History

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 15 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.

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.¹

Unlike operations in Puerto Rico, the Army`s next foreign disaster assistance mission did not occur in the context of military government. In May 1902the 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 of food developed. As terrible as the destruction was, however, it did not approach that on Martinique, where the eruption of Mount Pelée nearly obliterated Saint-Pierre, 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 consulat St. 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

¹RSW, 1900, vol, 1, part 13, Report of the Military Governor of Porto Rico, pp. 211-17, 270; RSG, 1900, pp. 188-89.
²Henry Neil (Marshall Everett), The Complete Story of the Martinique Horror and Other Great Disasters (Chicago: L.G. Stahl, 1902);Charles Morris, The Volcano`s Deadly Work (Philadelphia: W.E. Scull,1902), Angelo Heilprin, Mount Pelée and the Tragedy of Martinique(Philadelphia J.B. Lippincott, 1903).
³Quote from Morris, Volcano`s Deadly Work, p. 124. Neil(Everett), Story of Martinique, p. 118.

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, Constitution-bound 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

⁴Quote from Congressional Record, 57thCong., 1st sess., 1902, p. 5332. See also Morris, Volcano`s Deadly Work, p. 146; Neil (Everett), Story of Martinique, p. 118.
⁵Jarnes Martin Miller, The Martinique Horror and St. Vincent Calamity (Philadelphia National Publ., 1902), pp. 32, 53, 56, 149,330-31, New York Times, 3 Jun 02; U.S, Department of State, Papers Relating to the Foreign Relations of the United States, 1902, pp. 414-16.Telg, Buchanan to AG war, 15 May 02; Ltr, Sternberg to AG, 12 May 02, both in file 434288, Record Group 94, NA, George Kennan, The Tragedy of Pelée: A Narrative of Personal Experience and Observation in Martinique (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, file 90029, Record Group 112, NA.
⁶Congressional Record, 71st Cong., 3rd sess., 1930, pp.757-58; Curti, American Philanthropy, pp. 219-20; Ernest P. Bicknell, Pioneering with the Red Cross (New York: Macmillan Co., 1935), pp.196-97; Francis A. Coghlan, "The United States Navy and the Jamaica Earthquake," Prologue 8 (1976): 163-73.

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 anti plague 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 Colón, 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.

⁷Based primarily upon Johnson, "Life in the Army," pp. 144-47, in Johnson Papers, MHI. See also 1911 Returns from Camp McGrath, Returns from United States Military Posts, 1800-1916,M617, reel 673, NA. Miquel S. Maso, The Eruption of Taal Volcano, January 30, 1911 (Manila: Bureau of Printing, 1911); Bicknell, Pioneering, p. 193.
⁸On 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 in Porto Rico (Washington GPO, 1913), Creel`s account does not mention Kean`s aid. On Colón, see RSW, 1915, 1: 153, file 2283865,Record Group 94, NA; New York Times, 2 May 15.

Changes in the Domestic Scene and the San Francisco Earthquake

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 any one 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."¹⁰

In addition, profound changes had altered the nation`s institutional

⁹Lee, "Address," passim. Quote from William C. Rucker, "The Relation of the Military and Naval Forces of the United States to public Health," Military Surgeon 23(1908): 335. Leslie L. Lumsden, Sanitation of Flood-Stricken Towns and Cities with Special Reference to Conditions Observed in River Towns and Cities of Kentucky (Washington: GPO, 1913), p. 1197; Edward T. Devine, The Principles of Relief (New York: Arno Press and New York, Times,1971; orig. publ. 1904), p. 51. My argument here resembles that made by Howard Gillette, Jr, in a slightly different context. See his, "The Military Occupation of Cuba, 1899-1901 Workshop for American Progressivism, "American Quarterly 25 (1973): 410-25.
¹⁰Quoted in Paul Lester, The Great Galveston Disaster(Galveston: J. Singer Book Co., 1900), p. 115.

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.¹¹

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 nations 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

¹¹Wiebe, Search for Order; Thomas L Haskell, The Emergence of Professional Social Science: The American Social Science Association and the Nineteenth-Century Crisis of Authority(Urbana: University of Illinois Press, 1977); Neil Harris, "The Culture of Catastrophe in Nineteenth-Century America," paper delivered at the University of North Carolina at Chapel Hill, 20 Oct 75.
¹²Quote from Devine, Principles of Relief, pp. 4-5, Robert H. Bremner, "`Scientific Philanthropy,` 1873-1893," Social Security Review 30 (1956): 168-73; Trattner, Poor Law to Welfare State, pp. 44-115; Roy Lubove, The Professional Altruist: The Emergence of Social Work as a Career, 1880-1930 (Cambridge: Harvard University Press, 1965).

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

¹³On the limitations of the Marine Hospital Service, see Congressional Record, 55th Cong., 1st sess., 1897,pp. 601, 639. And for their existence, after it became the Public Health Service, see William R. Noyes, "Influenza Epidemic, 1918-1919: A Misplaced Chapter in, United States Social and Institutional History" (Ph.D. diss., University of California at Los Angeles, 1968), pp. 195-202. This interpretation of Red Cross development relies on Ellen L. Henle, "Against the Fearful Odds: Clara Barton and American Philanthropy" (Ph.D. diss., Case Western Reserve University, 1977), pp. 75-86, 94-108; Dulles, American Red Cross, pp. 63-80. On Red Cross disaster activity, see Congressional Record, 58th Cong., 3d sess., 1904, pp. 404-6; Bicknell, Pioneering, pp. 12, 94-95; Elliot, Red Cross Disaster Services, passim. Figures on Red Cross activities by time period can be found in Thomas H. Reynolds ,"American Red Cross Disaster Services, 1930-1947" (Ph.D. diss., Columbia University, 1954), p. 248.

homeless. A total 498 people died and another 415 were seriously injured.¹⁴

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 mobilize 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 federal 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 federal 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 be 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

¹⁴Figures from Russell Sage Foundation, San Francisco Relief Survey (New York: Survey Associates, 1913), pp. 4-5.For the story of the quake with emphasis on human interest stories, see John C Kennedy, The Great Earthquake and Fire: San Francisco, 1906(New York: William Morrow & Co., 1963), or the, less reliable (and bitterly anti-Army) Gordon Thomas and M. Morgan Witts, The San Francisco Earthquake (New York: Swin and Day, 1971).
¹⁵Adolphus W, Greely, Earthquake in California, April 18,1906: Special Report of Maj. Gen. Adolphus W, Greely. U.S.A. Commanding the Pacific Division, on the Relief Operations Conducted by the Military Authorities of the United States at San Francisco and Other Points with Accompanying Documents (Washington: GPO, 1906), pp. 5-6.
¹⁶On the Army`s taking charge, see Thomas and Witts, Earthquake, pp. 25-28, 49-50 102-3; 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 San Francisco Disaster and Mount Vesuvius Horror (Chicago: C.E. Thomas, 1906), pp. 74-75. In addition to sources already cited, on other types of aid see Johnson. "Emergency Response."4: 11-25; Carroll A. Devol, "The Army in the San Francisco Disaster. "Journal of the United States Infantry Association 4 (1907): 59-87.

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 . Torney, 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 powerplant, 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 tender what assistance they could and to inform, the authorities that Letterman would admit civilian casualties.¹⁸

¹⁷Quote from Henry H, Rutherford "Experiences of an Army Medical Officer during the San Francisco Earthquake," Military Surgeon 79 (1936): 208-10.
¹⁸Greely, Report, p. 31 George H. Torney, "Report to The Surgeon General, 16 Aug 06," file 115045, Record Group 112, NA. The exact sequence of events in neither Rutherford`s nor Torney`s account is clear.

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 burns, 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 able bodied 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

¹⁹Banks and Read, History, p. 76; Rutherford, "Experiences," p. 211; Endorsement to Ltr from E.F. Euphet, 4May 06, in Letterman General Hospital, Register of Letters Received, entry359, Record Group 112, WNRC; Letterman 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.
²⁰Quotes from Rutherford, "Experiences," p. 211. Greely, Report, pp. 31-32; Torney, "Report," p. 6.

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.²¹

In Washington, The Surgeon General acted to support the relief operation with additional supplies arid 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 saturation 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 Torney 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, San Francisco`s Great Disaster(Philadelphia: P.W. Zeigler Co., 1906), pp.162, 177; Ernest P, Bicknell, "In the thick of Relief Work at San Francisco," Charities16 (1906): 295-299; U.S. Congress, House, Relief for San Francisco, H. Doc. 714, 59th Cong., 1st sess., 1906, pp. 28-29, 32-33.
²²U.S. Congress, House, Relief for San Francisco, H.Doc. 714, 59thCong., 1st sess., 1906 pp. 6-7, 28-29; Torney, "Report," p. 20; George H. Kress, "United States Army Field Hospital in San Francisco in 1906, an Interesting Letter with Some Excerpts from the May,1906, Issue of the California State Journal of Medicine," California and Western Medicine 53 (1940): 215-17.

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 Army surgeons, including Letterman`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 Presidio. "A motley, disheveled, grimy group," they gathered beneath a tent tore hash the day and anticipate the morrow. They talked amid a cacophony of noises- chatting refugees, crying babies, groaning patients. An enterprising cadet from the University of California arrived with "quarts of shasta, hunks of

²³Greely, Report, pp. 31-32; Torney, "Report," pp. 8-11, Marie Louise Rodriquez, The Earthquake of 1906 (San Francisco: privately published, 195l), pp. 6-7.
²⁴Torney, "Report," p. 12; Ltr., Marshall to CO of Presidio, 4 Jun 06, Letterman General Hospital, Letters Sent, Dental Surgeon, entry 357, Record Group 112, WNRC; Rodriquez, Earthquake, pp. 7,12; Russell Sage Foundation, Survey, p. 78.

cheese and pretzels" 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 20thhe 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 21st, the Army established a temporary medical depot on the Presidio grounds. It operated for seven days, after which the Army opened a larger supply center east of the hospital reservation.²⁶

Despite all Torney`s activity, on the 21st 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

²⁵Quotes from Rutherford, "Experiences," pp. 213-14.
²⁶William E. Carll, "The Oregon National Guard at the San Francisco Earthquake Disaster," Journal of the Association of Military Surgeons 19 (1906): 460-63; Greely, Report, pp. 32, 131-32;Rodriquez, Earthquake, p. 9.
²⁷Greely, Report, pp. 9, 13, 39-40; Kennedy, Earthquake, p. 11; Russell Sage Foundation, Survey, p. 208; Elting E. Morison, ed., The Letters 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.

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, Torney 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 Torney. 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. René Bine, a local physician who

²⁸Kennedy, Earthquake, pp. 212, 223-24;Congressional Record, 81st Cong., 2d sess., 1950, p. 11900.
²⁹Quote from Telg, Greely to Mil Sec, 11 May 06, file 1121191,Record Group 94, NA.
³⁰Torney, "Report," p. 18; Greely, Report, pp. 58-59; Rodriquez, Earthquake, pp. 15-17; Russell Sage Foundation, Survey, p.90.

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. Bin 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.³¹

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 setup 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 10 a day. Not until20 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-burns, 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 hospitalization 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

³¹Rodriquez, Earthquake, pp. 13-21.
³²Greely, Report, p. 31; Kress, "Field Hospital," pp. 215-17; Letterman General Hospital Register, entry 372, Record Group112, WNRC.

50,000 people. Greely announced that beginning 13 May, the Army 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 ill 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 Torney`s health committee and made him Evan`s chief surgeon with staff responsibility for health affairs. Torney in turn 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 Army 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 ofbusiness.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

³³Greely, Report, pp. 32-37, 72-74.On 23 May, Lt Col Charles L. Heizmann replaced Torney.
³⁴Charles Keeler, San Francisco through Earthquake and Fire(San Francisco: Paul Elder & Co., 1906), p. 49; Greely, Report, pp. 33-34, 133-34.

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 15June, 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 undercharge of a surgeon of the Army as to sanitary arrangements." Onlydeft 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

³⁵On clinics, see Greely, Report, pp.32, 131-32; Russell Sage Foundation, Survey, p. 93.
³⁶First quote from Telg, Greely to Taft, 15 Jan 06. Second from Telg, Greely to Secretary of War, 15 Jun 06. Telg, E.E. Schmitz to Taft,14 Jun 06. All in file 1121191, Record Group 94 NA.
³⁷Quote from Keeler, San Francisco, p. 49. Russell Sage Foundation, Survey, p. 7; Greely, Report, pp. 33, 36, 41.

soldiers` was the cry of the people of San Francisco during the days following the disaster, and it was echoed the country over," effuse done 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 civil-military 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 air 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. 106-7, quote on p. 74. Second from "The Army at San Francisco, "Church man 93 (1906): 638. Third from Robert 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, How the Army Worked to Save San Francisco (San Francisco: Calkins Newspaper syndicate, 1906), especially p. 13. For other critics, see Kennedy, Earthquake, pp. 136-37.

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 Francisco.⁴⁰

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.⁴¹

As it had not in the nineteenth century, however, the Army now considered also sending medical relief. On 1 May The Adjutant General sent a memorandum to the Chief of Staff volunteering the services of ten medical officers arid 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 evacuated75 percent of the injured by special train. Two Navy surgeons who had arrived shortly after the tornado and had assisted in the evacuation

⁴⁰For mention of the movie, see Sylvester Q. Breard, "A History of the Motion Pictures in New Orleans, 1896-1908,"(M.A. thesis, Louisiana State University, 1951), pp. 200-1, 220-21.
⁴¹See Incl to Ltr, H.P. McCain to James Hay, 11 Jan 15, file1459754, Record Group 94, NA; Ltrs in file 1372113, Record Group 94, NA.
⁴²Memo for Adjutant General by Chief of Staff, 1 May 08, Memo for Acting secretary of War by Chief of Staff, 1 May 08; Ltrs from inspectors. All in file 1372113, Record Group 94, NA.

then established relief hospitals in Hattiesburg to care for the evacuees.⁴³

After Congress appropriated relief funds, the Army assumed responsibility. Maj. Caroll 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; Rpt of W.P. Chamberlain, 7 May 08; Rpt of Bailey K. Ashford,1 Jun 08; and other ltrs and telgs. All in file 1372113, Record Group 94,NA.

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- one 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 nearly800 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.⁴⁵

44Ernest P. Bicknell, Mississippi River Flood of 1912(Washington American Red Cross, n.d.), p. 3.
45Quote from Ltr, W.H. Taft to H.L. Stimson, 4 Apr 12, file 1897542, Record Group 94, NA. RSW, 1912, 1:14.

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 representatives.⁴⁶

In all of the camps, National Guard physicians, Red Cross doctors, state health department personnel, or private practitioners furnished healthcare. 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 Quartermaster General, 8 Apr 12, file 1897542, Record Group 94, NA; James E. Normoyle, Flood Sufferers in the Mississippi and Ohio Valleys, Report of James E. Normoyle in Charge of Relief Operations, April, May, June, July, 1912(Washington: GPO, 1913); "Flood sufferers of the Mississippi River,1912," entry 31 C, Record Group 192, WNRC; Bicknell, Pioneering, p. 164.

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.⁴⁸

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.

⁴⁷On 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.
⁴⁸On Kean`s mission, see Ltr, Harry L Stimson to Jefferson R. Kean, 3 Mar 12, Kean Papers, UVA; Bicknell, Flood of 1912, p. 11.

Miller blamed the failings on local officials who expected sanitary precautions to continue without supervision. The overall success of the effort be 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 Army 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 of1912 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 another68, 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 party 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 Sunday Register, 23 Mar 13;Logan Marshall, The True Story of Our National Calamity of Flood, Fire, and Tornado (Philadelphia: George F. Lasher, 1913), p. 243; Telg, C.C. Hare to President, 21 Mar 13; Ltr, J.P. Famety to L.M. Garrison, 21 Mar13; Telg, Garrison to CO, Fort Oglethorpe, Ga., 21 Mar 13; Telg, Morganto AG, 21 Mar, 13. All in file 2020998, Record Group 94, NA.

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 of 23 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 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."⁵¹

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

⁵⁰Telgs, Harmon to AG, 24 and 25 Mar 13; Ltr, Capt W.R. Doores to AG, 2 Apr 13; Memo for AG by Chief of Staff, 26Mar13; Memo for Secretary of War by Surgeon General, 24 Mar 13. All in file2020988, Record Group 94, NA. Mobile Register, 25 and 26 Mar 13.
⁵¹Quote from Miles Greenleaf and Carl G. Eddy, The Omaha Tornado: Omaha, Nebraska, Easter Sunday, March 23, 1913 (Omaha JohnL Gideon., 1913), no pagination. Marshall, True Story, pp. 212-13;Thomas H. Russell, Swept by Mighty Waters (Chicago: Laird &Lee, 1913), p. 280 Victor Rosewater, "Repairing a Tornado`s Havoc," Review of Reviews 47 (1913): 706.

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, among 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 in1912, 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 1912.⁵⁴

When he first took charge, Normoyle requested the services of his former assistants Miller and Coffin, but the War Department had already orderedother medical officers to the scene. Governor Cox`s original request for aid included medical supplies, and the department sent him more than heasked 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 St. 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

⁵²Quote from Incl to Ltr, H.P. McCain to JamesHay, 11 Jan 15, file 1459754, Record Group NA, Greenleaf and Eddy, Omaha Tornado; Russell, Mighty Waters.
⁵³New York Times, 27 Mar 13.
⁵⁴For an overview of the operation, see RSW, 1913, pp. 213-15.

corpsmen left Washington with medicine and equipment, and another load of medical supplies was sent from New York.⁵⁵

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

⁵⁵New York Times, 27 and 28 Mar 13;Telg, Normoyle to Chief of Staff, 26 Mar 13; Ltr Surgeon General to Adjutant General, 26 Mar 13; Memo for Adjutant General by Chief of Staff, 26 Mar13. All in file 2022074, Record Group 94, NA.
⁵⁶Ltr, 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; Ltr, John W. Keegair to George A. Dodd, 12 Apr 13. All in file 2022074, Record Group94, NA, RSG, pp. 174-75.
⁵⁷Telg, Normoyle to Wood, 30 Mar 13. Quote from Telg, Normoyle to Chief of Staff, 6 Apr 13. Both in file 2022074, Record Group 94, NA.

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 a tnoon 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 31st, Rhoads had assembled a large labor force and several hundred teams to remove dirt and debris from homes,

⁵⁸Telg, Normoyle to Wood, 11 Apr 13; Telg, Bankhead to Chief of Staff, 27 Apr 13. Both in file 2022074, Record Group94, NA. RSG, 1913, pp. 174-75.
⁵⁹Allen W. Eckert, A Time of Terror: The Great Dayton Flood(Boston: Little Brown & Co., 1965), pp. 56-63; Guy L. Irwin, Tragic Story of the Great Flood (Chicago: Hamming Publ. Co., 1913) p. 25;Henry Neil [Marshall Everett], Tragic Story of America`s Greatest Disaster(Chicago: J.S. Ziegler Co., 1913), pp. 150-53; Marshall, True Story, p. 77; Frederick E. Drinker, Horrors of Tornado, Flood, and Fire(Philadelphia: National Publ. Co., 1913), p. 94.
⁶⁰Account of work in Dayton based on RSG, 1913, pp. 174-76;Marshall, True Story, pp. 92-93; and Rpts by Thomas Rhoads dated 29, 31Mar, 2, 11, 22 Apr 13. All in file 2022074, Record Group 94, NA. See also Thomas L. Rhoads to Secretary of War, Rpt of Chief Sanitary Officer on the Work of the Sanitary Department at Dayton, Ohio, and Vicinity, 29 Marto 25 Apr 13, file 88925, Records of the Office of the Chief of Engineers, Record Group 77, NA.

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 orlarge military staff Torney 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

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 be 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 1917 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 Sophia and J. Black, "Prophylactic Vaccination against Epidemic Meningitis, "Journal of the American Medical Association 59 (1912): 527-32; Wesley W. Spink, Infectious Diseases: Prevention and Treatment in the Nineteenth and Twentieth Centuries (Minneapolis: University of Minnesota Press,1978), pp. 291-92. On the end of the mission, see RSG 1913, pp. 174-75;Telg, Bankhead to Chief of Staff, 27 Apr 13, file 2022074, Record Group94, NA.

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 able bodied 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 Group407, NA. All quotes below are from the regulation. For the drafting of the regulation, see Johnson, "Emergency Response," 6:27-32.

support- a pattern that would continue in future years. Nonetheless, medical personnel had rendered considerable civilian assistance between1898 and 1917, aid that ranged from near total control in San Francisco to limited support and advice during the floods of 1912 and 1913. With little mention in the regulations and such varied precedents, the Army`s medical role in domestic disaster assistance still remained to be fully defined.