TRENTHAM CAMP COMMISSION'S REPORT

Dominion, Volume 8, Issue 2552, 28 August 1915, Page 6

TRENTHAM CAMP COMMISSION'S REPORT

9 ■ SPREAD OP THE EPIDEMICS CONTRIBUTORY CAUSES DISCUSSED . MEDICAL SERVICES UNDER REVIEW CHARGES AGAINST OFFICERS NOT ' INVESTIGATED

The 1 ; report of the Trentham Camp Commission if as tabled in the House'of Kepreserytaitves yesterday.' Not' one word was said on tho oubject by any in the House, a circumstance which should indicate that the dissatisfaction which was'almost general some weeks ago regarding the conduct of affairs at Trentbam no longer exists. The report is a j'ory long and very interesting one. Attached to it is a highly informative dissertation (accepted and endorsed; by the Commission) by Dr. Martin on the nature of the dis- . eases of measles,- influenza, and cerebrospinal meningitis, the dangers'of the growth of, these'epidemics in extent and virulence, and the methods of coping \ with them.'. (This portion of the re- ' port is referred l to as the "Medical Review", byihe Commission.) ■■;'■ '■ ".■ ;_. following are the Commission's findings on the matters submitted'to them for inquiry;—; ,'■■'■'•. THE FINDINGS ' '"'".

CAUSES' of sickness not conFINED TO. CAMP. ■1. The extent, nature, and causes of the sickness among the troops at the •.. ' camp? .. ' .'. (a) The extent and nature of the sickness is sufficiently shown by the medical review." ■ .• : , . (b) The causes of the sickness: It is . impossible to state the causes of the sickness ui the full sense. .The causes were obviously not confined 1 to thecanip, for the maladies of influenza and measles were concurrently present among 'the civil population. There were, however, several causes that contributed to the sickness.'' In this connection :the: occupation of the camp jnust be di- ' vided into', two' periods, one to the end of April, and the other covering : May, June, and July, which last-named period; inay be termed the winter season. During tho latter period we ' consider upon the evidence brought before us inat 'the following were contributing .; causes:—. : ■ (1) The aggregation of so many men in a confined space and their close contact.with. each other, first, in tents, and afterwards in larger groups in the huts, and frcim time to time .in the recreation halls, often in' wet clothes. . '-.■' (2). Tho bringing into an already infected camp. ot large bodies, of fresh troops." This applies; especially to the .' drafts brought in between May. 29 and June 16. '. ■■.■■ ' ■"■;:■; ' ' (3) The wetness of the ground, because of the absence of efficient surface drainage. .':; (4) The absence of provision for drying clothes and hoots.. . ' . • (5) On and after May 29 the defi- ' ciencies in the design and equipment of tho hutments) combined! with the overcrowding' which continued for some ; time, and the presence of damp clothes in the hutments during tho sleeping hours. (6) Unnecessary exposure during sick parades, causing fatigued ■__'". (7) The want of appropriate provision for rapidly and:. effectually dealing to fthe best advantage with 'an increasing number of sick. ' ■•' .."'-.■ ...'■': (8) The specially infectious character and increasing virulenceof the diseases. (9) The sudden change from the habits and comforts of civil life'to the conditions'. :of. life in a,, military camp, and .the want of knowledge, until experience was gained on the part of the men of how to act with a due regard to the care of themselves and others under those .conditions. During the period prior, to May the same contributing causes, but in,a less degree (excepting always those arising from tho hutments) prevailed. 11. The extent and,causes of the mortality, among the troops. . '■ ': ■ These are shown in the medical review. \ -. ■." " I ■'' ' Due Care of Sick net Always Taken. 111. Whether duo care'and efficient measures have been* at all times. taken ~. vfo prevent or mininise:such sickness or mortality ? _ : ; Having regard, to our findings, under No. 1, wo say that due care and efficient measures were not at all times taken for these purposes.. ■: IY. Whether.-ah■.efficient system for the treatment of tho sick-has at all times existed in connection with the ... camp? , We answer this in the negative. Under this head we specially refer to the non-provision in advance of hospital accommodation and equipment at a stage when the necessity for it was imminent, thus rendering sudden action necessary when the emergency arose, with consequent disorganisation, confusion, and overcrowding to the prejudice of .the-sick.: ; ■ - Medical Supervision. . V. Whether an efficient system ,of .' medical examination has at all ..' times existed in connection with the camp? .We group under this-question:, (a)r Diagnosis —It is not established that the system adopted for the examination of the sick in camp;wasbthei than tho usual system followed, and efficient. ■ . _ (b) Sanitation.—Wo think the medical examination with respect to sanitation failed:—(l) In permitting overcrowding of the hutments; (2) in.not recommending drying apparatus;, (3) in not recommending better accommodation at sick parades. Were the Sick Neglected? VI. Whether in any cases the sick have been neglected or'.'. improper!}' treated?,. ■ • • ■ ■ Evidence was given in regard to certain individual cases _of hospital .treatment, in,somo of which tlie suggestior was that, tho patient had been neglect cd or improperly treated by tho medical officer and ")iurses_ in charge. ,W« consider that tho ovidencs before i ui does not warrant a finding that then was neglect or improper treatment ir any of the cases referred to. Instance! were given of inattention by orderlies, but as these men could-not be identified by name, it was impossible to inquire further. • ■ ■ ( VII. Whether unduo delay has in any casos taken placo in the removal of the sick from the camp to-a hos- ; pital? Thero'is no instance brought before us of any undue delay in the removal of any, patient from tbu camp to a ho pital. '■■;'.■' .', ',

Notification of Relatives. VIII. Whether proper - notification has ' at all times been made to the re- * latives of the sick, and sufficient facilities given to those .'relatives to afford assistance or' Comfort?' We find that there was for a time no provision made- for notifying 'relatives or next-of-kin of cases .of sickness unless or until the medical officer in charge of the case reported it as serious. There was some delay at a certaii stage of the epidemic in the transmission of the messages sent by the sick themselves to their friends, .and in certain instances delay in the case of serious illness. We find that in no serious case have other than full facilities been given to the relatives to afford assistance and comfort. Drainage, Water Supply, and Sanitation IS. Whether.' an efficient System oi drainage,. water supply ; • and sanitation at .all times existed in re- ■ spect of the camp? , •.- ' As regards' surface and sewage drainage, at the outset, tho system was efficient, but as the camp grew the necessity for a better system .arose, and at the period of the overcrowding of the camp we find'that the system became inadequate. To. remedy this inadequacy, the aid of the Public Works Department has been' invoked. -As regards water .supply, the evidence shows that this has at all times been efficient. ,■■.'■- < .As. regards .sanitation, we find that the general'system was efficient. the Site and the Huts, X. Whether the camp,is suitably situated, equipped, and arranged for the purpose for which it is used? And XL Whether sufficient sanitary or othoi reasons exist for its removal froa the present,position?.. _We find, that the. camp is suitably situated.: As -regards; equipment" and arrangement, embracing "under thai head surface drainage and road formation, sewerage, habitation, drying ap paratus, and hospital accommodation, upon the evidence that we;havo'had/beforo us, we find* that no sufficient sanitary ,or other reasons' exist for the ,'reof the camp from ! its present situation. Wo consider it may continue to be used provided the iollowing conditions are'observed:— • .: ■ <:-•/-' ' \(p) A.limitation of: the, size .of the camp to a number hot exceeding ' from 4000 to 4500 men. .'. -i - ; ■ ..-..': (b). The formation of roads with surface drainage, with such''- ample , . .outfall as wg understand is how iu progress'. ■ ' ■:■■■■'/:"'■- : :':'' (c) Tho execution of a complete • system of sewerage for tlie effective disposal of the liquid refuse of the . ,camp. . ''■■:. ~ • -'';,'■ ■;- (d) The improvement' in the con- • •struction and use of the huts,' by—' 1., An amendment of the ventila- '■ tion.' 2. The provision of stretchers. 3. The' lining of huts having galvanised iron walls with a le6s conducting, material. •4. The construction of a porch' or ante-room. ' 5. Tlie carrying of roof water clear of the huts and adjacent' ground. ■6. The provision of a ir concreted ; space for nightpails. 7, The restric- •;. tion, of the number of occupants. -"■. 8.- Where feasible t'ho use of separate hutments formeals >■ " '•';.'■ ■ : _ (e) The niaintenanc'e'of an effioient provision 'for drying, clothes .and boots. ■■ ■"'■j: '(f) The retention of the right to; use the racecourse buildings' and other hospital accommodation so long as no other substituted provi-' sion is available. . ■'.: ■ Food and> Clothing. XII. Whether the food supplied to the troops has been'at all times sufficient and of good quality and properly prepared and sorved? We find.that, with trivial exceptions oh isolated occasions, the food has been sufficient, of good quality, properly prepared and served; XIII. Whether the clothing supplied to the-troops has, b'o'eh at all times oi . .' proper quality <and . sufficient in 'amount? We find that there is no evidence to establish that the clothing has not been of proper quality or'sufficient'in'amount but it was shown that with the_ wet condition of the camp during the wintei season it was expedient' that the issue of the second pair of'boots should have been made as speedily as possible aft'ei ihe first issue so as to enable each mar to have a change of military boots, but that there was not sufficient supply in hand to enable an immediate issue to be made-., .. Accommodation not Sufficient. XIV. Whether the' tents,' huts, and other accommodation .of the troops have at ■ all times been sufficient. . suitable, and proper for the pur- • pose? .•'. . . We.find that the accommodation foi the troops;was not sufficient after Maj 29, thus leading to/serious overcrowding iu the hutments.' : We, have alreadj dealt with the sufficiency and,suitabilitj of the hutments, and' 'have pointed oui where improvements should be niade : and the conditions ■ under, which thoj should bo used. About Hardships. £V. Whether .in any - respects the troops, have been at; any time exposed to unduo-preventable hardships or .'discomforts? , ■ Except, so far as is shown in out irevious findings, wo find that the ;roops have not at any time been exjosed to undue or preventable hardihips or discomforts.! The prevention if hardships and discomforts to a great sxtent depends upon the melt theim;elves, and the care that they show in ooking after their health and comfort, is they gain experience they become ible to minimise tho discomforts, and ihose, from the training,' become of less mportanco and less noticeable. The ivideuce shows that camp life, undei 'avour'ablo conditions is of the healthest character. Charges Against Persons. SVI. Whether tho officers of tlie Defence Forces or of tho Expeditionary Forces or of the Public Sorvicc charged with the administration oi control of any of the matters •aforesaid have in any respect been incompetent or nogligcnt, or ha've in any manner boon guilty, of neglect of. duty or misconduct'in their oflico? Iu regard to. .this.aueation'.we o»liso

a grave difficulty which was perhaps not foreseen on the issue of the Commission. To find any person specifically chargeable' with incompetence, neglect, or misconduct by the method of inquiry we had to follow (and which was the only one that could bo followed) without first definitely formulating a charge and giving the person charged a full opportunity for -answering it, would be contrary to the ordinary notions of What is just. In respect of .persons now absent from the Dominion, such a procedure would be out of tho question. There is, moreover, very grave doubt whether it would not bo unconstitutional for such a body as this Commission to outer upon such a course of procedure. The Commission had at tho outset nothing in tho nature of specific charges laid before them for investigation. These had to be developed by the evidence as it proceeded. It -was not practicable to pursue thoni. with continuity. Consequently, it could not be known in many cases' until the Commission drew to a close what shape any charge ought to take, and the facts could not be appreciated until opportunity had been afforded the Commission to collate the great mass , of evidence which had accumulated. To have regularly proceeded by formulating charges against such person or persons as we considered involved in order that they, might bo fully heard, would have indefinitely protracted this Commission, now twice extended beyond the original date fixed for > tho report. .-. Moreover, one of the mem--7 bers of the Commission (Dr. Martin)' found himself unable to provide the time which, such a proceeding would B have involved. In the course of the inquiry wo did point out to some of s the witnesses the matters which at that stage appeared to require some answer, but we cannot regard that as • sufficient to have put ■ them on their trial in respect of any of those mat- ' ters. They might require to'produce ovidence besides their own in reply. " TWjhave, therefore, refrained from ' specifically answering question XVI, |. "As Soldiers'and as Men," ' Testimony was given as to the un- . complaining patience with ..which ; the l sick men and the men generally faced' . the conditions arising not only from _. their, ailments but! from the .inclement-. ' weather and.the discomforts that' ensued, and the difficulties and "disorganisation that 'accompanied the rapid .-.nd \ comprehensive nature of the' eisidomic. ] That some of the men have.given cvi- " deuce before the Commission is not' in- '■ dicative of any, general, spirit of. discontent.' : Many of them camo willing- _'. ly and only, because thoy were subpoenaed. Others, responding to the invitation to come in. the public interest, attended in 'that - spirit to point out ' what they .deemed to he the errors of ' the past in order "that the future might be amended, and. thus help the Com- ' mission to accomplish its end.'.We"concur in the view that throughout the trying conditions described, those of all ranks - acquitted themselves as sol- ■ diers and ssmen.- , > On the_ militant side of the camp administration, we are entitled to eay on ■ the'evidence produced before us that i the duty of providing for training and dispatching the troops had-.to be. met 1 with' a short staff, ..which cbuld.nbt '. supplemented: that'it.had to work un- :; i der the difficulties caused.by. the ljepeat- • ed increases upon the number for which. .. the camp.was originally laid'out, "and/ in particular, .'by the addition of - tho Trentham Regiment. The whole'.work' was a. new experience, and tver'and; above all'were the;exigencies oif war,, the limited resources, of the Dominion, .and: the stress of dispatching the promised number of men—trained and fit-Hjoi'tho dates' x prefixed.' .The;'oviden.oo. is that the members worked unsparingly, and, from what we have.'gauged of them, with - devotion to their task. '."••'•■ '.THE MEDICAL REVIEW

: DR. MARTIN ON THE DISEASES : ; ; v jMAUGNANT«LES:.v/:. : ; Following are extracts from ' ithe memorandum written, by Dr. Martin on the camp infections:—' "The mode of infection in measles is by. personal contact. . .'. Infection, is not infrequently conveyed by clothes, and this is a, point to. Keep Well in mind in dealing, with ■ a measles' outbreak in camps and barracks. Any patient who . develops.- pneumonia • in the ;course of an attack of measles 'should be/isolated from other measles patients, for.pneumonia must bo considered as one. of .tho infectious fevers. During the outbreak of measles, the type -of sickness:may at first be of a mild'character and gradually into a malignant'or virulent one. : This- tendency has always-to'be mind in dealing with any outbreak in camps, barracks, or closely populated -': areas. There is a so-called 'typhoid type,' due to ii complete'toxaemia or poisoning. Here the patient becomes submerged in the'poison or-toxin of the'disease, his nervous system is' profoundly disturbed, delirium. and excitement are . followed by a -comatose state, which ushers in a. speedy death. There is a', "suffocative type"'.wkere the patient suddenly develops a '■■ severo bronchitis and is in the excessive mucus in! his-bronchial tubes. In this form)'iii adults, death,may occur" with startling suddenness, and" the whole course of the disease, from onset to death, may/be appallingly short. There :is-a "haemorrhagic type""- associated with bleeding under the skin, and . with bleeding ' from the nose or bowels./ Tliis is "haemorfhagur measles," or the so-called "blacks measles." The-fact that some of our soldiers at Trentham Camp died'from pneumonia following measles, from the "typhoid type,*' from,the. "suffocative' type," and from the "haomorrhagio type" shows ...that, the. outbreak, though mild and gently warning in its initial stages; ibecomes dangerous and ruthless at a later period. Influenza. Measles is frequently associated with true influenza . and the. gravity. of tie former is always increased in the pre: sehce of the'latter ..disease. "That two or more infectious diseases are * capable of running concurrently in the same individual is notjso generally recognised as'the frequency of. t its occurrence would warrant" js a statement made by Dr. Foord Caigor, ono'of the greatest authorities' on infectious diseases. When dealing with: an infectious outbreak in a camp or barracks, this'medical, observation, should bo carefully reniombered. ■■:. Influenza is a contagious disease and is associated in a marked degree with such sequels as bronchitis, laryngitis, and pneumonia. In ■ civil piactice a very large number of pneumonias are _ associated with influenza, and the sinister partnership moans a sharp illness. Tho influenzal organisms aro the field artillery scattering bursting shrapnel and preparing the way for tho solidly attacking infantry battalions of pneumonia, organisms. In the Trentham Camp, influenza patients not only developed pheunrtmiay but also cerebro-spinal. meningitis.' ' Cerebrospinal Meningitis, , Cerebro-spinal meningitis, cerebrospinal fever, and malignant purpuric fever, mean oiio and the same, disease. It is sometimes called spotted fever. It was not recognised till-'the beginning of the 19th.century. •In 'the 19tb century two sweeping epidemics "of .'this disease occurred in Europe-,- and three in the .United 1 States. In Dublin an epidemic attacked tho troops and civil population in 1866. During tho American War of Secession (1.861-63) tho epidemic spread 'widely. Tho epidemic at times has assumed "Continental" dijjeayotifl and hftS swept from one. cpun.

try to another. Ono military-medica writer in England lias written recently "At tlio present tinio cerobro-spina meningitis is a disease of the greates moment because of its intense virul enco and great rapidity of progression and also because of its infectious na ture. An early diagnosis is of th greatest importance, for it gives bet tcr fiopo of recovery to the patient alu also_ lessens, tibo danger of tho.spreai of infection, ' as it enables iminediat attention to tlio given .to the- disinfec tion of quarters and isolation of con tacts, matters of vital -importance- whor moving troops are concerned. The active causal agent in cerobro spinal meningitis is the diplococcus lntracellularis, commonly called- tb meningococcus. This organism is pre Bent in the throat and naso-pharynx o tiioso suffering from the malady am is also present in the eerebro-spina fluid—the fluid bathing the brain aw spinal cord. Bacteriologists can isolat tins organism' and certainly establis' the diagnosis, for, on the speedy reco° nition of the disease depends the cur of the patient.' For treatment, a serur is in use. Outside the.human bod the meningococcus, the organism of thf disease, has a very short life, am therefore clothes, mattresses, and blan kets are not.likoly to be agents of in fection. -, But—and this is all-importan m dealing with this dangerous diseas —the organism can be carried in th throat for long periods, and any pei ■son carrying this organism in his throa is known as a "carrier." 'A carrier ca: infect those who come in contact wit him. Many observers have noted tha apparently healthy persons can be cai ners; and spread the disease to thos who come: in contact .with them.' Tlii makes t-lie task of controlling the in fection and spread of this disease aextraordinarily difficult one. Ther Beems to be no doubt, knowing tha the orgalnism of cerebro-spinal feve cannot'/lead a saprophytic life "out'sid the body, and .that it 16 peculiarly susceptible to cold, .and has never bee isolated from dust, air,- or formites that it has been introduced into TreE tliam -Camp by a- "carrier." '_ The- Trenthairi Gamp site has certain Iy had nothing whatever to do with th "appearance of cerebro-spinal iheningiti 'amongst. the .troops quartered; Neithe ■ in .tlio air above, the earth beneath, o the water.-under the earth at Trenthar l3id_t-he meningococcus live- -.' , Now Zealand is not alone in having had this' unfortunate . visitation. ■' Thi form of meningitis has appeared in .th camps of England, France, Belgium Servia, and' Australia during the pre Bent year, and toward the end of las year. - .; -.'. .:■ Laying Out of.Treritham. • v It is,-we think, : a matter of regre that when it was decided-to make ; permanent camp at Trent-ham.the Pub lie Works Department were not calte in to lay out'the drainage,' both for' sui face and; for polluted water, as well a to do the road-making, : They have no\ been called in, and the'work is: in hand Had this been done at first, a larg amount of fatigue work thrown', on .th recruits would have been avoided; am the time of the men devoted-to".thei military,training.. Mr.'. Holmes, . th Engineer-in-Chief, states thatiwhenth reading, draining,.and; other improve ments in. hand are completed the cam] will be-in cm absolutely.satisfactory con dition.: It -is to : be regretted that tin services of the Eiigineer r in-Ohief wen •not resorted to before' July. tion of the extra men in May-June un doubtedly overtaxed the capacity of. th accommodation and tho sanitary 'eys tern. - This event synchronised ; with' ai accession, of wet weather, and the'cut •ting up of the.'iro'ads and ground by'th< -traffic connected with:. the . extensivi building operations and cartage then go ing on, andthefe was, of course} . tn< extra,.traffic'.'caused-.by; jthe'-addition o: 3850 men to"the_ number '.in ':'■ camp. Th< evidence :of "varjous witnesses having practical experience of the camp goes fcc show that, it ought not -to; he regarded as sufficient for -more -than from, 4000-t« 4500 men, and with this we agree. ■ The preponderance .of' the evidence shows that Bqrhampore on the whole was ill-conditioned for the purpose foi . :"which it was used, a circumstance whicl in'itself should; we think, have prompted the Director of Medical .Services tc seek 'for better, accommodation to, take its place. ;.-.': ~'.',' The overcrowding was evidently due t< some want-of system by -which, medica officers at,the caiiip,could he kept informed whether-there was room,'at,-the other end for.'patients proposed to b( sent' »n,.' '''-, :': ' ; ': ,: .?. ,It is noted that no visit'was paid-tx Berhampore by the ;Director of ;Medica! Services or', anyone oii'his behalf-the daj .'after he had been informed of the,overcrowding, and that during tie .period oi increasing congestion from May '28 tc June 2j a period,of four_ days, he hac i-made no viist to the hospital. It seemt to.require explanation why'the Director of Medical Services, whilst coupled with the .'general duties of his office, 1 should 1 ' have -undertaken L the . personal charge.of. the patients at .Berhampore instead of detailing some subordinate • officer to make daily visits. - I ' Significant Figures, Taking the months of March' .and April together, there -were .164 admissions' for measles, and 109 for influenza and'septic sore throats. The measles incidence was therefore about 2.6 per cent;," and -the other groups' about 1.7 per. cent. - In- April it was important to have noted these figures for measles, because during those months influenza • and Aseptic sore throats were occurring concurrently, although in a- , slightly smaller ratio, -all the groups'had been present since December, arid from-De-cember to April the camp had not been free from influenza ■ and' sore throats'. It-was advisable, also, to have; taken notice -that. the two groups' of maladies were -of an,':infectious character, and were present in a-soldiers' camp where the men .we're young and . un : trained, unaccustomed to strict hygienic camp .laws, .and possibly a little careless in; observing' them'.... New Troops Coming into a Sick-Camp. :',■-. In' April .'these 'figures' were; significant',- and' if thoy- had been, appreciated .by.-the' Medical Service,.',should .'< have caused some' Given "suitable conditions/ such as' overcrowding, imperfect sanitation, and 'the approach of the cold and wot of winter, any infectious disease of a- respiratory nature might assume menacing proportions. In -May tho total number of measles, influenza, and septic sore throats was'3o6. The Director ;.of Medical ServiceE (Colonel Purdy) deposed that as far as ,1m could judge "tbo' infectious disease became opidemic oh May; 26." It was on' May 26 that the Director of Medical Services'recognised, the outbreak to bo now an epidemic. . Three days after, this fresh'troops began to arrive in oamp, viz M 2200 men of the Trentham Regiment, and from June 14 to 18, 1673: men of tho 7th _ Reinforcements arrived, -making, with troops already in camp, a. forco'of over-7000 men. It has been stated that it was the arrival of this large number of men that was the cause of all the serious epidemic trouble. We, however, note that these new ■• troops were quartered into, an already infected camp, that the overcrowding in the hutments which then took place, and to which wo shall hereafter refer, Would favour the spread of the'.infectious disease, and tend to .increase-the virulence of the infection, and that the infectious disease was recognised 'to_.liavo reached the stago of an epidemic boforo tho new troops arrived. Meningitis; . : Prom .tho opening of tho'camp to tha ond of July tho total number of cases of cerebro-spinal meningitis is given as twenty-nine. Tho total, number of deaths was six, making a death-rate of 20.09 per cent. On the- figures - supplied, which are only accurate for the .period l .following .the bacteriological re-

port, it is highly probable that there were deaths from cprebro-spinal niGlliii* getis anterior to the date of this report. For example, Private E. Pdied on July 1 in'a delirious state, and the. causo or death is returned as para-tj-phoid meningitis. Other such • instances could be cited, thus showing that the returns of the numbers of cerebrospinal meningitis cases and the death-rate are open to some question, and cannot be accepted as a truo'representation of the ftctual state. Epidemic Got Out of Hand. Thero were indications in the early, months of the year that the maladies' might assume dangerous proportions. Tho medical administrative service did not realise the significance of the indica-' bions, and therefore did rot in anticipation ■ provide sufficient means for the treatment and prevention of the mala- : dies. Energetic and effective \ methods were not pursued until Dr. Valintiiie in- 1 tervened. We supplement these an. swers (to specific questions) with, the obi' ■' serration which appears to. ils to .be o£ great importance, and that is that had the true significance of the indications been realised, there would not have been, introduced into the camp the large bodies of troops that, were brought in." there in May and June, and tho epidemic would not .have, therefore,.reached the proportions that it did. Tents and Hutments. • All the evidence shows that the .-tenti-' wore undoubtedly pitched closer than, is, the,recognised rule for standing camps, !, and that in-that respect, (it tile claim that the'camp wa3 laid out in the most up-to-date lines cannot be sustained. .One .very, obvious , disadvantage ! of the tents being spaced too : closely is that there is. :lees space'for, tie. night pails to be placed between the 'tentsj".'" and thero are therefore in closer : prosim- " ity. to the occupants of-the. tents,'with' the' contingency, of the;narrower space' of ground between ,becoming polluted. < The evidence, we: have, had, in our : opinion, justifies the inference' that the'- .'■ . vitality of the. men, must have teen reduced by the use of, imlinedV' iron wall buildings, and and by the ovcrcrowd-' ing. which, rendered the men more liable . to pollution by close contact. If it is , not feasible at present'to provide Ecpsr- - at« hutments for meals, -.we-recbnimena that whenever tho number of -soldiers m \ 'camp are so-few as,, to permit, it, that-, special hutments, 6hould bo set aside for that purpose.' '■' . ■ TVe find on tho evidence that no tentft or hutments were erccted on the Eltlof earth latrines. ; - Who Is Responsible? We aro of opinion that tho Head, quarters Staff is responsible; for bringing men into camp before Eiiffi- ■ cient accommodation had been' provided, but we .think the Medical Service ought:, to. have drawn the attention ~ of' the Camp Commandant; to: the risks attend- • ant oh the overcrowding which prevail-: ed-and was permitted. Whilst reoog" rising that the' Headquarters StafE.ha.ve beeii continuously, worlsing at; high pres- ' < 'sure, we think' that as soon as it was known that tents were to be .sent with the Expeditionary Force, and that, the stock' would bo. thereby depleted,' some ■ action should have, been taken at onco to provide \ a. scheme. for' other ■ accommodation, and that two or three months' ' miglit have been saved. ,It is not proved that the District Office of tns Public Works Department Muld.haya acted) more promptly fhati it did iri cany-. ing out the. instructions , given to it. The pressure leading to the overcrowding, was no doubt regarded' as temporary, ; and'- the , exigencies of the moment . may "have, left no-other course" opon. But without doubt the .overcrowding was due. .to- the fact .that the acpommo- : : dation was not there by tho date _the extra men were appointed to come into camp. '" ■ . , .:, . The Camp. Hospital. ' Referring to the Camp Hospital, the-. Commissioners say:—Ii this _T>uilding ... had been completed to time, it would have required 'to be furnished and equipped) but had it; been ready: even without complete' equipment it would have been of service about the' first week in July in relieving the pressure upon the accommodation, and it would have been particularly of service for the . reception and treatment of the spinal meningitis and pneumonia cases; i