AC^
           $mu\-(§mxttx$  judical  JJirectov^ #ffke,

                        ARMY  OF  KENTUCKY,

                                  Loiisvillk, September 23d, 1802.
          The following instructions tire published, to be observed and
      enforced by the .Medical Officers of this army:
               Of  the Dcties of Scrceons on the March.
          When the order for march  is communicated to the Surgeon—
      and this should be as early  as possible—the Surgeon should give
      his attention to the following particulars:
          I.  lie should direct his principal stores and equipments to
      be snugly and securely packed in his transport wagon; care being
      taken so to arrange the loading that easy access can  be had to
      those  articles most  apt to  be needed on the way without disturb-
      ance of the whole load.  It  is well  to give the hospital attendants
      some practice or drill in  this matter, so that in emergencies they
      can perform their duties with dispatch.
          II.  He should  inform himself at once as to the number of the
      sick to be left  behind and the number to be transported.   The
      determination of the number to be left behind in camp or sent to
      general hospital will be influenced, amongst other things, by the
      nature of the service into which the command is  ordered, and the
      circumstances in which those left will be placed.  If the command
      is in an enemy's  country, the Surgeon must take the order of his
'      commanding officer.   If any are to be left behind, provision must
      be made for their food, quarters, and medical  attendance.   The
\      number to be carried along with the command and requiring trans-
      portation having been ascertained, if that number is greater than 
can be transported in the ambulances, application nuisl be made for
additional transportation.  In providing transportation, reference'
must also be had to the contingencies occurring on the march.  Men
get injured and give out on the inarch.   As a general thing,  it is
desirable to move as few disabled men as possible.   So many  men
become disabled  on the march  that the available transportation is
always taxed to the utmost, so  that it needs to be husbanded with
great  care.   Surgeons must bear in mind that  in usual marches
no men should be left behind who will be likely to be fit for duty in
a week.  Many Surgeons are in the habit of leaving at every avail-
able point all the sick of their regiments, and finally regard their
duties as being more to designate what patients  are  to be left be-
hind, or to be sent to  general hospital, than to  treat  the  sick of
their regiments.
    III.   lie should see that the hospital knapsacks are filled with
those medicines, instruments, and dressings which the service  may
call into requisition, and that each  of these  knapsacks  is carried
by a hospital attendant, one  of whom attends upon each of  the
Medical Officers.
    The medicine chest may be carried in one of the ambulances.
    IV.   He will see that the  water kegs  are in good order and
filled with  water.
    V.   The ambulances,  the commanding officer  consenting.
should move directly  in the  rear of the regiment or corps
    A"I.   When men become disabled on the march, they are  pre-
sented to the Medical Officer under such  regulations as the com-
manding officer  may  prescribe.  It  is the duty of the Medical
Officer  to examine as carefully as possible the men thus brought
to his notice, and  he will  determine  whether  the disability is
feigned or real, and give them admission to the ambulance if they
need it, for such time and in such way as he may think most ad-
visable.   The  ambulances  should  be frequently inspected, to see
that no one occupies  them  without the proper authority.    Sur-
geons will be called upon to exercise great discretion and firmness
in this matter.   No officer should be allowed to ride in an ambu-
lance  unless by  reason  of disability: any deviation  from this rule 
should be  by the express order of the  commanding officer.  The
ambulances are provided for the sick and disabled.
    VII.   The Medical  Officers should always march  with the
command.   Their services may be  needed at any moment.  The
Surgeon should occasionally allow the column to pass him, so that
he may be enabled to advise his commander as to the condition of
I he men.   The post of the Regimental  Medical Officers  is in the
rear of their regiment.
     VIII.   It is well that  the  mens canteens should be filled be-
fore the march, and, as the halt is commonly made at  a  watering
place, the canteens should then be re-filled.  This  matter is in the
province of the line officers.   If it  is  attended to,  the  men, b}~
drinking <t little undfrcqurntlij, march much better.   Large draught*
of water are not only dangerous in their immediate effects, but are
fncrraling.
     IX.   Some cooked food should always be carried in the ambu-
lances, for disabled men need food  more frequently though in less
quantities than well men.  A good  supply of whisky should be on
hand, but must be allowed with careful discretion.  As  a general
thing,  a pill of opium will be found  available and  useful  for many
contingencies, and  this,  if carried in the pocket of the  Surgeon.
will be found exceedingly convenient.
     X.  As soon as the command encamps, the sick and  disabled
should be conducted or reported to the Surgeon  to the  end that
he may prescribe for them,  and advise  his  commanding officer as
to the  transportation  needed for  the next day's march; and if it is
found that there are some men  whom it is not Avell to move any
further, provision  must  be  made for their subsistence,  quarters.
and medical attendance, or, if they are to be sent  to the  rear, for
their transportation
     XI.   When men  are  to  be left behind on the inarch,  those
who are in the hospital arc to be provided with subsistence on the
requisition of the Surgeon.   Those who are in quarters are sup-
plied by the company commander  upon notice  by the Surgeon.
Quarters  are provided by the Quartermaster, details of guards by
the commanding officer.  And  when a  number of men are left be- 
4
hind sick in quarters, a commissioned officer of the line will  be
left with them in command of convalescent camps or barracks.
The Surgeon  left  in  charge  had better be  so  left  by  order
of  the commanding officer.   All of these arrangements should
be  made   as  soon  as possible  after   encamping,  for in  the
hurry  and  confusion  of  the morning  there is great  difficulty
in  making  the  necessary provision.   The Medical  Officer  left
in charge  of the  sick should, as soon as the command moves,  visit
the camps to see that all the men are  got together.   A list of the
men. their rank, company, and  regiment, should  be reported to
him in order that he may see  that  no one has been overlooked;
and it  must always be borne in  mind that whenever a  soldier is
separated  from his command, and especially when  sent  to a gen-
eral hospital, he must be furnished  with  a descriptive  list and an
account of pay and clothing.   When troops march in large bodies,
by brigades or divisions, the Surgeon  of the brigade or  division
should give direction to the Surgeons of regiments in regard to
the disposition of  the  sick.   The sick  should in  such  cases  be
gathered from the  different regiments or  corps, and  massed as far
as  practicable.  By this  arrangement fewer officers will be re-
quired for the care of the  men.
    When the encampment is within reach of general hospitals.
inquiry should be  made of the Medical Officer in charge of them
as  to  the  spare beds  for the reception  of patients.   The  men
should never be forwarded, unless in  very urgent cases or circum-
stances, without this preliminary inquiry.  By neglect of it, the
sick are often crowded  into hospitals having no adequate room or
provision  for them.  In such circumstances the men can be better
cared for  and their cases treated more successfully in the encamp-
ments. In all cases where the sick are forwarded  to general hos-
pitals, due notice should be sent beforehand, specifying the number
forwarded and the probable time of  arrival.   Proper  attendants
should always accompany the sick in transitu, and  they should be
provided  with such medicines and food as they  may  need on  the
journey.   In the selection of patients to be sent to  general hospi-
tals, Surgeons  should  exercise  great circumspection to the end 
that none  are  sent  who are not able to bear the journey: those
who can be  properly cured for on the field are kept in the field.
Many  contingencies will arise  in  field service for which specific
rules cannot  be prescribed beforehand.   In all such cases the Sur-
geon will advise his commander of the facts  mid ask his orders in
the circumstances.   Commander.- are given  a large discretion in
such matters, and the order  of the commanding officer is the suf-
ficient  warrant for the Surgeon's acts

    Ol-' THE  Dl'TiES OF  SlROEONS ON  THE FlELD OF BATTJ.E.

    When before  the enemy, the Surgeon  should  see that  the
Medical Staff is provided with all  the appliances  which  will  be
needed in the action.   To this end he will see that the hospital
knapsacks are filled  with the needful  medicines  and  dressings;
that the instrument cases are unpacked  and distributed; that the
stretchers  and litters are at  hand; that the ambulances are on the
ground and in good order t the ambulances are under the super-
vision  of the Quartermaster or one of his authorized agents); that
all the water vessels are tilled, and thai such food a* may be re-
quired is prepared.
    The men under  his  control for the various offices to be  per-
formed consist of the hospital attendants and the musicians of the
regiment.   The  Assistant Surgeons are also  under his direction.
These  men and officers should have their  various  duties assigned
them.  One of the Medical Officers accompanies the regiment; the
other takes post with the Surgeon at the field hospital.  One hos-
pital attendant with a hospital knapsack attends upon each of the
.Medical Officers.   The  remaining hospital attendants, in connec-
tion with  the musicians, are to  be  employed in transporting the
wounded.
    The position of the  field hospitals is determined by the senior
Surgeon present with the command.   They are placed as near the
line of battle as possible,  and yet without   the  range of fire.
For this purpose advantage is to  be taken of inequalities  of the
o-i-ound, and  screens  of  various  kinds,  as houses, haystacks,  and 
(i
timber.   Reference should be  had in selecting sites for field hos-
pitals to their accessibility by the ambulances.
    Markers of red flannel shou'd be  placed  when  practicable so
as to guide the wounded, straggling rearwards, to the posts of the
Surgeons.   When  large  bodies of troops are to  be engaged, the
Medical Director, with  the Quartermaster, establishes depots for
the wounded; and the Medical Director, moreover, distributes such
Medical Officers to these depots as he may deem best.
    It is of great importance in assigning Medical Officers to duty
at depots that  Surgeons of the most  professional experience and
ability are selected: the most important  surgical operations are to he
performed  here.   No amputations or other operations  of impor-
tance should be made without the direction of the  principal Sur-
geon in  charge of the depots, and. even in the field hospitals, never
should be  made  without  consultation, except in  cases  where the
necessity for the operation is unmistakeable. or the urgency of the
case is such  as not to  admit of delay.   The  great  and prevalent
error of surgical practice in this war, so far, has been the perform-
ance of unnecessary amputations   There is hardly a case of gun-
shot injury of the upper extremity, except that of artillery inju-
ries, which demands or  admits of amputation.
    Surgeons in the Direction of Medical Officers should see that all
amputated limbs  are jirexera'd for iii-yxXio)). for the reason  that the
part of the limb cut off will exhibit the nature of  the injury, and
will testify as to the necessity  for the  amputation as well  as show
how it was done.
    It may not always be possible to comply with these  instruc-
tions  in  the  confusion  and hurry  of  battle,  but  they will
serve to indicate the general  purposes  to be kept in  view.  This is
not the occasion to lay down  rules of surgical  practice.  Surgeons
are expected to have learned their art.   Those  who are found to
be ignorant of it will be dismissed from the service.

                       Police of Texts.
    The tents should be struck, the blankets and spare  clothing-
should be aired at least  once a week, and oftener if practicable. 
    The straw should be frequently aired and renewed, and in no
case allowed to become mouldy.
    No dirty clothes, no food  nor cooking implements should be
allowed in the tents.   As  soon  as  the soiled underclothes and
stockings  are removed, they should be  washed and packed in the
knapsack.   Foul  linen kept in the tents serves to contaminate the
air in the  tents.
    Every possible caution should be exercised  to keep the air in
the tents sweet and pure.
    This is to be effected in part by attention to the cleanliness of
the persons and clothes of the men; but still  more by attention to
ventilation.   Surgeons should remember that the vitiation of the
atmosphere in tents is the prolific source of  camp typhus.   It is
well to inspect the tents at night  after the men have  gone to sleep,
and. if the air is found to be foul, the tent door should be thrown
open, no matter how cold the  weather.

                     Personal Cleanlinkss.

     The men should be compelled to  wash  the whole  person at
 least  once a week.   The feet should be washed more frequently,
 and on the march ever}' evening.
     The underclothes should  be  changed  once a week,  and the
 stockings at least twice a week.  The stockings should fit the foot
 closely, otherwise there  will,  in  walking,  be friction  between the
 stocking  and the foot, and the man will get foot-sore.
     The  men should frequently be inspected to  see that they keep
 their persons clean and (dear of vermin.  The articles  necessary to
 destroy vermin  can be had  on special requisition upon the Medical
 Purveyor.
                       Food  and Cookino.

      It is necessary that as  great a variety of food  as is supplied
 bv the Government should be  afforded to  the men.  Potatoes,
 onions, and beans  are  issued  from  the  Commissary Depart-
 ment  when they  can  be had, and  requisition for these articles
 will  commonly be filled.   One of the principal  reasons  why they 
s
arc not issued more frequently is that requisition is not made for
them as  often  as  it should be.   It should be  remembered that
scurvy comes of lack of variety of  food as well as badness of qual-
ity.   If the ration is tolerably husbanded sufficient funds will
accumulate to procure for the men  every variety  of food commonly
supplied  in the markets.  The husbanding of the ration should be
looked to and enforced as far as possible.
     The cooking should  be done  by companies, not by messes.
This arrangement facilitates the instruction of the cooks as well
as the preparation of  food,  and tends  to  the  husbanding  of the
ration and to greater neatness of the camp.
    The  food should always be thoroughly cooked.   Beans require
five  hours for  soup.   Beans can  be excellently cooked in camp
kettles, set in trenches in which a hot fire has previously  been
made, and the  kettles  surrounded and covered with coals.    Beef
soups require at least  three hours  in cooking.   If soups are pal-
ateable and well made, they constitute the best food for the soldier.
    The  practice of frying meats should be discouraged.  Surgeons
should constantly inspect the food  of the men,  and if  they find
that cooking in all its  details is  not properly done, the fact  should
be promptly reported/  Commanders of companies are directed by
Army Regulations to see  that the cooking is properly done.  The
duty of the  Surgeons is to inspect it, and if found faulty to report
it.   They should  also have an eye upon the sutlers' stores and
upon  peddlers about the  camps, to the end that  no injurious arti-
cles of food or drink are sold to the men.

                          Of  Sinks.
    Immediately after encamping  a detail should be made for dig-
ging sinks.
    The  sinks for the  men will, when practicable, be five in num-
ber—one for each two companies and two for the officers.
    Those for the men should be placed one hundred  and fifty
paces in front of the color line;  but where the situation of the en-
campment renders this impracticable or  objectionable,  they may
be placed two on each flank or in the rear.   The  sinks for the 
                              !)

officers, which should  always be distinct from those for the men,
should be placed in the rear of the regimental staff tents.  In all
cases the sinks should  be one hundred and sixty paces  from the
exterior row of tents.
    The sinks should never be less  than four feet in depth—six
feet if possible—and as narrow as they can well be dug.
    The sinks  for the men should be 75  feet in  aggregate length.
Those for the officers should each be 12 feet long.
    Poles, rails, or boards should be placed along the front  edge
of the sinks, so that persons using  them  may  not  get  their feet
soiled by standing in the mud made by the urine discharged in
front.
     Pasts  should  be placed overhanging the front  edge of the
sinks, and these rests should not be mure  than  fourteen inches in
height.  They should be fixed on stakes  placed  at frequent inter-
vals and firmly secured, the whole structure being strong.
     The sinks should be carefully screened so as to secure privacy
for those occupying them.
     The  sinks should be so carefully policed at all times that no
odor from them can be perceived in any weather at  the distance
of twenty paces.
     The men  and officers  should  be compelled to use the sinks,
and any one caught depositing his excrements  in any other local-
 ity in or about the camps should be punished.
     A separate sink should be made for the  hospital.
     The reason for the above particular  instructions is found in
 the fact that emanations from human excrements are the prolific
 cause of camp diarrlnea.  when there is no epidemic influence pre-
 valent amongst the men.   But when typhus,  or the tendency to
 typhus, is once engendered, the contagium is set free for the in-
 fection of the well men more abundantly from this source than
 from any other.   The health of the men  is more concerned in the
 management of the sinks than in any other one particular incident
 to camp life.
     The reason for digging the sinks deep and narrow  is  this:
 The  decomposition of animal matter is greatly facilitated by the 
10
presence of light and the free access  of air.   The deeper they are
the less the access of air. and the narrower the less the entrance
of light.
    As soon as the sinks have been  filled within eighteen inches
of the surface, they  should be covered  in with earth, and  new
ones dug.
                     Police of Grolniks.

    The grounds upon which troops are encamped should  be kept
clear of all rubbish and filth—of filth because it breeds disease, and
of rubbish because  this,  lying about the camp, prostitutes the
sense  and destroys all appearance of neatness.  All bones, bits of
meat, bread, and ordure should be buried, or removed to a dis-
tance from the camp.
    Deep pits should be dug adjacent to the company kitchens for
the reception of all kitchen offal and  slops.  These pits should  be
kept carefully policed, and should be covered in  with earth before
they are quite filled with garbage, and new ones dug.   Excre-
ments, when  found  on the grounds, should be taken  up and  de-
posited  in the sinks.   The company streets should be swept daily.
    The company kitchens and cooking utensils, the kitchens  of
officers  and the whole grounds within the encampments, should  be
frequently inspected by the Surgeons, and the condition  of them
reported to the regimental commander  if  necessary.   Care should
be taken that the company streets are at least as wide as prescribed
by the Army  Regulations.

                          Drainage.

     When encampments are on  sloping grounds,  head  ditches
should be dug on the up-hill side  of  encampment,  so as to direct
the surface water by the flanks, or conduct it through the camps
confined to narrow channels.  Ditches should  be dug all around
and close to the foot of each tent.   These ditches should be shaped,
one foot deep, and in front of the tent door should be bridged over.
The  ditches around the  tents should be connected with drains
running in such direction as may be demanded by  the surface of 
11
      the ground,  and sufficient to permit the easy escape of the water.
      The earth removed from the ditches should be thrown in the mid-
      dle of  the company streets, so as to make them convex, or else it
      should be carted outside of the camp.
          These drains and ditches should be kept free and  clean, and
      the more tenacious the soil the deeper they should be.

                        Certificates of Disability.

          Great care  must betaken in making certificates of disability.
      No enlisted  man is to be discharged from the service except for a
      cause which renders him permanently unfit for  duty.   For  the
      purpose of ascertaining the  existence of such a cause, the Surgeon
      should carefully examine the man.  In making this  examination.
      the Surgeon is to be careful not to place too much reliance  upon
      the statement of the soldier; he will guard himself against decep-
      tion.   The ingenuity occasionally practiced in order to induce the
      Medical  Officer to give a  certificate  of disability  is  marvelous;
      one man has been detected  in  this  department in  lacerating his
      tonsils in order  to make out a show of luemoptysis, and another in
      mixing albumen with his urine to make  out a ease of albuminaia.
      The Surgeon  should also admit, with  suspicion,  the statement of
      a third person, who by any chance might be a party to the decep-
      tion.   In short, the Surgeon should, in giving a certificate,  speak
      out of his own personal  knowledge.  It is not safe to give the cer-
      tificate on any other evidence.
           The reason of the disability stated in the certificate should be
      conclusive.   If  the  disease causing the  disability is  such  that it
      may  not in general be a  cause  of disability, then  the circum-
      stances of the particular case must be stated.   For  instance, a
      fracture of  the former  may or may  not be a cause  of disability.
      If the fracture has healed without material shortening, it is  not.
      To be a cause,  the fracture must  have resulted in permanent and
*      material lameness, unfitting the soldier for the march.  A fracture
      of the  femur with  very slight shortening may be a cause for re-
►      jecting a recruit, but not for discharging a soldier.  Such a recruit
      may be rejected because of an injury rendering him liable to rheu- 
12
matic pains, &c.   But  a  soldier is  not to be dismissed from the
service because he may at  some time or in  some  contingency be
disabled.   The disability must be  present.   Again: a man with
fistula  in  ano  would  be rejected if offered  as a  recruit;  but  he
should not be  discharged for that cause, unless it appears that the
fistula is incurable.  The  Government  is entitled to the service of
a soldier if he is curable;  the  man  is entitled to the treatment of
his case if there is chance of cure; but  if  there is no probability
of a cure within  a  reasonable period, then it is better for both
parties that the man be discharged.
    The cause of the disability must  be plainly  as well as accu-
rately stated—plainly because the certificate will be acted upon by
officers  who are not surgeons—accurately because the  certificate
must set forth all the considerations which influence the mind of
the Surgeon granting the certificate.
    When the disability  arises from injury or other causes, by
reason of which application might be made for a pension, then the
certificate must set forth all the facts within the Surgeon's knowl-
edge bearing upon the granting of the pension.
    It will state, if possible, whether the  disability existed in part
or in whole prior to enlistment.   The man's  admission  would be
sufficient evidence of the pre-existence of the  disability.   At dates
not far removed from that of the enlistment, the state, appearance,
or progress of the disease  might throw some light on the question.
Thus  a considerable  hernia is commonly the growth of many
months.
    If the disability has accrued since the date of enlistment,  then
the Surgeon should state if he knows (belief is not sufficient) whether
at the time of receiving his injury the soldier was  engaged in the
discharge of  his  duties; a  man accidentally shot  in a brawl does
not have the status of one shot in battle.
    If the disability was  caused while  in the discharge of duty,
and will probably be a  case for pension, then the  certificate must
set forth the degree of the disability.   Thus: If the man's labor
was worth one dollar per  day before the injury, and the  man can
earn 75 cents per day after the injury,  it amounts  to one quarter; 
i:-5
     if he can  earn  only  50 cents then his  disability is one  half, and
     so on.
         The certificate must be in duplicate;  it must contain also the
     Captain's statement of what tacts he knows bearing on the several
     questions indicated above.
         The man will in the  next place be examined by the next su-
     perior Medical  Officer, or by a Board of Examiners, as may be the
     order governing the matter.  On  re-examination, the certificate  of
     the Surgeon is approved or disapproved, as may be determined.
     The certificates must have the  approval of the line  and medical
     officers in the order of their rank.

                       Of the  Morning Reports.

         Morning reports are made for the information of commanders.
         The commander of the force needs to be kept constantly in-
     formed of the number sick" in camp and unfit for duty.  He needs
     this information  in  order  that  he may  know  how many men
     would have to  be  left behind in case of a  march or engagement.
     He wants to know the number excused from  duty  in order that
     he may see if any men have been excused from  duty on account
     of sickness by  any other than the Medical Officer.  He  needs  in-
     formation as to the condition of the sick, whether they are in hos-
     pital or in quarters,  to the end that he can issue the proper orders
     for their care or removal; and he needs to be constantly informed
     of the sanitary status of his command.   The regimental command-
     ers must be  furnished  daily with the report setting forth these
     facts  in regard to the different companies as well as to the totality
     of the regiment.
         The  brigade  commander  needs information as to the same
     facts, and for like  purposes in regard to the regiments and corps in
      his brigade.   The division commander in reference to the brigade.
      The army commander in  reference to the army.
         Regimental Surgeons report the totals of the morning regi-
v    mental report to the Surgeon of the brigade.
          Brigade Surgeons report the  total of the several regimental
l     reports to the  Division Surgeons 
1-1
    Division Surgeons report the totals of the several  brigades to
the Medical Director of the army, if the arm}- consists of two or
more  divisions.
    These reports should  he  made at the same hour at  which the
reports of the several Adjutants are  made.
    When the nature of the  service  permits,  these reports should
be made with the utmost punctuality.   They are the essential pre-
requisites of so man}- important orders and  measures that  they
can never be neglected without detriment to the service.  Without
the information  which these reports  impart, it  is impossible to
give the necessary instructions or  make the necessary provision
for the sick and disabled.
    In making medical certificates on which officers base an appli-
cation  for leave of absence, if the  leave of absence asked is to go
out of the lines of the army or beyond the limits of thedepartment,
the certificate must set forth the fact that  such removal  is neces-
sary to the recovery of the  health  of the applicant.   It is not
enough that the  applicant is  unfit  for duly, and will be unfit  for a
certain time; his condition must be  such that a change  of air or
of some other,circumstances are  essential to  the safety of life or
the prevention of permanent  disability.  The general orders  gov-
ern the  rigidity of this rule.    The  medical  certificate states
the medical reason, no other.    Medical Officers will always  bear
in mind  that all their official statements  are made on honor, and
they will therefore see the necessity  of  guarding  themselves  from
favoritism to officers or men.   The order making it necessary that
the Surgeon next in rank above the  Medieal Officer giving the
certificate should re-examine  the applicant was doubtless made to
guard against this abuse as well as to correct errors in judgment, and
secure  form and  completeness in the certificate.  As a general  rule.
no personal examination of an applicant is made except by the Sur-
geon giving and  the one first  approving or disapproving the certifi-
cate; therefore the applicant should report in person with the certifi-
cate to the first  Medical  Officer approving or disapproving the
certificate, and to no other.
                       Of Sick  ("alls.
    At the sick  call,  which   should  be  at  an early hour, the sick 
                              15

are conducted or reported to the Surgeon: those who are able to
walk are conducted; those too ill for this are reported.  Each com-
pany Sergeant,  at the call of his  company,  presents himself with
the sick and also his company book with a  list of the sick.  On
this book the Surgeon marks against the name of each man pre-
sented  whether he  is excused from duty  or  not.   The  decree
of duty, if any of which he is capable, and designates the place each
is to occupy in  hospital  or quarters.  He also marks of those re-
maining  at last report,  those who are to be returned to quarters
or to duty.  It is to be remembered that no one can he excused from
duty on account of sickness, or of the sick can be put on duty, ex-
cept by the Surgeon's order.  To this end he will see that after morn-
ing call no sick men. able to report to the Surgeon, are prescribed for.
except in urgent cases, without being accompanied by the Orderly
Sergeant.   This rule should be rigidly enforced for the sake of the
soldier, and in  the interest of the service.   A Medical Officer will
proceed to  the tents  to visit those unable to report in person, and
dispose of them as their  eases require.  Orderly Sergeants,  it will
be remembered, cannot excuse a man from  duty except  upon the
written order of the Surgeon, and therefore the Surgeon's order
must always appear  in the company book.
    When  it happens that the commander neglects to issue  orders
which  the Surgeon  regards as of vital  importance to the  health
of troops, the Surgeon should notify his next superior officer in his
own corps of such neglect, accompanying this  notice with a copy
of the official communication made to the commander.  A copy of
the notice  sent to  his  superior  Medical Officer  should also be
served on the commander.  This latter is  not required except as
an act of courtesy.
    In earning out the  provisions of this  circular. Surgeons will
remember  that  in  many of its  particulars the  functions  of the
Medical  Officer are merely advisory.   Medical Officers  do not
command  except in their own department.   Surgeons give orders to
their inferiors in their own corps.   They prescribe t\\Q duties of
their assistants;  they order their  hospital attendants:  they control
patients while in hospitals: they have all needful authority for the 
Hi
care of the sick; they  ad rise their commanders as to those things
which relate to the health of their commands;  for instance,  they
may advise as to the necessity for the institution of sanitary police
measures.   They  advise as to the institution of any measures or
regulations necessary for the maintenance of health or removal of
causes of sickness  possible, probable, or present   The commander
orders the execution of the  measures recommended, not the Sur-
geon.  The Surgeon  gives his personal attention to  all events and
conditions which concern the health of the command.   He  reports
all the facts which  the  commander needs  to be advised of, so as to
correct errors in sanitary regulations.   Thus he reports that the
location of the camp is insalubrious; that the cooking is not  well
done; that the food is 'unsound; that the sinks are not policed or
properly placed; that the tents are not ventilated, &c.   The com-
mander gives  the  orders necessary for the correction of the evil.
    These instructions are issued for the  information of Surgeons
new to the service, and are intended to embrace only those points
which, in the experience of the volunteer service during the  past
year,  instruction seems to be most needed.   Surgeons  will soon
learn  all the common details of duty if they will diligently study
the Army Regulations, and it is expected that they will find their
superiors always ready to aid them in the study.
                    Respectfully,
           M. GOLDSMITH, Surgeon U. S. Vol.
                         Medical  Director Army of Kentucky.
    Lolisville, Sept. 10th,  1X<>2.

    By order of MAJOR GENERAL  W. KELSON".
                                   C. H. Buford, A.  A.  G.
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