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REPORT AND COMMENTS ON SOME OF THEMEDICAL FEATURES OF THE SANTIAGO CAMPAIGN, BY LIEUT. COL. V. HAVARD, CHIEF
SURGEON, UNITED STATES VOLUNTEERS
Wars, like years, succeed, but do notresemble, each other. Not only do they each have special features, calling forspecial preparations, but the lapse of time works constant changes in the shape,size, and power of projectiles, so that each new campaign opens with problemsunsolved and questions unanswered. The one subject about which military surgeonsdisagreed most-the behavior of the new small-caliber jacketed bullet-hasapparently been solved, and solved in a
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manner to comfort and cheer all whohave labored to render war less destructive and more humane. This new bullet,from which the swift annihilation of brigades and regiments had been predicted,is shown, on a sufficient scale to be conclusive, to cause no more casualtiesthan the large conical bullet of former wars to cause proportionately fewerdeaths (on the field and in hospital), and to give the wounded a much betterchance of recovery. Never before have so many wounds healed by first intention,were there so few fractures, and so few operations performed.
At the battle of San Juan Hill, July 1,in which our troops assaulted and captured an almost impregnable position, thetotal number of casualties was 932 for the 7,000 troops present and under fire,a ratio of 13 per cent-namely, 11 per cent of wounded and 2 per cent ofkilled. At El Caney the total casualties were about 11 per cent. Among theSpaniards, who fought mostly under cover, the casualties were much under 10 percent. Our proportion of killed in all the engagements at San Juan (1,039: 145 =7.16) was somewhat less than one-seventh of all struck; among the Spaniards itwas less than one-fifth.
It would seem that for the purpose ofinvasion of an enemy's territory by sea, where no harbor can be entered andlanding must necessarily be effected in open bay and through the surf,particular attention would be paid to the loading of transports, so that allneedful supplies can be readily found, readily landed, and in such shape as tobe easily carried into the interior. Concerning this matter, it is notoriousthat serious mistakes were made, arising from the apparent want of a systematicoriginal plan and from the great hurry and confusion which marked the last daysof preparation and loading. As a result, each regiment had more or less of itsmedical supplies lowered in the hold of its own or some other transport, andmostly inaccessible. Medical officers in dire need of many things stood on thebeach day after day making futile efforts to get at their supplies in the holdsof ships sometimes anchored only a few hundred yards away. The almost absolutewant of means of landing and disembarkation is one of the amazing features ofthe expedition. There was but one lighter and not a single steam launch with thefleet of transports. Obviously the Navy was expected to furnish help in thisrespect, and it did at times and places, but was oftener conspicuous by itsabsence.
A bit from my personal experience willillustrate the situation. On June 29 I transferred the provisional hospital atSiboney to Surgeon La Garde and joined the cavalry division, of which I waschief surgeon. I at once realized the scantiness of our supplies and theimpossibility of setting up a division hospital; therefore, on the very nextmorning, I returned to Siboney with Surg. George McCreery and an order for fourwagons to get our medical supplies from the hold of the transport Rio Grande.Only one rowboat was available for the service of all the transports. We tookpassage in it and on the way stopped by the Mohawk to let off an officer.A member of the untrained crew, lifting his heavy oar, dropped it upon andthrough the bottom, so that the boat filled up rapidly and we had to scrambleout upon the Mohawk. It happened that this transport was without a singleboat on which to forward us to our destination, the Rio Grande, only 300or 400 yards away, or send us back to the shore; and the captain, with theselfishness and indifference of many of his class in those troublous days,declined to make any effort in our behalf. It was only after several hours ofshouting and signaling that we succeeded in drawing the attention of thelighter, and, after much difficult maneuvering, were rescued and carried back tothe beach. The effort had been hopeless. I returned to the front that sameevening empty-handed, leaving Surgeon McCreery behind. He succeeded in a coupleof days, with the help of Assistant Surgeon Rafferty, in obtaining twowagonloads of supplies, which were a valuable addition to the overtaxed fieldhospital.
But few ambulances were brought fromTampa. Only three had been landed by July 1, and were available on the days ofthe fight at Caney and San Juan. They were ably handled by Assistant SurgeonGodfrey, but, in view of the number of wounded, played an unimportant part.
The wounded from San Juan were allbrought to the field hospital on the day they were hit or before the followingmorning; many of them on improvised litters carried by hand. In the evening andduring the night a few wagons returning from the front became available, and thesick and wounded were crowded into them iii an apparently pitiless manner, butit was either this or else an indefinite waiting by the roadside. All or nearlyall of the wounded from Caney were brought in by wagons the day after the fight.If we consider the abominable condition of the roads, the unruly state ofdrivers and mules, and the great difficulty of procuring the means of preventingjars and jolts, it is not saying too much that the 4 or 5 miles of wheeledtransportation from the battlefields to the field hospital cost the lives of nota few patients.
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The question of transportation ofmedical supplies and patients is a vital one, and deserves more thoughtfulattention than it has yet received. Reasonably or unreasonably, hardly anythingshort of perfection is now required from the Medical Department. To meet thisexpectation, we must accumulate stores on the most liberal scale and be leftperfectly unhampered in our disposition of them. In this campaign we should havehad a special medical transport ship in command of a medical officer, loadedwith all the equipments and requirements of ambulance and field hospitals, andlarge reserve supplies-everything stowed away in its proper place and readilyaccessible. Such ship should have two large, stout steam launches and be in allways independent. It could not be expected to carry ambulances and teams, but itcould and should carry a train of, say, 30 picked and trained mules with 12 setsof packs, 12 small two-wheeled carts, and 12 mule litters; the packs or carts,or both, as roads may permit, to carry supplies to the front, and the litters tocarry patients. Besides the medical ship, each regiment should have with it thematerial necessary, including hand litters, for a quick advance to the front,this material not to be stowed away in the hold, but kept above in the mostaccessible place and under the hand of the medical officer responsible.
Stress should be laid on the fact thatambulances are cumbersome, complex organizations, and (especially in a war ofinvasion), not available in emergencies when most needed. Pack mules and light1-mule 2-wheeled carts are indispensable, whether we operate by sea or land. Theinestimable value of these carts is not only as a means of transport beforewagons and ambulances are available, but also as classified store vehicles, allthe contents in their proper compartments and within reach. A large bulk ofmedical supplies filling up an army wagon is of no use until everything isunloaded and all boxes open; and by that time many bottles will have been brokenand much stuff wasted, to say nothing of the time consumed.
As to the transport of patients, theSantiago campaign revealed painful omissions and brought out instructive facts.Hospital Corps men were sadly deficient in number, being (at least in theRegulars) less than 1 per cent of troops in the field, although all previousexperience has shown the necessity of at least 3 per cent. This latter ratioshould have been reached and organized before the Fifth Corps left Tampa;transfers of combatants to the Hospital Corps after boarding transports andlanding upon the enemy's soil were obviously impracticable. It followed thatall hospital corps men were absorbed by the field hospitals and dressingstations; and that not a single one was available as litter bearer.
The new regulation hand litter wasconspicuous by its absence, having been left behind at Tampa and in thetransports. It was hoped that, on account of its lightness and ease of foldinginto a small portable compass, this litter, in which we all took a just pride,would be available in limitless abundance and in that way make up, to a largeextent, for all inevitable shortcomings of ambulances. It was a saddisappointment. Makeshifts of all kinds were resorted to-generally a heavyframe of poles covered with blankets and grass; many patients were thus carried4 and 5 miles, over miry, deeply gutted roads, mostly at night, and most of themarrived at the field hospital in fair condition, much better than if carried inambulance or wagon. Each of these improvised litters was borne by from 4 to 6men, with a few additional bearers for a second relay, and therefore took awayfrom 6 to 10 combatants from the line. One good effect of so many bearers wasnecessarily to "break step" and reduce the jolting.
In my opinion, the best means oftransport, under the circumstances, would have been mule litters-that is,litters carried one on each side of a mule, as first devised by the French andnow adopted in all armies but our own. Mule litters must become part of ourequipment and will prove invaluable in our colonies.
Of travois, it did not occur to anybodyto construct one, and not a single patient was thus carried away. Itsconstruction would have been easy and taken hardly more time than that of alitter. The main difficulty was felt to be the procuring of animals, It wouldhave been greatly to the advantage of patients to unhitch the six mules of awagon and make them drag travois, but who, in those days, would have had thetemerity to propose the abandonment of a single wagon while the whole front wasclamoring for food and ammunition.
The regulation litter, wherever used,stood the tests of the campaign in a very satisfactory manner, and shows itselfto be well adapted to its purposes. Its weak points are the canvas, which, underany unusual strain, bursts and fears, and the braces, which are liable to warpand break.
The new two-decker ambulance,constructed just before the war, is, in my judgment, such a defective andobjectionable vehicle that I need say nothing further concerning it.
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It was expected that the long range ofthe small-jacketed bullet would change some of our ideas of field sanitaryorganization, and this expectation has been realized. Distance does not nowcount for so munch, while shelter counts for a great deal more. We may even gofurther and say that distance may distinctly increase the danger. The advance oflarge bodies of troops, like brigades and divisions, in formation of attack, hasbecome more difficult. There is an instinctive, irresistible inclination to takeadvantage of all possible shelters, and this results in the breaking of theoriginally continuous line into more or less separated groups of battalions andregiments. This breaking or fragmentation of long lines becomes a matter of lifeand death, when, as at El Caney, a prolonged siege is maintained against anenemy having every advantage of position. Under the withering fire of anintrenched foe general officers lose their hold on the advancing line, and atthe critical moment regimental officers must often take the final and decisiveaction, each one according to the conditions confronting him.
The deduction, so far as the medicaldepartment is concerned, is that each regiment in battle must be provided withproper medical personnel and material, and be more or less independent. Theadvice of modern writers to concentrate all supplies behind the brigade as aunit is not borne out by the experience of this campaign. Of course thisregimental organization is only suitable for the battlefield and does not applyto the camp, where division hospitals very properly absorb most of the functionsof the regimental hospitals.
The best place for regimental dressingor collecting stations will be the nearest place to the line of fire at whichsufficient shelter can be had; such place will often be only a few yards back ofthe firing line, the latter being almost always along the crest of a hill or arise of ground. The farther back we go the more exposed is the station to dropshots and the less useful it becomes. If there be no shelter in the immediaterear and it is necessary to pass over any large area swept by the enemy's fireto carry the wounded to cover, the removal of the latter becomes veryquestionable; chances must be balanced and opportunities taken advantage of.
I used the name "regimentaldressing or collecting station," thus conveying a specific idea, which maybe, and often is, a wide departure from the facts. The raison d'?tre of astation is primarily its convenient location and safety, much more than theparticular organization in its front. Thus, in the attack on San Juan Hill, onlyone station was established, although several regiments were under fire, becausethere was but one available place (at the "Bloody Bend," under the lowbank of the San Juan River). It was a poor place, not even safe, but the onlyavailable one, and Assistant Surgeon Newgarden did wisely in locating it there,without regard to the position of the troops in front and rear of it.
After July 1, when our troops hadcarried the heights of San Juan, the "Bloody Bend" was no longerexposed to direct fire, but was still in danger from drop shots fired at least amile away, and from sharpshooters. As patients continued to be brought there,and it was the farthest point ambulances could reach, it was thought best toretain it another day.
Meanwhile, other dressing stations werebeing established in the immediate rear of the firing line, not far below thecrest of the hill and consequently in tolerably safe positions. It wasrecognized that one station may answer all the needs of a brigade; thus, a roadled up to the rear of the Third, Sixth, and Ninth Cavalry and in a deep, hollowpart of it Surgeon Harris established for the whole brigade a station which wascomfortable, almost absolutely safe, and easily approached by ambulances. TheFirst United States Volunteers (Rough Riders) and the Tenth Cavalry likewisejoined forces and placed their station in a tolerably safe spot at the foot of asteep spur. The First Cavalry, being separated from the latter by a largeexposed basin, required a separate station, which it shared later with two orthree artillery batteries. Here natural shelters were very imperfect and a gooddeal of digging was required. In the same manner, stations were established allalong the line, each corresponding to one, two, or three regiments, andsometimes to regiments of different but adjoining brigades.
According to books, each division oftroops should have at least one ambulance hospital (ambulance station) 2 or 3miles in rear and a complete, well-appointed field hospital 2 or 3 miles stillfarther back; but actual war is no respecter of theory and often upsets all ourpreconceived ideas. One field hospital was established near General Shafter'sheadquarters, 2 or 3 miles back of El Poso, and up to the time of the surrenderremained the only one, and the only hospital organization of any kind in rear ofthe dressing stations, 4 miles away. Efforts were made to find another suitableplace, but without success, owing to the facts that the country operated in wasone vast jungle, with but few small clearings, and that there was but one roadto the front. The only intermediate station was one improvised
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under a grove of large trees near ElPoso. Here much good work was done by the medical officer in command. Walkingpatients rested, received stimulants, and, if necessary, were placed in wagonsimpressed for the purpose; all litters were stopped and the patients carefullyexamined, but without meddlesome handling of the dressings; patients in wagonswere given more comfortable positions; several tourniquets twisted tight,probably too tight, at the dressing station were loosened to the great comfortof the patient and the possible avoidance of serious injury. The application oftourniquets on the line of fire, immediately after the receipt of a bleedingwound, must be useful, but further back it is of very doubtful utility, and itwill always be wise, if circumstances permit, to examine and loosen tourniquetsin transit to the field hospital.
It is safe to conclude that, in futurewars, the necessity for immediate operations being less and the patients able tostand longer transportation, less stress will be laid upon the importance of theambulance station, which will generally be merged into the division or fieldhospital. It will be enough to have an "observation station" to seethat all patients in transit are in the best condition possible to reach thehospital safely.
It is not my purpose to discuss matterspertaining to the field hospital; this I leave to others more directlyinterested and better informed, but the work in first aid done along the lineshould not be left unnoticed. Little dressing material had been taken to thefront. Fortunately, first-aid packets were plentiful. Medical officers hadsucceeded in impressing upon many officers and men the necessity of carryingthese packets, and along almost every part of the line they could be had insufficient quantity and were invaluable. Probably never before have first-aidpackets played such an important part in the treatment of gunshot wounds. Oursurgeons and hospital corps men had hardly anything else, and, in truth, did notneed much else. Let the surgeon of the next war provide himself with plenty offirst-aid packets, wire splints, a small case of instruments, rubber tourniquet,and a bottle of stimulant, and he is suitably prepared for all the eventualitiesof the firing line and dressing station.
The packet being of such vitalimportance, its composition should be carefully studied. We know how munchdepends upon the proper application of the first dressing and the necessity forleaving it undisturbed until special indications call for a reexamination of thewound. This first dressing is made easier and more successful with largecompresses, say twice the size of those now in use. Compressed cotton,containing an antiseptic powder, and which can be readily spread out, would, Ithink, prove a munch better material than gauze.
Diagnosis tags were not generally used.Many of the surgeons who were provided with them failed to appreciate theirvalue, thinking that when minutes are so precious tags do not matter. From myown experience of the tags seen in front, on the road, and at the fieldhospital, I am more than ever convinced of their great utility (under animproved form) and would urge that no dressing be considered complete until thetag is pinned on.
After the surrender of Santiago, whenthe troops had selected the best sites for their camps, and tentage wasabundant, each division set up a hospital of its own, the overflow from whichwas received into a large field hospital established at a central, readilyaccessible point. In addition to these, each regiment had also a few hospitaltents for its milder cases. This organization appeared to be the best possibleunder the circumstances, and gave excellent results.
In closing, one is naturally promptedto call attention to the excellent, nay, admirable work of our surgeons alongthe line of fire. I never heard that any medical officer had shirked his dutybecause of danger, or failed to help a patient that he could reach. I wasspecially well situated to see the first-aid dressing applied to the woundedunder fire, on June 24 as well as on July 1 and 2, and could not help admiringhow carefully and effectively the compresses and bandages of the packet had beenapplied in a majority of cases, as well as the improvised splints in fracturecases. Very few patients reached the field hospital with wounds unbound andunsupported.
