Empire and Insurrection 245

Chapter Thirteen

Empire and Insurrection

Admiral George Dewey’s victory over the Spanish fleet in Manila Bay was a 

decisive moment in American history. While the seizure of Manila was a 

valuable bargaining chip for the McKinley administration in its efforts to 

liberate Cuba, a secure port there forged another link in a chain of Pacific Islands 

leading to Asian trade markets. President William McKinley, however, was extremely 

hesitant to commit the nation to a policy of annexation, and this led to ambiguous 

and confusing directives from the White House. American authority would be 

absolute in protecting the people of Manila and their property and individual rights, 

assisting in resuming trade, and ensuring local laws were upheld; but no recognition 

was to be extended to Emilio Aguinaldo’s rebel government. Whether the expeditionary force was to subdue and secure only Manila or all of the Philippine Islands 

was never made clear. It was a situation that condemned Major General Wesley 

Merritt, commander of the Expeditionary Force to the Philippines, and his successor, 

Major General Elwell S. Otis, to a reactionary mission execution strategy.1

The Expeditionary Force to the Philippines, the Eighth Army Corps, landed at 

Cavite and established Camp Dewey near the village of Tambo some four and a half 

miles south of Manila at the end of June. Merritt convinced the Spanish commander 

to surrender after a sham engagement to satisfy Spanish honor and keep the Filipinos 

from entering the city on August 13. This left an irate Filipino army in the surrounding suburbs. Clashes between U.S. forces and Filipinos began almost immediately. 

Merritt worked aggressively with Aguinaldo to diffuse an extremely explosive 

situation and get Washington to define its mission and specify rules of engagement 

for self-defense. To complicate matters, General Nelson A. Miles continued to limit 

the size, composition, and duties of the Eighth Corps. Tired, frustrated, and in ill 

health, Merritt asked to be relieved and was replaced by Otis at the end of August.2

On the other side of the globe in Paris, Spanish diplomats—without bargaining 

options—agreed to American terms for peace. The United States held Cuba in 

trust and put her on the road to independence, but Spain assumed the Cuban 
246 The Life and Science of Surgeon General George Miller Sternberg 

war debt. Puerto Rico and Guam became American islands, and Spain ceded the 

entire Philippine archipelago to the United States for $20 million. The Treaty of 

Paris, signed on December 10, ended hostilities with Spain and gave America a 

new colonial empire. 

For Major General John R. Brooke, the new military governor of Cuba, and 

General Guy V. Henry, commander of the Department of Puerto Rico, instructions from the president were clear: the interests of the indigenous populations 

were paramount, administration was to be based on laws not military force, and 

the end stage was an environment that provided Cuba an independent government 

and a stable civil government on Puerto Rico. For Otis, the president’s intent was 

not so obvious. McKinley and his advisors minimized the risk of war with Filipino 

nationalists and regarded a secure Manila as a sufficient start point for the expansion 

of U.S. sovereignty based on an overly optimistic and naive belief that once Filipinos 

experienced the benefits of the American way of life, annexation would be accepted 

and conflict would be avoided. Essentially, this was the president’s benevolent 

assimilation policy, but little guidance for its implementation was forthcoming.3

Otis, a moody, undiplomatic, cantankerous, and parsimonious man, would 

become a much-maligned commander. However, he had the intellect to grasp 

the civil and military missions he had inherited and the managerial experience 

to see them accomplished. The first priority was to expand the American perimeter around the city. Otis, through the threat of violence rather than diplomacy, 

pushed Aguinaldo’s Army of Liberation out of the suburbs. Although the Army of 

Liberation contested some areas now held by the Eighth Corps, Otis recognized 

he could only keep the peace by eliminating insurgents from Manila and, thereby, 

more easily implement McKinley’s plan of benevolent assimilation. This larger 

task, centered upon cleaning up the city and maintaining the health and discipline 

of the soldiers, demanded a multidisciplinary approach for success. The provost 

marshal, Brigadier General Robert P. Hughes, employed three regiments and the 

engineer contingent to reestablish a police force, organize public works and sanitation programs with inspection teams, and create a public education system. A 

public health department was established under Hughes’ command, and Henry 

Lippincott expanded medical services. The old Spanish hospital beyond the walls 

of Manila was refurbished and enlarged with tents to become the First Reserve 

Hospital with 800 beds. A female seminary was converted into the Second Reserve 

Hospital of 300 beds, and on Corregidor Island a Convalescent Hospital of 280 

beds was established. The original hospital facilities in Cavite became a District 

Hospital for use by the regiment and smaller commands in that town. The 

Medical Department had ample funds and abundant supplies from the states as 

well as some procured locally and sufficient space for storage. Transportation for 

the sick and wounded was also more than adequate.4

As a new year dawned, the Medical Department faced challenges equal to—if 

not greater than—those of April 1898. Sternberg addressed these challenges from 

a position of strength and experience that he did not have before the war. With 

a budget exceeding $2.7 million, he built and generously supplied and equipped 
Empire and Insurrection 247

hospitals in both active theaters and in the continental United States. During the 

year, four general hospitals were established in the Philippines, four in Cuba, one 

in Puerto Rico, and one in Honolulu. Each of these hospitals, in conjunction with 

the regimental and departmental hospitals, was prepared to treat 15 percent of 

the command in-house and equipped to diagnose malaria, typhoid, and yellow 

fever by state-of-the-art methods. The hospital ships Relief and Missouri provided 

backup holding and treatment support, and the Army Transport Service, established in mid-November, guaranteed the safe evacuation of soldiers to the United 

States under the care of qualified physicians on well-supplied vessels designated 

for this purpose. Sternberg assigned Colonel Charles Greenleaf as medical inspector 

of the army and required a weekly sanitary report from all surgeons in the field 

and at temporary stations. Medical Department manpower remained a tenuous 

issue. Large numbers of contract surgeons and corpsmen, who had signed up for 

the duration of the war, would be leaving the service, and nurse’s contracts also 

were being annulled. For the moment, however, no serious deficiencies threatened 

army healthcare.5

With this essential healthcare infrastructure in place and well funded, Sternberg 

evaluated the public health situations in the Pacific and the Caribbean. Public 

health—both for the soldiers and the civilian populations in America’s new 

possessions—would play a major and interdependent role in accomplishing 

McKinley’s goals. Ravaged by war and the departing Spanish armies, whatever 

public health infrastructure had existed on any of these islands was in a shambles. 

A board of health had already been established in Manila under the direction of 

Major and Surgeon Guy L. Edie. Edie, a laboratory student in the first class of the 

Army Medical School, and his staff would perform heroic work with little support 

from their commanding general. In Cuba and Puerto Rico, the modest services 

that had kept some municipal water clean and removed human and animal waste 

and garbage had been poorly administered by the Spanish and had come almost 

to a standstill since the Cuban rebellion. These filthy conditions had the potential 

to preclude McKinley’s experiment in exporting democracy to the Caribbean and 

sicken thousands of the nonimmune regulars destined for the islands in the coming 

year with typhoid, dysentery, malaria, and yellow fever. Priority of effort went to 

the Caribbean.6

 To prepare for occupying forces and obtain a broad understanding of existing 

public health conditions in Cuba and Puerto Rico, Sternberg directed medical 

officers to conduct inspections of hospitals and various towns where soldiers were 

to be quartered to determine their sanitary conditions and disease status and 

locate potential campsites should units need to move to escape disease. At the 

same time, he sent Lieutenant Colonel Robert M. O’Reilly to Jamaica to study 

British field sanitation techniques. The British experience there in reducing morbidity and mortality from all diseases over the past seven decades had been one 

of continued success. O’Reilly reported the British put a premium on landing 

healthy, well-disciplined, and appropriately clad soldiers after the end of the rainy 

season in November and quartering these unacclimated troops at stations located 
248 The Life and Science of Surgeon General George Miller Sternberg 

at higher elevations. These stations had been cleared of underbrush, surface 

drains and earth-closet system latrines constructed, and clean water supplies 

established. Barracks were elevated over cement foundations, well ventilated, and 

not allowed to become overcrowded. Personal hygiene was a priority, and the 

introduction of the canteen, where soldiers could obtain beer, reduced drunkenness from spirituous liquors. O’Reilly included all of these tenets in some form 

in his report to Sternberg. Since American troops would not have the luxury of 

being acclimated, he recommended that “troops for service in Cuba should, as 

far as possible, be recruited from the Southern States, and a large proportion 

of these troops should be colored with white officers.”7

With this combined intelligence, Sternberg had sent recommendations to 

Adjutant General Henry Corbin at the end of December. The size of the occupation force should be no larger than necessary to accomplish the mission and 

composed predominantly of southern black soldiers or Cuban natives, as these 

soldiers were considered more likely to be immune to yellow fever. Unacclimated troops should not be stationed or even be allowed to visit yellow fever 

infected cities, and they should be on the islands and quartered in fixed barracks 

before the end of spring when the malaria and yellow fever seasons began. 

Sternberg included extracts from Circular No. 1 issued in April concerning 

sanitary precautions and was specific in his recommendations concerning fevers. “Every case of fever should receive prompt attention. If albumin is found 

in the urine of a patient with fever it should be considered suspicious [of yellow fever] and he should be placed in an isolated tent. The discharges of patients with fever should always be disinfected at once.... No doubt typhoid 

fever, camp diarrhea, and probably yellow fever are frequently communicated 

to soldiers in camp through the agency of flies, which swarm about fecal matter and filth of all kinds...and directly convey infectious material attached to 

their feet or contained in their excreta to food which is exposed.... Whenever a 

case of yellow fever occurs in camp the troops should be promptly moved to a 

fresh camping ground located a mile or more from the infected camp.... When 

cases of yellow fever occur in a camp or barracks under such circumstances as 

to indicate...the locality is infected the troops should at once be removed. The 

disastrous mistake has frequently been made of removing the sick and leaving 

the well in an infected locality.”8

Sternberg’s malaria chemoprophylaxis remained unchanged from the previous 

year, and he did not mention mosquito bars. Ronald Ross had completed his 

work describing avian Plasmodium species in May, sent Sternberg a copy of it 

the following month, and wrote him about further experimental results obtained 

in July and August 1898. He stated plainly: “I do not think that there is much 

probability in favour of infection by any other means than the bite of mosquitoes 

of the proper species, e.g. by air or drinking water.... My object in writing this 

letter may appear rather startling to you. It is to suggest the use of mosquito 

nets, when practicable for your troops in Cuba and elsewhere, where I understand they are suffering severely from malarial fever.”9
Empire and Insurrection 249

While these documents did not arrive early enough to preclude the summer 

fiasco in Cuba, Sternberg had read them prior to the post-war occupation. He, 

like many of Ross’ British colleagues, remained skeptical of the mosquito’s role in 

malaria transmission. Even Ross’ mentor, Patrick Manson, believed the mosquito 

transmitted Bancroftian filariasis through water contamination and not through 

its bite. Sternberg still believed malaria was waterborne, and, if the mosquito was 

involved, it was because the insect deposited parasites in water that were later 

consumed by soldiers.10

Sternberg, accompanied by Captain Edward L. Munson, made an inspection 

tour of Havana in the second week of January. They met with Brooke at his headquarters in the Hotel Iglaterra located on Havana’s main plaza, visited the army 

medical staff in the city, and toured the Alphonso XIII Hospital, now designated 

Military Hospital No. 1. The primary concern at this early stage of the occupation 

was for the continuing health of the incoming U.S. forces. The rainy season would 

begin in May, bringing with it an increased threat of yellow fever and malaria. 

Sternberg strenuously recommended to Brooke and his departmental commanders 

to expedite the cleaning and disinfection of identified barrack facilities so soldiers 

would be out of tents by that time. Otherwise, commanders would spend more 

time moving from one uninfected camp to another than assisting the Cubans with 

nation building. More pressing, however, was another outbreak of typhoid fever, 

this time in the garrisons scattered over the island. The 8th Infantry Regiment, 

camped at Quemados, six miles southwest of Havana, had brought typhoid fever 

with it from the United States; and regimental surgeon Albert E. Truby found his 

regimental hospital overrun with cases until Military Hospital No. 1 was ready 

for occupancy. Sternberg feared a repetition of the previous summer and urged a 

rapid refurbishing of Cuban hospitals for army use and the construction of new 

army hospitals in provincial towns where none existed.11

As to the health of U.S. forces in the Philippines, Sternberg reported to the 

Senate on February 4 that the sick rate among the Eighth Corps, which had been 

as high as 17 percent, was now 10 percent, with the large majority of illnesses 

being only slight ailments. The comparatively large admission rate—3,016 per 

1,000 soldiers12—was “due mainly to malarial diseases which are climatic and to 

diarrheal diseases which are no doubt in large part due to errors and irregularities of diet on the part of the affected individuals.”13 Although venereal disease 

rates—82 per 1,000—slightly exceeded those in U.S. garrisons—and according to 

Sternberg most assuredly were underreported—respiratory ailments and overall 

injuries were far less. The mortality rate from July through October was 9.6 per 

1,000 men, only a little more than what was seen in U.S. garrisons during peacetime. Typhoid and smallpox generated the highest death rates, but neither disease 

gained a substantial foothold within the regiments, and the malaria encountered 

proved to be nonfatal.14

The Philippine Expedition had been for the most part ignored by the American 

public. This was all about to change. Tensions created by the stalemated negotiations between Otis and Aguinaldo, as the latter attempted to maintain control of 
250 The Life and Science of Surgeon General George Miller Sternberg 

his Army of Liberation and establish a viable government, came to a fever pitch 

in February. On the same day Sternberg sent the Eighth Corps health report to 

Congress, Filipino rebels launched a night attack in and around Manila. While 

the timing may have caught some of the officers and men momentarily off guard, 

the eruption of hostilities had been long anticipated. Firefights throughout the 

night varied from sporadic to desperate, and regimental command posts—situated to guard the most likely avenues of approach to the city—were precluded from 

supporting each other by distance and terrain. The uprising, however, was poorly 

coordinated in its execution. The defensive perimeter was held throughout the 

night. The following morning, Major General Arthur MacArthur counterattacked, 

securing Santa Mesa Ridge, and Anderson’s First Division pushed the Filipinos out 

of the villages of Pasay and San Pedro. By the close of February 5, the largest and 

bloodiest battle of the Philippine Insurrection was over. One hundred ninety-four 

Americans had been wounded and 44 had been killed or died of wounds.15

The Medical Department again proved equal to its task. Lippincott reported to 

the surgeon general that the department had been “in fine condition from the 

moment of the first fire and continued to improve from day to day, so that there 

never was a delay in securing excellent attention for the wounded.”16 His “division 

surgeons and medical officers of regiments were alert,”17 and had prepared “for 

all emergencies.... Litters, [first aid] pouches, medical and surgical chests were 

in readiness, easily prepared articles of food, stimulants, and water were on hand, 

and our ambulance company...did, and is still doing excellent service.”18

The Second Battle of Manila nearly split the Army of Liberation in two. The 

Filipino leader and his forces retreated north to their capital at Malolos, while the 

southern half remained south of the Pasig River. Otis severed the two forces completely and secured his southern and eastern fronts, and then launched a northern offensive along the Manila-Dagupan Railway to crush Aguinaldo. From 

the beginning, Otis faced personnel, logistical, and environmental problems for 

which his experience and parsimonious nature were not prepared. He did not have 

a large enough army to keep rebels in the south in check, screen Manila, and pursue 

Aguinaldo, but he stubbornly refused to significantly increase manpower estimates 

sent to Washington. Campaigning in the jungles and rice paddies was slow, tedious, and debilitating work. In only a few weeks, chronic diarrhea, skin diseases, 

fatigue, heat injuries, various fevers, and depression took a large toll on Otis’ 

effective strength. Logistically tied to the Manila-Dagupan Railway, he struggled 

with caraboa carts and porters to supply food and ammunition to forward elements 

beyond the reach of the railway. Compounding these difficulties was the mustering 

out of volunteer regiments in April. On March 2, Congress attempted to improve 

this situation by passing an army bill that extended state regiment duty in the 

Philippines, increased the Regular Army to 65,000 men, and recruited a 35,000-

man volunteer force for service in the islands; but effects of this legislation would 

not be felt until late summer.19

Back in Washington, this same congressional legislation left the surgeon general 

in a state of frustrated despair. Talk in the War Department and on Capitol Hill 
Empire and Insurrection 251

since late 1898 gave Sternberg the impression that the 50,000-man army then 

authorized would soon be expanded to an end strength of 100,000 enlisted men. 

To support such a force, he submitted a Medical Department organizational memorandum to Secretary of War Russell Alger on November 30, 1898 calling for one 

surgeon general with the rank of major general, one assistant surgeon general and 

one medical inspector general with the rank of brigadier general, 20 surgeons with 

the rank of colonel, 40 surgeons with the rank of lieutenant colonel, 150 surgeons 

with the rank of major, 309 assistant surgeons, and a Hospital Corps of 4,750 men. 

Limited to 400 contract surgeons, Sternberg also requested the authority to appoint 

as many contract surgeons as circumstances required and pay them up to $150 per 

month.20 When the House ignored his proposal, he pleaded with Alger to recommend 

a compromise to the Senate for an increase of 310 medical officers, but stated, 

“This will by no means be an adequate provision...for an army of 50,000 men and 

will call for the employment of a considerable number of acting assistant surgeons...” 

Congress only granted the Medical Department an additional 43 medical officers 

and, while it increased the pay for contract surgeons, it did not increase their 

numbers or those of the Hospital Corps.21

On May 16, the capture of San Isidro ended Otis’ rather disappointing spring 

campaign. Although his army had pushed 40 miles north into the Balucan Province, it had not destroyed the Filipino army nor forced the rebel government to 

surrender. In the process, Otis had exhausted his army, supplies, and medical 

support. Lippincott managed to sustain effective medical support to the Eighth 

Corps throughout the campaign. While he had fairly stripped the regiments of 

their surgeons for work in the hospitals before February, he reversed the process 

at the beginning of the campaign and was able to keep enough surgeons with the 

troops. But by May, a long logistical and evacuation line and burgeoning sick rolls, 

which included many medical officers and hospital corpsmen, had stretched medical 

capabilities to the breaking point. Old age and ill health brought on by the stresses 

of the campaign brought Lippincott to the breaking point as well and, in mid-May, 

Lieutenant Colonel Alfred Woodhull inherited this unenviable situation.22

In the first of numerous reports to Sternberg, Woodhull poured out his frustrations in concise detail. There were too few hospital beds and medical officers 

to attend to them. The spring campaign had filled the fixed hospitals in Manila, 

Corregidor, and later at Malolos to overflowing, a situation Woodhull attempted to 

relieve by sending patients to the Relief and Morgan City in between their voyages to 

the states. The campaign had spawned a growing number of regimental hospitals, 

which Woodhull considered “pernicious” because they could not all be manned 

by physicians as U.S. forces advanced north.23 Otis denied Woodhull’s request for 

a field hospital at Malolos to support MacArthur’s advancing division, declaring 

hospital facilities in Manila were sufficient, and intimated that the surgeons were 

holding on to men who were well enough to be at the front. MacArthur soon 

convinced his commander that a field hospital was required when the Second Division headquarters was established at San Fernando, but it did not significantly 

relieve Woodhull’s burden in Manila. In addition to too few beds, the chief surgeon 
252 The Life and Science of Surgeon General George Miller Sternberg 

commented “the administrative work shows great lack of system and of energy. 

The hospital grounds have been in a wretched state of police; the Hospital Corps 

seems to have neither system nor order for its control; there is no dining room, no 

proper facilities for the preparation of food or its distribution...the wards which 

I have incidentally passed through are dirty and in poor order, they are horribly 

over-crowded and insufficiently manned both as to medical officers and attendants.”24 The candle was being burned from both ends, and disease was eating at 

it from the middle. To compound the problem, Woodhull had to struggle with 

Otis’ parsimonious caution and disregard of the Medical Department to obtain the 

personnel, facilities, and operational intelligence he needed. Otis approved all telegraphic communications from the command and, therefore, Woodhull could only 

accurately communicate with the Surgeon General’s Office by mail, which took 

five to seven weeks. After rigorous debate, Otis permitted Woodhull to wire for 10 

medical officers, when two to three times that number were required. Furthermore, 

Otis’ distrust of medical officers precluded his chief surgeon from participating 

in operational planning. As Woodhull told Sternberg, “Expeditions are sent out 

with no knowledge on the part of this office and...it is only by the very energetic 

and efficient work done by the division and brigade surgeons that disaster to the 

Medical Department is averted.”25

By June 1899, the majority of army units on Cuba were in fixed quarters. 

Hospitals had been established or were under construction in Havana, Pinar del 

Rio, Guanajay, Camp Columbia, Matanzas, Paso Caballo, and Sagua la Grande. 

However, typhoid fever continued to generate concern during the winter and 

spring of 1899. An extensive outbreak among regiments of the 8th Cavalry and 

15th Infantry near Puerto Principe led Sternberg to dispatch Walter Reed to the 

city in mid-April to conduct a sanitary inspection of the camps, barracks, and 

hospitals in the area as well as an investigation of the typhoid outbreak. In his 

instructions, Sternberg stated, “If this can be traced to a neglect upon the part of 

medical officers to make proper sanitary recommendations, or of Commanding 

Officers to enforce such regulations, or of Quartermasters to supply the necessary 

shelter and appliances for the protection of the health of our troops, you will endeavor...to fix...responsibility for such neglect. You will also ascertain whether 

the sick have been properly cared for and whether there has been any deficiency in 

the supply of suitable food or necessary medicines, or other articles necessary for 

their comfort and recovery.”26 As in 1898, Reed found that inexperienced surgeons 

did not recognize early cases and, as a result, failed to recommend measures to 

preclude further spread of typhoid.27

Sternberg recognized this continuing dilemma could only be rectified by education, 

not only of regular army medical officers, but also of a large corps of trained volunteer and National Guard medical officers who would swell the ranks of the 

Medical Department during wartime. If this idea became reality, it would require 

the formal sanction of the American Medical Association. Presented to this body 

at its annual meeting in Columbus, Ohio, in June, “Sanitary Lessons of the War” 

gave a concise review of the army’s experience with the disease since the Civil War; 
Empire and Insurrection 253

described field hygiene techniques for prevention; eliminated future diagnostic 

confusion between typhoid fever and malaria based on epidemiological differences, clinical presentation, simple laboratory tests, and therapeutic response; and 

noted a regrettable deficiency in preventive medicine education in U.S. medical 

schools. Not only was it a vision of what future military medical education should 

be, but also it was a lesson plan in how to get there.28

While typhoid fever and relapsing cases of vivax malaria, and camp and hospital 

facility inspections were the main drivers for Reed’s spring visit and a return trip 

in July, he also observed for cases of yellow fever and gathered information on the 

progress of yellow fever investigations being conducted by Doctors Eugene Wasdin 

and Henry Geddings of the Marine Hospital Service. These investigators had been 

in Havana since November 1897 and were making inroads toward confirming 

Giuseppe Sanarelli’s Bacillus icteroides as the etiologic agent of the disease. Sternberg 

was very concerned. Upon returning from Paris with a culture of the bacillus in the 

fall of that same year, Sternberg had turned it over to Reed and James Carroll for 

further investigation and comparison with Bacillus X. Their experiments demonstrated many differences between the two microorganisms, but both caused the 

same symptoms in dogs. In January 1898, Sternberg dismissed the differences in 

culturing the organisms and concluded “it is possible...bacillus [x] is concerned 

with the etiology of yellow fever.”29 Clearly, he was clinging to the hope he would 

be confirmed in the continued observations of Reed and Carroll, but the war interrupted their research. By the time occupation forces were taking over from 

the Spanish in December, he had lost touch with the work of Dr. Eugene Wasdin 

and Dr. H. D. Geddings. Anxious that they may have stolen a march on him, 

Sternberg sent Contract Surgeon Aristides Agramonte, a pathologist, to conduct 

autopsies and laboratory work at Military Hospital No. 1 and keep him informed 

of their activities.30

Epidemiologically speaking, 1899 was a slow year for yellow fever in Cuba. 

Outbreaks remained small and isolated, which put a damper on Wasdin’s and 

Geddings’ research. To obtain enough autopsy numbers, Wasdin had no qualms 

about performing a deception or two. In early February, an autopsy on an 8th 

Infantry soldier supposedly dead with yellow fever was performed by Agramonte, 

with William Gorgas, Carlos Finlay, Albert Truby, Wasdin, and Geddings in attendance, which revealed ulcerated lesions in the small intestine—an obvious typhoid 

death—but Wasdin counted it among his yellow fever cases. Agramonte wrote to 

Sternberg, “Their conclusions have not surprised me.... I appreciated that they 

had been formulated probably even before their appointment to make the investigation. What really amazed me not a little is...their impertinence in insisting that 

Patrick Smith was a yellow fever case in spite of all evidence to the contrary....”31

In June, Wasdin and Geddings presented results—14 Havana and 21 New Orleans 

cases, 92 percent and 85 percent positive for B icteroides, respectively—that 

confirmed Sanarelli’s results. Moreover, they claimed their investigations and 

Sanarelli’s had satisfied all of Robert Koch’s postulates. It was a powerful argument, 

but Sternberg remained unimpressed. Although Koch’s method was the gold 
254 The Life and Science of Surgeon General George Miller Sternberg 

standard, results obtained by it could be interpreted erroneously. They had found 

an organism in sufficient numbers to justify their claim; however, preliminary evidence 

provided by Reed and Carroll suggested that neither B icteroides nor Bacillus X

was the organism they sought. Bacillus X was found to be a common colon organism. More importantly, they had shown that B icteroides was identical to the hog 

cholera bacillus, and serum of animals immunized with B icteroides caused hog 

cholera bacilli to agglutinate or clump in a test tube, a clear indication the two 

organisms were closely related, if not identical. Sternberg had stated his skepticism 

in the validity of B icteroides to Wasdin and Geddings during his January inspection 

tour. He observed that there was no satisfactory evidence that lower animals ever 

contracted yellow fever during an epidemic, and multiple experiments over the 

past 20 years had failed to demonstrate any susceptibility in various laboratory 

animals. Moreover, man was extremely susceptible to yellow fever; but throughout 

all of his experiments and those conducted since, no laboratory epidemic had ever 

occurred. Although Sternberg had Agramonte continue his experiments with both 

organisms and monitor the Marine Health Service investigators, it was becoming 

obvious that he and Sanarelli had been fooled by the plethora of microbes that 

reside in the intestinal tract.32

Sternberg made no direct public comment on the report of Wasdin and Geddings 

published in June, likely a reflection of his contempt for shoddy and dishonest 

research, but an article by Sanarelli that appeared in the Medical News in August 

received a prompt reply. The Italian professor’s condescending tone, paragraphs 

filled with invective for Sternberg’s earlier work and the recent investigations of 

Reed and Carroll, and a reproach for not admitting the validity of his claim were 

clearly contentious and intended to generate a similar response. The somewhat 

obsequious editorial by Dr. J. Riddle Goffe in the same issue only added fuel to 

Sternberg’s already burning indignation. However, Sternberg did not let his emotions cast an unprofessional shadow over his summary of accumulated evidence 

against B icteroides prepared for the Medical News. There was no need to do so. The 

bacteriological and immunological experiments of Reed and Carroll—in which 

Sternberg had implicit faith—had made the Bacillus an untenable contender as 

the etiology of yellow fever. Furthermore, clinicians in Rio de Janeiro and New 

Orleans provided supporting evidence that Sanarelli’s antitoxic serum was also 

worthless. B icteroides was down and nearly out, and neither Sanarelli’s stinging 

comments nor Wasdin’s deceit would revive it. From a professional and humanitarian standpoint, Sternberg could only lament the results of his own laboratory. 

The world would have been better had either he or Sanarelli been correct, but he 

still had hope the Army Medical Department would discover the etiologic agent.33

With the exception of one campaign in the southern Philippines, the army 

remained on the defensive throughout the summer of 1899. The withdrawal of 

state regiments, which were well supplied with medical officers, and the arrival of 

regular and volunteer units during July and August created a shortfall of all officers 

that—with increasing disease rates—finally captured Otis’ attention. He endorsed 

Woodhull’s early August request for more regular medical officers. At that time, 
Empire and Insurrection 255

18 percent of the Medical Corps were on duty in Luzon, but illness significantly 

reduced their effectiveness. Woodhull pleaded for more regular medical officers 

because of their ability to implement practical preventive medicine, but cautioned 

Sternberg not to send Cuban veterans for fear malarial relapses would render them 

ineffective. Once the army had grown to sufficient size and the summer rains ended, 

Otis would launch a campaign to quash Aguinaldo’s rebellion for good. To support 

this campaign and accommodate the large number of sick would require 3,000 

hospital beds.34

As Woodhull’s letters made their way to Washington, Sternberg conducted a personal inspection tour of medical assets at the Presidio and other western posts. The 

Medical Supply Depot at San Francisco was expanding to hold supplies for 100,000 

men for six months. To allow Purveyor, Lieutenant Colonel J. V. D. Middleton 

to focus on Philippine demands, Sternberg reduced the depot’s responsibility to 20 

posts in the Departments of California and Columbia, and restricted depot operations in New York to support operations in Cuba and Puerto Rico and provide backup 

services to San Francisco. Colonel Forwood, now Chief Surgeon at the Presidio, had 

been sent by Sternberg to oversee the construction of a new hospital, the development 

of a reception camp for volunteers that would accommodate five regiments, and the 

establishment of a quarantine camp and school of instruction for the Hospital Corps 

on Angel Island. Forwood conducted business with the same efficiency as at Camp 

Wikoff, and Sternberg was pleased with the progress.35

The downhill spiral of medical activities described in the missals from Manila, 

however, was an eye opener for the surgeon general. The nature of active operations 

and diseases on Luzon, and stateside medical support activities were consuming 

Sternberg’s resources at a phenomenal rate, faster than he could acquire and deploy them. Seventeen regular medical officers and 29 contract surgeons had been 

deployed in late January, and another seven regulars and nine contract surgeons 

had been sent in June. Nurses—both contract and Red Cross—also had been sent. 

When the General Hospital at the Presidio opened in July, it was immediately 

filled to capacity, and Forwood began requesting more medical officers for the 

hospital and reception camp. Sternberg assured Woodhull he would continue to 

send physicians and nurses. The hospital ship Missouri would sail from San Francisco after repairs were completed in August, with a full load of supplies, 100 hospital 

corpsmen, stewards and acting stewards, and two Edison type x-ray machines. He 

sent a short telegram to Forwood that there were “plenty of doctors on orders for 

the Department of California.”36 

To free up more Medical Department resources, Sternberg closed the newly 

completed general hospitals at Fort Monroe and in Savannah. However, he 

declined to halt new hospital construction. Four new hospitals were opened and 

ground was broken for eight more during fiscal year 1900, and the surgeon general 

had been eyeing Fort Bayard, an old fort due for closure, in southwestern New 

Mexico as a suitable site for a tuberculosis sanitarium. The new Secretary of War, 

Elihu Root, who had replaced Alger in late July, approved the plan and the $9,000 

required to make it inhabitable.37
256 The Life and Science of Surgeon General George Miller Sternberg 

Root’s support for a project Sternberg considered extremely important for army 

health was gratifying. Root, a lawyer with no military experience, was rumored to 

be rather stern and harsh. In time, his selection to the post would prove to be one 

of President McKinley’s best decisions. Root found the War Department—split 

between the Secretary’s power of the purse, the commanding general’s visions of 

command, and bureau chiefs jealous of their prerogatives—an inefficient, chaotic 

mess. Root formulated a series of reforms that would reverse the current situation. 

These reforms became the foundation for America’s 20th century army. However, 

in 1899, Root moved cautiously, aware of the tremendous resistance to any organizational or operational change in the army.38

Although Root soon clashed with Commanding General Miles and may have 

had his difficulties with some of the bureau chiefs, it appears that he and the surgeon 

general developed a strong relationship early on and he admired Sternberg as a 

soldier and scientist. Throughout August and September, Sternberg worked with 

Corbin and Root to provide sufficient hospital beds, supplies, and ancillary staff 

to the Eighth Corps. A pavilion-style hospital was the most desirable accommodation, but the six-month construction time made it impracticable. Therefore, 

the surgeon general advised Woodhull to obtain as many available buildings as 

possible and rely on the 500 hospital tents that were being sent. Twenty nurses 

sailed aboard the Relief, and an additional 150 hospital corpsmen were on the Missouri. Sternberg wrote to Woodhull on September 23: “The Secretary of War fully 

agrees with me that you should have ample hospital accommodations and that 

there should be at all times at least 500 vacant beds ready for any emergency.... 

We are prepared to send you all the supplies and money necessary to enable you 

to provide for the care and comfort of the sick and wounded.... One hundred tons 

of medical supplies were lost upon the ‘Morgan City.’ Orders have been given...to 

duplicate these supplies and forward them to you as soon as practicable. I expected 

the Hospital Ship ‘Missouri’ would have been able to sail several weeks since, but 

she has been delayed by the extensive improvements considered necessary to fit 

her thoroughly for the work expected of her. She will sail within a few days and 

carries a full load of medical supplies.... I have been sending a large number of 

medical officers; and, so far as medical officers of the Regular Army are concerned, 

it will not be practicable to send any more at present.”39 Casting a critical eye on 

the Presidio, the surgeon general told Forwood and Major Alfred Girard, commander of the general hospital, that they had too many medical officers and contract 

surgeons. He directed them to send more to Manila or send them home. By the 

time Woodhull received the letter, Sternberg found 13 more medical officers and 

40 additional contract surgeons for Philippine service, and sent more nurses.40

Otis’ northern offensive, begun on October 9, suffered from a lack of logistical 

support, torrential rain, and the treacherous Philippine terrain. By the end of 

November, however, the Army of Liberation had been shattered, and Aguinaldo 

was sent fleeing into the jungles of the far northern provinces. Although Otis and 

his division commanders basked in their victory, the American logistical chain—

extending nearly 200 miles from Manila as General Young cleared Filipino 
Empire and Insurrection 257

resistance from the Ilocano provinces—stretched medical support to the breaking 

point. Woodhull reported to Sternberg on November 13 that “the battalions of the 

new regiments are not only serving separately but some of these are already being 

split up for garrison purposes.... The campaign in progress will undoubtedly lead 

to the serious incapacity of medical officers and also to the necessity for distributing them at various small stations which there is every reason to suppose will now 

be held.”41 Three days later, Woodhull wrote to his chief again of the relatively large 

field hospitals being established, staffed, and supplied along the American line of 

advance. He also related that hospital rolls were burgeoning—2,197 inpatients by 

the third week of November. Presuming these numbers would continue to climb, 

Woodhull urgently requested more medical officers, worked to expand both of 

the reserve hospitals and the newly opened Santa Mesa facility, and begged his 

commander for money to complete the physical plant on Corregidor. But Otis 

remained obtuse. He was secure with the 257 physicians he had in theater, so he 

declared no funds were available for hospital work and no more hospitals would 

be established in Manila.42

Otis was convinced the scattering of the Army of Liberation into the northern 

hills signaled an end to major resistance to American authority. Declaring the war 

was over and “all we have to do now is protect the Filipinos against themselves,” he 

concentrated on apprehending dispersed bands of Filipino rebels and occupying 

larger cities and towns in the north.43 McKinley, who was gratified at this success, created a second Philippine Commission with broad legislative authority to 

establish municipal and provincial governments in preparation for the transfer of 

power from military to colonial administration. The president selected William 

Howard Taft, a federal circuit court judge from Ohio, to head the commission 

beginning September 1.44

Operations in the Philippines had stretched Medical Department personnel 

thin across Luzon and promised to strain them further in the southern provinces. The 

transition from combat action to stabilization duties on Luzon, however, would 

reduce the medical emphasis on casualty care, evacuation, and diseases inherent 

to long campaigns, and allow the Medical Department to focus on routine care 

and public health. Public health had remained a paramount concern for the welfare 

of the soldiers and the Filipino population, even at the height of the insurrection. Now the time appeared right to strengthen the public health infrastructure 

in Manila and expand its operations. In the wide variety of diseases—malaria, 

dysentery, dengue fever, plague, beriberi, tuberculosis, smallpox—endemic to the 

archipelago, Sternberg saw a tremendous potential for practical medical research. 

With this in mind, he created in January 1900 the first board for the study of tropical diseases. A formal board would continue to foster the atmosphere of academic 

excellence and achievement Sternberg had initiated with the creation of the Army 

Medical School and expansion of laboratory activities in 1893. That atmosphere 

had already begun to accrue dividends by the time the Tropical Disease Board was 

organized. With only basic laboratory equipment and a zeal for medical science 

reminiscent of their chief’s days at isolated western posts, young medical officers were 
258 The Life and Science of Surgeon General George Miller Sternberg 

contributing steadily to an ever-increasing fund of medical knowledge. Assistant 

Surgeon Walter Cox described Malta fever (brucellosis) at a southwestern post 

in 1898, and Assistant Surgeon Baily K. Ashford demonstrated that Puerto Rican 

anemia resulted from the hookworm, Necator americanus, the following November. 

In the Philippines, Lieutenant Richard Strong had already begun studying dysentery 

in the First Reserve Hospital; and, after bubonic plague broke out in Manila’s Chinese 

slums in January 1900, Lieutenant William Calvert prepared an instructional text 

outlining methods to control and eradicate the disease that included poisoning 

rats, although this vector had not yet been proven.45

In his report to the Secretary of War for 1900, Sternberg stated: “It was my desire that this board should be given all the appliances and assistance necessary 

for conducting their researches and every opportunity for obtaining access to 

cases and making autopsies, etc. In my letter of instruction to the chief surgeon I 

stated ...the members of the board need not necessarily work in the same laboratory, and while pursuing their general investigations they could make blood examinations and bacteriological researches for the purpose of clinical diagnosis as 

well as with a view to the promotion of our knowledge of infectious diseases.... 

Each member should make an independent report of investigations conducted by 

him and of the general result of his blood examinations, etc. A quarterly report of 

progress should be made by each member of the board, which should indicate the 

nature of the work in which he has been engaged and the results attained.... 

Special attention should be given to tropical dysentery, to the malarial fevers...to 

beri-beri, to intestinal parasites, and in general to all tropical diseases the etiology 

of which has not been completely worked out.”46 Complete laboratory facilities 

to support this grand plan had been established at the First Reserve Hospital by 

the time Sternberg created the board. In addition, hospital ships Relief and Missouri had laboratory capabilities that frequently functioned effectively as portable 

labs, and the Manila Board of Health was awaiting a full complement of bacteriological apparatus, which would make it an independent laboratory. All these assets provided valuable assistance to local hospitals and commanders; however, 

Sternberg’s instructions defined a larger, more autonomous and permanent goal: 

the establishment of a professional, productive, and enduring research capability 

in the Army Medical Department.47

As the Tropical Disease Board became established and clarified its role in assisting Otis’ overall pacification program, Filipino rebels began to mock Otis’ efforts. 

Aguinaldo had called for an insurgency war throughout the archipelago. Theirs 

would be a war of attrition, one in which they would hopefully destroy the American 

will to remain. According to Aguinaldo’s calculations, he had 11 good months in 

which to wear down that will. Then the American electorate would supply the 

coup de grace at the polls and hail William Jennings Bryan as President.48

Greenleaf, who replaced Woodhull as chief surgeon on December 22, faced a 

challenge of greater magnitude and complexity than either of his predecessors. As 

he explained to Sternberg in mid-February: “The military situation...has changed 

materially within the past three months, the policy being to occupy all important 
Empire and Insurrection 259

strategic points with comparatively large bodies of troops, and a good many...

points of minor military importance with small bodies of troops. While many of 

these stations are on the line of railroad or comparatively near each other on the 

sea coast, there is a large number...so completely isolated, or approachable only 

over mountain trails or almost impassable roads, that communication for the purpose of supply is exceedingly difficult and infrequent.... The military conditions 

above...affect equally, and perhaps more seriously, the personnel of the Medical 

Department, since any of these detached commands is liable to be attacked by, 

or to themselves attack the insurgents who infest their immediate neighborhood, 

and have more or less wounded requiring medical attendance. The number of 

Medical Officers now in these islands is entirely inadequate to meet these conditions, and we have...in the several Divisions and Military Districts, 80 stations 

without doctors.... In many cases there are neither Hospital Stewards nor members of the Hospital Corps, and in several instances these commands have been in 

contact with the enemy and had wounded men who could not receive any medical 

attendance.”49 Greenleaf ’s difficulties were compounded by illness among medical 

officers; transportation delays from stateside that left arriving contract physicians 

with only a few months of service; a desire on the part of these physicians, since 

the conventional war was finished, to annul their contracts and go home; and the 

expensive manpower costs associated with the Manila hospitals. To relieve this 

situation, he directed medical officers to treat their sick and wounded in available 

field, division, and base hospitals. He gave medical officers responsibility for multiple 

outposts, spread his corpsmen as thinly as possible among the regiments, and 

fashioned lighter medical and surgical chests for each detachment that could be 

more easily carried by native porters. And, more medical officers were requested. 

Greenleaf estimated a total of 360 surgeons were needed to keep the Medical 

Department from embarrassment. He cabled his requirements to the Surgeon 

General’s Office, but apparently Sternberg questioned the validity of his thinking 

in these short, concise statements from Manila.50

Greenleaf, an experienced soldier, was not afraid to take charge and make 

decisions without waiting for the blessing of the surgeon general’s office if circumstances demanded. Nor was he afraid to speak frankly to the surgeon general. “I 

deem it my duty,” Greenleaf told his chief, “to ask that...any requisitions I make, 

either for men, money, or materials, may be acted upon in their entirety, or...if disapproved in whole or in part, I be notified of your action by cablegram. In arriving 

at the necessity for these items I am particularly careful to investigate thoroughly 

all the circumstances connected with them, and do not make requests unless it 

is deemed necessary, and then state exactly what I think is needed. The distance 

which separates us is so great.... I cannot in many instances wait for the mail to 

explain my reasons for making requests...and have assumed...my knowledge of 

the situation and...experience in the service would be sufficient to warrant you in 

acting favorably on any that I may send.”51 He noted that 28 officers were sick, a 

number that would undoubtedly increase with active campaigning. He also noted 

that the remaining officers were stretched so thin that some were attending up to 
260 The Life and Science of Surgeon General George Miller Sternberg 

five field stations and that “this state of affairs has produced much unfavorable comment from line officers regarding the administration of the Medical Department.”52

Sternberg’s hesitancy in approving all of Greenleaf ’s requests does not appear 

to come from any distrust of motives or actions, but rather from difficulty in 

understanding the rapidly changing events in the archipelago. Sternberg worked diligently to stay current with operations in two theaters, but suffered from not having 

firsthand knowledge of the fluid conditions in the Philippines. Greenleaf noted that 

time and distance delayed correspondence for weeks. This left an inevitable—and 

extremely frustrating—disconnect between Manila and Washington in which the 

surgeon general tried to keep up with and control real-time events through cablegrams and letters. The Spanish–American War experience had honed and tempered 

his ability to communicate with subordinates in a clear and concise manner, rapidly synthesize and distill operational and administrative data, make decisions, 

and project power from his Washington office. The conventional war with Spain, 

however, had not prepared him—or the Medical Department—to support operations 

in an intensifying insurgency war. With a larger budget and—apparently—a better 

working relationship with Root’s War Department, obtaining, replacing, and moving 

supplies and equipment was less problematic. However, despite Sternberg’s lobbying 

efforts with Root and McKinley, Congress denied his request for an additional 

124 regular medical officers in February 1900, leaving him with 192 regular and 

78 volunteer surgeons, and roughly 390 of the authorized 400 contract surgeons. 

Further lobbying efforts obtained authorizations for another 80 contract surgeons 

for fiscal year 1901.53

Sternberg extended regular and contract service to two years and required all 

contract surgeons to serve a full 12 months in theater. Officers and hospital corpsmen 

were plucked from army hospitals across the United States and shifted from the 

Caribbean theater of operations. Advertisements for more contract surgeons appeared in many leading medical journals, medical examining boards sat almost 

continuously, and a steady stream of assignment orders flowed from the typewriters in 

the Surgeon General’s Office. The weak link in the movement chain was the Army 

Transport Service. It had performed admirably as a safe, dependable strategic 

medical evacuation asset since its creation, but failed as a rapid and flexible means 

of putting physicians in theater due to refit and resupply time. During February, a 

total of 45 commissioned and contract surgeons had received orders, but by midMarch only nine had sailed.54

Nurses were also needed in ever-increasing numbers. Fortunately for the Medical 

Department, enthusiasm for Philippine service was high. Dr. Anita Newcomb McGee, 

Director of the Provisional Army Nurse Corps (Female), said “applications...pour 

into the office in a steady stream. It seems...as though almost every nurse who 

has had a taste of the army wishes to return to it.”55 Finding suitable, well-trained 

nurses whose conduct would be dignified and discreet was always of prime concern. 

McGee sought the finest, but despite her efforts some slovenly nurses and a few 

with less than stellar moral character and no nursing ambitions arrived in Manila 

in late 1899. Nurses in the Philippines needed more direct supervision. To this 
Empire and Insurrection 261

end, the surgeon general directed Greenleaf to temporarily assign Miss Mary J. 

McCloud, Chief Nurse at the First Reserve Hospital, as inspector of nursing services 

for all hospitals with nursing personnel and on the Relief. Her visits were to be 

followed by a complete report that addressed a comprehensive range of issues. 

Sternberg wanted to know if the nursing was “in all respects equal to that of the 

best civil hospitals?”56 If not, where were the defects? Were duty hours strictly kept; 

were nurses neatly dressed? Did the chief nurse have executive ability, tact, and 

suitability for her position? Were the nurse’s quarters and rations adequate; was 

there a proper sense of discipline; what was the status of morale; and how did the 

climate affect the health of the nurses? And lastly, did McCloud have any recommendations for increasing the efficiency of the corps?57

McCloud—probably recommended by McGee—was a good choice for the work 

Sternberg had in mind. She had brought organization, discipline, and efficiency 

to the First Reserve Hospital nursing service since her arrival the previous summer. But when Greenleaf read Sternberg’s directive, he was aghast. “Believing...

the conditions in the Archipelago are not fully understood by you, and the extension of the nursing service unknown to you at the date of the letter, I respectfully submit the following statement.... Contract nurses are now on duty at the 

following named hospitals: First Reserve and Santa Mesa in Manila; Corregidor 

Island, Manila Bay; Tayabas, Province of Laguna; Calamba, Province of Cavite; 

Dagupan, Province of Pangasinan; Vigan, Province of Ilocos Sur; Aparri, Province 

of Ilocos Norte; Iloilo, Island of Panay; and the Hospital Ship ‘Relief.’ In the present unsettled state of affairs travel by land or by sea is not only uncomfortable and 

trying to one’s physical strength, but in certain places on land is unsafe by reason 

of the constant presence of prowling band of insurrectos or landrones, and can 

only be accomplished with safety when the traveler is protected by a large military 

escort.... The railroad from Manila to Dagupan, 122 miles long, is in a bad state 

of repair, the carriages without upholstering, toilet or other conveniences and very 

uncomfortable, the trains are crowded...and the official time consumed...is nine 

hours, but...is oftener twelve hours with occasional wrecks, in which lives are often lost.”58

Sternberg responded to Greenleaf’s real concerns for McCloud’s safety by stating 

it was not his desire “she should be placed in danger for the sake of making such 

inspections,” but hoped she could visit hospitals in Manila, on Corregidor, and 

the Relief.

59 Written on June 30—presumably the earliest date he could have 

responded—this episode illustrates Sternberg’s difficulties in staying on top of 

events in the Philippines, and his changing attitude toward the status of nursing in 

general. Although forced by circumstances to accept the services of female nurses 

in early 1898, by the end of the year Sternberg and McGee agreed with members of 

the civilian Committee to Secure by Act of Congress the Employment of Graduate 

Women Nurses in the Hospital Service of the U.S. Army that nurses should be integrated into the army. However, neither Sternberg nor McGee could support the 

committee’s integration plans that included a semi-civilian nursing service commission in the chain of authority over nurses and hospital corpsmen. The surgeon 
262 The Life and Science of Surgeon General George Miller Sternberg 

general was also concerned about the numbers of nurses authorized by law, their 

pay, and funding for construction of quarters and so forth. While female nurses 

still posed a moral dilemma for the Medical Department, in the spring of 1900 

female nurses could boast of 20 months of dedicated professional service in fixed 

facilities, tent hospitals, and aboard hospital ships and transports in three theaters 

of operations, and for the past year in a burgeoning insurgency war. Their skills 

were appreciated and now demanded in nearly every army hospital. To Sternberg’s 

credit, he realized neither a few bad apples nor his angst over women being exposed 

to the rigors of an army in the field altered the fact that female nursing services 

were required by the Medical Department. His orders made McCloud the chief 

nurse for the Eighth Army Corps, and the standards he expected her to maintain 

reflected this changing attitude.60

Sternberg also recognized the potential for trained nurses to instruct hospital 

corpsmen in practical nursing on the wards, thereby extending nursing services. 

Congress was paring down the Hospital Corps, which had been expanded for the 

war with Spain. In June 1900, Congress appropriated monies for 200 hospital 

stewards, 356 acting hospital stewards, and 3,500 privates, forcing the surgeon general 

to set allowances for each theater of operations. The Philippines received the majority, but experience and quality were wanting. In Manila, Hospital No. 3 opened 

a school of instruction for these partially trained corpsmen coming from the states 

and those transferring from the line. Sternberg also suggested to his hospital 

commanders that female nurses should be engaged in instructing corpsmen in 

ward work, cooking, and so forth. With the exception of Major Valery Havard, 

who suggested a trained male nurse corps, the concept appears to have been well 

received. By the following spring, nurses were providing advanced training to 

corpsmen on all aspects of ward nursing in most of the army’s major hospitals.61

By April 1900, American pacification efforts and Filipino resistance had created 

a confusing collage of success and failure throughout the archipelago. Civic 

action programs had established municipal governments in many towns, roads 

and bridges were being built, schools and new marketplaces opened, telegraph 

lines strung, and public sanitation improved. These enclaves of Filipino support 

for American sovereignty, however, had become islands surrounded—and infiltrated—by a sea of guerilla resistance, and insurgents came to rely on supplies 

from towns and villages to sustain them in the field and intelligence provided on 

American activities. Attacks were made on these garrisons and the patrols and 

scouting parties dispatched from them. Otis, now labeled by the press as wholly 

inept, remained committed to the virtues of pacification by civic action, but the 

pressures of this deteriorating situation took their toll on him. With casualties 

mounting in a shadow war he could not comprehend, and soon to be saddled with 

a new Philippine Commission chairman, Otis asked McKinley to relieve him so he 

could attend to neglected personal matters back home.62

MacArthur, who assumed command from Otis on May 5, had been critical 

of Otis’ less than aggressive military posture for months. Yet, while his military 

instincts may have urged him to intensify operations against the guerrillas, his 
Empire and Insurrection 263

political conscience advocated caution. He saw himself as the scapegoat should 

Otis’ policies fail, and Taft would be a constant reminder the president had little 

confidence in his abilities. These considerations, plus the fact that the monsoons 

had started once again, led MacArthur to proceed with the policy of conciliation 

and civic action, which increased the number of military stations outside of Luzon 

by a third.63

For Greenleaf, the expansion of garrisons meant begging the surgeon general for 

more physicians and corpsmen, but through the first six months of 1900, his burden 

in supporting benevolent pacification had taken on a new and unplanned medical 

dimension. Wherever army units patrolled or established stations, their surgeons 

found sick and wounded Filipinos of all ages imploring them for relief. Medical 

officers—unwilling to refuse—soon had a growing indigent medical practice that 

contributed significantly to pacification efforts, but was not only officially unfunded, 

but also against army regulations. Both Philippine commanders had tended to 

ignore this point in prosecuting McKinley’s policies and gave Greenleaf meager 

funding to continue the unofficial mission. Greenleaf was in a difficult position, but 

apparently did not inform Sternberg of these events. Instead, he requisitioned large 

supply orders—such as 3,600 pounds of pearl barley, 3,600 pounds of farina, and 

six tons of malted milk—and continued to demand unquestioning support from 

the Surgeon General’s Office. When Sternberg informed him that six tons of malted 

milk cost $13,000, and he was apprehensive that “there may be unauthorized use of these 

supplies by persons not entitled to them,”64 Greenleaf understood which way the 

wind was blowing from Washington and took his case to what he thought was a 

higher court in the office of the new Philippine commissioner.65

The corps surgeon, who was committed to benevolent assimilation, presented a 

good and honest case to Taft. He noted the war had taken a terrible toll on Filipinos and providing for the sick was very important. “Our troops are now occupying 

nearly all of the towns of any importance in the Islands.... Medical officers on duty 

with them...are constantly appealed to by these people for relief of both medical 

and surgical cases, and the natural instincts of humanity...have led them to respond 

to these appeals almost unanimously. The effect of this humane work...has been 

marked, and numerous instances have been brought to my notice where Medical 

Officers possessed more influence with the natives than any other class of Americans 

in the neighborhood.”66 However, there was precious little funding for the humanitarian effort, and “Medical Officers have drawn from the supplies furnished to them 

for the use of the troops, to meet the obvious necessities of the case.”67 Greenleaf concluded his appeal by declaring “the average American doctor...cannot and will not 

resist appeals to his humanity, and will take whatever comes handy to relieve suffering 

and distress; this fact should receive due consideration by the medical authorities 

at the War Department.”68 Wanting to help, Taft added an endorsement to the letter 

recommending “the supply of medicines be not reduced for...nothing helps more 

in the pacification of the Islands than such benefits as are thus conferred upon the 

natives,” and forwarded it to the Secretary of War.69

Whether Greenleaf was confused as to the date—September 1—on which Taft 
264 The Life and Science of Surgeon General George Miller Sternberg 

assumed authority in the archipelago from MacArthur remains a mystery, but 

Adjutant General Henry Corbin clearly understood who was in command. Corbin 

redirected the letter to MacArthur with a second endorsement: “Respectfully 

referred to the Commanding General Division of the Philippines for report as to 

whether the recent large requisitions for medicines and medical supplies...was 

in fact...designed not merely for use in the military service but also for use and 

distribution among the people of the Philippine Islands.”70 Corbin reminded 

MacArthur that “no requisition for such purpose should be made without stating 

the fact,”71 that Greenleaf ’s letter should have been sent through MacArthur and 

not the president of the Philippine Commission, and finally that if MacArthur 

desired “to use medical supplies for the relief of the people of the Islands, his application for authority to do so will receive full consideration.”72 The surgeon general 

probably felt a certain sense of vindication in Corbin’s directives to Manila, but he 

had precious little time to bask in it.