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Report of Maj. R. W. Johnson, Brigade Surgeon, U.S. Volunteers, on the Work of the First Division Hospital, Fifth Army Corps at Santiago, Cuba

Spanish - American War

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REPORT OF MAJ. R. W. JOHNSON, BRIGADE SURGEON, UNITED STATES VOLUNTEERS, ON THE WORK OF THE FIRST DIVISION HOSPITAL,

 FIFTH ARMY CORPS AT SANTIAGO, CUBA

FIRST DIVISION HOSPITAL No 1,
Camp near Santiago, Cuba

Maj. M. W. Wood, U. S. A.,
Surgeon, First Division. Hospital No. 1, Fifth Army Corps.

SIR: I have the honor to submit the following report of wounded in the battles of the 1st, 2d. 3d, and 10th of the present month:

I am well aware that the list is defective, and does not include the names of a great many who were admitted to this division hospital for treatment, but this was unavoidable, owing to the limited number of medical officers on duty, whose services were in constant requisition, caring for the wounded for three days and nights immediately following the battles.

Accurate information of the names, regiments, and locality of wounds was obtained from the time the first patient was admitted, July 1, until dark, when, owing to the large number of wounded coming from the front, and also to the fact that a number of these had been awaiting attention for at least three hours, it was decided to omit the histories; so none were accordingly taken for the remainder of the night. It was supposed that ample opportunity would be afforded the following day to enter in the records any whose names had been omitted owing to lack of time during the night, but the morning of the 2d found us with wounded coming in by the score, and the services of a medical officer could not be spared for that purpose. As a consequence many were simply dressed and forwarded to Siboney with no record of their names or wounds having been obtained.

A number of severely wounded from the first day's battle died during the evening or early the following morning after their admission, with absolutely no means of identification. It is with sincere regret that this statement must be made, but the immediate care of the wounded demanded the services of each and every member of the staff, including Hospital Steward Denning, Acting Hospital Steward McGuire and all other privates of the Hospital Corps.

This matter of classification could have been properly attended to had there been a large number of medical officers on duty with the hospital, but being the only hospital in the field, the wounded of all three divisions were carried to us for treatment as soon as transportation facilities were available. Human endurance had its limit, and it was simply impossible to give to these matters the attention they deserved, although the staff worked nobly and uncomplainingly for nearly three days and nights with but little rest. I will say that during the night of July 1, Major Bell, surgeon of the Seventy-first New York Volunteers; Acting Asst. Surg. Thomas R. Marshall; and First Lieutenant and Assistant Surgeon Kirkpatrick, United States Army; and on the 2d and 3d Majors Havard and McCreery, surgeons, United States Army; Captain and Assistant Surgeon Stafford, Seventy-first New York Volunteers; and First Lieutenant and Assistant Surgeon Gates, of the Second Massachusetts, were detached from their commands and reported to the hospital for duty. All rendered timely and efficient service.

The fact that a number of soldiers died unknown, through no fault of ours, emphasizes the necessity of adopting some means of identification in men who are so badly wounded as to be unable to give any account of themselves. The diagnosis tags issued by the Surgeon-General were not used to any great extent, as a great many wounded were brought in without them. In some cases the writing was obliterated by the rain, or so indistinct as to render them of no assistance to us. As a result of my experience in this matter, I strongly urge the adoption of a metal tag to be worn around the neck, giving the name, rank, and regiment, and such other information as would be valuable in case of the death of a soldier.

There were only a few operations of any note; the most important being three laparotomies performed in apparently hopeless cases for perforating gunshot wounds of the abdomen, but all proved fatal. In this connection the question of the advisability of such major operations in the field is well worth careful consideration, A number of men recovered promptly who were wounded in the abdomen by bullets, which could not in their course possibly have escaped perforating the intestines. If to the natural shock attendant upon such injuries there be the additional one of opening the abdominal cavity, in the great majority of cases the result is sure to be unfavorable. That men can under certain conditions recover after the receipt of an abdominal wound in which the intestines are unquestionably injured, is well known; this has recently been well exemplified. I do not wish to be quoted as an advocate of nonoperative interference in such cases, as I consider surgical intervention a most necessary procedure when all the


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surroundings are favorable; but in the field with our limited means of performing aseptic surgery, our inadequate facilities for after treatment, and the enfeebled and often infected condition these men are in after lying possibly some hours on the field of battle, and then removed several miles to the hospital over rough roads in army wagons and ambulances, make me confess to a liking for conservative surgery, which in such cases amounts to practical noninterference, so far as operative measures are concerned, as affording the only chance for the ultimate recovery of the patient.

Two amputations of the thigh were performed; one of the upper third for extensive crushing injury with great loss of tissue, and the other in the lower third for compound fracture, with injury to the main arterial supply. The former case was fatal in a few hours. The latter was performed several days after the receipt of the wound, on account of gangrene of the leg and foot.

An amputation at the upper third of the leg for a compound comminuted fracture of the tibia, with extensive loss of tissue, due to the explosion of a shell, was also performed successfully.

Ligation of the right lingual artery for secondary hemorrhage following gunshot injury resulted fatally, owing to the large amount of blood lost prior to the operation, and the consequent weakened condition of the patient.

A comparatively large number of compound fractures of the femur were sent to the hospital among the first, which soon exhausted our supply of splint material, but an excellent substitute was afforded by the woody part of the old growth of leaf of the palm tree, which when moistened could be accurately molded to the limb, in which position it remained after drying.

This made a very satisfactory splint, and while affording suitable strength was very light, and caused no pain or other inconvenience to the patient: A few Hodgen's splints were extemporized, but were discarded for those previously mentioned when the patients were transferred to Siboney. A more extensive experience with this splint will, I am sure, cause its adoption in many cases where neither Hodgen's nor Smith's anterior are available, and I accordingly recommend that a suitable supply be sent to the States for trial, as I believe it will be an excellent substitute for the heavy and cumbersome plaster-of-paris dressing now in such universal use.

The wounds inflicted upon our men by the small caliber Mauser bullets were much less severe than I had expected from the literature read on the subject. I certainly consider it a humane bullet in every sense of the term. There were a number of gunshot wounds of the skull where the bullet simply perforated the bones without any comminution or apparent splintering. In the case of Sergeant C- a bullet entered the right parietal bone near its junction with the frontal and emerged at the posterior border of that bone, lacerating the brain substance. The first two days after admission to this hospital he was partially unconscious, but on the third day became rational and began to improve. When transferred to Siboney a few days later his condition was better, and beyond some blunting of the mental faculties, with peevishness and irritability of temper, gave fair prospects of ultimate recovery.

Private B- received a perforating gunshot wound of the neck, the ball entering the right sterno-mastoid muscle at its middle, passing through the pharynx in its course, and emerging at the anterior border of the left sterno-mastoid at the same level. This patient was scarcely confined to bed, and up to the time of his transfer to Siboney, experienced very little difficulty from the injury. Perforating wounds of the chest, abdomen, and every other portion of the body healed kindly by first intention when not previously infected. Occasionally a ball seemed to pass directly through a bone without producing a fracture, but in the majority of cases-noticeably of the femur-a solution of continuity resulted. From what I have seen of the injuries inflicted by the Krag-Jorgensen rifle upon Spanish prisoners falling into our hands after the receipt of wounds, I have come to the conclusion that it is a munch more effective weapon and produces wounds of far greater gravity than the Mauser.

Boiled and filtered water only was used in every case for cleansing and irrigation, and care taken at all times to secure as complete asepsis as possible. More efficient and satisfactory results with much greater comfort to our patients would have resulted had we been allowed to bring with us from Tampa the hospital equipment we had collected after so much time and labor. To be required to leave all our ambulances, cots, hospital tents, and depend on flies only in which to shelter our wounded men lying on the wet ground, was not a very encouraging outlook, but we determined to accomplish all we could under the circumstances. Our facilities were totally inadequate even for the First Division hospital, and owing to the absence from the field of the Second and Third Division hospitals,


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which necessitated our caring for their wounded, work was thrown upon our hands for which we were entirely unprepared, and which taxed our resources to the utmost.

I desire to make especial mention of the strict attention to duty and valuable services rendered by the numbers of the hospital staff, Asst. Surg. G. C. M. Godfrey, United States Army; Acting Asst. Surg. H. P. Jones, United States Army and Acting Asst. Surg. F. J. Combe, United States Army.

In conclusion I desire to express to you my appreciation of your valuable advice and counsel, freely rendered at all times, which was of great assistance to me in the management of the hospital in its various departments.