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Report of COL Charles R. Greenleaf, Chief Surgeon, Armies in the Field, on the Sanitary Conditions at Camp Wikoff, Montauk Point, Long Island

Spanish - American War

246

REPORT OF COL. CHARLES R. GREENLEAF, CHIEF SURGEON, ARMIES IN THE FIELD, ON THE SANITARY CONDITIONS AT CAMP WIKOFF, MONTAUK POINT, LONG ISLAND

Dated November 1, 1898

In compliance with your telegraphic direction I have the honor to submit herewith a report upon "the sanitary condition of the troops at Camp Wikoff since its occupation with statement as to provisions for care of sick," etc.

In view of the fact that my service at this place commenced at so late a period, and I was ignorant of any of the antecedent historical data necessary for making such a report, I called upon the heads of the various departments at the camp, and, also on Colonel Forwood, who organized the hospitals, for statements of their work; these have been compiled in the following report:

In transmitting to me, under date of September 20, 1898, the data which is embodied in this report, Maj. Ira C. Brown, surgeon, United States Volunteers, states:

"I desire first to say that the medical officer in charge of the detention hospital has aided me greatly in obtaining the facts pertaining to that institution. I also desire to thank Lieutenant Durfee, of the Engineer Corps, for information that would be difficult to obtain without his cooperation. I am also indebted to the Signal Corps for kind assistance, and to the various aid societies who have been engaged in relief of the sick.

"It is only fair to say in this connection that the detention hospital has been made a model of its kind under the direction of Major Ebert, and that those in charge prior to his administration did heroic work at a time when there was no opportunity to perfect an organization.

"Major Almy, who had charge of the annex hospital, rapidly perfected his organization, and soon had a model institution, which remained a monument to his executive ability until all the hospitals were combined under the head of the general hospital.


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"The success of the general hospital, through which the other hospitals received their supplies and to a certain extent their inspiration, is largely due to the efforts of Major Heizmann, who has been a tireless worker under many trying circumstances.

"Major Thomason, superintendent of wards of the general hospital, has been a very efficient officer, having had charge of the shipment as well as the receiving of most of the patients since he has been on duty here. His work has been so well performed that no accident or even discomfort to the patients has been noticed.

"The officers and contract doctors who have been on duty here in a professional capacity have all made good records for themselves, having worked faithfully and conscientiously for the patients intrusted to their care.

"It is a matter for congratulation that a hospital of this size, springing into existence in so short a time, should have such an able corps of physicians and nurses, and proves to my mind the unselfishness of the individuals connected with the medical department. The same can be said of the nurses, and when I speak of nurses I wish to be understood as including the Sisters of Charity and the trained nurses.

"Personally, I wish to thank you for the many courtesies received at your hands, and trust that the information furnished herewith may be of service to you in determining the success or failure of the medical department at Camp Wikoff."

Water supply-The following report in regard to the water supply, the pumps, the wells, the piping and hauling of water, the filter plant, etc., is furnished by Col. Willard Young, commanding Second United States Volunteer Engineers:

"The work of supplying water to camp was inaugurated by Colonel Hecker and Colonel Miller, of the quartermaster's department, who had placed Mr. Clinton Smith in immediate charge. practically as superintendent of waterworks.

"Immediately upon the arrival of this regiment in camp, on August 15, a request was made for a detail to assist in laying pipe. A detail of 24 pipe fitters was at once sent out and proceeded to work under the direction of Mr. Smith, reporting to him each day until August 17, when charge of the water supply was turned over to me by verbal orders of Maj. Gen. S. B. M. Young, and Capt. Fremont Hill placed in immediate charge. At the time of my arrival, August 15, the condition of the water supply was as follows:

"A pump had been set up on Fort Pond and a pipe line laid from it to the general hospital, and a branch line to detention hospital, with one outlet at each hospital. Work was just being begun on erecting a tank on the top of the hill a few hundred yards from the pimp. In all, about 6,000 feet of pipe had been laid. The pump was in operation, supplying water for all purposes from Fort Pond, and it continued in operation until August18, when well water was first supplied. At the same time, by an agreement with Colonel Hecker, Mr. C. A. Lockwood, a contractor from Jamaica, Long Island, was engaged in sinking a well at a point a few hundred yards from Fort Pond, near the present camp of this regiment. This was the first well put down, and will therefore be referred to as the first well in this report. It is the one with the greatest capacity, and the one at which the filter plant is located. The agreement with Mr. Lockwood included sinking this and another well, on a site to he selected.

"The first well was connected to the pipes on August 18. It delivered an amount of water satisfactory to Colonel Hecker, and was approved by him. Mr. Lockwood then began to sink the second on a site which had been selected by Colonel Hecker and Colonel Miller. This well was located at the edge of Peters Run, in a place likely to receive the surface drainage of the detention camp and hospital. Seeing the danger likely to result from the use of this well I consulted with Major Meacham, surgeon of my regiment, who strongly condemned its use. I then reported the matter to Colonel Forwood, who also condemned it, and General Young ordered its abandonment. A new site on higher ground was selected, and another well put down by Mr. Lockwood. In driving this well, at a depth of about 35 feet a large bowlder was struck. At this depth the well had a capacity of about 80,000 gallons, instead of 500,000 as agreed upon, and the supply has materially diminished since. It was not recommended for acceptance as fulfilling the contract, but was nevertheless accepted by Major-General Young on account of the urgent and immediate demand for water. This completed Mr. Lockwood's agreement with Colonel Hecker.

"Owing to the small amount of water supplied by the second, or Peters Run well, and the great length of pipe line between the first well and some of the camps to which it was supplying water, as well as to the fact that it was not known now long the camp here would be maintained, and that in case of breakdown of the


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pump or failure of the first well the camp would be left without water, I recommended that another well be put down.

"A contract was entered into with Mr. C. A. Lockwood to sink another well to have a capacity of 500,000 gallons per diem, on a location near Lake Wyandanne, beyond all camps, and hence out of reach of contamination from surface drainage. This well was to be sunk for $1,000. Mr. Lockwood finished work and withdrew his tools from this well on September 9, but the pump was not yet in the well at that time. The well was driven into fresh water at a depth of about 30 feet, and being driven deeper reached brackish water after passing through a clay stratum. The point was therefore withdrawn to where fresh water was found. This well yields only about 75,000 gallons per diem.

"The source of water here is undoubtedly the rainfall water sinking very rapidly through the sandy soil until it reaches a level somewhere near sea level, where it remains. There are in some places strata of earth or clay which cut off the flow in particular places, but there does not appear to be any continuous stratum of such material. The water in its natural condition is wholesome; the sole danger to be feared is that it will become contaminated with the impurities which will by degrees percolate down from the surface. Very little water runs off of the surface during a rain storm; most of it sinks into the soil. Most of the drainage is caught in basins and held to evaporate or slowly percolate downward.

"Not knowing how long the camp would be occupied, and seeing danger from contamination due to the presence of so many men and animals on the ground, I recommended that a filter be installed as an extra precaution against disease. This met with the approval of Major-General Young and yourself, and of the Secretary of War, who on August 30 authorized an expenditure of not more than $7,000 for this purpose. A contract for the immediate installation of two filters with a capacity of not less than 300 gallons per minute was entered into with the New York Filter Manufacturing Company.

"The elevation of the ground occupied by some of the camps at Montauk Point varies from a few feet to about 100 feet above sea level. The tank erected on the hill a few hundred yards from the first pump was not at an elevation sufficient to make it of any value in supplying water to the camps, and it is necessary to pump directly into the pipes, at a pressure as great as 120 pounds, to force the water to all points on the pipe lines. The tank is filled at night and the water drawn off during the day for sprinkling purposes. Another tank has since been erected and is used for the same purpose.

"On August 19 I divided the work of looking after the various matters intrusted to me among the officers of the Second United States Volunteer Engineers, assigning to Lieut. Col. E. W. Burr and Capt. Fremont Hill the immediate charge of all the work on water supply.

"About 12 miles of pipe lines were laid up to September 15. On these lines there are 178 faucets, with about 477 feet of three-fourths-inch pipe and 37 feet of 1-inch pipe used as connections.

"The water has been partially shut off on a few occasions; once on account of breakdown of the pump installed at the well first put down, and at other times on account of the pipe being stopped up with large pebbles in an inexplicable manner.

"There have been in continual use 11 water wagons hauling water from the wells to the hospitals and to points not supplied with water by pipe lies, and in sprinkling roads in front of the general hospital and elsewhere. Since September 4 these wagons have been under my supervision, and Lieutenant McAndrews, Second Regiment, United States Volunteer Engineers, has had immediate charge of them.

"Owing to the limited supply of water, only the road in front of the general hospital was sprinkled at first, but since the completion of the tanks, which are filled during the night, there has been plenty of water for both purposes."

The following additional statement in regard to the water supply at Camp Wikoff is from the report of Lieut. Col. Charles Smart, made to the Surgeon-General September 10 in compliance with instructions:

"The water supply of the camp and hospitals is taken from a well about 200 yards from the eastern margin of Fort Pond. A free supply was found at a depth of 40 feet below the surface. Two strata of clay-one near the surface, the other at a depth of 25 feet-separate the well water from surface contamination. It is distributed by about 8 miles of pipe, and is on tap in each of the regiments. Two of the regiments, the Ninth and the Thirteenth Infantry, are provided with Pasteur filters in their company kitchens.


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"The following tabulation shows the results of a chemical examination of the water by myself on Thursday, September 8, immediately after the samples were drawn:

 

Fort Pond Water

Well Water

Tap Water

Chlorin

62.00

3.00

3.00

Nitrite

None.

None.

None.

Oxygen required

.375

.075

.075

Free ammonia

.0025

.002

.002

Albuminoid ammonia

.048

.003

.003

"The figures represent parts per 100,000 of the water.

"The Fort Pond water is unfit for use as a potable water. The other samples are organically pure.

"I have instructed a medical officer to examine this water from time to time to note any change in its character.

"With this satisfactory water supply and the good sanitary condition prevailing in the regimental camps, I have no hesitation in saying that the troops could stay on their present ground in winter quarters without any such outbreak of typhoid fever as has occurred at Camp Alger and at Chickamauga Park."

On September 16 Acting Asst. Surg. Llewellyn P. Williamson made an examination of the water and reported as follows:

"I have this day examined the water supply of this hospital and found it the same as when examined by Colonel Smart last week. It is pure water, albuminoid ammonia being almost entirely absent."

Transportation facilities-In regard to the facilities furnished for transportation, Dr. Brown states:

"When the first troops arrived at Montauk (the Sixth Cavalry) there were scarcely any means of transporting supplies except that brought by the cavalry outfit. With the Sixth Cavalry came its sick, in the baggage car which arrived at Montauk about 4 a. m. August 8, 1898. There were ten ambulances parked near the station, and with these the sick were taken to what is now the general hospital. At that time there were no tents and no provision whatever for the reception of these men, and the medical officer in charge erected tents and had the sick (some 30 in number) under cover by 11 a. m. the same day. There were no cots, no mattresses, and only one blanket for each man. It was raining at the time and the ground was wet. There was no lumber on hand to put floors in the hospital tents, and consequently the patients were laid on the ground. These men were suffering from different diseases contracted in Tampa, Fla., and which developed on the way to Montauk. The greater portion had typhoid fever, quite a number malaria, a few cases of dysentery, and one of measles.

"There was no food for these men, nor could any be purchased at this end of the line. The medical officer, however, made arrangements on the way here to have milk sent by the first train arriving that morning, and to continue the supply until further orders. There was enough with the sick to last until the supply came.

"The medical officer found the location for the general hospital very early in the morning and before any of the officers here were at the site selected. Early in the morning General Young and Colonel Forwood came to the proposed site and did all that men could do to make the sick comfortable. Here was the first lack of transportation. There was some lumber at the station, but only one team to haul it. There were two carpenters waiting for lumber to go to work. When the officers in charge were able to get the lumber here it was used at once for putting floors in the tents erected, and the sick were transported to more comfortable quarters.

"Slowly the facilities for bringing up the lumber were increased, and also the number of carpenters. From day to day transportation facilities were increased until finally the lumber came in great quantities, and there were nearly 100 carpenters at work, but as the working force increased so did the number of patients. Transports commenced to arrive, and the sick came pouring in all clay, and frequently into the night, and only by the constant application to duty by Colonel Forwood were the patients able to be housed, let alone making them comfortable.

"It was thought necessary to get the lumber up if other departments had to suffer, for without a house other material would be of no consequence. As soon as it was possible cots and mattresses were brought up and the patients were placed upon these mattresses and made quite comfortable. It was almost impossible to find transportation for medical supplies and hospital furniture. At first


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there were no medical supplies here except those brought by the medical officer of the Sixth Cavalry, which consisted of one medical and one surgical field chest which had done duty all the way from Tampa here, and were more or less depleted:

"Colonel Forwood had great trouble with the carpenters, who came from some distance and would not remain here over night, but insisted on returning by a morning train, and they seldom got to work before 9 or 9.30 in the morning.

"The quartermaster's department did not show the interest in the matter that the situation seemed to demand. It is not my purpose nor desire to reflect upon the quartermaster's department, but it is only simple justice to say that supplies came to this hospital only by the personal efforts of officers who should have been on duty elsewhere and not compelled to go the quartermaster's office and beg for supplies that everyone knew were badly needed.

"Another great obstruction to getting supplies promptly was owing to the fact that cars came in billed as medical supplies, and when located and opened the boxes were not marked with their contents. Consequently hundreds of packages came to the hospital which were not needed at the time and that have been used very little since. Many of the boxes were so large that there was not force enough at times to handle them. It would seem upon reflection that anyone intrusted with packing of supplies of this nature would see the necessity of having boxes not larger than two men could handle and of having their contents plainly marked on the outside.

"The story of transportation could be made a volume in size, but it can be covered in a single statement, and that is, that so far as this hospital is concerned the service rendered by the Quartermaster's Department up to the beginning of September was very poor."

Hospital construction-The hospital construction was under the charge of Colonel Forwood, who worked hard all day and frequently far into the night, using every effort at his command to hurry along the building of the hospital. He was greatly handicapped in this work, owing to the lack of transportation and material for building purposes. The selection of ground for tentage was looked after by him personally. His desire to make his hospital a model one was appreciated by all who were on duty here, and his aim to make it a monument to the success of the Medical Department of the Army has been realized.

The success of this great hospital is due entirely to the efforts of Col. W. H. Forwood.

Surgical wards and work-Colonel Forwood, in his plan for the construction of a hospital, laid out one row of tents for a surgical ward, one tent for disinfecting, one tent for giving anaesthetics and preparing surgical dressings, one for operating, and three for the reception of patients immediately after operation, and another pavilion of twelve tents for convalescent surgical patients.

The surgical wards were models of modern field equipment, the operating tent being provided with everything essential to asepsis and to facilitating operative procedures. An especial diet kitchen was completely equipped. The nursing was done by Sisters of Charity who had been specially trained in their surgical work, and the selection of supplies and apparatus was carefully made. The whole section was organized by and under the charge of Lieut. Col. Nicholas Senn, chief surgeon, United States Volunteers, who had for assistants Major Adams, chief surgeon, United States Volunteers, and Acting Asst. Surg. H. S. Greenleaf, United States Army. About 115 cases were operated on, with no deaths. As it understand that Colonel Senn is to publish the result of his work in these wards, I prefer to leave a description of the surgical work to him, merely adding that so far as my observation went the results show that it was the perfection of modern field surgery.

Annex hospital-The general hospital, comprising 130 ward tents, and having a capacity for 780 patients, was soon found inadequate to meet the demands made upon it, and an annex, comprising 106 tents, and affording additional capacity for 636 patients, was commenced and completed in ten days; This was found to meet emergencies for a time, but it soon became evident that still more hospital room would have to be provided. Consequently a second annex was built, which accommodated about 400 patients, making the total capacity of the general hospital and its annexes nearly 1,700.

The work of the female nurses at this hospital has proven their worth for this particular service. They entered upon their duties with great enthusiasm, and while some of the male nurses complained of the amount of labor they were compelled to perform, there was never a complaint from the female nurses on account of their work or on account of the accommodations afforded them for rest. To them must be credited in a great measure the low death rate in this hospital, for on no occasion were the patients left a moment or neglected, and in this way medical help was summoned and many a patient received aid just at the time to save his life.


251

Total number of sick passing through hospital-The records of the hospital show the total number of sick passing through the general hospital up to September 17, 1898, to have been 6,564; through the detention hospital up to the same date, 1,640; and those passing through the division hospitals brings the number of sick handled in the hospitals in this camp up to about 10,000. Estimated number that will pass through the general hospital, 7, 264. Of course this does not include the furloughed men who pass through the hospital, which number several thousand. The above figures include only those who received treatment and were regularly admitted to the wards.

There were present 720 patients in the general hospital at the time the above statement was written.

Hospital staff-The total number of medical officers, comprising commissioned regular and volunteer surgeons, and contract surgeons. on duty while the hospital was at its greatest capacity, consisted of about 40. In the early part of the establishment of the hospital the hospital corps comprised 1 hospital steward, 1 acting hospital steward, and about 60 hospital-corps men, which was later augmented by the addition of 2 hospital stewards, 9 acting stewards, and about 60 additional privates. The total number of female nurses since the establishment of the hospital averaged about 100; Sisters doing duty as contract nurses also about 100; contract male nurses on duty at the hospital averaged about 50. In addition to these there were about 15 contract cooks who were on duty at the general hospital. This estimate includes all those on duty at the annex hospital.

Detention hospital-The following statement is from Acting Asst. Surg. H. C. More:

"This hospital was opened August 14, 1898, and I continued alone and in charge till August 18, 1898, when I was relieved by Captain Winter, having at that time about 85 patients, with no deaths. I then took charge of the quarantine tents until August 25, having exclusive charge of the five yellow-fever suspects, all of whom recovered. On that date the quarantine was raised, and I returned to duty in the camp. I took charge of half of the second row for one day and then of row 1, having 120 beds, all full, and also of the officers' pavilion August 28, and of half of row 8 August 29, other surgeons relieving me. On about August 31 my patients were moved to Pavilion G, where I still am.

"During this time I have treated patients as follows: Until August 18 about 85 patients, all here when I went to quarantine; August 18 to 25, 5 patients, all since recovered; August 25, about 55 patients in row 2, turned over to Dr. Carson; August 26 to 28, row 1 and Pavilion A, turned over to other surgeons, about 125 in all; since August 28, about 110 cases, of which 24 were sent to New York, 8 to general hospital, and the balance sent on furlough, with 2 dead; total 295 cases. Sent to other wards, 184; sent to other hospitals, 32; dead, 3; furloughed, 76."

Captain and Assistant Surgeon Winter, United States Army, was placed in charge of the detention hospital August 17, 1898. He submitted the following statement:

"At that time there was 1 physician in charge, and 6 Hospital Corps men. Dr. H. G. More and Dr. W. H. Booth, with myself, constituted the medical staff for the next two days. There was no organization at the time I joined the hospital although Dr. More had worked earnestly and faithfully to provide for the needs of some 60 patients. The kitchen was of ample size and range capacity, but for three days after taking charge there were no cooks save a few pronounced amateurs and neophytes in the culinary art. Fortunately the supply of prepared foods (cereals, etc.) was large and the sick were fairly well nourished. Of drugs there were almost none, most of the very essential articles being lacking. All of this was remedied the following day, when a good supply of all essentials, including two cooks, came from the general hospital, where all the officers cooperated most heartily with me in the effort to provide suitable supplies for the sick. During the next few days the accommodations of the hospital were materially increased by the very efficient work of the engineers under the command of Captain Cook. They pitched a number of hospital tents, set up bunks, and by putting in an abundant water supply solved a problem which had hitherto been a grave one. The increment of sick at this hospital was of the most uncertain character. One afternoon, with 6 Hospital Corps men, including cooks, to aid me, I fed 170 men of the Seventy-first New York Volunteers, who had just come off a transport and who clamored for food with the combined importunity of an India famine and a nursery. Fortunately there were some prepared soups on hand (the gift of Mr. Howard Townsend, representing the Red Cross), and with these and some bread I succeeded in staying the clamors of a lot of men who were eager as only a dearth of food can make men eager.

"The details of such a situation can scarcely be elaborated on paper. I could amplify the arrival of sick officers and men and point to the incoming of ambulance after ambulance, each with its full complement of sick, arriving from 10 p. m.


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to morning, with no notification of their incoming and no provision for their reception. The provision of one blanket became a study, and to exercise discrimination in their distribution was tantamount, in the soldier's opinion, to a personal assault upon his rights. Transports bearing sick were constantly arriving at Montauk from infected ports, and the element of detention was insisted upon in no unequivocal terms by the authorities. To one familiar with the multifarious details of a field hospital, and cognizant of the time necessary to the establishment of such an institution, it will not seem unreasonable or even unfitting that accommodations should be crude and simple for the first few days. The supplying of kitchens, cooking utensils, cooks, tents, beds, mattresses, pillows, sheets, pillowcases, buckets, basins, commodes, bedpans, urinals, lights, dishes, tableware, towels, and the thousand and one other things necessary for the comfort of sick takes time, and when the recipients are dependent on a one-track railroad the difficulties are enhanced. I have distinct recollection of the great efforts put forth by the chief surgeon (Colonel Forwood) to provide for the needs of this hospital, and it was due to his untiring work that the hospital was in good running shape when I left it on the 23d of August."

Dr. J. F. Cronin, acting assistant surgeon, United States Army, was left in charge of the detention hospital after Captain Winter left, and remained in this capacity until August 27. Maj. R. G. Ebert, surgeon, United States Army, took charge of the detention hospital August 27, 1898. He states:

"At that time the hospital consisted of 60 single hospital tents and 4 pavilions of 6 tents and 1 fly each, as wards for patients, with 4 single tents detached some distance as an isolation ward; an administration pavilion of 2 tents and 1 fly; another pavilion of 3 tents and fly as bathroom, storeroom, and officers' dining room; a frame kitchen with 2 ranges; an incompleted disinfecting plant; a single wall tent for morgue; besides tents for officers and attendants.

"There were on duty 6 acting assistant surgeons, 41 privates of the Hospital Corps and privates who belonged to volunteer organizations whose status was undetermined, there being no orders or descriptive lists at this hospital, 3 civilian cooks, and 6 civilian and volunteer nurses. Supplies, implements, and medicines were limited, many necessary articles being entirely missing. The food appeared to be the regular army ration supplemented by a supply of milk. Clothing for issue to patients consisted of a small quantity of articles of uniform and some few Red Cross supplies.

"Physicians and nurses were overworked, and the wants of patients, in spite of best efforts of all, were not always promptly met. Records did not exist except a directory of patients, in which some information relative to arrival and disease was noted. Stationery, books, and blanks there were none. No reports were rendered by the attending surgeons, and but a very limited number of 'registers of patients' were in use.

"Requests were made for a detail of 50 men from the line to assist in the work of attending to patients. This was filled imperfectly, and many of the men reporting absented themselves, while others, being themselves convalescents, became sick, 14 of the 40 present on second day after reporting being sick, as were also 10 of the Hospital Corps.

"Additional surgeons, entirely unfamiliar with army work and methods, reported the following week. Hospital Steward George W. Muller, United States Army, reported for duty on the 28th, and of his services I can not speak too highly. Being informed that no hospital stewards or acting hospital stewards were available, I requested and was given the detail of 3 privates of the corps in that capacity, and their services were of value.

"Female nurses under Miss L. A. Hughes, M. D., reported for duty on August 28; that day 9. The succeeding days these were increased by arrivals from New York, Michigan, and Massachusetts. The following table shows the status of hospital in various respects on the date I assumed charge; on the date of the greatest number of patients; on the date when orders were received to admit no more patients, and at present date:

a Includes 1 steward, 3 acting stewards; the others privates.


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"Total number of patients received in hospital, 1,850; died, 62; transferred to other hospitals, 415; furloughed and sent to regiment, 1,107; remaining (September

"A diet kitchen was commenced on August 29, with 2 oil stoves and tomato cans as utensils. As rapidly as possible this was increased and now occupies a pavilion of 3 tents and a fly; there are in use 2 ranges and 6 persons are employed. I can not say too much of its value, and Miss Fennessy, in whose charge it was placed, is worthy of the highest praise.

"The policing of grounds was at first under charge of Lieutenant Rowell, Fifth Cavalry; afterwards Lieutenant Jackson, United States Volunteer Engineers. While the work of construction was continued (September 13), it was difficult to keep grounds in the best of shape; but after the arrival of sufficient noncommissioned officers to properly oversee employees, the work was done satisfactorily.

"Medical supplies were obtained from general hospital, and after the 4th or 5th of September were ample. Previous to that time there was a shortage in some drugs and at times the preparations were not such as were desired by the prescribing physician.

"Stores for the sick were obtained by purchase, and also from the Red Cross and many organizations for time relief of soldiers, and gifts of private individuals. It is difficult to tell how much was thus donated. The lack of clerical force and competent men to take control rendered an accounting of property impossible. It became the first and only aim to take care of the sick at no matter what expense of materials or labor. The unpreparedness of this hospital to care for its sick at first and the constant building operations necessitated a vast amount of discomfort to patients and loss of time and labor to attendants; especially was this due to the system of single hospital tents.

"At present there is no complaint to be made excepting lack of noncommissioned officers and proper clerical assistance. It is only by working from 5 or 6 o'clock in the morning till late at night that progress can be made in straightening out records, which must be so valuable in the future to Government and patient; and here again must I give credit to Steward Muller, who, familiar with the papers of the medical department, is the only one competent to do this work besides myself of our present force.

"In conclusion, permit me to call attention to the magnitude of the task considering the limited amount of properly instructed material to do the work. A command equaling a regiment, a time of emergency, with more or less discordant elements, to be fed, clothed, cured, and furloughed is a difficult task to accomplish within the space of a month, and the many imperfections must be given the benefit of this excuse. To Dr. C. M. Lee, whom I appointed executive officer September 1, and to the many willing volunteer aids in the work, I desire to give this token of my appreciation of their services."

Construction and equipment of steam laundry-The provisions made in connection with the laundry work of Camp Wikoff are very fully set forth in the following statement of Capt. G. L. Goodale, assistant quartermaster, United States Volunteers:

"I arrived at Montauk at noon August 12, 1898, to take charge of the work of constructing and equipping a steam laundry for hospital work.

"On the morning of August13 location for building was selected at a point southwest of the infantry camp, between Atlantic Ocean and Fort Pond; this place being chosen that fresh water for laundry work might be drawn from Fort Pond and refuse water conveyed to the ocean, thus avoiding all danger of infection from any work done. On this date I made contract with American Laundry Machinery Company, through their New York branch, for all necessary machinery to fully equip a laundry capable of doing the work for all hospitals-general, detention, and division. Price to be $3,000, they to place the machinery in building in good running order in nine working days after building was ready and machinery had arrived there. In the event of failure on their part to do the work in the specified time it was stipulated and agreed that they should forfeit $50 for each and every day's delay. Arrangements were made by Colonel Hecker with Mr. Hyde, of Grace, Hyde & Co., for erection of building.

"August15 the greater part of lumber for building arrived at wharf, but as all wagons possible were being employed in transporting troops and baggage, arriving from Cuba, to camps, it was not until the 17th that any was teamed, and then only a small quantity. Not until the 21st was all the lumber and materials for building upon the ground.

"August 18 carpenters began work in a small way, and on 19th sills for building were laid.


254

"August22 I notified the American Laundry Machinery Company that building would be ready for machinery Wednesday morning, August 24.

"August 24 machinery arrived at railroad station. Mr. White, chief engineer of company, and 3 assistants came to place same in position. Owing to lack of transportation, delay occurred in getting machinery to building, the last piece arriving on the afternoon of 26th.

"September 1 received authority from Quartermaster-General to employ civilian laundrymen.

"September 3 started work, all machinery having been put in place in running order completed on the 2d. Owing to the difficulty in getting employees to come here from New York, had only 5 men of the necessary force of 12.

"September 4, after working one day, it was demonstrated that the pump put in by the contractors would not give sufficient water supply from the location of pump house near the shore of Fort Pond. I at once wired the company that a larger pump would have to be supplied. On the 8th a new one arrived with men to put it in position. Change of pumps and laying of larger steam pipes to pump house completed on September 10.

"September 7, employees arrived from New York, completing requisite force-10 civilians, 2 detailed men.

"Water is obtained through 425 feet of 1-inch iron pipe from Fort Pond, and refuse water conveyed to ocean through 650 feet of 3-inch pipe. Pipe furnished and laid by Second Regiment Volunteer Engineers, Colonel Young commanding.

"Handicapped though the work has been by delays caused by want of employees for four days, and short supply of water necessitating many stoppages from September 3 until September 10, fair progress has been made; from September 3 to September 19, inclusive, 23,670 pieces of work were sent from laundry to different hospitals.

Medical supplies-So soon as it was determined by the Government that a camp should be made at Montauk Point, the Surgeon-General gave orders to the medical supply officer at New York to ship to that point articles of every kind that might be necessary to equip the hospitals in the most thorough manner, and to spare neither labor nor expense in the work.

He instructed Colonel Forwood to call by telegraph for additional articles, and directed the medical supply officer to honor all such requisitions without delay or formality.

A vast amount of property was thus accumulated, and although the large and numerous hospitals were fully equipped there was at the time of my visit a sufficient quantity of surplus stores to have equipped another hospital of equal size.

An idea of the amount of this kind of property that was furnished by the Medical Department may be gained from the fact that of beds and bedding alone there had been shipped 3,452 cots, 3,000 mattresses, 18,254 sheets, 7,675 blankets, and general medical supplies such as drugs, hospital comforts, surgical instruments and appliances, furniture, table and mess ware, and other miscellaneous property for 12,000 men, comprising no less than 54 carloads of supplies. In addition to this, there were sent for the division field hospitals 400 cots with bedding complete, all without formal requisition, but solely on the order of the Surgeon-General, from Washington. Five thousand dollars of public money was also sent to a medical officer, appointed as disbursing officer, for the purchase of such property as was not on the supply table and for the payment of employees.

Food supplies-In regard to the supply of food in the early days of the camp, Dr. Brown states:

"That at the beginning the food was scanty and very poor when it reached the hospital. Meat, for instance, had to be sent up here in ambulances that were used for transporting the sick, and was then thrown on a crude table covered with dirt and often exposed to the sun, so that it soon became necessary to bury it. When we were able to cook it it was so full of grit that it took a strong heart to be able to masticate it.

"Milk came spasmodically and usually soured late in the afternoon, leaving us to depend upon canned milk for our night supply.

"For three days there was very little food of any kind except milk, which fortunately supplied the patients, and the help could get along under the circumstances. One day we would be out of meat, the next day out of bread, and so on; when we had a supply of one thing we were all out of the other. Here, too, was the lack of transportation plainly visible. From about the 18th of August the supplies came in in large quantities and very good in quality, so that latterly we actually had more provisions than could be used. And the canned goods and other articles not perishable accumulated so that we have quite a reserve stock on hand."

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Sanitary work done on grounds about general hospital-The following is a report of the sanitary work done on the grounds about the general hospital by the Second United States Volunteer Engineers, under the general supervision of Maj. Franklin A. Meacham, surgeon, Second United States Volunteer Engineers, by order of Col. Willard Young, commanding Second United States Volunteer Engineers:

"On the first visit of the Secretary of War to this camp, August 24, he found the grounds about the general hospital in a deplorably unsanitary condition. Desiring to remedy this, he, together with Maj. Gen. Joseph Wheeler, called Col. Willard Young in consultation as to the best means of accomplishing this much-needed reform. As a result of this conference the Second United States Volunteer Engineers were charged with this, doing the work.

"August 24 orders were received by me from Col. Willard Young to proceed to the general hospital and take entire charge of the sanitary work about the grounds. This was in no way to interfere with the internal management of the hospital. All work engaged in by the several details of the regiment, except those laying the water pipes and the laying out of the infantry camps, was to be suspended, and all efforts to be turned toward the rapid accomplishment of this much-needed sanitation.

"Accordingly, August 25, at 7.30 a. m., I proceeded to the general hospital with 6 officers and 150 engineers and inaugurated the work. Later in the day the Secretary of War and Maj. Gen. Joseph Wheeler visited the grounds, and reiterated the instructions given me by Col. Willard Young: Use every possible effort to remedy at once the existing insanitary condition; to continue in charge and see that the grounds were kept in order, and that all necessary help would be furnished; to use freely their names in ordering any necessary supplies or procuring needed assistance. In accordance with these instructions, Lieut. Oscar S. Durfee, Second United States Volunteer Engineers, by order of Colonel Young, reported to me with 67 quartermaster laborers and 2 foremen, with 10 wagons and 7 dump carts on the following morning. These laborers took the place of the engineers as soon as their labors had been completed, and have since carried on the general work under the immediate supervision of Lieutenant Durfee, assisted by 4 noncommissioned officers of engineers. This work was greatly facilitated by large details of men and wagons sent from the cavalry regiments.

"In looking over the ground I found that there was the greatest need for commodious and comfortable latrines, placed at a safe and respectable distance, and the immediate stoppage of the soiling of the surface of the ground, in many instances through the carelessness or ignorance of the attendants employed in the wards. The latrines already in use were small and placed only a few feet from the wards. Those at the northeast corner of the main hospital were placed on swampy ground and could not be dug over 2 or 3 feet deep. Similar latrines were placed at the northeast and northwest corners of the main hospital on high and dry ground. These latter were on the main approach to the hospital. Others were located on the east and west sides of that part known as the annex. These latrines were foul smelling and the men using them plainly exposed to public view. They were so small that they could not accommodate the great number of men, and in consequence the surface of the ground around about them was often befouled. Two men only had been employed in digging, filling, and disinfecting these latrines in a desultory way. From the constant necessity of moving the latrines the ground around about was rapidly becoming honeycombed and a great source of infection. Screens were at once built around these latrines, which were used while other and more comfortable ones could be constructed. The place chosen for these new latrines was to the north of the main hospital, where the necessary depth of 8 to 10 feet could be had. To reach these it was necessary to build a plank walk, with railings, 270 feet long across the swamp. Here latrines were built as follows:

"A latrine consisting of two sinks, each 100 feet long, 8 feet deep, and 4 feet wide, dug parallel to and 6 feet from each other and covered by light frame buildings 7 feet in front, 5 feet high in rear, facing each other. A board fence 3 feet high between the two sinks gave the necessary privacy and economized lumber, the front of the buildings not being boarded up. The seats were the ordinary holes, 10 inches in diameter and 2 feet center to center. At each end a lateral trough 6 inches wide and 4 feet long, leading into the sink, served as a urinal.

"The latrine was economical and served its purpose admirably. A hinged door on the bottom rear gave easy entrance for disinfectants. The building was strong enough to permit being moved to new sinks as often as necessary. Suitable openings were left for emptying bedpans, etc.

"Other and similar latrines were built for the annex, the officers, and nurses. Six laborers were assigned to the care of these latrines, keeping the seats and


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floors clean, and attending to the disinfection and the filling in of the sinks. All sinks were disinfected every hour during the day in the following manner: A liberal amount of lime was thrown over the fecal matter and over this fresh dry earth. On top of the dry earth was thrown a layer of copperas. In this way the fecal accumulation of the next hour fell in disinfectants and was in turn covered with lime and earth. There was scarcely any odor when properly attended to. This method took the place of the individual disinfection and covering of stools with dry earth as recommended by most sanitarians as the best, but in this special case impracticable owing to the sick and weakened condition of the men.

"The ward attendants, in many instances private soldiers with no knowledge of the modes of conveying infection, were in the habit of emptying bedpans and vessels on the surface of the ground about the latrines, in the roads, gutters, and swampy pools which surrounded the hospital. The garbage cans and barrels placed between the wards as receptacles for table refuse were even used as dumping places for the contents of bedpans and commodes. It was the custom also of these same attendants to wash these vessels in the swampy pools. These methods of conveying infection not only prevailed openly in daytime, but under cover of night were even more pronounced. To put a stop to these nuisances, on August 29 I applied in person to Maj. Gen. S. B. M. Young for a guard. One officer and 30 men reported to the hospital for guard duty and ten posts were stationed about the wards. In this way these insanitary offenses were stopped and the ward attendants made to empty the stools properly into the sinks.

"In order that there should be some place for cleansing the soiled bedpans, etc., a water plug was placed on line with the latrines and a hole 6 feet square and 10 feet deep was dug. This was covered after the manner of a "hopper," in which the vessels, etc., could be cleansed and the hole kept thoroughly disinfected.

"Garbage from the kitchen and wards, which was heretofore hauled to the beach in front of the First Division infantry camp, was now hauled to large refuse pits, properly disinfected, and buried. So great was the accumulation of refuse that it was some days before any impression could be made on its removal. This refuse as far as possible was separated into the destructible and burned, such as clothing brought from Cuba, such ordnance stores as haversacks, belts, etc., boxes, etc. The indestructible was buried. All materials left after burning were raked together and buried.

"Soiled and infected bed linen, blankets, mattresses, and pillows were thrown out and had been piled up under each ward. They were wet and moldy, foul smelling, most obnoxious to the sight, and a source of infection to the occupants of the wards above. It was now determined to haul the bed linen to the laundry and burn the infected bedding. At that time this was the only feasible method of disposing of this linen. The completion of the laundry being delayed, this infected material accumulated there in large quantities, which would have been a great source of infection had it not been properly ordered burned by Maj. Gen. S. B. M. Young, September 10. After this date no linen was destroyed, excepting cast-off clothing, as the laundry was now able to take care of it. All linen and blankets that had been laundered were delivered to the hospital under our detail.

"On account of the great amount of dust, on August 29 I obtained from Maj. Gen. S. B. M. Young an order for sprinkling carts. From this time on the entire grounds and wards about the hospital were free from dust.

"Hitching posts were constructed at a distance from the hospital, and orders issued that all horses and conveyances should be kept out of the avenues about the hospital headquarters and away from the kitchens, where they were wont to congregate.

"In addition to the building of all latrines, Capt. Barton F. Dickson, with 2 officers and a detail of 12 noncommissioned officers and 48 men, constructed all carpenter work. The kitchen of general hospital was properly floored after 12 inches of ground, indescribably foul by soakage, was removed. Platforms and troughs were built around all water plugs and filled around with sand. Three hundred feet of troughs were made for carrying away waste water. Large boxes were placed between wards as receptacles for refuse and soiled linen. Captain Dickson and detail were at work from August 25 to September 4.

"Capt. A. W. Cooke, with detail of 3 noncommissioned officers and 35 men, improved the roads leading to the hospital as well as those around about the hospital. Many swampy places were filled in with sand and box drains put in where necessary. The hospital tent wards were trenched. The soaked earth around kitchens was removed, filled in with sand, and drained. Captain Cooke and his detail were at this work from August 25 to September 5.

"Sufficient force for the policing and the sanitary work of the detention hospital and camp had not been provided. Refuse pits were placed too near the


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hospital, and the soiled and infected linen was thrown upon the ground between the wards, nor was there any surface or hydrant drainage. From September 8 to September 25 Lieut. C. F. Jackson, Second United States Volunteer Engineers, was placed in charge of this work under my supervision. New latrines were built and pits for garbage from kitchen and wards were dug at a safe distance from hospital. More garbage cans, and receptacles for soiled linen and paper were procured. Grounds about hospital were thoroughly policed, and lime sprinkled freely where refuse had been thrown. The latrines were now disinfected on the same plan as at the general hospital. All garbage was hauled to refuse pits and buried. The destructible refuse was burned and the indestructible buried. Drains were constructed for surface and hydrant water.

"The general policing of the various vacated camps was done by Lieut. Arthur T. Ballantine and quartermaster laborers from September 19 to 23.

"In a few instances only were any of the camps left in a clean and sanitary condition. This was notably so in the case of the artillery in the detention camp and the First and Twenty-fourth Infantry. The camps vacated by the regular troops were in an average sanitary condition only, while the camps left by the volunteer regiments were in a deplorable state. Here were to be found numerous infractions of the elementary principles of sanitary science, the natural causes of infectious diseases. There was evidently no attempt at policing. In many cases it was found the unoccupied tents were often used as latrines. Paper, boxes, ordnance stores, etc., were scattered in all directions. Some tents were trenched, others not. Wagonload upon wagonload of commissary stores and quartermaster stores were left upon the ground.

"In some camps the sinks were not dug over 2 feet deep; in other camps they were using buildings which rested on the surface of the ground and no holes dug at all. No effort was made to take care of their sinks in any manner whatsoever. Refuse and garbage were scattered over the surface of the ground or left uncovered in the garbage pits. The camps of the Seventy-first New York and Eighth Ohio, Thirty-third and Thirty-fourth Michigan, First District of Columbia, Eighth Massachusetts, and the Rough Riders were left in the above deplorable insanitary condition."

Protection against fire-Large barrels and galvanized iron tanks, filled with water, were placed at the front, rear, and sides of each ward, into which a quantity of salt was thrown, for the double purpose of keeping irresponsible persons from using the water for other purposes and increasing its efficiency in extinguishing fire. Inside each ward were placed three brass fire extinguishers, which were easily handled and could be carried by a child and operated by simply inverting the cylinder. Each will throw a stream of water one-fourth of an inch in diameter 30 feet and will continue in operation for ten minutes. These, together with the surveillance of outside sentinels and the constant watchfulness of those on duty in the wards, both day and night, it is believed afford positive assurance that there is no danger of spread of fire. The wooden buildings for the sick are provided with a door at each end and two on each side for exit in case of fire. Axes are kept under guard in a central location so that they may be had at any time in case they are needed. The reason they are not distributed among the wards is that it is feared that patients in their delirium might obtain possession of them if they knew of their whereabouts, as we have found that many of the delirious patients are anxious to get hold of weapons.

This protection is not only for the wards, but for the storehouses as well, where the Government property is kept. In a word, every precaution has been taken to insure our safety against fire.

Policing of the camps-With regard to the protection afforded by the provost-marshal in policing the camps, etc., Dr. Brown submitted the following statement:

"Capt. George F. Chase, Troop D, Third Cavalry, was appointed provost-marshal, and his guard was so effective that it was impossible to get in or out of detention hospital without a pass from the proper authorities. When visitors and others came to the general hospital in great numbers, Captain Chase gave us great relief by holding up people who had no other business about the hospital than sight-seeing. It was not only in the protection afforded the hospital that Captain Chase assisted us, but I might say in every way. His duties were constantly enlarged, until, if anything was wanted from about the station, and wanted badly and quickly all that was necessary to do was to notify Captain Chase, and it was forthcoming at once. This is mentioned because it was so unusual at times to get prompt attention, and to receive supplies badly needed, from any of the other officers on duty about the railroad yards.


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"Part of the work of the provost-marshal was looking after the sanitary conditions of the whole camp, which was done in a very satisfactory manner. In this connection Captain Chase says:

" 'It being part of my duty to look after the sanitary conditions and to see that the policing was properly done, I am warranted in saying that, with the exception of the Eighth Ohio, the Seventy-first New York, and the camp of the Rough Riders, it was perfectly done. The Seventy-first New York, the Eighth Ohio, and the First Volunteer Cavalry left Camp Wikoff and their camp sites in a filthy condition. It was necessary to employ a large gang of men for several days to get these camps cleaned up and in sanitary condition.' "

Sanitary condition of troops at Camp Wikoff-ln regard to the sanitary condition of the troops at Camp Wikoff, Maj. H. S. Kilbourne, under date of September 17, reported as follows:

"The Fifth Army Corps arrived at the camp by transports from Santiago do Cuba during the latter days of the month of August and the first two weeks of September, 1898, having about 1,500 men on sick report, in addition to those transferred from the general hospitals at Siboney-in all about 2,000 sick, with increasing numbers.

"For the reception of the sick a detention hospital and a general field hospital were established at this station, with a capacity sufficient to accommodate the more serious cases of illness and abundant supplies.

"In order to provide for the less serious cases of illness among the troops, three additional field hospitals were installed by the division surgeon of the Fifth Army Corps, with a capacity of 180 beds each, new tents being obtained from the depot quartermaster at Montauk for this purpose, and furniture and medical supplies from the purveying depot in New York City.

"From the supplies of this hospital necessary medicines were issued to regimental surgeons as they were required.

"I assumed the duties of chief surgeon of the Fifth Army Corps on September 6, 1898, since which date there has been no lack of supplies and accommodations for the sick of the command.

"Owing to the large number of sick to be provided for, and to relieve the congestion of the hospitals, the transfer of sick soldiers by rail and transports to other points and the furloughing of convalescents has been regular and continuous since the above-mentioned date.

"The movement of the troops to other stations has been in progress for the past ten days. At the present time a majority of the troops are arrived or en route to other stations, and there are remaining in the̓ hospitals a comparatively small number of the sick.

"The site of the camp is, in my opinion, well chosen. The locality is accessible by both land and water transportation. Proximity to the sea, an open, rolling, and elevated country, and an abundant supply of pure water are afforded here.

"The conditions to be dealt with here are unprecedented. The victorious army returning to the United States from Cuba was greatly debilitated by the exposure and fatigues of the campaign. A majority of both officers and men are enfeebled by the incessant labors of an active campaign in a tropical climate. And while now, after the fact, it is not difficult to perceive how the contingencies of war might have been better appreciated and met, I am able to say with confidence that all resources available in this place for the mitigation of the suffering of the troops have been continuously employed.

"Timely aid has been afforded here by various organizations and individuals, the Red Cross Society, the Massachusetts Aid Society, the Christian Brothers, and especially the service of the special diet kitchens, organized and conducted by prominent women. All these have been found valuable adjuncts to the Army of a nation whose custom it is to declare war and afterwards prepare for war."

Maj. H. S. T. Harris, on the same date, also reported on the sanitary condition of the camp as follows:

"I arrived at Montauk Point August 17, with the First United States Cavalry and a battery of the Fourth Artillery, in the steamship Matteawan. There were some 70 men on sick report in the ship, and the whole command was anaemic and wasted from malarial infection in Cuba to a greater or less degree.

"We found well-equipped hospitals already established for the reception of our more serious cases of illness (some 20 in number). The command found tentage already pitched and floored for its reception - in the detention camp; so that there was no work devolving upon them save the preparation of their own meals.

"Upon my release from detention camp, I found that the camp for the division was pitched before the arrival of the troops on a most excellent site as regards


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soil, drainage, situation, etc., the men being again spared the labor of making their own camp. The utmost care was used in preserving the cleanliness of the company kitchens, company streets, and the camp site in general, a police officer having been appointed in each brigade with full powers to report upon and correct any laxity in individual troops or regiments. Both quicklime and dry earth were used in the men's and officers' latrines. The water supply has been excellent, in my opinion, coming from deep wells lying below one or two impermeable strata of clay.

"Bed sacks were provided by the quartermaster's department and filled with straw. Many of the men constructed bunks for themselves out of lumber furnished by the engineers. New clothing was drawn in the usual manner to replace the worn articles brought from Cuba and Tampa, and free issues have been made to sick men leaving on furlough or going to hospitals.

"The regular ration has been added to by extra issues of ice, milk, eggs, oatmeal, canned soups, canned goods, and many other articles. These things, aided by many donations from various societies and individuals, have made such a profusion of diet, that in many instances the troops have refused to draw all their fresh meat and bread.

"Montauk Point is an ideal site for what has been really a malarial convalescent camp, swept as it is by refreshing ocean breezes, and presenting no exuberant vegetation to act as a means of fresh infection.

"The greater proportion of the sick at this date have either gone home on furlough, been sent to hospitals, or returned to duty. The remainder of the command has not fully recovered its former health and vigor, but is making as rapid progress as can be expected in view of the virulence of the malarial infection to which it has been exposed.

"Some cases of typhoid fever have been brought here from Southern camps, some few from Cuba. All suspicious cases which have came under my notice have been sent to general hospital, so that I am unable to state definitely how many, if any, cases have originated in this camp. Certainly, every practicable precaution in the matter has been taken.

"The medical care of the sick in this camp has been most careful. Both medical and line officers have taken the greatest interest in the matter, and delicacies have been furnished not to be surpassed in any hospitals in the country. Neither labor nor expense has been spared. So much has been furnished in the way of diet and help in its preparation (diet kitchens) ,that of the large sums available for this purpose only a small proportion has so far been used."

The following "Brief memorandum of the impressions produced as a result of my observations since I reported at Camp Wikoff, August 20," is furnished me by Maj. J. C. Powell:

"1. As to the condition of troops on their arrival .-From observing the officers and men on landing from transports and very soon afterwards in camp, their general appearance was that of men who had just gone through an extraordinary tax on their physical powers. Men who were not actually on sick report were wan, sallow, and greatly reduced, and all the conditions seemed present for the quick development of acute paroxysms of disease under but mild exciting causes.

"2. Effect of arrival at Montauk Point -There was no instant improvement in their condition as result of the change from the hot and exhausting equatorial zone to the mild and health-giving atmosphere of Montauk Point that prevails during the summer season. What change has taken place has been gradual, for to the conditions of disease brought along with them was added, as has just been suggested, that of thorough exhaustion. With the seasonal changes taking place now, many cases have been seen where disease had been lurking in ambush, so to speak, but with the advance of autumnal chill and damp it has been unmasked and developed into acute paroxysms.

"3. Capability for the performance of duty-It would be impossible to express an accurate opinion as to the amount of disability, but it was unquestionably very large, and even among those who were not on the official sick report I do not believe over half were equal to the proper performance of all their duties. Aside from the effects of a campaign, which it is agreed was exceptional in its demands upon the physical powers of officers and men engaged, the disabling character of the diseases from which they suffered-malarial and typhoid-is to be borne in mind on account of their prolonged effect, as it requires in a majority of such cases many months before the subject is able to shake off entirely the profound toxaemia that results.

"4. Care of sick and well-Nothing more could have been done under the circumstances. No more eligible site, in my judgment, could have been selected as


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a camp for the command than Montauk Point, limiting this remark, however, to the summer season. The rapidity with which hospital accommodations were prepared for -the sick and properly equipped camping outfits set in place for the apparently well, in my judgment, reflects great credit upon those engaged in that work, when it is remembered that such a mass of troops was rushed in with scarcely a moment's warning.

"5. The camp itself-For a summer sojourn of a couple or more months, this is in my opinion an ideal camp. In fall or winter I believe it to be the reverse. Climatic and weather conditions then exist favorable to the development of pneumonia, bronchitis, and allied diseases, and especially would this be the case with those who were in an enfeebled state in consequence of physical exhaustion or an impoverished state of the blood. The water I believe to be good, notwithstanding the insane crusade against it by the ignorant. For myself, I have taken it without boiling from all parts of the Point without the least inconvenience. Reference to some new features in military-hospital management may not be out of place. I wish to allude to the value of trained female nurses, which has been a revelation to me. The diet kitchens, too, where provisions for the sick, and especially for the very ill on such a large scale becomes necessary, are invaluable accessories."

Facilities afforded relatives and friends seeking information-The executive officer of the general hospital, whenever it was possible to ascertain the information, telegraphed to the friends or relatives the condition of those they were interested in. These, in case of a fatal termination, were at once notified of the death and information was solicited as to the disposition of the body. Those visiting the hospital to see their relatives and friends and who desired to remain overnight were comfortably tented, and provided with cots, mattresses, and blankets and permitted to eat Government rations. They were aided in every way possible to locate their friends, and if located, every facility was offered within our reach to afford them the means of visiting those sought for. Hysterical women and those seeking notoriety were not encouraged to remain here. Notwithstanding this, they continually hung on our flanks until quite recently, when, as the excitement began to wane, the place became uninteresting to this class of people, and they went to pastures new.

Records and clerical work-When the first troops arrived there was only one book in which to keep records; that being a blank book brought to the camp by the medical officer serving with the Sixth Cavalry. This served as a record of the troops coming with that organization, but could not be used for records of the patients soon arriving in great numbers. Consequently, there were no books or papers by which a record could be kept of anything except of admissions and deaths; and not until August 21 did we receive stationery that would permit us to undertake to keep a proper record of the patients here.

A report of the sick and wounded could not be furnished on account of the rapid change of the patients; for instance, patients arriving one day would be furloughed or transferred to another hospital the next day.

For a time after the stationery arrived it was impossible to work the clerks at night owing to the fact that there was no light. We were able only to obtain now and then a candle, which was absolutely necessary to have in the wards for the patients; the records, like the rest of the hospital, becoming better as time went by. Finally, when we had plenty of light and stationery, the clerks worked every night, sometimes all night, and now the records are as near perfect as one could wish.

The diet kitchen-The following is a statement by Mrs. M. H. Willard:

"Through the cooperation of Colonel Forwood it became possible to establish a diet kitchen for the sick and convalescent soldiers under the care of the general hospital at Camp Wikoff. Previous to August 27, 1898, all of the patients had been fed from the mess kitchen, a small wooden building presided over by an army cook, who had neither the time nor knowledge to prepare food necessary for the diet of malarial and typhoid patients. The army rations or hospital stores of rice, oatmeal, and milk formed the diet for every meal, until many of the patients were unable to digest their food. The physicians and nurses could not secure the simply prepared chicken, beef, and mutton broths, so necessary for the proper nourishment of the sick. As soon as the men were convalescent they were sent to the mess kitchen, where they could obtain only the army rations of pork, beans, bacon, and (at times) fresh beef. It is conceded by all physicians that the diet of the fever convalescent is the most important factor in the patient's recovery.

"It was the great need for carefully prepared food which prompted the Red Cross Society and the Massachusetts Volunteer Aid Association, represented by William H. Prescott, M. D., to establish between the general hospital and the


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annex a diet kitchen, to be conducted on scientific principles, and to provide all liquid, light, and special diets. Tents were secured August 23, 1898, and every arrangement made as speedily as possible to feed the 1,500 patients in the hospital. Every assistance was given by the authorities, and valuable aid was rendered by the volunteer engineer corps in putting up the framework, in perfecting the sanitary arrangements, and in bringing running water into the tents. All expenses of a large supply of kitchen utensils, cereals, and foods were paid by the Massachusetts Volunteer Aid Association, who also secured the cooks. The Red Cross Society placed Miss E. F. Cox in charge, a dietician and graduate of a Boston school of dietetics, who thoroughly understood cookery for the sick. On August 27, 1898, four days after the first plank was laid, supper was served to the patients. Since that date about 4,000 patients have been fed. Beef tea, mutton and chicken broths, custards, rennet, steaks, chops, scraped-beef sandwiches, broiled chickens, birds, and other delicacies have been served.

"The officials in charge of the hospital speedily recognized the value of the work, and a few days following the opening of the kitchen it was turned over to the Government, accompanying orders from Maj. C. L. Heizmann that all supplies needed outside of the general-hospital stores could be purchased independent of the commissary department. The kitchen was then enabled to meet almost every demand upon it for any delicacy required by the patients. The surgeons in charge of the division hospital requested that the diet kitchens should be established before the opening of their wards. This was done at once; ranges and other necessary articles being brought from New London by the tug Alert, the property of the Massachusetts Volunteer Aid Association. The diet kitchen of the First Division hospital opened September 5, 1898, with Miss E. D. Ballinger in charge, and was ready to receive the first patients brought in. It continued until the hospital was disbanded, September 19, 1898, during which time 340 patients were fed for seven hundred and sixty-six days, making the total number of meals served 2,198. The diet kitchen of the Second Division hospital opened September 3, 1898, with Mrs.. A. E. Aldred, a graduate of the New York Cooking School, in charge, and the same careful system was observed as at the general hospital. Four hundred and forty patients were received; total number of days, six hundred and sixty-nine, and 2,007 meals were served. Owing to the late completion of the regular mess at this division the patients also received solid diet. The Third or Cavalry Division hospital was ready to open September 7, 1898, and the diet kitchen was completed in time to care for every sick man brought in. This is still open and the statistics not yet made up. At the detention hospital there was opened on August 29, 1898, a diet kitchen in charge of Miss Mary Fennessey, who, with only an oil stove and a few kitchen utensils, did excellent work. Through the system adopted by the Red Cross and the Volunteer Aid Association, and later by the Government, we were able to render valuable aid in securing ranges, kitchen utensils, and a prompt delivery of supplies. The kitchen closed September 19, 1898, having distributed meals to about 1,000 patients. The kitchen at the general hospital will remain in active operation as long as there is a patient requiring its services."

Upon my arrival, September 10, I found the various hospitals in excellent condition. In fact, I have never seen field hospitals better arranged or in more perfect order. The wards were clean, the attendance was efficient both by doctors and nurses, the food was well cooked and served, the discipline was good, supplies of all kinds ample, and the patients as well cared for as they could have been in the best-managed city hospital.

As my specific duty was to expedite the transportation of the sick to city hospitals, my attention was first turned to the means at hand for accomplishing the work. I found a train of 22 ambulances under the command of Lieutenant Sile, assisted by Dr. Moore; this train was camped partly near the dock, and partly at the division hospitals of the Fifth Army Corps, so as to he readily available for service at any part of the field. At the dock was stationed Dr. F. G. Jones, to take charge of the sick and conduct their transfer to hospital ships, and at the hospital a medical officer was assigned to supervise the transfer from wards to ambulances.

Prior to leaving Washington, I telegraphed an order for the assembling of a board of three medical officers to examine carefully all patients about to be transferred, and to determine who were in proper condition to make the journey; no man should go who would be likely to be injured in the transfer, or who was well enough to return to his regiment. The function of the board was subsequently extended to applicants for furlough, and their action in both cases was final. The board at the general hospital was composed of Lieutenant-Colonel Senn, Major Nancrede, and Dr. Delafield, of New York; all men distinguished in their


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profession. Similar boards were arranged in all the other hospitals at the camp. This action was a necessity, since the importunity of relatives and friends, and the desire of the patients to be sent home was so great as to embarrass the ward physicians, warp their judgment and thus lead -to the transfer of men who subsequently fell by the way, or possibly would die from the exertion and excitement of removal.

The hospital ship Shinnecock and the yacht Red Cross were available for water transportation, and some railway cars, equipped at the private expense of Mr. McMillan and Mrs. Whitelaw Reid, furnished land transportation. On the day of transfer early word was sent to the several hospitals to prepare the patients for removal at a fixed hour, usually 1 o'clock p. m. Clothing was issued, food given, and transfer slips prepared, the number to go having been previously reported. Guards were placed at the leading stations to keep away sightseers. As fast as ambulances were loaded they were driven to the dock, where Dr. Jones, assisted by a large detail of attendants, took charge of the patients and placed them on the ship.

Telegraphic notice of departure was sent to the officer designated to receive them at the point of debarkation. The points of shipment were New York, Philadelphia, Boston, Providence, New London, and other cities along the sound. The hospital ship was fitted with every convenience, well supplied with doctors, nurses, medicines, food, etc. Shipments were made every other day, and during my tour of duty over 1,200 sick and convalescents were handled. The first and second division hospitals were soon emptied, and I ordered them closed; so, also, the annex and branch sections of the general hospital; this for the purpose of convenience of administration, and to afford better service for the remaining sick. The medical board referred to decided also on the condition of removal of the patients from one ward to another.

As there was much apprehension regarding suffering of the sick from storms and cold weather, I ordered the construction of wooden pavilion wards, each to hold 40 patients, placing them alternately between tent wards, one tent ward being removed to give place to a pavilion. Their plan of construction was super-intended by Dr. Delafield, of New York. They were furnished with stoves, water was piped into them, ventilation secured, and the comfort and convenience of the sick when in them were thus assured.

The vast amount of public property made surplus by the departure of the sick and the concentrating of administration, was collected, packed in containers for shipment, regular inventory taken, and the whole placed in store tents in the general hospital, where it could be properly guarded, until finally disposed of by order of the surgeon-general.

The surplus personnel was gradually utilized at other places, doctors and nurses being sent to Cuba, Porto Rico, and Southern hospitals, by order of the surgeon-general, and on their application for retention in service, while those who desired it were granted a discharge.

Thus quickly, but in an orderly manner and without disturbance, this host of sick soldiers left the great camp almost deserted. At the time of my departure there remained about 300 very ill patients; too ill to be moved. They were receiving every comfort amid had ample provision made for their care until the end should come, or they were sufficiently recovered to be returned to their homes.