War with Spain 215

Chapter Twelve

War with Spain

Over the past three years, Spain had attempted to crush the Cuban insurgency 

with fire, sword, and the mass relocation of entire provincial populations—

known as reconcentration—for easier observation and control. Such 

draconian methods only succeeded in hardening rebel resolve, restricting American 

trade with Cuban sugar and mining industries, and provoking U.S. public indignation. Journalists, such as Richard Harding Davis and Stephen Bonsal, filled leading 

newspapers with poignant accounts of Spanish atrocities perpetrated on the Cuban 

people and valiant patriots risking everything for independence. President William 

McKinley’s firm diplomatic efforts and a change in the Spanish government in 

1897 led to an easing of reconcentration policy, amnesty for political prisoners, 

and a grant of autonomy for Cuba from Madrid. However, the new Spanish 

government feared a coup détat should it give up the Caribbean colony or those in 

revolt in the Philippines. Unable to quell the rebellion by military force and unwilling 

to grant independence, Spain played for time while the new Cuban colonial government organized itself. On December 6, McKinley, in his first annual address to 

Congress, would not recognize Cuban belligerency or independence, and rejected 

calls for U.S. intervention, believing the issue could be resolved diplomatically. 

But in mid-January, Cuban loyalists and insurrectionists clashed in Havana. Congressional interest in recognizing Cuban belligerency revived, and the battleship 

USS Maine was sent from Key West to provide protection and refuge for Americans in case violence escalated. The USS Maine steamed into Havana Harbor on 

January 25. Three weeks later, an explosion heaved the ship from its berth, killing 

200 of the crew. The American public reacted with intense outrage, holding Spain 

responsible for a cowardly act of sabotage. While newspapers across the country 

called for an immediate armed response, McKinley remained hopeful for a peaceful resolution through uncompromising diplomacy and fiscal intimidation. He demanded Madrid cease its reconcentration policy, proclaim an armistice, and 

agree to Cuban independence with Washington as arbitrator in the forthcoming 
216 The Life and Science of Surgeon General George Miller Sternberg 

negotiations. On March 7, McKinley introduced a $50,000,000 appropriation bill 

for “National defense and for each and every purpose connected therewith to be 

expended at the discretion of the President.”1 Intended to impress and awe Spain 

with the vast financial resources the United States could instantly commit to its 

military, the bill was not meant as a preliminary move toward mobilization. Nevertheless, strategic operational planning for a war against Spain began in earnest 

on March 10, the day after the Fifty Million Dollar Bill passed.2

Navy and War Department assessments painted a bleak picture of Spanish forces 

on the island. Consisting of some 150,000 regulars and 80,000 Cuban loyalists, the 

garrison was impressive on paper only. The majority of these troops were young, 

inexperienced, and not appropriately trained or disciplined. Units were spread 

thin across the countryside without adequate roads or railways for effective communication or force concentration. Defensive positions would not withstand a determined artillery assault. Supplies of ammunition, food, clothing, and medicines, 

all of which had to come from Spain, were scarce and difficult to distribute because 

of a shortage of transportation. Furthermore, the entire contingent had been ravaged by malaria, dysentery, and yellow fever to the point where Consul General 

Fitzhugh Lee doubted if more than 55,000 soldiers on the island were combat effective. With the Spanish army on Cuba slowly deteriorating—kept alive only by 

naval transports from the mother country—strategic planners concluded the most 

efficient strategy was a naval blockade to cut off the garrison’s lifeline. This gave 

the navy the lead role and, therefore, the lion’s share—$29,000,000—of the new 

funding bill. The army bolstered coastal defenses and assisted operations in the Caribbean by supplying and advising the Cuban rebels in their last campaign. This 

supporting role, however, required the 25,000-man army to be increased threeand possibly four-fold. The War Department divided the remaining $19,000,000 

by operational priority: $15,000,000 was given to the Corps of Engineers and 

Ordnance Department for coastal defense, and the remaining $4,000,000 was distributed to the other army departments and bureaus. The Medical Department 

received a grand total of $20,000.3

Although Sternberg left no comments on what he thought of this pittance, he 

must have wondered what Congress was thinking. From 1894–1898, his budget to 

run the Medical Department had decreased by 5.4 percent annually while supply 

spending had increased 7 percent and the cost for medical attendance and drugs 

had risen, mainly resulting from the loss of assistant and contract surgeon positions, 

166 percent over fiscal year (FY) 1890–1893 levels. In March, he had been 

appropriated only $115,000, which was $20,200 less than in FY 1898, to support 

the Medical Department in 1899. The $20,000 he received from the president’s 

emergency package did not replace this annual loss of funds. Moreover, it would 

not equip field medical assets for an army of 75,000 to 100,000 men in peacetime 

nor when engaged in combat.4

The surgeon general had endeavored to live within the means Congress provided, 

but the Medical Department lived from year to year, a circumstance that precluded 

the stockpiling of medicines or equipment for emergency use. When Secretary 
War with Spain 217

of War Russell A. Alger directed Sternberg—on March 12—to prepare for large 

emergency purchases of medical supplies, an absurd situation became ridiculous. 

Alger interpreted the president’s “for the national defense” wording of the bill literally, which precluded the Medical Department from purchasing or even contracting 

for any materials or personnel required for offensive action until war was declared. 

Alger’s idea of preparation, therefore, was a fairly sedentary business of making 

lists of required equipment and supplies. The surgeon general already knew how 

to spend $20,000, but what he yearned for was the authority to do so. Sternberg 

perceived preparation as an active process. Alger’s directive was merely a warning 

order and led him to comment later, “Prior to the declaration of war no preparation for the approaching conflict had been made by the Medical Department.”5

 This 

was true from the standpoint of gathering consumable medical supplies, equipment, 

and personnel, but Sternberg knew that medical support to a campaigning army 

entailed a great deal more than pure combat trauma management. Sternberg and 

his staff began preparing for the coming conflict as best they could. Two days after 

the defense bill was passed, the surgeon general requested Alger to ask Congress 

for an additional 15 assistant surgeon positions. Over the next two weeks, he lobbied the military committee chairmen in the House and Senate for the same and, 

in time of emergency, authority to hire as many contract physicians as he required. 

Under Sternberg’s personal direction, existing medical equipment and field chests 

were reconfigured, inventory lists were revised, and essential items were purchased 

with funds remaining from the current fiscal year. A first-aid packet for the individual soldier, which contained antiseptic dressings, was created and stocked. He 

also authorized purveying officers at supply depots in New York, St. Louis, and San 

Francisco to increase their work force and secure additional workspace to assemble 

these items and distribute them liberally to units in the field. Late in March Sternberg, 

with the assistance of Acting Assistant Surgeon Juan Guiteras, submitted a disease 

threat estimate for Cuban operations to Alger in which he cautioned against a 

summer campaign. The document is—for the era—an accurate assessment of the 

health threats to be encountered by assault forces and precautions to avoid them. 

While typhoid and yellow fevers, malaria, and dysentery are all mentioned, it is evident 

from the lengthy epidemiological discussion and emphasis on prevention and 

containment measures regarding yellow fever that this disease was the major anticipated threat. Sternberg reviewed the incidence of the disease in Cuba over the past 

50 years and concluded no appreciable endemic difference existed between seaports 

and inland towns. Yellow fever occurred annually or every other year in most of 

them. Although country villages were less risky, they were subject to epidemics from 

the disease being generated in noxious refuse heaps or imported from infected areas 

on clothing, baggage, and other articles. On April 25, Circular No. 1 was issued to 

all medical officers, and recommended soldiers were to stay out of the cities as much 

as possible; and supplies, baggage, mail, and prisoners of war were to be disinfected 

before entry into the United States. It also gave instructions for camp, latrine, 

and refuse pit locations; disinfection techniques; appropriate clothing and nutrition; 

and the timing of daily fatigue details and marches.6
218 The Life and Science of Surgeon General George Miller Sternberg 

Sternberg also began looking for civilian transport ships suitable for conversion to hospital ships and floating medical supply depots for ground forces. The 

army had not required strategic water evacuation capabilities since the Civil War, 

and, therefore, he and the Quartermaster Department had to create this asset from 

scratch with limited funds. The most expedient and least expensive way was to 

charter and refit an existing vessel. On April 23, after discussions with Navy 

Surgeon General Marion Rixey, Sternberg recommended the relatively new 3,000-

ton steamship John Englis be chartered for these purposes. Assistant Secretary of 

War G. D. Meikeljohn immediately denied the request based on cost and told the 

surgeon general to keep looking for a more reasonably priced vessel. Early in the 

first week of May, Sternberg directed Major George H. Torney, then surgeon at 

the U.S. Military Academy and a former Navy Surgeon, to search the piers in New 

York City for an appropriate candidate. Torney inspected several craft, but always 

returned to the John Englis. The difficulty lie not only in finding a suitable ship, 

but also because shipowners hesitated to charter a vessel that would be drastically 

altered and might become infected with yellow fever and other diseases. Hence, 

charter prices remained high. Meikeljohn, however, was adamant that the War 

Department would not purchase a ship for hospital or transportation purposes.7

Although the Office of the Surgeon General struggled to secure a hospital ship 

and continued to develop and refine plans to support 100,000 regular army soldiers 

in a potential fall invasion of Cuba, events transpired through April and the first 

few days of May that radically altered this initial strategy and put the administration’s 

strategic planning into a state of flux. Madrid was undeterred by McKinley’s 

demands or his defense appropriations. McKinley heard the national cry to throw 

Spain forcibly from the island and, fearful he might lose control of Congress as 

an increasing number of Republicans joined in the chorus, asked for authority to 

use force to resolve the dispute. Congress granted his wish on April 19, and two 

days later a naval blockade was ordered. Spain ignored the threat and declared war 

on the United States. On April 25, one last request was made for Spain to remove 

itself from the island. When Spain refused, McKinley asked Congress for a 

declaration of war.8

By this time McKinley’s strategy for the conduct of the war had changed significantly. He agreed with Army Commanding General Nelson A. Miles that a major 

invasion of the island, with Havana as its primary objective, should be postponed 

until after the fever season had passed and the Navy had destroyed the Spanish 

fleet. Nevertheless, he directed regular army units to camps at Chickamauga Park, 

Georgia, and Tampa, Florida, to prepare to assist Cuban rebels before a general 

assault on the island. He also agreed to call up 175,000 volunteers. These men were 

to be clothed, equipped, trained, and armed in their state camps. Only after this 

had been accomplished would volunteer regiments assemble at Camp Thomas in 

Chickamauga Park; Camp Alger in northern Virginia; and smaller camps located 

in San Francisco, Tampa, San Antonio, New Orleans, and Mobile. This decision 

gave the War Department extra planning time, but nearly doubled the size of the 

force for which it was planning. Bureau chiefs were requested to submit cost 
War with Spain 219

estimates to sustain regular and volunteer forces for a year. Sternberg estimated 

another $800,000 would be required. Then on May 1, Admiral Dewey’s unanticipated destruction of the Spanish fleet in Manila Bay led McKinley to alter 

strategic objectives once again. Still concerned that European powers might assist Spain, McKinley wanted to secure his toehold in the Philippines and gain 

one quickly on Cuba. The following day, he gathered Secretary of War Alger, 

Navy Secretary John D. Long, and their uniformed advisors in the White House 

and announced a more aggressive plan of action. A 5,000-man force would deploy to the Philippines to sustain Dewey’s victory, and 40,000 to 50,000 would 

prepare for an assault on Havana through the port of Mariel by mid-May. Major 

General Wesley Merritt would lead the Philippine force, soon to be designated the 

Eighth Corps, and Major General William Shafter would command the Fifth 

Corps preparing in Tampa. These decisions relieved the navy of continuing a 

blockade as the hurricane season approached, but shocked Army Commanding General Nelson A. Miles.9

McKinley, the War Department, Miles, and particularly Sternberg initially feared 

a summer campaign because of the disease threat on the island. Miles still feared 

a rainy season campaign, but his position on the issue seems to have been undermined by a reassessment of the situation by Sternberg and Guiteras based on reports 

from U.S. residents and Cuban physicians on the island. Just when this reassessment 

was conducted and if it truly affected the president’s decision is unclear, but on May 

6, Guiteras made an inexplicable and unwise comment to a New York Times reporter 

when he said “there was no reason for alarm about yellow fever.”10 His follow-on 

remark to the same reporter that “malarial fevers are not dangerous” would come 

back to haunt him and the surgeon general in July.11 Mosquito transmission of 

malaria was just being worked out by Indian Medical Service Major Ronald Ross 

and Italian researcher Giovanni Grassi.12 For the moment, some medical authorities—Sternberg among them—believed that malaria, like typhoid and dysentery, 

was probably transmitted by water, and soldiers could avoid these infections by boiling 

their drinking water. Sternberg provided no description of malaria epidemiology in 

Cuba and may have believed—as Guiteras did—that malarial fevers encountered on 

the island were not dangerous because they had no potential to incapacitate an army 

on campaign. However, Sternberg did direct the use of 3 to 5 grains of quinine taken 

in the early morning as prophylaxis “in decidedly malarious localities...but the taking 

of quinine as a routine practice should only be recommended under exceptional circumstances.”13 These instructions, however, were ambiguous as he declined to advise 

on how such localities were to be determined or define what he meant by exceptional circumstances. In any event, the message he conveyed to McKinley mitigated 

the Commander-in-Chief ’s primary reservation—epidemic yellow fever—to 

a summer deployment. By not steadfastly supporting Miles in his opposition to 

a summer campaign, the surgeon general actively assisted in shortening the War 

Department’s planning and execution timeline.14

Since April 21, Sternberg and his staff had worked furiously not only to make up for 

lost planning and execution time, but also to keep pace with increasing operational 
220 The Life and Science of Surgeon General George Miller Sternberg 

demands for personnel, hospital and evacuation capabilities, and medical materiel. Colonel Charles Greenleaf was assigned as chief surgeon of troops in the field 

on Miles’ staff, and Lieutenant Colonels Benjamin Pope and Henry Lippincott 

reported to Shafter and Merritt, respectively, as corps surgeons. On the day war 

was declared, 177 medical officers and 791 hospital corpsmen were authorized for 

duty. Administrative, purveying, and hospital duties and physical disability immediately reduced the number of deployable physicians to 100. In mid-March, 

Congress magnanimously returned the 15 assistant surgeon positions removed in 

1894, but did not give Sternberg the authority to fill them until May 12. An applicant for the hastily convened medical examination boards had to be a graduate of 

a recognized medical college with one year of hospital practice and pass the high 

standards of an army medical examining board. Sternberg, an advocate for raising 

the academic bar for medical school candidates and the stringent standards for 

graduation from the Army Medical School, would not betray these standards for 

political or military expediency. However, this was not the case for the state medical 

examiners. Although medical officers in volunteer regimental staff positions were 

appointed by the president without sitting for medical examination, they were approved by Sternberg, and included some of the most capable and competent physicians in the country. State examination boards, however, approved all regimental surgeons. As Sternberg recalled later, their selections spanned the spectrum of 

medical competency and aptitude for military service. He also recognized as surgeons 

they may save lives on the battlefield, but virtually none of them knew how the 

army or the Medical Department operated on a daily basis. Until they became 

familiar with military medical administration and healthcare practices in the field, 

their learning curve would be steep and efficiency impaired. To alleviate this problem, Sternberg assigned five experienced regular army medical officers as chief 

surgeons of army corps and 36 as brigade surgeons of volunteers. The remainder 

was assigned to regular units. Sternberg also received approval to hire a large number of contract surgeons. He did his best to find qualified physicians, but had neither the staff nor the time to examine each candidate thoroughly. He selected men 

with hospital experience, 34 to 40 years of age, to ensure they were experienced and 

not too set in antiquated medical practices, based on the endorsements provided by 

their peers. He recognized that it was an imperfect selection process; but, left with 

no alternative, he had to trust in his own judgment and the mentoring abilities of 

the regular medical officers to guarantee soldiers received adequate care.15

Success or failure of wartime medical care did not devolve solely on the number 

of physicians in the field. Hospital corpsmen were required to provide immediate 

first aid on the firing line, evacuate the wounded, and provide nursing duties, as 

well as a variety of administrative and logistical functions. The Medical Department 

had a little less than 800 corpsmen, including 99 hospital stewards, 100 acting 

hospital stewards, and 592 privates, which was far too few for the coming conflict. Sternberg requested the law capping hospital stewards at 100 be rescinded 

in March, but Congress did not do so until June 2. Regrettably, while each volunteer battalion had a hospital steward, Congress made no provision for a volunteer 
War with Spain 221

hospital corps. To obtain the large number of medics needed, men were allowed 

to transfer from line regiments to the hospital corps, and recruiting officers were 

urged to search for suitable candidates. Many medical students, pharmacists, and 

young medical graduates enlisted in the corps for the duration of the war. However, medics in the large and fairly well trained National Guard Hospital Corps 

enlisted primarily as line soldiers in volunteer units rather than as corpsmen.16

Ironically, Congress did authorize—at the surgeon general’s request—the 

employment of male and female contract nurses during the busy March sessions. 

However, this put Sternberg in a rather trying and unenviable situation by midApril. Although a circular soliciting enlistments in the Hospital Corps was 

distributed to many training schools for male nurses, few applied to recruiting 

officers. Sternberg was forced to accept the services of a largely female nursing 

profession because he was unable to obtain enough corpsmen for nursing duties. 

This constellation of events was a turning point in the history of the Medical 

Department. Although the surgeon general envisioned only a small number of 

nurses would be needed and their use would be limited, the female army nurse 

had been conceived. In response to congressional actions to authorize the use 

of female nurses in general hospitals, Sternberg told the Secretary of War, “In my 

opinion it would be very unwise legislation. Trained female nurses are out of place 

as regular attendants of sick and wounded soldiers in the wards of a general hospital. 

They may be useful in certain cases and especially in the preparation and serving of 

special diet.... It is my intention to employ trained female nurses to such an extent as may be necessary and desirable, but the passage of this bill would greatly 

embarrass me in the administration of our general hospitals.”17 His position was 

not attributable to any lack of appreciation for women’s professional skills, which 

he freely admitted nurses had demonstrated over the past 20 years, but because he 

believed they would be an encumbrance to the army.18 His assumption—one that 

would change by war’s end—was completely valid at the time. The U.S. Army of 

1898 was not organized, equipped, or trained to integrate women into its operations while on campaign. Furthermore, Sternberg was a man of his era. Victorian 

men did not consider a military campaign—with its crudities and harshness—an 

appropriate environment for a woman, nor did they believe a “proper” woman—

nurse or not—should be tending to naked or half-clad male strangers. Sternberg 

did not expound on this belief publicly, but Colonel and Surgeon Dallas Bache did, 

commenting that the Spartan conditions, fatigue, and privation of a camp were 

unfit for a female. Bache also remarked corpsmen were “soldiers first and nurses 

afterward,”19 and he saw “much expense, idleness, risk of friction, and a certain 

disquietude about immorality, in this innovation, without commensurate gain.”20

The nursing profession at large did not share Sternberg’s worries concerning the 

campaign-worthiness of women and the reception they would receive from medical officers in the field. As with previous wars, applications from trained nurses 

deluged the Surgeon General’s Office. All requests were politely refused with the 

statement that the Medical Department had no authority to hire them, but, 

according to Sternberg, the office continued to be “overwhelmed with applications 
222 The Life and Science of Surgeon General George Miller Sternberg 

from women across the country who wanted to nurse the soldiers.”21 Sternberg 

finally relented to the pressure, at least for assigning nurses to army general hospitals 

in the states. However, as with contract surgeons, his office did not have the resources 

to review each applicant thoroughly. In this regard, he received help from an 

unexpected quarter. Dr. Anita Newcomb McGee, a prominent Washington 

gynecologist and Vice-President General of the National Society of the Daughters 

of the American Revolution (DAR), suggested on April 27 that the DAR create 

an examining board to relieve Sternberg from approving nurses for army service. 

Sternberg readily agreed, and the following day asked Congress for authority to 

hire as many nurses as required, paying them $30 per month and a daily ration. 

Before the end of the month, the DAR Hospital Corps had been organized with the 

34-year-old McGee as director. Following the surgeon general’s instructions, only 

graduate-trained nurses were accepted. The nursing selection committee, which 

included—among other notables in Washington society—Martha Sternberg and 

Mrs. Russell Alger, reviewed thousands of applications from patriotic white, black, 

American Indian, female and male nurses, and many in religious orders.22

Although the furor over female nurses that Sternberg anticipated among members 

of the Medical Corps never materialized to any significant extent, publication of 

Circular No. 3 describing the duties of medical officers in the field generated 

an indignant and unexpected outcry from volunteer regimental surgeons and their 

commanders. The regimental surgeon’s primary duties were to ensure the sanitary 

security of the camp, advise the commander on such matters, provide combat trauma 

care and stabilization at first aid stations, and attend to the reporting of the same. The 

document contained no mention of the regimental hospital. The sick and wounded 

were to be expeditiously evacuated to division hospitals, where the surgeon in charge 

was responsible for their care on the march and in camp.23 Indignation intensified 

when orders were received from the surgeon general to turn in regimental medical 

outfits to the division hospital, make a requisition for the supplies they needed, and 

have two of every three regimental surgeons report to the division hospital commander for duty. As the surgeon general stated later, “so long as a regiment constitutes a 

separate command, its surgeon and assistants remain with it, but when a regiment...

becomes part of a division, a redistribution of the duties of...medical officers of...

regiments constituting the division is needful to meet the exigencies of war service.”24

Commanders saw this action as impinging on their command authority. Regimental 

surgeons interpreted it as being demoted to glorified hospital corpsmen operating 

a dispensary. Contrary to popular belief at the time, Sternberg had not abolished 

the regimental hospital—that had been done in 1862—but rather created a more 

practical and efficient use of medical equipment and supplies organic to volunteer 

regiments.25 Maintaining seriously ill and injured men with a maneuvering army led 

to poor medical care and slowed operational movements. Furthermore, the most 

experienced field surgeons—medical officers of the regular army—would be located 

at division hospitals. The sooner casualties could be placed in their hands, the better. 

Sternberg refused to have these facts ignored based on the ignorance or parochialism 

of volunteer regimental commanders and their surgeons.
War with Spain 223

To accommodate men too seriously ill to deploy forward and the inevitable invasion 

of more casualties, Sternberg designated six general hospitals—Key West, Florida; 

Fort Thomas, Kentucky; Fort Myer, Virginia; Fort McPherson and Chickamauga 

Park, Georgia; and Fort Monroe, Virginia—between April 30 and June 26. These 

facilities were established in whatever space could be found and eventually provided 

3,137 beds. To evacuate sick and wounded soldiers from Tampa and the camps, a 

hospital train was chartered from the Pullman Company and positioned at Tampa. 

Although these facilities were adequately equipped with furniture, linens, clothing, 

medicines, hospital stores, and disinfectants, they were not properly staffed until 

late in the summer. Early on, Sternberg did not have enough physicians or hospital 

corpsmen to fill administrative, corpsman, and nursing roles in support of 

deploying forces and the general hospitals simultaneously. Recruiting, examining, 

and training these individuals were horribly slow and, therefore, these needs were 

met over many weeks. Ironically—and contrary to his later statements—Sternberg 

hesitated to employ female nurses—an asset he had in abundance by his own 

admission—in effective numbers at general hospitals until after mid-July. From 

experience, Sternberg knew he would never have enough corpsmen to provide 

competent nursing services at all of the divisional and general hospitals. But he 

also recognized clearly that Bache’s opinion of female nurses was preeminent 

among physicians in general. Whether resulting from his own sense of female 

propriety, or the fear that he might create a rebellious attitude within the Medical 

Corps, Sternberg remained unwilling to assign nurses to hospitals unless the 

surgeon in charge specifically requested them.26

McKinley’s optimism for a May invasion was soon dashed on the sharp rocks of 

false promises and military realities. The pompous political boastings that defeated 

the Hull Bill and guaranteed a massive turnout of trained and equipped National 

Guardsmen proved to be an illusion. Although the volunteer army did contain a 

large number of guardsmen, they were primarily new recruits. One-third to onehalf of the peacetime National Guard force either refused to enlist or could not 

pass physical examinations. Moreover, the states could neither clothe nor equip 

their forces. These logistical difficulties were compounded by the fact that, after 

arming the Philippine expedition, the country’s arsenals did not have enough 

cartridges for the 25,000 men who were to comprise the Cuban assault force.27

Sternberg was relieved when he heard about the postponement. To keep pace 

with the shifting operational demands and a tremendously expanded army, he 

ordered all medical officers deploying with regular army regiments to take what 

medical supplies and equipment they had at their home stations. Purveying officers 

at medical supply depots were directed to arrange supplies for 100,000 men for 

six months, and a new field supply table was quickly prepared to meet field 

contingencies.28 Congress gave Sternberg authority to obtain bulk orders of medications and many expendable items on the open market, but—to his disgust and 

frustration—bids had to be invited from national manufacturers for the purchase 

of durables and high-cost items such as medical and surgical chests, litters, field 

operating cases, etc. This process required time he did not have. Sternberg realized 
224 The Life and Science of Surgeon General George Miller Sternberg 

by May 3 that he could not wait on deliveries if he expected to have medical units 

equipped by the time the expeditionary force sailed. He asked governors of several 

states to give National Guard medical equipment and supplies to the state volunteer regiments. Once they received army orders to proceed, they could requisition 

new supplies from the government. The majority of governors who had medical 

equipment readily complied, but Sternberg was dismayed to learn that many states 

had only limited quantities and 16 had no medical equipment. To deal with this 

dilemma, he provided supply depots with a prescribed list of medical and surgical 

items, hospital stores, and miscellaneous articles that were packed and shipped to 

the assembly camps.29 While this was a reasonable measure, it did not solve a 

difficult and growing problem. 

The Surgeon General’s Office continued to conduct medical supply operations 

in the usual manner, that is, it approved all requests for purchases of supplies and 

equipment received from surgeons in the field and informed the nearest supply 

depot of the order. Given a continual shortage of storage space, the depot 

obtained and packed only the items requested. These parcels were then given to 

the Quartermaster Department for shipment by rail. Although this system 

ensured checks were in place to preclude fraud and wasteful expenditures, the 

current crisis demonstrated its dreadful inefficiency. Requisitions passed through 

too many hands. No stockpiles of equipment and supplies were obtained. Packages, 

although properly addressed to the receiving surgeon, were placed in boxcars without inventory lists; therefore, finding shipments became difficult and tracking lost 

shipments was nearly impossible. Moreover, the army logistics system moved on 

railroads overburdened with the massive requirements of mobilization. In Tampa, 

only two railroads supplied the town from the north; only a single track extended 

from the town to the port 10 miles to the south and its rail yard was congested with 

hundreds of boxcars in various states of unloading. If medical shipments did get 

through, they had to be ferreted out from huge mountains of supplies and equipment. Throughout May, Pope and his staff labored valiantly and successfully provided routine medical care and evacuation to the V Corps, immunized its growing 

numbers against smallpox, and supplied and equipped four divisional and all regimental hospitals for combat operations. But, as more volunteer regiments arrived 

in Tampa, Pope found his supplies dwindling, and the replenishing pipeline was 

not so much empty as it was constipated. Sternberg had been force-feeding supplies to V Corps throughout the month, but he either did not recognize the system 

was so incredibly fouled up or was loathe to deviate from routine procedures until 

May 28 when he authorized Pope to buy whatever he needed locally. He cautioned 

the corps surgeon that a large stock of supplies would not be necessary “because 

additional supplies will be sent upon the hospital ship which I expect to have fully 

equipped to follow the expedition....”30

As the Medical Department dealt with these problems, the Spanish fleet, under 

the command of Admiral Pascual de Cervera, eluded American warships in the 

Caribbean and steamed into Santiago Harbor on May 19. Admiral William T. 

Sampson, who was made aware of the situation that day, left his lighter vessels to 
War with Spain 225

maintain the blockade around Cuba and sailed his battleships and cruisers at once 

to Cuba’s southern coast arriving June 1. Sampson was eager to pry out Cervera, 

but did not dare to enter the narrow, twisting three-mile channel that led into the 

harbor because it was filled with mines and surrounded by well-fortified heights. 

The navy suggested that the army shift its objective to Santiago where the small, 

isolated garrison could be easily reduced, leaving the Spanish fleet defenseless. 

An earlier strike appealed to McKinley and the War Cabinet. In late May, strategy 

in the Caribbean changed once more. In Tampa, Shafter’s V Corps was rapidly 

reinforced with battle-ready regulars and volunteers from camps in Mobile and 

Chickamauga. Shafter was to embark immediately for an assault on Santiago, and 

Miles would follow with an expedition to Puerto Rico.31

McKinley’s final directive to Shafter—like earlier strategic alterations—required 

the Medical Department and the other combat service support bureaus to react 

rapidly to a new and expanding situation. However, unlike the others, it also 

altered assumptions concerning delivery of that support and the use of auxiliary 

resources available in Cuba. Sternberg had assumed the following: 

1. sufficient medical supplies, equipment, tents, ambulances, wagons, horses, 

and pack animals planned for would arrive on the island; 

2. they would all disembark at the fixed port facilities at Mariel; 

3. they would move medical assets to the front with organic transportation; and 

4. time was still available to outfit a hospital ship. 

The slow acquisition and preparation of a hospital ship for strategic evacuation leads 

one to believe also that Sternberg assumed the 2,000-bed Alfonso XIII military 

hospital in Havana could be used as a general hospital and holding facility for 

soldiers awaiting medical evacuation back to the states. McKinley’s change in 

plans made the last three of Sternberg’s planning assumptions obsolete, and it 

significantly increased the pressure on him to have a hospital ship ready by the 

time the invasion force sailed. Torney’s search for a better and less expensive 

ship than the John Englis had been fruitless. Sternberg told McKinley that he 

should buy the $450,000 ship outright with emergency funds and begin the 

necessary refitting without further delay. McKinley did so on May 18. Sternberg 

intended the ship, renamed the Relief, to be a general hospital and a supply 

depot for medical assets on the island. He placed Torney in command, with 

Major William C. Gorgas as his executive officer. Torney’s navy experience allowed 

him to direct renovations and buy the equipment required for a modern floating hospital, and he was demanding in his specifications. Bunks and water 

closets had to be properly equipped and spaced; a steam laundry, ice machine, 

disinfecting apparatus, and electric lighting throughout the ship were absolute 

requirements as were steam launches for moving supplies ashore. Haggling 

over cost estimates consumed another two weeks. It was June 1 before the Assistant 

Secretary of War approved all of the $185,000 required to renovate the Relief, 

and refitting commenced.32
226 The Life and Science of Surgeon General George Miller Sternberg 

From his office in Washington, Sternberg urged Torney to expedite the work 

on the Relief and assisted as much as he could in pushing supplies to V Corps. 

Shafter, who had intended to sail on June 4, experienced loading difficulties and 

delays in the arrival of troops from Chattanooga and Mobile, thereby precluding 

his departure for another 10 days. The delay was fortunate for the V Corps Surgeon 

because he received a shipment of 200 packages of sorely needed supplies the 

following day and distributed them before loading on the transports on June 9. By 

this time, however, Shafter was aware he had too few transports for the task. To put 

a sufficient fighting force on the island as expeditiously as directed, he had to be 

judicious with supply distribution on the ships. Moreover, Shafter was certain the 

campaign would have to be brought to a rapid conclusion if he were to avoid 

having his army destroyed by disease. This could be accomplished, Shafter believed, 

because he also assumed Spanish resistance would be light and quickly overcome. 

Therefore, the entire medical package assembled in Tampa would not be necessary. His first three priorities—and rightly so—were (1) men, (2) ammunition, and 

(3) rations. The fourth priority was medical support—and only enough of that for 

the immediate and essential treatment of sick and injured soldiers. To Pope’s chagrin, 

a large amount of the supplies, ambulances, litters, horses, and pack animals he 

had worked so diligently to procure and distribute appropriately to regimental and 

divisional hospitals were left on the docks in Tampa. However, according to Pope’s 

executive officer, Captain Edward L. Munson, “Drugs, medicines, dressings, instruments, hospital tentage, and supplies were loaded on the transports at Tampa in 

sufficient quantities to meet the needs of the Santiago expedition.”33

The Cuban expeditionary force sailed out of Tampa Bay into the Gulf of Mexico’s 

tranquil waters on June 13–14, and arrived off of Daiquiri a week later. With the 

exception of Santiago Bay, the southern coast of Cuba offered no ports or protected 

harbors from which to disembark. Unloading began at Daiquiri, but was soon 

shifted to a relatively better location at Siboney, seven miles to the west, the 

following day. Hasty loading had been done with more thought to balancing the 

ships than organized disembarkation. Medical equipment and supplies were difficult 

to locate, and hospital tents were deep in the holds. Pope and his colleagues were 

low on the priority list for getting a hospital established in Siboney, a tiny, 

dilapidated, rural village clinging to the jagged, jungle-covered cliffs of the coast. 

Pope directed the conversion of the few filthy huts and clapboard shacks in the 

village into wards for sick and injured soldiers until they could be transferred to 

a hospital ship. He also designated the Olivette, a water carrier and distribution 

vessel for the transports, as his hospital ship, and he directed Major Aaron Appel 

to establish the Second Division Hospital in the large, electrically lit state and ward 

rooms of this ship.34

As these events unfolded, the Medical Department was losing the race against 

time to provide a hospital ship before V Corps engaged the Spaniards. With troops 

loaded on transports in Tampa, Greenleaf wired on July 11, “How long before 

the hospital ship and railway train will be available? The ship should go if possible 

with the expedition...if it cannot shall I call on the Red Cross Association ship?”35
War with Spain 227

Sternberg replied the Relief would sail as soon as possible—hopefully in seven to 

10 days—and the Navy ambulance ship Solace would arrive at the station from 

Guantanamo. As to asking for Red Cross assistance, the surgeon general told 

Greenleaf to use his own judgment, but “I had hoped...this might not be necessary 

as it will be considered by many as a reflection upon the Medical Department of 

the Army.”36 In compliance with instructions from the Secretary of War, Sternberg 

had directed his corps and division surgeons to cooperate with Red Cross authorities, 

but it was a bitter pill. Sternberg had supreme faith and confidence in every member 

of his department, which for the most part was not misplaced. Moreover, he 

remembered the embarrassment the Medical Department had suffered when the 

U.S. Sanitary Commission had taken virtual control of medical operations after 

the Peninsula Campaign in 1862.37

Adamant that this would not happen again, Sternberg continued to badger Torney. 

Refitting of the Relief’s interior had been completed on June 16, and loading of 

supplies and provisions had begun. The surgeon general told Greenleaf he expected 

the ship to sail no later than June 22, but delays, apparently in loading as well as 

obtaining steam launches for unloading at Siboney, precluded this. Three days later, 

the Secretary of War directed the ship to sail as soon as practicable. Under pressure, 

Sternberg told Torney not to wait on the launches even though he was aware of 

the transportation shortage at the front. He also gave the major a few specific 

instructions concerning his mission. Torney was to proceed directly to Santiago 

and report his arrival to Shafter. Command and administration procedures would 

be followed just as if the ship were a land-based general hospital, and Sternberg 

emphasized Torney was to guard his command authority jealously. The ship was 

to anchor as close to active operations as possible and take on both army and 

navy casualties to full capacity before departing for home waters. Torney was to 

maintain communications with the surgeon general as was practicable. On June 27, 

Sternberg sent these last additional instructions: “You should keep in view the 

fact that the Relief is a well-equipped floating hospital and a depot of supplies for 

troops in the field. It is important...she should not be taken away from the scene 

of active operations unless it is absolutely necessary for the purpose of landing the 

sick and wounded at a home port. You should avail yourself of every opportunity 

to send proper cases by the navy ambulance ship, the Solace, or by army transports 

returning to home ports. As a rule, the more serious cases of injury and sickness 

should be retained on your ship, as the disturbance incident to a sea voyage would 

be injurious to them. Convalescents and those sick and wounded who can be 

transported without injury...and who are not likely to be fit for duty within a 

short time, should be sent to a home port whenever the opportunity offers.”38 The 

Relief departed New York Harbor on July 3, fully staffed and provisioned, with 250 

beds, 700 tons of medical supplies, the first U.S. deployed x-ray machine, and the 

first six female nurses to be officially sent to a combat zone by the U.S. government.39

Sternberg had little influence on the decisions that disrupted Medical Department 

planning and could only watch from Washington as his subordinates played the 

hand they were dealt. In this regard, the army, the Medical Department, and the 
228 The Life and Science of Surgeon General George Miller Sternberg 

soldiers in the field were fortunate. Lieutenant Colonel Pope, Captain Edward L. 

Munson (Pope’s executive officer), Division Hospital Commanders Majors Marshall 

W. Wood, Aaron H. Appel, Louis A. LaGarde, and Valery Havard were all energetic 

and resourceful medical officers. Their ability to organize and lead not only junior 

medical officers and corpsmen, but also the large number of volunteer and contract 

surgeons deployed turned a desperate, chaotic situation into one of relative order 

and efficiency as the campaign progressed. On June 27, Wood loaded his First Division Hospital on the horses and litters he had available, and the backs of his staff, 

and followed maneuver elements up the Siboney-Sevilla Road. Two days later, 

the Red Cross ship State of Texas arrived. Aboard were Miss Clara Barton, a host 

of surgeons and nurses, and tons of supplies for Cuban refugee relief—all eager 

to perform whatever duties were required by the army and share their supplies. 

Sternberg had directed his surgeons to accept Red Cross services earlier in the 

month, but LaGarde and his colleagues—although courteous—hesitated to put 

female nurses in the wards. As the ensuing engagement neared, however, LaGarde 

swallowed his reservations and a gratified Barton put Red Cross personnel and 

supplies ashore. By the time Shafter engaged the Spanish Army at El Caney and on 

San Juan Heights four days later, the First Division Hospital was established 1,200 

yards behind the front in a protected bend of the San Juan River, and LaGarde’s 

Third Division Hospital—known as the base hospital—had shifted as many patients 

as possible to the Iroquois and Olivette in preparation for casualties. Over the next 

four days, nearly 1,000 soldiers arrived at the First Division Hospital on makeshift 

litters, wagons, and the three ambulances that initially made it from Tampa. Most 

wounds required only a dressing change or fracture restabilization. Surgeons were 

impressed that the individual first aid packets had not only been used, but also 

carefully applied to a large number of wounds. They were also mindful of triage 

priorities and Sternberg’s pre-war warning of their responsibility to operate only 

emergently under the septic conditions of the battlefield environment. For the 

most part, soldiers requiring major operations were evacuated over a trail nearly 

axle deep in mud as expeditiously as possible to Siboney, a task made somewhat 

easier by the arrival of 10 more ambulances on July 2.40

After the battles at San Juan Heights and El Caney, the base hospital and the 

Olivette were overwhelmed by the wounded that descended upon them. There 

were nearly 500 patients at the base hospital when the Relief arrived at Siboney on 

July 7. To complicate matters further, the first five cases of yellow fever had been 

diagnosed the previous day. Torney’s arrival was followed a couple of days later by 

Miles and Greenleaf aboard the USS Yale and bound for Puerto Rico. At Siboney, 

Greenleaf found a bad situation deteriorating into one of desperation. From the 

distribution of the mounting yellow fever cases, it appeared the entire army had 

been exposed and Siboney was a focus of infection. LaGarde had established a 

separate hospital and detention facility for yellow fever cases two miles from the 

base hospital along the rail line to Firmesa, but he had inadequate numbers of 

personnel to staff them appropriately and those he had were all physically 

exhausted. His supplies, as well as those of the Red Cross, were nearly gone, and 
War with Spain 229

Torney could not replenish them quickly because he had no launches. Greenleaf 

swiftly brought his medical authority and relationship with the commanding general 

to bear forcefully on all aspects of the situation. Supplies and tents began to flow 

off of the Relief. Gorgas, immune to yellow fever, was put in charge of the yellow 

fever hospital. Colonel Nicholas Senn, Chief Surgeon, U.S. Volunteers, and other 

surgeons aboard the Relief relieved base hospital surgeons at operating tables, 

giving them a much needed rest. Miles ordered a recalcitrant Shafter to send the 

entire 24th Infantry to LaGarde for nursing and guard duties, and, upon Greenleaf ’s 

recommendation, directed Siboney be burned to the ground to eliminate it as a 

source of infection.41

After the Spanish capitulated on July 14, Sternberg recommended all V Corps 

troops move out of their trenches to higher, more salubrious ground north of 

Santiago, but “within easy reach of their base of supplies. The camps should be 

well separated, and any regiment which remains in such fresh camp for five days 

without having any cases of yellow fever...could be put on a transport....”42 There 

had been only 250 cases of yellow fever in a total force of about 17,000 men, and, 

although the numbers were increasing daily, only five deaths had occurred. This 

extremely low mortality rate indicated to the surgeons on the island that the yellow 

fever they encountered was a “mild” type. When this was considered in light of the 

current military situation, the most prudent action was to change campsites and 

contend with the fever there.43 

Since Sternberg had been kept well informed of these developments, he recognized that Greenleaf had performed a minor miracle. Granted it was through 

the power of Miles, who still feared an epidemic conflagration, but the Medical Department fat had been retrieved from the fire—at least momentarily—just 

the same. Greenleaf, however, had requested two more hospital ships abundantly 

staffed, a supply ship with 1,400 tons of medical supplies, 1,000 hospital tents, and 

sufficient clothing and bedding for 10,000 patients. Sternberg appears not to have 

even flinched when he read the telegram. It was a large request for a small outbreak 

of disease that was to be controlled by proper field sanitation and hygiene techniques, but a large number of diseased Spanish prisoners and Cuban refugees 

also needed attention. The supplies and equipment could be gathered quickly relative to Greenleaf ’s other requests because of the infusion of $504,000 into department coffers on July 7.44 Hospital ships and immune personnel were another matter. 

The Missouri, accepted by the government gratis from Mr. B. N. Baker, president 

of the Atlantic Transport Line, on July 1, was what Sternberg had hoped would be 

a rapidly serviceable sister ship to the Relief, but her refitting was progressing at an 

agonizingly slow pace. Although he had contract nurses in abundance, few were 

immune to yellow fever and therefore could not be sent to Siboney. Trusted agents 

were searching New Orleans and other southern cities for immune nurses and any 

other immune women willing to perform nursing duties in Cuba.45 It would all take 

time, and that was a commodity Sternberg feared he had too little of. He hoped the 

relocation of V Corps onto higher ground away from Santiago, into proper tents, 

with regular rest, decent rations, and appropriate sanitation would end the outbreak 
230 The Life and Science of Surgeon General George Miller Sternberg 

before the disease gained a foothold in the mostly nonimmune army and generate 

panic in Cuba and in the United States.46 These issues burdened his mind as he 

packed for the train to New York City, where he would greet the Olivette’s arrival.

The Olivette anchored off the quarantine station at 8:00 p.m. on Saturday, July 16. 

Sternberg accompanied Health Officers William Doty and E. R. Sanborn and other 

officials to welcome her home. Major Appel reported the majority of his 279 patients had improved since departing Santiago. Fully one-third of the men aboard 

were alive, thanks to modern surgical techniques now practiced on the battlefield. 

Furthermore, no yellow fever or contagious disease was on board. Sternberg was 

elated. It was the first truly good news he had had since March and the last he 

would enjoy for some time. A series of events began to transpire that would culminate not only in harsh criticism of Medical Department competence, but also in 

personal attacks on Sternberg’s abilities and fitness as a leader and administrator, 

which would linger in histories of the war forever.47

On July 19, the day Sternberg approved the Relief ’s departure from Cuba with 

255 patients aboard, the sensational story of medical mismanagement aboard 

the transport steamer Seneca hit the newsstands. According to witnesses, the 

ship had had no medical inspection before taking on patients. It was dirty and 

overcrowded, its water cisterns were polluted and stinking, only coarse regular 

army rations were available to feed the sick, and few medical supplies were to be 

found, except those obtained from the Red Cross. McKinley was outraged. Alger 

issued a warning to Shafter to avoid further embarrassments of this nature and 

ordered Sternberg to investigate. The V Corps Surgeon reported to the surgeon 

general he had quickly embarked patients on the Seneca to clear his wards for the 

large number of casualties expected to result from Shafter’s planned attack on 

Santiago on July 13. Torney verified this and commented that all of the patients 

aboard were able to take care of themselves. One of the two physicians aboard 

the Seneca, Dr. Hicks, assured Sternberg personally he had obtained sufficient 

supplies and foodstuffs from the Relief, and none of the soldiers evacuated were 

in a serious condition upon embarkation. Before the month ended, however, the 

Concho, Rio Grande, Alamo, and Leona would all dock at Fort Monroe or New 

York laden with sick and wounded soldiers, and reporters eager to sell papers with 

their stories of suffering due to medical neglect. When the sick and wounded 

accumulated after the Las Guasimas skirmish, Pope found his own urgent priorities 

dictated that he employ unsuitable transports to clear the increasing congestion 

at the base hospital. He had followed surgeon general guidance for this type of 

evacuation. Only convalescents who were well enough to withstand the voyage, 

able to eat regular rations, and required only limited if any medical care had 

been selected. Hence, the need for a robust medical staff and supply chest was obviated. Although patients had been evacuated on nine transports without noticeable difficulty or censure, by the time the Seneca and other transports embarked 

malaria had begun to make an impact. Sick soldiers who appeared well enough 

to travel after a single cycle of fever often relapsed. Those who were recovering 

from wounds often developed malaria, typhoid, or measles on the voyage home. 
War with Spain 231

Some soldiers who were too sick to sail, but desperate to escape the island occasionally became stowaways who were found only after the vessel was at sea.48

The tremendous influx of patients at Fort Monroe stretched human resources 

and consumed supplies at a terrific rate. The Red Cross delivered $115,000 worth 

of much appreciated supplies, but Sternberg chafed at the organization’s continued 

pressure for him to accept more female nurses. While locating adequate living 

quarters for the nurses was a major problem, he was quoted in the newspaper as 

refusing to allow Red Cross nurses on military posts because the society had overstepped its bounds and wished not only to take charge at the front, but also at all 

government hospitals in the east. Comments in the newspapers from Clara Barton 

that the Red Cross was well organized, had fed all of the wounded at the front, and 

was now helping them home only added insult to injury.49

The outcome reflected poorly on the Medical Department and gave credence 

to the idea that there had been insufficient medical personnel and materiel when 

Shafter landed in Cuba. Criticism for this state of affairs quickly descended on 

Sternberg. He was forthright—yet defensive—in his responses to New York Times

reporters on July 30, and his words carried the curt edginess of a man holding back 

a flood of frustration and indignation. He stated simply that the department was 

not responsible in any way for the supplies and equipment being left in Tampa. To 

the question of why this occurred, Sternberg could not say. He carefully avoided 

dispensing blame on the Quartermaster Corps or the V Corps commander at this 

juncture, but added “General Shafter wanted to get there with his fighting men, 

I suppose, ....”50 Sternberg, an officer with 37 years of experience in multiple 

campaigns, could not have had any suppositions about what Shafter was trying 

to accomplish. Like the surgeon general, the V Corps commander had been reacting to McKinley’s vacillating war plans since late April. Although Shafter suffered 

from the same malady that many line officers of his generation did—a lack of 

confidence in, and respect for, the Medical Department—his decision to leave 

medical assets behind was not influenced by this so much as that he had insufficient transportation. Even so, enough medical supplies and equipment made it 

aboard the transports for the campaign, but could not be taken off at Siboney—

once again—for lack of transportation. Sternberg failed to make this point to the 

reporters, as well as his comment above, which suggests there was some other 

underlying irritation with Shafter that he was unwilling to divulge publicly. That 

irritation had its genesis early in the preceding week when Shafter requested 500 

hospital attendants, 100 nurses, a large contingent of doctors, and two regiments 

of soldiers—all immune to yellow fever—be immediately dispatched to Cuba.51

This action garnered the War Department’s full attention. Secretary of War Alger, 

who was confident in the reports provided by Sternberg that the epidemic had 

been checked by moving troops to higher ground, became alarmed and demanded 

an estimate of yellow fever cases within the V Corps by regiment. Shafter responded 

on July 22 that he was not certain, but believed that fever cases were increasing. 

The following day, he estimated 1,500 men had fever, with yellow fever accounting 

for only about 150 cases; every regiment was affected. However, two days later, he 
232 The Life and Science of Surgeon General George Miller Sternberg 

telegrammed Corbin, “Notwithstanding figures, the situation somewhat improving.”52

Shafter was frustrated and fearful that Alger would refuse to let his army return 

home if the epidemic expanded, so he did not relay the true magnitude of the 

growing crisis to Washington until July 28 when sick call reports demonstrated 

that 4,270 soldiers—nearly a quarter of his men—were sick, 85 percent with fever. 

As the V Corps commander grasped the enormity of the problem, he began to 

panic. He complained he had too few doctors and intimated to Corbin that the 

surgeon general did not fully appreciate the gravity of the situation. This peeved 

Sternberg, who replied publicly that he was well aware of V Corps difficulties. 

Sixty-five immune physicians and 120 immune nurses had already arrived, and 

another 25 doctors and 65 nurses would depart over the next two days. He also 

advised Shafter to employ those recovered from yellow fever as hospital attendants.53

The wisest course of action to contend with yellow fever was to change campsites frequently, treat patients in place, and allow the outbreak to burn out before 

sending troops home, thereby precluding its introduction into the United States. 

Shafter complied with moving campsites. However, Acting Chief Surgeon Valery 

Havard wrote to Sternberg on July 31: “The sanitary condition of the army is far 

from being satisfactory; in fact it is quite bad; at least 20 per cent. of all troops 

present are totally unfit for duty, while 5 to 10 per cent more, although not excused from duty would be incapable to march or do any hard work.”54 He attributed this condition to a “peculiar form of malarial fever” that “lasted five to 

six days without distinct remissions or intermission, and responds to very large 

doses of quinine, 20-40 grains a day,” and would frequently recur multiple times 

over a two-week interval.55 Havard identified the real medical issue on the island 

precisely: malaria cases had eclipsed those of yellow fever. While both Plasmodium 

falciparum and Plasmodium vivax were endemic on the island, it was the nonfatal 

P vivax that predominated and accounted for the vast majority of fevers. P vivax

has an average incubation period of 17 days. Therefore, it was not until July 22 that 

it began to affect the V Corps.

Shafter and the V Corps wanted to come home. Alger permitted—upon Shafter’s 

recommendation and Sternberg’s concurrence—a portion of the dismounted cavalry 

division to embark for the planned recuperation camp at Montauk Point, Long 

Island, on August 1. This was based on the fact the division had been camped on 

high elevation, and all suspicious fever cases would be held back. The War Department had initiated the establishment of rest and recuperation camp at Montauk 

Point on June 3. Alger had assumed a leisurely pace in establishing the camp because 

Shafter had not registered any real alarm over the health of his command up until 

the end of July. That changed on August 2. Shafter informed Adjutant General 

Corbin, “I am told that at any time an epidemic of yellow fever is liable to occur. I 

advise the troops be moved as rapidly as possible while the sickness is of the mild 

type.”56 Furthermore, medical supplies were nearly exhausted. Alarm again raced 

through the halls of the State and Navy building, and an emergency meeting was 

held in the White House to discuss a course of action. Sternberg reaffirmed his 

belief that it was safe to bring the army home because of the mild nature of yellow 
War with Spain 233

fever encountered and the isolated, northern location of Montauk Point. If the 

military situation would not permit this, then he insisted the army could be moved 

to higher elevations in the interior, where yellow fever did not exist, and Shafter’s 

fears would be groundless. His opinion carried the day. McKinley and Alger were 

not yet confident the military situation was stable enough for forces to be removed 

from the island, so Shafter was directed to move his command once again, this 

time into the mountains at the end of the San Luis railroad.57

Upon receipt of this order, Shafter prepared a lengthy report detailing the true 

state of his command. Moving camps had had no effect on yellow fever incidence, 

but had only further fatigued his soldiers who were already weakened by malaria. 

He claimed 75 percent of his army had malaria, and they were “really an army of 

convalescents.”58 Shafter concluded by stating the only reasonable action was to 

bring the army home immediately. Before sending the report forward, he 

conferred with his subordinate commanders and surgeons who not only gave 

verbal concurrence, but also drafted a memorandum in support of their commander’s 

decision. All surgeons involved agreed the prevailing malarial fevers had reduced 

the army to its current pathetic state.59

This document would become the infamous “round robin” letter. It was read in 

the major U.S. newspapers on August 5 almost as quickly as it was read in the War 

Department. The letter astounded the American public with the first description 

it received of the true state of health affairs in the Caribbean. The administration 

in Washington was angered and embarrassed not only because the letter had been 

leaked to the press—perhaps with Shafter’s assistance—but also because it was 

printed alongside the announcement that the army would be coming home immediately. While the decision was based on Shafter’s communiqué, the perception across 

the country was that an insensitive bureaucracy had reacted to the crisis only after 

it realized the plight of the army would be made public. In truth, Sternberg had 

issued a directive concerning the proper organization, equipment, and manning 

for medical transports on August 3, and Secretary of War Alger issued orders for V 

Corps to embark to Montauk Point the following day. Shafter attempted to mitigate 

the damage of the “round robin” letter afterward by stating fresh and well-supplied 

troops would encounter little risk from diseases in Cuba; however, he bolstered 

animosity toward the Medical Department by declaring Sternberg solely responsible for the lack of medical supplies and attendants, and the horrible incidents on 

the transports.60

The administration’s knee-jerk reaction was to have Shafter begin loading his 

soldiers on transports and hope the reception camp would be prepared enough 

to receive them when they arrived. Alger put Brigadier General Samuel M. B. 

Young in command of the Montauk Point site, named Camp Wikoff in honor of 

Colonel Charles Wikoff, 21st Infantry Commander, who had been killed at San Juan 

Hill. Sternberg gave Colonel and Assistant Surgeon General Henry Forwood the 

chief surgeon duties. In his instructions to Forwood on August 6, he envisioned a 

detention camp for 4,000 to 5,000 troops placed near the landing with a supporting 

250-bed hospital, in addition to the 500-bed hospital already staked out. Soldiers 
234 The Life and Science of Surgeon General George Miller Sternberg 

arriving on ships with confirmed or suspected cases of yellow fever would go into 

the detention camp, and suspected cases would go into the hospital for observation. 

Sternberg ordered a steam disinfector from the Marine Hospital Service, gave specific instructions for building a disinfection facility, and promised to find a yellow 

fever expert for duty at the camp. He also cautioned Forwood, “Let us try and do 

this thing in such a way that there may be no criticism of the Medical Department.”61

At the time he penned these words to his old friend, Sternberg was feeling such 

criticism acutely. The previous week Dr. George F. Shrady, editor of the Medical 

Record, published two scathing editorials that branded the Medical Department as 

disorganized and incompetent in regard to the transports and an utter failure in 

providing for the sick and wounded in Cuba while praising the Red Cross. Sternberg 

was incensed and wired the following to Nicolas Senn: “I depend upon you to 

answer Shrady’s unfair editorials in the Medical Record.... Talk with Torney about 

it.”62 Four days later, Sternberg sent a long telegram to the Medical Record: “Large 

quantities of additional supplies, dressings, etc., sent to Tampa. Have objected to 

sending female nurses to camps of instruction or with troops to Cuba. We have 

trained Corps of non-combatants enlisted to care for the sick and wounded....

Have gladly accepted services of trained female nurses for General Hospitals and 

think highly of them. Red Cross and other volunteer organizations should furnish 

their own transportation. They are constantly applying for transportation for their 

agents and female nurses. I have not refused their assistance when needed. Shrady 

came to my office with a Committee from New York. I told them an emergency 

might arise in which they could be very useful, and advised them to equip a Hospital 

Ship and send to Cuba. The assistance they have rendered is trifling compared 

with the work done by our Medical Officers and Hospital Corps. They ignore this 

and magnify the importance of their own service. They send a female newspaper 

reporter as a Red Cross nurse and she writes sensational articles for the New York 

Sun.”63 Sternberg sent more composed replies, addressing each of these topics, to 

the Medical Record and Medical News, which were immediately published.64

The transport dilemma, however, continued to plague the surgeon general as if 

it had a life of its own. The Concho docked at New York on the evening of July 31 

with 183 patients, one physician, and eight Red Cross nurses. Colonel Charles C. 

Byrne, Chief Surgeon, Department of the East, inspected the ship and reported 

to Sternberg, “...I saw enough to satisfy me that things were not as they should 

have been.... Six patients died and several others appeared to be in a hopeless 

condition.”65 A few days later, the transport Santiago brought not only embarrassment, but also anger when the New York Times responded with a professional 

and personal attack on the surgeon general. The Santiago, with 180 convalescents 

aboard, had docked at Egmont Key, the quarantine station for Tampa, which had 

been prohibited by Sternberg as a convalescent landing point because no medical 

facilities existed there to receive them. Sternberg responded to questions by stating, “I did not know...the Santiago was coming with sick or convalescent soldiers. 

If I had heard...she was making for Egmont Key I should have directed...my 

former orders be obeyed.... But the shipment of convalescents and returning men 
War with Spain 235

is matter with the line officers at Santiago or Siboney. They may send back whom 

they please, and the Medical Department cannot prevent it.”66 But the correspondent, Stanhope Sams, clearly intended to indict Sternberg for this error. Sams did 

a bit of nosing about the War Department until he found an officer “familiar with 

the relations of the line and medical officers,” who was glad to put the knife into 

Sternberg and Alger and slap the Quartermaster Department in the process.67 He 

commented that “some quartermaster, anxious to get the job off his hands, hurried 

them [the convalescents] on board...and dispatched the ship to the first point suggested.... The trouble with the Medical Department of the Army is that unless it 

has a very strong, bustling, forcible head, and the War Department has a head that 

will work in with the head of the Medical Department, it can accomplish little.... 

It does not make any difference how fine and accurate a scientist or theorist the 

Surgeon General is...unless he can also be an executive officer. It does not do to 

write an order and think that something has been done. The chances are that it 

will not be done unless...the officer is a man of sufficient force, impressiveness 

of address, and persistency to badger the Secretary of War until his requests have 

been attended to — not merely promised.”68 For all of his supposed familiarity with 

the interactions of Medical Corps and line, the anonymous officer demonstrated a 

remarkable ignorance of them, army administrative procedure, and the events of 

the past three months.

Sternberg kept his finger on the pulse of activities at Montauk Point as rumors 

circulated that Alger was going to force his resignation.69 He was in daily telegraphic contact with Forwood, coaching and advising without micromanaging. 

To cut red tape early on, the surgeon general authorized him to purchase supplies 

directly from the New York depot, contract for physicians and nurses as required, 

buy and use disinfectants lavishly, push hard to get a laundry facility built, and 

have 100 hospital tents available for immediate use while hospital construction was underway. Sternberg also reminded him the Secretary of War ordered 

no pains or expenses to be spared in establishing these medical facilities and 

obtaining everything necessary for the patients. With this in mind, the surgeon 

general asked for an additional $500,000, which he received on September 8, to 

complete the project. But avoiding criticism was impossible. As with every other 

operation during the war, at Camp Wikoff too much was expected too fast from 

limited resources. From the outset, the single-track railroad and its terminus at 

Montauk Point were too small to handle the large amount of material being delivered. 

The Quartermaster Department could not provide sufficient wagons and animals 

to transfer these materials to the various construction sites. Boring wells in the 

rocky terrain made obtaining ample water a major problem; therefore, drift wells 

had to be dug, the water had to be slowly pumped into storage tanks, and every 

drop boiled before consumption. Late on August 7, 3,500 men from the 6th cavalry with a couple thousand horses and mules began to descend on the camp without tents, baggage, or any provisions. The 6th Cavalry, which was left behind at 

Tampa in June for want of transports, was now believed to be at risk for a typhoid 

epidemic. The War Department directed the cavalry to Camp Wikoff, hoping it 
236 The Life and Science of Surgeon General George Miller Sternberg 

could assist with construction, but in reality it only became another burden for 

General Young and his chief surgeon.70

Finding enough skilled carpenters, haggling over wages, and rain caused the 

construction of the pavilion-style hospitals to progress by starts and stops. Each 

ward consisted of six joined tents and accommodated 30 patients. Forwood 

reported he had “all kinds of medical and hospital property in abundance and under 

cover,” but what he really needed was more physicians and nurses.71 Sternberg 

successfully opened a pipeline for personnel by contracting physicians and 

nurses as rapidly as he could, and female nurses began to arrive on this day. 

Help was accepted from the Marine Hospital Service, Red Cross, American 

National Relief Association, and Sisters of Charity. He brought Major William 

Borden with a group of contract physicians, female nurses, and corpsmen 

from Key West and deployed more corpsmen from the hospitals at West Point 

and Washington Barracks.72

Hoards of reporters, physicians, philanthropists, and tradesmen descended on 

the camp. Although eager to help, they only added to the congestion and fanned 

the flames of impending disaster in the newspapers. Others—like Governor Frank 

S. Black of New York—were more focused on what infections arriving troops 

brought with them to Montauk Point’s shores. While yellow fever was the most 

terrifying disease to the public, the danger of a typhoid fever epidemic on Long 

Island generated tremendous angst. By August 11, the day Black sent his health 

officer, Dr. Alvah H. Doty, to visit Forwood, the papers were buzzing with typhoid 

tales from the mobilization camps, and the Relief was on its way carrying 260 

sick soldiers, mostly typhoid cases. The governor doubted the Medical Department’s ability to contain the disease. Doty was supposed to pressure Forwood into 

sending all typhoid patients to New York and Brooklyn hospitals or else he would 

quarantine the entire camp. However, Forwood said no. From experience, both 

Forwood and Sternberg agreed typhoid patients fared better in tents rather than in 

fixed general hospitals. Furthermore, sending diagnosed patients elsewhere would 

not preclude typhoid from entering the camp, and the surgeon general had 

confidence that disinfection of excreta would keep it from escaping. For Sternberg 

and Forwood, the real issues were providing proper patient care and maintaining enough bed space. Civilian and military hospitals closer to New York Harbor 

would shorten evacuation and provide extra bed space. Sternberg gave Forwood 

total decision-making authority at Montauk Point, but he directed Colonel Byrne 

to send all typhoid cases from the Relief to New York and Brooklyn. Then he informed 

the governor and his health officer that he would not be dictated to on the subject 

as they had no jurisdiction over a federal encampment.73

On August 18, the day the general hospital was completed and construction of 

a 500-bed annex immediately began, 730 patients were receiving care and another 

500 were waiting on transports. Forwood’s hospital census reports and the scheduled 

arrival times of transports made Sternberg concerned that the medical facilities 

would soon be overrun. Had he and Forwood significantly underestimated the V 

Corps sick rolls? To keep beds open, convalescents would have to be furloughed or 
War with Spain 237

evacuated to other facilities. Medical officers had been given approval to furlough 

those well enough to travel the previous week. To provide care for typhoid cases 

and convalescents still too weak to travel long distances, Sternberg coordinated 

for the use of facilities at Forts Hamilton, Wadsworth, and Columbus as well as 

local New York, Boston, New Haven, and Philadelphia hospitals. Sternberg advised 

Forwood to keep patients aboard the Olivette until steamers could begin transferring patients out. The rapid construction of annex wards by August 20, however, 

appears to have relieved the pressure enough for Forwood to telegraph “I feel 

confident I can take sick as fast as they come.”74 And they came. By August 24, 

there were nearly 1,500 patients in the detention and general hospitals and the 

hospital annex that was still under construction. At least 500 patients had been 

evacuated to city hospitals, and the steamer Catania was inbound with another 

410 patients aboard.75

By late August, patients were being continuously received, evaluated, treated, 

and shipped out by scores of doctors, nurses, and corpsmen. Under Forwood’s 

competent administration and leadership, medical operations slowly, but steadily, 

improved. This was noted by the New York Times, but never expanded upon.76

The last of Shafter’s troops docked at Montauk Point during the first week of 

September. On September 10, Forwood told Sternberg “There are over 1,000 vacant 

beds in the three hospitals. Everything is running smoothly.... There is nothing 

for me to do here now....”77 Forwood was exhausted. The surgeon general replaced 

him with Greenleaf, who directed operations until the camp closed in October. 

The camp had processed 14,000 patients, and of these only 257 died.78 No typhoid 

epidemic had occurred as predicted by the governor, Doty, and even Colonel 

Nicholas Senn; nor had yellow fever made a viable presence in the camp.

Until early August, public attention had been focused on the army and its difficulties in Cuba. Miles’ three-pronged assault on Puerto Rico that started on July 25 

attracted little adverse comment. The redeployment of the V Corps to the United 

States, however, shifted public attention not only to Camp Wikoff, but also to the 

other camps where the majority of volunteers had spent the war. On August 6 

and 7, the New York Times informed its readers that typhoid fever had broken 

out at Camps Alger and Thomas. Three days later, one of its first front-page 

articles covered the status of medical care in Camp Thomas at Chickamauga Park, 

Georgia. The heartrending story, given by Captain William F. Morris of the 9th 

New York Volunteers, told of sick soldiers languishing under poor medical care 

and their fear of the hospital. According to Morris, the camp was “a modern 

Andersonville.”79 If the content of the article did not generate indignation among 

its readers, the comparison of a contemporary mobilization and training camp to 

the infamous Confederate prison most certainly did.

Unlike Camp Wikoff, the major mobilization camps—Alger near Falls Church, 

Virginia, Thomas at Chickamauga Park, Georgia, and Cuba Libre near Jacksonville, 

Florida—had been selected in April and May by a three-man commission appointed 

by Alger without input from the surgeon general. With the exception of Camp Alger, however, it is doubtful Sternberg would have balked at the selections. Camps 
238 The Life and Science of Surgeon General George Miller Sternberg 

Thomas and Cuba Libre were spacious and had abundant pure water sources. What 

turned these camps into the pestholes—described by reporters in August—was 

the massive influx of inexperienced and undisciplined volunteer soldiers. In the 

government’s rush to war, Sternberg noted a repetition of Civil War era mobilization practices that should have been altered by current medical knowledge and 

past experience. The haste in which recruiting was accomplished precluded proper 

medical examinations and, therefore, men sick with typhoid and other infectious 

diseases were accepted for service. They became the nidus for various camp infections. 

This problem was compounded by a reduction in the recruiting age to 18 years. 

These militarily and immunologically unseasoned boys swelled the ranks and the 

sick call lists with cases of measles, chickenpox, upper respiratory infections, and, 

as the summer progressed, typhoid fever. Sternberg was under no illusion that typhoid fever could be kept out of the mobilizing army entirely. The disease was endemic throughout the United States, and even a careful medical examination would 

not reveal those incubating the disease. Although William Budd had described the 

transmission of typhoid through infected feces and soiled hands and the role of disinfectants in halting this transmission in 1873, appropriate camp sanitation would 

not preclude occasional local outbreaks, but it would at least reduce the impact of 

typhoid and other diseases. Guidance provided by Sternberg in Circular No. 1 was 

based on these principles. Regrettably, the majority of line officers were no more 

experienced or disciplined than the recruits, and many volunteer and contract physicians were ignorant of the medical science upon which the circular was 

based. Sternberg’s guidance was met with indifference or it was ignored. Camps became overcrowded, bivouac sites were poorly located, company latrines and refuse 

pits were placed too close to living quarters, and bathing facilities were inadequate. 

Soldiers defecated promiscuously about the camps, quenched their thirst from the 

nearest water source, and ate indiscriminately from local food vendors.80

Sternberg was aware of the potential, but never expected the large epidemics that 

engulfed Camps Alger and Thomas. The volume of work in his office was overwhelming. He read many sanitary reports, but could not possibly keep all of the 

information at hand on a daily basis. Furthermore, some sanitary reports that should 

have been made through command channels never reached the Surgeon General’s 

Office or, if they did, were filed before Sternberg had read them. By his own admission, 

he was not aware of the unsanitary conditions of these two camps until the newspapers 

brought it to light. At the end of July, he sent Walter Reed on a whirlwind investigative 

tour of general and division hospitals at Camps Alger and Thomas, and Forts Thomas, 

McPherson, and Monroe to discern the cause of these administrative deficiencies. 

Although sent to put paper trails in order, Reed’s keen eye undoubtedly also assessed 

the sanitary status of the camps for his chief. The following week, Lieutenant Colonel 

Alfred A. Woodhull was dispatched to Camp Thomas to make a thorough sanitary 

inspection. His report reached the surgeon general on August 7. Once apprised of the 

true state of affairs in the camps, Sternberg believed the epidemics were in large part 

resulting from the undisciplined behavior of individual soldiers and disregard of his 

original directives concerning camp sanitation by inexperienced officers. He opined 
War with Spain 239

the situation at Camp Alger to be serious, but not alarming, and this was confirmed a 

week later when surgeons there reported the epidemic was under control. However, 

this was not the case for Chickamauga. The epidemic continued there unabated until 

hospitals overflowed and services were stretched to the breaking point.81

On August 6, Adjutant General Corbin directed a sanitary investigation be 

conducted. The board consisted of three brigadier generals of volunteers, J. P. 

Sanger, Charles P. Mattocks, and Charles F. Roe, but medical representation was 

conspicuously absent. Their report of August 15 was a well-written, but weak 

defense of the volunteer officer corps at Chickamauga. While admitting that before 

August 1 general sanitation and policing of the camps had been less than desirable 

due to inexperience in the field, the board concluded the following: 

1. if the Quartermaster Department had provided enough kettles and barrels 

for boiling and storing, then water transmission via this medium would 

have been stopped; and 

2. had the Medical Department not stripped the regiments of surgeons, then 

general sanitation would have been attended to and patients would have 

been better cared for.82

Sternberg disagreed strongly with both of these conclusions. Three days after 

Sanger submitted his report, Sternberg established the Typhoid Board to conduct 

an epidemiological investigation of the disease in the major camps. Although the 

timing is interesting, the findings of Reed and Woodhull earlier in the month and 

the increasing number of typhoid cases and deaths motivated the creation of the 

board, rather than Sanger’s report. Sternberg also recognized typhoid was becoming 

another in an expanding list of Medical Department scandals. Therefore, 

he selected the board’s membership carefully. The indefatigable and experienced 

Reed was put in charge with Victor C. Vaughn and Edward O. Shakespeare to 

assist him. Sternberg shared a long professional history with all of them. Vaughn 

and Shakespeare were not only accomplished bacteriologists, but also experienced 

and trusted civilian public health experts. Their presence would lend credibility to 

the investigation and preclude accusations of a government cover-up.83

From August 20 to October 10, the Typhoid Board members visited the camps. 

They collected 1,000 pages of testimony from a large number of medical officers 

and carefully recorded their own observations on every detail of camp sanitation 

and hygiene. Upon their return to Washington, they made a thorough study of 

monthly sick and wounded reports for 118 regiments compiled in the Surgeon 

General’s Office. Although the final report of the board would not appear until 

1900, its initial findings were significant. Typhoid in the camps did not result from 

impure water as was commonly believed and reported in the newspapers, but 

rather from a disregard for personal and unit sanitation and hygiene. Soldiers had 

brought the disease with them from civilian life. These carriers deposited typhoid 

bacilli in the latrines and on the ground before they became ill, and then, by way 

of soiled hands and flies, the disease was transmitted to kitchens and dining tables. 

Moreover, medical officers, particularly among the civilian volunteers, were 
240 The Life and Science of Surgeon General George Miller Sternberg 

failing to recognize half of the typhoid cases encountered, calling them malarial 

or typhomalarial. To preclude further diagnostic errors, the board recommended 

each camp be equipped to perform blood examinations for malaria and to use the 

Widal test for typhoid fever.84

By the end of August, Sternberg was weary. The medical fiasco on Cuba and his 

tiff with Shafter had led to printed rumors that Alger was ready to relieve him. He 

had to continually explain he was not hostile to the American Red Cross, but truly 

did appreciate its efforts. Newspaper editorials labeled him an incompetent and 

a murderer, indicted him for an unending litany of medical failures based largely 

on emotion, placed unrealistic responsibilities on him while wholly ignorant of 

military command procedures and combat realities, and labeled his bacteriological work a distraction that led to unnecessary suffering and death. His home 

was no longer a haven for rest and recuperation, but had become a second office 

where he answered phone calls and telegrams constantly and consoled a continual 

parade of distressed relatives. In his heart and mind, Sternberg knew he had 

done everything in his power to ensure appropriate medical support had been 

provided on two foreign fronts and in the stateside training camps as quickly as 

the crisis permitted. Sternberg felt it was a stunning and hurtful blow that the 

American public felt this was not enough and that trust in him had been misplaced 

and abused. Mrs. Sternberg felt her husband’s emotions acutely, and the editorials 

cut her to the quick. The early excitement of the war had been reminiscent of 

those long ago days at Fort Lapwai. Then she worried about his physical safety; 

now she fretted over his psychological well-being and his apparent precarious 

status within the administration. She became so upset over the criticism that she 

stopped making her routine visits to the First Lady. When McKinley learned of 

this, he told Sternberg to bring her to the White House for a “needed lesson in 

politics.”85 McKinley regretted tremendously that she had taken press accounts 

so much to heart. He reminded her most of the criticism was only for political 

effect and “history would reveal that we had all done our duty, and in the meantime we had at least the approval of our conscience.”86 

Although McKinley’s words relieved Mrs. Sternberg’s fears that the war had 

splintered their friendship, they did nothing to allay Sternberg’s intense indignation. He had remained confident that he and his supporters could adequately 

explain their position through the lay and professional press and defend himself 

from what he considered—and historical investigation bears out—was unduly 

harsh professional and personal criticism. But the American public was not 

listening. Sternberg recognized only through an open and thorough inquiry 

by a disinterested committee that he and the Medical Department would be 

cleared of misconduct and neglect. On August 27, he asked Alger for a general 

investigation of the Medical Department and five days later made public his 

readiness and desire for the same whenever the War Department saw fit to 

do so. On September 8, he received his wish. McKinley directed the appointment of a commission to thoroughly investigate the army’s management of the 

war. Retired General Grenville M. Dodge, an Iowa businessman prominent in 
War with Spain 241

the Republican Party who had publicly defended the Army over the previous 

months, accepted the chairmanship. Through the fall, the commission scrutinized 

every aspect of army administration. The Secretary of War and all the bureau 

chiefs were minutely questioned. Officers, enlisted men, nurses, physicians, 

charity workers, and concerned citizens provided testimony, and army camps 

were inspected.87

With the Dodge Commission, Sternberg saw an opportunity for vindication. 

When directives arrived on his desk from the Dodge Commission later in the 

month, he directed his staff to prepare answers on Medical Department organization, staffing, logistics, hospitals, and evacuation, and he invited the commission 

to visit his office to assess its organization and work practices. He, too, prepared 

comprehensive memoranda of his department’s execution of the medical mission. 

Regrettably, there were no solid preliminary conclusions from the Typhoid Board 

to assist in the defense as Sternberg prepared to give his testimony on December 

8. It proved to be a long and grueling day. He answered 370 questions that covered 

every aspect of medical activity from personnel and equipment to rations and 

reports of physician drunkenness. Toward the end, fatigue set in and his temper 

began to rise, but he quickly rallied from the former and gained control of the 

latter. When he left the Lemon Building in downtown Washington, Sternberg was 

satisfied that he had honestly defended the Medical Department, his officers, and 

himself to the best of his ability.88

In its report of February 1899, the commission was satisfied the problems experienced by the Medical Department during the war did not result from improper 

management and wanton neglect. Its most damning conclusion was the department 

had failed in its primary duty to protect the health of the soldier by not having a corps 

of medical inspectors and/or insisting on timely sanitary reports. But the impact of 

this statement faded significantly when placed alongside the other seven conclusions 

concerning the Medical Department. The commission found, as a result of poor 

administrative methods and cost-containment initiatives that had developed over a 

generation, that Sternberg had been precluded from preparing for—or responding 

to—the 10-fold expansion of the army with men or materiel in a timely fashion. The 

demands made on the department were “much greater than had been anticipated,” 

and it had been “seriously crippled in its efforts” to provide all medical and hospital supplies.89 While the commission chided the surgeon general for not employing 

female nurses early on, it recognized the lack of a sufficient nursing force resulted 

from congressional failure to authorize the establishment of a hospital corps in the 

volunteers. The commission also noted that “a vast deal of good work was done 

by medical officers, high and low, regular and volunteer, and there were unusually 

few deaths among the wounded and the sick.”90 The commission recommended the 

surgeon general be granted the authority to increase the number of commissioned 

medical officers, establish a volunteer hospital corps during wartime and a reserve 

corps of trained women nurses, stockpile a year’s supply of medical stores for four 

times the actual army strength, manage Medical Department transportation, and 

simplify administrative paperwork for increased efficiency.91
242 The Life and Science of Surgeon General George Miller Sternberg 

To Sternberg, the facts had been presented to an unbiased panel of judges who 

had deliberated on the evidence, rendered their verdict, and made the proceedings 

available to the public at large. He and the Medical Department had been—for 

the most part—vindicated and that was the end of it. This was true, at least contemporaneously. Republicans maintained control of Congress in November, Alger 

remained as Secretary of War, Sternberg continued as surgeon general, and the 

McKinley administration would win reelection in 1900. While the public did not 

demand a sacrificial lamb or two from the administration, the War, or Medical 

Departments, historians would not be so kind. 

Sternberg has been painted as a brilliant, but austere, obstructive, and lazy man 

who was “authoritative and disdainful of contradiction” and detached from other 

human beings or their suffering.92 He was seen as unaggressive, wholly innocent 

of army politics and administration, and ignorant of military organization and his 

duties as surgeon general. These assessments of Sternberg lack a genuine grasp and 

appreciation of his personality; his character as a man, physician, and soldier; and 

his abilities as a military officer. Moreover, they fail to consider the limitations of 

his office in the overall command and staff structure of the army and the boundaries of his personal span of control. Historians have perpetuated a myth while 

ignoring the genuine flaws in Sternberg’s decision-making and their origins.93

Sternberg’s failures in the spring and summer of 1898 have their origins in his 

almost 40 years of experience with the traditional organization, regulations, and 

procedures of the 19th century army. He and nearly all of the line commanders 

and bureau chiefs were Civil War veterans. With the exception of Joseph Wheeler, 

none of them had commanded anything larger than a regiment or—in Sternberg’s 

case—a general hospital during wartime. The post–Civil War army was an extremely 

small and scattered constabulary that for the most part fought skirmishes, not 

battles, fell into a routine that changed little from year to year, and could be 

administered from Washington without significant difficulty. Sternberg and his 

peers had been doing the same thing, in the same place, with the same tools and 

austere budgets for so long that to think and act with vision on a broader scale—as 

the campaigns of 1898 demanded—was impossible within the timeframe of the 

conflict. Sternberg acted as rapidly and effectively as could be expected under the 

circumstances to advise the army concerning disease threats and build the robust 

Medical Department required. However, his judgment failed him significantly 

four times. Although each of these decisions was made independently early on, 

they all came home to roost in August.

First, he and Juan Guiteras erred when they vacillated on the threat posed to the 

army by yellow fever and malaria. Sternberg had the trust and confidence of the 

president on all medical matters. He was an internationally renowned subject matter 

expert on both maladies. He knew both diseases were endemic on the island and 

had an intimate understanding of the impact of these diseases on past armies. It is 

almost inconceivable that he would allow any doubt to shadow McKinley’s mind 

over the inevitable consequences of a summer campaign, but apparently he did. If 

Sternberg had remained immovable on this issue with Miles, then it is possible—
War with Spain 243

although unlikely—that the president may have opted to postpone the invasion 

while continuing with a naval blockade.

Second, Sternberg failed to recommend the general use of quinine for malaria 

chemoprophylaxis. This is also difficult to understand. Although quinine is a poor 

chemoprophylactic agent—acting to suppress rather than eliminate the disease—it 

was the only one available at the time. He was familiar with the success of quinine 

prophylaxis among Civil War surgeons as well as those of the British Army and 

Navy on African station and the French Army in Algeria over the past 40 years. 

He had written favorably of quinine prophylaxis in 1883 and was aware that leading medical experts, such as William Osler and Patrick Manson, both advocated 

its use in malarious areas.94 Furthermore, quinine was always abundantly available 

to the army surgeons in Cuba.95 Its use may have precluded the development of an 

army of convalescents, and hence the precipitous embarkation of V Corps to an 

unprepared Camp Montauk.

Sternberg’s third and fourth errors—losing sight of the health status of the training 

camps through poor reporting and not deploying a sufficient number of female 

nurses—appear at first blush to stem from a reluctance to break with traditional 

army practices and procedures. Although reporting procedures from field surgeons 

to the surgeon general went through a logical and appropriate command chain 

and army nursing was the province of men, these are thin excuses for the medical misadventures in the training camps. Sternberg was cognizant of the endemic nature 

and epidemic potential of typhoid fever, the immunogenic naiveté of 18-year-old 

recruits, the undisciplined inexperience of volunteers in camp, the unfamiliarity 

of volunteer surgeons with regular army healthcare practices, the shortage of 

hospital corpsmen for nursing duties, and the fact that he had too few officers on 

his staff to conduct routine inspections of the camps. Forearmed with this knowledge, he should have had a higher index of suspicion for problems in the camps 

and should have required a weekly status report be sent directly to him from the 

chief surgeon of each camp. Sternberg expected the regular army medical officers 

he put in positions of authority in the camps to perform division-level administration, patient treatment, and training of a large number of volunteer and contract 

surgeons in army administration and field sanitation. These expectations were 

unrealistic. While some novice army surgeons resisted the training, others and 

their commanders refused to let the traditional regimental hospital system die. 

If Sternberg had demanded more frequent and direct communications from his 

chief surgeons, then he would have realized he was asking too much from too few, 

and the resistance to proper sanitation and hospital management had primed the 

camps for a medical disaster, most likely in the form of typhoid fever.

Tied directly to the foregoing is Sternberg’s failure to employ female nurses until 

the typhoid wave had crested and broken on the camps. With inadequate numbers 

of regular army hospital corpsmen, Congress’ refusal to support a volunteer hospital 

corps, and the tendency for National Guard corpsmen to serve in nonmedical 

roles, the surgeon general had only two options for providing nursing care: he 

could hope recruiting efforts for competent corpsmen improved and filled the 
244 The Life and Science of Surgeon General George Miller Sternberg 

ranks rapidly, or he could employ appropriately trained and eager female nurses 

immediately.96 Regrettably, Sternberg chose the former solution and sent nurses 

only when requested by the hospital commander. His decision does not appear 

to be related to a lack of faith in their abilities or that women would be exposed 

to the realities of army camp life, but rather to the animosity held by a number 

of his medical officers for female nurses in general. While Sternberg’s respect 

for the autonomy of the hospital commander is commendable, in this instance it 

proved to be disastrous to mission accomplishment. Had he exerted his authority 

as surgeon general on this issue earlier, general and division hospitals would have 

provided better care, and the sharp criticism he received in reducing the capabilities 

of the regimental hospital would have been—to some extent—blunted.

It has been said the war destroyed Sternberg’s reputation as an eminent epidemiologist and bacteriologist.97 This, too, is a myth. Whereas he was severely misunderstood by a medically and militarily uneducated or uninformed public, neither the 

military nor civilian medical communities lost faith in his abilities as a physician and scientist, nor did the officers of the Medical Department as a whole feel 

their trust in him as a leader had been misplaced. Sternberg successfully applied 

knowledge gained from the hard lessons of the Cuban campaign to a new insurgency war in the Philippines. Moreover, he immediately recognized the projection of 

American influence into the Caribbean and South Pacific held great potential for 

the advancement of medical science through the auspices of the U.S. Army Medical 

Department.