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Report of Operations of the Medical Department at Santiago, Cuba, and in Porto Rico

Spanish - American War

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REPORT OF OPERATIONS OF THE MEDICAL DEPARTMENT AT SANTIAGO, CUBA, AND IN PORTO RICO,

BY COL. CHARLES R. GREENLEAF, CHIEF SURGEON ARMY IN THE FIELD

Dated August 24, 1898

Leaving Charleston, S. C., on the 8th of July, 1898, by the U. S. S. Yale, we found on board the Sixth Massachusetts Volunteers and one company of the Sixth Illinois, with General Garretson's brigade headquarters, these troops having previously been at Camp Alger. During the voyage to Cuba a number of cases of typhoid fever developed. They were as well taken care of as circumstances would permit, under the direction of Maj. George W. Crile, brigade surgeon of volunteers. 

Arriving at Siboney, Cuba, twenty cases were sent during my absence from the ship, by order of Captain Wise, of the Navy, and transferred to the steamship Seneca, to be sent north. 

It was at once reported to me that yellow fever had made its appearance among the troops in Cuba, and I proceeded to the shore to investigate the matter. I found that immediately upon landing the troops had occupied all the houses in the little town of Siboney, and along the line of march into the island had also occupied blockhouses or native huts without taking any measures for their disinfection or fumigation; they had also been brought in contact with refugees from Santiago. 

Prior to leaving the United States I had drawn up very carefully, after consultation with Dr. Guiteras, the yellow-fever expert, and others, a system of preventive measures to be put in force as soon as the troops should land; this was 


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communicated to the chief surgeon of the Fifth Corps. Having been informed by the officers of the Jaragua Iron Company, located at Siboney and Daiquiri, that the buildings occupied by their operatives had during each year been inhabited by persons with yellow fever, explicit directions were given to destroy by fire immediately after landing every building at this place and on the line of march of the troops. These directions were, at my suggestion, telegraphed from Washington by General Miles to the commanding general of the Fifth Army Corps. A small yellow-fever hospital and a camp of detention close to the borders of the town had been established before our arrival, but the large number of nonimmunes continually coming into the town and entering these infected buildings was rapidly adding to the number of these infected cases. I therefore, by authority of the general commanding, proceeded to have every building in the town that had been occupied as habitations destroyed by fire, hoping that by this action the source of infection at this place would be removed and a sufficient surface of sterilized ground obtained for the location of a large camp of detention. It became apparent within a few days that the entire army had become infected, as the reports from medical officers showed that every organization furnished one or more cases. I accordingly recommended the immediate removal of such troops as could be moved without detriment to the military situation, and after the capitulation recommended the removal of the entire army from the trenches, either towards Santiago, making fresh camps every second day, or backward into the mountains, and in the event of failure to stamp out the disease by this method, to ship the army as rapidly as possible back to the United States. To all these recommendations General Miles gave his cordial assent, and promptly issued the necessary orders. 

I was much embarrassed in taking care of the sick by the lack of nurses and proper guards, and applied twice to the general commanding the Fifth Army Corps for troops to perform this duty, but he declined to furnish them; on my appeal to General Miles, however, he promptly ordered the whole of the Twenty-fourth Infantry to report to me for duty. This regiment made a night march, arriving at Siboney early the next morning; the necessity for aid was so urgent that I requested the commanding officer to call for volunteers from that regiment to serve in the yellow-fever hospitals; this request brought forth a prompt response, more than twice the number of men required volunteering for this perilous duty. I desire to bring to the notice of the General Commanding the Army the conduct of these men; the cheerfulness with which they did their duty under the most adverse circumstances, and the promptness with which they volunteered for any service with the sick deserves in my opinion a special commendation. 

The hospital accommodations at Siboney were very limited owing to a lack of tentage. The number of medical officers on duty with the sick was inadequate, and the quantity of medical supplies on shore was insufficient; the reasons for this were a depletion of the personnel for service with transports returning wounded to the States, and a lack of facility for unloading either the transports or the hospital ship Relief, on board of which ample supplies were stored; it was only after forcible removal of pontoons, upon my own responsibility, from a transport loaded with engineering material, that the supplies from the Relief were unloaded. 

Two immune medical officers were taken from the Relief for duty in the yellow-fever hospital, and all loose tentage that could be obtained was sent to increase its capacity. The peculiar conditions made it impossible to furnish such care and attention to the sick as we desired, but not in the history of any war did medical officers of the army labor with more zeal and more self-sacrifice than did the officers under my personal observation at Siboney and its vicinity. 

To Maj. Louis A. La Garde, surgeon, United States Volunteers, and Capt. M. W. Ireland, assistant surgeon, United States Army, too much praise can not be given for their untiring devotion in the arduous and trying duties that were imposed upon them, and if there is any promotion the Government can give them for their service I most cordially commend them for it. 

Leaving Siboney on the 18th of July we proceeded to Guantanamo Bay, the rendezvous for the Porto Rican expedition. At this place we found a detachment of doctors and female nurses on board the steamship Lampasas that had been sent to work with the Red Cross Association. As they could not go into Cuba or land from their own ship, I determined, to use them in the Porto Rican expedition, and subsequent events demonstrated the wisdom of this action, since the increase of typhoid-fever cases on board the steamship Yale was very large, requiring the transfer of some 80-odd to the ship on which these nurses were quartered, which I converted into a quasi-hospital ship, notifying the medical officers in charge of the various transports to send their sick to it, and with them descriptive lists, complete transfer lists, and sufficient quantities of medical supplies and rations 


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to last during the return voyage to the States; the only things, however, that the doctors furnished were the patients. When en route to Porto Rico two deaths occurred on the transports, the interments in each case being at sea. To avoid a repetition of the disregard of sanitary measures that occurred in the army in Cuba other and more explicit directions were recommended, which General Miles promulgated in orders.

Arriving at Guanica on the 25th of July, the town and harbor were occupied and the next morning a sharp engagement occurred, in which we had four men wounded. These were cared for at the brigade hospital. Their wounds were so slight that transfer to the Lampasas was not considered necessary. More transports arrived while we were at Guanica, each one bringing a large detachment of typhoid cases, which were transferred to the Lampasas. The health of the troops on shore while we were at Guanica was good, although some typhoid cases developed, but later, heavy rains occurring, a large sick report speedily resulted. 

Arriving at Ponce on the 28th July, I found a large and well-appointed military hospital on the outskirts of the town, containing 44 sick Spanish soldiers who had been abandoned by their army in its retreat. As they were without proper food medicines, or medical attendants General Miles instructed me to provide for them and I employed a Porto Rican physician for that purpose, who has done excellent service up to this time. The men as they recovered were paroled, and finally the few remaining were removed, leaving the large hospital free for our own sick. 

The appointment of Maj. J. McG. Woodbury, surgeon, United States Volunteers, was recommended as sanitary inspector, and instructions were given him to put the town of Ponce, which was in a filthy condition, into as clean a state as possible. He convened a meeting of the local physicians, organized a board of health, and caused a vigorous cleaning up of the streets and alleyways of the town. All buildings that were likely to be occupied by troops were cleaned, disinfected, and fumigated, and no one was permitted to enter them until a certificate from the sanitary inspector as to their cleanliness was given. Major Woodbury's report on this subject is herewith appended. Similar sanitary precautions were taken with the camps occupied by our men, and every effort was made to prevent the introduction of sickness. 

As soon as practicable after our arrival the sick on the steamers Obdam and Lampasas were sent north, with a sufficient number of medical officers and hospital attendants and such dressings and comforts as could be spared. Similar difficulties were encountered at this place in the unloading of medical supplies from the transports to those we met at Siboney, although in a minor degree; and the sick were subject to much discomfort from the lack of tentage, ambulance transportation, and medicines for several days until these could be gotten on shore. Instances occurred where the hospital supplies would be on one transport, the tents on another, and the medical officers on a third. 

The military hospital before referred to was in an exceedingly filthy condition, the privies overflowing with liquid excrement and the various rooms being indescribably dirty. I placed the matter of cleaning these rooms in the hands of Major Daly, surgeon, United States Volunteers, who performed this work in a most, efficient manner, and within ten days after arrival we were able to use the building as a hospital for our own men. I placed Assistant Surgeon Ten Eyck, United States Army, in charge, drawing details from the various commands for nurses, and immediately commenced the admission of patients. I also detailed Assistant Surgeon Hartsock, United States Army, as medical-supply officer, making the basement of the hospital his depot. The troops in the field were supplied with barely a sufficient number of medical officers and hospital attendants to care for such wounded as might occur in the actions that were anticipated, and I did not feel justified in drawing upon their slender resources, for which reason the service of this hospital was not as efficient as it should have been. 

On the evening before the troops left their camp near Ponce to march against the Spaniards, the chief surgeon of the several divisions informed me that about 50 men would have to be left in the hospital, and I made the necessary arrangements for their reception; but during the night the building was invaded by a promiscuous crowd of stragglers, numbering nearly 150, not over two-thirds of whom required hospital accommodation. There was no guard at the hospital, and the surgeon could not control them; hence there was a good deal of confusion. I established as soon as possible a convalescent camp, under charge of the Nineteenth Infantry, to which most of these men were removed. The hospital ship Relief arrived at this time, and about 250 cases of sickness, together with the wounded from our immediate front, were transferred to her to be taken north. She also took on board at Mayaguez the wounded from the engagements in General 


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Schwan's brigade. While she was here I took advantage of the presence of Lieutenant-Colonel Senn, chief surgeon, to investigate the cause of typhoid among the troops. His report is herewith appended. A large force of quartermaster's men was engaged to police the grounds, and within a few days the hospital and its surroundings were in very good condition. About this time instructions came from Washington to send no more sick north; but, realizing that the conditions here were not understood, I telegraphed for permission to make tent hospitals and continue shipping sick on such properly equipped hospital ships as might be sent here. My request being promptly complied with, the country in the immediate vicinity of Ponce was carefully investigated for a proper site, which was finally located on the grounds in the immediate vicinity of the military hospital. These were cleared of underbrush; roads leading to them were made and graded by the engineers, who also staked out the general plan for the hospital, and the necessary flooring and plank walks were laid by the quartermaster's department. The Surgeon-General had cabled me that 200 hospital tents would be sent here on the Concho, but I found on her arrival that they had been put in the bottom of the hold, the entire cargo being on the top of them, and could not be unloaded for seven or eight days; this delay led to considerable embarrassment in caring for the sick.

The continued rains, followed by the fierce heat of the sun, now began to produce a depressing effect upon the troops at the front. While the progress of typhoid seemed to be checked, it was followed by a rapid increase in the number of intestinal disorders and malarial fevers, which ran the aggregate sick report up closely to 8 per cent of the effective force, with the prospect of greater increase in the future. This fact I communicated to the Surgeon-General, and requested that hospital ships should be sent here in order that the sick might be removed from the island as quickly as possible. 

The depressing effect of this climate upon northern men can only be appreciated by medical men who have served with them. They seem deprived of all recuperative power, and no sooner do they fall sick, even with slight ailments, than a physical and nervous depression follows, which aggravates the existing disease and renders the patient entirely unfit for service. 

I have established camp hospitals in the several divisions comprising the army, namely, one each in Generals Brooke's, Wilson's, Henry's, and Schwan's commands, and have given orders that so soon as the central hospital at Ponce is emptied by transfer to hospital ships the ambulance trains shall be utilized to transfer the sick from the camp hospitals to the central hospital, thus being ready at all times to load any transport that may arrive in the harbor. 

The medical supplies on hand are ample for current use, and due requisition has been made for their replenishment by transports that may arrive from the north. 

Valuable assistance has been given by the National Relief Association of Pennsylvania in a shipload of groceries and medical comforts that was brought here on the steam yacht May, belonging to Mr. Van Rensselaer, of Philadelphia. These were transferred to me and distributed among the hospitals by Dr. Groff, a member of the association, under my direction. 

The National Red Cross Association has also sent a considerable amount of supplies, which are, however, still unloaded on the steamship Concho, but will be distributed by the agent of the association under the direction of the chief surgeon. 

In conclusion, I desire to bear testimony to the zealous amid faithful manner in which their duties have been performed by most of the medical officers of this command, oftentimes under difficulties which appeared to be insurmountable. To Lieutenant-Colonel Huidekoper and Majors Woodbury and Crile special commendation is due for the faithful manner in which their duties have been performed; also to Assistant Surgeon Ten Eyck and Major Birmingham, now in charge of the United States general hospital at Ponce. 

On the 24th instant orders were given for the return to the United States of certain of the troops on supply transports in the harbor. Recommendation was made and order issued for a careful examination of the sick by a board of medical officers in order that no person should be shipped who was unable to bear the journey. A similar examination of the entire company was ordered after arrival on the ship, and no ship was allowed to leave port until it was reported by the officer in charge to be in good condition.


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REPORT OF COL. CHARLES H. GREENLEAF, CHIEF SURGEON, ARMIES IN THE FIELD.

[Dated November 5, 1898, covering the period May 3 to July 8, 1898, at which time he accompanied the Major-General Commanding the Army to Cuba and Porto Rico, and the period September 6, the date of his return to this country, to November 1, 1898.] 

I assumed charge of the office of chief surgeon May 3, 1898, the duties embracing a general direction of the affairs of tire medical department in the field. The wide separation of the several army corps from each other necessitated the direct transmission of records to the Surgeon-General, and I therefore have no statistical data to furnish. 

As the troops then camped in their respective States were to be mobilized and prepared as quickly as possible for active service against the enemy in Cuba, my first steps were directed to an organization of the medical department for that purpose. 

The acts of Congress approved April 22, 1898, increasing the military establishment and organizing a volunteer army, made no provision for the muster into service of privates of the hospital corps for the volunteer army or for commissioned medical officers additional to those of the regular and regimental staff for service in hospitals and to meet deficits made by casualties. The Surgeon-General informed inc that he had asked legislation, through the Secretary of War, for the muster in of 25 privates of the hospital corps for each volunteer regiment and 50 privates for each division hospital, but up to this time no action had been taken on his recommendation. The matter was referred to the Judge-Advocate of the Army, who decided that the existing law, if slightly amended, was sufficient for the purpose, and that the force could be obtained by transfers from volunteer regiments into the regular establishment. He prepared a bill embodying these amendments, which was submitted to Congress, passed both Houses, and became law. The available personnel thereafter consisted of the hospital corps of the Regular Army, augmented by transfers from the Volunteer Army on the basis fixed by the Surgeon-General, namely, 25 men from each regiment and 50 for division hospitals, aggregating a little over 3 per cent of the effective force in the field. 

The Medical Department of the Army in the field during the last three years of the civil war was administered as a composite organization, of which a division hospital in three brigade sections was the unit. Its personnel and material were drawn from the regiments and from a staff corps of surgeons of volunteers. In operating it the sick and wounded were removed from the regiments into brigade and division hospitals, from which they were transferred to large general hospitals in the North. and after recovery were sent to convalescent camps, to be finally returned to their regiments, the object of these transfers being to avoid overcrowding of the division hospitals and to keep their bed space as free as possible for emergencies caused by battle or camp disease. The success of this organization was complete, and its main features were subsequently adopted by foreign armies. Its enlisted personnel represented a little more than 5 per cent of the effective force of the Army. 

Although the available force under existing law was but a trifle over 3 per cent of the effective force, it was believed by the Surgeon-General that the full quota (5 per cent) could be obtained in time of need by detail from the line of the Army, which for several years had been instructed in the elements of first aid and could therefore be depended upon to meet the emergencies of the battlefield. 

Upon this basis I formulated a scheme of sanitary organization by consolidating the regimental personnel and material into division hospitals, each with a capacity of 200 beds and with an enlisted personnel of 99 men and 6 officers; a corps reserve hospital of equal size was also organized. Ambulance companies were similarly organized as auxiliaries to the division and corps hospitals, each with an enlisted personnel of 114 men and 6 medical officers. The cavalry, artillery, corps, division, amid brigade headquarters were supplied independently and there were left with each regiment 1 medical officer, 1 hospital steward, and 1 private of the hospital corps. 

In anticipation of a necessity that might arise during the campaign for changing the details of this scheme, authority was given chief surgeons to depart from it at their discretion, "to meet the exigencies of the camps or battlefield." 

The plan was submitted to the Major-General Commanding, approved by him, and published and put in operation by me on the 20th of May. It should here be stated that an effort was made to accomplish the "muster in" to volunteer regiments of members of the hospital corps on the basis of a State quota, but through 


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some objection made to the method by the Adjutant-General it fell through. The publication of the orders necessary to carry out this organization was delayed, and when put in force it met with opposition from many regimental colonels, who either objected to giving up men whose places they were obliged to fill by immediate recruitment, or transferred men who were useless to the regiment by reason of vicious habits, physical disability, or stupidity. It was a repetition of the antebellum story of giving to the Medical Department worthless material. In some instances medical officers opposed the work under the impression that their prerogatives were infringed upon.

At this time also there was lack of material with which to work; tents, ambulances, litters, medical and surgical chests, and a variety of material absolutely necessary in the establishment of hospitals were not manufactured and were therefore not to be had. Other material equally necessary that had been issued by the Department was not available, because still in the hands of the Quartermaster's Department in transit, and the ignorance of many willing medical officers in matters of military administration made the task of perfecting this organization a difficult one. 

Most of the obstacles were, however, overcome, and at my first inspection of the Army in May I found the hospital and ambulance organizations progressing toward a fair state of efficiency. 

Of sanitary recommendations made to the General Commanding were: 

First. The limitation of numbers in any one camp to a brigade, or at most a division.

Second. Time of remaining in camp not to exceed thirty days.

Third. Frequent inspections of camps by inspectors of the Regular Army.

Fourth. Stringent regulations regarding the care of sinks, the management of the ration and its cookery, the personal cleanliness of the men, and the general police of camps. 

These were considered prime factors in the sanitation of camps and subjects which were especially liable to be disregarded by undisciplined troops, whose officers were, as a rule, as ignorant as the men in the details of military life. In all of my inspections I witnessed frequent violations of these matters and directed renewed vigilance by corps surgeons to prevent their recurrence. 

My first inspection included the camps at Tampa, Fla., Mobile, Ala., Chickamauga, Ga., and Falls Church, Va. 

The sanitary condition of these camps, with the exception of the one at Tampa, was what might be expected of undisciplined troops. In Tampa, mostly occupied by regular troops, the difference between the conditions of disciplined and undisciplined soldiers was well marked. The camps of the former were comparatively clean, their sinks were well attended to, their cooking properly done, their rations ample. In the latter the camps were badly located, tent space ignored, streets, etc., dirty, sinks badly policed, and the cooking indifferently done. 

In all the quantities of the medical and hospital supplies were limited. As a rule, the regular troops brought with them sufficient supplies to last about three months, but in many instances the volunteer troops were destitute in this respect. Before leaving Washington the Surgeon-General informed me he had ordered, in anticipation of formal requisitions, ample supplies from the New York and St. Louis depots, but at the time of my inspection they had not arrived, and in order to meet the immediate wants of the sick of the volunteers it was necessary to draw upon the slender supplies brought by the regular troops, which were soon exhausted. 

At Tampa, Mobile, and Alger the corps chief surgeons, and at Chickamauga the chief surgeon, were authorized by telegraph from the Surgeon-General to purchase in local markets such medicines as were necessary to meet the emergency. Outfits for hospitals could not, however, be obtained, and the value of the division-hospital organization was immediately demonstrated by the ability of the Medical Department to utilize such supplies as it had and care for the sick of both volunteers and regulars. At my suggestion the Surgeon-General had, early in the campaign, requested the governors of the respective States to furnish their troops with the State medical outfits until such time as he could replace them by regular supplies, since the manufacturers had not yet furnished enough for all the troops. I was informed by several of the surgeons that, while the State authorities supplied the medicines in State camps, they refused to allow them to be taken outside the limits of the State, and for this reason regiments reached camp without supplies. Fortunately the sick report was small, the aggregate not exceeding 2 per cent in any camp. This favorable condition could not be expected to last if the troops were to remain any length of time in this country, and in anticipation of a 


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larger sick report the Surgeon-General had ordered the construction of large general hospitals and the organization of a railway hospital train service in order that the sick might be speedily removed and the overcrowding of division hospitals avoided.

I also found that time physical examinations of soldiers at muster-in stations had been carelessly made, and a large number of men incapacitated for active service were in the ranks. Boards of medical officers were organized for the purpose of examining these men and recommending their discharge by reason of disabilities existing prior to enlistment, with a view of protecting the Government against the claims for pensions, which would at the end of the campaign undoubtedly be made. 

At my second inspection in June I was met at Tampa by a report that seven cases of yellow fever had occurred at McHenry, a lumber camp in Mississippi, practically on the lines of communication with the military camps in Alabama and Florida. A conference with Dr. Guiteras, the yellow fever expert attached to the Army, Dr. Porter, the health officer of the State of Florida, and several medical officers was held at Tampa, Fla., and it was agreed that if the disease invaded Alabama it would be necessary to place the army at Mobile and Jacksonville in quarantine at points which could be best protected from invasion. The points selected were Tampa, Fernandina, and Miami, since they were each to be reached by a single line of railway and access to them could be completely controlled. The maximum force to be sent to Miami was fixed at one regiment, which was to be detained there only a few days before embarkation for Cuba. Fortunately, the disease was held in check at McHenry, and movements of troops on that account were rendered unnecessary. At the conference referred to, general recommendations for the protection of troops about to leave for Cuba, against yellow fever, were also formulated, and Colonel Pope, the chief surgeon of the Fifth Corps, was furnished with a copy of the proceedings. 

While at Tampa I inspected some of the transports that were loaded with troops and supplies awaiting departure for Cuba. The condition of these vessels from a sanitary standpoint was very bad. They were overcrowded to such an extent that the men could not properly attend to the ordinary wants of nature, or keep themselves reasonably clean. The cooking arrangements were defective and the fresh air and water supply were entirely inadequate. Attention was called to the matter, but it was too late to rectify it. The general commanding, however, authorized me to appoint a board for the sanitary inspection of the transports intended for future embarkation to Cuba, and this was done under tire direction of Lieutenant-Colonel O'Reilly until the arrival of a line officer, who took the matter out of his hands. 

Provision for the care of the sick of the command that was about to start was also meager; a fully equipped ambulance company, as well as a division hospital, having been left on shore for want of room on the transports. No provision was made for a hospital ship to accompany the expedition; but the chief surgeon finally succeeded in obtaining the Olivette for that purpose and partially outfitting her. My assistant, Major Daly, later in the day had her painted, in accordance with the requirements of the Geneva Convention, and the supply officer at Tampa succeeded in placing on board of her two wagonloads of extra medical supplies. 

Complaint having been made regarding the water supply at Camp Alger, I made an inspection of the camp and recommended that if it was to be retained an additional supply was necessary. The location of one of the division hospitals was bad, and was changed to a more suitable point, the corps surgeon being cautioned to watch the sanitary condition of the camp and the character of the sick report with great care, taking every precaution to prevent an increase and to transfer promptly cases that required it to the nearest general hospital. 

At this time (July 8) I accompanied the General Commanding on the expedition to Cuba and Porto Rico, returning with him to the United States September 6, when I was directed to proceed to Camp Wikoff, Montauk Point, Long Island, N. Y., for the purpose of expediting the transfer of the sick from that camp to city hospitals in its vicinity. This work having been accomplished, I commenced on the 6th of October an inspection of the military camps at Jacksonville, Fla., Anniston and Huntsville, Ala., Knoxville, Tenn., Lexington, Ky., and Camp Meade, Pa., a specific duty being the instruction of the medical officers in the purpose and function of the regimental hospitals, the establishment of which had recently been ordered by the Secretary of War, and to see that they were properly equipped prior to the projected movement into Cuba. 

The unexpected cessation of the war and the consequent retention of large numbers of troops in the United States had materially changed the conditions under which the field service of the Medical Department was originally organized. Camps which at first were assumed to be of the most temporary character, 


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intended for the organization and equipment of troops soon to face the enemy, had now become vast camps of instruction. The division hospitals, originally designed for mobile commands, had been extended into quasi-general hospitals, sonic of them with a capacity of 800 beds, the change in their function necessitating not only a greatly augmented force, but one of a different character, the trained female nurse and the Sister of Charity appearing in camp as a necessary part of the hospital personnel; and the presence of modern apparatus for the medical and surgical treatment of disease gave an appearance of stability to these institutions that seemed foreign to their original purpose. 

As a rule, the hospitals were well administered, and some were models of neatness; supplies of all kinds were abundant, and the sick apparently received every attention and comfort it was possible to give them in camp. 

I, however, recommended to the Surgeon-General that the large field hospitals be emptied as rapidly as possible by transfer to general hospitals in the North, until their bed capacity should be reduced to its original number. 

In nearly all of the camps the discretionary authority given to chief surgeons to vary from the original scheme of organization for time field had been exercised, and many regiments were already equipped with their own hospitals, varying in capacity from ten to sixty beds. 

Every regiment in these camps was visited by me and its surgeon carefully instructed in the views of the Surgeon-General regarding the function of the hospital to be established: the necessity of preparation for a movement of the regiment was emphasized, and particular caution given against the retention of any cases that might under such circumstances prove an embarrassment because of their serious nature. 

Instructions had already been given for the construction of wooden pavilion hospitals at the sites selected for winter quarters of the troops, and my inspection closed with a feeling of satisfaction that the sick of the troops now in the field would be properly cared for during their stay within the limits of the States.

DOCUMENTS ATTACHED TO COLONEL GREENLEAF'S REPORTS.

1.  Memoranda of sanitary precautions adopted at a conference in Tampa Bay Hotel, June 18, 1898, by Colonel Greenleaf, Dr. Guiteras, Major O'Reilly, Major Pope, and Major Daly.

For the troops in the United States.-On the appearance of yellow fever at Mobile, Ala., all troops at Tampa and other points in Florida to be moved to Fernandina and Miami, Fla. The establishment of sanitary inspectors on all railways leading into the State from the West and on all roads communicating with the camps from the West and North. All persons coming from the West for service in Florida to be sent to McPherson Barracks, Ga., for detention during ten days. Extra precautions to be taken regarding the policing of the camps, and a house-to-house visitation in the town of Tampa. 

For the troops in Cuba.-Extra precautions regarding diet and personal cleanliness of soldiers. All water to be boiled before used. All intercourse with natives to be prohibited. Immediately after the landing of troops, all buildings that have been used by the inhabitants to be destroyed by fire, as well as all clothing of refugees. A camp of detention to be formed for prisoners of war and refugees, to be guarded by immunes, if they are to be found; if not, by a guard that shall be permanent for at least five days, after which, if no yellow fever appears, they may be changed. Should yellow fever make its appearance, the camps of the command should be moved to new sites, the brush and undergrowth being first destroyed by fire. Suspected cases to be isolated in temporary camps of detention. For convalescents from yellow fever, the clothing to be destroyed by fire and new clothing issued. 

2.  Extract from letter of Colonel Greenleaf to the Adjutant-General, headquarters of the Army, dated July 7, 1898.

Finally, and by far the most serious, is typhoid fever, of which in each camp there is a number of cases, which, in spite of preventive precautions, is steadily on the increase. As this is a water-borne disease the greatest care has been exercised in the selection of the sources of water supply, and of the examination of the water by every means known to science, the result showing that the regular water supply at tire several camps is as yet free from any dangerous element;


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and there is a consensus of opinion among the medical officers that the germs of this disease are obtained from infected water sources outside the camp limits such as wells in the neighboring farms and infected water in adjoining towns, which are constantly visited by the troops. How long the camp sources can be kept free from infection is hard to say. Among the sanitary precautions taken are the recommendation of boiled water as a constant beverage for the soldiers, the perfection of drainage systems, and the disposal of the excreta, either by burying in pits or by cremation. If the former precaution should be carried out we might feel assured that further cases of typhoid fever would not occur, but as a practical fact it is as yet impossible to secure compliance with this order by the soldiers. The number of diseases attributable to malaria is comparatively small.

Considering the fact that troops are living under conditions entirely new to them, including insufficient tentage and clothing, indifferent cooking of food, and unaccustomed exercises, I think the general sanitary condition is good, but this should not be taken as an index of continued improvement. On the contrary, it is my opinion, in spite of the sanitary precautions, the percentage of sick will increase until the discipline of the volunteer troops has so far unproved that we may be assured of compliance with the orders that are given for the preservation of their health.

Regarding the health of the troops now operating in Cuba, I feel that there is reason for grave apprehension. Added to the conditions I have mentioned above as existing in camps of instruction, there are in Cuba climatic and other conditions infinitely more harmful and difficult of control; the long-continued and excessive daily heat of the climate, with rapid lowering of temperature at night; the necessary exposure to rain in the absence of tentage; the scarcity and poor cookery of food; the effect of prolonged physical exertion on the battlefield, inducing nervous exhaustion, are all factors which must be seriously considered in forming an estimate of the health of the troops if their continued residence in Cuba is contemplated. To this should be added the almost certain appearance of yellow fever. While the medical officers are fully alive to the gravity of this situation, and have prepared with the utmost care the sanitary measures which are necessary to prevent disease, and have ample medical supplies to control it should it appear, it must be borne in mind that the military situation renders the carrying out of most of these precautions an impossibility. Without proper tentage and clothing the ill effects of temperature and moisture can not be prevented; without the necessary means of cookery proper food can not be supplied. Under existing circumstances the sterilizing of water supply for the entire command by boiling may be said to be an impossibility, and should yellow fever make its appearance it will be almost equally impossible to thoroughly prevent its spread. 

3.  Lieutenant-Colonel Senn's report, dated August 10, 1898.

I have the honor to report to you the results of my investigations concerning the origin of typhoid fever among our troops in the city of Ponce and its vicinity, as requested in your order of recent date. There are at present about 250 cases of typhoid fever in the army of invasion at this point. A careful study of 200 cases of which I have reliable information shows that the disease in every instance was contracted before leaving the United States. By far the largest number were contracted in Camp George H. Thomas, Chickamauga, Ga. The Second and Third Wisconsin Volunteers furnish the largest contingent, followed by the Sixteenth Pennsylvania and Second Massachusetts. Camp Alger comes next; the fewest cases from Tampa. Typhoid fever is indigenous in Ponce to some extent throughout the entire year, and from the large number of infected cases extra precautions will become necessary to prevent further spread of the disease among our troops. In view of the great prevalence of the disease in Camp George H. Thomas it appears to me that the Medical Department of the Army should recommend immediate evacuation of the camp.

4.  Major Woodbury's report, dated August 6, 1898.

Upon receipt of Special Orders, No. 3, I immediately inspected the caserne, the jail, and the Spanish hospital, and the camping ground of the troops. Finding the city to be without any health organization, I summoned all the medical practitioners to meet me and organize a board of health. They chose for their representative Dr. Moret. who graduated at Bellevue Hospital Medical College in 1880, who, with the mayor of the city and the syndic exofficio, now compose the board of health of Ponce. The regulations issued to the inspectors of the board, who are four in number (one for each ward in the city), are as inclosed. The immediate


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questions pressed upon the board, with whom I meet three times per week, are: First, street cleaning. This has been begun, and in some districts is being carried on quite well, and will be pushed. Second, the public water supply. This is derived from the Rio Portegese. The intake of the aqueduct is at a pond formed by a dam about 6 feet high across the river. This pond has been almost filled with silt and the deposit caused by the wash of the heavy rains. It will be cleared out and another heavy galvanized iron strainer placed over the intake. As soon as possible a filter will be placed at the city end. The valley of the Rio Portegese, which I have carefully inspected, is clean, and only occupied by infrequent coffee estancias, the drainage from which is not considerable.

The disposition of the public dead must be immediately changed. The present method is to inter them five tiers deep, and in five years to dig over the same ground and begin again. I have begun arrangements for a new public cemetery outside of the city proper, all interments being heretofore intramural. As soon as the purchase of land is completed and the ground consecrated the new cemetery will be in use.

I have thoroughly disinfected and in part repaired the city prison. I am clearing the drain of the Spanish military hospital, which, with fumigation and cleaning, will render it suitable for immediate occupancy, as it is but one year old. I have fumigated and cleaned the caserne and rebuilt and cleaned the sinks therein, rendering it fit for use. All captured woolen uniforms and clothing have been immediately burned. Several bales of cotton clothing that were new have been boiled for an hour and might be used.

The troops are quartered in buildings, save the prison guard on the roof of the jail; one company of the Third Wisconsin in the caserne, as guard over the large quantity of ordnance stores therein, and two companies of the Sixth Illinois, which are acting as provost guard at Playa. The latter are partially sheltered by the sheds of a lumber yard.

I have inspected the sheds which the Government has used at the Playa as storehouses, and find them, after their policing, clean and proper for use.

The camps of our troops are so situated as to render them dry and well drained in the showers, and I can only beg strict regimental orders against the men filling canteens in the streams where the inhabitants are washing their clothes.

We have here at present 10 cases of smallpox and a few cases of measles. There is no yellow fever and no report of a case for three years. No typhus and but few cases of typhoid among the inhabitants. As soon as the proper virus can be obtained from New York, I shall begin compulsory vaccination of the inhabitants. On August 3, in accordance with your orders, I went to Arroyo, 45 miles east along the coast, obtaining transportation in New York Sun dispatch boat Kanapaha. Upon landing, I found a small Spanish town in the form of the letter T, with head toward the beach. It was fairly clean and well policed. The local medical authorities report no yellow fever and no smallpox in town; some cases of the latter in the surrounding country.

General Brooke is quartered in the second story of a building on the beach, General Hains in the custom-house, the staff in a large house in the village, and the troops in tents about a mile back from the beach. No buildings are used as storehouses. All officers will go into camp as soon as the tentage can be brought ashore.