it will not be until the sick call of the following day, thereby permitting evasion of duty for twenty-four hours in any case. If even only partially successful in this way, the malingerer has su ceeded in his purpose of securing absenteeism from duty-temporary if not permanent-and has been encouraged to further trials with a greater experience which, if within limits not great enough to themselves excite suspicion, gives increased prospects of subsequent larger success. The most effective way of checking unnecessary absenteeism is to prevent it at the very outset, namely at sick call.

To do this, company commanders should more fully appreciate the importance of the data, as to "line of duty" or not, which they are required to insert in the sick report before the man reaches the surgeon. This entry by them should be an invariable rule, scarcely to be broken even in energency. Frequently there is something in the character or habits of the man which will be unknown to the surgeon, and which may be of much importance in deciding as to the suitability of his case.

In addition, there is implied the proper appreciation by the n edical officer of sick call in its proper status, as the professional function of the first magnitude with the regiment. Any properly educated medical man fresh from civil life can efficiently treat cases of undoubted physical disability; but the determination of the actual existence of such disability is a phase of medical prac tice in which, from the nature of things, the average physician in civil life can have had little experience. Such physician in civil life sees men come to him, pay a consultation fee and rather unwillingly accept a status which may interfere with bread winning capacity. Under such conditions there is rarely reason for doubting a history of subjective ailment, even though little or nothing in the way of physical signs may outwardly be apparent. The whole attitude between physician and patient in civil life is one of mutual candor, honesty and trust, and the physician newly commissioned from civil life does not at first realize that under military conditions such relations are completely altered, that no financial consideration interferes with the seeking of his advice by the soldier, that an assured provision at the hands of the Government has removed the necessity for constant effort by the latter toward making a living, and that personal interest in many

instances is now in position to interfere with that perfect frankness which his civil training had accustomed him to expect from the patient class, irrespective of status. What wonder that he tends to be overcredulous and the easy victim of the designing! He can not be expected to at once change a habit of thought developed by years of professional practice.

It follows as a corollary, that the regimental surgeon on whom devolves direct responsibility for maintenance of the high physical efficiency of his organization, should either take the function of sick call himself or delegate it to a subordinate in whom he has confidence that an exaggerated sense of humanitarianism will not run away with professional judgment and military responsibility. Yet while thus safeguarding the interests of the Government, he must take care that the rights of the individual are fully considered. The task is difficult, medical officers are fallible, medical practice is not an exact science, and mistakes will be made by the best intentioned. It may be that in rarely occasional instances, subsequent events may prove that soldiers denied admittance to sick report were really deserving. Under such conditions, some line officers are too prone to see only the rare instance of individual error, and not realize the vast promotion of the military efficiency of their commands which has been caused by such careful scrutiny of candidates for sick report as in this case has resulted in an unintentional though none the less real injustice. The easiest way for the medical officer is, of course, to accept the soldier's statements at the latter's valuation. If this is done, however, armies will soon cease to exist as fighting forces. Men frequently lose their lives unnecessarily in war through professional error by their line commanders, and if necessary lives will unhesitatingly be sacrificed by the latter for military advantage. Surely occasional professional error rarely costing more than brief discomfort, made by medical officers in their legitimate endeavor to secure military advantage by keeping the ranks full, may be pardoned by the other class whose purpose is wholly inhumane, prac tical and logically devoid of sentiment! But whether such occasional mistakes by medical officers earnest in their endeavors to promote military efficiency are condoned or not by their confreres of the line, the former should remain steadfast in performing the duty of giving equal justice, in so far as in them lies, to the rights.

of the nation and of the soldier. For as General Upton has so weil pointed out, it is a mistaken humanitarianism which unduly favors the individual at the expense of prolongation of war and the thereby consequent vast increase in disability and suffering in the aggregate. Such utter wastage of military strength as thus resulted in the Civil War should never again be permitted to

occur.

REGIMENTAL INFIRMARIES IN RELATION TO ABSENTEEISM.

The regimental infirmary is intended under Field Service Regulations, "to care for emergency cases and the slightly sick or injured." Its real function is thus more military than humanitarian -to stop such cases from leaving the regiment as can be held for early duty. As the infirmaries have no beds, severe cases must be transferred to the field hospital. Conversely, the cases retained on the regimental sick report will habitually remain with their company organizations. Though excused from duty, the oversight of these slighter cases by medical officers must as a result of circumstances be occasional rather than continuous. Although usually remaining with the company, they are excused from duty and thereby removed from the jurisdiction of its commanders and placed under that of the regimental surgeon-yet it is apparent that the latter is not at all in the best position to determine, through constant observation, the actual existence and degree of the alleged disability for which admission to sick report was authorized. The arrangement is one which does not conduce to careful diagnosis; and if continued any length of time with individual cases, who are quartered with a company whose duties are not shared, it necessarily introduces a certain element of dissatisfaction therein, and will not meet with the full approval of the company commander. The elements of haste and possible official friction, in addition to that of defective medical oversight, thus become injected into the situation. If the man does not promptly seem able to do duty, the natural tendency on the part of all will undoubtedly be to favor his removal to the field hospital for more complete observation and greater care. To this, a designing patient himself may add by claiming discomfort and1 distress, through being held under the limited facilities present

with the regiment. All this, with the other factors previously outlined, will tend to incline the medical authorities toward transfer.

It would seem that this natural tendency to favor separation from the regiment could be successfully counteracted only by the issue of general orders, enjoining due watchfulness against the danger of malingering and requiring that under ordinary conditions all patients should, before transfer to a field hospital, be examined by a medical board composed of all the medical officers on duty with the regiment or separate organizations, and prohibiting such transfer in the case of those in whom the existence of disability could not reasonably be established.

FIELD HOSPITALS IN RELATION TO ABSENTEEISM.

The field hospital is not intended so much as a way station on the route to the rear for all who reach it, as an establishment in which the undeserving patient, who has been successful in evading duty and leaving his regiment, may be halted and prevented from escaping entirely from his command.

To this end, orders, emanating from either the commander or the chief surgeon, should prescribe that each case admitted to the field hospital should be examined and passed upon as to its merits, by a board of not less than two medical officers, within the calendar day of admission; and that except in emergency no case should be transferred from the field hospital to the rear, except as a result of such an examination and recommendation by the medical board, which should be repeated if the patient has remained more than two days in the field hospital.

As a further necessary check, sanitary inspectors should be ordered to pay particular attention to the nature of the cases received by field hospitals, retained therein, or approved for evacuation therefrom to the rear.

Regimental and other medical officers with the fighting troops should be informed as to the measures which are thus taken to verify the accuracy of their professional judgment, and be notified that carelessness in respect thereto, or repeated errors in diagnosis, will be cause for special investigation and appropriate disciplinary measures.

EVACUATION, BASE AND GENERAL HOSPITALS IN RELATION TO ABSENTEEISM.

The several requirements suggested above for application to field hospitals should likewise be applied to evacuation, base and general hospitals.

In addition, sanitary and other special medical inspectors should tour these great establishments at frequent intervals, carefully scrutinizing the diagnoses entered on the register of sick and wounded and checking up the latter in all doubtful cases by personal examination of the patients concerned.

They must not overlook the fact that in these establishments are liable to be found not only cases which have been malingerers from the outset, but many which, originally suffering from conditions which warranted their admission, have drifted into malingerism as convalescence progressed and return to duty became more imminent. These inspectors will also remember that these institutions in the rear of the fighting force will, from the nature of things, have their medical personnel largely made up of inexperienced, overcredulous and unduly kind medical men, fresh from civil life, whose every sympathy will be largely with not only the welfare but the wishes of the patient and who will be more readily influenced by sentiment, politics and other outside influences which make themselves so felt in these establishments.

An independent medical board of three medical officers, stationed at the advance base, should pass upon all cases referred to it by the medical boards established in the various evacuation and base hospitals, and orders should prohibit transfer further to the rear of any patients not receiving the sanction of this independent medical board, except during periods when its action was temporarily suspended by the Chief Surgeon as a result of battle or other emergency.

Such independent board should have no power to invalid soldiers further to the rear than the next sanitary formation on the line of communications; patients in its opinion requiring removal further to the rear should be merely recommended to the Chief Surgeon, who should take final action in their cases.

Similar medical boards with similar limitations of powers of invaliding, should be established at the various sanitary forma