History

CHAPTER 6

Relief Role in Transition: Assistance at Home and Abroad, 1918-1939

Though World War I had generated a need for unusual relief missions 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 troop ships 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.¹

After the war, Army Medical Department personnel resumed their role in relief operations. Following a June 1921 flood in Pueblo, Colorado,11 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-bedhospital 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

¹Alfred W. Crosby, Jr. Epidemic and Peace,1918 (Westport, Conn.: Greenwood Press, 1976), p. 206 and passim; Dorothy A. Pettit, "A Cruel Wind: America Experiences Pandemic Influenza,1918-1920: A Social History" (Ph.D. diss., University of New Hampshire,1976), pp. 121-22 and passim; Noyes, "Influenza Epidemic," pp.195-202 and passim, See also Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919 (New York: Atheneum, 1974).

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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 inter war years did occur abroad. From 1 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. Report`s told of 2 million people homeless, 100,000 seriously injured, and upwards of 200,000 dead.³Under 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 a typically 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 front 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, Frank R. 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 thequake.⁵

²On Pueblo, see Johnson, "Emergency Response,"7: 1-10; Memo for Assistant Chief of Staff by Kenzie Walker, 22 May 22,box 929, 400.38, Record Group 407, NA; "Army Notes," Army and Navy Journal 58(1921): 1124; "Army Medical Department Aids Flood Sufferers, Army and Navy Journal 58(1921): 1179. On Jacobstown, see S. Jay Turnbull, "Report on an Outbreak of Typhoid Fever at Jacobstown, N.J., August, 1921," Military Surgeon 50 (1922): 306-9.
³Mark J. McNeal, "Destruction of Tokyo," Catholic World 118 (1924) 315-16; Curti, American Philanthropy, p. 339.For a comprehensive account of the quake and its aftermath, see Bureau of Social Affairs, The Great Earthquake of 1923 in Japan (Japan: Bureau of Social Affairs, Home Office, 1926).
⁴Rpt of Lt Col Charles Burnett, bulky package, 400.38, Record Group 407, NA; "Destroyer Division No. 38 Makes Record Cruise, "Army, and Navy Journal 62 (1925): 1; Bureau of Social Affairs, Great Earthquake, p. 411, U.S. Department of State, Papers Relating to the Foreign Affairs of the United States, 1923, 2: 470.
⁵On motivations and private relief, see, Curti, American Philanthropy, pp. 339-43. On government aid, see Memos for AG by S. Heintzeman, 2 and 4 Sep 23; Telg, Read to AG, 5 Sep 23; Telg Secretary of War to Secretary of State, 6 Sep 23. All in box 929, 400.38, Record Group 407, NA. McCoy`s Narrative, bulky package, 400.39, Record Group 407,NA.

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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 didn`t depart until the 10th. In San Francisco, meanwhile, laborers rapidly loaded the U.S.S. Somme with hospitals, camp 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 41 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 1918-1920and by what the Japanese perceived as a slight to their national stature at the Washington Naval Conference of 1921. 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.⁷

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

⁶On activities in Philippines, see Memo for AG by Chas. C. Aalcutt, 6 Sep 23; Telg, Bundy to AG, 6 Sep 23. Both inbox 929,400.38, Record Group 407, NA. E.L. Munson, "Report on the Medical and Hospital Service of the Japan Relief Mission," Monthy Bulletin of the Philippine Health Service 4 (1924): 52. On loading in San Francisco, see Rpt of Maj G.R. McBrayor, bulky package, 400.38,Record Group 407, NA. Telgs, Morton to AG, 8 and 11 Sep 23; Memo for AG by R.U. Patterson, 15 Sep 23. All in box 929, 400.38, Record Group 407,NA.
⁷Quote from U.S. Department of State, Papers Relating to the Foreign Relations of the United States, 1923, 2:469.

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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 turn 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 at the 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

⁸Cable, AG to McCoy, 6 Sep 23; Telg, Davis to McCoy, 9 Sep 23. Both in box 929, 400.38, Record Group 407, NA. McCoy`s Narrative, bulky package, 400.38, Record Group 407, NA.
⁹Quote from Cable, McCoy to AG, 22 Sep 23, box 929, 400.38,Record Group 407, NA. McCoy`s Rpt; McCoy`s Narrative, Both in bulky package,400.38. Record Group 407, NA.
¹⁰Quote from Munson, "Report on Hospital Service." pp. 55-56.

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pitched, and on the same day the Americans turned the completed hospital over to the Japanese.¹¹

Then the relief force boarded the Somme for transfer to Tokyo, where, it continued to tender 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 1,000-bed facility on a "beautiful in closed 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 tent age 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 Bei-Hi, all but a small group of McCoy`s relief force departed. The commanders stayed for two days of sight-seeing 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

¹¹McCoy`s Narrative, bulky package, 4W.38,Record Group 407. NA, Munson, "Report on Hospital Service," pp.55-57; clipping from Nichi-Nichi (a Tokyo newspaper). 30 Sep 23,filed with Dr. McCoy to AG, 29 Oct 23, box 929, 400.38, Record Group 407.
¹²Munson, "Report on Hospital Service," pp. 57-60.

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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 Regulation67 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 tender 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,

¹³Ltr, McCoy to AG, 15 Oct 23; Cable, AG to Burnett, 20 Nov 23. Quote from Read`s Rpt. D.W. Hand`s Rpt; Note from State Department, 22 Jan 24. All in box 929, 400.38, Record Group 407, NA.

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the regulation introduced no alterations in medical relief policy.¹⁴

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 turn 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 World War II, the mid-twenties 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

¹⁴Copies of AR 500-60 and drafts of it are filed in bulky package, 400.38, Record Group 407, NA. On venereal disease in 1927 floods, see Pete Daniel, Deep`n As It Comes; The 1927 Mississippi River Flood (New York: Oxford University Press, 1977), pp. 118-23.
¹⁵On 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 are incomplete. On the, Red Cross`s attitude, see Bicknell, Pioneering, pp. 1-10, 216-18; Mabel T. Boardman, Under the Red Cross Flag at Home and Abroad (Philadelphia J.B. Lippincott,1915), pp. 156-68.For statistics on activity, see Reynolds, "Disaster Service," p. 248.

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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 finally 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 unsatisfactorymethod.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,

¹⁶On early mission, see U.S., Statutes at Large, 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., Statutes at Large,42: 963, ch. 297. Quote from Memo for the Budget Officer for the War Department,7 Apr 25, box 929, 400.38, Record Group 407, NA.
¹⁷Ltr, Secretary of War to the Speaker of the House, 22 May25, box 929, 400.38, Record Group 407, NA; U.S. Statutes at Large 44:1065, ch. 89.
¹⁸Ltr, John B. Payne to Dwight F. Davis, 17 Dec 25, box 191,080Red Cross, Record Group, 407, NA.

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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 Anny 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,

¹⁹Quotes from Memo for Chief of Staff by Fox Conner, 29 Dec 25, box 191, 080 Red Cross, Record Group 407, NA. Ltr, Secretary of War to L.B. Payne, 31 Dec 25, box 191, 080 Red Cross, Record Group 407,NA.
²⁰Copy of Telg, John M. Spence to Senator Harris, 23 Jan 25;Memo for Chief of Staff by Assistant Chief of Staff, 27 Jan 25, Both inbox 929, 400.38, Record Group 407, NA.

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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.²¹

Two years after operations in Newton, the Army undertook another 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 contractsf or air ambulances. Under them the Army received a Douglas C-1 and two Cox-Klemin XA-1`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-4observation planes, two Douglas transports, and, later in the day, the Cox-Klem in 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 General 4th Corps, Area to AG, 24 Jan 25; Ltr, E. T. Conley to AG, 10 Mar 25, Ltr, 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, Development of Aeromedical Evacuation in the USAF, 1909-1960, USAF Historical Studies No. 23 (Air University: USAF Historical Division, 1960), pp. 4-21; Memo for Maj Rush B. Lincoln by Delos C. Emmons, 10 Jan 28, box 2416, 400.38, Record Group 407, NA.

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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 andthen, 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 requiringsophisticated hospital treatment that they could not provide in the warehouse. The doctors decided to evacuate such patients in the Cox-Klemin. Shortlyafter it arrived that afternoon, its pilot began a series of flights to and from San Antonio. On the first flight the ambulance plane took onlyone patient, but after a ground crew cleared a landing field, on later flights it carried two patients and a medical attendant. Late in the afternoonseveral people unexpectedly ran across the runway as the plane taxied for takeoff; the, pilot swerved to avoid killing them arid crashed the planeinto 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`sfor transport to San Antonio, and the pilot repaired the Cox-Klem in "using cat-gut, a surgical needle, sheets, some tacks, a splint or two, adhesiveand flour-paste." Minus a tail skid but with another seriously injured patient on board, the Cox-Klemin took off for the day`s

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final flight to San Antonio.²³

Within twenty-four hours after the storm., the Army had treated theslightly ill, evacuated the seriously injured, and inoculated the populationagainst tetanus. Their work done, the surgeons and corpsmen left suppliesfor civilians to complete the work, and returned. to their stations. Theairplanes, especially the Cox-Klemin, had greatly increased the speed ofthe operation and ensured victims the best possible care. But the Rockspringsoperations remained for many years an isolated example of the utility ofair ambulances in domestic disasters, followed up only once during thefloods of 1927 when a sergeant who had flown in Rocksprings evacuated aseriously ill fifteen-year-old girl in his observation plane. After thecrash of both Cox-Klemins in 1929, the Army built no more of them, replacingthem with two Fokker air ambulances that had more space for patients butlacked their predecessors` sturdy versatility. In the thirties the Armyconcentrated on the development of a large transport ambulance rather thansmall rescue craft more adaptable to disaster service. Not until the developmentof helicopter ambulances after World War II did Army medical aviation cometo 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 important to the evolution of its relief role. In April 1927, one of the worst floods 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 of Tornado Victims at Rocksprings, Texas," Military Surgeon61 (1927): 99-101, quote on p. 100 "The Airplane Ambulances of the U.S. Army Air Corps," Red Cross Courier 8(Feb29): 6; "Army Lauded for Tornado Aid," Army and Navy Journal 64 (1927): 868.
²⁴"Airplane Ambulances of the Army," p. 6; Futrell, Development, pp. 20-27.

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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 University, 1908), quote on p. 105and 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`n As It Comes.

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and corps area commanders, filled orders as well. In all, the Army loaned more, than $2.6 million in materiel- tents, blankets, cots, mess gear, and the like- to the relief effort.²⁶

In most of the operations in which the Army had functioned mainly as a supply agent, its Medical Department had not played an active role. During the 1927 flood, the absence of Army medical participation was a clearly enunciated policy. On 28 April representatives from the Army Medical Department, the Public Health Service, the American Medical Association, state medical associations, and the Red Cross met in Memphis to plan for the medical and sanitary aspects of relief operations. Following Hoover`s suggestions, the assembly established procedures for local groups to request medical assistance and espoused several general policies. The group, as one participant reported, "put the responsibility for the protection of the health of the refugees and the sanitation of the camps and flooded areas where it belonged, on the state boards of health, and offered to the state boards of health the resources of the American Red Cross, and through the Red Cross the resources of the U.S. Public Health Service and the trained personnel of other states, who volunteered to help in the emergency." That policy all but eliminated a relief role for Army physicians. Only in Arkansas, a state with a traditionally weak health service, did Regular Army medical officers participate in flood relief. In late April and early May, four of them went to Arkansas and made sanitary surveys, tendered first aid, directed sanitation in camps, inoculated refugees, and furnished many supplies.²⁷

Hoover`s system was intended to dispense medical and other relief supplies with a minimum of confusion and conflict, but many soldiers believed it promoted chaos. One corps area commander claimed he had lost control of Army property and accused the Red Cross of being impossible to work with. He attributed much of his frustration to Hoover: when the powerful head of another department of Government gets into the game, and especially when that head is apparently the Supreme High Cockolorum [sic] of the administration in flood matters, I am forced to admit that the fellow who had the bear by the tail has nothing on me."

²⁶On charges of peonage and other mistreatment of blacks, see Daniel, Deep`n As it Comes, or perhaps the better account in his earlier The Shadow of Slavery: Peonage in the. South, 1901-1969(New York: Oxford University Press, 1972), pp. 149-69. On Army distribution of supplies, see Memo for Lt Col R.L. Collins by T.J. Flynn, 25 Apr 27,box 2418, 400.38, Record Group 407, NA; Financial Report of the Floods of 1927, box 2410, 400.38, Record Group 407, NA.
²⁷Quote from J.H., O`Neill, "Relief Measures during and following the Mississippi Valley Flood," American Journal of Public Health 18 (1928): 156-57. Rad, Craig to AG, 30 Apt 27, box 2418, 400.38,Record Group 407, NA. On work in Arkansas, see Ltr, John E. Marineau to 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 2418, 400.38, Record Group 407, NA.

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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 "beheld 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 $13million 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 next turned to the congressional leadership. Late in 1927 after extensive debate, Congress approved a supplemental appropriation of $2million 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 Ltr, Malin Craig to Braint H. Wells, 25 May 27. Second quote from Ltr, R.M. Howell to Malin Craig,23 May 27. Both in box 2418, 400.38, Record Group 407, NA.
²⁹Ltr, 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.
³⁰Ltr, Dwight F. Davis to John B. Payne, 30 Dec 27; Ltr, Payne to Davis, 26 Jan 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, 4)(YU, Record Group 407, NA, Lohof, "Hoover and the 1927 Flood," pp. 183-85; "Steps Taken by the Federal Government for Mississippi Flood Relief," Congressional Digest7 (1928): 41.

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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 of the next year the Army shipped supplies to Cumaná, 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 1931earthquake 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

³¹On Foster, see General Brown`s Report on Flood Conditions, box 2417, 400.38, Record Group 407, NA; "Vermont Flood Relief by the 3rd Cavalry," Cavalry Journal 37 (1928):137-39. On Jones, see Telg, Davis to AG, 19 Sep 28, Miscellaneous Division Correspondence, 1923-35, Army Postal Service to Floods and Cyclones, Record Group 407, NA.
³²On Puerto Rico, see documents in box 2416 and bulky package,400 38, Record Group 407, NA; Ltrs, in Miscellaneous Division Correspondence,1923-35, Army Postal Service to Floods and Cyclones, Record Group 407,NA; RSW, 1929, p. 8; Official Report of Relief Work, in, Porto Rico, the Virgin Islands and Florida (Washington: American Red Cross, 1929),pp. 15, 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; New York Times, 27 Jan 29 and 2 Feb 29. On the Philippines, see RSG, 1930 p. 401; "Typhoon in the Philippines Wrecks Many Villages, "Red Cross Courier 8 (1 Oct 29): 7. On Dominican Republic, see RSG,1931, p. 425, "Santo Domingo Tornado Relief Quick and Generous, "Red Cross Courier 9 (1 Oct 30): 6-7.
³³New York Times, 1 and 3 Apr 31; G.D. Hale and H.R. Boone, "Relief Work in the Managua Earthquake," U.S. Naval Medical Bulletin 30 (1932): 3-5. Rads, Sultan to Chief of Engineers,1 and 2 Apr 31; Ltr, Brigade Commander to MG Command, 16 Apr 31. All inbox 2410, 400.38, Record Group 407, NA.

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Reevaluation and Relief in the Thirties

Although, efforts such as Hawley`s certainly placed little hardship on the Army, the frequent request for military supplies from the Red Cross and other groups did tax military material 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

³⁴On equipment sent to Red Cross, see Value of Government Property Turned Over to the American Red Cross by the, War Department for Relief Purposes, 1925-1930, box 2406, 400.38, Record Group407, NA. Quote from Memo for AG by E.V.D. Murphey, 26 Mar 29, box 2416,400.38, Record Group 407, NA. On Army legislative proposals, see Memo for AG by W.B. Wallace, 1 Jul 29; Ltr, Robert L. Collins to Chief of Finance,20 Mar 29; Ltr, AG to Judge Advocate General, 4 Apr 29, All in box 2416,400.38, Record Group 407, NA. U.S. statutes at Large, 46: 1045, ch. 63;U.S. Congress, Senate, Relief of Sufferers of the Mississippi River Flood of 1927, S. Rpt. 1360, 71st Cong., 3d sess., 1931.
³⁵Ltr, Douglas MacArthur to James K. McClintock, 11 Apr 31,box 2409, 400.38, Record Group 407, NA. On the Army and Hoover`s budget, see John R.M. Wilson, "Herbert Hoover and the Armed Forces: A Study of Presidential Attitudes and Policy," (Ph.D. diss., Northwestern University, 1971), pp. 114-21, 129-33; D. Clayton James, The Years of MacArthur: Volume I, 1880-1941 (Boston Houghton Mifflin Co., 1970),pp. 351-63.

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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 issueda 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 non consumable 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

³⁶On Puerto Rican controversy, see Ltr, Douglas MacArthur to Merton L. Corey, 12 Oct 32, box 2410, 400.38, Record Group407, NA. On aid rendered there, see Ltrs in box 2410, 400.38, Record Group407, NA. Quote from Memo for Chief of Staff by C.C. Humphrey, Jr., 4 Oct32, box 2409, 400.38, Record Group 407, NA. MacArthur`s comment is penciled in.
³⁷Quote from Ltr, TAG to all corps area and department commanders,21 Dec 32, box 2409, 400.38, Record Group 407, NA.

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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 a shore 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 they 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 fanned the expedition, boarded a special train in San Antonio. Difficulties in loading the train delay edits 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 and Navy Journal 62 (1927): 824; "Army Tornado Aid Lauded by Governor, "Army and Navy Journal 62 (1925): 2087; "Peacetime Wars," New York National Guardsman (12 Mar 37), p. 12; Ltr, T. Siminoff to George, H. Dearn, 12 Mar 33, box 1409, 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 Group120, NA); Telg, AG to McCoy, 8 Sep 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 Jun35, 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.

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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 facilities. 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 of local 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 resident,, 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

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Regiment returned to San Antonio, part by train and the rest by motorconvoy.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 1937- were not the kind of clearly delineated missions the Army preferred. In 1936, the War Department leftmost 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.⁴¹

In January and February of the next year the Ohio and Mississippi Rivers flooded more than 12,721 square miles in twelve states. As part of the federal relief operation- directed 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 administered- refugee 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

⁴⁰Col 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 information is sketchy, See Rad, Hagood to AG, 21 May 35, 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 Group407, NA; "The Army in Flood Time," Quartermaster Review15 (Mar-Apr 36): 33-35; Reynolds, "Disaster Services," pp. 89,119-21.
⁴²On Army 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, 5th Corps Area on Flood Relief Activities, Final Report of Flood Relief, 6th Corps Area Rpt. 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.

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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 modem 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 housed 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 antireorganized 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

⁴³R.H. Garity, "Fort Knox Flood Relief Activities," Cavalry Journal 46 (1937): 133-37.
⁴⁴Garity, "Flood Relief," pp. 127-40; Alvin L. Gorby,"Army Flood Relief in the Ohio River Flood Area," Army Medical Bulletin 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 Group407, NA.

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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 floodrelief. President Franklin D. Roosevelt reimbursed the War Department withmoney diverted from two unrelated economic relief funds. The Army was reimbursedin similar fashion for its expenses incurred in a small, assistance operationafter the New England floods of 1937. The War Department`s suggestion atthe beginning of the relief effort that an account be created to whichrelief expenses could be charged was, however, ignored.⁴⁵

Toward New Relief Roles

After the floods of 1937, the Army did not undertake another major domesticrelief mission before the Second World War. It did, however, continue itseffort to define its role in assistance operations. In May 1938, Secretaryof War Harry H. Woodring and president of the Red Cross Norman H. Davisexchanged letters delineating a new relationship between their respectiveagencies. The Army recognized the Red Cross as the nation`s primary disasterrelief agency, though its corps area commanders retained the prerogativeof committing Army personnel and resources. Once involved, however, theArmy would abdicate a great deal of authority to the Red Cross, becauseas soon as the Red Cross established a headquarters the Army would issuesupplies through it. To ensure proper accountability in the Army`s supplysystem, all materiel issued to the Red Cross would be receipted for byits officials, but that did not commit the Red Cross to reimburse the Armyfor losses. In rescue work as well as supply, which of course includedmedical relief, the Army consented to submit to the direction of the civilianorganization. The War Department informed all corps area commanders andinterested departments of the terms of the agreement and later incorporatedthem into a revised AR 500-60 with an entire section on the authority,organization, and responsibility of the American National Red Cross.⁴⁶

If the Army appeared to be abandoning its relief mission in its agreementwith the Red Cross, other developments in 1937-1938 revealed that was notthe case. In the spring of 1937 the War Department instituted- as

⁴⁵Ltr, V.V. Tayler to Budget Officer for theWar Department, 17 Feb 37, box 2403, 400.38, Record Group 407, NA; Memoto 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, andDavis to Woodring, 26 May 38. Both in box 2404, 400.38, Record Group 407,NA.

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if by habit- another study of the Army`s response to disaster and askedcorps 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 communitiesto prepare for disasters and believed that the War Department should too.He recommended that the department require corps areas to have disasterplans similar to mobilization plans. The War Department concurred, andat its direction early in 1938 each area drafted and submitted such a document.The formulation of relief plans suggests that the War Department in thelate thirties really sought a more efficient, organized response to domesticdisasters, something that confusion over relief programs during the previoustwo decades had shown to be needed.⁴⁷

The War Department did not insist on a dominant role in the emergingdisaster relief system, because many more institutions existed to provideaid, the Red Cross had become capable and politically powerful, and theArmy realized the limitations of its own resources. In early 1938, GeneralMoseley succinctly summarized the Army`s position in a letter to civilianrelief 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. Thatis not a fact." The Army figured its budget in great detail and withlittle slack, he continued, for which reason any Army supplies issued must"be replaced in kind or paid for in fact." And if financed, Moseleyadded, the Army should be called only in an "emergency so criticaland so extensive that it taxes the regular civil institutions beyond theirpower." Even on such occasions the Army should remain only for aslong as absolutely necessary. As soon as possible, civilian authoritiesmust take control.⁴⁸

More than in many aspects of disaster assistance, the restrictions onArmy aid sketched by Moseley applied to medical relief. No longer wouldArmy medical personnel take charge of sanitation and health care as theyhad in San Francisco. Rather, corps area commanders might send a medicalunit to a community where local authorities needed help in quickly stabilizingthe situation, as happened in Harlingen. Or a medical unit might supplementother groups` efforts in coping with a massive

⁴⁷ Merno to AG by John J. Hughes, 13 Apt 37,box 2404, 400.38, Record Group 407, NA; Ltr, George Van Horn Moseley toAG, 6 May 37, box 2405,400.38, Record Group 407, NA, Memo for Chief ofStaff, 4 Nov 37; Memo for Chief of Staff by G.W. Cocheu, 14 Dec 37. Bothin box 2104, 400.38, Record Group 407, NA. Ltr. Edward Crowly to all corpsarea commanders, 27 Dec 37, box 2409, 400.38, Record Group 407, NA, FloodRelief Plan, 5th Corps Area, l Feb 38, box 2406, 400.38, Record Group 407,NA.
⁴⁸Quote from Ltr, George Van Horn Mosley to Mrs. Amy Brown,26 Mar 38, box 2402, 400.38, Record Group 407, NA.

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calamity, as happened in Louisville. But as the 4th Corps Area commanderexplained in a field order, state National Guard and civilian medical resourcesshould provide the first line of defense in disaster. If they did all thatthey could and it proved insufficient, Regular Army medical personnel andequipment should "augment" civilian resources and the NationalGuard.⁴⁹

The restriction of the domestic medical and other missions during theinterwar 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. Asthe feuding escalated and sometimes involved the military, the Army realizedthe time had come to withdraw; its aid was no longer essential. A similardevelopment occurred in the realm of policy. In the late nineteenth centuryand first two decades of the twentieth, local authorities lacked the meansto respond to disasters, other relief organizations had not developed sufficientlyto aid them, and the Army answered the nation`s plea for help. But afterWorld War I, the states, local authorities, and especially that peculiaramalgam of local volunteers and centralized professionals, the AmericanRed Cross, gradually became capable of tendering necessary assistance.The institutional crisis in disaster relief eased, the bickering began.The Red Cross adamantly defended its supremacy, and Congress withdrew itsfirm support for Army relief activities. Realizing the crisis had passedand it was no longer indispensable, the Army began to restrict its reliefactivities, especially those involving medical personnel.

Throughout the process of study and evaluation that led to the restrictionof domestic relief activity, the Army medical role in foreign assistancereceived little attention, probably because the Army undertook few majoroperations abroad during these years. Since Hawley`s efforts in Managua,which were, to some extent only the result of the chance presence of troopsin the area, the Army had performed only two foreign missions, neitherinvolving direct medical care. In 1934 Army planes flew tents and waterpurification chemicals to Honduras during a flood, and three years laterthe, Army helped citizens of Manila after a fire. Then in 1939 the Armyconducted a relief mission which though it did not result in any new policystill foretold increased activity in foreign disasters after World WarII. And though the Medical Department only contributed supplies, the operationsuggested that the postwar activism would include

⁴⁹Quote from Field Order 1, 4th Corps Area,Jan 37, box 2405, 400.38, Record 407, NA.

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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 eveningof the 26th, officials in Concepción, one of the hardest hit areas,wired Santiago requesting more, medical supplies, especially antitetanusand antigangrene serums. Learning of the request, the American ambassadorin 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 MartinB-10 and a Douglas B-18, to Chile. Loaded with several types of typhoidvaccine, antitetanus serum, and gas gangrene antitoxin, they took off fromthe Canal Zone on the 27th and arrived in Santiago two days later afterstops in Peru and Columbia.⁵¹

As the planes flew South, Col. Ralph H. Wooten, a military attaché,in Santiago, asked his superiors in Washington about employing the planesin relief work once they had arrived. Warning Wooten that the bombers wereprobably too big for the small Chilean airfields, they granted him permissionto use the planes at his discretion. When the bombers arrived, Wooten sentthe B-18 to Chillán and the B-10 to Concepción to delivertheir supplies. Over the next ten days- from 30 January to 9 February-the two planes made daily flights to those cities and others. On the flightfrom Santiago they ferried into the stricken area ten thousand pounds ofbread, medical supplies, and mail, as well as relief workers. On the returnflights, the bombers served as ambulance planes, with the B-18 evacuatinga total of sixty patients and the B-10 another five. The constant missionstook their toll on the aircraft, but Pan American Airlines helped withmaintenance and furnished spare parts for the planes.⁵²

On 1 February a Red Cross survey revealed a need for additional supplies.Officers in Chile called Washington, dictated a list of wanted items, andrequested that 30 percent of them be shipped by air. In response, the WarDepartment authorized a flight by a still experimental B-15 aircraft fromLangley Field in Virginia, and on 4 February, Maj. Caleb V. Haynes tookoff 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, aftera flight through very rough weather. He

⁵⁰On Honduras, see box 2408, 400.38, RecordGroup 407, NA; New York Times, 17 Jan 34, On the Philippines, seefile 4-8-37, box 2403, 400.38, Record Group 407, NA.
⁵¹"Worst Shake," Time 33 (6 Feb 39): 18, New YorkTimes, 27 Jan 39, Telg, Craig to Commanding General, Panama Department,26 Jan 39; Telg, Stone to Chief of Staff, 28 Jan 39; Rad, from Canal Zone,28 Jan 39; Rads, Stone to AG, 28 and 30 Jan 39. All in box 2403, 400.38,Record Group 407, NA.
⁵²Rad, Adams, to Wooten, 30 Jan 39; Rpt to AG, 9 Feb 39; Rad,Franklin C. Wolfe to AG, 19 Feb 39; Ltr, Wooten to John D. McGregor, 9Feb 39. All in box 2403, 400.38, Record Group 407, NA.

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stopped twice, once in the Canal Zone and again in Peru; his actualair time was only 29 hours and 53 minutes.⁵³

As a further precaution the War Department alerted a company of 100men at Carlisle Barracks` Army Field Medical Service School for possibledeployment to Chile. Plans called for the troops to motor to Middletown,Pennsylvania, board a plane for Pensacola, Florida, then fly by commercialairliner to Chile. The Army never dispatched them because the situationin Chile quickly improved enough to eliminate the need for additional Americantroops and to allow American planes there to depart after ten days. Butthe plan to send the company as well as the speed with which all reliefwas rendered pointed toward new capabilities in assistance abroad.⁵⁴

Before the Chilean operation, the Army`s inability to deliver personneland supplies to a foreign disaster scene in a short time had curtailedmedical and other types of relief. With the exception of the massive missionto Japan, during the interwar years medical personnel had only undertakensporadic, small foreign assistance operations, primarily in the Caribbeanor the Philippines. Coining at the end of two decades of

⁵³Rpt. to AG, 9 Feb 39, box 2403, 400.38, RecordGroup 407, NA; clipping from Washington Post, 15 Feb 39, in the AmericanRed Cross Library, Washington D.C. Haynes received the Distinguished FlyingCross for his efforts.
⁵⁴New York Times, 29 Jan 39; Rad, Wooten (?) to AG, 9Feb 39, box 2403, 400.38, Record Group 407, NA.

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relative inactivity, the airlift to Chile suggested the possibilityof a very different role for personnel and units of the Army Medical Departmentin the future. By 1960 the Army, with the help of the Air Force, wouldbe able to airlift an entire hospital to Chile in about the same time ittook to deliver the 3,300 pounds of supplies in 1939.