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Chapter 5

Table of Contents

Chapter 5

PREPARATIONS FOR CONQUESTS OVERSEAS

"The humane liberty-loving people of the United States have heard the cry of the oppressed starving Cubans for years, and have done all in their power, short of resort to the sword, to relieve their sufferings, but without avail. The ear of the proud, cowardly Spaniard remained deaf to well-meant and most earnest appeals," wrote Col. Nicholas Senn, surgeon general of the Illinois National Guard, not long after war was declared against Spain in April 1898. In his eyes, war, "always a great calamity," became "a weapon in the hand of the Almighty" when waged "for the sake of humanity, for the relief of the oppressed."1

The oppressed in Cuba would be the main focus of attention only until 1 May, when an effort to bring pressure on the Spanish in Cuba by threatening their forces in the Philippines resulted in Commodore George Dewey's unexpectedly easy and complete naval victory in Manila Bay. Plans to take over the Spanish empire in the Philippines were then added to those for the conquest of its territories in the Caribbean. The U.S. struggle against the old empire was over almost as soon as it was begun, but the Philippines strongly resisted becoming a part of the new empire. The guerrilla warfare that ensued produced a prolonged challenge both for the Army and for its Medical Department.2

When the U.S. battleship Maine exploded in Havana harbor on 15 February 1898, the American public blamed Spain and demanded retaliation. Both Congress and President William McKinley were reluctant to take positive steps to prepare for war, however, even under the goading of the abrasive General Miles, now commanding general of the Army. Although the number of medical officers was inadequate for peacetime needs, the possibility of hostilities did not inspire the legislature to vote an increase. The secretary of war specifically prohibited Surgeon General Sternberg from purchasing new supplies until "the question of whether or not there was to be war had been definitely settled." Both Sternberg's directive that supply depots be ready to issue whatever supplies they had and his comment that he had ordered new designs for medical and surgical chests "so as to have them ready for manufacture should the necessity arise" have an almost pathetic ring. Since no decision was made about the size and scope of any campaign until 19 April, when Congress authorized military action against Spain, neither Sternberg nor any of his superiors in the War Department could adequately prepare to meet


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NICHOLAS SENN

the requirements of war before the nation was committed to hostilities.3

Almost simultaneously with its call for action, Congress authorized both an increase in the regulars from roughly 27,000 officers and men to just under 65,000 and a call for 125,000 volunteers, who were to serve two-year terms. Although the National Guard was not called up as such, National Guard organizations were permitted to volunteer as units, and the nation's young men were not slow to respond. By the end of May the Army numbered more than 160,000, a figure that, after another call for volunteers was issued, reached 275,000 by August. Each of the eight corps that formed this force consisted of three divisions plus independent cavalry and artillery units. A division consisted of three brigades; a brigade, of three 1,200-man regiments. The Medical Department was abruptly required to obtain the supplies and equipment necessary to care for this vast army, to prepare for the evacuation and hospitalization of its sick and wounded, and to instill in the minds of a multitude of neophyte military surgeons an understanding of unfamiliar principles and procedures.

The Medical Buildup

With the declaration of war, Sternberg had to assume administrative duties of great complexity for which nothing in his career had prepared him. As a scientist he had not found it necessary to delegate significant responsibilities to others, and he had continued to follow this general approach in the early years of his tenure as surgeon general. His failure to make major changes in the organization of his office to meet the new challenge suggests that he had difficulty delegating authority, a characteristic of the unskilled administrator. His principal problem, the shortage of trained and experienced doctors, stewards, and hospital attendants, would have been insurmountable in any event.

The chief responsibility for the work of the Medical Department with the forces mobilized for the Spanish-American War, including those sent to the Caribbean, those sent to the Philippines, and those retained in camps in the United States, fell to Col. Charles R. Greenleaf, one of fourteen Civil War veterans still in the department. Greenleaf was designated chief surgeon of the Army in the field and, as such, served on Miles' staff. Greenleaf's duties included determining the organization for medical services in the field, planning for the training of the many neophyte medical officers who joined the effort against Spain, and dealing with any major crisis


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CHARLES R. GREENLEAF

concerning the management of supplies and hospitals in the field.4

Congress authorized positions for eight corps surgeons and a hundred division- and brigade-level surgeons on 22 April 1898, and on 12 May created spaces for fifteen more regular assistant surgeons. The legislature also allowed for the appointment of as many contract surgeons as were needed, but most of the men called in to serve in either capacity were, like a majority of their volunteer colleagues, strangers to military medicine. Filling these slots was not easy; at the end of May thirteen were still vacant. Since many of the Medical Department's more senior officers were committed to purely administrative duties, even the fall closing of the Army Medical School to free its professors for wartime duties left only a hundred experienced surgeons available for field service and the instruction of new medical officers.5

Few of the Medical Department's regular officers had had any experience in preventing disease in large groups of men, and none, not even Sternberg himself, was familiar with the problems of mounting an overseas expedition. Making the best of a bad situation, Sternberg placed those with the most experience in positions where they could guide those with the least. Five Regular Army doctors became chief surgeons of Army corps. Thirty-six served as division or brigade surgeons, leaving only fifty-nine to serve with individual regiments. Three corps and seventy-four division and brigade positions had to be filled by volunteers. They, like all Army surgeons serving in the field, reported to the officers commanding their units, being responsible to Greenleaf only for the professional aspects of their work. Thus the direct authority of the surgeon general was limited to general hospitals, medical supply depots, hospital ships, and enlisting and assigning hospital corpsmen. To guide the many newcomers upon whom the Army had to depend, Sternberg sent out a revised edition of the Manual of the Medical Department that briefly discussed the wartime responsibilities of the Hospital Corps and of medical officers in the field. He also issued a series of circulars outlining the duties of the various positions held by medical officers and detailing appropriate preventive measures, among them sanitary precautions.6

The approach to determining the qualifications of the volunteer surgeons for successful duty as military surgeons varied from state to state. State authorities chose the three physicians required by Congress to accompany each regiment, appointing boards to determine their fitness to serve. Few states insisted that candidates undergo physical examinations before joining the Army, and thus some new


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medical officers proved unequal to the physical demands of their duties. Although most state boards at least interviewed all physicians seeking to obtain such an appointment, the extent of their inquiry into the candidates' professional skills varied widely from state to state, and some appointments were politically motivated. Homeopaths, who believed that minute doses of medications that produced the symptoms of a disease should be used to treat the disease, appealed successfully to President McKinley for permission to take the examinations and to serve if they passed. Those placed in corps and brigade positions (a few of whom, like Senn, a lieutenant colonel in the U.S. Volunteers,7 were nationally prominent) were appointed at the national level, thus escaping any requirement for examination to determine either their physical or their professional qualifications.8

Service as a member of the National Guard had not fully prepared a physician for service in the wartime Army. The Guard required only that its doctors have medical degrees, this at a time when the nation's medical schools left much to be desired. Thus many physicians with state units were barely competent, if that, in civilian life, although some, like Senn, had received advice and instruction from Regular Army medical officers in the period before 1898. Senn designed thorough physical and professional examinations for those physicians wishing to enter the Illinois Guard, and a few of the National Guard-trained doctors attempted to conduct brief courses for their volunteer colleagues. For the most part, however, regardless of their professional competence, those who had never served in the Regular Army were significantly handicapped when called upon to perform as medical officers. They were totally devoid of any understanding of the administrative work required of them as military surgeons, were unaware of the vital role played by sanitation in maintaining the health of an army, and were unfamiliar with the procedures necessary to acquire and keep adequate stocks of medicines and hospital supplies.9

Friction between Regular Army medical officers and those who had only recently left civilian life was inevitable. Many of the latter displayed what a regular medical officer described as the "lack of subordination usual among volunteers." Attempts to give the regimental doctors of volunteer units assignments outside their original units often met with "rebuff or vigorous protest" from regimental commanding officers as well as from the physicians involved. Further exacerbating poor relations was the fact that inexperienced volunteer surgeons were in many instances put in higher positions than regular surgeons, who then found it difficult to guide and indoctrinate their neophyte colleagues, some of whom they regarded as graduates of "one of the inferior medical colleges" and even as "illiterate at the start." Volunteer Senn, on the other hand, looked down upon career Army physicians; he contended that they abandoned efforts to keep up with medical progress after passing the last required promotion exam to earn the rank of major. In some instances, however, the exercise of patience and tact in clearing up misunderstandings led to effective cooperation between regular medical officers serving at the division level and above and the commanding officers of volunteer units.10

To fill gaps left vacant by the shortage of military medical officers, the Medical Department signed contracts with civilian doctors. Because of the haste with which


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preparations had to be made, the department had to rely on references rather than competency examinations in hiring contract surgeons throughout the Spanish-American War. More than 300 had been hired by the first of August, with the total eventually reaching 650. Some contract physicians were young and inexperienced, and most, like their counterparts in the volunteers, were unfamiliar with the Army's administrative procedures and the specific requirements of military medicine. Their position was characterized by weakness and inconsistencies. Expected to control enlisted corpsmen, they lacked both the military training and the rank that would have enabled them to do so. As "civilians performing the duty of officers," they had "the rights of neither, if it suits the commanding general to deny them." Although they were free of any fear of court-martial because they were subject only to civilian courts, their contracts could be canceled, or, at the very least, not renewed. Many contract surgeons were considered well trained and educated, and one observer noted that they were by and large "temperate in their habits," which Regular Army surgeons, he believed, were not. Even so and despite their achievements during the war, contract surgeons tended to be regarded throughout the Army as "no better than our common packers or civilian teamsters."11

The medical officers who participated in the Spanish-American War were initially organized by regiment. Volunteer units were allowed to bring a surgeon, two assistant surgeons, and three hospital stewards with them, while each regular regiment had at least one physician and drew its hospital attendants from the various posts to which its companies had been assigned before the war. The Medical Department's wartime organization in the field was based on that of the Civil War, in which the division hospital became the fundamental unit. A few regimental officers were left with their units to maintain health and determine what soldiers should be sent to the division facility, but most were detailed to serve at the division level. The chief surgeon of each corps was responsible for transforming the organization of the medical staff to meet the new requirements.12

Even the physicians directly responsible for care of the Army's patients were required to handle many administrative duties, the performance of which took them away from their patients. Reports had to be filed, requisitions filled out, and records maintained. Regular medical officers sometimes found themselves spending as much as half their time in nonmedical chores, while many of their less experienced colleagues tended to ignore such duties or to make but a half-hearted effort, submitting requisitions in the form of notes on the back of envelopes and omitting other paperwork entirely. Attempts to train volunteer and contract physicians to fill out forms properly and to handle other administrative routines were not always successful. Although Greenleaf apparently set up what he called "schools of instruction" for them, units and their medical officers came and went in some camps with a rapidity that made training impossible. Furthermore, volunteers might have little appetite for learning to do something whose purpose they could not appreciate. The complexity of the Army system greatly discouraged many a former civilian, causing him to abandon the attempt to deal with what he regarded as red tape. A proposal was made, though not acted upon, that a lieutenant of the line be assigned to hospitals to handle administrative details. The


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severe shortage of hospital stewards with sufficient experience to assist in the paperwork only made the problem worse.13

Providing the wartime Army with an adequate number of either hospital stewards or attendants proved difficult. In increasing the size of the Regular Army in April 1898, Congress neither included a provision for an expanded Hospital Corps nor dealt directly with the question of volunteer hospital corpsmen. The volunteer system, with corpsmen organized by regiment, was not compatible with that of the Regular Army organization, which was formed on an Army-wide basis. Volunteer regiments were allowed three hospital stewards each, but their corpsmen were merely enlisted men detailed to serve as hospital attendants. When a minor change in the law made it possible for a corps commander to transfer from volunteer units to the Hospital Corps twenty-five men for each regiment and fifty more for each division hospital, many regimental commanders once again tended to balk at giving up their men. The adjutant general urged that, following their assimilation into the Hospital Corps, such soldiers be permanently assigned back to their original units. At least one Army corps chief surgeon managed to enlist experienced hospital corpsmen by what was apparently an informal guarantee that they would serve only in that capacity. Erroneously concluding that they would then be committed to three years of service, few of those who had been serving as National Guard corpsmen wished to sign up in the Regular Army. When volunteer units began to disband, authorities decided to let corpsmen who had joined as volunteers go home at the same time as the units with which they had originally served.14

The qualifications of the men most often assigned to the Hospital Corps from the line were marginal at best. Many were untrained and inexperienced, although one surgeon found them to be willing workers. Some hospital corpsmen taken from state units were physicians, medical students, or pharmacists in private life, but many were, as so many of their predecessors had been for over a century, "drunkards, epileptics, and other worthless men." Managing such soldiers presented a challenge beyond the talents of the average neophyte medical officer, a problem the chief surgeon of the III Corps met by having a line officer assigned to command his Hospital Corps companies. No time was available to put such a large number of inexperienced troops through the course at the school of instruction at Washington Barracks. This institution, therefore, virtually suspended operations for the duration, except for a few days of orientation, in favor of on-site training at the various general hospitals, and Sternberg had 2,400 copies of a revised Handbook for the Hospital Corps issued to assist in Hospital Corps training.15

In June 1898 Congress eased restrictions on the number and background of the hospital stewards assigned to the Hospital Corps for the duration of the war, thereby raising the total from 100 to 200. The requirement for a year's service as acting hospital steward before appointment as steward was also eliminated, although the Medical Department considered three months of experience before promotion advisable. Each volunteer battalion was allowed to have an additional hospital steward and each corps an additional 10 beyond that. By the end of June the Hospital Corps consisted of 133 hospital stewards, 172 acting stewards, and 2,940 privates, most of


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the latter having transferred from the line. Although 6,000 were serving in the Hospital Corps by November 1898, even this number proved to be inadequate for both an army of occupation in the Caribbean and units that would soon be actively involved in a struggle with the Filipinos.16

Initially the Medical Department acted on the assumption that female nurses would be needed only if the conflict proved to be lengthy or severe. Although some historians maintain that Sternberg was reluctant to hire women as nurses, in April 1898 he asked for and received permission from Congress to hire as many female attendants as he might need. In the twenty-five years since the establishment of the first nursing schools in the United States, Sternberg, like many other physicians, had begun to recognize the worth of professionally trained female nurses. Any reluctance on his part to employ them apparently stemmed from his belief that they might be an "encumbrance" should they be sent into the field with an army preparing for action. More than 1,700 contract nurses served at one time or another with the Army during the Spanish-American War; most of them were women, as male nurses were rare.17

Obtaining an adequate number of skilled and dedicated nurses remained a problem both throughout the Spanish-American War and, because of epidemics of disease, for months after the fighting stopped. Since no one in the Medical Department had the time to screen applications from women who sought contracts as nurses, the Daughters of the American Revolution offered to assume this responsibility. For a few months Anita Newcomb McGee, a physician and vice-president of the organization, headed a committee that included the wives of both Secretary of War Russell Alger and Surgeon General Sternberg. The members apparently went over the records of all applicants except members of religious nursing orders, who were exempted from the requirement that all nurses be graduates of training schools. They were unable to meet Sternberg's first request, made on 7 May, for four nurses to be sent to the general hospital at Key West, Florida. He wanted women who both met the requirements for training and character and were immune to yellow fever, but only one such nurse could be found. In August, although the active stage of the campaign in the Caribbean was over, "it became necessary to establish an Army Nurse Corps Division of the Surgeon General's Office." McGee became the head of the new organization with the rank of acting assistant surgeon.18

Some surgeons were convinced of the inherent worth of female nurses. Senn, for example, noted that "a true nurse is born, not made" and that "few men are born with intrinsic qualities which constitute an efficient, successful nurse." Yet others had serious misgivings, making Sternberg wary of sending nurses to a physician who had not requested them. Army surgeon Col. Dallas Bache believed that men were "more serviceable than women on shipboard, less liable to exhausting sea sickness, requiring fewer facilities and less comfort," and that they were preferable to women on transports and trains as well. Furthermore, "a certain disquiet about morality" inevitably arose when women were present. Small facilities lacked accommodations for them, and their patient loads fluctuated. When the hospital population load fell, nurses had to be able to handle non-nursing duties. As a result, Bache concluded that female nurses should be assigned only to general hospitals. Further complications arose from the fact that the relationship of female nurses to hospital corpsmen was not always good. Nevertheless, at least one department surgeon, future sur-


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DALLAS BACHE

geon general Col. William H. Forwood, pronounced "male citizen nurses" to be "worthless." And even Bache eventually praised the accomplishments of female nurses, accepted their help in emergencies, and concluded that the Spanish-American War had established that the Army needed them.19

Readying Supply

Because he had ordered before the war began that the supplies the Medical Department had on hand be prepared for distribution, Sternberg was initially somewhat optimistic about the department's ability to furnish all that might be needed; he may have assumed, as so many did, that the campaign would not begin until fall. Although the amount of medicines, stores, and equipment on hand in the spring of 1898 was adequate for the needs of a 27,000-man army in peacetime, Congress' failure to permit peacetime stockpiling for possible wartime needs continually frustrated attempts to provide physicians and hospitals with medicines and equipment once volunteers had been called up.20

Thus Sternberg, who was apparently attempting to deal with all supply problems personally, was required to buy enormous quantities at one time and on short notice. He moved quickly to request bids on the most important items, including medical and surgical chests, litters, and field operating cases. He had permission to buy on the open market, but he often could not obtain instruments, medical chests, and the like in this manner. His attempts to speed the process of acquiring the needed items were hindered by what a representative of a relief organization called "the meshes of red tape and requisitionism." Sternberg blamed some of his difficulties on congestion in depots and along a railway network not intended for such burdens. Because the Quartermaster's Department was responsible for most shipping, the Medical Department was powerless to solve the problem. Moreover, forbidden to hire extra personnel and uninformed both about where additional shipments would have to go and about how much would be needed, Sternberg was unable to establish in advance a system for distribution.21

Because many volunteer units were not adequately supplied when they arrived in camp, the Medical Department had to draw upon its reserves from the outset. Orders were filled slowly, and regiments that brought medical equipment with them had to rely upon it for some time. The quantities of each item needed were enormous; Sternberg reported in 1898 that he had issued, for example, 272,000 first aid packets, 7,500,000 quinine pills, 18,185 cots


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NURSES AT JOSIAH SIMPSON GENERAL HOSPITAL NEAR FORT MONROE, VIRGINIA

and bedsteads with bedding, 23,950 gray blankets, and 2,259 litters. The department was able to provide first aid packets containing antiseptic dressings for each soldier "promptly and liberally." But ambulances, the animals that pulled them, tents, and similar large items were, like railroad transportation, the responsibility of the Quartermaster's Department. Thus the Medical Department had once again to suffer from the failures of another organization, in this instance, one that was also experiencing difficulties related to the general lack of preparedness and a shortage of trained personnel. Ambulances came in slowly, and when they did arrive, they all too often could not meet Sternberg's requirements.22

Beyond the problems experienced in obtaining supplies and equipment were those involved in getting them promptly to the medical officers who needed them. On 9 May Sternberg issued a field supply table. When he realized that most of the troops would remain in camps of instruction indefinitely, he also permitted medical officers to order supplies from the regular supply table, which had been drawn up to meet peacetime needs. Inexperienced surgeons underestimated demand, however, ordering inadequate amounts despite Sternberg's warnings on the subject, and because they did not fully appreciate the concept of lead time, they failed to allow for the time that would inevitably elapse between the placing of the order and its arrival. The surgeon general's permission to place emergency orders by telegraph and without his prior approval and to have items shipped by express despite the expense did not solve the problem. Sternberg resorted to telegraphing the nearest depot personally to have the needed items ready


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GENERAL HOSPITAL AT FORT MONROE

in the appropriate quantity at the new site whenever he learned that troops were about to be moved or new camps established. Although medical supplies were, on the whole, at least marginally adequate, for a variety of reasons they were not always available. Units on the move often took many of the camp supplies with them, just as they had in the Civil War, forcing the medical officers remaining behind to rely heavily on the aid of charitable organizations. Boxcars laden with supplies were not labeled as to contents, making the job of locating Medical Department property difficult until the bills of lading arrived, possibly days later.23

To deal with the supply problem as rapidly as possible, Sternberg ordered the New York and St. Louis depots in early May to prepare at once to meet the needs of 100,000 troops for six months, using the new field supply table as a guide. He also had a subdepot established at Chickamauga, Georgia, to supplement the department's depots in New York, St. Louis, and San Francisco. St. Louis supplied the Chickamauga subdepot and camps in Tennessee, Kentucky, Alabama, and Louisiana and sent the San Francisco depot some items needed for the Philippine expedition. Medical officers with troops involved in the Caribbean effort, as well as those remaining in Florida and in large camps in the East requisitioned supplies from the New York depot.24

The pressure on these depots proved to be extreme. Storage facilities in New York City were totally inadequate for wartime. One witness reported that, in spite of the rental of extra space, for more than nine months, half the activity at the depot took place "on the sidewalk, thousands of packages being received, marked, and shipped to their destinations therefrom." In an attempt


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to alleviate the burden borne by the New York depot, the Medical Department began to buy directly from dealers in Washington, D.C., Philadelphia, and Baltimore for troops at Camp Alger, Virginia, and for the general hospitals at Forts Myer and Monroe and at Washington Barracks. This move also guaranteed faster delivery on needed items. But the effects of slow transportation were exacerbated by the Quartermaster's Department's custom of mixing medical with non-medical items in its boxcars.25

Organizing a Hospital System

Both the size and the organization of the Army gathering for the war with Spain dictated the development of a new system for providing hospital care in the field. The peacetime system had been based almost entirely on post facilities, which sooner or later received those who were wounded or who fell ill in the field during the Indian wars. The regimental hospital, too large for the peacetime Army and too small for Civil War armies, had been officially abolished in 1862. Surgeon Jonathan Letterman's success in the Civil War suggested that for future conflicts, a systematized approach to medical evacuation and hospitalization should be developed.26

The task of designing the Medical Department's approach to the management of evacuation and hospitalization for the Army in the field fell to Greenleaf. He decided to rely on the division facility, proven more effective than the regimental hospital during the Civil War and familiar to Civil War veterans as a field hospital that accompanied the division wherever it went. Each was to hold 200 beds and be manned by 6 officers and 99 enlisted. Three of these facilities, plus a fourth held in reserve, were to be allotted to each Army corps. An ambulance company of 6 officers and 114 men was to be attached to each, ready in time of battle to remove the wounded by litter to dressing stations and thence by ambulance to the hospital. Unfortunately, assuming that the department would draw upon the regimental staff to obtain division hospital personnel, Congress precipitated future controversy by never addressing the problem of staffing the division facility.27

The chain of evacuation in this scheme, which was in principle like that developed by Letterman in the Civil War, involved litter-bearers that picked up the wounded on the field and took them to collecting stations, at least one per division, two to three miles back of the front, where they would receive first aid. The casualties would then be loaded on ambulances for a two- to three-mile trip to a field hospital further to the rear. With the battle over, details would search the field and bring any wounded they found back to the collecting stations, where hospital corpsmen would assume responsibility for their care and further transport. This system Greenleaf believed to be much more flexible than the regimental hospital system.28

Outside the division hospital staff, a medical officer, a hospital steward, and a Hospital Corps private were to remain with each regiment, caring for soldiers with minor ills in a facility that resembled a dispensary more than a hospital. Each corps had not only a chief surgeon but also a medical inspector, this position being one that was abolished at the end of the Civil War. Each of the three divisions and nine brigades in the corps had a chief surgeon. Together with the forty-eight surgeons assigned to division field hospitals and ambulance companies, this brought the total


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number of physicians with a corps that might in theory have as many as 32,000 men to a minimum of eighty-nine. Since volunteer regiments sometimes brought up to three surgeons with them, the corps chief surgeon could hope that he would have additional physicians to cover for those who became ill or were for other reasons unable to serve. This form of organization appeared to offer the most efficient use of both personnel and equipment, although chief surgeons were authorized to deviate from it if necessary.29

The old arguments concerning the relative merits of the regimental hospital and a larger facility dated back to the days of the Continental Army. It arose early in the Spanish-American War because each regiment arrived at the huge new camps with at least the rudiments of its own hospital. After the regiments had been organized into brigades and divisions and with disease rates mounting, the Medical Department moved to disestablish the regimental facilities in favor of hospitals at the division level, intending that only patients retained in their quarters be treated at the regimental level and that any personnel, supplies, and equipment in excess of that needed for the dispensary be given to the division hospital.30

In spite of the greater efficiency of the larger institution, the decision to abandon the regimental hospital system remained an unpopular one, even at the War Department level. The strength of the opposition, which included volunteer medical and line officers as well as state governors, delayed the formation of division facilities. Regiments often did not have enough medicines and supplies to contribute to a division hospital. Regimental commanders and medical officers resented the threat to their independence, in one instance regarding the establishment of a division hospital as a power play by the corps chief surgeon, a Regular Army medical officer. The sick objected to hospitalization in the division hospital, and regimental surgeons tended to retain them under their own care as long as possible, even resorting to sending patients to boarding houses rather than to division hospitals. Some line officers maintained that the siphoning off of two-thirds of their medical staffs for their division hospitals was to blame for the poor sanitation in their units.31

Greenleaf was responsible only for planning the medical care and evacuation for units in the field. General hospitals and hospital trains remained under the direct control of the surgeon general. Sternberg opened general hospitals only as the need for them developed, often by expanding existing facilities. By 30 September he had established ten general hospitals in the United States, one of which was the Josiah Simpson General Hospital, for wounded and sick soldiers returned from Cuba and Puerto Rico. On 30 May he also recommended that arrangements be made for a ten-car hospital train of "tourist sleepers and a dining car." Trains were already removing from Tampa, Florida, men too sick to embark for Cuba when this proposal was approved on 16 June and ten Pullman sleepers, a private car, a "combination car," and a dining car were assigned to the Medical Department. In addition to the surgeon in charge, the train's medical staff consisted of an assistant surgeon, two hospital stewards, twenty Hospital Corps privates, and three civilian employees.32

The hospital train's first run began in Washington, D.C., on 17 June and ended in Tampa two days later. From Tampa the train then took patients to Fort McPherson, Georgia, where tourist sleepers, which were


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better arranged for the purpose and better ventilated, replaced the Pullmans. Although the slow response of local quartermasters to requests for transportation initially caused irregularities in schedules, on 4 July the appointment of the assistant surgeon accompanying the sick, who was motivated to give high priority to hospital trains, as assistant quartermaster eased the problem. The train continued in service until the spring of 1899, carrying as many as 270 patients on a single run. From time to time it took patients to the general hospitals at Forts Thomas (Kentucky), Monroe, Myer, and McPherson; to that at Washington Barracks; and even to the post hospital at Plattsburg Barracks in New York.33

Launching the Cuban Expedition

Although thousands of men assembled at the various camps in the southern United States in anticipation of the invasion of Cuba, only the V Corps,34 initially stationed in the Tampa area, fought there. As organized in early May, it was to be a 6,000-man force for small-scale raids and incursions that would be used to supplement a naval blockade of the island. Under the command of William R. Shafter, a major general in the volunteers, it grew to include 25,000 men, 17,000 of whom were in Tampa by the twenty-fifth, most of them regulars, accustomed to discipline and familiar with the demands of camp sanitation. Neither Surgeon General Sternberg, an expert on yellow fever, nor General Miles could convince President McKinley to postpone the invasion of Cuba until the fall, when the threat from that disease would be dwindling. In the end, the timing of the invasion and the location of the landing site were based solely on the U.S. Navy's urgent need to capture or destroy the guns guarding the Spanish fleet, bottled up in the harbor of Santiago but still capable of slipping by the U.S. ships guarding the harbor mouth. Shafter was not informed of his specific mission until the end of the month. Indecision at the highest levels resulted in a change of objective from Havana to Santiago at almost the last moment and made a shambles of efforts to plan for the most effective use of Shafter's force.35

The V Corps' chief surgeon was Benjamin F. Pope, who now held a volunteer commission of lieutenant colonel. The burden of managing the medical support of such a hastily organized and poorly planned operation must have been particularly heavy after his 1886 failure in managing the Record and Pension Division of the Surgeon General's Office. Under Pope served doctors of varying qualifications, an average of more than 4 for every 1,000 men, among them 36 regimental medical officers, 15 volunteer surgeons, and 20 contract surgeons. In this last group was Acting Assistant Surgeon Guiteras,36 who had worked with Sternberg on the Havana Yellow Fever Commission in 1879 and was regarded as an authority on yellow fever and other tropical diseases. Guiteras was assigned to work with Pope at V Corps headquarters. Chief surgeons at the division level were Majors Marshall W. Wood of the lst Division, Henry S. Kilbourne of the 2d, and Valery Havard of the Cavalry Division.37

To meet the needs of the V Corps in battle, Pope modified the organization of his hospital corpsmen to achieve greater flexibility, dividing them into three rather than four companies, all to be under his direct control rather than that of the division chief surgeons, with each company commanded by a medical officer of his choice. Only a few men were to be assigned to


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work with unit surgeons as orderlies. In the event of battle, each division would have a minimum of one ambulance station two to three miles back of the front and a complete field hospital another two to three miles back of the station.38

Although the V Corps ambulance companies were still not completely staffed or equipped when the invading force embarked for Cuba, the division hospital system had now been in place for some time. The hospitals that regiments brought with them to Tampa were gradually absorbed into four division facilities until most of the latter had beds for 150 or more patients. Since most regimental surgeons of the V Corps were regulars, this process aroused little opposition. Orders were issued on 6 June, however, that two tents, an ambulance, and two members of the Hospital Corps be kept at the regimental level. Maj. Louis A. LaGarde and his three assistant surgeons, including future surgeon general Capt. Merritte W. Ireland, set up the reserve division hospital at Port Tampa. As the senior medical officer in Port Tampa, LaGarde was also required to supervise the work of the medical officers with units stationed there. The remaining three division hospitals, each with a fully equipped operating room complete with steam sterilizers and enameled steel folding operating tables, were set up at Tampa under Maj. Wood, who managed his 1st Division's hospital personally, Maj. Aaron H. Appel with the 2d Division, and Maj. George McCreery with the Cavalry Division.39

Pope considered the health of the command in Tampa to be good before the invasion, despite a typhoid outbreak and the appearance of both measles and a mild diarrhea that was blamed on the change of climate. Because medical officers traditionally isolated patients with measles as soon as their condition was known, this disease never became epidemic. The form that prevailed in 1898 was mild, causing no real difficulty for medical officers. Typhoid was apparently less widespread than at other camps, probably because the regular troops who formed most of the command were more careful about sanitation than the volunteers who predominated at other large camps in the East. Measles and typhoid patients were kept in Tampa, but the victims of syphilis, a few patients with rheumatism, and some typhoid convalescents were sent north to Fort McPherson.40

Concern for the future health of the command when it was serving in the tropics caused guidelines about the prevention of disease to be issued before the invasion. Guiteras, who formulated the advice given out to the troops, was skeptical about the ability of quinine to prevent malaria but recommended it for those occasions "when the individual is subjected to extraordinary depressing influences." He advocated eating many tropical fruits and vegetables; limiting the intake of alcohol, which was "specially deleterious in the tropics"; and boiling all water that was not taken "directly from the springs." Guiteras believed that yellow fever was "not directly transmissible," but that rooms and tents could become infected and that, therefore, hospitals and their populations should be separated strictly from the rest of the force. Additional suggestions offered by Pope included warnings not to "take purgatives when the bowels are regular" and to "peel all fruits before eating." He noted that dry socks were important for healthy feet. The role of mosquitoes in malaria had just been revealed months earlier and their role in yellow fever was still unknown, but Pope also warned that all men should "protect [themselves] from mosquitoes by gloves and nets."41


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Adequate supplies were necessary to any successful campaign against disease. The need to move medicines, dressings, wagons, ambulances, and animals to and then from Tampa caused significant problems from the outset. Tampa had been chosen as a base when plans called for a small invasion force. As the size of this force grew, so did the congestion and confusion. Two single-track railroads served the base, but only one ran to Port Tampa, where the transports awaited loading. Moreover, the Quartermaster's Department contributed to supply problems through inadequate methods of loading and labeling cargo and a failure to provide more than a few of the wagons needed to move supplies from freight car to ship. The resultant delays in unloading freight and then removing it from the railhead led to a rapid backup of supplies at the Tampa station.42

Supply problems grew with the arrival of volunteer regiments without all of the medicines and surgical dressings they needed or the wagons and animals to move them in the field. Because Pope had to provide for these units, he was unable to build up a significant reserve of the required items. In early May he placed a large order and assigned an assistant surgeon to expedite deliveries by serving as acting medical supply officer at Tampa. By late May, however, the supplies Pope had on hand were almost exhausted. His request for permission to buy locally for volunteer units was granted, but by 2 June little was left in the Medical Department depot at Tampa. Three days later, although "freight traffic was almost hopelessly blockaded," part of what Pope had ordered arrived.43

One of the most needed items was quinine, which Pope had been ordered to supply to the rebels already fighting the Spanish in Cuba. On 28 May his stocks were further depleted by an order that he supply 300,000 quinine pills to the U.S. Navy and that he rely on local purchases until Sternberg could get another shipment to him. A week later Pope noted that the amount of quinine he had on hand was sufficient "to meet all possible demands."44

As the time for embarkation approached, the confusion was great and growing. Uncertainty about the timing of the invasion exacerbated the difficulties involved in preparing for it. With only one pier available for loading, long backups were inevitable. Although on 7 June Shafter was ordered under way as soon as possible, regardless of what might have to be left behind, the expedition's departure was delayed for several days because of false rumors that the Spanish fleet had escaped from Santiago. Unsure about when the ships would leave, Pope became so concerned about his medical supplies that he went to the Tampa warehouse with two hospital corpsmen at midnight of 8-9 June and personally loaded two wagons with supplies, which he then placed on the train for Port Tampa. He ordered his medical supply officer to send a third wagon load to Port Tampa on the ninth. Half the remaining stores formed a reserve to be taken with the expedition, and the other half was left for the use of newly arriving volunteers.45

Although Pope had managed, despite the handicaps under which he worked, to have adequate supplies, equipment, and animals on hand at Tampa when embarkation began on 7 June, much of his effort was frustrated, often because the Medical Department had no choice but to rely upon the Quartermaster's Department to deliver the necessary supplies. Medical items were placed in the ships in a random fashion, without regard to when they might be needed, and regimental supplies were not


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necessarily loaded in the same vessel as the unit to which they belonged. The quartermaster general's reluctance to obtain transports until he could be sure of how many would be needed added further to the confusion, since he then had to act in haste at the last moment. Because of the inadequate size and number of these vessels, much of what Pope wanted to take, including tents, ambulances, and wagons, was left at Tampa. Time may also have been a factor in leaving ambulances behind, yet Pope and LaGarde both blamed a lack of adequate space, a conclusion in which others concurred. Some of the reserve supply from the warehouse was placed on the headquarters ship and eventually ended up on the Olivette, a transport taken over for use as a hospital ship and equipped to handle at least 280 beds. Because most of the Medical Department's supplies in Tampa had already been divided among the medical officers, this reserve was not large.46

The vessels upon which the V Corps was embarking had been obtained under the assumption that the landing would be at Mariel, less than two days away, rather than at the southeastern tip of the island, 1,000 miles and almost a week's voyage from Tampa. Matters were further complicated when authorities adopted a British formula for space per man intended for troop transports rather than the converted freighters and passenger vessels available to Shafter's force. As a result, many more soldiers were placed aboard each vessel than it could carry without endangering their health, especially if they were on it for many days. The rough lumber bunks were crowded so close together that, should the hatches ever be closed, "light and air would have been totally excluded and suffocation [would] quickly result."47

Heeding warnings from the medical officers responsible for health on board these vessels during embarkation, at the last moment Shafter ordered that 900 men still on the shore not be permitted to board. When the delay in sailing continued, he had a total of 1,000 or more men already on the transports removed. Those who remained on the ships that rode at anchor in the harbor until 13 June suffered because of the heat and poor ventilation, uniforms not designed for extremely hot weather, a monotonous travel ration, and an inadequate water supply. Although Shafter allowed the men off the ships in detachments for exercise, they were not permitted to remain on shore because no satisfactory campsite could be found near the harbor.48

Since the refitting of the Relief, a vessel belatedly purchased in May for use as a hospital ship, had not been completed when men began to fall ill, the Olivette, which had been functioning as the fleet's water-carrier, had to serve in her place. Appel's 2d Division hospital and the medical supplies from the headquarters ship were moved to the Olivette, and those who became more than mildly ill were taken to her in small boats, a process Pope described as "often . . . slow and difficult." Once the other ships had set sail for Cuba, the Olivette unloaded her measles and fever patients to make room for the wounded that would result from the campaign and headed south.49

After days of confusion and with 815 officers, 16,000 men, 1,000 mules, and 1,000 horses on board, thirty-one vessels finally moved out of Tampa Bay onto a sea that was, fortunately, "smooth as glass." Pope was particularly grateful for the fact that the water remained calm while they were under way, since otherwise the "suffering from sea sickness and the foul air of the


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unventilated holds would have been intolerable." Even so, when the expedition arrived at its destination on 20 June, 100 patients, most of them suffering from measles or typhoid, had been taken aboard the Olivette.50

The supply problems with which Pope had been contending cast a long shadow; a matter so badly begun was scarcely likely to end well. Ignoring Guiteras' warning about mosquitoes would also prove to have serious consequences; these precautions apparently seemed to the average man more trouble than they were worth. Clearly, both Pope and Guiteras had done what they could under the circumstances to prepare for the care of the sick and wounded of the V Corps during the campaign in the Caribbean.

Launching the Philippine Expedition

While General Shafter and his V Corps prepared for the invasion of Cuba, the Philippine Expeditionary Force (which by the end of June would become the VIII Corps) was gathering at San Francisco under the command of Maj. Gen. Wesley Merritt, who had also been named commander of the Department of the Pacific,51 to launch a land attack on Manila to exploit Commodore Dewey's naval victory. Plans for Merritt's command were also changed several times, and its size escalated from 5,000 to 20,000 men. Its first components sailed more than two weeks before the V Corps left Florida, but while Shafter's objective shifted from Havana to Santiago, Merritt knew from the outset that Manila was his goal. Furthermore, San Francisco was already a major supply depot and a sizeable city with a widespread transportation network, and Merritt was a more skilled administrator than Shafter. As a result, the Medical Department was better able to provide care for the sick and wounded of the Philippine expedition than for those who fell ill or were injured in Cuba.52

When the force that would undertake the conquest of the Philippines was first ordered to gather at a camp, soon known as Camp Merritt, on high ground on the western side of San Francisco, plans called for it to consist of 5,000 men, most of them volunteers. Even when the entire VIII Corps had been formed, only a quarter of the men were regulars, and sanitation presented problems as it had at every other camp where eager neophyte soldiers and their inexperienced officers gathered. Typhoid as well as the inevitable measles soon appeared. Nevertheless, in July, when a broad-based program of immunization for smallpox was undertaken, disease had not yet become a serious problem, in spite of what Sternberg called the "crowded condition of the camp, the inexperience or carelessness of responsible officers and the unfavorable circumstances of season and location generally." An increase in the number of pneumonia cases, blamed on the cool ocean breezes and chill mists that settled about the site, caused the War Department to order the camp abandoned in favor of the Presidio of San Francisco, "one of the most beautifully situated and one of the most healthful military posts in the world."53

The medical personnel assembling in San Francisco were adequate in number to meet the force's needs until it reached the Philippines and faced active combat. Making sure that enough hospital corpsmen accompanied the expedition when it sailed was a problem for the expedition's chief surgeon, Lt. Col. Henry Lippincott. Hospital stewards from several geographic department commands within the United


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HENRY LIPPINCOTT

States joined the three who arrived with each volunteer regiment of Merritt's command, but only seventy-five privates had reported for duty before the first men left for the Philippines. After a certain amount of confusion about the status of the attendants in volunteer units, Lippincott, known for his considerable "administrative ability, . . . professional acquirements, [and] capacity for work," finally received authority to have them all transferred to the Hospital Corps. In this way he could obtain enough attendants both for the Camp Merritt division hospital and for those who fell ill on the transports on their way to the Philippines. Despite Lippincott's efforts and the lowering of "the requirements as to intelligence somewhat," the VIII Corps was able to acquire only half the number of authorized hospital corpsmen.54

Medical supply also presented difficulties. In planning for embarkation, Lippincott hoped to have each regiment supplied with medical chests by the time it boarded the transports. But when the first units to leave San Francisco sailed on 25 May, the volunteer regiments had "no chests of any description nor any hospital equipments." One of the regular surgeons, unhappy over what he regarded as the inadequacy of his supply of instruments, became embroiled in an argument (which he apparently lost) with Sternberg. When Lippincott arrived in the city, the first units were already embarking. Because of his efforts, combined with those of the San Francisco medical purveyor, the second contingent to leave for the Philippines and all regiments leaving thereafter were supplied with both medical chests and a month's worth of supplies for use on the transports, with another six months' worth in reserve. The ships were carefully loaded, with items most likely to be needed first placed where they could be quickly reached.55

Lippincott, like Pope and Guiteras, attempted to educate the troops about disease prevention by issuing a pamphlet about the health problems they might encounter on the transports and at their destination. He emphasized the importance of sanitation, pointing out that "preventable diseases are due to living germs, which flourish in tropical countries like all other plants which require warmth." Cleanliness and keeping dry were especially important. Work during the heat of the day should be avoided when possible. Like Guiteras, he also warned against mosquitoes, which "have been accused of causing malaria"; against flies; and against "a small red insect, or jigger, which burrows in the skin." He added that "the natives are notoriously careless of all sanitary laws, and are infected with numerous diseases. Intercourse with them will be dangerous," especially be-


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cause venereal disease was common among the villagers. He issued no warning about yellow fever, since it had never afflicted the population of the Philippines.56

The actual journey to reach the Philippines posed a considerable challenge, but the transports that Merritt had obtained to carry the men of the VIII Corps on the month-long voyage to Manila were, fortunately, more suited to the purpose than those available to Shafter's V Corps. The first vessels to set sail carried 2,500 officers and men under the command of Thomas M. Anderson, recently promoted to brigadier general in the volunteers. The vanguard was to be followed by two more contingents a few weeks later; more than 10,000 men had arrived when the Spanish surrendered Manila in August. With the vanguard were a regular medical officer and seven volunteer surgeons, who had "practically no experience in anything pertaining to their duties, except the professional care of the sick and wounded." The shortage of hospital attendants made it impossible to provide as many as Lippincott believed necessary for a voyage that would take longer than a month. Except for the three stewards allowed each of the two volunteer regiments involved, only one steward and five Hospital Corps privates accompanied Anderson's command, all assigned to a regular infantry regiment. Lippincott soon discovered, however, that the situation was not as bad as he had assumed, for in each volunteer unit were twenty-four men who, having been detailed to hospital duty, could serve as corpsmen.57

The length of the voyage dictated greater care with sanitation than had been required for ships bound for Cuba. Before each vessel was leased, a medical board inspected it. Before the soldiers boarded her, each ship was thoroughly cleaned and, when deemed advisable, disinfected. Although additional latrines were installed on many ships before the troops came aboard, Lippincott's goal ratio of at least 20 seats for every 1,000 men was not always reached. Since water supplies were limited on some transports and the men preferred showers, which were not available on all ships, personal cleanliness suffered. Dampness, inadequate ventilation, crowded sleeping quarters, and mattresses that teemed with vermin also caused the chief surgeon concern. But drinking water, largely derived from condensers, was good, and food, while not always well cooked, was officially considered of acceptable quality. At least one soldier, however, later recalled that on his transport he was served "rotten prunes and fruit, which, after nearly all the supply was consumed, was found by our surgeon to be full of worms." For those who fell ill on the voyage, hospital facilities varied since not every ship had space that could be set aside to meet Lippincott's standard of 30 hospital beds for every 1,000 men plus two small rooms to accommodate an operating room and dispensary.58

Despite the difficulties, Lippincott's efforts to ensure a healthy voyage were rewarded. The annual death rate from disease during the month-long voyage to the Philippines was 1 in 1,000. With every group of transports that sailed for the Philippines, however, some men invariably became too ill en route to continue the voyage. In Hawaii, formally annexed by the United States on 7 July 1898, the American Red Cross attempted to care for these patients with the aid of any Medical Department personnel who could be left behind, but it soon became obvious that continued reliance upon this approach would be unwise. Facilities specifically for the Army's sick were necessary, for the sake both of the ailing soldier and of vulnerable Hawaiians who might be exposed to


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diseases to which they had little resistance. In early July, when Lippincott's ship stopped in the islands, he arranged to set up an Army hospital at Honolulu. The initial site proved malarious, however, and since larger accommodations were soon necessary, land was rented and a 100-bed hospital built at a healthier location. As the Army moved increasing numbers of men to Honolulu, more medical officers and more medicines and hospital equipment were also sent to Hawaii, which became an important stopover point for the sick and wounded of the VIII Corps.59

The health of the men about to land in the Philippines, like that of those ready to go ashore in Cuba, would depend largely on efforts that had begun only in mid-April, with little chance for planning and even less for stockpiling supplies and equipment. In its attempt to care for thousands of soldiers, most of them enthusiastic amateurs, the Medical Department was handicapped both by its own lack of preparation and by that of the organizations upon which it had to rely. With more time at their disposal, Lippincott and the medical officers of the VIII Corps were able to surmount most of the difficulties that confronted them, but the haste and confusion that marked the planning of the campaign in Cuba would haunt the V Corps from Tampa all the way to Santiago.


NOTES

1. Nicholas Senn, Medico-surgical Aspects of the Spanish American War, pp. 9-10.

2. Unless otherwise indicated, all material in this chapter is based on Graham A. Cosmas, An Army for Empire.

3. First quotation from United States, Congress, Senate, Report of the (Dodge) Commission To Investigate the Conduct of the War Department in the War With Spain, 1:169 (hereafter cited as Dodge Commission Report); second quotation from War Department, [Annual] Report of the Surgeon General, U.S. Army, to the Secretary of War, 1898, p. 103 (hereafter cited as WD, ARofSG, date); Nelson A. Miles, Serving the Republic, p. 269; Walter Millis, The Martial Spirit, pp. 162-64; James L. Abrahamson, America Arms for a New Century, p. 60; James A. Huston, The Sinews of War, p. 276; Erna Risch, Quartermaster Support of the Army, pp. 519, 523; Report of Commission To Investigate the Conduct of the War, pp. 65-66, 68, Microfilm Reel 6, William R. Shafter Papers, Stanford University, Palo Alto, Calif. (hereafter cited as Com Rpt, Mf Reel no., Shafter Papers, SU).

4. Register of the Army of the United States for 1898, pp. 20-29.

5. WD, ARofSG, 1898, pp. 100-101, 137-38, and 1899, p. 19; Hermann Hagedorn, Leonard Wood, 1:144-45.

6. WD, ARofSG, 1898, pp. 100, 105, 138, 140-42; SGO Cir Ltr, 25 Apr 1898, Entry 66, Record Group (RG) 112, National Archives and Records Administration (NARA), Washington, D.C.; Dodge Commission Report, 7:3125, 8:38-39.

7. The U.S. Volunteers were drawn from the nation as a whole, rather than from individual states.

8. Martin Kaufman, Homeopathy in America, pp. 25-26; "Homeopaths for the Army and Navy of the United States," p. 1430; Nicholas Senn, "Qualifications and Duties of Military Surgeons," p. 505.

9. WD, ARofSG, 1898, pp. 139, 159, and 1899, p. 76; Senn, Aspects, pp. 20-22, 28-29, 256, 295; Dodge Commission Report, 1:169-70, 3:315, 346, and 6:2816; Edward L. Munson, The Theory and Practice of Military Hygiene, p. 943; idem, "Contract Surgeons in the United States Army," p. 588; Com Rpt, p. 66, Mf Reel 6, Shafter Papers, SU; "Army Medical Department," p. 206; John K. Mahon, History of the Militia and the National Guard, p. 126.

10. WD, ARofSG, 1898, pp. 157, 160, 166 (second quotation), and 1899, pp. 52-53 (first quotation); Champe C. McCullough, "The Qualifications, Responsibilities, and Duties of the Regular Army Surgeon," p. 498 (remaining quotations); "Disparagement of the Regular Army Surgeons," p. 378; "Some of the Medical Lessons of the War," p. 485; Rpt, Ch Surg, Second Army Corps, pp. 16-17, Entry 219, RG 395, NARA.

11. WD, ARofSG, 1898, pp. 100-101, 157, 160 (first two quotations); Wickes Washburn, "Montauk Point and the Government Hospitals," p. 805 (third quotation); "Army Contract Surgeons," p. 416 (fourth quotation); "Army Medical Department," pp. 201-02; Dodge Commission Report, 1:635, 4:1253; Munson, "Contract Surgeons," pp. 588-89; Com Rpt, p. 66, Mf Reel 6, Shafter Papers, SU; Rpt, Ch Surg, Second Army Corps, p. 18, Entry 219, RG 395, NARA.

12. WD, ARofSG, 1898, p. 115.

13. Dodge Commission Report, 1:609 (quotation), 3:192, 668-69, 4:1146-47, 1337, 1413, and 6:2975, 2982-83, 2987.

14. Dallas Bache, "The Place of the Female Nurse in the Army," pp. 308, 310-11; WD, ARofSG, 1898, pp. 101-02, 115, 121, 148-49, 157, 165, and 1899, pp. 51-52; Senn, Aspects, pp. 57, 60; Dodge Commission Report, 4:1251, 6:2529; Com Rpt, pp. 66-67, Mf Reel 6, Shafter Papers, SU; George E. Bushnell, "The Expansion of the Hospital Corps in War," pp. 145-46. The terms chief surgeon and medical director were apparently used interchangeably.

15. WD, ARofSG, 1898, pp. 101, 158, 167 (quotation), and 1899, p. 21; H. A. Haubold, "The Medical Aspects of Camp Management at Chickamauga," p. 586; Jefferson D. Griffith, "Hospital Experience in the War With Spain," pp. 162-63; Bushnell, "Expansion," pp. 146-47; James B. Agnew, "Carromatos and Quinine," p. 14.

16. WD, ARofSG, 1898, p. 148, and 1899, pp. 19-21; War Department, Surgeon General's Office, The Surgeon General's Office, p. 49 (hereafter cited as WD, SGO, SGO).


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17. Quotation from George M. Sternberg, "The Medical Department of the Army," p. 213; ibid., p. 214; Susan M. Reverby, Ordered To Care, pp. 5, 50; Senn, Aspects, pp. 313-15; WD, ARofSG, 1898, pp. 102, 121, and 1899, p. 24; idem, [Annual] Report of the Secretary of War, 1898, l(pt.1):179 (hereafter cited as WD, ARofSW, date); Bache, "Female Nurse," p. 318; Ltr (copy), Anita Newcomb McGee to SG, [28 Apr 1898], in Anita Newcomb McGee Journal, Entry 229, RG 112, NARA; Dodge Commission Report, 1:77, 7:3168; "Trained Female Nurses for the Army," p. 329.

18. WD, ARofSG, 1898, p. 102, and 1899, pp. 24-25; Bache, "Female Nurse," p. 316; Dodge Commission Report, 7:3168-72; Senn, Aspects, p. 320; in RG 112, NARA: McGee Journal, Apr-May 1898, Entry 229, Extract from American Monthly Magazine, Entry 229, and Narratives, [Anita Newcomb McGee], pp. 9-12 (quotation), Margaret Dunn, and Margaret Berry, Entry 230.

19. Senn, Aspects, pp. 314 (first two quotations), 318-19; Bache, "Female Nurse," pp. 307-09, 316, 319-20 (third quotation), 321-22 (fourth quotation), 323, 325; Dodge Commission Report, 2:752 (final quotations); Narrative, Esther V. Hasson, Entry 230, RG 112, NARA; WD, ARofSG, 1898, pp. 238, 260, and 1899, pp. 52, 74; Com Rpt, p. 67, Mf Reel 6, Shafter Papers, SU.

20. Martha L. Sternberg, George Miller Sternberg, pp. 169-70; "Army Medical Department," pp. 202-03.

21. Dodge Commission Report, 1:712, 5:2319, 6:2816, and 7:3117, 3128 (quotation); WD, ARofSG, 1898, p. 103; Graham A. Cosmas, "From Order to Chaos," p. 120; Com Rpt, pp. 69-70, Mf Reel 6, Shafter Papers, SU.

22. Sternberg, Sternberg, pp. 170-71 (quotation); Risch, Quartermaster Support, pp. 538, 556; WD, ARofSG, 1898, pp. 103-05, l49; idem, ARofSW, 1898, 1(pt. 1):179; Dodge Commission Report, 1:638, 712-13, and 3:192, 552; Bache, "Female Nurse," pp. 317-18; Com Rpt, p. 68, Mf Reel 6, Shafter Papers, SU. The concept of the first aid packet was not new. Apparently, Roman soldiers used a first aid packet as early as the second century B.C. (see WD, SGO, SGO, p. 26).

23. Charles Smart, "Correspondence," pp. 546-47; WD, ARofSG, 1898, pp. 103-04, 144; Dodge Commission Report, 1:173-74, 7:3117; Com Rpt, pp. 69-70, Mf Reel 6, Shafter Papers, SU; SGO Cir 6, 12 Aug 1898, Entry 66, RG 112, NARA.

24. Sternberg, Sternberg, p. 170; WD, ARofSG, 1898, pp.103, 105-06.

25. J. Morris Brown, "Organization and Conduct of a United States Army Medical Supply Depot," pp. 283-84 (quotation); Risch, Quartermaster Support, p. 541; WD, ARofSG, 1898, p. 104; Dodge Commission Report, 1: 173-74.

26. Dodge Commission Report, 1:571.

27. William H. Devine, "Management of a Field Hospital," p. 97; Charles R. Greenleaf, "The Organization of the Medical Department of the Army in the Field," p. 201; WD, ARofSG, 1898, p. 148.

28. WD, ARofSG, 1898, p. 208; Greenleaf, "Organization," p. 201.

29. WD, SGO, SGO, p. 51; WD, ARofSG, 1898, pp. 164-65; Dodge Commission Report, 1:571, 3:264, 4:1141, 1313, 1335, and 6:2529. Serving at the corps level were two physicians. Another three served at the division level, nine more as chief surgeons of brigades, twenty-four with field hospitals, twenty-four with ambulance companies, while twenty-seven remained with their regiments.

30. Mary C. Gillett, The Army Medical Department, 1775-1818, pp. 26-27; WD, ARofSG, 1898, p. 126, and 1899, p. 69.

31. WD, ARofSG, 1898, pp. 120-21, 159, 183-87, and 1899, p. 40; Dodge Commission Report, 1:643-44, 648, and 3:318.

32. Quotations from WD, ARofSG, 1898, p. 106; ibid., pp. 107, 128-29, 151, and 1899, pp. 60-65; Bache, "Female Nurse," pp. 312, 316, 323; Dodge Commission Report, 1:657.

33. WD, ARofSG, 1898, pp. 128-30; Dodge Commission Report, 1:83; Charles Richard, "The Army Hospital Train During the Spanish-American War," p. 201. Richard was in charge of the hospital train.

34. The official designation was V Army Corps. On 7 May 1898, under General Order 36, the War Department officially established seven army corps and on 21 June 1898, under General Order 73, an eighth army corps. Corps identification in this work conforms to modern usage, that is, referring to army corps as corps only.

35. Millis, Martial Spirit, pp. 154-59.

36. Although Guiteras is customarily referred to as having been a contract surgeon during the Spanish-American War, he is listed in the Register of General Officers and Officers of the General Staff, U.S. Volunteers, March 1, 1899, p. 13, as having been a major and brigade surgeon in the volunteers from 4 June 1898 to 15 July 1898. Pope, in his report in WD, ARofSG, 1898, pp. 184-203, refers to him as "Acting Asst. Surg. John Guiteras. Yellow-fever service at Siboney until July 20" in the list of physicians on duty with the V Corps (p. 202) and as an acting as-


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sistant surgeon throughout the text. LaGarde, however, refers to Guiteras as a major-specifically, "Maj. John Guiteras, Surgeon, United States Volunteers" (ibid., pp. 213, 216). The body of the surgeon general's annual report refers to him as Dr. Guiteras (see, for example, ibid., 1899, p. 145).

37. WD, ARofSG, 1898, pp. 116, 184, 200, 238, and 1899, p. 56; V Army Corps GO 1, 2 May 1898, and SO 4, 5 May 1898, Mf Reel 1, Shafter Papers, SU; Dodge Commission Report, 6:3040, 3042-43.

38. V Army Corps GO 7, 8 May 1898, and GO 3, 29 May 1898, Mf Reel 2, Shafter Papers, SU; WD, ARofSG, 1898, pp. 187-88, 208; WD, SGO, SGO, p. 51.

39. WD, ARofSG, 1898, pp. 116, 186, 200-201, and 1899, pp. 39, 57; V Army Corps SO 2, 3 May 1898, SO 6, 31 May 1898, and GO 14, 6 Jun 1898, Mf Reels 1, 2, and 3, Shafter Papers, SU.

40. WD, ARofSG, 1898, pp. 188, 199; War Department, Correspondence Relating to the War With Spain . . . , 1:36; in Shafter Papers, SU: Ltr, Shafter to SW, 10 May 1898, Mf Reel 2, and V Army Corps SO 13, Mf Reel 3.

41. WD, ARofSG, 1898, pp. 203-05. Ronald Ross' first articles on the role of the mosquito in the transmission of malaria appeared in late 1897 and in 1898. The British scientist also sent a letter, dated 24 August 1898, to Surgeon General Sternberg, which contained further evidence that mosquitos could spread malaria. After his arrival in Cuba in December, U.S. Volunteer surgeon Maj. Jefferson R. Kean recommended the use of mosquito nets. This step led to a marked reduction in the number of cases of malaria. For a discussion of public health efforts in Cuba, see Chapter 9. See also R. A. Ward, "The Influence of Ronald Ross Upon the Early Development of Malaria Vector Control Procedures in the United States Army" pp. 207-09.

42. Miles, Serving, p. 275; Risch, Quartermaster Support, pp. 527, 539, 543; WD, ARofSG, 1898, pp. 189-90; George Kennan, Campaigning in Cuba, p. 48.

43. Quotation from WD, ARofSG, 1898, p. 190; ibid., 1899, p. 56; Kennan, Campaigning, p. 5.

44. Quotation from WD, ARofSG, 1898, p. 190; idem, ARofSW, 1898, 1(pt.1):9; Dodge Commission Report, 1:586.

45. Autobiography, William R. Shafter, ch. VII, p. 5, Mf Reel 6, Shafter Papers, SU; WD, ARofSG, 1898, p.190.

46. Ltr, McKay to Shafter, 12 Nov 1898, Mf Reel 6, Shafter Papers, SU; WD, ARofSG, 1898, pp. 109, 187, 190-93, 210; Dodge Commission Report, 1: 129, 142, 188; Risch, Quartermaster Support, p. 550.

47. Quotation from WD, ARofSG, 1898, p. 190; ibid., pp. 150, 191, 210-11; Risch, Quartermaster Support, p. 548.

48. WD, ARofSG, 1898, pp. 150, 190-91, 210-11; Risch, Quartermaster Support, p. 524; Henry Cabot Lodge, ed., Selections From the Correspondence of Theodore Roosevelt and Henry Cabot Lodge, 1884-1918, 1:304-05; in Shafter Papers, SU: Ltrs, Shafter to AG, 9 Jun 1898, Edward J. McClernand to AG, 11 Jun 1898, and Shafter to Taylor, 19 Jun 1898, Mf Reel 3, and Shafter Autobiography, ch. VII, p. 5, Mf Reel 6.

49. Quotation from WD, ARofSG, 1898, p. 192; ibid., pp. 107-09, 193, 198, 218; Dodge Commission Report, 6:2893.

50. Quotations from WD, ARofSG, 1898, p. 192; Shafter Autobiography, ch. VII, p. 5, Mf Reel 6, Shafter Papers, SU; Hagedorn, Wood, 1:58; Miles, Serving, p. 276; Dodge Commission Report, 6:2893; Graham A. Cosmas, "San Juan Hill and El Caney, 1-2 July 1898," in America's First Battles, 1776-1965, p. 116.

51. The Department of the Pacific was created 16 May 1898. See WD, ARofSW, 1898, 1(pt.2):497, and 1899, l(pt.2):39.

52. David Trask, The War With Spain, p. 386; WD, ARofSG, 1899, p. 117.

53. First quotation from WD, ARofSG, 1899, p. 121 (see also pp. 98-99, 120); second quotation from W. F. Southard, "Opening of the New Military Hospital at the Presidio, July 9, 1899," p. 454; WD, Correspondence, 2:734-35; idem, ARofSW, 1898, 1(pt.2):123; N. N. Freeman, A Soldier in the Philippines, p. 17; Charles R. Greenleaf, "An Object Lesson in Military Sanitation," p. 485.

54. Ltr, Elwell S. Otis to SW, 17 Mar 1903 (first quotation), Henry Lippincott Papers, Entry 561, RG 94, NARA; WD, ARofSG, 1898, p. 263, and 1899, pp. 98, 121-22 (second quotation), 126, 137; Dodge Commission Report, 2:1202, 1217.

55. WD, ARofSG, 1898, p. 263, and 1899, p. 127 (quotation); WD, ARofSW, 1898, 1(pt.2):123; Dodge Commission Report, 2:1265; "Medical and Sanitary History of Troops in the Philippines," pp. 826-27.

56. WD, ARofSG, 1899, pp. 129, 131; see also pp. 130, 132.

57. Ibid., pp. 117, 122, 137 (quotation); Trask, War With Spain, p. 386.

58. Quotation from Freeman, Soldier in the Philippines, p. 21; ibid., p. 22; WD, ARofSG, 1899, pp. 99, 124-26; WD, Correspondence, 2:767; Frederick Funston, Memories of Two Wars, p. 171; John


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C. Brown, Diary of a Soldier in the Philippines, p. 14; Agnew, "Carromatos and Quinine," p. 15; Richard Johnson, "My Life in the U.S. Army, 1899 to 1922," pp. 13-14, Spanish-American War, Philippine Insurrection, and Boxer Rebellion Veterans Research Project, Military History Research Collection, U.S. Army Military History Institute, Carlisle Barracks, Pa.

59. WD, ARofSG, 1898, p. 125, and 1899, pp. 11, 138; idem, ARofSW, 1898, 1(pt. 1):7 and 1(pt.2):123; "Medical and Sanitary History" p. 826; WD, Correspondence, 2:756; Dodge Commission Report, 2:1287.