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REPORT OF MAJ. FRANK J. IVES, SURGEON VOLUNTEERS, CHIEF SURGEON INDEPENDENT BRIGADE AND PROVISIONAL DIVISION, FIFTH
ARMY CORPS
DURING THE PERIOD JUNE 7 TO SEPTEMBER 12, 1898
The Independent Brigade consisting of the Third and Twentieth United States Infantry and one squadron (Rafferty`s) of the Second Cavalry under command of Brig. Gen. John C. Bates, United States Volunteers, was on board the transports at Port Tampa, Fla., when I reported for duty pursuant to orders from corps headquarters.
Upon reporting to the brigade commander I received verbal instructions to embark on the transport Stillwater. The medical department of the brigade consisted of myself and 3 acting assistant surgeons, 2 acting hospital stewards,9 privates of the Hospital Corps, 4 being orderlies for medical officers, and 3being ambulance drivers. Each regimental surgeon was equipped with a medical and surgical chest and field case, the members of the Hospital Corps with their appropriate pouches, and every officer and enlisted man in the brigade was furnished a first-aid package. There were 3 ambulances fully equipped with this brigade, and it ultimately developed that these were the only ones with the corps until sometime after the battle of July 1, 2, and 3.
No hospital equipment beyond that above enumerated was taken, for the reason that prior to embarking from Mobile, Ala., from whence this brigade sailed on June 4, Colonel Greenleaf, of the medical department, had distinctly stated that it was absolutely unnecessary for troops leaving Mobile to transport hospital supplies, as these would be provided at Tampa, arrangements to that effect having been perfected. Notwithstanding this there was no chance to equip the brigade completely at Port Tampa, owing to the confusion incidental to embarking and the uncertainty as to the exact hour of departure.
The disembarkation occurred at Daiquiri, Cuba, on June 22 and 23, each man being equipped with the blanket roll, haversack, canteen, arms and ammunition, besides three days` rations. On the afternoon of the 23d the brigade marched toward Siboney, camping about 2 miles east of the same. On the following morning, the 24th, it proceeded to Siboney and went into camp at the extreme western end of the town. Soon after reaching the latter place the squadron of the Second Cavalry was detached from the brigade, and I received verbal orders to report for duty at brigade headquarters. At about 9 a. m. word was received that Young`s brigade of Wheeler`s division had encountered the enemy, resulting in many casualties. General Bates instructed me, at that time the senior medical officer present, to make arrangements for the reception of the wounded. Upon reaching the lower end of the town I found a temporary hospital had been established by Maj. W. B. Banister, brigade surgeon, United States Volunteers, in an abandoned house, which had been cleaned out and rendered as fit as possible for their reception, and that 8 or 10 of the First United States Volunteer Cavalry had already
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arrived and were being treated. The building occupied was an old, dilapidated structure, but it was impossible at that time to improve upon it. There was no tentage to be obtained, and as far as fear of infection was concerned, there was little choice between the buildings. The heat was intense, the hospital ship Olivette not in the harbor, and it was necessary to place the wounded under shelter of some kind at once. A large box of surgical dressings belonging to the First United States Volunteer Cavalry was soon after obtained and proved a most valuable acquisition. Maj. Valery Havard, chief surgeon of the cavalry division, arrived in the course of the day and assumed charge of this temporary hospital. There was some adverse criticism resulting from the use of this building for hospital purposes, which, in the opinion of the writer, was unjust. When it is considered that the Army was in a hostile country, that the village had just been occupied, that the base of supplies was practically at Daiquiri, 9 miles distant, and that there was absolutely no chance for shelter from the sun and rain until the arrival of the Olivette, there was nothing else left todo, as there was no natural shelter to be obtained. Subsequent events did not show that the slightest evil resulted from the occupation of this building by the sick or wounded. The independent brigade remained at Siboney until June 30.During this interval the brigade was encamped in close proximity to the houses of the town. The headquarters occupied a house previously used as a residence for the superintendent of the Juragua Iron Company. A hospital was established at Siboney, under charge of Major La Garde, and a limited amount of material was sent to the front for another located near General Shafter`s headquarters. As the independent brigade consisted of only two regiments, no effort was made to undertake the establishment of a hospital, but the field equipment, consisting of the medical and surgical chests and some additional medicines and dressings, was obtained for each regiment.
One set of chests, besides a box containing a fine assortment of dressings and medicines, was also secured for brigade headquarters. The latter articles, under the personal supervision of the writer, were loaded on a wagon with commissaries and ammunition and were transported to the firing line, reaching there after midnight on the night of July 1, and proved of the most inestimable value during the two days` fighting that followed. The brigade left Siboney at9 p. m., June 30, marching about 7 miles. On the following morning, July 1, at day break, it proceeded to General Shafter`s headquarters, leaving there at 10a. m. to support Lawton`s division, then engaged with the enemy at El Caney. Soon after noon the brigade went into action between Chaffee`s and Miles`s brigades, and at about 3 o`clock assisted in taking and holding a strong stone fort from which the enemy had been dislodged. Owing to the limited number of medical officers then with the brigade no attempt was made to establish addressing station, but it was deemed preferable for them to remain on the firing line and advance as far as practicable with the command. The wounded thereby received immediate attention, and were left in sheltered localities until ultimately transported to the nearest collecting station. By following this method the writer was enabled to render assistance in many instances, not only to the wounded of his own brigade but to many others who were too distant from their regularly established dressing station to hope for relief for a considerable time to come. Whereas these stations are necessary as gathering stations for the wounded prior to their transportation to the field hospital, it strikes the writer as essential that the wounds should be dressed as soon as possible after their reception, and that the medical officer and his assistants should be on the spot rather than have the patient wait indefinitely until means for transporting him to the dressing station are forthcoming. This was particularly evident during that portion of the battle following the capture of the stone fort above mentioned. After its capture the hill was occupied by the Third Infantry and portions of the Twelfth, Twentieth, and Twenty-fifth. The Spaniards concentrated a heavy fire upon these troops and there were many casualties, among them Captain Rodman. who was in command of the Second Battalion of the Twentieth, and Mr. James Creelman, a correspondent of the New York Journal.
The writer was the only medical officer present in this section during the battle, and at no other period were his services more urgently needed. The firing line at this point was stretched along the crest of the hill upon which the fort was situated, and a temporary dressing station established at a sheltered spot a few feet below the crest, so that the wounded had only to be carried by their comrades this short distance, thereby enabling the latter to return at once to their commands. In this way prompt assistance was rendered and the firing line not appreciably weakened, which would not have been the case were it necessary to depend upon the previously established dressing station. The regimental surgeon of the Twentieth, Acting Asst. Surg. T. S. Aby, United States Army, remained on the firing
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line with the First Battalion of that regiment, which did not participate in the charge above mentioned, and the surgeon of the Third, Acting Asst. Surg. E.R. Bragg, United States Army, remained with his regiment until just prior to the charge, when his professional duties kept him in the rear, which accounted for neither of them being present at the stone fort. When all our own wounded at this point were cared for, the wounds of a number of Spanish prisoners were dressed. As the writer was thus occupied, the prisoners showed signs of great amazement and gratitude, evidently as if they had expected harsh treatment. These prisoners received the same care as our own wounded, and that same evening were carried to the nearest dressing station. The Spanish dead were decently buried at the scene of their gallant resistance, the line of intrenchments around the fort being utilized as a common grave. At about 5 p. m. the enemy had entirely disappeared. The brigade was withdrawn and bivouacked a couple of miles to the rear. The writer remained at the fort until nearly dark, and then, accompanied by his orderly, rejoined the command. During this ride he was fired at by some one concealed in the brush, which was the only instance of bushwhacking personally known to him. About 9 o`clock the line of march was resumed, and the brigade took position on the left of Kent`s division, then occupying the San Juan Hill, before Santiago, this position being the extreme left of the line and covering that flank. It was reached between 1 and 2 o`clock in the morning.
On July 2 the Ninth Massachusetts Volunteers joined the brigade. During the 2d and 3d a portion of the brigade was in the intrenchments, the remainder being held in reserve about 300 yards behind the firing line. At this point the latter troops were exposed to a double enfilading fire and suffered considerably. A dressing station was established and efficient work done, the box of additional medicines and dressings proving a most valuable acquisition. Among the things in this box were sufficient extra "first-aid" packages, which were issued to the men to supply those used in the first day`s fight. The casualties in this brigade during the three days` fighting were 4killed and 29 wounded. This includes one member of the Hospital Corps wounded on July 2 while assisting in dressing a wound of a comrade. After the fighting of July 1 the wounded were transported on extemporized litters to adjacent dressing stations whose locations had been determined and were subsequently sent to the rear. On July 2 and 3 those treated at the brigade dressing station were carried to a collecting station on the Siboney road, near the San Juan River, where they were held until transportation could be procured to take them back. As the three ambulances above mentioned were the only available ones at that time, escort and many army wagons had to be impressed into service for this purpose.
I would respectfully submit the following remarks upon the personnel and equipment of the medical department on the battlefield, the conclusions being based upon personal observations, not only during the recent campaign, but for several years prior to the same: No regiment should go into active service with less than 1 surgeon, accompanied by his orderly; 1 steward and private of the Hospital Corps for each battalion; that each regimental surgeon should have a pack animal, with a mounted packer, under his exclusive control; that instead of the medical and surgical chests at present issued, ordinary stout boxes be employed, filled with a selected assortment of surgical dressings, together with a liberal allowance of a few very necessary medicines, such as quinine, cathartic pills, calomel, diarrhea tablets, antiseptic tablets, beef extract, aromatic spirits of ammonia, etc.; that each surgeon should carry on his persona small, compact pocket case-the present field case is of poor quality, clumsy, and useless.
There should be a light form of litter for active service. At an annual meeting of the Association of Military Surgeons of the United States, held in 1893, the writer submitted an article on a field litter. In the article it was claimed that an army in action required a light, serviceable stretcher that could readily and in comparatively large quantities be rushed to the front, and suggested one made of bamboo as possibly answering the purpose. However, the idea was rather discouraged by certain theorists who objected to the litter in question. In a discussion following the paper, some claimed the litter was useless on account of having no legs; others that it could not be used in an ambulance; others that it was not military enough, holding that it was desirable to have an article more suitable for the litter drill. The fights around Santiago demonstrated that the medical department should be equipped with just such a light stretcher which could be transported in quantities to within a short distance of the firing line and there distributed. The use of blankets, overcoats, and shelter tents for extemporaneous litters is not practical, owing to the difficulty and time in procuring poles. The area of destruction of the modern small arm is so extensive that the distance between the firing line and the collecting station is liable to be very great. On
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that account the extemporaneous litters should not be depended upon, but the strongest efforts should be made to provide more suitable methods of transportation. As far as the writer could inform himself, the litter drill was entirely dispensed with in this campaign, and no effort was made toward its employment.
The first-aid package filled its part most nobly. Too much praise can not be bestowed upon it nor can one overestimate the benefits derived from the excellent instructions given for its use. The contents of the package might be improved by adding a small quantity of pulverized boracic acid or some other powder for a dry dressing. In many cases it was found difficult to hold the antiseptic gauze in position, which could be accomplished by a few strips of adhesive plaster. Four such strips, 4 inches long by one-half inch in width, laid flat in a small paper envelope, would be a valuable acquisition.
Prior to going into action an opportunity was offered the brigade to replenish the canteen. The men were cautioned to use the water sparingly in drinking, which enabled the surgeons to have sufficient water to cleanse all wounds before applying the dressing. In instructions in first aid this point should be emphatically dwelt upon. Also the men should be carefully impressed with the folly and danger of unnecessarily removing the dressings without the sanction of medical officer. Several cases came to the knowledge of the writer where mischief resulted on account of the erroneous idea that a dressing should be frequently changed. By educating the soldier in this respect, much benefit will result. During the battle and subsequently the regimental bands rendered the most valuable assistance in the care of the sick and wounded. Some of their members procured rifles and participated in the fighting, while the remainder were attached to the medical department. Too much credit can not be given these men, who, under the most trying circumstances, performed their duties most excellently, displaying the greatest zeal, energy, and patience. For several years prior to the present war the writer has advocated the use of regimental bands for this purpose, and suggested that they receive special instructions in the duties pertaining thereto, but had received unanimous discouragement, especially from regimental officers. This instruction should be compulsory for all bands in the future. Better results in the instructions for the enlisted men can be obtained by requiring the medical officers to personally superintend them instead of their receiving it second-hand through their company officers.
During that portion of the campaign from July 4 to 17, designated as the siege, the brigade held its position on the left flank, and the main portion of it was located in the intrenchments, which were not abandoned until after the surrender of Santiago. The health of the command up to this period was excellent, but on the 4th the sick list was suddenly augmented by a large number of cases of acute ephemeral fever. This seemed to be confined principally to the Third and Twentieth Regiments of Regulars, the Ninth Massachusetts Volunteers apparently being free from it. The attack in most cases was sudden in its onslaught; in some preceded by a chill, but in the majority not; the temperature would suddenly run up to 104° or 105°, be attended by only a moderate increase in the pulse rate, severe frontal headache, pains in the back and limbs, a flushed and swollen appearance of the face, marked conjunctival congestion, and great prostration. The tongue in many cases was large and flabby, showing, after a day or two, the marks of the teeth. At night there was a tendency toward wakefulness or great restlessness, attended by vivid dreams; nausea and vomiting were usually present. The attack in most of these early cases lasted from three to five days, when the symptoms would subside and the patient gradually recover. This epidemic appeared during the latter portion of the battle, being fully developed about July 4. It was observed that a few days afterwards it seemed almost completely arrested, when there was a slight interval, lasting several days, when a second rush of cases occurred. This, in view of subsequent events, is of great importance, as the writer is convinced that many of the first series of cases were a mild form of yellow fever and the latter ones were malarial, thermal, or ephemeral in character. It is an established fact that Siboney was an infected locality, consequently the independent brigade, which had camped there almost a week, had been exposed to infection. The brigade headquarters had occupied a building previously used as a residence in the town, and among the first series of cases above mentioned, General Bates, all of his staff officers, orderlies, and servants were, without exception, included, and were taken sick almost identically at the same time: The writer was in the list, and although quite ill for several days, did not permit himself to be sent to the rear, but remained with the command. This illness prevented him making a clinical study of these early cases, but most of the symptoms enumerated above were present. In his case upon the abatement of the fever, the temperature became subnormal, and the pulse fell to about 45 per minute.
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Dr. Guiteras saw him a few days after convalescence was established and pronounced it a mild attack of yellow fever. This was the last sickness of any kind experienced by the writer during his sojourn on the island, although he was continually exposed to all the rigors of the climate and weather.
In the first series there must have been in all about 100 cases, of which possibly 40 were transported to Siboney. Of the second series about 200 cases, of which 75 were sent to the rear. Many of these latter were pronounced yellow fever by the experts, and placed in the fever hospital, where a large percentage of them were extremely ill, and many died from undoubted yellow fever. On July 15 the writer went to Siboney, and from personal investigation became suspicious that many cases of alleged yellow fever were in reality nothing more than some form of acute, noncontagious fever, and that in sending our patients to Siboney we were placing them in a position of the greatest danger. The impression obtained from this visit to Siboney was that the majority of these experts were completely stampeded, and were calling everything yellow fever. This resulted in many cases, which the writer is now convinced were not such, being sent to the fever hospital, there contracting the disease, and ultimately losing their lives. On returning to the firing line, instructions were given not to send anymore cases to the rear, which was strictly adhered to for the remainder of the campaign.
The above-mentioned suspicions became certainties in the opinion of the writer when subsequently it transpired that during the interval from July 20 to August 23, 4,900 cases of fever occurred in the provisional division (on July 13 the independent brigade was reorganized, becoming the provisional division), and there was not one death from yellow fever, nor was there a single case which could be clearly diagnosed as such. This proves conclusively, as far as the observations of the writer extend, that whereas an epidemic of yellow fever did exist at Siboney, that none existed among the army on the firing line, although sporadic cases may have developed from time to time. The medical officers of the Regular Army, and those on duty with the troops, were, as a rule, in no way included in this general stampede, which but for them might have proved disastrous to the Fifth Army Corps.
On July 18 orders were issued the division to vacate the position held on the left flank, and it took station in the neighborhood of the San Juan blockhouse. The division at this time consisted of the Third and Twentieth Infantry (regulars), the Ninth Massachusetts, the First District of Columbia, and the Thirty-fourth Michigan. The Thirty-third Michigan and the Eighth Ohio, although officially attached to the division, never actually joined. On July 19 a temporary division hospital was established on a strip of elevated ground behind the San Juan Hill. Capt. T. E. Roberts, assistant surgeon, First Illinois Volunteers, was detailed as officer in charge. Besides the surgeon in charge ,there were 3 medical officers, 2 stewards, and 2 privates of the Hospital Corps, detailed from the volunteer regiments. One full company of infantry from the Ninth Massachusetts Volunteers was also detailed to act as a hospital guard; they also performed the duties of a permanent police detail and assisted in the care of the sick.
Shelters were first constructed of bamboo uprights, with brush shed, and a few days afterwards eight wall-tent flies were secured. On July 21 the first official records show 115 sick in hospital and 264 in quarters, a total of 379,of winch all but 13 were from the original independent brigade.
On July 21 the writer received orders from the chief surgeon of the corps assigning him to duty in charge of two hospitals located in the neighborhood of General Shafter`s headquarters on the Siboney road. These proved to be a detention hospital under the charge of Acting Assistant Surgeon Pitt, and a yellow-fever hospital under charge of Acting Asst. Surg. Hamilton F. Jones. United States Army. Each hospital contained about 115 cases. They were fairly well supplied with hospital tents, cots, bedding, and camp furniture, although the supplies were not equal to the demand. The latter portion of the month these hospitals, under the writer`s personal supervision, were broken up and transferred to Siboney. Before effecting this transfer 100 complete suits of clothing were obtained from the quartermaster`s department and were issued gratuitously to the convalescent yellow-fever cases. The ground occupied by both camps was thoroughly policed and burned over; all cast-off clothing, rags, worn and soiled bedding, cots, and tents were destroyed.
About the 25th a cargo of medical supplies, under charge of Major Summers, brigade surgeon, United States Volunteers, arrived at Santiago. Immediate steps were taken to improve the condition of the sick. A fully equipped division hospital, with a capacity of 150 cots, and at the same time regimental hospitals of 15 or 20 cots, were established. The sick list from this time on became enormous; fully 25 per cent of the command were on the sick report, and of the remainder fully two-thirds were unfit for other than the lightest duty. An overwhelming
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majority of the cases were malarial, with a few typhoid. The latter disease developed as an epidemic about August 1. This epidemic of typhoid was, in a great measure, produced by contamination of the San Juan River, due to the exodus of noncombatants from Santiago to El Caney. The latter numbered about20,000, including many sick, who were collected in the town and in the immediate vicinity of El Caney.
The stream from which our army obtained its water supply became a common sewer for this temporary community. Except in isolated instances, there were absolutely no facilities for boiling the water; consequently, as a matter of necessity. the command was compelled to utilize the same. After the occupation of Santiago and the establishment of the hospital, 9 acting assistant surgeons and 3 civilian nurses were assigned to the division for duty. The division commander detailed Captain Sullivan`s company of the Ninth Massachusetts Volunteers for permanent duty with this hospital. It gives inc great pleasure to state that Captain Sullivan and his command performed the arduous duties connected with the hospital well and faithfully. These men performed guard duty connected with the hospital, general police, buried the dead, dug sinks, and, in addition, a detail was constantly on duty in each ward, night and day, administering nourishment, supporting patients to stools, and performing all the duties of nurses. Too munch credit can not be given this command for their subordination, obedience, and patience under the most trying circumstances, and the valuable work accomplished by them. In this connection I would add that the division commander and the officers at his headquarters cooperated most earnestly with the chief surgeon in advancing the welfare of the sick. Transportation for supplies was always furnished and special fatigue details made whenever requested. Lieutenant Reeve, aid-de-camp to General Bates, rendered valuable assistance by volunteering to superintend the obtaining of the hospital equipment and its transportation to the site of the same. Major Irons, engineer officer, personally superintended the laying out of the hospital camp and the pitching of the tents.
On August 3 the corps commander summoned all the general officers and chief surgeons of divisions to a conference at his headquarters. When assembled he stated that his motive in thus calling them together was to obtain their individual views regarding the present sanitary condition of the army of occupation and recommendations as to the best policy to pursue. The unanimous opinion was then expressed that the army was in a deplorable condition on account of illness, and the only course to prevent its ultimate destruction was its immediate removal from Cuba. The feasibility of moving the command to the high ground in the interior was discussed, but found absolutely impossible owing to the fact that there was no organization in the entire army which could undertake to break camp and march 5 miles without 80 per cent, at least, being compelled to go upon sick report. A 10 miles` march would have converted the army into an immense hospital. The railroad, having a carrying capacity of only600 men, could not be used. as it would have taken a month to transport the army and its supplies. The Washington authorities seemed more apprehensive of yellow fever than anything else, which was probably brought about by the alarming reports from the experts and the almost general stampede, above referred to, in their ranks. But the regular and volunteer officers on the firing line were convinced that yellow fever was one of the lesser evils so long as it was confined to Siboney, but that typhoid, malaria, and dysentery were to be dreaded. These diseases proved so extremely debilitating and the malarial relapses recurred so frequently that it was only a question of time when the vast majority would succumb unless removed from the pernicious influences. This resulted in two statements being prepared and signed, one by general officers and the other by the chief surgeon, setting forth the above facts, and recommending the immediate removal of the entire corps to some point in the United States. This was favorably acted upon.
On the following day a board of officers consisting of Col. C. F. Humphrey, quartermaster department; Maj. F. J. Ives, brigade surgeon, United States Volunteers, and Lieut. J. J. Pershing, Tenth Cavalry, was ordered to inspect all transports leaving Santiago, with the view of determining their condition, capacity, and supplies. This duty devolved almost exclusively upon the writer, as Lieutenant Pershing became ill and left on one of the early transports, and Colonel Humphrey`s duties occupied his time almost exclusively. Every transport which left Santiago from August 5 to the 26th, when the writer sailed on the Berlin, was personally inspected by him one or more times before sailing. These inspections were in every case thorough and covered the condition of each vessel as to cleanliness, sanitation, and supplies. No troops were allowed to board a vessel until it had been reported in fit condition for their reception. The water-closet facilities were examined and found to be amply able to accommodate the number of passengers, and each was provided with suitable means of flushing. The floor
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space was carefully examined, and in no case was overcrowding permitted. If the utmost capacity or a vessel was 1,000, not over 500 or 600 would be allowed to embark, winch ratio was approximately maintained. The board was particularly careful in this respect, owing to the known weakened condition of the men and the large number of sick. The question of hammocks for the men and proper stateroom capacity and messing arrangements for the officers was investigated also whether the command was properly rationed and the senior surgeon had sufficient assistance and medical supplies. A schedule of medicines was made out by the chief surgeon of the corps, based upon the number on the transports. These together with the liberal allowance of foodstuffs for the sick were, under the personal supervision of the writer, put on board each transport. In many cases cots, mattresses, and bedding were taken for the use of the sick. Notwithstanding adverse criticism in the daily press, the writer does not believe an army ever before in the history of the world was more completely and more comfortably equipped than the Fifth Army Corps in the journey from Santiago to Montauk. When it is considered that the army was an immense moving hospital the death rate was remarkably low. Two of these transports, the Mobile and the Alleghany, were the targets of unusually vindictive attacks. The Mobile is a large cattle ship, with an utmost capacity of transporting 3,000 troops. She carried on this occasion about 1,600. The ship was clean, well ventilated, and in good sanitary condition when the troops boarded her. The accommodations for commissioned officers were not particularly satisfactory, but no complaints were made on that score. Supplies of all kinds were ample, for there were ten days` travel rations for the men and a liberal amount of special foods for the sick. The former had hammocks and the latter cots.
Adverse comments have been fully indulged in on the employment of "cattle ships," grewsome mental pictures being drawn whereby visions of inhumane overcrowding were indulged in, leading one to imagine our men jammed like a pen full of cattle in the stock yards. As a matter of fact ships of the Mobile type are most admirably adapted for transport purposes. They are constructed with a view to steadiness, and are well ventilated. The writer personally examined and inspected every vessel in the transport fleet, and saw every type from the St. Paul to the Stillwater, and the so-called "cattle ships" were far above the average as far as individual comforts of the enlisted men were concerned. The Alleghany was one of the most commodious and desirable of the transports. The statements against her made in the press dispatches were absolutely without truth. Dr. Magruder, of the Marine-Hospital Service, who inspected her upon arrival, was quoted as stating that she was in a most deplorable condition. In my presence, and that of several reporters, he denied having made any such remarks, and said that on the contrary the vessel was above the average. Captain Sullivan, of the Ninth Massachusetts Volunteers, was the senior line officer on the Alleghany. He informed me that all derogatory statements as to the condition of the ship were false; that during the trip from Santiago the men were comfortable, well taken care of, and had abundant supplies. The large death rate (14) was due to the greatly debilitated condition of the men, and was in no way augmented by anything incidental to the journey. The same can be said of the death rate (10) on the Mobile. The following features impressed themselves upon the writer as essential for all transports: That the fixed berths be entirely done away with and hammocks substituted; that every sleeping section should not only have port holes, but there should be a system of electric fans and forced ventilation; that the bathing facilities be rendered as commodious as possible; the kitchen facilities should be much increased, so that one hot meal a day may be served. All vessels should be lit by electric lights, and the quartermaster`s department should be responsible that sufficient life-preservers are on hand. There was not a ship in the entire fleet that had anything like the requisite amount of the latter, and the lifeboat capacity was entirely inadequate. This fact seemed to strike nobody as particularly essential, but unless it is rectified there may be a terrible calamity. Suitable regulations should be established for the guidance of the men while on the transports. If the weather permits they should be forced to takeoff their leggings, shoes, and stockings, at least during a portion of the day while the decks are being scrubbed down. A light form of shoe or slipper should be furnished, and an inexpensive yachting cap or light headgear of some kind. Many of the men, through carelessness or otherwise, lose their hats overboard, and as it is impossible to replace these except by borrowing from someone having an extra one on hand, very serious results are liable to follow.
The division began to embark for Montauk Point on August 18, being the last to leave. It was deemed preferable for each organization to carry its own sick, leaving behind only those whose condition rendered their removal perilous. The Olivett ehad previously taken on 40 cases, all but 1 being typhoid. The steamer Bay
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State, a hospital ship sent by the State of Massachusetts, took 60 of the worst cases in the Ninth Massachusetts, the majority of these being typhoid. Aboard of medical officers, consisting of Major Kilbourne and Captain Fisher, of the medical department, United States Army, and Acting Assistant Surgeon Gonzales, was appointed to examine all the members of each regiment prior to its embarkation with the view of determining whether any cases of yellow fever or even suspicious cases existed. All cases pronounced such by this board were ordered to remain in a detention hospital established for that purpose. About 30cases in the division were designated by this board as suspicious, but it was afterwards demonstrated that none of them had yellow fever.
Major-General Bates, his headquarters and staff, including the writer left Santiago on August 26, on the transport Berlin, which also carried the First Illinois Volunteers. After a pleasant and uneventful voyage Montauk Point was reached on August 30, a landing effected on the following day, and everyone placed in the detention camp at that place. The Provisional Division was never reorganized, but one regiment after another was ordered to their respective homes until, on September 12, it was completely dissolved.
Sanitary regulations.-During the period from the time of debarkation to the surrender it was impossible to follow any sanitary rules beyond a proper location and care of all sinks and the general policing of individual campsites. Water could not be boiled; men were forced to sleep on the wet ground with no tentage other than shelter tents, and but few were provided with changes of underclothing. After the surrender the condition in many regiments was improved, their camp equipments being obtained from the transports. The Third United States Infantry and the Ninth Massachusetts Volunteers were not able to obtain their property and as a result were in a very deplorable condition, especially the latter, who were not so able to take care of themselves, not being seasoned soldiers like the others.
The commissary department fulfilled nearly every requirement during this campaign, and at no time was the brigade, and later the division, without rations. Occasionally one article or another might be missing, but under the circumstances the department was excellently administered. After the surrender fresh meat and fresh bread were issued. Canned fruit, vegetables, and quite an assortment of commissaries were also to be obtained. Ice in fairly good quantities was also issued for the sick. The writer recommended to the corps commander that an ice machine in Santiago be seized and turned over to the medical department, but the idea was not adopted, as a large supply of ice was expected, which was ultimately received and issued. Soon after the occupation of Santiago supply depots were established by the commissary and medical departments. Gratuitous issues of canned fruits, soups, lime juice, rice, and condensed milk were made by the commissary in sufficient quantities for all the sick, the same being readily obtained upon requisition countersigned by the chief surgeon of the corps. The issue of coffee in the bean to the command during active hostilities was very unsatisfactory and occasioned unnecessary hardships. There being no coffee mills on hand each soldier was forced to crush the bean in his cup, which was usually done with the bayonet handle. The coffee was thus imperfectly ground and the product not up to the ordinary standard. Tobacco in some form during such a campaign should be a component part of the ration. Much suffering was experienced by the command on account of its absence. An emergency ration of some kind should have been supplied.
The Red Cross Society was a valuable adjunct in supplying necessaries to the sick. The writer had no occasion nor opportunity to call upon the same until after the surrender, when a requisition calling for oatmeal, corn meal, rice, malted and condensed milk in quantities sufficient to last the division several days was promptly filled. This occurred before the commissary department had established depots for the issue of supplies outside of the regular ration. Subsequently the society was called upon from time to time and never failed to respond.
The supply of medicines during the campaign was at times woefully short. However, by active exertion on the part of the writer, he was enabled to obtain a fair quota of everything available. From the time of landing until after the battle of July 4 the brigade was fully equipped, but when the epidemic of fever set in the supply of quinine, antipyretics, and calomel were quickly exhausted. Beef extract and condensed food of some kind was most urgently needed, as the only articles of diet were bacon and hardtack. Quinine and antipyrine were furnished in quantities which, although not abundant, were sufficient to meet the requirements, but the beef extract and calomel were not to be obtained. In fact, until the latter part of August the supply of calomel was practically nil. After the surrender a medical supply depot and ambulance station was established under the control of Lieutenant Kennedy, assistant surgeon, United States Army. Under this officer`s able management, a good supply and
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variety of medicine were constantly on hand. Limited amounts of beef extracts and whisky were obtainable. This depot was discontinued in the latter portion of July, and another, under Major Summers, brigade surgeon, United States Volunteers, was established in Santiago. During a period of several days, until Major Summers was relieved by Major Carr, brigade surgeon, United States Volunteers, there was considerable difficulty in obtaining supplies, and for one or two days the division was almost destitute of medicine of any kind. Colonel Havard, the chief surgeon of the corps, made a limited purchase of medicines from a local dealer, and a day or so later the writer, upon the approval of the chief surgeon, made extensive additional purchases from the same source. The Olivette arrived about August 8 with an assortment of medicines, but the supply was limited and contained only two small bottles of calomel. Soon after this medicines of all kinds came rapidly pouring in, and, under the capable management of Major Carr, were available for almost immediate issue. Besides the purchases above mentioned, quite an amount of calomel and other drugs were bought by individual regiments.
In the opinion of the writer, many statements regarding the absolute lack of medicines were exaggerated. At the meeting of general officers and chief surgeons above mentioned a chief surgeon of a division stated and repeated that his division had been without medicine of any kind for eleven days. No such state of affairs existed in the Provisional Division, for the writer adopted the plan of going personally every morning to the supply depot and there ascertaining exactly what medicines were actually on hand and what expected, and in that way succeeded in never being totally without medicines, except for the couple of days above mentioned. By adopting this plan in all subsequent efforts he was enabled to equip a hospital which was, in the estimation of many, second to none in the corps. The medicines most sorely needed, and of which there was a decided deficiency, were calomel, bismuth, morphine, strychnine, and a tonic tablet of some kind. The latter would have been of inestimable value during the period of convalescence. After the arrival of Major Summers hospital supplies of all kinds, exclusive of medicines, were abundant and readily obtained.
One of the greatest difficulties encountered by the writer in the management of his department was the almost complete lack of experienced hospital stewards. There were a number of volunteer hospital corps men in the division, but, with the exception of two acting stewards, one each with the Third and Twentieth Infantry, there were no regulars on hand. These volunteers did excellent service, but, being unfamiliar with military matters, were unable to render such assistance in the management of affairs as the serious nature of the occasion demanded. With the exception of the chief surgeon, there was no medical officer of the Regular Army with this division, consequently nearly all of the executive work pertaining to his department devolved upon him, not only in his own office, but throughout the command. The qualifications of many of the acting assistant surgeons were far from satisfactory, this being especially the case with many who reported for duty toward the end of the campaign.
Colonel Havard on several occasions offered the services of female nurses, but the writer declined them, being at that time opposed to their use in the field. Before the final close of the campaign, however, he became convinced that his previous conclusions were erroneous and that female nurses were in every respect superior to males in all division and general hospitals. Their presence near the firing line during active hostilities would not be desirable, but from their work in this campaign there can be no doubt of their great value in military hospitals.
Before concluding this report the writer would like to state that the conduct of all the surgeons and hospital attendants while attached to the brigade and division was on all occasions exemplary. All duties were performed faithfully, and each man seemed to strive with all his energy to accomplish what was assigned him. As chief surgeon of the division he takes great pleasure in expressing his high appreciation of the valuable services rendered by Acting Asst. Surg. T. F. Aby, regimental surgeon, Twentieth Infantry. This officer`s unceasing devotion to duty under the most trying circumstances was a matter of general comment. Acting Asst. Surg. C. E. P?ey proved himself an excellent officer, performing all duties assigned him with an energy and thoroughness that merits recognition. Majors W. P. Willard. surgeon, First Illinois, and R. A. Pyles, surgeon, First District of Columbia Volunteers, proved themselves efficient and valuable medical officers. The sanitary condition of these two regiments was fully as good as any in the division, and would compare favorably with that of the very best in the corps.
Capt. T. E. Roberts. assistant surgeon, First Illinois Volunteers, being the officer in charge of the division hospital, was in close official relations with the writer and cordially operated with him on all occasions. This officer, under the
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direction of the chief surgeon, had exclusive control of the hospital, and by his energy, zeal, and constant attention to duty and high professional attainments contributed more than any individual toward its success. The regimental surgeons were unable to keep records during the campaign, owing to the immense sick report and total lack of clerical facilities. However, a list of all cases admitted to the division hospital from July 18 until its final abandonment on August 25 was maintained and will enable the writer to furnish your office in the near future with a report of sick. A consolidated numerical sick report of the division was made daily, beginning July 21, from which the following tables are compiled:
Consolidated sick report of the Provisional Division, Fifth Army Corps, from
July 21 to August 25, 1898.
|
Treated: |
|
|
In division hospital |
967 |
|
In regimental camps |
5,620 |
|
|
6,587 |
|
|
|
|
Returned to duty |
5,555 |
|
Transferred: |
|
|
To general hospital |
87 |
|
To hospital ships |
114 |
|
To detention hospital |
31 |
|
Died |
31 |
|
Transferred to transports a |
769 |
|
|
6,587 |
|
|
|
|
In division hospital: |
|
|
Fever (all kinds) |
942 |
|
Other diseases |
25 |
|
|
967 |
|
In regimental camps: |
|
|
Fevers |
3,998 |
|
Other diseases |
1,622 |
|
|
5,620 |
|
Total |
6,587 |
CONSOLIDATED REGIMENTAL REPORTS.
|
|
Treated in Division Hospital |
Treated in regimental camps |
Total |
Length of time attached to division |
|
3d Infantry |
80 |
719 |
799 |
July 21 to Aug. 18 |
|
20th Infantry |
108 |
1,040 |
1,148 |
Do. |
|
1st Illinois Volunteers |
70 |
1,443 |
1,513 |
July 21 to Aug. 25 |
|
1st District of Columbia |
101 |
1,221 |
1,322 |
July 21 to Aug. 21 |
|
9th Massachusetts Volunteers |
542 |
904 |
1,446 |
July 21 to Aug. 25 |
|
34th Michigan |
40 |
293 |
333 |
Aug. 4 to Aug. 19 |
|
Casual |
26 |
|
26 |
|
|
Total |
967 |
5,620 |
6,587 |
|
CAUSES OF DEATHS.
|
Typhoid fever |
11 |
|
Pernicious malarial fever |
7 |
|
Malarial fever |
4 |
|
Measles |
2 |
|
Functional disease of the heart |
2 |
|
Gunshot wound (assault in a brawl) |
1 |
|
Tuberculosis pulmonalis |
1 |
|
Shock from exposure |
1 |
|
Asthenia |
1 |
|
Dysentery |
1 |
|
Total |
31 |
_______
a Those actually on sick report taken by regiments on journey to Montauk.
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DEATHS.
|
Officers |
2 |
|
Enlisted men |
29 |
|
Total |
31 |
|
Civilians attached to command |
1 |
|
Total |
32 |
Maj. Patrick J. Brady, Ninth Massachusetts Volunteers, died suddenly of functional disease of the heart, July 29, 1898.
Maj. Michael J. O`Connor, Ninth Massachusetts Volunteers, died August 6 1898; pernicious malarial fever.
Frank Talley, civilian, with First Illinois Volunteers, died August 4, 1898; remittent fever.
When the medical service was systematized after the surrender, each regimental surgeon was required to report daily all suspicious cases of yellow fever. There were 26 of such cases reported. They were in every instance isolated, but none developed into yellow fever. Only two of these were taken to the detention hospital, and, as far as learned, neither proved to be as suspected. Frequent examinations were made by Acting Assistant Surgeon Aby, whose residence had been in Louisiana for years, and who is perfectly familiar with the disease. He maintained throughout that he saw no case of yellow fever while on the island. From the clinical history of the fevers under treatment, the absence of death, and the fact that not a single case of yellow fever developed in the division during the journey north and subsequently, it seems to the writer very clearly demonstrated that his conclusions regarding the character of the fever were verified.
Pursuant to verbal instructions from the chief surgeon of the corps, the division hospital was abandoned on August 25, the tentage left standing, and all property remaining therein undisturbed.
