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Report and Comments on Some of the Medical Features of the Santiago Campaign, by Lieut. Col. V. Havard, Chief

Spanish - American War

205

REPORT AND COMMENTS ON SOME OF THE MEDICAL FEATURES OF THE SANTIAGO CAMPAIGN, BY LIEUT. COL. V. HAVARD, CHIEF

 SURGEON, UNITED STATES VOLUNTEERS

Wars, like years, succeed, but do not resemble, each other. Not only do they each have special features, calling for special preparations, but the lapse of time works constant changes in the shape, size, and power of projectiles, so that each new campaign opens with problems unsolved and questions unanswered. The one subject about which military surgeons disagreed most-the behavior of the new small-caliber jacketed bullet-has apparently been solved, and solved in a


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manner to comfort and cheer all who have labored to render war less destructive and more humane. This new bullet, from which the swift annihilation of brigades and regiments had been predicted, is shown, on a sufficient scale to be conclusive, to cause no more casualties than the large conical bullet of former wars to cause proportionately fewer deaths (on the field and in hospital), and to give the wounded a much better chance of recovery. Never before have so many wounds healed by first intention, were there so few fractures, and so few operations performed.

At the battle of San Juan Hill, July 1, in which our troops assaulted and captured an almost impregnable position, the total number of casualties was 932 for the 7,000 troops present and under fire, a ratio of 13 per cent-namely, 11 per cent of wounded and 2 per cent of killed. At El Caney the total casualties were about 11 per cent. Among the Spaniards, who fought mostly under cover, the casualties were much under 10 per cent. Our proportion of killed in all the engagements at San Juan (1,039: 145 = 7.16) was somewhat less than one-seventh of all struck; among the Spaniards it was less than one-fifth.

It would seem that for the purpose of invasion of an enemy's territory by sea, where no harbor can be entered and landing must necessarily be effected in open bay and through the surf, particular attention would be paid to the loading of transports, so that all needful supplies can be readily found, readily landed, and in such shape as to be easily carried into the interior. Concerning this matter, it is notorious that serious mistakes were made, arising from the apparent want of a systematic original plan and from the great hurry and confusion which marked the last days of preparation and loading. As a result, each regiment had more or less of its medical supplies lowered in the hold of its own or some other transport, and mostly inaccessible. Medical officers in dire need of many things stood on the beach day after day making futile efforts to get at their supplies in the holds of ships sometimes anchored only a few hundred yards away. The almost absolute want of means of landing and disembarkation is one of the amazing features of the expedition. There was but one lighter and not a single steam launch with the fleet of transports. Obviously the Navy was expected to furnish help in this respect, and it did at times and places, but was oftener conspicuous by its absence.

A bit from my personal experience will illustrate the situation. On June 29 I transferred the provisional hospital at Siboney to Surgeon La Garde and joined the cavalry division, of which I was chief surgeon. I at once realized the scantiness of our supplies and the impossibility of setting up a division hospital; therefore, on the very next morning, I returned to Siboney with Surg. George McCreery and an order for four wagons to get our medical supplies from the hold of the transport Rio Grande. Only one rowboat was available for the service of all the transports. We took passage in it and on the way stopped by the Mohawk to let off an officer. A member of the untrained crew, lifting his heavy oar, dropped it upon and through the bottom, so that the boat filled up rapidly and we had to scramble out upon the Mohawk. It happened that this transport was without a single boat on which to forward us to our destination, the Rio Grande, only 300 or 400 yards away, or send us back to the shore; and the captain, with the selfishness and indifference of many of his class in those troublous days, declined to make any effort in our behalf. It was only after several hours of shouting and signaling that we succeeded in drawing the attention of the lighter, and, after much difficult maneuvering, were rescued and carried back to the beach. The effort had been hopeless. I returned to the front that same evening empty-handed, leaving Surgeon McCreery behind. He succeeded in a couple of days, with the help of Assistant Surgeon Rafferty, in obtaining two wagonloads of supplies, which were a valuable addition to the overtaxed field hospital.

But few ambulances were brought from Tampa. Only three had been landed by July 1, and were available on the days of the fight at Caney and San Juan. They were ably handled by Assistant Surgeon Godfrey, but, in view of the number of wounded, played an unimportant part.

The wounded from San Juan were all brought to the field hospital on the day they were hit or before the following morning; many of them on improvised litters carried by hand. In the evening and during the night a few wagons returning from the front became available, and the sick and wounded were crowded into them iii an apparently pitiless manner, but it was either this or else an indefinite waiting by the roadside. All or nearly all of the wounded from Caney were brought in by wagons the day after the fight. If we consider the abominable condition of the roads, the unruly state of drivers and mules, and the great difficulty of procuring the means of preventing jars and jolts, it is not saying too much that the 4 or 5 miles of wheeled transportation from the battlefields to the field hospital cost the lives of not a few patients.


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The question of transportation of medical supplies and patients is a vital one, and deserves more thoughtful attention than it has yet received. Reasonably or unreasonably, hardly anything short of perfection is now required from the Medical Department. To meet this expectation, we must accumulate stores on the most liberal scale and be left perfectly unhampered in our disposition of them. In this campaign we should have had a special medical transport ship in command of a medical officer, loaded with all the equipments and requirements of ambulance and field hospitals, and large reserve supplies-everything stowed away in its proper place and readily accessible. Such ship should have two large, stout steam launches and be in all ways independent. It could not be expected to carry ambulances and teams, but it could and should carry a train of, say, 30 picked and trained mules with 12 sets of packs, 12 small two-wheeled carts, and 12 mule litters; the packs or carts, or both, as roads may permit, to carry supplies to the front, and the litters to carry patients. Besides the medical ship, each regiment should have with it the material necessary, including hand litters, for a quick advance to the front, this material not to be stowed away in the hold, but kept above in the most accessible place and under the hand of the medical officer responsible.

Stress should be laid on the fact that ambulances are cumbersome, complex organizations, and (especially in a war of invasion), not available in emergencies when most needed. Pack mules and light 1-mule 2-wheeled carts are indispensable, whether we operate by sea or land. The inestimable value of these carts is not only as a means of transport before wagons and ambulances are available, but also as classified store vehicles, all the contents in their proper compartments and within reach. A large bulk of medical supplies filling up an army wagon is of no use until everything is unloaded and all boxes open; and by that time many bottles will have been broken and much stuff wasted, to say nothing of the time consumed.

As to the transport of patients, the Santiago campaign revealed painful omissions and brought out instructive facts. Hospital Corps men were sadly deficient in number, being (at least in the Regulars) less than 1 per cent of troops in the field, although all previous experience has shown the necessity of at least 3 per cent. This latter ratio should have been reached and organized before the Fifth Corps left Tampa; transfers of combatants to the Hospital Corps after boarding transports and landing upon the enemy's soil were obviously impracticable. It followed that all hospital corps men were absorbed by the field hospitals and dressing stations; and that not a single one was available as litter bearer.

The new regulation hand litter was conspicuous by its absence, having been left behind at Tampa and in the transports. It was hoped that, on account of its lightness and ease of folding into a small portable compass, this litter, in which we all took a just pride, would be available in limitless abundance and in that way make up, to a large extent, for all inevitable shortcomings of ambulances. It was a sad disappointment. Makeshifts of all kinds were resorted to-generally a heavy frame of poles covered with blankets and grass; many patients were thus carried 4 and 5 miles, over miry, deeply gutted roads, mostly at night, and most of them arrived at the field hospital in fair condition, much better than if carried in ambulance or wagon. Each of these improvised litters was borne by from 4 to 6 men, with a few additional bearers for a second relay, and therefore took away from 6 to 10 combatants from the line. One good effect of so many bearers was necessarily to "break step" and reduce the jolting.

In my opinion, the best means of transport, under the circumstances, would have been mule litters-that is, litters carried one on each side of a mule, as first devised by the French and now adopted in all armies but our own. Mule litters must become part of our equipment and will prove invaluable in our colonies.

Of travois, it did not occur to anybody to construct one, and not a single patient was thus carried away. Its construction would have been easy and taken hardly more time than that of a litter. The main difficulty was felt to be the procuring of animals, It would have been greatly to the advantage of patients to unhitch the six mules of a wagon and make them drag travois, but who, in those days, would have had the temerity to propose the abandonment of a single wagon while the whole front was clamoring for food and ammunition.

The regulation litter, wherever used, stood the tests of the campaign in a very satisfactory manner, and shows itself to be well adapted to its purposes. Its weak points are the canvas, which, under any unusual strain, bursts and fears, and the braces, which are liable to warp and break.

The new two-decker ambulance, constructed just before the war, is, in my judgment, such a defective and objectionable vehicle that I need say nothing further concerning it.


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It was expected that the long range of the small-jacketed bullet would change some of our ideas of field sanitary organization, and this expectation has been realized. Distance does not now count for so munch, while shelter counts for a great deal more. We may even go further and say that distance may distinctly increase the danger. The advance of large bodies of troops, like brigades and divisions, in formation of attack, has become more difficult. There is an instinctive, irresistible inclination to take advantage of all possible shelters, and this results in the breaking of the originally continuous line into more or less separated groups of battalions and regiments. This breaking or fragmentation of long lines becomes a matter of life and death, when, as at El Caney, a prolonged siege is maintained against an enemy having every advantage of position. Under the withering fire of an intrenched foe general officers lose their hold on the advancing line, and at the critical moment regimental officers must often take the final and decisive action, each one according to the conditions confronting him.

The deduction, so far as the medical department is concerned, is that each regiment in battle must be provided with proper medical personnel and material, and be more or less independent. The advice of modern writers to concentrate all supplies behind the brigade as a unit is not borne out by the experience of this campaign. Of course this regimental organization is only suitable for the battlefield and does not apply to the camp, where division hospitals very properly absorb most of the functions of the regimental hospitals.

The best place for regimental dressing or collecting stations will be the nearest place to the line of fire at which sufficient shelter can be had; such place will often be only a few yards back of the firing line, the latter being almost always along the crest of a hill or a rise of ground. The farther back we go the more exposed is the station to drop shots and the less useful it becomes. If there be no shelter in the immediate rear and it is necessary to pass over any large area swept by the enemy's fire to carry the wounded to cover, the removal of the latter becomes very questionable; chances must be balanced and opportunities taken advantage of.

I used the name "regimental dressing or collecting station," thus conveying a specific idea, which may be, and often is, a wide departure from the facts. The raison d'Ítre of a station is primarily its convenient location and safety, much more than the particular organization in its front. Thus, in the attack on San Juan Hill, only one station was established, although several regiments were under fire, because there was but one available place (at the "Bloody Bend," under the low bank of the San Juan River). It was a poor place, not even safe, but the only available one, and Assistant Surgeon Newgarden did wisely in locating it there, without regard to the position of the troops in front and rear of it.

After July 1, when our troops had carried the heights of San Juan, the "Bloody Bend" was no longer exposed to direct fire, but was still in danger from drop shots fired at least a mile away, and from sharpshooters. As patients continued to be brought there, and it was the farthest point ambulances could reach, it was thought best to retain it another day.

Meanwhile, other dressing stations were being established in the immediate rear of the firing line, not far below the crest of the hill and consequently in tolerably safe positions. It was recognized that one station may answer all the needs of a brigade; thus, a road led up to the rear of the Third, Sixth, and Ninth Cavalry and in a deep, hollow part of it Surgeon Harris established for the whole brigade a station which was comfortable, almost absolutely safe, and easily approached by ambulances. The First United States Volunteers (Rough Riders) and the Tenth Cavalry likewise joined forces and placed their station in a tolerably safe spot at the foot of a steep spur. The First Cavalry, being separated from the latter by a large exposed basin, required a separate station, which it shared later with two or three artillery batteries. Here natural shelters were very imperfect and a good deal of digging was required. In the same manner, stations were established all along the line, each corresponding to one, two, or three regiments, and sometimes to regiments of different but adjoining brigades.

According to books, each division of troops should have at least one ambulance hospital (ambulance station) 2 or 3 miles in rear and a complete, well-appointed field hospital 2 or 3 miles still farther back; but actual war is no respecter of theory and often upsets all our preconceived ideas. One field hospital was established near General Shafter's headquarters, 2 or 3 miles back of El Poso, and up to the time of the surrender remained the only one, and the only hospital organization of any kind in rear of the dressing stations, 4 miles away. Efforts were made to find another suitable place, but without success, owing to the facts that the country operated in was one vast jungle, with but few small clearings, and that there was but one road to the front. The only intermediate station was one improvised


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under a grove of large trees near El Poso. Here much good work was done by the medical officer in command. Walking patients rested, received stimulants, and, if necessary, were placed in wagons impressed for the purpose; all litters were stopped and the patients carefully examined, but without meddlesome handling of the dressings; patients in wagons were given more comfortable positions; several tourniquets twisted tight, probably too tight, at the dressing station were loosened to the great comfort of the patient and the possible avoidance of serious injury. The application of tourniquets on the line of fire, immediately after the receipt of a bleeding wound, must be useful, but further back it is of very doubtful utility, and it will always be wise, if circumstances permit, to examine and loosen tourniquets in transit to the field hospital.

It is safe to conclude that, in future wars, the necessity for immediate operations being less and the patients able to stand longer transportation, less stress will be laid upon the importance of the ambulance station, which will generally be merged into the division or field hospital. It will be enough to have an "observation station" to see that all patients in transit are in the best condition possible to reach the hospital safely.

It is not my purpose to discuss matters pertaining to the field hospital; this I leave to others more directly interested and better informed, but the work in first aid done along the line should not be left unnoticed. Little dressing material had been taken to the front. Fortunately, first-aid packets were plentiful. Medical officers had succeeded in impressing upon many officers and men the necessity of carrying these packets, and along almost every part of the line they could be had in sufficient quantity and were invaluable. Probably never before have first-aid packets played such an important part in the treatment of gunshot wounds. Our surgeons and hospital corps men had hardly anything else, and, in truth, did not need much else. Let the surgeon of the next war provide himself with plenty of first-aid packets, wire splints, a small case of instruments, rubber tourniquet, and a bottle of stimulant, and he is suitably prepared for all the eventualities of the firing line and dressing station.

The packet being of such vital importance, its composition should be carefully studied. We know how munch depends upon the proper application of the first dressing and the necessity for leaving it undisturbed until special indications call for a reexamination of the wound. This first dressing is made easier and more successful with large compresses, say twice the size of those now in use. Compressed cotton, containing an antiseptic powder, and which can be readily spread out, would, I think, prove a munch better material than gauze.

Diagnosis tags were not generally used. Many of the surgeons who were provided with them failed to appreciate their value, thinking that when minutes are so precious tags do not matter. From my own experience of the tags seen in front, on the road, and at the field hospital, I am more than ever convinced of their great utility (under an improved form) and would urge that no dressing be considered complete until the tag is pinned on.

After the surrender of Santiago, when the troops had selected the best sites for their camps, and tentage was abundant, each division set up a hospital of its own, the overflow from which was received into a large field hospital established at a central, readily accessible point. In addition to these, each regiment had also a few hospital tents for its milder cases. This organization appeared to be the best possible under the circumstances, and gave excellent results.

In closing, one is naturally prompted to call attention to the excellent, nay, admirable work of our surgeons along the line of fire. I never heard that any medical officer had shirked his duty because of danger, or failed to help a patient that he could reach. I was specially well situated to see the first-aid dressing applied to the wounded under fire, on June 24 as well as on July 1 and 2, and could not help admiring how carefully and effectively the compresses and bandages of the packet had been applied in a majority of cases, as well as the improvised splints in fracture cases. Very few patients reached the field hospital with wounds unbound and unsupported.