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.

The

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. 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.

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. The 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

are themselves protected. Owing to the continuous state of warfare that has existed on these islands for some years past, systematic vaccinations have been neglected among the natives, and hence the prevalency of this disease. Medical officers stationed in many of these towns report serious epidemics of this disease, and have been supplied with virus for use among natives in small quantities. While many officers are willing to perform this additional duty, not only for the protection of the men under their charge, but also from motives of humanity, it would seem wise for the military authorities to take this matter under consideration without delay. The natives in many instances are anxious for vaccination and frequently apply to medical officers along the line of railroad and also from interior towns. A systematic and compulsory system of vaccination should be required as far as it is possible within the territory now under our control. It is also believed that arrangements could be made to have these vaccinations performed all over the islands. When the work can not be performed under the direction of the medical officers, in towns where troops are stationed, the services of practicantes can be secured for from $15 to $25, Mexican, per month. The virus and expense of vaccination should be charged to the United States or to civil funds. L. M. MAUS,

Major and Surgeon, U. S. Army, Chief Surgeon.

The ADJUTANT-GENERAL SECOND DIVISION, EIGHTH ARMY CORPS.

This communication received the hearty approval of General MacArthur, the division commander, and the chief surgeon of the corps. I was directed by the corps commander to institute as quickly as possible a system for the protection of the natives of the division, which was to be paid for out of the civil funds. Although our men had been frequently vaccinated, numerous cases of smallpox were reported from day to day among them, and not infrequently a number of deaths. It is my opinion that before the public vaccinations were instituted as many as forty or fifty cases of smallpox were being daily treated in the division among the troops, while in some of the towns the disease was practically epidemic among the natives and deaths very common. Circular letters of instruction were written to brigade surgeons, as well as to medical officers, in regard to the matter of procedure, etc. They were authorized to hire native vaccinators at $30 Mexican per month and inspectors at the rate of $40. No limit was placed on the number of vaccinators for each pueblo, this depending on the amount of work required. Virus was furnished in abundance on telegraphic requisitions to the board of health, Manila. The following circular was sent February 17, 1900, to all medical officers in the division:

"I. Medical officers on duty in this division are directed to superintend the vaccination of natives in towns where troops are stationed, and are also expected to exercise control over towns and barrios in their respective neighborhoods. They will confer with the city authorities in the regard to the selection of a suitable place for these vaccinations and best method for gathering the inhabitants together for this purpose. Medical officers are specially cautioned in regard to proper instructions for cleansing arms, instruments, and performing the operations. Soap, nailbrushes, bichloride tablets, gauze, and blank books should be provided vaccinators. These articles can be secured from Manila on properly prepared requisitions, the cost of which is defrayed by the civil fund. Before vaccination the arm should be thoroughly washed with soap and scrubbed with a nailbrush, afterwards rinsed in boiling water. In case an antiseptic solution is used, care should be observed that it is carefully washed off before the operation. The arm should be left uncovered at least thirty minutes after vaccination, until it becomes dry and glazed over. The process of vaccination of large numbers may be greatly facilitated by systematizing the work— that is, assigning a certain portion of the work to each individual; for instance, one for washing arms, a second for preparing the spot for vaccination, and a third for inserting the lymph. A fourth person should be employed for keeping the records of those vaccinated. A record of every case will be kept and records forwarded to this office after completion of work."

The vaccinators were paid on rolls forwarded to the division supply officer, who had charge of the disbursement of the civil funds for vaccination and purchase of drugs for indigent natives. In order to lend official sanction to this work and secure the cooperation of the commanding officers in the various pueblos, the following order was issued from division headquarters:

GENERAL ORDERS,

No. 15.

}

HEADQUARTERS SECOND DIVISION

EIGHTH ARMY CORPS, Bautista, P. I., February 17, 1900.

1. The work of vaccinating the native population within the limits of this division being now in progress under the supervision of the chief surgeon, commanding officers

will cooperate with the medical department and render all assistance possible in the prosecution of the work.

By command of Major-General MacArthur:

BENJAMIN ALVORD, Assistant Adjutant-General.

The work of public vaccinations was fairly started February 20 and was industriously pushed by the medical officers in charge. The board of health, Manila, usually kept an abundance of fresh virus on hand and responded promptly to requisitions for it. There was very little objection on the part of the natives, probably no more than would have occurred among the same number of Americans. The insurgents objected to these public vaccinations in several of the pueblos, manifesting their disapproval by kidnapping the vaccinators.

District surgeons are required to render a report of work done in their respective districts after the completion of the work. The work is still going on, but the following reports show what was accomplished in each district from February 20 until May 31.

The first and second districts were not attached to the division until it was merged into a department in April, and owing to the poor mail facilities and uncertain transportation of virus little was accomplished in these districts before I was relieved as chief surgeon. Much of the virus sent to them became inert before it reached its destination.

Hospital cars. As the army advanced north the Manila and Dagupan Railroad was rehabilitated, and proved invaluable not only for the transportation of troops and supplies, but for the sick and wounded of the division as well. Ordinary freight cars provided with mattresses, blankets, pillows, etc., were first utilized for this purpose, but upon proper representation to the corps commander authority was obtained to fit up two long freight cars for hospital purposes. The division hospital was located at Angeles, 50 miles north of Manila, and all patients south of that point were sent to the division hospital. The base hospital at Dagupan, 70 miles farther north, received all patients north of Angeles. The hospital cars were fitted up with eight superimposed woven-wire bottom berths, racks for medical and surgical supplies, ice box for preserving milk and other foods, and a water-closet. Each car was provided with one acting steward and two privates, one of whom was a supernumerary. These cars made daily trips between Manila and Dagupan and served a most useful purpose. The following letter was embodied in an order by the department commander and issued as hospital car regulations:

HEADQUARTERS SECOND DIVISION EIGHTH ARMY CORPS,
CHIEF SURGEON'S OFFICE,

Bautista, P. I., April 18, 1900.

SIR: In order to more properly organize the hospital railway service for this department, I have the honor to recommend that a circular letter of instruction embodying the following rules and regulations be published for the information and guidance of all concerned:

1. The railway service in connection with the transportation of the sick and wounded will be under charge of the chief surgeon of the department and subject to his instructions.

2. The personnel of each hospital car will consist of one acting hospital steward and two privates of the hospital corps, one of whom shall be a supernumerary. They will be attached to the department hospital at Angeles for muster, pay, clothing, etc., and will be carried on the rolls of that hospital. When relieved from temporary or permanent duty with the hospital car service they will report to the commanding officer there for duty.

3. The acting hospital steward, or senior private, present in charge will be held responsible for the proper administration of this service and the care of the sick during transfer to their destination. He will keep a daily report, in a blank book provided for this purpose, of every one transferred, stating name, rank, company, regiment, corps, diagnosis, and place of destination. Where casuals are transferred without transfer slips, the cause, as far as possible, will be noted in the report. A copy of this report of each day will be transmitted to the chief surgeon of the department.

4. A daily inspection of the hospital car service will be made by a medical officer belonging to the staff of the department hospital at Angeles, under the directions of the commanding officer. He will examine into the condition of the service, see that the medical supplies and equipment of each car are properly maintained, report necessary repairs to cars, and make such recommendations as may be necessary for changes in the personnel.

5. No person will be permitted to travel on the hospital cars except the attendants and the authorized sick. Officers or soldiers taken sick en route, or found along the line, should be transferred in hospital cars, though having no transfer slips. The name of any officer, soldier, or citizen violating this regulation will be reported to the chief surgeon of the department.

6. Except medical supplies in small quantities for emergency use, and ice for hospitals, no articles will be shipped in hospital cars. L. M. MAUS,

Major and Surgeon, U. S. Army, Chief Surgeon. The ADJUTANT-GENERAL, SECOND DIVISION EIGHTH ARMY CORPS.

Public distribution of medicines to indigent natives-free dispensaries.—As a result of the recent wars, a large proportion of the natives had become impoverished, run down in health, and greatly in need of medicines. Practically no practitioners of medicine could be found in the country, and very few drug stores. Pernicious malarial fever was not uncommon among them, and deaths from that cause not infrequent. The only quinine available in the country was that supplied to the troops. In the pueblo of Mexico, province of Pampanga, twelve natives died from pernicious malarial fever in one week. Fifty ounces of quinine were sent there for distribution in charge of a medical officer, and the medicine dispensed on the main plaza. The judicious use of this medicine, together with a thorough overhauling of the sanitary condition of the city, relieved the situation. The condition of the people in this respect was represented to the division commander, and $20,000 Mexican requested to purchase medicines for the indigent poor. The application was approved and the money was turned over to the division supply officer. A supply of quinine, vaseline, carbolic acid, gauze bandages, bismuth, etc., was sent to sixty-six pueblos, and by these means great good was accomplished.

Prevailing diseases.-Malarial fever and intestinal diseases comprise about 60 per cent of all the diseases occurring on the island of Luzon. The malarial parasite is probably responsible for at least one-half of all the sickness, while next in order are diarrhea and gastric disorders. Dysentery is also common, but not so frequent as diarrhea; perhaps 25 per cent of the dysenteries are of the amoebic variety. Dhobie itch (tinea circinata) is not as common as generally supposed. Smallpox is very common among the natives, and while quite fatal, appears not to be dreaded. I think that 50 per cent of the living population have had the disease. Leprosy is widely scattered over the archipelago, an estimate of 30,000 cases having been made on good statistical authority. Beriberi is frequent during the rainy season. tarrhal diseases are also quite common, especially chronic inflammation of the nose, throat, and bronchial tubes. Pulmonary tuberculosis is also a widespread disease among the natives.

Ca

The large percentage of malarial fevers and intestinal diseases contracted by the troops was due to numerous "hikes" after insurrectos and ladrones under the most unfavorable hygienic conditions. While on these trips the men waded through swamps and flooded rice fields, drank water from all sources, ate poorly prepared food, and slept in wet clothes. They were also exposed at times to the sun's rays during the heat of the day. These conditions will in all probability not occur again, and if so, will be confined to only a small per cent of the troops, hence the general average of the mens' health should be better in the future. From my experience with troops that have been stationed here under favorable conditions, and with good hygienic surroundings, I am satisfied that a high standard of health can be maintained among them. During the acclimatizing process everyone is liable to lose his superfluous flesh, but that is rather an advantage. When proper barracks and living facilities are prepared in the Philippines for our troops and their duty is confined to