SANITARY COMMISSION. No. 51. ^lefeeir General Instructions for Camp Inspections. Note.—It is assumed that the Inspector to whom this is addressed has undertaken to systematically visit a specified portion of the army; that he is familiar with the Army Regulations; with the Report on Military Hi/giene and Therapeutics, (Doc. A,) and the Commission's Rules for Preserving the Health 0/ the S.ddier, (Doc. C.) The portion of the army to be visited is supposed to be mainly in a state of rest, and in camp. If it is in movement, or about to move, or if an engagement is immediately anticipated, or has just occurred, and the officers are therefore likely to be occupied with matters of an unusual and peremptory character, the duties of the Inspector to which the present instructions refer must be suspended. References.—Reference is made to the revised edition of the Army Regulations—that published pursuant to the order of the Secretary of War, dated August 10,1861. Central Office of the Sanitary Commission, Washington, J). C, 186 To I.—INTRODUCTION, ETIQUETTE, AND ifcciPLINE. In tbe performance of your duty as an Inspector of the Sanitary Commission, it is of tbe highest importance that you should, under all circumstances, be careful to show your respect for the Regulations of discipline, order, and rank in the army. To this end, in the first place, take pains to approach the inferior by way of the superior officer, and only with a formal or implied approval and endorse- ment of your purpose by the latter. Unquestionably, the first of all conditions of health in the army is strict discipline. Do all, therefore, in your power to encourage and strengthen a good purpose in this respect; 2 do all in your power to sustain it. Honor in your own conduct the strictest rules of military etiquette, and let it be seen that you expect them to be stringently enforced. Let it be known that you consider no disease so destructive to an army as laxity of discipline. Demand, wherever you properly can do so, that the standard of the volunteers shall be at least as high as that of the regulars in this re- spect, and reprove any intimation that this is not to be at- tempted. I have been mistaken in your character if it is necessary to assure you that the most determined enforcement of dis- cipline is consistent with an ordinary habit of friendly and confidential comradeship between officers and men. The cases where this is permanently impossible, without blame attaching to the officers, are exceptional. II.—RELATION WITH REGIMENTAL AND COMPANY COMMANDERS. On arriving at the camp of a regiment, ask for the officer of the day, and, stating your business, request him to pre- sent you to the colonel or commanding officer. Exhibit your credentials to the latter, and, if the opportunity is favorable, endeavor at once to obtain his confi- dence and co-operation in your business. Request him to introduce you to the captains, or to send another officer to do a% and endeavor in the same manner to establish a friendly acquaintance with them. At the same time, scrupulously avoid placing yourself on terms with them, or under any obligations, which you may feel will embarrass you in the exercise of your duties. III.—DUTY OF COMMANDERS OF COMPANIES. The most dangerous idea is often held by volunteer cap- tains of the functions of their office, it being derived appa- rently from the custom of the militia in peace, when the privates are living at their homes, and the captain has little other duty than to see to the drill of the men and marshal 3 them on parades. In our military organization the com- pany is the uuit of the army, and the commanding officers of companies are the principal agents of all the adminis- trative duties of the organization. If a major or a lieutenant (not acting as a commander) neglects his duties, the body to which he is attached becomes simply in a certain degree less effective. If a company commander neglects his duty, the men may starve for all that any one else is to do. The cap- tain should be, as has often been said, "the father of his company." Nothing, however small, which affects the com- fort, health, strength, and efficiency of his men is beneath his attention. He is the official registrar, and agent of all necessary communication between them and the source of their supplies, as well as with the superior command. He must leave the drill of his company chiefly to his subalterns and non-commissioned officers, for if he pays all necessary attention to his administrative duties, he will have no time to give more than a general superintendence to a task which, in its detail, involves but little exercise of judgment. Upon the thoroughness with which the captains attend to their duty, both in regard to their companies, and, each in his turn, as the officer of the day, superintending the police of the regiment, its health mainly depends. You are, there- fore, instructed to make yourself acquainted with the cap- tains, and to cultivate such relations with them as will com- mand a hearty reception for such instructions you may see occasion to give them. IV.__IMPORTANCE OF SANITARY REGULATIONS TO BE ILLUS- TRATED BY STATISTICAL FACTS. If necessary, you will point out to them the danger to which men, in military service, are exposed by neglect of sanitary laws, and impress on them the great practical importance of the business with which you are charged. To do this effect- ively, you should be prepared with a few statistical facts from'military history, as, for instance, with the proportion of deaths from disease to deaths from casualties of battle during our Mexican campaign, more than 7 to 1. (Sec also 4 statistics of the Crimean and other campaigns, in the Report on Military Hygiene and Therapeutics.) V.—INSPECTION OF COMPANY QUARTERS. Proceed thoroughly to scrutinize the camps, visiting the tents of one company after another, having, if possible, the captains of each company with you as you examine its tents. Do not too much hasten this part of your work, as it will proba- bly be your best opportunity of serving the cause in which you are engaged. The questions of the "Camp Inspection Return," with which you will have been furnished, indicate the more important points which should engage your attention. You are not expected to write answers to all these questions while walking through the camp; after you are familiar with them, indeed, it will be best to avoid unnecessary reference to them, especially in the camps of regiments which have been visited more than once before. Until then, however, you are advised to follow the "Return" in your enquiries somewhat closely, regarding it as a memorandum of points in which it is generally desirable that instruction should be given. Probably in nearly all cases-you will be able to trace what- ever is wrong (sanitarily considered) to a neglect of some of the requirements of the Regulations, as, for instance, to ^ 98, which demands#of captains "the utmost attention to the cleanliness of their men, as to their persons, clothing, accou- trements and equipments, and also to their quarters or tents," or to 1 116, which requires captains to attend care- fully to the messing and economy of their respective com- panies; to visit kitchens and inspect kettles daily, and colo- nels to make frequent inspections of kitchens and messes; or 1 101, which requires non-commissioned officers to see that all the privates properly wash their hands and faces, and comb their hair. 5 VI.—PREVENTION OF DISEASE POSSIBLE; SUPPRESSION DIFFICULT AND UNCERTAIN. Endeavor by every means in your power to remind the officers of these orders, and of the necessity of their strict obedience to them, to the safety and credit of the regiment. Explain to them that they are based upon a universal mili- tary experience, that disastrous consequences inevitably fol- low the neglect of such precautions as they are intended to secure. Let them know that, although the outbreak of malignant or epidemic disease in camps and quarters can be almost certainly prevented, it can seldom be suppressed after having once broken out, by any measure, however energetic, and never without great destruction of life. Point out to them the various sources of mischief that are to be anticipated, and explain in what way defects in camp police, ventilation, drainage, cooking, &c, are sure to operate in- juriously, especially in the destruction of the esprit du corps and morale of the soldier. VII.—COOKING ARRANGEMENTS. From an examination of the tents of each company, pass to its kitchen. Examine the cooking utensils, the fuel— which is generally extravagantly wasted—and the rations which have been drawn. If there is an opportunity, taste the cooked food, and criticise the cooking. Endeavor to stim- ulate an ambition to make wholesome and palatable food with the existing rations, by a skillful method of cooking with the simple utensils furnished by Government and the camp fire Every soldier should be a good camp cook, and he is not a good camp cook who requires a cooking stove or a large assortment of utensils. As a great variety of cook- in- stoves intended for camps are in use, when you meet with these, it will be well to notice the relative value of the different patterns as tested by experience. P.irt do not en- courage the opinion that any of them, or anything not pro- vided for by Government, is necessary to the comfort or 6 efficiency of the soldier. Foster a spirit of simplicity, fru- gality, an.d hardihood in this as in all things. VIII.—QUARTERMASTER AND COMMISSARY DEPARTMENTS. Subsequently, you Avill call on the quartermaster and com- missary, and investigate the method of making requisitions, (these should come from the captains in the first place, and be "consolidated" by the colonel: see forms 13 and 14, Army Reg., p. 267;) of receiving and accounting for supplies; of dividing the rations for companies; of subdividing for individuals; and again, of dividing with reference to time, (so that ten days' allowance shall not be exhausted in nine, &c.) If you hear complaint of insufficient food, look closely at these points, for it is unquestionable that, with honesty and a moderate degree of providence, there will always be more than enough. (See ^[ 205, Revised Army Reg., p. 36; also see General Orders of the War Department, No. 82, Sept. 23, 1861.) With regard to the important matter of regimental and company funds, the queries of the Return sufficiently indicate your duties. The rations provided hy Government do, and necessarily must, exceed the wants of the men. If less, the soldier would suffer; to be such in quantity as to exactly meet his wants, is, it is obvious, practically impossible; they must then be in excess. This excess, when saved, forms the basis of "funds"—regimental, company, and hospital. Where these funds are not established, either the excess must be wasted, or the savings be diverted from their legiti- mate use, namely, "the benefit of the enlisted men of the companies." If the regimental Council of Administration is regularly convened by the commanding officer of the regiment, and if the regimental fund is properly organized, and the balances periodically distributed to the several companies, it is obvi- ous that company funds would have been organized, at least partially. 7 IX.—SUTLER. Give attention to the sutler's store. A sutler should be engaged for each regiment, and the regulations prescribed in the Articles of War (Art. 29) and the Army Regulations (1 211 to 219, p. 37,) stringently enforced upon him. He should be required to keep every essential article for a healthy soldier's comfort, not provided by the quartermaster, such as brushes, blacking, needles and thread, pipes and tobacco, also a limited supply of under-clothing, and he should not be allowed to offer anything likely to prove unwholesome to the men, such as green fruit and leathery pies. Where di- arrhoea prevails, both the sutler and itinerant venders should be sharply looked after in this respect. If the sutler's list of prices is not conspicuously posted, you will urge that the requirements of the Regulations in this regard be forthwith observed. X.—RELATIONS WITH REGIMENTAL SURGEON. Having obtained an introduction in your official capacity to the regimental surgeon, it will not generally be difficult for you to gain his confidence and good will, for your duty will lead you to magnify his ofiice, and if he properly ap- preciates its responsibilities and difficulties, he will value the service you will be able to render him. XI.—DUTIES AND RIGHTS OF SURGEON. It is the duty of the surgeon to point out whatever is un favorable to the health of the regiment, and to suggest the proper remedy. You should encourage him to make and to persevere in making such suggestions, and wherever possi- ble, consistently with your judgment, should add the weight of your own influence to his advice. You may find it neces- sary to remind the surgeon that he becomes responsible for the existence and continuance of any unjustifiable sanitary condition pertaining to the camp, or to the management of the regiment, against which he does not perseveringly ex- postulate. 8 It is difficult to define the rights and the duties of regi- mental surgeons, because these vary so much with circum- stances. The medical and surgical provision for a regiment on detached service of a special kind should be altogether different from that of a regiment quartered with many others in the immediate vicinity of a general hospital. The Regu- lations were not formed with reference to large armies in the field, and are not perfectly adapted to the circumstances in which our volunteer surgeons at present fiud themselves. A patient study of their provisions will, nevertheless, dis- close the means of remedying most of the difficulties, of which you will hear much complaint. When this is not the case, an appeal may be made to the medical director, or, if necessary, to the major general commanding, who, for a spe- cial purpose, can override the restrictions ordinarily placed upon the supply of medical stores and hospital conveniences. XII.—ARRANGEMENTS FOR REGIMENTAL HOSPITALS SHOULD NOT BE TOO EXTENSIVE. Inexperienced regimental surgeons will generally be found to err in attempting to maintain too complicated and exten- sive hospital arrangements, and in undertaking to deal with cases for which proper supplies and accommodations cannot be provided, except in fixed general hospitals. There should be nothing in a regimental hospital to stand in the way of sudden and rapid movements; and whenever a cure cannot shortly be expected, patients should be transferred to a gen- eral hospital. In some cases, however, this will not be pos- sible; and when you meet with these, you are expected to do all in your power to obtain such supplies as are immedi- ately needed, and which cannot be got by official process. This may be done either by requisition upon the stores of the Commission, by an appeal to local benevolence, or, when necessary, by a moderate expenditure of money on account of the Commission. Whenever practical, special authority for this purpose may be requested by telegraph.* * Your duty in this particular is more fully explained—p. 70, Doc. 40. 9 XIII.—RELATION OF REGIMENTAL TO GENERAL HOSPITALS. Regimental surgeons also frequently err in the opposite extreme, sending patients to general hospital who have some simple illness which would yield to judicious treat- ment in the camp hospital in a few days. Experience is needed to enable the judgment to determine confidently between proper and improper cases for camp treatment, and your opportunities of observation and comparison will stand you in place of an extended experience in this respect. It is your primary duty, as it is that of the regimental sur- geon, not to take care of the sick, but to guard against what- ever weakens the regiment or embarrasses the use of its greatest possible strength for warlike purposes. The sur- geon's stores, and the hospital, and the ambulance, should all be instruments to the end of the utmost possible rapidity, spirit, and force of movement in the regiment. Discourage whatever really weakens the regiment; encourage whatever tends to strengthen it against the enemy. Oftentimes ten- derness to individuals is not true humanity; and the surgeon whose baggage impedes an advance or a retreat may easily be the cause of more suffering than the one who carries the hospital stores for a regiment in a knapsack, or whose medi- cines and instruments are all conveyed in a pocket case. XIV.—AMBULANCES AND AMBULANCE STORES. The surgeon should be prepared for battle duty. If he has an ambulance, has he a trusty driver for it, and an am- bulance corps, upon which he can depend under fire? Do they know how to lift and carry a man with shattered limbs? Do they know that water is more precious than gold to those who follow the track of a battle, and are they instructed how to secure it and administer it providently? Beds and sheets and wine and delicate food in the hospital tent are of little consequence to the regiment compared with these pre- parations. It is usual to employ the band as an ambulance corps but it will be of little service unlesspreviously drilled 10 for the duty, and habituated to obey commands from the surgeon. XV.—FINAL CONFERENCE WITH COMMANDING OFFICER. Having completed your survey of the camp, call again on the commanding officer, and acquaint him, in such a manner as you judge will be most likely to have the desired effect, with whatever you have seen to be important sanitary de fects of the camp; question him if they cannot be remedied, or point out the proper remedies. Full and specific direc- tions for this purpose cannot be given you. The Commis- sion depends mainly on your general kuowledge of the con- ditions of health, and upon your ingenuity and tact in so dealing in each case as, under the circumstances, will most contribute to the desired result. The present instructions have reference only to the more common defects of camps, and to remedies of geueral application. XVI.—FREQUENT CHANGE OF CAMP SITES, IMPORTANT. As experience proves that every camp ground becomes poisoned or malarious (it is supposed from the accumulated emanations from the bodies of the men) after thirty days, at most, of occupation, you will urge on the colonel the import- ance of frequent changes of position, even if only to the dis- tance of a few hundred yards, and it may be best for you to in- dicate a safe and advantageous site to which the camp may be removed. Camp sites lately vacated should in no case be reoccupied. Looking to sanitary conditions alone, a camp site cannot be changed too often. Such change also tends to break up the monotony of camp life, and improves the moral tone of the men. XVII.—SELECTION OF CAMP SITE. In studying the salubrity of a position, you should not neglect to observe the character of the subsoil. Should it be damp or hard and impervious, it will generally be your 11 duty to urge a change of position. If a change for the better cannot be made, you should recommend the most careful drainage without delay. With regard to the selection of camp sites, and the proper precautions for the lodging of the men, you will find useful hints in the lie port on Military Hygiene, p. 7; also in Rules for Preset-ring the Health of the Soldier, f 15, 16, 17, 18, 19; also in Doc 28, Advice as to Camping. XVIII.--ARTIFICIAL DRAINAGE. Should the camp be on a side-hill, you will especially recommend catch-water drains above it, and round its sides, by which the flow of water from the upper part of the hill will be effectually diverted. You will endeavor to secure also, in every case, the digging of a trench (the deeper the better, but at least six inches deep) around each tent or hut. These trenches should be connected, as far as may be, accord- ing to the nature of the ground, with main drains, so as to readily carry off rain water. They should be made as straight as practicable, as all sinuosities arrest the flow of water, and lead to stagnation. The sides should be cut sloping. You will urge, if you see occasion, that all drains, espe- cially those around tents and huts) should be kept clean, and that refuse food, &c, be not thrown into them. If they be- come offensive, they should be cleaned out at once, and dis- infected with lime or charcoal. In camps likely to be occupied for some time, especially in winter-quarter camps, the "streets" should be perfectly "turnpiked," or rounded, with a regular convexity, from the centre nearly to the drains, falling into a regular concave for the drains, with a convex rise again, to the front of the tents. XIX.—VENTILATION. Both in tents and huts, or citizens' houses occupied by soldiers, if they afford proper shelter, there is generally a deficient ventilation, which is often the parent of much dis- 12 ease. Wherever you find this to be the case, you must endeavor to devise some immediately practicable remedy or improvement, such as cutting square openings in the ends of tents, to be covered with canvas flaps, fastened down when necessary by lacings, or in a house, opening additional win- dows, or establishing wooden flues through the building. Where it is feasible, ventilation may be very greatly im- proved by introducing a lighted lamp or candle into such flue. A Sibley tent may be effectually ventilated by hang- ing a lantern near the roof. Any large building occupied as a hospital will require immediate attention, and no time should be lost in providing it with perfect ventilation. XX.—SINKS, MANURE AND OFFAL. In all cases you wTill visit the privies of the camp, and let it be seen that you regard the manner in which they are formed and kept as most seriously affecting the character of the regiment, as it is sure to have an important relation to its sanitary condition. A proper arrangement of the privies, and the usual method employed in well organized armies of keeping them, is described in 1" 14, page 6 of the Rules for Preferring the Health of the Soldier. You will advise that the manure and litter of all horses and cattle be collected, removed from camp and covered with earth, or burned, at short and regular intervals; and also that the offal of cattle slaughtered near any camp or post be buried at once, and at sufficient depth. See page 10, Report of Military Hygiene. XXI.—REFUSE FOOD AND SLOPS. You will observe whether men are in the habit of throw- ing away refuse food or slops anywhere and at random, or of doing anything else that tends to make the atmosphere of the camp unwholesome. If such practices prevail, you will do all you can to put a stop to them. 13 XXII.—DISINFECTANTS. You will ascertain whether quicklime or sulphate of lime (plaster of Paris) can be readily obtained in large quantities for purposes of disinfection; and if so, recommend its free use. The use of lime is to be especially urged for the white- washing of hospitals, quarters, &c. If neither of these arti- cles are at hand, you will remember that charcoal (either wood or peat) is among the best and most efficient of deo- dorizers or disinfectants, and urge that men be detailed to burn a supply of this material, and that it be copiously used. XXIII.—WATER. If the water supplied to the men is impure or unwhole- some, you will endeavor to devise some mode of improving it, however rough and temporary—as, for instance, aeration, by letting it fall from one vessel to another, or filtration through a barrel half full of coarsely-powdered charcoal. All springs should be carefully cleaned and secured by sur- rounding them with a barrel, or with masonry. All spring* and wells should be inspected from time to time, and be kept always under a guard. Wells should be cleaned out with care, especially in cases of epidemic. They are apt to become foul, from matters carelessly or wantonly thrown into them. They are then fruitful sources of disease. XXIV.—FRAUDS AS TO CLOTHING. If you find that clothing or other articles furnished by con- tract have proved so grossly defective as to indicate fraud on the part of the contractor, you will report all particulars in regard thereto, and will also forward written statements. under oath or otherwise, on which the Commission can de- termine whetner criminal proceedings against the contractor can be instituted with any prospect of success. 14 XXV.—QUALITY OF RATIONS AND MODE OF COOKING. You will pay particular attention to the quality of the rations, and the mode of cooking them. If they are unwholesome from bad cookery, you will point out the defect, and urge its remedy. See 1 8, 9, 10, and 11, of Rules for Preserving the Health of the Soldier. Should you find the meal-times of the soldier less regular than they might be, you will urge the necessity of correct- ing the evil as far as possible, as it is known to be provo- cative of diarrhoea and other disorders. You will keep in view the importance of varying the ra- tions, and of supplying the men with fresh vegetables as far as practicable. XXVI.—BEDDING. You will recommend the use of beds of hemlock, pine, or cedar boughs where they can be readily had. If straw be so used, it should be taken to a distance from camp and burned at least once a week. XXVII.—AIRING OF TENTS. All plank floorings of tents should be raised at least once a week, and the ground under them may be covered with lime or charcoal. Tents should be raised and their interior and floors ex- posed to direct sunlight every fine day, if possible. They should be struck, turned inside out, and thoroughly sunned, and the plank floors, if any, raised and sunned once a week, at least. XXVIII.—TRANSMISSION OF SAVINGS. The permanent assignment of the whole or a part of the pay of the soldiers, by means of the Allotment System, to those dependent on them for subsistence, should be encour- aged. Such systematic disposition of their payis important, as well from hygienic as from economical considerations, for habits of providence are favorable to health. 15 XXIX.—PUNISHMENTS. You will report if you observe or hear of any unusual method of punishment, and what its results have been. XXX.—MODE OF MAKING RETURNS TO CENTRAL OFFICE. In all cases, as soon as practicable after completing your inspection of any camp, prepare in ink, your return of obser- vations made. The manner in which this return is after- wards to be used, can in part be inferred from the Summary of Statistics derived from a limited number of returns of inspections, which will be found in the Commission's Docu- ment No. 40. You are particularly enjoined to be careful to avoid a mere repetition of the statements of the officers of the regi- ment. The return should represent, and will be assumed to represent, your own personal observations and the conclu- sions of your judgment upon all the information you have been able to obtain. The larger part of the questions of the return can be answered with considerable confidence from your own observations alone. Answers should be given to all questions as far as prac- ticable; mere guesses, however, should never be returned when facts are demanded. Vague answers must be carefully avoided. As a rule, the information returned should be as precise, full, and detailed as is practicable. Each return should be complete in itself, replies to ques- tions, which may have been answered in a previous report, not being neglected. The locality of the camp site (Q. 1) should be so described that a visitor years hence, guided by the return, would ex- perience little difficulty in finding it-as" Camp Bucking- ham on Meridian Hill, between 7th and 14th streets, A\ ash- ino-ton D. C; or, "Camp Johnson, 8J miles from Turkey- Hill, Mississippi, on the old road to Holly Springs." The various designations, if more than one, of the regi- 16 ment or corps inspected (Q. 6) should be given: as "84th Regiment New York Volunteers, infantry, (U. S. Chas- seurs;") or, " 71st Regiment Pennsylvania Volunteers, in- fantry, (California Regiment.") The full military titles of officers should be stated, as Major General Nathaniel P. Banks, commanding army«corps, not General Banks; or, Brigadier General E. S. Keycs, commanding division, not General E. S. Ivcves. Facts pertaining to the previous military education and experience (if any) of the officer commanding the regiment (Q. 7) may be given, as "Graduate of West Point," "Served in the war of the Crimea," "Hungarian Army officer," "Served in Continental and in South American armies." If a subordinate officer is in command, or if the command of the regiment has been transferred, (Q. 7,) explanatory circumstances of general interest should be stated; as in the case of the 20th regiment of Massachusetts volunteers, in- fantry, iuspected December 28, 1861, "Colonel Wm. Ray- mond Lee, (West Point graduate,) prisoner; Lieut. Colonel Francis W. W. Palfrey commanding." The answer required by the note to question 20 has some- times not been given, the note escaping the attention of the inspector. You must not consider your field of investigation restricted to the subjects referred to in these instructions, or to those with regard to which the queries of the Return relate. Questions of strategy and tactics are not within your official province, but ail questions are so that relate to matters af- fecting the physique or morale of the army. Nor is the army to be considered merely in its personal aspect, but a« an aggregate of men and material—a living organism. What- ever would materially affect its vigor and mobility as a whole, may be regarded as a subject of sanitary inquiry. Thus, the condition of its horses and wagons, may at times become worthy of your careful notice. 17 XXXI.--STATEMENT OF SPECIAL CHARACTERISTICS OF CAMP AND PARTICULARS OF ADVICE (ilVEN, TO ACCOMPANY THE " RETURN." Accompanying your Return, send to this office a written report of any notable characteristic of the camp of which information will not otherwise have been given, and especially state the more important particulars of the advice which you have offered to the regimental, company, or medical officers, and wherein you have been able to be of assistance to them. Report also if any of the officers exhibit habits or marked peculiarities, or if they express opinions from which influ- ences affecting conditions of health are likely to arise, as: 11 Captain of Co. B, regards coffee as an all sufficient pro- phylactic against malaria, urges his men to fill their canteens with it every morning, and chew the berry when on night duties." The discretionary duty here indicated is not to be neglected because discretionary. It is often one of the highest im- portance. XXXII.--CASE OF PERSISTENT NEGLECT OF SANITARY PRE- CAUTIONS. If you have found your advice disregarded, and important sanitary precautions persistently neglected, without sufficient military or other reasons therefor, address the proper officer on the subject in writing, stating the grounds of your advice. Take pains to do this in such a manner as not to cause irritation or give offence, and, at the end of the Aveek, send a copy of your letter to this office, together with any answer which may have been given you. In visits subsequent to the first, all important changes which have occurred since previous reports should be noticed ; and especially it should be stated whether and how far advice pre- viously given has been followed, and with what results. Whenever you see occasion, advise action which you think 18 desirable to be taken by the Commission or to be initiated at Washington. On urgent occasions, communicate directly with the Governors of States or other authorities, sending copies of your communications to this office. I am, doctor, Respectfully yours, FRED. LAW OLMSTED, Genered Secretary.