually the canal of 
 the penis (the urethra) in the male, although any 
 mucous or serous membrane may be involved. Thus 
 if, by carelessness or misfortune, a little of the pus 
 is transferred to the eye, a most violent inflammation 
 ensues and the sight is in grave danger of destruc- 
 tion. Gonorrheal rheumatism is a common and in- 
 tractable affection. Heart disease is an occasional 
 sequel. 
 
 Gonorrhea is even more frequently conveyed to 
 the wife than syphilis, and with most serious results, 
 as thousands of deaths and tens of thousands of 
 chronic invalids attest; 60 to 80 per cent, of pelvic 
 suppurations in women are due to this affection. 
 The eyes of babies become infected during birth. 
 It is estimated that 25 per cent, of blind people owe 
 their infirmity to this cause. 
 
 Gonorrhea is popularly regarded as something 
 of a joke, an affection but little more harmful than 
 a cold in the head ; but many surgeons look upon it 
 as more serious than syphilis in its results, for the 
 infection has a way of traveling along the various 
 routes to the bladder, kidneys, and testicles, leaving 
 
26 
 
 a man permanently injured and often greatly short- 
 ening his life. Gonorrhea is transmitted to inno- 
 cent people wife, child, comrade with extreme 
 ease, so, if thus affected, one cannot be too careful 
 to make sure that none of the discharge is brought 
 in contact with a healthy individual. Cotton or 
 other material soiled with the discharge should be 
 burned or otherwise safely disposed of. 
 
 Chancroid. The third venereal disease 
 chancroid or soft chancre is a contagious ulcer. It 
 is always local, never constitutional, and has no re- 
 lation to syphilis (although it is frequently necessary 
 to wait for weeks before one can be sure it is not 
 the latter). Its cause is a special bacillus. While 
 it may occur elsewhere, it is practically always found 
 about the genitals. Though less serious than the 
 other diseases of this class, it is a painful and repul- 
 sive affection. In about one-third of the cases it is 
 accompanied by an abcess in the groin known as a 
 bubo. 
 
 Personal Prophylaxis. Reference has been 
 made ealier in this lecture to the War Department 
 requirement that enlisted men who have exposed 
 themselves venereal infection shall report at hqs- 
 pital or dispensary for cleansing and preventive 
 treatment, but it may be said that the procedures 
 used are very successful in the prevention of infec- 
 tion. Objection has been made that such prevention, 
 by making licentiousness safe, encourages the latter. 
 As already shown, our problem is to keep our soldiers 
 physically fit, and purely sentimental considerations 
 are of secondary importance. Moreover, our navy 
 has given the system a fair trial, and finds an actual 
 diminution in percentage of exposures as the result 
 of the campaign of education. 
 
27 
 
 In the absence of legitimate intercourse (that is, 
 married life) nature will relieve the situation by 
 an occasional nocturnal emission, which is in no 
 sense harmful. The cultivation of pure thought, 
 the avoidance of temptation, cold baths, simple, non- 
 stimulating diet, vigorous physical exercise, and al- 
 coholic abstinence will prove efficacious in overcom- 
 ing desire. 
 
Lecture II 
 
 MILITARY HYGIENE 
 
 Water, Food, Fly, and Carrier-Borne Diseases 
 Typhoid Fever 
 
 TYPHOID fever (or enteric, as the English call it) 
 has for many years been known as "the scourge 
 of armies." In our Civil War the Union Army had 
 over 80,000 cases recognized as such, and there were 
 probably as many more which, because of imperfect 
 means of diagnosis, were thought to be malaria and 
 other infections. 
 
 War of 1870. The Germans, in the war with 
 France in 1870, had over 73,000 cases and nearly 
 7,000 deaths, although active hostilities lasted but 
 six months. 
 
 Boer War. The British Army in South Africa, 
 while fighting with the Boers, had 57,000 cases and 
 8,000 deaths. 
 
 War of 1898. In our war with Spain we had 
 20,738 cases, with 1,580 deaths, among 108,000 men, 
 all occurring within three and a half months ; 1 man 
 in every 6 had the disease, while this proportion was 
 increased to 1 in 5 among those regiments which 
 never left the United States. Typhoid fever caused 
 nine-tenths of all deaths occurring among troops 
 encamped in the United States in 1898. 
 
 Such instances might be multiplied indefinitely, 
 but enough has been said to show what an immense 
 amount of sickness and military inefficiency to say 
 nothing of the suffering and death of individuals, 
 with economic loss this dreaded disease causes. 
 
 29 
 
30 
 
 How Spread. Typhoid bacilli find the most 
 favorable soil for growth and increase in the bowels 
 of human beings ; they are usually found also in the 
 urine of infected individuals. The disease is spread, 
 therefore, by the discharges of such individuals gain- 
 ing access to the intestinal canals of others through 
 swallowing substances contaminated with the germ. 
 This may happen directly by contact with a diseased 
 person or indirectly through infected water, milk, 
 uncooked fruit and vegetables, dust, flies, soiled 
 hands, garments, bedding, or tentage. 
 
 If we had a perfect method of disposal of these 
 waste products of the body, it would not be long 
 before typhoid fever would cease to appear in epi- 
 demic form, and only an occasional case would be 
 encountered as the result of direct contact with an 
 infected individual. But, under the imperfect sani- 
 tary conditions of modern existence, it will be a long 
 time before this is realized, and in the meanwhile 
 we must employ such measures as will reduce to a 
 minimum the risks of contact with infectious ma- 
 terial. 
 
 Army Epidemics. Typhoid fever is more likely 
 to become epidemic in military than in civil life 
 because of the greater difficulty in disposing of 
 wastes, and the close crowding and intimate contact 
 of young men under the conditions of camp and 
 barrack life. A man affected with typhoid may 
 scatter the germs of the disease widely before its 
 existence is recognized in himself, since it frequently 
 happens that mild cases are not detected for a week 
 or two from their onset. Moreover, 3 to 4 persons 
 in every 100 who have recovered from attacks con- 
 tinue to breed the germs in their bodies and to dis- 
 charge them with their excretions. We call such 
 chronically infected individuals "carriers." Such a 
 
31 
 
 man, by defecating in the nearest brush, stepping 
 just outside his tent at night to urinate, or failing 
 to cover his discharges in the sink (whereby flies 
 may have access to them, to convey the filth to food 
 in nearby kitchens a little later) may be sowing the 
 seeds of the scourge broadcast. Each man who thus 
 offends seems to think he is the only one who does 
 such a trick and so it won't do any harm. Unfor- 
 tunately, many of his comrades are looking at the 
 matter from the same point of view. And flies are 
 not necessarily the agents in this matter. Let us 
 again assume one infected individual in camp. His 
 habits as to cleanliness may be bad or his opportuni- 
 ties therefor poor. At any rate, his hands are sure 
 to be soiled with infectious material, which he trans- 
 fers to everything he touches clothing, bedding, 
 towel, the cigars or matches he proffers to a comrade, 
 and even the food of others which he handles for he 
 may be company cook or cook's police. His saliva 
 is infectious and he fouls the common drinking cup 
 or a pipe which another may use. Or, again, a 
 soldier's shoes may be soiled with the filth deposited 
 upon the ground by a careless comrade. This ma- 
 terial is carried about the camp and into the tents, 
 and, since the typhoid bacillus may live for a time 
 in the earth, a puff of wind of a friendly scuffle 
 whirls the infected dust in the air, whence it is 
 likely to be blown upon food and thus swallowed. 
 By such means not one but dozens of men are in- 
 fected, and with each new case the risks grow in 
 geometric progression. In the multitude of cases 
 during the Spanish-American War, impure water 
 played little or no part. The three factors almost 
 wholly responsible for these cases were uncovered ex- 
 creta, flies attracted thereby, and personal contact 
 with infected individuals. 
 
32 
 
 Prevention. Now, what is the "ounce of pre- 
 vention" in this case ? It consists, first, in the pre- 
 liminary anti-typhoid vaccination of men believed 
 to be susceptible ; second, in a campaign of education 
 (which must be shared by line and medical officers 
 alike) in the facts just related; third, in the protec- 
 tion of the water-supply; fourth, in the systematic 
 and thorough disposal of excreta and organic wastes 
 generally ; and fifth, in sharp punishment for viola- 
 tions of sanitary regulations. 
 
 Anti-typhoid Vaccination. In anti-typhoid in- 
 jections we now have a method of protection against 
 this disease which is quite as efficacious as is vac- 
 cination against small-pox. It is well known that 
 an attack of typhoid usually protects a man against 
 a subsequent attack. Only 1 case in 143 has typhoid 
 a second time, and the method of protection referred 
 to is found to confer immunity in a similar way and, 
 it is thought, to an equal degree 
 
 It is in our own service that the procedure has 
 been most thoroughly tested and its value definitely 
 proved. Vaccinations of officers and men who volun- 
 teered for the purpose were commenced in 1909. 
 The results were so good that in 1911 the procedure 
 was made compulsory for all under forty-five years 
 of age who had never had the disease. The navy 
 followed suit, and immunization of both services is 
 now practically complete. A single instance of the 
 value of the prophylactic measure to our service 
 will suffice. This takes the form of a comparison 
 between an army division in Florida during the 
 Spanish War in 1898 and a division in Texas during 
 the border troubles in 1911. Conditions as to 
 strength of command, climate, season, purity of 
 water-supply, and duration of camp were approxi- 
 mately equal. The disposal of wastes was much 
 
33 
 
 superior in the latter camp, but the complete im- 
 munization of the Texas command by means of the 
 anti-typhoid prophylactic constituted the conspicu- 
 ous difference : 
 
 Mean Cases of typhoid Deaths from 
 
 Year strength (certain and probable) typhoid 
 
 1898 - 10,759 2,693 248 
 
 1911 12,801 2 
 
 Dysentery 
 
 Dysentery remains the most serious of the 
 diseases to which our people in the Philippines are 
 liable. Broadly speaking, dysentery is any inflam- 
 matory disease of the bowels in which blood and 
 mucus appear in the stools. Based upon their cau- 
 sative factors there are two types, the one due to 
 animal (protozoal), the other to vegetable (bacter- 
 ial) parasites. 
 
 Amebic Type. The principal form of dysentery 
 under the first head is caused by an ameba, a minute 
 animal consisting of a single cell. This is the type 
 which causes most trouble in the Philippine Islands ; 
 it is also met with in our Southern States. The 
 amebae enter the body with food or water and pro- 
 duce inflammations and ulcerations of the large intes- 
 tine, which are sometimes complicated by abscesses 
 of the liver. Their natural home appears to be the 
 human intestine, and from this source they con- 
 taminate foods (especially fruits and green vegeta- 
 bles) and drinking water. 
 
 BacillSry Type. The bacterial type of dysen- 
 tery is caused by the bacillus dysenteriae. Bacillary 
 dysentery can only be told from the amebic form by 
 an expert, but for our purposes this fact is unimport- 
 ant, since our preventive measures are the same 
 for both. This type is very widely distributed over 
 temperate as well as hot climates, and is the one 
 
34 
 
 which is responsible whenever epidemic outbreaks 
 occur in an army. The bacilli are conveyed from 
 fecal matter to the mouth by contaminated food or 
 drink. Flies are comman agents of transference and 
 personal contact plays as large a part as in typhoid. 
 As a result of their presence in the bowel and the 
 development of poisons (toxins) resulting from their 
 activities, ulcerations of the large intestine, hemor- 
 rhages therefrom, and great prostration result. This 
 form is usually more active and dangerous than 
 the amebic, being sometimes almost as rapidly fatal 
 as cholera. 
 
 Camp Diarrheas. Diarrheas are very common 
 in field service and may result from a variety of 
 causes, such as bad food, certain kinds of water, poor 
 cooking, or abdominal chilling. There is also an 
 epidemic form (heretofore referred to as camp diar- 
 rhea) which attacks large numbers of men at one 
 time and is severe in character. One cause of epi- 
 demic diarrhea is the dysentery bacillus, which 
 occasionally manifests its activities thus, but any 
 form of diarrhea is bad, since it not only rapidly 
 weakens a man, but, by irritating the intestines, it 
 increases the liability to attack by the more serious 
 affections, typhoid fever and dysentery. Under con- 
 ditions of active service the importance of "carriers" 
 of typhoid, dysentery, and epidemic diarrheas is 
 greater than in civil life. Indeed, these probably 
 constitute the most important of all factors. 
 
 Prevention. Preventive measures f 6r all forms 
 of dysenteries and camp diarrheas are identical 
 with those for typhoid fever save in the matter of 
 vaccination, for which we do not as yet possess 
 an efficient agent. The water-supply should be care- 
 fully protected from fouling; the feces of men sick 
 with these diseases should be disinfected or other- 
 
35 
 
 wise safely disposed of ; the sick should be separated 
 from the well; and all sources of irritation of the 
 intestinal tract should be avoided. 
 
 Cholera 
 
 Cholera, whose normal home is the tropics, is 
 by no means confined to warm climates, but is fre- 
 quently brought to our own shores. Since we know 
 its cause (the "comma" bacillus) and the fact that 
 the measures for its control are similar to those for 
 typhoid fever, we do not fear that it will affect a 
 lodgment in the United States. Cholera has given 
 us much trouble in the Philippines, but even there, 
 where sanitary measures are carried out with greater 
 difficulty, its invasions have been met and checked. 
 
 Flea-Borne Diseases 
 Plague 
 
 Plague, the "black plague" of the Middle Ages, 
 establishes itself independently of climate wherever 
 it finds favorable conditions. It has been demon- 
 strated that rats are even more liable to this disease 
 than man, and it is well established that infection 
 is usually incurred through the bite of the rat flea, 
 which after the death of its normal host, forsakes 
 the latter and attacks man. Rats should, therefore, 
 be relentlessly pursued, their haunts made inacces- 
 sible to them, and opportunities for obtaining food 
 cut off. Cousins of the rat such as the prairie dog 
 of our western plains and the ground squirrel (tar- 
 bagan) of California and Manchuria are subject to 
 the disease and may be agents in its transmission. 
 In some epidemics a very deadly form ("pneumonic" 
 plague) attacks the lungs. Here the germ is trans- 
 mitted by breathing and the flea is not a factor. 
 
36 
 
 Louse-Borne Diseases 
 Typhus Fever 
 
 Typhus fever, the "febris bellica" of older 
 writers, has been the scouge of armies. During the 
 Crimean war it caused more deaths than all other 
 diseases combined. All of you know what havoc it 
 has played in Servia. The great Von der Goltz, of 
 whom you will hear more about in the near future, 
 recently died with typhus. As it is quite prevalent 
 in Mexico it is of great importance for you to know 
 that vermin transmit the disease from one person to 
 another. The destruction of vermin will wipe out 
 an epidemic. 
 
 Mosquito-Borne Diseases 
 Malaria 
 
 The malarial fevers constitute an important 
 class of diseases. Other names by which they are 
 known are ague; chills and fever; remittent fever; 
 intermittent fever. The dreaded Chagres Fever of 
 Panama is a form of pernicious malaria. There are 
 three types of these fevers, each due to a different 
 minute animal parasite which attacks the blood of 
 man, but it is sufficient for our purpose here to know 
 that all have a similar origin, namely, the bite of an 
 infected mosquito. The method of transmission was 
 discovered as recently as 1898 by a British Army 
 surgeon. 
 
 Anopheles Mosquitoes. Only one variety of 
 mosquito (the anopheles) which, however, has rather 
 numerous species is capable of transmitting the 
 germs responsible for the disease. The mosquitoes 
 may be recognized, in their adult or even larval 
 forms, by peculiarities in their attitudes when at 
 rest. The larvae (popularly called "wigglers") of 
 
37 
 
 harmless (culex) mosquitoes lie head downward on 
 the water in which they are developing, with only 
 their breathing tubes in contact with the surface. 
 Those of the anopheles lie parallel with the water's 
 surface and just beneath it. Mosquitoes themselves, 
 when resting, show opposite peculiarities; that is, 
 the common forms lie parallel with the surface to 
 which they cling, while the anopheles rest with their 
 heads near the surface and their bodies angling 
 away from it. Another point of difference is that 
 the common form is humpbacked, while the anophe- 
 les is nearly straight from proboscis to tail. It is 
 worthy of remark that only females are blood- 
 suckers and thus transmitters of malaria. The male 
 may readily be recognized by the feathery tuft on 
 his head. 
 
 Mode of Transmission. The transference of 
 the infection from one man to another is accom- 
 plished in the following manner: A certain indi- 
 vidual has malaria, which means that he has in his 
 blood the germs which cause the disease. An ano- 
 pheles mosquito bites him and draws into her 
 stomach, along with the blood, a number of these 
 germs, which undergo a peculiar form of develop- 
 ment within her body. After this development is 
 complete, this mosquito bites a healthy man, and, 
 injecting a little saliva through her hollow proboscis 
 in order to make the blood more fluid, she thus 
 presents this second man with a number of undesir- 
 able guests in the shape of malarial parasites. These 
 promptly attack such of the red corpuscles of his 
 blood as are most available, and the cycle is complete. 
 Thus, the conditions which must exist to favor the 
 spread of malaria are : First, an infected human be- 
 ing; second, anopheles mosquitoes; third, healthy 
 man ; and fourth, opportunity afforded to .the mos- 
 
38 
 
 quitoes. The germ of the disease is a microscopic, 
 single-celled animal (protozoon). This germ was 
 discovered in 1880 by a French Army surgeon. 
 
 Prevention. Preventive measures are as fol- 
 lows ; first, precaution against mosquito bites by the 
 use of screens for doors and windows, bars for beds, 
 and head-nets and gloves when necessary at night; 
 second, the killing of mosquitoes in houses by fumi- 
 gation, trapping, or other means ; third, the destruc- 
 tion of their breeding places (i.e., collections of 
 standing water) , associated with the cutting of high 
 grass and underbrush near human habitations ; and 
 fourth, the routine administration (in malarious 
 localities) of small doses of quinine to officers and 
 men and attached civilians. When an individual is 
 known to be infected, he should be screened with 
 especial care to prevent access of mosquitoes to him. 
 General Gorgas is of the opinion that when troops 
 are marching through a malarious country the only 
 practical measure for their protection is the adminis- 
 tration of quinine. The theory of this procedure is 
 that when the malarial parasites are introduced into 
 the blood, they find there a substance hostile to them. 
 He says further, that such anopheles mosquitoes as 
 may bite soldiers in campaign, would not likely be 
 infected unless the troops are quartered in or camped 
 near some town. If the camp is occupied for more 
 than a day or two the ground should, of course, be 
 cleared and accumulations of water drained away 
 or oiled. 
 
 Dengue 
 
 Dengue, better known as "breakbone fever," is 
 a disease which causes much sickness among our 
 people in the Philippines, but which, fortunately, 
 does not terminate fatally. In common with malaria 
 
39 
 
 and yellow fever, it is transmitted by the bite of a 
 mosquito, so measures directed against this pest 
 receive an additional argument. 
 
 Yellow Fever 
 
 Thanks to the late and deeply lamented Major 
 Walter Reed, of our Army Medical Corps, who de- 
 mostrated the fact that yellow fever is transmitted 
 by the bite of a certain mosquito only, we have suc- 
 ceeded absolutely in eradicating this terrible disease 
 from Cuba and Panama, where for centuries it had 
 been prevalent. This has been accomplished by anti- 
 mosquito measures alone. The insect concerned in 
 the transmission of this disease is known as the 
 stegomyia calopus or "tiger mosquito," the latter 
 name resulting from its striped appearance, by 
 which it may be recognized. It is peculiar in the 
 fact that it bites chiefly in the afternoon. It is a 
 house mosquito, residing in or near dwellings, and, 
 since it finds favorable breeding conditions in water- 
 tanks of ships, it is often carried about the world in 
 this way. Its larva, like that of the culex, floats 
 head downward in the water. 
 
 GENERAL DISEASES CAUSED BY INFECTION 
 
 OF THE RESPIRATORY TRACT OR UPPER 
 
 DIGESTIVE TRACT. INFECTION BY 
 
 CONTACT WITH DISCHARGES 
 
 OF CARRIERS 
 
 Tuberculosis 
 
 Tuberculosis is what is commonly known as 
 "consumption," because of the wasting away of the 
 body which is an invariable accompaniment. The 
 tubercle bacillus, which is responsible for this dis- 
 ease, may and does attack any part of the human 
 
40 
 
 body, but tuberculosis of the lungs so greatly pre- 
 ponderates that when we apply the term the pul- 
 monary variety is generally meant. Though this 
 affection may result from food (especially milk) con- 
 taining the tubercle bacillus, the usual channel of 
 infection is by way of the lungs, the germs being 
 carried in the air. A soldier with the disease may, 
 before the condition is suspected, infect the air of 
 his squad room to such a degree that all other sus- 
 ceptible individuals therein may contract the disease. 
 
 Coughing and Spitting. The germs are 
 coughed up from their seat in the lungs; the spit- 
 ting habit, as we know, is one deeply engrafted upon 
 the American male ; the germs resist death by drying 
 to a remarkable degree. We are, therefore, likely to 
 have in barracks the conditions best suited to the 
 spread of this disease, namely, a number of sus- 
 ceptible individuals closely aggregated, an infected 
 man who scatters his sputum carelessly about, and 
 close air, breathed over and over because of the in- 
 adequate ventilation so dear to the average crowd. 
 
 Prevention. The information just given read- 
 ily suggests the means to be employed to prevent 
 the spread of this affection, which are: first, the 
 exercise of great care in recruiting, to exclude those 
 in the early stages of the disease ; second, the early 
 recognition of such cases in the military service, 
 with their removal to a special hospital ; to this end, 
 noncommissioned officers should be required prompt- 
 ly to report any man who has a persistent cough; 
 third, ample air space per man in barracks ; fourth, 
 adequate ventilation must be provided for and its 
 mechanism carefully guarded to insure its continuous 
 operation. In this connection it is well to state that 
 in our service the guard-house is the place most com- 
 monly infected, since it is usually overcrowded and 
 
41 
 
 the men of most careless habits are apt to be im- 
 mured therein. 
 
 Tonsilitis 
 
 Tonsilitis and other throat affections are very 
 common in barracks during cold weather and fre- 
 quently occur in company epidemics. When such is 
 the case, ventilation is at fault, and it will usually be 
 found that the men, for the sake of warmth, have 
 stopped up the air inlets. Such throat affections are 
 often quite severe and prostrating and may even re- 
 semble diptheria at first. They are not usually 
 due to any one specific germ, but rather to one or 
 more varieties of ordinarily harmless bacteria re- 
 siding in the throat, which have taken on virulent 
 properties by reason of the lowered vitality of the 
 tissues due to bad air. The sick should be isolated 
 promptly and the tendency on the part of fresh-air 
 cowards to plug up ventilation shafts in cold weather 
 must be appreciated and combated. 
 
 Influenza 
 
 Influenza, commonly known as "the grip," 
 occurs in epidemic waves which affect the civilian 
 population equally with the military, but as this is 
 clearly infectious, being due to a well-known bacillus, 
 and is transmitted chiefly if not wholly by contact 
 with the sick, such contact should be avoided as far 
 as possible. The influenzal bacillus prefers to attack 
 the respiratory system, but may affect the digestive 
 tract or the membranes surrounding the brain and 
 spinal cord as pneumonia, meningitis, and ear sup- 
 purations are not unusual. Marked depression of 
 spirits is a frequent accompaniment. Many people 
 are cripples in health for years after an attack. 
 
42 
 
 Colds 
 
 Though seldom serious in symptoms or results, 
 common colds are so frequent and temporarily dis- 
 abling that they deserve mention here. Many of 
 them are undoubtedly "catching," and persons suf- 
 fering from them should take pains to avoid close 
 contact with others. A large percentage of cases is 
 due to overcrowding and faulty ventilation in bar- 
 racks. Other causes are wet feet and chilling fol- 
 lowing overheating of the body's surface. 
 
 Measles 
 
 We are apt to underrate the importance of this 
 highly contagious disease, which, in time of war, 
 when new levies of troops are brought together, be- 
 comes a really serious condition. City-bred recruits 
 have usually had an attack in childhood, but those 
 from country districts very likely have not encoun- 
 tered the infection. The disease is much more 
 severe in its effects upon adults than upon children. 
 In the Union Army during the Civil War there were 
 76,000 cases, with more than 5,000 deaths. Among 
 the Confederates whole brigades were temporarily 
 disbanded on this account in the early part of the 
 war. No means of prevention other than isolation 
 of the sick and their attendants are at present 
 known. Measles is due to a virus whose exact na- 
 ture is as yet unrecognized. 
 
 Mumps 
 
 Mumps is also a contagious disease, and, like 
 measles, causes much disability among newly raised 
 troops. It is not so serious in its results as measles, 
 but is a painful and disabling affection, especially 
 when, as frequently happens, it attacks the testicles. 
 
43 
 
 Its ordinary characteristic is an inflammation of the 
 salivary glands located in the neck near the angle 
 of the, jaw. 
 
 Cerebrospinal Fever 
 
 Cerebrospinal fever (meningitis) occurs with 
 considerable frequency at recruiting depots, on 
 transports, and in camps. Luckily, though many in- 
 hale the micrococcus which is its cause, but few are 
 susceptible to the disease. Direct contact is respon- 
 sible for the transference of the infection and "car- 
 riers" play a large part in its spread. It is a very 
 deadly disease unless antimentingitic serum is used 
 promptly. Early recognition of its presence in the 
 command, rigid isolation of the sick and of such 
 carriers as can be located, with disinfection of all 
 discharges from their throats and noses, are the 
 essentials in its prevention. 
 
 Scarlatina 
 
 Scarlatina (scarlet fever), though a highly con- 
 tagious and dangerous disease, fortunately attacks 
 adults but seldom, so does not need extended dis- 
 cussion in this treatise, but a case of sore throat, 
 associated with a brilliant eruption on the skin, 
 should be regarded as suspicious of this disease and 
 immediately isolated. 
 
 Diphtheria 
 
 Diphtheria, another very contagious and serious 
 affection, is far less feared since the discovery of 
 its antitoxin. This substance has great value in the 
 prevention of the disease as well as in its cure. It is 
 given hypodermically to all persons exposed to the 
 infection, as well as to the sick man. 
 
44 
 
 Small-Pox 
 
 Small-pox, the disease most dreaded by our 
 forefathers because of its repulsiveness, its mor- 
 tality, and its disfiguring effects, has been robbed of 
 its terrors by the wonderful protection afforded by 
 vaccination, but if the anti-vaccinationists had their 
 way this loathsome pest would reappear, deadly as 
 ever, since it is kept alive in many communities by 
 those who evade the means of prevention. 
 
 Varioloid is simply a mild attack of small-pox. 
 
 DISEASES DUE TO EXCESS OR DEFICIENCY 
 IN FOOD PRINCIPLES 
 
 Beriberi 
 
 Beriberi is of interest and importance for the 
 reason that it has attacked many of our Filipino 
 scouts. No perfectly authenticated instance of its 
 occurrence in an American soldier is on record. This 
 does not mean that they are immune, but rather that 
 their food contains the essential preventive sub- 
 stances. Rice-eating peoples are most often affected, 
 and it has been found that some necessary food sub- 
 stance resident in the husk of the grain has been 
 removed in the polishing process to which the higher 
 grades of rice has been subjected. By substituting 
 an "undermilled" rice for the polished varieties, 
 this disease has been entirely controlled among the 
 scouts, and its incidence much lessened among the 
 Filipinos generally. This is the latest instance of the 
 beneficent effects, upon the health of the native popu- 
 lations, of the occupation of tropical lands by the 
 American Army. 
 
Scurvy 
 
 Seurvy is a disease resulting from scant or im- 
 proper diet and was formerly common among ar- 
 mies and navies. It is now but seldom encountered, 
 although beleagured garrisons (as the Russians in 
 Port Arthur) and remote detachments (as in Alas- 
 ka) are sometimes affected. Its chief causative fac- 
 tor is the absence from the diet of organic acids 
 contained in fresh meats and vegetables. Potatoes, 
 onions, tomatoes (raw 01: canned), vinegar, the 
 juices of rare meats, lemon and lime juice are pre- 
 ventive and curative. 
 
 MISCELLANEOUS 
 Effects of Heat 
 
 The effects of heat are frequently noted on the 
 march in hot weather. These effects are of two 
 kinds, notably differing in symptoms. In the severer 
 type (heatstroke) the sick man is unconscious, his 
 face is scarlet, his pulses throb violently, and his 
 skin feels burning hot. In the other condition ( heat 
 exhaustion) the consciousness is retained, but the 
 man feels exhausted, his face is pale, his heart beats 
 feebly, and his skin is cold and clammy. Heatstroke 
 is most apt to occur when the aif is not only very 
 warm, but is surcharged with moisture as well. 
 Evaporation from the skin is interfered with, and 
 as such evaporation is an important means whereby 
 excess heat is withdrawn from the body, the temp- 
 erature may rise to a dangerous degree. These heat 
 effects can largely be avoided by timing the march, 
 when possible, to take place during the relatively 
 cooler parts of the day. The head covering should 
 have a roomy air space and the crown should contain 
 some light, moist object, as a wet sponge or handker- 
 
chief or green leaves. Water should be sparingly 
 drunk on the march ; the man who empties his can- 
 teen between halts is most often the man who is 
 overcome by heat. 
 
 Skin Eruptions 
 
 Skin eruptions are very common in campaign, 
 for the reason that men cannot or do not keep their 
 persons and clothing in a sufficiently cleanly state. 
 The affections which occur most often are those due 
 to the presence of small animal parasites. Of these, 
 lice are the most objectionable. The hirsute parts of 
 the head and body should be inspected for the eggs 
 of these insects, which are readily seen as little 
 masses attached to the individual hairs. When in- 
 sects or their eggs are found, the man's undercloth- 
 ing should be boiled and the affected parts of his 
 body shaved or freely anointed with mercurial oint- 
 ment. 
 
 Hookworm Disease 
 
 Hookworm disease has recently been shown to 
 be of great economic importance in Porto Rico and 
 our South. Curiously enough, the animal source of 
 this affection, though its home is the human intes- 
 tine, makes its way into the body of the person at- 
 tacked through the skin and not by way of the 
 mouth. The eggs are passed out with the feces and 
 the larvae which constitute the infective form 
 hatch outside the body. The measures of prevention, 
 therefore, consist of two things, namely, the proper 
 disposal of excreta and the wearing of shoes. 
 
FEET, CLOTHING AND SHOES 
 Blistered Feet 
 
 Large numbers of men are incapacitated par- 
 ticularly at the onset of a campaign by blistered 
 feet. The two chief causes of blisters on the feet of 
 the marching soldier are bad fitting shoes and un- 
 cleanliness. The feet should be kept dry if possible ; 
 shoes, when wet, wrinkle and lose their shape. To 
 insure keeping the feet in good condition, their daily 
 washing, after getting into camp, is absolutely neces- 
 sary. If sufficient water is not at hand, wipe the 
 feet carefully especially between the toes with a 
 wet rag. 
 
 Shoes. The shoe is, at least for the infantry- 
 man, the most important article of clothing. It is 
 only after many years of experiment that a rational 
 marching shoe has been developed for our service 
 and the urgent necessity for exactness in the fitting 
 of each soldier with these articles and for their pro- 
 per care, appreciated. Company commanders are 
 now held responsible for undue injuries to the feet 
 of their men from ill-fitting footwear. Each man 
 should have at least one pair, well broken in, for 
 marching use. Men should be instructed in the care 
 of shoes and of feet, and frequent inspections of 
 both should be made. 
 
 Socks. An infantry ' soldier should carry two 
 or three pairs of socks, which ought to be soft, 
 smooth, and undarned. Those worn on the day's 
 march should be washed at the same time as the 
 feet; clean, dry socks are then put on and the wet 
 ones hung up to dry. In this way a clean pair may 
 always be had. A woolen sock (light or heavy) is 
 more comfortable when marching than a cotton one 
 because it is softer and more yielding, while it ab- 
 
sorbs the perspiration better. If perspiration of feet 
 is excessive, a thin cotton sock under one of light 
 wool does well. 
 
 Prevention of Blisters. To prevent blisters, 
 foot baths of strong brine, or alum or alcohol, used 
 for a week or more before the march, are of great 
 service in hardening the skin. Many experienced 
 soldiers of our army soap the feet before putting 
 on their socks. In the German Army, socks (or rags, 
 which many wear for economy's sake) are soaked 
 in grease. An excellent powder, made up of starch, 
 soapstone, and salicylic acid, is supplied by our medi- 
 cal department to sift into the socks. These mea- 
 sures are used to diminish the friction of the foot 
 against the sock. The French have found that a 
 small strap buckled about the instep, over the shoe, 
 diminishes friction and lessens the tendency to the 
 formation of blisters. If such form in spite of our 
 care, they must be opened to allow the serum to 
 escape. 
 
 Treatment. The opening is made at the lowest 
 point of the blister, with a clean needle, after the 
 feet have been washed. The raised skin must not 
 be disturbed, but is to be dressed with vaseline or 
 other ointment and protected from pressure by ad- 
 hesive plaster. Men afflicted with bunions or corns 
 should be required to report promptly to the surgeon 
 for appropriate treatment. 
 
 Clothing 
 
 Purposes. Clothing protects the body against 
 the changing conditions of the weather, such as cold, 
 heat, wind and rain, shields in a measure from blows 
 and bruises, and serves to adorn the person. The 
 materials used for this purpose are derived from a 
 variety of sources, animal and vegetable. The chief 
 
49 
 
 substances taken from the animal world are wool, 
 fur, leather, and skin; from the vegetable kingdom 
 we obtain cotton, linen, and rubber, as well as a 
 number of less important materials. A good ma- 
 terial for clothing purposes must meet the following 
 requirements : 
 
 1. It must afford proper protection against the 
 weather. 
 
 2. It must not interfere with the natural func- 
 tions of the skin. 
 
 3. It must exert no irritating effect upon the 
 skin. 
 
 The characteristics and merits of the more im- 
 portant substances will be considered briefly. 
 
 Wool is undoubtedly the most valuable of these 
 substances used by us. It has the merits (a) of 
 being a poor heat conductor, thus retarding escape 
 of warmth from the body and preventing the thermic 
 rays of the sun from passing freely. Through its 
 heat conservation it is much warmer than cotton, 
 and when loosely woven, so that much air is en- 
 tangled in the meshes of the fabric, its warmth is 
 markedly increased. This property makes it most 
 valuable in cold climates, and even in hot one it is 
 not altogether undesirable. The olive drab flannel 
 overshirt has been found to a very valuable gar- 
 ment in tropical field service. By day it keeps out 
 heat and chemical rays, and by night it prevents 
 chilling, (b) Wool is a great absorber of water, a 
 very important quality, as evaporation from the 
 body's surface during free perspiration is checked 
 and the danger of chill lessened. Perspiration passes 
 through linen and cotton freely and loss of heat is 
 rapid, (c) It does not absorb odors readily. A dis- 
 advantage of wool is that its fibers become smaller 
 and harder after washing, so that garments of which 
 
50 
 
 it is composed undergo marked shrinking and stiffen- 
 ing. This tendency is minimized by washing as 
 follows : Plunge garments, one at a time, in warm 
 soapsuds and use gentle friction to cleanse from 
 dirt. Remove and rinse out all soap carefully with 
 cold water. Hang up to dry without wringing. 
 Stretch into shape while drying if a tendency to 
 shrink is observed. 
 
 Cotton is next to wool in value for purposes of 
 clothing. It has these merits: (a) Good wearing 
 qualities ; (b) cheapness ; (c) non-shrinkage in wash- 
 ing; (d) coolness. Its demerits are : (a) Rapid heat 
 conductivity; (b) poor water absorption; (c) free 
 absorption and release of odors. 
 
 Merino (a mixture of cotton and wool) is much 
 used for underwear. 
 
 Linen (flax fiber) conducts heat even more 
 rapidly than cotton and is also a poor absorbent of 
 moisture, besides being much more expensive than 
 cotton. 
 
 Paper. It is useful to know that paper is of 
 value in conserving warmth, and the Japanese have 
 utilized it in military clothing. A paper vest affords 
 marked protection against cold winds, while a news- 
 paper between blankets adds much to comfort on a 
 cold night. 
 
 Warmth and Coolness. The warmth or cool- 
 ness of clothing depends upon several factors : these 
 are material, texture, and color. We have seen that, 
 according to heat conductivity the materials named, 
 in order of warmth, are wool, cotton, linen. Con- 
 versely, linen is coolest. With respect to. texture, 
 the more loosely woven the material, the warmer the 
 garment. Thus, a cotton or linen loose mesh under 
 shirt is much superior to one that is cloosely woven. 
 The same effect of warmth may be produced by wear- 
 
51 
 
 ing two or more thin undergarments, one over the 
 other, the advantage resulting not so much from the 
 increased thickness as from the layers of warm air. 
 Color is of importance in this connection, in accor- 
 dance with its relative heat-absorbing properties. 
 Thus, white absorbs least heat; black, the most. 
 Black clothes are, therefore, w r armest; white, cool- 
 est ; blue is next to black for warmth ; olive drab and 
 khaki are cooler than blue. Olive drab, being darker, 
 is markedly warmer than khaki. 
 
 Socks are furnished in cotton and in light and 
 heavy wool. Those of cotton are suitable for garri- 
 son wear, but not for marching. Those of light 
 wool (which are really 50 per cent, cotton) are used 
 by the majority of our men on field service. The 
 heavy socks, of pure wool, are quite bulky, but are 
 superior for marching wear, except in the rare cases 
 in which they cause skin irritation. Wool absorbs 
 perspiration better, stretches better, and fits mere 
 uniformly, so it is less likley to form creases and 
 produce blisters, callouses, and corns. Socks should 
 have a seamless foot, with reinforced toes and 
 heels. They should, fit well and have no rough 
 thread ends. It is of interest to note that only two 
 armies other than our own issue socks to their ^ol- 
 dies. These are Great Britain and Japan. The great 
 military nations of the European continent expect 
 their men to provide themselves somehow with these 
 articles, which by us are deemed of such importance. 
 From motives of economy many German soldiers 
 wrap oil-soaked cloths about their feet in lieu of 
 socks. A British military sanitarian (Colonel Mel- 
 ville) estimates the life of a sock to be only 60 
 to 70 road miles. This is probably a fair mileage for 
 our light wool sock, but it is believed that the heavy 
 woolen article will do considerably better.. Com- 
 
52 
 
 fort and cleanliness as well as regulations require 
 that socks shall be changed and washed daily on 
 the march. It is well to remember that a piece 
 of soft cloth a foot square (wool or part wool) 
 will make a better foot covering than a worn out or 
 poorly darned sock. 
 
 Shoes. No one article of the soldier's clothing 
 plays so large a part in his efficiency as the shoe. 
 Although army commanders and sanitarians of the 
 past century have emphasized the importance of 
 good footwear, it is but very recently that the mili- 
 tary shoe has received scientific study. The march- 
 ing ability of armies is second to no other military 
 factor, yet, while enormous percentages of troops in 
 campaign have been incapacitated by injuries to the 
 feet due to shoes badly made, shaped or fitted, it has 
 but lately been realized that the conditions were 
 preventable. A board of officers convened for the 
 purpose by our War Department has recently (1912) 
 rendered its report in the form of a truly admirable 
 study of the foot and the shoe. A number of import- 
 ant recommendations are made in this report, among 
 which are: (a) The adoption of shoes made on a 
 rational last (one developed by the board) ; (b) care- 
 ful fitting by company officers personally; (c) full 
 series of sizes carried in stock at posts; (d) fre- 
 quent inspections of feet by company and medical 
 officers. The War Department has adopted these 
 recommendations and has published them in the 
 form of an order, in which occurs the following 
 sentence: "Hereafter an undue amount of injury 
 and disability from shoes will be regarded as evi- 
 dence of inefficiency on the part of officers con- 
 cerned and as cause for investigation." This places 
 the responsibility where it belongs, and officers will 
 do well to study most carefully the foot and its cover- 
 
53 
 
 ings. This may best be done by consulting the 
 work "The Soldier's Foot and Military Shoe/' by 
 Major Munson, Medical Corps, United States Army, 
 president of the army shoe board above referred to. 
 Major Munson lays down the following requirements 
 for a good military shoe : 
 
 (a) It must be of good materials and well made. 
 
 (b) It must be fairly flexible, with pliable and 
 porous uppers. 
 
 (c) The interior should be perfectly smooth, 
 the heel broad and low, the sole but moderately thick. 
 
 (d) The arch should be flexible and without 
 metal shank or other stiffening. 
 
 (e) It should have eyelets (not hooks) for fas- 
 tening, and the tongue should lie smooth under the 
 laces. 
 
 (f ) The shoe should reach only a little above 
 the ankle; it should be wide across the ball of the 
 foot and should have a high toe cap. 
 
 (g) It must be comforable, neat looking, and 
 light in weight. 
 
 (h) It must be easily put on and removed. 
 
 Civilian Models. The styles of shoes pur- 
 chasable in the shops are practically all defective 
 in shape and unsuitable for marching. The "tooth- 
 pick" type and even broadtoed models produce a 
 forced outward angling at the junction of the great 
 toe with the main portion of the foot. This shifts 
 the axis of the foot, which normally should be direct- 
 ly to the front in marching. Shoes ordinarily pur- 
 chased are too small for the wearer, either in length, 
 in breadth, or in both these dimensions. It must 
 be remembered that the soldier is obliged to carry 
 a load of clothing and equipment amounting to at 
 least 40 pounds. Under such a weight the foot, if 
 unconfined, lengthens and broadens to a surprising 
 
degree. This may amount to more than -J an inch 
 from heel to toe and nearly as much across the ball. 
 It is thus evident that, to avoid injury in marching, 
 the shoe must be roomy enough to allow all or a ma- 
 jor part of this normal expansion. 
 
 Supervision in Fitting. Soldiers cannot be 
 trusted to fit themselves with marching shoes, as, 
 through ignorance or vanity (or, perhaps, lack of 
 proper size), tight-fitting footwear will usually be 
 chosen or accepted. Thus the supervision of officers 
 becomes necessary. 
 
 How to Fit Shoes. Feet are measured and 
 shoes fitted by company commanders in the follow- 
 ing manner: The soldier stands with bared foot 
 upon a small, graduated measuring board, resting 
 his entire weight (augmented by a 40 pound burden 
 on his back) upon that foot. The length of the ex- 
 panded foot is read off from the board and the cir- 
 cumference around the ball is taken by means of a 
 tape applied at the base of the toes. An approxi- 
 mation to the correct shoe length is then determined 
 by adding 2 to the scale reading. For width, the 
 table of sizes given in the annual price list of cloth- 
 ing, issued by the Quartermaster General, should be 
 consulted. For example, let us assume that a foot 
 measures 6i on the scale and has a circumference of 
 9i at the ball. Size 8^ D is found to be the shoe 
 which would approximate a fit; if this is not quite 
 correct, others will be tried on until a satisfactory 
 fit is had. With each trial the shoe should be snugly 
 laced and the soldier will throw his augmented 
 weight upon the shod foot. The company com- 
 mander personally verifies the fit, assuring himself 
 especially, by pressure with his hand, that not less 
 than f inch of vacant space exists in front of the 
 
55 
 
 great toe and that no undue pressure or wrinkling 
 exists over the ball of the foot. 
 
 Breaking In. New shoes should be adapted 
 to the contours of the foot by gradual wear and 
 should on no occasion be used for marching until 
 broken in. If there is need for haste in the process, 
 this may be accomplished by having the soldier 
 stand in water for a few minutes until the leather 
 is sodden. He should then walk about for an hour 
 or so on a level surface letting the shoes dry on his 
 feet. On removal, a little neat's-foot oil should be 
 rubbed into the leather to prevent hardening and 
 cracking. Shoes may be waterproofed by rubbing 
 a considerable amount of this oil into the dry 
 leather. 
 
 It is believed that with the adoption of the new 
 shoe and its complete supply to the army, to the 
 exclusion of other styles, our service will have foot- 
 wear superior to that of any other nation. The 
 average American has a foot rendered abnormal by 
 long wear of shoes of bad shape or improper size. 
 But, taken in conjunction with the oversight in fit- 
 ting and care of the feet now rendered obligatory, we 
 should have a minimum of foot troubles. The high 
 boots worn by German and Russian foot troops fur- 
 nish a striking contrast to our own shoes in appear- 
 ance, comfort and efficiency. That men can march 
 at all in such clumsy, mis-shapen footwear as that 
 of the foreign nations cited is surprising. The 
 weight of such boots is 4 pounds, which is twice that 
 of our shoes. 
 
 Overshoes are desirable for garrison wear, but 
 not usually practicable in field service. The "arctic" 
 type is the only one officially supplied. 
 
Lecture 
 
 MILITARY HYGIENE 
 
 Camp Sanitation 
 
 Camps 
 
 THERE is no subject of more vital importance in 
 the training of line officers than military hy- 
 giene. This applies with especial force to the military 
 hygiene of field service. Why is this? Because 
 when troops are in garrison, their mode of life ap- 
 proximates in hygienic arrangements, the life of the 
 better class of the civil population. Their dwellings 
 are constructed with a view to sanitary require- 
 ments. Their exercises and habits are similarly 
 governed. Their surroundings, food supply, water 
 supply and other necessities of life are established, 
 regulated and constantly watched by highly special- 
 ized officers. In garrison the individual line officer 
 must concern himself with the habits and personal 
 hygiene of his men, and the general police of the 
 post ; but very rarely is it necessary for him to con- 
 cern himself directly with the sanitary arrange- 
 ments for living in an established post. Moreover 
 in garrison, it is extremely unusual that the require- 
 ments of military necessity conflict with the prime 
 essentials of military hygiene. The troops of garri- 
 son life are ordinarily disciplined men, who have 
 received training in sanitary matters; whereas in 
 field service in our military forces, a line officer of 
 the standing army is very frequently placed in com- 
 mand of untrained or insufficiently trained troops, 
 of the organized militia or volunteers. In the field, 
 57 
 
58 
 
 and especially in active service the situation is com- 
 pletely reversed. Life in the field, especially where 
 very large bodies of men are congregated, offers 
 many problems in sanitary, as well as other ar- 
 rangements. When white men are assembled in 
 large communities, they are in modern life accus- 
 tomed to systematic arrangements for good, and 
 sufficient supplies of food and water ; for systematic 
 disposal of wastes, and all other sanitary appliances 
 of like character. When men are suddenly congre- 
 gated in the field, their officers at once find them- 
 selves face to face with the elementary problems of 
 field sanitation. Very often, these sanitary prob- 
 lems must be solved by the line officer individually. 
 At times, the requirements of military necessity 
 may compel him to disregard the recommendations 
 made to him by his sanitary officer even though he 
 himself realizes their full significance. However, 
 when we leave out of the question the factor of mili- 
 tary necessity, the vital fact remains that sanitation 
 in the field depends upon the line officer fully as 
 much if not more than upon the medical officer. By 
 the line officer I mean the company or detachment 
 commander fully as much, if not more, than the 
 regimental or division commander. This statement 
 will admit of much explanation and may demand 
 much evidence for substantiation, which I have not 
 the opportunity to give here. I will merely cite the 
 contrast between the mobilization camps of 1898 and 
 1916. In the former case, the line officers very fre- 
 quently did not realize the importance of camp sani- 
 tation; in the latter, they were frequently as eager 
 for sanitary conditions as the medical officers. In 
 this connection, I will read the following extract 
 from a press dispatch, dated San Antonio, Texas, 
 November 28, 1916. 
 
59 
 
 "As a result of the scientific methods adopted 
 by the Medical Corps and the steps taken to insure 
 absolute sanitation in border camps the big com- 
 mand of regulars and militia has set a new health 
 record. From May 1, to October 31, there were only 
 seventy-five deaths from disease in the force of more 
 than 150,000 men, and of this small number only 
 twenty-one deaths were due to infectious maladies. 
 
 "Typhoid fever was formerly the worst scourge 
 of camp, but it has no place among the troops along 
 the Mexican border. From May 1, to October 18, 
 only twenty-one cases of typhoid developed and no 
 deaths resulted from the disease. All of these cases 
 were among the National Guard organizations, 
 where in some instances the men were not inoculated 
 with typhoid serum until after regiments had come 
 to the border. There was not a single case among 
 the 42,000 troops of the regular army engaged in 
 patrol duty and stationed in Mexico with General 
 Pershing's command. 
 
 "In Spanish-American war days over a period 
 of eight months in 1898 among 147,000 regulars 
 and volunteers, the typhoid epidemic reached the 
 enormous total of 21,000 cases and there were 2,192 
 deaths from the disease/' 
 
 Why is it that administrative officers now lend 
 a ready ear to the demands of field sanitation ? This 
 question is answered in part by the foregoing quo- 
 tation. It will be emphasized by a statement of the 
 statistics of the deaths in battle or deaths as a result 
 of battle wounds and deaths from disease in a few 
 modern wars. 
 
60 
 Mexican War 1846-47 
 
 American Regulars Only 
 
 Died from sickness 22 per cent. 
 
 Invalided from sickness, additional to pre- 
 ceding __. 14 per cent. 
 
 Killed in battle or died from wounds __ 5 per cent. 
 
 American Civil War 
 
 Killed in battle or died from wounds 93,967 
 
 Died of disase 186,216 
 
 Thus two deaths are recorded for disease to one for 
 battle casualty. 
 
 Crimean War 1854-56 
 
 French forces 310,000 
 
 Died from disease 70,000 
 
 Invalided 65,000 
 
 Battle deaths 7,500 
 
 Spanish- American War 
 
 Deaths from battle in all camps and fields 293 
 
 Deaths from disease in all camps and fields 3,681 
 
 This is one death in battle to 12.5 from disease. 
 
 War Between China and Japan 1894-95 
 
 Japanese forces in the field 227,000 
 
 Deaths from battle 1,311 
 
 Deaths from disease 15,850 
 
 The ratio here is one to twelve. 
 
 That the Japanese were taught a lesson by this 
 record is shown in the following war. 
 
 Russo-Japanese War 1904-05 
 Total estimated Japanese strength in field of 
 
 operations 700,000 
 
 Deaths from battle 58,887 
 
 Deaths from disease 27,158 
 
 In the same war, Havard estimates the Rus- 
 sian casualties to have been approximately the fol- 
 lowing : 
 
 Deaths from battle 47,608 
 
 Deaths from disease 27,830 
 
61 
 
 Thus it will be seen that even in modern wars 
 until the last decade the deaths from sickness have 
 totaled a larger figure than the deaths from battle. 
 The non-effectives from sickness are an even more 
 vital military factor in war than the deaths, because 
 of the fact that ineffectives from sickness always 
 number many times more than the losses by death 
 from sickness. For it may be safely assumed that if 
 a command has in a certain period 200 deaths from 
 disease, its constant non-effective rate from sick- 
 ness will be may times that number for the same 
 period. 
 
 Before proceeding further, the question arises : 
 "What are the principle camp diseases which pro- 
 duce the frightful mortality and morbidity of mili- 
 tary campaigns?" The question is pertinent, be- 
 cause we are far better able to cope with an enemy 
 known, than one concealed. 
 
 In the European Wars of the 18th Century and 
 Napoleonic era, typhus fever was an ubiquitous 
 scourge. This disease has never been absent in any 
 of the prolonged wars of Europe so far as we have 
 record. It will be remembered by you that this 
 pestilence has prevailed in epidemic form on the 
 Eastern and Serbian fronts during the present Eu- 
 ropean struggle. The same disease is present in 
 Mexico today, and must be reckoned with by any 
 troops who wage war in the Southern Republic. 
 Typhus fever must not be confused in your minds 
 with typhoid fever, which it resembles in some re- 
 spects. One marked difference in the two diseases, 
 and the only one which here concerns us is the 
 metfrod of transmission; typhus fever being con- 
 veyed by the bites of the body louse, whereas typhoid 
 fever as you well know is a disease ordinarily trans- 
 mitted by infected water or food supplies. This 
 
62 
 
 brings us to the triad of cholera, typhoid fever, 
 dysenteries and allied camp diarrheas, which are 
 often termed the water-borne or fly-borne diseases 
 from the importance of these two factors in their 
 causation. In American military campaigns these 
 have caused the greatest number of losses from 
 disease. Other diseases to be dreaded in military 
 campaigns on this continent are the mosquito borne 
 malarial fevers ; yellow fever and dengue. Vener- 
 eal and respiratory diseases while not especially 
 associated with camp life in distinction from garri- 
 son life are always factors in the sick rate of ar- 
 mies. 
 
 We have briefly discussed the reasons for the 
 importance of field sanitation, and have enumerated 
 a few of the diseases which have decimated the ar- 
 mies of all history. Before passing on to the details 
 of this subject I shall pause to emphasize again the 
 important and responsible role which the line officer 
 holds in relation to this subject. The supreme com- 
 mander of the nation's armies, who would permit his 
 subordinates to neglect field sanitation of campaign- 
 ing troops could not with our present viewpoint be 
 considered a wholly competent commander, no mat- 
 ter what other military qualifications he might pos- 
 sess. In no less degree, the efficiency of the division 
 or regimental commander who would slight the sani- 
 tary care of his troops, would be diminished ; and his 
 chances of military success would be equally cur- 
 tailed. Finally the company or detachment com- 
 mander upon whom after all depends the execution 
 of the prime requisites of sanitation, who, neglects 
 or disregards the sanitary regimen of his command, 
 is morally responsible for the deaths and illness from 
 preventable diseases which occur among his men ; is 
 morally responsible to his country for the ineffec- 
 
63 
 
 tives from the same sources in. his command ; and is 
 directly and judicially responsible to his higher com- 
 manders for failure to enforce the well known laws 
 of camp sanitation or to adopt the proper and prac- 
 ticable recommendations of his medical officers. The 
 importance of your future position, gentlemen, as 
 executive officers in these matters, impresses me 
 strongly with my duty to you in this regard. Do 
 not, as you go out in the service, think lightly of the 
 sanitation of your command. Do not neglect it or 
 disregard the advice of your surgeon. Do not permit 
 petty personal or official differences to influence you 
 in the matter of the care of your command and its 
 protection from disease and death. Do riot make the 
 life of your sanitary inspector a burden by regarding 
 him as an iniquitous pest when he is in fact perform- 
 ing his proper military duty. Finally, do not modi- 
 fy or shelve or otherwise fail to take proper action 
 on his sanitary recommendations, unless you are 
 certain that the department will approve of your 
 action in stacking up your sanitary knowledge 
 against that of the medical officer; or that the law 
 of military necessity compels you to disregard his 
 advice ; or finally that his recommendations are 
 wholly impracticable. In the last event, you may 
 save yourself much difficulty by referring the matter 
 to higher authority with your indorsed expression 
 of opinion. 
 
 Camp Sites 
 
 Field Service Regulations has the following 
 sanitary requirements for camp sites and other sani- 
 tary arrangements of camps. 
 
 Par. 236. The ground should be easily drained, 
 naturally healthful, and large enough for depots, 
 corrals, hospitals, etc., and the encampment of troops 
 
64 
 
 without crowding, and with ample space for exercise 
 and instruction. 
 
 The water supply should be excellent and abun- 
 dant and not liable to contamination from any 
 source. 
 
 Par. 238. Selection of Site. There is often 
 little choice in the selection of camp sites in war. 
 Troops may have to camp many nights on objection- 
 able ground. Nevertheless, sanitary considerations 
 are given all the weight possible consistent with the 
 tactical requirements. 
 
 When tactical questions are not involved, and 
 especially when the camp is to be occupied for some 
 time, great care is exercised in selecting the site. 
 Through no fault of their own, troops occupying an 
 unsanitary site may suffer greater losses than in the 
 battles of a long caippaign. A medical officer assists 
 in the selection of camp sites. 
 
 The selection of camp sites while on the march 
 or during active operations is governed by the fol- 
 lowing conditions: 
 
 1. The ground should accommodate the com- 
 mand with as little crowding as possible, be easily 
 drained, and have no stagnant water within 300 
 yards. 
 
 2. The water supply should be sufficient, pure, 
 and accessible. 
 
 3. There should be good roads to the camp and 
 ood interior communication. 
 
 . 
 
 4. Wood, grass, forage, and supplies must be at 
 hand or obtainable. 
 
 Closely cropped turf with sandy or gravelly 
 subsoil is best; high banks of rivers are suitable, 
 provided no marshes are near. 
 
65 
 
 In hot summer months, the ground selected 
 should be high, free from underbrush, and shaded 
 with trees if possible. 
 
 In cold weather, ground sloping to the south, 
 with woods to break the north winds, is desirable. 
 
 Old camp grounds and the vicinity of ceme- 
 teries are undesirable. Marshy ground and stag- 
 nant water are objectionable on account of the damp 
 atmosphere and the annoyance and infection from 
 mosquitos. Ground near the foot of a hill range 
 generally has a damp subsoil and remains muddy for 
 a long time. Thick forests, dense vegetation, made 
 ground, alluvial soil, punch-bowl depressions, in- 
 closed ravines, and dry beds of streams are unfavor- 
 able. 
 
 Camp sites should be selected so that troops of 
 one unit need not pass through the camp grounds of 
 another. 
 
 As a protection against epidemics, temporary 
 camp sites in the theatre of operations should be 
 changed every two or three weeks. 
 
 Par. 240. Establishing the Camp. Camp is 
 established pursuant to the halt order. This order 
 provides for the outpost, if necessary, and gives 
 instructions for the encampment of the main body. 
 When practicable, large commands are encamped 
 by brigades. 
 
 The camping ground may be selected by the 
 supreme commander, but in large commands is gen- 
 erally chosen by a staff officer sent forward for that 
 purpose. This officer, with a representative from 
 each brigade and regiment and a medical officer, 
 precedes the command, selects the camping ground, 
 assigns sections thereof to the larger fractions of 
 the command, and causes them to be conducted to 
 their respective sections on arrival. He also desig- 
 
66 
 
 nates the place for obtaining drinking and cooking 
 water, for watering animals, for bathing, and for 
 washing clothing, in the order named, from up- 
 stream down. 
 
 On the arrival of the troops, guards are posted 
 to enforce proper use of the water supply; the in- 
 terior camp guards proceed to their places, and 
 after posting sentinels, pitch their tents. The re- 
 maining troops pitch tents and secure animals and 
 equipment; kitchens are established and details 
 made to procure fuel, water, forage, etc., and to 
 prepare latrines and kitchen pits ; if necessary, tents, 
 company streets, and picket lines are ditched. 
 
 In the presence of the enemy, places of assembly 
 for the troops are designated and directions given 
 for their conduct in case of attack. Lines of infor- 
 mation are established with the outpost. 
 
 Par. 241. Billeting. Unless the force is small, 
 shelter of this character is usually inadequate, and 
 some of the troops must use shelter tents or 
 bivouac. Villages and large farms often afford faci- 
 lities, such as wells and forage, which contribute to 
 the comfort of the troops; it is therefore advanta- 
 geous to camp or bivouac near them. 
 
 Par. 232. In enemy territory public and private 
 buildings may be used to shelter troops and for 
 other military purposes; but for sanitary reasons 
 troops are seldom quartered in private buildings. 
 
 Par. 242. Bivouacs. On marches or in the 
 presence of the enemy troops are frequently forced 
 to bivouac on account of lack of suitable ground or 
 for tactical reasons. On the other hand, in fine 
 weather, in midsummer, or in the dry season in the 
 tropics, the troops may bivouac from choice. 
 
 From the tactical point of view, bivouacs are 
 very convenient, but for sanitary reasons they are 
 
67 
 
 resorted to, as a rule, only when necessary. The 
 general principles governing the selection of camp 
 sites apply to bivouacs. The ground should be dry 
 and protected against sun and wind. Light woods 
 are nearly always good sites for infantry bivouacs, 
 on account of the shelter and material available. 
 
 Par. 244. Shelter During Sieges. To guard 
 against danger from epidemics in the necessarily 
 crowded camps or cantonments of the besiegers, the 
 most careful attention is paid to the water supply 
 and sanitation. 
 
 Par. 245. Care of Troops. Lack of sufficient 
 rest renders troops unfit for hard work and dimin- 
 ishes their power of resisting disease. Therefore 
 commanders should secure for the troops, whenever 
 possible, their accustomed rest. 
 
 The rules of sanitation are enforced. 
 
 Men should not lie on camp ground. In tem- 
 porary camps and in bivouac they raise their beds 
 if suitable material, such as straw, leaves, or boughs 
 can be obtained, or use their ponchos or slickers. In 
 cold weather and when fuel is plentiful the ground 
 may be warmed by fires, the men making their beds 
 after raking away the ashes. 
 
 When troops are to remain in camp for some 
 time all underbrush is cleared away and the camp 
 made as comfortable as possible. Watering troughs, 
 shelter in cold weather, and shade in hot, are pro- 
 vided for the animals, if practicable. 
 
 In camps of some duration guard and other 
 routine duties follow closely the custom in garrison. 
 The watering, feeding, and grooming of animals take 
 place at regular hours and under the supervision of 
 officers. 
 
 The camp is policed daily after breakfast and 
 all refuse matter burned. 
 
68 
 
 Tent walls are raised and the bedding and cloth- 
 ing aired daily, weather permitting. 
 
 Arms and personal equipment are kept in the 
 tents of the men. In the cavalry, horse equipments 
 are usually kept in the tents, but in camps of some 
 duration they may be placed on racks outside and 
 covered with slickers. In the artillery, horse equip- 
 ments and harness are placed on the poles of the 
 carriages and covered with paulins. 
 
 The water supply is carefully guarded. When 
 several commands are encamped along the same 
 stream this matter is regulated by the senior officer. 
 If the stream is small, the water supply may be 
 increased by building dams. Small springs may 
 be dug out and lined with stone, brick, or empty 
 barrels. Surface drainage is kept off by a curb of 
 clay. 
 
 When sterilized water is not provided, or when 
 there is doubt as to the purity of the water, it is 
 boiled 20 minutes, then cooled and aerated. 
 
 Par 246 "* *********** 
 From latrines 50 yards to nearest occupied tent; 
 but, when a smaller camp is desired, the space be- 
 tween company latrines and the men's tents may be 
 used to park carriages and animals. Latrine seats 
 are provided at the rate of one seat to about every 
 ten men ; shower heads at one to every 50 to 100 men, 
 depending upon water pressure." 
 
 Thus you see, the prime essentials of camp sites 
 are definitely prescribed in this manual, which is 
 primarily compiled for the use of combatant troops. 
 I have quoted them in detail, because your attention 
 is thus directed to the fact that you always have 
 at hand a guide in these matters; and further be- 
 cause you cannot go far wrong in camp sanitation 
 if you obey these simple rules. The War Depart- 
 
69 
 
 ment has under date of September 11, 1916, seen 
 fit to issue a General Order (No. 45) governing sani- 
 tary regulation of camps. This order should be in 
 the possession of every officer. I shall quote this 
 frequently in the subsequent discussion. 
 
 A few additional remarks will not be useless to 
 you. Whenever you are required to select a camp 
 site, it is important to consider the conditions in the 
 neighborhood of the proposed camp. Other things 
 being equal it is always better from a sanitary stand- 
 point to place a camp away from fixed habitations 
 such as villages or towns than in or near such places. 
 As a general principle also it is wiser to place a camp 
 above stream in preference to down stream from a 
 town when the camp site is to be along a water 
 course. If you are sent ahead of a marching com- 
 mand to select a site, do not regard your work as 
 satisfactorily done until you have endeavored to 
 ascertain some information concerning prevailing 
 diseases among the inhabitants and domestic ani- 
 mals of the locality. If any one of the serious water 
 borne diseases, typhoid, cholera, or dysentery is pre- 
 sent ; if typhus fever or other serious contagious di- 
 sease is present; if a serious epidemic is present 
 among horses or cattle; the community should be 
 avoided even for a temporary camp site. In the in- 
 stance of a temporary camp site for a small body of 
 men, it is often sufficient when you have selected a 
 location which appears to meet all requirements, that 
 you cause inquiry to be made at all nearby houses, or 
 to the village doctor or some other well informed per- 
 son in the community as to the presence of conta- 
 gious or communicable disease. In selecting camp 
 sites for large bodies of men, a medical officer will 
 assist his commander in this matter. His recom- 
 mendations should in all cases be given due consider- 
 ation. 
 
70 
 
 The following details are to be kept in view in 
 considering the desirability of a camp site from a 
 hygienic viewpoint. 
 
 1. The site must be sufficiently extensive to 
 accommodate the entire command without crowding. 
 For a bivouac or very temporary camp, this feature 
 is of much less moment than in camps of longer dur- 
 ation, because in the latter it is a well established 
 law that the more densely men are concentrated, the 
 more liable they are to the occurrence of communic- 
 able diseases. Havard considers that a brigade 
 should be the maximum for one camp. 
 
 2. The site should be high enough to secure a 
 dry camp. An especially desirable site is a plateau 
 or ridge with a gentle slope to secure natural drain- 
 age; but a sharp slope from one camp to the next 
 is most undesirable for the reason that the pollution 
 of one camp drains into the next. In cold weather, 
 a slope to the south with woods or other obstruction 
 to protect from the winds is desirable. In summer 
 or in tropical campaigns high grounds, breeze swept 
 and preferably shaded by trees are more agreeable 
 camp sites. Grounds at the foot of ravines are sub- 
 ject to flooding and are exceedingly unhealthful and 
 unsatisfactory. 
 
 3. Camps should not be placed in the vicinity of 
 marshes or stagnant waters. These favor the pre- 
 valence of mosquitos, with their attendant mosquito 
 borne diseases as well as their constant annoyance. 
 These localities also favor rheumatic affections, tu- 
 berculosis and many similar affections. A camp site 
 must be dry, well cleared and well swept by the sun 
 and prevailing breeze. A camp site which has been 
 priorly used for the same purpose within three 
 months should be avoided. 
 
-71- 
 
 4. The best soil for camp sites is a gravel or 
 sand-gravel soil which readily permits rain water 
 to sink through it. On the contrary a clay or clayey 
 soil is the least satisfactory. The character of he 
 soil and subsoil has much to do with the comfort and 
 health of a permanent camp, and when there is op- 
 portunity to choose, this factor deserves rememb- 
 rance. It is quite important that the ground water 
 should not be nearer the surface than eight feet. 
 Twelve feet is a safer figure. A pure sand soil is 
 disadvantageous on account of, the glare; the con- 
 stant blowing about of the surface sand; and the 
 mechanical difficulties of camping in sand. 
 
 5. The presence of occasional trees and shrubs J 
 is desirable because of the protection during the 
 heat of the day, the lessening of ground dampness, 
 and the restful effect upon the eyes. Heavy foliage 
 or underbrush is unhealthful and undesirable. A 
 grass covered soil is a blessing to a camp and should 
 be preserved as long as possible. 
 
 Water 
 
 Nothing is ,of greater importance in the selec- 
 tion of a camp site than an adequate supply of 
 potable water. 
 
 What is an adequate supply of water? Mani- 
 festly a temporary camp does not demand the same 
 amount as a prolonged camp with its shower baths, 
 laundering facilities, and even disposal of sewage by 
 a plumbing system. Again a mounted command re- 
 quires a much greater supply than a dismounted 
 one. You will find on p. 207, F.S.R. the following 
 useful data on daily water requirements. 
 
 Water. Approximate daily requirements: 
 
 1 gallon per man on march. 
 
 5 galons per man in camp . 
 
 6 to 10 galons per animal on march and camp. 
 
72 
 
 (The above figures apply to water taken from 
 streams, where animals are watered at the streams, 
 and cooking water carried. In estimating the daily 
 supply for permanent or semi-permanent camps, 
 where water is piped to kitchens, bath houses, etc., 
 the requirements will be 25 to 30 gallons per man 
 and 10 to 15 gallons per animal, depending on cli- 
 matic conditions.) 
 
 What is potable water ? The potability of water 
 supply should always be referred for decision to a 
 medical officer, when present with the command. 
 In case of doubt or suspicion as to the safety of a 
 water supply, you are directed by F.S.R. to require 
 that the water supply for your command be boiled 
 for twenty minutes. 
 
 Water supplies are derived from three sources ; 
 the sky ; the surface of the earth ; the depths of the 
 earth. Rain water properly collected in clean, im- 
 permeable cisterns is potable and above suspicion, 
 but is rarely available for even a small body of 
 troops. Surface waters from rivers, streams, lakes 
 and ponds may be pure or contaminated according 
 to circumstances. The chief factor in the matter is 
 human pollution. A river or stream flowing thru a 
 sparsely inhabited country is usually a reasonably 
 safe water provided there is no pollution within sev- 
 eral miles of camp. A flowing body of water is self 
 purifying by dilution ; by sedimentation ; by effect of 
 sunlight; by the activities of animal and vegetable 
 life. Factors to be considered are size and rate of 
 flow of stream, and amount and proximity of pollu- 
 tion. A river or stream even 100 miles below a 
 large community in which a water borne disease is 
 prevalent is an unsafe water supply. A camp site 
 on a very large lake, many miles removed from a 
 town usually affords a safe water supply, provided 
 
73 
 
 the camp is not permitted to pollute its own water 
 supply. Small lakes and ponds in thickly populated 
 regions or near human dwellings are a dangerous 
 water supply. Springs are really out-croppings of 
 subsoil water and must be considered with reference 
 to their source and liability to pollution. This may 
 often be approximately determined from the surface 
 configuration. More accurately by color or bacter- 
 ial tests. 
 
 Sub-soil water supplies are generally classed for 
 purposes of sanitarians as coming from deep or shal- 
 low wells. The distinction lies not in any mathe- 
 matical terms but in the fact that deep wells pass 
 thru one or more impermeable layers of the earth's 
 surface, whereas shallow wells do not. As you pro- 
 bably know, a layer of water is encountered a few 
 feet below the earth's surface. The depth varies 
 greatly in different localities from a few inches to 
 many feet. Similarly the height of this ground 
 water varies greatly in different localities. This is 
 called subsoil water or ground water and is the ac- 
 cumulated water from surface drainage of what- 
 ever description, which is thus held at this level by 
 reason of a supporting layer of the earth's surface 
 which is relatively or wholly impermeable. Any 
 well which does not penetrate at least one imper- 
 meable layer must then of necessity draw upon this 
 subsoil or ground water for supply. You will readi- 
 ly understand then why it is that in thickly popu- 
 lated communities we interdict the shallow well. 
 You will readily see that such water supplies in 
 thickly populated places will receive constantly pol- 
 lution of every character; and even in sparsely set- 
 tled places be liable to sufficient contamination to be 
 viewed with suspicion. 
 
74 
 
 That is the point I desire to emphasize. Shal- 
 low wells are always suspicious water supplies. It 
 would be suicidal for large bodies of troops to obtain 
 their water supply from shallow or dry wells on or 
 very near a camp site of any but the briefest dura- 
 tion. Small bodies of men may use water supplies 
 from shallow wells, when such have been carefully 
 examined, and sources of pollution excluded. In 
 this connection two phases of military field life must 
 be considered. Troops permanently or semi-perma- 
 nently encamped should not use shallow wells for 
 water supplies unless these supplies are treated as 
 suspicious water supplies and are kept under con- 
 stant medical surveillance. Troops on the march or 
 when campaigning may be obliged to use water from 
 these sources. In such cases, how would you as an 
 organization commander determine the probability 
 of the purity of such wells ? In the first place, you 
 must examine the surface area drained directly by 
 the well in question. This area is a circle whose 
 radius is four times the depth of the well. This 
 figure is merely approximate. Contamination from 
 surface pollution may of course proceed a much 
 greater distance. But in this special area no source 
 of pollution is permissible. Such sources may be 
 privies, cess-pools, pig-styes, manure piles, cattle 
 sheds, stables and in fact any manifest organic pol- 
 lution. When you come to examine the wells of 
 American villages and agricultural communities by 
 this simple test, you will be surprised to find how 
 many of these derive their water directly from such 
 filthy sources. The second test is the position of 
 the well with reference to the slope of the land. 
 Land slope may or may not indicate the current of 
 ground water depending entirely upon the geology of 
 the locality. On the other hand, a well dug on the 
 
75 
 
 mid slope of a hill, whose summit is crowned with 
 a privy would obviously be an unsafe water supply. 
 The third test for you to make is valuable in 
 proportion to your energy in its prosecution ajid the 
 intelligence and honesty of the response. Make in- 
 quiries among all households in the vicinity who are 
 using or have used this well for a drinking supply. 
 What illness have they had in the past two years? 
 If typhoid, dysentery, diarrheas or other water 
 borne diseases, this water supply is highly suspi- 
 cious and must be boiled before use for drinking. I 
 have outlined briefly the means whereby you can 
 judge roughly of the purity of shallow well-water. 
 Do not take upon yourself the responsibility of pass- 
 ing upon such supply if you have a medical officer on 
 whom to bestow this, his proper responsibility. In 
 the absence of a medical advisor, apply the foregoing 
 tests, exercising such judgment as your experience 
 formulates. In case of doubt, always order water 
 supplies to be purified. So doing you free your con- 
 science from the possibility of having illness or death 
 of your men placed upon it. Deep wells penetrate at 
 least one impermeable layer and if properly con- 
 structed are usually safe for drinking. Havard 
 says, "A well to be above suspicion, must comply to 
 the following requirements; it should traverse the 
 entire aqueous stratum and extend to the subjacent 
 impervious clay or rock ; it should be lined through- 
 out or at least above the water with a well construct- 
 ed masonry wall vaulted at top with manhole in cen- 
 ter, and thoroughly cemented inside." The safest 
 rule in prolonged camps is to require that a compe- 
 tent chemical and bacteriological examination of the 
 water supply of troops be made at frequent inter- 
 vals. 
 
7G 
 Food 
 
 Army Regulations are now quite brief in pre- 
 scribing the field ration as follows : 
 
 "The field ration is the ration prescribed in 
 orders by the commander of the field forces. It con- 
 sists of the reserve ration in whole or in part, sup- 
 plemented by articles of food requisitioned or pur- 
 chased locally, or shipped from the rear, provided 
 such supplements or substitutes correspond gener- 
 ally with the component articles or substitutive equi- 
 valents of the garrison ration/' 
 
 RESERVE RATION 
 
 Bacon 12 ounces 
 
 or meat, canned 16 
 
 Hard bread 16 
 
 Coffee, roasted and ground 1.12 
 
 Sugar 2.4 
 
 Salt 0.16 
 
 I shall not enter into an orderly discussion of 
 the relative values of different articles of food ; but 
 confine myself to a few remarks which appear to me 
 as practicable. 
 
 There are five essential elements in food supply 
 as follows : 
 
 1. Proteids; examples of this class are J" flesh of animals 
 
 Function to replace tissue loss. % | animal products 
 
 2. Fats; function to produce body heat. 
 
 3. Carbohydrates; examples, sugars, starches, vegetable 
 
 products. 
 
 Function to produce energy. 
 
 4. Salts and Extractives, obtained f fruits 
 
 chiefly from -j vegetables 
 
 [ flavoring agents 
 Function chemical and biologic adjustment. 
 
 5. Water. 
 
 All of these elements must be represented in 
 definite ratio in a diet on which human beings are to 
 subsist for any prolonged period. Failure to fur- 
 nish the minimum required amount of any one of 
 these elements will result in disease production. 
 
77 
 
 Some ofthe great scourges of the world have re- 
 sulted from disregard of this law of nature, among 
 them scurvy ; beriberi ; pellagra (probably) ; sprue 
 (probably) ; rickets. * These are well recognized di- 
 sease entities, in addition to which are to be remem- 
 bered the countless less definite evidences of mal-nu- 
 trition seen in persons who are deprived of a bal- 
 anced diet. A dietary then must not only be suffi- 
 cient in amount, but characterized by sufficient var- 
 iety. Of the five elements of diet which you as an 
 organization commander must always be on your 
 guard to remember in the company ration, No. 4, 
 listed as salts and extractives and obtainable chiefly 
 from fruits and green vegetables, is the one which is 
 most frequently neglected with unfavorable results. 
 Remember, gentlemen, that a diet containing all of 
 these elements except element No. 4 will not be made 
 complete for subsistence by the addition of canned 
 foods. The reason of this is that the process of 
 canning requires a very high degree of heat, which 
 destroys a certain element in the food. This is 
 called, "vitamin." Its prolonged deprivation is very 
 probably the causative agent in three of the world's 
 great plagues; Beri-beri, pellagra and sprue. Re- 
 member then, that a varied diet is equally as neces- 
 sary as a liberal one, and that fresh or dried fruits, 
 and green vegetables, potatoes and other articles 
 containing the essential salts or vitamines are neces- 
 sary for an adequate diet. 
 
 Concerning the amount of food necessary for 
 the subsistence of your men, you will quickly learn 
 when you begin to handle a company mess. Men 
 marching or campaigning in a cold or stimulating 
 climate may be safely given a very liberal ration. 
 On the contrary, men in garrison or prolonged camp 
 in a hot country will be in better health for a diet 
 
78 
 
 restricted especially in meats and fats. In the 
 former case, a wise commander will purchase with 
 his ration allowance the greatest possible amount of 
 real food utilizing the government straight ration; 
 whereas in the latter he will cut down on the beef 
 and beans and purchase more delicate and less heat- 
 ing foods. You will find that time devoted to the 
 conduct of your company mess is well spent. A well- 
 fed body of men is content, willing to work, and dis- 
 inclined to indulge in drunkenness. A well-fed com- 
 pany becomes an organization which enlisted men 
 desire to join and stay with. Consequently it can 
 build up a cadre of good men. Moreover if you do 
 not watch your mess, you will not only find dis- 
 content and disciplinary troubles, but you will find 
 financial frauds and dishonesty sooner or later 
 among the men to whom you leave the matter. 
 General Orders 45, 1916, has the following on foods 
 and drink in camps: 
 
 "Food and Drinks. No food, drinks, or like 
 commodities will be sold in camp except in the au- 
 thorized exchanges. 
 
 Attention is called to the use of the following 
 foods, the elimination of which from the messes will 
 serve to prevent a variety of intestinal disorders : 
 
 (a) Canned milk and fish opened the day be- 
 fore. (Fish and milk poisoning.) 
 
 (b) Hashes of meats and potatoes prepared 
 the night previous. (Ptomaine poisoning of severe 
 type.) 
 
 (c) Locally grown green vegetables, uncooked. 
 (Dysenteries and diarrhea.)" 
 
 The field cooking may be of any character from 
 the individual cooking of active campaign to the 
 comparatively elaborate methods of permanent 
 camps. At the present time the field range is the 
 
79 
 
 most usual means of field cooking. Time is lacking 
 for details concerning field paraphernalia for cook- 
 ing. A few simple rules will suffice. 
 
 1. Kitchens, messes and food-store tents must 
 be located at opposite end of company from latrines. 
 (F.S.R. Par. 246.) 
 
 2. Kitchens should be sheltered in marching 
 command by tent fly and brush shelter when pos- 
 sible ; in prolonged camp by a fly proof shack. 
 
 3. Kitchen floors should be well tamped, and 
 sprinkled before each sweeping, and should be well 
 ditched. 
 
 4. Kitchens and all utensils must be clean at all 
 times. Screened kitchen shacks should have im- 
 provised fly traps. 
 
 5. All fresh food should be covered or protected 
 from flies, dust and dirt at all times. Fresh food 
 should be handled in a cleanly manner. This in- 
 cludes bread. 
 
 6. Garbage and other refuse. should not be col- 
 lected in or about a kitchen. Much, if not all of it, 
 can be incinerated at once. 
 
 7. Men should not be permitted to sleep im 
 kitchen or food-store tents, nor to eat in their sleep-) 
 ing quarters. 
 
 8. Ice boxes and drinking water barrels should 
 not be sunk in the earth. 
 
 9. Tinned meats and vegetables should be re- 
 jected if perforated or bulging or otherwise evi- 
 dencing contamination. 
 
 10. Not only the kitchen, food-store tent, and 
 mess tent should always be scrupulously clean and 
 fly free, but the earth surface around and about 
 these places. 
 
11. Make it clear to your mess sergeants and 
 cooks that you will not be satisfied with anything 
 less than absolute cleanliness in their department. 
 
 12. Enforce your views by frequent personal in- 
 spection and disciplinary measures for neglect. 
 
 Disposal of Wastes 
 
 Wastes may be classified as: 
 
 1. General refuse. 
 
 2. Human excrement. 
 
 3. Animal excrement. 
 
 4. Kitchen wastes. 
 
 5. Waste waters from kitchens, shower baths, etc/ 
 
 F.S.R. provides for the disposal of general 
 refuse as follows : "The camp is policed daily after 
 breakfast and all refuse matter burned." 
 
 F.S.R. provides for disposal of human dis- 
 charges as follows : 
 
 "Latrines for the men are always located on the 
 opposite side of the camp from the kitchens, gen- 
 erally one for each company unit and one for the 
 officers of a battalion or squadron. They are so 
 placed that the drainage or overflow can not pollute 
 the water supply or camp grounds. 
 
 When the camp is for one night only, straddle 
 trenches suffice. In camp of longer duration, and 
 when it is not possible to provide latrine boxes, as 
 for permanent camps, deeper trenches should be dug. 
 These may be used as straddle trenches or a seat 
 improvised. When open trenches are used the ex- 
 crement must be kept covered at all times with a 
 layer of earth. In more permanent camps the 
 trenches are not over 2 feet wide, 6 feet deep, and 12 
 feet long, and suitably screened. Seats with lids are 
 provided and covered to the ground to keep flies from 
 reaching the deposits; urinal troughs discharging 
 
81 
 
 into the trenches are provided. Each day the latrine 
 boxes are thoroughly cleaned, outside by scrubbing 
 and inside by applying when necessary a coat of oil 
 or whitewash. The pit is burned out daily with 
 approximately one gallon of oil and fifteen pounds 
 of straw. When filled to within two feet of the 
 surface such latrines are discarded, filled with earth, 
 and their position marked. All latrines and kitchen 
 pits are filled in before the march is resumed. In 
 permanent camps and cantonments, urine tubs may 
 be placed in the company street at night and emptied 
 after reveille." This paragraph briefly states the 
 methods commonly employed in our service. G. 0. 
 45, 1916, disposes of excreta as follows : 
 
 "Disposal of Excreta. Where a water car- 
 riage system is not feasible, the Havard box will be 
 used over the earth latrines. Daily inspection of this 
 system is enjoined on the part of the medical officer 
 of the organization, who will see that the following 
 plan is carried out : 
 
 (a) The latrine will be burned out daily with 
 crude oil and hay. (Each burning, one gallon crude 
 oil and fifteen pounds of hay or straw.) 
 
 (b) The boxes will be at all times kept fly tight ; 
 this implies closure of all cracks, care of the hinges 
 and a back construction so that the lids drop auto- 
 matically. The latrine seats will be washed off 
 twice weekly with a one one-hundredths solution of 
 creolin, or other disinfectant, and whitewashed 
 inside twice weekly. 
 
 (c) When filled to within two feet of the top, 
 latrines will be filled with dirt, their position marked, 
 and new latrines constructed. 
 
 (d) Where water carriage system is in vogue, 
 either the automatic flush or trough systefn will be 
 installed." 
 
82 
 
 In the foregoing order it is customary to have 
 a noncommissioned officer such as the noncommis- 
 sioned officer in charge of quarters take a squad and 
 carry out the burning described under (a) . For the 
 compliance with requirement (b) it is an excellent 
 plan to require the company artificer to visit the 
 company latrine daily and repair defects. 
 
 Animal excreta is always a difficult problem 
 especially in a large camp. Only the highest dis- 
 cipline, and constant labor will dispose of the mass of 
 manure and picket line refuse. The reason that its 
 destruction is so imperative lies in the fact that 
 manure is the natural breeding place for flies. It is 
 estimated that ninety per cent, of flies breed in 
 manure and horse droppings. The complete process 
 requires about ten days. The fly larvae burrow into 
 the depths of the manure or the damp earth beneath 
 until maturity is reached, so that an apparently 
 harmless manure pile may harbor millions of flies. 
 The fly you must remember is just as much to be 
 regarded as a danger as the enemy's bullet, and may 
 kill off your men in much greater number. 
 
 G. O. 45 directs as follows : 
 
 "Disposal of Manure and Care of Picket Lines. 
 All manure will be hauled to the camp dump. 
 Picket lines will be kept broom swept, and all manure 
 and straw hauled off daily. A weekly incineration 
 of the picket lines will be accomplished with crude 
 oil at the rate of 10 gallons to each line. Crude oil 
 may be obtained from the Quartermaster Corps on 
 usual requisition." 
 
 The foregoing paragraph merely transfers the 
 manure and with it the responsibility for its dis- 
 position to another place, e. g. the camp dump. A 
 camp dump must be at least one mile from camp, and 
 in the opposite direction from prevailing winds when 
 
83 
 
 there are such. At the camp dump, manure may be 
 disposed of by burning in a huge improvised in- 
 cinerator; or by spreading out in thin layers for 
 drying. The first way requires much constant labor, 
 some fuel and the highest discipline, especially in 
 large commands. The second way requires labor, 
 discipline and constant official supervision, so much 
 so as to also prohibit complete success. Those of 
 your number who may have ever attempted to gov- 
 ern fatigue parties distributing manure in a thin 
 layer over the earth's surface will readily visualize 
 the difficulty of so governing the same work for a 
 division. One or the other of these ways may be suc- 
 cessful with a small body of troops. The very best 
 way for a large command such as a brigade of 
 mounted troops or an infantry division is by arrange- 
 ment with some commercial parties to haul away by 
 train or otherwise the entire supply each day. If 
 this can not be done, the best way is to have the 
 dump at least two miles from any. part of the camp. 
 Flies rarely travel so far unless carried by high 
 winds. Carcasses of dead animals should be carted 
 to a spot selected by a sanitnry officer and there 
 burned or buried. The latter is usually the more 
 practical plan. 
 
 G. 0. 45 prescribes the disposition of kitchen 
 wastes as follows : 
 
 "Disposal of Garbage. For detachments or 
 companies in camps, or in isolated location where 
 other means are not available, the incinerator will 
 be installed. 
 
 If wood is plentiful and medium-sized stones 
 can be obtained, both liquid and solid refuse can be 
 disposed of by using incinerators improvised for each 
 company as follows: 
 
84 
 
 A pit is dug about five feet long, two and one 
 half feet wide, and six inches deep at one end and 12 
 inches at the other; the excavated earth is banked 
 around the pit and the latter is then filled with stones 
 on which a fire is built ; when the stones have become 
 heated, liquid refuse is poured into the pit (shallow 
 end), where it gradually evaporates; solid matter 
 is burned on the fire. 
 
 The efficiency of this type of incinerator depends 
 largely upon the fact that porous earth absorbs a 
 very large part of the liquid slops, but is not con- 
 sidered practicable to destroy the usual accumula- 
 tion of slops every day without using an extrava- 
 gant amount of fuel. 
 
 A type of incinerator having a fire bed of rock 
 one foot deep will not permit the heat from the fire 
 to penetrate beyond that depth. The rock wall on 
 three sides of the fire bed absprbs much heat that 
 otherwise might be dissipated into space, which in- 
 creases the evaporating capacity of the incinerator 
 enormously, and requires a comparatively very small 
 amount of fuel. Incinerators built of large rocks are 
 considered to be most efficient. 
 
 About one sixth of a cord of wood per day per 
 company is considered more than sufficient for the 
 destruction of all slops and garbage if ordinary care 
 and attention are given the incinerator. Liquid 
 slops should be evaporated by being poured slowly 
 along the vertical walls of the incinerator not upon 
 the fire bed, and the solid garbage should be placed 
 on top of the fuel. It has been determined that a 
 skilled attendant can destroy 100 gallons of liquids 
 and 23 cubic feet of solid garbage in about 12 hours 
 by using one sixth of a cord of wood. 
 
 Where rock is not available, material (brick 
 340, lime three fourths bag) will be obtained on 
 
85 
 
 requisition from the quartermaster. Where dis- 
 posal in a sanitary way can be made by means of 
 carts, the garbage can may be used. The cans will 
 be thoroughly cleaned, scalded, and coated with 
 crude petroleum after emptying. 
 
 Kitchens and Mess Rooms. Kitchens and 
 mess rooms will be securely screened and an efficient 
 fly trap provided for catching such flies as gain 
 entrance thereto. An eflfectiye fly trap consisting of 
 a light wooden frame covered with wire gauze, ex- 
 tending to about one eighth of an inch of the floor of 
 the trap, is readily constructed. It has been found 
 that sweetened water slightly acidulated with vine- 
 gar is an excellent bait. 
 
 Ice boxes installed will be inspected daily and 
 drip pans emptied and scalded out. 
 
 Garbage cans will be kept on wooden racks and 
 elevated from the ground and cans burned out daily 
 with oil to prevent fouling, and kept clean outside 
 with a coat of whitewash." 
 
 There are briefly three ways of disposing of 
 kitchen garbage, burning, carting off and burying. 
 In a general way their relative sanitary value is as 
 in the order named. Sometimes, two methods may 
 be combined, thus for example : solids burned, liquids 
 carted off or burned. The principle involved is to 
 leave no organic refuse in or about camp, to pollute 
 water of food supplies or harbor and breed flies. 
 
 Waste waters from shower baths must be car- 
 ried off by natural or improvised watercourse so as 
 not to be a source of mosquito breeding or a nuisance 
 to a camp. 
 
 Hygiene of the March. A few remarks must 
 suffice. The health as well as the comfort of march- 
 ing commands is influenced by the manner in which 
 its details are arranged. A commander should con- 
 
86 
 
 sider these when military necessity does not rule 
 otherwise. When a prolonged march extending over 
 many days is undertaken, especially by a command 
 not inured to marching, it is wise to begin the jour- 
 ney by short daily maches, gradually working the 
 men up to longer marches. In this way, the men 
 gradually harden up, their feet toughen and by the 
 end of a week, they are fit for the longer hikes. He 
 who gives very long hard marches on the first three 
 days will not hasten the ultimate time of arrival, 
 nor bring an equal number of fit men to the goal. 
 This rule applies to regular troops as well as others. 
 An average day's march for commands not greater 
 than a brigade is for foot troops 15 miles, mounted 
 troops 20 to 25 miles. For divisions or larger bodies 
 the journey must be cut down 20 per cent. Troops 
 hardened or spurred by necessity may of course 
 cover much more territory. Remember that a com- 
 mand that is soft may much more readily march 20 
 miles on one day than 45 miles in three days, in 
 other words the fatigue is cumulative for unseasoned 
 men, because they do not recover from one day of 
 fatigue when the next begins. 
 
 The time selected for marching has appreciable 
 effect upon physical condition of men and animals. 
 Night marches or marches beginning before day- 
 break depress the spirits of men and the vitality of 
 men and animals. Especially is it hard on animals 
 to march before they have had their food in quiet 
 and at the customary time. In very hot places, how- 
 ever, marches are best conducted either in the early 
 morning hours or late afternoon and evening. When 
 a day's march begun in the early forenoon can not 
 be concluded by 1:00 P. M. it is wiser to break its 
 fatigue by a halt and light lunch shortly before noon. 
 Similarly all-night marches should be broken about 
 
87 
 
 midnight by a light meal. Customarily men march 
 fifty minutes and rest ten in the hour, thus cover- 
 ing about 2^ miles each hour. A faster rate is 
 more than proportionally wearisome. It is wise to 
 march methodically by the watch. The leading 
 troops march more easily than the tail of the column. 
 Therefore in long marches, each unit should have its 
 turn as the leading element. At the first halt on 
 the day's march, a period of twenty minutes is usual- 
 ly given men to relieve themselves, readjust packs or 
 otherwise get in marching trim. 
 
 Marching troops can eat and digest most any- 
 thing, so that no especial sanitary rules apply to 
 troops in this status. A moderate morning meal 
 eaten leisurely at least one half an hour before tak- 
 ing the road is the best provision for the coming 
 journey. The discipline of a command is well gauged 
 by its conduct respecting water drinking on the 
 march. It is an excellent rule for a company com- 
 mander to require his men to start the day's march 
 with a canteen filled with water, and with a clear 
 understanding that none shall have further supply 
 until at least one half hour after concluding the day's 
 march. The only exception is the march in exces- 
 sively hot weather when a greater water supply must 
 be provided. This should either be transported with 
 the command or taken from sources examined or ap- 
 proved by the C. O. Men should never be allowed 
 to break ranks and forage for water except in cir- 
 cumstances of extraordinary necessity. This rule 
 should be enforced for discipline and training as 
 well as health. The cardinal rules for a snapshot 
 judgment of water supplies have been already re- 
 cited. If you have a medical officer along, put him 
 on the trail of the water supply as soon as you near 
 the place of noon or evening halt. If not, exercise 
 
88 
 
 your own judgment, remembering the instructions 
 in F. S. R. concerning the boiling of suspicious 
 waters, and the protection of your water supply by 
 guards. 
 
 The care of the feet of your men is extremely 
 important. It should have begun long prior to a 
 march by personal supervision of the shoeing of 
 your men; by personal bi-monthly inspection of 
 your men's feet ; by inspection of the shoes and socks 
 of your men before the march ; and by the harden- 
 ing and seasoning of your men by practice hikes. 
 These are all prescribed by War Department orders, 
 and if their provisions have been intelligently and 
 faithfully executed, you will have little or no trouble 
 on the march. But if you have neglected them, 
 your men will suffer, and you may have the morti- 
 fication of seeing your company crippled by the disa- 
 bility of footsore men. Higher commanders now 
 place the blame for this condition on the unit com- 
 mander. In order to lessen the woes of the footsore, 
 require your men to start with good shoes and socks, 
 and if allowable with a pair of gym shoes or slippers 
 for resting the feet after the day's march. At the 
 termination of a day's march, men should bathe 
 their feet when practicable in cool water, dry them, 
 and apply clean dry socks, immediately washing out 
 the pair worn. Blisters are best treated by zinc 
 oxide plaster or dusting with the regulation foot 
 powder. Prevention is much simpler and more sat- 
 isfactory than cure of bruised and blistered feet. 
 
 When troops are marching in an inhabited coun- 
 try or when travelling along routes which will be 
 traced or retraced by themselves or their comrades, 
 it is imperative that the road shall not be left in a 
 polluted state. Therefore when a command reaches 
 the place for the day's halt, the commander selects 
 
89 
 
 sites for latrines, and causes there trenches to be 
 dug at once. In a fly country a guard is placed over 
 each straddle trench to compel men to cover their 
 deposit with earth. Before resuming the march, the 
 site of the bivouac is properly policed. This con- 
 stitutes the "good manners" of an army. 
 
Lecture IV 
 
 i 
 
 THE SANITARY SERVICE OF THE 
 MARCH IN CAMPAIGN 
 
 T MAY be said that the Sanitary Service of the 
 March should begin with the physical examina- 
 tion of the recruit. Napoleon, the most illustrious 
 of all eugenists, is alleged to have begun before this, 
 when he sent recruiting sergeants, selected for their 
 mental and physical qualities, to the villages of 
 France, almost depopulated of fit adult males by the 
 ravages of war. Certainly the selection, training, 
 clothing, and equipment of the soldier must be con- 
 trolled carefully, in order to permit efficiency on the 
 march, and in combat; and this canot be too pains- 
 taking and thorough. Given the recruit of proper 
 conformation, as shown by physical examination, he 
 should be trained physically and mentally for the du- 
 ties which will be required of him. His clothing, 
 shoes, and equipment, must be furnished and ad- 
 justed in such a manner, as to permit freedom of 
 movement, without constriction or interference with 
 organic functions; and he must be instructed, and 
 physically trained by carefully graduated exercises 
 in use, and manner of carriage of equipment, march- 
 ing, and personal and general hygiene. This train- 
 ing must not be excessive, as to duration in time of 
 effort, at first, because the average American recruit 
 has had little training in walking and weight carry- 
 ing, and his physical development is not completed. 
 Excessive drill will not only retard his set up, and 
 development, but may possibly, give a temporary 
 91 
 
92 
 
 breakdown in some part of the organs of locomotion 
 (most frequently in the feet) , and by reason of ex- 
 haustion and discomfort affect his morale as a 
 marcher. 
 
 The sanitary service on the march in campaign, 
 concerns itself with the institution of proper san- 
 itary measures for the prevention of disease, the 
 care and evacuation of the sick, and the conduct and 
 administration of the personnel and material for 
 these purposes on the march, in camp, and combat. 
 
 The attached sanitary troops, before beginning 
 the march, supervise the final sanitation of the aban- 
 doned camp, bivouac, or field and arrange for the 
 care and transportation of the sick and disabled; 
 usually each battalion surgeon with his unit per- 
 sonnel, covering the command to which he is at- 
 tached, under the supervision of the surgeon, who 
 makes a final survey of the situation. The battalion 
 sanitary personnel, consisting of a medical officer, 
 a noncommissioned officer, and an orderly mounted, 
 and one or more litter squads of two men each, 
 marches at the rear of the battalion to which at- 
 tached. This position places the sanitary personnel 
 at a point where on the ordinary march it will be 
 able to observe the general condition of the personnel 
 of the command, and come up in the course of the 
 march, to any fall-outs, without the necessity of 
 special exertion on their part, or upon the part of 
 anyone in going forward to secure their services; 
 and permits observation of signals from the front, 
 should service be required in this direction. This 
 position at the rear of the battalion, leaves the per- 
 sonnel in position to cover, without unnecessary 
 movement, the battalion, or any part of it, should it 
 deploy. 
 
93 
 
 The medical officer with the battalion, will not, 
 at all times confine himself to a position at the rear 
 of the battalion, but will, from time to time, go for- 
 ward to inform himself as to changes in march con- 
 ditions; the condition of various members tff the 
 command he has under observation; in response to 
 calls for services ; and to observe conditions of water 
 or other supply on the route of march ; and at halts 
 will supervise disposal of excrement, wastes, etc. 
 Before the noon halt, if there be such a halt intended, 
 and before approach to camp, he should ride forward 
 in order to inform himself as to water, drainage, 
 terrain, etc., in order to give such assistance, from a 
 standpoint of sanitation, as may be necessary. 
 
 Cases, sick or disabled, requiring care or treat- 
 ment, are sent with a pass, showing the name, com- 
 pany, and regiment or corps, of the sick person, to 
 the medical officer in the rear. The medical officer 
 returns the pass showing the disposition of the case. 
 The medical officer should dispose of this case ac- 
 cording to the conditions ; he may relieve him of his 
 pack, if he be an infantryman, and require him to 
 march, or he may put him in an ambulance or any 
 other transportation, if there be no ambulance at- 
 tached to the organization; or he may require him 
 to march full pack, at the rear of the organization, 
 under observation. Wherever a fall-out is separated 
 from the organization, he is given a diagnosis tag, 
 showing the orders given him. The arms and per- 
 sonal equipment of a foot soldier accompany him, 
 the mount, saddle equipment, and saber of a mounted 
 soldier are returned to the troop, usually by the n. c. 
 o., who accompanies him (F. S. R. 343.) 
 
 Rapidly moving mounted commands will usual- 
 ly have no transportation other than mounts or gun 
 carriages for the disabled, in which case, the squad- 
 
94 
 
 ron surgeon, must act in accordance with the pa- 
 tient's condition, and the circumstances of the 
 march. The patient may be required to follow the 
 command at a walk, he may be sent back, escorted 
 or unescorted by a sanitary soldier, with or without 
 wheeled transportation, toward the main body, or 
 the lines of communication or he may be left, with 
 or without an attendant, under shelter, to be cared 
 for by friendly inhabitants or to be picked up by 
 sanitary troops, furnished with proper transporta- 
 tion. 
 
 Whatever action is taken with regard to the dis- 
 position of the disabled and their equipment, careful 
 note and report must be made of it, in order that all 
 may be cared and accounted for, and at the end of 
 the march, collected, examined, treated, and, if nec- 
 essary, evacuated to the rear. 
 
 Those sanitary troops attached to separate or 
 independent battalions, will have in addition to their 
 personal equipment, one pack mule, with aid station 
 equipment, which will accompany the battalion com- 
 bat train, of which it is a part. The sanitary troops 
 attached to a regiment, are usually divided for 
 march, camp, and combat duties, into the battalion 
 or squadron, and headquarters sections, giving to 
 the regiment of infantry, three battalion and one 
 headquarters section. 
 
 The headquarters section usually consist of the 
 senior medical officer, the senior n. c. o., one orderly, 
 all mounted, and from two to four privates in num- 
 bers, and mounted or dismounted, in accordance with 
 the allowance of men and animals for sanitary troops 
 of the arm with which they are serving. The senior 
 medical officer the surgeon with his mounted 
 orderly, marches with the staff of the regimental 
 commander, unless there be no other medical officer 
 
95 
 
 with the regiment, then he marches in the rear. He 
 is required to be with the regimental commander, in 
 order that he may be available for consultation with 
 regard to sanitary matters, and that he may be in- 
 formed as to general and special situations, as they 
 may arise, relating to various conditions that might 
 affect sanitation and care of the troops, and the 
 handling of the sanitary troops; the selection of 
 camp sites, examination of water and food supplies, 
 disposal of wastes, and dispositions of the sanitary 
 troops. 
 
 The senior noncommissioned officer of the san- 
 itary troops (headquarters section) with the privates 
 of the Medical Department attached to his section, 
 marches at the rear of the last battalion, with the 
 sanitary troops of that battalion, and has in his 
 charge the pack mule, carrying the regimental aid 
 station equipment, and the ambulance, if the regi- 
 ment is part of a reinforced brigade or division of 
 which ambulance companies are a component. If 
 the regiment is acting independently, he will be in 
 charge of the three or four ambulances and, on 
 arrival at camps, the wheeled transportation, which 
 carries the regimental infirmary or hospital. The 
 position of the headquarters section of the regi- 
 mental sanitary personnel at this point on the or- 
 dinary march, permits control of equipment and 
 transportation on the march, and in case of deploy- 
 ment, leaves this equipment in proper position, in 
 readiness to advance and establish where directed. 
 Under this condition, the wagons of the regimental 
 infirmary or hospital would be back in the regi- 
 mental field train. 
 
 On a march in retreat, in a brigade or division, 
 if the regiment is not acting as advance or rear 
 
96 
 
 guard, the distribution of sanitary troops is the 
 same as given for the ordinary march. 
 
 If the regiment is marching alone with an ad- 
 vance guard of one battalion, the distribution is that 
 of an ordinary march and the battalion sanitary 
 troops will march with the reserves of the battalion, 
 with possibly one man with support, if such there is. 
 The formation will practically be the same for a regi- 
 ment acting as advance guard with a battalion as the 
 support each battalion will carry its personnel as 
 usual the surgeon will be with the commanding 
 officer, and the battalion forming the support will 
 have one or two men of the sanitary personnel, with 
 the advance party. 
 
 In a retreat of a regiment, or a regiment acting 
 as a rear guard, the reserve will be reinforced by 
 the sanitary personnel from the main body of the 
 battalion or regiment, in order that the wounded of 
 the retreating rear guard may be rapidly evacuated 
 ahead of the troops. If ambulances are available, 
 as in a regiment acting independently, it may be well 
 to attach one to the tail of the main body, between 
 it and the reserve of the rear guard, leaving the 
 pack mule and remaining ambulances to march with 
 the leading battalion. 
 
 Ambulance companies are divisional sanitary 
 organizations, but for purposes of care and trans- 
 portation of the sick and wounded, may be attached 
 to separate brigades, which are operating away from 
 the division. Under the conditions of the ordinary 
 march, when hostile contact is not expected, ambu- 
 lance companies march and camp together, with 
 the exception of one ambulance company, which 
 under proper orders may have its ambulances dis- 
 tributed through the column, one to each regiment, 
 for use in transportation of the disabilities that 
 
97 
 
 occur on the march. (F. S. R. 341.) Under these 
 conditions of the ordinary march, those ambulance 
 companies, not concerned in the regimental service 
 for the day, march as do other organizations ; their 
 positions ordinarily in the rear of the field trains 
 when marching as a unit, with their field wagons; 
 when marching with light transportation (pack 
 mules) only the ambulance companies march in ad- 
 vance of the field trains. 
 
 Under conditions of untrained, or fatigued per- 
 sonnel, bad weather, or long marches, action may be 
 taken to increase the number of ambulances tem- 
 porarily attached to the regiment, for the purposes 
 of the march, as much as may be necessary. These 
 ambulances so distributed to the regiments are for 
 use in transportation of the disabled and their equip- 
 ment, and must not be diverted to any other use. 
 They are under the orders of the Director of Ambu- 
 lance Companies and their movement will be con- 
 trolled by him, in carrying out the orders of the 
 surgeon or the commanding officer. At the begin- 
 ning of an engagement, or at the end of the march 
 the distributed ambulances will be assembled by the 
 orders of the director, usually given through the 
 company commander. All disabled sick in the ambu- 
 lances at this time, who require more than temporary 
 care or transportation will usually be sent back by 
 the regimental surgeon with the ambulances. When 
 they move to assemble in preparation for an engage- 
 ment, the disabled will be collected at some central 
 point in the rear for further evacuation, if on arrival 
 at camp, at the probable site of the camp infirmary, 
 or to the field hospital for further treatment and 
 evacuation according to the conditions and orders. 
 
 This arrangement of the ambulance companies 
 in column for the ordinary march, is to permit such 
 
98 
 
 use of organizations as may be necessary ' for the 
 transportation of the disabled, and to permit rapid 
 collection of the disabled on arrival at camp, without 
 unnecessary movement of disabled or transportation. 
 
 The ambulance companies whose ambulances 
 are not distributed to the organizations on the 
 march, are held in their position behind the field 
 trains, as they camp at the rear of the center of the 
 division, and ordinarily not more than one is con- 
 cerned in regimental duty. With this position, they 
 do not become involved in the movement of the field 
 trains to their organizations or on their return ; and 
 are in position to join the column for the next day's 
 mrach. The details for march duty with the regi- 
 ments, will be made by the director, ordinarily by 
 roster, and the positions in column will be determ- 
 ined in a like manner by the Director of Ambu- 
 lance Companies, acting as a battalion commander. 
 
 Changes from the routine order of march, will 
 usually be made on recommendation of the surgeon, 
 in the march order, according to the necessities of 
 the case. This position of the ambulance companies 
 behind the field trains, places them sufficiently far 
 forward to permit, in case of rencontre, advance of 
 the ambulance companies sufficiently early to be of 
 use when required, and yet not have them as far for- 
 ward as to have them unnecessarily involved in 
 conflict. 
 
 The ambulance companies with light transpor- 
 tation, march at the tail of the combatant column; 
 such a position usually is the result of a desire to 
 have the more mobile part of the organizations 
 ready for early use, or is the result of difficult roads, 
 or failure of heavy wheeled transport : either condi- 
 tion, if the ambulance companies were kept behind 
 the heavy transportation of the field trains, might 
 
99 
 
 possibly put them so far back as to render them 
 useless. 
 
 The usual order of march of an ambulance com- 6 
 pany is that of ordinary commands of mixed organi- 
 zations. The foot troops, the bearer sections with 
 litters, first, followed by the pack mules with the 
 dressing station detachment, next the ambulance 
 detachment, and lastly, the three wagons: The 
 first wagon carries reserve dressings and equipment 
 for the dressing station, and, where possible, accom- 
 panies the dressing station party forward as a com- 
 bat wagon. 
 
 The road distance of an ambulance company on 
 the march without elongation is 125 yards motor, 
 200 yards mule. The Director of Ambulance Com- 
 panies ordinarily accompanies the ambulance com- 
 pany in advance on the march, such a position places 
 him so that he will be able to receive messages from 
 the front and rear, easily, and yet supervise the 
 work of his organizations as it occurs. This ad- 
 vanced position also gives him an opportunity to 
 familiarize himself with the conditions of roads, ter- 
 rain, etc. On ordinary marches, particularly when 
 the roads are dusty, the dismounted detachments of 
 the sanitary battalion are frequently marched to- 
 gether, as a matter of comfort, followed by the pack, 
 ambulance and wagon detachments, combined in ord- 
 er of the companies ; such action while removing the 
 transportation from immediate control of the com- 
 manding officer, does not cause material delay in 
 going into action ; as these detachments have medi- 
 cal officers in command, and objection on this score 
 does not hold good the conditions of the march 
 are certainly improved greatly. 
 
 The march in the presence of the enemy, where 
 hostile contact may be expected, requires as it does 
 
100 
 
 with the line troops, a different arrangement of the 
 ambulance companies in the column. With the rein- 
 forced brigade, the single ambulance company at- 
 tached is moved up in advance of the field trains, to 
 the tail of the column of combatant troops ; so that it 
 will not be forced to participate in the retirement of 
 the field trains, if such retirement is necessary, and 
 that it may be in readiness for action, should the 
 bridgade deploy for attack or defense, and in case of 
 retreat, be sufficiently advanced to permit detach- 
 ment of a platoon of ambulances and bearers for 
 duty with the rear guard, for the purpose of expedit- 
 ing the evacuation of the wounded. 
 
 The distance from the reserve of the rear guard 
 to the tail of the main body of the brigade, will be 
 about 4,000 yards, a distance that could be traversed 
 by the ambulance company, if necessary, while the 
 brigade is deploying, if it were desirable to bring it 
 up to this point. Such action however would not be 
 contemplated until late in the action, and if the 
 dressing station establishes, it will be well to the 
 rear. The regimental sanitary personnel will be 
 sufficient to care for the wounded until the dressing 
 station can go into action and the position of the 
 ambulance company at the rear of the column is 
 correct, for a column of this size. 
 
 With a brigade in retreat, however, if the am- 
 bulance company were marched with the leading 
 troops (with the same 4,000 yards from the reserve 
 of the rear guard) in default of wheeled transporta- 
 tion, the wounded resulting from a general rear 
 guard action must be abandoned or carried by hand. 
 
 If, as mentioned above, a platoon of 3 ambu- 
 lances be attached to the reserve of the rear guard, 
 with 5 or 6 litter squads from the bearer detachment, 
 these reinforced by the regimental sanitary person- 
 
nel will be able, under ordinary conditions, to evacu- 
 ate a considerable portion of the wounded requiring 
 transportation. 
 
 With a division marching in the presence of the 
 enemy or when hostile contact may be expected, 
 ambulances will not be distributed to the regiments, 
 but will be held with the ambulance companies, 
 With the normal advance guard of one brigade, one 
 ambulance company will be attached to the advance 
 guard and march usually at the rear of the reserve 
 as the distance from the tail of the reserve to the 
 tail of the combatant troops of the main body will, 
 without elongation, be some seven miles ; a distance 
 too great to permit a unit of the size of a brigade 
 to be without medical assisitance, other than the re- 
 gimental personnel, during the time it would take 
 an ambulance company to come to the front. If 
 a general action is imminent, the advance guard will 
 be engaged for a considerable time and the ambu- 
 lance company, equipment, and personnel, will be 
 required early. If the advance must continue, this 
 equipment will be required to take over the wounded 
 and release the regimental personnel, so, that it can 
 continue with its command. If a retreat is required, 
 this organization well up to the scene of action, 
 offers the only means of evacuation of the wounded. 
 
 The positions of the sanitary units of a division 
 in retreat are identical with those of a march for- 
 mation with advance guard, except, that organiza- 
 tions are faced about, and, if necessity arises for 
 delaying actions of some duration, the ambulance 
 companies with the brigade rear guard may be 
 reinforced by additional ambulance and bearer pla- 
 toons, in order to expedite the evacuation of the 
 wounded of this force, which must retreat soon. 
 
.-,102 
 
 Flank guards of a brigade or more, when de- 
 tached a sufficient distance from the main body to 
 warrant such action, should be furnished a propor- 
 tional amount of sanitary assistance. As such a 
 command must keep in movement consonant with 
 the movement of the main body, it must not be im- 
 peded by the disabled, and the allowance of ambu- 
 lance company personnel and equipment should be 
 liberal. The method of distribution of sanitary 
 personnel of a flank guard on the march is that of 
 a brigade or division when hostile contact is ex- 
 pected. 
 
 The distribution of the three ambulance com- 
 panies on the march with a cavalry division con- 
 forms to that of an infantry division, except that 
 on account of the superior mobility of the cavalry 
 division on marches where contact may be expected, 
 it may be frequently necessary to carry the packs 
 of the dressing station equipment and bearer de- 
 tachment in ambulances, leading the unloaded pack 
 mules from the tails of the ambulances in order to 
 keep up with the command; the wagon transporta- 
 tion being directed to follow at best speed consistent 
 with constant marching. Such an arrangement per- 
 mits these organizations to go forward with all the 
 speed that can be expected from mule drawn wheel 
 transport. When getting into ground unsuitable 
 for wheeled transportation, the pack mules can be 
 reloaded and the bearer detachment move out on 
 foot from the ambulance head with light transporta- 
 tion. 
 
 The position of the field hospitals of an infantry 
 division on an ordinary march is at the rear of the 
 ambulance companies, which are preceded by the 
 field trains the director of the field hospitals usually 
 marches with the most advanced organization . The 
 
103 
 
 duties of the field hospitals on the ordinary march 
 are limited to arranging for establishment of suffi- 
 cient equipment to shelter the daily increment of 
 disabled, prior to evacuation. As these organiza- 
 tions camp, usually with the ambulance companies, 
 in a position to cover the rear of the center of the 
 divisional camp, their place in the column conincides 
 with this intent and permits entrance into the 
 column the following day without confusion. 
 
 The necessity of use of field hospitals in action, 
 such as would occur only under the conditions of a 
 meeting engagement, does not require, and in fact 
 forbids early establishment ; and the position of the 
 field hospitals in this column, some 8 miles from the 
 head of the main body, keeps them well out of range 
 of light artillery fire and yet permits arrival in 
 proper position within two hours if necessary. 
 While ^the field service regulations require a field 
 hospital to be located, so as to permit early care of 
 the sick on arrival at camp, the camp infirmary, 
 marching at the rear of the brigade, now provides 
 for and can do this, until the establishment of the 
 field hospital. Under conditions where delays of 
 trains may occur, a field hospital may be marched 
 at the tail of the main body, in order to place it in 
 position to establish an hour and a quarter earlier. 
 As the road space of a field hospital company is only 
 90-100 yards, such an arrangement will have little 
 effect in displacing the field trains to the rear. 
 
 Field hospitals with organizations marching 
 when hostile contact is expected, march with the 
 ambulance companies in advance of the field trains, 
 some 6A miles from the head of the main body in 
 position to halt in readiness to establish or march 
 forward according to the necessities; should the 
 division deploy, this position in the column puts 
 
104 
 
 them well up to the front and clears them f.rom be- 
 ing involved in the field trains should action occur. 
 This is essential as the transportation of these or- 
 ganizations, field wagons, is heavily loaded and can- 
 not move with rapidity. Position of these organiza- 
 tions further forward with the column would expose 
 them to involvement in the movements of the com- 
 batant troops and possibly to artillery fire with no 
 advantage, as these organizations will not ordinarily 
 be needed until the action has well developed, and 
 in their present position have ample time to establish 
 whenever ordered. 
 
 Field hospitals attached to brigades acting in- 
 dependently, conform to the same conditions as in 
 the march with larger units. Advance, rear, and 
 flank guards of less than a division, do not ordinarily 
 have field hospitals attached to them, but depend 
 upon the field hospitals attached to the main body. 
 
 In the retreat, the positions of the field hospi- 
 tals are the same as in the column on a march to 
 the front, the advance when hostile contact is ex- 
 pected, except that the organizations are faced 
 about. Owing to the slow movement of these or- 
 ganizations, the transportation and material could 
 not be used nearer the enemy, but the personnel will 
 be available to assist the ambulance companies with 
 litter bearers, in evacuating from the front, and for 
 care of excess wounded sent back to the sanitary, 
 field, ammunition, and supply wagons, for transpor- 
 tation. 
 
 All movements of the divisional sanitary units 
 other than those routine to the march, are directly 
 controlled by orders from headquarters of the com- 
 mand, usually upon the recommendation of the sur- 
 geon of the command. Detachments for ambulance 
 duty with regiments, advance, rear, and flank guards, 
 
105 
 
 are made by roster, where possible ; where organiza- 
 tions are on continued duty as flank guards, etc., it 
 is advisable not to make frequent change of sanitary 
 units, on account of the unnecessary movement in- 
 volved. The orders with regard to the sanitary 
 troops may come from the combatant commander, 
 or from the surgeon, when such authority is dele- 
 gated to him. 
 
 The relations of the lines of communications, 
 sanitary service, to the march in campaign consists 
 in the renewal of the technical supplies of the service, 
 by timely issues, renewal of personnel, and the eva- 
 cuation and care of the disabled. With the ordinary 
 march these duties lie largely under the control of 
 the surgeon, advance group, of the line of com- 
 munications, whose duties are practically those of an 
 advance field and forwarding agent for the surgeon 
 of the base group. With the line of communications 
 short, and near the base, and efficient transport 
 lines by rail, water, or motor, betwen the base and 
 the transportation head, there will be little inter- 
 vening in the way of sanitary establishments or 
 equipment; but as the line extends, establishments 
 and units must be brought up and placed in accord- 
 ance with conditions and requirements. Under the 
 conditions of the long line of communications, inter- 
 mediate medical groups may be required. 
 
 The duty of supply for the sanitary units, which 
 start the campaign with sufficient medical supplies 
 for one month, will be handled by timely issue from 
 the advance medical depot, usually at a rail, water, 
 or motor head. These supplies for issue must be 
 sent forward to the distributing point by lines of 
 communications transportation (as the abolition of 
 the Medical Reserve Supply Company by recent 
 action, furnishes no supply wagons for this purpose) , 
 
106 
 
 and will there be taken over by field wagons of the 
 ambulance company and field hospital companies, 
 which will issue to the organizations, as required. 
 Requisitions for supplies required, will come from 
 the chief surgeon of the units requiring these sup- 
 plies and probably they will be issued under his 
 direction. This matter of issue under the new con- 
 ditions has not been worked out as yet, but the 
 method given, follows the former method. Issues 
 to regimental sanitary service can be made by using 
 the regimental pack mule as transport, or by the 
 camp infirmary wagon attached to each brigade. 
 The technical supplies required consist of medicines, 
 dressings, and hospital stores, such as arrow-root, 
 chocolate, extract of beef, spices, soap, candles, 
 evaporated milk, tinned soups, etc., all packed in 
 convenient standardized containers; the medicines 
 and foods in tin, whenever their chemical properties 
 permit. Shipments of supplies of this character, 
 on account of the urgent need for them, usually will 
 be accompanied to the distributing point by a non- 
 commissioned officer of the sanitary service of the 
 advance group, in order to insure rapidity and cer- 
 tainty of delivery. 
 
 The service of the evacuation of the disabled 
 sick of the march in the campaign, will be organized 
 on the same basis as that for those resulting from 
 combat. The daily increment of sick for trained 
 troops in campaign as given by Straub, will average 
 about one per cent, divided in to the following 
 classes : 
 
 f (a) Able to do duty (light) 0.3% 
 1. Sick in Quarters ] 
 
 [ (b) Unable to do any duty 0.3% 
 
 f (c) Slight _________ P _____ 
 
 2. Sick in Hospital^ 
 
 [ (d) Severe ______________ 0.15% 
 
107 
 
 II 
 
 fl C m' < ^"~ l 
 
 ii fa - a 
 
 s ?l 2 -~ 
 
 Vi C3 <DT3 > g 
 
 ~ 3 S > i- 1 * 
 
 O Q <J o Q c 
 
 a, 3 days 3 4 
 
 b, 3 5 days 4 6 
 
 c, 514 days 10 15 
 
 d, 1450 days 32 51 
 
 But with relatively untrained troops or difficult 
 conditions of march, weather, improper foot, etc., 
 these averages may be much increased even from 
 5 to 15%. 
 
 The cases covered by classes a and b, amounting 
 to 6 per M, will under ordinary conditions of march 
 recover within three or four days; a considerable 
 number of these may be able to march without equip- 
 ment or ride on the field wagons and be available 
 as guards, etc. It would be uneconomical to send 
 these to the rear and ordinarily they can be cared for 
 in the regiment or at the camp infirmary and shel- 
 tered with their own equipment. Classes c and d, 
 will average from ten to thirty days lost by sickness 
 and will require hospital treatment. Such cases 
 cannot accompany the command and must be evacu- 
 ated. Sick call will be held by the attached sanitary 
 personnel and the light cases separated from those 
 requiring evacaution to the rear. The light cases 
 will be treated by the regimental sanitary personnel 
 or if their equipment is sufficient, at the camp in- 
 firmary ; a classified sick report will be made to the 
 division surgeon and the evacuation cases taken to 
 the camp infirmary, in order that they may be col- 
 lected by the ambulance detachments assigned to this 
 
^ 108 
 
 duty. From, the brigade collecting point the evacu- 
 ation cases are taken to the field hospitals, designated 
 to receive these cases, pending evacuation or if the 
 lines of communication, sanitary transport head, 
 such as a transport column, or hospital ship, or train, 
 is sufficiently near to require no extended movement 
 by the ambulance company, which in all probability 
 has made considerable march, the disabled may be 
 delivered directly to the lines of communication; 
 such conditions are unusual, and the chief surgeon 
 will ordinarily require delivery to the field hospitals. 
 
 The Director of Field Hospitals, like the Direc- 
 tor of Ambulance Companies, will receive informa- 
 tion from the division surgeon, as to the number of 
 evacuation cases, and each of these officers will have 
 designated the units to take care of the transporta- 
 tion and shelter these cases, and they will be held 
 at the field hospitals pending arrival of the lines of 
 communication, transport column. These cases for 
 a division will amount to about 75 men, of which a 
 considerable number will be recument. The total 
 sitting for an ambulance company of 12 ambulances 
 is at most 108 ; the total recumbents 48. Ordinarily, 
 one ambulance company will be sufficient to collect 
 them, and for purposes of economy in travel, that 
 company assigned for duty with regiments on the 
 march, will usually be designated as a routine for 
 this duty, by the Director of Ambulance Companies, 
 as it has marched in with the regiments and is al- 
 ready loaded with some of the cases and will collect 
 the remainder while at the regimental camp, or at 
 the infirmary. 
 
 The capacity of the field hospital is 216 beds', it 
 will set up such bedding units, as required for the 
 disabled, using available shelter, when possible, in 
 place of tentage. 
 
109 
 
 The division surgeon will notify the lines of 
 communications of the number, and classification of 
 cases, as soon as they are reported, and give the 
 point at which they are collected. Owing to the 
 fact that lines of march may be changed, and means 
 of transportation fail, the advance surgeon will have 
 his transport column of mule ambulances or motors 
 well up to the tail of the column, in the zone of ad- 
 vance at all times, in order that field hospitals may 
 be evacuated as speedily as possible. Evacuation 
 of the disabled will be effected as rapidly as possible 
 to rail or water transportation heads, if practicable, 
 distance, weather, and road conditions, considered. 
 If evacuation can be made by rail or water, as when 
 the line of march follows or intersects such routes 
 of transportation, hospital trains or boats, will be 
 arranged for to arrive at a place and time agreed 
 upon by the division surgeon and the advance sur- 
 geon. If evacuation must be by road, such a route 
 should be selected as will be different where possible, 
 from that traversed by the ammunition and general 
 supply trains, in order to prevent interruption and 
 congestion of traffic. Rest stations must be estab- 
 lished, if the number of wounded and distance of 
 march warrant them. Evacuation by rail or water 
 will require receiving detachments at the transporta- 
 tion head, with minor fixed hospitals at the refilling 
 point, or back further on the line for arrest of the 
 cases of lesser gravity; with rest and feeding sta- 
 tions for improvised ambulance trains. 
 
 During the march in campaign, the evacuation 
 hospitals attached to the line of communications, will 
 be kept well up to the head of the line, so that they 
 may be available for rapid movement to the front. 
 These units are without specially assigned transpor- 
 
no- 
 tation and must use water or rail transportation 
 where possible. 
 
 Wagon or motor transport from the rail or 
 water head, must come from the lines of communica- 
 tion for the final movement to the relief of the evac- 
 uation hospitals. Under conditions of necessity, 
 these organizations may be used as receiving hos- 
 pitals on the lines of communications, but their 
 mobility must be impaired as little as possible, and 
 when filled, substitute organizations must be sent 
 up from the rear. 
 
 Convalescent camps, and sanitary detachments, 
 may be established in the advance medical section 
 of the lines of communications under special condi- 
 tions, but ordinarily these will be back in the inter- 
 mediate or base groups. 
 
 The service of supply of sanitary personnel 
 begins within the home territory. Drafts of sanitary 
 troops are forwarded to the base of the lines of com- 
 munications, and held in casual camps, under the 
 control of the surgeon, L of C, and under the au- 
 thority of the commanding officer, L of C, assigned 
 to duty on the L of C, for organization of new units, 
 such as fixed hospitals, rest stations, convalescent 
 camps, etc., or to the organization in the zone of the 
 advance. The relations between the sanitary service 
 of the zone of advance, with the L of C, must be 
 carefully accorded, or much difficulty will result. 
 Constant communication must exist between these 
 sections, and between the sections of the L of C, 
 themselves ; and the various officers of these sections 
 should be given wide latitude, as to arrangement of 
 the duties of their service. 
 
 The essential features of the sanitary service in 
 campaign are prevention of disease, and care, and 
 prompt graded evacuation of the disabled, in such 
 
Ill 
 
 a manner as to keep the units organized, supplied, 
 and unencumbered; so that they will be available 
 for use under stress of a large increment from epi- 
 demic or combat and, yet, move no case further to 
 the rear than his condition requires. 
 
Lecture V 
 
 SANITARY SERVICE OF THE CAMP 
 
 THE sanitary service of the camp should begin 
 with an examination of the campsite, as to po- 
 sition, drainage, soil, vegetation, shade, evidence of 
 recent occupation, medical history of the tract and 
 vicinity, and presence of objectionable insects; the 
 investigation of the source, purity, and quantity of 
 water supply, -and means of distribution food sup- 
 ply, as to quantity and quality, purity and method of 
 handling, and quantity and quality of wood and 
 straw, and location and availability ; and the location 
 of buildings, roads, and means of transportation, 
 that might be available in the care or evacuation of 
 the disabled. Such an investigation should be made 
 for every camp or bivouac by a medical officer, sent 
 ahead with the quartermaster, who will perform 
 similar duties in conjunction with the medical officer. 
 Military necessity under stress of campaign or 
 combat, may require that the various considerations 
 inquired into, be ignored in part or altogether for 
 very temporary camps or bivouacs, for large or 
 small commands, but early search for proper sites, 
 fulfilling the conditions to be discussed later, will 
 result in such material advantage to the command, in 
 the case of supply, early establishment without con- 
 fusion, comfort and preservation of good feeling and 
 health, that such action should never be omitted 
 either for march bivouacs and camps, or semi-per- 
 manent camps. 
 
 113 
 
114 
 
 The position or situation of the camp with re- 
 lation to towns, villages, rail or water transporta- 
 tion lines, and roads, must be considered from the 
 standpoint of supply, shelter, and means of transpor- 
 tation for the command and the sanitary service, 
 as well as with regard to transmission of communi- 
 cable diseases within the native population, or in the 
 command. The situation of the campsite, with re- 
 gard to protection from prevailing winds or expo- 
 sure to desirable breezes ; proximity to insect produc- 
 ing streams, swamps, or collection of decomposing 
 organic matter ; possibility of flooding in wet weath- 
 er ; or dust, or sand storms in the dry season ; pre- 
 valence of fogs, and nearness to potable water and 
 other supplies in sufficient quantity ; and accessabili- 
 ty to transportation, must be given due weight. 
 Poor drainage or a high level of ground water will 
 not only affect the comfort of the command by 
 keeping them constantly damp and possibly cold, 
 but will actually conduce to transmission of infec- 
 tions, by interfering with disposal of waste, and may 
 produce collections of water sufficient to produce 
 breeding of disease carrying insects aside from the 
 material damage done to equipment and dispositions. 
 
 Soil conditions such as presence of a high con- 
 tent or organic matter, or clay, conducing to reten- 
 tion of moisture, fine sand, to the extent of dustiness, 
 are objectionable and unhealthy and should be 
 avoided. 
 
 Rank vegetation on a campsite furnishes shelter 
 for insects, prevents drying of soil sufficient to per- 
 mit a dry camp or bivouac, collects dew and rain, 
 and in general indicates a high organic content and 
 high ground water, and should be avoided, or if time 
 permits, eliminated. Excessive shade produces the 
 same conditions that does rank vegetation and 
 
115 
 
 should be avoided. Campsites should in general, be 
 in the open, not only to give the soil the benefit of 
 the drying effects of the sun, but also that most im- 
 portant effect, disinfection. Shade is as valuable 
 and enjoyable for the soldier as for any one else and 
 shade trees in the vicinity of a camp in the summer 
 season are highly desirable, but given the choice of 
 canvas under the sun or shade, choose the sun. 
 
 Careful examination of the history of cholera 
 and typhoid in the military service has forced the 
 conclusion that commands, camping on sites former- 
 ly occupied by infected contingents, have frequently 
 derived their infection by occupation of old sites, 
 and has led to the avoidance of these, wherever 
 possible. Experience with typhoid in our own ser- 
 vice during the Spanish War, that of the English in 
 the Boer War, and that of the Germans in the Fran- 
 co-Prussian War has led to this conclusion, which 
 was confirmed by bacteriological investigation of the 
 soil and water supply. The presence of disease 
 carrying insects must be considered with the medical 
 history of the vicinity of the camp ; such history can 
 usually be elicited by questioning the people living 
 in the neighborhood, or consulting town registers, 
 or health officers, with regard to the prevalence of 
 typhoid fever, cholera, dysentery, malaria, yellow- 
 fever, dengue, typhus and cerebro-spinal meningitis. 
 
 Typhus is a disease which we need not consider 
 ordinarily in the United States but, since the con- 
 stant prevalence of an attentuated form in New 
 York has been proven by Brill and confirmed by the 
 discovery of the causative micro-organism and meth- 
 od of transmission by the body louse, this disease, 
 always present in Mexico, must be of military in- 
 terest. This particularly in view of its appearance 
 in some European Armies, under good sanitary con- 
 
116 
 
 trol, in the present war. Presence of insects, such 
 as fleas, mosquitos, ticks, and bugs, and lice, must 
 not only be considered from the standpoint of disease 
 carriers, but also from consideration of personnal 
 comfort ; for while the buffalo gnat, the black flies, 
 the Canadian flies, and the various midges, and deer 
 flies, may not be as yet implicated in the carriage of 
 diseases, their presence in considerable number not 
 only will worry a command to the point of complete 
 loss of rest, but they may materially affect the ani- 
 mal transportation. Investigation of the water sup- 
 ply will be made by gross examination, as to color, 
 odor, taste, with a survey of the source, water-shed, 
 with an inquiry as to the history and use of the 
 water and natives using it ; and, if time and appara- 
 tus be at hand, a chemical and bacteriological exam- 
 ination. The quantity must be measured, and esti- 
 mation of the amount required by the command 
 must be made- on the basis of the need, for the type, 
 and duration of the camp, and the character of 
 methods of distribution and sanitary installations. 
 The food supply will also be investigated on the same 
 basis as is that of the water, particular attention 
 being given to milk and beverages, and method of 
 handling. The quantity of the local food supply 
 will be investigated with view to procurement of 
 special diet articles for use of the sanitary estab- 
 lishments, as will also the quality, quantity, and 
 location of wood, straw, and forage items essential 
 to the comfort of the sick at all times and to the 
 whole command in inclement weather, when a time- 
 ly certificate, given by the medical officer to the 
 quartermaster, may result in the avoidance of a 
 materially increased sick report. 
 
 The investigation of means of shelter and trans- 
 portation and condition and direction of roads, may 
 
117 
 
 later have an important value in the location of sani- 
 tary units and the evacuation of the wounded ; and 
 should not be neglected by the medical officer, sent 
 in advance, as he will usually have time and oppor- 
 tunities to survey the country before it is occupied 
 by troops, and can acquire a much better idea of the 
 general conditions, than officers arriving later. 
 
 Having reported the results of his sanitary sur- 
 vey of the campsites, the sanitary inspector will 
 consult with the advance quartermaster as to distri- 
 bution of water guards and water supply or distri- 
 bution points, and location of unit camps, in order 
 to prevent contamination. In large units, ordinarily 
 a special quartermaster and sanitary officer will be 
 detailed for selection of the site, the march camp, 
 or permanent camp, and they should co-ordinate 
 their duties as much as possible on the basis of prac- 
 tical efficiency. 
 
 Sanitary Routine 
 
 Given the campsite selected, and the various in- 
 vestigations completed, the sanitary inspector re- 
 ports the results to the commanding officer, or the 
 chief surgeon, if there be one. If the camp is to be 
 a permanent one, the sanitary service concerns itself 
 with the supervision of the various sanitary estab- 
 lishments of the details of the handling and periodi- 
 cal examination of the water supply, the disposal of 
 waste water, and wastes such as human and animal 
 discharges, kitchen wastes, the examination of the 
 food supply and its preparation, the investigation 
 of the health and habits of the command; the pre- 
 vention of disease, and the care and evacuation of 
 the sick, and the organization and training of the 
 sanitary personnel. 
 
118 
 
 Orders concerning the special detail of the sani- 
 tation of the particular camp are recommended, and 
 periodical inspection is made, both by the general 
 sanitary inspector of the camp, and also by the 
 senior medical officer. Special sites for the camps 
 of divisional sanitary units are arranged for, and 
 camp hospitals are established. Camp hospitals are 
 a revived feature of our service, the particular func- 
 tion of which is to care for the temporarily or semi- 
 permanently ill, pending evacuation, in order to pre- 
 vent the field hospitals from becoming immobil- 
 ized with disabled and thus lose the freedom of 
 action necessary for training or movement with the 
 combatant organization to which attached. The 
 camp infirmary will be situated, where a camp con- 
 forms to the scheme laid down in the diagram in 
 field service regulations, in such a position as to per- 
 mit ready access from all of the regiments of the 
 brigade to which attached, and with personnel as- 
 signed by the senior medical officer of the brigade 
 from the regiments which the infirmary serves ; and 
 will be available as a collecting point for temporary 
 treatment and evacuation of the sick. During occu- 
 pation of the camp, the ambulance companies will 
 be available for the transportation of the sick from 
 the camp infirmaries to the camp hospital, and from 
 there to the evacuation transport head, if the com- 
 mand is not under campaign conditions or the dis- 
 tance too far. In such case the line of communica- 
 tions, if they exist, will be called upon to perform 
 evacuation from the camp hospital. The regimental 
 sanitary personnel will, in the permanent camp, 
 busy themselves with the physical examination of 
 the command with respect to their general physical 
 condition and freedom from disease, and fitness for 
 the field, with the examinations of recruits, the ad- 
 
119 
 
 ministration of prophylactics for prevention of infec- 
 tious diseases, and the examination and the care of 
 the sick and the sanitary inspection of the campsite, 
 and environs of the command to which attached, and 
 the instruction of the sanitary personnel in their 
 duties, and the officers of the combatant units in 
 the first aid and personal hygiene. 
 
 For purposes of instruction and duty the regi- 
 mental sanitary personnel may be divided into 
 squadron or battalion sections as outlined in pre- 
 vious lectures. With this system in use, sick call 
 will be held in each battalion by the medical officer 
 on duty with the battalion assisted by the noncom- 
 missioned officer on duty with the battalion section 
 and a memorandum sick report sent to the regi- 
 mental surgeon, together with such sick as require 
 treatment not afforded by the personal equipment. 
 The battalion sick reports will be consolidated and 
 the sick requiring special treatment or evacuation 
 will be sent to the camp infirmaries. 
 
 As a routine, ambulance detachments will visit 
 the camp infirmaries twice daily, and specially in 
 emergency, and clear them to the camp or field hos- 
 pitals. For emergency duty in treatment of the 
 sick, etc., one battalion sanitary personnel unit will 
 be detailed for duty the medical officer being re- 
 quired to act as regimental sanitary inspector for 
 the day ; to attend to emergency calls and examina- 
 tions, such as the examination of recruits, etc., the 
 enlisted personnel assisting in this work, night 
 nursing, etc., in addition to their routine. 
 
 The duty tour for the emergency squad is usu- 
 ally 24 hours, during which time they will remain 
 in the vicinity of the regimental sanitary equipment 
 and camp. The emergency officer will mark his 
 tent by a red cross guidon by day, and a green Ian- 
 
120 
 
 tern at night, so that his whereabouts may be known, 
 and will notify the emergency sergeant of his where- 
 abouts, if it is necessary that he leave the vicinity of 
 his duty and assignment. 
 
 Each medical officer will form a sanitary squad 
 of his battalion unit and will be held responsible by 
 the surgeon for the sanitary inspection and condition 
 of the area assigned to his battalion. The sanitary 
 squads will be responsible for the sterilization or 
 treatment of the water for their battalion and the 
 supervision of the details of disposal of wastes, sani- 
 tary police of the area, including drainage and oil- 
 ing of pools, policing of latrines, and abolition of 
 sanitary nuisances. 
 
 The battalion surgeon will observe the condition 
 of the battalion personnel as to health, habits, cloth- 
 ing, and food suppy, making frequent inspections 
 of meals ; w r ill be charged with the physical examina- 
 tion of the personnel under his charge and will be 
 authorized to make direct recommendations to the 
 battalion or company commanders, concerned, for 
 the betterment of sanitary conditions in accordance 
 with the policy laid down by the regimental surgeon. 
 
 The division of duty in this manner does not 
 relieve the regimental surgeon from responsibility 
 or duty in this connection, as he should make daily 
 sanitary inspections of the camp and command, but 
 permits more rapid amelioration of sanitary condi- 
 tions and gives each medical officer a definite per- 
 sonnel and unit to which he is attached. Such con- 
 tinuity of duty gives the medical officer a closer 
 knowledge of the individuals under his care and 
 supervision, and produces the best results in medical 
 and general service. 
 
 The enlisted sanitary personnel become ac- 
 quainted with the individuals of the battalion, with 
 
121 
 
 which they are on duty and are able to furnish val- 
 uable information, both to the combatant personnel 
 as to sanitary proceedings, and to the medical officer 
 as to the habits of the men as affecting their general 
 status. Sick call held in the battalion area instead 
 of at the regimental aid station, will be finished 
 without loss of time, and will generally carry less 
 malingering to escape fatigue duties ; the service is 
 brought to the men, by an officer who knows them, 
 under conditions which will exist more or less in 
 campaign for which all are being trained. 
 
 The sanitary inspections of the camps, kitchens, 
 latrines, incinerators, dumps, etc., will be made at 
 such an hour that will permit completion of the rou- 
 tine police of these installations, in order to give an 
 idea as to the character of this work ; and, in order 
 that this may be properly accomplished, the general 
 sanitary order must fix a time for the completion 
 of this police. Inspections will also be made at odd 
 times in order to gain information, as to whether 
 the maintenance of this police through the entire 
 day is satisfactory. Ordinarily the battalion sur- 
 geons will accompany the regimental surgeon on his 
 tour through their areas; and the regimental sur- 
 geon will accompany the camp sanitary inspector 
 through the regiment. At these inspections, sani- 
 tary defects will be noted, and memoranda made by 
 the interested medical officers. The medical officers 
 responsible for the areas found defective will report 
 them to the combatant officer responsible, with sug- 
 gestions as to correction, and, if thought necessary 
 to the commanding officer of the unit, either verbally 
 or in writing. Frequently camp or regimental or- 
 ders require corrections of defects reported by a san- 
 itary inspector without requiring reference to the 
 camp or regimental commander, and it is customary 
 
122 
 
 to invite attention of regimental, battalion, or com- 
 pany commander to sanitary defects that require 
 only local action, without making special report to 
 higher authority, making written note of such ac- 
 tion. Such direct methods, if carried out in proper 
 manner, prevent delays, and ordinarily accomplish 
 the results most satisfactorily. 
 
 The first sanitary inspection occurs in the fixed 
 camp in the morning usually about 9-00 o'clock, an 
 hour at which routine police of kitchens, streets, 
 latrines, picket lines, and areas, is usually completed, 
 leaving the remainder of the morning for adminis- 
 trative duties and instruction. At this time will oc- 
 cur the bi-weekly physical examination of the com- 
 mand, usually in the company streets, by the medical 
 officers combined, moving from one battalion to an- 
 other, in order to perform this duty as rapidly as 
 possible with least exposure. In camps where it 
 is difficult to secure security from observation, it is 
 well to fix a time of assembly, immediately after 
 i^veille for this purpose, at which time there is suffi- 
 cient light and freedom from visitors; but in bad 
 weather, inclined to be chilly, an hour nearer noon 
 is advisable. 
 
 The administration of prophylactics by hypo- 
 dermic injection, will usually be done in mobiliza- 
 tion camps, at camp or field hospitals, in pre- 
 paration for field service ; but exposure to special di- 
 seases may require administration in the field. This 
 will usually be done by combining all available equip- 
 ment and marching sections of the command, to the 
 camp infirmaries, or if the command be small to the 
 aid point; prophylactics for prevention of venereal 
 diseases will be available at the organization sani- 
 tary aid point. 
 
 In camps of instruction and mobilization, drill 
 
123 
 
 and instruction should be carried out thoroughly, 
 and the regimental surgeon will not only instruct the 
 sanitary troops proper in their duties in camp, 
 march, and combat, but will, if authorized, have the 
 band participate with the sanitary troops in this 
 instruction. The band is an essential aid to the 
 sanitary service in combat and must not only re- 
 ceive drill and instruction for this service, but with 
 the sanitary service, receive special physical train- 
 ing to prepare them for the severe effort which will 
 be required of them. Neither the duties of the per- 
 sonnel of the band, or of the Hospital Corps in time 
 of peace, give them the physical fitness that litter 
 carriage requires and the requirements of combat 
 will find them inefficient, unless this is done. 
 
 The entire command must be instructed in the 
 hygiene of the individual, and of the camp, march, 
 and battle, and, while the regulations require in- 
 struction by the company officers, it is thought best 
 that in preparation for campaign, this instruction 
 be given the regimental medical officers, who are 
 especially qualified in this work. The command 
 should be instructed in the construction, use and 
 police of the various devices required in the sanita- 
 tion of the permanent or the march camp, and one 
 definite system should be constructed and demon- 
 strated for each condition. At present so many 
 types of camp sanitary installations are used that 
 much confusion results. Most of these devices are 
 good, but many of the best require so much labor, 
 material, and time in their preparation, that their 
 construction and use as a means of camp sanitation 
 is inadvisable. In order to attain some idea of 
 standard measures or devices for camp sanitation, 
 these will be discussed as briefly as possible. 
 
124 
 
 Water Supply 
 
 Amount required depends upon type of camp, 
 method of distribution or supply, sanitary installa- 
 tions, and weather. Camps with piped supply to 
 company kitchens, shower baths, and water car- 
 riage sewer system in hot weather will require 25 
 gallons per diem for each man and ten gallons for 
 each animal. Bivouacs and march camps will re- 
 quire a minimum, one gallon for each man for drink- 
 ing and food, aild from five to seven gallons to each 
 animal. This where water must be carried by hand 
 for personal and kitchen use, and the animals taken 
 to it. For purposes of ablution and kitchen service, 
 this must be increased by at least three gallons per 
 man. Requirements of procurement from natural 
 .containers as streams, ponds, springs, and wells, 
 will require designation of special points for pro- 
 curement for water for drinking, cooking, and for 
 use of animals, and washing and bathing, in order 
 to prevent pollution and soiling; and guards to en- 
 force the regulations. These arrangements will be 
 made in advance as mentioned above and required 
 by Field Service Regulations, 240 ; and consideration 
 given as to the most available means of storage and 
 disinfection, if such be found necessary. 
 
 Means for storage must be taken in case of in- 
 sufficient supply early before time of expected use, 
 ordinarily improvised from materials at hand. In 
 the choice of these materials care must be taken that 
 these are sufficiently clean for the purpose, and if 
 there is any doubt of the purity of the water or 
 storage containers, measures of disinfection must 
 be arranged for. At the present date there are three 
 methods by which this may be accomplished with 
 equipment at hand or improvised in march camps 
 or bivouacs. Boiling in individual or organization 
 
125 
 
 containers, precipitation with chemicals and filtra- 
 tion with the various types of filters, or sterilization 
 by chemicals in special containers. Of these the tin 
 cup and canteen, or the company kettles serve for 
 boiling; for precipitation and filtration the Darnall 
 filter as issued is satisfactory; and for chemical 
 sterilization the Lyster water bag serves most satis- 
 factorily, on account of ease of transport and reliabi- 
 lity. The Lyster bag is now a part of the company 
 equipment. The last two methods, however, require 
 special equipment and are not always at hand. 
 Where possible the matter of water ^ sterilization 
 should be turned over to the sanitary service, in 
 order to give it responsible supervision, and can 
 ordinarily be handled by the battalion sanitary de- 
 tachment, if it is afforded transportation or aid 
 for procurement and delivery. It can be considered 
 as constantly true that water from the average 
 stream or pond in any moderately populated area 
 is infected and will require sterilization. If this is 
 so, some special sterilization apparatus will be ne- 
 cessary. Of these the most efficient, bulk, weight, 
 and delivery considered, is the bag with the chemical 
 agents. 
 
 For permanent camps the water should be de- 
 livered in such a manner that it will not require 
 treatment by the troops and, if such action is neces- 
 sary, treatment must be done at a central plant, un- 
 der proper direction and control, with the usual bac- 
 teriological checks by a laboratory designated for 
 this purpose. 
 
 Care must be taken in camps supplied by pipe 
 to prevent waste and give sufficient drainage about 
 points of delivery. It cannot be too much impressed 
 upon organization commanders that wells, as sources 
 
126 
 
 of water supply, cannot but be regarded with sus- 
 picion with regard to capacity. 
 
 Ordinarily there is at hand no method of judg- 
 ing capacity except by the testimony of inhabitants. 
 The demands of a single family or group of families 
 upon a given well is usually so small that the ordi- 
 nary well gets a reputation for inexhaustibility. 
 The first 15 minutes or half hour after the arrival 
 of a regiment, finds the water taken from the two 
 or three wells available, roily, and another quarter 
 of an hour, frequently finds them exhausted. If 
 they are not exhausted the constant demand has 
 brought in surface water, too rapidly filtered through 
 the earth to insure precipitation or nitrification, and 
 as a result we find the neighborhood privy vault, 
 cesspool, or barnyard puddle contributing its moiety 
 to the liquid. 
 
 The average regiment can wreck a pump, curb 
 and casing in half an hour, and, if method of removal 
 is not regulated and controlled, pollute the well 
 contents by drippage from dirty boots within that 
 time. The essentials for preservation of a well and 
 its equipment is a guard who will require that no 
 vessel smaller than a bucket is filled at the well and 
 that the method of removal, proceed carefully under 
 his control without wastage, and that no refilling be 
 done within forty feet of the well, and that removed 
 from trails which would lead to muddying and soil- 
 ing of the curb. 
 
 An almost indispensable equipment for the pro- 
 curement of water for a battalion or regiment in 
 campaign is a horizontal marine pump, with 50 feet 
 of three-inch suction and 25 feet of delivery hose. 
 Such an apparatus is relatively indestructible and 
 will give sufficient delivery for the command without 
 soiling of the source of supply. It can be controlled 
 
127 
 
 by one sentry, and worked by the company water 
 detail. After a command is trained to its use, no 
 sentry is required other than for general patrol of 
 the general water supply line. 
 
 Food Supply 
 
 The sanitary service will examine the food sup- 
 ply from all sources with regard to its quantity, 
 quality, source, methods of handling and prepara- 
 tion, this by inspection of the quartermaster issues, 
 method of transport to the organizations and care 
 and storage therein. Company kitchens and messes 
 will be inspected with regard to their cleanliness, 
 the method of storage and handling food, and the 
 personnel of the kitchen will be scrutinized, with 
 regard to possibility of their being carriers of in- 
 fectious diseases. 
 
 Under the stress of march conditions and the 
 necessity of local purchases the especial care in ex- 
 amining food supplies, that is used in time of peace 
 may not be used, and the supply from the quarter- 
 master must be as carefully inspected, as that offered 
 for sale from civil sources. Inspection of abattoirs, 
 storage plants, butcher shops, groceries, and dairies 
 furnishing supplies must be made and action be 
 taken to prevent entrance into camp of supplies from 
 non-inspected and unsanitary sources. The general 
 provision that articles shall not be offered for sale 
 within the camp limits except at authorized estab- 
 lishments, under military control, will materially 
 limit consumption of unsanitary foods, and, under 
 proper conditions the visiting of unsanitary estab- 
 lishments may be forbidden. With large forces the 
 use of a mobile laboratory, will materially aid the 
 work of examination of food and water supply. 
 Such organizations are a feature of the sanitary ser- 
 
128 
 
 vice of all European Armies and are authorized 
 and have been used in our own. 
 
 Disposal of Wastes 
 
 Like the water supply the methods of disposal 
 of wastes of camps are dependent upon permanency, 
 purpose, and supply of the camp, the environs, char- 
 acter of the soil, the drainage, and the appropria- 
 tion available; and the individual who adapts his 
 methods to these conflicting conditions w r ill accom- 
 plish the best results. 
 
 Permanent camps and cantonments will un- 
 doubtedly save in the long run by installing a proper 
 water carriage system, for disposal of body dis- 
 charges, and liquid wastes, but ordinarily, the ini- 
 tial expense is too great, in consideration of the 
 allotments, for this purpose. The danger of produc- 
 tion of epidemic diseases by insect carriage from 
 human discharges, as proven within the last twenty 
 years, has caused the adoption of many expedients 
 for the proper disposal of f eces, urine, and garbage ; 
 aimed at prevention of contact with or breeding of 
 flies in wastes. These vary from destruction of 
 wastes by fire to storage and disinfection. 
 
 Destruction of human wastes by fire is un- 
 doubtedly an ideal method, but it has been found ex- 
 pensive, and the various incinerators used have been 
 so bulky and heavy, that it is only adapted to fixed 
 or permanent camps and cantonments ; and there are 
 other less expensive means that have been found ef- 
 fective. The average initial cost per seat of the la- 
 trine incinerator has been some forty dollars, and, 
 while they have materially safeguarded health, these 
 devices have not been an unalloyed comfort, as any- 
 one can testify who has had his appetite materially 
 affected by fumes from the stewing contents of the 
 
129 
 
 pans carried by on an unpropitious breeze. Another 
 objection to these latrine incinerators is that in 
 ordinary camps conditions will require use of some 
 extemporized latrine, usually some type of trench, 
 and troops should be trained in their use and con- 
 struction under favorable conditions. 
 
 The large camps are ordinarily established for 
 purposes of instruction, mobilization, or concentra- 
 tion; usually with personnel that requires instruc- 
 tion in general, and they should here be shown the 
 latrine that will be used by them in campaign. For 
 camps of more than one day, a trench of sufficient 
 width (2 feet), and depth according to probable 
 duration of the camp, and length proportioned to 
 the command it is to serve, is required. Seats 
 should be in the proportions of one to each ten men 
 and length on the basis of 2i feet to each seat. 
 F.S.R. 246, provides for 6 feet as the depth for per- 
 manent camps, such depths should depend upon the 
 character of the soil formations. 
 
 Access by flies must be prevented by police with 
 earth or other suitable material, if flylight covers 
 cannot be made, and some means of support such as 
 the pole in ordinary use should be provided. It is 
 needless to say that where possible arrangements 
 should be made for seat covers. In arranging the 
 seat hole, it will be found an excellent plan to make 
 it sufficiently long from front to rear, and this can 
 be done by cutting out a notch in the front and rear 
 for the purpose of preventing contact with the seat, 
 at these points, and soiling by urine and feces. A 
 special urine trough protected from flies by use 
 of crude oil should be provided where possible. A 
 very necessary precaution to prevent flooding is the 
 construction of a ditch or dike well away from the 
 trench to prevent access by storm water. The burn- 
 
\ 
 
 130 
 
 ing of oil and straw or similar material does not ac- 
 complish disinfection to any extent, but does de- 
 stroy fly eggs laid on the surface and furnishes a 
 layer of oily ashes and soot, which cover the sur- 
 face and walls of the pit and renders it repugnant 
 to flies. A growing practice in burning out of la- 
 trines is to do this without removing the box. This 
 method prevents the constant removal of the box, 
 with necessity for closing up crevices and fills the 
 interior and all cracks with a smoky soot, that serves 
 to keep flies away. If properly handled the boxes 
 and shelter will not be burned. The only objection 
 to this method is that the seats become smoked and 
 blackened and are unsightly. 
 
 Straddle trenches of the width of a spade, the 
 length of a spade and handle, and the depth of half 
 of the length of a spade and handle are provided 
 for one night march camps, these are provided in the 
 proportion of one to ten men, and should be placed 
 parallel to each other, with long axis parallel to the 
 company street, at a considerable distance away, so 
 as to permit construction of new trenches if neces- 
 sary nearer the company in order that filled trenches 
 may not be traversed in going to new ones. The 
 earth removed should be thrown to the end nearest 
 the company, instead of on the long sides and used 
 for policing. The psychology of the use of the strad- 
 dle trench is interesting. All latrines should be 
 located and drained in such a manner as to prevent 
 pollution of the water supply. 
 
 In permanent camps urine cans should be used 
 in the company streets, between darkness and re- 
 veille, to prevent pollution of the camp ground. The 
 garbage cans used for this purpose should be re- 
 moved and emptied immediately after reveille in the 
 latrine for this purpose, and burned out and sunned. 
 
131 
 
 Lights should be kept burning in the latrines and at 
 the urine cans during darkness. 
 
 In addition to the means for disposal of human 
 discharges given, the Reed trough, with the so-called 
 odorless excavator have been used at times. These 
 have been found ditry and objectionable, besides 
 liable to disarrangement. In permanent camps with 
 high ground water, as found on the coast or in 
 river villages, difficulty will be found with trench 
 latrines ; here a dry earth system will be found the 
 least expensive in actual cost; but here as well as 
 with the Reed trough, objection on account of liabil- 
 ity of scattering removed material, can be raised. 
 
 Kitchen waste of permanent camps or semi- 
 permanent 'camps is best disposed of by incinerators, 
 preferably in the camp kitchen incinerator, which if 
 properly constructed and administered will dispose 
 of all dry and liquid garbage of the company includ- 
 ing waste proper and sweepings. The essentials of 
 this sanitary installation are simplicity of construc- 
 tion and management, with efficiency and economy 
 of fuel. Various devices, such as the beehive, the 
 Alamo, and many others have been used and all have 
 merit; but most of them require considerable time, 
 labor, and special material, and have not the almost 
 universal applicability of the simpler forms. Of 
 these, probably the simplest is a trench 5 feet long, 
 2J feet wide and one foot deep, filled with stones 
 thrown in loosely to the ground level. On the 
 long side of the trench, stone walls one foot high and 
 eighteen inches wide are placed and backed by earth, 
 such a trench will accommodate two or three sticks 
 of cord-wood and if kitchen liquids are poured over 
 the stones on the sides and ends, in small amounts, 
 from time to time, will consume these and all of the 
 relatively dry garbage of the company. The ends 
 
132 
 
 are left open for the removal of debris, draught, and 
 the placing of wood. Experiments have shown that 
 sufficient heat for evaporation from an ordinary fire 
 penetrates the stone bed, only to the distance of one 
 foot, and additional depth is not only a waste of labor 
 but objectionable in that it creates a layer of un- 
 destroyed putrescent material at the bottom of the 
 trench. The stones selected for use in these incin- 
 erators should be about 8 or 10 inches in diameter 
 and as fire resistant as possible. These incinerators 
 owing to destruction of the stone by heat and water 
 require reconstruction from time to time. For a 
 company of ordinary size, larger pit incinerators are 
 unnecessary and wasteful of fuel. The incinerator 
 trench should be diked or ditched to prevent flooding. 
 
 In addition to the ordinary garbage, tin cans 
 should be well burned out, to destroy organic matter. 
 Incinerator debris should be removed twice daily 
 and stacked for removal ; as it is innocuous, it need 
 not be covered. 
 
 Experience has shown that many difficulties of 
 administration and control cause the larger impro- 
 vised incinerators, made for use of battalions, to be 
 inefficient and uneconomical. The company incin- 
 erator has proven its worth, is subject to direct con- 
 trol and should be used as a matter of training. 
 
 Kitchen wastes are usually disposed of in march 
 camps and bivouacs, by use of kitchen sink pits, with 
 diameter and depth varied to suit the size of the 
 command and the length of use. They should be 
 policed with earth and ditched in a manner similar 
 to trench latrines. All trenches must be filled and 
 banked on breaking camp. 
 
 The disposal of manure and care of the picket 
 lines is important in view of the fact tha the most 
 common source of flies in camps are collections of 
 
133 
 
 manure: while flies will breed under favorable cir- 
 cumstances in almost any decomposing organic mat- 
 ter, which is not repulsive or poisonous to them on 
 account of the contained chemicals, their chief breed- 
 ing ground is excrement of animals and man. 
 
 Ordinary police of the camp is usually sufficient 
 to prevent, destroy, or remove ordinary collections 
 of organic matter, but the ubiquity of horse drop- 
 pings, and the urine soaked ground of the picket line, 
 afford excellent breeding places, which are promptly 
 used by flies. Under ordinary weather conditions 
 of summer, the fly matures in from ten to fourteen 
 days, and destruction of organic material must occur 
 within this lesser limit. In order to prevent in- 
 crease of flies ; action* must be taken to limit move- 
 ments of horses and mules in the vicinity of the 
 camps, to the limits of the corral, and designated 
 roads, which will be reguarly policed and require 
 special attention to the removal of all droppings in 
 and near the camp area. Action must be taken to 
 designate hitching points for animals, and forbid 
 general entrance to camp streets. The manure 
 should be gathered from the roads, picket lines, and 
 camps, and removed to a distance from the camp 
 and burned. If arrangement is made with civilians 
 to dispose of this for fertilizer, care must be taken 
 to see that it is removed at least a fly-flight from 
 camp, and preferably spread out on the ground it 
 is to cover. 
 
 Thin layers of manure will dry out sufficiently, 
 to furnish no available pabulum for larvae, and are 
 not objectionable. Horse manure, unbroken, is 
 covered by a fine pellicle of mucus, which favors re- 
 tention of moisture and development of larvae. 
 When this is broken it dries quickly and is unfavor- 
 able soil for growth of maggots. 
 
134 
 
 The soil of stalls, and of the picket lines is a 
 fruitful source of flies, however well they are swept, 
 as the maggots find a hospitable environment and 
 rich food supply in urine-soaked earth and penetrate 
 it frequently to the depth of six inches and undergo 
 transformation into the perfect fly and emerge from 
 the burrows, ready to play their distinct game of 
 pussy wants a corner, between the camp latrine and 
 the soup tureen. 
 
 Careful scraping of the picket line to the depth 
 of an inch or so, and thoroughly burning over with 
 straw and petroleum, three times a week, will de- 
 stroy eggs and immatu e larvae which will not have 
 penetrated far beneath the surface in the short 
 interval of time between burnings. It would seem 
 that consideration of the life history of the flies and 
 the probability of the short duration of march camps 
 would not require enforcement of the sanitary mea- 
 sures outlined for disposal of wastes of camps of an 
 impermanent nature. It must be remembered, how- 
 ever, that the single organization represented in this 
 camp may be followed by others and the same con- 
 siderations that caused the selection of this site may 
 cause selection by another in this vicinity ; and that 
 the command must not only take the sanitary pre- 
 cautions outlined to protect themselves now, but the 
 other organizations of the zone of the advance, those 
 of the lines of commuications, and the civil inhabi- 
 tants of the territory occupied are entitled to con- 
 sideration. These sanitary measures are not only 
 directed to prevention of production of insects, but 
 also to the prevention of carriage of disease by them. 
 
 Many insects are merely mechanical carriers 
 of disease, and a fly, in being, may dabble in the se- 
 ductive delights of typhoid, cholera or dysentery 
 stool, and furnish a company with all of the invalid- 
 
135 
 
 ism it wants ; or transfer glanders, tetanus, or what 
 not in the way of disease, from soil or sore, to the 
 healing abrasion on the back of your hand; or the 
 flooded latrine trenches may spill their uncovered 
 contents into the first available stream, and give not 
 only typhoid to the unvaccinated, but its first cousin, 
 paratyphoid, to the first uninoculated individual who 
 drinks from the brook. 
 
 Divisional Sanitary Units 
 
 The service of ambulance companies has been 
 outlined in general for the camp and march in pre- 
 vious lectures. The organizations camp together in 
 the permanent, semi-permanent, and march camps, 
 where possible, unless they are separated for some 
 special duty, when those organizations so separate, 
 as with an advance flank or rear guard, camp in 
 advance of the trains of the organization to which 
 attached. This on account of the fact that the 
 nature of this detachment ordinarily implies like- 
 lihood of hostile contact. Whatever the nature of 
 the duty, they are camped in a position to give 
 them ready access to the front and rear, in order to 
 facilitate movement on the execution of their duties, 
 usually on a crossroads giving roads that lead to 
 the various sectors of the front. These organiza- 
 tions camp in column of companies, as does artillery, 
 with a depth of 350 yards and a breadth of 100 
 yards, allowing 25 yards to a company, including in- 
 tervals. Accessibility to water is essential to these 
 organizations, owing to their considerable number of 
 animals, 78 to each company. Under march or war 
 conditions, the camp of these organizations should 
 be such as to permit their retaining their place in 
 the column, without countermarching. 
 
136 
 
 Aside from the duties of evacuation and trans- 
 portation of the sick and issue of medical supplies 
 to organizations attached to the combatant troops, 
 these units are in part charged with the procurement 
 of additional supplies from the line of communi- 
 cations and performance of guard duty for field 
 hospitals, besides performing their own camp and 
 stable guard. 
 
 Field hospitals in semi-permanent camps have 
 little to do with the care of the sick, where camp in- 
 firmaries and camp hospitals are present. Their 
 duties as outlined in- the Manual for the Medical 
 Department, are the temporary care of the disabled, 
 pending evacuation, and they are the nightly collec- 
 ting points on the march, or in temporary camps, for 
 the individual sick who are unable to continue the 
 march. 
 
 Filling them up with disabled would immobilize 
 them and prevent mobility. In any camp, no more 
 field hospital equipment is established than is neces- 
 sary for the care of the sick, and usually one field 
 hospital or part of a field hospital is detailed for this 
 duty, by roster. 
 
 In march camps in campaign, field hospitals 
 ordered to establish, usually do so, taking advantage 
 of such buildings as are available to save time and 
 labor of unpacking tentage, and accumulate, as early 
 as possible, straw bedding and special diet supplies, 
 over the emergency supplies carried in preparation 
 for the daily increment of sick. The field hospital 
 designated for this duty can be marched at the tail 
 of the column, in order to permit, early establish- 
 ment, and will ordinarily be ready for action by the 
 time the disabled are brought to them, the remaining 
 organizations camp with the sanitary train, guarded 
 by personnel from the ambulance companies. The 
 
137 
 
 field hospitals, as well as the ambulance companies, 
 carry reserve medical stores, and will from time to 
 time issue and refill from those sent up from the 
 advance depot of the Line of Communications. 
 
Lecture VI 
 
 SANITARY SERVICE IN COMBAT 
 
 Attached Sanitary Troops, Infantry, Cavalry, 
 
 Artillery, Engineers, Signal Corps 
 
 Sanitary Train 
 
 THE duties of Sanitary Troops in combat are : 
 1. Care of the wounded by application of appro- 
 priate measures for their temporary treatment. 
 
 2. The collection and evacuation of the wounded 
 with care and distribution to the various establish- 
 ments according to the gravity of their wounds and 
 probable duration of disability. 
 
 3. The separation of the disabled from the non- 
 disabled and action to return the non-disabled to 
 duty. 
 
 4. The preparation of records of dead and 
 wounded. 
 
 5. The management of the Sanitary Service and 
 the renewal of sanitary material and personnel ex- 
 pended. 
 
 6. The examination and supervision of the in- 
 terment of the dead and the sanitary policing of the 
 battlefield. 
 
 The necessity for such a service is essential to 
 preserve morale among the combatant troops and to 
 prevent depletion of the firing line by detachment 
 for care of the wounded. F. S. R. 344 forbids com- 
 batants, unless duly authorized, to take or accom- 
 pany sick or wounded to the rear, and, in the light of 
 the experiences of the Russians in Manchuria, where 
 139 
 
140 
 
 the firing lines were depleted by such action, a provi- 
 sion of this kind is necessary. Fischer quotes Von 
 Tetlau as saying: "Of the Russians, seriously 
 wounded were carried by four unwounded soldiers 
 and followed by two men as companions; each one 
 who was wounded in the leg supported by two well 
 comrades, while a third carried the arms. The com- 
 panions never were in a hurry to return to their 
 organizations." "Help should seek the wounded, 
 not the wounded help, else we open the door wide for 
 the (un) wounded to loaf around." 
 
 Attached Sanitary Troops 
 
 Our tables of organization provide four med- 
 ical officers, four noncommissioned officers and 
 twenty-nine privates of the sanitary troops for a 
 regiment of infantry. The same number with a regi- 
 ment of cavalry ; and three to four officers, three to 
 four noncommissioned officers and twenty to twenty- 
 nine privates with a regiment of artillery, when at 
 maximum strength. 
 
 The combat equipment of these organizations 
 when 'serving with a brigade or division having 
 mobile sanitary units, consits of 1 field desk, 1 
 box reserve dressings, 1 medical and surgical chest, 
 1 bucket, G. L, 1 axe, 1 tent fly, 2 lanterns, and the 
 personal equipment of the men and officers, besides 
 litters and boxes of surgical dressings carried in 
 the combat wagons. 
 
 The contents of the field desk consist of sta- 
 tionery, blank forms, and books. As it is doubt- 
 ful that all of the space will be used for these arti- 
 cles, the canny medical officer may store dry medi- 
 cines or dressings in reserve. This field desk is 
 carried on the regimental headquarters wagon. 
 The remaining articles except those of the personal 
 
141 
 
 equipment are carried on the pack mule for use 
 with the regimental aid station. 
 
 This gives with each regiment, in addition to 
 one 1st aid packet on the person of each individual, 
 an amount sufficient for first aid of a regiment act- 
 ing in conjunction with mobile sanitary units, and 
 sufficient for 20 % loss. 
 
 Should the regiment be acting independently, it 
 will have available the contents of the regimental 
 hospital equipment, which will be pushed forward 
 as a combined dressing station, field hospital. The 
 medical, surgical and sterilizer chests and food boxes 
 and cases will give much additional dressings, sup- 
 plies and restoratives, together with necessary medi- 
 cines, instruments, appliances, towels and bedding 
 for 12 patients. 
 
 Independent battalions such as Signal Corps 
 carry the aid station equipment. Cavalry and artil- 
 lery, having a smaller sanitary personnel, do not 
 have so much personal equipment and dressings, 
 but have a sufficient equipment for their necessities. 
 
 Of means for transportation of patients, the 
 regimental sanitary personnel has available litters, 
 in amount according to the organization, carried 
 by the sanitary personnel attached to each battalion 
 with the headquarters section, and one litter belong- 
 ing to each company carried in the combat wagons 
 or all carried in the combat wagons. 
 
 In the infantry, there will be eventually avail- 
 able, eight litter squads of the Medical Department 
 personnel and fourteen litter squads of the band, 
 provided the band is kept to full strength. Usually 
 this is so with an infantry regiment. The cavalry 
 will have at best, only four litter squads from the 
 Medical Department troops, and the artillery six, 
 with only 6 or 7 company litters. If the regiment is 
 
142 
 
 acting alone it will have in addition, 4 ambulances 
 and two field wagons attached to the sanitary troops. 
 The ambulances can carry four recumbents and one 
 sitting or nine sitting each, and the wagons four or 
 five moderately wounded in the usual proportions of 
 recumbents to sitting 3 to 5 ; the wheeled transpor- 
 tation can carry in an infantry regiment on the 
 sanitary, combat, and ration and baggage sections, 
 field and combat trains, 12 recumbents and 100 sit- 
 ting cases, these latter including the-able-to-walk, 
 to the field hospitals. 
 
 Field Wagons 
 
 o> 
 *-> &JO tfi 
 
 I & I -3 
 
 I I 1 - i 
 
 . W 
 
 Regiment, Infantry, 11 5 11 27 
 
 Cavalry, 8 13 16 37 
 
 Artillery, 85 carriages 3 18 plenty 
 
 As noted in the Sanitary Service of the March, 
 the position of the surgeon, the battalion sanitary 
 personnel, and the headquarters section of the san- 
 itary personnel was that which placed them in a 
 satisfactory situation with respect to the command, 
 either for the service of the march or combat. 
 
 In preparation for combat the surgeon, up with 
 the commanding officer, has already traversed the 
 ground to tohe rear of the probable position, and is 
 informed as to the terrain and, with the command- 
 ing officer will examine the terrain to the front with 
 a view of determining the probable positions of the 
 combatant troops and probable covered lines of com- 
 munications to the rear as representing the course 
 of drift of the wounded. He will be informed of the 
 
143 
 
 plans of the regimental commander and in consider- 
 ation of these plans will make recommendations as 
 to the probable site or action of the regimental aid 
 station. Such action must be dependent upon the 
 type of action to occur. If it be a planned attack, 
 the surgeon will select a tentative site for an aid 
 station and hold his equipment in readiness, pend- 
 ing the development of the action. This organiza- 
 tion will not be needed for some time and should not 
 be established until there is a definite use for it. 
 Changes of disposition may require disestablishment 
 and change of position, a thing not difficult, unob- 
 jectionable when necessary, but nevertheless unde- 
 sirable when required through the fault of too early 
 establishment. A planned defense permits early 
 establishment and notification of the command as 
 to the position of the aid station in combat orders. 
 
 Rencontre requires, for the aid station and the 
 mobile establishments, delay in establishment until 
 the positions of the troops and the conditions of the 
 action are determined. Usually demands of wound- 
 ed for establishment will not be immediate. 
 
 Delaying actions require the earliest establish- 
 ment and evacuation possible, in order to clear the 
 wounded before the retreat. Transportation, if 
 available, should be pushed up as close as practica- 
 ble. Consider using combat wagons where advance 
 guard actions follow the lines of a planned attack. 
 
 The three essentials in the treatment of the 
 wounded in modern warfare are : 
 
 1. The prompt application of a sterile antiseptic 
 dressing in such a manner as to prevent contact of 
 matter to the wound surface other than the sterilized 
 dressings and to maintain these dressings on the 
 wound to prevent this. 
 
144 
 
 2. To describe the wound and manner of dress- 
 ing on the diagnosis tag, attached to the person 
 of the wounded man in such a way that redressing 
 or interference with the first dressing will not be re- 
 quired unless the diagnosis tag justifies or requires 
 such action, or special conditions make this neces- 
 sary. 
 
 3. To evacuate and treat the sick in a manner 
 to conserve their strength to the greatest possible 
 extent, with the least movement to the rear possible 
 according to their condition. 
 
 The necessity for prompt dressing in a skillful 
 manner lies in the strong probability that nature 
 may care for a moderate amount of infective ma- 
 terial carried into the wound by the wounding agent, 
 but that it may succumb to a larger amount. The 
 sterile cotton dressings act as a filter to exclude in- 
 fectious agents and yet permit the wound to drain 
 and dry while the antiseptics with' which the dress- 
 ings are treated form an unfavorable medium for 
 the growth of noxious bacteria. 
 
 In addition to prevention of infection, proper 
 dressing diminishes loss of strength through hemor- 
 rhage, and produces mental rest. 
 
 The use of morphine on the field is a great aid 
 in securing freedom from pain and worry and de- 
 creasing hemorrhage and shock particularly when 
 it may be impossible to secure prompt evacuation. 
 The conditions of action frequently do not permit 
 evacuation from the field until cessation of firing 
 or. intervention of darkness. 
 
 Tagging is necessary: (a) To prevent inter- 
 ference with the wound when properly dressed on 
 account of the fact that clotting of blood and serum 
 in contact with the antiseptic in the dressing forms 
 an antiseptic seal over the wound, and to reopen it 
 
145 
 
 breaks this seal and exposes the injury to additional 
 chance of infection and hemorrhage and may inter- 
 fere with reparative processes already started. 
 Blood soaked dressings in themselves are not cause 
 for change of dressing, (b) To conserve time and 
 energy and facilitate transportation and record. 
 The tag bears the name, rank, organization, diag- 
 nosis, class of case, walking, sitting or recumbent, 
 non-transportable treatment, disposition. Date 
 and name of person caring for him. They will be 
 affixed to sick, wounded, and dead. The duplicate 
 retained in the book, serves as a record for casualty 
 lists, etc., and the original, as a means of identifica- 
 tion record, record of treatment, movement, etc., 
 prior to admission to the field hospital, the first or- 
 ganization of permanent regulation record, and 
 serves as a pass to the rear. By this means, control 
 of the slightly \vounded can be had and kept away 
 from a dressing station and field hospitals, and loaf- 
 ing of wounded and malingering can be to a certain 
 extent prevented. 
 
 During the Russo-Japanese War this loafing and 
 malingering among the Russian wounded, was most 
 pronounced. With the diagnosis tag properly made 
 out, receiving departments of sanitary organizations 
 may see at a glance the condition of the patient and 
 make proper disposition of him without delay and 
 danger of reexamination, and change of dressing- 
 Tags are affixed by the n. c. o. or officer of the sani- 
 tary service who comes in contact with the case, 
 where possible. 
 
 In combat of infantry the battalion sanitary 
 personnel will accompany the battalion, using their 
 personal equipment; where time permits before go- 
 ing into action, they will draw additional dressings 
 and carry them in their haversacks. As the action 
 
146 
 
 will require the medical officers to be dismounted, all 
 orderlies or substitutes will depart to the aid station 
 with medical officers' mounts and will be available 
 for dressers or messengers. 
 
 The noncommissioned officers will serve as as- 
 sistants to the medical officer and record and dress 
 cases. 
 
 The band in campaign will ordinarily carry 
 light instruments and under authority of the regi- 
 mental commander may when marching in the pre- 
 sence of the enemy habitually march with the .sani- 
 tary troops, as litter bearers, or, at the beginning 
 of an engagement, be reported to the surgeon. They 
 should have been well trained in first aid and duties 
 of litter bearers, and will be supplied with company 
 litters from the combat wagons and used by the 
 surgeon, as a bearer section, to be sent wherever 
 lies the greatest need for their services. 
 
 The sanitary troops (in extended order) will be 
 disposed of in such a manner that one private shall 
 cover the rear of each company in the best manner 
 possible, exposure and first aid considered, with or- 
 ders that they will keep good observation and con- 
 tact with the organization to which attached (and 
 if possible contact with the aid station), whatever 
 the movements of the battalion. If a company. is 
 detached, the private covering that company, must 
 continue to do so. While it is frequently impossible 
 to render first aid to all that fall it is essential that 
 sanitary personnel be in contact with all troops for 
 the sake of morale, as well as actual service. It is 
 not intended that immediate dressing or removal be 
 made in the face of a dangerous fire, because few 
 wounded need immediate attention so badly that 
 the few individuals of the sanitary service should 
 be sacrificed in the individual case, when many more 
 
147 
 
 valuable, the lesser wounded will need their service. 
 So rare is the case that needs immediate service to 
 preserve life that of 1440 casualties at Santiago, 
 none such existed. The only type of case that re- 
 quires such attention is possibly a hemorrhage from 
 a large vessel, and ordinarily, first aid, such as can 
 be given on the firing line, is of little avail in these 
 cases. Remember, a desperately w y ounded case, 
 while he should have all of the attention that can 
 be given him, requires and should have the least 
 interference and movement possible, and in view of 
 results is not as valuable an asset to an army as one 
 of lesser gravity. Under the ordinary conditions of 
 combat the sanitary troops with the firing line do not 
 and cannot keep up with the line, but keep it under 
 observation, under cover, and taking advantage of 
 cover, dress all cases and remove them to depressions 
 or behind obstacles that would give them protection 
 from fire. Here the wounded of the battalion will 
 be collected at a point \vhich affords communication 
 to the rear, permitting early evacuation by the litter 
 squads. It will be infrequent that conditions will 
 permit early collection. 
 
 The position of a battalion surgeon will ordinar- 
 ily be at the rear of the center or inner flank of the 
 battalion in order to place him on the line of drift 
 or communication to the rear, and as close up as fire 
 and terrain permit. He will notify the enlisted san- 
 itary personnel, covering the companies, of his posi- 
 tion and keep in touch with them and the battalion. 
 Should the battalion be considerably detached from 
 the site of the aid station, he will choose a collecting 
 point, permitting movement from the front and eva- 
 cuation to the rear, where he will collect the trans- 
 port cases. Slightly wounded cases will either be 
 returned to their units or tagged and ordered to pro- 
 
148 
 
 ceed through the regimental aid station to the sta- 
 tion for slightly wounded if such exists. After en- 
 gagement, he will complete the evacuation of the 
 wounded, assist in the sanitary police of the field 
 and assist in clearing the aid station. 
 
 The surgeon, as soon as the command is com- 
 mitted to a position or the number of wounded war- 
 rant such action, will, under authority of the com- 
 manding officer, choose a site for the establishment 
 of the aid station. This is usually established as 
 near to the firing line as the conditions of cover for 
 movement under fire toward the front and rear, line 
 of drift of the wounded, shelter and supply of wood 
 and water permit. Given cover accessibility, and 
 proper lines of drift of wounded, under protec- 
 tion from fire, the aid station will be pushed as far 
 forward as is possible, so long as it will not, probably, 
 be involved in the movements of the line. The con- 
 sideration of shelter, wood and water supply near at 
 hand, while desirable, is not absolutely necessary, as 
 the first requirement, if in buildinigs or structures 
 of similar nature, frequently draws hostile fire, and 
 wood and water can be brought up. Given other con- 
 siderations, the aid station should cover the center in 
 order to equalize and lessen distances. The regiment- 
 al aid station is little more than a geographical ren- 
 dezvous for wounded, where they can be collected for 
 record, dressed, possibly fed, sorted, and sent to the 
 rear or front. The knowledge of possibility of food 
 and care will bring the wounded here and permit 
 organization of the return of the fit, and direction of 
 movements of ambulants, and evacuation of trans- 
 port cases. 
 
 The commanding officer, combatant troops, of 
 the battalion and the sanitary troops with them will 
 be notified of the site of the aid station by the com- 
 
149 
 
 manding officer. The surgeon also will notify the 
 battalion surgeon of the site, the battalion surgeon 
 will notify the combatants and his personnel. Con- 
 tact will be gotten with the divisional sanitary units 
 at as early a time as possible, and the dressing sta- 
 tion detachments and chief surgeon notified of site 
 and conditions. 
 
 When necessity occurs, and not before, the 
 equipment will be brought up, the packs unloaded, 
 and the tent-fly erected, if necessary. Marks, 
 (peeled twigs, blazes or bandages on trees or posts) 
 will be set up, showing direction to aid station: 
 larger marks are only advisable where they cannot 
 be observed by the enemy, as they have usually 
 drawn fire both in the Russo-Japanese and Euro- 
 pean War. 
 
 The aid station is organized into a receiving, 
 dressing, feeding, and dispatching section. The 
 bearers of the band are used in evacuating from the 
 battalions under the band n. c. o's., and noncommis- 
 sioned officers and privates of the aid station party 
 are used for technical work. All wounded passing 
 through the aid station are recorded and those need- 
 ing it are tagged. The ambulants are directed to 
 the rear in parties, under charge of a wounded offi- 
 cer or n. c. o., the slightly wounded to the appropri- 
 ate station and those very lightly wounded, who 
 do not require movement to the rear, utilized or 
 returned to their organizations, usually escorted 
 by the band litter bearers (armed). Here, as on 
 the firing line, the least amount of surgical work 
 compatible with saving life is done. The greatest 
 attention is paid to first aid, collection, sorting, eva- 
 cuation and organization of the wounded. Advan- 
 tage will be taken of all adventitious materials or 
 aids in this work. Should movement of the com- 
 
150 
 
 mand require it, the station may be reestablished 
 where necessary, leaving the collected disabled in 
 charge of sufficient personnel to care for them until 
 taken over by the organizations at the rear. The 
 personnel with a battalion not in action, in reserve, 
 will be utilized to the utmost and all personnel 
 brought back as a reinforcement, as they clear their 
 front. The pack mule may be sent to the rear to 
 renew supplies during an action; and, after the 
 action, must take on supplies to give full comple- 
 ment, according to the supply table. 
 
 On conclusion of the engagement, or during a 
 lull in firing, or after nightfall the bulk of collection 
 and evacuation will take place. The extended range 
 and rapid fire action of modern arms will ordinarily 
 prevent succor of the wounded in the zone of fire, 
 and overshots the use of wheeled transport near the 
 rear of the firing line. Here all removals must be 
 made by hand or litter. The regimental sanitary 
 troops, with band auxiliary, will make a search of 
 their sections, collecting the wounded, and tagging 
 the dead alike. If this is at the conclusion of the 
 action, the sanitary troops will be accompanied by 
 combatant details which will take over the dead, ex- 
 amined and tagged and listed, by the sanitary per- 
 sonnel, for burial; and in cases where necessary, 
 assist the sanitary personnel in the collection of the 
 wounded. 
 
 In case the aid station has cleared in its loca- 
 tion at the rear, it will be moved up and reestab- 
 lished on the field and avoid long hauls. When the 
 wounded are collected and cleared from the aid sta- 
 tions by the bearers or transport of the ambulance 
 company, a part of the regimental personnel may 
 be withdrawn to assist at the dressing stations under 
 orders from the division surgeon. 
 
151 
 
 The final police of the regimental section of the 
 battlefield, after removal of wounded, will proceed 
 under the advice of the local medical officer in con- 
 nection with the supervision of the sanitary inspec- 
 tor of the division. 
 
 In trench warfare modern practice shows the 
 best results where, like in the planned defense, the 
 attached sanitary troops are in the trenches with the 
 combatants with the aid equipment and party in a 
 special communicating trench, in such a manner as 
 to permit access to all parts of the line. Here under 
 the protection of bomb-proofs and trenches, most 
 satisfactory work can be done and the equipment 
 can be much more elaborate and complete. Evacu- 
 ation to the rear is ordinarily made in this case un- 
 der cover of darkness. The possibility of good roads 
 under these conditions makes rapid evacuation com- 
 paratively easy and swift, and can be direct from 
 the firing line to a field, or even an evacuation hos- 
 pital, or train or boat. 
 
 Artillery aid stations and those of cavalry dis- 
 mounted, conform to the action of those of infantry, 
 except that care must be taken in the case of the 
 aid station of artillery, to establish, rather on the 
 flank and away from the reserve, as this will or- 
 dinarily be searched for in artillery combat, and the 
 wounded will be needlessly exposed. The sanitary 
 troops with a cavalry regiment will ordinarily estab- 
 lish little, and devote most of their attention to ac- 
 companying the command, leaving their wounded 
 with detached personnel to be taken over by the di- 
 visional organizations. As the many small engage- 
 ments of cavalry preceding and during general ac- 
 tion will produce many scattered casualties over 
 a wide area, and the aid party will be of little use, 
 it will usually be advisable to keep the squadron 
 
152 
 
 units to full strength. Owing to the necessity of 
 frequent changes of position and plan of action, the 
 regimental surgeon serving with the mounted organ- 
 ization as well as those on foot, will do well to have 
 a mounted agent with the regimental headquarters 
 when he is absent at the aid stations or elsewhere, 
 in order to keep informed as to the changes in situa- 
 tion. 
 
 The Ambulance Company 
 
 The personnel of the ambulance company at 
 maximum strength, consists of officers, 5; enlisted, 
 119-150; ambulances, 12. 
 
 The ambulance company for duty assignment 
 is divided into four detachments. The bearer de- 
 tachment consisting of tw y enty litter squads, the 
 dressing station party, the ambulance detachment, 
 and the wagon detachment. 
 
 The technical equipment consists of the personal 
 medical equipment, the equipment in the packs, and 
 dressing station wagon, and the food and dressing 
 boxes of the ambulances. 
 
 The total of dressings, etc., for combat care of 
 wounded will give dressings for approximately 1800 
 cases and 4000 cups or dishes of restorative stimu- 
 lating food, such as blanc mange, beef tea, soup, 
 milk punch, tea, malted milk, oatmeal, porridge or 
 gruel, and chocolate. That is sufficient for 10% of 
 casualties, not considering the dressings put on by 
 the attached units or the equipment of the other am- 
 bulance companies. 
 
 As given in former lectures the ambulance com- 
 panies are under the direct control of the Director of 
 Ambulance Companies and on release of this portion 
 of the sanitary train from the control of the com- 
 mander of trains, will be managed by him under 
 
153 
 
 orders of the chief of staff, or surgeon, during and 
 after combat. The activities of the director and 
 the ambulance companies cover the entire zone, be- 
 tween the firing line to the field hospital. Under 
 the orders or authority of the chief surgeon, he will 
 establish dressing stations, change their sites and 
 make proper arrangements for the collection and 
 transportation of the wounded. 
 
 The four detachments of the ambulance com- 
 pany have usually different sections on the field for 
 their work. The bearer detachments collect the 
 wounded from the regimental aid stations, or under 
 favorable conditions from the field, and transport 
 them to the ambulance head, if conditions of terrain 
 or action permit use of wheeled transportation in 
 advance of the site of the dressing station. The 
 dressing station party remains with the dressing 
 station at its site and is reinforced as may be neces- 
 sary from the personnel of the bearer section. 
 
 The ambulance detachment transports the 
 wounded from as far forward toward the actual 
 field, as is possible, terrain and fire considered, to 
 the dressing station or field hospital. The wagon 
 detachment detaches one wagon with the equipment 
 and supply reserve of the dressing station and sends 
 it as far forward toward the dressing station as con- 
 ditions permit. The other field wagons ordinarily 
 remain back near the divisional field trains when the 
 other detachments go forward. 
 
 The time and place of establishment of the 
 dressing station will be determined by the conditions 
 of the action and the terrain ; for a planned defense, 
 they may be established early and the sites stated in 
 the combat order; but for offensive, or rencontre 
 actions, establishment will not be done until the 
 positions of the troops, the drift of the wounded 
 
154 
 
 and the type of action determines the necessity. Too 
 early establishment will, in case of an advance, leave 
 the station without function, and require advance 
 and reestablishment, or involve it in the line of fire 
 or movement of troops, in case of rectification of 
 lines. 
 
 The regimental sanitary personnel will be able 
 to handle the situation at the front for a considera- 
 ble time and the wounded who come back early will 
 ordinarily be ambulants, who have no need of the 
 dressing station. The transport cases will hardly be 
 back to the aid station during the first hour of the 
 engagement. Should the lines advance materially, 
 it will be well to advance the station to the wounded 
 and avoid littering the patients any farther than 
 necessary. 
 
 Littering, at best, is slow and exhausting work, 
 and every effort must be made to abridge distance. 
 In the eariler part of the Russo-Japanese War, much 
 difficulty of transport arose, through the tendency 
 to too early establishment. In delaying actions with 
 a planned defense and subsequent retreats, early 
 establishment and evacuation is necessary and re- 
 inforcement of the sanitary personnel is desirable 
 and necessary, particularly with bearer and ambu- 
 lance detachments. Ordinarily the time for estab- 
 lishment will come when the advance has ceased, 
 and the regimental aid stations have more wounded 
 than they can care for. 
 
 The division surgeon will determine where and 
 how many stations will be opened and will consider 
 in this decision the field of greatest casualties and 
 probability of further action as to location and num- 
 ber establishing: he may have them establish in- 
 dividually or combine and, if not pressed, will hold 
 one or more in reserve to reinforce other stations, 
 
155 
 
 or to place in points of future casualty, when the 
 proper time arrives. 
 
 The factors to be considered in the selection of 
 a site for the dressing station, given necessity and 
 consistency as to battle plan and actions, are : 
 
 1. Location near a practicable route of evacua- 
 tion from the front to the rear, usually on some 
 well maVked line of approach. 
 
 2. Possibility of cover at site of station from 
 aimed and overshot fire. 
 
 3. Sufficient proximity to aid stations to de- 
 crease transport distance, and, yet, not to include 
 station in minor changes in lines. 
 
 4. Proximity to shelter, wood, water; buildings 
 as shelter have the disadvantage of attracting ar- 
 tillery fire and are therefore not an unmixed bless- 
 ing, and wood and water may be transported if ne- 
 cessary; but frequently the same inequality of 
 ground which affords cover and covered communica- 
 tion to the front, will give wood and water. 
 
 The necessity for the establishment, on a prac- 
 ticable route is obvious and, other things being 
 equal, should contemplate a point which will inter- 
 sect a line of probable drift of wounded, who will, if 
 fire and cover permit, usually, follow the line by 
 which they approach the field the only route known 
 to them and will ordinarily follow ravines or the 
 lower slopes of hills, in order to get advantage of the 
 cover afforded. Interception of these ambulants is 
 necessary in order to give them proper direction and 
 care, at a time when the station is relatively idle as 
 they usually precede transport cases, and can be 
 pushed back to the station for slightly wounded on 
 foot, or to the field hospital, as their condition re- 
 quires. 
 
156 
 
 Necessity requires that the dressing station be 
 as close up as possible: a distance beyond infantry 
 or artillery fire would render the establishment use- 
 less. 
 
 Examination of almost any field will show suffi- 
 cient cover to permit movement forward of the per- 
 sonnel and equipment with pack transportation, 
 which may subsenquently be sent back for supplies. 
 
 On establishment, the bearer section will be 
 sent forward to establish contact with the aid sta- 
 tions, ordinarily dividing into two sections of ten 
 litters each, with a definite sector assigned, by sub- 
 division of the ambulance company sector assigned 
 by the director. 
 
 The bearer sections will place Red Cross guidons, 
 bandages, or peeled twigs, as route markers, indi- 
 cating the direction of the dressing station, while 
 moving forward and will notify all regimental per- 
 sonnel of its location. The commanding officer will 
 report time and place of establishment to the di- 
 rector. 
 
 The dressing station will estabish the following 
 departments: Receiving, dispatching, slightly and 
 seriously wounded, dressing and dispensing, feeding 
 and morgue. All patients received will be examined, 
 listed, tagged, if necessary sorted, distributed or 
 dressed, fed and dispatched to the rear or front. 
 The slighly wounded, requiring evacuation, will be 
 arranged in squads, in charge of a wounded officer 
 or n. c. o., and, after feeding, marched to the station 
 for slightly wounded; those requiring movement to 
 the front turned over to a provost officer. 
 
 The ambulant, seriously wounded, will be sent 
 to the field hospital on foot, convoyed by ambulances 
 loaded with transport cases ; and the transport cases 
 after being grouped as sitting and recumbents, 
 loaded as such by the dispatching section. 
 
157 
 
 No operations other than those immediately ne- 
 cessary to save life will be done, such as tying or 
 clamping an artery, or opening the trachea; and 
 such operations .will be rare. Feeding will be limited 
 to stimulating and restorative food and drinks, and 
 has been found advantageous, not only from a stand- 
 point of pure medicine, but also as a means of secur- 
 ing attendance of the slightly wounded, who other- 
 wise may straggle without control. Possibility of 
 food and aid brought many to the dressing stations 
 in the Balkan and Manchurian Wars. 
 
 For purpose of bringing up reserve supplies and 
 collecting local comforts, such as straw, hay, etc., 
 the reserve wagon will be brought up if possible 
 and the ambulance detachment will establish a head 
 at, or to the front of the dressing station, where 
 roads and cover permits, in order to decrease litter 
 haulage. 
 
 Every effort should be made to prevent over- 
 crowding of dressing stations, and to facilitate eva- 
 cuation. Additional transportation, field wagons 
 and local transport, may be used. 
 
 Neither the dressing station nor the ambulance 
 detachment must be held back on account of casual 
 fire, but must advance from cover to cover until it 
 reaches a relatively protected zone. Movement in 
 column will frequently draw fire, as at 600 yards, 
 with present system of marking, an ambulance can- 
 not be differentiated from a field wagon, so that 
 movements in evacuation can be frequently best ac- 
 complished by single wagons. The capacity of a 
 dressing station in material has been given, 1500 to 
 2000 cases, the capacity of the personnel is given as 
 from 15 to 20 dressings, per surgeon, per hour, in 
 fair weather. Although the Japanese state that at 
 Mukden, two surgeons and two assistants placed 25 
 
158 
 
 to 30 dressings per hour and could have done 30 to 
 40 in the same time, in summer. Fischer quotes 
 Schaefer as saying that it was not unusual for a 
 surgeon to do 24 dressings in an hour. 
 
 With two medical officers, this would give from 
 30 to 40, per hour, a considerable number of wound- 
 ed, more than half, will be properly tagged and 
 dressed, and these will not need dressing, giving a 
 capacity of 60-80 per hour to the dressing station 
 unreinforced. If additional help is necessary in the 
 early stages of the action, it must come from the 
 medical officers of the bearer detachment, who can 
 double the capacity of the dressings ; and if more is 
 needed, such can come from the personnel of the 
 field hospitals if they do not go into action, and, after 
 the aid stations are cleared can come from them: 
 and the chief surgeon may direct such reinforce- 
 ment. 
 
 After fire has ceased and the stations cleared, 
 the bearer detachment must search for the wounded. 
 With the combatant forces in position, this cannot 
 be done until after nightfall and then under diffi- 
 culties. The Manchurian War showed that moon- 
 light permitted view of the searchers, and on dark 
 nights, artificial light drew fire. While on the west- 
 ern front in the pan European War, the close prox- 
 imity of the lines, renders this almost impossible, so 
 much so that many wounded have lain for days with- 
 out succor. Systematic search will be made where 
 possible, by assignment of sectors, and the wounded 
 will be* evacuated to the ambulances, which can 
 usually be brought up under the conditions that 
 render this collection possible. 
 
 After clearing the wounded to the field hospitals, 
 the director of ambulance companies will usually 
 receive orders to pack. If help is needed at the field 
 
159 
 
 hospitals, personnel will be assigned from the ambu- 
 lance companies for this purpose ; and the ambulance 
 companies will bivouac on the field with the com- 
 mand or camp with the field hospitals, as directed. 
 
 The work of these organizations, both for men 
 and animals is exceedingly arduous and without re- 
 gard to hours. Under conditions of combat and 
 after, little rest can be given. Great care must be 
 taken to secure the most economical use of these 
 organizations, in order to prevent exhaustion. 
 
Lecture VII 
 
 SANITARY SERVICE IN COMBAT 
 
 Station for Slightly Wounded Field Hospital Com- 
 panies, Advance Group, Line or Communications 
 The Station for Slightly Wounded 
 
 THIS is an establishment of our sanitary service 
 created as a result of experience gained in the 
 Civil War and emphasized by observations during 
 the Russo-Japanese War. It has been adopted by 
 the Austrians, British, and Germans, following our 
 example. 
 
 This station is established for the purpose of 
 diverting the ambulant slightly wounded from the 
 field hospitals, and evacuation hospitals. If they 
 have been given a definitive dressing by the regi- 
 ment personnel these wounded can be sent directly to 
 the slightly wounded station, without interfering 
 with or encumbering the service of the dressing 
 stations and field hospitals. 
 
 The cases sent to these stations are the slightly 
 wounded ambulant cases, who are capable of march- 
 ing back to the railhead or if necessary to the con- 
 valescent camps or establishments for slightly 
 wounded in the advance group of the L of C, on 
 their own feet. Such cases comprise wounds of the 
 upper extremities, superficial wounds of the trunk, 
 head, etc., which will prevent full participation in 
 active service, but will, ordinarily, be able to care for 
 themselves and result in early return to their organi- 
 zations. This class of cases would fill the space re- 
 161 
 
162 
 
 quired for care of the more seriously wounded and 
 add to the burden of the transportation, if cared for 
 by the other institutions, and straggle, and be lost 
 from control, and materially delay their recovery 
 and restitution to their organization, if turned loose 
 to make their way to the rear uncontrolled. Genu- 
 ine slightly wounded requiring control by this sta- 
 tion amount to some 12% of all casualties, and these, 
 together with a considerable number of cases of 
 wounds so slight that they should be returned to 
 their organizations, and malingerers formed the 
 contingent, who during our war of the rebellion, and 
 the Russo-Japanese War, particularly in the Russian 
 service, the bulk of the straggling wounded who 
 were annoying; as they were not only disorderly, 
 but caused material depletion of the total of rifles. 
 Such cases were seized upon by enthusiastic citizens 
 in our Civil War, and in the early days in the French 
 service of the pan-European War and taken, unre- 
 corded, to the rear in great number. They were 
 lost to the services for considerable periods of time 
 and contributed much to permanent absenteeism. 
 
 The station for slightly wounded assists much 
 in the sorting process and may catch a considerable 
 number of more serious cases, which can be detained 
 and sent with proper transportation to the field 
 hospitals. 
 
 Under proper administration of the sanitary 
 service no .wounded man should be permitted to move 
 farther to the rear than the field hospitals or aid 
 stations, when not in custody of the sanitary service ; 
 and no wounded man should be permitted to move in 
 the zone in front of the field hospitals and aid sta- 
 tion untagged or unattended. Such requirement 
 will ensure control of wounded and give the best re- 
 sults in economy of service. Malingerers and tri- 
 
163 
 
 vial cases will not find encouragement or license, 
 and will remain with their organizations. 
 
 The routine in the past for the battle maling- 
 erer has been to avoid contact with the regimental 
 sanitary personnel, by whom he is generally known, 
 by skulking, and by attaching himself to some non- 
 sanitary unit by affecting slight wounds, gain the 
 rear. The requirement of constant sorting out and 
 control will make this relatively impossible. 
 
 The personnel of the station for slightly wound- 
 ed will ordinarily consist of a medical officer, a non- 
 commissioned officer, and six or eight men of the 
 sanitary contingent and should include a squad of 
 the military police for the control of the trivially 
 wounded and malingerers, and their restitution to 
 their organizations. 
 
 The equipment of the station for slightly wound- 
 ed will ordinarily consist of dressings, medicines, 
 food, and cooking utensils, in addition to that of the 
 personnel. Shelter will not, usually, be provided, 
 but advantage will be taken of buildings near the 
 point for establishment. All that is needed at this 
 point is sufficient personnel to record, examine, re- 
 adjust dressings, and provide stimulants and re- 
 storative food, as the cases will have been dressed 
 before arrival. Some shelter should be provided 
 with straw or improvised bedding, as some cases will 
 become exhausted through shock and loss of blood 
 or serious cases may be picked up which will re- 
 quire subsequent removal. 
 
 The personnel and material will come f r om the 
 ambulance company or more commonly from the 
 field hospitals as these organizations will usually be 
 more or less idle at the time of establishment and 
 hardly greatly occupied until the necessity for the 
 unit has ceased when the equipment and personnel 
 
164 
 
 withdrawn can most readily join these organiza- 
 tions, as the distance of these organizations from 
 the front is somewhat similar. The camp infirmary 
 equipment will be available. 
 
 The site for the station for slightly wounded 
 should be well to the rear on the line of drift of 
 wounded, well out of range of direct fire, preferably 
 at a fork or convergence of roads from the flank 
 and center, near some easily recognizable object 
 which can be mentioned as a guide to its location. 
 For purpose of recognition of its position this ob- 
 ject as a church, school, monument, or natural for- 
 mation should be selected, where possible, from 
 those passed by the command on advance to the 
 front. A most satisfactory distance from the firing 
 line is one of some 2| or 3 miles, with the under- 
 standing that the slightly wounded station should 
 be in advance and well removed from the site of the 
 field hospitals in order to divert the slightly wounded 
 from them. 
 
 Owing to the fact that these stations are to be 
 established well to the rear and their ephemeral 
 nature, a site can be chosen early and their location 
 announced in the combat order. Ordinarily only 
 one S. W. Station is established for a division and 
 none for units of lesser size ; but where, natural or 
 artificial conditions render it likely that the entire 
 area cannot be drained by one such station more may 
 be established. 
 
 The station consists of a receiving and forward- 
 ing section, a dressing and feeding section. The 
 wounded are examined, listed, sorted according to 
 their condition, and tagged if necessary, and fed; 
 some dressings may need renewal and some ex- 
 hausted or hemorrhage cases may require rest or 
 
165 
 
 hospital treatment. Of course these will be de- 
 tained. 
 
 Those to be sent to the L of C will be arranged 
 in detachments of 30 or 40 and placed under charge 
 of slightly wounded officers or noncommissioned 
 officers who will be given orders, where possible, 
 with a list of men in his charge, giving the route of 
 march. This route should coincide with a line of 
 evacuation of wounded so that these detachments 
 may be convoyed or supported by wheeled convoys 
 of wounded in order to give care to the exhausted. 
 
 The C. 0. of the S. W. detachments should be 
 directed to leave any exhausted cases under shelter 
 on the route and notify the nearest sanitary echelon 
 of their condition and position. If the road be 
 long, arrangements will have been made for rest and 
 refreshment stations, which will be necessary for 
 both the S. W. and the transport cases. 
 
 Field Hospital Companies belong to the division- 
 al sanitary train. 
 
 The field hospital companies are controlled by a 
 Director of Field Hospitals whose duties correspond 
 to those of the director of ambulance companies and 
 the field hospitals, moved, established, and closed 
 by orders of the chief of staff or chief surgeon 
 usually through the director, following the methods 
 outlined for ambuance companies. 
 
 The purpose of the field hospital is to provide 
 temporary shelter and care for the seriously wound- 
 ed or sick in camp and, during and after combat, 
 pending their evacuation to the rear. Their capa- 
 city has been changed from shelter (tent) and bed- 
 ding for 108 to 216 patients, giving for a division 
 864 beds and they carry technical equipment for 
 many more patients provided shelter and bedding 
 material can be secured from local sources. 
 
166 
 
 The personnel consist of 6 medical officers, and 
 80 enlisted men. Transportation, 7 field wagons, or 
 11 trucks. 
 
 The equipment of our field hospital differs from 
 that of the European armies in the fact that it 
 provides more, tentage and bedding equipment, and 
 medical and surgical equipment. The European ar- 
 mies depending upon adventitious shelter, bedding 
 and household equipment as a whole or in part ; and 
 in that part of the functions of the field hospital are 
 covered in the dressing stations of the sanitary com- 
 pany or "ambulance" and part by the clearing or 
 evacuation hospital. 
 
 A recent reorganization of the French service 
 found neesssary during the present war, has recog- 
 nized the necessity of this organization, which they 
 only had as did the English in the shelter section 
 of the "field ambulance" by introducing a new unit 
 the surgical operating hospital, a motor transport 
 affair of one hundred bed capacity, with a special 
 motor operating room. One of these to an army 
 corps. The functions of this organization are 
 covered by the equipment of our field hospitals. Al- 
 though present practice and opinion in America and 
 abroad questions the advisability of performing any 
 but the most immediate necessary operations, at a 
 point in front of the more or less fixed hospitals; 
 because not only must there be little or no pressure 
 of wounded when these are done, but also cases of 
 this character require post operative rest, which 
 cannot be secured in a mobile unit. 
 
 The field hospital, packed, is as mobile as its 
 method of transportation, field wagons, or motor 
 trucks, permits. 
 
 Not counting the desperately wounded who can- 
 not endure extended transportation, and will conse- 
 
167 
 
 quently, not be taken to the field hospitals, unless 
 they establish on the field, the field hospitals may be 
 expected to care for about 60% of the total casual- 
 ties, a high percentage of which must be bedded 
 until evacuation: the bedding capacity of the field 
 hospitals as given above is 864 patients and capable 
 of extension, depending on local improvised shelter 
 and bedding, straw with personal blankets collected 
 on the field. 
 
 For an infantry division this will give a capa- 
 city to accommodate a total casualty of roughly 10%. 
 The average daily battle casualties as shown in the 
 Franco-Prussian War was for the Germans 4.7% 
 and in the Manchurian for the Russians 1.7% and 
 the Japanese 2%. The high losses shown in some 
 battles in Manchuria of as high as 68% for some 
 organizations were distributed over several days ; al- 
 though one division lost 30% in a single day. No 
 sanitary service can be equipped to handle such a 
 high daily loss and, in view of the average losses 
 given and possibility of reinforcement by organiza- 
 tions from divisions less hardly pressed, this capa- 
 city of 10% carries a fairly high factor of safety. 
 
 In combat, field hospitals will establish at posi- 
 tions and times selected by the division commander, 
 or surgeon, in the absence of instructions. In an 
 attack they will not be established until the advance 
 has ceased or the numbers of wounded at the dress- 
 ing stations justify such action. In a planned de- 
 fense they may be established or at least in position 
 of readiness early, to establish when required. In a 
 meeting engagement, the field hospitals will be 
 halted off the road until the course of action is de- 
 termined. 
 
 In preparation for combat the field hospitals 
 will be assembled and, when establishment is justi- 
 
168 
 
 fied, one or more will be sent forward to cover the 
 lines of evacuation from the various sectors, those 
 remaining unestablished to be held in reserve and 
 fed in either position, as a reinforcement of other 
 hospitals, or independently. 
 
 The field hospital can be established in about 
 one hour, and if clear, packed in one and one half 
 hours; and, filled with wounded, will require three 
 ambulance companies for its evacuation and a much 
 longer time to dispose of the wounded and pack. 
 Particular care must be taken to avoid establish- 
 ment too early or in an unsuitable position, because 
 for use for the day after establishment, it is prac- 
 tically immobile. 
 
 The site of establishment should be some three 
 or five miles to the rear ; protected as much as pos- 
 sible from directed artillery fire; on good roads, to 
 the front and rear; and near the probable route of 
 sanitary evacuation, which will place it away from 
 the route to the front carrying ammunition and re- 
 inforcements. An ample supply of good water is 
 necessary, and it should be located, where possible, 
 near suitable buildings; these can be utilized as 
 shelter in place of or in addition to the tentage 
 carried; in addition to shelter, the vicinity should 
 also afford household conveniences, straw and wood. 
 In selecting a location for a field hospital, while due 
 regard should be given to the proximity of perma- 
 nent objects, as a means of locating it; nevertheless 
 the buildings, or site occupied by it, should not be 
 capable of being seen from the front, owing to the 
 tendency of hostile artillery to fire on aggregations 
 of buildings, men or troops. Experience in the pan- 
 European War would lead to the assumption that 
 the Red Cross flag is not easily recognized, as such, 
 at distances given, or that its protection has been 
 
169 
 
 disregarded. When establishing with adventitious 
 shelter much of the heavy equipment of the field hos- 
 pitals, will not be unpacked, and the personnel will 
 be employed in collecting and improvising local 
 equipment and materials for hospital use. 
 
 The various routes to the field hospitals will be 
 marked by day and night, by guidons, signs, or lan- 
 terns. The same care here is not necessary, as in 
 the dressing stations to avoid attracting hostile at- 
 tention, by guide flags, as the distance is too great 
 to permit recognition of ordinary sized flags. 
 
 Given other conditions as satisfactory, the field 
 hospitals will be located so as to cover the field of 
 greatest casualty, and, should the enemy retire, they 
 will be located near the dressing stations or on the 
 field itself. Where field hospitals are ordered up to 
 replace a dressing station, they will transfer the 
 equipment, by exchange, and take over the wounded, 
 releasing this part of the ambulance company for 
 further duty elsewhere. 
 
 The positions of the field hospitals on the march 
 with a division, when hostile contact is expected, 
 lend ease to their establishment, or position in readi- 
 ness, following deployment of the division. Their 
 position at the rear of the main body, places them 
 some five miles to the rear of the head of the main 
 body, and should this deploy on a position taken up 
 by the advance guard movement forward at ordinary 
 gaits, could put the field hospitals near their pro- 
 bable position within an hour and half after the 
 order for deployment is given, rather too early for 
 a position in readiness. 
 
 In order to clear the road, however, and put 
 them near where will be their probable location, 
 plans of the division commander, roads and terrain, 
 and probable field of casualties and fire considered, 
 
170 
 
 the field hospitals will be moved forward, or as- 
 sembled at a convenient point on a probable route of 
 evacuation. 
 
 The director will inform himself of conditions 
 of shelter, supply, and communication in the rear of 
 the sector covered by the division, and, as soon as 
 he receives information as to the sites of the field 
 hospitals, will designate the organizations and ar- 
 range for use of shelter and supplies at hand. He 
 will get in touch with the Director of Ambulance 
 Companies and arrange for co-ordinating his service 
 with that of the transport. The division surgeon 
 will be notified of the time of establishment as it 
 occurs. 
 
 The field hospital will establish: A receiving 
 and forwarding, slightly wounded (sitting), a seri- 
 ously wounded (bed), an operating, dispensary, kit- 
 chen, morgue and transportation department. 
 
 The receiving and forwarding section will re- 
 cord, sort, and assign patients on receipt and dis- 
 patch through the transport section, moving the 
 received. patients to the wards and operating section, 
 according to their classification, or turn them over 
 to the transport column for evacuation. The oper- 
 ating section will, as stated before, avoid operations, 
 which can be delayed until more suitable environ- 
 ments are available, and confine itself to those im- 
 mediately necessary to save life, or to prepare pa- 
 tient for evacuation. Patients will be cleared from 
 the field hospitals established, ordinarily, by trans- 
 fer to line of communications columns, transporting 
 them to evacuation hospitals on trains or water 
 transportation or, in default of these lines of com- 
 munications, to other field hospitals at the rear, in 
 order to permit release of mobile units to join thier 
 command. Transfer of the disabled is most easily 
 
171 
 
 and satisfactorily made by bringing up evacuation 
 hospital personnel and equipment on wagons or mo- 
 tors and exchanging equipment. 
 
 Under conditions where it will be impossible to 
 evacuate all of the wounded in a field hospital (as 
 where one is detailed to care for desperately wound- 
 ed, in an advance or immobilized with wounded in 
 a retreat) , these wounded may be left with suitable 
 personnel and equipment and the remainder move 
 out with the train. 
 
 The personnel of the field hospital company will 
 ordinarily furnish the personnel for the station for 
 slightly wounded, and this will usually be desig- 
 nated by the director, from that of a field hospital 
 which will be placed nearest this organization, in 
 order to avoid unnecessary movement of transporta- 
 tion and personnel in establishing and closing. 
 Prior to the time when field hospitals establish or 
 in delaying engagements, when establishment would 
 be inadvisable, the personnel of the field hospital 
 companies may be used to advantage as bearer de- 
 tachments and reinforcements to the dressing sta- 
 tion personnel. 
 
 The entire sanitary service of the division must 
 be under the observation and control of the division 
 surgeon, either through the chief of staff, or direct. 
 The service of the regimental sanitary troops will be 
 largely independent, under the control of the regi- 
 mental commander and surgeon, as to establishment, 
 disestablishment, and interior administration, but, 
 under the regulations a surgeon may be detached for 
 duty at a dressing station and field hospitals, and 
 this will be done by the chief surgeon when neces- 
 sary, from those organizations least engaged with 
 casualties. 
 
172 
 
 The surgeon will require reports of the time 
 and site of establishment and disestablishment, 
 the number of casualties, etc., in order that he may 
 be able to direct the sanitary service economically 
 and use the regimental and divisional sanitary per- 
 sonnel in the best manner, in the service of dress- 
 ing and evacuation. 
 
 While the station of the division surgeon is 
 with the headquarters of the division, he must ex- 
 ercise general supervision over the entire field, 
 either by use of his assistant and the sanitary in- 
 spector, or by leaving one of these in charge of his 
 office, by direct examination of the conditions. The 
 duties of the surgeon lie in administration and direc- 
 tion, and he can best serve the sanitary service, by 
 exercising these functions, rather than by personal 
 care of the wounded. He will co-ordinate the work 
 of the several lines of sanitary aid, in order to pro- 
 cure rapidity and continuity of action, in care and 
 evacuation of the disabled ; and, guided by his infor- 
 mation of the plan and course of the combat, direct 
 the movement, establishment, and closure, of the or- 
 ganizations within his department. 
 
 Orders for this purpose will be issued by the 
 chief of staff upon recommendation of the division 
 surgeon or may be direct by the surgeon, when so 
 authorized by the division commander. It would 
 seem that in stress of a general action, it would be 
 necessary for orders to be issued frequently, direct 
 by the surgeon to the director of ambulance com- 
 panies and field hospitals, in order to avoid damag- 
 ing delays, and it is probable that the division com- 
 mander will issue general authority to cover such 
 action. Orders to directors and unit commanders 
 should be so worded, as to cover the general require- 
 ments, leaving, as in orders for combatant command- 
 
173 
 
 ers, arrangement of details to the officer of whom 
 the action is expected. 
 
 Orders directing establishing or requiring move- 
 ment to a position in readiness, should carry the 
 phrase "in the vicinity of" or "near a certain point," 
 in order to permit use of natural or artificial fea- 
 tures of terrain, shelter, cover, or supply. Orders 
 to directors should be sufficiently broad to permit 
 adaptation of the units on hand to the particular re- 
 quirements. 
 
 Communication and interchange of information 
 will be constantly kept up between the sanitary 
 service of the zone of advance, and the line of com- 
 munication, in order that the service of the medical 
 supply and evacuation may be most efficient. ' Ar- 
 rangement will be made for movement of supplies 
 to the railhead or distributing point and transporta- 
 tion to organization for re-equipment after combat. 
 The advance surgeon will be notified of the location 
 of field hospitals and the distribution and classifica- 
 tion of wounded or sick therein, together with con- 
 ditions of roads, etc., in order that they may be 
 taken over. On the march and in camps prepara- 
 tory to evacuation, rendezvous points for collection 
 of disabled will be arranged for between the divi- 
 sion and advance surgeons and the sanitary service 
 line of communications will be kept informed as to 
 possibility of combat, change of route, presence of 
 epidemics, etc., in order that preparation can be 
 made in advance for unusual conditions. 
 
 The police of the battlefields, as stated before 
 will be attended to by the local commander in his 
 sector. Usually the sanitary inspector will be de- 
 tailed to supervise the sanitation of the field and will 
 be given such sanitary and combatant assistance by 
 local commanders, under orders from the division 
 
174 
 
 commander, as may be necessary. Sites for inter- 
 ment or cremation of men and animals, will be 
 chosen by the sanitary inspector, with due regard 
 to character of. soil, drainage, convenience to field, 
 and unlikelihood of disturbance by flood or animals. 
 Action will be taken to procure medical officers and 
 chaplains from the troops of each locality for exam- 
 ination and record of the dead and for appropriate 
 services ; and details of a noncommissioned officer or 
 private from each company to assist in recognition, 
 in cases where the identification tag is not found; 
 and burial details for collection and transporting 
 the dead and preparing and conducting the work of 
 interment or cremation. All dead will be recorded 
 on casualty lists with organization and cause of 
 death, and separate trenches prepared for the un- 
 known and the known of our own troops, and for the 
 enemy's. Those of the same organization, will, as 
 much as possible be buried together, and those of our 
 own troops will have their tags buried with them, se- 
 cured to the neck by a copper wire of generous size. 
 The tags of the enemy, or of the cremated dead, 
 will be retained. Careful note of location and con- 
 tents of burial trenches will be made to facilitate 
 later removal and recognition. Trenches will be 
 made at least five feet deep, that is bodies should 
 be covered by four feet of earth, in order to prevent 
 escape of gases of decomposition, or exhumation by 
 flood or animals. 
 
 All spare earth should be used in mounding 
 trenches, in order to provide for sinking and to give 
 additional covering. As a matter of sentiment and 
 comfort to relatives, it is well to have chaplains of 
 several denominations hold services for the dead, so 
 that each may have the benefit of the particular 
 rites of his church. 
 
175 
 
 Given proper space and soil, burial, if properly 
 conducted, is not objectionable. Ordinarily, in dis- 
 position of the dead, the end to be secured is destruc- 
 tion of the putrescible parts of the body, in the least 
 time, without real or sentimental offense. To secure 
 the most rapid decomposition, all clothing covering, 
 or boxing of bodies, should be interdicted and the 
 mass of dead should be supported upon a course of 
 open stone or logs in the bottom of the trench, with 
 a drain for fluids leading to a lower pit. The mass 
 should be topped with a layer of straw or branches, 
 in order to prevent too close contact of the earth 
 which will prevent drainage and rapid disintegra- 
 tion, and lastly mounding with all earth removed. 
 The use of lime, or of other disinfectants on the 
 bodies, or in the grave, prevents rapid disintegra- 
 tion and defeats the purpose of interment, without 
 accomplishing anything that cannot be done by four 
 feet of earth. Properly located and drained trenches 
 will secure this and be relatively safe. 
 
 Cremation is usually impracticable on account 
 of difficulty of procuring fuel in sufficient quantities, 
 as one single body on an open pyre will require one 
 third of a cord of wood and at least five hours of 
 attention. While this is an ideal method of disposi- 
 tion of the dead, public sentiment is as yet hardly 
 sufficiently educated to make it justifiable, when in- 
 terment is practicable ; but where fuel is at hand and 
 character of soil or rock formations and lack of 
 space as within a beleaguered area does not permit 
 interment, it is demanded. 
 
 The records of the friendly dead will be data for 
 casualty reports. The tags, records, private papers, 
 and possessions of the hostile dead will be turned 
 over to the provost marshal, who will send them to 
 the War Department, for ultimate transmittal to re- 
 
176 
 
 latives or other parties in interest, in the home 
 country. 
 
 Service of the Lines of Communications 
 Before, During and After Combat 
 
 As stated in former lectures the sanitary serv- 
 ice of the lines of communications is divided ac- 
 cording to the general organization, into advance, 
 intermediate, and base groups ; each with their pro- 
 per surgeon and equipment of personnel, units, and 
 supply, with the advance and intermediate groups 
 subordinate to the commander at the base. 
 
 The functions of the surgeon of the base group 
 are practically those of a division surgeon, and he is 
 governed by similar regulations. He will have 
 charge of the direction of the transportation, care, 
 distribution, of patients, from the time that they 
 are turned over to the lines of communications until 
 their final disposition; either by transfer to the 
 service of the interior, or return to their organiza- 
 tions; and, for the purpose of caring for them, he 
 will utilize all means of transportation, hospitals, 
 and convalescent camps within his control and, un- 
 der authority of the commanding officer, lines of 
 communications, will create or establish such other 
 organizations as may be necessary. He will arrange 
 for the supply of sanitary personnel for the lines 
 of communications and to the sanitary troops of the 
 zone of advance, and in order to regulate the flow 
 of these personnel to the front, will establish casual 
 camps for these troops; will establish and control 
 depots for sanitary supplies, which will be issued 
 to the organizations on the lines of communications 
 and the zone of the advance ; and will exercise sani- 
 tary supervision and control over the area of the 
 
177 
 
 lines of communication, and the country contiguous 
 thereto. 
 
 Previous to combat, the surgeon, base group, 
 will be informed as to the probability of action and 
 will direct his subordinates to prepare all of their 
 organization for additional service. All hospitals 
 and institutions will be resupplied and cleared of 
 patients, and mobile and semi-mobile units collected 
 at convenient points in the advance or intermediate 
 groups for service. Advance depots will be supplied 
 and additional units organized as required. 
 
 On notification of imminence of action the sur- 
 geon advance groups w r ill bring his evacuation hos- 
 pitals up to the railheads, and if the probable seat 
 of action is well removed from water or railheads, 
 will provide motor or wagon transport for them, so 
 that they can be advanced as necessary. Hospital 
 trains or boats will be brought up to the transporta- 
 tion head and sections of advance supply depots 
 equipped with transportation for movement to the 
 distributing point. The evacuation ambulance com- 
 pany will be reinforced by additional wagon or 
 motor transport and advance well toward the tail of 
 the column in the zone of the advance. Sites and 
 shelter for hospitals and convalescent camps will be 
 selected and plans and equipment for improvisa- 
 tion of trains and boats for patients prepared, in ac- 
 cordance with local conditions. Details for embark- 
 ation stations will brought up and rest stations, 
 personnel, and equipment, reinforced; and all mea- 
 sures possible taken to secure rapid and efficient eva- 
 cuation, care and distribution, of the disabled. 
 
 The evacuation ambulance companies of the 
 lines of communications, are allowed normally, on 
 the basis of one to each division, and carry the same 
 personnel and equipment and transportation as do 
 
178 
 
 the ambulance companies, less the four pack mules. 
 They will be used for road evacuation of the disabled 
 from the field hospitals to the evacuation hospitals 
 or rail, or water head. Under normal conditions of 
 daily flow of disabled, and usual road distance, their 
 capacity is ample, but in preparation for combat 
 they must be largely increased as to transportation 
 and personnel, by attachment of enlisted men and 
 wheeled vehicles, with enlisted or civilian drivers. 
 
 These organizations under usual conditions of 
 weather, work, on more or less satisfactory roads, 
 can employ motor transportation with excellent re- 
 sults. On the continent, where the roads are ad- 
 mittedly better than in America, transport columns 
 are composed entirely of motor ambulances, organ- 
 ized in groups of fifty, divided into three sections. 
 The use of such means of transport has made pos- 
 sible the rapid evacuation of the enormous number 
 of wounded, which would otherwise have encum- 
 bered the mobile organizations for days. To man 
 this additional transportation, the bearer detach- 
 ment is available either as attendants or drivers. 
 Automboile transportation in this organization is 
 more economical in personnel, as the chauffeurs 
 themselves can be used as a loading detail and at- 
 tendants, as they have no teams that require watch- 
 ing when halted. The transport column, when route 
 conditions require extensive marches will establish 
 rest stations en route, for the care, feeding, and 
 treatment of the wounded en route, detaching a 
 medical officer or a detail of enlisted men and equip- 
 ment for this purpose. 
 
 The rest stations of a line of evacuation is on 
 a by-road, and will be established at points at march 
 intervals or less and will be arranged by use of 
 buildings or other shelter for feeding and dressing 
 
ordinary cases in transport and bed equipment for 
 those cases that become untransportable. Arrange- 
 ment must be made for rapid feeding at these points, 
 and measures will ordinarily be taken to apprise the 
 stations of the time of arrival of convoys of wounded. 
 Should the route of evacuation be relatively extended 
 and permanent, special parties will be sent up from 
 the sanitary reserve of the line of communications 
 to relieve the evacuation ambulance company person- 
 nel and equipment. 
 
 Transport columns and rest station parties of 
 volunteer aid societies are extensively used abroad 
 for this duty, and can be well used in our service 
 particularly as a second echelon on long routes of 
 evacuation. Where convenient, those columns and 
 rest stations in the advance section should consist 
 of the military sanitary service. 
 
 Embarkation stations are formed at the trans- 
 port head, particularly at rail and water heads, for 
 the reception, care, and loading, of the disabled; 
 delivered by transport units, pending arrival of 
 other means of transportation: these correspond in 
 organization and equipment to rest stations, but 
 must have greater bed, feeding, and shelter facili- 
 ties. They may be formed of line of communica- 
 tions reserves or from aid societies personnel, with 
 a military control. As they are relatively stationary 
 and will have advantage of good shelter and accom- 
 modations near a fixed line of transportation, they 
 can be manned by voluntary aid personnel to advan- 
 tage. Their functions and duties are obvious. 
 
 Rest stations on railway and water transport 
 lines will ordinarily not be required by hospital 
 trains, as they will be equipped with ordinary ne- 
 cessities for feeding and caring for the sick. Trains 
 and boats for paitents, however, will not be provided 
 
180 
 
 with facilities for feeding the disabled ; rest stations 
 must be equipped with material and personnel for 
 this purpose. They will be located on a siding or 
 dock, where boats or trains can be stopped con- 
 veniently, and will have meals prepared in advance, 
 through proper notification. In order to expedite 
 movement, action can be taken, as in the German 
 service, to load prepared meals and serving equip- 
 ment on trains at the rest stations. The serving 
 equipment to be brought back on the next trip. 
 
 More elaborate dressing and ward equipment 
 will be provided at these points, than is had at the 
 road stations. The personnel should consist of 2 
 medical officers, and some 15 or 20 cooks or attend- 
 ants, arranged in day and night shifts. 
 
 The evacuation hospitals are allowed two to a 
 division; personnel, 16 medical officers and 179 en- 
 listed men; equipment of two field hospitals and 
 divisible into sections. Evacuation hospitals have 
 no transportation fixed, but will require some 16 
 wagons or trucks. Held well up on the lines of com- 
 munications, they will be available for use at the 
 front as soon as the conditions of the combat are 
 determined. Their function is to provide more elab- 
 orate care for the wounded than can be given in the 
 field hospitals, and they will be used primarily to 
 clear the field hospitals, so that they can move for- 
 ward with the command. As they have no trans- 
 portation, they will, ordinarily, be kept on a water 
 or rail transport line, packed for rapid movement. 
 
 In or after combat, these organizations may be 
 established in whole or part, or by section at the 
 lines of communication transport head, or near the 
 field, or moved to the field and take over the wounded 
 and field hospitals, by exchange of equipment. In 
 the movement to the field, if no other transportation 
 
181 
 
 is available, the evacuation ambulance company may 
 be used as transportation. 
 
 The equipment of the evacuation hospitals per- 
 mits use of tentage for shelter, but wherever pos- 
 sible, buildings of the locality will be taken. Here, 
 more elaborate surgery can be done, as these hospit- 
 als may be fixed, if necessary, and reserve organiza- 
 tions sent up from the base of the general line of 
 communications. Here, the definite sorting of pa- 
 tients will be made, and distribution according to 
 probable length of disability be accomplished. The 
 slightly wounded, sent to the convalescent camps, ad- 
 vance groups; those of moderate severity to the 
 hospitals of the intermediate and base groups, in- 
 fectious cases diverted to special hospitals, and 
 the relatively permanently disabled sent to the base, 
 en route to the service of the interior. 
 
First Aid and Personal Hygiene 
 
 (Extracts from Soldier's Handbook) 
 
 AS MOST of the first-aid work in war under pres- 
 ent conditions will be done by the individual 
 soldier acting alone and not by a squad of two or 
 more men, it is important that his training should 
 be largely individual and such as will develop self- 
 reliance and resourcefulness. 
 
 The object of any teaching upon first aid, or 
 early assistance of the injured or sick, is not only 
 to enable one person to help another but in some 
 measure to help himself. The purpose of these di- 
 rections is to show how this may be done by simple 
 means and by simple methods. It is a mistake to 
 think that you must know many things to be helpful, 
 but you must understand a few things clearly in 
 order to assist the patient in the severer cases until 
 he can be seen by the surgeon or those who are 
 thoroughly trained. In ordinary cases what you can 
 do may often be all that is necessary. 
 
 These short instructions are intended for appli- 
 cation anywhere at a military post, in camp, or 
 under any circumstances of ordinary life ; but as the 
 wounds received in battle are the most important 
 to the soldier, it is the more necessary that he should 
 know what to expect there, and what to do for him- 
 self and others. Most of these wounds are made by 
 the rifle ball, fewer by shell or shrapnel, while those 
 made by the saber and bayonet come last in fre- 
 quency. 
 
 Wounds 
 
 When a ball enters or goes through the muscles 
 or soft parts of the body alone, generally nothing 
 need be done except to protect the wound or wounds 
 183 
 
184 
 
 with contents of the first-aid packet, used as fol- 
 lows: 
 
 1. If there is one wound, carefully remove the 
 paper from one of the two packages without unfold- 
 ing compress or bandage and hold by grasping the 
 outside folds between the thumb and fingers. 
 
 When ready to dress wound, open compress by 
 pulling on the two side folds of bandage, being care- 
 ful not to touch the inside of the compress with the 
 fingers or anything else. 
 
 Still holding one roll of the bandage in each 
 hand, apply the compress to the wound and wrap 
 the ends of the bandage around the limb or part 
 until near the ends, when the ends may be tied 
 together or fastened with safety pins. The second 
 compress and bandage may be applied over the first 
 or may, if the arm is wounded, be used as a sling. 
 
 2. If there are two wounds opposite each other, 
 use one compress opened out but with the folded 
 bandage on the back for one wound, and hold it 
 in place by bandage of the compress used to cover 
 the other wound. 
 
 3. If there are two wounds, not opposite each 
 other, apply a compress to each. 
 
 4. If the wound is too large to be covered by 
 the compress, find and break the stitch holding the 
 compress together, unfold it, and apply as directed 
 above. 
 
 Be careful not to touch the wound with your 
 fingers nor handle it in any way, for the dirt of 
 your hands is harmful, and you must disturb a 
 wound as little as possible. NEVER WASH THE 
 WOUND EXCEPT UNDER THE ORDERS OF A 
 MEDICAL OFFICER. 
 
 The bandaging will stop all ordinary bleeding. 
 Generally this is all that is necessary for the first 
 
185 
 
 treatment, and sometimes it is all that is needed 
 for several days. The importance of the care with 
 which this first dressing is made can not be too 
 seriously insisted upon. It is better to leave a 
 wound undressed than to dress it carelessly or 
 ignorantly, so that the dressing must soon be re- 
 moved. 
 
 Bandages and Slings 
 
 In addition to the slings made with the bandage, 
 two forms of slings furnished by the ordinary cloth- 
 ing are shown. 
 
 Bleeding from Wounds 
 
 Now and then a wound will bleed very freely, 
 because a large blood vessel has been wounded, and 
 you must know how to stop the bleeding, or hemor- 
 rhage as it is called. Remember that all wounds 
 bleed a little, but that as a rule this bleeding will 
 stop in a few minutes if the patient is quiet, and 
 that the firm pressure of the pads and bandage will 
 keep it controlled. When bleeding is severe a feel- 
 ing of faintness occurs and often the patient loses 
 consciousness. This is due to the weakening of the 
 action of the heart, so that a sufficient supply of 
 blood does not reach the brain, and the bleeding 
 usually stops when the pressure is thus diminished. 
 The patient's head should be at once laid on a level 
 with or lower than the body, and attention given 
 rather to stopping the bleeding than a reviving the 
 patient, who will usually soon recover consciousness 
 if kept quiet with the head lowered after the bleeding 
 is checked. A little stimulant, but not much, may 
 be given under these circumstances. Occasionally, 
 but not often, something else must be done. 
 
186 
 
 Looking upon the heart as a pump, you will 
 understand that to stop the current of blood pumped 
 through the arteries you must press upon the blood 
 vessel between the wound and the heart. This pres- 
 sure stops the current of blood in the same way that 
 you would stop the flow of water in a leaky rubber 
 hose or tube by pressing upon it between the leak 
 and the pump, or other source of power. The points 
 or places where you can best do this for the different 
 parts of the body are illustrated in the woodcuts. 
 These points are chosen for pressure because the 
 blood vessels which you wish to control there lie over 
 a bone against which effective pressure can be made. 
 
 Points of Compression with Thumb 
 and Fingers 
 
 The temporal artery is reached by pressure 
 in front of the ear just above where the lower jaw 
 can be felt working in its socket. A branch of this 
 artery crosses the temple on a line from the upper 
 border of the ear to above the eyebrow. 
 
 The carotid artery may be compressed by pres- 
 sing the thumb or fingers deeply into the neck in 
 front of the strongly marked muscle which reaches 
 from behind the ear to the upper part of the breast- 
 bone. 
 
 In bleeding from wounds of the shoulder or 
 armpit the subclavian artery may be reached by 
 pressing the thumb deeply into the hollow behind 
 the middle of the collar bone. 
 
 In bleeding from any part of the arm or hand 
 the brachial artery should be pressed outwards 
 against the bone just behind the inner border of 
 the larger muscle of the arm. 
 
 In bleeding from the thigh, leg, or foot, press 
 backward with the thumbs on the femoral artery 
 
187 
 
 at the middle of the fold of the groin where the 
 artery passes over the bone and can be felt beating. 
 
 There are two other simple means for helping 
 to stop bleeding such as elevating or holding an 
 arm or leg upright when those parts are wounded, 
 and by applying cold to the wound ; but you will find 
 the compress and bandage, or the pressure made by 
 your fingers, as described to be most useful in the 
 great majority of cases. 
 
 When, however, the bleeding continues after 
 you have used these simpler means, which they may 
 do after 10 or 15 minutes, you will have to use what 
 is called a "tourniquet," and generally will be obliged 
 to improvise one out of material at hand.. The 
 principle of such a tourniquet is easily understood 
 a pad or compress placed on the line of the artery 
 and a strap or band to go over the pad and around 
 the limb so that, when tightened, it will press 
 the pad down upon the artery and interrupt the 
 flow of the blood. In the arm apply the tourniquet 
 over the point shown for compression by the fingers ; 
 in the thigh, 4 or 5 inches below the groin, as it 
 can not be applied higher up. 
 
 The pad or compress may be made of such an 
 object as a cork, or smooth round stone wrapped 
 in some material, to make it less rough ; the bandage 
 folded, a handkerchief or a cravat being used for 
 the strap. After tying the band closely around the 
 limb any degree of pressure may be made by pas- 
 sing under it a stick, bayonet, or something of 
 that kind, and twisting or turning it around so that 
 the pad is pressed firmly in place. Turn the stick 
 slowly and stop at once when the blood ceases to 
 flow, fixing and stick in place with another bandage. 
 Remember that you may do harm in two ways in 
 using this rough tourniquet. First by bruising the 
 
188 
 
 flesh and muscles if you use too much force, and, 
 second, by keeping this pressure up too long and thus 
 strangling the limb. It is a good rule to relax or 
 ease up on this or any other tourniquet at the 
 end of an hour, and allow it to remain loose but in 
 place, if no bleeding appears. By watching you can 
 tighten the tourniquet at any time if necessary. 
 
 Fractures 
 
 The next injury you must know how to help is a 
 broken bone. The lower extremeties, thigh and leg, 
 are more frequently wounded than the upper arm 
 and forearm ; and so you will find more fractures of 
 the thigh and leg bones than of the arm and forearm. 
 You will usually know when one of these long bones 
 is broken by the way the arm ,or leg is held, for 
 the wounded man loses power of control over the 
 limb, and it is no longer firm and straight. What 
 you must do is much the same in all cases straight- 
 en the limb gently, pulling upon the end of it firmly, 
 and quietly, when this is necessary, and fix or re- 
 tain it in position by such splints or other material 
 as you may have. This is called "setting" the bone. 
 If you have none of the splint material supplied, 
 many common materials will do for immediate and 
 temporary use a shingle or piece of board, a car- 
 bine boot, a scabbard, a tin gutter or rain spout cut 
 and fitted to the limb, a bunch of twigs, etc. What- 
 ever material you chose must be well padded upon 
 the side next to the limb, and afterwards secured 
 or bound firmly in place, care being taken never to 
 place the bandage over the fracture, but always 
 above and below. 
 
 Fracture of the arm : Apply two splints, one in 
 front, the other behind, if the lower part of the 
 bone is broken; or to the inner and outer sides if 
 
189 
 
 the fracture is in the middle or upper part ; support 
 by sling. The inner splint should be short, not more 
 than 7 or 8 inches long. 
 
 Fracture of the forearm: Place the forearm 
 across the breast, thumb up, and apply a splint to 
 the outer surface extending to the wrist, and to the 
 inner surface extending to the tips of the fingers; 
 support by sling. 
 
 Fracture of the thigh: Apply a long splint, 
 reaching from the armpit to beyond the foot on the 
 outside, and a short splint on the inside. The mili- 
 tary rifle may be used as an outside splint, but its 
 application needs care. A blanket rolled into two 
 rolls, forming a trough for the limb, is useful. 
 
 The carbine boot may be used to advantage in 
 splinting fracture of the thigh and leg. 
 
 Fracture of the leg : Apply two splints, one on 
 the outside, the other on the inside of the limb. 
 When nothing better can be had, support may be 
 given by a roll of clothing and two sticks. 
 
 Many surgeons think that the method of fixing 
 the wounded leg to its fellow, and of binding the 
 arm of the body, is the best plan for the field, 
 as the quickest and as serving the immediate pur- 
 pose. 
 
 The object of all this is to prevent, as far as 
 possible, any motion of the broken bone, and so 
 limit the injury to the neighboring muscles, and to 
 lessen the pain. 
 
 Be very careful always to handle a broken limb 
 gently. Do not turn or twist it more than is neces- 
 sary to get it straight, but secure it quickly and 
 firmly in one of the ways shown, and so make the 
 patient comfortable for carriage to the dressing 
 station or hospital. Time is not to be wasted in 
 complicated dressings. 
 
190 
 
 Other Wounds 
 
 There are, of course, many wounds of the head, 
 face, and of the body, but for the most part you 
 will have little to do with these except to protect 
 the wound itself with the contents of the first-aid 
 packet, or, if bleeding makes it necessary, use in 
 addition several of the packet compresses to control 
 it. As the surface blood vessels of the head and 
 face lie over the bones and close to them, it will 
 generally not be difficult to stop the bleeding by 
 this means or by the pressure with the fingers, as 
 already shown. Remember, as you were told, to 
 make the pressure between the heart and the bleed- 
 ing point when the blood flows in jets or pulsations, 
 showing that an artery is cut. When, however, the 
 blood flows in a steady stream and is somewhat dark 
 in color the wound is from a vein, and pressure 
 should be made by a fairly tight dressing and band- 
 age over the bleeding point, reenforced, if neces- 
 sary, by pressure with the fingers over the band- 
 age until the bleeding ceases. 
 
 With wounds about the body, the chest, and the 
 abdomen you must not meddle, except to protect 
 them, when possible without much handling, with 
 the materials of the packet. 
 
 Cautions 
 
 You have already been warned to be gentle in 
 the treatment of the wounded, and the necessity 
 for not touching the wound must always be in your 
 mind; but there are some other general directions 
 which you will do well to remember. 
 
 1. Act quickly, but quietly. 
 
 2. Make the patient sit down or lie down. 
 
 3. See an injury clearly before treating it. 
 
191 
 
 4. Do not remove more clothing than is neces- 
 sary to examine the injury, and keep the patient 
 warm with covering if needed. Always rip, or, if 
 you can not rip, cut the clothing from the injured 
 part, and pull nothing off. 
 
 5. Give alcoholic stimulants cautiously and slow- 
 ly, and only when necessary. Hot drinks will often 
 suffice when obtainable. 
 
 6. Keep from the patient all persons not ac- 
 tally needed to help him. 
 
 The Diagnosis Tag 
 
 The diagnosis tag is very important in prevent- 
 ing unnecessary handling of the wounded man and 
 interference with his dressing on the field. When 
 available, it is to be attached by the person who 
 applies the first dressing and is not to be removed 
 until the patient reaches the field hospital. When a 
 patient has a tag on, it is to be carefully read before 
 additional treatment is given, and will usually indi- 
 cate that no further treatment is needed before 
 reaching the hospital. 
 
 . Other Accidents and Injuries 
 
 There are a few other conditions about which 
 you should be informed, although they are not 
 peculiar to military life, the first two only being 
 related to wounds. 
 
 Poisoned Wounds 
 
 When a wound is known to be poisoned, such 
 as one infected by the venom of a snake or a rabid 
 animal, the treatment should be directed toward 
 preventing the passage of the poison into the cir- 
 culation. In snake bites the poison acts quickly; 
 
192 
 
 to prevent its absorption a bandage should be car- 
 ried around the limb between the wound and the 
 heart, tight enough to compress the veins; then 
 get the poison out of the wound by laying it open 
 and sucking the poison out (if there is no crack 
 in the mouth or ips) and destroying what is left by 
 cauterization with fire or caustic. Stimulants may 
 be freely given if the heart is weak. Care should 
 be taken, however, not to poison the patient with 
 overdoses of whisky or other stimulant, as has 
 been frequently done, especially in the case of chil- 
 dren. Do not give over half a pint of whisky to a 
 grown person inside of four hours, and proportion- 
 ately less for children, divided into four doses. 
 
 In the bite of a rabid animal the poison is for 
 a long time localized in the wound and there is no 
 danger of immediate absorption. Do not use a 
 tourniquet, but use the other local measures advised 
 for snake bite. 
 
 Shock 
 
 By this term is meant a very severe physical and 
 mental depression following extensive wounds, such 
 as those produced by shell, and ordinary wounds 
 in which the chest and abdomen are entered. You 
 can hardly mistake this condition, for it resembles 
 approaching death. If possible, the patient should 
 not be moved, but kept still, lying down with the 
 head low, warmed, and carefully stimulated. This 
 will be difficult, perhaps impossible, on the battle 
 field, but it should be attemped unless removal is 
 unavoidable. 
 
 Fainting 
 
 This condition is generally the result of severe 
 bleeding, or exhaustion from fatigue. The patient 
 
193 
 
 should be laid upon his back, head lowered, arms by 
 the side, feet extended, and should be carefully 
 stimulated.. This condition is rarely dangerous. 
 
 Poisoning 
 
 Poisoning by way of the stomach may result 
 from swallowing mineral or vegetable poisons. In 
 the military service it often follows the taking of 
 food which has undergone changes resulting in the 
 production of poisons ptomaines, etc. 
 
 Whenever there is no evidence of caustic action, 
 such as burns on the mouth, an effort should be made 
 to empty the stomach and bowels by the free use 
 of emetics and laxatives, such as mustard and warm 
 water, two teaspoonf uls ; a tablespoonful of salt in 
 a glass of warm water; epsom or rochelle salts; 
 castor oil, etc. After the poison has been evacuated, 
 give stimulants and apply heat and rubbing extern- 
 ally. 
 
 When the lips are burned, give no emetic ; give 
 olive oil, cottonseed oil, or castor oil, internally, and 
 also the proper antidote if you know it. 
 
 Drowning 
 
 Being under water for four or five minutes is 
 generally fatal, but an effort to revive the apparent- 
 ly drowned should always be made unless it is 
 known that the body has been under water for a very 
 long time. The attempt to revive the patient should 
 not be delayed for the purpose of removing his 
 clothes or placing him in the ambulance. Begin the 
 procedure as soon as he is out of the water, on the 
 shore or in the boat. The first and most important 
 thing is to start artificial respiration without delay. 
 
 The Schaef er method is preferred because it can 
 be carried out by one person without assistance, and 
 
194 
 
 because its procedure is not exhausting to the opera- 
 tor, thus permitting him, if required, to continue it 
 for one or two hours. Where it is known that a 
 person has been under water for but a few minutes, 
 continue the artificial respiration for at least* one 
 and a half to two hours before considering the case 
 hopeless. Once the patient has begun to breathe, 
 watch carefully to see that he does not stop again. 
 Should the breathing be very faint, or should he 
 stop breathing, assist him again with artificial res- 
 piration. After he starts breathing do not lift him, 
 nor permit him to stand until the breathing has be- 
 come ftill and regular. 
 
 As soon as the patient is removed from the 
 water, turn him face to the ground, clasp your 
 hands under his waist and raise the body so any 
 water may drain out of the air passages while the 
 head remains low. 
 
 Schaefer Method 
 
 The patient is laid on his stomach, arms ex- 
 tended from his body beyond his head, face turned 
 to one side so that the mouth and nose do not touch 
 the ground. This position causes the 'tongue to fall 
 f orw r ard of its own weight and so prevents its falling 
 back into the air passages. Turning the head to 
 one side prevents the face coming into contact with 
 mud or water during the operation. This position 
 also facilitates the removal from the mouth of for- 
 eign bodies such as tobacco, chewing gum, false 
 teeth, etc., and favors the expulsion of mucus, blood, 
 vomitus, serum, or any liquid that may be in the 
 aid passages. 
 
 The operator kneels, straddles one or both of 
 the patient's thighs, and faces his head. Locating 
 the lowest rib, the operator, with his thumbs near- 
 
195 
 
 ly parallel to his fingers, places his spread hands so 
 that the little finger curls over the twelfth rib. If 
 the hands are on the pelvic bones the object of the 
 work is defeated ; hence the bones of the pelvis are 
 first located in order to avoid them. The hand must 
 be free from the pelvis and resting on the lowest rib. 
 By operating on the bare back it is easier to locate 
 the lower ribs and avoid the pelvis. The nearer 
 the ends of the ribs the hands are placed without 
 sliding off, the better. The hands are thus removed 
 from the spine, the fingers being nearly out of sight. 
 
 The fingers help some, but the chief pressure 
 is exerted by the heels (thenar and hypothenar em- 
 inences) of the hands, with the weight coming 
 from the shoulders. It is a waste of energy to bend 
 the arms at the elbows and shove in from the sides, 
 because the muscles of the back are stronger than 
 the muscles of the arms. 
 
 The operator's arms are held straight, and his 
 weight is brought from his shoulders by bringing 
 his body and shoulders forward. This weight is 
 gradually increased until at the end of the three 
 seconds of vertical pressure upon the lower ribs 
 of the patient the force is felt to be heavy enough 
 to compress the parts ; then the weight is suddenly 
 removed; if there is danger of not returning the 
 hands to the right position again they can remain 
 lightly in place, but it is us.ually better to remove 
 the hands entirely. If the operator is light, and the 
 patient an over-weight adult, he can utilize over 80 
 per cent of his weight by raising his knees from the 
 ground, and supporting himself entirely on his toes 
 and the heels of his hands, the latter properly placed 
 on the ends of the floating ribs of the patient In 
 this manner he can work as effectively as a heavy 
 man. 
 
196 
 
 A light feather, or a piece of absorbent cotton 
 drawn out thin and held near the nose by some one, 
 will indicate by its movements whether or not there 
 is a current of air going and coming with each forced 
 expiration and spontaneous inspiration. 
 
 The natural rate of breathing is 12 to 15 times 
 per minute. The rate of operation should not exceed 
 this ; the lungs must be thoroughly emptied by three 
 seconds of pressure, then refilling takes care of 
 itself. Pressure and release of pressure, one com- 
 plete respiration, occupies about five seconds. If 
 the operator is alone he can be guided in each act 
 by his own deep, regular respiration, or by counting, 
 or by his watch lying by his side. If comrades are 
 present, he can be advised by them. 
 
 The duration of the efforts at artificial respira- 
 tion should ordinarily exceed an hour; indefintely 
 longer if there are any evidences of returning ani- 
 mation, by way of breathing, speaking, or move- 
 ments. There are liable to be evidences of life within 
 25 minutes in patients who will recover from electric 
 shock, but where there is doubt, the patient should 
 have the benefit of the doubt. In drowning, especial- 
 ly, recoveries are on record after two hours or more 
 of unconsciousness ; hence, the Schaef er method, be- 
 ing easy of operation, is more likely to be persisted 
 in. 
 
 Aromatic spirits of ammonia may be poured on 
 a handkerchief and held continuously within 3 inches 
 of the face and nose ; if other ammonia preparations 
 are used, they should be diluted or held farther away. 
 Try it on your own nose first. 
 
 When the operator is a heavy man it is neces- 
 sary to caution him not to bring force too violently 
 upon the ribs, as one of them might be broken. 
 
197 
 
 Do not attempt to give liquids of any kind to 
 the patient while unconscious. Apply warm blankets 
 and hot water bottles as soon as they can be obtained. 
 
 The Schaefer method of artificial respiration is 
 also applicable in cases of electric shock, asphyxia- 
 tion by gas, and of failure or respiration following 
 concussion of the brain. 
 
 First-Aid Rules 
 
 1. Never touch a wound with anything unclean 
 dirty fingers, nondisinfected bandages, dirty 
 water, etc.; it may cause inflammation, ulceration, 
 or blood poisoning. 
 
 2. Expose the wound by removing the covering 
 article of dress, which contains many impurities. Un- 
 button or cut clothes and examine extent of bleeding. 
 Open all articles of clothing which might hinder 
 circulation of blood or breathing (collar, necktie, 
 belt) . To avoid pain and bleeding, raise legs by put- 
 ting under them a blanket roll, saddle, truss of 
 straw, etc.; slight bleeding will often cease in this 
 position of its own accord, without bandaging. A 
 bandage is advisable to protect the wound from dirt, 
 flies, or cold. Use the first-aid packet. (Coats, 
 pouches, haversacks, etc., may be used as pillows. 
 
 3. If the wound does not bleed at all or only 
 a few drops at a time, no constriction or pressure 
 is necessary. 
 
 4. If the blood is spurting in a strong stream 
 from a wound, you must use measures to stop it. 
 
 5. Whoever is able to walk after being wounded 
 must repair at once to the dressing station. Those 
 who can not walk must be carried by stretcher bear- 
 ers and must await their arrival by lying down as 
 quietly and as comfortably as possible in order to 
 avoid pain, bleeding, and aggravation of the wound. 
 
198 
 Sunstroke 
 
 Sunstroke or heat stroke occurs in persons ex- 
 posed to high temperature either in or out of the 
 sun. The face is flushed, skin hot and dry, breathing 
 labored, pulse rapid, heat of body great. The patient 
 may be unconscious. Place him in the shade, remove 
 outer clothing, wet the undershirt, and try to lessen 
 heat of body by cold applications to the head and 
 surface generally. Give water to patient to drink 
 as soon as he is able to swallow. 
 
 The heat may also cause, especially when soldier 
 is much fatigued, a form of exhaustion without in- 
 sensibility. Rest on the back in the shade with cold 
 applications to the head and a little aromatic spirits 
 of ammonia are usually sufficient to relieve. 
 
 In rare cases this exhaustion may go on to 
 threatened collapse, with cold skin and extremities, 
 pale face, and very weak pulse. Here alcoholic stim- 
 ulants and heat to the body become necessary. 
 
 It is well to be warned that both sunstroke and 
 heat exhaustion are common and severe among 
 drinkers and the intemperate. 
 
 Burns 
 
 Do not pull the clothing from the burnt part, 
 but rip or cut it off. Do not break the blisters, or 
 prick them even if large. Protect a burn quickly 
 with a mixture of equal parts of linseed or olive oil 
 and limewater, if you have them ; or with the plain 
 oil, covering the whole with lint or cotton wool. Put 
 nothing on a burn that will be difficult to remove 
 afterwards. 
 
 Freezing and Frostbite 
 
 The part frozen, which looks white, or bluish 
 white, and is cold, should be very slowly raised in 
 
199 
 
 temperature by brisk but careful rubbing, in a 
 cool place and never near a fire. Stimulants are to 
 be given cautiously when the patient can swallow, 
 and followed by small amounts of warm liquid nour- 
 ishment. The object is to restore the circulation 
 of the blood and the natural warmth gradually and 
 not violently. Care and patience are necessary to 
 do this. 
 
 Transportation 
 
 The carriage of patients, for moderate distances 
 on or from the field, is best done with the service 
 litter, and when that can not be procured, by some 
 improvised substitute which secures the comfort and 
 safety of the person disabled. These methods, and 
 those by one or more bearers, are fully described 
 in the Drill Regulations for the Hospitals Corps, and 
 are not repeated here. 
 
 It will generally be found necessary during or 
 after an action to restrict the number of bearers to 
 two, and attention to methods requiring not more 
 than two bearers is recommended. 
 
 Take care of Your Health 
 
 1. In times of peace and freedom from deadly 
 infectious diseases about 4 men out of every regi- 
 ment of 1,000 men die of disease in a year. In time 
 of war this number is greatly increased on account 
 of unavoidable exposures and privations. A little 
 knowledge and a little care on the part of each 
 soldier will often prevent him from becoming sick, 
 and will increase the efficiency of the command to 
 which he belongs. Knowledge alone is of no use 
 unless care is taken to apply it practically. 
 
200 
 
 2. A soldier should care for his teeth because 
 their damage or loss will result in improper chewing 
 of food and thus in various diseases of the digestive 
 system. Decay, which is the commonest disease of 
 the teeth, is caused by allowing particles of food 
 to remain on and between them. These should be 
 removed by thorough brushing. It is well to use 
 a good tooth powder once or twice daily, In order 
 that decay of the teeth may be detected before 
 serious damage has occurred, a dental surgeon 
 should be consulted at frequent intervals. Toothache 
 indicates that the deeper parts of the teeth have 
 become diseased and a soldier should not, therefore, 
 wait until the teeth ache to consult a dentist, as by 
 that time destruction may be so great as to much 
 increase the severity of the dental operations needed 
 or even to make impossible any effective repair. 
 
 3. A soldier should endeavor to be always at 
 his best. He should avoid all exposures, not in line 
 of duty, which he knows would be likely to injure 
 his health, for if he is from any cause below par 
 he is liable to break down under influences which 
 otherwise might have had but little effect on him. 
 
 4. Even in garrison, in time of peace, soldiers 
 often expose themselves unnecessarily by going out 
 without overcoats when the weather is such as to 
 require their use, or by failing to remove damp socks 
 or other clothing on their return to barracks. 
 
 5. Before starting on a campaign the soldier 
 should provide himself with the necessaries for per- 
 sonal cleanliness and for keeping his clothing in 
 repair; towel, soap, toothbrush, a few strong safety 
 pins, and spare buttons. His shoes and socks should 
 be carefully selected to fit, and it is well to have 
 shoes broken in by a few days' usage before starting. 
 
 6. At rests on the march he should sit down or 
 
201 
 
 lie down if the ground is suitable, for every minute 
 so spent refreshes more than five minutes standing 
 or loitering about. 
 
 7. At the midday rest lunch should be eaten, 
 but it should always be a light meal. 
 
 8. On the march or during exercise in hot 
 weather the body loses water continuously by the 
 skin and lungs, and this loss must be replaced as it 
 occurs to keep the blood in proper condition. Free 
 evaporation of water from the skin is necessary to 
 keep the body at its natural temperature and prevent 
 heat prostration. Therefore, not only must water 
 be supplied as needed, but the clothing should be 
 open, when permitted, to assist the evaporation. 
 Only a few* swallows should be taken at a time, no 
 matter how plentiful the water supply may be. When 
 exceeding thirsty, after a long stretch, water should 
 not be taken freely at once but in smaller drinks at 
 intervals, until the desire for more is removed. Very 
 little water should be taken during the first two 
 hours of the march, but after the seventh mile in 
 hot, oppressive weather a canteenful will be needed 
 for each 6 or 7 miles march. If the soldier starts 
 with a full canteen it should last him, therefore, 
 for an ordinary march of 14 miles. 
 
 9. Smoking in the heat of the day or on the 
 march is depressing and increases thirst. 
 
 10. On hot marches water should be taken quite 
 frequently, but, as already stated, in small quantities 
 at a time, to replace the loss by perspiration. This 
 will often prevent attacks of heat exhaustion and 
 sunstroke. 
 
 11. On a hurried or forced march, particularly 
 in sultry weather, a soldier may become faint and 
 giddy from the heat and fatigue. His face becomes 
 pale, his lips lead-colored, his skin covered with 
 
202 
 
 clammy perspiration, and he trembles all over. His 
 arms and equipments should be removed and his 
 clothing opened at the neck, while he is helped to 
 the nearest shade to lie down, with his head low, 
 until the ambulance train or wagons come up. Mean- 
 while, fan him, moisten his forehead and face with 
 water, and, if conscious, make him swallow a few 
 sips from time to time. 
 
 12. In sunstroke the man is unconscious and 
 often has convulsions. He should be cared for as 
 stated in paragraph 11, using cold water freely on 
 the head, face, and body, until the arrival of the 
 surgeon. 
 
 13. Military operations often have to be con- 
 ducted without regard to temperature,* but in hot 
 weather unnecessary exposure to the sun should be 
 avoided. 
 
 14. When camp is reached and the tents pitched, 
 each tent should be trenched to keep out the rain- 
 fall, even although rain seems unlikely. Each man 
 should then prepare the floor for his bed by picking 
 out hard irregularities and scooping out a shallow 
 depression for the hip bones. Grass, hay, leaves, 
 or other available material should be laid on as a 
 mattress, with the rubber poncho or slicker over all 
 to keep dampness from the body. In good weather 
 blankets should be unrolled and spread out to air 
 before the time for their use. 
 
 15. If the soldier comes into camp much ex- 
 hausted a cup of hot coffee is the best restorative. 
 When greatly fatigued it is dangerous to eat heartily. 
 
 16. When the tents have been arranged for the 
 night and the duties of the day are practically over, 
 the soldier should clean himself and his clothes as 
 thoroughly as the means at hand will permit. No op- 
 portunity of taking a bath or of washing socks and 
 
203 
 
 underclothing should be lost. In any event the feet 
 should be bathed or mopped with a wet towel every 
 evening to invigorate the skin. 
 
 17. In the continued absence of opportunity for 
 bathing it is well to take an air bath and a moist 
 or dry rub before getting into fresh underclothes 
 and, in this case, the soiled clothes should be freely 
 exposed to the sun and air when the blanket roll 
 is unpacked. 
 
 18. By attention to cleanliness of the person and 
 of the clothing the discomforts of prickly heat, chaf- 
 ing, cracking, blistering, and other irritations of 
 the skin will be avoided. If chafings do occur apply 
 to the surgeon for a healing remedy, for, if neglected, 
 they may fester and cause much trouble. 
 
 19. A hearty meal should be eaten when the 
 day's w r ork is over, but the soldier should eat slowly, 
 chewing every mouthful into a smooth pulp before 
 swallowing ; and it is good when one can rest a while 
 after this meal. Hard bread and beans when not 
 thoroughly chewed give rise to diarrhea, one of 
 the most dangerous of camp diseases. Fresh meat 
 should be eaten sparingly when used for the first 
 time after some days on salt rations. 
 
 20. The soldier would do well to restrict himself 
 to the company dietary. Particularly should he 
 avoid the articles of food or drink for sale by hawk- 
 ers and peddlers. Green fruit and overripe fruit 
 are dangerous, as is also fruit to which the individual 
 is unaccustomed. Unpeeled fruit should never be 
 eaten, for it may have been handled by persons suf- 
 fering from dangerous infectious diseases. 
 
 21. It should be unnecessary to speak of the 
 danger from the use of intoxicating liquors, for 
 every soldier knows something of this. The mind 
 of a man under the influence of these liquors is so 
 
204 
 
 befogged that his is unable to protect himself from 
 accidents and exposures. How many men have been 
 passed from this world because of exposures during 
 intoxication ! How many have lost their health and 
 strength and become wretched sufferers during the 
 remainder of a shortened existence! Besides, for 
 days after indulgence in liquor the system is broken 
 down and the individual less able to stand the fa- 
 tigues, exposures, or wounds of the campaign. 
 
 22. If filtered or condensed water is not furn- 
 ished to the troops, and spring water is not to be had, 
 each soldier should fill his canteen overnight with 
 weak coffee or tea for the next day's march. This 
 involves boiling, and the boiling destroys all danger- 
 ous substances in the water. Typhoid fever, cholera, 
 and dysentery are caused by impure water. 
 
 23. All the belongings of the soldier should be 
 taken under shelter at night to protect them from 
 rain or heavy dews. 
 
 24. When not prevented by the military condi- 
 tions, soldiers should sleep in their shirts and draw- 
 ers, removing their shoes, socks, and other clothing. 
 
 25. In the morning, w r ash the head, face, and 
 neck with cold water. With the hair kept closely* 
 cut this can be done even when the water supply is 
 limited. 
 
 26. In hot climates, where marches are made 
 or other military work performed in the early morn- 
 ing or late in the evening, a sleep should be taken 
 after the midday meal to make up for the shortened 
 rest at night. Everyone to keep in good condition 
 should have a total of 8 hours sleep in the 24. 
 
 27. If the march is not to be resumed, the sol- 
 dier should take the first opportunity of improving 
 his sleeping accommodations by building a bunk, 
 raised a foot and a half or more from the ground. 
 
205 
 
 This is of the first importance when the ground is 
 damp. The poncho, or slicker, must be relied upon 
 as a protection in marching camps, but when the 
 camp is to be occupied for some days bunks should 
 be built. 
 
 28. Malaria and yellow fever are caused by the 
 bite of certain varieties of mosquitoes which have 
 at sometime before bitten a person having one of 
 these diseases. They do not usually bite while the 
 sun is above the horizon. To avoid malaria do not 
 sleep in or near the houses of natives of malarious 
 regions, and if possible protect the body during sleep 
 with a mosquito net, which should be carefully 
 tucked in so that it will not touch the bare skin of 
 any portion of the body. If nets are not available, 
 smear the uncovered skin with kerosene or some oil 
 having a strong odor, such as citronella or pepper- 
 mint. 
 
 29. When malarial fevers are prevalent, avoid 
 chilling the body by sleeping on damp ground by 
 building a bunk, and in the morning take hot coffee 
 immediately after roll call. Men doing duty at night 
 should, if practicable, have a lunch and some coffee 
 before starting. 
 
 30. The soldier should never attempt to dose 
 himself with medicine. He should take no drugs 
 except such as are prescribed by the surgeon.. 
 
 31. No matter how short a time the camp is to 
 be occupied, its surface should not be defiled. The 
 sinks should be used by every man, and the regula- 
 tions concerning their use should be strictly com- 
 plied with. Waste water and refuse of food should 
 be deposited in pits or other receptacles designed 
 to receive them. Attention to these points will pre- 
 vent foul odors and flies. 
 
206 
 
 32. When there are foul odors and flies in a 
 camp, the spread of typhoid fever, cholera, dysen- 
 tery, and yellow fever is likely to occur. 
 
 33. When any of these diseases are present in 
 a command, every care should be taken to have 
 the hands freshly washed at meal times. 
 
 34. In the camps of field service the interior of 
 tents should be sunned and aired daily, and efforts 
 should be made by every soldier to have his bunk, 
 arms, equipments, and clothing in as neat and clean 
 condition as if he were in barracks at a permanent 
 station. 
 
 35. Harmful exposures are more frequent in hot 
 than in cold weather. Soldiers seek protection 
 against cold, but in seeking shade, coolness, and 
 fresh breezes inhot weather they often expose them- 
 selves to danger from diarrhea,, dysentery, pneu- 
 monia, rheumatism, and other diseases. A chill is 
 an exciting cause of these affections; it should be 
 avoided as much as possible. 
 
 36. When the feet become wet the first oppor- 
 tunity should be taken of putting on dry socks. 
 
 37. When the clothing becomes wet in crossing 
 streams or in rainstorms there is little danger so 
 long as active exercise is kept up, but there is great 
 danger if one rests in the wet clothing. 
 
 38. When the underclothes are wet with per- 
 spiration the danger is from chill after the exercise 
 which caused the perspiration is ended. If the sol- 
 dier can not give himself a towel rub and a change 
 of underclothing, he should put on his blouse and 
 move about until his skin and clothes become dry. 
 
 39. To rest or cool off, and particularly to fall 
 asleep, in a cool, shady place in damp clothes is to 
 invite suffering, perhaps permanent disability or 
 death. 
 
207 
 
 40. When an infectious disease is known to be 
 present among the civil population in the neighbor- 
 hodd of a military camp or station, care should be 
 taken by every member of the command to avoid 
 exposure to the infection. Protection from smallpox 
 and typhoid fever can be obtained by timely vac- 
 cinations against these diseases, repeated when nec- 
 cessary. Scarlet fever, measles, and diphtheria are 
 met with in the United States, but in some localities 
 our troops may have to guard against smallpox, 
 yellow fever, cholera, and bubonic plague. The care- 
 less or reckless individual will be the first to suffer, 
 but he may not suffer alone ; many of his comrades 
 may become affected and die through his fault. 
 
 41. Such infections prevail mostly among the 
 lower classes of a community who have no knowledge 
 of the difference between healthful and unhealthf ul 
 conditions of life. Association with them and the 
 use of their dwellings, especially for sleeping pur- 
 poses, should be avoided. 
 
 42. The most serious risk to which the health 
 of young men is exposed* both in military and civil 
 life is one of their own making, that of venereal dis- 
 eases contracted by association with lewd women. 
 There are three of these diseases syphilis or pox, 
 gonorrhea or clap, and chancroid or soft chancre, of 
 which the first two are the more serious. Syphilis 
 is a blood disease which begins as a small hard sore 
 and may affect any part or organ of the body. Sores 
 in the mouth are very common in this disease and 
 render anything with which the lips come in contact 
 dangerous, as is contact with a sore in any other part 
 of the body. Therefore, persons with syphilis should 
 not allow others to use their drinking cups, spoons, 
 forks, pipes, towels, etc. 
 
208 
 
 Gonorrhea is an infection of the lining of the 
 penis and causes a burning when passing water, 
 and a white discharge. It is the cause of stricture, 
 inflammation of the bladder, and other serious 
 troubles, and is very hard to cure completely. The 
 discharge is often a cause of blindness, if by unclean 
 hands it is carried to the eyes. A soldier who be- 
 comes infected with these diseases should be very 
 careful to keep his hands and person very clean 
 and should promptly consult an Army surgeon and 
 carefully follow his advice, both for his own sake 
 and that of his companions. The advice and treat- 
 ment of friends who are not physicians and of quacks 
 should never be taken. The great majority of pro- 
 stitutes and other women of immoral life become 
 infected sooner or later with one or both of these 
 diseases, and give them to men who have intercourse 
 with them. The only sure way to avoid danger 
 of getting these diseases is to live a clean and moral 
 life. It is stated by medical authorities that sexual 
 intercourse is not necessary to preserve health and 
 manly vigor, and the natural sexual impulse can be 
 kept under control by avoiding associations, conver- 
 sations, and thought of a lewd character. Persons 
 who will nt exercise self-control in this matter can 
 greatly lessen the risks of indulgence by intelligence 
 and a care in the practice of personal cleanliness 
 and the prompt use of the means of venereal pro- 
 phylaxis prescribed by Army order for those who 
 have exposed themselves. Men who immediately 
 after intercourse urinate and wash the private parts 
 thoroughly with soap and water will usually escape 
 disease as will those who use the covering called the 
 condom. Drunkenness greatly increases the risk of 
 infection. 
 
209 
 
 43. Every soldier should become familiar with 
 the instructions in the "First Aid and Personal Hy- 
 giene/' so as to be able to help himself or others 
 in the event of wounds or accidents. 
 
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