ARMY HISTORICAL SERIES 

THE 

ARMY MEDICAL DEPARTMENT 

1865-1917 

by 

MaJY C. Gillett 

CENTER OF MILITARY HISTORY 

UNITED STATES ARMY 

WASHINGTON, D.C., 1995 
Library of Congress Cataloging-in-Publication Data 

Gillett, Mary C. 

The Army Medical Department, 1865-1917 / by Mary C. Gillett. 

p. cm. - (Army historical series) 

Includes bibliographical references and index. 

1. United States. Army Medical Dept.-History-19th century. 

2. United States. Army Medical Dept.-History-20th century. 

3. Medicine, Military-United States-History-19th century. 

4. Medicine, Military-United States-History-20th century. 

5. World War, 1914-1918-Medical care. I. Title II. Series. 

UA223.G544 1995 

355.3'45'0973-dc20 94-13147 

e lP 

First Prinling-CMH Pub 30-9-1 

For sale by the Superilllendenl of Documents, U.s. GovernmcllI Printing Office 

Washington, D. C. 20402 
ARMY HISTORICAL SERIES 

Jeffrey j. Clarke, General Editor 

AdvisOlY Committee 

(As of October 1994) 

john W. Shy (Chairman) 

Uni versity of Michigan 

joseph T. Glatthaar 

University of Housto n 

Brig. Gen. Gerald E. Galloway, jr. 

u.s. Mili tary Academy 

Brig. Gen. Randa ll L. Rigby, Jr. 

U.s. Army Command and General 

Staff College 

Carlo W. D'Este 

New Seabury, Mass. 

Rose L. Greaves 

Un iversity of Kansas 

Ira D. Gruber 

Rice University 

William A. Walker 

Arch ivist of the Army 

Col. john F Connolly 

U.s. Army War Coll ege 

Maj. Gen. john P. Herrl ing 

U.s. Army Training and Doctrine 

Command 

D. Clayton james 

Virginia Mili tary Institute 

Caro l A. Reardon 

Pennsylvania State Un iversity 

Michael]. Kurtz 

National Archives and Records Adm inistration 

u.s. Army Center of MilitaJY HistOlY 

Brig. Ge n. John W. Mountcastle , Chief of Mi litary History 

Chi ef Historian 

Chief, Histories Division 

Ed itor in Chi ef 

J effrey]. Cla rke 

Col. William T. Bowers 

J ohn W. Elsbe rg 

Foreword 

The third in a projected four-volume work that will cover the history of the 

ArmyMedical Department from 1775 to 1941, this volume traces the development 

of the department from its rebirth as a small, scattered organizati on in the wake of 

the Civil War, through the trials of the Spanish-American War and the Philippine 

Insurrection, up to the entrance of the United States into World War l. A time of 

revolutionary change both in the organization of the U.S. Army and in medicine, 

the period climaxed with the golden age of Army medicine, when u.s. medi cal 

officers played a leading ro le in research that developed new and effective weapons 

in the war against epidemi c disease. 

Til e Army Medical Departlllellt, 1865-1917, continues the contributions to 

the history of mil itary medi cine initiated by th e preceding vo lumes. 

Washington , D.C. 

17 November 1994 

v 

JOHN W MOUNTCASTLE 

Brigadier General , USA 

Chief of Military History 
The Author 

Mary C. Gill ett received B.A. , M.A., and Ph.D. degrees from The American 

University. She worked for the Naval History Division of the Offi ce of the Chief 

of Naval Operations from 1966 to 1969 and, beginning in 1972, for The Historical Unit of th e U.s. Army Med ica l Department. She joined the U.s. Army Center of Mili tary History when it absorbed The Historica l Unit in 1976. She is now 

chi ef of the Conve nti onal Wa r Studi es Branch of the Center's Histories Divisio n. 

She is the author of The Arm)' Mediwl Dep" "W1e ll t, 1775- 1818, and The Arm)' 

Medica l Departl11ellt, 1818-1865, and of articl es conce rning the history of military medicine in the Un ited States. 

VI 
Preface 

In wriLing The Army Medical Deparlmflll, 1865-1917, I followed severa l 

precedents established in the fi rst LwO vo lumes. As a resulL, I made no attempL 

to provide coverage of miliLary operaLions beyond thaL necessary to an understanding of the challenges faCing the Medical Department, and I observed the 

same principle in dealing with developments in the wo rld of civilian medici ne 

and in the armed forces of oLher major powers in Europe and Asia. 

IL is impossible to thank by name all the archivists, physicians, and hisLOrians from coaSL LO coast whose efforts co ntributed Significantly to this volume. 

My indebtedn ess is particularl y great, however, to Dorothy Hanks, now retired , 

andstephenj. Greenberg of the National Library of Medicine; to William E. Lind, 

also retired , William Grace, Robert W. Coren, Michael P. Musick , and Michael T. 

Meier of the Na tional Archives and Records Administration; and to Col. Robert 

j. T. Joy, MC (USA Ret.), of the Uniformed Services Un iversi Ly of the Health Sciences, who offered encouragement and shared his vast knowledge of military 

medici ne bOLh with me and wiLh the peer review panel for the manuscript.John 

Parascandola, then on the staff of the NaLi onal Library of Medicine, was kind 

enough LO give the panel the benefi t of his ex pertise, and I was fortunaLe thaL 

John Duffy, whose knowledge of public sanitation in the United States in the peri od covered by this volume is un equaled , was willing to read the manuscript. 

I am also especially grateful to man y of my colleagues and former colleagues 

at the u.s. Army Center of Military History. They include librarian James B. 

Knight, whose ingenuity and persistence eased my burdens; Brig. Gen. Harold 

W. Nelso n, former chief of military history, who approved the manuscript for 

publi cation; and the members of the review panel-Graham A. Cosmas, who repeatedly shared his profound understanding of the histo ry of the Arm)'; Albert 

E. Cowdrey, now retired as chief of the Conventional War Studies Branch, who 

patiently revi ewed version after version of the manuscript; Jeffrey ]. Clarke, Lhe 

chief historian; Col. Robert H. Sholly (USA Ret.), then the chief of the Histories 

Division ; Lt. Col. William G. Bell (USA Ret.); Judith L. Bellafaire; and John W. 

Elsberg, the editor in chief. I am appreciative, too, of the support of Lt. Col. 

Richard O. Perry (USA Rel.), chief of the Histories Division when 1 started this 

vo lume, and Col. Willi am T. Bowers, th e present chi ef. 

Among former members of the Center who made this volume possible are 

Col. William F s Lrobridge (USA Rel.), who proVided me wiLh photocopies of arLicles that I wou ld have otherwise missed and helped me to contacL a research 

Leam studyi ng the casual Li es of the San Francisco earthquake of 1906; Madeleine 

vii 
Sapi enza, who gave me the benefit of her skill as a tireless and imaginative researcher; and librarian Mary L. Sawyer, who greatly facilitated my research. 

The manusc ript also profited significantly as it approached publicati on from 

the unceasing and thorough work of seni or editor Joanne M. Brigno lo, from the 

resourcefulness of Howell C. Brewer and Beth E MacKenzie in locating photographs, from the cartographic skill of Sherry L. Dowdy in creating the maps, 

from the eagle-eyed proofreading skills of junior editors W. ScoLLJanes and Troy 

D. Wolfington, and from the typography and design expertise of printing specialist Kenneth R. Kidd. 

The assistance of two of my coll eagues, William M. Hammond and Lt. Col. 

Ad rian G. Traas (USA Rel.), when disaster by computer th reatened shou ld not 

be overlooked. Wi thout their techni cal knowledge, I might well have rendered 

the manuscript for this volume as invisible as my expertise with electronic brains. 

Finally, I wish to thank my daughter, Blakeney Gillett, who devoted many of 

her lunch hours to going over the papers of William C. Gorgas and his family at 

the University of Alabama in Tuscaloosa and to photocopying perlinentdocumenLs. 

In spite of the advice and assistance o f so many, inevitably errors remain. I 

must ruefully accept the responsibility for each and everyone. 

Washington, D.C. 

17 November 1994 

VIn 

MARY C. GILLETT 
Contents 

PROLOGUE: THE RETURN OF PEACE .......... . . ... . . . 

Page 

3 

Chapter 

1. 

2. 

VIEW FROM THE TOP ... . . ... . . .. . .. . . . . ... • . . . .. . . . 

The Surgeon Generals ... 

7 

7 

Demobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 

The Peacetime Organization .. ... . .. . . .. . . . .. .. .. ... 12 

Crea tion of the Hospital Corps. . . . . . . . . . . . . . . . . 18 

Probl ems of Victims of War. . . . . . . . . . . . . . . . . . . . . . . . 21 

State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 

SUPPORTI NG THE ARMY ........ . ................ . .. . 39 

Preventive Medic ine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 

Surgery. . . . . . . . . . . . . . . . . . . . . . . . 49 

Hospita ls. . . . . . . . . . . . . . . . . . . . . . 51 

Above and Beyond Health Ca re . .. . . . . . .. . .. . . . • . . . . . 52 

Ofr-duty Pursuits . . . • . . . . . . . . . . . . . . . . . 55 

3. THE INOlAN WARS . 63 

Fighting an Unorthodox Enemy. . . . . . . . . . . . . . . . . . . . . 63 

Supporting a Major Ex pedition . . . . . • . . . . . . . . . . . . . . . 67 

Surgeo ns and Their Work . . . . . . . . . . . . . . . • . . . . . . . . . . . 78 

Care of Reservation Indians. . . . . . . . . . . . . . . . . . . . . 81 

The Last Battle. . . . . . . . . . . . . . . . . . . . . 84 

4. A NEW OlRECTION. 

The New Surgeon General ... 

Personnel and Training .. . .. .. .... . . .. . 

Preventive Medicine . . 

Surgery ......... . 

Domestic Co nni e!. .... . .. . ... . ... .. .. . .. . . . . . 

IX 

93 

94 

96 

102 

106 

109 
C/wpler 

5. PREPARATIONS FOR CONQUESTS OVERSEAS ..... . .. . . . 

6. 

The Medical Buildup. 

Readying Suppl y. 

Organizing a Hospital System 

Launching the Cuban Expediti on. 

Launching the Philippine Expedition. 

SUPPORTING THE INVASION FORCES 

In Cuba ..... 

In Puerto Rico 

In the Philippines .. . .. . . 

7. DISEASE AND DEATH IN U.s. CAMPS 

Camp Thomas ................ . .... . . 

Camps in Florida. 

Camp Alger ... 

Retreat From Disease: New Camps ...... . .... . . . .. .. . . 

Camp Wi korr . . .... . . . 

The Typhoid Board ....... . 

The Dodge Commission Investigation 

8. CAMPAIG NS OF TH E NEW EMPIRE 

The Philippine Insurrection.. . ... . .. . . . . .. . . . .. . .. . 

Hospitals and Evacuation . . . . . .. . . ..... . . . . . . . . . . 

Med ical Perso nnel .. . . . . . . . .. . .. . 

Health or th e Troops ..... . . . 

Suppl y and Di et ......... . 

The China Reli er Ex pedition .. . 

9. PUBLIC HEALTH IN CUBA. 

Hea lth or the Troops . . 

Improving Sanitation . .... . . . .. . .. . .. .. . . .... . 

Fighting Yellow Fever. . .... . . ...... . . 

The Ye ll ow Fever Board.. . ... . .. . . . 

A Time or Trial and Triumph .... . .. . . 

10. PUBLIC HEALTH IN OTHER CARlBBEAN AREAS .. . ... . . . . . 

Puerto Rico 

Panama Canal Zone ..... . . . . . . .. . . .. .. . 

Gorgas and the Opposition 

x 

Page 

117 

118 

124 

127 

129 

133 

141 

141 

160 

164 

173 

175 

178 

181 

183 

186 

191 

193 

201 

201 

204 

213 

216 

219 

220 

229 

230 

232 

234 

239 

246 

257 

257 

263 

265 
ClllIpfer 

Fighting Disease ................................. . 

The Hospital System ............. . 

A Worthy Rivalry ................ . 

P(lge 

269 

275 

276 

11. PUBLIC HEALTH IN THE PHILIPPINES ... . . .. .. . . ... ... . 285 

Research and Disease Boards. . . . . . . . . . . . . . . . . . . . . . . . . 285 

Organi zing the Campaign. . . . . . . . . . . . . . . . . . . . . 293 

e~m~i~... .. . m 

The Most Dangerous Threats. . . . . . . . . . . . . . . . . . . 301 

Other Health Problems . ....... . . . . . . . . . 305 

12. THE ORGANIZATIONAL REVOLUTION ........... . 

The Surgeon Generals. . . . . . . . . . . . . . . . ......... . 

The Surgeon General's Ofrice ... . . . .. . .. . .. ....... ... . 

Medica l Ofricers ..... ....... .. . ..... . . ........ . . . . 

Dentists ........... .. ........ . . . . . .. .... .. . .... . 

Nu rses ......................... ... ... . .. . ..... . 

The Hospital Corps ............................... . 

Preparing Medical Personnel [or War .................. . 

General Hospitals ..... .. . . . 

Supply. . . . . . . . ...... . 

13. THE MEDICAL SERVICE IN ACTION .. 

Fighting Disease and Disability ...... .. . ... ..... . .. .. . 

Hospitals and Laboratories .... . . .. . . . . . .. .. . . .. . . . . 

313 

314 

316 

318 

326 

327 

329 

332 

336 

339 

347 

347 

361 

Evacuati on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 

Practice [or War . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 

Disaster Relier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 

14. IN THE SHADOW OF WAR . . . . . . . . . . . . . . . . . . . . . 377 

The Surgeon General. . . . . . . . . . . . . . . . . . . . 380 

Medical Department Personnel . . . . . . . . . . . . . . . . . . . . . .. 381 

National Guard Medical Personnel . . . . . . . . . . . . . . . . . . . .. 385 

Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388 

Hospitals and Laboratories . . . . . .. . . . .. . . . . .... .. .. . 390 

Training Along the Mexican Bord er . . . . . . . . . . . . . . . . . . .. 392 

Lessons Learn ed From Europe. 404 

EPILOGUE: THE YEARS OF CHANGE 413 

BIBLIOGRAPHY ........... . 

LIST OF ABBREVIATIONS 

INDEX ............. ........ ............ .. . ........ . . . 

X I 

417 

491 

495 
Table 

Ph ilippine Tropical Disease Boa rd Members ...... . . . . .. . . .. .. . . 

Maps 

No. 

l. 

2. 

3. 

4. 

Bighorn-Ye llowstone Exped ition, 1876 .. 

Cuba , 1898. . . . . . ...... . 

The Caribbean , 1898. 

The Philippines, 1899 ... . . . . . .. . .. . . .. . ... ... ..... . .. . 

Illustra tions 

joseph K. Barnes.. . .. . . . ..... . .. . . .. ... . 

Charles H. Crane ..... . .. . . . . .. . ... . .. . . ... . .... . 

Robert Murray . .. . . . •. . . .. . . .. . .. . ... ..... . .. . ... . . 

john Moore. . . . . . . . .. . .. . . . ... . . .. . . ........ . . . . . . 

j edediah H. Baxter. ............... . . .... . . . .. ...... . .... . 

Charl es Sutherland .............. . .. .. . . .. . . .. . .. . . ..... . 

William H. Arthur's Carica ture. 

j ohn van R. Ho[r ............. . . .. . . . . . ... . .. . . .. . .. . . . . . 

Fred C. Ai nsworth . 

George M. Sternberg . . . . . . . . . . . . . . .... . . . . ... . .. . . . . . 

Post Hospital atjef[erson Barracks, Misso uri. . .. . .... . . . . . . . .. . 

Al[red Alexa nder Wood hull . . . . . . . .. . . . .. . . . .. . . . . 

Daniel Smith Lamb ..... 

joseph]. Woodward 

Ell iott Coues .. ....... . 

Mule Pulling a Travois . 

Ho lmes O. Paulding 

james P. Kimba ll . 

George E. Lord 

Bennett A. Clements. 

Curtis E. Munn ...... . 

julius 1-1. Patzki . 

junius L. Powell 

Leonard Wood 

Bernard Semig ..... 

Peter]. A. Cleary. . .... . . 

Surgeon General Sternberg .. 

Army Medi cal Museum Classroom . 

x ii 

Page 

286 

68 

142 

161 

203 

8 

8 

9 

9 

10 

10 

14 

20 

24 

41 

44 

48 

50 

50 

56 

65 

69 

70 

71 

72 

73 

75 

75 

79 

80 

82 

94 

98 
J ohn Shaw Billings .. 

Charles Smart ..... . 

Daniel G. Caldwell ..... . ... . 

Nicholas Senn .......... . 

Charles R. Greenlea r . . .............. . ....... . . .. .. . . . 

Dall as Bache ............... . 

Nurses at Josiah Simpson General Hospital near Fort Mo nroe ...... . . 

General Hospital at Fo rt Monroe ..... . . . . . 

Henry Lippincott ... . 

Benjamin F Po pe ........ . 

Aaron H. Appel ............ . 

Marshall W. Wood .......... . 

George McCreery ......... . 

Valery Havard. . ...... . 

Francis]. Ives. . . . ...... . 

The Burning or Siboney . 

Louis A. LaGarde 

Albert Hartsurr .................... . . 

Louis M. Ma us ................ . 

Medical Care atjacksonville ........... . ..... . . 

Alrred c. Girard . . . . ...... . 

Sternberg at Camp Wikorr . . .............. . . 

Victor C. Vaughan. . . . . . . . .......... . 

Second Reserve Hospital, Manila, Philippines 

Ward on Hospital Ship Relief . .......................... . 

Co nverted Hospital Facilities at Angeles and Dagupan .. 

Medi cal Orncer Caring ror a Wounded Filipino Insurgent. 

William B. Banister . . . . . ..... . 

Wal ter Reed .... . 

Aristides Agramonte .. . 

Jesse W. Lazear . .... . 

James Carroll .. 

Carlos Juan Finlay. 

Clara L. Maass .. 

Bailey K. Ashford .. 

J efferso n R. Kean ... 

Willi am C. Gorgas. 

Cartoon by Gorgas 

Street in Colon, Panama. 

Theodore C. Lyster . . .. . ... . . 

Ri chard P Stro ng. . .... . . . 

Charl es F Cra ig. . ..... . . 

Percy M. As hburn ... . 

Edward B. Vedder ............ . 

XUl 

Page 

98 

104 

llO 

118 

119 

124 

125 

126 

134 

143 

144 

145 

146 

146 

151 

153 

158 

175 

179 

180 

181 

188 

191 

205 

207 

211 

215 

221 

236 

239 

240 

240 

241 

249 

260 

263 

264 

269 

274 

276 

287 

289 

289 

292 
Weston P. Chamberlai n 

Franklin A. Meacham ..... . . 

A Sewage-clogged Drainage Di tch . .. . . . .... . 

William H. Forwood. . ..... 

Robert M. O'Reilly. . ...... •.......... . . 

George H. Torney .... .. . 

Paul F. Straub ......... . 

Jane A. Delano . . . . . . . . . . . . . . . . . . ...... . . 

Company of Instruc tion Trai ning at Washington Barracks 

Henry L. Gilchrist. . . . . . .. . .. . . . 

Chief Surgeon Girard .......... . 

Letterman General Hospital, Presidio, San Francisco .. 

Frederick F. Russell . . ..... 

Ca rl R. Darnall 

William]. L. Lyster . 

Edward L. Munson 

San Francisco, April 1906 

Torney as a Young Office r. ....... . .. . . 

Robert U. PaLlerson ....... . 

P(/ge 

292 

297 

298 

315 

315 

316 

325 

329 

330 

336 

337 

338 

348 

358 

359 

360 

366 

368 

369 

Surgeon General Go rgas. . . . . . . . 378 

Base Hospital at Fort Sam Houston. 392 

Field Hospita l NO.7 En Roule to Mexico 393 

Henry P. Birmingham. . . . . 395 

Fi eld Hospital and l IS Surgical Ward . . . . . . . . . . . . . . . . . . . . 396 

An imal-drawn and Motor Ambulances. . . . . . . . . . . . . . . . . . . . 398 

Illustrations cou rtesy of the followi ng sources: pp. 44, 98, 211 (lOplbollom), 215, 358, 

and 359, Armed Forces Insti tute of Pathology; pp. 153 and 188, H"rpers WeeJliy, August 

1898 and September 1898; p. 366 (toplbottom), library of Congress; p. 316, National 

Archives and Records Administration; and pp. 65, 126, 269, 298, and 330, U.s. Ann)1 

Center of Military HisLOry. All other illustrations are from the fil es of the National library of Medicine. Because most of the phoLOgraphs from the latter co ll eclio n are undated and without icicllliricalion beyonclthe names of the subjects, the captio ns fo r the 

illustrations in th is vo lume do not specify rank. 

The work of Charl es Joh nson Post (1873-1956) depicted on the paperback coverFi eld Hospital BClcl? oJlll e lilies, Cuba , 1898, walercoior, 14 3

// X 18 3/t-is rrom the Army 

Art Collection. 

xiv 
THE 

ARMY MEDICAL DEPARTMENT 

1865-1917 

Prologue 

THE RETURN OF PEACE 

Peace had at last been restored. The 

Union had been preserved. With the end or 

the Civil War in April 1865, myriad opportunities beckoned to those with the energy, 

the ent husiasm, and the determination to 

take advantage or them. But ror the Medical 

p epartment of the victorious Union Army, 

a huge and complex organization designed 

to care for men massed in large units,the return or peace held little promise. The thousands or physicians who had served during 

the war were no longer needed now that the 

Army's only signincanl adversaries were the 

Indians. Hospital trains and ships quickly 

became as irrelevant as the very large and 

elaborate general hospitals to which the)' 

had been evacuating thousands or sick and 

wounded. Little that had been learned or experienced during the long and bloody conniet proved to be signincant once the amateur soldier:s who had rormed the bulk or the 

wartime army had re turned to civilian life. I 

The war had not rendered the weapons 

with whi ch the Army's medical orncers 

rought disease more errective. The connict 

had occurred too soon to be or great benefi t to medical sc ience, ror the instruments 

and techn iques that would make significant increases in understanding possible 

were only just being developed. Microscopic organisms could not be seen clearly 

enough to be identified. Both civilian and 

military physicians reared inrection so 

much that they rarely attempted any but 

the simplest operations. They were notable 

to determine what had caused the dysentery tha t was arnicting thousands orUni on 

soldiers. The inability to identiry either th e 

typhoid bacill us or the ma laria parasite 

during th e war had even led to the appearance in medical literature of an imaginary 

disease, typho-malaria , whose symptoms 

in some ways resembled typhoid rever and 

in others malaria. Andthe popularity or the 

notion thal poisonous miasmas-emanations rrom decaying vegetable or animal 

matter-were in some way behind th e 

sp read or disease and inrection endured.' 

Although the practical experiences or 

the Civil War co nfirmed the ract that the 

toll taken by disease co uld be lowered by 

improved sanitati o n, vacc inati o n against 

sma ll pox, a diet rich in rresh rrui ts and vegetabl es to reduce the threat or scurvy, and 

the use or quinine to treat malarial revers, 

disease in nearby towns orten rrustrated 

the errorts or post surgeons] Immuni zation against smallpox, mandatory in the 

U.S. Army si nce early in the nineteenth 

century, remained a subj ect or vigorous debate outside the military In spite or a growing public health movement, widespread 

concern in civilian communities about 

water supplies and the disposal or human 

wastes and garbage continued to surrace 

chieny arter an epidemic had begun.' 
4 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

When disease or inrec ti on derea tedtheir 

primitive attempts al prevention, both military doc tors and their civilian counte rparts were as helpl ess in 1865 as they had 

been in 1861. "The treatment or disease is 

th e weak spot in our pro ression," a physician noted several years arter the end or the 

Civil War. Another reported that "the history or medical progress [was still] a history or men groping in the darkness. 

And Charles W. Eli ot, presidelll or I-Iarvard , despaired at "the ignorance and incompetence or most American doctors 

who have graduated at American Schools. 

They poison, maim, and do men to death 

in va rious ways, and are unable to save life 

or preserve heal th.'" 

Understandably finding it dirri cult to 

stand by their palieills without making an 

attempt to help them, neither military nor 

civilian physicians abandoned the type or 

treatment that Eli otdeplored. They purged 

and even bled regardl ess orthespecific disease or condition involved. The use or opiates was nourishing by the end or th e 

war-veterans amicted with chronic dysentery continued to use the opiates initially prescribed to them by Army doctors, 

joining the growing number or men and 

women who turn ed to th ese drugs to relieve whatever it was that ailed them. The 

popu lari ty or medicinal alcohol , illlernall y 

applied, persisted, and the use or aspirin 

and chemi call y similar drugs became more 

common because or the side drects or the 

cost or other drugs that reduced rever6 

Because the Civil War had emphasized 

on a large scale the basic helplessness or 

Army physicians agai nst the inroads or disease and inrection, the average line orricer 

remained unimpressed by their recommendations about preventive health measures on post. Their position was rurth er 

und ermined by the ract that the exact implications or their rormal rank, granted in 

1847, had never been clarifi ed; they continued to be rererred to by a descripti ve 

title, such as surgeon or assistant surgeon, 

rather than by rank. The surgeon general, 

himselr a brigadier general, endured, however, as one or th e Army's powerrul burea u 

chid s with direct access to the secretary or 

war. Thus, whil e medical orricers as inclividuals orten had li ttle innuence, the Medical Department or 1865 retained its semiindependent status. 

The war had also rail ed to reli eve the inadequaci es or existing modes or transportation in the West, which handicapped 

both the Medi cal Departmentand the Army 

as a who le. Onl y in 1880 did railroads extend rar enough to assist signifi ca ntly in 

moving men and their supplies and equipmelll, making it possible for troops to move 

with such speed to any location that a multitude or small and orten inconvenientl y located rons became unnecessary. Uilliithen, 

military cargo was moved by water, where 

possible, and posts located any distance 

rrom a major waterway relied on wagon 

trains that could be delayed by weather, terrain, and the enemy' 

The post surgeons' dirri culti es in obtaining supplies were further exacerba ted 

by the ract that th eir needs continued to 

be met by a number or agencies. Although 

the Medica l Department's purveyors purchased medical and hospital suppl ies as 

well as special items of diet ror the sick, 

the Subsistence Department rurnished 

routine hospital rations. The Ordnance 

Department dispensed equipmelll ror 

horses, small arms, and such items as mess 

kits and spurs. The Quartermaste r's Department provided the storehouses at the 

Medical Department's supply depots, 

which were established in a rew strategica ll y located cities; transported suppli es; 
THE RETURN OF PEACE 

purchased clothing, mules, horses, and 

forage for the Army's animals; and, for five 

years after the end of the Civil War, built 

and repaired hospitals. It also procured 

ambulances built to Medical Department 

specifications· 

Despite the devastation, the huge 

armies, and the hordes of men suffering 

and dying from disease, wounds, and infection, the Civil War seemed for many 

years almost like an aberration in the his5 

tory of the Medical Department. In April 

1865 the wartime organization awaited 

dissolution, its medical offi cers a return to 

the conditions under which they had 

served before Confederate guns first 

opened fire on Fort Sumter, South Carolina, and the surgeon general the resumption of his struggle with a Congress 

congenitally unable to understand why 

guarding the health of a multitude of sca ttered units required the services of a multitude of physicians. 
NOTES 

1. Unless otherwise indicated , overall coverage of 

the Civil \-Varin this volume is based on Ma ry C. Gillett, 

Tile Ar/lly Medical Departlllelll, 1818-1865; of the history of the Army on Russell F. Weigley, HistOlY oj /lle 

Ullilecl Stales A rillY, enl. eel., and Maurice Matloff, ed., 

American Militm)' His/Ol)', pp. 281- 99; of medicomilitary history on Percy M. Ashburn,A HislOl)' oJlheJ'vledical Depannlellt oj Ihe United S/(lt es Anll)'; and of legislation on Raphael P. Thian, comp. , Legisllllive His/ol)' 

oj tire General SWf{ oj the Arllly oj the United 

Stmes . .. Fmm 1775 to J 901. For manuscript sources 

and works not listed in the bibliography, full details are 

given in the respective footnote entry. See the biblio-

~raph ical essay for specific guidance. 

2. Erwin H. Ackerknecht ,A SIlO I"( His/OI )' oJMedcinc, p. 171; \-Var Depanment, Surgeon General's 

Offi ce, Medical and Surgical f-lislOl)1 oj the War oj the 

Rebellioll , consisting of two three-part volumes that 

detail the struggles of the Union Army's medical offi cers to deal with diseases and infec tions whose 

causes they did not full y understand. 

3. Since the earl iest days of the Medical Department , the terl11 s!JIgeoll was used to refer to allmedical offi cers. IL was a generic term and did not connote specialization. 

4. j ohn Duffy, The Sani/arj(lIIs, pp. 93, 96, 

99- 102, 107- 08, 114, 118-19; Richard H. Shryock, 

The Developmellt oj Modern Medi cine, p. 256; \-Vesley 

W Spink, Infectiolls Discases, pp. 35-36; Stanhope 

Bayne-jones, The EVo/llliolr oj PrevcIIUve Medicine ill 

th e United S/llI es Army, 1607-1939, PI'. 11- 12, 2l. 

5. First quotation by William \-v. \-Vellington, 

"Modern Medicine," PI'. 142-43; second quotation 

by H. C. \-Vood, cited in William G. Rothstein ,Alllerican Physicial!S in the Nineteentir (eufluy, p. 183 (see 

also pp. 186, 196- 97); third quotation cited inj ohn 

S. Haller, Jr. , AmeriwlI 1\-lediciue ill ThlllSiLioll, 

1840- 191 0, pp. 218- 19;Ackerknecht ,Slrort His/OIY, 

p. 209; Lester S. King, "Medical Education," pp. 

2457-58. 

6. Rothstein , Americ(IIr P/r),sicialls, PI'. 18 1.-84, 

187, 19 1, 194-95; Leon S. Bryan ,jr. , "Blood-letting 

in Ameri can Medicine, 1830- 1892," p. 520; David 

T. CourLwright, Dar/l Paradise, PI'. 45-47, 54-55; 

H. Wayne Morgan, ed., 'es llla)'~ Addic/s, PI'. 6-7, 

12,37; Mark A. Quinones, "Drug Abuse During the 

Civil Wa r (1 861- 1865)," PI'. 1008- 10. 

7. Erna Risch, Qllart ermaster Suppor/ oj tire 

Arlll)', pp. 395, 476-78; \-Va r Department, fAmilial] 

Report of til e Sea etm), oJ War, .1.869, .1. :2 13 (herearter 

cited as \-VD, ARoJSW, dat e); Dm'lis A. Miller, ol ~ 

di efs (!lui Seltl ers, pp. 288-89. 

8. WD, ARofSW , 1869, 1:223-24, anel 1876, 

1:112- 1J; Risch, QrwrLer/)/aster S!lfJport, PI'. 486-87; 

War Department, Surgeon General's Orfice, MWllw/ 

Jar tire Mediwl Dep(lrllllelll , 1900, p. 47; idcm, Tire 

Swgeoll GCll cra/s Offi ce, p. 11 7; Miller, Solcliers wrd 

Selliers, pp. 287-88. Because or the various organizations involved in supplying the Arm)" obtaining 

ambulances or a new design required the cooperation Of the Quartermaster's Department and the Ordnance Department to fa cilitate the process of preparing the blueprints, constructi ng the vehicles, and 

purchasing the harnesses for the draft animals. For 

a detailed picture of this cooperation , see james \V. 

Wengert, "The 1878 Ambulance Board ," PI'. 8-23. 
Chapter I 

VIEW FROM THE TOP 

The Civil War's chief legacy to the Medical Department was an increase in the traditional peacetime burdens of the Surgeo n 

General's Office. In the years that followed 

the surrender at Appomattox, the offi ce 

would be asked to create botha medical museum and a medical history, using specimens and case histories gathered during the 

conflict; in response to a congressional 

mandate, to provide Civil War veterans with 

prostheses and the information needed for 

pension applications; and, fora brief period, 

to manage the medical care of freed slaves. 

As a result, for decades after the end of the 

connict, the Army;; surgeon generals dealt 

with war-related challenges while carrying 

out the c1 eparlment's historic mission or 

guarding the Army's health.' 

The SLtrgeon Generals 

All seven of the officers who headed the 

Medical Department from 1865 to 1893 

were Civil Wa r veterans. Six of them had 

also served in the prewar Army and thus 

were familiar with many of the difficulti es 

their subordinates wo uld face after the 

war. With their roots firml y embedded in 

a period when germs were not recognized 

as th e cause of disease and infection, all 

were to varying degrees unsure of the signifi ca nce of the medica l revolu tion then 

beginning to gather force across the Atlantic. They left the task of leading their 

organization to a prominent position in the 

era of modern medi cine to the man who 

would become surgeon general in 1893 1 

The first postwar surgeon general, Brig. 

Gen. Joseph K. Barnes, came to office in 

August 1864] A man of diplomacy and determination , Barnes was known ror his 

good judgment, hard work, and insight 

into the probl ems and personalities he enco untered. Assigned to Washington in May 

1862, he had qui ckly formed a strong 

fri endship with Secretary of War Edwin M. 

Stanton. Until his resignation from ornce 

in May 1868 as part of the power struggle 

that led to President Andrew Johnso n's impeachment, Stanton supported Ba rnes in 

all his undertakings, even when they involved activating projects he had previously disapproved. After holding offi ce for 

almost eighteen years, Barnes was the first 

surgeon general to whom a new law mandating retirement at Sixty-four applied. Already in poor hea lth when he left the department inJune 1882, he died a year later' 

Dea th or mandatory retirement because 

of age curtailed the time in office of the 

next six men to se rve as surgeon general. 

Barnes' immediate successor, Brig. Gen. 

Charl es H. Crane, was head of the department for only fifteen months. An obvious 

choice, the 57-year-old Crane had wo rked 
8 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

J OSEPH K. BARNES 

closely with Barnes, functioning as his assistalll surgeo n general. Crane was highly 

regarded because of his experience and 

skill as an administrator, for his good judgment, and for his enco uragement of competent subord inates. Unfortunately, he 

never realized his full potential. A sudden 

hemorrhage from a malignalll growth that 

appeared in his mou th soon after taking 

office proved fatal in October 1883.' 

The short terms served by Crane's successo rs precluded any significant easing of 

th e rivalry that existed among the Medical 

DeparlmeneS senior offi cers. Prominent in 

th e jostling that followed Crane's death 

was th e bright and very ambitious Col. 

j edediah H. Baxter, who as the chief medical purveyor bore the ultimate responsibility for obtaining Medical Department 

supplies. President Andrew j ohnson's appointment of this highly controversial 

Civil War vo lun teer medical offi cer to the 

C HARLES H. CRANE 

department as a Ii eutenalll colonel in 1867 

without the examination that was required 

of all others had aroused much resentment. It may have been responsible for his 

exclusion in 1881 from the bedside of the 

dying j ames A. Garfi eld, despite the fact 

that the president had for a time after his 

election been Baxter's patient. His ambition was thwarted after Crane's dea th 

when, once again , an assistant surgeon 

genera l was promoted to the Medical Department's leading position6 

In November 1883 Brig. Gen. Robert 

Murray began his tenure as surgeon general. At the time of his appointment Murray, then the departments senior offi cer, was 

only th ree years short of mandatory retirement. Although he had at one time served 

under Bax ter, his selection was not inappropriate. His militmy career had begun in 

1846, long before Baxter entered the Army, 

and he had been so successful that mem-
VIEW FROM THE TOP 

ROBERT M URRAY 

bers of the department pronounced him to 

be "in every respect a most estimable gentleman" who, li ke Crane, possessed "exceptional administrative capaCity." 7 

The fact that Murray would have to 

leave th e Army in three years was known 

at the time of his appoinltnent. Nevertheless, when that day came in August 1886, 

no decision had been made concerning his 

successor. Baxter was again a strong calltender; he was now the department's senior surgeon, given his Lim e in rank , and 

was serving as acting surgeon genera l until 

the position of surgeon general was fill ed. 

Both Baxter and his chid rival , Col. 

Charl es Suth erl and , who had served nr- teen years longer in the Medical Department than Baxter and was eight years older, 

lost out when President Grover S. Cleveland appointed an orn cer who was "politically of the same faith as" himseiL The 

new surgeon general was Brig. Gen. John 

9 

JOHN M OORE 

Moo re, who had been Sherman's medical 

director in the last months of the Civil War. 

Compa red to Baxter, Moore was eleven 

years older and had been a member of the 

departmenl fourteen years longer. At sixty 

he was only four years short of retirement 8 

When Moo re retired in August 1890, 

however, Cleveland was no longer in offi ce. Baxter benefited from the fact that the 

new preSident, Benjamin Harrison, was 

both a fri end and a patient; thus he triumphed over Sutherland, his long-time 

ri val for the position of surgeon general. 

In becoming head o f the Medical Department and attain ing the rank of brigadi er 

genera l, Baxter reached a goal long and energetically sought, possibly ever since he 

first gain ed favorable attention during the 

Civil War as a result of his assignment as 

chief medica l orn cer in the Provost Marshal General's Ornce in 1862. Except for a 

few months in 1861, his responsibilities 
10 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

J EDEDIAH H. B AXTER 

during the Civil War kept him in Washington, where his accomplishments included compiling the highly regarded 

Medical Statistics oj tli e Provost Marslial 

Genemll; Bureau. Wh ile fulfilling his military duties after his appointment to the 

Medical Department in 1867, he culti vated 

important fri endships. He also acquired a 

law degree and amassed a coll ection of 

photographs of department orncers so 

complete that he could eventuall y greet 

each member of the department by name. 9 

Unlike Murray and Moore, at fifty-three 

Baxter was still a relatively young man who 

could reaso nably ex pec t to serve many 

years as surgeon general. In the late summer of 1890 his plans for the department 

apparently included encouraging promising medical officers in their scientific pursuits, even th ough when serving as the departments chief medical purveyo r, he had 

shown a signifi cant lack of enthusiasm for 

C HA RLES SUTHERLAN D 

supplying such men with microscopes. His 

grea lest achievement as surgeon general 

may we ll have been assigning young Capt. 

Wa lter Reed to Baltimore long enough for 

Reed to take a seven-month postgraduate 

co urse in bacteriology and pathology at 

Johns Hopkins. Once ensconced as surgeon ge neral , Baxter also reportedly began 

to occupy himself with taking revenge 

upon those who had annoyed him before 

he reached the top in th e Medical Department. Among the unfortunates on his list 

was at least one medical officer whose only 

apparent crime had been insisting upon 

being provided with a microscope. Baxter's 

relative youth , his ambition, and the controversy in whi ch he had already been involved suggest that he would have been a 

memorab le and colorful surgeon genera l, 

but his hea lth was no longer robust. On 2 

December he suffered a stroke, and on the 
VIEW FROM THE TOP 

fourth, after less than four months in offi ce,Jedediah Baxter was deadIO 

On 23 December 1890 Charles Sutherland at last became surgeon general, thus 

attain ing also the rank of brigadier general. 

No reason for his failure to reach th is position earlier is evident, other than his apparent lack of powerful politi ca l fri ends. 

He was highly regarded both as a medical 

offi cer and as "a most delightful companion," of "a most amiable disposition. " As 

surgeon general he was considered by 

some to be "poor, weak, [and] old, " but he 

apparently was a capabl e administrator. 

His age made his retirement mandatory in 

May 1893, after forty-two yea rs in the department but less than three as surgeon 

general. With Sutherland's retirement an 

era came to an end. Unlike his predecessors in the immediate post-Civil War period, the next surgeon ge neral would not 

be content merely to observe the medical 

revolution rrom arar.ll 

Demobilization 

For both the Army and the Medical Department, the relurn to peacetime size was 

rapid. Although the demands of Reconstruction and the need to discourage the 

spread of French ambitions in Mexico delayed total demobilization for a few 

months, the million wartime volunteers of 

May 1865 had become 11 ,000 by November 1866. Few even of that number remained after the fall of 1867. Since the war 

left much of the nati on convinced that 

large-scale connict was for the Un ited 

States a thing of the past, Congress reduced 

the number of regular troops as well, from 

54,000 in 1867 to 26,000 in the late 1870s, 

when Reconstruction came to an encl.

12 

11 

During the year after the Civil War 

ended, much of the Medica l Department's 

time was devoted to processing departing 

medical personnel, to settling their accounts, and to closing facilities. Most of 

the doctors leaVing the Army by the end of 

1866 were volunteers, who were mustered 

out on an individual basis as soon as their 

services were no longer needed. The department red uced the number of contract 

surgeons to 1,997 by July 1865, to 262 a 

year later, and to 187 by 1870. Twelve regulars resigned soon after the end of the war, 

and six more di ed within the year. The hospital chaplains attached to wartime hospitals were dismissed as these facilities were 

closed. With the depa rture of the victims 

of that conOict, the department closed all 

general hospitals. The office of superi ntendent o[ women nurses was also abolished in the fall of 1865, when all female 

nurses were discharged. 13 

O[ the 65,000 patients in general hospitals in June 1865, only 97 remained a 

year later. The rapid decrease in the number of patients led to a corresponding decrease in theamounto[medicinesandsupplies needed for their care and in the 

number of facilities designed to shelter 

them. Surgeo n General Barnes was ca lled 

upon to disband the ambulance corps; to 

close suppl y depots; and to sell or otherwise dispose of hospital transports, hospital trains, and general hospitals. Some institutions were turned over to individual 

states for use as homes for wounded veterans, and others were returned to their 

original owners. By the end of the fisca l 

yea r 1866 the Medical Department had received more than four million dollars from 

the "sales of old or surplus medica l and 

hospital Property." By the summer of 1866 

only thedepots at New Yo rk, Philadelphia, 
12 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

St. Louis, New Orleans, San Francisco, and 

Washington, D.C., remained open" 

The Peacetime Organization 

In 1866, with the worst of th e demobilization problems resolved, Congress 

moved to offiCially establish a peacetime 

Medi cal Department. At the outset the new 

organization closely resemb led the old in 

structure, size, and fun ction. The new law 

retained the position of surgeon general 

with its rank of brigadi er general and LhaL 

of th e assistant surgeon general wiLh its 

rank of colone l. IL also made custom into 

law by requiring that the surgeon general 

be appointed from within the Med ical Department. But the responsibility for managing the purchase and distribution of the 

department's suppli es was no longer one 

that the surgeon general co uld assign to 

any medi ca l offi cer he chose. Medical purveyors were now to be appoinLed by the 

preSident, subj ect to the Senate's approval. 

They wo uld, as in the past, be ordered to 

post bonel. Congress also required th em to 

remain ava ilable for wo rk as surgeons 

should the need for their services arise. 

The chi ef medical purveyor wou ld hold 

the rank of lieutenant colonel, as would 

his four assistants. The wartime positions 

of medical inspector general and medical 

inspectors were eliminated. 

Co ngress co ntinued at this time to classifyall other Army physicians as either surgeons, who were ranked as majors, or assistant surgeons, who were lieutenants or 

ca ptains. The legislaLure kept at 60 th e 

number who could hold the rank of major 

and limited the number of assistant surgeons to 150. The total of 217 regu lar medical offi cers in the department, wh ile inadequate given the number of posts that 

needed coverage, was an increase of28 over 

the number of regulars in the Army at Lhe 

end of the Civil War. Congress required the 

Medical Department to give preference in 

choosing new assistant surgeo ns to Lhose 

who had served with the Union Army as 

vo lunteers, excepting them from the usual 

age limit of Lwenty-eighL by permilling 

them to subtract the number of years 

se rved in the Civil War from their aclLtal 

age. The Lime they had served in th e Civil 

War was also crediLed to them in determining their rank. Like all other appli cants, 

they had to pass an entrance examination. 

Five medical storekeepers-who were 

shortly thereafter given the offi cial rank of 

capta in-remained in the department. 15 

Under the new organiza tion, Army surgeons conLinued to serve both in the field 

and in Washington. In 1872, according to 

a medical olTicer working in the Surgeon 

General's Office, 3 medical offi cers, includ ing Crane, worked with Barnes in the 

Surgeon General's Offi ce, with 15 or so 

civilian clerks and perhaps 100 hospital 

stewards. In the wake of th e Civil War 

Barnes began offi Cially delegating some of 

the responsibiliti es of his offi ce LO his subordinates, establishing first a finance division- the exact date of the establishment 

of this d ivision is unclear, a lthough the 

records remaining from it date from 1873-

and, in 1874, a property division, with Baxter, as chief medical purveyor, at iLS head. 16 

Most of the profeSSional sLaff were assigned Lo positions outside Washington , 

D.C. A few medi cal officers fun ctioned as 

medical purveyors at medica l depots, and 

the senior surgeo n of each command was 

its medi cal director, managing medica l 

personnel , hiring and firing co nLract surgeons and hospital stewards, and granting 

leave to subordinates. The commanding 

offi cer of each miliLary departmenL deLer-
VIEW FROM TH E TOP 

mined ho\" many physicians were needed 

at each post and until 1892, when this responsibility was given to the secretary o[ 

war, gave them their assignments. T hose 

in charge o[ general hospitals wo uld, 

should such fa cilities ever be established, 

order supplies through the surgeon general. Otherwise, Army surgeons sent their 

requisitions through their medical directors to the medical purveyo r at the designated supply depot. Ve terans also sent 

their requests [or artificial limbs through 

the nearest medica l director. As necessa ry, 

medi ca l directors were also called upon to 

inspect sanitation at the various posts. BaSica lly, however, the Medical Department 

was no exception to the rule that in this 

period "the most minute details" o[ matters "in the smallest and most distant garrisons were regulated and handl ed" by the 

Army's bureaus [rom Washington." 

During Reconstruction the organi zation 

o[the Department o[the South into five military districts required the naming o[ nve 

distri ct medical directors. These orncers apparently reported directly to not only the 

surgeon general but also the medical direcLOr [or the Department o[ the South at Atlanta. Each district director was initially 

responsible [or the care prOVided the garrisons at both temporary and permanent 

posts. He also had to send physicians with 

units leaving the South as the occupation 

force was gradually reassigned. '· 

By 1868 the Medi ca l Department was 

expected to cover 289 garrisons, and many 

detachments also needed medical attendance, among them those sent to watch 

over the polls in the South at election time. 

To meet the challenge imposed by this requirement, Barnes suppl emented a small 

but elite corps o[ medical orncers with contract physicians (a lso referred to as ac ting 

assistant surgeons) as needed.'9 

13 

To guarantee that this elite COlVS remained 

elite, the Medical Department held the regular surgeons and assiSlant surgeons who remained in the Army to high standards. Meeting this goal proved dirncult. Although a 

Medical Department position might appear 

to be a better alternative to a young physician without prospects o[ joining a lucrative 

city practice, the slow advancement and low 

pay that characterized the peacetime Army 

had serious errects upon morale. A medical 

journal suggested that regular medical orncers-who, unlike their civilian counterparts, had had LO pass extensive examinations to establish and reestablish their 

competence-"could surely do much betleI''' as far as pay was concerned "in civil practice." Many medical orncers apparently 

agreed with the article, [or while the number 

taking the entrance examinations was considerable, resignations were [requentforty- eight medical orncers resigned [rom 

1865 to 1874'0 

These exams weeded out those who did 

not meet the department's standards, but 

[or those who did pass, they also laid out 

the path to be taken [or improvement. In 

theory, at least, they required profiCiency in 

scientific and medi cal topics and in literature and history as well. Candidates might 

be asked th e cube and cube root o[ 3.6; the 

capitals o[ such political entities as Saxony, 

Bavaria, and Switzerland; the principal 

Roman deities, giving also the corresponding names used by the Greeks; or Newton's 

first law o[ motion. Other questions might 

involve the chemistry o[ glassmaking, the 

differences between gastric and pancrea ti c 

digestion, the pathology o[ uremia, or the 

er[ects o[ exe rcise on the lungs. Weaknesses 

in any o[ the areas o[ questioning were 

brought to the attention o[ those passing, 

who were expected to remedy them. The 

proportion o[ those taking the exanrina-
14 THE ARMY M EDlCAL DEPARTMENT, 1865-1917 

WILLIAM H. A RTHUR'S CARICATURE of (III examining board ill actioll. ArtiIur imnwrtalized 

iIimself as tiIe wndidate in tiIe iIands of tiIe inquisitors. 

lions who passed varied widely, fro III as few 

as one-twelfth to as many as one-third, with 

perhaps a firth or more failing to qualify for 

physical reasons. At least one medical orncer whose military career was successful 

questioned the validity of the examinations. Brig. Gen. William H. Arthur commented years after passing his tests that 

many of those who did well on them did 

not make good Army surgeonsII 

Since no knowl edge of the way in which 

medi cine was practiced in the Army was 

required to pass these exams, Surgeon 

General Barnes decided that a newly commissioned assistant surgeon should initially be aSSigned to one of the few posts 

large enough to need the services of more 

than one medical orncer. Here an experienced surgeo n co uld teach th e neophyte 

the fundamentals of mi Iitary medicine and 

Army routines. On some occasions, when 

no opening was immediatel y ava ilable, the 

successful cand idate would be hired on 

contract and in that capacity sent to work 

with a senior surgeon until there was an 

opening for him. When he became eligible for promotion after three years, he was 

tested again to determine whether the required remedial stud y had been done and 

whether he had been keeping up with the 

latest developments in his profession. 

Those who fail ed this promotion exam 

might, if the surgeon general believed 

there were ex tenuating circumstances, be 

permitted another try, but a second failure 

brought a request for resignation, with a 

threat of dire but unspecified steps to be 

taken if it were not immediately forthcoming. Some doubt existed whether the 

department co uld legally drop an assistant 

surgeon merely because he did not pass his 

promotion exam, but apparentl y none of 
VIEW FROM THE TOP 

those who failed this test ever challenged 

the department's position. In new legislation concerning the Army in 1878, Congress ruled that those seeking to be promoted to the position of surgeon, or major, 

must also pass an examinati oll.

22 

The quality of the Army's contract surgeons, on the other hand, was not so easily controlled. These physicians did not 

have to take examinations, being required 

only to be graduates of reputable medical 

schools, of good character, and in good 

health. Their contracts, usually arranged 

by a local medical director on an annual 

basis and ca lling for a year of service, 

brought them as a rul e $1,200 to $1,500 a 

year, at a lime when the average civilian 

doctor was earning $1,000 a year. Because 

the agreement could be canceled whenever 

the department determined that their services were no longer needed, contract surgeons might be hired for the duration of a 

campaign or expedition. If their work or 

habits proved unsatisfactory, they need not 

be rehired. In the South, physicians eligibl e for contracts were difficult to find because few could take the required oath that 

they had never voluntarily borne arms 

against the government. Nevertheless, the 

disadvantages involved in hiring civilian 

physicians who might have no military experience were counterbalanced by the 

grea t flexibility the system gave Barnes in 

meeting the Army's needs." 

The passage of time did not improve 

Congress' appreciation either of the Army 

in general or of the caliber of the Army's 

regular medical officer and the nature of 

the demands placed upon the Medical Department. Thus the problems engendered 

by low rank and inadequate numbers remained unresolved. In 1869, when only 

168 medical offi cers were serving in the 

Army and 239 posts and innumerable de15 

tachments needed medica l attendan ts, the 

legislature, with its enthusiasm for using 

the Army as a police force in the South 

waning, included the Medica l Department 

among those organizations in whi ch no 

more vacancies were to be filled atany level 

and no promotions made. As a result, by 

1871 the department had 54 vacancies, 

oneof which was the position of chief medical purveyor. The number of posts to be 

served had also dropped from the 1869 

level, but only by 33. In reporting to the 

secretary of war on these problems, Barnes 

pointed out that naval medi cal offi cers 

held higher rank than Army surgeons, 

even though , in his opinion, they performed less arduous duties.'; 

When Congress reorganized the staff 

corps of the Army in June 1874, it was still 

of a mind to reduce expenses. Having forbidden recruiting beyond 25,000 men, the 

legislature went on to cut the budgets of departments supporting the Army. Although 

other departments also suffered because of 

the economy drive, no other bureau chief, 

with the possible exception of the quartermaster general, reported to the secretary of 

war as serious misgivings about its effect 

upon personnel as did the surgeon general. 

New legislation reduced the number oflieutenant colonel slots in the Medical Department from 5 to 2 and that of majors from 

60 to 50, thus effectively preventing promotions for years to come. Congress did remove the restriction on filling vacancies 

within the department and increased the 

rank of the chief medical purveyor to 

colonel. Reductions in rank were to take 

place through attrition only. The legislators 

also refused to allow hiring more than 75 

contract surgeo ns and abolished vacant positions at the grades of surgeon, medical 

storekeeper, and assistant medical purveyor. The only way in which Surgeon Gen-
16 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

eral Barnes could now meet the need for 

medical ofri cers was by paying private 

physicians on a fee-for-visit basis to care for 

those patients who would otherwise receive 

no medical care. Six months later Congress 

suspended the limitation on th e number of 

contract surgeons to be hired, but the legislators remained unhappy with the department's use of so many 25 

Civilian colleagues reacted with outrage 

to the trea tment accorded the Army's medical offi cers. The editors of the Medical 

Reco rd exclaimed that they were "in ract, 

asto nished at [the bill's] provisions, and 

thoroughly disgusted at the fact of its final 

passage. " The Ameri ca n Medica l Association, to whose meetings the Army had been 

sending a representative since 1850, 

stressed in an 1874 petition to Congress 

that 1 in 18 officers in the Ordnan ce Department was a colonel; in the Engineers, 

1 in 16; and in both th e Commissary and 

Quartermaster's Departments, 1 in 13. But 

in th e Medica l Department only 1 in 102 

was a colonel, and an officer might serve 

thirty to forty yea rs without rising above 

the rank of major. In support of its argument that the U.s. Army surgeon deserved 

belter treatment, the petition quoted from 

an address given by the ramous German 

pathologist Rudo lph Virchow that same 

year: "Whoever takes in hand and examines the comprehensive publications orthe 

Ameri can Army Medical Stafr will co ntinua lly have his astonishment excited anew 

by the ri ches of the ex perience which is 

there reco rded." The American Medical 

Association also emphasized that the ratio 

of 1 medical offi cer to every 200 or so men 

co ntrasted unfavorabl y with the 2 to 120 

ratio characteristi c of the British Army.'6 

In 1876 Co ngress relented somewhat 

concern ing promotions for medica l officers, doubl ing th e number of positions for 

li eutenant colonels and add ing 3 more for 

colonels. But it reduced th e number of 

openings for assistant surgeons rrom 150 

to 125 and even slashed the department's 

ap propriation for the fiscal year ending 30 

June 1877, forci ng drastic cuts in the number of contract surgeons and hospital stewards. When the original number of positions was restored the foll owing March, the 

department's troubles were no t at an end. 

After several years of dwi ndling appropriations, funds for the Army for the ro ll owing fiscal year were not voted until November 1877. This failure, which forced 

soldiers to go for many months without 

pay, can be blamed at least in part on the 

desire of southern congressmen to enco urage the comp lete removal of the Army 

from their states. The persistent un certa inty forced Barnes to reduce the number 

or contract surgeo ns hired. In February 

1877 he urged each medical directo r to 

annul contracts whenever he co uld, relying instead upon "local physicians ... employed by the visit. " He also ord ered that 

no leave be granted regular medica l officers. Although the usual appropriation 

was finally voted, diffi culti es caused by the 

shortage or physicians remained, Barn es' 

pleas for more assistant surgeons having 

been made in vain .27 

Undaunted, Barn es continued his efforts in behalf of the department, taking 

advantage, as was his custom, of the famil iari ty with the ways o[Washi ngton that 

his years of service and his position as 

long-term bureau chi ef had given him. In 

attempts to head off new measures he considered harmful , he approached congressional leaders co ncerned with the affa irs of 

the Med ical Depa rtment. Nevertheless, 

when age forced Barnes' retirement in] un e 

1882, the basic problem remained: 185 or 

the Army's posts were large enough to re-
VIEW FROM THE TOP 

quire the services of at least one physician, 

but only 183 of the 192 positions for regular medical orricers in the department 

were fi ll ed.'s 

Congress made a few minor adjustments 

in the organization of the Medical Department after Barnes' departure, in 1883 

downgrading the position of assistant surgeo n general. The ph ysician filling this slot, 

once the only medical orri cer with the rank 

of colonel, no longer served as the second 

in command in the department, but became "simply one of the colonels in the 

Medica l Corps." In 1892 another change 

gave all colonels the title of assistant surgeo n general and all li eutenan t colonels 

that of deputy surgeon general. Although 

Co ngress enacted no law at this time to 

change the way in which medical orricers 

were addressed, from 1890 onward the surgeo n general'sannual report referred to regular medical orricers by rank rather than as 

surgeon or assistant surgeon. 29 

Such changes had no effect on th e 

chroni c shortage of medical orricers. The 

effects of a lega l limitation on the number of Arm)' orricers who could be retired 

for disability were fe lt more intensely with 

the passage of time as the retention of an 

increasing number of disabled surgeons 

on the active dUly list blocked the appoinlmenl of replacements. By 1890 fifteen medical orricers, one of whom had 

been disabled for thirtee n years, could not 

perform their duti es. Seven more were in 

such poor health that their usefulness to 

the departmenl was limited. Fortunately, 

because of th e constant expansion of the 

railroad network in the West and the confinement of lndians to reservations, the 

concentration of troops at a few large 

posts-the Army closed 25 percent of its 

posts in the peri od 1890-1891-was 

gradua lly reducing the demand for post 

17 

surgeo ns. New needs develo ped as requests for advice and assistance from the 

Na tiona l Guard increased and as medical 

orricers were given such added duties as 

teaching military h),giene at the new U.S. 

Infantry and Cavalry School at Fan Leavenworth, Kansas. This laner assignment 

was particularly signifi canl because of the 

opportunity to impress line orricers with 

the importance of taking medi ca l advi ce 

seriously.'o 

In February 1891 Congress finall y removed from the limited retirement listwhich cOnlained the names of orri cers retired for disability or length of se rvice 

rather than age-all who were more than 

sixty-four years old . Because of the new 

openings on the limited list that resulted, 

six disabled medi ca l orricers could retire 

almost immediately, and two more left the 

department in midsummer. Surgeon General Sutherland's first annual report 

reco rded that on ly two medi ca l orricers 

who were permanenll), unabl e to perform 

their duties remained in the departmenl. 31 

The openings produced by the new retirements seemed especiall y desirabl e to 

young physicians who had just completed 

their professional educati on. As civilians 

beginning their careers, few could hope to 

match the Army's $1,500 a year starting 

salary and the 75 percenlof active-duty pay 

medi ca l orri cers could expect when retired, whether for disability or age. Although the departmenl did not suffer from 

a shortage of applicants, trad itionally 

man y who passed th e exam were recenl 

and untried graduates of medical school. 

The opening of man)' positions in the department on ly exacerbated a problem that 

had existed for decades. Barnes' approach 

to the problem, an informal apprenticeship 

system for nedgling assistant surgeons, 

was expanded by his successors to include 
18 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

those who were serving as contract surgeo ns while awaiting assignment. Surgeon 

General Moore attempted to reduce the 

magnitude of the problem by ordering that 

those with experience "in hospital and dispensary practi ce" be taken into the department firsl.32 

The pleas for more openings fo r regulars proved fruitl ess. Consequently, the 

need for large numbers of contract surgeons, whether or not they had passed the 

department's examination, did not abate. 

Crane pointed out that because the Army's 

demands nuctuated, the surgeon general 

should determine the number of contract 

surgeons to be employed. Nevertheless, 

Congress insisted on setting the limit, renewing in 1883 the reduction of the number of contract surgeons from 125 to 75 

that had been suspended nine years earlier. From this time onward, new contract 

opportuniti es for doctors other than those 

awaiting openings in the regular staff were 

rare, especially as the trend toward employing larger garrisons lowered the need 

for medical offi cers of any category. When 

Congress cut back the department's budget in 1886, and further economies were 

necessary, the number of contract surgeons was once again reduced. Surgeon 

General Moore adopted an informal policy of limiting new contracts to those who 

had passed the department's entrance examination, thus guaranteeing the Army 

superior contract surgeons and offering 

valuable experience to future regul ars. In 

drawing up the budget for fiscal 1893, 

however, Congress voted no funds for 

new contracts, forcing the department to 

rely once again on fee-for-visit hiring. 

Some scientists working for the department lost their positions as acting assistant surgeons and continued their work 

as civilian employees.

33 

Creation of the Hospital Co rps 

The one Significant change in the Medical Depa rtment in the period 1865-1893 

involved the effort to obtain and retain 

competent enlisted men to assist medical 

offi cers in the performance of their duties. 

The problem was as old as the U.5. Army 

itself. The tradition of detailing the dregs 

of a unit to assist surgeons in their work 

had lasted until fi ve years before the start 

of the Civil War, when Congress made hospital stewards permanent members of the 

Med ical Department. After the wa r as before, the legislature persisted in ignoring 

the argument that placing stewards in a 

permanent corps would make it possible 

to use them more effectively. 

Female nurses were not part of the solution to this problem. No forma l nursing 

schools existed in the United States until 

1873, and the qualifications of women 

willing to care for the Army's sick and injured were not particularly high. Thus the 

Army, having no real reason to hire women 

as nurses, employed none between the end 

of the Civil War and the beginning of the 

Spanish Ameri can War more than thirty 

yea rs later, even though the law permitted 

them to be engaged at 40 cents a day for 

work in general hospitals, whenever they 

might be established. The law also permitted women to wo rk in hospitals as matrons (that is, civilian housekeepers), 

whose chief duties were those of laundresses, for a monthly sa lary of $10. Matrons were few in number, 169 being in 

service as of 30 September 1887, and were 

hired only at the la rger posts and recruiting depots." 

By 1865 most stewards were competent 

men whose assistance to surgeons included wo rking as pharmaCists, performing minor surgery and simple dentistry, 
VIEW FROM THE TOP 

keeping records, and managing the post 

hospital. Some were themselves physicians, and at least one functioned as a fu lltime dentist. Nevertheless, their pay was 

less than half that paid th eir counterparts 

in th e U.s. Navy, and, as enlisted men, they 

never received the respect to which their 

professional attainments might otherwise 

have entitled them." 

In 1874, eight years after voting to allow 

the appoi ntmenL of as many hospital stewards as the surgeon general believed were 

needed, Congress voted to limit the number to 200. To his dismay Surgeon General 

Barnes discovered that the adjutant general, 

who controlled personnel procuremenL for 

the Army, could be a greater problem than 

the legislalllre. Ignoring the law, the adj utant general limited the number the department could hire to a Significantly lower 

figure. In its 1878 legislation concerning 

stewards, Congress divided them into three 

classes, with the first to be paid $30a month; 

the second, $22; and the third, $20. It also 

made them eligible for thesamesmallsalary 

increases that other enlisted men received 

as rewards for length of service or reenlistmenL and forbade appointing any civilian 

as first-class hospital steward un less he had 

previously served in that position. This new 

systematization in the managemenL ofMedica l DepartmenL enlisted men gained many 

admirers in Europe.36 

Nevertheless, problems were many. 

Stewards were scattered among the posts 

and never practiced together, and thus the 

Army was still unable to train teams to 

move wo unded from the battlefield until 

hostilities started. As a result, if a war 

should break out, able-bodied combatant 

soldiers would leave the battlefield to escort wounded comrades, just as they had 

in the Civil War, possibly never to relllrn 

to th e conOi cr. Nurses wo uld have to be 

19 

ga thered and instructed in the care of the 

wounded after the first of the inj ured had 

started pouring into hospitals. First-class 

stewards, often capable and intelligent, 

were so few in number that in 1886 Surgeon General Murray had to place restrictions on their leave. Department spokesmen continued to urge the creation of a 

permanent body of "able-bodied and intelligent men," to number approximately 2 

percent of the fighting strength and to be 

thoroughly trained to work as nu rses, 

cooks, and ambulance attendants." 

At this juncture the dwindling likelihood of further hostili ties with the Indians 

was, according to military historian Russell 

E Weigley, enco uraging "a few preparati ons 

for possible foreign war. " An enLire regiment gathered to train as a unit in 1887, 

and the beliefthattheArmy should be readied for war, rather than for the work of a 

constabulary, was beginning to grow. With 

it grew the beli ef that in such a force, a permanent co rps of enlisted men with centrali zed and systematic organization and 

training shou ld serve each staff bureau. 

When he became surgeon general in November 1883, Murray began urgi ng in his 

annual reports to th e secretary of war that 

some way be found to create such a corps 

for the Medical Department so that the department's enlisted men could be trained 

together in the performance of their duties. 

His goal was an organization of men who 

"shall be thoroughly instructed and trained 

in all the details of hospital service, ... 

thus preparing the DepartmenL for any 

emergency of peace, wa r or epidemic." 38 

A few months after Murray's retiremenL 

in August 1886, th e legislature passed a law 

creating the Hospital Corps, an organizati on of men who could be systematically 

trained to fun ction as hospital attendants. 

The new corps was to be composed of hos-
20 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

JOHN VAN R. H OFF 

pital stewards, acting hospital stewards, 

and privates, their exact numbers to be determined by the secretary of war. First-class 

stewards would now be designated hospital stewards and those of the second class, 

acting hospital stewards (the category of 

third-class hospi tal steward had been abandoned in 1885). Soldi ers who were not 

members of the Hospital Corps could no 

longer be detail ed to serve as nurses. Corpsmen would perform all "hospital services 

in garrison and in the Heier' and in wanime 

would manage the ambulance service as 

well. They would serve as ward masters, 

nurses, cooks, and assistants to olhersserving in these capacities, and also as orderlies who accompa ni ed surgeons during 

marches and in battle.'· 

In impl ementing the new law, the Army 

tried to establish a regular upward path for 

those who demonstrated an aptitude for 

Hospital Corps work. The plan ca ll ed for 

four men in each company to be selected 

as litter-bearers, with possibl e transfer to 

the Hospital Corps in mind . While remaining in the line, these men would be 

trained in first aid and the duties of th e litter-bea rer for at least four hours a month. 

After a minimum of a year's experience, 

they could take an examination that wou ld 

make them eligibl e for selection as Hospital Corps privates. After a yea r of service 

and upon the recommenda ti on of his commall cl's senior medical officer, a corps priva te could be detailed by the surgeon genera l to serve as an acting hospital steward. 

After a year's satisfactory service in this 

probationary capacity and the passage of 

yet another examination, he could become 

a hospital steward. Previous service in a 

similar capacity co unted in the computation of th e time required for promotions.'o 

Medical officers tended to rega rd this 

plan with some skepticism. The lot of the 

enlisted man had started to improve in the 

1880s, but his character was still not highly 

regarded. The assumption that the opportunity to transfer to the Hospital Corps 

would prove attractive to litter-bearers was 

"a proposition scarcely worth discussing," 

according to assistant surgeon Ca pt. John 

van R. Hoff, who beli eved that the new organization offered "no inducement to Lhe 

average soldier to transfer-the sanitary 

soldier if required to do his full duty must 

wo rk harder than any line soldi er-and 

there is nothing a soldi er abhors more than 

work, except it be drill-hence it is that the 

detail of company bearers is regarded as a 

punishment because it is additiona l duty." 

Furthermore, Hoff doubted that the Army 

contained 800 men physically and mentally capable of handling Hospital Corps responsibilities. Ano ther assistant surgeon 

remarked that the bearer drill was "as a 

source of amusement to the rest of th e com-
VIEW FROM THE TOP 

mand , ... a great success-but in all other 

respects, . .. a great failure and productive 

of no good." The pay was initially certainly 

not tempting-only in July 1892 was the 

hospital corpsman given the supplementary pay that had previously rewarded such 

"often exceedingly trying and very dangerous" work, a sum that might tempt him to 

brave drill, disease, and ridicul e.;' 

As Hoff had predi cted, the Medical Department experienced difficulty both in 

filling open ings in the Hospital Corps and 

in keeping them fill ed. By mid-1888, 135 

of the corps' 739 positions remained vacant. Some who had been hospital stewards before 1887 had not been ab le to pass 

the examinations for steward in the Hospital Corps, although considerable leeway 

was given to candidates who might reasonably be expected to remedy their deficiencies by further study. Great difficulty 

was also experienced in finding qualified 

men to serve as cooks. The ten openings 

for enlistees from civilian life were restricted to graduates of schools of pharmacy and veterans who had done Hospital Corps-type work while in the Army. 

Although the corps' desertion rate of2 percent in 1889 contrasted favo rabl y with the 

Army's average of 10.3 percent, low reenlistment rates made it diffi cult to keep a 

trained staff. Thus, whil e the creation of 

the Hospital Corps made systematic training possible, many probl ems concerning 

the Medica l Department's enlisted personnel remained to be solved.;' 

Problems of Victims of War 

New responsibilities resulting from the 

need to assist the victims of the Civil Waramong them refugees, newly freed slaves, 

and veterans-increased the expenses of 

21 

the Medical Department in the aftermath 

of that connict and for a time threatened to 

ensnare it in an unending tangle of administrative complexities. The requiremenllo 

provide the medical care that the Bureau of 

Refugees, Freedmen, and Aba ndoned 

Lands offered those it assisted was shortlived. Established within the War Department in March 1865, the bureau operated 

forty-six hospita ls by the fall. When Congressappropriated no funds [or the bureau's 

medical division for fiscal year 1866, apparently as the result o[ oversight, the secretary o[ war ordered the Medical Department to fill the gap. That year alone, this 

assistance cost $267,391.92, a sum that 

paid fo r medical supplies and, seemingly, 

the cost of contracts for civilian surgeo ns. 

The department also provided the services 

of medica l officers, eighteen of whom were 

detailed to the bureau for the period 1June 

through October 1865; one of them, initiall y a volunteer, headed the bureau's medical division from the time of its creation 

until its dissolution in 1872. The number 

o[ those in need decreased. Medical Department assistance rapidly dwindl ed, and 

the bureau began to hire its own contract 

physicians. By 1 September 1866 it needed 

the services of only nine medical offi cers. 

A yea r later they, too, had been reassigned, 

and by the spring o[ 1869 all burea u hospitals but the one in the District o[ Columbia had been closed. When the bureau's 

operations ended and the District of Columbia became responsible [or the expenses o[ the Freedmen's hospital there, a 

medical officer was assigned to handle that 

inSliLUtion's finances.43 

The responsibilities the Medical Department assumed for the veterans of the 

Civil War, on the other hand , brought it an 

enormous, persistently complex, longlasting, and totally unfamiliar administra-
22 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

tive burden. In 1862, when Congress first 

required the Army to provide prostheses 

to veterans who had held the rank of captain or below, the department assumed the 

responsibility for testing, supp lying, and 

overseeing the quality of these items. For 

decades afLer the wa r ended, it co ntinued 

to pay for prostheses and for associated 

travel expenses. Surgeon General Barnes 

duly reco rded thaL by th e end of fiscal year 

1866 the department had supplied almost 

4,000 legs, more than 2,000 arms, 9 feet, 

55 hands, and 125 other clevices" 

Barnes' suggesti on that provision be 

made to pay a monetary equivalent or commutation payment to those who qualifi ed 

for an artifi cial limb but did not choose to 

order one was adopted by Congress in 

1870, making it possibl e to compensate 

those unfortunates whose unhealed, inflamed, or abbreviated stumps co uld not 

accommodate a prosthesis. The legislature 

also permitted the Medi cal Department to 

replace prostheses or to make renewed 

commutation payments aL fi ve-year inlerva ls. The money qUickly became more 

popular than the prostheses it replaced . In 

1872 the department was also required to 

provide either commutaLion payments or 

prostheses for Civil Wa r veLerans whose 

loss of the use of a limb had resulted from 

paralysis, as well as Lrusses for soldiers 

who suffered hernias whil e on active duty 

in the Civil War. Four years later it had to 

furnish prosth eses, but not trusses, to all 

veterans in need of such aid, whether their 

service had been in the Army or in another 

branch of the military service." 

Although amputees died at a faster rate 

than their able-bodied comrades, the demands fo r prostheses did not materially diminish. Surgeo n General Murray believed 

that much of th e failure of requests for artifi cial limbs or their monetary equivalent 

to decrease in number should be blamed 

on the deterioration in wounded limbs that 

made prostheses necessary where they had 

not been befo re. BelieVing that a good artifi cial limb, if properly cared for, could last 

ten years, Murray protested a congreSSional 

move to red uce the replacement period 

from fi ve to three years. He noted that since 

only a small number of crippled veterans 

requested limbs rather than commutation 

payments, "legislation ... to secure more 

frequent payments seems to be, in my opinion, of doubLful utility or propriety. " Nevertheless, in Ma rch 1891 Congress enacted 

the measure to which Murray had objected 

and added injury to insult by failing Lo grant 

the Medical Department more money to 

meet the increased expenses. The tendency 

to choose the payment over the limb continued. The artificial arm was generally regarded as useless, and 98.6 percent of those 

entitled to receive it chose the monetary 

equivalent; 78. 1 percent of those en titled 

to the artificial legalso preferred the money, 

even though the prosthesiS in this instance 

was helpful ; 6 

Another reason for the failure of the demand to fall may have been private agents 

who worked to stir up business among the 

disabled so that they could claim 10 percent 

of the value of the commutation payment. 

These men concealed from the veteran the 

fact that he could easily deal directly with 

the Surgeon General's Offi ce himself. Surgeon General Moore was able to note in 1892 

that by 1889 the campaign to eliminate the 

use of intermediaries between his office and 

the disabled had been successfu l." 

The medical care of veterans living in the 

Soldiers' Home in Washington, D.C. , was 

another Medical Department responsibiliLY. 

The new hospital at the Home was named 

after Barnes and designed by Capt. John 

Shaw Billings, a man of many and varied tal-
VIEW FROM THE TOP 

ents and much determination.'s Only a portion of the Home's funds came directly from 

the government; but, as surgeon general, 

Barnes was a prominent member of the 

board. An Army medical officer, assisted by 

an Army steward, cared for the Home's sick. 

This institution was but one among several, 

including the Columbia Hospital for 

Women and Lying in Asylum and the Providence Hospital, for which the Medical Department managed federal funds voted to 

support indigents, regardless of their status 

as veterans or non-veterans .... 9 

The grea test of the Medical Department's 

administrative burdens in the decades immediately following the end of the Civil War 

invo lved paperwork, especially the paperwork concerning the sick and injured that 

was requ ired to enable the government to 

make decisions about pensions for Civil 

War veterans. The number of requests for 

the information necessalY to prove eligibility for this form of aid grew in proportion 

to Congress' liberalization of laws regarding it, even as the documents to be searched 

deteriorated both from age and use'o 

The Record and Pension Division of the 

Surgeo n General's Office, where hospital 

and burial records and monthly sick and 

wounded reports were sent and their data 

transcribed into permanent registers, was 

almost independent, from the outset seemingly as much a part of the Pension Bureau 

as of the Medical Department. Both the surgeon general and the secretary of war 

watched the division's work closely. The 

staff of clerks was large, the number reaching 290 in 1883, and the sheer volume of 

work was impressive. In the year fromJuly 

1865 through June 1866 the department 

provided information in 26,589 cases to the 

Pension Bureau, 8,000 to the paymaster 

general, 10,623 to the adjutant general, and 

4,000 to agents acting for various veterans. 

23 

In that same period it also "examined and 

classified" 210,027 disability discharges." 

This information was contained in 

4,000 registe rs. Their often faded or illegibly written entries, taken fro m the reports 

of medical officers serving in hospitals and 

in thefield, were arranged in the worst possible way for the purpose of verificati on, 

by date of admission rather than alphabetically. The number of clerks and hospital stewards conducting these searches remained inadequate, and their enthusiasm 

for their work was scarcely overwhelming. 

As a result, a backlog of requests soon developed. At the end of fiscal year 1870 

more than 3,000 requests remained unanswered, and by the end of the next fisca l 

year that fi gure had surpassed 9,000" 

The story of the next sixteen years was 

one of constant struggle. Employees were 

undisciplined, records deteriorating, and 

the memori es of veterans concerning the 

details of their service fading, thus complicating searches. Even though Civil War 

records continued to be added to the Medical Department's coll ection for many 

years, some clerks were still assigned to 

collecting and record ing meteorologica l 

reports from various post surgeons, a responsibility that was not turned over to the 

Signal Corps until 1874. Congress and the 

secretary of war added and withdrew personnel as the backlog waxed and waned, 

moti vated alternately by pressure from veterans gro ups and by a desire to reduce expenses. At times enlisted men had to be 

deSignated hospital stewards and detailed 

in that capacity to help in the work when 

funds to hire clerks were inadeq uate. Despite occasional direct intervention by the 

secretary of war himself, Surgeo n General 

Murray's instigation of an effiCiency rating 

system for the department's clerks, and, finally, pressure from the adj utant general, 
24 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

FRED C. A INSWORTH 

the situation [ail ed to improve. The head 

o[ the Record and Pension Division, Maj. 

Benjamin F. Pope, appeared to be totall y 

overwhelmed by the administration o[ his 

organization. In 1886, after consultation 

with both Acti ng Surgeon General Baxter 

and the adjutant general , the secretary o[ 

war finally decided to replace Pope with 

Capt. Fred C. Ainsworth ') 

Ainsworth, a remarkable and ambitious 

man whose talent [or administration was 

unadorned by diplomacy, proved to be the 

solution to much o[ the confusion and indfi ciency that had been plaguing the Medical 

Department in its attempts to deal with veterans and their records. He came to ornce in 

December 1886. Moore had been surgeo n 

general a month and, in the course o[ pushing vigorously [or increased discipline and 

order in the department's management, was 

already setting up guidelines that would 

smooth Ainsworth's path. Armed with new 

regulations calling [or semiannual erficiency 

ratings and severe restrictions on leave, 

Ainsworth fired the lazy and incompetent 

and instituted improved procedures. Instead o[ dealing with the backlog by hiring 

new clerks [or whom new work would have 

to be round i[ they were not to be Idt id le 

when it had been reduced, he requ ired those 

already hired to work overtime to clear it up. 

Not content with increased productivity and 

the resultant marked reduction in the number o[ unanswered requests, he began supplementing records with information he obtained [rom private hospitals that had 

sheltered sick and wounded Union soldiers. 

He also took up the matter o[ the deteriorating records and decided upon a card catalog as the answer to the problem. When his 

work was complete, all the cards on each individual soldier were nled together and 

grouped by regiment. Ainsworth's approach 

worked so well that the secretalY o[ war ordered the consolidation o[ his organization 

with the various ornces o[ the adjutant general that had been doing similar work and 

placed Ainsworth in charge o[ the new and 

independent Record and Pension Division 

that resulted." 

Ldt behind when the new di vision took 

over the Civil War personnel records were 

cards holding detailed desc riptions or men 

who had taken the physical examination 

[or entrance into the Army. This collection 

was va luab le in identifying deserters. 

When post commanders reported desertions to post surgeons, their medical orneel's turned the information in to the surgeo n general. Should a deserter or an 

undesirable then try to reenlist under another name, the Medical Department 

co uld usually identify him by mea ns o[ the 

description on his card ." 

Because the growing accumulation o[ 

records [rom the Civil War years was o[ 
VIEW FROM TH E TOP 

great value, its location was or considerable 

importance. In December 1866 the Medical Department round space in the rormer 

Ford's Theater, where th e medi cal records 

shared the second noor with the library, 

whose direction Surgeon General Barnes 

had placed in Billings' capable hands in 

1865. This building was to a limited degree 

fi reproor, but the roor was nammable and 

the walls were structurall y weak. By th e 

time or Barnes' retiremen t, Fo rd's Theater 

was also badly overcrowded, and a movement was under way to find still larger and 

sa rer accommodations,56 

Nevertheless, only in the spring orl885, 

arter much campaigning by both Surgeon 

General Murray and Billings, now a major, 

who became head or the Library and Museum Division when it was created in 

1883," did Co ngress authorize the co nstruction or a new fireproorbuilding. It was 

to be smaller than the Medical Department 

wanted and "very plain and simple." Even 

before the move into the new structure on 

what is now Independence Avenue had 

been completed in early 1888, the racility 

was too small ror the purpose [or which it 

had been built, and some records had to be 

housed elsewhere. [t was, however, definitely a sa rer have n than Ford's Thea ter, 

where during renovation in 1893 the noors 

collapsed, killi ng twenty-two people and 

injuring three times that number.ss 

State oj the Art 

Eve n before the Civil War had ended, 

the era or modern medici ne was already 

dawning across th e Atlantic, and by 1893 

rapid progress was being made in the 

struggle against disease and in rection. The 

age when miasmas were regarded as the 

cause or most sickness was rapidly com25 

ing to an end. In France Louis Pasteur was 

studyi ng the role played by microscopic 

bits of li ving matter in the diseases of 

plants and an imals, and in 1885 he introduced the fi rst successful rabies vacci ne. 

In Germany physician Robert Koch was 

developing an approach to obtaining pure 

bacterial cultures and refining the procedure by mea ns or which these cultures 

could be used to establish the iden tity o[ a 

specific organism and the ract that it 

caused a specifi c disease. Although he was 

not the first to identiry Vibrio cho/emc, his 

work with cholera was responsible in large 

measure ror the widespread acceptance or 

a small living organism as the cause or the 

much-dreaded Asiatic cholera and or its 

transmission through contaminated water. 

In England in 1867 surgeo n Joseph Lister 

published all th e Alltiscptic Prill cil'/e ill the 

Practice of SlII:geIY, deLailing his successes 

in preventing the inrection or surgical 

wo unds. His approach proved unnecessarily complex and was noL qu ickly accepted outside Europe; minimi zing theexposure or wounds LO germs by sLerili zing 

surgical inSLrumenLS and dressings soon 

proved more efrecLive than spraying Lhe 

operating room WiLh disinrectants. NeverLheless, because or his work as we ll as Lh aL 

o[ those who rollowed him, surgeons 

would be able to und ertake opera ti ons or 

a kind that wou ld ea rlier have almOSL ineviLably been rollowed by faLal inrecLion.

59 

The Signifi ca nce or the medical revoluLion thaL was Laking place in Europe was 

nOL iniLially appreciaLed by America n 

physicians. More co ncerned with the immediate and the practica l than their Europea n counterparts, Lhey were skepLica l 

abouL th e new scientific medi ci ne and Lh e 

germ Lheory. Moreover, medical educa Li on 

in the Un ited States was traditi onally not 

Lhe kind Lh aL would stimulate an interest 
26 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

in the scientific aspects of medicine. By the 

time Surgeon General Sutherland retired 

from the Medical Department in May 

1893, however, the number of medical scienlists following in the footsteps of the pioneers was rapidly growing60 

Despite their initial lack of enthusiasm 

about developments in Europe, the leaders 

of the Army Medi cal Department were 

eager to use the experiences of the Civil 

War to advance the science of medicine. 

During the conni ct Barnes' predecessor, 

Surgeon General William A. Hammond, 

had encouraged the creation of what became the Army Medical Museum to house 

the legacy of the Civil War in the form of a 

collection of anatomical specimens obtained from the victims of that con nic!. He 

had also supported the library, which became known as the Surgeon General's Library, that had been started on a modest 

scale by the first surgeon general, Joseph 

Lovel!." Hammond's successors attempted 

not only to build upon their heritage by assigning some of their most respected medical offi cers to work with the specimens and 

reports collected during the war but also to 

make the library into a world-respected institution. Both the library and the museum 

would continue to grow and to contribute 

to the progress of medical science. But, as 

the scientific work being undertaken in Europe would demonstrate, the altempt to 

uncover the mysteries of disease merely by 

amassing statistics and anecdotal accounts 

could not succeed'"' 

The Surgeon Genera l's Library, the collection that would in 1956 become the National Library of Medicine, was arguably 

the Medi cal Department's most va luable 

and lasting contribution to medical science 

developed in the decades immediately following the Civil War. As new developmenls 

in th e world of medical science began to 

grow in number with great rapidity, the nation's best-educated phYSicians came increaSingly to rely on medical li braries, particu larly the Surgeon General's Library, for 

the information that kept them abreast of 

the work of th eir COlleagues around the 

world. Much of the li brary'S growth in size 

and fame resulted from the work of Billings. 

Working aggreSSively and imaginatively to 

increase the library's holdings, he made the 

most of the meager funds allolted that institution by astute buying and by trading 

copies of the department's various publi cations for the books, journals, reports, manuscripts, letters, pamphlets, and portraits 

he believed it should have. By 1875 the library had copi es of about 75 percent of the 

available periodical li terature and the 

largest collection of pamphlets in the country. To claSSify the collection, after some experimentation, Billings adopted a revised 

version of the system used by the Royal 

Coll ege of Physicians in London , employing a series of 5" by 7" cards to keep track 

of the library's holdings 6 ' 

Because the library's funds seemed to be 

in almost constant jeopardy, Barnes and 

Billi ngs had to move shrewdly to fu rther its 

interests. They arranged to have it regarded 

as "the medical section of the Congressional Library" and thus as especially deserving of congreSSional favor. Billings actively publicized the facility, and the 

number of those relying upon its service 

grew rap idly, particularly among civilians. 

He urged physicians to pressure Congress 

any time it seemed li kely that it might cut 

the library'S fu nds, and he gave freely of the 

fruits of his own experience to advise those 

managing similar institutions. A vital part 

of his effort invol ved issuing caialogs that 

would inform the interested public, both 

in the United States and in Europe, of the 

library'S holdings. After Billings published 
VIEW FROM THE TOP 

a sampl e catalog in 1876 and brought to 

bear whatever political innuence he could 

garner, Congress, its enthusiasm dampened by the expense involved, voted a modest sum in February 1879 to print the first 

two vo lumes of the [li e/ex Catalogue, a volume of which appeared each year thereafter. Despite co ngressional misgivings, the 

publi cation wasan instant success with the 

physicians it was intended to serve. One 

physician called it "a monument of useful 

labor, a time saving directory to medical Iiterature, a delight and a blessing to the medical scholar," adding, "May the Lord save 

Dr. Billi ngs to finish it. " 64 

To compensate for the inability of the 

[lldex Catalogue to keep up with current 

Ii teralure, the surgeon general gave his 

permission in 1879 for Billings and an associate to list the most recently published 

medicalliteralure throughout the world in 

a privately financed journal, the [lldex 

MediCtls: A MOllthly Classifi ed Record of the 

CUfrell t Medical Litemture of the Wo,·ld. 

Billings requested authors and publishers 

to send him their publications for listing 

in the [lldex Medicus, forwarding what he 

received to the library after they had been 

indexed·' 

The library held copies of many books 

by Medical Department amhors, among 

them two painstakingly detailed volumes 

by Billings-A Report Oil Barrachs alld Hospitals, With Descriptions of Militaoy Posts 

(Circular No. 4), published in 1870; and A 

Report of the Hygiell e of the Ullitee/ States 

Army, With Descriptiolls of Militcuy Posts 

(Circular No.8), published in 1875. In response to epidemics of two long-dreaded 

diseases, cholera and yellow fever, from 

1864 through 1867 Billings, with the need 

for public support of the library obviously 

in mind, also prepared in pamph let form 

bibliographies of the library's works on 

27 

those diseases. Surgeon General Ba rnes, 

meanwhile, assigned assistant surgeo n 

Capt. Ely McClellan to conduct a study of 

cholera as ordered by Co ngress. The resultant report joined " A History of the Travels 

of Asiati c Cholera" by McClellan and a 

civilian physician, a report by Supervising 

Surgeon General of the Marine Hospital 

Service John M. Woodworth, and Bil li ngs' 

ful l-scale bibliography of works on cholera 

to become The Cholera EpidemiC of 1873 ill 

the Ullited States, which the Surgeon General's Offi ce published in 1875.66 

When Billings retired from the Army in 

1895, the library contained more medical 

publi ca ti ons than the two nex t largest 

medi cal libraries in the United States combined. It may have already become the 

largest such facility in the world. Thousands of physicians benefited from its 

riches. The money that Billings obtained 

from Co ngress for the library also made it 

the wealthiest medical li brary in the world . 

Moreover, he established a pattern of donations to the Surgeon Genera l's Libra ry, 

which permitted him to add Significantl y 

to the collection and thus to increase its 

value to the medical profession . 

The museum displays were anolher 

legacy from the past, one that eventually, 

like the library, came under Billings' guiding hand. Even before the end of the Civil 

War, the museum laboratory had seen Lt. 

J oseph J. Woodward's first pioneering experiments with microscopic photography. 

In the years after the war, Army scientists 

continued to prepare, examine, and photograph specimens of pathological anatomy and slides contributed by both civilian scientists and medical officers. As th e 

museum grew, it played an increaSingly important ro le in advanCing th e science of 

pathology. Skeletons, weapons, and other 

objects from Indian tribes, as well as spec-
28 THE ARMY MEDlCA L DEPARTMENT, 1865-1917 

imens from the animal world , also poured 

in to the museum. The surgeon general 

noted in 1891 that among these oddities 

was a newly acquired secti on of femur fracLUred by a shot at Chance ll orsvill e in 1863; 

in the twenty-eight yea rs since the injury, 

the bone had healed, but a chronic infection remained to cause the long-suffering 

veteran's death "from absorption of pus 

from wound." 67 

Work done in the museum laboratory 

was almost entirely limited to photomicrography and testing medical supplies. As 

lateas 1879 Woodward clearly thought that 

the theory thal germs caused disease was 

outmoded. In spite of the fact that th ree of 

the Medical Department's most outstanding medical offi cers, Woodward, Billings, 

and Maj. George A. Otis, were at one time 

or another aSSigned to the laboratory, "almost none" of the department's work, as 

medical historian Percy M. Ashburn has 

pointed out, "bore directly on the prevention of disease or the improvement of 

health. " Ashburn also noted that "practically none of it was being done outside the 

offi ce of the Surgeon General. " 68 

In 1869, having failed in the attempts he 

and another medical officer made to discover whether a minute fungi could cause 

disease, Billings expressed disillusionment 

with the potential of the microscope and the 

development of culLU res of bacteria for 

throwi ng light on the cause of disease. His 

interest in his microscope began towanejust 

when bacteriologists in Europe were beginning to discover the organisms causing such 

diseases as amebic dysentery, typhoid fever, 

malaria, leprosy,tuberculosis, cholera, diphtheria, tetanus, and one t)1Je of pneumonia. 

Although he made many significant contributions to the fi eld of public health thereafter, Billings remained, as Fielding H. Garrison has put it, a member of "the older or 

philosophical school of hygienists" and "in 

no sense of the term a bacteriologist." 6') 

As the years passed, the museum received from civilians an increasing numbe r 

of specimens illustrating 11011-\\'ar injuries 

and diseases. This situation met with Billings' approval, since he saw the museum as 

performing a service for all doctors and believed that it should contain items of general medical interest. To add to the coll ection, supernuous items were exchanged 

with other museums, which were kept informed of the Medical Department's holdings by means of catalogs and checklisLS. In 

less than fifteen months after the medical 

museum opened in Ford's Theater, its exhibits drew more than 1,400 visitors, both 

American and fo reign, and by 1870 European authors were illustrating their boo ks 

wi th woodcuts made from museum photographs. The museumS growing reputaLion led to iLS use by various organizations 

for their gatherings. Exhibits sent abroad 

showed fo reign scientists how the United 

States Army handled hospitalization, evacuation, and patient care. Despite the international reputation of the museum, congreSSional support was not generous and 

came only in response to pleas from the surgeon general. Yet from the museum and the 

activities centered there would come the 

Ameri can Registries of Pathology, where 

thousands of cases of diseases were 

reco rded for study, and, after World War II , 

the Armed Forces Institute of Pathology.'o 

The princi pal concern of museum personnel for many years after the end of the 

Civil War was transforming the mass of 

surgeo n's reports into the Medical Department's major publi cation, the Medical {IIIc/ 

Surgiwl History oj the War oj th e ReiJel/ioll, 

which made heavy use of museum specimens for its illustra ti ons. The history, conceived by Surgeon General Hammond in 
VIEW FROM THE TOP 

1862 "to advance the science whi ch we all 

have so much at heart, and to establish 

landmarks which will serve to guid e us in 

future," consisted of two vo lumes, one on 

medicine and the other on surgery, each of 

which was divided into three parts of 700 

or more pages. A 350-page appendix containing reports of engagements, usually 

submitted by the medical directors involved, was added to the medical volume. 

The author-editors of the volumes were all 

medical orncers. Woodward, an ex perienced pathologist, was responsibl e for the 

first two parts of the medi cal volume, published in 1870 and 1879, with the third 

published in 1888. The first two parts of 

the surgical volume were published in 

1870 and 1876, th e third in 1883. The entire history was finally completed after delays stemming both from Woodward's prolonged illness and death and from the 

"pressure of current work at the Government Printing Offi ce." 71 

The authors of these volumes detailed 

the medical and administrative problems 

faced by the Medi cal Department during 

the Civil War and the efforts made to resolve them. The illustrations, both photographs and drawings, were of exceptionall y fine quality, and the case histories are 

even today a gold mine for anyone interested in learning how the arts of medicine 

and surgery were practiced during the Civil 

War. The discussions often contai ned histories of how the problems in question had 

been hand led for centuri es, but the masses 

of statistics were essentially only listings, 

with little analysis. The multitudinous tables merely grouped diseases by geographic 

area and race. The categories into which 

the various ailments were divided in the 

statistical tables showed that the authors 

still regarded vapors and fumes from decaying matter as the most likely causes for 

29 

the spread of the diseases that trad itionally 

posed th e greatest threat to armies, among 

them malaria , typhoid , typhus, dysentery, 

diarrhea, and even measles . 

Woodwa rd's lengthy effort to pin down 

the cause of the dysentery that had devastated the Uni on Army was not a scientific 

study in the manner of Pasteur and Koch 

but a history of attempts to solve the puzzle dating from the days of the Greeks. He 

even attacked th ose who suggested that 

"bacteria are in some way disease-producers" and who thus "permitted the survival 

in certain quarters, of the doctrine that 

dysentery is thus ca used." Maj. Charles 

Smart, the author of th e final medical volume, was more ready than Woodward to 

admit the possibility that somethi ng he 

sometimes called a germ (a term he used 

alternately with poiso n) might be the 

cause of typhoid fever, but he obviously 

did not think it li kely. The instruments and 

the techniques that might have ind isputably proven that bacteria ca used the 

diseases and infecti ons of th e Civil Wa r 

had not been developed when Woodward 

and Smart made their observations. The 

info rmation th eir work might otherwise 

have revealed was unavailable even after 

more sophisti cated microscopes and staining techniques had been devised. The pioneering wo rk with wound antiseptics 

conducted during the Civil War and 

recorded in the Medical alJd Surgical His-

[OlY had no apparent impact on th e work 

of Lister, which was under way before the 

publication of the first vo lumen 

When the Medica l alJd Surgical HistDlY 

first appeared, it was greeted with entllllsiasm throughout the Western Wo rld. In 

praising the publica ti ons of Army medical 

orncers in 1874, Virchow undoubted ly had 

it principall y in mind when he spoke of 

"the most extreme exactitude of detail , a 
30 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

staLisLic carefu l even as to th e smallest maLters ... here united in order to collect and 

transmit to contemporaries and to posterity wiLh the utmost completeness, the 

knowledge purchased at so dear a pri ce." 

Hammond's hopes for the history were to 

a large degree frustrated, however. In the 

wake of the Civil War, asJames H. Cassedy 

noted in Americall Medicil1e alld Statistical 

T/lil1/'illg, 1800- 1860, "the laboratory effectively dominated medical research. Statistical analysis receded, temporarily but 

deCidedly, into the background," to reappear only in the twenti eth century, when 

"investiga tors [had ga ined] the competence in higher mathematics that was 

needed for statistics once again to playa 

major role in clinical and scientific studies." Thus, with the passage of time the 

Medical alld SlII gical HistOlY of th e War of 

the Rebellioll became recognized as "the 

world's outstanding compilation on military medicine." Much of its value today lies 

in its detailed descriptions and illustraLions o[ the plans used for Civil War general hospitals and ambulances, the discussions o[ the reasoning Lhat led to the 

development of the various designs, and 

the reports o[ various medical directors 

concerning some o[ the major battles. The 

very inability of the medi ca l ofricers responsible [or Lhese vo lumes to add signi[-

icantly to the progress of medical science 

is revea ling or an era that was coming to a 

close even as Lhey wrote. 73 

The Medical Department's major ofricia l 

contributions to medical science in the period 1865-1893 [ell in the realm of preserving th e past for the benefit of the present and the future. The work done in th e 

museum and library in the 1860s and 

1870s was, according to Bill ings in 1903, 

"in part merely incidental to th e preparation of [the] medical and surgical story of 

th e war, in part for the advancement of 

medicine, and in part for the pleasure of 

the yo ung men engaged in it. " The passage 

of time wo uld revea l that its "direct resulLs 

on the science and art of medicine were 

nOLgreat," even Lhough "iLS indirecL resulLs 

have been . . . important. " H 

Few U.s. Army medical ofri cers, 

whether they worked in the museum or in 

the fi eld, appear to have been seriously inLerested in the new techniques Koch had 

developed. One exception was Maj. George 

M. Sternberg who, impressed by Koch's 

work, visited the laboratory of the German 

physician and brieny wo rked WiLh him in 

1886, when the Medical DeparLment sent 

him to Europe as the U.s. representative to 

the InternaLional Sanitary Co nference in 

Rome. Although an article written in 1883 

promoLing an Army ca reer for young physicians maintained that Army posts provided 

good microscopes, some senior Army 

physicians still disapproved of work with 

th is instrument; in 1890 a medical ofricer 

working in the Surgeon General's Ofrice described Sternberg's work with it as o[ no 

"earthly biL of good" Lo the department. 

Mindful of the problems that this attiLude 

caused him, Sternberg noted with some bitLerness that he had had to pay personally 

for the expensive equipmenL he needed to 

set up his own laboratory, even though "apparatus of the same kind, purchased with 

government money, [had] been for two 

yea rs lying idle aL the Army Medical MuseUln. " Nevertheless, Sternberg co ntinued 

his research, in 1892 givinga paper 011 practical accomplishments in the fi eld of bacteriology and his own work in the field that 

produced favorable comment from the 

highly respected pathologist William H. 

Welch atJohns Hopkins." 

Although lister's wo rk met with much 

skep ticism for many years, the pracLical 
VIEW FROM THE TOP 

value of what he was doing was more easily grasped than that o f researchers with 

mi croscopes. Convinced after a visit to 

England in 1877 that Lister's work had 

great merit, another young medica l offi cer, 

Capt. Alfred C. Girard, informed Surgeon 

Gene ral Barnes: "Be the 'germ theory' true, 

or partly true, or an absolute mistake, practically it matters not; for the present it is 

the best explanation we have for a most 

successful method and the best guide in its 

use." Barnes was suffi ciently impressed by 

Girard's report to have it sent out to all 

medi cal offi cers as a circular, but without 

any specifi c endorsement. Surgeon General Murray, in spite of his reputedly conservative temperament, openly accepted 

the notion of bacteria as a cause of infection and predi cted a time when, because 

of Lister's research, the world of surgery 

would be transformed by antisepsis. Murray's annual report of 1884, issued when 

Lister's work was still not fully appreciated 

in England, was the first such document 

to mention the use of antiseptics by Army 

surgeons during or following surgery.' 6 

31 

By 1893 the first traces of the changes 

that would profoundly affect the Medical 

Department in the years to come were already evident. The formation of the Hospital Co rps would make training enlisted personnel for modern warfare easier, and post 

surgeons were less isolated than they had 

been in 1865. But most medical officers 

were still attached to small units that were 

scattered about the counlly, and the drive 

to prepare the Army for modern warfare was 

yet in its infancy. The Medical alld SlIrgica l 

Histo,y of the War of the Rebellio" stood as 

an eloquent symbol of the dedication and 

the frustrations of the medical officers who 

could not yet accept germs as a cause of disease. Steeped in the older traditions and almost overwhelmed by administrative burdens, the surgeon generals of the period 

1865-1893 left the challenge of leading the 

department boldly toward the new era of 

medical science to their successors while 

Army surgeons in the field continued to 

practice medicine as had their predecessors 

for generations. Change would come, but it 

would come only gradually. 
NOTES 

1. \;Va r Department, {A"lIIud / Reporl oj IlJ e slIrgeon Genem/, U.s. A rillY, to O,e scerctw), oj War, 

1866, pp. 2- 3 (herearlerciled as W D,ARofSG, dale). 

The nsca l year ran rromjul), through june. 

2. j ames M. Pha len, Clri cJs oj II, e Meelical Department, Unil eel SIM es A rillY, 1775- 1940, pp. 47- 69. 

3. Barnes became surgeon general as the result 

or the court-martial conviction or his predecessor, 

the brilliant but tactless and occasionally arrogant 

Brig. Gen. William A. Hammond. Although the ran k 

assigned to the position or surgeon genera l was 

brigadi er general, on l3 March 1865 Barnes was 

breven ed major general because or his se rvices in 

the Civil 'Wa r. See ibid., pp. 48-49. 

4. Ibid., PI'. 48-50; Ur, SG to Levi Maish, 3 jan 

1878, Enll")' 2, Record Group (RG) 11 2, Na tional 

Arch ives and Records Administration (NARA), 

\>\'ashingtoll , D. C.; L. D. Ingersoll , A His/OJY oj the 

W(lr Dcpa rllllcni oj Ih e Ull i/eel Stales . .. , PI'. 233, 

247 (hereaher cited as HistolY oj WD); \Villiam Q. 

Maxwell , UllCO/li S FiJt11 Wll eel, p. 318; George M. 

Kober, Rcmilliscellccs oj George Marlin Kover; M.D., 

LL.D. , p. 197. 

5. j ames E. Pilcher, Tire sillgeon Generals oj rh e 

Army oj tile Uniled SWles oj America , Pl'. 65-66; 

Phalen , Chi eJs, p. 52. 

6. Phalen, CllieJS, PI'. 62-64; Pilcher, Surgeon 

Genera /s, pp. 64, 74-76. 

7. First quotation rrom Ur,J. S. Billings LO Ezra 

M. Hunt, 13 Oct 1883, ci led in \>\')'ndham D. Mil es, 

A HislOJ)' oj tile National Ubrm)' oj I'vleelicille, p. 161 

(herearter cited as I-I;SIOI)1 oj NLM); second quotation rrom Pilcher, Surgeon Gellemls, p. 68; ibid. , pp. 

67,69; Phalen, Chiefs, PI'. 55-57; in IlG 112, NAIlJl: 

Ur, Ch Med Purveyo r to SC, 3 Nov 1873, vol. 17, 

En try lO, and Surgeon General's O fri ce (SGO) Cir 

3,2 1 Apr 1885, vol. 7, Enlr)' 63. 

8. Quotation rrom Pi lcher, SwgeOlI Genera/s, p. 

70; Phalc n, Clri eJs, pp. 60, 63. Not long be rore his 

death <ltthe age or 90, Brig. Gen.jdrerson R. Kean , 

who joined the Medi cal Depa rt ment in 1884, recalled hearing that President Grover Cleveland had 

selec ted Moore by ru nning down the names or medical ofri ce rs in the Ann)' Regisler and ap pointing the 

first one he reached ror whom he had no letters of 

recommendation. See Kean Interv, p. 14, in rolder 

Interview ( 1950), Ms C 14 ,j d ferson R. Keall Papers, 

National Li bra l")' o fM ecl icine (N LM), Bethesda , Md. 

9. Pilcher, slIIgeoll Genemls, PI'. 74-76 ; U r, SG 

10 F M. Cockrell , 23 Feb 1884, Enll')' 2, RG 11 2, 

NA RA; Uedediah H . Baxter], Til e Media d P(lrf oJl he 

Filwl Report Made 10 tile secrelw)' oj War b)' ti, e 

Provost Ma rslral Gencm/; Samuel C. Busey, Persorwl 

Remillisccnces wul Recollections . .. , PI'. 303, 306-

07,308. 

10. Pilcher, Surgeon Gellemls, pp. 75-78; Phalen, 

ChieJs, pp. 63- 64; William B. Bean, Wall.er Rced, p. 

45; Edward M. Corrman, Th e Old Army, p. 384. 

11. First and second quotations rrom Pilcher, 

Surgeon Generals, p. 82 (see also p. 79); third quotation rrom Ltr, jos. C. Baile), to SG, 3 1 May 1893, 

in Ms ClOO, George Miller Stern berg Papers, NLM ; 

Phalen, CIlieJs, pp. 66-69; "The New Surgcon General ," p. 5 L 

12. Corfman , Olel Army, p. 218. 

13. WD, ARofSG, 1865, p. 4, and 1866, Pl'. 7-8; 

in RG 11 2, NA RA: Llr, Charles H. Crane to C. McCormick, L8 ju11865, Entr), 7, and Ltrs, Crane to J. \.v. 

Morrison,3 Aug 1865, to Dorothea Dix, 11 Sep 1865, 

and to Henry A. Armstro ng. 10 Oct 1865, and SG to 

Henry \>\fatson, 17 Mar 1870, and J. S. Billings to 

Samuel A. Wood , 24 Sep 1874, Entry 2. In his capacit}' as assista nt surgeon general, Crane relieved Barnes 

or much of the routi ne administration or the ornce. 

14. Quota tion rrom WD, ARoJSG. 1866, p. 1; 

ibid. , PI'. 2, 5; in RG 112, NA RA: Ltr, Crane to 

McCormi ck, 18jul L865, Enu")' 7, and Ltrs, 'VV C. 

Spencer to O. P. MOrLon, 16 Nov 1865, Crane to Conrad Baker, 25 Nov 1865, Spencer to j . M. Ri chard , 25 

Oct 1866, SG to'VV W. Corcoran , 9 Nov 1866, Enll"}' 

2, and Telg, SG 10 C. Baker, 17 jan 1.866, Entry 2. 

15. WD , ARoJSG. 1866, p. 5; War Depart ment. 

Surgeon General's Omce, Medical (lnd Surgical His-

(01), oj/Ire War oj Ihe Rebellion, 2-3:90 l ; llrs, Crane 

lO D. C. Pearson, 2 1 Ap r 1868, to S. J. P. Mill er, 16 

ju11874, and to Thomas G. Maghee , 10 SCI' 1874, 

and SG to j. M. Marvin, Entry 2, RG 112, NA Rk 

16. George M. Kober's quo led comme nts, cited 

in PerC)' M. Ashburn, A HistOl)' oj Ihe lvledical DeparI mellE oj til e Ullifed slales Arlll)" p. 109 (herearter 

ci ted as His/or)' ojJ'vlD); Prelimina r}' Inventor)' or RG 

112, Pl'. 28- 29. NA RA, which states lhat the Fi-
VIEW FROM THE TOP 

nanee Division was in operation "frol11 the lime of 

(he Civil War" (I'. 28). 

l7. Quotations from Otto L. Neison,] r., i\laIiOlw/ 

Securily and the General $((1]1, p. 12; ibid. , p. 13; 

Memo,j . M. Schorield lO Se , 5 OCI L892,john MeA. 

Schofield Papers. Manuscript Division, libra r)' o f 

Congress, VvashingLOIl, D.C.; \oVar Depanment, Sur· 

geon General's arnee, The 5111geoll Gellerals Office, 

p. 224 (hereaher cited as WD, SGO, SGO); WD, 

ARoJSG. 1874, p. 20n. For the responsibilities of 

medi cal directors, see, for exam ple, in Enll")' 63: In· 

SI rs fo r Med Dirs, 14 SCI' l874. vol. 5, and llrs, Crane 

to "Sir" [All Med Dirs], 1 Aug 1876, vol. 5, and to 

Mcd Dirs, 3 Aug 1876, vol. 5, and 6 Jan 1877, vol. 

6; in Emf)1 2: MD Form, 1868 (e.g. , 17 Aug), and 

Ltrs, SG ( 0 E. L. Baker, 22 May 1877, ( 0 Med Dir, 

Oi" of Atlantic , 6 Scp 1877 , to Mec\ Oir, Depi of Ari· 

zona , U Nov 1878, among mallY others, and to G. 

W. Sconeld , 6 Feb 1873, and <llso Crane to Med Oir, 

Oepl of Gulf, ] 8 Apr and 10 J UIl 1873 , to Med Oir, 

Oi" of Atlanti c, 24 OCt 1874, to Med Dir, Dept of 

Gu lf, 6 Feb 1877, and to Med Dirs, Depts of South , 

Gulf, Dakota, Plaue, Missouri, Texas, California, 

Columbia, 20 Feb 1877; a nd in Elllr)' 12: Ltr, F. 

Branc h (0 SG, 9 Feb 1868. All in RG 112, NARA. 

18 . lIrs, johnj. Mi lhau to SG, 18 Mar and 7 Oc t 

1868 and 25 Feb 1869 , Thomas A. McParlin to SG, 

5 May 1868, Ebenezer Swift to SG, 13 jun 1868 and 

19 Ma r .l870,j amcs Simons to SG, 30 Aug 1868 and 

24 Feb and 19 Mar .1 869, Andrew K. Smith to SG , 

28 OCl1868, Williamj. Sloan to SG , Ujun 1869 , 

john Moore to SG , 9 jui 1869, and to Capt l. V. 

Eziane Isp ?I , 20 Sep 1869, and Charles Page to SG, 

25Jul 1869. All in Entr)' 12, RG 1I 2, NARA. 

19. WD , ARoJSG , 1868, p. 6; in RG 112, NA RA: 

lIrs, SG to j. D. Cameron, 16 Oct L876, a nd to Levi 

Maish, 3 jan 1878, Elllr)' 2, and lIrs,j.j. Milhau to 

SG, 18 Mar and 7 Oc t 1868, Entry 12. 

20. Quotation from "The Arlll)1 Medical Staff 

Bill," p. 150; Samuel l. Baker, "Ph)'sician licensure 

Laws ill the United States, 1865- 19 15," pp. 173- 74. 

21. Edgar Erskinc l-fulllC, "Admission to the Med· 

ica l Depa rtment of the Army Half a Century Ago,n p. 

199; lIr, Crane toJ oseph B. Browl1 ,30Aug 1875, Enlry 

2, RG 112, NARA . Arthur was promoted to brigadier 

general in the National Army on 5 August 19.1 7. 

22. Ltrs, Crane to Med Dir, Div of Atlanti c, 10 Med 

oir, Dept of Dakota , to C. B. Byrne, all 31 Jul 1875, 

to J. B. Brown, 30 Aug 1875, to E. E. Ba rnum, 23 Apr 

J880, and to Med Dir, Dept of Arizona, 1 Sep 1883, 

D. l. Huntington to Cha rl es M. Gandy, 22 May 1883 , 

and SG toj. D. Cameron , 16 Oct 1876, and to A. E. 

33 

BurnSide, 26Jul 1878 , all Entl"}' 2, a nd SGO Or Info, 

29 JlIn 1897, En" ,), 66. All in RG 1l2, NARA . 

23. john Shaw Billings, A Reporl 0 11 Ihe i-l),giclle oj 

fhe United SImes AI1I1)' ... • p. 106; Paul Starr, The Socifl/ TrallsJonlUlliOlI oj A" ,eric{U1 1'vledicillC, pp. 84-85; 

in RG 1l2, NA RA: Ltrs, SG (0 G. W Scofield, 6 Fcb 

1873, and Crane to 1-1. S. Smith, 13 j an 1876, and to 

Med Oirs, 4 Aug l880, Enlr)' 2, and llrs, A. K. Smith 

(0 SG , 28 OC( 1868,].]. Milhau to SG, 25 Feb 1869,]. 

Simons 10 SG, 19 Mar 1869,Josiah Simpson to SG, 24 

Jun 1869, and J. Moore to SG, 9 Jul 1869, Entr)' .12. 

24. Also affected by the restriction were the In· 

spector Genera l's, Quart ermaster's, Adjutant Gen· 

erai's, Engineer, Commissary, Pay, and O rdnance Depanments. Sec AGO GO 15, 11 Mar 1869. See also 

WD, ARoJSG, 1868, p. 7, 1869, p. 10, and 1871, PI'. 

6-7; "Army Medical Staff Bill ," p. 150. 

25. james A. Tobey, The Meelical DepCIJ"tmell1 oj 

Ihe A rill)" p. 23 ; Erna Risc h, Quar/ermas/er Support 

oj Ih e Arm)" p. 511; Robert M. Utley, Frontier Regu. 

lars, p. 15; WD, ARoJSG, 1874, PI'. 20- 21 ; Billings, 

Repor/ 011 I-l),gielle, p. 106; Inge rsoll , HiS/DIY oJWD, 

pp. 209, 286-87 ; in RG l.L 2, NARA: Ltrs, Crane to 

Sutherland , l OcI 1873, a nd SG to \Villhu n ""Vi n· 

dom, 1 JUIl 1878, 10 1-1 . CI}'mer, 5 Apr 1880, and to 

J oseph E.johnston , 5 Apr 1880, Entry 2, and Instrs 

for Med Dirs, 14 Sep 1874, vol. 5, Entry 63. 

26. First quotation from "Army Staff Rank," p. 

373 (see also PI'. 13- 14, 136, 374); second quota· 

lio n from American Medical Association (AMA), Pc· 

/ ilioll oj the AmeriClIII lvfedieal Associ(lt iOIl /0 the Sell· 

ale (mel House oj Represen/fllives ill Behalf oj til e 

,"'ledieal Corps oj the Anti)' ... , App., p. 19 (see <l lso 

pp. 3-4, 11); "Army Medica l Staff Rank, " p. 3 1 J; Har· 

vey E. Brown, The MeeliClII Dep(lrlmell/ of the Vni/ed 

5/(1/cs Ar/ll)' From 1775 101873. p. 203; "Memori al 

of the Ameri c<ln Medic<ll Association," p. 72. 

27. Quotation from Ltr, Crane to Med Oir, Dept 

of Texas, 8 Feb 1.877, Entr)' 2, RG 1 12, NARA. ln loc. 

ciL. , see his simil ar leLlers to Med Dirs, Depts ofPlatte, 

Missouri , Dakot<l, 8 Feb 1877, as well as those to 

Med Dirs, Depts of South, Gulf, Dakota, Platte, Mis· 

souri, Texas, Californ ia, Columbia, 20 Feb 1.877, 10 

J. D. Baynes, 5 J UIl 1877, and to J. B. Downey, 7 jul 

1877; in Enlr}' 63, sec lhose lo "Sir," 1 Aug 1876, vol. 

5, Lo Med Dirs, 3 Aug 1.876, voL 5, to Med Oi l', 6 j an 

and 25 Ma)' 1877, vol. 6, and (0 Med o rrs, 20 Feb 

1877 , voL 6, plus SG to A. E. BurnSide, 13 ju1 1878, 

vol. 7. See also james E. Sefton , Tile Ulli/eel Suites 

Arm)' anel Recollstrllc/ion, 1865- 1877, pp. 250-51. 

28. WD , ARoJSG, 1882, p. 19;Jerr)' M. Coope r, 

TI,e Army (IIu/ Civil Disorder, p. 27; in RG 112, 

NARA: sce, for exam ple, Ltr, SG to A. E. BurnSide, 
34 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

13 J ul 1878, vol. 7, Entry 63, and U,-s, SG to James 

A. Garfield , 2 j u11868, to W. vVi nciom, I ju1l1878, 

LO Burnside, 16 and 26 J ul 1878, to J E. Johnston, 

5 Apr L880. and LO t-I . Clymer, 5 Apr 1880, Elllr)' 2. 

29. Although in 1890 the legislature req uired 

promotion examina tions for all Armyofri ce rs below 

the rank of brigadier general > the regula tion was apparenLl y 11 0 t applied to the Med ical Departmenl. 

Quotation from Pilcher, Sw geoll Gell era/s, p. 69; 

John va ll R. Hoff, "Outlines of the San ita ry Organization of Some of the Grea t Armies of the World ," 

1'. 5 L3 ; SGO Cir In fo, 29 j un 1897, Entry 66, RG 

112, NARA. On the question of rank versus title for 

med ical ofricers, the reader will note that whi le 

Army surgeons are generally rererred to as surgeon 

or assistant surgeon in the 1888 and 1889 annual 

reports, they are consistently given the ir ranks in 

the 1890 and subsequent reports. 

30. Edwa rd M. Coffman , "The Long Shadow of 

the Soldier and the State," p. 80; Utley, Fronlier Regulars, p. 47; Ma rtha L. Sternberg, Ceolge IVli ller 

SlembClg, p. 91; WD, ARofSG, 1889, 1'1'.14-15, and 

1890, p. 12; A Milil(llY t-lis(OIY oj rhe US Army COIl1-

111(1/1(1 and General S/(ifJ Col/ege, ForI Leavellworth, 

K(lIIsas, 1881 - 1963, pp. 5-7; Timothy K. Nenninge r, 

Tllc Leavelllvor/ll Se rvice Scltools (llId lhe Old Army, 

PI'. 6-7; in RG 112, NARA: Telgs, Girard to SG, 24 

j un 1892, and e. H. Alden to Med Oil', Dept of 

Dakota, 26jun 1892, box 13, Entry 17, and lIr, SG 

10 james Laird, 20 j ul1888, Entry 2, and Ltr, SG to 

SW, 15 Feb 1890, Emr)' 22. 

31. WD , ARofSG, 1891, PI'. 13- 14; AGO GO 19, 

26 Feb 189 1, and GO 86, 26 Oct 189 1 (1'1'.41-43, 

46-49); Coffman, Old A rill)' , p. 232. 

32. Quotation from llr, SG to Charles H. Alden, 

27 Apr 1889, Entry 2, RG 112, NARA; in loe. ciL, 

see Ur, O. L. Huntington to e. M. Gandy, 22 May 

1883. See also Raphael E Thian, comp., Legislalive 

l-lislOl)1 oj Ille GClJeral S/(ifJ oj th e Arm)' oj the Ulli/ed 

Slal es ... From 177510 1901, p. 38; Morris]. Asch, 

"Army Medical Service," PI'. 203-04; and the surgeon general's annual reports for numbers of applicants to depanmenl. 

33. AGO GO 55, 27 j ul 1883; Ltrs, Crane to 

William B. Allison, 16 j an 1883, and D. L. Huntington to e. 1-1 . Miller, 16 JUIl 1883, 10 Charles A. 

Stunner, 5 j un 1884, IOjohn Raymond , 8 Oct 1884, 

to W. E. Fisher, 22 Nov 1884, and to A. e. Mooreland , 28j un 1886, and SG to E M. Cockrell , 26 Apr 

1884, to e. H. Penrose, 11 Dec 1886,10 Med Oil', 

Dept of Columbia, 2 Feb 1887, and 10 joseph R. 

Smith , 17 feb 1887, Entry 2, RG 11 2, NA RA; Robe rt 

S. Henry, The Armed Forces I11 sl.iluLe oj Pathology, p. 

L54 (hereafter cited AFIP). 

34. Erwin H. Ackerknecht, A S/,orf His/ol)' oj 

Medicine, p. 194; AGO Cir 9, 6 Aug 1892; AGO GO 

76, 16 Dec 1887; in RG 11 2, NARA: Ltrs, Charles 

R. Greenleaf LO Fred e. Ainsworth , 24 Dec 1887, 

and to Post Surg, Davids' Island , 26 Mar 1888, Enlry 

2, and Lt r, Greenleaf to Stephania Mikulcwicz, 14 

Ma r 1890, Entry 22. 

35. "The Ra nk and Pay of the Hospital Stewards 

of the Ann ),," pp. 670-71; Ltrs, Crane to j oseph Anderson, 21jun l871, and to Med Oir, Dept of Gulf, 

10 jun 1873, Entry 2, RG 112, NARA; Paul R. 

Cutright and Michael j. Brod head , Ellioll COIICS, p. 

107; j ohn M. Hyson, "William Saunders," p. 436. 

36. j ohn Shaw Billings, "Notes on Military Medic ine in Europe," pp. 236-37; AGO GO 78, 6 jul 

1874, GO 30, 9 May 1877, and GO 47, 15 Ma r 1881; 

in RG ll2, NA RA: Llr, AG to SG, 19 Sep 1872, vol. 

16, Entry 10,and Ll r,SGO to R. Murra}', 20 Feb 1880, 

vol. 1, Entry 16, and Ltr, SG !O]. O. e. Atkins, 5 Feb 

1877, Entry 2. 

37. Quotation from WD, ARofSG , 1886, 1'. 35; 

ibid. , 1885, p. 39;j ohn van R. Hoff, "\¥hat is a Hospital Corps? ," pp. 315-16;junius l. Powell, "Some 

Observa tions on the Organization and Effici ency of 

the Hospital Corps ... ," pp. 330-31; Coffma n, Old 

ArIllY, p. 381; AGO GO 62, 4 jun 1885; in Entry 2, 

RG 112, NARA: Ltrs, D. l. Huntington to Bernard 

Persh, 13 Sep 1884, to Med Oil', Div of Atlantic, 24 

Sep 1884, to H. C. Gesserer, 18 ju11885, to B. B. Gell , 

7 Apr 1886, and to Andrew E Pete rs, 22 jun 1886, 

and SG to Med Oi l', Dept of Ari zona, et aI. , 21 j un 

1886, and SGO to E. L. Bragg, 15 j an 1887, and C. 

R. Greenlea f to 2d Compt, Treas Dept, 13 j ul 1889. 

38. First quotation from Russell E We igle)', I-l is101 ), oj Lhc U,liLed SlaLes Ar",y, p. 290; second quota tion from WD, AHofSG, 1885, p. 39; ibid. , 1886, 

p. 35; Graham A. Coslllas, All Army Jor Elllpirc, pp. 

17-18; james l. Ab rahamson, America Arms Jor (I 

Ncw Centlll)" p. 61; Coffman, Old Arm)" p. 396. The 

motivation fo r the establishment of the Hospital 

Corps was not entirel y identical with that for the 

service corps sought by other departments (see 

Risch, QIUlrferlllClsrer SupporL , pp. 561-62, 565) 

since the Med ical Department had broken free befo re the Civil "Var of many of the problems caused 

by temporary detailing of civilians and enlisted men 

to se rve as stewards (see Ma ry e. Gillett, Ti,e Arm)' 

l'vleciiml Depllrtlllellt, 1818-1865, PI'. 129-30). 

39. Ltrs, D. l. Huntington to Post Surg, Watervli et Arsenal, 5 Nov .1.885, and e. R. Greenleaf to F. 

e. Ainsworth , 29 Apr 1887, to Med Dirs, 7 jan 1889, 
VIEW FROM THE TOP 

and \0 2e1 COmp1, Treas Dept, 13Jut 1889, and sea 

Cir 1, 26 Apr 1889, Entry 2, RG 1l2, NARA; WD, 

SeD, seD, p. 45. Unless ot herwise indi cated, all 

materia! on the I-I ospila l Corps is based on AGO GO 

56, 11 Aug 1887 , from which thequolation is taken. 

40. ltrs, Charl es Smart to C. W. Mill er, 8 Jun 

1888, and C. R. Greenl eaf \0 Smart , l OcI 1888, 

Entry 2; Note [initialed eRG], 22 May 1890, Entry 

22. All in RG 11 2, NARA. 

4 l. First and second quotations from Ltr, John 

van R. I-Ioff to SG, 13 OCI 1888, Enl'-), 17; third quotation frolll l. W. Crampton to Mcd Oir, Dcpt of 

Plaue, 26 SCI' J 888, Entry 17; and fo urth quotation 

from Uf, SG to C. E. Hooke r, 2lJan 1889, Enlry 2. 

All in RG 1.12, NARi\. In loc. cil. , sec Ltr5, Joseph 

K. Corson LO Med Dir, Dept ofColumbia.8Jul 1888, 

and C. Page to SC, 19 Nov 1889, Entry 17, and SG 

to Chair, MiiAffs CnHe, I-I offieps, 24 Mar l 888, 

Entry 2. See also Charles Sutherl and, "Organization 

of Hospital Corps," in P(ln-Alllcricclll Mcdic(l/ ( 01 1-

gress TrmIS(lctiOlIS, 1 :688;Jack D. Foner, TIle United 

s/(Iles Soldier Between TIvo Wafs, pp. 84-92. 

42. WD, AllojSG, 1888, 1'1'. 14 1-42 , 1889 , p. 9, 

and 189 1, pp. 10-13; Ltrs, C. R. Greenleaf to George 

Dieffenbach, 1 Dec 1887, to E. P. I-larrison, 6 Ma r 

1888, to Post Surgs, 7 Aug 1888, to 'vVilliam Evens, 

27 Aug 1888, and to Harry ]. Ramsey, 9 Sep L889, 

and C. Sman to Charl es H. Swan, 27 Mar 1888, Ell t I")' 

2, RG 112, NA RA. 

43. WD, ARojSG, 1866, PI'. 2- 3; Paul S. Peirce, 

The Freeclmens BII IWIII , pp. 44,48-49,87--89, 91- 92; 

J"lessage From tlte President 10 file Two 1-Iollses of COIIgress at fhe COIIHll ellCCllIelil of Ihe secolI(l ion oj 

lite Fortieth Congress . .. , ed. Ben. Perl ey Poore 

(Washington, D.C.: Government Printing Offi ce, 

1867), pp. 472, 478, 480-82, 494; Message frollll" e 

Presidenl oflhe Uniled SLafes 101/leTwo HOlIse50fCOIIgress 1II file Comllle/I cemen{ oflh e Third Session oJlh e 

Fortiel h Congress, ed. Ben. Perl ey Poore (Washington, D.C.: Government Printing Office, 1869), pp. 

49 L, 499; George R. Bentley, A l-lislOl)' of til e Freedmens BIIreelll , PI'. 76, 209; in RG 11 2, NARA: Ltr, SG 

LO Freedmen's Hospital, Wash., D.C., 19 jul 1872, 

Entry 2, and Rpl , Samuel jessop, 15 Jan 1869, Entry 

51 , Charleston, and AGO SO 435, 31 Aug 1866, and 

SO 266, 1Ojlll1 1867, Elllr)' 57. 

44. WD, ARojSG, 1866, PI'. 3-4; Ltrs, Crane to 

j . D. V\Z Grady, 1 Aug 1865, and]. S. Billings to Monroe 6;( Ga rdiner, 10 May 1867, En try 2, RG 112, 

NARA. 

45. WD ,ARojSG, 1876, PI'. 4-5, .1 877, p. 4, 1881, 

pp. 4-5, and 1892, p. 7; Lt rs, Crane to Hugo 'vVrUlgelin, 3 Aug L879, and loj ay Gould , 6j an L871 , and 

35 

SG to Com of Pensions, 15 Ju n 1872, Entr)' 2, RG 

112, NARA. 

46. QuoLaLi on from lIr, SG to john Findla)', 22 

j an 1886, Entr)' 2, RG 112, NARA; WD, JlRojSG , 

1891., p. 6, and 1892 , 1'.11. 

47. WD, ARojSG, 1892, 1'1'.7- 8, 1.0. 

48. Among Billings' later designs was the Johns 

Hopkins HospitaL 

49. Fielding H. Garrison, Joltn Shel\\l Billings, pp. 

278-335; Miles, HislOl)'ojNU,I, 1'.106; Paul R. Goode, 

The Ullileel SlmesSoltliers Home, pp. 28, 51, 91, 93- 94, 

97, .102; Constance McL Green, Washington, p. 310; 

Billings, ~eporl 011 Hygiene, pp. I,,- Ivi; in Entr)' 2, RG 

112, NARA: Agreement ,SG and Sisler Loretta O'Reilly, 

3 Dec 1868, and Ltrs, SG to Moses Kelly, 8 Aug 1868, 

to U.s. Sen and Homeps, 6 Dec J869, to Pres of Scn 

and Spea l<er of H, 10 Dec 1.870, 10 U.s. Sen and 

Hoffieps, 13 Dec 1872, and to Aprops Cmte, 5 Dec 

1874,and CraneLo Eels,Am Ellcyc/opedia, 10 Mar 1876. 

50. WD, ARojSG, 1883, p. 15, and J884, p. 19; 

Mabel E. Deulrich , Slrugglefor Supremacy, pp. 22, 

27, 32. 

51. WD, ARojSG, 1866, p. 6; ibid. , 1883, p. 15, 

1886, p. 5, 1. 887, PI'. 4-5 , and 1888, p. 5; Dcutrich, 

Slruggle, p. 22; in RG 11 2, NARA: Orders, SW to 

SG, 21 j un 1873, vol. 17, Entr)' 10, and Ltr, j. S. 

Billings to N. Va n Clernam, 26 Jul 1879, Entry 2. 

52. WD , ARojSG, 1870, p. 5; Deutrich, SlllIggle, 

PI'. 27- 28; in RG 112, NA RA: Ltrs, SG to j. A. 

Garfield, 2j ul1868and 23 Feb 1869, and to W. \¥indom, 10 Feb L877, and Ltr, Crane to J. J. Woodward 

and to George A. Otis, 22 Aug 1870, Enll"y 8. 

53. Oeutri ch, slruggle, pp. 21, 26-30; in RG 112, 

NARA: Orders, SW to SG, 21jun 1873, vol. 17, EnL ry 

10, and Ltrs, SG toj. A. Garfield , 2juI1868, to 1-1 . Williams, II Mar 1874, lo501 M. Merrill, 2 May 1874, to 

Com, IndAffs, 14 Jan 1876, to Vv. 'Wi ndom, 10 Feb 

1877, and to Oi\' Heads (va rious), 9 jun L885, and 

Crane to Campbell Williams, 3j ull 1877, LO PostSurgs, 

20 jull881 , and to Page, 25 jul l 881, all Elllr)' 2, plus 

SGO Cir, 27 jul 1883, and Orders, SG, 3 Aug 1.883, 

vol. 7, Entry 63. For more detail on this problem, see 

the surgeon general's annual reports for the period. 

54. WD , Jl RojSG, 1888, PI'. 137- 38, and 1889, 

p. 13; Deulrich , Struggle. pp. 30-34, 36-43; Ltrs, D. 

L Hunlington to T. T. Carso n, 29 jun 1887, and to 

Robert B. Va nce, 2 Feb 1887, and Orders, SG, 25 Jun 

and 14 ju11 887, Entry 2, RG 112, NARA. 

55. WD, ARojSG, 1891, p. 15, and 1892, pp. 

17- 18; AGO Cir 6, 3 jul 1. 891; SGO Cir, 9ju11890, 

Entry 22, RG 11 2, NARA. 
36 THE ARMY MEDICAL DEPA RTM ENT, 1865-1917 

56. WD , ARofSG, 1867, 1'. 4, l880, Pl'. 17-l8, 

and 188 1, pp. 16-17; Miles, I-lis/OI)' oJNLM , p. 28; 

Henry, AFII', Pl'. 54, 73-75. 

57. The library and Museum Division was pan 

of the Surgeon General's Ornec. 

58. The li br'\J)' and museum had iniliall)' been 

separate organiza tio ns. Quotation from \.yD, 

ARofSG,1885, p. 36; ibid. , p. 35, and 1888, 1'. 140; 

AGO GO 31, 19 Mar 1885; Miles, l1islOl)' of NLM, 

Pl'. 163-64,l68; Henry,AFlP, Pl'. 79-80; in RG l12, 

NAR1\: Orders, SG, 28 Dec 1883, and Ltrs, D, L. 

HUlllinglO1l to Edga r A. Means, 24Jan 1884, and SG 

to 'Will iam Mahone, 14 Dec 1883, 10 Hoffieps Mbrs, 

Conf e ml !':, .12 Feb 1885, and to Chair, Sen Aprops 

e mit, I Mar 1887,<111 Enlr)12, plus Pamphlet, 1883, 

vol. 7, Enlr)' 63. 

59. John S. Chambers, Til e COllqllest oj Cllofcm, 

pp.335,344,348; PClcrBald l)', Th e Ball/eAg(lillsl Bac· 

leri(l, pp. 30-3 1,37; \"'e5Ic)' \V Spink, Infectiolls Dis ~ 

ellses, Pl'. 7-8, 162, l65, 363, 428-29; Fielding H. 

Garrison, All IIu roclllCfioll fo fh e HislOIY oj Me(licille, 

3d rev. ed . and enl. , PI'. 620--2 1, 623-24, 633-35. 

60. Garrison, Histol)' oj Meclicillc, pp. 578-79; 

Richard H. Shryock, l"leelicilll~ ill America, PI'. 29-3 1, 

7 L; Ackerk neclll, Shorr l-li5lol)', pp. 209-11; ~ 

neth M. Ludlll erer, L C(lrllillg To Heal, PI'. 4, 18, 

23-26,83-84, ll9, 178, 235, 245; William G. RO lhstein , AlIJcrialll PllysicillllS ill fh e Nille/eelllh CCltflll)', 

Pl'. 265-66, 285-94. 

6 l. Bcfore j oseph Lovell was ap pOinted surgeon 

gene ra l in 18 18, the Army had no permanenl ~ 

ical service, and although the titl e or surgeon gen~ 

era l was sometimes used , it was nOlgiven to the head 

or any or the temporary medica l se rvices crea ted to 

mee t wart ;me needs. During the \Vaf or 18 12J ames 

Tilton was given the titl e or phYS ician and surgeon 

gelleral. 

62. James H. Cassedy, "N umbering the North's 

Medical Events," PI'. 232-33. 

63. DOfOl hy M. Schullian and Frank B. Roge rs, 

"The Na tional Li brary or Medicine," p. 11 ; "VD, 

ARoJSG, 1872, p. 10; Ltr, Billings 10 Will iam \Vesley, 

27 Jul 1867, En,,)' 2, RG I l2, NARA; John Shaw 

Billings, "Who Founded the Na lional Medical Li ~ 

brary? ," p. 299; idem, Sclec/eel Papers, PI'. 4, 8 1 ;james 

H. Cassedy, Medicine ill America, PI'. 77,85. For a e~ 

tail ed d iscussion or post-Civil "Var history or the Sur· 

geon Genera l's Library, see Miles, His/OI)' oJNUIII, on 

which, unless otherwise indicated, much or the Illa· 

terial in Ihis chapler concerning the library is based . 

64. Publi ca tion or the lnde..'( C(lw/ogllc ceased in 

196 1. Firsl quotation rrom Ltr, SG to Thomas Sel· 

lIe, 20 Aug L872, Entry 2, RG 112, NARA; second 

and third quotations ci ted in Miles, HisfOl)' oj NLM , 

p. 129. In Emry 2 above, see Ltrs, Bi llings to H. R. 

Sporrard, 12 Feb 1872, and SG 10 L. M. Morrill , 9 

Feb 1872, to M. vVunz, 22 Ma)' 1872, and 10 John 

Ealon, 25 Nov l872. See also WD, ARofSG, l874, 

p.l9, l878, pp.17- 18, 1879,p. l 7, l881, p.l6,and 

L882, PI'. 16- 17; Billings, Popers, p. 229. 

65. Billings, Papers, PI'. 229-30. 

66. WD, ARofSG, 1875, pp. 15-l 6; War Department, Surgeon Generals Ofrice, TIre Cholera Epi· 

dcrll ic oj 1873 irr lire Vlli/ ed S/afes; Orders and Llr, 

SG to Ely McClell an , 7 May and 24 Dec 1874, Enlry 

2, RG 11 2, NA RA. 

67. Q uotation rrom WD , ARofSG, 189.1 , p. 7; 

I-len I) ', AFIP, pp. 36, 51-66; Ltr, D. L. Huntington 

to E. A. Means, 24j <tn 1884, Entry 2, RG 11 2, NARA; 

Esmond R. Long, A HisfOl)' oj Americall Pafh%gy, 

p. 167. 

68. Q uol<ttiolls rrom Ashburn, His/DI)' oJ 1'1'10, p. 

134; WD, SGO, Medial/ ond SlIrgiw/ HisfOlY, 

l-2:374. 

69. Q uotations rrom Garrison , Billings , p. 342; 

ibid ., Pl'. 152, 411;JoI1l1 Z. Bowers and Elizabeth P. 

Purcell , cds., Adv(lIICCS ill Amcrican Medicilr c, 1. :347; 

vVi lliam D. Foster, A Histol)' oJMediw/ BClc/eriology 

wu/lllllllllllolog}', p. 65. 

70. The slory or the museum and its transrormation into the Armed Forces Institute or Patholog)' is told in deta il in Henry, AF/P. See a lso Ltrs, SG 

10 C. Cole, 15 May 1872, and D. L. Huntington to 

L. C. Pilcher, 4 Ma r 1886, Emr)' 2, RG 11 2, NA RA ; 

SGO Cir 2, 4 Apr 1867; WD, ARofSG , 1866, p. 8, 

1868, p. 6, 1870, Pl'. 9-10, 1873, PI'. 8-9, 1874, pp. 

15n- 16n, 1876, Pl'. 17-18, and 1877, Pl'. 12-13; 

George A. Ot is, "Notes on the Contributions to the 

Arm)' Medical Museum by Civil Practitioners," p. 

164; John E. Erichsen, "Impressions or American 

Surger)'," p. 720; "Science Schools and Museums in 

America," p. 290; j ohn Shaw Billings, "On Medical 

Museums," PI'. 309, 3 11; M. C. Leikind , "f\nn)' 

Medi ca l Museum and Armed Forces Institution or 

Pa tholog)' in Histori cal Perspective," p. 75; Long, 

Alll criw lI Palll% g)" p. 128. 

7 L. First quotation rrom Henry, AF/P, p . .1 4; sec· 

ond quo tation rrom WD, ARofSG, 1886, p. 33. See 

also ibid ., l888, p. 141. 

72. Quotalion rrom "VD, SGO, Medica l a/l(l 511/'· 

giw l l1islOl)" l-2:374; ibid ., 336-47, 367, 651, 653, 

and 1-3:500-508; George H. Daniels, cd., Ninc· 

fec llt/t-CCII /III)' AlllericclII Scicll ce, p. 177; Henry, 

AFIP, pp. 89-90; Owen 1-1 . \Vangensleen and Sa rah 

D. \OVangensteen, Thc Rise oj S"rgp), From Empiric 
VIEW FROM THE TOP 

Crafl toScicllfiJic Discipline, p. 507; CassCcl)l, "Nulllbering Medi cal Events," PI'. 232-33. 

73. First quotation from address given b}I Virchow on 2 August 1874, cit ed in AMA, Petition , p. 

L9. (This quotation from Virchow is a popular one, 

alt ho ugh ra rely reproduced at length. William G. 

Morgan's assumption that Virchow was specifically 

referring to the Medical Allei SIII:gica / HisIOf), is apparenti)' a COlll illon one. 13tH in the address as published in "Summary," pp. 299-300, as well as in 

Kober, RClll illisccllces, p. 224, in the AMA , Pelilion, 

p. 19, and very brien}, in Wi ll iam C. Morgan, "ConI ribul ions of the Med ical Department of the United 

Slates Army 10 the Advancement of Knowledge," p. 

781, Virchow refe rs an I), to Medi ca l Department 

publi cat ions in genera l. Thus, since only one pa rt 

of each volume of the McdiCli/ (111(1 SlllgiClill-lisfOI)' 

had appeared by 1874 a nd since medical officers 

wcre responsible for many other publica tions in the 

pe riod 1865-1874, it seems li kel y tha t Virchow held 

more tha n Ihe MediCli l (III(/ SlIIgiC(I / /-l i5(01), in mind 

when he spoke.) Second and third quotations frolll 

James H. Cassedy, Alllcd a m l'vlcdicillc (md SWlisfiCli / 

TIJi Jlhil1g. 1800-1860, p. 238. Fourth quotation from 

37 

Esmond R. Long, "The Arm)' Medica l Museum," p. 

370. Sec also idem, Alll cri a lll Pathology, 1'. 129; 

Cassedy, Medicine in AmeriCll , p. 66; AMA, Pefilioll , 

p.20. 

74. Bill ings, P(lperS , p. 264. 

75. Stern berg bec,llllc surgeon general in .1 893. 

First quotation fro m Ashburn , Hi stOl)' oJI\IIO, p. 148; 

second quotation frolll Sternbe rg, Slcnlberg, p. 88. 

Sec also ibid. , PI'. 67, 70-87, 91-92;John Mendinghall Gibson , Soldier ill White, pp. 136-37; Asch, 

"Army Medical Se rvice," PI'. 203-04; Ltr, Stern berg 

10 SG, 27 Nov 1883, Ms ClOO, NLM. In 1892Slernberg provided a group of scient ists with Ihe c\ela ils 

of his wo rk producing imm uni t)' to sma ll pox in 

ca lves, to inc lude data on an experi me nt that demonstrated the in vilro effects of immune se rum on the 

vaccine virus. See George M. Sternberg, "Practical 

Results of Bacteriological Researches," pp. 68-86. 

76. Q uotation from SGO Cil" Order 3, 20 Aug 

1877, vol. 6, Ell tr)' 63, RG 11 2, NARA; Garrison, 

/-l is/ol)' of Medicine, PI'. 588-91 ; Phal en, Chiefs , p. 

56; WD, ARofSG, 1884, p. 32, and 1885, p. 27; Gen 

1-1 . Brieger, "The Developme nt ofSurge r),," in OavisChristopher Tcxtbooll of SlIIgCIY, Pl'. 9- 10. 

Chapter 2 

SUPPORTING THE ARMY 

The administrative dirnculties enco untered in the Surgeon General's Ornce in the 

first decades after the end of the Civil War 

did not significantly affect the work of military physicians serving posts scattered 

about the Un ited States. Neither Reco nstruction in the South, where "federalmilitary activity ... was negligible," according 

to historian John Hope Franklin, nor labor 

unrest in the more northern states in 1877 

brought major new challenges. Wherever 

they were, Army surgeons con tinued to care 

for soldiers who had to endure long hours 

of physical labor under miserable conditions 

and disability from the ravages of disease. 

Because of corruption and wrangling between government and private contractors, 

the prompt and reliable delivery of the items 

or diet needed to preserve health still could 

not be guaran teed, even after the nation's 

railroad network had spread far through the 

West and refrigerated cars had joined the 

other cars that ran the rails. Finally, until the 

germ theOlY was widely accepted , Army 

physicians had no reason to change the way 

in which they attempted to main tain the 

health of the garrisons they served. ' 

Preventive Medicine 

In the United States in the decades immediately foll owing th e end of the Civil 

War, preventi ve medicine remained the 

only effective wea pon agai nst disease. The 

publ ic health movement was just beginning to gain real momentum. Although 

military physicians did no t understand the 

re lati onshi p bet\veen poor sanitation and 

disease, they traditiona ll y recognized the 

importance or preventive medicine. The 

su rgeon general emphasized his belief in 

th e vital role played by sanitation in mai ntaining the health of th e Army by requiring surgeo ns to report regularl y to him 

about the co ndition of their posts. Line offi cers were not motivated to take the recommendations of post surgeons seriously 

until 1874, when the Army requ ired the 

la tter to submit orn cial reports on post sanitation to the commanding orficer, who in 

turn had to record any objections and then 

forwa rd the reports to the command er o f 

the terr itorial command .

2 

Immuni zation against smallpox was , 

li ke sanitation, a weapo n in th e fi ght 

against d isease that was employed by the 

Army fa r more than it was by the civilian 

population. An anti vaccinati o n movement 

that d iscouraged immunizati on contributed to a rising incidence of smallpox in 

the communities near military posts and 

increased the exposure of soldiers to the 

d isease. Although vaccination was mandatory in the Army, those who had not been 

immuni zed for several years or who had 
40 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

been vaccinated with questionable material might be susceptible to th is highl y contagious and dreaded disease. Authorities 

blamed a postwar leldo\vll in precautions 

for an epidemic amo ng black soldiers that 

resulted in more than 800 deaths in the 

year ending 30 June 1866.3 

In spite of the Medical Department's effan s to preve nt illness, Army physicians 

still encountered a high rate of both disease and discharge for chronic disease and 

disability, and even occasional terrifying 

epidemics. Many more soldi ers were discharged beca use of the effects of rheumatism , venereal disease, hean disease, alcoholism, hernia, epilepsy, dysentery, and 

chronic respirato ry disease than because 

of crippling wounds. From 1 July 1868 

through 30] une 1873 the rate of discha rge 

for blacks and whites combined averaged 

32 per 1,000 men, a figure that Surgeon 

Genera l Barnes allemptedto put into perspective for the secretary of war by pointing out that during the period 1861- 1870 

the annual discharge rate for British troops 

sta tioned in the United Kingdom was 

33 .76 per 1,000' 

Major nuctuations in the overall disease 

rate in th e Army from year to year resulted 

chi eny from epidemics of cholera and yellow fever. Because both illnesses were associated with "dirt and unclean habits" 

(wrongly in the case of yellow fever, which 

is transmitted only by several species of the 

Aedes mosquito, most often Aedes aegypli), 

they were grouped with those that medical 

scientists classify as "filth diseases," spread 

through the feces and urine of their victims. U.s. soldiers were vulnerable to both 

cholera and yellow fever. Any immunity 

acquired from cholera is short-lived, and 

although one allack of yellow fever conrers permanent immunity, wilHe r temperatures in th e United States were too cold 

for the Aedes (legypli to survive. Epidemics 

of yellow fever occurred only when ships 

from Caribbean pon s where the disease 

was endemic brought these insects with 

them to the United States. A large majority of soldiers came from north ern cities; 

because of the vulnerability of Aedes aegypli to low temperatures and the durati on 

of the voyage from the Caribbean, th e likelihood of their gai ning immunity to yellow 

fever was small . Together the two diseases 

were responsible for almost half the total 

numbers of Army deaths from all causes. 

Onl y 9.7 percent of the fataliti es among the 

blacks and 13 percent among the whites 

resulted from wounds or injuries in 1867. 

Wi th blacks nowserving in the Army, medical offi cers studying possible racial differences in disease susceptibility noted [hat 

whil e 10.7 percent of total deaths among 

blacks resulted from yellow fever, the comparabl e rate among whites was 31.6 percenl. The number of cholera fataliti es 

steadily declined after 1867, whereas in 

1868 yell ow fever deaths were high. Beginning in 1869, disease rates from all 

causes fell, largely because of an overall decrease in yell ow fever and cholera cases' 

Yellow fever struck units in Florida with 

panicularseverity in the decade after the end 

of the Civil War. In 1867 it killed one soldier at Key West and twenty-seven more at 

Fan Jefferson. The surgeon general asked 

theAnnysurgeons involved to send him any 

information they had on how the epidemic 

might havestarted, and by 1868 Billings was 

actively attempting to add more books on 

yellow fever to the Surgeon General's Library. In 1869 yellow fever hit Pensacola. 

Despite efforts to isolate the garrison from 

the civi lian population, among whom the 

disease first appeared, twelve soldiers at Fort 

BalTancas fell ill and died. While assigned to 

the post, Assistant Surgeon Sternberg, then 
SUPPORTI NG THE ARMY 

a captain, contracted yellow fever, acquiring 

both a life long immunity and a lifelong interest in the disease 6 

Yellow fever reappeared at Fo rt j efferson in 1873. The attempt to spare the garrison by moving some men to Loggerhead 

Key was only partially successful ; a few 

cases occurred within fi ve days of arrival 

at the new site. Almost all those who remained at the fort fell ill , and thirteen of 

the twenty-fi ve who contracted the disease 

died. Moving the garrison stationed in the 

Mobile, Alabama, area proved more successfu l; although many civilians in Mobile 

died, soldi ers were spared. The disease 

continued to foll ow essentially the same 

pattern in subseq uent years, threatening 

posts fro m Charlesto n to New Orleans. 

The Army continued to respo nd in the 

same way, moving as many men as possible away from stricken areas until the epidemic had run its course, an approach that 

was generally effective. Among those who 

contracted the disease, mortality remained 

high, with a third or more dying. ' 

In 1879 Sternberg was detailed to join 

the civilians on the newly crea ted Havana 

Ye llow Fever Commissio n of the National 

Boa rd of Health ,S which had been formed 

following a dead ly yellow fever epidemi c 

the preceding year. With three other members, Sternberg traveled to Cuba to study 

the disease. Two of the men with whom 

Sternberg worked, commission member 

juan Guiteras and Carlos Finlay, an adviser 

to the commission in Cuba, would later 

play significant roles in the Army's struggle agai nst yellow fever, but at this time a 

year's study led only to the co nclusion that 

the science of bacteriology had not yet progressed to the point where the secrets of 

this deadly disease could be revea led. Despite strong efforts, the Medical Department lacked an effective wea pon aga inst 

41 

GEORGE M. STERNBERG 

yell ow fever except flight. Without an un -

derstand ing of how it was spread, doctors 

could not otherwise prevent it, and the 

purges and emetics still used to treat almost all diseases were of no avail as a cure 9 

Although yellow fever was widely 

feared , cholera coul d be more dangerous, 

especially in epidemic years. Because 

cholera was spread mainly through water 

co ntaminated with the cholera vibrio, it 

was not confined to the South. At the time, 

the understanding of how this disease was 

spread was limited . Although an English 

physician, j ohn Snow, had proved in the 

1850s that water co ntaminated with the 

feces of cholera victims transmitted cholera, medi cal historian Wesley W. Spin k 

maintains in his InjectioLls Diseases: Preventioll allc/ Trea tll1e1lt ill tile Nilleteellt/, all c/ 

Ii.elltieth Cell tlll·ies that "it was not until 

1892 that the etiology and mode of transmission of cholera was recognized." Ma ny 
42 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

in the United States who accepted the idea 

that cholera was "portable" continued to 

believe that something in the atmosphere 

was also involved or that "predisposing 

causes" were necessary for its spread. The 

number of titl es that Billi ngs listed in his 

1875 bibliograp hy on cholera illustrate the 

widespread concern caused by this disease, which could survive in almost any 

climate and kill in a matter of hours. In 

1864 another worldwide pandemic struck 

the United States, causing 278 fata lities 

along the coast of North Carolina, and by 

1866 the disease was spreading to the West 

at a rapid raLe, helped in part by the failure of the Army to realize that those without symptoms could be carrying the disease. Some mild cases of cholera might 

have been diagnosed as simple diarrhea, 

which also afflicted the Army at this time. 10 

From collecting points on Governor's Island in New York harbor, where "carcasses, 

offal , and noating debris of every description" covered the beaches, soldiers and the 

cholera vibrio boarded trains and boats together to journey to Fort Monroe, Virginia; 

to forts on the Mississippi River; and to 

posts in Missouri , Arkansas, and Texas. 

From July through December 1866, 192.6 

of every 1,000 white soldiers and 258.4 of 

every 1,000 black soldiers contracted Asiatic cholera. More than 40 percent of white 

cases were fata l; almost half the total of 

1,527 white soldiers dead from disease in 

1866 and 1867 fell victim to cholera, whil e 

wounds or other injuries killed only 155 . 

The Medical Department, its interest in the 

question of the extent to which health varied according to race unabated since the 

Civil War, noted that blacks, too, suffered 

severely from cholera, more than half the 

black victims dying. Their mortality rate 

from all causes was 12 percent, three times 

that of whites, and chol era caused twothirds of the total of 536 black fatalities. 

Cholera also killed several medica l offi cers 

and contract surgeons, including one who 

had left his sickbed to care for his patients. 

Among the civilians succumbing to cholera 

at Fon Harker, Kansas, in the summer of 

1867 was Sternberg'S first wife, and for 

some time after th is tragedy he "was unfitted [sic] for duty from physica l and mental prostration. " II 

Because of repea ted epidemi cs since the 

first in 1832, Asiatic cholera was more familiar by the late 1860s, but Army surgeons treating patients stricken with the 

disease were still unable to mitigate its terrifyingsymptoms. Despite their efforts, the 

cholera victim suffered from 

diarrhoea , vomiting and purging of rice water, 

cramps, collapse, cold surface, cold eX lr mi ~ 

lies, cold tongue, cold breath, . .. leaden 

hue . . . , shrunken features, anxious expression , sunken eyes . .. , incessantlhirSl, ... enlire suppression of urine, jactitation [LOssing 

back and fOfth] > nervous agitation, sometimes 

slight delirium, [and ] finally coma from 

uraemia, loss of pulse. and death. 

The mere sight of such a victim was 

horrible even after his death because of 

the corpse's "very striking ... muscular 

movements." 12 

With Army physicians unable to prevent deaths from cholera , the Medical Department redoubled its efforts to avert epiclemics. Especially after 1868, the most 

favored approach involved quarantine; 

men were moved neither into nor out or 

infected areas. Often when the need for 

such an approach became obvious, troops 

had already spread the disease far and 

wide. Efforts to prevent local contagion 

among the soldi ers at each individual post 

sometimes required "extraordinary precautions." A guard might be stationed over 
SUPPORTI NG THE ARMY 

th e latrines to require any man who had 

"two actions of his bowels within twentyfour hours" to use an "earth closed commode" the next time so "that its character 

might be inspected." Considerable attenti on was focused on the quality of the 

d rin king water and upon improved sanitation. Water might be sent to the department in Washington for testing, but this 

step was ta ken in the belief tha t any "organi c matter" in it was harmful to the patient who was already suffering from 

cholera. Potassium permanganate was 

used to purify wa ter found to contain such 

"organic impurity." 13 

Army surgeons also impl icated crowd -

ing, bad ventilation, "crowd poisoning," 

and human waste as factors contributing 

to cholera outbreaks. They in tensifi ed efforts aimed at keeping quarters "scrupu -

lously clean" and latrines disinfected in 

ti mes of epidemic; interest in disinfectants 

and methods of d isinfecting was considerable, even befo re the ro le of germs was genera lly recognized. The presence or vermin 

and swarms of fli es was noted at one New 

Yo rk port where cholera had taken a high 

to ll, but apparentl y no one suggested that 

these creatures we re more than a mere refl ection or poo r sanitation. Those responsible for the care of cholera patients might 

require that their soil ed bedd ing be bu rned 

and their unsoiled bed linen disinfected 

and boiled before laundering." 

The efforts of 1866- 1867 prod uced li ttle in the way of concrete and demonstrabl e resul ts, despite at least one attempt to 

study the blood and urine of victims and 

the appoin tment or a board to study sa nitation and ways to prevent the spread of 

cholera on Governo r's Island . A circular issued inJ une 1868 required Army surgeons 

to use specia l forms to reco rd the details 

of cases of epidemic disease, espec ially yel43 

low fever and cholera. With the coming of 

the public health movement and the use 

of the laborato ry to make prompt diagnosis of the first cases possibl e, cholera 

ceased to be a major threat in the United 

States after its final appearance as a significant problem in 1873. Only after this epidemic did Congress order the Medical Department to conduct the in vestigation of 

the disease, whi ch was carri ed out by Assistant Surgeo n McClellan.

I

' 

In spite of epidemics, the Medica l Department's advice was not necessarily followed, and the conditions under which the 

average enlisted man li ved remained primitive . liousing was put up casually and became increasingly defective with the passage of time. Latrines were poorl y located 

and maintained. Beds were crowded and 

vermin-infested. Although weekly baths 

were required, adequate fa ciliti es were 

often lacking, especially at smaller and 

older barracks and in the yea rs immediately following 1865.

16 

Although the water supply at most forts 

was apparently satisfactory, it was recognized as a possible source of disease. Surgeons could send samples to the Army 

Medical Museum laboratory fo r "biological examination" and "chemica l ana lYS iS," 

but the analysis resulted in a report that 

deta iled only the presence and amoun t of 

chlori ne, nitrites, nitrates, free ammonia, 

albuminoid ammonia, and to tal solids in 

the wa ter, not the presence of bacteria. Although by 1890 many posts were tapping 

in to municipal water supplies, this move 

guaran teed neither quantity nor quality. 

Ex periments with effective means of producing safe city water were under way in 

the late 1880s and 1890s, but as late as 

1911 only 20 percent of city populati ons 

drank fil tered water. Cisterns used to collect rain water could also accumulate for-
44 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

POST H OSPITAL AT J EFFERSON BARRACKS, MISSOU RI 

eign matter if not carefully maintained, 

springs and wells might be contaminated 

by runoff, and summer droughts could 

concentrate pollutants to the danger 

point,1 7 

In working up criteria for improved sanitation, the Medica l Department was particularly concerned with ventilating barracks and particularly with venting sewer 

gases, commonly believed to be capable of 

spreading typhOid and other diseases. 

With the passage of time, therefore, medical officers were increaSingly involved in 

designing and installing effective sewage 

systems. Post surgeons became very 

knowledgeable on the subj ect of the design of sewers, flush toilets, and vent 

stacks, and devoted much time and energy 

to the improvement of post sanitation. 

They rarely seemed concerned, however, 

that even the most effective system discharged raw sewage into the nearest river, 

from which the water supply of the post or 

of some other community might be drawn. 

As garrisons grew in size, the question of 

sanitation became more acute, yet the expense involved in installing new systems 

was discouraging. As a result, some surgeo ns continued to struggle to improve 

sanitation at bases where years of accumulated human wastes oozed to the surface with every rainstorm and the urinesaturated wood of ancient outhouses 

reeked in the sun. Others wrestled with 

problems originating in sewers that, while 

possibly of recent origin, were poorly designed, constructed, and maintained. The 

services of an ex perienced and ca reful 

plumber were necessa ry to ensure the 

proper installation of new sewer systems. 

The proper pipe, the caulking of the joints, 

the venting of the traps, and the ventilation by soil stacks were all important, but 

qualified plumbers were hard to fin d.'· 
SUPPORTING THE ARMY 

Between the inept installation of new facilities and the poor design and co ndition 

of older structures, unusual problems could 

arise. At Jefferson Barracks, Missouri, the 

cold air shaft of the furnace in the hospital 

basement ran within a yard of an open sewer 

vent. Because the wood of the shaft had rotted and was full of holes, sewer fumes were 

drawn into the furnace, heated, and sent 

throughout the building. Furthermore, 

since none of the soil pipes rose above the 

rooOine, few fumes ever left the building. 

When attempts to improve the plumbing 

were undertaken in the 1880s, the post surgeo n faced multiple problems. He insisted 

that he "had closely watched the wo rk as it 

was being done, but under [his] very eyes 

the soldier plumber had his own way." The 

miscreant connected the water closets in the 

new hospital annex not to the new pipe that 

ran to the river but to the old one, which 

led to an abandoned sinkhole. He also set 

venti lation pipes for the water closets so low 

that when a toilet was Oushed, the water 

Oowed in to the ventilation pipe. Rather 

than resetting the pipes after this disaster, 

he fi lled them "so completely with putty 

that neither air nor water could escape. " 

The surgeon reported that "this evil was corrected," but the "discovery and removing 

[of] defective plumbing" continued. The 

deCision to take water from the 51. Louis 

mains, following on the heels of the installation of the new plumbing system, was regarded as "a great san itary improvement" 19 

Another post with a high disease rate 

was Fo rt Douglas, Utah Territo ry, where 

the enlisted men did not have the benefit 

of a sewer and had to use ea rth closets (latrines in whi ch excreta were covered with 

earth) that were "unsuitabl e, offe nsive to 

both sight and smell, dangerous to hea lth, 

as well as indelicate from the mode of operating them." For a while th e sewer serv45 

ing offi cers was not Oushed frequently 

enough, and the odors that resulted mingled with those from the ea rth closets and 

from the "faeca l matter" spilled onto the 

ground when the closets were emptied. 

"The stench [rom this cause and from the 

buildings themselves is very great," the 

surgeon noted. He had also to co ntend 

with "waste pipes of the bath-room and 

kitchens of two barracks" that emptied 

onto the ground so that in winter, with the 

gro und [rozen, their efOu ent Oowed 

"under the barracks, saturating the groun d 

with fi lth." The ground was "strewn with 

fi lth dripped from th e boxes when emptied, filling the air with foul odors," and 

efOu ent from the post poll uted the river 

from which water was drawn.

20 

Old forts in the East experienced similar problems with sanitation. At Fort 

Hamilton, New York, whereas lateas 1890 

most of the garrison was sti ll lodged in 

damp, lea ky, badly ventilated casemates 

that prOVided "just the kind of quarters in 

which rheumatism, pulmonary trouble, 

and low fevers are developed," the enlisted 

men's toilet facili ties co nsisted "of an immense trough with a beam . . laid along 

the fro nt edge on which a man must sit. 

Everything behind is open . ... The disgusting Sights and odors and the lack of 

privacy condemn the plan utterl y. "21 

Recruiters traditionally counted on the 

large northern and midwestern cities to 

provide a major proportion of new soldi ers, but a common assumption was that 

rural areas provided the best soldiers. 

Crowded quarters and poo r sanitation 

were undoubtedly especia ll y hard on the 

morale of 

a )'Ollllg raw recruit, pure as the air upon his 11 3-

live hills, and as verdant as the grass and leaves 

of his rural home, fresh from clean feather-beds, 

butter, eggs and pumpkin pies, when . .. he is 
46 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ordered LO report to the Sergeant . .. , and is s~ 

signed to lillie else than standing room in a dormitory and a place in line LO wail his turn for a 

seal in the mess-room, to a pine-table, tin-cups, 

and everlastingly boiled meaL 22 

Convinced by his ex perience and resea rch that "nothing certainly is more productive of contentment than a generous 

and varied diet," Billings examined the 

Army ration. Far from butter, eggs, and 

pumpkin pies, it was conducive not only 

of poor moral e but of disease as well; the 

field ration consisted principally of greasy 

salt meat, dry bread, and thoroughly 

sweetened coffee, occasionally supplemented with beans. The Army officiall y insisted that it was more than adequate. 

Billings, however, maintained that "nothing can be more certain ... than that the 

ration per se, that is, without addition by 

exchanges and purchases, is insuffici ent. " 

Until the late 1880s the formal ration did 

not contain "any vegetable element," and 

without it, Billings pointed out, the men 

would "soon be affected with the scurvy." 

This defiCiency emanated , apparently, 

from a widespread failure to understand 

the importance of vegetables in the diet. 

Tomatoes were better for preventing 

scurvy than the traditional potato and 

could be easily provided in cans, yet ignorance about their importance sometimes 

led to a refusal to issue them on the 

grounds that they co uld be used only to replace an item in the regular ration. As a result, although at least one surgeon regarded even a single case of scurvy as 

disgraceful, in the years 1865 through 

1874 few forts west of the Mississippi escaped without at least one or two cases. A 

post's record for a single year sometimes 

showed more than a dozen victims, but 

only once did a severe problem run 

unchecked into a second year" 

Despite the growth of the nation's netwo rk of railroads, the increasing availability of canned goods, and the advent of ice 

machines and refrigerator cars to preserve 

fresh foods, the Army ration remained 

grossly defi cient fo r many yea rs. The Medica l Department encouraged soldi ers to 

hunt and garden to supplement their di ets 

and also suggested that a portion of the allotment of such items as bacon, sugar, coffee, soap, and vinegar be sold and that the 

money received in return be used to buy 

more valuable items of diet. To raise their 

own antiscorbutics, however, soldi ers had 

to pay for the seeds from their own pockets, and to save items from the ration in 

order to sell them or trade them to make 

up for defici encies, they had to deprive 

themselves. Some contributed their own 

money toward the purchase of vegetables 

and fruits. Even these options, however, 

were unavailable to members of the exploratory team that Lt. Adolphus W 

Greely led in to the Arctic in 1884. The 

largest number of Army deaths related to 

diet in this period resulted from the failure of a relief ship to arrive before Greely's 

food reserves gave out. With the expedition's contract surgeon among the dead, 

the medical details of the disaster will 

never be known, but the dea ths of twelve 

of Greely's men were attributed to starvation and one to scurvy. Eve n after 1890, 

when vegetables became a required part of 

the official ration, occasional cases of 

scurvy still appeared." 

Other fa cets of the Army's ration also 

came under fire. In the course of his examination of Army posts in 1875, Bi llings 

concluded that it lacked not onl y vegetables but "albuminates" (or protei ns). An 

experiment in preserving beef by freezing 

all the meat for the season in ice and snow 

in early winter was conducted at Fort Bu-
SUPPORTING THE ARMY 

ford in the Dakota Territory. The savings 

in forage that resulted from not having to 

feed the ca ttl e during the winter months 

was counterbalanced by the poor quality 

of the mea t so preserved. Billingsalso questioned the soldier's allotment of bread. In 

his opinion, 18 ounces a day was inadequate unl ess "supplemented by a good 

supply of the starchy vegetables." 2S 

In the final analysis, cooks could spoil 

not only the appeal to the palate but the 

healthfulness of any food, and some items 

were beyond redemption. Billings quoted 

a Civil War authority as saying that "beans, 

badly boiled, kill more than bullets" and 

particularly deplored the custom of detailing unqualified enlisted men to cook 

for hospitalized patients. He noted that the 

Army surgeon who was required to inspect 

the post's food once a week was also required to inspect the way the ration was 

prepared whenever he suspected that a 

food-related disease might be affli cting the 

garrison. Neither cooking nor refrigeration could make sa lt pork palatable in hotter climates. Even in the late 1880s it was 

"condemned as repugnant to the taste and 

Sight" in Texas, but the commissary general of subsistence insisted that it was "one 

of the most important and va luable components of the ration. " 26 

Post surgeons were also concerned with 

personal hygiene. Billings beli eved that 

"next to fresh air and proper food, personal 

cl ea nliness is the most important agen t in 

preserving the mind and body in proper 

working order. .. . A dirty man win, in 

most cases, be a discontented, disagreeab le, and dissolu te man; for the condition 

of his skin has more to do with a man's 

mora le than is generally supposed. " His 

studies of Army posts in 1870 and 1875 revea led his awareness of the difficulties involved in providing bathing facili ties. Both 

47 

offi cers and men seemed to understand the 

importance of personal cleanliness, but a 

poor water suppl y and a lack of adeq uate 

heat all too often discouraged a[tempts to 

bathe. Ava ilable facilities were sometimes 

antiquated, especially in the South. At Fort 

Monroe, where sa ltwater baths were possible in warm weather, "the grea ter part of 

the command do not wash their whole persons from November till June." Billings 

recommended the use of showers rather 

than tubs and urged that warm water be 

made ava ilable. "It is," he noted, "economy 

and good poli cy to make the facilities for 

this purpose such that men shall consider 

their bath a pleasure and a neceSSity." 

Commanding officers generally cooperated with efforts to encourage clea nliness, 

but the secretary of war apparently wanted 

garrisons to set up their own bathhouses 

without charging the government for the 

expense.

27 

The Medica l Department was also concerned about the clothing soldi ers wore. 

In the summer of 1867 medical directors 

in the various parts of the country were 

poll ed for their opinions on the "hygienic 

fitness (for the localities where they are 

now on duty) " of the uniform. One such 

report, printed by the Surgeo n General's 

Office in the spring of 1868, was the work 

of Capt. Alfred Alexander Woodhull. 

Woodhull emphasized the importance of 

different designs and weights of uniform 

for different seasons and climates. He believed that a lighter and better ventilated 

hat was needed for warm wea ther, and a 

different, more protective version for cold 

weather. The und ershirt, its thickness 

varying with the seasons, should reach 

"the middle third of the thigh," thus guaranteeing adequate protection for "the organs most sensitive to changes of temperature. " Woodhu ll suggested that this 
48 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ALFRED ALEXANDER W OODHULL 

garment wou ld be easier to wash if a fabric containing 35-percent cotton were substitu ted for all wool. Beyond this, "compa ny officers should be held responsible 

that their men always wear drawers," both 

for comfort and hea lth, and, in add ition, 

"large and warm leggings" for those at "exposed, north-western posts. " 28 

Woodhull was particularly cri ti cal of 

the design of the Army uniform. It was 

"tight-fitting, wadded," restricting breathing and preventing the evaporation of perspira tion. In the South it was "insufferable 

in the wanner months." The soldier's 

"martial bearing," Wood hull believed, 

should result from his trai ning, not from 

clothing so thick and so tight as to "hold 

th e soldier in position. " In 1878 commanding officers in the Deep South were 

permilled to use lighter-weight clothing, 

some of wh ich had to be purchased out of 

the individual soldier's sa lary.'· 

The combination of complaints from 

the South about clothing that was too 

warm with complaints from the No rth 

about the inadequacies of cotton underclothing during harsh winters only served 

to emphasize the need for a new approach 

to the design and fabri c of uniforms. In 

1893 a medical officer maintained that recent changes in clothing had only made 

matters worse. 

It seems essen tial to ti e the soldier clown with 

straps and strings and then load him up like a 

freight car. He is half-choked with high-standing collars; he has straps ingeniousl)1 arranged 

across his chest so thal he cannOL breathe by 

his chest muscles; he has belts and cloth ing so 

tighLl y bound arou nd his waist thm he can not 

breathe by his abdominal muscles, and on his 

head is placed a cOlllri vance that is protection 

neither to eyes nor head. 30 

The design of the uniform of the cadets 

at West Point was no better. The clothing 

in question was so tight that it interfered 

"materially with the natural development 

of the muscular, circulatory, and respiratory systems." It caused nausea, headaches, and faintness, but the cadets liked 

the appearance of close-fitting uniforms so 

much that they had their tailors alter them 

to be tighter still . The only way to eliminate the problem, therefore, was to completely restyle the uniform. An investigating commillee agreed and recommended 

that trousers be designed to be looser at 

the waist than the ones in USC. 31 

In the decades after the Civil War a 

broader and more positive app roach to the 

Army's health was also evident. The Army 

began promoting hea lth of mind and body 

rather than merely preventing disease. 

Much effort was devoted to reducing 

problems caused directly and indirectly 

by alcoho lism and to advocating athletic 
SUPPORTING THE ARMY 

training and specific programs of recreation. Echoing the philosophy then being 

espoused by such civilian authors as 

William James, Surgeo n General Sutherland beli eved that "the athlete cares more 

for his training than fo r vicious indulgence" and that the encouragement of athletics could be expected to "reduce the 

preva lence or drunkenness to a minimum. " This approach may have been in 

part responsible for the decrease in overall venereal disease and alco holism rates 

after 1879. By 1889 most Army surgeons 

rated "the personal habits, cleanliness, 

etc., of the men as excellent," bUl the 

number of alcohol-related admissions, 

more than 40 per 1,000 mea n strength in 

the 1880s, continued to arouse concern. 

Prohi bition of alcohol on base resulted 

only in the growth of "dens of dissipation 

and disease just beyond the j urisdiction 

of the comma nding officer," and with 

venereal diseases an important cause of 

ineffectiveness, doctors began to favor establishing post canteens serving beer. 32 

Although respiratory diseases trad itionally took a considerable toll among the 

nation's soldiers, they were taken for 

granted, perhaps because they did not have 

the chronic character of such problems as 

alcoholism and venereal disease. The common cold affec ted many. In fisca l year 

1887,80.9 men out of every 1,000 were 

admitted to sick report because of "catarrhs and common colds" and another 

62.24 per 1,000 because of more seri ous 

problems, primarily bronchitis, pneumonia, pulmonary tuberculosis, and pl eurisy. 

In 1890, however, a major influenza epidemi c caused the Medical Department 

some concern, and it was followed in 1891 

and 1892 by occasional serious but localized influenza outbrea ks." 

49 

Surgely 

Although disease remained a Signifi cant 

cause of ineffectiveness despite determined effon s of medica l offi cers to prevent 

its spread with improved sanitati on, 

deaths from wounds increased as campaignsagainst the l'lClians became more intense and inspired greater interest in target practice. In fisca l year 1870 wou nds 

killed half as many as disease among 

whites and more than a quarter as many 

among blacks. Thus the work of the surgeon who repaired the damage resulting 

from Indian attacks and mishaps with 

weapons continued to be vita l to maintaining the Army's effectiveness." 

The use of anesthesia no longer caused 

dissension within the medica l profession. 

Since the days of the Mexican War in the 

late 1840s, with rare exceptions, surgeo ns 

had not had to deal with struggling and 

terrifi ed patients. By late 1883 both Army 

surgeons and civilian practitioners were 

using coca ine and its derivatives as loca l 

painkillers. Chloroform was falling deeper 

in to disfavor because of its effects upon the 

hea rt. Medical Department phYSicians preferred ether, which in fisca l yea r 1886 they 

used almost twenty-fo ur times as often as 

a combination of ether with chloroform. 

No anesthesia deaths were reported that 

year, although surgeons noted problems 

related to the use of anesthesia in th ree 

cases receiving ether, one receiving chloroform, and one a mixture of the LWO.35 

In surgery as in preventive medicine the 

period 1865-1893 was one of tra nsition. 

For many years after the Civil War, physicians who did not appreciate the implications of the germ theory hesitated to perform complex operati ons for fear of 

infection. When an assassi n's bull et cut 

President Garfie ld down inJuly 1881, doc-
50 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

DAN IEL SM ITH LAMB 

tors did not undertake ex ploratory surgery 

to determine the extent of his injuries. Instead , they repeatedly poked and probed 

the wound with unsterilized instruments 

and unscrubbed hands. Even the use of a 

primitive metal detector, devised by 

Alexander Graham Bell , fa il ed to locate the 

bullet. In the postmortem examination 

performed foll owing Garfield's death two 

months later, Army Museum pathologist 

and contract surgeon Dan iel Smith Lamb 

traced th e bull et's ten-inch course through 

the body to its fi na l lodging near his pancreas. Lamb blamed the death on secondary hemorrhage, bu t modern scientists 

famil iar with the records of Ga rfield's care 

have conclud ed that the cause of the fatal 

bleeding was infection." 

For th ose fated to attend a dying president at a tu rning point in the histo ry of 

medicine, the stra in of the unusual responsibility they bore was almost unbearJOSEPHj. WOODWARD 

able, especially when coupled with th e 

nood of criticism that appea red in both 

profeSSional and more popul ar publications from those who wo uld seco nd-guess 

their approach to the president's care. 

Garfield's physicians, among them Maj. 

Joseph J. Woodward , considered by Ihose 

who kn ew him to be "highly strung," were 

emotionally drained. In july 1882, a year 

after the president's dea th , Woodwa rd was 

still so overwrought that he was unabl e to 

attend the autopsy of Garfi eld's executed 

ki ll er, Charl es]. Guitean." 

An increased appreciation of the benefits of antisepsis would eventuall y produce a major change in the approach of 

medical offi cers to surgery. Initially, they 

remained very cautious about undertaking abdominal surgery. A psychological 

barrier still lay between the surgeon, military or civilian, and his undertaking a 

type or opera tion previously associated 
SUPPORTING THE ARMY 

only with the direst of co nsequences. He 

first had to be sure in his own mind that 

removing an infected appendi x, for example, would save a life that would oth -

erwise probably be lost, and thus he 

wou ld perform an appendectomy only 

when the pati ent was so close to dea th 

that nothing was likely to save him. Neverth eless, as early as 1885, an optimisti c 

Surgeon General Murray foresaw a day 

when that barrier would fall , when 

the hope of modern abdominal surgery will . 

be realized, by the appli cation, at the hands of 

military surgeons, o f abdominal section [surgery involving an incision into the abdominal 

cavity I, under ailliseptic precaUlions, to gunshot wounds oftheabclominal viscera, with ligature of all bleeding vessels, and the closure by 

SlIture of all intestinal wounds.)/! 

Elaborate routines before beginning to 

operate became increasingly common as 

physicians began to realize that more 

than mere cleanliness was necessa ry to 

prevent the development and spread of 

infecti on during operations. RepresentaLive of this approach was the proced ure 

recommended in 1892 to surgeons of the 

Na tional Guard. They were to scrub their 

hands with a sterilized brush in hot wa ter 

for several minutes before operating, 

then immerse them for three minutes in 

a hOL saturated solution of potassium 

permanganate. A three-minute soak in a 

hot solu tion o f oxalic acid fo ll owed, with 

three minutes in a hot solu tion of bichloride of mercu ry completing the routine. 

Understandably, the adoption of rubber 

gloves in 1889 was dictated by concern 

for the hands rather than by any belief 

that germs on them might survive to infect the victim.'9 

5 1 

Hospitals 

When so many units were isolated and 

disease rates were high, even the smallest 

Army post had to have a building where the 

sick could be sequestered for care. The temporary field hospitals and dressing stations 

that served troops in the fi eld were in use 

too short a time to become contaminated 

with disease, but Medical Department experts believed that permanent hospitals 

were inevitably reservoirs of disease after 

Len years of use. Anticipatinga regular need 

for new co nstruction, they developed standardized designs for 12-, 24-, and 48-bed 

facilities. They recognized that while few 

posts were large enough to justify building 

the largest size, the 12-bed design that met 

most requirements was ineffi cient because 

the space necessary for offi ce and storage 

was almost as great as that taken up by its 

Single ward. The money necessary to build 

and maintain these faci lities was initiall y 

part of the Army's annual budget for construction, but after 1874 it was voted asspecific sums appropriated for hospital construction and maintenance. Although 

willing to fund a joint Army-Navy genera l 

faCility, Congress gave the department less 

than half that required to give each Army 

post a hospital, to keep it in good repair, 

and to replace it every ten yea rs. Medical 

offi cers were all too frequently forced to 

waLch their fac ilities deteriorate, powerl ess 

to remedy the situation:w 

In actual practice, many post hospitals 

occupied makeshift quarters, poo rl y constructed and of inappropriate deSign, 

where ventilation and heating systems 

worked at cross-purposes. An 1875 inspection revealed that the faCility aL Fo rt 

Hamilton, New York, was a "temporary 

hospital" in which "the origina l materials 

and workmanship were so inferior that a 
52 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

constantly increasing ex penditure was 

necessary to keep the buildings in repair. " 

At FortWood in New York Harbor, the hospital's drinking water supply was compromised by the location of the cistern in 

whi ch it was collected less than three yards 

from another that received the discharge 

from the water closets. Furthermore, many 

of the numerous posts hastily established 

in the Reconstruction South had to adopt 

whatever shelter was available until suitable buildings could be built. In 1877, with 

Reconstruction at an end , the secretary of 

war ordered that no building be either constructed or occupi ed as a hospital without 

first obtaining the written opinion of the 

medical offi cer concerned." 

The surgeo n general never stopped urging that medical officers be directly involved in the design of hospitals and the 

improvements made in them. Surgeon 

General Sutherland expressed himself as 

particularly pleased with the plans that 

had been used to build hospitals in 1887 

and 1889. These faciliti es were heated "by 

steam" and ventilated "by aspiration," 

their wa lls were covered with an "asbestos 

finish," and the woodwork was unpainted. 

Sutherland termed the design "a complete 

asepti c building. " By 1892 he was able to 

report that there were few complaints 

about hospital accommodations. A sign of 

the changing times was the debate thai 

arose in the late 1880s about whether co nstruction funds should be used to coverthe 

cost of installing telephones" 

Although the Army no longer had any 

use for the huge general hospital that 

served the men of many regiments during 

the Civil War, the Army-Navy Hospital at 

Hot Springs, Arkansas, was a new type of 

general hospital, staffed by both Army and 

Navy medical officers. Opened in January 

1887 to supplement the care offered by the 

network of post hospitals, it took in patients from all military services, both those 

on active duty and retirees, officers and enlisted , from all parts of the country. Among 

the max imum of eighteen offi cers and 

Sixty-four enlisted men treated there at any 

one time were patients suffering from diseases that were expected to respond to hot 

mineral waters, including rheumatism, 

gout, and neuralgia , as well as chronic diarrhea, skin diseases, alcoholism, and 

other chronic co nditions resulti ng from 

malaria or syphilis. Surgeo n Genera l 

Moore hoped that th e hospital wou ld significantly reduce th e number of disability 

discharges. After fou r years, Surgeon General Sutherland was pleased with what the 

new hospital's hot mineral waters co uld do 

for its patients, especially for sufferers 

from rh eumatism. Half of those sent to this 

facility because of "diseases of the nervous 

system" and (( nervous depression, brought 

on by the grea t strain of our modern life 

with its increased mental activities," were 

also returned to duty. Among the total 

number restored to duty, however, "necessarily, in a certain proportion , there is a return of the disease." H 

Above and Beyond Health Care 

In the course of guarding the Army's 

health during the years foll owing the end 

of the Civil War, medical offi cers were 

swept up by forces well beyond the fi eld of 

medicine that were shapi ng the nation's 

history and the Army's rol e in it. As Weigley wrote in his history of the U.s. Army, 

"These were the Army's last years as the 

constabulary for pacifying Indians ... . A 

restlessness of coming change was already 

present. " Almost imperceptib ly at first, the 

fou ndations were being laid for a new 
SUPPORTI NG THE ARMY 

Army, one in which the medi ca l offi cer 

would be increasingly required to develop 

administrative skills." The nati on itself 

was becoming more industrialized, and 

the labor upheavals that accompanied this 

change at times reached such a pitch that 

military intervention was needed, and 

physicians had to accompany Army units 

sent to the sites of violence or anticipated 

violence. 

Neither disease nor injuries ever seriously threatened th e troops call ed out to 

maintain the peace in the summer of 1877, 

when waves of labor disorder hit the East 

and Midwest. Nevertheless, surgeons from 

far distant posts had to be called in to support soldi ers who, with li ttle if any planning. were moved in small units from one 

place to another in response to violence 

and reports of violence. Although this type 

of threat was not limited to the East, eventually most of th e soldi ers in the Di vision 

of the Atlantic became involved in preserving order. 45 

For the Medica l Department, this silLtation again exacerbated th e shortage of 

surgeo ns. Any time a small garriso n remained at a post when most of the men 

were sent to the areas of greatest unrest, 

two physicians instead of one were needed, 

one fo r the post and one for the men in the 

fi eld. The surgeon general ordered that 

civilian doctors be hired to care for the men 

of posts whose surgeons were on detached 

duty, but only on a by-the-visit basis. Additional difficulties arose when, because of 

the rapidity and the lack of preparation 

that characteri zed these troop movements, 

surgeons found themselves short of supplies. One serving in West Virginia was 

fo rced to pl ead vigo rously by telegraph for 

rep lacements for medicines and instruments that were apparently lost in transit, 

either from his post or from the New York 

53 

supply depot. Fortunately, the acute stage 

of the situation lasted only a few weeks, 

and troops were soo n on their way back to 

their regular posts." 

With labor violence contained and with 

the dwindling of the Indian th rea t: ' time 

was available to co nsider and prepare fo r 

the ro le the Army wo uld play in the fu ture 

should the United States become invo lved 

in a major war. The increasingly intricate 

administrative duties that would be assumed by medical offi cers trying to meet 

the needs of an army functioning in ever 

larger units dictated a greater emphasis on 

education and training at all levels. The involvement of medical offi cers in this effo rt 

was initially somewha t sporadic, but it 

grew in magnilLtde and scope as both medicine and the organiza tion of the Medi cal 

Department became more complex. 

One ea rly teaching respo nsibility lasted 

only three years. In 1886 surgeons at posts 

whose garriso ns demonstrated an interest 

in first aid were ordered to co nduct informal classes for offi cers and enlisted men. 

They were to lecture on "practical treatment of the unhidden diseases, ea rl y aid to 

the injured, the most expediti ous and 

proper manner of trea ting temporarily 

gunshot wounds, poisoned wo unds, frostbi te, bruises, disloca tions, hemorrhage, 

and fractures of bones; applications of the 

tourniquet, the most approved method fo r 

reS1l5cita lion rrom drowning and other 

kindred subj ects. " 48 

Although this order setting up these 

classes was rescinded inJune 1889, the involvement of post surgeons in tra ining 

continued. Many found themselves responsi ble fo r training unenthusiastic litter-bearers and, after 1887, Hospital Corps 

members in fi rst aid as well as in the other 

aspects of their duties; they were pa rti cularly enco uraged to use marches to fa mil-
54 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

iari ze hos piLal corpsmen wiLh Lheir responsibiliLies. Field operations were esLablished at camps of insLrucLion to Lrain 

large numbers of men, which was noL possible aL individual pOSLS, and deLaiis from 

the Medical Department joined Lhem. The 

trainees lea rned how to seL up dressingsLaLions and fi eld hospiLals,'9 as well as how 

to move "dummy wounded" back through 

the chain of evacuaLi on much as had been 

done during the days of Jonathan LeLterman and his ambulance corps in the Civil 

War. Emphasizing the experimental nalure of these training operaLions to its surgeons, the departmenL urged participants 

to make suggestions [or improvement. 5O 

Experience brought severa l weaknesses 

to ligh t. Ambu lances proved to be fragile 

and their equipment inadequate. Add itional problems resulted from the fact that, 

as in the past, commanding offi cers did not 

assign Lheir ablest men to help th e 

wound ed . Moreover, those deLailed as litter-bea rers of Len ignored the required 

training dri lls. One surgeo n reported Lhat 

"th e perso nn el is not select, the servi ce is 

unaltracti ve, and the training inadequaLe. " 

The work of the hospiLal corpsmen , on the 

oLher hand, proved more encouraging. 

"All duties we re performed by the Hospital Corps cheerfull y and in a SaLisfacLory 

manner," rep0rLed an assistant surgeon 

with Lroops from ForL Niobrara, Nebraska . 

Because Lhese camps were often unable to 

provide the hospiLal co rpsmen with th e 

horses they needed for maximum mobility. the "OPPorLunity for instruction and 

practice" was limited , but it was nevertheless of "benefit La the service." 51 

Training varied fro m group to group 

under Lhis sysLem, and IiLtie uniformity 

was achieved. To help sLandardize procedures, Surgeo n General Moore encouraged 

his orficers to work on training manuals. 

In Lime several of good qualiLy were developed. For example, wiLh the aid o f a 

board of medical offi cers and the advice of 

other ex perienced Army ph ysicians, a provisional manual for Lraining hospiLal 

corpsmen was revised and published in 

1891 as th e Drill Malllla l for th e Hospital 

Co rps. Also, the volume Notes all MilitCilY 

Hygielle, based on lectures that Woodhu ll, 

by Lhen a major, gave to line offi cers studying at Fo rt Leavenworth beginning in 

1886, was recommended for use in new 

co urses bei ng taught line offi cers at Fort 

Leavenworth. West Point, and Fort Monroe. Surgeon General Sutherland urged 

that compani es of instruction be created 

fo r hospiLal corpsmen at a few pOSLS so LhaL 

medical officers could Lrain large numbers 

together. This approach, he believed, 

would also simplify the problem of enlisLing civilians directly in to the HospiLal 

Corps who might already have received educaLi on as druggisLs or coo ks but who sLill 

needed military training. 52 

In 1891, to try out his idea, Sutherland 

began orga nizing Lhree companies o f instructi on. He had Lhose training wesL of Lhe 

Mississippi spend six months at either Fort 

Ri ley in Kansas, Fort D. A. Russell in 

Wyoming, or Fort Keogh in MonLana. 

Three or more medical offi cers, three hospiLal stewards, four acting hospital sLewards, a bugler, an artificer, a tailor, and forty 

or more privates were to form each COm -

pany. At the time of the surgeon general's 

reLirement in May 1893 these schools were 

sLill being run on an experimental basis, 

but the genera l Lestimony was to the superi ority "of the schools-i nstructed men .. 

and no one who has seen the work of the 

compani es as units can question the cerLain superi oriLy of bodies of men so trained 

over any organization locally gaLhered and 

individually instructed ." 53 
SU PPORTING THE ARMY 

Medical DepallmenLofficers were also requested to help in Lraining the physicians 

serving with the NaLional Guard , whose 

supporters were growing because of the 

labor unresL of 1877. The relati.onship of Lhe 

state-comrolled Guard to the Regular Army 

was characterized by misgivings on both 

sides, but because Guard units would have 

to work closely with regulars in the evenL of 

war, wisdom dictated that the Guard's "organization and methods [be l based upon or 

assimilated with Lhoseof the regulartroops." 

During their tenure as surgeon general, bOLh 

Moo re and SULheriand expressed significant 

reserva Lions abouL the custom of having NaLional Guard surgeons appointed by Lheir 

colonels wiLhoUL the benefiL of an examinaLion for professional competence. YeL when 

the surgeon general of the Michigan NaLional Guard urged the creaLio n of a sLaLe examining board , Sutherland refused to allow 

Regular Army surgeons to serve on it, lesL 

Lhey be drawn into acrimonious dispuLes." 

Nevertheless, the Medical DeparLment 

did, upon requesL, deLailmedical offi cers for 

duty aL National Guard encampments La advise Guard doctors how best to maintain the 

health of their troops, to handle Lheir administrative responsibilities, ancl to assist in 

training nonproressional medical personnel. One Regular Army physiCian, nOL particularly impressed by whaL he saw, noted 

that the NaLional Guard surgeons seemed to 

regard "the annua l encampment in the lighL 

of a picniC, an 'ouLing,' which offers them relaxation from work, and which should be 

spent in frolic and fesLiviLy" Some camps 

were almosL luxurious, equipped with e1ecLriciLy and ciLy water and suppli ed with fresh 

fish and fresh vegetables and fruits, as well 

as eggs, bULter, and milk, even though their 

latrines might be "neglecLed and offensive." 

Familiar wiLh neiLher the importance of discipline and sanitaLion nor the everyday rou55 

tines o[ th e Medical DepallmenL, the average National Guard physician was unable La 

advise his commanding omcer on sanitary 

matters, to train stretcher-bearers and attendants, or to deal wiLh reports, s upplies, 

ancl other administrative requirements. 

Thus Surgeo n General Sutherland welcomed enthusiasLi cally the formaLion of Lhe 

Association of MiliLary Surgeons of the Nalional Guard of the United StaLes." From Lh e 

outset it \..vas an important vehicle ror the education of the NaLional Guard's medica l 

staff, and , Lhrough its journal, for the educaLion of all mil iLaJY surgeons. The surgeon 

general aSSigned some of his mOSL experienced med ical offi cers to aLLend the association's meetings. 56 

SULheriand also criticized Guard uniLS because o[ Lheir lac k of a permanently organized hospital corps to evacuate and care for 

Lhe sick and wounded . Even Lh ough National Guard corpsmen were merely deLai led 

La Lheir duties from the li ne, some too k to 

Lh eir responsibi li Li es wiLh enthusiasm. In 

1889 Regular Army Capt. Louis Brechemin 

complimenLed Illinois Guard corpsmen 

upon Lheir unfailing "zeal and inLell igence 

in learning the drill " and the "prompLness 

and faiLhfulness" wiLh which they "aLLended 

to their oLher dULies," praise LhaL another 

medical offi cer echoed in 1892 in descri bing the men of Michigan uniLs. Despite 

earnest efforts, Medical Department ollicers 

were only beginning to impress both medical and line officers in the National Guard 

wiLh the necessity for close aLLenLion to saniLaLion and hygiene and to familiarize them 

with the rouLines of the Regular Army" 

Off-duty Pursuits 

Since military posts were usually small, 

Lh e s urgeon was responsible [or the care of 
56 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ELLIOTT COUES 

only a few men, and the necessity for examining occasiona l local pension applicants added lillie to the demands made 

upon him. What he did in his off-duty 

hours was largely his perso nal choice. He 

might turn to private practi ce, to the study 

of the fauna and the nora of the area arou nd 

his post, or to other scientific pursuits. 

Surgeo n General Barnes believed that 

caring for loca l citizens enabled his medical offi cers to provide beLler care to their 

soldier patients, "by reaso n of the experience gained by becoming famil iar with the 

diseases preva lent in the locality." The tradition of private practice was thus enco uraged for many years, as long as care of 

private patients did not cause the medical 

offi cer to neglect his Army duties. The War 

Department, too, appa rently supported 

this approach, but civilian physicians, resenting competition from military physicians, occasionally protested that Army 

medical offi cers often treated even well-todo patients without charge and sometimes 

supplied th em with th e Army's medicines. 

In 1877 members of the Medi ca l Associati on of the Distri ct of Columbia complained about Colonel Baxter, then serving in Wash ington as chief medical 

purveyo r. They all eged that he deliberately, and with some success, tried to lure 

fema le patients away from the city's physicians and that he used th e opportu nity to 

care for prominent politicians as a means 

of furthering his own ca reer. They charged 

that President Grant had benefited both 

from the free services of medical offi cers 

and from medicine provided by the Army. 

The extent to which the medical offi cer in 

the fi eld was obliged to care for the civilians at his post, most often quartermaster 

employees and offi cers' famil ies and servants, had never been entirely cl ear, but in 

1884 the Army stated specifi cally that both 

regular and contract surgeons must care 

for the famili es of offi cers and enlisted men 

without pay as pan of their normal duti es 

whenever "practicable." This move deprived medi cal offi cers of a previously 

available source of added income, but 

since they had trad itionally cared for families as part of their private practi ces, it 

co uld not have added to the demands made 

upon their time. As Army posts climinished in number and grew in size, significant amounts of spare time were not as easily found , and in 1892 Surgeon General 

Sutherland co ncluded that a private practice interfered "materially with the performance of publi c duties" and ordered the 

time- honored custom abandoned.

58 

Hav ing devoted his off-d uty hours as a 

young medical offi cer to research, Billings 

was convinced that a post surgeon should 

always have some type of research project 

available to work on as time permitted, "for 
SU PPORTl NG THE ARMY 

his own mental health and pl easure." 

Arm)' surgeo ns continued to use their 

spare time to increase their knowledge of 

natural history, just as they had before the 

Civil War. The surgeon general offi cially 

ordered Capt. Elliott Coues, who would ' 

become a widel), respected naturalist, to 

work at the Smithsonian lnstitution classifying specimens he had coll ected while 

serving beyond the Mississippi. In 1881, 

concluding that he could not serve in the 

Medical Department and devo te the time 

he wished to his wo rk as a naturalist, 

Coues left the Army. Medi cal offi cers unwilling to give up their careers might be 

forced to sacrifice their wo rk in natural science. Although the official responsibilities 

of the medical officer became increasingly 

demanding and complex and his time fo r 

other pursuits was diminishing, within the 

57 

limitati ons that their careers in the Army 

permitted, a few always fo und time to pu rsue their interests in sciences other than 

med icine. 59 

The decades between the end of the 

Civil War and 1893 were, because of th e 

impending revolution in medicine, the last 

in whi ch the Medi cal Department officer 

would be forced to wage war against disease with few wea pons other than smallpox vaccine, the traditi onal devo tion to 

cleanliness, and common sense. They were 

the last when he wo uld be routinely required to work in relative isolati on, unable 

to obtain th e prompt advice of his peers 

whenever he needed it and to obtain supplies rapidly whenever he needed them. 

They were also the last when the Army 

would have to fight the Indian"O 
NOTES 

1. Quotation from john H. Franklin, Reconstruction, p. 120; \OVaI' Department, Surgeon General's Office, lvlmllia/. Jor fi,e .vledlad DeparfrllCIIf, 

1906, pp. 209-12; jack D. Foner, TI,e Uni/cci Slales 

Soldier Betweol Two W(II"S, p. 15;j ohn Shaw Bi llings, 

"Progress of Medicine in the Nineteenth Celllury," 

in SlIlifi,sonimr fll Slil!!lioll Report Jor 1900, p. 637; 

Edward M. Coffman, Tire Old A rillY, pr. 246, 

25 1-52; 'War Departmen l, (AII/HWI] Report oJt he Secret(IIY oj W(II", 1878, 1:102; james A. Huston, Ti,e 

Sinews oJ War, p. 256. 

2. The number, boundari es, and names of the geographic, or terrilOrial, divisions and the departments and distri cts into whi ch the)' we re divided 

and subdivided changed from time 1O ti me. See AGO 

GO 125, 17 Nov 1874. In Chapter 9 of his volume 

TI,c Smlifarians,j ohn Duff}' provides a detailed discussion of changes in public health in the United 

States after the Civil War. 

3. Austin Flim, Clinical lvledicirle, p. 751; Ma rtin 

Kaufman , "The American Anti-vaccinationislS and 

Their Arguments," pp. 464, 467-68; \;Var Department , Surgeon General's Offi ce, Mediad (llJd Swgical History oJII,e Wa r oJllle ReiJellion , 1-3:624, 627; 

Wa r Depa rtment, fA II/llwl] neporl. oj O,e Slligeon 

General, US Army, 10 fh e Secretar), oJ War, L886, p. 

9 (hereafter cited as WD, AnoJSG, da te); j ohn McL 

Kea ting, A HislOlY oJ)'ello\\P Fever, pp. 103-04; \OVilson G. Smillie, Prevelll ive .vledicine (Hui Public Hcaldl , 

p. 8; Ltr, Crane to Post Surg, Fort Craig, N.Mex., 9 

Feb 1869, Entl")' 2, and Rpt , Samuei j essop, 15 jan 

1869, Entry 51, Chari eslOn, Record Group (RG) 

112, National Archives and Records Administration 

(NARA), W.shington, D.C 

4. WD, ARofSC, 1874, PI'. 5-7. 

5. Quotation from Dorll1llds Illu strated Medical 

Dlcl.iOIlW)', 24th eel. , s.v., "disease, filth d. "; WD , 

ARoJSC, 1868, PI'. 3-4, 1869, PI'. 6-7, .nd 1870, 

pp. 4-5; Coffman , Olel Army, p. 328. 

6. WD, ARoJ5C, 1869, p. 4, .nd 1874, 1'.12; U rs, 

Crane LO E. Thomas, and to W. F Corni ck, both l 4 

Nov 1867, and]. S. l3illings to S. W. l3u tler, 14 jan 

1868, Entry 2, RG 11 2, NARA; George M. Sternberg, 

"An Inquiry Into the Modus Operandi of the Yel low 

Fever Poison," pp. 22-23; idem, "A Stud}' of the 

Natural !-l isto r}' of Yellow Fever and Some Remarks 

Upon the Treatment ... ," p. 639; Keating, Yellow 

Fever, pp. 15, 17. 

7. WD ,ARoJSC, 1874, 1'1'.10-12, 1875 , PI'. 6-7, 

1876, PI'. 7-9, .'lCI 1878, PI'. 6--7. 

8. The founders of the Na tional Board of Health 

we re, for the most part, those who had created the 

Ameri can Public Healt h Associa tion seven years ea rli er. The board lasted only three years, being 

"doomed to fail ure almost from the start," according to one medical historian, in pan because "the 

country as a whole was not yet ready for a nationwide health promotion service." Quotation from 

Smill ie, Public Health, p. 18. 

9. Ibid. , 1'1'. 18,21,576; Ralph C Willi.ms, Tir e 

Ulliteci Sfal.es Public HealtiIService, 1798-1950, pr. 

76-79, 165; ' Ma rtha L Sternberg, George Miller 

Ste rnberg , p. 274;james M. Phalen, ClrieJs oj ti,e Medical Dq)(lrtlllell l, United SImes Arll1)~ 1 775-1940, PI'. 

71-72; \·Villiam B. Bean , INalLer need, p. 73. 

10. First quotation from Wesley W. Spink, lrifeclious DiseC1 ses, p. 165; remaining quota tions frol11 

Charles E. Rosenberg, Tile Cholera Ye(lrs (1987), pp. 

196-97; Lloyd G. Stevenson, "Science Down the 

Drai n," p. 10; Wyndham D. Miles, A l-l islO/)' oj tile 

NaUOI1C1 l Librwy ojMedicine, p. 33; \·Var Departmen t, 

Surgeon General's Office, nepon Oil EpidemiC 

Cllolera ill Ihe Army oj the Ullit eel SlaLes Dllring ti,e 

Yea r 1866, p. 22 (hereafter cited as WD, SGO, Epidemic ClIO/era, 1866). The first epidemic, in L832, 

precipitated more terror in the Uni ted States than 

subsequent pancl emics, presumably because 

cholera had never been encountered before in this 

country. See Mary C. Gill ett, Tire Army iVlediwl Departlllenl, 1818-1865, pp. 11 -13. 

11. First quotation from john Shaw Billi ngs, 1\ 

Report on lire I-fygielle oj tllC United SIl1leS Arllly .. 

p. 18; second quotation from 'NO, SGO, Epidelllic 

ClIO/em, 1866, p. 35; ibid ., pp. vi, xiv-xv, xvii i; 'VD, 

AllofSG, 1866, p. 5, and 1867, PI'. 3-4. 

12. \OVD , SGO, EpidemiC Cli o/era, 1866, p. 26. 

13. First four quotations from 'Nar Departmenl, 

Surgeon General's Office, TIle Clr olera EpidemiC oj 

1873 ill Ihe Uniled Slales, p. 492 (see also pp. 

471-72); remain ing quotatiolls from idem, Epic/emic 

Cllo/em, 1866, pp. xvii and 61 (see also pp. xiv-xvi); 

idem, Report on EpidemiC Cholem (Uul Yel/o\\' Fever 
SU PPORTING THE ARMY 

illlhc Army oflh e United Simes, p. 35; WD ,ARojSG , 

1866, p. 4. 

14. Quotations from WD , SeQ, Epidem ic 

CllDiem, 1866, PI'. 25, 27 (see also PI'. 23, 29, 37, 

64); idem, Cholera Epidemic oj 1873, p. 479; SGO 

Or 5, 20 Apr 1867. 

15. John S. Chambers, The COllqllcst oj ClIO/em , 

PI'. 335-36, 351; WD, SGO, CllDlera Epidemic oj 

1873 , p. 476; idem, Epidell1 ic Cho/cr(l, 1866, pp. 26, 

62-63; WD,A ~ojSG , 1874, 1'.19; Will iam G. Ro,hslcin ,Allleriall! PhysiciwlS ill/he N ineteen/II Cell/III)', 

pp. 265- 66; Duffy, Salljwria/ls, pp. 193- 94. 

16. Foner, Ulli /cd Slates Soldier, pp. 8- 9, 17-19; 

Edward J. Forster, A JVlalllwl Jar A4ediw/ Officers oj 

fill: MiliUa of tire Ull i/ed Si(lieS , pp. 12, 68; Coffman , 

Old Army, Pl'. 385-86; WD, ARojSG, 1887, PI'. 

73-74,83, 1890, p. 77, and 1892, PI'. 87-88. 

17. WD, ARojSG, 1885, PI'. 37-38, 1888, PI'· 

120- 26, 1889, PI'. 8 1-82, 1890, PI'. 81-86, .1 89 .1 , 

pp. 61- 63 , and 1892, pp. 70-84; Duff)', SClIl ilcrria/ls, 

PI'. 20 1- 02; in RG 11 2, NA RA: Llrs, SGO to Charles 

E. Goddard, 23 May 1884, D. L. Huntington to Go ~ 

dard,9 Dc' 1884, and ro EI)' McCleJlan, 22 Dec 1884 

(quotat ions), and Charles R. Greenleaf to George E. 

Pond, 8 Feb 1888, and to John van R. Hoff, 19 Mar 

1888, all Entry 2, and Ltrs , Greenleaf to W. M . Mew, 

24 Jan 1890, and ro SG, 17 Feb 1890, and [Mew'! 

'0 SG, 1 Apr 1891, plus Memo, SG, 3J ul J890, all 

Entry 22. 

18. WD , IIRojSG , 1886, 1'.78, 1. 889, PI'. 55-57, 

59,87, and 1890, PI'. 57- 69. 

19. Ibid. , 1889, pp. 56, 59; quotations from pp. 

61- 62, except last, from p. 82. 

20. Ibid., 1886, p. 80 ; quotations from pp. 77, 

8 1, 82-83. 

2 1. Ibid., 1889, p. 55 (nrs, quotation), 57-58, 

1890 , p. 58, and 189 1, p. 56 (second quotation) . 

22. Quotation from Billings, Report 0 11 Hyglelle, 

p. xvii; Coffman, Old ArIllY, pp. 329-3 1. 

23 . Quotations from Billings, Report all Hygiene, 

pp. xxxii , xxvii, xxx; ibid. , pp. xxxviii- xxxix; Ltr, 

E. P. Morang to SG, 5 Sep 1865, vol. 10, Entr)' 10, 

RG 11 2, NARA; Don Rickey, Jr. , FarLy Miles (I D{IY 

all Beans (lnd Hay; Darlis A. Mi ller, Soldiers (1/1(1 Se ~ 

tiers, pp. 42-44. 

24. Billings, Report a ll Hygiene, p. xxx; W D, 

ARojSG, 1885, p. 52, 1889, PI'. 71, 74, 1891, p. 4, 

and 1892, p. 84; Ltrs, D. L. Hun tington to Zilla M. 

Pavy,7 Dec 1885, and J. H. Baxter to R. H. Firth, 24 

Sep 1886, El1t ry2, RG 112, NARA; Erna Ri sch, IUlr~ 

tCnJwsler Supparl oj tile Ar/llY, p. 507; Huston, 

Sillews, p. 268. 

59 

25. Bi ll ings, Report 0 11 Hygiell e, pp. xxix (first 

quotation), xxx, xxxiii (second quotation), 

xxx iv-xxxvi. 

26. First quotation from ibid., p. xl; remaining 

quotations from 'vVD, ARofSC, 1889, p. 79 (see also 

PI'. 76-77,8 1,81n3). 

27. First and second quotations from Billings, 

Report 0 11 Hygilme, pp. x, 52 (see also p. 107); third 

quotation from idem,A Report all B(lrrac/(s and Haspi/(lls . .. , p. xvii; Risch, Qlw rte/"llJ(lster SlIpport, pp. 

488-89. 

28. Quotations from Alfred Alexander Woodhull , A lvlcdi ca/ Reporl Upon lire Ulliform (lIId C/ol ~ 

illg oj tire Soldiers oj the U.S. Army, pp. I, 16, 19, 1.8 

(see also pp. 5-9, 24-25); Foner, Ulli led States So/-

dier, p. 86. 

29. Quotations from 'vVoodh ull , Ivlcdical Rcporl, 

PI'. 10, II; WD, ARojSG, 1889, p. 68n. 

30. Quotation from Charles E. \·Voodruff, li ~ 

tary Medical Problems," p. 235; ibid., p. 236; WD, 

ARojSG, 1887, PI'. 74, 78-80, 1888, p. 102, 1889, p. 

68, 1890, p. 76, and 1891, PI'. 68-69; AGO GO 80, 

17 Oct .L 888; Alfred Alexander 'vVoodhull, Notes all 

MilUm), Hygiene fo r Office rs oj the Line, 1899, p. 24; 

in RG 112, N ARA: llr, C. R. Greenleaf to Post Surg, 

Fort Huachuca, Ari z., 22 Jun 1888, Entry 2, and lIr 

W. C. Gorgas to Post Adj , 31 Mar 1889, Emr)' 22. 

3 1. WD, ARojSG, 1889, PI'. 63 (quo,a, ion), 

67- 68. 

32. Ibicl. , 1887, PI'. 64-65, 1889, p. 90 (third 

C[lIolCHion), 1890, pp. 78 (fourth quotation), 79; 

189 1, pp. 69-70; 1892, p. 9 1 (first lWO quotations); 

Rickey, Be{ms (md Hay, p. 159. 

33. Chambers, ClIO/era, pp. 35 1-52; WD, 

AllojSG, 1866, p. 5, 1867, PI'. 3-4. 1868, PI'. 3-4, 

1869, PI'. 6-7, 1870, PI'· 4-5, 1885, p. 7, 1886, PI'· 

8-9, 1887, p. 104 (quo,a,ion), and 1.891, p. 17; Lrrs, 

Joseph c. Brown to Mcd Dir, Dept of Texas, 20 Feb 

1890 (and those for March- May on innuenza), 

Moore to E. Leyden, 17 Jun 1890,J. O. Kennedy 10 

"Our Dear ProleclOr," 16 Mar 1891, and Arnold to 

Ass' AG , 25 Jan 1892, En,r), 22, RG 112, NARA; 

Corfman , Old Army, p. 390; Billings, Rcparl all )'~ 

gielle, pp. vii-viii; Edgar Erskine Hume, Victories oj 

Army Medicille, p. 187. 

34. WD, ARojSG, J870, PI'. 4-5, 1876, PI'. 6-7, 

1884, PI'. 20-21 , 1885, PI'. 47-48, 58-59, 1886, I' 

26, and 1887, p. 65. 

35. Erwin 1-1. Ackcrlmecht, A 5/101"1 His/OI)' oj 

Medicine, p. 177; Rothstein , Americall Physic iwrs, p. 

193 ; WD, ARojSG, 1886, p. 28; "Miscellan)'-The 

Danger of Chloroform and the Sa fety or Ether as an 

Anaest hetic," p. 223. 
60 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

36. Roben S. Henry, Th e Armed forces Institule 

oj PadlOlogy, pr. 68-69 (hereaft er cited as AFIP); 

Chml es G. Heyd , "The Evolution of Modern 

Surge ry," p. 63; Daniel S. Lmnb, "Record of the Postmortem Examination of the Body of Presidelllj. A. 

Garfield. . ," p. 585; Ms C66, Orfi cial Medi cal Bulletins Relating to the Health of the President , National Library of Medicine. 

37. Quotat ion from R. Murray, "Necrology, 

Joseph Janvier Woodwa rd," p. 280; Henry, AFJP, p. 

8 1; "ObiL lIar)'," p. 250 ; Charles E. Rosenberg, Tried 

of Ihe AsslISsin Guitcall, pp. 239-40; Daniel S. Lamb, 

"Repon of the Post-mortem Examination of the 

Bod), of Cha rlesJ. Guiteau ," p. 43 . 

38. WD, ARojSG, 1884, 1'. 23, 1885, PI'. 26 and 

27- 28 (quotation), and 1886, PI'. 96- 97; Ackerknecill, 51101'i l-l iS/OIY, pp. 177-78; Rothstein, 

Amcriall! Physicic1IIs, p. 258. 

39. The Goodyear Rubber Company made the 

first pair of rubber gloves to be used in surgery on 

the orde r of j ohns Hopkins surgeon William S. Halsted , who wished to protect the hands of the operating room scrub nurse who would soon become his 

wife. See Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Su rgclY From Empiric Cr{ift to 

Sc ientific Discipline, p. 476; idem, "Lister, His Books 

and Evolvement of His Antisept ic Wound Practi ces," p. 124; SGO Cir, 1 May 1888, Entry 2, RG 

il2, NARA ; Charl es B. Ewing, "The Treatmelll of 

Wounds From the Aspec t of Germ In fec tion ," pp. 

147-49; Rudol ph Ma tas, "Surgical Operations Fifty 

Years Ago," pp. 52-53. 

40. Bill ings, ReporL 011 Hygiene, p. 2; Ur, SG to P 

H. Sheridan, 31 Oct 1872, and Allnoullcement, 

Charles H. Crane, 20 Mar 1876, Entry 2, RG 112, 

NARA ; Foner, Vll ited Swtes Soldier, p. 23 ; Fielding 

H. Garrison,jollll Shaw Billillgs, pp. 156-57; Risch , 

QII{lrtenllas/cr Support, p. 486. 

41. Bill ings, Report Oil Hygiclle, PI'. lvii, 32 (quotations), 101; Rpt, S.j essop, 15 Jall 1869, Entry 51, 

Charleston , RG 112, NARA; AGO GO 98, 20 OCt 

1877. 

42. WD, ARojSG, 1889, PI'. 56- 57 , 1890, p. 12 

(quota tions), and 1892 , p. 59; Ltrs, SG to vVi lliam 

B. Allison, 18Jun 1884, and C. R. Greenleaf 10 Post 

Surg, vVill ett's Point , NY Harbor, 16 Aug 1887, to 

SG, 20 Sep 1887, and to C & P Tel Co. , I Oct 1887 , 

Entry 2, RG 112, NARA. 

43. WD, ARojSG, 1887, p. 92, and 1891, p. 9 

(quota tions); AGO Cir, 20 Oec 1886; in RG 112, 

NARA: Ltrs, SG to A. A. Sulcer, 4 Sep 1883, and to 

Med Oirs, 3 Oct 1888,and C. R. GreenleaflO Charles 

Ulime, 26 Apr 1889, Entry 2, and Ltr, SG to AG , 5 

Mar 1894, Entr}' 22. 

44. Russell F. Weigle)', His/olY of the Vllitcd Stat es 

Army, PI'. 265 (quotation), 292. 

45. Telg,SG to J. M. Dicki nson, 11 Aug 1877, 

En try 34, RG 11 2, NARA. Unl ess otherwise inclicated , material on the 1877 strikes is based on J err)' 

M. Cooper, Tile Army (I/ld Civil Disordcr, pp. 43-66. 

46. Ltrs, L. O. Maurice to SG, 23 jul1877, \,yO 

to Cra ne, 23 ju11877, and C. G. Sawalle I? I to SG, 

3 Aug 1877, Entr), 12; Ur, SGO to Med Dir, Oiv of 

Atialllic, 7 Aug 1877, Entry 2; Telgs, SG to John M. 

Cu),ler, 2 1 Jul 1877, and to S. M. Horton , 23 Jul 

1877, J. H. Oaxter to C. Suthe rl and, 23 J ul 1877, 

Cuyler to SG, 23 J ul 1877, E. McClell an to SG, 24 

J ul 1877, and C. S. DeGraw to SG, 7 and 31 Aug 

1877, Entry 34. All in RG 112, NARA. 

47. See Chapter 4 for a discussion of the Medical Department's role when the Army again became 

involved in social unrest in the 1890s. 

48. AGO GO 86, 20 Nov 1886. 

49. A general hospital was a faci li t), that served 

more than one regiment, a field hospital a facility of 

whatever size set up in the field. The dreSSing station 

was the ambulance station or the clearing station. 

50. WD, ARojSG, 1890, p. 44 (quotation), 1891, 

p. 40, and 1892, p. 17; AGO GO 56, 24 Jun 1889, 

and GO 3, 13 Jan 1891; in RG 112, NARA: Ltrs, D. 

L. Huntington to M. W Wood , 3 j ul 1886, C. R. 

Greenleaf to j. E. Pilcher, 15 Ma r 1887, and to 

Charles Page, 20 Mar 1888, and J. H. Baxter to Med 

Dirs, 23 Apr 1888, Entr)' 2, and Cir Ur, Charl es Page, 

28 Aug 1888, and Ltr, Louis Brechemin to Med Oir, 

Dept of Platte, 15 Oct 1888, Entry 17. 

51. First quotation from WO, ARofSG, 1890, p. 

49 (see also Pl'. 50- 55, and 1891, PI'. 40-41 ); second quotation from Ltr, Timothy E. Willing I? I to 

Med Dir, Dept of Platte, 2 Oec 1888, and rema ining 

quotations from Ltr, C. H. Alden to SG, 14 Aug 1889, 

both in Entry 17, RG 112, NARA. In lac. cil. , sec 

Ltrs, j. Meacham to Med Oil', Oept of Plaue, 22 Sep 

1888, and L. Brechemin to Med Oir, Oept ofPlau e, 

15 Oct 1888; Rpt, Wi lliam O. Dietz, 9 OC11889; and 

Note, Isigna ture ?1, 1889. 

52. WD, ARojSG, 1891, p. 37; Alfred Alexander 

Woodhul l, Noles 011 Militwy HygiClle fo r Officers of 

tile Line, 1909, Note to 4th Edition; ibid., 1890; in 

RG 11 2, NARA: Llrs, C. R. Greenl eaf to Lewis Balch, 

21 J ul L888, and to C. S. We izmann, to J un 1887, 

Entr)' 2, and Ltr, Green leaf to j. S. Billings, 12 Mar 

1890, and 2d End, CRG , 6 Aug 1898, Entry 22, and 

Ur, L. Brechemin to Med Oil', Dept of Plau e, 15 Oct 

1888, Entry 17. 
SUPPORTING THE ARMY 

53 . Ltr.]. M. Schofield to SW. 31 Dec 1892.John 

MeA. Schofield Papers, Manuscrip t Division , Librar}, of Congress, WashingLOIl , D.C.; WD, ARojSG, 

1891. 1'.12. 1892. 1'1'. 15-17. and 1893. 1'. 16 (qllolaLion); j ohn van R. Hoff, "Some NOles on Military 

Sanital")' Organization ," p. 79; Charles H. Alden, " Instruction of the Hospital or Ambulance Corps in the 

United Siales," p. 450. 

54. Ltrs. C. M. Woodward to SG. 10 Nov 1891 . 

and SG to AG , 8 Mar 1889 (quotation), and to Woodward , 14 Nov 1891 , and Rpl, Louis Brechemin, 2 

Dec 1889 . Entry 17. RG 11 2. NARA; WO . ARoJSG. 

1890, p. 56 , and 1892, p. 19; Charles R. Greenleaf, 

"The Necessit}' of a Properl y Organized Hospital 

Corps in the N<Hiona l Guard ," p. 496; Peler Karsten, 

"Armed Progressives," in The Mill/my ill Alllerica 

From lite C%lliol Era to th e Presenl, pp. 252-53. 

55. Although the members hip was initiall y 1i111 ~ 

ited LO National Gua rd physicians, it was soon opened 

to medical officers from all the military services. 

56. WD. ARoJSG. 1890. p. 55. 1891 . p. 35 (quolations on pp. 34, 36), and 1892, pp. 19-22; Gre ~ 

leaf, "Necessity," p. 493; idem, "The Medical Officer 

of the Summe r Encampment," PI'. 145-46; Alfred C. 

Girard , "The Sanitary Duties and Rights of Medical 

Officers as Affecting Their Relations With the om~ 

manclers ofthe Line," pp. 68- 69 ; Hoff, "Some Notes," 

p. 79; Ltr, AGO to SC, 21 Ma r 1889, and Rpts, Louis 

Brechemi n,2 Dec 1889, and William Owen, 18 Aug 

61 

1891 , Enlry 17, RC 112, NARA; Edgar Ers\<ine 

Hume, TIle Golclen Jubilee oj IIl e Association oj Mili-

/CII )' SllIgeOl ls oJllle Ullil ed SUit es, p. 7. 

57 . Rpt, Louis Brechemin , 2 Dec 1889 (quotations), and U r, Wi lliam COI'busier to SG, 21 Aug 

1892. Enu)· 17. RG 11 2. NARA ; WD. ARoJSG. 1892. 

1'. 19. 

58. First quotation from Llr, SG to .... VJ. Purnam, 

5 May 1874. Entry 2. RG 11 2. NA RA. In loc. cit. . 

see also SG LO H. J. McGaffigan, 8 Feb 1872, and to 

JamesB. Belford , 9 May 1884, and Crane to Med Oil', 

Dept o f California, 28 Apr 1873, and \0 Med Dirs, 

22 OCl 1879. Second quotation from Raphael P 

Thian , Legis/cHi ve HislOIY oj IIl e Gell era l S((IJJ oj lir e 

Army oj /lI e United Slal es ... , p. 433. Third quotation from SG O Cir, 11 May 189 2, E n LI'}1 66, RG 11 2. 

See also WD. ARoJSG. 1886. p. 7. and 1890. p. 57; 

AGO GO 55. 27 J u11883. GO 75. 23 Oct 1883 . and 

GO 65, 9 J ul 1884 (p. 8); Samuel C. Busey, Persollal 

Remin iscences a ll(/ Recollection s, pp. 303-09; Phalen, 

ClrieJs, p. 63;Sylvia D. Hoffert, "Childbea ring on the 

Trans-Mississippi Frontier, 1830- 1900," p. 279. 

59. Quotation from John Shaw Billings, Sclected 

Papers, p. 266; P,IllI R. Cutright and MichaelJ. Brodhead. ElliO/f COll es. PI'. 91 . 123 . 139-40. 150. 

200- 201; Edga r Erskine HUIlle., Omill!ologists oJllle 

Ullil etl Swl es Arlll>' Medical Corps, pp. xxiv- xxv, 1-6, 

77.546-47. 

60. Mill er, Soldiers and Sell.lers, p. 330. 

Chapter 3 

THE INDIAN WARS 

From 1865 until the Battle of Wounded 

Knee in 1890 the Army's primary responsibility was, as it had been before the Civil 

War, subduing the Indians who threatened 

white settlers and white ambitions. Most 

garrisons at the small and isolated forts of 

the West we re involved only in minor 

guerrilla engagements that placed a premium on mobility and resulted in few casualties, and thus their post surgeo ns were 

principally occupied caring for the sick. 

For the physicians accompanying the few 

major ex peditions organized to fight the 

Indians, caring for the troops in wild and 

unsettl ed country constituted a considerable challenge, their best efforts handicapped by the lack of a nearby hospital, by 

terrain that often prevented the use of 

wheeled vehicles for evacuation , and by 

acute supply problems. Supplies for men 

who were to be away from their base for 

months had to be kept to a minimum in 

the interests of mobility. At the same time, 

commanding offi cers had no alternative 

but to sacrifice mobility for days or weeks 

to move the sick and wounded with the 

expedition, since assigning a detachment 

to escort them back to the nearest post hospital weakened the entire force. As one offi cer pointed out, "In savage warfare, to 

leave one's wounded behind is out of the 

question." I 

Fighting an Unorthodox Enemy 

Many factors affected the way in which 

the Indian wars were fought, but none was 

as fundamental as the uncertain nature of 

communications. Since the headquarters 

of the geographical divisions and departmentsof the West were able to exercise only 

a minimum of control over their subordinate commands, the success of both soldiers and surgeons depended not only on 

their ability to function independently and 

reso urcefully but also on their willingness 

to take great risks and endure prolonged 

hardships. For all of them, much of the 

Civil War experience proved to be irrelevant; some of it was a definite handicap. As 

suggested by one military historian, "The 

Civil War had ... accustomed leaders and 

soldiers to conventional war fought according to white men's rules, and readjustmentto guerrilla-style war was not easy. " 2 

Because of the poor state of communica tions, neither the commanding officers 

of the Divisions of the Missouri and of the 

Pacific nor those of the subordinate departments were much involved in the decisions that governed day-to-day operati ons against the Indians. Thecommanding 

generals of the departments gave Army surgeons their assignments, and the departmental medi cal directors exercised super-
64 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

vision over the professional work of their 

subordi nates, reporting monthly to the surgeon general about their performance. 

During the height of the Indian wars, because of the shortage of medical offi cers, 

these subordinates incl uded contract 

physicians, who often had to accompany 

ex peditions as well as to staff Western 

pOSLS. Fortunately, the skills of many contract surgeons were comparable to those of 

career medical offi cers. Many had served as 

physicians in one capacity or another during the Civil War, while the youngest were 

frequently prospective medical offi cers, 

whose lack of ex peri ence was counterba lanced by their high caliber. 3 

Difficulties wiLh supply, evacuation , 

and hospitalization, all related to poo r 

transportation, handicapped surgeons attempting to care for the sick and wounded 

of units fighting Indians. Those trying to 

move supplies and Lhose Lrying to move 

pati ents fa ced similar hand icaps, many 

dictated by the nalllre of th e warfare, communications, and the terrain. A shortage 

of wagons at crucial times increased the 

probl ems ex perienced in keeping an expedition supplied, whether with food, 

medi cines, shelter, or litters for the sick 

and wo unded' 

To supply posts and expeditions in areas 

still seriously threatened by the Indian 

presence, items were usually moved by 

wa ter or rail as far as possible and then unloaded for transport by wagon, often under 

heavy guard , to those forts that were otherwise inaccessible. Ex peditions picked up 

what they needed from the posts where 

they originated and , when possible, from 

posts along the way. Supplies were occaSionally moved forwa rd beyo nd th e farthest posts for storage at an advance base. 

When troops were following a river, a 

steamer sometimes served as a mov ing 

depot, from which a train of pack mules 

could be periodi cally replenished. Logisti cs became even more complicated during the win ter because of the condition of 

roads and trails.' 

The successful pursuit of a highly mobile enemy over trails impassable to wagons required thaL only an absolute minimum of supplies be taken with an 

expedition. In addiLi on, when troops were 

deep in Indian country and contact with 

the enemy was momentarily anticipated or 

when the trail was parti cularly rough or 

steep, wagons might be aband oned and 

everything carried on the backs of mules. 

The expedition's surgeons would then 

have to carry all their needs on their own 

horses or, at the most, to rely on one or two 

pack an imals. Fortunately, in the era before antiseptic surgery, elaborate equipment was not necessary. When unexpected 

events brought the men to the point of starvation, the surgeons involved had to exercise more than the usual ingenuity, even 

though the number of wounded was usually very small 6 

The Medical Department had developed 

no evacuation doctrine describing how the 

wo unded should be moved in areas where 

trails were narrow, rough, intersected by 

streams and gullies, and thus impossible for 

wheeled vehicles to negotiate. Neither the 

department nor th e Army provided litters 

with which to carry the wounded. The need 

for mobili ty often forced surgeons accompanying expeditions to abandon all but the 

most essential of their equ ipment, and as 

far as evacuati on was co ncerned, they often 

in a very real sense lived off the land. Litters and similar devices, even if available, 

would not be taken with them because reasonable substitutes could be found along 

the way. Service in the fi eld against the Indians co nvinced AssistantSurgeon General 
THE INDIAN WARS 65 

M ULE P ULLI NG A T RAVOIS 

Crane that somewhere in each command 

involved in lndian warfare were men sufficiently ingenious to meet whatever challenge they might encoun ter in moving the 

wounded. Believing that an overall policy 

should be developed concerning the means 

of evacuation to be employed when wagons could not be used, Surgeon General 

Barnes instructed Assistant Surgeon Otis, 

then a captain, to report to him how evacuation in this type of situation had been 

handled in the past. After examining a variety of approaches, Otis could offer nothing more specific in the way of a solution 

than his conviction that "uniformity in 

equipment" was of great importance.' 

Thus left to their own devices as far as 

evacuation was concerned, Army surgeons 

reli ed heavily on the horse or mule li tter. 

Each litter required the services of two animals and four soldiers, one man to lead 

each beast and two more to wa lk beside 

the litter to keep it from swaying, a precaution that was necessa ry because when 

the animals walked in step, the litter took 

up a rocki ng motion. The opportunity to 

train animals to carry litters (mules, which 

took smaller steps, were preferred to 

horses) was rare, but untrained beasts were 

likely to pani c because of their unaccustomed burden. Each pair also needed to be 

matched carefully as to pace , since a faster 

animal in front might pull free of the harness, while a faster one in the rear would 

push the litter fo rward upon the leader. 

The length of poles used to construct the 

litter was also cri tical, as the animal in the 

rear had to be able to see the ground in 

front of his feetS 

A convenient alternative to the litter was, 

as contract surgeon Valentine T. McG illycuddy put it, the "travo r, travois, traveau, 

travoise, or travaiL" While one end of this 

litter-like device was fastened to a horse or 

mule, the other dragged upon the ground. 

The travois had distinct advantages. It could 

be made from materials near at hand, such 

as branches, small trees, or the poles from 

captured Indian tepees (since there was no 

animal at the rear, the length of the poles was 

not cri tical); any pack animal (pack an imals 

were usually mules) could be used because 
66 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

no special training was needed; and only one 

beast was sufficient to move the travois and 

only two men to guide it, one to lead and a 

second to steady the patient and carry the 

free end over streams or rough spots. As an 

expedition progressed and the number of 

disabled increased, the pack animals seldom 

became available to the Army surgeons for 

evacuation purposes. Even though the total 

weight of the supplies that the mu les carried 

was less and less over time as food was consumed by the men, they themselves were in 

a weakened state because of having to live 

on short rations, and redistributing loads to 

free them for use with litters was impossible because they could no long carry thei r 

usual heavy loads. While some surgeons 

preferred to use the litter over uneven 

ground, those favoring the travois pronounced it to be "well adapted for transporting the wounded over a rough country." 

Both litter and travois challenged physicians 

to experiment with improved designs that 

might minimize their drawbacks9 

When a hasty retreat allowed no time to 

construct litters or Lravois, surgeons were 

forced to improvise, placing a wounded 

soldier astride a horse or mule, regardl ess 

of his condition, the resultant pain , or the 

threat of hemorrhage. As a last reso rt, a patient was moved short distances seated 

upon the clasped arms and hands of other 

soldiers or carri ed in a blanket, with each 

corn er held by one of his comrades. The 

medical director of units in the Pacifi c 

Northwest that were involved in the 

Modoc War, wh ich took place in terrain 

where lava beds intimidated even unburdened horses, devised a litter that was 

borne on the back of a Single mule, "someth ing li ke a reclining chair," and had a carpenter make up severa l for his use. to 

The wounded of the Indian wars co uld 

usually be taken directly to a post hospital, but occasiona lly facilities had to be established in the field. Tents were generally 

used for this purpose, although any ava ilableshelter might be pressed into use. During the Modoc War a "genera l fi eld hospita l" was established in the late spring and 

early summer of 1873 to replace a temporary facility; in this instance, structu res 

made of "framing timber" covered with 

"pauli ns" suppl emented the tents. Under 

most circumstances the number of sick 

and wound ed who could not be sent back 

to a post hospital was very small, and what 

was called a fi eld hospital was most likely 

a ten-bed faCility at best." 

Performing surgery under such primitive conditions probably caused little diffi culty for surgeons who, as Civil War veterans, were more familiar with surgery and 

its problems than most civilian physicians. 

Arrow wounds were not of len encountered, however, even in the I nd ian wa rs, 

and thus few physicians became skill ed in 

deali ng with them. Removing an arrow 

from a wound without leaving its head behi nd requ ired particular skil l. Body nuids 

tend ed to soften the animal tendons that 

the Indians used to fasten the arrowhead 

on th eshaftso that the surgeon might leave 

th e head imbedd ed in the wound . Medical 

offi cer Lt. Joseph H. Bill had famili arized 

himself with the designs used by many differenttribes and developed a technique for 

removing the arrow shaft and head at one 

time. In an article published in 1862, he 

pointed out that since Indians inva riably 

placed th e head either parall el to th e slit 

in the shaft that accommodated the bow 

string or at right angles to it, it was easy to 

ascertain how the headla), without making a wide incision. One method that Bill 

described invo lved a looped wire inserted 

along th e shaft to snare the head, making 

it possibl e to pull out both parts of the 
THE INDIAN WARS 

arrow at once. He also pointed out that 

when an arrowhead had embedded itself 

in the sku ll , it could be used to raise any 

piece of bone that it had depressed in the 

process, possibly eliminating the need for 

the surgeo n to take further steps to alleviate pressure upon the brain. Indians often 

aimed for the navel, a broader target and 

one without bones to shield vital organs, 

but Civil War veterans knew that surgeons 

could do littl e to save men with penetrating abdominal wou nds. Unl ess th e victim 

were very lucky, if hemorrhage did not kill 

him, infection would.

12 

Wounds were not a major threat to soldiers serving in the West, but long grueling 

marches in extreme temperatures as well as 

severe food and water shortages could have 

devastating effects on their health. Disease, 

especially typhoid, malaria, and scurvy, was 

a great and often victorious enemy. Operations against the Indians in cold weather 

when snow covered the ground were too 

successful to be abandoned, but Army surgeons never found an effective treatment for 

the frostbite or freezing that was the possible price paid for continuing the effort. Deep 

gangrene and infection often resulted from 

cold injuries, and death was the frequent 

outcome. The amputation of toes or feet was 

common in these cases, but nonsurgical approaches were sometimes tried. On one occasion, at least, surgeons wrapped the patient's frozen feet in "cloths wet with 

whiskey." They dosed him internally with 

quinine mixed with a tincture of chloride 

and iron, administered three timesa day, and 

with morphine for his pain. Two days later, 

when the skin began to slough from the sufferer's feet, his doctor removed the whiskeyimpregnated fabric and substituted cloths 

soaked in lime water and olive oil, but the 

patient's legs continued to swell for two 

more days until death ended his agony. 13 

67 

Supporting a Major Expedition 

Army surgeons serving with the troops 

in the West saw action against many tribes 

and over a vast area, from the Southwest 

with its Apaches and Utes to the Northwest 

with its Modocs and Nez Perces. Yet no indians put up fi ercer resistance to the encroachment of the white man than those of 

the Northern and Southern Plains. Perhaps 

the most prolonged ordeal was that endured by the Army surgeo ns of the 

Bighorn-Yellowstone Ex pedition in 1876 

on the Northern Plains. This complex campaign, part of a decade-long and increasingly intense effort to force the Sioux and 

the allied Cheyennes onto a reservation, invo lved three separate commands, all from 

the Division of the Missouri, that attempted 

to converge on the Sioux in an area roughl y 

defined by the Yellowstone, Bighorn, and 

Little Bighorn Rivers and Rosebud Creek 

(see Mal' 1). Plans for this operation called 

for the commander of th e Department of 

Dakota, Brig. Gen. Alfred H. Terry, who also 

commanded the entire expedition, to lead 

troops, among them Lt. Col. George A. 

Custer's 7th Cavalry, east from Fort Abraham Lincoln , near Bismarck, Dakota Territory. Col. John Gibbon from the Department of Dakota led a second force east 

following the Ye llowstone River from Fort 

Ellis, Montana Territory. The commander 

of the Department of the Platte, Brig. Gen. 

George Crook, led a third column from Fort 

Fetterman, Wyoming Territory, north 

along the old Bozeman Trail. 

The area that was the expedition's destination was exceedingly difficult to supply. 

Much would have to come in th rough Fo rt 

Bufo rd, Dakota Territory, on the Missouri 

River nea r its co nnuence with the Ye ll owston e River, more than 1,000 miles from 

the nearest rail line. From Fort Buford the 
):1 

FO RT SHAW 

4/ . 

; "i D " , i 

~1 o :-'i T A ~ A T E 

• Helena 

MAP 1 

+ •••••••••• 

+ ......... . 

.............. 

+ .......... . 

+ .............. . 

+ .............. ... ):1 

® 

Crook's rOU t e 

Custer's route 

Gibbon's route 

Terry and Custer's route 

Terry and Gibbon'$ Toute 

Terry, Gibbon and Crook', route 

Fon 

Satdc site 

Campsite 150 

Miles 

R 

R; " n 

R 

.~::::::::\ 

2 9 MAY··.:-. 

• .... 1 

"'. 

it! ' J:::( A

I C R

FORT LARAM IE ~c P, 

";;,. 

,
THE INDIAN WARS 

mouth of the Powder River was 235 miles 

and that of the Bighorn 399 miles. The 

other rivers of the area could not be re lied 

upon for the movement of suppli es because 

they were both "shall ow and uncertain." Ii 

Evidence that Maj. William J Sloan, 

medical director of the Department of 

Dakota, was planning for the medical aspects of the expedition is scanty. During the 

winter of 1876 he was incurring added expenses for medical officers, hospital stewards, and other personnel, and also fo r medical suppli es for new posts and for fi eld 

service; but whether any of these expenditures represented planning specifically for 

the Bighorn-Yellowstone Expedition is hard 

to determine. The number and quality of 

the surgeons seemed to co ncern Sloan, as 

well as Maj. John E. Summers, medical director of the Department of the Platte, more 

than supply. Sloan, who supervised the 

work of a dozen regular medical offi cers and 

almost twice that many contract surgeons . 

serving more than twen ty posts, urgently 

telegraphed the surgeon general in late 

April that "if Assistant Surgeon Williams 

could be sent back without delay, it would 

relieve me of much embarrassment. " 15 

Sloa n's concern was justified, for when 

Gi bbon and 450 men left Fo rt Ellis on 3 

April to struggle eastwa rd th rough often 

deep snow, his entire medica l staff consisted of a single physician on his first assignment as a member of the Medical Department. Although Gibbon co uld have 

Signed on contract surgeons, ror unspecifi ed reaso ns he chose not to do so. His sa le 

medica l officer was Ll. Holmes O. Pauld -

ing, a 24-yea r-old physician who was apparently already showing the fi rst signs of 

the heart disease that wo uld kill hi m in 

1883. Paulding had been the post surgeon 

at Fort Ellis, where the cava lry battali on 

for Gibbon's force had been stationed." 

69 

H OLMES O. PAULDING 

From the outset Pauldi ng encoun tered 

two of the diffi culties that could co nfront 

ex peditions li ke the o ne to which he had 

been assigned. To the threat posed by the 

Indians were added supply shortages and 

treacherous wea ther. Pauldi ng could not 

bring with him as much of the suppli es that 

he had coll ected at Fan Ellis as he wished, 

"not having room for any more." Infantry 

units joining the expediti on from Fort 

Shaw, Montana Territo ry, brought him 

some of what he needed. Although the 

snow melted quickly when the sun shone, 

the weather was capricious. As late asJ une, 

warm sunshine alternated with heavy 

snow and high winds, and nights could be 

bitterl y cold. The Indians managed to 

make their presence known, although at 

first they did no t attack. Thus, un til the 

end of May, Paulding's patients, except for 

a man with a broken leg, were sick ra ther 

than injured. The ambu lance wagons that 
70 THE ARMY MEDlCAL DEPARTMENT, 1865- 1917 

J AMES P. KI MBALL 

were carrying those too ill to march moved 

slowly because ofLhesoft wet ground , and, 

in recalling his situaLion a revv weeks later, 

Gibbon co ncluded Lhat he had been "entirely devoid of any proper mea ns for the 

transportation of sick or wounded." He 

added Lhat his supplies should have been 

carried by a "well-organized pack train. " 17 

On 23 May the Indians struck for the 

first time, ambushing and killing th ree men 

who had left th e camp to hunt. Paulding's 

dU Li es on Lhis occasion were limited to examining mutilated bodi es. Only one soldier 

had been scalped , but knives and gun butts 

had wrought havoc. Some injuries had 

been innicted while the men were still alive. 

This horror caused the offi cers of Gibbon's 

command to reassess their vulnerability. 

Paulding was ordered to be prepared to 

douse all lighLs in the hospiLal tent in the 

event of a night attack unless a life depended on immediate surgery. 

As the column co ntin ued forward , more 

minor accidents and ailments required 

Paulding's attention, and he was himself 

brieny sick. One paLient, a scout who had 

broken his collarbon e, had to be retrieved 

six mil es from camp; the doctor noted that 

in this case he "expended a lot of brandy" 

as well as ten grains of quinine. Another 

pati ent was suffering from acuLe rheumatism and a third from a severe sore throal. 18 

On 9 June Gibbon's com mand met 

Terry's column, which had also been 

plagued by the weather. Even as Terry's 

forces gath ered at Fort Lincoln , a large 

number was suffering from frosLbite, and 

Lhe deep snow delayed the arrival of many 

more men. Capt. james P. Kimball , who 

had been detached from his new assignmenL at Fort Brady, Michigan, LO join Terry 

as Custer's senior medical ofHcer, was himself delayed by a blizza rd , which he laLer 

cred iLed for saving his life by preventing 

him from joining Custer. " 

When Terry fin ally sLarted ouL in May, 

Lhe medical direcLor for his command was 

Lh e same Capt. john W. Willi ams whose 

presence had been so urgently soughL by 

Sloan. Williams supervised the work of 

five med ical offi cers and bore the ultimate 

responsibility [or the healLh of a LOLal of 

925 officers and men, 700 of Lhem from 

CUSLer's 7th Caval ry. His supp lies moved 

by both steamer and wagon up the Missou ri and Ye ll owston e Rivers LO a depot aL 

the mouth of Glendi ve Creek, which ran 

in to the Yell owstone River so uth of Fort 

Buford. On 1-2 June a heavy snowstorm 

slowed th e command's progress, and Lhus 

iL did nOL reach the Powder River until th e 

seventh. Here a small hospita l was seL up 

to care for four men who became ill or were 

injured during the marchlo 

Upon Lh eir meeLing, Terry ord ered Gibbon to start up the Yell owstone River to-
THE INDIAN WARS 

ward lhe mouth oflh e Bighorn. On 18june, 

after an arduous march, Gibbon again mel 

with Terry, who had come upriver on his 

supply sleamer, the Far West. Gibbon 

joined him on lhal vesse l several days later, 

remaining lhere oSlensibl y "for the purpose of co nferring," but Paulding insisted 

lhat Gibbon stayed because he had coli c. 

By the twenty-firth , and after a day of ridge-

\Nalking far frol11 the nearest source of 

waler, Paulding informed Terry that the 

men wilh him could go no farther WilhoUl 

a resl. Terry appa rently wok his advice, but 

by the time the men could conlinue, a 

drenching rain was falling. Cava lry unilS 

preceded the infantry, and when the foot 

soldi ers fina lly arrived at the camp, the 

troopers were preparing Lo set out aga inheavy smoke had been spotted rising in the 

air "some miles up on the lillie Horn." 11 

Paulding sharedlhe general excitement 

that resulted from th e reports lhat began to 

come in. On 26 june he joined a company 

sent oulto sco ul along th e bluffs. He later 

reco rded in his diary lhal he had already 

co ncluded that Custer had been derea ted 

but that his opinion was not widely held. 

In facl, Cusler had divided his command, 

and all those he kept wilh him had been 

killed , among them the highly regarded Ll. 

George E. Lord, post surgeon al Fort Buford, who, like Paulding, had only recenlly 

been appointed to the Medical Departmenl. Lord's body, initially unrecognized, 

was positively identifi ed only after Williams noticed that one body was wearing a 

pair of unbleached socks, bought when he 

and Lord were together. Maj. Ma rcus H. 

Reno and the remainder of the 7th Cavalry 

were at that poinl so rely beset on the bluff. 

One of the physicians with Reno's command , conlract surgeon james M. DeWolf, 

was also among the dead, shot once in the 

abdomen and six times in the head and face . 

71 

GEORGE E. LORD 

A second contract surgeon with Reno, 

Henry R. Porter, sel up a fi eld hospital 

where, using a tent as both ground cover 

and operating lable, he amputated a private's leg. He was caring for more lhan fifly 

wounded when th e Indians finall y abandonedtheir attack with the approach of lhe 

Terry-G ibbon commands." 

Once the newly arrived force had determined that none of the men wilh Custer 

had survived, the challenge of evacua ling 

Reno's wounded "vas met under vVi lliams' 

watchful eye. Hand Iillers, mule lillers, and 

travols were constructed to move lhe 

wounded, but even when carried by eight 

men, the hand litters proved slow an d led ious. The litter-bearing mu les we re so 

fractious carry ing their unaccustomed burdens that the wo unded were lerrifi ed. Accounts of this phase of th e evacualion of 

wounded va ry, but acco rding to Williams, 

whose narrative is the most detail ed, lhe 
72 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

BENNETT A. CLEMENTS 

travo is proved entirely satisfactory. On 28 

June mules were chosen from Custer's pack 

train in the belief that their ex haustion 

wo uld render them tractable. Since the 

command had few mule litters and travois, 

and evacuating the wounded even just a 

few miles further by hand litters slowed 

progress, on the twenty-ninth Gibbon ordered that more mule li tters and travois be 

made. Tepee poles, rawhide, and canvas 

were used to produce nineteen mule litters 

and ten travois, the latter adapted from an 

Indian design with a basket of rawhide 

straps suspended from the two poles. With 

the less seriously injured men on horseback and the remainder on travois and li tters, the move to the Far West went surprisingly well. All were loaded on board 

and ready for their voyage back to Fort Lincoln before dawn on the morning of the 

thirtieth in spite of bad weather, six crossings of the Little Bighorn River, and a recalcitrant mule that knelt and dumped the 

amputee in his litter upon the ground." 

In the wake of the disaster both Sloan, 

just recently promoted to lieutenant 

colonel, and the surgeon general showed 

considerable anxiety about the future. In a 

telegram to Barnes, Sloan reported the catastrophe and the loss of two medical officers; asked for the immediate dispatch of a 

contract surgeon; and, "in view or recent 

events," requested the cancellation of the 

leave of one of his medical officers. A few 

days later Barnes telegraphed both Sloan 

and Summers to suggest that they assign 

both Terry and Crook a full surgeon. Summers replied that he had already ordered 

Maj. Bennett A. Clements, post surgeon at 

the St. Louis Barracks in Missouri, to join 

units coming to reinforce Crook. Sloan 

stated that although he had been waiting 

for the surgeon whose leave had been canceled to arrive in his department, he would 

send another to comply with the surgeon 

general's recommendation. Sloan also asked 

for and received permission to requisition 

a three-month supply of medicines for 300 

men to be sent to Fort Lincoln. Determined 

that Summers be promptly resupplied, 

Barnes telegraphed the medical sto rekeeper 

responsible for filling Summers' requisition 

that he was not to take leave until the supplies were on their way.'" 

For a month Gibbon and Terry remained 

in the area of the mouth of the Bighorn, 

awaiting the arrival of Crook's command. 

According to Paulding, a "general Hospital 

[was] established by Field Orders" on 4 

July. Although he gave no detail abo ut its 

size or constructi on, this faCi li ty was described as "general" because it served men 

from more than one regiment. Two weeks 

later one of Paulding's offi cer pa ti ents committed sui cide , shooting himself when he 

could no longer endure his "neuralgia and 
THE INDIAN WARS 

nervous prostra tion. " The weather was 

very hot, and both typhoid and scurvy were 

beginning to appear among the men. 

Paulding was caring for an average of 

thirty-five to forty cases at a time. AntisCOl'butics were promised but took weeks 

to be delivered. He could care for so many 

pati ents satisfactorily only because of the 

assistance of his hospital steward, who was 

"acting as a medical officer." 2S 

After moving three miles on 24 July, the 

Terry-Gibbon force awaited the return of 

Williams and the steamer from Fort Lincoln 

before starting out on the twenty-seventh 

toward the mouth of Rosebud Creek. The 

sick, accompani ed by Williams and Porter, 

went by steamer. On 2 August Indians attacked men from the steame r who were attempting to retrieve forage stored at the 

mouth of the Powder River. Artillery fire 

turned back the attackers, but a scout was 

wounded. Although "the gallant Dr. Porter" 

risked his own life to care for the scout 

where he fell , the wounded man soo n died. 

That same day the last of twelve companies 

arrived to reinforce Terry, and twenty patients were transferred to a second sleamer 

for the journey back to Fort Lincoln.'6 

As long as the command remained 

camped along a navigable part of one of the 

tributaries of the Yellowstone, neither supply nor the evacuati on of seriously or 

chronically ill patients was a major problem. On 8 August the Terry-Gibbon force 

left the mouth of the Rosebud, and on the 

tenth it finall y met Crook's command. 

United at last, the entire Ye llowstone Expedition on the eleventh "cut loose from 

[thel train & [wentl across country," still, 

however, foll owing the Ye ll owstone River 

eastward. On the seventeenth it reached the 

mouth of the Powder River, where thirtyfour more pati ents boarded the steamer 

that had been following the march. Crook 

73 

CURTIS E. MUNN 

left Terry on the twenty-fourth , and on 6 

September, when Terry and Gibbon 

reached Glendive Creek, Paulding concl uded that "the expedition against hostil e 

Sioux" had "died a natural death."" 

Crook's men were also preparing for the 

expedition against the Sioux in the early 

months of 1876. Since Summers, like Sloan, 

did not accompany the expedition, Capt. 

Curtis E. Munn, newly arrived on detached 

service from Camp Robinson, Nebraska, 

was Crook's senior surgeon and medical director. Under Munn served two contract 

surgeons, John Ridgely and Charles R. 

Stephens (three physicians to care fora force 

twice the size of Gibbon's command, which 

was accompanied only by Paulding). Mu nn 

was allowed the use of four ambulance wagons and a supply wago n. The weather in 

early March again proved a tough adversary 

when Crook's men finally started north 

from Fort Fetterman. On one occasion the 
74 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

warmth of the sun was "in a few moments" 

succeeded by "snow ... coming in from all 

quarters, accompanied with severe gusts of 

wind." The mercu ry in the thermometer 

dropped rapidly and eventually solidified, 

Crook recalled, "until we were having a regular blizzard. " A day and a night were spent 

waiting out the storm before the command 

could continue.'" 

Munn had a patient in one of his ambulances almost from the outset- for four 

days and 84 miles, a herder wound ed by 

the Indians journeyed with the command. 

The wago n train , including the ambulances, was left behind on 7 March at Crazy 

Woman's Fork with orders to head for the 

site of old Fort Reno, abandoned in August 

1866. Ridgely accompanied the wounded 

herder and th e sick to set up a field hospital thereforthem and for any evacuees sent 

back in the future. Munn continued on 

with his supplies, among them instruments, dressings, medicines, twenty-four 

blankets, a rubber bed cover, and bottles 

of brandy, all carried on the backs of two 

mules. With the ambulance wagons no 

longer ava ilabl e, he had to reso rt to a 

travois for a rider who was pinned when 

his horse fell on th e icy path. On 16 March 

the command was di vided once again. 

Now the pack train was also left behind , 

Stephens remaining with it and the two 

battalions assigned to guard it, while 

Mu nn went on with the three battalions 

making a night march to fo ll ow a fresh Indian trai!. '9 

In the encounter that followed, six soldiers were wounded and four killed. Only 

fifteen minutes were required to construct 

travois out of tent poles obtained at the village from whi ch they had driven the Inclians. These devices were very effective on 

this occasion; Mu nn reported that a private 

with a penetrati ng abdominal wound was 

evacuated over 100 miles of rough terrain 

back to old Fort Reno without harm. Two 

more of the men who were moved on 

travois were suffering from severe attacks 

of rheumatism-whether the "rheumatism" that so often plagued members of the 

expedition was caused by rheumatoid 

arthritis or some related co ndition or by 

hemorrhaging into joints and muscles resulting from scurvy is not known. Unfortunately, all that awaited the sufferers when 

they reached old Fort Reno was a single tent 

that was wet on the inside. As the outraged 

Munn reported, Ridgely, an elderly physician who had served as a co ntract surgeon 

in the War with Mexico thirty years before, 

had spent all his time either in sleep or in 

"querulous controversies." Within two 

hours Munn had made his patients comfortable; however, since all the men had 

been suffering intensely from the cold and 

many more cases of rheumatism were developing, Crook decided not to remain at 

old Fort Reno but to return to Fort Fetterman to awa it the arrival of better weather 

before proceeding with his mission." 

At Fort Fetterman , Munn discovered 

that several cases of erysipelas had recently 

occupied beds in the post hospital and that 

the wounded there had not done well. As 

a Civil War veteran he knew that erysipelas, 

later recognized as a streptococcal infection, was highly contagious. Despite his 

great respect for the post surgeon he decided, therefore, to send his patients, except the herder, with Stephens, who was returning to Fort D. A. Russell , Wyoming 

Territory. On his way back to Camp Robinso n on 30 March, Munn slOpped at Fort 

Laramie "much ex hausted. " He developed 

"pulmonary congestion, and remained severa l days a pati ent and guest of Assl. Surgeon Hartsuff, U.S.A., the post surgeon of 

the Station. " Although Munn finally 
THE INDIAN WARS 

J ULIUS H . P/ITZKI 

reached Camp Robinson on 7 April, it was 

several more days before he was well 

enough to resume his duties there." 

Crook set out once again from Fort Fetterman at the end of May. His force now 

numbered about 1,000 soldiers, slightl y 

more than in March, and th e medi ca l staff 

had been entirely replaced. His new medical director was the Fort Larami e post surgeon, Capt. Albert Hartsuff, who had been 

on leave when Crook's command first left 

Fo rt Fetterman. Hartsuff was assisted by 

Capl.Julius H. Patzki, a Regular Army surgeon and the post surgeon at Fort Fred 

Stee le in the Wyoming Territory; by a co ntract surgeon,]uni us L. Powe ll ; and possibly by a th ird doctor, identified in only one 

acco unt as Richard H. Stevens, about 

whom little else is known. Accompanying 

this force were 1,000 pack mul es. On 8 

June Crook aga in setup a supply base, this 

time at Goose Cree k, 300 miles from the 

75 

J UNIUS L. POWELL 

rail depot handling supplies fo r his expedition. Here 260 Indian scoutsjoined him. 

At Goose Creek he left his wagons and, apparently, Powell with some sick and injured. On the seve nteenth, 40 miles north 

of Goose Creek, Croo k's command encountered as many as 1,500 Indians. During the engagement that fo llowed , the surgeons had to move the wounded often lO 

keep them from the enemy. Dressings had 

to be hastily applied, and since Rosebud 

Creek, whi ch Hartsuff viewed as "a miserab le little stream," was 2 mil es away, no 

water was available. The Indians ki lled 

nin e soldiers and wo unded eighteen before they were driven off, and anot her soldi er aCCidentally shot himself with his pistol. No injuries were caused by arrows. " 

No serious attempt to pursue the enemy 

was possibl e because the wounded could 

neither be abandoned nor dragged along at 

lOp speed. Their suffering from the pain of 
76 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

their injuries and their loss of blood was 

magnified by the extreme heat and the 

shortage of wa ter. Soldiers built "a rough 

shelter of boughs and branches" to serve as 

a hospital, and Hartsuff, Patzki, and 

Stevens, assisted by a line officer who had 

once attended a course of medical lectures, 

worked all night to ready the wounded, 

both soldiers and Sioux, for the return to 

Goose Creek. The next day, 18June, travois 

and a litter were made from cottonwood 

and willow branches, and with thirteen of 

the wounded riding their own horses, the 

command turned so uth. Carried on the litter (Hartsuff maintained it was a litter, but 

Crook recalled that it was a travois) was 

Capt. Guy V. Henry, an officer who had been 

shot through the eye. A hardy soul, he reassured his anx ious comrades that he was 

"bully" even after one of the mules carrying the li tter shied and threw him twenty 

feet down a rocky incline. "Countless 

ravines and gullies" had to be traversed to 

avoid crossing deep water with the travois, 

but finally Crook and his men arrived back 

at Goose Creek. On the twenty-first, after 

having wagons spread with fresh grass for 

the wounded, a third of whom were in serious condition, Crook ordered them returned to Fort Fetterman, where they had 

to be sheltered in a barrack because the hospital was being renovated'3 

Crook and the rest of his command remained in the Goose Creek area until Lt. 

Col. Wesley Merritt and ten companies of 

cavalry arrived on 3 August to reinforce 

them. Merritt's medical director, Surgeon 

Clements, had under him at least two contract surgeons, Robert B. G ri mes, whose services Summers had specifically requested, 

and Edward LeCompte. Acting Assistant 

Surgeon McGillycuddy had apparently already joined Crook sometime in July, coming in with a supply train. Because ofhisseniority, Clements took over as the medical 

director of Crook's entire force. Two days 

after Merritt's arrival, Crook was again on 

the move, leaving his sick and wounded 

with a physician at Goose Creek and taking 

with him the remaining surgeons, seven in 

number if Stevens was still with Crook, and 

the more than 2,000 men that now formed 

his command. Keeping supplies to a minimum, he carried as much as he deemed absolutely necessary on 240 pack mules, two 

of which bore medical supplies. A few days 

later he joined Terry's force." 

On 23 August Crook put twenty-five of 

his sick on the Far West and then separated 

from Terry The next day, after leaving behind his wagon train and the remainder of 

those too ill to march, who were watched 

over by hospital attendants and a guard, he 

started east and turned south in his search 

for the Sioux. Crook was confident that he 

was adequately prepared to bring with him 

any in his command who became disabled 

along the way. The material that would be 

needed to make travois was loaded with 

othersupplies on the backs of his ever-faithful mules. Since they were trained to follow 

in a column behind an animal equipped 

with a bell and since they kept up with the 

march whether they dragged travois or carried packs, the sick and wounded were in 

no danger of being left behind to the savage mercies of the Indians." 

Despite the sacrifices Crook had made 

to enable his command to move rapidly 

in pursuit of the Sioux, heavy rains slowed 

progress. Thus his wet and shivering men 

began to pay the price for his gambl e in 

leaving so much of his suppli es behinda shortage of food. Crook telegraphed the 

commanding general of the Division of 

the Missouri, Lt. Gen. Philip H. Sheridan, 

to request that supplies of grain and vegetables be readied to meet them at Dead-
THE INDIAN WARS 

wood in the Black Hills of the Dakota Territory. By 7 September no pork, bread , or 

coffee remained. Soldiers had to kill and 

eat some of their horses and mules. Depression was widespread. Men and beasts 

alike were in poor condition, and symptoms of scurvy were appearing. Those 

whose horses could no longer bear them 

staggered forward , their feet bl eeding and 

their legs swollen. A member of Crook's 

force wrote less than two months later 

that he had seen "men so exhausted that 

they were actually insane. . "36 

By 8 September the command's situation 

was desperate, and life was "almost unendurable." Crook detached 150 men and 

sent them out on his strongest horses to 

find and bring back food to the others. in 

their search they encoun tered an enemy 

village near Slim Buttes. At the end of the 

ensuing two-day struggle, whi ch eventually involved another 250 of Crook's men, 

the indians abandoned the village, leaving 

behind their suppli es of dried meat and 

fruits. Surgeons cared for fifteen wounded 

soldiers, one of whom later di ed, and for 

indian casualties as well. Several lodges became temporary hospitals, where surgeons 

amputated the leg of a seriously wounded 

offi cer. An indian chief with a fatal abdominal wound und erwent surgery without chloroform , silently, but with "the 

sweat of agony ... upon his forehead." The 

command then resumed its trek south over 

ground that was wet from almost constant 

rain. McGillycuddy, who apparently shared 

th e responsibility for transportation with 

Ha rtsuff, reported that nine travo is and 

three litters were used to move the casualties from Slim Buttes so uth toward Deadwood, where wagons met them.

37 

Because captu red indian supplies, 

which were devoted to the sick and 

wounded, did not eliminate the need for 

77 

food, indian ponies became a part of the 

menu. Crook's men fo und no wood to use 

for fu el along the way. By 12 September 

some were so debilitated that they lay down 

upon the wet ground without shelter. 

When rain again began to fall, they were 

drenched. Mul es were exhausted by their 

struggle to keep going in the mud , and 

some fell while crossing streams. Frequent 

soakings led to "rheumatism and kindred 

ills," especially among older men. Only by 

eating wild plums, cherries, and buffalo 

berries did his soldiers limit the inroads of 

scurvy. Crook reported with some satisfaction that by the time his men reached the 

Belle Fourche River, near the end of their 

journey, only 2. 1 percent were disabled, a 

fi gure that incl uded wounded as well as 

sick. Clements later reported to Summers 

that his supply of medi cine up to that point 

had been "sufficient but not ampl e" and 

that he had lost no men to disease.'8 

An advance party had already reached 

Deadwood City, and on 13 September, 

while "breakfasting on pony steak," 

Crook's starving men beheld a wo nd ro us 

sight: Coming toward them was a herd of 

ca ttl e, followed by wagons full of nour and 

vegetables, and all accompanied by citizens of the va rious towns of th e area, hurrying to welcome them. That night "everyone ate as though he never expected to see 

anot her mea l, ... and the camp for the 

fi rst time in many days rang with laughter 

and merriment. " 39 

Even so, the situation [or Clements' patients remained diffi cult. Few men continued to fall ill. Their symptoms, however, 

had "a typhOid character. " The wagons had 

brought only food; tents were still needed 

to shelter th e sick and wo unded, and the 

clothing of all the men was in poor conclition. With cold and we t weather apparently 

on its way, Clements feared for the fu ture 
78 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

well-being of the men, bUl a supply train 

from Fort Fetterman arrived on 14 September, bringing medicines, blankets, and 

hospital tents. Croo k urged that the campaign be continued , but Sheridan decided 

to terminate the ill-fated expedition. 4o 

Although Clements never commented 

about personal hardship in his reports, he 

did complain bitterly to Summers in early 

October that line officers fail ed to keep 

medi ca l officers informed about what they 

intended to do. He emphaSized that he 

found it very difficult to plan for the care 

of his pati ents when he had no idea what 

the command wo uld be doing. He clearly 

blamed the lack of shelter for th em upon 

his ignorance of what might be ahead." 

Except for the 255 killed and 46 

wounded in Custer's disaster at the Littl e 

Bighorn, the casualties of the Bighorn-Yellowstone Expedition had been, like those 

of most effons against the Indians, quite 

low, 19 killed in action and 42 wounded. 

When Crook's command finall y headed 

back to Fort Fetterman, it left 39 sick and 

wounded with Curtis Munn at Camp 

Robinson. "Many of them were ill," 

Clements noted, but within "two hours, 

after their arrival all were washed, cleanly 

clad and in bed, and had beef tea given 

them. " The Surgeon General's Office concluded that "evely medical officer" involved 

in this campaign had performed we ll 

"under most trying and difficult circumstances and surroundings. " The effects of 

the ordeals, especially those of the fina l starva tion march, would long remain with its 

participants. In 1886, when Clements died 

after a length y illness, his physician noted 

that his patient had "shared ... hardships 

equally with the others, living for days on 

unsuitable food, from whi ch he co ntracted 

a dyspepsia that never deserted him and to 

which he attributed his symptoms. " 42 

Surgeons and Their Worh 

Because o f its size and compleX ity and 

the time it co nsumed, the Bighorn-Yellowstone Expedition differed marked ly 

rrol11 the Illost cOlllmon opera tions against 

the Indians, and because of the disaster 

that befell Custer, it has ga ined a prominent place in history's spotlight. The physicians who endured the ordeals of that expediti on were by no means the only Army 

surgeo ns to see action during the Indian 

wars, however. At least one saw his service 

less as hardship to be endured than as exhilaration to be enjoyed. Such a man was 

the remarkable physician who served with 

Capt. Henry W Lawton and his cavalry 

troop in 1886, when they were chasing the 

enemy through the rough and blaZing 

country along both sides of the Mexican 

border. ASSigned to the territory of Arizona, Lawton and his men covered 2,000 

mil es in the summer o f 1886 under conditions so ard uous and at times in areas so 

steep that horses broke down, and the pursuit eventually had to be conducted on 

foot. For all those participating in this campaign, unusual strength of will , zest for adventure, and physica l stamina were required, ye t no Army surgeon ever enjoyed 

the chall enge of Indian warfare more than 

co ntract surgeon Leo nard Wood." 

A recent Harvard medical school graduate, Wood was among those who had been 

given a contract while awaiting an appointment asassistantsurgeon. He had passed the 

Medical Department's entrance exam in 

spite of the board's misgivings about his "acquirements in Physics and Chemistry," but 

he did not thrive under the ordinal)' day-today routine and diSCipline of an Army post. 

When his command bega n the active pursuit of Geronimo and his Apaches, however, 

Wood came into his own. He eagerly vo l-
THE INDIAN WARS 79 

L EONA RD W OOD 

unteered ror fi eld duty, and the missions he 

undertook were so dangerous that they 

earned him a Medal or Honor (and with it 

the resentment or many line oITicers) twelve 

years later, by which point he had acquired 

many influential rriends" 

Ne ither the l2O-degree heat that alternated with violent storms nor th e rocky 

terrain razed wood as he rode with Lawton in pursuit or the desperate Apaches. 

He took eve ry opportunity to demonstrate 

and test the rabri c or which he was made, 

remaining in the saddl e ror incredible 

lengths or time and retaining his vigor and 

his enthusiasm whil e lesser men rell by the 

wayside. I n addition to the men or his command, he cared ror Mexican civilians who 

rarely received the attentions or a physician . In one instance, he operated on a 

child in an attempt to cure her cross-eyes 

when he was not experienced in this type 

or surgery and could neither provide postopera tive ca re nor lea rn whether his efrorts 

had been successrul. His willingness to operate suggests more rash enthusiasm than 

mature judgment. Nevertheless, Wood's 

commanding officer was in despair over 

the possibility or losing his services when 

he became the victim or a tarantula bite 

that temporarily laid him low with pai n, 

rever, and delirium in Jul y 1886<' 

Wood's prowess soo n attracted the attention or Brig. Gen. Nelson A. Miles, 

newly appointed to command th e Department o r Arizo na. Milesshared "Vood's New 

England background and was impressed 

by his physical condition. He aSSigned 

Wood, in add ition to his regular duties, the 

responSibility o r determining whether the 

best white athletes could equal th e endurance or Apache warriors. Wood's ex perience seemed th e best answer to the question, since only he and the orncer with 

whom he worked most closely lasted out 
80 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

B ERNARD SEM rG 

the el1lire campaign. By the late summer, 

when Geronimo finally surrend ered , 

Wood was fun ctioning more as a line officer than as a surgeon, having been placed 

in command o f a detachment that "vas o rdered to seek out escapees from Geronimo's band, a mission that failed despite 

Wood's best effo rts.'6 

Few surgeons are likely to have equaled 

Wood's stamina, vigor, and zest, although 

others faced and would continue to face with 

similar courage challenges like those in 

which Wood delighted. He obviously fo und 

the life of the line offi cer more intriguing 

than thaL of the Army surgeo n. His initial assignment, completed whil e he was sti ll a 

contract surgeon awaiting a vacancy in the 

Medical Department, started him out on an 

unusual path, one that he was to follow during the rest of his distinguished career in the 

Army: Wood the physician would continue 

to play second fidd le to Wood the military 

offi cer. In ulis he differed from most of the 

surgeons involved in the Indian wars, who 

were apparently content to limit their services to those normally expected of medical 

offi cers. 

Although they may not all have been as 

enmusiastic about the challenges they faced 

as Wood, Army surgeo ns exposed to danger in the West usually learned to live with 

it. Some became casual in the face of enemy 

fire, and the records of the period contain 

many stories of their heroism and levelheadedness in action. In the Pacific No rthwest contract surgeon Bernard Semig was 

severely wounded in 1873 while assigned 

to troops attempting to force the Modocs 

back onto th eir reservation in southern O regon. Although hit in the shoulder, he refused to leave his patient. After he was hit 

again, he fellunconsciolls. The loss of a foot 

because of the second wound apparently 

did not keep Semig from continui ng to wo rk 

under contract for [he Army unLiI he was finally appo inted assista nt surgeon in 1874. 

Du ring an 1877 campaign against the Nez 

Perces, who were resisting attempts to remove them fro m their homelands in the 

Wall owa Valley of Oregon, Surgeon Sternberg was forced to in terrupt his caring for a 

patient at night; the enemy fired so consta ntly at his ca ndle that he fi nally had to 

extinguish it. On the So uthern Plains yet 

another contract surgeon, Thom3stvi cGee , 

showed unCO lllmon coolness under fire 

when he was applying dreSSings La a wound 

during a raid on an Arapaho vi llage in July 

1874. Spotting a warrior about to shoot a 

nearby sold ier, McGee grabbed his patient's 

gun, shot the Indian, and calm ly returned 

to his bandages H 

Modern historians have questioned th e 

competence of these surgeons of I he I neli an 

wa rs, assuming thal no competent physician would 'vv il lingl)' unde rt ake to live in 
THE INDIAN WARS 

such isolation and to function under such 

primitive conditions. In Fronti er RegLdm-s: 

The United States Arl11y alld O, e Indian, 

1866-1891 , Robert M. Utley, believing that 

primitive living conditions and low pay discouraged "able doctors," concluded that 

most Army physicians, "whether regular or 

contract, ... lacked the competence of 

their brethren in civil life." In 1883, however, Morris]. Asch pointed out in the New 

York Medica l jou/1wl that although the 

medical officer's pay did not compare favorably with that earned by doctors practicing in large cities, it was generous when 

contrasted to that available to newly 

fledged physicians in civilian life, Medical 

officers also had the benefit of a steady income, even when sick, and could count on 

a pension of 75 percent of their salaries 

when they retired, Furthermore, in Asch's 

opinion, Regular Army surgeons on the 

whole were as capable as physicians anywhere in the world'S 

Care of Reservation Indians 

The long-term care of Indians who had 

given up the struggle against the white 

man was rarely among the Army physician's responsibilities, The reservations on 

whi ch they were gathered were under the 

Bureau oflndian Affairs, which had agreed 

that the Army wo uld play no ro le in their 

management unless the bureau requested 

aid, At least one medical officer, who apparently did not have the Army's approval 

for his care of reservation Indians, found 

his Army pay docked by the amount the 

bureau had paid him for dealing with its 

charges. The few Army surgeons who were 

assigned to care for reservation Indians did 

not seem to resent the responsibility and, 

on some occasions, seized the opportunity 

81 

to study the language of their patients, But 

for those caring for the Indians the Army 

retained as prisoners, the challenge was 

great and the satisfa ction small'9 

Unlike most Indians defeated by the 

Army, Geronimo and those who had 

fought with him against Captain Lawton's 

force were not immediately confined to a 

reservation, As prisoners, they remained 

the responsibility of the Army rather than 

the Bureau of Indian Affairs, A gro up of 

about 500 Chiricahua Apaches, including 

women and children, were sent from the 

Arizona Territory, where authorities believed they would continue to foment trouble, east to Florida, where the captives had 

been promised a new home on a reservation, There their health remained the responsibility of Army surgeons, so 

The health of Geronimo's Apaches, like 

that of so many Indians, whether they were 

the responsibility of the Army or of the Bureau of Indian Affairs, remained poor, 

plagued by high rates of both disease and 

death, Most of the Apaches defeated in 

1886 were shipped to Fort Marion, at St. 

Augustine, although in spite of promises 

that they would all be kept together, a few 

of the men were sent to Fort Pickens, Pensacola, Forced to live crowded together 

under conditions characterized by poor 

sanitation and given an inadequate diet, 

those at Fort Marion began to die at a rapid 

rate; 22, 15 of them children, died within 

the first six months, By 1888 all the Florida 

exil es had been moved to the Mount Vernon Barracks in Alabama, where initially 

they had no shelter but crude huts in a low 

area inhabited by malaria-bearing mosqu itoes, By 1890 the death rate was above 

100 per 1,000, In four years 120 of these 

unfortunates had died, This fi gure included 30 of the 112 children who, despite 

their parents' despair, had been sent to the 
82 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

P ETER]. A. CLEARY 

Indian School at Carl isle, Pennsylvania, an 

institution that was, like other Ind ian 

schools, severely overcrowd ed. More than 

half the 79 adult males sti ll ali ve were in 

poor health , often because of malaria.'1 

The Army surgeo ns responsible at various times for the health of the Apaches at 

Mount Vernon Barracks were a diverse 

group. The assignment was obvio usly not 

considered a desi rable one for regular medical offi cers-two who served there were 

heavy drinkers, if not actual alcoholi cs, 

and another was mentally ill. Although th e 

regulars were eager to be elsewhere, not all 

contract surgeons shared their opinion; 

one acting assistant surgeon who had 

served there was annoyed at having his 

contract canceled as not needed. All physicians assigned to care for the Apaches were 

to some degree frustrated by the poo r 

health of the Indians, but not all felt compassion for their cond ition. " 

Assistant surgeon Walter Reed, who was 

assigned to Mount Vernon Barracks from 

the summer of 1887 to 1890, was dismayed 

at the rapid in roads that tuberculosis, not 

generally recognized as a contagious disease until the end of the centu ry, was making among the captives, its progress aided 

in part, he believed, by their low morale. In 

January 1891 his successo r as postsurgeon, 

the hard-drin king Maj. Peter]. A. Cleary, 

blamed the mortality on the climate, ca llously assuri ng the surgeon genera l that 

"when they are thoroughly acclimated, 

those left of them wi ll be hea lthy. " But as 

th e months went by, the deaths continued. 

Cleary reported children dyi ng from 

chronic dysentery, bronchopneumonia, 

and tuberculosis, with the latter responsible for ad ult deaths as well. He blamed the 

death o f a deformed baby on deliberate poiso ning, a co nclusion he reached because of 

the tribe's reputation for destroying childrcn with congenital deformities." 

The susceptibility of the Apaches to el isease presumably resulted in part from th e 

stress under whi ch they li ved in an area of 

the co untry that was so far from home and 

so strange to them and in part from a lack 

of previous exposure to the ailments characteristic of Flo riel a and Alabama. Thus, in 

a sense, Cleary was correct-those who 

survived (became "thoroughly acclimated") wou ld undoubtedl y as a result 

thereafter have greater resistance to some 

of the diseases that had killed so many of 

their fell ow tribesmen. While confirming 

that venereal disease was not a significant 

problem, a study of th e health of all Indians in itiated in 1903 demonstrated that tubercul osis was a parti cular danger to them, 

both on reservations and in schools off the 

reserva ti ons. The investigation blamed 

both the unhygieniC surroundings in 

whi ch they had to live anel their poor el iet." 
THE INDIAN WARS 

In frustration at their inability to materially reduce the high death rate, physicians 

lOok to blaming the Indians themselves for 

it. In May 1891 Dillon]. Spotswood, a contract surgeon working under Cleary, attributed one dea th to "Indian medicine" 

and maintained that anothe r resulted frolll 

the patient's being "tampered with by the 

squaws" after successful treatmenl for an 

"enormous abscess." He noted in June, 

however, that the death rate was dropping, 

a fact he anributedto the establishment of 

a bakery. Although the Apaches no longer 

had to eat the "wretched bread which 

[they] baked for themselves," upon which 

he blamed most of the cases of dysentery, 

deaths and disease, particularly among 

children, continued. Of 5 fataliti es in July, 

Spotswood blamed 3 on "Indian poisons 

given as medi cines" and another on 

"syphilitic rheuma tism." Cleary, too, was 

now convinced that the foods the Apaches 

ate and the medicines with which they 

dosed themselves were responsibl e for 

many fatalities. Ignoring the apparent lack 

of milk to feed the infants, he insisted that 

the principal cause of infant deaths was the 

half-cooked meat their mothers fed them, 

si nce "the little wretches eat it with the 

avidity o r carnivorous animals." He ordered Spotswood, as the physician directly 

respo nsible for their care, to make a regular habit of visiting their homes and trying 

to educate the mothers" 

Despite the efforts of both Cleary and 

Spotswood, in fiscal year 1891 the death 

rate had reached more than 142 per 1,000. 

When Lt. William W Wotherspoo n, the offi ce r placed in charge of th e priso ners in 

1891, first visited these Apaches, he reported that they were "in filth y nakedness, 

clothed only in rags, with hair infected 

with vermin, their skin caked with accumulated filth , their ho uses fill ed with dirt 

83 

and offal , sleeping on the ground in the 

most abom inable rags, cooking and eating 

on the ground, treating and killing their 

own sick. " By the spring of 1892 strict controls over hygiene and sanitaLion were in 

force. All children except the very 

youngest had " to be paraded once each 

week" so that th e state of their health could 

be checked. All sick had to report at once 

to the surgeons, and the clothes of anyone 

who died had to be burned. A hospi tal was 

built, and the diet improved.'6 

Obviously proud of what he had accomplished as far as sanitation was concerned, 

Wotherspoon was distressed that in the 

summer of 1892 Spotswood's replacement, 

Capt. William C. Borden, considered his 

new charges to be filthy. The lieutenant admitted, however, that the improvement 

over what he had himself found a year earlier might make him see the 1892 picture 

as rosierthan itwas; the death rate had fa llen 

to less than 110 per 1,000. Borden apparently proposed such radical improvements 

in sa niLalion that even his superio r, Cleary's 

replacement, Maj. Curtis E. Munn, grown 

frail and bibulous since his days with the 

Bighorn-Yellowstone Expedition, questioned their practi cality. Munn emphasized, 

for example, that it was unrealistic to expect the Ind ians to use earth closets even if 

they were provided. He noted that there was 

a real need for fresh milk for the two-yearolds, who were too young lO be adequately 

fed on regular rations alone." 

Despite Munn's lack of support, Borden 

remained much interested in the health of 

th e Apaches. He blamed the high death 

rate of their chi ldren upon inadequate 

clothing in cold months and , above all, on 

an unsuitable diet after weaning. He noted 

that the Apaches, accustomed to the dry 

wea ther of the Southwest, preserved meat 

by hanging it in the sun to dry and that 
84 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

they continued to fo llow the same procedure in the humid climate of Alabama, 

where the meat rotted. Then, bad ly coo ked 

by Borden's standards, it was fed both to 

adu lts and to children, whose digestive 

systems could not handle it in its decomposed state. He also blamed the tuberculosis rate largely on the fact that the prisoners were, contrary to their custom, 

living in permanent housing and that th e 

buildings initially provided for them were 

poorly ventilated and co nstructed. Accustomed to leaving behind any filth that 

might have accumulated in th e short peri od they were in one place and to burning the hOUSing and clothing of anyo ne 

who died, Apaches all owed ga rbage and 

trash to collect in the dark dampness of 

their new quarters. 58 

By 1893 many Apache men had enlisted 

in the Army and, with the benefit of military inspections and diSCipline, were living 

under conditions simil ar to those of white 

soldiers. Borden noted that the village itself was now "on the crest of a hill ," with 

"plenty of sunlight and free circulation of 

air. The houses are of fairl y good construction, are well lighted by good-sized 

windows, . . . and are easily kept clean. " 

Despite the attention and care devoted to 

sanitation, hygiene, and diet, diarrhea was 

still causing a high death rate amo ng the 

Apache children in 1893, and tuberculosis 

continued to kill many adults. Borden , for 

whom tuberculosis was appa rently the first 

concern, explained that the rate was constantly high beca use the disease had become well entrenched in the tri be'9 

In 1894 the attempt to retain the 

Apaches in the East was finall y abandoned, 

and the survivors were sent to Fort Sill, 

Oklahoma Territory. Here the tuberculosis 

co ntracted in Alabama was blamed for a 

death rate that remained high, 83 per 1,000 

in 1894-1895, but in an environment 

more like that of their homeland, new 

cases of that disease were less common. 60 

The Last Battle 

As the 1880s wore on, major expeditions and Significant battles became fewe r. 

Railroads were proliferating and telegraph 

lines connected Army posts, easing th e 

Army's logistical probl ems and encouraging further settlement in the West. Finally, 

in December 1890 the white man and the 

Indian fo ught th eir last major engagement 

at Wounded Knee in South Dakota. No 

longer guerrilla warfare, the fight was 

waged on the white man's terms; the Medica l Department co uld fun ction much as 

it had in the Civil War, now with the help 

of the disciplined members of the new 

Hospital Corps drill ed in the management 

of evacuation." The Army was able to 

move the req uired men and supplies by 

train , and troops no longer had to march 

endl ess miles, in co nstant danger of ambush , along trails often impassable to 

wheeled vehicles. The Indian this fi na l 

time was surrounded, outnumbered , and 

totally vuln erable." 

Unrest among the Sioux at two reservations in South Dakota brought rei nforci ng 

Army units to the area in November 1890 

under Miles, now a major general and the 

commanding offi cer of th e Division of the 

Missouri . The tension was particularl y 

great at the Pine Ridge Reservation, where 

by the end of the month more than 1,300 

men were sta tioned. With the nature o f any 

possibl e action relatively predictabl e, the 

medical director of the Department of the 

Platte, Lt. Col. Dallas Bache, could plan 

and organize the Medi ca l Department's response. He sent in the tentage and eq uip-
THE INOlAN WARS 

ment needed for a 2S-bed hospital, a facility that was soon expanded to 60 beds to 

serve all the units involved in what became 

an effort to crush the Sioux. Surgeon Hartsuff, now a major and once again involved 

in a struggle against the Sioux, took charge 

of the fi eld hospital, aided by an assistant 

surgeon, two Hospital Corps noncommissioned officers, and ten Hospital Corps privates. The two battalions that formed the 

7th Cavalry brought with them two medical offi cers, a hospital steward, four Hospital Co rps privates, and two ambulance 

wagons. A battalion of the 9th Cavalry arri ved with a medica l offi cer, an acting hospital stewa rd, fi ve Hospital Corps privates, 

and an ambulance wagon. Although physicians at Pine Ridge concluded that a larger 

contingent from the Hospital Corps would 

have been desirable, they also believed that 

the field hospital, which had been set up 

on the Pine Ridge Reservation, co uld handle about 3 percent of the command6 ) 

The discharge of an Indian's riOe on 29 

December during the Army's attempts to 

disa rln the Sioux at their camp along 

Wounded Knee Creek led to violence. The 

Indians suffered high casualties. Their situation hopeless, the survivors were soo n 

neeing the melee, but the artillery stationed 

on high ground above the camp took a 

heavy toll as they ned. The Army had not 

expected hostiliti es, but the soldiers were 

prepared for the possibility. In their final 

battle, the Indians had never had a chance. 

During the connict, the value of training men for such duties as evacuating the 

wounded and the need to train more of 

th em became evident. Because of the 

shortage of hospital co rpsmen, civilians 

had been hired to drive the ambulance 

wagons. When hostilities broke out, several of these untrained men were so terrifi ed that they ned the scene. Captain Hoff 

85 

took over one of the abandoned ambulances himself, and when he encountered 

the men who had deserted their vehicles, 

"he d rove them to their duty. " The co ntrast 

between the co nduct of these men and that 

of the hospital corpsmen and the company 

bearers proved that the Army's training was 

well worth the effort and expense devoted 

to it. One hospital steward was killed in 

action. Two corpsmen rescued a wounded 

offi cer during renewed action on 30 December by taking an ambulance wago n beyo nd the line of skirmish to retrieve him. 

After surgeo ns examined all the wounded, 

placing a tag with each describing his injuries, the corpsmen handled the initial 

dreSSings acco rdingly. They then evacuated "not only ou r own wounded men but 

wounded Indians [whol were, with great 

promptness and dispatch, removed and 

ca red for in the field hospitals which were 

ex temporized for their benefit. "" 

The discipline and training that the 

Hospital Co rps provided its corpsmen 

stood them and the Army in good stead , 

but their ex periences during the Battle of 

Wounded Knee co nvinced Medical Department authorities that the services they 

could render should be taken more seriously. Medical officers had long realized 

that these valuable assistants should not 

be forced to face the enemy unarmed, and 

this engagement demonstrated that regardl ess of the circumstan ces, horses 

should be available for corpsmen just as 

they were for the cava lry.·' 

Not all surgeo ns were as diSCiplined as 

the hospital corpsmen. Standing on a hill , 

watching the battle unfold, was Capt. 

Charl es B. Ewing, who, accord ing to 

Colonel Bache, was present "not on duty 

but as a spectator." When a cavalry troop 

galloped by, Ewinggrabbed a riderless horse 

and sped off with the others, forgetting in 
86 THE ARMY MEDICA L DEPARTMENT, 1865-1917 

his enthusiasm to bring his dressi ngs with 

him. After nrteen minutes and three miles, 

he realized his mistake and turned back. B)' 

the time the da)' was over, Ewing had been 

0 11 the field more than seven hours. Excluding his brier escapade, he spent half his 

time at a dressing station and the rest helping in the evacuation of the wounded and 

the removal of most of the dead M 

Shonl), after th e baltle Colonel Bache 

told anoth er medi ca l o rn cer that 29 soldie rs, as well as an I nclian SCOllt, had been 

ki lled and another 30 wounded. He also 

estimated that as man)' as 115 Indians had 

been kill ed and knew that Arm)' surgeo ns 

were caring for 8 Indian wounded in addition to 25 wounded women and children. "The slaughter of the Indians must 

have been sickening," Bache wrote on 1 

Januar), 1891. "It is sickening now to step 

through the lines of broken women and 

children that we have as prisoners." 67 

Most of the duties performed by surgeons during th e baule were mundane, 

such as selling fractures and stopping 

bleeding, and requ ired medi cal skill rather 

than military discipline. Ewing's greatest 

challenge invo lved th e reallachment of the 

fleshy part of a nose. When he first saw this 

pati ent, an interpreter who accompanied 

th e command's Indian scouts, the entire 

nose forward of the bone was "hanging by 

a mere shred and bleeding profusel),." Several days later when Ewing removed the 

stitches, th e damaged appendage was 

firml )' in place. Among the patients encountered by other surgeons was an orn -

cer whose pocket watch had been fragmented and driven into his abdomen b)' a 

bullet; the pi eces were removed by Surgeon Reed, now a major assigned to Fan 

Keogh, Montana.

68 

In the days that followed the baltle, surgeons performed more major surgery, although Indian patients rerused to submit to 

operations even when death was the only alternative. Arter waiting thirty-six hours. 

Ewing decided that he mustamputateashattered leg because the breaking of both tibia 

and fibula had damaged major blood vessels 

and destroyed much soft tissue below the 

knee. He believed that the need for surgery 

was so urgent that he had to proceed even 

when allempts to lay the dust o[the din noor 

in the Sibley lent used as an operating rOOI11 

were only paniall)' successful. Despite "persistent antiseptic irrigation of the stump" 

and free drainage from the wo und, the patient died as a "result of pyemia in vo g 

staphylococcus pyogenes." 69 

Anticipating prolonged and fi erce hostiliti es, medica l orncers had set aside a considera ble amount of space in buildings in 

the area. Several large dormitories at the 

Oglalla School on the Pine Ridge Reservation were supplied with 150 beds and bedding; th e executi ve board of the new Sold iers' Home at South Dakota's Hot Springs 

a llotted two-thirds of the home's capacity, 

or 200 beds, for battle casualties; and another 40 beds awa ited the sick and 

wounded at Fons Robinson and Niobrara 

in Nebraska. Army casualties received 

th eir initial care in the fi eld hospital at Pine 

Ridge. Enemy wounded were also taken to 

th e reserva tion, where t hey were sheltered 

in tents and a small church made ava ilable 

to the Indi ans by a group of missionaries. 

Once emergency care had been given, 

Army casualties in need of funher treatmen t were sen t back to thei r post hospita ls as soo n as they co uld be moved. Only 

two went to Fort Rob inson and none to the 

other beds set up for the use o f ballie casualties. Many were ca rri ed twenty-six 

miles by ambulance directly from the fi eld 

hospital to Rushvill e, where Colonel Bache 

had arranged to have a sleeping car with 
THE INDIAN WARS 

its beds made up wa iting, and thence by 

train, six of them to Fort Omaha, Nebraska , and twe nLy-o ne to Fo rt Riley, 

Kansas. Of theforty-six patients in the fi eld 

hospital on 4 January 1891, only eighteen 

remained on the fifth . These were the last 

wounded from Indian warfare for whom 

Army surgeons would ever care. 70 

Until the Baule of Wounded Knee, the 

surgeons who accompanied the Indianfi ghting troops after the Civil War usuall y 

wo rked with small and isolated units, 

without the aid of a diSCiplined , welltra ined Hospital Corps and without the 

benefi t of the understa nd i ng of disease and 

infection that \",auld come w ith the era of 

modern medici ne. Just as the experi ences 

of the Civil War were irrelevant to those of 

the Indian wars, so, too, were the challenges of the Indian wars irrelevanL to the 

87 

demand s of mod ern large-scale warfa re. 

Although the Medica l Department had had 

its nrst signiri cant lesson in improving the 

health of primiti ve peoples when it tried 

to reduce the disease and death rates 

among the Apaches in Alabama, the experiences of the Ind ian wars before 1890 prepared neither the Army nor the department for the next military struggle the 

nation was to race. Wounded Knee was a 

turning point. It was the first battle in 

which the Medica l Department's Hospital 

Co rps took part and the last baule of the 

Ind ian wars. It was also the last battle 

whose wo unded did not have the care of 

physicians thoroughly co nscious of the 

danger germs posed to their patients. For 

the Medica l Department, Wo unded Knee 

was more the last engagemenL of an age 

that had almost passed than it was the fi rst 

or a new era . 
NOTES 

1. Quotation from War Depa rtment, {AmI/wI] 

Report oj tile Seaetar), oJWar, .1876, 1:476 (hereafter 

cited as 'NO, ARoJSW, date); Don Rickey, jr., Fony 

Miles aDa), 011 BUllis and Hay, p. 272; j ames A. Huston, The Sinews oJ War, pp. 256-59; Robert M. Utl e)" 

Frolllier Regulars, p. 48; Philip H. Sheridan, Record 

oJEllgagelllClIL s Wilh Hoslilelndia/lS .... Unlessotherwise indica ted , background material for this chapter is based on Russell F Weigle)', TIl e American WCI)' 

oJ War; idem, t-listOlY oj 1I1e United St at es Ann)'; and 

Utl e)" Frontier Regulars. 

2. Quotation from We igle)" His/my, p. 268; Francis P. Prucha, The Greal Father, 1:544-45,548-49; 

Ouo L Nelson, jr. , National seCllril), wul 'he Gelleral SwJJ, pp. 12-13; Paul A. Hulton, Phil Sheridan 

and His Arlll)" p. 301. 

3. AGO GO 101, 21 Aug 1882, and GO 121, l)ul 

1865; Llr, D. L Magruder to SG, 4 Apr 1866, Entry 

12, Record Group (RG) 112, National Archives and 

Records Administration (NARA), Washington, D.C. 

After 1882, commanding officers were urged to send 

only Regular Army surgeons with expeditions. 

4. Huston, sillews, p. 256; Darlis A. Miller, Soldi ers and seulers, pp. 287-88. 

5. Prucha, Greal Fat/IeI', 1:548-49; Mi ll er, Soldi ers a/ld Settlers, p. 300. 

6. George A. Olis, A Reporl 10 til e sw:geon Gelleraloll til e THlIIsport oj the sidi (Hut WOlwded by Padl 

Anima/s, pp. l-3, 19-20, 23n. 

7. Ibid. , p. 3. Sec also pp. 1-2,24,26-28, and 

passim. 

8. Ibid., pp. 13-15, 24-28; War Depa rtmem, 

fA ll/HUll} Report oj the Sw:geoll Gell eral, U.S. Arlll)" 

10 Lhe Seae/my oJWa/", 1875, p. 10, 1877, PI'. 11- 12, 

1880, pp.l0- 11, 1881, p.11 , 1882, p. 10, and 1883, 

pp. 19-20 (hereafter ciled as vVD. ARoJsG, date); 

Ri ckey, Beam alld Ha)" pp. 243-44. 

9. Quotations from Otis, Report Oil Transport. pp. 

25,22. See also pp. 17-19, 22n, 24, 26, 26n. 

10. Quotation from Ur, Henry McElderry loJohn 

Green, 30) un 1873, file F, Entry 624, RG 94, NARA; 

Ur, Crane to McElderry, 22 Aug 1873, Entry 2, RG 

112, NARA; Rickey, Beans and H Cl), . pp. 326-27. 

ll. Quotations from Ltr, H. McElderry to ). 

Green, 30 j un 1873, in fi le F, Entry 624, RG 94, 

NARA; WD, ARofSG, 1892, p. 5; Otis, Report 0 11 

Trallspor/, p. 19. See Chapter 2 for a discussion of 

post hospitals. 

12. Rickey, Bcalls (//1(1 Ha)" pp. 130, 254, 269, 

272; Manha L. Stern be rg, Geol:ge Miller S/ernhel:g, 

p. 13;joseph H. Bi ll, "Noteson Arrow Wounds," pp. 

367,369-71,374-77,381-83,385,387; Frank H. 

Hamilton, A Treafiseoll Militmy SUI:gel)' (II I(/ Hygiene, 

p. 526; George A. Otis, A Report oj s urgi((J/ Cases 

Trea/.etl ill the Army oj the Ullile(/sLales From 1865 /0 

1871, pp. 144-63; Peter D. Oleh , "Medicine in the 

Indian Figllling Ann)" .1866-1890," pp. 32- 41. 

. 13. Otis, Report oj sw:g i((J/ Cases, p. 167. 

14. WD, ARofSW, 1876, 1:309. 

15. Quotation from Tclg, William). Sloan to SG, 

22 Apr 1876, Entry 34, RG 112, NARA. In loe. cit., 

see Telgs,j ohn E. Summers to SG, 6 and 26j un 1876, 

and , in Entry 57, AGO SO 73, 23 Apr 1875. See also 

Holmes O. Paulding, slII:geolls Dim)' Witll file Cllsler 

RelieJ CO /UHlII , pp. i, 2-4, 33; j ohn M. Ca rroll , ed., 

General Cusler (lnd tile Ballie oj 'he Lillie Big Hom , 

p. 176. Except when otherwise indica ted, all material on the medical care of Gibbon's column is based 

on Paulding, Dimy. 

16. Ur, SG to Holmes O. Paulding, 10 Apr 1876, 

Emry 2; Ltr, Surgeon General's Office (SGO) LO L. 

C. Gordon, 17 Apr 1876, Entry 12; and AGO SO 

260,30 Nov 1874, Entry 57. All in RG 112, NARA. 

17. First quotation from Pau lding, Dim)', p. 3; 

remaining quotations from WD, ARoJsW, 1876, 

1:476; ibid. , 1:460, 471-72. 

18 . Paulding, Dimy , p. 17. 

19. Edward S. Luce, eel. , "The Diary and Lett ers 

of Dr. j ames M. DeWolf," p. 76; Maria B. Kimba ll , 

A solclierDoctoroJOurArmy, pp. 82-84; Ltr, William 

). Sloan 1.0 SG, 18 Nov 1876, H. R. Port er Papers, 

Enlr)' 561, RG 94, NARA; Mil Svc Ca rd, james P. 

Kimball , Emry 89, and Ltr, SG to Kimball, 27 jan 

1877, Entry 2, RG 11 2, NARA. 

20. WD, ARofSW, 1876, 1:460-61;) ohn S. Gray, 

Cell/ enllial CallI paigll, pp. 271-74. 

21. First quotation from WD, ARoJsW, 1876, 

1:473; second quota tion from Pau ld ing, Dim)', p. 20. 

22. WD, ARofSG, 1876, p. 7; idem, ARofSW, 

1876, 1:477; Augustus l. DeVoto, "A Trooper With 

Custer," pp. 68-71; Edward S. Petersen, "Surgeons 

of the Little Big Horn ," pp. 41-43; Douglas D. Scott, 
THE INDIAN WARS 

Richard A. Fox, Jr., Melissa A. Connor, and Dick 

Hannon, Arc/wcological Perspecti ves 0 11 til e Bailie oj 

tlJ e lillie Big/IO/"II , pp. 97,99, 132-33; in Enll)1 561, 

RG 94, NARA: Llrs, George E. Lo rd 10 SW, 8 j ul 

1875, J. F Head to J. B. Browl1 , n.d., and C. E. 

Michaelis 1.0 l. W Lo rd , 29 SCI' 1876, George E. Lord 

Pape rs, and also Mil Hisl, James M. DeWolf, idem 

Papers; in RG 11 2, NA RA : Ltr, SG to Lord ,S J un 

1876, Entry 2, and Ltr, Geo. D. Ruggles LO CO, Fort 

Buford , Dak.T. , 21 Apr 1876, Enlry 12; Gray, COIleJ lll ia/ CWII]Jaigll , pp. 274, 279. 

23. Otis, Rer an OIl Trclll sporl, pp. 21, 23n2; WD, 

ARojSG, 1876, 1'. 13; idem, A RojSW, 1:474-75; 

Sheridan, Record ojEllgagcmcnls, p. 58; Carroll, lilli e Big HOnl, p. 103. 

24. Quotation from Telg, WilliamJ. Sloan to SC, 

8 j u11876, Entry 34, RG 112, NARA. ln lac. eit. ,see 

also ibid. ,J. E. Summers to SC, and SG to Sloan and 

Summe rs, a ll 17 j uI1876;j. S. Billings to Sloan, 11 

jul 1876; a nd SG 10 Geo. T. Beall , 1 Aug 1876. 

25. Quotations from Pau lding, Dim)', pp. 27-28; 

S. L A. Ma rshall , Crimsoned Prai rie, pp. 170-71. 

26. Quota tion from Rpt, Orl ando H. Moore, 4 

Aug 1876, in WD, ARojSIV, 1876, 1:481; ibid., 

1:465; Sheridan. Record oj Ellgagemell/s, p. 60. 

27. Quotat ions from Paulding, Dim)'. p. 29; Olis, 

Report 0 11 Tr(Hl Sporl. p. 23n; WD, ARoJSW, 1876, 

1:466- 67. 

28. Quotation from George Crook, General 

George Cmoil, p. 19 1; ibid., p. 190; Herben M. Han , 

Old FarIs oj tile NOr/Invest, p. 146; Otis, Reporl 011 

Tnmsporl , p. 19; in RG 94, NARA: Ur, Curtis E. 

Munn lojohn E. Summers, 12Apr 1876, fi le F, Entry 

624, andStatemcnt, [?I to M. l-i eitman, 13jan 1903, 

Reel 409, Mfl 064; in RG 11 2, NARA: Ltr, SGO 10 

Abram French & Co., 18 j u11876, Entr}' 12. 

29. Ot is. Reporl on Transport, pp. 18-19; Rpt Extract, Charl es E. Munn, 12 April 1876,john Ridgely 

Pape rs, Entr)1 561, RG 94, NARA; Hart, Old FarIs, 

1'.42. 

30. Q uotation from Rpt Extract, C. E. Munn , 

Ridgely Papers, Enlry 561, RG 94, NARA; Otis, Reporl on Tra nsport , p. 19; Marshall , Crilllsoll ed Pra irie, 

1'. 126; WD, ARojSW, 1876, 1:441; idem, AliojSG, 

1876, p. 12. 

3 1. Quotations from Ltr. C. E. Munn (oj. E. Summers, 12 Apr 1876, fi le F, Entry 624, RG 94, NARA; 

in loco ci1. , see also Note, Munn , n.d. 

32. Sources do not agree o n the number of casuallies, which have been reponed to be as high as 

twen ty-eight killed and fift},-six wounded. Powell 

would become an assistant surgeo n in 1878. Quotation from Otis, Report on TmllSporl, p. 20; Crook, 

89 

Cmolt, pp. 194-95; Bo urke, Croo/t, pp. 289-90, 

318-19;john F Finert)', War-p<H1! aud Bivo[wc, p. 85; 

W D, ARojSW, Pl'. 1:308-09; in RG 94, NARA: AGO 

SO 17, 11 Feb 1876, and Mil Hisl. Curtis E. Munn, 

1876, Reels 267 and 409, Mfl064, plus Hartsuff's narrati ve, 1.876 [?I . repo rt, 17 jun 1876, and letter to 

Med Oil', Dept of Platte, 20 jun 1876, all file ~ Entry 

624; in RG 112, NARA: Ltr, SG LO julius H. Pa tzki, 7 

Dec 1876, Entry 2, and Ur, Patzki toSG, 29 Feb 1876, 

Entr}' 12, and Mil Svc Ca rd, PaLZ ki, Entry 89. 

33. First and third q uo tations from Bourke, 

Cmoil, Pl'. 316-17 (see also p. 319); second q uo tation from Crook, Crooll , p. 197; Ltr,j. R. Gibson to 

j. E. Summers, 28 j un L876, En tr y 12, RG 112, 

NARA; Otis, Reporl on TJ'(msporf, p. 20; Ma rs hall , 

Crimsoned Pl'(l iri e, p. 131; Finert y. War-path, p. 85. 

34. Crook, Crooll, pp. 197, 200-20 1.; Bourke, 

Croo , p. 345; Otis, Report 0/1 TrallSporl, p. 23n; in 

Entr}' 561, RG 94, NARA: Ltr, Edward LeCom pte to 

Med Dir, Dept of Plaue, 30 j ul 1876, Edwa rd 

LeCompte Papers, and Ltr, Robert B. Grimes to SG, 

jul 1876, Robe rt B. Grimes Papers, a nd Rpt, Valentine T. McGillycudd y, 31ju1187G, and Ltr, idem to 

SG, 18 Feb 1878, Va lentine T. McGill}'cuddy Papers; 

in RG 11 2, NARA: Ltrs. SG to Bennell A. Clements, 

14 and 26 j un 1876, Entry 2, and Telgs, J E. Summers to SG, 6j un 1876, and SG to Clements, 26 jun 

1876. and to Med Dir, Dept of Platt e, 27 j un 1876, 

Entry 34. 

35. Rpt (cop},), BennelL A. Clements, 25 Sep 

1876, rue F, Enlry 624, RG 94, NARA; WD ,ARojSW, 

1876, 1:467, 507-08; Ur. Clements 10 j. E. Summers, 25 Sep 1876, Enlry 12, RG 11 2, NARA. 

36. Q uole from llr, Walker S. Schuyler to his father, 1 Nov 1876, in Crook, Croo/t, p. 206; Ricke)/, 

Be(ms and Hay, pp. 262-63; Bo urke , Cmoll, p. 366; 

W D, AlIojSW, 1876, 1:506; Finerty, Wa r-pa, h, Pl'. 

254-56,261. 

37. First quotation from Finert y, WllI"-palh, p. 

278 (see also p. 300); seco nd q uota tion fro m Charles 

King, Ca ll1 paigllillg Willt Cmoll (111(1 Stories oj Arm)' 

Lije, 1'. 13 L; Crook, Craoll, Pl'. 206- 07, 207n ; WD, 

ARoJSW, 1876, 1. :506; Otis, Reporl 0 11 Transport, pp. 

23n, 25-26; in RG 94, NARA: MeG illycuddy Rpl, 

30 Sep 1876, McGill}'cuddy Papers, Entry 56 L, and 

Clements Rpt, 25 Sep 1876, fi le F, Entry 624; in RG 

112, NARA: U r, Clements (0 SUlllmers, 25 Sep 1876, 

Entr)' 12. 

38. First q uotatio n from Ltr, Schuyler 10 his father, 1 Nov 1876, in Crook, Crooll, p. 211 ; second 

q uo ta ti o n from Ltr, Clemen IS to Summers, 25 Sep 

1876, Entry 12, RG 11 2, NARA; WD,ARojSW, 1876, 

1:507-09; Finerty, War-pm/l , p. 301.. 
90 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

39 , First quotation from Finerty, WM-palh , p. 

306; second quotation from Lt r, Schuyler to his father, 1 Nov 1876, in Crook, Croo /l, p. 209. 

40. Ltrs, B. A. Clements toJ. E. Summers, 7 (quotation) and 80Cl 1876, Enlry 12, RG 11 2, NA Rk 

41. Ibid. , 7 Oct 1876. 

42. Crook, ,.oo/~ , p. 212; Wm Department, Adjutant General's Offi ce, ClJrOilOiogica/ List of AcLiollS ... With /ru/i(lIIs From jWlllmy 1, J 866, 10 )allIwry, 1891 (N.p., n.d.), PI'. 39- 40; in RG 112, NA RA: 

Ltrs, Charles H. Crane [?]IO Curtis E. Munn, 8Jan 

1877 (first and second quotations), and to B. A. 

Clemcllls, 16 jun 1877 (third and fOllrth quotations), Entry 2, and Llr, Clements to Summers, 8 

Oct 1867, Entry 12; in RG 94, NA RA: llr, Charl es 

Page 10 SG, 11 Nov 1886 (nfLh quotation), Bennett 

A. Clements Papers, Entry 561, and Mil !-l ist, Ben-· 

nell A. Clemen ts, Reel 409, Mfl064. 

43 . Hermann Hagedorn, Leollanl Wood , 1:68-69 , 

71. 

44. Quotation from Ltr, D. L. Hun tington to L. 

Wood,S May 1865, Entry 2, RG 112, NARA; john 

M. Carroll, ed. , The Mellal of HOllO/" , p. 98; Jack c. 

Lane, Anncll Progressive, pp. 2-4. 

45. Hagedorn, Wood, 1:68-69, 71-72, 76-77; 

J ack c. Lane, ed ., CII(ISillg Germlimo, pp. 16,65,69, 

132-33; idem, Armed Progressive, PI'. 8-11 , 13- 15. 

46. Hagedorn , Wood , 1:108-09, Li l ; Lane, 

Arllled Progressive , pp. 12- \3, J 7; Nelson A. Mil es, 

5ervillg tile Republic, p. 224. 

47. Lane, Armed Progressive, p. 8; Stern be rg, 

Slernbflg, PI'. 60- 61; WD , ARoJSG, 1875, p. 9, and 

1883, pp. 35-36; Frank U. Robinson, "The Battle of 

Snake Mountain," pp. 96-98; Bourke, roo/~ , p. 76; 

Ur, H. McElde rry to). Green, 30 J un 1873, in file F, 

Entry 624, RG 94, NA RA; George M. Kober, RemiIIiscences of Geolge J\;I(u"UII Kobel; M.D., Ll.D., pp. 

3 11-12; Ur, Charl es B. Ewing to SG, 30 May 1893, 

Ms CI00, George Mill er Sternberg Papers, Na tional 

Library of Medi ci ne (N lM), Bethesda , Md . 

48. Quotation from Utl ey, FronlicrRegu/{lrs, p. 87; 

Morris). Asch, "Army Medi cal Service," pp. 203-04. 

49. Ra)1 H. Mallison , eeL, "The Diary of Surgeon 

vVashington Mauhews, Fort Rice, 0 .1.," pp. 5-6; 

'William Corbusier, \'e!tle /() 5wI ( (Ir/OS, pp. 249-50; 

Urs, Thomas F. Az pell, En tl")1 227, RG 112, NARA. 

50. Angie Debo, Geronimo, pp. 294-95 . 

5 1. Ibid. , PI'. 292, 3 .1. 6-20 ; Crool<, (roO/l , pp. 

289-91; Telgs, P. H. Sheridan to G. Crook, 3 and 5 

April 1886, in George Crook , Croolls Resllme of 01'-

eraliollS Agai nsl Apache Indians, 1882 10 1886, pp. 

19 , 21; Herbe rt \·Veish , The Apache Prisollers (If ForI 

I'vl(/r;Oll , Sf. Augustine, Florida , pp. 3-4, 6; Frank C. 

Lockwood , Til e Apaclle Indilllls, pp. 320-21; \Villiam 

C. Borden , "The Vital Statisti cs of an Apache Indian 

Communit)/," p. 7; Prucha, Creat FtHller, 2:842- 44; 

William G. Poll ard, "StruclUreand Stress," M.A. thesis, PI'. 128, 133-34. 

52. In RG 94, NARA, see documents in papers 

of Willi am C. Borden and DilionJ. Spotswood , Entr}1 

561 , and in those of Peter). A. Cleary and Curtis E. 

Munn, Reels 325 and 409, Mfl 064. 

53. Quotation from "VD, ARofSG, 1892, p. 5 L; 

ibid., p. 52; Debo, Cera/limo, pp. 337,339,342-44; 

William B. Bean, W(llter Reed, pp. 42-45; Ltr, SG to 

Peter j . A. Clear)" 25 May 1890, Reel 325, Mfl064, 

RG 94, NARA ; John Dtiffy, Th e Salli!(,/"ialls, pp. 

L96-97; \Vesley \.v. Spink, Infeclious Diseases, p. 221. 

54. Prucha, GretH Fatll er, 2:846. 

55 . WD, ARoJSG, 1892, p. 52 (quotations), 53. 

56. Quotations fro m ibid., pp. 54,53; ibid., 1896, 

p. 92; Debo, GaO/limo, p. 348; Borden , "Vital Statistics," p. 7. 

57. WD, ARoJSG, 1892, PI'. 53-54; in RG 112, 

NA RA: Rpt, J os. D. Smith , 27 Jun 1892, sub: Inspection of the Medical Department, Enu"}1 38, 

Moun t Vernon Barracks; in RG 94, NA RA: Ltr, D.). 

Spotswood to SG, 12 Mar 1892, Spotswood Pape rs, 

Entry 561, and Efficiency Rpt, Curtis E. Munn, 13 

Feb 1892, Munn Papers, Reel 409, Mfl064. 

58. Borden, "Vital Statistics," pp. 6,8-9. 

59. Ibid., pp. 6 (quotations), 10. 

60. WD, ARoJSG, 1893, p. 69, and 1896, p. 92; 

Locl(wood , Apache Inc/ialls, p. 322. 

61. See Chapter 1 on the formation of the Hospital 

Corps and Chapt er 2 on the traini ng of its members. 

62. Prucha, Greal Father, pp. 560-61. 

63 . WD, ARoJSG, 1891, PI'. 37-38, 4 1. 

64. First quotation from lir, James W. Forsyth 

10 AG, 1 Ma), 1898, Entry 561, RG 94, NARA; second quota tion from WD, ARofSC, 1891, p. 12; ibid. , 

PI'. 39-41 , and 1892, p. 22. 

65 . WD, ARoJSG, 1891, PI'. 40-41 ; in RG 112, 

NA RA: Ltf, j ohn van R. Hoff to SG, 13 Oct 1888, 

Entry 17, and SGO Cir 14, 30 Apr 1891, En try 66. 

66. Quotation from Ur, Dall as Bache to Charl es 

R. Greenleaf, 18 Apr 1891, Ms C91 , Charles R. 

Greenleaf Papers, NLM . See also Charl es 13. Ewing, 

"The vVo unded of the "Vounded Knee Battle 

Field ... ," p. 40. 

67. Quotations from Llr, Bache to Greenl eaf, 31 

Dec 1890, cont on 1 Jan 1891, Ms C9 1, NLM. See 

also \VD, ARofSG, 189 L, PI'. 38, 40. The statistics on 

the number of wounded in Bache's letter differ from 

those given in the annual report, which ilself contains conflicting information. According to the an-
THE INDIAN WARS 

nllll] repon , the Arm)' had 31 wounded in the ma in 

banle and 8 in a lalcr skirmish. Yet, also ciling statistics from Colonel Bache's ofricial report , the Army 

had 36 caslIaliies and 30 severely injured Indians, 

most of them women and children. The annual repon further nOl es that 28 Indians we re laken to the 

hospital facilities on the Pine Ridge Reserva tion. 

9] 

68. Ewing, "Wounded Knee," pp. 39-43 (quotat ion): Dean, ~ccC/ , pp. 49-50. Reed was promoted 

to major on 4 December 1893. 

69. Ewing, ","Vounded Knee," PI'. 48-49 (quo-

,"(;On5); WD, ARofSG, 1.89J, PI'. 38- 39. 

70. Ewing, "\·Vounded I<nee," p. 42; U r, Bache 

{O Greenleaf, SJan 1891, Ms C91 , NLM. 

Chapter 4 

A NEW DIRECTION 

In 1893 the United States was entering 

a period of great change. The Indian wars 

were over. The nation's productivity, like its 

population, was increasing rapidly. The expansion of foreign trade focused attention 

on trade roules and international competition . President Grover Cleveland had 

scarcely been inaugurated, however, before 

a growing number of bank closings and 

business failures brought the nation to the 

brink of economi c chaos. By the summer 

of 1894 four million unemployed were 

seeking work. Among those still employed, 

wage reductions triggered strikes and related violence greater than those of 1877. 

By 1895 the threat to the economy was 

waning, and the nation was ready to channel its energies in new directions. Enthusiasm for the destiny of the United States as 

a wo rld power was burgeoning, and the 

outbreak of revolution in Cuba appeared as 

a promising opportunity to demonstrate 

u.s. strength and righteousness.' 

The world of medicine was also rapid ly 

changing. In Europe in the two decades 

immediately following the end of the Civil 

War, the pace of the medical revolution was 

accelerating, and American physicians 

who had studied in Europe were leaders in 

an increasingly successfu l effort to bring 

European standards in medical education 

to the United States. European scientists 

discovered the causa ti ve agents of an impressive list of diseases, among them amebic dysentery, gonorrhea, typhoid fever, 

malaria, tuberculosis, erysipelas, cholera, 

diphtheria , and teta nus, all threats to an 

army's effectiveness. Each discovery produced a host of new challenges for those 

who sought to prevent or cure disease. The 

isolation of the diphtheri a bacillus was followed by the finding that it produced a 

dead ly toxin. The subsequentdevelopment 

of an antitoxin that was clearly lifesaving 

convinced many doubters that the new scientific medicine was not mere "bacteriomania" and encouraged scientists to seck 

out other diseases whose ravages could be 

defeated in the same way. The discovery 

that serum from a patient who had recovered from typhoid, when mixed with the 

typhoid bacillus, would clump, or agglutinate, made possible the Widal test for diagnosing typhOid in 1896. A similar principle would eventually be used to develop 

the valuable Wassermann test for syphilis.' 

The proof that the so-called filth diseases-principally typhoid fever, cholera, 

and the various forms of dysentety-were 

spread by infected excreta and by anything 

that came in contact with them enabled doctors to develop more effective and efri cient 

approaches to sanitation. The public health 

laboratories that began to appear in major 

U.s. cities in response to developments in 

Europe tested water suppli es and assisted 
94 TH E ARMY MEDICAL DEPARTMENT, 1865- 1917 

SURGEON G EN ERAL STERNBERG 

in the diagnosis of communicable diseases. 

Towns and cities set up water and sewage 

systems, and more local governments accepted garbage collection as one of their responsibilities. In the Un ited States, publi c 

health was beginning to become "both institutionalized and professionalized." 3 

In providing "definite proof of the va lue 

of the laboratory approach," according to 

noted medica l historian Erwin H. Ackerknecht, these and similar developments 

encouraged the entry of the Army Medical 

Department into what would be a new and 

glorious era , one in w hich the new science 

of bacteri ology would make the laboratory 

an indispensable institution. The surgeon 

general who would now triumphantly ta ke 

the department to the forefront of the medical revolution was the 55-year-old Brig. 

Gen. Geo rge M. Sternberg. Resti ve under 

the regimes of his predecesso rs, Sternberg 

was apparently eager to create for his subordinates the climate he had long sought 

for himself.' 

During the last decades of the ni neteenth 

century, however, Congress made it impossible either for the Medi cal Department to 

take full advantage of the medical revolution 

in Europe or for the Army to prepare for the 

possibility of a foreign war. Sternberg himself believed that "the principal reason for 

supporting an army in time of peace" was 

the main tenance of "an dficienl organization . . . which will be ready for service in 

any emergency and serve as a nucleus for 

the larger army which will be required in 

case of war. " Because the legislature fail ed to 

vote an increase in the size o f the nation's 

armed forces, preparations to meet fu ture 

challenges had to be based on quality rather 

than quantity. Even this approach proved 

difficult to follow, for the nature of war was 

becoming ever more complex , and as Civil 

War veterans aged, fewer trained men were 

available for call-up. The need for planned, 

systematic training of the men, both offi cers 

and enlisted, who would be asked to meet 

the challenge of large-scale modern warfa re 

became increasingly obvious.

s 

The New Surgeon Gel1 eral 

After years of bitter political infighting, 

during which he had learned how to mani pulate legislato rs and politiCians to his 

own advantage, Sternberg succeeded 

Sutherland upon his retirement as surgeon 

general in May 1893. Sternberg was not the 

most senior member of the Medical Department. He had ranked at the very bOllom of 

the list of those who passed the depart men t's 

entrance exami nation when he LOok it during the Civil War. Hecould not claim LO have 

had the admin istrati ve experience o rhis predecessors or of some of the other candida tes 
A NEW DIRECTION 

for the position, nor had he spent any appreciable length of time in Washington, 

where he might have become familiar with 

the work of the Surgeon General's Ornce. 

Nevertheless, at a critical time in both the 

nation's histolY and the history of medicine, 

Sternberg was the man fo r \-vhom the momenL calied. Unlike his predecessors and his 

rivals, he was ascientist in the modern sense 

of the word. Years of determi ned, painstaking research, conducted under often dirncult circumstances, had made him a widely 

respected bacteriologist, one of the few 

Americans whose accomplishments rivaled 

those of the Europeans'" 

Sternberg developed his skills in th e use 

of both camera and microscope whil e still 

a post surgeon and also familiari zed himself with the latest laboratory techniques 

whil e working with Koch in 1886. His discoveries paralleled some of those of his famous contemporari es. Although the European bacteriologist Eli e Metchnikoff 

received credit for having discovered the 

phagocyti c action of white blood cells in 

1892, Sternberg had independently theorized about the scavenging activiti es of 

these co rpuscles in the early 1880s. Almost 

simul taneo usly with the French scientist 

Louis Pasteur he discovered the organism 

later identifi ed as th e principal cause of 

lobar pneumonia. He conducted experiments with disinfectants and established 

the fallacy of seve ral hi ghly regarded theories concerning th e causes of yellow fever 

and malaria, publishing many articl es and 

books based on his resea rch.' 

When Baxter di ed in 1890, physicians 

and military orncers-among them Maj. 

Gen.John McA. Schofi eld, the Anny's commanding general; United States senators; 

and such eminent citizens as Andre\-v 

Carnegie and Enoch Pratt- had joined an 

effort to have Sternberg appoin ted to the va95 

can cy. But the importance of bacteriology 

and the significance of Sternberg'S achi evements were not as \-videl)' appreciated as 

they would become by 1893, by which time 

the picture had changed. On learning that 

medical orncers junior to him were applying to succeed Sutherland, Sternberg decided to present his own name formally to 

th e president as a candidate. Th is time his 

candidacy, again supported both by men of 

inn uence and by an outstanding reco rd as 

a scientist, was successful.8 

After his selection as surgeon general, 

Sternberg co ntinued to publish and to assume positions on eadershi p in various civilian associations, clubs, and other organizations. These included Washington's Cosmos 

Club, the District of Columbia Subcommittee on Permanent Relief and SanitalY 

Dwelli ngs for the Poor, the Sanitary League 

of Washington, D.C., the American Medical 

Association, of which he was president in 

1897, and various scientific bodies. He also 

became a frequent visitor to the White 

House, as physician and then as friend, 

under both Cleveland and McKinley· 

The Medical DepartmenL had been moving forward into the new world of science 

before Sternberg'S appointment, and the 

use of antiseptics was by this time taken for 

granted. The new surgeon general stood as 

a symbol both of what the department had 

been and of what it should be in the yea rs 

to come. Whil e others in the department 

wo uld have undoubtedly made better administrato rs, Sternberg, with a record both 

of physica l courage in war and o[ scientific 

accomplishment in peace, was essentially 

the man of the hour. Captain Reed greeted 

Sternberg'S appointment to head th e department in May 1893 with the comment, 

"The fossil age has passed." 10 

ButSternberg had a darker side. The drivingambition that had enabled him to con-
96 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

tinue his research even during assignments 

to isolated posts was not an unalloyed 

blessing. Perhaps because he was frustrated that much of his work co nsisted of 

disproving the purported discoveries of 

others and that his positive achievements 

so often seemed to be anLi cipated by others, his continua l need for recognition 

eventually became strong enough to cause 

resentment. While many physicians who 

joined th e Medical Department during 

Sternberg's tenure became leaders in a 

golden age of military medicine, some became wary of their chief's private ambitions. Initially enthusiastic abo ut Sternberg, even Reed was eventually convinced 

that the surgeon genera l wou ld try to claim 

credit fo r his accomplishmenLs." 

Personnel and Ii-aining 

Although the number of posts and post 

surgeons had diminished since the late 

1860s, the responsibilities of the individual medical offi cer, for th e most part, had 

grown. The garriso n he served was larger, 

he was usually requiredlO care for military 

famili es, and he was involved in training 

litter-bearers and hospital corpsmen. The 

management of post hospitals grew in 

compl exity with the recognition of the importance of antiseptic surroundings and 

the accompanying increase in the number 

of operati ons. An understanding of exactly 

how filth was related to disease gave rise 

to an appreciation of the need to advise 

post commanders on the upgrading of sanitation and to remain abreast of the latest 

changes in the state of the an. Sternberg 

believed, moreover, that the medi cal officer had a responsibility to the publi c as 

well as to the Army and should th erefo re 

be willing to discuss hygiene and sanitation with all who were interested. Thus he 

raised no objection when medica l officers 

taught in civilian medical schools." 

A small staff of six medical officers 

worked in the Surgeo n General's Offi ce to 

coordinate th e efforts of Army surgeons in 

the field. The way in which the various administrative functions were organized varied with the passage of time. During most 

of the period of Sternberg'S service as surgeon general, the offi ce consisted of four divisions: the Library and Museum Division; 

the Hospital Corps and Supply Division, 

which bought and distributed medica l and 

hospital supplies to the National Guard as 

well as to the Regular Army; the Reco rd , 

Correspondence and Examining Division, 

whose functions included managing the department's accounts; and the Sanitary and 

Disbursing Division, which handled the 

prostheses issued to veterans, the personal 

identity section, and similar matters. A 

medical offi cer stationed in Washington 

was also responsible for health at the Soldiers' Home, although he was apparently 

not regarded as part of the administrative 

staff of the Surgeon General's Offi ce. '3 

Unappreciative of the increased responsibiliti es of Army surgeons and not co ntent 

with having en tirely eliminated funds for 

co ntract surgeons from the Medical Department budget, Congress proposed in 

1893 reducing the number of assistant surgeons from 125 to 95. The legislators reaso ned that if th e department could handl e 

210 posts in 1869 with only 193 medical 

ofri cers, the loss of 30 assistant surgeons 

would not cause a problem when only 120 

posts remained in existence. In 1869, however, the department had been able to hire 

184 co ntract surgeons. Repeated reductions in the number of contract surgeons 

over the yea rs and the elimination or this 

position had already resu lted in leave being 
A NEW DIRECTION 

a rare privilege for the department's regular surgeons, as Sternberg emphasized in 

his annual reports. Congress finally agreed 

to a reduction to 110 assistant surgeo ns, 

this figure to be attained by attrition. I. 

Thedecreasing number of surgeons in the 

Medical Department and the growing range 

of the duties that rested upon their shoulders made it more desirable than ever that 

Army doctors be completely prepared from 

the outset to meet the challenges that would 

face them. But even the best of neophyte 

medical officers was inadequately trained to 

deal with several aspects of his new responsibilities. Civilian medical schools devoted 

scant time to the preventive medicine that 

was so vital to maintaining the health of any 

Army unit. Since only in the last quarter of 

the nineteenth century did American 

schools begin to offer courses in bacteriology, U.s. physicians had to go abroad to 

study in this field. Moreover, the administrative aspects of military medicine were expanding and becoming more complex, but 

civilian medical schools did not familiarize 

young physicians with either the intricacies 

of the resultant paperwork or such matters 

as the design of hospitals and ventilating, 

heating, and sewer systems. Had study in an 

Army medical school been available earlier, 

a Civil War veteran pointed out, the new 

medical officer would have been "spared 

some of those hard lessons of laborious and 

dearly bought experience" and enabled "to 

adjust I his] previously acquired information to the exigenCies and changing phases 

of military life." Although several European 

countries had established military medical 

schools and former Surgeon General 

William Hammond had tried to start one 

during the Civil War, in 1893 the United 

States Army still had no such institution. I

' 

Since by this time advanced schools 

were being established for different 

97 

branches of the Army, Sternberg easily persuaded Secretary of War Dani el S. Lamont, 

a personal fri end, to order that a graduate 

school be established for the Medical Department. Perhaps as persuasive an argument as any in favor of the new institution 

at this point was that of Sternberg, who 

spoke in terms of "improvising a school" 

that wo uld add "nothing to the expenses 

of the Army Medical Department" while 

offering "all the advantages that could be 

derived from one costing heavily for its establishment and maintenance." It would 

use facilities, equipment, and materials, 

including biological specimens, that were 

already in the department's possession. Its 

regular staff would be composed of men 

working in Washington, although some 

lectures were to be given by experts who 

were not in the Medical Departmentwhether they contributed their services 

without charge is not stated in Sternberg'S 

annual reports. Since Sternberg believed 

that the principal "duty of an Army Medical offi cer is to preserve the effiCiency of 

his command by guarding it against unsanitary influence and preventing disability from diseases that are known to be preventable," the new school became the first 

institution in the country to specialize in 

public health and disease prevention. It 

also familiarized the neophyte medical offi cer with military regulations and provided him with the understanding of military discipline, authority, and training 

that would enable him to command respect as a military offi cer. 16 

The Army Medica l School's first session, 

held in the Army Medical Museum, ran 

from November 1893 to March 1894 and 

was attended by five newly commissioned 

medical offi cers and four experienced assistantsurgeons. The regular staff was composed of Col. Charles H. Alden, who as-
98 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ARMY MEDICAL MUSEUM CLASSROOM 

sisted Sternberg in his offi ce and served as 

presiden t of the fa culty; Lt. Col. William H. 

Forwood, attending surgeon atthe Sold iers' 

Home; and Majo rs Billings and Reed. An 

understanding of bacteriology was required, and the first graduates had to pass 

examinations in duties of medical officers, 

military surgery, military medicine, military 

hygiene, chemistI)', pathology, and Hospital Co rps drill . They were also given instruction in rid ing and "auxili ary courses," 

among them military law1 7 

Reed, who was the Army Medical M useU11l curator and director of the museum's 

pathology laboratory, taught clinical and 

sanitary mi croscopy, subj ects whose importance grew with every passing year. The 

number of "pathogeni c organisms" that 

his class studied Was co nsiderable. They 

included both staphylococci and the bacilli responsible for such diseases as anthrax, typ hoid, tuberc ulosis, and dip htheJ OHN SHAW BI LLI NGS 

ria . Ap parently not all o f his students were 

impressed by the American Medical Association's stand that "the in vestigation 

of ... microscopic organ isms and their effects lies at the very foundation of modern 

medicine and surgery"; a few showed little sign of effort beyond the absolute minimum necessary to pass. IS 

Another important subject in the new 

sc hool's curri culum was surgery, a rapidly 

expanding specialty. By 1897 yo ung Army 

physicians were being trained in the new 

field of abdominal surgery, learning how 

to manage intestinal anastomosis (the surgical joining of two separate sections of intesti ne to restore their continuity) and Lhe 

remova l of the ga llbladder or kidn ey. 

Willi am W. Keen, a Civil Wa r surgeo n so 

highly regarded that he had been asked to 

help care for the ailing President Cleveland 

in 1893, lectured on surgery of the head. 

In spite of the breadth of th e curricu lum, 
A NEW DIRECTI ON 

"fi eld service," or the management of the 

wounded and their evacuati on away from 

th e front, was not, as a medical historian 

of World War I commented, "dignifi ed by 

a special course of lectures ... "1' 

The 1894 decision to reduce the size of 

the Medical Department by attrition forced 

the cancellation of the session scheduled for 

the winter of 1894- 1895 because of the lack 

of students, although the laboratori es continued to be used as classrooms for several 

medical officers requesting instruction. 

When the school was reopened in November 1895, the number of students was again 

small , but the classes were considered so 

valuable that on 6July 1897 the school's session was lengthened to five months, beginning the fo llowing November.'o 

Part of the value of the Army Medical 

School was the opportunity to study specimens on display in the Medical Museum, 

among them some that had been involved 

in a series of experiments conducted by 

Capt. Louis A. LaGarde in cooperation with 

the Ordnance Department. Using an experimental .30-caliber Springfi eld rine and the 

standard .45-caliber Springfi eld, LaGarde 

sought to determine the effects on both men 

and armies.of newly developed small-caliber 

rines and the steel-jacketed bullets they 

fired, a topic of concern to all military surgeo ns. The tests used a variety of subjects, 

including rabbits, horses, powder cans fill ed 

with wet sawdust, and, apparently, human 

corpses. Of particular interest in this connection was LaGarde's report that the bullet 

fired by the .30-cali ber weapon had greater 

penetration than the .45 and caused less 

shock He also determined that the heat generated by the firing was never high enough 

either to cause damage to the nesh about the 

wound or to kill germs. 21 

The coll ecti ons managed by the Library 

and Museum Di vision of the Surgeon Gen99 

era!'s Offi ce und er Billings' direct supervision continued to inc rease in value. Both 

military and civilian sci entists used them 

to further their own professional growth . 

Many sources, including both dentists and 

physicians, contributed items for the musellin, some of which were used to educate 

the publi c as part of th e Medi ca l Department's exhibits at such widely publicized 

events as th e World's Columbian Exposition in Chi cago in 1893. This fair also featured a regulation post hospital "and a fi eld 

hospital under canvas, adjoining. " 22 

Many studies were conducted at the 

Army Medical Museum, including those 

Reed deSigned to improve methods of hancll ing and preserving specimens. Among 

th e most interesting were those involving 

the newly discovered "weird and wonderful " X-ray, first publicly demonstrated in 

Germany in December 1895. Reed's initial 

request for permission to buy X-ray equipment was rejected , but by lOJune 1896 he 

had an X-ray machine with whi ch he located a bull et in the thigh of a patient in a 

local hospital. Sternberg soon thereafter 

obtained machines for several post hospitals. Much was yet to be learned about the 

use of this revolutionary device, particula rly th e unpleasant nature of the burns 

that resulted from the long exposures th en 

required. A medical officer reported that 

one of his pati ents with a gunshot wound 

had been irradiated in a civilian hospital 

for twelve hours to make eight pictures. 

The bullet sought in this instance was 

never located, but the patient suffered an 

8- by I S-inch burn that was still not entirely healed six months later. The "most 

distressing feature of th e case," th e surgeon 

noted, was "the intense pain, which nothing but morphine will control. " 2J 

Wishing to offe r medi cal offi cers oppo rtuniti es to improve their skills beyond 
100 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

those available in Washington, Sternberg 

assigned promising young officers to posts 

near civilian medical schools to encourage 

them to undertake further study and research, an approach used by Baxter when 

he was surgeo n general. Following Sternberg's lead, the medical directors of some 

military departments also attempted to increase the professional expertise of their 

subordinates, presenting them with hypothetical practical problems to which they 

were expected to devise solutions. The 

goal of this type of exercise was not so 

much testing the medi ca l officers' knowledge as stimulating their minds. They were 

encouraged to include line offi cers in discussions of assigned probl ems so that their 

active cooperation in preventing disease 

might be more easily obtained " 

The training of the recently formed Hospital Co rps also co ncerned Sternberg, who 

so ught to perfect its organization and utili zation. He decided that because many of 

its members wou ld be serving in the East, 

a school of instruction should be established at Washington Barracks (now Fort 

McNair), a site ideally located for units 

along th e Atlantic Coast. Hospital Corps 

training could be run in co njunction with 

the medical school, providing inex perienced surgeons an opportunity to observe 

and participate. The program at Fort D. A. 

Russell in Wyoming was cut back and 

eventuall y eliminated in favo r of that in 

Washington, where a new hospital was 

built in co nn ection with the Barracks." 

Before hospita l co rpsmen could be adequately train ed, decisions had to be made 

about the role they wou ld play in the fu -

ture. Medical offi cers studied the way in 

which other armies handl ed the challenge 

of managing casualties on the battlefi eld 

and discussed the location and manning of 

fi eld hospitals, dreSSing stations, ambulance and medical supply depots, and the 

desirabl e amount and type of equipment. 

Since specifi c doctrine to guide the use of 

medica l perso nnel in the fi eld had yet to 

be determined, developing guidelines for 

lraining corpsmen to meet wanime responsibilities was difficult. At least one 

surgeon believed that the availability of 

medical officers at the front wou ld make 

the utility of first aid training for corpsmen 

questionable. The likelihood that the 

longer range of newly developed weapons 

wou ld require the dressing station as well 

as the fi eld hospital to be loca ted farther 

from the front made it difficult to predict 

whether medi cal officers or hospital co rpsmen would in the future be responsible for 

the initial care of the wounded.'· 

The training offered hospital corpsmen, 

however, was still principally designed to 

prepare them to meet the demands of a 

peacetime Army whose greatest challenge 

might continue to be Indian warfare. As a 

result, th e course in the East differed 

slightly from that in the West, because the 

hospital corpsmen in the West were more 

likely to have to bear arms to defend their 

patients. The school in Washington did not 

require drill with firearms, although all 

schools of instruction gave classes in cooking, riding, the care of horses, first aid, 

anatomy, physiology, nursing, and pharmacy. Doubts about the worth of ambulance and litter drills remained." 

In 1896 the Medical Department found 

it necessary to change its approach to the 

training of hospital corpsmen. From 1891 

to 1896 schools of instruction had trained 

more than 400, but attrition was so great 

that onlya minorityofthoseserving in 1896 

had been through the formal program. The 

department thus decided that schools in the 

West should return to the concept of training in small groups. The surgeon general 
A NEW DIRECTION 

had the training company at Fort Riley, 

Kansas, broken up and the men distribllted 

among other posts. The benefit anticipated 

from this approach was apparently entirely 

financial-once trained, these men would 

not have to be sent as far to reach their new 

assignments. Sternberg did not, however, 

break up the company of instruction that 

had been organized for corpsmen in Washington; it served as a pool from which men 

could be drawn to assist in emergencies 

wherever they occurred.'8 

Although much of the Medical Department's effort concerned corpsmen working in the fi eld, further changes involved 

those serving in hospitals. Experience 

showed that it was both impractical and 

unsanitary for such corpsmen to wear their 

regular uniforms wh ile on duty. Sternberg 

suggested that they be given white linen or 

duck uniforms to be worn over the regular clothing in cold weather and as a substitllte for it in hot. These fabrics would 

not absorb infectious material as easily as 

the customary uniform, and the conspi cuousness of stains would make it easier to 

spot areas that should be soaked in disinfectant before washing. Despite the logic 

of the suggestion , several years passed before the white uniform was adopted ." 

The increased salary availabl e to corpsmen after July 1892 resulted in an improvement in the quality of men submitting applications to take the Hospital 

Corps enlrance examination. Neve rtheless, complaints arose concerning their 

performance, since successful candidates 

were often the most intelligent rather than 

those best suited phYSically and mora lly 

for the work. They also proved less able to 

direct the efforts of others than those who 

had functioned as attendants in previous 

years. Sternberg pointed out to those who 

complained that if the offi cers making the 

101 

recommendations had exercised better 

judgment in their choice o[ candidates, the 

problem would never have arisen.3o 

As forts were abandoned and Congress 

continued its drive to reduce expenses, the 

number of hospital corpsmen and stewards, like the number of assistant surgeons, 

began to drop. Of the 589 privates in the 

Hospital Corps on 30June 1893 (positions 

for 598 were authorized), only 530 remained in 1895. In the same year 6 of 122 

hospital stewards left the service, and in 

March 1896 Congress reduced that fi gure 

to 100. Most medical offi cers publishing 

articles on the Hospital Corps seemed to 

agree that the ratio o[ Hospital Corps privates to the total strength of a command 

should approximate 2 percent, with 1 hospital steward and 3 acting hospital stewards assigned [or every 30 privates.3l 

The notion that every company had [our 

good men who were willing to add the 

work of the litter-bearer to their other duti es proved unrealistic, as had been predicted when the concept was originally 

proposed not long after the creation of the 

Hospital Corps. In Ma rch 1896, therefore, 

the War Department issued a genera l order 

requiringall enlisted men to be taught how 

to ca rry litters and to administer first aid. 

Surgeons were to familiarize company 0[-

fi cers with the litter drill and with emergency care of the wounded so that these 

officers could then train their men. In October 1897 a second general ord er required 

that enlisted men practi ce these skills at 

least [our hours every month and that each 

post surgeon train his hospital corpsmen 

in first aid and litter-bea ring [or at least 

eight hours in that period." 

The expertise of Regular Army hospital 

corpsmen was of little help to their National Guard counterparts. Guard components met rarely and briefl y, and if, as was 
102 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

often the case, a National Guard un it was 

not in th e same brigade with a regular regiment, then regular corpsmen were not 

available to familiarize their counterparts 

with their work. Train ing standa rds and 

equ ipment d iffered from un it to unit. The 

relati onship of Regular Army and Na tional 

Guard medical office rs conti nued, however, to be generally pl easant. Guard physicians o ft en displayed an active interest in 

the Med ical Department's most recently 

acqUired equipmen t and requested copies 

of the new suppl y table, whi ch listed the 

furniture, appliances, and d rugs used by 

the departmen t, including "appliances for 

operati ng in accordance with the requirements of aseptic su rgery." The two groups 

exc hanged informa ti on th rough the Association of M ilitary Surgeons, which in the 

summe. of 1893 opened its membership 

to Regular Army medica l offi cers. A few 

Guard doctors even attended some Army 

Medical School classes." 

Preventive Medicine 

In an era w hen disease was no t o ften 

treated successfull y, preventi on was critically important. After a year as surgeon 

general, Stern berg presumably beli eved 

that his medical offi cers were hand ling 

their respo nsibilities in this area satisfacto rily, despite the obstacies they encountered in their work, since he main tained 

that the health of the Army was generally 

good. The grea t majority of the enlisted 

men continued to come frol11 cities where, 

through exposu re since chil dhood to a 

host of diseases, they had acquired a certain resistance to many o f the most COI11 -

ma n ailments. The health of black troops 

had improved markedly, and onl y Ind ian 

scouts suffered to any great extent from 

sickness. The accommoda ti ons g iven to 

Indian sold iers were inferior, often old, dilapidated, bad ly ventilated, and dirty. 

Crowdi ng aggravated what was regarded 

as an inborn tendency to tuberculosis, 

while a high rate o f alcoholism only exacerbated all other problems. Blac k soldiers, 

on the other hand , were sick even less than 

white; their rate for 1895 was 811.6 per 

1,000 versus 1,116.44 for whites. High 

rates of sickness at a few posts served as 

reminders of the need for carefu l and co nstant auention to sanitation and hygiene. 34 

I n his auempts to maintain the Army's 

hea lth, Sternberg fo und himself fighting 

many of the problems that had challenged 

his predecesso rs. Casemates used as sleeping quan ers, defecti ve ventilation, vennin , 

dilapidation, overcro\vding, and poor sanitalian were stil l common wherever troops 

were stati oned, although by 1896 he could 

report that "fa cili ti es for personal cleanliness have been greatl y improved at our 

m i li ta ry posts." Determ i ned to be r u lly and 

accurately informed about living conclilions wherever Army units were stationed, 

he emphaSized to his medical directors 

tha t he expected them to co nduct perso nal 

inspections of all posts within their territories, avoiding reliance on the opinions 

of nonmedi cal orncers about sanitati on 

and the work of surgeons]' 

Water supplies remained a major concern-soldiers used many sources, including ri vers, cisterns, wells, anesian wells, 

streams, and ponds-but two new approaches to the problem of obtai ning a safe 

supply ga ined strength in the mid-1890s. 

One involved drinki ng only the water obtained from ice machine condensers. This 

move was so successful at Fort Ringgold in 

Texas, where it was inexpli cably fo llowed 

by a drop in malaria as well as typhOid rates, 

that a larger condenser was installed to 
A NEW DIRECTION 

produce 2,000 gallons a day. Mo re popular 

were [Hters, often employed in conjunction 

with boiling. Such a system had apparently 

been in use for some time atjefferson Barracks, where water was obtained from the 

St. Louis mains.

36 

For a period in 1895 while its settling 

basin was being cleaned, the local company that suppli ed water to Fort Leavenworth pumped directly from the Missouri 

River. Since the water came from a point 

less than a mile below the spot where the 

post sewage spewed into the river and less 

than two mil es below the outlet of a sewer 

system serving a village of more than 1,500 

people, it was not surprising that those 

who drank it found it was "not only very 

muddy, but positively foul. " Typhoid appeared at the fort, and efforts to have the 

drinking water boiled were only partially 

successful. By 1896 some families who relied upon river water for drinking were 

using filters.J7 

Properly used, some models of filters 

could remove an average of 98.54 percent 

of the bacteria in the water, but they required frequent cleaning and were very fragile. In 1897 the Medical Department began 

urging the use of portable filters in the field, 

where troops often drank from streams despite surgeons' efforts to discourage the 

practice. Although effective portable [Hters 

proved expensive, the cost seemed justifi ed 

because of the long-range savings that 

would result from improved health.

38 

In an era when enthusiasm for physical 

educati on and the vigorous life was growing, the discipline gained through athletics 

was increasingly va lued as a means both of 

preventing disease and of creating a state 

of glowing health. Believing that "the true 

athlete is he who has taught his muscular 

system absol ute, unquestioning obedi ence, 

and such a one is most amenable to con103 

trol ," the Medical Department continued 

its efforts to encourage athletics and physical fitn ess. Capt. James E. Pilcher pointed 

out that "preparatory training, by which 

defi ciencies are corrected and a proper 

equilibrium of the system secured," reqUired medical supervision. But the money 

for building the necessary gymnasiums was 

not always forthcoming, even when without them the men might head for the "evil 

resorts" of a nearby city. Recreati on and 

stimulation for the mind were also desirable as a means of filling the soldiers' spare 

time and lessening the temptation to indulge in the excessive use of alcoho l.'· 

Several other approaches to the problem of alcohol abuse were tried during this 

period. The canteen system was not universall y favored. Some beli eved that selling beer on base enco uraged young men 

to start drinking. Once they started, they 

might be more easily tempted to seek hard 

liquor off post. In any event, a red uction 

in the number of inebriates might come at 

the cost of increasing the total number of 

men who drank. The fact that the revenue 

of the canteen accrued to the fund used for 

the food that was bought to supplement 

the regular ration only tended to make a 

disinterested judgment more difficult. 40 

Few Army doctors attempted to cure alcoholics. The Medical Department recommended that they be dismissed from the 

Army or, at the very least, be refused reenlistment. Captai n Arthur devised a method 

of treating drunken episodes that was designed to restrain the alcoholic from further pursuing his inebriated ways. Arthur 

believed that it was important not to excuse the drunk from his duties any longer 

than absolutely necessary because this only 

encouraged his overindulgence. To speed 

the miscreant's return to sobriety, his stomach should be pumped, with the aid of a 
104 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

CHARLES SMART 

hospital corpsman and a wooden gag if he 

protested the procedure too vigorously. 

"!-IoL beef extract, with cayenne pepper," 

should then be administered and after an 

hour, the soldier should be returned to 

duty. Only if the drun kard fell into a coma 

or showed signs of delirium tremens would 

Arthur hospitalize him. In attempts to retain the services of an otherwise wo rthwhil e alcoholic sergeanL, Ll. Edward L. 

Munson devised a slightly different approach. !-lis cure used "suggestion and ... 

the association of ideas, combi ned with the 

effect of whatever tonic and anti-alcoholic 

properties that was possessed by strychnine." The sergeant was given a hypoderm ic of sui phate of strychnine, atropine, and 

morphine each day and allowed to drink 

all he wanted. After he had consumed alcohol, he was given a hypodermic of apomorphine, which worked as an emetic. The 

resultant "intensifying nausea," toge ther 

with assurances that the intolerance for alcohol caused by these drugs would be longlasting, made the very thought of alcohol 

Sickening. Both the Arthur and Munson approaches apparently won adherents among 

post surgeons;! 

In its drive to prevent disease, the Medical Department also took part in efforts to 

design an adequate emergency ration, one 

that would be light in weight and high in 

calories. Studies of various co ncentrated 

forms of food began in 1895, and when a 

decision was reached a year later, forty-fi ve 

officers, nine of them medical offi cers, had 

participated. In th e summer and fall of 

1895 units in the fi eld tested some of the 

proposed items. On one occasion soldiers 

were supplied with a coffee tablet, a bean 

soup tab let, crackers, and bacon. Each man 

then prepared his own lunch. By 1400 

hours some parti cipants were feeling nausea ted, and others were actively vomiting. 

Diarrhea added fu rther LO the misery of 

many. Wilhin two more hours th e landscape was littered with wretched and 

retching bodies, although all soon recovered. Interviews and furth er personal testing of the individual components of the ration by the intrepid surgeon involved in 

this test suggested that both the bean soup 

and the crackers were in some way to 

blame for the fi asco. During another test, 

the men of the 1st Cava lry subsisted on a 

different ration without apparen t harm for 

five days of a ten-cia)' march .. n 

In December 1896a4,110-calorieemergency ration was adopted, fo ll owi ng its 

recommendation by a four-man board 

headed by Major Smart. It ca lled for sixteen ounces of hard white bread of the ki nd 

normall y provided to the Army, si nce it 

kept wei l and \vas familiar to the men; roast 

ground coffee beans or tea , to be sweetened with saccharin rather than sligar to 
A NEW DlRECTION 

keep the weight of the ration down and to 

lessen "the preva lence of diarrhea due to 

in testinal fermentati ons"; and ten ounces 

of bacon. also of a type with which the men 

were fam ili ar. The board believed that the 

high proportion of fat was necessary to add 

calories to a ration that had to be compact 

and light in weight. A soup tablet was on 

the list. but th e boa rd could not find a manufacturer who would guarantee the use of 

the desired formula . This ration was not to 

be used for more than ten days at a timeY 

The drive to prevent disease. coupled 

with the realization that insects might in 

some manner spread "the germs of cholera 

and other diseases." led to suggestions that 

window screens were more than a mere 

luxury. Army surgeons were aware of the 

malaria parasite and searched for it in the 

blood of their fever patients. Some believed 

that these organisms were transmitted directly through drinking water. but Sternberg was skepti ca l of this theory. Although 

the role played by the mosquito in malaria 

was not yet firmly established. the connection of malaria with the sort of wetlands 

that breed mosquitoes had long been noticed. Having observed that at Fort Myer. 

Virginia. where the malaria rate was high. 

the number of patients with this disease 

went up rath er than down after the drinking wa ter was fil tered. Surgeo n Reed theorized that "emanations from the Potomac 

Flats" might have something to do with 

the malaria rat +~ 

1n diphtheria and. subsequently. tetanus. prevention was made easier by the 

ava ilability of both positive diagnosis and 

treatment. Since supplies of the diphtheria antitoxin were inadeq uate. the Army 

established its own "diphtheria antitoxin 

'plant' " atJ efferso n Barracks. Here horses 

were inj ected with the toxin in gradually 

increasing doses until a high level of anti105 

toxin had been produced in their blood. 

Some patients in whom the antitoxin from 

horses was used experienced typical immune reactions in the form of rashes. joint 

pains. and. in one instance. a fatal paralysis. all of which were blamed on the amitoxin. Nevertheless, reports on its use as 

both a cure and as a preventive for this terrifying disease were generally fa vorable" 

Despite the precautions taken to purify 

drinking water. typhoid and fevers with typhoid-like symptoms continued to plague 

the Army. The new Widal test would in 

time prove especially valuable. but its true 

value wou ld not be appreciated until 

physicians learned how to administer it 

and until they realized that different fevers 

were spread in different ways and that. 

therefo re. prevention depended on distinguishing between them.'" 

Treatment of typhOid. li ke that of other 

fevers. had changed to some degree 

through the years. Patients were no longer 

bled. and although the noted physician Sir 

William Osler maintained that purging 

had also been abandoned. Army surgeons 

were still dosing typhOid patients with 

calomel (mercurous chloride). followed 

by castor oil. Antipyretics. among them 

quinine and phenacetin. were frequently 

used. and other preparations. such as chloral or mixtures containing a narcotic, were 

employed to induce sleep·7 

Efforts both to prevent and to treat disease still often followed lines developed 

decades, even centuri es, earlier. But new 

discoveri es were beginning to provide explanations about why improved sanitation and hygiene resulted in lowered disease rates and to suggest different 

approaches to both diagnosis and treatment. In his "Valedictory Address to the 

Graduating Class of the Army Medical 

School. Washington. D.C. ... in 1896. Civil 
106 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

War surgeonjohn H. Brinton rejoiced that 

"the bright days of advancement illuminate the whole horizo n." In 1897 a physician wrote in the Boston Medical and Surgical j ournal that it was "but yesterday 

that medi cine [becamel a hand-maiden of 

science and ... escaped from th e domain 

of inexaCl empiric art. "-Is 

SurgelY 

Progress in surgery was more dramatic 

than that in the prevention and treatment 

of disease. Encouraged by the optimistic reports of colleagues who traveled abroad to 

observe the best surgeons of Europe, Medical Department officers were undertaking 

a wider range of operations than ever before. They not only performed abdominal 

surgery, but they performed it earlier in the 

course of the patient's disease, before a fatal 

outcome became inevitable. The resultant 

improvement in the survival rate led to further and still earlier attempts. One civilian 

physician used an article in the j otll"ll(ll of 

the American Medica l Association to urge in 

the strongest terms that surgeons operate 

"in every case of appendicitis, promising or 

unpromising, at th e earliest possible moment. " Nevertheless, the belief that the patient might recover from appendicitis without an operation and thus that surgery 

might subject him to unnecessary risk still 

caused many doctors to hesitate" 

Surgery to repair hernias had not been 

common before the era of antisepti c 

surgery. Even when it was ped ormed, it 

was done only in desperate attempts to relieve strangulation. Fewer attempts to 

force the protruding intestine back into 

place without an incision were made as 

surgeons experienced increasing success 

with what was then called the "radi ca l 

cure," or surgical repair involving an incision. Sternberg made herni otomy part of a 

campaign to keep good men with curable 

disabil ities in the Army-one estimate 

suggested that twenty to thirty men received discharges each year because of hernias. He hoped thereby also to limit the 

number of disability pensions the government had to pay. In 1895 the Army gave 

th e soldier with an operable hernia the option of having this problem repaired by an 

Army surgeon chosen by the surgeon general, thus avo iding a disability discharge. 

Sternberg noted that even when surgery 

did not enable the hernia victim to remain 

in the military, it at least made earning a 

li ving as a civilian easier. Medical offi cers 

performing herniotomi es appear to have 

been successful; in sixty-seven cases dating from 14 August 1895, th ere were only 

three relapses and no deaths.'o 

Success in Simpler forms of surgery encouraged attempts to conduct more demanding operations. In addition to herniotomies and appendectomies, Army surgeons 

were by 1898 undertaking hysterectomies 

and other forms of gynecological surgery, 

nephrectomies (removal of the kidney), and 

surgical repair of abdominal wounds. They 

removed gallstones and attempted the surgical relief of peri tonitis, peritoneal abscesses, and intestinal perforations. Their 

few failures no longer discouraged them, 

and the number of patients undergOing abdominal surgery grew. Of eighty-one patients upon whom such operations were performed in fiscal year 1898, seventy-seven 

surv ived.

sl 

Caution also marked postoperative 

care. Medica l officers waited several days 

before allowing th eir patients to take nourishment by mouth. Lieutenant Munson 

permitted nothing by mouth for two days 

after surgery, wh ile Maj. George W Adair 
A NEW DIRECTION 

recorded nourishing one of his patients by 

enema exclusive ly for fi ve days postoperatively. The postoperative recovery period 

for herniotomy pati ents in the mid-1890s 

was also prolonged. Deputy Surgeon General Forwood kept his hernia patients in 

bed for thirty days after surgery and insisted that they refrain from "violent exertion" for at least three months therea fter. 

Other Army surgeons kept their patients 

in bed as long as six weeks." 

The frequency of abdominal surgery led 

Sternberg to order post surgeons not only 

to set aside a room to be used excluSively 

for surge ry but also to develop routines designed to reduce the chance of infection 

and enhance the li keli hood of an un eventful recovery. After administering thirty cc. 

of sherry as preoperative medicati on 

(whiskey was also used for this purpose), 

one Army surgeo n had a large area around 

the operative site shaved and scrubbed with 

soap, wa ter, and a solution of bi chloride of 

mercury. The patients stomach was washed 

out by means of a lavage tube "as a special 

precaution against vomiting" before the 

eth er was admi nistered. Immediately before the operation began , all gauze, absorbent cotton, and other materials that 

would be needed were routinely sterilized. 

Once a patient entered the operating room, 

the area around the operative site was covered with "hot, steri lized towels." Kangaroo tendon was recommended for deeper 

sutures, although catgut was used for more 

superfi cial stitching. At least one surgeon 

preferred "silkworm gut" for stitches taken 

in the skin ; since they were non-absorbable, they were removed a week after 

the operation. To avoid infection and the 

fa ilure of hernia repair because of sloughing of internal stitches, the kangaroo tendons were sometimes soaked for fortyeight hours in ether and for another 

107 

twenty-four hours in bichloride of mercury 

in ether, then stored in a solution of ca rbolic acid and alcohol. Surgeo ns and attendants in the Army's operating rooms 

were beginning Lo wear "linen suits, linen 

opera ting aprons, and canvas shoes, the 

arms being bare to the elbow. " Hands and 

forearms were always subj ected to th e 

usual scrubbings and soakings to render 

th em as germ free as possible" 

The progress that had been made in the 

field of surgery since the death of President 

Garfi eld in 1881 was most eloquently 

demonstrated when, a few weeks before 

Stern berg'S appointment as surgeon general, President Cleveland first noticed a 

growth in the roof of his mouth. Maj. 

Robert M. O'Reill y, one of his perso nal 

phYSiCians, was asked to examine the 

growth when he arrived at th e White House 

to pay a socia l call . Alarmed by what he saw, 

he returned the next day to remove a bit of 

the abnorma l tissue. This he sent, without 

identifying his patient, to the Army Medica l Museum's laboratory for examination. 

Having established the malignant nature of 

the tumor, O'Reilly called in Cleveland's 

civilian physician, Joseph Decatur Bryant 

of New York, who had the grim diagnosis 

confirmed by Dr. Welch atJohns Hopkins. 

From this point onward O'Reill y helped 

Bryant coo rdinate th e president's care, but 

played only a minor role in it himself.54 

Much involved in the nation's problems, 

Cleveland postponed the necessary surgery 

until]uly. His physicians then faced a dOllble challenge-to do whatever could be 

done to preserve the president's life and ability to function effectively at the head of a 

troubled nation, and to keep word of the seriousness of his condition from reaching a 

public already on the verge of panic because 

of the depressed stateofthe economy. When 

rumors about Cleveland's health began to 
108 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

circulate, his doctors informed the press 

that he was suffering only from rheumatism 

and dental problems. Even the families of 

the surgeons involved were kept in the dark 

about the identity of the patient.S5 

Although Cleveland was only 56 years 

old in 1893, he was close to exhaustion because of his efforts to guide the nation 

through a critical period. He also had a histmy of kidney problems and was "velY corpulent, with a short, thick neck, just the 

build and age for a possible apoplexy." Nevertheless, Cleveland, physicians moved 

with a confidence that contTasted sharply 

with the uncertainty that amicted Garfi eld's 

medical attendants. Particularly concerned 

about the anesthesia to be used, they decided 

that as much of the surgery as possible would 

be done under nitrous oxide and arranged 

to have it administered by a dentist known 

for his skill and experience with its use. On 

IJuly, after two teeth had been removed and 

the initial incisions made in Cleveland's 

upper jaw, O'Reilly took over from the dentist and administered ether for thirty-one 

minutes while two civilian surgeons removed all the upper jaw on the affected side 

except "the Ooor of the orbit and the intermaxillary portion." A second operation, 

much smaller in scope, was performed on 

the seventeenth to remove remaining traces 

of the cancer. The prosthesis that replaced 

the missing bone enabled Cleveland to 

speak normally almost from the outset so 

that neither the press nor the public appreciated the extensive nature of the surgery he 

had undergone. Unlike his unfortunate predecessor, Cleveland did not have to contend 

with infection. He recovered with impressive rapidity from his ordeal, and Bryant was 

soon able to retu rn to his practice, leaving 

Sternberg to watch over his patient's recovery until 1 September, when Cleveland was 

found to be "all healed." 56 

Ever since the operation, much controversy has centered about the question of 

the true nature of Cleveland's tumor. In 

1975 the late Gonza lo E. Aponte, former 

chairman of pathology at the Jefferson 

Medical School in Philadelphia, initiated a 

thorough study of the tissue removed from 

Cleveland's mouth and held since 1917 by 

the Mutter Museum in Philadelphia. After 

both co nsidering the historical background of th e controversy and examining 

the tissue itself, the scientists co nducting 

the study concl uded that the tumor was 

"verruco us carcinoma, a low-grade malignant tumor known to behave more mildl y 

than the ordinary oral cancer," 57 

The growing compl exity of surge ry and 

the frequency with which it was now undertaken, the emphasis on antisepsis, and 

the greater reliance on diagnostic tests, antitoxins, and immunization in the battle 

against disease, all had increasingly widespread effects on hospital design. The old 

style of post hospital was not large enough 

to shelter both a room reserved exclUSively 

for surgery and the laboratory without 

which the physician could not offer his patients the benefit of modern medicine. In 

addition, proper accommodations were 

also needed for various types of equipment, 

including that for applying plaster casts, 

whose use eliminated the long confinement to bed that was otherwise necessary. 

Congress voted money for hospital constructi on on a year-by-yea r basis, and special bills were required for expenditures 

that went beyond the yearly sum. But 

Sternberg was ab le to obtain money both 

for new post hospitals and for the modification of existing facilities. The plans for 

the new hospitals ca lled for hot water heat, 

concrete basements, and pressed steel ceilings for the ground Ooor. Additions to existing facilities at some posts included 01'-
A NEW DIRECTION 

erating rooms and laboratories. At other 

posts, operating rooms were enlarged or 

new ones install ed in existing rooms. More 

space for beds also occasionally proved 

necessary. The joint Army and Navy general hospital in Arkansas was not being 

fully utilized, however, and an appeal went 

out to the medical directors of the various 

military departments to refer more patients. In 1897 eligibility was ex tended to 

include, whenever there were vacancies, 

honorably discharged soldiers and sa ilors, 

both regulars and volunteers. 58 

Domestic Conflict 

With the period of major Indian depredations in the past, few of the Medical Department's patients were the victims of intentionally inOicted wounds. The only 

action Army units saw from 1893 to the 

spring of 1898 involved social unrest. Labor 

violence was not a new problem to the postCivil War government, but Anny units were 

used more intenSively than ever before 10 

deal with strikes, riots, and threats of riot 

that occurred during Cleveland's second administration. In the West the unemployed 

stole trains or forced their way upon them 

in attempts to make their way East. Workers in mi nes and factories protested reduced 

wages. Strikers at the Chicago Pullman 

plant were supported by mobs who harassed railroads west of the Mississippi and 

interfered with their operations. Although 

governors mobilized the National Guard in 

their states 10 help restore order, appeals to 

Washington for assistance were numerous. 

Regu lar Army units were ordered 10 guard 

bridges and tunnels, reclaim stolen trains, 

and restore and maintain order from 

Chicago to Sacramento. An estimated twothirds of the Army was eventually invo lved 

109 

in dea ling with labor violence spawned by 

the railroad strikes alone. Injuries to Army 

regulars were few and usually minor, but 

since disease spread easily in areas where 

many men were camped together in temporary accommodations, surgeons were 

needed to advise on sanitation and to care 

for the sick. 59 

In July 1894, in respo nse to one of the 

most threatening episodes of labor violence of his administration, President 

Cleveland sent approximately 2,000 men, 

most of them from Fort Sheridan, near 

Chicago, and Fo rt Leavenworth, to Chicago to guard government property and restore the mail service during a strike by 

Pullman workers. The soldiers were stationed at various sites about the city, but 

the largest number camped in Lake Front 

Parl<. Because of th e lack of trees there, the 

sun blazed directly upon the men, an "impalpable black dust, which was exceedingly unp leasant" covered everything, and 

th e ground "emitted a disagreeable odor, 

when disturbed by digging or sprinkling 

wi th the hose." 60 

Unsure both aboUlthe possible inroads 

of disease and about the number of casualties for whi ch they might be responsibl e, 

the Medical Department co ntingent at 

Chi cago was ready for all eventualiti es. 

Since some units arrived unaccompanied 

by doctors, Maj. Alfred C. Girard , the post 

surgeo n at Fort Sheridan who served 

brieOy as the chief medical officer, was required 10 assign Army phYSicians recall ed 

from leave in such a way as 10 have at least 

one at each major camp. To ensure adequate coverage, a mi nimum of two civilian physicians also had to be brought in 

for the emergenc), With the arrival of Maj. 

Daniel G. Caldwell with troops from his 

post at Madison Barracks, New York, and 

with his assumption of responsibiliti es as 
no THE ARMY MEDICAL DEPARTMENT, 1865-1917 

DANIEL G. CALDWELL 

chief medical orri cer, the medica l staff at 

Chi cago was almost complete. The greatest number of Regular Army surgeons 

serving at anyone time in the Chicago area 

during the strike was ten, six of whom were 

sent to th e Lake Front camp. Four hospital stewa rds, four acting hospital stewards, 

and twenty-five Hospital Corps pri va tes 

assisted them. 

Girard set up a fi eld hospital in tents 

erected at the Lake Front site, orderi ng th e 

equipment he needed from Fort Leavenworth by telegraph. Supplementary equipment and suppli es were contributed by the 

medica l orricers of the va ri ous units sen t 

to th e area. Onl y a few days after the first 

troops arrived, a th irty-bed facility awaited 

th e sick and injured. Each bed had mosquito netting because of the man y nies that 

inhabited th e Lake Front Parle The hospital remained open until 18 Jul y, when the 

camp was broken up and pati ents sent to 

the hospital at Fo rt Sheridan. 

Each day a surgeo n and a hospital steward , eq uipped with a medicine chest, made 

the rounds in a light wagon from the Lake 

Front headquarters to each of the small 

units that were scatte red about the area. 

The medica l offi cer held sick call and had 

the Lake Front camp se nd an ambulance 

to pi ck up anyone in need of hospitalization. Ca ldwell stated that this app roach to 

the problem of providing care to the men 

of small units proved to be a "very satisfac tory plan." 61 

Most patients seen by medical orri cers 

suffered from acute diarrhea, blamed by 

Caldwell upon the heat and the fact that 

soldiers often drank water from fi re hydrants. Girard, on the other hand , maintained that the cause was "prolonged use 

of th e canned meat of the travel ration," 

whi ch ca used "intense thirst .... " He 

noted that the meat was of such quality 

that a man had to be very hungry indeed 

to eat it more than once. The injured who 

needed the help of Army doctors were few. 

A ca isso n explosion on 16July killed three 

and wo unded ten, but Army surgeons arrived too late to help. The physicians of the 

nearby Illinois Mi Iiti a cared fo r the victims 

and sent them on to civilian hospitals in 

Chi cago. When the explosion victims were 

in a co ndition to be moved furth er, they 

were taken to the Fort Sheridan hospital." 

The troops sent to main tain order when 

the railroad strike spread to the Sacramento area , early in Jul y. included approximately eight Army compan ies and 

three from the Marine Co rps. These men 

originally bivouacked in the railroad station, sleeping upon the hard surface "in the 

midst of the heat and roa r and glare. " After 

sevenleen days Lhey were permitled to 

pitch tents in the shop yards, where th ey 
A NEW DIRECTION 

could construct noors and paths of wood 

in the shade of euca lypLUs trees and piles 

of lumber. Only the cavalry troops lacked 

tents, and some of th em were able to seek 

shelter in railroad cars. The men's food 

consisted of the fi eld rati on supplemented 

"with a fair proportion of fresh vegetables," 

but the water taken from city mains contained "considerable river mud. " Those 

who regularl y drank this "beverage" prono unced it safe , despite the misgivi ngs of 

medical offi cers.') 

The Medical Department contingent at 

Sacramento grew gradua ll y. The initial two 

doctors, acting hospital steward, and two 

Hospital Corps privates were reinforced by 

four more privates on 13 July and the next 

day by a hospital steward, an ambulance, 

four mu les, and the pri vate who was detailed to drive them. Because of the presence of Marines, a Navy medical officer, a 

Navy apothecary, and twO male Navy 

nurses were also available to care for the 

sick and injured, although the senior medical officer at Sacramento was Major Pope, 

post surgeon at the Army's Ange l Island in 

San Francisco Bay. A civilian physician 

normally employed by th e railroad also offered his servi ces. As units were senl from 

Sacramento to guard the rail line at other 

points, medical personnel were detached 

to go with them, an Army assistant surgeo n and two Hospital Co rps privates to 

Truckee, California, on the thirteenth and 

Navy medical personnel to Rocklin, California, on the fourteenth. 

Pope se lected the railroad depot dining 

room at Sacramento as the site of the fi eld 

hospita l, since it was large, well lighted, 

and well ventilated. lnside, shutters 

blocked the hea t and glare, and a Pullman 

car standing in the depot supplied bedding. Under orders from the City's mayor, 

the restaurant provided special diets. The 

111 

Navy surgeon contributed a fi lter for the 

water so that patients did not have to imbibe mud. To remove the casualties of/abor 

violence and to guard them from the mob, 

the hospital sent out four armed litterbearers with an ambulance accompanied 

by a deputy U.S. marshal to guide the medical unit through the loca l streets. 

Like their colleagues in Chicago, medical ofricers in SacramenLo encounlered 

few injured men in need of treatment. On 

11 July, however, strikers derailed a tra in 

ca rrying U.S. mail when it was three miles 

from the station , killi ng four men and injuring six, one fa tally. The train sent to assist the victims carried armed guards, an 

Army assistant surgeon, a Navy assistant 

surgeo n, and two Hospital Co rps privates. 

Except for a man whose hideous injuries 

proved fata l while he was still in the operating room , the casualties quickly recoveree/. Two days later Pope and four members of the Hospital Corps were again 

called to the sce ne of violence, but the only 

casua lty was a stri ker shot in the abdomen. 

Pope cared [or hi m until a patrol wagon arrived to take him to a civilian hospita l, 

where he later died. 

The hea lth of the men at Sacramento 

was initially regarded as excellent, since an 

average of only 1 percent needed treatment. The di arrhea that arnicted the few 

who were ill was blamed on the heat and 

th e drinking of too much ice water. Doctors had those suffering from heat prostration sponged with cool water and dosed 

with "a little digitalis or Aromatic Spirits 

of Ammo nia ." They treated diarrhea with 

a saline laxative, fo llowed by "diarrhea 

tablets" co ntaining calomel (still in use despite its remova l from th e supply table by 

Surgeon Genera l Hammond during the 

Civil War), morphine sulphate, capsicum, 

ipecac, and camphor.6i 
112 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Although marshes bordered the camp at 

th e railroad station on two sides, malaria 

did not appear umil 2 August. The fact that 

so many developed the disease apparently 

LOok medical offi cers by surprise, for they 

had noted that civilians working in thearea 

had not been severely amicted in years 

past. By the time the troops left Sacramento 

on 3 September, doctors were treating 

forty-three cases, many suffering from gastric pain as well as fever. Pope used atropine and morphine in combination to 

treat these sufferers until their stomachs 

would tolerate quinine. Even after the men 

had left Sacramento, cases of malaria continued to develop among them- more 

than eighty were treated for the disease at 

th e Presidio in San Francisco. Thus, despite the occasional violence that marked 

the disorders, disease proved to be the 

greatest enemy fa ced by th e units called 

upon to restore order in the Sacramento 

area during th e strikes o[ 1894." 

In spite of labor problems, the period 

[rom 1893 to the outbreak of the SpanishAmerican War in 1898 was quiet for the 

Army. For the Medical Department, however, it was a period o[ great change. During these fi ve years under Sternberg's leadership, the department entered the era o[ 

modern medicine. An increasing number 

of Army hospitals became small medical 

centers in th e modern sense, complete with 

laboratories and well-equipped operating 

rooms. With Sternberg's encouragement, 

surgeons successfu lly performed operations that they would not have dared to attempt len years ea rlie r. At his insistence, 

young physicians began to receive formal 

training in military medicine, instead or 

being sent out to sink or swim on their own 

or being thrown upon the mercies of a senior surgeon [or indoctrination. Medical 0 [-

ficers also continued to educate National 

Guard offi cers about the basic requirements 

of Army medicine and the absolute necessity for strict attention to sanitation. Despite the advances made under Sternberg, 

supplies on hand were of the type needed 

by post surgeons-not by physicians caring [or the wounded o[ a modern fi ghting 

force-and the department itself remained 

small. As a result, the number of medical 

officers who benefited from Sternberg's efforts was also small , too small to overcome 

the ignorance of military medicine of the 

hordes of civilian physicians who wou ld 

swell the departments ranks in 1898. 66 

The effects of these defi ciencies were 

multiplied by the fa ct that Medical Department leaders were not preparing plans for 

meeting the demands of a major war that 

would result in large numbers of sick and 

wounded. The Franco-Prussian War o[ 

1870-1871 had had much to teach about 

the organization and operation of the medical service of troops in such a con Diet, but 

no one in the United States studi ed its 

lessons in any depth until after the Spanish-American War. Successive manuals deSigned to guide members of the deparLment 

continued LO concentrate almost entirely 

on the management o[ medical care at the 

various posts, and the need for fi eld servi ce 

regulations [or the Arm)' had not become 

apparent. Furthermore, the demands of the 

new military medicine were greater by far 

than those of the old, and the department 

had not yet had suffi cient time to create all 

the laboratori es, to acquire all the equipment, and LO train all the men needed LO 

meet the new expectations. These deficiencies would prove devastating as an 

abruptly swoll en Army gathered to launch 

the invasion of Cuba and the Philippines 6 ' 
NOTES 

1. Allan Nevins, Grover C/eve/(md, pp. 523-24, 

528; Edward M. Coffman, Ti, e Old Army, p. 246. 

2. Quotalion from D. W Calhell and William T. 

Cathell, Boo/~ 0/1 /l,e Physician Hi mself, 11 th ed. 

(Philadelphia: Davis, 1902), p. 109, ascited in William 

C. Rothstein, American Physicians in fhe Ninelecllfh 

CCJJ/w)', p. 266;]ames H. Cassedy, lvfedicillc ill America , p. 89; Harry F Dowling, figh ting Injcction, pp. 14, 

29-30, 99-100. Forms of dysentery other lhan the 

amebic include shigellosis, or bacillary dysentel)" and 

giardiasis. A receml}' discove red cause of dysentel)l is 

Campy /obactel'. The \Vidal agglutination lest was developed by French physician Fernand Wida \. The 

\-Vassennann test was developed by August von 

Wassennann, a Gennan bacteriologisl. 

3. j ohn Duffy, Ti,e 5(lII ital'i(1I]5, pp. 126-56, 175-

97,254 (quotation); Cassed}l, Medi cine in AllleriCll , 

1'1'.108-09. 

4. Erwin H. Ackerknecht,A 51101'/ Hislol)1 ojMee/-

ic ine, p. 161. See also pp. 167- 70, 199. 

5. Quotations from War Department, Surgeon 

General's Offi ce, {A lllUw /1 Reporf oj tlte SlIlgeon Genera/, U.S. Army, to tlJe 5ea elmy ojWa/' , 1894, p. 16 

(here<lfter cited as \VO, SGO, ARojSG, date);J ames 

L. Abrahamson, AmcriCll Arms jo/' (I Ncw CenllllY, 

pp. xiv, 14,34-35,37-38; Peter Karsten, "Armed 

Progressives," in Thc lvli/iimy in AllleriCll From file 

C% llill/ Era to Ihe Present, p. 247; Graham A. Cosmas, "From Order to Chaos, " pp. 105-06. 

6. La s, Sternberg to John M. Schofield , and 

Schofield to Sternberg, both 10Apr 1893,john McA. 

Schofield Papers, Manuscript Division, Libra!,)' of 

Congress, Washington, D.C.; Rpt, 1 May 1861, p. 6, 

Entry 77, Record Group (RG) 11 2, Nationa l 

Archives and Records Administration (NARA), 

Washington, D.C.; Fielding H. Garrison, All Il/l'O ~ 

ducliolllO Ihe HislolY ojMcciicill c, p. 718; Ltrs, R. C. 

Davis 10 Sternberg, 7 Mar 1887,jos. C. Ba il ey to SG, 

and ]. C. Breckinridge to SG, both 31 May 1893, ]. 

P Wright to SG, 8 jun 1893, and other correspondence in Ms CI00, George Miller Stern berg Papers, 

National library o f Medicine, Be thesda, Md. 

7. Esmond Long, A HistolY oj Americall Pal/wlogy, PI'. 206-07; in Entry 63, RG 11 2, NARA: Instrs 

fo r Med Offs to Whom a Microscope Is Furn ished , 

IJu11868, voL 3 , SGO (ir 1, IJ uI1871 , voL 4, and 

Sup ply Tables, 1883, vol. 7; Mary C. Gillett, "A Tale 

of Two Surgeons," pp. 406-07,411-13; Frederic P 

Gorham, "The History of Bacteriology and Its Contribution to Publi c Health Work," in A 1'la/jCclIl lH )' 

oj Public Hea/lli , p. 73; William Bulloch, The HistOlY 

oj Bl1CLCriology, pp. 182-85, 187,214. See also arti· 

cles by and about Sternberg in the Bibliography. 

8. john M. Schofiel d, Forly-six Years ill ti,e Army, 

p. 183;john M. Gibson,So/dierill Whitc, pp.159-60, 

166-67; Ma rtha L. Sternberg, Ceolge lv/iller Slcl'llbClg, p. 130. 

9. Sternberg, Slerllberg, pp. 139-40, 148-49; 

"Publi c Health," p. 98; George M. Sternberg, "The 

Address of the Preside11l," p. 1373; Gibson, Soldier 

ill Wlri le, PI'. 178--79, 243 . 

10. Cited in William B. Bean, Waller Reed, p. 55. 

11. Ltr, G. M. Sternberg to SG, 10 May 1869, voL 

12, Entry 10, RG 11 2, NARA ; Bean, Reed, p. 153 (quotat ion from Reed to Mrs. Reed , 9 Dec 1900). Among 

the medical office rs who joined the department in the 

late 1890s whose names would be wel1 known by the 

time of World War 1 were Bailey K. Ashford, frederick F Russell, and the Philippine Tropical Disease 

Boa rd members (see 'Rlb/e, Chapter 11). 

12. According to Edwa rd M. Coffman, in 1890-

1891 alone, the Arm)' abandoned roughly a fourth 

of its posts (see "The LongShadow of the Soldier and 

the State," p. 80). See also "Exam ination of Army 

Med ical Officers for Promotion," p. 694; Sternberg, 

"Address," p. 1374; Alfred Alexander Woodhull, 

"The Better Type of Medical Offi cer," pp. 341, 345; 

Bean, Reed, p. 64; WD, ARofSG, 1895, p. 50. 

13. For a time before june 1894 supply and the 

Hospital Corps were managed in two sepa rate divisions. See WD, ARofSG, 1898, PI'. 100, 138, and 

1899, p. 22; Prel iminary Inventory of RG 11 2, Pl'. 

28-32, NARA; Ur, Charl es Smart to SG, 30 jun 

1894, Entry 245, RG 112, NARA. 

14. "The Fifty-third Congress, the Army and 

N<lvy Medi cal Se rvices and the Marine-Hospita l Service," p. 413;AGOG0 43,6Sep 1894; WD,ARofSG, 

1893, 1'1'.13- 14, and 1894, PI'. L4-15, 17. 

15. Quotations from JohnH. Brinton , "Valedi c-

[or}, Add ress to the Graduating Class of the Army 

Medical School, \-Vashington, D.C. ," p. 604; "Army 

Medical School," p. 352; Samuel C. Buse}" "Address 
114 THE ARMY MEDI CAL DEPARTMENT, 1865-1917 

Delivered at the Closing Exe rcises or the Army Med· 

ical School, March 12, 1897," pp. 671-72; Charl es 

1-1 . Alden, "The Special Training of the Medica l Office r ... ," PI'. 676-77; WD, ARofSC, 1893 , p. 15; 

George Rosen, Prcvell/; ve lvledic illc ill lite VIIi/eel 

SIm es, 1900- 1975, pp. 23- 24; John Z. Bowers and 

Elizabeth ~ Purcel l, cds., AdVlI11CCS ill Alllcriall l Medicine, 1:258-59. 

16. W D,ARofSC, 1893, 1'1'.14-15, and 1894, PI'. 

21 (final quotation), 22 (olher quotations), 24-25; 

Stanhope Bayne-Jones, The Eva/llliDn oj Prc\'clllivc 

,vle(/i cinc ill the United SImes Arm)'. 1607- 1939, p. 

i2l; "Arm)' Medical School," p. 353; Charles E. 

\Voodrurr, "Mili tary Medical Prob lems," pp. 227, 

236-37; Sternberg, Slernbclg, pp. 132-34; Gibson, 

Soldier ill Wlrile, p. 175; Graham A. Cosmas, All 

Arll1)' Jor Empire, p. 8; AGO GO 5 1, 24 jun 1893. 

17. WD, ARafSC, 1894, PI'. 21-34 (quotation). 

18. Ibid., PI'. 23 , 25, 30 (first quotation), 1896, 

p. 22, and 1898, p. 23; "Ann)' Medical School," p. 

353 (second quotation); Coffman , Olel Arm)" p. 384. 

L9. Quotations frolll Wa r Oepanment, Surgeon 

Gene ral's Office, Tile Surgeoll Gellerals OJJice, p. 46 

(he reafter cited as WD, SGO, SeO); Rpt, Louis A. 

laGarde, 31 OCI 1893, Enlry 53, RC 11 2, NA RA; 

Roben S. Henry, TlteArll1ed Forces 1I 1sUtIlf.e oJPmholog,}' , p. 95 (hereafter cited as AFIP); \"vO, ~oJSG , 

1894, PI'. 23, 27,32,1896, PI'. 118-21, and 1897, 

pp. 26- 27; Nicholas Senn , "Abdomi nal Surge I')' on 

the BaLLl efi c1d ," p. 2. 

20. Sternberg,Slel'll/Jerg, p. 132; AGO GO 5 1, 24 

jun 1893, and GO 43 , 6 ju1 1897; "Army Medi ca l 

School," p. 353; W D,ARofSC, 1894, p. 23, and 1895, 

1'. 15. 

21. WD, AI~ofSC , 1893, PI'. 73-95. 

22. Quotation from LaGarde Rpl, 3 1 OCl 1893, 

EllIr)' 53, RG 11.2, NA RA; Willi ams Donnall)" "An 

OppOnUni l)' for a Great Na tional Museulll ," p. 137; 

WD, ARofSC, 1894, p. 28, and 1896, p. 15; Henry, 

AFIP, PI'. 93, 101, 103. 

23. First q uo tation frolll He nry 'vV Cattell , 

"Roentgen's Discove ry," p. 169; remaining quotations from 'NO, ARoJSG, pp. 106-07; ibid. , pp. 104, 

J08; M. Gohman, "The Histor), of X-rays and Their 

Ap plication in Medi cineand Surge r}'," p. 293; Henry, 

AF1P, p. 100; Gibson, Soldier ill Wllile, p. 177; Ur, 

Henry Lippincott to SG, 10 jan 1898, Ent ry 26, RG 

112, NARA. 

24. Ste rn be rg, Stel'll/Jerg, p. 138; Kimba ll , So ldier 

Doctor, p. 153; Alfred Alexander Woodhull , "Military Medical Problems," p. 540. 

25 . H. S. Turri ll , "Instruction of the Hospita l 

Corps of the U.s. Army," p. 395; WD, ARofSC, 1893, 

1'1'.15-18, 1894, p. 36, and 1895, 1'.14. 

26. \VO, SGO , seo, p. 48; Charl es Smart, 

"Transponation of Wou nded in Vv'ar," pp. 35-36; 

William C. Borden , "Hospital Corps Instruction at 

Mili lal')' Posts," PI'. 402-04; Lo uis A. LaGarde, "The 

Medica l Department in Tillle of War," p. 585;john 

vall R. Hoff, "Scheme of Mili t,u)' San itary O rg,Ll1izat ion ," pp. 437-47; idem, "Oull ines of the Sani tal,}' 

O rga ni zat ion of Some of the Great Armies of the 

Wo rld ," pp. 426-514. The need to develo p specific 

doc trine for the U.S. Army stimulated increased interest in forei gn armi es, whi ch in IlIrn inspirec1many 

articles on the subject in the Proceedil1 gs oj lile Associatioll ojl'vlili/{I/)' Sillgeolls oj tile Uni/ed Stales during this period. 

27. AGO O r 2, 6 Feb 1896; Turrill , "Instruction, " p. 400; Cha rles H. Alden, "Instructi o n of the 

Hospital or Ambulance Corps in the United States, " 

pp. 45 1-52; Borden, "Hospital Corps lnslfllclion," 

p. 40.1 ; Senn , "Abdominal Surge ry," pp. 7-8. 

28. Alden, " Instruction," p. 99; Turrill , "Instruction," p. 395. 

29. WD, ARofSC, 1893, p. 19, 1896, p. 15, and 

1897, PI'. 7-8. 

30. Ibid. , 1893, PI'. 15, 18, and 1895, p. l3. 

3 1. Sma rt , "Transport at ion ," pp. 35-36; I-Io ff, 

"Scheme," pp. 446-47; laGarde, "Med ical Depa rtmenl," p. 585; WD, Al/ofSC, 1894, p. 35, 1895, p. 

13, l896, p. 14, and 1897, p. 6; Coffman , Old ;\1'''')" 

1'.282. 

32. AGO CO 9,13 Ma r 1896, and CO 60, 28 OCI 

1897; LtGarde, "Medica l Department ," pp. 585-86; 

WD, ARafSC, 1896, 1'1'.14-15. 

33. WD, ARofSC, 1893 , p. 8, 1894, PI'. 38-39, 

1896, PI'. 13 (quotalion), 16, 33, and 1897, PI'. 

40-4l; Alden, " Instruc tion," pp. 94- 95; Brimon, 

"Va ledicLOI')' Address, " p. 599; Edga r Erskine I-iume, 

The Go/del'Ju/)ilee oj the Associatiol1 oj lvli/ilm), SlIrgeol1s oj the Vlli/ed SlaleS, pp. 13- 14; Karsten, 

"Armed Progressives, " in Mil l/al)' ill AlllcriCCl , p. 249. 

34. WD, ARofSC, 1893, PI'. 22, 63, lO2-03, 

1894, p. 16, 1895, 1'.17, 1897, p. 49, and 1898, p. 

28; Coffman, Old Arlll)" p. 328. 

35. WD, ARofSC, 1893, PI'. 141-42,1894, PI'. 

34,65-66, and 1896, p. 143 (quotation). 

36. Ibid. , 1893, PI'. 119-20, 125, and 1896, p. 57. 

37. Ibid. , 1895, p. 26 (quotation), and 1896, PI'. 

56, 140. 

38. Lo uis C. Parkes, Th e Elemen/s oj Heal/h , pp. 

29-30; W illiam Osler, "A Study of the Fevers of lhe 
A NEW DIRECTION 

Sou,h: 1'.1006; WO, ARoIse, 1895, PI'. 94-95, "nd 

1897, PI'. 67-68, 160-61. 

39. John S. Kulp, "What To Avoid in Arm)' Athletics," p. 3J 2 (first quotat ion); James E. Pilcher, 

"The Place of Physical Tra ining in the Military Se rvice," pp. 170, 173 (second quotation), 178; WD, 

ARoIse, 1893, PI'. 138-39, 140-41 (,hirdquo,"-

' ion), 1894, p. 75, and 1895, PI'. 98-99; C"ssed)" 

Metiicillc i., Ameriw, p. 104; Howard E. Ames, "The 

H)'gicl1ic Condition of Enlisted Men as Affec ted b}1 

Moral and Intellectual InOuences," pp. 422- 24; 

Coffman , Old Arm)'. p. 282. 

40. WO, Al/oISe, 1893, PI'. 138-39. 

41. Ibid. , 1895, p. 43 (first quola tion), all cl1896, 

pp. 84-87, 88-89 (remaining quotations). 

42. Charles E. Woodruff, "Eme rgency Rations," 

PI'. 309-44; Louis A. laGarde, "Notes on an Eme rgenc), Ra tion," pp. 345-5 l ; "The Emergenc), Ra tion 

of the Arm)'," p. 37; "Miscel lany-Emergency R<llions for the Army," p. 43. 

43. Quotation from "Miscellany-Emcrgency 

Rations," p. 43; ibid., PI'. 42, 44; "Emergency Ration ," PI'. 37-38. 

44. WO, ARoIse, 1893, p. 102 (firS! qllo,"'ion), 

1894, p. 52, 1895, p. 27, 1896, PI'. 67, 74 (second 

quotation), 77, 79, and 1898, p. 39; Baync-joncs, 

Preve'l/ive Medicine, p. 129; Osler, "Fevers of the 

South ," pp. 1002-03; "Are Malarial Diseases Airborne? ," p. 943. 

45. Quotation from "Public Health- Diphthe ria 

AllIitoxin ," p. 67; George W. Cox, "Present Status 

of Se rum Therap}'," pp. 830-31; H. W. Berg. "The 

Trea tment of Diphtheria , Including Serum Ther-

"1')': p. 4l; WO,ARoIse , 1896, PI'. 36-40,"nd 1897, 

pp. 58-59; Rothstein, AmericlIlI Physicialls, p. 278; 

Hans Zinsser and Stanhope Bayne-jones, A Texlbooh 

oj B(ICleriology , pp. 180-81; \Villiam D. Foster, A 

His/olY oj ,\llediw/ Bac/eriology (Ill d /1111111111 0Iogy. p. 

102; George M. Stern be rg, "Science and Pseudo-science in Medi cine," p. 200; idem, lllllllllllily, pp. 160, 

266-68; Leonard Pea rson, "Tetanus," pp. 381, 384. 

46. The Widal test lOok advantagc of the fa ct tha t 

the antibodies to typhoid fever found in the blood 

serum of victims will cause t}'phoid bacteria to 

clump. See William 1-1 . Welch , "Principles Underl ying the Serulll Diagnosis of TyphOid Fever and the 

Methods of Its Application," p. 301; Walter Reed , 

"Typhoid Fever in the District of Columbia," Pl'. 

145-46; WO ,ARoIse, l893, p. 59, 1894, PI'. 48-49, 

1895, 28-30, "nd 1898, p. 38. 

47. Osler, "Fevers of the South," p. 1001; WD, 

ARoIse, 1895, 1'1'. 27,31-34, "nd 1897, PI'. 9- 12, 

79. 

115 

48. First quotation from Brinton , "Valedictory 

Address," p. 604; second quotation frolllA. T. Cabot, 

"Science in Medicine," p. 481; Lester S. King, "Germ 

Theory and Its Innuence," p. 797. 

49. Quotation from j oh n B. Murphy, "Appendicitis, " p. 436; Alfred C. Girard, "Leller From Europe ," PI'. 319- 20, 361-62, 397-98, 435-37, 

636-37; WD, II RoIse , 1889, p. 44, 1895, PI'. 57, 

64-65, 1896, PI'. 95, 108-16, 1897, PI'. 96-97, 109, 

114-15, 128-29, and .L 898, p. 45; Scnn , "Abdominal Surgery," p. 1. 

50. Quotation fromJohn M. Banister, "The Radical Cure of Ingui nal Hernia From the Standpoilll 

oflhe Military Surgeon ," p. 478; ibid ., p. 485; "The 

Rad ical Cure of Hernia," p. 506; Sternberg, Slerllberg, p. 139; Owen 1-1 . Wangensteen and Smah D. 

\Vangenstecn , Tile Risc oJS.llgel)' From Empiric Crcifl 

/0 Scientific Disciplille, PI'. 111- 25; Arpad G. Gerster, "How Should the General Practitioner Deal 

'vVith Strangulated Hernia? ," p. 61. 

51. WO, ARoIse, 1897, PI'. 96-97 , 99, 109, 

128- 29, "nd 1898, p. 45. 

52. Ibid., 1895, p. 74, "nd 1896, PI'. 98 (qllO'"-

'ion), 102-03. 

53. Ibid., 1895, Pl'. 58, 71 (first two quotations), 

and 1896, PI'. 10, 99 (fourth quota tion), 101 (third 

qllo'"'ion), 103; sea Cir 6, 18 M"), 1895, Entr)' 66, 

RG 112, NAIIA. 

54. O'Rei ll y wo uld become surgeon genera l in 

1902. \Velch was not pOSiti ve that the lesion was 

malignant , but bel ieved that it probably was. See 

John J. Brooks, Horatio T. Enterline, and Gonzalo 

E. Aponte, "The Final Diagnosis of President Cleveland's Lesion," p. 5; Nevins, Cleve/(lIId , pp. 528-29; 

Cha rl es L. Morreels, Jr., "New Information on lhe 

Cleveland Opera tions," PI'. 542-44; William \V 

Keen, Tile SlIrgiCllI Opera/iolls 011 Prcsitiell{ Cleve/cwel 

ill 1893, p. 30. 

55. Keen , Cleve/mul, pp. 1- 17,32. 

56. Ibid., pp. 34 (first quota tion), 37; Morreels, 

"Cleveland Operations," p. 547 (second quotat ion); 

Nevins, Cleve/(Hlel, pp. 530,532 (third quotation); 

Brooks, Enterline, and Aponte, "Fina l DiagnOSis," 

p. 5; Ste rn be rg, Slcl'llberg, p. 136. 

57. Brooks, Enterline, and Aponte, "Final Diagnosis," p. 23 . 

58. WO, ARoISG, l893, p. 13, l894, p. 13, 1896, 

1'1'.9, 11- 12, 1897, PI'. 14- 16; AGO eo 26, 5 M"), 

l897. 

59. j err}' M. Cooper, Tile Army lIlId Civil Disorder, PI'. 99, 101-02, J06-08, 115-18 , 120. There is 

also an excellent discussion of the Army's role in 

civil affairs in Coffman, Old Army, PI'. 246-54. Un-
116 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

less otherwise sLaled, material on the Chi cago aspeCLS or the 1894 strikes is based on RpLS, Daniel G. 

Caldwell and Alrred c. Girard, and Lhal on the Sacramenlo aspects on Rpt, Benjamin F Pope , all in Entry 

26, RG 112, NARA. 

60. Caldwell Rpt, Entry 26, RG 1.1 2, NARA. 

61. Ibid.; Telg, S. M. Appel to SG, 5 jul 1894, 

Enlr}' 26, RG 112, NARA; Schofield, Forry-six Years , 

1'.495. 

62. Girard Rpt, Entry 26, RG 112, NARA. 

63. Pope Rpt, Entry 26, RG 112, NARA. 

64. Ibid. 

65. Cooper, Civil Disorder, p. 12L 

66. Sternberg, SLernberg. p. 158; M il Svc Card, 

Benjamin F. Pope, Entry 89, RG 112, NARA 

67. Gibson, Soldier ill White, PI'. 184-85; Sternbe rg, Stembelg, p. 169; WD, ARojSG, 1898, p. 103; 

WD, SGO, SGO, PI'. 43, 47, 62-63. 
Chapter 5 

PREPARATIONS FOR 

CONQUESTS OVERSEAS 

"The humane liberty-loving peopl e of 

the United States have heard the cry of the 

oppressed starving Cubans [or years, and 

have done all in their power, short o[ resort 

to the sword, to reli eve their sufferings, but 

without avail. The ear of the proud, cowardly Spaniard remained deaf to wellmea nt and most earnest appeals," wrote 

Col. Nicholas Senn, surgeon general of the 

Illinois National Guard, not long after war 

was declared against Spain in April 1898. 

In his eyes, war, "always a great calamity," 

became "a weapon in the hand o[ the 

Almighty" when waged "for the sake ofhumanity, for the relief of the oppressed. " I 

The oppressed in Cuba would be the 

main focus o[ attention only until 1 May, 

when an effort to bring pressure on the 

Spanish in Cuba by threa tening their forces 

in the Philippines resulted in Commodore 

George Dewey's unexpectedly easy and 

complete naval victory in Manila Bay. Plans 

to take over the Spanish empire in the 

Philippines were then added to those [or 

the conquest of its territories in the Caribbean. The U.5. struggle against the old empire was over ahnost as soon as it was 

begun , but the Philippines strongly resisted becoming a part of the new empire. 

The guerrilla wa rfare that ensued produced a prolonged chall enge both [or the 

Army and [or its Medi cal Department.' 

When the U.5. battl eship Maille exploded in Havana harbor on 15 February 

1898, the American public blamed Spain 

and demanded retaliation. Both Congress 

and President William McKinley were reluctant to take positive steps to prepare for 

war, however, even under the goading of 

the abrasive General Mil es, now commanding general of the Army. Although the 

number of medical offi cers was inadequate 

[or peacetime needs, the possibility o[hostilities did not inspire the legislature to vote 

an increase. The secretary of war specifically prohibited Surgeon General Sternberg 

[rom purchasing new supplies until "the 

questi on of whether or not there was to be 

war had been definitely settled." Both 

Sternberg's directive that supply depots be 

ready to issue whatever supplies they had 

and his comment that he had ordered new 

designs for medical and surgical chests "so 

as to have them ready [or manufac ture 

should the necessity arise" have an almost 

pathetic ring. Since no decision was made 

about the size and scope of any campaign 

until 19 April , when Congress authorized 

military actio n againstSpain, neither Sternberg nor any of his superiors in the War Department could adequately prepare to meet 
118 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

N ICHOLAS SENN 

the requirements of war before the nation 

was committed to hostilities.' 

Almost simultaneously with its call for 

action, Congress authorized both an increase in the regulars from roughly 27 ,000 

officers and men to just under 65,000 and 

a call for 125,000 volunteers, who were to 

serve two-year terms. Although the National Guard was not called up as such, National Guard organizations were permitted 

tovolunteer as units, and the nation's young 

men were not slow to respond. By the end 

of May the Army numbered more than 

160,000, a figure that, after another call for 

vo lun teers was issued, reached 275,000 by 

August. Each of the eight corps that formed 

this force consisted of three divisions plus 

independent cavalry and artillery units. A 

division consisted of th ree brigades; a 

brigade, of three 1,200-man regiments. The 

Medical Department was abruptly required 

to obtain the supplies and equipment necessary to ca re for this vast army, to prepare 

for the evacuation and hospitalization of its 

sick and wounded, and to instill in the 

minds of a multitude of neophyte military 

surgeons an understanding of un familiar 

principles and procedures. 

The Medica I Builchlp 

With the declaration of wa r, Stern berg 

had to assume administrative duties of 

great complexity for which nothing in his 

career had prepared him. As a scientist he 

had not found it necessary to delega te signifi cant responsibilities to others, and he 

had continued to follow this general approach in the ea rly years of his tenure as 

surgeon general. His failure to make major 

changes in the orga nization of his offi ce to 

meet the new challenge suggests that he 

had difficulty delegating authority, a characteristic of the unskilled administrator. 

His principal problem, the shortage of 

trained and experienced doctors, stewards, and hospital attendants, would have 

been insurmountable in any event. 

The chief responsibility for the work of 

the Medical Department with the forces 

mobilized for the Spanish-American War, 

including those sent to the Caribbean, 

those sent to the Philippines, and those reta ined in camps in th e United States, fell 

to Col. Charles R. Greenleaf, one of fo urteen Civil Wa r veterans still in the department. Greenleaf was deSignated chief surgeo n of the Army in the fie ld and, as such, 

served on Miles' staff. Greenl ea f's duties incl uded determining the organization for 

medical services in the field , planning for 

the tra ining of the many neophyte medical 

offi cers who joined the effort against 

Spain , and dealing with any major crisis 
PREPARATIONS FOR CONQUESTS OVERSEAS 119 

co ncerning the management of suppli es 

and hospitals in the fi eld.' 

Congress authorized positions fo r eight 

corps surgeons and a hundred divisionand brigade-level surgeons on 22 April 

1898, and on 12 May created spaces for fi fteen more regular assistant surgeons. The 

legislature also all owed for the appointment of as many contract surgeons as were 

needed, but most of the men ca lled in to 

serve in either capacity were, like a majority of their volunteer colleagues, strangers 

to military medicine. Filling these slots was 

not easy; at the end of May thirteen were 

still vacant. Since many of the Medical Depanment's more senior o ffi cers were committed to purely administrative duties, 

even the fa ll closing of the Army Medica l 

School to free its professo rs for wartime duties left only a hundred ex perienced surgeo ns available fo r fi eld service and the instruction of new medical offi cers' 

Few of the Medical Department's regular 

offi cers had had any experience in preventing disease in large groups of men, and 

none, not even Sternberg himself, was [amiliar with the problems of mounting an 

overseas expedition. Making the best of a 

bad situation, Sternberg placed those with 

the most experience in positions where they 

could guide those with the least. Five Regular Army doctors became chief surgeo ns 

of Army corps. Thirty-six served as division 

or brigade surgeons, leaving only fifty-nine 

to serve with ind ividual regiments. Three 

corps and seventy-four division and brigade 

positions had to be fill ed by vo lunteers. 

They, like all Army surgeons serving in the 

fi eld , reported to the orncers commanding 

their units, being responsible to Greenlea f 

only for the professional aspects of their 

work. Thus the direct authority of the surgeon general was limited to genera l hospitals, medical supply depots, hospital ships, 

C HARLES R. GREENLEAF 

and enlisting and assigning hospital corpsmen. To guide the many newcomers upon 

whom the Army had to depend, Sternberg 

sent out a revised edition of the Mallual oj 

the Medical Departmellt that brieny discussed the wartime responsibilities of the 

Hospital Corps and of medical officers in 

the field. He also issued a series of circu lars 

outlining the duties of the va rious positions 

held by medica l orncers and detailing appropriate preventive measures, among 

them sanitary precaulions.6 

The approac h to determining the qualifications of the vo lunteer surgeons for 

successfu l duty as military surgeons va ried [rom state to state. State authoriti es 

chose the three physicians required by 

Congress to accompany each regiment, appointing boards to determine their fitness 

to serve. Few stales insisted thal ca nd idales undergo physical examinations before joining the Army, and thus some new 
120 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

medical orficers proved unequal to the 

physical demands of their duties. Although most state boards at least interviewed all physicians seeking to obtain 

such an appointment, the extent of their 

inquiry into the candidates' professional 

skills varied widely from state to state, and 

some appointments were politica lly motivated. Homeopaths, who believed that 

minute doses of medications that produced the symptoms of a disease should 

be used to treat the disease, appea led successfull y to President McKinley for permission to take the examinations and to 

serve if they passed. Those placed in corps 

and brigade positions Ca few of whom, like 

Senn, a lieutenant colonel in the U.S. Volunteers,' were nationally prominent) were 

appointed at the national level, thus escapingany requirement for examination to 

determine either their physical or their 

professional qualifications· 

Service as a member of the National 

Guard had not fully prepared a physician 

for service in the wartime Anny. The Guard 

required only that its doctors have medical 

degrees, this at a time when the nation's 

medical schools left much to be desired. 

Thus many physicians wi th state units were 

barely competent, if that, in civilian life, although some, like Senn, had received advice and instruction from Regular Army 

medical officers in the period before 1898. 

Senn designed thorough physical and professional examinations for those physicians wishing to enter the Illinois Guard, 

and a few of the Na tional Guard-trained 

doctors attempted to conduct brief courses 

for their volunteer colleagues. For the most 

part, however, rega rdless of their professional competence, those who had never 

served in the Regular Army were significantly handicapped when called upon to 

perform as medical offi cers. They were totally devoid of any understanding of the administrative work required of them as military surgeons, were unaware of the vital 

role played by sanitation in maintaining the 

health of an army, and were unfamiliar with 

the procedures necessary to acquire and 

keep adequate stocks of medicines and hospital supplies 9 

Friction between Regular Army medical 

orficers and those who had only recently 

left civilian life was inevitable. Many of the 

latter displayed what a regular medical offi cer described as the "lack of subordination usual among volunteers. " Attempts to 

give the regimental doctors of volunteer 

units assignments outside their original 

units often met with "rebuff or vigorous 

protest" from regimental commanding offi cers as well as from the physicians involved. Further exacerbating poor relations was the fact that inexperienced 

volunteer surgeons were in many instances put in higher positions than regular surgeons, who then found it difficult to 

guide and indoctrinate their neophyte colleagues, some of whom they regarded as 

grad uates of "one of the inferior medical 

coll eges" and even as "illiterate at the 

sta rt." Vo lunteer Senn , on the other hand, 

looked down upon career Army physicians; he contended that they abandoned 

efforts to keep up with medical progress 

after passing the last required promotion 

exam to earn the rank of major. 1n some 

instances, however, the exercise of patience and tact in cleari ng up misunderstandings led to effective cooperation between regular medical orficers serving at 

the division level and above and the commanding orfice rs of volu nteer units.lo 

To fill gaps left vacant by the shortage 

of military medical orficers, the Medical 

Department signed contracts with civilian 

doctors. Because of the haste with which 
PREPARATIONS FOR CONQUESTS OVERSEAS 121 

preparations had to be made, the department had to rely on references rather than 

competency examinati ons in hiring contract surgeons throughout the SpanishAmerican War. More than 300 had been 

hired by the first of August, with the total 

eventually reaching 650. Some contract 

physicians were young and inexperienced, 

and most, like their counterparts in the 

volunteers, were unfamiliar with the 

Army's administrative procedures and the 

specific requirements of military medicine. Their position was characterized by 

weakness and inconsistencies. Expected to 

control enlisted corpsmen, they lacked 

both the military training and the rank that 

would have enabled them to do so. As 

"civilians performing the duty of offi cers," 

they had "the rights of neither, if it suits 

the commanding general to deny them." 

Although they were free of any fear of 

court-martial because they were subj ect 

only to civilian courts, their contracts 

could be canceled, or, at the very least, not 

renewed . Many contract surgeons were 

considered well trained and educated, and 

one observer noted that they were by and 

large "temperate in their habits," which 

Regular Army surgeons, he believed, were 

not. Even so and despite their achievements during the war, contract surgeons 

tended to be rega rded throughout the 

Army as "no better than our common 

packers or civilian teamsters." II 

The medical offi cers who participated in 

the Spanish-American War were initially organized by regiment. Volunteer units were 

allowed lO bring a surgeo n, two assistant 

surgeons, and three hospital stewards with 

them, while each regular regiment had at 

least one physician and drew its hospital attendants from the various posts to which its 

companies had been assigned before the 

war. The Medical Department's wartime organization in the field was based on that of 

the Civil War, in which the division hospital became the fundamental unit. A few regimental officers were left with their units lO 

maintain health and determine what soldiers should be sent to the division facility, 

but most were detailed to serve at the division level. The chief surgeon of each corps 

was responsible for transfonning the organization of the medical stafflO meet the new 

requirements.

12 

Even the physicians directly responsibl e 

for care of the Army's patients were required to handle many administrative duties, the performance of which took them 

away from their patients. Reports had to be 

filed, requisitions fill ed out, and records 

maintained. Regular medical offi cers sometimes found themselves spending as much 

as half their time in nonmedical chores, 

while many of their less experienced colleagues tended to ignore such duties or to 

make but a half-hearted effort, submitting 

reqUisitions in the form of notes on the 

back of envelopes and omitting other paperwork entirely. Attempts to train volunteer and contract physicians lO fill out 

forms properly and lO handle other administrative routines were not always successfu l. Although Greenleaf apparently set 

up what he call ed "schools of instruction" 

for them, units and their medical officers 

came and wenl in some camps with a rapidity that made training impossible. Furthermore, volunteers might have little appetite for learning to do something whose 

purpose they could not appreciate. The 

complexity of the Army system greatly discouraged many a former civilian, causing 

him to abandon the attempt to deal with 

what he regarded as red tape. A proposal 

was made, though not acted upon, that a 

lieutenant of the line be assigned lO hospitals to handle administrative details. The 
122 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

severe shon age of hospital stewards with 

surncient experience to assist in the paperwo rk only made the problem worse." 

Providing the wartime Army with an adequate number of either hospital stewards 

or attendants proved dirncul!. In increasing the size of the Regular Army in April 

1898, Congress neither included a provision for an expanded Hospital Corps nor 

dealt directly with the question of volunteer hospital corpsmen. The volunteer system, with corpsmen organized by regiment, was not compatible with that of the 

Regular Army organization, which was 

fo rmed on an Army-wide basis. Volunteer 

regiments were allowed three hospital 

stewards each , but their corpsmen were 

merely enlisted men detailed to serve as 

hospital attendants. When a minor change 

in the law made it possibl e fo r a corps commander to transfer from volunteer units to 

the Hospital Corps twenty-five men for 

each regiment and fifty more for each division hospital, many regimental commanders once again tended to balk at giving up their men. The adjutant general 

urged that, fo ll owing their assimilati on 

into the Hospital Corps, such soldiers be 

permanently assigned back to their original units. At least one Army corps chief 

surgeon managed to enlist experi enced 

hospital corpsmen by what was apparently 

an informal guarantee that they wo uld 

serve only in that capacity. Erroneously 

concluding that they would then be committed to three years of service, few of 

those who had been serving as Na tional 

Guard corpsmen wished to sign up in the 

Regular Army. When volunteer units 

began to disband , authorities decided to 

let corpsmen who had joined as volunteers 

go home at the same time as the units with 

which they had originally served. " 

The qualifications of the men most often 

assigned to the Hospital Corps from the 

line were marginal at best. Many were untrained and inex peri enced, although one 

surgeon found them to be willing workers. 

Some hospital corpsmen taken from state 

units were physicians, medical students, 

or pharmaCists in private life , but many 

were, as so many of their predecessors had 

been for over a century, "drunkards, 

epileptics, and other worthless men." 

Managing such soldiers presented a challenge beyond the talents of the average 

neophyte med ical orncer, a probl em the 

chi ef surgeon of the 1Il Corps met by having a line offi cer assigned to command his 

Hospital Corps companies. No time was 

available to put such a large number of inex perienced troops through the course at 

the school of instruction at Washingto n 

Barracks. This institution , therefore, virtually suspended operations for the duration, except fo r a few days of orientation, 

in ravor or Oil-site training at the various 

general hospitals, and Sternberg had 2,400 

co pies of a revised Halle/bool? for th e Hospital Corps issued to assist in Hospital 

Corps training. " 

InJune 1898 Congress eased restri cti ons 

on the number and background of the hospital stewards aSSigned to the Hospital 

Corps for the duration of the war, thereby 

raising the total from 100 to 200. The requirement for a year's service as acting hospital steward before appointment as steward was also eliminated, although the 

Medical Department considered three 

months of experience before promotion advisable. Each volunteer battalion was allowed to have an additional hospital steward and each corps an additional 10 beyond 

that. By the end of]une the Hospital Corps 

consisted of 133 hospital stewards, 172 acting stewards, and 2,940 privates, most of 
PREPARATIONS FOR CONQUESTS OVERSEAS 123 

the laner having transferred from the line. 

Although 6,000 were serving in the Hospita l Corps by November 1898, even this 

number proved to be inadequate for both 

an annyof occupa tion in the Ca ribbean and 

units that would soon be actively invo lved 

in a struggle with the Filipinos. 16 

Initially the Medical Department acted 

on the assumption that female nurses 

would be needed only if the co nnict proved 

to be lengthy or seve re. Although some historians maintain that Sternberg was reluctant to hire women as nurses, in April 1898 

he asked for and received permission from 

Congress to hire as many female anendants 

as he might need. In the twenty-five years 

since the establishment of th e first nursing 

schools in the United States, Sternberg, li ke 

many other physicians, had begun to recognize the worth of profeSSionally trained 

fema le nurses. Any reluctance on his part 

to employ them apparently stemmed frolll 

his belief that they mi ght be an "encumbrance" should they be sent into th e fi eld 

with an army preparing for acti on. More 

than 1,700 conlract nurses served at one 

time or another with the Army during the 

Spanish-American War; most of them were 

women, as male nurses were rare. 17 

Obtaining an adequate number of skilled 

and dedicated nurses remained a problem 

both th roughout the s panish-Amelican War 

and, because of epidemics of disease, for 

months after the fighting stopped. Since no 

one in the Medical Department had the time 

to screen applications from women who 

sought contracts as nurses, the Daughters of 

the American Revolution offered to assume 

this responsibility. For a few mOnlhs Anita 

Newcomb McGee, a physician and vice-president of the organization, headed a committee that included the wives of both Secretary 

of War Russell Alger and Surgeon General 

Sternberg. The members apparently went 

over the records of all applicants except 

members of religious nurSi ng orders, who 

were exempted from the requirement that all 

nurses be graduates of training schools. They 

were unable to meet Sternberg'S Grst request, 

made on 7 May, for four nurses to be sent to 

the general hospital at Key West, Florida. He 

wanted women who both met the requirements for training and character and were 

immune to yellow fever, but only one such 

nurse could be found. In August, although 

the active stage of the campaign in the 

Caribbean was over, "it became necessary to 

establish an Army Nurse Corps Division of 

the Surgeon General's Offi ce." McGee became the head of the new organization with 

the rank of acti ng assistant surgeon. IS 

Some surgeons were convinced of the inherenl worth of female nurses. senn, for example, noted that "a true nurse is born, not 

made" and that "few men are born with intrinsic qualities which constitute an effi cienl, 

successful nurse. " Yet others had serious 

misgivings, making Sternberg wary of sending nurses to a physician who had not requested them. Army surgeon Col. Dallas 

Bache believed that men were "more serviceable than women on shipboard, less liable to exhausting sea sickness, requiring 

fewer facilities and less comfort," and that 

they were preferable to women on transports 

and trains as well. Furthermore, "a certain 

disquiet about morality" inevitably arose 

when women were present. Small facilities 

lacked accommodations for them, and their 

patient loads nucLUated. When the hospital 

population load fell , nurses had to be able to 

handle non-nursing duties. Asa result, Bache 

concluded that female nurses should be assigned only to general hospitals. Further 

complications arose from the fact that the relationship offemale nurses to hospital corpsmen was not always good. Nevertheless, at 

least one department surgeon, [uture sur-
124 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

D ALLAS BACHE 

geon general Col. William H. Forwood, pronounced "male citizen nurses" to be "worthless." And even Bache eventually praised the 

accomplishments of female nurses, accepted 

their help ill emergencies, and concluded 

that the Spanish-American War had established that the Army needed them.!' 

Readying Supply 

Because he had ordered before the war 

began that the supplies the Medical Department had on hand be prepared for distribution , Sternberg was initially somewhat optimisti c about the department's 

ability to furnish all that might be needed; 

he may have assumed, as so many did, that 

the campaign would not begin until fall. 

Although the amoun t of medicines, stores, 

and equipment on hand in the spring of 

1898 was adeq uate for the needs of a 

27,000-man army in peacetime, Congress' 

failure to permit peacetime stockpiling for 

possible wartime needs continually frustrated attempts to provide physicians and 

hospitals with medicines and equipment 

once volunteers had been called up'o 

Thus Sternberg, who was apparently attempting to deal with all supply problems 

personally, was required to buy enormous 

quantities at one time and on short notice. 

He moved qUickly to request bids on the 

most important items, including medical 

and surgical chests, litters, and fi eld operating cases. He had permission to buy on 

the open market, but he often could not 

obtain instruments, medi cal chests, and 

the like in this manner. His attempts to 

speed the process of acquiring the needed 

items were hindered by what a representative of a relief organization called "the 

meshes of red tape and requisitionism." 

Sternberg blamed some of his difficulties 

on congesti on in depots and along a railway network not in tended for such burdens. Because the Quartermaster's Department was responsible for most shipping, 

the Medical Department was powerless to 

solve the probl em. Moreover, forbidden to 

hire extra personnel and uninformed both 

about where additio nal shipments would 

have to go and about how much would be 

needed, Sternberg was unable to establish 

in advance a system for distribution' ! 

Because many volunteer units were not 

adequately supplied when they arrived in 

camp, the Medical Department had to draw 

upon its reserves from the outset. Orders 

were fi lled slowly, and regiments that 

brought medical equipment with them had 

to rely upon it for some time. The qua ntities of each item needed were enormous; 

Sternberg reported in 1898 that he had issued, for example, 272,000 first aid packets, 7,500,000 quinine pills, 18,185 cots 
PREPARATIONS FO R CONQUESTS OVERSEAS 125 

, 

I 

NURSES AT J OSIAH SIMPSON GENERAL HOSPITAL NEAR FORT MONROE, VIRG INIA 

and bedsteads with bedding, 23,950 gray 

blankets, and 2,259 litters, The department 

was able to provide first aid packets co ntaining antiseptic d ressings [or each soldier 

"promptly and liberall y." But ambulances, 

the animals that pulled them, tents, and 

similar large items were, like railroad transportation, th e responsibility o[ th e Quartermaster's Department. Thus the Medical 

Department had once again to surfer [rom 

the [ailures o[ another organization, in this 

instance, one that was also experiencing 

dirnculties related to the general lack o[ 

preparedness and a shortage o[ trained personnel. Ambulances came in slowly, and 

when they did arri ve, they all too orten 

co uld not meet Stern berg'S requirements," 

Beyond the problems ex perienced in 

obtaining supplies and equi pment were 

those involved in gelling them promptl y 

to the medical orncers who needed them, 

On 9 May Sternberg issued a fi eld supply 

table, When he realized that most o[ the 

troops wo uld remain in camps o[ instruction indefinitely, healso permitted medi ca l 

orn cers to order suppli es [rom the regular 

supply table, which had been drawn up to 

meet peacetime needs, Inex perienced surgeo ns underestimated demand, however, 

ordering inadequate amounts despite 

Sternberg'S wa rnings on the subjec t, and 

because they did not [ully appreciate the 

concept o[ lead time, they [a il ed to allow 

[or th e time that would inevitab ly elapse 

between the placing o[ the order and its arrival. The surgeon general's permission to 

place emergency orders by telegrap h and 

without his prior approva l and to have 

items shipped by express despite th e expense did not solve the problem, Stern berg 

resorted to telegraphing the nearest depot 

perso nally to have the needed items ready 
126 THE ARMY MEDICA L DEPARTMENT, 1865·-1917 

GENERAL H OSPITA L AT F ORT M ONROE 

in the appropriate quantity at the new site 

whenever he lea rned that troops were 

about to be moved or new camps established. Although medical supplies were, 

on the whole, at least marginally adequate, 

for a variety of reasons they were not always available. Units on the move often 

took manyofthecamp suppli es with them, 

just as they had in the Civil War, forcing 

the medical offi cers remaini ng behind to 

rely heavily on the aid of chari table organiza ti ons. Boxcars laden with suppli es 

were not labeled as to co ntents, making the 

job of locating Medical Department property diffi cult until the bills of lading arrived, possibly days later." 

To deal with th e supply problem as 

rapidl y as possible, Stern berg ordered the 

New York and SI. Louis depots in earl y May 

to prepa re at once to meet the needs of 

100,000 troops for six months, usi ng the 

new field supply table as a gUide. He also 

had a subdepot established at Chickamauga, Georgia, to suppl ement the department's depots in New York, SI. Louis, 

and San Francisco. SI. Louis supplied the 

Chi ckamauga subdepot and camps in Tennessee, Kentucky, Alabama, and Louisiana 

and sent the San Francisco depot some 

items needed for the Philippine expedition. Medical offi cers with troops in volved 

in the Caribbean effort, as well as those remaining in Florida and in large camps in 

the East requisitioned supplies from the 

New York depot." 

The pressure on these depots proved to 

be extreme. Storage facilities in New York 

City were totally inadequate for wartime. 

One witness reported that, in spite of the 

rental of extra space, for more than nine 

months, half the activity at the depot took 

place "on the sidewalk, thousands of packages being received, marked, and shipped to 

their destinations therefrom." In an attempt 
PREPARATIONS FOR CONQUESTS OVERSEAS 127 

to alleviate the burden borne by the New 

Yo rk depot, the Medical Department began 

to buy directly from dealers in Washington, 

D.C. , Philadelphia, and Baltimore for troops 

at Camp Alger, Virginia , and for the general 

hospitals at Forts Myel' and Monroe and at 

Washington Barracks. This move also guaranteed faster deli very on needed items. But 

the effects of slow transportation were exacerbated by the Quartermaster's Department's custom of mixing medical with nonmedical items in its boxcars.25 

Organizing a Hospital System 

Both th e size and the organization of the 

Army gathering for the war with Spain dictated the development of a new system for 

providing hospital care in the fi eld. The 

peacetime system had been based almost 

entirely on post facilities, wh ich sooner or 

later received those who were wounded or 

who fell ill in the fi eld during the Indian 

wars. The regimental hospital, too large for 

the peacetime Anny and too small for Civil 

War armies, had been offi cially abolished 

in 1862. Surgeon J onathan Letterman's 

success in the Civil War suggested that for 

future co nOi cts, a systemati zed approach 

to medi cal evacuation and hospitalization 

should be developed .'6 

The task of designing the Medical Department's approach to the management of 

evacuation and hospitali za tion for the 

Army in the fi eld fell to Greenlea f. He decided to reiyon the division facili ty, proven 

more effecti ve than the regimental hospital during the Ci vil War and familiar to 

Civil War veterans as a fi eld hospital that 

accompanied the di vision \vherever it 

wenl. Eac h was to hold 200 beds and be 

manned by 6 officers and 99 enlisted. 

Three of these faci liti es, plus a fourt h held 

in reserve, were to be all otted to each Army 

corps. An ambu lance company of 6 officers and 114 men was to be attached to 

each, ready in time of battle to remove the 

wounded by litter to dressing stations and 

thence by ambulance to the hospital. Unfortunately, assuming that the department 

would draw upon the regimental staff to 

obtain division hospital personnel, Congress precipitated future co ntroversy by 

never addressing the problem of staffing 

the division fa cility.'7 

The chain of evacuation in this scheme, 

which was in principle like that developed 

by Letterman in the Civil War, invo lved litter-bearers that picked up the wounded on 

the fi eld and took them to collecting stations, al leasl one per division , two to three 

miles back of the front, where they would 

receive first aid . The casualties would then 

be loaded on ambu lances for a two- to 

three-mile trip to a fi eld hospital further to 

the rear. With the battle over, details wo uld 

search the fi eld and bring any wounded 

they found back to th e collecting stations, 

where hospital corpsmen wou ld assume 

responsi bility for their care and further 

transport. This system Greenleaf beli eved 

to be much more Oexibl e than the regimental hospital system.'B 

Outside the division hospital staff, a 

medical offi cer, a hospital steward, and a 

Hospital Corps priva te were to remain with 

each regiment, caring for soldiers with 

minor ills in a facility that resembl ed a dispensary more than a hospital. Each corps 

had not only a chief surgeo n but also a 

medical inspec tor, this position being one 

that was abolished at the end of the Civil 

Wa r. Each of the three divisions and nine 

brigades in the corps had a chi ef surgeon. 

Together with the forty-eight surgeons assigned to division fi eld hospita ls and ambulance companies, this brought the total 
128 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

number of physicians with a co rps that 

might in theory have as many as 32,000 

men to a minimum of eighty-nine. Since 

volunteer regiments sometimes brought 

up to three surgeons with them, the corps 

chief surgeon could hope that he wou ld 

have additional physicians to cover for 

those who became ill or were for other reasons unable to serve. This form of organization appeared to offer the most efficient 

use of both perso nnel and equipment, although chief surgeons were authorized to 

deviate from it if necessary." 

The old arguments concerning the relative merits of the regimental hospital and 

a larger faCility dated back to the days of 

the Continental Army. It arose early in the 

Spanish-Ameri can Wa r because each regiment arrived at the huge new camps with 

at least the rudiments of its own hospital. 

After the regiments had been organi zed 

into brigades and divisions and with disease rates mounting, the Medical Department moved to disestablish the regimental faciliti es in favor of hospitals at the 

division level, intending that only patients 

retained in their quarters be treated at the 

regimental level and that any personnel, 

supplies, and equ ipment in excess of that 

needed for the dispensa ry be given to the 

division hospitaP O 

In spite of the greater effiCiency of the 

larger institution, the decision to abandon 

the regimental hospital system remained 

an unpopular one, even at the War Department level. The strength of th e opposition, which included volunteer medical 

and line offi cers as well as state govern ors, 

delayed the formation of division fa cilities. 

Regiments often did not have enough medici nes and suppli es to co ntribute to a division hospital. Regimental commanders 

and medical offi cers resented the threat to 

their independence, in one instance regarding the establishment of a division 

hospital as a power play by the corps chief 

surgeon, a Regular Army medical offi cer. 

The sick objected to hospitaliza ti on in the 

division hospital, and regimental surgeons 

tended to retain them und er their own ca re 

as long as possibl e, even reso rting to sending patients to boarding houses rather than 

to div ision hospitals. Some line offi cers 

maintained that the siphoning off of twothirds of their medical staffs for their division hospitals was to blame for the poor 

sanitation in their units. 3] 

Greenleaf was respo nsible only for planning the medi cal care and evacuation for 

units in the fi eld. Ge neral hospitals and 

hospital trains remained under the direct 

control of the surgeon general. Sternberg 

opened general hospitals only as the need 

for them developed, often by ex panding 

existing facilities. By 30 September he had 

established ten general hospitals in th e 

United States, one of which was the Josiah 

Simpson General Hospital, for wou nded 

and sick soldiers returned from Cuba and 

Puerto Rico. On 30 May he also recommended that arrangements be made for a 

ten-car hospital train of "to urist sleepers 

and a dining car. " Trains were already removing from Tampa, Florida, men too sick 

to embark for Cuba when this proposal 

was approved on 16 June and ten Pullman 

sleepers, a private car, a «combination car," 

and a dining ca r were assigned to the Medica l Department. In additi on to the surgeo n in charge, the train's medica l staff 

consisted of an assistant surgeon , two hospital stewards, twenty Hospita l Corps privates, and three civilian employees." 

The hospital train's first run began in 

Washington, D.C., on 17 Juneand ended in 

Tampa two days later. From Tampa the train 

then took patients to Fort McPherson, 

Georgia, \-vhere tourist sleepers, which were 
PREPARATIONS FOR CONQUESTS OVERSEAS 129 

beller arranged for the purpose and better 

ventilated, replaced the Pullmans. Although 

the slow response of local quartermasters to 

requests for transportation initially caused 

irregularities in schedules, on 4 July the appointment of the assistant surgeon accompanying the sick, who was motivated to give 

high priority to hospital trains, as assistant 

quartermaster eased the problem. The train 

continued in service until the spring of 

1899, ca rrying as many as 270 patients on 

a Single run. From time to time it took patients to the general hospitals at Forts 

Thomas (Kentucky), Monroe, Myer, and 

McPherson; to that at Washington Barracks; 

and even to the post hospital at Plattsburg 

Barracks in New York." 

Launching the Cuban Expedition 

Although thousands of men assembled 

at the various camps in the southern United 

States in anticipati on of the invasion of 

Cuba, only the V Corps," initially stationed 

in the Tampa area, fought there. As organized in early May, it was to be a 6,000-man 

force for small-sca le raids and incursions 

that would be used to supplement a naval 

blockade of the island . Under the command of William R. Shafter, a major general in the volunteers, it grew to include 

25,000 men, 17,000 of whom were in 

Tampa by the twenty-fifth , most of them 

regulars, accustomed to discipline and familiar with the demands of camp sanitation. Neither Surgeon General Sternberg, 

an expert on yellow fever, nor General 

Miles could convince President MCKinley 

to postpone the invasion of Cuba un til the 

fa ll, when the threat from that disease 

would be dwindling. In the end, the timing of the invasion and the location of the 

landing site were based solely on the U.s. 

Navy's urgent need to capture or destroy 

the guns guarding the Spanish fleet, bottled up in the harbor of Santiago but still 

capable of slipping by the u.s. ships guarding the harbor mouth. Shafter was not informed of his specific mission until the end 

of the month. Indecision at the highest [evels resulted in a change of objective from 

Havana to Santiago at almost the last moment and made a shambles of efforts to plan 

for the most effective use of Shafter's force." 

The V Corps' chief surgeon was Benjamin F. Pope, who now held a volunteer 

commission of lieutenant colonel. The burden of managing the medical support of 

such a hastily organized and poorly planned 

operation must have been particularl y 

heavy after his 1886 failure in managing the 

Record and Pension Division oftheSurgeon 

General's Offi ce. Under Pope served doctors 

of varying qualifications, an average of more 

than 4 for every 1,000 men, among them 36 

regimental medical offi cers, 15 volun teer 

surgeons, and 20 contract surgeons. [n this 

last group was Acting Assistant Surgeon 

Guiteras,36 who had worked with Sternberg 

on the Havana Ye llow Fever Commission in 

1879 and was regarded as an authority on 

yellow fever and other tropical diseases. 

Guiteras was assigned to work with Pope at 

V Corps headquarters. Chief surgeons at the 

division level were Majors Marshall W 

Wood of the 1st Division, Henry S. Kilbourne of the 2d, and Valery Havard of th e 

Cavalry Di vision.

37 

To meet the needs of the V Corps in battl e, Pope modified the organization of his 

hospital corpsmen to achieve grea ter flexibility, dividing them into three rather than 

fo ur compani es, all to be under his direct 

control rather than that of the division 

chief surgeo ns, with each company commanded by a medical officer of his choice. 

Only a few men were to be aSSigned to 
130 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

work with unit surgeons as orderlies. In 

the event of battle, each division wo uld 

have a minimum of one ambulancestation 

two to three miles back of the fro nt and a 

compl ete fi eld hospital another two to 

three miles back of the staLion.'s 

Although the V Corps ambulance companies were still not comp letely staffed or 

equipped when the invading force embarked for Cuba, the division hospital system had now been in place fo r some time. 

The hospitals that regimellls brought with 

them to Tampa were gradually absorbed 

into four division fa ciliLies until most of the 

latter had beds for 150 or more patients. 

Since most regimenta l surgeo ns of the V 

Corps were regulars, this process aroused 

little opposition. Orders were issued on 6 

June, however, thaL two tellls, an ambulance, and two members of th e Hospital 

Co rps be kept at the regimental level. Maj. 

Louis A. LaGarde and his three assistant 

surgeons, including future surgeon general 

Capt. Men'ine W. Ireland, set up the reserve 

division hospital at Port Tampa. As the senior medical offi cer in Port Tampa, LaGarde was also required to supervise the 

work of the medical offi cers with units stationed there. The remaining three division 

hospitals, each with a full y equipped operating room complete with steam sterilizers 

and enameled steel fo lding operaLing tables, were set up at Tampa under Maj. 

Wood , who managed his 1st Division's hospital perso nally, Maj. Aaron H. Appel with 

the 2d Division, and Maj. George McCreery 

with the Cavalry Division.39 

Pope co nsidered the health of the command in Tampa to be good before the invasion, despite a typhoid outbreak and the 

appearan ce of both measles and a mild diarrhea that was blamed on the change of 

climate. Because medical offi cers traditionally isolated pati ents with measles as 

soon as their condi tion was known, this 

disease never became epidemic. The form 

that prevailed in 1898 was mild, causing 

no real d ifficulty for medical officers. TyphOid was apparently less widespread than 

at oth er camps, probably beca use the regular troops who formed most of the command were more careful about sanitation 

than the volunteers who predominated at 

other large camps in the East. Measles and 

typ hoid patients were kep t in Tampa, but 

the victims of syphilis, a few patients with 

rheumatism, and some typhoid convalescents were sent north to Fort McPherso n.'o 

Concern for the future hea lth of the command when it was serving in the tropics 

caused guidelines about the prevelllion of 

disease to be issued before the invasion. 

Guiteras, who formulated the advice given 

out to the troops, was skeptical about the 

ability of quinine to prevent malaria but recommended it for those occasions "when the 

individual is subj ected to extraordinary depressing inOuences. " He advocated eating 

many tropical fruits and vegetables; limiting the intake of alcoho l, which was "speCially deleterious in the tropics"; and boiling all water that was not taken "directly 

from the springs." Guiteras believed that 

yellow fever was "not directly transmissible," but that rooms and tents could become 

infected and that, therefore, hospitals and 

their populations should be separated 

strictly from the rest of the force. Additional 

suggestions offered by Pope i ncl uded warnings not to "take purga tives when the bowels are regular" and to "peel all fruits before 

eating." He noted that dry socks were important for healthy feet. The role of mosquitoes in malaria had just been revea led 

months earlier and their ro le in yellow fever 

was still unknown, but Pope also warned 

that all men should "protect [themselves] 

from mosquitoes by gloves and nets. " " 
PREPARATlONS FOR CONQUESTS OVERSEAS 131 

Adequate supplies were necessary to 

any successful campaign against disease. 

The need to move medi cines, dressings, 

wagons, ambulances, and animals to and 

then from Tampa caused Significant problems from the outset. Tampa had been chosen as a base when plans called for a small 

invasion force. As the size of this force 

grew, so did the congestion and confusion. 

Two single-track railroads served the base, 

but only one ran to Port Tampa, where the 

transports awa ited loading. Moreover, the 

Quartermaster's Department contributed 

to supply problems through inadequate 

methods ofloading and labeling ca rgo and 

a failure to provide more than a few of the 

wagons needed to move supplies from 

freight ca r to ship. The resultant delays in 

un load ing freight and then removing it 

from the railhead led to a rapid backup of 

supplies at the Tampa station."' 

Supply problems grew with the arrival 

of volunteer regiments without all of the 

medicines and surgical dressings they 

needed or the wago ns and animals to move 

them in the field. Because Pope had to provide for these units, he was unable to build 

up a signifi cant reserve of the required 

items. In early May he placed a large order 

and aSSigned an assistant surgeon to expedite deliveries by serving as acting medical supply o[ficer at Tampa. By late May, 

however, the supplies Pope had on hand 

were almost exhausted. His request for 

permission to buy locally for volunteer 

units was granted, but by 2 June littl e was 

left in the Medical Department depot at 

Tampa. Three days later, although "fre ight 

traffic was almost hopelessly blockaded," 

part of what Pope had ordered arrived." 

One of the most needed items was quinine, whi ch Pope had been ordered to supply to the rebels already fi ghting the Spanish in Cuba. On 28 May his stocks were 

further depleted by an order that he supply 300,000 quinine pills to the U.s. Navy 

and that he rely on loca l purchases until 

Sternberg could ge t another shi pment to 

him. A week later Pope noted that the 

amount of quinine he had on hand was suffi cient " to meet all possible demands."·' 

As the time for embarkation approached, 

the confusion was great and growi ng. Uncertainty about the timing of the invasion 

exacerbated the difficulties invo lved in 

preparing fo r it. With only one pier available for loading, long backups were inevitable. Although on 7 June Shafter was ordered under way as soon as possible, 

regardless of what might have to be left behind, the expedition's departure was delayed for several days because of fa lse rumors that the Spanish fl eet had escaped 

from Santiago. Unsure about when the 

ships would leave, Pope became so concerned about his medica l suppli es that he 

went to the Tampa warehouse with two hospital corpsmen at midnight of8-9 June and 

personally loaded two wagons with supplies, which he then placed on the train fo r 

Port Tampa. He ordered his medi cal supp ly 

offi cer to send a third wagon load to Port 

Tampa on the ninth. Half the remaining 

stores fo rmed a reserve to be taken with the 

expedition, and the other half was left for 

the use of newly arriving volunteers" 

Although Pope had managed, despite 

the hand icaps under whi ch he worked, to 

have adequate supplies, equipment, and 

animals on hand at Tampa when embarkation began on 7 June, much of his effort 

was frustrated , often because the Medical 

Department had no choice but to rely upon 

the Quartermaster's Department to deliver 

the necessary supplies. Medical items were 

placed in the ships in a random fashion, 

without regard to when they might be 

needed, and regimental supplies were not 
132 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

necessarily loaded in the same vessel as the 

unit to which they belonged. The quartermaster general's reluctance to obtain transports until he could be sure of how many 

would be needed added further to the confu sion, since he then had to act in haste at 

the last moment. Because of the inadequate 

size and number of these vessels, much of 

what Pope wanted to take, including tents, 

ambulances, and wagons, was left at 

Tampa. Time may also have been a factor 

in leaving ambulances behind, yet Pope 

and LaGarde both blamed a lack of adequate space, a conclusion in which others 

concurred. Some of the reserve supply from 

the warehouse was placed on the headquarters ship and eventually ended up on 

the Olivette, a transport taken over for use 

as a hospital ship and equipped to handle 

at least 280 beds. Because most of the Medical Department's supplies in Tampa had already been divided among the medical offi cers, this reserve was not large 46 

The vessels upon which the V Corps was 

embarking had been obtained under the 

assumption that the landing would be at 

Mariel, less than two days away, ratherthan 

at the southeastern tip of the island, 1,000 

miles and almost a week's voyage from 

Tampa. Matters were further complicated 

when authorities adopted a British formu la 

for space per man intended fortroop transports rather than the converted freighters 

and passenger vessels available to Shafter's 

force. As a result, many more soldiers were 

placed aboard each vessel than it co uld 

carry without endangering their health, especially if they were on it for many days. 

The rough lumber bunks were crowded so 

close together that, should the hatches 

ever be closed, "light and air would have 

been totally excluded and suffocation 

[would I quickly result. " 47 

Heeding warnings from the medica l offi cers responsible for health on board these 

vessels during embarkation, at the last moment Shafter ordered that 900 men still on 

the shore not be permitted to board. When 

the delay in sailing continued, he had a 

total of 1,000 or more men already on the 

transports removed. Those who remained 

on the ships that rode at anchor in the harbor until 13 June suffered because of the 

heat and poor ventilation, uniforms not 

designed for extremely hot weather, a monotonous travel ration, and an inadequate 

water supply. Although Shafter allowed 

the men off the ships in detachments for 

exercise, they were not permitted to remain on shore because no satisfa ctory 

campsite could be found near the harbor. 48 

Since the refilling of the Reli e!, a vessel 

belatedly purchased in May for use as a 

hospital ship, had not been completed 

when men began to fall ill, the Olivette, 

which had been functioning as the neel's 

wa ter-carrier, had to serve in her place. 

Appel's 2d Division hospital and the medical supplies from the headquarters ship 

were moved to the Oli vette, and those who 

became more than mildly ill were taken to 

her in small boats, a process Pope described as "often . . . slow and difficult. " 

Once the other ships had set sail for Cuba, 

the Oli vette unloaded her measles and 

fever pati ents to make room for the 

wound ed that would result from the campaign and headed south."9 

After days of confusion and with 815 offi cers, 16,000 men, 1,000 mules, and 1,000 

horses on board, thirty-one vessels finally 

moved out of Tampa Bay onto a sea that 

was, fortunately, "smooth as glass. " Pope 

was parti cularly grateful for the fact that 

the water remained calm while they were 

under way, since otherwise the "suffering 

from sea sickness and the fo ul air of the 
PREPARATIONS FOR CONQUESTS OVERSEAS 133 

unventilated holds would have been intolerable." Even so, when the expedition 

arrived at its destination on 20 June, 100 

patients, most of them suffering from 

measles or typhoid, had been taken aboard 

the O/i veUe'o 

The supply probl ems with which Pope 

had been contending cast a long shadow; 

a matter so badly begun was scarcely likely 

to end well. Ignoring Guiteras' warning 

about mosquitoes would also prove to 

have seri ous consequences; these precautions apparently seemed to the average 

man more trouble than they were worth. 

Clea rly, both Pope and Guiteras had done 

what th ey could under the circumstances 

to prepare for the care of the sick and 

wounded of the V Corps during the campaign in the Caribbean. 

Launching the Philippine Expedition 

While General Shafter and his V Corps 

prepared for the invasion of Cuba, the 

Philippine Expeditionary Force (which by 

the end of June would become the Vill 

Corps) was gathering at San Francisco 

under the command of Maj. Gen. Wesley 

Merritt, who had also been named commander of the Department of the Pacific," 

to launch a land attack on Manila to exploit 

Commodore Dewey's naval victory. Plans 

for Merritt's command were also changed 

several times, and its size escalated from 

5,000 to 20,000 men. Its first components 

sailed more than two weeks before the V 

Corps left Florida, but while Shafter's objective shifted from Havana to Santiago, 

Merritt knew from the outset that Manila 

was his goal. Furthermore, San Francisco 

was already a major supply depot and asizeable city with a widespread transportation 

network, and Merritt was a more skilled administrator than Shafter. As a result, the 

Medical Department was better able to provide care for the sick and wounded of the 

Philippine expedition than for those who 

fell ill or were injured in Cuba'2 

When the force that would undertake the 

conquest of the Philippines was first ordered to gather at a camp, soon known as 

Camp Merritt, on high ground on the western side of San Francisco, plans called for it 

to consist of 5,000 men, most of them volunteers. Even when the entire Vlll Corps 

had been formed, only a quarter of the men 

were regulars, and sanitation presented 

problems as it had at every other camp 

where eager neophyte soldiers and their inexperienced offi cers gathered. Typhoid as 

well as the inevitable measles soon appeared. Nevertheless, inJuly, when a broadbased program of immunization for smallpox was undertaken, disease had not yet 

become a serious problem, in spite of what 

Sternberg called the "crowded condition of 

the camp, the inexperience or carelessness 

of responsible offi cers and the unfavo rable 

circumstances of season and location generally. " An increase in the number of pneumonia cases, blamed on the cool ocean 

breezes and chill mists that settled about the 

site, caused the War Department to order 

the camp abandoned in favor of the Presidio 

of San Francisco, "one of the most beautifu lly situated and one of the most healthful 

military posts in the world." 53 

The medical perso nnel assembling in 

San Francisco were adequate in number to 

meet the force's needs until it reached the 

Philippines and faced active combat. Makingsure that enough hospital corpsmen accompanied the expedition when it sailed 

was a probl em for the expedition's chi ef 

surgeon, Lt. Col. Henry Lippincott. Hospital stewards from several geographic department commands within the United 
134 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

H ENRY L IPPI NCOTT 

States joined the three who arrived with 

each vo lunteer regiment of Merritt's command, but only seventy-fi ve privates had 

reported for duty befo re the first men left 

for the Philippines. After a certain amount 

of confusion about the stallis of the attendants in volunteer units, Lippincott, 

known for his considerable "administrative ability, ... professional acquirements, 

landl capacity fo r work," finally received 

authori ty to have them all transferred to the 

Hospital Corps. In this way he could obtain enough attendants both for the Camp 

Merritt division hospital and for those who 

fell ill on the transports on their way to the 

Philippines. Despite Lippi ncott's efforts 

and the lowering of "the requ irements as 

to intelligence somewhat," the VIII Corps 

was able to acqu ire only half the number 

of authorized hospital corpsmen." 

Medical supply also presented difficulties. In planning fo r embarka ti on, Li ppincOlt hoped to have each regiment supplied 

with medical chests by the time it boarded 

the transports. But when the fi rst units to 

leave San Francisco sail ed on 25 May, the 

vo lunteer regiments had "no chests of any 

desc ription nor any hospital equi pmems." 

One of the regular surgeons, unhappy over 

what he regarded as the inadequacy of his 

supply of instruments, became embroiled 

in an argument (which he apparently lost) 

with Sternberg. When Lippincott arrived 

in the city, the first units were already embarking. Because of his efforts, combined 

with those of the San Francisco medical 

purveyor, th e seco nd contingent to leave 

for the Philippines and all regiments leaving thereafter were suppli ed with both 

medical chests and a month's worth of suppli es for use on the transports, with another six months' worth in reserve. The 

ships were carefully loaded, with items 

most li kely to be needed first placed where 

they could be quickly reached." 

Lippincott, like Pope and Guiteras, attempted to educate the troops about disease prevention by issuing a pamphlet 

about the health problems they might enco unter on the transports and at their destination. He emphasized the importance of 

sanitation, pointing out that "preventable 

diseases are due to living germs, which 

flourish in tropical countries li ke all other 

plants which requi re warmth." Cleanliness 

and keeping dry were especiall y impo rtant. 

Work duri ng the heat of the day should be 

avoided when possible. Li ke Guiteras, he 

also warned against mosquitoes, which 

"have been accused or causing malaria"; 

aga inst nies; and against "a small red insect, or jigger, which burrows in the skin. " 

He added that "the nati ves are notorio usly 

careless of all sanitary laws, and are infected 

with numerous diseases. In tercourse with 

th em will be dangerous," especially be-
PREPARATIONS FOR CONQUESTS OVERSEAS l35 

cause venereal disease was common among 

the villagers. I-I e issued no warning about 

yell ow rever, since it had never arnicted the 

population or the Philippines. 56 

The actual journey to reach the Philippines posed a considerable challenge, but 

the transports that Merritt had obtained to 

carry the men or the VIII Corps on the 

month-long voyage to Manila were, rortunately, more suited to the purpose than those 

available to Sharter, V Corps. The first vessels to set sail carried 2,500 orncers and men 

under the command or Thomas M. Anderson, recently promoted to brigadier general 

in the vo lunteers. The vanguard was to be 

rollowed by two more con tingents a rew 

weeks later; more than 10,000 men had arrived when the Spanish surrendered Manila 

in August. With the vanguard were a regular medical orricer and seven volunteer surgeons, \vho had "practically no experience 

in anything pertain ing to their duties, except the proressional care or the sick and 

wounded. " The shortage or hospital attendants made it impossible to provide as many 

as Lippincott believed necessary for a voyage that would take longer than a month. 

Except ror the three stewards allowed each 

or the two volunteer regiments involved, 

only one steward and nve Hospital Corps 

privates accompanied Anderson's command, all aSSigned to a regular inrantry regiment. Lippincott soon discovered, however, that the situation was not as bad as he 

had assumed, for in each volullteerunit were 

twenty-rour men who, having been detailed 

to hospital duty, could serve as corpsmenY 

The length or the voyage dictated greater 

care with sanitation than had been required 

ror ships bound ror Cuba. Before each vessel was leased, a medical board inspected it. 

Berore the soldiers boarded her, each ship 

was thoroughly cleaned and, when deemed 

advisable, disinrected. Although additional 

latrines were installed on many shi ps before 

the troops came aboard, Lippinco tt' goal 

ratio or at least 20 seats ror evel), 1,000 men 

,:vas not always reached. Since waLer supplies were limited on some transports and 

the men preferred showers, which were not 

available on all ships, personal cleanliness 

surrered. Dampness, inadequate ventilation, 

cro\vded sleeping quarLers, and mallresses 

that leemed with vermin also caused lhe 

chier surgeon concern. But drinking water, 

largely derived rrom condensers, was good, 

and rood, wh ile notalways well cooked, was 

omcially considered or acceptable quality. At 

least one soldier, however, later recalled that 

on his lransporl he was served "rOllen 

prunes and rruit, which, arter nearly all the 

supply was consumed, was round by our 

surgeon to be rull or worms. " For those who 

rell ill on the voyage, hospital racilities varied since not evel)'ship had space that could 

be set aside to meet Lippincott's standard or 

30 hospita l beds ror every 1,000 men plus 

lwo small rooms lO accommodale an operaLing room and dispensary58 

Despite the dirnculti es, Lippinco tt's d -

rOrlS lO ensure a healthy voyage were rewarded. The annual death rate rrom disease dming the month-long voyage to the 

Philippines was 1 in 1,000. With every 

group or transports that sa il ed ror the 

Philippines, however, some men invariably became too ill en route to continue 

lhe voyage. tn Hawaii, rormall y annexed 

by th e United States on 7 July 1898, the 

American Red Cross attempted to ca re ror 

these pati ents with the aid or any Medical 

Department personnel who could be left 

behind, but it soon became obvious that 

co ntinued reliance upon this approac h 

wou ld be unwise. Fac ilitiesspec inca lly ror 

the Army'ssick were necessary, ror the sa ke 

both or the ailing soldi er and or vulnerable Hawa iians who might be exposed to 
136 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

diseases lO whi ch they had little resistance. 

In ea rly July, when lippincott's ship 

slOpped in the islands, he arranged lO set 

up an Army hospital at Honolulu. The initial site proved malarious, however, and 

since larger accommodati ons were soon 

necessary, land was rented and a lOO-bed 

hospital builtata hea lthier location. As the 

Army moved increasing numbers of men 

to Honolulu, more medical officers and 

more medi cines and hospital equipment 

were also sent to Hawaii , which became an 

important stopover point for the sick and 

wounded of th e VIII Corps." 

The health of the men about to land in 

the Philippines, like that of those ready to 

go as hore in Cuba, would depend largely 

on efforts that had begun onl y in midApril, with littl e chance for planning and 

even less for stockpiling suppli es and 

eq uipment. In its attempt to care for th ousa nds of soldiers, most of them enthusiastic amateurs, the Medical Department was 

handicapped both by its own lack of preparation and by that of the organizations 

upon which it had to rely. With more time 

at their disposa l, Lippinco tt and the medical offi cers of the VIII Corps were able to 

surmount most of the diffi culties that confronted them, but the haste and confusion 

that marked the planning of the campaign 

in Cuba would haunt the V Corps from 

Tampa all the way to Santiago. 
NOTES 

L. Nicholas Senn, ,"'edico-surgical Aspects of the 

Sp(lIIish Americ(IIr War, PI'. 9-10. 

2. Un less otherwise indicated, all material in lhis 

chapter is based on Graham A. Coslllas,An Anny for 

Empire. 

3. First quotation from United States, Congress, 

Senate, Report of tire (Dodge) COlllmission To IIr vesLigate tir e Condll ct of (lrc \Val' Dep(lrtlllcllt hr tlr c War 

With Spahr, 1:169 (hereafter cited as Dodge COIIImission Report); second quotation from \OVar Department, (A IIIIIWI/ Report of tire SlIIgCOII General, 

us Arm)" to lire Sccrelw)' of War, L898, p. 103 (hereafter cited as WD , ARofSC, date); Nelson A. Miles, 

Servillg the Rqmvlic, p. 269; 'vVa ller Millis, Tire M(lrtial Spirit, PI'. L62-64;James L Abrahamson, AmeriC(l ArmsJor(l New CeHtlll)', p. 60;James A. Huston, 

TIre Sinews oJ War, p. 276; Erna Risch, Quartenillistel' Support o/LlrcArmy, PI'. 519, 523; Reporl of Commission To Investigate the Conduct of the War, PI'. 

65-66,68, Microfi lm Ree16, William R. Shafter Papers, Stan ford UniverSi ty, Palo Aha, Calif. (hereafter 

ci ted as Com Rpt , Mf Reel no., Shafter Papers, SU). 

4. Regisler oj tire /\rmy oj tire United Stmes for 

1898, PI'. 20- 29. 

5. WD ,JlRojSG , 1898,1'1'.100-10 1, 137-38,ond 

1899, p. 19; Hermann Hagedorn, Leollard Wood, 

1:144-45. 

6. WD, Jl ~oj , 1898, PI'. 100, 105, 138, 

140-42; sGO Cir Llr, 25 Apr 1898, Entr)'66, Record 

Group (RG) 112, National Archives and Records 

Administration (NARA), Washington, D.C.; Dodge 

COllllllissioll Report, 7:3125, 8:38- 39. 

7. The U.s. Vo lunteers we re drawn from the nation as a whole, rather than from individual states. 

8. Martin Kaufman, HOllleopath), ill AnreriC(l, PI'. 

25-26; "Homeopaths for the Army and Navy of the 

United States," p. 1430; Nicholas Senn , "Qualifications and Duties of Military Surgeons," p. 505. 

9. WD, ARojSG, 1898, PI'. 139, 159, and 1899, 

p. 76; senn , As"eelS, PI'. 20- 22, 28-29, 256, 295; 

Dodge COHllllissiOlr Report, 1:169-70, 3:3 15, 346, 

and 6:2816; Edward L Munson , The Tll eol), alJd 

Prcrclicc oj J\ll ililm)' Hygicllc, p. 943; idem, "Contract 

Surgeons in the Uniled States Army," p. 588; Corn 

Rpl, p. 66, Mf Reel 6, Shafter Papers, SU; "Army 

Medical Departmel1l," p. 206;John K. Mahon , His101), oj tile Militia (IIld tIr e N(I/ioll(l/ GilaI'd, p. 126. 

10. WD, ARojSG, 1898, 1'1'. 157, 160, 166 (second quotat ion), and 1899, pp. 52-53 (first quolation); Champe C. McCullough, "The Qualifications, 

Responsibilities, and Duties of the Regular Army 

Surgeon," p. 498 (remaining quotations); "Disparagement of the Regular Army Surgeons," p. 378; 

"Some of the Medical Lessons of the War," p. 485; 

Rpt , Ch Surg, Second Army Corps, pp. 16- 17, Enlr}' 

219, RG 395, NARA. 

11. WD, ARojSG, 1898, PI'. 100- 101 , 157, 160 

(first two quotations); Wickes \-Vashburn, "Montauk Point and the Government Hospitals," p. 805 

(third quotation); "Army Contract Surgeons," p. 

416 (fourt h quotation); "Army Medical Department," pp. 201-02; Dodge Commissioll ReporL , 

1:635, 4: 1253; Munson, "Contract Surgeons," PI'. 

588-89; Com Rpt, p. 66, Mf Reel 6, Shafter Papers, 

SU; Rpt, e h Surg, Second Arm)' Corps, p. 18, Entry 

219, RG 395, NARA. 

12. WD , ARojSG , 1898, 1'.115. 

13. Dodge Commission Reporl, 1:609 (quotation), 3:192, 668-69, 4: 1146-47, 1337, 1413, and 

6:2975, 2982-83, 2987. 

14. Dallas Bache, "The Pl aceofth e Female Nurse 

in the Arm)'," PI'. 308, 310-11; WD, ARojSG, 1898, 

PI'. 10 1- 02, 115,121, 148-49, 157, 165, and 1899, 

PI'. 51-52; Senn, Aspects, PI'. 57, 60; Dodge COIIImissioll Report, 4:125 1,6:2529; Com Rpt, pp. 66-67, 

Mf Reel 6, Shafter Papers, SU; George E. Bushnell, 

"The ExpanSion of the Hospital Corps in Wa r," PI'. 

145-46. The terms chi eJ slIIgeolr and medical direclOr were appa rentl)' used in terchangeably. 

IS. \ND, ARojSG, 1898, PI'. 101, 158, 167 (quotation), and 1899, p. 21 ; H. A. Haubold, "The Medical Aspects of Camp Management at Chickamauga," p. 586; Jefferson D. Griffith , "Hospi tal 

Experi ence in the \-Var With Spain," pp. 162-63; 

Bushnell , "ExpanSion ," pp. 146-47; James B. 

Agnew, "Carromatos and Quinine," p. 14. 

16. WD, ARojSG , 1898,1'. 148, and 1899, PI'· 

19- 21; War Department , Surgeon General's Office, 

Tire SlIIgeoll GCll eJ'(l ~ Office , p. 49 (hereafter cited 

as WD, sGO, SGO). 
138 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

17. Quotation from George M. Ste rnberg, "The 

Medical Depart ment of the Army, " p. 213; ibid. , p. 

214; Susan M. Reverb)'. Ordered To Ca re, pp. 5, 50; 

Senn, AspeCls, PI'. 313- 15; WO, ARofSG, 1898, PI'· 

102,121, and 1899, p. 24; idem, /AIlIHWIJ Reporl of 

tile Secre/w)' oj W(!r, 1898, 1(1'1.1):179 (hereaft er 

ciled as vVD,ARoj5W, date); Bac he. "Female Nurse," 

p. 318; lIr (copy), Ani ta Newcomb McGee to SG, 

[28 Apr 18981, in Anita Newcomb McGeejotlrnal, 

Entry 229, RG 112, NARA; Dodge COlllmissiol1 ne· 

pOft, 1:77, 7:3168; "Trained Femal e Nurses for the 

Army," p. 329. 

18. WO, ARofSG, 1898, p. 102, and 1899, PI'. 

24-25; Bache, "Femal e Nurse," p. 316; Dodge COIl1 -

lIIissioll Report , 7:3 168-72; Senn, Aspects, p. 320; in 

RG 112, NA RA: McGee JOllrnal, Apr- Ma)' 1898, 

Entry 229, Extract from Ameri ca n !\llolll.lIl), Magazill e, Entry 229, and Narratives, [Anita Newcomb 

McGee], pp. 9- L2 (quotation), Ma rgaret Dunn, and 

Margaret Be rry, Entr)' 230. 

19. Senn, Aspects, pp. 3 14 (first two quotations), 

318-19; Bache, "Female Nurse," pp. 307- 09, 316, 

319-20 (third quotation), 321- 22 (rourth quotation), 323, 325; Dodge COlIJllJissioH Rer on , 2:752 

(nnal quotations); Na rrative, Esther V. Hasson, 

Enlr)' 230, RG 112, NARA; WO, ARofSG, 1898, PI'. 

238, 260, and 1899, PI'. 52, 74; Com Rpl, p. 67, Mr 

Reel 6, Shafter Papers, SUo 

20. Martha L. Sternberg, GeOige Miller Slembelg, 

pp. 169-70; "Arm)' Medical DeparLmelll ," pp. 202-03. 

21. Dodge COllllllissioli Report , 1:712, 5:2319, 

6:2816,and 7:3117,3128 (quota tion); WO,ARofSG, 

1898, p. 103; Graham A. Coslllas, "From Order to 

Chaos," p. 120; Com Rp' , pp. 69-70, Mf Reel 6, 

Sha fter Papers, SUo 

22 . Sternberg, Sfcnlberg, pp. 170-7 1 (quotation); Risch, Quarlenll(lsler Support, pp. 538, 556; 

WO,ARofSG, 1898, 1'1'.103-05, 149; idem,ARofSW, 

1898, l (p1.1):1 79; Dodge COl1llllissioll Report, 1:638, 

712-13,and 3: 192, 552; Bache, "Female Nurse, " pp. 

317-18; Com Rpt, p. 68, Mf Reel 6, Shafter Papers, 

SUo The concept of the nrst aid packet was not new. 

Apparentl y, Roman soldiers used a nrst aid packel 

as early as the second centur), B.C. (see WD, SGO, 

SGO, p. 26). 

23. Charl es Smart , "Correspondence," pp. 

546-47; WO, ARofSG , 1898, 1'1'.103- 04, 144; Dodge 

COllllll issioll Report, .L:.173- 74, 7:31 17; Com Rpt, pp. 

69-70, Mf Reel 6 , Shafter Papers, SU; SGO Cir 6, 12 

Aug L898, Entr)' 66, RG 112, NARA. 

24. Sternberg, Stem/)erg, p. 170; \VD, ARofSG, 

1898, pp. 103, L05-06. 

25. j. Morris Browll, "Organi za tion and Conduct 

of a United Slates Arm)' Medi cal Supply Depot," PI'. 

283-84 (quotation); Risch, QU(!I"/enlwster SlippOr! , 

p. 541; WO, ARofSG, 1898, p. 104; Dodge COllllllissiol! Report , 1: 173-74. 

26. Dodge COllJlllissioll Report , 1:57 l. 

27. Will iam H. Devine, "Managemenl of a Field 

Hospital," p. 97; Charl es R. Greenle<lf, "The Orga H 

nization of the Medical Departlllent of the Army in 

lhe Field ," p. 201; WO, ARofSG, 1898, 1'.148. 

28. WO, ARofSG, 1898, p. 208; Greenleaf, "Organi zat ion," p. 201. 

29. WO, SGO, SGD, p. 51; WO, ARofSG, 1898, 

pp. 164-65; DodgeCommissiol! Reporl, 1:571,3:264, 

4: 1141,1313, 1335, and 6:2529. Serving at the corps 

level were two physicians. Anot he r three served at 

the division level, nine more as chief surgeons of 

brigades, twent},-rour with fiel d hospi tals, twentyfour with ambulance companies, while twen tyseven remained with their regiments. 

30. Mary C. Gi ll ett , Tile Arm)' Mediad Depm'flII ell l, J 775-J8J8, pp. 26-27; WO, ARofSG, 1898, p. 

126, and 1899, p. 69. 

31. WO, ARofSG, 1898, PI'. 120-21, 159, 

183-87, and 1899, p. 40; Dodge COlllmission Report , 

1:643-44,648, and 3:318. 

32. Quolalions from WO, ARofSG, 1898, p. 106; 

ibid. , 1'1'. 107,128-29, l SI , and 1899, PI'. 60-65; 

Bache, "Female Nurse," pp. 312, 316, 323; Dodge 

COI!!IlIissioll Report , 1:657 . 

33. ,VO,ARofSG,1898, pp. 128-30; Oodge COIII -

mission Report , 1:83; Charl es Richard, "The An n}' 

Hospita l Train During the Spanish-Ame rican Wa r," 

p. 201. Richa rd was in charge of the hospital train. 

34. The official deSigna tion was V Arm}' Corps. 

On 7 May 1898, unde r General Order 36, the War 

Departlllent offiCiall y established seven ann}' corps 

<lnd on 21 june 1898, under General Order 73, an 

eighth army corps. Corps identifi cation in this work 

conforms to modern usage, that is, referring 10 army 

corps as corps on ly. 

35. Millis, lvl(U"/i(i/ Spirit, PI'. 154-59. 

36. Although Guiteras is customa rily re ferred to 

as havi ng been a contrac t surgeon d uring the Spanish-American War, he is listed in the Register of General Officers amI Officers of th e General S/(Iff, u.s. \101-

wHec rs, March 1, 1899 , p. 13, as having been a m<ljor 

and brigade surgeon in the volun tee rs from 4 J une 

1898 to 15 July 1898. Pope, in his re pon in '\'VD, 

ARofSC, 1898, pp . .184-203 , re fers to him as "Ac ting Assl. Surg. John Guiteras. Ye llowwfeve r service 

at Siboney until j ul y 20" in the list ofph)'sicians on 

duty with the V Corps (p. 202) and as an acting as-
PREPARATIONS FOR CONQUESTS OVERSEAS 139 

siSlanl surgeon throughout the text. L'1Gardc, however, refe rs to Guileras as a major-spccincally, 

"Maj. John Guilcras, Surgeon , Unitcd Siaies Vol unlee rs" (ibid" pp. 213,216). The body oflhcsurgeon 

general's annual repon rders to him as Dr. Guileras 

(see, for example, ibid ., 1899. p. 145). 

37. WD, ARofse, 1898, PI'. 116, 184,200,238, 

and 1899, p. 56; V Arm}' Corps GO 1,2 May 1898, 

and SO 4, 5 May 1898, Mf Reel I , Shaft er Papers, 

SU; Dodge COllllllissioll Repol'l , 6:3040, 3042-43. 

38. V Arm}' Corps GO 7, 8 May 1898, ancl GO 

3,29 May 1898, Mf Reel 2, Shafter Papers, SU; WD, 

Allofse, 1898, PI'. 187-88,208; WD, sea, seo, p. 

5 l. 

39. WD, ARofse, 1898, PI'. 116, 186,200--20 1, 

and 1899, PI'. 39, 57; V Army Corps SO 2, 3 May 

1898, SO 6, 31 May 1898, and eo 14, 6Jun 1898, 

Mf Reels 1,2, and 3, Shafter Papers, SUo 

40. WD, ARofse, 1898, PI'. 188, 199; Wa r Depa rt ment , Co,./,cS/JOIJ(/cll ce Rehlling /0 ,lte War Witl] 

SI'(1i1l ... , 1:36; in Sha fter Papers, SU: Ur, Shaft er 

10 5W, 10 May L898, Mf Reel 2, and V Arm}' Corps 

SO 13, Mf Reel 3. 

4l. WD, IIRofse , 1898, PI'. 203--05. Ronald 

Ross' first arlic les on the role of the mosquito in Ihe 

lransmission of malaria appea red in late 1897 and 

in 1898. The British scientist also sent a ICller, dated 

24 Augusl 1898, to Surgeon General Stern be rg, 

whi ch comained furth er cvidence that lllosquilOs 

could spread malari a. After his arrival in Cuba in 

Dccember, U.s. Vo lun tce r surgco n Maj. J efferson R. 

Kca n recommendcd the use of mosqui to nets. This 

stcp led to a markcd reduction in Ihe number of 

cases of malaria. For a discussion of public hcalth 

efforts in Cuba , sce Chapter 9. See a lso R. A. Ward, 

"The lnnuencc of Rona ld Ross Upon Ihc Earl)' DCM 

vc\opment of Ma laria Vector Comrol Procedures ill 

the Unit ed Statcs Ann)/," pp. 207-09. 

42. Mi les, Serving, p. 275; Risch, Qluu·terll!{lster 

5"1'1'01" , PI'· 527,539,543; WD,lIRofse, 1898, PI'. 

189-90; George Kennan , C(lllll)(ligil ingill Cub{/, p. 48. 

43. Quotation from WD, ARojSG, 1898, p. 190; 

ibid., 1899, p. 56; Kennan , C{IIIII)(ligning, p. 5. 

44. Quotation frolll WD,lIRofse, 1898, p. 190; 

idem, ARojSW, 1898, J (pl.l }:9; Dodge COllllllissioll 

Report, J :586. 

45. Autobiography, Will iam R. Shafter, ch. VII, 

p. 5, Mf Reel 6, Shafte r Papers, SU; WD, IIRofse , 

1898, p. 190. 

46. lIr, McKay to Shaft er, 12 Nov 1898, Mf Reel 

6, Shafter Papers, SU; WD, ARofse, 1898, 1'1'. 109, 

187, 190-93,210; Dodge COllllllis5iol' Report , 1: 129, 

142, 188; Risch, Qllal"/enJlllSter Support , p. 550. 

47. Quolalioll frolll WD, Al/ofSe, 1898, p. 190; 

ibid., Pl'. 150, L9 1, 210- 11 ; Risch, Qual'lCTIII(Jster 

SlIpport, p. 548. 

48. WD, Al/ofSe, 1898, PI'. 150, 190-91, 

210-11 ; Risch, Qlla r/enll{/Sler SUPl'orl, p. 524; 

Henry Cabot Lodge, cd., Selections From I/le Con'eM 

spont/cllre oj Tllcoclore Roosevell and I-IelllY Cabol 

LII"g<, 1884- 1918,1:304--05; in Shafter Papm, SU: 

lIrs, Sha ft er to AG, 9 Jun 1898, EdwardJ. McClernand to AG , 11 Jun 1898, and Shafter to Ta),lor, L9 

J un 1898, Mf Reel), and Shafter Autobiograp hy, ch. 

VII, p. 5, Mf Reel 6. 

49. Q uota tion fro m 'NO, ARoJSG, 1898, p. 192; 

ibid ., pp. 107-09, 193, 1. 98,218; Dodge COlli mission 

Ilel'0r' ,6:2893. 

50. Quotations from 'N D, ARojSG, 1898, p. 192; 

Shafter Autobiograph)" ch. VII , p. 5, Mf RrcJ 6, 

Shafter Papers, SU; Hagedorn, \Vood, 1:58; Miles, 

Se rving, p. 276; Dodge CmJllllissioll ~cpO"I, 6:2893; 

Graham A. Cosmas, "San J uan Hill and EI Caney, 

1- 2 Jul), 1898," in AmcriClls Firsl lJall/es, 1776- M 

1965 , 1'.116. 

51. The Department of the Pacific was crea ted 

16 May 1898. See WD , ARofSlll, 1898, 1(1'1.2 ):497, 

and 1899, 1(1' 1. 2):39. 

52. David Trask, Thc Well" Wilh SP(lill, p. )86; 

WD, ARofse, 1899, p. /1 7. 

53. First q uotation from WD, ARoJSG, 1899, p. 

121 (sec also pp. 98-99, 120); second quotation 

from 'vY. F Southard, "O pen ing of the New Military 

Hospital at the Presidio,J ul y 9, 1899," p. 454; 'ND , 

Co,.rcspOII{!cIlCC, 2:734-35; idem, ARojSW, 1898, 

1(pt.2): L23; N. N. Frceman, A Soldi er ill Ihe Philil)M 

JJilles, p . 17; Charlcs R. Greenleaf. "An Object LeSM 

son in Mi li ta r), Sanitation," p. 485. 

54. Lt r, Elwel l S. Otis to SW, 17 Ma r 190) (first 

quotation), Henry lippincott Pape rs, En t I")' 561, RG 

94, NA RA ; WD, ARofse, 1898, p. 263, and 1899, 

pp. 98.121-22 (second quo tation), 126, L37; Dodge 

COllllllissioll Reporl, 2: 1202, L217. 

55. WD, ARofse, 1898, p. 263, and 1899, p. 127 

(quotation); WD, ARofSlV, 1898, 1(1'1.2): 123; 

Dodge COlllmission ReJJorl , 2: 1265; "Medical and 

Sanitary Histor)' of Troops in the Phi lippines," pp. 

826-27. 

56. WD,AllofSe, 1899, pp. 129,131 ;scealso pp. 

130, 132. 

57. Ibid., pp. lL 7, 122, 137 (quot ation); Trask, 

\-Var \Villi Spain, p. 386. 

58. Quol<Hion frolll Freeman, Soldier ill L/le 

Philil'I'i,,«, 1'.21; ibid. , p. 22; WD, Allofse, 1899, 

pp. 99, 124-26; \-VD, Correspolldence, 2:767; Frcd M 

crick Funston, l'v'elllories oJ Two Wars, p. L7 1;Joh n 
140 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

C. Brown, Di(//)' oj 1I Soldier ill til e Philippines, p. 14; 

Agnew, "Carromalos and Quinine," p. 15; Ri chard 

Johnson, "My life in the U.s. Army, 1899 (0 1922," 

pp. 13-14. SpanislH \mcrican \.var, Philippine Insurrectio n, and Boxe r Rebel lion Veterans Research 

Project, Military History Research Collection , U.s. 

Arm)' Mililar)1 History Institut.e, Carlisle Barracks, 

Pa. 

59. WD, ARojSG, 1898, p. 125 , and 1899, PI'. I I, 

138; idem, ARojSIV, 1898, Hpl.l ):7 and 1(1'1.2): 123; 

"Medica l and Sanilar}' HislOr)'," p. 826; \-VO, Ca rrespan(/cucc, 2:756; Dodge COllllllissiol1 Report , 2:1287. 
Chapter 6 

SUPPORTING THE INVASION FORCES 

Medical support for the campaign against 

the Spanish in both the Caribbean and the 

Pacific in the summer of 1898 was heavily 

innuenced by events that took place whi le 

V and Vlll Corps troops were still gathering 

in Floridaand California. The haste and confusion of Tampa haunted V Corps medical 

orncers confronting the challenges of operations in Cuba, and those with the units that 

invaded Puerto Rico after the Spanish surrender in Cuba also experienced frusLraLions 

engendered by inadequaLe plann ing. In Lhe 

Philippines, however, Vlll Co rps medical offi cers, relaLively unburdened by handicaps 

imposed in the UniLed StaLes, encountered 

few dirnculLies caring for the soldiers involved in whaL proved La be an easy campaign against a thorough ly demoralized foe. 

An armiSLice signed on 12 AugusL brough L 

all hOsLiliLies beLween Spain and the Un iLed 

SLates to a halt the next day, bUL in bOLh the 

Cari bbean and the Phili ppines disease 

proved to be a more persistent and relentless enemy Lhan the Spanish. ' 

In Cuba 

The active stage of the Cuban campaign 

(see Map 2) was very brier. General 

ShafLer's V Corps Lroops landed at Daiquiri 

on 22J une and took Siboney, a better port 

eight miles La the west, a few hours later. 

They then moved in land and to the north 

to Las Guasimas, where LWO days later they 

suffered 52 or more wo unded in defeati ng 

Spanish Lroops reL reati ng toward Santiago. 

Muc h of the Medical Department's supplies and eq uipmenL needed to care for 

these men was on the transports. A week 

later, when U.s. Lroops met the enemy at 

El Caney and San Juan Hill, medical personn el, working wiLhout much of the 

equipment Lhey needed, had LO care for as 

many as 1,200 wo unded , 932 from San 

Juan Hi ll. On 3 July the U.s. neet destroyed 

the Spanish squadron when iL aLLempLed 

to leave the harbor aL Santiago, removing 

bot h the need to ta ke Santiago and the need 

to defend it. Except for exchanges of artillery, machin e-gun, and riri e fire between 

troops entrenched around Santiago on the 

LenLh and eleventh , which produced 2 

more wounded for the V Corps, El Ca ney 

and San Juan Hill were the lasL engagemenLS of the war in Cuba. On th e fourLeenth the Span ish opened disc ussions 

LhaL led LO the official surrender of Santiago three days later, Lhus bringing all pretex t o f Spanish resistance in th e island to 

an end . By this point, the victims of disease rather than the wound ed had a lready 

become the focus of the department's aLtention and concern .

2 

The abandonment of initial plans for the 

invasion of Cuba, whi ch ca ll ed for a land-
~ . 

. , .. 

, 

o 

, 

, 

~ 0 , 
SUPPORTING THE INVASION FORCES 

ing near Havana, where rIat terrain and 

good roads wo uld have made moving supplies wilh the troops a simple malter, led 

to the landing at Daiquiri, seventeen miles 

east of Santiago, where steep cliffs lined the 

beaches and roads were almost nonex istent. Although u.S. soldiers-6,000 on the 

first day and 11,000 in the fo llowi ng two 

days- landed unopposed , the surf was so 

heavy that the V Corps chief surgeon, 

Colonel Pope, co nsidered it remarkable 

that only 2 died from drowning. Bringing 

Medica l Department supplies ashore 

proved almost impossible-not only because the surf was high but also because 

th e need for a multitude of small boa ts to 

unload the transports had been overlooked in th e haste and co nfusion that 

characterized the invasion. Moreover, 

since the weapons of war had priority over 

medical suppli es, Pope had no claimlO the 

single lighter that was the only transportation co nSistently ava ilable. Unable to 

move his division hospitals ashore, he 

pleaded in vain for small boa ts and crews 

to move the sick and wounded to the hospital shi p Olivette, where he had setup the 

2d Division hospitaL' 

Although it was of the utmost importance that division hospitals be landed and 

established asho re as soon as possibl e, 

frustration after frustration continued to 

greet attempts to do so. After the troops 

had disembarked, the masters of the transports positioned their vessels fi ve to fifteen 

miles offshore for fear of coming to grief 

on the rocky coast. The port of Siboney 

provided a landing beach nearer Santiago. 

Yet here, as at Daiquiri , sma ll boats we re 

rarely ava ilable to un load the transporls. 

In add ition, as many as 200 badly needed 

hospita l tents were at the bottom of one 

shi p's ho ld and inaccessible for many days 

until the rest of the cargo had been slowly 

143 

• 

BENJAM IN F POPE 

unloaded. Much still remained on board 

when U.S. troops bega n their march toward San tiago. Since Medical Department 

baggage wagons and mules had been left 

behind in the tu rmoil at Tampa, medi cal 

officers had to improvise shore transportation over a road that was sca rcely 

more than a rocky trail. Some used their 

own horses as pacl< animals, but asking 

hospital corpsmen to carry suppli es in litters proved of little use because an average 

of only two per regiment had been brought 

ashore. The few surgeo ns who had taken 

chests of medical supplies along found 

them impossible bu rdens and abandoned 

them early in the march, to be retrieved 

later by passing wagons· 

The situatio n had not significantly improved when U. S. troops encountered the 

retreating Spanish on 24 June, although 

Colonel Pope attempted despera tely to obLai n add itional suppl ies. His request for a 
144 THE ARMY MEDl CAL DEPARTMENT, 1865-1917 

.. 

AA RON H . ApPEL 

steam laun ch La enab le one of his omcers 

to pick them up from the vari ous transpon s produced onl y a rowboat. Permission to use this cra ft was soon withdrawn 

beca use it was needed elsewhere, and , 

since the sea was ca lm only in the mornings, attempts to reach the transports that 

day soo n ended. Pope did manage 10 boa rd 

the OliveLte and order it to Siboney, but 

wagons to move the mo re seriousl)l injured 

casualti es the four miles from the batllefi eld 10 the beach were dimcult to obta in . 

Until the U.s. Navy could be persuaded to 

lend craft La move them out to the Oli vette, 

th ey lay without blankets or pillows on the 

noo r of the only ava ilabl e shelter, "a very 

foul old shed. " Some of the wounded were 

taken on board th e hospital ship th e 

evening of th e twenty-fourth , and the remai nder were removed there before dawn 

the nex t day. By 3:00 A.M., after opera ting 

at fo ur tables und er electric lights, twelve 

surgeons-including Major Appel of the 

2e1 Division and his three assistants-had 

compl eted all surgery. Some of the sick on 

the Oli vette had by this time recovered, but 

with 128 pati ents on boa rd , among them 

40-50 wounded, she was nearing her capacity. As a result, with no tellls or supplies on shore, Pope looked anxiously for 

the appearance of the hospital ship Reli ef, 

which fina ll y arri ved on 8 July' 

Fo rtunately, each soldier a t Las Guasimas carried with him a nrslaid packet containing antiseptic dreSSings and steril e 

bandages, which had been distributed 

among the troo ps on the transports. Enab ling the men to dress wounds eve n before the arriva l of a physician lessened the 

chance of infecti on, whi ch, beca use smallca liber bullets did not produce massive tissue damage, was the principal concern . Although Army surgeons credited these 

packets, used for th e first time on 24 June, 

with a considerable saving of li ves, many 

soldiers discarded them as they were 

marching through the tropi ca l jungle after 

Las Guasi mas. 6 

Despite the "fi erce, scorching rays of the 

tropica l sun ," the hea lth of the men was 

still good-fewerthan 150 were sick. During the lull of several days in the fighting 

that foll owed Las Guasimas, Medical Department personnel were free to prepare to 

care for future patients. The transports 

were slowly un loaded. The Red Cross, apparently notified the momelll the V Corps 

embarked, sent a steamer ready 10 help 

with the wounded. It reached Siboney on 

26June, and on the twellly-seventh a supply of medicines arrived from Tampa and 

was distributed among regimen wI medical 

omcers. Major Wood brought the first fi eld 

hospital, his 1st Division facility, ashore 

and, after coll ecting available transportation, including fourLeen litters and sur-
SUPPORTI NG THE INVASION FORCES 

geons' horses, moved it to a deserted mansion. Because of th e low priority given 

medical equipment and th e poor co ndition 

of th e roads, his unit brieOy fun ctioned 

without beds or bedding. As Shafter's force 

adva nced towa rd Santiago, Major Wood 

moved his fa cility aga in , this time to a site 

where, because no building was available 

for shelter and tentage was inadequate, his 

newly obtained bedding became wet.' 

Removing the wo unded from El Caney 

and Sanjuan Hill to Major Wood's facility 

proved exceedingly difficult. The entire 

line of evacuation was subj ect to fire, either from the guns on the battlefi eld or 

from guerrillas who hid in trees along the 

route and killed a co ntract surgeon during 

the battle of San juan Hill. The litters 

needed to remove the wounded from the 

battl efield often had to be improvised from 

whatever materials were available, just as 

they had been during the Indian wars. The 

ambulance stati on- also referred to as the 

aid, dressing, or coll ecting station- to 

which the wounded were first taken had 

to be set up near the line of battle because 

the further back it was, the more vuln erabl e it became to spent bullets fired from as 

much as a mile away. Eac h regiment usually had its own station, but some units 

shared faciliti es. An intermediate station 

was occaSionally established where walking wounded co uld rest, and , if necessary, 

be placed in wagons, and where those on 

litters could stop to have dreSSings 

checked or tourniquets loosened" 

A shortage of ambulance wagons complicated the rest of the journey back to the 

fi eld hospital. Exactly how many were on 

hand by the time of the engagements on 1 

july is not clear. Colonel Pope mai ntained 

that only three ambulances were ever placed 

on board the transports and that these were 

used on ljuly. In his autobiography, how145 

MARSHALL W W OOD 

ever, General Shafter wrote that seventeen 

were in Cuba by this time, a number that, 

he believed, would have been adequate had 

not the total number of wounded been 

higher than he had anticipated. The drivers 

of these veh icles and the mules that pulled 

them soon began to fall ill, often too ill to 

work, thus further complicating evacuation. Because of the shortage of ambu lances, 

those available to the V Corps were posted 

near corps headquarters so that Pope, who 

considered them invaluable, could control 

their use personally.9 

General Shafter differed with Colonel 

Pope on the value of the ambulance, rationalizing that "on muddy roads [supply] 

wagons could be made as comfortable as 

ambulances for the wounded. " But a surgeon who saw the wou nded and sick from 

El Caney and Sanjuan Hill packed intowagons "in an apparently pitiless manner" to 

avoid the "indefinite waiting by the road-
146 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

G EORGE M CCREERY 

side" that wo uld have been necessary to 

move them by ambulance \-vas not so sanguine. He maintained that between the wagons and the "abominable co ndition of the 

roads, the unru ly state of drivers and mu les, 

and the great difficulty of obtaining means 

of preventing jars and jolLS , ... the 4 or 5 

miles of wheel ed transportation from the 

battlefields to the fi eld hospital cost the lives 

of not a few patients." 10 

The only compl ete fie ld hospital awaiting the wounded frol11 EI Caney and San 

Juan Hill was Major Wood's facility. Although the supply of tents, co ts, and bedding was inadeq uate, the operating rOOI11 

equipment, instruments, and suppl ies of 

the three land-based division hospitals 

were by th is point on shore and qui ckly 

readied for use. The rest of th e division hospital supplies and equipment was reaching 

shore very slo'wly, most regimental equipmenl and medicines wereslill on board the 

VALERY H AVA RD 

transports, and much of Majo r McCreery's 

Cavalry Division hospital was apparently 

never un loaded before the shi ps moved 

away from the shore. Major Havard , the 

Cavalry Di vision chief surgeon, appealed 

for help to the Red Cross, which responded 

generously under the direction of its 

fou nder, Clara Barton. Surgeo n General 

Sternberg thundered at "the military authority whi ch ordered and superin tended 

the embarkation at Tampa and whi ch directed the forward movement, although 

the disembarkation of the medica l stores 

and supplies was unaccomplished." 11 

u .S. soldiers were not the onl), wounded 

fo r whom U.s. med ical officers cared. 

From the outset, they had been assisting 

their Spanish counterparts until th e injured priso ners-of-war co uld be moved to 

hospitals in Siboney accessible to Red 

Cross personnel. After the battl es on 1J ul)', 

Barton, two Red Cross physicians, and 
SUPPORTI NG TH E INVASION FORCES 

other Red Cross representatives joined 

U.s. medical o rn cers in caring for 150 

wounded enemy soldi ers until they could 

be sent to a large Spanish hospital at EI 

Caney. On the fourth , however, wanting to 

encourage surrender by disproving rLtmars among Spanish troops that suggested 

U.s. savagery toward prisoners, Shafter ostentatiously sent a group of pati ent-prisoners from EI Caney to Santiago by ambulance, making "an excellent impression 

among the Spaniards." 12 

The ultimate destination of u.s. 

wounded aft er the battles at EI Caney and 

Sanjuan Hill was a base hospital that Major 

LaGarde had finall y been able to set up at 

Siboney, principally in the tents of his reserve division hospital. He used the furniture and furnish ings of nearby buildings to 

supplement the hospital's supplies and 

eq uipment, whic h had been brought 

ashore only after Pope had obtained a personal order from Shafter for a steam lighter 

to unload it. Fortunately, the facility was 

ready when the vehicles that had carried 

the medical supplies stored at LaGa rde's 

hospital to the front on 1 july began returning to Siboney laden with wounded. 

The most severely injured were the first to 

arrive, 2 among the initial7 requiring major 

amputations. Ano ther 1,000 nooded LaGarde's hospital when Major Wood attempted to clea r his faCility of patients so 

that he could follow the V Corps forwa rd 

after the battle. The growing number of casualties at Siboney in the wake of EI Caney 

and San juan Hill led Pope to begin considering the feasibility of using transports 

to return some sick and wounded to the 

United States. D 

For fi ve days after th e engagements at 

EI Caney and Sanjuan Hill , the staff at th e 

Siboney base hospital wo rked with littl e 

opportunity for rest, although most pa147 

ti ents required only th e redreSSing of th eir 

wounds. Doctors were prepared to care for 

a maximum of200 men, and although 200 

wounded apparently remained with the 

troops in their camp outside th e city of 

Santiago, tents co uld not be put up fast 

enough to shelter the 1,142 injured at Siboney, many of whom were "entirely 

naked. " Littl e in the way of "articles of light 

di et" was on hand, and the O/i vcLtc co uld 

not offer much help. The supplies brought 

in by the Relief were not enough, and Major 

LaGarde had 10 struggle to have even that 

much unloaded. Once again, the Red Cross 

came forward with the needed "delicacies," as well as wit h beds, bedding, and 

similar items. The Red Cross steamer stood 

by to provide further aid, and Red Cross 

nurses assisted in the operating rooms at 

Siboney, where four U.S. Navy surgeons, a 

surgeon from th e Swedish Navy, and the 

assistant surgeo n genera l of th e Cuban 

rebel army joined U.s. Army physicians. 

Surgical teams worked at fi ve to six tables, 

their members rota ting to replace those 

who became too exhausted to co ntinueH 

Hostilities did not orncially end for another sixteen days, but when the guns fell 

silent at EI Caney and San juan Hill, almost 80 percent of the total of less than 

1,500 U.s. soldi ers wounded in the Spanish-American War in Cuba had already 

bee n injured. Some of th ese casua lties required major surgery, which was most 

often accomplished in fi eld hospital operating rooms; but, according to LaGarde, 

the damage done by "the portable hand 

weapons of to-day" was such that for the 

most part "the subj ect of military surgery 

Iwas reduced I to first-aid work. " The 

Mauser used by th e Spanish so impressed 

one medical officer that he ca ll ed its ammunition "a humane bullet in every sense 

of the word." Si nce most of the wounds 
148 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

had been innicted at a sufficielll distance 

to avoid "th e explosive effects" that resulted from the use of this type of weapon 

at close range, wounds hea led rapidly and 

fractures were few. The sterilization of instruments and the washi ng of surgeo ns' 

hands in antisepti cs prevellled hospital 

gangrene and many other forms of infection that had haunted th e milital")' hospitals of the Civil War. With a co nserva tive 

approach to surgery now feasibl e, amputations were rare. Although some patielits 

with abdominal wo unds di ed following laparotomy (surgery that involves opening 

the abdomen), others whose wounds suggested that their intestin es must have been 

repeatedly pi erced nevertheless recovered 

uneventfully without surgery. I' 

In its annual report for 1898 the War 

Department proudly noted that of 1,431 

regulars and volunteers who were 

wounded in the Santiago campaign, only 

13, less than 1 perce nt, died of their injuries. The statistics cited , however, are 

cOlllradi cto ry. The preceding figure is apparently far too low. One of the reports estimated that among approximately 1,000 

wo unded sheltered in one hospital in 

Cuba , th e mortality was 7 percent, or 

roughly 70. Elsewhere, th e War Department listed for the entire Spanish-America n War a total of only 65 men, regulars 

and volunteers, dying of wo unds from 1 

May through 30 September 1898. Of these, 

8 wound fatalities occurred as a result of 

action in the Philippines, where approximately 106 regulars and volunteers were 

injured in combat, a deaths-from-wounds 

figure of more than 7 percent. Anothe r 40 

were wounded, most of them only slightl y, 

in Puerto Rico, and thus, presumably, the 

number dying from their injuries was low. 

The surgeon general's totals suggest that 

for the calendar year 1898, 1,320 regulars 

were injured by guns in battle, wheth er in 

the Caribbean or in the Philippines, and 

that of 1,457 regulars wounded by gunshot 

under all circumstances in that period, 88, 

or 6 percent, later died as a result of injuries received in battle. Given th e distribution of the total number of casualties, it 

is highl y likely that most of the 89 regulars who di ed of wounds during the year 

died during the Cuban campaign, thus 

again bringing the fi gure above 13 even 

without counling volunteer casualties .16 

Among the lessons medical offi cers 

learned whil e ca ring for those injured in 

June and July was that too early or too frequent changing of dressings co uld lead to 

unnecessary infection. Furthermore, as 

long as the wound could be kept reaso nably cl ea n, surgery could wa it until the patielll had been moved to a permanent hospital. The need for a bener method of 

identifying casualti es was also revealed in 

this conni ct, since many of those who died 

were unidentified , with diagnosis tags either not used or, on the rare occasions 

when they were used, obliterated partially 

or entirely by rain. One surgeo n suggested 

that a small metal tag be adopted, to be 

hung around each soldier's neck. Some 

medi ca l offi cers discovered that X-ray pictures eliminated the need for extensive 

probing to locate bullets that had become 

lodged in th e body and thereby lessened 

the chances of infecti on. But X-rays, discovered in 1895 by Wil helm C. Roentgen, 

were still so new during theSpanish-American War that many surgeons did not understand their potential, and X-ray equipment was available onl y on two Army 

hospital ships and in general hospitals 

back in the United StatesH 

By the time peace offi cially arri ved in 

Cuba, the men of the V Corps had already 

begun to discover that their most danger-
SUPPORTING THE INVASION FORCES 

ous enemy was not th e Spanish, and medical officers soon realized that their greatest 

struggle would not be against wounds and 

infection. Most of the necessary surgery had 

been performed, and wounds were beginning to heal when Army physicians found 

themselves struggling against disease that 

was running out of control , "a thousand 

times harder to stand up against than the 

missiles of the enemy," according to Shafter. 

It spared neither officers nor men, neither 

civilians nor soldiers. Even the general himself was briefly sick because of what he believed to be sunstroke, causing considerable 

anxiety for his superiors. His offi cers were 

soon falling by the wayside; he later recalled 

that eventually "all the general officers were 

ailing, more or less. " Civilian employees of 

the Army also began to fall ill in increasing 

numbers, and if sick teamsters could not be 

replaced, the Army was in danger of losing 

the use of five to ten wagons a day. The sick 

rate was also high among the enemy-as 

many as a fourth or more of the Spanish 

force might be hospitalized at anyone time, 

a figure that reached 2,600 by 2 August. 

Colonel Senn, of the U.s. Volu nteers, now 

at the Siboney base hospital as chief surgeon 

of the operating staff, learned from a Spanish surgeo n that in his army "many were 

sick and no one well ." IS 

In the V Corps the esca lating rate of disease alarmed Lt. Col. Theodore Roosevelt 

as ea rly as 12 July, a day after th e last U.s. 

soldi er fell victim to Spanish guns. He informed Shafter that only 350 of the 600 offi cers and men among his Rough Riders 

were fit forduty.'9 Almost half his men who 

had survived battle had already bee n laid 

low by wo unds, fever, dysentery, and heat, 

and their living conditions in Cuba were 

causing an almost continuous deteriorati on in th eir hea lth . The V Corps lacked 

both adequate shelter and clothing, and 

149 

rain fell every night and almost every day. 

Temperatures might flu ctuate from 120 

degrees in the shade by day to th e 60s once 

the sun had set. While maintaining that he 

was personally "as strong as a bull moose," 

Roosevelt noted that his men were suffering from the sun, the rain, the poor drinkingwater, and the "lack of plai n food. " Men 

became so thirsty that even a surgeo n confessed that, having consumed all th e boiled 

waler in his canteen, he, too , drank from 

a puddle that he knew might be infec ted'O 

The start of negotiations with the Spanish on 13 July brought no respite from the 

onslaught of disease. By the twenty-second 

75 percent of the civilian teamsters and 

packers working for theAnny were ailingdoctors and a hospital were needed for sick 

civilians, whether Army employees or 

Cuban victims of the hostilities and the 

siege, who had no hospital to which they 

could go. General Shafter stated the fo llowing day that 1,500 soldiers were sick with 

fever, an estimated 10 percent of them with 

yellow fever. Although deaths were few, by 

1 August Shafter was ready to admit that his 

"command [wasl in no condition for active 

service at present. " Four days later, Roosevelt reported that no more than 100 of his 

men were "fit for any hard work" and that 

150 were probably too weak to wal k any distance even without their packs. Since they 

had only one-third of the transportation 

they should have, they could not move from 

the site, despite its unhealthiness. Some 

tents and camp equipment were now coming in, and the delivelY of canned tomatoes 

had reduced the threat of scurvy, but anxiety over the fate of the V Co rps should it remain in Cuba continued to grow." 

Physicians were fa lling victim to the diseases they fough t, as many as 15 percent 

being disabled at one time. U.s. Vo lun teer 

surgeon Maj. Victor C. Vaughan, who had 
150 TH E ARMY MEDICAL DEPARTM ENT, 1865-1917 

already earned an enviable reputati on in 

the fi eld of public health, fell ill with yellow fever on l2]ul)'. Major McCreery died 

of dysentery on the transport that was taking him home to co nvalesce from yellow 

fever, and by the twenty-seco nd Colonel 

Po pe himself was very ill-"l have almost 

constant venigo," he wrote, and "am unable to think, to plan, o r to reco ll ecl. " Although he remained with the V Co rps until 

it left Cuba, he was reli eved th e next day 

at his own request and replaced by Major 

Hava rd. Both Major LaGa rd e and Maj. 

William C. Gorgas, who bri eny succeeded 

the popular LaGarde in charge of the base 

hospital at Siboney, also fell ill. LaGarde, 

who a pparently had malaria, had to retu rn 

to the United States before the end of August, and Go rgas, a victim of typhOid , followed him in September. Liulesuccess met 

desperate allemp ts to locate physicians 

serving in the V Corps in a nonmedi ca l capacity who might be willing to sign on as 

co ntract surgeons to fill the vacan cies that 

were occurring. But since the number of 

ph ysicians in Cuba who were at least tempora ril y unabl e to perform their duties 

grew, the number of patients also rose, and 

the struggle to provide adequate care for 

the sick was co nstanl. Alth ough Sternberg 

sent more physicians to Cuba, keeping an 

adequate number o f doctors on duty rema ined difficult, and as late as 10 August 

General Shafter was still requesting th at 

twenty more physicians, preferably medica l offi cers, be sent to CubaH 

The number of men in the hospital at 

an yone time did not accu rately renecl the 

enormity of the problem, for those who 

were in the camps were generally weak and 

ex hausted. Whi le the number of those 

with fever who relltrned to duty often 

equaled or exceeded th e number of those 

newly ami cted and whi le the total hospitalized was falling after 2 August,the dea th 

rate continued to increase at a friglllening 

pace, from a monthl y rate of 0.21 per 1,000 

among the regu lars in May 1898 to 1.81 

per 1,000 in]uly, peaking at 6. 14 per 1,000 

in Augusl. The debilitation of the entire V 

Corps had a disastrous effect upon morale 

and military effecti veness, which deteriorated still further because of the fear thal 

a devastating yell ow fever epidemic might 

be yet to come." 

Several diseases contributed to the enfeeblement of the men of the V Corps atth is 

lime, but the most dangerous was malaria, 

which, because of the habits of the Anopheles mosquito, was a particularly great threat 

to the men camped outside Santiago during 

and after the Siege of that town . To Roosevelt'ssurprise, malaria affected black units 

as much as itdid white. An estimated 75 percent or more of the soldiers suffered from 

some form of the disease, but the most common was apparently faki parum. Although 

the fever usually lasted only [our to six days, 

it left its victims lOa weak to return to dUly 

Fortunately, quinine was in sufficielll supply by this POi lll, for it was widely used , even 

for cases of diarrhea, which were often 

blamed on malaria and were, therefore, often 

trealed with large amounts of quinine, usually administered by rectum. The way in 

which malaria was communicated [ro m one 

man to another had just been established, 

and many Army surgeons still believed that 

the infection was acquired through water 

that carried the plasmodium. Thus when the 

malaria rate continued to rise even after the 

men were ordered to boil their drink ing 

water, doctors assumed that the order had 

not been obeyed." 

Typhoid , too, was soon exacting a 

higher death toll in th e debilita ted V Corps 

than among the units that remained in the 

United States, and diarrhea and dysentery 
SU PPORTI NG THE INVASION FORCES 

were becom ing more COl11mo n as lime 

passed. Despite all efforLs to keep drinking 

waLer pure , sources might be polluted by 

men , by ani mals, and by laundry washed 

in streams. BOiling large amounts of wale r 

was rendered dimcult by the delayed arrival in Cuba of the necessary cauldrons 

and a shon age o f fu el for fi res. "Ephemera l 

fever," which did not respo nd to quinine 

and might have been either typhoid or 

dengue, and other fevers added to the miseries the men \",ere enduring, since they 

were widespread and debilitati ng, in volving a lengthy convalescence. None of the 

V Corps' man y hea lth problems involved 

the much publicized so-called embalmed 

beer. The meat was often unappetizing and 

sometimes had been so long unrdrigerated 

as to be inedibl e, but investigation fail ed 

to SUppOrL charges that any that had been 

preserved with harmful chemica ls had 

been fed to th e troops" 

Malaria and typhoid posed the greaLest 

threa ts to th e V Corps, but the most 

dreaded disease during the Caribbea n 

campaign was yellow fever. Because of the 

sociable nature of th e Aedes aegypti mosquito, this disease was more C0l11 111 0 n in 

towns and c ities than in the countryside 

and therdore a greater threa t to an OCCllp),jng army than to a force encamped outside its walls. The mere thought of yellow 

fever inspired a growing panic that was fed 

by uncerLai nty both about diagnosis and 

about the means of transmission. Distinguishing between malaria, typhoid, and 

yell ow fever was d imcult when neither adequate laboraLory equipment nor ph ysicians trained to make the distinction were 

present in Cuba . The role of the mosqu ito, 

only recently recognized as a possible ca rrier o f d isease, in sp reading yellow fever 

was unknown. To physicians unaware of 

the imporLance o f the Aedes aegypti mos151 

FRA NCIS J. IVES 

qui to, yell ow feve r infection seemed to 

lurk everywhere, in buildings taken from 

the Cubans and "in the shady nooks about 

rocky recesses, caves, arbors, etc." The 

customary approach La preventing disease, 

keeping camps clean and water sources 

unpolluted, proved to be as ineffective 

aga inst yel low fever as that against malaria. 

Under such circumstances, constant preoccupation with yellow fever and the CO I1 -

viction that an epidemiC was inevitable 

made both misdiagnosis and pani c easy.26 

As some suspected at the time, the panic 

abo ut yellow fever was notjustifieci. Stern -

berg later co ncludeci that many men supposedly ill with yellow fever were actuall y 

sufferi ng from wha t was then called aestivo-a uLUmna l ma laria , the form caused by 

th e falciparum parasite. U.s. Volunteer 

surgeon Maj. Francis]. Ives, chid surgeon 

of an independent brigade (also ca ll ed a 

provisional division) that had been formed 
152 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

of two infantry regiments and one unit of 

cavalry, co ncluded that the fear of Army 

surgeons in the fi eld only made matters 

wo rse. He beli eved that they frequently 

misdiagnosed cases, hospitalizing men 

who did not have yellow fever with those 

who did , thereby contributing, as he 

thought, to spreading the disease. "The 

majority of these experts we re completely 

stampeded, and were calling everything 

yell ow fever," he reported to Sternberg. " 

As disease rates mounted and reports of 

yellow fever cases inspired dread in those 

who heard them, greater attention was devoted to means by which all disease might 

be prevented. The long- held belief that yellow fever was somehow related to contamination of the campsite had led to an approach to preventing its spread that was 

often successfu l- night. Some authorities 

recommended that those diagnosed as 

hav ing yellow fever be hospitalized and 

that the rest of their unit advance two miles 

and reestablish camp. Once Santiago had 

surrendered, Genera l Shafter held a conference of his general officers and division 

chief surgeons to discuss an idea favored 

by Surgeo n General Sternberg, that of reloca ting the entire V Co rps from the area 

where yell ow fever was endemi c. At a 

higher altitude, if well cared for, the ailing 

troops might be restored to health. But in 

the moun tains of Cuba no roads existed 

over whi ch suppli es could be moved, 

water sources were inadequate, and heavy 

rains turned mountain plateaus into quagmires where malaria reigned supreme. 

Shafter decided that "Dr. Sternberg'S idea 

of going 700'-800' above sea level" was 

"all fo l-der-rol, as you will see if his advice 

is foll owed." Changes of camp were difficult for all concerned , including medical 

offi cers who had to uproot hospitals and 

t~ ir many patients, and the sick rate apparently rose marked ly with each move 

that was tried. The notion was finally abandoned as not feasible because the stress of 

repeated moves further lowered the resistance of th e men to disease.'8 

By the second week inJuly th e common 

assumpti on was that a yellow fever epidemic was taking possession of Siboney, 

where hundreds of wo unded, sick, and 

hea lthy nonimmune U.S. soldiers were 

gathered, a tempting smorgasbord to the 

city-IovingAedes aegypti . The first case was 

not diagnosed until the sixth, but panic 

was quick to set in. No more victims of 

Spanish weapons were being brought in to 

hospitals, but yellow fever had reportedly 

struck down 38 men in the town by the 

twelfth, when the commanding general of 

the Army and his chief surgeon arrived in 

Cuba. General Miles estimated at this time 

that 100 men had been stricken throughout th e island . The spread was blamed on 

troops who, against orders, entered buildings believed to be infected. An attempt 

was made to keep wo rd of the incipient 

epidemic secret, but when Colonel Greenleaf, who was responsible for the hea lth of 

the invasion forces, was informed of the 

outbreak, he immediately laun ched an investigation into its origins. He also initiated an aggressive effort to improve sanitation and to exclude all Cuban and 

Spanish refugees from th e city. Even after 

a Regular Army surgeon was made town 

administrator, these steps apparently had 

small effect upon V Co rps disease rates at 

Siboney. In his frustration Colonel Senn, 

who for a time assisted "in the wo rk of purificati on," blamed th e failure of sa nitary 

improvements to reduce disease levels on 

a lack of cooperation on Shafter's part.'· 

Drastic steps were clearly called for. At 

the recommendation of Guiteras, who appears many times playing an advisory role 
SUPPORTING THE INVASION FORCES 153 

TH E BURNING OF SmONEY. III Ca r/toll T Chapmall's drawing, the bUnIillg of th e f everillfected bllildi'lgs is depicted fro ll1 the wate,; witll the hospital ship Relief alld a storeship in th e foregroulld. 

to u.s. troops in the Caribbean, and with 

the encouragement of Miles, th e ultimate 

solution to the problem became obviousthe town must be burned down. Au thorities believed that the source of the infection 

thus would be destroyed and the ground 

sterilized. Major LaGarde fa vored this radical step, even though he considered typhoid a greater danger than yellow fever, 

which was proving to be generally mild with 

a short recovelY period. Following the prevailing line of reaso ning, Siboney was emptied of its inhabitants and, beginning 11 

July, each building was burned to the 

ground when it became vacant.30 

Attempts at preventing disease, no matter how drastic, proved clearly ineffective. 

On 21JulyGeneral Shafter reported that the 

number of fever cases in Santiago was increasing rapid ly, but he added that observers 

disagreed about how many were yellow 

fever. A day later he recorded 214 more cases 

of various kinds of fever. On the twentythird he noted a total of about 1,500 victims 

throughout the V Corps, about 10 percent 

of whom supposedly had yell ow fever. New 

cases of fever continued to develop as the 

month wore on. One estimate suggested that 

as many as 1,300 to 1,400 in the Siboney 

area alone eventually caught yellow fever in 

spite of the burning of the city, and that about 

15 percent died as a result. A physician commented that the incidence of yellow fever 

was no higher because it was a disease of the 

cities and the men were generally stationed 

about the countryside." 

Obviously the esca lati ng disease rates 

were placing an increasingly heavy burden 

on V Corps hospitals and their personn el. 

With ambulances to 1110ve the sick back to 
154 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

the base hospital at Siboney hard to find , 

regimental surgeo ns and their facilities 

were overwhelmed soon after EI Ca ney 

and San Juan Hill by th e ever-growing 

number of patients, some of whom at one 

point had to be left on the ground without 

adequate shelter. Recogni zing that he 

might be inundated with casualties if th e 

V Corps and the reinforcements then arriving from the United States with Miles 

should conduct a direct assault on Santiago, Major LaGarde cleared his hospital of 

most of its wounded by 11 July, sending a 

few back to duty and shipping the remainder north. He then turned an additional twenty-bed facility that he established for the wo und ed in a small cottage 

over to the Red Cross. Wishing to isolate 

those with co ntagious diseases, heset aside 

a railroad shed and tents for their exclusive use. He assigned a larger COllage to 

those with fever (most of whom probabl y 

had malaria) and placed Guiteras, who was 

continuing to serve as the command's expert on tropi ca l diseases, in charge. Still 

more sick were cared fo r with the wounded 

in a hospital that Major Havard had improvised in an old sto re. The care of these 

80 patients and the hospital itself were 

turned ove r to LaGard e when Hava rd and 

the Cavalry Division moved [o rward. 32 

Fo r Major LaGarde and the medical 

team at Siboney, the rea l trial began on 6 

July, when the first case of yellow fever was 

diagnosed. The entire staff of the Red Cross 

cottage soo n came down with the disease, 

even though those whom Guiteras questioned on the matter said the building had 

not been co ntaminated by yellow fever. It 

was burned nevertheless, and the ailing 

staff members joined other yellow fever 

cases, who were isolated in tents, where by 

the tenth LaGarde had fourteen patientsnine soldiers, ri ve civilians. The number of 

yellow fever patients mounted in spite of 

th e destruction of "this dirty little town. " 

He found that having "room to extend our 

canvas hospital" did not cure the problem 

of find ing enough hospital space, even 

though in anticipation of the possibility of 

an all-out assault on Santiago, all tents at 

Siboney and 200 from Daiquiri had been 

sent fo r his use by the thirteenth." 

Although most cases of yellow fever 

proved to be mild , on 19 July, with further 

confro ntation with the Spanish no longer 

a possibility, Colonel Pope reported to 

General Shafter that half the V Corps sick 

lacked shelter and he needed 1,000 more 

beds. In Siboney Major LaGarde was by 

this point both discouraged and exhausted . Colonel Greenleaf had put Major 

Gorgas in charge of the yellow fever hospital that LaGarde had set up, which seemingly freed Guiteras to resume his original 

role as co nsultant on tropical diseases, but 

LaGarde's responsibilities were still growing. His facilities were overnowing, three 

of his surgeo ns were ill , and the V Corps 

had left him no vehicles for transporting 

supplies. A move to set up a "yellow-fever 

noa ting hospital" at Siboney was ap parentl y abandoned. On the twentieth, concluding that everyo ne had been exposed to 

yellow feve r by that point, LaGarde in desperation threw open the entire tent hospital atSiboney to yellow fever victims, making no attempt to isolate them beyo nd 

giving them their own wards." 

At some time, presumably shortly after 

Colonel Greenlea f's arrival in Cuba on 12 

Jul y but before the surrender, a detention 

camp where suspicious cases could be isolated was set up near V Corps headquarters just outside Santiago on the road to Siboney.3S Soon th ereafter a yell ow fever 

hospital was established not fa r from the 

detention faCility and a contract surgeo n 
SUPPORTING THE INVASION FORCES 

assigned the responsibility [or identifying 

cases to be sent to it. Both the camp and 

the hospital we re placed under Major Ives 

on 2lJuly. Between them th e two [aciliti es 

held an average o[ about 115 pati ents. Both 

were "broken up and transferred to Siboney" sometime near the end of July.36 

Fortunately, on 17 July, the surrender of 

Santiago made it possibl e to open hospitals in that city. Regimental tents had at last 

been un loaded from all the transports, and 

with she lter available in quantity, accommodations co uld easily be made for as 

many patients as needed them. Each regiment was given four tents for pati ents who 

were onl y slightly sick. Each di vision set 

up its own hospital [o r those more seriously ill in the Santiago area. These [aciliti es were soon well equipped with such 

items as steam sterilizers, water heaters, 

bath lLtbs, and steel operating room tab les. 

A 300-bed genera l fi eld hospital was established on a hill in a central location to 

house th e overnow [rom di vision hospita ls, and a separate building was set aside 

for sick orn cers." 

A third yellow fever hospita l was established with 150 beds at the beginning o[ 

August "across the bay [rom Sa ntiago" to 

house all !lev" yellow fever patients 

throughout the V Corps, mak ing it possible to gradually close the Siboney [acility. 

It was relatively isolated, and by continuing the poli cy of diSinfecting the ambulances and wago ns used to transport yellow [ever victims, authorities hoped to 

prevent further spread o[ th e disease. Even 

though yellow [ever had apparently been 

raging in the city before the surrender, only 

61 cases were taken to this [acility in Jul y 

and August. O[the U.s. soldi ers stricken in 

the city before the epidemic end ed, 29 di ed, 

among th em the hospital's pathologist.38 

155 

On 9 August Secretary of War Alger decided that th e immediate establishment o[ 

a large general hospita l in Santiago was "of 

the utmost importance" and promised to 

send as many nurses to stafr it as General 

Shafter CClnsidered necessary. Since littl e 

lumber and no carpenters were availabl e in 

Cuba , he had to request that both be sent 

'rom the United States to create the faCility 

Alger had in mind. But the corps commander informed the secretary on the tenth that 

a new plant was not nccessal)' because a 

large hospital capable of holding 2,000 beds 

had already been set up in tents and 

eqUipped with modern kitchen equipment, 

a sterilizer, and isolation wards. This facility, presumably an expanded version of the 

general field hospita l, was, Major Wood 

maintained, "one of the best in the world." ~ 

Finding hospital beds at Siboney and 

Santiago proved in the end to be easierthan 

finding competent personnel. Hospital 

corpsmen, always inadequate in number, 

were needed in the fi eld. Voluntee rs who 

were left behind to serve as hospital guards 

attempted to assist in nursing chores, but 

few had had any tra ining, and because they 

had other duties, th ey were not always present when most wanted. The fear or yellow [ever exacerbated other dirnculti es. 

On at least one occasion at Siboney, where 

the problem was apparently most acute, 

the starr assigned to work during th e day 

had to remain on duty around the clock. 

After his Jul y arri val in Cuba, Colonel 

Greenlea[ pointed out to the V Corps adjutant general that 500 hospital attendants, 100 nurses immune to yellow [ever, 

and a large number or immune doctors 

were urgently needed. On the fifteenth 

Genera l Sha fter initially refused to grant 

Greenl eaf's pleas for the assignment of 

more men on a permanent basis to the hospital because he did not wa nt to expose 
156 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

those at the front to yell ow fever and because their services we re vilal where they 

were. Greenleaf immediately appealed to 

General Miles, and that very same day, presumably after Miles required him to do so, 

Shafter ordered the 24th Infantry, a regiment of black regulars, to help Major LaGarde at Siboney by performing guard 

duty, police, and nursing chores. Because 

of "the discipline of these seasoned 

troops, " many of whom volunteered to 

care [or yellow fever patients despite the 

danger this se rvice appeared to pose to 

their own health , LaGarde noted that "for 

the first time in the history of Siboney, 

order loomed out of chaos." 40 

Obtaining personnel [or duties that 

would involve possible exposure to yellow 

fever remained difficult throughout the 

summer. Cuban nurses soon "proved to be 

worth less" and were discharged. Immune 

or supposedly immune nurses, many black 

and female, "a hardy lot offemale nursesI do not mean lady nurses, " as Colonel 

Pope put it, came in from the United States 

and were considered invaluable. Although 

none of these nurses contracted yell ow 

fever, 2 of the supposedly immune physicians who came in with them in late July 

did. The first of about 2,000 men from two 

immune black egim nt s, the 2d and 3d 

Infantry, U.s. Volunteers, ordered to Santiago by Sec retary o f War Alger in mid-July 

to care for the sick in that city, arrived in 

Cuba a month later. Unlike the men of the 

24th Infantry, these soldi ers, as General 

Shafter reported after a few weeks, were 

"undisciplined , insubordinate and vicious. Are not controll ed by their offi cers, 

terrorize the community by violent acts 

and cannot be relied upon for any duty." 

Female nurses proved to be "in every respect superior to males in all division and 

general hospitals," acco rding to Maj or 

Ives, who achnitted that he had initi ally opposed their empl oyment in Cuba 4 ' 

A continuing shortage of supplies added 

still further to the difficulties being experienced by medical offi cers in Cuba . Ives 

blamed the problem on "vital defects in the 

supply department of the Army," although 

he also thought that some reports exaggerated the severity of the problem. Ships were 

still not carefull y loaded; when cargo was 

removed rrom two vessels arriving at Puerto 

Rico in late July, some items destined for 

Cuba were discovered. Delays in un loading 

in Cuban harbors also continued to contribute to supply problems. Fortunately, 

quinine, the most vitally needed medicine, 

was apparently never in short supply4' 

With adequate hospital s pace initially 

hard to find in Cuba , competent attendants 

to care for the sick rarely available, and 

supply probl ems unrelenting, the difficulties experienced at the V Corps' diseasecrowded fa cilities would have been even 

greater had it not been for hospital and 

transport s hips. These ve~se s were credited by Colonel Senn with th e saving of 

"hundreds of lives which , without s uch 

means of trans port, wo uld have perished 

in Cuba and Porto Rico. " Some of these 

sh ips evacuated wounded and co nvalescents to the United States, while a few others served as floating hospitals offshore 

and made periodic trips to move their patients back home43 

The Army's first such vessel in the 

Caribbean, the Olivette, had started her career without much planning. At the time of 

the invasion she took on the sick from the 

transports, who were later transferred to 

the steamer lJ"oquois to make room for the 

wounded. The retention of the 2d Di vision's hospital on board the Oli vette caused 

her to assume th e character of a permanent 

hospital s hip. She was soon full to capac-
SUPPORTI NG THE INVASION FORCES 

ity, and Shafter requested and received the 

help of a Navy hospital shi p, the Solace, 

while a third ship was ap parently later stati oned in Santiago Bay LO accommodate 

sick orfi cers and noncommissioned omce rs. On 9J uly, with hospitals in Cuba overnowing with the wounded of EI Caney and 

San Juan Hill and the disease rates climbing, the Olivette left Santiago with 279 

wounded , arri ving in New York Citya week 

later. She returned LO Cuba with medical 

suppli es and immune nurses and physicians shortly therea fterH 

By this point, the Reliefhad arrived in the 

Ca ribbean. Weeks had been consumed in 

co nverting her in to a hospital ship for the 

Army, and she was superbly equipped. Her 

ice-man ufacturing plant could produce two 

LO ns a day, her distill ery 1,500 gallons of 

water. She carried 360 beds, 750 fi eld cots, 

650 extra mattresses, an X-ray machine, 

medical supplies, and two immune physicians for the Sibo ney yellow fever hospital. 

She was ordered to stay close to the scene 

of military operations and to send the less 

seriously sick and inj ured to th e Solace, 

whence they would be shipped home if they 

were not in condition to be quickly restored 

to duty After twelve days in port, the Relief 

sailed for New York with 254 wounded. 

After her return to the Caribbean, she was 

sent to support the troops who had invaded 

Puerto Rico, and only transports were lert 

to move the sick and wo unded from Cuba 

to th e United States. One more hospital 

ship, the Missouri , put at the disposa l of th e 

Army on I July, was not ready for service 

until the end of August'S 

Because of th e shortage of hospital ships, 

sending sick and wounded patients north 

was a complex matter invo lving cOI}fusion 

and ultimately scandal. The use of transports was considered as early as 25 June, 

after Las Guasimas, and on 4 July, in the 

157 

wake of EI Caney and San Juan Hill , Brig. 

Gen. Henry C. Corbin , th e adjutant general, 

authorized Shafter to employ for this purpose any ships he fo und suitable. Shafter 

had already sent one transport north with 

300 wounded on 3 July, and a second set 

sail with 325 wounded on the fifth. Hospital ships were reserved [or the seriously ill 

and wounded, and transpons were neither 

deSigned nor staffed to handle patients who 

came on board in marginal condition or 

who fell i II on the way Patients eager to retu rn home sometimes sneaked 0 11 board , 

only to collapse once under way'6 

Sin ce the importation of yell ow fever 

into the United States was very much 

feared, a medica l board checked over all 

evacuees to exclude from shi ps relllrning 

to the United States all those even suspected of having yell ow fever. Co rb in ordered that at Santiago and, if possible, at 

every other important port, a ship be set 

aside where those abou t to return to the 

United States could be quaran ti ned while 

they were observed for signs of yellow fever 

and their possessions disinfected. A doctor 

from either the Army or the Marine Hospital Service was aSSigned to certify that all 

passengers \-ve re free o f infection; to supervise sanitation , including the quality of 

drinking waleI' taken on; and to guarantee 

thal 11 0 transport crews went on shore, 

where they might become infected. Asearly 

as 22 May 1898 Marine Hospital Service 

doctors were also authorized to stop and 

inspect all vessels arriving at U.s. pons, to 

fum igate them if necessary, and to detain 

any passengers who might be carrying disease. In addition, Marine Hospital Service 

physicians sometimes helped with patient 

care on board the transports, a responsibility usually borne by Army doctors H 

Preparing transports to carry convalescents from Cuba presented an even greater 
158 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

L OUIS A. LAG ARDE 

challenge than preparing them to carry 

healthy troops to the island. Despite all precautions, vessels taking men from Cuba 

often lacked supplies for the sick and carried drinking water that, because of a long 

period of storage, was repulsive to both smell 

and taste. As a result of the shortage of medical offi cers, adequate medical care was hard 

to obtain. Attempts to modify these vessels 

by removing partitions to improve ventilation , to set up mess and laundry facilities, 

and to load needed supplies apparently 

aroused hostility on the parLof captains and 

crews. Despite the difficulties, sanitation on 

these transports was regarded by the Medical Department as "fairly good."'· 

No scanda ls developed concerning conditions on these vessels until mid-July 

brought what Colonel Pope called "the 

Selleca and COllclio incidents." Pope, ill because of sunstroke when the Selleca left 

Cuba on the fourteenth, was "therefore UI1-

equal to the duties and responsibilities 

which devolved upon him." Major L,Garde, 

in his eagerness to have his facilityatSiboney 

ready to take on more wounded should fu rther hostilities place a premium on hospital 

beds, had loaded eighty-fi ve patients on the 

Sweca three days earlier. On board both the 

Selleca and the COIICI1 0, the bad water and 

lack of supplies became a cause celebre. Secretary of War Alger, obviously angry, asked 

General Shafter why these transports had arrived in the United States "without attendance and medicine. "-+9 

Excuses and explanations for the situation on the Seneca and the COll cho were 

many and co ntradictory. The Sell eca's captain later maintained that he had told authorities that his ship was not prepared to 

carry the sick and that he had been ignored. After a water shortage was also reported on these ships, LaGarde insisted 

that the ir captains did not indicate a need 

for water when pi cking up patients at Siboney. He further emphasized that in spite 

of the fact that most of the passengers on 

these transports 'were assumed to be either 

convalesce nt or healthy, he had placed as 

much in th e way of medica l suppli es as he 

could spare o n the Sell eu!. He had even asSigned th e vesse l two assistant surgeons, 

but one of th em was later reported to have 

been sick most o f the way. He could 11 0 t assign a medi ca l offi cer for th e Call clio, 

w hi ch carri ed a Red Cross surgeon and 

four nursing sisters. A nurse later alleged 

that the Sell eca carri ed too many passengers, but th e surgeo n responsible fo r determining th e load for each vessel deni ed 

th e charge. Although th e Medica l Department blamed w hat was rega rded as a hi gh 

dea lh rate aboard transports upon Lh e 

"grea tly debi li taleel condi tion of th e men," 

outraged commenLS, once slaned, did n OL 

qUi ckly end, anel Sternberg'S refllsallo ac-
SUPPORTING THE INVASION FORCES 

cept responsibility for any aspect of the situation only fueled public indignation 'O 

Some con fusion obviously also existed 

about the ports to which these passengers 

should be taken. Initially, Secretary o f War 

Alger apparelllly wallled the wounded 

placed on vessels relLtrning to Florida after 

unloading troops. By early July transpo rts 

with convalescents were being required to 

bring their passengers to Fort Monroe, nea r 

Newport News, rather than to Tampa. 

When the message ordering ships 10 Virginia was received in C Uba,lWQ more transports had just left, both bound for Florida . 

One off-loaded 100 of the most seriously 

wounded at Key West, where a convelll had 

been co nverted into a joint Army-Navy 

hospital, before proceeding 10 Tampa. At 

Tampa the hospital train met the remainder of her passengers and lOok them 10 Fort 

McPherson in Georgia. Alger was partiClIlarly upset, however, that even in early August a transport arrived at Tampa when she 

was to have go ne to New York'] 

The rest of the V Corps, neeing disease 

in a state approaching panic, soon joined 

the sick and convalescent that these transports were taking from Cuba . No efforts of 

the Medical Department could preven t the 

repeated altacks of malaria that were rendering these once-strong men ever more 

fragile. Typhoid and dysentery continued 

to undermine morale, and the fear that 

wo rse was yet to come grew as the number 

of diagnosed yell ow fever cases mounted. 

By 8 August three-fourths of the men were, 

according 10 General Shafter, "in no condition to withstand an epidemic of yell ow 

fever, whi ch all regard as imminenl."" 

Enthusiasm for the idea of withdrawing 

the V Co rps from Cuba grew rapidly, but 

the fear that returning soldiers would carry 

the enemy back with them 10 the United 

Stales had not abated. Mai l from Cuba was 

159 

already bei ng disinfected before entering 

the United States lest a lelter bring in yellow fever, and Genera l Mil es had forbidden the circulati on of paper money from 

infected units because it could not be disinfected. The Marine Hospital Service co ntinued to check all vessels coming in from 

Cuba, whether troop transports or merchant ships. Nevertheless, believing that 

they had no alternative and convinced that 

wholesa le deaths in their already seriously 

debilitated commands wou ld foll ow a yellow fever epidemic , offi cers began bringing pressure to have their units brought 

home immediately. General Shafter noted 

that th ey agreed with him that "the only 

salvation for the survivors of the arm y was 

to leave Cuba as soon as possible." Roosevelt thundered that the men should be 

sent north, "not nex t month or next week, 

but now, today if possible." 53 

Secretary of War Alger responded immediately and favorably 10 Genera l 

Shafter's urgent request that the V Co rps 

be moved back to the United States without delay. The decision made, preparations 

progressed swiftly, but with so many men 

sick, the evacuation took more time than 

the invasion had. Marine Hospital Service 

doctors in Cuba were ordered to inspect 

transports and their crews to ensure neither brought yellow fever back to the 

United States. Adjutalll General Co rbin cabled Shafter 10 emphaS ize his co nce rn that 

suffi cient effort might not be taken to make 

sure that men with yellow fever we re not 

among those returning home. Those ,,,,ho 

were too ill to move or who were suspected 

of having the d read disease, about I ,300 in 

a ll , were to be left "in very comfortab le 

condition" to recuperate in Cuba.54 

Except for th e men who could not be 

moved, th e entire V Co rps was to be relLtrned to th e United States. In spite of th e 
160 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

probability that some wo uld come down 

with yell ow fever on the transports, Ge neral Shafter beli eved that to keep a sick 

man in Cuba unti l his fever had gone 

wo uld be to inni ct a death sentence upon 

him. Secretary of War Alger, undoubtedly 

motivated at least to some degree by the 

furor sti rred up whe n the pl eas of V Corps 

offi cers reached the press, sent south all 

the transports he could find . The Olivette 

initially assisted in removing the sick from 

Cuba ; but, after ca rrying 203 sick to 

Boston on 15 August and heading south 

again, she foundered while coaling in 

heavy seas off Fernandina, Florida, fortunately without loss of life. Al though Camp 

Wi koff on Lo ng Island was not yet ready 

ror them and hurri can es threatened, north 

they came, the first ship departing Cuba 

on 7 August, the last eighteen days later. 

The press attacked co nditions on board the 

transports, and the debilitated co ndition 

of the men gave a poor impression, bUlllO 

epidemics broke out during th e voyage 

ho me, and th e men themse lves rarely complained. Major Ives concluded that the 

evacuation was well and humanely managed, given its hasty nature. " 

Spanish troops were also returning 

home-General Sharter's promise that all 

Spanish prisoners, sick or healthy, wo uld 

be evacuated rrom Cuba had been part or 

the surrender agreement- but the role or 

the u.s. Army Medical Department in their 

ca re ended when they left Cuba. The disease rate among th e hungry, demoralized 

enemy soldi ers on the island had also risen 

with the passage o r time, a situation 

blamed chieny on poor sanitation in th eir 

camps. Since no hospital was ava ilab le to 

house the growing number or sick, the 

Spanish commander, Genera l Jose Toral, 

had been rorced to seek help in establishing a hospital as well as in improving sanitalian. The repatriation was to be managed by co ntract, wi th the contractor providing medical atlenciance as necessary on 

board the tra nsports. Because the ships 

that were to return rormer enemy soldiers 

to Spain were slow to arrive, more than 

1,000 Spanish sick were yet to be moved 

rrom the island when the last or Sharter's 

men began leaving Cuba, but almost all 

had left by mid-September. 56 

111 Puerto Rico 

The campaign in Puerto Rico (Map 3) 

was even bride r than that in Cuba . The 

in itial landing took place on 25 Jul y, and 

th e armisti ce brought hostilities to an end 

on 12 August. For the troops and ror th ei r 

medical offi cers, the efrort in Puerto Rico 

was less demanding rrom the outset. The 

lranSpOrls that moved the men were far 

better equipped ror the task than th ose carryi ng the V Co rps. Although what was apparently fa lciparulll malaria affl icted 

Puerto Rico as it did Cuba, U.s. rorces 

under General Miles, who led this ex pedition personall y, did not encounter the 

dreaded yellow rever. Because the port or 

Guanica. near Ponce, taken o n lhe nrsL clay, 

was a good harbor and a highway went 

through the mountains between Ponce 

and San Juan, the capital , transportation 

did not pose the problems that characterized the Cuban campaign. With Miles on 

25 Jul y were 3,400 men, originall y destined to reinrorce General Sharter but who 

had been held on board their transports at 

Guantanamo; no troo ps from yellow reverinfected areas or Cuba were sent to Puerto 

Rico. Unrortunately, 3,500 reinrorcements 

sent rrom the United States brought typhoid with them when they joined the 

troops already there in taking Ponce. Even-
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PUERTO RICO 

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162 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

tuall y 17,000 men from the 1, ll, and IV 

Corps were servi ng on that island under 

Miles, reinforcemenls hav ing landed at 

such vari ed sites as Guayama, Ponce, ancl 

Arroyo. When the fighting ended , onl y 

four of Miles' force had been kill ed and 

fon y wounded, few of them seriously. 57 

Miles consulted ofte n with his chief surgeo n, Colonel Greenlea f, who, havi ng arrived in the Caribbean just as disease was 

beginning to overcome the V Corps, accompani ed the commanding genera l and 

personally directed the medica l support of 

the effort in Pueno Rico. Nevertheless, 

some of the d ifficulties the Medical DeparLment experienced during the invasion 

of Cuba recurred duri ng the brief Puen o 

Rican campaign. Among th e most persistent problems in this category was th e 

shortage of hospital ships ava ilable to serve 

the troops in Puen o Rico. Last-minute 

arrangemen ts for a vessel where those who 

fell ill on transpon s could be hospital ized 

became necessary. The Red Cross leased a 

steamer, the Lampasas, and staffed it with 

Red Cross doctors and nurses who had 

been prevented from landing at Guantanamo to avo id ex posing them to yellow 

fever. None of the wo und ed from the fi rst 

engagement near Ponce required care on 

the Lampasas, but her staff, with the aid of 

medical supplies from a transport and 

under the supervision of a contract surgeon appoinled by Greenleaf, cared for 

eighty sick from the invasion fo rce, many 

of whom were suffering from typhoid. 

Since no hospital ship accompanied the 

troops from th e United States who landed 

a few days after th e units from Guantanamo, as soon as supplies on the Lampasas and another steamer had been offloaded, Greenleaf had the sick from all 

units on the island, among them many typhoid victims, loaded on the two vessels 

and sent nort h to Fort Mo nroe.'8 

Secretary of War Alger was sufficiently 

concerned with the care of the wound ed 

that he asked General Miles whether he 

should not plan to set up a general hospital in Ponce at once and promised to send 

as many physicians and nurses as might be 

needed. Although medical personnel presented few problems, for a time nurses 

were in shon supply. Greenlea f asked Surgeon General Stern berg to send male 

nurses, although he co nsidered females acce ptable for service on a hospita l shi p or 

in a general hospital. EvenlLtally, howeve r, 

women were nursing natonl), in the Ponce 

genera l hospital but in smaller facilities, 

including four post hospita ls. 59 

An adequate number o f medical offi cers 

and hospital co rpsmen was presenlateach 

of the minor engagements that characterized the campaign. In one instance, howeve r, the grounding o f a transport near 

Ponce hampered the work of the medical 

staff of I Co rps units that landed at Arroyo 

on 2 August. As a result, neither the many 

hospital corpsmen nor the animals used to 

pull Medical Department wagons rejo ined 

th e rest of their unit for more than a week, 

signifi canll y delayi ng the unl oad ing of the 

reserve division hospital and its equipmen t. Some hospital supplies were unloaded by regimental teams that, despite 

efforts by med ica l officers, sometimes succeeded in acquiring and retaining division 

property. Beca use a certain amount of materiel had already disappeared during the 

move from u.s. camps to Puerto Ri co, the 

help of the Red Cross and other cha ri table 

organi zations was again most welcome. 60 

Other supply problems that foll owed 

the invasion of Puerto Rico resembled 

those experienced in Cuba, although they 

were notas severe. The first thirty-six shi ps 
SUPPORTI NG THE INVASION FORCES 

to arrive in Puerto Ri co were not accompanied by invoices, and thus the entire 

ca rgo had to be searched to find what each 

vessel carried. lighters to un load the transports were numerous, but minor delays resulted from the way in which th e transports had been loaded. In one instance 

hospital tents were at the bottom of th e 

ship's ho ld and were reached only a week 

after the landing. As a result, for a few days 

hospitals were overcrowded because of the 

lack of shelter. Similar minor delays involved both ambu lances, which were, to 

Greenlea f's annoyance, sometimes used to 

move supplies, and medi cines, causing 

temporary shortages on shore despite th e 

amplitude of suppli es brought with the invading force. Soon , too, "robbery was rife" 

as each shipment moved forward, but with 

"more perfect organization and better personnel," th e arrival of medical suppli es intact became more freq uent 6 1 

The struggle between those favoring 

regimental hospitals and those believing 

that larger institutions were more efficient 

naredup once again in Puerto Ri co, fue led 

in part by the fact that th e invading force 

was scattered about the island in small 

units, each requiring medical perso nnel 

and suppli es. Hospitals were offiCiall y orga ni zed by brigade, and the need to provide for both indi vidual units and th e 

larger facilities once more produced an apparent manpower shortage, despite th e 

Medica l Department's insistence that patients be consolidated in th e larger facilities as promptl y as possibl e. Some vo lunteer units brought no attendants with them 

oth er than hospital stewa rds, exacerbating 

the difficulty6' 

When the Army occupied towns in 

Puerto Rico, medical officers searched for 

buildings in whi ch to house part or all of 

their hospitals. As soon as Ponce had been 

163 

taken , th ey set up a general hospital there 

for U.s. pati ents in a fonner Spanish military faCility, moving out its forty-fo ur 

Spanish occupants, most of whom were 

the victims of venerea l diseases. The building, according to Colonel Greenleaf, "was 

in an exceedingly filthy condition, wi th 

pri vies ove rnowing with liqUid excrement 

and various rooms being indescribabl y 

dirty." On 9 August, when General Miles 

initiated th e move on Sanjuan from Ponce, 

Secretary of War Alger suggested erecting 

a new bUilding for the general hospital. Although Miles informed Alger that construction material was abundant, within 

ten days the surgeo n in charge of the 

cleanup operation had th e old structure in 

completely satisfa ctory condition, and a 

new faCility never became necessalY The 

former Spanish hospital could accommodate 200 patients, but since it was initially 

overcrowded, Greenleaf obtained additi onal space in a well-run Ponce charity 

hospital. The Sisters of Charity also allowed him to use a girls' school as a hospital. A minimum !lumber or men were detailed from the various commands to serve 

as nurses to allow as many corpsmen and 

medi cal o ffi cers as possible to accompany 

units into action.

63 

When the troops left Ponce to continue 

the drive aga inst the Spanish, Colonel 

Greenlea f was informed that 50 pa tients 

would be left in the Ponce hospital. Then 

"the building was invaded by a promiscuous crowd of stragglers, numbering 150, 

not over two-thirds of whom required hospital accommodation.1I Since no security 

had been set up at the hospital, co nfusion 

reigned. Gree nleaf quickly set up a convalescent facili ty that could eventuall y house 

500 in nOQl·ed and framed huts, to which 

he sent 125 men. When the hospital shi p 

Relief arrived shortl y thereafter, some of the 
164 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

men who were actively ill were placed on 

board with a few wo unded for evacuation 

to the United States. As the vessel sailed 

north after leaving Ponce on 15 August, she 

picked up a few wounded from the brigade 

hospita l at Mayaguez as well. Not long 

thereafter, however, Surgeon General 

Sternberg decided that, since the move 

might jeopardize the health of the increasing number of men actively suffering from 

typhoid, the Ponce facility should continue 

in use as a general hospital to shelter all 

who were still acutely ill with the disease· 4 

Similar fa cilities were set up in other 

Puerto Rican communities as they we re occupied. Even when of recent origin, the 

buildings used as hospitals required repair 

or remodeling of some kind before u.s. 

medical offi cers could consider th em satisfa ctory, and Sternberg believed that tents 

were preferabl e. Moreover, the laboratory 

equipment necessary to examine blood 

samp les from soldiers suffering from 

fevers was never present. Colonel Greenleaf warned against keeping the sick on th e 

island any longer than absolutely necessary, both because of the climate and because of the effect the presence of debilitated soldi ers had on morale. Since both 

he and Surgeon General Sternberg were reluctant, no doubt bepuse of the experiences in Cuba, to use transports to move 

the sick and wounded, Greenleaf decided 

to use only hospital ships for this purpose, 

although he did all ow co nvalescents to be 

moved by transport. He decided that when 

the patients in the Ponce hospital had been 

sent home, ambulance trains would move 

th e sick from camp hospitals to Ponce, 

whence they, too, could be evacuated to 

the United States." 

Familiar diseases affli cted troops in 

Puerto Rico as they had in Cuba , but the 

Army made sure by means of a quarantine 

that neither yellow fever nor smallpox came 

in from the outside. Investigation co nfirmed the fact that typhoid had been imported from the United States, although it 

was also endemi c in Puerto Rico , and the 

debilitating effect of the island's malaria followed the pattern that had already become 

familiar in Cuba. Heavy rains increased the 

incidence of disease. The remedy of moving camp was again discussed, and Greenleaf suggested that the men of one particularly debilitated unit be sent to the 

mountains to regain their health and 

strength . At first the disease rate continued 

to climb-300 remained when the Lall1 -

pasas sailed and new cases were occurring 

at the rate of ten a day in the Ponce area 

alone. As the campaign ended, the number 

of new typhoid cases was at last decreasing, 

but various digestive problems were increasing, and malaria continued to be a 

major problem for the army of occupation· 6 

In the Philippines 

Unlike the campaigns in the Caribbean, 

the effort of General Merritt's Vlll Corps to 

take Manila from the Spanish in the Philippines, so well begun in th e United States, 

encountered few difficulties that could be 

attributed to poor planning. When General 

Anderson's vanguard of offi cers and men, 

the first troops to arrive, landed during the 

first week ofJul y at Cavite, this peninsula 

on Manila Bay southwest of the city itself 

was already under the U.s. Navy's control. 

The guns of Commodore Dewey's neet, capable of forcing the surrender of Man ila but 

not of occupying it, and Filipino rebels surrounding the city already had the enemy at 

bay when U.s. troops began their advance. 

The Spanish put up li ttle resistance, although for a week they exchanged fire with 
SUPPORTING THE INVASION FORCES 

the in vaders approaching Manila, leaving 

more than sixty Americans wounded, until 

Dewey threatened to use his nee!'s heavy 

guns. The outcome of the final battle for 

the city on 13 August, one day after the 

armisti ce had been signed but before the 

fa ct was known in th e Philippines, was essentially prearranged during secret nego tiations earlier in the month. The Spanish 

commander, who wished to both save face 

and surrender, agreed to limit his resistance 

in exchange for an agreement not to shell 

the city or to invo lve the Filipino rebel 

forces that were allied with the Americans. 

As a result, the final conquest of the city 

produced less than fifty u.s. wounded· 7 

High seas and rough surf typical of the 

monsoon season compli cated ship-toshore movement and retarded all unloadingat Cavite, but Medica l Department perso nnel were spared th e struggle to locate 

medical and hospital supplies that had 

hampered the work of their counterparts 

in Cuba. Thus, Capt. Harlan E. McVay was 

able to set up a small post hospital 

promptly. When the sick who were removed from incoming transports began to 

crowd the fi rst faCility, he appropriated a 

second building nearbyso that he had room 

for 150 beds. Upon th e arrival of the corps 

chief surgeon , Colonel Lippincott, in midJuly, McVay's facility was upgraded and 

classified as the VIII Corps' reserve hospital. A hospital steward and Hospital Corps 

privaLes from volunteer units were asSigned to the hospital, and more joined 

them after the arrival of add itional transports nooded it with new patients. When 

the third group of transports arri ved at 

Cavite at the end of July, old Spanish cots 

of bamboo were used to accommodate all 

the sick. Although Colonel Lippincott considered the buildi ngs at Cavite "unsuitable 

in every way," they conLinued in use and 

165 

became the site of surgical operations then 

considered demanding, including appendectomies. Despite changing deSignati ons, 

the Cavite facility was apparently always regarded as "a kind of post hospital. " 68 

In actual fact, Cavite was a poor location 

fo r either a camp or a hospital. A stench 

blamed on rotting bodies trapped in the 

hulks of Spanish ships sunk in the bay by 

Dewey in May permeated the peninsula, 

and the seawall defenses trapped garbage 

and sewage nea r the shore. The buildings 

that sheltered troops were also "reeking 

with filth ." Not even the rudiments of a 

sewage system could be found; in some barracks and in all private homes "the faeces 

of generations had been carefully preserved 

in cemented vaults. " In one building where 

water closets discharging into sealed vaults 

had been installed, the gas vents had also 

been sealed, and from time to time "explosions of gas" drove the "trap water out over 

the room." The water supply was described 

as "worse than bad ," inadequate in quantity, polluted, brackish, and "fill ed with orga nic matter. " Bathing fa cilities as such 

were nonexistent. Lippincott believed that 

"the general insalubriousness of the locality" together with overwork was responsible for Capta in McVay's death fro.m typhOid 

in Jan uary 189969 

On 15 July General Anderson moved 

some of his men by water from Cavite 

north to a generally well-drained area only 

three miles south of Manila. Here, where 

peanuts had once been grown, Camp 

Dewey became a landing site for the rest 

of General Merritt's command. The water, 

once boiled , proved entirely satisfactory. 

Brigade surgeon Maj. Will iam D. Crosby 

of the U.s. Vo lun teers, who arrived midJuly with the seco nd group of transports, 

qui ckly set up "an excellent tent hospital," 

and Colonel Lippincott sent him fifty tents 
166 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

and other suppli es as they came in . Until 

the final day o r the campaign, all wou nded 

were sent to this ra cility. Although with the 

arri val or the expediti on's headquarters the 

men in the Philippines were organi zed as 

th e 2d Division, the chi d surgeon decided, 

as had Colonel Greenlea r in Puerto Ri co, 

LO rely at least ini tiall y on a brigade organization rather than one by c1ivision,70 

Thus th e Camp Dewey racility became the 

fi rst or two bri gad e hospitals rather than a 

new division racility. A hospital would be 

ready LO accompany a brigade on detached 

duty, and when still more troops reached 

the islands, each brigade hospital co uld be 

ex panded, if need be, into a division racility. Shortl y a rter the establishment or th e 

first brigade hospital , Maj. George H. Penrose, a brigade surgeon o r the U.s. Vo lunteers, set up the second. Some of the LO tal 

or a hundred hospital tents on hand ror th e 

use of these two facilities we re never 

needed. The men had been li ving und erarduous conditions, "alternately roasted and 

basted by the sun and the rain ," and, out 

or desperation in the last stages or the campaign, forced to drink whatever water the)' 

could find , butthesick rate was only 4 percent. o r the 124 still hospitalized on 13 

August, more than hair were wo unded H 

The arriva l of increasing numbers ol'soldiers di ctated a more rormal organization 

or the 2d Division's Hospital Corps perso nnel. Initially, only 144 Hospital Corps 

privates and the 48 men chosen rrom two 

volunteer units served under Colonel lippincott. o r this group, 60 served with their 

regiments, 27 went to each or the brigade 

hospitals, and 25 were sent LO the Cav ite 

hospital. The division chief surgeon , Maj. 

Herbert W. Ca rdwe ll or the U.s. Vo lunteers, observed that regimental surgeons 

tended to keep the best or their men ror 

th emselves and LO se nd the dregs LO serve 

elsewhere. The first ambulance company, 

LO which 50 pri vates were assigned, had 

been formed and its men instructed in their 

duties even berore Lippincott's arriva l in 

the Philippines. The ract that onl y two ambulances were available ca used no great 

hardship beca use these vehicles were too 

heavy to be used over the muddy roads or 

the area, and the Quartermaster's Department located about rorty local',ehicles that 

proved adequate to the need. Sin ce no tents 

or utensils were ava il able to allow the 

members or the ambulance company LO 

camp 01' eat LOge th er, they co nti nued to 

li ve with their ro rtner regiments. Most or 

the hospi tal stewards with the vo lunteers 

also remained "vith their units, but a regular steward served in each hospital

72 

Although the shortage or qualified hospital corpsmen was chroni c, the number or 

medical offi cers was essentially adeq uate 

during the first weeks in the Phili ppines. 

Colonel Lippincott round most vo lunteer 

physicians happy to be assigned to service 

in the brigade hospita ls and only one 

colonel particularl y reluctant to give up his 

medical offi cers. Initially, rew regimental 

surgeo ns were needed ror service outside 

their regiments, since less than 65 offi cers 

and men were wounded berore the final day 

or the campaign. The corps chief surgeon 

required the services or only one regimental medical offi cer,an excellentsurgeo n,capable or perrorming, among others, "a great 

many operations ror the radical cure or hernia, wiLh wonderrul success," 73 

By the time Lippincott was preparing ror 

the fina l move to Manila, the constant 

storms thal were causing a delay in UIlloading the transports had rendered supply 

a major source or rrustration. Arter co nsiderable drort, the chid surgeon obtained a 

small launch ror the exclusive use or the 

Medical Department so that medical offi-
SUPPORTING THE INVASIO N FORCES 

cers could remove some of their own supplies direcLl y. At Camp Dewey, rain added 

to th e difficulties experi enced by medical 

offi cers. Although a suffi cient number of 

ponchos had been unloaded to cover th e 

bamboo fram es for hospital tents, on 3 1 

Jul y the physicians fo und themselves caring fo r patients whil estanding in water fo ur 

inches deep. Problems with transpo rtation 

even led to a s hortage of fo od ; for severa! 

weeks "but little more than half rations 

were available.» 7-1 

On 13 August, the fin al day of Spanish resistance, between 40 and 47 men were 

wounded . Majors Penrose and Cardwell 

were at the front all day, supervising care and 

evacuation. The rocks and holes characteristic of the roads in the area made it likely 

that litter-bearers would fall , tossing the 

wounded o nto the ground, and thus only a 

few of the most seriously injured were moved 

in this way Since the construction of travOLS 

for their patients would have been too timeconsuming, surgeons resorted to "native carromatas, t,va-wheeled carts drawn by 

diminutive ponies . .. most abominable vehicles," to move the casualties three to rI ve 

miles to Camp Dewey over "execrable roads" 

so rough that the jostling tore dreSSings 

loose. The natives who drove the "abominable vehicles" worked under guard to prevent desertio n. Ambulance stations were set 

up along the road so that the damage to patients and their dreSSings could be repaired. 

Despite the difficulties, by 1900 hours of the 

day the guns fell silent, all wounded had received medical care and been placed in their 

beds in one of the hospitals." 

167 

The short-lived hostilities of the SpanishAmeri can Wa r taught a hard lesson about 

th e dangers of going to war without adequate preparation. Had the enemy been a 

more able foe, the result for the Medical Department, as for the Arm)' as a whole, would 

obviously have been far more tragic. Notsurprisingly, therefore, those concerned with 

the ability of the United States to defend its 

new role as a world power after 1898 pus hed 

to reorganize both the Army and its Medical 

Department so that involvement in modern 

warfare would not spell disaster. 

For the Medica l Depa rtment th e greatest tragedy for troops actively in volved in 

hostilities during the Spanis h-Ame rican 

War had been produced by disease. The 

story of the care of wounds in this war was 

a triumphant one-whether in the Philippines or the Caribbean , the casualties of the 

Spanis h-American War were far more fo rLUnate than those of the Civil War. By 1898 

physic ians knew how wounds became infected, and the precautions necessary to 

prevent wo und infectio n were easily taken. 

The wounded invariably did well in spite 

of large numbers of inexpe rienced physicians, difficult terrain , filth , and a s hortage 

of suitable shelter for hospitals. An understanding of how typhOid fever, malaria , and 

yellow feve r were spread was the necessa ry 

first step to eliminating the high toll these 

diseases traditionally took, and the medical 

professio n was only on th e brink of that understanding. In the care of wounds the wa r 

\vith Spain represented a Ilew era in medicine, but in the prevention of disease it 

marked the last gasp of a long dark age. 
NOTES 

1. Unless otherwise indicated, all material on the 

Span ~A ican Wa r is based on Graham A. Cos~ 

mas, Arm)' Jar Empire. 

2. "Yar Department , fA II/ltwl J Repol'f of tile 5111'-

geon General, U.s. Army, to tile Sec relw)' of W(Ir, 

1898, PI'. 206, 215 (hereafter cited as WD, ARojSG, 

date). Exact figures on the number of wounded from 

the Spanish-Ameri can Wa r in Cuba va ry. See, for example, in the William R. Shafter Papers, Stanford 

Unive rsity, Palo Alto, Calif. (hereafter ciled as 

Shafter Papers, SU), the fo llowing: Ltr, Joseph 

Wheele r to AG, 25 J un 1898, and Rpl, Shaft er to AG, 

8Ju11898, Microfilm (M!) Reel 3;and V Army Corps 

GO 36, 19 Ju11898, Mf Ree l 4. 

3. WD, ARojSG, 1898, PI'. 116-17, 195 , 206; 

idem, (Annllal/ Report of th e SeCref(/l)' of War, 1898, 

l(pt.1):4 (hereafter cited as WD, ARojSW, date); Edward Marshall , TIl e 5101), oJllle Rough Riders, p. 148; 

in Shafter Papers, SU: ltrs, Edward J. McClernand 

to Ch Surg. 23 Jun 1898, and Benjamin F Pope to 

Asst AG, V Army Corps, 23 Jun 1898, Mf Reel 3, 

and Report of Commission To Investiga te the Conduct of the Wa r, p. 7 1, Mf Reel 6 (hereafter ci ted as 

Com Rpt). 

4. George Kennan , Cwnpaigning in Culm, p. 87; 

WD,ARojSG, 1898, 1'1'.116-17, 147, 192,and 1899, 

Pl'. 57-58; Erna Risch, QII(!/'l erlll(lSfer Su pport oflhe 

Army, pp. 537,541 ,552-53; Ur, Shafter to AG, 3 

Jun 1898, Mf Reel 2, Shafter Papers, SU; United 

Stat es, Congress, Senate, Report of the (Dodge) Co ~ 

mission To In vestigate the COlldllcr of the W(!/' Department ill {/1 e War WUIJ Spain , 1.:645 and 8:137, 139 

(hereafter cited as Dodge Commission Report). 

5. WD, ARojSG, 1898, PI'. 193-94, 198 (quotation), 215, 221-23, 225; Kennan , Campaigning, pp. 

76,83; in Shafter Papers, SU: Ltrs, B. Pope 1.0 Asst 

AG, V Arm}' Corps, 23 Jun 1898, and Joseph 

Wheeler to Shafter, 24Jull 1898, MfReel3, and Ltr, 

B. Pope toSG, 25Jun L898, in Rpt, Benjamin F Pope, 

Mf Reel 6; Dodge Commission Reporl , 6:2894. 

6. Nicholas Scnn , J\lfedico-surgica / Aspects of Ille 

Spallisil-A meri((m W(II', pp. 363-64; "YO, ARofSG, 

1898, PI'. 192,209 ,224,233; Victor C. Vaughan, 

"The Care of Ihe Wounded at Santiago," p. 32; 

Robe rt Reyburn , Fifty Years in the Practice of lvlediCillealld SIIIgCI)" 185610 1906, p. 9; War Department, 

Surgeon General's Office, The SlIIgeoll Gellerals Offi ce, p. 52 (hereafter cited as WD, SGO, SGD). 

7. Kennan, Campaigning, pp. 5, 97 (quotatio n); 

WD, ARojSG, 1898, 1'1'.117, 194,2 18-19. 

8. WD, ARojSC, 1898, PI'. 208-09 (quotation), 

2 19,224,227-29,231; Dodge Commission Reporl , 

1:355. 

9. Autobiography, William R. Shafter, ch. VII , p. 

5, Mf Reel 6, Shafter Papers, SU; WD, A RojSG, PI'. 

116,187, ]95, 198, 206, 227; Dodge Commission Report , l:589;JohnJ. Bigelow, neminiscellces of the S(III -

liC/go Call1l'(lign, p. 1. 48; Theodore Roosevelt, "The 

Rough Riders," p. 678; WD, SGO, SGD, p. 52. 

1.0. Shafter Autobiography, ch. VII, p. 4 (first 

quotation), Mf Reel 6, Shafter Papers, SU; WD, 

ARofSG, 1898, pp.117, 206 (remaining quotations), 

214,224,227; Dodge Commission nerOI'I , 6:29 17, 

8:527. 

11. WD, ARoJSG, 1898, 1'1'.117, 194-95,206, 

221-23, and 1899, p. 58 (quotation); Kennan, ClllHp(]ignillg, pp. 130-36; Ltrs, Shafter to SW, 27 Jun 

1898, and to AG, 8 Jul 1898, and French E. Chadwick to E. McClernanci, 27 Jun 1898, Mf Reel 3, 

Shafter Papers, SU; Dodge Commission neport, 

6:3031,8:141; "New York Academy of Medicine," 

p. 566; WD, SGO, SGD, p. 52. 

12. John D. Miley, 1/l Cuva With Sluifler, pp. 

137-38 (quotation); WD, ARojSG, 1898, p. 198; 

Ltrs, Shafter to CG, Spanish Forces, Santiago de 

Cuba, 4 Ju l 1898, to Jose Toral, 5 Jul J898, and to 

AG, 5Ju11898, Mf Reel 3, Shafter Papers, SU; Senn, 

Aspects, p. 322; Kennan, Campaign ing, p. 148. 

13. WD, ARojSG, 1898, 1'1'.117, 197-98,212-

13; Dodge COllllllissioll Reporl., 1:645,5:1824. 

14. Senn, Aspects, p. 320; Kennan, Call1pa iglling. 

pp. 86, 114, 148; in Shafter Papers, SU: Ltr, Shafter 

to AG , 6Ju11898, MfReel3, and Ltr, B. Pope to SC, 

5 Jul 1898 (first quotation), in Pope Rpt, plus Com 

Rpt, p. 72, both Mf Reel 6; WD, Al/ojSG, 1898, PI'. 

198,212 (remaining quotations), 213, 226. 

15. WD, ARojSG, 1898, PI'. 215 (fourth quotation), 216 (first two quotations), 222 (third quotation), 223, and 1899, PI'. 305, 311-14; Senn, AsI'ecls, p. 341; Ltr, Shafter to AG, 6 Jul 1898, Mf Reel 

3, Shafter Papers, SUo 
SU PPORTING THE INVASION FORCES 

16. WD, ARoJSG, 1898, p. 198, and 1899, PI'. 

235-36, 305, 308- 14; idem, ARoJSlV, 1898, 

1(pl.l):5, ISO, 273, 786, and 1(pl.2):59, 124. 

J 7. William C. Borden, "Conservatism in Military Surge ry," pp. 250, 256; idem, The UseoJl he Rontgen Ray by the i'v/eciim/ Dep(lrflllCnlojtJlc United Slates 

Arllly ill lite War Willi Spain, PI'. 29,32-33; Va lery 

Havard , "The Krag-Jorgenscn Bullet-Wound," p. 

i 413; Nicholas Senn, "Recent Experiences in Milita ry Surge l,)' After the Baul c of San ti ago," p. 1164; 

idem, "Surgical Diseases of the Spanish-Ame ri can 

War," p. I4l9; WD, ARoJSG, 1898, 1'1'.209,221, 

233; Com Rpl, p. 76, Mf Reel 6, Shafter Papers, SU; 

Dodge COllll11issioll RepoH, 1:616, 8: 146-47; Bigelow, 

Reminiscences, p. 146; Narra ti ve, ESLh er V Hassoll , 

Entry 230, Record Group eRG ) 112, Nat ional 

Archives and Records Ad minislration (NARA). 

18. First quotation from Ltr, Sha fter to Wilson, 

9 Feb 1899, Mf Reel 6, Shaft er Papers, SUo In loc. 

ei L , 0 11 Mf Reel 3, see Ltrs, Edward J. McCiernand 

to Joseph Wheele r, 1 Jul 1898, to SW, 3 and 5 Jul 

1898, and to Henry 'vv. Lawton, 12 JuI1898; Henry 

M. Dufrield to Shafter, lO Ju11898; Leon S. Roucli ez 

LO McClernand , 10Ju11898; Cha rl es G. Starr to Me· 

Clernand, lOJuI 1898;J. C. Gil more toJ. Wheeler, 

12JuI1898; and Lawton LO AG, 12J uI 1898. Sec· 

a nd quotation from Selln , Aspects, p. 173. See also 

William R. Shafter, "The Capture of Santiago de 

Cuba," p. 625; Hermann Hagedorn , Leoll{ml Wood , 

1:212; 'vVa r Department, CorreSpOII{/cllce RelClting to 

file War Willi Spain .. " 1: 1. 96. Senn was initially 

aSSigned as chi ef s urgeon of the VI Corps, but on 22 

June, when he reali zed that lhis corps would not be 

organized, he asked for active duty. See idem, 

ARoJSG, 1899, p. 65 . 

19. The fa mous Rough Riders we re the 1st Cav· 

airy, U.s. Volunteers. 

20. Quotations from Henl,)' Cabot Lodge, ed., Se· 

lecLiollS Frolll rile Correspolldellce oj Tileodore Roosevelt and He/II)' C(I/Jot Lodge, 1884- 1918, 1:322, 

327. See also ibid ., p. 323; Victor C. Vaughan ,A Doc-

(01'5 lvlelllories, pp. 336-37, 340; in Shafter Pape rs, 

SU: LL r, Roosevelt to Shafter, 1.2 Jul 1898, Mf Reel 

3, and Ltrs, W W Cal houn to AG, V Ann)' Corps, 

16Jul1898, and B. Pope to SG,19 Jul 1898, in Pope 

Rpt, Mf Reel 6. 

21. First quotation from LLr, Shafter to J. C. 

Gilmore, 1 Aug 1898, and second quolalion from 

LL r, Rooseveh to Joseph 'vVheeJer, 5 Aug J898, both 

Mf Reel 4, Shafte r Pape rs, SU o In loc. ciL, see Lt rs, 

Charles F. Humphrey to Edward). McCiernand, 20 

Jul1898,Joseph T. Chl?!pe lO Adj , 22d In f, 31Jul 

1898, and Shafter 10 QMG, 22Ju11898, and to AG, 

169 

23 Jul 1898, and, on Mf Reel 6, U r, Shafter to AG, 

30 Sep 1898. See also WD, ARoJSG, 1898, p. 197; 

Va ughan, Memories, pp. 334, 336-37, 340; Ke nnan , 

C{llllpaigJlillg, p. 216. 

22. Quotation from Ltr, B. Pope to Assl AG , 22 

Ju11898, Mf Reel 4, Shafte r Pape rs, SUo In loc. ciL, 

see on Mf Reel 3: Ltrs, AG to Shafter, 3 and 5 J ul 

1898, SW to Shafter, 4 J ul1898, Shafte r LO AG, 5J ul 

1898, and). C. Gilmore to COs Iva rious], 14 J ul 

l898, and V Anny Corps SO 35,11 Ju11898; on Mf 

Reel 4: Ltrs, C. Humphrey 10 E. McClernand, 20J ul 

1898, Sha fter to AG, 25 Jul and 6 Aug 1898, John 

D. Mile), to E. McClernand , 27 Ju11898, and E. MeClernand to Henry W. Lawton , 28 J ul 1898, plus V 

A rm)' Corps GO 27, 23 Jul 1898, and Ch Surg, 5th 

Army Corps, Cir ( 10 Vo lunt ee rs), n.d. ; on Mf Reel 

5: Telg, Shafter to AG, 13 Aug 1898; and on Mf Reel 

6: End to Ltr, Cha rles D. Rhodes to William H. 

McKi ttrick, Nov J 931. See also Dodge COlli mission 

Report , 6:3044; 'vVD, Co rresponcience, 1:217; idem, 

AnoJSG, 1898, PI'. 137-38,200,228,230; Nelson 

A. Miles, Serving the Republic, p. 285; Charles H. 

Alden, "Roster of Volunteer Medical Officers Who 

Served During Ihe Spanish-American \oVaI' of 1898 

in the Mili tary and Naval Services," p. 58; "The Heroes at the Rea r," p. 235; John Duffy, TI,e Scmi/ad-

(illS, Pl'. 152, 194,222. 

23. Dodge COlllmission Report , 8:151; WD, 

ARoJSG, 1899, PI'. 236-39; ill Shafter Pape rs, SU: 

Rpts, Shaft er to AG, 27 J ul-23 Aug 1898, Mf Reels 

4-5, and Shafter Autobiography, eh. VII , p. 6, Pope 

Rpt, 19 J ul 1898, Ltr, Shafter to J. 'vVilson, 7 Feb 

1899, and Shafter Speech, all Mf Reel 6. 

24. WD, ARoJSG, 1898, PI'. 199, 203, 235, and 

1900, p. 74; in Shafter Pape rs, SU: Lt r,). Chl?]pe to 

Adj, 22d In r, 3 1 Jul 1898, IvIf Reel 4, and Te lgs, 

Shafter to AG, 8 and 9 Aug 1898, Mf Reel 5;Joseph 

Wheeler, Tile S{IIlti{IgO CWllpaign. 1898, pp. 357, 

359-60; Lodge,Selections, 1:332; Roosevelt, "Rough 

Riders," pp. 677, 680; Doc/ge COlllm ission Repon, 

8: 135; Fielding H. Garrison, All illl.roduclioll to the 

HislOl)' oj Ivleciicine, p. 526; "MosqUitoes and Malaria," p. 324. 

25. WD, ARoJSG, 1898, PI'. 199,218-19,229, 

233 (quotation); Risch, Qua rtermaster Support , p. 

534; Russel l A. Alge r, "The Food of the Arm}' During the Spanish \Nar," p. 58. See also in Shaft er Pape rs, SU: Ltr, Henry 'vV Lawton to AG, V Ann}' 

Corps, 24 Jun 1898, and V Arm)' Corps GO 23, 10 

J u1 1898, and Ltr, Roosevelt to Shaft er, 12 Ju11898, 

all Mf Reel 3; Lt rs, G. Creighton 'vVebb to AG , 1st 

Div, V Arm)' Corps,16J u11898, and J. Ch l?] pe to 

Adj,22d Inf, 3 1J u11898, MfReel4; and Ur, Sha fter 
170 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

to Charles P. Eagan, 24 Dec l89S, and Com RPI, pp. 

51-55, 72, bOlh Mf Reel 6. 

26. W O, ARoJSG, 1898, PI'. 114, 196, 205,216 

(quolation), 228-29, 234, and 1899, p. 690; Ltr, Edward]. McCie rnand to Charles R. Greenleaf, lS J ul 

L89S, Mf Reel 4, Shafter Papers, SU; \OVa lleI' Mi ll is, 

Tile Martial Spirif, pp. 346-47; Dodge Commission 

Report, 1:645; Hagedorn , Wood , 1: 201; Miles, Se /",, ~ 

illS, p. 282; Risch, Quartermaster SlIpport, p. 532; 

Will iam N. Bispham, Ma/aria , pp. 68, 74; Vaughan, 

Ivlemorics , p. 347; Roosevelt, "Ro ugh Riders," p. 679. 

27. WO, ARoJSG, 1898, 1'1'.1 17,230,234 (quotation), and 1899, p. 251; Miles, Serving, p. 287; 

Kennan, Campaigning, p. 162; Urs, Shafter to AG, 

6 Ju11898, I-lelll)' M. Duffield to E. McCiernand , 6 

Ju11898, and Charles S. Humphrey to QMG , l2Jul 

1898, Mf Reel 3, Shafter Papers, SU; Dodge Commission Report , 5:2104, 6:3049, and 8:15 1. 

28. Dodge COllllllission Repon , 1:588 (quotations), 6 14; WD, ARoJSW, 1898, 1(1'<. 1):33-34,37; 

idem, CorrespOIl(ieiICe, 1:303; idem, ARojSG, 1898, 

pp. 145,234-35, and 1899, p. 92; Hagedorn, Wood , 

1:262; Miley, In Cubl' , pp. 216-17; Rooseve lt , 

"Rough Riders, " p. 680. See also in Shafter Papers, 

SU, on Mf Reel 3: Ltrs,j. Wheeler to Asst AG, Cuba, 

28 Jun 1898, B. Pope to AsS( AG, 10 Jul 1898, and 

AG to Shafte r, 13J uI1898; on t>.iIr Reel 4: Ltrs, Miles 

to Sha fter, 15 Jul 1898, and to AG , 1st Div, V Army 

Corps, 16 Jul 1898, G. Creighton Web b to AG, 1st 

Diy, V Army Corps, 16J u11898, and SW to Shafter, 

2 Aug 1.898; and on Mf Reel 6: Shafter AlIlobiography, eh. VII, pp. 5-6. 

29. WO, ARoJSG, 1898, PI'. 144, 196 (quotalion); idem, ARoJSW, 1898, 1(pt.l):30-31; Dodge 

Commission Report, 1:645; Mil ey, III Cuba, p. 155; in 

Shafter Papers, SU: Ltrs, H. Dufrield to E. McClernand , 6 J ul 1898, and C. Humphreys to QMG , 12 

J ul 1898, Mf Reel 3, and Ltrs, E. McClernand to C. 

Greenlear, 15Jll11898,and Ch Surg, 1st Div, V Army 

Corps, to AG, 1st Di v, V Army Corps, 16 Jul 1898, 

Mf Reel 4; Nicholas Senn, War Correspolldellce (Hisl)(UlO-AmeriwlI Wm), pp. 8 1-82. 

30. Miles, Servillg, p. 293; WO, ARoJSG , 1898, 

PI'. 196, 213, 217; WO, ARoJSW, 1898, 1(pt.l):35; 

in Sharler Papers, SU: Ltr, Edward j. McClernand 

to Henry V. Boynton , 11 Jul 1898, Mf Reel 3, and 

Lt r, 130ynton to Henry M. Dufri eld, 28 Nov 1898, 

Mf Reel 6. 

31. Lt!'s, Sha fter to AG , 21-23, 25-26 Jul 1898, 

MfReel4, Sharter Papers, SU; Dodge Commission ReporL , 1:645; Va ugha n, Memories, p. 346; WD, 

ARoJSG, 1899, p. 60. 

32. WO, ARoJSG, 1898, PI'. 194--95, 212-13, 

216; Dodge Commission Report, 5:1829 and 8:145, 

150-51. 

33. Quotations from vVD , ARojSG, 1898, pp. 

216- 17; ibid., pp. 144--45,196,203, and 1899, PI'. 

145, 250; Miles, Servi/lg, pp. 287 , 292-93; Marie D. 

Gorgas and Bunon j. Hendric\{ , Wi lliam CrmvJord 

GO/gas, pp. 67-68; in Shaher Papers, SU: Ltrs, Ch 

Surg to Asst AG , V Army Corps, 26 J UIl 1898, and 

McCiernand to Shafle r, II and 13jllI1898, MfReei 

3, and U r, H. Boynton to H. Duffield, 28 Nov 1898, 

Mf Reel 6; WO, ARoJSW, 1898, l(pt.l):30-31, 35; 

Va ughan, lv/ell/ories, p. 346; Mile)" 111 Cuba , p. 155; 

Senn , \-\1(11' Correspondence, pp. 8 1-82; Dodge Commission Report , 1:645, 5:1840; "The First Battle 

Aga inst Yellow fever," p.1 26; O rl ando Ducker, "The 

Troops in Sant iago, " p. 669. 

34. Quotation from Dotlge Commission Rcporr, 

1:573; ibid. , 1:574, 616; Vaughan, Memories, pp. 

345,347; Esmond R. Long, A J-J istOlY oj AmcriClIII 

PaLh ology, 1'1'.156-57; WO, ARoJSG, 1898, 1'1'.115, 

117, 145, 150, 170,195-96,216- 17,220,234, and 

1899, p. 170; Ltrs, J. C. Gilmore to Shafter, 18-19 

J ul 1898, Maj Commanding to ASSl AG , V Army 

Corps, 23 J u1 1898, and Edward J. McClernand to 

Louis A. LaGarde, 31 J ul 1898, Mf Reel 4, Shafter 

Pa pers, SUo 

35 . The detention camp was also re ferred to as a 

detention hospita l. 

36. WO, ARoJSG, 1898, PI'. 115, 195-96, 209 , 

220, 234 (quotation), 240, and 1899, p. 60; Dodge 

Commissio/I Report , 6:3049. 

37. Dotlge COlllm ission Report, 1:400-403; WD, 

ARoJSG, 1898, pp. 185, 197,209,236-37, and 1899, 

1'1'.57, 170; Telg, Shafter to AG , 10 Aug 1898, Mf 

Reel 5 , Shaft er Papers, SUo 

38. Quotation from Ltr, McClernand to Tail, 3 

Oc t 1898, Mf Reel 6, Shafter Papers, SU (see also 

idem to LaGarde, 31 J ul 1898, Mf Reel 4); WD, 

ARoJSG, 1899, PI'. 60, 155, 170; idem, Corresl'OIItie/Ice, 1:140, 196. 

39. First quotation from Telg, SvV lO Shafter, 9 

Aug 1898, Mf Reel 5, Shafter Papers, SUo In lac. ci l. , 

see Telgs, Shafter to AG, 8 and 10 Aug 1898, and, 

on M r Reel 4, Ltr, E. McClernand to H. Lawton, 20 

jul 1898. Second quotation from vVD, Corrcsponden ce, 1:241. See also ibid. , 1:2 17; idem, ARoJSG, 

1898, p. 209, and 1899, 1'. 170. 

40. Quotations fro m WD, ARojSG, 1898, pp. 

214- 15; ibid., PI'. 145, 207, 213,216, 238; idem, 

Co rrcsponciCllce , 1: 140, 197; idem, ARoJSW, 

1(pl..l):35; Dodge COllllllissioll Report, 1:400-403, 

8:145. See also in Shafter Papers, SU, on Mf Reel 3: 
SUPPORTlNG THE INVASION FORCES 

LLrs, Shaft er to AG, 6 J ul 1898. and to Henr)' L. 

Turner, l Oju11898; on Mf Reel 4: Llrs, McClernand 

to Greenl eaf, Greenl eaf 10 AG, V Army Corps, a nd 

Miles 10 Shafter, all 15 Jul 1898, plus Shaft er 10 AG, 

18J u1 1898, and Alfred C. Markle), to AG, 51h Arl11 )' 

Corps, 1898; a nd on Mf Reel 6: Llrs, Pope to SG, LO 

and .l9 JuI 1898, in Pope Rpl. 

4l. WD, ARoJSG , 1898, pp. 117, 196 (first quotation), 217, 238 (fou rth quotation); Dodge Corll· 

mission Report, 5: 1833,6:3052 (second quotat ion); 

in Shafter Papers, SU: Ltr, AG La Shafler, 13 Ju11898, 

Mf Reel J, ancl ltr, Mil es to Shafter, 15 Ju11898, Mf 

Reel 4, and Te lg, Shafter to AG, 16 Aug 1898 (third 

quotation), Mf Reel 5; vVD , Correspondence , 1: 225, 

231; idem, ARoJSlV, 1898, l(pLl):34; Sta tement, 

[Anita Newcomb McGee !, p. 9, Entr}' 230 , RG 11 2, 

NA RA ; "The Yellow Feve r," p. 128. 

42. Quotation from Ives End LO U r, Morrison, 3 

Aug 1898, MfReci4, Shafter Papers, SUo In loc. cit., 

see Urs, Leon S. Roudiez to Edwa rdj. McClernand , 

20 J ul 1898, a nd Shaft er LO AG, 1 Aug 1898, and LO 

SW, 4 Aug 1898. See also WD, CorrcspolldCllce, 

1:197; idem,ARoJSG,1898, PI'. 237-38; Dodge COIII -

mission Report , 8:135. 

43. Senn, Aspects, p. 3 18 (quotation); Dodge 

Comm ission Report, 1:645. 

44. WD, ARoJSG, 1898, pp. 108-09, 217, 225, 

and 1899. p. 170 ; Dodge COllllll issiOlI Report , .1 :645, 

6:2897; in Shafter Papers, SU: Lt.-s, Shafter to AG, 25 

Jun 1898, and LO Willimll T. Sam pson , 26 Jun 1898, 

Ch Surg 10 Assl AG, V Army Corps, 26 jun 1898, 

and Sampson LO Shafter, Mf Reel 3, and La , Edwa rd 

J. MeClemand to Ch QM, 30 J ul 1898, Mr Reel 4. 

45. WD, ARoJSG, 1898, pp. 107-09, 145,215, 

a nd 1899, pp. 202-03; Dodge COlllmission Report, 

1:330, 339; WD, Correspondence, 1: 196, 199; Ur, 

Louis A. LaGarde to Shafte r, 2 Aug 1.898, Mf Reel 4, 

Shafter Papers, SU; Va ughan , 1\llenlOries, p. 347; "\-Var 

Articl es," p. 39; Statemen t, Esther V. Hasson, Enu")1 

230, RG 11 2, NA RI\. 

46. \·VD, Co rrespoll<iCllce, 1:197, 237; idem, 

ARoJSW, 1898, l(pl.1):1 28; Llr, AG to Shafter, 4Jul 

1898, Mf Reel 3, Shafter Papers, SU; Dodge Commission Report, 1:573. 

47. Ralph C. \-Villiams, The Uni/ ed Stales Public 

He(l/II, Serl'ice, /798- /950, pp. 85-86, 559 (hereafter cited as USP,.,S); Dodge COll1l11issiolt Report, 

1:571,573,646; in Shaft er Pape rs, SU: Memo,J. C. 

Gihnore, 22 Ma}' 1898, MfRee l 2, and V Army Corps 

GO 32, 7 Aug 1898, Mf Reel 4, and Telgs, AG to 

Shaft.er, 9 and 12 Aug 1898, Mf Reel 5; WD, CarH!-

sponclell ce, 1: 237; idem, ARaIse, 1899, PI'. 59-60; 

Vaugha n, Memories, pp. 358-59, 366. 

171 

48. Millis, Martial Spirit , p. 347; WD, ARaIse, 

1898, pp. 118 (quotation), 197-98, 226; Dodge 

COlllmission Report, 1:646; Senn, Aspects, p. 173. 

49. First quota tion fro m WD, ARoIse, l898, p. 

1.97; second quota tion rrom "The Medi cal Department of the Army Again, " p. 178; thi rd quotation 

from Ltr, SVV to Sha fter, 2 Aug 1898, Mf Reel 4, 

Shafter Papers, SUo In loc. cil. , on Mf Reel 6, see 

COIIl RP1 , p. 39. See also WD, CorrespOlldence, 1:141; 

Dodge COHl mission Report , 8: 153. 

50. WD, ARoJSG,1898, pp. 235-36 (quotation); 

"The Soldier and the Medical Depa rtmen t of the 

Army," p. 233; "The ResponSibili ty of the Army 

Medi cal Departmen t," p. 451; DadgeCollllllission Repon, 1: 143, 186-87, and 5:2108; WD, Correspon -

deuce, 1:141, J97, 24 1; "A Case for In vestigation," 

p. 127. See also in Shafter Pape rs, SU, on Mf Reel 3: 

Ltrs, Edwa rdJ. McClernand to Charl es F. Humphrey, 

llJ u1 1898, and Humphrey to McCiernand, l3 j ui 

1898; on Mf Reel 4: Llrs, AG to Shafter, 2 Aug 1898, 

and Louis A. LaGarde 10j. C. Gilmore, 2 Aug 1898; 

on Mf Reel 5: Telg, Sha rLer to AG, 20 Aug 1898; and 

on Mf Reel 6: Com Rp l, p. 39. 

51. W D, ARoJSW, 1898, I{pt.l): 129; Scheffel 1-1 . 

\-Vright , "Histori cal Issue; Medicine in the Florida 

Camps During the Span ish-Ameri can \-Va r," pp. 

24-25; in Shafler Pape rs, SU: Ltrs, AG to Sharte r, 26 

j un and 5 j ul 1. 898, and Shafter to AG , 5 Jul 1898, 

MfReel3,and Ltrs, SVv to Sha fter, 1 and 6A ug 1898, 

and Shaft er to AG, 7 Aug 1898, Mf Reel 4. 

52. \-VD, Correspondell ce, 1:213 (quoLalion), 

360; idem, ARoJSG, 1898, pp. 1.18, 145, 235; in 

Shafter Papers, SU: Ltrs, Shafter LO AG , 31jul 1898, 

SW to Shaft er, [1 Aug 1898[, a nd j oseph \Vheeler 

et al. to Shaft er. 3 Aug J898, Mf Reel 4, and Shafter 

Autobiogra phy, eh. VII , p. 6, Mf Reel 6; Miley, III 

Cubcl, p. 223; Lodge,Selecliolls, .1:332; \Vheeler,SclII -

liago Campaign, pp. 359-60. 

53 . First quotation from Shafter, "Capture," p. 

629; second quotation from Ltr, Roosevelt to j. 

Wheeler, 31 J ul 1898, tv! f Reel 4, Shafter Papers, SU. 

In loco cil. , sec V Army Corps SO 40, 17 Ju1 1898, 

and Ltrs, Shafter to AG, 3 1jui and 3 Aug 1898, AG 

to Shafter, .1 Aug 1898, j. Wheeler et al. to Shafter, 

3 Aug 1898, and Va lel")' Havard to AG, V Army 

Corps, 3 Aug 1898; and on Mf Reel 3: Ltrs, AG to 

Shafte r, 13 a nd 14 jul 1898. See also \-Villiams, 

USPHS, pp. 85-86; \:\,/0 , Co rrespalltieuce , 1:360, 396. 

54. \-V D, Correspondence, 1:204, 218, 224 (quotation); Ltr, AG to Shafter, 5 Aug 1898, Mf Reel 4, 

Sha fter Papers, SU; Dodge COlllm ission ReporL , 8:157. 

55. Martha L. Sternberg, GeOlge Miller Sremberg, 

p. 178; WD, ARoJSG, 1898, PI'. 235-36; Roosevelt, 
172 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

"Rough Riders," p. 688; Nicholas Senn, "The Me ~ 

ical DeparLmcnl of the Army," p. 215. See also in 

Shaft er Pape rs, SU, on Mf Reel 4: Ltr5, Shafter LO 

William H. Bisbee a nd (0 SW, bot h 4 Aug 1898, SW 

to Shafter, 4 and 5 Aug 1898, and J. C. Gilmore \0 

CO, 8th Ohio Vols, 5 Aug 1898; and on Mf Reel 5: 

Ltr, AG to Shafter, 9 Aug J 898, and Telgs, Shaft er (0 

AG . 13 and 15 Aug 1898. 

56. Dodge COllllllissiol1 Report, 1: 135-36; "Echoes 

and News," p. 402; Leona rd Wood, "Santiago Since 

the Surrender." p. 515; WD. ARofSG. 1898. p. 198; 

idem, CorrespolJdence, 1:196, 204; George G. Lewis 

and j ohn Mewha, HistOl)1 of Prisoner oj '~Ir Ut ilizalioll by ti,e United Sl atesA rlll)~ 1776- 1945, p. 45. See 

also in Shafter Papers, SU, on Mf Reel 4: Ltr5, Jose 

Toral La Shafter, 17 and 21Ju11898, and to C-in-C, 

24 Ju11898. AG to Shafter. 25 Ju11898. and Edward 

j . McClernand to Alfred C. Markl ey, 27 ju11898; and 

on Mf Reel 6: Sha fter Autobiography, ch. VII , p. 7. 

57. j ames A. Huston, Thc Sinews of Wa r, p. 284; 

WD. ARofSW. 1898. 1(1'1.1):6-7; Senn. War CorreSPOlldcIICC, p. 86; Lodge, SclccliollS, 1:330. 

58. WD. ARofSG. 1898. 1'1'. 145--46; Dodge COIIImissioll Report, 1:574- 78,623; Nicholas Scnn, "The 

Invasion of Porto Rico From a Medica l Standpoin t," 

p. 595; idem, W(l1' CorrespolldclI CC, p. 86. 

59. Dodge COlllmissioll Report, 1:592, 624; WD, 

ARofSG. 1898. PI'. 171-72, and 1899. p. 184; idem. 

CorrespOIu/ellce, 1:373,381. 

60. WD. AllofSG. 1898. PI'. 135-36. 171. and 

1899, pp. 184-85; Dodge COll1l11issioll Report, 1:600; 

Senn , War Corl'espollciell ce, pp. 129-30. 

61. WD. AllofSG, 1898. p. 146. and 1899. p. 185 

(quotation); Dodge COllllllissioll Report , 1:137,599, 

601. 

62. Dodge CO/ll/llissiOIl Reporf , 5:1741; WD, 

ARofSG. 1898. PI'. I ll. 176. 

63. WD. AllofSG. 1898. 1'. 146 (quotation). and 

1899, p. 174; Dodge COllllllissioll Report , 1:578, 620, 

625; WD, Correspondence, 1:373 . 

64. Dodge COll1l11issioll Report, 1:578 (quotation). 591. 593. 623; WD. ARofSG. 1899. PI'. 174. 

180; Borden, ROlltgcn R(I)" pp. 11- 12, 29; Bigelow, 

Reminiscellces, p. 146; Senn , War Correspolldence, 

pp. 97 , 99; Thomas C. Biddl e, "Typhoid Fever in the 

Tropics," pp. 104-05. 

65. Dodge COlli mission Report, 1:577,581, 622, 

624; Biddle. "Typhoid Fever." PI'. 104- 05; WD. 

ARofSG.1898. PI'. 124-25. 147. and 1899. 1'1'. 174. 

179-80. 185. 

66. "The Hospital Ship 'Relief'," p. 310; WD, 

ARofSG. 1898. PI'. 124-25. 146--47. 152; Dodge 

COlllmissioll Report , 1:575, 577-78, 594, 619 , 

621- 23, 625, 629; Nicholas Senn, "Typhoid Fever 

in the Porto Ri can Campaign," pp. 599, 604; idem, 

" Invasion of Porto Ri co," pp. 597-98; idem, War 

Corrcspolldwcc, p. 87. 

67. Frederica M. Bunge, ed., PhilipjJilles, pp. 

22-23; WD. ARofSW. 1898. 1(1'1.2):58--59 . 124. 

68. WD. ARofSG. 1898. PI'. 125.263-64 (first 

quotation). and 1899. PI'. 99. 122. 126. 133. 

136-37; Huston, SillCIVS, p. 302; "Medical and Sanitary History of Troops in the Philippines," pp. 828 

(second quotation), 830; Henry LippincoLl , "Reminiscences of the Expedition to the Philippine Islands," p. 171. 

69. WD. ARoJSG. 1898. p. 264. and 1899. PI'. 

lI8. 133-34 (quotations). 135; Teig. Elwell S. Otis 

to AG , 5 Jan 1899, Harlan E. McVay Pape rs, Entry 

561. RG 94. NARk 

70. The 2e1 Division was composed of two 

bri gades at this time. See WD , ARofSW, 1898, 

1(1'1. 2):42. 

71. WD. ARofSW . 1898. 1(1'1. 2):123 (fi rst quotat ion); idem. ARofSG, 1899. PI'. 99. 118. 126- 27 . 

135,138 (second quotation); "Medical and Sanitary 

Histor),," p. 826. 

72. WD. ARofSG. 1899, PI'. 102. 122. 124. 137. 

73. WD. ARoJSG. 1899. PI'. 121 (quotation). 

123; idem. AI~ofSW. 1898. 1(1'1.2):58--59. 71. 503; 

"Medical and Sanitar}' Histor)'," p. 826. Exact figures on the numbe r of wounded in August vary 

slightl)" probabl}' because, as lippincott explained, 

"a few slight wounds" we re not in itiall y reponed 

(idem. ARofSG. 1899. p. 124). 

74. WD. ARofSG. 1898. PI'. 263- 64. and 1899. 

pp. J27, 135 (quotation), 138; "Medical and Sanita ry History," p. 830. 

75 . "Medical and Sanitary History," p. 829 (quotations); WD. ARofSG. 1898. 1'.263. and 1899. PI'. 

99. 124. 137-38; idem. ARofSW, 1898. 1(pt.l): 273. 

851. and ](1'1.2):58-59.60-6 1. 81-82. 124. 503. 
Chapter 7 

DISEASE AND DEATH IN U.S. CAMPS 

While u.s. troops were defeating the 

Spanish in Cuba , Puerto Rico, and the 

Philippines, disease was devastating those 

who remained in the United States. The 

greatest threat was nolan exoLicailment imported rrom tropical lands but typhoid, carried by volunteers to huge and crowded 

camps where rew understood the necessity 

ror high standards or sanitation. The disease 

and death rates eventually climbed so high 

that, in a precedent-selling move, Surgeon 

General Sternberg appointed a board or 

medical orncers to investigate the cause or 

the epidemic and to make recommendations that would guarantee that the horrors 

or the summer or 1898 were never repeated. 

When the number or sick initially began 

to mount, the Medical Department had 

had less than two months in whi ch to train 

new perso nnel and create hospital and 

evacltalion systems. The department was 

onl y beginning to enter th e era or laboratory medicine, and equipment was in very 

shortsupp ly. Thus, physicians were unable 

to determine that the first rew scattered 

cases among troops pouring in rrom th e 

state camps where volunteers ini tially assembled were typhoid rather than malaria, 

whi ch was common in the South. Some 

physicians still believed in the existence or 

a hybrid disease known as typho-malari a, 

a rever born duri ng the Civil War as a resu lt or the inability to distinguish definitively between malaria and typhOid rever. 

Unaware that a disease spread by human 

waste was already threatening th e troops, 

"orncers, military and medical, having no 

experience or military lire in the fi eld, assumed that the deplorabl e condition in 

which they were living was th e usua l mode 

of lire or soldiers situated as they were, and 

that th eir duty as true soldiers was to endure, not only without complaint, but with 

a certain pride, the hardship of their camp 

lire." Most or the National Guard enlisted, 

like th e soldi ers of the Regu lar Army, came 

rrom citi es and large towns and thus were 

accustomed to relati vely crowded living 

conditions but not to relatively primitive 

sanitati on. Volunteer officers and physicians, who had littl e understanding or sa nitation, saw no reason to interfere when the 

men pitched their tents much too close togeth er and crowded four to seven soldiers 

in a s pace seven by eight feet. They allowed 

the troops to place tents too nea r the latrines and at sites that were bad ly drained 

and to use nearby "shady spots under trees 

or the surrounding ground" rather than latrines that had been set up at an appropriate distance. Typhoid was soo n sweeping 

the camps. No t surprisi ngly, volunteers 

died or the d isease at almost twice the rate 

characteristic or the regul ars.' 

The epidemic, together with esca lating 

d isease rates in Cuba, rorced many changes 
174 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

in the Medica l Depa rtment's approach to 

caring ror the Army's patients. Dire necessity eventuall y dictated a mod ification or 

the policy that forbade the assignment of 

remal e nurses to ot her than general racilities. Orten fi eld hospitals became so overburdened with typhoid patients as to lose 

their mobility; assignment to them was little dirferent rrom assignment to a genera l 

hospital. By mid-August 6 remale nurses 

were also working on the hospital ship Reli ef, and 18 had been assigned to Santiago. 

The demand for their serv ices esca lated so 

rapidly that by 15 September, in addition 

to Red Cross and oth er volunteer nurses, 

1,158 women held co ntracts to care for 

Army patients, working twelve-hour days 

for sa laries of$30 a month. When, because 

or a shortage or qualified applicants, several chid hospita l surgeons eventua ll y had 

to hire nurses on an emergenc)' basis, some 

who had received no formal training were 

signed on specifica ll y because of th eir supposed immunity to yellow rever.' 

The typhoid epidemic, whi ch gained in 

force as troops fr0111 many areas or the 

country gathered at a few large camps, 

greatly exacerbated initial problems with 

hospitals. By forcing division facilities to 

grow quickly to twice their in tended size, 

the high disease rate made it necessary to 

retain regimental racilities to care fo r the 

growing number or sick. The pressure on 

division hospita ls was so great that Colonel 

Greenleaf, as chid surgeon of the Army in 

the Held, recommended sending some patients to general hospitals. Sternberg initially postponed crea ting such racilities because he was unsure of when and whether 

the various Army corps would be sent overseas and or whether division hospitals 

wo uld be able to meet the Army's needs.' 

In mid-July, with disease rates climbing 

in both the U.S. and th e Caribbean, Surgeo n General Sternberg reali zed that he 

co uld wait no longer. The genera l hospita ls he ordered set up in co nnection with 

post hospitals at Forts Myer and Monroe 

in Virginia , McPherson in Georgia, and 

Thomas in Kentucky, as well as at Key 

West, Florida, and Washington Barracks, 

were usually managed by regular medical 

offi ce rs. These institutions ran more 

smoothly than division hospitals and were 

less subj ec t to criticism, but since their capacity was soon exceeded, he also had to 

open and expand severa l post hospitals on 

both coasts. Division hospitals at Oll e camp 

were eventually convened into general 

hospitals. In this capacity they came under 

the surgeon general's direct authority and, 

accord ing to Sternberg, "were promptly 

provided by me with the best availab le 

medical service , with trained nurses, with 

all permissible medical and hospital supplies, and with funds for special purchases." New hospitals co uld not be 

opened fast enough; vacancies at Marine 

Hospital Servi ce faciliti es, normall y used 

to shelter sick and injured merchant seamen, were made available to Army patients, anclmany others were sent to c ivilian hospita ls. By 30 September 1898 

almost 6,000 patients had been cared for 

in seven or the ge neral hospita ls and another 2,490 in six post hospitals, including one in Honolulu and another in San 

Francisco, in locations from Maine to 

Florida and rrom New York to Hawaii ' 

The food provided th e pati ents in these 

hospitals was a source of much complaint. 

Funds to buy more than a very rew basic 

items of the special invalid diet were lacking, although charitable organizations set 

up diet kitchens at the major camp hospita ls to provide foods that would tempt nagging appetites without upsetting rragile digestive systems. On 10 August 1898 
DISEASE AND DEATH IN U.s. CAMPS 

Adjutant Gene ral Corbi n remedied the situation by allowing the crea tion of a special 

fund to buy the food needed by the sick and 

conva lescent. The ravages of disease, however, and th e restricted diet required fo r its 

victims left the survivo rs of typho id or severe bouts of mala ria thin, and conva lescents returning to their commands often 

continued to loo k emaciated as a result of 

having to eat the regular ration too soon 

during their recovery, when they co uld not 

yet properly digest it. The ga unt appea rance of so many men triggered rumors that 

the Army was starving its sideS 

Camp Thomas 

The most glaring example of th e horrors of th e camps in the Uni ted States was 

th e largest, Camp Geo rge H. Thomas at 

Chickamauga, Georgia , where the I and III 

Corps, an "enormous army of inexperienced and undiSCiplined soldi ers" accompanied by equally inexperi enced doctors, 

arrived in the spring of 1898. Each corps 

averaged about 40,000 men, some of 

whom were not fi t for service when they 

joined the Army, and both were already infected by typhoid. The ultimate responsibility for their health belonged to Lt. Col. 

Alben Hartsuff, surgeo n in chief at Chi ckamauga and senior surgeon on the staff of 

Maj. Gen. Jo hn R. Brooke, commanding 

the I Corps and command er of th e enti re 

camp. Si nce even Colonel Hartsuffhimself 

had no command authority over th e line 

as far as sanitation was concerned, he and 

his medica l offi cers could only observe and 

make recommendations. Hartsuff later 

complained about his authority over medica l personnel, maintain ing that no lega l 

provision had ever been made for the position of chief surgeo n to a command and 

175 

, 

ALBERT H ARTSUFF 

that the chi ef surgeo n of the corps reported 

not to him but rath er through him to th e 

surgeo n general. Furthermore, because 

th e disease rate increased slowly at first 

and the seriousness of sanitation problems 

became apparent onl y with time, even 

high-ranking officers of the Medical Depanment were unconcerned as late as thL 

fi rst week in July· 

As the typhoid epidemic spread, it 

placed an ever greater burden on the medical staff at Chickamauga. Overworked 

physicians began to break down on duty 

and soon had little time to urge improved 

sanitation upon reluctant commanding offi cers. Some co ncluded that making recruits follow san itary regulations was, at 

best, "almost impossible. " The soil of the 

surrounding woods became covered with 

excremen t until it was impossible to wa lk 

there without stepping in it, whil e "myriads and myriads" of ni es buzzed from 
176 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

woods to food supplies, carrying "on their 

wings, legs and bodies the typhoid germs 

from the sinks and elsewhere , over the 

camp, infecting the food and drink. " Proper 

latrines were hard to dig in the heavy clay 

soil that, lying over a layer of rock, held 

water "like a barrel. " The rains that began 

at Chickamauga at the end of June lasted 

for two weeks, causing sinks to overflow 

and contaminating water sources. A medical offi cer familiar with the situation stated 

that he believed the camp's water supply 

was polluted by the end oUuly. Since filters, easily clogged, very slow, and very 

fragile, were impractical for use on a large 

scale, orders were given out to boil all water, 

filtered or unfiltered. In the one regiment 

that foll owed them, the precautions proved 

to be worthwhile, for as late as 7 August it 

was still free of typhoid fever.' 

By early August, with the soil at Camp 

Thomas becoming "more and more 

charged with filth ," almost 3,000 offi cers 

and men were sick, a fi gure that did not include th ose sent to general hospitals. Some 

cases were "virulent," suggesting to one 

surgeo n that "large quantities of toxins" 

had been taken in, but many of the earlier 

cases had been mild, and many pati ents 

co ntinued to mingle with th eir healthy 

comrades, thus sp reading the disease further. The sick rate co nti nued to grow beyond August's 6.83 percent, and the disease became increasingly virul ent with 

time, presumably because victims were 

taking in heavier doses of the typhoid 

bacillus as the disease became more widespread and exposu re more frequent. Because of the crowding at the hospitals, co nvalescents \-vere of len sent to recuperate 

with their units, a step that, un known to 

physicians of the time, helped to spread 

the disease, since many remained carriers 

for months or 10ngerS 

Stemming the tide became all the more 

challenging because typhOid was apparently an unpopular diagnosis and one that 

was difficult to make withou t either laboratory equipment or training in its lise. 

Some higher-ranking medical offi cers 

maintained that malaria rather than typhoid was the real culprit. Eventually, the 

Medi cal Department's few expert Army 

pathologists, among them, contract surgeon Charl es F Craig, using cultures and 

the recently developed Widal test for typhoid , finally verified the fact that typhoid 

was the principal problem. Craig also concluded that the houseny played an important role in the transmission of this disease. 9 

The slow response of the suppl y system, 

partially the result of the failure of the 

Quartermaster's Department to provide 

enough wagons to unload supplies at rail 

depots, contributed to a rapidly deteriorating situation at Camp Thomas. Overstrained offi cers took to quarreling as they 

attempted to stretch inadequate suppli es. 

Surgeons called franti call y for tents to expand their [acilities. A few patients had to 

lie for a brief period on the ground . In one 

division, where 1,225 of 11 ,000-12,000 

men were ill , some had to be retained in 

their quarters at least temporarily. There 

were not enough doctors. There were not 

enough attendants. Pleas for assistance 

produced results, but, as the cases multipli ed, never soon eno ugh. Inexperi enced 

medical officers gave up all attempts to 

maintain order and diSCipline. Regulations 

designed to prevent the transmission of disease within hospitals were ignored. Typhoid patients sometimes lost control of 

their bowels and soiled their bedding orthe 

noor by their beds. Medica l offi cers treated 

typhoid fever symptomatica lly. Sponging 

with cold water or cold baths reduced fever; 

small doses of a purgative, perhaps calomel, 
DISEASE AND DEATH IN U.S. CAMPS 

relieved constipation; strychnine and alcohoi lowered a rapid pulse; and a drug called 

sulphona l (sulfonat), presumably a hypnotic, was prescribed for sleeplessness. Although exaggerated stories of neglect 

abounded, apparently the drugs deemed 

most important were usually ava ilable either through the Medica l Department or by 

local purchase.'o 

Confusion obscures the facts concerning 

the supply shortages at Chickamauga. Some 

may have been more apparent than real. 

Onesurgeon at Camp Thomas later claimed 

that no one who had made "the proper dfort" had had a problem obtaining what he 

needed. On the other hand, Colonel Greenleaf maintained that a large quantity of supplies had been shipped to Colonel Hartsuff, 

but never received. Many surgeons suggested that Hartsuffhad the supplies but rejected requisitions on frivolous grounds. 

On at least one occasion the I Corps chief 

surgeon, Ll. Col. Rush S. Huidekoper ofthe 

U.S. Volunteers, appealed over Hartsuff's 

head to General Brooke, who in turn 

telegraphed Surgeon General Sternberg to 

get what was needed. Hartsuff countered 

the attacks by explaining that he was not receiving complete cooperation from the 

Quartermaster's Department in obtaining 

such items as tents and that, with supplies 

meager, he was forced to distribute what he 

had according to the greatest need. He also 

insisted that many hospital patients we re 

not really sick and that he should not have 

to provide for such men. In any event, drug 

shortages apparently did not last beyond 

1 August, and Hartsuff contended that no 

one at Camp Thomas really suffered because of shorrages.' , 

The typhoid epidemic undermined the 

hospital system at Camp Thomas, forcing 

the regimental fac ilities that were to have 

been abandoned to take more patients. 

177 

Since all but one physician with each regiment had been absorbed into the division 

organization , regimental hospitals were in 

no position to handle large numbers of patients. Thus the rule that no patient should 

remain in one more than forty -eight hours 

was not likely to be protested." 

When the number of patients exceeded 

the capacity of both regimental and di vision facilities, Sternberg had a general hospital set up in a converted modern hotel 

used by summer vacationers in Chickamauga Park, Georgia, near both the camp 

and the rail line to Chattanooga, Tennessee. 

Although "well managed," the new Leiter 

General Hospital , too, was "sadly overcrowded" by August, with 255 beds in a 

space that should hold no more than 130. 

Under such circumstances, even a staff that 

included a hospital director, a vo lunteer 

medical offi cer, fi ve contract surgeons, two 

Hospital Corps stewards, an acting steward, thirty Hospita l Corps privates (who 

were described as "ill discipli ned" and 

"very poorly clothed"), thirty female contract nurses ("said to bedfi cient"), ten Red 

Cross nurses, and two "excellent volunteer 

nurses" could not keep it thoroughly clean. 

In great need of assistance, the medical director told Ll. Col. Alfred Alexander Woodhull , who was inspecting the camp's facilities at the request of Secretary of War Alger, 

that he would particularly like to have the 

help of an executive offi cer, a line officer to 

handle quartermaster and commissary duties, and "more and beller clerks." Tents 

were soon added to increase Leiter's capacity, and the number of medi cal offi cers doubled, but Colonel Wood hull noted that the 

"vicious system of regimental hospitals 

I had to bel tolerated as a makeshift" because of the great number of sick. 13 

A second general hospital, named after 

Sternberg and , like all general hospitals, 
178 THE ARMY MEDICA L DEPARTMENT, 1865-1917 

under the surgeon general's direct authority, was opened at Camp Thomas in August with a 750-bed capacity and a staff 

more than doubl e thatofLeiter's. Here, too, 

the medica l orficers responsible for the 

hospital were generally inexperienced 

and , like the rest of th eir colleagues serving Camp Thomas, were a ll too often reassigned before they had had a chan ce to 

become compl etely familiar with the problems that fa ced them. Neverth eless, the 

hospiLal achieved a nne reputation. H 

The rapid increase in the disease rate, 

coupl ed with the departure of some of the 

troops, caused once-mobile division facilities at Camp Thomas to grow roots as a result of General Brooke's decision to remove 

them from under the division commanders 

and place them directly under Sternberg. 

Brooke's motives in doing so are unclear; 

he may have wished to take the physicians 

that were in charge of the division hospital 

with him when his command left Camp 

Thomas, or he may have merely distrusted 

Colonel Hartsufr. When th e 1st Di vision of 

the I Corps left fo r the ports from whi ch 

th ey would sail for Puerto Rico in late July, 

its hospital had to remain behind because 

space could not be found for its 153 patients at Leiter. Another 500-bed division 

hospital that also remained behind at 

Chickamauga became the Sanger General 

Hospital (la ter renamed after Alexander H. 

Hoff)." In recognition of the loss of mobility, division hospital tents now received 

frames and Ooors. Bathtubs were install ed 

and, with the aid of donations from private 

citi zens and th e Red Cross, diet kitchens as 

well. Despite all efforts, more than 40 percent of the over 4,000 men at Camp 

Thomas hospitalized by typhoid remained 

in regimental facilities, where 79 of the 263 

fata liti es from typh oid at Chickamauga occurred, a rate comparable to that in division hospitals. Sanitation at Camp Thomas 

co ntinued to be poor after th e departure of 

the 1st Division of the I Corps, but in late 

August and early September units remaining there were gradually dispersed. I. 

Camps in Florida 

Time and experience taught the same 

lessons at ot her camps that they did at 

Chi ckamauga . At Miami and Jacksonville, 

where most of the 30,000 men of the Vll 

Corps camped during the entire campaign 

in Cuba , the soil was absorbent and most 

units were suppli ed with city water that was 

co nsidered sa fe. The proximity of a lumber 

yard made the construction of privies and 

bathhouses easy; the Vll Co rps commanding general, Maj. Gen. Fitzhugh Lee, insisted on attention to sanitation; and the 

men were reasonably well disciplined. The 

corps' chief surgeon, Louis M. Maus, who 

held a volunteer commission of lieutenant 

colonel, was aware, however, that the high 

water table made co ntamination of loca l 

waleI' sources a constant danger. Once 

again , some men brought t)1)hoid feve r 

with them from the state camps, soldiers 

drank from nearby wells, and in August 

1898, when the epidemi c at Chickamauga 

had already been under way for several 

weeks, typhoid reached epidemic proportions at the Florida camps as well. By the 

end of September 5,072 men of the VlI 

Corps had become ill enough to be sent to 

division hospitals and 109 had died. " 

In the Vll Co rps, as elsewhere, the division/regimenta l hospital co ntroversy remained ali ve in spite of an anempt LO pacify 

those who supported the latter by sheltering men from th e same regiment together. 

Each regiment was allowed to retain only 

two hospital tents, one to be used as a dis-
DISEASE AND DEATH IN U.s. CAMPS 

pensary and a second ror sick call, with a 

single medical orri cer, a hospital steward, 

and a Hospital Corps pri vate caring ror the 

ill and injured. On 31 August Colonel 

Malls asked that each regimenta l surgeon 

setup a third tent with six cots, to be used 

as a "hospital tent or observation" ror cases 

not yet diagnosed. No pa ti ent would be allowed to remain here more than three days. 

A rew physi cians retained under their own 

care patients who should have been sent 

to the division hospital, some or whom 

were in serious condition, at limes as the 

result of a misdiagnosed illness. The presence or these men in camp only helped 

spread typhoid rurther among their comrades. The restri ction on the use of the regimental racility also led some sick orricers 

and enlisted men to seek medi cal ca re in 

jacksonville rrom private phYSiCians, who 

insisted that the illness involved was 

malaria rather than typhoid; their error 

was established by blood tests that suggested that only 2 percent or fever cases 

we re surfering rrommalaria and by a sllldy 

or 50 patients sent nonh rrom Florida ror 

testi ng at Fort Myer.'s 

Although typhOid rever was the predominant disease in the Army's camps, 

medical orricers also had to deal with other 

hea lth problems, some calling ror the services or specialists. No ti cing that many or 

his patients had very "bad teeth, and other 

troubles of the mouth," Colonel Maus assigned Hospital Steward j. W. Horner to 

work as the corps dentist, with an acting 

hospital steward to assist him. The demands made upon Horn er's time were so 

great that he co uld care ror on ly a rracti on 

o r the men who sought his aid. The dentist was th e only Hospita l Corps specialist 

to be obtained ror th e VII Corps, but Ma us 

round it wise to deSignate one or his 

brigade surgeo ns, Maj . William 5. Bryant, 

179 

LOUIS M. MAus 

to runction as the co rps "aurist" (ear specialist) and a co ntract surgeon,j ohn Ling, 

as "oculist." Maus beli eved that through 

the aid or these specialists, many men we re 

relllrned to duty who otherwise wo uld 

have been discharged from the Army. 

Maus' appeal ror th e appointment or a veterinarian and a veterinarian's assistant to 

the corps was ap parently less successru l. '· 

50 many or the VII Co rps survivo rs or 

the typhOid epidemic we re debilitated that 

a convalescent hospital was fina lly established ror them in july at Pablo Beach, a 

resort sixteen miles rromjacksonville. Despite instructions LO regimental surgeons 

that no one who was actively ill was to be 

sent there, some who were not yet convalescent arrived at the new hospital. A rew 

more came down with typ hoid while th ere, 

necessitating the renting or a 20-bed cottage and the aSSignment of a surgeon rrom 

the vo lu nteers to run it. In October, when 
180 TH E ARMY MEDICAL DEPARTM ENT, 1865-1917 

;f~~ Ii, 

~'~~ ./1 

/ 

MEDICAL CARE AT J ACKSONVILLE, where Sisters oj Charity nursed patients 

a hospital train became available to take 

conva lescents back to th eir hometowns, 

th e popularity of the Pablo Beach faCility 

began to wane. It was closed in November, 

after sheltering a total of 1,400 men' o 

Whil e preparati ons for the invasion of 

Cuba were under way, the VIl Co rps experienced supply probl ems as had the I and 

III Co rps at Chickamauga. In th is instance, 

delays in meeting VII Co rps needs resu lted 

from the prior claims of the V Corps, abou t 

to embark from Tampa. The VII Co rps 

fill ed th e requirements of its first fi eld hospital from Tampa and therea fter from purveyo rs in New York, St. Louis, and Washingto n, D.C. After mid-June, with supplies 

comin g in when needed and in abundance, 

Colonel Maus rented a building in Jacksonvill e to se rve as a corps supply depot. 

The Red Cross and other "benevolent societi es and individuals" provided some aid, 

always in the form of supplies; Maus did 

not beli eve that the Red Cross wou ld keep 

the necessa ry reco rds properl y if it were to 

follow Civil War precedents and estab lish 

its own hospital. " 

The first trainload of sick from Tampa 

arrived at the Fort McPherso n general hospital near Atlanta on 14 May and was 

housed with the evacuees from camps in 

the Deep So uth in a barracks and the post 

hospital. By the end of August 1,244 pati ents, most of them from Tampa, had go ne 

through this hospital, which eventuall y 

held 922 beds. Ironica ll y, the innux of sick 

and of medi ca l sta ff to care for them set the 

stage for a typhoid epidemic at a post that 

might otherwise have escaped it, for sa nitation problems grew as the populati on of 

the fort increased. Sewers became clogged 

with "paper of all kinds, socks, handkerchi efs, and even d rawers .... The woods 

became full of deposi ts made on the surface of the ground and these were washed 
DISEASE AND DEATH IN U.s. CAM PS 

into the brook whi ch suppli ed water to the 

bathing pool. " Despite warnings, men 

drank from the pool, and disease was soo n 

running rampant. 22 

Camp Alger 

Camp Alger, established in mid-May 

1898 in Virginia seven miles from Washington, D.C., was farther north than any of 

the other training sites and much smaller 

than Camp Thomas, but conditions there 

resembled those in camps farther south. 

Because \I Corps units came and went 

throughout th e summer, the number of 

men serving there under Maj. Gen. 

William M. Graham," the corps' commanding genera l, varied from roughly 

18,000 in May to a peak of more than 

23,500 inJune. For most of the time Camp 

Alger was in operation , the II Co rps was 

divided into but two divisions; a brigade 

formed on 2 August was designated "the 

Second Brigade, Third Division, " but was 

ordered to report for temporary duty with 

the 1st Division H 

Girard , now a lieutenant colonel of the 

volunteers and the chief surgeo n of the Il 

Corps, and, except for shan periods of 

time, the only Regular Army physician at 

Alger, was co nfronted with a "Herculean 

task." He reported that he had to teach the 

raw troops that crowded into the camp 

"how to procure food, water, fu el, clothing; to carry out ordinary principl es ofhygiene; in addition to this, to organize two 

large division hospitals, equip the hospital 

department of several large commands for 

active campaigns; to transfer, organize, 

clothe and equip a hospital co rps of abo ut 

seven hundred men, and to put them 

through some instruction. " His problems 

were magnified bya water shortage and the 

181 

ALFRED C. G illARD 

fact that, once again, many regimental surgeons were ca reless about sanitation and 

their colonels often ignored any recommendations th ey might make. The suggestion that each soldier in the 11 Corps 

cover his feces was for the most part ignored until early August, when an order 

was issued "enforcing this necessa ry sanitary measure. " Many soldiers did not 

bother with the latrines, and thus "by the 

careless and filth y habits of the men the 

woods surrounding the camp became generally the receptacle of feca l matter. Sentinels who were placed to prevent this use 

of the surroundings of the camp fa il ed to 

report their own comrades." 25 

Colonel Girard's initial problems were 

exacerbated by the fact that many regiments reported to Camp Alger without 

hospital tents or medicines, even though 

Surgeon Genera l Sternbe rg had warned 

state governors that he could not provide 
182 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

adequate supplies for vo lunteer units on 

shan notice. Girard was thus forced to establish adivision hospital immediately and 

to obtain an order from General Graham, 

compelling all units to contribute to its 

suppli es. The compl aints of regimental 

surgeons angered at having to depl ete their 

SLores drew newspaper reporters. As a result, like so man y other Army surgeons, 

Girard was, in his words, "held up to the 

horror of mankind .1l 26 

Among the other handicaps under 

which Girard was working was his mistaken impression that the en tire II Corps 

was to go overseas at once. Unaware that 

Camp Alger was to be a trai ning camp, he 

initially did not allemptto provide the division hospital with all th e equipment it 

would need if it were not to serve as a field 

hospital. In his haste to prepare fi eld hospitals, he also ignored th e unsanitary location of tents and privies. In late June, 

when three of the corps' nine brigades 

began moving from Camp Alger to the 

Caribbean, Girard was able to send a hospital with th em only by once again depri ving regimental hospitals temporarily 

of much of their suppli es." 

After an inspection o f Camp Alger early 

inJul y, Ll. Col. Charles Smart, head of the 

Sanitary and Disbursing Division of the 

Surgeon Genera l's Offi ce, concluded that 

the disease rate was low, but typhoid broke 

out soo n after his visit. Colonel Girard 

stated that cases were soon so numerous 

that he was never sure of their exact number. Some who felt ill went on leave before 

their condition could be evaluated, and 

others were removed to the nearby Fon 

Myer hospital befo re an accurate diagnosis 

could be made. Here, too, some physicians 

believed that th e prevailing disease was 

malaria , while others apparently reso rted 

to the old Civil War diagnosis, typhomalaria. Girard, however, insisted that typhoid was the prinCipal problem and that 

th e troops here, like those of other camps, 

had already been infected with itwhen they 

arrived. A careful but belated study of the 

diseases amicting the II Corps suggested 

that Girard's diagnosis was correcl. 2S 

The evacuati on to Fan Myer, onl y ten 

miles from Alger, was initially made by ambulance, butthe toll eventuall y became so 

great that the Medical Department had two 

hospital cars placed on the local trolley line 

to move the sick. Although a vacant barracks was added to the Fon Myer hospital, which was then upgraded to a general 

facility, it was not ready for such a sudden 

innux of patien ts. After 200 patients had 

been sent there, Colonel Girard was ordered to refrain for a week from sending 

more. At some point the Red Cross came 

to his aid , establishing both a hospita l at 

Camp Alger and a diet kitchen at Fan Mye r 

and providing trai ned female nurses 

whose care \vas, in G irard's opinion, "far 

superior to any whi ch could be given ... 

by untrained men of the Hospital Corps." 

Thereafter, since he never had more than 

600 sick at anyone time, Girard believed 

that he had enough equipment to care for 

patients satisfa cto ril y in camp. He therefore sought and ob tai ned Surgeon Gene ral 

Sternberg'S permission to reta in his patients, despite an initial shonage of medical suppli es resulting from the inadequacy 

of regimental resources. 29 

Colonel Girard devoted much time 

while at Camp Alger to dealing with the 

problem of hospital attendants. He had no 

ambulance company, and beca use of the 

difficulties invo lved in obtaining hospital 

corpsmen by details from the line, General 

Graham allowed him to recruit outside the 

Regular Army. Having managed to win 

over the colonel of an Ohio unit to his 
DISEASE AND DEATH IN U.S. CAMPS 

point of view, Girard received that olTi cer's 

complete cooperation in assigning men 

[1'0111 his regiment to hospital service and 

in employing some of his noncommissioned officers in a recruiting program. 

This effort was so successful that Girard 

was able to form a reserve company of 

co rpsmen after he had fill ed the regular 

quota for the un its at Alger. Having observed that few regimental medical officers 

were capabl e of commanding a Hospital 

Corps unit, Girard obtained Graham's permission to have the Quartermaster's Department officer routinely assigned to each 

d ivision hospital assume this responsibility. He also established a training program 

for his new hospital co rpsmen, but in late 

July the II Corps was in night from the diseases of Camp Alger, Girard later repo rted, 

"frustrat[ingl this design. " 30 

Retreat From Disease: New Camps 

The camps set up initi ally for the army 

ga thering to fight the Spanish had been regarded as temporary. The campsites had 

been chosen with little forethought-but, 

it was rumored, with considerable attention to political considerations-and the 

accommodations had been loca ted with 

little appreciation for the san itary requirements of large groups of men and without 

any notion that these men wou ld be rema ining there for any length of time. No 

plans had been laid for the management of 

units that did not go overseas when these 

camps were created. Many difficulties originated in the haste with which these camps 

were established, and the mere passage of 

time eased those caused by supply shortages or a lack of famil iarity with Army routines. Furthermore, the typhoid epidemic 

was gradually burning itself out as in183 

creasing numbers of men acquired temporary immunity through contracting the 

disease. Perhaps most important was the 

fa ct that the disaster that had resulted from 

ignoring the advi ce of Army physicians 

concerning san itation had given added 

force to their opinions." 

The end of the fighting in Cuba on 17 

July and the forma l surrender of the Spanish at Man ila on 14 August did not lead to 

immediate demobili zation, since troops 

were needed to serveasan occupation force. 

Furthermore, when the vo lun teers who responded to the call for men in the spring of 

1898 were mClstered out, camps had to be 

established for the equally green vo lunteers 

who replaced them." No ne of these men 

co uld be kept at the disease-ridden camps 

in the United States, and thus, as the summer progressed, many unils were sent in 

some haste to new ones. All offi cers involved in these efforts attempted to put the 

lesso ns of the preceding weeks to work; 

they prepared for the arrival of troops well 

ahead of the event, chose sites with greater 

consideration for the size and purity of 

wa ler supplies, had tents more widely 

spaced and latrines located farther from 

kitchens and mess halls, and more strictly 

enforced sanitary discipline. "Time and experience," as one surgeon concluded, had 

at last taught "offi cers and men the best 

methods for caring for themselves." 33 

Those responsible for th e initial move 

of the II Co rps' 2d Division from Camp 

Alger apparently made the decision to 

leave in mid-Jul), after concl uding that the 

camp, the site, and the equipment were 

thoro ugh 1)' infected. "Suddenl y ... one 

night" these Illen received orders Lo march 

the next morning to Thoroughfare Gap, 

Virgini a, whi ch they did in spite of inadequate food suppli es. As they progressed, 

those who fell ill were sent back to a fi eld 
184 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

hospital set up at BrislOw, Virginia. By the 

time they reached their new camp in Pennsylvania, Camp Meade, they appeared to 

have left typhoid behind." 

The II Corps' 1st Division marched to 

Dunn Loring, Virginia, when it left Camp 

Alger, sending diagnosed cases o[ typhoid 

back to Fort Myer with twenty-five men o[ 

the reserve Hospital Corps company detailed lO assist in their care. When the decision was made on 14 August to move 

those o[ the command who were still 

healthy to Camp Meade, the men benefited 

[rom greater forethought than had those o[ 

the 2d Division. They went by train, and be-

[ore they left, an advance party that included 

Colonel Girard went ahead lO inspect the 

area. The inspection revealed that water 

supplies were "precarious" in quantity but 

pure-[ortunately, Girard believed, because 

once the men arrived, most o[ them ignored 

orders to use nI ters. By the ti me the move 

had been completed, the disease rate in the 

1st Division had also begun to drop, although in the confusion and with patients 

scattered in hospitals [rom Fort Myer to 

Camp Meade, Girard had to abandon his 

training class [or hospital corpsmen." 

Colonel Girard had reason lO hope that 

the disease rate would remain low at the 

new camp, which was designed with the 

experiences o[ Camp Alger in mind, and 

that his troubles would be at an end. General Graham transformed everyone o[ Girard's recommendations into an order. All 

tents had been boiled and all blankets used 

by typ hoid patients disinfected by steam. 

Rules concerning sanitation were stri ctly 

enforced, and a contract surgeon was assigned responsibility [or inspecting latrines 

on a regular basis. Nevertheless, despite the 

[act that conditions here were almost ideal, 

the new and inexperienced volunteers who 

replaced those mustered out [rom Camp 

Meade brought typhOid with them [rom 

their state camps, and the sick rate once 

again began to climb. It is likely, too, that 

among the troops [rom Alger were seemingly healthy typhoid carriers. The hospitals were soon fill ed, and new cases were 

transferred to civilian hospitals in and near 

Philadelphia. The 11 Corps' 1st Division, 

which reported 893 admitted to fi eld hospitals at Camp Alger, had 687 admitted to 

the division hospital in October, and the 2d 

Division, which had a lOtal o[ 594 admitted to the hospital while it was in Virginia 

and at Camp Meade up until the end o[September, had 668 in October. The mustering out o[ so many regiments and their replacement with new units also brought a 

return o[ Girard's probl ems with untrained 

hospital corpsmen.'6 

The IV Corps, created to organize the 

various regiments left behind by the V 

Corps, also moved many times in the summer o[ 1898 without escaping disease. 

When its first hospital, a 200-bed division 

fa cility, opened in Mobile, Alabama , 

among its patients were nine typhOid victims. Once the corps moved to Tampa, 

Florida, where sanitation was poor, the 

sick rate was soon soaring. In July, after 

some IV Corps units sa il ed [or the 

Caribbean, the remaining men were 

moved to Fernandina because o[ their continuing high disease rate, but since physicians were still powerless to enforce sanitary regulations, sinks there were soon "in 

an indescribably nIthy condition. " To reli eve the division hospitals, many patients 

had lo be evacuated by hospital train to 

Fort McPherson. In August the IV Corps 

was ordered to Huntsvill e, Alabama, where 

a second hospital was established. The 

hospital train then periodically ran [rom 

Huntsville to Fort McPherson to remove 

the sick and wounded." 
DISEASE AN D DEATH IN U.S. CAMPS 

By contrast, the move from Camp 

Thomas in late August and September of 

those men of the I and III Corps who were 

not sent to the Caribbean apparently attracted littl e unfavo rable comment. Once 

again, those who were obviously sick were 

left behind in the old camp's hospitals. 

Even though for a whil e men continued to 

fall ill, conditions at their new and small er 

camps in Tennessee, Alabama, and Kentucky were regarded as excellent, and disease rates began to drop. The camp at Lexington, Kentucky, in particular, became 

known for the stri ct standards o[ sanitaLi on maintained there. 38 

With cold weather approaching, steps 

had to be taken to prepare for winter housing for all troops remaining in the United 

States. This had La be accomplished with 

the full kn owledge that diseases easily 

spread in the summer mighL be even more 

eaSily spread among men forced by the 

weather to spend more of their time Logether in a closed space, where the desire 

to keep warm might take precedence over 

ventilation. Whil e the new camps to which 

so many troops had been moved during 

the summer had represented improvements over the original camps, they were 

nOL always what could have been wished 

for. In September 1898, therefore, a military commission was named to study potential campsites for the Lroops sLill awa iting service as part o[ the occupation army 

in the Caribbean. Appointed to the commission were Theodore Schwan, a bri gad ier genera l in the volunteers, as its head 

and futu re surgeon general Robert M. 

O'Reilly, now a li eutenant colonel in the 

vo lunteers. Among the concerns of Lhe 

commissioners were water supplies, sanitaLion, drainage, and the climate." 

In ea rly October, while the commission 

was still at work, the Army reorganized the 

185 

vari ous corps created for the SpanishAmerican War, discontinuing the Ill, Y, and 

VI Corps,;o and reassembling the remaining men as the I, II, and IV Corps. Secretary of War Alger then ordered the movement of these co rps to their new southern 

camps to begin on the twenty-seventh, with 

the move La be carefull y managed so that 

no more than one regiment arrived at a 

camp in anyone day. The need to take "the 

necessary measures fo r plaCing the camp in 

good sanitary condition ... in advance of 

the arrival of the troops" was emphaSized." 

The high disease rates that had, La varying degrees, aflli cted the camps to which 

the va ri ous co rps retreated in the late summer did not reappear at the new southern 

sites. I Co rps troops found their camps in 

Georgia, where they moved in November, 

an improvement even over those at Lexington. The only typhOid cases enco un -

tered appeared among men being sent to 

Charl eston to embark for Cuba who drank 

water at a Georgia railroad station H 

Co ncern [or the hea lth of the 30,000 

men of the 1I Corps was so great that they 

were not allowed even to begin their move 

south from Camp Meade until mid-November, when the threat o[ yell ow fever 

had passed and the camps and their hospitals were entirely prepared to receive 

them. No time was fo und to give systemati c Lraining to th e men of the II Corps' 

Hospital Co rps company, and thus they 

had to lea rn by working with the female 

nurses assigned to the II Corps hospitals 

at the new camps in Georgia and South 

Carolina. Great attention was devo ted to 

san itation and, once again, Lyphoid disappeared as a major problem. Preparations to 

receive these men were not perfect; the 

pavilion hospital at Augusta , Georgia, 

proved to be of nimsy construction. The 

wall of one pavilion collapsed and another 
186 THE ARMY MEDICA L DEPARTMENT, 1865-1917 

took on a distinct list after a windstorm. 

The boards shrank, and during the winter 

the cold blew through the crevices that resulted. By December, however, the disease 

rates of each di vision were under 150, 

where they remained." 

The Vll Corps, unlike the other co rps 

se rvi ng in the East, did not leave the campsite in Jacksonvill e, Florida, until late October 1898, when it moved to Savannah , 

Geo rgia , whence it wou ld embark for occupation duty in Cuba. In spite of wet, cold 

weather the camps set up in Savannah, like 

th e others opened in th e fall of 1898, 

proved to be healthy. When the VII Corps 

shipped out in December and Jan uary, its 

camps were kept open, and when men 

began to return from Cuba and Puerto Rico 

in February 1899, they were sheltered at 

the same sites. The VII Corps was not mustered out until the fo llowing May, when the 

service of the volunteers o[ the summer o[ 

1898 came to an end." 

The few members of the 1 Corps that remained in the United States when most of 

the corps left [or Cuba had been assigned 

to the II Corps, and the I Corps was discontinued in J anuary 1899. By spring, almost all o[ the men o[ the Il Corps had also 

been mustered out. After having been organized into two divisions in the October 

reorganization and then ordered [rom 

Huntsv ille to Anniston , Alabama , the IV 

Corps, like the I Corps, was discontinued 

in J anuary 1899." 

The experiences of the summer o[ 1898 

led to major changes in overall policy for 

the Medical Department. Regimental hospitals again became respectable, and di vision hospitals were established principally 

to take their overnow. Camp medi cal officers were allowed to order freely from all 

items on th e standard supply table, and indi vidual preferences were given consideralion according to their merit raLiler than 

being dismissed out of hand. Because a 

shortage o[ mi croscopes had made ea rly 

and accurate diagnosis of typ hoid fever impossible, Surgeon General Sternberg ordered that every hospital, regardless of 

size, be issued one to ensure that this disease wou ld in the future always be identifi ed before it reached the epidemi c level. 

The disasters of the camps of 1898 wo uld 

never be repeated'6 

Camp Wi/wff 

One final camp was established at Montauk Point, Long Island , in August 1898 to 

receive th e V Corps after its night [rom 

Cuba. The fact that yell ow [ever cannot be 

spread without the presence of the Aedes 

aegyl'Li mosquito was still unknown, and 

the epidemi cs that amicted various U.s. 

ports earlier in the century had not been 

forgouen . As a result, authorities agreed 

that all troo ps returning from Cuba and 

Puerto Rico in th e late summer of 1898 

we re to be isolated at the new Camp Wikoff 

until phYSicians co uld be sure that yellow 

[ever would not break a lit among them and 

threaten the health of those who came into 

contact with them. Fear that tropical diseases no one co uld prevent would destroy 

the entire corps was Widespread. Since all 

concerned were apparentl y co nvinced that 

the onl y way to avo id such a calamity was 

to ship the men back to the United States 

immediately, the evacuation, like the invasion, was hastily plan ned and hastil y executed. When these "wan, sallow, and 

grea tl y reduced" veterans bega n th eir return to the United States in mid-August, 

an estimated 80 percenL were to some degree ill , and thus the need for hospitals and 

medical personn el wou ld be great. 47 
DISEASE AND DEATH IN U.s. CAMPS 

No time was allowed ror a careful and 

thorough preparation or the site where 

Camp Wikorr was to stand. Nor was time 

allowed ror dealing with the myriad problems that might arise. Among the greatest 

di rfi culties experienced rrom th e outset was 

supply. The arrival or the cars was orten delayed because the Long Island Railroad line 

to the site was single trac k and, accord ing 

to Wikorr's chief surgeon, Colonel Forwood, initially lacked "switches, side ways, 

platrorms, storehouses, or other racilities 

ror landing ... thousands or carloads or 

rreight, passengers, and material. " The 

Army had had to agree to rely excl usively 

on th is railroad ror all transport and to refrain even [rom using steamers to bring in 

suppli es in order to obtain the 5,000 acres 

on Montau k Point as a campsite. The railroad company did not begin to lay switches 

and sidetracks un til 6 August, a day before 

the arrival or the first or the camp's new occupants, V Co rps cavahy troops that had 

beenlert behind in Tampa, and neither lumber nor other materials were available to 

build the necessary accommodations.'s 

Mo re than hair or the men to occupy 

Camp Wikorr wo uld require hospital izati on, but the Medica l Departmen t's attempts to prepare ror their arrival were 

rrustrated both by the poor transporta tion 

system and by the inept management or 

shipping by the Quartermaster's Department; although ra ilroad cars carrying medical supp lies were properl y marked, many 

co ntainers were so la rge tha t they requ ired 

more than two men La move them , and 

none were labeled as to their contents. The 

result was long and tedious searches to obtain suppli es that were within reach.-Hl 

On 29 J uly, ordered to establish a 500-

bed "temporary tent hospital" at Montauk 

and to advise line orficers on the sel ecti on 

or campsites and water so urces, Colonel 

187 

Forwood worked rranti call y to ma ke the 

best or a bad situation. When lumber was 

fina lly obtained, carpenters railed to start 

to work because they wished to return to 

their homes each night and reared that they 

might be subj ect to the quarantine. Reassured on this subj ect, they struck ro r higher 

wages. No soo ner was this problem solved 

than rain began to pour down, turning the 

area into a quagmire that threatened to 

swallow the wagons hauling supplies.'" 

When the 4,000 cavalry troops rrom 

Tampa, [Ieeing their typhOid-ridden camps 

in haste, arrived at Montauk Poin t, no shelter or rood was available except that which 

they brought with them. Arter authorizing 

Colonel Forwood to telegraph his orders, 

Surgeon General Sternberg personally ordered the purveyor to rill them with great 

care, dispatched ten ts and hospital corpsmen to Wikorr, and rorwarded funds to alleviate the shortage or rood, especially or 

rood or good quality. On the eleventh the 

Red Cross started bri nging in supplies ror 

the genera l hospital, rrom whi ch other hospitals, including the division racilities accompanying returning troops, would be 

supp lied. In a short time an entire 15' by 

113' sto rage pavilion was fill ed. Other 

charitable organizations sent cooks and 

supplies or every kind. The Marine Hospital Service suppli ed Forwood with a steam 

sterilizer and a barge equipped to disinrect 

clothing and bedding [rom infected shi ps, 

whi le the preSident or the Long Island Railroad Company perso nally gua ranteed the 

prompt delivery or the sterilizer." 

Although matters had improved somewhat by 13 August, when the first 50 patients rrom Cuba landed, a representative 01 

the Massachusetts Volunteer Aid Association, who arrived two days later to assist in 

the care or returnees, was impressed by the 

conrusio n at the Wikorr hospitals. He re-
188 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

STERNBERG (l eft) AT CAMP WIKOFF, 

collductillg all illspectioll with chi ef 

swgeoll William H. Forwood (right) 

ported that "there were few physicians, 

fewer nurses, and fewer still hospital-corps 

men." Regular medical officers were neither 

trained nor experienced in hospital administration. The laundry was yet to be established, and dirty linen was piling up. Some 

wards were badly overcrowded, others 

sparsely populated. When physicians were 

transferred, wards were left without medical supervision for hours, and new patients 

were sometimes temporarily ignored. Visito rs began to pour in, complicating patient 

care, occaSionally misi nterpreting what 

they saw, and adding to the confusion. The 

Massachusetts volunteer concluded that 

"the absence of a firm, controlling hand always within reach" contributed to the diffi culties and that Colonel Forwood was 

sadly lacking in administrative tal ent. He 

also blamed some delays in correcting 

shortages upon the fact that Forwood, who, 

he believed, lacked the power to delegate 

authority, felt compelled to sign every order 

personally. " 

Transportation also continued to present seri ous problems. At one point no 

fewer than 220 railroad ca rs awaited unloading at the Montauk depot. Many of 

them had been there two or more weeks, 

and the suppli es needed by the physicians 

at Camp Wikoff continued to be "buried" 

in them. Moreover, items held in storage 

could not be promptly moved to the hospitals when needed because of a lack of 

transportation within the camp. No t surprisingly, Colonel Forwood, in defending 

himself later before the investigating 

Dodge Commission,53 struck out at the 

Quartermaster's Department for the inadequate nature of the support he received." 

In describing those aspects of the situation at Wikoff that were his responsibility, Colonel Forwood tended to paint a rosy 

picture. He reported that on 12 August, 

with four wards of the general hospital 

compl eted, "90 patients [were already] in 

bed under care of nurses, with all kinds of 

medi cal and hospital property in abundance. " With the weather good and carpenters numerous, construction was proceeding rapidly. The 210 patients in the 

general hospital on the fifteenth were enjoying a superfluity of both beds and supplies. Forwood had assigned a surgeon to 

supervise the unloading of patients from 

their ships, and since transportation remained a problem, he had placed a second 

surgeon at the railroad station to make sure 

that Medical Department supplies were 

unloaded and forwarded as expeditiously 

as possible. By the nineteenth the general 

hospital held 250 vacant beds, and Forwood had been abl e to guarantee each patient "as he landed from the ambulance .. 
DISEASE AND DEATH IN U.s. CAMPS 

hot soup and milk punch from the hands 

of the femal e nurses." " 

The general hospital was originally 

planned to include only eighteen pavilions, each co nsisting of six tents on 

wooden frames with wooden noors, but 

because of the large numbers of sick, two 

annexes were also eventually built. Although some comp laints arose about overcrowd ing, understaffing, and poor sanitati on, Colonel Forwood maintained that he 

always had enough tents and cots and that 

his only probl em in that regard was having tents set up and beds put in place. So 

sturdy was the construction of this facility 

that even extraordinarily heav)' rains and 

high winds fai led to cause damage. 56 

Within a few weeks the general hospital staff more than doubled in size. When 

the hospital population was at its greatest, 

it included 40 phYSiCians, 133 hospital 

co rpsmen, 50 male nurses, 329 female 

nurses, and 15 civilian cooks. Most of th e 

nursing staff, both male and femal e, were 

under contract. The surgi ca l wards, the operating tent, and th e hospital annex were 

run b)' the Sisters of Charity, some of whom 

were speciall y trained in th e ca re of surgical patients. Although physicians sometimes complained that fema le nurses 

"cou ld not appreciate that the doctor was 

supreme in his ward," most of them regarded these women more highly than 

th eir male counterparts. Colonel Forwood's efforts to increase the number of 

ph)'siciansassigned to him were often frustrated when those ordered to Wikoff never 

arrived, having managed to have their orders changed "for some reaso n or other." 

Neverth eless, the medi cal sta ff at Wikoff 

had, for the most part, a good reputation. 

The work done at Wikoff's su rgical facilities, organi zed and directed by Colonel 

Senn, was much admired. 57 

189 

The fea r that hospitalized patients 

among the returning troops might introduce yell ow fever into the United States 

led to the establishment of a second hospital at Wikoff, a detention fac ility where 

the sick and wounded from ships suspected of carrying yellow [ever infecti on 

could be held. This fa cility received its first 

patient on 15 August, and by the seventeenth 3 physicians and 6 hospital corpsmen were caring for 60 patients. As its population grew, its tents were put on frames, 

given wooden noors, and organized into 

pavilions li ke those in the general hospital. By the thirty-first, when its capacity 

reached 400 beds, fourteen such structures 

had been built, and another forty separate 

tents stood read)' for convalescents. The 

number o[ patients sent there tended to 

vary Widely, and it was difficult to meet 

sudden and large innuxes, especiall y when 

the deliver), o[ suppli es was slow. Despite 

the aid of th e Red Cross, Colonel Forwood 

had to admit that in this hospital "the 

wants of patients, in spite of the best efforts of all , were not always promptly met. " 

The only 5 patients ever suspected of actually havi ng yellow [ever were released 

from quarantine on the twenty-fifth , and 

by mid-September, when roads, wells, 

electric lights, and telephone and telegraph lines were all in place and when no 

new patients were being admitted, the size 

of the staff co uld be reduced. On the eighteenth only 60 patients remai ned of the 

1,850 men who had passed through the detention hospital since 28 August, more 

than 1,l00 of whom had been ei ther [urloughed or returned to their regiments and 

onl), 62 o[ whom had died'· 

The sick continued to come to the other 

hospitals serving Camp Wikoff in overwhelming numbers throughout August. 

Although by the end of the month patients 
190 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

were being rurloughed home at the rate or 

200 a day and the ge neral hospital's capacity had been increased to 2,500 beds, it 

became necessa ry La organize three division hospitals with beds ror another 600. 

As September progressed and even these 

most recently established raciliti es fill ed 

up, more and more soldi ers had to be cared 

ror in regimental hospitals.'9 

Because or the co ngestion at the Camp 

Wikorr hospitals, Surgeo n General Sternberg permitted their patients to be sent to 

civilian hospitals in such cities as New 

York, New Haven, Co nnecticut, and Providence, Rhode Island, which were more 

comrortable than "the bl ea k, temporary 

hospitals at Montauk. " To expedite the 

transrers, he sent Colonel Greenlear to the 

camp on 8 September, returning Colonel 

Forwood to his prewar assignment at the 

Soldi ers' Home in Washington, D.C. 

Greenlear assembled twenty-two ambulances to take patients to the train or boa t 

that wo uld carry them to their destinations. Long waits at the railroad depot by 

men weakened by disease led to many 

complaints, but finally an a rrangement 

was made that rorbade the sending or patients rrom the hospital until the chief surgeo n had bee n in rormed that a car awaited 

them at the stati on. Two private citizens 

paid to have railway cars speciall y 

equipped ror convalescents, while the Red 

Cross and such organiza tions as the Massachusetts Volunteer Aid Associati on provided boats to move pati ents rrom Mo ntauk. By transrerring pati ents and granting 

rurloughs, the Medica l Department so reduced the hospital populati on at Camp 

Wikorr th at on 10 September 1,000 beds 

were vaca nt. Two or the three d ivision racilities and all but the main section or the 

general hospital were th en closed.'" 

Pressure upon the Med ical Depa rtment 

to send pati ents home or to institutions 

near their homes was great, but when conva lescents collapsed on the way, criticism 

was loud. Colonel Greenlear decided to appoin t medical boards to determine which 

patients were strong enough to endure th e 

journey. Relapses were also rrequent 

among pati ents who had return ed to their 

homes in apparent good health , onl y to rall 

seriously ill aher too much welcoming celebrati on. Even on the trains taking th em 

home, some or these men were orrered rood 

they should not eat, and rami lies and 

rriends were wa rned that "many soldiers 

who had escaped the danger or the ba ttlefield have been killed by kindness at 

home." Several physicians commented on 

the dangerous type or malaria afni cting so 

many returnees, one Massachusetts physician bl aming these ratal and near-ratal relapses on "what we call aevisto [sic] autumna l malari a," caused by the highly 

dangerous falciparul11 parasite, olle rarely 

encoun tered in New England 6J 

As autumn approached, Surgeo n General Sternberg was rorced to consider a new 

probl em, the protection or the sick remai ning at Camp Wikorr aga inst "the 

chilly nights and high winds of September. " Acting on a plan to winterize the tent 

pavilions, he ordered "window sash, 

SLoves, hard ware, etc.," for five wards. 

Co nstructi on was promptly undertaken 

and apparently completed by 24 September, but the pop ulation or both camp and 

hospital was already dwindling rapidl y. All 

but seven regular regiments had left Montauk Point before the end or September, 

and rewer than 400 patients remai ned hospitali zed. On 3 Octo ber, when the V Corps 

was disbanded, less than 300 sick, all seriously ill , remai ned in the camp's hospitals, to be transrerred when well eno ugh to 
DISEASE AND DEATH IN U.s. CAMPS 

withstand the journey. On the sixth 

Colonel Greenleaf left to inspect military 

camps in th e South, and on 16 November 

the general hospita l fin ally c1osed 62 

Despite the hardships experienced at 

Montauk Poin t and the harsh criticism 

that some civili ans leveled at it, up to 30 

September on ly 257 of th e 21,870 who had 

gone th rough Camp Wikoff, of whom 

more than 17,500 were returnees from 

Cuba , had died. Although 10,000 patients 

had been cared for in the general, division, 

and detenti on facilities and another 4,000 

in regimental hospitals, n o maj or epidemi cs had deve loped among its weakened inhabitants.

63 

The Typhoid Board 

The devastating nature of th e epidemics 

that had swept Army camps in the summer of 1898 could not be ignored. Surgeon 

General Sternberg'S response to the challenge invo lved initiating a new approach 

to th e study o f disease. In August he named 

the first of a series of boards that wo uld be 

appo inted in the decades to come to investiga te the diseases that threatened the 

Army. The new Typhoid Board would 

study the way in which typhoid fever 

spread and means of preventing its transmission. To head it, Sternberg named 

Major Reed , whose preparation fo r the task 

he was about to undertake dated back to 

the days of his graduate studies at Johns 

Hopkins (1890-1891), which included 

the effec ts of typ hoid fever upon the 

human body. Sternberg had recogni zed 

Reed's expertise by appointing him to 

teach bacteriol ogy at the Army Medi ca l 

School in 1893. The 47-year-old Reed , "a 

man of charming personality" as well as "a 

polished ge ntleman and a scientist of the 

191 

...-

V ,CTOR C. VAUG HAN 

highest order," according to a colleague, 

was joined on the Typhoid Board by two 

surgeons of the U.S. Volu nteers, Major 

Vaughan, a professor of medicine at th e 

University of Michigan who had survived 

yell ow fever in Cuba, and Maj . Edwin 

Sh akespeare, who had stud ied tropi cal diseases in India and SpainM 

On Sternberg'S instructions, th e three 

physicians inspected all the maj or campsites in the United States. After examin ing 

such mattersassanilation , tent placement, 

and co nditions in genera l hospita ls, and 

after interviewing the medical officers involved , the members of the board returned 

to Washington in October to begi n thei r 

deta iled examination of camp records. 

They traced the progress of each soldier 

who might have had typho id through 

every hospital, military or civilian, that 

cared for him. Among the camps they studied was Camp Alger, where the surgeons 
192 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

caring for the troops had no microscopes 

and thus had been unable to examine the 

blood of their patients for evidence of 

malaria parasites. Medical officers had, 

therefore, found it easy to diagnose dubious cases as malaria rather than typhoid, 

even though the prevailing disease had not 

responded to quinine. Vaughan co ncluded 

that medical officers at Alger might have 

been frightened by the idea that the disease was typhOid, and he pronounced their 

suggestion that dengue was the principal 

disease at some camps to be "too absurd to 

receive serious attention ." 6S 

The Typhoid Board set up laboratories at 

each camp and sent experi enced bacteriologists to work in them. As a result, th e 

board could achieve far greater accuracy in 

its disease identifications than had been 

possible for camp surgeo ns. Although th e 

Widal test often failed to indi cate the presence of typhoid until the case was far progressed (the immune response developed 

strength with time) and a diagnosis of 

malaria could be missed if only a few plasmodia were present in the blood, the board 

was able to co ncl ude that malaria had never 

been a serious problem for U.s. troops in 

the United States. The board's research also 

suggested that as many as 82 percent of the 

sick in the Army in the United States had 

typhoid, that the disease was often presem 

in units before they reported to federal authorities, and that the fa ilure to diagnose it 

correctly and promptly had contributed to 

the epidemic.'" 

The Typhoid Board decided that, popular opinion to the co ntrary, polluted wa ter 

played only a minor role in the spread of 

typhOid. Whil e acknowledging that wa ter 

"always [had toJ be kept in mind" as a vehicle for the disease, Reed and his colleagues confirmed Sternberg'S theory that 

nies moving [rom latrines to kitchens and 

food supplies posed a greater danger. Men 

who emptied bedpans [or sick comrades 

and did not wash their hands before handling food transmitted disease, and those 

who dipped water [rom streams with contaminated hands endangered th eir own 

health and polluted the stream as well. 

Spread of th e disease also resulted [rom the 

failure to segregate those diagnosed as having typhOid from other pati ents. Those 

who were responsible for sanitation in the 

camps were all too often poorly trained, 

too few in number, and lacking adequate 

authority to enforce the necessary measures. Reed recognized the phenomenon 

of th e typhOid carri er when he pointed out 

that "the individual who ... acts as host 

for the imroduction of the bacillus need 

not necessaril y develop the disease himself, he may at the time be immune and yet 

his excretions may be in[ectious." 67 

The board despaired of ever being able 

to prevent epidemics by sanitation alone. 

Vaughan noted that he could not "help but 

feel that the engineer corps was largely responsible for the 1898 tragedy at Chi ckamauga, but th e ignorance of camp san itation at that time displayed by the army 

engineer was surpassed only by that o[ the 

line offi ce r. " Realizing that practices that 

favo recl the spread of typ hOid would continue as long as line offi cers treated the 

warn ings o[ medical officers with contemp t, the Typhoid Board concluded that 

immunization might be a more effective 

approach to preventing typhOid in the 

Army than sanitati o n alone. 68 

By the spring of 1899, although the 

money all otted [or this work had run out 

and Reed had been given another assignment, Vaughan and Shakespeare cominued to organi ze the dala lhey had coll ected 

on their own. They brought out a preliminary report in 1899, bUl in 1900, before 
DISEASE AND DEATH IN U.S. CAMPS 

the final version could be issued, Shakespeare died. Reed worked on the report 

only briefly in th e summer of 1900, since 

he was by then involved in his study of yellow fever, and thus Vaughan alone was 

available to compl ete a summary of the 

board's conclusions. Since the summary 

showed both that typhOid was too widesp read throughout the general population 

for the Army to be able to prevent the appearance of isolated cases and that the disease could be spread in many different 

ways, the full report with supporting data 

was eagerly awaited. An abstract was published in 1900 and the complete repo rt 

four yea rs later. By this time Reed, too, was 

dead, and the definitive document detailing the findings of the Typhoid Board was 

largely the work of its only survi ving member, Victor Vaughan69 

The Dodge Commission Investigation 

By the late fall of 1898 almost all the 

men once inhabiting the huge training 

camps had been sent to other camps and 

stations or to homes, famili es, and civilian 

life, and Secretary of War Alger had been 

suffiCiently impressed by their sufferings 

to require weekly inspections of all camps. 

More time was all owed commanders to 

choose their campsites, and care was taken 

to avoid massing large numbers of men at 

one location. In Colonel Greenleaf's opinion , postwar division hospitals were for the 

most part well run, and some were "models of neatness. " Supplies were plentiful, 

and th e sick were well cared for. 70 

But well-run, well-supplied, and clean 

hospitals were far more easily achieved in 

time of peace than in time of war. The lesson aboUl the possible consequences ofhostilities lightly entered into had cost dearly. 

193 

The inroads that disease had made among 

the men of the Army's camps of the summer of 1898, increasing the Army's death 

rate more than fivefold over the peacetime 

rate, would not be forgotten , especially at a 

time when more was expected of medicine 

and of those who practiced it than had been 

the case during the Civil War. The question 

of how this disaster came about would long 

be the subject of debate and speculation far 

beyond the boundaries of the Army Medical Department. 

Criticism centered upon what was perceived as administrative incompetence or 

callous neglect. The competence of the 

Army's physicians was not called into 

question. The collection of so many men 

in camps during the summer months rOf 

so long a period led to scenes enco untered 

during the Civil War only at the wo rst 

prison camps. Those who throve o n sensationalism found much to feed upon at 

the disease-ridden camps and especially at 

Camp Wikoff, where relatives so ught to 

comfort the newly returned veterans. In 

addition to the disease rate and the occasional lack of bare necessities, a general 

fa ilure to understand the way in which the 

military operated led to public outrage. In 

civilian life, hospitals were still used 

mainl y by th e ex tremely poor, and presumably few of th ose who co uld visit their 

relatives at an Army facility were familiar 

with th e nature of hospitals of any kind or 

with the care provided there. Some problems that led to the loudest outcry resulted 

from the failure of well-intended civilians 

to understand that their husbands and 

sons simply could not be cared for in a military situation as they would be if they were 

injured or fell ill at home. 

President McKinley responded to the tumult raised by the management of the war 

and the horrors of the camps by appoint-
194 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ing a commission, chaired by Maj. Gen. 

Grenville M. Dodge,7l to "investigate all 

cha rges of cri minal neglect of soldiers. 

and to make the fullest examination o[ the 

administrati on of the Wa r Department in 

all of its branches." After several months of 

inquiry, the comm ission concluded thaL the 

nation's leaders in bot h the legislative and 

executive bra nches were to a large ex tent 

responsible [or the situation that led to so 

much unnecessary suffering and death. 

Co ngress had not granted the funds necessa ry to prepare for war until the war was 

under way. A majority of the commission, 

including Dodge himself, did not believe 

that Secretary o[ Wa r Alger was to blame 

fo r the fa il ures of th e Spanish-American 

War. To present a united front, they compromised with the dissenters and stated in 

their official report: "In the judgment of the 

commission there was lacking in the general admin istration of th e War Department 

during the continuance of the War with 

Spain that complete grasp of the situation 

which was essentia l to the highest efficie ncy and d iscipli ne of the Army." 72 

The commission went on to highlight 

speci fi c problems and , in some instan ces, 

to make recommendations [or their solution. After noting that the lac k of funds to 

prepare fo r war before it was declared had 

made it impossibl e for the Medi cal Department to accumulatesufficientsupplies 

to meet a demand that proved to be higher 

than anticipated, the commission recommended that enough for four years be kept 

in reserve. It also pointed out that the department's inability to control the transportation of its supp lies had con tributed 

to the supply shortage . It observed that the 

shortage of trai ned physicians had prevented the necessary frequent and thorough inspection of camps and hospital 

sa nitation. The commission urged that a 

reserve of trained nurses be created LO prevent a recurrence of the shortage experienced in the summer of 1898 and that 

plans be laid to create a volunteer Hospital Co rps in the event o f another war. All 

physicians, in the commission's opinion, 

should be able to draw whatever food their 

pati ents needed without regard to the commutation of rations. Since administrative 

co nfusion had also contributed to the department's problems, anent ion should be 

given to simplifying routines and eliminating unnecessary red Lape.

7J 

Surgeon Genera l Sternberg's preoccupation with details that co uld have been 

ha ndl ed by his subord inates may have limited his ability to deal with the difficult situation that had been imposed on him from 

above. He may not have fu lly app reciated 

either the magni tude of the problems medical offi cers in the fi eld were experiencing 

or the possible benefit that might have resulted from his using the weight of his position and personal reputation to increase 

their infl uence wi th the line. The issuance 

of circulars was certain ly no substitute for 

perso nal inspection trips, which the surgeo n general apparently frequently asSigned to his subordinates. Neverth eless, 

in creating the pioneering Typhoid Board, 

Sternberg demonstrated his ambition to 

utilize the new medicine in the war aga inst 

tradi ti onal army diseases and his deep concern for the devastati on they caused in 

1898. 

Most of the Medica l Department's problems in the camps of the summer o[ 1898 

within the United States, however, had 

been too complex for any surgeon general 

to cure. Too many men totally unfamiliar 

with military life were gathered too rapidly 

by a government as heedless of the desirability of planning as a schoolboy playing 
DISEASE AND DEATH IN U.s. CAM PS 

wiLh his LOy soldie rs. Too liltl e Lime and effOrL were devoLed LO impressing upon 

masses of overenthusiasti c young men the 

impo rLance of sanitati o n. Too few Army 

surgeo ns were bo th Lrained in the newly 

developed Lechniques by which typhoid 

co uld be disLinguished from mala ria in Lhe 

living paLienL and provided WiLh Lhe equipme nL necessary LO Lhis work. WiLh an understanding of Lhe rol e of Lhe Lypho id carri e r sLili in Lhe fULure, pro pe r precautions 

to limit Lhis mea ns of s preading the d isease 

co uld nOL be taken . In add iLio n , few in positio ns of autho riLy seemed to have any appreciaLi o n fo r the facL Lhat hosp iLals for 

195 

Lhousands of paLi enLs co uld not be c reaLed 

overnight, nor cOmpeLe nL hospiLal sLaffs 

ga Lh ered LO run Lhem in an instanl. Und er 

such co nditi o ns, a small gro up of professio nal medica l offi cers, no mailer how 

greaL their dedi ca Li o n and skill, could nOL 

hope LO overcome Lhe zea lous and impulsive enthusiasm of a mass of ama teur soldiers who seemed LO regard saniLaLio n as 

unpatrio tic or, al leasl, an unmilitary CO Ilcern . The Army Med ical DeparLmenL, because ofiLS d irect responsibility for th e prevention and treatment of disease, became 

a convenie nL and popularscapegoaL in Lhis 

"splendid lillie war." H 
NOTES 

1. War Department , fA milial } Repol'f of fhe ur~ 

geoll Geueral, u.s. Army, to fhe Secretmy of W(lr, 

1898, PI'. 11 0- 12 (first quotation), 169 (second 

quotmion), and 1899, p. 38 (hereafter ci led as 'NO, 

~oJSG, date); "Some of the Medical Lessons of lhe 

War," p. 485; vValter Reed, Victor C. Vaughan, and 

E. O. Shakespeare, Reporl s Oil Ille Origill ali(I Spre(lt/ 

oj Typll oid Fever ill U.S. Mili/my Call1ps During file 

Sp(IIli sll War of 1898, 1:42-43, 106-07; United 

Slates, Congress, Senate, Rellorf oj the (Dodge) COIII ~ 

lIIissiOlI To hl ves/igate fil e COIlc/uet of fhe War DeparL ~ 

/II enl in Ihe War With Spail. , 6:2988 (hereafter cited 

as Dodge COlllmission Repor/); Victor C Vaughan, A 

Doctors I'vJelllories, p. 390; Dale C Smith , "The Risc 

and Fall of )' pho~Ma la ia ,n pp. 3 l 6-- 19; Manha 

Dcrthick, The Nalioll{ll Guard ill Polilics, p. 19;John 

Duffy, The SallitariclIIs, pp. 128, 131-32, 190. 

2. WD, ARojSG, 1898, p. 102, and 1899, PI'. 

24-25; Dallas Bache, "The Place of the Female Nurse 

in the Army," p. 3 16; Doc/ge Commission Report , 

7:3 l 68-72; Nicholas Scnn , Medico~sll"gjc{ll Aspecls 

oJI.ll eSjJc/IIish Americc/ll WCII", p. 320; in Record Group 

(RG) 12, Na tional Archives and Records Adlllini s~ 

tration (NA RA), Washington, D.C: Ani ta Newcomb 

McGee Journal , Apr- May 1898, Entry 229, Extracl 

from Americall MOlllllly M(lgaz.illc , Emr)' 229, and 

Na rratives, IAnita Newcomb McGee!. pp. 9-12, 

Margaret Dunn , and Marga ret Berry. Emr)' 230. 

3. WD ,A RojSG,1898,pp.120-21, 126, 15 1,and 

1899, p. 40; Bache, "Female Nurse," pp. 312, 3 14, 

316; PerC)' M. Ashburn , A /-liS/DIY oflh e Medical De~ 

pClrllllCl1I of/he VIIi/ cd SfCll esArlllY. p. 17l (hereafter 

cited as HislDlY of 1\lID) ; Report of Commission To 

Investigatc Ihe Conduct of the Wa r, PI'. 67, 76, ~ 

crofilm Reel 6, \>Villiam R. Shafter Papers, Stanford 

University, Palo Alto, Cali f. (hereafter cited as Com 

Rpt , Mr Reel no., Shafter Papers, SU); Dodge Co ~ 

miss ion Report. 1:643-44, 648, and 4: 11 39-4 1. ; 

Charl es R. Greenl eaf, "The Organi zation of the Mcd ~ 

ical Department of the Arm)' in the Field," p. 200. 

4. WD, ARojSG, 1898, PI'. 9, 127 (quotation), 

1. 28-31, 15 1, and 1899, pp. 9-10; Bache. "Female 

Nurse," pp. 3 J 2, 314,316; Massachusells Vo lunteer 

Aid Associa t ion, The Worll oj Ihe Massachllselts Vol~ 

mlleer Aiel Association During fhe War Willi Spllill, 

1898, pp. IS, 82-83 (hereafter cited as MVAA , 

WOr/l); Ralph C. \>Villiams, Tile Ulli/ ed SWles Public 

Hcolill Serv ic<, 1798- 1950, p. 559. 

5. Senn , IIspects, PI'. 193, 267-68, 325; WD, 

ARojSG, 1898, PI'. 258, 260-61. 

6. R. Stansbu.")' SUlLon, A SIOIY of ChiclwmCluga. 

1'1'. 6-7, 13 (quota tion); War Departmenl, CarrespollclClICC RelcHi/lg 10 Ihe W(II· Wi/h Spain . .. , 1:36; 

idem, ARojSG, 1898, PI'. 163, 167- 68, 174-75, 177, 

179-81; Reed eta\. , R<porfS, 1:42-43, 106-07; Dodge 

Commission Reporl , 1:607-08, 6 12-13, 3: 183, 

4:860 , 1135, 1354, and 6:2968-69, 2982-83; Senn , 

Aspecfs, pp. 44-45. 

7. SutlOll ,SIOIy, pp.I ,8, 1001.l (firslquot<ltion). 

12; Dodge COHllllissiOlI Repor/, 2:773, 3:26 l (second 

quotation), 545, 547 (remaining quotations). and 

4:834-35, 1136-37, 1147, 1305; WD, ARojSG, 

1898,pp. 1. 63, 173-74; H. A. Haubold, "The Medical Aspects of Camp Management a1 hi ka ~ 

mauga," p. 585; Reed eta!' , Reporl s, 1:265, 267; Com 

Rpt , p. 66, Mf Reel 6 , Shafter Pape rs, SU; Vaughan , 

Memories, pp. 377,384. 

8. WD, ARojSG , 1898, 1'1'.169, 173, L75 (first 

quotation), 180-8 1, and 1899, p. 40; Haubo1d , 

"Medi cal Aspec ts," p. 585 (rema ining quotations); 

SUlIon, 5 (01)" p. 11; Reed et aI. , Reporls, 1:265, 267; 

Dodge COlllmission ~eporl , 3:194-95, 4:1314. 

9. Joseph J. CUITY, "On the Va lue of Blood Ex~ 

ami nations in the DiagnOSiS of Camp Feve rs," p. 

5 15; George Dock, "Clinical Patholog}' in the ht ~ 

ies and Nineti es," p. 679; Dodge Comlllissioll Repon , 

3:19 1, 194-95, and 4:832; Ashburn , Hi s/OIY oj MD, 

pp. 168-70, 178; Ltr, Charles F. Craig 10 Tile COI ~ 

SliflitiOlI, Atlanta, 29 Oct L898, Papers From the Le ~ 

tcrpress o r Charles Franklin Craig, vValter Reed 

Army InstiLu te of Resea rch, Washington. D.C. 

10. 'WD,ARojSG, 1897, PI'. 66-67, and 1898, PI'· 

122, 176-80; Dodge COllllllissiol1 Report, 1:181, 

3: 187, 264--65, 4:831 , 1308-09 ,1316, 1380, 1405, 

5:1735 , 1817, and 6:2819, 2988; Haubold , "Medical 

Aspects," p. 584; Com Rpt , p. 69, Mf Reel 6, Shafter 

Papers, SU; Erna Risch, Quartermaster Supporl oJlhe 

Army, pp. 539-40. 

I.l. Dodge Conunissioll Report, 1:587; 3: 19 l 

(quotation); 4: 1145 , 1311, 1364, 1385, 1387-88, 

1402-03, 1732-33; and 6:2802, 2888, 2976-77, 

2979,2990,2999. 
DISEASE AND DEATH IN U.s. CAMPS 

12. Ibid., 3: 187, 4:1307. 

13. Quotations from WD, ARafSC, 1898, PI'. 

18 1-82; ibid ., PI'. 173, 183; Dodge COllllllissioll Rc* 

port, 4: 1308-09. 

14. WD, ARojSG, 1898, Pl'. 123, 128; Sulton, 

5(01)', pp. 7-8; Dodge COlli mission Report , 4:859. 

15. Alexander H. Hoff was an assistant surgeon 

in the Anny Medi ca l Department aftcr the Civil War 

and John van R. HoIT's father. 

16. WD, ARoj SG, 1898, Pl'. 40, 122-23, 127, 

177; Dodge COlllmission Repar" 1:73, 5: 1732-33, 

and 6:2990, 3005-06; Bache, "Female Nurse," p. 

3 14; Reed et aI. , Reports, t :4l. 

17. \li D, ARoj SG, 1898, Pl'. 123-24, 128, 150, 

183-84, and 1899, Pl'. 69-70,90-91,93; idem, Cor· 

respondence, 1:43; Dodge COllllll issioll RelJO rl , 

1;612- 13, 8:8 1; Scheffel 1-1 . v..'right , "Historical 

Issue; Medi ci ne in the Flori da Camps Duri ng the 

Spanish-Ameri can War," pp. 20-23; Will iam M. 

Straiglll, "Camp Mi ami , 1898," PI'. 504, 5 10-11 ; 

J ohn A. Holmes, Tile R(lw De(l l, p. 8; Vaugha n, Memories, pp. 372-73; Smith , "Rise and Fall ," p. 318 . 

18. WD,ARojSG, 1898, pp. I23-24, 183-84,and 

1899, Pl'. 66-67, 69-70, 72, 79, 83-84, 86 (quota· 

tion), 89- 90, 97;Smith, "Rise a ncl Fall ," pp. 3 17-19; 

Curry, "On the Value of Blood Examinations," p. 

515; War Depanment, Su rgeon General's O ffice, The 

Surgeon Gcmera ls Office, p. 5 1 (hereafter cited as 

WD, SGO, SGD). 

19. WD , IIRojSG, 1899, Pl'. 87 (quotations), 88. 

20. Ibid., 1898, p. 124, and 1899, Pl'. 81-83; 

Dotlge Commissioll Reporl , L:I08. Immunity conferred by t)'phOid fever is not usuall y long lasting. 

21. WD, ARojSG, 1899, Pl'. 67- 68, 76-78 (quo· 

taLion); Dotlge Commission Repor/ , 1:211. 

22. WD, Al/ojSG, 1898, p. 129, and 1899, p. 32 

(quotation); Dotlge COIl1 l11issiol1 Report, 1:657. 

23. Graham held a volunteer commission of 

major general from 8 May to 30 November 1898. 

24. The report ed number o f offi ce rs and men a t 

Camp Alger was: in May, 17,406; injllne, 23,5 11 ; 

injllly, 22,175; and in August, 2 1,454. See 'War Depa rtment, IAnlllwl} Report oj the Sec fetmy oj War, 

1898, 1(1'1. 2):476, 482-83, 498 (herea rter cited as 

WD, ARojSW , date). 

25. Alfred C. Gira rd, The Mwwgclllc!IIl of Camp 

Alger alltl Camp Meatle, pp. 1-2 (first two quotations),3-6; WD ,ARojSG, 1898, 1'1'. 153-54, ISS-56 

(fi nal two quotations), 160-61, and L899, p. 54; Rpt, 

Ch Surg, Second Army Corps, PI'. 2,4, 12, Enlr}' 

219, RG 395, NARA ; Dodge COllllllissioll Reporl, 

3: 106,8:56. 

197 

26. Girard , l'vlwl(lgelll cII I, pp. 3-4 (quotatio n); 

WD, ARoj SG, 1898, p. 154. 

27. WD, ARojSG, 1898, Pl'. 154, 157; Girard, 

Mmwgclllctlt, PI'. 3-4; Dodge COllllllissiol1 Report , 

4: 1248. 

28. \-VD, ARoJSG, 1898, p. 156; Gira rd , MwwgemellI, p. 6; Reed el al., RefJor/s, l:xv; Vaughan, Memories, pp. 370-7 1; Smith , "Rise and Fall ," p. 3 17; 

Rpl, Ch Surg, Second Ann)1 Corps, p. 13, Entry 219, 

RG 395, NA RA. 

29. Rpt, Ch Surg, Second Army Corps, p. 15 

(quotation), Entry 219, RG 395, NARA ; WD, 

ARojSG, 1898, Pl'. 130, 153-54, 156; Dodge C Olli· 

missiOH RetJorL , 4:1 249, 8:69. 

30. WD, ARojSG, 1898, Pl'. 158-59 (quotation); 

Rpt, Ch Surg,Se:co nd Army Corps, pp. 21-23, Entry 

219, RG 395, NARA; WD, SGO, SGD, p. 51. 

31. WD, ARojSG, 1898, Pl'. 150-51; "Some or 

Lhe Med ical Lessons," p. 485. 

32. Afler the end of the war, even though volunteers who had served the longest were being muslered out, new volunteers we re still coming in. 

33. Dodge Commission Report, 3: lJ. 7. 

34. Rpl, Ch Surg, Second Army Corps, pp. 7 

(quotation), 8, 10, 15, Entry 219, RG 395, NARA. 

35. Ibid., Pl'. 7-8 (quotation), 9-10, 2 1-23, 

En try 2 19, RG 395, NARA; WD , ARoj SG, 1898, pp. 

114, 155, 158, 160, and 1899, Pl'. 42-43. 

36. WD, ARojSG, 1898, p. 127, and 1899, Pl'. 

43-44, 49, 54; Reed et aI. , Reports, 1:480; Dotlge 

COllllllissiol1 Report, 4:1252; Va ughan , Memories, PI'. 

378, 387; Rpt, eh Surg, Second Arm)1 Corps, pp. 

22-23, Entry 219, RG 395, NA RA. 

37. Dodge COllllll issiol1 Report , 4:1330-3 1,1334, 

1337, and 8:89 (quotation); WD, ARojSG, 1898, p. 

124, and 1899, pp. 54-56; idem, Correspondence, 

1:534-35; Reed et aI. , Repor/S, 1:500-50 1. 

38. Dodge COllllllissioll Report , 3: 11 7, 258; j efferson D. Griffith, "Hospital Experience in the War 

With Spain ," Pl'. 164-65; WD, ARojSG, 1898, Pl'. 

171, and L899, PI'. 40-41,54; idem, Correspondence, 

1:5 10,530; Ashburn, His/o,)' oj MD, p. 18 1. 

39. Te lgs, George D. Meiklejohn to Theodore 

Schwan and AG Corbin 10 Schwa n, both 12 Sep 

1898, me 121918, RG 94, NA RA. 

40. The VI Corps existed only on paper; no men 

had ever been assigned to it. See Graham A. Cosmas, All Army Jor Empire, p. 133. 

41. WD, CorrespOIlclence, L:257-58 (quotation). 

42. Ibid. , 1:510; WD, ARojSW, 1899, 

1{p1.3): 193. 

43. WD, ARojSW , 1899, 1(1'1.2):396, 400-401; 

idem, ofSC, 1899, pp. 44-54; idem, Co rrespOII-
198 THE ARMY MEDI CAL DEPARTMENT, 1865-1917 

eicllce, 1:257-58,510-20; Telgs, AG Corbin to Ass! 

AG ConeI', 14 Oct 1898, fi le 299587, and S. O. M. 

Young to AG, 10 Dec 1898, file 175230, RG 92, 

NA RA. 

44. Dodge Commission ~efJor , 1:211; \VO, Co/"-

rcs/JOIldcll ce, 1:248; idem, ARoJS\V, 1898, 

1(1'1.2):640-41; Rpt,). O. Oell inge r to QMG, 30 Jun 

1899, [;Ie 133396, RG 92, NARl\. 

45. WD, ARofSW, 1899, I (1'1.2):407; idem, Corresponde/I ce, 1:529,534-35, 5 tO. 

46. WD, ARofSW, 1899, 1(1'1.2):364,396,400-

401,407. 

47. W D,ARofSG, 1898, pp. 242, 259 (quotation), 

and 1899, pp. 60-61; Lir, Va ler), Hava rd Lo Shart er, 

9 Aug 1898, Autobiography. William R. Shaft er, eh. 

VII , p. 7. and End to Ur, Charl es D. Rhodes LO 

Wil liam 1-1 . McKitt rick, Nov 1931, all !vir Reel 6, 

Shaft er Papers, SU; Dodge Commission Reporl, J :78, 

2:742; Seabury \I>.l. Allen, "The Conditions al Camp 

\:Vikofr," PI'. 326-27. See M ar), C. Gilleu , Arm)' J\llcdiced Dep(! r' IIICIIL, 1775-1818, and Arm)' M cdiw / Dcp(lrllllclli, 1818-1865, for details of earli er yellow 

feve r epidcmics thaI affected the nn)~ 

48. WD, ARofSG, 1898, pp. 241 (quotation), 

242; Senn, Aspects, pp. l 74, 176; Dodge Commission 

Report, 1:78. 

49. WD, ARofSG, 1898, PI'. 249-50. 

50. Ibid., 1898, PI'. 240 (quotation), 241-42, 

246-47,250 ; Dodge Commissioll Report, 5: 1893. 

51. WD, ARofSG, 1898, pp. 241- 43, 245, 254; 

Dodge Commission Report , 1:78, 114-] 5. 

52. MVAA, WorJ~, pp. 177 (quotalions), 180; 

Wicl<es \Vashburn , "Mo ntauk Poin t ancl the Government Hospitals," pp. 832-03; 'N D, ARoJSG, PI'· 

243, 246; Dodge COlllllliss ion Report, 1:78-79, 

114- 15, and 6:2586-87, 2589, 2590, 2597, 2801 ; 

All en, "Condi tions at Camp vVikoff," p. 326; 

Theodore Roosevelt, "The Rough Riders," p. 688; 

Slatement, Esthcr V Hassen, En try 230, RG 1l2, 

NAR.A ; Frank Donaldson, "'A Refutation of False 

Statcments Conce rning Camp \Vikoff," Pl'. 334-35. 

53. The work o f the Dodge Commission is d iscussed laler in the chapter. 

54. Dodge COlll lll issioll Report, 1:535, 5:1888, 

1900, and 6:2588 (quotation), 260J , 2732-33; WD, 

Al/ofSG, 1898, p. 250. 

55. Quotations from WD, ARoJSG, 1898, pp. 

243, 245; ibid. , pp. 241 , 244, 246, 249; Dodge COIllmi s.~ o/ I o,.t" 6:2736 

56. Dodge COllllllissioll Report., 5:1888, 189.1 , and 

6:2500, 2570; MVAA, WOrll, 1'.178; WD , ARofSG, 

pp. j 19, 243-45, 250-51; Bache, "Female Nu rse," 

p. 327; Scnn, Aspec/s, p. 177; AlI cn, "Conditions at 

Camp Wi koff," p. 327. 

57. Dodge COlllmiss ion Report , 6:2592 (first quotation); WD, ARoJSG, 1898, pp. 250 (second quotation), 25 1; Scnn , Aspects, p. 324; Bache, "Female 

Nurse," pp. 176-77,327; MVAA, WO rll, p. 179. 

58. W D,ARofSG,1898, PI'. U 8, 243-44, 25 1-52 

(quotation), 253; MVAA, WO r/I, p. 179; Dodge COIl1-

mi ssion ~c or , 2:740, 4:818-20, 823, and 6:2570; 

All en, "Conditions at Camp Wikoff," p. 326; 

Nicholas Senn , "The Returni ng Army," p. 653. 

59. WD, ARofSG, 1898, 245, 253, 255-57; Ltr, 

Shafter to AG, 30 SCI' 1898, Mf Reel 6, Shafte r Papers, SU; MVAA, .vo rl~, p. L 79; Dodge C0l11 111 issiOIl 

Rel'orl,6:2598. 

60. WD, ARofSG, 1898, PI'. 150,244-45 (quotation), 246, 261-62; Dodge COII/missioll Repor" 

1:528,5: 1971, and 6:2599, 2876; Ashburn , I'lisIOf)' 

of MD , p. 17 1. 

6l. Quotations from MVAA, Wadi, pp. 97-98. 

See also ibid., PI'. 96, 180-8 1; WD, ARofSG, 1898, 

pp. l20, 26 1-62; Dodge Coml11issiol1 Repor" 

6:2530-3 1; Allen, "Conditions at Camp Wikoff," 

1'1'.326-27; Ltr, Shaft er to AG, 7 Sep 1898, Mf Reel 

5, Shafter Papers, SU; E. M. Buckingham, "Tropical 

and Camp Disease," p. 433 . 

62. WD, ARofSG, I898, PI'. 128, 150,246 (quotations), 262; in Shafter Papcrs, SU: Telg, Shafler to 

AG, 24 Sep 1898, MfReel 5, and llrs,Shaftc r wAG, 

27-28 Sep and 1 Oct .L 898, and V Army Corps GO 

50,3 Oct 1898, all Mf Reel 6; Dodge COIII/ltiss ioll ne~ 

pori , 8:120; Joseph Wheeler, The SWlliago C(IIllpaigll , pp. 207-08. 

63. Dodge COl11miss iol! Report , 1: 183, 219. 

64. Smith, "Rise and Fall," p. 316; William B. 

Bean, Wall er Reed, pp. 3, 48-49, 64-68; United 

Stales, Congress, Senate, 61sl Congress, 3d Session, 

)'CI/O\\l f ever . . . , p. 8; Aristides Agramonte, "The 

Inside Story of a Great Medi cal Discovery," p. 214 

(quotations); Ashburn , Nist.DlY oj [vID, p. 259; 

Robert S. Henry, Th e Armed Fo rces InsUlIIl e oJPCH/101-

og)" PI'. 134-36 (hereafter cited as AFfP); Edgar Erskine I-I UIl1C, ViclOries oj Arl11)' l'vlcdiciIl C, pp. 

100- 10.1 ; Reed et aI. , Reports, I. :xv. 

65 . Victor C. Vaughan, "Some Remarks on TyphOid Fever Among Our Soldiers During the Lue 

War 'With Spain ," Pl'. 63-64, 66-67 (quotation); 

WD,A RofSG, 1899, pp. 273-74, 278-80; Reed et aI. , 

Reports, 1:xv-xvi; Henry. AFfP , pp. 134-35. 

66. WD , ARoJSG, .1 899, p. 280; Vaughan , "Some 

Remarks," pp. 64- 65, 68-69; Henry, AFIP, PI'· 

134-36; "Value of I3 lood Exam inat ions in Ma larial 

and Typhoid Feve rs," pp. 746-47. 
DISEASE AND DEATH IN U.s. CAMPS 

67. WD, A/loISG, 1899, PI'. 205, 216 ([irsl quolalion), 270- 71 , 276; Henry, AFIP, PI'. 137-38; 

Vaughan , "Some Remarks," p. 71; idem, Melllories, 

1'1'.376,384-86,393-94; /leed el ai. , /lepor's, 1:206; 

SGa Cir 1,25 A pr 1898, Enl ry 66, RG 112, NARA; 

Stanhope 13a}lll cwJones, The E\'olllliOlI oJ Prc"cII/ivc 

Medicine ill Ihe Ullited Swt es Army. 1607- 1939, pp. 

126-27. Sec also in Ms C48, \~ ltcr Reed and 

Willi am C. Gorgas Papers, Natio nal Library orMedicinc, I3clhcsda, Md ., the following reporls: Filters 

and the Sterilizat ion or ,"Ya ler; Prelimina ry Report 

on Typhoid Fever ill Mi li"'r)' Cam ps, 1899; Disposal 

or Excreta, 1898, p. 6 (second q uotation); and \Va lLeI' Reed to AG, 15 May 1899, in Orders, 1899. 

68. WD, ~oI , 1.899, p. 95; "Alllil)'phoid Vaccination in the Army," p. 728; l-Iu lll e, Vic/Dri es, p. J0 1; 

Frederick F. Russell, "The Prevention of Typhoid Feve r 

by Vaccinat ion and by Ea rl)' Diagnosis and Isolation," 

pp. 482, 485; Vaughan , l'vlclllories, pp. 369-70, 376 

(quotation); Ashburn, HislDlY oJMD, pp. 272-73. 

199 

69. WD, ARoISG, 1. 899, PI'. 273-74, 1900, p. 53, 

and 1903, PI'. 49-56; Henry, AF/P, pp. 133, 1.35-36; 

Harr)' F. Dowling, Figllting Injeclioll , PI'. 14- 15; 

Agmmonte, "Inside Stor}', n p. 219; Oay ne·j ones, Prevc.l/ive Mc{IicilU:. PI'. 125-26. 

70. WD, Al/oISG, 1898, p. 1. 51. 

71. Dodge heJd a volunteer cOlllmission of major 

genera l from 7 junc LS64 to 30 May 1866, when he 

resigned. 

72. Quotations from Dodge CommissiOlI Reporl , 

1:L07, 116. See also ibid ., L: 1. 13; "The One Great 

13 101 of the War," p. 279; "The Surgeon Genera l of 

the Arm}' and His Critics," p. 822. 

73. Dodge Commission Repon , 1:113, 116, ISS--

89; WD, ARoISG, 1908, p. 126. 

74. Quotation by john M. Hay. the U.s. ambassador to Grea t Britain from 1897 to 1898, cited in 

Coslllas, Arlll)" p. 245. See also Dodge Commission 

Repol'l , 6:2838; Vaughan, Memories, p. 390; Smith , 

"Rise and Fall," p. 316; WD , ARoISG, 1900, p. 75. 

Chapter 8 

CAMPAIGNS OF THE NEW EMPIRE 

The "splendid lillie war" was over almost as soon as it began, and in the United 

States even disease was defeated within a 

few months. But for U.S. forces in the Far 

East, the surrender of the Spanish was only 

the start of a long struggle. Beginning in 

the spring of 1900 and continuing for years 

thereafter, soldiers in the Philippines 

would be involved in guerrilla warfare, and 

the medical officers with them would fa ce 

challenges rendered more demanding than 

those of the lndian wars both by the complexities of the campaigns and by the tropical climate and its diseases. American soldiers and marines would also be called 

upon to join troops from other major powers to end violence engendered in China 

by members of a secret organization, the 

Boxers, who, with the tacit approval of the 

Dowager Empress, sought to end foreign 

ex ploitation of their nation. The physicians with them wo uld be required to deal 

with the consequences of generations of 

abysmally poor sanitation and of the diseases that inevitably resulted. 

The Philippine In5LUTection 

The defeat of the Spanish brought in 

mid-August 1898 only a short respite for 

Genera l Merritt's VlII Corps. During this 

period, beginning shortly after the surrender, a nurry of changes took place at the 

highest leve l of command in the Philippines. On 25 August the 1st Division of the 

Vlll Corps was organized under the command of General Anderson, who was recently promoted to major general in the 

volunteers. On the twenty-eighth Anderson was reli eved as commander of the 2d 

Division by Arthur MacArthur, now too a 

new major general in the volunteers, and 

General Merritt as commanding general of 

the V111 Corps by Elwell S. Otis, also a 

major general in the volunteers. On the 

twenty-ninth Otis also relieved Merritt as 

military governor and commanding officer of the Department of the Pacific.' 

Thus Genera l Otis was in command of 

u.s. forces in the Philippines when, in February 1899, the Filipinos, suspicious about 

the moti ves of their liberators, turned to 

violence, initially in the form of warfare as 

orthodox as it could be among the narrow 

jungle trails and waterways that surrounded Manila. U.s. units, and the medical officers accompanying them, gained 

their first taste of what was to come when 

they attempted to defeat their new enemy 

and found themselves struggling to penetrate the mountains northwest of Manilaessentially impassable for vehicles-and, 

once beyond the mountains, to progress 

along bad roads and across "insecure" 

bridges. These early efforts were success-
202 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

ful , but u.s. troops were not yet ready to 

seize and retain control of any extensive 

area , because all th e vo lunteers and a third 

of the regulars in the Vlll Corps were enti tled to return home in thespri ngofl899. 

When the vo lun teers of 1898 we re mustered out, they were replaced by 35,000 

men of new Uni ted States Vo lunteer regiments. By the autumn ofl899, with the arrival of new troops, u.s. forces in the 

Philippines numbered 66,000, more than 

30,000 of them volun teers.' 

The Americans now moved to take control of the islands, beginning with Luzo n 

and a three-pronged push north of Manila 

(Map 4). In this campaign too, as Secretary 

of War Elihu Roo t noted in his report fo r 

1899, "all ... movements were accomplishedunder great d i ffi cul ti es owing to the 

almost impassable condition of the co un -

try." By the end of November the resistance 

was abandoning its attempts to conduct 

conventional warfare, and U .s. troops in 

northern Luzon were "actively pursuing 

the fl ying and scattered bands of insurgents, further dispersing them . ... " America n fo rces soon ex tended the drive to take 

complete co ntro l of the Philippines to the 

east and south of Manila as well, into another area of difficult terrain . So successful 

were these effo rts that by the spring of 1900 

General Otis concluded that the insurrection had been defeated and in May asked 

to be relieved. Nevertheless, troops under 

General MacArth ur, who replaced Otis as 

comma ndi ng general in the Phili ppines, 

still faced guerrilla attacks and had to remain in the fi eld and establish wha t wo uld 

eventually be more than 500 posts to hold 

what they had taken.' 

During the earli est and most conventi onal stage of the Philippi ne Insurrection , 

a single military department formed the 

basis for the government of the islands. 

The orga nizati on o f Vl11 Corps med ical 

personnel still renec ted that of th e co rps 

itself. A chief surgeon headed the med ical 

service of the entire corps, and a chief surgeon was assigned to each division and 

brigade of the corps. The regimenta l staff, 

whi ch normally consisted of three physicians, increased significantly after the 

change from more conventional wa rfare to 

a guerrilla connict in ea rly 1900 and the 

increase in the number of posts that resulted. Eventually, although as many as 

seven medical offi cers sometimes served 

on a regimental sta ff, their numbers could 

still be too small to provide a physician for 

each garrison in its district. As a result, 

hospital corpsmen might be aSSigned to assume the physician's role for the smallest 

detachments and subposts." 

At the end of March 1900 the complexities invo lved in dealing with the guerrillas 

and governing the islands led to the transfo rmation of what had been the Department of the Pacific into the Division of the 

Philippines with four geographi cal departments, each of which was, in turn, d ivided 

into military distri cts. This step brought an 

end to the Vl11 Corps.' The corps chief surgeon become the chief surgeon of the Division of the Phili ppines. The position of 

the chief surgeon of a mili tary divisio n was 

transformed into that of the chief surgeo n 

of a department and that of the chi ef surgeon of a brigade in to that of the chief surgeon of a d istrict. The district form of orga nization was dropped late in 1901 and 

replaced by an organization by brigade6 

The government of the Philippines 

changed again in the spring of 1901 , after 

u.s. forces captured the chief guerrilla 

leader, Emilio AgUinaldo. Although minor 

guerril la activity wo uld co ntinue for many 

years thereafter, a successful effort to reduce expenses by co ncentrating resources 
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204 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

was initiated, and the four departments 

were consolidated into two. President 

McKinley confidently appointed a civilian 

government for the islands in the form of 

a commission with legislative and limited 

executive power and a civilian governor. 

By November fewer than 45,000 U.S. soldiers remained of the 100,000 who at one 

point were serving in the Philippines. 7 

Although the organization and size of 

the medical service in the Philippines was 

adjusted to conform with the organization 

of the Army and the needs of forces spread 

out over an increaSingly large area, the basic 

nature of the challenge faCing medical personnel in the fi eld changed only gradually. 

In this primitive land, the terrain controlled 

medical evacuation, while the number of 

sick and wounded and the difficulties experienced in moving them dictated the nature of the hospital system. The change of 

the confli ct from conventional to guerrilla 

warfare in the space of a few months had 

less direct influence on the demands placed 

on the Medical Department than did the 

gradual isolation in well-nigh inaccessible 

locations of the small units that were sent 

to fight the guerrillas. 

Hospitals and Evacuation 

Initially, the Medical Department's chief 

responsibility was establishing a system of 

base hospitals in the Manila area to care for 

the sick, for those recovering from wounds 

sustained in the brief hostilities with the 

Spanish, and for convalescents. The department then expanded the size of this system 

and extended it geographically to care for 

those disabled during the insurrection that 

followed. In a former Spanish military hospital, Major Crosby set up the first division 

hospital to be established in Manila. Before 

the fi rst patients arrived on 17 August 1898, 

the building of the newly created First Reserve Hospital was thoroughly cleaned and 

the necessary repairs were made. To avoid 

crowding, Crosby erected tents to handle the 

overflow. The unsatisfactory state of the hospital'S plumbing and the poor drainage of the 

land nearby initially caused the Medical Department to be uneasy aboUl using this 

structure, despite its electric lights and excellent ventilation. [n time, the sewer system was replaced, water closets were installed, and each ward was given its own 

bathroom with showers. The city water 

works provided ample supplies, from which 

drinking water was distilled8 

The First Reserve soon became the keystone of the Army's hospital netwo rk in the 

Philippines· Its surgical facilities, which 

included three operating rooms, were the 

most important in Manila. A two-ward 

smallpox unit was established 1,200 yards 

from the main building; another ward , consisting of two tents erected over raised platforms, was added later for those suspected 

of having smallpox; and a third tent was set 

up to isolate pati ents suffering from 

buboni c plague, if that disease ever affli cted 

the Army. All patients arriving in Manila by 

boat came through a First Reserve unit established near the docks, where the victims 

of accidents on the city streets or on the 

railroad also received emergency treatment. The hospital laborato ry, set up by 

Captain McVay, was well equipped to handle all pathological examinations for the 

Manila area. This entire division hospital, 

including the smallpox faCility, eventually 

held 400 beds. Sixteen mul es drew four ambulance wagons around the Manila area to 

pick up patients in response to telegraphed 

requests for their services.'O 

Two more hospitals were established 

not long after the fall of Manila. The Sec-
SECOND R ESERVE H OSPITAL, M AN ILA, PHILIPPINES 
206 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

a nd Reserve Hospital opened in September 1898 in a modern and attractive building that had been built to serve as a young 

women's school. With its eight porcelain 

bathlllbs and its acres of wall ed gardens, 

compl ete with fountains and flowering 

trees, this facility was "a really fine establishment. " Initially most of its 300 beds 

were assigned to convalescents who were 

transferred from the First Reserve Hospital or from regimental hospitals; but, as 

time went by and the disease rate rose, the 

seriously ill were also sent there. Convalescents did not have to share yet another 

fa cility, which was set up on Corregidor Island, a site only thiny miles from Manila 

that was chosen in November because of 

the City's poor health reco rd. The climate 

was more pleasant tha n that of the city, the 

natural drainage of the soil was good, the 

sea air was mild, and many trees tempted 

those whose hea lth was still fragil e to rest 

in th eir shade. This hospital initially occupied tents and a few old buildings, where 

250 beds were placed. In September 1899, 

with activity against th e Filipinos intensifying, the first of a series of new structures 

was compl eted to repl ace the old ones, and 

by June 1900 the facility held 220 beds. As 

described by the surgeon in charge of the 

Co rregidor facility, "The first dental ornce 

ever fitted out orncially by the Uni ted 

States government" was also set up, to be 

managed by a hospital corpsman who in 

private life had been a professional dentist. 

Plans to expand this hospital had to be suspended because of high construction costs 

that resulted in part from a conspiracy 

among lumber dealers 1 1 

In May 1899 another hospital , known 

simply as Hospital No.3 or the supplement3iY hospital, was opened just outside 

the city walls in barracks once belonging to 

the Spanish infantry. An enormous amou nt 

of work was necessary to make it fit for use. 

One medical orncer noted that "only one 

who has seen the mth can appreciate what 

that labor was." Among its 285 patients 

were those scheduled for disability discharges. No civilian nurses served on its 

staff, since the surgeo n in charge regarded 

them as neither necessary nor desirable." 

In November 1899, in response to the 

mounting disease rate and growing activity against guerrillas, the Medical Depanment increased the number of available 

beds by taking over a former barracks at 

Santa Mesa, a suburb of Manila , for a new 

1,000-bed unit. The staff of this new facility, eventually the largest in the Philippines, 

included 10 physicians, 25 fema le nurses, 

4 hospital stewards, 2 acting hospital stewards, and 122 Hospital Co rps privates. As 

late asJune 1900, however, the laboratory 

of Santa Mesa was regarded as completely 

inadequate, and eanh closets had not been 

replaced by more modern equipment. By 

15 August the hospitals in Manila, together 

with that on Co rregidor, held a total of 

more than 2,200 beds. Space was also available at a 600-bed Navy hospital in Yokohama ,Japan, and in Hong Kong." 

The Medical Department used the hospital ships Scalldia, Missouri, and Relief 

both to supplement its hospitals on land 

and to move patients by water to and from 

locations within the Philippine Islands. 

The Scalldia , a transport filled out to serve 

as a hospital ship and carrying with her 5 

medical orncers and 139 hospital corpsmen, was dispatched from Ca lifornia on 

27 August 1900. Although in the fall of 

1899 the Missouri briefl y joined th e transports in taking invalids back to the United 

Slates, the Reli ef, which had arrived in the 

Philippines on 8 April , rarely took pati ents 

all th e way to San Francisco because of her 

light construction and the limited amount 
CAMPAIGNS OF THE NEW EMPIRE 207 

WARD ON H OSPITA L SHIP R ELIEF 

of coal she could carry. Except for service 

during th e China Relief Expedition and 

trips to Hong Kong for repairs, she remained for the most part in Philippine waters. As she cruised up and down the coast 

of the Philippines, rendezvo using with 

units on the march, leaving off supplies, 

and picking up the seriously ill or 

wo unded from regimental surgeons or 

post hospitals, th e Relief provided her passengers with a "sea trip and good food. " 

The restorative effect of such a journey 

upon the debilitated caused the Medi cal 

Department in March 1901 to put 140 patients on board the Relief merely to enj oy 

the trip from Manila up the coast. More 

than half her invalid passengers, including 

the 51 she picked up on the way, improved 

markedly because of their sea voyage, and 

she was assigned to make seve ral more 

such journ eys. Because the Relief's deep 

draft preven ted her from entering shallow 

waters and because a transport that pi cked 

up patients from south of Manila was 

equally handi capped, the Medical Department also employed shall ow-draft vessels 

to move patients, including a hospital 

laun ch that took patients from Man ila on 

three- to four-hour sea jaunts.'; 

The need for hospita l beds dropped significantly fo llowing the capture of 

Aguinaldo in March, although some resistance, especially in the form of terrorism, 

conLinued for several months, and disease 

rema ined an enemy even after much of Lhe 

countryside had been paCified. A one-third 

reduction in the number of hospital beds 

was planned early in 1901 , but th e mass 

evacuation of pati ents to the United States 

upon whi ch the reduction depended progressed more slowly than had been an ti cipated because of a shortage of transports. 

Only inJuly, when the effort to co ncentrate 

the Army's resources in the Philippines was 
208 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

under way, could one of Manila's fac ilities, 

the Second Reserve Hospital, be closed. The 

remaining patielllsand stalT were selllto the 

Santa Mesa hospital, which, in turn, was 

closed before the end of the year. A 125-bed 

hospital was established on Nozaleda Street 

in Manila on 18 December to shelter patients still hospitalized at Santa Mesa when 

it was closed. On its attractive grounds a 20-

bed isolation faCi lity was set up in six tents 

for the victims of tuberculosis." 

Although from the outset the Medical 

Depanmentrelied heavily on the major hospitals of Manila and Corregidor, supplemented by those on hospital ships, much 

smaller facilities on the transports returning pati ents to the United States were also 

available. The Army Transport Service, established in November 1898, was responsible for seeing that each ship had the proper 

facilities for its passengers, whether they 

were en route to the Philippines or on their 

way home. The larger vessels of the Transport Service carried hospitals complete with 

isolation wards and diet kitchens, and even 

smaller ships carried medical personnel to 

care for the sick. Two Regular Army surgeons served as medical superintendents 

for the Transport Service, one in New York 

and the other in San Francisco. Their duties included adv ising the service's general 

superintendent in each city, supervising the 

work of the contract surgeons on service 

ships, and inspecting each vessel. A contract surgeon who was chosen by examination from among applicants who were graduatesof"regular reputable" medical schools 

accompanied each transport, as did a hospital steward or acting hospital steward and 

one to three Hospital Corps privates. Thus, 

by relying on transports equipped with hospital facil ities, the Army could return the 

sick and wounded to the United States without using hospital ships.'· 

Establishing the system of base hospitals, 

hospital ships, and transports was not as 

great a challenge as caring for the sick and 

wounded when troops were pushing 

through the jungle, far from good roads and 

intact portions of the rail line. Initially, medical offi cers did not anticipate the difficulties they would soon be encountering in the 

struggle with the Filipinos. As chief surgeon 

of the Vlll Corps, Colonel Lippincoll had 

planned a system of fi eld hospitals in which 

he had great confidence. In the winter of 

1899 he rejOiced that the medical service in 

the Philippines had been "in fin e condition 

at the moment of first fire" and had "continued to improve from day to day, so that 

there was never a delay in securing excellent attention for the wounded." 17 

In the early spring of 1899, when troops 

began pushing as much as thirty miles beyond Manila, they enco untered terrain that 

made evacuati on very difficult, regardless 

of the size of the units involved or the nature of the operation. When the Army 

began wo rking in smaller units to deal with 

the guerrillas and the number of posts more 

than tripled during the first six months of 

1900 to "embrac[e] the furthermost limits 

of the islands," the lightly equipped fie ld 

hospitals that accompanied the men had to 

become both smaller and more numerous. 

The nature of the problems involved in 

moving the disabled first to such small facilities and then from them to the rail line 

or to a major hospital did not change.'s 

To carry Iillers for these units in the 

field , natives of the area, and sometimes 

even prisoners, were hired or impressed 

into service, but for a lime the most SllCcessful bearer was the Chinese cooli e. If assured of his pay and rations, the coolie 

proved to be, acco rding to some authorities, "patient, tireless, and brave" and better able to bear grea t hea t than American 
CAMPAIGNS OF THE NEW EMPIRE 

hospital corpsmen. Others were considerably less enthusiastic about this practice. 

General Schwan, who commanded forces 

involved in the campaign in southern 

Luzon in late 1899 and early 1900, considered "the use of coolies, either for company or hospital use on a campaign, . 

injurious to discipline and of no value to 

the service. " He regarded them as "great 

looters," noting that "about all they do 

after a few days' march is to carry their own 

food and what they have stolen out of 

houses and churches." Early in 1900, when 

the end of the conflict seemed near and an 

awareness of the threat that cheap Chinese 

labor posed to local workers was growing, 

the Army forbad the hiring of Chinese for 

this type of work in the Philippines. 19 

Evacuation demanded much from those 

responsible for moving the wounded, especially from the many areas that were inaccessible to wheeled vehicles. The poorest lines of communicati ons were in the 

Camarines area of southeastern Luzo n. An 

officer leading two of the four companies 

involved in an operation in late February 

and early March 1900 reported: 

The trails on either side . .. are something that 

language can not describe. In all my experience 

in the mountains of Colorado, in the Bad Lands 

o f Montana, in Cuba, and o ther parLs o f the 

world where I have traveled, 1 have never seen 

worse. They are si ngle-fil e trai ls the greater pan 

of the way, closely hedged in by a dense jungle 

of trees and undergrowth, with mud and mire 

on the sides. Then every few hundred yards a 

mountain stream must be forded, the banks of 

these streams being precipitous, with a drop of 

40 to 70 feel. The cut down these banks resembles a wnnel, except thal it is open at the 

top . .. . No r is it possible to nank these posiLions, on accoun t of the dense growth, nor can 

anYlh ing be seen except direclly to the front, 

and then only for a short distance. 

209 

Because units fighting in the countryside 

could not take large amounts of equipment 

wilh them, corpsmen sometimes had to improvise liuers from bark, bamboo, or items 

of clothing just as surgeons had done in the 

Indian wars. Some trails were too narrow 

and twisting to permit the use of travois, and 

each litter had to be carried by four men.'o 

Even in areas from which wheeled vehicles could carry the disabled directly to a 

hospital or to a train or vessel that would 

take them the remaining distance to a hospital, difficulties arose. Native carts, including one described as "distantly related 

to the one-horse buggy," sometimes had to 

be substituted for the few available ambulances, which tended to be both old and 

fragile. The animals that pulled these wagons were usually either mules or native 

ponies so small that they had to be unhitched to swim across deep streams, leaving the larger mules to make several trips 

back and forth with the carts. Major Cardwell, now chief surgeon of the 1st Division, 

noted while with an expedition to the north 

of Manila in the spring of 1899 that ponies 

that were often "balky and vicious" fo rced 

"the hard est kind of physical labor" upon 

all the men with an ambulance train. In 

April of that year, another kind of problem 

arose when a bridge north of Manila proved 

too badly damaged for use. The chief surgeon of the 2d Division, Maj. Henry F Hoyt 

of the U.S. Volunteers, reported that ambulances had to disgorge four dead and 

twenty-six wounded on one side of a river. 

A small canoe then picked them up, going 

back and forth until all had been deposited 

in a second set of vehicles on the far shore. 

Patients brought to the coast near Manila 

might be spared further land travel if they 

could reach a hospital launch to take them 

to one of the city's facilities. But reaching 

the launch from the shore was complicated 
210 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

when the water was so shallow that only "a 

fair size nat boat" could move supine patients out to the larger vessel." 

Advancing along the rail line was also 

dimcu lt when roads were lacking and the 

track was in poor condition. Initially, only 

portions of th e rail line that ran north of 

Manila were open for use, and pati ents 

were sometimes evacuated in handcars operated by Filipino prisoners or, at best, in 

boxcars equipped with cots. The ability to 

use the railroad greatly eased the problems 

involved in evacuati on. By mid-1900 cars 

specifically equipped to move pati ents 

were part of a train sent along the complete 

length of the line each day." 

The hospitals that lay along the line of 

evacuation varied greatly in size and number, according to the distance from the 

major facilities of the Manila area, the diffi culties invo lved in evacuation, and the nature of the campaign under way. Fo r men 

who were only slightly injured, the application in the fi eld of an initial dressing 

taken from the first aid packet often eliminated entirely the need for hospitalization. 

From the beginning of the insurrection, 

dressing stations, sometimes referred to as 

light fi eld hospitals, accompanied troops in 

the fi eld to care for the sick and wounded 

until a more permanent facility co uld be 

found or set up for them. When units were 

serving in the jungle far from roads and 

navigable waterways, dressing stations 

sheltered those who might have to accompany their units for several days before 

evacuati on became possibl e23 

Since small hospitals lightened the load 

of large r insti tuti ons and pati ents co uld be 

returned to duty more expeditiously if they 

remai ned nearer the front, regimental facilities were occasiona lly utilized in the 

fie ld. As Colonel Greenl ea f, who became 

chief surgeon for the troops in the Philippines in January 1900,24 noted in his report of 15 August, they were "for emergency purposes onl y." Here, as many as 14 

percent of th e sick and wounded in the 

Philippines might be receiving care at any 

one time. Surgeons with troops on the 

move also set up camp hospitals, where 

those who were only slightl y ill could rest 

for a brief period before returning to duty. 

These small hospita ls were often housed 

in native dwellings, and native beds were 

used if the five to ten cots issued for this 

purpose proved insumcienL In areas 

where the troops could be cut off from large 

faciliti es by the weather and deteriorating 

roads, camp hospitals were organized before the rainy season. The Medical Department preferred to avoid relying on 

small hospitals, however, because they 

represented an inefficient use of personnel 

ancl caused administrative confusion. 

Thus, as the campaign progressed, larger 

ones were established in th e fi eld, sometimes in aband oned Spanish fa cilities of 

major towns, for the care of those with 

more than trivial injuries. 25 

As US forces advanced, the network of 

larger hospitals set up in the co unlIyside 

was ex tended to spare patients the ordeal of 

evacuation. Although the journey south to 

Manila by rail from San Fernando, captured 

in the spring of 1900, was less than fifty 

miles, it might take twelve hours. Before 

hospital cars became available, the move 

could be pa rticularly trying for the sick and 

wounded. Thus 2d Division surgeons at Sa n 

Fernando, which was directly on the railroad line, set aside five bui ldings for a 200-

bed field hospital. In October 1899, when 

the campaign to take northern Luzon was 

just getting under way, this facil ity was 

moved fu rther north to a church in Angeles, also on the rail line, where by mid-August itstill held more than 100 beds. By then 
CONVERTED H OSPITAL F ACILITIES AT A NGELES (top) AND D AGU PAN (bOltOIl1) 
212 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

the largest base hospital on northern Luzon 

was the approximately 350-bed facility established in December 1899 at Dagupan, 

ideally located at the northern end of the 

rail line from Manila and on the coast as 

well. Patients from advanced units were 

brought to Dagupan for care or for evacuation back to Manila or to the United States. 

A wood and masonry building once belonging to a Dominican college housed this 

hospital. By the spring of 1900 fifteen 

trained nurses there had earned the praise 

of the surgeon in charge, who reported that 

he found it "a satisfaction to have in immediate charge of the sick persons trained to 

do the work" and that he was unhappy that 

the only lodging he could offer these 

women was native houses. 26 

The establishment of many small post 

hospitals reminiscent of those once scattered about the American West, some 

merely dispensaries, or subpost hospitals, 

precipitated many of the same problems 

that Surgeon General Sternberg'S predecessors had come to know so well during the 

Indian wars in the United States. The shortage of medical officers was chronic as long 

as these small posts were required, and 

keeping each faCility adequately supplied 

with medicines and equipment was difficult. As the area under U.s. control expanded, however, sma ller hospitals could 

be consolidated, and the need for a multitude of extremely mobile or ve.yshort-lived 

hospitals also diminished. The Medical Department continued to establish larger and 

more permanent institutions, variously 

classified as fi eld, brigade, and base hospitals, usually of 50 or more beds, where men 

with typhOid, malaria, chronic dysentery, or 

wounds requiring skilled surgery could be 

cared for without being evacuated back to 

the Manila area. Such facilities were located 

where they could be easily supplied, along 

the rail line or the coast. When necessary, 

patients could be eaSily evacuated from 

them, either to Manila or to transports that 

would take them home." 

Representative of Medical Department 

field organization as it had developed by 

the spring of 1900, six months after the 

initiation of the drive to control Luzon, 

was the hospital system in the most northern district of the island. It consisted of a 

fifty- to sixty-bed unit on the northern 

coastatAparri and five post and camp hospitals, all housed in buildings considered 

comfortable. The ten medical officers who 

accompanied the one regular regiment and 

two battalions of a volunteer regiment stationed in the district had to be divided 

among the hospitals, and their supplies 

and equipment also had to be parceled out 

among six institutions. Forty-one hospital 

corpsmen, including a graduate dentist, 

were reqUired to care for the patients at 

Aparri and to handle the clerical work. Because the faCility was likely to be needed 

[or some time to come, the surgeon in 

charge also requested contract nurses, obtained permission to acquire an ice plant, 

and sought to obtain a small steam laundry and iron bedsteads.'· 

The hospital network serving 1st Division forces fighting in southern Luzon resembled that of the 2d Division north of 

Manila, but on a small er scale. By mid-August 1900 the largest hospital was the base 

fa cility at Calamba, on Laguna de Bay, 

which was rivaled for size by the brigade 

hospital at Bacoor, on the coast south of 

Manila, each of which held more than 100 

beds. A 60-bed hospital stood at Santa 

Cruz, on the eastern side of the Laguna, 

while two smaller base hospitals were also 

located along the seacoast south of Manila. 

Since almost every town in this area had a 

substantial church building that could be 
CAMPAIGNS OF THE NEW EMPIRE 

taken over to serve as a hospital, here, too, 

even the smallest facilities were well 

housed. [n the absence of a rail line, ambulance wagons had to be used to move 

patients from mobile and temporary faciliti es to base hospitals, from which water 

transportation could be used, if necessary, 

to reach Manila '9 

The Bacoor faCility, established in July 

1899, before the beginning of the guerrilla 

phase of the insurrection, was for some 

time the largest in southern Luzon . Since 

it was only twelve miles from Manila by 

sea and fourteen by land, it was a good 

point through whi ch to deliver supplies 

and evacuate patients. Although in the 

spring of 1900 tents at Bacoor held 85 of 

a total of 125 patients, surgeons were 

pleased with the situation because the 

tents were cool. The Calamba hospital , set 

up in a former Spanish convent in February, was initially smaller than that at Bacoor. Located in an area swarming with 

mosquitoes carrying dengue or malaria, it 

eventua lly grew to shelter more than 150 

patients, with hospital corpsmen assisting 

the eight female nurses who were responsible for patient care]O 

Hospitals were also established where 

needed on the various smaller islands of the 

Philippines, with a particularly large facility set up as a brigade hospital in FebruaJY 

1899 at Iloilo, on Panay in the Vi sayan Islands. Originally located in a private home, 

one of the few buildings that had not been 

burned by the insurgents, the hospital grew 

by taking over other private homes until by 

February 1900 it had 300 beds. The use of 

several separate buildings, however, made 

for an inefficient use of staff, since more 

hospital corpsmen were required to care for 

patients than would have been necessary 

in one structure. The shortage of medical 

personnel was also demonstrated in the 

213 

spring, when twenty-five posts in these islands, which included those of Samar, 

Leyte, Cebu, and Bohol as well as Panay, 

lacked a medical officer. The surgeons circulating between inland substations often 

encountered almost impassable roads and 

guerrilla attacks, while those visiting 

coastal positions required the services of a 

hard-to-find steamer or sailboat. 3 ! 

Medical Personnel 

The shortage of physicians and hospital 

corpsmen was one of the grea test challenges to those responsible for the care and 

evacuation of the sick and wounded of occupation troops in the Philippines. The 

Washington Barracks program for training 

hospital corpsmen had been for a time suspended because of the demands of the war, 

but it was resumed shortly thereafter. A 

similar school for corpsmen was opened at 

Angel Island, California , so that men could 

be taught while they awaited embarkation 

for the Philippines. In the twelve-month 

period ending inJune 1900, 692 trained at 

Angel Island and 726 at Washington Barracks, with most of both groups sent to the 

Pacific. The first class from a fourteen- to 

eighteen-week course for future acting hospital stewards taught at Manila's Hospital 

No.3 graduated inJune. In spite of the establishment of these schools, many corpsmen in the Philippines had little experience 

or formal training, although they seem to 

have been wisely selected. One surgeon reported that "he never knew of a hospital 

corps man who fa iled in his dUlyi n anyway 

under fire." Another later commented that 

the Hospital Corps had much improved 

since the Spanish-Ameri can War, many 

stewards and even some privates being "capable of rendering very va luable assistance 
214 THE ARMY MEDlCAL DEPARTMENT, 1865- 1917 

to the surgeons." Keeping the proportion 

of corpsmen to the number of wounded 

high so as to guarantee casualties adequate 

attention on the field caused the demand 

for attendants to remai n greater than the 

supply. Nevertheless, by August the Army 

was preparing to cut back the number of 

hospital co rpsmen in the Philippines from 

2,356 to 2,000, as required by Co ngress. 

The Medical Department warned that 

many problems co uld be anticipated as a 

result unl ess a grea ter number of Fili pinos 

could be found to replace them.32 

With some hesitation, Secretary of Wa r 

Alger allowed female nurses to be sent in 

from the United States to supplement the 

work of hospital corpsmen. According to 

Colonel Greenleaf, th ey became known in 

the Pacific for their "good work ," which 

was "much appreciated by all. " By mid-August 1900, 140 of these women had served 

in hospitals in the Philippines and 120 

were still on duty there, along with 7 male 

contract nurses. Improving conditions in 

the interior of the Philippines eventually 

made it feasible to send American women 

to some of the fa cilities located further out 

into the countryside." 

The need to provide medical coverage 

for a multitude of posts increased the demand for physicians and caused a shortage of medical officers so severe that Surgeon General Sternberg had to send in 

doctors who were unfamiliar with military 

medicine and who created confusion as a 

result. He again used the latest edition of 

the Mallualjo,' the Medical Del'ar·tll1 ellt in 

his attempt to indoctrinate th e new physicians. Ironically, many of them were contract surgeons whose contracts would run 

out just at that point when they were becoming most effective and who might 

leave even earlier, as soon as the novelty of 

the situation began to pale. Because of the 

shonage, at various Lim es a contract doctor from the Reliej was brought ashore, 

Navy physicians were pressed into Army 

service, or hospital corpsmen were left to 

assume responsibililies usually managed 

by physicians. Corpsmen often had to be 

responsibl e for reports and administrative 

duti es when camp surgeons had no time 

for such things, but in one instan ce two 

corpsmen had to perform an amputation. 

Unfortunately, because more hospital 

corpsmen were also needed-when General MacArthur requested the "immediate 

dispatch" of 100 more medica l offi cers in 

July 1900, he also asked for 300 more 

corpsmen- having them fill in for physicians merely exacerbated one probl em in 

the a ltempllO ease another.3-1 

The need for physicians in creased so 

rapidly that Colonel Greenlea f co uld not 

keep lip with the demand. On 31 December 1899, when 257 physicians were serving in the Philippines, the chief surgeon 

concluded that he should have 360. By 31 

May 1900, when he reported that 364 were 

serving lInder him, medical officers were 

lacking for 20 new posts that had been recently established and 5 to 10 more were 

needed to accompany two transports returning to the United States from the 

Philippines. As a result, in June Greenleaf 

called for 75 moresurgeo nsand for 20 more 

to be sent each month thereafter. Although 

as many physicians as could be spared were 

sent in , by the end of the fiscal year 1900, 

120 posts out of the almost 400 then in the 

Philippines still had no surgeons, leaving 

10,000 men without a source of adequate 

care. Concerned that the situation in the 

Philippines might be misunderstood, General MacArthur emphasized to the adjutant 

general that as long as the number of posts 

in the Philippines remained constant, the 

number of medical offi cers required would 
CAMPAIGNS OF THE NEW EMPIRE 215 

MEDICAL OFFICER CARING FOR A WOUNDED F ILI PINO I NSURGENT 

also remain constant, regardless of the 

number of troops serving there. By 31 May 

1901, although the situation had improved, 479 posts lacked medical attendance and only 423 surgeo ns were available for assignment. Greenleaf maintai ned 

that because of the need to have a reserve 

against the possibility of epidemi c, the figure should be at least 500.35 

In the 2d Division, difficulties engendered by the shortage of physicians were exacerbated by confusion over the responsibility for the assignment of surgeons and the 

granting of their leave in 1899. Communications between the headquarters and the 

units strung out from Manila to the Gulf of 

Lingayen were poor. Orders given to medical offi cers at many levels were rarely reported back to Colonel Greenlea f at corps 

headquarters. Local commanding officers 

granted leave to surgeons and then requested the assignment of another surgeon 

when no replacements were available. Early 

in 1900 orders were issued requiring that the 

division chief surgeons be informed whenever leave was granted to a medical offi cer 

and that each brigade surgeon keep a current roster of the medical offi cers and hospital corpsmen in his unit. Changes of assignment were to be reported to the brigade 

surgeon as soon as they were made.'6 

Medical officers aSSigned to the Philippines experienced their share of danger because of the guerrilla war, still further reducing the number available to care for the 

sick and wounded. A surgeon was one of 

the thirty-six men killed and horribly mutilated by bolo knife-wielding guerrillas in 

September 1901 in a surprise attack upon 

the garrison at Balangiga , on Samar. Yet another surgeon barely escaped death when 

he was ambushed during his attempt to 

bring ambulances to the aid of wounded insurgents. The shortage forced many physi-
216 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

cians to spend much time riding through 

the hostile countryside from post to post, 

each fi ve to fifteen miles from the other.37 

In spite of the difficulty medical officers 

experienced in providing adequate care for 

American soldiers, some had the time to care 

for Filipinos. Unfortunately, in at least some 

instances they may have been involved in 

extracting information from captured Filipinos, who were considered to be waging 

"irregular warfare against the only constituted authority" and therefore were, in theory, "merely bandits, . .. and as such ... 

not entitled to treatment as prisoners of 

war. " Americans serving in the Philippines 

evidently did not always regard torture as 

reprehensible; but, to preventseriousorpermanent injury to the victim, a medical officer was apparently often present when torture was being used. Army surgeons did not 

take their scorn for the guerrillas as far as to 

neglect Filipino casualties, though they 

were more difficult to care for than American soldiers because they tended to remove 

dressings and touch their wounds. Even 

with the best of intentions, medical officers 

were unable to achieve as good results with 

Filipino wounded as with their own men, 

although their attempts nevertheless contributed to pacification efforts. 38 

Health of the Ii'oops 

For troops fi ghting in the Philippines, 

as it was for th ose in the Caribbean, disease was the cause of most disability and 

death. Combat injuries took only 10.6 percent of the command out of action in the 

first half of 1900, for example, and rarely 

caused difficulties for American surgeons 

treating their own men, even when 

wounds were caused by bolo knives, daggers, knives, bamboo spears, and clubs. 

The surgical operations performed on u.s. 

soldiers in the Philippines more often involved hernias, appendi citis, liver abscesses, malignancies, and other problems 

unrelated to war wounds.'9 

The real challenge resulted from the cumulative and debilitating effect of physical exhaustion , inadequate diet, temperatures of well over 100 degrees, and malaria 

and the various forms of dysentery upon 

men already working under grea t stress. 

Medical officers became the victims of diarrhea, dysentery, typhoid, malaria, and 

sheer exhaustion; Lippincott himself was 

among those felled by disease. Soldiers at 

the front suffered the highest disease rates, 

as much as three times those experienced 

by the garrisons of even the most unsanitary towns, where rates were usually under 

10 percent. Attention to personal hygiene 

and the use of screens and neuings to prevent mosquito bites were almost impossible for soldi ers fighting guerrillas in the 

jungle. "The terrible nervous exhaustion 

which results from long continued exposure to great hea t and moisture," as one 

Army surgeon put it, severely undermined 

effectiveness, although with time many 

men became better able to tolerate the 

heat. For the 1900- 1901 fiscal year period 

the disease rate among the volunteers, who 

were for the most part new in the country, 

rose by almost 50 percent, whileamongacc1imated regulars it fell by 10 percent. The 

gradual end of active campaigning contributed to a drop in the disease rate, but 

physicians concluded after months of experience that many patients would never 

entirely recover if they remained in the 

Philippines.'o 

Although typhoid was endemic and the 

troops arriving in 1898 came from camps 

where typhoid had been a problem, careful 

attemion to sanitation reduced its inroads 
CAMPAIGNS OF THE NEW EMPIRE 

markedly. Despite its high death rate, this 

disease was never the serious threat to the 

Army's effectiveness in the Philippines that 

it had been both in the United States and in 

the Caribbean in the summer of 1898. New 

volunteer units coming in from the United 

States to replace state volunteer units returning home continued to bring typhoid 

with them, and from time to time medical 

officers feared an epidemic. Occasional 

cases were acquired at local restaurants or 

from streams so "clear and sparkling" that 

the troops drank directly from them until 

the appearance of typhoid made them realize the error of their ways. Heat exhaustion, 

an ever-present threat, added to the typhOid 

danger. In moments of desperalion when 

extreme heat led to the rapid emptying of 

canteens, soldiers were willing to drink 

"from ditches and holes when the water 

looked green and tasted very badly," though 

they knew that it was hazardous to do so. 

Renewed attention to sanitation and to the 

accuracy of diagnoses, however, limited the 

spread of this disease4 ] 

Return to the United States was believed 

particularly necessary to the complete recovery of the victim of dysentery, which, together with diarrhea, caused much havoc to 

the health of those serving in the Philippines. Dysentery and diarrhea rates climbed 

until they were four or more times higher 

than the rate characteristic of the peacetime 

Army in the United States, and, as time went 

by, dysentery seemed to become more virulent. The death rate rose from 2.52 per 

1,000 troops in 1898 to 4.58 per 1,000 in 

1899, perhaps because the stress of active 

campaigning lowered resistance. A few 

cases were identified as amebic, but atsome 

hospitals the most commonly seen cases 

were those in which malaria was accompanied by dysentery. In these instances, good 

results in the treatment of dysentery were 

217 

often achieved with quinine, and many 

physicians concluded that blood tests for 

malaria should beadministered to all dysentery sufferers. An increase in diarrhea cases 

in the spring of 1899 was blamed in part on 

the indiscriminate consumption of the locally available fruits. Surgeons also noted 

that many of the men with diarrhea were 

also among the many serving in the tropics 

who had very bad teeth, and they blamed 

this apparent and unexplained coincidence 

on the climate" 

Although dysentery tended to peak in 

the summer, the rainy season in the Philippines, malaria caused much ineffectiveness 

from October through December, the 

coolest months of the year, and was more 

common inland than along the coast or in 

the area around Manila. The form of 

malaria seen in the Far East tended to recur 

but constituted no appreciable direct threat 

to life, even though, because of its chronic 

nature, it tended to wear out its victims. 

The time the malaria victim spent in the 

hospital was often lengthened because of 

the accompanying diarrhea, for which one 

gram of quinine twice a day proved to be a 

very successful treatment. Discretion was 

necessary in prescribing quinine, however. 

Attempts to give quinine by inj ection to increase the speed with which it acted tended 

to produce local abscesses. Too prolonged 

a course of quinine, moreover, was believed 

to lead to mental and nervous complicati ons and even anemia:B 

Among other threats to health, venereal 

diseases apparently posed the greatest 

challenge to physicians. Major Ca rdwell, 

then the 2d Division chief surgeo n, reported in September 1898 that as the men 

became "habituated to the repulsiveness of 

the native women, sexual immorality [becamel more common," as did syphilis and 

gonorrhea. In 1902 a medical officer nOled 
218 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

in an article in a profeSSional journal that 

the rate of venereal disease in the Philippines was not unusual and that this fa ct 

was "a tribute to the Filipino women who, 

as a class, I do not hesitate to say, are full y 

as virtuous as their American sisters." An 

attempt to register and inspect prostitutes, 

hospitalizing those found to be diseased, 

was strongly opposed by a visiting missionary, who wrote the secretary of wa r 

that such a program was tantamou nt to licensing prostitu tion. The paucity of 

healthfu l amusemen ts lowered morale, although the amount of drunkenness and alco holism, so often associated with high 

venereal disease rates, seemed no greater 

than that usually fo und in the United 

States. Canteens where cool beer could be 

bought, together with hard wo rk and hard 

play, were seen as minimizing the temptation to associate "with natives, of the lowest class" and as relieving any "craving for 

immoral pursuit. " Authorities allempted 

to set up a reso rt for troops in the mountains of north Luzo n, but the lack of roads 

held up the project. An order issued in 

1901 requiring all men to be inspected 

weekly for signs of such diseases was, to 

some degree at least, successfu l in lowering the incidence. i4 

Among lesser threa ts to hea lth and effectiveness were smallpox and bubonic 

plague epidemics that developed in the Filipino popula tion of Ma nila. Although 

plague never became a problem for U.S. 

troops, the fi rst case of smallpox was diagnosed earl y in September 1898. By 31 

March 1899, when th e danger was considered to be over, 236 American soldi ers 

had co ntracted the disease and 77 had died 

of it. Fresh smallpox vaccine had proved 

difficult to obtain. The effectiveness of 

matlerSenl rrom San Francisco did nols urvive the long voyage, and new supplies obtained from]apan deteriora ted in the heat. 

When a former Spanish vaccine farm was 

reac ti vated, it became possible to revaccinate the entire command- along with all 

13,000 Spanish priso ners of war who had 

surrendered at Manila the previous summer-with malleI' fresh, not from the cow, 

but from the wa ter buffalo" 

Skin problems were also often seen , 

since soldiers fighting in th e Philippines 

were sometimes constantly wet for days. 

Ringworm, a fungal infection that usually 

responded to trea tment with sulfur, was 

coml11OO. Sometimes, however, it was mistakenly diagnosed as the "doby itch," a 

form of co ntact dermatitis that co uld cause 

legs to swell "and large knots and tumors 

I to I cover them until wa lking Ibecame] extremely painful. " The most effecti ve remedy against this condition proved to be having all clothes boiled during laundering. 

Doctors also encountered contagious pemphigus in a potentially fata l form most often 

found in the Philippines and characterized 

by blisters in the groin and armpits. It was 

apparently first encountered in troops en 

route to the Philippines when their ship 

stopped at Guam. Wh en sodium hyposulfite became available, doctors were successfu l in curing most of these patien ts."' 

Me ntal illness was also encountered in 

the Philippines, but the rate of psychoses 

was not high. Most often seen were cases 

diagnosed as "nostalgia," or homesickness, an understandable and predictab le 

problem for young men far from home in 

a strange coun try with a di ffi cult climate 

and a hostil e population. This problem disappeared with arrival back in the United 

States, but it was considered by some to be 

"undoubtedly the most severe affection in 

the command, affecting officers as well as 

enlisted men. Some regimental medical officers are badly infected with this com-
CAMPAIGNS OF THE NEW EMPIRE 

plaint, and such naturally sympathize with 

the men. The result is a sick list wholly out 

of proponion to the rea l disease presenl. " 

Some soldiers also apparemly took up 

smoking opium whil e in the Philippines, 

although repon s that many became addicted were disputed; ' 

Improved hygiene and sanitation were 

high among the measures favored in th e 

effon to prevent many ills that afmcted 

men in th e tropics. The debate over the 

virtues or woolen versus cotton underclothing in hot climates continued, and, in 

particular, the value of th e woolen abdominal bandage in preventing diarrhea 

caused much argumenl. There was no disagreement over the need for lightweight 

uniforms. Such clothing was not available 

to th e first arrivals in th e Philippines, and 

the khaki cloth that was being issued by 

the Qua rtermaster's Depanment by the 

spring of 1900 was regarded as too heavy. 

Lippincollalso urged in his31 March 1899 

report that th e Army issue a "light, broadbrimmed, khaki-covered helmet," in additi on to the campaign hat, which was highly 

regarded for wear in th e rainy season. Even 

the troops' shoes fa iled them in the Philippines, where "the ex tremely plastic, adhesive mud" ripped sales apan, making both 

marching and resuppl y diffi cull. On one 

occasion 230 of 240 men in a battalion 

were without shoes. By Jul y 1901 the official uniform for those serving in the 

Philippines was the kh aki blouse and 

trousers, with the choice of underwear 

being left up to the indi vidua l. 4s 

While medi cal officers debated the nature or the most appropriate clothing, they 

were agreed on the management of sanitation. Fai lures to maintain standards usually 

resulted either from overconfidence that led 

to neglect or from battlefi eld necessity, since 

local water sources often proved to be 1'01-

219 

luted. Much emphasis was placed upon the 

need to boil all water, even when it had been 

filtered. For the most part, earth closets continued to be the usual means of dealing with 

excreta, great care being taken in maintaining latrines and in disposing or their contents in a sanitary manner.-I9 

Supply and Diet 

In general, most supply shortages were 

temporary, and Army hospitals located on 

navigable waters or along the rail line 

rarely experienced problems, although th e 

insurgents sometimes destroyed secti ons 

of track. Quinine was hard to find for a few 

weeks in early 1900, possibly because doctors were also treating sick Filipinos in the 

communi Li es nea r thei r posts. Some temporary local shortages inevitably resulted 

from th e inability of physicians to anticipate th eir needs well in advance, especially 

at the fronl. Investigation in one instan ce 

revealed that whil e hospita ls we re complaining of shortages, large suppli es of 

many needed items had accumulated in 

Manila warehouses, presumably because 

of transponation problems. Delivering 

supplies became impossible when water 

levels fell and suppl y boats could no longer 

get through to troops serving along many 

rivers. When heavy rains washed out 

bridges, movi ng supplies by land became 

panicularly difficull. In the rainy season in 

th ose areas where whee led vehicl es could 

not go, surgeons learned to accumulate 

suppli es as much as six months ahead or 

th e time they were needed to avo id shortages. At least one surgeo n found himself 

fora time forced to rely upon "native leaves 

and roots for medi cines," and soldiers 

fighting in the jungle occaSiona lly had to 

exist on half rations'O 
220 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Fora time in the summer of 1900, a misunderstanding developed concerning orders for suppli es from the Philippines. The 

desire to respond to pleas for help from indigent Filipinos may have been behind 

what both the Medical and War Departments regarded as excessive demands. Surgeon General Sternberg threa tened to halve 

Colonel Greenleaf's quarterly requisition 

for medical supplies and hospital stores, 

but General MacArthur strongly supported 

his chief surgeon's insistence upon the reasonableness of his orders, thereby apparently preventing any severe cutbacks. 51 

Problems with diet often resulted from 

difficulties with supply, although surgeons 

continued to debate the ideal amount of 

meat and fat in the tropical di et. Many authorities believed that a higher proportion 

of sugar would be advisable because of the 

energy it provided and that the usual allowance of meat and fat, basically intended 

for men serving in cold climates, was larger 

than was necessary in the tropics. Some 

concluded that to maintain health in the 

tropics the soldier must eat much less than 

he would in a cooler climate to avoid producing too much hea l. Others disagreed 

strongly, saying that the u.S. soldier was a 

meat eater, that in the tropics he needed to 

eat more than ever, and that the problem 

of heat should be managed by increasing 

the ability to lose heat through wearing 

lighter clothing." 

Time made it apparent that the ration 

found acceptable in the United States 

would be satisfactory in the Philippines, 

but delivering meat, vegetables, and fruits 

unspoiled to the soldier in the field was at 

times "totally out of the question," according to one surgeon. Meat and even hard 

bread deteriorated rapidly in the climate of 

the tropics. Canned meat went "soft and 

disgusting" in the heat, and canned vegetables weighed too much to be carried far, 

although frozen beef could be sent fifty 

miles inland before it thawed out. Troops 

at the front, unable to carry adequate supplies with them without the use of wheeled 

vehicles, suffered from a shortage of food. 53 

Th e China Relief Expedition 

In late june 1900, despite misgivings 

about weakening his force in the Philippines, General MacArthur ordered the 9th 

Infantry to prepare to embark for China as 

the first Army contingent of the China Relief Expedition, which sought to protect 

u.s. interests and citizens threatened by the 

Boxer Rebellion. With the later addition of 

the 14th Infantry and an artillery battalion 

from the Philippines, as well as still more 

units coming directly from the United 

States, the China Relief Expedition would 

eventually number 2,500 and include 800 

marines with their Navy doctors. Adna R. 

Chaffee, who received his promotion to 

major general in the volunteers on 19 july, 

assumed command of the China Relief Expedition when he arrived in China on the 

thirtieth, three weeks after the landing of 

the first U.s. troops there. The expedition 

became part of an international force composed of troops from several major powers, 

including Great Britain, France, Russia , 

Germany, and japan, that were seeking to 

subdue the Boxers, to intimidate the Dowager Empress, and to make China again safe 

for foreigners. Because most ofthe U.s. soldiers who eventually served in China were 

sent from the Philippines, the responsibility for the medical care of the expedition 

fell upon the shoulders of Army Medical 

Department leaders there. 54 

u.s. Vo lunteer surgeon Maj. William B. 

Banister, assigned to the 9th Infantry, served 
CAMPAIGNS OF THE NEW EMPIRE 

as chief surgeon of the China Relief Expedition from the date of its formation until 

25 September 1900 and assumed the ultimate responsibility for the medical care of 

U.s. troops going to China, although Navy 

surgeons serving under him did not submit 

reports to the Army Medical Department. 

Two contract surgeons were detailed to assist Banister in his preparations, but one did 

not repo rt until 25 june, the day before embarkation, and the second never materialized. Thus the chief surgeon had to prepare 

for the expedition with little assistance, and 

only four medical officers, including regimental surgeons, initially accompanied the 

first 1,300 men to sail for China . Under 

these physicians served a hospital steward, 

three acting hospital stewards, and sixteen 

Hospital Corps privates, but the steward 

and four of the privates also arrived only the 

day before embarkation.55 

The men of the 9th Infantry were already worn down by eighteen months of 

service in the Philippines. Since many 

were suffering from malaria alld chronic 

dysentery, Major Banister concluded that 

the regiment was "in extremely bad condition for fi eld service." Neverth eless, 

some were so eager for service in China 

that they did their best to conceal any ailment that might prevent their going. " 

Although U.s. troops in China did not 

encounter humid and tangled jungles, they 

did fa ce hot summers and fami liar diseases 

presenting fami liar threats. Hoping to reduce the incidence of malaria to a minimum, Major Banister prepared for the landing by dosing each man with a daily gram 

of quinine for three days before he set foot 

for the first time on Chinese soil. The traditional fi lth-borne diseases, too, again 

threatened U.s. troops. In Chinese communities, instead of a sewage system, "the 

pail system [was] generally in vogue," but 

221 

WILLIAM B. BANISTER 

because night soil was highly regarded as 

fertilizer forCI·ops, itwas piled up at selected 

sites outside the city, awaiting "its ultimate 

transportation to the countly. " The towns 

were in an "indescribably filthy condition" 

because of poor drainage and the tendency 

of the poorer male members of the population to relieve themselves wherever they 

were. Despite efforts to have soldiers drink 

only water known to be safe, dysentel)' took 

a high toll, and typhoid rates were higher 

than they had been in the Philippines." 

After arriving near Tientsin on 10 and 

11july, Army and Navy physicians worked 

together to un load their equipment and set 

up an operating room in the building th ey 

shared outside the city. Major Banister assigned an acting hospital steward and four 

privates to each of the two battalions that 

landed in time to take part in the first battle of the Boxer Rebellion, the Battle of 

Tientsin on 13 july. The multinational 
222 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

fo rce was rapidly successfu l in taking the 

city. Of the wounded, 77 were U.s. soldiers, some of whom received their initial 

care in ditches, where the polluted water 

soaked their injuri es and caused a particularly high rate of infection among those 

with shrapnel wounds. Since none of the 

Army's amb ul an ce wago ns had yet arri ved 

befo re the city, th e casualties were evacuated by li tter-bearers who were forced from 

time to time to put down their burdens to 

return fire. Banister himself went into the 

city with the most advanced units, and the 

two hospita l corpsmen with him never left 

his side. Supplies were brought up to him 

after he had set up an aid station behind 

the city's inner wa ll. As soon as the enemy 

left the city, Banister and his Navy colleagues entered to set up their facilities. 

Some Army pa tients shared th e Marine 

hospital, and Banister took over a hotel for 

the remainder. By midnight every 

wounded man had received care and been 

moved in to a bed withi n the newly surrendered ci t y'. 

The interservicecooperation among U.s. 

units continued long after the battle had 

been won. With his sick and wou nded divided among three locations, the regiment, 

the Marine hospital, and the hotel, Banister's hospita l attendants were spread so thin 

that he was fo rced to supplement them with 

details from the line. He was soon able to 

co ncentrate his resources by moving all his 

patients from the Marine hospital, although 

the Army facility continued to receive occasional Marine casualties. After a few days 

Banister began to evacuate patients to the 

Navy hospital ship Solace; by 24 July she 

was sheltering 64 Army patients. She then 

departed for the United States via Japan, 

where theJapanese had made hospital space 

available at several cities, including 500 

beds at Nagasah '9 

Not surp risingly, given the condition of 

the troops when they were se nt to China , 

the number of ill among them grew as the 

summer continued. By 26 July 215 men 

were sick with their units and another 61 

were ill on board a transport, most of them 

with diarrhea and dysentery Major Banister decided to establish a base hospital in 

a pri vate home surrounded by enough land 

to permit pitching tents. Here the 

wo und ed could also recuperate until the 

expected arrival of th e Relief , then on her 

way to China, and supplies co uld be accumulated fo r the advance on Peking. By 

this point, more supplies, equipment, and 

personnel were coming in to Tientsin. 

Four ac ting hospital stewards and thirtytwo Hospital Corps priva tes were sent to 

the Tientsin hotel. The arrival of six more 

ph ysicians made it possible to assign th ree 

to the base hospital. The eleven female 

nurses who had volunteered for China service while en route to Manila arrived in 

early August. Five more and a professional 

male nurse, plus more contract surgeons, 

disembarked a short while later. 60 

A few days after General Chaffee took 

command of the China Relief Expedition, 

2,500 U.s. soldiers joined British and 

French troops to march on Peking. The U.s. 

contingent now included the 14th Infantry 

with its four regular medical offi cers, two 

co ntract surgeons, twenty-one hospital 

corpsmen, and equipment. Each regiment 

had "Chino" li tter-bearers, but they were 

trusted so li ttle that they were kep t "under 

guard to prevent their runn ing away. " A 

Regular Army assistant surgeon also accompanied the artillery battalion that was 

a part of the expedition. Marching with th e 

soldiers were U.s. Marines with their three 

phYSiCians, attendants, and li tter-bea rers. 

Although supply wagons were available [or 

the Medi cal Department, Major Banister, 
CAMPAIGNS OF THE NEW EMPIRE 

who co ntinued in the position of chief surgeon, had his medica l chests carried in his 

ambula nces so that they would be immed iatelyavaiiable. 6I 

Shortly after leaving for Tientsin , the expedition encountered the enemy at Yangtsun, suffering an estimated 61 casualties 

in the engagement that foll owed. The ambulances moved forwa rd just behind the 

troops, out of the line of fire, and picked 

up the wou nd ed, taking th em to the dressing station and then moving them forward 

to the campsite chosen for the night. Except for a surgeon who remained with the 

ambulances, all physicians stayed with th e 

troops. A junk took 11 of the wounded 

back to the Tientsin base hospital that 

evening, with the rest of th e wo unded and 

several sick men making th e same trip the 

next day. When the troops resumed th eir 

march, the heat too k a heav)' toll. Hea tstroke and even convulsions were common, and ambulances were fi lled to overOowing. Fortunately, since it was 

impossible to keep a ll the disabled with the 

expedition as it moved forward, the number of surgeons with the troops was large 

enough to permit one to be left behind with 

the sick at each campsite62 

The pattern set at Tientsin was generally followed at Peking. A multinationa l 

force handled th e attack, which began with 

an unsuccessful Russian assault on 13 August. On the fourteenth u.s. troops sca led 

the wall around the Outer City and provided cove r for the British soldiers who followed th em. The nex t day u.s. artillery destroyed the gates in the wa ll around the 

Inn er City, opening the way to the occupation of the entire city. American doctors 

with the attacking force prov ided medical 

care at Peking as they had in Tientsin , setting up a 150-bed fi eld hospital as soon as 

the city fell. Here the sick and the 30 

223 

wounded received exce ll ent care until they 

were evacuated by water bac k to the 

Tientsin base hospital. Whenever possible, 

the wounded and the seriously ill were 

then placed on the Relief for evacuati on to 

Nagasaki , which became a second-level 

base for the ex ped ition. On 29 September 

a seco nd Army hospital ship, the Ma ille, 

was assigned the responsibility for taking 

pati ents to Nagasa ki, where the Reli ef was 

to pick them up for the trip to Manila , 

which remained the primary base for 

Ameri can forces fi ghting in China63 

The Peking hospital initially lacked an adequate supply of standard hospital bedd ing 

and furniture, but surgeons found Chinese 

bedding satisfactory on a tempo rary basis. 

In the fall a permanent hospital of 85 beds 

was established for the brigade to be garrisoned at Peking; existing Chinese buildings were used because the arrival of cold 

weather allowed no time for new construction. Some modificaLions were deemed necessary in these bUild ings, including lowering high ceilings and replacing many 

paper-covered lattice-work windows and 

doors with glass. For a few months a second 

and smaller hospital was set up at Peking, 

together with a residence for the female 

nurses who wo rked at the larger hospitaL ... 

By the end of September 1900 almost 

4,000 soldiers were se rving in China. A second brigade was stationed at Tientsin , 

where, like the garrison at Peking, it was 

served by a large hospital in the city. Many 

detachments wereservingat other locations, 

and two of them had their own small hospitals. Since the railroad from Peking to 

Tientsin was still not operative, supplies had 

to be moved by river, and because junks covered no more than twenty miles a day, garriso ns also had to be stationed along the waterway until December, when the railroad 

was at last reopened. For troops thus scat-
224 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

tered about a land of almost nonexistent sanitation, typhoid remained a particular danger,even when the greatest of care was taken, 

since niescould carry the disease to food and 

watersupplies that were otherwise safe. Fortunately for their health, many of the U.s. 

troops occupyi ng China left in the spring of 

1901 , and many of the remaining men left 

the following autumn. By 1904 the only 

Army troops in China were the men of the 

company guarding the embassy at Peking, 

and the rates of typhoid, malaria, tuberculosis, venereal disease, and alcoholism 

among them were higher than those among 

men stationed in the United States·' 

Service with the multinational force enabled medical officers to compare their 

work and equi pment wi th that of the worlds 

major militaty powers. Major Ives, whosucceeded Major Banister in September 1900, 

commented unfavorably upon the transpOl·tation available to U.s. medical officers, 

blaming the situation largely upon the Medical Department's dependence on the Quartermaster's Department and the slow response time that resulted. He admired the 

Japanese Iiuer as particularly well suited to 

battlefi eld use, though by no means as 

sturdy and comfortable as the American 

model. He was particularly enthusiastic 

about the disinfecting plants and laboratories of the German hospitals, but his observations led him to conclude that "the medical department of the United States Army 

is the best and most intelligently equipped 

of any service there represented. " 66 

Although U.s. forces encountered astoundingly unsanitary conditions both in 

China and in the Philippines, the two campaigns were otherwise a study in contrasts. 

The refu sa l of the Filipinos to acceptAmerican occupation resulted in a prolonged 

guerrill a war that challenged medical officers to adjust to the demands of innumerable small-unit operations, most of which 

were conducted in a hostile enviro nment, 

and at times to work in comparative isolation. The Boxer Rebellion, on the other 

hand, involved conventional warrare and 

required U.s. physicians to work in proximity with medical officers of other nations 

in a situation where they could observe 

firsthand the way in which the medical services of other nations functioned. The 

campaigns over, physicians with both occupation forces were swept up in the effort 

to prevent the destruction of u.s. garrisons 

by disease. 

Like the Spanish-American War, the 

Philippine Insurrection and the Boxer Rebellion reacquainted the u.s. Army with 

the potentially devastating effects of disease upon the effecti veness of armed forces 

and also placed U.s. troops in the midst of 

disease-ridden civilian populations living 

under conditions of incredibl y poor sanitation. Unlike the Filipinos and the Chinese, who, U.S. observers beli eved, had accepted widespread disease and the deaths 

that resulted as inevitable, Army physicians were convinced by what they already 

knew that high morbidity and mortality 

rates were preventable. This conviction 

gave added strength to their struggles to 

guarantee the benefits of modern medici ne 

to American soldiers and also to the people of the lands they occupied.

67 
NOTES 

1. War Department, [Annua l) Report of tile Secretmy of War, 1899, l(p1.4):ix (hereafter cited as 

WD, ARoJSW, date). 

2. Ibid. , 1{pt.5):115 (quotation); War Department, Five Years of til e WClr Department Fo/ fowitlg the 

War With Spain . . . , pp. 8-11; Brian McA. Linn, 

"The War in Luzon," Ph.D. diss., pp. 30-31. 

3. WD, Fi ve Years, pp. 11- 14 (quotations), 79-

85, 172-75, 207-08, 256; linn, "War in Luzon," 

Ph.D. diss., pp. 33-34. MacArthur had been commanding orncer of the 1st Brigade of the 2d Division. 

4. War Department, /A nlllwl) Report of th e Surgeon General, U.S. Army, Lo th e Secretmy of War, 

1900, PI'. 94, 118--19 (herea rter cited as WD, 

ARoJSG, date). 

5. The departments were the Department of 

Northern Luzon (six districts), the Department of 

Southern Luzon (four districts), the Department of 

the Visayas (four distric ts), and the Department of 

Mindanao and Jolo (four districts). In December 

1901 the Departments of Northern and Southern 

Luzon were consolidated as the Department of 

North Philippines and the remaini ng departments 

as the Department of South Philippines. See WD, 

ARoJSW, 1900, 1{pt.3):26, 45-50; idem, ARoJSG, 

1902, p. 45; AGO GO 38, 29 Ma r 1900, and GO 49, 

13 Apr 1900. 

6. WD, ARoJSG, 1900, 1'. 117, and 1902, p. 45; 

WD, Five Years, p. 79. 

7. WD, Five Ye"rs, PI'. 173-75, 177 , 207-08; 

Frederica M. Bunge, ed., Philippines, p. 27; Linn, 

"War in Luzon," Ph.D. diss., pp. 33-34. 

8. WD, ARoJSG, 1898, p. 264, 1899, PI'. 99-100, 

and 1900, p. 109; "Medical and Sani ta ry History of 

the Troops in the Philippines," p. 828. 

9. In addition to a network of division, base, 

brigade, field , post, and camp hospitals, fi ve general 

hospitals we re serving troops in the Philippines by 

February 1900: the First Reserve, the Second Reserve, Hospital No.3, Santa Mesa, and the fa cili ty 

fo r conva lescents on Corregidor Island. See WD, 

ARoJSG, 1900, PI'. 97-98. 

10. Ibid., PI'. 104, 109- 10, and 1901, p. 128; 

idem, ARoJSW, 1900, 1(1' <.3):125; Henry LippinCOli, "Reminiscences of the Expedition to the Philippine Islands," p. 172; Simon Flexner and L. F. Barker, 

"The Preva lent Diseases in the Philippines," p. 523. 

11. WD, ARoJSG, 1899, PI'. 99-100 (first quotation), 110, and 1900, PI'. 105, Ill , 115-16; idem, 

ARoJSW, 1900, l (pt.3):124-25; William O. Owen, 

"Some of the Trials and Tribulations of a Medical Officer or the United States Arm}'," pp. 388-89, 392 

(second quotation); War Department, Correspondence Relating to tile War Witll Spa ill ... , 2:847, 

1014; Flex ner and Barke r, "Prevalent Diseases," p. 

523; "Medical and Sanitary History," p. 828. 

12. Rpt, John Kttlp, in United States, Arm)', 3d 

Reserve Hospital, "Manila Repon ," pp. 3 (quotation), 8, Na tional Libra ry of Medi cine, Bet hesda, 

Md.; WO, ARoJSG, 1900, p. 112. 

13. WO, ARoJSG, 1900, PI'. 97-98, 113-14; 

idem, ARofSW, 1900, 1(pI.3):125; idem, CorrespOIIdell cc, 2:756; United States, Congress, Senate, Report oj til e (Dodge) COlllmission To Investigate the 

COlldll ct oflIJ e War Department ill llle Wa r Wi/ II Spain, 

2:1318, 1320 (hereafter cited as Dodge COlIIllJ issioll 

Report); N. N. Freeman , A Soldier in fil e Philippi/les, 

p. 32; William T. Sexton, Soldiers in til e SUII , p. 148. 

14. WO, ARoJSG, 1899, PI'. 110, 116, 195, 

201-02, 1900, PI'. 71-73 (quotation), 97, 106, and 

1901, pp. 126-27; idem, Correspondence, 2:884. 

1022,1221; Dodge COlli mission Report , 2: 1308-09, 

1322; U r, H. O. Perl ey to Ch Surg, Div of Ph ilippines, 30 J UIl 1900, in Ms 4889, Entry 52, Record 

Group (RG) 11 2, National Archives and Records 

Administration (NARA), Washington, D.C.; 

William ]. L. L}'ster, "The Army Surgeon in the 

Philippines," p. 32; Flexner and Barker, "Prevalent 

Diseases," p. 523. 

15. WD, ARoJSG, 1901, PI'. 78, 135, and 1902, 

p. 145; John M. Gates, Sd100lboohs and Krags, pp. 

11 2,128,233-36; WD, Corresponcience, 1:442, 455, 

and 2:1245, 1253; idem, Five Years, p. 177. 

16. WO, ARoJSG, 1899, PI'. 193 (quotation), 

194, and 1901, pp. 78, 136; idem, Correspondence, 

2:766; Henry S. Kilbourne, "The Medical Department of the United States Army Transport Se rvice," 

pp. 4-5,8; Louis M. Maus, "Mili tary Sanita ry Problems in the Philippine Islands," p. 28. 

17. WD, ARoJSG, 1899, p. 109. 
226 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

18. WD, ARofSW, 1899, 1(pt.5):26, 68, 78-79, 

and 1900, l(pl.3): 1l7 (quotation); "Medical and 

Sanitary H istory," p. 826; Gates, Schoo/boob , pp. 40, 

76; Sexton, Soldiers ill tile SIIIl , p. 221. 

19. WD,ARofSG, 1900, PI'. 90 (first quotation), 

149, 159; idem, ARofSW, J899, 1(1'1.5):114-16, 

1900, 1(pI.3):509 (remaining quotations), and 

1901, 1(1'1.4):292-94; William E Strob ridge, "Chinese in lhe pani America n \Na l" and Beyond," in 

Tile Chinese America" Experiell ce: Papers From llJ e 

Seco/lci Naliollll / COIIJe rell ce 0 11 Chinese America" 

S/iu/ies, J980, cd. Genny Lim (San Francisco: Chinese H istori cal Societ)' of America and Chinese Cu1-

LUre CClllcr, n.d.), pp. 14-15; Questionnaire, 

RichardJohnsol1, in Spanish-A merican \Var, Philippine Insurrection , and Boxer Rebel lion Veterans Research Projec t, Military History Research Collection, U.s. Army M ili tary History Institute, Carlisle 

Barracks, Pa. 

20. WD, ARofSW, 1900, 1(1'1.4):679 (quotation); 

idem,ARofSG, 1900, PI'. 90, 142, 147; Frederick Funston, Memories oJTwo Wars, pp. 329-30; Franklin M. 

Kemp, "Field Work in the Philippines," p. 77. 

21. Funston , j\tlemories, PI'. 194 (first quotation), 329-30; WD, AllofSW, 1899, 1(1'1.4):527-28 

and l(pL.5): 115 (second and third quotations) , 116, 

565-69, and 1900, 1(1'1.3):130 and 1(1'1.4):522; 

idem,ARofSG, 1899, 1'1'. 110, 112- 13, and 1900, PI'· 

90- 92, 107, 123; Ltr, 1-1 . E. Wetherill to C h Surg, Div 

of Paci fic, 13 Apr 1900, in Ms 4888, Entry 52, RG 

112 , NARA ; "Medical and Sanitary History," p. 830. 

22. WD, ARofSG, 1899, PI'. lIO, 11 2-13, and 

1900, PI'. 90- 92, 107; idem, ARofSW, 1899, 1(pt.5): 

566-68. 

23. WD, ARofSW, 1899, 1(1'1.4):385,395; idem, 

AllofSG, 1900, PI'. 90-91, 93. 

24. Lippincott was replaced as chief surgeon in 

April lS99 by Colonel 'Woodhull, w ho was, in turn , 

replaced by Colonel G reenleaf inJanuary 1900. See 

WD, ARofSG, 1900, p. 95. 

25. WD , ARofSW, 1899, 1(1'1.5):.116, and 1900, 

I{pt.3):I24 (quotat ion); idem, AllofSG, 1900, PI'· 

97- 98, 121-22, 138, 142, 163; Lippincou , "Reminiscences," p. 172; "Medical and Sanitary I-l istory," 

p. 826; Manha L Sternberg, George l'vliller Stcmbclg, 

1'. 232. 

26. WD, ARofSG, 1900, PI'. 97-98, 122, 132-33 

(quotation), 138; idem, ARofSW, 1900, 1(1'1.3):125; 

Sexton , So/eli ers ill Ihe Sun , p. 19S;Joseph I. Markey, 

Frail! 10\\'a 10 Ihe Plli/ippilles, Pl'. 24 1.-42. 

27. WD, ARofSG, 1900, PI'. 97, 12/ ; idem, 

AllofSW, 1900, [(1'1.3):124; L),sler, "Ann)' Surgeon," p. 30. 

28. WD, ARofSG, 1900, PI'. 97- 98, 133, 135-37; 

idem, ARofSW, 1900, 1(1'1.3): 125. 

29. WD, ARofSG, 1900, PI'. 97- 98, .1 50; idem, 

ARofSW, 1900, 1(1'1.3): 125. 

30. Glenn A. May, Ball/eJol' Balallglls, p. 83; 'NO, 

ARofSG, 1900, PI'. 150, J55-56; idem, ARofSIV, 

1900, 1(1'1.3):125. 

3 1. WD, ARofSG, 1900, PI'. 98, 158-59, 161- 62, 

164- 65. 

32. Ibid. , PI'. 23 (firslquotat ion), 24, 90, 105, lIO, 

134; idem, ARofSW, 1900, 1(1'1.3):128-29; Gilbert E. 

Seamen, "Some Observations of a Medical Officer in 

the Philippines." p. 181 (second quotation); Lyster, 

"Army Surgeon," pp. 30- 31; "A New Course of Instruction for the Army H ospital Corps," 1'.375. 

33. WD, ARofSG, 1899, PI'. 21-23, 111 (quolalions), and 1900, pp. 25, 106, 109- 10; idem , 

ARofSW, 1900, 1(1'1.3):129-30; idem, Correspondel/ ce, 2:837. 

34. WD, ARofSG, 1899, PI'. J 11- 12, and 1900, 

1'1'.24, 95- 96, 105, 120- 21 , 127-28,134, 142, 151; 

idem , Correspondcnce, 2: 1l92 (quota tion), 126 1; 

idem, ARofSW, 1899, 1(1'1.5):114-15, and 1900, 

1(pt.3):lJ 7, J28. 

35. John C. Brown , Dilll)' oj (l So/elier illihe PllilippillCS, pp. 197,2 10; Lyster, "Arm)' Surgeon," p. 3 1; 

WD, ARofSW, 1900, l(pt.3):1l7, 127-28 ; idem, 

ARofSG, 1899, p. 112, 1900, PI'. 94-97, 105, 120, 

129, 138, 144, and 190 I, PI'. 141-42. 

36. WD, ARofSG, 1900, PI'. 118-20. 

37. Ibid. , p. 95; Sexton , So /e/i ers ill Ille S1II1 , pp. 

268-72; Ltr, Clarence R. Edwards to George H. Penrose, 6 Nov 1899, in M s 4888, Entry 52, RG 11 2, 

NARA. 

38. Funstoll ,Memories, p. 373 (quotations); Freeman, So/e/i er ill lite Philippilles, p. 5 L; United States, 

Congress, Senate, Cll(lIges oj Crl/elLy. Erc., 10 the Nalives ofth, "hili"pilles, PI'. 3, 6, 19; WD ,ARofSG, 1899, 

PI'. 1l0-lJ. , 1900, PI'. 91 , 93, 108, and 190 1, p. 142; 

idem, ARofSW, 1899, 1(1'1.4):512, and 1900, 

l.( pl.4):542; Sexton , Soldiers ill lite S1II1 , pp. 79-80, 

Sl-83, 240-42; Thomas McD. Fairfull, "General N elson A. Miles and l-l is Cha rges of Ann )' Brutality in the 

Phil ippine Insurrection, 1902," M .A. thesis, pp. 27, 

53-54; Gates, Sc oolboo /~ s, p. 86; Lippincott , "Reminiscences," p. 173; Kenlonj. C1)'lller, "Not So Benevolent Assimi lation," p. 550; James H. Blount, The 

All1 ericc/ll Occupll!ioll of fh e PJli1ippiIlCS, 1898-1912, 

PI'. 202-05; Leon Wolf, lillIe Brow/1 Bra/Iter, PI'· 

306-07; Linn, ""Var in Luzon," Ph.D. c1 iss., p. 208. 

39. WD, ARofSG, 1900, 1'.102; Sexlon, Soldiers 

ill lite SIIII , p. 238; John M. Banister, "Surgical Observations in the Philippines," PI'. 1118-19. 
CAMPAIGNS OF THE NEW EMPIRE 

40. Charles E. Woodruff, "The Sold ier in the 

Tropics," pp. 772 (quotatio n), 779; WD , ARoJSG, 

1898, PI'. 11 4- 15, 1899, PI'· 100, 110- 11, J 14- 15, 

1900, PI'. 89- 90, 92, 102- 04, 126, 141, and 1902, 

PI'. 105, 107; idem, AIlojSW, 1900, J(pl. 3):119; 

Sexton , Soldiers ill/he Sun , PI'. 58-59, 140, 152-54; 

Matis, "Mili tary San il ary Problems," pp. 22-23; 

"Medical and Sanitary Hislory," pp. 826-27. 830; 

Dodge COlllmiss ioll Report, 2:1247; Flexne .. and 

Barker, "Prevalen l Diseases," p. 525 . Sec also in 

Emr}' 561 , RG 94, NAR.A: lit', Edward T. Comegys 

l.o Mil Sec, U.s. Arm)" 23 Oct 1904; Telg, Elwell S. 

Olis (0 AG , 5 Jan 1899, and Statement, Edward j. 

Wagnitz, 11 Jun 1907, Henry Li ppincott Papers; 

Med CcrtiHeate, H. O. Perley, 21 Dec 1899, 'vVillimn 

D. Crosby Papers; a nd Oiv or Phi lippines SO 322 

(copy), 18 Nov 1900, Henry F Hoyt Papers. 

4!. WD, ARojSG, 1899, p. 173, and 1900, PI'. 

151-52 ( h r51 quota tion), 163; Freeman , Soldier ill 

the Philippines, p. 52 (second quotation); Maus, 

"Mililary Sani tary Problems," p. 6; SextOn, Soldiers 

inille 51111 , pp. L52- 54, 162; in Entry 52, RG 11 2, 

NARA: Ltrs, Greenlea r LO All Divs and Dists in Dept, 

26 Mar 1900, and vv. E Lewis to SG, 17 Ma}' 1900, 

Ms 4888, and Lt r, D. Glennan to Ch Surg, Di" or 

Phili ppines, 21 May 1900. 

42. WD ,ARojSG, 1899, 1'. 113, and 1900, PI'. 87, 

89, 11 4, 148, L63; R. W. Andrews, "Tropical Diseases as Observed in the Philippines," PI'. 86- 87. 

43. SextOn, Soldiers ill Ihc 511 11 , p. 58; VvD, 

ARojSG, 1900, PI'. 92, 131, 143; Andrews, "Tropical 

Diseases," p. 21; United States, Bureau or the Census, Censlls oj the Philippille /sl(lIIds . .. , 1:371-73. 

44. W D, AnojSG , 1899 , 1'. 136 (rirst quotation), 

1900, p. 141 (rounh quotation), and 1902, pp. 

48-49 (third quotation), 94- 96;Seamen, "SomeObservalions," p. 188 (second quotalion); Louis M. 

Maus, "Venereal Diseases in the United Stat es 

Arm),," PI'. 131- 32. 

45. WD, ARojSG, 1899, PI'. 106, 136, 141-42, 

244, 249- 50, and 1900, PI'. 89, 125, 134; idem, Correspondcllcc, 2:1247; Maus, "Mililnl"}' Sa nit ary Problems," pp. 16- 18,25, 28-29; Will iam T. Sexton , Soldiers illihe Philippines, PI'. 34, 56- 57; "Med ical and 

Sanitary HislOry," 1'. 827; Gates, s choolboob, p. 58; 

L),ster, "Arm}' Surgeon ," p. 33; BrierSummary or the 

Mili ta ry and Civil Services or Colonell. M. Nlalls, 

Medical Corps, Uniled States Army, Re tired , p. 5, 

Louis M. Maus Papers, Entr)' 561 , RG 94, NA RA. 

46. Freeman , So/clier in th e P/lilippines, p. 73 

(quotations); Uppincoll, "Reminiscences," 1'.171; 

"Medical and Sanitar), Hislory," p. 829; vVD, 

ARojSG, p. 131. 

227 

47. WD, ARojSG, 1899, PI'. 100, 102-03 (quotations); "Insanity in the Army," p. 586; "Medical 

and San it ary Hislory," pp. 826-27; Maus, "Military 

San itary Problems," p. 19; SexLOn , Soldi ers iI' fI,e 

slIn, pp. 184- 85; \lVoodru rr, "Soldi er in the Tropics," 

p. 779; L. G. Anderson, "Notes or an Army Surgeon 

in the Recent \¥ar," p. 477; P.). H. Farrel l, "Our Sick 

and Wo unded in the Philippines," pp. 334-35; 

David T. Courtwright , Dw-J~ Parmlise, PI'. 9611 , 

100- 101,202- 03. 

48. WD, ARojSG, 1899, PI'. III (first quotation), 

134-36, 229, and 1900, PI'. 127, 134-35, 140; idem, 

ARojSIV, 1900, I (1'1.4):523 (second quotation); Div of 

Philippines GO 1, 22 Ju11901, file 6355/45, Entr)' 22, 

RG 159, NARA; \¥ooclruff, "Soldier in the Tropics," p. 

776; G. \IV Richardson, "llllest inal Fever, Causes and 

Prevention," p. 817; Sexton, Soldiers ill llle swl, p. 230. 

49. WD, A RojSIV, 1900, 1(pl.3):I22; idem, 

ARojSG, 1898, p. 262, and 1900, PI'. 89, 92, 103, 

133- 34, 136, 139, 152, 155-56. 

50. Ltr, IG to SG, 10 Ma)' 1902, file 6355/106 , 

and Newspape r Cli pping, 1 Ma)' 1902, ri le 

6355/107 , both Entr)' 22, RG 159, NARA ; WD , 

ARojSG , 1900, PI'. 98, 107, 128 (quotation), 138, 

164; Lysler, "An n)' Surgeon," p. 31; Sexton , Soldiers 

ill Ille 51111 , pp. 11 9 , 180. 

5 !. WD , ARojSG, 1900, p. 107; idem, ConespOIulellce , 2: 1180, 1198. 

52. Louis L Seaman , "The U.s. Arm)' Ration , and 

Its Adaptabilit), ror Use in Tropical Climates," pp. 

381,389; Edward l. Munson , "The Ideal Ration ror 

an Army in the TropiCS ," p. 343; Sexton , So ldiers ill 

(he Sun , pp. 85 , 183; \lvoodrufr, "Soldier in the Tropics," pp. 770- 72, 775; Ma us, "Military Sanita ry 

Problems," p. 9; WD, ARojSG, 1900, PI'. 140-4 1. , 

and 1902, p. 50 ; Uni led States, Phi lippine Commission, 1899- 1900, Report oj file Philippi lIe Commission 10 Ille PreSident , 2:238; "Medical and Sanitary Hislory," p. 827. 

53. Quotations from Woodrufr, "Soldier in the 

TropiCS," pp. 770-7 1; ibid. , PI'. 772, 775; WD, 

ARojSG, 1899, PI'. 226, 228, and 1900, p. 127; Seaman, "U.S. Army Ration," pp. 387-88. 

54. WD, ARojSG, 1901, PI'. 150- 51; idem, Correspondence, 1:421, 426; idem, ~oJ , 1901, 

l (pl.6):434, 508; Perc), M. Ashburn , A His/ol)' ojdle 

lvlediccII Dq)(lfIlI1elll oj/he Unit ed s/alesAnHY, p. 228. 

55. WD, ARojSG, 1901 , 1'1'. 150, 152, 155; idem, 

Correspondence, 1:41 2, 41 8-19; William B. Banister, 

"Succinct Account or Services," n.d ., Will iam B. 

Banister Pape rs, En try 561 , RG 94, NA RA; Fred R. 

Brown , l-l isfOI), oJlheNill/1l U.s. /IIFHlt,),. 1799-1909, 

1'1'. 473-74. 
228 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

56. WO, A RofSG, 1901, 1'.152 (quolalion); Banister, "Succinct Account of Services," Banister Papers, Enlry 561, RG 94, NARA. 

57. First quotation from Frederick M. Hartsock, 

"Military Medical Conditions Relating to theAmerican Legation Guard in Pekin, C hina,n p. 252; ibid., 

p. 253; remaining quotations from WD, ARof5G, 

1901 , 1'1'.156-59; ibid., 1'.160. 

58. William B. Banister, "The Medical Reserve 

Corps," PI'. 34-35; WO , ARofSG, 1901, PI'. 150-52; 

idem, Correspondence, 1:429; Rpt Extract, Charles 

A. Coolidge, 13JuI 1900, Banister Papers, Elllry 56 1, 

RG 94, NA IlA. 

59. WO, ARofSG, 1901, pp. L51-52; idem, Corrcspondell ce, 1:427, 435. 442, 456; "Hospital Ship in 

Service at Taku," p. 276. 

60. WO, ARofSG, L901 , PI'. L52-55; idem, 

Co,.respo/ulcnCf, 1:444; Ur, SGO [unsignedl to 

Miss Brennan, 4 Oct 1900, Entry 103, RG 11 2, 

NARA. 

61. WO, ARofSG, 1901, p. 153 (quolal ions); 

idem, CorrespolUJcllce, 1:426, 442;Ja111e5 A. Huston, 

TIle Sill ews oj Waf, p. 303. 

62. Banister, "The Medical Reserve Corps," pp. 

34-35; WO,ARofSG , 1901, 1'1'. 153,155; idem, Correspondence, 1:449. 

63. W illiam G. H. Caner, The LiJe oj Licutellolll 

Gelleml C/JaJfee, p. 180; WO, ARofSG, 190L, p. L54; 

idem, Correspolldellce, 1:452, 455, 459-60; idem, 

ARofSW, 1901, L(pI.6):518. 

64. WO, ARofSG, 1901, pp. 157-58; idem, 

IIRofSW, 1901, 1(1'1.6):521, 539. 

65. WO, ARofSG, 1901 , pp. 155, 158, 161, 168, 

1903, p. 113, 1904, p. Ll3, 1905, pp. 99-102, and 

1917, p. 218; idem, Correspolldellce, 1:464, 480; 

Huston, Shlews, p. 303. 

66. WO, ARofSG, 1901, pp. L6 L (qllolalion), 

162-65. 

67. Ibid., pp. 150, 152; idem , Co rrespOIlcicllce, 

L:438. 
Chapter 9 

PUBLIC HEALTH IN CUBA 

The diseases that defeated V Corps 

troops in Cuba would also threaten those 

serving under the occupation. Victory on 

the island ultimately came from the efforts 

of Army physicians to improve sanitation 

and from the discovery of how yellow fever 

was spread. Unimpeded by the need to obtain popular approval for their work that 

frustrated reformers in the United States, 

medical officers in the conquered territori es waged a vigorous public health campaign, combining the new medical knowledge with the old rules of sanitation to 

crea te practical weapons for the fi ght 

against disease. 

The period from 1875 to 1900 was a 

"goldell em oj communicable diseasecolltml." 

As early as 1870 urban death rates in the 

United States had started to fall. In Memphis, Tennessee, which, according to the 

noted historian of the public health movement, John Duffy, was "one of the filthi est 

places in the United States" in 1872, one of 

the nation's highest annual death rates (46.6 

per 1,000) was halved in seventeen years by 

an energetic campaign to install city sewers 

and a safe water supply. In other municipalities in the South, improvements came 

more slowly, and rural areas were yet to be 

affected by the public health movement. But 

by the time American troops occupied the 

former Spanish territories, "improved sanitation and a higher standard of living" had 

produced a drop in the death rate in New 

York City from 30 per 1,000 in 1873 to 26 

in 1886. Although the population of Louisville, Kentucky, increased Significantly from 

1871 to 1874, the death rate fell from 23 per 

1,000 to 16.5 per 1,000. From 1873 through 

1886 in Cleveland, Ohio, the average death 

rate was 18-19 per 1,000. By fiscal year 

1887-1888 the average death rate in San 

Francisco was 18.27 per 1,000; by 1891 in 

Seattle, Washington, it was 11.5 per 1,000. 1 

PhYSicians now knew that specific bacteria found in body wastes were responsible for the spread of such epidemic diseases 

as typhOid and cholera. The mosquito had 

just been identified as the carrier of the organism that caused malaria, and almost all 

those knowledgeable about yellow fever 

agreed that it, too, was caused by a microbe, although neither the responsible 

virus nor the way in which it spread had 

yet been discovered. Scientists still tended 

to look on yellow fever as a disease lin ked 

in some way with poor sanitation. Fortified by the benefits that had followed improvements in sanitation and public health 

in the United States, by confidence in what 

would be learned in the future, and by the 

strong backing of their surgeon general, 

Army medical officers faced their assignments in the tropics with enthusiasm as 

well as determination.' 
230 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Health of the Troo ps 

Because of the Widespread rear that fo llowed the derea t of the victori ous V Corps 

by disease, President McKinley wished to 

limit th e number of u.s. troops sent into 

Cuba to replace th e V Corps until the 

months of the highest disease rates had 

passed . As a result, the initi al occupati on 

force o f seven new infantry regiments from 

the United States, four of them composed 

o f men be li eved to be immune to tro pical 

diseases, was sent only to the area around 

Santiago and Guantanamo. MOsl so-cal led 

immunes proved to be susceptible to tropical diseases once th ey arrived in the 

Caribbean, and thus even after the last of 

th e V Corps lert ror Camp Wikoff on 26 

August 1898, the Medical Department had 

to keep open the 150-bed yellow fever hospital in Santiago. An "observation station," 

apparently established to isolate suspicious cases after the closing of the yellow 

fever detention camp outside Santiago, 

also continued in use, while in late August 

a few pati ents remained at the Siboney yellow fever faCility.' 

To prepare for the occupation of the entire island during the late fall and winter 

months, the Military Evacuati on Commission, named to plan the U.s. takeover 

of the rest of the island, worked with the 

Spanish to arrange the timing of the replacement of their troops by Ameri ca n 

forces. The forma l turnover of power was 

to take place lJanuary 1899, regardless of 

whether the Spanish had completed the removal of their troops. In anti cipation of 

possible disorders following the departure 

of Spanish troops, as many as 43,000 U.s. 

troops arrived on th e island in the winter 

months of 1899. Butthe transition went so 

smoothly that within a few weeks almost 

half of this number had departed the island, leaving only the volunteers of the Vll 

Co rps in Cuba. Most o r these troops served 

in the Havana area, w ith the remainder 

sca ttered at key points about the island. On 

31 Marc h 1,207 offi cers and 25,197 men 

formed the occupation force, and the total 

dwindled still further when the volunteers 

began to leave Cuba iri Ma rch-all vol unteer troops were mustered out in May. By 

October the small force or regulars that assumed responsibility ror the occupati on 

upon the departure or the vo lu ntee rs numbered less than 15,000 offi cers and men.

4 

From the outset, the occupa tion troops 

arriving in Cuba benefited from the growing awareness or the role played by the mosquito in malaria. Ronald Ross, the British 

scientist responsible for the discovery or 

the malaria vector, had written Surgeon 

General Sternberg in late August 1898 from 

India about the results or his latest work, 

hoping that they would be helpful to him 

in developing "a rational prophylaxis 

against malaria.'" U.s. Volunteer surgeon 

Maj. Jerrerson R. Kean, who came to Cuba 

in December with the Vll Corps, recommended that the troops use mosquito netting, a step that, when foll owed, led to a 

marked decrease in the number of malaria 

cases. During the early months or the occupati on, line offi cers fail ed to take the use 

or netting seriously, however, and detachments tended to leave nets behind when 

they moved, causing sharp increases in the 

number of men who fell victim to malaria. 

Finally, on 21 December 1900 general orders requiring the use of mosquito netting 

were issued from the headquarters or the 

Department of Cuba6 

While the Spanish were still being evacuated from Cuba in late 1898, Surgeon 

General Sternberg sent Colonel O'Reilly, 

the chi ef surgeon on the starf of the Military Evacuation Commission, to study the 
PUBU C HEALTH IN CUBA 

problems enco untered by the British onJ amaica and to co nsult with the departi ng 

Spanish on the dirnculties that they had 

co nfronted while occupying Cuba . Impressed by the death rates from yellow 

fever, dysentery, and malaria, diseases that 

could devastate new arriva ls in the tropics, O'Rei ll y recommended that the occupati on troops be at least "thoroughl y protected against smallpox" before leaving th e 

United States and, once in Cuba, th at they 

be kept from cO lllact with the civili an population to th e ex tent possible. Co nvinced 

that sanitation was th e key to maintaining 

the health of the occupi ers, he also emphasized that stri ct regulations should be 

enrorced among the men. 7 

With the benefit of O'Reilly;; advice, the 

info rmation garn ered by medical o rncers 

sent to inspect the various Cuban towns 

where U.s. troo ps would be quartered, and 

th e ample funding that Congress had made 

availab le for wartime needs, Surgeon Genera l Sternberg could make preparations fo r 

the occupation that were "of the most generous character. " The regimental fa cility 

was welcomed back in to the Army; each 

regimelll arriving in Cuba brought a hospital with it. Division hospitals were ready 

to care for 1,000 patients each. Every camp 

on th e island , no matter how small, was 

provided with its own carefull y equipped 

hospital, and in each of the military departments in to which occupied Cuba was 

divided, an add itional fa cility was established to handle any overflow from the 

camp hospitals. Hospital ships and the 

general hospitals in the Un ited States 

formed a further backup. By restricting the 

area within the United States that the New 

York supply depot-"our cheapest purchasing market," as Sternberg put it- was 

expected to serve, the Medical Department 

could rely upon it to meet easily all the 

23 1 

needs of troops in the Caribbean. Sup plies 

of all kinds, includ ing mi croscopes, we re 

thus available in quantity on the island , 

and Sternberg stood by to fill promptly the 

orders sent to his offi ce. In the spring of 

1899 U.s. Volunteer surgeo n Major lves reported that "never before in that respect 

was an army more completely equipped." 

Regul ar troops replaced the volunteers in 

Ap ril, and the number of u.s. troops on 

the islands became so few that th e comprehensive system designed by Stern berg 

to serve th e occupati on force was no longer 

necessary. By June 1900 all genera l hospitals supporting these men had been 

c10sed B 

SanilaLio n on the somewhat modest 

scale requ ired by military posts was a familiar chall enge to medi cal offi cers, but 

the physicians given this assignment in 

Cuba had littl e knowledge of the island 

and its geography and geology. Attempts 

to prepare campsites before the arriva l of 

the men who would repIace both the V 

Corps and departing Spanish troops were 

notalwayssatisfactory. When the first men 

of the VlL Corps arrived in the Hava na area 

in December 1898, water was scarce at 

their camp, tents lacked fl oors, and latrines 

were in poor condition. Although the surgeons advised commanding offi cers on 

such matters, supervised the disinfection 

of bUildings taken over for barracks, and 

encouraged the maintenance or stri ct stan -

dards of camp sanitation, including protection of food supplies from fli es, th eir arguments were ap parently not always 

entirely convincing. Dysentery rates were 

higher than in th e United States. Since 

some regiments coming to Cuba had been 

infected with typhOid before they arrived, 

occasional cases cOlllinued to appear, although this disease had not previously 

been a serious problem on the island. In 
232 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

the Department of Matanzas and Santa 

Clara, soldiers were required "to avoid 

touching their lips before washing their 

hands" if they had touched anything that 

might be infected, to remain indoors after 

dark, and to disinfect their living quarters 

every week and their privies daily. These 

regulations, when stri ctly obeyed, did limit 

the spread of disease 9 

A rash of typhoid fever cases appeared 

on one occasion in the spring of 1899, 

when latrines were not expanded to accommodate 1,000 Cuban laborers who arrived to construct new barracks near Hava na. The outbreak occurred because the 

Cubans, permitted to ignore regulations, 

"defiled the surface at will." When the latrines were enlarged, the improvement in 

sanitation was followed by a drop in the 

number of cases. A nare- up of typhoid in 

the Puerto Principe area in February and 

March was not so easily managed. Major 

Reed, ordered to investiga te, concluded 

that once again the misdiagnosis of early 

cases had permitted the disease to make 

considerable headway before the problem 

was identifi ed as typhoid and that inept attempts to stem the spread of the disease 

had further contributed to the epidemic.1O 

The sanitary revolution had not reached 

the towns and cities of the former Spanish 

empire. The "environment [was] reminiscent of America in the early nineteenth century, if not Europe in the Middle Ages," according to historian Gaines M. Foster in his 

study of the Army Medical Department's 

role in disaster relief. After years of guerrilla warfare, Cuba's cities were, as military 

historian Graham A. Cos mas described 

them in his definitive work on the Spanish-American War, "filthy and war-ravaged," with some parts of Havana resembling "an outdoor cesspool. " The shortage 

of food had brought hunger to the city's 

population. One eyewitness recorded that 

"dead animals abounded, garbage was encountered everywhere, gutters were foul , 

and open mouths of sewers running into 

the ocean or into the harbor were reeking." 

Another commented that the city was 

"practi cally untouched by real progress 

and .. . years behind in everything except 

natural and man-made beauty." In Santiago, where water mains had been seriously 

damaged during the siege, disease was already rampant. Much of the rural population had been gathered by the Spanish into 

villages, where they could be more effectively controlled. By devastating the countryside between these communities and 

killing off the livestock, the Spanish had reduced the inhabitants to a state of semistarvation, wh ile the guerrillas resisting 

them destroyed the improvements that the 

occupiers had initiated. The first U.s. 

troops sent to Cuba had to bestationed near 

towns and cities, especially seaports and 

rail junctions, to be able to respond 

promptly to the first signs of trouble, but 

conditions in Havana led authorities to 

caution against locating troops in the city." 

Improving Sanitation 

The proximity of troops to Cuban communities made the problems involved in 

preventing disease among troops and in the 

civilian population interdependent. Because local authorities in the impoverished 

nation did not have the resources needed 

to conduct a thorough cleanup and disinfection of Cuban towns, "reclaiming towns 

from their present unsanitary condition" 

became the responsibility of the military 

government of the island, established in 

December 1898 and heacled by General 

Brooke. On the recommendation of 
PUBLIC HEALTH IN CUBA 

Colonel O'Reilly, the chief surgeon of the 

Division of Cuba from January to November 1899,12 Brooke initiated an island-wide 

campaign to improve sanitation. The effort 

was continued by Brooke's successor in December 1899, fonner medical officer 

Leonard Wood, newly promoted to major 

general in the volunteers, whose assignment as physician to the White House during the presidencies of Cleveland and 

McKinley had given him powerful suppon ers in his career as an offi cer of the line. 

General Wood was advised by O'Reilly's 

successors, LL Col. Calvin De Will and, 

subsequently, Maj or Havard. 13 Th roughout 

his rise to increasingly responsible positions in the military government,I< Wood 

gave his unswerving support to efforts that 

he assumed wo uld render the island a 

healthy place in which to live for Cubans, 

visitors, and occupying troops ali ke. Under 

him, medical offi cers strove to improve 

sanitation and educate the Cuban public, 

both medi cal and lay, about public health. 

By mid-1900 six Army surgeons were assigned as municipal sanitary officers, supervising civilian government workers. 

The management of Cuban chari ties, including city hospitals, being in a state of 

confusion, the military government created a department of charities under thesupervision of a medical offi cer to restore 

order to this aspect of the island's life. IS 

The cleanup of some smaller Cuban 

communities was accomplished with considerable success. As early as September 

1899 the commander of the Department of 

Matanzas and Santa Clara co uld proclaim 

that "the cities and towns, from a condition of fil th and unhealthiness, have been 

perfectly cleaned and put in first class condition. Cesspools have been emptied; 

yards and foul places have been cleansed; 

holes and badly-drained localities have 

233 

been fi lled and ditches and drains opened, 

umil the sanitary condition of the towns 

and citi es is as good as it is in cities of li ke 

size and situation in the United States or 

elsewhere." Nevertheless, the surgeo n 

general still considered the disease rate in 

Ma tanzas to be too high .1 6 

The greatest challenge for medical officers, however, was the responsibility for the 

sanitation of large civilian communities, 

whose inhabitants had been accustomed 

for generations to wholesale fi lth but not 

to taking orders. Large numbers of halfstarving men, women, and children were 

crowded together in "dark and damp 

houses" under conditions of incredibly 

poor sanitation, where the threat of disease 

remained serious even after the prompt 

restoration of food supplies to the once-besieged Santiago and the provision of medicines for the sick in the cities. The formation of Anti-lUberculosis League chapters 

in Cuba was encouraged, and attempts 

were made to end the prevalenl custom of 

spilting on the Ooor. Even though the death 

rate dropped, U.S. authorities became increasingly convinced that most public 

buildings were infected by yellow fever. I

' 

In Santiago the siege had led to a serious deteri oration in the hea lth of the population, and "the very air seemed laden 

with death." Thus a public health campaign became necessary even before the V 

Corps left Cuba. General Wood ordered 

that cleanu p of the city start as soon as its 

defenders capilUlated, at a time when 

2,000 Spanish soldiers lay sick within Santiago and ano ther 2,000 were ill in their 

camps outside iL lS 

As military governor of Santi ago, General Wood moved quickly in his effort to 

sanitize the city. He divided it into fi ve secti ons, placing a medi ca l offi cer in charge 

of each and assigning him a team of in-
234 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

spectors and street cleaners. This ('paramilitary fo rce attacked nIth with . . vigo r," 

removing from the streets and burning 

1,100 bodies of both humans and animals 

in barely more than two months and for a 

lime handling as many as 200 loads of 

tras h a day. Wood had th e overn ow from 

cesspools that had nooded the streets 

eliminated and ordered work on a modern 

sewage system LO begin. Accompanied by 

a committee of surgeons, he personall y 

visited each house to ensure that it was 

properly cl eaned up, "almost working 

miracles with the dirty old town. " He also 

reo rganized both military and civilian hospitals in Santiago, hired Cuban physicians 

to staff them where necessary, and inspec ted these fa cilities personally. He had 

the former Spanish military hospital 

clea ned up and disinfected so that it co uld 

be used for u.s. military patients. Total 

deaths in the city dropped from 103 a day 

on 17 july 1898, the day th e siege end ed, 

LO 37 a day only three weeks later, just as 

the V Corps began leaving Cuba. After the 

departure of the disease-ridden V Corps, 

several fac ilities were closed, among them 

two military hospita ls that were shut 

down in September. The yellow fever hospital , which too k in 35 pati ents in September, 22 in October, and 2 in November, all from supposedly immune troops, 

was optimistically closed in November. 

More than 1,100 pati ents remained ill 

withi n the city, ha lf with fevers of one kind 

or another. 19 

Fighting Yellow Fever 

When yellow fever struck the island 

again in mid-1899, most of the sick were 

U.s. soldi ers, since they formed the bulk of 

the nonimmune populatio n on the island. 

rvl.any other victims were civilians, presumably either employees of the Army or, since 

immigraLion was increasing arter falling to 

near zero in 1896, newly arrived Spaniards. 

In spite of General Wood's energetic 

cleanup campaign, the disease LOo k its 

heaviest toll in Santiago. The first soldier 

fell ill on 21 june, and by mid-July 158 cases 

had been reported. Milita ry authorities 

were criticized for not acting more 

promptly, but they responded to the epidemic on 30june by removing as many soldiers as possible from the immediate vicinity of buildings where yellow fever had 

appeared and by diSinfecting barracks, 

clothing, and the men themselves. Two 

companies and the band were ordered LO set 

up tents outside the parade ground while 

their barracks were fumigated. The clothing of the remaining two companies was 

sent to the Marine Hospital Service ship in 

the harbor to be disinfected, and a contract 

surgeo n and several hospital corpsmen escorted the men through a disinfection 

process that apparently in volved a "sublimate bath" ("sublimate" presumably meaning corrosive sublimate or mercury chloride) before they marched two miles into 

the countryside. Although 5 cases appeared 

shortly after their departure from Santiago, 

no more fell ill once the incubation period 

had passed. Of the 23 men stricken, 8 died. 

Yellow fever also struck patients in the general hospital, triggering an evacuation of the 

facility under th e assumption that it was infected. More than 80 patients and almost 40 

attendants were moved to the grounds. 

Cases continued to appear for several days 

after the move began , but no more occurred 

after 7 July, when the last patients were removed. On the twelfth the hospital was 

moved to a new site. 20 

Assuming that when yellow fever struck 

a private home the building became in-
PUBliC HEALTI-IIN CUBA 

fected, General Wood ordered that its inhabitants be removed while it was fumigated 

with sulphur fumes or formaldehyde. If the 

building could not be well sealed, he had it 

washed down with a disinfectant. He ordered corrosive sublimate to be spread 

around the ground outside. Each supposedly contaminated home was guarded by 

sanitary police to prevent entry for a week 

before immunes were allowed to return. 

Until 4 September, no one was allowed to 

remove furniture or bedding from an infected house, and even after this date such 

items had to be disinfected before being 

taken into a noninfected house. This routine was complicated in mid-September by 

the unexpected refusal of the Marine Hospital Service to handle any more disinfection." After this point, therefore, civilian 

property was taken either to the steam room 

at the old Spanish military hospital or to a 

formaldehyde pressure room built earlier for 

the Army. After conferring with civilian doctors and some of the city's merchants, U.s. 

Volunteer surgeon Maj. Lawrence C. Carr, 

who had been placed in charge of all yellow 

fever patients, closed bars and hotels where 

yellow rever had appeared. The city's physicians agreed to report all suspicious cases to 

the Medical Department, a measure to 

which all but one ad hered raithrully." 

Astounded by th e magnitude of the outbreak, which eventually produced more 

than 200 cases and a 22.S-percent death 

rate, General Wood imposed a quarantine 

upon the entire city. America ns were rorbidden to enter Santiago without the authoriza tion of the cit.y's military commander. Ships were denied permission to 

un load or take on passengers, or even to 

to uch at a wharf. Pack trains were ordered 

out or Santiago to campsites at least fi ve 

miles from the city and at some distance 

both from infantry camps and from th e 

235 

stream that constituted the mu ni cipal 

water supply. Those who were authorized 

to leave the city had to be disinfected before departing. Members of the stafr of the 

yellow fever hospital in Santiago harbor 

were ordered to wear distinctive yellow 

armbands and not to leave that faCility 

withou t both receiving permission and un -

dergoing disinrection. Carr's experience 

with the epidemic led him to co nclude that 

a health offi cer should be assigned by the 

city to guarantee that doctors reported 

possible cases of yellow fever within 

twelve hours and to supervise disinfection 

routines and quarantines. Since he regarded "the non-immune tramp element 

lasl a source of grave danger," he urged 

that each May, before the start or the yellow fever season, all in that category be deported rrom Santiago." 

More important than all other measures, however, was the isolation or yell ow 

fever patients, whether military or civilian. 

Ambulances marked with a yell ow nag and 

devoted exclUSively to the transportation 

of yellow fever victims were kept at Carr's 

headquarters at the offi cers hospital. A detention camp with a starf of four surgeo ns 

was set up nearby, where all nonimmune 

inhabitants of infected houses were sent 

for five days of isolation. Since early diagnosis had assumed a critica l importance, 

patients even suspected or havi ng co ntracted yellow fever were taken to an observation faCility guarded by a policeman 

who denied entrance to unauthorized perso nnel. If th e diagnosis was confirmed, 

they we re usually then moved by launc h 

to th e yellow rever hospital , but si nce yellow fever victims might become ill before 

their cases were diagnosed, some were apparentl y left at home until they had recovered suffiCiently to be moved. Convalescents from yell ow reve r were sent to a 
236 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

W ALTER R EED 

detention ship in the harbor, where they 

remained for eight days, by which point 

most military patients were capabl e of performing light duty and co uld be sent 

ashore to become part of a guard of immunes for the city. By 13 August so few 

men were still convalescent that th e detention ship was returned to its original 

owner. Followi ng the imposition of these 

measures and the quarantine, the epidemic 

began to taper o ff, with onl y 74 additional 

cases recorded from 13 Jul y to 15 October 

1899. Carr noted with apparent surprise 

in October that none of th e sta ff members 

at the observation and detention fa cilities, 

at the yellow fever headquarters, or among 

the patients in the detention camp ever 

co ntracted yell ow fever. H 

Although under the personal direction 

of the relentless Wood the publ ic health 

campaign in Santiago may have been more 

effectively co nducted than in any other 

community in Cuba, the Santiago experience was not unique. In other comrnunities markedly increased municipal cleanliness might also result in a lower incidence 

of typhoid, but it fail ed to eliminate yell ow 

fever. As far as sanitation was co ncerned, a 

miracle was performed in Havana , where 

250,000 people lived in 26,000 buildings, 

a "great number of neglected male infan ts 

[were[ often allowed, even in winter, to go 

naked or scantily clad," and decades of political upheaval had undermined sanitation. Havana's 30 hospitals, 6 of them military, were all inspected. Because of their 

poor sanitation and their widespread failure to thoroughly isolate their yell ow fever 

and smallpox patients, these facilities were 

placed under the supervision of Major Gorgas, who had been appointed chief surgeon 

of the Department of Havana when it was 

created in January 1899. Major Reed was 

sent to Havana to test disinfectants in an 

attempt to learn how best to prevent the 

spread of disease by disinfecting water supplies, sewers, streets, and households. Diligent efforts transformed the foul-smelling 

city, whose soil was saturated by cesspool 

efOu ent and whose disease rate was comparable to that of a seventeenth-century 

European city, in to a community that for 

hea lth and cleanliness riva led any in the 

United States. Dysentery, malaria , and typhoid rates dropped markedly. " 

In spite of both improvements in sanitation and attempts to prevent the importation of the disease from other ports, yellow 

fever also struck Hava na in 1899. As in Santiago, removal of potential victims from infected sites and disinfection of clothing and 

quarters failed to prevent the spread of the 

disease. In the course of the year 28 soldiers 

and 32 civili ans in the Havana area contracted yell ow fever. Of th e total, 14 died, a 

death rate that was regarded as 10w. '6 
PUBLIC HEALTH IN CUBA 

General Wood and the Department of 

Havana commander, Brig. Gen. William 

Ludlow," eventually became involved in a 

quarrel over yellow fever statistics. Wood 

publicly implied that Ludlow had suppressed these figures, especially those for 

1899-1900. Ludlow appealed to his chief 

surgeon, who was thereby placed in a very 

awkward position, since he felt that Ludlow 

did not "appreciate the importance of the 

work. " Gorgas diplomatically replied that 

he believed that the physician in charge of 

reporting all cases of ye llow fever tended to 

avoid classifying possible cases as actual yellow fever, thus producing lower figures than 

might otherwise have been expected. He 

added that by the fall of 1900 the fi gures on 

yellow fever were also being more widel), 

reported than they had been earlier.'· 

The successful efforts of smaller communities on the island to improve sanitation also failed to result in freedom from 

the onslaught of yellow fever, which struck 

81 more victims and caused 22 deaths outside the major citi es. Surgeon General 

Sternberg was obviously reli eved that the 

toll had been no higher and attributed 

what he considered th e minor nature of the 

outbrea k in 1899 to prompt action by 

Army surgeo ns in diagnosing th e disease, 

isolating its victims, and encouraging th e 

prompt removal of garrisons from infected 

posts. None of the cases that developed 

among troops there could be traced to outside so urces, and since removal from the 

post apparently brought the epidemic in 

its ga rrison to an end , medical officers concluded that the disease resulted from the 

infecti on of buildings. Apparently more 

strongly convinced than ever of the role 

played b)' poo r sanitation, General Brooke 

concl uded that installing complete sewer 

systems in various communities, despite 

the enormous expense that wo uld be in237 

volved, wo uld be necessary if yellow fever 

were to be finally defeated.'· 

Major Gorgas' success in dealing with 

the disease problems of Havana was so great 

that his appointment in 1900 to the positi on of chief surgeon for the Department of 

Santiago and Puen o Principe was greeted 

by protests. General Ludlow, whose opinion of Gorgas was obviously higher than 

Gorgas' opinion of him, pointed out to the 

adjutant general of the Division of Cuba 

that no one could replace Gorgas beca use 

he offered an unmatched combination of 

skill with a profound familiarity with conditions in Havana. Ludlow believed that the 

sanitation of Havana was "in a general 

sense, more important than all the rest of 

th e Island put together. " To the apparent 

satisfaction of all co ncerned, the transfer 

was promptly canceled, and on 4 April Gorgas "finally settled down as Chief Sa nitary 

Offi cer of the City of Havana. " 30 

Although the main concern of medi cal 

offi cers in Cuba was yellow fever, from th e 

outset they also had to deal with a disease 

that, unlike yellow fever, was far more of a 

threat to the civilian population than to the 

military. Cuban law requiring all citizens to 

be vaccinated aga inst smallpox was apparently often ignored, and when an epidemic 

broke out in a small area of th e Department 

of Santiago in the fa ll of 1898, General 

Wood deemed it wise to launch an antismallpox campaign. He sent 100 sanitary 

workers out to disinfect buildings that had 

sheltered smallpox victims and had as 

many people as possibl e vaccinated. He assigned a few medical offi cers to supervise 

Cuban physicians in setting up an isolation 

hospital; cases were so numerous thal from 

November 1898toJanuary 1899 it handled 

1,185 cases. Doctors discovered that only 

2 percent of those who contracted the disease had ever been vaccinated. None of the 
238 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

10 percent who died had ever been immunized. Thanks to the warnings of medical 

orncers li ke O'Reilly, none of the medical 

orncers or soldiers who guarded the hospita ls contracted smallpox. The success of 

the campaign was attributed to a large extent to the local doctors, who were able to 

overcome the distrust of the Cubans both 

for vaccination and for the hospitals where 

patients with potentially fatal contagious 

diseases were isolated. Although the U.s. 

military government managed to enforce 

the earli er legislation in some areas, it was 

not until 1901 that the law was revised to 

req uire that all children be immunized before their first birthdays." 

The occupying authoriti es, firm ly convin ced of the benefits to be derived from the 

great improvements achieved by their public health campaign in Cuba, apparently 

fa ced 1900 with some confidence as far as 

disease was concerned. Even so, faith in 

sanitation as the answer to the yellow fever 

problem was waning. The number of those 

not immune to yellow fever coming to the 

island was great. On the advice of Major 

Carr, now the chief surgeo n of the Department of Santiago and Puerto Principe, a circldar was issued in March 1900 outlining 

the usual precautionary steps, among them 

isolating or removing nonimmunes among 

the destitute, to be taken in the attempt to 

avoid a recurrence of the 1899 epidemic. 

Whether in spite of the precautions or because of them, yellow fever did not reappear in Santiago in 1900.32 

Other communities were not so fonllnate. One isolated patient with yellow fever 

was reported in January 1900, and in the 

spring a growing number of cases appeared 

scattered about the island. On 10 Maya soldier at Santa Clara and anoth er at Pinar del 

Rio Barracks co ntracted the disease, although the latter, who died six days later, 

was initially beli eved to have had malaria. 

A second case at the barracks was diagnosed as yellow fever on 14 June, and it was 

foll owed by fo ur more cases that month, all 

but one o f whi ch ended fa tally. In July 

twenty-seven cases were diagnosed, four 

among civilians, with eight fatal. At this 

point, the command at Pinar del Rio was 

ordered to leave the barracks. Since only 

two more cases occurred after the move, 

authorities concluded that this step should 

have been undertaken much earl ier. At 

Santa Clara the disease eventually amicted 

thirty-six orncers and men, killing ten of 

them. The first case at Quemados, near Havana and the headquarters of the DepartmentofHava naand Pina rdel Rio, appeared 

on 19 May, and eleven orncers and men 

eventually fe ll ill , butthe nearby Columbia 

Barracks was spared. By 1900 yellow fever 

and the fear of its spread had led to the establishment of seven hospitals where yellow feve r victims could be isolated-at 

Santa Clara , at Havana , at Quemados, and 

four in the Department of Santiago and 

Puerto Principe. Havana's Los An imas hospita l, well staffed and equipped with ambulances to transport pati ents, handled the 

victims of all co ntagious diseases." 

Removal from the a ffected area seemed 

to bring epidemi cs at the various posts to 

an end, but the fear that the health of soldi ers stationed near towns might be endangered if ye llow fever erupted there led 

medical orncers to continue th eir attempts 

to limit th e spread of yell ow fever among 

civilians. W hil e disco uraged at the fa ilure 

of high stan dards of sa nitation to eliminate 

yellow fever as a threat in towns and cities, 

military authorities continued the struggle. When the chi ef surgeon of the Department of Havana and Pinar del Rio , 

Major Kean, fell ill with yellow fever, the 

post surgeo n at Columbia Barracks super-
PUBLIC HEALTH IN CUBA 

vised the removal of the nonimmunes of 

the populaLi on of Quemados LO a camp Lwo 

miles away. Houses of prosLiLuLion, bars, 

and oLher publi c places of entertainment 

frequellled by soldi ers were then closed. 

O n 1July a circular was issued for the Department of MaLanzas and Santa Clara similar LO Lh aL issued in March for the Department of Sa nLiago and Puerto Principe. 

DespiLe the mOSL strenuous effons, yellow 

fever caused more than 300 deaths in Lhe 

civilian and miliLary population of Cuba in 

1900 , the highesL Lo ll , accord ing LO Major 

Gorgas' wife, in th e hisLO ry of the island. 

Gorgas blamed Lhis reco rd in pan on the 

growLh of the nonimmune population of 

Spanish immigranls.34 

The Yellow Fever Board 

NOL surprisingly, given the failure of 

cleanup effo rts to prevenL the epidemic of 

1899, yellow fever became the focus of inLensive study in the spring of 1900. Apparelllly at the instigation of Commanding 

General of the Army Mil es, Surgeon General SLernberg appoillled a board Lo study 

infectious diseases in Cuba. From the outseL this body concenLraLed on yellow fever 

and thus became known as the Yellow Fever 

Board or the Ye llow Fever Commission." 

Sternberg named Major Reed as chairman 

and aSSigned three contract surgeonsAristides AgramonLe, James Carroll , and 

Jesse W. Lazear- LO work WiLh him. AgramOille had been born in Cuba and was the 

only member of the board immune LO yellow fever. He had been educaLed in the 

United States and was serving as a bacteriologist in th e New York HealL h Department 

when the Spa nish-American War began. 

Carroll , who had been one of the bacteriologisLs in vesLigaLing the diseases of Army 

239 

ARlSTIDESAGRAMONTE, wea rillg fhe 1111 iform oj WI acting assistallt stlrgeOl J that 

was cllItlwrized Jar COil tract swgeolls 

camps in the United StaLes in 1898, had 

studied medicine while serving in the HospiLa l Co rps and had taken laboraLOry 

courses aL Johns Hopkins. Accord ing to 

AgramonLe, he was "indusLriousand of a reliring disposition," while Lazear was "a 

Lhorough universiLy man, ... the Lype of 

old southern genLleman, kind, affectionate, 

dignified, wiLh a high sense of humor.")· 

Discovering how yellow fever was 

LransmiLted wou ld be importalll for Lhe 

civili an population of the United States as 

well as for troo ps in Cuba, since the disease periodi cally amicted U.s. communiLi es, causing more Lhan 100,000 dea ths 

from 1793 LO 1901. It had inspired the fea r 

that had earlier precipiLated the formation 

of the commission upon whi ch Surgeon 

General Sternberg himself had served before the Spanish-American War. AILhough 
240 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

J ESSE W. L AZEA R 

his research had led him to speculate that 

the responsibl e organism might be too 

smalllO be seen und er the mi croscope, his 

chief accomplishment had been to prove 

current theo ries concerning yellow fever 

to be fa lse. 37 

One th eory retained credibility in 1900, 

however. A highly respected Italian bacteriologist, Guiseppe Sanarelli, maintained 

that yellow fever was caused by an organism he had dubbed Bacillus icLemides. 

Many highly respected auth orities regarded his theory with favor, all the more 

so since he had followed Koch's postulates 

in assembling his evidence. Some maintained that they had found Sanarelli's bacteria in many yellow fever victims they had 

examined. By 1899 this scientist had become so sure of his theory that he mocked 

Surgeon General Sternberg for "not readily" conceding "success to another when 

he had himself fa il ed." Everyo ne who was 

JAMES CA RROLL 

a true "man of science," Sanarelli announced, wou ld rejoice with him that th e 

riddle had been solved. Commenting that 

the surgeo n general's wo rk had been completed before the most recent progress 

made in bacteriology, he crowed that 

Sternberg's "primitive and defective technique" had resulted in "very serious lacunae" in his research. 38 

When Surgeon Genera l Sternberg ordered the new board to concentrate on th e 

va rious theories concerning yellow fever, 

Sanarelli's Bacilllls icLeroides seemed a good 

starting point for its research. Major Reed, 

Agramonte, and Carroll had all wo rked 

with the organism in the late 1890s, and 

when they arrived in Cuba and began their 

work in fa cilities at Columbia Barracks, 

near Quemados and several mil es from Havana , they continued this work. The epidemi c under way in the summer of 1900, 

both at Quemados and within Havana it-
PUBLIC HEALTH IN CUBA 

self, provided plentiful material with which 

to work. They examined the blood of 

twenty-four patients with yellow fever and 

the internal organs of eleven who had died 

of it without finding any trace of Bacillus 

ictemides or of anything else upon which 

they could fasten blame, a result that surprised Agramonte, who had personally 

identified the bacillus in 33 percent of the 

autopsies he had performed in Santiago in 

the 1898 epidemic. Further research led the 

board to conclude that Bacillus icteroides 

was the cause of hog cholera.'9 

After disposing of Sana rei Ii's theory to its 

own satisfaction, the Yellow Fever Board 

looked to the work of other scientists for 

ideas about further research. Major Reed 

accepted the conclusions of Marine Hospital Service scientist Henry Rose Carter, who 

had demonstrated that twelve to fifteen 

days usually elapsed between the appearance of the first case of yellow fever in a 

community and the development of subsequent cases. Reed then turned to a muchdisputed theory put forward by CarlosJuan 

Finlay, a U.s.-trained physician practicing 

in Havana who had long maintained that a 

specific mosquito, Aedes aegypti,<o was the 

yell ow fever vector- in actual fact, of 

course, only the female could serve as the 

vector because only the female mosquito 

bites. Unwilling to abandon his theory yet 

unable to prove it to anyone's satisfaction 

but his own, Finlay had become an object 

of ridi cule. Among the nonbelievers in Finlay's theory, apparently, was Surgeo n General Sternberg himself; when the surgeon 

general later maintained that he had known 

yellow fever to be mosquito-borne all 

along, he earned Reed's scorn and distrust. 

By 1900 Ca rter was suffiCiently impressed 

by Finlay's theory to write Lazear that it was 

"more than plausible, although his arguments as 1 read them are no t convincing. " 4 1 

241 

CARLOS J UAN FINLAY 

After famili arizing himself with the work 

of both men, Major Reed concluded that in 

light of recent revelations about insects as 

disease vectors and of the data produced by 

Carter's research, Finlay's theory deserved 

further investigation. The pattern of the 

spread of yellow fever was quite dirrerent 

from those classified as filth diseases, and 

the cleanup campaign in Havana had had 

no effect upon yellow fever rates. The disease sometimes spread from one home to 

another without any contact between the 

famili es involved. Unlike the victims of typhoid, moreover, yellow fever patients did 

not usually give their disease to their nonimmune nurses. Ree(Ps decision in the summer of1900 to turn from the puzzling question of the causative organism to the more 

promising one of the vector led to the research that would make his name famous'2 

Finlay was happy to proVide the eggs 

and larva of the insect he suspected of 
242 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

spreading yellow fever, but the small an imals usually used in laboratory experiments did not co ntract yellow fever. To 

find the necessa ry human guinea pigs, 

Major Reed turned to u .s. citizens in Cuba , 

both soldi ers and civilians, and to Spanish 

immigrants who had a rrived so recently in 

Cuba that they had not yet contracted yellow fever. History would suggest that if 

these men remained long in th e island they 

would, sooner or later, contract yellow 

fever. All those who came forward for the 

experiment were offered $100 after being 

warned of the potential consequences of 

taking part, and those who contracted yellow fever were offered another $100. Although Havana newspapers vigorously deplored the use of human guinea pigs, the 

Spanish consul gave his approval after receivi ng assurances that no minors would 

be used and that the unusual step Cat the 

time) of obtaining written consent wo uld 

be made in every instance." 

The Spanish immigrants rounded up by 

Agramonte were initia lly most enthusiastic, believing the notion that mosqu itoes 

co uld spread yellow fever was ridi culous. 

When they learned that those bitten were 

falling ill, some, according to Major Reed, 

"suddenly appeared to lose all interest in 

the progress of science" and "incontinently severed their co nnection" with the 

ex periments. Although no U.s. soldiers 

were asked to parti cipate in this aspect of 

the board's work, fourteen, of whom eleven 

were hospital corpsmen, requested permission to do so, and one joined a U.s. 

civilian employee of the Army in refUSing 

to accept payment. Thoroughly aware of 

the implications of what he was doi ng, 

Reed found the burden he had assumed a 

grea t one. In January 1901, when one of 

his subj ects was very ill , he commented 

that "th e responsibili ty for the life of a 

human being weighs very heavily, ... and 

I am dreadfull y melancholic. " H 

Because of his previous training in handling mosquitoes in Italy, Lazea r was asked 

to take charge of the "rather striking-looking and handsome" insects, each with a 

"broad, semilunar silvery stripe" on the 

middle of her body, that wou ld be vital partiCipants in the work of the foll owi ng 

months. He bred them, dissecting some of 

them and taking others to the nearby yellow fever hospita l to feed on its patients to 

become in fected. His charges fail ed at fi rst 

to infecllhe nonimmunes the)' were subsequently enco uraged to bite. Since Finlay 

had also been unabl e to transmit yellow 

fever in this way, the faith of Reed's team 

in his theory wea kened. Like Finlay, these 

physicians had not realized that the mosquito did not become infective immediately upon biting a yellow fever patient and 

that the length of time the patient had been 

suffering from that disease at the moment 

the bite was innicted was also criticall y 

important."s 

The first experiments with mosquitoes 

were initiated on 11 August, after Major 

Reed had returned to the United States to 

work on the Typhoid Board report. When 

Carroll vo lun teered on the twenty-seventh 

to be bitten by a mosquito that had fed 

upon the blood of a patient in his second 

day of illness, no one had yet acquired yellow fever in this manner. Carroll did not 

anticipate dire consequences, and although he bega n to fee l unusually tired 

two days later, he did not realize he was ill 

until the thirty-fi rst. After an examination 

of his blood for signs of malaria pa rasites 

proved nega ti ve, on 1 September the official diagnosis of yellow fever was rend ered. 

Nevertheless, because Carroll had been directly exposed to pati ents with yellow 

fever, his co ntracting the disease did not 
PUBLIC HEALTH IN CUBA 

prove concl usively that the mosquito was 

the vector. The insec t that bit him was one 

of several that also feasted at the expense 

of a man who had not been exposed to yellow fever patients, and he also came down 

with yellow fever;6 

In spite of the illness of his colleague, 

Lazear remained cas ual about the danger 

posed to him personally by his mosquitoes. Having already been bitten several 

times without ill effect and knowing that 

it was possible to have an attack of this disease so mild that it might not be recognized 

for what it was, he may have assumed that 

he had somehow acquired an immunity. 

(Finlay himself had suggested that the bite 

of a mosquito that had recently feasted 

upon a yellow fever patient could , as Surgeon General Sternberg put it, "confer an 

abortive attack of yellow [ever. ") Carroll 

and Agramonte agreed that when an insect 

that was Oying about a yellow fever ward 

during one of his visits bit Lazear on 13 

September, he made no attempt to in terrupt her meal. Some co ncluded that Lazear 

had deliberately in tended to infect himself. 

In any event, rive clays later, he, too , was 

ill . On 25 September, when Ca rroll was on 

his way to recovery, Lazea r d ied H 

When Major Reed returned to Cuba 

shortly after Lazear's death, Agramonte was 

apparently on leave in th e United States. 

Carroll, embittered by his conviction that 

Reed would deny him credit fo r the Ye llow 

Fever Board discoveries and by what he insisted was Reed's night to avoid contracting 

yellow fever, soon returned to the United 

States to complete his recuperati on. The 

truth of the former charge was clearly a matter of definition, but evidence exists that the 

latter charge was unfair. Reed main tained 

that initially he and his colleagues had all 

agreed to experiment on themselves and 

that he personally wo uld have do ne so had 

243 

he not left Cuba. He eVidently promised 

Surgeon General Sternberg as a condition 

of his return to the island that he would not 

allow himself to be bitten by an infected inseCl. Agramonte, on the other hand, maintained that after Reed returned to Cuba , he 

did not submit himself to a mosquito's bite 

because of the insistence of his colleagues 

there that the wo rk they were doing was too 

important to "justify our taking risks which 

then seemed really unnecessaly. ... For 

this reason he was never bitten by infected 

mosquitoes." 48 

While Agramonte and Carroll were in 

the Uni ted States, Major Reed examined 

Lazear's carefully maintained noteboo ks 

and concluded that a mosquito could be 

infected only by biting a yellow feve r patient in the first three days of the disease 

and that the insect could transmit the infection onl y a fter twelve more days had 

passed. Although Reed was now perso nall y convi nced that yellow fever was indeed mosquito-borne, only one of the 

three yell ow fever victims in his study had 

acquired the disease under controlled circumstances. The theo ry was yet to be 

proved, and the scientifi c community in 

the Un ited States remai ned un enthusiasti c 

about the board's line of researc h"9 

Using funds provided by General Wood, 

now military govern or of Cuba, Major 

Reed undertook to prove that the mosquito 

spread yellow fever. At a site where no 

cases of yell ow fever had ever been reported Reed established a camp named 

a fter Lazear. He had two frame huts built 

eighty yards apart in a well-drained and 

unculti vated open field, where he could 

control all access to the camp and thus 

eliminate outside sources o f infection. The 

"Infected Mosquito Build ing," as Reed 

ca lled it, was well ventilated and divided 

by a screen down the middle of th e inte-
244 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

rior. The "lnfected Clothing Building," on 

the other hand, was not divided. lts ventilation was strictly limited so that the resultant heat and humidity would foster the 

spread of infection and the occupants 

wou ld be, as Reed's biographer William B. 

Bean described it, "thoroughly sa turated 

with an agent known to be effectively 

malevolent. " Both huts were designed to 

prevent penetration by uninvited insects. 

Among those running the camp were two 

contract surgeons, one of whom was immune; an acting hospital stewa rd, also an 

immune; nine Hospital Corps privates, 

oneof whom was immune; and an immune 

ambulance driver. These men were quartered in seven hospital tents, each set 

twenty feet apart from every other.'o 

Major Reed proceeded with great care 

to see that no cases of yellow fever appeared at Camp Lazear other than those 

that were deliberately transmitted. Two 

men who developed fevers before the initiation of attempts to infect them with yellow fever were removed from the camp. All 

those suspected of having contracted the 

disease were at once put to bed at the camp, 

in the belief that absolute rest was necessary to the ca re of the yellow fever pati ent, 

and then carried, still in those beds, to the 

isolation of the yellow fever hospital. Several physicians in Havana were availabl e to 

examine them and to confirm a diagnosis 

of yellow fever." 

The experiments at Camp Lazear in the 

autumn of 1900 eventually involved a total 

of sixteen cases of yellow fever, twelve 

from mosquito bites. To keep their supply 

of insects alive and lively to make these experiments possible, the team at Camp 

Lazear had to become familiar with the life 

of Aedes aegypli. Major Reed undertook the 

study of entomology and maintained his 

contact with an authority on insects. Since 

even with devoted ca re, the scientists at 

Camp Lazear were unable to keep the average mosquito of this type alive more than 

fi ve weeks in captivily, and since few survived even that long, they had to undertake a breeding program. Because Reed 

wanted to establish whether yellow fever, 

like malaria, could be acquired by the "injection of blood taken from the general circulation of a patient suffering from this disease," he injected another four with 

infected blood. He succeeded in giving the 

disease to all but one, whose failure to react 

to subsequent bites by infected mosquitoes 

proved that he had actually been immune. 

Reed's attempts to produce a case of yellow fever by the injection of the blood of 

a diseased patient were apparently not the 

first, since Surgeo n General Sternberg said 

he had seen the experiment made, albeit 

unsuccessfull y, severa l times at Ve ra Cruz, 

Mexico, in 1887. Further work by Carroll 

in the fall of 1901 resulted in six more 

cases. After Lazea r's dea th, none of the 

cases produced by the Ye llow Fever Board's 

experiments proved fataL" 

The first phase of the research at Camp 

Lazear called for mosquitoes known to be 

infected to bite men believed to be nonimmunes who had been isolated from all other 

possible contacts with yellow fever. Some 

insects used in this test had bitten several 

yellow fever victims at various stages of the 

disease, and some men were bitten by more 

than one mosquito. The first vo lunteer 

began to sicken on 8 December, less than 

four days after he had been bitten by five 

mosquitoes. The next day his case was diagnosed as yellow fever. All but one of the 

men involved in this phase of Major Reed's 

research eventually contracted yellow fever, 

thereby substantiating the theory that Aedes 

aegypli carried the dread disease. The test 

also provided more information on the re-
PUBLIC HEALTH IN CUBA 

lationship of the time factor to the transmittal of the disease and demonstrated that 

the mosquito's role was merely that of the 

carrier and the injector of the blood.

53 

The next step required that two sets of 

subjects be placed in the Infected Mosquito Building. On one side of the screen 

a volunteer shared his quarters with infected mosquitoes, and on the other side 

two more volunteers breathed the same air 

but shared neither the insects nor the yellow fever he contracted. The fact that the 

bite of Aedes aegypti could spread yellow 

fever was again confirmed by this test, but 

the question of whether fomites (items exposed to vomit, urine, or feces) were a factor remained to be determined. To answer 

this question , volunteers slept in the Infected Clothing BUilding, in close contact 

with clothing and bedding that had been 

thoro ughly saturated with the vomit, 

urine, and feces of yellow fever patients. 

Although at times their stomachs churned 

while so intimately exposed to such unappea ling items, the supplies of which 

were several times renewed, the men did 

not become ill, nor did those participating 

in two repetitions of the experiment. 

When subsequently ex posed to bites by infected mosquitoes, the first three men who 

had been involved in the fomite test, an 

acting assistant surgeon and two hospital 

corpsmen, fell ill, thus demonstrating that 

their failure to contract yellow fever from 

the infected items had not resulted from 

any immunity to yellow fever." 

Other questions remained to be answered. The fact that the mosquito spread 

yellow fever specifically by means of the infected blood she had drawn was established 

by further experiments involving the inj ection of blood from yellow fever patients into 

nonimmunes. To demonstrate that the 

symptoms of yellow fever were not caused 

245 

by a toxin, Major Reed and Carroll heated 

blood from an infected patient to 55 degrees 

Centigrade for ten minutes, a procedure 

likely to kill bacteria but not to destroy 

toxin. Nonimmunes injected with this 

blood did not develop sym ptoms. Dr. Welch 

oOohns Hopkins called Reed's and Carroll's 

attention to work done by other scientists 

that had demonstrated thattheorganism responsible for foot-and-mouth disease in 

cattle would pass through a porcelain filter, 

and they decided to conduct the same experiment with the blood of a victim of yellow fever. Infected whol e blood transmitted 

the disease even after going through the 

finest of filters, thereby demonstrating, as 

Reed and Carroll put it in a paper read before the SOCiety of American Bacteriologists 

on 31 December 1901 , that "yellow fever, 

like the foot-and-mouth disease of cattle, is 

caused by a mic ro-o rganism so minule in 

size that it might be deSignated as ultramicroscopic." Its minute size established that 

it was certainly not Bacillus icteroides." 

The wo rk of the Yellow Fever Board in 

the fall and winter of 1900- 1901 solved 

the mystery of how yellow fever was spread 

and laid many misconceptions to rest. It 

clearly established that eighteen days were 

required, if the weather was cool, for the 

virus to mature within the mosquito's body 

before she became capable of infecting, although the period was appreciably shorter 

in warm weather. It also demonstrated that 

to become infective a mosquito had to bite 

a patient within the first th ree days of his 

illness. Once infected, the mosquito remained capable of spreading the disease 

indefinitely. The incubation peri od from 

the time of the bite to the time the disease 

first appeared varied from forty-one hours 

to five days, seventeen hours. 56 

Perhaps the most significant finding of 

the board was the proof that while mosqui-
246 THE ARMY MEDI CAL DEPARTMENT, 1865-1917 

toes did spread yellow fever, fomites did not. 

The implications of this discovery were farreaching. A house or a ship became infected 

only by the presence of infected insects, and 

their eliminaLion removed the infection. Yellow fever was not a so-called filth disease, 

and improper sanitation played no ro le in its 

spread. The expensive and time-consuming 

disinfection of clothing, bedding, merchandise, and cargos served no useful purpose in 

preventing the spread of this particular disease because a shi p co uld carry yellow fever 

to a foreign port only if a yellow fever patient or a living and infected mosquito were 

on board. Aedes aegypU , as the Reed team 

had learned, could live no more than fi ve 

days without food and water. Thus, under 

normal ci rcumstances, the insects in aships 

hold wo uld all be dead by the completion of 

any but the shortest voyage. Medical historianJ ames D. Goodyear suggested in 1978, 

however, that mosquitoes may be able to 

survive long voyages by feeding on molasses 

seeping rrom containers or raw sugar being 

exported from areas where yellow feve r is 

endemic. Since Aedes aegypU never flew far 

from where it was hatched, a ship loaded in 

midstream was in no danger of infection 

from the shore. Only the passage of 16-21 

days without the development of a case of 

yellow fever could prove that a ship loaded 

at an infected port carried neither infected 

mosquitoes nor infected passengers. The 

board recommended that if a passenger developed yellow fever during a voyage, nonimmunes on board be quarantined for fi ve 

days. Only if another case of the disease appeared in this time, according to Reed, 

would it be advisable to fumigate the ship's 

quarters, where mosquitoes might have remained alive by feeding on passengers.

57 

The members of the Yellow Fever Board , 

satisfied about the way in whi ch yell ow 

fever was spread even though unabl e to 

find the organism responsible for it, d ispersed in February 1901 to co ncentrate on 

what would be an unsuccessful search for 

the elusive virus in the laboratories orHavana. A somewhat embittered Reed predi cted that, recogni zing the importance of 

the board's discoveries, Surgeo n Gene ral 

Sternberg woul d "of course, . .. at once, 

write an article and say that for 20 years 

he had co nsidered th e mosquito as the 

most probable ca use of yell ow feve r. That 

would be just in order for him to do so." 

Those who we re unable to acce pt all of the 

boa rd's concl usions, on the other hand, 

bega n to publish their objectio ns. One 

main ta ined that the board's resea rch consisted of "very imperfect observations" and 

that the spread of yell ow fever by mosq uito 

was possi bl e only when it occurred by accident or by "artifi cial inoculation." Another, while accepting the noti on that mosquitoes spread yellow fever, noted that he 

knew o f epidem ics that had appeared in 

areas withollt mosquitoes or without any 

"precursor)' case oj yellow feve r" and concluded that the role aSSigned the mosquito 

by Major Reed left much still to be expl ained. The modern evaluation of the Ye llow Fever Board's work is un eq uivocal. 

"This simple ini tial report," wrote a medical histori an in 1978, "is a model in sc ientific literature."" 

A Time of Ii-ial and Triumph 

The prevalence of yellow fever and other 

diseases in the Caribbean had inspired the 

work of Major Reed and his colleagues, but 

even after their discovery that a mosquito 

was the yellow fever vecto r, disease rates 

could not be Significantl y lowered until 

practical means of acting on what they had 

discovered had been devised. Major Reed, 
PUBLIC HEALTH IN CUBA 

however, \-vas apparently connclenl as a 

result o f his contacts with an expert enLOmologist in the United States that a successrul approach to reducing the population or mosq uitoes already existed and 

need only be app lied. The Yellow Fever 

Board played no role in the translation or 

the board's research into practica l measures, but the entire nature or the antiyell ow rever campaign was transrormed because orits work. A directive issued by General Wood in December 1900 detail ed the 

approach to be taken throughout Cuba and 

authorized Major Gorgas to moun t bo th an 

anti-Allorheles campaign and an anti-Aedes 

aegypti efrort. Gorgas, discouraged by th e 

fa ilure of sanitation to prevent yell ow fever 

epidemics, found the racts revealed by Reed 

most welcome. Even though he was not yet 

convinced that the mosquito alone was responsible ror th e spread or yellow rever and 

was still more reluctant to rul e out some 

role ror rom ites, the isolation or yellow 

fever victims frolll mosquitoes to prevent 

the spread of the disease and th e destruction or Aedes aegypti now became the rocus 

or Gorgas' efforts.'9 

The campaign initiall y centered on Havana , although Major Reed believed that 

because of the city's size and the ignorance 

or its ph ysicians, the chances or success 

there were minimal. Majo r Gorgas was not 

optimistic about th e possibility or killing 

a significant number or mosquitoes, but he 

encouraged the use or all approaches that 

would prevent breeding, kill the adult insects, or prevent the mosquito rrom biting 

patients. He set up three units, two to deal 

with the prevention or th e breeding or 

Aedes aegypU and the third to destroy the 

adults. He also di vided Havana into twenty 

sanitary distri cts, each with its own inspec tor, who was required La examine 

every house in his area each month, loo k247 

ing ror co nditi ons that might favo r the 

breeding or Aedes aegypti. Any work required to cover cisterns, to pour oil over 

pudd les , or in other \-vays to eliminate 

breeding places was don e at public expense. The fi ve men who accompanied 

each inspector on his rounds even unplugged blocked gutters and retrieved old 

bottles that might hold water. Possible 

breeding sites vvere C0111m o n in Cuban 

homes, where a co ntainer rull or dri nking 

water was orten kept in the house, to be 

replenished as needed without ever being 

empti ed and cleaned out. The courts fined 

those who permitted wa ter to stand uncovered , but the sum co uld be remitted by 

the inspector if the probl em was eliminated. Cubans, accustomed to graft, assumed that the inspectors kep t the fin es 

for themselves and therefore were particularly impressed when the mon ey was returned to th em,since it seemed to bea personal gift rrom the u.s. ofri cial. 60 

The homes or yellow rever victims and 

houses near them were fum igated, usually 

with burning sulrur or pyrethrum , to kill 

adult mosquitoes that might have become 

in rected. The patient's room was disin fected 

and his clothing sent to the Los Animas 

diSinfecting plant, but these steps were 

soo n abandoned as unnecessary. Carpenters 

were sent to the dwellings or patients who 

had remained in their homes to screen windows and construct doubl e doors separated 

by a vestibule at the entrance, thus making 

it unlikely that any insect could enter. Asanitary officer was stationed near the doors to 

guarantee that the first doc; was closed berore the second was opened. Adult mosquitoes were also sought out in tobacco warehouses, where burning tobacco stems were 

used to destroy this minute enemy. When it 

became appa rent that yellow fever was being 

brought into Havana rrom a nearby com-
248 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

munity, a team began fumigating homes 

there in areas where cases of yellow fever 

had originated. The problem of the importation of yellow fever into Havana bysea was 

managed by a quarantine placed on all arriving ships. Any vessel carrying yellow 

fever victims was fumigated, and all nonimmune passengers were isolated for six 

days. The tedious disinfection of baggage 

that had been part of what Gorgas called "the 

mediaeval quarantines heretofore used" was 

no longer required· ' 

The promulgation on 27 April 1901 of 

a new circular based on the board's discoveries simplified the management of the 

hospitals where yellow fever patiellls we re 

isolated. Major Gorgas' initial skepticism 

about Major Reed's determination that yellow fever could be spread only by the mosquito was apparently soon dispelled. Although the fumigation of rooms and 

clothing exposed to yell ow fever victims 

was still required to be sure that all infected 

mosquitoes were killed, on 21 August he 

finally issued an order ending the required 

and ted ious disinfection of clothing and 

other material that had come into colllact 

with yellow fever sufferers. Medical officers were now allowed to move freely from 

yellow fever victims to their other patiellls 

and from one institution to another without fear of infecting the community. The 

movement of attendallls caring for yellow 

fever patients was still limited because of 

the possibility that they might take infected insects with them. Because of Gorgas' campaign, within three months yellow 

fever had disappeared from Havana , although it was reintroduced from time to 

time therea fter from the outside. The ponderous routines used without success to 

combat this disease had been proved unnecessary. For moslscientists, Gorgas' success may have provided proof of Reed's theory about how yellow fever wasspread , but 

a few skeptics still insisted that while the 

mosq uito obviously could spread yellow 

fever, other means must also be possible·' 

Major Gorgas' only failure in his battle 

against yell ow fever occurred at the very 

time that he was winning his campaign 

against the mosquito that spread the disease. In the summer of 1901 Gorgas and 

contract surgeo n Guiteras, who had served 

as an adviser on tropica l diseases to th e unlucky V Corps in 1898, were conducting 

research to discover whether they could 

safely immuni ze volunteers against this 

disease by deliberately infecting them, as 

had been done with smallpox in the days 

before vaccination . They theorized that 

men inoculated with matter from mild 

cases of yellow fever could be given a mild 

case that would result in permanent immunity. Using prinCipally Spanish volunteers, they gave yellow fever to ten. Unfortunately, three of their subjects, including 

Clara L. Maass, a nurse from the United 

States, died because of the attempts to immunize them, and the experiment was 

abandoned, partially because of the opposition of Major Reed, who was horrified by 

the fatalities. His own work with yellow 

fever had produced no deaths but that of 

Lazear, who had personally made the decision that resulted in his own demise. The 

deaths also made it more difficult to find 

volunteers for further experimelllation· J 

The campaign against yellow fever and 

Aedes was already well along when the lesspubliCized campaign against All orIJeles 

began in Cuba. The use of mosquito netting had never been particularly successful , largely because line officers, presumably unconvinced that malaria was carri ed 

by mosquitoes, failed to realize its importance. The scientists working under Major 

Gorgas studied the habits of AllorIJ eles, 
PUBLIC HEALTH IN CUBA 

learning, among other things, that it was 

extremely successful in locating holes in 

screens and that it was very selective in its 

choice of victims. TheAllopheles, unlike the 

yell ow fever mosquito, preferred fi elds and 

open places to human habitation , and thus 

the campaign against insects in the city was 

not as effective against malaria as it was 

against yellow fever. Go rgas assigned fifty 

men to trim banks and remove vegetation 

from slow-moving streams so that fish and 

tadpoles could feast on mosquito larvae as 

part of the campaign against Allopheles " 

Between the two campaigns, the incidence of both malaria and yell ow fever in 

the Havana area dropped dramatically. 

Malaria deaths in Cuba as a whole numbered 325 in 1900 but fell to 151 in 1901 

and to 77 in 1902. In Havana itself the 

malaria rate was reduced by 75 percent. 

Since, in addition, Havana had had no 

cases of smallpox since 1900, the death 

rate in that city reached its lowest in more 

than ten years. For the year 1901 the annual death rate of22.1 per 1,000 compared 

favorably with that of such southern U.s. 

cities as New Orleans and Charleston, 

whose populations were also exposed to 

malaria and periodica lly to yellow fever as 

well. A jubilant but somewhat surprised 

Gorgas concluded that he had established 

that both malaria and yellow fever could 

be eliminated in the tropics and that U.s. 

troops could , as a resu lt, serve as easily in 

the tropi cs as in temperate zones. Messages 

of congratulations were soon pouring in to 

the man who had made Havana as sa fe to 

live in as any of the cities of Europe6 ' 

The success of the campaign against yellow fever inspired much enthusiasm for 

what preventive medicine could do. An 

Army engineer wrote Gorgas that he could 

think of "several communiti es" in the 

United States where public health would 

, 

, 

, 

, 

, 

. 

249 

· • • • ..; ..I..- • • • 

C LARA L. MAASS 

be improved "if military supervision could 

be exercised over them as has been done in 

Havana. " The death rate in Havana from 

those diseases found in all large cities had 

also been high, that from tubercul osis averaging more than 7 per 1,000 per year from 

1890 to 1899. After a cleanup campaign 

that sawall houses regularly inspected and 

more than half "overhauled by the cleaning brigades of the sanitary department," 

mortality from tuberculosis fell to barely 

more than 3 per 1,000 in 1900, a rate lower 

than that in Vienna or Paris. After Major 

Gorgas became chief surgeo n of the Department of Cuba in December 1901, he 

undertook a campaign to eliminate this disease from Havana entirely, although he coneluded that a longer time might be required 

to reach this goal than had been needed to 

eliminate yellow fever.'" 

In 1902, as U.S. forces prepared to end 

offi cially the occupation of Cuba, Majo r 
250 THE ARM Y MED ICAL DEPARTMENT, 1865- 1917 

Gorgas was left behind to serve as "District 

Surgeo n for troops in Cuba. " His principal 

assignment was apparently to be the continuation of his experimental work with 

yell ow fever and mosq uitoes. When Brig. 

Gen. Willi am H. Forwood succeeded 

Sternberg as surgeon genera l in early June, 

offi cial support of this aspect of Gorgas' 

wo rk began to wane. Co ncerned about the 

possibility o f fataliti es resulting from Gorgas' attempts to find out more positively 

exactl y when yellow fever pati ents became 

infective, Surgeon General Forwood consulted Major Reed, who advised him 

against "assuming such risks with human 

life" when th e basic questions about yellow fever had already been resolved. Forwood forbade Gorgas to use mosquitoes 

longer than eleven days after they had become infected with yellow fever because 

he beli eved that after that point the risk of 

"fatal infection " was grea t. He did permit 

the lise of mosquitoes whose infection \vas 

more recent, but even in granting this permission, the surgeon general add ed that 

such ex periments were acceptabl e "at least 

so long as no accident occurs. " Gorgas interpreted Forwood's orders as forbidding 

all ex perimentation. 67 

Before leaving Cuba in 1902, Wood, who 

as military governor appointed Cuban civilians to run the government, named a 

fi ve-man board of hea lth to oversee the administration o f public health measures in 

the island. Finlay, "a most lovable man," 

Major Gorgas believed, a physician respe",fed for his "scientific honesty and 

straightforwardn ess," was a member. His 

authority was apparently limited, and in 

the four yea rs before disorders in Cuba resulted in the return of u.s. military government, yellow fever reappeared and san -

itation in man y communiti es, except 

Havana itself, deteriorated. 68 

The incidence of ye llow fever grew with 

t.he innux o f nonimmunes afte r a new occupation force of 4,000 U.s. sold iers- the 

Army of Cuban Pacifi cation-arrived late 

in 1906. In Cienfuegos 12 soldi ers contracted the disease in the summer of 1907 

and 3 died. All 12 had been working in the 

hospital, whi ch took in both military and 

civilian pati ents. Charles E. Magoon, appointed as provisional gove rn or of Cuba in 

October 1906, theorized in a report to Secretary of War William H. Taft that a patient 

in the hospital with a mild and therefore 

undiagnosed case must have been bitten by 

a mosquito that in time transmitted the disease to the nonimmunes in that facility. 

After noting that sanitation outside Havana 

had been left to loca l authorities who did 

not cooperate with efforts to maintain appropriate standards, presumably including 

those calling for the elimination of sites 

where mosquitoes could breed, Magoon 

concluded that the sanitation service must 

be managed on a nationwide basis. Although Magoon and Major Kean, his chief 

adviser on sanitation, were in conflict over 

the desirability and even the possibility of 

moving the drive for improved sanitation 

out of the politi cal arena , Magoon turned 

the administrative control of sanitation on 

the island over to Kea n and four other medica l offi cers detailed from the Army ofPacifi cation. A sixth medical offi cer was assigned to work with the provisional 

governmen t on the administrati on of hospitals and similar institutions. 69 

Many diseases still plagued the population, among them smallpox, malaria, dysentery, and typhoid, but Magoon's primary interest was apparently yellow fever, always a 

greater problem for strangers to the island 

than for Cubans. He sent Finlay, Guiteras, 

and Agramonte to Cienfuegos to take control of the situation there, which they 
PUBLIC HEALTH IN CUBA 

promptly succeeded in doing, and later sent 

Kean and a second medical offi cer to join 

them to enforce sanitary regulations. In fiscal year 1908 a total of eighteen soldiers, 

thirteen of them stationed in Cienfuegos, 

contracted yellow fever, of whom fi ve died. 

The following year, however, only one case 

was diagnosed in the Army. When the troops 

again left Cuba in April 1910, no further 

cases had appeared. When the provisional 

government was dissolved inJ anuary 1909, 

the management of public health on the island had been reorganized and centralized. 

The responsibility for sanitation in all the island's towns and cities had been taken from 

local bureaucracies and given to the national 

government, thus making the administration and financing of public health uniform 

throughout the island. The result was a 

marked drop in the rate of those diseases 

considered preventable, among them infantile diarrhea and tetanus resulting from unsanita,y care of the umbilical cord. The 

Army had restored Havana to such a high 

level of sanitation that an American visitor 

to that city hardly a year after the second occupation professed himself astounded by 

what medical officers had achieved in ridding the city entirely of filth and insects'· 

The good health record of the men of 

the second occupation force was credited 

largely to th e fact that only Regular Army 

physicians accompani ed them to Cuba . 

Medi cal officers had been taken from several important posts within the United 

States to accompany the new army of occupati on, and except for the brief epidemic 

of yell ow fever, the hea lth of th e garriso ns, 

though still linked with that of the civilian 

population, was genera lly main tained at a 

high level. Malaria rates were initially 

higher than those in th e United States, but 

251 

lower than that in the Philippines, a situation that in the early months was also true 

of dysentery. The rates of other digestive 

ailments was high, although no deaths occurred as a result. An outbreak of dengue, 

whi ch is ca rried by Aedes aegyl'ti , that accompanied the yellow fever epidemic, 

caused no deaths and was easily distin -

guished from the more fatal disease. The 

most serious health threat throughout the 

period of the new occupation was typhOid 

fever, whi ch appeared in localized epidemics that caused occasional fataliti es" 

The V Co rps had been defea ted by 

malaria and the fear of yellow fever, sent 

into headl ong night back to the United 

States by th e inability of the Medi cal Department in 1898 to prevent either disease. 

But even as Surgeo n General Sternberg devoted considerable energy to preparing the 

department to deal with potential epidemics in Cuba, he ordered the department's best scientists into the battl e to reduce th e likelihood that U.s. troops would 

ever again have to face such dangers. The 

Army's success in ridding Cuba of yellow 

fever would bring fame to Majors Reed and 

Gorgas and the Medical Department they 

served. The dramatic reduction of morbidity and mortali ty from both yellow fever 

and other diseases wo uld have far-reaching consequences for other tropi cal lands. 

The return of ye ll ow fever to Cuba when 

the campaign aga inst mosq uitoes was allowed to lapse after the departure of u.s. 

troops only prOVided add itional proof of 

th e value of this approac h. For U.s. medical offi ce rs, this exampl e of what th e new, 

scientific medici ne co uld do wo uld be a 

continuing reminder that they were no 

longer helpl ess in the face of disease. 
NOTES 

1. First quotation from Wilson G. Smillie and 

Edwin D. Kilbourne, Preventive Medicine (lt1(1 Public 

Healfh , p. 9; see also pp. 5--6, LO-D, 241. Remaining 

quo talions froll1 John Duffy, The Sanilarians, pp. 145, 

190; see also PI'. 80, 126, 128, 139-44, 146-54, 175. 

2. Marga re t Warne r, "Hunting the Yellow Fever 

Germ," pp. 361-63; Wesley W. Spink, jnjecLiolis Dis· 

eases, PI'. 162, 165,241-42,368-69. 

3. Quotation from War Depa rlillelll , fAllI llla/} 

Reporl oj lI, e Sillgeon General, U.S. Arm)" 10 lI,e Sec· 

reulIY oj War, 1899, p. 170 (hereafter cited as \-VD, 

ARoJSG, da te); Ltr, AG to Sharter, 13 jul 1898, Microfilm (Mf) Reel 3, and Telg, Shafter to AG, 16 Aug 

1898, MfReel5, William R. Shafter Pape rs, Stanford 

University (SU), Palo Alto, Calif.; Marvin Fletcher, 

"The Black Volunteers in the Span ish.American 

War, " p. 51; Graham A. Coslllas, "Securing the 

Fruits of Victor}'," pp. 85-86. 

4. Coslllas, "Securing," PI'. 85-87; War Depart· 

ment, Correspondence Re/aling 10 fh e War Will, SP(lill, 

l:l38, 179, 225, 381, 548; idem, {AIlIII"'/} Rel'ort oj 

the Secret"')' oJ IVaI', 1899, l (pLl):12 and 1(1'1.3):4, 

124 (hereafter ci ted as WD, ARojSW, date); idem, 

ARoJSG, 1899, PI'. 163-64. 

5. R. A. Ward, "The innuence of Rona ld Ross 

Upon the Ea rly DevelopmelllofMalaria Vec tor Con· 

trol Procedures in the United States Army, " p. 208. 

See a lso PI'. 207, 209. 

6. The geographical units into which Cuba was 

di vided by the occupation forces gove rnment var· 

ied with time. On 10 August 1898 the Department 

of Santiago was created to include all of Cuba then 

under u.s. control. On l3 December the Division 

of Cuba was crea ted. On 1. 7 January 1899 the lim· 

its o f the Department of Santiago were redefined to 

include only the Province of Santiago. On the 

twenty·fourth the Division of Cuba was divided into 

seven departmen ts: the Depa rtlllentof Pinardel Rio, 

the Depanmem of the Province of Havana, the De· 

partmenl of Havana, the Department of Matanzas, 

lhe Depa rt ment of Santa Clara, the Depa rtmenl of 

Puerto Principe, and the Department of Santiago. 

On L9 April the Depa rtments of Matanzas and of 

Santa Clara were merged into the Department of 

Matanzas and Santa Clara and the Departments o f 

the Province of I-Iavana and of Pinardel Rio into the 

Department o f the Province of Havana and Pinar del 

Rio. On 1 Ju ly the Departments of Santiago and 

Puerto Principe were merged , leaving the Division 

of Cuba wit h fou r de partments: the Depart ment of 

Havana, the De pa rtment of Ma tanzas and Santa 

Clara, the Depa rtment of Province of Havana and 

Pinal' del Rio (often referred to merely as the Dc· 

panment of Havana and Pinar del Rio), and the De· 

partmenl of Santiago and Puerto Pri ncipe. Both the 

Department of Havana and Pinar del Rio and t he De· 

panment of Santiago and Puerto Principe were dis· 

continued on 23 July 1900, when the Depart ment 

of Western Cuba and the Department of Eastern 

Cuba we re established . The Departments o f Eastern 

Cuba and of \-Vestern Cuba were discontinued on 

15 November, at which point the Division of Cuba 

became the Department of Cuba. See WD, ARojSW, 

1899, 1(1'1.3): 122-24,300, and 1901 , l(pt.3):282. 

7. WO, ARoJSG, 1899, PI'. 145-50 (quota tion), 

15 1, 169; Ltt', AG 10 Shafter, 5 Aug 1898, Mf Reel 4, 

Shafter Papers, SU; R. S. Woodson, "Smallpox in 

Cuba ," p. 1466; Duffy, SWliWria/l s, pp. 193-203. 

8. WO, ARoJSG, 1899, PI'. 5-7, 150-54, 156, 

162-63 (first quotation), 164, 168, 171, and 1900, 

PI'. 7-8,25 (second quota tion), 168; idem,ARojSW, 

1899, 1(1'1.2):363-64, 498, 505 (third quotation); 

Coslllas, "Securing," p. 87. 

9. WO, ARoJSG, 1899, pp. 98, 146, 15 1, 168-69 

(quotation), and 1900, p. 174; idem, ARojSW, 

J (1'1.2):450; Vale ry Havard, "Sanitation and Yellow 

Feverin Havana," p.18;John H.SLOne, "Remarks Sug· 

gested by Three Years' Service in Cuba," PI'. 330-31. 

10. WO, ARoJSG , 1899, PI'. 152, 163 (quotation), l64, 173,275-80, and 1900, p. 174; idem, 

ARoJSIV, 1898, 1(pt.2):376-77. 

1 1. First quotation from Gaines M. FOSler, The 

DClllwu/s oj I-Iulllwlily, p. 27 (see also pp. 26, 28); 

foun h quotation from Frankli n Matthews, Tile New· 

801'11 Cllba (New York: Harpe r and Bros., 1899), PI'. 

95-96, cited in ibid.; second and third quotations 

from Coslllas, "Securi ng," p. 87 (see also p. 86); fifth 

quotation from Wilfrid Turnbull , "Reminiscences of 

an Army Surgeon in Cuba and the Philippines," p. 

3 1. See a lso WO, ARoJSG, 1899, PI'. 162-65; idem, 

ARoJSIV, 1899, J(pI.3):132-33, 217-18, 30 1, 3 12, 

and 1(1'1.6):7-8; Ltr, SW to John R. Brooke, 5 Jan 
PUBLIC HEALTH IN CUBA 

1899, me 243526, Record Group (RG) 94, Nat ional 

Archives and Records Administratio n (NARA), 

Was hington, D.C. 

12. O'Reilly was honorably discharged from the 

volunteers on 12 May 1899, at whi ch lime he revened back to his pe rmanent rank of major. He was 

promoted to lieutenant colonel on 21 February 

1900, to colonel on 14 February 1902, and to 

brigadier general on 7 Septembe r 1902, whe n he became surgeon general. 

13. The position was apparently vacant in Decembe r 1899, but O'Reilly was replaced by De Will 

fromJ anuary LOApril 1900 and then by Havard , who 

served th rough most of 1901. Sec WD, ARofSG, 

1900, p. l72. 

1.4. 'Wood LOok over as mili tary governor of the 

city of Santiago immedi alely after the cily's surrender. He was commander of the Department of Santi ago and its successor agency, the Department of 

Santiago and Pue rto Princi pe, from October 1898 to 

December 1899, when he became militar), governor 

of Cuba. He rema ined in this position until May 

1902. vVood held va rious ranl<s in the voluntee rs: 

brigadier general from 8 July to 7 December 1898 

and again from 13 April to 5 December 1899; major 

general from 7 December 1898 to 13 April L899 and 

aga in from 5 December 1899 to 4 February 1901, 

when he reverted back to the permanent rank of 

brigadier general. On 3 August 1903 he was promoted to major general. See \-VD, ARojSW, 1899, 

l(p1.3):300, 1901, l (pL.3):282, and 1902, 1:9. 

15. WD,ARojSG, 1899, pp. 145-46, 162, 165-67 

(quotalion), 168-69, 1900, pp. 172-74, l76, and 

1908, p. 127; idem, ARojSW, l(p1.6):5-6, 10, 129, 

362, 367-68; Hermann Hagedorn, Leonard Wood, 

1:260; "Public Health-Good Sanitary Results at 

Santiago de Cuba," p. 869; CarlosJ. Finla)/, S(/Ilj{(II)' 

COII (li tiollS j'l Cub(l, p. 4; Coslllas, "Securing," p. 87; 

"To Select Camps in Cuba fo r the Arm)' of Occupation," p. 524;J. Hamilton Stone, "Our Troops in the 

Tropics," p. 364; Jefferson R. Kean, "Hospitals and 

Charities in Cuba," pp. 14L-42; vVoodson, "Smallpox ," PI'. 1466-68; Edward S. Petersen, "The Militar}, Surgeon in the West," p. 2. 

16. WD, ARojSG, 1899, p. l68; idem, ARojSW, 

l899, l(p1.6):340 (quotalion), and 1900, l(pt.J, 

1'01.J- pt.J):7-8. 

17. J. Hamilton Stone, "Remarks Suggested by 

Three Years' Service in Cuba," p. 329 (quotation); 

Duffy, S(lllill1rians, pp. 175,205; WD ,ARojSC, 1899, 

1(p1.6):8-9, 128-29,360-61. 

253 

18. Leonard \-Vood , "Santiago Since the Surrender," p. 517 (quotation); WD,ARojSG, 1899, p. 17 l; 

Hagedorn, Wood, pp. 186, 188-89. 

19. Foster, Demwl(ls ojHwn(mily, p. 28 (first quotation); "Public Health-Good Sanitary Results," pp. 

868 (second quotation), 869; Wood, "Santiago Since 

the Surrender," PI'. 515-17,524; "Yellow Fever Hospital at Santiago Closed," pp. 628-29; Stone, "Our 

Troops," p. 364; Hagedorn, Wood, 1:190, 192, 202; 

WD, ARojSG, 1899, pp. 60, 170-71; idem, ARojSW, 

1899, l (p1.6):8-9, 366, 827-28. 

20. Dept of Santiago and Puerto Principe Cir 22, 

21 Dec 1899, p. 4 (quota tion), William C. Gorgas 

Papers, Manusc ript Division, library of Congress, 

Washington, D.C. (hereafter cited as Gorgas Papers, 

LC); Rpl, P S. Rossiter to SG, 1 OCl1899, box 5-5, 

John vv. Ross Papers, Tennessee Stale library and 

Archives, NashVille, Tenn. (hereafter ci ted as Ross 

Papers, TSLA.) ; Hagedorn, Wood, 1:188-89, 192, 

242; llr, Shafter to QMG, 22 Jul 1898, Mf Reel 4, 

Shafter Papers, SU; United States (U.s.), Congress, 

Senate, 61st Congress, 3d Session, Yellow Fever. 

pp. 224, 235; WD, ARojSG, 1899, pp. 98, 145, 171, 

240,251-55, and 1900, p. 175; idem,ARojSW, 1899, 

l(p1.6):15. 

21. The Marine Hospital Service was the <lIlCestor of today's Public Health Service. Its progenitor 

was a series of government-owned hospitals for sick 

and inj ured merchant mariners, whi ch were orga~ 

nized into the Ma rine Hospital Se rvice in 1798. The 

name of the organiza tion was officiall y changed to 

Publ ic Health and Marine I-Iospital Service in 1902 . 

The Marine Hospital Service part of the name was 

drop ped in 1912. See Ral ph C. Williams, Til e Un itcd 

SLales Public Healtll Serv ice, 1798- 1950, pp. 25-32, 

166-67 (hereafter cited as USPHS). 

22. WD, ARojSG, 1899, pp. 257-58; Hagedorn , 

Wooel, 1:243. 

23. WD, AllojSG, l899, pp. 254-55, 260 (quotation); Hagedorn, Wood , 1:242. 

24. WD, ARojSG, 1899, pp. 254-58; Lir, Gorgas 

to " My Dearest" Jpresumably Mrs. Gorgas], 21 Nov 

1899, and Dept of Santitlgo and Puerto Principe Cir 

22, 21 Dec 1899, Gorgas Papers, LC. 

25. Havard, "Sanitation," p. 17 (quotation); 

Wi lliam N. Bispham, "Sanita ry Work in the Ci ty of 

Havana," p. 1094; U.s., Congress, Sena te, Yellow 

Fever, pp. 237, 244; Louis A. Perez, Jr. , "Vagrants, 

Beggars, and Bandi ts," p. 1103; WD, AllojSG, 1899, 

pp. 155-63, and 1900, Pl'. 171, 177-78; idem, 

A RojSW, 1899, l(p1.6):361, 366; Wi lliam C. Gorgas, SallilaliOIl ill PWI(/IIW , p. 73; Ltr,AG to C. S. Walton, 10 J un 1899, Gorgas Papers, LC. 
254 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

26. WD, ARoJSG, 1899, PI'. 261-62; William C. 

Gorgas, "Sa nitation of the Tropics With Special Reference \0 Malaria and Yellow Fever," p.107S; U r, Gorgas to "My Dearest," 15 Nov 1899, Gorgas Papers, 

LC. 

27. Lud low received his second volullIcer commission of brigadier genera l 0 11 l3 April 1899 and his 

regular colllmission for [he same rank on 21 January 

1900. 

28. Quotation fro m Ltr, Gorgas 10Johll YV. Ross, 

30 Dec 1899, box 3-6, Ross Papers, TSLA; Ltrs, 

'William Ludlow LO Gorgas, 3 1 Oct 1900, and Gorgas to Ludlow, 7 Nov 1900, Gorgas Pape rs, LC; \VO , 

ARoJSW, 1899, 1. (1'<.1):59. 

29. U.s., Congress, Senate, Yel/ow FevCl", pp. 235, 

237,244; Hagedorn, Wood, 1:281; Perez, "Vagrants," 

1'1'.1096,1103; WD,ARoJSG, 1899, 1'1'. 155-62; idem, 

ARoJSW, 1899, 1(1'<.6):15; Slone, "Remarks," p. 329. 

30. First quotation from U r, \Nilliam Ludl ow to 

AG, Oiv of Cuba, 4 Apr 1900, and second quotation 

from Ltr, Gorgas to Lud low, 16 May 1900, Gorgas 

Pape rs, LC In loc. cit., see also Telg, Henry Carter 

10 Leonard Wood , 4 Apr 1900; Oiv o f Cuba SO 44, 

3 Apr 1900; and Lt r, Gorgas to Valery Havard , 11 

Apr 1900. 

31. WD, ARaJSG, 1899, PI'. 245-46; Hagedorn, 

Wood, 1:213; Foster, Delll(Uuis oj l-lwlI(lIIil)" pp. 32-33. 

32. WD , ARoJSG, 1900, PI'. 168-69, 176, and 

1901, 1'.147. 

33. Ibid. , 1899, PI'. 162-63, 1900, PI'. 170-71, 

173 , 176, and .1 901, p. 177; Lt r, Gorgas to Ed., NY 

Mecljollnwl, 19 Oct 1901 , Gorgas Papers, LC 

34. WD, ARaJSG, 1900, PI'. 168, 170-71, 

177-86; Marie O. Gorgas and Bunon j. Hend rick, 

WilliwH Crawjord GOI:g{IS, Pl'. 87-88; Edgar Erskine 

Hume, Viclories oj ArlllY Medicille, p. 96; Robert S. 

Henr}', TheArlllccl Forces IlI sJ.iJ ll lc ojP{Hhology, p. l29 

(hereaft er ci ted asAFIP) ; U.s., Congress, Senate, )-ellow Fever, p. 235; Lt r, Gorgas 10 William Ludlow, .1 6 

Jun 1900, Gorgas Papers, LC j efferson R. Kean's 

March 1925 editorial in MiliWI)' SlIlgeoll (pp. 

366-70) was highl }' critical of the autobiography of 

her husband thm Mrs. Gorgas co-authored. He 

maintained that this volume gives Gorgas credit fo r 

accomplishments that Gorgas personally neve r 

claimed and that were not his. 

35. Although the offi cial name was Yellow Feve r 

Commission , it was popularly known as the Yell ow 

Feve r13o{mi, a term that is especiall y useful because 

it differentiates this organi zation from the ea rlier 

Havana Yellow Feve r Commission and emphasizes 

the Similarity Wilh the tro pical d isease boards of the 

Philippi nes. 

36. Aristides Agramonte, "The Inside Story of a 

Greal Medical Discovery," pp. 214-15 (quotations); 

Hen r)" AF1P, PI'. 113-3 1; WD, ARoJSG, 1900, p. 22. 

37. Hume, Viclories, PI'. 93-94; Henry, AFIP, p. 

109; \-Valter Reed and james Carroll , "The Prevention of Yellow Fever," p. 64 l ; U.S., Congress, Senate, )-el/ow Fever, pp. 131-32, 136, 16 l. 

38. Guiseppe Sanarell i, "Some Observations and 

Controve rsial Remarks on the Specific Cause of Yellow Feve r," PI'. 193-94 (quotations), 201; U.s., 

Congress, Senate, Ycl/Oll' Few.:r , pp. 25, 162, 208; 

\-Va lt er Reed , "The Propagation of Yellow Feve r," pp. 

201-02; George M. Sternberg, "Ye llow Fever Etiolog)'," p. 1040; "Tropical Diseases," p. 377; Warne r, 

"Yellow Feve r Ge rm," p. 375. 

39. \·Varner, "Yel low Fever Ge rm," pp. 374, 

376-78, 381; Ms, Ca rlos J. Finlay, n.d., Gorgas Papers, LC; Ur (copy), \-V Reeclto \-v. Gorgas, 27 j un 

1901, Ms C48, \-Valter Reed and William C Gorgas 

Pape rs, Na tional Library of Medi cine (NLM), 

Be thesda, Md .; U.s., Congress, Senate, )-e /low Fcver, 

pp. 161-63, 208; Wa lt er Reed ,james Ca rroll , Aristides Agramonte, and jesse Lazea r, "The Etiology of 

Yellow Feve r," p. 790 ; George M. Stern berg, "The 

Bacillus Icteroides as the Cause of Yellow Fever," pp. 

225-28; WD , ;\llaJSG, 1901, p. 181; Waher Reed 

and james Carroll, "A Comparative Study of the Biological Characters and Pathogenesis of Bacillus X 

(Stern berg), Bacillus lc teroides (Sana relli), and the 

Hog-Cholera Baci ll us (Salmon and Smit h)," p. 216. 

40. Aedes Cleg)'pli was then known as Stegomy ia. 

41. Williams, USP1-JS, PI'. 259-60 (quotation), 

26.1 ; 1-1 . R. Ca rter, "A Note on the Interva l Between 

Infectingand Seconelar}' Cases of Yel low Fever From 

the Records of the Yellow Fever at Orwood and Taylor, Miss., in 1898," pp. 617-36; Esmond R. Long, 

A I-fislOl)' oj Alllcriam PaJ/lO/og)', pp. 165-66; U r, 

Reed to Gorgas, 27 j un 1901, Ms C48, NLM; \·VD, 

ARoJSG, 1901, p . .l 82; U.s., Congress, Senale, l'e/-

low Feve r , p. 196; Carlosj . Finlay, "Mosquitoes Considered as Transmitlers of Yellow Feve r and 

Mala ri a," pp. 737-39, and other anicl es on this IO pic 

by Finlay listed in the Bibliography. Finlay was b)' 

no means the first physician to theorize tha t a mosqui lD migh t be behind the transmission of ye llow 

feve r (see Sigislllund Peller, "\Va lt e r Reed , C Finla)', and Their Predecessors Around LBDO," pp. 

195-200), but deba tes aboul what credit belongs 10 

whom seem to be unending and sometimes farfe tched (see, for example, Francois Deiaporte, Til e 

Hislmy oj )-e I/OlV Fever). 

42. The yel low fever virus was not d iscovered fo r 

another twent)' years. See Wilbur G. Downs, "The 
PUBLIC HEALTH IN CUBA 

Siory of Yellow Fever Since 'Wa ller Reed ," p. 723; 

'William B. Bean , ""VaILer Reed and Yellow Feve r," 

pp. 66 l-62; U.S. , Congress, Senate, Yel/o\\' Fever, pp. 

9,.l7, 93 , 201- 03; \-Villia1l1s, U5Pt-lS, Reed lO Carter, 

26 Feb 1901 , fo llowing p. 260; Hagedorn, Wood, 

I :326; Juan A. del Rega lo, "Carios Finia}' and Ihe 

Nobel Prize in Physioiog)' or Medicine," pp. 2-3. 

43. U.S. , Congress, Senate. Yellow f ever, pp. 

88-89; "The Etiologyo[Yeliow Fever," p. 461 ; Hage· 

da rn, Wood, ) :327; William B. Bean , "'Wa lte r Reecl 

and the O rdeal ofl-l uman Ex periments," pp. 75-92; 

idem , WCliter Reed, Pi>. 146-48. 

44. First and second q uotations from U.s. , Cong ress, Senate, }'ellow Fever, p. 99 (see a lso pp. 2 1.- 22, 

27-29); third quotation from Martha L. Sternberg. 

George Miller Sternberg, p. 227. 

45. U.s. , Congress, Senatc , l-ellow Fever, pp. 

25-26, L35 (quotations), 176. 

46. Ibid., pp. IS, 2 1, 26, 210; Agramontc, "Inside Story," Pl'. 210, 219; WD, ARojSG, 190 L, Pl'· 

L83-84. 

47. WD ,ARojSG, 1900, p. 22, and 1901, Pl'. L87, 

195 (quo tation); U.S. , Congrcss, Senat e, l-elloll' 

Fever, pp. 16, lS, 26; Agmmontc, "Inside Slory," pp. 

22 L- 22; Bean , Reed, pp. 134, 137. 

4S. Bean, Reed, pp. 126, 134 (quotati o n), 

136-38, 14L-42; Henry, AF/P, PI'. L20- 21. 

49. Bean, Reed, 1'1'.126,136- 38, 141-42; U.s., 

Congress, Senate, rellow Fever, PI'. 11 , 26; Regaw, 

"Carlos Finlay," p. 4. 

50. U.5. , Congress, Senat e, rdlow Fever, pp. 7 1, 

97 (rirst two quotations), 2 10- 11; Bean, Reell , p. 15 1 

(final quotation); idem, "Wa lt er Reed and Yellow 

Fever," p. 660; ,\lD, Jl RofSG, /90 L, Pl'. 187-88. 

51. WD, ARojSG, L90L , 1'1'. 188, L95; Sternberg, 

S/el"llberg, p. 223; Helll")', AFrP, pp. 122-24; Bcan , 

Reed, p. 150; U.S., Congrcss, Sena te, )'el/ow Fevc r, 

PI'. 10, 26, 70-7 1, 80. 

52. U.s. , Congress, Senate, )'ellow Fever, PI'. 10, 

19,82 (quotation), L35, L40, L63, 196, 229; Bean , 

Reed, p. 144. 

53. WD, ARojSG, L90 L, PI'. L78, 188-89; U.s., 

Co ng ress, Sena te, )'ellow Fever, pp. 18-19. 

54. Bean , Reed, 1'1'. 150-53; W D, ARojSG , L90 L, 

pp. 177-7S, 199- 200; U.S., Congress, Senate , l-el10\\1 Fever, pp. 19,22-23,82-84, 103. 

55 . U.s., Congress, Senat e, l-e //oll' Fever, pp. 149, 

158, 164-65 (quotati o n); Bean , Hced, p . 154. 

56. U.S., Cong ress, Senate, l'el/ow Fever, PI'. Sl , 

100- 101 , l S I; \:Va lt er Reed ,james Carroll, Aristides 

Ag ramollte, "The EtiologyorYel low Fever," PI'. 43 1, 

439-40; WD ,ARojSG, 1901, PI'. 178, 195,200-202; 

Henry, AF/P, p. 121. 

255 

57. WD, ARojSG, 1901, pp. 146, 198-99, 

200-202; Reed, "Propagation," PI'. 203, 209; U.S., 

Cong ress, Senate. Yellow Feve r, pp. 83, S6-87; Reed 

a nd Carroll , "Prevention," Pl'. 648-49; Mi chael D. 

Malison and Stephen H. Wa terma n, "Dengue Fevc r 

in tile Unitcd Statcs," p. 498; james D. Goodyea r, 

"The Sugar Connec ti o n," pp. 5-2l. 

58. Bean, Recd, p. 153 (rirst quo tati o n); Euge ne 

\:Vasclin , "The EliologyofYellow Fever," PI'. 95 1-52 

(second and third quotations); A. N. Bell, "Fomites 

and Yellow Feve r," p. 303 (fourth quo tati o n); Spink, 

"ljecUolls Discases, p. 156 (fifth quotati on); WD, 

ARojSG, 1901, p. 179, and 1902, p. 56. Shortly befo re his dea th , Brig. Gen . jefferson R. Keall , who 

worked with Reed in Cuba and who reported ly was 

the first case of this disease that Reed had ever seen , 

repo rted that Reed's papers disappeared from his 

desk afl cr his deal h. He stated that o ne of Ca rro ll's 

so ns was suspec ted of having taken them. Altho ugh 

proof of this fa cl was never found , the son refused 

1.0 deny any involvement in the I heft. See foldcrs interview, 1950, p. 13, and Biograph ical Data, Curri culum Vitae, Ai nsworth, Ireland, Ms C I4 , jcfrerson R. Kea n Papers, NLM . 

59. Hume, Victories, p. 96; U.s., Congress, Senale, l-etlow Fever, PI'. 235- 36; lIr, AG to C. S. ""Va lto n, 10 jun 1899, Gorgas Papers, LC; Stanhope 

Bayne-jones, Til e Evollllioll oj Preven/i ve Medicine ill 

/l,e Vlli/ed SUIfCS Army, /607- 1939, pp. l37- 3S; 

Kean, "Editorial ," pp. 366-6S. 

60. joseph A. LcPrince, A. j. Orenstein , and L. 

O . Howard , MOSCf11i/o Con/IVI ill Pwwma , PI'. 236 , 

240, 243; Ltr, Reed to Gorgas, 27 Jun 190 L, Ms C48, 

NLM ; Rpt. \Villiam C. Gorgas and j o hn W. Ross, 

"Methods of Destroying Adult Mosquitoes b), the 

Sanitary Department of Ha va na ," box 5-6, Ross Papers, TSLA ; Gorgas, Scmi/cH iol' , pp. 40-43 , 56-59, 

63; Bean, "Walter Reed a nd Yellow Feve r," p. 661; 

idem, Rced, p. 169; U.5., Congress, Senatc, Yel/olV 

Fcver, 1'. 11 ; Ltrs, joseph A. Le Prince to Gorgas, 28 

jun L901, and Gorgas to Los Sres. Inquilinos }' 

Duenos de Casa , 25 Ma)' 1901, Gorgas Papers, LC; 

Bayne-J ones. Prcvcllli vc Mcciicillc, p. 139. 

6l. Quotation from Llr, Gorgas to 'vv. A. 

MCLaughlin, 12 Nov 1901, Gorgas Pape rs, LC. In 

loe. cil. , sec Ltrs, j. A. Lopez to Gorgas, 2 jul 1901, 

a nd LcPrince to Gorgas, 2 j ul J90 1. See a lso LcPrince et aI. , ,1v/oS(IIIi/o Con/ro/ , pp. 252-53; Gorgas, 

Sallilatioll , PI'. 5 L-57, 63- 64,93, 102-03; U.S., Cong ress, Senate , l-ellow Fever, PI'. 223, 235-36, 247. 

62. WD, ARojSG, 190 1, PI'. 145-46; Rpt , 31 May 

IS99, Willi am C. Gorgas Papers, Entr)' 56 1, RG 94, 

NARA; U.s., Congress, Senate, Yellow FcvC/", PI'· 
256 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

225-26; in Gorgas Papers, LC: Treas Dept Cir, SC, Ma~ 

ri ne Hospital Service (MHS) to Med orrs, MHS, 20 

Jun 1901, and Ltr5, Gorgas to Manuel Cuevas, 19 Feb 

190 t, and Stanford E. Chaille 10 Gorgas, 27 Jan 1902. 

63. Bean, Reed, PI'. 146. 160. 168; idem, "Walte r 

Reed and Yellow Feve r," p. 662; U.s., Congress, Sen· 

ate, Yellow Fever, pp. 19, 29-30, 150, 169; Ltr, Gorgas 

to AG, Dept or Cuba, 1 April 1902, Gorgas Papers, 

Entry 561, RG 94, NARA; Helen Tigert! and W. D. 

Tigcru, "Clara Louise Maass," PI'. 252-53; Llr (COP)'), 

w. Reed to W. Gorgas, 4 Scp 1902, Ms C48, NLM. 

64. Ltrs, Gorgas to AG , Dept or Cuba, 6 Apr 

1901, and to L O. Howard, 29J ui1901 , and William 

Oincldcy to Gorgas, 29Jun 1901 , Gorgas Papers, LC; 

U.s., Congress, Senate, Ye llow Fever, PI'. 144, 237, 

247-48; WD, ARojSG , 1899, p. 288. 

65. See man)' lellers or congralUlalions in boxes 

3 and 4, Gorgas Papers, LC; Bayne-Jones, Preveillive 

Medicine, p. l37; Henry, AFtl', p. 128; Hume, Vic/Ories, p. 161; LePrince el al. . Mosquito COll /rol , pp. 

4-7,90- 92; United Stales, Bureau or the Census, 

Census oj /ll e P/lilippine IS/(IIlds ... ,3:74. 

66. First and second quotations rrom U r, L'lnsing H. Beach to Gorgas, 14 Mar 1901, Gorgas Papers, Le. In loco cil. , see Dept or Cuba GO 32. 23 

Dec 1901, and lIr, Gorgas to Henry e. Baker, 21 Mar 

1902. Third quotation rrom Havard, "Sanitation," p. 

15; see also pp. 14,20-21. 

67. First quotation rrom lIr, Gorgas to "Theo," 

16 Apr 1902, and third and rounh quotations rrOlll 

lIrs, SG to Gorgas, 15 and 20 Aug 1902 , Gorgas Papers, Le. In lac. ci t. , see also LtT, Gorgas to SG, 25 

Sep 1902. Second quota tion rrom ltr, \,v. Reed to W. 

Gorgas, 4 Sep 1902, Ms C48, NLM. In loco cil. , see 

also Telg, SG to Gorgas, 15 Aug 1902, and Ltr, SG 

La Gorgas, 20 Aug 1902. 

68. Gorgas, Sail/tal/oIl , p. 15 (quotations); WD, 

JlRojSG , 1909, p. 135; idem, JlRojSIV, 1900, 

l{pt.ll,\'01.l-pt.l):6; Order 159, Mil Go\', Cuba, 17 

Mal' 1902, Gorgas Papers, LC. 

69. WD, A RojSG, 1907, p. 80, 1909, Pl'. 86, 

135-36, and 1910, p. 85; lIr, Charles E. Magoon to 

SW, 19 Aug 1907, Ms 5324, Enlry 52, RG 11 2, 

NARA ; All an R. Milieu , Tire Politics oJ llllervelJliOlI , 

PI'. 208-10. Kean was promoted LO the permanent 

rank or major on 2 February 190 1. 

70. WD , ARojSG, 1908, Pl'. 66, 68, 1909, p. 8 1, 

and 1910, p. 85; Llr, Magoon to S\,V, 19 Aug 1907, 

Ms 5324, Emr)' 52, RG 112, NARA; Gorgas, S(IIlilaliOll , p. 15; Charl es E Craig, "The Army Medical 

Service," p. 425; "The Army as a Sanilary Corps," p. 

425; Foster, Delll(lluis oj HUlllallity. PI'. 45-46; Jose 

Antonio Lopez de l Va lle, Tire Development oj SWlilalion Wid ClllIl'ilies in Cuba During Ille Lasl Six/eell 

)'ears, pp. 4, 20; Millcll, Po/iLics, pp. 208-10; Charles 

E. Magoon, RepubliC oJCllb(l , 2:440-4 1; in Gorgas 

Papers, LC: Llr, Gorgas to "Theo," 16Apr 1902, and 

Hq Army SO 91, 17 Apr 1902, and Order 159, Mil 

Gov, Cuba , 17 Mal' J 902. 

71. WD, AllojSG, 1907, Pl'. 80-82, 1908, Pl'· 

66-68, 1909, Pl'. 80-88, and 19 10, p. 85; idem, 

ARojSW, 1906, p. 33. 
Chapter 10 

PUBLIC HEALTH IN OTHER 

CARIBBEAN AREAS 

Like their colleagues in Cuba , u.s. medical officers in Puerto Rico and the Isthmus of Panama tackl ed the public health 

challenges that confronted them with the 

confidence and enthusiasm characteristic 

of those in the forefront of the medical revolution. In Puerto Rico a smallpox epidemic and a mysterious, chronic, and disabling anemia affli cted much of the native 

population without affecting U.s. soldiers. 

In the Panama Canal Zone, as in Cuba, yellow fever and malaria threatened newcomers more than long-time residents. 

The two insect-borne diseases had for 

years paralyzed efforts to dig a canal from 

the Atlantic to the Pacific Ocean. Unlike 

their colleagues in Cuba and Puerto Rico, 

however, those attempting to improve 

public health in the Canal Zone worked 

without the backing of a military government; their chief stumbling block as th ey 

attempted to app ly the methods that had 

been so successful in Cuba proved to be 

the stubborn ignorance of the first members of the Isthmian Canal Commission. 

Puerto Rico 

In Puerto Rico,' as in the other newly 

conquered territories, a military government initially assumed power from the departingSpanish, who officially gave up control over the island on 18 October 1898. 

Until 1900, when the U.s. Congressgranted 

Puerto Rico an elected civil government 

with a U.s.-appointed governor, U.s. Army 

medical officers were responsible for the 

health of both the handful of small garrisons 

scattered about the island and the civilians. 

InJune 1899 the Ponce hospital, which had 

by then been modernized with new plumbing, a refrigeration plant, and other equipment, became a post hospital to serve the 

city's garrison. The newly established general hospital in Sanjuan became the island's 

only general faCility, where the supply depot 

was also located.' 

Since the Spanish board of health had 

been "almost purely ornamental," physicians were confronted from the outset with 

the island's dirt and stench, its "filth y small 

huts" and overcrowded "wretched hovels." Like their counterparts in Cuba , 

Puerto Rican communities were "in a fil thy 

condition." A Marine Hospital Service 

physician wrote in 1900 that the inhabitants of Ponce, for example, were "a class 

of people of no grea t endurance, badl y infected with ankylostoma (hoo kworm), living in unhygieni c surroundings, always on 

the verge of sickness." Because barracks 
258 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

were located in the midst of Puerto Rican 

communiti es, any disease that threatened 

the civilians was a potential threat to occupying troops as well , and public health 

on the island became a major co ncern for 

medica l officers sent to Puerto Rico.' 

By September 1898 disease rates were increaSing among the soldiers stationed in 

Puerto Rico. The situation was particularly 

frustrating to General Brooke, commanding the troops on the island , since he had 

insisted that high standards of sanitation be 

maintained for camps. He blamed his soldiers' fond ness for the island's fruits-and 

especially the mango- for the dysentery 

and diarrhea from which they were suffering, and stated that his medical officers had 

co ncluded that cases originally diagnosed 

as typhOid were actually malaria. A month 

later, the medical officer sent to inspect 

camps and hospitals in Puerto Rico co ncluded that their condition was improving 

and that sick rates would soon bedropping.' 

So great was the perceived danger from 

disease in Ponce that a U.s. Volunteer surgeo n Maj . John McG. Woodbury was 

named sanitary inspector of the town immediately after its occupation in the summer of 1898. With the assistance of civilian physicians, Woodbury organized a 

boa rd of health and immediately set to 

work to have streets and buildings in 

whi ch troops might be housed cleaned, 

disinfected, and fumigated. He had silt removed from the pond that provided the 

City's water supply and a filter appli ed at 

the city end of the aqued uct. Since bodies 

were already being buri ed in layers in the 

old city cemetery, he laid plans for a new 

one. He had th e city priso n disinfected and 

repaired , and he ordered vaccine from the 

United States in order to und ertake a compulsory immuni zation of all citizens 

against smallpox' 

Smallpox proved to be a threa t to the 

non immune not only in Ponce but 

throughout Puerto Rico. Spanish efforts to 

vaccinate the population had fail ed, U.s. 

Volunteer surgeo n Maj . Azel Ames noted,-

because of the Spanish "lack of purpose ... and vim." The two small vaccine 

farms that had been established by the 

Spanish we re "nearly moribund." As a result, few Puerto Ri cans had been immuni zed, and when the Department of Puerto 

Rico was created in October 1898 with 

John van R. Hoff, now a lieutenant colonel 

in the vo lunteers, as the chief surgeo n, 

smallpox was still a great concern . But before Hoff could mount an all-out campaign 

against this disease, he had to conquer a 

mass of administrative confusion and disorder, since when he arrived, as he put il, 

"nothing was and everyth ing had to be. " 

He noted that "the chief surgeon's office 

[wasl without form and void" and th ere 

was "not a reco rd, nor a book in which to 

keep it, nota desk, nothing, indeed, whi ch 

would furnish any information about th e 

existing organization of the medi cal department or the number, names, and location of its personnel. " 7 

The chief surgeon had little time to deal 

with the confusion, however, because by 

February 1899, smallpox was epidemic. 

More than 3,000 of the island's 960,000 

population had contracted the disease since 

the occupation began. Any campaign 

against small pox would be handi capped because, except for a military road from San 

Juan to Ponce "and three more short pieces, 

there [wasl not a good road on the island," 

and thus the many communities scattered 

about th e countryside were virtually inaccessible. Moreover, since Puerto Ricans 

were generally fatalistic about the disease, 

they tended to co nceal their sick rather than 

risk having them removed from their homes 
PUBLIC HEALTH IN OTHER CA RIBBEAN AREAS 259 

and famili es, renderi ng the management o[ 

the epidemic stillmore difficult8 

To deal with the rapidly growing number o[ cases o[ smallpox, at Hof['s suggestion, o rders were issued in January 1899 

that all inhabitants o[ the island who were 

not already immune be vacci nated under 

his supervision. The island was divided 

into fi ve areas o[ approximately 200,000 

population and a medical officer aSSigned 

to each to manage the vaccination program. Since guaranteeing that shipments 

o[ vaccine from th e Un ited States wou ld 

arrive with the virus still effective was almost impossible, providing sufficient fresh 

vaccine to immunize the island's population presented a considerable challenge. 

The responsibility for producing vaccine 

on the island [ell to Major Ames, who was 

already managing a new vaccine rarm, 

where 1,240 head o[ healthy yo ung cattle 

were being tested for tuberculosis so that 

this disease wou ld not be spread to those 

being inoculated [or smallpox. Medica l 0[-

ficers hoped to produce and send out to 

th e vaccinators in the fi eld 15,000 "points" 

(single dose containers of vaccine) each 

day. To do so, the [arm5 manager had to 

battle the screwworm , a co nstant threat to 

the health and vigor of the cattle. In addition, Army doctors had to obtain pack animals, the proper packaging to keep the 

points suffiCiently cool during transportation to prevent the deterioration o[ th e vaccine, and "[oot-runners" to take the material into the more isolated communities. 

Medical Department efforts resulted in the 

producti on o[ a vaccine that proved to be 

more than 87 -percent effective and in the 

delivery to the vaccinators of quantities 

suffi cient to protect the entire island 9 

Hoff, who by th is point had returned to 

his permanent rank of major, described 

dealing with the epidemic as "an immense 

task and possible onl y th rough military 

agency. " To immunize the entire population of the island, he, like Major Woodbury, 

worked closely with Puerto Rican authorities. He asked nati ve leaders to appoint 

local physicians to do most of the vaccinating and to !Jrovide the necessary clerical support, the storage, and the runners to 

carry the vaccine. Those doing the vaccinating had to be impressed with the necessity fo r washing their hands frequently 

with soap, water, and a nail brush, and then 

soaking them in a bichloride solution. They 

also had to be trained to wash each arm 

with soap, water, and a bichloride solution 

before breaking the surface of the skin for 

the vaccination. U.s. contract surgeons 

were hired, as necessa ry, to complete the 

team, and the Army provided much of the 

equipment. Since hospital stewards who 

served as attendants, recorders, and disinrectors at the various vaccination stations 

assisted the medica l offi cer in charge of 

each area, the release of many hospital 

corpsmen from the Army shortly after the 

end of hostilities made the campaign 

against smallpox more difficult and more 

costly; many of these experi enced technicians then had to be hired as civilians at 

twice their Army salaries. Fortunately, 

frightened by the mortality the disease produced and its rapid spread and possibly inspired by the effiCiency with which the 

Americans were conducting the work, the 

Puerto Ricans cooperated with the vaccination campaign. By 30 June 1899,800,000 

men, women , and children had been vaccinated. From that time on, all civilians on 

the island over the age of six months were 

required to be immunized against smallpox, and local government authorities were 

ordered to deny access to schools, theaters, 

and public transportation to all who had 

not undergone the procedure. lo 
260 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

BAILEY K. ASHFORD 

Major Hoff decided early in 1899 that a 

board of health for the entire island should 

be created to oversee public health 

throughout Puerto Rico and to receive reports from the local boards of health. On 

29 June 1899, with the immediate crisis at 

an end, Hoff was free to serve as president 

of the new body, which also included a Marine Hospital Service surgeon, a U.s. Navy 

surgeon, and three civilian physicians. 

One of the civi li ans, a public sanitarian 

with many years of experience in the field , 

became its permanent secretary. Within six 

months the board had appointed sanitary 

inspectors for the Department of Puerto 

Rico's two districts, II set up a laboratory to 

check food supplies, organized vaccine 

stations, started collecting health statistics, and published bulletins concerning 

various important diseases. It had also established li cense examinations for physicians, pharmacists, midwives, and nurses, 

and created a code of sanitary regulations. 

The board remained in existence until May 

1900, when the territorial governor and 

executive council appointed by the United 

States joined an elected assembly to rul e 

the island and the military government in 

Puerto Ri co came to an end." 

The board apparently did not take particular alarm from the presence in Puerto 

Rico of a mysterious chronic anemia, often 

referred to as "tropical chlorosis," that subtly undermined the health of the population and had been traditionally and variously blamed on malaria, inadequacies in 

the diet, the climate, and "unsanitalY habits 

of life." It regarded the problem as "a severe 

check to the physical and moral development" of the Puerto Rican population, but 

several years passed before the riddle was 

solved. The 26-year-old Lt. Bailey K. Ashford, although aware since his days as a student of Dr. Charles W Stiles at the Army 

Medical School that the hookworm could 

cause anemia, nevertheless did not initially 

suspect this parasite, which apparently was 

not prevalent in Cuba. He had noticed, 

however, not long after his arrival on Puerto 

Rico with General Miles that many natives 

were abnormally pale and suffered from indigestion, edema , and general debility." 

No serious effort to discover the cause 

of the mysterious anemia was made until 

the summer of 1899, when the deteriorating hea lth of the victims of a violent hurricane stimulated Lieutenant Ashford's interest. The storm killed more than 2,200, 

seriously damaged the hospital at Ponce, 

and so thoroughly devastated the banana 

and plantain crops vital to the diet of that 

island that the United States was at one 

point feeding as many as 183,000 Puerto 

Ricans a day. Ordered to establish a field 

hospital for the victims of the storm, Ashford discovered during the six months it 
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 261 

was in operation that the generally poor 

condition of his patients frustrated his best 

efforts to restore them to a state of health 

and vigor. In the last half ofthe year 28,700 

died because of anemia and dysentery 

alone. The city of Ponce was "having an 

epidemi c dea th rate without an epidemic," 

and Ashford concluded that some common disease or condition must underlie 

the failure of his patients to thrive." 

Lieutenant Ashford's attempts to solve 

the riddle first led him to examine the blood 

of the victims of the mysterious disease. 

The abnormal proportion of one type of 

white cell that he found triggered vague 

memories of having heard of a similar condition caused by internal parasites. While 

following up on this idea, he discovered on 

a feca l slide "four Ouffy gray balls" resembling the eggs of a parasite that had been 

found in anemic Italian workers some time 

before. A patient heavily dosed with thymol expell ed what Ashford later described 

as "a family of tiny wo rms" that differed 

from the European hookworm principally 

in having "no front teeth." Since both types 

of hookworm caused the same symptoms 

and responded to the same treatment, Ashford, working with Dr. Stiles, then on the 

staff of the Marine Hospital Service, determined that the new parasite was closely related to the European variety.15 

Discovering the cause and cure of hookworm disease (uncinariasis) proved easier 

than lau nching a successful campaign to 

eradi cate it from the island. The hookworm larva penetrates the skin and migrates to the small intestine. Since many 

inhabitants of the island worked barefoot 

in soil that was infected and reinfected by 

victims who reli eved themselves in the 

fi elds where they were harvesting coffee, 

uncinariasis amicted many inhabitants of 

the rural areas. Lieutenant Ashford's research suggested that perhaps as many as 

80-90 percent of those whose work 

brought them into contact with the soil fell 

victim to the disease and that in the fisca l 

year 1901 more than 11,000 died as a direct or indirect result. Hookworm disease 

severely undermined the health and stamina of as manyas 70 percent of those who 

survived, leaving many victims mere 

"ghost-like invalids," weakened by anemia 

and often suffering from diarrhea, headaches, listlessness, depression, and, sometimes, such complications as an enlarged 

heart. Although this problem adversely affected the island's economy as well as its 

population, Ashford was initially unable to 

gai n the wholehearted support of Puerto 

Rican authorities for his work and, as a result, progress in dealing with hookworm 

disease was very s10w. 16 

Sanitation in the island remained extremely poor, raising the questi on of 

whether the Puerto Ricans should be left 

to manage the probl em by themse lves 

when the civilian government took COlltrol. Although Lieutenant Ashford returned to the United States in 1900, the 

Army reassigned him to the island in 1902, 

when he was promoted to captain, to care 

for troops stationed there, and thus he 

could resume his efforts to inspire Puerto 

Ri cans to fi ght the disease that was devastating the population. Ashford, who had 

married a native Puerto Rican in 1899, addressed loca l medical associations in Spanish. His reputation as a Spanish scholar enhanced his inOuence. The Puerto Rican 

Board of Health created by the new government made his report on hookworm 

disease into a circular and sent it out to 

local physicians and pharmacists. His 

growing affection and respect for the 

Puerto Rican people no doubt made it easier for him to work with them. In 1904 the 
262 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

govern or appointed Ashfo rd, Publi c 

Health and Marine Hospital Service physician Walter W. King, and Ped ro Guti errez 

Igarav idez, a Puerto Rican physic ian 

whom Ashford came to regard highl y, to a 

commission to undertake a campaign 

againsL hookworm.

17 

Ashford became co nvinced that the best 

approach to the hoo kworm problem 

would involve the treatment of all affected, 

a campa ign to educate all Puerto Ricans on 

the natu re of the disease and the way in 

which it was spread, and the careful , tactful application of laws aga inst what he politely ca lled "surface poll ution." He also 

pointed out that eliminating the disease 

from the island would co ntribute significa ntly to its economy by making its wo rkers more efficient. Ashford and those who 

wo rked with him cured approximately 

22,000 in the first eighteen months, but he 

believed that Puerto Rica ns should run 

their own affa irs and was confi dent that 

many nati ve physicians were capable of 

serving on the commission. In 1906, at 

Captain Ashford's urging, Gutierrez became head of what now became the PerIllanenl Commission for the Suppression 

of Uncinariasis in Porto Rico . Commission 

members were all Puerto Ricans, but the 

Army detailed Ashford to assist in the antihookwo rm effort, which co ntinued despite the administrati ve changes. As many 

as 89,000 patients were treated in a year at 

the height of the campaign, but many more 

were yet to be reached. Dispensaries for the 

victims of this parasite were scaltered over 

the island, numbering thirty-fi ve by mid1908 and eventually reaching fi fty-nin e.'s 

When, after some confusion, the U.s. 

Congress established a health service for 

Puerto Rico in 1911, the governor wished 

to have Ashford, now a major, serve as its 

head, but the judge advocate general ruled 

that Ash ford could fun ction only in an advisory capacity. Although the new Boa rd of 

Health appeared at times less than eager to 

take Ashfo rd's advice, he apparently felt 

committed to the island and its welfare in 

spite of his frustration. The Army relieved 

him of his military duties so that he could 

assist the Puerto Ricans, and since he obviously expected to remain for a long period 

on the island, he opened a priva te practice 

to help support his family. To his delight, 

the Puerto Rican legislature rewarded his efforts in 1912 by creati ng the institute of 

Tropical Medici ne and Hygiene that he had 

long sought. Thro ugh it, he was abl e to establish a teaching program lor sanitary inspectors and to undertake resea rch ex peditions to study the island's diseases.'9 

Major Ashford's work had aSignificance 

that went well beyo nd the bounds of one 

island. T he exact extent of his innuence 

upon subsequent hookwo rm campaigns is 

debatable, but Ashford's "initiative" was 

responsible to a Significant degree for the 

campaign against this disease in the southern United States and for that of the Rockefeller Institute. Research undertaken by 

medical offi cers in the United States now 

began to suggest that hookworm was also 

present in many recruits from southern 

states. In the Deep South as in Puerto Rico, 

the soil rarely froze far enough down to ki ll 

the hookworm's eggs. W hen the Army 

began checking recruits from the South for 

hookworm , medical offi cers discovered 

that 16 of the first 19 they examined at Fo n 

Slocum , New York, were harbori ng th e 

parasite. Further studies confi nned the 

finding that as many as 85 percent of recruits from the South had hookworm. Ashford's research concerning uncinariasis encouraged many other scientists, including 

those whose work to erad icate th e parasite 
PUBLI C HEALTH IN OTHER CARIBBEAN AREAS 263 

on a worldwide basis was financed with 

Rockefeller funds'o 

Still other diseases endangered the 

hea lth of the island. With the hoo kworm 

problem under control, Ashford turned his 

allention to the problem of sprue, a tropical disease whose ca use is still unknown. 

Sprue affected the digesti on, ca using (liarrhea and leading to debilitalion. He proved 

to his own satisfaction that the disease was 

not, as anothe r researcher had suggested, 

caused by the fungus then known as 

Monilia albicclIIs (Ca ne/ie/a albicans). He 

noted that he had fou nd a new species of 

Monilia in bread eaten in the area of Puerto 

Rico where the disease appeared to be endemic and speculated that this organism 

might be the cause of tropical sprue. Although by 1915 he had concluded that the 

increase in the number of cases had placed 

this disease "in the very front rank of the 

serious and fatal affections of our islands, 

especiall y dreaded by American residents," 

he was, like th e scientists of the 1990s, un -

able to determine the exact cause." 

Among other diseases in Puerto Ri co, 

yellow fever was not a significant problem, 

although a few cases might be seen in the 

cou rse of a year. Brucellosis, or Ma lta fever, 

may have been endemi c, and Ashford estimated that as many as 10 percent of the 

Puerto Ricans were suffering from fil ariasis, caused by a tiny internal parasite that 

could not be eradicaled withoUlthe elimination of th e mosq uitoes that ca rri ed it. 

These ailments did not cause any great 

alarm , but when cases of bubonic plague 

were reported in San Juan in 1912, the 

Army created a specia l duty team to fight 

the disease. Lt. Col. J efferson R. Kean and 

two other medica l offi cers hastened to the 

island, accompanied by three hospital 

corpsmen and a field laboratory. By the 

time they arrived, 22 cases had been reJ EFFEHSON R. KEAN 

ported on the island. Although examinalion of dead rats pi cked up in the area revea led that only a small percentage was infected, th e sampling could not indicate 

speCifi ca ll y how widespread the problem 

was. After less than two weeks, the effort 

against the dreaded disease was well under 

way, and the Army turned the laboratory 

over to Public Health Service physicians, 

who compl eted the campaign." 

Panama Canal Zone 

Hea lth problems in th e Panama Canal 

Zone on the western shores of the 

Cari bbea n resemb led th ose in Cuba more 

than those in Puerto Rico. Its primitive environment, where, as olle physician put it, 

"eterna l summer reigns and the diabo li ca l 

mosquito goes on propagating descendants," made insect-borne disease a diffi-
264 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

WILLIAM C. GORGAS 

cult enemy to conquer. Although interest 

in enabling ships to sa il from the Atlantic 

to the Pacific without facing the dangers 

and delays of Cape Horn had taken root in 

both the United States and Europe decades 

before the Spanish-American War, yell ow 

feve r and malaria had been a major frustration to those trying to co nstruct such a 

passage. During the eight years the French 

spent on the canal until they aba ndoned it 

in 1889, d iseases end emi c to the jungles of 

Central America had killed more than 

20,000 men, representing as many as onethird of the workers brought in to handl e 

the construction. Mo reover, these deaths 

had come with terrifying promptness. Reportedly, 75 percent of the newcomers died 

within three months of their arri va l, most 

often from malaria, regarded by some as 

"the commonest and most fatal disease"; 

yellow fever; or the several forms of dysen -

tery prevalent in the area. The anonymous 

author of an article in the Medical Reco rd 

for 1903, well aware of the role played by 

mosquitoes, raised the questi on of 

whether Asian workers on the canal might 

carry yellow fever from Panama back to 

Asia , where it had never been found ." 

Having defeated yellow fever in Hava na, 

Major Gorgas hoped for a new chall enge. 

Still in Cuba in April 1902, he unhappily 

wrote a colleague: "My callal schell1 e does 

not seem to be materiali zing and [itl looks 

now as if I wo uld have to settle down to 

post life again." Eager for a chance to apply 

the techniques the Army had developed in 

Cuba to Panama's "damp, tropi ca l jungle, 

intensely hot, swarming with mosquitoes, 

snakes, alliga tors, sco rpions, and centipedes; the home, even as Nature made it, 

of yellow fever . . . ," he urged that he be 

named to any commission chosen to oversee such a proj ect. Encouraged by, among 

others, General Wood and Surgeo n General Sternberg, who recommended that 

Go rgas be put in charge of sanitation when 

ca nal work began, he familiarized himself 

with th e an timalarial efforts of the French 

at Suez whil e in Egypt attending a professional meeting and later studied the few 

reco rds relating to th eir ca nal work that 

were available in Paris. N 

Only in the sp ring of 1904, however, did 

Gorgas, now a colonel," at last fin d himself on the brink of the challenge he had 

sought. The trea ty granting the right to 

build the canal required the United States 

to assume responsibility fo r sanitation in 

both Panama CiLy and Colon, communiti es outside the ten- by forty-five-mile 

Canal Zone and under the co ntrol of the 

Panamanian government, as well as in the 

Ca nal Zone itself. But, in spite of pressure 

frolll the Ameri can medical community, 

Gorgas was not appointed to the new Isthmian Canal Commission that President 
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 265 

Theodore Roosevelt named on 3 March, 

whi ch would serve under War Department 

control. Named to the commission early 

that year were five civilians and two military ofri cers, none of them physicians. 

Colonel Gorgas, Navy surgeon j ohn W 

Ross,2. and Army surgeon Maj. Louis A. LaGarde were asked to accompany the commission on its first tour of inspection.

27 

Gorgas anel the Opposition 

Colonel Gorgas and his team soo n 

found that they were wo rking und er a signi fi cant handicap. The commissioners 

lacked all respect for the research of Waiter Reed and the Yellow Fever Board, an attitude that some members of the medical 

profession still shared. In spite of Gorgas' 

achi evements in Havana, they rejected the 

notion that mosquitoes spread yell ow 

fever and malaria. In an area where eve n 

the largest cOlllmuniti es had neither sewers nor sa fe water supplies, they beli eved 

that cl eanliness was the obvious answer to 

the problem of disease. Brig. Gen. Robert 

M. O'Reilly, who replaced Surgeo n General 

Forwood on 7 September 1902 and who 

greatly admired Gorgas and his work in 

Havana, warned the commission that "a 

knowledge o f Sanitary Engineering I wasl 

not sufricient" for dea ling with the problem of preventing disease among those 

wo rking on the canal, but his admonition 

failed to impress them. The order that formall y assigned Go rgas to the position of 

chi ef sanitary offi ce r o f the Canal Zone in 

june 1904 made him subordinate not only 

to his military superiors but to the commissioners as well. His insistence upon delay ing the traditi onal cleanup to concentrate upon ridding th e area of mosqu itoes 

made his relati onship to his immedi atesuperiors awkward from the outset. 28 

Gorgas' medical team, like Hoff's Puerto 

Ri can health board, came from th e Army, 

the Navy, the Publi c Hea lth and Marine 

Hospital Service and, most often, from 

civilian life. Many had worked with Gorgas in Havana. Ross became director of 

hospitals in th e Canal Zone and Major LaGarde superintendent of the area's major 

hospital , a faCility at Ancon originally built 

by the French. Henry Carter of the Public 

Health and Marine Hospital Servi ce, 

whose research about the incubati on period of yellow fever had been so valuable 

to the Yellow Fever Board, became chief 

quarantine ofricer. The Medical Department played a major role in «the sanitary 

regeneration of the Isthmus of Panama ," 

since a total of six Army medical o ffi cers 

were detailed to public health wo rk there. 

In recognition of the importance of their 

wo rk, their salari es were markedly higher 

than those they drew in their regular assignments. Gorgas, who normall y earned 

only $4,950 from the Army and wo uld 

have received a 20-percent increase for 

tropical service, was paid $7,500 a year, a 

sum later increased to $10,000.'9 

Colonel Go rgas, Ross, and Major LaGarde organized the Department of Health 

for th e Canal Zone3 0Together with Joseph 

Le Prince, th e chief sanitary inspector, who 

had been responsible for the destruction 

of mosquitoes in Havana and who arrived 

in Panama with them in june 1904, th ey 

formed the boa rd that ran th e new department. Many of those who served under 

th em were contract physi cians brought in 

from the United Sta tes, a lthough a few additional Army, Navy, and Public Hea lth and 

Marin e Hospital Service ofri cers held responsible positions in th e Ca nal Zo ne as 

well. Among the U.s. physicians were hos-
266 THE ARMY MEDICA L DEPARTMENT, 1865-1917 

pital interns, who received $50 a mOlllh 

for a year's servi ce, in addition to transportation to and from one of the principal 

ports in the United States. Should th ey 

wish LO remai n longer, they were given 

co ntrac ts that paid them salari es smaller 

than those given Army contract surgeons. 

Tra ined fema le nurses were also brought 

in under three-year co ntracts and paid $50 

a month for their services.) l 

Colonel Go rgas' probl ems began th e 

moment he took up his duties as chi ef sanitary orficer, bea ring the ultimate responsibility for the ca re of the sick, street cleaning, and garbage collection , as well as for 

campaigns agai nst mosq uiLOes. Suppl y 

caused him "insuperable dirficulties," 

since lilli e o f what he needed was available 

in Panama and those in the United States 

responsible for supplyi ng him were "slow 

in getting organized." The commissioners 

rarely left the United States LO visit the 

Canal Zo ne, but th ey moniLOred its expenses from afar. Although th ey promptly 

authori zed the creat ion of a research laboraLOry LO be staffed by experts proVided by 

Dr. Welch of J ohns Hopkins and also allowed that faCility to spend freely, Gorgas 

found it dirfi cultto obtain even such basic 

items as screens and disinfectants. Econom y was uppermost in the commissioners' 

minds, and many of his requisitions were 

for items they did not regard as necessary." 

The preoccupation with minor expenses was endlessly frustrating. Colonel 

Go rgas' attempts to have more men sent 

out to help him were also thwarted. Even 

after he returned bri eOy to WashingLOn to 

plead his cause, he was ordered to hire his 

inspectors locally. The relationship between the commission and the medica l 

team was so poor that, during a rare visit 

by some of the commissioners LO the Canal 

Zone, Major laGarde repo rtedly took his 

revenge on one, who was known to be particularl y terrified of yellow fever. While 

this parti cular commissioner was inspecting a wharf, LaGarde made sure that six 

elaborate coffi ns were on prominent display. When asked why the six were so obviously more expensive than others being 

unloaded , LaGarde reminded him that one 

of the seven commissioners had nOl made 

the trip to Panama on this occasion.)) 

Ghoulish humor did not help to co nvince the commissioners that an anti-mosquito campaign would reduce the threat of 

disease fasterthan the removal ofOith . They 

undoubtedly felt vindicated , when, months 

after Colonel Gorgas initiated his effort 

against disease but before serious work LO 

clean the towns had started , an epidemic of 

yellow fever erupted. Gorgas was using the 

same approach to erad icate yellow fever in 

the isthmus as had been applied in Cuba. 

Since Panama City was less than one-tenth 

the size of Havana, it seemed obvious that 

if his solution to the problem were valid , he 

shou ld have been able to prevelll a reappea rance of the disease. But 90 percent of 

the mosquitoes in Panama City were Aedes 

aegyl'ti , while only 5 percelll of those in Havana were capable of spreading yellow fever. 

Moreover, although Havana was much 

larger than either Panama City or Colon, 

the area involved in H avana was small, U.s. 

authorities completely controlled the government, and few restrictions were placed 

on expenditures. Gorgas' failure to duplicate his earlier success promptly was taken 

by those who did not understand the problem as proof that mosquito- hunting was a 

waste of time and that he had erred in delaying the Canal Zone cl eanup." 

a ni)' scallered cases of yellow fever developed among the fo reigners in th e Canal 

Zone before November 1904, but as the 

numberslowly but inexorably increased in 
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 267 

spite of Colonel Gorgas' efforts, the lack o f 

co nfid ence in the chief sanitary officer 

grew. After a personal visit to Panama late 

in November, Secretary of War Ta ft joined 

th e opposition. Shortly therea fter, however, Dr. Charl es A. L. Reed, an outspoken 

former president of the American Medica l 

Association and a close friend ofTa ft's, also 

visited the Canal Zo ne. His purpose in 

coming was conceal ed from the publi c, but 

he had been sent by Tart to investigate the 

situati on there. His impressions of the 

management of sanitation and health there 

led him to mount an allack on the commission so vigorous that even Gorgas 

wished it had been "wrillen more temperately." After examini ng the situation in the 

Canal Zo ne for fifteen days, Reed concluded that "very much has been accomplished in the way of sanitation under exceedingly adverse circumstances; that 

much remains to be done which can not 

be done unless better facilities are affo rded; 

and that very much more ought to be done 

and would have been done if the facilities 

had been properly furn ished. " Reed maintained that the earliest plans for the Canal 

Zone had call ed for the chief sanitary officer to operate with considerable independence but that Go rgas had been made subordinate to layer upon layer of oth ers, 

"subordinated in fact in the seventh degree 

from the original source of authority." " 

Many of those through whom Colonel 

Gorgas had to work were ignora nt of the 

probl ems that he had been asked to solve 

and upon whi ch he was an authority. The 

commission, Dr. Reed reported, ignored or 

pushed aside Gorgas' suggestions and requests, one commissioner responding to a 

request [or more latrines to improve sanitation with comments extoll ing the efficiency with whi ch hogs and buzzards d isposed of night soil. Since the commission 

insisted upon taking direct responsibility 

for the most minute matlers and since 

many questions we re "taken under advisement," decisions of any l<ind were extraordinarily slow in coming. Reed also 

noted that Gorgas' peo ple were not even 

permilled to determine the suitability of 

the items ava ilable to fill their requisitions, 

which were handled by a tortuous and 

time-consuming process under the supervision of a purchasing agent "notoriously 

ignorane' of their needs. 36 

Whil e Colonel Gorgas was enduring the 

turmoil of politics and personalities and 

the blame for the growi ng epidemic, he 

was also profoundly worried about his 

wife, whose health had been of concern for 

many months before their arrival in th e 

Canal Zone. With her husband faCing the 

greatest challenge of his ca reer, on 17 January 1905 Marie Go rgas was forced to leave 

the Canal Zo ne for the United States to undergo a series of major operations thaI 

would eve ntually include two radi cal mastectomies, the remova l of both ovaries, and 

"an X ray course in New York. " Apparently 

at Ma ri e's urging and despite his instin ct 

to "throw up the whole job" to be with her 

during her ordeal, Gorgas remained at his 

post, telling himself that "in two or three 

weeks" he wo uld "have yellow fever here 

und er control " and be able to join her in 

Philadelphia fo r the seco nd round of 

surgery. Time proved that whil e Go rgas' 

app raisa l of the epidemi c was tragically 

overoptimistic, Marie's "good hope of ultimate recovery" was justified. She lived to 

play the widow's tragic role in Gorgas' magnificent funera l in the summer of 1920. 37 

Leaders in Wash ington rea lized that the 

Canal Zone was not being well managed, 

but no solution to the difficulties encountered there was immediately forthcoming. 

Dr. Reeds obvious "personal animus" and 
268 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

his "often ex treme and somewhat nippant 

remarks" diminished the impact of his message. Although Colonel Gorgas concluded 

that the concept of rule by commission was 

inherently Oawed, "seven men [being] too 

many to do executive work," Surgeon General O'Reilly believed that whil e "the Commission are going to have trouble," Gorgas 

might "go down with them. " When changes 

were fina lly made in the management of 

Canal Zone affairs, Gorgas retained his position, but the commission concept was not 

abandoned. To achieve greater effi ciency, 

President Roosevelt named three of the 

members to an executive commission, relegating the remaining four to a fi gurehead 

position. The administrative departments 

invo lved in managing the Canal Zone were 

divided up among the three members of the 

execu tive committee. The "high-minded 

and honorable men" who replaced the first 

commission in March 1905 proved to be almost as skeptical about the role of mosquitoes in the spread of disease as their predecessors. They did move to alleviate delays 

in obtaining medical supplies by arranging 

for the Medical Department to provide essential items and to be responsible for meeting Canal Zone requirements in the future. 

Thus, according to O'Reilly, the process of 

handling the area's needs was "rescued from 

confusion and delay. " 3. 

The epidemi c's continued spread 

throughout the spring of 1905 did not improve the relationship of Gorgas and the 

new offi cials. By April severa l high canal 

officials had died of ye llow fever. Piles of 

coffins ap pea red at railroad stations. Panic 

grew, spread in the United States by the 

tales of those neeing the Canal Zone. Many 

deaths resulting from other causes were 

blamed on yell ow fever. From April 

through]une 500 fearful Ameri cans working on the isthmus ned home, and when 

the canal's chi ef engineer joined them at 

the height of the epidemi c, rumors became 

yet more desperate. Fortunately, by summer Gorgas' efforts to eradi ca te yell ow 

fever in th e Canal Zo ne were beginning to 

show results. June's 112 cases were followed by only 42 in July, and at last fears 

began to subside. 39 

Although the worst of the epidemic was 

behind him and he could hope that yellow 

fever wo uld no longer threaten th e Canal 

Zone, its history continued to haunt his 

thoughts. "The moonlight & the royal 

palms & the grea t Pacifi c are outside as 

quiet as the grave," he wro te one October 

evening in 1905, "& in the shadows of my 

room I can hear the rustle of the ghosts, 

along the edges of the light cast by my lamp, 

of the dozens of gallant French engi neers 

who gave up th eir lives in th eir gallant fi ght 

down here .... I suppose more gentlemen 

have died of yellow fever in this building 

than in any other building now standing in 

the world." What wo uld be the last case of 

yellow fever to originate in Panama City 

occurred not long after he penned this letter, but from 1 July 1904 through 31 January 1906, 64 of the 246 who were stri cken 

joined the spirits in the dark corners of Go I' -

gas' office. Only when he was sure that a 

case contracted in Colon in May 1906 was 

the last for the Canal Zone could Gorgas 

hope that the arrival of hordes of ca nal 

workers would not increase the volume of 

the rustl e in the shadows and that his 

ghosts could rest in peace at last. '0 

New cases of yellow fever were still appearing when the newly appointed Canal 

Commission concluded that Gorgas and his 

supporters would have to go. After consulting Dr. Welch and Alexander Lambert, 

a personal fri end and a physician, both of 

whom gave Gorgas their unqualified support, President Roosevelt ordered the com-
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 269 

-. -

.... ~ -i-....;.._ 

., ~-' 

~ . 

CARTOON BY G ORGAS 

mission to cease its opposition and cooperate fu lly with Gorgas. The chairman of the 

Canal Commission accepted this decision 

so wholeheartedly that he made Gorgas' organization into an independent bureau reporting directly to him. When yellow fever 

had been defeated in the Canal Zo ne, the 

president officially visited Panama in November of 1906 and, upon his return to the 

United States, made a speech in which he 

devoted much of his message to the praise 

of Gorgas and his accomplishmen ts.;' 

Fighting Disease 

In his campaign aga inst disease in 

Panama , Colonel Gorgas reli ed on the same 

approach that he had found so successful 

in Havana. His first effort was directed 

against Aedes aegypti, the carrier of yell ow 

fever. He divided the affected communities 

up into distri cts, plaCing in charge of each 

a Panmnanian sanitary inspector ramil iar 

with the life cycles of the various types of 

mosquito. Every inspector had 20 to 100 

workers under him and was responsible 

not only fo r inspections but also for the "actual direction and supervisio n of work fo r 

the extermi nation of mosquitoes and a general cleaning of premises and places and the 

disposal of night-soil and waste. " Gorgas 

knew from the outset that because early diagnosis of yellow fever was difficult, it 

would be impossible to keep mosq uitoes 

from biting vic tims during the first days of 
270 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

their disease, when they were infective. He 

had some hope that the screens would keep 

mosquitoes from infecting the healthy and 

recommended fo r each house the construction of a screened veranda in which 

there was only one entrance. Very limited 

success greeted this aspect of his campaign, 

however, although many frame buildings 

were U.S. government property.'2 

The campaign aga inst thesociableAedes 

aegypti was concentrated in the larger 

communiti es, especially Panama City and 

Colon. Since Panama City was so much 

smaller than Hava na, Colonel Gorgas decided tha t a house-to-house fumigation 

campaign to kill adult mosquitoes wo uld 

be feasible. When yellow feve r appeared in 

spite of a month of effort, he had his men 

repea t the process twice more. In a year 

Go rgas' teams consumed 300 tons of sulfur, 120 tons of insecticide, and the entire 

supply of newspaper th ey had acquired to 

seal openings in houses undergoing fumigation. To deal with the larval form of the 

insect, Gorgas launched another massive 

campaign. Teams drained standing water 

and, where this was not feasible, poured 

oil over the water to smother th e larvae and 

covered containers, such as cisterns, with 

a screen . They even emptied pitchers and 

jars. As the more obvious breeding places 

of the Aedes were eliminated, inspectors 

fill ed and set out conta iners of the kind 

Aedes preferred to tempt the frustrated insect to lay her eggs in loca ti ons where they 

coul d be easily found and destroyed." 

A parti cularly severe yellow fever problem surfaced at the large hospital at Anco n 

in the suburbs of Pa nama City. Colonel 

Go rgas' investigati on revealed that this facility, known for its "picturesque and delightful location," its gardens, its cleanliness, and its high yellow feve r rate , had 

become a breeding place for the Aedes 

partly because of the care of its staff, rather 

than in spite of it. Nu rses desiring to spare 

their pati ents the torment of ants that invaded the hospital placed the legs of each 

bed in small saucers of water, and even gardeners hoping to spare their plants damage from insects placed "hollow ea rthenwa re rings of semi-spherical secti on 

around eac h pl ant." These containers had 

become breeding places for the Aedes, a situati on akin to one encountered by Major 

Reed in Cuba, where he had fo und mosquito larvae in cans placed under table legs 

to thwart invasions o f ants. As a result, 

many patients hospitalized at Ancon with 

other health problems contracted yellow 

feve r. Gorgas and Major LaGarde, who was 

directl y in charge of this fac ility, had the 

saucers removed, the buildings screened, 

and the ga rdens cut down, to be replanted 

only when the mosq uitoes o f the area had 

been eliminated. Thereafter, any troublesome ants were fo ll owed to their nests, 

which were then poisoned, and the dishes 

of water were never aga in needed. Mosquito netting over the vehicles taking patients to Ancon prevented the infecti on o f 

more mosquitoes and thus the further 

spread of yell ow fever. At Ancon as elsewhere, Gorgas' campaign agai nst the Aedes 

was , in Lim e, sLtccessful. 44 

In spite of the vigor with whi ch he fought 

yellow fever, Colonel Go rgas perso nally regard ed malaria as an even greater threat to 

the health of canal workers, a belief others 

shared. Malaria, and particularl y th e more 

severe falci parum form of the disease, was 

so common in the Ca nal Zone that many 

older members of the pop ulation had 

gained a partial immunity to it. Since they 

ca rried the disease even th ough th ey had 

no symptoms, they became, in the words 

of one phYSiCian, "wa lking laboratories for 

the propaga tion of the plasmodia." When 
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 271 

at the end of 1905 Gorgas ex tended the 

anti-mosquito campaign to include the 

malaria-carrying Anopheles, he had to use 

a somewhat different app roach. Although 

these insects were plentiful at night, even 

within the hospital where research was taking place, unlike the Aedes, they were "peculiarlya co untry mosquito." They favored 

wet grassy areas or fresh water well supplied with algae, both of which were plentiful in the Canal Zo ne, where an estimated 

14,000 people lived between Colon and 

Panama City;' 

Nevertheless, to some degree Colonel 

Gorgas' campaign against the Anopheles 

resembled that against the Aedes. He urged 

the screening of the boxcars in which 

some workers lived. Wherever possible, he 

had accumulati ons of water drained and 

water that could not be drained treated 

with a larvacide or covered with oil. Brush 

and grass and, when necessary, gardens 

were cut down . Because even wagon tracks 

and hoof prints could hold wa ter long 

enough for a brood of Anopheles to mature, the eradication of this insect th roughout the Canal Zone would obviously be an 

enormous undertaking. Since Anopheles 

mosquitoes did not usua lly ny far during 

their life cycle, Gorgas co ncluded that it 

would be feasible to concentrate his efforts 

within a radius of 200 yards around 

human habitation;6 

Colonel Gorgas placed Le Pri nce, his 

chief sanitary inspector, in charge of the 

new campaign and provided him with three 

assistants and a clerical staff. He then divided the countryside into seventeen sanitary districts and assigned an inspector to 

each district to supervise the work of the 

forty to fifty labo rers who dug drainage 

d itches and carpenters who installed 

screens. A district physician was also appoin ted to keep both the centra l office and 

the distri ct inspector informed about the 

number o f cases o f malaria he encountered 

each day. Gorgas reqUired that all anti-mosqu ito work be done in an inspector's presence and under his contro l, since the "ordinary engineer has no special knowledge 

of the life histo ry of the mosquito," and 

therefore might not understand how to design and place drainage ditches to achieve 

a maximum beneficial effect. The drainage 

system eventually included 5 million feet 

of open, 1.5 million feet of concrete-lined, 

and 1 million fee t of rock-fill ed ditches, 

plus 1 million feet of drain tile, all to d rain 

100 square miles of land. After discovering 

that grass tended to clog open ditches and 

that debris co uld dam concrete-lined 

ditches, Gorgas decided to rely more heavily on subsurface drainage tile. Because the 

Anopheles favored slow-moving water, he 

had vegetation removed from an entire 

mouth of a river to increase its noW. Gorgas also had the chan nel deepened and narrowed and the banks li ned with stone. Leaving little to chance, when he learned that 

small fish, lizards, and even spiders could 

take a high toll in mosquito larvae, he had 

these natural predators bred and introduced in to streams and areas of lush plant 

growth to increase still further the devastation among the mosquito populaLions,i7 

Because destroying all infectedmosquitoes in the enti re Canal Zone was impossible, the fight to reduce malaria rates requ ired eternal Vigilance and considerabl e 

ingenuity. Any time a district phYSician reported a Significant rise in the number of 

malaria cases, Le Prince was required to 

send experts to assess the situati on and 

pinpoint the cause of the increase. Sometimes it was determin ed that the mosquitoes were breeding in a swamp too large to 

be dealt with by ordinary methods. In one 

instance, investiga tion revealed that silt 
272 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

was being dumped into a swamp from the 

canal construction and that th e All opheles 

were apparently very fond of the resultant 

brackish water. Colonel Gorgas had large 

quantities of salt water pumped from the 

canal into the swamp, producing a mi xture 

that was too salty to suit these insects. A 

particularl y severe problem developed despite precautions around a quarry from 

which stone for a set of locks was being 

taken. The malaria rate at nearby Porto 

Bello was high, but the town was outside 

the Canal Zo ne and beyond th e Medica l 

Department's authority. After consultation, the Panamanian government gave 

Gorgas the authority to manage sanitation 

in Porto Bello and to introduce whatever 

comrol measures he deemed necessary.;' 

Occasionally when inspectors were unsure about the origin of mosquitoes ca using high malaria rates, they had a large 

number of Allopheles sprayed with aniline 

blue dye and then, since these insects 

seemed to "find a strong light repulsive," 

released at night from the area suspected 

of harboring the guilty mosquitoes. At th e 

affected campsite, a man willing to serve 

as bait was setup for the night in an open 

tent near where worke rs were camped. In 

the morning the tent was closed, thus trapping the insects so that they co uld be examined. Should blue mosquitoes be found 

among them, the inspectors knew where 

they should concentrate their efforts 

against larvae. Jamaican workers were apparently often used to tempt the insects, 

Colonel Gorgas having concluded that 

they regarded being paid to slee p in the 

tent "as near complete bliss as was to be 

found in this world." In instances where 

no o ther means o f prevention was ava ilable, Go rgas reso rted to hav ing the men 

take three-grain doses of quinine, although this precaution was not always effective. To guarantee as much success as 

possible in this endeavor, one or two men 

in each distri ct were sent among the workers to offer pills, capsules, and a liquid quininesolution to all who would take it. Quinine was even placed on th e table in all 

messes. An average of 45,000 employees 

took 20,000 doses a day;9 

Despite the handi caps under which 

Colonel Gorgas worked, his campaigns 

against mosquito-borne disease were 

eventually successful. The yellow fever 

epidemic was over by the end of 1905 and 

never recurred in spite o f an occasional isolated case that appeared therea fter. The 

rate at whi ch men we re hospitalized with 

malaria dropped as the populati on of the 

Canal Zone increased. The cases per 1,000 

men, whi ch reached a high of821 in 1906, 

when Gorgas was just beginning his campaign aga inst the Allopheles, dropped to 

424 in 1907 and to 282 in 1908, and by 

1913 was below 100. By 1913 th e overall 

yearl y dea th rate in the Canal Zone was 8 

per 1,000, as compared to th e French 

yearl y average of 240 per 1,000.

50 

lnsect-borne diseases were not the only 

ones with which Colonel Gorgas, as chief 

sanitary offi cer, had to dea l, and his problems, though simil ar to those his colleagues faced in other tropical areas, we re 

not identi ca l with theirs. He had reason to 

believe, for example, that hookwo rm infestation was common, but since anem ia 

was not, he saw no need to become involved in attempts to eradicate this disease. Beriberi, too, was frequently encountered, but apparently ca used no grea t 

concern. Because of the understand ing 

reached by the Cana l Commission with the 

government of Panama , Gorgas' Department of Health was responsible for the care 

and housing both of the Canal Zone's lepers, who were placed in a colony under 
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 273 

Carter's supervision, and of the mentally 

ill of the entire nation of Panama ." 

Like mala ria and yellow fever, respiraLO ry diseases were one of Colonel Gorgas' 

major concerns. For the cana l workers, 

and especially for the black laborers from 

the Barbados who formed a large part of 

the work force, one of the most serious 

threats was pneumonia, sometimes complicated by tuberculosis. Physical examinations excl uded many unh ealthy men 

from th e work force, and all new hires were 

vaccinated against smallpox when they 

were put on the rolls. Ma ny were from the 

West Indies and immune LO yellow fever, 

and since they often lived with their families outside the Canal Zone, they were 

found in its network of hospitals much less 

frequently than whites. The blacks were 

badly housed , and most had no resistance 

to pneumonia . Their death rate was initially two to three times that of white laborers. Wet for the eight months of the 

rainy season, too poor to own a change of 

clothing, crowded into cabins that were 

chill and damp, they were very vulnerabl e 

to respiratory ills, which spread rapidly 

among them, reportedly killing more than 

all other causes combined. Believing that 

crowding contributed to the problem, 

Gorgas had dwellings, each well separated 

from the others, built for the workers and 

their families. The incidence of pneumoni a dropped markedly thereafter" 

Colonel Gorgas made a strenuous effort 

to avoid having infecti ous ills imported to 

the Canal Zone from the outside. He had a 

quarantine established at Porto Bello in an 

attempt to keep the local Indians from introducing disease when they entered the 

city to sell coco nuts. The Public Health and 

Marine Hospital Service, which had been 

inspecting ships bound from Panama to the 

United States since 1893, set up a quarantine to protect the isthmus from imported 

disease. Ships arriving with yellow fever 

victims on board were fumigated and all 

nonimmune passengers isolated at a quarantine station for six days. The vessel and 

those on board who could prove their immunity to yellow fever were released from 

quarantine when the fumigati on process 

had been completed. Quarantine offi cers 

also kept a partiCUlarly sharp watch for 

signs of plague, endemi c in some areas of 

South America, after a worker on a wharf 

at La Boca died of th is disease. A campaign 

against rats and the fumigation of ships and 

quarters in the wharf area prevented the 

appea rance of any more cases. The quarantine stations established and run by the 

Public Health and Marine Hospital Service 

at either end of the canal were equipped 

with fumigating equipment, and hospital 

facilities were divided so as to be able to 

isolate patients with several different contagious diseases, one from the other." 

Gorgas did not deny the need fo r greatly 

improved sanitation in the Canal Zone, and 

the cleanup of local communities was not 

long delayed once the yellow fever threat 

had been removed. The treaty with the Panamanian government obligated u.s. authorities to install sewage and water systems 

in the Zone. Both were du ly established in 

Panama City and in Colon, where cisterns 

had been collecting water that drained from 

roofs swa rming with "vulLllres [that) cover 

the roofs with fecal matter. " Eventually 

smaller communities, where even "the most 

rudimentary ideas of clean liness [were) unknown," acquired sewers and water systems, to which increasing numbers of 

homes were hooked up. The elimination of 

cisterns and standing water containers was 

then possible, further reducing the number 

of places where mosquitoes could breed. 

Gorgas had homes whose occupants were 
STREET IN COLON, PANAMA, before alld after pavillg 
PUBLIC HEALTl-1 IN OTHER CARIBBEAN AREAS 275 

suffering from dysentery, pneumonia, or typhoid disinfected. To reduce the typhoid 

threat, he had latrines made "fl y proof," 

foods screened in mess tents, and ditches 

and drains disinfected. Other measures included paving streets in Colon and Panama 

Cit)' and the start of garbage collection; in 

Panama City in 1907 this responsibility was 

turned over to the Panamanian government. Where no sewers existed, night soil 

by the bucket was also collected daily. Overnowing privies were cleaned up or closed 

down , and public fac ilities opened where 

needed. As sewer connections were completed, the size of the starr devoted to 

garbage collection and similar duties began 

to diminish , and Gorgas' empire began to 

shrink." 

The Hospital System 

In time, Colonel Gorgas' success in reducing the incidence of disease also reduced 

the need for hospital beds in the Canal 

Zo ne. In selling up the hospital system in 

Panama, he had originally estimated that 

the sick rate might run 50 per 1,00001' more 

at anyone time-about half that of u.s. soldiers in the Spanish-American War. Thus 

he initially concluded that he would need a 

minimum of 2,500 beds and possibly considerably more. Starting with three and expanding the network as construction of the 

canal progressed, he established in each 

sanitary district one or more 20- to 100-bed 

hospitals, sometimes referred to as "sick 

camps."" Many such faciliti es held dispensaries for outpatients, and at least one 

in each sanitaIY district could handle emergency surgery. Patients whose condition 

made moving unwise could also receive 

care in these small facilities. Since each district physician was responsible for the 

hea lth of all who lived in his district, 

whether or not they worked on the canal, 

he knew about prevailing diseases and 

could act promptly at the nrstsign of an impending epidemic. Gorgas also had "rest 

camps," or hospitals with 5 to 15 beds, set 

up in each worker village, where those with 

minor ills could rest for a day or two unti l 

able to return to work. Regardl ess of the size 

of the faCility they served, all physicians had 

to be medical school graduates and eventually were also required to pass a civil service examination. Because they were paid a 

salary, they received no fee [rom the sick, 

and the medicines they dispensed were also 

free o[ charge to workers who could not pay 

for them. 56 

Colonel Gorgas preferred to have patients treated, when possible, at the Ancon 

and Colon facilities, which he was determined LO make "first-class in ever), respecl. " In June 1905 he had a hospital car 

put into daily service on the railroad that 

ran from one end of the Canal Zone to the 

other, retrieving patients to be depOSited at 

one of these hospitals. He brought in more 

than 100 of what he regarded as the best 

young physicians from the United States to 

care for the sick and injured and, by using 

the buildings that had housed French fa -

cilities, could devote most of his hospital 

budget to bedding and suppli es. The largest 

hospital, the 700-bed Ancon facility, 

ach ieved a nne reputation once yellow 

fever had been routed from its premises, 

nush toilets had been install ed, and connecti ons had been made to the new sewer 

system of Panama City. Its staff numbered 

more than 400 and increased in size even 

when Gorgas' Deparunent of Health was 

otherwise growing smaller. Because pri vate 

pati ents used this hospital instead of going 

to the Un ited States or Europe, it became a 

pront-making organization; Gorgas esti-
276 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

TH EODORE C. L YSTER 

mated private patients produced $50,000 

in revenues for every $30,000 the hospital 

spent for their care. Nonemp loyees paid $2 

a day to stay at Ancon , with extra charges 

being made for private rooms and private 

nurses. The charge the hospital made for 

famili es of employees (employees themselves received free care) varied according 

to income, from $1 a day for the famili es of 

employees earning $50 or more a month to 

30 cents a day for those with an income of 

less th an $50 a month . Most of the insane 

of Panama, who had previously been jailed , 

were now sheltered at Ancon for 75 ce nts 

a day. The sums collected from pri vate patients did not go to help fin ance Gorgas' 

work , but were rather fed into the general 

funds of the Canal Zo ne government. " 

Colon el Gorgas co uld take pride in the 

staff at Ancon , among whom was Maj. 

Theodore C. Lyster, Marie Gorgas' nephew. 

Lyster set up an eye, ear, nose, and throat 

department, whose fine reputation drew 

patients in from a great distance. The hospital laboratory was well enough equipped 

to enable hospital physiCians to conduct 

original research. After discovering that the 

French Sisters of Charity "did not possess 

the tec hnical knowledge necessary fo r this 

work," Gorgas replaced them with American nurses. Thecareat Ancon wasso highly 

regarded that, in spite of th e drop in th e 

number of workers in th e Canal Zo ne and 

in the incidence of disease among them, by 

1909 th e hospital was required to expand, 

adding two new bUildings and 150 beds to 

its capacity. By the end of 1907, when Gorgas' campaign against mosqui toes was beginning to show results, the need for hospital beds was already lower th an had been 

originally antiCipated , and by 31 December 

fewe r than 1,200 remained in the instillltions serving the Canal Zo ne. 58 

A Worthy RivallY 

As a reward for his successes, Colonel 

Gorgas also nnally became a member of a 

new commission, consisting entirely of 

military offi cers, that "vas appointed in 

1907. Ironi cally, by this point the Canal 

Commission's power was rapid ly disappea ring as the determined Col. George W. 

Goe thals, the new chairman, co nsolidated 

his authority over the co nstructi on of the 

canal ancl all thal pertainecilO it- 59 

The ri valry between Colonel Gorgas and 

Colonel Goethals was intense almost from 

the outset. Even th ough Goethals had no 

quarre l with Gorgas over th e need to eliminaLe mosquitoes, he \vollid not grant Gorgas full credit for eli minating yell ow feve r 

in both Havana and the Canal Zone and fo r 

redUCing the incidence of malaria. Goetha ls 

insisted that Go rgas had merely been fo l-
PUBLIC HEALTH IN OTHER CARIBBEAN AREAS 277 

lowing a program that had been wo rked out 

in full by Walter Reed, who had made specific suggestions about the use of screens, 

fumigating houses, and similar matters in 

1901 , and, before Reed, by the English mili tary surgeon Ronald Ross, who proved that 

mosquitoes spread malaria. Aristides Agramonte, one of Reed's colleagues on the Yellow Fever Board , quickly pointed out that 

th e board had never been concerned with 

th e practical application of the results of its 

resea rch and that Go rgas had personally devised the methods that he had used to defeat mosquito-borne disease in both Havana and the Canal Zone. Indeed, before 

his death in 1902 Majo r Reed himself had 

recommended the procedures that Gorgas 

had developed. Apparently unmoved, 

Goethals further irritated Gorgas by removing from the surgeon's authority the responsibility for such anti-mosquito activities as grass cutting and ditch digging, 

placing them under the Quartermaster's 

Department, though subject to Gorgas' instructions. This logica l move reduced the 

number of men in Gorgas' organiza tion asSigned to "Zone Sanitation" and thus appeared threatening to him. Neither the 

pra ise Gorgas was receiving nor his electi on as president of the Ameri can Medica l 

Associa tion in 1908 seemed to impress 

Goetha ls, who co ntinued until Go rgas left 

the Canal Zone in 1913 to belittle the chi ef 

sanitary offi cer and his department. 60 

Despite his adversarial relationship with 

Goethals, Colonel Gorgas never developed 

the si ngle-mi nded intensity of the dedicated 

feuder. Obviously awa re of the humor in the 

si tuation, Gorgas reported to his family just 

when his rival was at th e peak of his power, 

that "Goethals & I are getting along most 

lovingly. We seldom meet but write daily. 

And are just as polite as two dancing masters. " Woodrow Wilson's election as president in 1912 brought a delightful change in 

Goethals' attitude, Gorgas concl uded in 

September 1913. He reported: "Everything 

is running along here smoothly. Goethals is 

as mild as a lamb. He does not feel quite as 

certai n of this good Democratic administration as he did of the fanner. " In October 

Goethals asked Gorgas to tell Mrs. Gorgas 

"that he would gladly do anything he could 

for her and that she had no better friend 

than he was." He even unexpectedly and 

"warmly" approved several requests that 

Gorgas made, including one that he be permitted "to go to South Afri ca for a sanitary 

inspection" in November 1913, all of which 

led Gorgas to conclude that "the old villai n 

is up to something." 61 

Colonel Gorgas' appo intment as surgeon general on 16 January 1914 brought 

an end to his confrontations with Goethals 

in Panama. In the springofl914, when the 

death rate was less than half that in the 

Un ited States, the Isthmian Canal Commission was abol ished, and Goethals was 

appointed governor of the Cana l Zo ne6 ' 

The wo rk of medical offi cers in both 

Puerto Rico and the Panama Canal Zo ne in 

the years immediately following the Spanish-American War had signifi cance well beyond those two small portions of the globe. 

Captain Ashford's work in redUCing the toll 

taken by hookworm disease in Puerto Rico 

ultimately led to successful campa igns 

against that disease in many other parts of 

the world. Gorgas' achi evements as chi ef 

sanitary officer in the Panama Canal Zone 

went beyond his cl ai ms of saving more than 

70,000 li ves, of preserving th e hea lth of 

three times that number, and of savi ng th e 

Canal Commission a total of $80 million, 

half in hospital ization costs alone. Gorgas 

had proved to his 0\\,11 salisfacLi on that 

those of European ex traction could live and 
278 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

thri ve in the tropics. In doing so, he li kened 

himse lr to Columbus beca use he had 

thrown "jusL as large an area or the earth's 

surrace open to man's settlement" as had 

Lhat explorer when he discovered Ameri ca. 

This part or the wo rld no longer need be a 

green hell. In the rULu re, all who knew the 

land that Gorgas regarded as "my Panama" 

could remember iL as he did, "a beauLirul 

mounlainous country . .. , the hills covered 

WiLh deep green verdure &: the valleys fill ed 

with cl ear &: sparkling SLreams. " 63 
NOTES 

1. Although the name of the island was spelled 

Pono Rico in CO il temporary documents, the mod· 

ern spclling hns been used throughol1tthis volume. 

2. War Dcparl1l1cnt, IAllllllal/ Ueport of lll e Sill'· 

geoll Geltcml, U.S. Army, 10 lite SccrCf(lt)' of W(lI', 

1898, p. 147, and 1899, Pl'. 174, 178-79, 181, 

184-85 (hereafter ci ted as \¥D, ARoJSG, date); idem, 

(Altltlla l/ Reporl of fil e SCC I'C/(It)' oj \.v(II', L899, 

1(1'1.3):320- 2 1; Lt r,John R. Brooke to Alger, 18 OCt 

1898, nle 155700, Record Group (RG) 94, NaLional 

Archives and Records Administration (NARA), 

\·Vashington, D.C. 

3. First quotation from William F. Smith, "San i· 

talion in Puerlo Ri co," p. 171;second and third quo· 

tations from United States, Congress, Senate, RCjJon 

oJfhe (Dodge) COllltllissioll To /I, vcsligale lit e Co/lducf 

OJfltc War Dep(U'fmetll ill tile W(H' Willi Spa;II , 1:628 

(hereaher ci ted as Dodge Com mi ssion Reporl); fourth 

quotat ion from WD, A/~oJSG , 1898, p. 146 (see also 

1899, p . .l88); fifth quotation from Walter \V. King, 

"Report otl the High Mort al it}' on the Island of Porto 

Rico." p. 2723. 

4. Ltrs, john R. I3rooke to AG, 8 Sep 1898, nle 

128803, and Rush S. I-I uidekoper to AG, 70ct1898, 

nl e 221633 , RG 94, NA RA . 

5. DodgeCottlmissiOtl Repol'l, 1:628; ,"VD,ARoJSC, 

1898, 1'1'. 146, 152-53, and 1899, 1'1'. 188, 191. 

6. Ames was initially a contract surgeon and was 

"appointed brigade surgeon ... whi le lhe work lof 

vaccimHionl was in progress. " See \VD, ARojSG, 

1899, PI'. 19 1- 92. 

7. Azel Ames, "The Vacci nation of Pono Rico," 

PI'. 30 1 (first quolntion), 302, 305-07, 310; WO. 

ARa/SG, 1899, pp. 173 , 177 (remaining quotations); 

Charl es H. Alden, "Pono Rico," p. 19. 

8. Alden, "Porto Rico," 1'.19 (quotation); Ames, 

"Vaccination," pp. 300- 301, 313; ,"VD, ARoJSC, 

1.899, p. 176. 

9. Ames, "The VaccimHion," PI'. 301-02, 305 

(first quotation), 306-07, 3 \0; WO, ARojSG, 1899, 

1'1'.191,246. 

10. Alden, "Pon o Rico," p. 2 1 (quotation); \V D, 

ARojSG, 1899, PI'. 19 1- 92, 246-48; Ames, "Vaccination," pp. 302-04, 306-07, 3.l0, 3 J3 ;john van R. 

Hoff, Mililw)' GovenulJelll oj Pono Rico From Octoher 18, 1898, fOApril30, 1900, 1'. 131. 

11. The Department of Puerto Rico was dividcd 

into the Dislrict of San j uan and the District of 

Ponce. See WO, ARojSG, 1899 , p. 177 . 

12. Ibid. , p. 189; Alden, "POrLO Ri co," p. 22;John 

" <In R. Hoff, "The Sharc of the 'White Man's Burden' 

Thm Has Fallen to the Medical Departments of thc 

Public Se rvices of Porto Rico," p. 798; idem, Mi/iWI)' COI'CnlttICl1f , p. 134. 

13. Alden, "Pono Rico," p. 20 (first quotation); 

Ba il ey K. Ashford and Pedro Guti errez Igaravidez, 

Ullcitwriasis (Hoolllllorm Discase) ill PorIa Rico, p. 

23 (second quotation); Bailey K. Ashford and WaIter W. King, "A Study of Uncinariasis in Pono Rico," 

p. 391; "Uncinariasis: An Economic Question for 

Porto Rico," p. 422 (third quotation); Edgar Ersk· 

ine Hume, ViClories oj Arm)' l'vleclicille, p. 158; Die· 

liollCII), oj AIIUTiwtJ Biogmplly, supp. 1, S .\'. "Ash· 

ford, Ba il cy Kclly"; Martha L Stern be rg, Gcorge 

MilicI' SlcrniJclg, p. 212; William G. Morgan, "Con· 

tri butions of the Medical Department of thc Un itcd 

States Army to thcAdvanccmen t of Knowledge," pp. 

784-85; Rpl , j ohn van R. Hoff, FY ending 30 Junc 

1900, Ms 4890, Entr)' 52, RG 112, NA RA; Stanhope 

Bayne-Jones, Tlte Evo/uli ol1 oj Pl'cvcllli vc Mcc/iciIlC, p. 

l36; j. Hamilton SlOne, "Remarks Suggested by 

Th ree Yea rs' Service in Cuba," p. 330; Charl es W. 

Stiles, Reporl UpOtt fil c Preva/cll cc (1/1(/ Geographic 

DislribufiOlI oj Hoo/twoml Diseasc (Uncinariasis or 

Altcil),/oslOlI1i(tsis) ill tltc United SWles, Hygien ic L'1boralory l3ulletin no. 10 (Washington, D.C.: Gov· 

ernment Printing Office, 1903), p. 33. 

14. Ki ng, "Report," pp. 2724, 2726 (quOIalion); 

Ga ines M. Foster, Tile DClllwuis oj HUIIUlIIil)" pp. 

48-49; Ashford and King, "Sludy, " p. 391; "Unci· 

nariasis," p. 422; "Editors Table," p. 28J; Alden , 

"Porto Rico," p. 22; Hoff, "Share," p. 796; idem, Mili/(IIY Covcnrmenl, p. L40. 

l5. Quotalions from Ba iley K. Ashford, A Soldier 

ill Scieltce, Pl'. 3, 45. Ashfo rd ma intained thal vague 

memories of having encollillered an article on "pork 

measles" led him to consider lhe possibility of an 

intcsti na l pa rasite (ibid. , pp. 42-43). john ElLling, 

howcver, suggests lhal the art icle recall ed by Ashford was probably on tri chinosis (idem, Tllc Germ 

of Laziness, pp. 29-30). See also Ashford and King, 

"Study," p. 392. 
280 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

16. Bailey K. Ashford , "Where Treatment of All 

Infected Is the Surest Prophylac tic Measure," p. 42 

(quo tation); Ashfordand King, "Study, " p. 391; \-VD, 

ARojSG, 1903, p. 49, and 1906, p. L3 J: Rpt , B. H. 

Dutcher, 13 Oct 1915, Ms 5367, En try 52, RG 11 2, 

NARA; Ashford and Glll ierrez, UIICill(ll"iasis, pp. 8, 

11 , 16-17, 25, 27-28, 40-43 , 109- 10. 

17. WD,ARojSG , 1900, p. 274, 1905, 1'.159, and 

1913, pp. 177-78; Ltrs, Bai ley K. Ashford LO Gorgas, 15 Nov 1903 and 13 Mar 1906, Will iam C. Gorgas Papers, Manuscript Division, library of Congress (LC), \·Vashinglo n, D.C.; Ashford and 

Gutierrez, Uncillt1 riasis, p. 28; Ltrs, Ashford to Alben K. Smiley, 26 Sep 1905 and 12 Oct 1908, and 

to Henry Haskins, 6 May 1913, Alben K. Smil ey Papers, Quaker Coll ec tion, Haverford Coll ege (He), 

Haverfo rd, Pa.; Ra lph C. Willi ams, Tile Unilcd Stoles 

Pllblic Heald] Service, 1798- 1950, PI'. 261- 62. In RG 

112, NARA,see Ln, W. A. j ones lo jefferson R. Kean , 

31 May 1910, Entry 231, and Rpt , B. H. Dutcher, 13 

Oct 1915 , Ms 5367, Ent ry 52. See also in Ba il ey K. 

Ashford Papers, Entr}' 56 1, RG 94, NARA: Indi vidual Svc Rpts, 1 jul 1903 and 29 Sep 1906; LL rs, 

William P. Craighi ll to SG, 14 Ma r 1904, and Ashford to Merritle 'Vv. Ireland , 12 Mar 1906. 

18. Bailey K. Ashford, "Notes on Medica l Progress 

in Porto Rico," p. 727; idem, "'Whe re Treatment of 

All Infected, " p. 47 (quotation); Ashfo rd and Gutie rrez, Uncinariasis, pp. 1-2, 230; WD , ARofSG, 1906, 

p. 131, and 1908, p. 127; Individual Svc Rpt , 29 Sep 

1906, Ashford Papers, Entry 561, RG 94, NARA; Rpt, 

Dir, Anemia Dispensary Svc, p. 329, and SUllllllal)' of 

Anemia 'VVork, Ent]")' 23 1, RG 11 2, NAHA 

19. WD ,ARojSG, 1914, 1'.129: Ashfo rd, Soldier ill 

Sciellcc, p. 131; lIr, Ashford to Henry Haskins, 3 Sep 

19 11 , Smiley Papers, HC; Ltr, O. 'Vv. Underwood to 

Ashford, 25 j ul 1911, Gorgas Papers, LC. In Ashfo rd 

Papers, Em!'}' 561 , RG Ll2, NARA, see Telg, Geo rge 

R. Cohon to SW, 11 Mar 19 11; Memo, C. R. Edwards 

to AG, 13 Mar 1911; Memo, Arth ur Murray to AG , 7 

ju1191 1; Memo, Ge neral Staff to Capt Graves, 17 Mar 

1911; and lIr, AG to CG, Eastern Dept , 15 Sep 19 15. 

See also in Entry 231 , RG 1.1 2, NA RA: Ltrs, Ashford 

lojefferson R. Kean, 29 Mar 19 11 and 7 Feb 19 12, 

and W lippitllO Kea n, 5 Feb 1912. 

20 . Quotation from Di cliollw)' oj Alllerica/l o;ogmpil)', Supp. 1, s.v. "As hford, Bailey Kell)'''; Baynejones, Prevcntivc J"'ec/icil1c, p. 136; Ashfo rd and 

Guti errez , Uncilwriasis, p. 26; lIrs, j. F Siler to SG, 

7 and 26 Dec 1908, Ms 5345, Entr)' 52, RG 112, 

NA RA: WD , IIRojSG, 1904, p. 89, 1909, p. 1. 23, and 

L91O, pp. 122-23; Sternberg, Slembclg, p. 212; As hrord , "Notes o n Medical Prog ress," p. 727; \I>.'ilso n 

G. Smillie, Prevfll/ive lvtec/ icillc clIld Publi c Hc(!/fh , p. 

167; \<\TestOn P. Chamberl ai n, "Is the Poor Physical 

Development of Southern Rec ruits d ue LO Uncinariasis? ," pp.49-50; Ma rie D. Gorgas and Bunon j. 

Hendrick, WilIi(lm Crawjord GO/g(IS , p. 296; Victor 

C. Va ughan, Epidemiology mui PlIblic l-Ie(llril , 2:508, 

513; Stiles, Reporf, p. 33. For a disclIssio n of the Ashfo r(VStil es ri va h")', see Ellling, Germ oj Laziness, pp. 

29-32, 124, 127. 

21. Baile)' K. Ashford , "Studies in Mo niliasis of 

the Digestive Tract in Porto Rico," pp. 681 (quotation), 690. 

22. Alden, "Porto Rico," p. 20; \-VO, ARojSG, 

1904, p. 92, 1912, p. 103, and 1913, PI'. 177-78: 

Foster, De/ll(//u/s oj Hlllllanil)" p. 5 1; Richard H. 

Creel, Oillbreall (illd Suppressiol] oj Plagll e in Pono 

Ri co , pp. 3, 9. 

23. ltr, john .... V. Ross to Ed., The Indepcll(/ent, 23 

jul 1904 (first quolation), box 3-13, john VI/. Ross 

Papers, Tennessee Stale library and Archives (TSLA), 

Nashvi lle, Tenn.; 1-1. Goldthwaite. "Matters of Sanitary Interest on the Isthmus," p. 56 (seco nd quolalio n); "Ye llow Fever and the Panama Canal," p. 580; 

Miles P. DuVal , Jr. , And tile Mountains 'Viii Move. p. 

126; Hume, Vi ctories, p. 97; Richard F Nyro p, ed. , 

Pm/wlla , pp. 3, 22; Hugh G. Mill er, The/sl/llllian Highwa)" pp. 26-27; Richard L. SUllon, "The Diseases of 

the Isthmian Canal Zone," p. 43; P. Desfosses, "Canal 

cle Panama et fi evre jaune," PI'. 731- 32. 732n. 

24. I3ayne-J ones, Preventive Medicille, p. 139; 

Slernberg, Ste nliJerg , PI'. 266-67; Gorgas and Hendrick, CO/gas, pp. 140 (second quotat ion), 146- 47; 

Wi lli am C. Gorgas, Salli/aliol] il] Palll/JJ]a, pp. 

138-42, 149; David McCulloug h, Tile P(!{il Belweell 

Ihe Se(!s, pp. 159, 415; Hermann Hagedorn , LCOlwrd 

Wood, 1:104. In Gorgas Family Pape rs, V·/' S. Hoole 

Special Collections library, Uni ve rsity or Alabama 

(UA), Tusca loosa, Ala. , see Ltrs, Gorgas to Dick 

[bro ther]' 9 jan 1903 , and lO mOlher, 7 Mar 1903 

(copy). In Gorgas Papers, LC, see Resol ution , Assoc 

Mil Surgs, 20 May 1903; Ltrs, Gorgas \.0 Va lery 

Havard , 14 Ap r 1902 (first quo tati o n), to SG and 

AG, both 28jun .1 902 , to Harry F I-lodges, 14 j ul 

1902, 10 Harper & Bros., 17 jul1902, a nd to Philippe 

Bunau Varilla, 19 Aug 1902; and Ur, Charles A. l. 

Reed to Theodore Roosevelt, 24 Feb 1904. 

25 . Gorgas was promoted from major to colonel 

by an act of Cong ress. As Gorgas put it , "Il is the 

firsllime an Army Medical Officer has been d irectly 

recogni zed by Congress. It places me in a rank that 

would have taken me aboul fift een years 10 reach in 

lhe ordinary course of promotio n." See Ltr, Gorgas 

to mother, 7 Mar 1903, Gorgas Famil y Papers, UA. 
PUBLI C HEALTH IN OTHER CARIBBEAN AREAS 281 

26. According to the inve ntory for the Ross Papers, TSLA, Ross received the rank of medi cal direc tor in 1903 b)' a "special a CI of Congress" (p. 3), 

and in .1904 he signed himself in Ihm fashion. Ross 

is also inexplicably refe rred lO as "Major Ross" fo r 

a time period when he waS se rvi ng in Cuba but apparently was still in the Navy (pp. 2, 5), See also lIr, 

Ross to Eel. , The lllciepeluiclIl , 23 Ju11904, box 3-13. 

27. McCullough, Palll , p. 407 ; John W. Ross, 

"Outline of the Organi zat ion of the Department of 

Health orthe Isthmi an Canal Comm ission, Isthmus 

of Panama," p. 419; Gorgas, Scmi/aLioll , pp. 142-43; 

Congressional Research Service, Library of Congress, BacitgroUllci DOCIIIIICllts Rdati llg to Lh e p(//UI/IW 

Cmwl . .. (\Vas hington, D.C.: Government Priming 

O frice, 1977), p. 504; in Gorgas Pape rs, LC: Resolution, Assoc Mil Surgs, 20 May 1903, and lIr, C. 

Reed to T. Rooscveh , 24 Feb 1904, and Memo for 

Col Gorgas' Efricienc)' Rpt, L8 j u1 1904. 

28. Quotation rrom Memo, SG to SW, 24 Feb 

1904, 'vVilliam C. Gorgas Pape rs, EllIry 561, RG 94, 

NA RA. In 10c. cit., see SO 125, 27 May 1904, a nd 

Ltr, j ohn C. 'vValker to SW, 16 May 1904. See a lso 

Ross, "Outline," pp. 418-19; H. 'vv. Austin , "Retrospec t or Co-Operati ve Work or the Medical Se rvices 

of the Government," p. 455; WD, ARoJSG, 1903, Pl'. 

48-49; Gorgas, Scmi/(ltion, pp. 142-43, 146-47, 

152-53, 156-57; Gorgas and Hendri ck, Gorgas, pp. 

150, 16 1-65, 188; DuVal, Alld /.lI e !\I/OIlII/(liIlS Will 

AIJove, p. 3 11; McCullough, Palll , PI'. 421-22; Draft 

Al'licie, Oc t 1908, Gorgas Papers, LC; lIr, Gorgas 10 

Dick, 9 jan 1903, Gorgas Famil)' Papers, UA. 

29. WD, ARojSG, 1903, PI'. 48-49, and 1908, p. 

127 (quotation); Rpt, "Organization of the Depal'lm CIll or I-Iealth ror the Isth mus of Panama," p. I, box 

5-8, Ross Papers, TSLA; "News of the Se rvice," p. 

141; Ross, "Outline," pp. 418-19, 4 26; lIr, Gorgas 

to [Kia?\, 15 Aug 1904, Gorgas Fmnily Papers, UA; 

Weston Chamberla in, TIVCltfy-Jive Years oj Allleri ccIII 

Mediced Activify ill PWUI/I/(/, 1904-1929, p. 65. 

30. The organi za tion headed by Colonel Gorgas 

is variously referred to as the Department of Hea lth , 

the Depa rtment of Sani tation, and the Sanitary Depa rtment. An examination of the lett erheads of Gorgas' letters in the Gorgas Family Papers at the Unive rSity of Alabama suggests tha t the te rlll 

Depanlllent oj I-Ieah/l W.1S used in the ea rl y period 

and that it was replaced by Departll1enf oJSallitcuiol/ 

sometime afler 1906. The term Scmitlll)' Depart",e"t 

is used in tvlarie Gorgas' biography of her husband . 

3 1. Rpt, "Organizat ion of the Department of 

Health ," pp. 2,9-10, box 5-8, and llr, j ohn W. Ross 

to Edward R. Marsha ll , 21 Oct 1904, box 3-13, Ross 

Papers, TSLA; Ross, "O utline," pp. 419-20, 423-24; 

William C. Gorgas, "San it ar}' Conditions as Encoun tered in Cuba and Panama and What Is Being 

Done To Render the Canal Zone Healthy," p. 163; 

Charles A. L. Reed, " Isthmian San itation," pp. 8 15, 

8 18; Chambe rl ain , TWC/ll)'-Jivc Yelll's, p. 66; McCullough, Pcuh , Pl'. 4 16,419. 

32. Gorgas, S(lIIiulliOJI , p. 148 (quotations); 

DuVal, A"d the MaUl/willS Will Move, p. 150; Ltr, 

Gorgas to Vale ry Havard , 7 Feb 1908, Gorgas Papers, LC; Gorgas and Hendrick, GOI:gas, pp. 150-52, 

162, 1. 64-65. 

33. Gorgas and Hendrick, Gorgas, PI'. L66-67; 

Draft Article, Oct L908, Gorgas Papers, LC. 

34. Miller, lstlulljeUl Highway , pp. 23-24; Gold thwaite, "Matters of SanitaJ,), Interest," pp. 59-60; 

Roland G. Cunin, "Medical Conditions of the Isthll1 uso[Panama, With Other Notes," p. 345; William 

C. Gorgas, "Mosqui to 'Nork in Relation to Yel low 

Fever on the Isthmus of Panama ," pp. 322- 24. 

35. First quotation from Ln , Gorgas to mother, 

3 Apr 1905 , Gorgas Family Pape rs, UA; remaining 

quola tions from Reed , "Isthmian San itation," PI'. 

812-13; ibid ., PI'. 814, 8 17; Gorgas and Hendrick , 

Gorg(ls, pp. 190-92;jefferson R. Kean, "Editoria l," 

p.368. 

36. Reed , "Isthmian Sanitation," pp. 8 12-13 

(quotations), 8 14-18; Gorgas and Hend rick, Gorgas, pp. 162- 63 , 189-92, 194-97; Gorgas, SallifllIiOll , pp. 152-53; Llr, S'vV to Roosevelt, 17 Mal' 1905, 

Elllr)' 231, RG 11 2, NA RA; DuVal, Allclllte MOIIII-

/ajlls Will Move, pp. 151, 190. 

37. First quotation from Ltr, Gorgas to mother, 

3 Apr 1905, and remaining quota tions from Ltr, Go ~ 

gas 10 Dick (brother], 16 j an 1905 , Gorgas Family 

Papers, UA. In loc. cit., see also Ltrs, Gorgas to 

(Kia?], 15 Aug 1904; Richi e to j essie, 18 Aug 1920; 

and Aileen Gorgas \0 Marie Gorgas, 25 j an 1905. 

38. First two quotations frolll j ohn G. Leigh, 

"Sanitation and the Panama Canal," p. 1531; following three quotations from Ltr, Gorgas to Dick, 16 

jan 1905, and sixth quotation frolll Ltr, Gorgas to 

mother, 3 Apr 1905. Gorgas Family Papers, UA; final 

quotation from WD, ARoJSC, 1908, p. 127. See also 

ibid., 1905, p. 148; McCullough, P(l/iI, PI'. 449-50. 

39. DuVa l, Allc/ til e MOIIIIl(lins Will Move , pp. 

176-77, 179-80; Gorgas, StIIlilllUOII, p. 154. 

40. Ltrs, W. W. Keen to Gorgas, 12 Oct 1904, 2 

Feb 1905, a nd 6 a nd 17 Mar 1905, Gorgas Papers, 

LC; Ltrs, Gorgas to mOlher. 17 Oct 1905 (quota-

[ions) and 19 j un 1906, Gorgas Famil}' Papers, UA; 

DuVal, And tlte MOUllfaills Will J\-Jove, pp. 164-65; 

Gorgas, Sanitation , PI'. 275-76. 
282 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

41. Gorgas, 5(IIII/(/L;Oll, pp. 136, 142-43, 148, 

154-55, 172- 73, 183, 197-98; Gorgas and Hendri ck, 

GOIgtlS, pp. 196-97, 204; Percy M. Ashburn, The His101 ), oj fhe MediCld DeparllltCII / oj fh e UllilCd Sf(lIeS 

Arm)" p. 266; DuVal,Alld th e MOIIIl/(fins Will l'vlove, pp. 

175 , 190, 240; McCullough, Pm" , PI'. 447-48, 468, 

500; Miller, Isl/lIl1ia/l Highway, pp. 23- 24. 

42. Rpt , "Organization of the Department of 

Health ," p. 19 (quotation), box 5-8, Ross Papers, 

TSLA ; Gorgas and Hendrick, Gorgc/5, pp. 172 , 

175- 76, 180; Gorgas, S(//lilaliOll , pp. 182 , 192- 93, 

195-97; McCullough, Pm" , p. 448. 

43. Gorgas, S(lIIiUltiOIl , pr . 150-51; Gorgas and 

Hendrick, GO/gas, pp. 176- 81. 

44. Goldthwaite, "Matters of Sanitary Interest," 

p. 58 (first quotation); Joseph A. LePrince, A. J. 

Orenstein , and L. O. Howa rd, J'v/osqllilo Control ill 

PWICIIIICI , pp. 18- 19 (second quotation); Gorgas and 

Hendrick, Gorgas, pp. 183- 85; Gorgas, s alljw/iOll , 

pp. 224, 230- 32,236-37; Walter Reed and James 

Carroll, "The Prevention or Ye llow Fever," p. 119; 

Curtin, "Medical Condit ions," p. 346. 

45. Sulton, "The Diseases or the Isthmian Cana l 

Zone," p. 41 (first quotation); Gorgas, Sa/lI/(lI iOlI , p. 

1. 59 (second quotation); McCullough, Pa /l1 , p. 4 19; 

Goldthwa ite, "Ma tters or Sani ta ry Interest," p. 56. 

46. LePrince et al. , Iv/osqllilo Con frol, pp. 17- 18, 

22; Goldthwaite, "Matters or Sanitary Interest," pp. 

56-57; Gorgas, Sanifation , pp. 159- 60; idem, "Sanita ry Conditions," p. 162; Gorgas and Hendri ck, 

Go/gas, pp. 225-32; Miller, ISl/lIl1i(1II Highway, pp. 

25-26; Drah Articl e, Oct 1908, Gorgas Papers, LC; 

Monthly Rpts, Sanitary Dept , May 1907 and f eb 

1908, RG 185, NARA . 

47. William C. Gorgas, "The Sanitary Organization 

of the Isthmian Canal as It Bea rs Upon Anli-Jl1aIClrial 

Work," pp. 263- 64; idem, Salli{(II;OII, pp. 183- 90, 

192- 93, 195 (quotation); Gorgas and Hendrick, Gorgas, PI'. lS0, 230-31; McCullough, Path , p. 44S; Drah 

Article, Oct 1908, Gorgas Papers, LC; Monthly Rpts, 

Sanitary Dept, May 1907, RG 185, NARA. 

48. Gorgas, Sanifa tion, PI'. 160, 166-67,202-05; 

Monthly Rpts, Sanitary Dept , May 1907, RG 185, 

NARA; Drart Art icle, Oct 1.908, Gorgas Papers, LC. 

49. LePrince et al. , IvlOSqllirO Conlrol, p. 94 (first 

quolaLion); Gorgas, Scm ita/iOlI , Pl'. 199-200, 

203-04 (second quota tion), 205; idem, "Sani tar}' 

Organ ization," pp. 263-64; Draft Art icle, OC11908, 

Gorgas Papers, LC. 

50. Gorgas, S(1I1i/(llioll , pp. 156, 205, 275; DuVal , 

And til e MOil/I/ai llS \Viii Move, pp. 199-200; Annual 

Rpts, Sanitary Dept, 1905-1914, esp. J907, 1:6-7, 

RG l S5, NARA; Fullerton L. "'hldo, "Panama," p. 

773; Louis A. LaGClrde, "Rela tion or the Civilian 

Physician to National Prepa redness," p. 238. 

51. Gorgas, s(III I/alioll, pp. 256-57; Ltr, Gorgas 

to Bail ey K. Ashford, 8J un 1905, Gorgas Papers, LC; 

LePrince et aI. , MOS(lllil o COll l rol , pp. 24-25. 

52. McCullough, Pal" , PI'. 405-06, SOl , 577, 

585; Gorgas and Hendrick, GorgllS , pp. 266- 68; 

Michael L Connirr, Blach Lelbor 0 11 a While C(IIwl , 

pp. 3, 27,30; Annual Rpt, Sanitary Dept, 1904, 1:13, 

Clncl Monthly RPIS, Sanitary Dept, 1905-1914, RG 

185, NARA. 

53. Rpl, "Organization of the Department or 

Health ," pp. 16-19, box 5- S, Ross Papers, TSLA; 

Gorgas, saI1 1/alI0I1, PI'. 166--67, 261- 62 (quotation), 

263, 271-73, 276; DUVa l, And Ille Moun tains Will 

Move , pp. 135-36; McCullough, P(l/II , p. 454; Annual Rpt ,Sanitary Dept , 1908, 1:6-7, RG 185, NARA. 

54. Cunin , "Medi cal Conditions," p. 343 (first 

quotation); Gold thwaite, "Matters o f Sanitary Interest," p. 57 (second quotation); Monthly Rp ts, 

Sani tary Dept, 1906- 1914, esp. May 1907 (third 

quotat ion), and Annual RPIS, San itary Dept, 

1907-1909 , RG 185, NA RA; William C. Gorgas, 

"San ilalion on the ISlhmus of Panama," pp. 37-38; 

Chamberl ain, Twenty-Jive Years, p. 13; DuVal, And 

the MOillltains Will Move , p. 247 . 

55. There is some confusion in the records oflhis 

pe riod about the nomenclature used 10 classir}1 the 

va rious hospital faci li ties. The lerm sid camp is frequently lIsed 10 describe many or the sma ll er d istric t units, but in some reports individua l facili ti es 

are called sick camps and in others hospitals. 

56. Gorgas, S(lII i{(l£ ioll , pp. 206--07, 209 (quolalion), 21.0- 11 , 213- 14, 223; Rpt , "Organization oflhe 

Depanmelll of Health," p. 14, box 5--8, Ross PClpers, 

TSLA ; Miller, tsllJlIIl(/II Highway, p. 23; Gorgas and 

Hendrick, GOIg(IS, p. 247; Monthly Rpts, Sanitary 

Dept, 1905- 1914, and An nual Rpts, Sanit<uy Dept, 

1906, 1:26--27, 32-33, 1907, 1:28, 30, and 1908, 

1 :28--29, RG 185, NARA; Ross, "Outline," pp. 42 1- 22. 

57. Gorgas, sall ilaliOIl , pp. 209 (quotation), 

210- 12, 223-24, 229-30, 241-43, 247; DuVal , All" 

the MoulllaillS \Vill Move , p. 179; Rpt, "Organ iza tion 

of the Department or Healt h," p. 7, box 5-8 , Ross 

Papers, TSLA; McCullough, Palh , p. 501 ; Monthly 

Rpts, SanitClr), Dept, 1906- 19 14, esp. May 1907, and 

Annual Rpts, Sani tal'}l Dept, 1. 907, l:77, and 1909, 

1:31, 71 , RG 185, NARA ; Reed , "Islhmian Sani tation," p. S16. 

58. Gorgas and Hendrick, GOIgas, p. 185 (quotat ion); Gorgas, s allitation, pp. 213- J4, 226, 242, 

245; Th e C(1IIa/ Recoltl , L5 Sep 1909, p. 19, Entry 

231, RG 11 2, NARA; J. F. Sil er, "Major-Gene ral 
PUBLI C HEALTH IN OTHER CARIBBEAN AREAS 283 

Willialll Crawford Gorgas," p. 162; Annual Rpt, an ~ 

itar), Dept, 1906, 1:26-27, and MOllIhly RPIS, San· 

itary Dept , 1905-1907 and Feb 1908, plus Rpl , 

Caldwell , Jan 19 12, RG 185, NA RA; Ur, Stephen C. 

Craig to Author,S Apr 1990, HislOrian's file, U.s. 

Arm)1 Cente r o f Milito\l)' HislOry, \VashingLon, D,C. 

59. Draft Biograph>" Gorgas, n.d., Gorgas Papers, 

LC; Llr5, Gorgas to mother, II Oct 19 12, 10 Mamie. 

27 OC11 9 12, <lnd loJ essie, 2Jul 19 13, Gorgas Famil), 

Papers, UA;Gorgas and l-iendrick,COIg(IS , pp. 213-J 4. 

60. Annual Rpls,Sanilmy Dept, 1907, 1:77 (quo-

!alion), and 1909, 1:71, RG 185. NARA ; Gorgas, 

5 (111i/ (II;Oll , p. 155; Gorgas and Hendrick, GO/gas. PI'. 

184, 220-2 1,232-38; DuVal ,And IheMOIIII/(dns Will 

Move, Pl'. 240, 260-61, 270,309- 11,330; McCullough, P(lIh , p. 572; Drart Biograph)" Gorgas, and 

Uf, E. Strive r LO Gorgas, 2 Dec 1904, Gorgas Papers, 

LC; U r, Gorgas to mother, 5Jun1908, Gorgas Famil }' Papers, UA; Reed and Carroll , "Prevention," p. 

123; George vV Goe thals, "The Building or the 

Pa nama Cana l," p. 72 1; Henr), S. Wdlcome, "Observa tions 0 11 the Medical and Sanitary Depanment 

o r the Pa nama Cana l Commission ... ," pp. 3, to. 

6!. Ltrs, Gorgas to Mamie, 27 Oc t 1912 (fi rst 

quotat ion), 20 ScI' 19 13 (second quotation), 16 OCt 

19 13 (third. rouJ'lh, and sixth quotations), and 27 

Aug 1913 (rirth quotation), Gorgas Family Papers, 

UA; Siler, "Gorgas," p. 167; Chamberlain, l ivcllf),-

fi ve )'C{I/'s, pp. 65-66; Roben E. Mit chell ,Jr., "NOles 

on thc Medi ca l Hislory orthc Panama Ca nal ," p. 89. 

62. UIGa rde, "Relat ion ," p. 238; U r, Gorgas to 

Mamie. 1Jan 19 14, Gorgas Fami ly Papers, UA; Sil er, 

"Gorgas," p. 167; Chamberl ain, livcllly-Ji vc )'(;al'5, 

1'1'. 65-66: Mitchell , "Notes," p. 89. 

63. Gorgas, S(lIliwfioll , pp. 280 , 282-83, 

29 1-92 (first quolation); Speech, Gorgas to Ame rican Med Eds., 5 Jun 1907 (remaining quOtations), 

Gorgas Papers, LC; Gorgas and Hendrick, GO lg (IS, 

p. 259; lIr, Gorgas to [Kia?], 15 Aug 1904, Gorgas Family Papers, UA. 

Chapter II 

PUBLIC HEALTH IN THE PHILIPPINES 

When U.s. soldiers arrived in the Philippine Islands in 1898, they encountered another green hell, another hot and humid 

country seething with disease. Malaria-bearing mosquitoes haunted the jungles, and the 

drinking water and fruiLS and vegetablescarried organisms that innicted dysente,y upon 

the careless or unsuspecting. The Spanish 

had been quickly defeated, and the victory 

left "the Philippine Islands, with their teeming millions of inhabitan ts, .. . on our 

hands . .. ," a physician noted in the j ow·-

lIal oj O, e Americall Medical Associatioll. The 

resistance of Filipinos to occupying U.s. 

forces made it necessa,y to keep American 

soldiers in this hostile environment, where 

they were exposed to all the afni ctions from 

which the native population suffered. Thus 

Army surgeons in the Philippines, inspired 

both by what has been termed an effort to 

"bestow the spiritual and material blessings 

of [America'sl exceptional society on the 

new possession" and by a new understanding of disease, took up a sweeping challenge. 

To meet it, they began to study the health 

problems of the country and to use both traditiona l approaches and new methods suggested by their research to lower the incidence of disease. Following the pattern set 

in Cuba , however, those conducting research in the Philippines did not manage the 

public health campaign that attempted to 

put their d iscoveries to practical use.' 

Research and Disease Boards 

Resea rch into the d iseases of the Phi lippines was conducted by members of two 

tropi cal disease boards (see Table), as well 

as by other medi ca l officers in the islands 

wo rking independently of the boards. Except for the period 1902-1906, th e two 

boards served through 1914, with many 

medical offi cers rotating through them. 

Un like the scientists who worked with 

Major Reed, the members of the Philippine 

Tropical Disease Board investigated a wide 

range of diseases and health problems, 

those that posed a significant threa t to the 

civilian population as well as to the military and those of interest principally because or their exo ti c nature. Members 

often worked separately, submitting individual reports. In at least one instance they 

investigated a disease that affected large 

animals rather than human beings. Their 

discoveries were not as spectacular as 

th ose of the Reed board. The va lue of their 

work lay principally in the accumulation 

of information rather than in any single 

discovery. Mostof th eir research took place 

in Ma nil a, where until 1902 laboratory 

space and equipment were available at the 

First Reserve Hospital and later at the 

Ma ni la Board of Hea lth as well. After that 

date, both the Army's ancl the Board of 
286 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

TABLE- PHILIPPI NE TROPICAL DISEASE BOARD M EMBERS 

1899-1900 

ll. Jere B. Clayton 

Lt. Richard E Strong 

ConlraCt Surgeon Joseph J. Curry 

1900-1902 

lieutenan t Strong 

Ll. Williamj. Calvert 

Cont ract Surgeon Curry 

March- December 1906 

Capl. Percy M. Ashburn 

LI. Charles F. Craig 

December 1906-July 1909 

Capt. James M. Phalen 

LI. Henry j. Nichols 

July 1909-January 1910 

Captain Phalen 

Capl. Edwi n D. Kilbourne 

January-March 1910 

Maj. WesLOIl P. Chamberlain 

Captain Phalen 

Captain Kilbourne 

March- December 1910 

Capl. Horace D. Bl oombergh 

Major Chamberlain 

Captain Kilbourne 

December 191O-February 1911 

Capl. Edward B. Vedder 

Caplain/Major Bloombergh 

Major Chamberlain 

Februal,), 1911-January 1912 

LL.!Capl. John R. Barber 

Caplain Vedder 

Major Bloombergh 

January 1912-April1913 

Ll. Ernest R. Gentry 

Captain Vedder 

Maj. Percy M. Ashburn 

April-June 1913 

Major Ashburn 

June-J uly 1913 

Major Ashburn 

Capt. Ferd inand Schmilter 

Jul y 1913-0cLOber 1914 

Captain Schmiuer 

SOl/rcc: Based on Vedder, "Synopsis," in Army A'lediccli Bu l/clill and VvD , ARofSG , 1900. p. 21. The rirst 

board funclioned from ,1899 to 1902 and the second board fro m 1906 10 19 1. 4. Excepl where indicated, all 

members of these boards we re medical orfi cers. 

Heallh's fa cililies were replaced by the Bureau of Government LaboralOries, where 

separale chemical and biological fa cilities 

were eSlablis hed , logether Wilh a serum inslilUle lO hand le the manufaclure of immunizing sentms.2 

Allhough the facililies were adequate, lhe 

heal and humidilY of the lropics imposed a 

considerable handicap on the work of researchers from the Uniled Slales. The menlal concentralion possible in a temperate climate was unattainable in the Philippines, 

andlhe speed with which cadavers deteriorated made it difficult to obtai n unco nlaminated cultures from them because of the 

"rich and varied" nalure of the thriving "bacterial nora" of the area. When rinderpest, or 

cattle plague, became so prevalent in the islands that researchers had to resort lO water 

buffalo for cullUres requiring milk, contaminalion of the cullUre medium also became 

a significant problem.' 

First among the researchers' concerns 

was dysentery, a hislOric enemy of military 

forces whose cause was still a subject of 

controversy. It preCipitated so many diffi-
PUBLIC HEALTH IN THE PHILIPPINES 

culti es for the soldiers fighti ng the Filipino 

guerrillas that two of the first members of 

the Tropical Disease Board, contract surgeo n j oseph j. Curry and Lt. Richard P 

Strong," started investigating it as soon as 

they arrived in the Philippines late in 1899. 

Although, unlike some in the medical profession at the time, both physicians had accepted the fact that dysentery co uld be 

caused by either a bacterium or an amoeba, 

they found the disease puzzling. Curry's research added to the confusion , for it apparently led him to the erroneous conclusion that the organism now known as 

Elltamoeba coli , one of six species of nondisease-causing intestinal amoebas that 

parasitize man, and the amoeba causing 

dysentery (El1tamoeba histolyUca) were essentially identical. Under these circumstances, he could not account for the fact 

that E. coli could be found in healthy men 

as well as in those suffering from dysentery. 

Curry co rrectly co ncluded that E. histoly tica could be present in drinking water and 

developed statistics that suggested the extent of the threat posed by amebic dysentery, which he maintained was responsible 

for 66 percent of the deaths caused by 

dysentery in cases that he had autopsied.' 

In spite o[ Curry's interest, Li eutenant 

Strong was the board member initially assigned responsibility [or the study of 

dysentery, although he resigned on 5 December 1902 to continue his research for 

another eleven years as a civili an working 

for the Philippine government. Assisting 

Strong was a talented hospital steward , 

physician, and pathologist, William E. 

Musgrave, who would soon sign a contract 

with th e Army Medical Department to 

work as a co ntract surgeon. The First Reserve Hospital,6 where Strong and Musgrave wo rked, offered the two scientists a 

rich field in which to conduct their re287 

RICHARD P STRONG 

search, since in the ten months preceding 

th e submission of their 17 june 1900 report to th e surgeon general, more than 

1,300 patients, almost 15 percent of the 

total number, had dysentery. Fewer than 

600 of those who survived the disease were 

able to return to duty, and 125 di ed. Postmortems on III cases established that 79 

deaths resulted from amebic dyse ntery. Although Strong and Musgrave were able to 

isolate bacteria in 19 more postmortems, 

they inexpli cably did not look [or bacteria 

in 56 cases. They noted , however, that th e 

bacillus they found resembl ed that fi rst 

recorded by thejapanese scientist Kiyoshi 

Shiga.' 

Thegreat difficulty experienced by Lieutenant Strong and Musgrave in isolating 

and precisely identifying the organisms 

that caused dysentery is a problem still experienced by scientists more than seventyfi ve years later. Unli ke Curry, Strong con-
288 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

eluded that E. hislOlytiw was not identical 

with E. coli ,s which he described as "apparently harmless." He held in 1910 that 

even though the incidence of bacillary 

dysentery was at that time increasi ng, amebic dysentery was "by far the commonest 

form of the disease met with in the Philippine Islands" and that many other organisms could also be involved, including the 

malaria parasite. Simon Flexner and Lewellys F Barker, leaders of a civilian team of 

scientists who brought their own equipment with them from the Johns Hopkins 

medical school to join the study of diseases 

in the Philippines, also experienced great 

difficulty in determining which of the 

hordes of organisms in the specimens they 

examined actually caused the problem9 

While Li eutenant Strong and Musgrave 

were seeking to gain a greater understa nding of dysentery in Manila, in the 

general hospital at th e Presidio in San 

Francisco, to which many of their patients 

were sent, contract surgeon Charles Craig, 

reassigned after his work at Camp Thomas 

during the typhoid epidemic in 1898, was 

beginning the research concerning this 

disease to whi ch he would devote much of 

the remainder of his distinguished career. 

Craig, who joined the Medical Department 

as a li eutenant in 1903, noted that in four 

cases of dysentery he found large numbers 

of "pear-shaped organisms, possessing a 

nucl eus and from 2 to 8 slender, hair-like 

nagella, which propel the parasites. 

He referred to these protozoa as "Cercomonas inteslinalis," but they are all too 

fam ili ar to modern travelers and backpackers as Giardia lall1blia. Although Craig 

had never seen them in hea lth y patients, 

he was not entirely sure of their ro le in 

dysentery and concluded that "they apparentl y thri ve in a diseased in testi ne and 

probably cause diarrh ea and perhaps ulceration. " He was sure, however, that they 

"aggravated the intestinal co ndition." 

Craig's interest in the snbj ect inspired him 

to years of research and the publication in 

1911 of The Parasiti c AlI10ebae oj Mall. 'o 

In March 1906, when Surgeon General 

O'Reilly succeeded in having the Tropical 

Disease Board reconstituted on a pennanent 

basis with Lieutenant Craig and Capt. Percy 

M. Ashburn as its members, these physicians co ntinued the board's study of dysentery, as did their replacements, Ll. Henry J. 

Nichols and Capt.James M. Phalen. Nichols 

and Phalen decided that they could not with 

confidence distinguish between the two varieties of Al110eba and that therefore all 

amoebas should be considered potentially 

harmful. Lieutenant Strong's conclusions 

concerning the identity and harmlessness 

of the E. coli was later confirmed by work 

undertaken by other scientists working in 

the Philippines, although even ten years 

later the role of this organism was still not 

completely understood. " 

Research into the question of the identi ty of dysentel),-causing organisms in the 

Philippines continued for many years. Initially, work with the bacterial form of dysentery proved more fruitful than that with the 

amebic type. Attempts to infect monkeys 

with amebic dysentery generally failed, but 

the discovery that the medium used in 

studying typhOid also favo red the growth of 

the Shigella organism made bacillary dysentery research much easier. The examination 

of stool specimens in the attempt to detect 

typhOid carriers also revealed the possibility that bacillary dysentel)" too, could be 

spread by healthy carriers." 

Because of the prevalence of dysentery, 

doctors in the islands ga ined ex perience 

with many types of trea tment. Alth ough 

ipecacuanha (i pecac) was to some degree 

successful in the treatment of amebic 
PUBLIC HEALTH IN THE PHILIPPINES 

C HARLES E CRAIG 

dyse ntery when carefully used, the facl 

that it was an emeti c made it diffi cult for 

the patient to retain. Since in the Philippines men with dysentery often had 

malaria as well and since faiciparum 

malaria could cause dysentery-like symptoms, quinine was also widely used. Because even ipecac did not kill all amoebas 

in every part of the body, the medi cal trea tment of dysentery remained frustrating for 

doctor and patient alike. I } 

The li ver abscesses that co uld result 

from amebiasis occupied th e attention of 

medi ca l offi cers in th e various army hospitals scattered throughout the Philippines. Although nine of th e sixtee n cases 

upon which he operated died, Ll. Edwa rd 

W. Pin kham was satisfi ed by th e autopsy 

results th at indi cated death had been inevitable in eight of them. He also co ncluded that none of the cases wo uld have 

survived without surgery and that the true 

289 

PERCY M. A SHBU RN 

reaso n for the oppositi on of physicians 

who were not surgeo ns to surgica l treatment for li ver abscesses was the intrusion 

upon their domain. 14 

Among other insect-borne diseases 

studied by the Tropica l Disease Board in 

th e Philippines was dengue, a problem 

with whi ch medical offi cers in both the 

United States and the Caribbean had become familiar. Also known as breakbone 

fever, dengue, whil e rarely fatal, was both 

painful and debilitating. Brig. Gen. Geo rge 

H. Torney, O'Reill y's successor as surgeon 

general, reponed that it caused a "small 

constant non-effective rate" among troops 

in the island , serving as "an inconvenience" ra ther than "a sanitary danger. " 

When the Tropi cal Disease Boa rd renewed 

its work in 1906, a dengue epidemi c was 

sweeping the garrison of Fort McKi nl ey, 

located on a low damp site near Manila , 

and the study of this disease qUi ckly be-
290 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

came part of the board's responsibiliti es. 

The erratic pattern characteristic of its 

spread at that post qui ckly convinced Captain Ashburn and Lieutenant Craig that 

dengue was mosquito-borne, but much remained to be learn ed." 

To conduct their research in to the 

causes of dengue, Captain Ashburn and 

Lieutenant Craig, like Major Reed, reso rted to human guinea pigs, although, because the disease was as a rule not fata l, 

the risk to the vo lunteers in thei r experiments was no t serious. When all four 

corpsmen who volunteered had contracted the disease from the initi al experimen ts and had thus become immune, Ashburn and Craig tu rned to volunteers from 

the line, encouraging their altru ism with 

$25 gold pi eces and the promise of favorable assignments. Unable to find parasi tes 

in dengue pati ents, the medical o ffi cers resorted to injecting their blood into the vo lunteers. Upon discovering that, whether 

filtered or unfiltered, the blood transmitted the disease, they assumed that dengue, 

like yellow fever, was caused by an "ultramicroscopic" organism. They also co ncluded that the minimum incubation period for dengue was three days and that the 

disease was carri ed by the Culex j{lUgalls 

mosquito. The latter conclusion proved to 

be in error, however, since the pri nci pal 

vector for dengue is Aedes aegypU, the insect that also carries yellow fever. " 

Except for the attempt to discover more 

accurate means of diagnosis, malari a did 

not inspire as inlense a research efrort in 

the Phili ppines as might have been anticipated in view of the fa ct that the disease 

had arni cted so many soldiers through the 

years. In writing the history of the Army 

Medica l Department some years later, Ashbu rn reported that almost 300 sold iers of 

every 1,000 in th e Army in 1902 were suffering from malaria . In fiscal year 1900, 

when Craig was assigned as a co ntract surgeon to the general hospital in the Presid io 

at San Francisco, he noted that the blood 

of 13 percent of the pati ents entering that 

hospital showed evidence of malaria, in 

most cases the tertian form, caused by the 

vivax form of the malaria pa rasi te and 

characterized by a feve r that returns every 

third day. Craig was obviously most interested in learning more about the appearance, behavior, and life cycles of the various malaria parasites and was developing 

improved techniques to use in this effort. 

In the Phili ppines the work of the Tropical Disease Board along these li nes was 

limited to the use of mosquito nelling to 

determine the size of the mesh that would 

exclude the Allopheles. " 

In 1900 the offi cers of the Tropical Disease Board fo und th emselves in vestigating 

plague, ye t another insect-borne disease in 

the Philippines, without being sure that it 

was, indeed, insect-borne. Although the 

orga nism that caused plague had been discovered in 1894 and physicians were aware 

of a co nnection between the disease and 

rodents, the precise means by whi ch it was 

spread would remai n in the realm of conjecture for severa l yea rs longer. Even such 

an authority as zoo logist Charl es Stiles was 

still convi nced as late as 1901 that if rat 

fleas did playa role in the spread of the 

plague, it was not by biting. At th is time, 

with his usual caution, Surgeon General 

Sternberg avoided ac tually taking a stand 

on the subject. IB 

Lieu tenant Strong, Curry, and Lt. 

William]. Ca lvert, who replaced Lt.Jere B. 

Clayton ,19 began studying the dread d isease in the laboratories o f the First Reserve 

Hospital in Man ila in the first months follOWi ng the appearance of plague, moving 

to th e fa cilities of th e Man il a Board of 
PUBLIC HEALTl-1 IN THE PHILIPPINES 

Health as soon as the laboratories there 

were properly equi pped. Curry was particularly intrigued, as the epidemic continued, by the fact that while the death rate 

among Filipi nos was 81 percent, it was 

only 72 percent among the Chinese who, 

because of the impoverished circumstances in which they lived, might have 

been expected to have a higher mortality. 

Lieutenant Calvert, however, credited 

what he call ed "racial immunity" to lifestyle, including clothing and cleanliness, 

but somewhat paradoxically blamed the 

Chinese for the spread of plague, both 

through their perso ns and their merchandise. He noted that "poverty, poor food and 

dwellings, and ignorance" were the breeding grounds for the disease and that ignorance was the most important factor20 

Lieutenant Calvert based these concl usions upon his study of plague both in the 

Manila laborato ry and in Japan a nd Hong 

Kong. In Manila he carried out physica l examinations of plague victims, grew cultures that proved capable of killing laboratory rats in three to fi ve days, and 

co nd ucted autopsies. When he was sent to 

Japan an d Hong Kong to study the way in 

whi ch plague was handled in nations long 

familiar with the disease, he visited a 

serum fa rm near Tokyo, where an anlitoxin was being prepared. This type of 

serum impressed Surgeo n General Ste rn -

berg more than Lieutenant Strong, who 

worked for months without notable success to develop a more effective means of 

immuniza ti on. In 1901 Calvert prepared a 

circular on the subject of pl ague that was 

promptly issued by the surgeo n general. In 

it he covered all aspects of the disease, its 

history, its symptoms, its pathology, the c1illlates where it was Ill ost prevalent, the 

types of people it most often a fni cted, and 

the means by whi ch it was transmitted. Be291 

cause he had observed that it could appear 

where no rats were present, Calven concluded that plague co uld be sp read in two 

ways. The bite of an infected nea tra nsmitted the buboni c form , whil e th e inhalati on of germs present in beddi ng, 

feces, and urine, or coughed up by bubonic 

pl ague victims with pneumonia as a complicati on spread the pneumonic type, 

which was particularly fa taL" 

Unlike bubonic plague, an object of interest and study for centuries and a swift 

and legendary killer, one of the diseases that 

drew the attention of the Tropical Disease 

Board was relatively un known , especially in 

the United States. In the Philippines, however, beriberi, now known to result from th iamine defiCiency, soon became familiar to 

medical officers who were responsibl e for 

the health of Filipino scouts. Heart problems, edema, nerve pain, dirficulties wilh 

gait and vision, weakness, mental deterioration, and paralysis severely reduced the 

effectiveness of sco ut and poli ce units and 

thus limited th e support th ey could provide 

the Army in its struggle with the insurgents. 

Very few American sold iers ever suffered 

from this disease, but in Bilibid prison, 

where many captured guerrillas were held, 

beriberi sickened more than 2,000 prisoners in a six-month period in 1902 and 

caused 77 deaths." 

Although vitamins as such were still u nknown in the ea rly 1900S,23 physicia ns 

knew thar a deficiency of certain elements 

in the d iet co uld seriously underm ine the 

health. Scurvy, however, had been placed 

in the category of a de fi ciency disease long 

before the members of the Tropical Disease 

Board were born, and in Lheir ini tial uncertainty as to the cause of beriberi, Medical Department researc hers could only 

specul ate, as their predecessors had speculated about scurvy, about the effects of ex-
292 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

EDWARD B. VEDDER 

posure to dampness, or to the cold, or to 

wide temperature changes. They also co nsidered the possibility that "germs . . in 

the so il ," polluted wate r, or malaria was at 

the rootofthe problem. In 1901 a medica l 

officer maintained co nfidently that "diet 

had littl e to do with the propaga ti on" of 

beriberi, whi ch he believed was most probably spread by ge rms. Eve n as late as 1911 

some were still not convinced, but diet was 

increasingly regarded as a possibl e factor. 

Many experiments with different di ets establ ished that those who ate unmilled ri ce 

(ri ce from which the hulls had not been removed) did not get this disease. Largely because of the efforts of the Tropical Disease 

Board and in spite of difficulties experienced in persuadin g the scouts to abando n 

their customary diet, beriberi had almost 

entirely disappeared from among the native troops by 1911, when only three cases 

were recorded H 

WESTON P C HAMBERLAIN 

u.s. medical offi cers conducted much 

research in to the possibl e ca uses of 

beriberi, initially using animal subjects. In 

1911 Capt. Edward B. Vedder and Maj. 

Weston P Chamberlain, who became 

members of th e Tropical Disease Board in 

1910, began experimenting wit h the trea tment of infantile beriberi with an ex tract 

of rice polishings. Other physicians had already tried feeding the polishings to nursing moth ers; believing the problem to be 

a poison in the mother's milk, they reqUired that each baby be exclusively bottle-fed until the mother's treatment had 

been compl eted. Vedder and Chamberlain 

cured fifteen infants whose mothers had 

symptoms of beriberi by suppl ementing 

each mother's milk with an extract of rice 

polishings and all owi ng nursing to continue. 1n every case, regardless or the seriousness of the baby's condition, the cure 

was rap id and complete. The experiment 
PUBLlC HEALTH IN THE PHILlPPINES 

demonstrated concl usively that beriberi 

was a deficiency disease rather than the result of a toxi n in th e mother's mille In 1913 

Vedder capped his wo rk in this fi eld with 

the publication of a book on the subj ect" 

A disease famili ar to Filipinos and far 

more familiar to medical offi cers than 

beriberi was cholera, which stluck the 

Philippines in 1902. In the course of their 

research Army surgeons tri ed new approaches to both prevention anel treatment; 

results were disastrous in one instance, 

when a bottle of bubonic plague serum was 

mixed in with bottles of a cholera serum 

destined to be tested as a vaccine on prisonersa t Bilibid prison, and the ten men who 

received the plague serum died. Strong, 

who was working with the cholera serum 

now in a civilian capacity. had been reserved 

in his reaction to the preparation of cholera 

vaccine from the outset because of questionsabout its safety and his belief that years 

might be required to prod uce a strain of the 

organism sufficiently attenuated for safe 

use. By 1903 the Japanese had developed 

both a vaccine La prevent cho lera and an antitoxin to treat it, and the results achieved 

in a few tests of the antitoxin impressed U.s. 

Army contract surgeons whose patients received it on an emergency basis when they 

fell ill on a transport. But it was initially not 

for sale and was hard to obta in . Although 

the work of the Japanese had promise, that 

of th e Tropical Disease Board was of little, 

if any, practical value to those responsible 

for attempts to stem th e cholera epidemic 

in the Philippines'6 

Attempts to cure cholera by injecting a 

saline solution under th e skin or into th e 

vei ns were more successful. A medical o ffi cer in charge of two cholera hospitals in 

the Manila area not long after the start of 

the epidemi c reported to Surgeon General 

Sternberg that he was using a normal salt 

293 

solution by vein, havi ng learned that "in 

collapse it gave the most gratifying results. " Many patients, however, were apparently so near death at the time they arri ved at the hospital where this treatment 

was used that nothing could save them. 

Two physicians reported using intravenous injections to save 80 percent of 

their cholera pati ents when cholera again 

became epidemic in 1908-" 

Skin diseases also drew the attention of 

the Tropical Disease Board while Captain 

Phalen and Lieutenant N ichols were members. Yaws, caused by an organism similar 

to that responsible fo r syphilis, was no 

threat to U.s. soldiers, but th e huge skin ulcers it caused in many Filipinos, especiall y 

children, were hard to ignore. Although 

Captain Ashburn and Lieutenant Craig 

confirmed the identity of the organism 

causing this disease, first revealed in 1905, 

Strong discovered in 1910 that it co uld be 

successfull y treated with a drug newly 

found effective with syphilis, arsphenamine, a compound or arsenic. Fungal infections, however, were often difficult both 

to diagnose and to cure. In the hope of preventing this type of problem, the board encouraged experiment with dillerenttypesof 

clothing to reduce excess sweating'S 

Organizing the Campaign 

While the offi cers of the Tropical Disease Board co ntinued their work, the remaining Army surgeo ns joined th e effort to 

reduce disease rates in th e Philippines. As 

far as could be ascertained from studying 

Spanish records, the occupying U.S. troops 

had come to a land where death rates had 

been averaging 50 percent or more above 

those in many majo r cities in the United 

States and usually more than 30 per 1,000 
294 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

per year even in non-epidemic years. The 

attempt to devise practical means to improve public health could not wait for the 

ne'vv discoveri es thal lllight be made by the 

medical orn cers who were cond ucting laboratory research. Knowledge of the specifi c 

organisms that caused specific diseases was 

not at this point as important as an awa reness of the fact that, as historia n Ken de 

Bevoise has put il, "poverty, crowded ancl 

unhygienic living conditions, and lack of 

education" were associated with the spread 

of many diseases, among them cholera, 

plague, dysentery, and smallpox. Medica l 

orncers leading the effort to improve public health in the Phili ppines would soon 

discover that the spread of disease was also 

related to "the gregarious nature of the culture ," which "required that those stri cken 

by disease be attended co nstantly by family and fri ends. " 29 

The Philippines "presented nearly ideal 

conditions for the propagation of all infecti ous disease." "A cycle . . . in which poverty 

was reinforced by ullclereducation, malnutrition, and disease" was already well under 

way when the Americans first arrived. Years 

of connict between Fi lipinos and Spanish, 

then between Spanish and Americans, ancl 

fina lly between Ameri cans and Filipinos 

only exacerbated an already tragic situation. 

The deprivations and dislocations accompanying the armed struggle contributed to 

the spread of disease. As rar as sanitation was 

concerned, Manila resembled a fifteenthcentury European city. Reconcenlralio ll 

policies aimed at gathering Filipinos into 

communities that the occupiers could more 

easil y control favored the spread of disease, 

and the customalY diet of polished rice favored high rates of beriberi. Many Filipinos 

were especially vulnerabl e to epidemics because their resistance had been undermined 

by such endemic problems as chronic 

malaria, amebic dysentery, tuberculosis, and 

hoo kworm infection. What de Bevoise has 

described as the Fili pino "dysfunctional 

concepts of health and illness" still further 

complicated the situation. Cholera, malaria. 

the diarrhea-like illnesses, and tuberculosis 

caused the greatest number of deaths, which 

in 1902, the first postwar period for wh ich 

reasonably accurate statistics could be obtained, reached an annual death rate of 63.3 

per 1,00030 

For U.s. physicians newly arrived in the 

Philippines, the discovery that even wellto-do Fili pinos were not impressed by the 

va lue of sanitation cameasashock. By 1900 

U.S. cities generally requ ired, one observer 

maintained, "garbage collecti on, sewage 

disposal, street sweeping, uni versal vaccination, the proper disposition of feca l matter." In Manil a, on the other hand , Army 

medical offi cer Lt. Col. Louis M. Maus, who 

had arrived in the Philippines in December 

1899 to serve as chief surgeon of the 2d Division, VIll Corps,3l reponed in 1902 that 

"until quite recently some o f the best 

houses . .. were provided with aseaton the 

second sto ry, on the outside of the house, 

a nd the deposit allowed to drop in the yard 

below, where it was fin ally scraped up and 

carried away. " Other homes were equipped 

with indoor latrin es located in a lOwer at 

the top of the building, whence the waste 

fell through a hole into a pit. After a century or so of use, "a solid column of ... decayed fil th" accumul ated. Rich and poor 

ali ke built latrin es over wa terways, usually 

"above low-water mark, [so that} when the 

tide is out, the deposits are left high and 

dry, .. . being ex posed to th e action of nies 

and oth er insects for from eight to twelve 

hours daily." The surface of the ground occupied by many of the poorer' houses was 

so badly drained that, Maus noted, "during 

heavy rains the accumu lation of filth and 
PUBLIC HEALTH IN THE PHILIPPINES 

garbage is nomed out into the stree ts and 

deposited over the district, thus spreading 

the germs of disease far and wide." The 

challenge that faced Army surgeons attempting to improve public hea lth was still 

further complica ted by the fact that it was 

difricu lt to make even the need for soap and 

hot water appa rent to naLi ves who spoke a 

multitude of dialects." 

The main responsibility fo r the effort to 

improve public health in Manila was borne 

by u.s. Army medical orricers or former 

medical orricers from the time of the Spanish surrender in 1898 unLi11904. The military government created a board of health, 

composed of six Army surgeons assisted by 

two Filipino phYS icians as honorary members, making it responsibl e to th e provost 

marshal general for the city's public health. 

The campaign "of cleaning and sweeping, 

so characteristic of the American sanitarian," that the Mani la Board of Health initiated, doing "what it could in the fa ce of an 

overwhelming problem," was limited for 

the most part to the city o f Manila. To facilitate th e board's public hea lth efforts, the 

chief of the its sanitary division, Lt. Harry 

L. Gilchrist, worked from January to April 

1901 to conduct what was probably Manila's first accurate census. 33 

Shortly after taking over th e government inJuly 1901, the new civili an Philippine Commission created a second board 

of health , officially the Board of Hea lth for 

the Philippine Islands and the City of 

Manila," to monitor health in all of the 

Philippines, requiring it to function as the 

board of health for Manila as well. The first 

two commissioners of public health who 

ran this new board and its chief sanitary 

officer were, once again, Army medi cal offi cers." Regulations required th at officers 

serving the civilian government resign 

from the military, but the Army skirted the 

295 

problem by making serving und er the 

Phi li ppine Commission a duty assignment. O ther Army surgeons and even, on 

at least one occasion, a hospital steward , 

we re detail ed from time to time to assist 

the new organizaLion in dealing with its 

mission , which was principa lly "th e prevention and suppression or diseases." A 

laboratory that slowly grew in size was initiall y established on a small sca le and man -

aged for the board by Tropical Disease 

Board member Lieutena nt Calvert. Medical o ffi cers were permitted to work with 

th e Philippine Board of Health without exam inati on if the commissioner of public 

health recommended their exemption and 

his decision was approved by the Philippine Civil Service Board. The qualifi cations of all others who wished to prac ti ce 

medi cine in the Philippines had to be established before a board that the commissioner appointed for the purpose.'6 

The responsibility for sanitation in each 

area of the countryside was initially borne 

by the military orricers stationed there. The 

challenge involved was great, fo r, according 

to a surgeon stationed three years in the 

provinces, "the people had no faith in preventive or any other medicine and relied 

solely on nightly religious processions and 

on prayer, fighting all our efforts tooth and 

nail. . .. " In 1901, under the organization 

devised by the new civilian government, a 

network of subordinate boards assumed the 

responsibility for health in all parts of the 

provinces not under direct military control, 

supported by the Bureau of Government 

Laboratories in Manila with former medical 

officer Richard Strong, who was already 

gaining considerable prominence in the 

field of tropical medicine, at its head. The 

provincial boards that worked under the 

Philippine Board of Health were composed 

entirely of civilians and headed by local doc-
296 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

tors, for whom the board established a training course in Manila in 1903. U.s. Army surgeons could advise the local boards but 

could not serve on them as voting members. 

Large communities were also permitted to 

form their own municipal organizations, 

subordinate to the provincial board of 

health. Findingan adequate numberof "sufficiently intelligent" citizens and qualified 

civilian physicians interested in serving in 

the field of public health was often difficult, 

although Filipino and Spanish doctors were 

numerous. If needed, physicians serving in 

the U.s. Army could still be sent out into the 

provinces to check on sanitation, epidemics 

among either humans or an imals, and economic conditions, a practice favored by the 

Medical Department because the experience 

gave these physicians a greater opportunity 

to study disease and the conditions that contributed to its spread.

37 

The military role in public health began 

to wane when the Philippine Board of Health 

was replaced by a bureau of health in 1904. 

The eleven divisions of the new organization were apparently all headed by civilians 

under the Army medical officer who was 

briefl y detailed to run it until replaced by a 

medical officer of the Public Health and Marine Hospital Service. Steps were under way 

to abandon provincial boards of health in 

favor of a system of district health officers. 

Although the Medical Department's dominance of public health efforts in the Philippine Islands was thus brought to an end, in 

some areas, post surgeons often continued 

to function as the health officer of communities near their stations.38 

The Campaign 

The challenge faced by those involved in 

the campaign to improve public health in the 

Philippines was formidable from the outset. 

Although accurate figures were not available 

until many months after the u.s. occupation 

began, a review of the death rates of Manila 

conducted by medical officers revealed a dismal picture. Available Spanish figures for the 

twenty years preceding the war did not separate the City's figures from those of the surrounding province, but the statistics for both 

areas ranged from a low of 28.8 deaths per 

1,000 per year to a high of 63.1 , with a fifteen-year average of 38 per 1,000. In 1900, 

44.5 of every 1,000 inhabitants of Manila 

died. In 1901 the rate was 42.6, while in the 

first nine months of 1902, when cholera 

began to rage in the city, the annual death 

rate rose to 64.81 per 1,000. Infant deaths 

formed the major part of the toll , however, 

even in cholera years; convulsions from unspecified causes killed 2,038 children from 1 

September 1902 to 1 September 1903, duringa period when a total of894 men, women, 

and children died of cholera and 789 from 

pulmonary tuberculosis.'9 

Many of the fatal diseases, whether they 

afflicted adults or infants, could be linked 

directly or indirectly to the garbage and 

human wastes decaying in the hot and 

humid streets and the overcrowding that 

characterized Manila. The challenge involved in attempting to clean up the city 

was made all the greater by the fact that, 

in the fan of 1898, when presumably disease and death rates were high, the Manila 

Board of Health lacked adequate funding, 

the city had no municipal government 

with which the board could work, and conditions were generally unsettled. 

Sanitation seemed a logical approach to 

redUCing the inroads of disease in the Phili ppines. In the United States, where epidemiCS 

of such filth diseases as cholera were a thing 

of the past, the benefits of improved sanitation had become apparent on an empiri-
PUBLIC HEALTH IN THE PHILIPPI NES 

cal basis even before germs were accepted 

as the cause of so many devastating epidemics. The Manila Board of Health established fi nes for those who relieved themselves in the streets or [ailed to correct 

problems that had been pointed out to 

them, as well as a system o[ inspections to 

detect violations of sanitary laws and supervise their elimination. The first inspection apparently came in response to the specific threat o[ bubonic plague, first 

diagnosed late in December 1899. Once 

plague had been identified, a team of a hundred inspectors, most o[ them medical students, was quickly gathered with the aid of 

the chief of police and sent out on houseto-house inspection tours throughout all of 

the city, except [or the Chinese sections, 

where community leaders o[ a population 

o[ more than 51,000 ran the inspections. A 

surgeon of the u.s. Volunteers assumed responsibility for a cleanup campaign that involved poisoning rats and [or such 

markedly less useful efforts as whitewashing homes inside and out. The Marine Hospital Service inspected all those leaving 

Manila to ensure that no one who was coming down with the disease went out into the 

provinces. "0 

Recognizing that plague was by no 

means the only serious danger to public 

health in the Philippines, the Philippine 

Board o[ Health continued to refine the 

system of sanitary inspections when it assumed responsibility [or the city o[Manila. 

The inspections were the responsibility o[ 

one of the board's members, Franklin A. 

Meacham, who had resigned [rom the 

Army to serve as chief sanitary inspector. 

The board gave Meacham an interpreter 

and appointed a chief inspector to serve 

under him. Also part of Meacham's team 

were sixty inspectors, ten o[ whom were 

Chinese, with the balance Filipino. Each 

297 

FRANKLIN A. MEACHAM 

of the ten districts into which Manila was 

now divided was served by a district inspector, who was assisted by three subdistrict inspectors, and by a medi cal officer, 

usually a contract surgeon awaiting transportation back to the United States, who 

became responsibe for public health'l 

Repeated frustrations greeted efforts in 

Manila to red uce disease rates Significantly. 

The Manila Board o[Health started its work 

with lillie equipment, having neither ambulances nor wagons equipped to handle 

disinfection on a large scale. Native inspectors, accustomed to the ways o[ their 

people, had to be closely supervised by 

Americans lest they ignore the very failings 

they had been hired to report. Because there 

was no better alternative immediately 

available, [or a time the board had no choice 

but to all ow the use of drainage ditches as 

latrines to continue, consoling itsel[ by the 

fact that the heavy rains o[ the wet season 
298 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

A SEWAGE-CLOGGED DRAINAGE DITCH, lIseel by Filipino velldors alldfwl1ilies 

wo uld eventually nush them out. The most 

fundamenta l problem, however, was the 

fac t that inadequate funding threatened the 

much needed permanent solutions to th e 

city's hea lth problems: the construction of 

a city sewage system; the establishment of 

a safe and ample water supply; and the 

cleaning of the sewage-clogged moats and 

drainage ditches that crisscrossed the city, 

the breeding grounds of multitudinous 

mosq uitoes. The challenge remai ned when 

the Philippine Board of Health assumed responsibili ty for Manila. Within a few 

months, Meacham's unceasing efforts to 

improve the hea lth of the city's population 

in the face of these frustrations had completely ex hausted him. In April 1902 he 

succumbed to heart failu re after refusing to 

leave his desk despite the fact that he was 

running a high fever." 

Even as lateas 1907,onlyeighteen mil es 

of the new sewer system had been completed. Long before this point, the lack of 

a modern sewage neLwork in Manila had 

forced the Ph ilippine Board of Health to reso rt to the Chinese night soil system for 

removing excrement. Pails were provided 

to each household for this purpose, and indoor toilets were required to be emptied 

and cleaned twice a week. The contents of 

the pails joined all other forms of human 

wastes and garbage on barges, which 

dumped their unattractive cargoes in the 

bay at a spot where the current nowed 

away from the land. Since even after the 

pail system had been install ed, the sanitation in poor homes was defective, the 

board decided to begi n estab lishing public latrines where attendants would be responsible for cleanliness day and night." 

Other steps taken to improve Man ila's 

sanitation ea rl y in the U.s. occupation included drawing up a sanita ry map of the 

city and sanitary plans of each dwelli ng in 
PUBLlC HEALTH IN THE PHILlPPINES 

it as part of the census done early in 1901 , 

in order to fa cilitate the work of the inspectors. The Philippine Board of Health 

also resorted to the prosecuti on of a few 

wealthy landlords for putting too many 

tenants in th e tenements they owned, a 

step that inspired noticeable improvement 

in conditions in many similar buildings. 

The selling of food by vendors in the streets 

was also strictly regulated, with netting required to keep ni es from the items for sale 

and forks required to avoid the handling 

of fo od with bare hands. By th e fall ofl 903 

the system of sanitary inspection was in 

full operation, even though the size of th e 

inspecti on force had been cut by 75 percent injune of that year with the discharge 

of inspectors hired to help with the cholera 

epidemic. Almost 2 million homes were inspected or reinspected in the twelve 

months fo llowing 1 September 1902. As a 

result, more than 241,000 houses and almost 162,000 yards were cl ean ed, and 

more than 11 ,000 cesspools and simil ar 

sewage systems were emptied.;; 

Since Manila lOok its water from a river 

often contaminated by the urine and feces 

of the 20,000 people who lived along it, either directly or through rain water that 

washed wastes into the ri ver, the poor sanitary habits of some Filipinos who lived upriver continued to threaten the city's drinking water. Keeping these people entirely 

away from its banks was impossibl e, for traditionally th ey washed both themselves and 

their clothing in it and watered their livestock there as well. Furthennore, since they 

did not live in the city, they were little interested in changing their habits for the 

benefit of those who did. The river was also 

poll uted by as many as 15,000 people who 

li ved on boats and used it as both laundry 

and latrine, even though it was their only 

so urce of drinking water. The boat people 

299 

were so hostile to interference that on occasion th ey attempted to avo id attracting 

visits from inspectors by throwing the bodies of their cholera dead, suitably weighted, 

in to the river. Even within the city itself, 

hundreds of bamboo huts lay close to the 

water, w here the occupant, "his carabao and 

his pigs, his hens, and his family bathed and 

often drank in the same stream. The few 

dishes and pots he possessed, together with 

the family wardrobe, his dutiful wife habitually cleaned in this common water, and as 

it saved labor, the nearer the shack was to 

the stream the better; and so it very often 

was placed right in it.";' 

Relying on the city's wells, however, was 

not the answer to the probl em of polluted 

water, since they were shallow and their 

openings so badly encased that the run -off 

from the city streets drained into them 

after every rain . Thus when cholera hit 

Manila in 1902, the Philippine Boa rd of 

Health had no choice but to close all of the 

city's shallow wells and have a few new 

ones driven to a depth of 700-1 ,000 feet. 

It had distilling plants set up to produce 

10,000 gall ons of pure water a day, but 

since more ex tensive measures were 

clearly called for, the board also made longrange plans to dam the river between its 

so urce ancl th e area where people had located their homes so that wa ter could be 

piped th ence around the sources of pollution and into th e city The building of this 

new water system was almost compl ete by 

the end of 1906. Medical offi cers also 

urged, but with onl y partial success, that 

publi c lavatories and laund ries be established in areas along the ri ver nea r where 

the boat people were an chored and that 

good water be piped to locations where 

they could easily use it. These measures 

would both improve th eir health and reduce the threat to th e city's water supply;6 
300 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

Manila's hospital system was particularly important when the rates of communicable diseases were so high among the indigent, yet in 1898 apparently only one 

publi c hospital, one of the Philippines' two 

facilities for lepers, existed in the capital. 

Work had been started on a new general 

hospital for patients with noncontagious 

diseases, but the building was never completed within the lifetime of the Manila 

Board of Health. High smallpox rates, resulting from the fact that compulsory vaccination laws had been ignored here as in 

other Spanish colonies, necessitated the 

hasty erection of tents- the only type of 

shelter that could be afforded- to serve as 

a "pest hospital. " The Chinese community, 

which had its own hospital, built a facility 

for contagious diseases as well. By the end 

00901, however, barracks with a capacity 

for 3,500 beds had been constructed and 

divided into two hospitals, where patients 

with plague or cholera could be isolated. 

Late in 1901 an 80-bed hospital was created for civil servants and their fami lies. 

Nevertheless, the shortage of hospital beds 

continued; in 1903 the Philippine Board of 

Health was both urging the creation of 

more beds for the insane and deploring the 

closing of two women's hospitals'7 

Initially when cholera invaded the city 

in March 1902, hospital space was available for its victims. Even though cholera 

patients could be treated in their homes if 

the proper precautions were taken to prevent them from infecting others, the 

Philippine Board of Health was soon experiencing considerabl e difficulty in supplying beds for those who could not be 

kept in their own houses and in finding adequate space in which to isolate those who 

had come in contact with them. When the 

100 beds set up at Santa Mesa, along with 

a detention camp for 6,000 contacts, 

proved to be so far from Manila that the 

trip caused the condition of the pati ents 

moved there to deteriorate, a third hospital was opened in the city. Here it shared 

space with a privately operated facility for 

the Spanish community in buildings that 

had housed the Second Reserve Hospital. 

Medical officers were in charge of both the 

facility at Santa Mesa and that in the Second Reserve buildings's 

In 1903, with the need for beds for 

cholera patients still great, a rapidly. spreading fire destroyed both the cholera hospital in Manila and the detention facility set 

up nearby for suspected cases. The corral 

for the Philippine Board of Health's horses 

and the buildings of the pail collection system that handled the city's night soil were 

also burned down. Although its facilities 

had been heaVily damaged, the board had 

tents and temporary latrines erected for 

those rendered homeless by. the connagration, thereby avoiding the marked rise in 

disease rates that might otherwise have 

been expected to follow a disastrous fire in 

such an overcrowded and unsanitary city. 

Fortunately., the board was given a large increase in funds for the fiscal year 1904.9 

One of the motivating factors for the 

creation of the Manila Board of Health had 

been the customary conviction that the 

maintenance of public health required the 

isolation of lepers from the rest of the publi c. The facility for these unfortunates had 

a capacity of 150-200 beds, but U.s. medical officers initially estimated that as many 

as 30,000 of them remained unsegregated 

in the islands, a figure later lowered to 

6,000. One of the first duties of the board, 

therefore, was to locate an island that co uld 

be developed into a leper colony. While the 

investigations necessary to dea l with this 

problem were being made, the boa rd had 

a door-to-door search conducted to ascer-
PUBLIC HEALTH IN THE PHILIPPINES 

tain who and where in Manila the lepers 

were. This inspection, started in January 

1900, revealed more than 100 un hospitalized victims of this horrible disease in the 

city. By 1904 Culion Island (see Map 4) had 

been chosen for the leper colony and work 

to establish the facility was well under way. 

The Philippine Bureau of Health appointed a fonner medical officer as the 

colony's first director'O 

The Most Dangerous Threats 

In addition to the struggle to limit the 

spread of disease through improved sanitati on and to create facil ities where those 

with contagious diseases could be isolated , 

U.s. medical officers directed considerable 

effort agai nst specific epidemic diseases 

that threatened the Philippines. Smallpox 

was a conce:·n from the moment of the 

Spanish surrender in August 1898. The 

Filipinos took the disease casually. On the 

island of Luzon (see Map 4) it was prevalent in every village, yet no attempts were 

made either to isolate the victim or to disinfect his home. Despite the immunization 

that was mandatory for u.s. troops, American soldiers occasionally acquired the disease from the Filipinos, making its eradication doubly desirable. The Manila Board 

of Health promptly initiated a campaign 

later described by Colonel Greenleaf, then 

the Army's chief medical officer in the islands, as "forcible vaccination and revaccination, where that was necessary. " The 

effort was eventually extended to all inhabitants of the islands over the age of 

three months. Medical officers in the 

provinces received authority to hire Filipinos and to send them from door to door 

within the city to perform the actual vaccinations, with the proviso that they su301 

pervise the procedure and consult local authorities to ensure their cooperati on. The 

success of the board's efforts in this instance was marked. In March 1899 sma llpox deaths numbered 75 in Manila alone; 

from October 1899 through July 1900, 

however, the disease killed only 7 in that 

city. In the provinces, where loca l boards 

of health were responsible for the immunization program, the campaign aga inst 

smallpox was not under way until February 1900 and was handicapped by the fact 

that the insurgents occasionally kidnapped the vaccinators. Despite these 

problems, in the twelve months preceding 

1 September 1903 almost 1. 2 million units 

of vaccine were used in the effort to eradicate sma ll pox in the Philippines.' ! 

The Manila Board of Health supervised 

the preparation of the smallpox virus for 

all of the Philippine Islands, but when the 

long trip seemed to be reducing the effectiveness of the vaccine sent to some of the 

islands, vaccine farms were also set up in 

the Visayas and on Mindanao (see Map 4). 

In Manila the board established a vaccine 

institute to prepare both smallpox vaccine 

and any other serums that might be called 

for to immunize or treat other diseases of 

man and beast. As the campaign progressed into the provinces and grew in 

both magnitude and complexity, developing a formal organization under a chief of 

vaccination to manage all aspects of the 

immunization program became necessary. 

Nevertheless, despite the care exercised, 

all too often the sma llpox vaccine proved 

to be ineffective; in 1905 less than half of 

those vaccinated ea rlier were determined 

to have actually been rendered immune. In 

1904, however, when no deaths from 

smallpox occurred among those who had 

been vaccinated, the problem appeared to 

be under control. 52 
302 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

The Manila Board of Health had scarcely 

laun ched the campaign against small pox 

before it fo und itself co nfronted with th e 

plague epidemi c. Although U.S. medica l 

orncers were experienced in dealing with 

smallpox and vaccination and could manage the problems of th e campaign against 

that disease with confidence, they were 

much less familiar with plague. Believing 

that the rat might be in some \ovay connected with its spread, the board included 

within th e generalized campaign to clean 

up the city a spec ifi c plan to eliminate rats 

by trapping or poisoning them. These rodents were killed at the rate of 5,000 to 

10,000 or more a month and as many as 

possible were examined in the laboratory 

to determine if they were infected. Strenuous efforts were also made to detect and 

isolate plague victims and those exposed 

to them and to disinfect their homes and 

possessions. Whenever possible, those 

who died from plague were cremated, but 

if their famili es had religious sc ruples 

against this method of disposing of infected bodies, the board had the corn ns 

fill ed with disi nfectan ts and qui ck lime." 

Although the incidence of plague in 

Man ila in 1900 ornciall y dropped from a 

high of 49 identified cases in March to 11 

by May, these statistics were not alI-inclusive, since an average of 40 to 80 Chinese 

were apparently dying of the disease each 

month witho ut medica l attendance. Even 

after the epidemic ended in Manila in 

1902, it co ntinued to haun t the rest of th e 

Philippines. From 1January 1900 to 1 September 1902, 772 cases were identified and 

646 deaths noted. In the following year 

198 cases and 166 deaths occurred. The 

rate continued to drop, with 94 cases and 

87 deaths from 1 September 1903 to 1 September 1904 and another 24 cases and 23 

deaths in the eight months from 1 September 1904 to 30 April 1905. Moreover, 

by July 1902, only three Ameri can soldiers 

had contracted the disease and the rates in 

other cities in the Far East were far worse 

th an in Man ila" 

After the outbreak of plague had lasted 

two yea rs, the epidemi c of cholera , like 

plague most often found in communities 

with poor sanitation, diverted the allention of the harried and harassed Philippine 

Board of Hea lth. This disease inspired 

growing concern from the moment it was 

fi rst diagnosed in Manila in Ma rch 1902. 

Once again, the board had no weapon but 

a more ex tensive effort to improve sanitati on. Going beyond the attempt to create 

safe sources of wa ter, it also forbade the 

sale of fru its and vegetabl es that co uld be 

eaten raw. In addition, inspectors made 

house-to-house visits within the city at all 

hours of the day and night to make sure 

that no case of cholera went undetected, 

and a quarantine was placed on the city to 

limit the spread of disease. But the natives 

of the island, incl uding Fili pino physicians, were not always cooperative. As one 

Army surgeo n noted, the Filipinos tended 

to take alarm only at th e appearance of 

some spectacular disaster and otherwise 

accepted suffering and death with "a curious indifference. " The board could take 

some consolation in th e fact that few 

Ame ricans contracted the disease, and 

those who did were usuall y me n who had 

"visited or lived with native womenl! or 

who had made the mistake of assuming 

that adding alco hol to water would make 

it sa fe to drink." 

In spite of the efforts of the Philippine 

Board of Health , cholera soo n escaped 

[rom Man ila in to the co untryside, where it 

was more dirncult to control. At the request of the commissioner of publi c 

hea lth, Colonel Ma us, thirty-one medica l 
PUBLIC HEALTH IN THE PHILIPPI NES 

officers were detailed to assist him in dea ling with the epidemic. The board also 

asked to have medical officers placed on 

the municipal boards of hea lth of the 

towns where their posts were located. The 

campaign included requiring medical officers to form municipal boards where they 

did not exist, to prevent the pollution of 

streams, and to report all cases of cholera 

to their division chiefs. The Philippine 

Board of Health urged American school 

teachers serving on the municipa l boa rds 

to educate Filipinos on the nature of 

chol era and the steps to take to avo id its 

spread. It also encouraged the appointment o f American civilians as inspeCLOrs 

so that soldi ers wo uld be given this assignment only as a last resor1. 56 

Superstiti ons about th e source of the 

disease were more widespread in the provinces than in the city, and the efforts of 

military authorities to stem th e epidemi c 

in the countryside were often thwarted. 

The hundreds of posts throughout the islands became centers from which medical 

help was rendered to th e surrounding 

populations, but the opposition to the 

work of medical offi cers in some areas was 

so strong that they were accused of causing the epidemi c by poisoning th e water. 

Maj. Charles E. Wood ruff, an Army surgeo n serving in the Philippines in the 

summer of 1902, beli eved that the Fi lipinos were unable "to understand such 

abslruse matters. To their mystic minds/' 

he noted, "the disease is ca rried by the air, 

and even the most intelligent are so fata listic that they beli eve if their time has 

come to die it is futil e to try to ward it 

ofr. " Moreover, a pamphl et first issued by 

the Spanish in 1888 that maintained that 

cholera was an air-born e disease was still 

in circulation, rea ffi rmi ng pop ular belief 

on th e subject and encouraging Fili pinos 

303 

in their refusal to aband on the customs 

and habits of generations to cooperate 

with a campaign against a water and insect-borne disease." 

Shallow and easily polluted wells were 

the ordinary so urce of drinking water in 

th e provinces, and crops were fertilized 

with human excrement. Natives relieved 

both bladder and bowel in th e immediate 

vicinity of their homes, further faci litating the spread of disease. The Army surgeon working in one community reported 

that "everywhere there were carabao wa llows and oth er pools o f stagnant water, 

where the amphibious Filipino moti ve 

power Ithe water buffalo] li es dormant 

the greater part of the time, sunken up to 

his nostrils in th e muddy water. " Na tives 

instructed to dig drainage ditches pil ed 

the earth on either side of th e trenches 

they had just dug, thereby preven ting 

wa ter from entering. Run-off ca rried 

cholera to th e drinking water, uncooked 

vegetables added the disease to the food, 

and nics transported the infecti on from 

fi elds and yards to food , water, and dishes, 

both within th e native villages and at 

Army camps nearby. Women laundered 

the soiled linen from the beds of cholera 

victims in the stream whence came their 

drinking wate r. Guards posted around th e 

homes and villages of cholera victims to 

guarantee their isolation, vigorous efforts 

to disinfect the premises, and the use of 

smudge pots to dri ve away \lies and other 

insects were of no ava il to stem the tide 

of the epidem ic. 58 

Even where the loca l popula ti on 

seemed "peaceably in clined toward" the 

Americans and "disposed to obey the laws 

without questi on ing them," a basic problem remained in the [ann o f what. Olle 

Army physician regarded as a "lack of energy, improvidence and inability to ad-
304 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

minister public affairs" on the part of the 

Filipinos. A Philippine Board of Health 

publication on the subject of cholera was 

apparently largely ignored, and the efforts 

of medical officers to protect the civilian 

population too often came to nothing. "It 

is perfectly useless," one medical officer reported, "for any health offi cer to attempt 

to check an epidemic unless he can ru le 

with a rod of steel. " Furthermore, he 

added, "orders ought not to emanate from 

a central bureau. The officer in immediate 

command must be able to control his own 

movement. A chief cannot understand 

conditions in a town he has never visited. " 

Sending medical inspectors to affli cted 

areas seemed to help, but these physicians 

were too few to reach all communities. 

Thus, because the rod of steel could not be 

used, people "died just as they used to die 

years ago and will continue to die for years 

to come." 59 

On 27 April 1904 the epidemic was declared to be at an end. A total of 166,252 

cases had been offiCially reported, of 

which 109,461 had resulted in death. Perhaps as many as a third more victims had 

not been reported. Thanks to the military 

diSCipline that guaranteed adherence to 

preventive measures, only 305 U.s. soldi ers died of cholera, in addition to 81 

Philippine Scouts (their formal designation as of ( 901), for whose health Anny 

surgeons were also responsible. Mortality 

was highest among Filipino victims, their 

death rate being more than 80 percent, 

while fewer than 49 percent of the Chinese patients died, less than 56 percent of 

the Europeans, and barely more than 47 

percent of all the Americans in the islands. 

Almost 96 percent of the infa nts under one 

year contracting cholera died. Few Chinese, it was remarked, even came down 

with the disease, a fact that was credited 

to their custom of cooking almost all of 

their food and drinking principally tea. 

One medical officer also noted that cholera 

seemed to grow more virulent with the 

passage of time. Significantl y, however, despite the pronouncement that the epidemi c was at an end, cholera had not been 

erad icated from the Philippines. Although 

it apparen tly no longer inspired panic, in 

the twelve months ending 31 August 1904 

it killed 423 residents of Manila alone60 

In waging such a vigorous campaign to 

save lives from cholera , Army surgeons 

were indirectly waging a campaign to prevent disaster to the local economy. So 

many farmers died or neglected their 

fi elds and animals because of the need to 

minister to their sick famili es that crops 

were neither cared for nor harvested at the 

proper time. This neglect came just at the 

time when two epizootic diseases of much 

interest to medi cal officers-ri nderpest, 

which affected cattle; and surra, nearly always fatal to horses and spread by the 

bites of flies-were sweeping through the 

Philippines, in some areas killing as many 

as 90 percent of the cattle and water buf-

[alo and 60-75 percent o[ the horses and 

ponies. The very quarantine laws that 

were aimed at preventing the spread of 

cholera brought internal trade to a standstill, thereby further depressing the 

Philippine economy. While the Tropical 

Disease Boarel began experiments to develop a serum against surra, the Phili ppine Board of Health, responsible for the 

health of animals as well as humans, 

launched a campaign to immunize ca ttle 

against rinderpest. Both time and money 

were required to reach any substantial 

proportion o[ the islands' livestock, but by 

the fa ll of 1903 the death ra te from that 

disease had fa ll en from 90 percent to 3 

percent. 61 
PUBLIC HEALTH IN THE PHILIPPINES 

Other Health Problems 

Particularl y distressing to U.S. physicians in the Philippines was the mortality 

among infants, who suffered not only from 

epidemic diseases but from infections and 

an inadequate diet. Those under a yea r of 

age died at a rate twice that found in the 

United States, although the rate in the islands might be less than that found among 

the infants of black Americans, who were 

almost uniformly very poor and whose 

overall mortality could be double that of 

whites. The infant death rate was particularly appalling in Manila, where in the 

cholera year of 1902 three-fifths died before they were twelve months old. 

Throughout the islands the annual death 

rate that year among children under five 

years old was 141 per I,OOO,ata time when 

the comparable rate in the United States 

was 52 per 1,000 and 131 per I ,OOO among 

blacks." 

Filipino children died of all the other ills 

afflicting the population, but Army surgeons soon realized that superimposed 

over these causes were problems stemming 

from poor nutrition and lack of cleanliness. 

All too often, neither midwife nor physician attended the mother in childbirth, and 

tetanus resulting from a lack of proper care 

in handling the newborn's umbilical cord 

caused many deaths, perhaps as many as 

30 percent of the total. Meningitis also contributed to the mortality. The infant who 

was breast-fed exclUSively by a mother suffering from poor nutrition might also develop beriberi. No safe alternatives existed 

for a mother who could not produce 

enough milk herself, especially after 

rinderpest had killed many of the cows in 

the islands. Because refrigeration was not 

available to the poor, infants might be given 

sour milk, and since the mothers knew 

305 

nothing of how to modify cow's milk to 

make it more closely resemble that of humans, their babies often did not do well 

even if it was otherwise safe. Diluting cow's 

milk with water from polluted sources 

spread disease to the hapless offspring. In 

the attempt to keep them from starving to 

death, mothers might also feed their infants 

solid foods in a form they could not possibly digest. Statistics were difficult to obtain. 

Only physiCians could record deaths, but 

few Filipinos called for medical assistance. 

Required to cite a cause of death for infants 

for whom they had not cared, doctors 

tended to list "infantile convulsions." 63 

Realizing that a reduction in infant mortality depended on the education of the 

mother, the Philippine Board of Health prepared a bulletin on infant care and had it 

translated into all the main dial ects of the 

Philippines and distributed throughout the 

islands. The board also hired eight midwives to help poor women in the city of 

Manila with theirde1iveries, hoping thereby 

to reduce infection in newborns and to educate mothers in the need for cleanliness. 

The death rate from convulsions in those 

under twelve months of age stayed high, 

however, and infant mortality in general remained a problem for years to come. 64 

Many of the health problems that attracted researchers received lillie or no attention from offi cers on the various boards 

of health. No real campaign was ever made 

aga inst hookworm or beriberi during the 

boards' lifetime, although the research of 

the Tropical Disease Board would prove invaluable to the Publi c Health and Marine 

Hospital Service officers when they became responsibl e for public health. Medical offi cers were concerned about dysentery and typhOid, but their concern 

centered about these diseases as threats to 

the health of troo ps. Malaria was not as 
306 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

great a problem for the native population 

as might have been antiCipated, even 

though screening was not often used, apparenti), because th e predominant species 

of Anopheles mosquito did not breed in the 

coastal areas where most Filipinos li ved. 

Although tuberculosis ca used man)' 

deaths among the Filipinos and medi cal 

o[fi cers blamed its spread at least in part 

on poor hygiene, no campaign was und ertaken against this disease. Mental illness 

in the civilian population concerned doctors principally because the lack of hospital beds for its victims resulted in their 

being impriso ned at Bilibid65 

When the Army relinquished its leading 

role in the attempt La improve sanitation 

and to lower disease rates in the Phili ppines, the work on sewage and water s)'stems initiated at the urging of the various 

boards of health was not ),et complete. Although infant mortality fell to 20 per 1,000 

in 1920, in the earliest years of the twenLieth centur), it remained great, and overall 

death rates in Manila cOnLinued to var), as 

epidemics waxed and waned. The cit)' was 

definitely cleaner because of the Army's efforts, but the death rateof the Filipinoscontinued both high and nuctuating. The role 

cultural factors pla)'ed in the spread of disease was demonstrated by the contrast in 

mortalit), rates between the Filipinos and 

the Chinese, who cooperated with the fight 

agai nst disease and whose customs lowered 

their exposure to cholera. Chinese disease 

rates in Manila, like those among Americans and Europeans there, d ropped 

markedl), and consistenLl)' in the period 

1902- 1905. In the ),ear ending 31 August 

1903, when the Chinese rate was 28.26 per 

1,000, that of Manila's Filipinos was 43.42. 

A ),ear later the Chinese rate was 21.85, the 

Filipino 53.72. The ),ear ending 31 August 

1905 saw a Chinese rate standing at16. 15, 

the Filipino at 44.54.66 

Victory over rats and insects proved to 

be far moreeasil),achieved than victOlyover 

the customs, traditions, ignorance, and superstitions of a people accustomed to accepting disease and death without a struggle. The work of the disease boards was 

important to th e understanding or such diseases as beriberi, dysentery, and dengue, 

and a campaign to reduce drasticall), the rat 

population of Manila cOnLributed to the defeat of the plague, but the e[[ort to reduce 

disease rates b)' improving standards of sanitation met with almost constant frustration. Discovering that a di et based on polished rice led to beriberi proved easier than 

inducing the people endangered by beriberi 

to adopt an unfamiliar diet, and the end or 

the cholera threat, like the end or the insurrection, was achieved b)' proclamation 

rather than by vanquishing the enemy. Nevertheless, su[ficient progress had been made 

b)' 1913 to lead an A merican observer to 

comment that Manila was, "except in the 

maLler of infant monalit)', ... about as 

healthy a cit)' as any ofits size in the wanner 

part of America." 67 
NOTES 

1. First quotat ion from David]. Doherty, "Medicine and Disease in the Philippines," p. 1526; second quotation from Stanl ey Kamow, I II Ol/r Illlage, 

pp. 196-97. See also Louis M. Maus, "Military Sanitary Problems in the Philippine Islands," pp. 1- 2, 

11 ; Edwa rd L. Munson , "The Civil San it ary Function of the Arm)' Medi ca l Departmen t in Te rritory 

Under Military Control," p. 273. 

2. Unless otherwise indi cated, da ta concerning 

t he work of the Tro pical Disease Boards is based on 

Edwa rd B. Vedder, "A SynopSiS of the Wo rk of the 

A nn}' Medical Researc h Boards in the Phil ippines," 

in Arm)' Mcdical Bul/clill , and Percy M. Ashburn, A 

HisIDI )' of Ihe Medical DepClfllllcHI of I,he VIIi/ ell 

SIC1 les Army; idem, "The Board for the Study of 

Tropica l Diseases as The), Occur in the Phi li ppine 

Islands," pp. 298-301; Richard P Strong, "The Bureau of Gove rnment Laboratories for the Phi li ppine 

Islands," pp. 665-67; 'Wa r Depart ment, {A /I/lual} 

Reporl of tile Swgeoll GClleml, u.s. Army, 10 Ihe SecrC/eily oj War, 1900, p. 21 , 1908, p. 99, 1912, p. 

140, and 191 5, p. 131 (hereafter cited as W D, 

ARofSG, date); William]. L Lyster, "The Army Surgeon in the Philippines," p. 31. 

3. J oseph]. CUlT}', "U.s. Army Pathological Laboratories in the Philippine Islands," p. 176. See also 

1'.175. 

4. Strong j oined the Army Medical Depa rtment 

in 1898 and was appointed to the Tropi cal Disease 

Board when it was created late in 1899. He fell ill, 

however, on 25 December and was appa rently unable to wo rk until Februar}, 1900. At this time, he 

directed t he Army's patholog)' laboratory in the First 

Reserve Hospital in Manil a and continued in this 

position when the faCili ty was reconsti tuted as the 

Government Biology Laboratory. Strong resigned 

frolll the Army in 1902. As a civili an, he remained 

as head of tile Government Biology Laboratory until 

his reSignation in 1913. His reputation as an ex pen 

on tropical medicine cOlltinued to grow after he lefl 

the Philippines to teac h tro pi cal medicine at Harvard. See Curry, "u.s. Arm}'," p. L76; WIlDS Wlto ill 

AmeriCCl, 1910- 1911 ,s.v. "Stro ng, Richard Pearson"; 

\tVa r Department, [Al1IlIw/j Report of the Seaeu,,)' of 

Waf, 1903, 6(pt.2):39-40 (hereafter ci ted as \ND, 

ARoJSW, date); idem, ARoJSC, 1900, p. 109. 

5. Joseph]. Curry, "Dysenteric Diseases in the 

Philippine Islands ... ," pp. 177-78. Although both 

organ isms are cOllllllonly refe rred to as E. coli, EIIIClllloeiJa coli should not be confused with Esdleric hia coli , which , unlil<e EII/WIIOe/)(1 coli , does 

ha ve pathogeniC strains-in other words, strains 

that cause ill ness. 

6. The First Rese rve Hospital is discussed in 

Chapter 8. 

7. WD, ARoJSC, 1900, PI'. 245-46, 251 , 273 ; 

Curry, "U.S. Army," p. 176; Whos Who, .1910- 19 11 , 

s.v. "Strong, R. P" 

8. Ell/amoeba hislolyOca was then known as 

Allloe/m dyselllCl'iae and Elltwlloeba coli as Amoeba 

coli. 

9. WD, ARoJSC, 1900, PI'. 246, 261, 267- 68, 

270-7l, 273, 1901, p. 205 (first quotation), and 

1909, p. 96; Richard S. Strong, "Tro pica l Medicine ," 

p. 9 (second quotation); "Pseudo-outbreak of Intestinal Amebiasis," p. 186.1; Curry, "U.s. Army," p. 

175; Simon Flexner, "On the Etiology of Tropical 

Dysentery," pp. 4 15-17, 424; idem, "BaCill ary 

Dysentery," p. 2 19; Charles F Mason, "Baci ll ar)' 

Dysentery (Sh iga)," Pl'. 242-43; Simon Flexner and 

L. F. Barker, "The Prevalent Diseases in the Ph ilippines," pp. 525-26; Esmond R. Long, A HiS/DIY oj 

America/l Paillology, pp. 153, 158-59, 413- 14n5. 

10. WD, Al/oJSC, 1900, PI'. 66 (quotations), 

67-71 ,246, 250; Charles F. Craig, "Observa tions 

Upon the Amoebae Coli and Their Stain ing Reaction," p. 415; idem, "The Pathology of Chronic Specifi c Dyse ntery," pp. 353 , 376, 378; idem, The 1'(1/"-

asHi c Amoebae of M(III; Manha L Sternberg, George 

Miller StcmiJerg, p. 210; Edwa rd B. Vedder, "An Examination of the Stools of LOa Healthy Individuals ... ," p. 872 

11. WD, ARoJSC, 1906, p. 130, 1907, pp. 40-4 1, 

and 1908, p. 98; James M. Phalen and Henry]. 

Nichols, "Tro pica l Diseases in the Philippines," p. 

467; Ernest l. Walker, "Ex perimen tal Entamoebic 

Dyse ntery," pp. 254,325. 

12. WD, ARoJSC, 19 12, PI'. 144-45, and 1913, 

pp. 131-32; Henry j. Nichols and James M. Phalen, 

"The \-Vork of the Board ror the Stud y of Tropica l 

Diseases in the Philippines," p. 368; J ames M. 
308 THE ARMY MEDI CAL DEPARTMENT, 1865-1917 

Phalen and E. D. Kilbo urne, "The Bacteriology of an 

Epidemic of Bacillary Dysentery," pp. 433, 435-42. 

13. "The Treatment of Acute Dysentery," p. 281; 

Gilbert E. Seamen , "Some Observations of a Medical OITiccr in the Philippines," p. 184; Richard P. 

Strong, SliHS DiagllOsis, Prevention {l/IclTI'catmcnt oj 

Tropical Diseases, 1:72, 453; WD, ARojSG, 1900, p. 

114, 1901, p. 204, 1904, PI'. 87-89, and 1911, PI'. 

144-45; Alfred Alexander Woodhull , "The Va lue of 

Ipecac in Dysentery," p. 223; Henry I. Raymond, 

"Ipecacuanha in Amebic Dysentery," p. 46. 

14. Edward W Pinkham, "Tropical Abscess of 

the Liver," p. 309. See also pp. 312, 314, 316. This 

articl e was published posthumously. 

15. WD,ARojSG, 1910, p. 96 (quotations); Percy 

M. Ashburn and Cha rles F. Craig, "Experimcntal lnvesliga tions Rega rding the EtiologyorDengue . 

1'1'.97, 102. 

16. Percy M. Ashburn and Charles F. Craig, 

"Study or Tropical Diseases in the Philippine Islands," pp. 692-93; idem, "Experimentallnvestigations," pp. 102, 105,123 (quotation), 136; Charles 

F. Craig, "On the Nature or the Virus orYellow Fever, 

Dengue, and Pappataic Fever," pp. 363-65; Joseph 

F. Siler, M. W. Hall, and A. P. Hitchens, "Results Obtained in the Transmission or Dengue Fever," pp. 

1163; WD, ARojSG, 1907, p. 41, and 1910, p. 96. 

17. WO , ARojSG, 1899, PI'. 289-90, 1900, PI'. 

53-60,235, 1911, 1'.145, and 1912, 1'.147; Curry, 

"U.s. Army," p. 176; Frederick F. Russell, "The Results or Two Seasons Anti-malarial Work, " p. 161. 

18. WD, ARojSG, 1900, pp. 210-12; George M. 

Sternberg, "The History and Etiology or Buboni c 

Plague," p. 813; "The Mode orSpreadingorBubon ic 

Pest," p. 1372; Arthur H. Moorhead, "Plague in 

India, " p. 167; Charles W. Stil es, "Insects as Disseminators or Disease," p. 7; H. Harold SCOll, A HisiOlY oj Tropica/ Medicine, 2:733, 735. 

19. Clayton Idtlhe Tropical Disease Board soon 

arter his appOintment in 1899. 

20. Quotations rrom Williamj. Calven , "Plague 

in the Ori en t," pp. 60, 63. See also j oseph]. Curry, 

"Bubonic Plague," p. 278; idem, "U.s. Army," pp. 

175-76. 

21. WO, ARojSG, 1900, PI'. 218-20, and 1901, 

PI'. 202, 219-34; Sternberg, "History," pp. 813-14; 

Richa rd P. Strong, "Studies in Plague Immunity," pp. 

157-59, 302, 324-27, 329; Charles E Craig, "The 

Bubonic Plague From a Sanitary Standpoint," pp. 

586-87. 

22. WO, ARojSG, 1901, p. 236, 1903, p. 69, and 

1911 ,1'.129; Richard H. Follis,Jr. , "Cellular Pa thology and the Development or the Deficiency Disease 

Concept ," p. 295. 

23. The lerm ViWllIill c was introduced in 1911 

by biochemist Casimir Funk, who in the course or 

his resea rch into the cause of beri be ri concl uded thaI 

the necessary rac tors in the di et were all amine deriva tives. See Henry A. Skinner, Tile Origin oj I\llcdiall Terllls, p. 365. 

24. WD, ARojSG, 1901, PI'. 237, 239 (first quotation), 1902, pp. 100 (second quotation), 101, 

1903 , pp. 69-70, 1905, p. 52, 1910, PI'. 120-21, 

1911 ,1'1'.128,130, 132, and 1912, 1'1'.130, 138; Rpt, 

Harry A. Littlefield, I May 1902, Ms 5000, Entry 52, 

Record Group (RG) 112, National Archives and 

Records Administration (NARA), Washington, D.C.; 

'vVeston P. Chamberlain, Horace D. Bloombergh, and 

Edward B. Vedder, "Report of the U.s. Army Board 

roJ' the Stud}' or Tropical Diseases as They Exist in 

the Philippine Islands," p. 446; Weston P. Cbamber~ 

lain, "The Disappearance orBeriberi From the Philippine (Na tive) Scouts," pp. 514- 15; Weston P. Chamberlain and Edward B. Vedder, "The Cureof lnrantile 

Beriberi by the Administration to the Infant or an Extract or Rice Polishings ... ," p. 30. 

25. Chamberlain and Vedder, "Inrantile 

Beriberi," pp. 26-27,29; Scott, HislOlY, 2:892; Edwa rd B. Vedder, Beriberi, pp. 257, 264; Edward B. 

Vedder and Robert R. Williams, "Concerning the 

Beriberi-preventing Substances or Vilamines Contained in Rice Polishings," p. 194; Roben R. 

Williams and N. M. Saleeby, "Expe rimental TreatIllent or Human Beriberi With Constituents or Rice 

Polishings," p. 118. 

26. United States, Bureau or the Census, Cellslls 

oj the Philippille Is/CHIC/s ... , 1:323 (herearler cited 

as Philippi/Ie Censlls); WD, ARoJSG, 1903, pp. 

96-97; idem ,ARojSIV, 1902, 10(pt.l):359,384, and 

1906, 1:80-82; Richard P. Strong, "Vaccination 

Against Plague," p. 190; idem, "The Investigations 

Carried on by the Biological Laboratory in Relation 

to the SuppreSSion or the Recent Cholera Outbreak 

in Manil a, " pp. 437-38. See also Kristine A. Campbell , "Knots in the Fabric," pp. 600-38. 

27. WD, ARojSG, 1902, PI'. 81 (quotation), 92; 

Henry j. Nichols and Vernon L. Andrews, "The 

Treatmentor Asiatic Cholera During the Recent Epidemic," pp. 81, 91. 

28. james M. Phalen and Henry]. Nichols, "Blastomycosis or the Skin in the Philippines," pp. 

280-81, 285,288,292; idem, ''The Work orthe Board 

ror the Study orTropical Diseases in the Philippines," 

1'.467; WO, ARojSG, 1907, p. 41, 1908, p. 99, 1911, 

1'1'.122, 141-42, and 1912, 1'.140; Weston r Cham-
PUBLIC HEALTH IN THE PHILIPPINES 

be rla in , Horace D. Bloombergh, and Edwin D. Kilbourne, "Report of the Board fo r the Study of Tropica l Diseases in the Phili ppine Islands, Quarter Ending Sept. 30, 1910," p. 195; Nichols and Phalen, 

"Wo rk of the Board," p. 370; Perc), M. Ashburn and 

Charles F. Craig, "ObserVaLions Upon Treponema 

Pertinuis Castellani of Yaws and the Experimenta l 

Productio n of the Disease in Monkeys," pp. 443, 463; 

Willi am E. Musgrave and M. T. Clegg, "The Etiology 

of Mycetoma ," p. 499. 

29. Ken de Bevoise, "U nlil God Knows When," 

p. 160 (quota tions); Philippine Censlls, 3: 17; John 

Duffy, The Sanilarj(IIIS, pp. 146-47. 

30. Bevoise, "Until ," pp. 149 (second quotation), 150-54, 159- 60 (rirsL quota tion); idem, "The 

Compromised HOSLS ," Ph .D. diss" PI'. iv-v (third 

quo tation), 280-81 , 285; Pll ilippine Census, 3:10, 

23-24,38-39; Reynaldo C. Ileto, "Cholera and the 

O rigins of the American Sanitary Order in the 

Phili ppines," in imperi al Medi cine a nd Indigenous Socielies, pp. 128. 130-31, 140;jose P. Bant ug, A SllOrt 

HistOlY of Medicine in til e Plli /ippines Durillg tl! eSpmlish Regillle, 1565-1898, pp. 26,35- 37,70,76,109; 

William T. SexlOll , Soldiers ill the Philippines, p . 33. 

31. Maus held the pe rmanent rank of major 

when hea rrived in the Phili ppines anc1 la ter received 

his promotion to lieutenant colonel on 7 April 1902. 

32. Frederick Chambe rlin, The Philippine Probielll, 1898- 1913, pp. 116- 17 (nrst quotation); WO, 

ARofSW, 1902, lO(pt.l):330 (second quotation), 

371 (fourth quotation), 329 (fifth quotaLi on), 1904, 

12(pI.2):89, and 1907, 9(1'1.3):281-82; G. J. 

Youngh usband, The Philippines and Round About 

(New York: Macmillan Co., 1899), pp. 53-54, cited 

in Gaines M. Foster, The Demands of HllnWllity, p. 

29 (third quotation); William T. Sexton , TheSoldiers 

in the SUII, pp. 51-52, 104- 05; MaliS, "Military Sanitary Problems," p. 5; Duffy, Sa nitaria ns, pp. 175, 

178, 190,199; Victor G. Heiser, "Unsolved Hea lth 

Problems Peculi ar to the Philippi nes," p. 171. 

33. Victor G. Heiser, All American Doctors 

Odyssey, p. 60 (quota tions); Regulations oftlleAnJlY 

of the United States, 1895, p. 11 (hereaft er cited as 

Army ReglllaliOlls, date). Maj. Frank S. Bourns of the 

U.S. Volunt eers was the first president of the Man ila 

Board of Health. He was succeeded on 28 August 

1899 by Maj. Guy L. Edi e, also or the U.S. Volunteers, who was followed in this office by Maj. 

Franklin A. Meacham, U.S. Vo lunteers. See WD, 

ARofSG, 1899, 1'.119, 1900, p. 99, and 1901, 1'.138. 

34. This board will be referred to as the Philippine Board of Health to distinguish it from its predecessor, the Manila Board of Health. 

309 

35. Major MallS was detailed to serve as the first 

commissioner of public healt h fo r the Philippines 

on 26j uly 1901. He was succeeded in 1902 by Maj. 

Edwa rd C. Carter, U.S. Volunteers. The first chi ef 

health inspector was Major Meacham. His successor in April 1902 was Major Bourns, who reSigned 

two months later. The pOSition of c hief hea lth inspec tor was apparently vacant until September, 

when T. R. Marshall , presumably a civilian, became 

chief health inspecLOr. See WD, ARofSW, 1902, 

10(pl.1):31O, and 1903, 6(1'1.2):136, 143. 

36. WO, ARofSG, 1900, p. 99, 1901, Pl'. 138, 

141, and 1902, p. 46; idem, ARofSW, 1900, 

1(pl.lO):283-84, 1902, 10(1'1.1):261-62, 274, 

309-10, 1903, 6(pI. 2):66 and 8:9, 11 1, 567, 596, 

and 1904, 11 :75-77 and 12(1'1.2):83 (quotations); 

Army RegulaLiolls, 1901, p. 12; Digest of Opinions of 

tlteJlulge Advocate General of Llle Army, 1912- 1940, 

p. 115; Paul C. Freer, "Plague a nd La te Cholera Epidemic in the Philippine Islands," p. 346; Cha rles R. 

Green lea f, "A Brief Statement of the Sanitary Work 

So Far Accomplished in the Phili ppine Islands. 

p. 159; Louis H. Fales, "The American Physician in 

the Philippine Civil Service," p. 5 15. 

37. Wilfrid Tu rnbull, "Reminiscences of an Army 

Surgeon in Cuba and the Philippines," p. 48 (first quolalion); WD ,ARofSG, 1902, p. 46 (second quotation); 

idem ,ARofSW , 1902, 2(pl. l ):290a, lO(pl. l ):263, 356, 

and 11:69-72, 1903, 6(1'1.2):116--18, 1904, 

12(pI. 2):84, 134, and 1907, 9(pI.3):280; Samuel O. L. 

POLLer, "Notes on the Philippines," p. 805; Fales, 

"American PhYSician," Pl'. 513-14, 516-17. 

38. WO , ARofSW, 1904, 12(pI.2): 132 and 

14:406, 1905, 11(pI.2):63, 66-67, and 1907, 

8(pI. 2):96, 110; idem, ARofSG, 1911, pp. 104-05; 

j ohn M. Gates, ScllOolboob (lnd Krags, p. 59. 

39. WO, ARofSW, 1903, 6(1'1.2):68-70; idem, 

ARofSG, 1899, Pl'. 119, 135-36, and 1900, p. 99; 

Sexton , Soldiers ill [lIe Philippines, pp. 29-30,33,38; 

Philippine Censlls, 3:74. 

40. Foster, Demands of Humanity. pp. 29-30; 

WO, ARofSG, 1900, 1(1'1.10):285, and 1901, 

l (pL.9):381-82; Greenleaf, "Brief Statement," p. 

162; Richard H. Shryock, Medicine in Alllerica, pp. 

126-27, 129-32, 138. 

41. WO, ARofSW, 1902, lO(pl.l):261, 272. 

42. Ibid., Pl'. 262, 272, 274, and 1903,6(1'1.2):79, 

81; idem, ARofSG, 1899, pp. 135-36, and 1901, p. 

L39;Sexton,Soldiers illl,/J eSull, p. 56; Freer, "Plague," 

p. 346; Greenleaf, "Brief Statement," p. 161. 

43. Sexton, Soldiers jll the SUII, pp. 56, 59-60; 

WO, ARofSW, 1903,6(1'1. 2):86-87 and 8:49, and 

1907,9(1'1.3):285. 
310 T HE ARMY MEDICAL DEPARTMENT, 1865-1917 

44. WD , AllofSC, 1901, PI'. 138-39; idem, 

ARofSW, 1903 , 6(1'<.2):66-67,74,82-83,93, 104, 

137. 

45. Malis, ;'Military Sanitary Problems," p .. 14; 

WD, AllofSW, J903, 6(1'<.2):75, 77, 91-92; Chamberlin. Phi/ippille Prohlem , pp. 22-23 (quotation), 

24-25. 

46. WD, ARofSW, 1903, 6(1'<.2):74, 76-77, 

91- 92, 1904, 12(1'<.2):90, and 1907, 

9(pt.3):284--85; idem, IIRofSC, 1903, p. 44. 

47. WD, ARofSW, 1900, \{p!.l0):285 (quotation), 1902, 10(1'<.1):277-78, 1903, 6(1'<.2):96-97, 

1904, J2(p<.2): 150 and 13(1'<.3):733, and 1905, 

11 (1'<.2):94; idem, ARofSC, 1900, p. 215; Cates, 

Sclwolboohs, pp. 57-58; Sexton , Soldiers ill 'he 51111, 

pp. 55-56; Frank S. Bourns, "Some NOLes on the 

Philippines," pp. 732- 33; Freer, "Plague," pp. 

346-47; HmT}' Morell , "A Brief Description of the 

Hospitals of Manila, vVilh a Few NOles on the 

Plaglle," p. 261; Bevoise, "Until," pp. 155, 158. 

48. WD, AlloJSIII, 1902, JO(p<.I):264, 343--44. 

49. Ibid. , PI'. 277-78, 1903, 6(1'<.2):96--97, 

101-02, 1904,12(1'<.2): 150 and D(p<.3):733, and 

1905, lI(pl.2):94. 

SO. Ibid. , 1900, l(pLlO):284, 1902, 

10(1'<.1):411 , 1903, 6(pl.2): IIJ ,1904,12(pl.2):94, 

and 1905, 11(pl.2):75; idem, ARofSC, 1900, PI'. 

100--101, 106, and 190 I, PI'. 140, 240-4 1; "Medical News," p. 437; SexLOIl , So ldi ers ill Ihe SlUt, pp. 

55-56. 

5 1. WD ,ARofS\\I, 1900,l(pl.IO):284, and 1903, 

6(pl.2): Ito; idem, ARofSC, 1900, PI'. 99 (quot ation), 123- 24, 143;John M. Banister, "Medical and 

Surgical Observations During a Three-Year Tour of 

DUly in the Philippines," p. 275; Bourns, "Some 

Notes," p. 732; Green leaf, "Brief Statement," pp. 

158-59. 

52. WD, ARofSW, 1902, 10(1'1.1):264, 1904, 

12(1'1.2):95-96, 101, and 1905,5(1'1.1):770,819; 

idem, ARoJSC, 1900, PI'. 99,106,125, and 1901, p. 

140; Greenleaf, "Brief Statement," p. 159; freer, 

"Plague," p. 347. 

53. WD, ARoJSW, 1900, \(pI.10):285, 1902, 

10(1'1.1):275, and 1903,6(1'1.2): 181-82, 186; idem, 

ARofSC, 1900, p. 214, and 1901, 1'1'. 139,230-31; 

Sex LOn, Soldiers ill the 5 1111 , PI'. 56-57; James A. 

LeRoy, "The Philippines Health Problem," p. 779; 

Sternberg, Slemvelg, PI'. 210-11; Freer, "Plague," p. 

347; Maxmill ian Herzog, "Bubonic Plague in the 

Philippine Islands From Its First Outbreal< in 1899 

[0 1905," PI'. 652-54. 

54. WD, AI~oJSW , 1903, 6(pI.2):18J, 188; idem, 

ARofSC, 1900, p. 211, and 1902, p. 99; Freer, 

"Plague," p. 347. 

55. \-Villimn E. Musgrave, "Infant Monality in 

the Philippine Islands," p. 466 ([irs! quotation); 

WD, ARofSW, 1902, 10(1'1.1):271,1903,5(1'1.1 ):57 

and 6(pl.2):109, and 1904, 12(1'1. 2):114 (second 

quotation), 115-16; Banister, "Medical and Surgical 

Observations," pp. 15 1, 1.62; Ban tug, Sharf /-liS/OI) ', 

1'.35. 

56. Henry du R. Phelan, "San itary Service in 

Surigao, a Filipino Town in the Island of Mi ndanao," 

pp. 1.,3; Banister, "Medical and Surgical Observations," p. 157; Gates, ScllOOlbooils , p. 136; L}'ster, 

"Army Surgeon," p. 33; WD, ARoJSW, 1904, 

12(1'1.2):121; idem, ARofSC, 1902, PI'. 81, 94. 

57. WD,ARojSG, 1903, p. 92 (quotations); idem, 

A RoJSW, J903, 6(1'1.2):106, 11 5, and 1904, 

12(pt.2):117-18, 123-26; Banister, "Medical and 

Surgical Observal ions," p. l 5 1. 

58. Phelan, "San itary Service," PI'. 5 (quotation), 6, 9; Banister, "Medical and Surgical Observat ions," p. 152; Maus, "Mil itary Sanital")' Problems," p. 7; WD, ARofSW, 1902, lO(pl.J ):413. 

59. Phelan, "Sanitary Service, " p. 18 (firsl lhree 

quotations); WD, ARoJSIII, 1902, 10(1'1.1):413 

(next three quotations) and 411 (fi nal quotation), 

and 1903, 6(pt.2):106; Banister, "Medical and Surgical Observations," p. 157. 

60. 'vI'D, ARoJSC, 1902, PI'. 82-83, and 1910, p. 

95; iclem, A RoJSW, 1903, 6(1'1. 2):]07, and 1904, 

12(pl.2):86, 114, 132;John M. Banister, "A nny Sanitary Administration in the United States and in the 

Tropics," PI' . 570-71; idem, "Medical and Surgical 

Observations," pp. 149-51; Elbert E. Persons, 

"M edical Service With Philippine Scouts," PI'. 

708-10. 

61. WD, A RoJSII', 1903, 6(1'1.2):63-65, 112; 

Joseph J. Curry, "Report on Parasitic Disease in 

Horses, Mules and Caribao in the Philippine Islands," p. 512; Edwin D. Kilbourne, "Some Experiments \-Vith the Trypanosoma Evansi," p. 250; Paul 

G. \-Voolley, "Rinderpest," p. 577. Glenn A. May in 

Baffle JOI" Bafangas suggests that by killing ofr so 

many of the animals upon which mosquitoes preferred to reed, the rinderpest epidemic and military 

operations led these insects to feed more frequentl y 

upon humans and thus indirec tly contributed LO ri sing malaria rates (see PI' . 26, 266-67,271). 

62. Philippille Censlls, 3:28-29; Duffy, Swlifari-

{illS, p. 180 

63. Louis Shapiro, "Umbilical Tetanus," p. 245; 

WD, ARofSC, ]901, p. 139; idem, ARofS\\I, 1903, 
PUBLI C HEALTH IN THE PHILIPPINES 

6(1'1.2):7 1, 100, and 1904, 12(pl.2):85, 88; Fales, 

"Ameri can Physician," p. 513 (quotation); W illiam 

E. M usgrave and George F: Rich mond, ") nfant Feeding and Its Influence Upon Infa11l Mortality in the 

Philippine Islands," pp. 362, 364-65, 385; Vernon 

L. Andrews, "Infantile Beriberi," Pl'. 85-86. 

M. WD , ARofSW, 1903, 6(1'1.2): 100, 1904, 

12(1'1.2):85,87, 1905, 2(pl.2):131 and 5(pl.I):58, 

and 1908, 8(pL2):22; Musgrave, "In fant M ortali ty," 

pp. 459, 466; George Rosen, PrevclIUve Medicille ill 

til e United Slales, .1900- 1975, pp. 3, 5, 7, 42. 

65. WD, ARofSG, 1900, PI'. 126, 133-34, 1906, 

p. 109, 1907, p. 40, 19 12, p. 140; idem, ARofSW, 

1902, 1O(pt.l):347, 1903, 6(pl.2):97-98, 110- 11 , 

1904, 12(pl.2):93, and 1908, 8(1'1. 2):90; Sexton, 

Soldiers ill lite SIIII , pp. 58-59; Gales, SdlOOllJoob, 

p. 136; "J-Iealt h of Ameri cans in the Philippines," 

pp. 700-70 1; Ban ister, "Medical and Surgical Observations," PI'. 270, 272; ltrs, 1-1 . E. Wetheri ll to 

311 

SC , 13 Apr 1900, and 'v.l. F. Lewis to SG, 17 May 

1900, Ms 4888, En!r)' 52, RG 112, NARA; Hem)' j. 

N ichols, "The Simple and Double Contin ued Fevers 

or the Philippines," p. 368; Rosen, PrcvcltU ve lvlell;-

eilte, p. 4; Department or the Arm)', Office or the Surgeon General , ComlltwliwlJle Diseases: Ma/(lria , p. 

526; Chamberlain and Vedder, "The Cure or Inrantile Beri beri," pp. 30, 32. The unexpecled ly low nile 

or malaria in Ihe Philippines might, however, have 

been related to a genetiC resistance. See Andrew A. 

Skolnick, "Newround Genetic Derect Hints al Clues 

for Developing Novel Ant imalarial Agents," p. 1765. 

66. WD, ARofSW, 1903 , 6(1'1.2):68-70, 1904, 

12(1'1. 2):86, and 1905, lI(pl.2):I24; Gales, SchoolboollS, p. 60. 

67. Leila)" "Phili ppines," p. 778; WD, ARofSW, 

1903, 6(pI.2):65; Rosen, Prc\'eltli ve Medicine, p. 48; 

Chamberlin , Pililippine Problem , p. 115 (quotation); 

IICIO, "Cholera," in Imperill/ Medicine , p. 125. 

Chapter 12 

THE ORGANIZATIONAL REVOLUTION 

The organi zati onal revolUlion that took 

place in the Army Medical Department 

after 1898 was inspired by a growing 

awareness of the implications of the nation's new status as a world power and a 

long-held concern of reformers about the 

lack of preparation of the Army as a whole 

for modern warfare. The experiences of the 

Span ish-American War had confirmed 

their belief that significant changes were 

needed in the orga nization and managementofboth the Army and its va rious components, in the size of the permanent force, 

and in the training of officers and men. 

Thus the pattern characteristic of previous 

postwar periods, when the Army and its 

Medical Department had tended to revert 

to their prewar staLUs, was broken after the 

Spanish-American connict. i 

The initial changes accomplished during the period before the outbreak of World 

War I came largely because of the efforts of 

Secretary of War Root, who believed that 

strong centrali zed control and close coordination of the work of the various 

branches of the Army were needed. The 

most Significant of the changes Root inspired was the creation in 1903 of the position of chief of staff, with its supporting 

General Staff to coordinate the work of the 

Army's various branches and to be responsible for overall planning. A medical officer was usually detailed to the General 

Staff, thereby providing the Army's leaders 

with insight into the Medical Department's 

concerns. Although not himself a member 

of the Genera l Staff, the surgeon general 

could also explain his department's needs 

and responsibilities to that organization, 

thus increasing the likelihood that they 

would be considered when the Army's fuLUre course wassel. Butdisagreementabout 

the best way to prepare for modern warfare 

and opposition from those whose positions 

were threatened by change made progress 

tedious and rendered the achievement of 

still further reform difficult for both the 

Army and its Medical Department.' 

After Root's resignation in January 

1904, his drive to improve the Army's effi ciency and effectiveness langUished until 

April 1910, when Maj. Gen. Leonard 

Wood became Army chief of stafr. Despite 

having endured two operations to remove 

a brain tumor only weeks before taking offi ce, General Wood attacked his new responsibiliti es with characteristic vigor. He 

soon discovered that the chief obstacle to 

his plans for an Army more nea rly approaching European standards in size and 

training was another former medical officer, Maj. Gen. Fred C. Ainsworth , the adjutant general, who strongly and actively 

opposed the more centralized organization 

Wood sought. In May 1911, when Henry 

L. Stimson became secretary of war, the 
314 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

chief of sta ff gained a valuable all y in support of his reform efforts. With the forced 

retirement of Ainswo rth in 1912, Wood's 

authori ty was left un cha llenged, enabling 

hi m to concentrate on crea ting an army 

that could hold its own against any foe.' 

The means General Wood used to 

achieve his goal- increasing the size of the 

Army, making the division rather than the 

regimenl lhe basic unit of organi zation, and 

emphasizing the training of bo th orncers 

and men- had profound effects on the 

Army Medical Department. The increased 

size of th e Army di ctated an increase in the 

size of the Medical Department, one that 

led to additi onal administrative complexity. The move to make the division the basic 

unit of organization in the fi eld required 

collateral changes in th e depa rtment's approach to medical support. The emphasis 

on training placed a heavy obligati on upon 

those already in the department, who 

would be call ed upon to indoctrinate new 

members of the depanment, Nati onal 

Guard physicians, and line orncers in the 

department's increaSingly complex responsibiliti es. Because of the need to accommodate Medica l Department orga nization 

and procedures to those of the Army as a 

whole and also beca use of co ntinu ing 

progress in the world of medicine, the years 

befo re the outbrea k of World War I were a 

time of Significant change. 

The Surgeon Generals 

With the focus of attention increasingly 

upon preparedness, attacks on Su rgeon 

General Stern berg for his role in the Medica l Department's fa ilure to make adequate 

medical care availabl e to the soldiers of 

1898 never ceased, in spite of the fact that 

the Dodge Commission had not placed 

major blame on the department for the d isasters of 1898.' At least one critic rea listicall y commented that the department had 

"accomplished all that could have been accomplished undenhe circumstances. " Few 

could argue, however, that Stern berg's pri ncipal contribution to the Medica l Department and to the Army lay in his attempts 

to give medical orncers better weapons 

with which to fi ght the diseases that had 

threa tened the health and the lives of the 

troops in war and in peace. By creating 

boards specifica lly to study typhoid fever 

and yellow fever and by assigning the fin est 

scien tists in the department to serve on 

them, Sternberg ga ined for himself a large 

degree of the credit fo r redUCing the threat 

these diseases posed to soldiers and civilians alike. In appointing a board to study 

the health problems of the Phili ppines, he 

set a precedent that was foll owed by his 

successo rs [or many years. A law passed on 

2 February 1901 as part of the Root refo rms 

limiting the term of a surgeon general to 

four years did not apply to Sternberg;' because of age and with charges still ringing 

in his ears that his "vain regime" had been 

an "ingrained orgy of incapaCity" and that 

"the one great blot of the war [rested] upon 

the medical and surgical department of the 

army," he retired in June 19026 

Alone of the men who served as surgeon 

general between the Spanish-America n 

War and Wo rld War I, Stern berg'S immediate successor, Surgeon Genera l Forwood, failed to leave his mark upon the 

Medical Department. In orn ce only three 

months, until September 1902, Forwood 

was fated to be remembered chieny for his 

management of Camp Wikoff in 1898,' 

which had brought him under heavy attack. Upon Forwood's retirement, the law 

passed on 30 June 1902 that forbade the 

appoin tment of any o rncer as head of a de-
THE ORGANIZATIONAL REVOLUTION 

W ,LLIAM H. FORWOOD 

partment whose age would require retirement in less than foul' years came into effect. As a result, Colonel O'Reilly was appointed as Forwood's successor over 

several other medical offi cers who had 

more time in service. 8 

Surgeon General O'Reilly's career in the 

Army began when he interrupted his medical education during the Civil War to 

serve as a medical cadet, a wartime position created for medi ca l students. He completedmedical school after the war and in 

1867 was appointed assistant surgeon. By 

1868 he was reported to be suffering from 

"premonitary [sic] symptoms of cerebral 

disease," including insomnia, nightmares, 

memory loss, and headaches, requiring 

him to take several months of leave to head 

off what was seen as the threat of pennanent disability. Although O'Reilly's health 

thereafter was apparentl y not robust, he 

acquired through the years an enviable 

3 15 

ROBERT M. O'REILLY 

reputation. Bailey Ashford in his autob iography described him as "an excellent administrator, the very embodiment of a 

high-ranking military officer, ... also a 

great physician," wh ile Walter Reed wrote 

in 1902 that he was "a distinguished gentl eman ... with sufficient politi cal acumen to make him of material assistance in 

the Medical Depa rtment. " Later in his autobiography Brig. Gen. Jefferson R. Kean 

wrote of the great affecti on O'Reill y's many 

fri ends, and especially those who had 

served under him, had for him. O'Reilly's 

image amongjunior officers as "a father to 

us all " was undoubtedly furthered by the 

fact that, brea king with tradition , he chose 

younger men to serve in the Surgeon Generai's Office. Having selected th ese men 

"wisely and well ," as one medi cal historian 

put it, he went out of his way to encourage them to use their talents to the full est9 
316 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

G EORGE H . TORNEY 

Upon O'Reilly's retirement in January 

1909, Torney became head of the Medical 

Department. Torney's success in managing 

the medical response to the challenges of 

the San Francisco earthquake and fire of 

1906 led to his promotion over several of 

the department's most distinguished medical offi cers who were senior to him in 

rank, among them Colonel Gorgas, whose 

work in Panama was bringing him increasing fame in the fi eld of public health. 

As surgeon general , Torney followed the 

path laid down by his predecessor, retaining O'Reilly's staff and policies. Although 

Torney had a reputation for impulsiveness, 

his work in preparing the department to 

care for an army at war was so highly regarded that he was reappointed La a second term in January 1913. As that year 

neared its close, however, Torney was desperately ill as a result of a bacterial infection of the heart. After developing pneumania on 22 December he survived but 

fi ve days, dying on 27 December. He left 

the completion of his work to Gorgas, who 

succeeded him in January 1914. 10 

The Surgeon Ge ral ~ Office 

Although the Dodge Commission exonerated the Medical Department for any 

major responsibility for the horrors of the 

Spanish-Ameri can War, it was criti ca l of 

the organization and management of the 

Surgeon General's Offi ce. Neither Surgeo n 

Generals Sternberg nor Forwood attempted the reorganization and streamlining suggested by the Dodge Commission. 

After nine months of study, Surgeon General O'Reilly concluded that the work of 

his office was unevenly divided among his 

assistants and that many minor matters 

that burdened him could be better handled 

by his subordinates. The delegation and redistribution of authority he initiated 

would make it possible, he believed, to expand the department to meet wartime 

needs without encumbering fu ture surgeon generals with details of the kind that 

had preoccupied Sternberg. II 

In attempting to deal with the problems 

of his growing organization, Surgeo n General O'Reilly created a fifth division in his 

offi ce specifi ca lly to manage personnel, a 

responsibility that had been handled by the 

chief clerk. He also established a foreign 

service roster, which made it possible to 

give medical offi cers several months' advance warning of impending overseas assignments and also La "equalize foreign 

service among the officers so far as was 

practicable . . .. " He wasapparentlyunable 

to improve the situation of the department's clerks. Since no retirement was 

available for them, the oldest members of 
THE ORGANIZATIONAL REVOLUTION 

the staff, 28 percent of whom were over 60, 

were given lesser responsibilities as their 

capacity for work dwindled to avoid discharging them. In a report to Secretary of 

War Root, the curator of the Army Medical Museum suggested another problem, 

one that resulted from the fa ct that women, 

considered to be less efficient workers because they were sick more often and 

needed more help than the men , formed a 

quarter of the clerical stafL " 

When Torney became surgeo n general 

in 1909 the Surgeon General's Offi ce itself 

was still a simple organization, in spite of 

the increased size of the Medical Department and of the cleri cal stafL I) As under 

O'Reilly, the superintendent of nurses reported directly to the surgeon general, and 

all other personnel in the office were 

grouped into fi ve di visions. Medical officers headed separate divisions of supply, 

sanitation, and personnel, while yet another ran the museum and library, where 

seven speCialists, two with permanent civil 

service appointments, were part of the 

stafL The fifth division consisted of the 

clerical staff of ninety-eight employees, 

both male and female, which handled general administra ti ve matters under the supervision of a chief c1erlc H 

Like O'Reilly, Surgeon General Torney 

was concerned about the female clerks in 

his office. He wanted to restrict hiri ng to 

men until the percentage of women had 

been red uced because he believed that the 

"largely scientific and professional" work 

expected of clerks at the higher levels dictated an increase in the number of men at 

the lower levels available for promotion. 

"Vacancies in the higher executive positions [should} be fi lled from among the 

men clerks," women being "not as universally as men amenable to the calls of discipline." Furthermore, he noted, women 

317 

"as a rule do not exhibit that larger zeal 

and interest in wide offi cial horizons 

which wo uld fit them for higher usefulness ... . " Torney also urged that he be allowed to offer higher sa laries, and, moved 

by the plight of some of his elderly, longtime employees whose low salaries fo rced 

them to continue to work in spite of physical and even mental infirmities, he suggested that a pension plan be created. IS 

Despite his sensitivity to the needs of his 

male subordinates, no matter how humble 

their positions, Surgeon General Torney 

found himself invo lved in a controversy 

over his management of personnel, the 

seeds of which he inherited from his predecessors. Since the days of the second surgeon general, Brig. Gen. Thomas Lawso n, 

the head of the Medical Department had 

traditionally retained his most trusted assistants in Washington , where their skills 

and their advice were constantly available 

to him. Unlike Lawson, however, whose refusal to grant preferential treatment to 

world-famous Surgeon William Beaumont 

led to the latter's resignati on from the 

Anny,16 subsequent surgeon generals occasionally also undertook to spare some of 

the department's foremost scientists and researchers the routine rotations that were 

the lot of others. As growing numbers of 

medical officers became involved in research, the question of whether the assignments of all medical officers should be rotated and whether, beyond that, all medical 

officers should receive fore ign assignments 

look on an increasing importance. 17 

Surgeon General O'Reilly's exclusion of 

the medical officers serving in his office 

from the foreign service roster highlighted 

the time-honored custom of retaining the 

surgeon general's assistants in Washington. 

Surgeon General Torney was not successfu l in retaining that policy, in spite of his 
318 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

1912 protest of a move to extend the fouryear rotation rule customary in the rest of 

the Army to the Medical Department. He 

maintained that un less a delay were 

granted, such a move would upset the 

schedule of the Army Medical School. He 

also claimed that although it was desirable 

that most medi cal orricers be generalists, 

the great strides in preventive medicine 

made by th e Army had resulted from the 

work of speCialists, for whom regular rotation from assignment to assignment would 

have been counterproduc tive. Rotation 

overseas seemed to be at the heart of the 

discussion, and the now particularly obvious fa ct that certain medical orricers, men 

who were not necessarily eminent specialists, were rarely, if ever, rotated to foreign 

assignments triggered charges of favo ritism 

against Torney and eventually involved 

Chief of Staff Wood. In December 1912 

General Wood, who had th e reputati on of 

going out of his way to avoid the appearance of favoring th e Medical Department, 

ordered that certain medi cal orri cers who 

seemed La have benefited from fa voritism , 

among th em future surgeon genera l Lt. 

Col. Merrille W. Ireland , be sched uled for 

foreign service immediately. 18 

Medical Officers 

Many demands placed upon the Medical 

Department after 1898 exacerbated old diffi culties even as they created new ones. Perhaps the department's oldest problem, a 

shortage of trained and experienced physicians, became formidabl e in the face of the 

possibility of modern warfare. Experience 

dating from long before the Spanish-American War had already taught the Army that 

waiting to deal with this situation until war 

was imminent and large numbers of civilian 

physicians had to be called in to meet emergency needs precipitated further complications, for "an untrained, or even a halftrained Medical Orricer" was "by the very 

nature of things an ally of the enemy. " Furthennore, although one of the Dodge Commission's specifi c recommendations had 

been for increases in the number of medical 

orricers in the department, any significant 

progress that might be made toward achieving this goal would only add to the problem 

of familiarizing new medical orricers with 

the ever-increasing complexities of their administrative and medical responsibilities. 

Nevertheless, Co ngress continued to ignore 

the question of medical care for the victims 

of future wars and to be niggardly in increasing the size of the department to meet 

already existing needs. Thus, for years after 

the end of the Spanish-American War, Medical Department efforts to prevent a recurrence of the shortage of trained and experienced personnel were, like those of other 

agencies in a similar predicament, in vain. 

In 1904 the proportion of medical orricers 

to the total number of men in the Army was 

less than half that in either the Civil War or 

the Spanish-American War.'· 

That these problems wo uld continue to 

plague the Medica l Department began to 

become obvious in the months after the 

end of the war. The volunteers and regulars who had enlisted specifically for the 

war were mustered out, and in March 1899 

Congress authorized an army of 65,000 

regulars, an increase from the previous authorized peacetime strength of 27,000. 

The legislature also created a 35,000-man 

volunteer force to rep lace the wa rtime volunteers in th e Phili ppines and to serve 

unti l 30 June 1901. Eac h o f the vo lunteer 

regiments was to have three surgeons. Although most of the physicians who accepted positions as regimenta l and assis-
THE O RGANIZATIONA L REVOLUTION 

Lan1 surgeons with the volunteers at this 

time were veterans of the Spanish-American War, Surgeo n General Sternberg believed that ideally at least one physician 

with each volunteer regimen t should be a 

regul ar medi ca l orncer. As a result, of the 

140 medical orncers appointed to the 

United States Vo lunteers by J une 1899, 45 

were regular medi cal o[[i cers'o 

Surgeon General Sternberg protested 

the continued shortage of trained medical 

ofricers by poillling out tha t a department 

with only 15 more physicians than before 

th e beginning of the Spanish-American 

Wa r could not provide adequate ca re for 

an army spread out from th e Caribbean to 

the Pacifi c, espeCially when troops were 

still conducting acti ve military operations 

in the Philippines. Congress' initial response to Sternberg's pl ea was restricted, 

however, to granting his request that th e 

previous limit of 400 co ntract physicians 

be raised to 480. To make the best of this 

bad situati on, the surgeon general urged 

that Nati onal Guard physicians be instructed in hygiene and sa nitation to create a pool of doctors trained as military surgeons to be ava ilable in th e event of war." 

The situation did not improve when, on 

2 February 1901, shortly before the volunteers of 1899 were mustered out, Congress 

voted to increase regular infa lllry regiments from twenty-fi ve to thirty and regular cavalry regiments from ten to fi fteen, 

but added only 129 more medical orficers 

to the Medical Department stafr. A total of 

320 medical orficers was thus expected to 

care fo r the almost 86,000 orficers and men 

that could now serve in th e Regular Army 

and their families as well. Rather than further increasing the department'sstaff of regulars to meet th e needs of th e hundreds of 

isolated posts still existi ng in the Philippines and to care for 5,000 scouts, the leg319 

islature permitted the president to appoint 

200 surgeons and assistalll surgeons of the 

U.s. Volunteers to supplement the regular 

medical o rficers in th e Phili ppines for two 

years. With barely more than 500 physicians, the depattment was thus requireclto 

provide medical attendance to a total of 125 

posts, to 567 garrisons in the Phili ppines, 

to fi ve general hospitals in the United States 

and the Philippines, and to troop tra nsports. Moreover, add itional physicians 

were needed at the Army Medica l Museum 

and the Surgeon General's Libra ry. Even the 

new Hygieni c Laboratory of the Publi c 

Health and Marine Hospital Service used 

the services of the Army's medical experts; 

a medical orfi cer was regularl y detailed to 

its eight-member advisory board . Sti II faced 

with a shortage of orficers, the department 

was forced to continue its heavy reliance 

on contract surgeons. 22 

To obtain the max imum benefi t from the 

new openings for regulars voted in 1901, 

Surgeon General Stern berg encouraged experienced contract and volunteer surgeons 

to take the Medical Department's entrance 

exam, and Congress permitted the time the 

volunteers had served to be counted toward 

their rank if they passed. The reopening of 

the Army Medical School in November 1901 

guaranteed that even inexperienced medical 

olTicers would soon become familiar with 

the most basic requirements of militaty 

medicine; however, although more than half 

of the nation's physicians earned as civilians 

less than what they could earn as first lieutenants, Medical Department salari es were 

too low to attract the best doctors. Furthermore, the large proporti on of medical officers in the lower ranks clogged the pathway 

to promotion, and thus Sternberg was losing to civilian life some of the most promising young surgeons already in the department. Since the 1901 law did not address the 
320 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

problem of how to obtain the large numbers 

of trained physicians that would be needed 

in the event of war, the Medical DepartmenL 

was still not prepared to meet the demands 

of a major emergency." 

When O'Reilly too k offi ce as surgeon 

general, the Medical Department's problems seemed to be multiplying, but he 

showed no sign of being intimidated. Initially, he was no more successful in obtaining further increases in the number of 

commissioned officers in the department 

than Sternberg had been. The poor opportunity for promotion discouraged potential 

applicants. Fewer medical school graduates were ava ilable to apply to the Army 

Medi cal Department because, as a result of 

the movement to reform medical education 

then rapidly gaining momenLum, inferior 

civilian medical schools were closing. The 

number who passed the entrance examination, always a small percentage of the 

total, was also dwindling. The surgeon general chose this time to make the examinations fo r promotion more demanding. He 

also continued the custom of having candidates for promotion serve a year as "attending surgeons in the principal medical 

centers of the United States." To add to the 

department without lowering its standards, 

O'Reilly, li keSternberg before him, tookadvantage of the experience of fonner volunteer medical officers, hiring some as contract surgeons so that he could send them 

back to the Philippines. He allowed those 

who were under 42 years of age to take the 

department's entrance exam. The fi ve who 

passed received the rank of capta in, to 

which they would have been entitled had 

all their service been as regulars." 

In spite of the difficulty in fi lling vacancies, Surgeon General O'Reilly rejected 

the idea of appointing even completely 

qua li fi ed black surgeons to serve with 

black troops. Among the reasons he cited 

for this decision were his belief that black 

troops had more respect for white offi cers, 

including medical offi cers, than they had 

for blacks and that the white offi cers of 

black units would fi nd "the attendance of 

a colored physician ... repugnant," espeCially as far as the care of their women was 

concerned. Furthermore, most hospital 

corpsmen were white and wo uld object to 

taking orders from a black" 

In 1904 the surgeon general took advantage of the Oexibility of the ConLract hiring system to add a new contro l over the 

Medical Department's would-be medical 

offi cers. Rather than commission them immediately upon their passage of the entrance examinati on, he decided to require 

them to sign contracts when they entered 

the Army Medical School and to award 

them commissions only upon the successful completion of their courses. O'Reilly 

thus gained a period during which he could 

obse rve their conduct as students of military medi cine; easily eliminate any who, 

though unsuitable, might have slipped by 

the entrance examination; and motivate all 

to greater efforts in their studies.26 

Although Surgeon General O'Reilly was 

able to maintain the quality of the Medical 

Department, the problem of size remained. 

Troops were still needed in the Philippines, 

but since the number of posts to be garrisoned had dropped drastically, the 200 volunteer surgeons sent to the islands in 1901 

were not replaced when their terms of service were up in 1903. When, also in 1903, 

Congress took a step forward by finally requiring the Medical Department to familiarize the civilian physicians of the National 

Guard with the demands of mil italY medici ne, it Simultaneously took a step backward 

by fa ili ng to increase the size of the Medical 

Department to reOect these added duties." 
THE ORGANIZATIONAL REVOLUTION 

O'Reilly argued the department's need 

for more medical officers before Secretary 

of War Root, who endorsed the surgeon 

general's plea in December 1903. The following January, Root emphaSized that to 

have available in wartime men who were 

"competent to conduct the administration 

of the great and compli cated medical service," the most difficult challenge the Medical Department was likely to face, the appropriate training must be undertaken in 

peacetime. O'Reilly then drafted a "bill to 

increase the efficiency and enlarge the Medical Department," whi ch Secretary of War 

Taftapproved shortly after his appointment 

in February 1904. In January 1905 President Roosevelt, who even published an article on the subject in Mili ta.y Swgeoll , 

called upon Congress to pass the bill, stating that "it is not reasonable to expect successful administration in time of war of a 

department which lacks a third of the number of officers necessary to perform the 

medical service in time of peace." 28 

Nevertheless, though Congress was 

willing to vote increases in the Ordnance 

Department in 1906, it ignored the needs 

of the Medical Department. Secretary of 

War Taft noted in his annual report that because experienced medical officers were 

taken from their posts to accompany the 

new army of occupation in Cuba , the care 

of garrisons at several large posts had to be 

entrusted to inexperienced contract surgeons. Surgeon General O'Reilly emphasized in his annual report that whil e the 

number of line officers in the Army wassufficient for a force of 100,000, the number 

of medical offi cers was appropriate for but 

42,000. Because war would force the Army 

to call in large numbers of civilian physicians, the Medical Department would face 

"a lamentable breakdown" in the event of 

321 

hostilities, "for the selection and training 

of medical officers is a gradual process. " 29 

When Congress finally add ressed the 

question of the need for more regular medical offi cers in April 1908, it created 123 

new vacancies. Italso made official the designation Medical Corps, already in informal use as an inclusive term for the department's regular phYSiCians, thereby 

emphasizing their status as career military 

offi cers. But unless Congress made the 

Medical Department more attractive to 

promising young phYSiCians, the authority to sign on more doctors would be meaningless in view of the fa ct that the department could not find physicians willing to 

fill the vacancies it already had. To deal 

with the discouragement caused by slow 

promotions, therefore, the legislature 

placed more than half the new openings at 

the level of major or above. More openings 

at the top resulted from initiating examinations for promotion from major to lieutenant colonel; the major who failed both 

the promotion examination and a reexamination was retired. Although a requirement for promotion examination up to the 

rank of brigadier general in all corps and 

burea us had been on the books since 1 October 1890, it does not appear to have been 

appli ed to the Medical Department. Further inducements included increases in the 

pay of the Army surgeon so that it compared favorably with incomes availabl e to 

civilian phYSicians, as well as retirement 

on three-quarters pay after forty years of 

service. The post surgeon would still be allowed to supplement his military income 

by caring for private patients, but now he 

could do so only if it neither interfered 

with his Army duties nor involved opening an off-post office. At this point, the outdated system of giving Medical Department offi cers labels, such as assistant 
322 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

surgeon and surgeon, above and beyo nd 

their rank was finall y abandoned.'o 

In the 1908 law Congress also created 

the Army's first reserve co rps, the Medica l 

Reserve Corps, a step whose importance 

Medica l Department authoriti es desc ribed 

aft er Wo rld War I as "impossible to overestimate." Surgeon Genera l O'Reilly believed that this step at last met the Dodge 

Commission's objective in calling for more 

medica l orricers in the department. In theory, in providing a pool of physicians from 

which the Army co uld draw, the new corps 

wou ld eliminate the need to rely on co ntract surgeons. The Medical Department 

could now screen civilian doctors willi ng 

to help the Army in time of need and verify their credentials and skills before their 

services were required. Any orri cer joining 

the Reserve Corps who refused active duty 

when call ed up wou ld forfeit his commission. But since the law did not require military training of Reserve Corps orricers, it 

did not create a pool of physicians with an 

understanding of military medicine." 

To be eligible for the Medi cal Reserve 

Corps, a doctor had to be between twen tytwo and forty-fi ve years old, a graduate of 

a reputable meeli cal school, and entitled to 

practice medicine in his home state. With 

the passage of both physical and professional examinations, he was commissioned as a lieutenant. Except for payment 

for disability received in li ne of duty, the 

reserve officer was entitleelLO non e of the 

benefits received by his counterpart in the 

regulars, but Surgeo n General O'Reilly believed that the patriotism of the nation's 

leading physicians woulel lead many of 

them to joi n the new corps." 

Although Surgeo n Genera ls O'Reilly 

anel Torney were successful in putting into 

effect Illost of the recommendations made 

by the Dodge Commission , and although 

O'Reilly suggested that he had met them 

all, one escaped them despite their best efforts. The early detection of health problems of any type or, belter yet, their prevention, made the work of the inspector so 

important that the commission urged the 

creation of a co rps of sanitary inspectors 

or of chief surgeons performing that fun ction and blamed some of the troubles of 

the Spanish-Ameri can Wa r on th e lack of 

such an organiza tion. Unable to altain this 

goal despite his belief in the need for it, 

Torney was forced to rely on assigning a 

medi ca l orri cer to act as sanitary inspector 

in each geograp hic department. Thus, 

even though the trend at the time was LOwa rd formaliZing common practices and, 

as a result, other speCialized corps were 

being created, he had to continue the practice of deSignating individual medical offi cers to serve in this capacity whenever 

th e ga thering of many men at one site 

posed a parti cularly grea t threat to sanitation. In 1912 the War Department ordered 

that medical orricers conduct twice a 

month "phYSica l inspections" of every enlisted man to ensure that th e earliest signs 

of vermin infestati on. venereal disease, 

and foot problems, among other th ings, 

co uld thus be detected. Even though th e 

function of the inspector was recogni zed, 

no specific place for him in the Medi cal 

Department was created. 33 

Plans for th e Medical Reserve Corps 

reached full maturity under Surgeon General Torney with little Signifi cant opposition . On 30june 1909, when he had been 

in orrice barely more than six months, 364 

physicians were on the Medica l Reserve 

Corps roster; of these, 29 were students at 

the Army Medical School. The number of 

Reserve Corps members on acti ve duty 

va ried in the ea rly years of the co rps' existence from under 100 to a little more than 
THE ORGAN IZATIONAL REVOLUTION 

180, but because olthe availability of these 

offi ce rs, no more than 20 co ntract surgeons vvere needed at anyone time. In 

1910, to encourage service in the Medical 

Reserve Corps, Congress decided to permit all)' reserve medical officer with a total 

of forty years of active service in any capacity-whether enlisted, contract, regular, volunteer, or reserve-to retire at age 

seventy with the pay of a first li eutenant. 

By June 1913, although the number of reserve officers on active duty was fa lli ng, 

the total number in the combined active 

and inactive reserve had reached 1,205, 

giving the department a large pool from 

which to draw in time of need." 

The new Medi cal Reserve Corps offered 

many advantages. Most of the first physicians on active duty with the Reserve 

Corps were former contract surgeons, men 

with at least a minimulll of military experience. Since Congress allowed those 

vouched for by the surgeo n general to 

enter the co rps without taking the entrance examination , Surgeon General 

O'Reilly could give commissions to 160 of 

these physicians almost immediately after 

th e passage of the 1908 law while annulling the contracts of all o thers. For former contract surgeons who did join the 

corps, their new status as commissioned 

officers would, acco rd ing to O'Reilly, bring 

"great benefit ... from correcting the former unp leasant and anomalous positions 

of these gentlemen." 35 

Among the members of the new co rps 

were yo ung doctors passing the examinati on to enter the Army Medical School, 

who now routinely became Reserve Corps 

lieutenan ts on active duty rather than contrac t surgeons. H no openings were immediately available in the regulars, they remained in this status for some time a fter 

grad uation . Surgeon General O'Reilly an -

323 

ticipated having the younger and less eminent doctors on th e inactive list devo te a 

short period each year to military training. 

when th rough ex peri ence and disc ussion 

with regular medi cal officers they could 

become familiar with Army routines and 

requirements. Those who had "already 

proved th eir qualifi ca ti ons by their good 

work" wo uld not be as ked to take time 

from their busy civilian lives to train and 

would be required to take only the most 

perfunctory of examina tions. Although 

O'Reilly was enthusiastic about th e Reserve Corps, he ad miued that th e occasional hiring of a co ntract surgeon might 

be unavoidable.' 6 

Active-d uty reservists served in several 

capacities. The largest single block was the 

contingent at the Army Medical School, but 

an individual reservist was occasionally 

called upon to take the place of a surgeo n 

at a nea rby post while that offi cer joined 

troops in the fi eld. Reserve physicians were 

also ordered to join regulars in ca ring for 

the sick and injured and dealing with sanitation on such occasions as the reunion of 

the veterans of the Union and Confederate 

armies at Gettysburg, when 24 Medical Reserve Corps offi cers joined 25 Medical 

Corps physicians to care for more tha n 800 

sick among th ese elderly men. Surgeon 

General Torney was not happy, however, 

with the need to use reservists for such duties. He believed that the regular Medical 

Corps should be large enough to dea l with 

these situations without calling up physicians from the Medi cal Reserve Corps. The 

existence of the new organi zation did not 

eliminate the old problem of an inadequate 

number of regular medical offi cers to meet 

more or less routine needs. 37 

The effects of the shortage of medical offi cers were exacerbated by Surgeon General O'Reilly's policy of encouraging "in 
324 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

every way important scientific work and 

original investigation" and of helping 

"other departments of the Government," 

even when doing so made the men involved 

unavailable for Army assignments. By the 

time Torney became surgeon general, the 

achievements of Medical Department's 

physicians were well known and requests 

for assistance from them were many. Medical schools and scientific organizations 

sought the assistance of the department's 

bacteriologists and tropical medicine experts. Openings were offered for medical 

officers in respected civilian laboratories 

where they could learn "to do more efficient laboratory work at their posts," an 

offer that Torney could not wholeheartedly 

accept because he could spare so few officers from their routine assignments. Some 

of Colonel Gorgas' subordinates in the 

Canal Zone worked to lure medical officers 

to Panama. When cases of plague appeared 

in Puerto Rico, authorities there successfull y sought the gUidance of Medical Department experts on how to prevent an epidemic. The U.S. Commission to the 

Republic of Liberia took an Army surgeon 

with it to study health problems in that 

country. A medical officer on sick leave in 

Europe was asked to manage a hospital for 

sick and wounded soldiers in the Balkans 

during hostilities until more permanent 

arrangements could be made. He was then 

asked to help in caring for the victims of a 

cholera epidemic in the same region. To all 

such talented subordinates Torney apparently gave enthusiastic support.

3S 

As the Army grew in size and the emphasis on large-scale maneuvers increased, 

medical officers were ca lled upon to participate in an effort to give medica l and line 

officers a greater understanding of one another's responsibiliti es. In 1910 the inspector general commented that medical 

officers needed more training in "campaign work" but that those at maneuver 

camps were too busy to acquire "tactical 

knowledge." Until this point, as Maj. Edward L. Munson, an instructor in the care 

of troops at the Line and Staff College at 

Fort Leavenworth, noted, "medica l officers did not know, were not expected to 

know, and it was too commonly presumed 

should not know, anything about the tactica l handling of troops," the range of 

weapons, trajectory, or similar matters. 

The 1911 creation of the Field Service and 

Correspondence School for Medical Officers as one of the new schools of the Fort 

Leavenworth Army Service Schools was a 

step in the right direction, the suggestion 

that basics of the Leavenworth course be 

taught at the Army Medical School was not 

approved because apparently no room 

could be found in the curriculum there." 

The first class for physicians at Leavenworth began in 1912, offering a six-week 

nonmedical course designed to familiarize 

the physician with his staff, field , and administrative duties. The field service course 

was open to both regular and National 

Guard officers, with six of each attending 

the first session-one of the first graduates 

was future surgeon general Maj. Robert U. 

Patterson. Among the topics covered were 

the organization of sanitary work and the 

equipment used, sanitation in wartime and 

in occupied territory, and the transport of 

the sick and wounded. The correspondence course, which was regarded as preparation for the fi eld service course, offered 

to approximately twenty-five students a 

broad spectrum of basic courses concerning military planning. Because all classes at 

the Leavenworth schools were suspended 

in the spring of 1916, only a few medical 

officers had had the opportunity of ed uca-
THE ORGANIZATIONAL REVOLUTION 

lion there before the entry of the United 

States into World War 140 

The education of line officers in the responsibilities of the medical officer and the 

work of medical units was also vita!' Medica l officers continued in the footsteps of 

such colleagues as Colonel Woodhull, 

writing books for the instruction of line officers. Major Munson, himself one of these 

authors, noted that "the general failure by 

tacticians to recognize medica l units as tactica l elements had resulted in the medical 

service being regarded as something to be 

utilized after battles were fought, and not 

concurrently with the combat units except 

so far as the medical service directly attached to combat units was concerned." By 

1911 he had succeeded in having a requirement made at Leavenworth that "no 

combatant problem ... should ... be 

considered as solved until the student officer had demonstrated a suitable disposition of the medical detachments, organizations and wounded. " Another medical 

offi cer, Maj. Paul F. Straub, who, like Munson, published on the subject of medical 

service in the field, was teaching at the 

Army War Coll ege. In teaching military 

hygiene at Fort Leavenworth and the Army 

War College, medical officers placed emphasis on the course as "a conservation 

measure" to maximize its appeal to the line 

and staff officers who were its students. To 

teach u.s. line officers about the importance of disease prevention early in their 

careers and upon the recommendation of 

the surgeon general, a Department of Military Hygiene was even established at West 

Point, with the senior medical officer there 

serving as its heac!." 

The increased respect for the opinion of 

the medica l officer that was a side effect of 

this sort of course could prove valuabl e. 

Even at this late date, the surgeon in the 

325 

PAUL F. STRAUB 

U.5. Army might be informed by his commanding officer that when his advice on 

sanitation "was wanted he would be sent 

for and told to offer it; until then he could 

keep it to himself. " This situation was not 

characteristic of all armies. According to a 

U.s. medical offi cer who observed the 

Russo-Japanese conflict ofl 904-1905, the 

first war in which disease caused fewer fatalities than wounds,Japanese line offi cers 

held the opinion of their medical officers 

in high regard. To their respect, he believed, should be credited the impressive 

sanitation of the Japanese Army and thus 

the fact that only 26 percent of the deaths 

resulted from disease." 

The notion of educating line offi cers 

about disease prevention was not always 

greeted with enthusiasm. Because even the 

best of courses would provide only limited 

information , the result migbtserve chiefly 

to make a complex problem seem simple. 
326 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

Instructing line offi cers in such maLters, 

the authors of an article in the joumal oj 

ti, e Associatioll oj M ilil"'), Surgeolls wrote, 

was "extremely dangerous, unless it is distin ctly understood" that its "sa le purpose 

r wasl impressing upon the you ng offi cer 

the importance of the matter, and that he 

will be acting foo lishly if he igno res th e 

sanitary recolllmendations he receives. " n 

The lack of enthusiasm engendered for 

the idea of adding further material to the 

curriculum of the Army Medical School 

was understandable. Indeed, although 

skilled instructors, among them physicians who had se rved with the Tropica l 

Disease Boa rd, taught at th e medical 

school, its fac iliLies and stall were too small 

even to enable it to enroll many National 

Guard officers. The growth of the sc hool 

and of the museum and library that shared 

its building rendered the fac ilities increasingly inadequate. In 1901, since Congress 

had still not voted money for a bUilding on 

the gro unds of the new hospi tal being built 

to replace the faCility at Washington Barracks, the school was forced to move in to 

rented quarters. This development crea ted 

diffi culties for both students and staff at 

the school, since they were accustomed to 

using the museum's specimens and laborato ry as well as their own laboratory during their work. As a result, Surgeon General Torney continued to urge that a 

building for the medica l school be erected 

on the gro unds of the new hospital." 

Dentists 

The concern for the number and qualifi cations of the physicians serving the 

Army was traclitional, but even the Dodge 

Commission had not considered the 

Army's need for clentists. Dentistry was still 

regarded as "a mechanical trade" whose 

practitioners were called upon to resolve 

problems after they occurred rather than 

to prevent them. In 1890, howeve r, the 

publication of a book on the role of bacteria in causing dental decal' brought the 

medical revolution to de ntistry and offered 

hope of successful prevention and treatment. The important ro le that dentists 

co uld play in the U.s. Army began to become ap paren t not long therea fter, when 

the teeth of U.S. soldiers servi ng for long 

peri ods in the tropics rap idly deteri orated. 

This state of affairs might have been related 

to a general deterioration in their health 

during any long period of service in these 

areas or even to the nourishing bacteri a of 

a hot climate. In February 1901, when 

Co ngress increased the number of offi cers 

in the Medica l Department, it also authorized contracts with 1 dentist for every 

1,000 men, up to a maximum of30 dental 

surgeons, who as civilians were given the 

relative ra nk of li eutenant. In addition, the 

legislature permitted hospital co rpsmen 

who had served satisfac torily as dentists to 

receive contracts without the examination 

required of all ot hers. By June 1902 a board 

of 3 dentists had administered qualifying 

examinations to all app li cants reqUired to 

take them and had hired 30." 

Time wo uld prove that 30 dentists were 

not enough. Si nce using ex traction to deal 

with rampant decay would leave too many 

soldiers with too few teeth to eat the Army 

ration, more and more teeth were fi lled or 

crowned rather than removed. Abscesses, 

gum innammation, and similar problems 

also received attention. Far more skill and 

time were required fo r treating dental disease than for extraction. Even though each 

dentist was provided with a Hospital Co rps 

pri vate or acting hospital steward to assist 
THE ORGAN IZATIONAL REVOLUTION 

him, he orten round it di rri cult to stay rar 

enough ahead or decay to preserve teeth.'· 

When Torney became surgeo n general 

in 1909, the limit or 30 dentists was a severe handi cap, since the ratio oD per 1,000 

men wou ld suggest that 85 should be employed. The del1lists who were serving in 

the Medical Department we re so seriously 

overworked that th e best among th em 

\-ve re not likel), to renew their contrac ts. 

Torney's errorts to co rrect the situation 

were initiall y doomed to railure, but the 

prestige or th e denta l pro ression was growing. At last, on 3 March 1911, arter the 

American Medi ca l Associa tion joined the 

50,000-member American Dental Associa tion to pressure Congress to give dentists 

rank, the legislature created the Denta l 

Corps, to co nsist or no more than 60 dental surgeo ns. They were to be assisted by 

as many acting. or contract, dental surgeons as needed to provide a ratio or no 

more than 1 dentist ror every 1,000 enlisted men, but the number or denta l surgeons in the new corps grew very slowly 

beca use the path to be rollowed in reaching that position was slow and tedious. 

Each cand ida te passing the initial examination had to accept co ntrac t status. Only 

arter three years or satisractory work as an 

acting dental surgeon and the passage or 

yet ano th er examination could he receive 

a commission as rirst lieutenant. On 30 

June commissions were awarded to 29 or 

the Army's dentists, 28 or whom remai ned 

in the Army a year later, when 10 more 

dentists were caring ror Army patients 

under contract. By 1913 , 13 additional acting dental surgeo ns had qualified ror commissions, but the increase in the number 

or commissioned dental surgeo ns in the 

corps or necessity remained slow." 

327 

Nurses 

The Dodge Commission had ignored the 

need ror dentists, but it had called ror the 

crea li on o f a reserve co rps of trained fema le 

nurses. T he lise of women to care for the 

Army's patients was by no m eans new, and 

with the development or training schools 

ror remale nurses, their value became undeni able, making th e rormali zing or their 

position as a permanent institution within 

the Medical Department a logica l step. 

This development came ani), gradually. 

In June 1899 th e War Department added 

the position of reserve nurse to the Army 

Nurse Corps, whose members stil l worked 

on a contract basis. To be eligible ror the reserves, a nurse had to have worked ror the 

Army ror at least rour months and had to 

agree to return to an active slalLtS whenever 

her services were requested. The duties or 

Army nurses remained arduous; by 1 July 

1900, 13 had di ed because or disease contracted while on duty. Until 1901 their organization remained basically an inrormal 

one, created by the Executive Branch in response to need rather than by Congress, 

and medica l offi cers continued to debate 

th e value orthe remale nurse to the Army'· 

In the bill or February 1901 that increased the number or regiments in th e 

Regular Army, Congress fi nally took action 

th at placed the Nurse Corps "on the same 

rooting with the Hospital Corps, as an integral and permanent part or the Army" 

The Army Nurse Corps now became a matter or law rather than o r departmental regul ati on, its members to be appointed to the 

Medical Department rather than hired by 

contract and its head to be rormall y known 

as superintendent. The number serving in 

the new corps was to be determin ed by 

need, and each nurse was to serve three 

years. As a physician, McGee could no 
328 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

longer direct the Army's nurses, since in 

appointing a superintendent, the secretary 

of war was allowed to consider only graduates of two-year or longer courses at 

nurses training schools. Congress also 

adopted the concept of the reserve nurse, 

but the number in this category remained 

small-only 44 of the 167 nurses in the 

Medical Department in 1902. 49 

The number of nurses on active duty hovered around 100 in the years after the creation of the corps, with the two largestgroups 

serving at the general hospital at the Presidio 

in San Francisco and at the First Reserve hospital in Manila. Retaining even this small 

number of qualified nurses in the Army became very difficult. The Isthmian Canal 

Commission tempted nurses as well as 

physicians, offering bettersalaries and working conditions than the Army. A "large contingent of ex-army nurses" who might otherwise have reenlisted in the Medical 

Department was soon serving under Colonel 

Gorgas. Surgeon General O'Reilly's attempts 

to make Army service more attractive to 

nurses were in vain. By 1908, when the Canal 

Commission had been offering nurses a 

higher salary than the Army [or several years 

and the new Navy Nurse Corps was giving 

women more fringe benefits than O'Reilly 

could offer, including more generous leave 

and travel allowances, he was unable to fill 

all the vacancies in the Army Nurse Corps.'" 

In 1910, to encourage qualified women 

to join the Army, Congress finally authorized an increase in pay from $40 to $50 a 

month. An additional $10 was allowed for 

overseas service, and an increase of $5 for 

every add itional three years of service up 

through nine yea rs was also voted. This 

measure encouraged enlistment to the 

point where all vacancies had been fill ed 

when the appropriation went into effect. 

The fo llOWing year another 25 spaces were 

voted for the Nurse Corps, with yet another 25 in 1913, for a total of 150" 

The increase in the size o[ the Nurse 

Corps made necessary greater attention to 

the fac ilities available for housing femal e 

members o[ the Medical Department. The 

add itional nurses recruited in 1911 were 

assigned to the Army-Navy Hospital in Hot 

Springs, Arkansas; to the base hospital at 

Fort Sam Houston in Texas; to the new 

Walter Reed General Hospital in Washington, D.C.; and to the office of the Army 

surgeon responsible for the care of government officials in the District of Columbia. Although initially the fa cilities at WaIter Reed, like those at many other 

hospitals, were not adequate, by June a 

new building [or the nurses was in place. 

Thereafter whenever possible, nurses un-

[amiliar with the Army were sent to Washington , D.C. , for training in the military 

aspects of their duties and for observati on 

about their fitness for this type of wo rk, 

much as prospective medical officers were 

sent to the Army Medical School" 

The Army Nurse Corps owed its growth 

to its second superintendent, Jane A. Delano, who was also chairman of the Red 

Cross Nursing Service. 53 Since the Medical 

Department had never been success[ul in 

building up a sizeable group of reserve 

nurses, Delano's position with the Red 

Cross and her determination in increasing 

the number o[ nurses in both organi zations 

were of particular significance. Army planning already assumed Red Cross support in 

wartime, and by 1911 more than 2,000 

"carefu lly selected" Red Cross nurses had 

pledged to serve in the event that hostilities broke out. When Delano resigned in 

1912 after three years as superintendent, 

the pool of registered Red Cross nurses was 

the officially recognized source from which 

the Army would draw its reserve nurses." 
THE ORGANIZATIONAL REVOLUTION 

JANE A. DELANO 

The Hospital Corps 

In the Hospital Corps the Medical Department had already realized before the 

Spanish-American War the enlisted corps 

that other bureaus were still seeking, but 

obtaining and retaining enough hospital 

corpsmen proved to be difficult. Because 

hostilities with Spain had ended, the department was required to refrain rrom signing on more hospital stewards so that the 

original prewa r limit or 100 co uld be 

reached by attrition. The shortage that resulted rorced the use or acLing hospital 

stewards in positions normally fill ed by 

stewards. In May 1900 Congress finall y 

voted to crea te 100 more openings ror hospital stewards. The rollowing February, 

raced with the loss or experienced stewards mustered out with their volumeer regiments, the legislalLlre voted still another 

100 slots, to be reserved specifi ca lly ror 

329 

stewards who would otherwise leave the 

service. As a resulL of these two measures, 

the 167 hospital stewards or 30 June 1900 

became 246 a year later" 

The demand ror Hospital Corps privates 

was also great, particularly in the Philippine Islands, where [or several years [01-

lowing the end o[ the connict with Spain 

they served the Filipino scouts as well as 

U.S. troops. The secretary or war's ability 

to appoint as many privates as he saw fit 

did not solve the problem because o[ a 

rapid turnover o[ personnel; the almost simultaneous end o[ many enlistments in 

the volunteers saw 1,275 hospital corpsmen leave the Army in one [our-momh period late in 1901. A year later, after many 

replacements had been sent to the Pacifi c 

and the total number or troops there had 

begun to dwindl e, a surplus developed. Because the proportion o[ corpsmen to 

troops was higher than the goal or 5 corpsmen to 100 men with white troops and 3 

per 100 with native units, Surgeon General O'Reilly brieny stopped sending privates to the Pacific. In March 1907, howeve r, the Medi cal Department gained 

permission to organize a Hospital Corps 

company in the Philippines. Vaca ncies in 

this company were [iJled as they occurred 

by transrers rrom the line, though such 

men were traditionally not highly regarded 

because o[ their "moral and mental inreriority. " Hospital Corps noncommissioned 

orncers were retained with the Philippine 

Souts, but in 1908 a program to train three 

privates [rom each scout company to do 

the work or Hospital Corps pri va tes reduced the number or u.s. corpsmen 

needed in the Pacifi c. The exclusive reliance upon native troops in Puerto Rico 

after 1905 also contributed to a Significant 

reduction in the need [or U.s. hospital 

corpsmen in the tropi cs. 56 
330 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

COMPANY OF I NSTRUCTION T RA INING Ar WASHINGTON BARRACKS 

The declining need for Hospita l Corps 

privates was especially welcome because 

th e requirement for exceptional strengt h 

of mind and body made replacements hard 

to fin d. The probl em was furth er complicated by the fac t that th e number of new 

enlistments tended to nuctuate for reaso ns 

Surgeon General O'Reill y co uld not specifica lly identify. At times, authority had to 

be granted to recruiting o ffi cers and surgeo ns to hire locally without obtaining the 

spec ific ap prova l usually requi red from the 

Surgeon General's Offi ce." 

Army regulations issued in 1901 added 

the grade of lance acting hospital steward to 

the Hospital Corps so that the Medical Department ,..vauld have "an opportunity to test 

the men as to their qualincatioll5 for t.he position of noncommissioned officers"; of the 

first ninety appointed to the new grade, 

twelve were later made acting hospital stewards. In the spring of 1903, as part of a reorganization of the corps, the old titles of hospital steward and acting hospital steward 

were abandoned in favo r o f reliance upon 

grade alone. At this time, the grade of corporal was authorized for as many as twenty 

corpsmen, a promotion regarded as an appropriate reward for those who, though "excellent and experienced soldiers land I good 

diSCiplinarians," could not pass the exams 

necessary for promotio n to sergeanl. Army 

regulations issued in 1904 added the grade 

of lance corporal to the Hospital Corps'8The 

men so named were to be appOinted, apparently vvithout the usual examination, by either the surgeon general or one of the chief 

surgeons of the military departments. No 

more men were to be given this grade than 

would, together with the other noncommissioned officers, constitute a fifth of the detachment with which they served.

59 

To train hundreds of hospita l corpsmen 

in laboratory work, in lhe care and lrans-
THE ORGAN IZATIONAL REVOLUTION 

portation of patients, in such tasks as vacci nation, and in the management of paperwork, the Medical Department had to 

maintain permanent training companies 

(companies of instruction). These units 

generally handled no more than 100 

trainees ala lime in a course that look four 

months. One such company was set up at 

Angel Island, Ca lifornia, and another was 

routinely assigned to Washington, where 

it could also be used in training th e students of the Army Medical School in their 

future duties. During those periods when 

the number of corpsmen was being reduced and few new men were available for 

instructi on, the program for studentmedical orri cers was adversely arrected. When 

the demand for hospital corpsmen was 

great, men who were not full y trained 

might be sent out into th e fi ekl 60 

Other companies of instructi on were 

less permanent. The company of instruction in Manila, for examp le, was disbanded 

in 1901, although in 1903 medical o rri cers 

set up a school [or Fi lipino hospital corpsmen on Mi ndanao. By 1907 the company 

on Angel Island had been disbanded, but 

the Medical Department was maintaining 

four companies of instruction- two in 

Cuba, one in the Phi lippines, and one in 

Washington. Since many who had joined 

during or after the Spanish-American War 

had had no opportunity [or careful training, th e department also set up "detachments of instruction" at various posts, following the pattern initiated before the war. 

The chief surgeon of each military department, who was responsible for recruiting, 

train ing, and disciplini ng the corpsmen 

'within thal deparLment, was required to 

see that at least five hours each week were 

devoted to instructing them in their duties. By 1908 an increase in pay had partially all eviated the problems invol ved in 

331 

training hospital corpsmen by making it 

more likely that those already trai ned 

wou ld either remain in the Army or reenlist after a period as civilians 61 

Like his predecesso rs, Surgeon Genera l 

Torney wrestled with probl ems resulting 

from the shortage of co rpsmen and the diffi culties experienced in recruiti ng and retai ning the "better class of men," as he put 

it. Increasing numbers of experienced 

corpsmen, 67 in fisca l yea r 1909 alone, 

were leaving the Medi cal Department in 

favor of the line, where the pay was higher, 

promotio ns were more rapid, and duties 

were more attrac Li ve to the average soldier. 

When Congress created new openings at 

the top of the Hospital Corps in the spring 

of 1909, it did so at the ex pense of openings at the lower levels, leavi ng the deparLment more in need than ever o f Hospital Corps privates, si nce many were 

needed by the larger hospitals. Even calling in corpsmen from posts to work with 

maneuver units could not completely meet 

th e demand in th e fi eld, and requests from 

post surgeons for hospital corpsmen too 

often had to be deni ed. When the number 

of corpsmen dictated by th e size of the 

Army should have been 4,000, the number all otted remained 3,500, with an additiona l l2 appointed to serve militia units 6 ' 

Surgeon Genera l Torney emphasized 

that the shortage of co rpsmen would be 

disastrous in th e event of war. He argued 

in vain that a proper interpretation of the 

appli cable law would permit the secretar)' 

of war to appoint as many pri vates as were 

needed without rega rd to personnel ceilings for the Army as a whole. The easiest 

way to fi ll openings-that is, transferring 

unaSSigned recruits-"has not resulted," 

Torney emphasized, "in obtaining the 

most desirable class of men for service with 

the sick" and was not likely to produce a 
332 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

supply of the highly skilled men he especially sought. He also urged that the rank 

of sergeant major be added to the Hospital Corps to attract "pharmacists of exceptional ability, X-ray experts, anesthetists," 

and similar specialists from civilian life, 

where they were paid more than th ey 

would be in the Anny. Organizing the Hospita l Corps into four permanent fi eld hospitals and ambulance companies in 1911 

was a step forward , since it eliminated the 

need to form these units from the existing 

companies of instruction each time medical personnel were required for maneuvers, but it did not resolve the probl em of 

the co rps' inadequate size63 

Preparing Medical Personnel for War 

Obtaining adequate numbers of good 

men and women for the Medi ca l Department could not alone prevent a repeat of 

the chaos and co nfusion of the SpanishAmerican War. To prepare adequately for 

the demands of wa r, doctrin e had to be developed to gUide the use of medical personnel, who had to be trained in the roles 

th ey were expected to play. In the immedia te wa ke of that connict, plans [or using 

medical perso nnel effectively were sketchy 

and based on the approach used in 1898. 

The responsibility [or devising new and 

detailed plans for meeting the challenges 

of modern warfare and for training medical personnel fell upon the shoulders of 

Surgeo n General Sternberg'S successors. 

Perhaps the most crucial and exacting 

responsibility medical personnel would 

have to hand le in time of war was evacuating th e wounded. As many men as possibl e, including phYSiCians, had to be kept 

at the front, but the fi ghting forces must 

not be encumbered by those no longer able 

to fight. Medical offi cers had to be prepared to divide the sick and wounded according to their condition so that those 

who wou ld not be able to return to th e 

front within a short period co uld be swiftly 

evacuated far from th e battlefi eld. In 

briefl y outlining how these goals should 

be achieved, early versions of the Army's 

Field Servi ce Reglliatiolls and Medical Department manuals foll owed an approach 

based on that used in the spring of 1864 

in the Civil War. The manual issued in 

1906, drawn up, like succeeding manuals, 

by a board of medica l offi cers who util ized 

suggesti ons solicited from members of the 

department, offered a deta il ed refin ement 

of earlier plans for the organizati on of medical service in the fi eld. It was designed, according to Surgeo n General O'Reill y, "not 

only to meet the needs of to-day, but also 

the exigencies of war and the requirements 

of field service, making all the details of 

admin istration plain to the untrained volunteer surgeon." The medical units-field 

hospitals and ambulance companiesthat took pan in the maneuvers of 1908, 

however, were still "wholly proviSional, 

since permanent units did not exist. " 6i 

Although even more detailed instructions were available by 1909 to gUide every 

step of Medical Department activity in the 

fi eld, the first attempt to gather a force as 

large as a division together at one time 

would not be made fo r another two years, 

and the Hospital Corps was yet to be permanently organized into fi eld hospitals and 

ambulance companies. The 1909 regulationsstated that in th e event of war the chi ef 

surgeon of an army, who was the equivalent of the modern theater surgeo n,6' 

would give general instructions to the chi ef 

surgeons of component fi eld armies who, 

together with the division surgeons, wo uld 

be responsible fo r devising specific and 
THE ORGANIZATIONAL REVOLUTION 

comprehensive plans LO be followed at the 

front. Of the fa cilities to care for the 

wounded, dressing stations, each established by an ambulance company, would be 

nearest the front, but their number was LO 

be as small as possible to avoid breaking up 

division medica l personn el. Dressing stations and fi eld hospitals were to be in the 

collecting zone, evacua tion and base hospitals in the evacuation zone, and general 

hospitals in the distributing zone. In addition LO four fi eld hospitals and four ambulance companies and any dressing stations 

that were set up, the di visional medical organization in the fi eld was to include a 

transport column, two evacuation hospitals, a base hospital, and a supply depo!.66 

When in 1910 the division replaced th e 

regiment as "the basis for army organization," thereby becoming the Army's "great 

administrative and taClical unit,)) the Medica l Department tailored its approach LO 

caring for the sick and wounded in the fi eld 

to suit th e new 20,000-man division, whi ch 

was composed of three brigades, eac h of 

which had three regiments. Plans that covered the entire line of evacuation from battalion aid station to base hospital were formalized. The manual issued in 1911 offered 

still greater detail than previous versions 

and represented a further refinement and 

formaliza tion of earlier approaches rather 

than a signiHcant altera tion in them.

67 

As ca lled for by the 1911 manual, a director of ambulance compani es and a direcLOr of fi eld hospitals wo uld serve under 

the chief surgeon of each division. A reserve medi cal suppl y would a lso accompany eac h di vision. Accordi ng LO this plan, 

wounded who could wa lk were expected 

to follow one of the roads to the rear to the 

division's cl earing station, a new concept 

for th e U.s. Army designed to prevent the 

overcrowding of fi eld hospita ls by those 

333 

least in need of aid. For those who were 

seriously injured, an aid sta tion established by a regimental surgeon would be 

the first stop. They wou ld then be taken 

by litter to the ambulance or dreSSing station. An ambulance would complete the 

move back to the nearest of the four 108-

bed fi eld hospitals that were all owed each 

division. Except in regiments operating 

independently, th e regimental hospital had 

already been reduced to a 6-bed infirmary 

that played no role in the handling of th e 

wounded in battle. Litter-bearers were organized into four ambulance companies 

per di vision, all of which worked under instructions from either th e di vision's director of ambulances or its chi ef surgeon. Patients in need of prolonged care wou ld be 

moved to one of the division's two 324-bed 

evacuation hospitals and from there to the 

division's 500-bed base faCility. A 200-bed 

hospital train or ship-the fa nner with 

three physicians, the latter with fi veco uld evacuate patients still farther. When 

th e battl e was over, all severely wo unded 

who could not be evacuated would be 

placed in one o f the fi eld hospita ls. This 

fa cility would become a fi xed unit, while 

th e three remaining fi eld hospitals would 

move on with the division.

os 

Surgeo n General Torney benefited from 

the existence of the General Staff and the 

Army War Coll ege. Though established 

"to train offi cers for General Sta ff duties 

on the principle of learning by doi ng," in 

practice the college "instead o f becoming 

excl USively an academic institution ... 

became a part of th e General Stafr. " The 

surgeon genera l was thus able to discuss 

his reservations about how well the Medica l Department could carry out its role as 

outlined in the most recent regulations directly with those responsibl e for crea ting 

wa r plans. In 1911 Torney, Chi ef of Sta ff 
334 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

Wood, and th e planners of th e Army War 

Coll ege became invo lved in a heated discussion when th e surgeon general rea li zed 

that they did not appreciate the implications of th e shortage of hospital corpsmen. 

When the possibility o f crea ting a second 

division to join the maneuver division already in the field along the Mexican border was discussed, Torney pointed out in 

very positive terms that he wo uld not be 

abl e to provide it wi th adequate medical 

coverage without a much larger compl ement of hospital corpsmen. He could draw 

on the Medical Reserve Corps for as many 

more physicians as he needed, but "by no 

kind of legerdemain can an effi cient medica l service be provided for another di vision of regular troops without the enlistment of additional Hospital Co rps men. " 69 

Surgeon General Torney's efforts to obtain an adequate number of worthwhile 

men for th e Hospital Co rps so that the 

Medica l Department co uld play th e role 

outlined for it in the event of a major war 

were never successful. The Army's Field 

Service Regll /atiolls called for every division to be aSSigned four fie ld hospitals and 

four ambulance companies. Even as late as 

1913, when the Army was organ ized into 

four di visions, th e surgeon genera l did not 

have the manpower to staff the requisite 

sixteen field hospitals and sixteen ambulance compani es '?o 

The increaSingly complex doctrine 

bei ng developed to gUide the medical service in the field emphasized the critical 

need to fami liari ze the civilian physicians 

upon whom the Army wo uld have to rely 

in wartime with their duties before hostiliti es began. The task that wo uld face the 

Medical Department in the event of hostiliti es would be enormous. The largest group 

of physicia ns and corpsmen that the department would have LO train "vas round in 

the National Guard. For each division of 

the Guard, whose members were presumably totally unfamiliar with the most recent 

plans, as many as 100 or more civilian 

physicians, 132 noncommissioned offi -

cers, and 745 privates and priva tes first 

class would have to be trained. Of these, 5 

doctors and 33-57 enlisted men would be 

needed in each fi eld hospital and 4 medica l 

officers and 24 enlisted wo uld be required 

to accompany each infantry regimenl.1 1 

Eager to increase the size of th e nation's 

pool of physicians with military training 

and wishing to foster a close relationship 

between National Guard med ical offi cers 

and their counterparts in the regulars, Surgeo n General O'Reilly urged Guard personnel to loo k to the Medical Department 

for advice, assistance, and suppli es. Guard 

and regular units bega n training together 

when pennanentcampsofinstruction were 

authorized in 1901, and in 1903 Congress 

increased the Regular Army's ro le in trainingand equipping the Guard. Regular medica l offi cers noted a lack of discipline on 

the part of Guard medica l offi cers, who reported to camp only when it suited their 

fancy. Natio nal Guard physicians were eligible to take many courses open to members of the Medical Department, but few 

took adva ntage of the opportunityn 

General Wood believed that brief periods of intensive military training in summer camps were the only realistic way to 

prepare bot h support and line troops for 

any future wartime expansion of the nation's armed forces) yet the time available 

for training militia physicians in this \-vay 

proved to be inadeq uate. Surgeon Gene ra l 

Torney urged making additi onal training 

available through summer camps run 

specifically for medical officers. In the 

summer of 1909 such camps were established on both coasts and a third was 
TH E ORGAN IZATIONA L REVOLUTI ON 

opened in the Midwesl. At each, a fi eld 

hospital and an ambulan ce company were 

ca ll ed in lO demonstrate the work of the 

Medical Depanment in the fi eld. During 

the month these instituti ons were in operation, National Guard doctors rOLated 

th rough them for two-week training periods. The reaction lO these camps was 

mi xed, and the enrollment was sometimes 

poo r, but Guard offi cers who auended 

them were genera lly enLhusiasti cB 

Although the medical camp concept was 

apparently abandoned arter one summer 

because of lack of funding, in 1910 a regular medical offi cer, Capl. Henry D. Thomason, was assigned to the Army's Division of 

Militia Affairs lO guide the medical and sa nita,,), service or the National Guard and lO 

prepare its medical personnel to work in the 

fi eld with their regular counterparts. During joinL maneuvers involving both Guard 

and regular units that year, regular medica l 

offi cers were "liberally supplied as inspector-instructors to the Nati onal Guard and 

the sanitary units or the Army were senL out 

as object lessons." The effect of this training by example as well as b), discussion was 

"a general awa kening and improvement in 

the sanitary service" of Guard units. With 

the National Guard growing rapidly in size, 

Captain Thomason succeeded in having th e 

institution or the instructor-inspector made 

permanent with regular medical orncers assigned to fUI1cLioll in this capacity. He was 

also successrul in his attempt to have a rew 

of the lOp noncommissioned offi cers or the 

Hospital Co rps senL to help train the corpsmen of Guard units. In spite or some improvemenL, the success of th is approach was 

limited because supplies or both trained 

personnel and equipmen t cO nLinued to be 

inadequate; in 1911 Thomason noted that 

the National Guard had but twenLy ambulance companies and twenty fi eld hospitals 

335 

when it should have sixty-one or each. Since 

the regulars themselves lacked twentyseven of their goal in each categOl,), at this 

time, they were in no position to supplement Guard units. As a result, Thomason 

remained pessimistic about the Guard's 

ability lO handle wa nime casualties." 

Concl uding that many Na tional Guard 

probl ems went beyo nd inadequate numbers, Surgeon General Torn ey blamed 

some d ifficulties experienced in training 

Guard medical personnel on the lack of 

federal co ntrol over state Guard units. 

Commanding offi cers o f Na tiona l Guard 

regiments in some states could appoint 

their medi cal offi cers without benefit of 

an examination to test their competence 

as ph ysicians. Other difficulties stemmed 

from th e rac t that few outside th e Army 

appreciated that there was more to being 

a medi cal offi cer than patient care. Local 

ofricials were Orlen not aware that even 

the most competenL physicians required 

training in such areas or military medici ne 

as map reading, weapons, tacti cs, and the 

art or predicting approximately how many 

men might be wounded in a particular 

bailie. The probl em or the malingerer was 

also difficu lt for civilian doclOrs to appreciate since they almost instincLi veiy 

placed the good of the individual above 

the good o r the military unit. Because so 

many o r th e Army physician's duti es were 

administrative, Torn ey agreed with Captain Thomason th at inspecto r-instructors 

shoul d serve with Guard units. He also 

urged that more medical offi cers in the 

Guard take adva ntage or the Leavenworth 

courses. 75 

By the time or Surgeon General Torney's 

death in 1913, co nd itions in the National 

Guard were improving. Some states had organizedtheir medical services roll owing the 

Medical DepartmenL example. But the need 
336 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

HARRY L. G ILCHRIST ill his office 

for doctors to be familiar with "tacLi cal principles, the methods for the employment of 

sanitary troops, the transportation of their 

materiel and supplies, the organiza tion of 

the different units of different anns, and 

many other things too numerous to mention" was still too often un recognized. Although more states were requiring phYSical 

examinalions and immunizations for their 

recruits, the requirement placed a greater 

and unwelcome burden on Guard physicians. Captain Thomason's successor, Maj. 

Han)' L. Gilchrist, pointed out that "the majority of men" in the National Guard joined 

"not only from a patriotic standpoin t but 

also for the purpose of diversion," one of the 

diversions apparently being practice with 

weapons. Theassignment to spend evenings 

examining and immunizing soldiers, work 

similar to that which occupied their days as 

civilians, left Guard physicians less than enthusiastic about their patriotic duty. This 

trend, many believed, undermined the enthusiasm of doctors already in the Guard, 

led to an increase in resignations, and discOUl"aged prospective new members.76 

General Hospitals 

Many of those so seriously wou nded in 

a major war that their recovery period 

might be prolonged would have to be cared 

for in facilities in the Un ited States, for the 

most part in general hospitals. Although 

plans were developed for the use of these 

facilities, few adjustments were being 

made in th e network of permanent general 

fac ilities in the United States and its territori es to prepare them to care for any large 

number of the paLi ents that a major connict might produce. Those changes that 

did take place in these hospitals came, with 

one partial exception, in response either to 
THE ORGANIZATIONAL REVOLUTION 337 

• 

C HIEF SURGEON G IRARD ([£lite r left) operating 

peacetime requirements or to the continuing need to care ror the sick and wound ed 

rrom the Philippines n 

By 1900 some general hospitals established to meet the needs or the SpanishAmerican War had been closed , among 

them the modern 1,020-bed hospital at 

Fort Monroe, Virginia. Oth ers remained in 

operation a rter the end of hostilities and 

were even expanded , fundin g apparently 

being more easily obtained for them than 

for post facilities. To these instilLltions, 

whi ch were under th e direct control or the 

surgeon general rather than that or the 

loca l commander, came the sick and injured brought back rrom fore ign lands and 

soldiers and members of military famili es 

with more serious illnesses or injuries. 78 

A large general hospital was maintained 

on each coast. In the West, where the sick 

from units goi ng to and from the Pacinc 

were lert for care, the need for genera l hospital space increased ror several years after 

the end of hostiliti es with Spain . X-ray specialists were in such great demand that 

during the period of the Philippine Insurrection the services of at least one civilian 

technician were req uired. The work or 

Elizabeth Fleischmann-Aschheim was apparently very highly valued by civilian and 

military physicians alike in San Fra ncisco, 

but her own ex tensive exposure to the new 

device led to her early dea th in 1905 while 

still in her thirti es. By 1902, according to 

the chi ef surgeon, Lt. Col. Alfred C. Girard,'9 the genera l hospital in San Francisco (named Letterman General in 1911), 

whi ch received pati ents evacuated rrom 

the Philippines, had recovered rrom the 

nre that had destroyed "the entire culinary 

department" in 1901. Of its average 

monthly case load of 480 patients, more 

than half came rrom th e Philippines. It 

housed the post facility for the Presidio and 
338 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

L ETTERMAN GENERAL H OSPITAL, PRESIDIO, SAN FRANCISCO 

other posts in the San Francisco a rea and 

served as the general hospital for the western half of the United States. It was also 

the base hospital for the Philippines and 

Hawaii. The largest general hospita l in the 

United States, Letterman hand led more 

than 3,000 cases in 1913 and continued to 

grow in the years before Wo rl d War 180 

In the East, in the nati on's capital, both 

the needs of the Army Medical School and 

an increasing number of patients led to the 

constructi on of a new general hospita l to 

replace the ma kes hift wartime faCility at 

the Washington Barracks. Since in th e East 

the demand for large hospitals slowly diminished after the end of hosti li ties with 

the Spanish , Congress was in itiall y reluctantto fund a new general hospital. As time 

went by, more pati ents were admitted than 

the buildi ngs at the Washi ngton Barracks 

could hold, mak ing it necessa ry to erect 

tents and then , as the weather llIrned cold, 

temporary structures. When the Army 

Medica l School reopened in November 

1901 , its clinics in surgery were housed in 

the hospital, where sllldents were also 

trained to use X-ray equipment. Enlarging 

the old hospita l at the Washingto n Barracks wo uld not sufrice. Surgeon General 

Sternberg maintained that a twenty-Hveto thirty-acre site was needed for a genera l 

hospital not only to house fa ciliti es where 

hospital co rpsmen and medical sllldents 

could be trained but also to serve as a base 

hospital in wartime. 8 1 

As the months went by without congreSSional acti on, the old buildings of the 

Washington Barracks hospital co ntinued 

to deteriorate. Finally, in 1904, after a vigorous campaign waged by Major Reed's 

fri end and colleague, Maj . William C. Borden, the legislature vo ted $100,000 for the 

land and another $200,000 for the plant to 

house a new hospital, to be named after 
THE ORGAN IZATIONAL REVOLUTION 

Reed, and such lesser strucluresas barracks 

for hospital corpsmen and a new building 

fo r th eAnn y Medical Museum and the Surgeo n General's Library. At the time th e WaIter Reed General Hospital opened in 1909, 

its capacity was eighty beds, a few of which 

\",e re made avai lable to the women of Arm}' 

families. For several years thereafter, work 

to make it comfortable and safe for its patients and to create facilities to house the 

hospital staff cominued B ' 

The other general hospitals operated by 

the Medical Department included facilities 

that differed widely in locati on and fun cti on. The First Reserve Hospital in Manila , 

whil e regarded as a general hospital , was a 

division hospital because it was th e responsibility of the area commander. If the 

Army should be invo lved in a war in the 

Pacifi c, this facility could become very impOl·tanl. Sustained guerrill a activity during 

the Philippine Insurrection placed considerable demands on it, and the Army's sick 

a nd wo unded co ntinued to be so numerous that additional faciliti es had to be established to house contagious cases. Unhappy about the co ndition of the old 

Spanish building that housed this fi xed 

hospital, which cared for as many as 2,000 

or more patients every year, the division's 

commanding ofricer recommended the 

construction of a new and more modern 

faCility, preferab ly one with "an intercommunicating telephone system ... and an 

automobile ambulance." 83 

The Army's two remaining general hospitals were specialized-care institutions for 

those suffering from specific illnesses. The 

pati ents of the Army-Navy facility in Hot 

Springs, the Army's oldest permanent general hospital , for the most pan treated those 

for whom the waters of the springs were 

deemed useful, although some of its occupants were the victims of venereal disease or 

339 

other problems. It was opened to veterans 

in 1901. Several years passed before any significantnumber of them took advantage of 

th e privilege, but its pati ent load increased 

in the years immediately preceding World 

War I. Modernized through the effons of 

Torney when he was ilS commander immediately after the Spanish-America n War, this 

l30-bed facility was described by Surgeon 

General O'Reilly in 1903 "as comp lete in 

every respect as the most elaborate insLilLtlions of like nature anywhere." 8-1 

The hospital at Fort Ba)'ard in New Mexico was opened in the summer of 1899 for 

the victims of tuberculosis. For man)' years 

soldiers with newly diagnosed cases or tuberculosis had been assigned to posts in the 

Soulhwesl, an area Orlen recommended lO 

victims of this disease. The new facilit)" not 

far from the Marine Hospital Service's LUberculosis hospital at FonStanton, provided 

a place where all soldiers, dependents of the 

Soldiers' Home and, until 1908, Nav)' pati ents with the disease could be isolated and 

cared for according to their needs. Given the 

condition of man)' patients when they arrived, often from the Philippines, the high 

death rate at Fo rt Bayard was predictableBS 

Supply 

Although reformers had demonstrated 

lillie concern about the Army's permanent 

hospital system, the Dodge Commission's 

repondirected considerable attention to the 

needlo prepare lO meel wanime's suddenly 

increased demands for medica l supplies, 

equipment, and transportation. The Medical Department's 1902 manual eliminated 

possible confusion concerning precisely 

what equipment was needed for each fi eld 

hospital and ambulance unit and who 

would supply each item, but in the earl)' 
340 THE ARMY MEDICAL DEPARTM ENT, 1865-1917 

years of the new centlllY efforts to accumulate the four-year reserve of nonperishable items suggested by the commission 

met with frustration. Congress expected the 

Medical Department to supply other government organizations, among them the 

National Guard, the Department of Commerce and Labor, and the Isthmian Canal 

Commission. The discovery that obsolete 

surgical instruments at many posts would 

have to be replaced added to the department's burdens. Congress was relatively 

genero us for fiscal years 1901 and 1902, but 

obtaining the funds necessary to replenish 

supplies was thereafter dimcult at best. A 

fire that badly damaged the medical depot 

in New York City in 1909 increased the diffi culties ex perienced during the drive to accumulate and maintain the recommended 

reserve. Thus, although the department was 

not ready to meet the demands of a possible future war, a great deal of the energy of 

those responsible for managing its supplies 

was consumed by current needs.

86 

Since prices were generally lowest in New 

York, a considerable amount of buying was 

still done there. As a result, the medical 

depots capacity had to be increased to provide space for the new reserves. Because 

much of the current demand resulted from 

continuing hostilities in the Philippines, 

Surgeon General Sternberg also initiated the 

enlargement of the faCility in San Francisco. 

Plans called for each of these two depots to 

hold supplies sufficient for 100,000 men for 

six months. To leave the major sto rage 

points on the coasts free to supply units outside the continental United States, warehouses to store supplies for 20,000 men for 

six months were built at the st. Louis depot, 

which assumed responsibility for fifty-two 

posts within the United States. Depots were 

also now maintained at Manila , Havana, and 

San Juan. Shipping medicines to and from 

these sites was simplified by a system developed by Munson, a physician of considerable practical genius, who devised a packingsystem based on the liter. Containers for 

fractions of a liter were designed so that two, 

four, eight, or thirty-two of them would fit 

into the space occupied by a liter container 

and could be stored with no packing material beyond the carton itselfs, 

Surgeo n General Sternberg wished to 

accumulate sumcient supplies and eq uipment to provide each of the firteen military departments (nine within the United 

States and six abroad) with two regimental fi eld hospitals, a chall enge made somewhat Simpl er by the reduction in the number of hospitals and concentration of 

supplies in the PhilippinesSBBy 1903 Medica l Department goals call ed for having 

two base hospitals, thirty-eight fi eld hospitals, ten stationary hospitals, seventyeight regimental hospitals, and seven supply depots, stored in Washington, D.C., 

San Francisco, st. Louis, and Manila and 

ready for shipment within twenty-four 

hours. The Medica l Department's reserve 

of the type of field equipment needed in 

wa rtime was large enough to supply fi ve 

Army corps, except for the items provided 

by th e Quartermaster's Department. When 

Army units reoccupied Cuba in 1906,8· 

their medical suppli es and equipment 

were ready for immediate shipment. By 

January 1909, when Surgeon General 

O'Reilly retired, all the hospitals and depots originall y called for in 1903 had either been accumulated or were in the 

process of being acquired90 

The Dodge Commission had recommended that the Medical Department 

manage the transportation of its needs to 

the extent necessa ry to guarantee prompt 

delivery. Although convinced that the 

principal cause of the supply probl ems of 
THE ORGANIZATIONAL REVOLUTION 

the Spanish-American War was inadequate transportation, Surgeon Genera l 

O'Reilly concluded that the movement of 

goods from depots was an administrative 

problem that "would probably be no 

nearer solution if the medi cal department 

should be given its own transportation departmenLII A separate quartennaSler service for each branch of the Army being totally impractical, he dealt with the problem 

by appointing acting quartermasters from 

within the Medical Department and assigning men from the department, including Hospital Corps detachments, to accompany supply shipments 9 1 

Although Surgeon General O'Reill y was 

on the whole determined to carry out the 

recommendations of the Dodge Commission, he was also not convinced of the necessity for building up significant reserves 

of all items, since some items could be readily bought in great quantity in the open 

market. Believing that confusion was in 

part to blame for the difficulti es of 1898, 

he undertook to have routine needs stored 

separately from items req uired only in 

wartime. He also initiated a system to assemble all supplies needed for a field hospital- regardless of whether they were obtained by the Medical Department, the 

Quartermaster's Department, or the Ordnance Department-ready for shipment 

within twenty-four hours. This unitsupply 

system was extended to include equipment 

for an emergency recruiting setup to handle the first round of physical examinations, for a camp hospital to provide emergency treatment, for a base hospital, for 

handling regimental needs in combat, for 

a camp infirmary and reserves for the camp 

infirmary, for an ambulance company, and 

341 

for an evacuation hospital. Surgeon General Torney continued the work begun by 

his predecessors, assembling needed items 

in Washington, D.C., and shipping them 

out where needed for use or fo r storage at 

a field medical depot created speCifically fo r 

the purpose. Supplies for one division were 

sent to San Francisco and for a second division to Honolulu, while some field equipment was stored in Manila 9 2 

The changes that had been made in the 

organization of the Medical Department by 

December 1913, when Surgeo n General 

Torney died, would make possible a more 

effi cient administration of the department 

than could have been achieved under its 

monolithic structure in the nineteenth 

century. Detailed plans for the opera tion 

of the department in the field had also been 

developed as part of Army-wide preparations for the possibility of large-scale modern warfare. Grea ter attention had been 

devoted to the problems involved in acquiring and distributing supplies, and 

thought had been given to the use of general hospitals in time of major connict. Still 

to be solved was the fundamental and 

perennial problem of how to prepare the 

hordes of civilians who would have to supplement the work of regular medi cal personnel in the event of such a conni ct to 

perform their roles effectively. By 1913, except for the problem of training adeq uate 

numbers of civilian physicians, the Medical Department may well have been prepared to meet the demands of a connict 

like the one in which it had most recently 

been involved. It was not ready for a connict on a scale never before encountered 

in the course of human history. 
NOTES 

L. James L Ab rahamson, America Anns jO/"(1 New 

CCII""Y, 1'1'.29-44,67,96-97, 100, 153. 

2. Paul E Straub, Met/ica/ Service in/he CWllt)(ligll , 

p. 3; Rpt 1036 (Request or the Surgeon General ror an 

Increase in the Enlistcd Personnel of the Hospital 

Corps) and Rpl 1752 (Proposed Amend lllcllIsofParagl"llphs 5 14, 61), 6 l8, and 636, Army Regulations), 

Entr), 5, Record Grou p (RG) 165, National Archives 

and Records Administration (NA RA), \Vashington, 

D.C,; Ouo L Nelson,Jr., NaliOlw/ SeCllrily wu//hc GCIIcmI S/(!l{, pp. 56-57; United States, Congress, Senate. 

Report oj the (Dodgc) COlllmissiOlI To Iltvcsligt1/e lite 

COItt/II" oJllte \vhr Del)(lrllllellt ill/he W(,,- With S,)(lill, 

1: 115-16, 188--89 (hereafter cited as Do<lge COllllllisSiOlI Report); J eny M. Cooper, Civil Disorder, p. 34; 

War Department. /AIIIIII(III Report oj Ihe Surgeon Gellem/, U.s. /"III) ~ 10 the Sec retm), oJ War, 1903, p. 18, 

and 1908, Pl'. 12 1-28 (hereafter cited asvVD,ARoJSG, 

dat c); john N. Goltra, "The Executive Element in the 

Training and Skill orthe Arm)' Surgeon," p. 206; Waite r Mi llis, Arllls alld Mell, pp.173-76; Wa r Department , 

Surgeon General's Offke, Tile Slr/geOlI Ge leml ~ Office, 

pp. 56-57 (herearlcrci tcd as WD , SGO, SGQ) . Unless 

othe rwise ind icated , material on the General Staff and 

tile chief or staff is based on James E. Hewes, From 

~OOlIO McNamara. 

3. Hermann Hagedorn , Leollard Wood, 2:89. 

4. See Chapter 7 for the Dodge Commission's 

find ings. 

5. The law limited the te rms of the heads of all 

the A1"I11)"S bureaus 10 four years. 

6. "TheSurgeonGe neraloftheArm), and HisCri tics," p. 822 (first quotation); Charlesj. Post, The Liltic W(II' oj Private POSf, p. 3 17 (second and th ird quotatio ns); "The One GreaL Blot of the War," p. 279 

(fourth quola tion); j efferson R. Kea n, "lnOuence of 

the Association or Mili ta l)' Surgeons on the Status of 

Medical Offi cers," p. 599; Graham A. Coslllas, All 

ArmyJo rEll lpire. Pl'. 282-83, 295; DocigeColllmissioll 

Rcpol'l, 1:107, 1.1 3, 116, 188-89; James M. Pha len, 

ChieJs oj /Ire Medica l Deparllllell l, Ull iled Slates ArlllY, 

1775-1940, p. 70; Thc Militm)' Laws oj IIlc Ull i/ed 

Swtes, 1915, 5th eel. (Washington, D.C.: Government 

Prillling Offi ce, 1917). 1'. 154, pa ra. 373. 

7. See Chapter 7 fo r the details of Forwood's 

manClgcment of Camp Wikoff. 

8. Phale n, Chiefs, pp. 75, 81 ; Milifm)' Laws, 

1915, p. l55, para. 380. 

9. Lt r, P. Ivliddl eton to SG, 8 Dec l868 ( 11 rst quo· 

talion), vol. 12, En tr), LO , RG 11 2, NA RA; Baile)' K. 

As hford , A Soldier ill Sciclt cc, PI'. 105-06 (second 

and fOllrth quotations); Ltr (cop),), \Va lter Reed to 

William C. Gorgas, 2 1 Jul 1902 (third quotation), 

Ms C48, Wa lt er Reed and Will iam C. GorgCls Papers, 

Na tiona l Library of Med icine (NLM), Bethesda , 

Md.; Perc), M. Ashburn, A /-listOl)' oJlli e Mcdiad Depar/melll oj lite Ulli/ ed SIllies Army, p. 283 (hereaft e r 

cited as l-lislOl)' oj MD); Phalen, e llieJs, pp. 75, 

79-8 1; Auto biograph)'.Jefferson R. Kea n, p. 157, Ms 

C 14,jcfferson R. Kean Papers, NLM . Kean was promoted to brigadier genera l in the Na tional Arm)' on 

26 June 19 18. 

10. Phalen , Chi eJs, p. 86; Ur, Alben G. Love to 

jefferson R. Kean, 29 Dec 1913 , fo lder Correspondence. 1913- 1915. and Keall Autobiograph )" pp. 

139, l65, Ms Cl4, NLM. 

11. Dodge Commission Report , 1: 189; WD , 

ARojSe, 1908, PI'. 125-26. 

12. Memo , SG to S\·V, 3 Sep 1. 909 (quo tation), 

I: ntl,)' 231, and Rpt , Curator, Army Med Museum, 

10 SW, 9 OCL 1909, Elllry 245, Re 112, NARA; Kean 

Autobiograp hy, pp. 78-79, Ms C14, NLM . 

13. By the ti me of Torney's death ill December 

191.3, the Surgeon Geneml's Office WClS ma naging 

the work of about 4,300 men and women. 

J 4. Jefferson R. Kea n, "Medical DepClrtment of 

the Army," March 1913, Entry 23 1, RG Il2, NARA; 

WD, sea, seo, p. 126. 

15. WD, ARojSe, 1910, pp. l61-62 (quoLations). 163; Kean, "Medical Department," En tr)' 

23 l, Re U 2, NARi\. 

16. Beaumonl's studies of human digestion, 

made possible when a wo und thro ugh the stomach 

wa ll of one of his pat ients fa il ed to hea l over, brought 

him wiele acclaim. 

17. See Mary C. Gillett , The Army Medical De· 

Farl mellf, 1818-J865, fo r details on Lawson's policies a nd his relationshi p with William Beaumonl. 

18. Memos,j. E Bell toSW, 20 Apr 191O. Leonard 

Wood LoAG , 27 Dec 1910, and SG LO SW, 3 Sep 1909 

a nd 15 jan 1912, Emry 23 1, RG 112, NA RA; Louis 

M. Maus, "The Eth ics, Scope ClIlCl Preroga tive or the 
THE ORGANIZATIONAL REVOLUTION 

Army Medical Officer," p. 304; I(can Aulobiograp hy, 

pp. 126, 1. 48, MsCI.4,NLM. 

19. Goltra, "ExcClui ve Element," p. 2 10 (quotations); Dodge COlllmission Report , 1:188-89; Memo, 

Acting SG [0 Presiden t, 19 OC11904, folder Memoranda, 1. 904, 1. 9 1..1 , Ms C14, NLM. 

20. R. G. Ebert, "The Medical DepartmcllI of the 

U.s. Ann)'," pp. 93, 96; "Arm)' Co ntract Surgeons," p. 

417; W D,/lIloJSC, 1899, 1'. 19, and 1.900, 1'1'.19- 20; 

Azel Ames, "1\ Medica l Reserve Co rps for the Arm)' 

orlhe United StaLes," Pl'. 70.89; C. B. G. de Nancrcde, 

"Personal Ex perience During Ihe Spanis h-American 

War ... ," p. 6 11;Joseph M. HeUer, "Ex periences of 

Ihe Spanish-American \·Var From a Differcm ViewpOilll Than Major Nancrede," p. 7 1; CaSillas, ArIllY, 

pp. 296-97; Memoranda on Mcd Corps,) I Dec 1899, 

Elllr)' 245, RG 112, NARA; C. Joseph Bernardo and 

Eugene H. Bacon, I\lII cri((1/I Militwy PoliCY, p. 288, 

21.. WD, Al/oJSC, 1899, PI'. 328-29, and J 900, 

PI'. 17,20, 96; Martha L. Sternberg, GeO/ge Miller 

Stcmbclg, p. 20i. 

22. Erna Risch , QUMleI"ll1(lS{er SIIPPOr( oJ(lIc A rillY, 

pp. 563-64; james A. HuslOn, The Sinews oj W(lr, p. 

302; ACO CO 36, 4 Mar 1899, and CO 14, 1.2 Feb 

1901 ; Edgar Ers ki ne Hume, Victories oj Army Mecli ~ 

eille, p. 30; Eben, "Medical Department ," p. 92; \VD, 

AI/oJSC, I901 , p. 35, 1902, p. 1.6, 1.903, PI'. 42, 44-45, 

and 1907, p. 119; Will iam O. Owen, "The Ideal Rela~ 

lion ro r the Medi cal Department of an Ann)'," p.365; 

'-Va l' Depart menl. Surgeon General's Office, 1'\1/(11111(11 Jor 

{llc Medical Dep(lf{IIIcll!, 1906, PI'. 9-10: Victoria A. 

Hm·den, Invcnl ing lile NIH, 1'.18; Robert S. Henry, Tile 

Armed fo rccs IrlsU/ufe oj Palhology, pp. 93, 139 ~ 

arter cited asAFIP); Frederick C. l-luide koper, The lil~ 

il(ll)l Unprep(lredll css oj tile United Stales, p. 324. 

23. WD, SCO, SCD, PI'. 58-59; lillidekoper, Mi/i1(//)1 Unpreparedness, p. 324; Eben , "Medical Departmenl," PI'. 92- 93, 97-99; WD, ARofSC, 1. 903, p. 15, 

and 1904, p. 11 ; Edwa rd L Mu nson, "An Outline o r 

the Orga nizatio n and '-York of the Medical Department 

of the United States Arml ' pp. 254-55;]ames G. Burrow, Olg(lI1i zed Medicille ill tile PlVgrcssive Era, p. 15. 

24. Munson, "Outline," p. 256 (q uotation); WU , 

ARoJSC, 1902, 1'.14,1903, 1'1'. 18- 1.9, 42, 1904, PI'· 

10-11, 14, and 1907, pp. 119, 122; George Rosen, Tile 

Slrl/ClllreoJ Americall Medical Pmclice, 1875- 1941, pp. 

6 1, 67; j ohn S. l-I aller,Jr., Alllerialll l'vledicinc ill Tlmlsilioll, 1840-1910, pp. 22 1-33; '-v. Bruce F)'e, "The 

Origin of the Full-time Facuil), System," p. 1555. 

25. Memo, SG LO Presidelll, 24 Dec 1904, Entry 

242, RC 112, NA RA. 

26. Ltr, j efferson R. Kea n 1.0 William C. Gorgas, 

23 Aug 1905, 2:93, Ms C5, SGO Correspo ndence, 

343 

1.903- 1907, NLM; "The Discussion in the Scnateoll 

the Army Medical Reo rganization Bill ," Pl'. 305-06; 

WD,ARoJSG, 1.903 , p.18, 1.904, pp.1. 3- 14, 1.905, pp. 

131, 134, and 1908, p. 127; "Cha nge in the Exam ination fo r the Arm)' Medi cal Service ," p. 6l; Roben 

Smart, "Military Hygiene ," p. 38; R. M. Culler, "Some 

Facts Abou t the Arm)' Medical Corps," pp. 1092-93. 

27. Wa r Department , Fi ve )'fars oj Ille \Var Deparlmenl FollOWing Ille War \Villi Spa;1I ... , 1'. 36 1. ; 

idem, ARoJSC, 1903, p. 18. 

28. First quotation from Hea rings Befo re Committees o n Mili tar), Affairs of Uni ted States Senate 

,md House of Representatives, 64th Cong., 1 st Sess., 

p. 629, RG 287, NARA; remai ning q uotations from 

V·,ID, ~oJ , 1906, p. 112. See also Theodore Rooseve lt , "Preside nt Rooseve lt on Arm)' Medical Reorgani zation ," pp. 133-34. 

29. \~alter D. McCaw, "The Medi cal Service of 

an Arm)' in Modern '-Ya r," p. 348; War Department , 

fAll/nUll] ~e orl oj thc Sccrcl(ll), oj War, 1906, p. 33; 

idem,ARoJSC, 1903, 1'1'.1.8- 19, 1905, 1'.131, 1906, 

p. J 12 (quota ti o ns), and 1908, p. 123; I-Iu idekoper, 

MiliullY UnprcpMcdness, p. 324. 

30. WD, A/loJSC, 1.899, p. 329, 1908, PI'. 101 , 

123, 1. 26, and 1909 , 1'.126; WD,SCO,Mmrrra/, 190G, 

PI'. J l, 123; Cull er, "Some Facts," p. 1092; Cha rl es 

f Craig, "The Army Medical Se rvice," Pl'. 417 , 

419- 20; Percy M. Ashburn , "Se rvi ce in the Arm)' 

Medical Corps," p. 667; Huidekoper, Mili/al)' UIIprep(U"cdllcss, p. 344; Louis L. Seaman , "Some of the 

Triumphs of Scientific Medi cine in Peace ancl 

'-Val' ... ," p. 340; Rosen, Structurc, pp. 19 , 35- 36; 

Edward L. Munson, "The Army Medica l Service," 

pp. 677-78; idem, "O uLiine ," pp. 254-55; Burrow, 

Org(l/li z.ed Medicil/ c, p. 15; Paul Starr, TI,c Soci(ll 

TI"(Il/sJol"llw/ioll oj AllIericclll Medicinc, pp. 84-85; 

"The Arm)' Medical Corps," p. 58; james A. Tobe)" 

Tile Mediccll Dcpa rlmenl oj Ille Army, p. 3i. 

31. \.yO, SGO. seo, p. 60 (q uotalion); I-I uidekope r, MiliUIIY UI'Pl"cp(lfcclll css, p. 345; '-YD, 

ARoJSC, 1908, p. 123. 

32. Huidekoper, MiliWI)1 Unprepa redness, pp. 

344-46; "Medica l Rese rve Corps," p. 68; 'vYD,ARoJSG, 

1899, p. 329, 1908, PI'. 123, 126, and 1909, p. 127; 

Ricbard B. Crossland and james T. Currie , l illice Ille 

Oli z.el! ('-Vashingtoll, D.C.: Office of the Chief, Army 

Rese rve, 1984), p. 14; Seaman, "Some of the Triumphs," p. 34 1; Dodge Commission Report, 1:188-89. 

33. WD, ARoJSC, 1912, PI'. 90 (quolalion), 91 , 

1913,1'1'.86-91 , 93,and 1914, PI'. 82,85; DodgeCorrrmissiol/ Report, 1:188-89; \-VD, SGO, SGO, p. 120. 

34. WD, ARoJSC, 1909, p. 1. 27, 1. 910, p. 1. 26, 

1911., PI'. 170, 1912, 1'. 177, 1913, 1'. 163 , and 1914, 
344 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

pp. 154-55; Huidekoper, Militmy Unpreparedn ess, 

pp. 37l, 388. 

35. WD ,ARojSG, 1908, pp.l03 (quotation), 104. 

36. Ltr, SG lOJesse Overstreet, 19 Feb 1909 (quotation), Entry 27, RG l12, NARA; WD, ARojSG , 

1908, pp. 103, 127; Huidekoper, M ilitary Ullpreparedness, pp. 344-45. 

37. WD, ARojSG, 1913, pp. 162-63, and 19 14, 

pp. 13, 155; Richard Slee, "The Veterans' Reunion 

at Gettysburg," PI'. 723, 725-26. 

38. WD, ARojSG , 1908, 1'. 127 (first two quotations), 1910, PI'. 157-59, and 1913, pp. 177-79; in 

RG 112, NARA: Ltrs, SG to Arthur F. Chase, 20 Jan 

1909, to Simon Flexner, 18 and 26Jan 1909, and to 

\-Villiam C. Gorgas, 6 and 30 Mar 1909 (final quotation), Entry 27, anci Jeffersoll R. Kean to SW, 16 

Ju11912, Entry 231; Percy M. Ashburn , "Report on 

Medical Conditions in Liberia," pp. 402-09; Clyde 

S. Ford , "Some Medicomilitary Observations in the 

Late Ba lkan Wars," PI'. 53-56, 58; Craig, "Army 

Medical Service," pp. 421-22; Ira L Reeves, Mili1(11), Ecl!lClltiolJ ill the United Sw/cs, p. 289. 

39. First quotation from Paul F Straub, "The 

Training of Sanitary Troops," p. 359 (see also p. 360); 

second quotation from "Beller Instruction for Arm)' 

Medi cal Ofricers," p. 1737; third quotation cited in 

Ashburn , Histol), oj MD, p. 253. 

40. Phalen, CI, ieJs, p. 102; Ma rvin A. I<riedberg 

and Me rton G. Henry, HistolyoJMili/ar)' Mobili z.afioll 

ill tl,e Ullited SWles Am )~ 1775-1945, pp. 204-05; 

WO, ARoJSG, 1912, p. 187; Reeves, Mililmy Edl/calioll, PI'. 229-30; W. G. SchaufOer, "Report of Medical Service School, New Jersc}'," p. 531; A J\llililwy 

HisLD,)' oj th e U.s. Ar/lly COlll lllarrd and Gellcm/ Staff 

College. FOil LeavclJ lVOrllJ, 1«(lIIS(lS, 1881- 1963, p. 20; 

Straub, Medical Service, pp. 7- 8,35-37. 

41. Quotations cited in Ashburn , l-lislOl)' oj MD, 

pp. 253-54. See also WD, ARojSG, 1905, p. 157, and 

1906, p. 130; Winslow Anderson, "The U.s. Army 

Camp of Instruction for the Offi cers of the Medical 

Corps of the Organized Militia," p. 527; Ur, Jeffe rson R. Kcan to Charles Woodbury, 26Jan 1910, Entry 

231, RG U 2, NARA; Henry I. Raymond , "What Is 

the Most Effec tive Organiza tion of the American National Red Cross for War ... ," p. 156; Sternberg, 

SlcmiJerg, pp. 203-04; Timothy K. Nenninger, The 

LeClvcmvorlil SdlOo/s and fil e Old ArIllY, p. 102;John 

F. Morrison and Edwa rd L. Munson, A Study ill Troop 

Leading (//1(/ Management oj tile 5(lIIi/(l'), Service ill 

War; Edward L. Munson, Tile Principles oj 5(//rifwy 

UICfics; FrancisA. Winter, "Preparedness of lhe Medical Department of Ihe Arm)' in the Malle r of Field 

Medical Suppl ies," (PaperdeJivered al the Arm)IWar 

Coll ege, Washington, D.C., [Fall 1912[), Mili tary 

History Research Collection , U.s. Army Military HislOry Institute, Carlisle Ba rracks, Pa. 

42. Owen, "The Ideal Relation," pp. 362-63 

(quotation), 364;Johl1 M. Banister, "Arm)' Sanit<lry 

Administration in the Unit ed Slates and in the Tropics," p. 562; Louis L. Seaman, "Lessons for America 

in the Japanese Army Medical Service," pp. 585-86; 

WD, ARojSG, 1905, p. 160; "Var Department, ReporlS of !'-'Iil iuu)' Observers AU(lched /0 the Arll1i es ill 

M(lIIciwria Dtlrillg the RlIsso-jap(lIIcse Wa r, pt. 4, p. 

13. Even in the Russian Army during the RussoJapanese \OVar, wo unds killed more than disease. 

43. Charl es E. Woodruff and Frank T. Woodbury, "The Prevemion of Disease in the Arm)' and 

the Best Me thod of Accompl ishing That Result," pp. 

22-24 (quotations); WD, ARojSG, 1908, PI'. 39-40, 

and 1909 , 1'1'. 10, 76. 

44. Wynd ham D. Miles, A I-l islo,y oJtlre NaLiorr al 

Libra ,y oj Medicine, pp. 206- 07; Henr)" AFIP, pp. 

147-49; WD, ARojSG, 1909, p. 140, 1910, p. 133, 

1911, 1'1'. 176,183, and 1912, p. l 85. 

45. WO, ARojSG, 1902, PI'. 17, 25, and 1903, PI'. 

19, 23; Ashburn, HiS/ DIy oj MD, p. 211; WD, SGO, 

,"laIllUlI, 1906, p.l0; V O. Hunne, "Notes on the Ph)'sical and Dental Condition of U.s. Arm)' Men in 

1901 - 1903," PI'. 255, 25S-64;John D. Millikin, "The 

Origina l U.s. Army Dental Corps," p. 387; Gardner 

P. H. Foley, "The Peaks of Dent al History," p.14. 

46. WD, ARojSG, 1902, pp. l S-19, 1903, 1'1'.21-

B , 26, 1905, p. l35, 1906, 1'. 114, and 1907, p. 120. 

47. Ibid., 1909, 1'.128, 1910, pp. 126-27, 1911, 

p. 171, 1912, p. 178, and 1913, p. 164; Huidekoper, 

M il ilwy Unpreparedll ess, p. 386; Memo,Jefferson R. 

Kean IOSG, B Mar 1909, Entry B l , RG 112, NARA; 

Millikin , "Original," p. 387. 

48. Dodge Com miSS/OIl Reporl , 1:188-89; \-VD, 

ARojSG, 1899, PI'. 25, 29-30, 52, 54, 74, and 1900, p. 

24; Hoff's commemon Anita Newcomb McGee paper, 

f. idem, "Nurse Corps of the Army," p. 273; Dallas 

Bache, "The Place of the Female Nurse in the Army," 

pp. 309, 328; Thomas C. Clark, "Some ObservaLions 

Upon the Medical Service of the Late \-Var With Spain 

From the Standpoi nt of a Vol unt eer Surgeon," p. 365; 

in RG 112, NARA: SGO Cir 14, 7 Nov 1898, and Cir, 

20Jul1 1899, Entry 66, and Ltr, William C. Gorgas to 

Anita N. McGee, 27 Feb 1900, Entry 147. 

49. McGee, "Nurse Corps," pp. 267-68 (quolation); WD, ARojSG, 1901, p. 61, 1903, p. 39, 1908, 

p. 124, and 1909, p. 133; Hume, ViclOries, p. 205. 

SO. W D,ARojSG, 1904, 1'.24, 1906, 1'.119 (quotation), 1907, 1'. 126, and 1908, 1'1'. 109-10. 
THE ORGANIZATIONAL REVOLUTION 

5 1. Ibid., 1910, p. 130, 1913, p. 164, and 1914, 

p. 159. 

52. Ibid., 1911, p. 172. 

53. J ane Delano!:; name jmpliessome relmionship 

lO Franklin Delano Roosevelt's mother; howeve r, 

when Delano died in Franceduring World Wa r I and 

plans were being made to exhume her body, initia lly 

buried in France, and to reinter it in the United SLaLes, 

it became apparenllhat she had no near kin and thus 

that her success was presumably not based on famiI), influence. See Ltr, Cla ra D. Noyes loJulia C. Stimson, II Feb 1920, Entry 103, RG 112, NARA. 

54. Kean, "Medical Deparllnent" (quotation), 

Entry 231, RG 112, NARA; Gustavus Blech, "Organi zation of Red Cross Personnel for Wa r," PI'. 

228-36; Raymond, "National Red Cross," PI'. 177, 

180; WO, ARoJSG, 1910, p. 130; AGO GO 16, 23 

May 1912; War Department, Surgeon Genera l's Office. MOII/wljo!" the IVleciiw/ Department, Uniteel SflIt es 

Arlll)', 1911 , change to Sec. 96; idem, seo, p. 60. 

55. WO, ARoJSG, 1898, 1'. 14, 1899, PI'. 20- 21 , 

183, 232-35, 1900, PI'. 22-23, 1901, p. 36, 1902, p. 

25, and 1908, pp. 123-24; Hume, Victori es, p. 28; 

Risch. Quartermaster Support, pp. 561-62. 

56. W D,ARoJSG, 1902, p. 27, 1903, p. 32, 1904, 

p. 20, 1905 , PI'. 87, 96, and 1906, p. lI8; E. L. 

Ruffner, "The Private Sanitary Fi lipino Scout," p. 

410; WD,SGO, M(IIIII"i, 1906, p. 65; IIpt 1036, Entr)' 

5, RG 165, NARA. 

57. Goitra, "Executive Element ," p. 2 1 J; Eiben 

E. Persons, "Medical Service With Philippine 

Scouts," PI'. 708-09; WO ,ARoJSG, 1901, PI'. 37, 39, 

1902, p. 28, 1903, p. 32, 1. 904, p. 20, 1906, 1'1'.116, 

118, 1907,1'1'. 124-25 , and 1908, 1'.108; WO,SGO, 

lvlwlllai, 1906, p. 66. 

58. The lance corporal was a private serving temporarily as a corporal. 

59. WD, ARoJSG, 1902, p. 27 (first quotation), 

1903, PI'. 31-32, 1904, p. 19, and 1908, p. 108 (second quotation); "VD, SGO, MQ/luai, 1906, p. 63. 

60. WO, SGO, M""",,i, 1906, PI'. 69, 72; WO , 

ARoJSG, 1900 , p. 23, 1901, p. 48, 1902, p. 39, 1903, 

1'1'.32,35, 38, 1904, p. 36, and 1905, 1'.138. 

61. WO, ARoJSG, 1899, p. 182, 1901, PI'. 39 

(quotation), 40, 1902, p. 39, 1906, 1'.116, 1907, p. 

124, and 1908, p. 108. 

62. Ibid., 1909, 1'. 131, 1. 9 11 , p. 174, 19 12, PI'. 

180-81, and 1913, p. 168 (quotation). 

63. Ibid., 191 1, p. 175, 1913 , PI'. 14-15, 166 

(first quotation), 167- 68 (second quotation), and 

19 14, 1'1'. 12-13. 

64. Ibid., 1908, p. 127 (first quotation); WD, 

seo, SGO, pp. 63, 70 (second quotation); Frank R. 

345 

Keefer, "The Functions of the Medical Departmelll 

of the Army, Especially in the Field ," p. 358; fielel 

Serv ice ReguimiDlIS, 1905, pp. 184-87, and L910, pp. 

12, 183-92; War Department, Surgeon General's Offi ce, lvlalllUli Jor fh e Meriimi Deparlmelll, 1900, pp. 

13- 17,23-26; ibid., 1906, PI'. 178-244; ibid., 1911 , 

pp. 169-310; Tobey, Meeli cal Deparlmellt, p. 32; 

Straub, Mediad Service, p. 4; Papers of Med Dept 

Manual Board , 1906 (see also 1914), En tr)' 245, RG 

11 2, NA RA. Using maneuvers 10 train all elements 

of the Army under condit ions resembling as closely 

as possible those encountered in war was one of Secretar}' of War Eli hu ROOl'S goals (see discussion in 

Charles D. McKenna, "The Forgouen Refo rm," Army 

HislDlY, Winter 199 1192, pp. 17-23). 

65. When a number of field armies conduct op· 

erations in the same theater, the), might be organi zed 

into an arm)'. The field arm)' was a group of divisions, the equivalent of the corps of the SpanishAmerican "Yal". 

66. Straub, Medical Serv ice, pp. 68-69 , 75, 77, 

89, 156. 

67. Ficld Servi ce Regll/(I/ioIlS, 1910, p. 12; WO, 

SGO, SGO, p. 65. 

6B. Fielel Service Regu/(lliolls, 1905, pp. 11-12; 

'NO, SGO, 1"'(IIlIIal, 1911 , pp. 184-206; Manus McCloske)" "The Importance of the Service of the Evac· 

lIalion of the Sick and "Vounded by the Medical Departmenl in Time of ,"Yar," p. 414; Paul E Straub, 

"Medical Service in the Campaign," pp. 691- 92, 

695 , 698-700, 702-03; idem, lvledical Se rvice, pp. 

95, 129, 139, 149; Henry D. Thomason, "Sani tar), 

Troops in the Organized Militia of the United 

Stales," pp. 518-19; Herbert A. Arnold, "Report on 

Maneuver Camps at San Antonio and Leon Springs, 

and on Juarez, Mexico," p. 21; "Villiam B. Banister, 

"The Medical Reserve Corps," pp. 27-29 ,3 1-32, 36, 

38-41; Elbert E. Persons, "Special Article," p. 403; 

Reeves, Mili/(IIY EdllcaUol" p. 293. 

69. Hewes, From Root 10 McNanwrtl , p. 12 (first 

two quotations) and 12n; in Entry 245, RG 11 2, 

NA RA: Memos for CofS, 16 Mar, 24 Apr (final quo· 

tal ion), and 8 May 1911, plus Memo by Sec, GS 

Corps, 27 Apr 1911, Memo for Sec, GS, 18)an 1911, 

and Ltr, AG to SG, 31 Mar 1911. 

70. Mahlon Ashford, "The Mission of the AmbulanceCompan),," p. 165; WD,ARoJSG, 1911, pp. 175-

76, 1912,1'. 182, and 1913, PI'. 168-69; WO, SGO, 

SGO, PI'. 66-67. Field hospita ls had also been infor· 

mall), organized on a division basis in the Civil War 

(see Gillett, ,"Iet/iclll Dep(lrllllellt, J 818- 1865, p. 289). 

7 1. Joseph 1-1 . Ford , "Notes on Organi za tion and 

Equipment fo r Evacuation of vYounded," p. 669; 
346 THE A RMY MEDICAL DEPARTMENT, 1865- 1917 

Thomason, "Sanitary Troops," Pl'. 5 11 , 518- 19; Per· 

sons, "Special Art icle," p. 403; Field Se rvice Regula. 

IiOIlS, 1910, p. 18J ; WD , SGO, M<Hl!wl, 1911 , pp. 

l 76-233; Straub, MeciiCllI Serv ice, pp. 6-7. 

72. WD, ARofSG, 1903, p. 39, 1904, p. 25, and 

190B, p . .1. 28;John K. Mahon , /-l iS/DIY of til e Mi li/in 

and file Na/iollal GUlli'll, p. 143. 

73. WD, Al/ofSG, 1910, PI'. 80-83, and 19 11, p. 

9 1; Roben 1-1 . Pierson, "Conclitions of Military 

Surgery," p. 71 ; "Better Instruction," p. 1737; George 

S. Crampton, "Campsof I nst ruct ion for M ilit ia Med· 

ical Officers in 1909," p. 362; Henry H. Doan, .,/\ 

Plea for More Camps of Instruction Under Govern· 

ment SuperviSion, for Officers of the Organized 

Mi litia," pp. 75,77; Edward L Munson, "The Con· 

duclion of Ficld Maneuvers of Mi litary Sanitary 

Troops," p. ] 7:J. F. Edwards, "T he: Adaptation of the: 

Medical Service of Lh e National Guard La That of the 

Army," pp. 48-49. 

74. W D,ARofSG, 1910, 1'.125, 1912, 1'1'.185-86 

(quotations), 187, and 1913, pp. 184-85; Charl es 

O. Center, "Lessons Learned aL a Maneuver Camp," 

p. 34; Thomason, "Sanitary Troops," pp. 515, 517; 

WD, SGO, SGO, PI'. 66, 68-69. 

75. WD, ARofSG, 1913, p. 185, and 1914, p. 172; 

Straub, "Training," pp. 363-69; Ashford, "Mission," 

pp.163, 168; Edward L. Munson, "Mi litary AbsenLeeism in War . . . ," PI'. 489- 90, 624, 626- 28, and p. 25. 

76. WD, ARofSG, 1913, p. 89, and 19 14, PI'. 

170-7.1 (quotat ions). 

77. War Depart ment, Surgeon General's Ornce, 

RegulClLiolls fortlle Governlil ent of United Stales Arm)' 

Gelleral I-lospil(t/s, J 914 (Washington, D. C.: Government Prilliing O rnce, 1914); idem, I\-lwIIWI, 

191 1, PI'. ] 73-75. 

78. WD, ARofSG, 1898, p. 130, and 1899 , PI'. 

61-62. 

79. Girard received his permanenL rank of IieuLenant colonel on 8 October 1900. 

80. WD, ARofSG, 1899, PI'. 240-4 1, 1900, PI'. 

28- 29,33, 1901, PI'. 79,84 (quolation), 1902, 1'.138, 

and L912, p. 152; \VO, SGO, Mallual, 1906, p. 57; 

Peter E. PalmqUist, comp., "Elizabeth FleischmannAschheim, Pioneer X-ray Photographer," pp. 35-45. 

81. WD , ARofSG, 1902, PI'. 136-38, 1903, p. 

.1. 25,1904, p.1 27,and 19 12, p. 156; W illiam C. l3or· 

den, "The Walter Reed General Hospital of the 

United Slat es Army," PI'. 20, 22- 25. 

82. 'ND,ARofSG, 1905, p. 146, 1908, p. ! 13, and 

1909, p. L 40; Bordcn, "Vlalter Reed," p. 32. Sec also 

Mary W. Standlee, "Borden's Dream," 1:75-78, in 

Manuscript and Correspondence on HislOry ofWal· 

IeI' Reed Army Medical Center ("Borden's Dream) 

Series, RG H 2, NA RA. 

83. WD, ARofSG, 1911 , p. 157, 1912, p. 165, 

19 13, 1'1'. 148-49 (quotation), 152, 188, and 1914, 

1'1'.142, 145. 

84. Ibid., 1903, PI'. 123 (quotation), 129, 132, 

1909, 1'1'. 141-42, 1912, 1'. 159, 1913, 1'. 143 , and 

1914, PI'. 137, 140; WD, SGO, Mo nllol, 1906, PI'. 

58-59. 

85 . SGO eir I, 6 Apr 1903, Entr)' 66, RG 11 2, 

NARA; Daniel M . Appel, "The General Hospital and 

Sanatoriulll for Treatment of Pulmonary Tuberculosis al Fort Bayard , New Mexico," p. 203; Paul M. 

CarringlOll, "Further Observations on the Treatment of Tuber cui os is at Fort Stan to n, New Mexico," 

1'.207; WD ,ARofSG, I902, PI'. 68-69, 1903, 1'1'.19, 

65 , 124, 1904, PI'. 122 , 125-26, and 1908, p. 112; 

Sternberg, Sternberg, p. 139; "An Army Sanitarium 

for Tuberculosis," p. 248. 

86. WD, ARofSG, 1899, p. 205, 1901 , PI'. 59-60, 

1903, p. 126, 1908, PI'. 124, 126-27, and 1909, PI'. 

78, 148-50; Fielding 1-1. Garrison, NOles Oil/lie His101 ), oj MilUm), Medicille, p. IB6; Dodge COll1 l11issiol' 

11<I'0rt, I:188-89; WD,SGO, SGO,I:70; /vIemo,Acting SG La Prcsidcnt, 19 Oct 1904, folder Memo· 

ra nda, I904, I911, /vis Cl4, NL/vl. 

87. WD, Al/ojSG, 1900, p. 25, 1903, p. 39, and 

1904, p. 29. 

88. For the situat ion in the Philippines, see 

Chapter B. 

89. For information on the second occupat ion 

of Cuba, see Chapter 9. 

90. WD , ARofSG, 1901 , PI'. 59-60, 1903, p. 39, 

1904, Pl'. 28- 29, 1907, 1'1'.130-31, and 1908, PI'· 

124-25; Woodruff and 'vVoodbury, "Prevention of 

Disease," p. 12; Persons, "Special Art icle," p. 402; 

Field Service negu/atiolls, 1905, pp. 21-24; \ ·VD , Five 

)'<:ars, p. 177; WD, SGO, SGO, PI'. 61 , 70. 

91. WD, ARofSG, 1908, p. 125 (quotation); 

Dodge COlllll1 ission nep0rf, 1: 189. 

92. WD ,ARofSG, 1908, 1'1'.122, 124, 126, 1911, 

p. 184, and 19 12, p. 193; Abrahamson, AllleriCll 

An"5, PI'. 83 , 92-110; WD, SGO, SGO, PI'. 61- 62, 

220; Clark, "Some Observations," p. 36 1. 
Chapter 13 

THE MEDICAL SERVICE IN ACTION 

AILhough nothing could adequaLely 

prepare the Medical DepanmenL for the 

sLruggle to come, the challenges medical 

offi cers fa ced in peaceLime gave them experience that wou ld prove valuable a fter 

Lh e United States enLered the war in Lhe 

spring of 1917. Large-scale training maneuvers offered medical offi cers a greaLer 

understanding of Lheir abiliLY Lo handle 

military probl ems similar on a small scale 

to those they would fa ce in France. A city 

Lemporarily paralyzed by a natural disaster provided inSights thaL would help deal 

with the helpless, homeless, and terrified 

populations of Europe once the war was 

over. Finally, troops sLaLioned wiLhin Lh e 

United States and at posts scattered abouL 

the new empire cOnLinued to benefit from 

the ever-growing insighLs and revelaLions 

that characterized the new era in medicine. 

Fightil1g Disease and Disability 

Before the medi ca l revolution, the 

Army's physicians had wo rked in the dark 

in Lheir unending struggle to limit the inroads o f disease and infec Lion. Although 

they relied heavily on sanitation in their 

attempLs to prevenL epidemi cs, they had 

lacked a clear understanding of why iL was 

effecLi ve. Since the d iscovery that vacc ination prevenLed smallpox had been accidental, scientists had been unabl e to develop a similar approach to other diseases. 

Complex surgery had rarely been undertaken because fatal infection so of Len resulted. By th e turn of the century the efforts of medical offi cers to maintain high 

standards of sanitation were increasingly 

effective because they now understood 

what they were fi ghting. Their abiliLy to 

develop vaccines with which to immunize 

troops against th e most prevalenL diseases 

was growing. Because they knew how 

wound infec tion developed , they co uld attempt forms of surgery they had never 

dared before, invading even th e abdomen, 

which until the medica l revolution had 

been largely a forbidden territory. 

The most obvious approach to preventing a recurrence of the epidemi cs of 1898 

was improved sanitation. in December 

1898 Sternberg named Colonel Greenleaf 

medical inspecLor for the Army, making 

sanitation in the fi eld , aL posts, and in hospitals one of the major responsibiliLies of 

the new offi ce. In the camps established for 

volunteers in the summer of 1899, tents 

were placed a Lent's width apan, and all tents 

were noored , with the noaring raised well 

above the ground. The contents of camp latrines were either nushed into a seweragt' 

system or regularly removed. WaLer supplies were carefull y monitored, and 

kitchens closely supervised. Bathhouses 
348 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

FREDERICK F R USSELL 

with hot and cold running water were available to encourage personal cleanliness.' 

The triumph over typhoid fever, traditionally a great danger to any military 

force, represented one of the Medica l Deparllnent's most signifi cant victories. A 

major factor in this ach ievement was the 

recogn ition of the fact that the key to maintaining sanitation at a co nsistently high 

level was discipline. Discipline was not always easily maintained among new recruits, especially when line officers tended 

to treat medica l officers' warnings abo ut 

poo r sanitation with contempt. Recognition of this situati on led the members of 

Major Reed's Typhoid Board to co nclude 

that immun ization might be a more effecti ve approach to preventing typhoid in the 

Army than sanitation alone. Because the 

department's attempts to develop an oral 

vaccine had fail ed, in 1908 Surgeon General O'Reilly appointed a new board to 

study the problems involved in immunizing an army against typhoid. The board 

was composed of both military and Medical Reserve Corps members, among them 

reservist Dr. Victor Vaughan, the lone survivor of the first Typhoid Board , and medical officer Capt. Frederick F Russell , who 

was promoted to major shortly after he assumed his new responsibilities.

2 

Under Major Russell's guidance, U.S. 

soldiers were inj ected with a vaccine of a 

type developed by the British that had been 

prepared by the Army Medica l Museum as 

part of an effort to develop standardized 

dosages. Experience gained through a voluntary immunization program started in 

1909 proved that though the protec ti on 

given was relative rather than absolute, th e 

results justified wider use, especially since 

on ly 1.2 percent of those given the vaccine 

had severe reactions, while 92.1 percent 

had mild reactions or non e at all . In 1911 

immuni za tion was made compulsory first 

for a division serving in Texas near the 

Mexican border, then for the entire Army, 

and in 1912 for all recruits. The process o f 

immunizing the entire Army was COI11 -

pleted earl y in 1913, when the last men in 

the Philippines received their third and 

final shots. As a result, the 1907 typhoid 

admission rate of 379 per 100,000 men 

dropped to 243 in 1910 and to 4.41 in 

1913. But only time would answer the 

question of how long immunity lasted.' 

The Medical Department set aside a 

room in the Army Medical Museum specifically for the manufacture of vaccine in 

large amounts. "Entirely new apparatus" 

was used in a way that would assure the 

purity of the vaccine, and no exchange of 

equipment with other laboratories was allowed. Another laboratory to make typhoid vaccine was established in Manilaso 

that soldiers serving in the Far East co uld 
THE MEDICAL SERVICE lN ACTION 

be promptly immunized. The Army was 

soon supplying thousands of units of vaccine to the U.s. Navy, where immunization 

had been made mandatory, as well as to 

National Guard units and various departments of the federal government and state 

and city boards of hea lth. Surgeon General 

Torney proudly noted that "among thesanitary achievements of the Med ical Department in preventive medicine since the time 

of the Spanish-American War this sanitary 

measure for the prevention of typhoid 

fever should . .. rank second in importance only to the discovery of the method 

of transmission of yellow fever. " , 

The phenomenon of the typhoid fever 

carrier, however, was yet to be completely 

understood. Major Russell , the medical offi cer most closely associated with the development of the typhOid vaccine, noted in 

1909 that he had encountered few carri ers 

up to that point in the United States, a fact 

that he believed might be related to the relative yo uth of the Ameri can soldier and to 

a possibly greater preva lence of the carrier 

stateamongwomen than men. [11 the course 

of their effort to identify ca rriers, Army doctors concl uded that the Wida l test was not 

as reliable as the examination of blood, 

urine, and fecal samples. As a resu lt, three 

consecutive negative reports based on laboratory examinations of fecal and urine 

samples collected at six-day intervals were 

required before an Army hospital cou ld release a typhOid patient. Wh en a carrier was 

identified, he was immediately isolated , and 

every effort was made to eliminate the typhOid bacillus from his body. In two chronic 

carrier cases reported by Surgeon General 

Torney in his 1913 ann ual report, when all 

else failed , gallbladder removal proved successful in ending the carrier state.' 

Even while Signifi cant progress was 

being made in the battle against typhoid , 

349 

venereal diseases-specifically syphilis, 

go norrhea , and chancroid, a locali zed nonsyphilitic infection that produced genital 

ulcers-were causing increasing concern. 

The identification of the go nococcus in 

1879 and of Trepollell1a pallidLlIl1 , which 

causes syphilis in man, in 1905 and the development of the Wassermann test for 

syphilis in 1906 made the diagnosis of 

venereal disease easier. Recogniti on o f the 

extent to whi ch both diseases were responsible for deteriorating health and 

damage to organs outside the genitourina ry system led Surgeon General O'Reilly 

to comment in his 1907 annual report that 

they caused a loss in service "equa l to the 

loss for the entire yea r of the service of 

about 11 fu ll companies of infa ntry." Civilian physiCians could avo id dea ling with 

venerea l disease because of th eir personal 

distaste for conditions associated with 

moral degradation or co uld co nceal its 

presence to protect their pati ents from disgrace. By 1913 only fi ve states req uired 

doctors to report cases of venereal disease. 

Med ical o ffi cers had no such options. The 

need to prevent the spread of the disease 

was more important than either the physician's qualms or the patient's pri vacy· 

The ability to identify the causative organisms led to an awareness both of the 

prevalence of these diseases in the Army 

and of the embarrasSing fact that they were 

more common in the U.s, Army than in 

any other major military force in the Western world. The number of cases diagnosed 

\-vas increasing rapidly, from an annual average of fewer than 75 per 1,000 from 1889 

to 1898 to 128 per 1,000 in 1900. By 1905 

the figure stood near 180. Venerea l disease 

was the primary cause of rejection of recruits in both 1911 and 1912, although by 

1913 it was only the third. [n the Philippines the rate of cases reported among U.S. 
350 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

soldiers-275.64 per 1,000 in 1910-was 

much higher than the 62.05 per 1,000 

characteristic of the Philippine Scouts, 

who generall y li ved with their fami li es. 

The 1909 figu re of 11.44 per 1,000 soldiers 

in the continental United States rendered 

actually non effective by venerea l disease 

was a record high and obviously posed a 

serious concern for an army being prepared for possible wartime service. As late 

as 1913 the gonorrhea rate remained 

higher than that of any oth er nation's army 

on record, while only the British Army, 

with its large numbers of men serving far 

from home, suffered more from syphilis.' 

The realization of how prevalent these 

diseases were made discovering a successfu ltreatment for them all the more mgent. 

At the llIrn of the centul), the only treatment for syphilis with hope of successmercury-was a grim o ne that could result 

in loosened teeth, kidney damage, anemia, 

tremors, and various mental problems, side 

effects that physicians may have considered 

on ly fitting for the victims of a disease they 

associated w ith depravit y. At leasl o neArmy 

surgeon treated S)1Jhilis with two inj ections 

a week of "gray oil made of meta llic mercu ry, carefully rubbed up with lanolin," 

which added occasional local abscesses to 

the paLi ent's miseries. l njections were given 

once a week for another twelve to fifteen 

weeks after all symptoms had disappeared. 

Inj ury could also follow the injection into 

the urethra of a solution of bichloride of 

mercury given in w hat was usually a vain 

attempt to cure gonorrhea8 

For a time high hopes were held for a 

newly discovered trea tment for syphilis, 

salvarsan, known in the United States as 

arsphenamine. The Medical Department 

w as apparently av/are o f the new drug rro m 

its inception, since when Paul Ehrlich developed it in 1909, Army assistant surgeo n 

Capt. Henry J. Nichols was working in the 

German bacteriologists laboratol),. Nichols 

began his own experiments in 1910 and 

for several years wo rked in the Army Medical School laborato ry with Capt. Charl es 

E Craig, who was studying syphilis th ere. 

For their tests of the new approach, they 

used subj ects in the Washington, D.C., 

area, includi ng soldiers and patients in the 

Government Hospital for the Insane who 

were the victims of advanced syphilis. 

Time proved that s alvarsan produced significantside effects, some of which, as both 

civilian and military physicians soon realized, were related to th e method of administration. Given by intramuscular injection, it caused swelling and pain that 

could last as long as four days and was severe enough to require the use of narcotics 

for reli ef. In some cases the tissue around 

the site o f injectio n di ed. Even intraveno us 

administration was accompanied by nausea, diarrhea, headache, a low fever, and a 

minor amount of vomiting.9 

The grea test qu estion about salvarsan 

concerned its effectiveness. Although 

treatment with me rcury was far fro m ideal 

and doctors we re eager to find something 

better, they were not initi all y sure about 

the dosage and timing of th e new drug and 

thus could not accurately estimate its 

wo rth. To evaluate their experiments, they 

decided that if a pati ent's Wasse rmann was 

still negative after a yea r without symptoms, they wo uld consider him cured. 

Judged on th is basis, cure with a Single 

dose, as recommend ed by Ehrli ch, ra rel y 

proved possible. Surgeo n General To rney 

blamed failmes on insufficiently vigo rous 

treatment and in 1912 recommended 

using Salvarsan and mercury together. 

Captain Nichols preferred to treat primary 

syphilis wi th an intravenous injection of 

Salvarsan and a month of me rcury «by in-
THE MED ICAL SERVI CE IN ACTION 

unction I rubbing in a mercury ointmenLl 

or injection," fo llowed by a second inj ecti on of Salvarsan and possibly another 

month of mercury. Pati ents with secondary 

or tertiary, or advanced, syphilis received 

evenl110re energetic treatm ent. Those with 

secondal,)' syphilis suffered from fever, a 

rash, hair loss, headache, and pain in the 

joints that appeared six weeks after exposure and lasted rough ly three months. The 

symptoms of those with tertiary syp hilis 

often occurred after a period without 

symptoms and affected skin, bone, and internal organs. Nichols found that his approach produced a negative Wassermann 

in 72 percenL of his cases within two 

months. Hope [or a new drug, Neo-Salvarsan , a supply of which Ehrlich sent the 

Medical Depa rtment in 1912, was high for 

a time, since it was reported to have rewer 

unfortunate side effects than Salva rsan. 

After establishing a register of patients so 

that the results of treatment could be eva luated even when the men involved had 

been tra nsferred, the department determined that Neo-Sa lva rsa n was less effecti ve than Salvarsan. Ex perience had suggested that those being treated with either 

drug could remain on duty without unfortunate co nsequences and thus that the 

loss to the Army through ineffectiveness 

could be held to a minimum. Torney was 

suffi ciently impressed with the findings of 

the various studies to urge that prompt 

treatmenL o f syph ilis be made mandatory. 10 

Since th e Medical Department relied 

heavily on the Wassermann reaction both 

to detect unsuspected cases of syphilis and 

to show the progress o f treatment with the 

vari ous drugs, ex tensive studies were conducted to asce rtain the accuracy of this 

test. By the end of 1911 it had been used 

more than 6,000 times, but often no co nclusions co uld be drawn from test results. 

351 

In others they proved misleading; in one 

group of 1,661 men beli eved to have 

syphilis, for exampl e, only 1,315 tested 

positi ve. Medi cal offi cers eventua lly concluded that negative test results co uld not 

be relied upon , since such factors as recent 

heavy alcoho l intake could interfere with 

th e Wasserman's accuracy. They learned 

that false positi ves were also possibl e in pati ents suffering from such diseases as 

malari a, scarlet fever, and leprosy, and on 

occasion even cancer or tuberculosis. Although experiments with different cultures and with varying methods of preparing anLigens led to improvements in 

accuracy, misinterpretations by technicians who did not und erstand th e test also 

caused d iffi culties. As a result, Capta in 

Craig emphasized that th e test shou ld be 

don e only in well-equipped laboratori es 

and by a well-tra ined staff'l 

With venereal disease rates alarmingly 

high and treatment likel y to do more harm 

than good, the Medical Department urged 

that greate r emphasis be placed upon prevention. Because rates in the ne""ly occupied areas were particularly high, troops 

serving overseas should be warned that 

local "hovels are sources of infection," 

whose occupants might carry both venereal disease and tuberculosis. Punishment 

only led to co ncealmenL and ver)' possibly 

the infection of oth ers. After returning from 

Belgium, where he was a U.s. delegate to 

the Second International Conference for 

the Prevention of Venereal Disease, held in 

1902, Lt. Col. Valery Havard suggested that 

consideration be given to stri ctly controlled prostitution. This approach was 

popular in Europe and, in modified fo rm , 

had been tri ed in at least one area in the 

Philippines. Some posts where venereal 

disease rates were low credited th eir success in part to the cooperation of nearby 
352 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

communiti es in controlli ng prostitution, 

often by using medical examinations to 

identify infected women. Although the 

concept of deali ng with venereal disease by 

such unofficial li cenSing of prostitutes was 

distasteful to all, its proponents believed 

that this trade, "vicious and shameful" 

though it might be, should be subj ect to 

legal control, just as less distasteful businesses were. Recognizing that those who 

had no source of recreation on post wou ld 

be "tempted to drink distilled liquors" in 

locations where they wo uld be "exposed to 

the solicitations of the worst class of prostitutes," some post commanders and also 

some surgeons urged that post canteens 

again be allowed to sell beer. " 

Although he supported the "reglementation" of prostitutes, Colonel Havard 

noted that "it is in the conscience of the 

young man that prophylaxis should begin." 

Ma ny favo red a campaign of education designed to enco urage the recruit to report at 

once for treatment if a disease were contracted and to convince him that "nOl only 

are chastity and continence not prejudicial 

to health, but, on the contrary, [they are l 

most commendable from th e medical point 

of view." Since "popular opposition to taking preventive measures" continued to 

compli cate the Army's attempts to combat 

syphilis and gonorrhea and since in theory 

abstinence was the simplest and surest way 

to avoid venereal disease, Surgeon General 

Torney, too, supported education, urging 

his surgeons to teach the men abo ut the 

dangers of unmarried sex and "the advantages of sexual continence. " 13 

In no position to entertain ill usions 

about the effec ti veness of this approach, 

Surgeon General Torney pointed out that 

while it was "a grievous fault that a young 

man should fai l to control his passions, it 

is a far wo rse thing for him and for the 

co untry if ... he acquire an infectious disease which unfits him for th e performance 

of his duty as a soldier. " The War Department should, therefore, adopt "a philoso phical indifference to criticism on the 

part of self-constituted censors of the public morals whose susceptibili ti es are offended by a publi c discussion of these 

questions" and seek more realistic approaches to the problemH 

The use of prophylax is shou ld be encouraged "for those who have not the 

moral stamina and self-co11lrol to observe 

co ntinence." Post surgeo ns should experiment with the exact methods to be used. 

One possibility was setting up a room at 

either the barracks or the post hospital to 

whi ch a man newly returned from a night 

of uncontained passion could retreat to 

take advantage of a supply of prophylactic 

medi cations. These often included calomel ointment for external use and an Argyrol, silver nitrate, or potassi um permanganate solution fo r irrigating the urethra , 

stored with the syringes needed to inj ect 

the fluid . The Medica l Department also 

made ava ilable indi vidual packages of disinfectants, known as K packets, for men 

apprehensive about being seen entering a 

room known to have been set aside for 

those lacking moral stamina. These packets co ntained, as Edgar Erskine Hume put 

it, "a tube of mercurous ointment with 

added coll oidal silver." The medi cations 

appeared to be effective if the men using 

them were neither befuddled by alco hol 

nor repelled by stains left on clothing. Precauti ons proved to be most effecti ve when 

hand led in a hospital under the supervision of a corpsman . 15 

The co ndom was apparentl y never 

given serious consideration, although its 

effec tiveness against venereal disease was 

genera ll y recogni zed. The reaso ns for the 
THE MEDICAL SERVICE IN ACTION 

failure to incorporate the condom in the 

campaign, a failure shared with the Canadian Army at the time, are not clear. Jay 

Cassel in Th e Secret Plagll e: Vel1 ereal Disease ill Canada, 1838-1 939, speculates that 

perhaps in the period of World War I the 

condom was regarded as less effective in 

preventing disease than ointment, or that, 

since it was a very effecti ve means of birth 

control, encouraging its use might appea r 

[0 be advocating illi cit sexual activity as 

well. Apparently the condom did, however, play an important role in the anti-YO 

effort in the New Zealand Army." 

The ultimate success of any campaign 

against venereal disease depended upon 

line offi cers as well as physicians. The commanders of some geographical departments 

gave their subordinates specific orders to 

cooperate with post surgeons in their efforts, and Surgeon General Torney urged 

that both post surgeons and post commanders report on their work to reduce venereal disease rates and on the results they attained . The cooperation he received vari ed 

conSiderably from post to post. At least one 

officer refused [0 permit the distribution of 

K packets at his post, while others allowed 

them to be doled out to any soldier requesting them. In the Philippines post commanders sponsored lectures on the need for 

continence; encouraged inspections to detect signs of infection; and punished those 

who, despite the availability of preventive 

measures, contracted a venereal disease. 

Punishment added another difficulty to efforts to keep track of disease rates, however, 

since it might lead soldiers who had contracted syphilis or gonorrhea to conceal 

their condition,I 7 

After an encouraging drop in 1910, venereal disease admission rates rose again in 

1911. The rate for syphilis, at times higher 

in whites than in blacks, continued to climb, 

353 

but the increase may have been only apparent because the Wassermann test now revealed cases, particularly secondary cases, 

that might otherwise not have been diagnosed. The average soldier, unmoved by the 

grim details oftheeffectsof venereal diseases 

upon his health, all too often ignored the 

prophylactics made available to him. Thus 

the appeal of docking the enlisted man's pay 

for time lost from his duties because of venereal disease grew. The judge advocate general pointed out that only enlisted men 

could be dealt with in this manner, since the 

Army could not legally reduce the pay of offi cers because of sickness. IS 

The anti- venereal disease campaign also 

needed to be made moresystemati cand less 

dependent on the whim of the offi cers at 

the individual posts. In 1912, therefore, the 

War Department issued an order that made 

both venereal prophylax is administered in 

the hospital and unannounced medical examinati ons fo r venereal disease mandatory; the soldier who contracted a sexually 

transmitted illness after fa iling to avail himself of the hospital-administered program 

would have his pay docked for time lost 

from duty, as would all others lOSing duty 

time because of a disease contracted 

through misconduct. No serious opposition to this campaign ever developed. Many 

inquiries came in about it from those concern ed with public health, but to Surgeon 

General To rney's distress, a circular he issued detailing anti-VD measures was "furnished confidentially to medical officers" 

rather than being made free ly available to 

all who were interested.'9 

Care must be used in evaluating the statisti cs of this period, since some include 

each time a soldier reported for treatment, 

regardless of when he contracted the disease, while others represent only new 

cases. Nevertheless, the use of a th rea t [0 
354 TH E ARMY MEDICAL DEPARTM ENT, 1865-1917 

the soldier's wallet appeared to have a positive effect. Beginning in 191 2, the rates of 

venereal disease began to drop more 

rapidly, from 163.49 first-Lime admissions 

per 1,000 in 1911 to 136.70 in 1912 and 

97.22 in 1913 . The total Army-wide noneffective rate from this ca use fell to 10. 14 

per 1,000 in 1911 and to 4.51 by 1913. 

Even in the Philippines the YO rate was 

"markedl y reduced." These figures renected a decline in the individual rates of 

each of the three prevalent venerea l diseases, but the surgeon genera l was not entirely happy; at some posts, rates remained 

high, leading him to suspect that the regulations were not uniformly enforced. 

Moreover, the possibility that men were, 

under the threat of punishment, failing to 

report to sick ca ll cannot be ruled out. 

When men were allowed to delay reporting for prophylax is more than six hours 

after sex ual intercourse, they ran higher 

risks of contracting an infection. Prophylacti c packets, which could be used immediately after exposure and were sold at 

a nominal price, were not popular. Torney 

concluded that either the packets must be 

given out without any charge or passes 

must be limited so as to requi re soldiers to 

return to base for treatment within the allotted time after ex posure.'o 

Associated with th e venerea l disease 

rate was th e old probl em of the alcoholism 

rate, which was also greater in the u.s. 

Army than in the other forces whose statistics were availab le to the surgeo n general. Alcoholism was a problem chieny 

among white troops. After years of rising 

rates, th e incidence fina lly began falli ng in 

1908. In 1912 the rate dropped from the 

28.26 per 1,000 of the previous yea r to 

16.67, lowe r than it had been since 1873. 

This achievement, too, was credited in part 

to th e stoppage of pay for those whose ineffectiveness was deemed to be the result 

of their willful behavior. The improvement 

dampened enthusiasm for restoring the instituti on of the canteen.

2 1 

Unlike alcohol addiction, drug add iction had received lilli e attention fro m 

Army authori ties. Beginning in th e twenti eth century, attitudes towa rd th is problem began to change, and habitual use 

came to be rega rded as a sign of mora l 

weakness. Occasional instances of heroin 

addi ction were uncovered, this drug being 

easily obtained, but cocaine was not widely 

recogni zed as a threat to either health or 

moral strength; former surgeon genera l 

William Hammond was reported to take "a 

wineglass of cocaine with each meal. " Cocaine was named "the official remedy of 

th e Hay Feve r Association" and was also 

used to treat addiction to opium, morphine, and alcohol." 

Nevertheless, at least one Army surgeon 

recogni zed the dangers of cocaine. At 

Texas City, Texas, young Lt. William B. 

Meister was alarmed by the add icted soldiers he discovered in the spring of 1913. 

He concluded th at because few cases were 

normally encountered, the surgeo n general had never attempted to discover the 

ex tent of the problem in the Army. After 

pOSitively identifying eleven cases in 

whi ch th e men had been fou nd to be in actual possession of cocaine, Li eutenant 

Meister became convinced that this drug 

was a "new Ogre" that was "gatheri ng adherents unto itself. " He noted that the men 

in volved usuall y first tried it because of curiosity reinforced by the persuasion of a 

friend or a prostitute who raked in a considerable profit from its sale. Users eventually found that cocaine, often taken by 

inha ling from a quill or a kni fe blade, was 

"more necessary than food itsel f. " 

"Whosoever worships at the Shrine of 
THE MEDICAL SERVICE IN ACTION 

Coca," Meister noted, "remains fa ithful 

UIllO the End." He beli eved that the problem was "alarmingly on the increase in our 

army" and that the habit was impossible 

to brea k, but his warning to medical officers to be on the alert for it apparentl y 

made no impression. Z3 

The U.S. Arnl)' tended to have a higher 

rate of mental illness as well as higher rates 

of venereal disease and alcoholism than 

other armies. ]n the continental UniLed 

States in 1910, for example, 1.58 men in 

1,000 were hospitalized because of melllal 

illness, while in 1909 th e comparable figure in the British Army was 0.8, in the 

Bavarian Army 1.4, in the Austro-Hungarian Army, 1.3, and in the Japanese Army 

0.32 in 1,000. In the cOlllinenta l United 

States in 1912,2.78 soldiers per 1,000 were 

diagnosed as suffering from mental problems, wh ile in the Philippines, although th e 

troops still had to contend with guerrillas, 

the rate was only 2. 19 per 1,000. The surgeon general's annual report recorded 2.57 

per 1,000 discharged from the Army in 

1913 because of melllal alienati on, but statisti cs for mental illness are of little va lue, 

since much depends on how a given Army 

defines it and how ill a patielll has to be before he is in cluded in the reco rds. The high 

rate of alcoholism among soldiers was beli eved to cO lllribute to the situation. The 

surgeo n general's annual report for 1910 

shows that the rate of acute alcoholism in 

the U.s. Army in 1909 was 22. 19 per 1,000, 

while the rate for the British Army was 0.9 

per 1,000; in 1907 in the French Army the 

rate was 0.35, while in the Prussian Army 

it was 0.11. Other cases of mental illness 

were blamed on sunstroke and such diseases as malaria, typhoid fever, and dysentery. Sin ce the diagnosis of mental ali enation included homesickness, then ca lled 

nostalgia, and hypochondriasis, as well as 

355 

a "constituti onal ps)'c hopath ologic state" 

and retardation, comparisons to rates in 

other armi es were not necessa rily valid. 

The problem was of such magnitude that a 

buil ding was set aside at the Presidio in San 

Francisco where th ose believed to be insane could be held for observation before 

being sent east to the Government Hospital for the Insane in Washington, D.C." 

With tuberculosis, as with venereal disease, the increased ability to diagnose that 

followed in the wa ke of the medical revolution exacerbated anx iety about the 

prevalence o f the illness. Recognizing the 

organism that caused tubercul osis, th e seco nd grea test cause o f noneffecti veness in 

the U.s. Army, led to the chilling discovery that the bacillus might li ve in dust for 

long peri ods of time if it was not ex posed 

to sunlight. This fact further complica ted 

co ntrol of the disease." 

The rate of tuberculosis, too, was higher 

among U.s. soldiers than among those of 

many European armies, in pan, presumably, 

because so many A mericans were stat.ioned 

in the tropics. Even Filipino troops eaSily 

contracted the disease because of what 

Sternberg called "the enervating effects of 

the tropical climate." Tuberculosis was especially devastating to black troops in the 

Philippines and, because they were so often 

exposed, to hospital corpsmen. By 1903 

more than 4 of evety 1,000 soldiers in the 

United States had been discovered to have 

TB. With so many new cases originating in 

the tropics, rates did not fall appreCiably in 

the first years of the new celllury in spite of 

the Medical Department's efforts.'6 

As late as 1912 tuberculosis was still a 

major hea lth problem for the Army, causing 17.48 percent of all disability discharges among troops in th e Phil ippines at 

a time when disease in general was responsible for more than 86 percent of dis-
356 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

charges there. Since the Medical Department round it impossible to screen out all 

recru iLs wiLh Luberculosis, which was common in the civilian population, a third or 

Lhe Army's cases were round in men who 

had not yet compleLed a year or servi ce. Xray picLures were nOL rouLinely used in the 

diagnosis ofTB until 1917, and the tuberculin tesL did not distinguish between 

those who had been ex posed LO the disease 

and those who actua lly had it. Thus, rejecLing all those who tested posiLive was 

not feasibl e because it would drasLi cally reduce the number or recruits. Finally Lhe 

Army ado pLed a policy common in Europe, 

dismissing rrom the miliLary service raLher 

Lhan hospitalizing those who were diagnosed as having TB during their first enIisLment, th ereby lowering the Army's admission and deaLh rates." 

To further reduce th e incidence or tuberculosis in the Army, the Medical Department suggested thaL no one under the 

minimum weight ror his height be taken 

into the Army, since 74 percent or those 

treated for TB in 1911 were underweight. 

Surgeon General Torney also co ntinued to 

urge that proper attention be paid to ventilation and other sanitary measures, incl uding removi ng TB victims from their 

barracks. Some urged that this step should 

be taken as soon as the disease was suspec ted, bUlthose who ravored delaying it 

until the diagnosis was definite eventually 

prevailed. Torney concl uded that greater 

care in the selection of recruits and improved sanitation had contributed to the 

fall in the tubercul osis rate, whi ch, by the 

end or 1913 was at an all-time low or 3.07 

per 1,000 ror soldiers stationed in the 

United SLates. Because or a minor increase 

in the incidence abroad, the overall rate 

was slightly higher than it had been in 

1911 and 1912.'8 

Soldiers sent to the tuberculosis hospital at Fort Bayard, New Mexico, received 

trea tment that was, as Surgeon General 

O'Reilly put it, "simply hygienic and climatic, w ith the treatment of intercurrent 

complications as they arise. " Sleeping out 

or doors was recommended, and tents and 

porches were provided for the pu rpose. In 

the attempt to keep abreast or their physical condition, the sputum or all paLi ents 

was regularly examined, after which each 

surrerer was classified as "arrested," "improved ," or "unimproved." Longer hospiLal stays had been shown to result in a 

higher survival rate, but most pati ents at 

Fort Bayard were discharged rrom the 

Army arter a two-month stay. Although 

they could then immediately be taken onto 

the rolls or the Soldiers' Home and remai n 

at the tuberculosis hospital as veterans, 

they could not be rorced to stay at the sanitarium once they were no longer in th e 

Army. Those whose condition permilled 

their release were regarded as "missionaries in th e education or the general public 

in the all-important knowledge of the hygieni c mode orlire and protective measures 

so practically learned." 29 

Enro rcing regulations designed to enhance the chances for recovery or patients 

who remained at Fort Bayard was difficult, 

in part beca use many victims or the disease were alco holics with co nsiderable 

skill in sneaking in supplies or their favo riLe beverage. Among other paLients 

who apparently bent or broke some regulations was co ntractsurgeonJ oseph Curry, 

formerl y a member or the Tropical Disease 

Board in the Philippines, who obviously 

did not take the thorough rest insisted 

upon ror other pati ents at the sanitarium. 

Curry co ntinued to examine possibl y inrective material ga thered rrom the hospital's efnuent un til a shon time before his 
TH E MEDICAL SERVICE IN ACTION 

death from tuberculosis in January 1903, 

presumably jeopardizing his chances for 

recovery; like so many other patients, he 

may have already been too ill when he arri ved to be saved J O 

Malaria was yet another disease whose 

rates were falling in the period immediately preceding World War I, in this case 

because of campaigns to kill mosquito larvae and to keep man and the adult insect 

separate. In the Philippines malaria rates 

were invariably higher among Filipino 

troops than among Americans, presumably because mosquitoes could not be entirely excluded from the houses where they 

slept with their famili es inl11alaria-infested 

villages. Surgeon General Torney insisted 

that all occupied buildings in those islands 

should be screened. Although the malaria 

rate for u.S. troops unexpectedly increased 

in 1912, a fact for which Torney could not 

find an entirely satisfactory ex planation, 

by 1913 it was lower thaI' it had been in 

any year previously recorded by the Surgeon General's Offi ce." 

Strangely, in the United States the greatest diffi culties in dea ling with malaria were 

experienced not at a post in the Deep South 

but at Fort Washington, Maryland. Here 

dense undergrowth and a nearby marsh favored the breeding of mosquitoes, and the 

rate resembled that in the Philippines. 

When cases increased from 144.3 per 

1,000 in 1908 to 333.33 per 1,000 by 1911 , 

a board of doctors and representatives of 

the Quartermaster's Department called together to study the problem recommended 

draining wet areas, oiling standing water, 

and eliminating all growth more than an 

inch high. A Medical Reserve Corps officer was assigned to serve as sanitary inspector at the fort. When the herd of goats 

bought to deal with the brush proved unequal to the task, prison labor had to be 

357 

used. The time-consuming work was not 

completed until the spring of 1913, by 

which time the malaria rate had fall en 

below 175 per 1,000. Continual vigilance 

remained necessary, for malaria was a common amiction among the civilians of the 

area, who served as a reservoir to infect 

new generations of mosquiloes.32 

Encouraged by successive surgeon generals, medical officers also became bolder 

in their attack on health problems that 

could be relieved by surgery. Their success 

in exploring the new world that antisepsis 

had opened to them rendered previously 

dangerous surgery safe and effective. A 

study of operations to repair hernias, a 

common but disabling amiction, revealed 

only three recurrences of the condition out 

of 59 1 operations in the period 1898-1903. 

Because this operation was now regarded 

as safe, men with hernias could be required 

to undergo the procedure-only "in case of 

a capital operation involving the riskoflife" 

could a soldier refuse surgery without risking court-martial. Ex perience also proved 

that appendectomies did not have to be followed by disaster. When the operation was 

performed promptly, most patients recovered without major difficulty. But Medical 

Department surgeons could not save one 

of their own; MajorReeddied in 1902 when 

peritonitis fol lowed long-delayed surgery 

to remove his appendix." 

Much surgery now involved the abdomen and would thirty years earlier have 

almost inevitably led to the patient's 

demise, but deaths were few. Although 

Army surgeons apparently had not yet 

begun to use rubber gloves in the operating room, in one series of 904 operati ons 

only twent)'-four patients di ed, among 

them four after amputations foll owing leg 

wounds, two as a result of gunshot wounds 

of the abdomen, and two following surgery 
358 THE ARMY MED ICAL DEPA RTMENT, 1865-1917 

CARL R. DARNALL 

to relieve empyema (the accumulation of 

pus, most often in the pleural cavity). Since 

anesthesia also made a vital contribution to 

successfu l surgery, physicians attempted to 

learn more about using it; studies of the use 

of spinal anesth esia aroused enthusiasm 

about its advantages for both th e patient 

and the surgeo n. Noth ing medical orncers 

encountered in peacetime could entirely 

prepare them for the wounded they would 

encounter in war, but, no longer restricted 

to dealing with injuries by fear of infection, 

Army surgeons could undertake surgery of 

a complexity rarely attempted bdore the 

Spanish-American War.)4 

Sa nitation and hygiene remained strong 

weapons in the al'senal of those fighting disease and disability. The need to fi nd a simple and effecti ve device to purify water 

without adding a disagreeable navor enco uraged Maj. Carl R. Darnall of the Medical Corps to apply his ingenuity to yet another problem that co ncerned the Medical 

Depa rtment. Seeking an uncomplicated, 

movable device that would process large 

quantities of wa ter in a short time without 

giving it an unpleasant taste, he ri rst experimented with a siphon fil ter and the use 

of an agent to precipitate solid particles. To 

kill bacteria, he eventua lly turned to chlorine in gaseous form raLiler than the 

hypochl orous salts and ozone generall y 

used. Major Da rnall's ap proach had never 

before been tried, but it requ ired only simple and inexpensive equipment, and he 

could eaSily obtain chlori ne gas since it was 

a by-product of the man ufacture of sod ium 

hydrox ide (caustic soda). Chlorine used in 

this form proved more d fective than fil tration alone, although coarse fil ters might 

still be needed in some instances to remove 

particles. The additi on of the gas to the 

water was also easier to regulate th an that 

of the salts tri ed ea rlier. In 1910 Darnall's 

device was put in to use with great success. 

Onl y three years later, anoth er Army ph ysician, Maj. Will iamj. L. Lyster, deve loped a 

simple apparatus to be used to purify water 

qUickly in the fi eld, using calcium 

hypochlorite added to wa ter stored in what 

became known as a Lyster bag." 

Water purification was of particular interest to th e Army because efforts to keep 

sewage out of the water supply were not always successful. Badly designed systems to 

hand le sewage could still leak polluted material in to wa tersupplies, and sewage could 

still be dumped directly into a post's water 

source by a nearby civilian community. 

Should local co nd itions lead to a temporary contamination of wells, an easily 

moved apparatus like that devised by Major 

Darnall would be especiall y valuable. In 

October 1909 the War Department appointed a board to study water and sewage 

disposal problems at Army posts. Captain 
THE MEDICAL SERV ICE IN ACTI ON 

Russell and Colonel «ea n joined a representative of the Quartermaster's Department to find that although "notable 

progress" had been made in the management of sewage, dirficulties remai ned at a 

few posts, somet imes because a disposal 

system was defective or too small for the 

efnuent it was required to handle. In at least 

one instance the system recommended by 

the board was highly elaborate, yet it, too, 

relied on guaranteeing the elimination of 

bacteria by using calcium hypochlorite.

J6 

Eternal vigilance was also necessary to 

preve nt overcrowding and poor ventilation in barracks and guardhouses. Surgeo n 

Genera l Torney recommended posting on 

the doo rs of dormitories and squad rooms 

the maximum number of people to be allowed in each and was shocked to learn 

that at some posts "overhead or doubledeck bunks, asanitary abomination which 

was believed to be obsolete in the United 

States Army, had reappea red." He also advocated using electri c rather than gas 

lights in barracks with poor ventilation 

and resisting the temptation to use the 

more economical soft coal in preference to 

hard. "It certainly does not seem desirable 

to this office," he reported to Secretary of 

War Stimso n, "that for the purpose of a little supposed economy that the beauty of a 

post should be destroyed, the buildings 

rendered unSightly, and the health of the 

inhabitants endangered by clouds of 

smoke," 37 

Disease was not the only problem that 

could undermine an army's effectiveness. 

The problem of ill-fitting shoes had co ncerned Major Munso n for several years. 

After spending four years examining soldiers' feet ':y the thousa nds as one of the 

officers appointed to the Army Shoe Board 

to swdy th e problem, he published a book 

in 191 2 on th e subj ect of Army shoes and 

359 

WII.LlAM J. L. LYSTER 

their fit that Surgeon General Torney recommended to "all officers and noncommissioned officers who are concern ed in 

the fitting of shoes." While the board was 

at work, medical offi cers checking the fit 

of the shoes of the enlisted men at th eir 

posts discovered the discouraging fa ct that 

more than half oftheArmy'ssoldiers might 

be wearing shoes too small for them. One 

study of almost 600 men revealed that on ly 

43 pairs of shoes were perfectly fitted, 

wh ile 451 were too short, 33 too long, ill 

too wide, and 266 too narrow, with some 

obviously misfits in both dimensions. 

Co rns, bunions, ingrown toenails, and 

other ills were th e inevitable result. At least 

some examinations of th e fit of shoes invo lved the use of X-ray pictures, although 

Munson, who examined va rious approaches to fitting shoes, did not recommend this step as a general procedure.'8 
360 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

E DWARD L. M UNSON 

As a result of his study of shoes and soleliers' feet, Major Munson designed a special last, wider anel thicker in proportion 

to its length than the model usually used. 

Unfortunately, although the new last was 

adopted, soleliers receiveel the new shoes 

only after the supply of the aIel model had 

been completely exhausted. Surgeon General Torney urged that an offi cer supervise 

all fittings, since a shoe that did not fit 

wo uld cause problems regardless of its design. The Army Shoe Board also made recommendations about the fitting of shoes 

anel pointed out that adequate supplies of 

the various sizes must always be available. 

As a result of Torney's concern about the 

fact that enlisted men were issued only one 

pair upon joining the Army, leaving th em 

nothing to change into when their shoes 

became wet, orders were issued that in the 

future each soldier be issued two pairs. The 

shoe that was developed as a result of the 

work of Munson and the boa rd was regarded as the best ever used in the Army.'9 

Although medical offi cers were experiencing success along many fronts, the Almy's 

improved effectiveness resulted largely from 

their victories over the principal diseases that 

had afflicted military forces for centuries. 

Theirachievements in the battleagainstu·opical diseases and typhoid led to a drop in overall disease rates from their 1899 peak, with 

death and noneffective rates at last falli ng 

below those of the pre-1898 period shortly 

after Torney became surgeon general. The 

number unable to perform their duties at any 

one time fell from 41.48 per 1,000 in 1909 

to less than 25 per 1,000in 1913, a year when 

roughly a fifth of hospital admissions resulted from injury, which caused only onetenth of the total number of deaths. Only 

20.02 per 1,000 were unable to perform their 

duties in 1913 speCifically because of illness 

rather than injury, as opposed to 42.83 in 

1904 and 35.62 per 1,000 in 1909. Tuberculosis continued to be the greatest killer, followed in an order that varied from year to 

year by heart disease, nephritis, alcoholism, 

and pneumonia. The disease rates for troops 

in the Philippines continued to be higher 

than for those in the continental United 

States; overall disease rates in the Philippines 

in 1910, for example, were 544.68 per 1,000, 

while in the United States the comparable 

figure was 347.79 per 1,000. Torney noted 

in his last annual repon that overall admission rates in the U.s. Army were now lower 

than those in the French and British armies 

and, indeed, than those in all major armies 

in Western Europe and Asia except those of 

Prussia, Bavaria, and Russia. M oreover, the 

death rate among u.s. soldiers, which at one 

point hael been twice that of civi lians, was 

now much less, thanks in part to the Army's 

attention to sanitation as well as to careful 

selection of men allowed to enter the Army.40 
THE MEDICAL SERVICE IN ACTION 

Hospitals and Laboratories 

As small posts were slowly consolidated into large ones after the end of the 

Indian wars, the Medical Department, always hard -pressed for funds, began to discover that the new and large post hospitals it had to build were both more cost 

effective and more effi cient than small 

ones. Since every post facility now had to 

have a room set aside speCifically for 

surgery, a reduction in the number of hospitals minimized the expense imposed by 

this new requirement. Another new concept, one first put to use in 1906 at Fort 

Myer, Virginia, the isolati on pavilion with 

its own steam sterilizing plant, diet 

kitchens, and bathrooms, promised to 

wreak further havoc upon the department's hospital construction budget. Its 

drive to replace many o[ the deteriorating 

small post hospitals with larger buildings 

was handicapped by a lack o[ funds. Although willing to vo te the funds necessary to increase the perso nnel o[ the Medical Department, Congress had never 

repealed a law dating from the 1850s that 

limited the money to be spent on such 

construction to $20,000 unl ess special 

legislation were passed waiving the requirement. Costs had more than doubled 

in the fifty years since the law was passed, 

and post surgeons were still occasionally 

forced to rely upon antiquated and dilapidated hospitals and even to take over old 

barracks. In the Philippines, where post 

[aciliti es were often particularly makeshift, were made of local materials, and 

were subject to rapid decay, patients with 

more than passing illnesses or minor 

wounds had to be transferred promptly 

from inferior accommodations to newer 

and better facilities, which became known 

as "base hospitals."" 

361 

Before the medical revolution arrived in 

the United States, the laboratory at the 

Army Medical Museum was adeq uate to 

handle the Medical Department's laboratory work. Since U.s. physicians tended to 

be concerned considerably more with the 

practical than the theoretica l, when the 

value of the labora tory for diagnosis became apparent, the demand for its services 

grew rapid ly. But if diseases were to be diagnosed promptly enough to all ow effective measures to prevent epidemics to be 

ta ken, specimens could not be sent great 

distances, especially since any microbes 

involved might not survive a long journey. 

Surgeon General Sternberg was not slow 

in dealing with this problem; by 1902 he 

could boast that the department had established "a thoroughly equipped laboratory" at the Army Medical School, in each 

of the general hospitals in the United States 

and the Philippines, and "at every military 

post of any importance" in the United 

States. With the opening of the Southern 

Department laboratory at the post hospital at Fort Sam Houston in 1912, each military department had its own laboratory. 

The facility at the Medical School, where 

much Medical Department resea rch took 

place, became the main laboratory for the 

Eastern Department. The general hospital 

in San Francisco, which served as the post 

facility [or the Presidio and other posts in 

the San Francisco area, housed the major 

laboratory for the Western Department. 

The Central Department laboratory was at 

the Fort Leavenworth post hospital. The 

division hospital in Hawaii housed another major labora tory, while the mai n laboratory for the Philippines shared the [aciliti es of the Tropi cal Disease Board. A 

medical offi cer was speCifically aSSigned to 

direct each of these large laboratories" 
362 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Evacuation 

Providing beds and care for men who 

became sick whil e en route by train or ship 

to a new assignment and removing to a 

hospital those who fell ill or were injured 

in the fi eld were both continuing concerns 

for the Medi ca l Department. Evacuation 

by sea or rail, Significant whil e so many 

U.s. troops were still stationed overseas, 

required chi eOy the further refinement of 

an approach initiated during the Civil Wa r. 

To stay abreast of the most recent developments in evacuati on by ambulance, the 

department had to enter a new era , that of 

the motor vehicle. 

Since isolating troops for an adequate 

period before they embarked on longjourneys to guarantee that none of them would 

come down with a contagious disease 

proved impossibl e, the Medical Department ordered that each troop train have a 

sleeping car where the sick co uld be sequestered. A hospital car was to be used 

when troops were en route for longer than 

two days. Physicians were to inspect all 

passengers twice each day to determine 

whether any were coming down with 

measles or a similar disease. A co ntract surgeo n chosen by the department was responsible for each ship's sanitati on, and if 

no medical offi cer accompani ed the 

troops, he was responsible for the health 

of the men on boa rd as well . Facilities 

where th e sick could be isolated were reqUired on every transport, and at least two 

hospital corpsmen were assigned to each 

vessel to care for them'3 

Although evacuation by ship involved 

no radica l innovations, evacuation on land 

was being affected by a revolution that 

wo uld soon end the era of the horse- or 

mu le-drawn ambulance. One of Surgeon 

General O'Reill y's more unusual quandaries invo lved the question of whata newfangled machine, the motor ambu lance, 

had to offer. The Medical Department provided its own ambulances, although the 

Quartermaster's Department remained responsible for "the accessory motor vehi cles 

which experience shows are necessary. " 

When the Medical Department's first motor 

ambulance, a steam-powered model, 

proved its superi ority to the horse-drawn 

version at the Washington Barracks, a second was acquired for West Point. A certa in 

distrust for this unfamiliar machine led a 

board of offi cers from both departments to 

go on with plans to adopt a new design for 

horse-d rawn ambu lances. To find the best 

vehicl es for moving the wo unded, the department even resorted to conSidering several types of travois" 

Obtaining the vehicles needed to move 

patients and medical supplies was a longstanding problem, especially since the 

Medical Depa rtment was dependent on the 

Quartermaster's Department for animalpowered ambulances, mule teams, and harness. Although reacti ons to the new type of 

vehicle were mixed, with the cooperation 

of th e Quartermaster's Department, the 

Medical Department continued experimenting with the motor ambulance after 

Torney became surgeon general. Initial 

purchases involved several differen t types 

of "motor trucks and machines adaptable 

to ambulance construction" to determine 

which model best suited the need. At least 

some purchases apparently involved the 

frame, engine, and wheels only, with th e 

Army supplyi ng the body. When heavy 

commercia l truck chassis proved to be too 

heavy, twelve of medium weight were ordered from th e Keeton Motor Company, 

which agreed to supply a Six-cylinder vehicle with special wheels and tires for just 

under $3,000. The Medical Department 
THE MEDICAL SERVICE IN ACTION 

sent ambulance bodies to Keeton ror that 

firm to mount on the chassis, but conrusion developed co ncerning the type or body 

to be sent. When Torney died, the problems 

between Keeton and the Medical Department were still increasing, but the advantages orrered by the motor ambulance, including a diminished need to rely on 

railroads, had been recognized" 

Practice for War 

The Medical Department's plans both 

ror disease prevention and ror the care and 

evacuation or the sick and injured were repeatedly tested at camps established ror 

National Guard summer training and during joint maneuvers staged by the Guard 

and regular units. The combination or 

large numbers of inexperienced soldiers 

with inexperienced doctors, all camped at 

sites without sewers or safe water supplies, 

produced problems similar to those that 

had proved so devastating during the 

Spanish-America n War. The situation was 

rurther exacerba ted by the fa ct that some 

National Guard line offi cers had concluded that sa nitation required no greater 

attention in camp than in the fi eld , where 

the men would not remain long in one location . Although typhoid did appear at 

some maneuver camps, constant vigilance 

kept the disease under control. Septic systems, where bacteria destroyed sewage, 

were tried at more permanent campsites, 

and the department began ex perimenting 

with the use both or Major Darnall's wa ter 

nIter and or an espec iall y designed incinerator to dispose or excreta where pennanent arrangements were ack in g.~6 

Summer training and maneuvers where 

militia and regular troops trained together 

arrorded an opportunity to indoctrinate 

363 

corpsmen in field duties, espeCially those involved in maintaining high levels or sanitation. The need to organize and train each 

ambulance company and to have it capable 

of rapid wartime expansion was obvious, especially since the militia corpsmen were 

often "poorly developed boys, without experience or training." In 1906, in response 

to Surgeon General O'Reilly's urging, san itary squads consisting of both hospital 

corpsmen and hired civilian employees were 

appointed at maneuver camps and were set 

to work purirying water, killing mosquitoes, 

and disposing or waste material. O'Reilly 

considered the use of "the medical department for more extended executive sanitalY 

functions" a Significant development." 

The reservations or many military officers about the Army's readiness ror war 

were not dispelled by the experiences or the 

maneuver camps. Such doubts were to a 

large degree justified in 1911, when political turmoil in Mexico led to an attempt to 

gather U.s. troops at the border in what 

proved to be another giant training exercise. Three months were required to bring 

13,000 officers and men together in a maneuver di vision near San Antonio, Texas, 

and in two separate brigades, one at Galveston , Texas, and the other at San Diego, 

Calirornia. Although th ese units proved 

woefully unprepared ror combat, the perrormance or Medi cal Department personnel, incl uding the men or the Guard, 

formed a bright spot in the gloomy picture. 

The department orga nized the first complete sanitary train, consisting or rour fi eld 

hospitals and rour ambula nce companies, 

since the days or the Civil War. When the 

maneuver division was broken up in July, 

the depa rtment was the undisputed victor 

over disease. The division's chi ef surgeon 

maintained that the health or the men had 

been "unirormly good," with a nonefrective 
364 THE ARMY MEDlCAL DEPARTMENT, 1865-1917 

rate that remained below 2.5 percent, and 

as the Medical Department's representative 

in the Army's Division of Militia Affairs, 

Captain Thomason noted a "very marked 

advancelnent in sanitary service . .. in the 

recent maneuver division in Texas." 48 

The low disease rate at the camps near 

the border with Mexico was largely the result of immunization against typhoid, coupled with strict attention to sanitation. The 

close working relationship that developed 

between Medical Department and Quartermaster's Department (after 1912, the Quartermaster Corps) personnel also "proved to 

be of mutual advantage and to the best interests of the service. " Presumably not only 

the lessons of the Spanish-American War 

but the guidelines laid down in the Field 

Service Regu /aUol1s encouraged and facilitated cooperation. Because adequate quantities of equipment and supplies were 

promptly delivered to Medical Department 

representatives, both the division's chief 

surgeon and sanitary inspector had the 

means as well as the authority necessary to 

devise and execute a sound plan for sanitation. SanitalY experts studied each camp to 

determine the most suitable methods fo r 

managing human and kitchen wastes. All 

recruits were segregated and inoculated. If 

after two weeks no signs of disease had appea red, they were sent to join their units'· 

AtSan Antonio, when efforts to form sanitalY squads of medical offi cers and corpsmen at the regimental level encountered difficulty because only a little more than 

three-quarters of the required number of 

hospital corpsmen reported for duty, those 

available instructed enlisted men in such 

matters as the operation of incinerators. A 

medical offi cer, two noncommissioned 

Hospital Corps officers, five Hospital Corps 

privates, and four to ten civilian laborers 

were appointed to a "general sanitary 

squad" that kept drains clear, spread oil over 

standing water, and performed similar 

tasks, among them removing and burning 

horse manure so that disease-spreading nies 

could not live and breed in it. Because of the 

efforts of medical personnel and the use of 

vaccination, even though "all rules governing continued or repeated use of camp sites 

[were] violated," typhoid never appeared in 

the brigade at Galveston. At San Diego only 

two cases developed, with two more being 

diagnosed at San Antonio.'o 

Militia physicians spent two weeks with 

units along the Mexican border in 1911, 

with one week usually devoted to camp 

sanitation and management of a regimental infirmary and the second to the administration of an ambulance company 

and fi eld hospital. These tours helped 

demonstrate that "to be a good sanitarian," 

the medical officer "must develop his executive ability. " Experienced physicians 

closely supervised the inexperienced , 

most of whom were soon performing satisfactorily, but some militia medi cal officers who, familiar with the old ways, could 

not easily accept the new encountered considerable difficulty. Nevertheless, some 

former contract and volunteer surgeons 

were inspired to attempt to rejoin the Medical Department, leading Surgeon General 

Torney to decide that those under fortyfi ve years of age with good records could 

be taken into the Medical Reserve Corps." 

Reviewing the maneuvers, Surgeon 

General Torney concluded that the Medical Department had done well in its first 

division-level test. In his annual report for 

1913 he pointed out that "for the first time 

a division appeared with a compl ete modern sanitary organization and with its full 

quota of fi eld hospitals and ambulance 

companies in addition to the regimental 

medical service." The contrast to the situ-
THE MEDICAL SERVI CE IN ACTION 

ation in the camps of 1898 was obvious, 

not only because of the vastly improved 

health record but because of the relative 

lack of administrative confusion." 

When the tu rmoil in Mexico became 

threatening once more in 1913 and a division was again dispatched to the border, 

the Medical Department welcomed the opportunity to further refine its approach to 

managing the hea lth of a division in the 

field. A sanitary inspector was assigned to 

each camp, and each regiment had its own 

sanitary squad under the direction of the 

regimental surgeon. Outside the area for 

which the individual regiments were responsible, a civilian sanitary squad wo rked 

directly under the authority of the division's sanitary inspector. In Texas City, 

when the diseases of the civilian population seemed to threaten the health of the 

soldiers camped nearby, a sergeant first 

class of the Hospital Corps was sent to inspect each restauranl. Any establishment 

that did not heed his recommendations 

was declared off limits. Since soldiers 

brought substantial income to local businesses, compliance was usually not difficult to obtain. All men were required to 

sleep under mosquito netting because of 

the danger of malaria. Even though some 

camps were poorly sited, no typhOid cases 

appeared and health again remained good, 

fewer than 2 percent being sick at anyone 

time. An Army surgeon who served at 

Texas City and Galveston believed that this 

success in 1913 served to enhance the respect of line offi cers for medical offi cers 

and thus to increase their cooperation" 

Disaster Relief 

As more effective organization and 

training programs were developed to deal 

365 

with the Army's increaSingly complex 

needs, the Medical Department could offer 

those outside the Army more effecti ve aid 

when called upon to do so. Although the 

department helped the civilian populati on 

on many occasions, perhaps never in the 

early twenlieth century was its aid more 

evident than in the aftermath of the earthquake of 18 April 1906 at San Francisco, 

when two shocks, ten seconds apart, collapsed buildings, senl chimneys crashing 

upon their occupants, and fill ed streets 

with rubble. Within minutes, fi res began 

to break out all over the downtown sections of the city. For a brief time, while 

names fed by gas from ruptured lines 

slowly but inexorably consumed block 

after block, broken water mains crippl ed 

firefighting efforts, and cracked sewer 

lines spewed their contents into the streets, 

the Army, "the only undisturbed and thoroughly equipped organization in Califo rnia," ran the stricken city of San Francisco. 

More than 220,000 people were rendered 

homeless, but how many hundreds died 

because of earthquake, fire, disease, and 

shock may never be known" 

Brig. Gen. Frederick Funston, acting 

commander of the Pacific Division, estimated at the time that the death toll was 

1,000. Maj. Gen. Adolphus W. Greely, commander of the Pacific Division, later reported that in the city of 500,000 only 498 

lost their lives. Contemporary reports suggested that in the outlying communities 

fewer than 200 were dead and less than 500 

of the 5,000 injured were seriously hurt. 

Authorities, who were determined not to 

discourage investment in the rebuilding of 

the city, dismissed out of hand claims that 

the loss of life resulting from the earthquake was actually much greater. Thus the 

low fi gures were accepted for more than 

fifty years, un til brought into question by 
SAN FRANCISCO, APRIL 1906,fol/olVilig the ea rthCflwhe 
THE MEDICAL SERV ICE IN ACTION 

the work of the San Francisco Earthquake 

Research Project, operating from the San 

Francisco Public Library's archives. This research suggested that more than 2,500 may 

have eventuall y died as a direct or indirect 

result of the disaster" 

Among the first to offer aid to the 

stricken populace was Capt. Henry H. 

Rutherford, an Army medica l offi cer at the 

genera l hospital at the Presidio. He was 

watching th e smoke that began to rise from 

the city when the second shock struck, "a 

great many seconds long, like the first one." 

His patients and their aLlendants did not 

panic, eve n though "the shadow of an unearth ly sti ll ness seemed to have fa ll en 

amongst us. We all spoke softly, in whispers some of us." When the tremors ceased, 

the hospital power plant and telephone and 

telegraph li nes were no longer operative, 

the hospital water pipes were dry, and brick 

and plaster were everywhere. All buildings 

were to some extent damaged. In spite of 

the situaLion at the Presidio, Captain 

Rutherfo rd and eleven other members of 

the hospital staff, without wa iting for official orders and "all laden down with medical suppli es," hiked three miles to San 

Francisco's Convention Hall in forty-fi ve 

minutes. A civilian doctor LUrneci down 

their offer of help as not needed, "an interesting and amusing commentary on the 

characteristic of self-sufficiency and independ ence of the native Californian of the 

time." He soo n had a change of heart, however, and began personally helping to load 

patients for transport to th e Presidio hospital. By day's end, with the fi re threatening city hospitals, 127 injured civilians had 

taken refuge at the Army facility, where 145 

patients from San Francisco's seven hospitals wo uld join them the next day.'· 

Only 40 o f the 2,000 men stationed at 

the Presidio itse lf were injured, but by 

367 

evening, as the names began to consume 

the city, Captain Rutherford could see 

"multitudes seeking refuge, as th e livid 

menace in the skies grew ever more appall ing." Hospital Corps and engineer barracks at the hospital and at Fo rt Maso n 

nearby we re empti ed so that refugees 

coul d be taken in. Mattresses were laid out 

on the general hospital porch, and tents 

began to go up on the grounds. From 18 

April to 23 May, 756 new patients were 

cared for at the general hospital, of whom 

no more than 56 died. Since the general 

hospital, whi ch held 700 patients when the 

ea rthquake struck, was in danger of being 

overwhelmed, Rutherford was ordered to 

set up an emergency receiving faCility 

through whi ch all incoming patients could 

be cleared before being assigned either to 

a hospital or to outpatient care. From 150 

to 200 outpatients a day were trea ted at this 

station, while three dispensari es established on the Presidio grounds hand led 

300-400 dressings a day. A to tal of more 

than 4,000 refugees, halrsick, half injured, 

were eventually trea ted as outpatients. At 

nearby Fort Mason three of th e 365 admilled to the temporary hospital died. The 

hospital at anoth er nearby post also took 

in civilian patients. Doctors and nurses 

among the refugees neeing the city joined 

Army personnel to provide first aid and to 

distribute patients in need of furth er care 

among ava ilabl e faci lities." 

On the evening of the nineteenth , when 

the peak of the dema nd placed on the general hospital was reached, "the fire could 

be seen gathering his mighty forces," Captain Ruth erford remembered, "consolidating them into one awful tremendous roar, 

driving the homeless in before him .... 

They were everywhere and still they came; 

old and young, sober ones and th e hilarious, hysteri cal men, women, and children; 
368 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

TORNEY AS A YOUNG OFFICER 

horses and mules and dogs and cats." 

Under the strain, those of less than robust 

health broke down; "apoplecti cs had their 

strokes, worn old hearts gave out, neurotics went to pieces and drunkards had 

D.T.s. Most embarrassing of all were the 

numerous cases of childbirth . Women 

were having babies all over the woods. 

The illuminati on from the ski es, brighter 

by the moment, was a godsend . It hel ped 

mightily in our ministerings." 5. 

The initial reactions of the medical officers in the San Francisco area to the disaster were instinctive and improvised. Torney, at the time a lieutenant colonel and the 

chief surgeon at the general hospital, together with the post surgeon at nearby Fort 

Mason and presumably others as well, unhesitatingly made financial commitments 

without the authority to do so, correctly assuming that the fo rmalities would be taken 

care of later. Now at the request of city offi cials, General Funston, in the absence of 

General Greely, who was on leave, moved 

to restore system and order in the wake of 

the disaster. One of the first steps he took 

was to reli eve Colonel Torney, who was also 

acting chief surgeon of the Department of 

California at the time of the earthquake, of 

his command of the general hospital so that 

he co uld take "charge of the sanitary 

arrangements for the city of San Francisco," coordinating all medical efforts, 

both civilian and military, in the area and 

advising the city's health commission about 

sanitation. In this capacity, Torney became 

head of a committee of civilians responsible for ensuring the cooperation of Army 

and civil authorities in sanitary matters." 

When General Greely returned from 

leave on 22 April , water had been restored 

to the general hospital and repairs to the 

electrical system were almost complete. Although he continued the effort to design a 

plan to maximize the effectiveness of the 

Army's contribution to the relief of the city, 

Greely was concerned that the Army's activities might undermine the city's ability 

to take care of itself. On 7 May, therefore, 

when he announced that he was making 

each of the six military districts in to which 

General Funston had divided the city a sanitary district, he had civil authorities assign 

each a civilian rather than a military doctor to be responsible for "all sanitary matters other than hospitals in the military district in which he is stationed." While these 

civilians would still report to Colonel Torney, Greely retained direct Army responsibility for sanitation and health only at the 

camps under military control.'" 

I n the confusion that followed the earthquake, a week passed before shelter was 

found for all in need. Sanitation in these 

hastily erected camps, except those under 

military control, was often poor. General 
THE MEDICAL SERVICE IN ACTION 

Greely soon concluded that the homeless 

would be better oIT in the twenty-one camps 

that were eventually established by the 

Army. Although the first of these communities were set up on an emergency basis, the 

remainder were created only after Colonel 

Torney had worked with civilian authorities 

to choose healthy sites. The operation of all 

Army camps, which atone point held 20,000 

refugees, was supervised by a chief camp 

surgeon, who inspected both military and 

nonmilitary camps. Reporting to him in 

each camp was a medical orncer named to 

work with the camp's commanding orncer 

to maintai n the sanitation of the community 

and the health of the refugees. Hospital 

corpsmen were also assigned to each camp, 

as was a civilian physician. Sick call was held 

evelY day, and all those more than slightly 

ill were hospitalized. Patients with contagious diseases were isolated in hospitals established for the purpose· 1 

The initial Medical Department response 

to the disaster had in volved only the department personnel who were in the area at 

the time, but the needs of hundreds of thousands of people sheltered in hundreds of 

camps required a much larger medical team 

than could be found in northern California. 

The first shock was scarcely over, therefore, 

berore Medical Department resources, both 

human and materiel, together with much 

from civilian agencies, began coming in 

from far as well as near. A special train, bearing a medical orncer, three noncommissioned orncers,and a hundred men of a Hospital Corps company, was soon speeding 

west from Washington , D.C., picking up 

Red Cross nurses and doctors and extra carloads of supplies as it wen l. The attempts of 

the Red Cross team to provide aid aroused 

resentment; a member of the Oregon National Guard stated that too many Red Cross 

orncials were "riding about in automobiles 

369 

R OBERT U. PATTERSON 

making much noise and fuss, promising all 

sorts of relief for evely body and so far as my 

observation went failing to execute these 

promises." Efforts of the Hospital Corps 

unit were apparently more successful. It 

spent almost two months in the San Francisco area, on 25 April setting up a fi eld hospital in the Golden Gate Park, "a model institution" with one ward specifically for 

maternity cases, where future surgeon general Ll. Robert U. Patterson assisted the 

chief sanitary orncer. A second ward and a 

200-bed hospital that had been established 

four days earlier served patients with contagious diseases· 2 

Before the end of the mon th two Hospital Corps detachments came in from St. 

Louis, one of which brought another fi eld 

hospital. Fifteen surgeo ns from western 

posts, six recently returned from the 

Philippines, and two on leave in the area 

were also assigned to work in San Fran-
370 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

cisco. By 22 April forty-two doctors were 

serving th e Presidio sanitary di vision 

alone, and on the twenty-fourth Colonel 

Torney notified Surgeo n General O'Reilly 

that no more medical officers were needed. 

The Medi cal Department supplied the 

twenty-six dispensaries opened at Torney's 

suggesti on by the city's health commission, although twenty-fi ve of them were 

closed shortly thereafter when the city's 

health remained good and local pharmacists and physicians began to complain 

about the harm done their sources of live Iihood by government competition. Units of 

the Oregon National Guard also joined 

those helping the refugees, opening an 

emergency hospital in a school63 

Supply was not a serious probl em, 

though th e fire that fo llowed the earthquake had destroyed the San Francisco 

medical depot. A new depot was quickl y 

set up, first in the basement of the general 

hospital and later, because of the danger of 

fire and the crowded conditions there, in 

tents near the hospital. All items except 

those needed by the general hospital were 

pooled at this site, to be drawn upon as 

needed. Medical officers fill ed the new 

depot with supplies brought in from neighboring cities or shipped in from SI. Louis. 

On 28 April it was closed in favor of a larger 

depot. Even a fire that destroyed the general hospital's laundry was taken in stride." 

The au thori ty of the Army to provide assistance at San Francisco had never been 

clear, and its resources in supplies and manpower were limited, but the Medical Deparllnent played a vital role in the prevention of epidemics among refugees as well 

as in the care of the sick and injured. Three 

times in April 1906 Co ngress vo ted money 

to aid earthquake victims, and on the 

twenty-fourth and the twenty-eighth Secretary of War Taft allotted the Medical Department a total of $400,000 to meet its 

share of the expenses. InJune Congress appropriated another $100,000 to replace 

medica l and hospital supplies destroyed at 

San Francisco. The sanitary inspectors assigned to refugee camps worked to ensure 

that water supplies were safe, latrines properly located and maintained, and food 

properly prepared and protected from f1ies. 

By the end of April the Army was also issuing small pox vaccine at th e rate of 3,500 

doses a day. Although no compulsion was 

used, all who were willing were immunized. In the two months foll owi ng the 

quake, military and civilian authorities and 

hospitals also coo perated to create a comprehensive daily report on typhOid cases so 

that their origin could be traced. When several cases appeared in the same area, the 

Pacific Division's sanitary inspecto r 

checked into co nditions and, working 

through the mayo r'soffi ce, had those camping in the area removed. In spite of the 

strain under which the dispossessed inhabitan ts of San Francisco lived, a brief increase in typhOid and smallpox cases in the 

six weeks immediately after the earthquake 

did not lead to epidemics. Moreover, of the 

123 cases of smallpox with 11 deaths that 

were reported in the two months after the 

earthquake, onl y 1 was found in a camp 

under military control. Only 5 of the 95 

cases of typhoid fever diagnosed among 

refugees after 18 April originated in a military camp. The average number of t)1Jhoid 

fever cases in San Francisco before the 

earthquake had been 12 a month , but 30 

were diagnosed in April and 55 in May, with 

the rate falling back to 10 in J un e6 ' 

In mid-May 50,000 people were still 

sheltered in a hundred or more camps 

when General Greely announced that he 

was turning over to city officials complete 

respo nsibility for sanitation in San Fran-
THE MEDICAL SERVICE IN ACTION 

cisco. The Army began returning the civilian patients remaining in military facilities 

to civilian hospitals. As part or the Army's 

gradual withdrawal rrom the relid d rort, 

on 13 May Colonel Torney's almostunlimited authority ended. From this time unlil 

he was relieved on 23 May, his responsibility ror civilians was confined to that or the 

chier surgeo n to the newly appointed commander o f permanent camps. Torney's successor, the new chid surgeon or the Department or Calirornia, also served as chier 

sanitary orri cer or th e Army-controlled 

camps. As medical orricers returned to their 

normal stations, the number serving in the 

city dwindled. By July only those camps located on the Presidio grounds remained 

under the Army's control, and by the end 

or that month the Army's role in the relid 

or San Francisco in the artermath or the 

earthquake had been played OUl.66 

Dealing successrully with the orten terrined victims oHire, nood, storm, and earthquake at the turn or the cenlury emphasized 

the importance or capabilities civilian agencies did not have. Among the advantages 

the Army had were a tightly controlled organization and a dedicated rorce or men and 

women too well disciplined and too well 

trained to panic, who were prepared to obey 

orders promptly and without argumenl, 

and who were ramiliar with maintaining 

standards or sa nitation in primitive circumstances. FUrLhermore, to meellhe sudden and overwhelming needs arising rrom 

unpredictable natural disasters, large 

amounlS or medicines, vaccine, and hospital supp li es unlikely to be immediately 

371 

available rr0111 civilian sources and the 

transportation to move them and additional 

manpower swirtly to the disaster site were 

necessa ry. Equipped with reserves rrom the 

Army's warehouses, the Army Medical Departmenl's proressionally trained men and 

women co uld be moved promptly to the site 

or the disaster, where, regardless or the conditi ons surrounding them, they were capable or runctioning errectively both to care 

ror the sick and injured and to prevent rurther disaster in the rorm or an epidemic. 

In th e neld, Medica l Department perso nnel handled the chall enges that they 

encounlered in the period or peace between the Spanish-American War and the 

outbreak or World War 1 in Europe erriciently and errectively. One o r th e Army's 

most dangerous roes, typhOid rever, had 

been ddea ted. Disease rates were low. Surgeons were experi encing ever greater success in surgical operations that had been 

never bdore successrull y und ertaken. The 

population or a disaster-stricken city owed 

its hea lth to the Army anel, in parti cular, 

to Arm)' medica l personnel. But th e scale 

or th e challenges was small. Success in prevenling a recurrence or the disaster or the 

Spanish-American War camps, even under 

circumstances resembling th ose that 

spawned 1898's epidemi cs, may well have 

encouraged medical orricers to believe that 

they were rar more ready ror any rUlUre war 

than they were. As 1913 drew to a close, 

department leaders still had onl y their 

Spanish-American War experience to 

guide them. 
NOTES 

1. 'tVar Deparll11elll, {Anllllal} Report of the 5111'-

geon General, U.S. Army, fa th e Secrelmy of War, 

1900, PI'. 83-86 (hereafter cited as WD, ARofSG, 

date); idem, {Amuw// Report of tlt e Secretmy ofWa/" , 

1899, [(pI.2):556, 560 (hereafter cited as WD, 

ARofSW, date). 

2. "Ant ityphoid Vaccination in the Army," p. 728; 

Edga r Erskine Hume, Vic/aries oj Army I\lledic ille, p. 

102; Thomas j. Kirkpatrick, "Camp Sanitation," p. 

426; Stanhope Bayne-Jones, The Evo/ll tion oJPrevclJ -

li ve Medici ne ill the United Slales Army, 1607- 1939, 

PI'. 139-43; Frederick F. Russell , "The Prevention of 

Typhoid Fever," PI'. 482, 485; Percy M. Ashburn, A 

His/OJY oj Ole Medica l Department of the United States 

ArIllY, 1'1'. 272- 73 ; WD, ARofSW, 1899, 1(1'1.2):560; 

W. D. Tigeru, "The Initial Effort To Immun ize American Soldie r Vo lunteers With Typhoid Vacci ne," PI'. 

342-49; Memo, Harry L. GilchrisLloSG, 30Jan 1934, 

Ms C322, Harry L. Gilchrist Papers, National Library 

of Medicine (NLM), Bethesda, Md. Russell became 

a major on 1 January 1909. 

3. Ashburn , HislOlY oj MD , pp. 272-75; Hume, 

Victories, p. 103; Ltr, Frederi ck F. Russell to Valery 

Havard, 11 Nov 1908, Entry 231 , Record Group 

(RG) 11 2, Na tional Archives and Records Administra lion (NARA), Washington, D.C.; WD, ARoJSG, 

1909, PI'. 46, 48, 1911, p. 50, and 1912, PI'. 52-54; 

Frederick F. Russell , "Antityphoid Vaccination," PI'. 

8 l 6, 821- 22; idem, "Anti-typhoid Vaccination in 

the American Army," p. 479; idem, "Progress in Antityphoid Vaccination During 1912," p. 667; idem, 

"Prevel1lion," pp. 481-82, 518; William j. L. Lyster, 

"Vaccination Against Typhoid in the United States 

Army," pp. 511- 12; E1. Conzelmann, "Typhoid Inocul ation," p. 3l6; Henry E. Meleny, "Tropical Medicine in United States Mil itary History," p. 332; 

Frank W. Foxworthy, "Anti-typhOid Vaccina tion," 

pp. 333-34; Frank R. Keefer, "The Prevention ofTyphoid Fever," pp. 290- 91 ; United States, Army Medical School, 1IIIIIIIIIli zlll.iOIl/O Typhoid Fever, pp. 7- 8, 

10- 11 , 13; Bayne-Jones, PrevellLive J\lledicille, pp. 

L 41-43; Robert S. Henry, The Armed Forces IllsliLute 

of PalilOlogy , 1'1'.143-44, 146. 

4. WD, ARofSG, 1909, p. 46 (first quotation), 

1910, 1'.148, 1911, p. 53 , anclI9 12, PI'. 56- 57 (second quotation). 

5. Ashburn, HislDlY of MD, p. 273; Charles E 

Craig, "The Arm}' Medical Service," p. 4 19; WD , 

ARofSG, 1913, PI'. 54, 142, 212-13, and 1914, PI'. 

1.1.- 12; Kirk patrick, "Camp Sanitation," pp. 423, 

425; Russell, "Prevention ," p. 500. 

6. WD, ARofSG, 1902, PI'. 94--95, 1903 , p. 98, 

1905 , PI'. 14--15, 55, 1906, pp. 19,81, 1907, p. 13 

(quotation), 81, and 1909, PI'. 14, 93 ; George Rosen, 

Preventive Meciicillc ill (/le Ull ited SUItes, p. 37; Harry 

F. Dowling, Figll Lillg Illfect ioll , pp. 91, 104; Va lery 

Havard , "The ValLIe of Statistics in Connection \tVith 

Ve nereal Diseases in the Army and Navy," pp. 

114- 15; Anita Newcomb McGee, "Facts About the 

Army Canteen," pp. 262- 63; Allan M. Brandt, No 

Magic Bul/eL, pp. 9- 11 , 14- 15, 22 , 40, 42; Prince A. 

Morrow, "Publicity as a Factor in Venereal Prophylaxis," p. 1245. 

7. WD, ARofSG, 1902, p. 94, 1906, p. 49, 1910, 

PI'. 16,23, 28-29, 58- 60, 8tHl7, 1911, 1'1'.126-27, 

1912, PI'. 104, 107, 1913 , PI'. 22, 38, 60, 124, 

128-29, 1914, 1'1'. 12, 57, 117, 120, 123, and 1915, 

p. 187; Dowli ng, Fig/Hillg injection, p. toO; Brandt, 

No Magic Bill/et, PI'. 12- 13. 

8. WD , ARofSG, 1904, p. 90 (quotation); Dowling, f igJHing InJectioll, pp. 83, 89, 92- 93; Brandt, No 

Magic Bullet , pp. 11- 12; William G. Miller, "The 

Trea tment of Gonorrhea by Irriga tion," p. 231. 

9. Champe C. McCullough, "The Scientific and 

Administrative Achi evement of the Medical Corps of 

the United SLales Army," p. 425; Henry j. Nichols, 

"The Present Status orSalvarsan Therapy in Syphilis," 

PI'. 603-05; Brandt, No Magic Bill/el, p. 40; WD, 

ARofSG, 1911, p. 160, and 1913, p. 155; Mallhew A. 

Reasoner and Ray W Matson, "The Trea tment of 

S)'1)hilis," PI'. 741-42; "Salvarsan," p. 179;James S. 

Fox, "ProphylaxiS of Syphilis and Practical Pointson 

Its Trea tment by Salvarsan," pp. 95-96. 

10. Nichols, "The Present Status," PI'. 604- 05, 

608 (quotation); Branclt , No Magic Bu//et, p. 4 1; WD , 

ARofSG, 1909, 1'. 143, and 1912, PI'. 70- 71 , 169-70; 

Dowling, Fighting Infectioll , p. 94; Reasoner and 

Ma tson, "Treatment," pp. 735, 739, 742; McCullough, "Achievement of Medical Corps," p. 425 ; 

Henry 1. Nichols, "The Immediate Clinical Results 

of the Use of Salva rsan in the Army," pp. 212- 13; 

Claude Quetel, His/DIY of Syphilis, p. 142. 
THE MEDICAL SERVI CE IN ACTION 

II. WD , ARojSG, 1911, PI'. 161- 62, 165, 1912, 

PI'. 169- 73 , and 1913, PI'. 155-58; Charles c Craig, 

"The Interpretation of the Results of the Wassermann Test," p. 565. 

12. J. Hamilton Stone, "Our Troops in the Tropics," p. 365 (first quot<\lion); Jefferson R. Kean , "A 

Plea for Applying the Usua l Methods of Preventive 

Medicine to Vene real Diseases," p. 199 (second quoLaLi on); WD, ARojSG, 1903 , 1'. 99, 1905, 1'. 88, and 

1911 , pp. 60-61 (remaining quotations), L04-05; 

Llr to Ed ., W. A. Wiseman a nd W 'ltv. Keen ,jollfllCli 

oIllle AlIlcric(/II l\lledical AssociaLioll 58 (19 12): 575; 

A. S. Condon, "The Army Canteen," p. 721; Brandt, 

No Magic BlIllel, p. 35; Charles 1-1 . Alden, "Porto 

Rico," p. 21; jeromc H. Greenberg, "Venereal Disease in the Armed Forces," p. 172. 

13. WD ,ARojSG, 1902, p. 95 , 1903, pp. 99- 100 

(first three quolatiolls), 1909, p. 19 (fourth quotation), 1910, p. 62, and 1911, p. 57 (nrth quotation); 

"Syphilis or the Innocent ," p. 526; Greenberg, 

"Venereal Disease," p. 172. 

14. WD , ARojSG, 1910, p. 59 (second quoLation), and 19 11, p. 59 Hirst quotation). 

15. Ibid., 1911, PI'. 57 (fi rsL quoLaLion), 59- 60, 

104, and 1912, pp. 64, 67; Hume, Viclories , p. 123 

(second quotation); Greenberg, "Venereal Disease," 

1'. 177; QueLe!, Syplli/is, 1'1'. 122- 23, 141. 

16. J a)' Cassel, The Semi Plaglle, PI'. 129- 30; 

Brandl, No Magic BlllIel , p. 99. 

17. WD, ARojSG, 1910, PI'. 60-61, 19 11 , PI'. 

57- 61 , 104-05, 1912, PI'. 64-67, and 1914, p. 55; 

Greenberg, "Venereal Disease," p. 172. 

18. WD, AllojSG, 1911, PI'. 23, 54, 59- 61, 63 , 

66, 69,19 12, p. 26, and 19.14, p. 56. 

19. Ibid., 1908, p. 28, 1909 , p. 26, 1911, p. 55 , 

19 12, PI'. 40,57-58, 60, 191 3, PI'. 19 , 35,58 (quota tion), .md 1914, p. 58; Jerrerson R. Kean, "The 

Venereal Problem in the Army and Navy," p. 285. 

20. WD, ARojSG, 1913, PI'. 14, 59-60, and 1914, 

pp. 55- 58, 62, 93 (quotation); Mahlon Ashrorci, "Statistical Report orVenereal Prophylaxis. . ," pp. 9- 1.0. 

2 1. WD, ARojSG, 1908, p. 53, 1911 , PI'. 25, 71, 

107, 1912, 1'1'.28,78 , 1913, PI'. 14, 76, and 1914, 

1'1'.12, 69. 

22. Virginia Cowart, "Control, TreatmentorDrug 

Abuse, Have Chall enged Nation and Its Physicians 

ror Much or History," Pl'. 2465 (quotations), 2469; 

R. M. Blanchard , "Heroin and Soldiers," pp. 141-42. 

23. Quotations rrolll William B. Meister, "Cocainism in lheAnny," pp. 344-45, 348. See also ibid., 

pp. 346, 350; Edga r King, "The Use or Habit-rorllling Drugs (Cocaine, Opium and Its Derivatives) by 

Enlisted Men ," pp. 380-8 1. 

373 

24. R. l. Richards, "The Imporlance or Alcohol, 

Hea t, and Acute Inrectious Diseases Occurring in 

the United States Army in the Past Ten Years," pp. 

616, 626; WD, ARojSG, 1910, p. 58 , 1911, PI'. 25, 

107, 237-38, 1913, p. 98, and 1914, PI'. 22, 69 (quotation). The latter source, 1911 , reports on alcoholism in European armies; however, the ngures 

ci ted are not based on the same years ro r all armies 

(see Tables 65 and 66, PI'. 237-38). 

25. WD, ARojSG, 1902, pp. 75- 76, and 1905, p. 

144; Rosen, Prevcn/il'c Medicine, p. 28. 

26. WD, ARojSG , 1902, PI'. 70 (quotaLi on), 

71- 72, 1903, PI'. 65, 132, 1904, p. 57, 1905, PI'. 

lI5, 144, 1906, p. 122, and 1908, pp. 21 ,51, 89; 

Fielding H. Garrison, All I11 trodllClioll to Ille HiS/DIY 

oj MediCi/Ie, p. 579; Rosen, Preventive MediCine, pp. 

10-1 1, 28; Daniel M. Appel, "The General Hospital 

and Sanatoriulll ror the Treatment or Pulmonary Tuberculosis at Fort Baya rd , New Mexico," p. 215; 

Spink, IlIjecliolls Diseases, p. 225. 

27. WD, ARojSG, 1909, PI'. 55-56, 1910, PI'. 54, 

137- 38, 19 11 , p. 67, 19 12, p. 40, and 1913, p. 99; 

George E. Bushnell, "The Diagnostic Use or Tuberculi n in Pulmona ry Tuberculosis," Enll)' 231 , RG 

112. NARA; Rosen, Preventive tvledicille, p. 28. 

28. WD, ARojSG, 1910, p. 80, 1912, PI'. 75-76, 

1913, 1'. 70, and 1914, PI'. 65- 66; LLr,Jefferson R. 

Kean to Surg, Vancouve r Barracks, 22 Sep 1912, 

EnL r)' 231, RG 112, NARA. 

29. Quota tions rrom WD, ARojSG, 1904, pp. 

122- 23, 126. See also ibid., 1903, p. J 24, 1905, pp. 

54, 142-43, 1908, p. 21, and 1909, 1'. 138. 

30. Appel, "The General Hospital," p. 2lL; 

RichardJohnson, "My lire in the U.s. Anny, 1899 to 

1922," p. 82, Spanish-American War, Philippine Insurrection, and Boxer Rebellion Ve terans Research 

Project , Military History Research Collec tion, U.s. 

Army Military Hislory Institute, Carlisle Barracks, Pa. 

3 !. WD , ARojSG, 1909, 1'.19, 1910, p. 51, 1911 , 

1'1'. 64, 127, 1912 , p. 71, 1913, PI'. 62- 63 , 67, 101, 

1913, 1'.112, and 1914, 1'1'. 12,65,93, 115. 

32. Ibid., 1911 , PI'. 64, 66, 1912, PI'. 73- 74, 

1913, pp. 64, 68, and 1914, PI'. 64-65. 

33. War Department, Surgeon General:S Office, 

Manllaljorlhe t\>ledical DeparlllJent, 1906, p. 123 quo~ 

LaLio n); WD,ARojSG, 1905, PI'. 38-39, and 1908, PI'· 

28-29; William B. Bean, Walter Reed, pp. 181-82; 

William H. Crosb)" "The Death or Wa lter Reed ," p. 

1342; William C. Borden, "History or Doctor Walter 

Reed's Illness From Appendicitis," pp. 425-26. 

34. WD, ARojSG, 1904, PI'. 115- 16, 1905, p. 

145, 1906, PI'. 29-30, 1910, p. 28, 1911 , p. 150, 

1912, p. 30, and 1914, p. 36;Josiah C. Trent, "Sur-
374 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

gical AnestheSia , 1846- 1946," in Tll eol), (lnd P/"(/ c~ 

!ice ill J\meri a lH Medicine, pp. 209- U ; Henr)' D. 

Thomason , "Perso nal Expe ri ence With Spinal Anes~ 

thesia, and Its Appli cation to Militar}' Surgery," p. 

297; Owen H. Wangensteen and Sarah D. \¥ang ~ 

steen, Tile nise of Swge l), From Empiri c CrCifll.O Sc ~ 

elllifr c Discipline, pp. 58-59; Bruce D. Ragsdale, 

"Gunsho t Wounds," p. 3 10. 

3 5. Ba e~ ones, Preventi ve MediCine, pp. 

]43-44; Ca rl R. Darnall , "The Purifi cati o n o f Drinking \¥aler for Troo ps in the Field ," pp. 268, 272-76; 

idem, "'vValer Purifi cation by Anh},drolls Chlo rine," 

PI'· 787, 783, 796-97; WD, ARojSG, 1911 , 1'1'. 

82-83, and 1912, p. 99; \·VilliamJ. L. Lyster, "Sterilization of Dri nking Wa ter b}' Calcium Hypochlorite in the Field ," pp. 223,225-28. 

36. WD, ARojSG, 1910, PI'. 74 (quoLation), 

75-76,78, 148, 1912, PI'. 94- 95, and 1914, 1'.88. 

37. Ibid. , 1910, PI'. 56, 79 (firsL quotation), 80, 

19 11 , p. 82, and 1912, p. 96 (remaining q uotations). 

38. Ibid. , 1911 , p. 82, 1912, p. 91 , and 1913, p. 

88 (q uo ta tion); Hume, Victories, p. 178; Ba c~ 

J ones, Preventive Mec/icine, pp. 145-46; Edward L. 

Munso n, The Soldier's FOOL and Ille Mi/itm)' SII oe, pp. 

60- 63. 

39. WD, Al~oj , 1908, 1'.63, 1912, PI'. 96- 97 , 

and 19l4, p.85. 

40. Ibid. , 1897, PI'. 48-49, 1902, PI'. 136, 150, 

1908, 1'1'. 13, 17, 59, 1909, 1'1'.13, 17, 37-38, 1911, 

PI'. 12, 16, 39, 99, 224-31, 1912, PI'. 12, 41 , 1913, 

1'1'. 24,36, anelI914, 1'1'. 11, 20- 22, 24-27,32,36; 

John va n R. Ho ff, "Experience of the Arm}' With ~ 

cina tion asa Prop hylacti c Aga inst Smallpox," p. 497. 

41. WD ,ARojSG, 1902, 1'.13, 1904, 1'.111 (quoLaLi on), 1905, PI'. 39, 147-48, 1906, PI'. 123- 24, 

1907, 1'1'. 70- 71, and 1909, 1'1'.145, 148; WD, SGO, 

MWIIWI, 1906, p. 62. 

42. Martha L. Stern berg, GeOlge !\;1iller SlcrllbClg, 

p. 244 (quotations); WD , ARojSG, 1911 , PI'. 15] , 

165- 67 , 1912, PI'. 152, 167- 76, 1913, Pl'. 152, 

18 7-92, and 19 14, p . .l3 1; j ames M. Phalen, Chiefs 

of (he !\;Ieclical Depc.,./lUcmt, United Stales J\ nl1 ~ 

1775-1940, p. 86; Perc}, M. As hburn, "The Board for 

the Stud}' o f Tropical Diseases as The}' Occur in lhe 

Philippine Islands," p. 300; Rosen , Preventive Meclrei lie, p. 23. 

43. WD ,ARojSG, 1899, PI'. 193- 95, 1902, p. 51, 

1906, 1'. 110, 1907 , 1'. 117, and 1908, PI'. 97- 98; 

W D, SGO, Manllal, 1906, p. 3 2. 

44. WD ,ARojSG, 1905, 1'.140, 1909, p. 149, and 

1917, p. 158 (quo tation); Norman M. Car}" j r. , "The 

Mechanization o f the United States Arm)" 

1900- 1916," M.A. Lh esis, PI'. 26, 28. 

45. Quotation frolll Ur, SG to SW, 26 Aug 1913, 

Enl .. ), 28, RG 11 2, NARA. In loc. cit. , see the following: Ambulance Specs, Keeton Motor Co. , 13 

Nov 1913, and Ltrs, H. D. Snyder [0 Keeton MOlOr 

Co., 28 Aug, 9 5ep, 6 Dec 1913 and 16Jan 1914; 

Keelon Mowr Co. to SG, 4 Scp 1913; Charles M. 

Gand), to Ch, QM Corps, 17 Feb 1914; H. H. Newson 10 QM, Fon 'vVayne, 18 Feb 1914. See also LOllis 

C. Dunca n, "The Use of MOLor Vehicles in Transpo ning \·Vounded," Pl'. 241-43; George M. Ekwurzel , "Obse rvatio ns of a Regiment al Surgeo n 

Wi th the Maneuve r Division ," pp. 52- 53; \~ , 

~ofSG , 191 2, p. 194; War DeparLmclH, Surgeon 

Gene ral's Ofri cc, Tire Swgeoll Generals Offi ce, p. 65 

(hereafter cilCd as WD, SGD, SeD). 

46. WD ,ARojSG, 1899, p. 329, .1902 , p. 59, 1903, 

1'1'. 42-43, 1904, PI'. 31-32, 74-76, 112, 1905, PI'. 

39-40, 126- 27, 1906, PI'. 65, 130, ] 907, PI'. 69, 71, 

113, 1908, PI'. 63-64, and 1909, PI'. 72-74, 77, lI8; 

Damall, "PuriricCltion ," PI'. 253- 8 5. 

47. WD, ARojSG, 1904, PI'. 30, 36, 39 (firsL qUOtation), 40, 42, <1nd L908, pp.126-27 (second quotatio n). 

48. WD, ARojSG, 1911, PI'. 92, 94 (firsL quotati o n), 95, and 1912, p. 51; Henry D. Thomason , 

"Sanitary Troops in the Organized Militia of the 

United States," p. 521 (second q uolation); Josep h 

H. Ford, "Galveston Maneu ver Cam p," pp. 282- 83; 

Pau l F. Strau b, "Sani tati o n of the Maneuver Camp 

a t San Antonio, Texas," Pl'. 607- 08; vVD, SGO,SGO, 

p. 70; I-Iermann Hagedorn, Lcollwr/ Wood, 2:11l. 

49. Straub, "Sanit ati o n," p. 622 (quotation); 

Field Service Regulations, 1910, pp. 126, 131-32, 

181-82; WD, ARojSG, 1911, PI'. 92, 94-95, 184. 

50. WD, ARojSG, 1911 , PI'. 93 (nrst qlloLaLion), 

94-96, and 1912, PI'. 5 t-52; I-Ierben A. Arnold, Re~ 

port on Maneuver Camps at San Antonio and Leon 

Springs, and onJuarez , Mexico," p. 22 (second quo~ 

t,Hion); Straub, "Sanitation, " pp. 620, 622 , 626, 

629- 30; C. 'vV Decker, "San Diego Maneuver Camp," 

pp. 271- 72; Ekwurze l, "Observations," pp. 57-58. 

5 1. Charles S. Yo ung, "The Adva ntages Accru ~ 

ing to the National Guard From Tours o f Dut}, With 

the Regular Establishment ... ," p. 62 (quo tatio n); 

WD, ARojSG, 1911 , PI'. 95, 170, 172; SLrallb, "Sanitalion ," pp. 627- 28; Arnold , "Report," p. 24. 

52. WD ,ARojSG, 1913,1'1'. 91- 93,214 (quOlaLion). 

53. Ibid., ARojSG, 1914, p. 82; Reuben 6. Miller, 

"The San itation of the Second Division, U.s. Arm}" 

at Texas Cil}' and Galvesto n, Texas . .. ," pp. 5 15-16. 

54. Ad olphus W Greel}', Em·tl1(fIUll?e ill California, 

April 18, 1906, p. 15 (quOlaLion); WD, ARoj SIV, 

1906, p. 101; Charles Keel er, SCIIl Francisco Tllrollgll 

Ea rtilquallelllld Fire, pp. 4, 9 , 26, 48; Gordon Thomas 
THE MEDICAL SERVICE IN ACTION 

and Max M. W ilts, The 5(111 FrwlCisco Eal'lIlqua/w, PI'. 

7 1,78, 149. An exccltclll stud), of the Medica l Departmelll's role in aiding the vi ctims of disaster, including those of the San Francisco canhquakc, call 

be found in Gaines M. FOSler, Tile DCllulIIds oj I-Iu-

//IallU)'. on which Ihis accounl of the San Francisco 

d is<1Sler is based , except where otherwise indicated. 

55. Glad}ts Hansen and Frank Quin n, "The San 

Francisco Numbers Game," Paper of the San Fnlllcisco Earthquake Research Project, San Fnlllcisco, 

CaIiL; Terry Link, "The Greal Earthquake Coverup"; Greety, E(lrfJr(/! wllc, pp. 7-8, 14- 15,30, 32, 44; 

WD , ARojSW, 1906, p. 200. 

56. QUOI<tlions from Henry 1-1 . Ru therford, "Experiences of an Arm)' tvlcdical Officer During the 

Sa n Francisco Eanhquake ," PI'. 208-09. Sce also 

ibid., p. 210; WD, ARojSG, 1907 , p. 126; Greel)', 

Ea flilqlw/w, PI'. 31 , 129; Keeler, Sail Fr(lIIcisco, Pl'. 

9- 10; J ohn C. Kennedy, The Greal Ea rlhqua/le mul 

Fire, p. 132; Rpts, George H. Torne)' 10 Adolphus 'IN 

Greel y, 14 Ma}' 1906, vol. 3, andJ. M. Kenned}', vol. 

4, Ms 13286, "Repon on Sanitation in San Francisco 

AhertheEanhquake," NLM; Thomas and Witts,S(1II 

Francisco Earlll(juaile, p. 71. 

57. Rutherford, "Expe riences," p. 210 ll ota ~ 

lion); Greely, EClrlllquahe, pp. 3 1, 129-30; Rpts, 

Henry H. Rutherford, ). M. Kennedy, and William 

SLephenson, vol. 4, Ms B286, NLM ; WD, IIRojSG, 

1907, p. 126. 

58. Rutherfo rd, "Expe riences," pp. 210- 11. 

59. Quotation from Pacific Div GO 1.1 , 20 Apr 

1906, vol. 3, Ms B286, NLM. Sec also Greel)', Earthq"oilC, Pl'. 5, 1 I , 18, 24- 25, 3 1- 32, 60, 72, 130; 

Kennedy, E(IrfJIl/l/ahe, p. 169; 'WD, ARoIs e , 1906, 

Pl'. 131- 32. 

375 

60. Greely, E(lrfJlqua /lc, pp. LO , 58-59, 66 quo~ 

talion); RPIS, Albert Tru by and). M. Kenned}" vol. 

4, Ms B286, NLM ; WD, ARojSG, 1906, p. 132. 

61. Greel}" Earl /r({lIahe, PI'. 33, 35, 66. 73 , 

130-3 1; Kenned}" Earfhqlllll?e, pp. 109- 10; Rpts, 

Kenneth A. J. Mackenzie, vol. 1, A. Tru by, vol. 4, 

and H. 1-1 . Rutherford , vols. 1 and 4, Ms 13286, NLM . 

62. Wi lli am E. Carl l, "The O regon Nationa l 

Guard at tile San Francisco Earthquake Disaster," p. 

462 (first quotation); Gree ly, EarlJlfl,wllc, PI'. 20-21, 

3 1-32, 13 1 (second quoLation); WD ~oj , 1906, 

PI'. L 16, 132- 33; Rpts, l-I . 1-1. Ruthcrford, vol. 1, a nd 

Roben U. PatLerson, 5 J UIl 1906, vol. 4, Ms 13286, 

NLM ; George H. Kress, "United States Arm}' Field 

Hospita l in San Francisco in 1906 ... ," p. 215. 

63. Carll, "Oregon National Guard," p. 462; 

Kenned}" Earllil/llalle, pp. L09- 10; Greel}" Earlilqlw/le, 

p. 44; ~o , Sanitmy Div, Presidio, 22 Apr L906, vol. 

I. , and Rpts, George H. Torney 1.0 SG, 24 Apr 1906, 

and 10 Grecl)', 14 Ma), 1906, vol. 3, Ms B286, NLM. 

64. WD, ARojSG, 1906, PI'. 126, 132-33; 

Ken ned}" Earfilf{lw/w , p. 45; Greely, Earlll ll , PI'. 

32, 131-32; RpL,j.M. Kenned)" vol. 4, MsB286, NLM. 

65. Greely, E(lrtilf/lw/U!, pp. 32- 34, 58-59, 131, 

133-34; RpL, A. Trub)" vol. 4, Ms B286, NLM; WD, 

ARojSG, 1906, p. 12, and 1907, p. 9. 

66. Greely, Earlllfilwhe, pp. 32-33, 72, 131; Pacific Oiv SO 66, 23 Ma}' 1906, vol. 3, and Rpts, H. 

H. Rutherford ,). M. Kennedy, and W. Stephenson, 

vol. 4, Ms B286, NLM. According 10 WD, AllojSG, 

1906, p. 12, the sec retary of war allollcd the Arm}' 

Medical Depanmenl $400,000 of money voted for 

the "relief of sufferers from earthquake and onna~ 

grat ion on the Paci fi c coast (joint resolutions of 

April 19, 21, and 24, 1906)." 

Chapter 14 

IN THE SHADOW OF WAR 

Even as late as 1914, few in the Un ited 

States expected to be drawn into an overseas connict unless the territories acquired 

in the Spanish-American War were threa tened. Furthermore, almost until the moment when the nation entered the struggle in April 1917, President Wilson 

believed that energetic preparations for 

war would make u.s. involvement in European hostilities more likely. Congress, 

uncertain first about whether to prepare 

for war and then about how to do so, refrained from vo ting a major increase in the 

size of the Army until raids by Pancho Villa 

in to the United States led lO the mobilization of all available regular and National 

Guard troops along the Mexican border in 

1916and a campaign within Mexico itselL' 

Military o[[i cers reali zed that the United 

States might eventually become involved 

in a major war. But they were preoccupied 

with thoughts of a connict that might take 

place after the war in Europe, especially if 

Germany failed to achi eve a decisive viclOry and tri ed to recover stature by aggressive moves in the Americas, possibly 

taking advantage of the problems with 

Mexico, or if Japan attempted to take advantage of any weakening of the Western 

powers. Thus, although the Army was by 

no means idle in the years before the 

United States entered World War 1, not 

even the nation's military leaders envisioned a need for great haste in preparing 

for war.' 

The hostilities already under way in Europe did emphasize the concerns of those 

who had for decades wished to see the nation better prepared to meet the challenges 

of modern warfare. Their efforts moved into 

high gear early in 1916. The surgeon general, Maj. Gen. William C. Gorgas,' was 

among those who testifi ed before congressional committees as they worked lO prepare the legislation that would become 

known as the National Defense Act of 1916 

and lO appropriate the money necessary for 

implementing it. Beginning his testimony 

in January 1916, he noted that the size of 

the Medical Department had not changed 

since 1908, even though the size of the 

Army had increased by 50 percent. The resultant ratio of less than 5 physicians to 

1,000 men was, in his opinion, woefully inadequate. Only by calling up Medical Reserve Corps o[[icers and hiring a few contract physicians could he provide peacetime 

medical attendance for the posts, hospitals, 

and depots within the United States and in 

the Caribbean and the Pacific and for the 

units serving along the border with Mexico. 

Gorgas believed that 7 phYSicians for 1,000 

men wasa bare minimum forpeaceLimeand 

that 10 per 1,000 would be necessary to 

meet wartime needs. Should the Congress 

decide upon a peacetime Army of 140,000 
378 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

SU RGEON GENERAL GORGAS 

men, the Medica l Department would have 

to be more than doubled in size, signing on 

537 new medical officers to reach the required tota l of 980· 

Surgeo n General Gorgas pointed out 

that abruptly doubling the size of the Medica l Corps would bring in to the service 

large numbers of untrained civilian doctors who were not prepared to do all that 

was required of a military surgeon. Managing a military hospital was so comp lex 

that it had "attained the rank of a distinct 

speciali ty. " Many duties routinely aSSigned 

to the medica l officer ca lled for experience 

and training not available to civilians, and 

a co nsiderable lengt h of time wo uld be 

necessary before physicians without military experience who were called up in 

wartime could fun cti on successfull y as 

medical officers. Allowing Medical Reserve Corps offi cers to train with the National Guard and other branches of the 

government rat her than with the Regular 

Army meant that some of th em would initially be unable to function with compl ete 

effecti veness if call ed up in wartime. The 

demands upon experienced medical officers was great. The servi ces of many of 

them would be deni ed to units in the fie ld 

because they wo uld be needed to tra in 

civi Ii ans. Gorgas was by th is point resigned 

to th e fact that the "rea l func tion" of the 

Medical Department had become "training 

whatever medica l officers are required for 

whatever Army may be arranged for," but 

he seemed to fin d th e French approach of 

using non-physicians to hand le many administrative responsibilities appealing.' 

Surgeon Genera l Gorgas also testified 

that the larger the number of men called 

up to meet a major co nnict, the greater th e 

difficulties that would be involved in 

mai ntaining their health, especially during 

the first yea r of service , when vo lun teers 

traditionally suffered a higher ra te of disease than regulars. If an army as large as 

500,000 men should be ca ll ed up to meet 

a critical emergency, he predi cted that the 

Medica l Department wou ld have great diffi culty in providing adequate care. The situation in early 1916 was only "somewhat 

better" than it had been at the beginning 

of the Spanish-American War.' 

In his testimony Gorgas emph aSized 

that supply wo uld also be a problem if th e 

nation were suddenl y plunged into war. In 

January he had on hand suppli es fo r 

300,000 men-or 200,000 more than the 

existi ng strength of the Army-for only 

fi ve to six months. He pointed out that he 

would have the greatest difficulty 

promptly supplying the army of two million that might be necessary to defeat a 

major military power. An inability to purchase abroad would further complicate the 

supply situation, since some items were 
IN THE SHADOW OF WAR 

not obtainable in the United States and, in 

the case of drugs, no effort was being made 

to develop substitutes. After Co ngress 

voted th e Medi cal Department another 

$37,500 in March, the surgeon generaltestified that he now had enough in reserve 

to supply an additiona l 220,000 men beyo nd those already serving-in other 

words, a 320,OOO-man force.

7 

As passed in June 1916, the National 

Defense Act demonstrated the attitude 

prevailing among the nation's leaders. It 

called for a gradual increase in the Regular Army, not for a rapid mobilization 

of men and resources, to take place over 

a five-year period and to peak ultimately 

at a peacetime strength of 175,000, with 

an additiona l increase to 286,000 to be 

allowed in the event of wa r. Although 

passed against the backdrop of th e Mexican border situation, this legislation remained baSically, as histo rian John P. 

Finnegan has put it, "a decision that the 

United States would IIot arm immediately 

to meet the menaces of a world at war 

[It wasl a peacetime measure produced 

by wa rtime demands," and an "act ... far 

more intelligible when looked upon as an 

implementation of the Army's peacetime 

demands than as a response to world 

war. " 8 

The nation's military forces remained 

unprepared to meet the chall enges they 

would face in the spring of 1917. Even so, 

the Medical Department was offi cially delighted with the Nati onal Defense Act of 

1916. A medical offi cer who fough t in 

Wo rld War I termed it "the most important piece of preparedness legislation ever 

passed before any of our wars. " According 

to Surgeo n General Go rgas' annual report 

of 1916, it placed th e department "for the 

first time in its history, upon a sa tisfactory 

basis." To keep up with the gradual ex379 

pansion of the Army, the new legislation 

call ed for gradually adding 1,107 medical 

offi cers to the department. It also created 

a Veterinary Corps as part of the department, authorized assigning 5 medica l offi cers to work with the Red Cross' military 

reli ef department, and established a working relationship between the department 

and the Red Cross in matters of supply. Lt. 

Col. Edward L. Munson of the Medical 

Corps had reservations about th e new legislation, however He pointed out that although the new law established the ratio 

of 7 medical officers to every 1,000 men 

that Gorgas favo red, the proportion was 

still less than the 10 to 1,000 the British 

co nsidered necessary· 

The passage of the Nationa l Defense Act 

did not relieve individual Medical Corps 

offi cers and civili an physicians of their 

anxieties about the lack of attention being 

paid to the "sa nitary plans" that must, acco rding to Colonel Munson, be "a part of 

the general plan of the campaign. " Dr. 

Geo rge F Keenan wa rn ed in Southweste,." 

Medicille that "we face a serious situation, 

an ease lOVing people, self pampered and 

prosperous. We possess the uni versa l short 

sightedness of Americans about the possibility of conquest by invad ing powers .... " 

Dr Charles H. Mayo of Rochester, Minneso ta, agreed, noting in an articl e in the 

SI. Pall/ Medicaljounw/ that "our nation is 

becoming soft, dissipated and ineffi cient" 

with "from 25 to 50 per cent of our youth 

from 20 to 30 years of age ... phYSically 

defective from preventable causes. " Attacking what he regarded as the trad itional 

neglect of medica l preparedness, he mai ntained that "in recent times, through army 

officers and war boards, the great nations 

have prevented th eir medical offi cers from 

doing th ei r fu ll duty because, like that of 

law, the conduct of war has been estab-
380 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

lished by precedent. " In the Crimean, Boer, 

Civ il , and Spanish-American Wars, Mayo 

concluded, "the rea l cause of failure was 

lack of medical preparedness. " With the 

zest and optimism typi cal of his generation, however, he predicted that "two years 

of war with disCipline and sacrifice will 

make us the greatest nation on earth." 10 

A rider attached to the Defense Appropriations Act of August 1916 increased 

Surgeon General Go rgas' ability to meet 

the great challenge that faced him when it 

created a Council of Na tional Defense, and 

the six cabinet members and civilian advisors who were to coordinate defense 

preparations under this measure appointed Go rgas to the Council's committee on medicine. But because few predicted 

that the United States would enter the vast 

connict in Europe, the Medical Department, like the Army itself, remained unprepared to handle the rapid expansion 

that wartime needs would dictate." 

The Surgeon General 

When William Gorgas became surgeon 

general in January 1914 fo llOwing Torney's 

unexpected death, less than eight months 

remained before the outbreak of what 

would be the most deadlywarthe world had 

ever known. He was a 63-year-old physician of illustrious credentials, remarkable 

accomplishments, and genial disposition, 

an offi cer apparently well qualified to meet 

the challenge facing the Medical Department. His successes in Cuba and the 

Panama Canal Zone were familiar to many 

(and possibly most) Americans and to the 

scientific world abroad as well. His achievements as a scientist were made all the more 

remarkable by the fact that his medical career had initially been undertaken as an expedient,a meansof obtaining an Army commission when he was unable to obtain an 

appointment to West Point, possibly because he was the son of an offi cer who had 

resigned his commission to serve with the 

Confederate fo rces in the Civil War. The esteem in which he was held was both demonstrated and enhanced by his becoming the 

first surgeon general in the history of the 

Medical Department to be given the rank of 

major generaL" 

But Gorgas, according to a contemporary 

in the Medical Department, had little interest in administration. His wife later commented in her biography of her husband 

that "the new Surgeon-General had little 

opportunity, at this time, to give to his official labors. The call for his services in the 

fi eld that he had made his own became insistent. " The fi eld that he had made his own 

was yellow fever, whi ch, should the nation 

be required to defend its new tropical empire, might well be a matter of concern. In 

June 1916, after spending many weeks testifyi ng about the department's needs before 

Congress while it prepared the budget for 

fisca l year 1917 and designed the National 

Defense Act, Gorgas accepted an invitation 

to spend several months visiting countries 

in South and Central America on behalf of 

the Rockefeller Foundation, a privately 

funded organization concerned with world 

health, to advise it on the formation of comprehenSive plans fo r the struggle against 

yellow fever. There, while the Germans, 

French, and British killed one another by 

the hundreds of thousands at Verdun and 

along the banks oftheSomme, he spent four 

months that were, according to his wife, 

"among the most delightful and enjoyable 

of his life. " Everywhere acclaimed and 

awarded honorary degrees, he joined in the 

festivities, she noted, "with the zest of a 

schoolboy. " By January 1917, th ree years 
IN THE SHADOW OF WAR 

after he became surgeon general, Gorgas 

was eager to retire to concemrate emirely 

on yellow fever, but his return to the United 

States coincided with Germany's resumption of unrestricted submarine warfare, and 

"the war for a time necessarily postponed" 

his departure from the Army. He remained 

at the head of the Medical Department until 

the end of the struggle. IJ 

Medical Department Personnel 

Although Gorgas' major interests were 

clearly sciemific, the principal challenges 

he faced as surgeon general were administrative. The Surgeon General's Office 

would be responsible for directing the 

Medical Department during the inevitable 

turmoil that could follow entry into a 

major war, but it was still composed only 

of the surgeon general himself and six 

other offi cers, with a civilian staff of 146 

working under them. Medical officers 

headed divisions for personnel, sanitation, 

supply, and the library and museum, while 

the Record, Correspondence, and Examining Division worked under the direct authority of the chief cl erk. " 

The shortage of trained, experienced 

personnel posed an especially formidable 

problem. Physicians specializing in either 

scientific or administrative fields were becoming increasingly important to the 

Army, and training in many of those specialties was scarce outside the military. Yet 

a total of barely more than 5,000 men and 

women, including 426 medical officers, 

were working in the entire Medi cal Department in 1914. The modest increase in 

the number of enlisted men and Medical 

Reserve Corps officers on active duty resulting from the conflict along the Mexican border brought the total serving in the 

381 

department by 30 june 1916to 5,792. The 

theoreti cal capacity of the fi eld hospital 

had increased from 108 to 216 beds, and 

the Field Se rvice Regulations of 1914 called 

for an increase in the size of the evacuation hospital from 324 to 423 beds; but, 

because of the shortage of personnel, medical support on this scale could be provided 

for only half the Regu lar Army. Any expansion of the Army would make it necessary to call up an add itional 3,500 physicians, almost all untrained, for every 

additional 500,000 men. Thus, although 

plans for the management of medical care 

in the fi eld continued to be refined, the 

question remained as to whether the Army 

wou ld have enough physicians able to 

carry them out effectively if the United 

States were drawn into a major war. " 

The first challenge resulting from the decision to triple the size of the Medical Corps 

was to make a career in the military service 

seem attractive to more than 1,100 medical 

graduates capable of passing the entrance 

examinations. Although the nation's dwindling number of civilian medical schools 

had improved in quality, they continued to 

graduate fewer physicians than before the 

turn of the century. Thej oul1lC1l of t"eAmerican Medical Association joined MilitQly 

Surgeon in trying to convince more of them 

of the advantages of an Army career. The 

increased salaries and benefits voted in 

1908 made it possible for MilitCllY Sllrgeoll 

to emphasize that the medical offi cer was 

paid well enough "to live like a gentleman 

in a community of gentlemen," with an income that was "adequate [andl assured" 

and increased with time. Furthermore, 

"proportionate to the whole number of 

physicians in the country, the number of 

medi cal officers of the Army who have 

achieved an enviable position in the profession, is greatly in excess of the average 
382 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

in civil lire. " The j Ollrllal noted that the 

Medical Corps physician was also "encouraged to specialize" and that the Army's 

laboratories, operating rooms, and post libraries were all equipped to assist the research-minded surgeon with his wo rk. 

What drect the appeal had is difricult to 

judge, since the growing possibility or u.s. 

involvement in war may have also encouraged wo uld-be applicants. In any event, 

whil e only 20 young physicians who had 

passed th e initial examination reported ror 

class at the Army Medica l School in the rail 

or 1915,65 did so a year later. 16 

The increase in the size or the Medica l 

Corps exacerbated the problems or the 

Army Medical School's already inadequate 

racilities. Beginning in OClOber 1916, two 

terms were scheduled ror the academic year, 

with U 5 young physicians qualirying ror 

commissions as Medical Reserve Corps orfi cers in order lO enroll ror one or the other 

or them. o r th e 101 passing the final examinaLions in that 5chool year, 98 won Regular Army commissions. The school had to 

prepare to accept a still larger enro llment, 

but the Medical Department had not yet 

succeeded in ga ining acceptance or the idea 

or building a new medical school on the 

grounds or the Walter Reed GeneralHospital. With no time to waste, Surgeon General 

Gorgas round a ronner Departmentor Commerce bUilding in the city twice as large as 

the racility then in use and had the school 

and laboratories moved into it in September 1916. Since even the new grounds were 

not large enough to permit establishing a 

camp and initiating fi eld exercises, Go rgas 

con tinued to hope ror something better in 

the way or accoll1l11odations.17 

Even ir the Medica l Department was 

successrul in fi lling all openi ngs in the 

Medical Corps, in the event or ru ll-sca le 

war the Army would have to rely heavily 

on National Guard physicians, who numbered about 800 in 1916, and Medical Reserve Corps offi cers, roughly twice that 

number, and possibly on civilians without 

any exposure to the military. Military training was not required ror members or the 

Medical Reserve Co rps, and rew reservists 

were likely lO have attended th e lectures 

on military medicine that civilian medi cal 

schools and soc ieti es were beginning to 

orrer. Few Medical Reserve Corps offi cers 

und ertook active duty, less than 100 in either 1914 or 1915, though this figure included those at the Army Medica l School. 

In fisca l year 1916, when 1,903 were on 

the combined ac ti ve and inactive reserve 

lists, onl y 146 requested acti ve duty. The 

ex periences or Medical Reserve Corps orfi cers ca lled up lO care ror troops during 

th e crisis with Mexico in 1916 showed 

their lack or enthusiasm ror more than the 

bridest o r training, since some resigned 

rather than be subjected to a similar ex perience again . The Nationa l Derense Act 

di ctated an end lO th e Medica l Reserve 

Co rps as or June 1917 and orrered each 

Medical Reserve Corps orncer a commission in the newly created Orncers' Reserve 

Corps, a step that the surgeon general opposed vigorously but in vain. IS 

The untrained medical officer was 

deemed La be "worse than useless. " As an 

article in Mili[Q1Y SW15eoll pointed out, an 

Army surgeon had to be able to "visualize 

the cou ntry rrom a map ... to hand le 

Imedica l] units land] to coordinate their 

movements with those or other troops. " He 

also had to learn lO understand military orders and how to execute them. As a result, 

the co rrespondence course given through 

Fo rt Leavenworth and designed specifically ror reserve ofricers who could not 

leave their civilian practices was greeted 

with enthusiasm. InJ anuary 1916 Surgeon 
IN THE SHADOW OF WAR 

Genera l Go rgas inrormed the House CommiLlee on Military Arrairs Lhat abouL 700 

Medical Reserve Corps o rri cers were Laking the correspondence course. I. 

SLill ano Lher meLhod ortraining medical 

personnel was introduced not long arLer 

Gorgas became surgeo n general, one inLended ror those who could arrord to leave 

Lheir pracLi ces brieOy. JoinL camps or instruction, apparently similar to Surgeon 

General Torney's med ical camps, orrered 

Medical Reserve Corps orricers and Lheir 

coll eagues in the National Guard the opportunity to work with fi eld hospiLals and 

ambulance companies both rrom th e Medical Department and rrom the Gua rd . In 

1915 five such camps were estab lished, 

each wiLh iLS own field hospiLal and ambulance company. The Army set up the camps 

at centrall y located sites that varied rrom 

year to year, LO whi ch reserve and Guard 

medical orricers could come with a minimum of transportation expense to spend a 

week learning about medica l probl ems in 

the military. At least one prominenlmember or the Medical Reserve Corps, Maj. 

Joseph c. Bloodgood or th eJohns Hopkins 

Medical School, believed that his colleagues should be willing to pay ror themselves "the small expenses incidental to this 

experience," which for reservists involved 

the uniforms they wore, transportation, 

and mess rees. In spite or Bloodgood's personal enthusiasm, joint camps of instruction ror training Medical Reserve Co rps orficers initially aroused less enthusiasm than 

Lhe co rrespondence coursew 

Since the Medical Department was allowed to hire enough co nLract denLisLs to 

maintain a ratio of Ito 1,000 men, no new 

legislation was necessary to increase the 

size or the Dental Corps. Because dentists 

were expected under 11 0rmal circumstances to care for dependents, servants, 

383 

and civilian employees as well as soldiers, 

in fiscal year 1915 the ratio or den Lists to 

the total number or eligible pati ents in the 

Eastern Department, ror example, was 1 to 

2,300. Shortly arter passage or the National 

Derense Act in June 1916, 40 denLal surgeons and 50 contract dental surgeons 

were on duty with the Army. Their small 

number and the ract that Lheir work did 

not require their presence near the rront 

lines mea lll that military training for them 

was not a major probl em ror th e department, even when as many as 43 dentists 

were serving in the Southern DeparLmenl 

during the crisis with Mexico.>1 

AILhough the new law did not change 

the ratio or dentists to soldiers, it did modiry the organizati on or the Dental Co rps, 

abo lishing the instituti on or th e conLract 

denta l surgeon and decreeing that th e appli cant ror a position as a dentist who met 

the Medical Department's standards be immediately commissioned a lieutenant. Examinations ror proressional competency 

were required ror eligibili ty ror each promotion th erearter. Arter eight years the 

dentist could be promoted to captain , and 

arter twent)'-rour ),ears he might be chosen as one or the 15 dental surgeo ns holding the ra nk or major. " 

The size or the Army Nurse Co rps, like 

that or the Denta l Co rps, seemed inevitabl)' 

to lag behind the need. Three nurses rrom 

the Red Cross reserve had to be ca ll ed in 

to assist the 9 members or the Army Nurse 

Corps sent to Ve ra Cruz when it was occupied by a joint Mari ne/Arm)' rorce earl)' 

in 1914, by which poi nt many base and 

mililary departmenl hospilals ,,,,ere urgentl), requesting more nurses. Transports 

sent to Europe to bring Americans back 

after wa r was declared lhere in the summer or 1914 needed nurses, and the shortage thaL this situation created rorced the 
384 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Medical Department again to hire contract 

nurses, in this instance for the Walter Reed 

General Hospital. The 1916 mobilization 

resulted in a serious shortage until Secretary of War Lindley M. Garrison lifted the 

ceiling of 150 nurses that he had imposed. 

Although eventually more than 300 additional nurses were added to the Nurse 

Corps, the increase did not come in time 

to avoid the necessity of calling in reserve 

Red Cross nurses; during the mobilization 

184 of the 251 nurses in the Southern Department were from the reserve. " 

To house nurses, new quarters had been 

completed at the Army-Navy Hospital in 

Hot Springs, Arkansas, and were either 

under way or almost complete at Lettelman 

General Hospital in San Francisco and the 

hospital in Honolulu, all areas relatively unaffected by the Mexican situation. In June 

1915, however, the quarters at the Fort 

Leavenworth hospital were still inadequate. 

At the Fort Sam Houston facility, upon 

which much of the strain fe ll , space had to 

be rented in 1916 to house the average of 

42 nurses assigned to meet the needs of the 

newly mobilized forces there. The nurses 

quarters at the various base and camp hospitals near the border were, of necessity, 

"temporary structures," the surgeon general reported, but "comfortably furnished, 

and in the main, very satisfactory" H 

Although seri ous complaints about female nurses were no longer heard, some in 

the Medical Department believed that the 

Army needed male nurses as well; however, no significant body of trained civilian ma le nurses existed. Furthermore, of 

the 900 ma le nurses in the United States, 

few were interested in serving in the Army, 

and not all of those who were interested 

could qualify for military service. InJanuary 1915, therefore, 10 Hospital Corps privates were chosen to receive four months 

of training as nurses. A second 10-man 

class was organized the following November for a six-month program, but the surgeon general's annual report for 1917 does 

not reveal whether courses of this type 

were given thereafter" 

These 20 student nurses were but a few 

of the more than 4,000 enlisted men in the 

Medical Department during this period, 

most of whom were not of the caliber the 

surgeon general wanted for the Hospital 

Corps. Gorgas blamed "inferior inducements" for the poor quality, noting that the 

War Department had been ignoring his 

suggestions for improving the situation. 

Although as early as 1914 the threatofhostilities on the Mexican border rendered the 

secretary of war more responsive to pleas 

for an increase in the quantity and the quality of enlistees, except for the sergeants, 

the enlisted men caring for the sick and 

wounded continued to be, as one offi cer 

put it, "the riffraff of the Army." The quantity was as inadequate as the quali ty. Gorgas pointed out that while a ratio of 5 

corpsmen to 100 soldiers was adequate in 

peacetime, twice as many would be needed 

in the event of war and that the department 

was already having great difficulty in interesting enough men in the corps to keep 

all authorized positions fill ed'· 

In 1916 the National Defense Act ended 

the official life of the Hospital Corps, the 

Medical Department's first corps. All the 

department's enlisted men, including saddlers, farri ers, and mechanics as well as 

former corps members, became part of the 

enlisted force. Privates first class were 

given extra pay to serve as dispensary assistants, nurses, or surgical assistants. Surgeon General Gorgas believed that since 

the extra pay would serve as an incentive, 

the red tape involved in obtaining the three 

better-paid specialties for those deemed 
IN THE SHADOW OF WAR 

wo rthy of them would have to be endured. 

Enlisted men new to th e department still 

had to start at the bottom as privates and 

work their way, if they could, up to the 

highest position, master hospital sergeant, 

with its pay of $75 a month. The new law 

allowed the president to increase the number of the Medical Department's enlisted 

men by as many as he believed necessa ry 

in wartime, but it set the peacetime ratio 

at 5 percent of the total number of enlisted 

men in the entire Army.27 

While causing the Hospital Corps to lose 

its idemity, the National Defense Act gave 

the veterinarians an organization of their 

own within the Medical Department The 

new law recognized the fact that one of the 

many new developments foll owing the advem of scientific medicine was the appearance of the professional veterinarian, replacing the self-taught farrier and similar 

untrained figures who had traditionally 

cared for sick and injured animals. To be 

appointed to the new Veterinary Corps, a 

veterinarian had to be between twenty-one 

and twenty-seven years old and a graduate 

of an approved school of veterinary medicine. Veterinarians already in the Army 

could join the new corps upon passing the 

required physical and professional examinations, but many proved unable to do so. 

To receive rank, those accepted into the 

Veterinary Corps had to serve a two-year 

probationary period, during which they 

could be dismissed at any time. By April 

1917 sixty-two veterinarians had received 

commissions as second lieutenants. After 

fi ve years of service and the passage of the 

first of the exams they would have to take 

to progress through the ranks, they would 

become first lieutenants and after ten years 

of acceptable service, captains, moving 

from the category of assistant veterinarian 

to veterinarian. After another five years, 

385 

they would become eligible for promotion 

to major. Two members of the corps were 

to be assigned to each cavalry regiment, one 

to every three artillery baltalions and one 

to every moumed engineers ballalion, 

while seventeen would inspect horses and 

mules. As veterinarians for the Quartermaster Corps, another seven were assigned 

to inspect meal. Reserve veterinarians, who 

also had to be graduates of approved institutions of veterinary medicine and pass 

professional and physical examinations, 

could also be appointed to care for Quartermaster Corps animals. While on active 

duty, the reserve veterinarian would be paid 

as a second lieutenant'· 

The creation of the new corps and the 

solidifying of the position of the Army dentists could not mask the fact that, even after 

the passage ofthe National Defense Act, the 

Medical Department continued to face the 

same basic problem, the shortage of trained 

personnel. The increases in number, 

whether voted by Congress or, in the case 

of nurses and enlisted personnel, allowed 

by the secretary of war, were inadequate. A 

system to train the massive numbers of 

phYSicians that would be needed in the 

event of a major war had not been found. 

National Guard Medical Personnel 

Problems of both quality and quantity 

plagued the National Guard medi cal organization as it did the Medical Department 

Although some Guard units heeded the 

congressional requiremem that after 21 

January 1910 "the organization ... and 

discipline of the Orga nized Mili tia ... be 

the same as that ... forthe Regular Army," 

this goal was completely realized only after 

December 1914, when the Division of Military Affairs issued a circular describing the 
386 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

desired form of organization in detail. As a 

result, for a time some Guard physicians 

were still chosen and promoted because of 

favoritism rather than competence. In addition, the size of the Guard medical establishment grew slowly. While the 869 

medical offi cers serving as of 30 June 1914 

represented an increase of 90 from the previous June, the 3,554 enlisted men who 

handled the duties of the hospital corpsman in 1914 cou ld form on ly one more 

Hospital Corps detachment than had existed in 1913. By August 1916, when the 

number of guardsmen called to the Southern Department to meet the Mexican threat 

peaked at more than 110,000, the number 

of enlisted medical personnel was at full 

strength- 19,000 men-and 59 field hospitals, 47 ambulance companies, and 267 

sanitary detachments had been federalized. 

Failures of medical personnel to report 

with their units for federal service and resignations among those who did continued 

to cause shortages. Since some state units 

brought no enlisted medical personnel 

with them, men had to be transferred from 

the line to make up for the defiCiency. Although the commissioned medical personnel on National Guard rolls at this point included 1,407 medica l offi cers, 307 dentists, 

and 81 veterinarians, in addition to 53 militia reserve medical offi cers who had not 

been ca lled into the federa l service, the 

number of federali zed medical officers fell 

60 short of those needed.

29 

Until the entire Guard was federali zed 

in 1916, most of the military experience of 

militia medical offi cers consisted of determi ni ng fitness for duty, but their ability to 

make obj ective decisions was compromised by the fact that the men with whom 

they were deali ng were often friends, pati ents) and rriends or patients. Moreover) 

many civilian and Guard phYSicians giving physica l exams did not bother to familiarize themselves with the standards 

and might not even require those being examined to undress. One report maintained 

that a man with a glass eye had been accepted , and a Medical Corps offi cer reported that "frequently anyone who is 

strong enough to wa lk can enlist" in the 

Guard. Those taken into the Guard in spite 

of their physical condition might have to 

be discharged shortl y therea fter when it 

became obvious that they could not function successfull y as soldiers.'o 

Nevertheless, Major Gilchrist, who was 

still detailed to the Division of Militia Affairs (shortly thereafter renamed the Militia Bureau), was encouraged by the 

progress that had been made by early 1915 

toward solving the problems of the Guard's 

medi cal organization. He gave the credit for 

the improvement to the adoption of a uniform organization throughout the Guard, 

greater support from the states, correspondence courses for interested militia physicians, the elimination of offi cers whose interest in their responsibilities was minimal, 

the enrollment of younger doctors, and the 

use of inspector-instructors to spot deficiencies and bring about improvements. 31 

Five Medical Department surgeo ns had 

been made available to work as inspectorinstructors with the Nati onal Guard east 

of the MiSSiSSippi, usually in areas with 

whi ch they were familiar. They taught a 

correspondence course, added to it by personal instruction, and inspected camp sanitation. The great size of the areas to whi ch 

th ey were aSSigned was a handicap, for an 

offi cer might be responsibl e for several 

states whose medica l orga nizations diffe red. Instructors' problems were furth er 

aggravated by a shortage of textbooks and 

by the fa ct that they sometimes received 

littl e coo perati on from state authorities, 
IN THE SHADOW OF WAR 

which rendered their wo rk "very trying 

and ex tremely dirri cult. "" 

Uniformity in the operations of th e various sanitary units of the National Guard 

became an important goa l. Together with 

eleven Regular Army post surgeons designated to teach correspondence courses for 

militia surgeons in areas to which instructor-i nspecto rs had not been sent, instructor-inspecto rs taught an identi cal and carefull y plan ned course. Since perso nal 

instructi on proved especially valuable, 

when the assignment of a post surgeon 

teaching such a course was changed, the 

effectiveness of the co urse was to a degree 

red uced. Nevertheless, more than 60 percent of the students taki ng the course completed it successfull y in fiscal year 1916. 

As a result, a sixth medical orricer was assigned to work as an inspector-instructor, 

and Surgeon General Gorgas concluded 

that still more orricers should be aSSigned 

to that position . The National Defense Act 

requirement that all doctors appoin ted to 

or promoted withi n the Guard pass examinations before boards of Regular Army 

medical orricers also contributed to creating uniformity, but when the units of 

Texas, New Mexico, and Arizona were federalized in May 1916, too few regular medical offi cers were avail ab le to man the examination boards." 

Unfit guardsmen might become the responsibility of the Medical Department because the law allowed men from states that 

had orricia lly adopted federal standards to 

be mustered into federal service before undergoing federally admi nistered physica l 

exams. Because of inadequate state examinations, a total of 25 percent of the men 

in newly federali zed units had to be discharged in 1916 as physica lly unable to do 

all the duties required of them. The new 

recruits ca ll ed up to replace them proved 

387 

to be no healthi er, man y ending up in hospitals not long after arriving at the recruit 

depots. The department's suggesti on that 

a Regular Army medical officer examine all 

men before th ey were accepted into federal 

service was overtaken b)' events. When the 

Guard was called out and sent so uth toward the Mexican border, haste was the 

order of the day, Medical Corps orricers 

we re few, and Medical Reserve Co rps officers who were ca lled in to help were sometimes slow in arriving. On occasion, federal physical examinations were given fi rst 

to Guard medical orri cersso that those who 

passed could assist in examining the rest." 

Both Guard and Regular Army physicians worked as man)' as sixteen hours a 

day conducting physicals and administering the required immuni za ti ons agai nst typhOid and smallpox in each mobiliza ti on 

camp. In spite of pressure sometimes 

brought upon physicians at this point to 

overlook defects, Regular Army surgeons 

were never given permission to waive 

problems that wo uld interfere in the performance of duty. Nevertheless, in th e 

haste, men who were not qualified to serve 

sometimes slipped through." 

The qua lity of the medical enlisted men 

of the Gua rd also left something to be desired. Men "of high quality, ... medi ca l 

students of good education," might find 

the duties beneath their dignity, and others would have to improve markedly, 

Major Gilchrist beli eved, if they were to 

meet federal standards. Furthermore, 

noncommissioned orricers, although 

often able pharmacists, were not necessa rily competent to manage the wo rk of 

oth ers. Guard line orri cers co ntributed to 

th e problem by their failure to appreciate 

the role the Medica l Department wanted 

th e corpsmen to play, too often regarding 

co rpsmen as mere laborers available for 
388 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

digging trenches and latrines. Under such 

circumstances, the work of Medica l Department sergeants as sanitary instructors 

for the militia proved so valuabl e that in 

fiscal year 1916 three more were named 

to join the twelve already assigned to this 

duty. Even so, the Medical Department 

noncommissioned offi cer and two privates who were sent to each mobilization 

camp to assist and train their Guard counterparts sometimes ended up doing both 

their own work and that of the men they 

were sent to train because so few guardsmen were willing to do the work of a hospital corpsman.'6 

Supply 

Thesupply situation continued to cause 

the Medical Department less concern than 

the shortage of trained personnel, although Surgeon General Gorgas had on 

hand in December 1914 but half the fouryear reserve recommended by the Dodge 

Commission. He blamed the deficiency at 

least in part upon the fact that much of the 

department's reserve had accompanied the 

force sent to Vera Cruz earlier that year. 

Rebuilding the reserves would not be easy. 

The rate at which the warring nations in 

Europe had been buying up medicines and 

equipment made it difficult for production 

to keep up with demand, and 80 percent 

of the surgical instruments used in the 

United States were of German manufacture. The surgeon general agreed with 

other members of the nine-member committee that Secretary of War Garrison had 

named to investigate potential problems in 

war production that private industry could 

handl e the demand and that a government 

monopoly over the production of such 

items was neither needed nor wise. 37 

In April 1916 Surgeon General Gorgas 

showed no great anxiety over supply. The 

Medical Department had on hand the 

equipment for 20 evacuation hospitals, 3 

base hospitals, 44 field hospitals, 41 ambulance companies, and 131 regimental 

infirmaries and a reserve of supplies that, 

Gorgas estimated, would last 250,000 to 

300,000 men fi ve to six months. He admitted early in 1916 that if an army of 2 

million men were to be put into the fi eld, 

providing adequate supplies of medicine 

would be extremely difficult. The problem 

would be exacerbated if control of the sea 

were lost, since he had made no preparations to make in the United States any 

items usually obtained abroad. By January 

1917 he could no longer keep pace with 

the National Guard's requirements, and in 

February he noted that eight to twelve 

months would be required for the department to acquire and pack everything necessary to lTIeel wanime demands. 38 

Although the volume of suppli es and 

equipment held by the Medica l Department left much to be desired-the reserve 

at its maximum was sufficient for a force 

only three times the size of the Army rather 

than four- its management was increasingly effi cient. The unit system of supply 

initiated by Surgeon General O'Reill y had 

been adopted on a Widespread basis so that 

everything needed by a Medica l Department unit, be it a fi eld hospital or a recruiting depot, was carefully recorded, 

stored together, and ready for use regardless of which department of the Army was 

responsible for procuring each individual 

item. Plans called for camp infirmari es to 

hold a reserve of supplies for regiments 

and to draw on a base medical depot for 

replenishment. Base depots, similar to 

those used in the Civil War, each manned 

by two medical offi cers and fifteen enlisted 
IN THE SHADOW OF WAR 

men, would in turn draw on the major depots in New York, St. Louis, and San Francisco. A reserve medical supply, described 

as "a movable depot," would move with 

each division, under the control of the division's chief surgeon, and be replenished 

as needed from base depots along the line 

of march. To further standardize medi cal 

suppli es and to find ways in which to speed 

production and reduce costs, a committee 

was organized of representatives from the 

Army and Navy Medi cal Departments, 

from the Public Health Service, and from 

the Red Cross a few weeks before the 

United States entered the war.'· 

Standardizati on was but one of the 

problems involved in supplying motor ambulances, the only vehicles the Medical 

Department bought for itself. Design improvements were frequent, and no one 

type fill ed all needs, making standardization impracti ca l at this early stage of the 

use of motor transportation. Surgeon General Gorgas did note the need for "a standard commercial chassis made by a reliable 

firm" so that spare parts would always be 

available and pointed out that the motorization of all hospital transportation would 

"increase its effiCiency, and ... economize 

in the maintaining of this department." A 

board that met to consider the question of 

ambulance design recommended buying 

500 "standard ambulance bodies," but 

when the United States declared war in 

April 1917, motor ambulances were continuing to come from several sources'o 

Quality was as much of a difficulty as 

design. A Keeton MOLOr Company ambulance shi pped to Texas City, Texas, for example, in the spring of 1914, a time when 

the Medical Department had fewer than 

twenty motor ambulances, arrived with 

dead batteries. "The entire machine 

seemed LO have been carelessly put to389 

gether," the department informed the 

manufacturer. On a march LO Houston it 

broke down the first day, when "the differential came loose and broke up." Incorrect instructions accompanied a Keelon 

vehicle sent to Fort Riley, Kansas, and the 

starter could not be located for some time; 

the discovery that pushing down the light 

button, which was twisted LO control the 

light, activated the starter was accidental. 

Nevertheless, the department continued to 

buy ambulances, although when one old 

KeeLOn was condemned in the Philippines, 

two models from the White automobil e 

company were bought LO replace it. So impressed was Surgeon General Gorgas with 

motorized transport that in the spring of 

1916 he even urged Congress to appropriate money for motorcycles, a few of which 

the department had been trying out in 

Mexico, LO be used LO carry Medical Department messages and fi eld supplies" 

The true potential of the motor ambulance for meeting Medical Department 

needs, as well as the difficulties that vehicl e might present, first became apparent in 

1916 on both sides of the Mexican border. 

Initially, trucks and mule-drawn ambulances provided transportation for the sick 

and wounded within Mexico. When mOLOr 

ambulances arrived, the harsh punishmentLO which they were subjected in Mexico, where roads were often nonexistent, 

demonstrated that the models from the 

General Motors Company were "cheaply 

constructed." The lack of shock absorbers 

led to much breakage of springs, and one 

of the two types provided by this finn had 

a body so high that it was easily overturned. The problems experienced with 

these vehicles were exacerbated by the fact 

that the only trained mechanics available 

were those sent in LO service the expedition's planes. 42 
390 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

The difficulti es experienced with motor 

ambulances along th e border enco uraged 

debate over the relative merits of this vehicle and the mule-drawn model. The ambulance company with mule-drawn vehicles had, acco rding to one medi cal offi cer 

in 1916, "fully justified its organization and 

continued existence." Mules co uld cover 

terrain too rough for motor vehicles, but 

this advantage was at least partially negated 

by questions about the advisability of subjecting the wounded to the jolting caused 

by a ride over a surface too uneven for 

motor ambulances. The motor vehicle 

could go faster than its mule-drawn counterpart, did not have to stop to be fed, could 

carry a comparatively large number of patients \,vithin a given period, ancl was, European experience suggested, cheaper to 

operate. Furthermore, some of the ambulances used by the Army apparemly had 

pneumatic tires to provide a less jarring ride 

fo r their passengers, and although a truck 

designed speCifically for Army use had yet 

to be developed, some cOlllmercia lmodels 

had proved to be very durable even uncler 

difficu lt conditions. Despite the fact that by 

the end of September 135 Illotor vehicles 

were in service in the Southern Department 

and many more were on their way, the 

motor ambulance company was still rega rded as "experimental. " 43 

The supply system estab lished by the 

Medical Department was very effective, 

but the magnitude of World War I had not 

been anticipated in designing plans to 

meet wartime demands. Occasional clifficulties with distribu tion were inevitable. 

National Guard physicians were generally 

ignorant about how to buy supplies in an 

emergency. The sites of mobilization 

camps were occaSionally changed on short 

notice, delaying delivery and making for 

even greater diffi culties if the requisitions 

had not been made in a timely rashian in 

the fi rst place. The movement of supplies 

rapidly and in adequate amounts remained 

the major problem, principally because the 

Quartermaster Corps, hampered by demands for economy and the need to determi ne when, whether, and how to convert to motor transportation. was, like 

almost everyone else, un inspired by any 

sense of urgency" 

Hosp itals and Laboratories 

The fragi le relationship with an unstable Mexico and attemp ts to prepare for the 

demands of a major war added to the diffi culties traditionally experienced in managing the Army's hospitals and laboratories. Permanent hospitals, whether large or 

small , had rarely received the attention and 

the finanCi ng they needed, and the work 

of labora tories in the rest of the United 

States was curtailed in the interests of 

meeting the demands upon those near the 

Mexican border. Surgeon General Gorgas' 

co ntinued effo rts to obtain the money to 

improve and enlarge aging facilities often 

met with frustration, especially since the 

limit on money to be spent on construction undertaken without specific co ngressional authorization still app lied. The hospitals at posts near the Mexican border 

were expanded to meet the needs of troops 

that gathered there, but in 1914 capacity 

did not keep up with demand at Forts Bl iss 

and Sam Houston in Texas or at Fort 

Huachuca in Arizona. Since, in addition, 

female nurses were not alwaysavailable for 

the posts in the Southwest and both medical officers and hospital attendants often 

lacked app ropriate training, a Southern 

Department surgeon reported to Gorgas 

that the "care of the sick and the general 
IN THE SHADOW OF WAR 

management of these hospitals ... at 

times suffered severely." is 

In 1914 the Army-Navy Hospital became an informal general hospital for th e 

Southern Department and the 2d Division, 

stationed at th e Mexican border. A wa rd 

for another mty beds and a new barrack 

for sixty hospital corpsmen were built 

there in 1915, but the waiti ng list was long, 

and stillmore space was needed. The hospital at Fort Bayard remained restri cted 

principally to the treatment of pati ents 

with tuberculosis, but its population, too, 

was slowly growing. Because the funds to 

comp lete all of the requisite co nstructi on 

there were dirri cult to obtai n, a wa rd had 

to be set aside at Letterman Genera l Hospital in San Francisco to accommodaLe tuberculosis patients. The existing buildings 

at Len erman, which served as the hospital 

for posts in the San Francisco area, were 

all of wood , and the danger of another disastrous fi re was rea l. Surgeon Genera l Gorgas ordered that all new construction th ere 

be of reinforced co ncrete, but because of 

the size of the hospital grounds, little expansion could be attempted. 46 

The overseas hospitals that might be 

needed in the event of a colonial war experienced their share of dirriculties, many 

of which co uld also have been cured by 

granting more money to improve or enlarge the facilities. Wha t had been a 12-bed 

post hospital in Honolulu , Hawaii, only a 

few years before had by 19 16 become a 

275- to 300-bed facility, serving both as a 

post hospita l for nearby garrisons and as 

th e general hospital for the entire Department of Hawaii and handling well over 

2,000 patients a year. In the Philippines, 

where one quarter of the Army was stationed in 1914, the hospitals were inadequate in size and required repair. In the 

Canal Zone, now undera U.s. civilian gov391 

ernment, th e absence of mili ta ry hospita ls 

made it necessa ry for Army perso nn el and 

their fam ilies to use civilian facilities for 

all problems that could not be handled by 

a post dispensa ry. As a resul t, while an 

Army medi cal orricer remained responsible for the overall management of Canal 

Zo ne hospitals and sometimes another 

Army physician might manage an individual faCility, the ca re of the individual hospitalized military patient was not otherwise under the Army's control. Military 

dependents were charged for the entire 

cost of their hospital ization rather than 

merely for subsistence and medi catio n." 

Although hospitals had always been impOl·tant to the Army, the role of laboratories, constantly increasing with the growth 

of medical kn owledge, grew still more 

rapidly under the stimu lus of mobilizing 

large numbers of troops. The experi ence 

gai ned along the Mexican border provided 

inSight into th e vital part they would play 

if the Un ited States were to become involved in a majo r war. At a lime when venereal disease was regarded as a major threat 

to theArmy's effecti veness, both actual and 

potential, the labora tor)' was needed to 

help in the diagnosis and to fo ll ow the 

progress of the treatment of both syph ilis 

and go norrh ea as well as many other health 

threa ts. Rou tine tests, such as urinalyses 

and blood counts, were done in the small 

labs that existed in every hospita l, while 

more compli ca ted work, including testing 

drinking water for signs of bacteria and 

pollutants, was assigned to major facilities. 

The importance of the Army Medical 

School laboratory also grew during the 

mobilizati on, initially because it was responsible for making all vaccines. When 

the demands of the Mexican situati on necessitated moving the Central Department's laborato ry into the Southern De-
392 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

BASE H OSPITAL AT FORT SAM H OUSTON, TEXAS 

partment, the Medica l School was assigned 

the routine work normally done by the 

Central Department's main facility at Fort 

Leavenwo rth, Kansas'· 

The burden of the 1916 mobilization fe ll 

most directly upon the Fo rt Sam Houston 

laboratory. Although the size of its staff was 

increased, additi onal laboratories had to be 

set up at EI Paso, where the Fort Leavenworth unit was moved in August 1916, and 

at Nogales, Arizona, a month later. After 

medical offi cers discovered that the cl imate 

in Texas fa vored raising guinea pigs, many 

tests that requ ired the use of these animals 

and were vital to the correct diagnosis of 

several diseases were run at the Fort Sam 

Houston laboratory. The facility also sent 

out guinea pigs to scientists at EI Paso and 

Nogales. An epidemi c, probably paratyphoid Ca disease similar to but milder than 

typhoid), first diagnosed in units along the 

Mexica n border in the earl y summer, 

struck theguinea pigs in December, threatening vital diagnostic work The th reat was 

brought un der co ntrol by vaccinating 

breeding females, the chief victims of the 

disease, by isolating sick animals, and by 

disinfecting cages. Even after the epidemic 

was brought under control, the load that 

th e Fort Sam Houston laborato ry had to 

carry remained high, d ictating the construction of a new building by early 1917.19 

Ii-aining Along the Mexican Border 

The invo lvement of u .s. forces in the 

turmoil w ithin Mexico increased with time 

in the fi rst years of Gorgas' service as surgeo n general. As a result, Mexico and th e 

Mexican border became, both li terally and 

fi guratively, training areas for the medi cal 

offi cers watchi ng over the health of both 

u.S. soldiers and foreign nationals. When 
IN THE SHADOW OF WAR 393 

FI ELD H OSPITAL No.7 EN ROUTE TO M EX ICO 

Gorgas first assumed th e duti es of his offi ce inJanuary 1914, members of the Army 

Medi cal Department were already joining 

representati ves of the Red Cross to care for 

5,000 Mexica n refugees, soldiers, and 

civilian camp followers who had crossed 

the border to escape rebel forces. Ten hospital corpsmen and two sergeants were 

sent to Fort Bliss, Texas, where the refugees 

were initially intern ed in a camp commanded by a medical offi cer, and fou r more 

corpsmen joined them there on a temporary basis. Finding the physicians among 

the refugees of little assistance in either 

caring for th e sick and wo unded or taking 

measures to prevent outbreaks or disease, 

the six medica l officers sent to the fort 

promptly began immuni zing against typhoid and smallpox, thus nipping incipient epidemics in the bud. Because Medical 

Department personnel insisted upon high 

standards of sanitation, the 21.8 per 1,000 

death rate experienced by the refugees during their six-month internment, first at 

Fort Bliss and then at Fort Wingate, New 

Mexico, was blamed on the hardshi ps they 

had endured, th eir debilitated co ndition 

when they crossed th e bord er, and their 

poor morale. 50 

Army units were concentrated north of 

the border with Mexico throughout 1914 

and 1915 in a state of watchfulness, the soldiers for hostile activity, the medical officers for signs of disease. Because the 

refugees continued to bring typhoid, typhus, small pox, and innuenza with them, 

co nstant vigilance was necessary to prevent 

the reappearance of typhoid and smallpox 

epidemics. Immunization agai nst both was 

compulsory in the Regular Army and in 

federalized National Guard units as well, 

but medical officers were aware that vaccine did not always prevent disease and 

concluded that the effectiveness of the ty-
394 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

phoid vacc ine began to weaken after no 

more than three years. The source of every 

typhOid case that did develop was rou tinely 

traced so that the reasons fo r any outbreak 

could be ascertai ned and steps taken to prevent furt her spread. Mosquito control kept 

malaria rates low, and sa nitation reduced 

the threat of dysentery. At times, medical 

officers also ca red for the casualties resulting frol11 minor incursions by Mexicans 

into Texas and Arizona , including a few 

members of the factions contending for 

powe r within Mex ico.

51 

Although medica l ofri cers could rely on 

sanitati on and immunization to limit the 

threat of the old camp diseases, chiefl y typhOid and dysentery, to manageable proportions, they could not be equall y confident of their ability to devise a truly 

effec ti ve approach to the prevention of 

venerea l disease. While the stoppage of pay 

for time lost because of self-infli cted health 

problems caused alco holism rates to co ntinue the steady decline that had started in 

1907, the new regulation had not produced a comparabl e trend in venereal disease rates. Army studi es offered Surgeo n 

General Gorgas the small consolation that 

the VO rates in the civilian and military 

populati ons were similar, a conclusion 

that the high rejection rate of recruits because of VO seemed to support. One of the 

Army's most experienced bacteriologists 

concluded that s)'philis alone was "a 

greater menace to the public health than 

any other single infecti ous disease, not 

eve n excepting tuberculosis." 52 

The thought of what was likely to happen to the venereal disease rate when soldiers were far from their families, were 

alone in a strange environment, and were 

more likely than ever to become the victims of diseased women, was alarming. 

Surgeon General Gorgas decided that the 

medi ca l ofri cer's lecture on the dangers of 

venerea l disease at each post should be appropriately illustrated. Because he had received reports that soldi ers might use the 

prophylacti c treatment once-just to have 

th eir names on the reco rd should they later 

discover they had contracted a venereal 

disease-but th en fail to reportsubsequent 

sex ua l co ntacts, he also suspected that the 

rule calling for prophylax is within six 

hours of ex posure was being violated. He 

therefore urged that prophylacti c packets, 

to be used promptly after sex ua l activity, 

be given rather than sold to individual soldiers as the men seemed reluctant to buy 

these items. In spite of the a larm about VO 

rates, the packet still did not contain co ndoms, although the recent introducti on of 

vulca nized rubber made their manufacture 

both easier and cheaper. As late as 1918 an 

au thority on syphilis noted that "the objections to the use of such a mechan ical 

device are practical and moral " (apparentl y a common belieO, since they were 

expensive and hard to locate when needed 

and appea red to make immorality safe') 

U.S. Army units first ventured across 

th e border into Mexico at the end of April 

1914, when they joined the marines who 

had just taken Vera Cruz. Since military 

action was by that time at an end , Army 

medical offi cers under Col. Henry P Binllingham, the expedition's chief surgeon, 

could again add the health of civili ans to 

their routin e responsibilities. They took 

over the direction of local health authorities in all mallers except quarantine from 

the Public Health Service physicians who 

had borne that bu rden during the Marine/Navy phase of the occupation. A 

Medical Reserve Corps lieutenant who 

lived in Mexico was made temporary superintendent of the civil hospi tals, later to 

be replaced by a retired U.s. Army offi cer, 
IN THE SHADOW OF WAR 

under whom he then served as assistanl. 

To care for their military patients, Army 

physicians set up a 21 6-bed field hospital 

in a preparatory school, "the newest and 

most modern structure in the city," with 

modern plumbing and electric lights. The 

building was large enough to shelter a laboratory and quarters for hospital co rpsmen, while the twelve nurses sent in by 

the Army Nurse Co rps were housed in a 

nearby private building. Two medical offi ce rs and twenty-fi ve enlisted men 

formed an ambulance company. Navy 

doctors worked under Colonel Birmingham in a separate facility they established 

for Marine patients, using supplies from 

th e Army" 

The burden of the responsibility for 

civilian and military health was made particularly heavy by th e condition of Vera 

Cruz, "one of the unhea lthiest and most 

disease-ridden cities of the wo rld," where 

yellow fever, malaria, smallpox, and 

dysentery were rampant and, according to 

Colonel Birmingham, th e "more or less 

disorganized state" of the government had 

resulted in the neglect of sa nitation. Army 

surgeo ns quickly set to work to immunize 

the civilian population aga inst small pox, 

vaCCinating more than 41 ,000 in the period from 18 May to 30 June. U.s. troops 

were stationed on the outskirts of th e city, 

where th ey co uld use city water and sewers while reducing their exposure to the 

city's hordes of insects and the diseases 

they bore. The floors and wa lls of the buildings occupi ed by soldiers were disinfected, 

and a daily dose of three grains of quinine 

was made mandatory for each man because 

of the danger of malaria. Experts from the 

Canal Zo ne, some of whom had trai ned 

under Gorgas, were called in to help improve the city's sanitation, using the techniques he had developed." 

395 

H EN RY P. BIRMI NGHAM 

Since city ordinances already in effect 

allowed authoriti es to control prostitutes 

in Vera Cruz, these women were restricted 

to specifi c areas, registered, inspected by a 

medi cal offi cer each week and, if diseased, 

co nfined in a charity hospital until pronounced cured. Only 25 percent of th e registered prostitutes required hospitalization 

because of venerea l disease, but 90 percent 

of a sampling of the "c1andestines" who 

had escaped regulation were infected. Free 

prophylac tiCS and educationa l materials in 

both Spanish and English were made availabl e at several sites. Colonel Birmingham 

concluded that "a ll these measures proved 

amply effective" and that, as a result, what 

could have been "an inordinately high rate 

of venereal infecti on" was kept at what he 

regarded as a reasonable leve l under the 

circumstances, a noneffective rate [or the 

peri od from late April through the fa ll o[ 

1914 o[ 5.21 per 1,000.'6 
F IELD H OSPITAL AND ITS SURG ICAL WARD 
IN THE SHADOW OF WAR 

u.S. troops entered Mexico again in 

1916, when the situation at the border 

reached a crisis point after a raid on 9 

March by Pancho Villa upon the New Mexican community of Columbus. When Brig. 

Gen.John]. Pershing led a provisional division across the border, physical and psychological stress was added to the threat 

of disease. Although National Guard 

troops were federalized in response to the 

fear that the situation might get out of hand 

and many were sent to the border area, 

only regulars accompanied General Pershing's force in an unsuccessful attempt to 

run Vi lla down within Mexico. Medi cal officers learned at this time, as one of them 

put it, that "to work with real men and animals and equipment and machines over 

miles of territory" was "quite different 

from moving pegs on a map." 57 

General Pershing's punitive ex pedition 

was composed of two cavalry brigades and 

one infantry brigade, all regulars, initiall y 

numbering some 5,000 men. Units in the 

fi eld operated in detachments of varying 

size slretched out over "an attenuated line 

of communicati on ." Some of Pershing's 

offi cers co nsidered the campaign the most 

grueling they had ever kn own . During its 

active stage, which ended in late June 

1916, they chased Villa much as U.S. soldiers had chased the Apaches in the 

1880s, when Leonard Wood was first 

making a name for himself. Like Wood, 

they discovered that the environment was 

as difficult an enemy as the Mexicans. The 

days were very hot, th e nights very cold, 

and violent winds blasted both men and 

horses with ab rasive dust. Pershing's men 

never went farther than 150 miles so uth 

of the border, but the stress they endured 

was great; horses and men were sometimes inadequately fed as they attempted 

to live off the land, and some animals died 

397 

of sheer ex haustion. PhYSicians left behind with those too exhausted to cOl1linue 

became espec iall y vuln erable to guerrilla 

attack. Surgeo n General Gorgas noted, 

however, that although service in Mexico 

involved "a restricti on of food , clothing, 

and shelter quite unparalleled in the 

history of the United States Army," medical supplies were "plentiful and of good 

quality" and shipped from the EI Paso 

depot "with remarkab le speed, faCility, 

and accommodation . ... " 58 

Since General Pershing's campaign was 

conducted by regiment-sized or sma ll er 

units, the medical service reli ed heavil y on 

the regimen tal organization, backed up by 

one of the division's two field hospitals set 

up as a camp hospital and by one of the 

two ambulance companies from the advance base at Colonia Dublan. Each infanUT regiment was usuall y accompanied 

by a mul e-drawn ambulance, its infirmary, 

its share of equipment, and two medical 

offi cers, but cava lry regiments with Pershing in pursuit of Villa sometimes had to 

leave most of their supplies and their ambulances behind to move as rapidly as possible. The division surgeon beli eved that 

all ambulances should be motorized except those accompanying regiments in the 

fi eld , which were needed to move patients 

from areas that moto rized vehicl es could 

not reach. Long marches proved so exhausting to Medical Department personnel that the division surgeon urged that 

transportation be provided for them in the 

fUlllre. Fortunately the health of the men 

was ex tremely good in spite of the hardshi ps; the sick rate was under 2 percent. 

Casualties were light; in 11 encounters 

from March through May, 31 were 

wounded and 15 kill ed, and in the campaign's most disastrous engagement on 21 

June, 11 were wounded and 33 killed. 
ANIMAL-DRAWN AND M OTOR A MBULANCES 
IN THE SHADOW OF WAR 

Thus regimelllal plans for evacuation and 

hospitali zation were never really tested.

59 

When not engaged in th e active pursuit 

of Mexican soldiers, General Pershing's 

troops fell prey to Mexican prostitutes who 

swarmed around the camp. The general finally had th e prostitutes rounded up and 

placed in huts behind a formidabl e barbed 

wire fence with only one gate, by whi ch he 

set a guard. For a fee, each soldier was allowed ha lf an hour in the hut of his choice; 

when he lingered longer, a guard came to 

fetch him. To leave the compound, thesoldier had to visit the proph ylaxis stati on by 

the gate. The approach of legalizing and 

co ntrolling prostitution proved to be moderately successful , despite its obvious 

drawbacks to moralists. The syphilis and 

go norrhea rates of the men in Mexi co remained low. Nevertheless, venereal disease 

caused th e return of more men to the U.s. 

than any other health problem, since men 

with gonorrhea were not up to hard service and th ose undergOi ng treatment for 

syphilis were obviously even less S0 60 

Venereal disease, which a fOi cted 44 of 

every 1,000 men on the sick list in General Pershing's force, was but one of several ills encountered by the men in Mexico. "Intestinal disease," including 

diarrhea, dysentery, typhOid, and paratyphoid, all common diseases in nort hern 

Mexico, struck 243 of every 1,000 sick. 

Paratyphoid was a new threat to hea lth that 

affected troo ps along both sides of the 

Mexican bord er. Although it had been so 

rare amo ng u.s. soldi ers that in 1914 Medical Department au thorities decid ed not to 

use a mi xed paratyphoid/typhoid vaccine, 

paratyphoid was identifi ed in 93 cases 

among Pershing's men and suspected in 

many more. Malaria was found principally 

in a regimel1lthat had camped for a lengthy 

period in a damp area. Disease rates in gen399 

era I were highest where the contact with 

Mexican civilians was greatest. 61 

Preventing disease among the men of the 

punitive expedition required eternal vigilance. Although vaccination against 

paratyphoid prevented its spread, keeping 

all immuniza tions current was difficult 

when soldiers were conducting what was 

essentially anti-guerrilla wa rfare. The chief 

surgeon with theexpedition , Lt. Col.J ames 

D. Glennan , urged that no civilians be hired 

until they, too, had been immunized 

against smallpox, typ hOid, and paratyphoid. Washing, boiling,and ironing c1othing freq uently and thoroughly was necessary to eliminate lice and prevent thespread 

of infection. An effort was also made at this 

time to discover how large a role the ex pedition's veterinarians could play in preventing human disease, but medi ca l officers were not sure how much inspecting 

cattle and supervising their slaughter contributed to disease prevention in humans. 

The drive to keep disease rates low was successful in spite of the stress members of 

General Pershing's expedition endured, 

since the annual death rate from disease 

was less than 2 per 1,000 men,ascompared 

with 3 per 1,000 from injury.62 

The units se rving across the border in 

Mexico formed but a fraction of the entire 

force call ed out in 1916 because of the Mexica n situation. Although most of the regulars had been moved into the area, the 

length of the border and the wild cou ntry 

that lay on either side led President Wilso n 

to co nclude that the National Guardshould 

also be called out. The Mexicans never attacked in force across the border, and since 

the entire National Guard was not needed, 

the Army took advantage of the situation 

to stage maneuvers, rotating Guard units 

from state camps to the border so that as 

many as possibl e were trained. By the fall 
400 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

of 1916 a total of 42,000 regulars and 

128,000 Guard troops had been involved, 

60,000 of whom were totally without previous military experience. 63 

Some diffi culti es experi enced by those 

guarding th e hea lth of these men developed well before th e militia troops arrived 

in the Southern Depa rtment, among them 

supply problems resulting from state government red tape. Because some Guard 

units brought no ambulances with them, 

vehicles sometimes had to be hired to take 

patients from th ecamp to the hospital. The 

initial strangeness of Army routines to National Guard medical officers and the relative scarcity of Regular Army medical offi cers to gUide them add ed to theconfusion 

at mobilization camps. Surgeon General 

Gorgas se nt each camp the equipment and 

supplies necessa ry to estab lish its own 

camp hospital so that fi eld hospitals could 

be kept packed and ready to move. Some 

militia phYSiCians, apparently unable to 

believe in the adequacy of the camp hospita l beca use their equipment was scanty 

in comparison to that of civilian fa cilities, 

set up fi eld hospitals for their sick and injured, though this move jeo pardized th e 

mobility that was the reaso n for the field 

hospital's exislence,M 

In the Southern Department, men still 

unfamiliar with military sanitation were 

gathered in camps to accommodate from 

4,000 to 15,000 that were reminiscent of 

those seen during the Spanish-American 

War. To ensure against a repetition of the 

disaster ofl 898, seven "general sanitary inspectors" were appOinted to report to the 

adjutant general on th e cond itions they 

found while preparing camps for the arrival 

of th e militia. Another sanitary inspector, 

who might be the district surgeon, one of 

the general inspectors, or even a medical 

offi cer, fun ctioned exclUSively as distri ct 

inspector in each district. The regulations 

required that at least one sanitary inspector, who had to be a Regular Army medical 

officer, be aSSigned to each camp along the 

border. He reported problems that he noticed both to the commanding officer, who 

had th e responsibility for seeing that the 

defects were remedi ed, and , through one of 

the general inspectors, to the surgeon general. The camp sanitary inspector was also 

to instruct "the untrained troops in the care 

of their camps and personal hygiene." Because of the shortage of Regular Army surgeons, the camp inspector also had to fun ction as camp surgeo n. Some older Guard 

line officers, convinced that age alone gave 

a superior understanding of sanitation, ignored the advice of younger sanitary inspecto rs and even aSSigned their own medical officers the role of camp surgeo n. In 

some instances, this move could be justifi ed by the fact that physical exams and the 

work of sanitary inspection sometimes 

overwhelmed the single Medical Corps offi cer detailed to eac h camp·' 

Recognizing the importance of what he 

called "the human factor" to the maintenance of proper sanitary standards, Surgeon General Gorgas had no doubt that instructing these men about sa nitation was 

crUCia lly important. Each line offi cer and 

each enlisted man would have to be convinced of the need "for almost meticul ous 

care in carrying out many rules which appea r to them more or less unimportant," 

since, as one surgeo n put it, they were not 

likely to "appreciate the necessity for sanilary precautions except in an academic 

way. " Genera l orders issued in July 1916 

required hand washing after every use of 

the latrine and bathingat least twicea week. 

The surgeo n genera l urged dail y baths during the summer, a step made all the more 

advisable by the presence of typhus, a 
IN THE SHADOW OF WAR 

louse-borne disease, among the Mexicans. 

Since the Mexican laborers working on the 

roads used by the u.s. forces were infested 

with vermin, caring for them was instructive for medical offi cers, who even devised 

an "inex pensive plant" that could delouse 

a man and his clothing every twenty minutes. They were also prepared, should typhus break out among the troops, to provide "a completely equipped bath and 

disinfecting train" to move its victims. 111 

August a "systematic scheme of training," 

to be conducted at every camp "as far as 

circumstances . .. permitled," was started 

in the Southern Department, with the 

pupils to be enlisted men and jun ior officers, especially those in the militia and the 

Medical Reserve Corps·6 

Like the camps, the hospitals set up to 

care for the men servi ng along the Mexican border formed a train ing gro und , in 

this instance for medical personnel. They 

included 200-bed base fac ilities at EI Paso 

and at San Antonio, Texas, where an early 

patient was a member of a new and hardy 

breed, a victim of an airplane crash who 

reportedly wa lked for two days from the 

site of the disaster to reach San Antonio. 

Patients more fortunate than the aviator 

arrived at San Antonio on a 160-bed hospital trai n of ten Pullman ca rs especially 

co nstructed for this purpose, staffed by 

Medical Department offi cers and enlisted 

men and seven members of the Nurse 

Corps. This train made occasional runs 

from San Anto nio to the Army-Navy Hospital at Hot Springs, Arkansas, or to the 

West Coast. A temporary facility of 150 

beds was buil t at Columbus, New Mexico, 

and temporary add itions went up at San 

Antonio, where the total number of beds 

reached 750, and at EI Paso, for a total of 

900 beds. New base hospitals of 500 beds 

each were put up at Brownsville and Eagle 

401 

Pass, Texas, and at Nogales, Arizona. Six 

small er 100-350 bed facilities, presumabl y 

classified as camp hospitals, were co nstructed in Texas and one each in Arizona 

and New Mexico. By the end of October 

1916, 4,600 hospita l beds were available 

to the troops in the Southwest. Each hospital had an operating room with an X-ray 

machine and a sterilizer and a small laboratory, and all but three of these facilities 

was staffed by the Nurse Corps and usually by Medica l Corps and Medical Reserve 

Corps offi cers and Medi cal Department 

enlisted, assisted by carefull y chosen officers and men from the Nati onal Guard ·' 

Six "permanentl y organized fi eld hospitals" and ambulance companies wi th 

motor transport as well as three provisiona l fi eld hospitals and ambulance companies with mu le-drawn vehicles had also 

served in the Southern Department by the 

end of fisca l yea r 1916, and state troops 

brought thirty-two more fi eld hospitals 

with them. Field hospitals were "merel y 

meagerly equipped shelters," where in 

wartime the sick and wo unded could be 

held until sent back to a base hospital. Two 

fi eld laborato ri es were also set up, ready to 

be moved wherever they might be needed 

to assist in diagnosis. 68 

Among the health problems threatening 

effectiveness in the Southern Department, 

venerea l disease caused the most concern. 

In spite of instruction on the price that 

could be exacted by sexual incontinence, 

"the human factor" remained a major 

problem. Two Texas forts, Sam Houston 

and Bliss, eventually developed th e highest VD rates of any Army post in the co untry. Near the border in the Brownsville 

area , the prostitutes, few in number, apparentl y did such a th riving business that 

all were soo n infected with both venereal 

disease and pubi c lice. In the course of a 
402 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

year, courts-martial convicted seventeen 

of the soldiers in the Brownsvill e area for 

contracting venereal disease when they 

were not recorded as having used prophyla xis. Along the border at Nogales one surgeon attributed the low infection rate of 

his infantry regiment, where 5,401 prophylactic treatments were recorded in a 

yea r, to the absence of saloo ns in the area, 

"venery associated with drunkenn ess" 

being "a serious menace." 69 

Maj. Henry J. Nichols, now head of the 

El Paso laboratory, beli eved that the huge 

size of the Na tional Guard camps tended 

to make access to prostitutes dimcu lt, and 

the incidence of sex ually transmitted ills 

among the Guard troops in his area was 

low, 44 per 1,000 men. This rate, roughly 

one-third of that of the regu lars in the al'ea, 

was allributed to either the Ugreater moral 

restraint" of the militia or the "failure of 

medical omcers to detect and report many 

cases as required by orders." 70 

Apparently many omcers assumed that 

their men inevitably needed the services of 

prostitutes, and the stories that the public 

heard about the drunkenness and debauchelY of the camps, surrounded and engulfed 

by saloons and brothels, did not suggest that 

access to prostitutes was necessarily difficult. Mexican prostitutes were known to 

boast of serving 40 to 60 soldiers a day, and 

medical omcers encountered one woman 

with syphilis who had had 120 customers in 

the two days preceding theirdiscoveryofher 

disease. Although some attempts were made 

to examine prostitutes regularly, no one in 

the Un ited States adopted the approach 

General Pershing used to the problem in 

Mexico. Some omcers reported that their 

problems with discipline diminished when 

they closed down the brothels and saloons 

frequented by their men. " 

In 1916 anot her potential threat to 

health developed when cases of paratyphOid began to appear in signifi cant numbers in National Guard troops, especially 

those in the area of Mission, Texas, although prompt action prevented any extensive spread. The affected regiments, 

principally New York State troops, were 

quarantined, victims sent to civilian hospitals, and ca rri ers isolated, while the use 

of a triple vaccine was initiated to protect 

against typhoid and both A and B paratyphOid. In fisca l year 1917 the Army had 

410 cases, of which 296 with 4 deaths were 

among the men of th e federalized Na ti onal 

Guard and 114 among regularsn 

With the new recruits called in during 

the Mexican crisis, measles also remained 

a Significant problem, and compli cations, 

including pneumonia, empyema, and middl e ear infections, co ntinued to cause high 

death rates. The increase in the number of 

recruits in 1916 brought an increase in the 

number of cases of measles from 555 in 

1915 to 1,247, with 9 deaths. An epidemic 

of pneumonia that erupted in November 

1916 and lasted until April 1917 was 

blamed in part on measles, from which 

bronchial pneumonia often resulted, as 

well as on mumps and innuenza. The outbreak, which was limited to Texas, Arizona , 

and New Mexico, resulted in 611 cases of 

lobar pneumonia with 103 deaths and 68 

cases of bronchial pneumonia with 29 

deaths. Surgeon General Gorgas beli eved 

that usi ng serum had kept the death rate 

from climbing even higher. 73 

A study of regiments suffering the highest rates of disease along the Mexican border in 1916 led to testing the men of two 

southern units for hoo kworm. More than 

half the soldiers from Alabama tested positi ve, as did almost a third of th ose from 

Mississippi , but a Texas regiment had a 6-
IN THE SHADOW OF WA R 

pe rcent rate. The investigation demo l1 -

strated that soldiers with hookwo rm we re 

much more likely than those not harboring this parasite to cO l1lrac lmeasles and to 

have serious complications when they did . 

The men rou nd to be inrec ted were all 

treated berore their units were demobilized, and Surgeo n General Gorgas recommended that in the ruture a ll men rrom 

hookworm-inrected areas be tested berore 

they lert the mobili zation campH 

Medi cal Department errorts to prevent 

nonsex ually transmitted diseases among 

the soldiers along the border brought impressive results, for the sick rate remained 

below 2 percent. The contrast in the disease rates with that in the camps or the 

Span ish-American War showed the va lue 

or immunization and also suggested that 

much had al ready been learn ed about how 

to impress neophyte soldiers and their orricers with the impa rlance of camp sanitaLion and to indoctrinate them into its mysteries. Long marches also taught that 

grea ter care would have to be exercised in 

weedi ng out those who were unfit, many 

who seemed so und in camp proving not to 

be up to the "daily stresses or burden carrying" on a march.

75 

Virtual unanimity characterized appraisals of th e value or the Mexican border 

experience. All seemed to agree with the 

National Guard physician who noted that 

"the maneuvers we re uniformly most in -

teresting and instructive ror officers and 

men. " The authors or the Medical Department's mammoth history or World War I 

noted thalthe mobilization had done more 

to inspire improvemen ts in the supply situation than had the outbreak or the war in 

Europe and that the Army's "sanitary conscience" had been raised to a high point 

when th e United States entered that connict. One surgeon maintained that the 

403 

Mexican border experience had shown a 

cl ear need for a considerabl e increase in 

the size or the medica l reserve and that it 

suggested , as Colonel Munson had also 

theorized, that even 7 physicians ror every 

1,000 men would not be a high enough 

ratio should the Uni ted States become involved "in a war or the first magnitude. " 

Because or his experiences in 1916, yet another Army surgeon concluded thal an 

Army-wide policy on dealing with prostilUtion was necessary. Still others call ed for 

a systemati za ti on or the Army's approach 

to fi eld sa nitation, which should not be lert 

up to "chance and individual caprice. " 

Surgeon General Gorgas, too, co nsidered 

the experience or the 1916 mobili zation 

"inva luable. " He concluded that it showed 

that "military medical administration ," 

and speCifically "the rendering and keeping or repons and records or sick and 

wounded and the handling or other essential papers," was still a wea k point in 

the Medical Department's operations'· 

The training maneuvers along the Mexica n border in 1911 had involved the use 

or planes, whose pilots were assigned to 

the Signal Corps. A prototype or a plane 

designed to serve as an ambulance had 

been tried out in January 1910. Yet little 

was accomplished to create a medical service specifically ror aviators berore the 

United States entered World War 1 in April 

1917. According to the Medical Department's history or World War I, "No division havi ng to do with aviation existed in 

the Surgeon General's Offi ce, but some 

thought had been given ... to what 

should constilUte the physical requirements for admissions to the aviali on service." In 1912the Medica l Department had 

designed a phYSical examination for 

would-be pilots that strongly resembl ed 

th e one given to all Army recruits, with 
404 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

added emphasis on heart, eyes, and ears, 

and especiall y balance, but this errort apparently had not completely satisfi ed the 

head or th e Aviation Section or the Signal 

Co rps. The department's "partial study" or 

the physical standards ror nyers set by 

major European nations in an d rort to design a beller examinati on proved rruitless, 

and "preparation ror wa r by way of a Medical Aviati on Service had gone no rurth er 

than this when war came in 1914. " The 

next test to be devised was based o n existing requirements modifi ed by informati on 

derived rrom physiology textbooks, but it 

proved so rigorous that few could pass it 

until it had been changed n 

By June 1916, when the National Ddense 

Act assigned the responsibility ror accepting or rejecting all candidates ror the Aviation Section or the Signal Corps to a fi vemember board, two of whose members were 

to be medical offi cers, the quest ror adequate physical standards ror aviators was 

still underway. Although Ll. Col. Theodore 

C. Lyster of the Medical Corps and two Signal Corps offi cers were named in 1916 to a 

board to develop the physical standards to 

guide such decisions, their recommendations and the orders that the adjutant general based on them were not issued until 

May 1918, arter the United States had entered the war. At this time, Colonel Lyster 

was required to add the Medical Department's "aviation work" to his other duties, 

thus becoming the first Army medical officer to be assigned speCifically to examine 

candidates for the Aviation Section'· 

Lessons Learned From Ew-ope 

The ex peri ence or th e troops in th e 

Southwest was not the on ly source of inSight in to the diffi culties U.s. rorces might 

encounter as participants in a major connict, nor were physica l standards set ror pilots by the warring nations th e only subject or interest to Americans in Europe. 

The Medi cal Department's histo ry or 

World War I reco rded that in 1917-1918 

"our early arrangements . .. were inOuenced to a co nsiderab le extent by what we 

had learned berore we entered the war, 

rrom the experience or our future alli es and 

enemi es." U.s. phYSicians, both civilian 

and military, Navy as well as Army, had 

long been interested in what the medica l 

services of European armies were doing. 

Medical officers who happened to be in Europe at the time the connict broke out were 

detail ed to serve as observers with the various armies involved, and from time to 

time the War Department sent others over 

to join them. Six were sending back reports 

and observations in the late summer of 

1916, when the surgeo n general's annual 

report ror the fiscal year was being prepared. The work or th ese offi cers, Gorgas 

noted, was "a matter of grea t assistance to 

the War Department and of particular adva ntage and satisfactio n to the Med ical 

Corps. " Some Ameri ca n civilians, having 

worked with small groups rrom U.s. medical schools that assisted the medical services or one or another of the belligerent 

nations and having been "imbued with the 

spirit to serve in their professional capacities," wrote journal articl es about what 

they saw. The Army Medical Department 

itselr also coll ected pertin ent articles rrom 

European journals and other publi cations 

concerning war surgery on the nervous 

system and published them for the enlightenment or u.s. physicians.'9 

Among th e observa ti ons sent back by 

Medica l Department representatives in 

Europe were those of Ll. Col. Frank R. 

Keefer, who emphaSized the diffi culty of 
IN THE SHADOW OF WAR 

maintaining proper hygiene and sanitation 

in the trenches, where the men were co nstantly wet and "tormented by a va riet)' of 

insects, " including li ce. Lt. Col. Willi am]. 

L. Lyster concluded that when American 

troops joined th e war in Europe, they 

should take medical consultants with 

them, a member of each specialty "for each 

group o f casualties," physicians who 

would study both the administrative problems or their specialty as practiced in a military context and the medical problems. 

An observer who worked with hospital 

units sent to Germany and Austria in 1916, 

having resigned his reserve commission to 

do so with the guarantee that it would be 

returned to him when he go t back from 

Europe, urged grea ter attention to preparedness by the U.S. medical profession, 

both civilian and military. The Army Medical Department also learned that the 

French preferred light-bodied ambu lances 

to heavier models because they were more 

man euverable and easier to free from the 

mud when they had to leave th e road to 

allow military traffi c to get by. Based on repons he had received about the successful 

use of dogs to search for the wo unded on 

the balliefi eld, Surgeo n General Gorgas 

was convinced that the department should 

begin training animals for this purpose. 

And after months of service in the Balkans, 

Maj. ClydeS. Ford informed the readers of 

the New YOril MedicaljollnJ(f/ that he was 

co nvinced that "no doubt ... future 

changes in national fronti ers will be effected more permanently by those who eat 

ga rliC than by those who do not. " 80 

A major conclusion drawn by America n 

observers was that the nation could not 

wait until it entered the wa r to take the necessarysteps to form a backup system of base 

hospitals. As a result, the Army began 

working with the Red Cross' new Military 

405 

Relief Division to create such a network , 

using the Army's SOO-bed base hospital as 

a model. The National Defense Act allowed 

the president to detail up to five Medica l 

Corps offi cers to work with the Red Cross 

as it prepared to assist th e Army in the event 

of war. Undenheguidance of Colonel Kean 

of the Medical Corps, the first director general of the Military Relief Division , the Red 

Cross adopted the approach suggested by 

Dr. George W Crile of Cleveland , Ohio, 

who had operated an American hospital in 

France, turning to th e sta ffs of large civilian hospitals to fo rm the basis for the new 

organiza Li ons. 81 

By the time the United States entered the 

war, more than thirty such teams had been 

fo rmed. In October 1916 Crile's unit from 

Cleveland's Lakeside Hospital was mobilized in Philadelphia so that the publi c 

could see what such a unit en tailed and appreciate that it was not a hospital building 

buta hospita l stafr. The staffs of institutions 

too small to create full-sized hospitals 

could either form the basis upon which a 

larger unit could be built or serve as a camp 

hospital. The Red Cross provided the necessary equipment for all facilities, but Army 

authorities made decisions concern ing the 

nature and quantity of the eq uipment. With 

the guidance of fUlllre surgeon general 

Major Pallerson, the Red Cross also organized forty-five ambulance companies, bu t 

the judge advocate general ruled that they 

could not be called in to assist the Army 

unless war had begun or was imminent. As 

a result, none of the Red Cross units was 

mobilized fo r the Mexican crisis·2 

Principally because of the experiences 

both of observers in Europe and of medical 

officers in theconOictwith Mexico, the leaders of the U.s. Army Medical Department 

were aware before 1917 of the general na-
406 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

lUre or the dirriculties their organization 

might face if the nation were drawn into the 

European conOicl. The National Defense 

Act or 1916 had created the rramewo rk upon 

which a wartime personnel expansion could 

be based. A system ror the erricient handling 

or supplies was being devised , but a surricient reserve had not yet been built up, and 

in the early months or 1917 the prospects 

ror speedily enlarging it were not good. The 

men who would have to be call ed up ir th e 

United States entered the European war 

were not yet trained. Many months would 

be required ror a thousand experienced 

medical orricers to train 29,000 physicians 

in the intricacies of military medicine, sanitation, and military medical administration 

and ror enlisted men already rami liar with 

their Medical Department duti es to assist 

Regular Army physicians in train ing an additional 260,000 or more new department 

recruits. Widespread unwillingness to believe that the United States would in ract be 

drawn into the war in Europe had caused 

Medical Department preparalions ror it, li ke 

those or the rest or the nalion, to progress 

slowly. In March 1917, however, a sense or 

urgency was fin ally created with the resumption of unrestricted submarine warfare 

by Germany and the publication or a secret 

note suggesting thal it would rorm a military alliance with Mexico irthe United States 

joined the war on behalr or the Allies. On 6 

April , still unprepared, the United States entered "the most rormidable militaIY contest 

or all Lime." BJ 
NOTES 

L An excel lent discussion of the prevalent auitudes toward preparat ions ror W,1I" can be found in 

john ~ Finnegan, Agclillsl ti,e SpeCIe,. oj (I DragO/I. 

2. Mahlon Ashford, "The Most Practicable Plan 

for the Organization, Training and Utilization or the 

Medical OH"l cers orthe Medical Reserve Corps of the 

Unit cd Stat es Army and Navy and of the Medical o rficers of the OH"lcers' Reserve Corps or the United 

States Army in Peace and 'VI.'ar," p. l26; Marvin A. 

Kri edberg and Merion G. HeI1l")t, l-l islOI), oj MiliICII), 

tvlobili ZClfioll ill Ill e Ulli/ed Sillies A/"III)~ 1775-.1945, p. 

189;j ames L. Abrahamson, Alllerica Anllsjor (/ New 

Celli III)" pp. 92-100, 151, 162-76; 'War Depanment, 

fAll/wail Reporl oj Ille SlIIgCOII CCIICI'CII , U.S. Arllly, 10 

Ihe Sccre/(uy oj WCU", 1916, pp. 20, 24, and 1917, PI'. 

121-22, 124 (hereafter cited as WD, ARoJSG);James 

G. Harbord, Tile Alllericall ExpcditiOIICII)' Forces, p. 22. 

3. Gorgas was appoinled surgeon gene ral with 

the rank of bri gadi er general on 16 Jan uary 1914 

and waS promoted to major general, the first surgeon general to attain Ihis rank, on 4 March 1915. 

See j amcs M. Phalen, Clli ejs ojlll e Medical Deparfment, Ulli/eel Sillies ArIl1Y, I'p. 91-92. 

4. Heari ngs Before Committees on Militar)' Affairs of Un ited Slates Senate and House of Represent ati ves, 64th Cong., 1st Sess., pp. 572-73, 

578-80,627,689,695-97,719-20 (hereafter cited 

as Sen/HofReps MilAffs Cmte Hea rings), in Record 

Group (RG) 287, Na tional Archives and Records 

Admi nistration (NARA), Washington, D.C. 

5. Ibid. , pp. 578, 627, 688 (remaining quotations), 695-97 (first quotation), 720-21 , RG 287, 

NARII. 

6. Ibid., pp. 578 (quotation), 697, RG 287, 

NARA; WD Bull 16, 22J un 1916, p. 40. 

7. Sen/HofReps MilAffs Cmte Hearings, pp. 578, 

583,866-67, RG 287, NA RA ; WD, ARoJSG, 1916, 

p.233. 

8. Fi nnegan , Agclinst llle Specter, p. 155. 

9. Percy M. Ashburn, A HislDlY oj Ihe lvlediwl Oeparlll1eltl oj /lle Un it eel Siales Army, p. 256 (first quota tion); WD, ARojSG, 1916, pp. 16 (second quotation), 194, and 1917, I'p. 11, 118; Phalen, Chiejs, p. 

92; Stanhope Bayne-j ones, The Evolll(iOIl oj Prevelllive ,'vledicine ill Ihe Unil ed Slates A/"III)', 1607- 1939. 

p. 148; "Medical Preparedness ~nd the Army," p. 

575; Louis A. LaGarde, "Relation of the Civilian 

Physician to National Prepa redness," p. 240; War 

Department, Surgeon General's Office, The Smgcon 

Celleral's Office. p. 75 (hereafter cited as WD, SGO, 

SGO); "Current Comment ," p. 1308; George E 

I<eenan, "Our Medico-mili tary ResponSi bil ity," p. 

13; Edwa rd L. Munson, "The Training of Medical 

Reserve Officers," p. 7 14; WD Bull 16, 22 jull 1916; 

\ViIliam B. Banister, "The Medical Mechanism for 

'Wa r in the U.s.," p. 411 ; Paul E Straub, lv1e(/ieci/ Service ill tlte Call1paigll , p. 129. Munson was promoted 

to colonel on 15 May 1917. 

10. Edwa rd L. Munson, "Military Prepa redness 

From theMedi cal Standpoint," p. 447 (firsl lwoquolalions); Keenan, "Medico-mi li tary Responsibility," 

pp. 14 (th ird quotation), 17; Charles H. Mayo, 

"Medical Se rvice in the Uni ted Stales Army," Pl'. 

35 L-52 (remaining quotations); Herman n Hagedorn , Leollard Wood , 2:148, 169; Edward M. Coffman, The \Var To Eml All Wars, pp. L5--16. 

1 L Ba)'ne-jones, Prevelltive Me(/icille, pp. 148-49. 

12. Phalen, Chiejs, pp. 88, 92; Ltr, William C. 

Gorgas to Mami e, 27 Aug 1913, Gorgas Fami ly Papers, W. S. Hoole Special Coll ections librar)', UniverSi ty of Alabama (UA), Tuscaloosa, Ala.; Ma ri e D. 

Gorgas and Burton j. Hendrick, \.\IilliclIIl Crawjord 

Gorgas, pp. 302, 305; WD Bull 16, 22J un 1916, p. 

9; j ohn M. Gibson, Soldier in While, pp. 39-40, 212. 

13. Quotations from Gorgas and Hendrick, Corg llS , pp. 296,301,304. See also ibid. , pp. 302, 305; 

Beryl Williams and Samuel Epstein , WilliclIIl Cmwjord GOlgas, Pl'. 159-60; Hanson W. Ba ldwin, Worlel 

WClr I, pp. 77-79; Franklin H. Martin, Major William 

Cmwjord GOlgas, M.C, U.S.A., pp. 55-56; Gibson, 

Soldier ill While, pp. 231, 296, 299, 301- 02, 304-05. 

14. WD, SGO, SGO, pp. 126, 137, 218, 246; 

Robert S. Henr)', The Armeel Forces IllsliLttle ojPalllOI0&>', Pl'. 150, 157; War Department, {A llllllalJ Report 

oj rhe Sec rellllY oj War, 1917, 1:138 (hereafter cited 

as \VD, ARoJSW, date); Preliminary Inventoryof RG 

112, pp. 30-32, NA RII. 

15. WD ,ARoJSG, 19 14, pp. 13,154,1915, p. 157, 

1916, p. 194, and 1917, p. 122; WD, SGO, SGO, p. 

75; Elbert E. Persons, "Special Article," pp. 406-07; 

Banister, "Med ical Mechanism," p. 413; Weston E 

Chamberlain , "Care of Troops 011 the Mexican 30r-
408 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

cler, " pp. 1576-77; Mahlon Ashford, "Most Practicable Plan," p. 125; Field Serv ice RegllklliollS, 1914, 

p. 206; Reuben B. Miller, "The New Manual for the 

Medical Department," pp. 309-10, 314; Paul F 

St.raub, "Medical Service in the Campaign," p. 695; 

SenfJ-lofReps MilArrs Cmlc Hearings, pp. 624,629, 

695-97, RG 287, NARA. 

16. Ini tial quotations from "Is the Medical Corps 

of lhe Army \Vonh While," pp. 660-6 1; final quotation from "Current COlll ment," p. 1308. See also 

Banister, "Medical Mechanism," p. 4 18; vVilliam G. 

Rothste in, American Physicians ill the Ninelcolll! 

CeI"III)" PI'. 287, 294; WD, ARojSG, 1909, p. 126, 

1916, p. 194, and 1917, p. 291; Sen/HorReps Miltiffs Cm!e Hearings, PI'. 612-22, RG 287, NA RA. 

l7. WD ,AllojSG, 1914, 1'.149, 19l6, p. 220, and 

1917, pp. 298-99,3.10; "Current COlllment," p. 

1308. 

18. \VD Bull 16, 22 Jun 1916, p. 40; Keenan, 

"Medi co~ militar y Responsibility," p. 13; WD, 

ARojSG , 1914, 1'. 154, 1915, PI'. 157-58, .1 916, p. 

195, and 1917 , p. 292; WD, SGO, SGO, PI'. 82-83; 

LaGarde, "RebLion," PI'. 241-42. 

19. Harold Hays, "The Camp of Instruction for 

O ffi cers of the Medical Reserve Corps, U.s. Army," 

p. 263 (first quotation); W illiam O. Owen, "Relalion of the Army Medical Corps and the Medical Reserve Corps to the Medical Corps of the Organized 

Militia," p. 555 (second quotation); S. H. Wadhams, 

"Military Preparedness From the Medical StandpOint," p. 448; M. A. W. Shockley, "The Corres pon ~ 

dence Course for Officers of the Medical Reserve 

Corps," pp. 64, 67;Sen/ Hoffieps MilAffsCmte ear~ 

ings, p. 581, RG 287, NARA. 

20. Joseph c. Bloodgood, "The Tobyhanna 

Camp," pp. U 8, 122 (quoI<Hion); Hays, "Camp," p. 

263; WD, ARojSG, 1915, p. 170; S. C. S.anlOn, "The 

Sparta Encampment, " p. U 5; "Camps of Instruction for Medical Offi cers," p. 722. 

21. WD A1~ojSG , 1915, PI'. 8 1-82, l59, .1 9 1. 6, p. 

195, and 1917, p. 122. 

22. Ibid., 1915, PI'. 81-82, 1916, PI'. 16, 195, 

and 19 17, p. 122; Chamberlain, "Care of Troops," 

1'1'.1574, 1577; WD Bull 16, 22Jun 1916,1'1'.12-13. 

23. WD, ARojSG, 1914, PI'. 159- 60, 1915, PI'· 

160--61,1916, PI'. 19, 197, and 1917, PI'. 22- 23, 123, 

226-27; Chamberlain, "Care of Troops," p. 1577. 

24. WD, ARojSG, 1914, PI'. l31 , l 60, 1915, p. 

161, and 1917, p. l53, 296 (quo.a.ions). 

25. Ibid., 1915, p. 82, 1916, p. 149, and 1917, p. 

123; "W hat About the Sanitary Private?," pp. 

326-27. 

26. WD,ARojSG, 191 4, pp. l 56-57(secondquotat ion), 158 (first quot ation), 19 L5, pp. 12, 160, and 

1917, p. 119; Sen/HorReps MiiAffs Cmte Hearings, 

1'1'.627-28, RG 287, NARA. 

27. WD, ARojSG, 1916, 1'.197; WD Bull 16,22 

Jun 1916, PI'. 10- 11; WD, SGO, SGO, PI'. 76-77. 

28. WD Bull 16, 22Jun 19 16, PI'. 9, 18-20; WD, 

AI~ojSG , 1916, 1'.16; WD,SGO, SGO, 1'.78; Cassedy, 

Medicille ill America, p. 69. 

29. Di" of Mi litia Affs Cir L8, 23 Dec 1914, p. 1 

(quota!ion); WD, ARojSG, 1914, 1'.173,1915, PI'. 

168-69,1916, p. 206, and 1917, 1'1'. 122,316-17; 

WD Bull 18, 7 Jun 1913, p. 12 (58-210, JAG, 17 

May 1913); Harry L. Gilchrist, "The Necessit}' for a 

Uniform Organization for the Medical Corps of the 

National Guard," p. 22; United States (U.s.), National Guarcl Bureau (NGO), Repor' olll'l,IfobiliZ(I(ioll 

oj /lIe Org(lIIi zed Militia (111(1 National Gluml oj til e 

Ullited Sla/cs, .1916, pp. 99- 100. 

30. 'William N. Bispham, "Sanitary Service With 

National Guard Troops," p. 47 (quotation); 'NO , 

ARojSC, 1916, PI'. 207- 08, and 1917, PI'. 115-16, 

123; U.S., NGB, Report all MobilizaUoll, pp. 106-07; 

W. H . Blodgett , "The Doctor on the Border," pp. 

432-33. 

31. WD, ~ojSG , 1914, p. 170, and 1915, PI'· 

168-69; Kriedberg and Hel1l")', Mi lUmy MobilizeHioll, 

p. 194; William S. Terriberr}', "The Medical Service 

in the Organized M ilitia," p. 399. 

32. WD, ARojSG , 1914, p. 172, 1915, p. 170 

(quotation), and 1917, p. 123. 

33. Ibid., 1915, 1'. 170,1916, PI'. 206--07, and 

1917, p. 3 17; Chamberlain, "Care of Troops," p. 

1573; "Report of the Chief, Bureau of M ilitia Affairs, 

1915," PI'. 220--21. 

34. WD, ARojSG , 1917, PI'. 11 4--16, 121; John 

K. Mahon, His(OIY oj tile Miliria (111(1 lhe National 

Guard, p. 152; Finnegan, Agaillst tile Specter, pp. 

166-67; U.s., NGB, Reporf all Mobilizatioll , pp. 4-5, 

53-56, 108. 

35. WD,ARojSG , 1916, p. 20, and 1917, 1'.115; 

U.s., NGB, Report Oil l\llobiliZ(l/iOIl, pp. 54, 70. 

36. WD,ARojSG, 1915, 1'. 169, 1916, p. 207,and 

1917, PI'. 114, 117, 122-23 (quo.a!ion); J. Harry 

Ullrich, "Sanitar)' Troops-State and Federal," p. 

547; Bispham, "Sanitary Service," p. 44. 

37. Ban ister, "Medical Mechanism," p. 415; WD, 

Al/ojSG, 19l4, 1'. 179, and 1917, p. 323; Kreidberg 

and Hem}', Mobili zmion, p. 234; Frederick C. 

Huidekoper, Militmy Unprep(ll"edlleSS, Pl'. 494-95; 

WD, SGO, SGO, p. 61. 
IN TH E SHADOW OF WAR 

38. WD , SGO, SGD, p. 61; Sen/ HofReps MilAffs 

Cmte Hearings, PI'. 578-80, 583 , 866-67, RG 287, 

NA RA ; W D, ARojSG, 19 17, p. 317. 

39. Henry I. Raymond and Edwin P. Wolfe, "Duties of Medical Supply O friccrs and Their Methods," 

p. 2 1 (quotation); Banister, "Medi cal Mechanism," 

p. 41l; H. C. Fisher, "Preparedness of the Medical 

Departmellt for \VaT," p. 125; Vi O, SeQ, seo, 1:220-21, 559; Mary C. Gillett , The Army Medical 

Department, 18 18- 1865 , p. 183. 

40. Memo , P. Halloran 10 Col Fisher, J 2 Nov 

1914 (first quotation), and Mig MillS, H. W.Jones, 

Recorder, 19 Feb 19 17 (third quota tion), bOI h Enlr)' 

28, RG 11.2, NARA; WD, ARojSG, 1917, 1'1'. 163 , 

245 (second quotation). 

41. llrs, 1-1 . D. Snyder LO KeeLon MOlOr Co., 28 

April 19 14 (quotations), and Henry Raymond lOSe , 

8 and 19 May 1914, Entry 28, RG 112, NARA; I<ent 

Nelson, "An Army MOLO r Ambulance," p. 152; WD , 

ARojSG, 19 15, p. 164,and 19 16, 1'. 162; HUidekoper, 

Mili/(II), Ullpreparedll ess, pp. 494-95 ; \,yO, SGO , 

SeQ, p. 11 5; Sen/ Hoffieps MiiArrs Cmle Hearings, 

1'1'. 855-57, RG 287, NA RA. 

42. Quotation from U r, CO, Ambulance Co 3 , 

[ 0 SG , 10 Oct 1916, Emr)' 28, RG 11 2, NtlRA. In 

loc. cit, see Ur, Percy L J ones to SG, 23 OCI 1916; 

MIg MillS, H. W Jones, 19 Feb 19 l 7; and Ltr. \Valter McCaw 10 SC, 12 Mar 1917, esp. "Distribution 

of Motor Ambulances, Southern Department. " See 

also George C. Clendenen, Blood 0 11 Ille Bon/cr, p. 

226; Ha ldeen Braddy, /lill ~ J\llissioll ill Mexico, 

1'. 62; WD, SGO, SGO, p. 71. 

43. Mahlon Ashford, "A Proposed Motor-Ambulance COmpml)'," pp. 303 (quotations),304-06,394; 

E. C. Jones, "Transportation of Ambul ance Companies," PI'. 429, 43 1-33; WD, AllojSG, 1917, p. 149; 

Chamberlai n, "Care of Troops," 1'. 1576; Norman M. 

Care)', j r., "The Mec haniza tion of the United States 

Arm)" 1900-1916," M.A. thesis, PI'. 40-43 , 59-60, 

77, 84-85, 100-101 ; Konrad E Schreier,j r. , "Army 

MOLOr Tra nsport \Vo n Spurs in Mexico," p. 9. 

44. WD, AllojSG, 1917, PI'. 11 4, 11 7; Fisher, 

"Preparedness," p. 127; WD, SGO, SGD, 1:61 , 

221-22; Erna Risch, Qllel/'terfllaster SUppO!'1 oj Ihe 

Army, p. 598. 

45. WD, ARojSG, 1914, PI'. 174-76, 178, 19 15, 

1'. 82 (quotation), 1916, p. 2 11, and 19 17, PI'. 

112-13. 

46. Ibid., 1914, 1'1'. 114, 131, 177-78, 1915, PI'. 

140, 172-73, 175, 19 16, PI'. 159,162-63, 168, 17 1, 

210, and 1917, PI'. 221 , 227, 236, 237, 240; 

Sen/ Hoffieps MiiAffs CnHe Hea rings, p. 87 l , RG 

287, NA RA. 

409 

47. WD, ARoj SG, 1914, PI'. 176-77, 19 15, p. 

144, 19 16, PI'. 89, 176, 178-79, and 1917, 1'1'. 109, 

244-45. 249- 50; "History of Mili ta ry Records," pp. 

3-5, Ms C16, Albert E. Trub)' Papers, National Libra ry of Medicine (NLM), Bethesda , Mel.; 

Sen/ Hoffieps MilAffs Cmle Hea rings, PI'. 868, 870 , 

RG 287, NtlRA. 

48. WD,ARojSG, 1915, p. 148, 1916, PI'. 17, 162 , 

181 , and 19 17, 1'1'. 121, 254. 

49. Ibid., 191 7, 1'1'. 156-57, 256-57,267. 

50. Ibid., 19 14 , pp. 83, 164; Louis C. Duncan , 

"The Wo unded at Ojinaga ," PI'. 411 - 13, 41 5; 

Richard Jo hnson, "My Life in the U.s. Ann)', 1899 

to 1922," p. 174, Spanish-American War, Philippine 

Insurrection, a nd Boxe r Rebel lion Ve terans Resea rch Project, Military History Research Collection, U.S. Army Military History Institut e, Ca rlisle 

Barrac ks, Pa.; Mahon, Nellioll al C IIClf(/, p. J5 t. 

51. Clendenen, Blood, p. 180; WD, ARojSG, 

19 15, 1'1'.51, 64, 81, 121, 169, 1916, 1'1'. 12,24,30, 

57-58,72, 91 , 96- 98, 111, 113, 141, 145, 15 1, 186, 

208, and 19 17, PI'. 13, 15- 16, 27,33-34, 48,59,60, 

68,75, 11 6, 125, 129, 131, 274; Charl es F Craig, 

"The Occurrence of Endamoebi c Dyse ntel)l in 

Troops Serving in the EI Paso District From j ul), 

1916 to December 1916," pp. 286,296,302, 423, 

427-28, 434; Edga r E Haines, "The Modern Trea tment of Amoebic D)'sentery," PI'. 8 16 , 8 18; Glenn 

l.jones, "The Trea tment of Intestinal Amoebiasis," 

pp. 982- 83; G. Fo)" "Health in the Uni ted States 

Ann)'," pp. 292-93; Henr),j. Nichols, "Possible Rea· 

sons fo r Lack of Protec tion Afler Antil)tphoid Vaccina tion ," pp. 267-68; Eugene R. vVhitmore, "Antit)'phoid Vacci nation ," pp. 259, 262, 264; Willi am 

1. L Lyster, "Present Sta tus of ArtifiCiall y Trea ted 

Drinking vVa terin the Field ," p. 401; Banister, "Med· 

ical Mechanism," PI'. 409- LO . 

52. Edwa rd B. Vedder, "Prevalence of Syphilis," 

1'1'. 309 (quotation), 3 10; WD, ARojSG, 1914, p. 

149, 1915, PI'. 11, 68, 151, 1916, 1'1'. 16,75, 113, 

and 19 17, 1'1'. 17,79, 131; Edgar King, "The Military Delinquent," p. 577; Richmond C. Holcomb, 

"Has O ur Pro paganda for Venerea l Prophylaxis 

Fail ed? ," p. 30. 

53. Edwa rd B. Vedder, Syphilis mill Pu blic Hea lth, 

p. 167 (quotation); Albert Ne isser, "War, Prosti tution, and Venereal Diseases," p. 539 ; Richard C. 

Cabot, "Arc Sanitary and Mora l Prophylaxis Natura l 

Allies?," PI'. 21, 23; WD, ARojSG, 19 15, PI'. 56-57, 

8 1,83, and 191 7, p. 17; Allan M. Brand l, No Magic 

Bullcl, pp. 52- 53; Mazyck ~ Ravenel, "The Prophylaxis of Ve nereal Disease," p. 190; Cha rl es vv. Clarke, 

u ,boo, p. 40; Linda Gordon, WOIIUIII S Body, WOIIICIII S 
410 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

Right, pp. 64, 205; E. Kilbourne Tullidge, "Venereal 

Disease in the European Arm ies," p. SO; Ronald G. 

'Wa lt ers, ed. , Primers Ja r Prudel)" p. 135. 

54. Henry P. Birmingham, "Sanitary \Vork or the 

Army al Vera Cruz," pp. 205, 215 (quota tion), 

216-17. 219; idem, "Coordination or the Medical 

Depa rtments of the Army and Navy in Cam paign ," 

1'1'. 377-78; Clendenen, Blood, 1'. 161 ; WD ,ARoJSG, 

1914, 1'. 160, and 1915, 1'1'.128-30. 

55. Clendenen, Blood, p. l66 (first quotation); 

Birmingham, "San ita ry Work," pp. 205-06 (second 

quotation), 207, 211-13, 220-21; WD, ARoJSG, 

1915, pp. 129-30; "Correspondence," p.184; "Mexican NOles, " p. 907; "Rep rints and Translatio ns," p. 

165. 

56. Birmingham, "Sanitary 'Work," pp. 214-15 

(quotations); WD , ARoJSG, 1915, p. 128; Clendenen, Blood, p. 171; Brandt , No Magic Bul/el, p. 54. 

57. Raymond C. Turck, "Fie ld Maneuvers of Divisiona l Sanilary Troops, Leon Spri ngs, Texas, November 191.6," p. 156 (quotalions); Clendenen, 

8100d, 1'1'.201- 02,297,341; WD, ARoJSG, 1916, p. 

20, and 191 7, p. 23; Friedric h Katz, "Panc ho Vill a 

and the: Attack o n Columbus, New Mexico," p. LOl ; 

Maho n, NatiolJ(d Gtwrel, p. 15 1; Chamberlain, "Care 

of Troops," p. L573. 

58. WD, ARoJSG, 1917, PI'. 23 (ri rst two quotations), 24, 159 (remaining quotations); Braddy, Pershillg's Missioll, pp. 1,8-9 , 16,43-45,56,59, 72n38; 

Clendenen, Blooel, pp. 216, 22 1, 224n1 4, 237, 244, 

248,262- 63,272,310; Roben S. Thomas and Inez 

V. Allen, The lvtexicctll PWliUve Expeditioll Uncler 

Brigaeli er Gener(1i j ohll J. Pershing, UlliUci SWl es 

Army, 1916-1917, eh. 2, 1'.11, eh. 4, PI'. 24-28,34. 

59. WD, ARoJSG, 19 17, PI'. 122, 158, 162-63; 

idem, AnofS\V, 1916, 1:291; Turck, "Ficld Maneuvers, " pp. 157, 166; Frank E. Va ndiver, BI(lCiljac/l , 

2:612; Braddy, Pershing's Mission, PI'. 43-45, 56; 

Clendenen , Blood, p . 310. 

60. Clendenen, Blooel, pp. 329, 334-38; WD , 

ARoJSG, 1917, PI'. 160-61; Braddy, Pershillgl Mission , p. 61; Vandive r, B/acJljacil , 2:6 12;J ames A. Sandos, "Prostitu tion and Drugs," pp. 623, 626-27,633 . 

61. WD , ARoJSG, 1917, 1'.160. 

62. Ibid. , pp. 23, 159-61; Bayne-Jones, Preven-

/.ivdvlecii cine, p. 147; Clendenen , Blooel , pp. 24 1- 43, 

335; Braddy, Pershings tvfi ssiol1 , pp. 9 , 10; Chamberl ai n, "Care of Troo ps," p. 1577; Ashb urn , HislDl)' 

oj MD, PI'. 236-37. 

63 . Mahon, NaLiDlwl Gllarci, p. 151; Finnegan, 

Against /it e Specter, p. 168; Kri edbergand Henry, l'vliliL(lI), Mobili zaUolI , p. 199; U.S., NGB, neport 0111'1'10-

bilizalioll, p. 54; WD, flRoJSIV, 1916, 1:9- 13, 193. 

64. WD, ARoJSG, 1917, PI'. 114-17; Miller, 

"New Ma nual ," pp. 307, 3 15. 

65. WD, flRoJSG , 1916, p. 93, and 19 17, PI'. 132 

(q uo tati o ns), 133, 137; Chambe rl ain , "Care of 

Troops," pp. 1577-78; Bispham, "Sani tary Service," 

1'.45. 

66. Bispham, "Sanitar}' Service," PI'. 47 (third 

quotation), 55; WD, ARoJSG, 1916,20 (fi fth quotation ), and 1917, pp. 24, 133 (first two quotatio ns), 

134, 136-37 (remaining quo ta ti ons); Chamberl ain , 

"Ca re of Troops," pp. 1573, 1578. "Disinfecting" 

here apparently referred to eliminating ve rmin. 

67. Chamberl ain , "Care of Troops," pp. 1574-

76; Clendenen, Blood, p. 297; WD, ARoJSG, 1916, 

1'1'. 20,209, and 1917, p. 142. 

68. WD, ARoJSG, 1917, p. 122 (first quotation); 

Chamberl ain , "Care of Troops," pp. 1574 (second 

q uo tati o n), 1575-76; Jay D. Whitham, "Paratyphoid Infec ti o ns," PI'. 49 J-96. 

69. WD, ARoJSG, 1916, PI'. 69-70, 91- 92 (rema ining quo tati o ns), 188, and 1917, 1'.133 (first 

q uo tati o n); Clendenen, Blood, p. 183. 

70. WD, ARoJSG, 1917, p. 131.Niehols was promot ed frolll captain to majo r o n 1 July 1916. 

71. Brandt, No MagicBlIllel , pp. 53-54; Blodgeu , 

"Doc to r o n the Borcier," p. 431; M. J. Exner, "Prostitutio n ill Its Rela tion to the Army on the Mexican 

Bo rder," pp. 208-12, 214; Sandos, "Prostitut ion," 

1'1'.629-30. 

72. \-" hitham, "Paratyphoid In fec ti ons," p. 496; 

WD , ARoJSG, 1.915, p. 149, 1916, PI'. 64, 66, and 

1917, PI'. 15, 68, 116-17; WD , SGQ, SGO, p. 73. 

73 . WD, flRoJSG, 19 15, p. 84, 1916, 1'1'.14,77, 

and 1917, PI'. 16, 19- 20, 81, 130, 151; Wesle), IV. 

Spink, Infectious DiseClses, p. 67. 

74. WD, fl RoJSG, 1917, p . .13 1; Joseph F Siler 

and C. L. Cole, "The Preval ence of Hookworm Disease in the Fourth Texas Infantry, First Mississippi 

Infantry and FirSI Alabama Cava lry Regiments," p. 

96; George B. Foster and Charles G. Sinclair, 

"Hookworm Infecti on as a Medico-military ConSideration ," Pl'. 43 1-33. 

75. Edward L. Munson, "The Effec t of Marc hing 

on the Rates fo r Non-effici ency of Newly Raised 

Troo ps," pp. 17 1-72, 176 (q uo tation); Chamberlain , "Care of Troops," pp. 1574, 1580- 81 ; WD, 

flRoJSG, 1916, p. 21 , and 1917, p. 133. 

76. Turck, "Field Ma neuvers," p. 156 (first quotaLion); WD, SGO, seo, pp. 73-74 (second quota -

tion ), 83; Chambe rlain , "Care of Troops," pp. 1573, 

1582 (third quotat ion); WE Lewis and R. B. Mille r, 

"Recent Develo pments in Camp Sanitalion ," p. 5 10 

(fo urth quotation); WD, ARoJSG, 1917, p. 123 (re-
IN THE SHADOW OF WAR 

maining quotations); Exner, "Prostitution," p. 219; 

Kreidberg and Henr)'. Militm)' Mobilization, p. 199. 

77. Albert E. Truby, "The Airplane Ambulance," 

Ms C 16, NLM; WO,SGO,SeO, p. 488 (quOI a,ions); 

Mac M. Link and Hubert A. Coleman, Medical SupporI oj the Army Air Forces ill World WarlI. PI'. 6-8. 

78. WO, SGO, seo, PI'. 488 (quOIa,ion), 489, 

494,501; WO Bull 16, 22Jun 1916, p. 16; Link and 

Coleman , I'vfedi ca l SlIpporl, p. 8. 

79. Wa r Department, Surgeon General's Office, 

Adll1il lis/r(lfiOlI, A mcricClll Expcclilio/lw)' Forces, p. 13; 

idem, seo, pp. 75 (first quotation), 83 (third quotation), 92; idem, War 5 111&CI)' oflile Nervous System; 

WO, ARojSe, 19 15, p. 164,19 16, PI'. ll, 18, and 

1917, p. 22 (second quotation); Memo for SG, 24 

Sep 1908, Em .. )' 245, RG 11 2, NA RA; SenlHoffieps 

MilArrs Cnlle Heari ngs, PI'. 697, 874, RG 287, 

NARA. The Navy Department also had at least one 

observer in Europe in the person of Surgeon 

Archibald M. Fauntleroy, USN, sent to Paris in the 

spring of 1915 (see Fauntleroy's Report 0/] tl]e Met/komi/itmy Aspects oj tire ElllvpealJ War From Obse,v(I-

(iolls Talw] Bellilld Lite Allied Armies i]1 France). 

411 

80. Frank R. Keefer, "'The Sanitary Problems of 

Trench Warfare," pp. 618, 62 1 (first quotation); "A 

Consulting Staff for the Med ical Department," p. 484 

(second quotation); Clyde S. Ford, "Some Medicomilitary Observa tions," p. 58 (third quota tion); 

Memo, E. B. BabbitilO Gen SCOlt, 1 Mar 1915, Ent]y 

28, RG 11 2, NA RA; WO, seo, SGO, p. 84; 

SenlHoffieps MiiAffs Cmte Hea rings, PI'. 875-76, RG 

287, NARA;John R. McDill, Lessolls From the Enemy. 

81. WO, seo, seo, PI'. 76,92-93,95-96; E B. 

Lund, "The Surgef)' of the "Var and the Part Played 

Therein by Ameri can Surgeons," p. 698; George W. 

e ri1c, "The vVork of American Units in France," p. 

710; idem, "The Unit Plan of Organization of the 

Medi cal Reserve Corps of the U.S. for Se rvice in Base 

Hospi,als," p. 68; WO, ARojSe, 1916, p. 16;Jefferson R. Kean, "New RoleoftheAmerican Red Cross," 

p. 541; Te rriberr)'. "Medical Se rvice, " p. 399. 

82. WO, SGO, SeD, PI'. 97-100, 104. 

83. WO, ARojSe, 1917, p. 12 (quo,a'ion), and 

1918, PI'. 15, 17; Finnegan , Against the Specler, p. 

189; Coffman , War To El](I All Wars , pp. 7, 18, 20; 

Munson, "Training," p. 714. 

Epilogue 

THE YEARS OF CHANGE 

The period from 1865 to 1917 was one 

of great change for the Army Medical Department. The department initially resumed after the Civil War the form and 

function it had before that conmct; very 

little changed from th e prewar model. 

With the Army again broken down into 

small units scattered about among many 

posts, the individua l surgeon was once 

more responsible for all aspects of the 

health of a relatively few men. Medical offi cers had no Signifi cantly greater ability to 

prevent, diagnose, or treat disease than 

their predecessors, and their surgery was 

distinguished from that of 18 18, when th e 

Medical Department was first organized, 

principally by their use of an esthesia. But 

by 1917 two great revo lu tions-one in 

medicine, the other in the orga nization of 

the u.s. Army-had transformed a small 

department into a much larger and more 

complex organization whose officers were 

among the leaders in a new age of scientifi c medi cine. 

The gradual acceptance of the fact that 

small living organisms caused disease and 

infecti on opened a vast, unfamiliar, and exCiting world to th e physicians of the lateninetee nth century. The nati on's outraged 

reaction to th e epidemics of the SpanishAmerican War suggested that by 1898 the 

American publi c felt entitled to ex pect that 

th e Medical Department wo uld prevent 

the diseases that had traditionally devastated armies in wanime. In assigning several medi cal offi cers to study ways in 

whi ch this expectation might be met, Surgeo n General Sternberg, a Civil War veteran, was follOWing in the footsteps of his 

illustri ous predecessor of that period, Surgeon Ge neral Hammond, who had assigned some of the department's most distinguished scientists to study the illnesses 

that had afni cted the Uni on Army. By 1898, 

however, a confident faith in th e ultimate 

triumph of scientific medicine had replaced Hammond's desperate hope that department scientists would discover how 

such diseases as typhOid were spread. 

To battle these old foes, medical offi cers 

had to be able to identify the disease and 

pinpoint the means of its spread. Examinations of specimens of blood, urine, sputum, and feces, as well as of samples of 

water and food, were now part of preventive medicine and required the crea tion of 

many laboratories, both small and large. 

By 1917 every post hospital was expected 

to have the means of performing simpl e 

tests. Eac h major geographical area was asSigned a large central laboratory, where 

more elaborate stud ies could be conducted. New and more equi pment was 

necessary, as well as new faciliti es to house 

it, ancl the men who would use the equip-
414 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

menl required training in its use, whether 

they were physicians or enlisted men. 

The acceptance of the germ theory also 

transformed the practi ce of surgery. The 

adop tion of antiseptic techniques minimized the chances of infection, and medical offi cers began to undertake operati ons 

they would never have dared during th e 

Civil War. Appendectomi es and hernia repairs became common as surgeons ventured ever further into once forbidden terri tory. The dri ve to reduce infection after 

surgery led to a requirement that a room 

be set aside exclusively fo r surgical operations, a step that could lead to the expense 

of new construction. 

To the changes brought about by th e 

new developments in the world of medicine were added those resulting from the 

nation's new image of itself. After 1898 the 

Army never returned to its pre-SpanishAmerican-War size, for as the nation gradually accep ted its inevitable role as a world 

power, the responsibilities borne by its 

armed forces increased. The realizati on 

that the United States might have to defend its new empire from encroachment by 

other great nations and that it was by no 

means ready to do so led to the transformation of a small, simply organized military force in to a larger, more complex 

Army and, as a result, to a larger, more 

complex Medical Department. Al though 

Congress slowly acceded to the need for 

greater expenditures to meet the department's requirements, the new openings it 

crea ted were never sufficient to meet the 

growi ng demand for medical personn el. 

The department was expected to furnish 

offi cers to design and manage public 

hea lth campaigns in co nquered territories, 

to conduct research into the various diseases that threatened u.s. troops wherever 

they were, to tra in civilian doctors who 

might be ca ll ed in to assist them in an 

emergency, and to provide the best ava ilable medica l care to sick and wounded soldiers. The department was also expected 

to find solutions to the administrative 

problems highlighted by the Dodge Commission and to produce an effective plan 

for hospitalization and evacuati on that 

wou ld be adaptable to large-sca le warfare 

on foreign territor),. 

Und er such circumstances, th e creation 

of several specialized corps within the 

Medical Department was inevitable, in the 

interests both of effiCiency and of guaranteeing the Army's patients the best possible care. The Dental Corps was created 

when it became obvious that a handful of 

hospital corpsmen fun ctioning as dentists 

co uld not successfull y treat the rapidly decaying teeth of the large numbers of troops 

being sent to the tropics. The constant 

need for nurses and th e obvious superi ority of nursing school graduates over men 

hastil y trained led to the creation of a permanent Army Nurse Corps. The desire to 

guarantee the Army's animals the benefits 

of modern medicine resulted in the creation of the Veterinary Corps. In the movement to orga nize the department according to the specialties of its staff, however, 

the Hospital Co rps, with its enlisted men 

who, as jacks of many trades, were often 

masters of none, lost its separate identity. 

The trend toward specialization that led 

to the crea ti on of new corps for the Medical Department affected individual Army 

physiCians as well. The many administrative duties arising from the growing size 

and compl exity of the department could 

seriously interfere with the scientific work 

that was also a part of the department's respo nsibiliti es to the nation's soldiers. To 

deal with this problem, some medica l offi cers were allowed to concentrate for ap-
THE YEA RS OF CHANGE 

preciable periods of time upon research 

with the orncia l support of the departmem, 

which made ava ilable to them its resources 

in men and equipment. Those serving on 

the disease boards and those working in 

the major laborato ries could not have 

given their research the cominued effort it 

necessitated if they had been required at 

the same time to allend sick call; to functi on as regimental, brigade, or division surgeo ns; or to train National Guard doctors. 

To deal with the growing size and compl exity of the Medical Department and the 

many and va ri ed demands that were made 

upon it, the Surgeon General's Orn ce also 

grew in both size and complexity. The 

number of civili ans serving the department in Washington increased signihcamly, in large measure to manage the vast 

collection of records resulting from the 

Civil War, but for many years the number 

of medica l orricers changed remarkably little. Even when overwhelmed by the demands of the Spanish-A merican War, the 

surgeon general delegated few of his major 

responsibilities to others. 

Ironi ca ll y, as World War I came ever 

nearer, the solutions to some of the Medica l Department's probl ems complicated 

the solution of others. Sending medical offi cers to observe the work of their European coun terparts enabled the department 

to prepare more effec tively fo r th e time 

when th e United States would become directly involved in the conni ct, but it also 

reduced the number of experi enced military physicians available to perform more 

415 

routine tasks or to tra in the doctors of the 

Medical Reserve Corps and the Nati onal 

Guard . The development of hospitali zation and evacuation plans designed primarily for use in a major war added to the 

volume of information that Regular Army 

doctors would have to impart to their civilian counterparts. Thus the problems created by the co nstant shortage of regular offi cers were exacerba ted by the effort to 

establish a large group of trained physicians to assist them in time of emergency. 

By the spring of 1917, however, th e 

Army Medi cal Department was in a position to give military patiems the benefi t of 

t he most recent developments in medici ne. 

It was also making signifi cam progress toward instituting an organizational structure capable of handling battlefi eld casualti es swiftly and erriciently rega rdless of the 

scale of the connict and toward establishing both a large rese rve of supplies and an 

effective system fo r delivering them wherever they might be needed. The department 

had even made some headway against an 

almost unsolvable probl em, that of creating a large pool of civilian physicians who 

were familiar with the demands of modern 

military medicine. But despite the magnitude of the changes made si nce the late 

1860s and the years of effort that followed 

the Spanish-Ameri can War, the Medical 

Department had not actually achieved any 

of these goals by April 1917, when the 

United States emered a co nnict being conducted on a scale never befo re encountered 

by the a rmed forces of the United States. 

BIBLIOGRAPHY 

To cover as wide and as eventful a time 

period as that between the end of the Civi I 

War and the beginning of u.s. participation in World War I, research in a large 

number of primary sources was necessary. 

Vo lumin ous Army records are in the custody of the Na tional Archives and Records 

Administrati on (NARA) in Washington, 

D.C. As in the preceding vo lume, TheAnny 

Medi cal Department, 1818- 1865, 1 have relied heavily on various entri es of Reco rd 

Group (RG) 112, the Records of the Offi ce 

of the Surgeon General (Army), and have 

listed them below in the Archival Records 

secti on. Anyone intending to work ex tenSively with RG 112 would be well advised 

to obtain a copy of the Preliminary Invento ry .. . , wh ich apparently is in very short 

supply. Some of the entries in RG 112 are 

easily used. Entry 27, for exampl e, consisting of only eleven months worth of 

"semioffi cial letters," is quickly perused. 

Entry 2 for the peri od 1818-1873 is also 

easy to use, since it co nsists of sturdy letterbooks, each with its own name and subject index. But research in other entri es can 

be difficult. Outstanding in this catego ry is 

Entry 12, Leners Received. The collection 

is arranged by a combined chronologicalalphabetical system too complex to describe coherently; a partial name and subject index is marginally useful and a register 

of leners even less so. Nevertheless, Entry 

12 is far too valuable to ignore. Surely the 

most surprising entry is Entry 245, Miscellaneous Records, Chief Clerk's Office, 

which contains a fascinating collection of 

odds and ends. RG 94, Records of the Adjutant General's Office, 1780s-1917, has 

proved most helpful, particularl y when the 

assistance of an archivist familiar with the 

collecti on was available. The researcher 

planning to rely on any of the collections 

at th e National Archives should be warned, 

however, that some have been moved out 

to repositories scanered about the United 

States and can no longer be seen in the 

Washington , D.C., area. 

Many of the collections in the bibliography that foll ows are self-explanatory. 

Those at th e National Library of Medici ne 

in Bethesda, Maryland, like th ose in the 

Manuscript Room at th e Library of Congress, add detail with which the story revealed by th e entries of RG 11 2 can be 

fl eshed out. 

I would like to emphasize the value of the 

apparently often-neglected National Union 

CCltalog ojManllscripts in search i ng out other 

valuable collections. Many of these have inventories that make it possible to obtain microfilm or photocopies of useful documents 

without undergoing the expense in timeand 

money of traveling about the country to 

view material that may prove, upon examination, to be of lillie use. Unfo rtunately, at 

the time this volume was written, the Gorgas Family Papers, held by the University of 

Alabama in Tuscaloosa, had not been completely cataloged. Thus this collection is of 
418 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

limited use to those who cannot travel to 

Tuscaloosa. By contrast, the William R. 

Shafter Papers, invaluable for the researcher 

concerned with the Spanish-American War 

in Cuba, have been microfilmed and can easily be borrowed in that form from Stan ford 

Un iversity in California. 

Anyone interested in the development 

of military medicine as a specia lty must inevitably consult the articles written by a 

multitude of medical officers contained in 

the journa l published by the Association of 

Military Surgeons, the name of which has 

changed over time from Transactions of th e 

Association of Mi/itQl y SUlgeons of the Nati onal ell",,1 of th e United States to Proceedings of the Association of Mi/itQly SUlgeons 

of til e United States to JOll1'11al of th e Association ofM i /itQlY SLllgeons of the Un i ted States 

to MilitQly Swgeon to, finally, Mi/itQly Medicin e. Because many medical officers contributed to other professional journals, a 

search through them for the names of Army 

surgeons can also be worthwhile. 

Obviously the published annual reports 

both of the Surgeo n General and of the War 

Department were crucial in the writing of 

this volume. The researcher should not be 

discouraged by the multiple volumes characteristi c of the War Department's reports 

during and immediately after the SpanishAmerican War, for they provide copious 

information on such topics as the government of the Philippines immediately after 

that connicr. 

Although biographies of such Medical 

Department leaders as Walter Reed and 

Surgeon Generals Sternberg and Gorgas 

exist, they are, for the most part, very disappointing, lacking either footnotes and 

bibliographi es and written in a spirit of 

hero worship. 

The bibliography that follows is divided 

into six sections, each alphabetically 

arranged. Despite its length, it is not intended to be all inclusive. It includes only 

manuscripts and publications that were useful in the preparation of this specific volume. 

Footnotes citing works that are included in 

the bibliography do not repeat all the details 

given in the bibliographical entry, being limited to the full name of the author; the complete main title (no subtitle) of the book, or 

journal article, or dissertation or thesis; and 

the relevant page number(s). Dissertations 

or theses are identified as such to avoid any 

confusion with articles. Works not listed in 

the bibliography are cited in full at first mention in each chapter. Subsequent references 

in the same chapter are shortened. All abbreviations used in the footnotes are explained in the list of abbreviations. 

Archival Records 

Bethesda, Maryland. National Library of Medicine. 

Ms B280. "Resume of th e History of the Medical Department" [by John 

van R. Hoff] . 

Ms B286. "Report on Sanitation in San Francisco After the Earthquake" 

[by u.s. Army, Pacific DivisionJ . 4 vols. 

Ms C5. Surgeo n General's Offi ce. Correspondence, 1903-1907. 3 vols. 

Ms C12. "Lectures on Tuberculosis, 1910- 1913" [Fort Bayard , N. Mex.J. 

Ms C14. J efferso n R. Kean Papers. 

Ms Cl6. Albert E. Truby Papers. 1898-1953. 
BIBLIOGRAPHY 

Ms C48. 

Ms C66. 

Ms C9l. 

Ms ClOO. 

Ms ClO1. 

Ms Cl02. 

Ms Cl55. 

Walter Reed and Wi lli am C. Gorgas Papers. 1898-1902. 

Ofri cial Medical Bulletins Relating to the Health or the President. 

Charles R. Greenl ear Papers. 1890- 1892. 

George Miller Sternberg Papers. 1861-1912. 

Louis M. Maus Papers. 

John van R. I-Iorr Papers. 

Stanhope Bayne-Jones, William C. Gorgas, I-Ians Zinsser Papers. 

1870- 1969. 

Ms C318. Ri chard Reynolds Papers. 

Ms C322. Harry L. Gilchrist Papers. 

Ms C37 1. Stanhope Bayne-Jones Papers. 1942-1947. 

Ms F1l7. 

Ms [B68. 

"Case Records or the Cholera Epidemic or 1873. " 2 vols. 

"Regulations or Pharmacy, Republic or Cuba , 1909" [by Jerrerson R. Kean [. 

Ms [B127. Frank R. Ked er Papers. 1890-1938. 

United States. Army. 3d Reserve Hospital. "Manila Report: Supplementary 

Hospital, Manila, PI. " 

Ca rlisle Barracks, Pa. U.s. Army Military History Institute. Military History 

Research Coll ecti on. Spanish-A merican War, Philippine Insurrection , 

and Boxer Rebellion Veterans Resea rch Project. 

Haverrord, Pa . Haverrord College. Quaker Coll ec ti on. Alben K. Smil ey Papers. 

Nas hville, Tenn. Tennessee State library and Archives. John W. Ross Papers. 

Palo Alto, CaliL Stanrord University. William R. Sharter Papers. 1862-1906. 

MicronIm (7 reels). 

Tuscaloosa, Ala. University or Alabama. W S. Hoole Special Coll ections. Gorgas 

Family Papers. 

Washington, D.C. library or Congress. Manuscript Division. William C. Gorgas 

Papers. 

---- ---- ----. William McKi nley Papers. 

------- ----.John McA. Schofi eld Papers. 

Washingto n, D.C. National Archives and Records Administration. 

Record Gro up 75, Records or the Bureau or Indian Arrairs. 

Entry 681. Sanborn Commission. Papers Relating to the Sanborn Commission Investigation or the Fetterman Massacre. 

MicronIm 234. Letters Received by the Bureau or Indian M rairs. 

1824-1881. 

Record Group 92, Records or the Ofri ce or the Quartermaster General. 

Record Group 94, Records or the Adjutant General's Orrice, 1780s-1917. 

Entry 561. Personal Papers or Medica l Orricers. 

Entry 624. Fil e F. Reports or Surgeons Accompanying Expeditions. 

MicronIm 1064. Commission Branch Files. 

419 
420 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Record Group 11 2, Records of the Offi ce of the Surgeon General. 

Entry 2. Letters and Endorsements Sent. April 1818-0ctober 1889. 

Enll")' 7. Letters and Endorsements Sent to Medical Offi cers ("Military 

Letters"). September 1862-September 1872. 

Entry 8. Letters Sent by the Assistant Surgeon General Relating to Personnel. 1869-1883. 

Entry 10. Registers of Letters Received. 1822-1889. 

Entry 12. Letters Received. 18 18-1889. 

Entry 13. Correspondence Relating to Army Medical Examining Boards. 

1831- 1898. 

Entry 15. Correspondence Relating to the Promoti on, Discharge, and 

Rating of Personnel ("Confidential File"). 1871-1894. 

Entry 16. Correspondence Regarding the Organ ization of the Hospital 

Corps. February 1860- March 1888. 

Entry 17. Correspondence With Medical Offi cers Regarding Field Maneuvers. 1888-1890. 

Entry 18. Name and Subj ect Indexes to Parts (1889-1890) of Seri es 12 

and 22. 

Entry 22. General Correspondence. 1890- 1894. 

Entry 23. Name and Subject Index to Series 26. 1894- 1917. 

Entry 26. General Correspondence. 1894- 1917. 

Entry 27. Semioffi cial Letters Sent b), Surg. Gen. Geo rge H. Torn ey. 

January-November 1909. 

Entry 28. Correspondence Rega rd ing the Automobi le Ambulance. 

1912- 1917. 

Entry 34. Telegrams Sent and Received. 1868-1889. 

Entry 38. Inspection Reports of Medical Faciliti es at Army Posts. 1890-

1894. 

Entry 40. Extracts of Inspecti on Reports Made by the Inspector General's 

Department Relating to Medi ca l Facilities at Army Posts. 1891- 1894. 

Entry 41. Sanitary Inspection Reports. 1892-1894. 

Entt")' 51. Reports Relating to Living Conditions at Army Posts in No rth 

Carolina, South Carolina, Georgia, Florida, and Alabama. 1868-1869. 

Entry 52. Reports of Epidemics, Rare Diseases, and Vacci nations. 1888-

1917. 

Entry 53. Report of Capt. Louis La Garda [sic] Relating to the Medica l 

Department Exhibit at the World's Columbian Exposition, Chicago, 

III . October 31, 1893. 

Entry 57. Excerpts of Wa r Department Spec ial Orders Relating to Medica l Department Personnel. 1860-1875. 

Entry 63. Circulars and Circular Letters of the Surgeon General's Offi ce. 

1861- 1885 . 

Entry 66. Circulars of the Surgeon General's Offi ce. Jul y 1889-January 

1905. 
BIBLIOGRAPHY 

Emry 77. Reports of Examinations of Candidates for Appointment as 

Regular Army Surgeo ns ("Merit Rolls"). 1860-1888. 

Entr)' 89. Military Service Cards of Medical Offi cers. 1860-1917. 

Entry 100. Register of Dea ths of Regular Army Medica l Officers. 1861-

1896. 

Emry 103. Historical Files of the Army Nurse Corps. 1900-1947. 

Entry 147. Correspondence Relating to Spanish-Ameri can War Contract 

Nurses. 1898-1900. 

Emry 150. Correspondence Relating to the Service of Spanish-American War Contract Nurses. 1898-1939. 

Entry 223. Abstracts of Correspondence and Orders Relating to the Establishment and Organization of the Army and Navy General Hospital, Hot Springs, Ark. 1882-1888. 

Entry 227. Letter Book of Surgeon Thomas F. Azpell. 1862-1876. 

Entry 229. Journal of Dr. An ita Newcomb McGee. 1898- 1899. 

Entry 230. Correspondence of Dr. Anita Newcomb McGee. 1898-1936. 

Entry 231. Papers of Col. J. R. Kean and Col. W J. Lyster. 1905-1916. 

Entry 232. Abstracts of U.5. Statu tes and Army Regulations Relating to 

the Medical Department. 1790- 1898. 

Entry 235. Decisions of Government Offi cials Relating to the Surgeo n 

Genera l's Offi ce. 1866-1892. 

Entry 241. "Memorandum Book" Relating to the Hospital Corps. 1887-

1905. 

Entry 242. Decisions and Opinions of the Judge Advocate General Relating to the Medica l Department. 1904- 1909. 

Entry 245. Miscellaneo us Records of the Chief Clerk's Offi ce. 1880- 1917. 

Entry 336. Letters Received Relating to the Examination of a New Type 

of Ambulance. March-July 1891. 

Record Group 153, Records of the Office of the Judge Advocate General. 

Microfilm NNM073-113( 465). Proceedings of a Court of Inquiry Into 

the "Fetterman Massacre." 1866. 

Record Group 159, Records of the Offi ce of the Inspector General. 

Record Group 165, Records of the War Department General and Special 

Staffs. 

Entry 5. Offi ce of the Chief of Staff, Army, General Correspondence ("Reports"). 1907-1916. 

Record Group 185, Records of the Panama Canal [Commission] . 

Record Group 287, Publicati ons of the United States Government. 

Record Group 395, Records of the U.5. Army Overseas Operati ons and Commands, 1898-1942. 

Entry 219. Report of the Chi ef Surgeon, Second Army Corps, to the Surgeo n General, U.S.A. 

Washington, D.C. Walter Reed Army Institute of Research. Papers From the 

Letterpress of Charles Franklin Cra ig. 

421 
422 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Secol1dwy Manuscripts 

Bevoise, Ken de. "The Compromised Hosts: The Epidemiologica l Context of 

the Philippi ne-America n War. " Ph .D. dissertation, University of Oregon, 

1986. 

Ca rey, Jr. , Norman M. "The MechanizaLio n of the United States Army, 

1900-1916. " M.A. thesis, Uni versity of Georgia , 1972. 

Fairfull, Thomas McD. "General Nelson A. Miles and His Charges of Army 

Brutality in Lhe Philippine Insurrection, 1902. " M.A. Lhesis, Duke Uni versity, 1972. 

Hansen, Gladys, and Quinn , Frank. "The San Francisco Numbers Game." 

Paper o f the San Francisco Ea rthquake Research ProjecL, San Francisco, 

Calir. , 1986. 

Latshaw, George W "Military Medical Service During and Immediately After 

the Spanish-American War (1898- 1901). " M.A. thesis, University of Wisconsin , 1958. 

Linn, Brian McA. "The War in Luzo n: U.S. Army Regional Counterinsurgency 

in the Philippine War, 1900-1902. " Ph.D. dissertation, Ohi o State University, 1985. 

Pollard, William G. "Structure and Stress: Social Change Among the Fort Sill 

Apache and Their Ancestors, 1870-1960." M.A. thesis, University of Oklahoma , 1965. 

Primary Bool1s 

Addresses Delivered Before the CQlladicIII Cll,b of Toronto, Season of 1915-16. 

Edited by Literary Correspondent. Toronto: Warwick Bros. and Rutter, 

1916. 

American Medical Association. Petition of the American Medica l Association to 

th e Senate and HOllse of Represelltatives in Behalf of tlte Medical Corps of the 

Army, With a Brief Statement of the Facts in tile Case. Washington, D.C.: N .1'. , 

1874. 

Ashford, Bailey K. A So ldier in Science: The All tobiogmphy of Bailey K. Ashford. 

New York: William Morrow and Co. , 1934. 

Ashford, Bailey K. , and Gutierrez Iga ravidez, Pedro. Unc inariasis (Hoolavonl1 

Disease) in Porto Rico: A Medical wld Econom ic Problem. Washington , D.C.: 

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436 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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438 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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440 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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450 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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457 
4 58 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

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460 TH E ARMY MED ICAL DEPARTMENT, 1865-1917 

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462 THE ARMY MEDICA L DEPARTMENT, 1865-1917 

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484 THE ARMY MEDICAL DEPARTME NT, 1865-1917 

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486 THE ARMY MED ICAL DEPARTMENT, 1865-1917 

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487 
488 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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489 
490 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

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LIST OF ABBREVIATIONS 

Adj Adj utant 

AG Adjutant general 

AGO Adjutant General's Office 

Am American 

AMA American Medical Association 

Aprops Approp riations 

AR Annual report 

Assoc. Association 

Asst Assistant 

Bull(s) Bulletin(s) 

C-in-C Commander-in-chief 

CG Commanding general 

Ch Chief 

Cir(s) Circular(s) 

Cmte Committee 

CoO Company 

CO(s) Commanding officer(s) 

Com Commission, Commissioner 

compo compil er 

Compt Comptroller 

Co nf Co nference 

Co ngo Co ngress 

cont continued 

CofS Chief of staff 

Dept(s) Department(s) 

Dir Director, Directive 

diss. dissertation 

Dist(s) District(s) 

Div(s) Division(s) 

ed(s). editor(s), edition 

Encl Enclosure 

End Endorsement 

en!. enlarged 

Ex Exhibit 
492 

r. 

GO(s) 

Gov 

GS 

H 

HC 

Hist 

Hq 

Ho rReps 

IG 

IndAffs 

In f 

Info 

Inslr(s) 

Interv(s) 

LC 

loco ci l. 

Ltr(s) 

M.A. 

MD 

Med 

Mf 

MHS 

Mil 

MiiAffs 

Mins 

Ms 

Mtg 

MVAA 

NARA 

NGB 

NLM 

n.s. 

O ff(s) 

O IC 

Pam 

Ph .D. 

Pres 

T HE ARMY MEDICAL DEPARTMENT, 1865-1917 

fo llowing 

General Order(s) 

Governor 

General Sla ff 

House 

Haverford Co ll ege, Haverford, Pa. 

History 

Headqua rters 

House of Represenlatives 

Inspecto r general 

Indian Affairs 

In fa ntry 

In formati on 

Instructio n(s) 

Inlerview(s) 

Library of Congress, Washinglo n, D.C. 

loco citato , in the pl ace cited 

Letter(s) 

Master of Arts 

Med ica l Department 

Medi ca l 

Microfilm 

Marine Hospital Service 

Mililary 

Military Affairs 

Minutes 

Manuscript 

Meeting 

Massachusetts Vo lun teer Aid Association 

National Archives and Records Administrati on , 

Washingto n, D.C. 

Na tio nal Guard Bureau 

Natio nal Library of Med icine, Bethesda, Mel. 

new series 

O ffi cer(s) 

Officer-in-cha rge 

Pamphle t 

Docto r of Phil osophy 

Presidenl 
LIST OF ABBREVIATIONS 

QM 

QMG 

rev. 

RG 

Rpt(s) 

Sec 

Sen 

ser. 

Sess. 

SG 

SGO 

SO(s) 

SU 

supp. 

Surg 

s.v. 

Svc 

SW 

Tel 

Telg(s) 

Treas 

TSLA 

UA 

U.s. 

WD 

Quarte rmaste r 

Quartermaster general 

revised 

Record Group 

Report(s) 

Secretary 

Senate 

seri es 

Session 

Surgeon general 

Surgeon General's Offi ce 

Special Order(s) 

Stanford Un iversity, Palo Alto, Calif. 

suppl ement 

Surgeon 

sub verbo, under the word 

Service 

Secretary of war 

Tel ephone 

Telegram (s) 

Treasury 

Tennessee State Library and Archives, Nashville, Tenn. 

University of Alabama, Tuscaloosa, Ala. 

United States 

War Department 

493 

INDEX 

Ackerknecht, Erwin H., 94 

Acting assistant surgeons. See Contract surgeons. 

Adair, Maj. George W , 106-07 

Adjluant general, 19, 23-24 

Adjttlant General's Depanmcl1 t, 331124 

AgramO!llC, Aristides, 239, 240-41, 242, 243, 250-

51 , 277. See. (1/50 Yellow Fever Board. 

Aguinaldo, Emilio, 202, 207 

Ainswort h, Maj. Gen. Fred c., 24, 313-14 

Alabama, 81, 82-84, 126, 185, 402- 03 

Alcohol, 4, 49, 352 

Alcoholism 

discharges due to, 40, 103-04 

among Indian scouts, 102 

among medical officers, 82 

prevention or, 48-49 

among soldiers, 103, 218, 224 , 354, 355, 356, 

360,37311 24,394 

treatment or, 52, 103-04 

Alden, Col. Charles H., 97- 98 

Alger, RusselJ, 123, 155, 156, 158, 159, 160, 162, 

163, 177, 185, 193 , 194, 214 

Ambulance attendants, 19, 20, 166 

Ambulancecompanies, 127, 130, 13811 29, 166, 182, 

332,333, 334-35,339-40, 341, 363, 364,383, 

386, 388,390, 395,397,40 1,405 

Ambulance corps, 11 , 54 

Ambulance stations, 129-30, 145, 167 

Ambulance trains, 164 

Ambulances 

in China, 222-23 

Civil War, 30 

in Cuba, 145-46, 147, 153- 54, 155, 235 

design or, 362-63, 405 

disinfection of, 155 

drivers for, 85 , 145-46, 244 

equipment for, 54 

in Mexico, 397 

moLOr vehicles, 362-63, 389-90, 397, 401 

National Guard , 400 

personnel for, 100 

Ambulances-Continucd 

in 'he Philippines, 166, 209, 213, 215, 297, 339 

procurement of, 4-5, 6118 , 166, 362-63, 389 

Spanish-American War, 125, 130, 131, 132, 145-46 

used LO move supplies, 163 

lVagons, 69-70, 73 , 74, 76, 77 , 85, 86, 145, 155, 

204, 209, 213, 222, 390, 397 

for yellow fever patients, 235, 238 

Amebiasis, 289 

American Dental Association, 327 

American Medical Association, 16, 95, 98, 106, 267, 

277 , 285, 327, 381-82 

American Public Health Association, 58,18 

American Red Cross, 135, 144, 146-47, 154, 158, 

162, 174, 178, 180, 182, 187 , 189, 190, 369, 

379, 389, 393 

M ilitary Relief Division, 405 

N ursing Service, 328 

reserve nurses, 383 , 384 

American Regis tries of Pathology, 28 

Ames, Maj. (Vol.) Azel, 258, 259, 279,,6 

Amoeba coli. See Ellwllloebli coli. 

Amoeba dysfnleriae. See En lamoeba histolylicCl. 

Amputa' ions, 67, 71 , 77, 80, 86, 147, 148, 214, 

357-58 

Anatomical specimens, 26 

Ancon, Panama, 265 , 270, 275-76 

Anderson, Maj. Gen. (Vol.) Thomas M. , 135, 164, 

165,201 

Anemia, 257, 260-61, 272 

Ancsthesia, 49, 108, 332, 357- 58. See also Ch ~ 

form; Ether. 

Angel Island , Calirornia, 111, 213 , 331 

Angeles, Ph il ippine Islands, 210 

Anniston, Alabama, 186 

Anthrax, 98 

Antipyretics, 105. See also Quinine. 

Antiscorbutics, 73 

Antisepsis, 50-51 , 357 

Antiseptics, 29, 31 , 95 , 96 

Antitoxins, 93, 105, 291,293 
496 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Anti-tuberculosis League, 233 

Antivaccination movement, 39-40 

Apaches, 78-80 

children, 81-84 

Chiricahua,81 

deaths of, 81-82, 83, 84 

in Florida, 8 1 

as prisoners, 81-84, 87 

Aparri, Philippine Islands, 212 

Apomorphine, 104 

Aponte, Gonzalo E., 108 

Appel, Maj. Aaron H., 130, 132, 144 

Appendec tomi es, 50-5 1, 106, 165,357 

Arapahos, 80 

Arctic exploralOry team, 46 

Argyrol,352 

Ari zona, 387, 394, 401 , 402 

A ri zona, Department of, 79 

Ari zona Territory. 78, 8 1 

Arkansas, 42 

A rmed Forces Insti tute of Pathology, 28 

Army Medical Museum, 26, 27-28, 30, 97-98, 317, 

3 19,326,338-39 

catalogs of holdings, 28 

exhibits senl abroad, 28 

labora tory, 28, 43, 50, 98-99, 107, 348-49, 361 

Army Medical School, 97-99, 100, 102, 119, 19 1, 

318,3 19,320,322- 23 ,324,326,328,331,338, 

350,361,382,391 

Army-Navy Hospital, 51, 52, 109,328, 339,384, 

391, 401 

Army Nurse Corps, 327, 383-84, 395, 401 , 414 

Army of Cuban Pacification, 250 

Army Service Schools, 324, 335 

Army Shoe Board, 359, 360 

Army Transport Service, 208 

Army War College, 325, 333-34 

Arrow wounds, 66- 67 

Arroyo, Puerto Rico, l62 

A rsphenamine, 293, 350-5 1 

Arthur, Brig. Gen. W illiam H ., 14,331121 

Asch, M orris]., 8 1 

Ashburn, Capl. Percy M., 28, 288, 290, 293 

Ashford, Maj. Bailey K., 113,11 1, 260- 63, 277, 

279,,1 5,315 

Asiatic cholera. See Cholera. 

Aspirin, 4 

Athletic training, 48-49 

Atlantic, Division of the, 53 

Atropine, 104 

Augusta, Georgia, 185-86 

Aurists, L 79 

Austria , 405 

Austro-Hungarian Army, 355 

Autopsies, 50, 24 1,286,287, 289, 29 1 

Aviation medicine, 401, 403-04 

Bache, Col. Dall as, 84-85, 86-87, 90,,67, 123- 24 

Bacillus iCleroicles, 240-4 1, 245 

Bacoor, Phil ippi ne Islands, 212, 213 

Bacteri a 

as cause of disease, 29, 1151146 

as cause of infection, 31 

cultures, 25, 28 

filt ered from wa ter suppl)" 103 

Bacteriologists, 28, 95, 192,239,324,394 

Bacteriology, 30, 41 , 94, 95 , 97 , 98, 19 1,240 

Balangiga, Samar, 2 15 

Banister, Maj. (Vol.) W illiam B. , 220-21, 222-23, 

224 

Barbados, 'West Indies, 273 

Barker, Lewell)'s F, 288 

Barnes, Brig. Gen. Joseph K. , 7-8, 11 , 12, 13, 14, 

15-17, 19,22-23 , 25,26,27,31,32,,3,32,,13, 

40,56, 65 ,72 

Barton , Clara, 146-47 

Bathing 

facilities for, 43, 45, 47, 135, 165, 178, 180-81, 

204, 206,347-48 

promotion of, 43 , 47 , 400-40 1 

Battalion aid stations, 333 

Bavarian Ann}', 355, 360 

Baxter, Brig. Gen.Jedediah H., 8- 11, 12,24,56,95, 

100 

Bean, W illiam B., 244 

Beaumont, W illiam, 317, 342111 6 

Bell , Alexander Graham, 50 

Beriberi, 272, 29 1-93, 294,305,306,308"23 

Bevoise, Ken de, 294 

Bighorn River, 67, 70-7l, 72 

Bighorn-Yellowstone Expedition, 67, 69-78, 83 

Bilibid prison, Philippine Islands, 29 1, 293, 306 

Bill, Ll. Joseph H., 66 

Billings, Maj. John Shaw, 22-23, 25, 26, 27, 28, 30, 

35"48,40-41,42,46-47,56-57,98,99 

Birmingham, Col. Henry P. , 394-95 

Bismarck, Dakota Territor}', 67 

Black soldiers, 40, 42, 49, 320 

black surgeons for, 320 

as hospital assistants, 156 

illnesses of, J02 

malaria and , 150 

Black workers, Canal Zone, 273 

Bleeding ( treatment), 4 

Blood 

as disease transmitter, 244-45, 290 
INDEX 

Blood-Continued 

examinations of, 164,241,26.1 ,349 

white cells, 95, 26 1 

Bloodgood, Maj. Joseph C, 383 

Board of Health fo r the Philippine Islands and the 

City of Manila, 295 , 30911 34. 

Boards of health, 303 

Manila, 285-86, 290-91, 295,296-98,300,301, 

302,3091133,30911 34 

Philippine, 295-96, 297-305, 30911 34 

Puerto Rico, 257, 258, 260, 261-62 

Spanish,257 

Bohol, Phil ippine Islands. 213 

Borden, Maj. William c., 83-84, 338--39 

Bourns, Maj. (VoL) Frank S., 30911 33, 3091135 

Boxer Rebellion, 201 , 220, 221-22, 224 

Brechcmin, Capt. Louis, 55 

Brigade surgeons, 215 

Bri nton,John 1-1 . .L05-06 

Bristow, Virginia, l84 

British Arm)" 16, 40, 350, 355, 360, 379 

Bronchitis, 49 

Brooke, Maj. Gen.John R., 175, 177, 178,232-33, 

237, 258 

Brownsville, Texas, 40 1-02 

Bruce llosis, 263 

Bryant,joseph Decatur, 107, 108 

Bryant, Maj. Wi lliam S., 179 

Bullet wounds, 99 

nature of, 147-48 

treatment of, 49-50, L47-48 

Burial records. 23 

Calamb<l , Philippine Islands, 212 , 213 

Caldwell, Maj. Daniel G., 109-10 

Calirorn ia , l41 

California, Department of, 368, 371 

Calverl, Lt. W illiam j., 290-91, 295 

Camps 

Alger, Virginia, 127, 181-83, 184, 191-92, 1971124 

Dewey, Philippine Islands, 165- 66, 167 

Lazear, Cuba, 243-44 

Meade, Pennsylvania, 184, 185 

Merrill, Californ ia, 133-34 

Robinson, Nebraska, 73, 74-75, 78, 86 

Thomas, Kentuck)" 129, 174, 175-78, 185 

Wikorr, New York, 160, 186-9 1, 193,230,314 

Canadian Army, 352-53 

Cardwe ll , Maj. (VoL) Herbert W, 166, 167,209, 

217-18 

Caribbean, 11 7, 118, 122-23, 126. See also Cuba; 

Puerto Rico. 

Carl isle, Pennsylvania, Indian School, 8 1-82 

497 

Carnegie, Andrew, 95 

Carr, Maj. (VoL) Lawrence C, 235, 236, 238 

Carroll , James, 239, 240-41 , 242-43 , 244, 245, 

2551158. See (I /so Ye llow Fever Board. 

Caner, Maj. (Vol.) Edward C, 3091135 

Carler, Henr)' Rose, 241 , 265, 272-73 

Cassedy, James H., 30 

Cassel, Ja)" 353 

Callle plague, 286 

Cavalry 

1st, 104 

7th, 67, 70, 71 , 85 

9th,85 

Cavalry, 151, U.S. Volunteers. See Rough Riders. 

Cavite, Philippine Islands, 164, 165, 166 

Cebu, Philippine Islands, 213 

Central Department, 39 1-92 

Cesspools, 233, 234, 236, 299 

Charree, Maj . Gen. (VoL) Adna R., 220, 222 

Chamberlain, Maj. 'Weslon ~, 292-93 

Chancroid,349 

Chaplains, 11 

Charitable organizalions, 126, 162, 163, 174-75, 

233. See "/50 American Red Cross. 

Cheyennes, 67 

Chicago, Illinois, 109-10, 111 

Chicl«.unauga, Georgia, 126, 174-78, .1.92 

China, 201, 220-24 

China Relief Expedition, 207, 220- 24 

Chinese 

communities, 297, 298, 300, 302, 306 

laborers in the Philippine Islands, 208-09, 290, 

304 

Chlorine, 358 

Chloroform, 49. See (I/so Anesthesia; Ether. 

Cholera 

Asialic, 25, 42 

causes,25,28, 41-42,43,93, 105,241,294,303 

diagnosis, 43 

epidemics, 27, 40, 41-43, 58.11 0, 229, 293, 296, 

299,300,302-04,305,306, 324 

hog, 241 

hospitals, 293 

immunity to, 40 

isolation of patients wit h, 303 

prevention, 42-43, 293, 302 

stud), or, 27, 43 

symptoms, 42 

treatment , 293 

Cholera EpidemiC oj 1873 illlhe Uniled SillIes, Tile, 27 

Chronic respirator)' disease, 40 

Cienfuegos, Cuba, 250-51 

Cisterns, 43-44, 52, 247, 270, 273 
498 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Civil War, 9-10, 54, 63, 64, 121, 193,332,34511 70 

aflcnnalh, 3, 7 

assistance to victims of, 21-25 

records, 23 

and scientific medicine, 26, 29-30 

ve terans, 21-25 

ClaY Lon, Lt.)ere B. , 290-9 1, 3081119 

Clearing stations, division, 333 

Cleary, Maj. PeLer J. A., 82, 83 

Clements, Maj . Bcnnell A., 72, 76, 77-78 

Clerks, 23-24 

Cleveland , Grover S., 9, 32118, 93, 95, 98, 107-08, 

L09, 233 

Cleveland, Ohio, 229 

Clothing 

adequacy or, 77-78, 83 

health and, 47- 48, 149, 219, 220, 291, 293 

purchase of, 4-5 

Cocaine, 49, 354-55 

Cofrman , Edward M., 1131112 

Cold injuries, 67 ,70,74 

Colon, Panama, 264, 266, 268, 270, 273, 275 

Colonia Dublan , Mexico, 397 

Columbia Barracks, Cuba, 238--39, 240-41 

Columbia Hospital for Women and Lyi ng in Asy· 

Itlm,23 

Columbus, New Mexico, 397, 401 

Commerce and Labor, u.s. Depanment of, 340 

COllll1lissar}' D epartment, 16,3311 24 

Common cold, 49 

Construction materials, 163,187 

Contract dentists, 383 

Contract physicians. See Contract surgeons. 

Contract surgeons, 11, 176,356-57,364 

on Arctic expedition, 46 

aSSignments, 177, 179,321,362 

in China, 222 

in Cuba , 129, 150, 154-55, 234, 239-46, 248 

deaths of, 42, 71, 72 

for Freedmen's Bureau, 21 

hiring or, 12-13, 14, 15, 18, l50, 208, 320, 322, 

323,377 

on Indian War ex peditions, 64, 69, 71, 72, 73, 74, 

75,76,78,80 

numbers or, 11, 15-16, 18,96-97, 119,319,323 

in Panama, 265-66, 275, 279/16 

in the Philippines, 214, 221 , 287-90, 293, 297, 

320 

promotions of, 14- 15,320 

providing care of Indians, 82, 83 

in PuerLO Rico, 259 

qualifica tions, 15,12 1, 275 

research by, 287-88 

Contract surgeons-Continued 

responsibilities of, 56,120--2 1, 162, 184,275 

on ships, 208,214,293,362 

in the South, 15,21 

in Spanish-American War, 120- 21, 162 

training of, 17-18,12 1 

in the WesL, 64, 69, 71, 72, 73, 74, 75, 76 

Convalescents 

in Cuba , 159 

hospitals ror, 179-80, 189, 190, 204, 206, 235-36 

in Puerto Rico, 163-64 

returned to troop units, 175, 176 

returned to the United States, 156-59, 160, 164 

Cooks, 187, 189 

hospital corpsmen as, 20, 21 

qualil}' of, 47 

training of, 1. 9,47,54, 100 

Corbin, Brig. Gen. Henry C, 157, 159, 174-75 

Corps, Anny, 118, l38n34 , 185 

I, 162, l 75, 177, 178, 185, 186 

11 ,162, 181-86 

Ill, 122, 175, 185 

IV, 162, 184, 185, 186 

V, 129-33, l35, 136, l3811 34, l3811 36, l41 , 

143-60, 162, 180, l84, 185, 186, 187, 190,229, 

230,231,233,234,248,251 

VI, 169,118, 185, 1971140 

VII, 178, 179, 180, 186,230,231 

VIII,133-36, 141 , 164-67,17211 70,20 1- 04,208 , 

294 

Corps surgeons, l19, 12l, 122, 127, l28, l381129, 

181 

Corregidor Island, Philippine Islands, 206, 208, 

225119 

Cosmas, Graham A., 232 

Coues, Capt. Elliott, 57 

Craig, Capl. Charles F, 176, 288, 290, 293, 350, 351 

Crane, Brig. Gen. Charles H., 7-8, 9, 12, 18,32111 3, 

64- 65 

Crile, George W., 405 

Crook, Brig. Gen. George, 67, 72, 73-74, 75, 76-77, 78 

Crosby, Maj. (Vol.) Wi lliam D., 165,204 

Cuba, 41 , 93, 1l7, 129-33, 136, 1391141 , 141-60, 

l6811 2, l 78, 180, 183, 186,229,230-51,260, 

263,264,28 111 26,321,331,340,380 

anti-yellow fever campaign, 247-5 L, 266, 269 

military government of, 252/16, 253/1)4 

veLerans or, 128, 186, 187-88, 190 

Cuba, Department of, 230, 249, 252,1 6 

Cuba, Division of, 232-33, 237, 252/1 6 

Cuban nationals 

laborers, 232 

phYSicians, 234 
INDEX 

Cui ion Island , Philippine Islands, 301 

Curry.Joseph).. 287. 290-9 1. 356-57 

Custer, Lt. Col. George A. , 67,70,7 1,72,78 

Dagupan , Philippine Islands, 212 

Daiquiri , Cuba , 141, 143, l54 

Dakota, Department of, 67, 69 

Darnall , Maj. Ca rl It, 358, 363 

Daugillcrs of lhe American Revolution, l23 

Deadwood, Dakota Territory, 76-77 

Death rates. L3 5. 150. 158-59. 173. 178. 191. 193. 

231.339.356.360 

in Cuba. 233. 235. 236. 239. 249 

of Indians, 81-84 

in Panama, 272, 273 

in the Philippines. 290-91. 293-94. 296. 304.306 

in Puerto Rico, 259, 261 

racial differences, 42, 49 

in the United Siales, 229 

Deaths 

from anem ia, 26 l 

from beriberi , 29 l, 305 

causes of. 40. 46. 49. 234. 360 

from cholera, 42, 304 

from dysentery, 261 , 264, 287 

among Indians, 81-84 

infants, 296,304- 06 

from malaria, 264 

among Mexican refugees, 393 

from para typhoid , 402 

from plague, 302 

from San Francisco earthquake, 365, 367 

from scurvy, 46 

from smallpox , 40, 301 

from tuberculosis, 306, 339, 360 

from typhOid , 216- 17, 251 

from yellow fever, 41, 243, 244, 248, 250, 251, 

264.268 

DeJano,J ane A., 328, 3451153 

Demobilization, 11 - 12 

Dengue. 151. 192. 213. 251. 289- 90. 306 

Dental Corps. 327. 383. 414 

Den tists. 18- 19. 99. 108. 179. 206. 212. 326-27. 

383.385.386 

Department of the SOltl h, L3 

Depression (mental), 76-77 

Desen ers, iden tificalion of, 24 

De tention cam ps, 154-55, 170,,35, 189, 190, 230, 

234.300 

De Witt, LL. Col. Calvin, 233, 2531113 

Dewey, Com modore George, 11 7, 133, 164-65 

De'Wolf,James M. , 71 

499 

Dia rrhea. 42.84. 104-05. 110. 111. 130. 150-51. 216. 

2 17.219. 222. 251 .258. 261.263. 288.399 

Diet. 3. 4. 39. 46-47 . 76-77. 81. 82. 83-84. 103. 

104-05. 110. 111. 132. 135. 147. 149. 151. 167. 

174-75 . 190. 194. 207.208. 216.217.219.220. 

258. 260- 61 . 29 1-93. 294 . 304. 305. 306. 

30811 23 . 326. 405 

Digesti ve problems, 164, 251, 263 

Diphtheria. 28. 93.98. 105 

Disabil ity discharges. 17. 23. 40. 52. 106. 206. 355-

56.387 

Disaster relief, 365-71 , 37511 66, 379 

Disease. See also Disease rates; Dea th rates; partic· 

ular diseases. 

causes of. 3. 25. 26. 28. 29 . 39, 46. 93. 173. See 

also part icular diseases. 

diagnosis of. 93-94. 151. 191-92.36 1.392. Sec 

also particular diseases. 

prevelllion of, 4, 28, 39-49,97, LOO , L02, 105, 

119. 130. 134. 151. 152-53. 167. 232-34. 

325-26.363. 399 

trea tment of, 3, 4, 105- 06. See also particula r 

diseases. 

Disease rates. 40. 128. 148. 164. 193.399. 402- 03 

in Cuba. 149-60. 173-74. 230. 233. 236. 246-47 

in mobili zation camps, 173-74, 175 , l 76, 178, 

182. 184-86.378 

in Panama, 275 

in the Philippines. 166.206.216.287.293- 94. 

297-98.300 

in Puerto Rico, 258 

Disin fectants. 25. 43 . 95. 235-36. 266. 352 

Disinfection 

of buildings. 231-32. 234-35 . 236. 237. 246. 

247-48. 258.270. 273. 275.277. 297-98.301 . 

302 .303.395 

of ind ividua ls, 234, 235 

of mail, 159 

met hods of. 43. 184. 187. 224. 234-35. 270. 399. 

401 . 41011 66 

of patient's effe cts. 157. 184. 187. 234. 236. 246. 

247-48.302.399. 40 1 

of ships. 157. 247-48. 3 17 

of tents, J 84 

of towns, 232-33 

Dispensaries. 135. 262. 275. 367. 370. 391 

Division surgeons, 119, 121, 129, 13811 29,332-33, 

364 

Doctri ne (Medical Department), 332, 334 

Dodge. Maj . Gen. (Vol.) Grenville M .• 193-94. 

19911 7.1 

Dodge Commission, 188, 193-94,3 14,316,318. 

322.326.327.339-41 .388.414 
500 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Drainage, 185, 204, 206, 221, 233, 27 1, 297-98, 

299,303 

Dressing stations, 5 1, 53-54, 6011 49, 86,100, l 27, 

145,210,222,223,333 

Drug addiction, 354-55 

Durry,John, 229 

Dunn Loring, Virginia, 184 

Dysenlery, 216, 222, 236, 251, 394, 399 

causes, 3, 28, 29, 93, U 311 2, 287-88 

chronic, 4, 82, 83, 212, 22 1 

in Cuba, 149, 150-51, 159, 23 1 

discharges due to, 40 

and malaria, 2 17, 288 

in Panama, 275 

in lhe Philippines, 2 17, 285-88, 305-06 

in Pueno Rico, 258, 261 

treatment, 4, 217, 288-89 

Eagle Pass, Texas, 401 

Ear inreclions, 402 

Eanhqlwkes, 365-7 1, 3751]66 

Edi e, Maj. (Vol.) Guy L. , 3091133 

Erfi cicilcy rating s)'stems, 23, 24 

Ehrlich, Paul, 350, 35 1 

EI Caney, Cuba, 141, 145, 146, 147, .1 53-54, .1 57 

EI Paso, Texas, 392, 397, 40 I, 402 

Eliot, Charl es W., 4 

Empyema, 357-58, 402 

Engineers, U.s. Army Corps of, 16,3311 24 

England, 25. 3 1 

Enlisted men, Medical Department, 19, 20, 100, 

123-24, 155, 156, 162, 163,334,38 1,384-85, 

401, 414 

Ellt(HllOeba coli , 287-88, 307115, 30711 8 

Ellt(JIll oeba his folyLica, 287-88, 307.18 

Epidemics, 3, 40, 159, 190, 229, 296-97, 306 

cholera, 27, 40, 41-43, 5811 10, 229, 293, 296, 299, 

300,302- 04,305,306,324 

dengue, 289-90 

innucllza, 49 

plague, 302, 324 

pnelllllonia, 402 

prevel1lion or, 347, 361, 370, 393-94, 413 

small pox, 40, 237-38, 257-59, 301-02 

lyphoid, 173-78, 180-81, 183, 186, 19 1,229,251 

ye llow rever, 27, 40-41, 43, 150, 152, 1. 55, 159, 

186, 234-36, 238-39, 240-41, 246, 247, 251, 

266-69,272 

Epilepsy, 40 

Epizool ic diseases, 259, 286, 296, 304, 305, 3101161 , 

392 

Equipment, laboratory, 173 

Erysipelas, 74. 93 

Elher, 49, 107, 108. See (ilso AnestheSia; hl oro~ 

[onn. 

Ealing, John,279111 5 

Evacuation, medical. See a/so Ambulance companies; Ambulances; Hospital ships; Hospital 

trains; Litter-bearers. 

in China, 222, 223 

rrol11 Cuba, 143-44, 145, 156-58, 160 

doctrine, 64-65, 100, 127 

to field hospitals, 74. L4S, 167,208 

to hospital ships, 143-44,207 

during Indian campaigns, 63-66, 71-72, 84-86 

management of, 127, 362-63 

from the Philippines, 207-08,212 

in the Philippines, 167, 204, 208-10, 2 12, 2 13 

planning ror, 128, 173,399,4 14,415 

from Puerto Ri co, 163-64 

b)' ship, 156-59, 160, 163-64,222,223 

tmining ror, 53-55, 84, 85, 98-99, 324, 332 

Evacuation hospitals, 333 

Ewing. Capt. Charles B., 85-86 

Far West (supply steamer), 70--71, 72, 73, 76 

Fevers 

in Cuba, 149-51, 153, 154, 234 

dengue, 15 1, 192,213,25 1,289-90,306 

diagnosis or, 105, 153, 164, 173, 179 

isolation of patients with, 132 

in the Philippines. 213 

in Puerto Rico, 164 

treatment o f, 4 

typho-malaria, 173 

Field Service and Correspondence School for ~ 

ical O ffi cers, 324-25 

Field Service Reguialiolls, 332, 334, 364, 381 

Filipino scouts. See Philippine SCOUlS. 

Finla)', Ca rlos Juan, 41 , 241-42, 243, 250-5 1, 

25411 41. See also Ye llow Fever Board . 

Finnegan,John P. , 379 

Firsl aid 

packelS, 124-25, 138,,22, 144,210 

services, 127,367 

lraining in, 20, 53,10 1 

Firsl Reserve Hospilal, 204, 206, 225119, 285-86, 

287,290-9 1,307,,4,328,339 

Fleas, 290, 29 1 

Fleisc hmal1n ~Asc hh m, Elizabelh, 337 

Flexner, Simon, 288 

Flies, 43,134, 175-76, 192,224,23 1. ,299,303,304, 

364,370 

Florida, 40, 81,82, 126, 141 , 159, 178-81 

FomiLes, 245-46, 247, 349, 356 
INDEX 

Food. See also Diet. 

contamination of, 175-76,192,224,231,260, 

285,299,302,303,304,370 

preservation of, 46--47, 83-84 

shortages, 67, 76-77, 167, 183-84, 187, 194, 219, 

220,232,233,397 

Fool problems, 219, 322, 359-60 

Forage, for Army animals, 4-5, 73, 397 

Ford, Maj . Clyde 5., 405 

Ford's Theater, 24-25, 28 

Forts 

Abraham Lincoln , Dakota Territory, 67, 70, 72, 73 

Barranc<ls, Florida, 40-41 

Bayard, New Mexico, 339, 356, 391 

Bliss, Texas, 390, 393, 40 L 

Brady, M ichigan, 70 

Buford, Dakota Terri tory, 46--47 , 67, 69, 70, 71 

D. A. Russell , Wyoming TerrilOry/Wyoming, 54, 

74, 100 

Douglas, Utah Territory, 45 

Ellis, Montana Territory, 67,69 

Fetterman, Wyoming TerrilOry,67, 73-74, 75, 76, 

77-78 

Hamihon. New York, 45, 5 1-52 

Harker, Kansas, 42 

Huachuca. Arizona, 390 

Jefferson, Florida, 40-41 

Keogh , Montana, 54, 86 

Laramie, Wyoming Terrilory, 74, 75 

Leavenwort h, Kansas, 17, 54, 103, 109, 110, 

324-25,335,361,382,384,391-92 

McKinl ey, Philippine Islamls, 289-90 

McNair, Washington, D.C., 100 

McPherson, Georgia, 128-29, 130, 159, 174, 180, 

184 

Marion, Florida , 8 1 

Mason, Calirornia, 367, 368 

Monroe, Virginia, 42, 47, 54,127,129, 159, 162, 

L74,337 

Myer, Virginia, 105, 127, 129, 174, 179, 182, 184,361 

Niobrara, Nebraska, 54, 86 

Omaha, Nebraska, 87 

Pickens, Florida, 8 1 

Reno, Wyoming Territory, 74 

Riley, Kansas, 54, 87,100-101,389 

Ringgold, Texas, 102-03 

Robinson, Nebraska , 73, 74-75, 78, 86 

Sam HOllslOn, Texas, 328, 361, 384,390, 392, 401 

Shaw, MOlllana Territory, 69 

Sheridan, Illinois, 109, 110 

Sill , Oklahoma Territory, 84 

Slocum , New York, 262 

Stanton, New Mexico, 339 

Forts-Continued 

Fred Steele, Wyoming Ter rilOry, 75 

Thomas, Kentucky, 129, 174,175-78, 185 

Washington, Maryland, 357 

Wi ngate, New Mexico, 393 

Wood, New York, 51-52 

501 

Forwood , Brig. Gen. William H. , 98,107 , 123-24, 

187, 188-89, 190, 250, 265,314- 15,316 

Foster, Ga ines M. , 232 

France, 25, 220, 222, 264, 265, 268, 272, 3451153 

FrancowPrussian War, 112 

Franklin, john Hope, 39 

Freedmen's Bureau. See Rdugees, Freedmen, and 

Abandoned lands, Bureau or. 

French Army, 355, 360, 405 

Frostbit e, 67, 70 

Fungi ,28 

Funk, Casimir, 3081123 

Funston, Brig. Gen. Frederick, 365, 368 

Galveston, Texas, 363, 364, 365 

Gangrene, 67 

Garbage 

coll ection of, 94, 234, 266, 275 

disposal of, 3, 84, 234, 294-95, 296, 298 

Garfield, James A., 8, 49-50,107 , 108 

Garrison, Fielding H., 28 

Garrison, lindley M., 384, 388 

General Motors Company, 389 

General Slaff, 313, 333 

Georgia, 185 

Germ theor)', 25-26, 28, 29,31,39, 49-50, 4 L4 

Germany, 25, 30, 99, 220, 224, 377, 405, 406 

Geronimo, 78-79, 80, 81 

Giardia lamblia , 288 

Gibbon, Col. John, 67, 69, 70-71, 72, 73 

Gilchrisl, Maj. Harry L., 295, 336, 386, 387 

Girard , LI. Col. Alfred c., 3L, L09, llO, 18L-83, 184, 

337,3461179 

Glennan, lL Col. james D., 399 

Goelhals, Col. George W, 276-77 

Golden Ga te Park, San Francisco, 369 

Gonorrhea, 93, 217-18,349, 350, 352, 353, 391,399 

Goodyear, j ames D., 246 

Goodyear Rubber Company, 60,139 

Goose Creek, 75, 76 

Gorgas, Marie, 267, 277, 281 11 30, 380 

Gorgas, Maj. Gen. William c., 150, 154, 236, 237, 

239, 247, 24!>-50, 251, 25411J4, 264-78, 

28011 25, 281 11 30, 316, 324, 328, 377-78, 379, 

380-81, 382-83, 384-85, 387, 388, 389, 

390-9L,392-93,394,395, 397,400, 402,403, 

404, 405,40711J 
502 TH E ARMY MEDICAL DEPARTMENT, 1865-1917 

Government Hospital for the insane, 350, 355 

Governmclll L,bonHorics, Bureau of, 285-86, 

295-96 

Governor's island, New York, 42, 43 

Graham, Maj. Gen. (Vol.) Wi lliam M ., 181 , 182-83, 

184, 1971123 

Grant, Ulysses S., 56 

Greal Britain , 220, 222, 223, 23G-3 1, 348 

Greel)', Maj. Gen. Adolphus w., 46, 365, 368-69, 

37G-7 1 

Greenl eaf, Col. Charl es R., 118-19, 121 , 127, 128, 

152, 154, 155-56, 162, 163, 164, 166, IH , 177, 

190- 91 , 193, 210,214-15,220,2261124,301 , 

347 

Grimes, Roben B., 76 

Guam, 218 

C uanica, PUCrlO Rico, 160 

Guanl<1namO, Cuba, 160, 162,230 

Guerrill a warfare, 63, 11 7, 145,20 1, 202,204,206, 

207,208,213,215 ,2 16,232, 286-87,301,339, 

397,399 

Guiteau, Charles]., 50 

Guiteras, Juan , 41 , 129, 130, 133, 134, 1381136, 

152-53, 154,248,250-51 

Gutierrez Igaraviclez , Pedro, 262 

Halsted, William S., 60,,39 

Hammond, Brig. Gen. William A., 26, 28-29, 30, 

32113, 97, Ill, 354, 413 

Harri son, Benjamin , 9 

Hans uff, LI. Col. Albert, 74, 75, 76, 77, 85, 175, 177, 

178 

Havana, Cuba, 117, 129, 143,230,232,236,237, 

238,24G-41, 242,244,246,247-48, 249,250, 

25 1, 264,265,266,269, 270,276-77,340 

Havana, Department of, 236, 237, 238-39, 252116 

Havana Yel low Fever Commission, 4 1, 129,239-46, 

2541135 

Hava rd, LI. Col. Vale.")" \29, 146, 150, 15'1, 233, 

2531113 ,35 1,352 

Hawa ii, 135-36,337-38,36 1 

Hawaii, Department of. 39 1 

Hay Fever Association, 354 

Hean disease, 40 

Heal exhaustion, 111, 216, 2 17, 223 

Hemorrhage, 74 

Henr)" Capl. Gu)' V., 76 

He rni as, 22 , 40, 106-07, 166,357 

Heroin, 354 

Hoff, Alexander 1-1. , 178, 197111 5 

Hoff, Maj. (Lt . Col. , Vo l.) J ohn van R. , 20, 21, 85, 

197111 5,258,259,260,265 

Homeopalhs, 120 

HOIIg KOllg, 206, 207, 291 

Honolulu, Hawaii , 136, 174.341,384,391 

Hookworm , 257, 260-63, 272, 277, 294, 305-06, 

402-03 

Horner, J. 'vv., 179 

Horses 

diseases of, 304 

equipment for, 4 , 6118 

purchases of, 4-5 

shortages of, 54 

laken 10 Cuba, 132, 143, 144-45 

lraining in the care of, 100 

used as food, 77 

used LO produce ami toxin, 105 

used to transport patients, 65, 66, 72, 76 

Hospital attendants. See Hospital stewards; Nurses. 

Hospital construction, 4-5, l85-86, 187, 188. 189, 

190,206,338-39,361. 5eealso Hospilals, design. 

fun ds for, 51, 108,206,361,390,391 

materials for, 163 

Hospita l Corps, 341138, 84, 100, 11311 13, 329-32 

companies, 122,329,369 

creation of, 18-21 

desertion rates, 2 1 

entrance examination, 20, 21 

organiza tion, 332, 385, 4 14 

priva tes, 329, 330, 33 1, 384 

size, 122 

wartime responsibilities, 119, 134 

Hospital Corps, National Guard. See National 

Guard. 

Hospital corpsmen, Regular Army. Sec a/so National 

Guard , hospital corpsmen. 

in China, 22 1, 222 

command of, 183,320 

in Cuba , 129-30, 155,234, 242,244 

as denlisls, 18- 19,206,2 12,326-27 

dUli esof, 18-20, 85, 100, 1l0, I ll, Jl9, 122, 127, 

128, 129-30, 155, 166, 177, 178, 179, 187, 189, 

202, 206,208-09, 212,214,326-27,331 ,335, 

341,352,362,363,364 

Filipino, 33 1 

handbook for, 122 

hOUSing for, 39 1 , 395 

in laboratory work, 330-3 1 

numbers of, 19, 101, 122-23, 155, 166, 2 14,329 

as nurses, 19,20, 123-24,384 

organiza tion of, 129-30, 166 

pa)', 21 , 10 1, 33 1, 384-85 

in the Phi lippines, 133-34, 135, 165, L66, 206, 

212,2 13,214,215,329,355 

promotions, 330 

in Puerto Rico, 1. 62, 163,259,263 
INDEX 

Hospital corpsmen, Regular Ann)'-Continued 

quality of, 101 , 122, 182, 184, 213-14,331-32, 

384 

rank, 330, 332, 34511 58 

al refugee camps, 369, 393 

shortages of, 21, 85, U8, 121-22, 155, 166, 

182-83, 188,2 13,222,329,331,333-34,364, 

384-85 

training of, 21 , 53-54, 96, 100- 101 , 122, 155, 

173, 181, 183, 184, 185,213,330-31,334-35, 

338,363,390 

uni[onns for, 101 

U.s. Vo1umeers, 122, 133-34, 135,163, 165, 166, 

329 

and Yellow Fever Board, 242, 244, 245 

J-J ospital ships, 3, 11 , 119, 132, 143,144, 148, 156-

57,163-64,206-07,208,222,223,231,235-

36,333. See (I/so individual ships. 

shortages of, 157, 162 

Slaffing of, 174,206 

Hospital stewards, pre-l SB7, 12-13, 18-20, 21, 23 , 

341138,69,73 

J-Jospital trains,3, II , 128-29, 1381133, 179-80, 182, 

184, 190,210,275,333,363,369,40 1 

Hospitals 

administration of, 120-2 1, 174, 177, 188, 210, 

265,275-76,378,390-91 

base, 222,223,333,337-38,340,341,361,384, 

388,401, 405 

beds, 124-25, 145, 147, 212 

buildings used for, 86, 144-45, 154, 163, 164, 

165, 177,204,206,210,212-13,221-22,223, 

275 , 300,361,395 

camp, 23 1,384,397, 400, 401 , 405 

city, 233, 234, 267 

civilian , 174, 184, 190,300,367,371,39 1,394-

95 ,405 

construction. See Hospital construction. 

convalescent, 179-80, 189, 190, 204, 206, 225119, 

2821155 

crowd illg at, 176, 177, 188, 189, 367 

design, 30, 45 , 5 1-52,97, 108-09 

detention, 154-55, 17011 35, 189, 190, 230, 234, 

300 

diet kitchens, 182,361 

equipment for, 134, 173, 182, 186,212,22 1,388, 

400 

evacuation, 333, 341, 38 L, 388 

Freedmen's Bureau, 21 

funds for, 36 1, 390 

for Indians, 83 

isolation, 204, 208, 230, 236-38, 248, 273, 293, 

300-301,349,361,369 

503 

Hospitals-Continued 

laboratories, 204, 206, 224, 276, 391-92,395, 401 

laundry facilities, 188,212 

Marine, 222 

for National Guard, 96 

Navy, 206, 221-22 

organi za tioll of, 130, 173, 177-79, 208, 210, 212, 

275-76,390 

planning for, 195, 208, 275-76, 340-41 

plumbing, 204, 275, 361 

sanitation at, 180-81,194,236,258,270,347-48 

ships. See Hospital ships; individual ships. 

staffi ng of, 177, 188, 189, 206, 2 13-14, 275, 405 

supplies, 4, 120, 124, 162, 165 ,212,223,275, 

340-4 1, 388, 400 

tenLS used for, 71 , 77-78, 86,130, 132,143,144, 

146, 147, 154, 163, 164,165-66, 167,176,177, 

18 1-82, 187, 189,204,206,208,213,222,300, 

338 

Iranspons. See Hospilal ships. 

wanimcorganiza tion, 11, 127-29, 130, 155, 163, 

333 

J-J ospitals, brigade, 166, 212, 213 

Hospilals, division, 121 ,122, 128,130, 174, 177, 

178, 179, 182, 183-86, 190,193,204,339 

in Cuba, 143,146, 155,23 1 

organization of, 181,333 

reserve, 130, 147, 162 

on ships, 132, 143, 156-57 

staffi ng of, 127, 134, 156 

supplies for, 187 

J-J ospitals, field , 51, 53-54, 6011 49, 66, 70, 71, 72, 

74,77,84-85,86-87, 11 0,332,333-35,340, 

3451170,364,383,395,397,400,401 

in China, 223 

in Cuba , 144-45, 146-48 

for disaster relief, 369-70 

exhibited,99 

faci lities for, 1 Ll , 363 

Nalional Guard, 386 

in the Phi lippines, 208, 210, 212 

planning for, 118-19, 127,332,339-40,34 1 

in Puerto Rico, 260-6 1 

shortages of, 145, 146,334,335 

and Spanish-American War, 127, 129, 180, 182, 

184 

staffi ng of, 100, 127, 1381129, 174, 334, 38.1 

supplies for, 339-4 1 , 388 

J-J ospitals, gell eral, 3, 601149, 174, 190, 231, 333. 

336-39,367 

Civil War, 11 , 30 

in Cuba, 155, 234 

design of, 30 
504 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Hospitals, general-Continued 

disaster relief, 367-68 

equipment for, 148 

facili lies for, 177-78, 182, 187,188,391 

funding for, 337 

laboralories, 361 

localion of, 127,333,391 

in the Philippines, 204-08, 225'19 

in Puerlo Rico, 163, 164, 257 

responsibility fOf, 119, 128 

slamng of, 177 

supplies for, 13, 127, 187-89 

training at , 122 

women nurses in, 18, 123, 156, 188-89,328 

Hospilals, POSI, 18-19,51-52,66,74,76,86,96, 

100, 110, 174, 180,337-38,390-9 1 

cooks for, 47 

equipment for, 99, 108 

exhibit ed, 99 

faci lilies for surger)" 86, 107, 108-09, 165,361 

laboratori es, 36 1, 413- 14 

in the Philippines, 165, 207,208,212 

in Puerto Rico, 257 

women nurses in , 162 

Hospitals, regimental, 127. 128, 130, 144-45, 146, 

153-55,163, 174, 177, 178, 179, 186, 190,206, 

210,231,333,340,388 

Housing 

in Cuba, 149, 233, 234-35, 237, 247-48 

fumigation of, 234-35, 237, 247-48, 277 

for hospital corpsmen, 39 1, 395 

for Indian prisoners, 83, 84 

for lepe rs, 272-73 

for nurses, 212, 223, 328, 384, 393 

in Panama, 272-73 

in the Philippines, 29 1, 299 

in Puerto Rico, 257-58 

for refugees, 367, 368-69 

for soldiers, 43, 102, 149, 185, 187,257-58,367 

HO)'I, Maj. (VoL) Henr), E, 209 

HUidekope .. , LI. Col. (VoL) Rush 5., 177 

Hume, Edgar Erskine, 352 

Huntsville, Alabama, 184, 186 

H ypnolics, 176-77 

Illinois Militia, 110 

Illinois National Guard , 55, 11 7, 120 

Immuniza tion, 336, 403 

of animals, 304,392 

paral)'phoid , 399, 402 

plague, 291 

rabies, 25 

serums, 285-86, 291, 293 , 301 , 304 

Immuniza tion-Continued 

smallpox, 3, 37,, 75, 39-40, 133, 231, 237-38, 

248,258,259,273,30 1,347 ,370,387,393 , 

395,399 

lraining for, 330-3 1 

I)'phoid, 192,348-49,364,387, 393-94,399, 402 

}Iellow fever, 248 

lI ulex C(lwloglle, 26,36/1 64 

l/Ide.x Medicus: A MOIIIIIly Classified Record ofth eellrre/lt Medical Lileratllre of ti,e World, 27 

Indian Affairs, Bureau of, 81 

Indians, American. See also specific tribes. 

as adversaries, 3 

artifacts, 27-28 

campaigns against, 49, 52, 63-91 

dealh rates, 8 1-84 

illness among Army scouts, 102 

medical care for, 81-84, 85, 86, 9011 67 

as prisoners, 81, 86 

on reservations, 8L-84 

schools for, 81-82 

Indigents, care for, 23 

Infantile convulsions, 296, 304-06 

Infantry 

91h,220- 21 

141h, 220, 222 

241h, 156 

Infantry, u.s. Volunteers 

2d, 156 

3d, 156 

In fection 

causes of, 3, 29, 31, 148, 167,222 

from cold injuries, 67 

rear of, 49-50, 358 

preven lion of, 4, 25, 51, 144, 148, 167,305,347 

studies of, 27-28 

InOuenza, 49, 393, 402 

Insects, as disease vectors, 134, 24 1-5 1,257,263-

64, 266, 269-72,285,289-90,395 

Inspector General's Department, 33,124 

Institu te of Tropical M edicine and Hygiene, 262 

Instruction, camps of, 53-54, 334-35 , 383 

Instruction, companies of (hospital corpsmen), 54, 

101,330-31 ,332 

11llernational Sanitary Conference (Rome, 1886),30 

Ipecac, 288-89 

Ireland, Ll. Col. Merrille W., 130,318 

Isthmian Canal COlllmission, 257, 264-65, 266, 

267-69,277,328,340 

Ives, Maj. (VoL) Francis). , 151, 155, 156, l60, 224, 231 

Jacksonvi lle, Florida, 178, 179, 180, 186 

Jamaica, 230-31 , 272 
INDEX 

James, William, 49 

Japan, 206, 218, 220, 222, 223, 224, 291, 293, 377 

Japanese Army, 325. 355 

Jerrerson Barracks, Missouri , 45, 102-03, 105 

Johns Hopkins Hospital, 351148 

Johns Hopkins University, 10, 60 .. 39, 191,239,266, 

288 

Johnson, Andrew, 7, 8 

josiah Simpson General Hospital, 128 

K packels, 352, 353, 354 

Kean, Brig. Gen. (NA) Jefferson R., 32,,8,139"11 , 

230,238-39,250-51, 254,,31,255,,58,256,,69, 

263,315,358-59,405 

Keefer, Ll. Col. Frank R., 404-05 

Keen, William W., 98 

Keenan , George F, 379 

Keeton MOlor Company, 362-63, 389 

Kentllcky, 126, 185 

Key Wesl, Florida, 40, 123, 159, 174 

Kilbourne, Maj. Henry S., 129 

Kimba ll , Capl.James P. , 70 

King, Wa ller W. , 262 

Kitchens, 178, 192,208,347 

Kiyoshi Shiga, 287 

Koch, Roben , 25, 30, 95, 240 

Labor violence, 53, 55, 109-12 

Laboratories 

analyses done in , 43, 260, 324, 349 

equipment for, 176, 266, 285-86, 348-49 

experiments done in , 241-46, 276, 350, 351 

fac ilities, 285-86, 290-91, 295, 307114 , 326, 361, 

381,390,391-92, 402, 413-14, 415 

field, 263, 40 1 

sel lip by Typhoid Board , 192 

training for use or, 324 

laGarde, Maj. LOllis A., 99, 130,132,1381136, 147, 

150, 153, 154, 156, 158,265,266,270 

Lakeside Hospital, 405 

Lamb, Daniel Smith , 50 

Lambert, Alexander, 268-69 

Lamont, Daniel S., 97 

Lampasas (hospital s hip). 162. L64 

Las Guasimas, Cuba, 141, 144, 157 

Latrines, 42-43, 44, 45, 83, 135,173, 176, 178, 18 1, 

182, 183, 184, 192,219,231-32,267,275,294, 

297-98,300,347,370 

Lawson, Brig. Gen. Thomas, 317 

Lawton, Capt. Henr)' W. , 78, 79, 8J 

Lazea r, Jesse W, 239, 241, 242, 243, 244, 248. See 

(ilso Yellow Fever Board. 

Le Prince, j oseph , 265, 27 1 

LeCompte, Edwa rd , 76 

Lee, Maj. Gen. Fitzhugh, 178 

Leiter General Hospital , 177, 178 

Leprosy, 28, 272-73, 300-30J 

Lett erman ,j onalhan , 54, 127 

505 

Lcu ennan General Hospital, 337-38, 384, 391 

Lexington, Kentucky, 185 

Leyte, Philippine Islands, 213 

Liberi a, U.s. Commission to the Republic of, 324 

Li brary of Congress, 26 

Li ce, 322, 399, 400-402, 404-05 

Line and Staff College, 324 

Ling, john, 179 

Lippincolt, Lt. Col. Henry, 133-34, 135-36, 165-66, 

17211 73,208,216,219,226,,21 

Lister, Joseph , 25 , 29, 30-3 J 

Liller-bearers, 20, 101 , 127, 167,222,333 

arming of, 111 

Chinese coolies, 208-09, 222 

Filipino, 208 

in the Philippines, 208- 09 

prisoners of wa r, 208 

training of, 53-54, 85. 100, 101 

Lillers, 64-66, 71-72, 77, 124-25, 127, 144-45, 

209,224 

Little Bighorn Ri ver, 72 

Liver abscesses, 289 

Living conditions. 149, 173, 294, 297-99, 359. See 

a/so Housing. 

Loggerhead Key, Florida, 41 

Long Island, New York, 160, 186 

Long Island Railroad, 1.87 

Lord , Ll. George E., 71 

Los Animas disinfec ting plant, 247 

Louisiana, 126 

Louisville, Kentuck),. 229 

LoveJl, j oseph, 26, 36,,61 

Ludlow, Brig. Gen. Wi lliam, 237, 25411 27 

Luzon, Philippine Islands, 202, 209. 210, 212, 213, 

30 1 

Lyster, Lt. Col. Theodore C, 276, 404 

Lyster, LI. Col. William). L., 358, 404-05 

Maass, Clara L. , 248 

MacArthur, Maj . Gen. (Vol.) Arthur, 20 1, 202, 214, 

220,2251'1'3 

McCle llan, Capt. Ely, 27, 43 

McCreery, Maj . George, 130, l46, ISO 

McGee, Ani ta Newcomb, 123,327-28 

McGee, Thomas, 80 

McGillyc udd y, Valentine T. , 65, 76, 77 

MCKinley, William, 95, 117,120,129, 193-94,204, 

230,233 
506 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

McVa)', Capt. Harian E., 165,204 

Madison Barracks, New York. 109 

Magoon, Charles E., 250 

Ivl(IiIlC (hospital ship), 223 

Malaria, 3, 67, 8 1-82, ISO, 154, 159, 182,212,213, 

216,221 

causes of, 28, 93, 95,105, 130, 134, 136, 1391141 , 

150, 152, 190,248,290 

in China, 224 

chronic,294 

in Cuba, 230, 236, 251, 276-77 

danger of, 365 , 394 

diagnosis, 151, 173, 176, 179, 192,217,258,290, 

292 

and dysclllcr)'. 2 17, 288 

faleipm"" , 150, 151, 160, 190, 270-71 , 289 

immunity to, 270-7 1 

in Mex ico, 399 

in Panama, 257, 263- 64, 270-72, 276-77 

in lhe Philippines, 2 L7, 285, 289, 290, 305-06, 

3 101161 ,3 1 JII65 

prevention of, 102- 03, 130, 221, 248-49, 276-

77,357,395 

in Puerto Rico, 258, 260 

symptoms, JI2, 164, 175,217 

transmission of, 150, 229, 230 

Malta fever, 263 

Manila, Philippine Islands, 133, 135, 164-65, 166-

67,201, 202,204, 206,207- 08, 209-10,212, 

213,217,2 18,219, 288, 289, 290-9 1, 293, 294, 

296,299,300,305,306,307114, 328,331,339, 

340,341,348-49,354 

Board of Health , 285-86, 290-9 1, 295, 296-98, 

300,301,302,3091133,30911 34 

ccnsus, 295 , 298-99 

fire, 300 

Manila Bay, 117, 164 

Manuals (Medical Depart menl), 119, 214.332,333, 

339-40 

Mariel, Cuba, 132 

Marine Hospital Service, J57, 159, 174, 187,234, 

235,241,2531121 ,257,260,261, 297,339. See 

also Public Heallh and Marine Hospital Serv ice; 

Public Heahh Servi ce. 

Marshall , T. R., 309,1 35 

Massachusells Vo luntee r Aid Associati on, 1.87-88, 

190 

Ma tanzas, Cuba, 233 

Ma tanzas and Santa Clara, Depanment of, 23 1-32, 

233,239,252116 

Ma trons (civilian housekeepers), 18 

Maus, LL CoL (Vo L) Louis M., 178, 179, 180, 294, 

302-03,309113 1,3091135 

Ma)', Glenn 1\., 31011 61 

Ma)'aguez, Puerto Rico, 164 

Ma),o, Charles H., 379-80 

Meacham, Maj. (Vo l.) Franklin A. , 297-98, 30911 33, 

3091135 

Measles, 130, 132-33,362,402,403 

Medica l and SurgiCl/ 1 HislOlY oj rhe War oj fhe Rebellioll , 28-30, 31, 3711 73 

Medical Association of the Distri ct of Columbia. 56 

Medical boa rds, 173, 190-93, 262, 285-93, 314, 

332,348,357,358-59,362,387,415. See ,,/so 

Boards of health; Havana Yellow Fever Commission; Philippine Tropical Disease Board; TyphOid Board ; Ye llow Fever Board. 

Medical chests, 117, 124,134, 143,222-23 

Medical Corps, 321, 379, 381-82, 386, 387, 401, 

405 

Medical directors 

Civil War, 30 

of military districts, 1.3,63-64 

responsibiliti es of, 12- 13, 15 , 16, 63- 64, 102 

Medical educmion, 4, lO, 15, 17, 25-26, 93, 97 , 

99- 100,320 

Medical inspectors, 12, 127, 135, 299, 300-301, 

303,304,322,347-48 

Medical labora tories, 28, 43, 50, 94, 107, 108-09, 

11 2, 164 

Meclicallibraries, 26-27. See also Surgeon General's 

Library. 

Medical officers, Medi cal Reserve Corps, 322-23, 

334,348,377,381,382, 386,401 

benefits, 322, 323 

duti es, 323, 357, 386, 387, 394-95 

qualificati ons, 322, 323, 364 

tra ining of, 322, 323, 378, 382-83, 386, 415 

Medical officers, Regular Army 

administrative duties, 52-53, 96, 97, 119, 120, 

121 , 152, 174, 188, 193, 208,250,3 18,324, 

332,335,364- 65 ,378, 403,405,406,414-15 

aSSignments, 52, 53, 64, 69-80, 82,13811 29, 163, 

18 1,364-65,379,400, 404 

black Ameri cans, 320 

in China, 220-24 

competent)' of, 81, 188, 193 ,391 

in Cuba, 233, 250-51 

deaths of, 42, 165 

demobili zati on of, 11 

detailed to Freedman's Bureau, 21 

detailed to Red Cross, 405 

disabled, 17, 149-50 

and disaster relief, 368--69 

disease among, 1.49-50 

education of, 53, 78 , 99-100, 188 
INDEX 

Medical offi cers, Regular Army-Comillucd 

engineering responsibilities, 42 , 52, 97 

entrance examinations for, 12, 13- 15, 18,78,3 19, 

320,381,382 

foreign servi ce, 316-18. See a/so subheads for parti cular coullIries. 

leave, 16, 72,96-97,212 

morale, 13 

as municipal sanitary ofricers, 233, 250-51 

with National Guard units, 55, 112, 334-35, 

386-88,400 

numbers of, 12, 15,96-97, 11 9,127-28,319-20, 

321,381 

in Panama, 265, 275 

paperwork, 43, 97, 121 

pay, 13,81,319, 321,381 

in the Philippines, 133-34, 202, 212, 213, 214-

16,285,295,301-04 

planning by, 69, 78, 84--85 

and private practice, 56, 262, 321 

promotions, 13-16,341129, 120,3 19-20,321 

in Puerto Rico, 163, 257,258-63 

on punitive expedition, 397 

rank, 4, 12, 15, 16, 17, 341129, 319, 320, 321-22, 

407113 

research by, 239-46, 262, 3 17-18 

responsibili'ies, 43, 56, 96, 109, 119, 152, 157, 

214,320,324-25,369,378,394,406 

rCL iremcm , 17,321 

shorLagesof, 16-17,53,64,69, 117, 118, 120- 21, 

150, 158, 176, 188, 194,202,212, 213-16,318, 

320-21 ,323-24, 377,38 1, 400, 415 

specialists, 381 

standards for, 13,320 

leaching responsibilities, 17,53-54,96, 101 , 112, 

119, 120, 181,314, 334-35,386-87,388,394, 

406, 415 

!raining of, 14, 17- 18,53, 97-98, 112, 118,318, 

3 19-21,324-25,332 , 338,378,381-82 

on transport ships, 134, 157-58, 206, 208, 3 19 

for U.S. Volunteer units, 3 18-19 

Medical orncers, U.s. Navy, 15, 18-19, 52, Ill, 147, 

214, 220- 22, 260, 265,395 

Medical offi cers, U.S. Volunteers, 11 , 12, 2 1, 121, 

128, 129, 173, 177 , 318- 19,320,323,364 

aSS ignments, 120, 129, 177-81, 185 , 191 

in Cuba, 149-52, 230,231,233,235,253111 4 

in the Philippines, 165, 166, 209, 220-2 1, 297, 

3091133,30911 35,319,320 

in Puerto Rico, 258 

training of, 120, 121 , 332 

Medical purveyors,8, 10, 12, 13, 15-16, 56, 134,180 

Medical records, Civil War veterans, 24-25 

507 

Medi cal research, 30, 95- 96, 99-100, 239-46, 248-

49, 250,262,265,266, 271,276,277,285-93, 

294,305-06,30811 23,317-18,323-24,350-

51,361,382,414-15 

Medi cal Reserve Corps, 322-23, 334, 348, 357,364, 

377,378,381, 382, 40 1, 41 5 

Medical schools, 15,96,97,99-100, 120,320, 324, 

381,382,404 

Medical statistics, 29-30 

Meclical Statistics oj tile Provost Marsha l Gellel'll/3: 

Bureau, 9-10 

Medical sLO rekeepers, 12, 15-16, 72 

Medical supplies 

for Cuban expediti on, 13 1-33, 141 , 143-44, 146, 

157 

for disaster relief, 369, 37 1 

dimibu'ion of, 12, 124, 125-26, 2 19, 339-41, 

390,395,397, 41 5 

and equipment, 84-85, 118 , 124, 134, 144-45, 

176,339-41 

for the Freedmen's Bureau, 21 

for military expeditions, 63, 64, 67, 69, 70--71, 

76, 222-24,364 

for the Nati onal Guard, 96 

for Panama, 266, 267, 268 

for ' he Philippines, 134, 165, 166--67, 2 19-20 

planning fo r, 69, 11 7-19, 124, 131 -33, 134, 136, 

194,333,339-41,390,406 

for posts in the West, 4, 64 

for Puert o Rico, 162-63 

for punitive expedition, 397 

purchase of, 12, 13, 124, 127 

reserve, 132, 194, 333, 339-41, 371 , 378-79, 

388-89,406, 415 

shonages of, 53, 69, 112, U 8, 128, 131, 156, 

176-77, 182, 194,219,266,267 

for Spanish-American War, 124-27, 180, 186, 194 

standardization o f, 388-89 

,abies of, 125, 126, 186 

testing of, 28 

transportation of, 64, 69-70, 74, 76, 124-26, 127, 

162, 187, 188, 194, 223,340-41 ,362- 63 

wartime need, 339-41, 390 

Medical supply officers, 13 1 

Medi cines. Sec also individual names of speci fic 

medicines. 

emeti cs, 288-89 

Indian, 83 

prophylactic. 352 

shonages of, 128, 177, 2 19 

supplies of, 11,53,72,77-78, 120, 124-25, 131, 

143-44, 147, 156, 163, 176-77, 1.81-82,212, 

233 ,275,340,371,378-79,388 
508 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Meister, LI. William B. , 354-55 

Memphis, Tennessee, 229 

Meningitis, 305 

Mental illness, 218-19, 272-73, 276, 300, 306, 350 

among medical office rs, 82 

alllong soldi ers, 76-77, 355 

Mercury. 350-51 

Merrill, Maj. Gen. Wesley, 76, 133-34, 135, 164, 

165, 201 

MClchn ikoff, Elie, 95 

Meteorological reports, 23 

Mex icans, care of, 79, 393, 394-95 

Mexico,406 

border skirmishes with, 78, 334, 363-65 , 377, 

379,381,382,383-84,386,387,389- 90,391, 

392-403, 405 

punitive expedition to, 397, 399 

M iami, Florida, 178 

Michigan National Guard, 55 

Microscopes, 3, 10, 28, 29, 30-31, 95 , 98, 186, 

191-92,231 

Microscopic photography, 27,28,95 

Miles, Maj. Gen. Nelson A. , 79, 84, 117, 11 8, 129, 

152-53, 154, 156,159,160,162,163,239 

Militar)' Affairs, House Com miuee on, 383 

Militar)1 dependents, medical care for, 56, 96, 337. 

339,391 

Military Evacuation COlllmission (Cuba), 230-31 

Military gove rnments 

Cuba, 229-33, 243, 25211 6, 25311 14 

PuerlO Rico, 257 

Mililar)1 maneuvers, 332-34, 335, 34511 64, 347, 

363-64, 392-404 

Milifmy Swgeol1, 32 1, 381--82 

Military Surgeons, Association of, 102, 1131126,326 

Military Surgeons of the National Guard of the 

United Stales. Association of. 55 

M ilitia Affairs, Army Division of, 363-64, 385-86 

M ilitia Bureau, 386 

Mindanao, Philippi ne Islands, 30 1, 33 1 

Mission, Texas. 402 

Mississippi,402-03 

Missouri, 42 

Missouri (hospital ship), 157, 206 

Missouri, Division of the, 63-64, 67, 76, 84 

Missouri River, 70, L03 

Mobile, Alabama, 4 J. , J.84 

Mobiliza tion cam ps, 193 

disease rates at, 173-76, 178, 182, 184-86,378 

location of, 183 

sanitation problems at, 173, 175-76. 1.78, 181, 

182, 183, 184 

Modoc \.var, 66 

Modocs, 67, 80 

Montauk POilll , Long Island, 186--91 

Moore, Brig. Gen.John, 9, 10, 18,22,24,32118,52, 

54,55 

Morale 

effect on disease incidence, 82 

of medical officers, 13 

of soldiers, 45-46, 47, 150, 159, 164,218 

Morgan, W illiam G., 3711 73 

Mosquitoes, 81-82, 213, 216, 263, 298 

Aecles aegypti, 40, 151, 152, 186, 24 1, 244-45, 

247,248,251,25411 40,266,269-70,271,290 

Allopheles, 150, 247, 248-49, 270-72, 290, 306 

connec tion tomalaria, 105, 130, 133, 134.1391141, 

229,230,263-64,265, 270-72,285,3101161 

CIlIe..Xjtllig(IIIS.290 

and dengue, 289-90 

eradication of, 247, 266, 269-72, 273, 276-77, 

357,363,364,394 

netting, 11 0, 130, 1391141,216,230,248-49,270, 

290,299,365 

and yellow fever, 241-46, 247, 248-49, 25 1, 

25411 41, 265,266,268, 269-70 

Motorcycles. 389 

Mount Vernon Barracks, Alabama, 8 1, 82 

Mules 

purchase of, 4-5 

taken to Cuba, 132, 145 

uscd for food, 77 

used as pack animals, 64, 74, 75, 76 

used to transport paticnts, 65-66, 7 1-72. 76, 204, 

209 

Munn., Maj . Curtis E., 73, 74, 78, 83 

Munson, LL Col. Edward l., 104, 106, 324, 325, 

340,359-60,379,403 

Murray, Brig. Gen. Robert, 8-9,10, 19,22,23-24, 

25,31,51 

M usgrave, Wi lliam E. , 287-88 

Mutter Museum, 108 

Nagasaki, Japan, 222, 223 

Narcotics, LOS, 2 18, 350. See a/so Cocaine. 

National Board of Health, 41, 58118 

National Defense, Council of, 380 

Na tional Defense Act of 1916, 377, 379, 380, 382, 

383,384,385,387,404,405,406 

National Guard 

assistance to, 17,55, 112,335-36,340 

dentists, 386 

hospital corpsmen, 55, 122, 334-35, 363, 386, 

387-88,401 

medical officers assigned to, 55, 11 2, 334-35, 

386-88,400 
lNDEX 

National Guard-Conlinued 

medical organi zation, 385-86 

medical supplies ror, 96, 348-49, 388, 400 

on Mexican border, 393, 397,399, 402 

sanitary detachments, 386, 387 

state units, 55, 117, !l8, 120, 173,369,370,377, 

386,387 

surgeons. See Surgeons, National Guard. 

tra ining, 322, 323, 378, 399-400 

llsed to suppress labor violence. 109 

ve lerinarians,386 

National library of Medicine , 26 

Naturalists, 57 

Navy Medical DepanmclH , 389 

Navy Nurse Corps, 328 

New Mexico, 387, 397, 401 , 402 

New Orl eans, Louisiana, 11-12 

New York City, 157, 159 

death rale in , 229 

supply depo t, ll- 12, 126--27, 180, 23 1, 340, 

388-S9 

New Yo rk Slale National Guard, 402 

New Zealand Army, 353 

Newpon News, Virginia, l 59 

Nez Perces, 80 

Nichols, Maj . Henry j., 288, 293, 350-51, 4101170 

Nogales, Arizona, 392, 401, 402 

Nurses. See also Army Nurse Corps; Hospital 

corpsmen. 

in China, 222, 223 

civilian, 206 

contrac t, 123, 174, 177, 189, 212, 214, 266, 

283-84,327 

Cuban, 156 

female, 11, 18, 123-24, 156, 158, 162, 174, 177, 

182, 185, 188-89, 206, 212,213,214,222, 223, 

276,327-28, 384 

hOUSing for, 212, 223, 328, 384, 395 

naval, HI 

numbers of, 383-84 

pay, 174,384-85 

qualifications, 18, 123, 174,327 

quality of, 182 

Red Cross, 147, 162, 174, 177, 182,369,383,384 

reserve, 327-28 

shortages of, 123, 162, 174, 188, 194, 383-84, 

390 

sisters (religious order) , L23, 158 

training, 19, 100, 174,327,328,384 

volunteer, 174, 177, 194 

for yellow fever patients, ISS-56, 157 

Nursing schools, 18, 123,327-28 

Occupation armies, 122-23, 183, 185 

in Cuba, 186,229,230-51,321,351 

509 

in Philippines, 201-24, 225115, 293-95, 296, 298, 

329,351,361 

planning for, 23 1 

in Puerlo Rico, L64, 186 

Ocu liSLS, 179 

O fficers' Reserve Corps, 382 

Olil'ef/ e (hospital ship), 132-33, 143, 144, 147, 

156--57, 160 

Operating kits, field , 124 

Operating rooms, 25, 86, 107-09, 1l2, 130, 135, 

147-48, 165, 189,204,22 1,361, 401,414 

Opiates, 4, 219 

Ordnance Department, 4, 611 8, 16,331124,99, 32 L, 

341 

Oregon National Guard, 369, 370 

O'Reill y, Brig. Gen. Robert M. , 107-08, 11511 54, 

230-31, 232-33, 238, 25311 12, 2531113, 265, 

268, 288, 289, 315- 16, 3 17, 320-21, 322, 

323-24,328,329,330,332,334,339,340-41, 

348,349,356,362,363,369-70,388 

O rganization (Medical Department), 12, 17, 

1131113, 121,313-42,382 

O rganized Militia . See National Guard . 

OsIer, W illiam , 105 

Otis, Maj. Gen. (Vol.) Elwell S., 201 , 202 

OtiS, Maj . George A., 28, 65 

Pablo Beach, Florida, 179-80 

Pacil1 c, Depanment of lhe, 133,201,202 

Pacil1c, Division of the, 63-64, 365, 370 

Pack animals, 64, 65-66, 70, 74, 75, 76 

in Pueno Rico, 259 

taken to Cuba, 143 

training of, 65-66 

used to transport patients, 65-66, 71- 72 

Panama Canal Commission, 268-69, 272, 276-77 

Panama Canal Zone, 263-78, 324, 380, 391 , 395 

Department of Health, 265-66, 272-73, 275, 

2811130 

government, 277. See a/so Isthmian Canal Commission; Panama Canal Commission. 

Panama City, 264, 266, 268, 270, 273, 275 

Panay, Philippine Islands, 213 

Paperwork, admi nistrative, 23, 43, 121- 22, 212, 

214,331,403, 415 

Parasites, 290 

Ell /amoeba coli , 287-88 

Ellf,allloebalJisLoiy Li ca , 287-88 

Giardia /amblia , 288 

hookworm, 260-63, 272, 277, 279111 5, 402- 03 

Treponema palliliutll , 349 
510 THE ARMY M EDICAL DEPARTM ENT, 1865-1917 

Paratyphoid, 399, 402 

Pasteur, Louis, 25, 95 

Pathological anatomy, 27-28 

PalhologiSls, 176, 287 

Pathology, science of, 27-28 

Pallerson, Maj. Robert U., 324, 369, 405 

PaLzki, Capl.Julius H., 75, 76 

Paulding, Ll. Holmes 0., 69, 70, 71, 72-73 

Pay 

hospital corpsmen, 21 , lOL, 331, 384-85 

medical office rs, nava l, 18-19 

medical ofricers, Regular Army, 13,81,319,321, 

38 1 

nurses, 174,384-85 

Pay Depa rtment, 3311 24 

Peking, China, 222, 223 

Penrose, Maj. (Vol.) George H., 166, 167 

Pensacola, Florida, 40-41 , 81 

Pension Bureau, 23 

Pensions, Civil War veterans, 7, 23 

Permanent Commission for the Suppression of 

Uncinariasis in POrlO Rico, 262 

Pershing, Brig. Gen. JohnJ. , 397, 399, 402 

Personal hygiene, 49, 55, 216, 219, 231-32, 259, 

291,347-48,404-05 

of Filipinos, 294--95, 299, 305 

of Indians, 83 

instruction in, 17, 134, 18 1,325, 400--40J 

post surgeons responsibili ty for, 47, 96, 102 

on ships, 135 

Petitions to Congress, 16 

Phalen, Cape James M. , 288, 293 

PharmacislS, 18-19,54,332,370,387 

Pharmacy, schools of, 21 

Philadelphia, Pennsylvania, 11- 12, 184, 405 

Philippine Commission, 295 

Philippine Ex peditionary Force, 133, 148 

Philippine Insurrection, 20 1- 04, 285, 306, 337, 

339,340 

Philippine Islands, 117, !l8, 122-23,331,340,353, 

355,357,360,361,389,391 

Civil Service Board, 295 

medi cal boards, 25411 35. See also Philippine Tropical Disease Board. 

medi cal care for Filipinos, 215, 219, 220 

med ical evacuees, 336-38, 339 

prostitution, 351-52 

public health organi za tions. See Boards of health ; 

Public heahh. 

u.s. expedilion 10, 133-36, 141, 148, 164--67, 183 

U.s. occupalion of, 201-24, 225115, 293-95, 296, 

298,329,35 1, 361 

Philippine SCOUIS, 291, 292, 304, 319, 329, 349-50 

Philippine Tropical Disease Board, 113111 1, 285, 

287, 288, 289-90, 291, 292, 293, 295, 304, 

305-06,307n4,308111 9,314,326,361 

Philippines, Division of Ihe, 202 

Photomicrography. See Microscopic photography. 

Physical exhaustion, 216, 397 

Physical fil ness, 28, 48-49, 103, 120 

Physicians, civilian, 56, 109-12, 179,321,322, 334, 

335,349,367,368,369,370,378,379,382 , 

414, 415 

fee-for-visit, 15-16, 18 ,53 

foreign. See Physicians, foreign. 

short ages of, 16-17 

Physicians, foreign 

Cuban, 147, 234,237-38 

Filipino, 295, 296, 302, 305 

Puerto Rican, 258, 259, 262 

Spanish,296 

Swedish Navy, 147 

training of, 295-96 

Physicians, U.s. military. Sec Medical officers. 

Pilcher, Capt. James E., 103 

Pina r del Rio Barracks, Cuba, 238 

Pine Ridge Reservation, Soulh Dakota, 84-87, 90,1 67 

Pi nkham, U . Edwa rd W., 289 

Plague, 263,273,290-91,294,300,302, 306,324 

bubonic, 204, 218, 291 , 293 , 297 

pneumonic, 29 1 

Planning(Medi cal Depanment), 112, 131, 134, 136, 

141 ,313-14,332-36,339-40,381 

Plaue, Department of the, 67, 69, 84-85 

Plattsburg Barracks, New York, 129 

Pleurisy, 49 

Plumbers, 44, 45 

Pneumonia , 49, 273, ~75, 360, 402 

broncho-, 82, 402 

causes of, 28,95 , 133 

epidemics, 402 

and plague, 29 1 

Ponce, Puerto Rico, 160, 162, 163-64, 257 , 258, 

260--61 

Pope, Ll. Col. (Vol.) Benjamin F. , 24, Ill, 112, 129, 

130, 13 1, 132-33, 134, 1381136, 143-44, 145, 

147, 150, 154, 156,158 

Port Tampa, Florida, 130, 131 

Port er, Henry R., 71, 73 

PortO Bello, Panama, 272, 273 

POSI surgeons, 3, 4, 12- 13,14, 17,23,39, 44, 47, 

63- 64, 69, 102, 107, 219, 296,303,319,323, 

331,352,353,361,368 

off-duty pursuits, 55-57, 321 

shortages of, 15-16,64,212-15 

leaching responsibilities, 53-54, 387 
INDEX 

Postoperative care, 106-07 

Potassiulll permanganate, 43 , 51 

Powder River, 69, 70, 73 

Powell,Junius L, 75, 89,132 

Prau, Enoch, 95 

Presidio military poSt. See San Francisco, California. 

Preventi ve health measures, 4, 39-49, 97,102-06, 

134,318,413. See a/so Sanitation. 

Prisoners of war 

Filipino, 208, 210, 215, 291 

Spanish, 146--47, 160,2 18 

Promotions 

of contrac t surgeons, 14-15, 320 

of delllisls, 383 

of hospital corpsmen, 330 

of medical offi cers, 13, 14-15, 16, 341129, 120, 

319-20,321 

of ve terinarians, 385 

Prophylactics, 352-53, 354, 394, 395, 399, 401- 02 

Prostheses, 7 

commutat ion payments in lieu of, 22 

dental , 108 

for President Cleveland, 108 

for ve terans, 7, 13, 21-22 , 96 

Prostitutes, 218, 239, 351-52, 395, 399, 401-02, 

403 

Providence Hospital , 23 

Provost Marshal General's Office, 9-10 

Prussian Army, 355, 360 

Public health, 28, 5811 2, 94, 97 

in Cuba, 229-5 1 

laboratories, 93-94 

in the Panama Canal Zone, 263-76 

in the Philippines, 285-306 

in Puerto Rico, 257-63 

Public H ealth and Marine Hospital Service, 2531121 , 

262, 265,273,296, 305--D6, 319. See also Marine Hospital Service; Public Health Service. 

Public health campaigns, 229, 232-34, 236, 238, 

247-51,257-78,285-306, 414 

Public health movement, 3, 39, 43, 229 

Public Health Service, 253112 1, 263, 389. See (1/50 

Marine Hospital Service; Public Health and Marine Hospital Service. 

Publications (Medical Department), 28-29, 371173 

Puerto Principe, Cuba, 232 

Pueno Rico, 141 , 148, 156, 157, 160-64, 166, 178, 

277, 324,329 

public health organization. See Board of health; 

Public health. 

veterans of, 128, 186 

Puerto Rico, Department of, 258, 260, 2791111 

Pullman cars, 128-29,401 

Pullman Company, 109 

Pulmonary tuberculosi s, 49 

Punitive expedition. See Mexico. 

Purgatives, 176-77 

Purging, 4 

511 

Quarantines, 42-43, 157, 164, 187, 189,235,236, 

246,248,265,273,302,304,402 

Quartermaster Corps, 364, 385, 390 

Quartermaster's Department, 4-5, 6118, 16,331124 , 

124,125,127,131-32, 166, 176, 177,183, 187 , 

188, 219, 224, 277, 340, 341, 357, 359, 362, 

364 

Quemados, Cuba, 238-39, 240-41 

Quinine, 3, 70, 112, 124-25, 130, 131, 150, 151, 

156, 192,217,219,221,272,289,395 

Rabi es vaccine, 25 

Racial differences 

alcoholism, 354 

in disease susceptibility, 40, 42, 150, 291, 304 , 

306,353,355-56 

in fatalities, 40, 42, 304, 305 

Railroads, 4, 39, 46, 64, 75, 84, 86-87, 184, 208, 

210,212,219,223,275,362-63,369. See also 

Hospital trains. 

and labor unrest, 109-11 

problems with shipping by, 124, 125, 126, 131, 

187, 188 

Ration. See Diet. 

Rats 

as disease veclOrs, 273, 290, 291 , 302 

eradication of, 273, 297,301 

Reconstruction, 11 , 13 

Record and Pension Division (War Deparunent), 24 

Records management, 18-19,24-25 

Recreational ac tivities, 48-49, 103 

Red Cross. See American Red Cross. 

Reed, Charles A. L., 267-68 

Reed, Maj. Walter, 10,82,86,95,96,98,99, 105, 

191, 192-93,232,236, 239-47,248, 250,25 1, 

2551158, 265, 270, 276-77, 285 , 290, 315, 

338-39,348,357 

Reenlistment rates. 21 

Refugees 

camps fo r, 368-69, 370, 371, 393 

Civil War, 21 

Cuban, 152 

from Mexico, 393 

from San Francisco earthquake, 367, 368-69, 

370- 71 

Spanish, 152 
512 THE ARMY MEDICAL DEPARTMENT, 1865- 1917 

Refugees, Freedmen, and Abandoned Lands, Bu reau 

of, 21 

Regimental surgeons, 119, .1 21, 129,13811 29, 144, 

153-54, 166,179, 182,218-19,221,333,365 

Relicf (hospital ship), 132, 144, 147, 157, 163-64, 

174,206-07,214,222,223 

Reno, Maj. Marcus H., 71 

Reporl oj the Hygie'lf oj fhe United Stafes Army. With 

DescriptiO/Is oj Milifllly Posts, A, 27 

Report OIl Barraclls CIIut Hospila/s, Wilh Descril'liOlIS 

of l\tliliLary Pos/s, A, 27 

Respirator), diseases, 49, 273 

Retirement 

disabili ty, 17 

laws pertaining lO, 7,8-9, li. L 7 

Rheumatism, 70, 130 

causes or, 45, 74, 77 

discharges due to, 40 

treatment o f, 52 

Ri chard, Charles, 138,,33 

Ridgely, John, 73, 74 

Rinderpest, 286, 304, 305, 31011 61 

Ringworm, 218 

Roads 

in Cuba, 143, 145-46, 152 

in Mexico, 389 

in the Philippines, 166, 167, 201-02, 210, 213, 

218 

in Puerto Rico, 160, 258 

Rockereller Foundation, 380 

Rockereller Institute, 262-63 

Rocklin, CaM ornia, 111 

Roemgen, Wilhelm C, 148 

Roosevelt, Franklin D. , 3451153 

Rooseve lt , Theodore, 149, 150, 159, 264--65, 

268-69,321 

Root, Elihu, 202, 313, 314,317,321,34511 64 

Rosebud Creek, 67, 73, 75 

Ross, j ohn w. , 265, 28111 26 

Ross, Ronald, 13911 41,230,277 

Rough Riders, 149, 169,,1 9 

RO)lal College or PhYSicians, 26 

Rubber gloves, 51, 601139, 357-58 

Rushville, South Dakota, 86-87 

Russell, Maj. Frederick E, 113111 J, 348, 349, 

358-59,37211 2 

Russia, 220, 223 

Russian Anny, 34411 42, 360 

Russo-japanese War, 325, 34411 42 

Rutherrord, Capt. Henry H., 367-68 

Sacramento, Calirornia, IIO- L2 

Sl. Augustine, Florida, 81 

SL Louis, Missouri, 369-70 

supply depot, 11-12, 126, 180,340,370,388-89 

water supply, 45 

S1. Louis Barracks, Missouri, 72 

Salvarsan, 350-51 

Samar, Philippine Islands, 213, 215 

San Amonio, Texas, 363, 364, 401 

San Diego, Calirornia, 363, 364 

San Fernando, Philippine Islands, 210 

San Francisco, Calirornia, 174, 218, 316. 328, 337-

38,361,391 

dea th rate, 229 

earthquake, 365-7 1, 3751166 

general hospital, 288, 328, 361, 367. See also Letterman General Hospital. 

and Philippine expedition, 133, 134 

Presidio military post, LI 2, 133, 288, 328, 

337-38,355,361,367,369-70,371 

supply depot, 11-12, 126, 133,340,370,388-89 

San Francisco Earthquake Research Proj ect, 367 

San j uan, Puerto Rico, 163, 263 

hospital,257 

supply depot, 257, 340 

San j uan Hill , Cuba, 141, 145, 146, 147, 153-54, 

157 

Sanarelli, Guiseppe, 240-4 1 

Sanger General Hospital, 178 

Sanilar}1 inspectors, 233-34, 247, 258, 260, 262, 

269,271, 272, 297, 299, 322, 335, 357, 364, 

365,370,400 

Sani tary train, 363 

Sanitalion 

at Army encampments, L09, 120, L29, 152, 

175-76,178,181, 182, 183, 184, 185, 194,195, 

258,325-26,335,347-48,363,364,379,394 

in Cuba, 229, 231-34,236,247,250-51 

and disaster relier, 368 

at hospitals, 180--81 , 194,236,258,270,347-48 

at Indian prison racilitics, 81, 83, 84 

inspections, 194, 233-34, 236, 247, 249, 258, 

260, 262, 270, 297, 299, 364, 365, 369, 400 

in Mexico, 395 

municipal, 229, 233-34, 236, 247, 250-51, 

2%-97,395 

National Guard detachments ror, 386, 387 

at National Guard encampments, 55, 112, 173, 

363,400-401,403 

in Panama, 264, 266,267,270-75 

in the Philippines, 216--17, 219, 294, 296--301, 

302 

planning for, 93-94, 379 

on posts, 13,39,43,44,96, 102,180--81,347-48 

in Puerto Rico, 258, 260-62 
INDEX 

Sani lal ion-Comillucci 

in rerugee camps, 368-69, 370-7 1 

regulations, 23 1-32, 250-51, 260, 262 

responsibili ty for, 13, 96, 119, 175, 184, 192, 324, 

347-48,363,386-87, 400 

training, 324, 335, 363, 400, 406 

on Inmspons, 135, 157, 158 

in trench warfare, 404-05 

and typhoid, L92,216-l 7 

and volullleer troops, 130, 133, .1 73 

and yellow fever, 229, 237-39, 246, 247, 264, 266, 

267 

Santa Clara, Cuba, 238 

Santa Cruz, Philippine Islands, 212 

Santa Mesa, Philippine Islands, 206, 208, 22511 9, 300 

Santiago, Cuba, 129, 13 1, 141, 143, 145, 147, 148, 

150, 152, 153, 154, 155, 156, 157, 174,230, 

232,233-34,235-36,238,241, 253n14 

Santiago and Puerto Principe, Department of, 237, 

238,239,25211 6,25311 14 

Santiago Bay, Cuba, 156-57 

Savannah, Georgia . 186 

5call<iill (hospital ship), 206 

Schofi eld, Maj. Gen. John MeA., 95 

Schwan, Brig. Gen. (Vol.) T heodore, 185, 209 

Scientifi c medicine, 25-26 

Screens, 243-44, 245, 247, 266, 269-70, 27 1, 275, 

277,305- 06,357 

Screwworm, 259 

Scurvy, 3, 46, 67, 73, 74, 77, 149,291- 92 

Seattle, Washington, 229 

Second Reserve Hospital , 204, 205, 207-08, 225'1 9, 

300 

Semig, Bernard , 80 

Senn , Co!. (NG) Nicholas, 117, 120, 123, 149, 152, 

156, 169111 8, 189 

Serums, immunizing, 285-86, 29 1, 293,301,304 

Sewage s),stems, 3, 43, 94,204,229,347-48,358-

59,363,365 

in China, 221 

conslruclion or, 44-45, 52 

in Cuba, 232, 234, 236, 237 

lack of, 165 

in Mexico, 395 

in Panama, 265, 273, 275 

in Ihe Philippines, 297-98, 299, 306 

problems Wilh, 180-81 

ventilalion, 44-45 

Shafter, Maj. Gen. (Vo!.) William R., 129, 131, 132, 

133, 141, 145, 147, 149, 150, 152, 153, 154, 

155-56, 157, 158, 159- 60 

Shakespeare, Maj . (Vol.) Edwin, 19 L, 192-93 

Sheridan, LI. Gen. Philip H., 76, 78 

513 

Ships 

cargo identificalion, 13 1-32, L34, 156, 162-63 

Concho, .1 58 

disinrec tion or, 157,247-48,317 

Far West, 70-71, 72, 73, 76 

hospital. See Hospital ships. 

IroqUOiS, 156 

MlIilIC, 117 

Marine Hospital Service, 234 

medical personnel on, 134, 206, 208, 2 14, 221, 

222,362,383-84 

quarantines or, 248, 273 

Se/l ew , 158 

shortages or, 207 

steamers, 70-71, 72, 73, 144, 147, 156, 162 

as supply depots, 64 

as transporters of disease vectOrs, 40, 159, 246, 

248, 273 

transports, 132, 135, 156, 160, 207-08, 212, 222 

unloading difficulties, J43, 146, 147, 156, 165, 

166- 67 

used 10 transport medical supplies, 70, 130-32, 

134, 141, 147, 156 

used to transport patients, 72, 73, 147, 156-59, 164, 

188, 190,206-07,208,209- 10,212,2 13,223 

ventilation problems, 132-33, 135, 158 

Shoes, 2 19,359-60 

Siboney, Cuba, 141 , 143, 144, 146-47, 149, 150, 

152-53, 154, 155, 156, 157, 158, 230 

Sick and wou nded reports, 23 

Sioux, 67-73, 76,84-85 

Sisters of Charit)" 163, 189,276 

Skin problems, 218, 293 

Slaves, rreed, 7,2 1 

Sli m Bunes, Dakota Territory, 77 

Sloan, Maj. Williamj., 69, 70, 72, 73 

Smallpox, 249, 294 

epidemiCS, 218, 237-38, 257-59, 301-02 

immunization, 3, 3711 75, 39-40, L33, 23 1, 

237-38,248,258,259,273,30 1,347,370,387, 

393,395,399 

isolation orpalienls with, 204, 236, 237,300,30 I 

protection rrom, L64,301 

Smart, LI. Col. Charles, 29, 104-05, 182 

Smithsonian Institution, 57 

Snow,John,41 

Society of American Bacteriologists, 245 

Solace (hospital ship), 156-57,222 

Soldiers' Home (Hot Springs, South Dakola), 86 

Soldiers' Home (Washington, D.C.), 22-23, 96, 190, 

339,356 

South Carolina, L85 

South Dakota, 84 
514 TH E ARMY M EDlCAL DEPARTMENT, 1865-1917 

Southern Departmcl1l, 386, 390, 391-92, 400, 401 

Spain, 11 7, 118, 131 ,135, 141, 164,230-3 1, 257, 

258, 285 ,293,296,300,303 

Spanish-A merican War, 118-36, 141-73, 194, 3l3, 

314,316,318-19,322,337,340-41 ,364,377, 

378,413, 415 

Spanish troops, 141,143, 160, 164-65, 1. 67, 230-31 

repatriated, 160 

sickness among. 148. 160, 233 

Spink, Wesley W , 41-42 

Spotswood, Dillon]. , 83 

Sprue, 263 

Stanlon, Edwin M., 7 

Staphylococcal infec ti on, 98 

Starvation, 46, 64, 76-77, 78 

Stephens, Charles R. , 73, 74 

Sterilization, 25, 107, 130, 148, 187,401 

Sternberg, Brig. Gen. George M., 30, 3711 75, 40-4 1, 

42,80,94--98,99-100,10 1. ,102,105, 106, J 07, 

108, 112, 11 7-19, 122, 123, 124, 125, 126, 128, 

129, 131, 133,134, 13911 11 , 116, 150, 151, 1.52, 

158-59, 162,164, 173, 174, 177-78,181--82, 

186, 187, 190, 191, 192, 194, 212, 214, 220, 

230,231 , 237, 239-41,243,244,246,250,251, 

264,290, 291, 293,314,316,319-20,338,340, 

347,355,361,113 

Stevens, Richard H. , 75, 76 

Stil es, Charl es W , 260, 26 1, 290 

Stimson, I-lenr)' L., 313-14, 359 

Storage faci lities, 4-5 , 126-27 

Straub, Maj. Paul F., 325 

Street cleaning, 233- 34, 236, 258, 266, 295 

Streptococcal inrection, 74 

Stress, 397, 399 

Stro ng, Lt. Ri chard r, 287- 88, 290-9 1, 293, 295, 

30711 4 

Strychnine, sulphate of, L04 

Subsistence Department, 4, 47 

Summers, Maj. John E. , 69, 72, 73, 76, 77, 78 

Sulphonal, 177 

Sunstroke, 149, 158 

Suppl}1 depots 

10cati ol1 of, 4, 11-13, 70, 100, 340, 341, 370, 

388-89,397 

ror military expeditions, 70, 75 

ror occupation armies, 23 1, 257 

ships used as, 64 

ror Spanish-American War, 125-26, 131 

wartime, 117, 119, 180, 333, 388-89, 397 

Surgeon general 

ann ual reports, 19, 28, 3 1, 34,,29 

rank, 4, 1.2, 380,40711 3 

responsibilities, U 8, 119, 128, 174, 178, 380 

Surgeon General's library, 26-27, 30, 40-41, 3 17, 

319,326,338- 39 

Surgeon General's O frice, U8, 316-18, 4 15 

Army Nurse Corps Division, 123 

Finance Division, 12 

Hospital Corps and Supply Division, 96 

library and Museum Division, 25, 361157, 361158, 

96,99,381 

PrOperl}' Division, 12 

publications, 27, 47, 11 9 

Record, Correspondence and Examining Division, 96, 38 1 

Record and Pension Division, 23-24 , .129 

responsibilities, 7, 1 L8. 34 1111 3, 381 

Sanitary and Disbursing Division, 96, 182 

Staffing of, 12, 96,315,316--17,38 1 

veterans' dealings with, 22 

Surgeons, contract. See Contract surgeons. 

Surgeons, corps. See Corps surgeons. 

Surgeons, division. See Division surgeons. 

Surgeons, National Guard, 5 1,611155, 10 1-02,336, 

385-88,390,400,403 

examinations ror, 55, 120,335-36, 387 

numbers of, 382, 386, 415 

short ages or, 386 

training of, 55, 120,314,3 19,320,324--25,326, 

334-36,363,364,382,383,388,415 

Surgeons, post. See Post surgeons. 

Surgeons, Red Cross, 158, 162,369 

Surgeons, regimental. See Regimental surgeons. 

Surgery 

abdominal, 50--5 1, 67, 77, 98, 106--07, 148, 165 , 

166, 216, 289,347,357-58, 414 

dressings for, 131, 144 

emergency, 275 

exploratory, 49-50 

fac ilities for, 25, 86, 107--09, 112, 130, 135, 

147-48, 165, 189,204, 221, 361, 401 ,414 

fear of, 3, 49-50,347 

gynecological, 106 

instruments for, 25, 1. 46, 148,340,388 

oral, 108 

performance by hospital stewards, 18-19 

prevention of infec tion during, 25,31,51,86,96, 

107, 148,317,414 

Surgical chests, 11 7, 124 

Surra, 304 

Sutherl and, Brig. Gen. Charles, 9, 11, 17,26,49,52, 

54,55,56,91,95 

Syphilis, 52, 93, 130,2 17- 18,293,349,350--51, 

352,353,391,394,399,402 

Taft , William H., 250, 267, 32 1, 370 
INDEX 

Tampa, Florida, 128-29, 130, 131, 132, 14 1, 144, 

146, 159, 180, 184,187 

Telegraph, 84 

Tennessee, 126, 185 

TenlS, 71, 77-78, 84-85, 86, 125,132, 143,144, 

146, 147, 149, 154, 155, 163, 165-66, 167, 173, 

176, 177, 178-79, 181-82, 183, 184,204,231, 

300,347,356,367 

Terrain, 70, 78, 79, 143, 201, 202, 204, 208, 

209 

Terry, Brig. Gen. AI[red Ii., 67, 70-7 1, 72, 73, 76 

Tetanus, 28, 93, 105, 251, 305 

Texas,42,47,387,392,394,40 1,402-03 

Texas Cit),. Texas. 354.365 

Thomason, Capt. Henry D. , 335, 336, 364 

Thoroughfare Gap, Virginia, 183-84 

Thymol,261 

Tientsin , Bau lc of, 221-22 

Tientsin, China, 22 1, 222, 223 

Tihon,Jamcs, 361161 

Tokyo,Japan , 291 

Toral , Generaljose (Spain), 160 

Torney, Brig. Gen. George Ii., 289,316, 3 17-18, 322, 

323-24, 326, 327, 331-32, 333-34, 335-36, 

339,341,342111 3,349,350-51,352,353,354, 

356, 357, 359, 360, 362-63, 364-65, 368, 

369-70,371,380,383 

Training 

of ambu!<mce aucndants, 19 

camps, 182,363-64,383 

for evacuation of wounded, 53-54, 55, 84, 85, 

98-99,324,332, 363 

in nrst aid , 20, 53-54, 100, 101 

of foreign phYSicians, 295-96 

of hospi tal corpsmen , 21.53-54,85, 96, 100-101, 

122,155, 173, 181, 183, 184, 185,213,330-31, 

334-35,338 

of hospital stewards, 19 , 213 

of laboratory personnel , 176,330-3 L 

of liller-bearers, 53-54, 85, 96, LO] 

maneuve rs, 332, 3451164, 347, 363-64, 392-404 

manuals, 54 

o[medical omcers, 14, 17-18, 173,332,334-35, 

338,382 

of Medical Reserve Corps ofri cers, 322, 323, 378, 

382-83 

of National Guard hospital corpsmen, 101-02, 

173,334-35,388 

of National Guard surgeons, 55, 101- 02, 173, 

334-36,363,378,383,388 

o[ nurses, 19, 100, 174,327,328,384 

of san itar)' inspectors, 262 

for war, 332, 363 

515 

Transportation 

of medical supplies, 64, 69-70, 74, 76, 124-26, 

127, 162,223,340-41 

of patients. See Ambulances; Evacuation, med· 

ical; Travois. 

problems, 4, 64, 67-68, 128-29, 131, 143-44, 

147, 149, 152, 154, 167, 176,187, 188, 194 , 

219,224,362-63 

Travois, 65-66, 71 -72, 74, 76, 77, 167, 209, 362 

Trench warfare, 404- 05 

Truckee, California, 111 

Tube rculosis, 394 

in cattle, 259 

causes, 28, 82, 84, 93, 98, 355 

in China, 224 

in Cuba, 249, 351 

diagnosis, 355-56 

aillong Indians, 82, 84, 102 

isolation of patients with , 208, 256, 35 1, 355-56, 

391 

in Panama, 273 

in the Phi lippines, 294, 296, 306 

among soldiers, 355-56, 360 

trea tment of, 339, 356-57 

Typhoid [ever, 3, 67, 73, 77, 130, 132-33, 159, 160, 

288,360 

antibodies to, 11 511 46 

carriers, 192,349 

causes, 28, 29, 44, 93, 98, 103, 180-81 

in C hina, 221, 223-24 

in Cuba, 150-5 1, 153,23 1-32,236,251 

diagnosis, 93, 1151146, 151, 176, 178-79, 182, 

186, 192, 195,217,232 

epidemics, 173-74,175-78, 180-81, 183, 186, 

191 ,229,251 

immunization, 192,348--49,364,387,393-94 

immunity 10, 1971120 

in Mexico, 399 

in Panama, 275 

in the Phi lippines, 165, 212, 216-17,305-06 

preven tion, 102-03, 192,195,365,370 

in Puerto Rico, 162, L64. 258 

stud)' of. See Typhoid Board . 

transmi ssion, 176, 191-93, 223-24,349 

treatment, 105 , 176-77,349 

in Ihe Unitecl Stales, 173-75, 180-81, 182-85, 

187,363 

Typhoid Board, 191-93,314,348 

Typho-malaria, 173, 182 

Typhus, 393, 400-401 

Uncinariasis. See Hookwonn. 

Uniforms. Sec Clothing. 
516 THE ARMY MEDICAL DEPARTMENT, 1865-1917 

Union Army, 3, 12,29 

u.s. Infmu r), and Cavalry School, 17 

U.s. Marine Corps, LlO-ll , 222, 394 

U.s. Military Academy. See West PoinL. 

U.s. Navy 

in Cuba, 129,13 1, 144,281 11 26 

hospital ships, 156-57 

medical officers. See Medical offi cers, U .S. Navy. 

in Panama, 265 

in the Philippines, 133, 164-65 

quinine pills for, 13 L 

vaccines for, 348-49 

U.s. Signal Corps, 23, 403- 04 

U.s. Volunteers, 118, 120, 121, 122, 129, 130, 133, 

135, 137117, 148, 156, 1691119, 173, 1971132, 

216-17 

in Cuba, 230, 231 

hospital corpsmen, 122, 133-34,135, J63, 165, 

166,329 

medical supplies for, 124-25, 13 1, l 8 1-82 

in the Philippines, 202, 216-17, 3 18-19 

physicians. See Medical officers, U.s. Volunteers. 

Utley, Robert M., 8 1 

Vacc ines, 39 1-92, 402 

cholera, 293 

paratyphoid, 402 

rabies, 25 

smallpox, 3711 75, 2 18, 258, 259, 301, 347 

typhoid, 348--49, 393-94, 399 

Vaughan , Maj. (Vol.) Victor c., 149-50, 191 , 

192-93,348 

Vedder, Capt. Edward B. , 292-93 

Venereal disease, 163,349-54,40 1-02 

causes, 93, 134--35,349-50 

in China, 224 

diagnosis, 322, 349-50, 353, 391 

discharges due to, 40 

examinations for, 351-52, 353 

alllong Indians, 82 

in the Philippines, 217-18, 349-50 

prevention, 35 1-53, 394, 399, 40 1- 02 

among prostitutes, 35 1-52, 395 

ra tes, 49, 349-50, 353-54, 355, 395, 399, 401--02 

treatment, 52, 339, 350-5 1, 352, 353-54, 391, 

399 

Veneral Disease, Second International Confe rence 

for the Preveillioll of, 35 J 

Ventilation 

of hospitals, 45, 51-52, 204 

of living quan ers, 43, 44, 102, 185,356,359 

of sewage gases, 44 

on ships, 132-33 

Vera Cruz, Mexico, 244, 388, 394-95 

Vermin , 43, 102, 135,322,399,400-402, 404--05 , 

4101166 

Ve terans, 4 

Civil War, 21-25 

hospitals for, 128 

housing for, 11 

medical care for, 22-23, 52, 108, 339, 356 

pension applications, 7, 23 

prostheses for, 7, 13,21-22,96 

records, 23-24 

travel expenses for, 22 

Veterinarians, 179,379,385,386,399 

Veterinar)' Corps, 379, 385, 414 

Vibrio cllO/eme, 25, 4 1,42 

Villa, Pancho, 377, 397 

Virchow, Rudolph , 16, 29-30, 371173 

Visa)'an Islands, Phi lippine Islands, 213, 30 1 

Vitamins, 29 1-92, 30811 23 

Walter Reed General Hospi tal, 328, 338-39, 382, 

383--84 

War, secretar), of 

directives of the, 11 7-18 

responsibilities, 12-13, 20 

War Department, 56, 128 

Washington, D.C., 128--29,328,331,369 

Washington Barracks, D.C., 100, 122, 127, 129,174, 

213,326,338--39,362 

Wassermann , August von, U 3112 

Wasserman n test, 93, 113112,349,350-5 1,353 

Wastes, human 

disease spread by, 1.73,229,269-70,294--95,296 

disposal or, 43, 44, 269-70, 298, 363 

management of, 364 

problems with , 175-76, 181, 22 1, 294-95, 

297-98,299,303,358--59,363 

Wate r filters, 43,103 , 105, Ill, 176, 184,219,258, 

358,363 

Water supply 

in China , 22 1, 222 

contamination of, 3, 41-42, 43-44, 45, 52, 103 , 

150-51, 165, 176, 180--8 L, 192, 217, 222, 224, 

265,287,294,299,303,305,347-48,358--59, 

363 

in Cuba, 151, 152, 232 

in Mexico, 395 

atlllilitar), facilities, 43 , 47,52, 102-03, 178, 185 

municipal, 43-44, 45, III , 178, 204, 229, 232, 

235,236,258,273,299, 306,370,395 

in Panama, 265, 273 

in the Phi lippines, 165, 166, 285, 287, 294--95, 

297-98,299,302,303,305,306 
INDEX 

Water suppl}'-Contillued 

in Puerto Rico, 258 

purification of, 43, 102-03, 105, HI, 130, 

150-51, 176,204,219,236,258,263,299,302 

quality of, 149, 165, 183, 184,285,363,370 

on ships, 135, 157, 158 

shortages, 67, 75-76, 132, 165, 181, 185, 231 

testing of, 43, 93-94, 391 

Weather, 69-70, 71, 72, 73-74, 75-76, 77-78, 79, 

133, 144, 149, 152, 164, 165, 166-67, 176, 185, 

186, 187, 188,189, 190,206,208-09,210,216, 

2 17,2 19,220,221,223,260,286,297-98,326, 

355,356,392,397 

Weigley, Russell E, 19,52 

Weich, William H.,30, 107, 115 .. 54,245,266,268-69 

West Point (U.S. Military Academy), 48, 54, 325, 

362,380 

White automobile company, 389 

Widal, Fernand, 113112 

Wida l test, 93, 105, 113 .. 2, 115 .. 46, 176, 192,349 

Williams, Capl. John W., 69, 70, 71, 73 

Wilson, Woodrow, 277,377,399 

'Nomen employees, 3 17. See also Nurses, female. 

Women nurses. See N urses, female. 

Wood, Maj. Gen. Leonard, 78-S0, 233-35, 236, 237, 

243,250,253 .. 14,264,313--14,31.8,333-34,397 

Wood , Maj . Marshall W , 129, 130, 144-45, 146, 

147, 155 

Woodbury, Maj. (Vol.) John MeG. , 258, 259 

Woodhull. Ll. Col. Alfred Alexander, 47-48, 54, 

177,226 .. 24,325 

Woodruff, Maj. Charl es E., 303 

Woodward, Maj. Josephj., 27, 28, 29, 50 

Wooc!worth ,John M., 27 

World War 1,345 .. 53,377,380-81,404-06 

World's Columbian Exposition (893), 99 

Wotherspoon, U. William W. , 83 

Wounded 

ca re of, 162, 165-66, 167,394,414 

in China, 222, 223 

mortality among. 49, L 48 

WoullCled-COlllinued 

numbers of, 166, 1. 68112, 1721173,216,397 

in the Philippines, 208-10, 212, 213 

on punitive expedition, 397 

Wounded Knee, Baule of, 84-87, 90,,67 

517 

X-rays, 99, 148, 157,332,337,338,356,359,40 1 

Yangtsun, China, 223 

Yaws, 293 

Yellow fever 

causes, 40, 41 , 95, 130, 229, 239-46, 254 .. 41, 

2541142, 290 

convalescents from, 235-36 

and Cuba, 129, 149-50, 151-55, 157, 159, 186, 

229,230,233,234-51,276-77 

detention camps, 230, 234, 235 

detention ships, 235-36 

diagnosis, 151-52, 154, 235, 237, 238, 242, 244, 

269-70 

epidemics, 27, 40-41, 43, 150,152, 155, 159, 186, 

234-36, 238-39, 240-4 1, 246, 247, 251, 

266-69,272 

fear of, 151, 155,157, 159, 162, 186,189 

hospitals, 234, 235, 238, 242, 248 

immunity to, 40-41, 123, 155-57, 174,242,244, 

245,248, 273 

isolation of patients with, 154-55. 157, 186. 189 , 

230,235-38,244,248 

in Panama, 257, 264, 266-70, 272, 276-77 

in the Philippines, 135 

prevention, 41, 164, 185, 189, 238, 247-51, 

266-70,273,276-77,380-81 

in Puerto Rico, 160, 164, 263 

transmission, 229. 239-46, 25411 41 

trea tment, 41, 155-56. 244 

Yellow Fever Board, 239-46, 247, 248, 25411 35, 265, 

277,314 

Yellow Fever Commission, 239-46, 25411 35 

Yellowstone Ri ver, 67,70-71,73 

Yokohama, J apan, 206 

tl u.s. GOVERNMENT PRINTING OFFICE: 1995 360-566