Books and Documents > The U.S. Army Medical Department in the Aftermath of the San Francisco Earthquake and Fire of 18 April 1906
ARMY HISTORICAL SERIES
THE
ARMY MEDICAL DEPARTMENT
1865-1917
by
Mary C. Gillett
CENTER OF MILITARY HISTORY
UNITED STATES ARMY
WASHINGTON, D.C., 1995
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Chapter 14
The Medical Service in Action
Disaster Relief
As more effective organization and training programs were developed to deal with the Army`s increasingly complex needs, the Medical Department could offer those outside the Army more effective aid when called upon to do so. Although the department helped the civilian population on many occasions, perhaps never in the early twentieth century was its aid more evident than in the aftermath of the earthquake of 18 April 1906 at San Francisco, when two shocks, ten seconds apart, collapsed buildings, sent chimneys crashing upon their occupants, and filled streets with rubble. Within minutes, fires began to break out all over the downtown sections of the city. For a brief time, while flames fed by gas from ruptured lines slowly but inexorably consumed block after block, broken water mains crippled firefighting efforts, and cracked sewer lines spewed their contents into the streets, the Army, "the only undisturbed and thoroughly equipped organization in California," ran the stricken city of San Francisco. More than 220,000people were rendered homeless, but how many hundreds died because of earthquake, fire, disease, and shock may never be known.54
Brig. Gen. Frederick Funston, acting commander of the Pacific Division, estimated at the time that the death toll was1,000. Maj. Gen. Adolphus W. Greely, commander of the Pacific Division, later reported that in the city of 500,000 only 498 lost their lives. Contemporary reports suggested that in the outlying communities fewer than 200 were dead and less than 500 of the 5,000 injured were seriously hurt. Authorities, who were determined not to discourage investment in the rebuilding of the city, dismissed out of hand claims that the loss of life resulting from the earthquake was actually much greater. Thus the low figures were accepted for more than fifty years, until brought into question by
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SANFRANCISCO, APRIL 1906, following the earthquake
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the work of the San Francisco Earthquake Research Project, operating from the San Francisco Public Library`s archives. This research suggested that more than 2,500 may have eventually died as a direct or indirect result of the disaster.55
Among the first to offer aid to the stricken populace was Capt. Henry H. Rutherford, an Army medical officer at the general hospital at the Presidio. He was watching the smoke that began to rise from the city when the second shock struck, "a great many seconds long, like the first one." His patients and their attendants did not panic, even though "the shadow of an unearthly stillness seemed to have fallen amongst us. We all spoke softly, in whispers some of us." When the tremors ceased, the hospital power plant and telephone and telegraph lines were no longer operative, the hospital water pipes were dry, and brick and plaster were everywhere. All buildings were to some extent damaged. In spite of the situation at the Presidio, Captain Rutherford and eleven other members of the hospital staff, without waiting for official orders and "all laden down with medical supplies," hiked three miles to San Francisco`s Convention Hall in forty-five minutes. A civilian doctor turned down their offer of help as not needed, "an interesting and amusing commentary on the characteristic of self-sufficiency and independence of the native Californian of the time." He soon had a change of heart, however, and began personally helping to load patients for transport to the Presidio hospital. By day`s end, with the fire threatening city hospitals, 127 injured civilians had taken refuge at the Army facility, where 145 patients from San Francisco`s seven hospitals would join them the next day.56
Only 40 of the 2,000 men stationed at the Presidio itself were injured, but by evening, as the flames began to consume the city, Captain Rutherford could see "multitudes seeking refuge, as the livid menace in the skies grew ever more appalling." Hospital Corps and engineer barracks at the hospital and at Fort Mason nearby were emptied so that refugees could be taken in. Mattresses were laid out on the general hospital porch, and tents began to go up on the grounds. From 18 April to 23 May, 756 new patients were cared for at the general hospital, of whom no more than 56 died. Since the general hospital, which held 700 patients when the earthquake struck, was in danger of being overwhelmed, Rutherford was ordered to set up an emergency receiving facility through which all incoming patients could be cleared before being assigned either to a hospital or to outpatient care. From150 to 200 outpatients a day were treated at this station, while three dispensaries established on the Presidio grounds handled 300-400 dressings a day. A total of more than 4,000 refugees, half sick, half injured, were eventually treated as outpatients. At nearby Fort Mason three of the 365admitted to the temporary hospital died. The hospital at another nearby postal so took in civilian patients. Doctors and nurses among the refugees fleeing the city joined Army personnel to provide first aid and to distribute patients in need of further care among available facilities.57
On the evening of the nineteenth, when the peak of the demand placed on the general hospital was reached, "the fire could be seen gathering his mighty forces," Captain Rutherford remembered, "consolidating them into one awful tremendous roar, driving the homeless in before him. . . . They were everywhere and still they came; old and young, sober ones and the hilarious, hysterical men, women, and children;
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horses and mules and dogs and cats." Under the strain, those of less than robust health broke down;" apoplectics had their strokes, worn old hearts gave out, neurotics went to pieces and drunkards had D.T.s. Most embarrassing of all were the numerous cases of childbirth. Women were having babies all over the woods. . . . Theillumination from the skies, brighter by the moment, was a godsend. It helped mightily in our ministerings."58
The initial reactions of the medical officers in the San Francisco area to the disaster were instinctive and improvised. Torney, at the time a lieutenant colonel and the chief surgeon at the general hospital, together with the post surgeon at nearby Fort Mason and presumably others as well, unhesitatingly made financial commitments without the authority to do so, correctly assuming that the formalities would be taken care of later. Now at the request of city officials, General Funston, in the absence of General Greely, who was on leave, moved to restore system and order in the wake of the disaster. One of the first steps he took was to relieve ColonelT orney, who was also acting chief surgeon of the Department of California at the time of the earthquake, of his command of the general hospital so that he could take "charge of the sanitary arrangements for the city of San Francisco," coordinating all medical efforts, both civilian and military, in the area and advising the city`s health commission about sanitation. In this capacity, Torney became head of a committee of civilians responsible forensuring the cooperation of Army and civil authorities in sanitary matters.59
When General Greely returned from leave on 22 April, water had been restored to the general hospital and repairs to the electrical system were almost complete. Although he continued the effort to design a plan to maximize the effectiveness of the Army`s contribution to the relief of the city, Greely was concerned that the Army`s activities might undermine the city`s ability to take care of itself. On 7 May, therefore, when he announced that he was making each of the six military districts into which General Funston had divided the city a sanitary district, he had civil authorities assign each a civilian rather than a military doctor to be responsible for "all sanitary matters other than hospitals in the military district in which he is stationed." While these civilians would still report to Colonel Torney, Greely retained direct Army responsibility for sanitation and health only at the camps under military control.60
In the confusion that followed the earthquake, a week passed before shelter was found for all in need. Sanitation in these hastily erected camps, except those under military control, was often poor. General
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Greely soon concluded that the homeless would be better off in the twenty-one camps that were eventually established by the Army. Although the first of these communities were set up on an emergency basis, the remainder were created only after Colonel Torney had worked with civilian authorities to choose healthy sites. The operation of all Army camps, which at one point held 20,000 refugees, was supervised by a chief camp surgeon, who inspected both military and nonmilitary camps. Reporting to him in each camp was a medical officer named to work with the camp`s commanding officer to maintain the sanitation of the community and the health of the refugees. Hospital corpsmen were also assigned to each camp, as was a civilian physician. Sick call was held every day, and all those more than slightly ill were hospitalized. Patients with contagious diseases were isolated in hospitals established for the purpose.61
The initial Medical Department response to the disaster had involved only the department personnel who were in the area at the time, but the needs of hundreds of thousands of people sheltered in hundreds of camps required a much larger medical team than could be found in northern California. The first shock was scarcely over, therefore, before Medical Department resources, both human and materiel, together with much from civilian agencies, began coming in from far as well as near. A special train, bearing a medical officer, three noncommissioned officers, and a hundred men of a Hospital Corps company, was soon speeding west from Washington, D.C., picking up Red Cross nurses and doctors and extra carloads of supplies as it went. The attempts of the Red Cross team to provide aid aroused resentment; a member of the Oregon National Guard stated that too many Red Cross officials were "riding about in automobiles making much noise and fuss, promising all sorts of relief for everybody and so far as my observation went failing to execute these promises." Efforts of the Hospital Corps unit were apparently more successful. It spent almost two months in the San Francisco area, on 25April setting up a field hospital in the Golden Gate Park, "a model institution" with one ward specifically for maternity cases, where future surgeon general Lt. Robert U. Patterson assisted the chief sanitary officer. A second ward and a 200-bed hospital that had been established four days earlier served patients with contagious diseases.62
Before the end of the month two Hospital Corps detachments came in from St. Louis, one of which brought another field hospital. Fifteen surgeons from western posts, six recently returned from the Philippines, and two on leave in the area were also assigned to work in San Fran-
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cisco. By 22 April forty-two doctors were serving the Presidio sanitary division alone, and on the twenty-fourth Colonel Torney notified Surgeon General O`Reilly that no more medical officers were needed. The Medical Department supplied the twenty-six dispensaries opened at Torney`s suggestion by the city`s health commission, although twenty-five of them were closed shortly thereafter when the city`s health remained good and local pharmacists and physicians began to complain about the harm done their sources of livelihood by government competition. Units of the Oregon National Guard also joined those helping the refugees, opening an emergency hospital in aschool.63
Supply was not a serious problem, though the fire that followed the earthquake had destroyed the San Francisco medical depot. A new depot was quickly set up, first in the basement of the general hospital and later, because of the danger of fire and the crowded conditions there, in tents near the hospital. All items except those needed by the general hospital were pooled at this site, to be drawn upon as needed. Medical officers filled the new depot with supplies brought in from neighboring cities or shipped in from St. Louis. On 28 April it was closed in favor of a larger depot. Even a fire that destroyed the general hospital`s laundry was taken in stride.64
The authority of the Army to provide assistance at San Francisco had never been clear, and its resources in supplies and manpower were limited, but the Medical Department played a vital role in the prevention of epidemics among refugees as well as in the care of the sick and injured. Three times in April 1906 Congress voted money to aid earthquake victims, and on the twenty-fourth and the twenty-eighth Secretary of War Taft allotted the Medical Department a total of $400,000 to meet its share of the expenses. In June Congress appropriated another $100,000 to replace medical and hospital supplies destroyed at San Francisco. The sanitary inspectors assigned to refugee camps worked to ensure that water supplies were safe, latrines properly located and maintained, and food properly prepared and protected from flies. By the end of April the Army was also issuing smallpox vaccine at the rate of 3,500 doses a day. Although no compulsion was used, all who were willing were immunized. In the two months following the quake, military and civilian authorities and hospitals also cooperated to create a comprehensive daily report on typhoid cases so that their origin could be traced. When several cases appeared in the same area, the Pacific Division`s sanitary inspector checked into conditions and, working through the mayor`s office, had those camping in the area removed. In spite of the strain under which the dispossessed inhabitants of San Francisco lived, a brief increase in typhoid and smallpox cases in the six weeks immediately after the earthquake did not lead to epidemics. Moreover, of the 123 cases of smallpox with 11 deaths that were reported in the two months after the earthquake, only 1 was found in a camp under military control. Only 5 of the 95 cases of typhoid fever diagnosed among refugees after 18 April originated in a military camp. The average number of typhoid fever cases in San Francisco before the earthquake had been 12 a month, but 30 were diagnosed in April and 55 in May, with the rate falling back to 10in June.65
In mid-May 50,000 people were still sheltered in a hundred or more camps when General Greely announced that he was turning over to city officials complete responsibility for sanitation in San Fran-
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cisco. The Army began returning the civilian patients remaining in military facilities to civilian hospitals. As part of the Army`s gradual withdrawal from the relief effort, on 13 May Colonel Torney`s almost unlimited authority ended. From this time until he was relieved on 23 May, his responsibility for civilians was confined to that of the chief surgeon to the newly appointed commander of permanent camps. Torney`s successor, the new chief surgeon of the Department of California, also served as chief sanitary officer of the Army-controlled camps. As medical officers returned to their normal stations, the number serving in the city dwindled. By July only those camps located on the Presidio grounds remained under the Army`s control, and by the end of that month the Army`s role in the relief of San Francisco in the aftermath of the earthquake had been played out.66
Dealing successfully with the often terrified victims of fire, flood, storm, and earthquake at the turn of the century emphasized the importance of capabilities civilian agencies did not have. Among the advantages the Army had were a tightly controlled organization and a dedicated force of men and women too well disciplined and too well trained to panic, who were prepared to obey orders promptly and without argument, and who were familiar with maintaining standards of sanitation in primitive circumstances. Furthermore, to meet the sudden and overwhelming needs arising from unpredictable natural disasters, large amounts of medicines, vaccine, and hospital supplies unlikely to be immediately available from civilian sources and the transportation to move them and additional manpower swiftly to the disaster site were necessary. Equipped with reserves from the Army`s warehouses, the Army Medical Department`s professionally trained men and women could be moved promptly to the site of the disaster, where, regardless of the conditions surrounding them, they were capable of functioning effectively both to care for the sick and injured and to prevent further disaster in the form of an epidemic.
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NOTES
54. Adolphus W. Greely, Earthquake in California, April 18, 1906, p. 15 (quotation); WD, ARofSW, 1906,p. 101; Charles Keeler, San Francisco Through Earthquake and Fire, pp. 4,9, 26, 48; Gordon Thomas
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and Max M. Witts, The San Francisco Earthquake, pp. 71, 78, 149. An excellent study of the Medical Department`s role in aiding the victims of disaster, including those of the San Francisco earthquake, can be found in Gaines M. Foster, The Demands of Humanity, on which this account of the San Francisco disaster is based, except where otherwise indicated.
55. Gladys Hansen and Frank Quinn, "The San Francisco Numbers Game," Paper of the San Francisco Earthquake Research Project, San Francisco, Calif.; Terry Link, "The Great Earthquake Coverup"; Greely, Earthquake, pp. 7-8, 14-15, 30, 32, 44;WD, ARofSW, 1906, p. 200.
56. Quotations from Henry H. Rutherford, "Experiences of an Army Medical Officer During the San Francisco Earthquake," pp. 208-09. See also ibid., p. 210; WD, ARofSG,1907, p. 126; Greely, Earthquake, pp. 31, 129; Keeler, San Francisco, pp. 9-10; John C. Kennedy, The Great Earthquake and Fire, p. 132; Rpts, George H. Torney to Adolphus W. Greely, 14 May 1906, vol. 3, and J. M. Kennedy, vol. 4, Ms B286, "Report on Sanitation in San Francisco After the Earthquake," NLM; Thomas and Witts, San Francisco Earthquake, p. 71.
57. Rutherford, "Experiences," p. 210 (quotation); Greely, Earthquake, pp. 31,129-30; Rpts, Henry H. Rutherford, J. M. Kennedy, and William Stephenson, vol.4, Ms B286, NLM; WD, ARofSG, 1907, p. 126.
58. Rutherford, "Experiences," pp. 210-11.
59. Quotation from Pacific Div GO 11,20 Apr 1906, vol. 3, Ms B286, NLM. See also Greely, Earthquake, pp. 5,11, 18, 24-25, 31-32, 60, 72, 130; Kennedy, Earthquake, p. 169; WD, ARofSG,1906, pp. 131-32.
60. Greely, Earthquake, pp. 10,58-59, 66 (quotation); Rpts, Albert Truby and J. M. Kennedy, vol. 4, Ms B286,NLM; WD, ARofSG, 1906, p. 132.
61. Greely, Earthquake, pp. 33,35, 66, 73, 130-31; Kennedy, Earthquake, pp. 109-10; Rpts, Kenneth A. J. Mackenzie, vol. 1, A. Truby, vol. 4, and H. H. Rutherford, vols. 1 and 4, MsB286, NLM.
62. William E. Carll, "The Oregon National Guard at the San Francisco Earthquake Disaster," p. 462 (first quotation); Greely, Earthquake, pp. 20-21, 31-32, 131 (second quotation);WD, AR of SG, 1906, pp. 116, 132-33; Rpts, H. H. Rutherford, vol. 1, and Robert U. Patterson, 5 Jun 1906, vol. 4, Ms B286, NLM; George H. Kress, "United States Army Field Hospital in San Francisco in 1906. . . ," p.215.
63. Carll, "Oregon National Guard," p. 462; Kennedy, Earthquake, pp. 109-10; Greely, Earthquake, p. 44; Roster, Sanitary Div, Presidio, 22 Apr 1906, vol. 1, and Rpts, George H.Torney to SG, 24 Apr 1906, and to Greely, 14 May 1906, vol. 3, Ms B286, NLM.
64. WD, ARofSG, 1906, pp. 126,132-33; Kennedy, Earthquake, p. 45; Greely, Earthquake, pp. 32,131-32; Rpt, J.M. Kennedy, vol. 4, Ms B286, NLM.
65. Greely Earthquake, pp.32-34, 58-59, 131, 133-34; Rpt, A. Truby, vol. 4, Ms B286, NLM; WD, ARofSG,1906, p. 12, and 1907, p. 9.
66. Greely, Earthquake, pp.32-33, 72, 131; Pacific Div SO 66, 23 May 1906, vol. 3, and Rpts, H. H.Rutherford, J. M. Kennedy, and W. Stephenson, vol. 4, Ms B286, NLM. According to WD, ARofSG, 1906, p. 12, the secretary of war allotted the Army Medical Department $400,000 of money voted for the "relief of sufferers from earthquake and conflagration on the Pacific coast (joint resolutions of April19, 21, and 24, 1906)."
