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Report of the Chief Surgeon of the Fifth Army Corps, Giving a Brief Account of the Operations of the Medical Department

Spanish - American War



In compliance with telegraphic instructions from the Secretary of War, dated April 16, 1898, I proceeded on the 19th day of April with the Seventeenth United States Infantry from Columbus Barracks, Ohio, to Tampa, Fla., arriving there about the 21st of April. This organization, and a number of other regiments rapidly following, were placed in camp on Tampa Heights, an elevated plateau, about 2 miles from the center of town. The ground was apparently well adapted for camping purposes, being a sandy loam, subsoil water, at that time about 12 feet from the surface. There was good shade from pine trees and scrub oaks. The water supply from the city reservoir was delivered by hydrants through 3-inch mains. The quality was good and the quantity ample for all purposes of men and animals.

Within the next few days there were gathered the following regiments of infantry, which went to form what was later known as the "Second Independent Division:" The Sixth, Tenth, Twenty-first, Thirteenth, Ninth, Twenty-fourth, Twenty-fifth, Twenty-second, Seventeenth, and the Fourth, to which was later added the Eighth, Sixteenth, Twelfth, Seventh, and Second United States Infantry, these latter regiments forming a camp below the Tampa Bay Hotel.

On the 23d of April, by the operation of General Order, No. 3, as senior medical officer of time command I was announced chief surgeon, and reported to the commander, Brigadier-General Wade, accordingly.

With the approval of the general commanding, Maj. Henry S. Kilbourne, surgeon, and Capt. William F. Stephenson, assistant surgeon, were announced as chief surgeons of brigade; and later, as the number of commands increased and the organization of the Fifth Army Corps was completed, the following chief medical officers were designated:

Lieut. Col. B. F. Pope, chief surgeon, United States Volunteers, chief surgeon of the corps; Maj. Valery Havard, chief surgeon of the cavalry division; Maj. Henry S. Kilbourne, chief surgeon of time Second Division; Maj. M. W. Wood, chief surgeon of the First Division; Maj. F. J. Ives, brigade surgeon, United States Volunteers, as chief of General Bates*s independent division.

With a view to ascertain the amount of supplies on hand, I at once proceeded to obtain from medical officers accompanying the command a list of such medical and surgical stores and instruments, tents, ambulances, public animals, etc., as they had brought with them from their stations, directing them at the same time to make requisition for such supplies as they might need, forwarding the same to the chief surgeon. A consolidated list of these memoranda, prepared for future reference, was left with the acting medical supply officer at Tampa, Fla., and is not now accessible.


It was found that while nearly all of the regiments had brought with them their medical and surgical chests, field cases of instruments, and camp outfit of mess chests, food chests, etc., there were many regiments which were lacking in surgical dressings and medicines, and most of them in transportation for such supplies as they had brought.

For this reason on April 27 I telegraphed the following to the Surgeon-General:

"Please have forwarded by express 8 pack saddles complete for medical and surgical chests, 10,000 first-aid packages, 1,000 rolls wire splints, 100 rolls of adhesive plaster, 1,000 rolls of cotton batting, 1,000 yards of absorbent gauze, 100 bottles of sterilized catgut, 1,000 packages of absorbent cotton, 500 grams of silk ligature, 500 packages of sheet lint, 50 dozen towels, 50 pounds of soda sulphate, 10 Arnold sterilizers, 00 yards of rubber sheeting, 10 yards of rubber drainage tube, 3 sheets of rubber intestinal cylinders, 100 boxes of roller bandages, and 300 tubes of vaccine virus."

In reply to my telegram, I was informed that the supply of antiseptic dressings, according to list selected by the Surgeon-General, was being made up and would be forwarded shortly, and later some 20 boxes of surgical dressings were received at Tampa, which were issued to the various regimental surgeons as they arrived. These boxes were complete and in every respect fitted for antiseptic surgical work.

The arrival of the cavalry commands and the batteries of light artillery rapidly followed, and their camps were located partly at Port Tampa, near Tampa Bay Hotel, and some at Lakeland. The supplies brought with the cavalry commands were ample in every respect, both in medical and hospital material, tentage, and ambulances. The batteries of light artillery were practically destitute of hospital tentage, and several of them of medical and surgical chests, the batteries from the Pacific coast being best equipped.

The vaccination of troops began early in May and was continued without interruption until the protection of the whole command was assured.

Field hospitals-The establishment of field hospitals other than regimental early occupied the attention of the chief surgeon, although he was informed that it was the desire of the War Department that the regimental system should remain intact, it being the intention to have 1 medical officer of the Army with each regiment of infantry, 1 steward or acting steward, 10 privates of the Hospital Corps, tents, field furniture for a field hospital to accommodate 10 patients, and field supplies for three months. (See letter Surgeon-General's Office, April 20, 1898.)

With a view to the establishment of a divisional rather than a regimental system of hospitals, I succeeded in having the following orders promulgated by the commanding general:

[Special Orders, No. 2.-Extract.]

Tampa, Fla., May 3, 1898.

2. A field hospital for the troops at Port Tampa will be located on convenient ground adjacent to the camps of the two commands now at that point.

Major La Garde, surgeon, is relieved from duty with the Ninth Cavalry, and will establish the hospital above indicated. His assistants will be designated in further instructions. In addition to his duties as commanding officer of the hospital, Surgeon La Garde, as senior medical officer present, will have general supervision of the medical officers with the cavalry and light artillery at Port Tampa, Fla. He will report to the chief surgeon at these headquarters for further instruction in regard to his duties.

By command of General Shafter:

Assistant Adjutant-General.

Tampa, Fla., May 3, 1898.

Infantry Division, United States Forces, Tampa, Fla.

Sir: The commanding general desires that a division field hospital be established in your command at Tampa Heights. The chief surgeon at these headquarters has been directed to designate to you from the medical officers of your command the commanding officer of the hospital and his assistants.

Very respectfully,

Assistant Adjutant-General.

To regulate the formation of these hospitals and the transfer of regimental hospital equipment and personnel, the commanding general issued instructions which were afterwards promulgated in the general orders following.


[General Orders, No. 14.]

Tampa, Fla., June, 6, 1898.

The chief surgeon of the Fifth Army Corps will assign for division hospital and ambulance train service such members of the Hospital Corps detachments, tentage, ambulances and wagons, animals and their equipments, hospital and medical supplies and field equipments, as maybe required and designate the medical officer to receipt for the same.

A minimum allowance to be retained with each regiment will be as follows:

One acting hospital steward and 1 private, 1 hospital and 1 common tent, 1 ambulance and necessary animals fully equipped in order to preserve the regimental organization.

Officers detached for duty at division hospitals are authorized to take with them their allowance of tentage, giving receipt for the same.

Whenever necessary, the chief surgeon is authorized to take any or all ambulances assigned to regiments for temporary use of the field hospitals.

The commanding general also authorizes the chief surgeon to instruct chief surgeons of divisions to make transfer for temporary service with field hospitals, ambulance trains, dressing stations, or regiments, of such regimental medical officers, members of the Hospital Corps, ambulances and medical or hospital supplies at any time when such action becomes necessary for the proper care of the sick or injured under their charge.

By command of Major-General Shafter:

Assistant Adjutant-General.

Under the operation of these orders the formation of four field divisional hospitals was begun, the preliminary steps being to gradually enlarge the regimental field hospital of the Ninth Cavalry under Major La Garde, surgeon; that of the Thirteenth Infantry under Maj. A. H. Appel, surgeon; later the regimental hospital of the Sixth United States Cavalry under Major McCreery, surgeon; and lastly, that of the First Division under Maj. M. W. Wood, surgeon. This latter hospital was formed too late to open for the reception of patients before the embarkation, but after the landing of troops at Siboney it became the advanced field hospital and nearest the line of action at San Juan Hill, near Santiago de Cuba. The gradual absorption of regimental hospitals went on until Major La Garde's hospital was expanded and equipped to accommodate nearly 150 patients; that of Major Appel, 150; and that of Major McCreery, for the cavalry division, about 65 patients. Later the hospital of the Twenty-second Infantry was moved to Jacksonville, Fla., where it became the nucleus of the field hospital of the Seventh Army Corps.

The equipment of the second divisional hospital under Major Appel was made complete at an early date. It contained about 85 cots, a sufficient outfit of furniture and messing fixtures. The operating tent was well supplied with enameled steel folding operating tables, steam sterilizers, and water heaters; a bathing tent, bath tubs, wash basins, and other extra appliances were purchased under authority of the Surgeon-General. As the demands for space increased additional tentage was received by Major Appel until the capacity was increased to nearly 180 patients.

The personnel consisted of Maj. A. H. Appel, surgeon, in command; Asst. Surgs. Deane C. Howard, and L. P. Smith, United States Army; Acting Asst. Surgs. W. E. Parker and U. S. Bird, United States Army, as assistants. There also was allotted a detachment of acting stewards (number not recollected) and about 35 privates of the Hospital Corps.

The hospital at Port Tampa, known as the reserve or divisional hospital No. 3, was about the same size and similarly equipped; Maj. Louis A. La Garde, surgeon, in command, Asst. Surgs. M. W. Ireland, H. A. Shaw, James M. Kennedy, and later Asst. Surg. P. C. Fauntleroy. I am unable to recollect the number of hospital stewards, but the Hospital Corps detachment numbered some 37 privates and noncommissioned officers.

The tentage was received partly from the various commands centered at Port Tampa and partly from the depot quartermaster at Tampa on requisitions approved by the chief surgeon.

Divisional hospital No. 1, under command of Maj. M. W. Wood, surgeon, was formed late in the month of May, and much difficulty was experienced by that officer in securing an adequate amount of tentage and furniture, the regimental supply being nearly exhausted by drafts made for the other hospitals. A special


requisition for 30 hospital tents was made by the chief surgeon and approved by the general commanding. On receipt from the depot quartermaster a very large number were found to be unserviceable from lack of guy ropes and former wear, so that the second divisional hospital was drawn upon to assist the equipment of No. 1. Major Wood's surgical outfit proved later to be an admirable one, the supply of instruments, dressings, sterilizers, and tables sufficing to meet the great strain put upon it by the battles of July 1 and 2, 1898.

The personnel of this hospital consisted of Maj. M. W. Wood, surgeon, in command; Maj. R. W. Johnson, surgeon, United States Volunteers; Asst. Surg. G. C. M. Godfrey; Acting Asst. Surgs. Hamilton P. Jones and F. J. Combe. Later Acting Asst. Surg. T. H. Marshall, United States Army, was attached to the hospital.

Ambulance trains- With the formation of the several field hospitals came the simultaneous formation of two ambulance trains. That at Port Tampa was made up by drawing in ambulances from the Ninth Cavalry and the several artillery commands adjacent, also by requisition upon the depot quartermaster. Mules were received later and harness last of all. The train was placed under the command of First Lieut. J. M. Kennedy, assistant surgeon, and although left behind for lack of transportation on embarkation of the Fifth Army Corps a part of it was forwarded in time to render most valuable service in the campaign against Santiago de Cuba.

The train of the second divisional hospital consisted of some seven ambulances. While its formation was completed prior to embarkation, it also was left behind with a portion of the hospital at Tampa Heights, for lack of transport room.

The first divisional hospital had a few ambulances, which were left behind on embarkation. Three ambulances which had been taken apart and stored on one of the transports were later assigned to this hospital and became of much service under charge of Assistant Surgeon Godfrey in removing wounded from the field at San Juan Hill and El Caney.

Wagon transportation-To every hospital it was designed to assign a sufficient number of 4 and 6 mule wagons to haul all of the tentage and supplies. For this purpose the second and third divisional hospitals had about eight wagons each, with a complete equipment of mules and civilian drivers. I can not recollect how many were with the First Division or the cavalry command under Major Havard. At all events they were all left behind on embarkation and never seen again by the medical department of the Fifth Army Corps.

Hospital Corps companies-The next step in organization of the medical department of the corps was the formation of Hospital Corps companies, which was authorized by the commanding general in the following general orders:

General Orders, No. 3 (new series).


Upon recommendation of the chief surgeon, the following will be the organization of the members of the Hospital Corps now on duty with or hereafter attached to the Fifth Army Corps.

There will be three companies which are to be known as Hospital Corps companies and all of them under the control of the chief surgeon of the corps.

Each company will be commanded by an officer of the Medical Department, selected for that purpose by the chief surgeon, and to these companies will be transferred all Hospital Corps privates, hospital stewards, and acting hospital stewards, except the following, who are retained with the several commands to which they are now attached:

To every regiment of infantry, 1 acting steward and 1 private as orderly. To every regiment of cavalry, 2 acting stewards and 2 privates as orderlies for medical officers. To every battalion of artillery, three batteries each, 3 acting hospital stewards and 3 privates.

Descriptive lists will be prepared and forwarded to the officers designated by the chief surgeon, and later invoices for the Hospital Corps, quartermaster, and ordnance department equipments for each Hospital Corps man.

Receipts will be given by the commanders of the several Hospital Corps companies for the property transferred.

According to the necessities of each organization, as represented by their medical officers, details from the Hospital Corps companies will be made by the chief surgeons of division for temporary duty with the several commands, which detail will terminate at any time at discretion of the chief surgeon of the corps.

By command of Major-General Shafter:

FRED. A. SMITH, Captain,
Twelfth Infantry, Acting Assistant Adjutant-General.


The work of organizing the first of these companies was assigned to Capt. E. L. Munson, assistant surgeon, who was attached to the office of the chief surgeon for that purpose, and also to act as his executive officer. But before the necessary books and blanks could be obtained and the transfers made, the embarkation of the corps took place, and the work was indefinitely postponed. It was the intention of the chief surgeon to draw into these divisional companies all of the Hospital Corps men, so as to have them entirely under the control of the medical department and not subject to the control of regimental commanders. In case of necessity the number of Hospital Corps men could be increased with any Command or be drawn from other commands by mere detail without the intervention of higher authority than the division surgeon, who would be the best judge of the needs of his troops in any given emergency. To give effective working to the plan a company of at least 104 enlisted men would be necessary, exclusive of those employed in divisional hospitals and on regimental service.

Mounts for Hospital Corps privates, etc-The question of mounts for Hospital Corps men and for acting assistant surgeons was taken up as early as practicable, as there was an almost universal demand on the part of medical officers that the provision of the regulations in this respect should be complied with if possible.

On requisition being made to the depot quartermaster for the necessary animals, it appeared that neither animals nor equipments were on hand, nor were they likely to be unless provided from some other point than Tampa.

On May 11 the Surgeon-General was asked to confer with the Quartermaster-General with view to securing the mounts if possible. This request elicited the information that at Chickamauga there had been some 200 horses purchased for the purpose, and directions were given that efforts be made to locate them in Tampa. On the 15th of May I replied that the 200 Hospital Corps horses could not be located by the quartermaster at that point, but on the 17th of May it was reported to me that the 200 horses had arrived, and I at once directed the preparation of the necessary requisitions, so that they could be distributed according to the requirements of the command. Later instructions were received that only the Hospital Corps men attached to mounted commands should be mounted, the orderlies of medical officers, acting assistant surgeons, and hospital stewards being excluded from the provisions. Saddles and other horse equipments were secured later, after much difficulty. In the meanwhile the horses had been issued by the depot quartermaster as requisitions were made, so that very many of the 200 had been distributed, which furnished a mount for nearly every one of the Hospital Corps privates requiring the same then on duty with the command.

Under date of May 27, and in reply to an inquiry on part of the Surgeon-General, who wished to know the number of horses required, I wired that "according to the scheme published May 20, 1898, from the Surgeon-General's Office, 293 mounts would be required, but according to present assignment about 170."

This closed the incident of mounts for the medical department, so far as the Fifth Army Corps was concerned, as on embarkation of the command they were all left behind for the lack of room on the transports to carry them to Cuba.

NOTE.-The following telegram sent by me is of interest as bearing upon the case: "May 18. Tampa, Fla., to Surgeon-General, Washington, D. C. Authority is requested to provide mounts for all acting assistant surgeons; also for one orderly for every medical officer serving with foot troops. There are more than enough horses for the hospital corps now at this place. We have 167 privates and 29 acting stewards present with the command."

Transfer of sick to Fort McPherson, Atlanta, Ga-In reply to inquiry in regard to the disposition of patients who might be too ill to accompany the command in case of embarkation, the Surgeon-General wired the following under date of May 2, 1898: "Men too sick to go with command should be sent to hospital at Fort McPherson, Atlanta, Ga."

In compliance with these instructions I proceeded, about May 11, to gather from the several field hospitals a number of men in whose cases there was no prospect of early return to duty. Many of them were venereal bubos, which unfitted the men for marching and made them a burden upon the medical department. Others were convalescent from typhoid fever of a mild type, rheumatism, etc. Cases of measles and severe typhoid were not forwarded. A small detachment of Hospital Corps men accompanied them, and they were supplied with food and medicines for three days. Necessary amount of hospital fund to purchase delicacies for the trip was directed to be turned over to the Hospital Corps man in charge. The party, I was informed, arrived safely.

About two weeks later a second party was fitted out, numbering some 34 patients, and placed in charge of Assistant Surgeon Woodson, United States Army, and 3 Hospital Corps men as nurses. All reported as arriving safely.


About this date the chief surgeon recommended that a number of so-called tourist cars be chartered and fitted up for special service in the transfer of patients to the North. As the Plant System and the Southern railways did not have these cars in stock they were difficult to get at the point indicated. After our departure I believe that regular hospital train was established and run from Tampa and Jacksonville to the northern hospitals.

Medical supplies-The establishment of a medical supply depot at Tampa became an early necessity, and, as already stated, a storeroom was secured from the depot quartermaster. where all stores received from New York could be placed and unpacked for issue. A large number of requisitions, forwarded by medical officers on duty with regiments arriving from Chickamauga, were sent to the chief surgeon from Washington with directions that they be filled from stores in the Tampa depot. As other requisitions were corning in the chief surgeon directed the acting medical supply officer to consolidate all of them, with the view of making a general requisition according to the supply table approved by the Secretary of War under date May 9, 1898. His most pressing needs were wired to the Surgeon-General, as follows:

"May 16, 1898. Surgeon-General, U. S. Army, Washington. Send one medical and surgical chest, a case of surgical instruments, one desk; mess and food chest, commode chest for Engineer Battalion. All of above supplies have been issued to other commands."

"May 17, 1898. Tampa, Fla. The Surgeon-General. Send to me at Tampa 144 cans condensed milk, 180 cans beef extract, 60 cans tea, 300 bottles chloroform, 10,000 first-aid packets."

"Tampa, May 17, 1898. The Surgeon-General. Chloroform and beef extract sent May 9 have been distributed to regiments. The amount requested is for regiments arriving from Chickamauga."

In reply to the above, the chief surgeon received the following telegram:

"Washington, D. C., May 18, 1898. * * * Beef extract and chloroform ordered from New York to-day."

In addition to the above the chief surgeon received information that advance medical chests for issue to troops and other medical supplies had been ordered from New York. But as the stores were late arriving, and as the demands for medicines continually increased, the chief surgeon wired the following:

"May 25. Tampa, Fla. Surgeon-General, U. S. A., Washington. Authority to purchase medical supplies for volunteer regiments is asked. They have nothing. My supplies are nearly exhausted. Gandy relieves Woodson at medical depot. Send 2,000 vaccine bulbs (for volunteers)."

In reply to the above, two orders were received, one from Col. C. R. Greenleaf, under date of May 26:

"Pope, chief surgeon. Deliver to Admiral Remey at once 300,000 quinine pills. Purchase for daily needs of troops here, until supplied by the Surgeon-General." And another under date of May 28, 1898:

"Gandy, supply officer, Tampa, Fla. Buy medicines absolutely necessary. Ample supplies will be sent in a few days. Sternberg, Surgeon-General."

"Washington. D. C., May 29: One-million quinine pills sent to your supply office. Sternberg, Surgeon-General."

Under the above authority purchases in Tampa were commenced, particularly magnesium sulphate, bismuth subnitrate, camphor and opium pills, compound cathartic pills, amid other drugs needed to treat the increasing number of those sick from camp diarrhea, dysentery, constipation, and other digestive diseases incident to camp life.

The chloroform and beef extract, also the first-aid packets, arrived promptly, but the other supplies continued to delay. Surgical operating tables put in an appearance and other articles of utility, but it was still necessary to keep up the purchase of drugs, until the city was about stripped.

On June 1 I received the following from the Surgeon-General:

"Washington, D. C., June 1, 1898. Already authorized to purchase supplies for immediate use. Report promptly your needs and any shipment received."

Under date of June 2 I wired the Surgeon-General:

"Tampa, Fla., June 2. Can get no trace of medical supplies here shipped from New York. The depot is nearly empty and the town about stripped. Send 2,000 points vaccine virus to acting medical supply officer by express, as I expect to leave any day on transport."

Under the belief that the supplies thought to have been forwarded from New York were lost en route, I inquired of the depot quartermaster whether duplicate bills of lading had been received. He stated they had not, and wired the shipping quartermaster in New York to send a tracer to hunt up the lost supplies.


On June 2 I wired the Surgeon-General as follows:

"Medicines not yet found. The depot quartermaster at New York must telegraph number of car in which located."

Believing that the freight traffic was almost hopelessly blockaded, as there were at this time nearly 1,500 loaded and unloaded cars standing upon the tracks in Tampa, and as an equally hopeless blockade existed in the Post Office Department, I wired the following to the Surgeon-General:

"Tampa, Fla., June 4. Order sent by express 200 ounces bismuth subnitrate, 50 ounces of powdered opium, 100 bottles of castor oil, 50 bottles of calomel and soda tablets, 50 bottles of morphine tablets."

So far as I know, the above was not received until after the embarkation of the expedition. But on the 5th of June the stringency was relieved by the arrival of some 200 packages of stores, the receipt of which I acknowledged by wire to the Surgeon-General. The issue of these was begun at once, the field hospitals receiving the first share and next the volunteer regiments who had been lacking sadly in every sort of medical supplies. Then the requisitions were filled with such articles as were on hand. Fortunately the supply of quinine was large enough to meet all possible demands. What was the actual amount and the character of the issues can best be given by Capt. C. M. Gandy, assistant surgeon, who was in charge of the supply depot.

On the 8th of June. at 10 p. m., the chief surgeon received the order for embarkation. The field hospitals had been warned and the medical supply officer directed to set aside one-half of the stores remaining as a reserve stock to be taken with the expedition.

At midnight I entered the medical storeroom and took out two wagon loads of supplies, two more loads being sent down by Captain Gaudy to Port Tampa the next morning. The first lot was taken on board the headquarters transport Seguranca, and the second on the transport containing the second divisional hospital, under Major Appel, which, I think, was at first the Comal and later the Olivette.

The embarkation and condition of transports-The embarkation of the Fifth Army Corps on transports took place on the 9th and 10th of June, at Port Tampa, Fla. The ships were drawn into a long canal, on one side of which trains of cars were run loaded with troops, who rapidly transferred their camp equipage and travel rations to the ships, which then slowly pulled into the larger waters of the bay.

In all there were some 27 transports into which the troops were packed, in lots varying from 700 to 1,300 each. The ships had stands of rough lumber bunks, usually three tiers high, sometimes four, built into the holds and lower and main decks. The packing of these bunks was so close that there was hardly room to pass between them, while in too many instances, with the closure of the hatches, light and air would have been wholly excluded and suffocation quickly result. The transports were originally built for freight and cabin passenger service, and no one of them was properly adapted to the carriage of troops.

Complaints of overcrowding were so numerous and so serious that the commanding general appointed a board of officers, consisting of Brigadier-General Lawton, the chief surgeon, and Captain Mendoza, to inspect the vessels and report which had the greatest number of troops, and how, by redistribution of the men, the trouble might be corrected. And he at once ordered back some 900 recruits that were to have joined their commands on the transports.

The inspection of the board showed that on the Cherokee, transport No. 4, there were 40 officers and 972 men, total 1,012, part Seventh Infantry and part Twelfth Infantry. On the lower deck theme were 345 men; bunks in three tiers, closely packed; no ventilation or light when the ports were closed. No wind sails for the lower decks. On the main deck there were about 430 bunks and men, two 15-inch openings for ventilators when the main hatch was closed. No wind sail for this deck. On the upper deck 200 men, without protection, and who in case of storm would have to be crowded below. Only two water-closets accommodating 5 men each for the whole outfit. There was about 8,000 gallons of water on hand. No condenser. There was about 9 days' supply in the casks, and in tanks about 4,000 gallons. The board recommended that 200 men be taken from the ship, that water-closet accommodations be increased, and wind sails supplied.

Steamer Concho, transport No. 14. Commands, Fourth Infantry, Twenty-fifth Infantry, Third Battalion Second Massachusetts Volunteers, 71 officers and 1,256 men, total 1,327. In the lowest deck, where it was so dark that one could not see 10 feet from the main hatch, it was intended to pack nearly 800 men, the Twenty-fifth Infantry and Second Massachusetts Volunteers. The bunks were in four tiers and crowded so closely that men could hardly pass between them. Ventila-


tion by open hatches and open ports. If these were closed, ventilation would be impossible, as there were no other openings. On the second deck was the Fourth Infantry, 460 men. On the upper deck where the men stayed most of the time there were no bunks or shelter. Of 71 officers crowded into the cabins three were medical officers; Maj. William Stevenson, surgeon United States Volunteers (who was relieved before the ship sailed),* Maj. Paul R. Shillock, surgeon United States Volunteers, of the Twenty-fifth, and Hitchcock of the Second Massachusetts Volunteers. Only one water-closet on board for use of the troops. This was a trough accommodating 10 men only. Additional closets recommended and that the volunteer troops be taken off, which relieved the ship of 13 officers and 306 men. The water capacity was reported at 40,000 gallons, of which 30,000 was on hand. The water was brought from St. Petersburg, Fla., 3,000 gallons per day being used.

Steamer Leona, transport No. 21. Command, General Young's Cavalry headquarters, First and Tenth Cavalry, 57 officers, 1,026 enlisted men. The total bunkage said to be 1,046, which I very much doubted. On the lower deck were 230 men, main deck 496, and it was reported that nearly 300 men slept on the upper deck. The ventilation was by deadlights, open port, and open hatches. There were two wind sails, six water-closets. Health of the men excellent. Water storage capacity, 50,000 gallons, but it was not all on hand. No condenser on board. The board found the transport overcrowded by 230 men.

Steamer Saratoga, transport No. 20. Command, Thirteenth Infantry and one battalion Twenty-first Infantry, also division hospital No. 3, under Major La Garde, surgeon. Ship carrying 46 officers and 705 enlisted men. The bunks were three-tier, for 2 or 3 men each. On the lowest deck there were no bunks or men. On the main deck, bunks for 568 men. On the upper deck about one-fifth of the men were camped, as there was no room below. The water capacity was about 10,000 gallons; a condenser was on the ship for use if necessary. Ventilation was very bad. As the ship was a freight steamer only, there were no deadlights and but two wind sails where there should have been four. The ends of the main deck were dead spaces into which no air could be forced. The battalion of the Twenty-first Infantry was recommended to be taken off (235 men). There were 10 cases of fever on board and 2 of supposed measles. (These were removed to the Olivette.) Water-closets, 3; ample for command.

Steamer Orizaba, transport No. 24. Command, Twenty-second Infantry, Siege Artillery, 2 companies heavy artillery, 1 battalion Second Massachusetts Volunteers and 125 mules. Total, 43 officers and 927 men. Lower decks, 300 bunks and no men. Main deck, 300 bunks for 500 men. Upper decks, no bunks, 400 men. Water supply, 39,000 gallons. No condenser. Ventilation limited to one wind sail and open ports, all of which must be closed in bad weather. Board recommended battalion, Second Massachusetts Volunteers, to be removed-300 men.

Steamer Miami, transport No. 1; Command, Ninth Cavalry and Sixth Infantry, Officers, 6; enlisted men, 902. On the lower deck were no bunks. On the main deck 750, in which were accommodated 652 men. On the upper deck no bunks. There were 250 men camped out. The ventilation of the main deck was bad, the hold being a tight box without deadlights. There were two wind sails. Water-closets, 2-not sufficient. Increase recommended.

Several other transports were inspected by the board, in which the conditions appeared to be very satisfactory. The changes recommended were made so far as time would permit.

Water on transports-The water on the transports, which was stated to have been largely drawn from New York, in many cases had a fetid odor of decomposition, apparently due to the foulness of the tanks. This pertained likewise to ships that had St. Petersburg water furnished them through the water steamer Olivette. St. Petersburg was a small town across the bay whose water supply appeared to have been exceptionally good. It was conveyed by pipe line to the wharf and pumped into the Olivette's tanks for distribution. The tanks on this steamer being clean, the water was always good. That ship casks should get foul is no wonder, as they were usually in such position as to gather dirt whenever opened, the opening being a square hole 6 by 8 inches covered with a piece of canvas, which was as often off as on.

The hospital steamer Olivette-As the embarkation took place and reports of sickness on the transports came in, it became quite evident that a hospital steamer must be secured with the least possible delay. Under direction of the commanding general I examined several boats with view to selection, but none of them presented more desirable qualities than the steamer Olivette, which was doing service

* First Lieut. James Stafford, Seventy-first Now York Volunteer Infantry, assigned to Fourth Infantry just as transport sailed.


as a water carrier and distributor for all the transports of the fleet. She had large stateroom accommodation both on the upper and lower deck, a large-sized dining saloon, which was later used as a place for surgical work; she carried plenty of ice and water, and was without cargo except some horses, I believe, and forage for the same, which was cleaned out later.

The transfer of Major Appel's hospital from the Comal was quickly effected, and he at once proceeded to gather up the sick from the various transports, signals being hoisted every morning when his services were needed. These were from time to time transferred to a small hospital on shore in the artillery camp, with a view to their early transportation to the north. The removal of the sick from transports was often a slow and difficult process, particularly in rough water; for they first must be lowered into a small boat, which was at one time lifted on the crest of a rising wave and the next plunged into the gulf of a sinking one, and then pulled to the side of the hospital ship, where the same dangerous process was to be repeated in getting them on board. But the work was continued, and happily without accident, until the fleet was cleared of its most serious cases.

On the afternoon of June 13 and the morning of the 14th the fleet of twenty-eight transports and other craft sailed out from Tampa Bay with crowded decks and rigging, and hands playing. The weather was delightful and the sea as smooth as glass. Indeed, fair weather accompanied us the whole voyage, which occupied some eight days. Hatches and ports could be kept wide open and the men lived virtually in the open air. Had it been otherwise, their suffering from sea sickness and the foul air of the unventilated holds would have been intolerable.

After the departure of the fleet the Olivette steamed to the dock to take on coal for the voyage. An opportunity was given to unload the ship of some cases of measles and light cases of fever. This was a fortunate circumstance, as it placed the steamer in condition to relieve the transports of their sick on arrival at Daiquiri, many of whom were later transferred to the steamer Iroquois, so that room was made for the wounded of the impending battle on the 24th of June at Guasimas and the 1st and 2d of July at San Juan Hill and before the intrenchments of Santiago de Cuba.

The landing of the Fifth Army Corps on the 22d of June at Daiquiri was accomplished in a brilliant manner. The escapes from death by drowning were many. That there were only two casualties of this nature is really remarkable, all of the circumstances being considered. As is well known, the troops went on shore with only such rations, shelter tents, and cooking apparatus as they were able to carry on their persons. The same is true of all medical officers and men of the Hospital Corps assigned to duty with the several organizations. This prevented the transportation of any medical supplies beyond what could be carried in the hands.

Of litters there was by no means a sufficient number, as many of the regiments had neglected to bring them from their several stations. This was a deficiency which we keenly felt later upon the field of battle, and which could not be rectified by the Medical Department. Where there should have been 10 litters to each regiment there were often but 2, and sometimes none.

First-aid packets-Prior to embarkation there were received at the medical supply depot in Tampa about 12,000 first-aid packets, which, under direction of the chief surgeon, were issued to the several brigade surgeons with a view to their subsequent distribution to the troops while on transport, it being considered that if placed at once in the hands of the soldiers they would often be lost or thrown away, as they subsequently were on the march through the tropical jungle extending from Siboney to San Juan Hill.

These first-aid packets were liberally used in dressing the wounds received in battle, and the skill and care with which they were found to have been applied on receipt of the wounded at our field hospitals attest the courage and devotion of our medical staff.

Medical supplies-Medical and surgical chests with which the regular regiments were in nearly every instance provided were in the hurry of departure unfortunately left on the transports, together with all extra medical supplies. A few medical officers took their chests with them only to abandon them within the first mile of march, leaving them to be afterwards picked up by passing wagons or ambulances. After the departure of the troops came the unloading of the pack animals, the subsistence stores, and the ammunition. It was a tedious and dangerous work that could only be done in the early morning hours, before the wind sprang up, by the small boats amid later by the single steam lighter, the Laura, because of the rocky nature of the coast even in the harbors, the abrupt plunge of the beach into deep water, and the inadequate docking facilities at both Daiquiri and Siboney. Then, too, the masters of transports took them out to sea after debarkation of the


command, for many hours and even for days, because of their fears of wreck by collision with each other or by drifting upon the rocks. With all these difficulties in getting out the absolute necessities for life and military security for the troops, it can well be appreciated that little opportunity was given to unload tents and medical chests. Constant efforts were made by the chief surgeon to recover them, but with very meager results. He was more than grateful when he succeeded in getting the field hospitals on shore, as will be described later.

The absence of the medical chests was a great blow to regimental medical officers and a matter of keenest anxiety to the chief surgeon, particularly after the troops had dug the trenches and the sick lists were increasing rapidly by the appearance of malaria and thermic fevers and by diarrheas and dysenteries.

Reserve medicines, hospital delicacies, etc-Three days prior to the order of embarkation, which was given on the night of June 8, I directed Capt. C. M. Gandy, assistant surgeon, the acting medical supply officer at Tampa, Fla., to set aside one-half of all the medicines and surgical supplies remaining in the storehouses to be taken as a reserve upon the headquarters ship the Seguranca under my own charge. At the time the order was given supplies were beginning to be unloaded from the trains by the quartermaster's department and issues were made to regimental surgeons, of both volunteer and regular organizations, of such articles as were needed. The reserve was not large, and was gotten out of the storehouse by myself and two hospital corps men at midnight of the 8th and put upon the train which left for Port Tampa at 2.30 a. m. of the 9th. There were two wagon loads taken that night, and Captain Gandy sent two more on the following morning. Among this lot of medicines there was fortunately a large amount of quinine-2 barrels in all-and other material, and three sets of surgical chests and sterilizers. The medicines received on the morning of the 9th were ultimately placed on the steamer Olivette, where they were much needed.

My reason for taking only one-half the amount of supplies in the storehouses was that volunteer regiments were continually arriving at Tampa, and I felt certain that they would need everything that I could spare, as these troops were usually destitute of everything.

This lot of medicines was landed from the Seguranca at Siboney about June 27 and placed in charge of Maj. Ogden Rafferty, surgeon, United States Volunteers, with orders to act as medical-supply officer and issue the same. As the headquarters of the Fifth Army Corps was moved to the front on the 28th, the chief surgeon left instructions to Major Rafferty to use every effort to get the medical supplies known to be on transports and either ship them to the front as opportunity occurred or turn them into the hospital at Siboney, from which point our supplies were drawn up to July 23.

Although no report was made to me of the results of these efforts, I do know that medicines (in small quantities, to be sure) were brought up by returning ambulances and distributed to the chief surgeons of divisions. But there was never enough to satisfy the demands, even after the arrival of the hospital steamer Relief, which was reported to the chief surgeon to have on board 700 tons of medical supplies. What these supplies consisted of I do not know, as I was continually at the front, but I do know that the medicines required by us and the hospital delicacies brought by her were reported to me as practically exhausted by the 22d of July.

As the chief surgeon of the corps had been twice informed by the Surgeon-General that the Relief was not only loaded with everything that we should need, but would join the expedition at an early date, it can be imagined with what anxiety he awaited her arrival and what disappointment he suffered when he learned that her supplies were being exhausted at so early a date.

NOTE.-The arrival of the Relief was reported to the chief surgeon by telephone about July 8 by Major Torney, the officer in charge. Later, Colonel Greenleaf, who arrived on the Yale, telephoned they would have to be unloaded before the exact nature of her supplies could be ascertained, as no packer's list was on hand and the boxes were without content marks. Further, lie requested the chief surgeon to send to Siboney a steward and some hospital-corps men to assist in the work of unpacking and sorting contents of boxes, which request was complied with as soon as possible, the men being detailed from volunteer regiments. Later, Acting Asst. Surg. W. E. Parker, United States Army, was placed in charge of the stores and attended to their issue. His report in this connection would be of interest.

Memorandum of events from June 22 to 28.-On the 22d of June the landing took place at Daiquiri, the naval steam launches and boats conveying the troops to the shore.

On the 23d the Navy furnished a few launches and some boats to convey the remainder of the troops on shore at Siboney, also some rations and ammunition,


but nearly all were withdrawn in the afternoon, as the heavy surf prevented any further landing.

On the morning of the 24th the chief surgeon requested of the commanding general that he be furnished a steam launch and boats to hunt up transports and get off the medical supplies. As it was impossible to get the steam launch from the navy so early in the morning, the use of a rowboat from the Seguranca was authorized and sent out with such supplies as belonged to the First Infantry, under charge of Captain Munson, assistant surgeon, who was the executive officer of the chief surgeon. Permission to continue the use of this only boat was then withdrawn, as it was needed for other purposes. By this time a strong breeze sprung up, which prevented any further attempt to reach the scattered transports or safely to board them. About noon of the 24th, news of the battle at Sevilla having been received, the chief surgeon and his executive officer after much difficulty were put on board the steamer Olivette. He ordered the ship to proceed at once to Siboney, where it arrived in time to take care of all the wounded that could be brought on board that night and the next day by naval boats and launches.

On the 26th of June the transport Saratoga came into Siboney Harbor. This steamer had on board a field hospital under command of Major La Garde, surgeon. After much difficulty the chief surgeon managed to board her and order the immediate landing of all her tentage and medical supplies, etc. The steam lighter was alongside taking off commissary stores under command of the chief commissary. The chief surgeon asked that the hospital might be taken on shore with the stores. He was informed that it was positively prohibited that the lighter be used for any other purpose than to unload subsistence stores. The chief surgeon after munch difficulty boarded the headquarters boat again and got a direct order from the commanding general to take the hospital to shore on the lighter. This order was personally delivered by the chief surgeon and the landing was accomplished that afternoon.

On the 27th of June the commanding general directed Dr. Goodfellow to take the steamer Cumberland and proceed to Daiquiri, hunt up transports, take off from them certain quartermaster's employees known to be on board, and at the same time to remove and land all medical chests and supplies. Thirteen ships were visited. On several of the transports they were found and landed. On others they could not be found, the ship officers and crew claiming to know nothing of their whereabouts. In the afternoon the work was stopped, as the Cumberland was imperatively needed elsewhere.

On the same day, at Siboney, by direction of the commanding general, the chief surgeon, with great difficulty, managed to get a small boat to take him on board the steam tug belonging to Mr. Hearst, of the New York Journal. Finding that that gentleman had gone to the Olivette, the chief surgeon boarded that ship and begged that he would lend his steam launch to tow boats to transports for the purpose of removing medical stores. Mr. Hearst kindly promised to give its use, but the launch never appeared. The chief surgeon was then authorized by the commanding general to hire any tug that he could find and to use it to run down transports and get off the medical supplies. The only tug in sight was a newspaper boat, with which he was unable to communicate before it put off to sea.

On the morning of the 28th the chief surgeon succeeded in landing from the steamer Seguranca all his reserved stock of medical supplies and placed them in charge of Maj. Ogden Rafferty, surgeon, United States Volunteers, who had just reported for duty. He also directed Major Rafferty to act as medical storekeeper and make every endeavor to get from the transports as they were unloaded such regimental medical stores as might be on board. What success he had at that work I do not know, as I accompanied the commanding general to the front and was detained there by my duties until the end of the campaign.

It may here be stated that the steamer Relief had equal difficulty in unloading stores, nearly one week being consumed in getting them on shore, when the facilities were much better than during the early days of the expedition.

Field hospitals.-Of the field hospitals that had been organized at Tampa the first divisional, under command of Maj. M. W. Wood, surgeon, was the first to be landed. The report of Major Wood for June, which was forwarded to the Surgeon-General, shows under what difficulties this was effected, and how, by the heroic struggles of the Hospital Corps detachment, it was carried to the front practically by hand and by litters used as hand barrows.

The second field hospital landed was, I think, that of the cavalry division, under command of Major McCreery, surgeon, who succeeded in getting off only a portion of its tentage and surgical supplies when the transport stood out from land with the remainder of the outfit on board. I do not think that the whole of this hospital was ever assembled. Where it went I have not been able


to ascertain. It was moved to the front at an early date, and under the direction of Major Havard, chief surgeon of the cavalry division, became of service during the battles of the 1st and 2d of July.

The third or reserve hospital, under command of Major La Garde, surgeon, after many delays, daring which the transport Saratoga was drifting miles at sea, was successfully landed by the lighter Laura at Siboney, and ultimately became the base hospital. To this was sent all medical supplies that could be gotten from transports and those from the hospital ship Relief.

The fourth hospital, under command of Maj. A. H. Appel, surgeon, was retained on the steamer Olivette, which became a hospital ship.

Two other hospitals were organized near corps headquarters, one under charge of Major Crampton, surgeon, for the reception of the sick-a detention camp, so to speak-until they could be separated; the second, a yellow-fever hospital, under charge of Dr. Hamilton R. Jones and Dr. F. J. Combe, acting assistant surgeons, United States Army. These hospitals, like all the others, were for a long time sadly deficient in tentage, bedding, and supplies, but later they were procured and good work was done, 125 cases of yellow fever being treated in them up to July 23, with a record of 35 deaths.

Major Crampton's hospital, which was at first only a collection of shelter tents, unfortunately located on bad ground, the mud at times being several inches deep, was later changed to a side hill, and some tents, furnished by Major La Garde from the hospital at Siboney, put up. These two hospitals were later placed under the control of Surgeon Ives, United States Army, and were continued until larger hospitals were established near the city of Santiago.

As has been stated, these hospitals were all of them lacking in a sufficient supply of tents, cots, bedding, and medicines, but were well equipped with surgical operating tables, surgical instruments, sterilizers, dressing chests, etc. After the headquarters of the commanding general was moved to the front an order was given by the chief surgeon to Major Appel to unload from the Olivette all his tentage and camp outfit and transfer it to Major La Garde at Siboney, and I am informed this was done, although no formal report was made to me of the matter.

The lack of tents was not particularly felt after the battle at Sevilla, as the wounded were brought at once to the steamer Olivette, where operations were performed and the officers and men made comfortable. But after the battles of July 1, 2, and 3 the inadequacy of shelter that could be furnished the wounded, and later to those who were sick, gave the greatest distress to all concerned. But the tents were not at hand, and only supplied in sufficient numbers after weeks of delay.

Ambulances.-Only three ambulances were carried on the transports. These were unloaded and set up in time to be of service during the battle of July 1 and subsequently. They were placed in charge of First Lieutenant Godfrey, assistant surgeon, and he carried them to the fighting line, frequently under fire of the enemy, in the work of removing wounded to the rear.

Later (about July 2) a train of ten ambulances arrived on the transport Louisiana, in charge of First Lieut. J. M. Kennedy, assistant surgeon. They were promptly disembarked at Daiquiri and brought to the front. The park was stationed near corps headquarters, where the train could be under control of the chief surgeon. This train, though small and frequently depleted of its drivers by disease, was of immense service, and under the efficient management of Lieutenant Kennedy was constantly engaged in transporting the sick and wounded from the camps to the advance hospitals, and from them to the base hospital at Siboney; and from that place medical supplies were transported to the front as fast as they were received, any reserve that might accumulate being protected by wagon paulins and a few tents. Through frequent discouragements, due to the breaking of tongues and other parts of ambulances, of harnesses and litters, the sickness of mules and of drivers, he kept them steadily at work over the awful roads, and efficiently did all so small a train could do.

Wagons bedded with hay, so long as any could be procured, and sometimes with grass, were also largely used in moving patients, but it was painful and sometimes frightful work, which the overwhelming pressure of numbers rendered unavoidable.

Among the precautions taken by Lieutenant Kennedy to prevent the spread of disease, he had the inside of his ambulances frequently washed with bichloride solutions 1:1000, the seats, curtains, and floors being attended to after every occupancy by a yellow-fever case; then separate ambulances were assigned to yellow-fever hospitals for removal of the sick from camps of detention to the same.


Yellow fever.-During the second week in July Dr. John Guiteras, acting assistant surgeon, United States Army, who had been left at Siboney with view to special work in connection with yellow fever, reported having discovered five cases of that disease. Three of the patients were newspaper correspondents; others from the Thirty-fourth Michigan Volunteer Infantry. Later, daily reports showed a steady and rapid increase of the disease, local unsanitary conditions favoring its spread. The fact that most of the patients had been sleeping in or resorting to habitations which were considered infected was reported. Upon this the commanding general directed the destruction by fire of all the buildings at that point.

On the arrival of the steamer Yale, Col. Charles R. Greenleaf, assistant surgeon- general, took charge at Siboney, and commenced a vigorous police of the town and the exclusion of all Cuban and Spanish refugees. Col. Nicholas Senn, chief surgeon, United States Volunteers, had before this assisted in the work of purification, and Major Gorgas, surgeon, United States Army, was detailed in charge of the yellow-fever hospital, and Major McCreery, surgeon, in administrative charge of the town.

A few days later, as cases were reported among the sick received from the front at the detention camp near corps headquarters, Acting Asst. Surg. Hamilton R. Jones was directed to make an inspection of all sick arriving and separate the yellow fever cases. A hospital for these was established three-quarters of a mile distant on an eligible site. Dr. Jones was placed in charge of this hospital with Acting Asst. Surg. J. F. Combe as his assistant. Cuban nurses were employed at first, but they proved to be worthless, and were either discharged or left in a short while. As was always the case, the lack of shelter was a serious evil, which was corrected very slowly and only as tents could be spared from Siboney and the surgical hospital under Major Wood. Up to July 23, 125 cases were received in this hospital and a mortality rate reported of about 12 per cent.

At Siboney cases continued to accumulate until over 400 were reported, the death rate being slightly higher than the above.

NOTE.-Very shortly after the debarkation of troops at Siboney the chief surgeon of the corps called upon the commander of the Cuban forces, who with his staff was quartered in the most desirable house in the place, and asked him in regard to the existence of yellow fever in or near the village. He stated in excellent English that there had been no case in the place recently. When questioned as to possible danger in occupying dwellings there or coming in contact with his people, he said he believed there would be no danger, as the Cubans rarely had yellow fever. When asked as to the advisability of burning the village to destroy infected houses, he replied that he did not think it necessary and that it might seem like wanton destruction of property.

Under the influence of this opinion neither the chief surgeon nor the commanding general thought it advisable to burn the town at that time, but orders were given that the troops should keep out of the houses and palmetto shacks. This order was not observed by civilians, nor by the commander of certain volunteer regiments and their staffs, the result being that they discovered the infective points very promptly and were attacked by the disease. After this had happened the town was destroyed, as stated.

Dr. Jones, who was ordered to inspect the fever cases under treatment in the lines, reported many mild cases and several serious ones, all of which were removed as quickly as possible to the hospital, the presence of albumen in the urine being apparently the main diagnostic point. Unfortunately regimental surgeons were without their urinary test sets, and nitric acid and test tubes were very scarce at all the hospitals. For this reason many cases that were thought to be simple ephemeral or thermic fever and various forms of malarial manifestation, which were widespread among the troops and complicated every disease, were really mild and undetected cases of yellow fever. The uncertainty of diagnosis was increased by the practical absence of yellow fever among the refugees or in the city, as reported by Dr. Hartmann, of Santiago, who had been a lifelong resident and practitioner, and who was one of the 22,000 refugees at Caney. Then numerous regiments which had suffered no contact with refugees, were isolated in fact, furnished cases of the disease. All of the regiments had one common condition, however, that of the construction of heavy lines of intrenchments and the necessity of living in or near this upturned soil for nearly two weeks. As I believe this was one of the principal causes of widespread malarial infection, so do I believe that it was the main cause of yellow fever infection. That this telluric variety of yellow fever was mild in type gave a reasonable hope that by the prompt recognition and separation of cases and the removal of camps the disease might be controlled before the virulence of the infective germ was increased by transmission through the human body.


Removal of camps, etc.-So soon as the military situation permitted, the commanding general directed the removal of all camps from the trenches, and the selection of elevated and well-drained sites on the hills to the north and east of the city. One camp, that of the First Infantry, was located near San Luis, for military reasons. The mountain range was avoided because of the lack of roads over which supplies could be drawn and the lack of water; also because of the marked increase of rainfall in that region, storms being much more frequent there than near the city. The camps varied in distance from Santiago. The nearest and the healthiest, that of Corps headquarters, was 1 mile from the edge of town, on the ridge about 100 feet high. The farthest, that of the cavalry division, about 4 miles, under the foothills to the north. The mountain plateau country was unsuitable for camping purposes, because of the lack of shade and the deep black muck of soil, which was a perpetual quagmire during the rainy season. The men and officers of the First Infantry suffered intensely in that country from the moist heat of the day and the drenching by storms.

Tentage, etc.-It was not until the last week in July and the first week of August that regimental tents and camp equipage began to be unloaded from the transports and were carried to the camps, and up to the the of reembarkation many of the regiments were still protected only by their shelter halves. Where the material could be procured some of the troops made themselves bunks, elevated from the ground, but ordinarily this was not done, the material not being at hand, arid the energy of the men exhausted by sickness and the tropical climate. Where the tents and the bunks were combined the greater comfort possibly revived the waning health of the men. But this was not apparent at once.

Among the camp equipage were to be classed the kettles for boiling water and the ovens for cooking and baking, all of which were necessary to establish the company messes and better methods of preparing the food supply. At the same time canned tomatoes and other vegetables began to appear and fears of scorbutic complications to wane; but with it all the intense infection of trench fever continued its work until over 4,000 men and officers were on sick report. It became thus evident that the solution of the problem lay only in the immediate removal of the whole command to the United States, which was commenced August 8, and continued under regulations established by the War Department as rapidly as transports were furnished until the 25th of August.

Use of transports for the sick and wounded.-Very early after the battle of Sevilla, and from that time on, the use of transports for the accommodation of slight cases of wounding and for the sick and convalescent became absolutely, necessary, in the absence of regular hospital ships and the congestion of the hospitals with numbers of patients for whom necessary shelter could not be provided on shore, because of the lack of tents and the lack of cots. At the front and in the trenches hundreds of men were waiting for hospital treatment, which could not be given them until room was made, and room could only be made by shipping north those able to travel. For this reason the chief surgeon recommended the use of transports, and they were used with evident satisfaction up to the Seneca and Concho incidents, when there seems to have been complaint as to the alleged foul water on the ships and the lack of supplies for the sick. In regard to the first condition, these transports were wholly under control of the quartermaster's department in all matters pertaining to the ship itself, and foul-smelling water from long storage was a condition common to nearly all of them.

About the 20th of July Major La Garde, surgeon in charge of the hospital at Siboney, was asked by the chief surgeon, through telephone, how many more patients he could accommodate. He replied that his hospital was full, but that he had 175 convalescents, who, while unable to be returned to duty, were able to travel. In order to make room for many grave cases of sickness reported in camps, I requested that a transport be designated to take these convalescents to the States, and thus vacate beds and shelter for graver cases. The commanding general authorized the transfer and the chief quartermaster designated the vessels named. The conditions were urgent and because of the lack of tents the hospitals could not be enlarged, so as many convalescents as possible were sent north. The selection of those to go and the provision of medical stores was in the hands of the surgeon in charge of medical administration at Siboney. The foulness of the ships was a matter to be remedied by the captain and crew, and with the powerful pumps on hand I was assured no difficulty could be met in making a ship clean at any time during the voyage.

The lack of surgeons and nurses on these vessels was probably unavoidable, the lack because of sickness and other causes being one that pertained to all the hospitals of the corps at that time and to many regimental organizations also. Furthermore, the convalescents were supposed to be practically well men, and at least able to care for themselves, except during such illness as might break out during


the voyage, and for this contingency reasonable provision had been made by the presence of two medical officers and some most necessary medical stores. If any serious cases of illness or wounds were sent on these ships it was without direction from the chief surgeon.

Fight at Sevilla or Guasimas.-The engagement occurring on the 24th of June at a locality known as Sevilla or Guasimas, about 4 miles from Siboney, furnished 52 wounded men, who were slowly brought on litters to the shore, where they were temporarily rested in a very foul old shed until boats and launches could be procured from the Navy to transport them to the steamer Olivette. In handling the wounded much skill was shown by the sailor and hospital corps private, as well as a good deal of courage, in carrying the boat through the surf and alongside the steamer, where they were unloaded near an open port hole, and the patients carried thence onto the main deck to await their several turns at the operating table.

The chief surgeon spent the night on this steamer and can not too highly commend the effective administration of its affairs by Maj. A. H. Appel, surgeon in charge. The ship was well adapted to hospital work, and the surgical outfit made easily available. The large dining room, which was lighted by electricity, was rapidly converted into an operating room, the mess tables and chairs being moved away, and surgical tables, sterilizers, and dressing cases substituted.

The staterooms of the Olivette were largely above the main deck and well ventilated, although the use of staterooms rendered the task of nursing and surgical dressing more difficult than where open and clear decks could be fitted up. Bathrooms were extemporized, and the mess and nursing appliances of the field hospital were easily sterilized. A large stateroom was used as a dispensary, and the smoking room on the upper deck as an office.

This early battle gave the first illustration in actual warfare of the value of the first-aid dressings. All of the wounded showed most careful application of the dressing, which in many cases might have been left undisturbed could the exact nature of the surgical condition have been known without their removal. The nature of the surgery was conservative, no occasion for the graver operations appearing. One case of trephining for wound of the head was made by Lieut. L. P. Smith, assistant surgeon, United States Army, and a laminectomy for shot wound of the lumbar vertebrae by Major Appel.

Battles.-The action of July 1, 2, and 3 have been so fully written up in military reports that a further description would be unnecessary. The operations of the medical department have received no description that has come to my notice that does justice to the gallantry of the medical staff on the field or its skillful and tireless work in the hospitals. The bravery of our men under fire was conspicuous. They shared all the dangers and sufferings of the campaign equally with the officers of the line.

In Major Wood's hospital over 1,000 wounded men were received within three days, and in spite of lack of shelter and the subsequent exposure to intense heat and drenching rains, the mortality rate was less than 7 per cent.

All of the wounded showed the most careful primary dressing, which permitted deliberate work in the hospitals in the application of operation and secondary dressings. Fractures of the thigh were carefully splinted on the field, sometimes with rods or wire, at others with the broad bark of the palm tree, which when wet was pliable and when dry firmly adherent, and it could be cut into any desired shape with a knife or rolled into desired forums with great ease.

The transportation of the wounded from the field of battle, 3 miles distant, was mainly by litter and three ambulances. In a few cases an extemporized carriage was tried, but not often with success. The wounded from the fight at El Caney were cared for at that place by Major Ebert, surgeon with the Seventeenth Infantry. They were brought in later by means of ambulances and wagons. There were at this place over 150 wounded Spanish prisoners, who were cared for by Major Ebert and later by Drs. Goodfellow, Marshall, and Menocal, until they were transferred through the lines to the large Spanish hospital in the city.

Early after the battle the hospital was honored by the presence of Miss Clara Barton and her staff of four assistants, who immediately set up their tents and cooking apparatus, and labored incessantly day and night, in the broiling sun and drenching rain, preparing sick food for the wounded and serving it to them, and in a thousand other ways giving the help that the Red Cross Society brings.

At the earliest practicable date the wounded were moved to Sihoney, commencing with the slighter injuries, and proceeding day by day until about the 17th of July, when the hospital was empty and ready to be moved further to the front. This was done by Major Wood, a site being selected on a hill near the road running north and not far from Cubitas, a collection of houses on Purgatorio Creek.


Health of the troops.-The health of the troops while at Tampa was excellent as a whole, the number of those excused from duty being considerably less than the rate of peace service at military posts. But this low rate did not include the large number who were suffering from an acclimating diarrhea, which broke out in the regiments newly arrived. This disorder, which was widespread and annoying, resulted in using up a large amount of medicines without materially impairing the effectiveness of the command. The reasons for its incurrence, I think, may be found not in any defect of water supply, which would have affected citizens as well as soldiers, nor yet in the food, which among the regular troops did not materially differ from that to which they were accustomed, but I believe it was due rather to change of habitation from warm, dry bedding in warm, dry barracks to the damp chills of sleeping on the ground, often with no other bed than a thin rubber sheet. Every night our clothing was drenched with dew, and every day it was drenched with sweat, and from this alternate heat and chill I believe the intestinal catarrhs and colics arose. When we became accustomed to the change, our troubles in that respect ceased. Another cause was the innumerable so-called soda water and "pop stands" that peddled their indigestible stuff on the outskirts of the camps, and with which the unwary and imprudent soldier was always gorging himself, not because his food was insufficient, but because of his childlike hunger for sweet stuff of any nature.

About the same time measles appeared among the troops, affecting regulars as well as volunteers, and old men as well as young. The disease, which had been unusually prevalent all over the North during the winter preceding, spread rapidly in the camps. Prompt isolation of the patients by removal from their commands to the field hospitals seemed to hold it in check, so that in the history of the expedition it did not become a very important factor. The type was not severe, and the mortality rate was small.

Typhoid fever appeared early and increased with rapidity as the season advanced. Just why it should have become so widespread I can not now conjecture. While we naturally look to an infected water supply as the universal cause, I think we must admit the possibility of infection of both food amid water through showers of infected dust and swarming of infected flies who travel from the sinks to the mess tents with intolerable regularity. In too many cases the covering of sinks was perfunctory-usually done at reveille and in the afternoon-but its contents left bare during the middle of the day when most in use.

The infection of water barrels by dust being blown into them was easy, and the inhalation and swallowing of infected dust was by no means impossible.

The typhoid fever existing in Tampa prior to embarkation of the troops was of a grave type, but fortunately the mortality was not large. Later, in Cuba, after the strength and vitality of the men became lowered by the exposures and hardships of war, the mortality rate increased and the disease took its place among the foremost causes of disability. Malarial fevers and a variety of ephemeral fever, which simulated dengue, appeared in Cuba. The diseases were widespread and of a severe type. In all of them great prostration would follow apparent recovery, and convalescence was protracted. Large doses of quinine were required to control the malarial variety. The ephemeral fever, which exhibited a temperature often as high as 105̊ and 106̊ F., would disappear in about four days, with protracted convalescence and a tendency to recurrence. Quinine was used in large doses, but without checking the disease.

In Cuba many of these ephemeral forms were later diagnosed as yellow fever, particularly when they were subjected to urinary test; but without that the Tampa and Cuban varieties looked much alike.

During the latter part of July and August the tendency to diarrhea and dysentery became pronounced, although the diet of the troops had much improved and the water supply was certainly no worse than it had been from the first. The majority of medical officers regarded it as of malarial origin and treated it as such, and frequently with large rectal injections of quinine. Attempts were made to check its spread by recommending the use of boiled water for drinking purposes without favorable results, probably because the men preferred the disease to the remedy. At divisional hospital No. 1, where boiled and filtered water was freely supplied, and about all that was to be had, the incurrence of diarrhea and dysentery was almost unknown. Among the regiments the excuse for not furnishing boiled water was valid; the commands were, until very late, without the necessary kettles and cauldrons to heat the water. When the soldier had only his tin cup and ration can and a little fire of green twigs with which to cook his food, boiled water was omitted.

Sanitary advice.-Before leaving Tampa the chief surgeon secured the publication of General Orders, No. 8, headquarters Fifth Army Corps, June 2, 1898, in


relation to the sanitary care of troops. This circular was prepared by Dr. John Guiteras, acting assistant surgeon, United States Army, as was also a small card circular intended as a pocket companion. Copies of these are hereto appended.

Medical staff.-A pocket register of the medical officers, regular, volunteer, and contract, was kept by the chief surgeon, from which the following information can be given, and in the absence of verification by comparison with the larger desk records turned over to Lieutenant-Colonel Havard, chief surgeon, United States Volunteers, it is believed may be said to be fairly correct.

On the 22d of June there were on duty with the Fifth Army Corps 36 regular medical officers, 15 volunteer medical officers and 20 contract surgeons, total 71, to supply 20 regiments of infantry, 5 regiments of cavalry, 2 squadrons of mounted troops, 3 batteries of light artillery, 1 battalion siege artillery, 1 engineer battalion, 3 field hospitals, a large wagon train, 1 hospital ship, the pack train, the Gatling-gun detachment, signal-corps detachment, and 2 independent stations; in all, 37 military organizations and 2 quartermaster stations-Daiquiri and Siboney, and 4 hospitals.

It is my opinion that the number of medical officers was insufficient to meet the demands of service in Cuba. There should have been to every regiment at least 2 medical officers, or 50 to start with. To every squadron of cavalry, battery of artillery, and battalion of engineers, gun detachment, squad corps, pack train, 1 or 2 assistants. To every hospital, 4 as regular staff and 4 contracts as assistants, or 32; making a total of 90 officers.

Concerning the medical officers and men of the hospital corps who were with the expedition, I can not speak too highly. They shared all the hardships that came to the Fifth Army Corps, not alone during the assault and siege of Santiago de Cuba, but in the far more trying battle with disease, which day after day ravaged our camps and threatened annihilation as a fighting force to the gallant troops who had won one of the most splendid victories of history. These brave and devoted men, through the blistering heat and drenching rains and equally drenching dews of a tropical summer, marched side by side with their comrades of the line, slept in the mud, breathed the deadly vapors of the jungles, and more pestilential miasmas of the upturned earth in the trenches, endured the same privations as to lack of food and shelter, worked when others slept, resting neither day nor night so long as their services were anywhere called for, whether on the march, in the camps, or in the hospitals. Can we deny to them equal share in the honors that may be bestowed upon their fellow soldiers? I can at least append their names, in the hope that they may not be forgotten. There are also others, who joined the command later and did faithful and valuable service, whom I hope will be embraced in a supplementary list.

This report closes with July 23, 1898, when, on account of continued illness and at my own request, I was relieved by the commanding general from duty as chief surgeon of the corps and Maj. Valery Havard, surgeon, was appointed acting chief surgeon in my stead, the administrative duties of the office being assumed by him. His report will cover the operations of the department from that date.



1. List of regular and volunteer medical officers and acting assistant surgeons on duty with the Fifth Army Corps at the date of the landing of the expedition at Daiquiri and Siboney, Cuba.

Lieut. Col. B. F. Pope, chief surgeon, United States Volunteers, chief surgeon, Fifth Army Corps, April 23 to July 23, 1898, when relieved on account of illness. Remained with the corps, however, until it returned to the United States.

Lieut. Col. Valery Havard, chief surgeon, United States Volunteers; chief surgeon, Fifth Army Corps, from July 23, 1898, to August 25, 1898, when he was announced as chief surgeon of the Department of Santiago; chief surgeon of the cavalry division to July 23, 1898.

Maj. Henry S. Kilbourne, surgeon, United States Army; chief surgeon, Second Division. Later, September 10, 1898, chief surgeon, Fifth Army Corps.

Maj. M. W. Wood, surgeon, United States Army; chief surgeon, First Division; also in charge divisional hospital No. 1 to July 21,1898.

Maj. L. W. Crampton, surgeon, United States Army, Eighth United States Infantry; in charge detention hospital near corps headquarters; chief surgeon, First Brigade, Second Division.

Maj. S. Q. Robinson, surgeon, United States Army, Tenth United States Infantry; chief surgeon, Second Brigade, and acting chief surgeon of the Second Division. Later, in charge of divisional hospital No. 1. Left at Santiago de Cuba on departure of the Fifth Army Corps for the United States.


Maj. L.A. La Garde, surgeon, United States Army, Ninth United States Cavalry; in charge of divisional hospital No. 3, at Port Tampa, Fla., and Siboney, Cuba; also in charge of all administrative work at that place.

Maj. A. H. Appel, surgeon, United States Army; in charge of divisional hospital No. 2, at Tampa, Fla.; also of same hospital on steamer Olivette.

Maj. George McCreery, surgeon, United States Army, Sixth United States Cavalry; in charge of field hospital, cavalry division; executive officer at Siboney during the yellow-fever epidemic. Died at sea en route to the United States.

Maj. R. G. Ebert, surgeon, United States Army, Seventeenth United States Infantry, chief surgeon, Second Brigade, Second Division; also in charge of wounded Spanish prisoners at El Caney, Cuba.

Maj. R. W. Johnson, brigade surgeon. United States Volunteers. Executive officer amid surgeon, divisional hospital, No. 1. Left at Santiago de Cuba after the departure of the Fifth Corps for the United States.

Maj. W. D. McCaw, brigade surgeon, United States Volunteers, Sixth United States Infantry; chief surgeon First Brigade, First Division.

Maj. F. J. Ives, brigade surgeon, United States Volunteers, Twentieth United States Infantry; chief surgeon General Bates's Independent Division.

Maj. H. S. T. Harris, brigade surgeon, United States Volunteers, Ninth United States Cavalry; later chief surgeon Cavalry Division.

Maj. W. B. Banister, brigade surgeon, United States Volunteers, Second United States Infantry. In charge field hospital near General Bates's Division. Left at Santiago after departure of the Fifty Army Corps.

Maj. Paul Shillock, brigade surgeon, United States Volunteers. Twenty-fifth United States Infantry; chief surgeon, Second Brigade, Second Division.

Maj. Ogden Rafferty, brigade surgeon, United States Volunteers. On duty at Siboney, Cuba, as acting medical supply officer. Returned to the United States in charge of sick, transport Cherokee, July 6, 1898.

Maj. Philip G. Wales, brigade surgeon, United States Volunteers, Twelfth United States Infantry.

Capt. A. B. Heyl, assistant surgeon, United States Army, First United States Cavalry. Returned to the United States about July 9, 1898.

Capt. Joseph T. Clarke, assistant surgeon, United States Army, Twenty-second United States Infantry.

Capt. M. W. Ireland, assistant surgeon, United States Army; surgeon at divisional hospital, No. 3 at Port Tampa, Fla., and Siboney, Cuba.

Capt. H. C. Fisher, assistant surgeon, United States Army, Twenty-first United States Infantry.

Capt. F. A. Winter, assistant surgeon, United States Army, Third United States Cavalry. Returned to the United States on transport City of Washington, July 9, 1898.

Capt. M. M. Brewer, assistant surgeon, United States Army, Tenth United States Cavalry. Died of typhoid fever on his return to the United States.

Capt. H. M. Hallock, assistant surgeon, United States Army, Seventh United States Infantry.

Capt. G. J. Newgarden, assistant surgeon, United States Army, Third United States Cavalry.

Capt. E. L. Munson, assistant surgeon, United States Army, executive officer to chief surgeon, Fifth Army Corps, on steamer Olivette, June 24 to 26; in charge of outfitting transports for reception of wounded to July 10; left for the United States on the Breakwater July 10, in charge of sick and wounded.

First Lieut. J. M. Kennedy, assistant surgeon, United States Army; commanding ambulance train, Fifth Army Corps; in charge of distribution of supplies and the transportation of wounded and sick from July 20 to August -, 1898; in charge of the Nautical Club Hospital at Santiago de Cuba to -.

First Lieut. W. W. Quinton, assistant surgeon, United States Army, Battery A, Second Artillery.

First Lieut. D. C. Howard, assistant surgeon, United States Army. On duty at divisional hospital, No. 2, and on steamer Olivette to -.

First Lieut. W. H. Wilson, assistant surgeon, United States Army, Battery K, First Artillery.

First Lieut. T. J. Kirkpatrick, assistant surgeon, United States Army, Twenty-fourth United States Infantry.

First Lieut. J. H. Stone, assistant surgeon, United States Army, Sixteenth United States Infantry.

First Lieut. P. C. Fauntleroy, assistant surgeon, United States Army, Fourth United States Infantry, and divisional hospital, No. 3, at Siboney.

First Lieut. L. A. Fuller, assistant surgeon, United States Army, Tenth United States Cavalry.


First Lieut. L. P. Smith, assistant surgeon, United States Army, divisional hospital, No. 2, and on hospital steamer Olivette.

The following are State volunteer officers:

Maj. W. D. Bell, surgeon, Seventy-first New York Infantry Volunteers.

Capt. H. E. Stafford, assistant surgeon, Seventy-first New York Infantry Volunteers.

First Lieut. James Stafford, assistant surgeon, Seventy-first New York Infantry Volunteers.

Maj. H. C. Bowen, surgeon, Second Massachusetts Infantry Volunteers.

E. A. Gates, assistant surgeon, Second Massachusetts Infantry Volunteers; also on duty at divisional hospital, No. 1.

J. S. Hitchcock, assistant surgeon, Second Massachusetts Infantry Volunteers.

Maj. Henry La Mott, surgeon, First United States Volunteer Cavalry.

Capt. J. A. Church, assistant surgeon, First United States Volunteer Cavalry.

Lieut. Frank Donaldson, assistant surgeon, First United States Volunteer Cavalry.

Maj. F. T. L. Magourn, surgeon volunteers, Ninth Massachusetts Infantry.

First Lieut. Peter Shea, assistant surgeon volunteers, Ninth Massachusetts Infantry.

Maj. V. C. Vaughan, surgeon, Thirty-third Michigan Infantry.

Guy B. Baily, assistant surgeon, Thirty-third Michigan Infantry.

Maj. James A. King, surgeon, Thirty-fourth Michigan Infantry.

John A. Bobb, assistant surgeon, Thirty-fourth Michigan Infantry.

Julius M. Wilhelm, assistant surgeon, Thirty-fourth Michigan Infantry.

Dr. George Goodfellow, of California, rendered volunteer service without pay to the wounded after the assaults on Santiago, and to wounded Spanish prisoners at El Caney. He was present with headquarters of the corps and rendered much assistance to the chief surgeon and general commanding.

Dr. Karl Rudberg, fleet surgeon, Royal Swedish navy. Distinguished services in the hospital at Siboney and on the Iroquois to Key West.

Maj. Charles P. Nancrede, surgeon of division, General Duffield's command at Siboney.

Contract surgeons who were with the Fifth Army Corps on its landing at Daiquiri and Siboney and during the assault and siege of Santiago de Cuba:

Acting Asst. Surg. W. W. Calhoun, Ninth United States Infantry.

Acting Asst. Surg. H. W. Danforth, Ninth United States Cavalry; fatally wounded July 2, 1898.

Acting Asst. Surg. W. E. Parker, divisional hospitals, Nos. 2 and 3. Yellow-fever service at Siboney and on hospital steamer Olivette.

Acting Asst. Surg. John Guiteras. Yellow-fever service at Siboney until July 20.

Acting Asst. Surg. B. C. Leonardi, Ninth United States Cavalry.

Acting Asst. Surg. W. P. Lawrence, Battery G, Fourth Artillery; also yellow-fever hospital at Siboney.

Acting Asst. Surg. R. N. Pitts, First United States Infantry, and in yellow-fever hospitals.

Acting Asst. Surg. Hamilton P. Jones, divisional hospital, No. 1. In charge yellow-fever hospital near headquarters and at Siboney.

Acting Asst. Surg. R. Echeverria, Light Battery D, Fifth Artillery, and in yellow-fever hospital at Siboney.

Acting Asst. Surg. Wilfrid Turnbull, battalion United States Engineers.

Acting Asst. Surg. F. E. Menocal. Second United States Cavalry, Sixth United States Cavalry, First United States Infantry, Headquarters Fifth Army Corps, and among Spanish refugees at El Caney.

Acting Asst. Surg. J. M. Delgado, First United States Cavalry.

Acting Asst. G. Surg. Moreno De La Torre, Tenth Infantry, to June 23. Steamer Olivette to -.

Acting Asst. Surg. J. A. Tabor, Eighth United States Infantry.

Acting Asst. Surg. T. B. Marshall, Sixth United States Infantry, divisional hospital, No. 1, and among refugees at El Caney and Spanish prisoners.

Acting Asst. Surg. F. J. Combe divisional hospital No. 1, and yellow-fever hospital near corps headquarters.

Acting Asst. Surg. Arthur Jordan, Second United States Cavalry.

Acting Asst. Surg. A. E. Wynter, Thirteenth United States Infantry, and yellow-fever hospital.

Acting Asst. Surg. Thomas Y. Aby, Twentieth Infantry.

Acting Asst. Surg. E. R. Bragg, Third Infantry.

Medical officers who joined the command after the assault on Santiago and rendered service during the siege:

Maj. W. G. Willard, surgeon, First Illinois Infantry Volunteers.

Capt. Thomas C. Roberts, assistant surgeon, First Illinois Infantry Volunteers.


First Lieut. C. B. Walls, assistant surgeon, First Illinois Infantry Volunteers.

Maj. Richard Pyles, surgeon, First District of Columbia Infantry Volunteers.

First Lieut. S. C. Cox, assistant surgeon, First District of Columbia Infantry Volunteers.

Capt. C. F. Kieffer, assistant surgeon, United States Army, Artillery Battalion.

Maj. E. C. Farquhar, surgeon, Eighth Ohio Infantry Volunteers.

Capt. G. H. Wuchter, assistant surgeon, Eighth Ohio Infantry Volunteers.

Capt. A. V. Smith, assistant surgeon, Eighth Ohio Infantry Volunteers.

Acting assistant surgeons:

A. A. Snyder, divisional hospital, No. 3; Stanley Warren, Ennis Battery; J. Ramsburgh, detention hospital to -.; R. D. Boss, First United States Infantry to -.; J. T. Arwine, detention hospital to -.; J. McV. Mackall, Daiquiri to -.; C. C. Marbury, detention hospital to -.


2. [General Orders, No. 8.]

Tampa, Fla., June 2, 1898.

The following is published for the information of this command: 

Suggestions to commanding and medical officers for the prevention of yellow fever, and the preservation of the health of the United States forces in the Tropics, by Dr. John Guiteras, United States Army.

The general hygienic rules for the government of military camps should be enforced. Your attention is called to the following special points:

The use of quinine.-The regular administration of quinine for the prevention of malaria is of doubtful advantage. Quinine, however, should be used when the individual is subjected to extraordinary depressing influences, such as traumatism, exhaustion. Several substitutes for quinine have been used by the Cuban army, but with little effectiveness. The best is probably a decoction of coffee and lemon.

Alcohol.-The excessive use of alcohol is specially deleterious in the tropics. Diluted wines, with the meals, are generally used, and with advantage. Stronger liquors internally, and in the form of frictions. may be recommended after prolonged exposure to wet. The aguardiente produced in the country is used with advantage in slight diarrheal troubles. In the treatment of the later stages of yellow fever effervescing alcoholic drinks are useful, but we can not prescribe the large doses employed in typhoid fever and pneumonia.

Fruits.-We would especially recommend the cocoanut water when the nut is green (may be found throughout the year), the sugar cane (from November to April), the sugar apple (August and September), the orange (during the winter months), and the mango (June and July). The latter fruit should be especially avoided when green or overripe. The sapodilla (May and June), the mammey apple (August), the banana (all the year round), and the pineapple (November and December) are less easily digested and should be eaten sparingly. The alligator pear (July and August) should be eaten with the meals, and not to excess. The tamarind and the ripe guava (the latter most abundant from June to November) are laxative.

The vegetables of the country-the yam, the yuca, the malanga, and the sweet potato-should be thoroughly cooked. Rice and plantains properly cooked are favorite dishes with the natives. They are nourishing and easily digested. I recommend that the method of preparation should be learned from the natives.

Water.-The spring waters in Cuba are usually good and abundant in many sections of the island. Yellow fever is not conveyed in the water, but typhoid fever and probably also malaria, dysentery, and some of the parasitic diseases are transmitted in the drinking water. Unless the water be obtained directly from the springs it should be boiled.

Bathing.-Bathing every day in the running streams is safe, and to be recommended. The best hour for bathing is about 11 a. m.

Clothing.-Light linen or cotton should be worn next the skin. Wool irritates the skin, promotes excessive perspiration, and prevents the cooling effect of evaporation. The danger of chilling by the rapid cooling of the surface under wet linen can be prevented readily by a change of clothing, or by an outer dry garment, or the woolen blouse, when the body is exposed to drafts of air.

The bed covering should be comfortable. Wet clothing and wet feet should be especially avoided during sleeping hours.


The tent flooring.-The hammock may be more comfortable than the floor, and it will certainly afford protection against troublesome insects, but there is no proof that the elevation of 2 or 3 feet from the ground will prevent the introduction into the body of the miasms of disease. If it be not practicable to swing large bodies of troops, there will be found in Cuba an abundance of tall grass that may be used in lieu of straw.

Work.-No exercise or exposure to the direct rays of the sun should be permitted between the hours of 11 a. m. and 3 p. m. The morning hours are the best for marching. The heavy showers and thunderstorms occur usually in the afternoon after 2 o'clock. The mornings are usually clear. Continuous rain storms are cyclonic, and they occur mostly in September and October.

The site of the encampment .-The ordinary rules should govern us in the selection of a camp site. The ground should be high. The prevailing winds are from the northeast, and the slopes of the hills fronting to this quarter should be selected. The privies should be located to the northwest of the camp.

With respect to yellow fever, two important facts should be borne in mind: (1) Yellow fever prevails habitually (so-called endemicity) only in a few and small sections of the island. (2) Yellow fever may be carried to, and when so carried may spread in, all sections of the country. The sections referred to under No. 1 are the populous centers, especially the seaport towns of commercial importance, such as Havana, Matanzas, Cardenas, Sagua, Santiago de Cuba, Manzanillo, Cienfuegos, Batabano. The large towns in the interior that have a free communication with the above are also frequently the se-at of epidemics. In the country districts yellow fever is an imported disease.

The troops, then, should be kept, as far as it is practicable, out of the cities, and every precaution must be taken to prevent the introduction of yellow fever into the camps.

The means of conveyance of the disease into the camp will be through supplies, through prisoners of war, through detachments of our troops that may have been forced to occupy infected districts, through the smuggling of things into the camp. Against all these dangers we must institute the rules governing a strict quarantine. Our supplies should come from the north, and if depots for such supplies must be established on the island we should select noninfected places for this purpose. Prisoners of war should be corralled in a place of detention, guarded, if possible, by immune troops. The clothing of the prisoners should be disinfected at once. If no other measures of disinfection are available, we can place much reliance upon fresh air and sunlight, provided the exposure of every piece be complete. The period of detention and observation of these prisoners should extend over seven days.

The presence of a case of yellow fever in a camp is no evidence that the camp is, or that it will become, infected. Yellow fever is not directly transmissible. If the house, the room, the tent where a case of yellow fever is found be not infected, individuals may come in contact with such a case or cases without contracting the disease. Large yellow-fever hospitals have been managed without a single case occurring among the attendants, though these were not immune.

In the detention camps established by the Marine-Hospital Service near large epidemic centers the disease has never spread among the refugees. Of course, a certain proportion of these refugees are stricken down with the disease. They have contracted it in the epidemic center, and when they arrive in camp they are going through the process of incubation. The disease, therefore, breaks out within the first five days after arrival. The permanent residents of the camp-the attendants and the refugees who have been detained in camp longer than seven days-never contract the disease from these imported cases. This means that the camp has not become infected.

The measures taken to prevent the infection of these camps are twofold. (1) The baggage of these people is disinfected immediately upon arrival in camp. (2) A careful watch is kept upon these new arrivals and upon everybody in the encampment. On the first appearance of suspicious symptoms the individual affected is removed to a hospital especially provided for this purpose. The safety then depends upon the prompt recognition of the symptoms and the immediate isolation of the cases.

Our military camps should be divided from the start into two distinct and separate parts-one a main camp, the other a hospital camp. The latter should be situated from one-fourth to one-half a mile to leeward of the main camp.

A few tents should be placed about 100 yards from the hospital camp for the care of suspicious cases in which the diagnosis may be uncertain. This should be called the probation camp.

The hospital camp should be surrounded by a barbed-wire fence, and should be carefully guarded.


Even the hospital camp does not necessarily become infected. Disinfection of the clothing and the dejecta should be instituted to prevent this. The probation hospital should be carefully guarded against infection. When a case has been recognized as one of yellow fever and has been removed to the hospital camp, the walls of the tent should be washed down with a solution of bichloride of mercury, 1:2000, and the ground should be burned by a Barber asphalt furnace. Patients may be returned to the main camp ten days after the establishment of convalescence and after disinfection of the clothing.

If there be evidence that cases of yellow fever have originated in the main camp, it should be moved.

The diagnosis of yellow fever is based upon the following three cardinal symptoms: The characteristic appearance of the face, which may show itself with sufficient distinctness in the first twenty-four hours; and the albumin in the urine, and the peculiar discrepancy between the pulse and temperature. The two latter symptoms may not appear until the third or fourth day of the disease.

By command of Major-General Shafter:

Assistant Adjutant-General.


3. Memorandum of instructions to the soldiers of the Fifth Army Corps for the preservation of their health in the tropics.

The body adapts itself readily to changes of climate. You do not require any special preparation for the climate of Cuba. You should meet the heat in the same way that you do in the summer season of the North.

Avoid, therefore, the use of medicines that are recommended to protect the body against the action of climate.

The danger in the tropics does not come from the direct action of the climate. The danger is due to the presence, in some districts of the warm countries, of the microbes of certain diseases. The chief measures for the prevention of these diseases will be instituted by your commanding officers. There are no medicines that will protect us from these diseases.

Do not take quinine regularly when your health is good.

Do not take purgatives when the bowels are regular.

Drink boiled water when you can not get natural spring water. Stagnant surface water is specially dangerous.

If possible, drink water only at mealtime.

The fruits of the country are wholesome when eaten in season.

Avoid unripe and unsound fruits. Peel all fruits before eating. Use as little alcoholic beverages as possible.

The clothing should be light and loose. When wet from sweat or rain, remove it for drying and rub the body briskly with a wet towel until it is clean. Also, if exposed to drafts when perspiring freely, put on some extra covering.

When your feet are wet, rub them dry and put on dry socks, even if you can not change your shoes.

Protect yourself from mosquitoes by gloves and nets.

Bathe your whole body morning and evening if you can, but do not swim in the heat of the day, except under shade.

Sleep in dry clothing only. Otherwise keep awake and move about.

The health of the command will depend to a great extent upon the strict observance of orders not to communicate with suspected persons or places.

Report all sickness to a medical officer at once.

Lieutenant-Colonel, Chief Surgeon, United States Volunteers.