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DISEASE AND DEATH IN U.S. CAMPS
While U.S. troops were defeating the Spanish in Cuba, Puerto Rico, and the Philippines, disease was devastating those who remained in the United States. The greatest threat was not an exotic ailment imported from tropical lands but typhoid, carried by volunteers to huge and crowded camps where few understood the necessity for high standards of sanitation. The disease and death rates eventually climbed so high that, in a precedent-setting move, Surgeon General Sternberg appointed a board of medical officers to investigate the cause of the epidemic and to make recommendations that would guarantee that the horrors of the summer of 1898 were never repeated.
When the number of sick initially began to mount, the Medical Department had had less than two months in which to train new personnel and create hospital and evacuation systems. The department was only beginning to enter the era of laboratory medicine, and equipment was in very short supply. Thus, physicians were unable to determine that the first few scattered cases among troops pouring in from the state camps where volunteers initially assembled were typhoid rather than malaria, which was common in the South. Some physicians still believed in the existence of a hybrid disease known as typho-malaria, a fever born during the Civil War as a result of the inability to distinguish definitively between malaria and typhoid fever. Unaware that a disease spread by human waste was already threatening the troops, "officers, military and medical, having no experience of military life in the field, assumed that the deplorable condition in which they were living was the usual mode of life of soldiers situated as they were, and that their duty as true soldiers was to endure, not only without complaint, but with a certain pride, the hardship of their camp life." Most of the National Guard enlisted, like the soldiers of the Regular Army, came from cities and large towns and thus were accustomed to relatively crowded living conditions but not to relatively primitive sanitation. Volunteer officers and physicians, who had little understanding of sanitation, saw no reason to interfere when the men pitched their tents much too close together and crowded four to seven soldiers in a space seven by eight feet. They allowed the troops to place tents too near the latrines and at sites that were badly drained and to use nearby "shady spots under trees of the surrounding ground" rather than latrines that had been set up at an appropriate distance. Typhoid was soon sweeping the camps. Not surprisingly, volunteers died of the disease at almost twice the rate characteristic of the regulars.1
The epidemic, together with escalating disease rates in Cuba, forced many changes
in the Medical Department's approach to caring for the Army's patients. Dire necessity eventually dictated a modification of the policy that forbade the assignment of female nurses to other than general facilities. Often field hospitals became so overburdened with typhoid patients as to lose their mobility; assignment to them was little different from assignment to a general hospital. By mid-August 6 female nurses were also working on the hospital ship Relief, and 18 had been assigned to Santiago. The demand for their services escalated so rapidly that by 15 September, in addition to Red Cross and other volunteer nurses, 1,158 women held contracts to care for Army patients, working twelve-hour days for salaries of $30 a month. When, because of a shortage of qualified applicants, several chief hospital surgeons eventually had to hire nurses on an emergency basis, some who had received no formal training were signed on specifically because of their supposed immunity to yellow fever.2
The typhoid epidemic, which gained in force as troops from many areas of the country gathered at a few large camps, greatly exacerbated initial problems with hospitals. By forcing division facilities to grow quickly to twice their intended size, the high disease rate made it necessary to retain regimental facilities to care for the growing number of sick. The pressure on division hospitals was so great that Colonel Greenleaf, as chief surgeon of the Army in the field, recommended sending some patients to general hospitals. Sternberg initially postponed creating such facilities because he was unsure of when and whether the various Army corps would be sent overseas and of whether division hospitals would be able to meet the Army's needs.3
In mid-July, with disease rates climbing in both the U.S. and the Caribbean, Surgeon General Sternberg realized that he could wait no longer. The general hospitals he ordered set up in connection with post hospitals at Forts Myer and Monroe in Virginia, McPherson in Georgia, and Thomas in Kentucky, as well as at Key West, Florida, and Washington Barracks, were usually managed by regular medical officers. These institutions ran more smoothly than division hospitals and were less subject to criticism, but since their capacity was soon exceeded, he also had to open and expand several post hospitals on both coasts. Division hospitals at one camp were eventually converted into general hospitals. In this capacity they came under the surgeon general's direct authority and, according to Sternberg, "were promptly provided by me with the best available medical service, with trained nurses, with all permissible medical and hospital supplies, and with funds for special purchases." New hospitals could not be opened fast enough; vacancies at Marine Hospital Service facilities, normally used to shelter sick and injured merchant seamen, were made available to Army patients, and many others were sent to civilian hospitals. By 30 September 1898 almost 6,000 patients had been cared for in seven of the general hospitals and another 2,490 in six post hospitals, including one in Honolulu and another in San Francisco, in locations from Maine to Florida and from New York to Hawaii.4
The food provided the patients in these hospitals was a source of much complaint. Funds to buy more than a very few basic items of the special invalid diet were lacking, although charitable organizations set up diet kitchens at the major camp hospitals to provide foods that would tempt flagging appetites without upsetting fragile digestive systems. On 10 August 1898
Adjutant General Corbin remedied the situation by allowing the creation of a special fund to buy the food needed by the sick and convalescent. The ravages of disease, however, and the restricted diet required for its victims left the survivors of typhoid or severe bouts of malaria thin, and convalescents returning to their commands often continued to look emaciated as a result of having to eat the regular ration too soon during their recovery, when they could not yet properly digest it. The gaunt appearance of so many men triggered rumors that the Army was starving its sick.5
The most glaring example of the horrors of the camps in the United States was the largest, Camp George H. Thomas at Chickamauga, Georgia, where the I and III Corps, an "enormous army of inexperienced and undisciplined soldiers" accompanied by equally inexperienced doctors, arrived in the spring of 1898. Each corps averaged about 40,000 men, some of whom were not fit for service when they joined the Army, and both were already infected by typhoid. The ultimate responsibility for their health belonged to Lt. Col. Albert Hartsuff, surgeon in chief at Chickamauga and senior surgeon on the staff of Maj. Gen. John R. Brooke, commanding the I Corps and commander of the entire camp. Since even Colonel Hartsuff himself had no command authority over the line as far as sanitation was concerned, he and his medical officers could only observe and make recommendations. Hartsuff later complained about his authority over medical personnel, maintaining that no legal provision had ever been made for the position of chief surgeon to a command and that the chief surgeon of the corps reported not to him but rather through him to the surgeon general. Furthermore, because the disease rate increased slowly at first and the seriousness of sanitation problems became apparent only with time, even high-ranking officers of the Medical Department were unconcerned as late as the first week in July.6
As the typhoid epidemic spread, it placed an ever greater burden on the medical staff at Chickamauga. Overworked physicians began to break down on duty and soon had little time to urge improved sanitation upon reluctant commanding officers. Some concluded that making recruits follow sanitary regulations was, at best, "almost impossible." The soil of the surrounding woods became covered with excrement until it was impossible to walk there without stepping in it, while "myriads and myriads" of flies buzzed from
woods to food supplies, carrying "on their wings, legs and bodies the typhoid germs from the sinks and elsewhere, over the camp, infecting the food and drink." Proper latrines were hard to dig in the heavy clay soil that, lying over a layer of rock, held water "like a barrel." The rains that began at Chickamauga at the end of June lasted for two weeks, causing sinks to overflow and contaminating water sources. A medical officer familiar with the situation stated that he believed the camp's water supply was polluted by the end of July. Since filters, easily clogged, very slow, and very fragile, were impractical for use on a large scale, orders were given out to boil all water, filtered or unfiltered. In the one regiment that followed them, the precautions proved to be worthwhile, for as late as 7 August it was still free of typhoid fever.7
By early August, with the soil at Camp Thomas becoming "more and more charged with filth," almost 3,000 officers and men were sick, a figure that did not include those sent to general hospitals. Some cases were "virulent," suggesting to one surgeon that "large quantities of toxins" had been taken in, but many of the earlier cases had been mild, and many patients continued to mingle with their healthy comrades, thus spreading the disease further. The sick rate continued to grow beyond August's 6.83 percent, and the disease became increasingly virulent with time, presumably because victims were taking in heavier doses of the typhoid bacillus as the disease became more widespread and exposure more frequent. Because of the crowding at the hospitals, convalescents were often sent to recuperate with their units, a step that, unknown to physicians of the time, helped to spread the disease, since many remained carriers for months or longer.8
Stemming the tide became all the more challenging because typhoid was apparently an unpopular diagnosis and one that was difficult to make without either laboratory equipment or training in its use. Some higher-ranking medical officers maintained that malaria rather than typhoid was the real culprit. Eventually, the Medical Department's few expert Army pathologists, among them, contract surgeon Charles F. Craig, using cultures and the recently developed Widal test for typhoid, finally verified the fact that typhoid was the principal problem. Craig also concluded that the housefly played an important role in the transmission of this disease.9
The slow response of the supply system, partially the result of the failure of the Quartermaster's Department to provide enough wagons to unload supplies at rail depots, contributed to a rapidly deteriorating situation at Camp Thomas. Overstrained officers took to quarreling as they attempted to stretch inadequate supplies. Surgeons called frantically for tents to expand their facilities. A few patients had to lie for a brief period on the ground. In one division, where 1,225 of 11,000-12,000 men were ill, some had to be retained in their quarters at least temporarily. There were not enough doctors. There were not enough attendants. Pleas for assistance produced results, but, as the cases multiplied, never soon enough. Inexperienced medical officers gave up all attempts to maintain order and discipline. Regulations designed to prevent the transmission of disease within hospitals were ignored. Typhoid patients sometimes lost control of their bowels and soiled their bedding or the floor by their beds. Medical officers treated typhoid fever symptomatically. Sponging with cold water or cold baths reduced fever; small doses of a purgative, perhaps calomel,
relieved constipation; strychnine and alcohol lowered a rapid pulse; and a drug called sulphonal (sulfonal), presumably a hypnotic, was prescribed for sleeplessness. Although exaggerated stories of neglect abounded, apparently the drugs deemed most important were usually available either through the Medical Department or by local purchase.10
Confusion obscures the facts concerning the supply shortages at Chickamauga. Some may have been more apparent than real. One surgeon at Camp Thomas later claimed that no one who had made "the proper effort" had had a problem obtaining what he needed. On the other hand, Colonel Greenleaf maintained that a large quantity of supplies had been shipped to Colonel Hartsuff, but never received. Many surgeons suggested that Hartsuff had the supplies but rejected requisitions on frivolous grounds. On at least one occasion the I Corps chief surgeon, Lt. Col. Rush S. Huidekoper of the U.S. Volunteers, appealed over Hartsuff's head to General Brooke, who in turn telegraphed Surgeon General Sternberg to get what was needed. Hartsuff countered the attacks by explaining that he was not receiving complete cooperation from the Quartermaster's Department in obtaining such items as tents and that, with supplies meager, he was forced to distribute what he had according to the greatest need. He also insisted that many hospital patients were not really sick and that he should not have to provide for such men. In any event, drug shortages apparently did not last beyond 1 August, and Hartsuff contended that no one at Camp Thomas really suffered because of shortages.11
The typhoid epidemic undermined the hospital system at Camp Thomas, forcing the regimental facilities that were to have been abandoned to take more patients. Since all but one physician with each regiment had been absorbed into the division organization, regimental hospitals were in no position to handle large numbers of patients. Thus the rule that no patient should remain in one more than forty-eight hours was not likely to be protested.12
When the number of patients exceeded the capacity of both regimental and division facilities, Sternberg had a general hospital set up in a converted modern hotel used by summer vacationers in Chickamauga Park, Georgia, near both the camp and the rail line to Chattanooga, Tennessee. Although "well managed," the new Leiter General Hospital, too, was "sadly overcrowded" by August, with 255 beds in a space that should hold no more than 130. Under such circumstances, even a staff that included a hospital director, a volunteer medical officer, five contract surgeons, two Hospital Corps stewards, an acting steward, thirty Hospital Corps privates (who were described as "ill disciplined" and "very poorly clothed"), thirty female contract nurses ("said to be efficient"), ten Red Cross nurses, and two "excellent volunteer nurses" could not keep it thoroughly clean. In great need of assistance, the medical director told Lt. Col. Alfred Alexander Woodhull, who was inspecting the camp's facilities at the request of Secretary of War Alger, that he would particularly like to have the help of an executive officer, a line officer to handle quartermaster and commissary duties, and "more and better clerks." Tents were soon added to increase Leiter's capacity, and the number of medical officers doubled, but Colonel Woodhull noted that the "vicious system of regimental hospitals [had to be] tolerated as a makeshift" because of the great number of sick.13
A second general hospital, named after Sternberg and, like all general hospitals,
under the surgeon general's direct authority, was opened at Camp Thomas in August with a 750-bed capacity and a staff more than double that of Leiter's. Here, too, the medical officers responsible for the hospital were generally inexperienced and, like the rest of their colleagues serving Camp Thomas, were all too often reassigned before they had had a chance to become completely familiar with the problems that faced them. Nevertheless, the hospital achieved a fine reputation.14
The rapid increase in the disease rate, coupled with the departure of some of the troops, caused once-mobile division facilities at Camp Thomas to grow roots as a result of General Brooke's decision to remove them from under the division commanders and place them directly under Sternberg. Brooke's motives in doing so are unclear; he may have wished to take the physicians that were in charge of the division hospital with him when his command left Camp Thomas, or he may have merely distrusted Colonel Hartsuff. When the 1st Division of the I Corps left for the ports from which they would sail for Puerto Rico in late July, its hospital had to remain behind because space could not be found for its 153 patients at Leiter. Another 500-bed division hospital that also remained behind at Chickamauga became the Sanger General Hospital (later renamed after Alexander H. Hoff).15 In recognition of the loss of mobility, division hospital tents now received frames and floors. Bathtubs were installed and, with the aid of donations from private citizens and the Red Cross, diet kitchens as well. Despite all efforts, more than 40 percent of the over 4,000 men at Camp Thomas hospitalized by typhoid remained in regimental facilities, where 79 of the 263 fatalities from typhoid at Chickamauga occurred, a rate comparable to that in division hospitals. Sanitation at Camp Thomas continued to be poor after the departure of the 1st Division of the I Corps, but in late August and early September units remaining there were gradually dispersed.16
Camps in Florida
Time and experience taught the same lessons at other camps that they did at Chickamauga. At Miami and Jacksonville, where most of the 30,000 men of the VII Corps camped during the entire campaign in Cuba, the soil was absorbent and most units were supplied with city water that was considered safe. The proximity of a lumber yard made the construction of privies and bathhouses easy; the VII Corps commanding general, Maj. Gen. Fitzhugh Lee, insisted on attention to sanitation; and the men were reasonably well disciplined. The corps' chief surgeon, Louis M. Maus, who held a volunteer commission of lieutenant colonel, was aware, however, that the high water table made contamination of local water sources a constant danger. Once again, some men brought typhoid fever with them from the state camps, soldiers drank from nearby wells, and in August 1898, when the epidemic at Chickamauga had already been under way for several weeks, typhoid reached epidemic proportions at the Florida camps as well. By the end of September 5,072 men of the VII Corps had become ill enough to be sent to division hospitals and 109 had died.17
In the VII Corps, as elsewhere, the division/regimental hospital controversy remained alive in spite of an attempt to pacify those who supported the latter by sheltering men from the same regiment together. Each regiment was allowed to retain only two hospital tents, one to be used as a dis-
pensary and a second for sick call, with a single medical officer, a hospital steward, and a Hospital Corps private caring for the ill and injured. On 31 August Colonel Maus asked that each regimental surgeon set up a third tent with six cots, to be used as a "hospital tent of observation" for cases not yet diagnosed. No patient would be allowed to remain here more than three days. A few physicians retained under their own care patients who should have been sent to the division hospital, some of whom were in serious condition, at times as the result of a misdiagnosed illness. The presence of these men in camp only helped spread typhoid further among their comrades. The restriction on the use of the regimental facility also led some sick officers and enlisted men to seek medical care in Jacksonville from private physicians, who insisted that the illness involved was malaria rather than typhoid; their error was established by blood tests that suggested that only 2 percent of fever cases were suffering from malaria and by a study of 50 patients sent north from Florida for testing at Fort Myer.18
Although typhoid fever was the predominant disease in the Army's camps, medical officers also had to deal with other health problems, some calling for the services of specialists. Noticing that many of his patients had very "bad teeth, and other troubles of the mouth," Colonel Maus assigned Hospital Steward J. W. Horner to work as the corps dentist, with an acting hospital steward to assist him. The demands made upon Horner's time were so great that he could care for only a fraction of the men who sought his aid. The dentist was the only Hospital Corps specialist to be obtained for the VII Corps, but Maus found it wise to designate one of his brigade surgeons, Maj. William S. Bryant, to function as the corps "aurist" (ear specialist) and a contract surgeon, John Ling, as "oculist." Maus believed that through the aid of these specialists, many men were returned to duty who otherwise would have been discharged from the Army. Maus' appeal for the appointment of a veterinarian and a veterinarian's assistant to the corps was apparently less successful.19
So many of the VII Corps survivors of the typhoid epidemic were debilitated that a convalescent hospital was finally established for them in July at Pablo Beach, a resort sixteen miles from Jacksonville. Despite instructions to regimental surgeons that no one who was actively ill was to be sent there, some who were not yet convalescent arrived at the new hospital. A few more came down with typhoid while there, necessitating the renting of a 20-bed cottage and the assignment of a surgeon from the volunteers to run it. In October, when
MEDICAL CARE AT JACKSONVILLE, where Sisters of Charity nursed patients
a hospital train became available to take convalescents back to their hometowns, the popularity of the Pablo Beach facility began to wane. It was closed in November, after sheltering a total of 1,400 men.20
While preparations for the invasion of Cuba were under way, the VII Corps experienced supply problems as had the I and III Corps at Chickamauga. In this instance, delays in meeting VII Corps needs resulted from the prior claims of the V Corps, about to embark from Tampa. The VII Corps filled the requirements of its first field hospital from Tampa and thereafter from purveyors in New York, St. Louis, and Washington, D.C. After mid-June, with supplies coming in when needed and in abundance, Colonel Maus rented a building in Jacksonville to serve as a corps supply depot. The Red Cross and other "benevolent societies and individuals" provided some aid, always in the form of supplies; Maus did not believe that the Red Cross would keep the necessary records properly if it were to follow Civil War precedents and establish its own hospital.21
The first trainload of sick from Tampa arrived at the Fort McPherson general hospital near Atlanta on 14 May and was housed with the evacuees from camps in the Deep South in a barracks and the post hospital. By the end of August 1,244 patients, most of them from Tampa, had gone through this hospital, which eventually held 922 beds. Ironically, the influx of sick and of medical staff to care for them set the stage for a typhoid epidemic at a post that might otherwise have escaped it, for sanitation problems grew as the population of the fort increased. Sewers became clogged with "paper of all kinds, socks, handkerchiefs, and even drawers. . . . The woods became full of deposits made on the surface of the ground and these were washed
into the brook which supplied water to the bathing pool." Despite warnings, men drank from the pool, and disease was soon running rampant.22
Camp Alger, established in mid-May 1898 in Virginia seven miles from Washington, D. C., was farther north than any of the other training sites and much smaller than Camp Thomas, but conditions there resembled those in camps farther south. Because II Corps units came and went throughout the summer, the number of men serving there under Maj. Gen. William M. Graham,23 the corps' commanding general, varied from roughly 18,000 in May to a peak of more than 23,500 in June. For most of the time Camp Alger was in operation, the II Corps was divided into but two divisions; a brigade formed on 2 August was designated "the Second Brigade, Third Division," but was ordered to report for temporary duty with the 1st Division.24
Girard, now a lieutenant colonel of the volunteers and the chief surgeon of the II Corps, and, except for short periods of time, the only Regular Army physician at Alger, was confronted with a "Herculean task." He reported that he had to teach the raw troops that crowded into the camp "how to procure food, water, fuel, clothing; to carry out ordinary principles of hygiene; in addition to this, to organize two large division hospitals, equip the hospital department of several large commands for active campaigns; to transfer, organize, clothe and equip a hospital corps of about seven hundred men, and to put them through some instruction." His problems were magnified by a water shortage and the fact that, once again, many regimental surgeons were careless about sanitation and their colonels often ignored any recommendations they might make. The suggestion that each soldier in the II Corps cover his feces was for the most part ignored until early August, when an order was issued "enforcing this necessary sanitary measure." Many soldiers did not bother with the latrines, and thus "by the careless and filthy habits of the men the woods surrounding the camp became generally the receptacle of fecal matter. Sentinels who were placed to prevent this use of the surroundings of the camp failed to report their own comrades."25
Colonel Girard's initial problems were exacerbated by the fact that many regiments reported to Camp Alger without hospital tents or medicines, even though Surgeon General Sternberg had warned state governors that he could not provide
adequate supplies for volunteer units on short notice. Girard was thus forced to establish a division hospital immediately and to obtain an order from General Graham, compelling all units to contribute to its supplies. The complaints of regimental surgeons angered at having to deplete their stores drew newspaper reporters. As a result, like so many other Army surgeons, Girard was, in his words, "held up to the horror of mankind."26
Among the other handicaps under which Girard was working was his mistaken impression that the entire II Corps was to go overseas at once. Unaware that Camp Alger was to be a training camp, he initially did not attempt to provide the division hospital with all the equipment it would need if it were not to serve as a field hospital. In his haste to prepare field hospitals, he also ignored the unsanitary location of tents and privies. In late June, when three of the corps' nine brigades began moving from Camp Alger to the Caribbean, Girard was able to send a hospital with them only by once again depriving regimental hospitals temporarily of much of their supplies.27
After an inspection of Camp Alger early in July, Lt. Col. Charles Smart, head of the Sanitary and Disbursing Division of the Surgeon General's Office, concluded that the disease rate was low, but typhoid broke out soon after his visit. Colonel Girard stated that cases were soon so numerous that he was never sure of their exact number. Some who felt ill went on leave before their condition could be evaluated, and others were removed to the nearby Fort Myer hospital before an accurate diagnosis could be made. Here, too, some physicians believed that the prevailing disease was malaria, while others apparently resorted to the old Civil War diagnosis, typho-malaria. Girard, however, insisted that typhoid was the principal problem and that the troops here, like those of other camps, had already been infected with it when they arrived. A careful but belated study of the diseases afflicting the II Corps suggested that Girard's diagnosis was correct.28
The evacuation to Fort Myer, only ten miles from Alger, was initially made by
ambulance, but the toll eventually became so great that the Medical Department
had two hospital cars placed on the local trolley line to move the sick.
Although a vacant barracks was added to the Fort Myer hospital, which was then
upgraded to a general facility, it was not ready for such a sudden influx of
patients. After 200 patients had been sent there, Colonel Girard was ordered to
refrain for a week from sending more. At some point the Red Cross came to his
aid, establishing both a hospital at Camp Alger and a diet kitchen at Fort Myer
and providing trained female nurses whose care was, in Girard's opinion, "far
superior to any which could be
Colonel Girard devoted much time while at Camp Alger to dealing with the problem of hospital attendants. He had no ambulance company, and because of the difficulties involved in obtaining hospital corpsmen by details from the line, General Graham allowed him to recruit outside the Regular Army. Having managed to win over the colonel of an Ohio unit to his
point of view, Girard received that officer's complete cooperation in assigning men from his regiment to hospital service and in employing some of his noncommissioned officers in a recruiting program. This effort was so successful that Girard was able to form a reserve company of corpsmen after he had filled the regular quota for the units at Alger. Having observed that few regimental medical officers were capable of commanding a Hospital Corps unit, Girard obtained Graham's permission to have the Quartermaster's Department officer routinely assigned to each division hospital assume this responsibility. He also established a training program for his new hospital corpsmen, but in late July the II Corps was in flight from the diseases of Camp Alger, Girard later reported, "frustrat[ing] this design."30
Retreat From Disease: New Camps
The camps set up initially for the army gathering to fight the Spanish had been regarded as temporary. The campsites had been chosen with little forethought-but, it was rumored, with considerable attention to political considerations-and the accommodations had been located with little appreciation for the sanitary requirements of large groups of men and without any notion that these men would be remaining there for any length of time. No plans had been laid for the management of units that did not go overseas when these camps were created. Many difficulties originated in the haste with which these camps were established, and the mere passage of time eased those caused by supply shortages or a lack of familiarity with Army routines. Furthermore, the typhoid epidemic was gradually burning itself out as increasing numbers of men acquired temporary immunity through contracting the disease. Perhaps most important was the fact that the disaster that had resulted from ignoring the advice of Army physicians concerning sanitation had given added force to their opinions.31
The end of the fighting in Cuba on 17 July and the formal surrender of the Spanish at Manila on 14 August did not lead to immediate demobilization, since troops were needed to serve as an occupation force. Furthermore, when the volunteers who responded to the call for men in the spring of 1898 were mustered out, camps had to be established for the equally green volunteers who replaced them.32 None of these men could be kept at the disease-ridden camps in the United States, and thus, as the summer progressed, many units were sent in some haste to new ones. All officers involved in these efforts attempted to put the lessons of the preceding weeks to work; they prepared for the arrival of troops well ahead of the event, chose sites with greater consideration for the size and purity of water supplies, had tents more widely spaced and latrines located farther from kitchens and mess halls, and more strictly enforced sanitary discipline. "Time and experience," as one surgeon concluded, had at last taught "officers and men the best methods for caring for themselves."33
Those responsible for the initial move of the II Corps' 2d Division from Camp Alger apparently made the decision to leave in mid-July after concluding that the camp, the site, and the equipment were thoroughly infected. "Suddenly . . . one night" these men received orders to march the next morning to Thoroughfare Gap, Virginia, which they did in spite of inadequate food supplies. As they progressed, those who fell ill were sent back to a field
hospital set up at Bristow, Virginia. By the time they reached their new camp in Pennsylvania, Camp Meade, they appeared to have left typhoid behind.34
The II Corps' 1st Division marched to Dunn Loring, Virginia, when it left Camp Alger, sending diagnosed cases of typhoid back to Fort Myer with twenty-five men of the reserve Hospital Corps company detailed to assist in their care. When the decision was made on 14 August to move those of the command who were still healthy to Camp Meade, the men benefited from greater forethought than had those of the 2d Division. They went by train, and before they left, an advance party that included Colonel Girard went ahead to inspect the area. The inspection revealed that water supplies were "precarious" in quantity but pure-fortunately, Girard believed, because once the men arrived, most of them ignored orders to use filters. By the time the move had been completed, the disease rate in the 1st Division had also begun to drop, although in the confusion and with patients scattered in hospitals from Fort Myer to Camp Meade, Girard had to abandon his training class for hospital corpsmen.35
Colonel Girard had reason to hope that the disease rate would remain low at the new camp, which was designed with the experiences of Camp Alger in mind, and that his troubles would be at an end. General Graham transformed every one of Girard's recommendations into an order. All tents had been boiled and all blankets used by typhoid patients disinfected by steam. Rules concerning sanitation were strictly enforced, and a contract surgeon was assigned responsibility for inspecting latrines on a regular basis. Nevertheless, despite the fact that conditions here were almost ideal, the new and inexperienced volunteers who replaced those mustered out from Camp Meade brought typhoid with them from their state camps, and the sick rate once again began to climb. It is likely, too, that among the troops from Alger were seemingly healthy typhoid carriers. The hospitals were soon filled, and new cases were transferred to civilian hospitals in and near Philadelphia. The II Corps' 1st Division, which reported 893 admitted to field hospitals at Camp Alger, had 687 admitted to the division hospital in October, and the 2d Division, which had a total of 594 admitted to the hospital while it was in Virginia and at Camp Meade up until the end of September, had 668 in October. The mustering out of so many regiments and their replacement with new units also brought a return of Girard's problems with untrained hospital corpsmen.36
The IV Corps, created to organize the various regiments left behind by the V Corps, also moved many times in the summer of 1898 without escaping disease. When its first hospital, a 200-bed division facility, opened in Mobile, Alabama, among its patients were nine typhoid victims. Once the corps moved to Tampa, Florida, where sanitation was poor, the sick rate was soon soaring. In July, after some IV Corps units sailed for the Caribbean, the remaining men were moved to Fernandina because of their continuing high disease rate, but since physicians were still powerless to enforce sanitary regulations, sinks there were soon "in an indescribably filthy condition." To relieve the division hospitals, many patients had to be evacuated by hospital train to Fort McPherson. In August the IV Corps was ordered to Huntsville, Alabama, where a second hospital was established. The hospital train then periodically ran from Huntsville to Fort McPherson to remove the sick and wounded.37
By contrast, the move from Camp Thomas in late August and September of those men of the I and III Corps who were not sent to the Caribbean apparently attracted little unfavorable comment. Once again, those who were obviously sick were left behind in the old camp's hospitals. Even though for a while men continued to fall ill, conditions at their new and smaller camps in Tennessee, Alabama, and Kentucky were regarded as excellent, and disease rates began to drop. The camp at Lexington, Kentucky, in particular, became known for the strict standards of sanitation maintained there.38
With cold weather approaching, steps had to be taken to prepare for winter housing for all troops remaining in the United States. This had to be accomplished with the full knowledge that diseases easily spread in the summer might be even more easily spread among men forced by the weather to spend more of their time together in a closed space, where the desire to keep warm might take precedence over ventilation. While the new camps to which so many troops had been moved during the summer had represented improvements over the original camps, they were not always what could have been wished for. In September 1898, therefore, a military commission was named to study potential campsites for the troops still awaiting service as part of the occupation army in the Caribbean. Appointed to the commission were Theodore Schwan, a brigadier general in the volunteers, as its head and future surgeon general Robert M. O'Reilly, now a lieutenant colonel in the volunteers. Among the concerns of the commissioners were water supplies, sanitation, drainage, and the climate.39
In early October, while the commission was still at work, the Army reorganized the various corps created for the Spanish-American War, discontinuing the III, V, and VI Corps,40 and reassembling the remaining men as the I, II, and IV Corps. Secretary of War Alger then ordered the movement of these corps to their new southern camps to begin on the twenty-seventh, with the move to be carefully managed so that no more than one regiment arrived at a camp in any one day. The need to take "the necessary measures for placing the camp in good sanitary condition . . . in advance of the arrival of the troops" was emphasized.41
The high disease rates that had, to varying degrees, afflicted the camps to which the various corps retreated in the late summer did not reappear at the new southern sites. I Corps troops found their camps in Georgia, where they moved in November, an improvement even over those at Lexington. The only typhoid cases encountered appeared among men being sent to Charleston to embark for Cuba who drank water at a Georgia railroad station.42
Concern for the health of the 30,000 men of the II Corps was so great that they were not allowed even to begin their move south from Camp Meade until mid-November, when the threat of yellow fever had passed and the camps and their hospitals were entirely prepared to receive them. No time was found to give systematic training to the men of the II Corps' Hospital Corps company, and thus they had to learn by working with the female nurses assigned to the II Corps hospitals at the new camps in Georgia and South Carolina. Great attention was devoted to sanitation and, once again, typhoid disappeared as a major problem. Preparations to receive these men were not perfect; the pavilion hospital at Augusta, Georgia, proved to be of flimsy construction. The wall of one pavilion collapsed and another
took on a distinct list after a windstorm. The boards shrank, and during the winter the cold blew through the crevices that resulted. By December, however, the disease rates of each division were under 150, where they remained.43
The VII Corps, unlike the other corps serving in the East, did not leave the campsite in Jacksonville, Florida, until late October 1898, when it moved to Savannah, Georgia, whence it would embark for occupation duty in Cuba. In spite of wet, cold weather the camps set up in Savannah, like the others opened in the fall of 1898, proved to be healthy. When the VII Corps shipped out in December and January, its camps were kept open, and when men began to return from Cuba and Puerto Rico in February 1899, they were sheltered at the same sites. The VII Corps was not mustered out until the following May, when the service of the volunteers of the summer of 1898 came to an end.44
The few members of the I Corps that remained in the United States when most of the corps left for Cuba had been assigned to the II Corps, and the I Corps was discontinued in January 1899. By spring, almost all of the men of the II Corps had also been mustered out. After having been organized into two divisions in the October reorganization and then ordered from Huntsville to Anniston, Alabama, the IV Corps, like the I Corps, was discontinued in January 1899.45
The experiences of the summer of 1898 led to major changes in overall policy for the Medical Department. Regimental hospitals again became respectable, and division hospitals were established principally to take their overflow. Camp medical officers were allowed to order freely from all items on the standard supply table, and individual preferences were given consideration according to their merit rather than being dismissed out of hand. Because a shortage of microscopes had made early and accurate diagnosis of typhoid fever impossible, Surgeon General Sternberg ordered that every hospital, regardless of size, be issued one to ensure that this disease would in the future always be identified before it reached the epidemic level. The disasters of the camps of 1898 would never be repeated.46
One final camp was established at Montauk Point, Long Island, in August 1898 to receive the V Corps after its flight from Cuba. The fact that yellow fever cannot be spread without the presence of the Aedes aegypti mosquito was still unknown, and the epidemics that afflicted various U.S. ports earlier in the century had not been forgotten. As a result, authorities agreed that all troops returning from Cuba and Puerto Rico in the late summer of 1898 were to be isolated at the new Camp Wikoff until physicians could be sure that yellow fever would not break out among them and threaten the health of those who came into contact with them. Fear that tropical diseases no one could prevent would destroy the entire corps was widespread. Since all concerned were apparently convinced that the only way to avoid such a calamity was to ship the men back to the United States immediately, the evacuation, like the invasion, was hastily planned and hastily executed. When these "wan, sallow, and greatly reduced" veterans began their return to the United States in mid-August, an estimated 80 percent were to some degree ill, and thus the need for hospitals and medical personnel would be great.47
No time was allowed for a careful and thorough preparation of the site where Camp Wikoff was to stand. Nor was time allowed for dealing with the myriad problems that might arise. Among the greatest difficulties experienced from the outset was supply. The arrival of the cars was often delayed because the Long Island Railroad line to the site was single track and, according to Wikoff's chief surgeon, Colonel Forwood, initially lacked "switches, side ways, platforms, storehouses, or other facilities for landing . . . thousands of carloads of freight, passengers, and material." The Army had had to agree to rely exclusively on this railroad for all transport and to refrain even from using steamers to bring in supplies in order to obtain the 5,000 acres on Montauk Point as a campsite. The railroad company did not begin to lay switches and sidetracks until 6 August, a day before the arrival of the first of the camp's new occupants, V Corps cavalry troops that had been left behind in Tampa, and neither lumber nor other materials were available to build the necessary accommodations.48
More than half of the men to occupy Camp Wikoff would require hospitalization, but the Medical Department's attempts to prepare for their arrival were frustrated both by the poor transportation system and by the inept management of shipping by the Quartermaster's Department; although railroad cars carrying medical supplies were properly marked, many containers were so large that they required more than two men to move them, and none were labeled as to their contents. The result was long and tedious searches to obtain supplies that were within reach.49
On 29 July, ordered to establish a 500-bed "temporary tent hospital" at Montauk and to advise line officers on the selection of campsites and water sources, Colonel Forwood worked frantically to make the best of a bad situation. When lumber was finally obtained, carpenters failed to start to work because they wished to return to their homes each night and feared that they might be subject to the quarantine. Reassured on this subject, they struck for higher wages. No sooner was this problem solved than rain began to pour down, turning the area into a quagmire that threatened to swallow the wagons hauling supplies.50
When the 4,000 cavalry troops from Tampa, fleeing their typhoid-ridden camps in haste, arrived at Montauk Point, no shelter or food was available except that which they brought with them. After authorizing Colonel Forwood to telegraph his orders, Surgeon General Sternberg personally ordered the purveyor to fill them with great care, dispatched tents and hospital corpsmen to Wikoff, and forwarded funds to alleviate the shortage of food, especially of food of good quality. On the eleventh the Red Cross started bringing in supplies for the general hospital, from which other hospitals, including the division facilities accompanying returning troops, would be supplied. In a short time an entire 15' by 113' storage pavilion was filled. Other charitable organizations sent cooks and supplies of every kind. The Marine Hospital Service supplied Forwood with a steam sterilizer and a barge equipped to disinfect clothing and bedding from infected ships, while the president of the Long Island Railroad Company personally guaranteed the prompt delivery of the sterilizer.51
Although matters had improved somewhat by 13 August, when the first 50 patients from Cuba landed, a representative of the Massachusetts Volunteer Aid Association, who arrived two days later to assist in the care of returnees, was impressed by the confusion at the Wikoff hospitals. He re-
ported that "there were few physicians, fewer nurses, and fewer still hospital-corps men." Regular medical officers were neither trained nor experienced in hospital administration. The laundry was yet to be established, and dirty linen was piling up. Some wards were badly overcrowded, others sparsely populated. When physicians were transferred, wards were left without medical supervision for hours, and new patients were sometimes temporarily ignored. Visitors began to pour in, complicating patient care, occasionally misinterpreting what they saw, and adding to the confusion. The Massachusetts volunteer concluded that "the absence of a firm, controlling hand always within reach" contributed to the difficulties and that Colonel Forwood was sadly lacking in administrative talent. He also blamed some delays in correcting shortages upon the fact that Forwood, who, he believed, lacked the power to delegate authority, felt compelled to sign every order personally.52
Transportation also continued to present serious problems. At one point no fewer than 220 railroad cars awaited unloading at the Montauk depot. Many of them had been there two or more weeks, and the supplies needed by the physicians at Camp Wikoff continued to be "buried" in them. Moreover, items held in storage could not be promptly moved to the hospitals when needed because of a lack of transportation within the camp. Not surprisingly, Colonel Forwood, in defending himself later before the investigating Dodge Commission,53 struck out at the Quartermaster's Department for the inadequate nature of the support he received.54
In describing those aspects of the situation at Wikoff that were his responsibility, Colonel Forwood tended to paint a rosy picture. He reported that on 12 August, with four wards of the general hospital completed, "90 patients [were already] in bed under care of nurses, with all kinds of medical and hospital property in abundance." With the weather good and carpenters numerous, construction was proceeding rapidly. The 210 patients in the general hospital on the fifteenth were enjoying a superfluity of both beds and supplies. Forwood had assigned a surgeon to supervise the unloading of patients from their ships, and since transportation remained a problem, he had placed a second surgeon at the railroad station to make sure that Medical Department supplies were unloaded and forwarded as expeditiously as possible. By the nineteenth the general hospital held 250 vacant beds, and Forwood had been able to guarantee each patient "as he landed from the ambulance . . .
hot soup and milk punch from the hands of the female nurses."55
The general hospital was originally planned to include only eighteen pavilions, each consisting of six tents on wooden frames with wooden floors, but because of the large numbers of sick, two annexes were also eventually built. Although some complaints arose about overcrowding, understaffing, and poor sanitation, Colonel Forwood maintained that he always had enough tents and cots and that his only problem in that regard was having tents set up and beds put in place. So sturdy was the construction of this facility that even extraordinarily heavy rains and high winds failed to cause damage.56
Within a few weeks the general hospital staff more than doubled in size. When the hospital population was at its greatest, it included 40 physicians, 133 hospital corpsmen, 50 male nurses, 329 female nurses, and 15 civilian cooks. Most of the nursing staff, both male and female, were under contract. The surgical wards, the operating tent, and the hospital annex were run by the Sisters of Charity, some of whom were specially trained in the care of surgical patients. Although physicians sometimes complained that female nurses "could not appreciate that the doctor was supreme in his ward," most of them regarded these women more highly than their male counterparts. Colonel Forwood's efforts to increase the number of physicians assigned to him were often frustrated when those ordered to Wikoff never arrived, having managed to have their orders changed "for some reason or other." Nevertheless, the medical staff at Wikoff had, for the most part, a good reputation. The work done at Wikoff's surgical facilities, organized and directed by Colonel Senn, was much admired.57
The fear that hospitalized patients among the returning troops might introduce yellow fever into the United States led to the establishment of a second hospital at Wikoff, a detention facility where the sick and wounded from ships suspected of carrying yellow fever infection could be held. This facility received its first patient on 15 August, and by the seventeenth 3 physicians and 6 hospital corpsmen were caring for 60 patients. As its population grew, its tents were put on frames, given wooden floors, and organized into pavilions like those in the general hospital. By the thirty-first, when its capacity reached 400 beds, fourteen such structures had been built, and another forty separate tents stood ready for convalescents. The number of patients sent there tended to vary widely, and it was difficult to meet sudden and large influxes, especially when the delivery of supplies was slow. Despite the aid of the Red Cross, Colonel Forwood had to admit that in this hospital "the wants of patients, in spite of the best efforts of all, were not always promptly met. " The only 5 patients ever suspected of actually having yellow fever were released from quarantine on the twenty-fifth, and by mid-September, when roads, wells, electric lights, and telephone and telegraph lines were all in place and when no new patients were being admitted, the size of the staff could be reduced. On the eighteenth only 60 patients remained of the 1,850 men who had passed through the detention hospital since 28 August, more than 1,100 of whom had been either furloughed or returned to their regiments and only 62 of whom had died.58
The sick continued to come to the other hospitals serving Camp Wikoff in overwhelming numbers throughout August. Although by the end of the month patients
were being furloughed home at the rate of 200 a day and the general hospital's capacity had been increased to 2,500 beds, it became necessary to organize three division hospitals with beds for another 600. As September progressed and even these most recently established facilities filled up, more and more soldiers had to be cared for in regimental hospitals.59
Because of the congestion at the Camp Wikoff hospitals, Surgeon General Sternberg permitted their patients to be sent to civilian hospitals in such cities as New York, New Haven, Connecticut, and Providence, Rhode Island, which were more comfortable than "the bleak, temporary hospitals at Montauk." To expedite the transfers, he sent Colonel Greenleaf to the camp on 8 September, returning Colonel Forwood to his prewar assignment at the Soldiers' Home in Washington, D.C. Greenleaf assembled twenty-two ambulances to take patients to the train or boat that would carry them to their destinations. Long waits at the railroad depot by men weakened by disease led to many complaints, but finally an arrangement was made that forbade the sending of patients from the hospital until the chief surgeon had been informed that a car awaited them at the station. Two private citizens paid to have railway cars specially equipped for convalescents, while the Red Cross and such organizations as the Massachusetts Volunteer Aid Association provided boats to move patients from Montauk. By transferring patients and granting furloughs, the Medical Department so reduced the hospital population at Camp Wikoff that on 10 September 1,000 beds were vacant. Two of the three division facilities and all but the main section of the general hospital were then closed.60
Pressure upon the Medical Department to send patients home or to institutions near their homes was great, but when convalescents collapsed on the way, criticism was loud. Colonel Greenleaf decided to appoint medical boards to determine which patients were strong enough to endure the journey. Relapses were also frequent among patients who had returned to their homes in apparent good health, only to fall seriously ill after too much welcoming celebration. Even on the trains taking them home, some of these men were offered food they should not eat, and families and friends were warned that "many soldiers who had escaped the danger of the battlefield have been killed by kindness at home." Several physicians commented on the dangerous type of malaria afflicting so many returnees, one Massachusetts physician blaming these fatal and near-fatal relapses on "what we call aevisto [sic] autumnal malaria," caused by the highly dangerous falciparum parasite, one rarely encountered in New England.61
As autumn approached, Surgeon General Sternberg was forced to consider a new problem, the protection of the sick remaining at Camp Wikoff against "the chilly nights and high winds of September." Acting on a plan to winterize the tent pavilions, he ordered "window sash, stoves, hardware, etc.," for five wards. Construction was promptly undertaken and apparently completed by 24 September, but the population of both camp and hospital was already dwindling rapidly. All but seven regular regiments had left Montauk Point before the end of September, and fewer than 400 patients remained hospitalized. On 3 October, when the V Corps was disbanded, less than 300 sick, all seriously ill, remained in the camp's hospitals, to be transferred when well enough to
withstand the journey. On the sixth Colonel Greenleaf left to inspect military camps in the South, and on 16 November the general hospital finally closed.62
Despite the hardships experienced at Montauk Point and the harsh criticism that some civilians leveled at it, up to 30 September only 257 of the 21,870 who had gone through Camp Wikoff, of whom more than 17,500 were returnees from Cuba, had died. Although 10,000 patients had been cared for in the general, division, and detention facilities and another 4,000 in regimental hospitals, no major epidemics had developed among its weakened inhabitants.63
The Typhoid Board
The devastating nature of the epidemics that had swept Army camps in the summer of 1898 could not be ignored. Surgeon General Sternberg's response to the challenge involved initiating a new approach to the study of disease. In August he named the first of a series of boards that would be appointed in the decades to come to investigate the diseases that threatened the Army. The new Typhoid Board would study the way in which typhoid fever spread and means of preventing its transmission. To head it, Sternberg named Major Reed, whose preparation for the task he was about to undertake dated back to the days of his graduate studies at Johns Hopkins (1890-1891), which included the effects of typhoid fever upon the human body. Sternberg had recognized Reed's expertise by appointing him to teach bacteriology at the Army Medical School in 1893. The 47-year-old Reed, "a man of charming personality" as well as "a polished gentleman and a scientist of the highest order," according to a colleague, was joined on the Typhoid Board by two surgeons of the U.S. Volunteers, Major Vaughan, a professor of medicine at the University of Michigan who had survived yellow fever in Cuba, and Maj. Edwin Shakespeare, who had studied tropical diseases in India and Spain.64
On Sternberg's instructions, the three physicians inspected all the major campsites in the United States. After examining such matters as sanitation, tent placement, and conditions in general hospitals, and after interviewing the medical officers involved, the members of the board returned to Washington in October to begin their detailed examination of camp records. They traced the progress of each soldier who might have had typhoid through every hospital, military or civilian, that cared for him. Among the camps they studied was Camp Alger, where the surgeons
caring for the troops had no microscopes and thus had been unable to examine the blood of their patients for evidence of malaria parasites. Medical officers had, therefore, found it easy to diagnose dubious cases as malaria rather than typhoid, even though the prevailing disease had not responded to quinine. Vaughan concluded that medical officers at Alger might have been frightened by the idea that the disease was typhoid, and he pronounced their suggestion that dengue was the principal disease at some camps to be "too absurd to receive serious attention."65
The Typhoid Board set up laboratories at each camp and sent experienced bacteriologists to work in them. As a result, the board could achieve far greater accuracy in its disease identifications than had been possible for camp surgeons. Although the Widal test often failed to indicate the presence of typhoid until the case was far progressed (the immune response developed strength with time) and a diagnosis of malaria could be missed if only a few plasmodia were present in the blood, the board was able to conclude that malaria had never been a serious problem for U.S. troops in the United States. The board's research also suggested that as many as 82 percent of the sick in the Army in the United States had typhoid, that the disease was often present in units before they reported to federal authorities, and that the failure to diagnose it correctly and promptly had contributed to the epidemic.66
The Typhoid Board decided that, popular opinion to the contrary, polluted water played only a minor role in the spread of typhoid. While acknowledging that water "always [had to] be kept in mind" as a vehicle for the disease, Reed and his colleagues confirmed Sternberg's theory that flies moving from latrines to kitchens and food supplies posed a greater danger. Men who emptied bedpans for sick comrades and did not wash their hands before handling food transmitted disease, and those who dipped water from streams with contaminated hands endangered their own health and polluted the stream as well. Spread of the disease also resulted from the failure to segregate those diagnosed as having typhoid from other patients. Those who were responsible for sanitation in the camps were all too often poorly trained, too few in number, and lacking adequate authority to enforce the necessary measures. Reed recognized the phenomenon of the typhoid carrier when he pointed out that "the individual who . . . acts as host for the introduction of the bacillus need not necessarily develop the disease himself, he may at the time be immune and yet his excretions may be infectious."67
The board despaired of ever being able to prevent epidemics by sanitation alone. Vaughan noted that he could not "help but feel that the engineer corps was largely responsible for the 1898 tragedy at Chickamauga, but the ignorance of camp sanitation at that time displayed by the army engineer was surpassed only by that of the line officer." Realizing that practices that favored the spread of typhoid would continue as long as line officers treated the warnings of medical officers with contempt, the Typhoid Board concluded that immunization might be a more effective approach to preventing typhoid in the Army than sanitation alone.68
By the spring of 1899, although the money allotted for this work had run out and Reed had been given another assignment, Vaughan and Shakespeare continued to organize the data they had collected on their own. They brought out a preliminary report in 1899, but in 1900, before
the final version could be issued, Shakespeare died. Reed worked on the report only briefly in the summer of 1900, since he was by then involved in his study of yellow fever, and thus Vaughan alone was available to complete a summary of the board's conclusions. Since the summary showed both that typhoid was too widespread throughout the general population for the Army to be able to prevent the appearance of isolated cases and that the disease could be spread in many different ways, the full report with supporting data was eagerly awaited. An abstract was published in 1900 and the complete report four years later. By this time Reed, too, was dead, and the definitive document detailing the findings of the Typhoid Board was largely the work of its only surviving member, Victor Vaughan.69
The Dodge Commission Investigation
By the late fall of 1898 almost all the men once inhabiting the huge training camps had been sent to other camps and stations or to homes, families, and civilian life, and Secretary of War Alger had been sufficiently impressed by their sufferings to require weekly inspections of all camps. More time was allowed commanders to choose their campsites, and care was taken to avoid massing large numbers of men at one location. In Colonel Greenleaf's opinion, postwar division hospitals were for the most part well run, and some were "models of neatness." Supplies were plentiful, and the sick were well cared for.70
But well-run, well-supplied, and clean hospitals were far more easily achieved in time of peace than in time of war. The lesson about the possible consequences of hostilities lightly entered into had cost dearly. The inroads that disease had made among the men of the Army's camps of the summer of 1898, increasing the Army's death rate more than fivefold over the peacetime rate, would not be forgotten, especially at a time when more was expected of medicine and of those who practiced it than had been the case during the Civil War. The question of how this disaster came about would long be the subject of debate and speculation far beyond the boundaries of the Army Medical Department.
Criticism centered upon what was perceived as administrative incompetence or callous neglect. The competence of the Army's physicians was not called into question. The collection of so many men in camps during the summer months for so long a period led to scenes encountered during the Civil War only at the worst prison camps. Those who throve on sensationalism found much to feed upon at the disease-ridden camps and especially at Camp Wikoff, where relatives sought to comfort the newly returned veterans. In addition to the disease rate and the occasional lack of bare necessities, a general failure to understand the way in which the military operated led to public outrage. In civilian life, hospitals were still used mainly by the extremely poor, and presumably few of those who could visit their relatives at an Army facility were familiar with the nature of hospitals of any kind or with the care provided there. Some problems that led to the loudest outcry resulted from the failure of well-intended civilians to understand that their husbands and sons simply could not be cared for in a military situation as they would be if they were injured or fell ill at home.
President McKinley responded to the tumult raised by the management of the war and the horrors of the camps by appoint-
ing a commission, chaired by Maj. Gen. Grenville M. Dodge,71 to "investigate all charges of criminal neglect of soldiers . . . and to make the fullest examination of the administration of the War Department in all of its branches." After several months of inquiry, the commission concluded that the nation's leaders in both the legislative and executive branches were to a large extent responsible for the situation that led to so much unnecessary suffering and death. Congress had not granted the funds necessary to prepare for war until the war was under way. A majority of the commission, including Dodge himself, did not believe that Secretary of War Alger was to blame for the failures of the Spanish-American War. To present a united front, they compromised with the dissenters and stated in their official report: "In the judgment of the commission there was lacking in the general administration of the War Department during the continuance of the War with Spain that complete grasp of the situation which was essential to the highest efficiency and discipline of the Army."72
The commission went on to highlight specific problems and, in some instances, to make recommendations for their solution. After noting that the lack of funds to prepare for war before it was declared had made it impossible for the Medical Department to accumulate sufficient supplies to meet a demand that proved to be higher than anticipated, the commission recommended that enough for four years be kept in reserve. It also pointed out that the department's inability to control the transportation of its supplies had contributed to the supply shortage. It observed that the shortage of trained physicians had prevented the necessary frequent and thorough inspection of camps and hospital sanitation. The commission urged that a reserve of trained nurses be created to prevent a recurrence of the shortage experienced in the summer of 1898 and that plans be laid to create a volunteer Hospital Corps in the event of another war. All physicians, in the commission's opinion, should be able to draw whatever food their patients needed without regard to the commutation of rations. Since administrative confusion had also contributed to the department's problems, attention should be given to simplifying routines and eliminating unnecessary red tape.73
Surgeon General Sternberg's preoccupation with details that could have been handled by his subordinates may have limited his ability to deal with the difficult situation that had been imposed on him from above. He may not have fully appreciated either the magnitude of the problems medical officers in the field were experiencing or the possible benefit that might have resulted from his using the weight of his position and personal reputation to increase their influence with the line. The issuance of circulars was certainly no substitute for personal inspection trips, which the surgeon general apparently frequently assigned to his subordinates. Nevertheless, in creating the pioneering Typhoid Board, Sternberg demonstrated his ambition to utilize the new medicine in the war against traditional army diseases and his deep concern for the devastation they caused in 1898.
Most of the Medical Department's problems in the camps of the summer of 1898 within the United States, however, had been too complex for any surgeon general to cure. Too many men totally unfamiliar with military life were gathered too rapidly by a government as heedless of the desirability of planning as a schoolboy playing
with his toy soldiers. Too little time and effort were devoted to impressing upon masses of overenthusiastic young men the importance of sanitation. Too few Army surgeons were both trained in the newly developed techniques by which typhoid could be distinguished from malaria in the living patient and provided with the equipment necessary to this work. With an understanding of the role of the typhoid carrier still in the future, proper precautions to limit this means of spreading the disease could not be taken. In addition, few in positions of authority seemed to have any appreciation for the fact that hospitals for thousands of patients could not be created overnight, nor competent hospital staffs gathered to run them in an instant. Under such conditions, a small group of professional medical officers, no matter how great their dedication and skill, could not hope to overcome the zealous and impulsive enthusiasm of a mass of amateur soldiers who seemed to regard sanitation as unpatriotic or, at least, an unmilitary concern. The Army Medical Department, because of its direct responsibility for the prevention and treatment of disease, became a convenient and popular scapegoat in this "splendid little war."74
1. War Department, [Annual] Report of the Surgeon General, U.S. Army, to the Secretary of War, 1898, pp. 110-12 (first quotation), 169 (second quotation), and 1899, p. 38 (hereafter cited as WD, ARofSG, date); "Some of the Medical Lessons of the War," p. 485; Walter Reed, Victor C. Vaughan, and E. O. Shakespeare, Reports on the Origin and Spread of Typhoid Fever in U.S. Military Camps During the Spanish War of 1898, 1:42-43, 106-07; United States, Congress, Senate, Report of the (Dodge) Commission To Investigate the Conduct of the War Department in the War With Spain, 6:2988 (hereafter cited as Dodge Commission Report); Victor C. Vaughan, A Doctor's Memories, p. 390; Dale C. Smith, "The Rise and Fall of Typho-Malaria," pp. 316-19; Martha Derthick, The National Guard in Politics, p. 19; John Duffy, The Sanitarians, pp. 128, 131-32, 190.
2. WD, ARofSG, 1898, p. 102, and 1899, pp. 24-25; Dallas Bache, "The Place of the Female Nurse in the Army," p. 316; Dodge Commission Report, 7:3168-72; Nicholas Senn, Medico-surgical Aspects of the Spanish American War, p. 320; in Record Group (RG) 12, National Archives and Records Administration (NARA), Washington, D. C.: Anita Newcomb McGee Journal, Apr-May 1898, Entry 229, Extract from American Monthly Magazine, Entry 229, and Narratives, [Anita Newcomb McGee], pp. 9-12, Margaret Dunn, and Margaret Berry, Entry 230.
3. WD, ARofSG, 1898, pp.120-21, 126, 151, and 1899, p. 40; Bache, "Female Nurse," pp. 312, 314, 316; Percy M. Ashburn, A History of the Medical Department of the United States Army, p. 171 (hereafter cited as History of MD); Report of Commission To Investigate the Conduct of the War, pp. 67, 76, Microfilm Reel 6, William R. Shafter Papers, Stanford University, Palo Alto, Calif. (hereafter cited as Com Rpt, Mf Reel no., Shafter Papers, SU); Dodge Commission Report, 1:643-44, 648, and 4:1139-41; Charles R. Greenleaf, "The Organization of the Medical Department of the Army in the Field," p. 200.
4. WD, ARofSG, 1898, pp. 9, 127 (quotation), 128-31, 151, and 1899, pp. 9-10; Bache, "Female Nurse," pp. 312, 314, 316; Massachusetts Volunteer Aid Association, The Work of the Massachusetts Volunteer Aid Association During the War With Spain, 1898, pp. 15, 82-83 (hereafter cited as MVAA, Work); Ralph C. Williams, The United States Public Health Service, 1798-1950, p. 559.
5. Senn, Aspects, pp. 193, 267-68, 325; WD, ARofSG, 1898, pp. 258, 260-61.
6. R. Stansbury Sutton, A Story of Chickamauga, pp. 6-7, 13 (quotation); War Department, Correspondence Relating to the War With Spain..., 1:36; idem, ARofSG, 1898, pp. 163, 167-68, 174-75, 177, 179-81; Reed et al., Reports, 1:42-43, 106-07; Dodge Commission Report, 1:607-08, 612-13, 3:183, 4:860, 1135, 1354, and 6:2968-69, 2982-83; Senn, Aspects, pp. 44-45.
7. Sutton, Story, pp. 1, 8, 10-11 (first quotation), 12; Dodge Commission Report, 2:773, 3:261 (second quotation), 545, 547 (remaining quotations), and 4:834-35, 1136-37, 1147, 1305; WD, ARofSG, 1898, pp. 163, 173-74; H. A. Haubold, "The Medical Aspects of Camp Management at Chickamauga," p. 585; Reed et al., Reports, 1:265, 267; Com Rpt, p. 66, Mf Reel 6, Shafter Papers, SU; Vaughan, Memories, pp. 377, 384.
8. WD, ARofSG, 1898, pp. 169, 173, 175 (first quotation), 180-81, and 1899, p. 40; Haubold, "Medical Aspects," p. 585 (remaining quotations); Sutton, Story, p. 11; Reed et al., Reports, 1:265, 267; Dodge Commission Report, 3:194-95, 4:1314.
9. Joseph J. Curry, "On the Value of Blood Examinations in the Diagnosis of Camp Fevers," p. 515; George Dock, "Clinical Pathology in the Eighties and Nineties," p. 679; Dodge Commission Report, 3:191, 194-95, and 4:832; Ashburn, History of MD, pp. 168-70, 178; Ltr, Charles F. Craig to The Constitution, Atlanta, 29 Oct 1898, Papers From the Letterpress of Charles Franklin Craig, Walter Reed Army Institute of Research, Washington, D.C.
10. WD, ARofSG, 1897, pp. 66-67, and 1898, pp. 122, 176-80; Dodge Commission Report, 1:181, 3:187, 264-65, 4:831, 1308-09, 1316, 1380, 1405, 5:1735, 1817, and 6:2819, 2988; Haubold, "Medical Aspects," p. 584; Com Rpt, p. 69, Mf Reel 6, Shafter Papers, SU; Erna Risch, Quartermaster Support of the Army, pp. 539-40.
11. Dodge Commission Report, 1:587; 3:191 (quotation); 4:1145, 1311, 1364, 1385, 1387-88, 1402-03, 1732-33; and 6:2802, 2888, 2976-77, 2979, 2990, 2999.
12. Ibid., 3:187, 4:1307.
13. Quotations from WD, ARofSG, 1898, pp. 181-82; ibid., pp. 173, 183; Dodge Commission Report, 4:1308-09.
14. WD, ARofSG, 1898, pp. 123, 128; Sutton, Story, pp. 7-8; Dodge Commission Report, 4:859.
15. Alexander H. Hoff was an assistant surgeon in the Army Medical Department after the Civil War and John van R. Hoff's father.
16. WD, ARofSG, 1898, pp. 40, 122-23, 127, 177; Dodge Commission Report, 1:73, 5:1732-33, and 6:2990, 3005-06; Bache, "Female Nurse," p. 314; Reed et al., Reports, 1:41.
17. WD, ARofSG, 1898, pp. 123-24, 128, 150, 183-84, and 1899, pp. 69-70, 90-91, 93; idem, Correspondence, 1:43; Dodge Commission Report, 1:612-13, 8:81; Scheffel H. Wright, "Historical Issue; Medicine in the Florida Camps During the Spanish-American War," pp. 20-23; William M. Straight, "Camp Miami, 1898," pp. 504, 510-11; John A. Holmes, The Raw Deal, p. 8; Vaughan, Memories, pp. 372-73; Smith, "Rise and Fall," p. 318.
18. WD, ARofSG, 1898, pp. 123-24,183-84, and 1899, pp. 66-67, 69-70, 72, 79, 83-84, 86 (quotation), 89-90, 97; Smith, "Rise and Fall," pp. 317-19; Curry, "On the Value of Blood Examinations," p. 515; War Department, Surgeon General's Office, The Surgeon General's Office, p. 51 (hereafter cited as WD, SGO, SGO).
19. WD, ARofSG, 1899, pp. 87 (quotations), 88.
20. Ibid., 1898, p. 124, and 1899, pp. 81-83; Dodge Commission Report, 1:108. Immunity conferred by typhoid fever is not usually long lasting.
21. WD, ARofSG, 1899, pp. 67-68, 76-78 (quotation); Dodge Commission Report, 1: 211.
22. WD, ARofSG, 1898, p. 129, and 1899, p. 32 (quotation); Dodge Commission Report, 1:657.
23. Graham held a volunteer commission of major general from 8 May to 30 November 1898.
24. The reported number of officers and men at Camp Alger was: in May, 17,406; in June, 23,511; in July, 22,175; and in August, 21,454. See War Department, [Annual] Report of the Secretary of War, 1898, l(pt.2):476, 482-83, 498 (hereafter cited as WD, ARofSW, date).
25. Alfred C. Girard, The Management of Camp Alger and Camp Meade, pp. 1-2 (first two quotations), 3-6; WD, ARofSG, 1898, pp. 153-54,155-56 (final two quotations), 160-61, and 1899, p. 54; Rpt, Ch Surg, Second Army Corps, pp. 2, 4, 12, Entry 219, RG 395, NARA; Dodge Commission Report, 3:106, 8:56.
26. Girard, Management, pp. 3-4 (quotation); WD, ARofSG, 1898, p. 154.
27. WD, ARofSG, 1898, pp. 154, 157; Girard, Management, pp. 3-4; Dodge Commission Report, 4:1248.
28. WD, ARofSG, 1898, p. 156; Girard, Management, p. 6; Reed et al., Reports, 1:xv; Vaughan, Memories, pp. 370-71; Smith, "Rise and Fall," p. 317; Rpt, Ch Surg, Second Army Corps, p. 13, Entry 219, RG 395, NARA.
29. Rpt, Ch Surg, Second Army Corps, p. 15 (quotation), Entry 219, RG 395, NARA; WD, ARofSG, 1898, pp. 130, 153-54, 156; Dodge Commission Report, 4:1249, 8:69.
30. WD, ARofSG, 1898, pp. 158-59 (quotation); Rpt, Ch Surg, Second Army Corps, pp. 21-23, Entry 219, RG 395, NARA; WD, SGO, SGO, p. 51.
31. WD, ARofSG, 1898, pp. 150-51; "Some of the Medical Lessons," p. 485.
32. After the end of the war, even though volunteers who had served the longest were being mustered out, new volunteers were still coming in.
33. Dodge Commission Report, 3:117.
34. Rpt, Ch Surg, Second Army Corps, pp. 7 (quotation), 8, 10, 15, Entry 219, RG 395, NARA.
35. Ibid., pp. 7-8 (quotation), 9-10, 21-23, Entry 219, RG 395, NARA; WD, ARofSG, 1898, pp. 114, 155, 158, 160, and 1899, pp. 42-43.
36. WD, ARofSG, 1898, p. 127, and 1899, pp. 43-44, 49, 54; Reed et al., Reports, 1:480; Dodge Commission Report, 4:1252; Vaughan, Memories, pp. 378, 387; Rpt, Ch Surg, Second Army Corps, pp. 22-23, Entry 219, RG 395, NARA.
37. Dodge Commission Report, 4:1330-31, 1334, 1337, and 8:89 (quotation); WD, ARofSG, 1898, p. 124, and 1899, pp. 54-56; idem, Correspondence, 1:534-35; Reed et al., Reports, 1:500-501.
38. Dodge Commission Report, 3:117, 258; Jefferson D. Griffith, "Hospital Experience in the War With Spain," pp. 164-65; WD, ARofSG, 1898, pp. 171, and 1899, pp. 40-41, 54; idem, Correspondence, 1:510, 530; Ashburn, History of MD, p. 181.
39. Telgs, George D. Meiklejohn to Theodore Schwan and AG Corbin to Schwan, both 12 Sep 1898, file 121918, RG 94, NARA.
40. The VI Corps existed only on paper; no men had ever been assigned to it. See Graham A. Cosmas, An Army for Empire, p. 133.
41. WD, Correspondence, 1:257-58 (quotation).
42. Ibid., 1:510; WD, ARofSW, 1899, l(pt.3):193.
43. WD, ARofSW, 1899, l(pt.2):396, 400-401; idem, ARofSG, 1899, pp. 44-54; idem, Correspon-
dence, 1:257-58, 510-20; Telgs, AG Corbin to Asst AG Corter, 14 Oct 1898, file 299587, and S. B. M. Young to AG, 10 Dec 1898, file 175230, RG 92, NARA.
44. Dodge Commission Report, 1:211; WD, Correspondence, 1:248; idem, ARofSW, 1898, 1(pt.2):640-41; Rpt, J. B. Bellinger to QMG, 30 Jun 1899, file 133396, RG 92, NARA.
45. WD, ARofSW, 1899, 1(pt.2):407; idem, Correspondence, 1:529, 534-35, 510.
46. WD, ARofSW, 1899, l(pt.2):364, 396, 400-401, 407.
47. WD, ARofSG, 1898, pp. 242, 259 (quotation), and 1899, pp. 60-61; Ltr, Valery Havard to Shafter, 9 Aug 1898, Autobiography, William R. Shafter, ch. VII, p. 7, and Encl to Ltr, Charles D. Rhodes to William H. McKittrick, Nov 1931, all Mf Reel 6, Shafter Papers, SU; Dodge Commission Report, 1:78, 2:742; Seabury W. Allen, "The Conditions at Camp Wikoff," pp. 326-27. See Mary C. Gillett, Army Medical Department, 1775-1818, and Army Medical Department, 1818-1865, for details of earlier yellow fever epidemics that affected the Army.
48. WD, ARofSG, 1898, pp. 241 (quotation), 242; Senn, Aspects, pp. 174, 176; Dodge Commission Report, 1:78.
49. WD, ARofSG, 1898, pp. 249-50.
50. Ibid., 1898, pp. 240 (quotation), 241-42, 246-47, 250; Dodge Commission Report, 5:1893.
51. WD, ARofSG, 1898, pp. 241-43, 245, 254; Dodge Commission Report, 1:78, 114-15.
52. MVAA, Work, pp. 177 (quotations), 180; Wickes Washburn, "Montauk Point and the Government Hospitals," pp. 802-03; WD, ARofSG, pp. 243, 246; Dodge Commission Report, 1:78-79, 114-15, and 6:2586-87, 2589, 2590, 2597, 2801; Allen, "Conditions at Camp Wikoff," p. 326; Theodore Roosevelt, "The Rough Riders," p. 688; Statement, Esther V. Hassen, Entry 230, RG 112, NARA; Frank Donaldson, "A Refutation of False Statements Concerning Camp Wikoff," pp. 334-35.
53. The work of the Dodge Commission is discussed later in the chapter.
54. Dodge Commission Report, 1:535, 5:1888, 1900, and 6:2588 (quotation), 2601, 2732-33; WD, ARofSG, 1898, p. 250.
55. Quotations from WD, ARofSG, 1898, pp. 243, 245; ibid., pp. 241, 244, 246, 249; Dodge Commission Report, 6:2736
56. Dodge Commission Report, 5:1888, 1891, and 6:2500, 2570; MVAA, Work, p. 178; WD, ARofSG, pp. 119, 243-45, 250-51; Bache, "Female Nurse," p. 327; Senn, Aspects, p. 177; Allen, "Conditions at Camp Wikoff," p. 327.
57. Dodge Commission Report, 6:2592 (first quotation); WD, ARofSG, 1898, pp. 250 (second quotation), 251; Senn, Aspects, p. 324; Bache, "Female Nurse," pp. 176-77, 327; MVAA, Work, p. 179.
58. WD, ARofSG, 1898, pp. 118, 243-44, 251-52 (quotation), 253; MVAA, Work, p. 179; Dodge Commission Report, 2:740, 4:818-20, 823, and 6:2570; Allen, "Conditions at Camp Wikoff," p. 326; Nicholas Senn, "The Returning Army," p. 653.
59. WD, ARofSG, 1898, 245, 253, 255-57; Ltr, Shafter to AG, 30 Sep 1898, Mf Reel 6, Shafter Papers, SU; MVAA, Work, p. 179; Dodge Commission Report, 6:2598.
60. WD, ARofSG, 1898, pp. 150, 244-45 (quotation), 246, 261-62; Dodge Commission Report, 1:528, 5:1971, and 6:2599, 2876; Ashburn, History of MD, p. 171.
61. Quotations from MVAA, Work, pp. 97-98. See also ibid., pp. 96, 180-81; WD, ARofSG, 1898, pp. 120, 261-62; Dodge Commission Report, 6:2530-31; Allen, "Conditions at Camp Wikoff," pp. 326-27; Ltr, Shafter to AG, 7 Sep 1898, Mf Reel 5, Shafter Papers, SU; E. M. Buckingham, "Tropical and Camp Disease," p. 433.
62. WD, ARofSG, 1898, pp. 128, 150, 246 (quotations), 262; in Shafter Papers, SU: Telg, Shafter to AG, 24 Sep 1898, Mf Reel 5, and Ltrs, Shafter to AG, 27-28 Sep and 1 Oct 1898, and V Army Corps GO 50, 3 Oct 1898, all Mf Reel 6; Dodge Commission Report, 8:120; Joseph Wheeler, The Santiago Campaign, pp. 207-08.
63. Dodge Commission Report, 1:183, 219.
64. Smith, "Rise and Fall," p. 316; William B. Bean, Walter Reed, pp. 3, 48-49, 64-68; United States, Congress, Senate, 61st Congress, 3d Session, Yellow Fever. . . , p. 8; Aristides Agramonte, "The Inside Story of a Great Medical Discovery," p. 214 (quotations); Ashburn, History of MD, p. 259; Robert S. Henry, TheArmed Forces Institute of Pathology, pp. 134-36 (hereafter cited as AFIP); Edgar Erskine Hume, Victories of Army Medicine, pp. 100-101; Reed et al., Reports, 1:xv.
65. Victor C. Vaughan, "Some Remarks on Typhoid Fever Among Our Soldiers During the Late War With Spain," pp. 63-64, 66-67 (quotation); WD, ARofSG, 1899, pp. 273-74, 278-80; Reed et al., Reports, 1:xv-xvi; Henry, AFIP, pp. 134-35.
66. WD, ARofSG, 1899, p. 280; Vaughan, "Some Remarks," pp. 64-65, 68-69; Henry, AFIP, pp. 134-36; "Value of Blood Examinations in Malarial and Typhoid Fevers," pp. 746-47.
67. WD, ARofSG, 1899, pp. 205, 216 (first quotation), 270-71, 276; Henry, AFIP, pp. 137-38; Vaughan, "Some Remarks," p. 71; idem, Memories, pp. 376, 384-86, 393-94; Reed et al., Reports, 1:206; SGO Cir 1, 25 Apr 1898, Entry 66, RG 112, NARA; Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the United States Army, 1607-1939, pp. 126-27. See also in Ms C48, Walter Reed and William C. Gorgas Papers, National Library of Medicine, Bethesda, Md., the following reports: Filters and the Sterilization of Water; Preliminary Report on Typhoid Fever in Military Camps, 1899; Disposal of Excreta, 1898, p. 6 (second quotation); and Walter Reed to AG, 15 May 1899, in Orders, 1899.
68. WD, ARofSG, 1899, p. 95; "Antityphoid Vaccination in the Army," p. 728; Hume, Victories, p. 101; Frederick F. Russell, "The Prevention of Typhoid Fever by Vaccination and by Early Diagnosis and Isolation," pp. 482, 485; Vaughan, Memories, pp. 369-70, 376 (quotation); Ashburn, History of MD, pp. 272-73.
69. WD, ARofSG, 1899, pp. 273-74, 1900, p. 53, and 1903, pp. 49-56; Henry, AFIP, pp. 133, 135-36; Harry F. Dowling, Fighting Infection, pp. 14-15; Agramonte, "Inside Story," p. 219; Bayne-Jones, Preventive Medicine, pp. 125-26.
70. WD, ARofSG, 1898, p. 151.
71. Dodge held a volunteer commission of major general from 7 June 1864 to 30 May 1866, when he resigned.
72. Quotations from Dodge Commission Report, 1:107, 116. See also ibid., 1:113; "The One Great Blot of the War," p. 279; "The Surgeon General of the Army and His Critics," p. 822.
73. Dodge Commission Report, 1:113, 116, 188-89; WD, ARofSG, 1908, p. 126.
74. Quotation by John M. Hay, the U.S. ambassador to Great Britain from 1897 to 1898, cited in Cosmas, Army, p. 245. See also Dodge Commission Report, 6:2838; Vaughan, Memories, p. 390; Smith, "Rise and Fall," p. 316; WD, ARofSG, 1900, p. 75.