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Report of Maj. Louis A. La Garde, Surgeon, U.S. Army, on the Operations of the "Base Hospital," at Siboney, Cuba

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REPORT OF MAJ. LOUIS A. LA GARDE, SURGEON, UNITED STATES ARMY, ON THE OPERATIONS OF THE "BASE HOSPITAL," 

AT SIBONEY, CUBA

Dated October 31, 1898

Origin of the hospital.-The hospital was the outgrowth of a field hospital which I was ordered to establish in accordance with paragraph 2, Special Orders, No. -, dated Headquarters United States Forces, Tampa, Fla., May 3, 1898, for


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the accommodation of the troops serving in Port Tampa and vicinity. The troops serving on the ground were composed of the Ninth Cavalry and the 10 light batteries of the artillery arm. These troops were not brigaded; each arm was commanded by its ranking officer, independently.

The hospital was established as is contemplated in our scheme of organization by calling in all property and personnel, except such minimum allowance as might be required by the battery and regimental surgeons at sick call. In the manner mentioned we found ample supplies of all kinds for the immediate needs of the command. There were 9 medical officers, 1 hospital steward, 11 acting stewards, and 35 privates of the hospital corps for duty.

As time passed during the month of May, it became more and more certain that the troops serving about Tampa would be organized into an expeditionary force for the early invasion of Cuba. The exact time for the latter was always a matter of doubt, still the officers in all the departments worked faithfully to complete and perfect their organization with the view of placing themselves and those under them on a war footing. About the middle of May I was informed that the field hospital at Port Tampa would be designated as one of the divisional hospitals of the Fifth Corps. I never knew until June 8, the day of embarkation, that it would be known as the reserve divisional hospital. When the object of the hospital dawned upon us, we proceeded in earnest to supply it accordingly. By this time the matter of obtaining medical supplies had become very much simplified by the establishment of a medical supply depot Tampa, from which we obtained all the necessary medicines, dressings, some stores, especially stimulants, bedding for 200 men in the event of battle or other necessity. The necessary amount of tentage, a thoroughly equipped ambulance train of 10 ambulances, and mounts for 56 members of the Hospital Corps were obtained by timely requisitions upon the different departments. First Lieut. and Asst. Surg. James M. Kennedy was appointed ambulance chief, and it was largely to his indefatigable efforts that the train was placed in condition for field service in such a short space of time.

Orders to embark on transports with the rest of the Fifth Corps were received on June 6. The hospital, consisting of the following personnel and supplies, was loaded on the steamship Saratoga on the 8th: Three medical officers, 1 steward, 2 acting stewards, 17 privates of the Hospital Corps; tentage, bedding, medical supplies, and stores, as already stated, for 200 men. The stores, with the exception of stimulants, were insufficient. We trusted to the commissary, which carried an abundance of milk, soups, and other delicacies for the sick. Our deficiency in medical officers and personnel generally was painfully apparent, but the hurry and confusion of throwing a large army in the field so suddenly made this unavoidable. Our large number of members of the Hospital Corps, which at one time aggregated 69 men, had been reduced from time to time by demands from the corps surgeon to supply deficiencies elsewhere. At the last moment we were informed that the ambulance train and mounts for the Hospital Corps could not be taken, presumably for lack of transportation. The train was left encamped at Port Tampa, under command of Assistant Surgeon Kennedy, to be shipped at some future time. Request was made of the chief surgeon Fourth Corps not to disintegrate the train unless it should become absolutely necessary. I am happy to state that the request was strictly complied with.

Aside from the reserve divisional hospital, the steamship Saratoga was loaded with the Thirteenth Infantry and one battalion of the Twenty-first Infantry, Lieutenant-Colonel Worth, commanding. The voyage to Siboney, our place of landing, was long, tedious, and marked by many weary delays. The command was on board ship nineteen days before disembarkation took place. The overcrowded condition of the ship for a long voyage, the inadequate ventilation and heat between decks, the hot, blue woolen uniform, and the sameness in the diet of the travel ration had begun to tell on the strength of the men, whose resistance had been correspondingly lowered for the exigencies of an arduous campaign in the tropics, out of season.

The comments I may have occasion to make in this report are not employed with a view to criticise the conduct of my superiors. I believe we should all be mindful of the fact that the conduct of a war in the tropics is to us a new business, and that we were apt to make mistakes, which are now generally admitted. It is by a candid admission of certain facts that we can the better prevent such errors in the future. I believe that the overcrowding on the transports on the way to Cuba had much to do with subsequently reducing the effectiveness of the command. I am of the opinion that we erred in allowing ourselves (1) to believe that we were attempting a short voyage, and (2) we erred in estimating the carrying capacity of our vessels by the rule observed with the British troopships of "a man to 1 tons, an animal to 2 tons." This rule is applicable to ships with clear between decks, especially constructed for the transportation of troops, like those


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possessed by England; but it is not in any way applicable to the passenger and freight steamers fitted up with tiers of bunks, composing the fleet which carried us across. In the vessels built for the purpose with clear between decks the space is occupied during the sleeping hours by men in tiers of hammocks. During the day the hammocks are taken down, thereby increasing the superficial area.

I was ordered by the adjutant-general of the United States forces near Tampa, by letter dated May 8, to inspect certain transports then lying at Port Tampa. The letter was accompanied by a memorandum estimate of the carrying capacity of the transports. It was at once apparent that the carrying capacity had been largely overestimated. For instance, if we take the D. H. Miller, by the memorandum, which was based on "the ton and a half rule," we find that its reputed capacity was 1,116 men, while its actual carrying capacity, as determined by due regard to superficial area and cubic air space, was found to be but 341 men. The latter figure agreed exactly with the judgment of the captain as to the capacity of his vessel, and the same may be said of the other captains of vessels when the figures obtained by the two methods were shown them. They invariably admitted that the tonnage rule could not apply, except for an extremely short voyage.

After the command had been loaded upon the transports, June 11, prior to sailing, there were many complaints of overcrowding on the Saratoga. On the latter date I stated as follows: "As an instance of overcrowding, * * * the vessel that I am on gives but 77 cubic feet per capita in the after part (aft between decks), where tiers of bunks have been erected. At two inspections last night the heat and fetid condition of the air was intense. The men lay in their bunks naked, fanning themselves with their hats. Such a condition of overcrowding is not justified, except for a short voyage, not to exceed twenty-four hours. There are six cases of fever that have developed in the last thirty-six hours." We succeeded in having two of the companies of the Twenty-first Infantry removed to another transport. Still the overcrowding was in excess for anything except a very short voyage.

In a report to the assistant adjutant-general, Third Brigade, First Division, Fifth Army Corps, dated off Santiago, June 20, 1898, a report required by the manual (Troops on the March and in Campaign), I again touched upon the subject of overcrowding. "The practice of harboring men on these transports in tiers of bunks between decks is pernicious in the extreme. * * * As the floors are required to be washed once per week, the dampness that ensues for the want of aeration lasts two and three days. The bunks deprive the men of the superficial area upon which to move about in the day, to say nothing of their infringement upon the cubic contents. The bunks are superimposed in tiers of three double bunks with passages between so narrow that two men can scarcely pass each other. * * * Two cases of measles and 13 cases of fever from heat and exhaustion were noticed." As stated before, the men on the Saratoga were cooped up in this manner nineteen days, which lacks a great deal of being a short voyage.

The troops disembarked at Siboney on or about June 26. On the latter date I went on shore with the corps surgeon and the surgeon in chief of Admiral Sampson's fleet. We walked the ground over carefully in our endeavor to find a site for a hospital. Troops were quartered everywhere. Camp sites were limited, there were no sinks, and the stench from dried and recent human excreta overpowered the senses on all sides. The population and houses comprising the town of Siboney had but little to recommend them better than the ground outside. The vicinity just north of the landing was marked by a number of sloughs, which precluded its use for a hospital site. The region to the east was rocky and marked by high hills. To the west lay the site of Siboney, well drained, hut rather contracted. The subject of burning the town down to prevent any possible infection from yellow-fever, and to allow more available space was discussed and repeatedly urged. The fleet surgeon stated that this had been done by the Navy at the point of landing at Guantanamo. The wisdom of such a step was brought to us very forcibly afterwards.

We commenced to unload the hospital the next day, the 27th. We had but 17 members of the Hospital Corps, and 3 small boats to move our stuff, which in bulk amounted to one and a half carloads. The Saratoga lay 300 yards in the stream, the surf was high. The plan was to have a detail to load on the ship, and when the boats were loaded, to row one and tow the rest to shore, where another detail proceeded with the tedious work of unloading. The surf being high-there were no docks-the small boats could not be gotten nearer than 15 feet from shore, so that it was necessary for the men to walk in the water waist deep for the property, which was placed on their backs and carried to the beach. It was not possible to land much property in one day under such circumstances; still we continued to work in this way, as the only means at our disposal, until orders were


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finally issued to place the property on one of the lighters, while Colonel Weston the chief commissary, very kindly unloaded it for us.

The hospital site on Siboney's water front was about a half mile from the land mug, to which all the property must be carried by human muscle. Large details were obtained for the purpose from the commanding officer at Siboney.

About 80 patients with wounds, measles, heat stroke, fever, etc., were quartered in an old store under the care of Maj. V. Havard, United States Army. As Major Havard's division had gone to the front, the hospital was turned over to us. Capt. M. W. Ireland was placed in charge, while I busied myself transferring the property from the landing, superintending the pitching of tents, and the arrangement of a record room and dispensary. Assistant Surgeon Fauntleroy was placed in immediate charge of all arrangements pertaining to the operating room. His fertility in resource-in making something out of nothing-may be mentioned in part herewith; tubs for slops, and bichloride solutions were made out of barrels and kegs sawed in two; glass demijohns of 3 and 4 gallons capacity, found in a store near by, were utilized as jars for sterilized water and antiseptic solutions; operating tables were made by placing litters on the frames of bunks from an old Spanish barrack. These bunks were higher than common, and they answered the purpose very well when covered with a rubber cloth.

Tables were taken from the offices of the Juragua Company's offices and other buildings, to hold dressings, instruments, etc. The water main of the little town was tapped opposite the operating room so that water was provided in abundance. With few exceptions our assortment of instruments was liberal, having provided ourselves from Fort Robinson, upon taking the field; until later when Dr. Fauntleroy joined us at Port Tampa, on the eve of sailing, he brought a large assortment. In this way we had instruments sufficient to supply six tables very nearly. A few instruments were furnished by Major Nancrede, United States Volunteers, and Dr. Lesser, of the American Red Cross Society. The vexed question of sterilizing dressings in the field was overcome by the abundance of clean dressings so handsomely prepared by the makers, and abundantly furnished by our department.

On the morning of July 1 we were ready for the reception of 200 wounded. We soon learned that an advance of our line had been ordered and that the troops were engaged in battle. Our base was practically stripped of soldiers. The Thirty-third and Thirty-fourth Michigan regiments, under General Duffield, who commanded at Siboney, had been ordered, on the night of June 30, to make a demonstration on Aguadores, on the left of our line, along the Juragua railroad, 8 miles to the west. His command, which was entirely composed of infantry, fared badly in running upon some batteries which poured shell and shrapnel into it, causing a rather precipitate retreat. A train bearing 2 dead and 7 wounded steamed in front of the operating room, accompanied by Majors Nancrede and Vaughan, shortly after noon. The wounds were caused by fragments of a shell, necessitating two amputations, one of the forearm and the other of the thigh. Later in the day some of the less severely wounded commenced to arrive from the main line. Their reports of the extent of our casualties were necessarily inaccurate and conflicting. At about 10 p. m., a teamster road into camp on one of his niules, stating that a train of 8 wagons of wounded was blocked on the road to our advance, 4 miles away, and that men were needed to extricate the wagons from the mud.

I proceeded with the teamster to obtain an order from General Duffield for a detail of men. Before the detail had time to reach the sufferers they had received assistance from some other source. They reached the hospital at about daybreak. Many of the wounds had to be redressed. The injuries were not severe, as a rule. We busied ourselves in providing beef tea, coffee, etc. I regret to say that our outlay of delicacies was very limited. As stated already, we had depended for condensed milk, soups, oatmeal, lime juice, and other delicacies, upon our commissary department, which was well provided with such articles of light diet; but, for the lack of facilities to land, these articles were still on the transports. The landing of the troops was done in such a precipitate manner that ammunition and the bare ration of the soldier seemed by military necessity to be the first consideration. It was at this time that I remembered the offer of the honorable Clara Barton, president of the American Red Cross Association, through the corps surgeon, to assist us in any way she could with supplies and help from the State of Texas, which lay at anchor near our landing. I desire to testify herewith to the loyal manner in which this promise was kept.

While the wounded for four days kept crowding into our hospital faster than large details of men could provide them with canvas shelter, Miss Barton's assistants worked unremittingly with us to relieve the pangs of suffering humanity. They furnished us, with willing hearts and willing hands, delicacies like gruel


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malted milk, ice, soups, etc., when military necessity prevented us from getting our own. As the wounded crowded upon us in numbers far beyond anything we had reason to anticipate, they came forward with cots, blankets, and other articles for the comfort of the unfortunates. For such help at a moment of supreme need, coming from people in no way connected with the military service, the deep sense of gratitude, not only of the medical department, but of the whole of the Fifth Corps, can not be conveyed by words. I desire to emphasize our gratitude in this manner because efforts have been made to make it appear that the medical department was not mindful of the extent of the services rendered; and, again, there are those who have attempted to minimize the efforts and preparations of the medical department of the army, while in their opinion, the bulk of the credit in the care of the wounded at Siboney belonged to the Red Cross Association. As far as my personal knowledge extends, the officers of the Red Cross Association are not responsible for such impressions. They are willing to accord to the medical department due praise for the work it had to accomplish under great difficulties. They understood the military situation which governed in the premises, and saw, as we did, our helplessness, for the time being, at least.

The actions of the 1st, 2d, and 3d of July, as already stated, crowded our hospital to overflow. In addition to canvas shelters, a railroad shed was used for cases of measles. A small cottage containing about 20 beds was turned over to the Red Cross Sisters, under Dr. Lesser, for wounded officers and men, and the large cottage, known as the Garcia headquarters, was used as a fever hospital, under Maj. John Guiteras. surgeon, United States Volunteers. The latter, who was the yellow fever expert of the expedition, had inquired into the history of the last two of these buildings, and, from reports made to him by the Cuban population, he was reasonably sure that they were free from infection, which opinion, we regret to admit, was far from correct, as the sequel will show.

At the same time that the kitchens were preparing diets day and night and that men detailed from the regiments were helping the regular Hospital Corps men to care for the wounded, the operating room was the most active part of the hospital. On the 2d of July, Drs. Nancrede and Fauntleroy, of the operating staff, requested me to ask the Sisters of the Red Cross to assist at the operating tables. The second day of work had convinced us that we were very much in need of those having special training in operating-room technique. The few men we had possessing the qualifications necessary in this department were not able to satisfy the wants of the five and six tables that were running constantly, day and night. Accordingly I applied to Dr. Lesser for the Sisters, four in all, I believe. I also extended Dr. Lesser an invitation to assist in the operating room. We thereby received the benefit of their skill during the rest of the work which followed for the next few days.

After the services of the Red Cross were no longer required in the operating room, the worst cases among the wounded were placed in a ward over which Mrs. Lesser and her assistants ministered to the needs of those who required special nursing. In addition to the services of the Red Cross people, I desire to mention the names of Lieut. Col. Phillipe Varanes, assistant surgeon-general, Cuban army, also Surgeons Lewis, Elliot, Smith, and Spear, United States Navy, from the New York, and Dr. Karl Rudberg, royal staff, Swedish Navy. These surgeons, with Majors Nancrede, Vaughan, Captain Ireland, First Lieutenant Fauntleroy, and Acting Assistant Surgeons Parker and Lawrence, United States Army, formed the operating staff of the hospital. As the members of the operating staff became exhausted from overwork, their places were taken at different times by Major McCreery, Captain Winters, First Lieutenant Smith, United States Army, and others who were ordered by the corps surgeon as assistants. Later, upon the arrival of the hospital ship Relief, Lieut. Col. N. Senn, chief surgeon, United States Volunteers, and Acting Asst. Surg. Harry S. Greenleaf, gave us assistance. Our only regret was that this distinguished party had not been with us earlier. When the surgical work was completed, Colonel Senn busied himself in other fields. In the sanitary department he inaugurated reforms that proved of great value.

On the evening of July 4 the hospital contained over 500 wounded men and officers. Such a number so far in excess of our calculations, which, as was shown afterwards, was but a fraction of the number yet to come, was naturally appalling. The military surgeon is nearly always at a loss to estimate beforehand the probable casualties on the eve of action, since his knowledge of the battle tactics are too often limited by the military commanders, who keep their plans to themselves. Aside from these difficulties, common to all battles, the operations about Santiago presented unknown problems of a highly interesting character to all military men. For the first time in the history of the new armament two large opposing armies were to contest the ground between them with the hand weapons of reduced


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caliber employing smokeless powder. Although much has been written upon the casualties of battle to be expected under such circumstances, the opinions of men amounted to little more than theories prior to the operations in question.

If one will take pains to run over Longmore's tables on the subject he will find that the casualties in war have not kept pace with the improvements in firearms and this is especially true of the period which marks the evolution of the rifle from the smooth-bore gun. The reason is plain enough since troops in the days of the flintlock weapons, having a maximum effective range of 80 yards, advanced upon each other in close formation. The casualties under such tactics were apt to be larger than subsequently when additional range, flatter trajectory, and penetration were conferred upon the projectiles. The change of warfare in late years has really been a race between the scientific gun makers and the tacticians. As the former added range and penetration to their weapons, the latter sought to thin out their ranks-to fight in extended order-for the purpose of lessening the casualties incident to superior ballistics. The action near Santiago was about to furnish the first opportunity for an actual test of the new battle tactics with the small-bore rifle.

The opposing armies were about equal in number. They were armed with virtually the same gun. The arm of the Spaniard-the improved Mauser-has some advantages in penetration over those of the Krag gun, but they are so very slight that they need not be considered in battle. The wounds which the two guns inflict are practically the same. Writers upon the effects of the new armament in battle have estimated the results quite differently. Some have maintained that the new arm would be more deadly-that is, that the usual ratio 1 to 4 or 4 between the killed and wounded would be materially altered; that henceforth there would be one killed for every 2, or possibly 3, wounded. But few have maintained the opposite condition. There are those, again, who have argued that the percentage of the wounded to the number of troops engaged would be less than heretofore, owing to the extended order, except in those rare instances when troops should be more or less massed to assault fortified positions, at which times the casualties would far exceed those with the use of the less effective weapons. I have written at length on this subject to show the additional reasons which served to mystify the surgeon in basing his calculations on the estimate for supplies and personnel, and especially the distribution of the latter. Had it been known beforehand that the battle about Santiago must consist of dislodging infantry armed with Mauser rifles, intrenched in well-fortified positions, with no artillery preparation on our part, and that the approaches to these positions must be along narrow paths-death lanes-it would have been in order to put the bulk of the relief corps at the collecting stations and well to the front.

The transportation of the wounded in escort wagons was attended with much suffering and inconvenience until the unloading of the ambulance train, which we had left, as stated, at Port Tampa, under Assistant Surgeon Kennedy. The train arrived on the Louisiana and commenced to unload at Daiquiri on July 1, the day of the battle. Two ambulances reported to me on the same day and were hurried to the front that night. The rest of the train was unloaded by July 3. As the ambulances were unloaded they were hurried to me, and I, in turn, dispatched them to the front with such medicines and dressings as were needed. This train continued to do invaluable service, day and night, in transporting the wounded and afterwards the sick to the hospital at Siboney until about August 1.

The lack of skilled nurses in the care of the wounded and sick was one of the chief troubles at the base. The volunteer organizations left as guard did as well as they could to assist us. Some of their men had received training in first aid, but the proportion was too small to result in much benefit. Even this help, as unsatisfactory as stated, could not be depended upon. Military necessity often deprived us of it at the very time we needed it the most. From one to two companies of infantry were constantly required for the proper policing, guard, to assist in nursing, etc.

On July 7, after one company of infantry had been distributed for the night among the various wards, which contained nearly 500 wounded, a sergeant came to the hospital, and, without reporting to the surgeons on duty, passed the word down the rows of tents "that the company should assemble at its camp at once." The surgeons became aware of our plight at about 9 p. m. Upon inquiry I was informed by the commanding officer that the troops had all been ordered for outpost duty. The surgeons and the day nurses, already worn out with watching, had to care for the distressed the rest of the night. I made repeated endeavors to obtain larger and more permanent details, but to no purpose. Finally the arrival in camp of Col. Charles R. Greenleaf, United States Army, chief surgeon in the field, had the effect to clear matters. The whole of the Twenty-fourth Infantry was ordered from the front to assist us. The discipline of these seasoned troops


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changed the aspect of affairs at once. For the first time in the history of Siboney order loomed out of chaos.

During those days of uncertainty as to help and lack of sufficient quantity of supplies from the 1st to the 8th of July, for causes already mentioned, I wish to record the many acts of kindness of the gentlemen of the press in out behalf. Mr. Lyman, president of the Associated Press, furnished us ice and delicacies often. Mr. Hearst, of the New York Journal, sent us ice by the ton, and gave us the use of his steam launch to tow the wounded to the transports and to bring supplies to shore when it was impossible to obtain other transportation. The spirit of humanity which prompted these gentlemen to come to our assistance, so regardless of their own interests, was beautiful.

The work of Capt. E. L. Munson, adjutant, of the medical department, Fifth Corps. in unloading supplies from the different transports, from the 1st of July to the 4th, supplied many deficiencies which must have persisted without his excellent efforts.

Although we might have done better with transportation of our own, and though the disappointment because of our inability to get at all of our supplies was bitter and exasperating in the extreme, we managed to care for the wounded, with no special amount of suffering, until the arrival of the hospital ship Relief, August 8. This vessel, so well equipped for the work at hand, was laden with 1,000 cots, and everything in the way of hospital supplies in quantities to correspond. Our hospital then assumed other functions besides the care of the sick and wounded from the front. Paulins and flies were pitched to receive this veritable purveying department. Captain Ireland was placed in charge of all supplies, and it was to his admirable method of systematizing his difficult task that the different hospitals and camps of the army were supplied by rail, ambulance, and wagon trains.

Knowing that we were at the place where the relief ships would first touch, the orders were at all times to send to the different points all supplies asked for. When we had run so low at one time that the wisdom of our liberality seemed questionable, the steamer Resolute hove in sight to supply all impending deficiencies once more.

The character of wounds-The wounds inflicted by the improved Mauser did not differ from the wounds of the reduced caliber weapons generally. They correspond to the wounds inflicted with the new arm by experimenters on the cadaver, dead and living animals, as well as those heretofore noted on man by accident and in war. The explosive effects so often noted in wounds at close range were not seen, for the reason that none of the wounds were received within the zone of explosive effects, which, under some conditions, though rarely, may extend to 500 yards. Those organs containing tissues rich in fluids, incased in cavities with bony walls, are more apt to show these highly destructive effects. The absence of these ugly wounds was often commented upon by surgeons. It is safe to say that examination of the dead on the field could have shown evidences of explosive effects in the wounds of the head, the heart, liver, spleen, intestines, etc. In reckoning upon explosive effects one should always remember the factors upon which they depend. To be brief, destructive effects are commensurate with velocity and sectional area of the projectile on the one hand, and with resistance in the body on the other. High velocity, greater sectional area, and greater resistance exhibit explosive effects, and vice versa.

It should also he borne in mind that only two things offer resistance in the body, viz, (a) compact bony tissue and (b) water. The fractures of the long bones were attended with but little comminution, and in quite a number of instances with guttering and perforation unattended with fracture. More than a score of gunshot wounds of the kneejoint were treated by immobilization and simple dressings alone with the happiest of results. Injuries of the joint ends of bones were invariably marked by clean-cut perforations. The injuries of the soft parts were comparatively trivial. Wounds of the head involving injury to the brain matter had to be opened up on several occasions on account of sepsis. The skullcap invariably showed fissures radiating between the wounds of entrance and exit, and islands of bone, sometimes free from dura and periosteum, but more often attached. All wounds of the lungs were recovering rapidly without apparent complications when received in hospital. The wounds that astounded us all were those of the abdomen. Four were noted of such wounds which, from the anatomical regions traversed, must have involved the caliber of the intestines numbers of times, and yet recovery had taken place with no apparent sequelae or ill effects of any kind. These cases were very wisely kept at the field hospitals, well to the front, until recovery was assured. Capital operations, such as amputations and opening of the larger joints, were done but seldom, and then only for


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sepsis, which, in the nature of things, would seem to be unavoidable in war in a certain proportion of cases.

Another circumstance which rather puzzled us was the frequency with which lodged balls were seen. This was variously attributed to (1) defective ammunition, (2) ricochet shots, and (3) long range. By testing the penetration of the two ammunitions in blocks of yellow pine, Capt. Charles A. Worden, United States Army, was able to demonstrate for me the fallacy of the first of these theories. The Spanish ammunition penetrated as much as 9 inches farther in the wood than ours, a fact which is not surprising, since the muzzle velocity of the Mauser is greater than that of the Krag-Jorgensen, and since, also, the sectional area of its projectile is slightly less. The lodged balls were evidently due, therefore to ricochet shots through the thick underbrush and to long range. Acting Asst Surg. W. E. Parker visited Santiago late in July to confer with the Spanish surgeons upon their observations concerning the character of the wounds from our guns. He informs me that their conclusions tallied with ours in every respect. They remarked especially on the number of lodged balls, which they attributed to long range, and the number of recoveries from gunshot wounds of the abdomen with undoubted intestinal perforations.

When we contrast the ravages inflicted by leaden bullets of large caliber with the humane effects of the projectile of reduced caliber noted in this battle, it is not extravagant to say that the portable hand weapons of to-day have largely reduced the subject of military surgery to first-aid work.

Although the operating staff was occupied for a period of five days of incessant work in the operating room, the surgical work consisted principally in the redressing of wounds. The number of operations of all kinds was very small.

Yellow fever and the burning of Siboney-On July 11 we had cleared the hospital of wounded by shipments north, and by the restoration of a few light cases to duty. The negotiations for the fall of Santiago were pending; still, our experience of a few days back convinced us that another battle of infantry, pitted against infantry with the new arm, must give in this instance a large casualty list to the attacking army. Our efforts were, therefore, directed to meet the exigencies of such a contest. More tents were pitched and wards were arranged in order for the reception of the wounded. Fortunately our apprehension in this direction was not realized. Yet there was a foe at work which was soon to put our resources to the severest test. About July 6 Maj. John Guiteras, our yellow-fever expert, reported that he had a suspicious case from our advance post near Aguadores Bridge. The admissions from yellow fever very soon multiplied day by day, and we at once established a detention station near the fever hospital in the old Garcia headquarters. In a very few days cases from the front commenced to arrive. The cases became so numerous that a yellow-fever camp had to be established on the railroad to Firmesa, 2 miles to the east.

To augment our difficulties, it was discovered, about July 9, that the buildings occupied as hospitals, dwellings, and offices in Siboney were recognized as sources of infection. Men of the Signal Corps, who had never gone away from the base and who lived in the offices of the Juragua Iron Company occupied by us as a telegraph station, were taken ill with the disease. Surgeons amid nurses were taken down in the Garcia and Clara Barton hospitals. The wisdom of occupying these buildings for any purpose had always been a matter of doubt. We deferred all questions of this kind to Dr. Guiteras. The reports to him from the Cuban physicians were most positive that the houses were free from infection and that yellow fever had not prevailed in the buildings which we were induced to occupy. I believe that the reports were probably true with regard to the non-susceptible Cuban population. For the susceptible American, it is doubtful if any part of Cuba in the vicinity of our base was safe. Infection is not only prevalent in the habitations; it is to be met with in the shady nooks about rocky recesses, caves, arbors, etc.

At one time two regiments-the Twentieth Regulars and Thirty-third Volunteer Michigan-led in the number of admissions from yellow fever. The latter regiment was then encamped on ground such as I have described, recently vacated by one battalion of the Twentieth, while the rest of the regiment was encamped on more open ground. Reference to the hospital records showed that the battalion of the Twentieth Infantry, composed of Companies A, E, F, and H, furnished all the cases of yellow fever from that regiment except one, the latter coming from that part of the regiment camped in the open. This is certainly convincing evidence with regard to the common origin of the disease in the two regiments, especially as the Thirty-third Michigan had camped nowhere else.

The destruction of the town of Siboney by fire seemed to be a matter of absolute necessity. In thus destroying this dirty little town, we were, at least, sure of


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limiting the number of new cases about us, and, as already stated, we needed the room to extend our canvas hospital, which was from the beginning on very contracted premises. Accordingly, on July 9 a formal request was made to headquarters at the front for the necessary authority. The authority was granted on the 11th and the buildings in West Siboney were burned on the 12th. The remainder of the buildings, with the exception of the railroad shed and a sawmill near the landing, were similarly destroyed as soon as vacated.

The accessions of malarial and yellow fever cases from the front continued until July 31, on which date 90 cases were admitted by transfer from Dr. Jones's hospital. By July 20 yellow fever had developed so rapidly among the patients in hospital and the overflow in the detention camp was so far in excess of our ability to accomplish transfers to the yellow-fever hospital that we were compelled by the universal presence of the infection to declare everything in the way of a canvas hospital about us a yellow-fever hospital. The lines which had heretofore defined the yellow-fever hospital from the detention camp and the hospital proper were no longer regarded. Certain wards were set aside for yellow fever; beyond that no effort was made to isolate those infected. The steamship Resolute arrived July 25, laden with 10 immune surgeons, 35 male and female nurses, and large quantities of supplies of all kinds. On August 2 the Olivette appeared in Santiago Harbor with large quantities of supplies, 35 immune nurses, and more immune surgeons. The sick, under these circumstances, received the best of care. The female nurses proved a great comfort to the sick, and physicians who came with them worked most faithfully.

August 5 the register showed 816 sick in hospital from all causes. It was on this date that I was taken ill with fever. I struggled to do my work until the 7th, at which time I was too much overcome to continue longer on duty. I turned the command over to Maj. W. C. Gorgas and placed my name on the sick list.

In closing my report of the events which have connected me with the reserve divisional hospital of the Fifth Corps it is fitting that I should testify to the heroic deeds and faithful services of some of its officers.

Capt. M. W. Ireland, assistant surgeon, United States Army, the executive officer, deserves special mention. He has demonstrated unmistakable capacity for work. He was the only one of those connected with the hospital from its establishment at Siboney to escape entirely the effects of the tropical diseases. Aside from his ability in the executive department, he showed skill and rare judgment in the operating room in the early days of July.

First Lieut. J. M. Kennedy, assistant surgeon, United States Army, ambulance chief, deserves mention for the skill and celerity with which he outfitted his train for field service at Port Tampa and for his faithful performance of duty in the transportation of sick and wounded from the 1st of July to the 1st of August.

First Lieut. P. C. Fauntleroy, assistant surgeon, United States Army, exhibited superior knowledge and skill in the preparation of the operating room, and as an operator. He showed skill, endurance, and pluck in the treatment of yellow fever before the arrival of the immunes, and until he was stricken with the disease.

W. E. Parker, acting assistant surgeon, United States Army, of New Orleans, who was connected with the operating staff, proved to be one of the best operators on the staff. His skill as a surgeon was already sufficiently established before his entry into the service to have deserved advancement beyond the grade which he so humbly accepted. His knowledge as a yellow fever expert proved of inestimable value to us during the epidemic. Although a supposed immune, he was taken ill with the disease, from which he was temporarily disabled. At a time when errors during convalescence were causing fatalities daily, he insisted upon resuming his duties when he was still too weak to stand the work. His services to the Government were certainly far beyond his reward.

H. C. Gavitt, chaplain, United States Army, displayed great capacity for handling men in the executive department during the days of July 1-4. It was largely to his efforts-whilst Captain Ireland was employed in the operating room-that the wounded were properly sheltered and fed. He buried the dead, and was constant in his efforts to comfort the living. I left him in Siboney August 15 going his daily rounds, though much reduced in strength, in the same way he had done in the early days of July. We owe the systematic arrangement of the dead in the cemetery and the proper inscription for identification to his faithful performance of duty.

Maj. Victor C. Vaughan, surgeon, United States Volunteers, professor of hygiene at the University of Michigan, Ann Arbor, did good work in the operating room, and later his suggestions and advice pertaining to sanitary matters were of great value. He continued on duty until July 12, when he was stricken with yellow fever.


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Maj. C. B. Nancrede, surgeon, United States Volunteers, professor of surgery in the University of Michigan, Ann Arbor, was naturally a prominent figure in the operating room. His advice was sought on every side in cases requiring the opinion of an expert surgeon. He and Major Vaughan brought us our first cases from the engagement at Aguadores Bridge where they were subjected to a sharp fire from the Spanish batteries. Men of prominence like these, who would abandon their interest in civil life through patriotic motives to engage in the hazards of war without stint, deserve richly the thanks of their countrymen, and I am pleased to be able to call the attention of the War Department to their conduct in this instance.

Maj. John Guiteras, the yellow-fever expert of the Fifth Corps, rendered valuable service in recognizing the presence of yellow fever at the inception of the epidemic. It was largely upon his advice that measures were employed at the outset to restrict the spread of the disease.