28th of December I requested the chief surgeon of the corps to send me a roster of the medical officers on duty in the division, to which he replied that the information was so meager in his office that it was impossible to send anything like a correct list. At this time medical officers and the hospital corps personnel were subject to orders issued not only from Manila, but from brigade commanders, regimental commanders, detachment commanders, by other medical officers, and even at times by the authority of the medical officer himself, and it rarely occurred that an information slip or telegram was sent to the division surgeon announcing these changes. The division commander apparently did not feel authorized to issue orders effecting changes in the status of medical officers in his division on account of the control exercised in Manila, but was very anxious to have the matter properly adjusted. Colonel Greenleaf, the chief surgeon of the corps, recognized the impossibility of arranging these details from Manila and approved of the plan of turning the matter over to the division commander.

Duties of brigade surgeons.—In order to define the functions and prerogatives of brigade surgeons I issued, January 10, 1900, the following circular to them and sent a copy to each medical officer in the division:

"1. Brigade surgeons will keep a roster of medical officers, hospital stewards, acting hospital stewards, privates of the hospital corps, nurses, or other employees of the medical department on duty in their respective brigades.

"II. They will keep the chief surgeon of the division informed by telegraph of any changes affecting the status of medical officers or hospital corps personnel without delay, which information will be transmitted to brigade surgeons by regimental or camp surgeons as soon as such changes occur.

"III. The following reports, etc., will be transmitted to the chief surgeon of the division through the office of the brigade surgeon, viz:

"1. Daily consolidated brigade report of number of sick in quarters, hospital, or absent. When reports can not be obtained for each company in the regiment companies missing should be designated.

"2. Weekly inspection report.

"3. Weekly sick report.

"4. Monthly report of sick and wounded.

"5. Personnel of hospital corps.

"6. Statement of hospital fund.

"7. Monthly report of medical officers, information slips.

"8. List of killed and wounded.

"9. Requisitions for medical and hospital supplies.

"10. Information slips containing all changes in the status of medical officers and personnel of hospital corps.

"11. Telegraphic reports of all deaths belonging to the commands within the brigade.

12. The monthly sanitary report required by regulations should be referred to the brigade surgeon for his information and action."

"IV. Brigade surgeons are expected to make frequent visits to posts and stations within the limits of their brigades for the purpose of inspection, and will make careful inquiries into the administration of regimental and camp hospitals, treatment of the sick, messing, sanitation, medical and hospital supplies, reports, efficiency of medical officers, personnel of hospital corps, and such other matters as may come under their supervision. Frequent reports with recommendations are desired.

"V. All changes in the duties of medical officers and hospital corps personnel. serving in the brigade will be made upon the recommendation of the brigade surgeon, with the approval of the chief surgeon of the division. Where such changes are urgent and the exigencies of the service do not admit of delay, brigade surgeons are authorized to take action at once with the brigade commanders, and report the fact as soon thereafter as practicable.

"VI. Requisitions will be prepared by the regimental surgeons for the entire regiments when practicable and forwarded to the chief surgeon of the division through the brigade surgeons. When necessity demands it, requisitions will be made by wire through the brigade surgeons. Regimental surgeons as a rule should not make requisitions for ordinary medical and hospital supplies oftener than once quarterly." Owing to frequent changes in the stations of medical officers by brigade, regimental, and post commanders, I requested the division commander to issue an order directing that such changes be only made with the approval of the division commander. Telegraphic instructions were sent to brigade commanders on this subject on January 15, but in spite of these orders changes continued to be made without proper authority. On January 26 an order was issued by the division commander which, except in cases of emergency, limited all changes affecting medical officers and hospital corps personnel to division headquarters.

Regimental and post commanders were in the habit of granting leaves of absence to medical officers for the purpose of visiting Manila, and not infrequently officers granting such leaves would immediately make a requisition on the division commander for another medical officer. Owing to the scarcity of surgeons this practice became so frequent that it became necessary to submit the subject to the division commander, who issued the following order:

"The practice of medical officers leaving their stations without informing the chief surgeon having embarrassed the medical administration of the division, such officers will not in future leave their stations, except on duty, without authority from these headquarters."

With the organization of the department came a large increase in territory and troops. By the time this reorganization had occurred the district surgeons had become fairly well acquainted with their administration duties and were in a position to take entire control of the hospital corps of their respective districts. A letter was written to the department commander, recommending that an order be issued to the effect that all changes of this personnel be made by district commanders on the recommendation of district surgeons. The following order was issued on the subject:

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Upon recommendation of the chief surgeon of the department changes affecting stations of medical officers will only be made by authority of department commander. When the case is urgent and the exigencies of the service do not admit of delay such changes may be made by district, regimental, or post commanders, and the facts reported to these headquarters as soon as possible. It is believed that such urgency orders will not be necessary with troops located at points where telegraphic communications may be had. Orders directing changes in stations of members of the hospital corps within each military district will in future be made by district commanders on the recommendation of the chief surgeon of the district. Since the chief surgeon of the department is held responsible for the proper administration of the medical service of this command, district surgeons are directed to notify him immediately after such changes are made.”

This transfer of authority has worked greatly to the advantage of medical administration. It was considered advisable, however, to retain control over the assignments of medical officers in the department.

Regimental surgeons.-Three regimental surgeons, one surgeon with the rank of major, one assistant surgeon with the rank of captain, and one assistant surgeon with the rank of first lieutenant, were included in the organization of each volunteer regiment, but curiously enough, in spite of his rank, the captain was only allowed the pay of the first lieutenant. About one-half of the surgeons of the volunteer regiments were selected from the ranking assistant surgeons of the Regular Army. The same regimental organization was applied to the regular regiments in the division except that the regimental surgeons were taken from the junior assistant surgeons of the Army, and in many instances from the acting assistant surgeons. The colonels and other officers of the regular regiments made frequent complaints as to the invidious distinction of selection of medical officers for regular and volunteers. In accordance with instructions received from the chief surgeon of the corps, the regimental surgeon was directed to make out the monthly report of sick and wounded for the entire regiment, the personnel of the hospital corps, muster rolls for the entire regimental detachment, supply hospital and medical supplies, carry all the hospital property on his papers, etc., which was an impossibility in the majority of cases separated and detached, as most of the companies in each regiment were. Very soon the allowance of regimental surgeons for each regiment became inadequate, owing to the number of posts garrisoned and their distance apart. In a number of instances medical officers had to attend from three to four different stations, varying from 4 to 10 miles apart, and owing to the hostile condition of the country it became necessary for them to take a guard, or run the risk of being shot or boloed. The scarcity of medical officers made the medical administration difficult and unsatisfactory, and resulted in many complaints from line officers. As it was impossible to obtain a sufficient number of surgeons, it became necessary to assign intelligent noncommissioned officers or privates of the hospital corps to these stations. In one instance seven medical officers were assigned to one regiment and still others were needed with it. A very large proportion of the medical officers serving in the division were acting assistant surgeons who evidently had come over for the novelty of the trip. Many of them became tired of their contracts and under various pretexts sought to be sent home. A number became unfit for duty on account of sickness and had to be returned to the States. One acting assistant surgeon, finding that he could not get away honorably, deserted the service. I refer to Dr. Roger T. Atkinson, who was stationed at Abucay. The majority of the medical officers on duty in the division were young and inexperienced. This remark applies to the acting assistant surgeons as well as

those belonging to the volunteers and regular corps. I think the service suffered very much on this account. After regiments had become broken up into eight or a dozen posts it practically became impossible for the regimental surgeon to carry out instructions in regard to monthly reports, etc., for the entire regiment. The following circular was therefore issued February 6, 1900:

"I. Regimental surgeons are no longer required to submit the monthly report of sick and wounded for the entire regiment when companies are serving at different stations. The senior medical officer at each station will submit this report in accordance with existing regulations from the Surgeon-General's Office as printed on inside cover of register for patients. This report will be forwarded direct through the brigade surgeon to this office not later than the 5th of each month. Brigade surgeons will see that they are properly corrected before being transmitted. Reports for regulars and volunteers to be made out separately.

"II. Reports from troops where no medical officer is serving will be prepared by the medical officer having indirect charge. Hospital stewards, acting hospital stewards, or privates having charge of such stations should be provided with blank books for making out the daily sick report, and instructed as far as possible in the detail of preparing the necessary data for the medical officer responsible for the report.

"III. The reports of personnel of the hospital corps will also be prepared and forwarded from each station, where medical officers are serving, direct to this office through brigade surgeons. At stations where no medical officers are serving this report will be made out and forwarded by the medical officer having indirect charge of the station.

"IV. Brigade surgeons will also submit the monthly report of sick and wounded for headquarters of brigade and personnel report for members of the hospital corps serving in their office."

Instructions were also given regimental surgeons in regard to muster rolls for their detachments, and they were authorized to have rolls prepared for each station if deemed advisable. The regimental surgeon was required by a circular issued from corps headquarters to carry all the nonexpendable property issued for use of his regiment on his returns. The complications arising from this ruling frequently led to much dissatisfaction and seemed to a certain extent unjust. In many instances the regimental surgeon had to take up property he had never seen and to account for it, although it had been stolen, lost, or destroyed while not in his possession. In the organization of the various camp hospitals, equipment was sent direct from the supply depot without passing through the hands of the regimental surgeon. After a thorough study, both in garrison and field, I have become thoroughly satisfied that the regimental system of medical officers, generally speaking, is a failure. Whether he serves with volunteers or regulars, the medical officer should belong to the general medical staff, and be so situated that he could be relieved and sent elsewhere should the occasion require it. This should also apply to the hospital corps detachment attached to a regiment. Under the ruling the hospital corps detachment attached to a regiment is supposed to belong to it for the time being and follow the regiment under all circumstances. The constant changes in the personnel of camp hospitals, as a result of this system, worked to the detriment of the medical administration and the care of the sick. During the changes, which were frequently occurring among troops, companies leaving pueblos and replaced by others of different regiments would not only rob the camp hospitals of the personnel, but also dismantle them and carry off all the supplies and equipment. In order to break up this system, I requested the department commander to issue an order to the effect that during such changes the hospital personnel and equipment be left undisturbed, except when authorized to do otherwise by instructions from department headquarters.

Regimental and camp hospitals.—In addition to the regimental hospital organized at the headquarters of the regiment, it became necessary to organize a small hospital for the use of each separate station, except in the case of very small detachments. Medical officers were directed to organize such temporary hospitals in nipa houses or other buildings conveniently located, after a thorough cleansing and disinfection. From 5 to 10 field cots were issued for this purpose, and in many instances these hospitals were equipped with native beds and furniture. In every pueblo suitable buildings were found large enough to accommodate 50 beds if necessary. For all patients in such hospitals a gratuity of 30 cents, Mexican, was allowed from the civil fund in addition to the ration. Medical officers were directed to transfer all serious cases from the regimental and camp hospitals to the permanent field and base hospitals established within the division. Typhoid and malarial fevers, chronic dysentery, chronic diarrhea, and surgical cases requiring special skill were included in this list. Before these camp hospitals were established a large number of all the cases appearing on sick report were sent to the division hospitals or to Manila, and, consequently,

many of these large hospitals were overcrowded with mild cases. These camp hospitals also reduced very greatly the percentage of sickness in the division. A large number of the cases were really not serious enough for transfer to the permanent hospitals, a rest of a few days in camp hospitals on a proper diet being all that was necessary in such cases. It is believed that men sent to Manila, or the permanent hospitals, remained on sick report much longer than necessary in many instances, and in this way kept up the percentage of sick.

Field and base hospitals.-The division hospital was established in the cathedral at Angeles by First Lieut. P. C. Fauntleroy, assistant surgeon, United States Army, September 29, 1899, and has a capacity of 260 beds. The main floor of the church is divided into four aisles, each of which has been converted into a ward. This hospital receives patients from troops stationed south of Angeles, and generally contains from 140 to 160 cases. The pueblo of Angeles is located in a sandy country about 90 feet above the level of the sea and is regarded as a very healthy section of the country. It is located on the railroad running from Manila to Dagupan and is thus favorably situated for the transportation of the sick. The nursing in the hospital is entirely done by members of the hospital corps, which has proven as satisfactory as in other hospitals employing trained female nurses. Lieutenant Fauntleroy is a very capable and painstaking officer, and possesses a high order of executive ability. He deserves great credit for the successful manner in which he has administered this hospital. In addition to his duties with the division hospital, he also is medical supply officer of the department, the depot being located at present in Angeles. Since the department headquarters were removed to Manila, orders have been issued transferring the depot here.

Base hospital, Dagupan,-As a result of General Wheaton's expedition north and campaign through the province of Pangasinan, it became necessary to establish a base hospital at Dagupan. A large building constructed by the Dominican Friars and used for college purposes, was selected for this purpose. This building is located on a tongue of land surrounded on one side by an arm of the sea and the other by a series of salt beds flooded by the ocean and is admirably arranged for hospital purposes. It has a capacity for 375 patients, besides rooms for dispensary offices, stores, diet kitchens, and a large corridor for mess hall. The hospital was established during the month of December, 1899, but was not thoroughly equipped before the 1st of February, 1900. The locality of this hospital makes it a very valuable place for the treatment of malarial and intestinal affections.

Brigade hospitals.-In additon to the division and base hospitals, a hospital for the First Brigade had been established at Tarlac, and one for the Third Brigade at San Isidro. On joining the division I found the First Brigade hospital had degenerated into a regimental hospital for the Ninth Infantry. On an inspection tour made to Tarlac, January 2, I found 49 patients in this hospital, 47 of whom belonged to the Ninth Infantry stationed in that and neighboring pueblos. This hospital was continued as the regimental hospital of the Ninth Infantry; the building which it occupied, the pueblo Presidencia, was well suited for hospital purposes, and was capable of accommodating 80 beds. The Third Brigade hospital at San Isidro, now officially known as the Fourth District hospital, occupies a large building in the center of the town and has a capacity of 75 beds. This hospital was originally established by General Lawton for the First Division during his expedition through Baliuag. At present it serves an excellent purpose for use of troops in San Isidro and those stationed in towns along the Rio Grande de Pampanga.

Division supply depot.-Until February requisitions for medical and hospital supplies were sent direct from regimental surgeons to the chief surgeon of the corps for issue from Manila. About this time so much work had accumulated on the hands of the supply officer in Manila that it became impossible to have requisitions filled with the necessary dispatch in cases of emergency. With the consent of Colonel Greenleaf, I established a medical supply depot for the division in the convent adjoining the division hospital at Angeles. Lieutenant Fauntleroy, the commanding officer of the hospital, was placed in charge. The building selected contained a number of rooms on the ground floor which rendered it specially suitable for depot purposes. Ample requisitions were made on the main depot in Manila, and from about the middle of February the medical officers of the division were supplied from Angeles. Regimental surgeons were directed to forward their requisitions for supplies for the entire regiment quarterly, except when it became necessary to submit specials; they were also authorized to use the wire when necessary. Regimental surgeons, when practicable, drew and issued supplies to the other posts of the regiment, and carried the nonexpendable property on their papers. Owing to the location of portions of the regiment this method could not be carried out, and the medical officers in charge of such troops were authorized to submit their own requisitions. Under these circumstances the medical officers drawing such supplies became responsible for them, it being

impossible for the regimental surgeon to do so. On account of the press of work in the medical supply depot at Manila, the chief surgeon of the corps did not require medical officers receiving supplies to receipt for the expendable articles. This reduced the clerical work very materially. This same system was carried out in the division supply depot. Owing to the regimental system of receipting for medical supplies, Lieutenant Fauntleroy experienced considerable difficulty in obtaining receipts for supplies issued direct to medical officers serving with companies detached from regimental headquarters, and it became necessary to issue a circular on this subject. The medical officer receiving such property was required to send a memorandum receipt of it to the regimental surgeon, and in that way the matter was arranged. Since the department headquarters have been removed to Manila, steps have been taken to remove the department supply depot here also. Owing to the enormous seacoast occupied by troops of this department, and the water transportation necessary, Angeles is no longer a suitable place for this depot.

Division ambulance company.-An ambulance company had been organized for the division during the fall and before the command had begun its campaign north. This company was made up of 6 ambulances, a number of caraboa carts, litters, and a hospital personnel of 1 hospital steward, 2 acting stewards, and 40 privates. The company was under command of Acting Asst. Surg. A. B. Smith, and stationed at Tarlac when I joined the division. I understand it did excellent service in removing the sick and wounded along the line of march during the fall campaign. As there was no further use for such an organization, the troops being divided into one and two company garrisons, this company was disbanded early in January, the ambulances, personnel, etc., being assigned elsewhere.

The

Buildings occupied by troops, camp sanitation, etc.-Owing to the hostile condition of the country and the facilities offered for harboring insurrectos, ladrones, etc., the division commander decided to garrison all the principal pueblos in the limits of the division; hence each regiment was required to cover from six to twelve stations. The majority of the pueblos contain a church and convent, and this property as a rule was taken for the use of the troops, the friars having left the country during the insurrection. Private residences constructed of hard wood or nipa houses were occupied in towns where convents did not exist, and as a rule the troops were well and comfortably housed. A suitable building was also selected for the camp hospital. The sanitation of the towns was extremely bad when our troops entered them. The habitations of the natives as a rule were surrounded by filth of all kinds-slops, garbage, fecal accumulations, rubbish, and other débris. Weeds and rank vegetation were allowed to grow along the fences, in the yards, and in the streets. The native privy consists of a small bamboo house, erected about 5 feet from the ground and located in the yard, and connected with the main house by a bamboo bridge. deposits as they drop are disposed of by the Filipino hog, the scavenger of the island, who usually remains around during the morning hours. Where this arrangement does not exist, the fecal matter is deposited amongst the weeds in the vicinity of the house. The slops and garbage as a rule were thrown to the hogs outside of the door or beneath the house through the open bamboo floor. Each family generally possesses a well, located near the kitchen door and not over 5 or 10 feet deep, the exception being to find them walled. Smallpox was prevalent in nearly every pueblo in the division, and it is questionable whether any house could be found which was not more or less infected. No attempt was made at isolation or disinfection by the natives, and the funerals of those dying of the disease were public in every sense from house to church and cemetery. Under these circumstances it became necessary to take unusual precautions with our troops. Stringent orders in regard to the boiling and filtering of drinking water, disposal of garbage and night soil were issued by the division commander. Post commanders were required to consult with the town presidents and counselors in regard to the sanitary conditions of the towns, and a great reformation was accomplished in this direction. As soon as possible the dry-earth system was introduced throughout the division, the closets being supplied by the quartermaster's department.

Smallpox and public vaccination.-Owing to the prevalence of this disease the following letter was written to the division commander, which resulted in an order for the public vaccination of natives within the limits of the division:

HEADQUARTERS SECOND DIVISION EIGHTH ARMY CORPS,

CHIEF SURGEON'S OFFICE, Bautista, P. I., February 30, 1900.

SIR: I have the honor to state that smallpox is more or less prevalent in every town within the limits of this division, and not rare among our troops as a consequence. I do not believe it possible to stamp out this disease among our soldiers, in spite of the frequent and careful vaccinations practiced among them, until the natives