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I have the honor to make the following report of the expedition to China in the capacity of surgeon, Ninth United States Infantry, and as chief surgeon China relief expedition, as far as concerns the operations of the Medical Department. This report covers the period from June 22, 1900, the date I reported for duty with the Ninth Infantry, to September 25, 1900, when I was relieved from duty as chief surgeon of the expedition by Maj Francis J. Ives, surgeon, United States Volunteers, per paragraph 1, General Orders No. 19, headquarters China relief expedition, dated Pekin, China, September 25, 1900. By virtue of paragraph 11, Special Orders No. 70, headquarters Department of Southern Luzon, dated Manila, P. I., June 20, 1900, I was relieved from duty as chief surgeon first district, department of Southern Luzon, and ordered to accompany the Ninth Infantry to China. I was relieved by Maj. W. P. Kendall, brigade surgeon, United States Volunteers, on June 21, and on June 22 reported for duty with the regiment. Only a part of the regiment had arrived in Manila, and was quartered part in the Malate Barracks and part in the Exposition Barracks. First Lieut. Charles E. Marrow, assistant surgeon, United States Army, Contract Surgs. William W. Calhoun and Fred M. Barney were ordered for duty on the expedition. Contract Surg. William W. Calhoun reported on June 25, and the others not until the morning of the 26th, the day of embarkation. This left the entire work of equipping and organizing the medical department to me without assistance, and also the care of the sick of the regiment, which had in great part arrived. One hospital steward, 3 acting hospital stewards, and 16 privates were detailed to accompany the expedition. The hospital steward and 12 privates reported on the afternoon of June 25. Arrangements were made for the companies quartered at the Exposition Barracks to receive medical attention from hospital No. 2, which was close by, and a contract surgeon was detailed from headquarters, Division of Philippines, to hold sick call at Malate Barracks. The requisitions for medical supplies were filled and packed in the medical supply depot in Manila and turned over to the Quartermaster’s Department for transportation to the Logan. The regiment embarked on June 26, but Capts. Thomas S. McCaleb and George Palmer were sent to hospitals in Manila, as they were incapacitated for field service, also several enlisted men. In a letter from headquarters Ninth Infantry I was directed on June 24 to send the necessary medical supplies, 1 surgeon, 1 steward, and a suitable number of hospital—corps men on the transport Port Albert, which transported the stock, which was under charge of 100 men. Acting Assistant Surgeon Barney, 1 acting hospital steward, and 4 privates were detailed for this duty. It soon developed that a great many men in the regiment were suffering from malarial cachexia and dysentery and had avoided going on sick report before leaving, from the fear that they would be left behind. Sixty-one of these men were left on the Logan for hospital treatment.

The regiment arrived off Taku, China, on July 6. The First and Second battalions left the Logan on separate lighters on July 9, Assistant Surgeon Marrow with 1 acting hospital steward and 4 privates with the First Battalion and I with 1 acting hospital steward and 4 privates with the Second Battalion. Contract Surgeon Calhoun remained on board the Logan with the Third Battalion, and an acting hospital steward and 4 privates were left with him. This battalion did not arrive in time to participate in the battle of Tientsin. The First Battalion arrived at the foreign concession of Tientsin on July 10 and the Second Battalion on July 11 about 10 p.m. During the 12th I was occupied in separating the medical supplies from the vast amount of material contained in the lighters and arranging an operating room in the marine hospital, which was under the charge of Passed Assistant Surgeon Oliver D. Norton, who arranged with me for the joint use of this building for the wounded of both the marines and soldiers, and, in fact, it was the only building at the time available. I was in general charge, being the ranking officer, as chief surgeon of the United States forces in China, and during the entire period of our association the army and navy medical departments worked together in perfect accord and with mutual assistance. Our troops were formed for attack at 3 a.m. July 13, and at 3.30 a.m. moved out on the road to the Walled City in conjunction with English and Japanese troops. As our columns came under the fire of the enemy--

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rather a long-range fire--we were deployed and advanced on the mud wall in open order. Columns of troops could be seen skirting this wall and protected by it, advancing toward the main gate. As we advanced 1 man was killed and 7 wounded in the First Battalion. This delayed Assistant Surgeon Marrow, on duty with that battalion, so that after we charged across the bridge in front of the main gate and then to the left over the mud wall I was the only medical officer on duty with the two battalions, though I was not aware of the fact until later in the day. After going over the mud wall we could see another wall, apparently of brick, about 1 mile or a mile and a half off, and this was the wall proper for the Chinese City of Tientsin. Our attack began about 5 a.m. After advancing on to the plain between the two walls the fire of all arms from the enemy was most severe and many of our men were hit. Thirty-two men had been detailed as litter bearers from the regiment, but as soon as the fire became hot they threw the litters down to fight to better advantage. This will always be the case with such details, and the only advantage it presents is that it furnishes transportation for the litters to the field. At the time of the battle none of our transportation which was on the Port Albert had arrived. Two privates of the hospital corps remained with me throughout the advance under a most severe frontal and flank fire, assisting me in dragging and carrying the wounded to the shelter of the irrigation ditches which seamed the plain and in which the troops took shelter. These men, Privates Thomas Hamilton and Julius C. Heinze, were recommended by me for a certificate of merit. They also assisted me in having Capt. E. V. Bookmiller removed from the field. After our advance had stopped and the troops were sheltering themselves in the ditches, I concluded to take Captain Bookmiller off the field, as he was so wounded that he had to be held up in the water in the ditch, and the men who were holding him up were becoming exhausted. I was also desirous of making arrangements for the prompt removal of the wounded from the field to the hospital and for their refreshment at the collecting station. I therefore returned with the captain to the main gate of the mud wall and established a station behind the wall, just outside the gate. First Lieut. Charles E. Marrow, assistant surgeon, took my place on the firing line and remained there until the withdrawal of the troops, about 8 p.m., and who, on their withdrawal, brought the wounded with them. In the meantime I had sent for and received a number of “gold medal” cots, malted milk, beef extract, and several cases of mineral water for the thirsty, as the water obtainable was practically poisonous. By 12 o̓clock midnight every wounded man was in hospital and on a bed in Tientsin. The “gold medal” cot makes a good litter, and when the patient arrives at the hospital has his bed with him, but it requires six men to carry it, as the hinges in the middle will give way unless supported on both sides.

In this battle 18 men, including Col. Emerson H. Liscum, were killed and 78 wounded out of about 420 engaged. The details above mentioned left First Lieut. Charles E. Marrow and myself as surgeons, available for duty during the battle, and 2 acting hospital stewards and 6 privates, as 2 had been detached for duty with two companies on detached service the afternoon of the 12th. Assisted by Assistant Surgeon Marrow, we examined the wounded as they arrived at the collecting station and gave them such refreshment as seemed necessary previous to sending them into the hospital, where Dr. Oliver U. Norton, of the Navy, had gone to receive them. I also sent Contract Surg. W. W. Calhoun into the hospital to assist Dr. Norton, he having reached the battlefield in the afternoon with the Third Battalion, which came up too late to participate. Assistant Surgeon Marrow and myself remained on the battlefield with our battalions, as it was thought that either our forces would renew the attack at daylight or that we might be attacked by the enemy. Early the morning of the 14th one battalion of the Ninth Infantry entered the Walled City, it having been found that the enemy had evacuated during the night.

Finding that the Marine Hospital was too crowded with wounded, I took possession of the Tientsin Hotel and moved all the wounded officers over to that building, including the wounded officers of the Marine Corps. The regiment was quartered about 1 mile from the nearest of the two hospitals occupied, and as quite a large number of sick were present with the regiment, this necessitated the establishment of a dispensary there. Thus the necessities of the situation required the personnel of the medical department to be divided into 3 portions, and, even with the small number of hospital orderlies with the marines, was inadequate to render proper service to 95 wounded (27 marines wounded), beside attending the sick. This difficulty was overcome by asking for details from the regiment, which worked in the wards under charge of Hospital Corps men. Ice in abundance and boiled water was obtained by me for both hospitals. Our transportation  had not arrived until several days after the battle, but I believe there are few instances where wounded have had to undergo less hardships than on this occasion.

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On July 19, the wounded officers of the Ninth Infantry were sent to the Solace off Taku, with proper medical attendance and supplies, viz: Maj. James Regan, Capt. Chas. F. Noyes, adjutant, Capt. Edwin V. Bookmiller, First. Lieut. Louis B. Lawton, and First Lieut. Frank Schoeffel, who was suffering from dysentery. Six enlisted men were sent to the Solace on July 21 and 48 on July 24, these patients being sent to the Solace under direction of the commanding officer of the American forces in China. All the sick requiring hospital treatment were moved to the Tientsin Hotel and the joint occupation of the marine hospital ceased, but some marine officers still remained in the Tientsin Hotel. One of these was Lieutenant Leonard, who was not in condition to be moved. On July 21 I found it necessary to operate on Lieutenant Leonard, and the left arm was amputated by me at the shoulder joint, by Esmarch’s operation. Some wounds became infected from the fact that it was necessary to shelter the wounded in irrigating ditches on the battlefield, and the filthy water soaked some of the dressings. The Mannlicher makes a wound similar in character and effect to the Mauser, and some rather remarkable instances occurred of men shot through the thoracic, abdominal, and pelvic cavities without resulting suppuration or apparently serious effects. A number of our men were hit by shrapnel and these wounds, even flesh wounds, were of a serious nature, lacerating and bruising the soft tissues and comminuting bones, and most of them became infected.

This regiment having served about eighteen months in the Philippines, was very much run down and in extremely bad condition for field service, many of the men suffering from various forms of malarial poisoning and chronic dysentery. Three days before landing every man was given 1 gram of quinine each day, and with a marked decrease in the number of cases of intermittent fever, and comparatively few cases have since developed. I think this measure as a prophylactic one is of decided value, and in this case was tried on about 1,200 men. On July 26, 215 men of the Ninth Infantry were present sick. This did not include 61 patients left on the Logan or the wounded. The number steadily increased, and it was readily seen that a base hospital should be established at that point of at least three or four hundred bed capacity, with the necessary complement of nurses and surgeons independent of the regimental organization. After the arrival of the cargo of the Port Albert, about July 16, the work of conducting the hospital was much easier, as we were then provided with the use of 1 escort wagon and 4 ambulances, and also had an accession of 1 surgeon, namely, Contract Surg. Fred M. Barney. On July 27 the Fourteenth Infantry began to arrive, and brought with them medical supplies for 5,000 men for three months. With this regiment were five surgeons, namely, Capt. and Asst. Surg. W. F. Lewis, First Lieut. and Asst. Surg. E. R. Schreiner, Contract Surgs. Robert N. Winn, H. N. Van Kirk, and C. F. Dickenson.

Immediately after the battle of Tientsin, when it was necessary to keep the operating table in use day and night, and with a hundred or more wounded in hospital, including the marines, Surgeons Norton, Step, and Gunnel, of the Navy, rendered most valuable assistance. The sick report continued steadily to increase, and on August 1 there were 46 sick in hospital and 192 in quarters, and nearly all suffering from diarrhea or dysentery. On July 30 Maj. Gen. Adna R. Chaffee, United States Volunteers, took command of all the American forces at Tientsin, and under the provisions of General Orders, No. 3, Headquarters China Relief Expedition, dated Tientsin, China, July 30, 1900, I became chief surgeon of the China Relief Expedition. I had recommended that Tientsin be selected as the location for the base hospital, contrary to the course pursued by the allies, for the reason that our supplies were there; that it would be a halfway place when the army advanced on Pekin; that after the wounded had recuperated at the base hospital they could be carried on junks direct to the hospital ship Relief, which had been cabled for at my request prior to the battle of Tientsin, and was expected soon, thus making it unnecessary and undesirable to establish a hospital at Taku. Paragraph 2, Special Orders, No. 4, Headquarters China Relief Expedition, dated Tientsin, China, August 1, 1900, directed the establishment of a 300-bed hospital. The Tientsin Hotel hospital was in operation with a capacity of 100. In anticipation of this order the Isabella Fisher hospital had been selected for use as a base hospital, and though its capacity was much below the number of beds required, it had yard room for enough hospital tents to make up the number of beds required, and also a very comfortable dwelling house, with room for an office, wards for officers, and quarters for the surgeons on duty. There was also in connection with the hospital a building suitable in every respect for a number of contract female nurses, who were on a transport in the bay off Taku, and who had volunteered for duty in China while en route to Manila. Upon my recommendation, First Lieut. and Asst. Surg. E. R. Schreiner was put in charge of the hospital, with 2 contract surgeons from the Grant, 11 female nurses, 4 acting hospital stewards, and 32 privates of the hospital corps as its personnel. At the Tientsin Hotel hospital, at

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the time the expedition left, Contract Surg. Fred N. Barney was in charge, and 1 acting hospital steward and 8 privates, 4 each from the detachments of hospital corps of the Ninth Infantry and Fourteenth Infantry, on duty therein. The number of female nurses was subsequently increased to 16, and 1 professional male nurse, and the number of surgeons materially increased from time to time, as shown by the appended list.

The expedition left Tientsin on the afternoon of August 4. One hundred and seventy-three men of the Ninth Infantry and 27 of the Fourteenth Infantry were left back in Tientsin sick. The American force consisted of the Ninth Infantry, 2 battalions Fourteenth Infantry, Battery F, Fifth Artillery; detachments of the engineer, signal, and hospital corps, and about 500 marines, aggregating in all about 2,500 men. The medical department was distributed and organized as follows:

Chief surgeon, Maj. W. B. Banister, surgeon, United States Volunteers; 1 hospital steward as clerk, and 1 private, hospital corps, as mounted orderly.

Ninth Infantry: First Lieut. Charles E. Marrow, assistant surgeon, United States Army, surgeon; Contract Surg. William W. Calhoun, United States Army; 2 acting hospital stewards and 11 privates, hospital corps; 2 ambulances; 8 chino litter bearers to each company (under guard to prevent their running away).

Fourteenth Infantry: Capt. W. F. Lewis, assistant surgeon, United States Army, surgeon; Contract Surg. Robert N. Winn, United States Army; Contract Surg. H. N. Van Kirk, United States Army; 2 acting hospital stewards and 12 privates, hospital corps; 1 ambulance; 8 chino litter bearers to each company.

Light Battery F, Fifth Artillery: First Lieut. Henry S. Greenleaf, assistant surgeon, United States Army, surgeon; 1 acting hospital steward and 4 privates, hospital corps; 1 push cart.

Marines: P. A. Surg. George A. Lung, United States Navy; P. A. Surg. George D. Costigan, United States Navy; Asst. Surg. Joseph C. Thompson, United States Navy; 2 naval hospital apprentices; 1 cart; 8 chino litter bearers to each company.

One four-mule escort wagon was assigned to the medical department. Two junks and one for the marines were loaded with reserve medical supplies and stores and were to follow by river. The medical, surgical, and detachment chests were carried in the ambulances, and arranged on each side so that they could be used as seats, or with blankets folded over them for patients unable to sit up. This was absolutely necessary, as it was imperative to have these supplies with the regiments and to follow them into action, as I knew from experience that supplies on a wagon with the train would frequently be unavailable at critical periods, though generally available at night as a reserve supply. It was utterly impracticable, with only one escort wagon, to carry an equipment for a field hospital, nor did we have the personnel to have an independent staff and nurses for a field hospital.

The first battle the Americans figured in after leaving our base was that of Yangtsun on August 6, and in this fight our casualties numbered 65. At the beginning of the fight the ambulances were stationed in the rear of the line, just out of reach of the shell fire, and as this range receded on the advance of our line, the ambulances followed up, picking up the wounded after they had received attention, and following the line of battle till filled with wounded, then going as far forward as safety permitted and unloading. They were then employed in collecting all the wounded at this dressing station, and when our troops camped were all moved to this camp by ambulances and wagons, as it was necessary that they should have protection and water, which could only be obtained in the village where the troops camped. The hospital tent and walled tent were obtained from the wagon and pitched for operation shelters, and refreshment was prepared in the way of hot beef tea, etc. The most seriously wounded were dressed first, and 11 of them gotten off that night on a junk to the base hospital at Tientsin, and all the wounded, with quite a number of sick, on the next day, thus disembarrassing the command of the wounded and sick. This was a necessity, as we could not leave the field hospital for their shelter for reasons above stated, nor could we carry them with us.

The next three days the heat was fearful; sometimes 150 men being prostrated and many having convulsions. Some having convulsions and rendered unconscious would in the cool of the evening be able to walk into camp. The ambulances would be filled to their utmost capacity, and on reaching camp would return and haul until all those unable to walk were in camp. The wagon train would also pick up quite a number. Camps were established on the march at Hoshuon, Matao, and Tung Chow, and it was necessary to leave a number of sick at the camps. Contract Surgeon Van Kirk was left at Matao with sick, and subsequently all these stations were provided with surgeons. During a battle the regimental surgeons remained on the line to render first aid, except one in charge of the ambulance station. After the battle they and the men of the hospital corps were assembled at camp dressing

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station to attend to the wounded—a system that was uniform throughout the campaign and worked very satisfactorily, but with larger armies and greater casualties would break down, and should not be depended on in lieu of a properly equipped field hospital with staff and personnel independent of the regimental equipment except where necessity dictates.

In the attack on the wall of Pekin, August 14, there were but 11 casualties, and in the attack on the grounds of the Forbidden City, August 15, 23 casualties. The wounded were moved on August 16 to the field hospital established in a building, in the grounds of the Temple of Earth, and on August 21 were sent in ambulances to Tung Chow, the head of navigation on the Pei-ho and by junk from there to the base hospital at Tientsin. The field hospital at Pekin has a capacity of 150 beds and the maximum number present at one time up to date is 141.

The great majority of men admitted to sick report during the campaign were suffering from intestinal disorders, which is the great scourge of American troops. The greatest need in our equipment at present is a medical cart that can follow each regiment as a traveling dispensary and accompany the regiment when detached. These carts form part of the equipment of the medical department, but I have never seen them provided or in use in the field. The value of the first-aid package has already been demonstrated. The orderly pouch proved defective when used by a mounted orderly as the thread holding the strap to the pouch usually broke, rendering the pouch practically useless. The strap should be riveted to the pouch. The new detached service chest proved invaluable, and I consider it the most complete and valuable article in our equipment. The new aseptic hypodermic syringes, all metal, proved very unsatisfactory, and on forcing out the contents the point would become separated from the barrel. There was a great deal of complaint about the syringes.

First Lieut. E. R. Schreiner, assistant surgeon, United States Army, was relieved of the command of the general hospital at Tientsin on August 20, by Maj. William Stephenson, surgeon, United States Army. The latter was also medical disbursing officer and purveyor. Maj. William H. Arthur, surgeon, United States Army, was appointed chief surgeon, Second Brigade, China relief expedition, Tientsin, on September 14, 1900.

The field hospital at Pekin was under command of Capt. W. F. Lewis, assistant surgeon, United States Army, to whom I am indebted for most valuable assistance throughout the advance on Pekin. The work of the hospital corps detachment was satisfactory, and that of Acting Hosp. Steward Arnold D. Tuttle was specially efficient, and he deserves and has earned promotion to the grade of hospital steward. On September 26, I reported for duty as chief surgeon, First Brigade, China relief expedition, and my connection with the duties of chief surgeon of the China relief expedition ceased.

Summary of casualties which occurred in the United States Army expeditionary force in
China, from July 12, 1900, to September 25, 1900.

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The losses of the United States Marine Corps were: At Tientsin, July 13, killed, 4; wounded, 27; Yangtsun, August 6, wounded, 1; Pekin, August 15, wounded, 1; total killed 4, wounded 29. Total of killed and wounded of the United States forces in the Pekin relief column, 232.

Summary of deaths, period July 12 to September 25, 1900.

Classification:
    

   
    
Summary of the personnel of the medical department serving with the troops in China, September 25, 1900.

    
    
  
 
REPORT OF MAJ. FRANK J. IVES, SURGEON, UNITED STATES VOLUNTEERS, CHIEF SURGEON, CHINA RELIEF EXPEDITION.

PEKIN, CHINA, April 5, 1901.

I have the honor to submit the following report of the medical department of the China relief expedition for the period from September 24, 1900, to March 31, 1901, during which time the undersigned served as chief surgeon thereof.

The United States forces in China in September, 1900, consisted of 144 officers and 3,900 enlisted men of the United States Army, and two battalions, each consisting of four companies of United States marines, numbering in all about 800 men, making a total strength of approximately 5,000. Although these marines were a component part of the command, the medical officers on duty with them, who were naval officers, were not required to make the reports incidental to the Army. As these marines left China early in November, I was unable to obtain any records of sickness among them, so that all data quoted in this report pertains solely to the Army. It is presumed that these naval medical officers submitted all necessary reports to the chief of their department.

In the latter portion of September, 1900, our forces were divided into two brigades stationed, respectively, at Pekin and Tientsin, with scattered detachments along the Pei Ho at Peitsang, Yangtsun, Hoshiwu, Matao, and Tungchow, the latter being about 16 miles from Pekin and the nearest point to that city on the river. Owing to the railroad between Pekin and Tientsin not being in operation, it became necessary to ship all supplies by junks on the river, thus necessitating strong garrisons along the waterway, to which the American forces contributed its quota at the places above enumerated. The junks were towed by coolies, and as not more than 15 or 20 miles per day could be traveled it required seven or eight days to make the journey between the two cities. In December the railroad was put in operation and all supplies were subsequently shipped thereby.

Upon assuming the duties of my office I found that a base hospital of 150 beds, under command of Maj. William Stephenson, surgeon, United States Army, and known as the “General Hospital at Tientsin,” had been established and was in successful operation at that place. This hospital was well equipped with an adequate quantity of all necessary medical supplies, there being on hand a sufficient reserve for expansion to 300 beds should the emergency for such arise. The personnel of this institution consisted of 7 assistant surgeons, about 40 members of the Hospital

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Corps, and 15 trained female nurses. It received the sick not only from the command in Tientsin, but such severe cases from Pekin and the river detachments as could with safety be transferred. In this connection I would state that the journey down the river was speedy and comfortable, and the sick thus transported were, as far as known, in no case injured by the trip. They were invariably accompanied by surgeons and suitable attendants, and everything possible done for their well-being and comfort. The hospital at Tientsin was from time to time depleted by transferring many of the sick to the hospital ship Relief, then at anchor at Taku. It was discontinued on November 11, as the American forces at that time had been mostly withdrawn from China, and the garrison at Tientsin had been reduced to two companies of infantry.

The condition of the command in Pekin in September was such as might invariably be expected after the rough and trying experiences to which it had been exposed. What was designated a field hospital had been located in one of the large buildings in the Temple of Agriculture. It was under command of Capt. W. F. Lewis, assistant surgeon, United States Army, and a certain degree of organization had been effected. The sick were segregated and a diet kitchen established. There were in use a number of “Gold Medal” cots, which had been furnished by Captain Ramsay, regimental quartermaster of the Ninth Infantry. In addition to these, a few hand litters were used as cots, but some of the sick were obliged to sleep on the floor, as the cots and litters were inadequate for all, there being about 150 sick in the hospital at that time. There was no hospital bedding, clothing, nor furniture. The sick were forced to wear the clothing in which they entered the hospital, but there was a fair allowance of blankets and Chinese bedding to render them comparatively comfortable. Major Stephenson was directed by wire to ship at once a suitable amount of bedding, clothing, and other necessary supplies from his surplus stores, which, upon their arrival, relieved the most pressing wants until the permanent hospitals were established.

The War Department having decided upon the strength of the command to remain in China during the winter, I was directed by the commanding general of the China relief expedition to make suitable arrangements for the care and accommodation of the sick of a command of about 2,000 for one year. Of this force, two companies of infantry were to garrison Tientsin, the post being designated Liscum Barracks, one company at Tungchow, and the remainder to take station in Pekin. The garrison in Pekin was divided into three sections, the military post known as “Camp Reilly,” situated in the Temple of Agriculture, and two detachments, each consisting of two companies of infantry, doing police and provost duty in the two American sections of the city, one in that portion known as the “Tartar,” and the other in the “Chinese” city.

The Temple of Agriculture is a large oval inclosure situated in the extreme southern section of the Chinese city, surrounded by a massive brick wall 15 or 20 feet in height with only two gates or entrances, and inclosing about 300 acres. The ground is elevated above the surroundings, is well drained, and in no place are the city residences in juxtaposition to the wall. The inclosure is divided by walls into five or six smaller inclosures, and in the center are situated the altars, temple buildings, and residences of the priests and caretakers. The ground is covered with grass, and there are groves and avenues of cedar trees, many of great age and proportionate size. This site was selected by the commanding general shortly after the military occupation of Pekin, for the use of the American forces, and for hygienic and military reasons a more desirable location could not have been fixed upon.

Medical supplies.   During October an immense quantity and assortment of medical supplies arrived from San Francisco and Manila. These were intended to equip a medical supply depot in China, to be under the charge of Maj. E.T. Comegys, surgeon, United States Army, who had reported for duty in September. Owing to the withdrawal of a large portion of the troops, this station was never established. Such of these supplies as were needed for the command were sorted out and retained, and the balance, by direction of the commanding general, turned over to the quartermaster’s department for shipment to the medical supply depot in Manila. The selection and separation of these supplies was attended with serious difficulty, owing to the absence of any marks or lists by which the contents of many of the boxes and packing cases could be determined. Such information is usually shown on the packers’ lists, but it has been my experience that the latter are rarely available, especially when most needed. Not only were there many packages unmarked, but I was informed that in some instances old boxes had been used, from which the marks of some previous shipment had not been obliterated. In the present instance a great deal of unnecessary labor could have been avoided had the markings on the packages shown the contents in a more definite manner. It was particularly aggravating to open box after box to find out they contained nothing that was required.

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I am not familiar with the regulations governing the shipment of supplies from a medical supply depot, but would urgently recommend that each package shipped should first have every other mark carefully obliterated and then be legibly stamped with, (1) name of depot or consignor, (2) date of invoice, (3) the number, (4) name and address of consignee, (5) contents, (6) the red cross. It has been suggested by Maj. J. C. Byron, depot quartermaster in Pekin, that where packages contain a miscellaneous assortment of articles, tin envelopes with a movable flap or lid be securely attached to the box. The box is marked as above enumerated, with the exception of the list of contents, and into these envelopes cards can be inserted containing all the above data, including a complete list of contents. For a long shipment, three or four more similar cards to be placed in each envelope, so that one can be retained by each quartermaster through whose hands the consignment passes. This would enable each to keep an accurate check on every article received and shipped by him, and would be of great service to the medical officer ultimately receiving them. Should any article be removed from the case, a note to that effect could be made on the card. The clerical work incidental to manifolding the cards could be easily reduced by means of the mimeograph or other manifolding appliances. Shipping quartermasters have informed me that the red cross mark on the package has proved most valuable in enabling a rapid separation of medical from other property, especially when the shipment is large and supplies from other departments are mixed together. In the case of boxes it should always be placed on the two ends, so as to be visible when they are piled in tiers.

Hospitals.   On September 27, 1900, I addressed a letter to the adjutant-general, urging the immediate establishment of permanent hospital arrangements for the command in Pekin, and submitted plans for the conversion of some of the Chinese buildings in the Temple of Agriculture into a hospital of 150 beds. These plans were such as to render it easy to expand or contract the size of the hospital, should the occasion for such arise. With some alterations these plans were adopted, and what was officially designated as “United States Military Hospital No. 1” was established. This hospital had a fixed capacity of 85 beds, which could be increased to 100 by crowding, and still further enlarged as above mentioned by occupying adjacent buildings, should the necessity present itself. It was imperative that the sick be provided for before the advent of the winter season, and as there was no time to construct suitable wards, it became necessary to utilize such Chinese buildings as were available for hospital quarters. These buildings, owing to their peculiar construction, were poorly adapted for such purposes unless materially altered. They were constructed of massive walls, were closed on all sides except toward the front, and the interiors consisted in each case of one large hall extending to the roof. The two buildings utilized for wards were respectively 30 and 32 feet in depth and about 25 feet in height from the floor to the center of the roof. The roofs were of the curved, sloping design peculiar to all Chinese buildings. The fronts of these buildings had no windows, but consisted of a continuous series of doors about 3 feet wide and 8 feet in height, so that the entire front could, if desired, be thrown open. The main difficulty, therefore, was to provide for suitable heating, lighting, and ventilation. The doors above mentioned were not made of solid wood, but were constructed of an open lattice work, covered on the inner side with white paper. This system of using lattice work covered with paper for doors, windows, and even entire sides of buildings is largely in vogue in China, and seems to serve a very useful purpose. It is cheap, the heat in winter time is retained, and considerable light admitted.

In the present instance all these doors, except a few retained for egress and ingress, were closed and securely sealed. In every alternate one a glass window 3 by 3 feet was inserted, which could be opened when desired. Suitable partitions were then erected to divide the interiors to suit the requirements, and 11-foot ceilings constructed. These ceilings were entirely of Chinese design and conception. They consisted of a light bamboo or reed framework, upon which a layer of brown paper, and over this one of ordinary wall paper, were pasted. Although of the flimsiest character, they proved most serviceable, provided due care was exercised in preventing sudden drafts from without. On one occasion during a high wind an outside door was held open, which caused such a strong draft that the entire ceiling of one ward was torn from its fastenings and lifted several feet, resulting in its almost complete destruction. By observing proper precautions this did not occur again. By thus cutting off the spacious lofts above the wards the latter were most comfort ably heated by excellent coal stoves furnished by the quartermaster's department. The wards were ventilated by means of the windows, and every 15 feet along the center of the ceiling there was an opening 18 inches square. In the loft there was an opening about 1 foot square every 15 feet just below the eaves, and at each end, very near the angle of the roof, a window about 18 inches in diameter, which could

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be opened or closed by means of cords worked from below. By these means the ventilation was at all times good. All the interior walls were hung with white wall paper of a neat pattern, which made the wards and other rooms present a bright, cheerful, and attractive appearance. An 8-foot inclosed brick passageway was constructed, connecting the two main buildings, which being properly heated, served also as a recreation and smoking room for the convalescent patients. A sink, with earth closets, which could be emptied from without, was also constructed, opening from the passageway.

A building originally intended for a laundry was built in the southeast angle of the court, but was ultimately utilized as a dining room for the detachment and such patients as were not subsisted in the diet kitchen. Another building was suitably partitioned and utilized for administration purposes and quarters for the medical officers. The enlisted men of the detachment of the hospital corps, like all enlisted men attached to Camp Reilly, occupied hospital tents within the hospital inclosures. Two isolation wards made of hospital tents were erected in the southwest corner of the inclosure, but no occasion arose for their use.

This hospital was excellently equipped with a full assortment of medicines, surgical dressings, and hospital stores of all kinds. The folding field furniture was used in the wards and proved most servicable [sic], with the exception of the folding cots with woven-wire mattresses. In most cases these were frail and became easily broken being inferior to the adjustable folding cots with canvas bottoms. The “Gold Medal” cot was not used in this hospital after the other cots were received, but it proved one of the most useful and serviceable articles issued to our troops. Too much can not be said in praise of this cot for troops in the field, and for a movable field hospital I do not believe any other can compare with it for compactness, lightness, and strength. The new model, which stands higher from the ground, is a decided improvement, especially for hospital purposes.

The operating room was excellently equipped and lighted by means of a large window cut in the south side of the main building. The new mess chests, with service for 100, were used in the dining room. This chest gave the utmost satisfaction. The kitchens were plentifully supplied with all necessary culinary apparatus and the field ranges furnished by the Quartermaster Department, which were used by all the troops, proved most excellent. I mention these details merely to show that our sick received almost the same care and comfort which would be possible in any of our military hospitals in the United States.

This hospital was commanded by First Lieut. H. S. Greenleaf, assistant surgeon, United States Army. Under him were 3 assistants, about 40 members of the hospital corps, and 6 trained female nurses. The diet kitchen was admirably managed, and everything was done conducive to the welfare of the sick. I do not believe it would be amiss to state that the United States Military Hospital No. 1, in Pekin, was, in point of equipment, the most complete hospital among the allied forces in north China, and it reflected in the most favorable manner upon the Medical Department of the Army. Lieutenant Greenleaf proved himself an efficient and capable officer and a large part of the success of this hospital was due to his untiring energy and ability.

Military Hospital No. 2 was located in the American section of the Chinese city. Its capacity was 30 beds. It was originally intended for officers and selected cases among the enlisted men. At the time of the withdrawal of the troops in November, 1900, it was under discussion whether or not some of the female nurses then at Tientsin be retained in China during the winter. As there were no accommodations for them in the Temple of Agriculture, it was determined to establish a small hospital in the city where they could all reside and those on duty at hospital No. 1 be each day sent to that place. The plan at first appeared a little cumbersome, but it worked smoothly. The services of these nurses proved most valuable and contributed much to the efficiency of the department. This hospital, under the efficient management of Contract Surg. J. T. Halsell, United States Army, proved of great service and more than fulfilled its original requirements. It was located in the building used by the Canton Club and received the sick from the provost guard. It was discontinued as a separate organization in the latter portion of February and its personnel attached to hospital No. 1.

A 20-bed post hospital was established at Liscum Barracks in Tientsin, and a 6-bed hospital at Tungchow.

Sanitary conditions.   Owing to the apparently total lack of all sanitation on the part of the Chinese, and the indescribably filthy condition of their towns and cities, the sanitary environments at first presented a discouraging outlook. The surface drainage is crude, and although there is no sewer system a few imperfectly constructed underground drains were observed. All trash and refuse is usually thrown into the street,

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where it is liable to remain undisturbed indefinitely. In a Chinese house but little garbage exists and that is usually thrown into the streets and devoured by dogs, which are plentiful and seem the natural scavengers. There are apparently no water-closets in the private houses. In all the better classes of residences a small oblong hole about a foot in depth is dug in some secluded angle of the inclosure. This is emptied from time to time, the contents being carried by coolies to a public dumping ground. These privies are used by the women and children, and only in the better class of people by the men. Throughout the city public inclosures are located for “defecatories.” These are used by the poorer classes of men and boys, who merely use the ground, as there are no privies, seats, or even sinks. When the ground in these becomes impassable for pedestrians the night soil is collected and taken to the dumping grounds. Toward the outskirts of the city these “defecatories,” as they were designated, cease to exist, and the male population utilize vacant lots; angles in the walls, and even the public highways. The night soil is considered a valuable asset for fertilizing purposes, and it is therefore not difficult to arrange for its removal. It is collected in certain outlying sections (the dumping grounds previously referred to), where it is piled, awaiting its ultimate transportation to the country. This system is extremely crude and indescribably offensive, and although it may not be the means of contaminating the drinking water, it affords every facility for conveying disease through the medium of flies and dust.

The experiences of the past three years in Cuba and the Philippines, however, have to a large extent familiarized the American Army with the most efficient methods of dealing in such cases, so within a reasonably short period those sections of Pekin controlled by our troops were in a comparatively clean condition.

Quarters.   The troops stationed at “Camp Reilly” in Pekin were housed in tents, all others occupied Chinese houses, which had been previously thoroughly cleaned and put in proper condition for habitation. Considerable discussion arose in the early fall as to the risk of subjecting troops, so lately from the Tropics, to so rigorous a climate with only canvas as a shelter, and many were the forebodings as to the direful results of such a procedure. The undersigned, as chief surgeon, did not see fit to submit recommendations against the occupying of tents, as he believed it was better to remain in the Temple of Agriculture, regardless of the character of shelter to be provided. Had there been opportunity to erect suitable barracks in the inclosure there would have been no argument, but the winter was approaching and skilled labor was difficult to procure, so that the question sifted down to remaining in the Temple of Agriculture under canvas, or occupying Chinese quarters in the thickly settled portion of the city. The former course was adopted with the most gratifying results. Considerable inconveniences and personal discomforts are unquestionably engendered by tent life, but in the present instance these were minimized as far as possible. The tents used were the walled conical, made of drab canvas. I believe that drab or other dark color is unsuitable for ordinary camp use. The interior of the tent is too dark, causing unnecessary discomfort for the occupants and making it more difficult to keep clean. The tents were heated by Sibley stoves converted into coal stoves by erecting an ovenlike base of brick about 3 feet square and 18 inches high. The central portion was hollow, opening above and to the front. An iron grate was fixed in the upper opening and the stove rested over this, being sunk about an inch into the cement top of the oven. These stoves worked admirably and maintained as comparatively even a temperature as is possible under canvas. A few fires occurred, but none of a serious character. One occurred in the hospital, in the tents used by the medical officers for their mess. In this case four hospital tents were consumed, with almost all the contents. The fire spread so rapidly that but little could be removed. The rapid destruction of these tents indicated very clearly to my mind that tents should never be used for housing the sick in winter time unless no other shelter is available, as in case of a fire it would be impossible to remove those inmates unable to escape unassisted. In the present instance the canvas was extremely dry, owing to the extreme dryness of the atmosphere. Still, it must be borne in mind that even in moderately humid climates the heat from the stoves soon dries the canvas most thoroughly and renders it very inflammable.

Bedding and clothing.   All our troops were supplied with “Gold Medal” cots. The clothing was adequate and suitable for the climate. For troops serving in the field a khaki uniform made of some suitable woolen fabric would be more serviceable than the regulation blue. The latter is kept neat and clean with difficulty. In camp it soon becomes dirty and unsightly, and gives the entire command a slovenly and discreditable appearance.

Food.   The subsistence department was abundantly provided, not only with all the component parts of the ration, but with a large assortment of extra supplies. Native beef and mutton were readily procurable. The quality of this meat, although

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inferior to the corn-fed beef from our packing houses, compared favorably with the average range cattle of the plains. Considerable rinderpest existed among the cattle in the vicinity of Pekin, and at one time some cases appeared in the commissary herd, but as far as could be ascertained all so diseased were killed, and if any escaped detection and were issued no injurious results followed. Besides the beef and mutton, poultry and eggs were cheap and plentiful. An excellent bakery was established, and an abundance of well-baked, wholesome bread was available.  For service in North China the ration as now authorized is excellent in every particular, as is well testified to by the healthy condition of the command and the few cases of digestive diseases.

Water.   All drinking water in Pekin was obtained from wells, the water level being about 30 feet below the surface. These wells are thickly scattered throughout the city, and as there is absolutely no attempt at sewerage one would infer that most of them would be contaminated. Although many unquestionably were, still, where sufficiently removed from adjacent residences, the water in many seemed wholesome. All the water is hard and loaded with salts. In some wells it was found quite brackish to the taste, in others sweet and agreeable. An analysis made for me in the laboratory of one of the German military hospitals of the water taken from a well in the Temple of Agriculture showed an abundance of chlorides and other salts, but no organic matter. In the Temple of Agriculture the water was at first obtained from two wells in the compound ultimately occupied by Military Hospital No. 1, but subsequently the depot quartermaster dug three other wells, as the supply from the first two was inadequate. The water in all was of the same quality, and from the five wells an abundance was obtained for all purposes.

Five distilling plants, each with an alleged capacity of 600 gallons per day, were provided for the expedition. Of these one was put in operation in the fall and another later on in the winter, orders being issued and enforced, requiring the water from these plants to be used for drinking purposes by all troops at headquarters and at Camp Reilly. Shortly after the first plant was erected it was reported to my office by a medical officer that the water was not being properly distilled, but flowed from the coils in almost the same condition as when leaving the well. The matter was at once, and repeatedly afterwards, brought to the attention of the authorities and referred to the depot quartermaster, under whose supervision the plants were being operated, but without material results. The command in the meanwhile used the water as issued, with no noticeable ill effects, a fortuitous circumstance due to the remoteness of the wells from all sources of contamination. Although no evil result followed, it was, nevertheless, unfortunate that after all the expense and trouble incidental to transporting these plants to China they should not have served their legitimate purpose.

Bathing facilities.   The two distilling plants mentioned in the previous paragraph, although distinct failures in so far as furnishing distilled drinking water is concerned, served a most useful purpose in heating the bathrooms and water for bathing. Two commodious buildings adjacent to the men’s quarters were obtained and fitted up with facilities for supplying baths for about 20 men each. The distilling plants were located in these, the fire from the boilers rendering the interior temperature of the room warm and comfortable. By turning steam into large caldrons kept filled with water direct from the well an abundance of warm water for bathing was available.

Climate.   The climate of North China during the winter season is bracing, invigorating, and well calculated to produce robustness and healthfulness. The atmosphere is extremely dry, and there is no sudden variation in temperature. From November 1, 1900, to April 1, 1901, there was no rainfall and only two very light falls of snow. There were no facilities for taking maximum and minimum temperatures, but observations were taken and recorded at military hospital No. 1, of the temperature at the hours of 7 a.m. and 7 p.m. During the month of January the maximum temperature thus observed was +35° F. and the minimum +2°, the average morning temperature was +16°, the average evening temperature +20° . As this month was the coldest during the winter, the above figures give a comparative idea of the daily temperature. Owing to the aridness of the atmosphere and absence of precipitation, the ground becomes very dry, and the soil being alluvial is soon ground into a fine powder along the roads and thorough fares, few of which are paved. This section of China is visited every few weeks by severe winds of several days’ duration. As a result, dust storms of indescribable severity are developed, and constitute one of the most insanitary conditions of Pekin, in addition to causing great bodily discomfort and annoyance. In each case after a storm of this character the sick report materially increased, the additional causes of admissions being affections of the respiratory organs, including pneumonia and bronchitis. Being appointed on

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a sanitary commission, in conjunction with medical officers from other branches of the cooperating forces, the purpose being to devise measures for the proper sanitation of the city of Pekin, I brought this matter into prominence, recommending most urgently that means be adopted for street sprinkling. This was subsequently done, resulting in the greatest benefit to all the foreign residents.

Health of the command.   During that period of the military occupation prior to October 1, 1900, the sick report, although large, was in no manner excessive when the severity of the campaign and attending circumstances are taken into consideration. Many of the troops actively engaged, having previously been on duty in Cuba and the Philippine Islands, were necessarily debilitated and proper subjects for disease incidental to a campaign. Digestive diseases, including diarrhea and dysentery, led all others with a total of 2,426 cases, or 43.5 per cent of all. Malarial fever came next with 651, or 11.6 per cent. Accidents and injuries, 577, or 10.3 per cent. Respiratory, 568, or 10.1 per cent. Venereal, 451, or 8 per cent. Cutaneous, 360, or 6.4 per cent, and the others scattering. There was but 1 case of measles and 77 of typhoid fever. All of these latter occurred in the summer and fall, except three, which developed in December. Of the 353 cases of dysentery 351 occurred prior to December 1, and of the 1,710 cases of diarrhea 1,602 occurred prior to November 1. Under the heading accidents and injuries, 258 cases out of a total of 577 occurred during August; these included 14 killed and 100 wounded during the campaign from Tientsin to Pekin and 100 cases of heat exhaustion on that march.

During the winter an excellent opportunity was afforded for meeting the medical officers of the various armies and observing the equipment and organization of their departments. In all cases the medical officers were courteous and cordial in their manner and gave the impression of being men of intelligence and ability.

Equipment.   After a careful examination of the equipment of the various forces in China, I have no hesitation in asserting that the medical department of the United States Army is the best and most intelligently equipped of any service there represented.

Ambulances.   With the exception of the United States the Germans were the only contingent having an ambulance for the transportation of the sick. The British had a two-wheeled vehicle, the “tonga,” also known as a “dhanjiboy,” used by the Indian troops, which could transport about four in a sitting or semi-reclining position. This was drawn by two animals and was well adapted for a rough, hilly country, but did not present especial advantages over an ordinary ambulance. A comparison as to the relative merits of the American and German ambulances, according to my idea, is absolutely in favor of the former. Our wagon is considerably lighter and in emergency can be handled by two instead of four animals, which is hardly possible with the German. The seating capacity of both is the same, but in an emergency we can load six reclining patients, whereas the other has reached its limit with four. In the German ambulance the seats are arranged somewhat similar to our old-style ambulance, and when in use are rather unstable and rickety. For reclining patients they use the regulation hand litter, four of which belong to each vehicle. It is difficult to conceive of a more simple, compact, and practical method than our present arrangement of making the seats and back serve as litter beds. Unfortunately the ambulances actually in use by our army in Pekin were old, dilapidated, and out of date, so that we were not in a position to demonstrate our superiority except by explaining to our visitors what improvements had been made.

The hand litter in our Army is, for strength, lightness, compactibility, and comfort the superior of any seen in China. The British troops were supplied with what is known as the “dhoolie” litter, of which there are several varieties. The ordinary dhoolie used by the Indian troops weighs 71 pounds. It consists of two A-shaped frames, between which the litter bottom is stretched, suspended at the apex to a large bamboo pole, by means of which the litter is carried upon the shoulders of the bearers, usually four in number. When resting on the ground, the prolongations of the A serve as legs, and a curtain or hood is hung on the framework above the patient to protect him from the sun or rain. There have recently been two modifications to this litter, the Ames and Kay dhoolies. Each reduce the weight to 50 pounds. In the former there is an arrangement by which the litter bottom can be reversed and used as a hammock. The Kay dhoolie can be carried either by hand or suspended to a pole. In the mountainous regions of India, where coolie labor is plentiful and cheap, these litters undoubtedly serve a most useful purpose, but I do not believe them practical in ordinary warfare.

When it may be necessary to carry the sick or wounded a great distance and no wheel or horse transportation is available, I believe this can be accomplished with less difficulty by means of a litter suspended from a pole and carried on the shoulders of the bearers rather than by hand. This would be especially true in locations where coolie or other cheap native labor can be obtained. Our litter might readily be converted

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into one of this kind by adopting some simple device such as a set consisting of two iron rings 3 or 4 inches in diameter, upon each of which is attached by a closed loop two iron rods, each terminating in a circular ring of sufficient size to fit over the handles of the litter. This would be packed or carried detached from the litter until required for use.

The German litter is heavy and cumbersome and presents no single feature for special commendation. That used by the French army is in many respects similar to the German, but has wooden legs and does not seem as strong or durable.

The Japanese have two litters—a light stretcher without legs, consisting of two bamboo poles, with iron braces and a canvas litter bottom; the second is what they call a “rickshaw” litter, being nothing more than an ordinary “rickshaw” with a sufficiently long body to permit the patient to rest in a half reclining position. Although the Japanese have never had practical experience with these rickshaw litters in actual warfare (those in China were received after the active campaign was ended), I believe they will prove most useful, and the question of experimenting with them in our service would be well worth the effort. The Japanese hand litter is nothing more than a light stretcher, and, having no legs, can only be used for the actual transportation of the sick or wounded. They are admirably adapted for use on the battlefield to transport the wounded from the firing line to the dressing stations, but otherwise do not compare in strength, utility, and comfort to the litter in our service.

In this connection I would state that several years ago the undersigned gave considerable attention toward devising a light stretcher for field use, and at the annual meeting of the Association of Military Surgeons of the United States, held in Washington in May, 1894, he read a paper on that subject, at the same time exhibiting a bamboo litter which he believed might answer the purpose. I still am of the opinion that such a stretcher would be a valuable adjunct to our field equipment in ordinary civilized warfare, the chief advantages being that a large consignment of litters could be rapidly pushed to the front, thus obviating the necessity of improvising, which has practically been shown to be not only a slow and laborious progress but in many instances an impossibility.

First aid packages.   All of the troops of the various cooperating forces were supplied with first-aid packages more or less similar to that in use in our service, although none were as complete. The Japanese contains 1 triangular bandage, 3 compresses of gauze, and a safety pin; the German 1 bandage, 2 gauze compresses, 1 safety pin; the British, 1 piece macintosh 12 by 6, 1 gauze bandage about 12 feet in length, 1 compress. In the British Indian service there is also a triangular bandage; the French, 1 charpie enveloped in gauze, 1 bandage, 1 compress, and 2 safety pins; the Italian, 2 gauze compresses, 1 bandage, and pins. By comparing the contents of these various first-aid packages I believe that the one adopted for our army is superior. The contents of ours seems of better quality than most, and although somewhat more bulky, I believe that the additional articles thus furnished more than counterbalance the slightly  increased weight and size.

Hospital corps pouches.   In addition to the first-aid packages the members of the hospital corps of the various foreign contingents were equipped with pouches carried by a sling over the shoulder and containing a specified list of medical supplies. These pouches in many respects resembled that furnished our army, and I observed no feature worthy of special commendation. In the French army, however, they use saddlebags for the cavalry service. In this connection I would invite attention to the fact that the slings for our pouches have been reported as not sufficiently secured. This has been especially observable with mounted men, the jolting of the horse causing one or both fastenings of the sling to give way, which on the march is a most serious defect, there being no means of making the necessary repairs, and the pouch is thereby rendered useless. The French saddlebags present many advantages, but it should be borne in mind that in actual warfare a man is frequently separated from his horse, and when a command is fighting dismounted members of the hospital corps on duty with it should be at or near the firing line. In this case the pouch slung over the shoulder would be of greater service.

Medical and surgical chests.   In the Japanese service each battalion is allowed one set of chests, two in number, a medical and surgical. These panniers are constructed of wickerwork, inclosed in a strong leather case. They are somewhat larger than those in our service, but the contents are, in my opinion, not nearly so complete. The French have a set of four panniers for each regiment, the arrangements and contents of which do not present any special feature for remark. They are constructed of wickerwork and are practically obsolete. The British medical chests comprise a set of ten, of equal size and about the same dimensions as ours. This set is one of the component portions of what is known as a “section,” which is actually one-
    

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fourth of a field hospital. Each field hospital has a capacity of l00 beds, and the entire personnel and equipment is specified in regulations. The hospital is subdivided into four sections, each identical in personnel and equipment. The field hospitals are numbered from one upward, and the four sections are designated as A, B, C, D. The section is therefore an independent 25-bed hospital. The chests and everything pertaining to the equipment of the section are distinctly marked, “Field Hospital, No. —,”  “Section A,” as the case may be. The contents of the chests are in many respects obsolete; there is very little idea of compactness and some of the British medical officers admitted that for actual utility they could be vastly improved upon. Assuming that a section is about equivalent to a regimental field hospital, their ten chests in no way compare with our present regimental set, consisting of the medical, surgical, sterilizing, and detachment chests, the box of additional dressings, and the field desk. The German army was, as far as observed, not equipped with medical panniers or chests of any kind, their medicine wagon being apparently substituted. These wagons are of two kinds, furnished respectively for battalions and field hospitals. Of the former, one is supplied each battalion (1,000 men), and of the latter, two to each field hospital. The wagons are divided into compartments opening to the sides and rear, and are very serviceable and complete. Those for the field hospital are considerably heavier than the others, and would on ordinary rough roads require four animals, although on the smooth roads of the continent two might be sufficient. The interior arrangement consists principally of a series of drawers resting on the side and slid into the bed of the wagon by small rollers. These drawers, when pulled out, present the appearance of small cabinets about 3 feet square, open at the front. They are rather elegant in design, and when arranged around a room in two rows, one above the other, give very much the appearance of a well-appointed dispensary. The contents are well secured, the bottles are square and arranged in slots on shelves, so that the danger of breaking is slight. The medicines in these wagons are principally tabloids, and the dressings are well selected and of good quality. There was considerable dispensary paraphernalia, such as mortars and pestles, etc., which in their various compartments looked very well, but I believe the space thus employed might be better utilized. The tabloids are more bulky than those in our service, and in nearly every case had the name and quantity of the drug printed on each tabloid. This wagon has the advantage of enabling a larger and more complete assortment of medical supplies to accompany each command. Its chief disadvantage is that should one or more of the animals assigned it die, become sick, or be arbitrarily withdrawn by the commanding officer, the entire fabric goes to pieces, which might not necessarily be the case with a set of chests.

Transportation for field medical supplies.    In this respect I believe the United States Army is inferior to the German, British, Japanese, French, and possibly many others. In our service the Medical Department, being dependent for the transportation of its supplies entirely upon the Quartermaster’s Department, is seriously handicapped and frequently made subject to criticism which should not justly be laid at its door. When a regiment goes into active service, a certain portion of the medical supplies, in addition to what is carried by the men, should at all times be in touch with the troops and available for use at short notice. These supplies should include the medical and surgical chests, additional dressings, litters, and such other articles as may be designated by the Surgeon-General as belonging to a regimental equipment. The German medicine wagon fulfills these conditions, but in the French and Japanese services each regiment is furnished with a small one-horse vehicle on two wheels, for the sole purpose of carrying these supplies. Such a wagon can be so constructed as to readily follow troops in all but the most difficult mountainous country, to be sufficiently strong to stand the usual wear and tear of the service, and light enough to require but one animal on ordinary roads. The Japanese wagon was small, low, and moderately broad, constructed very much on the plan of railroad station trucks for handling baggage.

At present in our service the medical chests, litters, and other necessary articles are packed securely in one of the wagons of the regular wagon train, which is possibly miles in the rear and never available in case of emergency. I believe a light wagon as above described would prove far more serviceable than pack animals, unless the troops were operating in a country impassable for wheel transportation of any kind. Another important element is that the Geneva Convention does not recognize the quartermaster’s transportation, and troops on the firing line should be provided with a distinctive wagon bearing the red cross, which could not under any circumstances be diverted by commanding officers to illegitimate uses. As a matter of fact, this should apply to all medical transportation, but it is especially applicable to the wagons under consideration.

The Russian troops withdrew from Pekin before an opportunity was afforded to

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inspect their equipment, but one article used by them on the march struck me as most serviceable in times of actual warfare. This was a large, circular metal caldron with a closed lid, having a capacity of 25 or 30 gallons, supported on wheels, the bottom of the caldron being 10 or 12 inches from the ground. This was easily drawn by one horse or mule. It is used for making soup or stew. In the Santiago campaign such an apparatus for our troops would have been of incalculable benefit.

Military hospitals.   Although the various hospitals in Pekin were originally organized as field hospitals in the strict sense of the term, when the permanent garrisons were established efforts were made to equip the individual hospitals to as high a standard of perfection as possible.

The Germans had two field hospitals of 200 beds each and a marine hospital of 100 beds. These were located in Chinese buildings in sections of the city convenient to their troops. The general equipment, as compared to the United States Military Hospital No. 1, was crude. The cots were of iron and folded in the center, making a rather unwieldy and weighty package 3 by 3 feet, of such a nature as to be difficult to transport and pack. I saw no effort to provide other folding furniture, and the bedside stands, tables, chairs, and benches seemed to have been rather roughly extemporized. Some mattresses were in use, although bed sacks filled with straw were employed to a considerable extent. There seemed to be a good allowance of blankets and bed linen of suitable quality. All patients not in bed were required to wear hospital clothing made from material resembling bed ticking. The kitchen was well and systematically regulated; in it was hung a large blackboard from 4 to 5 feet square, lined and ruled in white paint with the vertical columns for the various kinds of diet, and the number of each ward on the horizontal lines. This served as an excellent general guide for the cooks. The quality and quantity of the food was good, but in no way compared to the commissary department of our army. The wards were well ventilated and heated by means of large brick ovens constructed in each. A bathroom was attached to each ward, and the arrangements for removing the nightsoil were sanitary. Each hospital was provided with an excellently equipped operating room. Excellent disinfecting plants were established in each for bedding, clothing, etc., and also a well-equipped bacteriological and chemical laboratory. In these last two respects the Germans were superior to any of the forces in Pekin, including our own; but otherwise our equipment was in every way more serviceable and complete. After the United States, the Germans came next in point of hospital equipments. I endeavored to ascertain the extent and character of the prevailing diseases amongst them, but their medical officers seemed unwilling to impart information. However, in going through their wards, the large number of cases of typhoid fever and dysentery was apparent to the most casual observer; in fact, at times an entire ward, with 20 or more patients, seemed affected with these diseases. As my visits were made during February and March, when there were practically no typhoid and dysentery amongst the American troops, it would look as if our sanitary measures were superior, both of the above being preventable diseases.

The personnel of a German field hospital consists of 6 commissioned medical officers (the senior with the rank of major), 1 chief steward (who seems to rank higher than the hospital stewards in the United States Army, being, I should judge, similar to the highest warrant officers in the Navy), 11 noncommissioned officers, 12 nurses, privates, 1 wagon master, 18 men (laborers), 1 bookkeeper, 1 druggist—a total of 6 commissioned and 45 enlisted men.

British.   The British had but one hospital in Pekin, situated in a new and spacious compound known as the Chee Foo palace. With the exception of a limited number of iron cots and bedding, this hospital had practically no equipment beyond that of the regulation field hospital. It consisted in part of two field hospitals of four sections each, thus affording separate organizations for the native Indian and British troops. The division is essential in that service with mixed commands, owing to caste prejudices and the necessity of preparing the food in certain ways for the natives. The British hospital was clean, well ventilated, and the usual sanitary regulations enforced. Their kitchen and mess equipment seemed deficient, and no system nor arrangements for special diets for the sick were noticed.

There did not appear to be an unusual amount of sickness amongst the British and native troops, the character of diseases among the former being very similar to that amongst the Americans. I believe smallpox broke out amongst them, but only a few cases occurred, and no epidemic was even threatened. A very singular feature about the native troops is their apparent immunity from typhoid fever. Although totally unaccustomed to the vigorous climate of north China, they seemed to stand the winter well, and comparatively few succumbed to pneumonia and other pulmonary diseases.

Japanese.   The Japanese had 2 field hospitals of 200 beds each. These were arranged very much on the order of the German, but were not so comfortably

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equipped. The cots were principally extemporized and the bedding, clothing, etc., of a crude quality. Their operating room was provided with an excellent assortment of surgical instruments, belonging to the field equipment. One of the principal diseases amongst them was beri-beri. There were some cases of typhoid. I do not believe they suffered as extensively from diarrhea, dysentery, and digestive diseases as the European and American troops. This would be easily accounted for, from the similarity of the food and natural conditions of the country.

Organization.   As the Medical Department of the United States Army is practically without any specific organization, they were in that respect different from any of the allied forces in Pekin.

A careful study of the various organizations reveals the fact that whereas they are for the most part suitable for coherent masses of large bodies of troops, they are not well adapted for the scattered detachment service, such as our Army is liable to perform. The problem then arises, Can a system be devised which can be readily convertible to both conditions? The British system is very similar to that in our Army with the addition of the regularly organized and equipped field hospitals previously mentioned. This latter gives them a certain mobility which is sadly lacking in our service. For instance, when the various brigades of British troops were ordered from India to China, the commanding general in his order merely designated that such and such field hospitals (giving numbers) should accompany the command. This was all that was necessary, and a few words expressed what in our service would have required much previous thought and calculation to effect.

The Japanese organization is on a more elaborate scale than others. Each regiment has 6 medical officers, 3 hospital stewards, 12 privates of the hospital corps, and 48 assistant stretcher bearers (4 from each company) detailed from the line. In addition to these there is a sanitary corps of 500 men for each division. This is usually under command of a field officer of the line and is divided into 2 companies of 250 men each. One of these companies carry the wounded from the first dressing stations to the second line, known as the “collecting stations,” and the second company carry them from there to the field hospitals. This force of hospital men comprises over 6 per cent of the total command.

In the German army there are 6 medical officers with each regiment, 2 to each battalion. One noncommissioned officer of the hospital corps is assigned to each company, and 4 men from each company are designated as company bearers. In addition to this, each division has one company, consisting of 6 medical officers and 100 enlisted men, who act as litter bearers. This company has 8 ambulances and 72 litters. It advances as near as possible to the firing line without unnecessary risk, and there establishes stations, to which the wounded are brought by the company bearers. The sanitary corps then takes charge and transports the wounded to the rear. In addition to the above, each division has 6 field hospitals of 200 beds each. A division consists of 4 infantry regiments of 3,000 men and such artillery and cavalry as may be assigned it.

Each French regiment has 4 medical officers and 12 enlisted men of the hospital corps, 1 to each company. As in the German and Japanese services, company bearers are detailed from the line. The wounded on the firing line are carried to the first dressing stations and from there to what is designated their ambulance stations. Here the function of the company bearers ceases. These ambulance stations are in reality temporary field hospitals, with a capacity of about 50 patients. There is apparently only one of these ambulance stations to a division. Still farther to the rear there are, for an army corps, 6 field hospitals of about 100 beds each. Behind these are the general and base hospitals. I was unable to obtain figures as to the complement of officers and enlisted men for these various hospitals, but inferred from remarks of the medical officers that the strength of the hospital corps was about 4 per cent of the total strength of the command.    

It is thus seen that in the principal foreign armies the system of company bearers seems to be generally adopted. I inquired as to the use of musicians for hospital purposes on the battlefield, but was unable to obtain much satisfaction.

To minutely relate all one’s observations and impressions during this remarkable period would require more space than the limits of an ordinary report would warrant. I have therefore endeavored to restrict my remarks to what appeared to me the most salient features, and as such respectfully submit them.

In conclusion, I would state that the conduct of the medical officers and enlisted men of the hospital corps of our army was such as to reflect credit upon the department. Their duties were performed in a thorough and efficient manner, as was amply demonstrated in the admirable results obtained. These results brought the medical department prominently forward as an evidence of the efficiency of the United States Army, and enabled it to contribute its quota to the laurels won in the presence of the combined armies of the world.