Cuba; on her second and third those at Ponce, Puerto Rico. She carried in all on these three trips 704 patients. Her next service was between Savannah, Ga., and Havana, Cuba. On the second visit to the latter place she remained for two months on duty as a floating hospital.

Her gratuitous service on the Atlantic coast ended early in May, when she was purchased by the Government and sent to Brooklyn, N. Y., to be put in thoroughly good condition for duty in connection with military operations in the Philippine Islands. She sailed for Manila by the eastern route September 30, 1899, with a medical staff consisting of 4 medical officers, 2 acting assistant surgeons, 2 hospital stewards, 7 acting hospital stewards, 47 privates of the hospital corps, 11 contract nurses (male), 1 chief cook and 4 assistants, 1 laundryman, and 3 cabin boys. She carried a large amount of medicines and medical and hospital supplies and property, and had on board as passengers 2 medical officers of the Army, 2 hospital stewards, 3 acting hospital stewards, and 149 privates of the hospital corps en route for service with the Eighth Army Corps.

The hospital ship Aid was purchased from the Massachusetts Volunteer Aid Association in November, 1898. This vessel, formerly a fruit steamer, had been fitted up at considerable expense by the people of Massachusetts, and under the name of the Bay State was reported to have done good work during the previous summer. It was found, however, after a short experience during the occasionally severe weather of the winter months, that her motion in a seaway was such as to render her unsuitable for the transportation of sick. While in New York Harbor getting ready for sea her ice machine exploded, killing 1 man, injuring 11 others, and causing much damage to her machinery. Her first voyage was with medical supplies to Santiago, Cuba, which she reached December 24, 1898. Thence she proceeded to Kingston, Jamaica, and Havana, Cuba, returning to Savannah, Ga., for more supplies January 24, 1899. She was then ordered to Cienfuegos, Cuba, the intention being to use her as a supply ship and floating hospital for posts on the southern coast of the island, but early in March, having suffered considerable damage from storms, her commanding officer, Capt. A. N. Stark, assistant surgeon, United States Army, was directed to take her to Newport News, Va., for repairs. Here she was turned over to the Quartermaster's Department and her hospital property and personnel were carried by the Missouri to Havana, Cuba, to be used in outfitting the transport Terry as an extemporized hospital ship.

SANITARY REPORTS AND INSPECTIONS.

In view of the difficulty experienced in learning through chief surgeons of corps and departments the sanitary condition and sick rates affecting individual regiments in the field, temporary garrisons, and detachments, I called, in General Orders, No. 194, Adjutant-General's Office, December 31, 1898, on medical officers serving in the field or at temporary stations for a weekly sanitary report of the commands with which they were serving, these reports to contain a reference only to existing insanitary conditions and to be forwarded through military channels to the Adjutant-General of the Army, after the manner of monthly reports rendered from permanent posts, under Army Regulation 1393. The object of these weekly reports was to obtain prompt action by local authorities on such conditions as lay within their jurisdiction. They effected this object admirably in securing the removal

of many faults in the sanitation of camps which would otherwise have had a powerful influence in augmenting the sick lists of the Army. About the same time Col. Charles R. Greenleaf, assistant surgeongeneral, United States Army, was assigned to duty as medical inspector of the Army. His duties were defined in a communication

dated December 2, 1898, as follows:

In the discharge of your duties as medical inspector of the Army you are expected to report to me upon the sanitary condition and wants of troops in the field, at military posts, and in general hospitals, and as regards the skill, efficiency, and conduct of officers, enlisted men, and civilian employees connected with the Medical Department.

You will see that the existing orders and regulations relating to the Medical Department are complied with, and that all prescribed reports and returns are promptly made and forwarded when due.

You will examine into the quality, quantity, and condition of medical and hospital supplies, reporting any failure on the part of responsible medical officers to make proper requisitions and any deficiencies found due to failure on the part of supply officers to promptly fill approved requisitions.

You will ascertain what diseases are most prevalent in the camps visited by you, and will inquire into the cause for such prevalence and the steps which have been taken for the prevention or arrest of any infectious diseases which may exist, indicating verbally or in writing to the responsible medical officers such additional measures or precautions as may be requisite. When sanitary reforms requiring the sanction and cooperation of military authorities are urgently demanded you will report at once, in writing, to the officer commanding the military department, corps, division, or camp, calling his attention to the facts and recommending such measures as you consider necessary for the relief of insanitary conditions existing. A duplicate of such report should be forwarded to the Surgeon-General of the Army.

You will ascertain whether medical supplies are properly used and with a due regard to economy; whether any additional articles not now included in our supply table are necessary for the treatment of the sick; whether the equipment of regimental hospitals is such as is contemplated by recent orders; whether cases of infectious diseases or of soldiers seriously ill are improperly retained in regimental hospitals; whether division hospitals are fully equipped as regards supplies, medical officers, and attendants to properly care for the sick of the command to which they belong, and whether contract surgeons have been examined as prescribed by recent orders.

You will give special attention to diet kitchens and see that they are equipped for providing the sick with suitable diet.

You will ascertain whether a proper use is made of the fund provided for the purchase of suitable articles of diet for the sick, as prescribed in General Orders, No. 116, and whether the Subsistence Department has on hand for sale such articles as are necessary.

You will inquire as to the sufficiency of tents, ambulances, and other articles furnished by the Quartermaster's Department.

You will report any abuses or deficiencies existing to the commanding general of the department, corps, division, camp, or military post, sending a duplicate of the report to the Surgeon-General of the Army.

You will also report upon the professional competence, attention to duty, and general qualifications of medical officers, calling the attention of the SurgeonGeneral to those who deserve commendation, and also to those who are considered incompetent or for any reason undesirable members of the Medical Department. You will give special attention to the efficiency of the hospital corps, reporting whether proper discipline is maintained and proper instruction given in all that pertains to the duties of enlisted men of that corps.

In a report by Col. Charles Greenleaf, dated San Francisco, Cal., July 31, 1899, he gives the following satisfactory summary of the conditions observed during his various inspections:

My first inspection was made between December 6 and December 21, 1898, and had for its principal objects the outfitting of the medical department of the Seventh Army Corps, then at Savannah, Ga., en route for Cuba, and the establishment of regimental hospitals in the various camps throughout the Southern States.

The next inspection was made between January 4 and January 29, 1899, and was in continuation of the former duty and to examine the transport and medical-supply service at San Francisco, Cal. The next inspection, between February 2, 1899,

and March 12, 1899, was to examine the various military stations occupied by United States troops in Cuba, with a view to their sanitary condition, and particularly to determine the fitness of Spanish military buildings for occupancy and to advise as to their disinfection and repair. The next journey was made between March 12, 1899, and May 19, 1899, and was for the purpose of inspecting the general hospitals at Fortress Monroe and Atlanta, the field hospital at Greenville, S. C., the hospital ship Aid at Newport News, Va., and the camp at Savannah, Ga., of the volunteer troops returning from Cuba for muster out. The next journey was made between May 22, 1899, and May 25, 1899, to Camp Meade, Pa., to supervise the sanitation of the muster-out camp at that place, and the next, on June 5, 1899, was to perform a similar duty in the Model Camp at San Francisco, Cal.

One of the most noticeable features at these inspections was the improvement in the methods of sanitary administration for the troops that were in camps and in the field. The privy pit had given place to the box system, with dry earth and lime as disinfectants, and at a later date this was in turn displaced by the trough system now coming into general use, with milk of lime as its disinfectant. The excreta in the box system was removed by civilian labor and disposed of either by cremation, by burying, or by fertilizing, and in the trough system it was removed in odorless excavating carts, also under the charge of civilian employees. Urine tubs placed in company streets for night service are coming into general use, avoiding ground pollution of camps. Kitchen garbage and camp refuse are cremated or hauled to distant points, and tents, bedding, and company streets are now policed by details from the troops under regimental orders. These methods have been effective, however, only through the constant vigilance of regimental officers and their requirement of strict obedience to regulations for cleanliness. It has become evident that until the men of our Army have been seasoned by service in the field and have become disciplined soldiers no dependence can be placed upon them for camp sanitation. The untrained American soldier, whether regular or volunteer, will never perform the duty of scavenger except under compulsion; and unless that duty is performed willingly and thoroughly, the troops will suffer from disease. Civilian help was often called on to take the place of soldier labor for this purpose; sometimes it was paid for by voluntary contribution in regiments, sometimes by individuals, and sometimes by the quartermaster's department. This latter method has, by sheer necessity, gradually become universal and should be adopted by official recognition from the War Department. The personal cleanliness of the men was occasionally provided for by constructing bath houses containing shower baths and requiring a systematic use of them. The lack of facilities for securing personal cleanliness to the soldier is much to be regretted; he has no tub in which his clothing can be washed, no means by which it may be boiled, and little or no means by which his person may be washed. These should all be furnished for his use as a part of the official equipment of the company to which he belongs. As a rule, I found that regimental officers, both regular and volunteer, were not sufficiently alive to the necessity of cooperation with the medical officer in securing health conditions for their men. Medical officers have done their whole duty as the official advisers in sanitary matters, but the officers who should have carried out health measures have too often disregarded this advice and either not followed it at all or have been so indifferent in the matter that their work has been barren of results.

Division and field hospitals were well organized and equipped, although their personnel was in many instances not satisfactory, particularly as to the men of the hospital corps, many of whom were inefficient and untrustworthy, and with the prospect of an early muster out of the services before them, had no interest in their work. This feeling, indeed, extended itself occasionally to medical officers, who performed their duty in a perfunctory manner. The sick were, however, well cared for; female nurses, who were zealous and faithful, and whose professional efficiency was generally assured, rendering valuable service. The equipment of regimental hospitals was somewhat delayed by the disinclination of medical officers to burden themselves with the necessary property responsibility, but at the time the order for their establishment was issued, the division, field, and general hospitals were in good working order and furnished ample accomodations for the sick.

Medical supplies were ample, and in many instances in great excess over the needs of the troops, through injudicious requisition from medical officers, who feared that the exigencies of foreign service might leave them without the necessary material to care for the sick. Occasionally there was delay in filling requisitions from supply depots, notably from the one in New York, but the authorization of local purchases relieved present necessities, and in no case did I hear of suffering from lack of supply.

There was often laxity in methods of dispensing medicines, which were occa