r-NRLF 170 flD7 GIFT OF 11BRARY IIAi ' N*i C I6*ih DEPOT BR LEWIS, W.'vEM. SPECIAL REGULATIONS NO. 28 SANITARY REGULATIONS AND CONTROL OF COMMUNICABLE DISEASES 1917 WASHINGTON GOVERNMENT PRINTING OFFICE 1917 OLOGY SPECIAL REGULATIONS NO. 28. WAR DEPARTMENT, WASHINGTON, August 10, 1917. The following regulations governing the subjects I. Sanitary Regulations, II. Control of Communicable Diseases. are published for the information and guidance of all con- cerned and supersede General Orders No. 45, War Department, 1916. [300.42, A. G. o.} BY ORDER OF THE SECBETABY OF WAB I TASKER II. BLISS, Major General, Acting Chief of Staff. OFFICIAL : H. P. McCAIN, The Adjutant General. 66?3i6 'TABLE OF CONTENTS. Paragraphs. Sanitary regulations 1-18 Control of communicable diseases 19-37 SANITARY REGULATIONS AND CONTROL, OF COMMUNICABLE DISEASES. ' "' ' SECTION I. SANITARY REGULATIONS. Paragraph. Responsibility for sanitation 1 Division surgeon 2 Sanitary inspector '. 3 Sanitary squads . 4 Water supply 5 Kitchens and mess halls 6 Food and drinks 7 Baths and lavatories 8 Disposal of garbage 9 Care of picket lines and disposal of manure 10 Disposal of excreta 11 Personal cleanliness 12 Venereal diseases 13 Fitting of shoes and care of feet 14 Physical inspections of troops 15 Sanitary inspections of organizations " 16 Mosquito breeding 17 Flies 18 1. Responsibility for sanitation. Commanders of all grades are responsible for police and sanitation and for the enforce- ment of the provisions of these regulations within their organi- zations. 2. Division snrgeon. The division surgeon is charged, under the commanding general, with the general conduct and super- vision of the Medical Department of the division in the per- formance of its duties, and will make recommendation con- cerning all matters pertaining to the sanitary welfare of the command. 1 $ SANITARY REGULATIONS AND 3. Sanitary inspector. The sanitary inspector is assistant to the division surgeon, and is charged especially with the super- vision of the sanitation of the command to which he is assigned. It is the duty of organization commanders to remedy defects reported to them with the least possible delay. 1. Sanitary s&vads will be organized by the division surgeon for special sanitary purposes, such as the purification of water supplies mocQuito and fiy prevention, disposal of wastes, and disinfection. They will consist of officers, noncommissioned officers, and privates, first class, or privates of the Medical Department, assisted by civilian sanitary laborers employed by the Quartermaster Corps, and, when necessary, by details of officers and enlisted men from other branches of the service. 5. Water supply. In the field water must not be used for drinking purposes until it has been pronounced fit for use by a medical officer. Care must be taken to prevent contamina- tion of stored water by keeping all containers scrupulously clean and covered in such manner as to prevent " dipping," and the entrance of dust and other sources of infection. The use of a common drinking cup will not be permitted. An appliance carried on the supply table as "Water bag, field, sterilizing," consists of a 40-gallon canvas bag of spe- cially woven flax, 20 inches in diameter and 28 inches in length. The purpose of the bag is not to transport water, but to pro- vide a stationary receptacle in which water can be held long enough to sterilize, and then be distributed. The empty bag weighs from 7 to 1\ pounds and folds into a convenient package for carriage in the field, for which purpose it was especially designed. After the bag is suspended and filled, the water is sterilized by the addition of a small amount of hypochlorite of calcium. This is carried in measured doses, sealed in glass tubes. The process is one of oxidation. In the strength used, waters highly infected are rendered safe. Water ordinarily used will be entirely safe after being so treated. As the chemical acts more efficiently in clear waters, a filter cloth, to be fastened over the opening of the bag and weighing 1 ounce is provided, or water may be strained through a blanket. Sus- pended matter, such as clay, is largely removed and not left to interfere with the action of the chlorin. The bag is filled after it is put in place. 6. Kitchens and mess halls. Kitchens and mess halls will be securely screened and flytraps provided for catching flies that gain entrance. An effective flytrap consisting of a light wooden CONTROL OF COMMUNICABLE DISEASES. 9 frame covered with wire gauze, extending to about one-eighth of an inch from the floor of the trap, is readily constructed. Sweetened water,' slightly acidulated with vinegar, is an excel- lent bait. Fly paper may also be used. All food, food receptacles, dishes, and tableware will be protected from flies and dust. Unit commanders will see that an amn^le supply of hot water and dish towels are provided for cleansing cooking utensils, dishes, and mess kits. Ice boxes will be kept elevated at a height sufficient to allow for inspection and cleansing. Drip pans will be emptied and scalded out daily. 7. Food and drinks. No food or like commodities will be sold in camp except in the authorized exchanges. Bills of fare should be prepared in advance and adhered to as far as is practicable. Attention is called to the use of the following foods, the elimi- nation of which from the messes will serve to prevent a variety of intestinal disorders : (a) Canned milk and fish opened the day before. (Milk and fish poisoning. ) ( & ) Hashes of meats and potatoes prepared the night previous. (Ptomaine poisoning of severe type.) (c) In certain localities green vegetables, uncooked. (Dysen- teries and diarrhea.) 8. Baths and lavatories. Careful inspection will be made daily to see that waste water is so disposed of as to prevent mosquito breeding and other nuisances. 9. Disposal of garbage. For detachments or companies in camps, or in isolated locations where other means of disposal are not available, an incinerator will be installed of a type approved by the sanitary inspector. The Guthrie incinerator may be used, detail drawing for the construction of which may be found in the Manual for the Quartermaster Corps. Where disposal in a sanitary manner can be made by cartage, the garbage may be carried away in the can and disposed of. The returned can will be thoroughly cleansed. Cans will be kept tightly covered on open stands. 10. Care of picket lines and disposal of manure. Picket lines will be kept broom swept, and all manure and straw hauled away daily and burned, or otherwise disposed of as directed by the sanitary inspector. A weekly incineration of the picket lines will be accomplished with the use of crude oil. Crude oil may be obtained from the Quartermaster Corps on usual requisition. 4620 17 2 10 SANITARY REGULATIONS AND 11. Disposal of excreta. In permanent camps where a water- carriage system is not installed, the Havard or other fly-tight box and pit latrine will be used. Each day the pit will either be burned out or sprayed with a lampblack or bone-black mix- ture. If burned out, 1 gallon of crude oil and 15 pounds of hay or straw should be used. A satisfactory mixture for spraying consists of one-half pound of lampblack to a gallon of kero- sene, or 1 pound of bone black to 3 gallons of crude oil. Spray- ing should be done preferably with a spray pump. Both the interior of the box and of the pit should be kept thoroughly coated with the mixture. Detail drawing of the Havard box may be found in the Manual for the Quartermaster Corps. The box must be kept fly-tight. This implies closure of all cracks and care of hinges and back construction, so that the lids drop automatically. The latrine seats will be scrubbed with soap and water daily, and washed off at least twice weekly with a y^ solution of creolin or other disinfectant. When filled to within 2 feet of the top, pits will be filled with earth to within 6 inches of the surface and covered with a layer of sacking, soaked in crude oil to extend 3 feet beyond the edges of the pit ; the pit will then be filled in with earth and the location marked. Urinal cans will be placed in the camp streets at night and removed in the morning, emptied, and burned out. Facilities for washing the hands should, if possible, be provided in each latrine. 12. Personal cleanliness. Every member of the command will bathe at least twice weekly. Army Regulations (par. 286) require that the men shall wash their hands before each meal and immediately after visiting the latrines. Teeth will be cleansed w^ith a brush at least once a day. Underwear should be frequently changed. Bedding and clothing will be sunned and tent walls raised daily, weather permitting. Barracks and tents will be adequately ventilated. Tents will be furled or struck frequently, so that the sites may be thoroughly sunned. 13. Venereal diseases. The cause of these diseases is a matter of common knowledge. They are entirely preventable, and the Government punishes those who expose themselves and contract venereal disease by prompt stoppage of pay and restriction of privileges while under treatment. It is enjoined upon all officers serving with troops to do their utmost to encourage healthful exercises and physical recreation, and, to supply opportunities for cieaaly social aiKl interesting y CONTROL OF COMMUNICABLE DISEASES. 11 mental occupations for the men under their command ; to take advantage of favorable opportunities to point out, particularly to the younger men, the inevitable misery and disaster which follow upon intemperance and moral uncleanliness, and that venereal disease, which is almost sure to follow licentious liv- ing, is never a trivial affair. Although the chief obligation and responsibility for the instruction of soldiers in these matters rests upon company officers, the medical officers should co- operate by occasional lectures or other instruction upon the subject of sexual physiology and hygiene, and the dangers of venereal infection. Commanding officers will require that men who expose them- selves to the danger of contracting venereal disease shall at once, upon their return to camp or garrison, report to the hospital or dispensary for the application of such cleansing and prophylac- tic treatment as may be prescribed by the Surgeon General. Any soldier who fails to comply with such instructions, if found to be suffering from a venereal affection, shall be brought to trial by court-martial for neglect of duty. Cases of these diseases will be promptly subjected to treat- ment, but not necessarily excused from duty unless, in the opin- ion of the surgeon, it is deemed desirable. They will be made of record in the medical reports in any case. A list of those diseased but doing duty will be kept both by the company or detachment commander and the surgeon, and the infected men will be required to report to a medical officer for systematic treatment until cured. While in the infectious stages the men should be confined strictly to the limits of the post. When a venereal case, whether or not on sick report, is transferred to another command, the surgeon will send a transfer slip giving a brief history of the case. 14.' Fitting of shoes and care of feet. Company commanders are charged with personal supervision of fitting the shoes of the men of their commands, and will be held responsible that instructions herein contained nre followed and that their men are required to wear shoes properly fitted. To determine the fact of fit the shoes will be laced snugly, and the soldier, with a 40-pound burden upon his back, will throw his entire weight on one foot. The officer or noncommissioned officer fitting the shoe will then press in the leather of the shoe in front of the toes to determine the existence of sufficient vacant space in that region to prevent toe injury, Uu4er no circumstances should tbl 12 SANITARY REGULATIONS AND vacant space in front of the great toe be less than two-thirds of an inch, nor should there be pressure on the top of the toes. The officer or noncommissioned officer will then grasp with his hand the leather of the shoe over the ball. As his fingers and thumb are brought slowly together over the leather the shoe should feel snugly filled without apparent tension, while the leather should lie smoothly under the hand. If the leather wrinkles under the grasp of the hand, the shoe is too wide and a narrower width is needed; if the leather seems tense and bulgy and the hand tends to slip over easily, the shoe is too narrow and a greater width is necessary. Usually it will be necessary to try on several pairs of shoes in this manner before an entirely satisfactory shoe is secured. No shoes will be issued or worn by enlisted men which are not fitted in accordance with this order. All shoes should be properly broken in before beginning a march. The following is required : The soldier stands in his new shoes in about 2 inches of water for about five minutes until the leather is thoroughly pliable and moist; he should then walk for about an hour on a level surface, letting the shoes dry on his feet, to the irregularities of which the leather is thus molded in the same way as it was previously molded over the shoe last. On taking the shoe off a very little neat's-foot oil should be rubbed into the leather to prevent its hardening and cracking. If it is desired to waterproof the shoes at any time, a con- siderable amount of neat's-foot oil should be rubbed into the leather. Light woolen or heavy woolen socks will habitually be worn for marching; the socks will be large enough to permit free movement of the toes, but not so loose as to permit of wrinkling. Darned socks, or socks with holes, will not be worn in marching. Company commanders, by frequent inspections throughout the year, will maintain the feet of their men in condition for proper marching. They will cause the proper trimming of nails, removal of pressure from corns and callouses, relief of painful bunions, treatment of ingrowing nails, and other defects, sending serious cases to the surgeons. Before a march is undertaken by foot troops company com- manders will personally inspect the bare feet of their men. While on the march they will personally see each day that their men wash their feet as soon as possible after reaching camp, 14. Fitting of shoes and care of feet On page 12, be- tween the twenty-eighth and twenty-ninth lines, insert the fol- lowing: Shoes issued to enlisted men will be regularly inspected by company commanders to see that waterproofing substance is applied often, and that they are not injured by being placed too near heating apparatus. Heat ruins leather and causes wet leather to rapidly decompose. (S. R. No. 28, C. No. 1, Apr. 1, 1918.) CONTROL OF COMMUNICABLE DISEASES. 13 prick and evacuate blisters, and cover such blisters or excoria- tions with zinc oxide plaster, supplied by the Medical Depart- ment, applied hot, dust the feet with the foot powder supplied by the Medical Department, and put on clean socks. An undue amount of foot injury and disability from shoes will be re- garded as evidence of inefficiency on the part of the officers concerned, and as causes for investigation. Quartermasters will provide a place where shoes may be fitted for the purpose of determining or verifying the record to be kept in each company, troop, battery, and detachment of 1!u proper sizes of shoes required for each enlisted man thereof. For the purpose of fitting they \vill keep on hand at all times a complete series of each size and width of shoes furnished for issue. Company commanders will report in writing to the next higher commander every instance of failure to secure proper shoes for their commands, or to obtain proper facilities for fitting the shoes as herein directed. Commanders will investigate the reasons for and be held responsible as far as lies in their power for the rectification of such deficiencies. A brief record of the number of such reports from company commanders and the reason for such deficiencies will be fur- bished to inspectors at each inspection. Inspections conducted under the provisions ot paragraph 889, Arm., Regulations, will embrace an inquiry into the manner in which this order has been complied with, and the report of inspections will include a statement of all instances of failure on the part of company commanders to secure proper shoes for their commands and the cause of such failure. 15. Physical inspections of troops. Commanding officers will require a medical officer, accompanied by the company or detach- ment commander, tc make a thorough physical inspection twice in each month of all the enlisted men of each organization be- longing to or attached to the command. These inspections will be made at times not known beforehand to the men, and prefer- ably immediately after a formation. The dates on which the physical inspections of the various organizations are made will be noted on the monthly sanitary reports. At these inspections an examination of the feet and footwear and of the condition of personal cleanliness of the men will be mnde, as well as careful observation for the detection of venereal diseases. J 14 SANITARY HEGTJLATlONS, ETd. 16. Sanitary inspections of organizations. Surgeons of organi- zations will make a daily inspection of the commands to which they pertain, giving particular attention to the following: Picket lines ; latrines ; kitchens and mess halls, including cleanli- ness of cooks, utensils, and fixtures; barracks and tents; in- closed toilets ; baths ; lavatories ; laundries ; exchanges ; garbage receptacles; incinerators; and all food supplies. They will make a verbal report at once to their respective commanding officers for the correction of any sanitary defects noted, and a similar report, with the action taken, to the sanitary inspector on his next visit. 17. Mosquito breeding. Areas about camps in which mos- quitoes might breed, such as cisterns, tanks, woods, gutters, pools, and drains, will be kept under close observation by the responsible medical officers and the proper remedies applied, i. e., screening, draining, oiling, etc. The use of the mosquito bar is imperative in all districts where mosquitoes are preva- lent, except where tents or barracks are effectually screened with wire. 18. Flies. All possible breeding places of flies should be de- stroyed, particular attention being given to manure and refuse from picket lines and stables. An energetic campaign must be begun at once against the mature flies. SECTION II. CONTROL OF COMMUNICABLE DISEASES. Paragraph. Purpose 19 Main object of sanitary science 20 Environment 21 Principal routes of infection 22 Program 23 Typhoid fever 24 Paratyphoid fever 25 Cholera 26 Dysentery 27 The intestinal group of diseases 28 Epidemic meningitis 29 Malaria 30 Yellow fever 31 Typhus fever 32 Epidemic jaundice 33 Smallpox 34 Vaccination 35 Measles, mumps, and scarlet fever 36 Venereal diseases 37 19. Purpose. In carrying out effective sanitary measures in the military service particular attention should be paid to cer- tain of the communicable diseases. The following notes are published for the information and guidance of medical officers and others whose duties impose upon them the prevention of disease among the troops of the United States. 20. Main object of sanitary science. The practice of modern sanitary science may be summarized in the statement that its main object is to seek the sources amongst infected persons and animals whose excreta or other constituents or body contents enter the bodies of other persons. Its main postulate is that the routes of infection are simply the routes of infected bodily discharges, which are the routes of ordinary uninfected discharges in ordinary life. 15 16 SANITARY REGULATIONS AND 21. Environment. The influence of environment depends upon whether or not it permits of or necessitates the exchange of human discharges. Overcrowding, if combined with lack of discipline and order, and lack of facilities for washing, espe- cially of the hands, contributes to the spread of infection, not of itself, but only if infection be introduced into the com- munity. Overcrowding, if there is discipline and intelligence, w r ith proper precautions to avoid the exchange of excreta, does not spread infection even if it be introduced. 22. Principal routes of infection. Water, food, flies, and milk are the main public routes of gastrointestinal infection from individuals to group, and from group to group. Contact is the great private route from individual to individual. Contact in- fection radiates directly from the infected person through nose, mouth, bladder, and bowel discharges. The great route of ex- change is by smears on the hands, although mouth spray and sputum also act in many diseases. If we classify the chief communicable diseases of the Temperate Zone by their prin- cipal routes of infection, we plainly see that of all the routes contact alone is common to all diseases. 23. Program. A program of military sanitation should aim: (a) To secure to each individual continuously the highest possible health. (&) To secure to each instruction and training in personal conduct in order to avoid receiving into his body the discharge of infected persons. (c) To secure to each specific immunization. These three measures place the abolition of infection directly upon the individual. The three following place the abolition of infection upon experts who deal directly with the infection itself: (a) The supervision of the four great public routes of infec- tion, to exclude all bodily discharges from them. ( & ) The supervision of all known infectious cases, to exclude their discharges from all routes. (c) The sociological supervision of all infected persons. 24. Typhoid fever. Cause. The bacterial cause of typhoid fever is a' rod-shaped microorganism or germ called the typhoid bacillus. Nature. Typhoid fever is chiefly a filth disease, and is widely distributed over the world. The typhoid bacillus is present in the feces and urine of all persons who are ill with the disease, CONTROL OF COMMUNICABLE DISEASES. 17 and of certain persons who have long recovered from it. The latter persons are referred to as carriers of the bacilli, or typhoid carriers. Means of communication. Lack of care in the disposal of the excreta and want of personal cleanliness are the chief sources of the disease. A faulty method of disposing of feces and urine may lead to contamination of drinking water, milk, or other food directly or through the agency of flies. Human excrement should be properly disposed of, breeding places of flies destroyed, food supplies protected, and persistent warfare against the fly unceasingly curried on. Sources of the disease in military camps. The commonest mode of infection in military establishments is through personal contact, especially by means of the hands, with individuals who harbor the typhoid bacillus. Sometimes this contact is direct, sometimes indirect. About 60 per cent of the cases are believed to arise in this manner. The direct instances are those in which infection follows upon personal association with an infected person or carrier. The indirect ones are such as arise from clothing, bedding, water, milk, or other foods, and the dishes or drinking cup of an infected person. The carrier is, therefore, because unsuspected and more in- sidious, a greater source of danger than the sick person. The medical officer should be on the alert to suspect and detect him. Once detected, he requires particular care in respect to isolation and treatment. The carriers who handle or prepare food are especially dangerous. In order to avoid increase in carriers, no patient convalescent from typhoid fever should be released until three successive examinations of the stools and urine, collected at six-day intervals, have shown him to be free from typhoid bacilli. Personal precautions to be observed. From what has been stated it is obvious that habits of personal cleanliness are to be encouraged in every way. Bathing should be frequent, the wash- ing of the hands before eating and after visiting the latrine should be obligatory, and due attention paid to the laundering of underclothing. The eating and other utensils used by per- sons sick of typhoid fever and carriers of the typhoid bacilli should be promptly sterilized. 18 SANITARY REGULATIONS AND 25. Paratyphoid fever. Causes. Like typhoid fever, paraty- phoid fever is produced by bacteria. Two bacilli, known as paratyphoid A and B, are its bacterial causes. Nature. Paratyphoid fever, like typhoid fever, is a filth disease, and as such is to be dealt with precisely as is typhoid fever. In addition, the paratyphoid bacilli B occur in animals and may be present in their flesh. Hence, such infected foods, when improperly cooked or preserved, may give rise to paraty- phoid fever. This form of the disease constitutes one of the kinds of food or meat poisoning. Healthy carriers of the para- typhoid bacillus also exist. Vaccination. Typhoid vaccination does not protect against paratyphoid infection. It is, therefore, necessary to vaccinate against paratyphoid, as well as against typhoid fever. For this purpose a vaccine is supplied containing both the A and B bacilli. It is injected in the same manner as the typhoid bacillus vaccine. Distinction between typhoid and paratyphoid fever. These two kinds of fever are often indistinguishable clinically. But labora- tory test methods serve to distinguish them from each other. Every case of undetermined fever and every case of clinical typhoid or paratyphoid fever should have a blood culture made not later than the fifth day, this culture to be examined at an Army laboratory, unless specific authority to do otherwise is given by the Surgeon General's office. A subculture from any positive blood culture will be sent to the nearest department laboratory for confirmation and record. Typhoid and paratyphoid vaccination. All persons entering the military service will be vaccinated against typhoid and paratyphoid fevers, under the direction of the medical officer, as soon as practicable after entrance. Exception may be made in the case of persons over 45 years of age, and when the occur- rence of a previous attack of typhoid fever or a complete course of vaccination within three years is established to the satis- faction of the responsible medical officer. Officers under 45 years of age will be vaccinated after three years, and enlisted men on reenlistrnent. Vaccination will consist of a series of three injections given exactly as in the first series. Recruits will be vaccinated at places of enlistment, unless, be- cause of special assignment or other reason, the men are not to remain at the station long enough to allow the completion of the course, in which event the vaccination will be completed CONTROL OF COMMUNICABLE DISEASES. 19 immediately after they join the organizations or stations to which they are assigned. On page 2 of the service record of every recruit or enlisted man will be entered the dates of com- pletion of vaccination against typhoid and paratyphoid fevers. The absence of any date in the line provided for that purpose will indicate that the vaccination has not been administered. Company and detachment commanders will examine the service records, and, if the vaccination has not been completed, will see that the vaccination is begun immediately after the men join the organizations or stations to which assigned. Civilian employees who are subject to field service of any kind, including those on transports and in the mine-planter service, will be vaccinated as soon as employed. Records will be kept of all officers, soldiers, and civilians in the military service who receive the antityphoid and antipara- typhoid vaccinations, giving the dates of vaccination. The following directions for vaccination against typhoid and paratyphoid fevers are published here for the information of medical officers: The first dose is one-half cc. (7$ m.) ; the second and third are each 1 cc. (15 m.). An interval of at least seven days should elapse between doses. This interval may be extended to the fourteenth day in case of necessity. The site of inoculation is the arm, at the insertion of the deltoid muscle. If for any reason this site can not be used, the needle may be introduced into the back, over the lower por- tion of the scapula, or in the chest below the clavicle. The dose is to be given subcutaneously, and not into the muscles nor into the skin. The arm should be cleansed as for any other operation. Tincture of iodine painted over the dry skin, before and after the injection, has proven satisfactory. The ampule should be washed off in an antiseptic solution and opened after making one or more cuts near the top with a file. The vaccine can be drawn out of the container with a syringe, or it may be emptied into a shallow glass dish, such as a salt cellar, which has been sterilized by boiling. The syringe and needle should be sterilized by boiling in 2 per cent soda solution. To insure perfect sterilization, draw the piston out to its full length, or remove it entirely so that the barrel is full of water during the boiling. A fresh needle should be used for each man, or if one needle must be used on two or more men, it should be resterilized before each injection. 20 SANITARY REGULATIONS AND No person should be vaccinated who is not perfectly healthy and free from fever. The temperature should be taken in doubtful cases, and the urine should be examined ; if fever or any other symptoms of illness are present the procedure should be postponed. These precautions are necessary to avoid vacci- nating men who may be in the incubation stage of typhoid or other fever. Neither beer nor alcohol in any other form should be drunk on the day of treatment. Vaccination is well borne by children and by women, using doses proportionate to the body weight, taking 150 pounds as the unit. Women should not be given the first dose during or near the time of the men- strual period. The most suitable time for the administration is about 4 o'clock in the afternoon, as the greater part of the reaction is then over before morning. There is usually some headache and malaise, and a local reaction consisting of a red and tender area about the size of the palm of hand, and sometimes tender- ness in the axillary glands. It is best not to require any duty for 24 hours, nor to permit active exercise, such as long rides or walks. Rarely, marked general reactions occur headache, backache, nausea, vomiting, herpes labialis, occasionally albu- minuria, and some loss of body weight. The number of such reactions is exceedingly small, and regardless of their severity they as a rule disappear inside of 48 hours. The Widal reaction is positive after typhoid vaccination, appearing in about 10 days after the first dose, and it remains positive for six months to a year. This fact must be considered in diagnosing typhoid in vaccinated persons. They may give a positive Widal regardless of the nature of the illness, and the reaction is frequently of no assistance in diagnosis. The vaccines should be stored in an ice box. They will keep for four months, and perhaps longer when stored at low tempera- tures in the dark. A fresh ampule should be opened for each day's use. Any vaccine remaining unused in an open ampule at the end of the day should be thrown away. The only vaccines used will be those obtained from the Army Medical School, and will be furnished on request by letter or by telegram to the department surgeon. When for any reason a larger stock is on hand than appears to be needed, directions as to disposition will be obtained from the commandant, Army Medical School, upon application to him directly, stating date of receipt of the CONTROL OF COMMUNICABLE DISEASES. 21 vaccine. Stock over four months old will be destroyed when a new supply has been received. 26. Cholera. Cause. The bacterial cause of cholera is a comma-shaped bacillus known as the comma or cholera bacillus. Nature. Two main forms of cholera are distinguished. In one type of the disease large epidemics break out more or less suddenly. In these, cases the cholera bacillus is contained in the drinking water. In the other form of the disease the rase* occur separately and occasionally; they arise from contact with other cases of cholera, with cholera bacillus carriers, or from filth contamination by flies, as in the manner of spread of typhoid fever. The cholera bacillus breeds in the intestine of man and escapes with the intestinal discharges. Gaining access to water sup- plies, it survives there for a time. Upon the hands, clothing, etc., it may be carried to healthy persons by contact. In the cholera patient only -the intestinal discharges contain the bacilli. Prevention. The control of the drinking water is imperative to avoid water-borne epidemics. The cleansing of the hands, disinfection of clothing, bedding, eating utensils, etc., are neces- sary to prevent contact infection. The discovery and isolation of carriers, who in infected localities may constitute from 5 to 10 per cent of the population, should be assiduously attended to. Carriers are an especial menace when they are engaged in the handling and preparation of food. Should cholera appear, the things to be especially kept in mind are : (1) Close watch over the persons who have to do with the handling of food. (2) The safeguarding of water and milk. The latter should always be boiled before, use. (3) The use only of food recently cooked. (4) The screening of kitchen and mess halls. (5) The reduction of flies by trapping and killing, and the destruction of their breeding places. 27. Dysentery. Causes and nature. Dysentery, or inflamma- tion of the large intestine, is caused by two classes of micro- organisms, an amoeba and certain bacteria. The former gives rise to amoebic, the latter of bacillary, dysentery. The bacterial or bacillary form of dysentery is more widely distributed over the world than the amoebic. While the former is found in all Climates, the latter ig chiefly restricted to warm countries, Biit 22 SANITARY REGULATIONS AND persons suffering from amoebic dysentery may carry the disease from a warm to a cold climate. Sources of infection. The amoebae and bacilli which cause dysentery are contained in the intestinal contents and are dis- charged with them. They are, therefore, subject to the same manner of distribution as are the typhoid bacilli, and the pre- ventive measures to be employed are identical with those em- ployed in typhoid fever. It may be well, however, to emphasize the common occurrence of carriers of dysentery bacilli and amoebae among exposed and recovered cases, and the necessity of enforcing habits of personal cleanliness and other related meas- ures to control the disease. Diarrhea, etc. In addition to dysentery, slighter and non- dysenteric forms of intestinal trouble are more or less common. As the results of chill and indiscretion in diet, diarrhea, griping, and even bloody stools may arise. But any case of persistent diarrhea in which blood and mucus are being discharged should be regarded as suspicious and submitted to a laboratory ex- amination, in order to determine whether it may be dysentery. The amoebae are searched for by direct microscopical examina- tion ; the bacilli may be obtained in culture or an agglutination test made with the patient's blood to determine their presence. 28. The intestinal group of diseases. (a) Typhoid and para- typhoid fever, cholera, and amoebic and bacillary dysentary form a group of intestinal infections in which the causative micro- organisms are discharged with the excreta, and gain access to healthy persons through the mouth. The general principles of their prevention are practically identical. The first effort made should be to destroy the infectious agents at the source, namely, in the discharges from the intestine. The next effort should be to control the water and food supply and the personal habits of the men, so that any of the microorganisms which escape de- struction may not find their way into the digestive tract in a living condition. (&) No man should be employed as cook or handler of food or water who is a carrier of B. typhosus, B. paratyphosus, A or B, or cysts of Entamceba histolytica. (c) Stools of all cooks and food handlers (including handlers of water and drivers of water and ice wagons) will be examined for typhoid, paratyphoid A and B, and dysentary bacilli, and for cysts of Entamceba histolytica. In case of enlisted men, notation of positive findings should be rna^e on tiie service- pecorcl, CONTROL OF COMMUNICABLE DISEASES. 23 29. Epidemic meningitis. Names. Epidemic meningitis, cere- brospinal meningitis, and cerebrospinal fever are different names for one and the same disease. In certain epidemics, hemorrhages into the skin are common; because of this fact the disease is also called spotted fever. Cause. The bacterial cause of epidemic meningitis is a diplo- coccus called meningococcus. It is present in the inflamed mem- branes of meninges about the brain and spinal cord and within the ventricles of the brain of those ill of the disease. It is also present upon the mucous membranes of the nose and throat of the ill, and even of the well, who act as healthy carriers of the diplococcus. Sporadic cases. Epidemic meningitis has not been absent from this country as a whole in many years. The severe epi- demics have practically disappeared, but occasional or sporadic cases have, nevertheless, continued to arise. From time to time groups of cases or small local epidemics have also appeared. Carriers. The healthy carriers of the meningococcus are more numerous than the cases of the disease which arise. The per- sistence of the sporadic cases indicates, therefore, the continued existence of such carriers in the general population. The as- sembling of large groups of men from various parts of the coun- try is certain to introduce carriers, and the close association of the carrier with other persons is as certain to lead to the ap- pearance of cases of epidemic meningitis. Mode of infection. Infection with the meningococcus takes place by way of the mucous membrane of the nose and throat. Even when meningitis does not arise the carriers harbor the diplococcus upon those mucous membranes. They are present also in their secretions, and gain access to others through cough- ing, sneezing, hawking, and spitting, and through contact of the hands contaminated with the secretions. Sources of danger. The ill patient is a source of danger only to his attendants, because he is kept isolated in bed. To reduce this danger to a minimum every precaution should be taken to disinfect or destroy the discharges from the nose and throat. This is necessary primarily in the interest of the at- tendants doctors and nurses and secondly in the interest of others, since doctor or nurse may be converted into a carrier. The chief danger to others is the healthy carrier, because he is not suspected or isolated and moves about freely. He can be detected by means of a bacteriological examination, and, 24 SANITARY REGULATIONS AND having been detected, .methods exist for ridding the mucous membranes of the diplococcus. The occurrence of a case of epidemic meningitis in a barrack, tent, or mess is the signal for the bacteriological examination of all the men in this group. Until this is done, the men should not be permitted to move about freely. All those not found to be carriers can be at once released. The others are released as soon as they become meningococcus free. Likewise the convalescent patient is not released until a bacteriological examination has shown the mucous membranes of the nose and throat to be free of the meningococcus. Varieties of cases. Two main clinical varieties of epidemic meningitis occur. They are called ordinary and fulminating or explosive. In the former the symptoms come on and de- velop gradually, and death or recovery is a matter of one or several weeks. In the latter the symptoms appear suddenly and quickly become alarming, and death may result in a few hours, and usually does occur within 36 hours. The greatest number of recoveries occur among the ordinary cases, but recovery has been observed even among the fulminant ones. Recovery from both is now more frequent as the result of the use of the antimeningococcic serum. Prevention. No certain means of prevention of epidemic meningitis is known, except the detection and removal of car- riers of the meningococcus and the isolation of cases of the disease. The incidence of the disease is, however, influenced by hygienic conditions. The greatest number of cases tends to occur in the winter when people are much indoors and ventila- tion is deficient. In the spring, summer, and autumn, when they live less within doors, fewer cases arise. Hence the ap- pearance of the disease in camps is an indication for better separation of the inmates. The less they are in intimate con- tact the smaller the danger from coughing, sneezing, etc. Moreover, every effort should be made to prevent sneezing, coughing, hawking, and spitting, except under conditions in which the secretions can be caught, as in a handkerchief. Cleanliness of person, especially of the hands, is also a safe- guard. Treatment. The treatment most relied upon consists in the injection into the membrane of the spinal cord and brain of the antimeniugococcic serum. This is done by means of lumbar puncture, a certain quantity of the cerebrospinal fluid first being removed. This fluid, whicli normally is perfectly clear, becomes CONTROL OF COMMUNICABLE DISEASES. 25 turbid or purulent as a result of the infection, and contains the raeningococcus and leukocytes and other cells. The diplococci are partly within and partly without the leukocytes. Removal of the cerebrospinal fluid is of benefit because it withdraws a certain number of meningococci, but it also reduces the pres- sure within the ventricles of the brain, which is of value. The antimeningococcic serum acts directly upon the diplococci, de- stroys them, or prevents their multiplication. Hence it is defi- nitely curative. The serum acts only as long as it is within the meninges or membranes of the spinal cord and brain, and as it escapes into the blood its injection must be repeated. The rule is to repeat the injection every 24 hours for two or three or more days. In severe cases it has been found of advantage to repeat the injection every 12 hours. The detailed methods of employing the serum and of treating carriers are given in a special circular. 30. Malaria. Cause. Malaria is caused by a microorganism (plasmodium malarise) which gains access to the body through the bites of mosquitoes belonging to the genus Anopheles. The predisposing causes of the disease are those that favor the development of mosquito life. On account of the nocturnal habits of the malaria-bearing mosquitoes, the disease is more likely to be contracted at night. Prevention. Camps should not be located near swamps or in places where standing water favors the development of the mos- quito. Every precaution will be taken to destroy breeding places by draining and filling, or by oiling them, and by the cutting away of all grass or undergrowth for a distance of 200 yards about camps and habitations in order that the adult mosquitoes may not find lodgment and protection. In certain conditions, the use of preventive doses of quinine may be required, and administered by order under the super- vision of the medical officer. All cases of malaria will be promptly isolated for treatment and protected from the attack of mosquitoes. See also paragraphs 195-197, Manual for the Medical Depart- ment. 31. Yellow fever is transmitted by the bite of the yellow-fever mosquito (Stegomyia calopus). Yellow fever is essentially a disease of the Tropics, and its existence is dependent upon the distribution of this single species of mosquito, small and silver striped, active principally 26 SANITARY REGULATIONS AND at evening time, and breeding generally in small accumulations of water close to the habitations of man. The prevention of this disease, as of malaria, depends chiefly on the destruction of the mosquito and its breeding places, the proper protection against the bites of the insects at all times, and the early isolation, protection, and treatment of each case of yellow fever as soon as suspected. 32. Typhus fever. Definition. Typhus fever is an acute in- fectious disease caused by a specific germ, characterized by sud- den onset, high fever, marked nervous symptoms, and macular eruption. It has prevailed in Mexico and in eastern Europe since the middle of the sixteenth century. Transmission. Typhus fever is transmitted to man only by the bite of the louse, which infests the clothing and body of tha victims. Prevention. The prevention of typhus fever depends, there- fore, upon personal cleanliness and the avoidance and destruc- tion of infected lice. Frequent bathing and cleansing of clothing, with repeated inspection of garments, particularly the seams where the eggs of the louse are deposited, are imperative precautions. The clothes louse lays its eggs among and attached to the fibers of clothes, with a special preference for seams and lin- ings, a point to be remembered in the destruction of lice. The eggs are the size of a pin point, yellowish white in color, goblet-shaped, and attached at the lower end of the cloth by a cement excreted by the female. They can be destroyed by boil- ing water or kerosene. In this connection see Bulletin No. 10, War Department, 1916. The avoidance of buildings, places, and persons known to be infected with lice is of first importance. In case troops are sent into a typhus area, a railway disin- fecting and bathing train will be provided, and stationary plants of like character at the bases. 33. Epidemic jaundice. Cause. Epidemic jaundice is caused by a spirochete, which is abundant in the urine and feces of convalescents, and is also frequently found in the kidneys of rats. This spirochete lives for some time in water, and the disease is contracted by standing in contaminated water, and less frequently by eating contaminated food. Prevention. Prevention consists in isolation of all cases until the urine is free from spirochetes, avoidance of urine and fecal contamination of trenches, destruction of rats, the protec- CONTROL OF COMMUNICABLE DISEASES. 27 tion of food, and keeping trenches free from water. If the trenches become contaminated water should be pumped out and lime sprinkled freely over the soil. 34. Smallpox. Any case of smallpox occurring among persons subject to military control will be isolated, and contacts not protected by recent successful vaccination will be revaccinated. 35. Vaccination. Vaccination being recognized as an effective means of preventing smallpox, all recruits upon enlistment and all soldiers upon reenlistment will be vaccinated. When the first vaccination of a recruit is ineffective, it will be repeated at the end of eight days. All the personnel of a military command, station, or trans- port, including civilians connected therewith, will be vaccinated when in the opinion of the medical officer responsible for sanita- tion it is necessary as a means of protection against smallpox. Civilians refusing to be vaccinated when so directed by proper authority may be excluded from the military reservation or station. Officers should be vaccinated at least once in a period of seven years. Troops under orders to perform oversea journeys or field service will be inspected by the responsible medical officer with respect to their protection against smallpox, and those who in his opinion require it will be vaccinated. Technique. The skin at the selected site must be clean. Washing with warm water, followed by alcohol, Is usually suffi- cient, the alcohol being permitted to evaporate before proceed- ing. Scrubbing with soap and water is necessary for a dirty skin, but needless irritation of the skin Is to be avoided. The procedure, described as follows, is preferable to " scarifi- cation," which will no longer be used : Incision is the method of choice, and should be made with the point of a sterile needle, producing a "scratch." A sterile scalpel may be used, but is more likely to cause bleeding. The incision or scratch should preferably not draw blood. There should be at least two incisions, three-quarters of an inch long and 1 inch apart; after exposure to smallpox four incisions will be made. The virus is then placed upon the abraded surface and gently rubbed in, unnecessary irritation being avoided. The wound is allowed to dry thoroughly and can be left with-- out dressing, though several layers of gauze may be applied with adhesive plaster. Any dressing that retains heat and moisture is bad. Shields will no longer be issued. 28 SANITARY REGULATIONS, ETC. Bathing is permitted, but unnecessary use of the limh is to be discouraged when practicable. 36. Measles, mumps, and scarlet fever. When these diseases appear in a command all cases of illness with catarrhal symp- toms having a temperature of 101 or over will be promptly isolated, and the general preventive measures used against the contagious respiratory diseases will be instituted. Susceptible contacts will be isolated and inspected daily. If practicable, a detention camp will be established where all recently joined recruits will be held under observation before being permitted to join their organizations. 37. Venereal diseases. See paragraph 13. INDEX. Paragraph. Barracks, ventilation of 12 Bathing, requirements 12, 24 Baths, inspection of 8 Cholera, cause, nature, and prevention 26 Clothing, regulations concerning 12, 24, 26, 32 Commanders, responsibility of 1 Diseases : Communicable 19 Contraction of "2'2 Intestinal groups of ^ 28 Venereal 13, 37 Drinking cup, common, use of, prohibited 5 Drinks, precautions relative to 7 Dysentery, causes, nature, and infection 27 Excreta, disposal of 11 Feet, care of 14 Flies, destruction of breeding places 18 Flytraps, description and use 6 Food, instructions concerning 7 Garbage, disposal of : 9 Infection, routes of 22 Inspection, physical and sanitary 15, 16 Inspector, sanitary, responsibility of 3 Jaundice, epidemic of, cause and prevention 33 Kitchens and mess halls 6 Lavatories, inspection of 8 Malaria, cause and prevention 30 Manure, disposal of 10 Measles, isolation and prevention 36 Meningitis, isolation, prevention, and treatment 29 Mosquito, breeding, prevention of 17 Mumps, isolation and prevention 36 Paratyphoid fever, cause, nature, and protection against- 25 Physical examination 15 Picket line, care of 10 29 30 INDEX. Paragraph. Policing, commanders responsible for 1 Revaccination, instructions governing 34, 35 Sanitary science, object of 20 Sanitation, military 23 Sanitation, responsibility for 1 Sanitary inspections, instructions governing 16 Sanitary squads, organization of 4 Scarlet fever, isolation and prevention 36 Shoes, fitting of 14 Smallpox, isolation of 34 Stoppage of pay, while under treatment for venereal dis- eases 13 Surgeon, division, responsibility of 2 Teeth, care of 12 Tents, ventilation and sanitation 12 Typhoid fever, cause and prevention 24 Typhus fever, definition, transmission, and prevention 32 Vaccination, instructions governing 25, 34, 35 Venereal diseases, instructions relative to 13 Waste water, inspection of 8 Water supply, care of '. 5 Yellow fever, prevention of 31 o IC.3.S.ILN0.2&J SPECIAL REGULATIONS NO. 28. CHANGES } WAR DEPARTMENT, No. 3. J WASHINGTON, September 20, 191S. Paragraph 14, Special Regulations No. 28, Sanitary Regula- tions and Control of Communicable Diseases, is changed, us follows : 14. (Changed by S. R. No. 28, C. No. 3, W. D., 1918.) Fitting of shoes and care of feet. With the view of increasing the marching capacity of troops, company, troop, battery, and de- tachment commanders will personally satisfy themselves that the men of their commands have been properly measured and fitted with shoes and socks, and will be held responsible that the instructions herein contained as to care of feet are strictly followed, and that their men are required to wear shoes and socks properly fitted. Foot-measuring machines and shoe-fitting devices will be sup- plied by the Quartermaster Corps in such nunii>. vs us may be needed at each camp and garrison post in th I" nit- -I States, the Philippine, Panama Canal, and Hawaiian Dcp; tm- nts for use in fitting shoes. The use of the measuring machines and the fitting devices is to be under the general supervision of the unit supply officers and supply officers of depot brigades, to whose offices will be attached personnel properly instructed in meas- uring and shoe fitting. A record of the proper size and width of shoes as determined by use of the foot-measuring machine and shoe-fitting devices and of the proper size of woolen sock will be kept by company, troop, battery, and detachment com- manders. DIRECTIONS FOB OPERATING " KESCO " FOOT-MEASURING MACHINE. (a) After taking the machine from it. c j box, open it wide by moving the lever as far front as possible and pulling out the plunger as far as it will go. The machine is now ready for use. (b) Let the man put his foot in the machine and stand with all his weight. The heel should rest lirmly ; gainst the heel block. It is important that the foot should rest in the exact center of tin; machine. (c) Release lever which operates the width indicator and push the plunger until the plate touches the toe. Do not touch the plunger again while the foot is in the machine. Make sure that the metal side pieees touch the toe joints. (d) Then let the man throw his entire weight on the bull of his foot, misin.L' the heel slightly. - 18 S. R. No. 28.] (e) The width is automatically registered by the arrow. As the arrow wavers, following the action of the heel up and down, take the average of the extremes. (Example: If the arrow Wavers from width "b" to width "d," use width "c.") The correct size of the shoe is indicated by the pointer on the plunger on the right-hand scale. (/) Measure the other foot in the same manner, and if there should be a difference, select size to fit the longer foot and the narrower width. (g) Oil the slide under the device occasionally. NOTE. Verify the length selected by testing with shoe-fitting device. v INSTBUCTIONS FOB USING THE SHOE-FITTING DEVICE. (a) Select from the several measuring devices in the set the one marked with the size or half size corresponding with the shoes to be tried on. (6) Insert the knob end of the device into the toe of the shoe, springing the other end of device down to the inner sole, against the counter. (c) The middle of the flat spring piece will lie flat with slight pressure of the foot. (d) If the soldier, with pack and rifle on his back, can with- out discomfort pace back and forth in shoes with device in- serted, the shoes will be sufficiently long to allow for foot ex- pansion when device is withdrawn. NOTE. The shoes must in every case pass satisfactorily I he above described test. Shoes of the size indicated by measuring machine, fitted with the proper shoe-fitting device, will be laced snugly ; and the soldier, with a 40-pound burden on his back, will throw his entire weight upon one foot. The officer or enlisted man will grasp with his hand the leather of the shoe over the ball. As his fingers and thumb are brought slowly together over the leather the shoe should feel snugly filled without apparent ten- sion, while the leather should lie smoothly under the hand. If the leather wrinkles under the grasp of the hand the shoe is too wide and a narrower width is needed; if the leather seems tense and bulgy and the hand tends to slip over easily, the shoe is too narrow and a greater width Is necessary. Usually it will be necessary to try on several pairs of shoes in this manner before an entirely satisfactory shoe is secured. No shoes will be issued or worn by enlisted men which are not fitted in accordance with this order. When foot-measuring machines and shoe-measuring devices are not available, the procedure in determining the fact of fit of the shoes will be the same as contained in the preceding para- graph. The officer or enlisted man fitt'ng the shoe will also press in the leather of the shoes in front of the toes to determine the existence of sufficient vacant space in that region to prevent [C. 3, S. II. No. 28.] 3 toe injury. Under no circumstances should this vacant space in front of the great toe be less than two-thirds of an inch, or the width of a man's thumb, nor should there be pressure on top of the toes. Measurements will be taken and shoes will be fitted as soon as practicable after the enlistment or induction of the soldier into the service, and the record will be changed from time to time if subsequent fittings render a change necessary. S zes called for in requisitions will conform to the record, and the fact of fit of shoes and socks issued on such requisition will be personally verified in every instance by a company, troop, battery, or detachment officer. New shoes should be adapted to the contours of the feet as soon as possible. Shoe stretchers, with adjustable knobs to take pressure off painful corns and bunions, are issued by the Quartermaster Corps. All shoes and socks must be properly broken in before begin- ning to march. The following is suggested, but not required : The soldier stands in his new shoes in about 2$ inches of water for about five minutes, until the leather is thoroughly pliable and mo'st; he should then walk for about an hour on the level surface, letting the shoes dry on his feet, to the irregularities of which the leather is thus molded in the same way as it was previously molded over the shoe last. On taking the shoes off a very little neat ? s-foot oil should be rubbed into the leather to prevent its hardening and cracking. If it is desired to waterproof the shoes at any time, a con- siderable amount of dubbin should be rubbed into the leather. Shoes issued to enlisted men will be regularly inspected by company, troop, battery, and detachment commanders to see that waterproofing substance is applied often, and that they are not injured by being placed too near heating apparatus. Heat ruins leather and causes wet leather to decompose rapidly. Light or heavy woolen socks will be worn habitually for marching; the socks will be large enough to permit free move- ment of the toes, but not so loose as to permit of wrinkling. Darned socks or socks with holes will not be worn in marching. (This is not to be construed, however, as prohibiting soldiers from wearing properly darned socks while on ordinary duty, at drill, etc. If on marches two pairs of socks are worn, the outer pair may be darned socks.) Woolen, socks will shrink about one size after being washed a few times. Proper fitting of socks must be secured under personal supervision of a com- pany, troop, or battery officer. Company, troop, battery, and detachment commanders, by frequent inspections and care throughout the year, will main- tain the feet of their men in condition for proper marching. They will cause the proper tr'mming of nails, removal or pnring of corns and callouses, relief of painful bunions, treatment of ingrowing nails and other defects, sending serious cases to the surgeon. [C. 3, S. R. No. 28.) Before a march is undertaken by foot troops, company, troop, battery, and detachment officers will personally inspect the bare feet of their men. While on the march they will per- sonally see each day that their men wash their feet as soon as possible after reaching camp, prick and evacuate blisters, and cover such blisters or excoriations with zinc-oxide plaster supplied by the medical department, applied hot, dust the feet with a foot powder supplied by the medical department, and put on clean socks. Hereafter an undue amount of foot injury and disability from shoes will be regarded as evidence of ineffi- ciency on the part of officers concerned and as causes for investigation. A place will be provided where officers may have shoes fitted for the purpose of determining or verifying the record. For the purpose of fitting, unit supply officer will draw from the camp quartermaster, on memorandum receipt, a try-on set consisting of a complete series of each size and width of shoes furnished for issue. Shoes of this series will be put in stock and issued before they become unserviceable, and will be replaced by new shoes, keeping the series always complete. Company, troop, battery, and detachment commanders will report in writing to the post or regimental commander every instance of failure to secure proper shoes for their command. Post or regimental com- manders will investigate the reasons for and be held responsible as far as lies in their power for the rectification of such defi- ciencies. A brief record of the number of such reports from company, troop, battery, and detachment commanders, and the reason for such deficiencies will be furnished to inspectors at each inspec- tion of the post. Inspections conducted under the provisions of paragraph 889, Army Regulations, will embrace an inquiry into the manner in which this paragraph has been complied with, and the report of inspections will include a statement of all instances of failure on the part of company, troop, battery, and detachment com- manders, to secure proper shoes for their commands and the cause of such failure. (8. R. No. 28, C. No. 3, Sept. 20, 1918.} [421.5, A. G. O.] BY ORDER OF THE SECRETARY OF WAR I PEYTON O. MARCH, General, Chief of Staff, OFFICIAL : P. C. HARRIS, Acting The Adjutant General. : GOVEB.XMEXX PEIXTIXG OFFICE : UNIVEESITY OF CALIFOENIA LIBEAEY, BEEKELEY THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW Books not returned on time are subject to a fine of 50c per volume after the third day overdue, increasing to $1.00 per volume after the sixth day. Books not in demand may be renewed if application is made before expiration of loan period. MAR 27 1943 APR 19 IS' FEB291958 i. 1959 $6? 30 1983 75m-7,'30 Photomount Pamphlet Binder Gay lord Bros. Makers Stockton, Calif. PAT. JAN. 21. 1908 UNIVERSITY OF CALIFORNlAMlIBftARY