SPECIAL STUDIES 

THE DEMANDS OF 

HUMANITY: ARMY MEDICAL 

DISASTER RELIEF 

by 

Gaines M. Foster 

CENTER OF MILITARY HISTORY 

UNITED STATES ARMY 

WASHINGTON, D.C., 2000 
Library of Congress Cataloging in Publication Data 

Foster, Gaines M. 

The Demands of Humanity. 

(Special studies I Center of Military History, United States Army) 

Includes bibliographical references and index. 

I. United States. Army Medical Dept.- History. 2. Disaster reliefUnited States-History. 3. United States- Civil defense-History. 

I. Title. II. Series: Special studies (Center of Military History) [DNLM: 

1. Disasters-History. 2. Military medicine- History-United States. 

HV 553 F754d] 

UH223.F75 1983 355.3'45'0973 83-8791 

CMHPub4~3 

First Printed I 983-CMH Pub 40-3 

For sale by the Superintendent of Documents, U.S . Government Printing Orfice 

Washington. D.C. 20402 
SPECIAL STUDIES SERIES 

David F. Trask, General Editor 

Advisory Committee 

(As of 1 January 1982) 

James C. Olson 

University of Missouri 

Maj. Gen. Quinn H. Becker 

Deputy Surgeon General, USA 

Maj. Gen. John B. Blount 

U.S. Army Training and 

Doctrine Command 

Joseph E. Harris 

Howard University 

John H. Hatcher 

The Adjutant General Center 

Morten Jay Luvaas 

Allegheny College 

James O'Neill 

Brig. Gen. Dallas C. Brown, Jr. National Archives and Records Service 

U.S. Army War College 

John Shy 

Richard D. Challener University of Michigan 

Princeton University 

Col. Roy K. Flint 

U.S. Military Academy 

Arthur L. Funk 

University of Florida 

Col. William A. Stofft 

U.S . Army Command and 

General Staff College 

Betty M. Unterberger 

Texas A. & M. University 

U.S. Army Center of Military History 

Brig. Gen. James L. Collins, Jr., Chief of Military History 

Chief Historian 

Chief, Histories Division 

Editor in Chief 

iii 

David F. Trask 

Col. James W. Dunn 

John Elsberg 

Foreword 

From the earliest days of the Republic, the United States Anny has 

not just maintained the national defense but has also performed a wide 

variety of peacetime missions. Army officers helped explore the West, 

Anny engineers built early flood control systems, and Army pilots flew 

the first airmail routes. The Army Medical Department in particular has 

long aided the civilian community. Its members regularly contributed to 

the advancement of medical knowledge and in special situations provided 

health care for civilians. The Demands of Humanity examines one aspect 

of that direct assistance, medical aid rendered during natural disasters. 

Discussing help given both at home and abroad, this third volume in 

the Special Studies Series examines the origin of the relief mission in the 

nineteenth century and recounts its history to 1976. With their special 

expertise in public health and the treatment of mass casualties, Army 

medical personnel during these years compiled an impressive record of 

assistance . After the Spanish-American War, Anny doctors made medical 

history in their campaigns against epidemic diseases in Cuba , Puerto 

Rico, and the Philippines. In times of twentieth century floods, hurricanes, 

tornadoes, earthquakes, famines, and epidemics, Anny medical personnel 

aided individuals and furnished stricken communities valuable advice on 

sanitation and health care. 

The Demands of Humanity chronicles the humanitarian contribution 

made by Army doctors, nurses, and medical corpsmen during disaster 

situations. It also examines the problems their units encountered in relief 

operations and explains the development of the Anny's assistance role . It 

thereby contributes not only to the often-neglected history of the peacetime 

role of the military but to the history of social welfare policy in the United 

States as well . 

Washington, D .C. 

30 September 1982 

v 

JAMES L. COLLINS, JR. 

Brigadier General, USA 

Chief of Military History 
The Author 

Gaines M. Foster received his A.B. from Wofford College in 1971 

and an M.A. in history from the University of North Carolina at Chapel 

Hill in 1973. From July 1973 to August 1975 he served as a lieutenant in 

the Medical Service Corps. Assigned to the Anny Medical Department 

Historical Unit, he completed much of the work on this volume at that 

time. He received his Ph.D. from the University of North Carolina in 

1982 and is currently an assistant professor of history at Louisiana State 

University. 

VI 
Preface 

In 1973 the Army Medical Department Historical Unit sought a way 

to contribute to the celebration of the approaching Bicentennial and 

needed to do something with a newly arrived lieutenant. A history of 

Army medical relief for civilian communities struck by natural disasters 

offered an answer to both problems, and I received an assignment to 

prepare one. I have tried to make the record of that aid as complete as 

possible and hope my account gives a sense of the significant and 

commendable contribution Army medical personnel have made in relieving 

human suffering. In compiling a list of relief missions, however, I 

became intrigued by how and why the Army's role evolved. In the 

individual disaster relief operations, not just the delivery of health care 

but the relations between soldiers and civilians and the conflict between 

local cultural practices and modem medicine interested me. Within the 

constraints imposed by the focus of the volume on medical missions, I 

have tried to explore these larger issues. 

Before I completed the study, the Bicentennial passed, the Army 

Medical Department Historical Unit became a part of the Center of 

Military History (CMH), and I returned to civilian life. I am particularly 

grateful to Col. John Lada, the late Rose C. Engelman, and especially the 

late Charles J. Simpson for helping make it possible for me to finish the 

project after I left active duty . I also appreciate the kindly aid of the 

archivists, librarians, and other individuals who eased the task of compiling 

a list of disasters and finding records of Army aid during them. John B. 

Corr, author for CMH of a brief history of Army disaster relief, and 

Lillian C. Kidwell, librarian at the headquarters of the American National 

Red Cross, were extremely helpful in the early stages. Throughout my 

research, the staffs of the Old and Modem Military Records sections of 

the National Archives-particularly Elaine Everly, Michael Musick, Tim 

Nenninger, and Edward Reese-guided me to their holdings. Richard J. 

Sommers helped me use the archives at the Military History Institute at 

Carlisle Barracks, Pennsylvania. His colleague John J. Slonaker, who 

has an awesome knowledge of the institute's library and unfailing patience 

with researchers, provided frequent and invaluable aid. Charles Phillips, 

Sarah Gastley, Mary Ambrose, and the other members of Roderick M. 

Engert's General Reference and Research Branch at the Army Medical 

vii 
Department Historical Unit not only located documents but cheerfully 

filled countless interlibrary loan requests. 

I owe much to several generous scholars who read and criticized 

earlier drafts of the study. John Duffy of the University of Maryland, 

Robert H. Bremner of the Ohio State University, and Samuel R. Williamson 

of the University of North Carolina at Chapel Hill suggested ways to 

improve and shorten-if a distinction can be drawn-an early 900-page 

draft. Robert W. Coakley, Col. James W. Dunn, Rod Engert, Walter 

Hermes, Col. William Strobridge, and Col. Earl L. Ziebell at CMH gave 

advice on a succeeding draft. Graham A. Cosmas offered useful perspective 

on the Spanish-American War era section, and Mary C. Gillett tried very 

hard to teach me a bit of medical history and at least succeeded in 

improving my treatment of the topic here. I am also grateful to Albert E. 

Cowdrey. As chief of the Medical History Branch of CMH, he inherited a 

bulky, unfocused manuscript and guided it into a book. Almost every line 

benefited from his suggestions and revision. Finally, Mary D. Nelson 

kept me from many errors with her conscientious and skillful editing. Not 

even all of these people working together could save me from my own 

stubbornness, and the errors and infelicitous prose that remain are mine. 

Baton Rouge, Louisiana 

30 September 1982 

VllI 

GAINES M. FOSTER 
Contents 

Chapler Page 

I. INTRODUCTION 3 

2. THE NINETEENTH CENTURY: PRECEDENTS. 6 

The Emergence oj Federal Disaster Assistance . 8 

The Role of the Medical Department . 18 

3. EMERGING MISSIONS: COMBATING EPIDEMICS 

ABROAD . 23 

Sanitary Gild Organizatiollal Reform . 26 

Combating Epidemics . 32 

4. ESTABLISHING THE MISSION: VOLCANOES, 

EARTHQUAKES, TORNADOES, AND FLOODS, 

1898- 19 17 48 

Changes ill the Domestic Scell e and the Sail Francisco 

Earthquake . 52 

Additional Relief Operations and Formal Recognition of the 

Mission . 66 

5. DISEASE IN THE AFTERMATH OF WAR: DISASTER AID 

TO POLAND AND RUSSIA AFTER WORLD WAR I . 80 

Postwar Relief and America's Sense o/Humanitarian Mission. 80 

Typhus in Poland . 83 

Famine in Russia . 94 

6. RELIEF ROLE IN TRANSITION: ASSISTANCE AT HOME 

AND ABROAD, 1918-1939 . 99 

Confusion over the Army's Disaster Relief Role 104 

Reevaluation alld Relief illlhe Thirties . 115 

TOlVard NelV Relief Roles . 121 

7. DOMESTIC ASSISTANCE UNDER CIVILIAN 

COORDINATION, 1945- 1976 . 127 

The Texas City Explosion 128 

Creation of a Federal Relief Bureaucracy 131 

Medical Relief Missions of the Fifties and Sixties 135 

Federal Reorganization alld Minor Medical Missions a/the 

Seventies . 142 

8. ACTIVISM ABROAD: FOREIGN DISASTER RELIEF, 

1945-1976 . 146 

Relief in the Early Pos/IVar Period . 146 

Establishing a Relief System and the Activism of the Early 

Sixties . 150 

ix 
Chapter Page 

increasing Problems ill Foreign Disaster Relie[Operatiol1s 165 

9. CONCLUSION. 174 

BIBLIOGRAPHICAL NOTE 177 

INDEX 185 

Illustrations 

Sanitary Department, Commission and Staff, Santiago de Cuba 28 

Destruction after the San Francisco Earthquake . 54 

Refugee Camp on Grounds Adjacent to and East of Lettennan General 

Hospital . 59 

Captain Ashford's Staff . 67 

Dining Tent, Temporary Hospital 69 

The Cox-Klemin Evacuating Passengers 109 

Herbert Hoover on Board the U.S.S. Control 111 

Patients Prepared for Air Evacuation 125 

Flames and Destruction . 128 

Anny Ambulances Stand Ready . 129 

Air Force Globemasters Deliver Aid 149 

American and Pakistani Soldiers Administer Typhoid Inoculation 150 

One of the Few Patient Evacuation Missions 154 

Anny Nurse Dresses the Head ofinjured Woman 155 

Anny Medical Corpsman Feeds the Newborn Ida 159 

Anny Nurses Help Survivor of Earthquake . 160 

Preparation of a Patient's Foot . 162 

Cast Specialist Trims Newly Applied Upper Body Cast 163 

Air Force Doctor and Anny Corpsmen Treat Disaster Victim 169 

Illustrations courtesy of the following sources: that on p. 54, Office of the 

Chief of Engineers; those on pp. 67,69, and 125 are from the National Archives; 

that on p. 109 is from Anny Air Corps; those on pp. 149 and 150 are from the 

Anned Forces Institute of Pathology; that on p. 160 is from Department of 

Defense files; and those on pp. 162 and 163 are from the 26th Medical Detachment. All others are from Signal Corps files with the exception of that on 

p. 154, courtesy of Bell Helicopter Textron, Fort Worth, Texas. 

x 
THE DEMANDS OF HUMANITY: 

ARMY MEDICAL DISASTER RELIEF 
.
CHAPTER 1 

Introduction 

The term disaster usually evokes images of massive material damage 

and great human distress caused by some swift catastrophe. In offering a 

more rigorous definition, a leading sociologist has defined a disaster as a 

sudden event that disrupts the social structure and prevents execution of 

some or all of its essential functions. Commonly, disasters caused by 

natural forces or events are distinguished from those that man brings upon 

himself. With one exception, the disasters examined in this study are 

natural, though they may have been provoked or exacerbated by human 

customs or follies. Specifically, the study examines how Army medical 

personnel have responded to such events and shows how they aided 

disrupted civil societies or communities by furnishing health care. I 

Studies of disaster relief usually focus on fires, floods, storms, and 

earthquakes. Two other types of calamities-famines and epidemicsare included here. Such happenings are in truth disasters since they 

disrupt the social structure and interrupt some of its essential functions. 

They often occur as direct results of natural upheavals or of war, and a 

story of medical assistance that excluded them would obviously be 

incomplete. 

Significant changes in the response to disaster have developed over 

the past two centuries. Disasters of all types awed early Americans, who 

did not understand their causes; some interpreted disaster as a supernatural 

message, while others sought an elusive natural explanation. Since the 

eighteenth century, the search for causes has revealed disasters to be 

understandable natural occurrences that scientists have tried with increasing 

sophistication to explain, predict, and-especially for epidemics-prevent. 

Without an organization to deliver aid, however, more knowledge would 

have accomplished little. During the same period, American society 

developed a much more organized and comprehensive response to disaster; 

ICharics E. Fritz, "Disaster. " in COllfemporar), Social Problems. ed. Robert K. Merton and 

Robert A. Nisbet(New York: Harcourt, Brace & World, 1961). p. 655; "Disasters," in IlIfernm;olla/ 

Encyclopedia of rhe Social Sciences (New York: Macmillan Co. & Free Press. 1968), pp. 202-7. 

One disaster that was caused by man , the Texas City explosion of 1947, is included in Ihis study 

because it did disrupt the community and because the Army responded in Ihe same fashion as in 

natural disasters. 
4 T HE DEMANDS OF HUMANITY 

in this evolution, the federal government came to play an increasing role. 

In the early nineteenth century, the national government accepted no 

responsibility for helping its citizens cope with disaster. Nor did many 

local agencies or voluntary groups exist to provide relief, though most 

Americans considered disaster assistance a task for local government or 

voluntary associations when self-help fa iled. But in the latter half of the 

nineteenth century, the suffering of victims-the ' 'overruling demands of 

humanity" in the language of the War Department's first regulation on 

civilian assistance- began to transform traditional attitudes and practices. 

During the century and a half that followed, the nation organized, perhaps 

overorganized, for disaster relief as it did for other purposes. By the 

1970's a plethora of acts administered by a host of agencies guided federal 

relief efforts, and many local agencies and voluntary groups furnished 

assistance as well '> 

Within this changing context, the relief role of the Army Medical 

Department developed. Medical Department aid was almost always part 

of the Army's overall disaster assistance mission . From the first, Army 

regulations delegated authority over assistance missions to area commanders 

who, when they considered it necessary, integrated medical units or 

personnel into relief operations. These line offi cers rather than The 

Surgeon General or the department he commanded assumed responsibility 

in planning before disasters and in committing medical resources once 

calamity struck. The history of Army medical relief, consequently, is 

more a story of the contributions of indi vidual medical units and personnel 

than an institutional study of the Medical Department. Because the 

department rarely acted alone, its work must be examined as part of the 

development of the Army's overall relief mission. 

Army disaster relief began Shortly after the Civil War and increased 

throughout the late nineteenth century. During that period, Army aid 

rarely included medical care , in part because of the relatively primitive 

state of the healing arts. Only with the emergence of modern medicine did 

doctors acquire skills that equipped them to offer significant help to 

distressed communities. At the time that happened, however, neither 

local authorities nor voluntary associations had the capability to provide 

extensive medical assistance. In this organizational near-vacuum during 

the first years of the twentieth century, Army medical personnel became 

the nation's primary source of medical and public health aid in domestic 

disasters. 

After World War I, tensions arose between the Army and the Red 

2Quote from Special Regulation 67 , " Regulalions Governing Flood Relief Work of the War 

Depanmcnt," 1917 , copy in Record Group 407. National Archives (NA). 
INTRODUCTION 5 

Cross over authority in relief operations and between the Army and 

Congress over funding of relief activities. As a result, the Army became 

uncertain about its assistance role in the interwar years, and Army 

medical participation declined. After the Second World War, the federal 

government accepted greater responsibility in disaster situations and 

created civilian institutions to reduce tensions between agencies and 

ensure funding, but it never completely abandoned older traditions of 

localism and voluntarism. In fact, the federal government gradually 

concentrated its efforts on long-term rehabilitation, leaving the responsibility 

for immediate relief to local and private groups. Within the newly 

organized federal disaster aid structure, Army medical participation continued 

at the low pre-World War II level, though certain emergencies so taxed 

civilian resources that some military assistance continued to be needed. 

Unlike domestic relief, foreign rlisaster assistance was rendered only 

sporadically before World War II. The United States undertook a few 

missions in the nineteenth century and many more-often with the help of 

the Army-during the early twentieth century in Caribbean countries and 

the Philippines. For a short time after the Spanish-American War and also 

after the First World War, unusual circumstances involved the Army 

Medical Department in substantial relief operations abroad. Both periods 

proved exceptions, however, to the general inactivity. In the years after 

1945, intercontinental air transportation, the stationing of American 

troops abroad, and the cold war increased both the means and motives for 

the United States to provide assistance abroad. The government created 

civilian coordinating institutions to direct and provide such relief, but 

Army medical personnel still frequently rendered foreign disaster assistance. 

By 1976, the United States government had a history of providing 

disaster assistance both to its own and to foreign communities. Relief that 

had been rendered only in isolated instances in the nineteenth century had 

become routine, and complex civilian bureaucracies had developed to 

direct both foreign and domestic operations. Once the only agency to 

which the government could turn to provide disaster relief, the Army was 

now but one of many from which civilian relief officials could request 

help. At times, however, civilian resources still proved inadequate, and 

Army medical personnel went once again to the assistance of civilian 

communities. 
CHAPTER 2 

The Nineteenth Century: Precedents 

Most eighteenth and early nineteenth century Americans, awed by the 

destructive power of natural disasters for which there were no scientific 

explanations, judged them to be signs from God, mighty manifestations 

of divine displeasure over the sins of the world. Consequently, when 

disaster struck, governments issued proclamations of prayer and fasting , 

and many individuals made or renewed religious commitments. Although 

their religious response in no way precluded more practical measures, in 

the early years of the American republic, communities rarely had the 

knowledge or the means to render effective relief-and no outside agency 

rushed assistance to them. I 

Two similar calamities sixty years apart demonstrated the persistence 

of patterns of public ineptitude and citizen self-help. During the 1793 

yellow fever epidemic in Philadelphia, one of the more devastating 

disasters of the nation's early history, most public officials fled to safer 

areas, and national, state, and local government in the city disintegrated. 

Local physicians who remained, the famous Dr. Benjamin Rush among 

them, had little knowledge of how to treat the sick and less of how to stop 

the spread of the fever. They sometimes did as much harm as good, and 

frequently quarreled among themselves over proper medical procedures. 

Other citizens volunteered to help and three weeks into the crisis formed a 

relief committee under the direction of the mayor. Financed for the most 

part by private funds, the committee and its assistants directed relief 

efforts until a fall cold spell finally ended the epidemic'> 

Two generations later, New Orleans responded in similar fashion to a 

yellow fever epidemic. The same confusion over tactics and treatment 

'John B. Blake , Public Health ill (he Town of BostOIl , /630-1822 (Cambridge: Harvard 

University Press. 1959), pp. 24- 26, 50-51; Charles E. Rosenberg, The Cholera Years: The United 

States jll 1832, 1849, and 1866 (Chicago: University of Chicago Press, 1962); Marshall Scott Legan, 

"Popular Reactions to the New Madrid Earthquake, 1811 - 1812," Filsoll Club Historical Quarrerly 

50 (1976): 69; James Penick, Jr., The New Madrid Eart/lqlwkes of 1811 - 1812 (Columbia: 

University of Missouri Press, 1976), pp. 117-21; Waller B. Posey, "The Earthquake of 1811 and 

Its Influence on Evangelistic Methods in the Churches of the Old South," Tennessee Historical 

Magazine. 2d ser. , 1 (193 1): 107- 14. 

2J. H. Powell , Bring 0111 YOllr Dead: Tire Great Plague o/Yellow Fever i1l Philadelphia ill /793 

(Philadelphia: University of Pennsylvania Press, 1949). 
THE NINETEENTH CENTURY 7 

developed, with the city trying everything from a quarantine to cannon 

fIrings intended to clear the atmosphere--the latter abandoned because 

they literally frightened some victims to death. Local govemment, particularly 

a board of health strengthened during the calamity, exercised greater 

authority than in Philadelphia's crisis, but private sources again provided 

most relief. The Howard Association, a voluntary association of young 

businessmen in the city, mobilized to care for the sick and impoverished. 

As in Philadelphia, however, only the arrival of cold weather rescued the 

city from its distress.3 

In their lack of medical knowledge and reliance on local and often 

private aid, Philadelphia and New Orleans were not unusual. During the 

recurrent cholera epidemics that afflicted parts of America during the 

antebellum years, other cities responded in much the same fashion. As the 

century progressed , unaffected cities did begin to send money or supplies 

to suffering communities, and a Howard Association in one town sometimes 

aided victims in another. Nevertheless, disaster relief in the last years of 

the eighteenth and first half of the nineteenth century remained primarily 

local , voluntary, and ineffective' 

In those early years of the nation , the extremely small size of the 

federa l establishment, the concentration of its manpower in the capital, 

and, above all, the lack of the means to send relief discouraged federal 

disaster assistance. The Army, the most obvious agency to render such 

aid, possessed insufficient resources to meet its normal defense mission, 

much less to assume additional duties in disasters. Deployed in widely 

scattered posts often consisting of only a hundred soldiers, the Army 

could spare few men, if any , for disaster work without endangering the 

safety of its forts. Furthermore, with posts located in remote frontier areas 

and transportation far from rapid, the dispatch of troops to the scene of a 

calamity in time to be of any real help was usually impossible.' 

Philosophical as well as practical considerations discouraged the 

commitment of federal resources. In the first half of the nineteenth 

lJohn Duffy. Sword of Pestilence: The New Orleans Yellow Fever Epidemic of 1853 (Balon 

Rouge: Louisiana State University Press. 1966). 

"Rosenberg. Cholera Years, passim. See also Douglas F. Stickle, . 'Death and Class in Baltimore: 

The Yellow Fever Epidemic of 1800," Mary'land Historical Magazine 74 ( 1979): 282- 99; Jacqueline 

Kamell Com. "Community Responsibility for Public Health: The Impact of Epidemic Disease and 

Urban Growth on Pittsburgh . .. Western Petlllsy/wmia Historical Qllarterly 59 ( 1976): 319- 39. 

!lOn the size of the 'federal establishment, see James Sterling Young, The Washington Commllllit)'. 

1800 - /828 (New York:: Harcourt . Brace & World . Harbinger Book. 1966). pp. 13-37 . For the 

Army's difficulties in meeting itscommilmenls, see Franci s Paul Prucha, The SlI'ord of the Repllblic: 

The United States Army on the Fl'ofllier. 1783- 1846 (New York:: Macmillian Co., 1969), p.320; 

and Robert M. Utley, Frontiersmen in BIlle, The Ullited Swtes Army and ,he I"dian , 1845 - /865 

(New York: Macmillan Co., 1967), pp. 10- 17. For the Army's dispersion, see Francis Paul Prucha. 

" Distribution or Regular Army Troops berore the Civil War," Military Affairs 16 ( 1952): 169-73. 
8 THE DEMANDS OF HUMANITY 

century, most Americans considered health care, social welfare, and 

other aspects of disaster relief to be tasks best left to the individual or to 

private charity. If a calamity necessitated additional aid, only local, or 

possibly state, government had the authority to assist. The Constitution 

included no clause providing for federal disaster assistance, and a pervasive 

parsimony in Congress reinforced constirutional scruples. Disaster assistance, 

as one congressman typically reminded his colleagues in 1847, was a 

"dangerous exercise of power" best left " to the liberality and generosity 

and better judgment of their constituents.' ,6 

The Emergence of Federal Disaster Assistance 

That the federal government began to provide relief in a few disasters 

despite practical and philosophical impediments testified to the power of 

calamity to disrupt established patterns of thought and behavior. Congress 

approved aid, however, only when constitutional authority to act could be 

easily derived from traditional federal powers. Even then it carefully 

evaluated each proposed relief measure and usually approved aid only 

when compassion and national interest coincided. Though the bills Congress 

passed in the nineteenth century were taken up one by one, they can be 

grouped into three categories: aid to the Indians, foreign assistance, and 

domestic relief. 

The federal government clearly had constitutional authority over 

Indian affairs and undertook its first disaster relief mission under that 

power. In 1792 a severe drought ruined the crops of the Creek Indians, 

and famine threatened to destroy a large part of the tribe. On 31 October, 

the Secretary of War, who directed Indian affairs at thattime, informed his 

agent among the Creeks that the government had made available more 

than $ 13,000 for the tribe's relief. The agent, James Seagrove, then 

distributed both cash and corn. The United States fed the tribe not only for 

humanitarian reasons but also because it wished to supersede Spain as the 

Creeks' friend and to acquire thereby a ready market for American goods. 

The Secretary of War instructed Seagrove to make the American desire 

for recompense clear to the Creeks: "You may intimate to them that the 

President of the United States, actuated by his humanity and regard for 

6Duffy, SWOrtJ of Pestilence. p. 43; Morris Kagan, "Federal Public Health: A Reflection of a 

Changing Constitution, ,. 10urnal o/the His/ory ojMedicine(md Allied Sciences 16 (196 1): 256-79; 

Waller I. Trallner, From Poor unv 10 Welfare Stare: A History of Social Welfare ill America (New 

York: Free Press. 1974), especially pp. 57 - 59. For an exception, see Walter I. Trauner, "The 

Federal Government and Social Welfare in Early Nineteenth-Century America," Social Sen.ice 

Review 50 ( 1976): 243 -55. Quote from U.S. Congress. Senate, Congressional Globe. 29th Cong., 

2d sess., 1847, p.513. 
THE NINETEENTH CENTURY 9 

them, will order a further quantity, provided they exhibit, on their parts, 

similar dispositions of kindness and attachment to the UOlted States ... 7 

If the white man granted relief to glean certain advantages, he just as 

easily withheld it to gain others. In the early 1830's the whites' rapid 

encroachment on the Creeks' land in Alabama and their depletion of local 

game again placed the tribe in danger of starvation. Many of the men 

began to beg or steal, and women and children pleaded for permission to 

scour the whites' fields for the small potatoes and roots that remained 

after the harvest. On this occasion no aid came from the government 

because it wished to remove the Indians to the west to free land for white 

settlement. As one historian explained, assistance to the Creeks would 

have been "unpolitic" because it " would have delayed their enrollment 

for emigration ." 8 

In the same decade, Congress did approve a different type of assistance 

to tribes in another area of the country. With smallpox threatening the 

western Indian nations, Congress in 1832 passed a bill to provide for their 

vaccination. The act authorized Indian agents to employ local civilian 

doctors to perform the vaccinations but proposed that, where practical, 

military surgeons be used too. The Surgeon General procured the vaccine, 

and Army surgeons in several areas, notably Illinois and Michigan, 

vaccinated Indians who came to their forts. In most localities, though, 

Indian agents apparently relied on civilian physicians. Unfortunately, the 

nomadic life-style of the Indians undermined the government's attempt to 

control smallpox, and in 1837 an epidemic may have halved the population 

of the western nations. 9 

As with aid to the Indians, foreign relief could easily be justified on 

the basis of recognized constitutional powers. At any rate, Congress early 

rationalized such measures as legitimate when it considered them to be in 

the national interest. In 1812 the nation's first foreign disaster assistance 

mission followed an earthquake in Venezuela that killed 10,000 people in 

Caracas alone. American newspapers carried accounts of bodies littering 

70 n constitutional authority. see Francis Paul Purcha, Americall Illdiall Polic), in the 

Formative Years: The Illdiall Trade alld IlItercOllrse Acts. /794-1834 (Cambridge: Harvard 

University Press. 1962), p. 41. On the aid, see George D. Hannon. Sixt), Years of Illdiall 

Affairs: Political. Economic. alld Diplom(l/ic. 1789-1850 (Chapel Hill: University of 

Nonh Carolina Press, 1941 ). pp. 97-98. Quote from lIr. Secretary of War to James 

Seagrove, 31 Oct 1792, in American State Papers: Illdiall Affllirs, 3: 259-60. 

8Hamlon . Sixt), Years. pp, 2 12- 13. 

9U.S. Congress, House, Report of the Commissioner of Illdian Affairs ill Relation to the Act 

Extendillg the Belle fit of Vaccination to the III(/iall Tribes. H. Doc. 82, 22d Cong., 2d sess. , 1833; 

Ltrs, T. Hastley Crawford to Joe l R. Poinsett, II Dec 1838 and 25 Nov 1838. Both in Repon Books 

of the Office oflndian Affairs, 1838- 85, M348, reel I, NA. See also Richard White, "The Winning 

of the West: The Expansion of the Western Sioux in the Eighteenth and Nineteenth Centuries, ,. 

Journal of American History 65 (1978): 328-29. 
10 THE DEMANDS OF HUMANITY 

the debris and orphaned children wailing for lost parents. Prompted by 

these reports, Alexander Scott, an American diplomatic representative to 

Caracas who had not yet departed for his post, urged Congress to send 

food to the victims. The Venezuelans also requested assistance. Congress 

responded by appropriating $50,000 for relief supplies to be administered 

by Scott upon his arrival in the country. Unfortunately, the donation 

arrived in May but Scott did not land until June . In the meantime , the 

royalists, then battling revolutionaries for control , seized many of the 

supplies and did not distribute them. They also impounded the vessels and 

crews that had brought the supplies and released both only after extended 

negotiations. But despite all the problems, food reached some of the 

people and saved them from starvation. 

In sending aid, Congress obviously acted from more than purely 

humanitarian motives. With the outbreak of revolutions in Latin America 

during the early years of the nineteenth century, American interest in the 

region intensified. Many people in the United States believed the times 

auspicious for establishing closer ties with their neighbors to the south, 

and many merchants envisioned Latin America as a potentially lucrative 

market. Scott's instructions left little doubt that Congress intended the aid 

as a spur to closer trading ties, for he was directed to let the people of 

Venezuela know that the relief presented" strong proof of the friendship 

and interest which the United States . .. [took] in their welfare ... [and] 

to explain the mutual advantages of commerce with the United States." 10 

The refusal of Congress to send aid to the locust-plagued Canary 

Islands at the same time it approved relief for Venezuela lent further 

credence to the view that in such matters Congress acted as much from 

national and mercantile interest as from humanitarian concern. Initially, a 

single resolution approved aid for both Venezuela and the Canary Islands, 

but some congressmen insisted upon separate consideration of the two 

measures. They convinced the House to instruct a committee to explore 

further the extent of the locust plague and famine in the Canaries. 

Although the committee reported additional evidence of suffering, the 

House still balked at sending assistance. Some of the victorious opponents 

continued to question the severity of the famine, but others doubted 

whether the relief would contribute to America's national interest. John 

Rhea, a representative from Tennessee, expressed the feelings of the 

second group. He opposed aid to the Canary Islands but said he favored 

an appropriation for Venezuela, with "a regard to the interests of the 

IOQuote from Merle Curti, American Philanthropy Abroad: A History (New Brunswick, N.J.: 

Rutgers University Press, 1963), pp. 10- 12; see also E. Taylor Parks, "Foreign Aid - ISO Years 

Ago," Foreigll Service Jounwl 39 (lui 1962): 36 - 39. 
THE NINETEENTH CENTURY 11 

United States, which peculiarly required them to cultivate amity with and 

conciliate the South American provinces." The Canary Islands, he implied, 

did not offer the United States enough to merit assistance. II 

On two other occasions during the antebellum period, Congress 

considered proposals to provide disaster assistance to foreign nations. In 

1847 , after rejecting an appropriation for sufferers in the Irish potato 

famine, Congress approved the loan of United States naval vessels to 

transport privately raised supplies. With civilian captains and crews, the 

United States ships Macedolliall and James/own ferried 8,000 barrels of 

grain, meal, clothing, and other essentials to Ireland. Nine years later, 

however, Congress refused to allow the detail of twenty-five sailors to a 

private group that needed a crew to sail a relief ship to the droughtstricken Cape Verde Islands. The House voted in favor of the measure, 

but it died in the Senate; exactly why remainen unclear. After the Civil 

War, Congress still developed no consistent policy; lawmakers approved 

the use of United States ships in two instances but denied it in a third. 12 

While the approach of Congress to foreign relief was practical, 

limited, and ad hoc, broader justifications were occasionally heard. 

During the debate over an appropriation for aid to Ireland in 1847, 

Senator John M. Clayton of Delaware proclaimed American abundance 

to be a sure sign of God's favor and aid an excellent opportunity to 

demonstrate to the world that" the genius and essential character of our 

institutions lead us to the indulgence, as a nation, of the best feelings of 

the human heart, and the noblest impulses which govern and direct the 

energies of man." Clayton convinced few of his fellow legislators, but a 

similar argument in more secular form, that such aid served to advertise 

the American way of life, would foster increased relief activity abroad 

during the next century. 13 

For domestic disaster assistance, the third type of congressionally 

approved aid, the nineteenth century was an era of slow but steady 

expansion of government involvement. Initially, Congress was more 

hesitant to provide relief in this category than in the others, since the 

" U.S. Congress. Amwls o/Collgress, 12th Cong .. 1st sess., 1812. pp. 135 1, 1348-50 . 1429. 

1435. quote on p. 1350; Curti. American Philomhrop),. p. 13. 

12Curti. Americall Philallfhropy . pp. 41 - 2. 94 - 5. 103-7; Congressional Globe. 29th Cong. , 

2d sess .. 1847 , pp. 503. 572 - 75; U.S .. Statutes at lArge. 9: 207. no. 10: Robert 8 . Forbes, All 

Interesting Memo ir orthe Jamestown Voyage to Ireland (Boston: J. B. Cullen & Co .. 1890). p. 5 and 

passim . See also COlIgressio!1lI1 Globe, 34th Cong .. 1 st sess .. 1856. pp. 1254-55. 1257- 58. 1262; 

U.S. Congress. Senate. Relie/to the People of Foreign Narions Oil AccO/l1lf o/Earthqu(/kes, Etc .. S. 

Doc. 629. 60th Cong .. 2d sess .. 1908; U.S. Congress. COlIgreJsiollal Record. 8 1 st Cong .. 2d sess .. 

1950. pp. 11 900- 902; E. M. Hall iday. " Bread upon the Waters." American Heritage 11 (Aug 

1960), 62-69. 104-5. 

13Quote from Congressional Globe, 29th Cong .. 2d sess .. \847. p. 5 13. 
12 THE DEMANDS OF HUMANITY 

constitutional authority to contribute money, supplies, or personnel in 

domestic disasters seemed problematical. Whenever Congress entertained a 

bill authorizi ng domestic relief, the chambers rang with denunciations of 

its patent unconstitutionality. Only in a few instances before the Civil 

War were critics overcome and relief bills enacted. 

The earliest case of congressionally approved domestic assistance 

followed a devastating fire in Portsmouth, New Hampshire. Here in 1803 

the burning of a large section of the commercial district threatened the 

financial stability of many merchants. To ease their burdens, Congress 

granted them an extra year to payoff bonds owed at the local customhouse. 

Congress later passed similar measures for the relief of merchants in other 

ports ravaged by fire: in Norfolk, Virginia, in 1804; in Portsmouth again 

in 1807; and in New York in 1836." 

After an earthquake in the Mississippi Valley, Congress passed a 

measure that provided a more clearly defined precedent for future disaster 

relief. Between 16 December 1811 and 7 February 1812, powerful 

tremors struck the Missouri Territory, completely destroying Cathers ville 

and severely damaging New Madrid, the second largest town in the 

territory. In January 18 14, the territorial assembly petitioned Congress 

for aid and cited that sent to victims of the Venezuelan earthquake as 

precedent. A year later, Congress passed a law granting landholders with 

property damaged by the quake the right to relocate on other public lands 

in the territory. The act allowed residents to claim 160 acres if they held 

present claims smaller than that or a plot equivalent to their present 

hOldings if they held no more than 640 acres. Once they had secured new 

claims, their land in New Madrid reverted to the government. A seemingly 

innocuous act of compassion, the law allowed a great deal of corruption 

and generated an almost endless debate over land titles. 15 

Another early disaster assistance act followed a February 1827 fire in 

the town of Alexandria, then still a part of the District of Columbia. 

14Collgressiollal Record, 81s1 Cong., 2d sess., 1950. p. 11 900. Mention was made during the 

debates of 1836 of a similar relief bill for Savannah in 1820. but I can find no record of it nor was it 

included in the compilation above. See U.S. Congress. RegislerojDebales ill COl/gress. 24th Cong., 

ISl sess., 1836.p. 120. 

HOn the earthquakes, see Penick, New Madrid Earthquake: Legan, "Popular Reactions"; 

Wayne Vilancn, "The Winler the Mississippi Ran Backwards: Early Kentuckians Report the New 

Madrid, M issouri , Earthquake of 18 11 - 1812." Register of the Kentucky Historical Society 71 

( 1973): 51-68; Francis A. Sampson, "The New Madrid and Other Earthquakes in Missouri" 

Procudillgs of Ihe Mississippi Valley Historical Associatioll 6 ( 19 13): 2 18- 38. For a copy of the 

act. see Statutes at Large. 3: 21 1- 12. ch. 45. On corruption, see Penick, New Madrid Earthqllake. 

pp. 49-50; Malcolm J. Rohrbough, The umd Office Business: TheSeulemell1 (//1(/ Administration of 

American Public Lal/ds. 1789- /837 (New York: Oxford University Press, 1968), pp. 106-7; 

Benjamin H. Hibbard. A His/o')' ofille PI/blic Lalld Policy (New York : Macmillan Co., 1924), p. 

264. 
THE NINETEENTH CENTURY 13 

Moved by the proximity as well as the severity of the damage and satisfied 

that congressional responsibility for the District rendered aid constitutional, 

proponents pushed for a direct appropriation. Despite strong opposition, 

they secured a grant of $20,000 for the relief of " the indigent sufferers" 

of the fire and delegated the distribution of the fund to the mayor and city 

council of Alexandria. 16 

Clearly some Americans already considered the federal government a 

source of disaster assistance. The Missouri assembly had turned to 

Congress for aid. And after an 1836 fire in New York City , a public 

meeting appointed a committee of 125 distinguished citizens to petition 

Congress for help. When Congress received the committee's memorial, 

Daniel Webster warned his fellow lawmakers that " a strong expectation 

prevailed out of doors that Congress would do something for the relief of 

the sufferers. " But despite growing public demand, Congress did not 

approve any other domestic disaster assistance bills before the Civil War. 

And all the acts that it had passed provided for long-term financial aid 

rather than immediate relief. 17 

By contrast, in the years after the Civil War, Congress frequently 

passed disaster relief bills that sought to render immediate aid to the 

suffering. The creation of the Bureau of Refugees , Freedmen, and Abandoned 

Lands, better known as the Freedmen's Bureau, contributed to this 

transformation of congressional policy. In 1865, the lawmakers established 

the bureau to help ease the slaves' transition to freedom, a task that 

entailed social welfare work including direct relief unprecedented on the 

federal level. Consequently, the Freedmen's Bureau itself became a 

powerful argument for future disaster relief. If Congress could act to 

reduce black suffering in the South, congressmen could and did ask, why 

could it not also help its citizens everywhere when afflicted by a natural 

disaster? 18 

Furthermore , during its brief existence, the bureau undertook disaster 

relief efforts essentially unrelated to its responsibility for the freedmen. 

16Registero/Debates i" COl/gress, 19th Cong .. 2d sess .. 1827. pp. 752 - 77; Stalllfes ar Large. 6: 

356- 57. ch. 3. 

17Register of Debates i" COl/gress, 24th Cong., 151 sess .. 1836, pp. 13. 46 - 47. 

Is-rhe standard history of the bureau is George R. Bentley, A Hislory of/he Fru dmell' s BI/reall 

(New York: Octagon Books, 1970), but for emphasis on its welfare function see Victoria M. Olds. 

"The Freedmen's Bureau as a Social Agency" (Ph.D. diss., Columbia University, 1966); Louis 

Henry Bronson, "The Freedmen's Bureau: A Public Policy Analysis" (Ph.D. diss .. University of 

California, 1970); and Trattner. Poor Lnll' to Welfare State. p. 78. See also John Cox and Lawanda 

COil. "General O. O. Howard and the 'Misrepresented Bureau ... · JOflmal ofSoflfllem H istory 19 

(1953): 427 - 57; Harold M. Hyman. A More Perfect Vllioll: The I mpact of the Civil War lI11d 

ReCOlISfrllcfioll 011 theCollstitlllioll (Boston: Houghton Mifflin Co .. Sentry Ed .. 1975), especially pp. 

285 - 91. For an argument for relief based on the bureau. see Congressiollal Globe. 40th Cong .. 1st 

sess .. 1867. p. 47 
14 THE DEMANDS OF HUMANITY 

Throughout the life of the bureau, its medical officers furnished aid and 

advice to civilians of both races during local outbreaks of smallpox or 

cholera, and its agents sometimes supplied bedding and tents to stricken 

communities. But it was bureau flood and famine relief, rather than aid 

during epidemics, that led the way to an increasing federal and eventually 

Army involvement in civilian disasters. 19 

In 1867 an unusually severe winter followed by a very dry spring 

caused many fields of food crops in the South to yield only a quarter of 

their normal production. In the midst of the incipient famine, the Mississippi 

and Tennessee rivers flooded . Concerned bureau agents wrote their 

headquarters in Washington relaying the dire plight of the doubly distressed 

South and asking permission to aid white as well as black sufferers. 

Though he wanted to grant their requests, bureau directorO. O. Howard , 

a general detailed from the Army, doubted his authority to do so and 

therefore lobbied in Congress for authorization to provide emergency 

relief for all Southerners who needed it. After the predictable debate over 

constitutionality-<>n this occasion spiced by sectional animosity-Congress 

on 30 March 1867 granted the Freedmen's Bureau authority to supply 

rations for all classes of people in the South as long as the expense did not 

exceed already appropriated funds. Constitutional scruples, it seemed, 

gave way more readily than congressional niggardliness 2 0 

Under the act, Howard allocated $50,000 from the bureau's budget to 

finance emergency relief in the south and designated General Eliphalet 

Whittlesey, already serving with the bureau, to administer the program. 

Whittlesey in turn directed the purchase of corn and wheat in northern and 

midwestern markets and supervised their shipment to southern ports. 

Together with corn bought in the South, the grain went to Louisiana, 

Mississippi, Alabama , Georgia, South Carolina, North Carolina, and 

Virginia. In each state a bureau officer accepted supplies in bulk and 

oversaw their delivery to local agents. The local agents, usually operating 

at the county level, consulted with civil officials to determine who needed 

aid, negotiated contracts for transporting the rations, and established 

distribution centers. Distribution, begun in a few areas in April, continued during May in many and until August in most. Except for the slight 

19Ltr. L. A. Edwards to E. V. Du vall. 22 Apr 1867 . and Circular Letter No.1 , 21 May 1867. both 

in Le tte rs Sent, Chief Medical Officer, entry 98, Records of the Bureau ofRcfugees, Freedmen . and 

Abandoned Lands, Record Group 105, NA; Rpl. A. W. Shaffer. 25 Jun 1867, Records of the 

Assislant Commissioner for the State of North Carolina. Bureau of Refugees. Freedmen. and 

Abandoned Lands, 1865- 70, M843. reel 24. NA; Llr, A. C. Smartzmelder to J. R. Lewis, 31 Oct 

1866, Lette rs Sent, Chief Medical Officer, Tennessee . Cnlry 3436, Record Group 105 , NA . 

2OLlf, W . P. Carlin to O . O . Howard . 13 Mar 1867, Letters Received . entry 198, RecordDroup 

105 , NA; COllgreniollal Globe. 40th Cong., 1st sess. , 1867 , pp. 39 - 40, 46- 47, 83 - 9 1 . 233 - 47 , 

281. 
T HE NINETEENTH CENTURY 15 

delay in beginning the program and a few complaints about the quality of 

the corn, the ad hoc relief system functioned well .

2 1 

The bureau's famine relief operation supplemented rather than replaced 

traditional voluntary and local efforts. In fact, private aid dwarfed that of 

the government as northern charity organizations contributed an estimated $5 million worth offood to the South. 22 The bureau's program also 

respected the heritage of local control by shipping supplies in bulk and 

leaving the determination of individual need and most of the distribution 

to resident civilian officials. Nevertheless, the bureau's operation involved 

more government employees and generated greater national interest than 

any of the antebellum measures. The resulting display of the potential for 

federal assistance helped inspire local authorities and the American 

public to turn increasingly to the national government for supplementary 

relief. 23 

In the 1870's, Congress often granted such requests, then gradually 

began to anticipate them. Opponents still challenged the constitutionality 

of relief appropriations but swayed fewer of their colleagues, who now 

justified assistance under the general welfare clause or boldly declared 

that " necessity knows neither law nor constitution, and never did in this 

country." To support that contention, proponents of relief cited a continually growing list of precedents. Opponents, on the other hand, lost an 

effective argument in the 1880's when the nation developed an embarrassingly large budget surplus. In the face of-this unaccustomed plenty, even 

hardened dissenters realized the futility of their opposition. Lamented 

one: " I know from my experience here that I might just as well seek to 

dam up this flood in Mississippi with a paper dam as to keep members out 

of an overflowing Treasury when they want to get there." Increasingly, 

Congress became a willing though not always generous patron of relief. 2' 

To administer the appropriations it voted, Congress depended on the 

Army, primarily because it had no other organization capable of rendering rapid relief. The postwar Army remained small , underpaid, poorly 

2 1 Account based on Records of Special Offices, Lellers Received, March 1867-July 1868, entry 

198, and Copies of Congressional Resolutions. War Dcpartmentlssuances and Letters to and from 

Commissioner Howard Relating to Relief of the Desti lUte. entry 200. Both in Record Group 105. 

NA. 

22Solllhern Famine ReliefCommissioll , Filial Proceedingsond General Reporl oflhe SOl/thern 

Famine ReliefCommissiofl (New York: William H. Arthur & Co. , 1867). 

23Nt! 1V York Times, 10 Jul 1874. 12 Feb 1884, 4 Apr 1897: Mabel A. Elliot, American Nalional 

Red Cross Disaster Services, J 88 1- / 9/ 8 (Washington: American National Red Cross, 1950). p. 

17: R. P. M . Ames, Official Report of the ReliefFllrnished 10 the Ohio River Flood SI/fferers ... 

Feb/'uary and March / 884 (Evansville. Ind .: Journal Pub!. Co., 1884). p. 25 . 

24First quote from Congressional Record, 48th Cong., 1st sess .. 1884, p. 1033. Second quote 

from COl1gressional Record. 48th Cong., 1st sess., 1884, p. 2296. On the budget surplus, see Robert 

H. Wiebe, The Search for Order. 1877- /920 (New York: Hill & Wang, 1967), p. 31. 
16 THE DEMANDS OF HUMANITY 

equipped, widely dispersed, and generally neglected, but it still maintained more of a presence throughout the nation than did any other federal 

agency. In addition, it held stockpiles of rations, clothing, and tentagethe staples of government grants to victims of disasters. Even when it did 

not have stores on hand, the Army- again more than any other government agency- had an established purchasing and transportation system. 

Finally, the military chain of command facilitated quick response . Once 

the Army had undertaken the task of relief in a few instances, its role 

became so fixed that Congress rarely questioned its use during the 

remainder of the century. In 1897, when a member introduced a resolution authorizing the United States Marine Hospital Service, an organization already involved in epidemic control, to direct a relief mission, a 

colleague responded that " distinctively, this duty belongs to the War 

Department, " and Congress agreed 2 S 

Between 1868 and 1898, sometimes on its own initiative but more 

often at the lawmakers' behest, the Army rendered some form of relief in 

seventeen or more disasters. Included were the Chicago fire (1871); 

yellow fever epidemics in Memphis and Shreveport (1873); Mississippi 

River flooding (1874); a locust plague in the Southwest (1874- 75); 

another yellow fever epidemic in the South (1878); storms in Braskett, 

Texas, and Macon, Mississippi (1880); flooding in the Missouri River 

Valley (1881), the Mississippi River Valley (1882), and the Mississippi 

and Ohio River Valleys (1884); the Johnstown flood and Seattle fire 

(1889); flooding of the Mississippi (1890); drought in Oklahoma (1890); 

forest fires in Hinkley, Minnesota (1894); tornadoes in St. Louis (1896); 

and Mississippi and Rio Grande flooding (1897).26 Though the Army's 

function expanded to include law enforcement during the Chicago fire 

and engineer support on several occasions after the Charleston earthquake, 

in most of these disasters Army assistance followed the pattern of the 

southern famine relief operation of 1867. Soldiers served primarily as 

administrators: they estimated needs, purchased supplies, delivered them 

in bulk, and left to local authorities the actual distribution to the needy. 27 

2'For lack of organizational structure in government, see Wiebe, Search/or Order, pp. 31- 32. 

Quole from COllgressional Record. 55th Cong. , 1st sess ., 1897, p. 639. 

26-y'his list was compiled from the following sources: Reports of the Secretary of War, J 865- 98; 

a search of military records on disasters by the Adjutant General 's OFfice in 191 5 (see Lir, H. P. 

McCain to James Hay, II Jan 1915 , file 1459754, Records of The Adjutant General's Office. 

General Correspondence , 1890- 1917. Record Group 94. NA); and a list of disaster legislation 

compiled by the Con&ressionai Research Service (see Congressiollal Record. Sist Cong., 2d sess. , 

1950, pp. 11900). Unfortunately, such lists do not always account for aid rendered by local units 

when not specifically directed by Washington . Other instances may, therefore, remain to be 

discovered. 

270n police work at the Chicago fire . see The Adjutant General's office flIe on the fire on reel 33, 
THE NINETEENTH CENTURY 17 

Sometimes, before voting an appropriation, Congress directed the 

War Department to determine the extent of destitution. The Secretary of 

War then sent one or more Army officers to the scene to evaluate the 

needs of the victims and report them by telegraph to the secretary, who in 

turn advised Congress. More often, Congress appropriated a lump sum 

without an investigation and charged the War Department with providing 

relief out of it. In that case, the secretary dispatched a commissary agent 

or instructed one stationed in the vicinity to purchase the requisite supplies, 

then detailed a few quartermaster or line officers to supervise delivery to 

local authorities. Relief items consisted primarily of rations but sometimes of clothing, bedding, and tentage as well. The original appropriation usually paid the cost of shipping or allowed use of government boats. 

This system preserved the primacy both of local control and of 

voluntarism. Unfortunately, it thereby allowed corruption by local officials who could easily sell supplies or hoard them for personal use. 

Charges of such abuses surfaced during the relief operation after the 

grasshopper plague in 1874-75. 28 A more insidious form of corruption 

developed because the dominant group in any area could determine how 

much relief others received . Many disaster assistance missions took place 

in the Mississippi Valley, where whites misused supplies intended for 

black tenant farmers and sharecroppers. In the floods of 1874 and of 

1882, whites allegedly used government supplies to coerce black votes or 

labor: During the floods of 1890, a groupoffifty-nine black men in White 

Station, Mississippi, petitioned the president for relief, claiming they 

were unable to" get anything from the white people at all." They pleaded 

for the government to ship food and other supplies directly to their 

chairman because "if you all don't help us we will all be dead by July 

sure, without a doubt, and please for God's sace (sic) help us for we can 

not live this way and there is a great deal of our collur is dieing out on 

account of they can't get anything to eat." The War Department, however, 

appeared more sensitive to simple corruption than to that generated by 

race relations in the South, and the problem continued 29 

leiters Received by the Office of The Adjutant Geneml (Main Series). 187 1- 80. M666. NA; and 

Robert Cromie, The Great Chicago Fire (New York: McGraw Hill Book Co. , 1958). On increasing 

engineer support, see Leland R. Johnson. "Emergency Response: A History of the Army Engineer 

Disaster ReHef Mission, 1794- 1950" (unpublished manuscript. Engineer Historical Division. 

Washington, D.C .. 1978). 

18Evereu Dick , The Sod·House Frontier. 1854-1890: A Social Histol)' of the Northem Plains 

from the Creation of Kansas ali(I Nebraska to the Admission of 'he Dakotas (New York: D. 

Appleton-CenlUry Co., 1937), pp. 208-9; see also Gilbert C. File. "The United States Army and 

Relief to Pioneer Settlers. 1874- I 875." JOllmal'o!the West 6 (Jan 1967): 99 - 107. 

29Sarah Woolfolk Wiggins. TheScalawag iI/Alabama Polilic.\·, 1865- 1881 (University: University 

of Alabama Press. 1977), pp. 96- 97: Ltr. James Lorrans to Benjamin H. Brewster, 2 1 Mar 1882. 

(Continued) 
18 THE DEMANDS OF HUMANITY 

The Role of the Medical Department 

Despite failings of prejudice and parsimony, by the end of the nineteenth century the federal government- and the soldiers who were its 

agents-had become an important source of assistance for disaster victims. 

That aid provided a strong precedent when in the early twentieth century 

the federal government expanded its relief operations- an expansion that 

included greater participation by members of the Army Medical Department. 

Yet for reasons rooted both in the department and the medical profession 

at large , the Army doctor's role remained minimal throughout the nineteenth century. Occasionally a medical officer might participate in a 

nonmedical relief mission, as when an assistant surgeon served as a 

distribution officer during the 1874 locust plague in the Southwest. Or a 

nonmedical officer might render medical assistance, as when Lt. Eugene 

A. Woodruff, an engineer officer who happened to be in Memphis when 

yellow fever struck in 1873, helped care for the sick. Acting on his own, 

Woodruff remained in the city, joined the Howard Association, and 

worked in a hospital where he contracted the disease and died. Such 

isolated occurrences, however, did not change the fact that the Army 

provided little medical assistance to civilians in disaster situations during 

the nineteenth century. 30 

Before the Civil War, medical professionals, both military and civilian, 

had only limited skills and knowledge to offer disaster casualties. Anesthesia, 

an American discovery, came into use in the 1840's, and surgeons 

possessed such basic skills as bone setting. But except for the use of 

quinine against malaria and vaccination for smallpox, the profession as 

yet could offer little to cure or prevent disease. The vast majority of 

American physicians still relied on the old practices of bleeding, purging, 

and blistering, which produced neither relief nor recovery. Consequently, 

antebellum Americans often placed little faith in physicians, and wisely 

SO.3 1 

Even if physicians had commanded more effective skills and greater 

(Continued) 

leiters Received by the Office of The Adjutant General (Main Series), 188 1- 89, M689, reel 84, 

NA; Llf. Organization of 59 Black Men In White Sial ion, Mississippi, (0 the President of the United 

Siaies. 26 May 1890. Letters Sent Concerning Relief of Flood Sufferers, Mississippi Floods of 1890. 

entry 46. Records of the Oflice of Commissary General of Subsistence , Record Group 192, 

Washington National Records Center (WNRC). Engineer officers tcnded to emphasize the fac t that 

free rations di scouraged laborers from helping in relief work. See Johnson. "Emergency Response." 

)()RSW. 1875. p. 68; New York Times, 24 Oct 1873; Johnson, "Emergency Response." 

31Rosenberg, Cholera Years. pp. 155 - 57; William G. Rothstein, Americall Physicialls ill the 

Nilleteemh Cellfllry: From Sects to Science (Baltimore: Johns Hopkins Uni versity Press, 1972), 

especially pp. 4 1- 62; Richard H. Shryock, Medicine ill America: Historical Essays (Baltimore: 

Johns Hopkins Uni versity Press, 1966). 
T HE N INETEENTH CENTURY 19 

public support, the Army had too few to spare for disaster relief. The 

Army Medical Department was not permanently established until 18 18 

and for decades remained so chronically understaffed as to be unable to 

meet the Army's needs. In 183 1, for example, the Secretary of War 

typically reported that the Army had sixty-four stations requiring doctors 

and fifty-three physicians with which to staff them. Moreover, the problems of dispersion and slow transportation that hindered all federal relief 

in the period were especially disadvantageous in the case of medical 

assistance. Scattered at distant outposts, Army physicians could hardly 

have reached many disaster victims in time to be of help. 32 

By increasing the awareness of sanitation, the Civil War raised the 

possibility of greater medical involvement in disaster relief. Although a 

few people had agitated for public health reform in the antebellum years, 

only during the war did sanitarians begin to gain popular support. Civilians eager to help the boys in the camps rallied to the cause of the soldiers' 

aid commissions which sponsored workers among the armies. Some 

commission agents were more concerned for the soldiers' spiritual wellbeing than for their physical health, if indeed they would or could have 

made the distinction. But others-particularly those of the Sanitary 

Commission---sought to prevent illness among the troops, agitated for 

improved treatment by an Army Medical Department ill-prepared for 

war, and often supplemented the military's own health care. Since the 

etiology of disease was still not understood, their most important contribution lay in mobilizing public opinion. The Union army's own widely 

publicized efforts to control yellow fever, particularly in New Orleans, 

also contributed to a new sense of the potential value of public health in 

preventing epidemics. 33 

Despite the increased public concern and awareness of the war years, 

participation in disaster assistance by the Army Medical Department 

remained minimal. Medical and public health capabilities advanced slowly, 

and traditions of localism and voluntarism remained strong in disaster 

situations. The newly formed American Red Cross incorporated both 

traditions and increasingly rendered medical and other direct relief. 34 

J2Mary C. Gillett. Til e Army Medical Department, 1775- 1818 (Washington: GPO, 1981); 

RSW. 1831. p. 25. 

JJRichard H . Shryock , .. A M edical Perspective on the civil War," in Medicille ill America, pp. 

90- 108: Howard O. Kramer, " Effect of the Civil War on the Public Health Movement, ,. Mississippi 

Vtllley HiSlOriCCl1 Review 35 (1948): 449- 62; Roben. H . Bremner, "The Impact of the Civil War on 

Philanthropy and Social Welfare ," Civil War History 12 (1966): 293-303. For effon.s in New 

Orleans, see Jo Ann Carrigan. "Yankee Versus Yellow Jack in New Orleans, 1862- 1866," Cil'il 

W(lr History 9 ( 1963): 248- 60; and for an example of its inOuence, New York Times, 50cI 1873. 

34 Fosler Rhea Dulles, Tile Amer;cclII Red Cross: A History (New York: Harper & Bros., 1950); 

Elliot, Red Cross Disaster Services. 
20 THE DEMANDS OF HUMANITY 

When the federal government proffered additional aid, it could tum to the 

United States Marine Hospital Service--predecessor of the Public .Health 

Service--which was capable of furnishing some assistance. Its physicians aided civilian authorities in a Florida yellow fever epidemic, the 

floods of 1884, and the Johnstown flood, to cite only a few examples." 

Finally, despite the war, the Army Medical Department remained poorly 

staffed and organized, with civilian contract physicians still caring for 

many soldiers. 

Nevertheless, the Army medical personnel dia provide some medical 

care to civilian communities, creating a legacy from which twentieth 

century disaster relief activity grew. Throughout the nineteenth century, 

sometimes but not always at the direction of Washington, Army surgeons 

worked to control or prevent epidemics. And on the frontier, military 

doctors found themselves ministering to the needs of civilians in medical 

emergencies of all types. 

On a few occasions, the Army loaned its facilities to a community 

suffering from an epidemic. An early instance of such aid, though not one 

directly involving the Medical Department, occurred during the 1853 

yellow fever epidemic in New Orleans. Military authorities there allowed 

the city's board of health to establish quarantine stations in Forts Jackson 

and Phillips, inactive posts situated on opposite sides of the Mississipi 

River several miles below New Orleans. Nearly a quarter of a century 

later, in June 1877, assistant surgeon Joseph Y. Porter in Key West, 

Florida, permitted the local board of health to care for epidemic victims in 

his post hospital . 36 

More typical of Army medical aid were the efforts of individual Army 

surgeons who cared for victims of epidemics. For example, in the antebellum period, Nathan S. Jarvis, a military doctor at Fort Brown, ministered 

to the mechanics and laborers of nearby Brownsville, Texas, during an 

outbreak of cholera. Civilian assistance became more common during 

Reconstruction, when many small units were stationed throughout the 

South. In 1869 a detachment commander in Warsaw, Kentucky, heard of 

a case of smallpox, removed the stricken family to the outskirts of town, 

and then directed his surgeon to vaccinate most of Warsaw's population. 

In another instance, Army surgeon George Taylor cared for both soldiers 

and civilians during a yellow fever epidemic in Galveston, Texas. Taken 

3.5Elihu Burritt. Jacksollville, Florida: Experiences ili a Strickell City (Jacksonville: Riverside Art 

and Pub!. Co. , 1888), p. 3; Ames, Official Reporl. passim; New York Times. I I Jun 1889. For the 

Marine Hospital Service's limitations in disaster assistance, see Congressiollal Record. 55th Cong., 

1st sess., 1897, p. 639. 

36Duffy, Sword of Pestilence, pp. 100--2; Continuation of Brief. 20 Aug 1877. M689. 

reel 54 1, NA. 
THE NINETEENTH CENTURY 21 

ill himself, Taylor died when he left his sickbed to serve as a guide for a 

delegation of doctors studying the outbreak.

37 

The routine relationship of frontier military physician to neighboring 

settlers, however, did more to create a nineteenth century legacy of aid to 

civilian populations than did sporadic aid during epidemics. In some 

sparsely settled areas, Army surgeons were the first, and for many years 

the only, medical men. Consequently, they treated a variety of patients: 

soldiers, local settlers, lumbermen, hunters, Indians. In the Old Northwest, 

the nation's first frontier, Army doctors prescribed for Whooping cough, 

vaccinated for smallpox, pulled teeth, and generally provided medical 

service for all comers- red or white, military or civilian. 38 

The best known example of such aid was rendered by Dr. William 

Beaumont in 1822. A military surgeon stationed at Fort Mackinac, 

Beaumont was the only doctor on the island in Lake Huron and received 

permission from the Medical Department to maintain a civilian practice. 

The hard-drinking, ready-fighting voyageurs and trappers who frequented 

the island insured him a thriving practice. When one such character, 

Alexis SI. Martin, was wounded in the abdomen by a shotgun blast at 

close range during a barroom brawl, his friends sent for the Army doctor. 

Beaumont arrived quickly, and through his ministrations and a near 

miracle, Martin survived despite the fact that the opening in his stomach 

never completely closed. In a long series of experiments, the Army 

surgeon used the civilian's stomach to enlarge the world's understanding of 

the digestive process- the first major American contribution to medical 

knowledge . Of course, most military medical contacts with civilians were 

considerably less dramatic and celebrated-more on the level of assistant 

surgeon John S. Griffin's action during the 1840's in treating an old man 

in Los Angeles for a dog bite. 39 

Aid to civilians continued as the frontier shifted westward after the 

Civil War. On the advancing frontier, a generation of Army medical men 

who would win renown in the twentieth century cared for civilians in 

J1N .S. Jarvis. "Report on the Rise. Progress. and Decline of Epidemic Cholera in the Va lley of 

the Rio Grande." Southern Medical Reports I (1849): 436: Ltr. C. A. Bell to R. Rinble. 25 Jun 1868. 

Letters Sent. Chief Medical Officer of Kentucky. entry 109 1. Record Group 105. NA; Unlabeled 

newspaper clipping, in Medical Officers of the Civil War. p. 116. entry 86. Records of the Office of 

the Surgeon General, Record Group 112. NA . 

38Francis Paul Prucha, Broadax and Bayonet: The Role of the United States Army in the 

Development of tire Northwest, / 8/ 5- /860 (Madison: State Historical Society of Wisconsin, 1953). 

pp. 212- 13; N. S. Jarvis ••. An Anny Surgeon's Notes on Frontier Service, 1833- 48," JOllrnal of 

the Military Service Illstilllte 38 (1906): 132; Gillett, Medical Department, pp. 139- 40. 

39Jesse S. Myer, Life alld Lelfers of Dr. William Beal/mom (SI. Louis: C. V. Mosby Co .. 1912), 

p. 95 and passim; John S. Griffin . A Doctor Comes 10 California: The Diar), of JollII S. Griffin. 

Assistant Sl/rgeollwith Kearn),' s Dragoons. /846 - /847. California Historical Soc iety Publications 

No. 18 (San Francisco: California Historical Society. 1943). pp. 84- 85 . 
22 THE DEMANDS OF HUMANITY 

emergencies. Walter Reed once walked through a snowstorm to deliver a 

baby, and on two occasions William Gorgas nearly perished in a blizzard 

while trying to reach suffering civilians in isolated Dakota cabins. And 

George Sternberg had an active practice among settlers around his stations, 

among them a trapper whose life he saved by an emergency amputation. 40 

Throughout the nineteenth century, whether aiding a community 

threatened by an epidemic or answering an emergency call, Army doctors 

established a tradition of helping civilians in need. Such work anticipated 

the time when the Medical Department would have greater resources and 

the medical profession greater skills. Then Army medical personnel 

would play an important role in disaster relief. 

In the meantime the involvement of both the federal government and 

the Army in disaster relief had changed. Where early in the century the 

federal government only hesitatingly approved minor rehabilitation programs, 

in later decades it undertook substantial relief missions on a routine , if 

still ad hoc, basis. Where before the Civil War, the Army had rarely been 

considered for such operations, it later served as the federal government's 

primary agent for disaster relief. Army assistance abroad lagged behind 

that at home, but even so the United States had begun to render aid in 

foreign countries and to contemplate the military as an agency for doing 

so . 

40Laura N. Wood, Waller Reed: Doclar ill Uniform (New York : Julian Messner, 1943), pp. 

132-33; Marie D. Gorgas and Burton J. Hendrick, William Crawford Gorgas: His Life and 

Work (Garden City, N.J.: Doubleday, Page & Co. , 1924), pp. 58- 61 ; John M. Gibson, Soldier in 

While : The Life a/General George Miller Sternberg (Durham, N.C.: Duke University Press, 1958), 

pp. 64 , 85- 86. Forolher examples, see Percy M. Ashburn, A His/Dry oflhe Medical Department of 

the United States Army (Boston: Houghton Mifflin Co., 1929), p. 11 6; Maria Brace Kimball , A 

Soldier-DoCior a/Our Army (Boston: Houghton Mifflin Co., 1917), pp. 53-54. 
CHAPTER 3 

Emerging Missions: Combating 

Epidemics Abroad 

The accomplishments of the Army Medical Department in disaster 

relief between 1898 and 1917 surpassed not only its meager contributions 

in the nineteenth century but those of any subsequent era as well . The 

transformation of the department's role began as it combated epidemics in 

the tropical dependencies acquired by the United States as a result of the 

Spanish-American War. The spectacular success that resulted rested 

upon both the emergence of modern health science and the prewar reform 

of the Medical Department itself. 

Between 1865 and 1890, Louis Pasteur and Robert Koch demonstrated that germs caused certain forms of infectious illness. Armed with 

that basic insight, other scientists soon implicated microbes as causal 

agents of many diseases-{)f typhoid, leprosy, and malaria in 1880, 

tuberculosis in 1882, cholera in 1883, diphtheria, tetanus, and bubonic 

plague in 1884, and dysentery in 1898 . By 1"901, the president of the 

American Public Health Association could proclaim: "We no longer talk 

vaguely of cosmic perturbations, aerial influences, noxious miasms, and 

epidemic constitutions of the atmosphere , but have exact and definite 

knowledge of the characteristics, habits, and life-story of nearly all the 

organisms which are the cause of contagion ." I 

Relying on this "exact and definite knowledge ," physicians cured 

more patients, and the status of the medical profession rose . Concurrently, 

sanitarians and engineers spurred municipal governments into forming 

new or strengthening existing boards of health with authority to enforce 

sanitary laws and regulations. Advances in medical knowledge and 

practice combined with these organizations for implementing them to 

make the two decades between 1890 and 1910, in the words of one 

historian of public health, a "period of sc ientific control of communicable disease by the application of bacteriology. ,, 2 

ITrauner, Poor Law to Welfare Stale, pp. 116- 35 . Quole from Benjamin Lee , "President's 

Address ," Papers and Reports oJthe American Public Hell/Iii Association 27 ( 190 1): 13. 

2Rothstein, From Sects /oScietlce ; Lawrence H. Larsen, " Nineteenth-Century Street Sanitation: 

(Continued) 
24 THE DEMANDS OF HUMANITY 

The Anny Medical Department was able to contribute to this age of 

"scientific control" for it was a refonned service in a refonned Army. In 

common with many other segments of American society, the Army in the 

late nineteenth century strove to increase professional competency within 

its ranks-by the creation of special service schools, for example. The 

Medical Department, . staffed by an unusually skilled, highly educated 

cadre of doctors who were frequently leaders in the revolution in medical 

knowledge, participated in this increased professionalism. The doctors 

also acquired specialized enlisted support in 1887 when Congress and the 

president approved the formation of the Hospital Corps. The corps 

strengthened the department by adding enlisted personnel who received 

training in elementary first aid, stretcher-bearing techniques, and other 

aspects of hospital and evacuation work. 3 

Unfortunately, all the weaknesses of the nineteenth century had not 

been corrected, as the Medical Department's performance in the SpanishAmerican War all too prominently revealed. The department did not have 

sufficient numbers of surgeons or corpsmen to support the massive troop 

buildup, and when it expanded its ranks it did not always secure qualified 

or trained personnel. Problems of supply, organization, and line indifference 

to medical needs further contributed to a failure of health care for the 

annies. After the war, a specially appointed presidential commission 

headed by Grenville M. Dodge examined medical operations as well as 

the conduct of the entire War Department. Its report recommended 

refonns which, when enacted over the next few years, strengthened the 

Medical Department4 

(Continued) 

A Study of Filth and Frustration," Wisconsin Magazine of History 52 (1969): 239-47; Stanley K. 

Schultz and Clay McShane, "To Engineer the Metropolis: Sewers, Sanitation, and City Planning in 

Late-Nineteenth-Century America," Journal of American History 65 (1978): 389- 4 11 ; John 

Duffy, A History of Public Health ill New York City, /866-/966 (New York: Russell Sage 

Foundation, 1974), passim , but especially pp. 70-280. Quole from C.-E. A. Winslow, The 

£VOil,I;01l and Sigllificallce o/ the Modem Public Health Campaign (New Haven: Yale University 

Press, 1935), p. 49. 

)For efforts at modernizing the Anny, see Peter Karsten, "Anned Progressives: The Military 

Reorganization for the American Century ," in Building tile Organizatiollal Society: Essays 011 

Assoc iational Acti vities in Modem America, cd. Jerry Israel (New York: Free Press, 1972), pp. 

197-232; James E. Hewes, Jr. , From Root to McNamara: Army Organizatioll alld Administration, 

/900 - /963 (Washington: GPO, 1975). Fordeve!opments in the Medical Department, see Reports 

of The Surgeon General, 1887, p. 91, and 1888, pp. 14 1- 42; Ashburn, History oj the Medical 

Department, pp. 140, 142, and passim. 

"Graham A. Cosmas, All ArmyJor Empire: The United States Army ill theSpanish-Americall War 

(Columbia: Uni versity of Missouri Press. 1971), pp. 245 - 314. See also U.S. Congress, Senate, 

Report of the CommissiOIl Appoillfed by the Presidellf to Investigate the COllduet oj the War 

Department;1I the War wi/h Spaill , S. Doc. 221, 56th Cong., 1st sess., 1900, 8 vols. All eight 

volumes include infomlation on the Medical Department, but for the commission's fi ndings and 

recommendations, see 1: 169- 89. 
EMERGING MISSIONS 25 

Even before these reforms, the Army Medical Department received 

an opportunity to demonstrate its new professionalism in work that highlighted 

its members' medical expertise and abilities to administer public health 

programs. Army medical officers directed several campaigns against 

epidemics, with success that may not have atoned for earlier failings but 

at least rehabilitated the Medical Department's public image. Maj. Walter 

Reed, one of the doctors most active in this work, wrote in 190 I: "Thank 

God that the Medical Department of the U.S. Army, which got such a 

'black eye' during the Spanish-American War, has during the past year 

accomplished work that will always remain to its eternal credit. " , 

The Medical Department's oppOIlunity for "eternal credit" resulted 

from a dramatic shift toward international activism in American foreign 

relations at the time of the Spanish-American War. Several of the motives 

that spurred early foreign disaster relief-humanitarian concern, national 

prestige, and commercial considerations-contributed to American 

imperialism as well. The practical result of the new policies was vastly 

expanded military involvement abroad, as the victorious United States 

replaced Spain as the ruler of Cuba, the Philippines, and Puerto Rico'" 

In all three countries, the Army governed for a time, but the length 

and form of its administration varied in each. In Puerto Rico the Army 

quickly reestablished order and turned affairs over to a civilian government 

that ruled the island as a territory of the United States. In the Philippines 

an insurrection against occupying forces led to a long battle to pacify the 

island. Shortly after the subjugation of the rebels, the military government 

abdicated in favor of an American civilian Philippine Commission. In 

Cuba the military imposed stability and, after four years, withdrew when 

a newly elected government agreed to American terms. Four years later, 

the United States decided it had not complied and sent the Army back to 

support an American civil government. This time the troops remained on 

the island for almost three years before once again returning Cuba to the 

Cubans 7 

5Quote from L1r. Walter Reed to William C. Gorgas, 29 Jut 01. in W. C. Gorgas Papers. 

University of Alabama Library. 

fiFor an introduction to the literature on Ihechange in policy , sec Daniel M. Smith, " Ri se 10 Greal 

World Power, 1865 - 19 18," in The Reilllel'preWlioll of American History alld Clllillre, cd. William 

H. Cartwright and Richard L. Watson, Jr. (Washington: National Council for the Social Studies. 

1973), pp. 443- 64. 

1See Edward J. Berbusse, The UlliledSlates in PllertoRico, 1898- 1900 (Chapel Hill: University of 

North Carolina Press. 1966); John M. Gales, Schoolbooks (II/{I Krags: Tile United States Army infhe 

Philippines. /898 - 1902 (Westport, Conn.: Greenwood Press, 1973), but cr. Leon Wolff, Litlle 

/Jrown Brother (Manila: Erehwsa. 196 1); David F. Healy, The Ulliled SWles ill Cllba, 1898- 1902: 

Generals. Politicialls. alld the Se(lrchfor Polic), (Madison: University of Wisconsin Press, 1963); 

Allan R. Millcu, The Politics oj Intervention: rhe Military Occllpatioll of Cllba, 1906- 1909 

(Columbus: Ohio Stale University Press, 1968). 
26 THE DEMANDS OF HUMANITY 

Several factors influenced the Army's decision to institute programs 

of sanitary reform in all three possessions. The nineteenth century legacy 

of Army medical aid on the frontier probably conditioned Army doctors 

to consider a ci vilian relief mission, but pragmatic considerations dictated 

a public health effort as well . Obviously, a reduction in the incidence of 

communicable disease in the civilian community would protect the health 

of the troops. It would also offer some protection to American civilians 

working in the countries and thereby facilitate the development of commercial relations 8 

Finally, a few medical officers argued that the containment of contagious 

diseases, especially in Cuba and Puerto Rico, offered a means to reduce 

the likelihood of epidemics in the United States. Army surgeon John Van 

R. Hoff, in an article entitled " The Share of 'The White Man's Burden' 

That Has Fallen to the Medical Departments of the Public Services of 

Porto Rico ," proclaimed: "Robbed of all superfluities, the real reason 

why we are in the Antilles today is because our people had determined to 

abate a nuisance constantly threatening their health, lives, and prosperity." 

"Spain," Hoff added, "was maintaining a pesthole at our front door and 

we could no longer endure it. ,,9 

The goals of protecting Americans and eliminating pestholes led the 

Medical Department to devote most of its attention to highly contagious 

diseases, though it did furnish some routine care and instituted minor 

programs to control tuberculosis and leprosy. But all three countries 

harbored various epidemic diseases-smallpox, plague, cholera , yellow 

fever- which with the sudden influx of nonimmunes during the war and 

its aftermath presented a situation of potential medical disaster. Driven by 

the possibility of such a calamity, the Army concentrated its efforts on the 

prevention or control of epidemics. 

Sanitary and Organizational Reform 

In 1898 doctors knew how to prevent smallpox epidemics and control 

cholera. The transmission of yellow fever and plague by insects had not 

yet been proven, even though the vectors for some other diseases had 

been recently established. Despite rapid advances, medical theory still 

held filth to be the leading cause of disease and organized sanitation the 

80 n this point, see RSW, 1903, vol. 6, The Philippille Commission, part 2, p. 64; Republic of 

Cuba, Report o/fhe Prol'is;ollal Administratioll/rom October J 3, 1906 to December /SI, 1907. p. 47. 

9Quote from clipping from the Philadelphia MetJical Jour/wi, 7 Apr 1900, in the Jefferson R. Kean 

Papers, Alderman Library, Un iversity of Virginia. Forevidenceofpopular support for Ihis attitude in 

the States, see John H. Ellis, " Yellow Fever and the Origin of Modem Public Health in Memphis, 

Tennessee, 1870- 1900" (Ph.D. diss., Tulane University, 1962), pp. 250-51. 
EMERGING MISSIONS 27 

best means to prevent sickness. Cleanups reduced the incidence of 

.. camp diseases" such as diarrhea and dysentery, may have helped 

prevent the spread of cholera, eliminated some breeding places of mosquitoes, 

and lessened the food supply of rats. Sanitation could not, however, have 

prevented or controlled the epidemics of plague and yellow fever which 

American officials so feared. Nonetheless, knowing what sanitation 

could accomplish and expecting---{)r perhaps only hoping-it could do 

more, the Army first cleaned occupied areas in all three countries and then 

established modem boards of health to maintain that cleanliness. 

On all three islands, Army doctors encountered an environment 

reminiscent of America in the early nineteenth century, if not Europe in 

the Middle Ages. One American who arrived in Havana, Cuba , about the 

time the Army did recalled how " dead animals abounded, garbage was 

encountered everywhere, gutters were foul, and open mouths of sewers 

running into the ocean or into the harbor were reeking. Nauseating odors 

filled the air, and the condition of the public buildings was such that the 

American army officers practically refused to occupy them." With minor 

geographical variations, his description fitted cities the Army occupied in 

the Philippines and Puerto Rico as well. Most of the residents of all three 

countries still considered disease an act of God's will and apparently 

remained oblivious to the aesthetic as well as the medical benefits of 

sanitation. They drank from impure water supplies and made little provision 

for disposal of personal waste . So many people stopped by the roadside to 

relieve themselves or dumped chamber pots out of windows that one 

American official in the Philippines advised nighttime strollers in Manila 

to walk only in the middle of the street and to carry an umbrella. 10 

Since this tactic was unsatisfactory, particularly for soldiers who were 

not issued umbrellas, the Americans had to remove the accumulated filth 

and teach local civilians to maintain cleanliness through proper sanitation. 

At first the Army resorted to draconian measures. In the early days in 

Cuba, American troops entered the "dirty little town" of Siboney in 

which yellow fever was raging. Under the direction of Col. Charles R. 

Greenleaf, the surgeon in charge, the Army instituted a "vigorous" 

cleanup program and excluded all Cuban and Spanish refugees. When 

those measures failed to halt the epidemic, the Army burned the town. II 

In Santiago, Cuba, the first American military governor, Gen. Leonard 

10Quote from Franklin Matthews. The New-Born Cltbt, (New York: Harper & Bros .. 1899), pp. 

95-96. Advice from Dean C. Worcester. The Philippines Past alld Presellf. ed. Ralston Hayden 

(New York: Macmil lan Co .. 1930). p. 329. See also Joseph B. Van Hise ... American Contributions 

to Philippine Science and Technology. 189 1- 19 16" (Ph.D. diss., University of Wisconsin. 1957). 

p. 14: L.P. Davison. "Sanitary Work in Porto Rico. " Independent 5 1 (1899): 2 128-29. 

llQuote from RSG, 1898, pp. 196,2 16-17. 
28 THE DEMANDS OF HUMANITY 

SANITARY DEPARTMENT, COMMISSION AND STAFF, Salltiago de Cuba, 

Major George M. Barbour ill chair, 1900. 

Wood, employed less extreme tactics but still forcibly imposed cleanliness 

on the community. Wood, a physician himself, sought a general reduction 

in the city's death rate but also hoped to prevent yellow fever. He did not 

assign the cleanup task to Anny medical personnel but appointed "Major" 

George M. Barbour director of sanitation. Barbour had simply assumed 

the title of major; he was a civilian, a former business partner of Buffalo 

Bill Cody, and an experienced free-lance sanitarian . Charged with cleaning 

the city, Barbour commandeered carts and drafted laborers, sometimes 

horsewhipping the recalcitrant. But local residents probably participated 

to receive the food and cash Wood's government offered as wages, rather 

than from fear of Barbour's lash. Wood added some of his own men to the 

sanitary force and organized soldiers and civilians alike in military 

fashion. Crew foremen exercised absolute control, and subordinates 

saluted superiors. To keep his eye on the troops, Wood rode through the 

streets of the city on horseback several times a day. 

This paramilitary sanitary force attacked filth with a vigor "as sharp 

and hot as the charge of San Juan Hill," according to one observer. Crews 

cleaned shops, bakeries, and slaughterhouses. And the streets became the 

main battlefront where workers shot stray dogs, burned trash, and began 

to clean what seemed to be the dirt of centuries. They compiled an 

impressive body count: 1,100 corpses both human and animal were 

removed and burned in the first 68 days. At the height of the battle, crews 
EMERGING MISSIONS 29 

carried off 200 loads of rubbish a day. The habits of the populace also 

came under attack: "People making sewers of the thoroughfares were 

publicly horsewhipped in the streets of Santiago; [and] eminently respectable 

citizens were forcibly brought before the commanding general and sentenced 

to aid in the cleaning of the streets they were in the habit of defiling." 

Coerced if not convinced of the merits of sanitation, local residents 

started to cooperate. By the middle of the summer Wood proclaimed, 

"the old town is at last clean, and we are down, so to speak, to modern 

dirt which, while not attractive , is of a less offensive character than that 

of 1520. ,,12 

In other cities in the three countries, the Army relied not on a dramatic 

military assault but on a modern sanitation program that combined military 

authority with bureaucratic methods. In the capitals, San Juan, Manila, 

and Havana, the Americans formed crews composed mainly of local 

civilians to clean streets and public buildings, established inspection 

procedures to examine all residences, and attempted to force citizens to 

practice sanitation. Though Army medical officers did not always direct 

the cleanup efforts, they did oversee the establishment of new public 

health bureaucracies and often played a central role in their administration. 

Efforts in Manila illustrated how their attempts at sanitary reform proceeded in all three cities. 

Cleaning the Philippine capital was no simple task; the Army drastically 

increased the size of the former Spanish sanitation force and hired many 

more carts and mules. The reinforced crews scoured the city, removing 

refuse and garbage which the Army then burned rather than dumping it 

into the ocean as had been Manila's practice. The disposal of personal 

waste posed a special problem because of the citizens' century:old habits. 

Many homes had picturesque towers housing a small room at the top with 

a hole in the floor that served as a wretched system of indoor plumbing. 

According to one observer, "this pit of iniquity is never cleared out" and 

"the excreta of fifty or one hundred years lie there" forming "a solid 

column of this decayed filth. ,. A group of American soldiers, no doubt 

unwilling volunteers, took three weeks to clean out just one tower. After 

cleaning all of them , the Army instituted a night soil pail system and hired 

civilian contractors to remove the buckets and barrels but even so never 

12First two quotes from Robert P. Porter, /ndU$tri(11 Cuba: Being (I Study o/Present Commercial 

and Industrial Conditions. w;11I Suggestions as to tile Opportunities Presented ;n the Island for 

American Capital, Emerprise. and Labor (New York: G. P. Putnam's Sons, 1899). p. 63. Hermann 

Hagedorn, Leonard Wood: A Biography (New York: Harper & Bros .. 1931), I: 187-202, Wood 

quote on p. 202; Matlhews. New-Borll Cuba pp. 127-35, 298-99,302; for a cautionary nOle on 

Wood's achievemcni. see Albert O. Robinson , Cuba and the Intervention (New York: Longmans. 

Green. & Co., 19(5), pp. 79-80. 
30 THE DEMANDS OF HUMANITY 

completely solved the city's waste disposal problem. 13 

Once Manila became minimally free from foulness, the Army tried to 

institute modern public health practices to keep it so. The Board of Health 

was created, directed by an Army medical officer and composed of six 

Anny Medical Corps members and two local doctors. The board supervised 

cleanup operations, compiled vital statistics, regulated medical practice, 

and , most important, promulgated sanitary regulations. These included a 

ban on using public places for toilets as well as ru les that required 

householders to empty privies at least once a week, market vendors to use 

garbage cans, and slaughterhouses to burn carcasses. Unfortunately, 

since these and other rules sometimes confl icted with Spanish or local 

customs, many citizens remained unconcerned about or even hostile to 

sanitary measures. To stimulate their cooperation, the military adopted 

house-to-house inspections and street patrols. " 

The Army medical officer who directed the inspections divided the 

city into ten districts, recruited workers from the local Filipino and 

Chinese populations, and organized them into a hierarchical staff of 10 

district inspectors, 30 subdistrict inspectors, and 60 inspectors. The staff 

tried to check every house at least once a week, and at each the inspector 

posted a card with his signature, the date , and his findings. If he judged 

the premises unsanitary, he gave the householder a set of printed instructions 

explaining how to correct the problem. Householders who refused to 

make corrections could be fined , but those who agreed to cooperate were 

given time to perform the work. The hierarchy of inspectors coupled with 

the use of posted cards allowed thorough supervision, but as a further 

precaution the Army never fined a citizen without first sending an Army 

officer to reinspect the premises. Because the inspection system was 

judged to be fair, local cooperation improved." 

The populace responded less enthusiastically to the other method of 

enforcement, street patrols by American soldiers. Under the direction of 

the provost marshal, military details patrolled Manila to enforce compliance 

with sanitary ordinances. The soldiers not only fined people who broke 

I)QUOICS from G. J. Younghusband , The Philippilles and Round Aboll' (New York: Macmillan 

Co .. 1899). pp. 53-54. Gates. Sc oolbook ~, p. 60: Almlml Repol'/ of Major General Arthur 

MacArthlir. Miliflll'y COI'nllOr in Ihe Phili'1f}illl' 15/0Ild.\', 190 1. 2: 8- 15: Van Hisc ... American 

Contributions:' p. 14 . 

'''On the Board of Health. see Gales. Schoolbooks, pp. 57-60: RSG, 1900. p. 189: and 190 1. 

pp. 138-40; R. C. Humber. "Military Government in the Philippines" (3 study prepared in the 

Historical Section. Anny War College, Jun 1943), Appendix FF; Charles R. Greenleaf. "A Brief 

Statement of the Sanitary Work So Far Accomplished in the Philippine Islands. and of the Present 

Shape of the Sanitary Administration." Papersalld Repol'Isofthe American PI/blic: Healt" Association 

27 ( 190 I): 157; Van Hise. "American Contributions." pp. 15- 17, 

'ljMacArtlllir Report. 1901. 2: 11 - 13; Greenleaf. "Statement on Sanitation." p. 160; RSG, 
EMERGING MISSIONS 31 

the rules but also befuddled and angered many Filipinos accustomed to 

Spanish informalities by refusing bribes. One English traveler described 

how older local residents "ma·le and female, who from time immemorial 

had been accustomed to perform the offices of nature in any convenient 

spot in the public streets, now found that the continuance of such habits 

was a luxury which, pecuniarily speaking, they could no longer afford for 

even the most opulent would hardly care to pay a couple of dollars on each 

occasion." The visitor added that "the custom of emptying slops out of 

windows was also severely discountenanced, and one Spanish officer 

who happened to hit an American sentry in this way spent the night in the 

guardroom, and, in addition, had to pay a handsome fine in the morning." 16 

As a part of its cleanup campaign , the Army attempted to improve 

Manila's water system and public market. Since 97 percent of the residents 

drew their drinking water from the public hydrants, immediately after 

occupying Manila the Army restored that service. Nevertheless, military 

authorities still worried about the system's efficiency and safety, so they 

thoroughly cleansed the reservoirs, constantly checked for contamination, 

and continually sought to maximize pressure and minimize waste . In the 

caSe of Manila's "unsightly and malodorous " market, however, the 

Army decided simply to abandon it and construct a new one. Beginning 

in November 1899, the military government built a new market, a wonder 

of modern merchandising with corrugated roof with iron supports, a 

concrete slab floor, and water hydrants for washing the entire structure. 17 

Manila 's may have been the most thorough of the Army's sanitary 

campaigns, but programs in Havana and San Juan were nearly as 

comprehensive. In both cities the Army cleaned streets and buildings and 

created district staffs to ensure the cleanliness of every house. Outside the 

three capitals, however, Army sanitarians exerted less influence, and 

their message never reached the majority of small villages. Even in the 

handful of provincial towns where they did work, Army officials provided 

less structured, less thorough aid than in the capitals. 

In the village of Malabon , to cite another example from the Philippines, 

the Army found filth everywhere since residents worried little about the 

cleanliness of either their houses or the village. Hogs served as the town's 

"official scavengers," but unfortunately the job exceeded their appetites. 

1901. p. 139. 

IbQuotes from Younghusband. ROlllld About, pp. 52-53. Van Hise, •. American Contributions," 

p. 17; Karl!. Faust. Campaigning in the Philippilles (San Francisco: Hie' ~-J udd Co., 1899), pp. 

111 - 12. 

" Gales, Schoolbooks. p. 59. Quote from Van Hise . .. American Contributions." p. 47. Van Hise 

contends the improvements to the market were more to increase rentals than to ensure sanitary 

conditions. 
32 THE DEMANDS OF HUMANITY 

In attempting to improve the situation, the local Army commander 

initially tried persuasion. He sent through the village a drum-beating crier 

accompanied by a soldier who delivered a speech on the people's 

responsibility to clean their homes. The citizens remained unpersuaded, 

conditions worsened, and the Army resorted to regimentation. The 

commander dismissed dirty people from their jobs in the market. He 

appointed a corporal as sanitary inspector who, with the assistance of two 

local civilians, examined all the houses in the village. The corporal fined 

householders between fifty cents and a dollar for a first offense of 

uncleanliness and twice as much for the second. When fine collections 

lagged, the Army started to double the fine after twenty-four hours, 

threatened uncompliant citizens with prison, and finally employed soldiers 

as collection agents. 18 

Combating Epidemics 

Despite the mammoth cleanup of major cities and lesser efforts in 

some smaller ones, epidemics still struck. Smallpox threatened areas of 

all three countries. In the Philippines, bubonic plague broke out during 

the military government, as did cholera after the assumption of authority 

by American civilians. In Cuba, yellow fever threatened throughout the 

first and second occupations. These outbreaks provided dramatic testimony 

to the limits of sanitation as a means of disease control and prompted 

Army Medical Department civilian disaster assistance on a unprecedented 

scale. To provide relief, Army medical officers mobilized the newly 

created boards of health and utilized the latest medical knowledge. For 

smallpox and cholera that knowledge proved sufficient, but with plague 

an effective campaign was not devised until the Army acted on a then 

unproven theory of the disease's transmission. In the case of yellow 

fever, another malady that still perplexed epidemiologists, the Medical 

Department itself achieved the breakthrough upon which an eradication 

program was then based. 

Fortunately, the state of medical knowledge rendered Army medical 

personnel best prepared to control the first type of epidemic they 

encountered- smallpox. In November 1898 an outbreak occurred in the 

Holguin district of Cuba's Santiago province. The American military 

Governor sent the 2d Volunteer Infantry, composed of troops who had 

been vaccinated and revaccinated and augmented by several additional 

medical officers, to the affected area. Still influenced by the conviction of 

18Ltr, A. Millard to W. A. KoblX. 31 May 1899" William A. Kobbe Papers, Military History 

Institute (MHI). For variations in another lown, see James Parker, The 0/(1 Army: Memories, 

/872 - 1918 (Philadelphia: Dorrance & Co .. 1929), pp. 35 1-52. 
EMERGING MISSIONS 33 

a close relationship between filth and disease , the troops cleaned and 

disinfected the more permanent towns and burned (until Wood ordered 

the practice discontinued) the thatched hut communities. The medical 

officers vaccinated 30,000 people and, aided by the Cubans who actually 

provided most of the patient care, administered a hospital that treated 

1,185 cases of smallpox with only a 10.1 percent death rate. The Army's 

efforts continued into January but then the epidemic had passed and did 

not recur. 19 

In Puerto Rico the Army encountered a more widespread smallpox 

epidemic. The outbreak began in October 1898; by the next February the 

disease had struck more than 3,000 people in almost all parts of the island. 

Since it spread from the countryside to the city, Army medical officers 

had no choice but to attempt to vaccinate everyone in Puerto Rico. But 

several factors made such a comprehensive program extremely difficult. 

The disease already had a firm hold in many parts of the country, the 

climate favored its survival, a huge number of people had to be vaccinated, 

and the Americans could not count on popular support since most residents 

discounted the danger. To counter their opposition, the Army had limited 

sanitary authority and few medical men to marshal for the crusade. The 

available Army doctors met severe difficulties in traveling because of 

poor roads, which also intensified the problem of supplying fresh vaccine 

to isolated parts of the island. 

Undaunted, the chief surgeon of American forces, Maj. John Van R. 

Hoff, in December 1898 convinced the military government to authorize 

a plan to vaccinate all adults who had not previously had the disease and 

all infants under six months. Although in name a civil program, the 

·vaccination effort actually was, according to its director, Maj. Azel 

Ames, "organized and directed wholly by medical officers of the army. " 

Ames, also a member of the Medical Corps, both supervised the program 

and directed its implementation in the region around Ponce. In the four 

other administrative divisions designated by Hoff, medical officers also 

headed the project. In addition, doctors at all American Army posts 

inspected operations in their area, and at many vaccination stations, 

Hospital Corps personnel acted as orderlies, assistants, and recorders. 

The vaccinators, however, were usually Puerto Ricans 2 0 

With the Army furnishing much of his staff, Ames's major problem 

19Ltr. R.S. Woodson to Leonard Wood. 23 Nov 1898, in Hanllnilton V. Bail. "The Military 

Government of Cuba. 1898- 1002" (a study prepared in the Historical Section. Anny War College. 1943). 

Appendi x HH; RSG. 1899, p. 245: Leonard Wood, "The Military Govemment of Cuba , " AlIIllIfJoJ 

the American AC(ldem}, of Political and Social Science 21 (1903): 155. 

2OQuote from Azel Ames, "The Vaccination of Porto Rico: A Lesson to the World ," Joumal oj 

the Association of Military Surgeol/s 12 (1903): 302. 
34 THE DEMANDS OF HUMANITY 

became securing adequate supplies of potent vaccine. Vaccine sent from 

the United States tended to lose its potency before it arrived in Puerto 

Rico. At Hoff's suggestion and with the governor's approval, Ames built 

a vaccine farm on a site near Coamo and stocked it with cattle donated by 

local farmers. Its operators experienced considerable difficulty getting 

lymph brought from the States to grow, but eventually the farm's cows 

produced sufficient quantities of vaccine. 

Ames then had to ensure the continued potency of the vaccine during 

shipment from the farm to the vaccinators. To do so workers at the farm 

placed 500 vaccine points in absorbent cotton, put them in specially 

constructed shallow tin boxes, wrapped the boxes in more cotton followed 

by oiled silk, and finally placed fifteen of the boxes in a pannier. With two 

panniers slung across the backs of their horses, riders immediately set off 

for the division vaccination stations. At the five division stations other 

laborers divided the packets into units of 100 points, placed them in 

quadruple wrappings, and mailed them to the vaccinators. 

Once it had devised a way to deliver vaccine to the stations, the Army 

had to convince people to be vaccinated. To secure their cooperation, the 

Americans employed a shrewd blend of political savvy and administrative 

fiat. The Army obtained the support of the alcaldes de barrio , the Puerto 

Rican equivalent of ward heelers, who knew or at least were acquainted 

with all the people in their neighborhood. The officials in charge of 

vaccination had these men compile a list of all residents in their precincts. 

Shortly before the time scheduled for vaccination, the officials notified 

the local alcalde who in turn summoned 225 people from his list to report 

to the station, usually located in a nearby school. Army authority, 

however, reinforced the influence of the neighborhood leader, since 

Ames convinced the military government to issue a decree that prohibited 

employment of anyone without a vacc ination certificate. 

Under Ames's program nearly 860,000 people were vaccinated at a 

moderate cost of about $30,000. The United States supplied half of that 

sum, with Puerto Rico contributing the other half. Most of the money was 

paid to local physicians who served as vaccinators; the remainder defrayed 

the cost of operating the stations. The benefits of the expenditure and the 

Army's efforts were readily apparent. In the nine years before the program 

began, an average of 621 people died each year from smallpox. In 1899, 

the program's first full year of operation, total deaths dropped to 242; 

from I January to 30 April 1900, no one died of smallpox in Puerto 

Rico. 21 

2IRSG. 1899. pp. 191 - 92.246- 248: RSW. 1900. vol. I. part 13. Re,)orr of 'he MiNlary 
EMERGING MISSIONS 35 

Though it employed a simil ar program, the Army had more limited 

success eliminating smallpox in the Philippines, where the disease "was 

so common among the natives that one met them walking in streets all 

broken out, with great sores on faces and hands." Almost immediately 

after the Army's arri val, a near epidemic broke out among American 

troops and Spanish prisoners in Manila. The task of eradicating smallpox 

in the city fell to Maj. Frank S. Bourns. Bourns, a volunteer officer serving 

in the Medical Corps, had been in the Philippines twice before as a 

civilian, spoke fluent Spanish as well as a few local dialects, and had 

many friends in Manila. Fortunate in its director, the American program 

also benefited from the fact that the Spanish colonial government earlier 

had undertaken a token vaccination effort. Therefore, some residents 

understood the process, and a pool of trained vaccinators existed. In 

addition, Spanish officials had built a vaccine farm that Bourns rapidly 

reactivated to produce vaccine from native carabao calves. With the head 

start provided by Spanish efforts as well as Bourns's own political and 

organizational abilities, the Army rapidly vaccinated 80,000 people, 

preventing a major disaster. As a further precaution the Americans treated 

infected Filipinos in a smallpox hospital opened in a local church.22 

As the American Army subdued the rebels and gained control of other 

parts of the Philippines, it extended its efforts against smallpox to additional 

areas. For a time, local garrison surgeons vaccinated limited numbers of 

Filipinos when epidemics threatened. Lt. Col. Louis M. Maus, chief 

surgeon in the Philippines, considered that approach too haphazard and 

secured the military governor's approval for a systematic, compulsory 

vaccination plan. For adequate supplies of vaccine, Maus at first depended 

on the farm Bourns had used but when production fe ll behind demand 

started a second farm and, still later, three more. For his corps of 

vaccinators he recruited and hired Filipino medical students, taught them 

the fundamentals of vaccination and sterilization, and sent them throughout 

the islands. Maus assigned his own Army medical officers to supervise 

the program in their towns and neighboring villages. They hired people to 

keep the records and ensured that the students properly vaccinated the 

populace. 

The program began in February 1900, and by the end of 190 1 a 

Governor of PorlO Rico. p. 153; Ames. "Vaccination or Porto Rico. " pp. 293- 3 13; Henry K. 

Carroll , Reporl 011 the Islalld o/Porlo Rico: Ill' Popultllion . Civil Governmellf. Commerce. IndllSlries. 

Prod'leliollS. Roads. TarijJ. alia Cllrrellc),. willt RecOII/mendariolls (Washington: GPO. 1899). 

pp.2 12- 16. 

22Quote rrom Mrs. L. M. MUlls .. 'Old Army Days." manuscript in Halstead-Maus Family 

Papers, MHI. Van Hise , "American Contributions." pp. 134- 35; Worcester. Philippines, p. 333: 

Gates. Schoolbooks, pp. 58. 64 - 65. 
36 THE DEMANDS OF HUMANITY 

million people had been vaccinated. After the Army had vaccinated 

adults and children , however, it entrusted vaccination of the newborn to 

the Filipinos, who neglected it. Outbreaks of smallpox recurred, forcing 

the Philippine Commission in 1904 and again in 1910 to launch other 

vaccination programs. 23 

At the height of their efforts against smallpox, occupation forces in 

the Philippines faced the added threat of an outbreak of bubonic plague. 

In December 1899, two residents of Manila died, apparently from plague. 

When additional cases developed in January , alarmed Army medical 

officers decided to take precautions. In all the districts of the city, they 

established offices with direct telephone lines to the Board of Health and 

because of personnel shortages staffed them with Army doctors who were 

awaiting transportation to the United States. Each doctor received notification 

of every illness or death in his district and, when notified, hurried to the 

scene to investigate. If he found someone dead from plague, he took the 

corpse to be cremated . If the victim was still alive but appeared to be 

suffering from plague, the doctor accompanied the patient to a special 

hospital in an ambulance maintained solely for that purpose. When he 

left, another inspector assumed charge in the house until a disinfection 

crew arrived. The victim's personal belongings were sterilized or burned. 

Other residents received disinfectant baths and then were sent to a 

detention center for observation. Finally, the crew thoroughly washed 

and disinfected the premises, closed and placarded the house, then 

returned daily for twelve days to inspect it. Occasionally , if cleaning 

proved too cumbersome, the crew simply demolished the house. 2

' 

These measures failed to eradicate the disease. In 1900 Manila reported 

271 plague causes and 200 more than that the next year. Early in 1902, 

Colonel Maus, now detailed to serve as president of the Board of Health 

in the new civilian Philippine Commission, escalated the attack. He 

continued the district office operation but expanded hospital service and 

instituted an inoculation program. Since the original plague hospital at 

San Lazaro had only tents, the board moved it to an old Spanish hospital 

where an Army surgeon directed its operation. The detention center 

remained at a site near San Lazaro, but now people admitted to it were 

inoculated against plague as were others considered likely to have had 

contact with the disease. Maus secured most of the vaccine used in the 

13RSG, 1900, pp. 122-25; Greenleaf, " Statement on Sanitation. I ' p. 159; Maus, " Old Anny 

Days." passim: Van Hise, "American Contributions." pp. 135 - 36; Gates. Schoolbooks. p. 217; 

ViclOr O. Heiser. "A Note on Smallpox and Vaccination in the Philippine Islands." United States 

PI/blic Health Reports 26 (1911): 495 . 

14RSG . 190 I, pp. 139- 40. 214 - 15: Greenleaf, "Statement on Sanitation," p. 161 : MacArthur 
EMERGING MISSIONS 37 

program from one of the world's leading authorities on plague, Professor 

Shibasaburo Kitasato of Tokyo, and produced the rest in a local government 

laboratory. In all , the board inoculated more than 100,000 people-though 

the process probably provided at best temporary immunity . 

Maus's major innovation, however, was to declare total war on the 

city's rat population. The role of the rat flea as a carrier of plague was not 

proved until 1905 by the Indian Plague Commission, but some sc ientists 

already suspected that rodents were involved in the transmission of the 

disease. Realizing the failure of the methods attempted so far, Maus 

decided to act upon this theory . The Board of Health organized a civilian 

" rat-catching corps" with forty uniformed members divided into squads. 

Each squad distributed poison every night and at the same time collected 

dead rats, caught living ones when it could, and performed spot disinfection. 

Not content to depend totally on its professional rat catchers, the board 

also paid bounties to citizens bringing the animals to stations conveniently 

located throughout the city. 

At the stations, sanitary workers tagged each rat with the street 

number where it had been found , dipped it in a strong antiseptic solution , 

and sent it to the biological laboratory . There a staff examined the animal 

for plague and cremated it. Of the 75 ,000 rats examined by the laboratory, 4 

percent were diseased. Sanitary inspectors quarantined buildings where 

plague carriers had been found and followed the disinfection procedures 

applied to houses of human plague victims. Initially, the board simply 

burned all thatched houses but later discontinued that practice in the face 

of strong public opposition. It continued, however, to force homeowners 

to whitewash walls, lay cement ground floors, or make other improvements 

to their residences. 

Many people remained hostile to the program, especially since opponents 

of American rule made use of a few mistakes by poorly trained workers 

for propaganda purposes. Even some SpaniSh and Filipino doctors refused 

to participate in the plague work, although many others rendered most 

valuable service. Community cooperation improved, however, when 

Maus returned to the United States in July 1902 and Dr. Frank Bourns, at 

that time a civilian, succeeded him. Increased support resulted both from 

Bourn's skill at public re lations and the success of earlier efforts. In 1902 

Manila reported only three cases of plague. Unfortunately, attempts to 

quarantine the city had failed , and the disease spread to the provinces, 

obliging the government to institute similar programs there. The sporadic 

cases in the hinterland, though, presented less danger than would outbreaks 

Report, 1900,2:9- 12; 1901,2: 17. 
38 THE D EMANDS OF HUMANITY 

in the capital, where American efforts had a'lI but eliminated plague 25 

A two-year cholera epidemic that followed the plague was even more 

frightful and deadly. Between 1902 and 1904, 4,386 people died in 

Manila alone, while another 105,075 succumbed in the provinces. "The 

burial forces were all too slow to keep pace with the swath cut by the 

grim reaper," reported one American, "and the bodies were laid in rows 

in the trenches, the earth covering just reaching the corpses of the latest 

victims being constantly brought up in carts only to be covered in turn by a 

few shovels of earth." The rapidity with which death fo llowed the first 

symptoms of the illness intensified the anxiety of the living. The same 

American who watched the burials commented how fear increased when 

" a friend who might have been perfectly well at noon, was stricken ill by 

mid-afternoon, and died during the night. ' ,26 

If cholera terrified the Americans, it left the Filipinos singularly 

unconcerned- which of course made combating the epidemic considerably 

more difficult. Political distrust, differing cultural values, and ignorance 

of sanitary principles caused many nationals to oppose American efforts. 

Since the epidemic occurred shortly after the end of the war with the 

insurgents, tensions and antagonisms remained which hostile Filipinos 

exploited to portray American sanitary efforts as attempts at genocide. 

Even people unswayed by such charges obstructed measures that conflicted 

with local practices. Some tried to hide the sick in the belief that everyone 

should remain at home to die; others surreptitiously buried the dead 

because the burning of corpses violated religious beliefs. 27 

But most of those who ignored orders designed to check the spread of 

cholera probably did so simply through ignorance of modern sanitation. 

People took few if any precautions to insure the purity of the food or water 

that could transmit cholera. Residents of Manila bought vegetables that 

had been " refrigerated" on the way to market by being hung from the 

stern of boats in a polluted river. When someone reported seeing a patron 

saint rising from a well , people flocked to draw their water there, 

convinced it could not possibly be infected. It was. In another place, 

water " miraculously" broke through the ground; many interpreted the 

event as a sure sign of purity and avidly drank from a broken sewer line . 28 

25Third Amlllal Report o/ the Philippille Commission. 1902, part I. pp. 265- 73. 336- 37. Maus. 

" Old Army Days"; clipping from San Francisco Chrollicle: both in Halstead-Maus Papers. MHI. 

26Statislics from Worcester. Philippilles. p. 337. Quotes from W. Cameron Forbes. The PhifiPIJil1€ 

Islal/ds (BaSion: Houghton Mifnin Co. , 1928), I: 336. Sec also Richard Johnson. "My Life in the 

United Slates Army, " p. 63, manuscri pt in the Richard Johnson Papers. MHI. 

27Worceslcr, Philippilles, pp. 335- 36; RGS , 1903, p. 82; Van Hise, " American Contributions." 

p. 105; James A. Le Roy, " Phili ppine Health Problems," OUflook'll ( 1902): 780. 

28John M. Banister, " Medical and Surgical Observations during a Three-Year Tour of Duty in the 
EMERG ING MISS IONS 39 

Without public support or popular awareness that cholera was a 

waterborne disease, with Filipino officials generally " apathetic" and 

" native doctors ... proverbially as scarce as hen's teeth," offi cials of the 

Philippine Commission , which now controlled the country, had few 

resources to battle the epidemic. They turned to the Army Medical 

Department for assistance . Unfortunately, the Army itself had a very 

limited number of medical men in the Philippines, so initially the govemment 

concentrated its scarce manpower in Manila 2 9 

Cholera first broke out in the capital in late March 1902, and civilian 

health authorities at once asked the commander of American troops in the 

Philippines to patrol the Marikina River, the source of Manila's water 

supply. The commander dispatched patrols to prevent bathing, washing 

of animals, and dumping of sewage. At the same time, authorities closed 

Manila 's wells and distributed distilled water throughout the city. 

Health officials at first thought they could restrict the outbreak to the 

Farola district, one of the capital's worst slums, but quarantine of the 

section failed miserably . Since the overcrowded and filthy neighborhood 

defied sanitary improvement, the head of the Philippine Commission 

ordered it burned. Colonel Maus hesitated to destroy a whole neighborhood 

but, after being commanded to do so three times, complied. Just before 

setting fire to the area, the Army removed to a detention camp all 

residents who had not already fled . Maus's compassion had been wise 

since surely the neighborhood's water supply was the source of the 

disease. Burning Farola accomplished little, while it prompted many 

inhabitants to flee to other sections of Manila where additional cholera 

cases soon appeared . 30 

Patrols along the ri ver, distribution of water, and other precautions 

continued. Faced with an expanding epidemic, authorities detailed 31 

Army physicians with a force of 1,500 workers to conduct daily house-tohouse inspections. They also disinfected and closed for five days the 

residence of every known cholera victim. People exposed to the disease 

were sent to a detention camp near San Lazaro capable of handling 2,500 

inmates. When it quickly became overcrowded, authorities set up a tent 

camp at Santa Mesa . To care for the increasing number of victims, 

officials operated two cholera hospitals, both under the command of one 

Army medical officer. Unfortunately, the Filipinos often dreaded the 

detention centers and hospitals even more than the plague and tried to 

Philippines, " JOllrnal of the Association of Military Sllrgeoll ~ 18 (1906): 151- 53, 

2<JFirst quote from RSG. 1903. p, 79; second from Johnson, "Life in the Army, " p. 63. 

3O-rltird Allllllal Report of the Philippille Commi.uioll , 1902. part I . pp, 267 - 69; Van Hise, 

" American Contributions," pp. 10 1- 3. 
40 THE DEMANDS OF HUMANITY 

escape being sent to them. 31 

In late summer, after conspicuous courting by the Americans, local 

cooperation improved. Bourns assumed direction of the program and 

established better relations with civilians. More important, authorities 

repaired physical facilities in the detention centers and served better food 

prepared according to local customs. The directors even began to allow 

inmates under observation to leave the facility during the day for work. 

Finally, the program received a valuable endorsement when members of a 

few prominent families entered cholera hospitals and recovered. With 

greater local support and the continuation of the Anny's sanitation efforts, 

the scourge passed in Manila by February 1903.32 

The epidemic continued in the provinces, however. Manila authorities 

had tried to seal off the city, but residents resented restrictions on their 

travel and took little-known paths to other parts of the islands. Cholera 

quickly appeared in several provinces and, by the end of May 1902, in all 

the islands. Since the Filipinos did little to halt its spread, American 

health officials depended on the aid of Army surgeons serving with small 

garrisons stationed throughout the country. Headquarters, Division of the 

Philippines, appointed the garrison surgeons to the boards of health in 

their towns and made them responsible for public sanitation. They were to 

check the purity of both foodstuffs and water supply, to ensure the 

removal of garbage and the proper burial of the dead, and to keep 

neighboring streams free of fecal matter. If their precautionary measures 

failed and cholera appeared in their town, the order directed surgeons to 

establish a detention camp and send to it all persons who had contact with 

the disease. They were also to ensure that townspeople boiled all drinking 

water and that vegetables that could be eaten raw were not sold.

33 

In most areas Army medical officers strove to comply with this rather 

demanding order. Many not only directed efforts in their own cities but 

also visited and established anticholera programs in nearby towns. As the 

epidemic waned in Manila, Army doctors were freed for assignment to 

the larger provincial towns, where they supervised sanitation or directed 

cholera hospitals. Reforms took effect slowly, and for a time the disease 

continued to spread . Eventually, though, Army and civilian efforts contained the epidemic, and on 27 April 1904 the Board of Health declared 

the Philippines free from cholera. Though the crisis had passed, as late as 

1906 the civilian government still requested the aid of Army surgeons in 

l 'Fiflh Anllllal Report of fhe Philippine Commission. 1904, part 2, p. J 16: RSG, 1902, pp. 

80- 81. 

32Worcester, p'hilippilles, p. 336; Le Roy. "Health Problems," p. 7~ . 

3JRSG, 1902, pp. 81- 83; 1903, pp. 78- 79. An original copy of the order is in the W ilkinson 

File , Spanish-American War Archive. MHI. 
EMERGING MISSIONS 41 

containing outbreaks of cholera in a few localities. 34 

In Cuba, too, the fight against epidemic disease--in this case, ye\1ow 

fever-continued for several years, as total victory proved elusive. The 

Army's extensive sanitary efforts in Havana had left the city cleaner than 

ever before, but ye\1ow fever still appeared there during the winter of 

1900. In the spring, more cases developed, and that summer, ye\1ow 

fever spread to other parts of the island. The recurrence of the disease 

despite improved sanitation, lamented Gen. Leonard Wood, who had 

become military governor of a\1 of Cuba, "compe\1ed those who looked 

beneath the surface to realize that the spread of ye\1ow fever could not be 

contro\1ed simply by cleaning and disinfecting methods." In Washington, 

Surgeon General George M. Sternberg shared Wood's conclusion and 

concern. On 24 May 1900, the Surgeon General established the Ye\1ow 

Fever Commission in Cuba to study the etiology of the disease. Maj . 

Walter Reed headed the commission, which also included Army contract 

surgeons James Carro\1, Jesse W. Lazear, and Aristides Agramonte. 35 

We\1 before the Ye\1ow Fever Commission began its investigation, 

other medical researchers had begun to look " beneath the surface." As 

early as 1881 Dr. Carlos Finlay had hypothesized that the mosquiio 

carried ye\1ow fever. Between 1894 and 1898, Sir Ronald Ross and Sir 

Patrick Manson had proved that anopheline mosquitoes transmitted malarial 

fevers. And in 1899, Henry Rose Carter showed that approximately 

fourteen days passed between the introduction of ye\1ow fever into an area 

and the time that area became infective. Carter's findings together with 

Finlay's theory and the research on malaria suggested the mosquito as a 

possible intermediate host. 

Impressed by this evidence, Reed quickly decided to focus the commission's research on the mosquito. Early tests, one of which accidently resulted 

in Lazear's death, revealed that the bite of an infected mosquito caused 

ye\1ow fever. In October 1900, Reed disclosed the preliminary findings in an 

address to the American Public Health Association. At about the same time, 

he asked Wood for $ 10,000 and authority to conduct a series of experiments 

to prove that the mosquito was the vector. Wood readily agreed. The commission then established an isolated camp named for Lazear and staffed by two 

medical officers and eleven nonimmunes from the Hospital Corps. 

34RSG, 1903. pp. 80- 85; Fifth Anllllal Report o/the Philippine Commission, 1904, pan 2, pp. 

118- 31; Van Hise. "American Contributions," p. 106; J. R. Hatheway, . 'Teachers and Cholera in 

the Philippines," Natioll 77 (1903): 278- 80. 297- 99; Worcester, Philippines. p. 337; Llr, George 

W. Jean 10 Adjutant, 10 Jul 06, George W. Jean Papers, MHl. 

)sQuole rrom Wood. "Military Government ." p. 169. See also Hagedorn . Wood, p. 242: 

Gibson. Soldier ill Wllile. p. 221 . 
42 THE DEMANDS OF HUMANITY 

The doctors first placed two courageous Hospital Corps volunteers in 

a poorly ventilated cabin filled with clothing and bedding from yellow 

fever wards. Sometimes wearing shirts taken from victims, the volunteers 

spent twenty nights in the rooms without contracting the disease, thereby 

destroying theories that yellow fever was contagious. Then Reed and his 

colleagues built another hut enclosed and divided in halfby wire screens. 

On one side, the commission ensured sanitary conditions but introduced 

several infected mosquitoes. There a volunteer who had been isolated to 

prevent previous exposure spent a few hours on two successive days. 

Bitten several times by the mosquitoes, he soon developed yellow fever. 

Meanwhile two other nonimmunes slept on the other side of the hut, 

protected from the insects by the screen, for eighteen days without 

becoming sick. Such controls demonstrated conclusively that the mosquito 

spread yellow fever. The commission continued its study of the etiology 

of the disease , but Reed reported its proof to the world in February 

1901 36 

Even before the experiments removed all doubt, the Army in Cuba 

had acted upon Reed's preliminary findings. On 15 October 1900, the 

chief surgeon of the Department of Western Cuba published a circular 

warning that mosquitoes might carry yellow fever and directed the use of 

kerosene to control them. One Army wife in Cuba wrote that "everybody 

is crazy about the mosquito theory, the garrison hardly talks of anything 

else, and they all take such an interest in killing the mosquitos with 

kerosene there is scarcely one on the post. " In December, Wood's 

headquarters also issued an order directing the destruction of mosquito 

larvae. 37 

When the commission proved that yellow fever resulted from the bite 

of a Stegomyia mosquito (later renamed Aedes aegypti) that had previously 

fed on someone with the disease, the Army escalated its efforts. Reports 

36-Jnis brief account is based on Wood, " Military Government ," pp. 168-73; speech delivered 

by Jefferson R. Kean allhe dedication of the Walter Reed Memorial in Belroi , Va., in the Kean 

Papers. University of Virginia (UVA); Russell H. Fitzgibbon. CI/baand 'he United States, /900-/935 

(Menasha. Wis.: George Bania Pub!. Co., 1935), pp. 40- 42: Aristidcs Agramonle. "The Inside 

History of a Great Medical Discovery," Sciellfijic MOl/thly I ( 1915): 209-37; francis A Winter . 

. 'The Romantic Side of the Conquest of Ye llow Fever." Military SlIrgeon 6 1 (1927): 438- 52. Reed 

gave a report on hisexperimenls in RSG, 1901 . pp. 176-202. For more inrormation. see Howard A. 

Kelly, \Va/ler Reed alld Yellow Fever (New York: McClure, Phillips. &Co., 1906); Albert E. Truby, 

Memoir of \Va/ter Reed: The Yelfow Fever £pisQ(le (New York: Paul B. Hoeber. 1943): and the 

Walter Reed/Yellow Fever Archive compiled by Philip S. Hench. now al UVA. 

)1The use or kerosene 10 control the breeding or mosquitoes was well known to AmlY sanitarians 

through the work orL. O. Howard. See Llr. L. O. Howard to Jerrcrson R. Kcan, I May 24. and copy 

or Ltr to New York Times by Kean, 27 Apr 24. Both in the Kean Papers. UVA. Quote rrom Ltr. 

Loui sa Kean to Mumsie, 9 November 1900. Walter Reed/Yellow Fever Archive, UVA. General 

Order No.6. 2 1 December 1900. Headquarters Department or Cuba, copy in Kean Papers. UVA. 
EMERGING MISSIONS 43 

of yellow fever were investigated everywhere, but since most Cubans 

were immune, areas with few foreigners were unlikely sites for epidemics. 

The real danger lay in Havana, where a sizable non immune population 

almost disappeared in the mobility and anonymity of its urban environment. 

If the Army hoped to eradicate yellow fever in Cuba, it first had to rid the 

capital of the disease. 

In February 190 I the campaign in Havana began under the direction 

of Maj. William C. Gorgas of the Army Medical Corps. His eradication 

program exploited the peculiar habits of Stegomyia, which prefer to live 

near its human food supply and lay eggs only on the walls of water-filled 

containers. If all such vessels could be sealed or destroyed, Stegomyia 

would be eliminated and with it yellow fever. While Gorgas concentrated 

on eliminating breeding places, he also devised a strategy to kill all 

mosquitoes that had an opportunity to bite a yellow fever sufferer and a 

system to observe visitors to the city to see if they became sick. 

To accomplish the first task, the mayor of Havana issued an ordinance 

that required all residents to make water containers mosquito-proof, and 

Gorgas designated one group of his mostly Cuban staff to ensure that they 

did . Gorgas divided the city into districts and assigned an inspector and 

assistant to each. Visiting every house monthly, they taught the principles 

of mosquito eradication and assisted the householders in complying with 

the ordinance. Rain barrels were covered with planks, leaving only a wire 

screen for the water to come through, and other containers were either 

completely covered or doused with kerosene. The inspectors fined 

householders who refused to take the necessary precautions, and, if on 

their next visit the owners still had not complied , emptied and destroyed 

all vessels in which mosquitoes could lay eggs. After each visit the 

inspector submitted a detailed report from which Gorgas's office staff 

compiled a card file on all premises in Havana, listing the location of 

water barrels, jugs, and other containers. 

Through frequent inspections and detailed records, the Americans 

drastically reduced available breeding places. During the first inspection 

of the city , every house had at least a few larvae, and officials found a 

total of26,OOO infractions of the ordinance. The last inspection before the 

Americans left Havana uncovered only 258 violations. As an added 

precaution, Gorgas had another group drain ditches and canals or cover 

them with oil if draining proved impractical. Such efforts reduced the 

mosquito population and helped curtail malaria but, since such places 

provided no surfaces for Stegomyia to lay eggs, did little to eliminate 

yellow fever. 
EMERGING MISSIONS 45 

In the Platt Amendment, a resolution that set conditions for the 

transfer of power to the Cubans, Congress included a clause calling for 

the new Cuban government to continue the Army's sanitation program. 

But the clause accomplished nothing . Soon after the Americans left in 

May 1902, sanitary conditions drastically worsened, for the Cubans cared 

little about sanitation and rarely caught yellow fever. Moreover, their 

government lacked cash to finance programs, and the representatives 

from the eastern provinces and Pinar del Rio opposed spending what little 

there was for yellow fever control in Havana. The United States repeatedly 

remonstrated with the Cuban government for its negligence , but to no 

avail. 40 

In 1906 political and commercial considerations prompted the United 

States to intervene in Cuba once more . President Theodore Roosevelt sent 

an Army of Cuban Pacification but established a civil government headed 

by Charles E. Magoon to govern the island. Although Magoon's 

administration emphasized reform of Cuban laws and regeneration of its 

economy much more than health reform, it did include a Department of 

Sanitation as one of its five major administrative branches. Maj. Jefferson 

Randolph Kean, an Army Medical Corps officer, directed its operations 41 

Kean was chosen because of his experience in Cuba during the 

previous intervention; he functioned more as a public health officer than 

as a soldier. In the daily administration of his department he worked both 

with Magoon and with the Cubans themselves. In time he reorganized the 

Sanitation Department and, serving only as an adviser, set policy which 

the Cuban civilians implemented. Kean did, however, have four Army 

surgeons assigned to the department and could request temporary assistance 

from medical officers serving with the occupying troops in thirty towns. 

Especially in the yellow fever campaign, he often relied on these Army 

doctors in the more troublesome provinces or in areas with high visibility. 42 

Yellow fever was the primary health concern of American officials 

creation of the board, see Jose A. Lopez del Valle, The Developmem 0/ Sanitation ami Charities ill 

Cuba during the Last Sixteen Years (Havana: La Modema Poesia, 19 14). pp. 11 - 14. On Wood's 

influence on continuing the program, see Llr, Leonard Wood to Elihu Root, 19 Feb 01 , Elihu Root 

Papers, Library of Congress; and James Hitchman. "Leonard Wood and the Cuban Question, 

1898 - 1902" (Ph.D. diss .. University of California. Berkeley, 1965), pp. 280- 81 , 3 10. 

4OLopez, D evefopmellf. p. 13; Fitzgibbon, Cuba alld U .S .. pp. 103 - 4; David A. Lockmiller. 

Magoon ill C'IOO: A Hisrory of the Second Iflfervelltioll, /906 - /909 (Chapel Hill: University of 

Nonh Carolina Press, 1938), pp. 22- 24; Dana G. Munro, Intervelllioll al/d Dollar Diplomacy ill the 

Caribbeall. 1900 - 192 1 (Princeton: Princeton University Press, 1964). p. 36. Munro maintains that 

much of this agitation actually concerned contracts with American finns for public works projects. 

not genuine concern for Cuban sanitation. 

"'Millett, Polilics of Imervemioll, pp. 148- 53, 191 -208 . 

.. 2Ltr, Kean to Provisional Governor, I Dec 08; Decree No. 70 prepared for Magoon, I Nov 06: 

Ltr. Kean to Dr . Agostini, 14 Jul 08; Ltr. Kean to Ireland , 16 Jan 08 . All in Kean Papers. UVA. On 

reorganization. see Millett, Politics of IIIIerventioll , pp. 208- 12. 
44 THE DEMANDS OF HUMANITY 

More important was the work of a third group which Gorgas divided 

into crews for dispatch to the scene of any reported case of yellow fever. 

Within an hour of Gorgas's notification, a crew placed the victim under a 

specially designed isolation screen and allowed only a doctor and four or 

five immunes to enter. Then the crew killed the mosquitoes that had 

already had an opportunity to bite the victim. Its members sealed one 

room of the victim's house by papering over the cracks, burned pyrethrum 

powder in it, and after the fumigation swept up and burned all the insects 

that had fallen to the floor. They repeated the process in each room of the 

house, with the patient's room treated last. 

In addition to mosquito control, Gorgas sought to monitor the flow of 

nonimmunes into Havana. On the roads leading to the city, the government 

posted officials to whom all nonimmunes reported their names and 

destinations. The officials in turn notified the city's Sanitary Department, 

which on the third and sixth days of the visitor's stay in Havana dispatched 

an inspector to the given address to ascertain that the nonimmune had not 

fallen ill . In the summer of 190 I the department tried to improve its 

information on the arrival of possible disease carriers or victims by 

establishing contact with individuals in neighboring towns who reported 

anyone visiting Havana. 38 

Killing mosquitoes, isolating patients, and monitoring the visits of 

nonimmunes brought quick results. During February 1901, the first 

month of Gorgas's program, only five people died from yellow fever. 

From March through September, only six more deaths occurred, and in 

the nine months after that no one succumbed. Cuba, declared Wood, had 

been freed from yellow fever. To help insure that it stayed free, in 1902 

the military government issued a civil order creating a Superior Board of 

Health with a chief sanitary officer who served as its president. The board 

consisted of eleven members, four active and seven honorary, representing 

the different parts of the island . The order charged the board with the 

responsibility of monitoring and studying epidemics and developing and 

lobbying for necessary sanitary laws. But Wood still feared that once the 

Americans departed, health conditions would degenerate and again endanger 

American ports with yellow fever. He urged the Secretary of War to 

require Cuba to continue the Army's sanitation efforts. 39 

38William C. Gorgas, "A Short Account of the Results of Mosquito Work in Havana, Cuba," 

JOltrM/ of the Association of Military Surgeolls 12 ( 1903): 138-39; William C. Gorgas, "The 

Results of Yellow Fever Sanitation in Havana , Cuba, for the Yeal 1901 Up to September lSI. 

Carried on upon the Basis ThaI the Stegomyia Mosquito Is the Sole Means of Its Transmission," 

Papers alld Reports of,IIe American Public Health Association 27 (1901): 130-33; Gorgas and 

Hendrick, Gorgas. pp. 110-34. 

39Fitzgibbon , Cuba and U.S .. pp. 39-43; Wood, " Military Government ," p. 171. On the 
46 THE DEMANDS OF HUMANITY 

during the second intervention, as it had been in the first. Kean designed 

his eradication program along the lines formulated by Gorgas, employing 

house-to-house inspections, mosquito-killing crews, and disinfection 

procedures. But he added a few variations of his own . Kean recruited 

Cuban physicians to report all suspicious cases and tightened control over 

nonimmunes by requiring travelers both to carry passes and to report to 

local health officials upon arrival in a new town. More important, because 

of the tenacity of the fever in rural areas, Kean extended the techniques 

used in Havana to more cities 4 3 

Kean's regime also introduced one significant procedural innovation . 

Previously, mosquitoes had often escaped while workers taped the rooms 

in preparation forfumigation. By a change initiated in 1907, disinfecting 

crews covered the house itself with canvas and fumigated all of it at once, 

killing more insects more rapidly. Early in 1908, Capt. Henry D. Thomason, a 

medical officer serving with Kean , further improved the process when he 

covered an entire city block for fumigation all at once . Kean considered 

Thomason's procedure the most efficient yet developed, and it became 

standard procedure despite a $ 14,000 expenditure for canvas. 44 

Even with the help of other Army surgeons and the new procedures, 

Kean still had "the Devil 's own time with yellow fever." When scattered 

outbreaks continued, Kean attributed them to increased Spanish immigration, 

greater movement within the island because of an improved road system 

built by the American government, shortage of people to discover and 

report cases, and lack of men trained in disinfection. The island experienced 

an epidemic in 1907 and again in 1908 . Both were contained, but final 

victory never came. In January 1909, just before the Americans withdrew 

from Cuba , Kean wrote , " My soul is heavy within me because of those 

two cases of yellow fever from San Luis. ,,45 

The deterioration of health conditions in Cuba between the two 

interventions as well as Kean's failure to completely eradicate yellow 

fever indicated that the Army was better able to provide immediate relief 

than to institute long-term reform. Medical work during the occupation of 

Vera Cruz, Mexico, from 23 April to 23 November 1914 conformed to 

the pattern. There Army doctors encountered sanitary conditions and 

disease rates similar to those in Cuba orthe Philippines. Though the Army 

43Memo for Dr. Frederick C. Meyer. Mar 07. in Kean Papers. UVA; RSG . 1909, pp. 135- 36; 

Fitzgibbon, C//ba and U.S .. p. 128; Llr. Keao 10 Provisional Governor. 9 Apr 07, Kean Papers, 

UVA. 

44Rpl, Keao to Magoon, 5 Oct 07; Ltr. Kean to Ireland, 10 Mar 08; Memo for the Provisional 

Governor. 18 May 08. All in Kean Papers. UVA. 

4!1Firsl quote from Llr, Kean to Ireland , 16 Jan 08. Second quote from Llr, Keao to Thomason. 2 

Jan 09. Paper entitled only "Yellow Fever in Cuba," All in Keno Papers, UVA. Repol'l oflhe 
EMERGING MISSIONS 47 

undertook a smallpox vaccination program, Army medical officers never 

faced an epidemic and were able to concentrate their efforts on cleaning 

the city, establishing sanitary practices, and treating victims of a few 

prevalent local diseases. They had stellar success, but shortly after their 

withdrawal, conditions returned to what they had been before the Americans 

came. 46 

Army medical officers proved more effective in relieving crises than 

in reforming local practices for many reasons, but two were crucial. First, 

the two aims often conflicted, and the doctors' responsibility to protect 

the health of the troops left them no choice but to concentrate on the 

former. To prepare local citizens to assume responsibility for maintaining 

health standards required a slow, laborious process of conversion and 

education. But in an epidemic, medical officers did not have time and 

resorted to fiat or force which residents usually resented and rarely 

learned from. Second, the Army brought a scientific, organizational 

society to countries where cultural development remained in a much 

earlier state. The ArmY- <)r anyone else, for that matter- simply could 

not impose modern methods on premodern societies. Unfortunately, 

Army medical men were not sensitive to the problem and tended to decry 

native barbarism rather than to try to understand and respect local culture---an 

attitude that limited their effectiveness and that, unfortunately, recurred 

in later missions. 

Nevertheless, in Puerto Rico, the Philippines, and especially Cuba, 

their overall accomplishment was brilliant. The Medical Department 

demonstrated to the world the capability of scientific medicine and 

modern organization to control epidemic disease. Moreover, medical 

officers displayed an ability to render casualty care and furnish effective 

preventive measures during a health emergency. Their achievements 

thereby suggested the Army Medical Department's value in other types of 

disasters as well. More than any other single factor, the Army doctors' 

success in the tropics transformed the role of Medical Department personnel 

in relief. 

Provisional Administratioll , 1906- 1907. pp. 457- 59; MilJett, PoliticJ ofll1lervellfioll. pp. 209- 10. 

46Robcrt E. Quirk, All Affair of HOllor: Woodrow Wilsoll alltl tile Occupatioll of Vera CrllZ 

(Louisville: University or Kentucky Press, 1962); Henry P. Binningham. "Sanitary Work or the 

Army at Vera Cruz., " Military Surgeoll 36 ( 1915): 205 - 21; Charles Jenkinson, "Vera Cruz: What 

American Occupation Has Meant to a Mex ican Community," Survey 33 (7 Nov 14): 133- 41. 
CHAPTER 4 

Establishing the Mission: Volcanoes, 

Earthquakes, Tornadoes, and Floods, 

1898-1917 

The Army's involvement in Puerto Rico, the Philippines, and Cuba 

had an immediate impact on the Medical Department's role, not only in 

combating epidemics, but in other types of disaster assistance as well. 

Such work was foreshadowed early. On 8 August 1899, during the 

military government in Puerto Rico, a severe hurricane struck the island, 

claiming 3,000 lives and destroying countless buildings, roads, and 

bridges and much of the island's sugar crop. According to many estimates, 

100,000 people faced starvation. 

To meet their needs, the American military governor instituted an 

assistance program closely resembling nineteenth century flood relief 

operations in the United States. He appointed a relief committee chaired 

by his chief surgeon, Maj. John Van R. Hoff, and composed of another 

Army medical officer, four other Americans from various agencies, and 

one Puerto Rican. It divided the island into twelve districts (later increased 

to seventeen) and dispatched men to inspect damage in each, report on 

residents' needs, and supervise distribution of supplies. With local authorities 

deciding who was to receive assistance, the Army fed an average of more 

than 180,000 people a day for the first four months after the storm. In 

most areas, distribution ended by IS July 1900 but in seven of the districts 

continued until December of that year. Private sources in the United 

States paid for much of the food, but the War Department supplemented 

private charity with almost'$400,000 in public funds. 

For the most part, the principle of local control governed 

medical relief as well. Hoff preferred to send supplies to Puerto 

Rican physicians and let them care for the injured. In all, he issued 

120,405 pounds of medical supplies to local doctors and boards of 

health . However, in two major cities on the island, San Juan and 

Ponce, the Army provided direct medical assistance. In San Juan 

the storm badly damaged the Santa Rosa Hospital, an institution for 

the indigent. Apparently on his own initiative, Capt. George M. 
ESTABLISHING THE MISSION 49 

Wells, the commander of the Army's hospital in the city, opened 

his facility to patients from Santa Rosa, who remained there until 5 

September. 

In Ponce, where the brunt of the storm struck, winds and floods 

left the city in shambles and its only hospital virtually useless. 

When at the end of the month the health and sanitary situation there 

had not improved, Hoff instructed 1st Lt. Bailey K. Ashford, an 

Army surgeon stationed in the town, to establish a field hospital at a 

nearby abandoned convalescent camp. Ashford dispatched seven 

Hospital Corpsmen, who began construction of a well-equipped , 

sanitary tent hospital capable of accommodating 125 patients. Even 

before they completed it, the sick and injured besieged the site; 

Army corpsmen and a few Puerto Rican attendants treated the first 

arrivals. As word of the availability of health care quickly spread 

through the countryside, the flow of patients increased. As a result, 

the hospital, initially conceived as an emergency facility, remained 

open for six months. During that time , its staff of Army medical 

personnel and Puerto Ricans treated more than 400 patients. I 

Unlike operations in Puerto Rico, the Army's next foreign disaster 

assistance mission did not occur in the context of military government. In 

May 1902 the West Indian islands of Martinique and St. Vincent experienced 

a series of devastating volcanic eruptions. On St. Vincent nearly 1,350 

people died, and with crops ruined, severe shortages offood developed. 

As terrible as the destruction was, however, it did not approach that on 

Martinique, where the eruption of Mount Pelee nearly obliterated SaintPierre, a town near the crater. All but one of its inhabitants died, and lava 

flows and ashes damaged other areas of the island. 2 

American response was prompt. On 12 May, the United States consul 

at SI. Vincent wired his superiors: "Sixteen hundred deaths at St. Vincent; 

four thousand destitute. Immediate wants supplied. Aid needed for 6 

months. This authentic. " As soon as President Theodore Roosevelt heard 

of the twin catastrophes, he asked Congress to appropriate $500,000 for 

emergency supplies and ordered the War Department to prepare to deliver 

them.' 

In Congress, Roosevelt's request attracted unanimous support in the 

'RSW, 1900, vol. I, part 13, Report of the Military Govemor of POriO Rico. pp. 2 11 -17, 270; 

RSG. 1900, pp. 188- 89. 

l Henry Neil (Marshall Everett). The Complete Story of the Martiniqlle Horror arid Other Great 

Disasters (Chicago: L. G. Siahi. 1902); Charles Morris. The Volcano's Deadly Work (Philadelphia: 

W. E. Scull , 1902); Angelo Heilprin, MOl/til Pe/e.e ami the Tragedy ofMartiniqlle (Philadelphia: J. 

B. Lippincott, 1903). 

)Quole from Morris, Volcarlo' sDeadl), Work. p. 124. Neil (Everett), Stor)'ofMarlilliqllc, p. 11 8. 
50 THE DEMANDS OF HUMANITY 

Senate and only minimal opposition in the House. Though not as generous 

as the president, the lawmakers had approved a $200,000 appropriation 

by sundown of the same day. In response to objections by opponent Oscar 

W. Underwood of Alabama, Congressman John J. Jenkins of Wisconsin 

vocalized the new activism tinged by braggadocio prevalent in the United 

States at the time: " Does not the gentleman from Alabama understand," 

Jenkins almost sneered, " that this is the greatest and foremost nation in 

the world and that we propose to be foremost on all of these great 

questions, and that we have got lots of money and it is not coming out of 

the pockets of the poor people that the gentleman from Alabama represents? 

The people of the United States are ready and willing to do their duty on 

great occasions of this kind without reference to the Constitution or to the 

views of the gentleman of Alabama."4 

Plainly there was a new spirit abroad in the once cautious, Constitutionbound nation. Two Navy ships and an Army collier delivered supplies 

from American stations in the Caribbean. A third naval vessel, the Dixie, 

brought relief supplies directly from the United States. In a departure that 

revealed the increased involvement of the Medical Department, three 

Medical Corps officers, six Hospital Corpsmen, and $5,000 worth of 

Army medical supplies sailed on the Dixie. Though the Americans 

donated half of the medical supplies to relief efforts on each island, the 

medical contingent provided no direct care. On St. Vincent, British 

health officials had the situation well under control , and at Saint-Pierre, 

Martinique, the American doctors found no victims in need, " every living 

being having been killed within three minutes. ,,5 

After foreign medical relief missions in successive years, a period of 

relative inactivity followed. Congress approved several operations: the 

Navy transported disaster relief to Jamaica in 1907, Italy in 1909, and 

Costa Rica in 1910, and Army vessels ferried privately raised supplies to 

famine-stricken China in 1907 and 1911 . None of these, however, involved 

Army doctors or corpsmen. 6 

4QUOIe from COllgressional Record. 57th Cong .. 1st sess., 1902, p. 5332. See also Morris, 

Volcallo's Deadly Work, p. 146; N eil (EvereH). Story of Martilliquc. p. 118. 

5 James Martill Miller, The Manilliqlle Horror (llid Sf. Villcellf Calamity (Philadelphia: National 

Pub!. , 1902). pp. 32. 53, 56, 149.330 -3 1; Nell' York Times, 3 Jun 02; U.S. Department of State , 

Papers Relatillg 10 ,he Foreign Re/atioll.5 of the UI/ired Slates, 1902 , pp. 4 14- 16. Telg , Buchanan to 

AGwar. 15 May 02; Ltr, Sternberg to AG . 12 May 02; both in file 434288, Record Group 94, NA. 

George Kennan. The Tragedy of Pe!t1e: A Narrative of Personal Experiellce (llId ObservatiOIl ill 

Martiniqlle (New York: Outlook Co., 1902), pp. 16- 18: Ltrs in Hugh J. Gallagher Papers, MHI; 

RSW , 1902. p. 541. Quote from Ltr, James B . Clayton to Surgeon General , 25 May 02. fi le 90029, 

Record Group 11 2 , NA. 

6CongressiOlwi Record, 7 1s1 Cong., 3rd sess., 1930, pp. 757-58; Cuni, Americal/ Phi/amhropy, 

pp. 219- 20; Ernest P. Bicknell, Pioneering lVith the Red Cross (New York: Macmillan Co., 1935), 

pp. 196- 97; Francis A. Coghlan. "The U nited States Navy and the Jamaica Earthquake." Prologlle 8 

(1976),163- 73. 
ESTABLISHING THE MISSION 51 

Then in 1911 Army medical personnel stationed in the Philippines 

undertook a relief mission similar to that in Ponce, when Mount Taal, a 

volcano forty miles south of Manila, erupted on 30 January. An Army 

doctor and two Hospital Corpsmen from nearby Camp McGrath rushed to 

the scene in a borrowed automobile, followed later by other soldiers who 

brought supplies of food and clothing. While burial teams began their 

gruesome task, the Army medical contingent and a few Red Cross 

representatives ministered to the needs of injured survivors. Relief workers 

quickly evacuated a hundred or so victims to a temporary hospital staffed 

by both medical personnel from Camp McGrath and Filipino volunteers. 

A few of the serious cases were treated in the camp's hospital 7 

The next year, Col. Jefferson R. Kean, two other Army physicians, 

and three Hospital Corpsmen helped civilian officials in Puerto Rico 

design and conduct an antiplague program similar to the Army's in 

Manila. Another medical relief mission followed a large fire in May 1915 

that destroyed most of the business district and many of the homes in 

Co16n, Canal Zone. When American soldiers pitched a 325-tent encampment 

for the homeless, Army medical officers and corpsmen helped the Red 

Cross maintain sanitary standards. 8 

These early missions abroad-especially the last two--reflected a 

growing awareness of the importance and efficacy of public health, 

spurred in part by the Medical Department's success in the tropics after 

the Spanish-American War. Together with the international activism 

reflected in Jenkins's speech, that awareness accounts for the burst of 

foreign disaster assistance activity in the first years of the twentieth 

century. The limited nature of that early relief, however, was readily 

apparent. None of the operations involved a large commitment of Army 

personnel or equipment. Most occurred either in countries where United 

States troops were stationed or in the Caribbean where Americans had 

traditionally exercised authority. Nonetheless, a foreign assistance 'role 

and a rationale for an even greater one had been established. But with the 

impossibility of rapid transportation to the scene and with American 

troops stationed in so few areas, medical assistance continued to be 

infrequent. 

78ased primarily upon Johnson, "Life in the Anny," pp, 144- 47 , in Johnson Papers, MHI. See 

also 1911 Returns from Camp McGrath. Returns from United States Military Posts, 1800- 1916, 

M617, reeJ673 , NA . MiqueJ S. Maso, The Eruplion ofTaal Volcano. January 30. 19J1 (Manila: 

Bureau of Printing. 191 I); Bicknell: Pioneeriflg. p. 193. 

80n Puerto Rico, see Ltr, Henry L. Stimson to Jefferson R. Kean, 3 Mar 13; Ltr, Kean to 

Secretary of War, 16 Jul 12; both in Kean Papers. UVA. RSG, 1913, pp. 177-78; Richard H. 

Creel, Outbreak and Suppression of Plague ill Porto Rico (Washington: GPO, 19 13). Creel's 

account does not mention Kean's aid. On Col6n, see RSW, 191 5, I: 153; file 2283865, Record 

Group 94, NA; New York Times. 2 May IS . 
52 THE DEMANDS OF HUMANITY 

Changes ill the Domestic Scelle 

and the Sail Francisco Earthqllake 

A substantial increase in Medical Department relief activity occurred 

at home rather than abroad. The Army's successful efforts in Cuba and 

the Philippines trained a cadre of Army medical officers in disease control 

and publicized the benefits of scientific medicine in emergency situations. 

In 1901 three Army doctors-Walter Reed, William Gorgas, and Charles 

Greenleaf--delivered papers to the American Public Health Association 

on their work in the tropics. Health professionals in the United States not 

only learned from their reports but also were inspired by the Army's 

accomplishments. Even more important, success abroad educated the 

American public as well as the professionals. Public Health surgeon 

William C. Rucker declared that the Army's efforts had ' 'awakened in the 

mind of the general public the belief that epidemics are not a visitation 

from God, but are wholly unnecessary offerings on the altar of ignorance 

and perhaps commercial greed," and his colleague Leslie L. Lumsden 

maintained that this realization extended to other types of disasters as 

well 9 

Several factors made the nation more receptive to the Army's example 

and the government more willing to employ Army doctors in domestic 

disasters. First, urban growth with a concomitant increase in damage, 

death, and casualties during anyone disaster increased the need for a 

federal response . Though sufferers in New Madrid, Missouri, had been 

able simply to move to new homesteads, the more numerous victims of 

the less severe San Francisco earthquake had no such option. And in 

almost all twentieth century disasters, concentrations of population and 

crowded building patterns multiplied relief tasks. Often, as the mayor of 

Galveston, Texas, observed after a devastating hurricane there in 1900, 

the calamity was "so terrible no municipal authority in the country could 

be expected to handle it unaided.' 010 

In addition, profound changes had altered the nation's institutional 

9Lee, .. Address." passim. Quole from William C. Rucker, " The Relation of the Military and 

Naval Forces of the United States to Public Health," Milirary Surgeoll 23 (1908): 335. Leslie L. 

Lumsden. SanitatiOIl of Flood-Stricken Towlls aud Cities wi,h Special Reference to Conditions 

Observed ill River Towlls all(/ Cities of Kentucky (Washington: GPO, 191 3), p. 1197; Edward T. 

Devine. The Principles of Relief (New York: Arno Press and New York Times, 1971; orig. pub!. 

1904). p. 5 1. My argument here resembles that made by Howard Gillette. Jr .. in a slightly different 

context. See his "The M ilitary Occupation of Cuba. 1899- 1902: Workshop for American 

Progressivism." American Qlwrrerly 25 ( 1973): 410- 25. 

IOQuoted in Paul Lester, The Great Ga/veston Disaster(Galveston : J. Singer Book Co .• 1900), p. 

11 5. 
ESTABLISHING THE MISSION 53 

landscape during the preceding generation, as the small isolated communities 

of an earlier day were integrated into a new national order. Increasingly, 

formal nationwide organizations replaced informal local or regional 

groupings. Advances in communications and transportation created a 

greater sense of interdependence. Mass circulation newspapers--exploiting public fascination with disasters-spread stories of suffering and 

helped to generate interest in sending aid. II 

Modifications in public attitudes toward social welfare made people 

more forthcoming with assistance than in the early nineteenth century. As 

Edward T. Devine, one of the nation's leading social workers, wrote in 

1904, . 'society has become conscious of its responsibility for the relief of 

distress, and is awakening to its obligations to devise effective and 

remedial systems of relief. " As Devine's choice of the word" systems" 

implied, the new concern for the needy was expressed in what historians 

have labeled "scientific philanthropy"-efficient, ordered, carefully 

controlled assistance by specially trained professionals. 12 

In the early twentieth century, though, there was no organization 

capable of providing "scientific philanthropy" to a community stricken 

by a massive calamity. The United States had not developed national 

institutions to provide disaster assistance, especially in the fields of 

medical care and public health. The United States Marine Hospital 

Service, which in the early years of the century became the Public Health 

Service, had furnished most of the little medical assistance rendered by 

the federal government in the nineteenth century, but it did not have the 

resources to support a massive effort. State and local boards of health 

were only slowly emerging. And the American Red Cross, which would 

later become the nation's most important source of disaster relief, could 

not yet provide leadership because of its own inchoate structure. Chartered 

only in 1881 , the voluntary society underwent an internal battle for 

control and direction at the turn of the century. By 1905, the forces 

advocating a modern organization had triumphed, and in that year Congress 

designated the Red Cross the nation's primary agency for disaster assistance. 

However, it only gradually increased its activities and still lacked the 

ability to support a large mission. With none of these institutions yet in a 

position to provide frequent or massive relief, the Army Medical Department 

IIWiebe. Search for Order; Thomas L. Haskell , The Emergence of Professional Social Science: 

The Americall Social Sciellce Associatioll and 'he Nilleteen,II-Centliry Crisis of AII,horit)' (Urbana: 

University of Illinois Press, 1971); Neil Harris, " The Culture of Catastrophe in Ni neteenth-Century 

America," paper delivered at the University of North Carolina at Chapel Hill, 20 Oct 75. 

I~uote from Devine,Principleso/Reliej, pp. 4- 5. Robert H. Bremner. '''Scientific Philanthropy,' 

1873 - 1893, ,. Social Service Review 30 ( 1956): 168-73; Trattner, Poor Law 10 Welfare Stale. pp. 

(Continued) 
54 THE DEMANDS OF HUMAN ITY 

DESTRUCfION AFTER THE SAN FRANCISCO EARTHQUAKE, looking toward 

bay, 1906. 

with its cadre of doctors trained in public health operations abroad 

became a logical choice for the job. 13 

Such was the case when an earthquake struck San Francisco, California. 

Early on the morning of 18 April 1906, as most respectable San Franciscans 

slept and the less so stumbled home from another riotous night, the city 

shook with tremendous force. Residents tumbled into the street and began 

to evaluate the damage, but their ordeal had only begun. Another tremor 

followed at 0800 hours, and soon broken gas mains started fires which 

spread, combined, and created a holocaust. The raging flames burned 4. 7 

square miles of the city and in combination with the earthquake destroyed 

28, 188 buildings and left just under half of the city's 450,000 citizens 

(Continued) 

44- 115; Roy Lubovc, The Professional Altruist: The Emergellce of Social Work as a Career. 

1880- 1930 (Cambridge: Harvard University Press, 1965), 

I30n the limitations of the Marine }-(ospital Service, see Congressional Record, 55th Cong., l sI 

sess., 1897, pp. 60 1, 639. And for their existence after it became the Public Health Service , see 

Wi ll iam R. Noyes, "Influenza Epidemic, 19 18- 1919: A Misplaced Chapter in United States Social 

and Institutional History" (Ph.D. diss., Un iversity of California at Los Angeles, 1968), pp. 

195- 202. This interpretation of Red Cross development relies on Ellen L. Henle, "Against the 

Fearfu l Odds: Clara Barton and American Philanthropy" (Ph .D. diss. , Case Western Reserve 

Uni versity, 1977), pp. 75-86, 94 - 108; Dulles. Americal/ Re(1 Cross. pp.63-80. On Red Cross 

disaster activity, see Ol/gres, iollal Record. 58th Cong., 3d sess .. 1904, pp. 404- 6; Bicknell , 

Pioneerillg. pp. 12, 94- 95; Elliot, Red Cron Disaster Services. passim. Figures on Red Cross 

activities by time period can be found in Thomas H. Reynolds, " American Red Cross Disaster 

Serv ices. 1930 - 1941" (Ph.D. diss .. Columbia University, 1954), p. 248. 
ESTABLISHI NG THE MISS ION 55 

homeless. A total 498 people died and another 4 15 were seriously 

injured . '4 

Brig. Gen. Frederick Funston, earlier a hero of the Philippine War 

and now acting commander of the Division of the Pacific headquartered 

in San Francisco, awoke after the first shock. Perceiving at once the 

magnitude of the quake, he quickly dressed and hurried on foot (no street 

cars were running) to the business district of the city. Funston inquired of 

a policeman how he might get in touch with the mayor or chief of police. 

The officer informed Funston he did not know, since the city's phone 

system no longer functioned. The general told the officer to relay to his 

chief Funston's intention to mobili ze the Army. Then Funston went 

home, dispatched messengers to the commanders of the Presidio and Fort 

Mason to turn out the troops, saddled his horse, and galloped off to direct 

the Army's relief effort from the headquarters of the Pacific Division. 15 

Funston acted without any clear legal authority. The statutes provided 

that the president could use military force to enforce federa l law when 

ordinary judicial process failed or to suppress riots and disorder when a 

state legislature or governor requested it. Only the president had the 

authority even in these cases, and there was no legal provision for federa l 

military intervention in natural disasters. But, witnessing the destruction 

and sensing that city authorities could not provide the necessary control or 

relief, Funston probably gave little thought to legalities. Only later in the 

morning, well after he had mobilized the troops, did he even consult with 

Mayor E. E. Schmitz. Then the general promised complete cooperation 

with the civil authorities. Schmitz, realizing that he had only meager 

resources to meet the emergency, could only accept. Over the next few 

days that aid took various forms-military patrols in certain sections of 

the city, dynamiting of buildings in an often futile attempt to create a 

firebreak, distribution of food and clothing. But for the first time in a 

domestic disaster, it also included major medical assistance. No one 

issued a policy directive on the matter. Medical officers simply responded 

to the catastrophe. 16 

'4Figures rrom Russell Sage Foundation, Sail Fral/cisco Relief Survey (New York: Survey 

Associates. 19 13). pp. 4- 5. For the story orthe quake with emphasis on human interest stories, see 

John C. Kennedy. The Great Earthquake alld Fire: Sail Frallcisco. /906 (New York: William 

Morrow & Co. , 1963), or the less reliable (and bitterly anti-Anny) Gordon Thomas and M. Morgan 

Witts. The San Francisco Earthquake (New York: Stein and Day, 1971). 

15 Adolphus W. Greely. Ecmhql/ake ill California. April/B, 1906: Special Report of Maj. Gel/. 

Adolphus W. Greely, U.S.A . Commalldillg the Paciftc Divisioll. 01/ the ReliefOperatiolls Condllcted 

by the Military AI/ thorities o/the United States at Sail Fr(lllciscocllld Other Poillts with Accompal/yil/g 

Docllmell ~ (Washington: GPO, 1906), pp.5 - 6. 

160n the Army's tak ing charge. see Thomas and WillS. Earthquake, pp. 25-28. 49-50, 

(Contin ued) 
56 THE DEMANDS OF HUMANITY 

The morning of the quake, one of the medical officers, Capt. Henry 

H. Rutherford, awoke in a shaking bed as the furniture danced about his 

Presidio room. He noticed that the chimney had tumbled down and he 

heard other bricks falling outside his room. Rutherford's first duty was to 

see that the orderlies and patients under his charge had survived unscathed, 

but he found himself pausing during his activities to look toward the city, 

noting with wonder "how tomb-like silent" it seemed. Soon another 

tremor struck. Rutherford decided to go downtown-not, he later admitted, 

because he was " foreseeing enough to first take in the situation" but 

"because of the itch irresistible" for " romance and adventure. " 

Rutherford and a party of eleven men heavily " laden down with 

medical supplies" hiked into the rubble of downtown San Francisco. 

They intended to search for the injured and " bring them in" but found 

only a few casualties, most of whom were receiving attention. Rutherford 

did meet a doctor who had loaded his patients into wagons. " Presidio?" 

Rutherford inquired. Yes, nodded the doctor. And the captain then 

mounted and drove the lead wagon because, as he recounted later, "the 

Colonel might balk in his dismay at an unheralded trainload of men, 

women, and children patients." He " feared for [his] hide" if they 

arrived before him and told the Colonel he had sent them. But "the Old 

Man arose to the situation nobly," Rutherford added; " he didn't pat me 

on the back exactly, [but] he welcomed the patients I'd brought and told 

me to get about my business and help take care of them. ,,17 

The Old Man- Lt. Col. George H. Tomey , commanding officer at 

Letterman General Hospital-had already realized San Francisco's need 

for medical aid from the Army. Even though the quake had damaged his 

hospital's power plant, disrupted its telephone and telegraph system, and 

cut off its water supply, Torney decided to open his facility to civilians. 

At 0900 hours he sent three medical officers and a Hospital Corps 

detachment into the city with instructions to render what assistance they 

could and to inform the authorities that Letterman would admit civilian 

casualties. 18 

(Continued) 

102-3; Kennedy , Earthquake, pp.30-36; Telg., Schmitz to Taft. 22 Apr 06, file 1121191, Record 

Group 94, NA; Charles E. Banks and Opie Read, The History of the Scm Fra"cisco Disaster and 

MtI/l1II ('.~ III ilu H orror (Chicago: C. E. Thom:tS. 19(6). pp. 74 - 75. In addition to sources already 

cited. nn other tyP'!s or aid sec Johnson. "Emergency Response." 4: 11 - 25: Carroll A . Devol. 

"Thl! Army in the San Francisco Ois<t!\lcr:' Jourl/al of ,I/(' UI/ill'll Sraft's II/fellltry A. 'iOdllfi() " 4 

(1907), 59- 87. 

170UIlIC from Henry H . RUlhcrfun.l. "Experience!> of an Army M edical Orficer during the San 

FrolOdscll Earth4uakc.·· M ififllf.I' SIII"'!WOII 79 11936 ): 20K- 10. 

IXGrccly. RI'lwrr. p. J I: George H. T{lrney, " Rep{)rt to The Surgeon Gcnerul , 16 Aug 06," file 

I 15045 . RecnnJ Group 11 2. NA . TIll' cxm:t :-.C4ucncc of eve nts in neither Rutherfurd 's nur Turney's 
EST ABLlSHING THE MISSION 57 

By 0930 patients began arriving. Citizens and soldiers evacuated 

them from the city in volunteered or commandeered automobiles as well 

as in horse-drawn buggies. By 2300 hours Letterman had admitted 127 

civilians. Many were victims of the fire or quake , but others were patients 

evacuated from destroyed or damaged hospitals. Since Letterman's register 

listed many admittances for shock, contusions, lacerations, fractures, 

concussions, and bums, casualties probably outnumbered hospital evacuees at 

first. 19 

The next morning more civilians from the city sought hospitalization, 

and a stream of sick and dazed refugees poured into Letterman. Captain 

Rutherford decided a receiving station in front of the hospital might ease 

the crush, and Torney agreed. Rutherford " grabbed four men and two 

pushcarts," secured the aid of ablebodied refugees, and in less than an 

hour had "an emergency hospital of a sort" in operation. Later in the 

morning, he recruited volunteer nurses and doctors to work in the facility . 

Before it closed, the receiving station treated thousands of patients for 

minor complaints and referred hundreds of more serious cases to Letterman 

or the small Army hospitals at Fort Mason and the Presidio. In the 

receiving station, the " peak of emergencies" occurred during its first 

night of operation, when in reaction to the stress of the quake "apoplectics 

had their strokes, worn old hearts gave out, neurotics went to pieces and 

drunkards had D.T. 's." To add to the confusion, pregnant women who 

were camped in the woods around the hospital summoned doctors to 

deliver babies by moonlight. 20 

Between the receiving station and regular military hospitals- not to 

mention the woods-ample bed space existed for patients during the first 

two days. Enough doctors were available as well. In addition to Army and 

local civilian practitioners, many of the participants in a just-concluded 

medical convention remained in San Francisco to help. Dr. K. A. J. 

MacKenzie, chief surgeon of the Oregon Railroad and Navigation Company, 

and a party of twenty physicians rushed to the city's aid, as did a medical 

contingent from the Oregon National Guard. But fire had destroyed the 

Army's medical supply depot in San Francisco, and stocks at Letterman 

quickly dwindled. Supply shortages developed . Soldiers rescued small 

account is clear. 

19Banks and Read. His/ory, p. 76; Rutherford, "Experiences." p. 21 1; Endorsement to Ltr from 

E. F. Euphet, 4 May 06, in Letterman General Hospital , Register of Letters Received, entry 359, 

Record Group 112, WNRC; Leiterman General Hospital. Register of Patients, entry 372, Record 

Group 112, WNRC. The register shows only 114 admittances for the first day, but the figure comes 

from Greely's report. 

2OQuotes from Rutherford. "Experiences," p. 211 . Greely, Report. pp. 31- 32; Tomey, 

"Report," p. 6. 
58 THE DEMANDS OF HUMANITY 

stocks from drugstores about to burn or be dynamited, and the Army 

purchased medicines locally and borrowed from nearby naval facilities. 

From such sources sufficient supplies were obtained to meet the immediate 

emergency. 2 1 

In Washington, The Surgeon General acted to support the relief 

operation with additional supplies and personnel. On the second day of 

the disaster he telegraphed doctors at Vancouver Barracks, Washington, 

to send gauze and cotton and instructed the medical supply depot in St. 

Louis to ship by rail a full complement of medical supplies. He also 

ordered to the city a field hospital from Washington, D.C., and fifteen 

surgeons from various posts in the West. In addition, two captains on 

leave in San Francisco and six surgeons who arrived from Manila also 

joined the relief effort. 22 

By the end of the second day, the Army had met emergency needs, 

and additional supplies and personnel were en route to the city. But in 

many ways San Francisco's health problems had only begun. Much of the 

city lay in charred ruins, and basic city services had broken down . From 

the first day, refugees had streamed out of the more heavily damaged 

sections, and by the 20th , 200,000 hungry, tired, and dirty people living 

in tents or shelters rigged from tablecloths or blankets occupied almost 

every available open lot in the city. Conditions in the makeshift camps 

invited an epidemic, necessitating a sanitation program similar to those 

the Army had undertaken abroad. 

On 20 April, Dr. James Ward of the San Francisco Health Commission, 

apparently at Funston's suggestion , met with Colonel Torney to discuss 

health and sanitation in the camps as well as in the city as a whole. The 

two men decided to establish a committee of civilians chaired by Torney 

which would coordinate military and civilian aid. Torney consulted with 

Funston, who issued orders placing him in charge of sanitary arrangements 

for the city of San Francisco; at that time Torney relinquished command 

of Letterman to Capt. James M. Kennedy. The next day Tomey talked 

with Mayor Schmitz and Dr. Martin Rosenberg of the State Board of 

Health and secured their agreement to the plan. He then appointed his 

committee of civilian medical leaders; the group met daily until 7 May 

21Sydney Tyler. Sail Fn mciofco' s Greal D i.m.fler (Philadelphia: P. W. Zcigler Co .. 1906). pp. 

162. 177; Ernest P. Bicknell. " In the Thick of Relief Work al San Francisco. " Charities 16 ( 1906): 

295- 99: U.S. Congress. House . Relieffor S(/II Francisco. H. Doc . 714 . 59th Cong .. 1st sess., 1906, 

pp. 28- 29. 32 - 33. 

22U.S. Congress. House, Relie/ Jor S(l1I Fl'(lIIciJco, H. Doc. 714. 59th Cong .. 1st ses!> .. 1906. pp. 

6- 7. 28- 29; Tomey. "Rcpon ," p. 20; George H. Kress, " United States Anny Field Hospital in 

San Francisco in 1906, an Interesting Letter: with Some Excerpts from the May. 1906. Issue of the 

California Srale Journal of Medicine, " CaliJomia and lVestem Medicine 53 ( 1940): 215- 17. 
ESTABLISHING T HE M ISSION 59 

REFUGEE CAMP Oil grounds adjacent to and east of Letterman General Hospital, 

Sail Frallcisco, 1906. 

and every day after that until abolished on the 13th. Despite the close 

cooperation with civilian leaders, though, Torney remained ultimately 

responsible both for sanitation and for much of the health care in San 

Francisco.

23 

The biggest problem Torney faced was the horde of refugees scattered 

over the city for whom the Army now accepted direct responsibility. On 

the 20th he dispatched all available Anny surgeons, including Lettennan's 

dentist, to the camps. He left Captain Rutherford and Dr. Wallace I. 

Terry, a prominent local physician, in a command tent in front of 

Letterman to direct volunteer civilian doctors to camps still without 

physicians. The civilians, too, would answer to Torney. 24 

At the end of the day many of those he had sent out, as well as other 

civilian and military relief workers, straggled back to Presido. "A motley, 

disheveled, grimy group, " they gathered beneath a tent to rehash the day 

and anticipate the morrow. They talked amid a cacophony of noiseschatting refugees, crying babies, groaning patients. An enterprising cadet 

from the Uni versity of California arrived with ' 'quarts of shasta , hunks of 

23Greely, Report, pp. 3 1-32; Tomey, "Report," pp. 8- 12; Marie Louise Rodriquez, Tile 

Earthqllake of 1906 (San Francisco: privately published, 195 1). pp. 6- 7. 

~orn ey , " Report," p. 12; Ltr., Marshall 10 CO of Presidio, 4 Jun 06. Lellennan General 

(Conlillucd) 
60 THE DEMANDS OF HUMANITY 

cheese and pretzeis" purloined from a nearby stockpile of supplies. "Fit 

feast for the famished, it cheered things up mightily though there wasn't 

so much talk--our throats were tired, our voices had run out, " Rutherford 

recalled. After their refreshments, the workers did begin to talk, to 

compare notes, and to realize the enormity of the task that faced them. At 

the same time, an unspoken consensus emerged that " the turning of the 

tides was at hand. ,,25 

To help turn the tide Torney began to strengthen the emergency 

hospital system that would care for many sick refugees in the camps. On 

the 20th he ordered the Oregon National Guard unit to open a temporary 

hospital in an industrial school. The next day he established a 200-bed 

contagious disease hospital at Harbor View Park, an area adjacent to the 

Presidio with a large pavilion and its own water supply. Captain Rutherford 

supervised the facility, but Portland railroad surgeon MacKenzie directed 

its staff of nurses and corpsmen . Also on the 21 st, the Army established a 

temporary medical depot on the Presidio grounds. [t operated for seven 

days, after which the Army opened a larger supply center east of the 

hospital reservation.

2• 

Despite all Torney's activity, on the 2 1 st a continuing role for the 

Army was far from certain. That day Maj . Gen. Adolphus W. Greely, 

Funston's superior, who had been traveling when the quake struck, 

returned and relieved Funston as commander of the military forces in San 

Francisco. Greely proved as anxious to avoid employment of the troops as 

Funston had been determined to commit them. For one reason, Greely 

appreciated the dubious legality of the operation . Furthermore, President 

Theodore Roosevelt had initially indicated he wanted the Red Cross to 

play a prominent role. On 24 April , when community leaders, Red Cross 

officials, and military commanders gathered at Fort Mason to discuss 

future relief measures, Greely offered to relinquish control in favor of the 

Red Cross. Edward T. Devine, the Red Cross director on the scene, 

quickly declined. " The Army," he explained his reasons later, " had the 

organization , the equipment, the trained officers and men for dealing with 

the situation, and no one else had it or could create it except at enormous 

expense, and with inevitable waste ... 27 

(Continued) 

'Hospital , Letters Sent, Dental Surgeon, entry 357, Record Group 11 2. WNRC; Rodriquez, Eanhqualce, 

pp. 7, 12; Russell Sage Foundation. Survey, p. 78. 

HQuotcs from Rutherford , "Experiences," pp. 213-14 . 

11'\Villiam E. Carll , " The Oregon National Guard at the San Francisco Earthquake Disaster, " 

Journal oj t"e Anocia/ioll of Military Slirgeons 19 ( 1906): 460-63; Greely, RelJOrl, pp. 32, 

131-32; Rodriquez. Earthqllake. p. 9. 

27Greely. Report, pp. 9,13.39- 40: Kennedy. £arrhqll(lke. p. II : Russell Sage Foundation. 
ESTABLISHING THE MISSION 61 

His effort to foist the job onto another agency blocked, Greely informed 

Schmitz that he wanted to remove the troops anyway. Schmitz demurred, 

contacted the governor, and prevailed upon him to file a formal request 

for military assistance with the president, who then agreed to let the Army 

direct operations. By that time, Congress had passed relief authorization 

that at last legalized the Army's presence. Still reluctant, Greely took 

charge in the city. 28 

The mayor and Dr. Devine may have wanted to place the Army in 

charge for reasons other than its organizational capabilities: they may 

have also sought to avoid responsibility for tough decisions that might 

provoke public hostility. If Greely did not suspect as much in the beginning, 

as relief efforts progressed he came to understand that the Army to some 

extent was being used. " All civil authorities, relief committees and Dr. 

Devine ... look to me for final decisions and full responsibility which I 

am regularly assuming thus obviating embarrassments which surround 

men in civil life and subject to political and personal criticism," Greely 

wired the War Department at one point. Not only military organization 

and material resources but the Army's potential as a scapegoat may have 

led the civilians to abdicate control 29 

With the Army firmly in command, Tomey continued his direction of 

health affairs in San Francisco. He benefited from the volunteered assistance 

of Brig. Gen. Charles R. Greenleaf, retired and living in Berkeley. 

Relying on his experience in Cuba and the Philippines, the former Army 

surgeon formulated a sanitary plan that divided the city into six military 

districts, each under the charge of a commissioned medical officer. 

Greenleaf also provided guidelines on medical care and sanitation and 

required every camp surgeon to submit daily reports on health conditions 

in his camp. The district officers received these reports from camps in 

their areas and forwarded compilations to Tomey. As a further precaution, 

the district officers sent inspectors to each camp to ensure maintenance of 

sanitary standards. 30 

Primary responsibility for health and sanitation, however, still rested 

with the camps' surgeon. Activities in the Coast District Camp illustrated 

their duties under Greenleaf's plan. Dr. Rene Bine, a local physician who 

Survey, p. 208; Elling E. Morison, ed., The Leuers of Theodore Roosevelt (Cambridge: Harvard 

University Press, 1952),5: 216, 219-20. Quote from Edward T. Devine, " The Situation in San 

Francisco," Charities 16 (1906): 302. 

28Kennedy, Earthq//ake, pp. 212," 223 - 24; Congressional Record, 81 st Cong. , 2d sess., 1950, 

p. 11900. 

29Quote from Telg, Greely to Mil Sec, II May 06, file 1121191 , Record Group 94, NA. 

»romey, "Report," p. 18; Greely, Report. pp. 58-59; Rodriquez, Earthqllake, pp. 15- 17; 

Russell Sage Foundation, SlIrvey, p. 90. 
62 THE DEMANDS OF HUMANITY 

had volunteered his services to the Army, served as surgeon in the camp, 

which had a population of 600 people living in 300 tents arranged along 

twenty numbered streets. To each street Bine assigned two inspectors 

who maintained a roster of the street's residents, estimated their need for 

clothing and bedding, kept records on the supplies issued to them, and 

ensured that all got to meals on time. Bine also placed garbage cans at the 

end of each street and installed thirteen latrines in the camp. Garbage cans 

were emptied and latrines cleaned, disinfected, and pumped out at least 

twice a day.3I 

If a resident fell ill , he reported to a daily sick call Bine conducted in a 

small clinic in the camp. In it Bine and an Army nurse treated an average 

of thirty-six patients a day for minor complaints, mainly bowel problems. 

When Bine or any other camp surgeon encountered a complicated case, 

he sent the patient to a larger, better equipped facility . The same procedure 

was followed with contagious diseases. Greenleaf's plan specified the 

evacuation of the seriously or dangerously ill both to provide better 

treatment for the victim and to allow the camp doctors to concentrate on 

sanitation . 

Patients suffering from contagious diseases- measles, scarlet fever, 

diphtheria, or typhoid- were sent to the hospital at Harbor View Park. 

Other patients went to the post facilities at Fort Mason and the Presidio, 

temporary facilities at the Presidio, the hospital operated by the National 

Guard, or the field hospital sent by train from WaShington which was set 

up in Golden Gate Park on 25 April. Throughout the relief operation, 

however, Letterman General Hospital remained the center for major 

medical procedures. In the first four days it admitted 362 civilian patients; 

during the following two-week period, admittances averaged a little over 

lOa day. Not until 20 May did a day pass in which Letterman admitted 

no new civilians. In all, it cared for 593 San Franciscans with a variety of 

medical problems- bums and crushed toes to pregnancy and ulcers. Only 

24 died, and that total included 3 who were dead on arrival. 32 

Even with Letterman hiring temporary personnel , the field hospital 

from Washington functioning, and additional medical officers serving in 

the city , responsibility for sanitation in San Francisco and hospitilization 

of so many civilians soon taxed the Army's resources. Greely, who had 

never relished the idea of military control, decided to restrict the Army's 

services. Citing insufficient power, personnel, and financial resources to 

correct sanitary abuses daily reported among the 100 camps housing 

3l Rodriquez , Earthqllake. pp. 13- 21. 

32Greel y. Report, p. 3 1; Kress, "Field Hospital," pp. 215- 17; Letterman General Hospital 

Register. entry 372, Record Group 11 2, WN RC. 
ESTABLISHING THE MISSION 63 

50,000 people, Greely announced that beginning 13 May the Anny 

would no longer be accountable for all of San Francisco. Instead it would 

accept the' 'entire control and expenses of medical and sanitary measures" 

only in the camps then under direct military authority. By making them 

models of good order and health, Greely hoped to induce refugees in less 

sanitary sites to move to Army facilities. 

Under the new system, Greely administered as a miniature military 

installation each of the twenty-one refugee centers that had come under 

Army control. He appointed Lt. Col. Robert K. Evans "commander of 

permanent camps" to supervise the entire system and designated Army 

commanders for individual camps. Greely also dissolved Tomey's health 

committee and made him Evan's chief surgeon with staff responsibility 

for health affairs. Tomey in tum appointed camp surgeons, many of them 

from the Army, who reported to the camp commander. The surgeons 

usually had several Hospital Corpsmen and at least one civilian physician 

to assist them. 

Health administration, however, continued very much as before. 

Camp surgeons still operated only small tent hospitals and relied on 

evacuation to more permanent facilities in serious cases. They retained 

responsibility for sanitation. To aid them, the Army provided most camps 

with bathing facilities, efficient trash removal and disposal, and screened 

latrines. To insure compliance with sanitary procedures, commanders 

and surgeons inspected the premises every day . Less frequently, Evans, 

one of his assistants, or Torney checked their work. 33 

Though no epidemics occurred, health officers worried constantly 

about typhoid and smallpox. The city did report cases of both , mainly 

outside the camps. Since the Army had no authority to vaccinate the 

populace, it could do little about smallpox, but it did take an active role in 

preventing typhoid. If two or three cases appeared in the same neighborhood, 

the Anny examined conditions in the area and, through local authorities, 

attempted to render them more sanitary. To check the spread of typhoid to 

the camps, surgeons relied on testing water samples and vaccinating all 

consenting residents. With such precautions and constant vigilance, 

neither disease became a serious problem, and the contagious hospital 

closed for lack of business. 34 

As the threat of an epidemic receded and the crisis passed, the Army 

chafed under the burden of providing civilian relief. Most of the extra 

)JGreely. Report. pp. 32- 37, 72- 74. On 23 May, Lt Col Charles L. Heizmann replaced 

Torney. 

l4Charies Keeler, Sail Francisco through Earthquakealld Fire (San Francisco: Paul Elder& Co., 

1906), p. 49; Greely, Report. pp. 33-34, 133-34. 
64 THE DEMANDS OF HUMANITY 

medical officers returned to their stations, and in late May the scarcity of 

physicians in the Pacific Division forced Greely to reduce the number of 

Army surgeons on duty in San Francisco even more. Although the 

reductions left the Army more dependent on local civilian practitioners, it 

-still retained control into June. As the sense of emergency faded , though, 

some city residents and officials tired of the military presence. Many 

civilian doctors and druggists, for example, complained about free clinics 

the Army operated in the city and pressured Greely into closing them. 35 

Tensions also rose over the enforcement of sanitary practices. On 15 

June, Greely sent Secretary of War William Howard Taft a confidential 

telegram complaining that the last two weeks had convinced him that the 

"exercise of police power by troops and enforcement of military sanitary 

regulations on public parks and other city grounds must inevitably lead to 

[a] clash of authority and consequent discredit of [the] Army. " In a 

separate telegram to the secretary, Greely added that only the day before 

"a health inspector invaded one of the military camps . . . and insisted 

on dictating changes, although this camp was in first class condition 

under charge of a surgeon of the Army as to sanitary arrangements." 

Only deft handling of the situation by the major in charge prevented an 

incident. Greely wanted out. Even though the mayor requested that the 

Army remain for another ninety days, the Army relinquished control on 2 

July, leaving the Red Cross in charge of relief. The Army did, however, 

continue to administer camps on the Presidio grounds for a few weeks after 

the withdrawal. 36 

Despite some civil-military tensions toward the end, the Army had 

achieved an exemplary success in its relief work in San Francisco. No 

epidemics occurred, and the populace remained generally healthy. One 

visitor marveled at his inability to find any " serious illness" (which he 

apparently defined rather stringently) in the camps. Though he did discover 

a few people troubled with " pneumonia resulting from exposure, or heart 

trouble from excitement and fatigue, and of insanity from the nervous 

tensions, " he considered the " general health of the population . .. improved 

to an unprecedented degree . " Other observers agreed that the outdoor life 

actually helped people 's health, and rates of sickness in the camps 

remained below 2 to 4 percent. 37 

Such an achievement did not go without praise. "'Thank God for the 

3500 clinics. see Greely. Reporr. pp. 32. 13 1-32; Russell Sage Foundation, Survey. p. 93. 

36Firsl quote from Telg. Greely to Taft. 15 Jun 06. Second from Telg, Greely to SecrctaryofWar, 

15 Jun 06. Telg. E. E. Schmitz to Taft. 14 Jun 06. All in file 11 2 11 9 1, Record Group 94. NA. 

31QUOIC from Keeler, Sail FNl1ldsco. p. 49. Russell Sage Foundalion , Survey. p. 7: Greely, 

Report. pp. 33. 36. 41. 
ESTABLISHING THE MISSION 65 

soldiers' was the cry of the people of San Francisco during the days 

following the disaster, and it was echoed the country over," effused one 

journalist. In another paean to the Army, the Episcopal magazine The 

Churchman proclaimed: "The nation has reason to be proud of the part 

played by its army in the stress of great disaster." Its editorial went on to 

commend General Funston and specifically saluted the Medical and 

Quartermaster Departments. Professional social workers echoed the praise 

from the press. Writing in one of their professional reviews, Charities, 

Robert de Forest called the " accidental presence of federal troops under 

General Funston . . . all important, not only for the maintenance of order 

but for the distribution of relief, " and commended the Army's efficiency 

in disaster situations. 38 

By contrast, a few critics, some of them quite vitriolic, condemned 

the Army's efforts. They usually decried the enforcement of martial law 

or the destruction of private property to create firebreaks rather than any 

of the Army's public health measures. While not as widely publicized, 

the civil-military tensions in June did involve disputes over sanitary 

procedures. The various strains that developed over medical and other 

activities indicated that the Army's role in disaster relief was best limited 

to the emergency phase. As the situation returned to normal, some people 

began to resent military involvement, either because of traditional civilmilitary hostility or because the Army's aid threatened their own interests. 39 

But neither the criticism nor the problems late in the operation 

significantly detracted from public appreciation of the Army's efforts. 

The San Francisco earthquake received wide publicity---even a movie 

was distributed about it-and helped fix in the public mind the feasibility 

of employing the Army and its Medical Department in disaster relief. The 

San Francisco operation became almost an archetypical disaster relief 

mission; the phrase "who served with the Army in San Francisco" after a 

man's name soon served to establish competence in an emergency. But 

even as the San Francisco mission spurred greater Army medical relief, it 

proved a model that few later missions could emulate . The magnitude of 

the calamity there had necessitated a temporary abandonment of localism 

and self-help. In the following years, local authorities were seldom so 

overwhelmed. Meanwhile the Red Cross increased its capability to provide 

38First quote from Banks and Read , History. pp. l06-7, quote on p. 74 . Second from "The 

Army at San Francisco," Churchmt/1l 93 (1906): 638. Third from Raben W. de Forest, "Some 

Lessons of the San Francisco Disaster." Charities 16 ( 1906): 155. Russell Sage Foundation, Survey. 

p.369. 

39For a good example of criticism. see Henry A. Lafler, HoII' the Army Worked to Save Sail 

Francisco (San Francisco: Calkins Newspaper Syndicate, 1906), especially p. 13. For other critics, 

see Kennedy, Earthquake. pp. 136-37. 
66 THE DEMANDS OF HUMANITY 

leadership. In most future operations the Army Medical Department 

would provide advice and supplies, but only in areas with extreme 

problems would it take charge of the entire medical operation as it had in 

San Francisc040 

Additional Relief Operations and Formal Recognition of the Mission 

The next major disaster relief operation undertaken by the Army 

featured this more limited role for medical personnel but demonstrated 

again that at least some medical assistance was acceptable. On 24 April 

1908 tornadoes swept through sections of seven southern states, and 

shortly thereafter the Red, Black, Atchafalaya, and Mississippi rivers 

flooded. The combined disasters rendered nearly 33,000 people destitute. 

Congress appropriated $250,000 for their relief and charged the War 

Department with administering its distribution. Following procedures 

developed in the nineteenth century, the Secretary of War dispatched 

Army officers to the flooded or destroyed sections to evaluate the needs of 

residents and to supervise the issuance of food, clothing, and other 

essentials 4 1 

As it had not in the nineteenth century, however, the Army now 

considered also sending medical relief. On I May The Adjutant General 

sent a memorandum to the Chief of Staff volunteering the services of ten 

medical officers and thirty-six Hospital Corpsmen for immediate assignment 

in the South. With twenty-four hours' notice, he added, he could send a 

fully staffed and equipped field hospital. The Chief of Staff, perhaps 

thinking of precedents set either in St. Vincent and Martinique or San 

Francisco, agreed that funds appropriated by Congress could be spent for 

" medicines and medical aid" and advised inspectors of that fact. But 

they reported only one area that needed medical assistance .

42 

. In Purvis, Mississippi , a town in the southeastern part of the state with 

between 1,800 and 2,500 inhabitants, a tornado had killed 40 people and 

damaged 70 percent of the homes. Between 250 and 300 other people 

sustained some type of injury; many needed hospital care. Physicians 

from nearby Hattiesburg rushed to Purvis and by dawn of the next day had 

evacuated 75 percent of the injured by special train. Two Navy surgeons 

who had arrived shortly after the tornado and had assisted in the evacuation 

<l°For mention oflhe movie. see Sylvester Q. Breard •.. A History of the Motion Pictures in New 

Orlc:ms. 1896- 1908." (M.A. thesis, Louisiana Slale Uni versity . 195 I). pp. 200- 1. 220- 2 1. 

41Sce IncllO lIr, H . P. M cCain to James Hay, II Jan 15. flle 1459754 , Record Group 94, NA; 

Ltrs in me 1372 11 3. Record Group 94. NA. 

42Mcmo for Adjutant General by Chief of Starr. I May 08: Memo for Acting Secretary of War by 

Chief of Stafr. 12 May 08; Ltrs from inspectors. All in file 1372 113, Record Group 94. NA. 
ESTABLISHING THE MISSION 67 

CAPTAIN ASHFORD'S STAFF. Hattiesburg. Mississippi. 1908. 

then established relief hospitals in Hattiesburg to care for the evacuees. 43 

After Congress appropriated relief funds, the Army assumed 

responsibility. Maj . CaroB A. Devol, a veteran of San Francisco who 

headed Army relief operations in the vicinity, visited Hattiesburg and 

decided that the situation merited continued medical assistance . On 3 

May, Maj. Weston P. Chamberlain, an Army medical officer from 

Jackson Barracks, relieved the Navy surgeons, although they remained 

until 5 May to help. Later, Capt. Bailey K. Ashford and Capt. Howard H. 

Baily, both surgeons at Washington Barracks, relieved Chamberlain in 

turn. The War Department also ordered a 24-man Hospital Corps detachment 

to the scene, and by 8 May both the soldiers and medical supplies from St. 

Louis had arrived in Hattiesburg. 

With assistance from eighteen Red Cross nurses, Ashford took charge. 

His policies displayed a continued regard for local control: as far as 

possible, he left patient care to resident physicians, and he respected the 

racial segregation practiced in the area. Over the next two weeks, 179 

victims were hospitalized. Ashford relied on the town's two permanent 

hospitals to Care for many of them. Although he assigned a few nurses and 

corpsmen to each, local 'doctors provided care , with the government 

43Following account based on Rpt of Maj C. A. Devol. 6 May 08; Rpl of W. P. Chamberlain. 7 

May 08; Rpl of Bailey K. Ashford, 1 Jun 08; and other Ilrs and telgs. All in file 1372 11 3. Record 

Group 94. NA . 
68 T HE DEMANDS OF HUMANITY 

paying a fixed per diem fee for each disaster victim. In both hospitals, 

patients were segregated by race, with whites receiving substantially 

better accommodations. In addition, Ashford set up temporary wards in a 

local hotel and oversaw completion of a tent hospital that the Navy 

surgeons had started. The tent facility boasted electricity, water pipes, 

water closets, operating tents, dining tents, and five patient tents, all 

connected by boardwalks. 

Ashford and Baily also drove one of the hospital's ambulances down 

the path left by the storm to search for additional victims. Some they 

found were evacuated by ambulance to the railroad and then to Hattiesburg. 

Others, slightly injured or too seriously ill to move, were treated on the 

spot. At the battered town of Purvis, the Army doctors prodded local 

officials into sanitary reforms and furnished advice and supplies for the 

effort. By the end of May, their emergency role ended, the soldiers 

departed. 

In 1912 Army medical personnel performed a different type of relief 

service~ne in many ways more like future missions than those in San 

Francisco and Hattiesburg. Rather than rendering direct care to victims in 

one locality, Army doctors furnished medical supplies and professional 

advice to civilian officials throughout an afflicted region . The occasion of 

the operation was a flood of the Mississippi River which at its height 

covered an irregular strip of land varying from 5 to 60 miles wide for a 

distance of nearly 800 miles. Though surprisingly few people perished, 

the magnitude of the flood demanded a massive assistance·operation. 44 

Informed of the devastation, President William Howard Taft decided 

that the government should help and that "only the War Department" had 

the organization and resources to respond at once. The president contacted 

members of the House Appropriations Committee who assured him that 

Congress would replace any deficit the War Department incurred. Yet 

until Congress actually appropriated funds, the department had no authority 

to send assistance. Taft told his Secretary of War, Henry L. Stimson, that 

" we have to act without legal authority ... and depend upon the action 

of Congress to ratify what we have done." He reminded Stimson that 

previous disaster relief operations had proceeded on such an assumption 

and assured Stimson that he would accept full responsibility for their 

actions. Taft's ploy worked. The relief mission began at once, and 

Congress later appropriated $1,240,000 to pay its costs's 

44Ernest P. Bicknell. Mississippi River Flood oj 1912 (Washington: American Red Cross, n.d.), 

p.3. 

4.5Quote from Ur, W. H. Taft 10 H. L. Stimson. 4 Apr 12, file 1897542, Record Group 94, NA. 

RSW. 1912. 1: 14. 
ESTABLISHING THE MISSION 69 

DINING TENT, TEMPORARY HOSPITAL, Hattiesbllrg, Mississippi, 1908 . 

In carrying out the president's decision, Stimson appointed Maj. 

James E. Normoyle of the Quartermaster Corps to direct relief operations. 

Normoyle divided the flooded area into districts and assigned an Army 

officer to direct a program of rescue and relief in each. Although these 

officers supervised the removal of stranded people and livestock from 

housetops and levees, their major contribution was delivering food , 

clothing, and tents to local authorities. More than in previous floods, the 

Army also participated in the erection of refugee centers. Some camps 

had Army commanders, but more often the regulars pitched the camp and 

then left its administration to' National Guard officers or Red Cross 

representati ves. 46 

In all of the camps, National Guard physicians, Red Cross doctors, 

state health department personnel, or private practitioners furnished health 

care. At the outset of the mission, the Army adopted a policy of utilizing 

army doctors to distribute supplies and advise camps on sanitation but not 

46Memo for Chief of Staff by QuartermaslerGeneral. 8 Apr 12, file 1897542, Record Group 94, 

NA; James E. Normoyle , Flood Sufferers ;" the Mississippi allli Ohio Valleys, Report 0/ James £. 

Normoyle ill Charge o/Relie/Opertlliolls, April. May. JUlie . July. 1912 (Washington: GPO, 1913); 

"Flood Sufferers oflhe Mississippi River, 1912," entry 31C, Record Group 192, WNRC; Bicknell , 

Pioneering. p. 164. 
70 THE DEMANDS OF HUMANITY 

providing direct medical assistance. To perform these duties, The Surgeon 

General assigned two medical officers, Maj . Reuben B. Miller of the 

Army and Navy General Hospital in Arkansas and Capt. Jacob M. Coffin 

of Fort Riley, Kansas. Though they received support from other Medical 

Department personnel at various times, Miller and Coffin performed the 

bulk of the relief work. 47 

Miller feared that if he had to determine the needs of each camp, make 

separate requisitions, wait for the return shipment, and then forward the 

supplies, the resulting delay would largely nullify the benefits of Army 

aid. To avoid that, he directed the St. Louis Medical Depot to pack an 

assortment of essential remedies, surgical dressings, and hospital stores 

in standard units which were stored at convenient spots along the river. 

Miller mailed a printed circular explaining his system and listing the 

units' contents to chairmen of all relief committees. When a camp or 

community needed medical supplies, the committee simply requested a 

certain number of units which Miller then sent from the nearest storage 

site. Since the units did not include everything a physician might want or 

need , Miller authorized the camp surgeons to purchase small amounts of 

supplies locally at government expense. This method held cost to a 

minimum and enabled the two officers to service a large area . 

Miller and Coffin advised local authorities on sanitation as well as 

distributed supplies. Between them, they visited every camp or refugee 

center that received government rations between Hickman, Kentucky, 

and the Gulf of Mexico. The two were aided by Col. Jefferson R. Kean, 

something of a sanitation celebrity after his work in Cuba and Puerto 

Rico, who inspected all the camps in Kentucky, Mississippi, Arkansas, 

and Louisiana. Although detailed to the Red Cross and acting under its 

authority, Kean worked closely with Miller and Coffin 4s 

Traveling mostly by boat, the physicians inspected each camp and 

recommended sanitary improvements. Because of the many camps to be 

visited, they could ensure that the measures they suggested were actually 

enforced only in the larger ones. In the numerous small camps they could 

not supervise compliance, and as a consequence many of their 

recommendations were never stringently enforced. 

Health conditions among the refugees remained stable and the region 

escaped serious epidemics, but outbreaks threatened in a few areas. 

4"'00 policy , see Memo for Adjutant General from Secretary of War, 19 Apr 12, file 1897542, 

Record Group 94, NA. Unless otherwise indicated, the following account is based on Miller's report 

in Normoyle , Flood Sufferers, pp. 122-34. 

480n Kean's mission, see LIft Henry L. Stimson to Jefferson R. Kean, 3 Mar 12, Kean Papers, 

UVA; Bicknell, Flood of / 9/2. p. 11 . 
ESTABUSHING THE MISSION 71 

Miller blamed the failings on local officials who expected sanitary precautions 

to continue without supervision. The overall success of the effort he 

attributed to the cooperation of the Red Cross, the dedication of the state 

boards of health, and the resiliency of the mostly black refugee population. 

Even though Miller found local authorities undependable and attributed 

the success of the operation to other factors, in succeeding missions the 

government did not abandon local control and only slightly expanded the 

scope of federal medical involvement. 

In the year that followed Miller's work in the Mississippi Valley, the 

Anny Medical Department participated in relief missions in three disasters: 

tornadoes in Lower Peach Tree, Alabama , and Omaha, Nebraska, and 

another massive flood in the Ohio and Mississippi River valleys. In all 

three, medical personnel rendered more direct assistance than in the 

floods of 1912 but under conditions that testified to the strength of 

localism and voluntarism. Local authorities refused to turn the entire 

relief operation over to the military, and the Army itself tried to limit its 

role. The relief missions of 1913 also involved two problems that would 

plague such operations in future years: confusion over authority and 

funding when the War Department acted before Congress voted an 

appropriation, and duplication of effort when several agencies rendered 

aid without proper coordination. 

In the first relief mission both problems arose . A tornado struck the 

small southeastern Alabama town of Lower Peach Tree early on the 

morning of 21 March, destroying much of it and leaving a trail of corpses 

stripped of hair and clothing. The storm killed 28 people immediately, 

injured another 68 , and left about 200 destitute. When one resident wired 

President Woodrow Wilson pleading for medical assistance, the president 

instructed the War Department to provide it. The commander of Fort 

Oglethorpe, Georgia, after finding exactly where Lower Peach Tree was, 

dispatched a four-man medical relief pl\fly on the morning of the 22d.

49 

Commanded by Medical Corps officer Capt. Daniel W. Harmon, the 

party quickly transformed a church into a temporary hospital for black 

victims. White sufferers had already been housed in private homes. But 

during his first day in the village, Harmon learned that the little town's 

plight had aroused the sympathies of many. Doctors sent by the Mobile 

Chamber of Commerce and others who came on their own had formed a 

49Mobile SlInda), Regisler. 23 Mar 13; Logan Marshall , The Trlle Slor), o/Ollr Nalional Calamit), 

0/ Flood, Fire, liml Tormulo (Philadelphia: George F. Lasher, 19 13), p. 243; Telg, C. C. Hare to 

President, 21 Mar 13; Ltr, J. P. Famety to L. M. Garrison, 21 Mar 13; Telg, Garrison 10 CO, Fort 

Oglethorpe, Ga ., 2 1 Mar 13; Telg, Morgan loAG, 2 1 Mar 13. All in file 2020998, Record Group 94, 

NA. 
72 THE DEMANDS OF H UMANITY 

relief corps. A National Guard doctor arrived to represent the Red Cross. 

Following instructions from the War Department, Harmon determined 

that the Red Cross had the situation under control and returned to Fort 

Oglethorpe. Brief as the mission was, The Surgeon General had already 

begun to worry about the propriety of acting without congressional 

appropriation. If the work involved only personnel and supplies already 

purchased, everything was proper, he informed the Secretary of War. But 

the Army did not have the legal authority to spend additional funds. He 

might have added that in this case it did not need to, because the response 

was uncoordinated and unnecessary. 50 

The next relief operation followed within two days and met with 

greater success. Early on the morning of23 March a tornado tore diagonally 

across the most populous section of Omaha, Nebraska, causing severe 

damage. The Army waited for neither congressional approval nor a 

presidential order but responded within minutes when an alert teenager 

reported the calamity at Fort Omaha. The post's commander, Maj. Carl 

F. Hartmann, who had seen duty in the San Francisco quake, ordered 

three companies to the heart of the damaged area. Officers assigned part 

of the soldiers to guard duty and put the rest to work clearing wreckage. 

They labored until the next evening without relief, resting occasionally on 

the snow-covered ground with only their blankets for protection. Meanwhile, 

the fort's medical personnel established a temporary hospital at the scene 

of the tragedy. Stretcher and ambulance parties brought the wounded to 

it, and 1st Lt. John H. Trinder, the surgeon at Fort Omaha, toiled through 

the night caring for the victims. He had a rough job. One private detailed 

to work with the hospital recounted: "I have been through two wars, and I 

have carried men off the battlefield in the Philippines, shot to pieces, but 

this thing of women-and in one case, a women and her two children, we 

carried them in the same stretcher- that just got my goat. ,,5 1 

The troops from Fort Omaha remained in the city for a few days, and 

the War Department sent a quartermaster officer to distribute rations. No 

one seemed to question the propriety of dispatching troops, perhaps 

because Hartmann had conferred on the first morning with the mayor, 

who welcomed the Army's aid. After the crisis passed, the Commercial 

Club of Omaha wrote the War Department commending' 'most highly the 

SOorelgs, Hannon to AG, 24 and 25 Mar 13; LIT, Capl W. R. Doores to AG, 2 Apr 13; Memo 

for AG by Chief of Staff. 26 Mar 13; Memo for Secretary of War by Surgeon General , 24 Mar 13. All 

in file 2020988, Record Group 94, NA. Mobile Register. 25 and 26 Mar 13. 

5lQuote from Miles Green leaf and Carl G. Eddy, The Omaha TOri/ado: Omaha, Nebraska, 

EaSler SUI/day, March 23. 19 13 (Omaha: John L. Gideon, 19 13), no pagination. Marshall , True 

Story. pp. 212-13: Thomas H. Russell, Swepl by Mighty Walers (Chicago: Laird & Lee, 191 3). p. 

280; Victor Rosewater, "Repairing a Tomado's Havoc." Review of Reviews 47 (1913): 706. 
ESTABLISHING THE M ISSION 73 

quick response of Major Carl Hartmann" and thanking several other 

officers, including Trinder, for handling "the situation in so masterly a 

manner as to win the admiration and respect of the entire community. " 

Clearly, in certain situations the public appreciated rapid response by the 

Army and did not consider it a threat to local control. 52 

Even if Hartmann's efforts in Omaha were successful, relief operations 

both there and in Lower Peach Tree were relatively minor. The same 

week, the Army became involved in a major disaster after a series of 

deadly floods in the Ohio and Mississippi valleys. On 26 March, President 

Wilson read in the newspapers of the first flooding along the Dayton and 

Ohio rivers and immediately went to the Executive Office Building to 

ascertain how the federal government could help. There he received a 

telegram from Ohio's Governor James M. Cox informing him that Cox 

had already contacted the War Department about assistance. Wilson 

called Secretary of War Lindley M. Garrison and learned, arnong other 

things, that the executive branch had no explicit authority to act. But it 

had done so in the past, and Wilson decided to proceed. In this, he 

followed precedents set by other chief executives, but the .problem of 

authorization remained unresolved. 53 

Garrison appointed Major Normoyle , who had directed flood relief in 

1912, to command the operation. As he had the year before, Normoyle 

divided the affected area into districts, appointed officers to direct operations 

in each, and instructed them to work closely with local committees. 

Again officers plied the rivers in steamers, rescuing the stranded and 

feeding the starving. Army medical efforts, however, differed somewhat 

from those in 191 2.54 

When he first took charge, Normoyle requested the services of his 

former assistants Miller and Coffin, but the War Department had already 

ordered other medical officers to the scene. Governor Cox's original 

request for aid included medical supplies, and the department sent him 

more than he asked for. On 26 March, the day of Cox's request, The 

Adjutant General ordered Maj. Powell C. Fauntleroy of the Surgeon 

General's Office to Columbus, Ohio, instructed the commanding general 

in Chicago to dispatch eight medical officers within "convenient reach of 

Columbus" to join Fauntleroy, and wired the SI. Louis Medical Supply 

Depot to send fifty Hospital Corpsmen and supplies to the flooded region. 

On the following day, a party of three hospital stewards and fourteen 

'2Quote from Inclto Llr, H. P. McCain to James Hay, II Jan 15. file 1459754, Record Group 

94, NA; Greenleaf and Eddy. Omaha Tornado; Russell. Might)' Wmers. 

'lNew York Times, 27 Mar 13. 

S4For an overview of the operation. see RSW. 1913. pp. 2 13- J 5. 
74 THE DEMANDS OF HUMANITY 

corpsmen left Washington with medicine and equipment, and another 

load of medical supplies was sent from New Y orks5 

Army work in Columbus began even before officers ordered to flood 

duty by The Adjutant General arrived. On 28 March, the commander of 

nearby Columbus Barracks had dispatched his post surgeon Maj. Frank 

T. Woodbury and five enlisted men to Columbus at the request of the 

Ohio National Guard. Upon arrival they hastily set up a headquarters, and 

Woodbury ordered a sanitary inspection of the city. Within eight hours, 

the thirty-five cadets from Ohio State University who conducted the 

survey compiled a report. Two days later, Major Fauntleroy arrived in 

Columbus and was later joined by four other medical officers. Occasionally 

the Army doctors helped in the hospitals, but they spent most of their time 

conducting sanitary surveys, determining medical needs, or furnishing 

hospital stores. The treatment of patients was left to the Ohio National 

Guard or local physicians. 56 

Once Fauntleroy considered the situation in Columbus stabilized, he 

expanded his operations to other towns in the affected area. He had only 

four officers and a few enlisted men to commit to the effort, since the 

flood prevented others from reaching Columbus. Nevertheless, Fauntleroy 

sent his small staff to survey sanitary conditions in the Ohio Valley. On 

arriving in each town, its members first contacted local relief or health 

officials, consulted with them to determine the needs of the community, 

and then issued necessary vaccines or other supplies. Major Fauntleroy 

remained in Columbus but received daily telephone or telegraph reports 

from his men. He limited his relief activities not only because of the size 

of his staff but also because Normoyle did not want the Army " to get in 

too deep " - no pun intended, surely- but rather intended "to force states 

to take proper measures.' , 57 

As civil authorities in the area assumed greater control and the crisis 

eased, military sanitarians followed the flood downriver. Four Medical 

Corps officers and three Hospital Corpsmen served under Normoyle in 

the lower reaches of the Mississippi system, where they concentrated on 

inspecting refugee centers rather than advising towns. In both areas, 

Army assistance encouraged proper precautions, and only a few sporadic 

$5NelV York Times. 27 and 28 Mar 13; Tclg, NonnoyJc to Chief of Siaff, 26 Mar 13; Llf. 

Surgeon General 10 Adjulant General , 26 Mar 13: Memo for Adjutant General by Chief of Staff, 26 

M ar 13. All in file 2022074. Record Group 94, NA. 

S6Ltr. Sterling Taylor to George A. Dodd, 13 May 13; Telg, Fauntleroy to AG , 30 Mar 13; 

Telg, CO Columbus Barracks to AG, 13 May 13; Llf, John W. Kcegair to George A. Dodd , 12 Apr 

13. All in file 2022074, Record Group 94, NA . RSG , pp. 174-75. 

51Telg, Nonnoy le to Wood, 30 Mar 13. Quote (rom Te lg, Nonnoyle to Chief of Staff. 6 Apr 

13. Both in file 2022074, Record Group 94 . NA. 
ESTABLISHING THE MISS ION 75 

cases of contagious disease developed. But in two towns-Dayton, Ohio, 

and Deckerville, Arkansas--conditions necessitated more direct involvement 

by Army medical personnel. 58 

The March flooding of the Dayton River was particularly devastating 

in the city that bears its name. Quick response by the Dayton-based 

National Cash Register Company, the Ohio National Guard, and a few 

surgeons from the Navy and Marine Hospital Service met the city's 

emergency needs. Yet when Secretary of War Garrison, touring the 

flooded region, arrived at noon on the 29th, sanitary conditions remained 

hazardous. Garrison assembled local physicians to discuss the city's 

plight, and a consensus emerged in favor of placing Dayton under federal 

control. Later Garrison, other federal representatives, and local relief 

officials met again and consulted with Governor Cox by telephone. This 

group decided to leave the city under control of the state militia but to 

place a federal officer in charge of sanitation. Garrison appointed to that 

post Maj . Thomas L. Rhoads, a Medical Corps officer serving as President 

Wilson's personal physician, but then traveling with the secretary . 59 

Rhoads commanded a force of local physicians, state and city health 

officials, national guardsmen, Navy surgeons, Marine Hospital Service 

physicians, six Army doctors, and forty-six Hospital Corpsmen- the 

Army contingent composed mainly of men originally ordered to Columbus 

who had been unable to get there. Rhoads divided Dayton into sixteen 

districts of roughly equal population and appointed local doctors to 

oversee each one. He granted the physicians the authority to hire or 

impress assistants, nurses, and laborers to conduct house-to-house 

inspections. During their inspections, medical workers treated or evacuated 

the sick and injured, isolated people with contagious diseases, disseminated 

advice on disease prevention, and located sanitary hazards. 60 

Once such dangers were identified, district officers sent cleaning 

crews to correct them. By the 31 st, Rhoads had assembled a large labor 

force and several hundred teams to remove dirt and debris from homes, 

$"Telg, Nonnoyle to Wood, 11 Apr 13; Telg, Bankhead to Chief of Staff, 27 Apr 13. Both in file 

2022074. Record Group 94. NA. RSG. 19 13. pp. 174- 75 . 

.wAllen W. Eckert . A Time of Terror: TIle Great DaYfoll Flood (Boston: Linle, Brown & Co. , 

1965), pp. 56- 63; Guy L. Irwin, Tragic Story of tile Greal F/o()(1 (Chicago: Hamming Pub! . Co., 

19 13), p. 25; Henry NeillMarshall Everenl. Tragic Story of America's Greatest Disa.uer (Chicago: 

J. S. Ziegler Co. , 19 13), pp. 150 - 53; Marshall , True Story, p. 77; Frederick E. Drinker. Horrors of 

Tornado. Flood. m/{I Fire (Philadelphia: National Pub!. Co., 19 13), p. 94. 

6OAccount of work in Dayton based on RSG, 19 13, pp. 174- 76; Marshall. True Siory. pp. 

92- 93; and Rpts by Thomas Rhoads dated 29, 31 Mar. 2. 11, 22 Apr 13. All in file 2022074. Record 

Group 94, NA. See also Thomas L. Rhoads to Sec retary of War. Rpl of Chief Sanitary Officer on the 

Work of the Sanitary Department at Dayton. Ohio. and Vicinity. 29 Mar to 25 Apr 13, file 88925 , 

Records of the Office of the Chief of Engineers, Record Group 77. NA. 
76 THE DEMANDS OF HUMANITY 

lots, and streets. Its crews accomplished a major feat of sanitary engineering, 

removing massive amounts of filth and a considerable number of corpses. 

Rhoads charged the secretary of the Ohio State Board of Health with the 

task of restoring water and sewer services. While work went on, Rhoads 

took emergency precautions. Until completely confident of the water 

system's purity, he ordered citizens to boil all drinking water. When 

reconnection of damaged sewer tie-ins from private homes proceeded 

slowly, Rhoads installed public comfort stations over manholes. He 

closely supervised all sanitary work and met with district officers and 

health officials every night to discuss the progress and problems of the 

day. 

Since Rhoads had responsibility for other types of aid, he also worked 

closely with relief committees. Learning that food was becoming scarce, 

he requested rations from Normoyle and established stations throughout 

the city where residents drew food, clothing, and medical supplies. 

Rhoads also established two refugee centers for the homeless. These were 

needed because many buildings in which people had sought shelter had 

become overcrowded. To add to the crush, the district officers required 

the residents of homes that failed to pass sanitary inspection to move out 

until repairs were completed . 

To care for the city's sick, Rhoads wanted to establish a full field 

hospital in conjunction with one of the centers. When Normoyle refused 

to send one, Rhoads instead employed small improvised aid stations 

located throughout the city. He also relied on Red Cross nurses to treat 

minor illnesses in the patients' homes, while Dayton's regular hospitals, 

which had survived the flood , cared for the seriously ill. With such 

service available, the field hospital did prove unnecessary, and by 2 April 

the small neighborhood facilities had begun to close. 

Rhoads's success in practicing preventive medicine helped to prevent 

an overflow in the hospitals. Although Dayton experienced scattered 

cases of measles, scarlet fever, and especially diphtheria, no serious 

outbreaks developed. Rhoads claimed that the rate of sickness dropped to 

half what it had been before the flood . By 11 April he considered the 

situation sufficiently improved to allow his return to Washington; he 

departed on the 26th. The local boards of health carried on the program he 

had begun. Rhoads had provided much of the expertise and administrative 

savvy to guide the civilian authorities through the worst of the crisis 

without the total control or large military staff Tomey had in San Francisco. 

As Rhoads began to relinquish control in Dayton, a representative of the 

Army Medical Department undertook another direct aid mission further 

south. On 14 April, Normoyle received reports of an epidemic of 
ESTABLISHING THE MISSION 77 

cerebromeningitis in Deckerville, Arkansas, and ordered Maj. Sanford 

H. Wadhams, a Medical Corps officer on flood relief duty in Helena, to 

investigate. When Wadhams arrived in Deckerville-a "small town right 

in the center of about One Thousand square miles of flood country"-

only the railroad tracks remained above water, and the town's mostly 

black population " had taken refuge in box cars." They had no doctor, 

meningitis had indeed struck, and several people had already died. The 

state of Arkansas offered no help, but the county did send Dr. M. S. 

Alexander from nearby Weiner. 

In the following nine days, the two physicians vaccinated 500 people, 

fed the sufferers, and improved the sanitary condition of their refuge. 

Using a technique that had been developed only a few years earlier, 

Alexander and Wadhams cared for those who had already contracted 

meningitis. "We have treated them all by spinal puncture and injection of 

serum," Wadhams reported. "It has been done under the greatest of 

difficulties, but the results have been excellent." Soon he believed the 

danger of an epidemic had passed, even though he expected a "few more 

sporadic cases of meningitis in the surrounding country." Wadhams left 

Deckerville on 23 April, commenting that "the people have been most 

appreciative" and feeling "better satisfied with the work .. . than at any 

other place." Shortly thereafter, Normoyle directed him to return to his 

station. By the end of April, only one member of the medical contingent 

remained on relief duty, and he worked only until about the end of May, 

when Army relief operations of 1913 came to an end 61 

The three operations that spring illustrated that the Army had become 

a ready source of aid in a variety of disasters. Not only Congress but also 

private citizens summoned the Army in times of crisis. No longer did 

relief missions await congressional appropriations. Instead, presidents 

boldly ordered the War Department to act at once and sought reimbursement 

later. De facto, the Army was in the business of aiding civilian disaster 

victims, and medical assistance was an important part of the services it 

offered. 

Issuance on 2 October 191 7 of Special Regulation 67, • 'Regulations 

61Account of Deckerville and all quotes from Ltr, Wadhams to Fauntleroy, 24 Apr 13, file 

2022074, Record Group 94, NA. Wadham's report does not state how he performed the vaccinations. 

An effective vaccine for meningitis was not developed until the early 1970's; however, doctors were 

performing vaccinations at this time. See Abraham Sophian and J. Black, "Prophylactic Vaccination 

against Epidemic Meningitis, ., JOllrnal of the American Medical Association 59 (1912): 527 - 32; 

Wesley W. Spink, Infectiolls Diseases: Prevelllioll and Trealmelll iI/ the Nil/eteel/II! alld Twetllielh 

Celllllries (Minneapolis: University of Minnesota Press, 1978), pp. 29 1- 92. On the end of the 

mission, see RSG, 1913, pp. 174-75; Telg, Bankhead to Chief of Staff, 27 Apr 13, file 2022074, 

Record Group 94. NA. 
78 THE DEMANDS OF HUMANITY 

Governing the Flood Relief Work of the War Department, " signaled the 

department's official acceptance of its new mission. The regulation even 

provided blank forms for requesting aid- in the new bureaucratic society, a 

sure sign of official commitment. Though claiming to cover actions in all 

types of disaster, the title clearly indicated that the regulation had been 

written with the most frequent type of assistance, flood relief along the 

Mississippi , in mind. The regulation assigned responsibility for direction 

of relief efforts to department commanders, directed the afflicted area to 

be divided into districts, and laid out proper accounting procedures for the 

issuance of supplies. Placing the Army's role in the context of local 

control, the regulation made no mention of total military responsibility 

for relief efforts, as in San Francisco. It authorized distribution of medical 

supplies but contained little else about medical relief. 62 

The regulation did , however, address some major problems that 

marred relief missions in the late nineteenth and early twentieth centuries. 

It provided safeguards to prevent fraud and provided for proper accountability 

of government property. To prevent whites from withholding relief 

supplies to compel black agricultural labor, it ordered that "wherever and 

whenever possible supplies will be issued direct to sufferers" and specified 

that " in no case will relief supplies of any description be issued to 

employers for their employees." But the regulation also urged that relief 

be given to the ablebodied only when they worked in order to "safeguard 

against a promiscuous distribution of supplies and consequent demoralization 

of labor conditions thereby ." Concerning the problem of authorization, 

the regulation stated that flood relief without the approval of Congress" is 

not contemplated ... unless the overruling demands of humanity compel 

immediate action to prevent starvation and extreme suffering and local 

resources are clearly inadequate to cope with the situation. " On coordination 

with other agencies, the regulation urged cooperation with local relief 

committees but failed to mention liaison with the Red Cross or any other 

national group. 

Special Regulation 67 certainly did not resolve all the problems 

associated with relief operations, and it said almost nothing about the 

nature of medical relief. The work of the skilled personnel of the Medical 

Department had been part of the Army's expanded and more frequent 

assistance mission but was provided under the direction of officers from 

other branches of the service. The Medical Department as an organization 

exercised little or no control and provided only limited administrative 

62Copy of Special Regulation 67 in Record Group 407. NA. All quotes below arc from the 

regulation. For the drafting of the regulation. see Johnson, " Emergency Response. " 6:27-32. 
ESTABLISHING T HE M ISSION 79 

support- a pattern that would continue in future years. Nonetheless, 

medical personnel had rendered considerable civilian assistance between 

1898 and 19 17, aid that ranged from near total control in San Francisco to 

limited support and advice during the fl oods of 19 12 and 1913. With little 

mention in the regulations and such varied precedents, the Anny's medical 

role in domestic disaster assistance still remained to be full y defined. 
CHAPTERS 

Disease in the Aftermath of War: 

Disaster Aid to Poland and Russia 

after Wodd War I 

In the aftennath of World War I, members of the Army Medical 

Department became involved in unusual foreign relief operations that 

resembled earlier battles with epidemics after the Spanish-American 

War. This postwar activity contributed very little to the definition of the 

Anny's medical assistance role; but it illustrated the variety of relief tasks 

that Anny doctors could perform and further illuminated the complex 

motivations of the United States government in providing assistance. 

Postwar Relief and America's Sense of Humanitarian Mission 

The unusual postwar medical missions occurred as part of a larger, 

comprehensive American relief effort designed to reduce starvation and 

disease among European noncombatants during and after the First World 

War. To help them, several American private and governmental agencies 

furnished food, medical care, and other assistance. They did not do so 

solely for humanitarian reasons, however. On occasion, American relief 

officials frankly donated or withheld food to further American policynot unlike the time ninety years earlier when the government had used 

similar tactics with the Creek Indians. 

More important was the fact that the entire assistance program implied a 

decision by American leaders to employ humanitarian relief to encourage 

governments and ideologies compatible with those of the United States. 

Herbert Hoover, who directed the American effort, and his boss, President 

Woodrow Wilson, sought through American relief measures to prevent 

civil disintegration, preserve a liberal world order, and thereby check the 

spread of bolshevism. Hoover declared that his program was designed to 

"sustain the feeble plants of parliamentary government which had sprung 

up in all of these countries. A weak government possessed of the weapon 

of food and supplies for the starving people can preserve and strengthen 

itself more effectively than by arms. " President Wilson agreed: "Bolshevism 
DISEASE IN THE AFTERMATH OF WAR 81 

is steadily advancing westward, it is poisoning Germany. It cannot be 

stopped by force , but it can be stopped by food. "I 

With such statements, Hoover and Wilson displayed a political motivation 

for humanitarian relief that had rarely been so forcefully or clearly 

enunciated. Their thinking, however, did not differ drastically from that 

of earlier leaders who had supported. overseas relief as a means to gain 

commercial entry into an area or to demonstrate to the world America's 

superiority . In fact, in the debate over a later phase of postwar relief- the 

decision to send aid to Russia during its famine of 1921- the continuity 

with previous efforts was especially pronounced. 

Some historians have argued that the relief effort in Russia was but a 

cleverly disguised attempt at counterrevolution, and such a goal probably 

influenced Hoover's support for it. Yet few Americans shared Hoover's 

hope that American aid would reverse the fortunes of Russian communism; 

rather, they suspended their hostility toward Russia's new leaders for a 

time to ease the suffering of its citizens. Many probably agreed with New 

York Congressman W. Bourke Cockran, who vividly evoked the traditional 

American sense of humanitarian mission. 2 

In 1921 Cockran told his colleagues in the House that he supported an 

appropriation for famine relief in Russia because it was a .. measure of 

sound policy" and " of absolute necessity to the security of our civilization, 

which is seriously imperiled-aye, rocking on its foundation- by reason 

of conditions which must be remedied if it is to survive." And, Cockran 

ISee George W. Hopkins, . 'The Politics of Food: United States and Soviet Hungary, March- August, 

1919," Mid-America 55 (1973): 245 -70; Benjamin M. Weissman, " The American Relier 

Administration in Russia , 1921 - 1923: A Case Study in the Interaction between Opposing Political 

Systems," (Ph.D. diss. , Columbia Uni versity, 1968), p. 47 . Quote rrom Herbert Hoover, The 

Memoirs of Herbert Hoover: Tile Years of Advefllllre, 1874- 1920 (New York: Macmillan Co., 

1951), p. 301, but see also pp. 4 12- 14, 427 . Wilson quoted in Weissman, " ARA in Russia," p. 37. 

For additional evidence on Wilson's altitude, see Raymond L. Bland and Frank M. Surface, 

Americall Food in ,he World War alld Recollstructioll Period: Operatioflsoftile Orgallizations under 

the Direction of Herbert Hoover, 1914 to 1924 (Stanrord: Stanrord University Press, 193 1), p. 30; 

Joan Horr Wilson, Ideology al/d Economics: UI/ited States Relatiolls with the Soviet Ul/iOIl , 

1918- 1933 (Columbia: University or Missouri Press, 1974), pp. 6-7; John M. Thompson, Russia, 

Bolshevism, alld the Versailles Peace (Princeton: Princeton University Press, 1966), pp. 15 - 16, 

220. 

2:For a summary or the h'istoriographical controversy, see Banjamin' M. Weissman, Herbert 

Hoover al/d Famine Relief to Soviet Russia: 1921 - 1923 (Stanrord: Hoover Institution Press, 1974), 

pp. 188- 89, but also Leo Eugene Chavez, "Herbert Hoover and Food Relier: An Application or 

American Ideology," (Ph.D. diss., University or Michigan, 1976), which stresses Hoover's search 

for a new world order, and Wilson, Ideology and Economics, p. 7, which emphasizes its political 

intent. Even one of the scholars who stresses its counterrevolutionary purpose admits the American 

public considered it humanitarian relief. See PeterG. Filene, Americans and tile Soviet Experimellf, 

1917- 1933 (Cambridge: Harvard University Press, 1967), pp. 76- 79. Another ractor in the 

American decision may have been support for aomestic grain prices. See Weissman, Hoover and 

Famine, p. 103, and Thompson. Rllssia. Bolshevism, alld Versailles, p. 222. 
82 THE DEMANDS OF HUMAN ITY 

continued, no one could " dispute the proposition that of the civilization 

which we call Christian, this country is at once the bulwark and the 

citadel, the latest fruit and the crowning glory." In a situation where a 

people are ' 'starving before our eyes" and will " disappear under conditions 

too awful to describe or even to conceive" if not given food , he thanked 

God that "philanthropy is always included within the scope of duty to 

American patriotism. " The United States must now act to preserve " an 

important part of the human family " and on all other occasions as well to 

bring ' 'relief to the uttermost ends of the earth wherever the hand of God 

rests heavily upon His creatures." In evoking an American, God-given 

responsibility to provide relief for the world, Cockran unknowingly 

expanded on themes in speeches delivered by Clayton in 1845 and 

Jenkins in 1902.3 

Cockran expressed the older tradition of American philanthropy, but 

Herbert Hoover gave it new form. Hoover directed all the major American 

agencies that rendered assistance in Europe, and his personality and goals 

shaped each one. During the first years of fighting in Europe, Hoover 

headed the private Commission for Relief in Belgium and after American 

entry into the war directed the government's Food Administration. Following 

the armistice he continued the same efforts under the aegis of the American 

Relief Administration (ARA), a governmental agency that later became a 

private corporation. Through the four different bureaucracies, Hoover 

and the United States distributed more than 33 million tons of food at a 

cost of about $5 billion.4 

In the ARA, Hoover's staff included some soldiers, nearly all volunteer 

officers whose wartime enlistments were extended so that they could 

serve while still salaried by the government. Hoover also secured presidential 

approval to draw supplies from the surplus stocks of food and equipment 

the Army had at the end of the war. Even with this Army aid, Hoover's 

relief operations were always civilian, not military, programs. They 

could not precisely be called disaster relief, and only rarely did they 

involve Army Medical Department personnel. On three occasions, however, 

Hoover did summon the Army and its doctors to perform relief missionsand two of them involved disaster relief. 5 

JQuote from Congressional Record, 67th Cong., 2d sess., 192 1. pp. 470- 7 1; see also pp. 

452- 58, 556- 58.574 - 81. 

4Curti, Americall Philanthropy . pp. 224- 300; Robert D. Cuff, " Herbert Hoover, the Ideology 

of Voluntarism and War Organization during the Great War," Jourl/ol of Americall History 64 

( 1977 ): 358- 72; Chavez, "Hoover and Food Relief"; Bland and Surface . American Food , passim, 

statistics from pp. 274- 75. 

'On Army in volvement in the ARA. see Bland and Surface . American FQ()(I. pp. 52- 55; Herbert 

Hoover. An American E,Jie. 4 vols. (Chicago: H. Rcgnery Co. , 1959- 64).2: 247- 49, 274- 79, 

373: Hoover. Memoirs. pp. 306. 319. 
DISEASE IN THE AFTERMATH OF WAR 83 

In 1919, Hoover asked the Army to conduct what would later come to 

be called a nation building mission. Near East Relief, a private philanthropic 

organization, discovered its resources insufficient to strengthen Armenia 

in its struggle for independence amid a flood of returning refugees, 

shortages of food , and the threat of a Russian invasion . Officials of the 

organization asked Hoover for government assistance, and in August 

1919 he and President Woodrow Wilson dispatched a military mission 

under Col. William N. Haskell, a Regular Army officer. Haskell 's 

contingent included a medical department headed by Medical Corps 

officer Maj. Walter P. Davenport. Davenport and his American and 

Armenian staff provided hospital service for about 4,000 people each 

month and significantly improved Armenia 's health care facilities. The 

American doctors also conducted a successful program of inoculation 

against typhoid and vaccination for smallpox, which reduced death rates 

from both diseases. Finally, they tried to improve sanitary practices in 

local communities but devoted less attention to that work and met with 

less success. Early in the summer of 1920, a Bolshevik invasion seemed 

imminent, and Haskell's mission withdrew. Shortly after it did , the 

Russians overran Armenia. 6 

Typhus in Poland 

Concurrently, and again at Hoover's instigation, Army medical personnel 

undertook a second mission, one that did involve disaster relief. From the 

first months of World War I, typhus had been a threat in many areas of 

Europe. Transmitted by lice, typhus was a particularly painful and dangerous 

disease whose course ran from twelve to sixteen days, during which the 

victim suffered from high fever, a generalized rash, severe headaches, 

and nervous disorders. Historically, typhus epidemics had been associated 

with a cold climate, a starving population, and the movement of armies or 

refugees. All three conditions existed in Europe following the outbreak of 

war. 7 

Typhus was endemic in southeastern Europe, the Balkans, and Russia, 

and with the breakdown of social discipline in the area the disease spread 

60 n private efforts, see James Barton, Sroryo/ Near Easr Relief( /9/5 - /930): All /merprerarioll 

(New York: Macmillan Co., 1930) or Robert L. Daniel , Americal/ Philamhrop), ill 'he Near East 

(Athens: Ohio University Press, 1970), pp. 148- 70. On the Haskell mission, see Barton, Near East 

Relief: Bland and Surface. American Food. pp. 15 1- 52; Hoover, AmeriCQI/ Epic. 3: 397-408; 

Walter P. Davenport, "General Health Conditions and Medical Relief Work in Annenia," Military 

Surgeoll48 ( 192 1): 139-58. 

7Melville D. Mackenzie, Lou Borne Typhus Fever," in Me(lieal Diseases o/ War, ed. Si r 

Arthur Hurst et al. (Baltimore: Williams & Wilkins Co .. 1944), pp. 235-60; Hans Zinsser, Rats, 

Lice a1l(1 History (New York: Blue Ribbon Books. 1934). 
84 THE DEMANDS OF HUMANITY 

rapidly. In 1915 it ravaged Serbia, and by 1920 it had struck in Russia, 

Rumania, Lithuania, and the Near East. Poland-where typhus first 

appeared in the closing months of 1916 and raged for nearly four yearswas one of the more severely afflicted countries. Multitudes of refugees 

fleeing Russia and the Ukraine repeatedly reinfected its people. In 1919 

alone , more than 230,000 Poles contracted typhus, and nearly 20,000 

died.s 

In late March of that year, Hoover began receiving reports of the dire 

developments in Poland. Moved by the human suffering and fearful that 

typhus would spread to other parts of Europe, Hoover sought a means to 

check the epidemic. He may have considered relief a means to halt the 

spread of communism as well; certainly some Americans eventually sent 

to Poland considered stopping the spread of bolshevism a part of their 

task. In any case, Hoover verified the reports of suffering and investigated 

various means of sending relief9 

He found that the international community was only slowly responding 

to Poland's plight. In the spring of 1919, the American Red Cross sent a 

delegation of about fifty relief workers. Later its contingent grew to more 

than 150 people who distributed clothing, provided medical care, and 

helped the Poles establish preventive measures. That summer, the British 

Society of Friends also dispatched a small unit to Poland. Late in 1919 

and early in 1920, the League of Red Cross Societies sent two groupsone to aid in the treatment of the sick and to assist in the battle against the 

epidemic, the other to study the etiology of the disease . 10 

In the late spring and early summer of 1919, however, the expectation 

for sufficient private aid was extremely dim. Hoover determined that his 

8Richard P. Strong. " The Anti-Typhus Campaign in 1915 in Serbia Considered in Connection 

with the Present Typhus Epidemic in Pol and," IlIIematiOllal Journal of Public Health J (1920): 

188- 210; Harry L. Gilchrist. " Typhus Fever in Poland, " Military Sllrgeofl 46 (1920): 622-29: 

Harold H. Fisher and Sidney Brooks, America and the New Polalld (New York: Macmillan Co., 

1928), p. 242; Richard P. Strong el aI. , Typhus Fever with Particular Referellce 10 the Serbian 

Epidemic (Cambridge: Harvard University Press, 1920), pp. 94- 98. 

9Hoover, Memoirs, pp. 324- 25; Fisher and Brooks, America alld Po/(md, pp. 238- 40. For 

participants' references to political motives. see Marjorie K. Snive ly, comp., The Battle of the 

NOIl-combatallls: The Letters of Dr. Harry Hamilloll SlIively 10 His Family from R//ssia, Poland, 

France. Belgi//m, Persia, elc .. Assembled by His Dtmghler (New York: Business Bourse, 1933), p. 

110; Ltr, Harry L. Gilchrist to James Grindstarr, 27 Ju1 20, box 2, American-Polish Relief Expedition 

(APRE), Record Group 120. NA. Also see Vernon Ke llogg, " Poland. the Verge of Bolshevism. " 

Allalllie MOlllhly 124 ( 1919); 126-31: William R. Grove , War's Aflermath (Polish Relief i1l 1919) 

(New York: House of Field, 1940), pp. 127-28. 152- 54, 19 1- 92. 

IOStrong. Typhus Fever, pp. 98- 104; E. W. Goodall. " Typhus Fever in Poland, 1916- 1919, ,. 

Proceedings of the Royal Society of Medicine 13 ( 1920): 26 1- 76; Charles Halliday. " Conditions in 

Poland, 19 19- 1920, ,. Military SlIrgeon 51 (1922): 418- 43; S. Burt Wolbach, John L. Todd. and 

Francis W. Palfrey, The Eliology and Pathology of Typlms: Being the Main Report oflhe Typhus 

Research Commission of Ihe League of Red Cross Socielies to Polalld (Cambridge: Harvard 

University Press. 1922). 
DISEASE IN THE AFTERMATH OF WAR 85 

only recourse was to enlist the aid of the United States government. He 

expected no problems in arranging the sale of American stores to Poland 

but realized that the Polish government needed expert advice as badly as it 

did supplies. "The mere furnishing of equipment . . . ," Hoover wrote 

the president, " will have little result unless it is handled by experienced 

men." The American Army had men who possessed the requisite expertise 

and experience, and Hoover urged their dispatch to Poland as an expression 

of America's "sympathy for the distressed peoples of Central Europe." 

Wilson approved both the sale of equipment and dispatch of medical 

experts if Gen. John J. Pershing, commander of Army forces in Europe, 

concurred. Pershing did, and once Hoover had circumvented bureaucratic 

objections to the detailing of Regular Army officers, he secured his relief 

force I I 

To direct the Polish Typhus Relief Mission-in October 1919 

redesignated the American-Polish Relief Expedition (APRE)-Hoover, 

apparently at Pershing's suggestion, requested Col. Harry L. Gilchrist. A 

Medical Corps officer, Gilchrist had gained experience in public health 

work while serving in the military government of Manila and with 

disaster relief as part of the Army's medical contingent in San Francisco 

after the earthquake. He had arrived in Europe with the first American 

units in World War I and stayed to direct the Medical Section of the 

American Expeditionary Forces Gas Warfare Service. More important, 

Gilchrist had commanded the Army's delousing program in France after 

the armistice and so was familiar with typhus control. In the last days of 

June 1919, Gilchrist, who was still in Paris conducting research on gas 

warfare, received orders to organize a relief expedition and take it to 

Poland. 12 

Remaining in Paris and relying on second- or thirdhand reports of the 

epidemic, Gilchrist decided he would need at least 500 enlisted men and 

25 or 30 officers, 12 of whom should be medical officers. On 16 July the 

Secretary of War approved Gilchrist's request for personnel and authorized 

the detail of the necessary officers and enlisted men, though he insisted 

Gilchrist accept only volunteers. Meanwhile, Gilchrist had begun to 

assemble his staff. He convinced Col. Harry H. Snively to serve as his 

I I Hoover, American Epic. 2: 444- 45. Quotes from Fisher and Brooks,America and Poland. pp. 

240- 41; Telg. Pe~hingtoAG, 3 JU119. box 3, APRE. Record Group 120, NA. On a simiiarpattem 

of behavior by Hoover in a later disaster see Bruce Lohar .. 'Herbert Hoover. Spokesman of Humane 

Efficiency: The Mississippi Flood of 1927," American Quarterly 22 (1970): 690- 700. 

12"Obituaries: Major General Harry L. Gilchrist, U.S. Army Ret., ·' MiUtarySurgeon 94 (1944): 

122- 23. After this study was completed. an extensive discussion of the APRE appeared; see Alfred 

E. Comebise , Typhus and Doughboys: The American-Polish Typhus Rt!/iejExpedition, 1919- 1921 

(Newark: University of Delaware Press, 1982). 
86 THE DEMANDS OF HUMANITY 

deputy; launched a search for officers who spoke French, German, or 

Polish; and wired several posts seeking enlisted volunteers. For the most 

part the officers who responded, like Snively, had served in the Army's 

delousing program and therefore had the necessary expertise. The enlisted 

volunteers did not always possess the required skills, and some were not 

even of suitable character. But at least they were easily recruited, and by 

the end of July, Gilchrist had the number if not the type of men he needed. 

He and three other medical officers departed for Poland on 6 August, 

leaving Capt. Fred Pumphrey in charge of collecting and forwarding 

equipment and personnel. 13 

Pumphrey, a Sanitary Corps officer, inherited an irksome responsibility. 

The United States Army donated beds, hair clippers, portable baths, a 

million and a half suits of underclothes, and tons of soap to the Polish 

government. In addition, the Poles bought great stocks of surplus supplies 

from the American Expeditionary Forces, including numerous motorized 

bath plants, mobile steam laundries, mobile machine shops, portable 

bathing plants, trucks, ambulances, touring cars, beds, bedding, more 

soap and underclothes, and many other items. Pumphrey and his assistants 

were to'advise the Polish government on acceptance of individual items in 

the huge purchase. But the Polish officer in charge, who Pumphrey 

alleged spent all of his time motoring about Paris with his lady friends, 

neglected to inspect the goods and even accepted damaged or useless 

equipment against the counsel of the American advisers. 14 

Once the Poles had accepted the purchases, Pumphrey had to ship the 

supplies to Poland , no mean logistical feat in an area recently ravaged by 

war. He sent some by rail; in all , thirty-three trains with a total of 1,291 

cars carried supplies to Poland. But shortages of rolling stock necessitated 

transporting many of the vehicles and other parts of the purchase by 

motorcade. Unfortunately, the convoys were slow and expensive and the 

troops in them undisciplined. Many of the vehicles that had been accepted 

with mechanical problems broke down, and others were demolished in 

accidents caused by inexperienced drivers among Gilchrist's volunteers. 

All along the route, citizens complained about the soldiers' rowdy behavior. 

One convoy commander, for example, dressed a group of French women 

in American uniforms and brought them along. When the " men under 

him reported to Warsaw undisciplined and a large number of them with 

13Harry L. Gilchrist, Rpt of the American-Polish Relief Expedition. 1 Aug to 31 Dec 19, box I , 

APRE, Record Group 120. NA. See also Telgs sent from the Paris office, box 8, APRE, Record 

Group 120, NA . 

14Hoover, Memoirs, p. 326; Strong, Typhus Fever. p. )00. Memo for Gilchrist by Fred 

Pumphrey , 1 Sep 19. box 1; Ur, Gilchrist to Minister of Public Health of Poland, 29 Oct 19, box 4. 

Both in APRE, Record Group 120, NA. 
DISEASE IN THE AFTERMATH OF WAR 87 

venereal disease, " the captain was court-martialed, convicted, and 

discharged. 15 

As Pumphrey struggled with purchasing and shipping supplies, Gilchrist 

began operations in Poland. He and the three medical officers arrived in 

Warsaw on 10 August and immediately met with the minister of health, 

through whom the Americans would coordinate their relief effort. After 

conferring with him, Gilchrist traveled about the countryside to observe 

conditions, discussed Poland's problems with other Americans on the 

scene, and reviewed the lessons learned by the Army in earlier campaigns 

against plague, cholera, and yellow fever. Gilchrist concluded that his 

relief program had to achieve two interrelated goals: elimination of 

typhus-bearing Ike and modernization of the Polish health care system. 

In its dual aim, his program resembled Army medical operations after the 

Spanish-American War. But in Poland, unlike Cuba and the Philippines 

in 1898, a national ministry of health had already begun efforts to check 

the epidemic, so Gilchrist adapted his plans to it. 16 

To eliminate the lice, Gilchrist committed his relief force to the 

maintenance of a sanitary cordon along the eastern border of Poland, the 

project that Hoover had intended for the APRE all along. The APRE and 

Polish officials would operate facilities for cleaning and delousing everyone 

crossing the border to destroy the typhus-bearing lice before entering 

Poland. The Americans would also help eliminate typhus where it already 

existed through establishment of bathing and delousing plants in local 

communities and the operation of mobile columns to delouse residents of 

the remaining towns and villages. 

Gilchrist also wanted to accomplish the second goal, modernization 

of the Polish health care system. That involved American participation in 

the reorganization of Poland's various health agencies into one administration 

with a central committee to direct operations and functional departments 

to carry out its will. Gilchrist joined four Polish physicians on this central 

committee which was supported by departments of Propaganda, 

Transportation, Statistics, Hospitalization, Quarantine, Finance, and 

Schooling. This bureaucracy oversaw health and sanitation throughout 

Poland. To administer its policies, the committee and the minister of 

health created six districts of 18 to 25 counties each and appointed 

resident chief medical officers for every county. 

To provide' 'expert" advice, not only in typhus control but also in the 

administration of public health, Gilchrist assigned three Army physicians 

I'Gilchrist, Report of APRE; Ltr, Gilchrist toJ. C. White , II Jun 20; Ltrs, Pumphrey to Gilchrist, 

10 Sep 19, 29 Aug 19. All in box I , APRE, Record Group 120, NA. Quote from Statement by 

Gilchrist, 29 Jan 20, box 3, APRE, Record Group 120, NA. 

16Ltr, Gilchrist to Surgeon General, 20 Aug 19. box I , APRE. Record Group 120, NA. 
88 T HE DEMANDS OF HUMANITY 

to work with Polish medical officers at the district and county levels. 

Visiting the districts, the American doctors advised local officials on 

general sanitary conditions and inspected fac ilities and management in 

hospitals, orphanages, and other public institutions. To improve their 

services, other Americans distributed the supplies that had arrived from 

Paris and had been stored in a Warsaw warehouse to local hospitals 

throughout Poland. Still other members of the APRE established bathing 

and delousing stations in various towns and trained local citizens to 

operate them. J7 

Another facet of the modernization of the Polish health servicemotorizing it- absorbed the energies of a large number of the American 

enlisted personnel. The Polish government had purchased a sizable fleet 

of mobile steam baths, trucks, ambulances, and assorted sedans. The lax 

inspection process at purchase, the long and rugged convoy to Poland, 

and the lack of spare parts which necessitated frequent cannibalization 

combined to make keeping the vehicles in operating condition a task 

beyond the capabilities of the Polish nationals, who had little experience 

with motorized vehicles. The American soldiers, not always the best of 

mechanics themselves, trained the Poles to operate and repair their new 

equipment. 

A chauffeurs' school graduated more than 300 Polish drivers from a 

twenty-day course, but in a school for mechanics training took longer and 

never really succeeded. Language difficulties complicated instruction, 

and even the use of pictures only slightly eased the confusion. Too often 

the Americans, who either did not speak Polish or lacked the necessary 

technical vocabulary, tired of the tedious process of explaining repairs to 

the Poles and simply performed the maintenance themselves. Certainly 

the temptation to do so grew as the months passed, language imbroglios 

continued, the Poles learned only gradually, and commanders ranted 

about slow service. When Americans yielded to the temptation , however, 

they achieved efficiency at the cost of subverting attempts to teach the 

Poles to operate a motorized health service. I. The soldiers partic ipating in vehicle mai ntenance not only trained the 

Poles but also serviced many of the vehicles used in the second aspect of 

Gilchrist's plan, the direct assault on lice. In the APRE's first fa ll season 

in Poland, five Army medical officers assumed command at stations with 

bathing, delousing, and quarantine operations in the sanitary cordon 

l7"lnfonnation from Poland," Militllry SlIrgeoll 46 (1920): 221 - 28; Gilchrist, "Typhus Fever," 

passim. 

18" lnfomlation from Poland," passim: Rpt of the Service Department of the MOlorTransportation 

Service, 1 Feb 20; Llr, I. L. Hunt to Commanding General. American Forces in Germany (AFG). 3 
DISEASE IN THE AFTERMATH OF WAR 89 

along Poland's eastern border. They worked at the il)1portant border 

crossings, while Polish officials administered the remaining posts. The 

program intended to clean and delouse everyone entering Poland, but 

between I November 1918 and I January 1920, more than 2.5 million 

prisoners of war and civilian refugees entered the country. American and 

Polish officials did their best against such odds, but the sanitary cordon 

was far from totally effective. 

In addition to the cordon, the APRE utilized mobile field columns in 

its attack on lice. Each column had a staff of one commissioned officer, 

three noncommissioned officers, and fifteen privates and was equipped 

with a motorized bath plant, tents, stoves, bedding, and everything 

needed to support the staff and its operations. Gilchrist had initially 

considered sending 10 to 40 such units into the Polish hinterland but 

actually deployed only 4, which traveled from town to town in affected 

areas. 

The commander preceded the column to each town and conferred 

with the medical officer and other local leaders. With his advice, they 

chose a site for the temporary bathing facility and set its hours of 

operation. Then the commander and the officials attempted to convince 

the residents to submit to the delousing program. Rumors proliferated 

about the' 'real" purpose of the columns, and in one town everyone fled 

fearing the baths were in preparation for deportation. In other instances, 

Polish reluctance stemmed simply from a natural fear of the strange and 

unknown. One old lady living in a filthy little shack could not be 

persuaded to participate. "Death here in my hovel," she reportedly cried, 

"rather than the torture of bathing." Such vehement opposition should 

not have surprised Army medical officers whose predecessors after the 

Spanish-American War had encountered similar mistrust when bringing 

modem health care to a people unused to it. Nevertheless, the Americans 

in Poland quickly became exasperated and forced the people to cooperate, 

usually by withholding bread from anyone without a certificate from the 

bathing units. 19 

As preliminary coordination was accomplished, the column entered 

the town or village. With the help of civilians hired locally, the soldiers 

pitched two tents in a line with showers near one end and a sterilizer 

positioned to one side. When the equipment was in place and the appointed 

hour had arrived, local residents-whether cajoled or coerced- reported 

in designated groups. The process began with clipping the people's hair; 

Mar 20; Ltr, Frank H. Dixon to Gilchrist, 14 Oct 20. All in box I. APRE, Record Group 120, NA . 

Ltr, Francis McFitts to All Units, 17 Ocl 19. box 6. APRE. Record Group 120. NA . 

19Quole from Llr, HowardJ . Gonnan lOCO, 17 Nov 19. box I, APRE. Record Group 120, NA. 
90 THE DEMANDS OF HUMANITY 

Snively told of one column that had four or five men who spent an entire 

day doing nothing else. "If long hair means Bolsheviki, " he commented, 

" we are converting a big bunch every day." For many Polish Jews, long 

hair had a very different symbolic meaning, and in deference to their 

religious practices the Americans never insisted that they be shorn2 o 

Clipped and unclip'ped alike then entered the tents, where American 

attendants, or Polish employees in the case of women, directed them 

through the showers and at the same time took and sterilized their clothes. 

Scarcity of water and the high cost of heating it necessitated strict 

regimentation in bathing; the attendants allowed each group only a short 

time under the showers. After their baths, the people dressed and left, 

clutching their bars of soap---a valuable commodity in Poland- which 

they were allowed to keep.21 

Through this systematic procedure , each column bathed an average of 

500 people each day, and on some days as many as SOO. In all, the four 

columns deloused 2S ,OOO Poles, and no area in which they operated 

reported cases of typhus. Unfortunately, early winter storms forced the 

Americans to discontinue field operations in the first days of November. 

"From now on to May there will be intense suffering among these 

people," Snively wrote home, "cold, lack of fuel , clothing, food . My 

God! How I pity them. " In the remainder of the letter, Snively recounted 

an earlier experience in the field that revealed the psychological and 

emotional turmoil that the relief workers themselves had endured. "I 

went back to Warsaw after two weeks in the villages, more nearly 

knocked out and nervous than ever in my life. I stayed in my room, 

refused to think of them, read the lightest literature. " Only "after a week 

away from it" could he return to the field without " those awful nightmares." 

"It is awful when you cannot keep from seeing this mass of hungry, 

staring, hollow-eyed, ghostly, ragged, verminous humans. When they 

stare out at you from the walls of your locked room, from the sky, from the 

forest, from the rivers, and from the books you are trying to read.' 022 

The winter storms that ended the operations of the field columns 

arrived only shortly before the scheduled departure of the Americans. The 

Polish government wanted to retain American assistance, however, so the 

minister of health wrote Secretary of War Newton D. Baker requesting 

that the APRE be allowed to remain in Poland. The minister also convinced 

2()Quote from Snively. Non-combatants, p. 127. 

21Ltr, Howard J. Gorman to CO, 17 Nov 19; J. M. Gillespie. Rpt on Activities of the Field 

Column No.3, I Oct to 8 Nov 19; Rpt loCommanding Officer. AFG. 2 1 Jan 20. All in box I, APRE, 

Record Group 120, NA. Snively. Notl-combarallfs, passim. 

2l" lnfonnalion from Poland, ,. passim; J. M. Gillespie , Rpi on Activities of the Field Column 
DISEASE IN THE AFTERMATH OF WAR 91 

Hoover to intervene with the secretary on Poland's behalf. The lobbying 

succeeded, and Baker extended the APRE's stay, at first until 30 June 

1920 and later to I November 1920. Baker reasoned that the Polish 

campaign provided the Army Medical Department with "experience not 

otherwise to be secured in dealing with an epidemic disease" at a minimal 

cost since Poland provided the equipment and with the help of private 

agencies paid most of the administrative expenses. Despite the extension, 

the strength of the APRE was reduced to 161 men in November and even 

further cut in December. Between January and November 1920, the total 

number of soldiers serving with the APRE fluctuated between 94 and 

51. 23 

Despite his smaller staff, Gilchrist attempted to continue all the 

programs except the field columns. Efforts to strengthen and modernize 

the Polish health service continued and increased. After a crisis in the 

Polish cabinet in early 1920, the government appointed a new health 

administrator with authority over areas of the country previously subject 

only to military rule . He became an antityphus dictator of sorts, and 

Gilchrist worked closely with him. Even under the reorganization, however, 

American officers continued to inspect health facilities, counsel local 

authorities on saniiary matters, and instruct the Poles in delousing procedures 

and the operation of sterilizers. 2. 

In fact, Gilchrist wanted to expand efforts at sanitary reform in the 

smaller Polish towns. As an experiment, he sent 1st Lt. Robert C. Snidow 

to one of the fIlthiest villages, Garwolin. Snidow and three American 

enlisted men, two of whom spoke Polish, instituted programs to clean and 

disinfect houses and public facilities. Partly because of tensions between 

Poles and Jews, but mostly because of the reluctance of all the villagers to 

participate, the Americans exercised greater and greater authority. Serving 

simply as advisers did not ensure reform, Snidow reported, and' 'we in a 

very insidious manner gradually assumed the control of the town so.that at 

the end of the work we were practically the government. " Lack of time 

No.3,8 Nov 19, box I. APRE, Record Group 120. NA. Quote from Snively, Non-combatants, 

p. 143. 

DFisher and Brooks. America and Poland, pp. 243-44; RSG, 1920. p. 378; Memo for Chief of 

Staff by Newton D. Baker, 6 May 20, Poland 710, Records of the Adjutant General's Office, 

19 17-. Record Group 407, NA. Company Returns. 1 Ocl 19 1031 Dec 20, HQRA, APRE, box 9, 

APRE, Record Group 120, NA. Hoover estimated total costs at well overS l00 million (see Hoover, 

American Epic, 3:266). The ARA paid S950.000 for transportation and incidental expenses; the U.S. 

Foreign Service paid some civilians; The Surgeon General listed the cost to the Medical Department 

at $ 105,601 (see RSG , 192 1, p. 192). 

2ASummary Report, APRE, 1920, box 10, APRE, Record Group 120. NA; RSG, 192 1, p. 193; 

Fisher and Brooks, America and Poland, pp. 246-47. For a report by one such American officer, see 

Ltr, Frank H. Dixon to Gilchrist, 14 Oct 20, box 10, APRE, Record Group 120, NA. 
92 THE DEMANDS OF HUMANITY 

and personnel, however, limited work in individual communities. 25 

The major focus of American and Polish health officials during the 

winter of 1919- 1920 remained maintenance of the sanitary cordon along 

Poland's eastern border. American medical officials helped to staff the 

stations. In December 1919 one of them, Lt. Col. Edward C. Register, 

contracted typhus and several weeks later died. He was not the only 

casualty in the APRE; one enlisted man was killed when a sterilizer 

exploded, and another died of pneumonia. Still the work of the fifteen 

delousing stations continued, and at each , health officials let no one pass 

without a bath and sterilization of his clothes. As an added precaution, 

Gilchrist assigned Lt. Arthur E. Fox and a group of eighteen enlisted men 

to a mobile unit that included four rail-mounted delousing plants located 

in cities where rail lines entered Poland26 

Just as the increased activity along the border began to yield results, a 

Russian invasion of Poland destroyed the sanitary cordon. As early as 

May 1920, Fox reported difficulty maintaining contact with his units 

because of the Russian advance, and during early summer the Bolsheviks 

completely overran the area. One American sergeant who waited until the 

last minute to get his train out of the Soviet's path was captured but soon 

released. Other bathing trains were captured, and all the quarantine 

stations fell to the Russian troops. Gilchrist termed the Bolshevik advance 

"a great calamity," and later ARA historians estimated that the invasion 

nullified 75 percent of the progress the APRE had made againsttyphus. 27 

With its major program so summarily suspended, the APRE turned to 

other, less important tasks. Some of its members deloused and prepared 

for repatriation of a group of Polish-Americans, known as Haller's army, 

who had corne to Europe to fight for Poland before American entry into 

the war and had remained to help the Allies. Other members of the APRE 

supervised sanitation and conducted a delousing program in a refugee 

camp near Krakow with more than 6,000 residents. Late in August 1920, 

stunned by the success of the Russian invasion, Gilchrist agreed to 

establish within the Polish Army a delousing program similar to that he 

conducted for the American Army in France. Although Poles performed 

most of the work, American soldiers traveling with Polish fighting 

divisions instructed and supervised them. Their contribution to the Polish 

25Quote from Rpl of Duties Perfonned , APRE, I Jan to 1 Nov 20, by 1st Lt Robert C. Snidow, 

box I, APRE, Record Group 120 , NA . . 

260ilchrisl, "Typhus Fever," p. 625; RSG, 192 1. p. 192- 93; Rpt, Inspector General to 

Commanding General , AFG, 1 Sep 20, Poland 710, Record Group 407, NA . 

21Ltrs. A. H. Fox 10 Commanding Orneer, 27 May and 27 Ju1 20. box 10, APRE, Record Group 

120, NA. Llf, Gilchrist to Col Godlowski. 9 Sep 20, box I , APRE. Record Group 120, NA. Quote 

from Rad. Commanding Officer, APRE. to Commanding General, AFG , 21 Aug 20, Poland 7 10, 
DISEASE IN THE AFfERMATH OF WAR 93 

Army was neither large nor of long duration. It began at a time when only 

fifty soldiers remained with the APRE, and by October almost all APRE 

activities had ended. 2

• 

On 2 November all of the Americans except Gilchrist and four 

enlisted men left Poland; the latter stayed to finish the paperwork and 

dispose of the remaining supplies. On 4 January 1921 they, too, completed 

their duties, and the unit officially disbanded. It could not easily be 

labeled a stellar success. A highly negative Inspector General's report on 

its operation concluded that the APRE had simply not accomplished its 

mission. The inspector proposed several reasons for the failure: Gilchrist 

had to plan his mission in Paris without knowing the real situation in 

Poland; the personnel sent did not best represent the United States; the 

constant breakdown of motor transportation curtailed effectiveness; and 

the Americans coordinated relief through the Ministry of Health rather 

than the Polish Army, which actually had the power to accomplish 

things.

29 

Even though tainted by line prejudice against a medical officer in 

command, the report retained some validity . The troops who went to 

Poland did not conduct themselves in exemplary fashion. Courts-martial 

for drunkenness, introducing women into quarters, theft, disorderly conduct, 

disobeying officers, striking civilians, and various combinations of these 

were frequent. Gilchrist may not have exercised sufficient control amid 

such disorder, but his task was more difficult than it need have been. He 

simply had too many responsibilities: professional consultant to the 

Polish Ministry of Health, director of a campaign against an epidemic 

entrenched in a large area wracked by war, as well as commander of a 

military unit. And the unit had been especially assembled-though thrown 

together might more accurately describe the process-for the mission, 

when one already established might have served better. Finally, a 

development over which he had no control, the Russian invasion, more 

severely limited the APRE's accomplishments than did poor planning, 

shoddy maintenance, or disciplinary problems. 30 

Record Group 407. NA; Fisher and Brooks. America and Poland, p. 247. 

211Rpt, Inspector General to Commanding General , I Sep 20; Rpt, Commanding Officer APRE to 

Commanding General AFG, 21 Aug 20. Both in Poland 7 10, Record Group 407, NA. Ltr, Gilchrist 

to Minister of Public Health, 26 May 20, box 4, APRE, Record Group 120, NA: Rpt of Duties 

Perfomled, APRE, 1 Ian to 1 Nov 20, by 1st Lt Robert C. Snidow, box I, APRE, Record Group 120, 

NA; Company Returns, APRE, Mar 10 Nov 20, box 9, APRE, Record Group 120, NA. 

29Company Returns, APRE, box 9, APRE, Record Group 120, NA; Rpt, Inspector General 10 

Commanding General , AFG, I Scp 20, Poland 7 10, Record Group 407, NA. The IG came from 

Headquarters, AFG , which had administrative control over the APRE after 5 Nov 19. See Memo for 

Chief Surgeon by Brehon Somervell. 29 Jan 20, box 10, APRE. Record qroup 120, NA. 

JOSee the records of special courts~ marti l and summary courts-martial, box 10, APRE, Record 

(Continued) 
94 T HE DEMANDS OF HUMANITY 

Despite all shortcomings, the unit did help the Polish people. The 

APRE may have failed to rid the country of typhus, but it did ease the 

intensity of the epidemic. It deloused thousands of entering refugees; it 

deloused many residents in the hinterland that first fall; it helped to 

modernize, motorize , and generally strengthen the Polish health service. 

The American-Polish Relief Expedition proved something less than a 

total success, but it was far from an abject failure . 

Famine in Russia 

In the year after the antityphus campaign in Poland ended, Hoover 

called on Army medical personnel a third time. In 1921 the devastation of 

war followed by the disruption of revolution, both compounded by the 

cruelties of nature, left Russia in the throes of one of the worst famines in 

recorded history. Starvation loomed for nearly IO million people; 2 or 3 

million did die; and some survivors were desperate enough to tum to 

cannibalism. In a small village, young boys orphaned by the famine 

hanged their little sister, left her swinging in the kitchen, and cut off 

pieces of her body to eat as they became hungry. Those who survived 

starvation, by whatever means, still had to endure intense cold and 

outbreaks of typhus, typhoid, cholera, smallpox, and other diseases. 

Taxed by war and reorganized by the Communists, the Russian medical 

system offered little comfort to the suffering. Medical personnel fell 

victim to famine as readily and rapidly as patients, and poorly supplied, 

unsanitary hospitals did not have sufficient space to accommodate the 

sick and dying. 3 1 

On 13 July 1921 Russian writer Maxim Gorky appealed for foreign 

assistance to save his starving countrymen. Gorky's plea prompted Herbert 

Hoover, then secretary of commerce but still head of the ARA, to 

instigate a new ARA relief program. He began a complicated series of 

(Continued) 

Group 120, NA. Although no onc was tried . at least onc Pole accused an American serviceman of the 

rape of a Polish woman. For a comment on the creation of the unit, see Synopsis of Reports from 

APRE, Poland 7 10. Record Group 407, NA . 

:uOn the causes o f the famine, see Weissman . Hoover (UU/ Famine. pp. 1- 3; Harold H. Fisher, 

The Famine in Soviet Russia . 1919- 1923: The Operations of the American Relief Administration 

(New York: Macmillan Co ., 1927). pp. 429- 36 , 469 - 506; Frank Golder and Lincoln Hutchinson , 

011 fhe Trail of the Russian Famille (Stanford : Stanford University Press, 1927), pp. 1- 26. The 

incident of can nibalism is mentioned in W. R. Dear, "The A.R.A . in Russia," Military Surgeon 69 

(193 1): 403 - 4; but for others, see F. H. Foucar, "Resume of Experiences and Work Accomplished 

in Russia with the American Relief Administration, 192 1- 1923, Part I," Military Surgeon 54 

( 1924): 688; Henry Beeuwkes, " American Medical and Sanitary Relief in the Russian Famine, 

192 1- 1923," American Relief Administration Bulletin , 2d ser., no . 45 (Apr 26): 20 -2 1. On 

problems in the Russian medical system, see Golder and Hutchinson, Oil tile Trail, pp. 70, 125- 26, 

137 , 143; Beeuwkes, "Medical and Sanitary Relief." 
DISEASE IN THE AFTERMATH OF WAR 95 

negotiations with the Russian government to set the conditions under 

which the ARA would render aid to the famine-stricken. With each side 

extremely suspicious of the other's intent, the talks dragged on for nearly 

two months before reaching agreement. Though the ARA had become a 

private corporation, its need for huge sums of money and large quantities 

of supplies to fu lfill the pact forced it to seek United States government 

support. During the fall, Hoover asked Congress for aid; after a heated 

debate it appropriated $20 million for Russian famine relief. Still later in 

the fall, at the request of the president, Congress made $4 million worth of 

War Department, Navy, and Public Health Service medical supplies 

available to the ARA. 32 

Well before the congressional appropriation, the ARA had begun its 

work in Russia. Toward the end of the summer, Hoover appointed Col. 

William N. Haskell , who had headed the Army mission to Armenia and 

served with relief forces in Rumania, to direct the operation. The agreement 

with the Russians allowed him a staff of about 180 Americans, who 

started trickling into Russia in August. They served both in administrative 

departments and as district supervisors and assistants actually controlling 

the flow of food and supplies to the people. Though some of them were 

Regular Anny personnel, Haskell directed an essentially civilian operation 

that happened to have soldiers serving with it. 33 

However, a little more than a fifth of the Regulars who served in 

Russia with the ARA were in its Medical Division , in which military 

doctors occupied key leadership positions. Hoover again called on the 

Army to direct medical relief, appointing Medical Corps officer Col. 

Henry Beeuwkes to head the division. Beeuwkes assembled a staff that 

included five other Regular Anny officers from the Medical Department: 

Maj . Walter P. Davenport, his assistant director; Capt. John H. Dawson, 

of the Medical Administrative Corps, chief of the central medical warehouse; 

and Majors William R. Dear, Frederick H. Foucar, and Glenn r. Jones, 

all district medical officers. Thus medical relief work depended more on 

the Army than did other aspects of the operation, even though the 

remainder of the division's personnel were civilians.

34 

When Beeuwkes arrived in Russia on 21 September 1921 he promptly 

opened a Moscow office from which he directed medical operations. The 

llFisher. F{/mi" e, passim , but especially pp. 138-54: Weissman. Hoover {Iud Famille, pp. 

1- 110; Bland and Surface . American Food, pp. 11 5- 16. 

330 n Army involvement. see Weissman. Hoover and Famine, p. 85: on the administration of 

relief. see Fisher , Famine. pp. 11 2- 15. 

34Hoover. American Epic, 3: 467; Beeuwkes .. 'Medical and Sanitary Relief. ,. pp. 85-8'1. A lisl 

of the Medical Division's personnel was compared with theArmy Regisler. In all. 26 Regulars served 

with the ARA . but no more than 19 were in Russia at anyone time. 
96 THE DEMANDS OF HUMANITY 

capital was also the site of the ARA's central warehouse, which received 

medical supplies shipped from the United States and channeled them to 

locations throughout Russia . Both Beeuwkes's office and the warehouse 

supported health teams in the districts that had an American doctor in 

charge, one or two American assistants, and a varying number of Russian 

workers. Together, they conducted four types of assistance programs. 35 

First, and most important, the district medical officers sought to 

improve the Russian health care system. They frequently inspected hospitals 

and other types of health care facilities to determine their needs and then 

requested appropriate supplies from the central warehouse. When the 

warehouse shipped their requests, the district staff distributed them to the 

various facilities. In all, the ARA Medical Division furnished medical 

stores and equipment to 16,419 institutions-most of them hospitals, 

dispensaries, or children's homes-with a total capacity of more than a 

million beds. Supplies furnished included 357 kinds of medicine, 627 

types of surgical instruments,. and hundreds of varieties of laboratory 

supplies, disinfectants, and other medical items. Some of them came 

from the cache of Army supplies donated by Congress, but since it offered 

limited variety the ARA also depended on purchases and grants from the 

American Red Cross. District medical officers also ensured that the 

Russian personnel at medical institutions had enough food to eat. With 

staffs no longer starving and facilities better equipped, hospital service in 

Russia improved. 36 

Perhaps not as important as the resupply of Russian hospitals but still 

a major aspect of medical operations was a program to vaccinate and 

inoculate the people. The district medical officers administered the program 

but employed and trained Russians to serve as vaccinators. Both the 

Americans and the Russians had to proceed cautiously, because in earlier 

attempts visiting vaccinators had been beaten or killed by suspicious or 

hostile villagers. Before sending vaccinators to any town, the medical 

staff conducted an extensive educational and propaganda campaign. For 

the most part it succeeded, and nearly IO million Russians submitted to 

inoculation against five types of disease: typhoid fever, two kinds of 

paratyphoid, smallpox, and diphtheria 37 

The other types of medical relief, public sanitation and delousing, 

l5For the philosophy behind them, see Beeuwkes, " Medical and Sanitary Relief, ,. pp. 75-76. 

36Beeuwkes. "Medical and Sanitary Relief." pp. v, 70- 72; Bland and Surface, American 

Food. pp. 252. 936-86. 

37SJand and Surface, Americall Food, pp. 252- 53. For the operation of the program in the 

districts, see F. H. Foucar, " Resume of Experiences and Work Accomplished in Russia with the 

American Relief Administration, 1921 - 1923, Part II," Military Surgeon 55 (1924): 32- 34; Dear, 

"ARA in Russia, ,. pp. 393-94. 
DISEASE IN THE AFTERMATH OF WAR 97 

were not as central to the ARA medical staff's efforts. District officers did 

encourage local officials to improve sanitary practices and sometimes 

used food to hire local citizens to clean streets, sewers, and drains. To 

delouse the residents, medical workers opened baths equipped with 

autoclaves for sterilizing clothes in Moscow, Samara, and other locations. 

The district doctors insisted that institutions supported by the ARA 

operate delousing programs for their own patients. Between the two 

methods, many Russians were deloused. 38 

A list of the various types of medical relief, although indicating what 

the Americans did, obscures the personal sacrifice and dedication the 

work entailed. The American doctors lived and labored among an alien 

people and under the watch of hostile political officials. When they 

visited a town to discuss inoculation, they did not know if they would be 

killed for their trouble, as some previous health emissaries had been. But 

they did know that their visits necessitated freezing rides through vast 

snow-covered regions where any accident meant they would not be found 

until the spring thaw, if then. Many times they slept in cold haylofts rather 

than endanger themselves in the warmer but usually contaminated peasant 

huts. Despite their precautions, several of the Americans contracted 

typhus, and others for whom the mental strain surpassed the physical 

suffered nervous breakdowns. And, one of the Army medical officers 

observed, " the horrifying experiences to which [they 1 were continually 

subjected in this land of despair" left none who were not " permanently 

changed by the experience. ,,39 

Their sacrifices helped to ease the suffering, however, and by April 

1922 Hoover suggested the mission conclude its work in Russia . Other 

relief officials disagreed, and Hoover consented to the continuation of the 

ARA's labors, though after the September harvest the Americans did 

greatly reduce their assistance. The next month they sensed pressure from 

the Soviets to withdraw, which indicated the crisis had indeed passed and 

political priorities were reemerging. Nevertheless, the ARA continued a 

less extensive program until June 1923, when the operation drew to a 

close. By then all the district physicians had gone home and of the 

medical contingent only Beeuwkes and his assistant remained. On 20 

July, Haskell, Beeuwkes, and the remainder of the staff left Moscow, and 

the ARA mission to Russia ended. It had fed almost ten million people, 

inoculated nearly as many, and significantly improved medical and 

hospital service. The ARA had done so with a minimum of political 

38Hoover, American Epic. 3: 474; Bland and Surface, Americ{lJi Food, p. 253; Foucar, "Experiences, 

Part 11 ," pp. 29-30; Dear, .. ARA in Russia," pp. 401 -2. 

lYBased on Foucar. "Experiences. Parts I and II" ; Dear ... ARA in Russia," quote from p. 396. 
98 THE DEMANDS OF HUMANITY 

friction and without subverting the Russian government. The operation 

had proved both a helpfu l humanitarian venture and a successful experiment 

in cooperation between hostile political systems. 40 

The operations in both Russia and Poland had been responses to 

particular situations to some extent created by the war, and Army Medical 

Department personnel undertook no more such missions. Both operations, 

though, testified to the continued strength of America's sense of humanitarian 

mission. The famine relief operation in Russia revealed that the United 

States would undertake aid in a nation with whom it shared few political 

values if the needs of humanity demanded it. On the other hand, the 

ARA's operation in Europe- and Gilchrist's typhus control efforts as 

part of it- suggested that the United States often sought political as well 

as benevolent goals in its relief activities. Just as Hoover had hoped to use 

American food and medical care to strengthen the free countries of 

Europe, government leaders after World War II would dispatch disaster 

relief to many parts of the world for similar reasons. But for the remainder 

of the interwar years, America's fear of expanding bolshevism as well as 

its commitment to internationalism waned, and the relative inactivity of 

Army medical personnel in foreign disaster assistance resumed. 

4OFisher , Famine. pp. 393- 401 ; Weissman , "ARA in Russia," pp. 2. 308 - 94; Weissman, 

Hoover and Famine. pp. 192 - 202. 
CHAPTER 6 

Relief Role in Transition: Assistance 

at Home and Abroad, 1918-1939 

Though World War I had generated a need for unusual reliefmissions 

in Poland and Russia , it did not spur increased Army medical involvement 

in other types of disaster assistance. In fact, the war effort precluded the 

participation of the Medical Department in providing major aid in the 

nation's deadliest disaster- the 1918- 1919 epidemic of influenza, which 

claimed about 675,000 lives. State and local boards of health along with 

the Red Cross rendered most of the relief, though all three received 

support from the United States Public Health Service (PHS). Congress 

passed a special appropriation to pay for the PHS's efforts; the bill also 

authorized the Army and Navy medical departments to provide civilian 

relief. But the influenza struck first and possibly hardest in Army training 

camps and aboard troopships bound for Europe , and caring for soldiers 

absorbed the military's medical resources. The Army Medical Department 

did occasionally assist civilians-as when it loaned hospital tents and 

corpsmen to Washington, D.C., for a temporary influenza hospital- but 

for the most part its own responsibilities prevented significant civilian 

aid.' 

After the war, Army Medical Department personnel resumed their 

role in relief operations. Following a June 1921 flood in Pueblo, Colorado, 

II doctors, 15 nurses, and 25 enlisted men from Fitzsimons General 

Hospital in Denver provided health care as part of a larger relief operation 

directed by Army engineers. On 6 June the medical contingent established a 

250-bed hospital in Pueblo, which remained in service until early July. 

During that time , its staff treated cases of smallpox, typhoid fever, and 

other illnesses. In August of the same year, Fort Dix, New Jersey, 

assisted nearby Jacobstown during an outbreak of typhoid fever. The post 

loaned the town equipment to establish a hospital in a local chapel, sent 

I Alfred W. Crosby, Jr .• Epidemic ami Peace, /9/8 (Westport, Conn.: Greenwood Press, 1976), 

p. 206 and passim; Dorothy A. Pettit. "A Cruel Wi nd: America Experiences Pandemic Influenza, 

19 18- 1920: A Social History" (Ph.D. diss. , University of New Hampshire, 1976), pp. 12 1-22 

and passim; Noyes .. 'Influenza Epidemic . " pp. 195- 202 and passim. See also Richard Coll ier. The 

Plague o/Ihe Spallish Lady: The IlIflllt llZG Pandemic of 1918- 1919 (New York : Atheneum. 1974). 
100 THE DEMANDS OF HUMANITY 

soldiers to set it up, and detailed medical officers to serve on its staff and 

to administer an antityphoid program. 2 

Such minor domestic missions were much more common in the 

1920' s than foreign operations, but the largest single medical effort of the 

interwar years did occur abroad. From I to 3 September 1923 an earthquake 

rocked Japan, causing terrific destruction centered in the large cities of 

Tokyo and Yokohama, where fires burned out of control. Reports told of 

2 million people homeless, 100,000 seriously injured, and upwards of 

200,000 dead. 3 Under the direction of the American military attache, the 

small Army delegation in Japan at once mobilized to locate, succor, and 

report on their stranded countrymen. Almost as quickly, the United States 

Navy's Asiatic Squadron dispatched ships to the area to aid distressed 

Americans and provide a communication link with the outside world 4 

Because of special circumstances, the response of the United States to 

the quake in Japan was unusually generous and the Army's mission 

atypically large. Many businessmen considered it a propitious time for 

increased trading ties, while other Americans recalled the large Japanese 

contribution to the Red Cross relief fund during the San Francisco 

earthquake. Of course, some people were simply moved by the magnitude 

of the suffering. Contributors channeled funds through private groups, 

but the United States government decided to send a relief force as well. As 

reports from the Asiatic Squadron became bleaker, the size of that 

delegation grew, and the War Department eventually ordered preparation 

of two relief vessels in the Philippines and another in San Francisco. To 

coordinate supplies and personnel, the Secretary of War sent Brig. Gen. 

FrankR. McCoy and Col. George T. Langhorne to Japan to command the 

expedition. Assistants to the governor general of the Philippines, the two 

happened to be in China at the time of the quake .

5 

20 n Pueblo, see Johnson, "Emergency Response," 7: t - 10; Memo for Assistant Chief of Staff 

by Kenzie Walker, 22 May 22. box 929, 400.38, RccordGroup407, NA; "Anny NOles, " Armyalld 

Navy JOllmal 58 (192 1): 11 24; ,. Army Medical Department Aids Flood Sufferers." Army alld Navy 

)ollma/ 58 (192 1): J 179. On Jacobstown, see S. Jay Turnbull , "Report on an Outbreak of Typhoid 

Fever at Jacobstown, N.J., August , 1921, ,. Military Surgeoll 50 (1922): 306-9. 

3Mark J. McNeal , "Destruction of Tokyo," Catholic World 11 8 (1924): 315- 16; Curti, 

American Philanthropy, p. 339. For a comprehensive account of the quake and its aftermath, see 

Bureau of Soc ial Affairs, The Grellt E(lrtliqllake 0/1923 ill Japal/ (Japan: Bureau of Social Affairs. 

Home Office. 1926). 

4Rpl of LI Col Charles Burnett, bulky package. 400.38, Record Group 407. NA; " Destroyer 

Division No. 38 Makes Record Cruise ," Army lIlId Nav)' JOllrnal 62 ( 1925): I; Bureau of Social 

Affairs, Great Earthqllake. p. 4 11 j U.S. Depanment of Slale, PalJers Relatillg to the Foreign Affairs 

o/the United States. 1923,2: 470. 

50 n motivations and private relief, seeCuni,Americall Phi/(lIIlhrop),. pp. 339-43. On government 

aid, see Memos for AG by S. Heinlzeman, 2 and 4 Sep 23; Telg, Read 10 AG, 5 Sep 23; Te1g, 

Secretary of War 10 Secretary of State, 6 Sep 23. All in box 929, 400.38. Record Group 407, NA. 
RELIEF ROLE IN TRANSITION 101 

As McCoy sailed to Japan, preparation of the relief ships proceeded. 

In the Philippines, crews quickly loaded the U.S. transport Merritt with 

subsistence and medical supplies. On the 6th, a relief party including ten 

Medical Corps officers, two Medical Administrative Corps officers, a few 

American civilian physicians, and a sizable contingent of Filipino medical 

personnel sailed on it. A second ship, the Meigs, had to be unloaded and 

then reloaded with relief items, so it did not depart until the 10th. In San 

Francisco, meanwhile, laborers rapidly loaded the U.S.S. Somme with 

hospitals, carnp infirmaries, and other medical equipment. The Somme 

left San Francisco harbor on the 8th, but in the haste to be under way it 

sailed without tents for the field hospitals it carried or all of the personnel 

originally assigned to the mission. Even without them, the contingent 

included 10 Medical Corps officers, 6 Army Nurse Corps officers, and 4 1 

medical enlisted personnel. 6 

As the ships sailed, the role their relief parties would play remained 

unclear, and the political situation in Japan appeared potentially as 

volatile as that in Russia had been. Japanese-American relations were 

strained because of ill will engendered during joint occupation of Siberia 

in 19 18- 1920 and by what the Japanese perceived as a slight to their 

national stature at the Washington Naval Conference of 192!. Japan's 

traditional hostility toward visiting military delegations did nothing to 

improve prospects for a harmonious operation. American Ambassador 

Cyrus E. Woods warned Washington that a "small incident" could have 

devastating diplomatic reverberations and suggested the American delegation 

simply give its supplies to the Japanese rather than attempt to distribute 

them" 

Partially heeding Woods' warning, American relief officials proposed 

to aid only foreigners in Japan unless they were specifically requested by 

the government to help the Japanese. But as the relief ships approached, 

Japan decreed that no foreign delegations would be allowed ashore for 

any reason . McCoy, who had already arrived, pleaded with a few of the 

country's leaders to disavow that policy. He failed to convince the 

Japanese to abandon it completely but secured a modification allowing 

McCoy's Narrative. bulky package, 400.38. Record Group 407. NA . 

~n activities in PI}i1ippines, see Memo for AG by Chas. C. Aalcutt, 6Sep 23; Telg, Bundy to AG, 

6Sep23. Both in box 929, 400.38, Record Group 407 t NA. E. L. Munson, " Report on the Medical 

and Hospital Service ohhe Japan Relief Mission , , t MOlllhly Bul/etin o/the Philippine Hea/th Service 

4( 1924): 52. On loading in San Francisco, see Rpt ofMaj G. R. McBrayor, bulky package , 400.38, 

Record Group407, NA. Telgs, Morton toAG, 8 and II Sep23; Memo for AGby R. U. Patterson, 15 

Sep 23. All in box 929, 400.38, Record Group 407 , NA. 

7Quote from U.S. Department of State . Papers Relalillg to the Foreigll Relatiollso/the Vllited 

Stat.es, 1923 , 2: 469. 
102 THE DEMANDS OF HUMANITY 

any party already en route to land.

8 

Even so, American relief officials chose to minimize American 

involvement to avoid any infringement of Japanese sovereignty. They 

decided, first, " to establish nothing ashore unless requested by the 

Japanese authorities; second, to tum over to the Japanese any installations 

or equipment requiring personnel ashore as rapidly as they can be taken 

over by Japanese personnel; [and) third, after delivering Army supplies 

now en route to withdraw all facilities and personnel. " Under the policy, 

McCoy would give the American embassy all the subsistence supplies it 

needed and donate the remainder to the Japanese Relief Bureau for 

distribution. With medical and hospital stores, he planned to have American 

troops establish an operating model of every type of facility in the 

shipment to be transferred as quickly as feasible to the Japanese and to 

give the others to them at once. 9 

On 15 September the Merritt arrived in Yokohama and was followed 

over the next few days by the other ships. As each arrived it began to 

unload, but rough weather, a shortage of lighters, and jumbled cargo 

holds resulting from hasty and haphazard loading slowed the process. 

Crews spent a good deal of their time sorting supplies before sending 

them ashore, and one officer complained that "a delay of half a day in 

Manila ... would certainly have saved more than a week's delay in 

rendering hospital service in Japan ... Once on shore, soldiers unsystematically 

dumped the supplies, creating new snarls which slowed erection of the 

contingent's own bivouac. When at last it was pitched, the Americans and 

Filipinos turned to the work of constructing the first model hospital. 10 

Although ideally located in the midst of the distressed populace, the 

site adjacent to the bivouac had several shortcomings. Tremors continued 

to shake it periodically, the old and new fissures that crisscrossed its 

surface created severe drainage problems, and the resulting bog proved 

hazardous to trucks. Since no water supply existed, the Navy brought in 

distilled water until a fairly efficient system could be jury-rigged from a 

well discovered nearby. Despite these disadvantages, construction began. 

Quarters for the hospital staff and most of the ancillary tents went up 

quickly, and a dispensary opened. But ward tents had been loaded aNhe 

very bottom of the hold on the second ship and were not brought ashore 

until 29 September, ten days after the ship's arrival. They too were finally 

IICable, AG to McCoy. 6 Sep 23; Telg, Davis to McCoy. 8 Sep 23. Both in box 929. 400.38, 

Record Group 407. NA. McCoy's Narrative. bulky package, 400.38, Record Group 407. NA. 

9Quotc from Cable, McCoy to AG, 22 Sep 23, box 929, 400.38, Record Group 407. NA. 

McCoy's Rpt; M cCoy's Narrative. Both in bulky package. 400.38, Record Group 407. NA. 

IOQuote from Munson, "Report on Hospital Service," pp. 55 - 56. 
RELIEF ROLE iN TRANSiTION 103 

pitched, and on the same day the Americans turned the completed 

hospital over to the Japanese. II 

Then the relief force boarded the Somme for transfer to Tokyo, where 

it continued to render assistance. At the request of the staff and with the 

permission of the Japanese government, McCoy's troops rebuilt and 

resupplied St. Luke's Hospital, an American-administered facility in the 

city that treated both foreign and resident patients. Disorganization in 

unloading again prolonged the process, but line officers with guidance 

from medical personnel supervised construction of a 216-bed hospital 

complete with field laboratory, bedside X-ray outfit, and a stock of 

medicines. When finally completed, it was turned over to the St. Luke's 

staff. 

As this work proceeded, the remainder of the American contingent 

began constructing a I,OOO-bed facility on a' 'beautiful inclosed park-like 

area" in the Azabu district donated by a Japanese prince. Named the 

Bei-Hi Hospital, when finished it had administrative and personnel sections; 

laboratory, X-ray, and operating facilities; but ward tents to accommodate 

only 480 patients. For a few days a combined American Army and 

Filipino staff provided care for Japanese patients. On 10 October the staff 

began familiarizing Japanese replacements with administrative procedures, 

operation of the equipment, and other hospital matters. On the afternoon 

of 13 October, the Americans formally transferred Bei-Hi to Japan along 

with tentage and equipment to expand it to the full 1,000 beds if the 

Japanese felt they needed the additional bed space. The Americans also 

left a 24-bed camp hospital pitched nearby to demonstrate its capabilities 

to the Japanese. In the succeeding weeks the Japanese found the fifty-two 

camp hospitals their visitors had brought more useful than a large facility 

like Bei-Hi because they could be moved wherever needed to handle 

refugees. 12 

The day after the transfer of Be i-Hi, all but a small group of McCoy's 

relief force departed. The commanders stayed for two days of sightseeing as guests of the Japanese government, and one medical officer 

with a small detachment remained to assist the ambassador. The Americans 

had delivered more than $5 million worth of food and medical supplies 

and left three functioning hospitals. In doing so, McCoy had kept control 

over his men and avoided any unpleasant incidents. Though initially 

some relief workers perceived a great deal of Japanese hostility, by the 

llMcCoy's Narrative. bu lky package. 400.38. Record Group 407. NA: MUnson. "Rcpon on 

Hospital Service." pp. 55 -57; clipping from Nichi-Nichi (a Tokyo newspaper), 30 Sep 23. filed 

with Ltr, McCoy to AG. 29 Oct 23. box 929. 400.38. Record Group 407 . 

12Munson, " Repon on Hospital Service:' pp. 57 - 60. 
104 THE DEMANDS OF HUMANITY 

end of their stay most believed that their hosts accepted and appreciated 

the "altruistic spirit" in which the Americans came. Other participants 

still considered local officials hostile to the expedition. If they were, the 

Japanese presented a good diplomatic front, sending the Americans off 

with a cordial farewell and several months later forwarding the State 

Department a book of thanks signed by 500,000 citizens. 13 

Confusion over the Army's Disaster Relief Role 

After the Japanese operation, medical personnel did not participate in 

another foreign disaster relief mission for five years, and not until after 

World War II would they undertake one of similar size. Domestic operations 

continued on a more frequent basis, but throughout the interwar years the 

Army encountered prOblems in defining its disaster relief role that often 

indirectly influenced Medical Department participation. The process of 

definition began in December 1924 when the Army published AR 500-60, 

"Employment of Troops: Relief Work by the War Department, in Cases 

of Flood, Earthquake, or Other Great Catastrophe." The new regulation 

replaced Special Regulation 67 but did not significantly change its procedures. 

Primarily, the new regulation only incorporated changes in the Army's 

geographical command structure from departments to corps areas made 

by the National Defense Act of 1920. Like their predecessors, the department 

commanders, corps area commanders were placed in charge of all civilian 

assistance in their region-continuing the practice of having medical 

personnel act under line command. On the question of authority to render 

aid, AR 500-60 slightly revised the language but did not clarify the 

ambiguity of the earlier regulation. AR 500-60 stated that relief would 

be given only at congressional request, unless the "overruling demands 

of humanity" compelled it or a "clearly inadequate" local response 

necessitated it. 

AR 500-60 did differ from Special Regulation 67 in minor ways. The 

regulation provided more detailed directions for filling out forms and 

reports, and it furnished instructions on establishing refugee centers. 

These included the seemingly prudish suggestion that single men and 

women be housed on opposite sides of the camps, but extremely high 

venereal disease rates among refugees during the 1927 Mississippi flood 

later made the proposal appear a well-meaning if futile attempt at disease 

control rather than a vestige of Victorianism. For the most part, though, 

1JLtr, McCoy to AG, 15 Oct 23; Cable, AG to Burnett, 20 Nov 23. Quote from Read's Rpl. O. W. 

Hand's Rpt; Note from Slate Department, 221an 24. All in box 929, 400.38, Record Group407, NA. 
RELIEF ROLE IN TRANSITION 105 

the regulation introduced no alterations in medical relief policy. " 

In fact, simply continuing older policies was not enough. The context 

in which the military provided assistance had changed. No longer need 

the government depend on the Army and its Medical Department-as it 

had at the tum of the century-because no other agency existed to 

perform the work. By the mid-twenties state and local boards of health 

had become increasingly competent to manage emergency situations. 

After the PHS's weakness had been demonstrated in the flu epidemic, 

Congress strengthened its resources for mass medical relief activities. 

National Guard units became more active in relief, and, most important of 

all, the Red Cross emerged during the two decades under its 1905 charter 

as a strong organization capable of handling most disaster situations. 

During the interwar years, it sent aid following a substantially higher 

number of disasters and became increasingly jealous of its position as the 

nation's primary relief agency. 15 

As all these agencies became more active in disaster situations, no 

institution arose to coordinate their efforts. The federal government did 

not even establish a definite relief policy for its own agencies. Bedlam did 

not reign, but bureaucratic confusion did develop. For the Army, the 

confusion centered on two recurring problems: reimbursement from 

Congress and coordination with the Red Cross. Though hints of possible 

difficulties in both areas had appeared before Worlc! War I, the midtwenties saw both become central concerns of the Army that were crucial 

to the definition of its relief role . 

The War Department had always responded immediately to requests 

for disaster assistance, confident that Congress would later reimburse its 

expenditures. But in the twenties, Congress did not automatically pay the 

Army back for the cost of its relief work. Lawmakers took five years to 

reimburse the Army for a 1920 mission to West Point, Georgia, and more 

than a year to fund a 1923 operation in northeastern Mississippi. After the 

Japanese earthquake, Congress did not move to restore the $6 million the 

Army had spent out of its own funds. The executive branch, which had 

ordered the Army to Japan in the first place, discouraged the War 

.4Copies of AR 500-60 and drafts of it arc filed in bulky package, 400.38, Record Group 407, 

NA. On venereal disease in 1927 floods, see Pete Daniel. Deep'" As II Comes: The 1927 Mississippi 

River Flood (New York: O)tford University Press. 1977), pp. 11 8-23. 

1$0n PHS , see Noyes, "influenza Epidemic," pp. 195-202. For National Guard activity, see 

Annual Reports of the Chief of the Militia Bureau for these years. State units were not required to 

report relief work, so the records arc incomplete. On the Red Cross's attitude, see Bicknell, 

Pioneering, pp. 1- 10, 2 16- 18; Mabel T. Boardinan, Under Ih e Red Cross Flag al Home and 

Abroad (Philadelphia: 1. B. Lippincott, 1915), pp. 156-68. For statistics on acti vity, see Reynolds, 

"Disaster Service," p. 248. 
106 THE DEMANDS OF HUMANITY 

Department from requesting repayment since the additional appropriation 

would conflict with the administration's policy of budgetary restraint. 

The Secretary of War went to Congress for the money anyway, lobbied 

actively, and in February 1925 fmally convinced the lawmakers to reimburse 

its expenses. The necessity of appealing to Congress for funding, however, 

shook the Army's confidence in reimbursement, which of course raised 

questions about its continuing relief role. An April 1924 staff memorandum 

on the problem concluded: "Unless the Army can be assured that its 

meagre funds and supplies will not be taken from it by reason of its doing 

[relief] work, it must either have greater funds and supplies or relief from 

the duty. " 16 

Since the War Department preferred to continue its relief activities, it 

decided to attempt to establish the principle of reimbursement at a 

minimal price. In May 1925 it requested $733.37 from Congress to pay 

for Army disaster assistance performed in Georgia that year. Congress 

refused to appropriate funds for that or any other mission, though over the 

next few years it occasionally passed bills legalizing Army expenditures 

in disasters. The unwritten procedures under which the Army had furnished 

relief for half a century began to disintegrate. Congress expected the 

Army to finance civilian assistance out of its current budget, but an 

already financially hard-pressed War Department naturally considered 

that an unsatisfactory method. 17 

Shortly after its troubles with Congress, the War Department found 

itself in a dispute with the Red Cross. In December 1925, John Barton 

Payne, the president of the American National Red Cross, wrote Secretary 

of War Dwight F. Davis complaining that corps area commanders realized 

neither his agency's supremacy nor their own authority to assist it. To 

correct their misapprehension, Payne suggested revision of Army regulations 

to recognize the Red Cross as the nation's official disaster agency and to 

make more explicit the commanders' authority to lend it supplies. 18 

Army officials rejected Payne's suggestion for several reasons. They 

felt it would lead to " increased demands for supplies which in many cases 

might not be justified. " Despite the Red Cross's claim to supremacy, 

they still wanted to be able to fill requests from local groups. And, 

'OOn early mission. see U.S .• StalJlles oliArge. 43: 1252. ch. 478; 43: 1285-86. ch. 547 - 48. 

On Japan. see series of memos. box 929. 400. 38, Record Group 407, NA; U.S., Slalllles al Large, 

42: 963 , ch. 297. Quole from Memo for the Budget Officer for the War Depanment, 7 Apr 25. box 

929, 400.38. Record Group 407. NA. 

17Ur. Secretary of War 10 the Speaker of the House. 22 May 25, box 929. 400.38. Record Group 

407. NA; U.S., Statutes a/ Lorge. 44: 1065, ch. 89. 

,sLlr, John B. Payne to Dwight F. Davis. 17 Dec 25. box 191 , 080 Red Cross. Record Group407, 

NA. 
RELIEF ROLE IN TRANSITION 107 

perhaps most important, since the Army always acted without statutory 

authority in disaster relief, the officials perceived an " added obligation 

on the War Department to take adequate measures " to safeguard military 

property. The surest way to do so was to keep it under military control. 

Consequently, Davis informed Payne that corps area commanders would 

continue to investigate conditions themselves before issuing Army equipment 

and would retain control over it when they did decide the situation merited 

Army intervention. Davis's reply apparently failed to convince Payne, 

the Red Cross and War Department reached no agreement, and friction 

between the two agencies over rights and responsibilities in relief continued. 19 

The War Department's relations with both Congress and the Red 

Cross influenced the level of Medical Department participation in disaster 

relief operations. Any restriction of Army involvement because of lack of 

funding obviously would have led to a curtailment of direct medical 

assistance. And the modification of the Army's function sought by 

Payne-making the Army responsible for supply while the Red Cross 

rendered direct aid- would have meant a return to late nineteenth century 

patterns of relief in which Medical Department personnel did almost 

nothing in disaster situations. In the mid-twenties the Red Cross did not 

succeed in modifying the Army's mission, however, and the Army 

continued to perform medical relief operations. 

In January 1925 a senator from Georgia relayed a constituent's 

request for disaster assistance to the War Department. The entire southwestern 

portion of the state, the petitioner wrote, had experienced severe flooding, 

leaving the people badly in need of help. In response, the War Department 

ordered the corps area commander to investigate conditions and render 

any necessary relief. The commander dispatched several officers to the 

affected region, but most of them reported little need for Army assistance. 20 

In Newton, Georgia, a Medical Corps officer serving as an inspector, 

Col. Percy L. Jones, did encounter unsanitary conditions that he feared 

could easily lead to an epidemic. Jones held a mass meeting to warn the 

citizens of the danger and then supervised the committees appointed to 

conduct relief work . Still the threat of an epidemic persisted. On his third 

day in Newton, Jones asked his superiors to send another medical officer, 

a sergeant from the Medical Department, and the equipment for a battalion 

dispensary. Nearby Fort McPherson dispatched the men and equipment, 

19Quotcs from Memo for Chief of Staff by FOl( Conner. 29 Dec 25. bel( 191. 080 Red Cross. 

Record Group 407. NA. Ltr , Secretary of War to J. 8 . Payne. 3 1 Dec 25, hol( 191.080 Red Cross. 

Record Group 407, NA. 

20Copy of Tc1g, John M. Spence to Senator Harris. 23 Jan 25; Memo for Chief of Staff by 

Assistant Chief of Stafr. 27 Jan 25. Both in bol( 929, 400.38, Record Group 407. NA. 
108 THE DEMANDS OF HUMANITY 

and Jones and his new assistants promptly opened a dispensary in a local 

church, where they inoculated the town's residents against typhoid and 

paratyphoid. They also sent one of the Army doctors to make a house call 

on anyone too sick to come to the church. In addition, the Army team 

supervised various public health programs, including a limited mosquito 

control project and the distribution of Lyster bags to provide residents 

with safe drinking water until Newton's water system was repaired. After 

a week of such activities, Jones returned to his station, but the other two 

men remained in Newton until 2 February. When they departed they took 

the dispensary equipment with them but left expendable articles, drugs, 

serums, and a roster of citizens who had been inoculated 2 1 

Two years after operations in Newton , the Army undertook ano'ther 

small relief mission, one which for the first time involved air medical 

evacuation of disaster victims. In 1924 the Army Air Service had let its 

first contracts for air ambulances. Under them the Army received a 

Douglas C-I and two Cox-Klemin XA- I 's; it was the Cox-Klemin that 

proved extremely valuable in emergency medical missions. Powered by a 

Liberty- 12 engine, the little biplane had an exposed cockpit and a 

" humpbacked compartment or cabin" behind it capable of transporting a 

medical attendant and two litter patients. Reputedly the Cox-Klemin 

could land on any road or cotton patch, and its partisans swore it could 

take off in a backyard. In 1926 the Army deployed one Cox-Klemin at 

Kelly Field in Texas and the other at France Field in the Canal Zone. The 

plane stationed in Panama operated what amounted to a prototype of the 

Military Assistance to Safety and Traffic program sponsored by helicopter 

units in the 1970's, evacuating victims of-automobile accidents, hunting 

mishaps, and other emergency cases. The plane at Kelly Field performed 

similar missions but also participated in a disaster relief operation. 22 

On 13 April 1927, a tornado struck the small town of Rocksprings, 

Texas, killing 56 people and injuring another 200. The Army sent 

eighteen DH -4 observation planes, two Douglas transports, and, later in 

the day, the Cox-Klemin from Kelly Field. In the planes came several 

Army and Veterans Bureau doctors as well as large stocks of medical 

supplies, litters, and blankets. The physicians quickly commandeered a 

local warehouse and established a hospital where they treated minor 

cases. Since many of the victims had dirty puncture wounds, the physicians 

21Rad, Commanding Gcneral41h Corps Area to AG, 24 Jan 25; Llr, E. T. Conley to AG, 10 Mar 

25; Llr, AG to William J. Harris, 4 Feb 25; Summary of Action Taken in Flooded Districts, by 

Thomas H. Darrel , 3 Feb 25 . All in box 929 , 400.38, Record Group 407 , NA. 

22Robert F. Futrell, Developmem of Aeromedical Evacllation ;11 rile USAF. 1909- /960 . USAF 

Historical Studies No. 23 (Air University: USAF Historical Division, 1960), pp. 4 -21; Memo for 
RELlEF ROLE IN TRANSITION 109 

THE COX-KLEMIN EVACUATlilG PASSENGERS AT ROCKSPRINGS. TEXAS. /927. 

feared an epidemic of tetanus. Using serum flown in from Fort Sam 

Houston, one of the Army doctors inoculated all of the people in the 

warehouse and then, with a nurse assistant, drove through the town 

inoculating everyone else he could find. 

A possible epidemic was not the only medical problem in Rocksprings. 

As the physicians sorted the sick, they realized several had injuries 

requiring sophisticated hospital treatment that they could not provide in 

the warehouse. The doctors decided to evacuate such patients in the 

Cox-Klemin. Shortly after it arrived that afternoon, its pilot began a series 

of flights to and from San Antonio. On the first flight the ambulance plane 

took only one patient, but after a ground crew cleared a landing field , on 

later flights it carried two patients and a medical attendant. Late in the 

afternoon several people unexpectedly ran across the runway as the plane 

taxied for takeoff; the pilot swerved to avoid killing them and crashed the 

plane into the nearby mesquite. Fortunately the accident did not injure the 

nurse or the patient aboard, a little boy. He was transferred to one of the 

DH-4's for transport to San Antonio, and the pilot repaired the CoxKlemin "using cat-gut, a surgical needle , sheets, some tacks, a splint or 

two, adhesive and flour-paste." Minus a tail skid but with another 

seriously injured patient on board, the Cox-Klemin took offfor the day's 

Maj Rush B. Lincoln by Delos C. Emmons, 10 Jan 28. box 24 16, 400.38, Record Group 407 , NA. 
110 THE DEMANDS OF HUMANITY 

final flight to San Antonio. 23 

Within twenty-four hours after the storm, the Army had treated the 

slightly ill , evacuated the seriously injured, and inoculated the population 

against tetanus. Their work done, the surgeons and corpsmen left supplies 

for civilians to complete the work and returned to their stations. The 

airplanes, especially the Cox-Klemin, had greatly increased the speed of 

the operation and ensured victims the best possible care. But the Rocksprings 

operations remained for many years an isolated example of the utility of 

air ambulances in domestic disasters, followed up only once during the 

floods of 1927 when a sergeant who had flown in Rocksprings evacuated 

a seriously ill fifteen-year-old girl in his observation plane. After the 

crash of both Cox-Klemins in 1929, the Army built no more of them, 

replacing them with two Fokker air ambulances that had more space for 

patients but lacked their predecessors' sturdy versatility . In the thirties the 

Army concentrated on the development of a large transport ambulance 

rather than small rescue craft more adaptable to disaster service. Not until 

the development of helicopter ambulances after World War II did Army 

medical aviation come to play an important role in domestic assistance 

missions. 24 

The month of the Rocksprings incident, the Army became involved in 

an operation more typical of disaster assistance in the interwar years and 

more importantto the evolution of its relief role. In April J 927, one of the 

worst fl oods in the history of the Mississippi Valley caused suffering that 

was intense, widespread, and long lasting. When several state governors 

requested federal assistance, President Calvin Coolidge appointed Herbert 

Hoover, his secretary of commerce and America's leading relief expert, 

to chair a committee of other department heads and a few Red Cross 

officials to direct federal relief. As anyone who had served with the 

American Relief Administration in Europe would have predicted, the 

relief operation quickly became Hoover's show. 

Through a policy that a recent study has labeled "concentrated 

decentralization," he sought to amass all available resources from various 

organizations, consolidate them, and then through a well-managed 

organization place them at the disposal of an efficient grass roots operation. 

To do so, Hoover's committee decreed general policy and delegated 

day-to-day management to Henry M. Baker of the Red Cross. Baker 

23C. L. Beaven .. , Airplane Ambulance Evacuation ofTomado Victims al Rocksprings. Texas." 

Military Surgeon 6 1 ( 1927): 99- 10 1. quote on p. 100. "The Airplane Ambulances of the U.S. 

Army Air Corps . .. Red Cross COl/rier S ( 15 Feb 29): 6: "Anny Lauded for Tomado Aid." Army and 

NavY ) OIlrIwl 64 ( 1927): 868. 

14" Airplane Ambulances of the Army," p. 6; Futrell. D el'elopmellf. pp. 20- 27. 
RELIEF ROLE IN TRANSITION 111 

HERBERT HOOVER ON BOARD THE U.S.S. CONTROL dllrillg tile floods of 1927. 

opened a headquarters in Memphis from which he directed shipments of 

supplies and handled other administrative chores. Meanwhile, Hoover 

journeyed through the devastated regions, rallying the populace.

25 

Hoover's plan resembled the Army's system in the nineteenth century 

in that the federal government provided supplies in bulk for local officials 

to distribute and control as they pleased. Not surprisingly, this approach 

opened the way for some of the most serious racial discrimination ever to 

mar a disaster relief operation . But despite the basic similarity, at least 

one crucial change had occurred: a civilian official and the Red Cross 

directed relief operations, not the War Department and its corps area 

commanders. Since Hoover wanted local forces---primarily the volunteers 

of the Red Cross and the sometime-soldiers of the National Guard-to 

render relief, the Army functioned as what amounted to a wholesaler of 

equipment, though no one paid it for its merchandise. From 0900 to 2300 

hours, seven days a week, the Finance and Supply Division of the War 

Department operated a command post in Washington to process requests, 

25Bruce A. Lohof, "Hoover and the Mississippi Valley Flood of 1927: A Case Study of the 

Political Thought of Herbert Hoover," (D.S.S. diss .. Syracuse Un iversity. 1968), quote on p. 105 

and passim. For his argument in brief, see Lohof, "Herbert Hoover, Spokesman." For a somewhat 

anecdotal history of the flood based on many oral sources, see Daniel, Deep'" As It COt1lr!s. 
112 T HE DEMANDS OF HUMANITY 

and Co.rps area co.mmanders filled o.rders as well . In all, the Army Io.aned 

mo.re than $2.6 millio.n in materiel-tents, blankets, Co.ts, mess gear, and 

the like---to. the relief effo.rt. 26 

In mo.st o.fthe o.peratio.ns in which the Army had functio.ned mainly as 

a supply agent, its Medical Department had no.t played an active ro.le . 

During the 1927 flo.o.d, the absence o.f Army medical participatio.n was a 

clearly enunciated Po.licy. On 28 April representatives from the Army 

Medical Department, the Public Health Service, the American Medical 

Associatio.n, state medical associatio.ns, and the Red Cro.ss met in Memphis 

to. plan fo.r the medical and sanitary aspects o.f relief o.peratio.ns. Fo.llo.wing 

Ho.o.ver's suggestio.ns, the assembly established pro.cedures fo.r Io.cal 

groups to. request medical assistance and espoused several general policies. 

The group, as o.ne participant repo.rted, "put the responsibility fo.r the 

protectio.n o.f the health o.f the refugees and the sanitatio.n o.f the camps and 

flo.o.ded areas where it belo.nged , o.n the state bo.ards o.f health, and o.ffered 

to. the state bo.ards o.fhealth the reso.urces o.fthe American Red Cro.ss, and 

thro.ugh the Red Cro.ss the reso.urces o.f the U.S. Public Health Service and 

the trained perso.nnel o.f o.ther states, who. vo.lunteered to. help in the 

emergency. " That policy all but eliminated a relief role fo.r Army physicians. 

Only in Arkansas, a state with a traditio.nally weak health service, did 

Regular Army medical o.fficers participate in flo.o.d relief. In late April 

and early May, fo.uro.fthem went to. Arkansas and made sanitary surveys, 

rendered first aid, directed sanitatio.n in camps, ino.culated refugees, and 

furnished many supplies. 27 

Ho.o.ver's system was intended to. dispense medical and o.ther relief 

supplies with a minimum o.f co.nfusio.n and co.nflict, but many so.ldiers 

believed it promo.ted chao.s. One Co.rps area co.mmander claimed he had 

Io.st co.ntro.l o.f Army property and accused the Red Cro.ss o.f being 

impo.ssible to. wo.rk with. He attributed much o.f his frustratio.n to. Ho.over: 

"when the Po.werful head o.f ano.ther department o.f Go.vernment gets into. 

the game, and especially when that head is apparently the Supreme High 

Cocko.Io.rum [sic] o.f the administratio.n in flo.o.d matters, I am fo.rced to. 

admit that the fello.w who. had the bear by the tail has no.thing o.n me." 

260n charges of peonage and other mistreatment of blacks, see Daniel, Deep'" As If Comes, or 

perhaps the better account in his earlier The Shadow of Slavery: Peol/age in file South, f OOl - 1969 

(New York: Oxford University Press, 1972), pp. 149- 69. On Army distribution of supplies, see 

Memo for LI Cal R. L. Collins byT. J. Aynn t 25 Apr27, box 24 18, 400.38, Record Group407. NA; 

Financial Report of the Roods of 1927, box 24 10. 400.38, Record Group 407. NA . 

27Quote from J. H. O'Neill, " Relief Measures during and following the Mississippi Valley 

Flood," American Journal a/Public Health 18 (1928): 156- 57. Rad, Craig 10 AG, 30 Apr27, box 

2418,400.38. Record Group 407, NA. On work in Arkansas. see Llr, John E. Marineau 10 Dwight F. 

Davis,7 May 27; Telg, Ireland to W. R. Redden , 26 Apr 27; Memo for AG by Deputy Chief of Staff, 

26 Apr 27. All in box 24 18, 400.38, Record Group 407, NA. 
RELIEF ROLE IN TRANSITION 113 

Perhaps the commander unfairly blamed Hoover, but the relief operation 

did exasperate many Army officials. The Army had previously expressed 

its hesitancy to abdicate control over its equipment, yet Hoover's plan 

necessitated that it do just that. To make matters worse, when the Army 

loaned its property, the Red Cross sometimes refused to accept responsibility 

for it. In New Orleans, for example, Maj. Reese M. Howell reported that 

Red Cross officials stoutly maintained that " under no conditions" would 

they "be held responsible for any property lost damaged or destroyed 

during flood relief work." Consequently, Howell added, "the government 

has . . . thousands of dollars of property in the hands of people who 

assume no responsibility whatsoever. ,,28 

The fears of Howell and other officers proved justified. Much of the 

equipment the Army loaned was never returned, and some that it did 

recover was in such poor shape as to be worthless or in need of extensive, 

expensive repairs. Some of the losses resulted from carelessness or 

confusion, but a number of tents went home with the refugees when 

camps broke up. Since many of the poorer inmates had no home to return 

to because the flood waters had swept away their shacks, local and Red 

Cross officials allowed them to take their tents with them-a very 

understandable policy. Yet whether through mismanagement or justifiable 

charity, the Army still had a $1 .3 million bill for loss and depreciation on 

its equipment 29 

The War Department thought the Red Cross should pay the bill; not 

surprisingly, the Red Cross disagreed . Payne had a close friend of 

Hoover's speak with the "Supreme High Cockolorum" who agreed that 

the Red Cross owed the Army nothing. Rebuffed, the Army asked the 

executive branch of government for funds. The Bureau of the Budget 

returned its request for reimbursement marked not in accord with the 

financial policy of the president. The Secretary of War nextturned to the 

congressional leadership. Late in 1927 after extensive debate, Congress 

approved a supplelnental appropriation of $2 million to cover administrative 

costs of the Army flood relief operation but not the lost equipment. 30 

Despite limited success in the funding fight following the 1927 flood, 

28First quote from Ltc, Malin Craig to Brain! H. Wells, 25 May 27. Se<:ond quote from Llr, R. M. 

Howell to Malin Craig, 23 May 27 . Both in box 2418, 400.38, Record Group 407, NA. 

29Llr, Earl Kilpatrick to Red Cross representatives in the field. box 2418. 400.38, Record Group 

407. NA; Financial Report of the Floods of 1927, box 2410. 400.38. Record Group 407. NA. 

3OLlr . Dwight F. Davis to John B. Payne. 30 Dec 27; Ltr, Payne 10 Davis, 26Jan 28; Memo for the 

Director of the Bureau of the Budget by F. W. Coleman. 9 May 28; Ltr. Dwight Davis to Senator 

David A. Reed. 23 Jun 28. All in box 2410. 400J8. Record Group 407. NA. Lohor. "Hoover and 

the 1927 Flood," pp. 183-85; "Steps Taken by the Federal Government for Mississippi Flood 

Relief." Congressional Digest 7 ( 1928): 41. 
114 THE DEMANDS OF HUMANITY 

the Army continued to participate in disaster relief. Mostly confined to 

engineer support or the distribution of supplies, such aid involved little 

Medical Department activity. In the New England floods of 1927, Maj. 

George B. Foster, Jr., of the Medical Corps rendered conspicuous service 

in delivering relief supplies to isolated areas rather than as a doctor. After 

a 1928 hurricane, Col. Percy Jones again served as an adviser on sanitary 

matters, this time in West Palm Beach, Florida 31 

Medical Department personnel proved slightly more active in disaster 

relief outside the continental United States around the turn of the decade. 

In the same year that Jones assisted in West Palm Beach, the Army sent 

five physicians and large quantities of hospital stores to aid Red Cross 

efforts after a storm in Puerto Rico. In January ofthe next year the Army 

shipped supplies to Cumana, Venezuela, after an earthquake and in 

September sent medical personnel, supplies, and airplanes to the southern 

part of the Philippine Archipelago after a typhoon. In 1930 the Army 

played a very minor role when the Navy and Marine Corps rendered 

assistance in hurricane-devastated Santo Domingo, Dominican Republic. 32 

An Army physician also played a secondary role after a 31 March 

1931 earthquake in Managua, Nicaragua. Army troops were in the Latin 

American country surveying possible locations for a new interoceanic 

canal, but United States marines occupied Nicaragua at the time and 

therefore had more men and resources on the scene. Marines performed 

much of the rescue work, cared for casualties, fought the fires that broke 

out, and maintained civil order. But a party from the Army survey team 

rushed to the capital's aid, too. Most of the Army men were engineers 

who joined in fighting the blazes, but with them came surgeon Maj. Paul 

R. Hawley and three enlisted assistants who reported to the marines' 

temporary hospital set up to care for quake victims. Hawley joined with 

four Navy physicians to perform more than 500 operations in two days 

and later helped evacuate the recuperating patients to neighboring towns. 33 

310n Foster, see General Brown's Report on Flood Conditions. box 2417.400.38, Record Group 

407 , NA; "Vermont Flood Relier by the 3rd Cavalry, ., Cavalry Journal 37 (1928): 137-39. On 

Jones, see Teig. Dav is to AG, 19 Sep 28, Miscellaneous Division Correspondence. 1923 - 35, Army 

Postal Service to Floods and Cyclones, Record Group 407, NA. 

320n Puerto Rico, see documents in box 2416 and bulky package, 400.38, Record Group 407, 

NA; Ltrs, in Miscellaneous Di vision Correspondence, 1923- 35, Army Postal Service to Floods and 

Cyclones, Record Group 407, NA; RSW. 1929. p. 8; Official Report of RelieflVork ill Porto Rico. 

the Virgin Islallds(md Florida (Washington: American Red Cross. 1929). pp. IS, 17. On Venezuela, 

see RSW. 1929. p. 9; Indorsement to Ltr on Requests for Reports on Disasters . 31 May 29, box 2416, 

400.38. Record Group 407. NA; Nell' York Times. 27 Jan 29 and 2 Feb 29. On the Philippines, see ' 

RSG , 1930, p. 40 1; "Typhoon in the Philippines Wrecks Many Villages," Red Cross Courier 8 ( I 

Oct 29): 7. On Dominican Republic. see RSG. 193 1, p. 425; "Santo Domingo TomadoReliefQuick 

and Generous'" Red Cross COl/rier 9 (1 Oct 30): 6- 7. 

))New York Times. I and 3 Apr 3 1; G. D. Hale and H. R. Boone , " Relief Work in the Managua 
RELIEF ROLE IN TRANSITION 115 

Reevaluation and Relief ill the Thirties 

Although efforts such as Hawley's certai nly placed little hardship on 

the Army, the frequent request for military supplies from the Red Cross 

and other groups did tax military materi al stockpiles. A study of the 

problem initiated by the Secretary of War in 1929 concluded that the 

donation of supplies to civilian relief had " not only depleted the stocks of 

items held for war reserve , but many supplies required for immediate use 

of the Army and purchased out of current appropriations have been 

diverted from their purpose and the Army left without certain articles 

needed for current use." To dam the drain of military resources, the War 

Department wrote and submitted several proposed acts to reimburse the 

Army for relief expenditures. One even proposed the establishment of an 

emergency fund to cover the cost of any future relief operations. Congress 

passed none of the bills during the first session they were introduced; in 

the next session they granted the Army credit for equipment lost during 

the 1927 floods- which it had earlier declined to do-but refused 

reimbursement for any other operations. 34 

Congress's parsimony and the debate within the executive branch 

over the issue convinced Army Chief of Staff General Douglas MacArthur 

that both Congress and the president opposed the loan of Army supplies to 

the Red Cross or any other agency without assurance of reimbursement. 

Although no such consensus on a definite policy existed, perhaps MacArthur 

felt that it did because he and the Army had wearied of the constant 

demands on military resources. Certainly the Hoover administration's 

public calls for significant reductions in military expenditures did nothing 

to increase his or the Army's enthusiasm. The Army considered its budget 

totally insufficient and naturally resented donating a share of its paltry 

appropriation to civilian assistance- which, after all, was not a part of its 

mission to defend the nation. 35 

Earthquake." U.S. Naval Medical Bulletin 30 (1932): 3-5. Rads, Sultan 10 Chief of Engineers, I 

and 2 Apr 31; Llr. Brigade Commander 10 MG Command, 16 Apr 31. All in box 24 10, 400.38. 

Record Group 407. NA . 

J40n equipment senl 10 Red Cross. see Value of Government Property Turned Over to Ihe 

American Red Cross by the War Department for Relief Purposes. 1925- 1930. box 2406. 400.38, 

Record Group 407 , NA. Quote from Memo for AG by E. V. D. Murphey . 26 Mar 29. box 24 16, 

400.38 . Record Group 407. NA. On Army legislati ve proposals. see Memo for AG by w. B. 

Wallace. I Jul 29: Ltr. Robert L. Collins to Chief of Finance. 20 Mar 29; Llrt AG 10 Judge Advocate 

General, 4 Apr 29. All in box 241 6.. 400.38. Record Group 407. NA. U.S. , Statutes at Large, 46: 

1045 , ch. 63; U.S. Congress. Senate. Relief of Sufferers of tile Mississippi River Flood of 1927, S. 

Rpl. 1360. 71st Cong., 3d sess .. 193 1. 

lSLtr, Douglas MacArthur to James K. McClintock. 11 Apr 31. box 2409. 400.38, Record Group 

407. NA. On the Amly and Hoover's budget, see John R. M. Wilson. "Herbert Hoover and the 

Arnled Forces: A Study of Presidential Altiludes and Policy." (Ph.D. diss .. Northwestern University, 

(Continued) 
lJ6 THE DEMANDS OF HUMANITY 

In 1932 MacArthur implied that congressional refusal to reimburse 

the Army and its own inability to absorb any loss with its tightened budget 

influenced his decision to restrict assistance during the Puerto Rican 

storm of that year. In any case, during the emergency the Army only 

issued a few supplies and allowed the use of Army barracks, leaving 

almost all relief work to the Red Cross. The ensuing controversy over the 

Army 's meager aid apparently prompted another War Department 

reevaluation of the Army's role in disaster assistance. "The large amount 

of War Department stocks on hand at the close of the World War has been 

reduced to the bare necessities of war reserve," wrote the officer who 

staffed the study . For that reason, he concluded, the Army must abandon 

the "very liberal policy" that the surplus had allowed. "The time has 

arrived when the War Department must cease to be regarded as an 

eleemosynary institution and insist upon a strict observance of the law 

regarding the use of public property . " MacArthur fully agreed with the 

study's conclusions but suggested waiting for the " repercussions of the 

Porto Rican controversy" to die down before announcing any restrictions. 36 

The War Department did wait, then issued a directive to corps area 

commanders reminding them of the limits of Army participation. It 

decreed that supplies on hand could be dispensed only under the provision 

of AR 500-60, that no shipment could be ordered from a depot or post 

without prior approval from the War Department, that any organization 

borrowing supplies must be informed that the Army expected reimbursement 

for all consumable and unreturned noncomsumable items, and, finally, 

that troops could be used only in the emergency phase and even then must 

be withdrawn at "the earliest possible moment. " Although the directive 

promulgated no new policy, it intended and effected a restriction of Army 

disaster relief.37 

The restriction did not mean an abandonment of a relief role for the 

Army, however. The Army could hardly refuse to perform such work if 

so directed by the commander in chief, nor did it want to alienate 

members of Congress who drafted the military budget by refusing their 

requests for aid. Morever, many military leaders had long appreciated the 

public relations value of such work and were not averse to tactics designed 

(continued) 

197 1), pp. 114- 21, 129-33; D. Clayton James, The Years ofMacArl/lllr: Volume I. 1880-1941 

(BaSIon: Houghton Mifflin Co. , 1970), pp. 35 1- 63. 

360n Puerto Rican controversy, see Llr, Douglas MacArthur to Merton L. Corey, 12 Oct 32, box 

2410,400.38, Record Group 407 , NA. On aid rendered there, see Ltrs in box 2410, 400.38. Record 

Group 407. NA. Quote from Memo for Chief of Staff by C. C. Humphrey, Jr. , 4 Oc132, box 2409. 

400.38, Record Group 407, NA. MacArthur's comment is penciled in. 

37Quote from Llf, TAG to all corps area and department commanders, 21 Dec 32. box. 2409. 

400.38, Record Group 407, NA. 
RELIEF ROLE IN TRANSITION 117 

to maximize it. In the following years the Army continued to furnish 

assistance, including medical support, when the need was clear and the 

situation met the conditions of AR 500-60. A medical relief expedition 

in 1933 to Harlingen, Texas, ideally suited the Army's conception of its 

role: troops responded at once, worked alone and on their own authority , 

furnished emergency aid, and then quickly withdrew when other agencies 

could take charge.

38 

The mission originated with a request from both a Texas congressman 

and the governor of the state after a destructive hurricane came ashore 

along the lower Rio Grande Valley on 5 September 1933. The governor 

informed Maj . Gen. Edwin B. Winans, the commander of the 8th Corps 

Area, that local authorities would be unable to meet the medical needs of 

victims for at least a couple of days. Army air and ground reconnaissance 

of the area confirmed reports of distress, and Winans wired the Chief of 

Staff that he planned to send part of the 2d Medical Regiment from Fort 

Sam Houston to Harlingen, the principal town in the area. MacArthur 

"fully approved" his plan and commended him for acting with his "usual 

energy and splendid efficiency" - a response that suggested MacArthur 

had objected all along more to congressional parsimony than to a relief 

role for the Army. 39 

After receiving MacArthur's approval, Winans ordered the 2d Medical 

Regiment, less the 2d Veterinary Company, to report to Harlingen. He 

attached to the regiment a surgical team from the station hospital at Fort 

Sam Houston, additional quartermaster troops, and the 7th Signal Service 

Company. The 10 officers and 175 enlisted personnel who formed the 

expedition boarded a special train in San Antonio. Difficulties in loading 

the train delayed its departure , and the poor condition of the track along 

the route further slowed its journey. 

When the regiment finally arrived, its commander, Col. Louis 

Brechemin, Jr., immediately conferred with the mayor and local law 

enforcement officials. They feared looting that night and urged Brechemin 

to assume responsibility for maintaining order in the town. Brechemin 

refused, rightly arguing he had no authority to declare martial law, and 

38For examples of pUblicity, see Army alld Navy JOllmal64 (1927): 824; ., Army Tornado Aid 

Lauded by Governor," Army a"d Nov), Joumal 62 (1925): 2087; "Peacetime Wars," New York 

NatiollalGlIardsmoll (12 Mar 37), p. 12; Llt, T. SiminofftoGeorge H. Dearn, 12Mar33, box 2409, 

400.38, Record Group 407, NA. On efforts to foster it, see Typhus Fever in Poland; Ltr, Publicity 

Officer, APRE to Commanding Officer, 20 Sep 20 (both in box 2. APRE, Record Group 120, NA); 

Telg, AG to McCoy, 8 Scp 23, box 929, 400.38, Record Group 407. NA; Memo for Assistant Chief 

of Staff, G- 2, by Chief of Staff, 30 Dec 27, box 2417,400.38, Record Group 407, NA; Memo for 

AG by H. E. Knight, 7 Jun 35, box 2408, 400.38, Record Group 407, NA. 

39Winans to AG. 5 Sep 33. Quote from Rad, MacArthur to Winans, 5 Sep 33. Both in box 2409. 

400.38, Record Group 407, NA. 
118 THE DEMANDS OF HUMANITY 

said his men would only provide medical assistance. After the meeting, 

city officials took the colonel to several possible camp sites for his troops; 

when at last shown a dry spot, Brechemin selected it. Rather than pitch 

camp in the dark, he had his men unload the train and spend the night in 

the cars. Early the next morning, they erected their camp and began 

providing medical assistance. 

Local residents had already established · treatment centers for the 

storm's victims in the Valley Baptist Hospital, the Commerce Building, 

and the Reese-Will-Mond Hotel. As inspection revealed that none of the 

three was equipped to render satisfactory care, Brechemin decided to 

eliminate the temporary hospital in the hotel and to concentrate on 

improving services in the other two faci lities. He assigned the 4th Hospital 

Company to provide patient care in the Valley Baptist Hospital and the 

Commerce Building. At the Valley Baptist Hospital, soldiers set up a 

ward tent in the front yard, transferred the patients to it temporarily, and 

spent two hours that morning trying to repair and refurbish the facility. 

When they completed their improvements, Valley Baptist housed the 

more serious cases, and the surgical team used its operating room. The 

4th Collecting Company transferred patients from the hotel to it, while 

other personnel continued to care for the injured at the Commerce Building. 

With the help oflocal doctors and nurses, the Army treated 103 patients in 

the two facilities. 

Once the patients in the hospitals had received emergency care, the 

relief team turned its attention to the sick and injured in isolated, outlying 

areas. Many residents of the countryside around Harlingen had telephoned 

for ambulance service, and an aerial survey located others in need of help. 

To evacuate them, Brechemin had five animal-drawn and eight motor 

ambulances-the former in greater demand because of the muddy terrain 

and poor road network. Brechemin sent all five animal-drawn ambulances 

to Rio Hondo, an area reportedly in the worst condition, where they 

brought patients out over thirty miles of miry roads to concrete highways. 

Corpsmen then transferred them to motor ambulances for the remainder 

of the trip to the hospitals in Harlingen. In other, less isolated areas, the 

Army requested that people bring the sick to the concrete highways where 

ambulances met them. 

On the 8th, requests for evacuation eased, so Brechemin toured the 

surrounding countryside and decided to suspend the ambulance operation. 

The next day Red Cross officials arrived in Harlingen, investigated 

conditions, and announced they would take over the hospital work. On 

the 10th, the Army transferred control of all health facilities and much of 

the Army's medical supplies to the Red Cross. Then the 2d Medical 
RELIEF ROLE IN TRANSITION 119 

Regiment returned to San Antonio, part by train and the rest by motor 

convoy 40 

Unlike its aid to Harlingen, the final domestic assistance operations 

before World War II in which members of the Medical Department 

participated- those during the floods of 1936 and of I 937-were not the 

kind of clearly delineated missions the Army preferred. In 1936, the War 

Department left most of the flood relief work in the New England and 

Atlantic states to the Red Cross and other agencies. The Office of the 

Surgeon General helped solve a few administrative problems, a few 

Army medical officers provided administrative support for the medical 

relief effort of the Civilian Conservation Corps, and a representative of 

the 3d Corps Area Chief Surgeon along with a sanitary engineer from the 

Quartermaster Department conducted a sanitary survey of the affected 

region.

4 ' 

In January and February of the next year the Ohio and Mississippi 

Rivers flooded more than 12,72 1 square miles in twelve states. As part of 

the federal relief operation---<iirected by a committee of officials from 

several private and governmental agencies- personnel and units from the 

Army Medical Department provided various types of assistance. Its 

medical depots supplied serums, vaccines, field hospitals, and medical 

equipment to relief agencies throughout the flooded region. In some areas 

Army medical officers conducted sanitary surveys, advised local officials 

on medical matters, inspected-and in Arkansas even administeredrefugee camps. But only in two Kentucky cities, West Point and Louisville, 

did Army doctors provide substantial direct medical care 42 

For two days in the flooded town of West Point, members of the 7th 

Cavalry Brigade (Mechanized) rowed heavy pontoon boats amidst sleet, 

driving rain, and a ferocious wind, picking up stranded residents and 

ferrying them to safety. Once the evacuees were landed, they boarded a 

..acol Louis Brechemin. Jr .. Rpt of Relief Expedition to Harlingen. Texas. 21 Sep 33. box 2409. 

400.38 , Record Group 407. NA. There may have been a similar mission to Oklahoma City in 1935. 

but infonnation is sketchy. See Rad. Hagood to AG. 2 1 May 3S. box 2408. 400.38. Record Group 

407, NA. 

41Memo for Franklin D. Roosevelt. 18 Mar 36. box 2409. 400.38. Record Group 407. NA: Rad. 

Conley to all corps areas. 19 Mar 36. box 2407.400.38. Record Group 407. NA: Summary of Flood 

Relief Activities of the Medical Department, 3d Corps Area. bulky package. 400.38, Record Group 

407, NA; "The Amly in Flood Time. ,. QJUlriermaster Review IS (Mar-Apr 36): 33-3S; Reynolds. 

"Disaster Services," pp. 89, 119-2 1. 

420n Anny aid in general, see Telg. R. G. Bress to AG . 24 Mar37; War Department Directive. 27 

Jan 37. Both in box 2407, 400.38, Record Group 407. NA. Reynolds. "Disaster Services." pp. 

169-71: RSW, 1937, p. 36. On medical aid, see Rpt of Commanding General. Sth Corps Area. on 

Flood Re lief Activities; Final Report of Flood Relief. 6th Corps Area: Rpl. Flood Relief of Southern 

Illinois. All in box 2406. 400.38. Record Group 407. NA. Rads. Ford to AG. 24 Jan and 9 Feb 37. 

Both in box 2407, 400.38, Record Group 407. NA. 
120 THE DEMANDS OF HUMANITY 

train and rode to Fort Knox , where other soldiers had established a 

refugee camp in unoccupied barracks. Survivors requiring surgery or 

about to give birth were admitted to the post hospital , but refugees with 

minor illnesses went to a temporary infirmary that medical officer Maj. 

Gaston W. Rogers had opened. As the number of evacuees climbed to 

over a thousand, his facility became completely inadequate. Under the 

direction of an officer's wife who had served as an Army nurse in World 

War I, the post opened another temporary hospital where other wives and 

a few soldiers served as nurses. For four-footed refugees, the post 

veterinarian opened a quarantine camp in an older section of the post's 

stables, and before long he had assembled a small dairy herd that produced 

milk for sale at Fort Knox.

43 

In Louisville, Army medical personnel brought health care to the 

town rather than the converse, as in West Point. Sanitary conditions 

remained perilous for more than a week after the flood; Company G 

(Hospital) from Carlisle Barracks, Pennsylvania, arrived by train to 

furnish the distressed populace with additional hospital service. As the 

unit unloaded, its commander inspected the school building his troops 

would occupy. Capt. Alvin L. Gorby judged the modern structure with its 

good cafeteria and conveniently located, indoor bathrooms an excellent 

location for an emergency hospital. Even though civilian volunteers had 

operated a hospital there for a week, the Medical Corps officer decided it 

needed a thorough reorganization . He quickly moved his troops into the 

school and got them settled into quarters on the top floor. Gorby then 

assigned them various tasks in administering and improving the emergency 

facility and reorganized the civilian volunteers into regular shifts. To his 

dismay, he found that the school's abysmally poor water pressure rendered 

the water pipes and toilets worthless, so Gorby arranged for water to be 

trucked in and for latrines to be dug in the backyard. Despite the unforeseen 

plumbing difficulties, within a day or two the high school hO.used an 

efficient temporary medical facility . 

With the hospital functioning smoothly, the doctors and corpsmen 

from Carlisle Barracks expanded their assistance in Louisville. First they 

assumed responsibility for the typhoid inoculation station, then repaired 

and reorganized another high school turned hospital- this one serving 

black patients. During the unit's thirteen-day stay in the city , it administered 

more than 5,000 inoculations and provided nearly 2,000 patient-days of 

care in the two hospitals 44 

4)R. H . Garity, "Fort Knox Flood Relief Activities, " Cavalry Joumal46 (1937); 133- 37. 

44Garity, "Flood Relief. 0, pp. 127 - 40; Alvin L. Gorby . .. Anny Flood Relief in the Ohio River 
RELIEF ROLE IN TRANSITION 121 

After Gorby's and all other units had completed their assistance 

missions, the Army had the good fortune to recover the money it had 

spent for flood relief. President Franklin D. Roosevelt reimbursed the 

War Department with money diverted from two unrelated economic relief 

funds. The Army was reimbursed in similar fashion for its expenses 

incurred in a small assistance operation after the New England floods of 

1937 . The War Department's suggestion at the beginning of the relief 

effort that an account be created to which relief expenses could be charged 

was, however, ignored. 45 

Toward New Relief Roles 

After the floods of 1937, the Army did not undertake another major 

domestic relief mission before the Second World War. It did, however, 

continue its effort to define its role in assistance operations. In May 1938, 

Secretary of War Harry H. Woodring and President of the Red Cross 

Norman H. Davis exchanged letters delineating a new relationship between 

their respective agencies. The Army recognized the Red Cross as the 

nation's primary disaster relief agency, though its corps area commanders 

retained the prerogative of committing Army personnel and resources. 

Once involved, however, the Army would abdicate a great deal of 

authority to the Red Cross, because as soon as the Red Cross established a 

headquarters the Army would issue supplies through it. To ensure proper 

accountability in the Army's supply system, all materiel issued to the Red 

Cross would be receipted for by its officials, but that did not commit the 

Red Cross to reimbur!;e the Army for losses. In rescue work as well as 

supply, which of course included medical relief, the Army consented to 

submit to the direction of the civilian organization. The War Department 

informed all corps area commanders and interested departments of the 

terms of the agreement and later incorporated them into a revised AR 

500- 60 with an entire section on the authority, organization, and 

responsibility of the American National Red CrosS.' 6 

If the Army appeared to be abandoning its relief mission in its 

agreement with the Red Cross, other developments in 1937 - 1938 revealed 

that was not the case. In the spring of 1937 the War Department institut~as 

Flood Area," Army M edical BIlllelin 39 (Apr 37): 45 - 50. Rad , 5th Corps Area CG to AG, 3 Feb 37; 

Rad , Cole to AG. 7 and 8 Feb 37 . All in box 2406. 400.38, Record Group 407. NA. 

d Ur, V. V. Tayler to Budget Officer for the War Department, 17 Feb 37. box 2403. 400.38 . 

Record Group 407 . NA; Memo to Assistant Chief of Staff from the Budget Officer, 10 Oct 38, box 

2402,400.38. Record Group 407, NA. 

46Ltrs, Harry H. Woodring to Norman H. Davis, 19 May 38 , and Davis to Woodring. 26 May 38. 

Both in box 2404, 400.38 . Record Group 407, NA. 
122 THE DEMANDS OF HUMANITY 

if by habit-another study of the Army's response to disaster and asked 

corps area commanders for suggestions. Maj. Gen. George Van Horn 

Moseley, commander of the 4th Corps Area who had much experience in 

assistance operations, replied that over the past three years he had repeatedly 

urged local communities to prepare for disasters and believed that the War 

Department should too. He recommended that the department require 

corps areas to have disaster plans similar to mobilization plans. The War 

Department concurred, and at its direction early in 1938 each area drafted 

and submitted such a document. The formulation of relief plans suggests 

that the War Department in the late thirties really sought a more efficient, 

organized response to domestic disasters, something that confusion over 

relief programs during the previous two decades had shown to be needed. 47 

The War Department did not insist on a dominant role in the emerging 

disaster relief system, because many more institutions existed to provide 

aid, the Red Cross had become capable and politically powerful, and the 

Army realized the limitations of its own resources. In early 1938, General 

Moseley succinctly summarized the Army's position in a letter to civilian 

relief officials in Tennessee. "There was a feeling for a long time," 

Moseley wrote , " that parts of the Army could be employed in the eventof 

an emergency and that funds were ample to meet all such cases. That is 

not a fact." The Army figured its budget in great detail and with little 

slack, he continued, for which reason any Army supplies issued must "be 

replaced in kind or paid for in fact. " And if financed, Moseley added, the 

Army should be called only in an "emergency so critical and so extensive 

that it taxes the regular civil institutions beyond their power. " Even on 

such occasions the Army should remain only for as long as absolutely 

necessary. As soon as possible, civilian authorities must take control. 48 

More than in many aspects of disaster assistance, the restrictions on 

Army aid sketched by Moseley applied to medical relief. No longer 

would Army medical personnel take charge of sanitation and health care 

as they had in San Francisco. Rather, corps area commanders might send 

a medical unit to a community where local authorities needed help in 

quickly stabilizing the situation, as happened in Harlingen. Or a medical 

unit might supplement other groups' efforts in coping with a massive 

47Memo lor AG by John J. Hughes, 13 Apr 37, box 2404. 400.38, Record Group 407. NA; Ltr, 

George Van Hom Moseley to AG. 6May 37, box 2405, 400.38, Record Group 407. NA. Memo for 

Chief of Staff. 4 Nov 37; Memo for Chief of Staff by G. W. Cocheu, 14 Dec 37. Both in box 2404. 

400.38, Record Group 407. NA . LIT, Edward Crowly to all corps area commanders. 27 Dec 37. box 

2409.400.38. Record Group 407. NA; Flood Relief Plan, Sth Corps Area , 1 Feb 38, box 2406, 

400.38, Record Group 407. NA . 

411QU01C from Llf. George Van Hom Moseley to Mrs. Amy Brown , 26 Mar 38. box 2402. 
RELIEF ROLE IN TRANSITION 123 

calamity, as happened in Louisville. But as the 4th Corps Area commander 

explained in a field order, state National Guard and civilian medical 

resources should provide the first line of defense in disaster. If they did all 

that they could and it proved insufficient, Regular Army medical personnel 

and equipment should "augment" civilian resources and the National 

Guard.<9 

The restriction of the domestic medical and other missions during 

the interwar years paralleled what actually happened in most individual 

disasters. With a crisis at its bleakest, people invited, even pleaded, for 

Army assistance, but as conditions improved, bickering among various 

factions began. As the feuding escalated and sometimes involved the 

military, the Army realized the time had come to withdraw; its aid was no 

longer essential. A similar development occurred in the realm of policy. 

In the late nineteenth century and first two decades of the twentieth, local 

authorities lacked the means to respond to disasters, other relief organizations 

had not developed sufficiently to aid them, and the Army answered the 

nation's plea for help. But after World War I, the states, local authorities, 

and especially that peculiar amalgam of local volunteers and centralized 

professionals, the American Red Cross, gradually became capable of 

rendering necessary assistance. The institutional crisis in disaster relief 

eased, the bickering began. The Red Cross adamantly defended its 

supremacy , and Congress withdrew its firm support for Army relief 

activities. Realizing the crisis had passed and it was no longer indispensable, 

the Army began to restrict its relief activities, especially those involving 

medical personnel. 

Throughout the process of study and evaluation that led to the restriction of domestic relief activity, the Army medical role in foreign 

assistance received little attention, probably because the Army undertook 

few major operations abroad during these years. Since Hawley's efforts 

in Managua, which were to some extent only the result of the chance 

presence of troops in the area, the Army had performed only two foreign 

missions, neither involving direct medical care. In 1934 Army planes 

flew tents and water purification chemicals to Honduras during a flood, 

and three years later the Army helped citizens of Manila after a fire. Then 

in 1939 the Army conducted a relief mission which though it did not result 

in any new policy still foretold increased activity in foreign disasters after 

World War II. And though the Medical Department only contributed 

supplies, the operation suggested that the postwar activism would include 

400.38 , Record Group 407, NA. 

49Quote from Field Order) , 4th Corps Area, Jan 37. box 2405, 400.38, Record 407. NA. 
124 THE DEMANDS OF HUMANITY 

unprecedented medical participation. 50 

On 24 January 1939 an earthquake shook Chile for a full three 

minutes, leaving a 450-mile-long segment of the country in ruins. On the 

evening of the 26th, officials in Concepci6n, one of the hardest hit areas, 

wired Santiago requesting more medical supplies, especially anti tetanus 

and antigangrene serums. Learning of the request, the American ambassador 

in Santiago cabled a report of the city's medical needs to the State 

Department. In response, Army forces in the Canal Zone dispatched two 

bombers, a Martin 8 - 10 and a Douglas B- 18, to Chile. Loaded with 

several types of typhoid vaccine , antitetanus serum, and gas gangrene 

antitoxin, they took off from the Canal Zone on the 27th and arrived in 

Santiago two days later after stops in Peru and Columbia. 51 

As the planes flew south, Col. Ralph H. Wooten, a military attache in 

Santiago, asked his superiors in Washington about employing the planes 

in relief work once they had arrived. Warning Wooten that the bombers 

were probably too big for the small Chilean airfields, they granted him 

permission to use the planes at his discretion. When the bombers arrived, 

Wooten sent the B - 18 to Chillan and the B- 1 0 to Concepci6n to deliver 

their supplies. Over the next ten days- from 30 January to 9 Februarythe two planes made daily flights to those cities and others. On the flight 

from Santiago they ferried into the stricken area ten thousand pounds of 

bread, medical supplies, and mail, as well as relief workers. On the return 

fljghts, the bombers served as ambulance planes, with the 8 - 18 evacuating a 

total of sixty patients and the B - 10 another five .. The constant missions 

took their toll on the aircraft, but Pan American Airlines helped with 

maintenance and furnished spare parts for the planes. 52 

On I February a Red Cross survey revealed a need for additional 

supplies. Officers in Chile called Washington, dictated a list of wanted 

items, and requested that 30 percent of them be shipped by air. In 

response, the War Department authorized a flight by a still experimental 

B- 15 aircraft from Langley Field in Virginia, and on 4 February, Maj . 

Caleb V. Haynes took off in the B- 15 loaded to capacity with 3,300 

pounds of medical supplies. He delivered his cargo in Santiago 49 hours 

and 18 minutes later, after a flight through very rough weather. He 

SOOn Honduras, see box 2408. 400.38. Record Group 407, NA; Nell' York Times', 17 Jun 34. On 

the Philippines. see file 4 -8-37. box 2403. 400.38. Record Group 407. NA. 

5L"Worst Shake ," Time 33 (6 Feb 39): 18; New York Times. 27 Jan 39. Telg. Craig to 

Commanding Genera l, Panama Depanmenl, 26 Jan 39; Telg, Stone to Chief ofSlaff. 28 Jan 39; Rad, 

from Canal Zone, 28 Jan 39; Rads, Slone to AG . 28 and 30 Jan 39. All in box 2403. 400.38. Record 

Gmur. 407. NA. 

5 Rad, Adams to Wooten. 30 Jan 39; RplloAG. 9 Feb 39; Rad. Franklin C. Wolfe to AG , 19 Feb 

39; Llf. Wooten 10 John O. M cGregor, 9 Feb 39. All in box 2403, 400.38, Record Group 407 . NA . 
RELIEF ROLE IN TRANSITION 125 

PATIENTS PREPARED FOR AIR EVACUATION, Chile, 1939. 

stopped twice, once in the Canal Zone and again in Peru; his actual air 

time was only 29 hours and 53 minutes 5 3 

As a further precaution the War Department alerted a company of 100 

men at Carlisle Barracks' Army Field Medical Service School for possible 

deployment to Chile. Plans called for the troops to motor to Middletown, 

Pennsylvania, board a plane for Pensacola, Florida, then fly by commercial 

airliner to Chile. The Army never dispaiched them because the situation 

in Chile quickly improved enough to eliminate the need for additional 

American troops and to allow American planes there to depart after ten 

days. But the plan to send the company as well as the speed with which all 

relief was rendered pointed toward new capabilities in assistance abroad. 54 

Before the Chilean operation, the Army's inability to deliver personnel 

and supplies to a foreign disaster scene in a short time had curtailed 

medical and other types of relief. With the exception of the massive 

mission to Japan, during the interwar years medical personnel had only 

undertaken sporadic, small foreign assistance operations, primarily in the 

Caribbean or the Philippines. Coming at the end of two decades of 

·

S3Rpt. to AG, 9 Feb 39, box 2403, 400.38, Record Group 407, NA; clipping rrom Washillg/oll 

Pos/, 15 Feb 39. in the American Red Cross Library . Washington D.C. Haynes received the 

Distinguished Flying Cross ror his errons. 

$4New York Times. 29 Jan 39; Rad . Wooten (?) to AG, 9 Feb 39, box 2403, 400.38, Record 

Group 407, NA. 
126 THE DEMANDS OF HUMANITY 

relative inactivity, the airlift to Chile suggested the possibility of a very 

different role for personnel and units of the Army Medical Department in 

the future. By 1960 the Army, with the help of the Air Force, would be 

able to airlift an entire hospital to Chile in about the same time it took to 

deliver the 3,300 pounds of supplies in 1939. 
CHAPTER 7 

Domestic Assistance under Civilian 

Coordination, 1945-1976 

The Second World War curtailed U.S. Army medical as well as other 

types of disaster assistance-though some soldiers participated in at least 

one flood relief operation during the war. After the end of the conflict, 

military aid efforts resumed, but in the late forties and early fifties the 

federal government reorganized its procedures for rendering assistance. 

The changes influenced the role of Army medical personnel in civilian 

relief, although medical matters had not prompted them. 1 

To some extent, the new methods and organizations were designed to 

provide coordination and planning to reduce the problems that had 

characterized the interwar years. But in addition, they followed from the 

gradual transformation of nineteenth century attitudes toward disasters 

and government aid to communities stricken by them. Americans by the 

1950's considered disasters natural phenomena rather than supernatural 

messages. Scientists had, for the most part, explained their causes, and 

social scientists had even begun to study how human beings behaved 

during them. Years of government assistance in individual disasters had 

left a heritage of federal involvement, and many people thought aid 

should be made automatic. In the postwar years, Congress responded 

with laws approving continuing federal disaster assistance and creating a 

civilian bureaucracy to coordinate it. 2 

The laws delegated responsibility for foreign and for domestic operations 

to different agencies, and to some extent the Army's procedures for 

I For records of the wartime operation, see box 3 149, 400.38, Record Group 407. NA. 

~e evidence on changes in the religious interpretation of disasters is fragmentary and 

occasionally contradictory. It is important to remember that many people could see disaster (and the 

relief effort) as God's work without retai ning the nineteenth century view of disasters as punishment 

from God. On the issue, see especially Russell R. Dynes and Daniel Yutzy, "The Religious 

Interpretation of Disaster. " Topic 10: A JOllmal of the Liberal Arts to (1965): 34-48, but also Harry 

E. Moore , Tomadoesover Texas: A Study oflVacoand Sail Angelo ;1I Disaster (Austin: University of 

Texas Press, 1958), pp. 102- 9.220-23; Donald B. Robinson, The Face o/Disaster (Garden City, 

N. Y. : Doubleday & Co., 1959), pp. 183-89. For an introduction to the new social science approach to 

disasters, see Fritz , "Disaster"; Anthony F. C. Wallace, Human Behavior in Extreme Situations: A 

Study 0/ the Literature and Suggestiolls/or Further Research , Disaster Study No. I (Washington: 

National Academy of Sciences-National Research Counc il , 1956). passim. but especially pp. 4-5. 
DOMESTIC ASSISTANCE 129 

ARMY AMBULANCES STAND READY during Texas City explosion, 1947. 

2,500 feet. Where they fell, these missiles ignited warehouse and fuel 

storage tanks on shore. Almost instantly the entire dock area erupted in 

flames. Many dockhands and onlookers died immediately; others sustained 

injuries from the blast or the projectiles. J 

Lt. Col. John P. Horan, commander at neighboring Fort Crockett, 

heard the explosion and saw the smoke; he immediately phoned the 

sheriff and offered his post's services. When the sheriff accepted, Horan 

at once alerted the entire garrison. Within fifteen minutes Anny ambulances 

and crews had begun the rescue and evacuation effort. Horan realized, 

however, that Texas City would need even more assistance. Early that 

morning he requested help from Fourth Anny Headquarters. Because of 

the requirements the Anny adopted in the later 1930's, the command had 

a disaster plan, which it implemented at once. Commanding General 

Jonathan M. Wainwright assumed direction of the relief effort and that 

afternoon arrived in Texas City with several of his staff officers. Wainwright 

personally inspected the destruction and left Brig. Gen. Josef Sheetz in 

'Elizabeth L. Wheaton, comp .• Texas City Remembers (San Antonio: Naylor Co .• 1948); Adolph 

A. Hoehling. Disaster: Major American Catastrophes (New York: Hawthorn Books, 1973), pp. 

114- 30; Virginia Blocker and T. G. Blocker, "The Texas City Disaster: A Survey of 3.000 

Casualties," Amuican 10urnal of Surgery 78 (1949): 756- 71. 
128 THE DEMANDS OF HUMANITY 

FLAMES AND DESTRUCfION after the Texas City explosion. 1947. 

rendering both became distinct as well. Futhermore, the two types of 

relief missions developed in such different fashion after the war as to 

merit separate discussion. Army medical assistance abroad, discussed in 

the next chapter, increased in the postwar period. Domestic assistance, on 

the other hand, continued at the restricted level of the late thirties, or 

possibly even declined. 

The Texas City Explosion 

Before all the administrative changes began, however, personnel 

from the Army Medical Department became involved in another largescale relief effort. On the morning of 16 April 1947, longshoremen at 

the port of Texas City, Texas, discovered fire aboard the ship Grand 

Camp docked there and loaded with ammonium nitrate. Few people 

considered the fire a serious danger, attempts to extinguish it proceeded 

perfunctorily, and no one bother~d to evacuate the area or disperse the 

crowds that gathered to watch the excitement. The fire fighters did not 

realize the danger of the highly volatile cargo until 0912 hours, when 

the Grand Camp exploded, atomizing two sight-seeing planes flying over 

it. Flaming metal fragments, some as large as 60 tons, were thrown up to 
132 T HE DEMANDS OF HUMANITY 

passed laws providing for loans to victims of certain disasters, and in 

1941 it enacted a measure authorizing the Army Corps of Engineers to 

conduct rescue operations and emergency repairs during floods. Three 

years later, in legislation with important implications for the Army 

Medical Department's role, Congress placed the Public Health Service 

(PHS) in charge of assisting states during health emergencies. This law 

gave legal authority to the increased PHS activity that had begun during the 

twenties and thirties and recognized the reduced participation of Army 

medical personnel 6 

None of these acts, however, authorized automatic relief or created a 

civilian agency to coordinate federal assistance . A major step in that 

direction occurred in July 1947 when Congress enacted Public Law 233, 

the Surplus Property Law, which authorized the president to initiate 

federal disaster relief without specific funding or approval from Congress. 

The law allowed him to transfer surplus property held by the War Assets 

Administrator to the Federal Works Administrator, who could then transfer 

it to any state or local government in a distressed area. The administrator 

could donate medicines or other expendable items, loan nonexpendable 

supplies, and pay shipping costs. The statute permitted the Federal Works 

Administrator to use officers of other federal agencies when necessary to 

fulfill his mission and directed all departments to cooperate with him'" 

Although precedent-setting, the Surplus Property Law did not mark a 

dramatic change in policy. After World War I a similar distribution of war 

surplus property had occurred without benefit of law . Furthermore, the 

program obviously had a limited life span- roughly until surplus stocks 

were depleted- at which time either a return to the prewar ad hoc system 

or another program would have to replace it. The law did, however, 

further reduce Army involvement by delegating the responsibility for 

distributing surplus property to a civilian agency. 

Under these provisions, the federa l government rendered assistance 

in thirty-two disasters. Surplus stocks quickly dwindled, and Congress 

twice revitalized the program with supplementary appropriations. Many 

people advocated new legislation that would offer a permanent solution to 

the disaster relief problem, and those who administered the law perceived 

6Collgressiollal Record, 81st Cong., 2d sess., 1950. pp. 11901-2; OrticeofEmergency Preparedness, 

Report 10 the Congress: Disaster Preparedlless (Washington: GPO, 1972), 1:168; L . E. Burney, 

" Public Health Problems in Major Disasters ," AIII/ais of 'he American Academy of Political alld 

Social Sciellce 309 ( 1957): 82- 84. 

7Surplus Property Law of 1917; Subcommittee on NalUral D isaster Relief, A Sllbcommiuee 

Report 011 Narl/ral Disaster Relief (Washington: GPO, 1955), pp. 3-4; U.S. Congress. Senate, 

Alleviation a/Damage/rom Flood or Other Carasfrophe , S. Rpt, 435, 80th Cong., 1st sess. , 1947; 

Congressional Record, 80th Cong ., 1st sess., 1947, pp. 8300- 1; Congressional Record. 8IstCong. , 
130 THE DEMANDS OF HUMANITY 

charge of the Army's operation, with all the resources of Fourth Army 

available to him" 

Lt. Col. Irvine H. Marshall , a medical officer from the Fourth Army 

surgeon's office, initially directed medical aspects of the relief effort. To 

assist him, Fourth Army ordered 36 doctors, 40 nurses, a medical 

administrator, and the 32d Medical Battalion-all from posts in San 

Antonio--to report to Texas City without delay. It also sent all expendable 

medicines from its own stocks and requested the St. Louis Medical Depot 

to ship additional items. By midnight all the extra personnel and the first 

of the supplies had arrived at Fort Crockett. 

Some of the personnel started work at once in the Fort Crockett 

Station Hospital . The facility had been inactive at the time of the explosion, 

but shortly after the blast Lt. Col. Eugene H. Mitchell, a military science 

teacher at a Galveston high school , volunteered to help reopen it. With the 

assistance of Army wives, a medical sergeant, and fifty Red Cross 

volunteers, he quickly had the hospital in operation. By 2100 hours it had 

admitted fifty-eight civilians, though the majority of casualties had been 

sent to local hospitals. That night Colonel Marshall toured those institutions 

and assigned the remainder of the Army's doctors and nurses from San 

Antonio to them. He placed the 32d Battalion on standby at Fort Crockett. 

Soon it, too, was called into service. 

In the rush to rescue as many people as possible, little had been done 

to extinguish the flames along the dock. Late in the afternoon, fire broke 

out on a second ship carrying ammonium nitrate, the High Flyer. Attempts 

that night to tow it out to sea failed, and workers noticed the same orange 

smoke that preceded the explosion of the Grand Camp . Forewarned this 

time, they quickly evacuated the area . Shortly after midnight the High 

Flyer exploded with an intensity equal to the first blast and reignited fires 

along the waterfront. Officials at Fort Crockett sent doctors from the 

station hospital and ambulances from the 32d Battalion to evacuate any 

new victims. Fortunately, the late hour and prior warning held casualties 

to a minumum, and by 0900 hours the ambulances returned, their services 

unneeded. 

4Unless otherwise ciled, account based on J. R. Sheetz, "Disaster Relief Activities by Military 

Personnel during the Texas City Disaster." 5 May 47; Statement by John P. Horan fi led with Sheetz 

Rpt; Ltr, Lewis C. Beebe to War Department, 16 May 47; Memo forMG Kirk by Robert P. Williams, 

23 Apr47. All in 370. 1 (Texas City), Record Group 407, NA. Wheaton, Texas City. passim, bUI 

especially pp. 6. 32- 33, 46- 48; Reynolds, " Disaster Services, tt pp. 3 17- 46; American National 

Red Cross, A Prelimillary Report 011 'he Texas City Explosion (51. Louis: American National Red 

Cross, 1947), pp. 20- 22; William H. Witt, "The Anny's Coming," Army Information DigesI3 

(Ma< 48): 14- 18. 
DOMESTIC ASSISTANCE 131 

Even without additional victims, casualties still taxed available health 

care facilities. The blast killed 513 people almost at once; another 50 died 

after hospitalization . Between 2,000 and 3,000 people were treated for 

injuries that did not require hospital care, and 150 serious cases were sent 

to Houston hospitals. That still left 836 patients to be cared for in three 

local civilian hospitals and the Fort Crockett facility . Staffed by the 

clearing company of the 32d Battalion after the first day, the station 

hospital treated a total of 121 patients during the emergency, although its 

patient census fluctuated between 40 and 60. With the approval of Col. 

Prentice L. Moore, who relieved Marshall as head of medical operations 

on the 17th, the Army continued to detail surgeons and nurses to the 

overburdened civilian facilities. In addition to the hospital work, Army 

doctors and first aid teams periodically visited Camp Baldwin, a refugee 

center ten miles from Texas City. They provided routine care for its 

residents and identified several cases of infectious diseases-mumps, 

chicken pox, possibly whooping cough-but no serious health threat 

developed. 5 

An outbreak of gas gangrene in Texas City itself was reported, 

however, and on the 17th a specialist from Brooke Army Medical Center 

investigated but confirmed only one case. When TUmors of more persisted, 

the Army's Surgeon General sent two surgical consultants, one a civilian 

and the other an Army medical officer, to conduct another study. The two 

experts confirmed nine cases but still pronounced previous reports 

exaggerated. With no serious gas gangrene outbreak or problems with 

infectious diseases, the necessity for Army medical support in Texas City 

quickly passed. By the 19th, requests from civilian hospitals for surgical 

services had ended, and some Army personnel began returning to their 

stations. On the 22nd the Army transferred the remaining patients in the 

station hospital to civilian facilities and closed it. By that time all but a 

few of the Army's medical personnel had gone home. 

Creation of a Federal Relief Bureaucracy 

Army medical missions like that in Texas City, which had been 

unusual in the interwar years, .became more so after the war as military 

involvement declined and the trend toward greater centralization and 

increased civilian control continued. In the late thirties Congress had 

5Statistics from Blocker and Blocker. "Survey of Casualties ••• p. 759; and Sheetz Rpt,lnclosure 

13, p.6. See also David Minard, John H. Killough. and Bernard Zimmerman, "Medical Aspects of 

the Texas City Disaster with Special Reference to the Effects of Air Blast," project NM 0 11101 5, 

Report No.4, Naval Medical Research Institute, 1948. 
134 THE DEMANDS OF HUMANITY 

law substantially altered the means of rendering federal assistance and set 

a strong precedent for increased federal involvement. 

At the same time Congress had considered the disaster act, it had 

debated a civil defense bill, and most officials expected one agency to 

administer both programs. But President Harry S. Truman decided that 

the fledgling Federal Civil Defense Administration (FCDA) had enough 

responsibility and assigned the disaster work to the Housing and Home 

Finance Agency (HHFA). Then in 1952 Truman transferred the disaster 

relief function to FCDA. In 1958 the FCDA-still responsible for disaster 

relief-merged with another agency to form the Office of Defense and 

Civilian Mobilization (ODCM), but three years later ODCM split, with 

the Office of Emergency Planning (OEP) assuming responsibility for 

disaster relief. iO 

The Army had at first been ambivalent about civilian control of 

disaster relief, but by 1950 its officials welcomed the new law and 

agency . The Army really did not have the resources to coordinate federal 

assistance itself, and reorganization eased some of the problems that had 

complicated its disaster relieffunction during the interwar years. Funding 

for each mission no longer depended on special congressional action, and 

the law provided for Red Cross reimbursement of the Army for the 

transfer of supplies if the president did not declare a major disaster. If he 

did, the Red Cross received expendable equipment free of charge and 

accepted responsibility to return nonexpendable items, but the Army's 

costs were refunded by the president from disaster relief funds. II 

On the question of the Army's authority to approve and conduct relief 

operations, Army regulations were slow to recognize the new civilian 

relief organization's responsibility. In the early 1950's AR 500-60 

made no mention of it and delegated relief responsibility to the continental 

Army commanders- a policy similar to the earlier practice of relying on 

the corps area commands (which no longer existed). In 1956 a revised AR 

500- 60 first incorporated the principle of civilian coordination with 

sections defining the FCDA's role. That same year, a Department of 

IOShifts between agencies and the rationale for them can be followed in Reporl /0 Congress: 

Disaster Preparedness. I: 168; Pelerson , "Coordinating Assistance," p. 58; Lyon G. Tyler, Jr .. 

"Civil Defense: The Impact of the Planning Years, 1945- 1950" (Ph.D. diss., Duke University . 

1967), p. 291 ; Executive Order 10427, 16 Jan 53; Edward A . McDcnnolt, "Emergency Planning," 

Military Review 44 (Feb 64): 19- 28; Executive Order 10773, I Jul 58; Executive Order 11051 , 27 

Sep 62 . 

IIFor two views in 1948, see Coordinating EmergencyAclivities of Federal Agel/cies in Disaster 

Areas: Hearings before the SlIbcommillee of tIle Commillee 0 11 Public Works. U.S. Senate, 80th 

Congress, 2d Session. onS 2831 (Washington: GPO, 1948), pp. 9, 16, 67. On orficial view in 1950, 

see Ltr, Frank Pace, Jr., to William M . Whittington , 7 Jun 50, box 695, 370. 1, Record Group 407, 

NA. 
DOMESTIC ASSISTANCE 133 

a need- as the Army had in the thirties-for more coordination in relief 

efforts. Gen. Philip Fleming, Federal Works Administrator, complained 

that in a relief operation "with so many public and private agencies 

converging on a panic-stricken area, they are bound to get into each 

other's way and that confusion is certain to result in wasteful duplication 

of effort and failure to accomplish some necessary measures.,,8 

Some congressional advocates of disaster relief realized the need for 

both continued funding and closer cooperation among federal agencies. 

After three years of discussions, in 1950 Congress passed a comprehensive 

Federal Disaster Act with three stated goals: to furnish "an orderly and 

continuing means " of federal assistance to state and local governments 

"in carrying out their responsibilities to alleviate suffering and damage 

resulting from major disasters"; to provide for the repair of essential 

public facilities; and to foster the development of state and local organizations 

to cope with disasters. To accomplish these goals the law authorized 

federal agencies to lend personnel, supplies, facilities, and other resources 

to state and local governments and approved the distribution of federal 

medicines, food , and other consumable supplies through the American 

National Red Cross. It also allowed using federal personnel for saving 

lives and property, clearing debris, and making emergency repairs to 

public facilities. Authority to mobilize federal aid was given to the 

president, but the law instructed him to designate an existing office to 

coordinate relief rather than create a new agency. 9 

Although in many ways a dramatic assumption of federal responsibility, 

the Federal Disaster Act of 1950 did incorporate much of the traditional 

response to disasters. In its stated purpose of aiding states and the Red 

Cross to render relief, it continued the heritage of local control and 

voluntarism. In granting authority to act to the president, it simply 

legalized what had been customary practice since the 1880's. Nevertheless, 

the statute made the federal response automatic rather than dependent on 

the whims of Congress, and for the first time it provided for an agency 

with authority to coordinate all federal relief efforts. To that extent the 

2d SOSS. , 1950, p. 11 896. 

IIQuote from "Gen. Philip Fleming Seeks Coordination in Disaster Relief, II Eastern Undenvriter 

49 (20 Aug 48): 1. On developments in this period, see also Report to Canguss: Disaster 

Preparedness, I: 168; Sllbcommillee 011 Nalllrot Disaster Relief. p. 4; Hearings before the Commitleeoll 

PI,blic Works, HOllse a/Representatives, 8J slCongress, 2d Session 011 HR 8396, HR 8461, HR 8420, 

HR 8390, and HR 8435, Bills to Allthorize Federal Assisfallce to Stales and Local Government in 

Major Disasters (Washington: GPO, 1950) pp. 81-82; Val Peterson, "Co-ordinaling and Extending 

Federal Assistance, I. Allnals of Ille Americall Academy of Polirical alld Social Sciellce 309 (1957): 

53. 

9Cotlgressiotlal Record, Slst Cong., 2d sess., 1950, pp. 11 895-9 15. 15O<J5-98. Quote from 

Federal Disaster Act of 1950. 
DOMESTIC ASSISTANCE 135 

Defense directive established channels for liaison between its officials 

and those of the civilian agency but reaffinned that the Anny was to be the 

department's primary source of domestic aid. Within the Anny, responsibility 

for providing assistance remained with the continental Anny commands, 

though under the direction and supervision of the Continental Anny 

Command (CONARC) after its creation in 1955. 12 

Even with the newly established channels for requesting and 

administering relief, the revised AR 500-60 still retained the clause 

carried by its predecessors, allowing aid without prior appeal from the 

coordinating agency when " local resources " were "clearly inadequate" 

or the "ovenuling demands of humanity" compelled it. The clause 

remained through repeated changes in the regulation, though in later 

years the phrasing-reflecting the increasing bureaucratization of reliefwas changed to "imminent seriousness" and still later to "imminently 

serious condition." 13 

Medical Relief Missions of the Fifties and Sixties 

In the 1950's an "imminently serious condition" did not arise very 

often, and the Anny rarely undertook relief on its own authority. Although 

the civilian bureaucracy did request Anny's assistance occasionally, it 

rarely summoned members of the Anny Medical Department. Both the 

Red Cross and the Public Health Service had been designated by law to 

render assistance, and their roles had been reaffinned in the Federal 

Disaster Act of 1950. In addition, two other agencies assumed an increasing 

share of the medical burden. In the late thirties the Anny had advocated 

reliance on the National Guard in disasters, and state units increased their 

relief activities after the Second World War. Local civil defense organizations 

created after 1950 because of fears of nuclear war also rendered aid in 

local natural disasters, even though civil defense and disaster relief were 

not always coordinated by the same agency on the federal level. Together, 

l2Qn Department of Defense policy, see 000 Directive 3025.1, "Responsibilities for Civil 

Defense and Other Domestic Emergencies," 14 Jul 56; 000 Directive 3025 .1, "Employment of 

Military Resources in Natura1 Disaster Emergencies within the United States, Its Territories, and 

Possessions," 18 Nov 65. 000 Directive 3025. 1, . 'Responsibilities for Civil Defense and Related 

Programs," 24 Jan 52, the ftrst of this series, set policy for civil defense and other emergencies but did 

not mention disaster relief. On changing Anny regulations, see AR 500- 60, "Emergency Employmentof 

Army Resources: Disaster Relief," I Oct 52; AR 500- 60, change 2, "Emergency Employment of 

Army Resources: Disaster Relief," 29 Feb 56; AR 500- 60, "Emergency Employment of Army 

Resources: Disaster Relief," 10 Ju159. 

13AR 500- 60, "Emergency Employment of Army Resources: Disaster Relief," 1 Oct 52; AR 

500- 60, "Emergency Employment of Anny Resources: Disaster Relief," 6 May 6f?; AR 500- 60, 

"Emergency Employment of Army and Other Resources: Disaster Relief," 14 Feb 72. 
136 THE DEMANDS OF HUMANITY 

the Red Cross, Public Health Service, National Guard, and local civil 

defense organizations were usually capable of meeting emergency meclical 

needs in domestic disasters. Hence the civilian relief bureaucracy rarely 

had to request Regular Army assistance. 14 

The Army Medical Department did, however, have resources and 

capabilities for one type of assistance, helicopter support, that the civilian 

agencies lacked. The Army received many requests for the dispatch of 

helicopters, and the rotary-wing aircraft proved most versatile in relief 

operations. They served not only as air ambulances but could also fly 

rescue , reconnaissance, and supply missions. The Army had begun 

development of the helicopter before World War II; a few served as air 

ambulances during that conflict but only proved themselves fully in the 

Korean War. Though Air Force helicopters had participated in domestic 

relief operations as early as 1949, it was only after Korea that Army 

helicopters became active in disaster assistance missions. When Army 

craft did participate, they were not, of course, always from medical units, 

since other Army organizations had them, too. But when air ambulance 

units did participate, they not only evacuated patients but also performed 

other relief tasks. Two missions flown by Army medical aviators during 

the 1950's illustrated the versatility of helicopter ambulances in disaster 

situations. 15 

One of the earliest domestic missions involving Army helicopter 

ambulances occurred in June and July of 1954 when the Rio Grande and 

its tributaries flooded much of the area along the Mexican border between 

Langtry and Laredo, Texas. Operating out of Laughlin Air Force Base, 

Air Force and Navy craft with two H-25's and nine H-13's from the 

Army's Medical Field Service School and two ambulance detachments at 

Fort Sam Houston, Texas, participated. Shortly after their arrival on the 

14Demonslraling statistica lly the increase in National Guard medical participation is almost 

impossible since accurate statistics are unavailable and even numbers for all missions are difficult to 

find. However, between 1947 and 1953, guard units aided in 194 disasters. See Bennett M. Rich and 

Philip H. Burch. Jr., "The Changing Role of the National Guard," American Political Science 

Review 50 (1956): 704. Reports of the Militia Bureau, with incomplete statistics, for the interwar 

years show nowhere near that many missions in an equivalent period. Of course , onc has 10 assume 

thai the number of medical missions within the overall figures remains constant. No good overview of 

civil defense medical assistance in natural disaslerscx.ists, bUI for indications of what was happening, 

see William L. Wilson, "Medical Plans for Civil Defense and Disaster, ,. Americall Practiliollerand 

Digest o/Treatmelll 2 ( 1951): 151-62; and a series of articles on disaster medicine in Califomia 

Medicine 93 ( 1960): 69-98. 

l'On the development of helicopters, see Peter Dorland and James Nanney, Dust Off: Army 

Aeromedical Evacuatiotl ill Vietllam (Washington: GPO, 1982). On the employment of Air Force 

helicopters in 1949, see Memo for Secretary of Defense by William H. Draper, Jr., 5 Feb 49, box 

695 , 370. 1, Record Group 407, NA. On general use of Anny helicopters in disasters during this 

period, see William E. Vance, "Ready, Willing, and Able," V.S. Army Aviatioll Digest 2 (Nov 56): 

5-9; .. Disaster and Emergency Relief Operations, ,. V.S. Army A viatiolt Digest 4 (Mar 58): 26-27. 
DOMESTIC ASSISTANCE 137 

scene, the Army helicopter ambulances evacuated the passengers of a 

train stranded near Langtry. Later they transported medical supplies, 

food, and mail to isolated cities along the border and maintained a 

communications link between United States and Mexican relief officials 

by flying messages between Laughlin and the roof of a hotel in Nuevo 

Laredo. Ten days after they reported, all of the helicopters except one 

H-25 had returned to station . In this craft Capt. Joseph L. Bowler, a 

veteran of air evacuations in Korea, continued to fly food, milk, and Red 

Cross supplies to isolated spots on both sides of the border. 16 

Five years after the Texas floods, the 57th Medical Detachment 

(Helicopter Ambulance) at Fort Meade, Maryland, undertook a very 

different type of relief mission. On 27 January 1959, three of the unit's 

H - 19 helicopters with a demolition team from the 19th Engineer 

Battalion flew to Meadville, Pennsylvania, where an ice jam in a nearby 

creek threatened to renew flooding in an area already hard-hit. That 

afternoon the crews conducted air reconnaissance of the jam, and blasting 

operations began shortly thereafter. The crews of the H- 19's flew 

demolition experts to inaccessible areas on the ice and dropped 540-pound 

loads of TNT for their use. By 9 February the jam had been blasted loose, 

and the helicopters returned to Fort Meade. 17 

Despite continued minor and occasional missions, the early sixties 

saw little relief work by Army medical personnel. In 1964, however, a 

calamity severe enough to tax civilian resources compelled renewed 

Army medical assistance. On 27 March 1964 a massive earthquake struck 

south-central Alaska, triggering tidal waves along the coast. The quake 

damaged military facilities in the area; patients from the post hospital at 

Elmendorf Air Force Base near Anchorage had to be transferred to a 

temporary facility the Army's 64th Field Hospital from nearby Fort 

Richardson helped operate. But despite their own problems, military 

units in Alaska answered pleas for help from their civilian neighbors. 18 

16, 'Copters Aid Flood Victims in Stricken Del Rio Region, ,. Americlln Helicopter 36 (Aug 54): 

16. "Brooke AMC 'Chopper' Continues Mercy Flights," unidentified clipping; Llr, John R. Russell 

to CO, Brooke Anny Medical Center, 16 Jul 54. Both in CMH files. 

17Tempest Rapid Report of Installation Resources Employed at Meadville , Pennsylvania. 57th 

Medical Detachment (Helicopter Ambulance), 13 Mar 59; Sections rrom Log. 57th Medical Detachment 

(Helicopter Ambulance). Both in 2-05 Organizational Historical File, 57th Medical Detachment. 

WNRC. 

18Unless otherwise cited, account based on Herbert H. Kerr, "Earthquake," Medical Service 

Digest 15 (1964): 2-9; Daniel Yutzy , Communit), Priorities ill the Anchorage. Alaska, Earthqlwke. 

1964. Disaster Research Center Monograph Series No.4 (Columbus: Ohio State University, 1969); 

Truman R. Strobridge , Operatioll Helpillg Hand: The United Stllles Army alld the Alaskall Earlhqllllke. 

27 March 10 7 May 1964 (Historian . U.S. AmlY, Alaska); Operatioll Helpillg Hal/d.' The Armed 

Forces React to Earthqllake Disaster (Headquarters, Alaskan Command, 1964). Amly Medical 

Service Activities, Annual RpIS, U.S. Anny Alaska; HQ. U.S . Anny, Alaska, Support Command, 

(Continued) 
l38 THE DEMANDS OF HUMANITY 

Since power service had been disrupted, the night of the quake troops 

at Fort Richardson worked by candlelight to establish a logistical center. 

The soldiers manned phones and poured Army supplies into the civilian 

relief effort. During the remainder of the emergency, requests for supplies 

or assistance generally came from civil defense officials to Alaskan 

Command (ALCOM). ALCOM passed them on to the U.S. Army , 

Alaska (USARAL), which sent them to the logistical brigade or to the 

office best equipped to fill the request. Bassett Army Hospital at Fort 

Wainwright coordinated all Army medical assistance. That aid primarily 

supplemented civilian health care efforts and went mostly to the cities of 

Anchorage and Valdez. 

On the night of the quake, Anchorage police requested and rece:ved 

two Army ambulances staffed by four aidmen and stocked with emergency 

equipment. The next day the aidmen participated with other soldiers and 

local policemen in a search of all buildings in the downtown area. The 

Army also loaned equipment and personnel to local civilian hospitals. 

Late the first night Fort Richardson sent a generator to Presbyterian 

Hospital and cots, blankets, and pure water to Providence Hospital. 

During the next few days, two Army doctors worked at Providence, and 

twenty Army technicians helped care for additional patients transferred 

there from a psychiatric institute damaged by the quake. Since Presbyterian 

Hospital had sustained damage too extensive to continue its services, 

authorities evacuated its patients to other civilian facilities. Before it 

reopened, Army troops helped clean and prepare it to receive patients, 

and during the first four days of its renewed operations Fort Richardson 

did its laundry . 

The Army also furnished public health assistance in Anchorage. 

Because the quake broke water and sewage lines, polluting the city's 

water supply, Anchorage health officials asked the Army for water 

trailers. The Army provided and staffed them, and for a time these water 

distribution points furnished the only potable water in many areas. They 

were phased out as public officials restored water service, but an Army 

preventive medicine officer and two technicians continuously monitored 

the city's water supply during the process. In addition, a USARAL 

veterinarian inspected food outlets in the anchorage area to prevent public 

health problems from that source. 

Battered both by the quake and the subsequent tidal wave, the small 

coastal town of Valdez experienced greater devastation than Anchorage 

(Continued) 

and Fort Richardson; 64th Field Hospital; and Bassett Anny Hospital; all for 1964 and in CMH fi les. 
DOMESTIC ASSISTANCE 139 

and did not have so well organized a civil defense force to help it recover. 

Since more help was needed from the Army, Fort Wainwright dispatched 

relief troops late on the night of the quake. Because of bad weather, the 

advance party, which included an Army surgeon, did not arrive until the 

next morning . Its members immediately examined the extensive damage, 

consulted with local officials, and decided to evacuate most of the 

population. 

All but forty-five people left. Other members of the Army rescue 

party, who had stopped in Gulkana when poor weather prevented them 

from proceeding to Valdez, prepared to receive the evacuees. After 

conferring with local civil defense officials, the soldiers established a 

hospital ward and refugee center in the gymnasium of a local high school. 

In addition , the Army established a checkpoint along the highway leading 

from Valdez where a medical team could examine evacuees for possible 

injury or disease. Over the next two days, Army medical personnel 

processed about six hundred refugees and sheltered a hundred of them in 

the gym. 

Back in Valdez, Army medical and engineer troops labored to restore 

sanitary conditions. Fearing an epidemic, Army doctors inoculated all 

remaining residents. Dogs left behind by the evacuees posed another 

health problem as they began to prowl for food. Some anxious civilians 

suggested the Army shoot them, but realizing that most were family pets, 

the task force commander detailed dogcatchers to impound them. Meanwhile 

cleanup operations continued, and a preventive medicine officer and an 

enlisted technician arrived from Fort Wainwright to conduct final sanitary 

surveys. 

No other towns or cities in the affected area received as much medical 

assistance as Valdez or Anchorage , though in Seward preventive medicine 

specialists spent two weeks checking all sources of food and water for 

possible contamination. In other areas, assistance was not required, 

though the armed forces were ready to furnish it. Upon receiving word of 

the disaster, Bassett Army Hospital immediately alerted all personnel and 

expanded to maximum capacity but admitted no civilian casualties. A 

medical team from Madigan General Hospital at Fort Lewis, Washington, 

arrived in Anchorage on 29 March to support the 64th Field Hospital, but 

the unit was not needed for civilian relief and returned to Madigan on 5 

April. Two air transportable 36-bed hospitals and a I DO-bed casualty 

staging unit flown in from Air Force bases in CONUS were never offloaded, and two Army hospitals alerted in CONUS were never actually 

deployed. 

Most of the Army medical personnel committed to civilian relief 
140 THE DEM ANDS OF HUMANITY 

completed their work within five days. In badly damaged Valdez, Army 

doctors remained on duty a little longer, until 14 April, but by that time 

public health conditions even there had returned to normal. Throughout 

the area, despite massive property damage, total casualties from the 

quake remained low and no medical emergency developed. Consequently 

the need for Army medical assistance from CONUS never developed , and 

aid rendered by ALCOM could be quickly withdrawn . 19 

As had happened following earlier major relief efforts, requests for 

Army medical assistance increased after the Alaskan quake, as widespread 

publicity reminded relief officials of the Army's availability. After Hurricane 

Betsy in September 1965, Fourth Army dispatched ten medical officers 

and fifty-nine enlisted men from Fort Polk, Louisiana, to the stricken city 

of New Orleans. There they provided outpatient care, immunization, and 

ambulance services. The next year Army helicopters flew water, food, 

and vaccines into flooded Dell City, Texas, and sent a motor column from 

Fort Bliss. Though Dell City officials believed they could handle the 

immediate health problems, they feared the possibility of an epidemic. At 

their requests, Army medical personnel established an aid station and 

vaccinated 2,000 residents against typhoid 2o 

In August 1967 the Army again provided medical assistance in Alaska 

when the Chena River, which borders Fort Wainwright and flows through 

nearby Fairbanks, rose dramatically. The rising river endangered the 

city's St. Joseph Hospital, perched precariously on the north bank of the 

Chena. On 14 August the mayor decided to evacuate its patients and 

consulted military authorities at Fort Wainwright who agreed to admit 

them to Bassett Army Hospital on the post. Bassett's commanding officer 

summoned all physicians and staff for duty; they activated the reserve 

ward, and within three hours of notification the hospital had admitted all 

sixty-one patients from St. Joseph's. Bassett became the only operational 

hospital in the area, receiving all civilian emergency cases during the 

remainder of the flood crisis 2 1 

Only hours after the infl\lx of patients, the Chena's waters flooded the 

19. 'Medicine in Alaska Nearly Normal; Major Hospitals Are Being Repaired. ,. Medical Tribulle, 

20 Apr 64, clipping in CMH files. 

200ne student of disaster situations has suggested thai as a rule people do not associate the 

military and medicine; perhaps a large disaster reminds them. See William A. Anderson . MilitaryCiVi/illtl RelmiOlls ill Distlsrer Operariolls, Disaster Research Center Report Series No.5 (Washington: 

Office of Civil Defense, 1968). p. 63. On Hurricane Betsy, sec "White House Fact Sheet: Rpl on 

Army Medical Service Activities 10 Chief of Staff from OTSG. " 20 Sept 65, in Directorate of 

Mi litary Support (DOMS) files, WNRC. Army Medical Service Activities. Annual Rpt, Anny 

Hospital. Fort Polk. La .. 1965, in CMH files. On Dell City , sec New York Times, 24 Aug 66; John J. 

Koehler. " Dell City. Texas, Flood Disaster" (student essay. Anny War College. 1968). 

21Following account based on Anny Medical Service Activities. Annual RpIS, U.S. Anny, 
DOMESTIC ASSISTANCE 141 

basement at Bassett. All available hospital personnel worked feverishly 

in a vain attempt to salvage emergency equipment located there , but by 

morning the basement was completely underwater. Engineers installed 

pumps to keep down the rising water level, and strategic points throughout 

the hospital were sandbagged. Since the hospital had already lost power 

from the post's regular electrical system and the flood in the basement 

eliminated its emergency source, the staff placed large mobile generators 

in critical areas such as the operating room, delivery suite, and X-ray and 

outpatient clinics. On the 17th, power from private and Air Force sources 

replaced the emergency generators, but the building still lacked heat, 

water, and sewage facilities. Loss of heat posed the most immediate 

danger because after three days the hospital had cooled to a dangerously 

low temperature. To alleviate the crisis, the staff set up electrical units 

and a few Herman Nelson heaters in strategic spots. Tankers brought in 

water from EieJson Air Force Base, and the hospital used chemical 

toilets. 

Even though dependent on emergency or makeshift support systems 

most of the time, Bassett operated an efficient relief facility . It treated 172 

civilians for a total of 1,135 patient days of care. Its own staff physicians 

handled the increased patient load, but the hospital did hire additional 

civilian help and borrowed Air Force nurses. The Air Force also provided 

Bassett with supplementary supplies. Although the emergency passed 

quickly, the last civilian patient was not discharged until 6 September. 

Obviously Army medical resources could still be useful in emergency 

situations. By the late sixties, though, demand for Army medical support 

in civilian disaster had declined. Two Army relief missions, one in 1967 

and the other in 1969, illustrated the reason why. Only two weeks after 

the floods in Alaska, Hurricane Beulah severely damaged Rio Grande 

City, Texas, and the Army dispatched a large relief force. Its medical 

contingent, however, found civilian resources sufficient to meet all health 

care needs. Army medical personnel operated a communications center 

and worked as sanitary teams in refugee centers. Only the task force 

surgeon, who conducted a health survey of the area, actually served in a 

professional capacity . In the second relief operation, after Hurricane 

Camille struck the Gulf coast in 1969, Army doctors and corpsmen did 

little, even though more than 1,500 soldiers took par!. Army aviatorsnot from Medical Department units-flew 600 medical evacuation missions, 

and Army medical depots fumished vaccines and other supplies. Nonetheless, 

direct health care by Army persQnnel was simply unnecessary in this 

Alaska; Bassett Anny Hospital; I71 s1 Infantry Brigade (M). All for 1967. in CMH files. 
142 THE DEMANDS OF HUMANITY 

relief effort as in most domestic disasters.

22 

Federal Reorganization and Minor Medical Missions of the Seventies 

The year before Camille struck, 1968, marked the beginning of 

further administrative changes in the procedures by which the Army and 

the federal government rendered relief. Spurred by increasing demand for 

Regular Army assistance in quelling civil disorders, the Defense Department 

created the Directorate of Military Support (DOMS). Staffed primarily by 

Army personnel, DOMS setpolicy and coordinated all military assistance 

to civilian communities, including disaster relief. On medical matters, 

DOMS worked closely with Plans and Operations Division of the Office 

of the Surgeon General. 23 

Even after the creation of DOMS, the commanding general of CONARC 

and the continental Army commanders actually conducted disaster assistance 

operations. In 1972 - 1973 the Army adopted a new organizational structure 

under which the Training and Doctrine Command (TRADOC) and Forces 

Command (FORSCOM) replaced CONARC. Within the new structure, 

the commanding general of FORSCOM assumed responsibility for domestic 

disaster assistance. He could delegate relief missions to his subordinate 

CONUS Army commanders or call on resources from TRADOC, the 

Health Services Command (created in the reorganization, HSC included 

all medical installations), or other DOD components. Most relief operations, 

though , involved FORSCOM's own units. In such cases, the FORSCOM 

surgeon provided his command with advice on medical relief, and the 

surgeon's office of the CONUS Army commands did the same for them. 

As before , actual control of medical resources most often remained with 

officers designated by the Army commander rather than the Medical 

Department. 24 

220 n Beulah see Task Force Bravo, After Action Report, Hurricane Beulah, 22 Sep-8 Oct 67, 

DOMS files, WNRC. Anny Medical Service Activi ties, Annual Rpts, 47th Field Hospital, l SI 

Medical Group, Fort Sam Houston , Tex .; 37th Medical Battalion, 1st Med ical Group. Fort Sam 

Houston , Tex. Both for 1967. in CMH fil es. On Camille, see " Hurricane Camille: Amount of 

Federal Assistance , Office of Emergency Preparedness"; Memo to Director of OEP by Richard G. 

Stilwell, 23 Sep 69; " Hurricane Camille, Military Disaster Relief," 22 Aug 69. Copies of all in 

OOMS fil es, WNRC. Federal Response 10 Hurricane Camille. Hearings before rhe Special Stlbcommitree 

on Disaster Relief of the Commiltee 01/ Public Works. U.S. Senate. 9/S1 Congress. 2d Session 

(Washington: GPO, 1970), part I, pp. 10-1 1,27- 29. 104; Jimmie S. Ford, "Hurricane Camille: 

4th Army Operations," U.S. Army Aviation Digest 16 (Jul 70): 18 - 20; D. T. irby, Jr .. "Virgini a 

Disaster Relief," U.S. Army Aviarion Digest 16 (Jul 70): 21-23; John W. Griffin, "Operation 

Camille," U.S. Army Aviarion Digest 16 (Jul 70): 3-9. 

230n DOMS , see Marsha ll B. Garth, "Military Support: A Helping Hand for the Civilian 

Community. ,. Army 23 (Oct 73): 83- 87. See also " Information Paper: Support for Civil Disasters," 

prepared by DASG-HCO, copy in CMH files. 

24 AR 500- 60, "Emergency Employment of Army and Other Resources: Disaster Re lief, ,. 
DOMESTIC ASSISTANCE 143 

During the years of Anny reorganization, the civilian relief establishment 

was also undergoing change. Though the rechristening of the OEP in 

1969 as the Office of Emergency Preparedness entailed no change of 

mission, significant new departures were on the way. Later that year 

Congress passed a new disaster relief law with greater provision for 

long-term rehabilitation, including direct financial aid to victims. In 1970 

Congress passed a revised omnibus Disaster Relief Act which incorporated 

most of the features of its predecessors but increased aid to individuals, 

expanded assistance to local communities for the repair of public facilities, 

and allowed OEP to coordinate relief by private agencies such as the Red 

Cross with their permission. In 1973 President Richard M. Nixon transferred 

relief responsibility from OEP to the Department of Housing and Urban 

Development, which created a new agency, the Federal Disaster Assistance 

Administration, to coordinate federal disaster aid. 25 

This bureaucratic shift symbolized a change in emphasis in federal aid 

from relief to rehabilitation. Since 1950 all disaster acts had by implication 

endorsed a division of function that charged the federal government with 

greater responsibility for rehabilitation and left most immediate aid to 

local and voluntary groups. In fact, the trend in that direction dated to the 

early twentieth century and was obviously related to the increasing 

capabilities of the Red Cross, National Guard, and civil defense organizations 

to render emergency assistance 26 

In addition, a shift in the primary problem in disasters from mass 

casualties to massive property loss spurred the federal government to 

devote more of its resources to rehabilitation. In 1900 the Galveston 

hurricane killed 6,000 people and caused $30 million damage. Sixtyone years later Hurricane Camille struck the same region, killing only 46 

people but destroying $400 million worth of property. Although obviously 

an imprecise comparison, the dramatic difference nevertheless highlighted 

the change that had taken place. The shift was clearly present ih the 

Alaskan earthquake of 1964 in which casualties were few but property 

damage was substantial. Over the course of the twentieth century, early 

warning systems for tornadoes and hurricanes, evacuation planning, and 

28 Nov 69; AR 500- 60, "Emergency Employment of Anny and Other Resources: Disaster 

Relief," 31 Mar 72; AR 500-60, "Emergency Employment of Army and Other Resources: Disasler 

Relief," 20 Aug 73; "'nformalion Paper: Support for Civil Disasters. " For mention of use of 

TRADOC and HSC resources, see ''Tornado: Fort Knox Un its Respond," HSC Mercllry I ( 17 May 

74), 1,8. 

25Report to COl/gress: Disaster Preparedness, I: 168 - 69; Executive Order 11575, 31 Dec 

70; Executi ve Order 11725,27 Jun 73. 

26Peterson, "Coordinating Assislanee ," p. 53. 
144 THE DEMANDS OF HUMANITY 

improved building techniques reduced deaths and injuries in disasters. 

During the same period, however, increased urbanization and greater use 

of marginal lands in floodplains and along the coast meant that the costs of 

property damage soared. In most disasters-though any loss of life was 

tragic-the larger problem became reconstruction, and the federal 

government increasingly directed its efforts toward that end2 7 

The shift in federal efforts affected various types of Army aid in 

different ways. For the Corps of Engineers, with a Civil Works Directorate 

able to repair community facilities, it meant increased responsibility. For 

the Army Medical Department, it became one more factor contributing to 

a decline in disaster relief activity. Medical aid never completely ceased, 

of course . For no matter how strong other relief agencies became, no 

matter what federal responsibility became, the Army still had medical 

resources that could be of value to distressed civilian communities. It also 

had a long heritage of helping civilians in emergencies, and procedures 

existed whereby it could be called upon to help . After 1970 the Army 

continued to render medical aid, but only in isolated emergencies or as a 

small part of a larger civilian relief effort. 

The pattern of minor aid within a predominantly civilian program was 

more common. In 1972, for example, Tropical Storm Agnes caused 

tremendous destruction in the mid-Atlantic states and prompted a large 

relief operation . Though other agencies provided most medical care, the 

Army did ship supplies and furnished ambulances in Maryland and 

Pennsylvania. That same year, civilian agencies and West Virginia National 

Guard conducted relief operations after the Buffalo Creek dam burst. 

Four Military Service Corps sanitarians from Fort Meade, however, 

aided 'local authorities in establishing emergency procedures to safeguard 

public health 28 

On other occasions Army medical units provided helicopter support 

while civilians furnished medical care. After a tornado in the small town 

of Salina, Kansas, on 25 September 1973, the 82d Medical Detachment 

(Helicopter Ambulance) received a request from the Kansas Highway 

Patrol for search and rescue assistance. Over the next few days the unit 

flew survey missions along the track of the storm, kept civilian officials 

27This argument based on Douglas C. Oacy and Howard Kunreuther, The Economics of 

Nal/lral Disasters: Implicatio1ls/or Federal Policy (New York: Free Press, 1969). pp. 3- 5, 13 - 18, 

44- 57. See also Hoyt Lemons. "Physical Characteristics of Disasters: Historical and Statistical 

Review," Al/fllIls of the Ameri<;cUl Academy of Political (lnd Social Sciellce 309 ( 1957): ) - 14. 

280n Agnes, see "Tropical Storm Agnes" in DOMS files; Early J. Rush, "Disaster Relief: 

Domestic Action in the Spotlight" (case study . Army War College, 1973). On dam burst, see 

"Assistance Provided in Rood Areas," Army Pholo Features, 7 Mar 72; "Anny Medics Aid in West 

Virginia," press release, Office of the Surgeon General , 3 Mar 73. Copies of both in CMH files. 
DOMESTIC ASSISTANCE 145 

apprised of the damage and of new tornadoes, and resupplied local 

hospitals. Throughout the emergency , its commander reported, civilian 

resources proved " totally effective and in most cases an excess of 

ambulances and medical personnel were on hand at the sites hardest 

hit. .. 29 

Not all medical missions in the seventies consisted only of support for 

civilian efforts, however. On 3 April 1974 a tornado nearly demolished 

the small Kentucky town of Brandenberg. Nearby Fort Knox received a 

request from the state police for helicopter evacuation of the injured, but 

bad weather conditions prevented helicopter operations. Military personnel, 

including the 42d Field Hospital, drove to the scene. Since Brandenberg 

had only two doctors and the storm had incapacitated its sole clinic, Army 

medical personnel cared for the injured. As soon as the weather cleared , 

they evacuated the more serious cases by air to Ireland General Hospital at 

Fort Knox and sent many less seriously injured patients by ground 

ambulance either to Fort Knox or to a civilian hospital in Elizabethtown, 

Kentucky. Residents with only minor injuries were treated in an emergency 

clinic set up in a local school. Within twenty-two hours, the Army had 

completed its mission and returned to post. 30 

As the Fort Knox effort demonstrated, the changes that the seventies 

had brought to the federal government's domestic disaster mission had 

not completely eliminated a role for Army medical personnel. In fact, 

dispersion of troops and the ubiquitous helicopter had increased the 

Army's potential for rapid medical relief to almost any area of the nation. 

On the other hand, the federal government in the years after the Second 

World War had created a disaster assistance establishment based upon 

civilian rather than military control and with primary federal responsibility 

for rehabilitation rather than relief. Both principles entailed a further 

reduction in Army Medical Department participation . Nevertheless, in 

certain situations-either a massive calamity that exhausted civilian 

resources or a less severe disaster in a small, isolated community that had 

few resources to begin with-Army medical units continued to be summoned 

for aid. 

19Quole from Civilian Mission 51, Disaster After Action Report, 73- 1, 82d Medical Detachment, 

copy in CMH files; Joesph L. Bradley, Jr .. "Twister, " U.S. Army Aviation Digest 21(Jun 75): 

16- 18. 

3ORonaid O. Naser, Jr .. and Waller A. Cole, "3 April 1974-Tornado. ·' JOIlTl/al o/the Kelllllcky 

Medical Association 72 ( 1974): 319- 21; "Tornado: Fort Knox UnilS Respond," HSC Merc flry I 

( 17 May 74), 1,8. 
CHAPTER 8 

Activism Abroad: Foreign Disaster Relief, 

1945-1976 

After the Second World War, procedures for rendering foreign disaster 

relief developed like those set up for domestic assistance. Congress 

passed a series of laws authorizing aid to other lands and establishing a 

civilian bureaucracy to administer it. Unlike developments on the domestic scene , however, the resulting changes led to greater Army Medical 

Department participation in foreign assistance than had been the case in 

the interwar years. In fact, the sixties and seventies witnessed unprecedented 

involvement in disaster relief abroad by Army medical personnel. 

Relief in the Early Postwar Period 

The Army did not actively assist destitute civilians after the Second 

World War as it had after the First. Army medical personnel were often 

the first to aid displaced persons and the victims of concentration camps. 

But in rendering long-term aid, the United States, rather than create 

another American Relief Administration, joined with forty-two other 

nations to set up the United Nations Relief and Rehabilitation Administration 

(UNRRA). Though this nation fmanced roughly 75 percent of the operating 

costs and American citizens-including a few soldiers-served on its 

staff, UNRRA was an internationally controlled civilian agency. Performing 

services similar to those of the ARA, in the first two years after the war it 

rebuilt transportation systems, repaired and reequipped hospitals, distributed 

food, inoculated refugees, and provided many other relief measures in 

Europe and Asia. I 

However, in time Americans became critical both of UNRRA's 

efficiency and of its politics. In late 1946 the United States withdrew its 

support from the organization , which then concluded operations in July 

IOn medical work of UNRRA, see A Program all UI/ired Nmiolls Relief all(/ Relwbilirarioll 

(Washington: United Nations Relief and Rehabilitation Administration, 1944), p. 2; Marvin Klemme, 

Tile II/side Story of UNRRA: All Exercise il/ ImemafiOI1(llism; A First Halld Repon 011 the Displaced 

People of Europe (New York: Lifetime Editions. 1949), p. 254; Thomas G. Paterson, SovielAmerican Confrolltatioll: Posfll'{lr ReCOils/ruction (III(/ the OrigillsoJlhe Cold War (Baltimore: Johns 

Hopkins University Press. 1973), p. 77. 
ACTIVISM ABROAD 147 

1947. Far from signaling abandonment of America's sense of humanitarian 

mission, the action marked a retum to more traditional forms of assistance 

abroad. In May 1947 Congress passed an appropriation for unilateral aid 

to the needy people of Europe. As usual , compassion mingled with the 

urge to seek "diplomatic profits ... in terms of order, stability, prosperity, 

and anti-Communism." When, three years later, Congress debated aid 

for famine-stricken Yugoslavia, an agricultural attache more poetically 

phrased the motivation for American assistance: "Every morsel of food 

that goes into Yugoslavia from America, every kernel of hybrid com seed 

is a golden yellow diplomat. ,,2 

Over the next twenty years, as the United States engaged in a cold war 

with what it considered to be intemational communism, Army medical 

personnel also served as diplomats. American medicine offered a means 

of demonstrating the superiority of the American system and building the 

strength of the free world. In 1961, Maj. Gen . Leonard D. Heaton, 

Surgeon General of the Army, advocated such a policy of employing 

"American medicine .. . to improve our relations with the free nations 

of the world," in particular the " under-developed" countries. Doing so, 

he argued, would help to remove the sources of totalitarianism and thereby 

make America more secure in its freedom. Although The Surgeon General 

wrote primarily of civic action, he mentioned opportunities for improving 

America's foreign relations through disaster relief. Medicine had assumed a 

greater importance than in earlier days, but such goals and attitudes 

reflected an American tradition almost a century and a half old. 3 

As postwar developments encouraged greater American international 

involvement, the United States became better able to provide disaster 

assistance. New definitions of national security led to the stationing of 

American military forces in many areas of the world. From these outposts, 

American aid could move rapidly to the scene of a disaster. Even more 

important, advances in aviation meant that huge Air Force transport 

planes could quickly carry field hospitals and their staffs wherever needed. 

4 

Though between 1946 and 1950 such planes delivered medicines and 

other supplies to the Dominican Republic, Bolivia, Ecuador, and Mexico 

20 n u.s. withdrawal from UNRRA, see Paterson, Soviet-American COllfrolltmiol/, pp. 77 - 98; 

Curti, American Phi/amhropy, pp. 484-86. On appropriation of unilateral aid , see Statllte ~ at 

ulrge, 6 1: 125. First quote from Paterson, Soviet-Americall COllfrontatioll, p. 97. Second from 

Yllgoslav Emergency Relief Assistance ACI of 1950. Hearillgs before ,he Committee 011 Foreign 

Affairs. House of Represelllatives, 8 1s1 COllgress, 2d Sessioll 011 HR 9853 (Washington: GPO, 

1950), p. 74. 

3Leonard D. Heaton and Carl W. Tempel, "The Role of the Army Medical Service ill America's 

People-Io-People Program," Military Medicine 126 ( 196 1): 256- 58. 

40n the change in the nature of America's security requirements, see C. Vann Woodward, "The 

Age of Reinterpretation," Americall Historical Rel1iew 66 (1960): \ - 19. 
148 THE DEMANDS OF HUMANITY 

after disasters, these missions resembled earlier American activities in the 

Caribbean. The year 1953 saw the first major relief operation demonstrating 

the new ability of Americans stationed outside the Western Hemisphere 

to render assistance in more distant areas of the world. 5 

During February of that year, high tides and very strong offshore 

winds overwhelmed Holland's dikes and flooded much of the country. 

The Dutch accepted an offer of assistance from the United States, and 

American military forces in other parts of Europe organized the American 

Military Relief Organization (AMRO). A temporary unit tailored specifically 

for the operation, AMRO rendered much valuable assistance, particularly 

in rescue work performed by Army amphibious tracked vehicles and 

helicopters. Initially the Army alerted several medical units, but Dutch 

authorities considered their own health resources adequate and declined 

American medical aid. Two surgeons did serve on the staff of the 

commander of AMRO, and the 5th Mobile Army Surgical Hospital 

provided medical support for its personnel. AMRO, however, furnished 

no medical care. for civilians.

6 

The next year the Danube River in Germany and Austria flooded , 

prompting another massive American rescue and relief effort. Again 

medical relief was minimal, though the Army furnished Linz, Austria, 

with emergency stocks of typhoid vaccine. Perhaps the major American 

contribution was rescue and reconnaissance flights by Army helicopter 

units, including the 58th Medical Detachment (Helicopter Ambulance). 

Certainly their work proved popular with the victims. On one mission a 

pilot plucked several people from an isolated housetop and noticed that 

one of them looked familiar. "Didn't I bring you out a few hours ago?" 

inquired the curious aviator. "Yes," answered the man, "I enjoy riding 

in a helicopter and so I went back by rowboat.,,7 

A major medical operation followed about a month later when the 

500 Dominican Republic and on Bolivia, see Rpt, Operations Branch, AGO 10 Chief of Finance. 

5 Aug 47, 400.38, Record Group 407 , NA. On Bolivia, see also New York Times, 26 Feb 47,3 Mar 

47. On Ecuador, see Ltr, Dillon S. Meyerla John R. Dey. 1 Sep49. box 203, 201 .22, Record Group 

407 , NA ;New York Times, 8, II Aug 49. On Panama, see Ltr, B. M. Bryan to AG. 10 Aug 50, box 

794.400.38, Record Group 407, NA. 

6Historical Division, U.S. Anny, Europe, U.S. Military Flood Relief Operations ill the 

NetherlalldJ (published by the command, n.d.); Harvey F. Ludwig, " Sanitary Engineering in 

'Operation Tulip,' .. Public He(lith Reporls 69 ( 1954): 533- 37; James W, Reed, "QM Operations in 

Holland Disaster, " Quartermasler Review 32 (1953): 11 8-20; Instituut Voor Sociaal,Onderzoek 

Van Het Nederlandsc Volk Amsterdam, SlIIdies ill Hollalld Flood Disaster, 1953 (Washington: 

Committee on Disaster Studies of the National Academy of Sciences- National Research Council, 

1955). 

7Quote from New York Times, 14 Jul 54. See also New York Times. 10, II, 18 Jul 54; Final' 

Report on Civil Disaster- Floods in Austria during Period 8- 15 Jul 54, box 245, 370,1, Record 

Group 407, NA. 
ACTIVISM ABROAD 

t ••• . 

AIR FORCE GLOBEMASTERS DELIVER AID to Pakistan. J 954. 

149 

Brahmaputra River and its tributaries overflowed in Pakistan. On II 

August 1954 the Defense Department placed the Chief, Military Assistance 

and Advisory Group, Pakistan, in charge of coordinating relief under the 

general supervision of the American ambassador. To assist, Far East 

Command sent the chief of its Preventive Medicine Division and the 37th 

Medical Company (Preventive Medicine) augmented by forty two-man 

enlisted inoculation teams from stations in Korea . The first elements of 

the relief party arrived in Dacca on 16 August, and by the 18th the 37th 

Medical Company had assembled there. The next day Air Force Globemasters 

landed in Pakistan with ninety-three tons of supplies including multivitamins, 

drugs, hypodermic needles, powdered food, bedding, shirts, jeeps, and 

trailers.s 

On the 19th and 20th, the Americans and local health officials 

designed an inoculation program and formed thirty-seven teams, each 

composed of two U.S. Army enlisted medics, two medics from the 

Pakistani Army, and one Pakistani soldier who was to keep order in the 

inoculation station. The teams dispersed to the major towns in the flooded 

region, where they inoculated inhabitants for cholera and "typhoid. The 

"Following account based on John O. Thisler. "On Mercy's Wings," Army '"/ormatiotl Digest 

10 (Feb 55): 18-21; Orfice of the Surgeon General, "Summary of Major Events and Problems, 1 

July 1954 to 30 June 1955," pp. 122-24, in CMH files; Historical Summary, Office of the Chief 

Surgeon, U.S. Army Forces, Far East and Eighth United States Army , 1954, in CMH files; New York 

Times, 17, 19,27 Aug and 23 Sep 54. 
150 THE DEMANDS OF HUMANITY 

AMERICAN AND PAKJSTA~I SOLDIERS ADMINISTER TYPHOID INOCULATION, 

Pakistan, 1954. 

natives were frightened by the hypodermic needles, but the promise of 

rice and clothes with each shot encouraged them to overcome their fears. 

By 30 August, the teams had completed work in the major centers of 

population and shifted their efforts to the smaller provincial towns, where 

they not only immunized the populace but also treated sufferers from 

various ailments. By 20 September, American and Pakistani medical 

personnel had inoculated 850,000 people and completed the program. On 

21 September the scattered medical teams assembled at the Dacca airport, 

and on the following day the Americans departed. 

Establishing a Relief System and the Activism of the Early Sixties 

Despite the frequency of fore ign assistance operations in the late 

forties and early fifties, the United States still had no established policy on 

relief nor any agency responsible for its administration. In 1954 Congress 

passed the first act that granted the president continuing authority to order 

disaster assistance abroad: the Agricultural and Trade Development and 

Assistance Act (PL 480), which authorized free distribution of commodities 

to foreign nations threatened by famine or other emergencies. In certain 

circumstances it also allowed other types of aid financed out of foreign 
ACTIVISM ABROAD 151 

currencies that had accrued from grain sales. Four years later, the Mutual 

Security Act created a contingency fund from which the president could 

fmance relief after" any economic, poli tical, or natural emergency abroad" 

to further the ends of the act. The fact that the first provisions for routine 

disaster assistance abroad were contained in acts devoted to trade development 

and security helped to underscore the importance of economic and political 

motives to American humanitarian activities in the postwar world. 9 

Following Congress's authorization of continuing relief, the govemment 

had to assign some agency the task of supervising it. As with domestic 

relief, the task went to a civilian agency----eventually to several of them. 

In tum, the Foreign Operations Administration and the International 

Cooperation Administration received the assignment, but in 1956 the 

Operations Coordinating Board, a part of the Executive Office of the 

President, created a special committee to supervise disaster relief abroad. 

Under its guidelines, the Department of State assumed responsibility for 

recommending aid missions for presidential approval. State, however, 

depended on the assistance of other departments and agencies, including 

the Department of Defense if its larger mission allowed, to assist in 

carrying out any actions the president approved. 10 

The creation of standing procedures for providing foreign relief did 

not immediately spur increased assistance abroad. In the late fifties the 

Army helped civilians after floods in Italy and Korea and a typhoon in 

Japan, but none of the missions involved Medical Department aid. 

During a 1958 polio outbreak in Nicaragua, the Army did send two iron 

lungs, two chest respirators, and a medical technician to train nationals in 

operating both, but that aid hardly constituted a new activism. However, 

the United States Army, Caribbean, had been making preparations to play 

a greater role in disasters. In 1956 the command, with responsibility for a 

region in which historically the Army had rendered aid most often, ,set up 

disaster survey teams headed by a quartermaster officer and composed of 

specialists in medicine, refugee care, food service, communications, and 

other relief functions. The teams were designed to serve as advance 

parties in a disaster area with the task of determining how the United 

States could best render aid. 11 

On 21 May 1960 an earthquake and tidal wave struck Chile, prompting 

9U.S. Congress, House, U.S.' Foreign Aid: Its Purposes, Scope, Administration, lind Related 

III/ormation. H. Doc. 11 6, 86th Cong .. lsi sess. , 1959, pp. 69. 80. 

IOOperalionsCoordinating Board, "Foreign Disaster ReiiefOperalions," 22 Aug 58, manuscript 

copy in Army War College Library. 

lIOn aid to Italy, see New York Times. 10 Feb 56. On aid to Korea, seeNe", York TimeJ. 7, )4 Sep 

58. On aid 10 Japan, see New York Times. 28 Sep 58, I Oct 59. On aid 10 Nicaragua, see Annual 

(Continued) 
152 THE DEMANDS OF HUMANITY 

the first deployment of such a team in a major disaster. The Chilean 

government requested United States assistance , including hospitals, and 

two days after the quake the Caribbean Command dispatched an elevenman team to evaluate the situation. Unfortunately, officials in Washington 

did not wait for its report to send medical aid. 12 

That same afternoon, the 7th Field Hospital at Fort Belvoir, Virginia, 

and the 15th Field Hospital at Fort Bragg, North Carolina, received orders 

for Chile. Professional staffs for both units were drawn from various 

neighboring posts. Because the hospitals would have to serve a diverse 

civilian population, an obstetrician, two pediatricians, an orthopedic 

surgeon, an internist with psychiatric training, and a dentist with maxillaryfacial background were substituted for some of the general medical 

officers and general surgeons. To support the hospitals, laundry, water 

purification, Signal Corps, and maintenance detachments were also ordered 

to Chile. Two air ambulance units--the 56th Medical Detachment (Helicopter 

Ambulance) and the 57th Medical Platoon (Air Ambulance}-followed 

in time. All flew in Air Force Globemasters from Andrews or Pope Air 

Force Base, an airlift that required fifty-nine planes. 13 

After stops in Panama and Peru, on 27 May the transport planes began 

to land in Santiago, and by the 30th all had arrived. While the Amencan 

units awaited transportation to the scene of the disaster, their leaders met 

with Chilean officials, the American ambassador, and members of the 

survey team, who were back from the scene. From team members, the 

hospital commanders now learned that the emergency had been vastly 

exaggerated and that local medical personnel had the situation well under 

control. The officers decided to provide medical supplies for the Chileans 

but to give direct care or even professional advice only if specifically 

asked by their hosts. At the request of local officials, the visitors supported 

Chilean operations in Valdivia and Puerto Mont!, where hospitals had 

been destroyed by the quake. Between 28 and 31 May the 15th Field 

Hospital moved to Puerto Mont!, the 7th to Valdivia, and both helicopter 

(Continued) 

Report, Headquarters, United States Army, Caribbean, 1958, sec. I, p. 10, in CMH files. On survey 

learns, see Jobie J. Dixon, . 'Mercy Mission to Chile." Quartermaster Review 39 (Sep-Oct 60): 28. 

120ixon, "Mercy Mission," pp. 28, 3 1. Daily Log, 13 Jul60; CINCARIB to JCS, 26 May 60. 

Both in "Chilean Operations Daily Staff Journal, Emergency Planning Branch, OTSG," notebooks 

in CMH files. All manuscript material on this subject cited below is in these notebO'Jks, unless 

otherwise indicated. An unpublished history of the Chilean operation, "U.S. Anny Medical Service 

Disaster Relief Operations in Chile," also in CMH files, provides a longer, more detailed account 

than presented here. 

1l0aily Staff Journal, 26 May 60; gist of telephone conversation between Colonel Godwin and 

representative of the OTSG. See also After Action Reports: 7th Field Hospital, 15th Field Hospital, 

56th Medical Detachment, 57th Medical Platoon; and untitled manuscript by Thomas J. Whelan, Jr., 

Jun 60, pp. 4-5. All in CMH files. 
ACTIVISM ABROAD 153 

units deployed with the former. 14 

Upon arrival in Puerto Montt, the 15th Field Hospital under Col. 

James C. Van Valin pitched its personnel tents in a soccer field , near a 

school where the Chileans had established a temporary hospital. There 

the unit's physicians operated a consultation service for local doctors, 

while the remainder of the staff trained the Chilean relief workers in the 

operation of equipment donated to their facility. In addition, the 15th 

established a dispensary and treated many citizens for minor illnesses, 

few of which were related to the quake. Personnel from the unit also 

established a tent city and field kitchen for displaced persons and distributed 

medical supplies as needed. 15 

In Valdivia the 7th Field Hospital, under Lt. Col. Howard G. Krieger, 

furnished much the same type of assistance to an emergency facility 

there. Unlike the 15th, the 7th pitched its ward tents because of apprehensions 

about a possible epidemic, but, when none developed, opened them to 

refugees. The unit supplied laboratory and X-ray equipment to the temporary 

hospital. It also set up and staffed an operating room in the school where a 

team of its doctors performed one operation and an anesthetist assisted 

with a birth by cesarean section. Army nurses attempted to help in the 

wards but found they were not needed and that, in any case, the language 

barrier limited their effectiveness. 16 

American helicopter units proved more active and useful than the two 

partly utilized field hospitals. Initially, all the air ambulances were 

stationed at Puerto Montt, but after 2 June some were moved to Valdivia. 

Even operating from two locations, the units evacuated only thirty-two 

people, since most casualties had been evacuated before their arrival. The 

helicopters were still extremely valuable , enabling Chilean and American 

officials to inspect vast areas quickly and transporting more than 100,000 

pounds of relief supplies. One unit, the 56th Medical Detachment, also 

supported an inoculation program in the isolated department of Castro. 

Both units accomplished their varied tasks despite foul weather- high 

winds, rain, and poor visibility. 17 

Except for the busy air ambulance units, the American relief contingent 

found itself overstaffed, and the hospitals quickly began to return personnel 

14 .. U.S. Anny in Chile." pp. 22- 25; Howard G. Krieger. " After Action Report (Medical). 

Valdivia, Chile, 22 Jul 60," pp. 4-5. Copies in CMH files. 

1SAfter Action Report. 15th Field Hospital . in CMH files. 

16Krieger, "After Action Report"; Daily Log, 17 Jun 60; TWX, CINCARIB to Ambassador in 

Chile, 16 Jun 60; Whelan manuscript, pp. 17- 18 . All in CMH fil es. 

17 After Action Repon., 56th Medical Detachment (Helicopter Ambulance), 55th Medical Group. 

Fort Bragg, N.C.; After Action Report, 57th Medical Platoon (Air Ambulance), Fan. George G. 

Meade, Md.; Daily Log, news release, Bell Helicopter. All in CMH files. 
154 THE DEMANDS OF HUM ANITY 

ONEOFTHE FEW PATIENT EVACUATION MISSIONS. Chile , 1960. 

to the States. On 4 June, sixty people from the 15th went home, and on 6 

June all but a skeleton staff left the 7th. Two weeks later the helicopter 

units disassembled their aircraft and loaded them for return to the United 

States. On 24 June, the United States government donated the two 

hospitals to Chile, and by 14 July all the Americans had departed. IS 

Despite the Army's failure to use its own survey teams properly, most 

participants considered the operation a success, the experience good 

training, and their reception by the Chileans gratifying. Although the 

local left-wing press lambasted the Americans, the rest of the country 

seemingly adored them. People warmly greeted soldiers on the streets and 

besieged them with offers of drinks, prompting one pilot to remark, "If I 

accepted half the drinks the Chileans want to buy me, I couldn't stand 

up." In a more serious observation, an American reporter noted how the 

apparent friendliness among black and white servicemen served to improve 

Chilean perceptions of North American race relations. A local official 

considered the mercy mission " a serious blow to the size of the Chilean 

Communist Party," and a South American diplomat labeled it "not only 

a great humanitarian act but the smartest diplomatic move the United 

States had made in Latin America in years." Despite a certain hyperbole, 

18Whelan manuscript, p. 43 , in CMH files. 
ACfIVISM ABROAD 

such observations indicated that the 

mission had achieved political 

gains. I. 

The failings of the mission 

received little notice. Dispatch of 

the hospitals before a valid estimate 

of the situation had been received 

resulted in too many people being 

sent and therefore in unnecessary 

costs. Because casualty loads were 

much smaller than initially reported, 

medical professionals left installations in the United States understaffed only to find they had no 

patients in Chile. But uncritical 

newsmen, perhaps themselves 

influenced by the atmosphere of 

the cold war, gave little attention 

155 

ARMY NURSE dresses the head of 

injured woman, Chile, 1960. 

to the inactivity of Anny personnel and instead praised their success in 

representing American society. 

After the diplomatic points scored by the Chilean mission-and in 

part because of its success, though the Kennedy administration's activist 

foreign policy was the larger reason-the United States increased its 

commitment to an involvement in foreign disaster assistance. In 1961 

Congress passed a comprehensive foreign aid bill, one provision of which 

established a contingency fund to finance disaster relief and other emergency 

measures. That same year, the State Department created the Agency for 

International Development (AID) and assigned it responsibility for 

coordinating disaster relief. Three years of vigorous activity by Anny 

medical personnel followed?O 

The series of medical missions began when the prime minister of the 

flooded African nation of Somalia requested medical assistance from the 

American ambassador. After the request passed through the channels 

established to coordinate foreign assistance, Lt. Col. John H. Painter, a 

190n left-wing press, see TWX. USARMA to ACSI. I Jun 60, Daily Log. On race relations. see 

"Chilean Disaster Appraisal Drops, Aid by U.S. Held Gain in Prestige," clipping from Washington 

SUllday Star, 5 Jun 60. All quotes from "U.S. Mercy Airlift to Chile Ends in Wave ofOoodwill," 

clipping from Philadelphia II/quirer, 2 Jun 60. All in eMH fil es. 

lOfor a survey of the development of foreign disaster relief legislation and organizations, see 

Agency for International Development, 1966 Rpt, in Foreign Disaster Relief Division Offices, 

Departmenl of Siale. 
156 THE DEMANDS OF HUMANITY 

Medical Corps officer with the 9th Hospital Center in Landstuhl, Gennany, 

was ordered to head the relief effort. To accompany him, Painter selected 

two other medical officers and six enlisted men from the 2d General 

Hospital and the 540th General Dispensary. Meanwhile, the Anny Medica) 

Depot at Einsiedlerhof prepared six tons of medical supplies for shipment 

to Somalia. Shortly before midnight on 18 November 1961- the same 

day that Painter was notified- the team and its supplies left Ramstein Air 

Force Base 2 1 

The tearn arrived in Mogadiscio, Somalia, on 20 November, turned 

over most of their supplies to the government, and began to plan for the 

mission. From embassy, AID, and local officials, Painter learned that no 

valid assessment of the flood damage had been made, so he conducted his 

own aerial reconnaissance. He found that the area had a poor road 

network and few landing strips and decided that only helicopters could 

quickly reach many of the villages. At his request, Army officials in 

Europe ordered a team of nineteen men and two H - 19 Chickasaw 

helicopters airlifted to Somalia. Team members, who came from the 

421st Medical Company (Air Ambulance) and several nonmedical units 

in Seventh Anny, left Echterdingen Air Field on 25 November and 

arrived in Somalia on the 28th 22 

Painter stationed the helicopters at a base camp from which they could 

fly into the area of worst destruction. After initial survey flights, crews 

began delivering food and medicines to the stranded villages on 4 December. 

Sometimes while out of radio contact with their base, the pilots flew over 

crocodile-infested waters and densely forested terrain where a crash site 

would have been inaccessible to rescuers. In many places helicopters 

could not land to unload but had to fly low over a village while their crew 

chief pushed packages through the door. 

To supplement helicopter delivery, Painter had two thirty-foot power 

barges constructed to ferry teams and supplies to villages along the rivers. 

Each boat carried one American doctor, two American medical corpsmen, 

and two Somalis, a helmsman and an interpreter who acted as a general 

assistant. Operations began on 12 December but did not proceed smoothly. 

The barges had trouble finding places to land and consumed excessive 

amounts of fuel . Then on 15 December, while attempting to cross under a 

cable stretched across the river, a barge snagged on it, dumped the entire 

l lUnless otherwise cited, account based on . 'Record of Even Is, HQ, U.S. Army Medical Teams, 

Rood Disaster Relief, Mogadiscio, Somalia"; "Summary Report of U.S. Medical Relief Team 

Operations"; "Daily Activity Log of Emergency Helicopter Disaster RcliefTeam While Participating 

in the Somalia Republic Flood" ; "USAFE, Army Aids Somali Flood Victims," clipping (rom Stars 

alld Stripes (22 Nov 61 ). All in e MH files. 

22"Team Effort." U.S. Army Aviation Digest 8 (Feb 62): 22. 
ACTIVISM ABROAD 157 

crew into the water, and sanle All of the crew but Pfc. Edward Lovett 

swam to shore. Attempts to find the missing man were in vain. Later, 

villagers recovered Lovett's body; it was honored at the village as well as 

in the Somali capital and then flown back to the United States. A veteran 

of World War II and Korea, Lovett had volunteered for the mission 23 

After the tragedy, the Americans temporarily abandoned barge operations 

but helicopter deliveries continued and medical teams still visited villages. 

By 19 December, conditions in the area had so improved that the Somalis 

themselves could deliver food by barge to any village still in need. In 

addition, the helicopters had reached their mechanical limits and could 

no longer be safely flown without substantial maintenance. On 22 December 

team members returned to Mogadiscio, were entertained by their hosts, 

turned over a barge-mounted dispensary to a local public health official, 

and then flew back to Germany . In their 35-day stay in Somalia, the 

Americans had distributed nearly 38,000 pounds of food and over 500 

pounds of medicine to more than 60 villages. 24 

The stepped-up pace of relief work continued. A month after Painter's 

return, an Army medical team of one doctor and six enlisted men conducted 

a smallpox vaccination program in Ethiopia. Later in 1962 another major 

relief operation occurred. On I September a series of earthquakes struck 

. northwestern Iran, and on the 3d the Joint Chiefs of Staff directed United 

States Army, Europe (USAREUR), to send aid to the victims. Early the 

next morning, the airlift of the 8th Evacuation Hospital with a professional 

staff drawn from several hospitals in Europe began at Ramstein Air Force 

Base. With the 8th Evacuation Hospital went helicopter elements of the 

421st Medical Company (Air Ambulance), a field maintenance detachment 

from the 29th Transportation Company, a preventive medicine detachment 

from the 485th Laboratory (Preventive Medicine), and a water purification 

unit from the 299th Engineer Battalion. Lt. Col. Alexander M. Boysen, 

8th Evacuation Hospital commander, assumed command of the entire 

relief force. 2' 

When the Americans arrived in Tehran, Iranian officials instructed 

them to locate their hospital on the plain of Kazvin, a site near the worst 

2lSomafi News Weekly, 22 Dec 6 1; United States Information Service. American Embassy, 

Mogadiscio release , "Airport Ceremony and Funeral Service Held for American Soldier, 21 Dec 

196 1. " Copies of both in CMH fi les. 

24Landslllhl Army Medical Center Record 2 (12 Jan 62): I. 

250n Ethiopia, see Staff Meeting, 16 Feb 62, account in book 25, Staff Conference Notes, Office 

of the Surgeon General. in CMH files. Un less otherwise cited, account of operations in Iran based on 

Floyd L. Wergeland and Joseph W. Cooch, "Operation Ida." Miliwry Medicine 128 ( 1963): 

850-57; Alexander M. Boysen. "Operation Ida ," Medical Bullelil/, U.S. Army, Europe 20 ( 1963): 

275-76,278; After Action Report of Operation Ida (Iranian Disaster Assistance), 14 Nov 62; Army 

Medical Service Activities. Annual Rpt, U.S. Anny, Europe. 1962. Both reports in CMH files. 
158 THE DEMANDS OF HUMANITY 

area of destruction but adjacent to a rail line and a hard-surface road . 

Iranian drivers transported the unit, and the Americans worked through 

the night to become operational at 0900 hours on 6 September. The next 

day the Americans established a base camp near Buin, further into the 

disaster area , to serve both as a first aid station and as a helicopter base. 

From it, crews flew medical teams into the distressed area and evacuated 

seriously injured victims to the hospital. On the flight back into the area to 

pick up the teams, the helicopters brought in food, tents, and other 

essentials. In all, the choppers flew 404 sorties, delivered 45,000 pounds 

of supplies, and evacuated 66 patients. 26 

Operations at the 8th Evacuation Hospital where the helicopters 

brought the casualties did not proceed without difficulties. High winds 

wreaked havoc on the unit's tents because pegs did not hold in the sandy 

soil. After two days' service, the laundry exploded, badly burning three 

enlisted men. Supply shortages developed, particularly of items not 

ordinarily required by a fighting unit-<:atheters for small children, for 

example. The professional staff drawn from various facilities in Europe 

had never trained with the hospital, and the resulting confusion hindered 

operations. 

Another difficulty, the suspicion and hostility of the local population, 

was only overcome through Iranian cooperation and American flexibility. 

Local government officials, and the shah himself during a visit, urged the 

people to cooperate. Even with a royal endorsement, however, the 8th 

Evacuation Hospital's staff had to make minor adjustments to local 

customs- such as constructing latrines that pointed south. Its commander 

reported: "Many decisions that ... were strange to Americans were 

made because they were not strange to Iranians ... When one helps a 

foreign nation you accept their strange philosophy in many things, if by 

doing this it means you eventually gain" your objective 27 

As it solved its organizational problems and slowly secured the 

cooperation of the Iranians, the 8th Evacuation Hospital became an 

efficient emergency hospital. It admitted 182 victims, provided a tqtal of 

794 patient-days of care, and reported five deaths. Its surgeons performed 

seventy-five surgical procedures, most involving multiple fractures or 

internal injuries. Many victims suffered cuts and bruises; other patients 

had been badly burned, and one of the bum cases had a baby during her 

stay in the hospital. Fortunately, a doctor assigned for general medical 

work had an obstetrical specialty, and he delivered a healthy baby, 

26Louis L. Mizell , "IDA, ". U.s. Army Aviation DigesI9 (Jun 63); 27- 28. 

27Quote from Boysen, "Operation Ida. " p. 276. 
ACTIVISM ABROAD 159 

ARMY MEDICAL CORPSMAN FEEDS NEWBORN IDA. lrall, 1962. 

promptly named Ida after the code name of the American relief operation 

(Iranian Disaster Assistance). Hospital staff members cut fingers from 

rubber gloves to make bottles, the kitchen crews and pharmacists improvised a 

formula, and a sergeant constructed a crib for Ida from packing crates. 

In addition to nursery service , hospitalization , and helicopter support, 

the American relief force furnished preventive medicine assistance within 

the disaster area. Working out of the base at Buin , Army specialists 

visited some 150 villages where they supervised delousing and immunization 

teams and instructed the local populace in personal hygiene and public 

health. The Americans also tried to ensure a clean, pure water supply for 

each of the villages. The Erdlator, a water purification machine the 

engineers had brought with them, proved useless since the ambling, 

truck-mounted monster could not traverse the rugged terrain. The Americans 

relied on the simpler Water Purification Set No.3 or chlorinated water 

from deep wells distributed in tank trucks. 

By September the medical and sanitary situation in the area had 

stabilized, and the United States ambassador approved the withdrawal of 

the 8th Evacuation Hospital . Because of difficulties in air transportation, 
160 THE DEMANDS OF HUMANITY 

ARMY NURSES HELP SURVIVOR OF EARTHQUAKE, Irall,1962. 

all were not able to leave until the middle of October; when they finally 

did depart, the Americans left the equipped hospital for the Iranians. 

More like the Somali operation than that in Iran was a mission to 

Morocco's Rharb Valley in January 1963. After a flood , United States 

Air Force personnel at an American air base there conducted supply and 

rescue missions, but as the flood waters receded, USAREUR was requested 

to provide medical assistance to prevent a possible epidemic. Lt. Col. 

Joseph W. Cooch of the Medical Corps headed the mission. With a small 

group of medical officers and enlisted men, Cooch arrived at Sidi Slimane 

Air Base in Morocco early on the morning of II January, only thirty-two 

hours after their initial alert. 2

• 

Cooch and Moroccan health officials decided to send five American 

teams into the flooded area to vaccinate the people and perform sanitary 

work. Borrowing vehicles and one doctor from the Air Force, Cooch 

formed teams of a doctor, a Medical Service Corps officer, and one or 

two enlisted men. Each team carried a multiple injector gun with generator, 

280n Air Force aid, see "Diary of Disaster." Airmail 7 (Apr 63): 46- 49; Joseph Micci and John 

Viuer, " (roquois Airlifts 36 in a Single Load," U.S. Army Aviatioll DigesI 9 (Apr 63): 24-25. The 

following account of Army aid based on Joseph W. Cooch, "Moroccan Flood Relief-An Essay in 

Co-operation," Military' Medicine 128 ( 1963): 11 73-76; Philip J. Keating, "Moroccan Flood 

Relief: A Personal Report," MediclIl Blllletill, U.S. Army, Europe 20 (1963): 96-99; Joseph W. 

Cooch, "Moroccan Relief, Journal of Operations for Moroccan Relief," copy in CMH files. 
ACfIVISM ABROAD 161 

a delousing machine, a residual sprayer, and other supplies. On the 

morning of 13 January the teams and their interpreters went to different 

sections within the Rharb Valley and then traveled from village to village. 

The Americans inoculated 41 ,000 residents for typhoid and dusted 9,000 

with DDT to kill lice-standard procedure before scientists became fully 

aware of the chemical's dangers. They also discovered a large number of 

people suffering from trachoma or other chronic eye troubles for which 

the doctors dispensed ointment. In addition, team members usually 

inspected each village well and sprayed houses and public buildings with 

residual insecticides to control mosquitoes. (One soldier unthinkingly 

sprayed a picture of Mohammed V and barely escaped alive after profuse 

apologies rendered in French.) By 18 January the teams had visited most 

of the villages in the area; Cooch conferred with Moroccan health officials 

and decided to end American operations. The teams concluded their work 

on the 19th and flew back to Germany on the 22d. The deputy chief of the 

United States Mission to Morocco pronounced their efforts a significant 

humanitarian accomplishment and a benefit to American interests in the 

African nation . 

Later in the same year, the 8th Evacuation Hospital at Landstuhl 

Army Medical Center in Germany undertook still another relief mission. 

Personnel of the l20-bed facility had returned from Iran enthusiastic 

about such exercises and had maintained their readiness. When on 27 July 

1963 the United States decided to send medical aid to Yugoslavia after an 

earthquake , Seventh Army again chose the 8th Evacuation Hospital for 

the mission. Within eight hours of its notification, an advance party from 

the hospital flew out of Ramstein Air Force Base. Hospital commander 

Lt. Col. George C. Santos with the remainder of the unit and its equipment 

followed shortly thereafter. 29 

The 8th Evacuation Hospital flew to Belgrade and then drove the 270 

miles to Kumanovo, a town fifteen miles northeast of Skopje. The quake 

had claimed 4,000 casualties in the Skopje area and severely damaged the 

hospitals available to care for them. Consequently, the 8th received the 

mission of relieving the excess patient load upon Yugoslavian facilities. 

29Unless otherwise cited, account based on "Operation Blue Boy: Earthquake Relief Mission to 

Skopje, Yugoslavia, July-August, 1963, 8th Evacuation Hospital and Attachments"; "The Skopje 

Disaster-Dperations of 8th Evacuation Hospital in Yugoslavia." Both in CMH files. "Yugoslav 

Earthquake Relief Activities." Medical Bulletin, U.S. Army, Europe 20 (1963): 295-97; U.S. 

Congress, House. Skopje, Yugoslavia, Earthquake Tragedy; Hearing before lite Subcommittee 011 

Foreign Agricultl/ral Operations o/the Committee 011 AgricJllture, House of Representatives, 88th 

COl/gress, 1st Ses,~iolJ (Washington: GPO, 1963); Isador Popa. "Surgical Care in the Disaster of 

Skopje," in Heip;1Ig H01ld: A Report 011 Exercise Helping Hand aI Ash Vale on 6, 7, and 8 October 

1972, copy in OTSG files; John P. Angstadt ... Army Disaster Reliefat Skopje." Military Engineer 57 

(1965): 159-61. 
162 THE DEMANDS OF HUMANITY 

PREPARATION OF A PATIENT'S FOOT prior to receivillg a skill graft, 

Yllgoslavia, 1963. 

Upon arrival in Kumanovo on 28 July, Santos first met with the American 

consul-who served as an invaluable liaison with the Yugoslavs throughout 

the hospital's stay-and with local officials. After consultation, the 

commander quickly selected an old airfield four or five miles from the 

center of town for the hospital site, and the staff began setting up the 

facility. At 0630 hours the next day Santos declared the hospital operational. 

The first patients arrived three hours later, and by the end of the day 

the 8th Evacuation Hospital had admitted seventy-eight people. The 

Americans placed them in wards by sex; one doctor assumed responsibility 

for each ward but could refer his patients to a consultation service. Of the 

124 Yugoslavs eventually admitted, eighty-two were orthopedic patients, 

with injuries primarily to the extremities rather than to the abdomen or 

pelvis as in Iran. The large number of orthopedic cases kept the X-ray 

section, which took over 300 films, and the cast room, which made 124 

appliances, quite busy . On the third day one doctor and two nurses 

became full-time physical therapists. Because the medical problems 

differed from those in Iran, even the disaster-experienced 8th at first 

found itself short of certain supplies not normally stocked, but resupply 

functioned properly and no acute shortages developed. 

As in so many other disaster missions, the 8th Evacuation Hospital 

staff had to practice diplomatic discretion as well as medicine. The 
ACTIVISM ABROAD 163 

CAST SPECIALIST TRIMS NEWLY ApPLIED UPPER BODY CAST for a patiellt 

with a fractured cervical vertebra, Yugoslavia, 1963. 

hospital's headquaners unit exercised firm control, and Santos frequently 

reminded both officers and enlisted men of the importance of international 

relations. The hospital staff also devoted much time to public relations, 

entertaining American Army officials from Germany and even the United 

States secretary of agriculture. Many Yugoslavian officials and medical 

professionals visited the facility, too. In return, some of the hospital's 

personnel toured local hospitals and feasted at their hosts' tables. 

By 7 Augustthe patient census dropped to seventy-four, all buttwo of 

the wards were closed, and some of the staff returned to Germany. Over 

the next four days the 8th Evacuation Hospital discharged or transferred 

to Yugoslavian hospitals the remaining patients. On 13 August, after a 

three-day wait for air transport, hospital personnel motored back to 

Belgrade, while Yugoslavs along the route tossed flowers and cheered as 

they passed. After a brief ceremony at the airport, the unit loaded the 

aircraft and took off for the return flight to Germany. Throughout their 

stay Army medical personnel received lavish praise and profuse expressions 

of gratitude from the local populace3o 

30See Memo for the Commander in Chief by Maj . Gen. Floyd L. Wergeland, 3 Aug 63; clipping 

"Dysentery Breaks Oul in Skopje," I Aug 63, unidentified; clipping "U.S. Troops Winding Up 

Skopje Mercy Effort," from Washington Star, II Aug 63; David Bender, "Gl's Leave Skopje and 

(Continued) 
164 THE DEMANDS OF HUMANITY 

The Yugoslavian mission occurred at the end of three years of frequent 

disaster assistance by members of the Army Medical Department. In that 

time the Army had learned much about providing medical assistance: the 

importance of sending survey teams, of augmenting hospitals with special 

personnel and equipment, of displaying proper respect for local sovereignty 

and cultural practices. But as happened in domestic relief, increased 

frequency led to the creation of a civilian coordinating agency and a 

concomitant reduction in Army involvement. 

In 1963, consultations among State, Defense, and AID resulted in 

revised assistance procedures. The State Department still initiated plans 

for major disaster missions, and, when necessary, could request assistance 

through the Office of the Secretary of Defense and the Joint Chiefs of 

Staff. The new plan, however, allowed the American ambassador in any 

country to spend up to $25,000 on disaster relief without securing approval 

from his State Department superiors. In such cases, an American military 

commander on the scene could commit his resources without consulting 

Washington. 

To coordinate all overseas relief, both that above and below $25,000, 

AID in 1964 created the Foreign Disaster Relief Division . This office 

kept the State Department-and through it the president-informed of 

disaster developments throughout the world and, if the president authorized 

aid, monitored the relief effort. When AID wanted military help, it 

contacted the coordinator for Foreign Disaster Relief Operations, who 

worked for the Assistant Secretary of Defense (International Security 

Affairs). The secretary, acting through the Joint Chiefs of Staff, then 

directed the appropriate unified command to fumish assistance. After its 

creation in 1968, the Directorate of Military Support (DOMS) assumed 

the coordinator's liaison duties and monitored all military relief activity 

abroad. When AID asked the military to provide medical relief, the 

unified commands maintained control over any Army medical units 

involved, but DOMS often sought advice and assistance from Plans and 

Operations Division, Office of the Surgeon General. Though on paper 

and sometimes in practice this seemed a confusing system, a civilian 

bureaucracy now existed to coordinate foreign disaster relief on a nearly 

routine basis 31 

(Continued) 

Recall Patients' GratiludeaflcrQuake, ,. clipping from New York Times. 14 Aug63. All in CMH files . 

New York Times. I , 15 Aug 63. 

31Agency for Intemationa1 Development, 1966 Rplj "Foreign Disaster Emergency ReiiefOperations, 

1964." Copies of both in AID, Foreign Disaster Relief Division Office, Department of State . 

Department of Defense Directive 5100.46, "Responsibilities for Foreign Disaster Relief Opera· 

lions," 15 Oct 64; "Infonnation Paper: Support of Civil Disasters." 
ACfIVISM ABROAD 165 

Increasing Problems in Foreign Disaster RelieJOperations 

Whether because the formation of AID's Foreign Disaster Relief 

Division increased civilian capabilities or because the growing involvement 

in Vietnam reduced those of the Army, less frequent and less substantial 

military medical relief was provided during the remainder of the sixties. 

Army assistance did not cease, however. Preventive medicine specialists 

assisted local officials after a frre in Panama City in 1964 and an earthquake 

in San Salvador in 1965. In 1966 the Army donated medical supplies to 

the Sudan after a cholera epidemic and to Colombia after a fire. That same 

year Army medical teams spent a day in Colimes, Ecuador, furnishing 

medical and dental treatment to nearly 2,000 victims of another fire . An 

earthquake in Turkey in July 1967 prompted American military authorities 

there to dispatch ambulances, doctors, medicines, and tents to the scene, 

but local officials refused all but the tents. 32 

The following year a minor medical mission to Sicily revealed that the 

new bureaucratic structure had not eliminated inefficiencies in international 

relief. On 15 June 1968 USAREUR ordered a team of two enlisted 

medical personnel and four drivers under the command of Capt. Eugene 

L. Mascoli to the scene of an earthquake in Sicily. While at Ramstein Air 

Force Base awaiting transportation, Mascoli learned that the Army planned 

to ship general purpose tents, blankets, C-rations, and two 3/4-ton 

trucks with the team. When the Medical Corps officer questioned the 

absence of medical supplies in the shipment, he was told he could take 

only what he could gather himself. Mascoli then visited the nearby 2d 

General Hospital at Landstuhl and scrounged six boxes of medical supplies 

and a trusty black medical bag. 33 

The next day the team flew to Trapani/Birgi, Sicily, where it was met 

by the American consulate general, who knew little about the purpose of 

Mascoli's mission. Since the quake had disrupted phone service to his 

superiors in Rome, he and Mascoli decided to work in a refugee center in 

Santa Ninfa to which American relief supplies had been sent. After a 

night's delay, the team arrived to find five or six hundred people milling 

about the tents, blankets, and C-rations which lay unused in the center 

of the field. The Italians asked the Americans for help in pitching the 

tents. The Americans complied, and Mascoli considered that "the most 

important thing the medical team did during its stay in Sicily." The 

Americans also showed the Italians how to open C-rations, but that 

32Agency for International Development. 1964 Rpt; AID 5th Rpt, 1966: 7th Rpt, Federal 

Emergency Relief. Copies of all in AID offices. 

33 Account based on After Action Repon, USAREUR Medical Team Disaster Relief. Sicily, Jan 

68, in CMH files. 
166 THE DEMANDS OF HUMANITY 

proved a less important contribution, since the refugees refused to eat 

them. 

With the camp pitched, Mascoli decided to remain to furnish medical 

care for its residents, only to discover that the camp already had an Italian 

doctor. Mascoli took one of the trucks and visited nearby towns but found 

little to do since the towns, too, had adequate medical service. On the 

return leg of one trip he did give away supplies to small groups along his 

route. Frustrated by his inactivity and finding phone service restored, 

Mascoli requested permission to return to Germany. This was granted. 

On the 19th the team broke camp. As it did, a five-man Army photography 

team, loaded with equipment, drove up in a rented car, too late to take 

pictures of the relief team in action. Mascoli and his men continued to 

pack, flew that night to Rome, then on to Germany. 

Mascoli, understandably disgruntled about the mission on which he 

had been sent, pointed in his report to the confused instructions he had 

received and complained that "we were a medical team without medical 

supplies." The problem might have been more serious if there had been 

patients. "Allofthe injured," he pointed out, "had been cared for by Italian 

medical personnel prior to our arrival. " 

Although a minor mission, Mascoli's frustrating trip to Sicily revealed 

again the necessity for an accurate survey of damage and full cooperation 

among all relief forces. It also demonstrated an unfortunate obsession 

with public relations during assistance work. But, more important, it 

suggested that in many disaster situations local resources were quiie 

sufficient. Such problems, which seemed almost amusing in so small an 

operation, were indicative of growing inefficiencies in international disaster 

assistance. A relief mission to Peru in May and June of 197CJ.---<:ritiqued 

by an Army medical officer who took part- illustrated how the same 

confusion and waste occurred in large operations. 

After a disastrous earthquake and avalanche in the Andes, an Army 

disaster survey team went to Peru but, according to critics, conducted at 

best a perfunctory investigation. The Navy sent a hospital ship with 

helicopter ambulances that could not operate in the mountains. AID sent 

expensive tents that did not have enough insulation to keep people warm 

in the disaster area. Only Army helicopters and fixed-wing aircraft 

rendered valuable assistance, delivering almost two million pounds of 

cargo and evacuating nearly 5,000 people. Their work, however, was 

interrupted for two days so that they could support a visit to the scene by 

American First Lady Patricia Nixon accompanied by a host of reporters. 34 

:W U.S. Congress, House, ReviewQ!U,S. Assistallce Actil1ities Related 10 'he Earthquake Disaster 
ACTIVISM ABROAD 167 

The problems of relief received thoughtful criticism in the report of an 

Army Medical Department officer, Maj. Craig H. Llewellyn of the 

Epidemiology Consultant Service at Walter Reed Army Institute of 

Research. Llewellyn went to Peru as part of the North American Andean 

Relief Mission organized by an American alpine club. He spent three 

weeks in the disaster area, working first with mountain rescue teams and 

later with the Army helicopter crews. Llewellyn found operations in 

chaos and casualties greatly exaggerated. Rather than the reported 50,000 

victims, he learned there had actually been three to four thousand. Most 

had received care, and over half the injured had been discharged by the 

time the Americans arrived. Local authorities had been capable of handling 

all casualties, Llewellyn emphasized in his report, which pointed again to 

the necessity for prior surveys by the Defense Department to ensure the 

validity of disaster reports. He recommended that surveys include an 

epidemiological study by a trained professional, possibly a junior preventive 

medicine officer, for whom such work would provide excellent training. 35 

Llewellyn's report examined a basic problem in Army medical relief 

but spurred no systematic reform. Perhaps the success of other relief 

missions may have contributed to this; not all Army efforts in the seventies 

were as marred by confusion and duplication as those in Sicily and Peru . 

And the Army did experiment with new techniques in disaster assistance. 

Special Action Force Asia (SAFAsia), an Army Special Forces group 

stationed in Okinawa, developed the Disaster Assistance Relief Team 

(DART) concept. A twelve-man Special Forces detachment augmented 

by medical and engineer personnel , a DART could be flown or airdropped at the scene of a disaster anywhere in Asia. Once there, the team 

could conduct an immunization program and carry out other minor 

medical missions. 

SAFAsia undertook two such missions in the early seventies. In 1971 

a Medical Corps major and four enlisted medical personnel from the 1st 

Special Forces Group aided medical officers from the U.S. Army Medical 

Research Unit and nationals in immunizing more than 100,000 people for 

typhoid when an epidemic threatened Malaysia. The next year, during 

floods in the central Luzon Valley of the Philippines, the 2d Special 

Forces Battalion sent a command and control element and seven DART's 

ill Peru: Repol'/ of a StafJ Survey Team 10 the SlIbcommilleefor Review of Foreign Aid Programs. 

Commilleeoll ForeigllAJJairs. U.S. HOliseofRepresentatil'es(Washington : GPO, 1970). passim, but 

especially pp. 3- 4, 14- 15; Roger Class, "AID Fi asco in Pem," clipping from New Republic 

attached to Llewellyn's report; Craig H. Llewell yn, "Trip Report: Participation in Disaster Relief 

Operations following the Recent Earthquake in Peru , 26 October 1970," in OTSG, Plans and 

Operations Division filcs. 

3SLlewellyn. "Trip Rpl ," passim. 
168 THE DEMANDS OF HUMANITY 

into the inundated region. At first the teams performed rescue missions, 

but as the weather cleared and flood waters receded they redeployed to 

conduct an immunization campaign. Overthe nextten days, they inoculated 

more than 325,000 people for typhoid and treated more than 23,000 

Filipinos for minor ailments. Two years later the DART program ended 

when the Special Forces left Okinawa. The concept, however, persisted. 36 

The Army also successfully employed traditional methods during a 

mission to Nicaragua at the end of 1972. At 0035 hours on 23 December 

an earthquake struck the most populated section of Managua, injuring 

nearly 20,000 residents. Since the quake substantially damaged the city's 

hospitals as well , they could offer little or no help to the sufferers. When 

reports of the devastation reached AID, officials there asked the Departrilent 

of Defense to send a disaster survey team augmented by forty medical 

personnel from Southern Command in Panama. DOD agreed, sending 

also the 24-bed I st Tactical Hospital (Air Transportable) from McDill Air 

Force Base, Florida, and a l20-bed segment of the 21st Evacuation 

Hospital from Fort Hood, Texas.

37 

An advance party of eight physicians, an MSC officer, and eighteen 

enlisted medics arrived in Managua at 1400 hours the same day-{)nly 14 

hours after the quake and 5 hours after Southern Command had been 

notified. Headed by Maj . Paul Manson, the party moved immediately to 

the front lawn of the partially collapsed General Hospital where Nicaraguan 

health officials had already set up an open-air center to sort the injured. 

The Americans established a staging area nearby, which, during the next 

24 hours, received nearly 300 patients. Because the Americans had the 

only functioning X-ray equipment, they received the more serious cases. 

Manson's party worked through the night, operating and setting bones. 

By this time, Col. Raymond L. Coultrip, Jr. , the chief surgeon of the 

survey team, had arrived and had been made director of all American 

military medical relief. When the Air Force's I st Tactical Hospital landed 

in Managua at 0600 hours on Christmas Eve, Coultrip directed it to the 

General Hospital site. Under the command ofLt. Col. George Sutton, it 

l6Qn Malaysia, sec After Action Report (Medical), DART Malaysia, 24 Mar7l . On Philippines, 

see After Action Report, DART Philippines. 19 Sep 72, Headquarters and Headquarters Detachment, 

2d Special Forces Battalion. copies of both in eMH files . 

. l7Foliowing account based on Raymond L. Coultrip. Jr., "After Action Report on Medical 

Activities, Nicaraguan Disaster Relief Operations. ,. in eMH files; and "Medical Aspects of U.S. 

Disaster ReliefOperalions in Nicaragua, ,. Military Medicine 139 ( 1974): 879- 83. See also Richard 

Whittaker et aI. , "Earthquake Disaster in Nicaragua: Reneclions on Ihe Initial Managemenl of 

Massive Casuahies," Journal of Trauma 14 (1974): 37 - 43; U.S. Congress, House, Report on the 

Earthquake in Nicaragua, Hearing before the Subcommittee Oil Inler-American Affairs of the 

Committee Oil Foreign Affairs, HOllse of Represemalil.es. 93d Congress, / st Session (Washinglon: 

GPO, 1973). 
ACTIVISM ABROAD 169 

AIR FORCE DocroR AND ARMy CORPSMEN TREAT DISASTER VICTIM. after 

Managua earthquake. 1972. 

became fully operational by 1600 hours. Normally a casualty staging 

fac ility with a staff of only thirty-eight, this unit added civilian volunteers 

and personnel from the Army survey team to its staff, expanded its bed 

capacity to 105, and undertook regular patient care. 

Like Manson's temporary operation which it replaced, the 1st Tactical 

Hospital, because of its X-ray capabilities, received badly injured casualties, 

mostly with bone injuries, usually to the arms and legs. The fIrst day its 

doctors saw 520 patients, performed 20 major operations, and put casts 

on more than 100 fractures. Thereafter, its patient load steadily declined. 

It admitted only 378 more patients over the next 4 days, and toward the 

end of its stay it treated mostly outpatients. On 29 December the hospital 

closed, its staff returned to the States, and the survey team personnel 

departed to the Canal Zone. The tents and equipment were donated to the 

Nicaraguans. 

Meanwhile the 21 st Evacuation Hospital had arrived in Managua, 

oocoming partially operational on the 25th and fully so on the 26th. From 

then until the Americans turned the facility over to the Nicaraguans on 3 

January, the 21st treated between 500 and 600 outpatients a day and 

maintained a 40- to 50-patient census. Since the medical crisis had passed 
170 THE DEMANDS OF HUMANITY 

by the time it opened, its doctors saw mostly routine cases rather than 

disaster-related injuries. 

In addition to the hospitals, the Americans furnished other medical 

services in Managua. An environmental health specialist from Southern 

Command worked to repair the city's water system, and Colonel Coultrip 

advised local officials on health and sanitation. Army personnel brought 

order to the chaos of medical supplies sent to Nicaragua by various 

countries, moving the materiel from the airport to a field where they 

sorted, inventoried, and organized them. Finally they set up a depot 

system based on the Army model and turned it over to the Nicaraguans on 

2 January. 

The progressive takeover by locals was ably handled. Nicaraguan 

personnel took jobs in the 21st Evacuation Hospital to receive training 

from its American staff without any interruption in service. By the 4th it 

had become apparent that the Nicaraguans could administer the facility . 

The 21st returned to Fort Hood. Only Maj . Dugald S. Mcintyre, Jr., and 

three enlisted specialists remained in Managua; they furnished medical 

care for Americans still in the city but also worked in refugee camps and 

advised the government on health matters. On 16 January they too left, 

and the American medical mission to Managua ended. 

Despite some successful missions, however, problems in postwar 

international disaster assistance persisted. In 1976 a major medical mission 

proved less successful than that in Nicaragua and again raised questions 

about the utility of large-scale foreign assistance. On 4 February 1976 an 

earthquake struck Guatemala, a land little touched by modernity, where 

the Indian population lived barely above subsistence level. Moved by 

their plight, the United States responded with a wealth of aid and a welter 

of administrators to deliver it. Southern Command quickly mobilized a 

disaster survey team, and its seven members- including a preventive 

medicine officer-flew to Guatemala the first night. Upon arrival it 

conducted a helicopter survey of the area and discovered devastation 

worse than early reports had indicated 38 

When the Army mobilized to send a hospital to Guatemala, the Army 

reorganization of 1972 - 1973, mentioned in the last chapter, made it an 

administrative challenge. Following standard procedures, the State 

Department requested the deployment from the Joint Chiefs of Staff, who 

38Unless otherwise ciled. following account based on Arter Action Report-Guatemala Disaster 

Relief Operations, 3 Mar 76, prepared by Headquarters, United Slates Anny Medical Department 

Acti vity. Canal Zone; After Action Report-Guatemala Earthquake. nol otherwise identified but 

apparentl y prepared by OTSO. Both in CMH files. "HSC's Medical People Help Field Hospital Care 

for Guatemala's Earthquake Victims." HSC Mercury 3 (Apr 76): 4- 5. 
ACTIVISM ABROAD 171 

in turn charged the Directorate of Military Support with coordinating the 

Army's part in the operation. The DOMS 's staff contacted Plans and 

Operations Division, Office of the Surgeon General (OTSG). But The 

Surgeon General actually controlled no hospitals. Hence OTSG had to 

coordinate with Forces Command (FORSCOM), which had the hospital , 

and Health Services Command (HSC), which controlled the professional 

staff. Staffs at all three commands worked together and exercised great 

care to prevent any infringement on each other's area of responsibility. In 

fact, medical officers at OTSG may have been too careful since some of 

them thought the type of hospital sent was a mistake but considered it 

unwise to question a FORSCOM decision.'9 

In any case, FORSCOM sent the 47th Field Hospital to Guatemala, 

and HSC designated Col. Thomas C. Birk of Fort Sill Medical Activity as 

hospital commander. HSC also filled the professional slots with as many 

Fort Sill people as possible, pulling the remainder from other installations, 

particularly Fort Sam Houston. After a flight on Air Force transport 

planes, the hospital assembled in Guatemala City and moved to 

Chimaltenango, forty miles west of the capital. American and Guatemalan 

officials had agreed that the United States would operate within a fifteenmile radius of this spot. An advance party from the 47th Field Hospital 

had preceded the main party there and selected a hospital site. Here the 

47th became operational at 2035 hours on 6 February, two days after the 

quake. 

Patients who came to the hospital suffered primarily from cuts and 

broken bones; nearly 30 percent had crushed pelvises. The unit encountered 

so many orthopedic cases that its professional staff, which already included 

one orthopedic surgeon, had to be reinforced with another, plus two cast 

specialists from the United States. During its stay, the 47th treated 700 

patients. Yet more than half were outpatients, and the hospital would 

have operated at no more than 50 to 60 percent capacity during its first 

week if many less seriously injured people had not stayed there because 

they had nowhere else to go. 

Underutilization resulted in part from the low number of casualties in 

the area, but the hospital staff alienated many local residents. At the 

request of the Americans, Guatemalan soldiers blocked the paths to the 

hospital to keep families from visiting relatives. This made sense from a 

medical standpoint but seemed absurd to local peasants. An American 

doctor who had lived and worked in the area for fourteen years reported 

that some people wanted " to take their relatives out of the Army hospital 

390n Ihis r inl. see After Action Report-Guatemala, pp. 5.7, and 8. 
172 T HE DEMANDS OF HUMANITY 

because they say the Americans don't speak their language, don't understand 

them and never explain anything." The doctor added that though the 

Army was " doing a good job" and " keeping a low profile" it practiced a 

medicine unadapted to the customs and lives of the people it served.4o 

Modern medicine did aid the Guatemalans, though, not only in the 

field hospital but also through public sanitation projects. Soldiers from 

the I05th Medical Detachment (Preventi ve Medicine) carried on 

immunization campaigns, while other medical officers were helping 

restore the water supply in Guatemala City and the surrounding area. As 

the emergency phase of the disaster passed, the 47th Field Hospital 

ceased operations on 17 February, and the entire Army contingent began 

to withdraw. 

Although medical operations went well in Guatemala, American 

personnel adjusted poorly to local customs, and the Army hospital was 

underemployed. The latter failing was not necessarily the fault of the 

Army but part of a larger problem with the entire American relief effort. 

Guatemala became, figuratively speaking, filled with relief workers. 

Some observers complained that the American effort was, in one reporter's 

words, "overstaffed, overorganized, and slow. ,,4 1 

Problems that hindered operations in Guatemala, Peru, and Sicily 

were characteristic of international relief operations in the seventies. 

Frequently so many supplies arrived that the resulting confusion actually 

made relief more difficult--especially if no one organized them as the 

Army medical supply personnel had in Managua. Too much aid-not just 

from the Army but from all sources-and too little coordination sometimes 

meant international aid was as much harmful as helpful. A situation had 

developed like that in the domestic sphere in the late thirties, when too 

many agencies sent aid and no one group had responsibility for coordinating 

it. As early as 1972 several conferences discussed the formation of some 

sort of international coordinating institution for disaster assistance operations. 

The United Nations did create a Disaster Relief Office, but it never 

functioned as a true coordinating agency , and problems continued,,2 

4OQuotes from New York Times, 13 Feb 76. 

41Quote from New York Times, 14 Feb 76; see 18 Feb 76 for a particularly interesting analysis. 

42For a helpful overview of aid in the seventies, see Leslie Plommcr, "The DisaslcrGame," New 

York Times. 17 Nov 78. On talk of international agency, see Conference on Disaster Relief, London, 

1972. An Imemaliollol Diso.uer Relief Force: Report all 'he Conferellce Held by 'he Church of 

Ellg/alld Board a/Social Respolisibiliry, 17111 November /972 (London: Church Information Service. 

1973); U.S. Congress. House. Disaster Assistance Authorization: Hearing before the Commillee 011 

Foreign Affairs, VI/ited States Sellate, 93d Congress. 2d Sessioll 011 HOllse Resolutioll 12412 

(Washington: GPO, 1974). pp. 61 , 64-65; R. J. B. Rossborough . . 'The Need for Coordinated Relief 

Efforts in Natural Disaster Internationally," in Helping Halld: A Report 011 Exercise Helping Hand at 

Ash Vale 011 6, 7. 011(18 October 1972. copy in OTSG files. 
ACfIVISM ABROAD 173 

The United States Army, obviously, could not solve the problem by 

itself, but within the context of international aid it still faced a difficult 

situation when deciding to send aid. After action reports by medical units 

in disaster operations reiterated the necessity of an accurate survey of the 

medical situation coupled with careful tailoring of units to the problems 

discovered. But a "Catch-22" situation could develop. In a disaster in 

which a hospital was needed, the casualty load might peak and the need 

for a hospital decline in the time it took the survey team to report and a 

hospital to mobilize , move to the scene, and become operational. On the 

other hand, the immediate dispatch before the survey team reported could 

mean the costly shipment of an unsuitable facility, which might well be 

underutilized or even be without patients. 

The activism of the postwar period had not always escaped the 

"catch. " Army medical units had undertaken some missions that constituted 

questionable employment of scarce resources-the Chilean or Guatemalan 

operations, for instance. On other occasions, in situations where a small 

team could do great good- such as missions in Somalia, Morocco, 

Malaysia, the Philippines-or where a hospital eased the crush of patients 

in damaged local facilities- as in iran, Yugoslavia , or Nicaragua- the 

Army Medical Department had made a significant humanitarian contribution. 

If activism is to continue, Army medical relief must be undertaken with 

an awareness that too much aid can be almost as debilitating as too little 

and that reports of mass casualties in disasters must be quickly yet 

competently investigated before costly relief operations are ordered. 
CHAPTER 9 

Conclusion 

An Army medical role in disaster relief emerged from a particular 

historical context. It followed three developments: the rise of an urban, 

interdependent nation in which traditional local sources of assistance 

were sometimes insufficient; the acceptance by the federal govemment of 

responsibility to augment those sources when necessary; and the development 

of the medical knowledge and skills to render effective care. Even then, 

Americans preferred to leave health care to the private sector and disaster 

relief to local and voluntary agencies, so Army medical participation was 

always limited to instances when' 'the overruling demands of humanity" 

required it. When a network of voluntary, municipal, state, and federal 

agencies which fumished and coordinated disaster assistance matured 

after 1950, such occasions occurred less frequently and the Army further 

reduced its efforts. It did not end them, however, for a few disasters 

overwhelmed established relief institutions and prompted Army aid. 

Though the Army assumed a medical role partly by default and 

reduced its involvement when other relief agencies were created, its 

participation proved beneficial to civilians and soldiers alike. In the first 

years of the twentieth century, Reed, Gorgas, and other military surgeons 

were among the most talented health care professionals in the country. 

Employing and expanding the latest medical discoveries and techniques, 

they saved lives in Cuba, the Philippines, and several domestic disasters. 

As medical practice advanced, their less-heralded successors rendered 

valuable assistance in many later crises. The history of their efforts 

revealed the ability of Army medical personnel to furnish rapid and 

effective aid to civilians in emergencies. 

This history also suggested that the Army itself benefited from disaster 

relief operations. Civilian emergencies provided more realistic experience 

in the care of mass casualties than most training exercises, and participating 

units learned a great deal about operating in an environment that resembled 

combat. Moreover, the personnel felt a sense of accomplishment that 

came from helping people in need and using the skills they had worked to 

develop. Successful disaster relief missions, in sum, improved technical 
CONCLUSION 175 

skills while they increased morale and esprit. They thereby strengthened 

the Army Medical Department as well as aided civilians. 

Not every Army medical relief operation was totally successful, and 

all of them encountered various difficulties. Failures in planning and 

execution plagued many missions. Not until the 1960's did the Army send 

survey teams to estimate the medical needs in a stricken area, and even in 

the 1970's a few critics contended the teams did not accurately assess the 

medical situation. On a few occasions, the wrong kind of health care 

facility was dispatched. In other instances, medical units arrived at the 

site with inappropriate personnel or insufficient equipment for the types 

of casualties they encountered. Other minor problems sometimes hindered 

operations: sloppy packing or unloading of equipment, poor coordination 

between hospital and professional staffs unused to working together, 

minor maintenance fai lures, to name a few. Such failings could have 

occurred in any mission. 

Problems also arose out of the special character of disaster assistance 

missions. Relations between the military unit and host community sometimes 

generated difficulties. Medical personnel in domestic disaster missions 

had to be careful not to provoke civilian hostility. After the San Francisco 

earthquake, for example, civil-military tensions developed because some 

residents resented what they considered arbitrary military intrusion into 

their affairs. The Army had to respect their feelings but could not totally 

give way to their complaints. Medical officers had to maintain strict 

sanitary measures even if a few San Franciscans objected. Wisely, the 

relief force also moved to reduce tensions by first restricting and then 

quickly withdrawing its services. On other occasions, officials were too 

solicitous of civilian attitudes. During Mississippi flood relief in the 

decades around 1900, Army officials may have too readily accommodated 

their plans to the white racial attitudes prevailing in the delta. 

Relations with civilians, especially knowing when to conform to and 

when to confront their cultural attitudes, became more troublesome in 

operations abroad. In Cuba and the Philippines after the Spanish-American 

War, and in other missions as well, American medical personnel were not 

always sufficiently responsive to local beliefs and practices. Their insensitivity 

sometimes undermined medical goals, though they rightly felt they could 

not abandon basic principles of scientific medicine. Military doctors had 

to respect the local culture, abide by its practices when possible, but still 

provide modem health care. Theirs was not an easy task. 

In addition to the potential conflict between local custom and modem 

medicine, political differences sometimes complicated relations with 

foreign civilians. In all relief operations abroad, participants found they 
176 THE DEMANDS OF HUMANITY 

served as diplomats as well as doctors. In a few- those in Japan in 1923, 

Chile and Yugoslavia in the 1960's--Anny medical personnel encountered 

extremely tense political situations. Commanders exercised strict control 

during these and other operations, and their units proved successful 

ambassadors. In fact, medical personnel appeared to cope with political 

tensions better than with the more insidious cultural conflicts. 

Operational difficulties and civil-military tensions were present 

throughout the history of Anny medical aid. A third problem developed 

only after the establishment of a disaster bureaucracy. In the late nineteenth 

century there had been too little assistance, but by the mid-twentieth 

century, there was sometimes too much aid from too many groups. An 

abundance of help but a dearth of coordination complicated a few domestic 

missions during the interwar years and a number of foreign operations 

after World War II. Working as part of an increasingly bureaucratized 

system of relief, medical personnel could do little to eliminate the 

inefficiencies, since responsibility for planning and coordinating relief 

resided with civilian agencies. But they had to be aware of the difficulties 

and dangers involved . 

Though all three types of problems bedeviled assistance operations, 

they never overshadowed the success of Army medical relief. Army 

medical personnel employed their special talents and resources to succor 

countless victims of nature's wrath who might not otherwise have received 

help. Though the historical conditions changed and the phase of extensive 

Anny Medical Department assistance quickly passed, emergencies continued 

to arise that necessitated use of its expertise and manpower. The people it 

aided on those occasions probably cared little about operational difficulties, 

civil-military tensions, or the complications of the relief bureaucracy. 

Their personal suffering was eased, and that was enough. 
Bibliographical Note 

Most of the sources for this study deal with only one disaster and can 

be more easily located in the footnotes than in a bibliography. Sources 

that were particularly helpful in delineating the development of the 

mission or providing necessary background information are discussed 

below. 

Primary Sources 

Compiling a list of instances in which the Army aided civilian 

communities in natural disasters proved no simple task. Hoping that the 

offices and agencies responsible for relief work might have such a list, I 

naively began my research by calling them. The responses to my inquiries 

were depressingly uniform. First the .respondent laughed heartily, then 

told me his office kept no such record and kindly suggested two other 

offices or names to call. Each time I followed the suggestion but to no 

avail. Days later my final contact suggested I call the one with whom I had 

begun. 

The idea of compiling a complete record of Army aid in natural 

disasters-to determine when it had involved medical assistance--proved 

as ludicrous as my respondents found it. A fairly comprehensive list, 

though, was obtained by exploiting a variety of sources. Useful, though 

disappointingly incomplete, were the Reports of the Surgeon General , 

published annually from the creation of the Medical Department to the 

present. Sometimes, but not always, these reported on medical relief 

missions. More helpful as a rule, but still far from complete, were the 

Reports of the Secretary of War published each year before World War II. 

In 1969, the Office of the Chief of Military History began publIcation of 

the Department of the Army Historical Summary, which sometimes 

mentioned disaster relief. All of the annual reviews, however, were 

incomplete and had to be supplemented with information from other 

sources. 

Most useful was a list of congressionally approved disaster relief 

operations prepared by the Congressional Research Service, the majority 

of which before the Second World War were Army missions. This 

compilation first appeared in the Congressional Record, 71st Congress, 
178 THE DEMANDS OF HUMANITY 

3d Session, 1930, pp. 757-59, and was updated in the CongressionaL 

Record, 81st Congress, 2d Session, 1950, pp. 11 900-902. Another 

helpful compilation of congressional actions on disasters turned up in a 

letter and attachments, Edward H. Cavin to Mr. Schaeffer, 24 April 

1952, in the Library of the American National Red Cross, Washington, 

D.C. 

More complete listings of Army aid, though covering only limited 

periods of time, can be found in the military records at the National 

Archives. For the period before 1915, a helpful compilation, brought to 

my attention early in my research by John B. Corr, can be found in a letter 

and attachments, H. P. McCain to James Hay , II January 1915, file 

1459754, in Record Group 94. For later periods, Record Group 407, 

400.38, contains the following documents that list missions: Relief Operations 

of the War Department, 1903- 1928 (box 2416); Value of Government 

Property Turned Over to the American Red Cross by the War Department 

for Relief Purposes, 1925- 1930 (box 2406); B. J. Tourville, "Department 

of the Army Participation in Disaster Relief," 12 July 1948 (box 1351). In 

addition, Operations in Disaster Relief Assistance Since I July 1951, 

dated 13 January 1954, is filed in 370.1, Record Group 407 . 

For the years between 1954 and the early 1960's, no good source for 

finding Army disaster missions exists. For the years after 1963, lists can 

be made from the files of two "action agencies " : the Office of the Disaster 

Relief Coordinator, Agency for International Development, in the State 

Department; and the now abolished Directorate of Military Support, the 

records of which are in the Washington National Records Center. For all 

periods, however, such listings are incomplete, because Army units 

sometimes rendered aid without reporting it to the authorities who kept 

these lists. Mention of some-but assuredly not all-of such missions can 

be found in articles in military periodicals and through the New York 

Times Index. 

Records and reports for the missions are also located in a variety of 

places. For relief missions undertaken before 1954, they are found in the 

National Archives, primarily in two groups of Adjutant General's Office 

papers. Reports on missions before 1917 are filed in Record Group 94, 

Records of the Adjutant General's Office, 1784-1917, General Records. 

Documents for each mission are grouped together under one file number 

that can be found through the indexes. Papers from missions that occurred 

from 1918 to 1954 are located in Record Group 407, Records of the 

Adjutant General's Office, 1918-, decimal file. Toward the end of that 

period, a few disaster relief reports are filed under decimal 370.1 , that 

designated for disasters, but most are under400.38, a supply designation. 
BIBLIOGRAPHICAL NOTE 179 

A few other record groups in the National Archives contain infonnation 

on certain pre-1954 relief missions. Some accounts of Army medical aid 

to civilian communities stricken by epidemics appear in Record Group 

105, Records of the Bureau of Refugees, Freedmen, and Abandoned 

Lands. Record Group 112, Records of the Office of the Surgeon General 

(Anny) , contains some but surprisingly few medical reports from disaster 

missions. Records of some late nineteenth and early twentieth century 

relief operations are in Record Group 192, Records of the Office of the 

Commissary General. Finally, the papers of the American-Polish Relief 

Expedition are in Record Group 120, Records of the American Expeditionary 

Force (World War 1), 1917 - 1923 . 

After 1954 the Army abandoned its central decimal file, making the 

historian's task in locating records of disaster relief missions more difficult. 

Records management people at the Adjutant General's Office explained 

that there was no way to locate all the reports after that date except to go 

through almost all the records of the Army. Such a task was clearly 

impractical. However, the annual Medical Service Activities reports for 

major medical commands for available years after 1954 were examined. 

When they were consulted, these reports were in the files of the Anny 

Medical Department Historical Unit, which has now become a part of the 

Center of Military History (CMH). For missions in the early 1960's and 

after, new sources of records exist to ease the problem created by the 

abolition of the central decimal file . In addition to the annual Medical 

Service Activities reports on individual commands, after action reports 

and other records from medical relief missions in the sixties and seventies 

are in CMH files. Reports on most of the major relief operations by the 

Army after 1964- 1965 can be found in the files of the Directorate of 

Military Support in the Department of Defense. They were examined 

when still in the DOMS office but have since been moved to the Washington 

National Records Center. Yearly summaries and printed case reports on 

individual foreign disaster missions are kept in the Office of Disaster 

Relief Coordinator, Agency for International Development, in the 

Department of State. Although neither type of AID report provides much 

detail, both show any Army assistance rendered. 

Because of the nature of this project, few private manuscript collections 

were consulted. However, the papers of individual medical officers 

involved in relief efforts after the Spanish-American War did prove 

helpful. The most useful of them, the Papers of Jefferson R. Kean at the 

Aldennan Library of the University of Virginia, included some infonnation 

on relief efforts during the American military government of Cuba and a 

great deal on such work during the 1906- 1909 intervention. Also of 
180 THE DEMANDS OF HUMANITY 

value in studying the Spanish-American War relief missions are the 

William A. Kobb6, Halstead-Maus Family, George W. Jean, and 

Richard M. Johnson papers as well as the H. B. Wilkinson file in the 

Spanish-American War Collection- all in the archives of the United 

States Military History Institute at Carlisle Barracks, Pennsylvania. 

In addition to private papers and records of individual missions, other 

government documents provide information on the development of federal 

disaster relief policy. Special Regulation 67 (a copy of which is in the Old 

Military Records Branch, NA) and the series of revisions to Army 

Regulation 500- 60 (available in the Army Library) reveal changes in the 

Army's conception of its role . In addition, for the post-World War IJ 

period, policy changes can also be found in several Department of 

Defense directives, especially DOD Directive 3025. I, first issued 14 July 

1956 but changed several times since, usually titled " Employment of 

Military Resources in Natural Disaster Emergencies within the United 

States, Its Territories and Possessions, " and DOD Directive 5100.46, 

"Responsibilities for Foreign Disaster Relief Operations." 

Changes in the federal government's relief role can be traced through 

the Congressional Record and its predecessors using the lists of legislation 

mentioned above. For an overview of developments after 1947 see Office 

of Emergency Preparedness, Report to the COllgress: Disaster Preparedness 

(Washington: GPO, 1972), pp. 165 - 73. A list offederal disaster statutes 

since 1947 appears in Federal Respollse to Hurricane Camille, Hearings 

before the Special Subcommittee on Disaster Relief of the Committee 011 

Public Works, U.S. Senate, 91st Congress, 2d Sessioll (Washington: 

GPO, 1970), part 2, Appendix . The shift in bureaucratic responsibility for 

relief can be traced through the following presidential Executive Orders: 

10346 (17 April 1952); 10427 (16 January 1953); 10737 (29 October 

1957); 10773 (1 July 1958); 11051 (27 September 1962); 11575 (31 

December 1970); 11725 (27 June 1973). 

Secondary Sources 

No adequate history of Army disaster relief exists, and the best 

available brief overview is unpublished. See John B. Corr, "Disaster 

Relief and Rescue Operations," in "Two Centuries of Service" (unpublished 

manuscript, Center of Military History, 1974). Leland R. Johnson has 

completed a soon-to-be-published history of the Corps of Engineers' role 

in relief, "Emergency Response: A History of the Army Engineer Disaster 

Relief Mission, 1794- 1950" (unpublished manuscript, Engineer Historical 

Division, Washington, D.C., 1978). Johnson's thorough account is based 
BIBLIOGRAPHICAL NOTE 181 

primarily on Corps of Engineers records not consulted for this study. 

Because of its different capabilities in disaster situations, the corps' role 

developed differently from that of the Medical Department or other Army 

agencies. 

General histories of the institutional development of the Army tend 

to ignore the disaster relief mission, though several studies of the civic 

action mission mention it in passing. Perhaps the most useful is Edward 

B. Glick, Peaceful Conflict: The Non-Military Use of the Military 

(Harrisburg, Pa.: Stackpole Press, 1967), but also of some value are 

Harry F. Walterhouse, A Time to Build: Military Civic Action, Medium 

for Economic Development and Social Reform (Columbia: University of 

South Carolina Press, 1964), and the helpful brief summary (which 

unfortunately is hard to find) Virgil Ney, The United States Soldier in a 

Nonviolent Role (An Historical Overview) (Fort Belvoir: Headquarters, 

United States Army Combat Development Command, 1967). For an 

examination of civic action work by armies of several countries with 

some discussion of disaster relief included, see Hugh Hanning, The 

Peaceful Uses of Military Forces (New York: Frederick A. Praeger, 

1967). 

No thorough history of the Army Medical Department exists, but 

Percy M. Ashburn, A History of the Medical Department of the United 

States Army (Boston: Houghton Mifflin Co., 1929) provides a survey of 

its development. Mary C. Gillett's The Army Medical Department, 

1775-1818 (Washington: GPO, 1981) furnishes helpful background 

but covers a period prior to most of the activity covered in this study; a 

second volume in this series covering subsequent years through 1865 is in 

preparation. Additional information on some aspects of the Medical 

Department's history can be found in Edgar E. Hume, Victories of Army 

Medicine (Philadelphia: J. B. Lippincott, 1943) and Stanhope BayneJones, The Evolution of Preventive Medicine ;'1 the United Slales Army, 

1607- 1939 (Washington: GPO, 1968). 

With one exception, the role of the organizations that aided and 

eventually replaced the Army Medical Department in providing civilian 

disaster has not been well documented. I found no general histories of 

disaster relief work by the Public Health Service, local civil defense 

organizations, or the National Guard. Even general histories of the guard 

devote little attention to its role in natural disasters. 

The Red Cross, the one exception, has had its disaster relief 

accomplishments frequently examined. The resulting studies shed much 

light on the changing nature of disaster relief and the role of the Army, as 

well as on the Red Cross's own work. Foster Rhea Dulles, The American 
182 THE DEMANDS OF HUMANITY 

Red Cross: A History (New York: Haqrer & Bros., 1950) provides a 

useful organizational history with a good deal of attention to disaster 

relief. For a discussion of the development of the Red Cross assistance 

role (though with little on specific instances of aid), see Clyde E. 

Buckingham, Red Cross Disaster Relief" Its Origins and Development 

(Washington: Public Affairs Press, 1956). The Red Cross also sponsored 

a valuable history of the relief operations themselves. It is presented in 

three volumes, the first two in mimeographed form from the Red Cross 

library and the third available as a dissertation. They are: Mabel A. 

Elliott, American National Red Cross Disaster Services, 1881 - 1918, 

History of the American National Red Cross (Washington: American 

National Red Cross, 1950), vol. 20-A; Catherine Fennelly, American 

Red Cross Disaster Services, 1919-1939 (Washington: American National 

RedCross, 1950), vol. 20-B; and Thomas H. Reynolds, " American Red 

Cross Disaster Services, 1930-1947" (Ph.D. diss., Columbia University, 

1954). 

Social welfare historians have devoted little more attention to the 

history of disaster relief than have their military and institutional colleagues. 

No general history exists, but there are three surveys of closely related 

topics. Walter I. Trattner in From Poor Law to Welfare State: A History of 

Social Welfare in America (New York: Free Press, 1974) traces governmental 

policy toward charity, public health, and other welfare activities often 

associated with disaster relief. Robert H. Bremner's American Philalllhropy 

(Chicago: University of Chicago Press, 1960) discusses all types of 

organized charity over the course of American history . Perhaps most 

helpful of all is Merle Curti 's American Philalllhropy Abroad: A History 

(New Brunswick, N.J.: Rutgers University Press, 1963). Curti deals in 

his encyclopedic volume with all types of foreign assistance rendered by 

Americans except that by government. Nevertheless, his chapters on 

private disaster relief abroad are still extremely useful in studying military 

aid, and his interpretation of American motives in foreign assistance is 

provocative . 

Medical practice has received more attention than social welfare 

policy, and historians of medicine have provided many good studies of 

changes in medical science and public health that furnish useful background 

material for this study. Among those I relied on heavily were: C.-E. A. 

Winslow, The Evolution and Significance of the Modern Public Health 

Campaign (New Haven: Yale University Press, 1935); Richard H. Shryock, 

Medicine in America: Historical Essays (Baltimore: Johns Hopkins 

University Press, 1966); William G. Rothstein , American Physicians in 

the Nineteelllh Century: From Sects to Science (Baltimore: Johns Hopkins 
BIBLIOGRAPHICAL NOTE 183 

University Press, 1972); and John Duffy, A History of Public Health in 

New York City, 1866- 1966 (New York: Russell Sage Foundation, 

1974). Historians of medicine and other scholars have also written several 

histories of individual epidemic disasters. Two good ones that I found 

informative are J. H. Powell, Bring Out Your Dead: The Great Plague of 

Yellow Fever in Philadelphia in 1793 (Philadelphia: University of 

Pennsylvania Press, 1949) and John Duffy, Sword of Pestilence: The New 

Orleans Yellow Fever Epidemic of 1853 (Baton Rouge: Louisiana State 

University, 1966). Social historian Charles E. Rosenberg's The Cholera 

Years: The United States i111832, 1849, and 1866 (Chicago: University 

of Chicago Press, 1962) is particularly helpful because of his concern 

with public attitudes toward disaster and how they changed with time . 

A few historians have published scholarly examinations of individual 

disasters other than epidemics. Recently appeared are a history of a very 

early disaster, James Penick, Jr. , The New Madrid Earthquakes of 

1811-1812 (Columbia: University of Missouri Press, 1976), and two 

studies of an important twentieth century disaster, Bruce A. Lohof, 

"Hoover and the Mississippi Valley Flood of 1927: A Case Study of the 

Political Thought of Herbert Hoover" (D.S .S . diss. ,Syracuse University, 

1968) and Pete Daniel, Deep'n As It Comes: The 1927 Mississippi River 

Flood (New York: Oxford University Press, 1977). Penick and Daniel 

focus on the disaster and its effect on people's lives but include some 

information on relief efforts, while Lohof provides a valuable discussion 

of the government's organized relief effort. Other historians, usually 

popular rather than professorial, have published accounts of many disasters, 

some of which are cited in the text. Something of a genre, these books 

usually present a series of human interest anecdotes, though the better of 

them also furnish some useful information on relief efforts. 

If historians have not devoted a great deal of scholarly attention to the 

study of disasters, since 1950 social scientists have. A good introduction 

to social science theory about human behavior in disasters is Allen H. 

Barton, Commul1ities in Disaster: A Sociological Analysis of Collective 

Stress Situations (Garden City, N.Y. : Doubleday & Co., 1969). In the 

early fifties the National Science Foundation- National Research Council 

created a Committee on Disaster Studies which published reports on 

disaster phenomena. It was abolished in the early sixties; since 1963 the 

Disaster Research Center in the Department of Sociology at Ohio State 

University has continued the work. The two groups have prepared and 

published many studies of disaster behavior, a few of which have been 

cited in the text. Many of their other monographs also mention military 

relief efforts (though not Army medical aid), and a few address the theme 
184 THE DEMANDS OF HUMANITY 

directly. John H. Balloch et al., Studies of Military Assistance in Civilian 

Disasters: England alld the United States, Disaster Research Report No. 

2 (Washington: National Academy of Sciences-National Research Council, 

1953) offers a study of Air Force response in natural disasters. Also 

pertinent are a monograph and two articles by William A. Anderson: 

Military-Civilian Relatiolls in Disaster Operations. Disaster Research 

Center Report Series, no. 5 (Washington: Office of Civil Defense, 

1968); "Social Structure and the Role ofthe Military in Natural Disaster," 

Sociology and Social Research 53, no. 2 (January 1969); and "Military 

Organizations in Natural Disaster: Established and Emergent Norms," 

American Behavioral Scientists 13, no. 3 (January/February 1970). 

Another theoretical perspective, one developed by historians in contexts 

other than disaster assistance, has influenced my interpretation of the 

development of the Army medical relief mission. Over the last decade, a 

host of scholars have espoused what one of them has labeled the 

"organizational synthesis of modern American history. "Emphasizing the 

institutional changes in American society as it evolved from homogeneous 

communities to heterogeneous society, the interpretation is best represented 

in a survey text in Robert Wiebe's The Searchfor Order, 1877-1920 

(New York: Hill & Wang, 1967), but many other books and articles have 

contributed to it or utilized its general framework. Most important of 

them for my work were: Samuel P. Hays, "The Social Analysis of 

American Political History, 1880- 1920," Political Science Quarterly 

80, no. 3 (September 1965); Louis Galambos, "The Emerging Organizational 

Synthesis in Modern American History," Business History Review 44, 

no. 3 (Autumn 1970); Alfred D. Chandler, Jr., and Louis Galambos, 

"The Development of Large-Scale Economic Organizations in Modern 

America," Journal of Economic History 30, no. I (March 1970); Robert 

D. Cuff, "American Historians and the 'Organizational Factor,'" Calladiall 

Review of American Studies 4, no. I (Spring 1973); and John Higham, 

"Hanging Together: Divergent Unities in American History, " Journal of 

American History," 61, no. I (June 1974). 
Index 

Agnes. tropical storm, 144 

Agramonte, Aristides. 41 

Air medical evacuation, 108 

Alexander, Dr. M. S. , 77 

Alcltandria, Virginia, fire, 12- 13 

American Medical Association, 112 

American Military Relief Organization, 148 

American policy and food supply, 8-9, 80 

American·Polish Relief Expedition, 85, 87-94 

American Public Health Association, 23, 52 

American Relief Administration, 82, 94-98 

Ames, Maj . A. Aul, 33 

Anesthesia . 18 

Anny Corps of Engineers, 144 

Ashford, Capt. Bailey K., 48. 67 

Avalanche, in the Andes. 166-67 

Baily, Capt. Howard H., 67-68 

Baker, Henry M. , 110- 11 

Baker, Newton D., 90 

Barbour, George M., 28 

Beaumont, Dr. William, 21 

Beeuwkes, Col. Henry, 95, 96, 97 

Bine, Dr. Ren6, 61 

Birk, Col. Thomas C., 171 

Board of Health, 30 

Bourns, Maj. Frank S., 35, 37 

Bowler, Capt. Joseph L. , 137 

Boysen. U . Col. Alexander M., 157 

Braskett, Texas, storm, 16 

Brechemin, Col. Louis, Jr. , 117 

Bubonic plague, 23, 26. 32, 36-38 

Budgetary restraint, in disaster relief, 105-06 

Bureau of Refugees, Freedmen, and Abandoned 

Lands, 13-14 

Camille, hurricane, 142, 143 

Canary Islands, 10- 11 

Cape Verde Islands, II 

Carroll, James, 41 

Catter, Henry Rose, 41 

Cerebromeningitis,77 

Chamberlain, Maj. Weston P., 67 

Chicago fire, 16 

Chile, earthquake, 151 -55 

China, 50 

Cholera, 20, 23, 26, 38-41, 149-50 

Civil War, 4, II , 13, 18, 19 

Civilian Conservation Corps, 119 

Civilian control of disaster relief, 134-35 

Civilian medical emergencies, 20, 21 

Clayton. Senator John M., 11 

Cockran, Congressman W. Bourke, 81, 82 

Coffin, Capt. Jacob M., 70 

Congress, g- 17 

Constitution, provision for fede ral disaster 

assistance, 8 

Cooch, Lt. Col. Joseph W., 160, 16 1 

Coolidge, Calvin, 110 

Coultrip, Col. Raymond L. Jr., 168, 170 

Cob., 25, 26, 27, 28-30, 32 

Davenport, Maj. Walter P., 83, 95 

Davis, Dwight F., 106, 107 

Davis, Norman H., 121 

Dawson, Capt. John H., 95 

DDT, 161 

Dear, Maj . William R. , 95 

Delousing programs. See Lice elimination. 

Demolition of houses after bubonic plague , 36 

Devine, Edward T., 53, 60 

Devol: Maj . Caroll A., 67 

Dianhea,27 

Diphtheria, 23, 76 

Directorate of Military Support, 142, 164, 171 

Disaster 

assistance, and abuse of blacks, 17 

assistance, domestic, 11 - 12 

Assistance Relief Team, 167- 68 

definition of, 3 

Relief Act, 143 

relief operations, foreign, increasing 

problems in, 165- 73 

relief role of Anny, confusion over, 104-14 

Discrimination. 17 

Dodge, Grenville M., 24 

Domestic disaster assistance, 11 - 12, 54-66, 

99- 100,105- 14,117-21, 127- 45 

Dysentery, 23, 27 

Earthquakes, 12 

in Alaska, 137- 40 

in Chile, 124, 151 -55 

in Guatemala, 170-72 

in Iran, 157-60 

in Japan 100- 104 

in Managua, Nicaragua, 114, 168-70 

in Peru, 166-67 

in San Francisco, 54-66, 100 

in Sicily, 165-66 

in Skopje, Yugoslavia, 161 - 62 

in Venezuela, 9-10 
186 

Epidemics, 3, 20. 32- 47. 99 

Erdlator, water purification machine, 159 

Evans. Lt. Col. Robert K., 63 

Explosions in Texas City, Texas, 128-31 

Famine, 10. II , 14, 94- 98 

Fauntleroy, Maj. Powell C., 73. 74 

Federal Civil Defense Administration, 

134-35 

Federal Disaster Act, 133-34 

Federal disaster assistance, emergency. 8- 17 

Federal government, responsibility of in 

disaster situation, S 

Federal relief bureaucracy, creation of, 

131 -35 

Finlay. Dr. Carlos, 4 1 

Fir<, 12- 13, 16,5 1, 54 

Fitzsimons Genera! Hospital, 99 

Fleming. Gen. Philip, 133 

Floods, 16,68-71,73, 74- 77, 119-21, 

140-42,148- 49, 155- 57, 160-61 

Food supplies and American policy, 8-9, 

80 

Foreign disaster assistance, 5, 9 - 11 , 

23 - 47,48-51,80- 98,100- 104, 11 4, 

123-26, 146-73 

Foreign Disaster Relief Division 

creation of, 164 

increasing problems in, 165- 73 

Foreign Operations Administration, 15 1 

Forest faes, 16 

Fort Crockett, 130 

Foster. Maj. George B., Jr., 114 

Foucar, Maj. Frederick H., 95 

Fox, Lt. Arthur E., 92 

Freedmen's Bureau, 13- 14 

Funston, Brig. Gen. Frederick, 55 

Garrison, Lindley M., 75 

Gas gangrene, 13 1 

Gilchrist, Col. Hany L., 85, 93 

Gorby, Capt. Elvin L., 120 

Gorgas, Maj. William C., 43, 52, 174 

Gorky, Maxim. 94 

Government involvement. early, 4 

Grand Camp, 128 

Grasshopper plague, 17 

Greely, Maj. Gen. Adolphus, 60 

Greenleaf. Brig. Gen. Charles R., 27. 52, 6 1 

Griffin, John 5., 21 

Hannon, Capt. Daniel W., 7 1 

Hartmann, Maj. Carl F., 72, 73 

Haskell, Col. William N., 83, 95, 97 

Hawley. Maj. Paul R., 114 

Haynes, Maj. Caleb V., 124 

Heaton, Maj. Gen. Leonard D., 147 

Helicopters, 136- 37, (44- 45, 148, 156 

THE DEMANDS OF H UMANITY 

Hoff, Maj. John Van R. , 26, 33, 34, 48 

Hoover, Herbert. 80, 83-84, 91,94, 110, III 

Horan, Lt. Col. John P., 129 

Hospital Corps, fonnation of, 24 

Housing and Home Finance Agency , 134 

Howard Association, 7,18 

Howard. O. 0. , 14 

Howell. Maj. Reese M., 113 

Humanitarian missions, post·World War I , 

80-98 

Hurricanes, 48-49, 117- 19, 141,142 

Indian affairs, 8-9 

Innoculalion program in Pakistan, 148- 50 

International Cooperation Administration, 

151 

Ireland, 11 

Italy, 50 

Jamaica, 50 

Jamestown, II 

Japanese Relief Bureau, 102 

Jarvis, Nathan 5., 20 

Jenkins, Congressman John J. , 50 

Jones, Maj. Glenn I., 95 

Jones, Col. Percy L., 107, 11 4 

Kean, Col. Jefferson R. , 45, 46, 51 , 70 

Kennedy, Capt. James M., 58 

Kitasato, Prof. Shibasaburo, 37 

Koch , Robert, 23 

Krieger, Lt. Col. Howard G., 153 

Langhorne, Col. George T., 100 

Latin America, 10 

Lazear, Jesse W., 4 1 

League of Red Cross Soc ieties, 84 

Leprosy, 23 

Letterman General Hospital, 56, 57, 62 

Lice elimination 

in Poland, 87-90 

in Russia. 96- 97 

Llewellyn, Maj. Craig H., 167 

Locusts, 10, 16, 18 

Lovett, Pre. Edward, 157 

Lumsden, Leslie L., 52 

MacArthur, Douglas. 115 

McCoy, Brig. Gen. Frank R .• 100, 101. 

102, 103 

Macedonian, 11 

McIntyre . Maj. DugaJd 5., Jr. , 170 

MacKenzie, Dr. K. A. J. , 57, 60 

Magoon, Charles E. , 45 

Malaria, 23 

Manila, 30. 31 

Manson, Sir Patrick, 4 1 
INDEX 

Manson, Maj. Paul, 168, 169 

Marikina River, 39 

Marshall, Lt. Col. Irvine H., 130. 13 1 

Mascoli. Capt. Eugene L., 165 

Maus, LI. Col. Louis M., 35, 36, 37. 39 

Media coverage of disasters, S3 

Medical Department, U.S. Army 

major domestic disaster relief assistance 

in Alaska, 137 - 42 

in California. 52- 66 

in Colorado, 99 

in Florida. 114 

in Georgia. 107 -08 

in Ohio and Mississippi, 119- 2 1 

in the Mississippi Valley, 110- 13 

in New England, 114 

in New England and the Atlantic states. 

119 

in New Jersey, 99-100 

in Pennsylvania, 137 

in Texas, 108- 10, 117 - 19, 128-31 

major foreign disaster relief assistance 

in Chile, 123- 26, 151 - 55 

in Cuba, 27-29. 32-33.41 - 47 

in the Dominican Republic, 114 

in Guatemala. 170-72 

in Honduras. 123 

in Iran. 157 -60 

in Japan, 100- 104 

in Mexico. 136 

in Morocco, 160- 61 

in Nicaragua, 114, 168- 70 

in Pakistan, 148- 50 

in the PhilippUlCS. 29- 32. 35-41. 114. 

123 

in Puerto Rico, 33 - 34, 114 

in Somalia , 155- 57 

in Venezuela, 114 

in Yugoslavia, 161 - 63 

minor assistance. 16- 22. 142 -45. 

165 -68 

relief role 

definition of. 78- 79.104-07 , tl5-

16. 121 - 23. 127- 28. 131 - 34 

regulation of, 104-05 , 134- 35, 

146- 48.150- 51. 164.172- 73. 

174- 76 

Meios, 101 

Memphis yellow fever epidemic, 16 

Merrill. 101, 102 

Miller, Maj. Reuben D., 70 

Mississippi, floods in, 14, 16,68 - 71 

Mississippi Valley, earthquake, 12 

Missouri 

earthquake, 12 

River Valley flood, 16 

Mitchell, Lt. Col. Eugene , 130 

Moore, Col. Prentice L., 131 

Moseley, Maj. Gen. George Vanhorn, 122 

Mosquitoes, 27, 41 - 44 

Natural disasters, vs. man-made, 3 

Near East relief, 83 

New Hampshire. 12 

New Madrid, 12 

New York, fire, 13 

Newspaper coverage of disasters. 53 

Nixon. Patricia, 166 

Nixon, Richard M., 143 

Nonnoyle, Maj. James E., 69, 73 

}87 

Office of Defense and Civilian Mobilization. 

134 

Office of Emergency Preparedness, 143 

Ohio River Valley flood . 16 

Organizalional reform, 26-32 

Painter, Lt. Col. John H .• 155 -56 

Pasteur, Louis, 23 

Payne, John Barton, 106. 107 

Perry, Dr. Wallace I., 59 

Pershing, Gen. John J. , 85 

Philippine Commission. 25, 36, 39 

Philippines, 25. 31-32, 51 

Platt Amendment, 45 

Poland, typhus in, 83- 94 

Polish Typhus Relief Mission, 85 

Porter, Joseph Y . . 20 

Portsmouth, New Hampshire, 12 

President, U.S. See Coolidge, Calvin; Nixon, 

Richard; Roosevelt, Franklin; Roosevelt .. 

Th~odore; Taft, William Howard; 

Truman, Harry S.; Wilson, Woodrow. 

Presidential commission. in medical operations, 

24 

Prevention of disasters, 3 

Public Health Service, 20, 53, 99, 105, 112, 

132. 135. 136 

Puerto Rico. 25, 26. 33, 48 

Pumphrey. Capt. Fred, 86 

Red Cross. 53. 84. 105. 106. 107. 112- 13. 

114- 16. 118-19. 121.123. 133. 135. 

136. 143 

Reed. Maj. Walter. 22, 25, 52, 174 

Register, Lt. Col. Edward C., 92 

Relief 

bureaucracy, federal, creation of. 131-35 

missions, medical , of the '50s and '60s, 

135 - 42 

operations (additional) and fonnal recogn ition of the mission, 66-79 

and reevaluation in the '30s, 115-21 

roles (new), 121 - 26 

system, establishing, and the activism of 

the early '60s, 150- 64 
188 

Rhea, John, 10 

Rhoades, Maj. Thomas L .• 15- 76 

Rogers, Gaston W .• 120 

Roosevelt, Franklin. 121 

Roosevelt, Theodore. 45, 49. 60 

Rosenberg. Dr. Martin. 58 

Ross, Sir Ronald, 41 

Rucker, William C .• 52 

Rush, Dr. Benjamin, 6 

Russia, famine in, 94-98 

Russian invasion of Poland, interference in 

typhus program, 92 

Rutherford, Capt. Henry H., 56, 59, 60 

St. Martin, Alexis, 21 

San Francisco earthquake, 52-66 

Sanitary refonn, 26- 32 

Santa Rosa Hospital, 48 

Santos. LI. Col. George C., 161 

Schmitz, Mayor E. E., 55, 58, 61 

Scou, Alexander, 10 

Secretary of War. Su Baker, Newton D.; 

Davis. Dwight F.; Garrison, Lindley 

M.; Slimson, Henry L.; Woodring. 

Harry H. 

Sheetz. Brig. Gen. Josef. 129 

Shreveport yellow fever epidemic, 16 

Slavery, 13 

Smallpox. 9, 26, 83 

in Cuba and Puerto Rico, 32-33 

in Ethiopia, 157 

vaccination, 33-36 

Snidow, 1st Lt. Robert C., 91 

Snively. Col. Hany H., 85 

Society of Friends, 84 

Somalia, flood, 155-57 

Somme, 103 

Spanish~American War, 5, 25 

Special Action Force Asia, 167 

Sternberg, Surgeon General George M., 41 

Stimson, Henry L., 68 

Surplus Property Law, 132 

Sulton, Lt. Col. George, 168 

Taal Mountain volcano. 51 

Taft, William Howard, 64, 68 

Taylor, George, 20 

THE DEMANDS OF HUMANITY 

Tennessee 

Memphis yellow fever epidemic, 16 

River, 14 

TelanUs, 23, 106-10 

Texas City, Texas, explosion, 128-31 

Thomas, Capt. Henry D., 46 

Tornadoes, 16,66-68,7 1,12,108-10, 

145 

Tomey, Lt. Col. George H., 56, 58, 59, 

60 

Training and Doctrine Command. 142 

Trinder. 1st Lt. John H., 12 

Truman, Harry S., 134 

Tuberculosis. 23 

Typho;d, 23, 83, 99- 100, 149-50, 161 

Typhus. in Poland, 83-94 

Underwood, Oscar W., 50 

United Nations Relief and Rehabilitation 

Administration, 146 

United States Marine Hospital Service, 16, 20. 

53 

Van Valin, Col. James C., 153 

Venezuela, 9- 10 

Volcanoes, 49- 50, 5 1 

Volunteer disaster assistance, 4 

Vo!unteerism, 17, 19 

Wadhams, Maj. Sanford H., 77 

Wainwright, Johathan M., 129 

Ward, Dr. James, 58 

Water, drinking, 31, 76, 159 

Webster, Daniel, 13 

Wells, Capt. George M., 48- 49 

West Indian islands, 49 

Whilt!esey, General Eliphalet, 14 

Wilson, Woodrow, 71, 80 

Winans, Maj. Gen. Edwin B., 117 

Wood, General Leonard. 27 - 28, 41 

Woodring, Harry H. , 12 1 

Woodruff, LI. Eugene A., 18 

Woods, Cyrus E., 101 

Wooten, Col. Ralph H., 124 

Yellow fever, 6, 16,20.26,32,41- 47 

-0: U.S. GOVERNMENT PRINTING OFFICE: 2000 0-458--670 



PIN: 052511-000