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the law, it will undoubtedlv be done. It is recommendea that the
state authorities be required to organize and thoroughly equip a field
hospital with its ambulance company for each three regiments, in
addition to the regimental medical service.

ALASKA.

The average mean strength of the troops serving in Alaska during
the year was 1,015, composed of infantry. Signal Corps, and Hospitd
Corps, all white.

Alaska still maintains its record as the healthiest territory in
'which American troops are stationed, the total admission and con-
stantly noneffective rates having continuously improved each year
since 1905. The rates for the year 1908 are 419.70 and 12.99. as com-
pared with 657.62 and 21.22 for the year 1907. The death rate is
larger than in previous years, being 9.17, as compared with 3.40 for
1907, there having been in all 10 deaths as compared with 3 in the
preceding year. This increase is due to the large proportion of
deaths by violence from the following causes: Drowmng, 3; suicide, 2;
freezing, 1; and cerebral hemorrhage, caused by a boxing contest, 1.

The principal causes of admission were tonsillitis 23, muscmar
rheumatism 14, and acute bronchitis 13. There were 6 admissions
for appendicitis, all of which recovered. One case of typhoid fever
occurred during the year. The highest admission and noneffective
rates were in February, the lowest admission rate was in June, and
the lowest noneffective rate in May.

Four enlisted men were invalided home, of whom 2 were discharged
for disability, 1 died, and 1 returned to duty.



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BEPOBT OF THE SURGEON -GENEBAL. 14$

CUBA.

The average mean strength of the troops pertaming to the army
serving m CSiba was 4,694, all white. All the admission and dis-
charge for disease rates are somewhat higher than last year, while the
death, discharge for iniury, and constantly noneffective rates are less.
The latter rates are also less than for the United States during 1908.

The principal causes of admission were venereal diseases 202.17,
abscesses and furuncles 101.19, diarrhea and enteritis 57.73, dys-

?epsia 42.82, malaria 39.20, alcoholism 36.43, and bronchitis 27.48.
'he rates for the last five diseases are all decidedly less than the
year before, and although the admissions for venereal diseases are
greater, the constantly noneffective rate for them is less. As was
the case in 1907, typhoid fever is the principal cause of death, as
shown in the following table, but yellow rever caused only 1 death, as
compared with 5 in the preceding year.

The highest rate for admissions was at Cienfue^os, for discharges
at Guines, and for deaths, total losses, noneffective rate, and days
lost by each soldier, Santa Clara.

PREVALENCE OF SPECIAL DISEASES.
TYPHOID FEVER.

Forty cases of this disease with 5 deaths occurred, of which 24 were
in the month of January. An epidemic of 25 cases occurred between
December 21, 1907, and January 26, 1908, at Columbia Barracks,
a part of which shares, with Havana, the advantage of an unimjieach-
able water supply. The chief surgeon reports as follows concerning it :

An outbreak of typhoid fever appeared among the troops of the Second S<iuadron,
Eleventh Cavab-y, and Company I, Signal Corps, immediately after their return
from the target range at Guanajay, at which point they had been on duty from Novem-
ber 25 to December 21, 1907, and where the disease originated.

The first case was admitted to the hospital three days after reaching the poet, the
man having complained of feeling badly two davs before leaving camp. The others,
with the exception of three men, who will be referred to later, were taken sick within
the next three weeks, all having been infected in camp.

The point selected as a camp site was an excellent one, with imlimited room, good
drainage, and an abundant water supply from a limestone spring, which was of Rood
quality. The surrounding country was open and rolling, with a pleasant outlook in
all directions.

As this camp was to be used as a target range for the entire command at Camp Colum-
bia during the target season, it should have oeen considered a permanent one. This,
however, was not dfone, but the old pit latrine established, and the water was distributed
by barrels throughout the camp, while the spring was not adequately protected from
possible pollution. The Forbes sterilizer was m general use. On account of the
shallow and rocky soil the latrines had to be frequently changed, so that this unsanitary
contrivance was at its worst.

Upon an unofficial visit to this camp about December 5, I found the conditions
as stated and made a report to the chief sui^eon, as medical inspector of the army,
citing these conditions and embodying certain recommendations for their correction,
including protection of the source of water supply, the establishment of a pumping
plant and reservoir, and the installation of the McCall incinerators.

These recommendations were carried out and thereafter this camp was in all sanitary
respects a model one.

An analysis of the water and the fact that the command which preceded and fol-
lowed this one remained perfectlv free from the disease shows that neither the water
or other conditions pertaining to the camp were responsible for the origin of the disease,
and furthermore, a careful inspection of the town of Guanajay, with Capt. David Baker,



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150 BEPOKT OP THE SUBGEON-GENERAL.

Medical Corps, of the poet of Giianajay, and the local health officer, showed the town
to be free from typhoid fever, and the fact that the men from the adjoining permanent
post of Guanajay (at which post typhoid fever had not appeared for a year) visited the
town daily and ate and drank there without infection, is corroborative proof that the
disease was not contracted in this town.

A careful analysis of the cases demonstrates to a practical certainty that the disease
was introduced by an ambulatory or walking case of typhoid, in the person of a ser-
geant of the Signal Corps, who had been sick since the latter part of October, but who
did not go on sick report while in camp, and who was finally admitted to hospital with
what proved to be a mild case of typhoid fever. He was quartermaster and mess ser-
geant of the company, so it will be seen how intimate were his relations with the men
and how readily he could act as a disseminator of infection.

The exact means by or through which this soldier was infected I have been unable
to determine, but members of the Signal Corps, in pursuance of their work as linemen
and repairmen, are constantly moving about, and it is well known that typhoid fever in
a sporadic form prevails in many Cuban towns, and it is believed that the original
infection was acquired in that way.

As three of the cases were either cases of prolon^ted incubation or infection after
their return to barracks — a month having elapsed in each case since leaving camp —
as a precaution against barrack infection, this part of the command was put in tents and
thorough disinfection of the barracks, equipment, and personal effects of the men was
carried out. After this disinfection no other case of fever appeared, and Camp
Columbia has been free from the disease since.

The occurrence of the disease by organizations was: Company I,
Signal Corps, 9 ; and in the Second Battalion, Eleventh Cavalry, Troop
F, 4; G, 6; H, 4. There were two additional cases, one a hospital
corps man, who became infected while nursing his comrade sick with
the disease, and an engineer soldier, who Uvea in camp in close prox-
imity to Company I, Signal Corps, and was closely associated with one
of the early cases in Troop H. In Company I, Signal Corps, 6 of the
9 cases were in a group of four adjoining tents, one of which was oc-
cupied by Sergeant E, who is regarded as the carrier who originated
the epidemic. In Troop F, 3 out of the 4 cases occurred in two ad-
joining tents. In Troop G, 5 out of the 6 cases occurred in three
adjoinmg tents. In Troop H, 3 out of the 4 cases occurred in
two adjoming tents.

This epidemic is a marked example of what is believed to be a most
common and serious method of infection among troops in camp, viz,
by contact from man to man.

UNDETERMINED FEVERS.

The occurrence of this group was greater in absolute number and
ratio than in 1907, the ratios being 27.06, as compared with 20.96.
The marked diminution of the malarial fevers with the increased
number diagnosed as given in the following table shows the growing
indisposition on the part of the medical officers to use the diagnosis
malaria as a nosological dumping ground for obscure febrile conditions
in the absence of definite clinical or microscopical evidence to support
such a diagnosis.

Febricula 72

Simple continued fever, cause unknown 10

Fever, type undetermined 34

Ephemeral fever 6

Thermic fever 4

Continued fever, type undetermined 2

Total 127



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REPOBT OF THE SURGEON-GENERAL.. 151

MALARIAL FEVERS.

The admission rate for malarial fevers was noticeably better than
the year before, being 39.20 as compared with 51.40 for 1907 and 26.69
for the United States for 1908. This improvement is due to a corre-
sponding ameUoration of the conditions of Uving in the army of
Cuban pacification due to improvements in the temporary barracks,
the substitution of beds for camp cots whereby more enective use
could be made of mosquito nets, and by the withdrawal of troojjs
from some of the smaller stations where adequate provisions for their
comfort did not exist.

DYSENTERY.

This infection is not very prevalent in Cuba, the admission rate
being 6.82, of which just one-half was amebic — the rate for the
Phihppines being 26.23.

YELLOW FEVER.

Five cases with one death occurred in February, 1908, in the garri-
son at Santa Clara, which was composed of a battalion of the Fifteenth
Cavalry. Four of these cases occurred in Troop K, and one in Troop
M. No other cases occurred during the vear in the army and the
vigorous campaign which was carried on by the provisional govern-
ment of intervention resulted in its extinction throughout the island.

SANITATION.

The sanitary condition of the numerous garrisons scattered over the
island of Cuba was excellent, although the locations of these were deter-
mined by poUtical reasons rather than those of sanitary convenience.

The cnief surgeon in his final report remarks :

The sanitary condition of the various posts and stations occupied by this army was,
with a few minor excepjtions, of a temporary nature, excellent, and no disease attrib-
utable to sanitary deficiencies of any kind has been reported.

In concluding his remarks he adds:

In concluding this final report of the work of the medical department of the army of
Cuban pacification, it might be well to note that it was composed wholly, as far as its
ofl&cers were concerned, of commissioned members of the Medical Corps, United States
Army, which, I believe, is the first time in our military history where so considerable a
body of troops, either for home or foreign service, has been so officered. That this was
a wise measure is, I believe, borne out by the results attained, and I am convinced that
the same results, at least in a relative way, could be attained by a like body of trained
men anywhere or imder any conditions, providing they were given the same earnest
and thoughtful support which has been accorded the medical department of this arm^.

In addition to the strictly military duty performed by the medical officers of this
army, there were five officers of the corps detailed from it for duty with the civil
government, who were engaged in important sanitary work throughout the island
under the supervision of Maj. J. K. Kean, Medical Corps, U. S. Army, who was
detailed by the War Department, and who, as adviser to the sanitary department of
Cuba, was charged with the supervision of all civil sanitary matters on the island.

The commanding general, Maj. Gen. Thomas H. Barry, makes the
following comments with reference to the sanitary administration of
this army:

Credit for the excellent medical and sanitary conditions that characterized the
occupation of Cuba by United States troops from October 6, 1906, to April 1, 1909, is



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152



REPOBT OF THE SURGEON-GENERAL.



primarily due to the intelligence and efficiency of the officers and enlisted men of the
Medical Department, United States Army, who served in Cuba, either with the army
or with the provisional government, especially to the efficient chief surgeon, who, in
that capacity and also in his former capacity as medical inspector, proved himself a
substantial prop on whom any commanding general might lean with absolute security
in all matters medical and sanitary.

PORTO RICO.

The mean enlisted strength of the native Porto Rican troops was the
same as last year, 564, no change having been made in the garrison.

The following table shows the movement of sick for the year 1908
as compared with that for 1907:



Years.



From all causes.



Total.



In hos-
pital.



Excluding injuries,
venereal diseases,
and alcoholism.



Total.



In hos-
pital.



Batlo per 1,000 of mean strength:

Admissions to sick report

Discharges on surgeon's certificate of disability

Deaths !

Total losses

Noneffective from sickness

Average number of days lost:

For each soldier

For each case



1908

1907

1908

1907

1908

1907

/ 1908

V 1907

r 1908

\1907

1908
1907
1908
1907



1,242.91

1,207.45

7.09

7.09

7.09

14.18

14.18

21.27

37.02

42.38

13.65
15.47
10.90
12.81



1,102.84
1,072.70



34.40



12.59
14.55
11.42
12.05



918.44
886.52
7.09
3.55
5.32
12.41
12.41
15.96
22.78
26.85

8.34
9.80
9.08
11.05



20.73
25.46



7.69
9.29



The admission rate was slightly higher, and the discharge rate
exactly the same as the previous year. All the other rates were con-
siderably lower than for any year since the statistics have been com-
piled separately for Porto Kican troops. The death rate ratio, 7.09,
was slightly higher than for the total army, but was much lower than for
the previous year, when the ratio was 14.18. The principal reduction
is in typhoid fever, which caused only 1 death in 1908, and 3 deaths
in the preceding year.

The rate for malarial fevers is 219.86, which is a considerable
reduction over the two preceding years, but is greatly in excess of the
army as a whole, which is 46.33. Venereal diseases give an admission
rate of 242.91, which is in excess of the preceding year.

The highest admission rates were in December and the lowest in
August. The highest noneffective rate was also in December, and
the lowest in Juty. The deaths were one each from typhoid fever,
malarial fever, septicemia, gunshot wound (homicidal).

The following table shows the prevalence of the more important
diseases among the Porto Rican troops. It is to be noted that there
were no cases of pneumonia, hepatic abscess, appendicitis, or alcohol-
ism among these troops during the year.



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REPORT OF THE SURGEON-GENERAL. 153

Diseases of Porto Rican troops — Admission rates per 1,000 of mean strength.

Venereal diseases ^ 242. 91

Gonorrhea and results 143. 62

Chancroid and results 60. 28

Syphilis and results 39. 01

Malaria 219. 86

Influenza 83. 33

Furuncle 78.01

Dyspepsia 62.06

Dengue 44.33

Measles 19.50

Bronchitis, acute and chronic 19. 50

Dysentery 15. 96

Smallpox 7.09

Typhoid fever 5. 32

Rheumatism, acute, articular 5. 32

Filariasis 3. 55

Tuberculosis, all 1. 77

Insanity 1. 77

Dhobie itch 1. 77

RECRUITING.

Eighty per cent of the recruits examined by medical oflBicers were
accepted. This is slightly better than last year.

Forty-five per cent of the accepted candidates were between the
ages of 21 to 25, inclusive; only 3 candidates being under this age.
Fifty-four per cent were over 25 years.

Fifty-eignt per cent were 66 inches, or under, in height, and only
one reached the height of 6 feet. Eighty-five per cent of all recruits
were under the average height of the American recruit, viz, 67 inches.

Fifty-seven per cent weighed less than 130 pounds and only 5 per
cent weighed 150 pounds, or over.

Sixty-six per cent had a chest measurement of 33 inches, or under,
and 17 per cent had chest measurements of 35 inches, or over — A
considerable improvement over the previous year.

REJECTIONS.

Twenty-five per cent of the rejections were caused by deficiency
in weight; 18 per cent for defects of vision, and 10 per cent each for
venereal diseases, diseases of the genito-urinary system (nonvenereal),
and heart disease. Alcoholism does not appear as a factor for

rejections.

Examination of recruits.






Number.


Ratio per
1,000 exam-
ined.


Examined by medical officers. . .


450
360
62
308

88
2


1,000.00


Accepted . . .'


800.00


By flist enlistment


115.66


By all Othei" ftnlistTrpftnt'? - -


684.44


Rejected by medical officers


195.66


Declined


4.44







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154 BBPOBT OF THE SURGEON-GENERAL.

HAWAn.

The garrison of the Hawaiian Islands is situated on the island of
Oahu and has been increased during the year from four companies of
infantry so that a battahon of engmeers were added before the end
of the year and 8 companies of cavalry on January 15, 1909. The
average enlisted strength during the year, however, was only 255.

All the rates have increased as compared to those of the preceding
year, the total admission rate being 1,282.35, and the constantly non-
eflFective rate 37.61, as compared with the admission rate of 1,188.03
and constantly noneffective rate of 42.68 for the whole army.

Except for the very high admission rates for venereal diseases,
239.22, and alcoholism, 74.51, the sanitary record of Hawaii would
be excellent; as for diseases, exclusive of these, its admission rate is
onJy 713.72.

There were no cases of typhoid fever, only one of dysentery, and
one of tuberculosis during the year. Only two deaths occiUTed, one
from tetanus and one from drowning.

Seven enlisted men were invahded home during the year, of whom
three were subsequently returned to duty, and foiu* discharged on
sui^eon's certificate of disabiUty.

PHILIPPINE ISLANDS.

AMERICAN TROOPS.

The health of the American troops in the Philippines continues to
improve year by year. The admission rate for disease and the con-
stantly noneffective rate are better for 1908 than for 1907, which in
turn was better than for any preceding year. The dpath rate was.
however, larger both for disease and external causes. The principal
increase in tne former was from cholera, which caused 7 deaths as
against 1 for the preceding year. Among external causes woimds
caused 20 deaths as against 12, and acute poisoning 11 as against 1
for 1907.

The mean strength of the American troops was 11,971, not includ-
ing a force of native troops, the Philippine Scouts, with a mean strength
of 5,085, whose medical statistics will be given separately later. 'Rie
more important diseases showing a notable reauction are malarial
fevers, dysentery, venereal diseases, and bronchitis. On the other
hand, there was an increased admission rate for diarrhea and enteritis,
appendicitis, and intestinal parasites. The increase in ankylostomal
infection, 77 cases as compared with 33, indicated probably only an
increased care in searching for this infection.

The diseases causing the highest noneffective rates were venereal
diseases, 17.97; malana, 2.76; dysentery, 2.57; dengue, 1.80; an&
diarrhea and enteritis, 1.75.

The principal causes of death from diseases were (absolute num-
bers) tuberculosis, 12; cholera, 7; organic diseases of the heart, 5;
and alcoholism, 5. It should be noted that deaths occurring in the
United States from diseases originating in the Philippines are credited
in this report to the station of the regiment or organization to which
the soldier belongs. Thus of the 12 deaths from tuberculosis credited
to the Philippines, only 2 actually occurred there, the balance being
among soldiers invalided home on accoimt of tnat disease. Four
cases of sunstroke occurred without a death. No case of snake bite



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REPORT OF THE SURGEON-GENERAL..



155



was reported. Sixteen deaths occurred from gunshot wounds and 4
from other wounds, none of them having occurred in action. There
were 13 deaths from drowning.

PREVALENCE OF SPECIAL DISEASES. *



TYPHOID FEVER.

The admission rate was 2.76 as compared with 3.60 for 1907, with
5 deaths as against 3 for the preceding year. This rate was less than
that for the army. Nine cases occurred in the Cuartel de Espana
between November 29 and December 10, in Company M, Twenty-
sixth Infantry. The outbreak having been investigated by the
board for the study of tropical diseases, the company cook, who gave
a history of a former attack and a positive Widal reaction was be-
lieved by them to have originated the outbreak, altKough the bacillus
of Eberth was not found in his excreta. The assistant cook was one
of the last cases attacked. As the men attacked were not closely
associated with each other in barracks it seems probable that contact
infection was not a feature of this outbreak, but that all the cases are
to be ascribed to infection of the food by the cook.

Typhoid fever J Philippine Islands.



Posts.



Camp Bumpus, Leyte

Manua posts

Fort William McKinley, Luzon.

Camp Stotsenburg, Luzon

Camp Downes, Leyte

Doilo, Panay

Camp Keitmey, Mindanao

Jolo. Jolo

Division hospital, Manila



Total.



Mean
strength.



327
988
2,354
981
281
177
993
942



11,971



Admis-
sions.



33



Deaths.



MALARIAL FEVER.

The admission rate for all fevers of this class was 123.97 as compared
with 167.79 for 1907, 304.20 for 1906, and 261.55 for 1905. This
great improvement is to be ascribed to the steps taken to protect the
men at night from the bites of anopheles mosquitoes ana doubtless
also the measures taken to destroy their breeding places near the
garrisons. In this connection the chief surgeon of the Philippines
Division states in his annual report as follows:

Although every possible precaution has been observed to prevent infection, malarial
diseases occupy the third place among causes of sickness, following immediately after
diseases affectmg the digestive system. Mosquito bars have been universally used,
and recommendations were made for the screening of all buildings occupied by troops,
but as yet the screens have not been installed . It is my opinion that not only to safe-
guard against malarial infection, but for the personal comfort of the command as well,
the expenditure of the money is justifiable for screening every permanent post in the
islands. The infection of the anopheles in a commimity adjoining military stations
should be considered in this connection, through new commands suffering from
malarial diseases. Many of the posts occupied by America^ troops in this division
are constructed of lumber and, with slight alterations, could be arranged for screen-
ing. Many of the smaller posts occupied by native troops in the pueblos could also
be screened. It is my opinion that a large number of the command, both Americans
and natives, suffer from latent malaria in the Philippine Islands, and only exhibit



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156 REPORT OF THE SURGEON-GENERAL.

active symptoms of the disease when called upon to perform unusual duty, such as
campaigning or severe fatigue labor. This was exemplified at Fort William McKinley,
during the last calendar year, during the employment of the Twenty-ninth Infantry
in digging ditches in the not sun for several da^rs, resulting in the feickness of a large
number of the men. Upon examination of their blood a large percentage of them
were found to contain malaria parasites.

The chief surgeon of the Department of Mindanao observes as follows: ** Apart from
admissions due to external causes, the highest admission rate during the year was
caused by malaria, and of a total of 884 cases the post of Jolo had 428 cases. The in-
sanitary condition of the town of Jolo was responsible for this large number of cases,
and in June, 1908, arrangements were made with the municipal authorities by which
a sanitary squad waa organized under the supervision of a medical officer. This squad
commenced work in Jmy, cleaning the city and doing away with mosquito-breeding
places, and the efficiency of its work is shown by a progressive decrease m the number



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