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the surgeon before deciding to accept a volunteer. The diseases, defects, or deformities which afford cause for rejection of recruits have been fully laid down in the books of instruction for the examining surgeons, and do not come prop. erly within the range of our inquiries. It is, however, to carelessness and neglect in the inspection of those who have offered to enter the service that a large portion of the sickness of the new troops is due, and from this cause more than any other has it happened, more than once, that with very large numbers on the rolls, the effective force of our armies has often been very small.

But the soldier once received into the army, there are many causes which tend to impair his health, and prevent that sound hygienic condition necessary to make him effective and serviceable. These causes may be classed under one or the other of two heads-those inherent in the organism of the soldier, and those external to that organism and acting upon it only from without. In the first class may be enumerated Race, which exerts a powerful influence; the men of one race being far more subject to some diseases, and enjoying a greater immunity from others, than those of another. To a limited extent this is true even of nationalities, the Celt, the Teuton or the Scandinavian having a constitutional predisposition to some forms of disease from which the Anglo-Saxon is free, and vice versa. In the different races of men this difference becomes strongly marked. The volunteer army of the United States is principally composed of the European or Caucasian race, some regiments being largely Teutonic, others mainly Celtic, and others, the great majority, of that conglomerate of different nationalities, the native-born American. Within a year past, however, another element has been added to the army, in the numerous regiments of African descent. The experiment has not yet progressed quite far enough to enable us to compare the hygienic characteristics of the two races very fully, but these facts have been ascertained: the negro troops are more subject to phthisis, scrofulous affections, and tetanus, and their wounds do not heal so readily as those of the whites, but they are far less liable to malarious diseases, nervous affections, or the influence of the syphilitic poison than the white troops. The mortality from disease among them has been thus far proportionally much below that in the white regiments in the departments of Tennessee, the Gulf, and the South. There are three or four regiments of Indians and halfbreeds on the western frontier, but they are not sufficiently numerous to offer the opportunity of a fair comparison. Age, temperament, hereditary tendencies, habit in the mode of life, morbid and vicious habits, and the natural constitution are also among the agencies inherent to the organism which influence the hygienic condition of the soldier, all of which must be taken into account by the regimental surgeon who would keep the body of soldiers

under his charge in the highest effective condition. To the watchfulness of some surgeons over these agencies, as well as those presently to be mentioned, is due the superior condition in which their regiments are always found.

But, aside from these inherent tendencies to impair the health of an army, come another class equally formidable, to assail vigor and ef fectiveness from without.

Of these external agencies the most important are the atmospheric condition, temperature, light, heat, electricity, water, soil, and locality of camp, bivouac, or barracks, the climate, and the necessary acclimation where that climate is essentially different from the one in which the soldier has previously resided, the habitation, in its plan, space, ventilation, etc., whether that habitation be a camp, barrack, or hospital; the food of the soldier in all its relations, quantity and varieties, accessary food, including condiments, spirits, tea, coffee, and tobacco, and the clothing of the army in its relations to health.

On some of these agencies a few words of explanation may be desirable. The atmosphere is an agency for the promotion or transmission of disease when loaded with moisture, especially when the temperature is low, producing at such times rheumatism, neuralgia, and often pulmonary disease. A hot and moist or a hot and dry condition of the atmosphere is also unfavorable to health. The atmosphere is also a medium of imparting disease, when it is corrupted by noxious gases, when it is saturated with the effluvia thrown off by perspiration, as in over-crowded rooms, tents, etc.; when it is impregnated with the spores of fungi, or whatever it may be, which we denominate malaria; and, perhaps, when it contains an excess or deficiency of ozone. The promotion of health in these various atmospheric conditions in the army requires the use of the rubber blanket, the protection of tents where possible, a sufficiency of good clothing, the strict avoidance and prohibition of over-crowding, whether in tent, barrack, or hospital, the careful selection of camping ground on high and dry locations, to windward of marshes or malarious positions, and, if possible, with water between the camp and the marsh; the building of fires, wherever there are not military reasons to prevent; the flooring of tents, and the raising of the floors of barracks some distance above the ground. The administration of quinine or cinchonine in small doses daily to the men when exposed to malaria, is also an important prophylactic against the intermittent and remittent fevers which would otherwise prostrate so many of them.

The temperature exerts a powerful influence upon the health of the army. When provided with proper clothing and food, the temperature has rarely been so low as to effect serious injury upon persons in health. In a few instances, however, men in cavalry expeditions, or in transit from one point to another, where

they had become very wet and were subsequently subjected to the cold in a season of immeasurable severity, have suffered from frozen extremities. With the sick or wounded when exposed the sudden accession of a low, moist temperature often proves fatal, idiopathic and traumatic tetanus supervening, and causing speedy death. Apoplexy, bronchitis, pneumonia, diarrhea, and rheumatism are often induced by it; clear, bracing, moderately cold weather is highly conducive to health. The amount of sickness is less than one half during the winter months of the summer ratio. In the army of the Potomac, in 1862, March was the healthiest month, and July the sickliest; in the army of Western Virginia, May was the healthiest and October the sickliest. In South Carolina, March was the healthiest; in Florida, December, while in July the ratio of sickness was more than five times as great. In Kansas the health of the troops was best in May, and worst in September. High temperatures are prolific in disease, unless great caution is exercised. Sunstroke is very prevalent, and to prevent it the troops should wear the Zouave turban, or a wet folded cloth in their cap. Diseases of the liver, diarrhea, dysentery, and fevers also prevail in the hot season, and the constant care of the surgeon is requisite to ward them off.

Water is a very active agent both in promoting and in preventing disease in camps, barracks, and garrisons. In its use for drinking and cooking purposes it is absolutely essential to health that it should be at least moderately pure, and yet it seldom is so. The water for the use of armies in the field is supplied usually from rivers or streams, from springs, or from pools or ponds, very rarely from wells or from cisterns, in which rainwater has been collected. In barracks or hospitals, cisterns, wells or reservoirs are the usual sources of supply. Rainwater, though containing some impurities acquired from the atmosphere, or from the roofs, etc., from which it is collected, contains fewer hurtful substances in solution or admixture than water obtained from any other source. River water usually contains earthy and sometimes mineral substances, and when drawn from the vicinity of a large town has also more or less animal matter in solution. Spring water and well water also very generally contain lime, magnesia, and other mineral salts in solution, while water from pools, marshes or stagnant ponds, is largely charged with confervæ and infusoria, and is thus more injurious in its effects than any other, producing typhoid and paludal fevers, and other diseases of a grave character. The presence of earthy or mineral substances very generally induces diarrhea, dysentery, and sometimes serious ulceration of the bowels. To prevent these evil results from the use of impure water, the surgeon of each regiment should require all water drank or used for cooking to be filtered by some one of the numer

ous simple processes in use in the army, and at permanent camps, barracks, and hospitals great care should be taken to have all the water used in the purest possible condition. The use of water in bathing and thorough ablution by the soldiers is a matter so important that it should be insisted upon wherever it is possible to obtain sufficient water for the purpose, but the time of taking the bath, the condition of the men when taking it, and the temperature, should be carefully attended to by the surgeon. Dr. Calvin Cutter, surgeon of one of the Massachusetts regiments, and for some time brigade surgeon, kept the men in his command in perfect health during the intensely hot summer of 1863, in the Department of the Tennessee, by the strict enforcement of cleanliness and frequent bathing, the careful selection of positions for the camps, and the avoidance of unnecessary exposure to the sun. Similar care would have been rewarded, in most regiments or brigades in the field, with similar success. The influence of soil and locality upon the health of an army is also very important. Some soils retain the heat of the sun much longer than others; this is especially the case with sandy soils as compared with those of a clayey character, or those composed of decomposed vegetable matter. The latter, on the other hand, retain moisture with great tenacity, and hence are unfitted for healthful camping grounds. A clayey soil, overlaid with gravel, is, of all others, the worst for the site of a camp, and should never be chosen when it is possible to obtain any other. Dry, sandy positions sloping to water, to secure good drainage, with wood at no great distance, yet not overshadowing the camp, and where the sun can have access to the ground and dry up the moisture speedily, are preferable to all others. The locality should not be in a valley if it can be avoided, but rather on a hillslope-not on the top of a lofty height, since the soldiers would be exhausted in the transportation of fuel, etc.; not on a plain unless the plain is extensive and dry.

An army going, as the army of the United States have done, to a climate warmer than that in which they had previously resided, find a necessity, if health is to be maintained, for care in diet and habits, and should as far as possible adopt the customs and food of the people of the new climate, to secure that acclimation without which the change will be likely to prove fatal to large numbers. The food in a hot climate should be to a greater extent composed of fruits and amylaceous substances. Meat and spirituous liquors should be sparingly used in health, and coffee or tea substituted for the latter. The clothing should be adapted to the climate, and violent exercise avoided in that portion of the day when the heat is most intense. The use of anti-scorbutics and sub-acids, to avoid scurvy, is indispensable.

The habitations of the soldiers greatly in

fluence their hygienic condition. These may be considered under three heads: camps, in the field, consisting of tents or huts; barracks for those in garrisons or camps of instruction, and hospitals for the sick or wounded. In camp, there are several descriptions of tent used, the principal of which are the Wedge tent, now falling into disuse from its inconvenience; the Sibley tent, conoid in form with a movable cowl at the top, so arranged as to be easily shifted according to the direction of the wind, or a modification of it made by fastening three poles together at one end, the other ends being separated so as to form a large tripod; and the Bell tent, so named from its form, and which is ventilated by a window cut in one side near the top, which can be closed by a canvas flap. These tents are in use by the men; the Sibley is intended for fifteen infantry soldiers, or thirteen mounted men, too large a number for effective ventilation or comfort. The officers' tent is square, and has a canvas wall four feet high, which can be raised all around. It has also a fly or movable canvas flap on each side of the roof, which aids in preventing the heat of the sun or the rain from entering. The hospital tent is larger and higher, being 15 feet square and 12 feet high, with a wall 4 feet high, and has a heavy fly. The ends are open, and it is so arranged that two or more can be joined together, forming a continuous ward. On the march the troops sometimes use the small shelter tent or tent d'abri, composed of canvas sheets and jointed sticks, of which each one of the four soldiers who are to occupy it carries his portion. These afford a slight protection from rains and heavy dews at night, but most of the soldiers prefer sleeping in the open air. Where a camp is somewhat permanent, the soldiers often build huts. These are generally large enough to contain 20 men, and should, but do not always, have a ridge ventilation. There is a great tendency to overcrowding in the camps, by placing them too closely on the plot selected for a camp. The army regulations, based on the number of men in the old Wedge tent, prescribed a density of population equal to 86,448 to the square mile, a far greater number than are crowded into the same space in either London or New York. With the Sibley tent, the application of this rule would have led to a density nearly three times greater than this. The evil effects of such overcrowding were soon exhibited in the increase of sickness in the camps, and the space occupied has been greatly enlarged by the commanding generals. The police regulations of the camp must be strictly enforced, or there is invariably a serious increase of illness. Every tent or hut must have a trench around it, the streets and open spaces must be carefully swept every day, and all garbage and filth carried off, the latrines placed to leeward of the camp, and a foot of fresh earth thrown on them daily, fires built in the open spaces, as often as military necessity will admit, tents struck and moved to another

position, and the earth on which they stood allowed to sun, and the sides of the tents raised to admit fresh air. With the observance of these precautions, a camp life is favorable rather than prejudicial to health.

The attention to ventilation, the avoidance of overcrowding, and the careful observance of cleanliness, so requisite in camp, are still more necessary in barracks, and in addition to these, there should be strict regard given to bathing and ablution by every inmate. Most of the barracks have ample provision for this, and it should be enforced, if necessary, as a matter of discipline. While great attention has been paid to the hygienic condition of the camps and barracks, a work in which the Medical Inspectors of the Sanitary Commission have rendered valuable service to the army and to the medical department, that department has performed a Herculean labor in the erection and fitting up of 233 general hospitals, in different parts of the country, beside a very considerable number of post and garrison hospitals. These hospitals are generally temporary structures, intended to last, without material repairs, for ten years, but in their vast extent, their admirable plans, and their completeness of outfit, they have never been approached by those of any other nation. At the commencement of the war, the War Department had no hospitals, save a few post and garrison establishments of antiquated design, and whose aggregate capacity was less than that of a single one of the magnificent structures since erected. In the battles of the spring of 1862, though new hospitals were erected with the utmost rapidity, consistent with their thorough adaptation to the wants of the patients, they were inadequate to accommodate the tens of thousands of the sick and wounded who needed care, and the Government was compelled to solicit the admission of its patient sufferers into the civil hospitals in the large cities. In this way many were provided for in Baltimore, Philadelphia, New York, Boston, Pittsburg, Cincinnati, St. Louis, and Louisville. The pushing forward of the new hospitals to completion, as well as the erection of others, meantime occupied the energies of the Quartermaster-General and the Surgeon General, both men of extraordinary executive ability, and in the autumn of 1862, they were able to announce their readiness to accommodate in their own hospitals all their sick and wounded. the construction and administration of those hospitals the Surgeon-General laid down these principles to be observed:

In

1st. That they should be capable of being well ventilated.

2d. That each should be sufficiently capacious for the number of inmates it was to contain. 3d. That they should admit of good drainage. 4th. That they should be provided with a sufficient number of windows.

5th. That the kitchen, laundry, and other offices of administration, should be separated from the wards, well arranged, and of ample size.

6th. That efficient water-closets, ablution, and bathing accommodations should be provided.

7th. That they should be amply supplied with water and gas, or other means of illumination. 8th. That the furniture of all kinds should be of suitable quality.

9th. That the officers and attendants should have their proper respective duties assigned to them, and that they should be in number sufficient for the wants of the sick.

10th. That proper rules should be established for the government of the hospital, for the diet of the inmates, and for preserving order and an e ficient state of police.

The idea of a hospital, conceived by most non-professional readers, is that of a huge barrack-looking building or buildings, three or four stories in height, gloomy in appearance, and into whose cavernous walls many a poor unfortunate enters, but very few return to the life and bustle of the outer world. This typical hospital is as far as possible from the conception of Surgeon-General Hammond, or the able medical directors and surgeons who have been his coadjutors in planning and superintending the construction of the General Hospitals of the Army. They started with certain fundamental ideas of construction, which have been carried through all their hospitals. The first of these was ridge ventilation, or the supplying a way of egress for the foul air of the ward by an opening of from ten inches to three feet at the ridge or apex of the roof, protected from the admission of rain, snow, or violent winds by a false roof, raised four inches above the true one, and projecting over it on each side about two feet. A perforated iron plate near the floor and behind each bed admits the fresh air, which passes thus upwards, and forces the foul air through the roof opening. This forms the summer ventilation. In winter the fresh air is admitted around the stove from below, and passing between the stove and an outer casing of zinc, which surrounds it, is distributed through the room; while a large, square wooden tube open at the bottom, and extending to the roof, receives and encloses the pipe of the stove to its termination above the ridge, and thus becomes the ventilator of that portion of the ward.

Another new feature in the construction of these hospitals was the entire separation of the wards from the administrative portion of the hospital, and the making of each ward a single one story pavilion, removed so far from every other ward or building, that it could have the benefit of the sun, and the free circulation of pure air on both sides of it, throughout the day, while at the same time one end of each ward opened from a corridor which would serve as a covered hall for exercise to the convalescing patients, and through which there was communication with the administrative buildings. The pavilions were to have their long diameter, where possible, a north and south line. An

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other point insisted upon was that no patient
should have less than 1,000 (except under very
peculiar circumstances not less than 1,200) cubic
feet of space, and the air of this, by the system
of ventilation, constantly changing.

The pavilions were to be raised at least one
foot, generally two, above the ground; the
floors to be coated with a mixture of beeswax
and oil, to prevent any liquid from soaking
into them; the baths and water closets to be at
the extreme end of the pavilions, and form an
angle with them, and to be connected with
such a system of sewerage as would convey all
offensive matters and odors away instantly. A
ward or pavilion was not to contain more than
fifty-two beds, and these were to be placed in
pairs with three feet space between the two,
and each pair to be placed between the win-
dows; the two beds occupying an average
space of fifteen feet in the length of the ward,
and of seven and a half feet in width, and a
passage way of ten feet to extend through the
middle of the ward for its whole length, thus
making the width of each ward twenty-five
feet, and its length, if it contains fifty-two
beds, about two hundred and twenty feet; the
additional twenty-five feet being occupied with
water closets, scullery, &c., at one end, and
wardmasters', nurses' rooms, and mess room at
the other. In the practical application of these
principles, it has been found better not to have
the wards quite so long, and they generally
contain only thirty-six or forty-eight beds (some
only twenty-four); or, if there are fifty-two,
they occupy somewhat less than fifteen feet to
the pair. The first large hospital built upon the
principles presented by the surgeon-general,
was the West Philadelphia Hospital, situated at
the intersection of Forty-fourth and Spruce
streets, half a mile outside of the limits of the
city of Philadelphia. We subjoin an engraving
(fig. 1) of the general plan. The corridors are
each 860 feet long, 14 feet wide, and 13 feet high,
and serve as mess rooms for the pavilion. There
are 34 pavilions, b b b, each 24 feet wide, and
13 feet high at the eaves; they are now of un-
equal length, ranging from 150 to 250 feet.
There are three kitchens, ccc;
Between the corridors is the administrative
building, a.
two laundries, d d; a chapel, e; store rooms,
ff; a mess room for special occasions, g;
two buildings for officers' quarters, hh; boiler
room, i; residence of surgeon in charge, k;
water tanks, 7; barber shop and printing of-
fice, m and n; boiler and tank, o; smoking
rooms, p p; reading and lecture room, I;
knapsack room, r; guard room, 8; stable, t;
guard, u.

The pavilions are 21 feet apart, The which is too close by at least ten feet. building is of wood, lathed and plastered on the outside. Its cost, aside from furniture, exceeded $200,000. It has 3,124 beds. The number of medical officers is fifty-two, beside eighteen medical cadets, and of cooks, nurses, and other attendants, four hundred and sixtyfour. There are also three chaplains.

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