Tabb, transport Manitoba; relieved by Asst. Surg. C. H. Lavinder, in turn relieved by Asst. Surg. L. L. Lumsden; Asst. Surg. John McMullen, transport Mississippi; Asst. Surg. S. B. Grubbs, transport Chester; Asst. Surg. H. B. Parker, transport Minnewaska; Acting Asst. Surg. J. S. Hough, transport Roumanian; Acting Asst. Surg. T. D. McClintic, transport Port Victor; Acting Asst. Surg. Maxime Landry, transport Berlin.

The following instructions were issued:

INSTRUCTIONS TO MEDICAL OFFICERS OF THE MARINE-HOSPITAL SERVICE ON BOARD TRANSPORTS OF WAR DEPARTMENT.

WASHINGTON, D. C., August 3, 1898.

(1) Your duties are primarily to keep the transports from becoming infected. (2) At the foreign port the crews must be forbidden and prevented from going ashore; everything brought on board from shore must be inspected, and if doubt exists, rejected or disinfected. All persons coming on board at foreign ports must be inspected at the gangway. Vessels must lie off the shore and not go to dock. (3) Certificates from medical officers of the Marine-Hospital Service on duty at Santiago and other ports should be accepted.

(4) If troops are brought on board, obtain certificate from responsible medical officer of the Army of freedom from infection.

(5) No passengers should be allowed on board except on written order of the Commanding General (see correspondence on this subject with War Department, copy herewith inclosed).

(6) If transport brings back sick or wounded soldiers, the latter are under the care of the medical officer of the Army detailed for this purpose. For their treatment, medical supplies, etc., the Medical Department, United States Army, is responsible. The crews of the vessels, however, are under your professional care, and a supply of drugs, etc., has been sent you for this purpose. If, however, you are called on by the proper authority for assistance of the sick or wounded soldiers, you are authorized to render it. In absence of a regular medical officer of the Army, you will, of course, render such assistance as the ordinary dictates of humanity demand.

(7) Look carefully after water supply. Keep accurate notes and furnish such certificate as you are able to give to the quarantine officer at the port of arrival in the United States. Transmit reports to Bureau on arrival in home port.

(8) A copy of the quarantine regulations is sent you herewith for your further guidance, and your attention is particularly called to pages 160 et seq.. of the work on yellow fever recently issued by the Bureau.

(9) At Santiago and other ports you will communicate with the medical officer of the Marine-Hospital Service in command, and will receive and obey any reasonable order from him.

(10) Disinfectants will be furnished from the Bureau on requisition as soon as practicable, but if for any reason purchase is necessary, the officer may purchase in accordance with the regulations of the Marine-Hospital Service.

(11) These instructions will be amended or added to hereafter, and if for any cause it is impracticable or impossible to enforce them, the officer must carry out their spirit, if not their letter, to the best of his ability and report the facts to the Bureau.

WALTER WYMAN, Supervising Surgeon-General U. S. M. H. S.

At the date of this report this arrangement is still in force, and the value of the services of these officers may be judged by the reports thus far received, as follows:

REPORTS OF SERVICE ON THE UNITED STATES ARMY TRANSPORT OBDAM.

By Asst. Surg. A. R. THOMAS.

STEAMSHIP OBDAM, New York, N. Y., September 8, 189. SIR: I have the honor to make the following report concerning the recent trip of the steamship Obdam from Newport News, Va., to Ponce, Porto Rico, and thence back to New York City. As stated in my last report, we left Newport News on August 18, and arrived off Charleston, S. C., on the morning of the 20th, and took on additional stores and passengers. On leaving there we had about 50 cabin passengers and 110 troops. Three enlisted men were sent ashore in Charleston because of sickness. I either saw them myself or had one of the contract surgeons do so, using the medicines supplied by the Bureau. We arrived in Ponce on the 25th of August, having had no serious sickness and no deaths. We were boarded by the port quarantine officer, who is a Spaniard, still holding the position he did under Spanish rule. Orders were given prohibiting the crew from going ashore, but there was pretty free communication between the boat and the shore. In consultation with Colonel Greenleaf, of General Miles's staff, surgeon in chief of the Army, I learned that there were no contagious diseases among the United States troops in Porto Rico and, as far as known, no yellow fever in the island of Porto Rico. There were a few scattered cases of smallpox among the natives of the interior towns, but none had occurred among the troops. We were also visited by the Army sanitary inspector, who examined particularly the availability of the ship for transporting convalescents. She was unloaded as rapidly as possible, native stevedores being used. An effort was made to have the sanitary apparatus of the boat put in order, but no plumber was available for the purpose. We left the port of Ponce on September 1 and arrived in New York Harbor on the morning of September 7. We had on board General Miles and staff and the two battalions of the Second Wisconsin Regiment of Volunteers, with their officers, a total of about 900. At the request of Colonel Greenleaf, I looked after such of the cabin passengers as needed medical aid, and he turned over his medicine to me for that purpose. The troops were in charge of the regimental surgeon. No serious illness occurred during the voyage, either among passengers or troops or crew. Each day during the voyage I have inspected the entire ship, usually in company with the captain and one or more ship's officers, and frequently with one or more army officers. During the outward voyage the troops were in many small detachments, with no central head, and it was only with difficulty they could be made to keep their quarters in good condition. On the return voyage there was the greatest difficulty in having the quarters occupied by the troops properly policed and cleaned. Eventually it was necessary to carry the matter to headquarters, and after that it was effectually accomplished.

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The water supply throughout has been good. The Obdam has a distilling plant capable of supplying 3,500 gallons of aerated water per day, so that there has been an abundance at all times. The sanitary arrangements of this boat are old and worn out, and have frequently needed repairs, causing a great deal of annoyance and inconvenience. In consultation with Colonel Greenleaf I have recommended that the whole plumbing of the boat be thoroughly overhauled before she again leaves port, and I think this will be done. The food supply has been only fairly good, due largely to the fact of the supplies being bought in great haste at Newport News. The ship has an efficient cold-storage plant, operated by compressed air.

As stated above, there is no known yellow fever in Porto Rico at the present time, but it was reported to me that there are always more or less cases in San Juan city, but I could not verify the statement. If the island should become infected it would be extremely difficult to prevent infection of a transport loading or unloading at the port of Ponce if native stevedores are employed.

The instructions received from the Bureau have been carried out as carefully as possible. All troops were inspected at the gangway, unless loading by two gangways at once. No supplies were brought back from Porto Rico except personal baggage and rations. Certificates were obtained from the medical officer of the Second Wisconsin, and my certificate of the condition of the transport was accepted at quarantine in New York.

In conclusion, I would say that if possible the sanitary inspector's position aboard a transport should be more accurately defined, and some power given him to enforce his sanitary measures.

The report of sick treated during the month of August will be forwarded as soon as I can gain access to an official nomenclature.

Yours, respectfully,

SURGEON-GENERAL MARINE HOSPITAL SERVICE.

A. R. THOMAS, Assistant Surgeon, M. H. S.

STEAMSHIP OBDAM,

New York City. October 20, 1898.

SIR: I have the honor to make the following report concerning the recent voyage of the United States transport Obdam from New York to Porto Rico and Santiago de Cuba and return. The Obdam left her dock on the night of September 14, having on board one battalion of infantry, with officers, including the lieutenant-colonel of the regiment, in charge, and about 20 cabin passengers and a crew of 70 men. She carried a large amount of supplies, a considerable amount being stowed on deck, and making the washing of decks much more difficult. Upon our departure it was suggested to the commanding officer of troops that it was advisable that the quarters occupied by the men should be policed and thoroughly cleaned each day, and that guards be placed at the fresh-water faucets to prevent waste, and also at the water-closets. Orders were accordingly issued to this effect by the commanding officer, but owing to lax discipline were carried out in a very indifferent manner, and it became necessary each day to remind the officer of the guard of the absence of guards or failure to put quarters in order. As a result, at one time the water supply was rather short, due entirely to wastefulness, inasmuch as the distilling plant on the Obdam is amply sufficient to produce all the fresh water necessary for ordinary purposes. There was very little sickness during the voyage and the food supply was abundant and good. The Obdam arrived at San Juan, Porto Rico, and was boarded by the pilot, who reported to United States representatives in the city, and that no one could be put ashore previous to the visit of the Spanish health officer. It was therefore decided to proceed at once to Ponce, and she reached that port on September 22. Previous to entering port at Ponce it was suggested to the quartermaster, captain of the Obdam, and to the commanding officer of the troops that no unnecessary communication be allowed between the ship and the shore until the status of yellow fever in the city could be ascertained. We were boarded by the Spanish health officer and given pratique. He could give no definite information regarding the health of Ponce, and as soon as possible I reported to the surgeon in chief on General Henry's staff, Major Snowden. He stated that there had been four cases of yellow fever in the general hospital-one death and three recoveries. All were from one regiment and from a guard that had been placed in the prison where

some sewer pipes were being repaired. They had been isolated and their effects disinfected, and quarantine against the town had been raised. He reported two cases of smallpox-one in the general hospital and one a native. It was there fore decided that there was no reason why the Obdam should quarantine against the shore.

September 23 Major Seaman inspected the Obdam, to ascertain its capacity for carrying convalescents. In conversation he stated that, as a member of the board of investigation into the cases of supposed yellow fever, he did not think there had been a single case of that disease in the city of Ponce. For two days after arrival at Ponce there was a steady downpour of rain, and the troops could not be disembarked. As soon as they had left the vessel the quarters were thoroughly cleaned and scrubbed and put in as sanitary a condition as possible.

While at Ponce three the of ship's crew were sent to hospitals on shore. Third Officer Robbins was knocked from the deck to a lighter below by a boom swing and sustained a fracture of the skull. He was sent to the general hospital next day. Two of the crew were sent to the quartermaster's hospital suffering from malarial fever.

September 27 about 238 convalescents and 40 cabin passengers came on board and the vessel left the next day for Santiago de Cuba. The convalescents were under the medical care of Surgeon-Major Seaman and Assistant Surgeon Jorrel, and Lieutenant Johnson, of the Nineteenth Infantry, looked after the discipline of the men, which was most excellent. The quarters were invariably kept in good sanitary condition and guards were rigorously maintained.

The Obdam reached Santiago the evening of September 30, and anchored in the harbor about 1 mile from shore.

During the voyage from Ponce I drew up a set of regulations regarding the conduct of the vessel at Santiago, in order to prevent every possibility of infection, and a copy of the same was given to Captain Allen, quartermaster, in charge of the boat, and also a copy to Major Seaman, at his request. I inclose herewith a copy of the same. Captain Allen assured me that, with the exception of the employment of native stevedores, he saw no reason for not carrying out these regulations.

We were visted early on the morning of October 1 by Dr. Caminero as health officer of the port. He stated that there was very little yellow fever at Santiago, and that it was confined very largely to the troops encamped outside the city. There was, however, great diversity of opinion among the officers in the city as to this question, and I saw no reason to modify my request regarding the isolation of the Obdam from shore communication. It was at first stated that we were to take on board all those who wished to go, but a very vigorous protest was made against such action, inasmuch as the convalescents aboard would be especially liable to infection in their present weakened condition. At first it was stated by the depot quartermaster that he would put whomsoever he chose aboard; but by appealing to the surgeon in chief and to General Lawton this was so modified that only those were sent aboard who were obliged to go at an early date, and no one was included who would be liable to carry infection. About 15 passengers were, however, taken aboard, all stating that they had not been in contact with yellow fever, but it was found during the voyage that these statements were not always quite accurate. Dr. Horord, surgeon in chief to General Lawton, issued a certificate stating that all passengers sent aboard were free from infection, and gave verbal orders to me to admit no one whom I thought suspicious. It was difficult to enforce this order, because I had no authority to prevent the officers from boarding if they brought orders from the depot quartermaster.

During our stay in Santiago harbor, most of the cabin passengers were granted permission to go ashore, and a considerable number visited the ship from shore. None of the crew, so far as I know, were ashore in Santiago, however. Native

stevedores were put aboard for unloading the cargo and were everywhere about the ship, mingling freely with the convalescents. I do not see how it is possible to prevent this under the present system.

We sailed from Santiago on the evening of October 2, but were obliged to put back next day because of fire in the coal stored in the hold as ballast. Also during this second visit to Santiago harbor about 20 discharged men were allowed to visit the city for rations. I suggested that some one person should be commissioned to do this duty, but I was overruled, and each man was allowed to obtain his own supply of food.

We left Santiago finally on October 6 and reached New York Harbor on the evening of October 11. During the voyage one death occurred, the man being found at night dead on the deck. One case of pneumonia developed and was convalescent on reaching port. During the trip from Ponce to New York I not only treated the crew but also the cabin passengers, Major Seaman denying any responsibility for any but the convalescents.

Twice during the voyage I made sick call for the medical officers, because of their sickness. Upon reaching quarantine at New York Harbor orders were received to wait at that place for disinfection, but it was the intention of the quartermaster at New York to take off all passengers and their baggage. It had been reported that there had been a case of smallpox on board. Upon my statement that I considered the vessel as free from infection, and therefore in no need of disinfection, she was allowed to proceed to the city.

During the entire period of absence from New York I made a personal inspection of the vessel each day in company with the ship officers, and one of the officers in command of troops if possible. All passengers were discharged

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on October 12 and the vessel put into dock for repairs. The crew were discharged, and only guards and workmen remained aboard.

The trip as a whole was unsatisfactory, because I could not feel that the ship was free from the danger of infection.

SIR: I have the honor to make the following suggestions concerning the conduct of this vessel while in Santiago Harbor, in order to conform to the quarantine laws of the United States against yellow fever:

First. The vessel should lie at anchor in the harbor and not at the dock.

Second. There should be no direct communication with the shore, i. e.: (a) Passengers bound for New York and the ship's crew should under no circumstances leave the boat. (b) No persons from shore should be allowed to visit the ship, and, if possible, the cargo should be unloaded without employing native stevedores. (c) Those officers having business ashore should attend to it between the hours of 9 a. m. and 4 p. m., and not remain ashore at night. (d) No passengers should be taken aboard at Santiago. (e) No supplies or freight should be brought aboard unless previously disinfected. (f) Trafficking with "bumboats" should be pro

hibited.

Yours, respectfully,

Capt. WALTER ALLEN,

A. R. THOMAS,

Assistant Surgeon, M. H. S., Sanitary Inspector Steamship Obdam.

Assistant Quartermaster, U. S. A., Steamship Obdam.