Books and Documents > The U.S. Army Medical Department in the Aftermath of the San Francisco Earthquake and Fire of 18 April 1906
Extract from
Annual Reports of the Secretary of War for the Fiscal Year Ended June 30, 1906
Volume I, Appendix A
Earthquake in California, April 18, 1906
Special Report of Maj. Gen. Adolphus W. Greely, U.S.A., Commanding the Pacific Division
30 July 1906
117
EMERGENT SANITATION
These were first entrusted to Lieut. Col. George H. Torney, deputy surgeon-general, U.S. Army, who, addition to his work in command of the Army General Hospital at the Presidio, was serving as chief surgeon, Department of California.
The magnificent and well-equipped General Hospital was left by the earthquake with a disabled power plant, deprived of its water supply, without telegraphic or telephonic connections, and its buildings more or less injured. These adverse home conditions did not prevent prompt medical relief. On the first day 127 city patients were admitted to the hospital, followed the next day by 145 others from hospitals burned or threatened. When the capacity of the wards was exhausted, the Hospital Corps barracks were vacated and fitted up for relief work temporarily. In addition, large numbers of refugee patients were received at the hospitals of the Presidio and Fort Mason, and other facilities were extended through tent emergency hospitals. On the arrival of Company A, Hospital Corps, a field hospital was established in Golden Gate Park to care for the sick among the thousands of refugees there having temporary shelter.
On April 20 Colonel Torney`s cooperation with the civil authorities commenced at the request of Dr. J. W. Ward, president of the health commission of San Francisco. It was fortunate that an officer of Colonel Torney`s ability and professional attainments was available for this work, which has been performed in an able manner. He acted as head of a committee appointed to insure between the army and civil authorities coordinate action relative to sanitation of
118
the city. In this capacity the inhabited parts of he city were divided into districts, with a medical officer of charge of each. He also assumed control of the camps of refugees on the Presidio reservation and Fort Mason and in Golden Gate Park and exercised sanitary supervision over other small city parks. A hospital for contagious diseases was established April 21,at Harbor View Park, large enough to accommodate 200 patients. It was admirably situated for this work, through its water supply and laundry pavilion.
In the beginning needful medical supplies were freely issued from the General Hospital to hospitals and camps. On April 21 a medical supply depot was improvised in tentage with the ground of the General Hospital, under Lieutenant-Colonel Brechemin, deputy surgeon-general, U.S.A., who assumed charge of the work, his entire depot of medical supplies having been destroyed in the city. Medical supplies have been promptly issued by Colonel Brechemin to all authorized applicants. Vaccine virus was also freely distributed on requisition. Twenty-six dispensaries were speedily opened, where free medicines and free medical attendance were available to every applicant. The wonderful health of the city and the not unreasonable complaints of destitute doctors and druggists that such action was most injurious to them caused me soon to reduce the number to six, which were very speedily still further reduced to one, with the consent of the city authorities and of the health commission.
Except for the first week, when many slight and minor injuries were treated and delicate persons placed on the invalid list, the hospitals of San Francisco were fully able and entirely willing to treat all cases. Indeed, it may be noted, as showing that there was no absolute need of outside medical help, that, as officially reported to me, one large hospital had some sixty vacant beds and was not called upon to attend to a single patient on account of the earthquake and fire. Nevertheless, the extensive precautionary arrangements by the Medical Department, tough happily not absolutely necessary, were none the less wise in view of the many instances in the past where epidemics have followed great disasters.
As soon as settled conditions obtained, it seemed best to return to army methods and control. Cooperation with the Board of Health had not proved entirely satisfactory, as it developed responsibilities and expenses upon the army far exceeding the advantages derived from a system wherein the army could only express its opinions with means of enforcing them.
CAMP SANITATION
On May 13 there were 50,000 living in more than 100 separate camps, of which 21 were under military control. The health commission was unable to care for these great and extensive problems thrust upon them, and the sanitary conditions were gradually becoming worse and worse. In many cases there was neither power, personnel, nor money to remedy even the worst conditions which were daily reported by the inspector-generals of the military division.
On May 13 official cooperation between the health commission and ceased by the relief of Colonel Torney. Dr. J. W. Ward, president of health commission, was informed, with the assent of
119
Mayor Schmitz, that thereafter the army would neither assume responsibility nor incur expenses connected with the sanitation of the city of San Francisco, but that medical advice would be given on any particular problem, should such counsel be desired. It was further stated that the army assumed the entire control and expenses of medical and sanitary measures connected with the21 military camps.
In reorganizing this service Army Regulations were followed, the relations of the camp surgeons and commanding officers to be identical with those obtaining at military posts. Colonel Torney remained as chief sanitary officer until May 23, on which date, with the consent of General Funston, the duties devolved upon Col. C. L. Heizmann, who succeeded Colonel Torney as chief surgeon, Department of California. Colonel Heizmann`s extended experience and professional knowledge were freely placed at my disposal. To as great an extent as was practicable, his recommendation were followed, though, owing to the scarcity of officers in the Medical Department, I noticed the requisition for additional surgeons of the Army from 25 to 10, depending on the local profession in case of an emergency.
The most rigid supervision was exercised over military camps in which there were at different times 20,000 refugees, and a close eye was had on 25,000 scattered campers not under our supervision, and the 5,000 temporary shacks. In addition to rigid daily inspections by the surgeons and commanders the camps were often visited by the officer in general charge of camps and his chief surgeon. The division inspectors kept close watch on the outside private camps. Careful attention was given to limiting fly infection by screening the kitchens and insisting on the use of gauze over all cooked food. Reed troughs were added in every camp, and in the larger camps odorless excavating machines were utilized. Facilities for washing, for bathing, and for laundry work were furnished as far as practicable. The tents were floored and daily ventilation and the exposure of the interior of the tents to sunlight were insisted upon. Provisions were made for the prompt transfer of all serious cases of sickness to selected hospitals so that the attention of the camp surgeons could be given almost exclusively to sanitary and precautionary measures. The daily report showed an average sickness of less than 3 percent.
Whenever a case of typhoid fever occurred in or near any one of the military camps the utmost care was used to thoroughly disinfect everything connected with it. As typhoid cases were almost entirely contracted outside of military camps, instant and suitable action was urged on the municipal authorities. Later, samples of water in common use were collected weekly and cultures made therefrom to determine its potable safeness. Every resident of a camp who would consent was vaccinated. As to those refusing, it seemed best under the condition of the public mind to defer compulsory vaccination until smallpox should break out in some camps, which it did not. The cooperation of the health department and of every hospital in the city was secured relative to typhoid fever cases, and a daily report thereon was made. Every case was traced to the point of its original infection, and these were charted on a map of the city. While the cases were sporadic, yet when two or three developed in the same general neighborhood the sanitary conditions of the district
120
were carefully examined by division inspectors. Steps were then taken to enforce suitable sanitary regulations and to removing the campers through the medium of the Mayor, the health department, and the police.
Asst Surg. J. R. Devereux, in charge of the medical data at these headquarters, reported, in part, on the conditions from April 18 to June 23, as follows:
We have an account of 99 cases of typhoid fever; of these 99 cases 4 cases occurred prior to April 18; of the 95 remaining cases 30 originated in April, 55 in May, and 10 in June. Of these 95 cases there are remaining 49 either in hospitals or in private houses, 17 have died, and 33 have been discharged as cured. Of the 49 remaining cases there are 4 in the United States General Hospital that are, to all intents and purposes, cured cases, so that practically we have but 45 cases of typhoid fever remaining in the city. Of the total number of cases reported there have only been 5 that were derived from the permanent camps whose residence was sufficiently long to have made their infection possible at these camps. . . . Of the smallpox cases there were admitted in the smallpox hospital in the month of April 74 cases, with 9 deaths; during the month of May 41 admissions, 2 deaths; during the month of June to date there have been 8 new cases admitted, no deaths, and 25 cases remaining in hospital. The total number of cases therefore is 123, with 11 deaths. There have been approximately in permanent camps 15,000 people (as an average) and only one case has originated in a camp under our control.
It is too much to assume that this wonderful record of freedom from infectious disease among a population of 50,000 person living in camps has been due to methods followed or precautions taken. It is, however, reasonable to assume that the above precautions, along the lines recommended by medical officers of the Army, served as preventives against the development of sporadic cases into an epidemic.
