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Report of the Surgeon-General of the Army to the Secretary of War for the Fiscal Year Ended June 30, 1898

Spanish - American War

REPORT OF THE SURGEON-GENERAL OF THE ARMY

TO THE SECRETARY OF WAR FOR THE

FISCAL YEAR ENDED JUNE 30, 1898

WASHINGTON: GOVERNMENT PRINTING OFFICE, 1898


THE WORK OF THE MEDICAL DEPARTMENT DURING THE SPANISH WAR.

    Medical Officers

    Hospital Corps

    Contract Nurses

    Medical and hospital supplies

    Railroad and ambulance train

    Hospital ships

    The health of the troops

    The care of the sick and wounded

    General hospitals

    The medical statistics of the war

    Volunteer relief work

    Special fund

    The Medical Corps

    Recommendations


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THE WORK OF THE MEDICAL DEPARTMENT DURING

THE SPANISH WAR

The annual report of the Surgeon-General, rendered usually late in September, presents the medical and surgical statistics of the Army for the previous calendar year, the financial statements of the Surgeon-General's Office for the previous fiscal year, and those subjects of interest or importance in sanitary administration that have been under consideration up to the date of the report. The medical and surgical statistics of the calendar year 1897 and the financial transactions of the office for the fiscal year ended June 30, 1898, have been submitted above; but I find it impossible at the present time to present a full and complete discussion of the important events of recent occurrence in which the Medical Department has been concerned. This can not be done until the reports from the various regiments and field and general hospitals have been gathered in, tabulated, and studied. I purpose, however, giving a general view of the salient points of these occurrences and of the work of the Medical Department of the Army in connection therewith.

MEDICAL OFFICERS

The number of medical officers, 192, allowed by law to the Army is inadequate in time of peace. This number includes the additional 15 assistant surgeons authorized by the act approved May 12, 1898. Later in May there were 13 vacancies; 6 officers were engaged in administrative duties in the office of the Surgeon-General and in the superintendence of the library and the Army Medical Museum, 11 were on duty at medical supply depots and as chief surgeons of military departments, 1 at the United States Soldiers* Home, Washington, D. C.; 56 at general hospitals and at garrisoned posts, 1 as colonel of

volunteer regiment, while 4 were disabled. One hundred officers were thus left for field service, 5 of whom were placed on duty as chief surgeons of Army corps, 36 as brigade surgeons of volunteers, and 59 as regimental surgeons and assistants with the regular troops. The insufficiency of the last-mentioned number was made up by the assignment of medical men under contract.

All volunteer regiments had 3 medical officers appointed by the governors of States. Volunteer surgeons to fill the staff positions authorized by the act approved April 22, 1898, were appointed by the President: Eight corps surgeons with the rank of lieutenant-colonel and 110 division and brigade surgeons with the rank of major; 5 of the former and 36 of the latter positions were filled as indicated above by the appointment of officers of the Army Medical Department. The President also appointed 3 medical officers for each of the regiments of United States volunteer infantry, cavalry, and engineers. The very small proportion of medical officers having experience of a military character impaired the efficiency of the department at the outset, but many of the staff surgeons from civil life showed great aptitude for the service, and speedily became of value as administrative and sanitary officers.

The large number of sick which had to be cared for during the progress of the war in regimental, division, and general hospitals rendered imperative the employment of additional medical assistance. Under the provisions of the act approved May 12, 1898, the services


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of over 650 contract surgeons were engaged. Most of these doctors from civil life did good service. Many of them were thoroughly well equipped physicians and surgeons, with ample hospital experience, but it was impossible to make a careful selection owing to the great pressure of business in this office. Since it was impracticable to have the qualifications of each passed upon by an examining board, I endeavored as far as possible to obtain satisfactory professional indorsement before authorizing the contract.

HOSPITAL CORPS

On April 25, 1898, in connection with the call of time President of the United States for 125,000 volunteers, I recommended that the law restricting the number of hospital stewards to 100 (see p. 14) be changed, and that for each regiment of volunteer infantry or cavalry there should be enlisted 1 hospital steward, 1 acting hospital steward, and 25 privates; for each battery of artillery 1 hospital steward and 5 privates, and for each division of the Army 1 hospital steward, 1 acting hospital steward, and 50 privates, to serve under the direction of the chief surgeon of the division. These recommendations were acted upon so far favorably that by the act approved June 2, 1898, Congress suspended during the existing war all provisions of law limiting time number of hospital stewards at any one time to 100, and requiring that a person to be appointed a hospital steward shall first demonstrate his fitness therefor by actual service of not less than twelve months as acting hospital steward, provided that the increase of hospital stewards under this act shall not exceed 100. In addition to the 200 stewards thus authorized, each volunteer organization received into the service was allowed 1 hospital steward for each battalion (act approved April 26, 1898). There was, however, no provision made for Hospital Corps men for the volunteer troops except that which empowered the Secretary of War (act March 1, 1897) to enlist as many privates of the Hospital Corps as the service may require.

To provide this corps with the necessary number of men recruiting officers were urged to secure suitable men and medical officers to effect the transfer of men from the line of the Army. Letters were sent to superintendents of training schools for male nurses in the prominent cities advising them of the need for desirable men and asking their assistance in securing unemployed nurses. A number of medical students, pharmacists, and young graduates in medicine enlisted in the Hospital Corps for service during time war, and it is believed that the efficiency of the corps was thereby raised considerably.

Recommendation was made May 14, 1898, that mustering officers be instructed to enlist desirable men approved by medical officers at the rate of 5 for each battalion, and subsequently that these be permitted to accompany the regiments on their future service. This recommendation was reiterated June 18 in a communication to the Adjutant-General. Meanwhile General Orders, No. 58, headquarters of the Army, Adjutant-General*s Office, May 31, 1898, authorized the transfer of men from the line of the volunteers to the Hospital Corps of the Regular Army, upon the recommendation of the chief surgeon, and suspended the provisions of Army Regulations governing the Hospital Corps so far as they were inapplicable in time of war and with troops in the field. Commanders of corps and of independent divisions and brigades were charged with the full control of the transfer from the line, the enlistment and discharge of members of time Hospital Corps, the detail of acting hospital stewards, and the


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appointment of stewards, the last limited by subsequent orders to 10 stewards for an Army Corps in addition to those authorized for the volunteer regiments. Authority for immediate enlistments, without reference to this office except in cases where slight defects existed, was also given to a number of chief surgeons.

The number of men enlisted and transferred was approximately 6,000.

CONTRACT NURSES

The want of a sufficient body of trained Hospital Corps men necessitated the detail of enlisted men from the regiments for hospital duty in several of the camps and the employment of trained nurses at the general hospitals. Foreseeing the necessity for a large force of the latter, I applied to Congress April 28, 1898, for authority to employ by contract as many nurses as might be required during the war, at the rate of $30 per month and a ration, the pay proper to be paid from the appropriation for the Medical and hospital Department. This was promptly granted. About the same time the National Society of the Daughters of the American Revolution offered its services as an examining board for female nurses, and a committee, of which Dr. Anita Newcomb McGee was chairman, was designated to take charge of the work. Thereafter most of the female nurses employed were selected by this committee, with the exception of those immune to yellow fever, who were recruited in New Orleans and other Southern cities, and a few who were enrolled at Montauk Point, Long Island, and Jacksonville, Fla., by the chief surgeons at these places. A number of patriotic societies offered to provide the hospitals with nurses, but the committee referred to answered its purpose so well that I did not feel the need of additional assistance, and was relieved from what would otherwise have been a serious responsibility.

Over 1,700 female nurses have been employed, at first at the general hospitals and later at the field division hospitals, when it became evident that the field service purposes for which the latter had been organized would have to give place to the imperative need of caring for the many sick men coming from the regimental camps. These hospitals ceased to be ambulance hospitals and their character of fixed field hospitals was promptly recognized by assigning contract surgeons and nurses to duty with them and providing them with articles of equipment which can not be carried in the hospital wagons of a marching command. Female nurses were not sent to these field hospitals until their original function as an essential adjunct to a command mobilized for active service became lost in the current of immediate necessities. Many of the trained nurses were Sisters of Charity, whose services were highly appreciated by medical officers in charge, as well as by time individual sick men, who benefited by their ministrations. Others were obtained through the kind assistance of the Red Cross Society for the Maintenance of Trained Nurses, Auxiliary No. 3, and I desire to express niy high appreciation of the valuable services rendered to the Medical Department by this organization.

MEDICAL AND HOSPITAL SUPPLIES

The authorized strength of the Army, April 1, 1898, was a little over 28,000, officers and men. This force was stationed as garrisons at military posts, and while the supplies furnished were more especially adapted to the medical wants of troops serving under such conditions,


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there was ample provision for field service, especially at posts where active service against Indians or riot duty was possible. Further than this, it is believed the available medical supplies were sufficient for the then existing Army for any duty, though, necessarily, additions would have to be made in mobilizing for foreign service.

Up to time time that war was declared it was not practicable to take any immediate steps to obtain supplies, as it was not known until that date that the troops would actually he called out, nor were there funds available from which to make purchases. But already, before April 1, in view of the possibility of future needs, orders were given to have the field medical outfits, medical and surgical chests, instruments, etc., at the supply depots put in order for issue in case of need, and early in March the preparation of new pattern medical and surgical chests was begun so as to have them ready for manufacture should the necessity arise.

Immediately upon the declaration of war, April 21, steps were taken to obtain medical supplies for the new Volunteer Army. For the more important articles, and those of highest cost, bids were invited at short notice, such, for instance, as medical and surgical chests, litters and slings, field operating cases, pocket cases, orderly and hospital corps pouches, etc. Orders were given and the manufacture expedited with the utmost dispatch. Requests for proposals for the usual spring purchases had been made in March, but to obtain medicines and other additional supplies, in view of a state of war, advantage was taken of the authority granted by act of Congress and purchases were made in open market, the interests of the Government being guarded by obtaining informal bids when the amount was large and the permitted.

On May 3, foreseeing that it would be impossible to have ready for issue to the volunteer regiments, as soon as they were mustered in, the medical and surgical chests above referred to, as well as other articles of field equipment, although their preparation was pushed with the utmost dispatch, I telegraphed the governors of the several States for authority to utilize the medical equipment of the National Guard in the service of the State Volunteers until our army medical supplies were ready for issue.

Most of the governors of the States who had field equipment responded promptly and satisfactorily, but, unfortunately, many of the State medical departments had no such equipment. These deficiencies were supplied by the issue of the advance field regimental outfits referred to hereafter. Most of time State field medical equipment so loaned has been, or probably will be, eventually paid for by the United States.

Meanwhile the officers in charge of the medical supply depots in New York and St. Louis were directed to make arrangements so that supplies could be immediately obtained for 100,000 men for six months.

As the supply table published in 1896 was prepared for garrison use in time of peace and was inappropriate for the use of troops in the field, a field supply table was prepared and approved by the Secretary of War May 9, 1898. This supply table specifies the contents of the medical and surgical chests, the hospital corps and orderly pouches, field operating, surgeons* field and pocket cases, mess chest, food chest, and field desk, and gives the allowance of medicines and disinfectants, hospital stores, stationery, furniture, bedding, clothing, and miscellaneous articles for field hospitals and ambulance trains. It was intended to provide for time needs of commands in


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active service where only a limited supply of articles could be carried owing to the necessity of restricting transportation. But as soon as it was evident that the troops were likely to be retained in camps of instruction, notification was given that articles on the regular supply table could also be obtained. On August 12, in Circular No. 6, from this office, I again called attention to this subject, directing chief surgeons of army corps, of divisions, and of smaller commands to make timely requisition for supplies, by telegraph if necessary, and to see that field hospitals in which typhoid fever and other serious cases were treated were liberally supplied with all articles necessary for the treatment and comfort of the sick.

The patterns of the new medical amid surgical chests were prepared in this office under my immediate supervision, and the chests for issue were put up at the Army Medical Museum in this city. This was done to insure satisfactory workmanship and prompt delivery.

New patterns for the field operating case had been already fixed upon in the fall of 1897.

New forms of surgical dressings especially designed for field use, composed of sterilized, sublimated, and iodoform gauze; sterilized gauze bandages, absorbent cotton, catgut, and silk, sterilized and packed in convenient envelopes; tow, compressed cotton sponges, and plaster of paris bandages were also prepared under the immediate supervision of this office. Samples of these were sent to the three supply depots, New York, St. Louis, and San Francisco, and all issues directed to be in conformity therewith. Forty boxes of these specially prepared dressings were put up at the temporary supply depot, Army Medical Museum, Washington, D. C., and sent to Tampa Fla., for the use of the army about to sail for Cuba.

To provide temporarily for volunteer regiments organized and ordered to camps before the new medical and surgical chests were ready for issue, supplies of medicines, instruments, hospital stores, stationery, and miscellaneous articles, according to a prescribed list and packed in convenient boxes, were prepared at time supply depots.

An important article to be provided was the first-aid packet, containing antiseptic dressings for immediate use in emergencies and intended to be carried by each individual soldier. These were promptly and liberally supplied.

Whenever notice was received from the Adjutant-General*s Office that commands were 'to be moved or camps formed, I endeavored to anticipate the wants of the troops by telegraphing the officer in charge of the nearest supply depot to forward supplies for the stated number of men according to the field supply table.

Requests from medical officers for supplies and orders based thereon transmitted to the supply depots were largely by telegraph, and orders were given that when the supplies were needed promptly they should be forwarded by express to their destination. When a medical officer desired to purchase medical and other supplies for use in emergencies authority to do so was always granted.

Extensive purchases of medical supplies were made direct from this office from dealers in Washington, Baltimore, and Philadelphia to provide for the immediate wants of the troops at Camp Alger, Va., and the general hospitals at Fort Myer, Va., Washington Barracks, D. C., and Fort Monroe, Va. This was done not only to meet with promptness the urgent needs of troops and hospitals in this vicinity but to relieve somewhat the great pressure upon time supply depot at New York.


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In addition to the field-supply table issued May 9, 1898, a revised edition of the Manual for the Medical Department was published. These, together with 2,400 copies of a revised edition of Lieutenant-Colonel Smart*s handbook for the Hospital Corps, were freely distributed throughout the Army, so that medical officers might become acquainted with the proper mode of obtaining supplies and their many other important duties.

It is impossible to give a full list of the medical supplies that were provided, no complete report of purchases having as yet been received from the field medical-supply depots, but the following will give an idea of the amounts of some of the principal articles:

First-aid packets        

number  

272,000

Hospital-corps pouches       

do 

5,797

Orderly pouches                       

do

509

Pocket cases 

do 

962

Surgeons* field cases 

do 

369

Field operating cases 

do 

328

Medical and surgical chests 

do 

1,204

Litters 

do 

2,259

Litter slings 

do 

7,600

Cots and bedsteads, with bedding 

do 

18,185

Blankets, gray 

do 

23,950

Field desks 

do 

440

Quinine pills 

do 

7,500,000

Chloroform and ether 

bottles  

13,220

Gauze, sublimated, 1-meter packages 

packages 

100, 625

Gauze bandages, 3 sizes 

number 

331,770

The medical supply depot in New York, Lieut. Col. J. M. Brown in charge, supplied the posts in New England, the Middle States, and along the Atlantic coast, including Florida, and the troops that have been sent to and are now serving in Cuba and Porto Rico. Ordinarily requisitions received from officers serving in the localities mentioned were acted on and sent by the next mail to the depot for issue, but as already stated the telegraph and express companies were brought into use where the necessity called for prompt action.

The pressure on this depot was at times extremely great in supplying the troops sent to Cuba and Porto Rico and the large camps at Falls Church, Va.; Middletown, Pa.; Hempstead and Montauk Point, N. Y., and Jacksonville, Fernandina, and Miami, Fla.

On account of the urgency attending, the establishment of Camp Wikoff the officer in charge of the New York supply depot was directed to honor all requisitions made by the chief surgeon at Montauk Point without referring them for approval of this office.

The medical supply depot at St. Louis, Mo., under the charge of Col. J. P. Wright, assistant surgeon-general, United States Army, supplied the States of the Mississippi Valley and region east of the Rocky Mountains, including Texas. The large camp at Chickamauga was supplied entirely from this depot, together with the camps formed at Knoxville, Tenn.; Lexington, Ky.; Anniston, Huntsville, and Mobile, Ala., and New Orleans, La. Many articles were sent from this depot to the supply officer at San Francisco, Cal., for the use of the Philippine expeditions. To provide for the large aggregation of troops at Camp George H. Thomas, Chickamauga, Ga., a subdepot, drawing its supplies from St. Louis, was organized and put under the charge of Maj. E. T. Comegys, surgeon, United States Army. This subdepot was discontinued on the departure of the troops from Camp Thomas. Owing to the distance of the camps at Lexington, Knoxville, Huntsville, and Anniston from this city the chief surgeons of these several


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camps were authorized to draw upon the depot at St. Louis for any articles on the supply table without submitting requisitions in advance to this office.

The officers in charge of the depots at New York arid St. Louis were directed, July 8, to keep in stock 1,000 iron beds or cots, with a full supply of bedding, ready for immediate issue.

The responsibility of supplying the posts on the Pacific coast and of outfitting the troops leaving for time Philippine Islands was placed upon Lieut. Col. J. V. D. Middleton, deputy surgeon-general, United States Army, in charge of the supply depot at San Francisco, Cal. As much delay and expense of transportation would have been incurred by sending supplies from Eastern depots to San Francisco, Colonel Middleton was authorized to purchase at discretion all necessary medicines, hospital stores, instruments, and miscellaneous supplies of every kind needed for the troops going to Manila. Articles of special manufacture, such as medical and surgical chests, litters, and litter slings, hospital-corps and orderly pouches, and the specially prepared field dressings already referred to, were shipped to San Francisco from St. Louis, not being obtainable on the Pacific coast. The distance of San Francisco from the center of the Government was so considerable that the officer in charge of that depot was necessarily given large discretion in the purchase of supplies and expenditure of funds. Lieutenant-Colonel Middleton deserves great credit for the efficient service rendered by him both as medical supply officer and as chief surgeon of the Department of California.

RAILROAD AMBULANCE TRAIN

A railroad ambulance train was, in my opinion, essential to the well-being of the sick and wounded during transportation from Tampa, Fla., the probable base of operations against Cuba, to general hospitals in the interior. Accordingly, on May 30, 1898, I recommended the equipment of a train to consist of ten tourist sleepers and a dining car. This was approved, and on June 16 I was informed that a train of ten Pullman sleepers, a dining car, a private car, and a combination car was ready for service. The train was inspected by Maj. Charles Richard, surgeon, United States Army, who was placed in command. One assistant surgeon, 2 stewards, 20 privates of the Hospital Corps, and 3 civilian employees were assigned to him for service. The train was amply provided with all the medicines, hospital stores, and comforts required for the patients to be transported. The first trip made was from Washington, D. C., to Tampa, Fla., for the purpose of transporting sick from the latter place to the general hospital, Fort McPherson, Ga. Tampa was reached June 19, and Fort McPherson June 22. Here the Pullman cars were exchanged for the tourist sleepers originally requested. The latter were much better adapted for hospital purposes on account of their general arrangement, better ventilation, and convenience for cleanliness and the handling of patients. They had 134 lower and 136 upper berths, giving a total carrying capacity of 270. It was impracticable, however, to use the upper berths for severe cases, on account of the impossibility of giving proper care and attention to such patients occupying them.

Several trips were made between Tampa and Atlanta, on each of which great delay, involving inconvenience and anxiety to all concerned, and discomfort and even harm to the sick, was occasioned by


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the difficulty of obtaining a prompt response from local quartermasters to requisitions for the necessary transportation. On one occasion, after a delay of twenty-four hours, telegraphic communication with Washington had to be established before a movement was made. However, on July 4, Capt. H. R. Stiles, assistant surgeon, United States Army, on duty with the train, was appointed an acting assistant quartermaster, with authority to issue transportation requests. Major Richard reported of this:

Not only has this change given me more time to attend to the more important functions of my charge and has avoided many vexatious delays, but it has enabled me to come in direct communication with the railroads and a better understanding is reached regarding speed. routes and care of train en route, all of which factors should be considered in a service which has for its object the comfortable and rapid transportation of the sick and wounded.

On July 9 the hospital train met the transport Cherokee at Port Tampa, Fla., on her return from Santiago with 323 sick and wounded removed 87 that same night to the hospital on Tampa Heights, and on the following day left for Atlanta with 235 patients. This number, together with the Hospital Corps detachment and civilians, taxed the capacity of the train to its utmost, especially in time way of serving meals, but all wants were fully supplied. During this trip, while the engine was taking on water, the hospital train was struck in the rear by a passenger train. A caboose on the rear of the train was completely shattered; the private car used by the medical officers was so badly injured as to necessitate its abandonment, and many of the platforms were splintered, while the sick and wounded were severely shaken up by the collision, but fortunately no serious casualty resulted.

During the latter part of July excessive heat and dust rendered a trip from Tampa to Newport, Ky., extremely trying to the sick, and largely contributed to the fatal ending of two cases en route. A large proportion of the total number of cases transported were of typhoid fever, usually in the first week of the disease. Under certain circumstances the loading of the train at night was necessary, and in one instance loading was completed during a severe rain storm. Up to August 31 the hospital train had run about 17,500 miles and transported 1,935 patients with only four deaths.

Notwithstanding the large number of typhoid cases transported and the difficulty of handling such cases on this train, disinfection was so efficiently carried out that no case of this disease occurred among the personnel of the train. The utmost care was given to the disinfection of excreta to prevent any danger of the dissemination of the disease during the transportation of the sick.

HOSPITAL SHIPS

The hospital ship Relief - On April 15, 1898, I applied for a ship to be used as a hospital ship. After an inspection had been made of various ships offered I recommended, April 23, the purchase of the steamship John Englis as well adapted for the purpose in view-a floating hospital for the care of the sick and wounded at any point on the Cuban coast, for their transportation to any point on our own coast, and to act at the same time as a depot of reserve medical supplies for troops in the field. This recommendation was not approved at the time, and various other ships were inspected, but none found to be suitable. On May 18, by direction of the President, the John Englis was purchased, and the Quartermaster*s Department took


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charge of her to prepare her for the special service required. Maj. George H. Torney, surgeon, United States Army, was directed to make recommendations with reference to necessary alterations and apparatus, and was subsequently placed in command of the ship. The necessary work upon the vessel required much more time than was anticipated.

On June 12 I wrote to Major Torney:

The hospital ship will be required at the earliest possible moment to go to Santiago, where you are likely to have plenty of sick and wounded men awaiting your arrival. I trust that you will do everything in your power to have the ship ready for orders at the earliest possible moment. Be sure to get everything on board as soon as possible, for when you get your orders we want no delay on the ground that certain articles for which requisition has been made are not yet on board ship.

Again, on June 22, I wrote:

You will do everything in your power to expedite the work upon the hospital ship Relief, and when she is ready for sea report to me by telegraph. Upon receiving telegraphic orders to that effect you will proceed directly to Santiago de Cuba, reporting your arrival to the commanding general at that point. Your ship should be anchored in a safe harbor at such point as may be designated by the proper authorities, and as near as possible to the seat of active operations. You will receive on board up to the full capacity of the ship the sick and wounded of the Army and Navy and care for them exactly as if they were in a general hospital. The Relief is regarded as a United States general hospital, and you will be expected to make such reports and returns as are required by regulations for a general hospital. Your attention is especially invited to Army Regulations, 1433, and should anyone attempt to exercise unauthorized authority over you or your ship you will invite their attention to this regulation. When in your judgment or that of the commanding general or the chief surgeon of the troops at whatever point you may be located it is desirable that you should proceed to a home port for the purpose of landing the sick and wounded, you will, if practicable, communicate with me by telegraph, and orders will be sent you designating the port for which you should sail. If it is not practicable to communicate with me by telegraph you should apply to the commanding general of the troops for orders to proceed to such home port as may seem desirable, and immediately upon your arrival you should communicate with me by telegraph in order that arrangements may be made to transfer the sick and wounded to a general hospital. You will issue medical supplies upon properly approved requisitions to troops in the field, and will do everything in your power to aid the medical officers with these troops in providing for the comfort of the sick by the issue of ice, hospital stores, and such delicacies as you may have at your disposal. When practicable, you will send to me once a week a telegraphic report showing the number of patients of the Army and of the Navy on board the hospital ship. You should make timely requisition for necessary supplies for use on the ship and for issue to the troops in the field.

Further instructions were sent June 27:

You should keep in view the fact that the Relief is a well-equipped floating hospital and a depot of supplies for troops in the field. It is important, therefore, that she should not be taken away from the scene of active operations unless it is absolutely necessary for the purpose of landing the sick and wounded at a home port. You should avail yourself of every opportunity to send proper cases by the navy ambulance ship, the Solace, or by army transports returning to home ports. As a rule, the more serious cases of injury and sickness should be retained on your ship, as the disturbance incident to a sea voyage would be injurious to them. Convalescents and those sick and wounded who can be transported without injury to themselves, and who are not likely to be fit for duty within a short time, should be sent to a home port whenever an opportunity offers.

The Relief sailed from New York July 2 and arrived at Siboney on the 7th. She left Siboney July 19 with 254 sick and wounded and arrived at New York on the 23d. She sailed for Ponce, Porto Rico, August 3, and returned to New York on the 19th with 255 sick and wounded. The vessel made another trip to Ponce, Porto Rico, returning


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with sick, September 6, to Philadelphia, whence she went to Montauk Point to transport sick to hospitals in Boston, Mass., and Philadelphia, Pa. Another trip to Porto Rico was then made, the vessel returning October 11 to Fort Monroe, Va.

The hospital ship Missouri.-On July 1, 1898, Mr. B. N. Baker, president of the Atlantic Transport Line, Baltimore, Md., tendered the steamship Missouri, with her captain and crew, to the Government as a hospital ship. This generous and patriotic offer was accepted by the Secretary of War, and Maj. W. H. Arthur, surgeon, United States Volunteers (assistant surgeon, United States Army), was ordered to take charge of her preparation for service and subsequently to command her. It was recognized that considerable refitting would be required before the vessel could be utilized. Ten days or two weeks was the period estimated as needful to permit of making the necessary alterations and providing the vessel with a steam laundry, steam sterilizing apparatus, and ice and carbonating plants, but it was not until August 23 that the ship was reported ready to sail, and even then a good deal of work had to be done on board during a stormy passage to Santiago. She returned from Cuba with 256 sick men, who were landed at Montauk Point. Her second voyage was to Porto Rico, whence she brought 270 patients to the Josiah Simpson Hospital, Fort Monroe, Va., on October 6.

The hospital ship Olivette.-This vessel was a steamship which had been doing service as a water boat for the fleet of transports when Lieutenant-Colonel Pope, chief surgeon of the Fifth Army Corps, selected her for use as a hospital ship during the voyage from Tampa, Fla., to Santiago, Cuba. The equipment of one of the field division hospitals of the corps was used in outfitting her for this work. On the arrival of the fleet at Daiquiri she relieved the transports of their sick, many of whom were later transferred to the steamer Iroquois, so that room was made on the improvised hospital boat for the wounded expected from the impending battle. The Olivette answered her extemporized purpose excellently. She left Santiago July 9 with 279 wounded officers and men and reached New York on the 16th. She returned to Santiago with medical supplies for the troops, and on August 15 sailed with 203 sick men, who were distributed in Boston city hospitals. The Olivette sailed August 25 from Boston under orders to Fernandina, Fla., for the purpose of bringing sick to the general hospital at Fort Monroe, Va. On August 31, while coaling in stormy weather off quarantine at Fernandina, she listed heavily, filled with water, and sank in 20 feet of water. No loss of life occurred.

THE HEALTH OF THE TROOPS

Promptly following the declaration of war, arrangements were made by the War Department to recruit the Regular Army to its war strength, and to muster in the volunteer troops called out by the proclamations of the President. The Regular Army at that time consisted of well-developed men, sound in physique, and well drilled and disciplined. In its ranks were only about 40 boys under 21 years of age enlisted as musicians; but when recruiting was begun the minimum age for enlistment in the regulars was reduced to 18 years, and boys of this age were accepted for the volunteers. In my opinion, this reduction of the age limit had a notable influence in increasing the prevalence of disease among the troops. All military experience shows that young men under 21 years break down readily under the


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strain of war service; and every regiment had many of these youths in its ranks.

I am of the opinion, also, that the haste with which the volunteer regiments were organized and mustered into the service was responsible for much of the sickness which was reported in the early days of their camp life. Medical examiners were appointed to testify to the physical qualifications of each man before acceptance, but, notwithstanding this, which at the time was characterized in the press as a very rigorous procedure, so many men were afterwards found on the sick lists of the camps unfit for service, from causes existing prior to enlistment, that special arrangements had to be made for their discharge.

Soon after the newly raised levies were aggregated in large camps sickness began to increase progressively from causes that were so general in their operation that scarcely a regiment escaped from their harmful influence. These causes may all be referred to ignorance on the part of officers of the elementary principles of camp sanitation, and of their duties and responsibilities as regards the welfare of the enlisted men in their commands. Officers who were responsible for the clothing and equipment of their men, for their shelter, drill, discipline, and personal cleanliness-in fact, for their comfort, well-being, and sound physical condition-were to a large extent ignorant of how to act in order to sustain their responsibilities, and others were even ignorant that these responsibilities rested on them. Medical officers, as a rule, were also without experience in the sanitation of camps and the prevention of disease among troops. The few who knew what should be done were insufficient to control the sanitary situation in the large aggregations of men hastily gathered together. As a result officers and men appear to me to have regarded the deplorably insanitary conditions under which they lived in their camps of organization as the inevitable conditions of camp life preparatory for field service, and to have accepted them without question until general attention was attracted to them by an outbreak of typhoid fever. Officers and men in these camps were rife for war, and drill, parades, practice marches, and military-camp duties occupied the whole of their time and energies. Considerations of domestic economy and sanitation in the companies and regiments were not given proper consideration, and men who were being taught to meet the enemy in battle succumbed to the hardships and insanitary conditions of life in their camps of instruction.

The sites of certain of the camps have been instanced in the newspapers as the cause of the sickness that was developed in them. It is true that in some localities the sinks could not be made of the proper depth on account of underlying rock; in others a substratum of impermeable clay, and in others again a high level of the subsoil water interfered with a satisfactory condition of the sinks. At Miami, Fla., the water supply was generally regarded as not good, and at Camp Merritt, Cal., the climatic conditions were such as to lead to its speedy abandonment. But these were local conditions, while the sickness which invaded the camps was general in its onset. A review of the whole situation shows that it was not the site but the manner of its occupation which must be held responsible for time general spread of disease among the troops.

The primary evil was overcrowding of the site. The aggregation of the troops was effected hastily. On his arrival at Camp Alger the medical officer assigned to duty as chief surgeon found a number of


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regiments already in camp; "troops were arriving with every train, generally without previous announcement, and these camped where they saw fit." As a general hygienic, as well as a military principle, troops in the field should encamp in rear of their color line. The area occupied as a camping ground should be as wide as the color line is long. This gives wide streets, ample space for the separation of tents, and a front which affords room for the needful sink accommodation. But no principle of this kind was manifest in the regimental camps of the newly organized commands. On the contrary, the idea seemed to prevail that the troops should be compacted as much as possible. Both at Alger and Chickamauga the companies of a regiment were crowded on an area insufficient for those of a battalion, and brigades were packed together with scarcely any interval between the regiments. Lieutenant-Colonel Smart, in his inspection of Camp Alger, found company streets hardly wider than the intervals between adjacent companies should have been, and tents of the same company in contact with each other on the sides and in contact on the ends with those of the adjoining company, so that the double row of tents between the narrow company streets made a continuous canvas covering 70 to 80 feet long and 16 feet wide, under which 100 men had to find shelter. Even when space was allowed between the tents of the same and adjacent companies, it was wholly insufficient for proper trenching, ventilation, and passageway. With streets reduced in some instances to a width of only 13 feet, the natural surface of the ground with its matting of grass roots is speedily eroded and the camp surface converted into a layer of dust or mud, according to the character of the weather. This constitutes a serious evil, but the great sanitary objection to crowding the area in this way is that the slops and garbage of the kitchens and the excreta of the sinks are too near to the quarters of the men. Fecal odors were perceptible in many of the camp streets; and of certain regimental camps it is reported that their odors were in themselves a veritable nuisance. The contracted front of the camp gave no room for a sink of the proper size for each company. A battalion of troops had to use a sink insufficient to accommodate a company. It was impossible to keep these pits in good condition when used by so many men. Covering the excreta at regulation intervals was unsatisfactory, as fresh deposits were made while the police party was at work. Efforts were made to remedy this by requiring the individual men to cover the deposits as soon as made. There was no room for the only efficient remedy, a sufficient number of properly constructed and well-cared-for sinks, 150 yards in front of the color line, or at a corresponding distance on the flanks of the camp. These small sinks had the further disadvantage that they were filled up almost as soon as dug and had to be replaced by freshly dug pits, so that in a short time the whole of the contracted front of the camp was converted into sink surfaces. On April 25, 1898, foreseeing the likelihood of insanitary conditions in the camps of our newly raised troops, and with the view of preventing them, I issued Circular No. 1 from this office impressing upon medical officers their responsibility in sanitary matters, and the necessity for a strict sanitary police, particularly in the care of the sinks and in the preservation of the camp area from contamination. But the density of the military population on the area of these contracted camps prevented the possibility of a good sanitary condition. Camps of this character may be occupied for a week or two at a time without serious results, as in the case of national guardsmen out for ten days* field practice during the


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summer, but their continued occupation will inevitably result in time breaking down of the command by diarrhea, dysentery, and typhoid fever.

Not only was the area crowded by the tentage, but the individual tents were overcrowded. Four to seven men were crowded into the small, wedge-wall tent which covers an area of only 7 by 8 feet. Some company or regimental commanders encouraged their men to build sleeping bunks, or rather low platforms, for the area under canvas would not permit of a separate bunk for each man; others directed the men to carpet the floor of their tents with pine twigs or a layer of bark. Others again had straw littered on the floor; but most of the commands lay for weeks upon the ground, their blankets soiled and matted with dust, and their clothes, even to their change of underclothing, soiled and dusty, for it was impossible to preserve anything clean under such primitive camp conditions. Facilities for bathing were rarely found in time camps, and laundry and lavatory facilities were not always readily available.

These troops were subjected to most of the discomforts, hardships, and climatic exposures inevitable to an active campaign, while nominally enjoying the comforts of a fixed camp of instruction. Only on active service in front of an enemy should it be allowable to have men sleep on the ground for weeks at a time, under insufficient shelters, and with inadequate facilities for personal cleanliness. On active service many of the unsanitary features of their surroundings would have been removed. While campaigning they would have changed camp sites from time to time and would have been freed from the harmful influence of accumulated filth, while opportunities for bathing would have been presented occasionally in passing or camping near streams. The only explanation that can be given is that the officers, military and medical, having no experience of military life in the field, assumed that the deplorable condition in which they were living was the usual mode of life of soldiers situated as they were, and that their duty as true soldiers was to endure, not only without complaint, but with a certain pride, the hardships of their camp life.

Practically nothing was done to make the men comfortable or to remedy the insanitary conditions until these were brought to the attention of the Secretary of War by inspectors sent out by special orders from the War Department. Then the camps held for so long were abandoned, but not before the manifestations of typhoid infection were rife in them, new sites were carefully selected, regimental camps were expanded, company tentage increased, and board flooring provided. Then, for the first time, the troops went into camps suitable for the occasion.

An increased prevalence of diarrheal diseases was the first manifestation of danger in the early camps. Much of this was no doubt due to chill to the surface in cooling off after the perspirations attending drills in hot weather, much to sameness of diet and bad cookery, much to over-indulgence in fruit of doubtful quality, pies, etc., purchased from peddlers of food and soft drinks who were established in business in or around most of the camps, and much to similar indiscretions following the arrival of boxes of dainties from friends at home. Chill to the surface was aggravated by the ignorance or recklessness of the men, few of whom appreciated its danger. The sameness of diet led to criticism of a ration which is not only more liberal than that of any foreign military service, but more liberal than that


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which sustained the volunteers of the civil war during their arduous campaigns. Regimental commissaries and company commanders require experience which few of our volunteer officers possessed. The annual outings of the National Guard, with a caterer to provide special diet for the men, gave no opportunity for line officers to learn how to use a fixed ration to the best advantage or to exercise time needful supervision over cooks of doubtful qualifications. But notwithstanding the disadvantages arising from this ignorance, medical officers generally report that so-called delicacies purchased by individuals or sent by sympathizing friends was the cause of more sickness than the sameness of the Government*s ration aggravated by bad camp cookery. It is hardly needful to cite reports to sustain these statements. Many medical officers noted each of these causes and cautioned commanding officers against them. Testimony of a similar kind comes from Porto Rico and the Philippines. General Brooke attributed the diarrheal troubles which affected his command to the excessive indulgence of the men in the fruits of the island, and the chief surgeon of the Department of the Pacific, in referring to the prevalence of diarrhea and dysentery, attributes these diseases to the difficulty experienced in restraining the men from eating and drinking unwholesome articles.

One prominent cause of the increase of sickness in the early camps has been commented upon by only a few of our medical officers. These cite the prevalence of drunkenness and of venereal disease due to the facilities and temptations afforded by the proximity of cities to the large camps. They hold that if the systems of the men had not been weakened by dissipation they would not have succumbed so readily to the other influences which affected them.

Malarial fevers added to the sick lists of camps in Florida, and of southern regiments in the camps in Georgia and Virginia.

It was, however; typhoid fever which broke down the strength of the commands generally, the outbreak becoming distinctly manifest in July. Sporadic cases appeared in most of the regiments in May and June, these cases having been brought, in many instances, from the State camps. In fact some regiments, as the Fifteenth Minnesota, suffered more from this disease at their State rendezvous than any of the regiments in the large Federal camps. A few of the regimental commands in the latter may be said to have escaped visitation. The sanitary conditions affecting the commands in the various camps have been studied in connection with the prevalence of typhoid fever among the men by a board of medical officers consisting of Majors Reed, Vaughan, and Shakespeare, but the results of the investigations of this board have not as yet been reported in full. It appears to me, however, from a general review of the sanitary reports already filed, that the prevalence of the disease was proportioned to the insanitary camp conditions which I have described above. My circular No. 1, already cited, was intended to bring the danger from this fever to the notice of medical officers with the view of obviating it. The probability of its communication to soldiers in camp through the agency of flies was pointed out as a reason for insisting on a sanitary police of time strictest character. At the time of the outbreak and rapid spread of the disease all the camps were suffering from what many reports characterized as the "plague of flies." Clouds of these insects swarmed about fecal matter and filth of all kinds deposited on the ground or in cesspools or sinks, and conveyed foul and infectious matter thence to the food exposed while in preparation in the company kitchens or while being served to the men.


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It is well known to the medical profession that this fever is propagated by a contaminated water supply, and it is now recognized that the great prevalence of this disease in an aggravated form in the camps of the civil war was due to the use of surface and shallow well waters infected by typhoid excreta. To prevent transmission by the water supply I recommended the use of boiled and filtered water when a pure spring supply could not be obtained, and to enable an efficient filtration of suspected waters to be made field filters of approved construction were issued on my recommendation by the Quartermaster*s Department. Circular No. 4, of May 31, 1898, was issued from my office that medical and company officers might have a thorough understanding of the intention and action of these filters and that the full benefit of their use might be secured to the troops.

Chief surgeons were instructed to forward samples of water to this office for analysis whenever a doubt existed as to its quality, and the water supply of several of the camps was thereafter kept under analytical observation. This care exercised in the exclusion of typhoid infection from the water did much to retard the epidemic progress of the disease. Regiments camped near each other and using water from the same sources were not equally affected, thus showing that the cause was disseminated in other ways than by the water supply. The disease was slow in its development at Jacksonville, Fla., which had a water supply from artesian wells. But the infection once introduced into a camp, from State rendezvous or by sporadic infection from the neighborhood, began slowly to spread on account of the close contact of the men through overcrowding and the bad condition of the sinks.

Undoubtedly the very dust of the camp site became a medium for the transmission of the disease from the drying up of deposits of filth on the neighboring surface, and from the breaking up of the dried soil over disused sinks. At Tampa, Fla., many of the sinks were shallow, and heavy rains flushed their contents over the surface of the ground to become afterwards dried and pulverized; and at Jacksonville, where barrels were used instead of privy pits, it is reported that there was much carelessness in the handling of the tubs, and that during their transportation through the camps the contents were frequently spilled. Troops camped on the leeward side of the line of transportation suffered heavily from typhoid fever.

The prevalence of typhoid fever was lessened in some instances by leaving the infected locality, and exercising greater care in the arrangement and sanitary administration of the new camps. This was illustrated by the record of the Second Army Corps after its removal from Camp Alger, Va., to Camp Meade, Pa.

The infection was carried by the Fifth Army Corps from Tampa to Santiago where, under the unfavorable conditions affecting the troops in the trenches, its rapid spread, together with the occurrence of yellow fever and the general prevalence of malignant malarial fevers, occasioned the utter breakdown of the health of that command. The infection was carried also to Porto Rico, but its spread, so far as I can learn from the reports that have been rendered, has not been as rapid as in the home camps, probably on account of the movement of the troops from place to place in the advance from Guanica.

The disease prevailed to a considerable extent among the regiments aggregated at Camps Merriam and Merritt, San Francisco, Cal., for embarkation to the Philippine Islands, but according to the latest advices from the chief surgeon at Manila it has not reappeared to any extent in the command there. This is probably to be attributed to


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the use of distilled water during the long voyage and the flushing of the latrines on board ship by a constant stream of sea water. All men notably sick were left behind at the division hospital at the Presidio; and it must be assumed that the cases embarked in the incubatory stage were prevented from infecting the command by virtue of the excellent sink arrangements. Only 14 deaths from typhoid fever were reported from the expeditionary force of 18,000 men from May 25, when the first vessels sailed, to August 31, the date of the last report received.

THE CARE OF THE SICK AND WOUNDED

Each regiment of the Volunteer Army was authorized by law to have 1 surgeon, 2 assistant surgeons, and 3 hospital stewards. Inasmuch as at the time of its muster into the service of the United States it was of necessity a separate organization, the sick had to be cared for by the regimental medical staff, assisted, in the absence of hospital corps men other than the stewards, by enlisted men of the line detailed by the regimental commander for duty as hospital attendants: Each regiment of the Regular Army had one or more medical officers, and its quota of hospital corps men detached from the military stations at which the companies of the regiment had been stationed prior to the outbreak of the war; and each had an ample provision of medical supplies derived from the same sources. Some of the regiments of the Volunteer Army were provided by State authorities with more or less of the equipment needful to establish a regimental hospital, but the majority had little or nothing in the way of medical supplies. I have already stated (p. -) the measures adopted by me to supply the necessities of these regiments.

As soon as the regiments were organized into brigades and divisions, preparatory to active service, it became the duty of each chief surgeon of an army corps to see that the medical department of his command was organized to meet the casualties of battle. The object of the concentration of the troops was to accustom the regiments to operations in which they constituted the units of a higher organization. The experience of the civil war demonstrated that for efficient service in an active campaign the medical department also required a higher organization. Circular No. 3, from this office, dated May 18, 1898, in specifying the duties of the various medical officers in an army corps, indicated the character of the organization to be adopted. The seriously sick were to be treated in division field hospitals (unless their transfer to a general hospital was advisable) under the care of the most experienced physicians and able surgeons on duty with each division. Medical officers left on duty with their regiments were to exercise sanitary supervision over the well men and to determine whether a soldier reporting himself sick should be sent to hospital or remain as a trivial case under treatment in quarters. This consolidation of the medical force by divisions, implying as it did the breaking up of the regimental hospitals, met with a strong opposition from regimental medical officers, particularly from those who were not detailed for special service at the division hospitals. Regimental commanders were also, in many instances, opposed to it, forgetful that the object of the medical department, as of the line, was to get into training for field service. Similar objections were raised in 1862 and 1863 to the establishment of field hospitals and the practical disestablishment of the regimental institutions, but the civil war lasted long enough to demonstrate the efficiency of the system.


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The Fifth Army Corps-The organization of the division hospitals of the Fifth Army Corps was begun May 3 at Tampa, Fla. Long before the corps embarked for Cuba its field hospitals were in condition for efficient service, and although its ambulance companies were not filled up to their intended strength nor fully equipped with ambulances, wagons, horses, and harness, such sections of them as had their equipment completed were well drilled in hospital corps work and ready for active service. Each hospital had about eight 6-mule wagons to haul its tentage and supplies. The equipment of the Second Division hospital was completed at an early date. It contained 85 cots, with a sufficiency of furniture and necessary fixtures, and as the demand for extra accommodations increased, the capacity of the hospital was augmented to 150 beds. The operating tent was provided with enameled-steel folding operating tables, steam sterilizers and water heaters, bath tubs, and other necessary appliances. The hospitals of the First and Third divisions and of the cavalry division were similarly outfitted. In addition to these hospitals certain medical supplies, with 1 acting steward, 1 private, 1 hospital and 1 common tent, 1 ambulance wagon, and the necessary animals fully equipped were retained as a minimum allowance with each regiment. (General Orders, No. 14, headquarters Fifth Army Corps, June 6, 1898.)

Subsequent events, however, rendered valueless these preparations of the medical department for active service in Cuba. When the command embarked on the transport vessels, the baggage wagons and mules were left behind "and were never seen again by the medical department of the Fifth Army Corps." The ambulance trains of all the divisions, with a large part of the outfit of each of the hospitals were also left behind. Three ambulance wagons were taken apart and stored on one of the vessels. These did excellent service at San Juan and El Caney and showed how efficient the ambulance companies would have been had they not been deprived of their equipment. Ten of the ambulances of the third or reserve divisional hospital were subsequently shipped to Cuba, where they arrived July 2, and were of value in moving the sick and wounded to the hospital at Siboney and to the hospital ships and transports. The ambulance service of the division hospitals of this command was thus practically destroyed by these failures to embark or disembark its wagons, harness, horses, and mules. Part of the tentage and property of the hospitals was left at Tampa with the sick left there. Of the property and supplies carried to Cuba, a portion was not available for service at the time it was most needed, to wit, on July 1, 2, and 3, when the wounded from El Caney and San Juan were coming from the front for care and treatment. This was because, in general, no opportunity was afforded to land the medical property, because there was no transportation on shore for such articles as might be landed, and because the masters of transports took their vessels out to sea after the debarkation of the troops because of their fear of wreck by collision with each other or by drifting on the rocks. Earnest efforts were made by medical officers to have supplies at the front with the troops. Some having succeeded in getting their medicine chests and other articles of medical property ashore had these carried forward on litters by hospital corps men to the camps near Sevilla, while others turned their private mounts into pack horses for this purpose. A reserve supply of medicines shipped on the Seguranca from the purveying depot at Tampa was landed June 27. These, issued to regimental medical officers, materially relieved the stress caused by the failure to land their regimental medicine chests.


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The tents and property of the First Division hospital were landed by the efforts of the hospital corps men, under the direction of Maj. M. W. Wood, surgeon, United States Army. The hospital outfit was carried to the front by hand and on litters used as handbarrows by the nurses and attendants.

The second field hospital landed was that of the cavalry division under Major McCreery, but the transport put to sea before the whole of the property was removed front her. This, with the immediate incoming of the wounded from the fight at Guasimas, led Major Havard, the chief surgeon of the division, to look for assistance from the Red Cross Society. Assistance was freely given then and afterwards, but a misunderstanding, the particulars of which have been specially reported by Major Havard, gave origin to many press accounts of the refusal of Red Cross assistance by medical officers. Both Major Havard and Lieutenant-Colonel Pope, the chief surgeon of the Fifth Army Corps, have testified to the value of the field supplies received from the State of Texas, the Red Cross supply ship, and to the earnest and untiring work of Miss Barton and her assistants in caring for the wounded.

The Third Division hospital, which was landed front the Saratoga, after many delays, afterwards became the base hospital at Siboney. To this were sent all the medical supplies recovered from the transports or landed from the hospital ship Relief. The fourth divisional hospital of the corps was retained on the steamer Olivette, which was thus extemporized into a hospital ship. The tents and camp outfit of this hospital were landed for service at Siboney. During and after the battles at El Caney and San Juan there was an insufficiency of tents, cots, bedding, and medicines, due to the causes already stated, but all the hospitals were well equipped for surgical work.

Early in time second week of July a few cases of yellow fever appeared among persons who had occupied the huts at Siboney, and day by day thereafter a steady and rapid increase of the disease was observed. This necessitated the establishment of a yellow-fever hospital and of a detention hospital in which cases of a suspicious character coming from the camps were held pending a decision as to their nature. The want of shelter was seriously felt at these hospitals, and was, under time circumstances, corrected but slowly when tents could be spared from the base hospital at Siboney, and from the first divisional hospital as its wounded were removed for transportation from Cuba.

After the capitulation of Santiago the troops at the front broke down rapidly under the fatigues they had undergone and the malarial influences to which they were exposed. Remittent and typhoid cases became exceedingly common.

By this time an ample supply of tents, furniture, bedding, clothing, and medical stores had reached Siboney, together with a corps of trained nurses and a force of surgeons, those sent to duty at the yellow-fever hospital being immune to that disease. Meanwhile, to relieve the pressure on the field hospitals, such convalescents and sick as could bear the journey home were sent to the United States on transport vessels.

This was an emergency measure to relieve the hospitals at Siboney and permit of the transfer to them of the men who were sick in regimental camps. It should have been carried out under the supervision of the military authorities at Santiago, who alone were cognizant of the necessity and of the means available for effecting the transfer. My circular of July 18, 1898, defining the duties of army medical


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officers, requires that the chief surgeon of a corps "should supervise the movement of sick and wounded to the base or general hospitals, providing transportation and detailing medical officers and attendants for their care." The lack of surgeons and nurses on these vessels was probably unavoidable, this lack, because of sickness and other causes, being one that pertained to all the hospitals of the corps at that time and to many regimental organizations also. Furthermore, the convalescents were supposed to be practically well men, and at least able to care for themselves, excepting during such illness as might break out during the voyage, and for this contingency provision supposed to be reasonable was made by the presence of one or more medical officers and the supply of some of the most necessary medical stores.

The transfer of troops from Santiago to Montauk Point, New York, was also an emergency measure, but it was conducted under proper supervision by the military authorities concerned. The great responsibility of excluding yellow-fever infection from every transport rested on the medical officers who had charge of the embarkation. Had they failed in this duty the effect would have been disastrous during the voyage to the men confined on shipboard, and the risk of importing the disease into this country would have been greatly increased. Fortunately the delicate task was accomplished without the occurrence of any such outbreak of disease among the troops as was anticipated by many medical men amid others who could appreciate the deadly character of the risks involved.

The sanitary conditions on board of most of these transports were fairly good. According to reports rendered by Maj. Walter P. McCaw, surgeon, United States Volunteers, who accompanied the Sixth and Thirteenth United States Infantry on the Vigilancia, the ventilation of the sleeping quarters of the men was satisfactory-plenty of deck room was available and the berths below were not overcrowded. The ship*s officers and crew were attentive to the wants of the command, aiding the men in the preparation of their meals and in making them comfortable in their quarters. The water supply was plentiful and good. The weather was excellent during the short voyage, and the health and spirits of time men improved every day.

In view of the necessity for the return of the troops of the Fifth Army Corps from Santiago, Cuba, preparations were made for encamping them at Montauk Point, Long Island. These included the establishment of temporary tent hospitals, not only for the treatment of the large number of sick brought by each command from Cuba, but for the isolation amid treatment of those from transports lying under the suspicion of yellow-fever infection.

The detention hospital received its first eases on August 15. At that time it consisted of separately pitched hospital tents, but as the cases received from the transports increased in number, framed and floored tent pavilions were erected, consisting of six tents pitched end on to each other, with a fly inserted in the middle length of the pavilion to promote ventilation. On August 31 fourteen of these pavilion wards were in use, with 40 tents pitched singly for convalescents. At this time there were 15 medical men on duty at the hospital. At first the corps of nurses comprised only 41 members of the hospital Corps and 4 volunteer Red Cross nurses. Policing was done by hired laborers. A temporary detail of men from the Two hundred and third New York was obtained to increase the hospital force until the arrival of trained female nurses. Sixty of these were employed at the hospital. The patients were provided with cots, bed linen, and


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blankets, and the limit of 5 patients to each tent was seldom exceeded. This hospital had about 500 beds. Civilian cooks were employed. Milk and eggs were always plentiful for special diet. Medicines were drawn from the Montauk Point hospital, which was but a few hundred yards distant. The difficulties in the way of administering the affairs of this establishment were very great, owing to the rapidity with which the transports followed each other in their arrival. As many as four reached the Point on some days from August 13 to 31, most of them bringing sick requiring detention for medical observation. The obviously temporary nature of the establishment prevented efforts to provide it with fixtures or furniture when the purpose could be effected by extemporizations. Thus, in the tents used as offices, dispensary, and storehouses, empty packing boxes were utilized as desks, washstands, etc. This no doubt created an impression of discomfort and privation in the minds of superficial observers, but the sick men were as well cared for and as comfortable in their cots here as afterwards when transferred to the general hospital at Montauk Point. There was an excellent steam disinfecting plant on the grounds, with a formaldehyde chamber attached. The laundry work was done at a steam laundry near the hospital.

The temporary tent hospital, which was locally known as the general hospital, Montauk Point, consisted of eighteen pavilions similar to those of the detention hospital. A central corridor running east and west had nine of these pavilions opening on it on each side. An annex had speedily to be constructed to accommodate the large number of sick arriving on the transports, transferred from the detention hospital, or received from the regimental camps of the Fifth Army Corps. This annex consisted of fourteen tent pavilions, arranged seven on each side of a central corridor. Other pavilions were added in parallel rows as an extension of the accommodations became necessary. Tent pavilions were used as dining rooms, but frame buildings were erected for use as kitchens. The capacity of this hospital was 1,600 beds. Its personnel consisted of 40 medical men, 3 stewards, 10 acting stewards, 120 privates of the Hospital Corps, 15 cooks, 50 male nurses, and an average of about 200 female nurses, one-half of whom were Sisters of Charity. Supplies of all kinds were amply provided on timely requisitions. Emergency calls were met by direct purchase in New York City. Large supplies of milk, eggs, chickens, canned articles, and other material for special diets were always on hand. Provision for special diet was made not only by the hospital, but by the Massachusetts Volunteer Aid Association, the Red Cross Society, and the Women*s War Relief Association. Cooks and helpers were kept on duty night and day to meet emergencies in special cases.

In one or two instances inquiry has been made as to the treatment of the body in the case of soldiers who died at these or other military hospitals. As a rule, immediately after death the body was washed, the jaws bandaged, and the rectum closed. When cold the body was dressed in uniform and placed in a coffin. If the relatives of the dead soldier desired his body to be sent home for burial an undertaker removed it to his establishment, where he embalmed it and expressed it to its destination in a hermetically sealed zinc-lined coffin. If no communication was received from the relatives it was buried in a suitable place twenty-four hours or more after death unless hot weather rendered an earlier burial necessary. The grave was properly marked for identification.

The Medical Department has been criticised adversely for granting furloughs to go to their homes from this camp and its hospitals to


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men who, it is claimed, were obviously unfit to travel, and cases were cited in the newspapers to sustain this criticism-cases of men who had fainted by the way and had to be cared for by the Red Cross agents or sympathizing strangers. To correct this abuse and prevent a recurrence of such cases it was not the carelessness or recklessness of the army doctors which had to be restrained, but their sympathy with the patient and with the desire of the patient*s friends to be intrusted with his care in view of a speedier recovery in time atmosphere of home. As a matter of fact, the officers charged with time duty of furloughing the sick men were kindly and sympathetic, and such mistakes as were made were attributable to the great pressure brought to bear on this side of their nature.

It is needless to refer at thus time to the complaints of starvation which appeared almost daily in the newspapers during the occupation of Camp Wikoff, for it is now generally understood that the weakness, prostration, anaemia, and emaciation of so many of the troops were the results of malarial, typhoid, and yellow fever, from which time army suffered as a consequence of its exposure to the climatic influences and local infections of Santiago and its neighborhood pending and subsequent to the surrender of the city.

The Medical Department has been criticised also for moving typhoid cases from the camp to hospitals in various cities, with the attending risk of propagating this dangerous disease not only in these cities, but throughout the country while en route to them. The movement was made to have these cases of prolonged duration carefully sheltered before the oncoming of the chilly and stormy weather which is usually expected on that coast about the equinoctial period, but as it was effected by steamship the spread of the disease by cases en route was prevented, and as the city hospitals to which the sick men were transferred had all the needful facilities for disposing of infected material without danger to the community, it is seen that there was no basis for the criticisms cited.

Troops in the home camps-The regiments composing the other corps of the Army were camped at first in State camps and afterwards aggregated in camps of organization and instruction. The First and Third Corps were organized at Camp George H. Thomas, Chickamauga Park, Ga.; the Second at Camp Russell A. Alger, near Falls Church, Va.; the Fourth at Mobile, Ala., and Fernandina, Fla.; the Seventh at Jacksonville, Miami, and Panama Park, Fla., and the Eighth near San Francisco, Cal., preliminary to its embarkment for Manila.

The method of hospital organization in all these camps was practically the same, and there was much similarity in the conditions affecting them, and correspondingly in their history. Regiments reported, as already stated, provided in but few instances with time material and supplies for their medical care, and in no instance with that liberality which by consolidation or concentration of regimental supplies would permit of the formation of a well-equipped hospital for a division. But they brought sick men with them, and these required immediate care. Provision had to be made for division hospitals in view of future field service, and for regimental hospitals in view of the immediate necessity. The difficulties in the way of the contemporaneous accomplishment of these two objects were great and they were greatly augmented by some of the very men who should have aided in overcoming them. The inexperience of a majority of the regimental medical officers and of many of the chief surgeons prevented them


Hospital Interior, Third Division, First Army Corps, Camp Hamilton, Lexington, Kentucky.


Interior of Hospital Ward, Camp George H. Thomas, Chickamauga Park, Georgia.


121

from seeing beyond the immediate necessity. The sick had to be cared for, and to this end medicines and other things had to be procured. Relief societies offered assistance, and this was eagerly accepted by many of these medical officers, not alone for delicacies or luxuries not otherwise provided for, but for supply table articles which could have been had from the medical purveyors in their camps or by telegraphic requisition on the Surgeon-General. It was easier to accept what was so freely offered than to learn how to obtain the articles from the proper source. The aid given by the relief societies did harm indirectly by demonstrating this fact. To explain their prompt acceptance of this assistance these officers referred to the red tape of the War Department methods, and the insinuation that the said methods were beyond the comprehension of the ordinary intellect was accepted by the sensational press as an explanation in full. In these early days of the camps the exuberance of the patriotic spirit of the people which led them to aid the sick soldiers did much good, but, as I have implied, it also did much harm.

Meanwhile chief surgeons of corps and divisions began the organization and equipment of their field division hospitals and ambulance companies, but they were met at the outset by the apparent impossibility of securing men for service as cooks, nurses, litter bearers, ambulance drivers, teamsters, etc. The Hospital Corps of the Regular Army could not supply these men, because recruiting for this corps progressed slowly. The popular tendency to volunteer led men away from the regular recruiting offices. In the regimental hospitals the sick were cared for by details from the companies, but when transfers from the volunteer regiments to the regular Hospital Corps were authorized (see p. 14) these men did not care to leave their local connections for service in the Army at large as regular soldiers. Concessions were made to them-among others, that when their former regiment became attached to another corps, camp, or duty they also would be detached to accompany it-but notwithstanding these the Hospital Corps was recruited so slowly that had the military necessity required one or more army corps to take the field their medical service could have been perfected only by drafting men from the incomplete hospital organizations of those corps that remained in the home camps of organization and instruction. It may be mentioned also as a well-recognized fact that the transfers so much desired by the Medical Department to enable it to complete its organization were not regarded favorably by line officers, for, although every line officer will probably acknowledge as a general principle that only the most intelligent and capable men should be employed to care for the sick and wounded, he is not likely to act on this general principle when it is a question of withdrawing for such service the most intelligent and capable men of his own company or regiment.

The division hospitals of the First and Third corps at Camp George H. Thomas, Chickamauga, Ga., and of the Second Corps at C1amp Russell A. Alger, Falls Church, Va., were usually established in the immediate neighborhood of the regimental camps of the divisions. They consisted of two or three hospital tents pitched end on to each other as pavilion wards, or of four or five tents, two or three end on to each other at each end of aim intervening fly, the latter inserted to break the continuity of the wall and thus to promote ventilation. The pavilions were arranged in various ways, according to the configuration of the area available as a site, but in general there was a tendency to crowd the area. In none of the camp hospitals were the


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pavilions separated from each other by a space equal to twice their width, a distance which is necessary to give restful quiet to the inmates, free ventilation and good policing, and to lessen the danger from fire. Surgeons in charge recognized that a tent should not be occupied by more than six patients, but sometimes this number was exceeded temporarily while waiting an increase of tentage. The intention of chief surgeons was to have each hospital equipped for 200 patients, but in some the number of beds had in July to be increased to 250. In some when first established there were not enough cots for all the patients, the convalescents or lighter cases sleeping on bed sacks on the ground, but this was promptly remedied when observed by chief surgeons or reported to them. As a rule the hospitals were kept in campaigning condition-that is, the tents were neither framed nor floored-until the increased prevalence of typhoid fever attracted attention to their crowded condition, when the object of their existence became suddenly changed from a school for field service to a hospital for the treatment of a local outbreak of disease. The pavilions and other tent shelters of the hospitals were usually well trenched and the camp surface well policed. A small pavilion did duty as an office and dispensary. A surgical ward was connected with an operating tent suitably fitted for antiseptic work. Bath tubs were provided to insure a cleanly condition of the patient before admission to the wards and for the subsequent treatment of cases requiring them. In most of time hospitals there was also a special ward for venereal cases, and isolation wards for cases of measles and mumps. Commodes and bedpans were used in the wards with disinfectants, and the preliminary reports of the medical board which investigated the propagation of typhoid fever in the camps show that the medical officers on duty in these hospitals realized the importance of the use of disinfectants in limiting the spread of the disease, but it was difficult for them to have efficient service in this regard with untrained hospital corps men and details from the line with even less experience. Sinks were dug for convalescents and attendants, but at first these were like those in the regimental camps, not far enough removed from the occupied tents and not eared for with that strict attention which their importance demanded. Special efforts were made in all the hospitals to have good cooks. Seldom, however, was there that knowledge on the part of the medical officers which enabled them to accumulate a hospital fund for the purchase of special articles of diet for the sick, but this did not operate to the detriment of the patients, as special-diet kitchens, under the management of capable individuals, were opened at most of the hospitals. Money for this purpose was sent to them by me from funds contributed and placed at my disposal. Money was also sent directly by individuals and by representatives of aid societies, and the Red Cross committees supplied quantities of ice and milk, chickens, eggs, lemons, etc. Pajamas, night shirts, and other articles of hospital clothing were also provided by the Red Cross and other aid societies. Subsequently the order authorizing time commutation of the sick soldiers* ration at 60 cents rendered these hospitals wholly independent of outside assistance.

In the Third Army Corps, particularly in the Second Division, many of the regiments continued to maintain regimental hospitals after the organization of the hospital for the division, because the epidemic of typhoid fever interfered with the progress of preparation for field service. As illustrating time condition of these field hospitals, it may


Trained Nurses of the Third Division Hospital, First Army Corps, Camp Hamilton, Lexington, Kentucky.


123

be stated that on July 27, 1898, the hospital of this division consisted of 37 hospital tents, 8 conical and 6 common tents, with 285 cots, 250 of which were occupied by patients, cared for by 8 medical officers, 6 stewards, and 138 privates, of whom 25 were detailed from the line of the Army. The hospital streets were broad and the general police excellent. The general wards were in good condition, but the typhoid fever wards were crowded. Assistance was given by the Red Cross, including milk, special articles of food, comforts, and ice.

The division hospitals of the Second Corps at Camp Alger were relieved by transfers to the general hospital at Fort Myer, Va. The overflow from the division hospitals of the First and Third corps was at first received at the Leiter Hospital, at Chickamauga Park, Ga., but as this proved insufficient, a large hospital was established in August to receive the rapidly increasing number of cases of sickness occurring in these corps. This hospital early in September was officially recognized as the Sternberg General Hospital. Its first report showed a capacity of 750 beds and a personnel of 15 medical men, 1 steward, 6 acting stewards, 107 privates of the hospital corps, and 167 female nurses. On the movement of the Third Division, First Army Corps, from Camp Thomas to Lexington, Ky., its sick and the equipment of its field hospital were left in situ, the establishment, then containing 500 beds, being known first as the Sanger and afterwards as the Alexander H. Hoff General Hospital. It was discontinued September 25, when its sick were in condition to be furloughed.

The division hospitals of the Seventh Army Corps, at Jacksonville and Miami, Fla., consisted of 6 tent pavilion wards of 5 tents each, with a fly between the second and third tents of each ward. The pavilions formed a semicircle of radii from a central point, at which was established the office, dispensary, etc., of the hospital. Two pavilions were to be regarded, under ordinary conditions, as the allowance of accommodation for each brigade; and the attempt was made to keep men of the same regiment together to satisfy the desire of the volunteer troops to preserve the regimental organization in the medical service of the corps. The prevalence of measles and mumps necessitated the pitching of extensive isolation wards in connection with the formally planned pavilions.

In August preparations were made at the First Division hospital at Jacksonville to give a better shelter than that afforded by the tents. The proposition to build frame pavilions, each for 60 beds, was approved, and building was begun under contract. Concerning the hospitals of this corps a board of medical officers convened by Special Order 194, Adjutant-General*s Office, August 1, 1898, reported favorably. The board considered the equipment ample as to tentage, cots, bedding, etc., and was well pleased with the care and treatment given to the patients. The cots and bedding were sent from the supply depot in New York City.

A rapid increase of sickness in time Second Division, at Miami, as compared with the First Division, at Jacksonville, led to a thorough investigation as to its causes. The tents were pitched a short distance from the town on a rough tract of ground of coralline formation. The troops were fairly well supplied with tentage and cooking utensils and the camp was well policed. Sinks were not generally used, as it was difficult to make them of the proper depth. Metallic troughs or latrines flushed into the ocean by a constant stream of water were used in time First Brigade, while the Second Brigade was


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provided with galvanized iron tubs, which were taken away twice daily to be emptied into the ocean. Garbage was collected and carried to the municipal dumping ground. Water was delivered by pipe lines from the supply of the town. It was derived from a pond or lake in the everglades, and was reported as being warm and having a disagreeable taste and odor, on account of which the men used that from wells. These wells were regarded by many as contaminated with surface drainage. In fact, the opinion that the water supply was the cause of the prevailing sickness was generally entertained. Samples analyzed at the laboratory of this office gave results confirmatory of this opinion. The division hospital was established on a vacant lot in the center of the town, an unsuitable and insanitary location. On account of insufficient area, cases of measles, many of which were under treatment, could not be properly isolated. Sinks and garbage, emitting an offensive odor, surrounded the lot. The hospital was fairly well provided with tents, folding cots, medicines, and other needful supplies to care ordinarily for the sick of a division. Early in August the troops were moved to Camp Cuba Libre at Jacksonville, Fla.

The hospital of the Third Division was established at Panama Park, about 6 miles from Jacksonville.

In connection with the division hospitals of this corps a convalescent camp was established July 27 at Pablo Beach, 16 miles from Jacksonville, for the recuperation of men who had become debilitated through climatic influences.

The Fourth Army Corps.-A few regular and volunteer regiments concentrated at Mobile, Ala., formed the nucleus of the Fourth Army Corps and of the cavalry division. A division hospital of 200 beds was established here, but shortly afterwards the corps moved to Tampa and Fernandina, Fla. Tent hospitals were established and an excellent reserve ambulance company was manned and equipped for service with troops expected to operate in Cuba or Porto Rico. The sanitary conditions in the camps at Tampa were not good. Malarial fevers became prevalent and typhoid fever common. The division hospital had to be relieved by removing serious cases in the hospital train of the medical department (see page 106), to the general hospital at Fort McPherson, Ga. About August 1 an overflow hospital was organized in a school building at West Tampa.

The spread of disease among troops remaining in Tampa after the departure of the Porto Rican expedition led to the removal of many of the regiments to the neighborhood of Fernandina. The hospital of one division was pitched on the beach about 3 miles from Fernandina. A convent in the city was also used for hospital purposes.

About July 20 the troops for the invasion of Porto Rico embarked and sailed. The field-hospital accommodation with this expeditionary force was ample and the supplies abundant. The chief surgeon of the Fourth Corps urged the shipment of his reserve ambulance company with this expedition, but General Brooke considered this to be unnecessary.

A short time after the arrival of the troops at Ponce, malarial fevers appeared among them, and typhoid infection, brought from Chickamauga, Ga., and Tampa Fla., manifested its presence in the camps. Some of these cases were sent home on returning transports, but as the voyage was found to be very trying to severe cases of typhoid fever I telegraphed Colonel Greenleaf, chief surgeon, to establish a general hospital at Ponce for such cases. Tent wards were


Water filter and sterilizer at Third Division hospital, First Army Corps, Camp Hamilton, Lexington, Kentucky.


125

considered to be preferable to the use of any of the buildings in the city. Two hundred hospital tents were sent by the Concho on August 13, and furniture, supplies, medical officers, and nurses on the Relief, Obdam, and other vessels. Colonel Greenleaf was also well supplied with funds to provide everything necessary for the well-being of the sick. No special report of the conditions of this hospital has yet been received.

Troops on the Pacific coast.-The troops on the Pacific coast were concentrated mostly at San Francisco, Cal. Camp Merriam came first into existence on the Presidio reservation near the Lombard-street entrance. Nearly 10,000 men were encamped here, but when it was understood that the expeditionary force to the Philippines was to be increased to 20,000 men a new camp had to be established. The site selected was near the northern boundary of time Golden Gate Park, including the sand dunes in its vicinity. This was Camp Merritt, at which 18,000 thousand troops rendezvoused for shipment to Manila. Much sickness occurred among the regiments in this camp. Some of the commands brought with them the infection of measles, and this disease spread rapidly. The cases were in many instances complicated with bronchitis and pneumonia on account of exposure to the cold, raw winds which blew constantly over the site, a site selected without consultation with any representative of the Medical Department. Cases of typhoid fever also appeared, with a few eases of cerebrospinal meningitis.

Camp Merritt was therefore abandoned, and the troops of the independent division of the Eighth Army Corps were removed to the grounds of the military reservation at the Presidio.

Eighteen thousand of the troops from Camp Merriam and from Camp Merritt were dispatched to the Philippine Islands. They were carried on twenty transport steamers, the first expedition sailing on May 25. Each steamship, before being accepted by the Government, was inspected by a board of medical officers, and in each instance the vessel was thoroughly disinfected before the troops went on board. Two or three medical officers, as many hospital stewards, and ten to fifteen privates of the Hospital Corps, equipped for field service, were assigned to each ship. With each expedition was a large quantity of medical supplies to provide the troops for six months and to equip suitable hospitals at Manila. These supplies included medicines, surgical instruments, dressings, hospital furniture, beds amid bedding, and all the miscellaneous articles required for the proper treatment and care of the sick. Many articles believed to be necessary in the treatment of the diseases incident to time climate of the Philippine Islands were largely in excess of the allowances of the supply table. Large reserve supplies were sent on the Arizona and the Scandia, which sailed late in August, to replenish the stores already sent. An additional supply was also placed on both ships in case they should be required to make the return voyage in the capacity of hospital ships.

The precautions taken to secure a good sanitary condition of the vessels prior to embarkation and the sanitary supervision exercised over the men during their long voyage must be credited with time excellent condition in which the troops arrived at Manila, for if any notable sickness had occurred on these vessels its presence would certainly have been announced in the press dispatches. I have received but few reports, as yet, from medical officers who accompanied this expeditionary force, but those which have come to hand give a most gratifying view of the conditions affecting the men while on board the


126

transports. During the attack on the Spanish lines at Manila, August 13, the field hospitals were established at Camp Dewey, 4 miles from the scene of action. All the wounded, 45 in number, were in hospital and comfortably cared for by 7 p. m. of that day.

The service of the division field hospital, Presidio of San Francisco, Cal., began June 2, 1898, at Camp Merritt, with tents for 48 patients. At this time serious cases, mostly complications of measles, were treated in various civil hospitals in San Francisco. The site of this camp was, as stated above, unsuitable. Its surface was a cold, damp sand, continually exposed to chilly winds and heavy fogs, which saturated the tents, clothing, and bedding of the men with moisture. On July 21 the hospital was moved to the Presidio, where two large brick barrack buildings and a few hospital tents constituted the accommodations. The ventilation was poor; water had to be carried from the lavatory, and the sewerage system, if not faulty, was at least inconvenient for hospital purposes. All necessary supplies and furnishings were promptly furnished by the chief surgeon of the department. A separate special diet kitchen, which gave satisfaction, was maintained. After the departure of the last Philippine troops on the Scandia, August 26, the hospital force consisted of 5 hospital stewards, 7 acting stewards, 73 privates of the Hospital Corps, 33 female nurses, and 10 Sisters of Charity, the capacity of the hospital at the time being 320 beds.

The ladies of the Red Cross Society of San Francisco established a convalescent hospital of 25 beds in a sheltered place at the Presidio, to which patients were transferred from the division hospital to recuperate before going on furlough or being returned to duty. The chief surgeon of the department testifies to the value of the assistance given by these ladies, not only as regards this hospital, but in feeding troops on their arrival and departure, and in providing clothing and delicacies for the sick in the camps, hospitals, and transports.

To complete this general review of the camp hospitals a further reference is needful to the history of the regimental hospitals. At first when regimental commands ceased to be separate commands, in becoming the constituent units of brigades and divisions preparatory to operations against the enemy, the regimental hospitals were disestablished to consolidate the working force of the Medical Department and Hospital Corps into division hospitals and ambulance companies. The objects in view were, first, to complete the field organization of the department and, second, to instruct untrained officers and men in their respective duties, so that when field service was undertaken the Medical Department would be efficient in rear of a marching or fighting command.

The want of hospital corps men was the main cause of the failure of chief surgeons to accomplish their purpose promptly. Instead of organizing for field service their time was occupied and their energies spent in endeavoring to procure the necessary men by enlistment or transfer. Instead of instructing for field service they had to instruct untrained men in caring for the ordinary percentage of sick in a healthy command. But after a time, when sickness invaded the camps and the division hospitals became filled, preparations for field service had to give place to the immediate necessity of caring for the sick. The division hospitals became expanded, as at Siboney and Tampa, into base hospitals with increased needs and increased responsibilities. To these I sent with the utmost dispatch physicians and surgeons under contract, to relieve the strain on the medical officers attached to the troops, and trained nurses to relieve the details from


Camp of Hospital Corps-Hospital in background-Third Division, First Army Corps, Lexington, Kentucky.


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the regiments who were temporarily acting as hospital corps men. At Camp George H. Thomas, Chickamauga Park, Ga., the expansions of the division hospitals, under the conditions brought about by the typhoid invasion of the camps, became officially recognized as general hospitals and were promptly provided by me with the best available medical service, with trained nurses, with all permissible medical and hospital supplies, and with funds for special purchases.

The altered conditions under which the division hospitals were operating were immediately recognized by the chief surgeon of the Fifth Army Corps at Santiago on the breakdown of that corps after the surrender of the city, and the efforts of his medical officers to care for their sick locally were encouraged by giving them every available facility. The effect of this was seen in the camps at Montauk Point, Long Island, where regimental medical officers cared for many sick under hospital or line canvas, with details by regimental commanders as hospital attendants.

Similarly in other camps regimental hospitals were in many instances equipped to meet the necessities of the occasion. In view of the insidious progress of typhoid fever in infected individuals, febrile cases in the regimental camps required such close attention as could not be given when the men were scattered in quarters, and this called for hospital shelter and supplies. There were, therefore, in some of the camps regimental hospitals in which very serious cases were treated and in which deaths occurred, but these latter were few in number, as a transfer to the division hospitals was usually effected when the dangerous character of the disease became manifest.

The tabulation which I submit below does not include all the cases and deaths in the field hospitals, because medical officers have not in every instance rendered the required reports. The work, for instance, of the hospitals of the Second Army Corps is on this account not fully represented in the tabulation, and the reports for August from the command in the Philippine Islands have not been received. Were all the reports available that are due but not rendered the figures in this tabulation would be materially increased.

Besides this, the cases enumerated below do not represent all the men that were taken on sick report. They do not include the trivial cases that were treated in quarters, nor those cases of a serious character which were treated in regimental hospitals when the accommodations of the division hospitals were temporarily under strain. They do, however, include most of the cases that are tabulated (see p. 131) as admitted into general hospitals, for the majority of those admitted into the general hospitals passed through the division or other field hospitals en route.

Cases and deaths reported from field hospitals to September 30, 1898.

Army Corps

Location

Cases

Deaths

First

First Division, Chickamauga Park, Ga.

981

25

 

Second Division, Tampa, Chickamauga, and
    Knoxville

1,827

32

 

Third Division, Chickamauga Park and
    Lexington

998

35

 

First Brigade, First Division, San Juan Road,
    Porto Rico

267

6

Second

First Division, Camp Alger, Va.

893

6

 

Second Division, Camp Alger, Va., and
    Thoroughfare, Va.

353

2

 

Second Division, Camp Meade, Pa.

241

---

Third

First Division, Chickamauga Park, Ga., 
    and Anniston, Al.

1,818

32

 

Second Division, Chickamauga Park, Ga.

2,664

28

Fourth

First Division, near Mobile, Ala.

279

2

 

Second Division, Fernandina, Fla., and
    Huntsville, Ala.

646

12

 

Third Division, Fernandina, Fla.

226

2


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Cases and deaths reported from field hospitals to September 30, 1898-Continued

Army Corps

Location

Cases

Deaths

Fourth

Field hospitals, Tampa, Fla.

2,951

50

 

Reception Hospital, Picnic Island, Fla.

39

3

Fifth

Field hospitals, Tampa

91

1

 

Camp near Santiago, Cuba

890

116

 

Siboney, Cuba, reserve division hospital

2,682

111

 

Siboney, Cuba, yellow-fever hospital

549

46

 

Montauk Point, Long Island

5,034

126

Seventh

First Division, Miami and Jacksonville, Fla.

2,423

41

 

Second Division, Jacksonville, Fla.

2,013

58

 

Third Division, Panama Park, Fla.

636

10

Eighth

Division hospital

2,722

76

Separate Camps

Camp Bushnell, Columbus, Ohio

231

---

 

Camp Black, Long Island, N.Y.

163

---

 

St. Simons Island, Ga.

48

1

 

Target range, Waco, Ga.

458

---

 

Fernandina, Fla. (Colonel Coates)

122

---

 

Camp Hobson, Ga.

799

5

 

Total in field hospitals

33,044

826

 

GENERAL HOSPITALS

Up to September 30, 11 general hospitals were established and fully manned and equipped. These had a capacity of nearly 7,000 beds. At the same time certain post hospitals having good accommodations were used for the treatment of army cases generally, without alteration of their official status as post hospitals. Those, for instance, at Forts Columbus, Hamilton, and Wadsworth, N. Y., in the East, and at the Presidio of San Francisco, Cal., and Vancouver Barracks, Wash., on the Pacific coast, were expanded in this manner. The vacant beds in the hospitals of the Marine-Hospital Service of the Treasury Department were placed at my disposal and the civil hospitals of the country were ready on call to receive and care for sick and wounded soldiers. These offers of hospital accommodations and medical care were accepted by me in many instances, particularly in New York, Boston, Philadelphia, and Providence to relieve the tent hospitals at Montauk Point when crowded by the rapid transfer of sick from Santiago.

1. The Leiter General Hospital, Chickamauga, Ga.- The building occupied was a summer hotel converted to hospital uses. It is a modern and apparently well-constructed building, well furnished throughout, heated by steam, and lighted by electricity. It is situated in 5 acres of ornamental grounds near Crawfish Springs, on a railroad direct from Chattanooga to Camp George H. Thomas. It was estimated to accommodate 175 patients, but cots for 30 convalescents were placed in the verandas, and two wards of 16 tents in all, with an occupancy of 80, were established in the grounds-total capacity, 285 beds. The water supply is pumped from Crawfish Springs into a distributing tank. The personnel of this hospital consisted of 14 medical officers, 38 members of the Hospital Corps, and 34 female nurses. Its kitchens, including special diet, are reported as excellent. The hospital was established June 6, 1898.

2. General hospital, Key West, Fla.- On April 20, 1898, the convent and two school buildings and grounds of the Sisters of Mary Immaculate, Key West, Fla., were turned over by agreement to the Medical Department of the Army for use as a hospital during the war. Cots with bedding for 500 patients were immediately forwarded, and the surgeon in command was instructed to call for such supplies as were


The General Hospital, Fort Monroe, Virginia


Street View, U. S. General Hospital, Fort Monroe, Virginia


129

needful. The post hospital at Key West Barracks afforded many desirable facilities for the establishment of the general hospital at this place. Frame buildings were erected on time convent grounds for use as isolation wards, earth closets, etc. A pesthouse for the treatment of yellow fever and smallpox cases was established in connection with the general hospital. The personnel consisted of 7 medical officers, 34 members of the Hospital Corps, 9 contract nurses, 23 sisters of the convent, and 29 employees, cooks, laborers, teamsters, etc.

3. General hospital, Fort McPherson, Ga. - This hospital may be said to have been established May 14, 1898, when a train load of patients from Tampa, Fla., was received for treatment. Certain of the barrack buildings of the post were used in connection with the wards and offices of the post hospital. On June 20 the accommodations were extended by the use of 35 hospital tents, and shortly afterwards 100 more tents were pitched on frames and floors for use. The number of available beds for patients is 922. The general mess hall of the post is used as a dining hail for convalescents, hospital-corps men, trained nurses, and employees. There are also 4 special diet kitchens, which suffice for time needs of those seriously sick. The personnel consists of 14 medical officers, 3 stewards, 5 acting stewards, and 112 privates of the Hospital Corps, with 2 hospital matrons, 71 female nurses, and 92 other civilian employees, cooks, waiters, and laborers. The patients were mostly derived from the camps at Tampa, Fla., but one train load was received from Chickamauga, Ga., and two from Fernandina, Fla., with a number of cases from the large body of recruits (2,000 to 3,800 men) aggregated at the post.

4. The general hospital at Fort Monroe, Va. - Orders were issued June 26 for the establishment of this hospital in connection with the post hospital of the fort. One hundred hospital tents were furnished by the Quartermaster*s Department, cots and bedding for 500 patients by the Medical Department, and the surgeon in charge was directed to make requisition for other necessary supplies. The tents were pitched end on to each other in threes and fours, forming pavilion wards with streets between. They were raised from 1 to 2 feet above the surface of the ground, floored, framed, and raftered to give them stability, and connected with other parts of the hospital camp by a board walk. A frame building was erected for use as a kitchen and dining hall, the latter capable of seating 250 persons. Other buildings were constructed for use as water-closets and bath houses, the latter furnished with hot and cold water. Water from the post supply was conducted to all parts of the camp and a condensing plant provided a sufficient supply of distilled water for drinking. All sewage was delivered by sewers into the mains of the sewerage system of the post. This hospital was strengthened by the conveniences of the post hospital, including, besides its wards, an operating room, laboratory, dispensary, X-ray room, offices, special-diet kitchen, and storage rooms. The first patients were received July 13, 244 officers and men from the City of Washington, a transport from Santiago, Cuba. These were accommodated in the tent pavilions, but as the kitchen and mess hall building was yet unfinished, Buzzacott ovens under tent flies were used until July 18, when the hospital buildings were completed. This hospital received sick and wounded from the transports City of Washington, Breakwater, Solace, Hudson, Obdam, and Lampasas and from the camp at


130

Newport News, Va. The medical force attached to the hospital consisted of 15 officers, 2 stewards, 4 acting stewards, and 94 privates of the Hospital Corps, and 43 female and 11 male contract nurses.

5. General hospital at Fort Myer, Va. - On May 13, 1898, the Secretary of War approved my request to utilize time vacant barrack buildings of Fort Myer, Va., in connection with the post hospital at that place as a general hospital. The buildings were speedily fitted up and the hospital provided with all needful supplies. One building had to be erected as a deadhouse. The riding hall of the post was floored and converted into a ward for 175 patients. At each end of the riding hall, but detached from it, two water-closets were constructed for the disinfection and disposal of typhoid excreta. Water was brought into this hall, with two faucets at each end of the building, for use in filling tubs for baths. The hospital kitchens were supplemented by a Red Cross special-diet kitchen. The capacity of this hospital is 544. Most of the cases were derived from the Second Army Corps at Camp Alger, Va. The personnel consisted of 18 medical men, 2 stewards, 9 acting stewards, 67 privates of the hospital Corps, 49 female and 12 male contract nurses, and 28 laborers.

6. General hospital, Fort Thomas, Ky. - On April 27 I requested authority to make use of the vacant barrack buildings at Fort Thomas, Ky., as a general hospital. This was granted, and I immediately sent 200 beds and bedding with instructions to the surgeon in command to make use of the quartermaster*s bedsteads then in the barracks and to make requisition for the necessary personnel, and supplies for active service in his hospital. The proposed establishment was intended as a reserve hospital, and patients were not sent to it until July 7. The number of available beds was 416. Ten medical men were on duty at this hospital, 1 steward, 3 acting stewards, 67 privates of the hospital Corps, 33 female and 3 male contract nurses.

7. General hospital, Washington Barracks, D. C. - This hospital consisted of a tent hospital expansion of the hospital accommodations of the post. The tents were framed and floored; the boards of the flooring were waxed lightly before the cots were put in. Four medical officers were on duty at this hospital, with two stewards. No female nurses were employed, as the surgeon in command had a hospital-corps company of instruction to draw upon according to his needs.

8. The Josiah Simpson Hospital, Fort Monroe, La. - This is a frame pavilion hospital of 1,000 beds, arranged en echelon, on the plans which gave the best satisfaction during the civil war, with an administration building, quarters for medical officers, hospital-corps men, male and female nurses, etc., and buildings for kitchens, dining rooms, storerooms, laundry, chapel, crematory, workshops, etc., all connected by covered board walks and lighted by electricity. Authority for the building and equipping of this establishment was granted by the Secretary of War, on my application of July 12, 1898. It was opened for the reception of patients in September.

The Sternberg and Sanger general hospitals in Chickamauga Park, Ga., and the Ponce general hospital, Porto Rico, have already been briefly described.

The post hospitals, which did duty as general hospitals during the war period, were chiefly six, although many others cared occasionally for sick and wounded men not members of the local garrison. The hospital building at each of these posts is in excellent condition. It formed the administration building of the extended hospital and provided commodious wards for cases of grave sickness. Fifty or more


The Sternberg General Hospital, Chickamauga Park, Georgia


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tents with cots, bedding, etc., for 250 or more patients were sent to the surgeon in charge of each with orders to get in readiness for immediate service. These movements were instituted July 17-28. The tents were floored, framed, and pitched in pavilion wards, and prior to the reception of sick the personnel of the establishment was increased to meet the necessities of the case. At Fort Hamilton, for instance, there were assigned to duty 5 medical men under contract, 1 steward, 6 acting stewards, 24 hospital Corps privates, and 4 male and 15 female contract nurses. Details made by the commanding officer from the troops in garrison did the policing and other heavy work of the extemporized hospital.

The appended tabulation summarizes the cases and deaths reported to September 30, 1898, from the general hospitals and the post and civil hospitals.

Cases and deaths reported from general, post, and civil hospitals to September 30, 1898.

Hospital

Location

Cases

Deaths

General hospitals

Chickamauga, Ga. (Leiter General Hospital)

555

73

 

Key West, Fla.

547

6

 

McPherson, Fort, Ga.

1,342

63

 

Monroe, Fort, Va.

1,218

31

 

Myer, Fort, Va.

802

77

 

Thomas, Fort, Ky.

519

30

 

Washington Barracks, D.C.

733

5

 

   

Total

5,736

285

 

 

 

 

Post hospitals

Columbus, Fort, N.Y.

338

12

 

Hamilton, Fort, N.Y.

115

1

 

Presidio of San Francisco, Cal.

1,194

33

 

Vancouver Barracks, Wash.

314

1

 

Wadsworth, Fort, N.Y.

475

---

 

Honolulu, Hawaiian Islands

54

1

 

    

Total

2,490

48

 

 

 

 

Civil hospitals

Charleston, S.C., city hospital

118

8

 

Charleston, S.C., St. Francis Xavier Hospital

83

4

 

Key West, marine hospital, Fla.

5

---

 

Mobile, Ala., marine hospital

79

5

 

New York civil hospitals

1,084

19

 

Philadelphia civil hospitals

427

11

 

San Francisco, Cal., marine hospital

100

14

 

Stapleton, N.Y., marine hospital

106

---

 

   

Total

2,002

61

Aggregate

 

10,228

394

 

THE MEDICAL STATISTICS OF THE WAR

The work of gathering up the records of sickness of the various commands in service during the war has been one of great difficulty. Volunteer medical officers were ignorant of the methods of keeping their records, and many failed to appreciate the importance of what was frequently regarded as 'mere paper work," which had no practical bearing on the welfare of their men. Notwithstanding repeated calls from this office and from chief surgeons, many regimental surgeons failed to report concerning their commands, even up to the time when the order was issued for their muster out. War Department instructions to mustering officers have recently succeeded in bringing in many reports of sick and wounded that would otherwise have probably never been rendered.


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The work, however, of volunteer surgeons in this regard must be considered as satisfactory when compared with that of the volunteer medical officers of the war of the rebellion. In August, 1862, over tour months after the President's call for 75,000 volunteers and five weeks after his call for 500,000 men, the medical reports represented a strength of only 109,054, in September 162,217, and in October 252,037, whereas in May, 1898, while many of the 275,000 men authorized as the war strength of the country had not yet been enlisted, medical reports representing 151,685 men were rendered.

It is to be noted, also, that the reports sent in during the recent war give a complete record of the individual eases, whereas the reports galled for during the civil war were merely numerical, and specified the names of the affected soldiers only in the cases of death, discharge Cor disability, transfer to general hospital, etc. Thus, where a regimental surgeon of the civil war reported 15 cases of diarrhea, all ending in return to duty, the regimental surgeon of the present time reports of each case the name, rank, company, regiment, date of admission to sick report, complications, etc., and date of return to duty. Our present reports are therefore of much greater value for Pension Office purposes than were those of the civil war.

The following tabulations compiled from reports received up to October 25, 1898, are submitted to show the incidence of sickness and mortality on the troops during the five months, May 1 to September 30, 1898. The first presents the absolute number of admissions and deaths from typhoid fever, malarial fevers, diarrheal diseases, and from all causes, during each of the months, while the second gives the ratios per thousand calculated from these numbers.

Our medical officers have reported in full concerning 1,715 deaths,* of which number 640 were occasioned by typhoid fever, 97 by malarial fevers, and 39 by diarrhea and dysentery. The fact that the mean strength for September is only 130,763 shows that all the reports for that month have not as yet been received.

The table giving the ratios per thousand of strength enables comparisons to be made with facility. The death rates for May and June were not in excess of those of the Army in time of peace. In July the rate became somewhat higher than that of most well-cared-for cities, 2.15 for the month, or the equivalent of an annual rate of 25.80 per thousand living. In August it became excessive, 4.08 for the month, equal to an annual rate of 48.96 per thousand. In September the influence of the energetic measures taken in July and August to improve the health of the Army becomes manifest in the falling of the death rate to 2.45 or the equivalent of an annual rate of 29.40. The same progression to an acme in August, with a sudden fall in September is seen in the various ratios given under the specific titles typhoid fever, malarial fever, and diarrheal diseases. This is exceedingly gratifying, and must be credited, as stated, to the sanitary measures adopted, for our experience in the civil war demonstrates that in the absence of these measures the high ratio of August would have been continued for many months to come.

______

* Reports to the Adjutant-General to September 30, 1898, show 345 killed and died of wounds and 2,485 died of disease in a mean strength of 275,000 men.


Ward of the Josiah Simpson Hospital


133

Admission to sick report and deaths in the United States Army, May to September, 1898.
[Reported to October 25, 1898.]

Ratios per thousand of mean strength deduced from the numbers in the preceding tabulation.


I submit herewith for comparison with the statistics given above two tabulations from the records of the Medical and Surgical History of the War of the Rebellion. The first gives the absolute figures reported monthly by medical officers for the thirteen months, May, 1861, to May, 1862, inclusive; the second gives the ratios deduced from these numbers. Attention is invited, in the first place, to the relatively large number of admissions from all causes reported monthly during the civil war, and secondly to the high death rates. Even in May, June, and July, when the army consisted only of the 75,000 volunteers called out by the proclamation of April 15, 1861, the death rates were higher than during the first three months of our recent aggregation of more than three times as many raw troops. And these high death rates continued month after month, becoming higher as the new levies under the 500,000 call were gradually enrolled and became exposed to the insanitary conditions of the camps of that period. In November, 1861, the death rate was higher than that of the month of August last, which so alarmed the country and virtually broke up the army as a fighting machine. December, 1861, and January and February, 1862, had equally high death rates. Disease increased its ravages in March to 6.08, and in April, 1862, it reached its acme, with 3,331 deaths during the month out of a force of 395,703 men, or 8.42 deaths out of every thousand men, as compared with 4.08, the maximum monthly rate of the Spanish-American war.

Similar remarks might be made concerning the relative prevalence and mortality of typhoid and malarial fevers and diarrhea and dysentery, but what I have already said will suffice to direct attention to the points of interest in these tables.


134

Admissions to sick report and deaths in the United States Army, May, 1861, to May, 1861, inclusive.

 Ratios per thousand of mean strength deduced from the numbers in the preceding tabulation.

I submit also tables of absolute numbers and of ratios by which the incidence of sickness and mortality of the regular and volunteer troops may be contrasted. From these it will be seen that the exposures of the regular troops during the Santiago campaign gave them from June to September a higher death rate than the volunteers, and that the rate of the latter during August, the month of maximum mortality, was 3.62, as compared with 5.89 among the regular troops:


135

Admissions to sick report and deaths in the United States Army, May to September, 1898.
[Reported to October 25, 1898.]

Ratios per thousand of mean strength deduced from the numbers in the preceding tabulation.

VOLUNTEER RELIEF WORK

My attitude toward relief organizations is shown by an indorsement. dated May 5 upon a letter addressed by Rev. Henry C. McCook, of Philadelphia, to the President and referred to me for remark:

MAY 5, 1898

Respectfully returned to the Adjutant-General of the Army.

The plan proposed for the organization of a relief association appears to have been well considered, and the object in view will commend itself to every patriotic citizen. But it is a question whether the President should give special. privileges to any particular organization. Other prominent individuals in different parts of the country may be organizing for the same purpose. One such proposition has come to me from Chicago. While I approve in a general way of organization for the relief work proposed, it appears to me that it will be best not to give in advance-exclusive privileges to any one particular organization. In case of need assistance should be accepted from any organization prepared to give it.


136

This has been my guiding principle throughout, that relief when needed should be promptly accepted without reference to the source from which it comes. The relief afforded by the National Red Cross at Siboney was promptly accepted by the surgeons on the spot, but it is evident that it was entirely inadequate to meet the emergency. 

A committee of the American National Red Cross Association called upon me in my office in Washington some time in advance of the landing of our troops in Santiago, making an offer of assistance. I received them most courteously and advised them to use their resources in fitting up a hospital ship, telling them that a hospital ship was now being fitted up for the use of the Medical Department, but that it was not at all improbable that an emergency would arise which would overtax our resources, and that in such an event a hospital ship properly equipped, having on board a corps of doctors and nurses, would be a most valuable auxiliary.

The American National Red Cross Association has had full authority to send agents and supplies to all our camps since June 9, 1898.

The following letter was sent by me to every chief surgeon of a department or independent army in the field on June 9, 1898:

The Secretary of War has approved of the following proposition made by the American National Red Cross Association, and the chief surgeons of army corps and divisions will cooperate with the authorized agents of this association for the purpose indicated.

"We can put any desired amount of hospital supplies-ice, malted milk, condensed milk, Mellin's food, etc.-into any of the volunteer camps in a few hours. Will you be kind enough to bring this letter to the attention of Secretary Alger and ask him if there is any objection to our appointing a Red Cross representative to report to the commanding officer and the chief surgeons in every camp, confer with them as to their immediate needs, and, if anything of any kind is wanting, open there a Red Cross station and send in the supplies. We can do this, not in a few weeks or a few days, but in a few hours, and can furnish any quantity of any desired luxury or delicacy for hospital use. We hereby tender our aid and put our organization at the War Department's service for cooperation in this field."

In accordance with their promise the American National Red Cross Association has had agents in all of our principal camps and has contributed supplies of various kinds in a most liberal manner for the use of our field hospitals. The value of the assistance rendered by them has been highly appreciated by medical officers generally. Other organizations which have rendered very valuable services are the National Relief Commission, having its headquarters in Philadelphia, and the Massachusetts Volunteer Aid Association, with headquarters in Boston. Both of these organizations fitted out hospital ships, which were placed at my service for the transportation of our sick from Porto Rico, and I take pleasure in testifying to the valuable services rendered by the yacht May, of the National Relief Commission, and the hospital ship Bay State, of the Massachusetts Volunteer Aid Association.

SPECIAL FUND

Sums of money, varying from 33 cents, sent by Master Oliver S. Whitaker, of Detroit, Mich., to $5,000, by Mr. Cleveland H. Dodge, chairman of the supply committee, National Red Cross Society, have been sent to me to be used according to my discretion for the benefit of our sick and wounded soldiers. In all, I have received $24,244.94. The largest contributors have been: The Colonial Dames of America, through the treasurer, Miss E. B. Nicholas, of Washington, D. C., $3,500. The Red Cross Society, through Mr. Cleveland H. Dodge, 


137

chairman supply committee, $5,000. The Red Cross Auxiliary, No. 3, through Mrs. Winthrop Cowdin, of New York, $2,000. The Women's War Relief Association, through Mrs. Victoria Raymond, treasurer (contributed for hospital ship Relief), $2,275. The Colonial Dames of New York State, through Mrs. Mary J. Chauncey, secretary, $500. The War Emergency Relief Board, Cleveland, Ohio, through Mrs. K. V. Painter, $600. The Blue Anchor Society of New York, through Miss Alice Sandford, $250. The Rhode Island Sanitary Relief Association, of Newport, $500. The Society of "Spinners," through Mrs. Harriet T. Thorne, Bridgeport, Conn., $300. The Women's Aid Society, of Rhode Island, through Mrs. Wm. M. Greene, $600. The Brooklawn Country Club, through Mr. Charles Sherwood, of Bridgeport, Conn., $110.50. The ladies of Jersey City, through Mrs. James H. Noe, $600. Mrs. Jonathan Thorne, of Bridgeport, Conn., $300. The General Council of Colonial Wars, of Philadelphia, $1,200. The Daughters of the Revolution, of Wheeling, W. Va., through Mrs. R.M. Baird, $60. The Martha Washington Chapter, Daughters of the American Revolution, New York City, $335. The Spanish and Portuguese Congregation and Sisterhood of Shearitch Israel of New York City, through Mr. Albert J. Elias, $494. Women's Relief Corps, Yankton, S. Dak., through Mrs. S. Nevada Hereford, $50. The Ohio National Women's Relief Corps, through Mrs. I. T. Bagley, of Zanesville, $700. Mrs. Robert Patterson, Chicago, Ill., $100. Mrs. Courtland Hoppin, Pomfret Center, Conn., $125. Dr. Annie H. Pierce, Perry, N. Y., $125. Sale of bale of cotton at New York, Boston, Chicago, St. Louis, and Kansas City, $2,261. W. J. A. Bliss, Lynton, England, $100. Mr. I. I. Bargen, Mountain Lake, Minn., $76.14. Mrs. Kate A. Wolf, Bordentown, N. J., $60. Mrs. Paula Bronson, Summit, N. J., $76.41. Mrs. Imogene Granbery, Lotus Lodge, Essex County, N. Y., $100. Miss Louise Hoppin, $380.


This money has been sent by me principally to general hospitals, to chief surgeons of army corps in the field; and to commanding officers of hospital ships, for use in the purchase of delicacies for the sick.

 THE MEDICAL CORPS

Before concluding my report of the operations of the Medical Department during our short and glorious war with Spain I feel it my duty to call special attention to the efficient services rendered by the medical officers of the Army in the various responsible positions which the exigencies of tile service have made it necessary for them to fill. The inadequacy in the number of trained and experienced medical officers has been very evident and has been a source of great embarrassment to me in my efforts to meet the demands of the service; but, as a rule, our medical officers have performed the duties imposed upon them in a most loyal, intelligent, and zealous manner. They have shared with line officers the dangers of battle, and they have encountered with unflinching courage the more difficult and protracted combat with the infectious diseases which have invaded our camps and filled our hospitals. Many of them have suffered attacks of typhoid and malarial fevers, and at one time no less than 15 per cent of the corps was disabled by sickness. Of those who accompanied General Shafter's army to Santiago very few escaped serious sickness, and two of those who distinguished themselves for devotion to duty lost their lives as a result of exposure to the malign 


138

influences which in so short a time sapped the vitality of the flower of the American army, during the operations in the vicinity of Santiago. But credit is due not alone to those in the field. The labors of those on duty as chief surgeons of military departments and in charge of medical-supply depots have been enormously increased and it has required unremitting effort to meet the exigencies of the war. One officer, Lieut. Col J. V. D. Middleton, deputy surgeon-general, has been called upon to do the double duty of chief surgeon of the Department of California and medical-supply officer at San Francisco. He has had the responsible duty of supplying the troops going to Manila, and has acquitted himself to my entire satisfaction as was to have been expected of an officer of his intelligence and experience.

Col. Charles H. Alden, assistant surgeon-general, has been next to me in responsibility, as he is in rank in the Medical Department. During the five years that he has been my principal assistant he has distinguished himself by his indefatigable industry, familiarity with all that pertains to the administration of the Medical Department, and conscientious devotion to duty. During the greater part of the war, as previously, he has had general. charge of two of the most important divisions in my office-that pertaining to the purchase and issue of supplies and the hospital corps division.

The sanitary division has for many years been under the charge of Lieut. Col. Charles Smart, deputy surgeon-general, who is a recognized authority upon hygiene, sanitary chemistry, and army sanitary statistics. I can not speak too highly of his zealous and intelligent performance of the responsible duties connected with this branch of the medical service. But in addition to this he has acted as a disbursing officer, as a sanitary inspector on several occasions, and has been charged with various other important duties.

Col. Joseph P. Wright has been in charge of the medical-supply depot in St. Louis, and Lieut. Col. J. M. Brown, deputy surgeon-general, of that in New York. The demands upon these supply depots have called for the most unremitting labor, and the results accomplished under the most difficult conditions entitle these officers to special commendation.

The medical officers selected to take charge of our general hospitals and hospital ships have all distinguished themselves by their intelligent devotion to their responsible duties.

The duties imposed upon Maj. Charles Richard, who has had charge of the hospital train, have been especially important and arduous, and have been performed in a manner most creditable to him and to the medical corps. Although nearly 3,000 cases have been taken by this train from field hospitals in the camps to our general hospitals, not a word of complaint from any source has reached me with reference to this transportation service.

The chief surgeon of the army in the field, Col. Charles R. Greenleaf, assistant surgeon-general, United States Army, and the chief surgeons of the several army corps have been unremitting in their efforts to organize an efficient medical department for active military operations; but, as was to have been expected, this proved to be a task requiring both time and patience. The result has, however, been all that could have reasonably been expected when the difficulties encountered are taken fully into consideration. The amount of sickness from diseases classed by sanitarians as "preventable" has been excessive, but the conditions which have led to the wide prevalence of these diseases in our camps of instruction have been to a large extent beyond the control of the Medical Department, which has, nev-


139

ertheless, heroically and successfully met the difficult task of caring for a large number of seriously sick soldiers in field hospitals. The care of the sick in the field and in hospital and the administration of medical affairs in our camps has been to a large extent in the hands of the enlarged Medical Department, resulting from the organization of a volunteer army. Many of the division and brigade surgeons appointed by the President upon my recommendation and a considerable proportion of the regimental surgeons have proved themselves to be well qualified for the important duties devolving upon them, and after a few months' experience in camp have acquired a satisfactory knowledge of matters pertaining to army administration, camp sanitation, etc., which for a medical officer are quite as important as his professional qualifications.

Before closing this report I desire to call attention to the patriotic devotion to duty of the clerical force of the Surgeon-General's Office, and especially to the efficient services rendered by Mr. George A. Jones, chief clerk, and other clerks in charge of the principal divisions in my office. The enormous increase in the amount of work to be done as a result of the war, amid the want of experience on the part of clerks temporarily employed to meet the emergency, has made it necessary for a considerable number of our most experienced clerks to remain at their desks until long after office hours, and often to return to their work in the evening. This they have done cheerfully and without complaint, and as a result the work of my office has not at any time fallen behind to any considerable extent.

RECOMMENDATIONS

The increase of the enlisted strength of the Army to a total of 60,000, and the large number of new stations to be garrisoned in the islands acquired and occupied by the United States, makes an increase in the Medical Corps absolutely essential. I therefore recommend an addition to the number of medical officers now allowed by law of 2 assistant surgeons-general with the rank of colonel, 6 deputy surgeons-general with the rank of lieutenant-colonel, 30 surgeons with the rank of major, and 50 assistant surgeons with the rank of first lieutenant.

This recommendation is based upon the present organization of the Army. Any increase made by Congress during the coming session will necessitate a further increase of the Medical Corps.