APPENDIX K. HEADQUARTERS DEPARTMENT OF THE COLORADO. Chief Surgeon’s Office. To The Adjutant General. Department of the Coloi'ado: Sir: I have the honor to present for the information of the De- partment Commander this report of the Medical Department for the fiscal year, 1896. The mean strength of the command for the year, as re- ported by the medical officers, was: officers, 172; enlisted men, white, 2,443, colored, 603, total 3,046; aggregate, 3,218. There were no Indian soldiers. These figures are probably some- what less than those of the military returns, because there are always a few detached officers and men not within the imme- diate observation of the medical department. Nevertheless, as any genuine illness or accident among these would ulti- mately be reported, the vital statistics that follow may be de- pended upon as not unduly favorable. Inasmuch as, especially in peace, officers and men are prac- tically distinct classes, differentiated by conditions of social life and of duty, their statistics are presented separately. The 172 officers of all grades present represented 62,952 days of possible duty. These officers lost 800 days by sickness and 141 by injury; total ineffective 941, or an average of 5.47 days per officer. In addition to the foregoing there were 11 officers belonging to the department outside of its limits on account of sickness 1,439 days. There were also two other officers, dropped from the medical reports when transferred, in the Government Hos- pital for the Insane 'a part of this time, one of whom was wholly retired. One officer died from disease contracted on duty. Denver, Colorado, August 8, 1896. The principal sickness of officers present was: 2 Character of Disability. Days lost. 99 113 Diseases of the Digestive System 75 Hemorrhoids (6 cases 1 135 Diseases of the respiratory organs 79 Bright’s disease (one case) 122 Total 623 The other sicknesses were not important in character or duration. The death was from influenza complicated with pleurisj'. The ineffectiveness by injury was: Contusions and sprains 80 days, fractures 30 days, and the remaining 31 days taken up with six other conditions of a few days each. Twelve officers were absent on account of sickness 1,439 days; the causes and periods were: Malarial cachexia (one case) 123 days. Glycosuria (one case) 123 “ Diseases of the nervous system 477 “ Surgical diseases of the bowels 422 “ Abscess of the lung 48 “ Chronic nephritis (Bright’s disease), two cases 172 “ Chronic rheumatism 74 “ At the close of the fiscal year two officers, both apparently permanently disabled, were absent sick. The ineffectiveness of the enlisted men, excluding 5 sent into the department for treatment and including to the date of their departure 23 transferred out of the department, reckoned by days, was: 27,130 5,542 12,227 20,286 159 Colored Infantry H. C.and N. C. S Total 32,672 Total 32,672 This represents for the department at large a daily loss of 89.27 days, or a yearly loss per man of 10.72 days. That is, the percentage of constantly ineffective from all causes was 2.93. In detail it is white 3.03, colored 2 51. Unfortunately there are no figures at my disposal that show the strength by arms, consequently the interesting relation of ineffectiveness to branch of the service cannot be represented. This ineffectiveness consisted of 26,023 days or 8.54 per man on duty, and 6,649 or 2.18 per man not on duty. It was made up of 17,713 days’ sickness on duty, or 5.81 per man, and 8,310 days’ injury on duty or 2.73 per man, and 5,666 days’ sickness not on duty or 1.86 per man and 983 days’ injury not on duty or .32 per man. Although it is customary to show the whole number of ad- missions to sick report and also by the thousand of strength, I do not regard such figures of any real importance, because there is no necessary or indeed actual relation between the cases and the days lost; that is, between the admissions and the ineffectiveness. A case of colic and one of typhoid fever would each represent an admission, but their respective in- effectiveness might be one day and seventy. Nevertheless, the actual admissions were for sickness 2,527 or 830 per M., for injury 887 or 291 per M., total 3,414 or 1,121 per thousand. Of the ineffectiveness from sickness in the line of duty 859 days were lost by vaccinia, due to the direct transfer of un- vaccinated recruits to the posts. Although this is true mili- tary ineffectiveness, it should always be disregarded in consid- ering the healthfulness of a station or of a command. It is an incident of the service, not a condition of the post. The more important classes of disease incurred in the line of duty bore the following relation to the various posts: EPIDEMIC INFLUENZA. POST. Mean Strength Days Lost. Percentage constantly ineffective. 261 96 .10 368 148 .11 265 160 .17 600 662 .30 3046 1066 .96 AFFECTIONS OF THE LUNGS. 110 7 .017 310 74 C65 600 215 .038 261 96 .10 496 245 .134 368 172 .135 297 181 .16 254 160 .17 265 228 .237 3046 1378 .124 MALARIAL DISEASES. 265 332 .34 2781 703 .07 8046 1035 .09 AFFECTIONS OF THE BOWELS. POST. Mean Strength. Days Lost. Percentage constantly ineffective. DuChesne 110 33 .082 Bayard 368 113 .085 Douglas 49C 367 .202 Whipple 261 193 .203 Wingate 265 209 .217 Logan 600 525 .239 Giant 310 392 .26 Huachuca 254 120 .27 San Carlos 47 54 .314 Apache 297 376 .346 Department 3046 2292 .205 RHEUMATISM, ARTICULAR AND MUSCULAR. Apache 297 38 .035 Logan 600 358 .106 San Carlos 47 23 .134 Grant 310 157 .14 Whipple 261 146 .153 Bayard 368 258 .19 Douglas 496 373 .205 DuChesne 110 86 .21 Huachuca 254 374 .40 Wingate 265 592 .615 Department 3046 2405 .216 Thirteen cases of typhoid fever occurred among the men at three posts, with an aggregate loss of 674 days. This is equiv- alent to a daily ineffectiveness, distributed throughout the De- partment, of .06 per cent. But as is well known, the military gravity of typhoid fever depends upon its duration and its fatality. The mortality was two, or about 15.4 per cent, of those treated. The principal daily loss from disease not incurred in the line of duty was of venereal or alcoholic origin, or existed before enlistment. This loss is shown in the following table, but as the injuries following alcoholism are also included in a later table, care must be taken not to combine these in judging of the total in- effectiveness not in the line of duty. Days lost by diseases not incurred in the line of duty includ- ing all the effects of alcoholism with percentage of mean strength. POSTS. From Alcohol. From Venereal. From other Diseases. Total. Days lost. Percentage Days lost. Percentage. Days lost. Percentage. Days lost. Percentage. 2 .017 2 .017 Wingate 68 .071 200 .21 268 .278 DuChesne 3 .007 125 .31 128 .318 Apache 56 .05 309 .28 9 .008 374 .314 Whipple 108 .113 249 .27 8 .008 365 .382 Douglas 68 .04 583 .32 94 .052 745 .410 Huachuca 27 .029 305 .33 70 .075 402 .432 Grant 37 .03 437 .39 71 .063 545 .480 92 .53 2 .012 94 .546 Bayard 27 .02 722 .54 76 .056 825 .612 Logan 231 .105 1652 .75 199 .091 2082 .948 Department 625 .056 4674 .42 531 .048 5830 .523 The loss by days from injuries in the line of duty, subdivided by classes and arranged by posts in the order of constant ineffec- tiveness is,— Department Stanton Huachuca Whipple Bayard Douglas Logan DuChesne San Carlos Wingate Grant Apache POSTS. ss zo 53 26 18 80 8 20 52 9 113 Abrasions. Days Lost. 3459 14 100 79 433 442 771 162 27 346 514 571 Contusions and sprains. 1277 Fractures. CO 00 a> 47 63 36 140 Gun shot wounds. 1746 M M M W M M u M iHw-—k CO Cft -3 071 <£*■ OdwiogsOo-^h-^cs^c;'^ Wounds not gun shot. 1163 1 50 96 153 83 97 20 27 252 141 244 Other injuries. 8310 18 331 382 805 1088 1344 284 162 997 1249 1650 Total. & .150 .356 .400 .598 .599 .612 .705 .942 1.035 1.101 1.519 Percentage ineffective. None of the wounds, gun shot or other, was received in action. The increased interest in athletics is responsible for part of the contusions and sprains. The loss by days from injuries not in the line of duty, arranged as in the last table, is: Department San Carlos Stanton DuChesne Bayard Grant Douglas Apache Wingate Huachuca Whipple Logan POSTS. j- 09 * * • • «© Abrasions. Days Lost. 8 -J 5 39 65 23 34 22 109 Contusions and Sprains. CO 33 57 84 23 Fractures. H* zn 19 68 28 Gun Shot Wounds. 00 CO 15 45 5 11 46 5 a5 12 15 Wounds not gun shot. —1 *•> 24 38 5 107 Other Injuries. s M • iK00C0O5-JO®00©C?** Total. 8 .037 .04 .06 .078 .098 .099 .111 .124 .129 Percentage ineffective. The loss by days from all causes combined among the enlisted men, arranged in the order of constant ineffectiveness, was as follows: POSTS. From Sickness. From Injury. Sickness and Injury combined. Possible number of days on duty. Percen tage con- , stantly ineffective In line of duty. Not in line of duty. Total. In line of duty. Not in line of duty. Total. In line of duty. Not in line of duty. Aggregate. 35 2 37 18 18 53 2 55 12018 .782 DuChesne 459 128 587 284 15 299 743 143 886 40260 2.201 Bayard . 1689 831 2520 805 50 855 2494 881 3375 134688 2.506 Douglas 2595 726 3321 101S8 [ 142 1230 3683 868 4551 181536 2.507 Huachuca 1509 400 1909 332 103 435 1841 503 2344 92964 2.521 Whipple 1710 359 2069 382 118 500 2092 477 2569 95526 2.689 218 94 312 162 162 380 94 474 17202 2.755 Grant 1265 577 1842 1248 68 1316 2513 645 3158 113460 2.785 Apache 1405 355 1760 1647 107 1754 3052 462 3514 108702 3.233 Logan 4372 1983 6355 1349 284 1633 5721 2267 7988 219600 3.638 Wingate 2456 211 2667 j 995 98 1091 3451 307 3758 98330 3.901 Department 17713 5666 23379 8310 9S3 9293 26023 6649 32672 1114836 2.849 * Fort Stanton was discontinued 16th January, 1896. The actual number of days lost is given, but the possible days of duty and the percentage of ineffectiveness are calculated upon the basis of a completed year. The deaths of the enlisted men were seventeen, distributed as follows: a 3 tl C Whipple. Grant. 6 a ■ s 5 3 Q 3 ii Q (- 3 3 cc j Apache. j Huuchnca. I _o ~£ cd 3 3 G 3 tL Tota i 1 o 1 i 1 i i 1 Alcoholism (not on sick rop.) i i 1 i 1 i 1 i 2 2 2 2 Suicide 2 1 l 4 1 3 3 i 3 1 1 2 1 l 17 Of diseases actually treated there were eight fatal cases, Seven of the other deaths were immediate with no possibility cf treatment, and two promptly followed serious injury to the brain. The remaining seven cases of original disease repre- sent .316 percentage of the admissions. The tetanus following gun shot was .113 per cent, of the injuries admitted. Discharges for disability: including cases discharged by order as well as on formal certificates, and those transferred to the Government Hospital for the Insane: Occurring in line of duty. Occurring not: in line of duty. Rheumatic fever 1 Tuberculosis of lungs 1 Before enlistment. Syphilis 11 1 before enlistment Gonorrhoea 2 Alcoholism, chronic, 1 Epilepsy 1 Before enlistment. Insanity 2 Paralysis 1 Neuralgia 1 1 Paresis 1 Somnambulism 1 Before enlistment. Enteritis 1 Appendicitis, chronic, 1 Before enlistment. Valvular disease of the heart 2 1 Before enlistment. Bronchitis 1 Nephritis, chronic, 1 Before enlistment. Varicocele 1 Before enlistment. Chronic rheumatic arthritis 1* Splay feet 2 Before enlistment. Chronic inflammation eyelids 1 Before enlistment Opacity of the cornea 1 Inflammation middle ear 1 Concussion of the spine 1 Contusions and sprains 3* Fractures at Hernia, inguinal, 2 Loss of fingers by injury 3 Wound, punctured, 1 Wounds, gun shot, Chronic inflammation foot after! wounds by cactus spines ) 2 1* Total 28 25 * 1 at Army and Navy General Hospital. 11 at Jefferson Barracks. Eighteen men were transferred for treatment to the Army and Navy General Hospital at Hot Springs, Ark., and at the commencement of the year there were five cases from this Department in that Hosiptal, making twentj’-three to be ac- counted for. Of these fifteen were returned to duty, four were discharged for disability, including one at Jefferson Barracks whither he had been sent for trial, and four remained there under treatment. Of those returned to duty two have since been discharged for disability. The total loss to the service by physical disability has been 5.548 per thousand by deaths and 17.30 per thousand by dis- charges, total 22 52 per thousand. Of those not in the line of duty five of the deaths were from homicide or suicide, and one from alcoholism not on sick report. The total deaths in the line of duty are therefore 2 937 per thousand. The ratio per thousand of discharges for disability in the line of duty, including those discharged after transfer to the General Hospital, was 9.14. The rate of discharge per thousand for disability not in the line of duty was 8.16, and about three per thousand of these were discharged for disabilities that might have been detected by ordinary observation at a depot. The rate of discharge as reported last year was 3.49 per thousand less than that of this year, but the former statistics did not include the cases of disability discharged by order nor those discharged at the General Hospital. It is neither the form nor the place of a discharge but the reason for it that should admit it among such statistics as these. One man was sent to Fort Leavenworth to be operated upon for hernia, concerning whom no report has been received. The death rate from all causes is 1.35 per thousand in excess of that reported for 1895. This appears to depend upon an increase in suicides and very severe accidents. The formal reports required by the medical regulations are very full in every particular of the military history and the character of the disability in each case, but there is no analy- sis of the mass of details by which the number of disabilities of one kind or the im ffectiveness from each group can be de- termined at once. With the assent of the Department Com- mander there has been required from medical officers a nu- merical report of disabled enlisted men, showing the number of cases of each kind of disease and injury admitted and treated during the month, the days lost and the disposition of the cases. These reports are consolidated in this office to show for each post the days lost by sickness and by injury and whether on duty or not, with the percentage of ineffectiveness, and this information has been furnished the medical officers monthly. Every post retains a copy of its own numerical re- port. Those on file in this office permit easy comparison of the character of the various disabilities month by month, and the published summaries afford a basis of comparison, not only as to the condition of the posts among themselves but also for every post with itself at different seasons. A preceding table has given the constant disability from all causes combined, which shows the daily military ineffective- ness at each post. But the sanitary ineffectiveness is, speaking generally, that from disease alone. Omitting Fort Stanton, discontinued in January and garrisoned by only a single troop of cavalry but marked by very high effectiveness, the rela- tions of the various posts to each other and to the general health of the Department, for sickness and for injury sepa- rately are: POSTS. Percentage of constant ineffectiveness from sickness. POSTS. Percentage of constant ineffectiveness from injury. 1.458 .468 1.619 .523 1.623 .635 1.813 .677 1.829 .743 1.871 .744 2.053 .942 2.166 1 133 2.768 1 160 2.894 1 616 Department 2.177 Department .841 FORT APACHE, A. T. The sick rate at Fort Apache has been very low, but the post is very far down in the list of combined ineffectiveness owing to its inordinately high rate of injuries. The relative ineffec' tiveness from injury places this post at the bottom of the list with nearly double the percentage of the department at large. FORT BAYARD, N. M. Notwithstanding Fort Bayard has a very imperfect system of sewage disposal and is believed by the Surgeon to be under constant risk from that source, it has maintained a very cred- itable relative position. Fort Bayard suffered from a moderate epidemic of influenza but from no other general morbific cause. Repeated intelligent explanation of the state of the sewerage, supported at this office, has secured no relief. There is reason to fear an outbreak of disease may occur should the sewage be- come infected. FORT DOUGLAS, UTAH. An increased water supply has been introduced within the year. The disposition of the sewage which has long been a vexed question is yet unsettled. In 1892 the Medical Director of the Department to which Fort Douglas then belonged re- peated his former recommendation that the sewage should be disposed of by sub-surface irrigation. The surgeon there has independently made the same recommendation, which has been approved in tb'13 office, but no final action has been taken. The ventilation of the barracks has been much improved by simple measures initiated by the medical officer, and it is be- lieved that sickness has thus been avoided. Notwithstanding the proximity of a large town, the disability not in the line of duty has not been excessive and Fort Douglas stands third in the order of constant ineffectiveness from all causes combined. No disease especially prevailed. FORT DUCHESNE, UTAH. The sick rate has been the lowest of all, the disability from injury very light for a cavalry command and the combined ineffectiveness places this post at the top of the list. The homogeneousness and isolation of the garrison doubtless in part account for this, but the inference may fairly be made that there is no local, physical, or other cause for ill-health. FORT GRANT, A. T. During the dry season Fort Grant suffered from insufficient water, apparently due in part to inadequate storage capacity and in part to a small original supply. There is reason to be- lieve that underlying water in sufficient quantity could readily be reached and utilized, but this has not been done. The region of which Fort Grant is the centre has been the scene of a great deal of activity among the cavalry, but the sick rate proper has been very low. The injuries incident to a cavalry command, however, reduced its relative combined ineffectiveness. FORT IIUACHUCA, A. T. Nothing of special medical or sanitary interest occurred during the year. FORT LOGAN, COLORADO. This post suffeied from a sharp attack of epidemic influenza and its percentage of constantly sick was the greatest of any. Six cases of typhoid fever occurred here, two of them being in recruits of less than one week's service. It is probable that the other cases arose outside the limits of the reservation. The rate of both sickness and injury in the line of duty at Fort Logan has been high, but the daily ineffectiveness not in the line of duty was very high, being more than one per cent, of the command present. This is probably to be attributed to the proximity of Denver. As foreshadowed by the Medical Director in 1892, the dispo- sition of the sewage at Fort Logan has become a source of com- plaint by the civil authorities. SAN CARLOS, A. T. This is a sub-post of Fort Grant, and its garrison of one troop of cavalry, exclusive of the Medical Department, is changed monthly. Their sick do not accompany the troops to San Carlos, and when practicable those taken sick return to Fort Grant at the expiration of their tour. Therefore, notwith- standing the extreme heat of the summer and other physical discomforts the sick rate of San Carlos is below the mean for the Department. WHIPPLE BARRACKS, A. T. Until within the last week of the fiscal year, the old and ill- arranged barracks of this post have been overcrowded and subject to much sanitary criticism. The disposal of waste has not been satisfactory and the water supply not above sus- picion. There were six cases of typhoid fever of undetermined origin, but probably dependent upon the adjacent town of Prescott. The constant ineffectiveness from alcohol, .113 per cent, of the command, was greater than at any other post. Analysis of the reports shows this to depend chiefly on multi- ple entries, as for example a sergeant losing 66 days on five different occasions, a corporal 14 days on four occasions, and a private 18 days on seven admissions to sick report. The re- duction of the garrison that has just occurred will probably improve the sick rate by the increased relative air space. FORT WINGATE, N. M. This post continues to maintain its reputation of having a high sick rate due to local conditions and in spite of excellent administration. Fort Wingate stands on the northerly slope of a mountain range over a deep and heavy clay soil. There is sub-soil dampness the most of the year from the overflow of springs above the post, but during the hot and drier season the surface soil is baked and the harm from it is reduced to a minimum. But in the winter and spring rains and melting snow bring the ground water to a very high level, and there is an imme- diate outbreak of severe sicknesss attributable to that condi- tion. Thus, for six months July-December inclusive, 1895, the percentage constantly sick was 2.17 of the command, that for December having been 1.60. For the four months January - April,1896, inclusive, it averaged 3.91, the percentage of sick in April having the very high grade of 5.18 nearly the whole be- ing in the line of duty. It fell to 2.69 in May and to 1.76 in June. The lower floors of the barracks there are close to the ground, and as might be anticipated the most of the sickness was among men occupying those rooms. The local conditions are such that effective sub-soil drainage would be very costly and difficult, but a properly constructed intercepting or “header” drain could be made to carry off most of the underground water coming upon the post. It is understood that a relatively dry site presents itself a few hundred yards away. If that is the case, Fort Wingate adds another to the list of military locations determined in igno- rance or in defiance of sanitary laws. While this report was in preparation the barracks in ques- tion have been burned, and I am informed that two of them will be re-built on the old site but with provision for ventila- tion under the lower story, and with the dormitories in the second story. There was a moderate epidemic of influenza in the spring. One very severe case of typhoid fever that recovered oc- curred at Fort Wingate, for which no direct cause could be found. Five men received for treatment from without the depart- ment are thus accounted for: Total Chronic articular rheuma- tism Chronic pneumonia and pleurisy Tuberculosis of the lungs.. Chronic bronchitis DISEASES. - 1 M Fort Reno. hrj O 3 RECEIVED, to | to | Fort Yates. I-* M Fort Leavenworth. - 1 ; >-> \ | Vancouver Barracks. to | - ■ i-* Whipple Barracks. > to | • >-* i-* Fort Wingate. - I; • | Fort Apache. M | m ; >-> | For disability. o o. Cj RESULTS - 1 | Exp. of service. - 1 Returned to duty -1 t- |j| Remaining. During the year operating rooms have been prepared and equipped in all the hospitals according to the latest require- ments of sanitary surgery, under the special instructions of the Surgeon General. No hospitals nor stewards’ quarters have been constructed during the year, but repairs have been carried out as follows: POSTS. Hospitals. Hospital Stewards’ Quarters. Total. Hospital Enlarged. $ 507.15 99.31 1,091.00 153.40 155.24 633.75 2,649.04 122.40 634.31 $ 115.89 33.00 67.40 $ 623.04 132.31 1,158.40 153.40 155.24 763.25 2.649.04 122.40 651.81 Huachuca 129.50 17.50 Total $6,045.60 $363.29 $6,408.89 Fort Stanton was discontinued January 16, 1896, previous to which all the medical property was turned into depot for re- issue, transferred to other posts, or sold, as its condition re- quired. The ice machines under the control of the Medical Depart- ment continued to supply large quantities of ice gratuitously to the sick and at very low cost to the well, and thus mater- ially increased the comfort of both classes. Practice marches covering two hundred miles each were made from all the posts except Fort Douglas. Under instruc- tions from this office the medical officers made very full re- ports of everything pertaining to the medical and sanitary condition of the troops, and in January last a careful summary of those reports was presented to the Department Commander. I invite renewed attention to the facts and opinions there stated, all of which have a direct practical bearing upon the efficiency of troops in the field. The sections on packs, on shoes, and on the use of kola in muscular fatigue seem to me particularly important. With the concurrence of the Department Commander three sets of Problems in Msiical Adninistration have been sent out at quarterly intervals to the medical officers serving in this department. There have been three problems in each set in accordance with the three grades of such officers, and their object has been to give medical officers a formal opportunity of considering practical questions that may arise outside of ordinary post routine and, by their consideration in anticipa- tion, of preparing themselves for more active pervice. These problems are not in the nature of examinations, but are offered as forms of duty corresponding to those that the Lyceum pre- sents to officers of the line. After the solutions ai*e received a general discussion is made in this office, and where it seems desirable private comment is added. Speaking generally, the solutions presented have shown an active and intelligent in- terest in the subjects treated. PERSONNEL OF THE MEDICAL DEPARTMENT: CC -d CC £ © c fl CC CO *3 0 o ’3 C0 £ -6 CO fl 6 g *3. CL 4-3 CO © c CC .s C 0 © *3 W CC 5 p © CC be p © #0 a P _© "3 0 tH - o be cC > 1 o u bo be <1 s 6 W ◄ PM H 1 4 9 7 21 13 9 57 79 100 Transferred into the dept Joined by promotion 1 1 1 7 10 7 7 17 1 1 2 2 2 3 4 9 9 14 14 14 2 2 2 Total to be accounted for.. 2 6 11 14 33 15 14 82 111 144 Transferred out of the dept.. 1 1 2 3 7 1 1 2 9 1 1 2 2 1 i 1 Dischd. by expn. of enlstmnt. 2 3 9 14 13 2 14 13 2 13 2 3 3 3 1 i i Total loss 1 1 5 4 H 3 3 28 34 45 Attached 30th June, 1896 1 5 6 10 22 12 11 54 77 99 1 5 5 10 21 12 10 1 53 1 75 2 96 2 Absent with leave Absent sick *1 1 1 * In the Government Hospital for the Insane. Two officers present are unfit on account of their health for field duty of any severity. The medical force is adequate when all are for duty and the troops are in garrison. Neither offi- cers nor men are sufficient when troops take the field, for the force required for the permanent hospital administration is not materially diminished. During this year detachments were repeatedly in the field with the Medical Department necessarily unrepresented. Captain Carter Nelson Berkeley Macauley, of the Medical Department, died the 6th of February, 1896, at Fort ; Logan, Colorado, after a short illness with epidemic influenza com- plicated with pleurisy, while on temporary duty from Fort Apache, A. T. He was an enthusiastic and personally a most attractive medical officer, admirable in all the social relations, whose loss has been deeply and persistently regretted. To my regret and I believe to the disadvantage of the ser- vice I have been refused an opportunity to inspect. Conse- quently I have no personal knowledge of the condition of any post. Denial of inspection duty divests the senior medical officer of the intelligent oversight that he is presumed to ex- ercise and deprives him of information useful in the recom- mendations that he may be called upon to make. It leaves the medical officers at the posts with no opportunity for the personal discussion or explanation of the serious and often important questions that are liable to arise in connection with the prevention as well as the treatment of disease, and the junior officers in particular have no aid in the conduct of affairs that sometimes are delicate. No inspector of the line is fitted to advise or indeed to investigate in strictly medical matters, or has competent sanitary equipment. It is unfair to those medical officers that they should be debarred the encouragement, or if necessary the warning, that a sym- pathetic senior can give; and it is quite unjust to the troops under their care that there may not be occasional careful and kindly supervision, such as has always heretofore obtained in 23 our own and in every other civilized army. The Medical De- partment, which is unique in its functions, is thus abandoned to circumstances that may as readily be adverse as auspicious. The isolated condition of the commands aggravates the evil. If the functions of this office are to be limited to those of a supervising clerk correcting and noting formal reports, medi- cal administration and so much of military efficiency as de- pends upon it will suffer. As far as the formal reports indicate, the duties of the med- ical officers have been efficiently performed, the supplies are adequate, and the sanitary conditions, except as heretofore noted, good. I am personally acquainted with but eight of the twenty one officers on duty at the posts, and I have no knowledge of the drill, the special instruction or the efficiency of the Hospital Corps. I believe, however, that both the offi- cers and the enlisted men of the Medical Department compare favorably in intelligence and in the discharge of their duties with those in other parts of the military service. Except in occasional cases no complaint has been received as to the pri- vates, and the non commissioned officers are reported as doing their duty well and in some instances with special excellence. Very respectfully, Your obedient servant, ALFRED A. WOODHULL, Lt. Col., Dep. Sgn. Gen., Chief Surgeon.