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 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 WAR CORRESPONDENCE 
 
 {HISPANO AMERICAN WAR) 
 
 LETTERS FROM 
 
 DR. NICHOLAS SENN 
 
 CHIEF SURGEON U.S. VOLUNTEERS. 
 CHIEF OF OPERATING STAFF WITH THE ARMY IN THE FIELD. 
 
 REPRINTED FROM THE 
 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 
 
 CHICAGO: 
 
 American Medical Association Press. 
 
 1899.
 
 Library 
 
 CONTENTS, 
 
 War Correspondence 1 
 
 An Old Battle Ground 24 
 
 Letter from Camp George H. Thomas 31 
 
 Assigned to a New Field 41 
 
 The Floating Hospitals 50 
 
 The Medical Department of the Army in the Cuban Cam- 
 paign 55 
 
 The Qualifications and Duties of the Military Surgeon . . 61 
 The Invasion of Porto Rico from a Medical Standpoint . . 79 
 
 Typhoid Fever in the Porto Rican Campaign 95 
 
 The Returning Army 101 
 
 The National Cry 108 
 
 Our Relief Societies 115 
 
 The Wounded of the Porto Rican Campaign 122 
 
 On the Frequency of Cryptorchism and its Results .... 131 
 
 The Seat of War and our Military Surgeons 133 
 
 Headquarters Fifth Army Corps 138 
 
 Recent Experiences in Military Surgery after the Battle of 
 
 Santiago 146 
 
 The Surgery of Camp Wikoff 183 
 
 Empyema in Camp George H. Thomas 237 
 
 Esculapius on the Field of Battle . 255 
 
 Nurses and Nursing in War 265
 
 WAR CORRESPONDENCE. 
 
 The beating of the drum, the measured tread of an armed 
 host are again heard throughout the land and have aroused 
 the patriotic spirit of the American people. For a fifth time 
 our nation is face to face with a war the gravity of which it is 
 impossible to estimate at the present time. The first war 
 brought us our liberty and independence ; the second estab- 
 lished our reputation on the sea ; the third taught our Mexican 
 neighbor respect for our country ; the fourth saved the Union, 
 and the fifth, which is now being waged, was provoked in the 
 cause of humanity. 
 
 For centuries the beautiful neighboring island of Cuba has 
 been in the greedy grasp of a foreign nation. The people to 
 whom this gem of the ocean belongs have been downtrodden, 
 tyrannized over and abused by the cold iron hand of an effete 
 monarchy. The humane liberty-loving people of the United 
 States have heard the cry of the oppressed starving Cubans 
 for years, and have done all in their power, short of resort to 
 the sword, to relieve their sufferings, but without avail. The 
 ear of the proud, cowardly Spainard remained deaf to well- 
 meant and most earnest appeals. The Chief Executive of the 
 United States exhausted every resource to improve the condi- 
 tion of the native Cubans, the rightful owners of the unfor- 
 tunate island, without bloodshed, but all his efforts were 
 ignored and antagonized by the brutal oppressors. 
 
 War is always a great calamity, but when entered upon for 
 the sake of humanity, for the relief of the oppressed, it becomes 
 a weapon in the hand of the Almighty. The issue before us is 
 a righteous one, and it is not difficult to forecast the ultimate 
 result. Justice and humanity are on our side ; corruption and 
 oppression on the other. On our part the struggle is purely 
 unselfish ; on the other it is a desperate but vain attempt to 
 ignore the claims of an enslaved people. Such are the condi- 
 tions of the present war with Spain, at the same time our peo- 
 ple will now and for all time come "Remember the Maine."
 
 The war has begun, the deafening roar of cannon has been 
 heard in different Spanish ports, the hero of Manila has planted 
 the Stars and Stripes, the emblem of liberty and equality, on 
 the shores of the distant Philippine Islands ; there it will 
 remain until the unhappy inhabitants breathe the bracing air 
 of independence. No war was ever undertaken in which the 
 government had such a firm and enthusiastic support from the 
 mass of the people regardless of politics, religion, nationality 
 and position in life. 
 
 The policy laid out, advised and carried in effect by President 
 McKinley, meets with the undivided support of the reunited 
 nation. The gray is eager and anxious to don the blue in his 
 country's cause. Federal and Confederate meet again to talk 
 over the memories of the past at a common camp fire during 
 the campaign against a common foe, who has been permitted 
 far too long a time to abstract the life blood of an innocent 
 people, the legitimate owners of one of God's most beautiful 
 islands so close to our own great, forever free and united 
 country. 
 
 ILLINOIS ARMY. 
 
 Illinois has always been in the front when our country was 
 in danger. Its record during the War of the Rebellion stands 
 foremost in the history of the nation. It gave to the nation 
 Abraham Lincoln, who, during the dark days of the Rebellion, 
 guided the Ship of State through many a storm and many a 
 danger into a harbor of safety and gave freedom to a despised 
 and degraded race. It gave to the nation Grant, who led the 
 army from victory to victory, until the misguided but deter- 
 mined foe was willing to sue for peace and accept the terms 
 offered by its conqueror. It gave the nation a Logan, whose 
 heroic and gallant deeds brought terror to the enemy. It gave 
 the nation an army of soldiers who took an honorable and heroic 
 part in the deadly contiict. It gave the nation Dick Oglesby, the 
 intimate friend of Lincoln, who happened to be in Washington 
 on the memorable night of Lincoln's assassination. The moment 
 the fatal shot was fired he was summoned, and when he arrived 
 at the entrance of the house to which Lincoln had been taken, 
 he was confronted by an armed guard who refused him admis- 
 sion. There was no time for argument ; the sturdy Governor 
 grasped the guard by his collar and pushed him aside like a
 
 J. N. Reece, Adjutant-General,
 
 toy, with the words, '* I am the Ciovernor of Illinois, get out of 
 my way I" 
 
 Illinois will do her share in the present conflict. When the 
 War Department called for troops, the message was received 
 by Governor Tanner on April 26. After a brief consultation 
 with Adjutant-General Reece, the button was touched flashing 
 the order over the wires to the regimental commanders in 
 different parts of the State, and in less than thirty six hours 
 10,000 men were at the State Fair Grounds at Springfield ready 
 to do their duty. General Barkley, the senior Brigadier Gen- 
 eral, was placed in command of the post, which he named 
 Camp Tanner, and thanks to his foresight, energy and knowl- 
 edge of military art. the troops received proper shelter and 
 were assigned to their quarters immediately upon their arrival. 
 Adjutant-General Reece demonstrated by every act that he 
 was master of the situation. There was probably never a time 
 when upon such short notice a temporary camp for so large a 
 force was made more comfortable and efficient. Both of these 
 officers, as well as their subordinates, are entitled to great 
 credit and to the thanks of the good people of Illinois for 
 having acted so promptly and wisely to efficiently meet such an 
 emergency. The newspaper reporters and visitors to the camp 
 were astonished by the fact that no complaints were made 
 either by officers or men. Considering the limitations of equip- 
 ment, the number of men in the camp, the unprecedentedly 
 disagreeable weather and the short notice, this must certainly 
 appear as the most satisfactory proof of the intense patriotism 
 which animated every man and made him ignore his physical 
 requirements in the thought that he was called upon to dis- 
 charge a duty to his country. 
 
 A few days after the arrival of the seven regiments of infan- 
 try and the First Regiment of Cavalry, Captain Veager of Bat- 
 tery A, First Artillery, appeared in camp with a splendid body 
 of well drilled men, which added much to the military appear- 
 ance of the camp. The representatives of the United States 
 army, Lieutenant Colonel Roberts, Captain Swift and Lieuten- 
 ants Ballou, Cole and Davis were on the field early and ren- 
 dered invaluable service in the organization and mustering in 
 of the troops. It was indeed pleasant to observe the harmony 
 in word and action which prevailed between these officers of the
 
 regular army and the officers and men of the National Guard. 
 This war will do much in cementing together more closely the 
 professional and citizen soldier. In less than four weeks all 
 of the troops were examined, mustered into the United States 
 service and turned over to the Government. 
 
 Lieuteiiaut-Colonel Kobeils. 
 
 The Fifth and Third Regiments of Infantry were the first to 
 leave Camp Tanner amid the cheers of their comrades left 
 behind. In due time they reached their appointed station, 
 Camp George H. Thomas, Chickamauga, Ga. The Sixth 
 Infantry was next ordered to Camp A Iger, Falls Church, Va.,
 
 6 
 
 near Washington, and the First Infantry a few days later 
 joined their comrades of the Third and Fifth Regiments at 
 Chickamauga. The Second Infantry was then ordered to 
 Tampa, but en route received notice to report at Jacksonville, 
 Fla. The Fourth Infantry, after considerable delay, was 
 ordered to Tampa, the Seventh Infantry to Virginia, and the 
 First Cavalry is now on its way to Camp Thomas, Chickamauga. 
 
 GOVERNOR TANNER. 
 
 The office of governor of a State is always important and 
 responsible, but especially so in time of war. The citizens of 
 Illinois have reason to congratulate themselves that during 
 the last election their choice fell upon the right man at the 
 right time. Governor Tanner has shown that he is made of 
 the right metal for an effective and wise war governor. His 
 experience during the late war as a private has been of great 
 value to him in meeting the duties of the hour. He knows 
 what it is to serve in the ranks, and has therefore taken the 
 deepest interest in the welfare and comfort of every soldier who 
 has come to the camp. He is a staunch friend of the common 
 people (the backbone of the nation), and has catered but little 
 if any, to the whims and fancies of the silk stocking element. 
 He is now more popular than ever with the National Guard. 
 He takes pride in his army. He imbues every soldier with the 
 idea that the highest position is within his reach if he devotes 
 himself to his legitimate duties. He has strained every nerve 
 in bringing his troops to the front, and has had the satisfac- 
 tion of seeing an Illinois regiment the first to be mustered into 
 the volunteer service of the United States, and that the Stale 
 he represents has thus taken the lead as regards prompti- 
 tude and dispatch in answering the call of the President for 
 volunteers. 
 
 Our Governor is intensely patriotic ; he has shown this in 
 every act in the organization and equipment of the troops. It 
 is not generally known that Governor Tanner is a great orator ; 
 the speech which he made at a banquet he gave to the officers 
 of his staff and of the regiments in camp, was a revelation to 
 every one present. He seemed to be inspired ; his eyes flashed : 
 every nerve and muscle responded to his intense emotion ; 
 every word and thought found a hearty response in the hearts 
 of his profoundly interested audience. I doubt very much if
 
 he will ever be able to duplicate that speech, because such an 
 occasion comes but once during a man's life. It was a speech 
 which left a deep and permanent impression, a speech calcula- 
 ted to make a man better and more devoted to his country and 
 his country's flag. 
 
 John R. Tanner, Governor of Illinois.
 
 8 
 
 The Governor has visited the camp daily and always has a 
 cheerful word and a pleasing smile for everyone he meets, pri- 
 vates and officers alike. John R, Tanner will go down in his- 
 tory as a famous war governor, a worthy successor to Govern- 
 ors Vates and Oglesby. 
 
 MRS. TANNEK. 
 
 The beautiful, youthful and accomplished wife of our Gov- 
 ernor came to the Executive Mansion at the right time. She 
 takes great interest in the work of her distinguished husband. 
 
 Mrs. John K. Tauiier. 
 
 She is a great favorite with the people of Springfield. She is 
 ready in conversation and quick in perception. She visits the 
 camp frequently and takes an active interest in the care of the 
 sick. Her cheerful disposition and her tender care of her hus- 
 band have done much to lighten the heavy burden and many 
 perplexities, which have been resting upon the shoulders of 
 our overtaxed Governor since he assumed the duiies of his 
 office, and more particularly since the declaration of war with 
 Spain.
 
 9 
 
 THE CAMP GROUND. 
 
 When the sudden call for troops came it was an important 
 matter to select a camp centrally located and adapted for the 
 season of the year. The officers of the State Agricultural 
 Society came to the rescue of the military authorities and 
 
 Brigadier-Geueral James H. Barkley, Senior Coiumauder of the Camp.
 
 10 
 
 offered gratuitously the State Fair Grounds for the use of the 
 troops during mobilization. The grounds occupy 160 acres of 
 land, north of the city limits, and are easily accessible by a line 
 of electric cars. The surface of the ground is undulating and 
 divided by several ravines well adapted for effective surface 
 drainage with a little expenditure of time and money. The 
 subsoil is of clay, which in combination with the continued 
 rains made the streets pools of mud for more than a week, a 
 destroyer of foot gear and a rich harvest for the bootblack. 
 
 The permanent buildings were well adapted for temporary 
 quarters for the imperfectly equipped soldier. For two weeks 
 two of the regiments lived in tents. The camp was supplied 
 with filtered water from the Sangamon River. A specimen of 
 the water was sent for analysis to Dr. A. W. Palmer, professor 
 of chemistry at the State University, who pronounced it whole- 
 some and practically pure. 
 
 A sufficient number of sinks were dug and boarded in and 
 the dejecta were daily covered with dry earth. Fresh straw 
 was furnished in abundance. The rations were satisfactory 
 both in quantity and quality, 
 
 EXAMINATION OF SURGEONS FOR THE UNITED STATES VOLUN- 
 TEER SERVICE. 
 
 Soon after the troops reached Camp Tanner an order was 
 sent from the War Department to Governor Tanner, making 
 provision for the formation of an Examining Board. This 
 board was to consist of one surgeon from the United States 
 Army and two National Guard surgeons. The Government 
 detailed Capt. H. P. Birmingham, U. S. A., stationed at 
 Chicago, and Governor Tanner appointed Surgeon General 
 Senn and Brigade Surgeon C. C. Carter of Rock Island, as 
 members of the board. The duties of this board were to con- 
 sist in the examination both as to physical condition and pro- 
 fessional attainments of applicants for commissions in the 
 Medical Department of the United States volunteers and the 
 National Guard volunteer forces. The board was organized at 
 once and proceeded to examine applicants for the Medical 
 Department. The following blank was drawn up, typewritten, 
 and presented to each applicant to fill out : 
 
 Applicants for the volunteer service are respectfully requested 
 to fill out carefully the following blanks :
 
 11 
 
 1. Name . 2. Age . 3. Height ■. i. Weight . 
 
 5. Family history . 6. Physical defects, if any, either of 
 
 congenital or acquired sources . 7. Residence and P. O. 
 
 address . 8, Command, if any . 9. Place and date 
 
 of graduation , 10. Professional or scientific study and 
 
 investigation, other than military . 11. Foreign languages 
 
 studied ; a, able to speak : b, jiIjIo to translate 
 
 Surgeons of the National Guard and Illinois Volunteers. 
 
 12. Subjects or titles of books written or published, essays 
 prepared, lectures delivered or papers read, when and where 
 
 ; a, No. ; b, ; c, . Remarks . 
 
 The physical examination was made in a very thorough man- 
 ner, the man being stripped, and demonstrated that the candi- 
 dates for commissions in the Medical Department compared 
 favorably with the line and field officers. Out of the whole 
 number only three were rejected.
 
 12 
 
 It was the intention of the Board, in view of the fact that 
 most of the candidates had done good service in the National 
 Guard for a longer or shorter period, to make the examination 
 as broad and practical as possible. The following are some of 
 the subjects on which the examination was conducted : 
 
 Anatomy and Surgery. — 1. Give the origin and distribution 
 of the pneumogastric nerve. 2. Mention the bones of the car- 
 pus and give their relative locations by illustration. 3. Describe 
 the innominate artery and give its relations to surrounding 
 structures. 4. Enumerate the different hemostatic measures 
 and describe their technic and indications. 5. Detail the treat- 
 ment of recent compound fracture of the leg. 6. Describe the 
 different amputations through and below the ankle joint and 
 mention the names of the surgeons who devised them. 
 
 Hygiene. — 1. Give your ideas on the selection and sanitation 
 of camps. 2. The prophylaxis and treatment of sunstroke. 
 3. How would you determine, in the field, in a general way, 
 the salubrity of the water-supply, and what measures would 
 you take for preventing its pollution? 
 
 Military surgery. — 1. Give method of treating (temporary) 
 gunshot fracture of the thigh, on the field, and when and how 
 would you remove the patient? 2. What is the effect produced 
 by modern small jacketed bullet, compared with the old large 
 caliber missile? 3. Give method of procedure in rendering 
 first aid to, and removal of, wounded from fighting line to field 
 hospital. 
 
 Practice of medicine. — 1, Describe pneumonia : Definition, 
 etiology, morbid anatomy, symptoms, complications, prognosis, 
 termination, diagnosis, treatment, 2, Describe cerebrospinal 
 meningitis : Cause, pathology, symptoms, diagnosis, prognosis, 
 treatment. 3. Describe diseases most liable to occur in trop- 
 ical countries, with short description of causes, symptoms, 
 pathology, prophylaxis, diagnosis and treatment. 
 
 Materia medica.—l. What are the more common forms of 
 mercury used in medicine? Write prescriptions for four. 2. 
 Mention the comparative advantages of ether and chloroform 
 as anesthetics. 3. Indications for the use of emetics, cathar- 
 tics and alcohol. 
 
 The minimum standard was fixed at 70. It was a source of 
 great gratification to the Board that, notwithstanding the fact
 
 13 
 
 that many of the applicants had been busy practitioners for 
 years, the papers they turned in were of a high character. The 
 result of the examination shows that in these applicants the 
 State had desirable material for service in the volunteer regi- 
 ments. 
 
 The fact that the revised code of the Illinois National Guard 
 made provision for five surgeons to each regiment and the 
 regulation for the United States Volunteer Service called for 
 
 j 
 
 mk 
 
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 h^ 
 
 1^ 
 
 
 Group of Hospital Stewards Illinois Volunteers. 
 
 only three, made it necessary for the junior assistant surgeons 
 of some of the regiments to return unwillingly to their respec- 
 tive homes. 
 
 As soon as the results of the examination were announced, 
 the assignments were made. The following is a list of the 
 medical officers of the volunteer forces of Illinois : 
 
 First Infantry. Surgeon, W. G. Willard ; Assistant Sur- 
 geons, T. E. Roberts and C. B. Walls.
 
 14 
 
 Second Infantry. Surgeon, G. F. Lydston ; Assistant Sur- 
 geons, J. (i. Byrne and G. P. Marquis. 
 
 Third Infantry. Surgeon, J. B. Shaw ; Assistant Surgeons, 
 A. F. Lemke and C. E. Starrett. 
 
 Fourth Infantry. Surgeon, T. C. McCord ; Assistant Sur- 
 geons, C. M. Galbraith and G. E. Hilgard. 
 
 Fifth Infantry. Surgeon, M. R. Keeley ; Assistant Surgeons, 
 E. A. Ames and J. L. Bevans. 
 
 Sixth Infantry. Surgeon, F. Anthony ; Assistant Surgeons, 
 C. A. Robbins and L. S. Cole. 
 
 Seventh Infantry, Surgeon, T. J. Sullivan : Assistant Sur- 
 geons, G. W. Mahoney and F. P. St. Clair. 
 
 First Cavalry. Surgeon, W. Cuthbertson; Assistant Sur- 
 geons, T. J. Robeson and J. Rowe. 
 
 Battery A, First Ariillery. Hospital Steward, Dr. Jackson. 
 
 PHYSICAL EXAMINATION OF FIELD AND LINE OFFICERS 
 AND ENLISTED MEN. 
 
 The examinations were conducted at the Senate Chamber of 
 the State House from 9 a.m. to 6 p.m. daily, with an interval of 
 an hour for lunch. The Board of Examiners was assisted by 
 the regimental surgeon of each regiment and his assistants. 
 The officers were examined separately in the Lieutenant Gov- 
 ernor's room. One of the assistant surgeons took the chest 
 expansion, another examined the eyes and ears and a third the 
 head, mouth, pharynx and neck. The Surgeon-General exam- 
 ined the lower extremities and abdomen, and Captain Birming- 
 ham the chest and the general aptitude for active service. 
 Colonel Carter acted as clerk in conjunction with a number of 
 the field and line officers. 
 
 The following blanks for physical examination were drawn 
 up, and 10,000 copies were jjrinted and distributed to the vari- 
 ous regiments : 
 
 physical EXAMINATION. 
 
 Name . Rank . Co. . Regiment . Age . 
 
 Residence . Chest Expansion . Inspiration . 
 
 Expiration , Are you subject to coughs or colds? . 
 
 Have you ever had any serious illness? . Are you subject 
 
 to sore throat? . Discharge of the ear? . Rheuma- 
 tism? . Stiffening of the joints? . Hemorrhoids or 
 
 piles? . Fistula? . Diarrhea or dysentery? . Do 
 
 you believe you are sound and well now? .
 
 15 
 
 Soon after the arrival of the Surgeon-General an order was 
 issued instructing the regimental medical officers to make a 
 preliminary physical examination of the recruits, which resul- 
 ted in the return to their homes of several hundred men phys- 
 
 
 '/^VJTtH^D [^' " 
 
 ically unfit for duty and which materially assisted the work of 
 final examination. The most unenviable part of the examina- 
 tion fell upon the shoulders of the Surgeon-General, who for 
 the purpose of quickening and lightening his duties devised
 
 16 
 
 the following commands : Heels together I Turn around I 
 Turn back I Cough I Cough harder I which ccmmands after- 
 ward became a favorite and familiar chorus among the men 
 who passed the final ordeal to the satisfaction of the Board. 
 On an average, it was found possible by following the thorough 
 system adopted, to examine from 800 to 950 recruits a day. In 
 all, 9899 men were examined. 
 
 The most common causes for rejection were hernia, varicose 
 veins of the lower extremities, poor physi«iue, heart disease, 
 imperfect chest expansion, loss of teeth and flat foot. The 
 presence of varicocele of different degrees in men otherwise 
 apparenly in good health was marked. It was found that 
 nearly 25 per cent, of all those examined presented a condition 
 of varicocele of some degree. Only two recruits were rejected 
 for this cause, as in their cases the varicocele appeared to be 
 an acknowledged source of pain. In all the rest the statement 
 was plainly made either that the applicant had no knowledge 
 of the condition, or that it gave rise to no inconvenience. In 
 probably one-half of all the cases the subjects were ignorant 
 of the existence of this condition. The same remark may 
 apply to flat foot as a cause of rejection, inasmuch as the 
 deformity appeared to be extremely common, but only in a 
 few isolated cases was it a cause of pain and consequently of 
 disability for the volunteer service. The rejections for good 
 and substantial causes were less than 10 per cent. This was 
 influenced somewhat by the thoroughness with which the pre- 
 liminary examinations had been conducted. The proportion of 
 rejections was, on the whole, larger in the country regiments 
 than in those made up of Chicago men. A great many men 
 who passed the physical examination returned unwillingly to 
 their homes by reason of the regulation reducing the number 
 of men to a company from 109 to Si. 
 
 The intensity of the patriotic feeling which pervaded the 
 men in camp is best shown by the illustrations which accom- 
 pany this communication. The word "rejected" in many 
 instances seemed to make a more profound impression than 
 would a death sentence. The disappointment would be such 
 that the soldier was often speechless, pale, staggering, and in 
 not a few instances hot tears would roll down the bronzed 
 cheeks as the best evidence of the deep regret of the recruit
 
 19
 
 20 
 
 of both field and line officers, who did everything in their power 
 to encourage them in their work. 
 
 LECTURES ON FIRST AID. 
 
 On May 10, the Surgeon-General issued the following order : 
 "Regimental surgeons are requested to give officers and men in 
 their commands instruction in first aid or self help, as the case 
 may be, in the following subjects : Diet and drink in health 
 and disease. Care of the person, bathing, clothing, feet, etc. 
 What to do in sunstroke. Temporary treatment of fractures. 
 Temporary arrest of hemorrhage. Transport of injured men. 
 Application of first aid dressings. The illustrated triangular 
 bandage will be furnished, to be displayed in a conspicuous 
 place in company quarters so that every man may understand 
 its application." 
 
 These lectures were well attended and proved of signal value 
 in preparing the line officers and men in the use of the first aid 
 package, and in the prevention and treatment of hemorrhage, 
 as well as enlightening them on the subjects of hygiene and 
 sanitation. 
 
 VACCINATION. 
 
 On May 12, the Surgeon- General issued the following order : 
 
 "To all surgeons and assistant surgeons : 
 
 "Vaccination by regiments will take place as soon as they are 
 mustered. You are directed to operate according to the fol 
 lowing rules, assisted by your hospital stewards : 
 
 "1. The left arm is to be bared. A space four inches square 
 at the outer border of the deltoid midway between its origin 
 and insertion is to be thoroughly scrubbed with warm water 
 and potash soap, then cleansed with alcohol and finally washed 
 with pure water and dried with a pledget of absorbent cotton. 
 
 "2. The arm is to be lightly scarified where cleansed for a 
 space of one-half inch square. Both ends of the vaccin tube 
 are to be broken off, and the virus blown on the wound with 
 the rubber bulb furnished, and thoroughly rubbed in with the 
 point of the lancet. The lancet is to be cleansed with alcohol 
 after each scarification. 
 
 "3. The arm is to be left exposed until thoroughly dry. A 
 pledget of sterile cotton two inches square, is to be placed over 
 the wound and held in place by an adhesive strap one-half inch 
 wide and four inches long."
 
 21 
 
 There is reason to believe that the above specific directions 
 did much in the prevention of septic complications. 
 
 CAMP DISEASES. 
 
 The season of the year at which the troops were called out, 
 the crowded condition of the camp, the imperfect equipment of 
 the men, the continuous rain for over a week, and the change- 
 able temperature were influences well calculated to test the 
 strength and power of resistance to disease of the men who 
 sought the service of the Government. 
 
 The appearance of cerebrospinal meningitis on the first day 
 the troops were in camp in the case of a man of K troop. First 
 Cavalry, excited much interest, and as this was followed in 
 rapid succession by three additional cases in other commands, 
 led to a thorough investigation as to the origin and spread of 
 this disease. This investigation was conducted by Lieutenant 
 Colonel Kreider pursuant to an order from the Surgeon ( Gen- 
 eral. Colonel Kreider presented the following report : 
 
 Camp Tanner, Springfield, May 23, 1898. 
 Colonel N. Senn, 
 
 Surgeon-General, I. N. G., Camp Tanner, 111. 
 
 Sir: — Pursuant to your order to investigate the origin and 
 spread of the cases of cerebro spinal meningitis which have 
 occurred at this camp, I have the honor to report that up to 
 this time three cases have appeared, all of which have resulted 
 fatally. 
 
 1. Ernest Royal Parish, of Troop K, First Cavalry. On my 
 request, Major William Cuthbertson assigned to the First Cav- 
 alry made the following report : "He was ailing for some days 
 prior to enlistment. While waiting at Tattersall's at Chicago 
 I have ascertained that he was compelled to lie down, but was 
 up and able to pass inspection. He was taken violently ill on 
 the train on the way down, with chills and vomiting. On 
 reaching Springfield in the morning he was unable to walk and 
 was removed to the Post Hospital on a stretcher. As soon as 
 possible he was transferred from there to St. John's Hospital, 
 where he now lies. I have just learned that another case of 
 this disease exists at Western Springs, the patient's home." 
 Parish died May 1. As stated in Surgeon Cuthbertson' s 
 report, he had not placed a foot on the camp ground, and his 
 stay there did not exceed half an hour.
 
 22 
 
 2. Edward B. Beebe, of the Third Infantry, residing at 
 Elgin, was sent to the Hospital May 13 by the Surgeon of the 
 Regiment on the eve of its departure, and was first seen by me 
 on the following morning. In the afternoon I found him deli 
 rious, so that he required restraint and constant watching, 
 which was given by a hospital steward of the Second Infantry. 
 He died May 15. 
 
 3. Robert Leland, of Third Infantry, residing at Ottawa, was 
 first seen by me at the camp at 6 p.m.. May 14, and, as all am- 
 bulances were in use, was conveyed in my buggy to the Hospital. 
 Assistant Surgeon Lemke writes of the onset of the disease as 
 follows : ' 'I saw him at noon, when he was complaining of intense 
 headache. He became delirious the same night, although he was 
 rational when aroused." The disease ran a very rapid course 
 and death occurred May 17 at 11 p.m. From his family phy- 
 sician I have learned that a sister aged 20 and a brother aged 
 15 had died of tuberculosis. As ordered, I had intended hold 
 ing a postmortem on this case, but the body was removed 
 from the Hospital at 2 a.m. by his father. 
 
 The disease in the first case may be traced to other cases in 
 his home town. He was not associated in any way with the 
 men of the Third Regiment, and it seems hardly probable that 
 the disease could have been transmitted from him to the others. 
 It seems probable that the disease in the Third Infantry was 
 caused by the crowded and poorly ventilated quarters which 
 this regiment occupied, or by the damp straw on which they 
 slept. Each of these conditions was caused by the weather pre 
 vailing during the stay of this regiment at the camp. Because 
 of the rains the men did not leave the building during the day, 
 and thus the rooms became foul. 1 called the attention of the 
 Surgeon of the Regiment to this foul odor early in the tour; 
 because of the rain also, the straw was brought in damp and 
 may have figured in causing the trouble. 
 Respectfully, 
 [Signed] Geor(;e X. Kreider, Post-Surgeon. 
 
 Among theother camp diseases must be mentioned pneumo 
 nia, measles and mumps. The pneumonia contracted in the 
 camp proved to be of an unusually malignant type. Of the 
 thirty-two cases only two died, a mortality of about 6 per cent. 
 
 Upon the outbreak of measles an isolated part of camp
 
 23 
 
 ground was selected for an isolation hospital, and placed under 
 guard with a yellow tiag in front of the hospital tent. Three 
 cases of measles and three or four cases of mumps occurred. 
 The patients were placed in separate hospital tents, and as soon 
 as they recovered from the illness were subjected to a thorough 
 disinfection and their clothing disinfected before they were 
 allowed to return to duty. This isolation of patients suffering 
 from infectious diseases proved effectual in the prevention of 
 a further spread of the diseases. 
 
 The ranks of the medical department were broken at an early 
 date by the untimely death from pneumonia of Assistant-Sur- 
 geon Cole of the Sixth Infantry, who was taken ill while 
 en route with his regiment to Washington, and died at Port 
 Wayne, Ind. Upon reeeipt of the news of his death the medi- 
 cal officers drew up the following resolutions : 
 
 Whereas, By the untimely death of our comrade. Lieuten- 
 ant L. S. Cole, Assistant Surgeon, Sixth Illinois Infantry, U. 
 U. A., a career of brilliant promise has been cut short, be it 
 
 Resolved, That in the death of Lieutenant Cole the State of 
 Illinois has lost a valuable medical officer and the medical 
 profession an efficient and able member. 
 
 Resolved, That we, the members of the Medical Department, 
 of the Illinois National Guard and United States Volunteers at 
 Camp Tanner, extend to his bereaved family and friends our 
 condolence and sincere sympathy. 
 
 Resolved, That copies of these resolutions be sent to his 
 mother, and to his regiment. 
 (Signed) 
 T. J. Sullivan, Major and Surgeon Seventh Infantry. 
 T. C. McCoRD, Major and Surgeon P^ourth Infantry. 
 Wm. CuTHBERTSON, Major and Surgeon First Cavalry. 
 S. C. Stanton, First Lieut, and Ass' t. -Surgeon, I.N.G. 
 
 Committee. 
 
 With this communication my official connection with the 
 National Guard of Illinois is temporarily severed, as I have 
 been mustered in as Lieutenant- Colonel and Chief Surgeon, 
 Sixth Army Corps, U.S.V., to be assigned to the command of 
 Major General Wilson, Camp George H. Thomas, Chicka- 
 mauga, Ga.
 
 AN OLD BATTLE GROUND. 
 
 Chickamauga, June 3, 1898. 
 Chickamauga I What a terrible name to the reunited nation I 
 Here was enacted one of the bloodiest dramas in American his- 
 tory. It is here where one of the most desperate battles of the 
 War of the Rebellion was fought. Almost every foot of soil of 
 this great National Park was stained with the blood of heroes 
 on both sides. What a grand spectacle this beautiful park 
 must have presented when it was the scene of one of the great- 
 est battles known to history I Two great armies composed of 
 the same flesh and blood, face to face, engaged in a deadly con- 
 flict. Upon the issue depended much on both sides, hence the 
 heroism displayed and the terrible sacrifice of life. It seems to 
 me I can hear now the beat of the drum, the shrill voice of the 
 fife, the thundering roar of cannon, the rattle of musketry, 
 the shouts of command, the groans of the wounded and the 
 labored breathing of the dying. The bullet-riddled trees, the 
 innumerable cannon occupying the same position as when they 
 vomited forth fire, death and destruction, the many beautiful 
 monuments and tablets commemorating the position of troops 
 during action, and the places where distinguished leaders fell, 
 are the silent witnesses of those awful days when our Nation 
 was threatened by disruption and even death. It was no fault 
 of our valiant enemy that the star spangled banner triumphed. 
 The victory was dearly bought. Thousands of brave soldiers 
 are resting in yonder cemetery. Many wounds inflicted still 
 remain. Many an aged mother and father have had their life 
 saddened by an irreparable loss sustained in that battle. Many 
 an empty chair has remained in numerous lonely households. 
 It will take more than another generation to wipe out the 
 immediate consequences of the horrors of that battle. Let the 
 present and'all coming generations remember with veneration 
 and true gratitude the heroic deeds enacted here. Years have 
 gone by and this great park has become again the camping 
 ground of a large army. Within a few weeks nearly fifty 
 thousand men have pitched their tents and are making active
 
 25 
 
 preparations for war. The hills, fields, woods and ravines are 
 swarming with soldiers. Mounted officers are galloping in all 
 directions in clouds of dust. Brigades, regiments, companies 
 
 and squads are hard at drill under the burning sun. Sentries 
 are stationed everywhere to preserve order, protect property 
 and learn the art of watch dogs to protect the troops during 
 the active campaign along the coast and in distant islands, the
 
 26 
 
 the prospective fields of warfare. Almost every day new regi- 
 ments arrive from every part of the country, often without 
 arms and uniforms, but eager and ready to be instructed in 
 the art of war. Our patriotic citizen soldiers in civilian drees 
 env> their more fortunate comrades in showy blue, and impa- 
 tiently await their turn to don the soldier's garb. It is refresh- 
 ing and interesting to observe what patriotism will do in 
 antagonizing the imperfections and hardships of camp life. 
 Do you imagine you could hire many of these soldiers to do 
 ordinary work under similar conditions at §5 per day? No ! 
 Give them a uniform, a gun, and an opportunity to fight for 
 the honor of their country and the glorious stars and stripes, 
 and they rush to the front without a word of complaint, 
 unconscious of the privations and hardships incident to the 
 life of the soldier. 
 
 SANITARY CONDITIONS, 
 
 Chickamauga Park is admirably adapted for a large camp. 
 It embraces several square miles. The forest trees furnish 
 protection against the burning rays of the semitropical sun and 
 the many open places and fields are utilized as drill grounds. 
 Humus is scanty and the subsoil is of clay. The surface is 
 somewhat undulating and is cut up here and there by ravines, 
 which add much to the beauty of the scenery. An ample sup- 
 ply of pure water is obtained from numerous wells, from 15 to 
 65 feet in depth, recently supplemented by a pumping station 
 which derives the water from the river, a short distance below 
 Crawfish Springs, and distributes the water to different parts 
 of the park through iron pipes. The vastness of the grounds 
 are realized by the visitor as soon as he reaches George H. 
 Thomas camp, which at the present time is occupied by nearly 
 50,()00 men, and yet seldom more than one regiment can be 
 seen at one and the same time. In the past, Chickamauga has 
 had an unenviable reputation as a health resort. The Indian 
 name Chickamauga signifies literally "River of death." Along 
 the banks of the Chickamauga river, which flows through the 
 park, malaria was very prevalent years ago, which probably 
 had something to do in inducing the Indians to designate this 
 river by such a terrifying name. At the present time malaria 
 has nearly disappeared from this part of the country, except a 
 very localized district north of Crawfish Springs. The malaria
 
 27 
 
 contracted in this circumscribed locality has been of a mild 
 form and is probably due to the draining of a little pond on the 
 south side of Park Hotel. 
 
 An adequate number of sinks from four to eight feet in 
 depth have been dug a safe distance from tents and field hos- 
 pitals, all of which are boarded in. Three times a day the 
 deposits in the sinks are covered with dry earth and ashes 
 from the stoves and camp fires. One of the difficulties so 
 constantly prevailing in camps has been the introduction of 
 harmful articles of diet by interested friends and enterprising 
 merchants. The regulations governing this evil are becom- 
 ing more and more stringent and are more eflfectively carried 
 out, so that the danger from this source is diminishing pro- 
 gressively, 
 
 PREVAILING CAMP DISEASES. 
 
 The most common disease affecting the troops at this time is 
 diarrhea. The continuous heat, the change and often impru- 
 dence in diet and sleeping on the ground are the most impor- 
 tant etiologic elements. The last mentioned cause becomes 
 apparent from the fact that the privates are much more fre- 
 quently affected proportionately than the commissioned officers, 
 most of whom enjoy the luxury of a cot. A number of deaths 
 have occurred from cerebro spinal meningitis, more especially 
 among the Illinois troops. In my first communication I traced 
 the disease to Camp Tanner, where it originated from a case 
 brought there by the first regiment of cavalry. A few days 
 ago Capt. Lemke, 3rd Regiment Illinois Volunteers, made a 
 postmortem examination at the Ist Division Hospital, 1st Army 
 Corps, which demonstrated the pathological appearances of 
 the disease to perfection. There was a difference of opinion in 
 reference to the location and nature of the disease, as during 
 the early history of the case the symptoms referable to the 
 cerebro-spinal centers were conspicuous, while later a compli- 
 cating pneumonia masked the manifestations of the original 
 disease. The examination showed croupous pneumonia involv- 
 ing one lobe of the lung, of recent origin, while the meninges 
 of the brain and spinal cord presented all the evidences of an 
 acute inflammation. The lining membranes of all the ventricles 
 were involved. The pathological changes were most marked 
 at the base of the brain and more especially the pons Varolii
 
 28 
 
 and medulla oblongata. In these localities the meninges were 
 found infiltrated and covered with a plastic exudate. 
 
 The remaining portions of the membranes enveloping the 
 brain and cord were extremely vascular and in some places 
 presented an opalescent appearance. A considerable quantity 
 of turbid serum was found in the ventricles and subarachnoid 
 space. It was evident from the postmortem appearances that 
 the primary disease involved the nervous centers and that the 
 lobar pneumonia set in later as a complication and contributed 
 toward an early fatal termination. Two cases of cerebro spinal 
 meningitis, presenting grave symptoms observed in Camp 
 Tanner, improved promptly after lumbar puncture and I have 
 been subsequently informed that both of these cases ultimately 
 recovered. The first tapping was made by Lieut. Rowe of the 
 1st Illinois Cavalry. All cases of cerebro spinal meningitis 
 that have been sent to the Division Hospital have been placed 
 in isolation tents for the purpose of preventing further spread 
 of the disease. Measles has broken out in the camp and all 
 patients suffering from this disease, about twenty in number, 
 at the present time are under guard in isolation tents. The 
 disease is mild in type, the patients as a rule being confined to 
 bed not longer than four or five days. Pneumonia has been 
 prevalent, especially among the regiments from the northern 
 States. Delirium is usually absent although the disease other- 
 wise has assumed a grave type. In several fatal cases the 
 postmortem changes indicated that death resulted from sec- 
 ondary streptococcus infection. At the present time there are 
 only three or four cases of typhoid fever in camp and in most 
 of them it is more than probable that the disease was con- 
 tracted before the patients reached the camp. Considering 
 the inadequate clothing of many of the volunteers, the heavy 
 dew and the chilliness experienced some nights, it is remarka- 
 ble that so few suffer from rheumatism and bronchitis. Sun- 
 stroke and heat exhaustion have so far not visited the camp, 
 although heavy marching and active drilling often take place 
 with the sun high up in the horizon. On the whole the health 
 of the troops is excellent. 
 
 A TIMELY BENEFACTRESS. 
 
 As soon as I arrived at Camp George H. Thomas I called on 
 Lieut. Col. Harteuff, U. S. A., who received me very kindly
 
 29 
 
 and spent nearly half a day in showing me the location of regi- 
 ments and field hospitals. His experience since he took charge 
 of the medical affairs of the camp had taught him that the 
 hospital facilities even with the limited number of sick at the 
 present time were entirely inadequate. Near the park and on
 
 :30 
 
 the south Bide of it, adjacent to the famous Crawford Springs is 
 a large well built hotel containing seventy rooms, which had 
 recently been evacuated and on which he had an option for a 
 few days, purchase price 810,000. The building alone cost 
 $65,000 and as the purchase price included the entire furni- 
 ture, water privilege and four acres of land, and the building 
 was in a condition that it could be occupied at once without 
 much repair he had strongly recommended its purchase for 
 hospital purposes to the Surgeon-General. There was no ques- 
 tion as to the desirability of acquiring the property to better 
 and increase the hospital facilities ; neither could there be any 
 doubt of the government's willingness to buy it to meet the 
 existing emergency, but past experience satisfied all concerned 
 that it would take weeks, and perhaps months, before the 
 building could be made available by relying on the routine way 
 in acquiring the property. Recognizing the necessity for imme- 
 diate action in the premises and the fact that the option was 
 open only for a few days, at the expiration of which the ovi^ners 
 intended to reopen the hotel, I asked permission of Col. Hart- 
 suff to allow me to make an attempt to secure the building by 
 donation and later present it to the Government, This 
 request was willingly granted. I telegraphed to Mrs. L. Z. 
 Leiter, Washington, D. C, the condition of affairs and in due 
 time received the pleasing information by wire from her hus- 
 band that I should proceed at once and draw on him for the 
 amount. After overcoming some of the technical difficulties 
 in the way of securing the necessary water supply from the 
 adjacent Crawfish Springs, the purchase was made and the 
 'Leiter Hospital" has become a beautiful monument to the 
 memory of a distinguished family that has given the first large 
 donation for the benefit of our sick citizen soldiers at the very 
 beginning of the Spanish-American war. May this noble 
 example find many imitators !
 
 i^iySiL§pPi 

 
 Chickamauga, Ga., June 22, 1898. 
 
 CAMP GEORGE H. THOMAS. 
 
 Prom early dawn until taps, Camp Thomas is the scene of 
 a busy, active life. It is the gathering point of the largest 
 army concentrated in one place since the War of the Rebellion. 
 It is at the present time the temporary home of 45,000 men 
 representing almost every State in the Union. Many of the 
 regiments are short of their quota, and recruits to the number 
 of 500 on an average arrive daily to complete the organization of 
 the regiments now in camp. The commander of the whole 
 army in camp is Major General John R. Brooke, General in 
 Chief in charge of the Department of the Lakes. He came 
 here from Chicago with his entire staff. He enjoys the repu- 
 tation of being a strict disciplinarian who does everything 
 through the legitimate military channels. The greatest sour- 
 ces of confusion and consternation to the officers of the vol- 
 unteers from civil life are these mysterious military channels 
 which extend from the General's tent to the heads of the 
 many departments in Washington. One of the blue books in 
 constant use by officers, high and low, young and old, is the 
 U. S, Army Regulations, 1895. The thousands of questions 
 asked the professional soldier daily by his less informed volun- 
 teer officer are answered more often than otherwise by " Study 
 the Regulations, Study the Regulations, Study the Regula- 
 tions." Such advice, as a rule, is more easy to give than to 
 follow with any expectation of approval at headquarters. The 
 experience here has satisfied me more than ever that the Na- 
 tional Guard officers need more thorough training in execu- 
 tive, clerical work, so essential in the efficient management of 
 troops at home and in the field. One of the common sights 
 in camp is to see an officer hide himself away under a solitary 
 tree and pore over a work on tactics or the much feared " Reg- 
 ulations." If this war does nothing else but demonstrate 
 to our people and to the legislators, State and National, 
 the necessity of a well organized militia it will have accom- 
 plished a great deal. If we had in this country, as we
 
 32 
 
 ought to have, a well organized, well equipped militia force of 
 200,(X>0 men, we would have been in possession of all the Span- 
 ish islands and Spain itself, if we wanted it, long ago. As it 
 is, it takes two millions a day and the hardest kind of work to 
 bring our volunteers into fighting trim. The officers of the 
 regular army have reason to be thankful to Spain for having 
 given them a chance to fight. They have been looking a long 
 time anxiously for such an opportunity. They are the recog- 
 nized salt of the army. The Government has fully recognized 
 their claims. Nearly every day the newspapers bring columns 
 of names of lucky officers who have been advanced in rank, in 
 fact it seems almost impossible for any one of them to escape 
 promotion of some kind. This is probably as it should be, but 
 occasionally such promotions lead to giddy heights. To make 
 a lieutenant colonel out of a second lieutenant of very limited 
 practical experience is a transition of doubtful propriety and 
 often followed by the most detrimental results, both to the 
 over-ambitious officer and the over-confiding troops placed 
 under his charge. Officers thus honored by promotion and 
 assigned to the army of volunteers are, as a rule, more anx- 
 ious to change the shoulder straps than to add the V. to the 
 U. S. on the collar of the blouse. On the whole, the regular 
 army officers are perfect gentlemen and great favorites in the 
 camp, and the feeling between them and the officers from civil 
 life is of a most cordial nature. 
 
 The First Army Corps under General Brooke is nearly com- 
 pleted. The Third Army Corps under command of Major-Gen- 
 eral Wade is nearing completion., The Sixth Army Corps is 
 soon to be organized under Major-General James H. Wilson. 
 General Wilson gained an enviable reputation during the late 
 war as a dashing cavalry officer and will undoubtedly make a 
 creditable record during the present war if it lasts long enough 
 to bring his army into the field, Lieut. -Colonel Hartsuff, an 
 experienced medical officer of the regular army, is Surgeon-in- 
 Chief of the army gathered here, and as such is attached to 
 the statf of (ieneral Brooke. Lieut. -Colonel Van Iloff is Chief 
 Surgeon of the Third Army Corps, and has worked incessantly 
 in completing the organization of the medical department under 
 his supervision. He is regarded as one of the ablest executive 
 officers of the medical service, and is known as a warm friend
 
 33 
 
 of the medical officers of the National Guard. He has from 
 the very beginning taken a deep and active interest in the work 
 of the Association of Military Surgeons of the United States. 
 Every medical officer of the Third Army Corps should con- 
 
 Major-General John R. Brooke. 
 General in Chief in charge of the Department of the Lakes. 
 
 sider it a great privilege to serve under Lieut. - Colonel Van Hoff . 
 The medical department of the First Army Corps is in charge 
 of Lieut. -Colonel Heidekoper of New York, a hard-working, 
 conscientious officer. Major Kimball of Marion, Ind., and Ma-
 
 34 
 
 jor Woodbury of New York, have reported here and are await- 
 ing with the writer the formation of the Sixth Army Corps. 
 At present my time is profitably occupied by consultations in 
 the camp and by performing operations in the Leiter General 
 Hospital and the St. Vincent's Hospital. Chattanooga. The eve- 
 nings are occupied by giving lectures on first aid to the Hospi- 
 tal cori)S. St. Vincent's Hospital has been used as a tempo- 
 rary hospital for the troops until the Leiter Hospital was in 
 condition to receive patients. The abandonment of regimen- 
 tal hospitals meets with the same opposition here as elsewhere, 
 but the wisdom of such a course must be apparent to all who 
 have had experience in the field. Major E, C. Carter, U. 
 S. A., is now in charge of the Leiter General Hospital. He is 
 one of the busiest men in the camp. He is in every way ad- 
 mirably adapted for the position he now occupies. He is 
 straining every nerve to improve and equip the building for the 
 accommodation of from 300 to 500 patiec^ts. He has the hearty 
 co-operation of the Surgeon-General and Colonel Hartsuff 
 in pushing the work. About thirty patients are at present in 
 the hospital and in less than two weeks the number of patients 
 will exceed one hundred. Hospital furniture and supplies are 
 arriving every day, and in the course of two weeks the hospi- 
 tal will be fully equipped. The value of this hospital to our 
 sick soldiers can not be overestimated. Mrs. Leiter will have 
 the respect and sincere gratitude of every one of the inmates 
 and of hundreds yet to come. Chickamauga is a quiet little 
 country hamlet where our patients can enjoy to the fullest ex- 
 tent what they are so much in need of, rest and quietude. Six 
 trained nurses have been sent by the Surgeon-General and are 
 now on duty. With the increase in the humber of patients 
 more will be sent. A corner room in the tower on the second 
 story has been set aside as an operating room and is now under- 
 going the necessary repairs to adapt it for this purpose. The 
 first operation performed in this hospital was for empyema 
 following pneumonia. Two additional cases await a similar 
 operation during the course of the week. 
 
 CRAWFISH SPRINGS. 
 
 One of the great attractions near the National Park and 
 adjacent to the Leiter General Hospital is the famous Crawfish 
 Springs, At the end of a large basin and at the base of a rock
 
 35 
 
 a large volume of water, as clear as a crystal, is poured out 
 with considerable force. This spring yields 62,(X)0,0()0 gallons 
 of water in twenty-four hours. The temperature of the water 
 is 56 degrees F., summer and winter alike. The dam a little 
 
 Maior-General James H. Wilson. 
 
 below the springs, utilized to furnish water power for the hotel, 
 has been removed for the reason that it interfered with the 
 supply of water, deviating it evidently through subterranean 
 channels in another direction. As soon as the property was trans- 
 ferred to Mrs. Letter for Government use I had the basin cleaned
 
 36 
 
 out of moss and dirt by a detail of soldiers furnished by the 
 Fifth Illinois Infantry. The sides of the hill around the basin 
 were ditched a few feet above the level of the water for the 
 surpose of draining the surface water to a safe distance below 
 the springs. The Hospital is supplied with water from this 
 spring. Besides, hundreds of barrels of water are brought daily 
 into the camp by mule teams. The water is wholesome and 
 palatable. 
 
 The following is the result of a chemical analysis made by 
 a competent chemist : 
 
 ANALYSIS OF CRAWFISH SPRINGS WATER. 
 
 Bicarbonate of lime 0.6753 
 
 Bicarbonate of magnesia 0.454^ 
 
 Sodium chlorid 0.856 
 
 Potassium chlorid 0.048 
 
 Silica 0.0537 
 
 Free ammonia 0.0029 
 
 Albuminoid ammonia 0.0025 
 
 Oxygen absorbed 0.031 
 
 The presence of free ammonia and albuminoid of ammonia, 
 although small in quantity, led us to suspicion the presence of 
 organic matter which might possibly prove to be a source of 
 danger. For the purpose of testing the water still further as 
 to its fitness for hospital and camp use, samples were sent at 
 three different times to the professor of chemistry in the Chat- 
 tanooga Medical College. Dr. H. Berlin made a very careful 
 chemic analysis and bacteriologic examination with the result 
 that he pronounced the water free from dangerous organic 
 matter and pathogenic microbes. The only microbe which he 
 was able to cultivate was the colon bacillus, and the presence 
 of this microbe could be readily accounted for by the blocking 
 of the sewer pipe, an evil which was promptly removed. The 
 springs would furnish an ample water supply for the whole 
 army if the (Jovernment would only erect a pumping station 
 near it, a project which is now under serious consideration. 
 With such an improvement Camp George H. Thomas would be 
 one of the most salubrious camping places in the United States 
 for a large army. The intake now is some distance below the 
 springs where the How of water is impeded by a dam two miles 
 and a half below the springs. Above the dam is a narrow
 
 37 
 
 beautiful lake two miles and a half in length, extending to near 
 the springe, which is leased by the Chickamauga Fishing Club. 
 
 CHATTANOOGA MEDICAL SOCIETY. 
 
 This medical society meets twice every month, on the first 
 and third Friday. At the last meeting the subject selected by 
 the committee was "The Modern Treatment of Gunshot 
 
 Major-General Joseph C. Breckinridge. 
 Wounds in Military Practice." The writer was invited to open 
 the discussion. After a brief resume of the character of wounds 
 inflicted by the modern bullet, the treatment was considered 
 in detail. Special stress was placed upon the inutility of the 
 ordinary and Nelaton's probe in locating and finding bullets 
 lodged in the body. Attention was called to the value of the
 
 38 
 
 X ray as a substitute for the probe in making a reliable diag- 
 nosis. The use of the bullet probe on the battlefield was con- 
 demned and the advice given that bullet wounds should be 
 hermetically sealed with the first aid package, which should con- 
 tain an antiseptic powder composed of boracic acid and salicy- 
 lic acid (4 :li, and no exploration made until the patient reaches 
 the field hospital, where all facilities for aseptic surgery and 
 the necessary instruments for diagnosis and operation should 
 be at hand. A new bullet probe and bullet forceps devised by 
 the writer were exhibited and their manner of use explained. 
 The balance of the paper treated of gunshot wounds of the 
 extremities, cranium, chest and abdomen. For want of time 
 consideration of the last subject, "Gunshot Wounds of the 
 Abdomen," was postponed until the next meeting. Invitations 
 to attend the meeting were sent to the military surgeons in 
 camp, consequently the attendance was large and the discus- 
 sion became general and proved of interest to all present. 
 Considering that Chattanooga has only 40,000 inhabitants and 
 that the average attendance at these meetings on ordinary oc- 
 casions is never less than from thirty-five to forty, is the surest 
 indications that our colleagues in this city take an active 
 interest in the scientific work of the profession. 
 
 AMUSEMENTS. 
 
 The civilian soldier finds it difficult to satisfy his mind and 
 body with what is required of him in camp life. But a few 
 weeks ago he was a professional man, a clerk, teacher, or left 
 the school, workshop and plow, and now it is hard for him to 
 imagine that he should not be kept busy from sunrise to sunset. 
 He is only too anxious to drill in sunshine or rain, and considers 
 it a privilege to do guard duty, where his power and military 
 significance can be made to appear at greatest advantage. He 
 finds it difficult to occupy his many leisure hours in a profitable 
 manner. To the credit of our soldiers it must be said that 
 evidences of intemperance are rarely seen in camp. Temperance 
 canteens are common and are better patronized than those in 
 which beer is sold. 1 have not seen an intoxicated soldier since 
 I arrived in camp. The more common amusement of the soldiers 
 during the heat of the day, between 10 a.m. and .3 p.m., between 
 drill hours, consists in reading, writing letters, playing cards, 
 and the college boys are bound to play base- or football. The
 
 39 
 
 chaplains make themselves useful not only in caring for the 
 spiritual welfare of their soldiers, but they also look after their 
 intellectual interests. They extemporize reading-rooms and 
 supply them with writing and reading material. These reading 
 tents are very popular, and when the men are off duty they are 
 always crowded. The many regimental bands furnish excellent 
 music, which does so much in cheering up and amusing the 
 soldiers. Two theaters have sprung up in the camp, mushroom- 
 like. Performances are given in the afternoon and evening. 
 The admission fee is twenty-five cents, box seats fifty cents, I 
 have been told by those who have been in the habit of attending 
 that the plays are good and that the patrons are made to feel 
 that they have received their money's worth, 
 
 RED CROSS ASSOCIATION, 
 
 The Medical Department during the present war is in a con- 
 dition fairly well prepared to supply the sick and wounded with 
 the necessary instruments, medicines and food. There will be 
 only a very limited field of usefulness for the Red Cross Asso- 
 ciation to fill in defects here and there as occasion and circum- 
 stances may require. The work of the Red Cross Association 
 is, however, recognized by the War Department, as becomes 
 evident from a circular letter received a few days ago from the 
 Surgeon- General : 
 
 Sdkgeon- General's Office, Washington, June 9, 1898, 
 Lieutenant- Colonel Nicholas Senn, Chief Surgeon U. S. Vol- 
 unteers, Sixth Army Corps, Chickamauga Park, Ga. 
 Sir: — The Secretary of War has approved the following 
 proposition made by the American National Red Cross Associ- 
 ation, and the chief surgeons of the Army corps and divisions 
 will cooperate with the authorized agents of this Association 
 for the purposes indicated : 
 
 " We can put any desired amount of hospital supplies— ice, 
 malted milk, condensed milk, Mellin's food, etc, into any of 
 the volunteer camps in a few hours. Will you be kind enough 
 to bring this letter to the attention of Secretary Alger and ask 
 him if there is any objection to our appointing a Red Cross 
 representative to report to the commanding officer and the 
 chief surgeon in every camp, confer with them as to their 
 immediate needs and, if anything of any kind is wanting, open 
 there a Red Cross station and send in the supplies. We can 
 do this, not in a few weeks or a few days, but in a few hours, 
 and can furnish any quantity of any desired luxury or delicacy 
 for hospital use. We hereby tender our aid and put our organ-
 
 40 
 
 ization at the War Department's service for co-operation in the 
 field." Very respectfully, 
 
 Geo. M. Sternberg, Surgeon-General U. S. A. 
 
 It was prudent and wise that the Surgeon-General and the 
 Secretary of War granted this modest request. Dr. Gill of 
 New York represents the Red Cross Association here. He 
 arrived a few days ago and intends to erect a frame building 
 near the general headquarters as a storehouse for the supplies. 
 He possesses excellent executive abilities combined with mod- 
 esty, which will ensure him a wide avenue of usefulness and 
 the hearty appreciation of the medical officers. In my next 
 communication I will speak of the hospital corps, its organiza- 
 tion and scope of work in actual warfare.
 
 ASSIGNED TO A NEW FIELD. 
 
 War always has been and always will be a cruel thing. The 
 very object of war is to kill, disable, maim and starve until the 
 result of the contest shall decide the issue by demonstrating 
 the superiority of one army over the other in number, courage 
 or skill of warfare. " The battle is the Lord's," but victory is 
 not always on the side of justice. The Lord teaches, rules and 
 benefits the children of men now, as during the time of the 
 prophets, as often by defeat as victory. The God of battles 
 has ways and means often impossible to comprehend, but they 
 always lead to results beneficial to mankind. The terrors and 
 sufferings of war are the prices paid for defeat as well as vic- 
 tory. The wonderful improvements made in weapons and pro- 
 jectiles during the last quarter of a century have made modern 
 warfare more destructive if not less cruel. It is difficult to 
 foretell the relative number of dead and wounded in the engage- 
 ments of the future. Reliable information on the subject must 
 come from actual observation on a large scale on the battlefield 
 and not from the results of experiments on the lower animals 
 and the cadaver. Warfare has become a science and an art, 
 and victory will depend as much on the skill and foresight in 
 strategy of the commanding officers as the endurance and valor 
 of the troops. The long range rifles and the better marksman- 
 ship of the average soldier will increase the distance between 
 the fighting lines and give the commanding officers better 
 opportunities for the exercise of their skill in maneuvering the 
 troops. In every respect war will and must assume more sci- 
 entific aspects for the display of skill. What the improve- 
 ments will be can only be determined by experience on a large 
 scale. The rapid mobilization of troops, supply of ammunition 
 along the line of battle, flank movements, the quick digging 
 of shallow entrenchments for the protection of the soldiers in 
 line of battle, are some of the important subjects which are 
 engaging the minds of our wide awake military officers and 
 which await a satisfactory solution by as yet an unknown
 
 42 
 
 second Napoleon. Let us hope that this important person is 
 now in existence, an American citizen and now engaged in the 
 present war with Spain. 
 
 HOSPITAL CORPS. 
 
 The humane side of the present methods of warfare is best 
 shown by the organization of an efficient hospital and ambu- 
 lance corps. The sick and wounded of the great war of the 
 rebellion suffered indescribable pain and agony owing to inad- 
 equate provisions for transportation, first aid and nursing by 
 
 Private, hospital corps U.S. Army, 
 field equipment (front view). 
 
 Private, hospital corps U.S. Army, 
 field equipment trear view). 
 
 men detailed for this special purpose. Our sick and wounded 
 can look forward more hopefully for more prompt and efficient 
 treatment. The Government, through the Surgeon- General 
 and Secretary of War, is making ample preparations for the 
 prompt and efficient treatment of those requiring medical or 
 surgical aid. The prevention of disease by the employment of 
 improved hygienic and sanitary measures will do much in
 
 43 
 
 minimizing the number of ignominious deaths in the field and 
 general hospitals and in maintaining the full fighting force. 
 The need of a well organized and well equipped hospital corps 
 became apparent during our late war, but it was many years 
 after the Union was restored before the necessary legislation 
 was effected which brought it into existence. The Hospital 
 Corps in the United States Army was created by an act of 
 Congress approved March 1, 1887. 
 
 The law under which the Hospital Corps was established 
 and as revised by March 16, 1895, and March 16, 1896, reads as 
 follows : 
 
 (The Military Laws of the United States, 1897.) 
 
 "673. That the Hospital Corps of the United States Army 
 shall consist of hospital stewards, acting hospital stewards and 
 privates ; and all necessary hospital services in garrison, camp 
 or field (including ambulance service) shall be performed by 
 the members thereof, who shall be regularly enlisted in the 
 military service. Said Corps shall be permanently attached to 
 the Medical Department, and shall not be included in the 
 effective strength of the Army nor counted as a part of the 
 enlisted force provided by law. 
 
 "674:. That the Secretary of War is empowered to appoint 
 as many hospital stewards as, in his judgment, the service may 
 require ; but not more than one hospital steward shall be sta- 
 tioned at any port or place without special authority of the 
 Secretary of War. That there shall be no appointments of 
 hospital stewards until the number of hospital stewards shall 
 be reduced below one hundred, and thereafter the number of 
 such officers shall not exceed one hundred. 
 
 "675. That the pay of the hospital stewards shall be forty- 
 five dollars per month, with the increase on account of length 
 of service as is now, or may hereafter be allowed, by length of 
 service, as is now or may hereafter be allowed by law, to other 
 enlisted men. They shall have rank with ordnance sergeants 
 and be entitled to all the allowances appertaining to that grade. 
 
 "676. That no person shall be appointed a hospital steward 
 unless he shall have passed a satisfactory examination before 
 a board of one or more medical officers as to his qualification 
 for the position, and demonstrated his fitness therefor by 
 service of not less than twelve months as acting hospital stew- 
 ard ; and no person shall be designated for such examination 
 except by written authority of the Surgeon-General, 
 
 "677. That the Secretary of War is empowered to enlist or 
 cause to be enlisted, as many privates of the Hospital Corps as 
 the service may require, and to limit or fix the number, and 
 make such regulations for their government as may be neces- 
 sary ; and any enlisted man in the army shall be eligible for
 
 44 
 
 transfer to the Hospital Corps as a private. They shall per- 
 form duty as wardmasters, cooks, nurses, and attendants in 
 hospital, and as stretcher-bearers, litter-bearers and ambu- 
 lance attendants in the field, and such other duties as may by 
 proper authority be required of them, 
 
 "678. That the pay of privates of the Hospital Corps shall 
 
 Litter drill. 
 
 be eighteen dollars per month, with the increase on account of 
 length of service as is now or may be hereafter allowed by law 
 to other enlisted men ; they shall be entitled to the same allow- 
 ances as a corporal of the arm of service with which on duty. 
 "679. That privates of the Hospital Corps may' be detailed 
 as acting hospital stewards by the Secretary of War upon the 
 recommendation of the Surgeon-General whenever the necessi-
 
 45 
 
 ties of the service require it ; and while so detailed their pay 
 shall be twenty-five dollars per month, with increase as above 
 stated. Acting hospital stewards, when educated in the duties 
 of the position, may be eligible for examination for appoint- 
 ment as hospital stewards as above provided." 
 
 Since the original law providing for a hospital corps was 
 passed many new features have been added which have made 
 this branch of the military service more efficient. 
 
 The pay of members of the Hospital Corps is according to 
 grade, as follows per month: Hospital steward, $45; acting 
 hospital steward, $25 ; private, §18. 
 
 To the rates of pay enumerated above, 20 per cent, is added 
 in time of war. 
 
 During the present war the commander of an army corps, or 
 of a division, or of a brigade acting independently of a corps, 
 has full control of enlistments for the Hospital Corps within 
 his command, and of the detail of acting hospital stewards and 
 the appointment of hospital stewards. The Hospital Corps 
 force of the present war is made up three per cent, of the pri- 
 vates obtained by special enlistment or transfer from the line, 
 that is, a regiment of 1000 men is entitled to 30 men for the 
 Hospital Corps. The allowance for horses, wheel transporta- 
 tion and tentage is ample, as will be seen from the following 
 order recently issued by the War Department : 
 
 General Orders.) HEADQUARTERS OF THE ARMY, 
 
 V Adjutant General's Office, 
 
 No. 76. ) Washington, June 22, 1898. 
 
 1.— By direction of the Secretary of War, the following allowance of 
 horses for mounts, wheel transportation, tentage, etc., for the Medical 
 Department of the Army in the field is authorized : 
 Horses for Mounts. 
 
 To each regiment of infantry 
 
 To each artillery battalion (S light bat- 
 teries) 
 
 To each cavalry regiment 
 
 To each corps headquarters 
 
 To each division headquarters . . . . 
 
 To each brigade headquarters 
 
 To each division ambulance company 
 
 To each corps reserve ambulance com 
 pany 
 
 To each division field hospital . . . . 
 
 To each corps reserve hospital . . 
 
 Hospital 
 stewards. 
 
 Acting 
 hospital 
 stewards. 
 
 Privates. 
 
 Wheel transportation.— One ambulance to 400 men of the effective force. 
 One 4-horse wagon to (iOO men of the effective force. One -l-horse wagon 
 to each brigade.
 
 46 
 
 Tentagt.— For each ambulance company: 17 common tents for pri- 
 vates; 2 common tents for noncommissionetl officers. For each divi- 
 sion field hospital: 15 common tents for privates; 2 common tents for 
 noncommissioned officers; 1 common tent for supplies. Hospital tents 
 on a basis of 6 patients (beds) to each tent. Hand litters, with slings, 
 to be furnished by the Quartermaster's Department: 1 for each com- 
 pany; 2 for each ambulance. 
 
 Requisitions for the necessary articles of camp and garrison equipage, 
 tools, etc., will be based on the official allowances for companies of 
 infantry. 
 
 Requisitions for the before mentioned supplies will be sent in sep- 
 arately for divisio7is, -with statement whether or not the division organi- 
 zation is complete. 
 
 Horses and wheel transportation will be furnished by the Quarter 
 master's Department, and horse equipments by the Ordnance Depart- 
 ment. 
 
 II.— Commanding Generals of Army Corps are directed to detail, upon 
 the application of Chief Surgeons of Corps, two officers not above the 
 grade of first lieutenant for duty as Acting Assistant Quartermasters 
 with the medical service of each division. 
 
 By Command of Major General Miles: 
 
 E.G. CORBIN, 
 
 Adjutant General. 
 
 Litter drill. 
 
 As usual, many difficulties have presented themselves in the 
 way of securing the necessary material both in quantity and 
 quality, for the Hospital Corps during the present campaign.
 
 47 
 
 The commanding officers are always averse to lose the most 
 desirable men of the line. I have reason to believe that at the 
 present time the importance of a good Hospital Corps is appre- 
 
 Travois. 
 
 ciated more than ever by the commanding officers. The field 
 officers have co-operated with the corps surgeons in the selec- 
 tion of the best men for this special service. The work of 
 organization has progressed slowly, but on the whole in a sat-
 
 48 
 
 isfactory manner. The enormous demand for equipments and 
 the sudden mobilization of troops have contributed much in 
 retarding the organization and instruction of the Hospital 
 Corps. The designation of the Corps as a Hospital Corps does 
 not convey the proper meaning of the manifold purposes for 
 which the men are enlisted and transferred, and has been the 
 means of misleading many a patriotic doctor and medical stu- 
 dent now engaged in this branch of military service. Many 
 complaints are heard because instead of doing hospital duty 
 proper the men are made to cook, drive ambulances, chop wood, 
 dig sinks and haul water. There are today too many doctors 
 and medical students in the Hospital Corps. The duties of 
 the Hospital Corps are manifold, and in their proper discharge 
 requires more skilled artisans than medical men. A good Hos- 
 pital Corps should consist largely of young, bright, intelligent, 
 robust men skilled as carpenters, cooks, blacksmiths, stenog- 
 raphers, photographers, ambulance drivers, tailors, shoemakers 
 and other trades. Doctors and medical students should be in 
 the minority, and ought not to exceed twenty-five per cent, 
 of the non-combatant force. If the legitimate function of 
 the Hospital Corps were better understood there would be 
 fewer applications for this service on the part of profes- 
 sional men. The general impression prevails that the duties 
 of the members of the Hospital Corps are less onerous 
 than those of the private soldier of the line. It is difficult to 
 conceive how such an idea could have originated. It is also 
 understood that the non-combatant soldier is exposed to less 
 risk of life than his comrade of the line, when the fact is ap- 
 parent that in addition to the ordinary dangers incident to 
 warfare, he is more exposed to the greatest source of danger — 
 disease. The nursing in the field hospital is done exclusively 
 by the Hospital Corps men, and involves much loss of sleep 
 and constant care and attention. The transportation of sick 
 and wounded is a task requiring good judgment, promptitude 
 and care. A combination of firmness and gentleness, thought- 
 fulness of action and a determination to perform duty regard- 
 less of rest and comfort, is an essential element of success in 
 the work of every Hospital Corps man. The climatic influence, 
 the prevalence of tropical diseases will tax to the utmost the 
 resources of the Hospital Corps during the present war with
 
 49 
 
 Spain. That the work will be well and cheerfully done I have no 
 doubt, judging from my observations during the last two months. 
 The American people expect that the sick and wounded of 
 this war shall receive the best possible attention, and in this 
 they will not be disappointed. The Government, although 
 sometimes necessarily tardy, is willing and anxious to do all 
 in its power to alleviate the horrors of this war, and in this 
 humane intention it will receive the hearty co-operation of the 
 Hospital Corps. The writer has been permanently detached 
 from the Sixth Army Corps now at Chickamauga by a recent 
 order, and is now on his way to Santiago de Cuba on special 
 duty. He goes to the front as Chief of the Operating StafiP 
 with the troops in the field. For the purpose of informing my 
 many friends among your readers what I am expected to 
 do, I append a copy of the letter assigning me to my new field 
 of labor. 
 
 HEADQUARTERS OF THE ARMY. 
 
 Washington, D. C, June 29, 1898. 
 Lieutenant-Colonel Nicholas Senn, U. S. V., Chief of the 
 
 Operating Staff. 
 
 Sir .-—In assigning you as Chief of \he Operating Staff, the 
 Major General Commanding the Army directs me to say that, 
 at the several points to which you may be assigned to duty, 
 you will confer with the Chief Surgeon of the Corps engaged 
 as to the means by which you may consult with and advise the 
 medical officers serving with that army regarding the clinical 
 features of their professional work ; that you will recommend 
 such methods, either by lectures or operative demonstration, 
 as may in your judgment be best suited to accomplishing the 
 purpose in hand ; that you will take the necessary steps for 
 collecting data upon which the clinical and pathologic records 
 of the field and hospital service may be classified, and from 
 which the future medical and surgical history of this war may 
 be prepared. Your present assignment will be for duty with 
 the Fifth Army Corps, now operating before Santiago de Cuba, 
 and at such future time as the General Commanding may 
 decide, you will be transferred to other points where active 
 military operations are progressing. 
 
 Very respectfully, 
 
 Col. Chas. R. Greenleaf, 
 Asst. Surg.-Genl. U. S. A., Chief Surgeon, Army in the Field. 
 
 I hope I will reach Santiago before surrrender and enter it 
 with our victorious troops. My address for the present will be 
 Fifth Army Corps, Santiago, Cuba. 
 
 My next communication will be from the seat of war.
 
 THE FLOATINC; HOSPITALS. 
 
 Off Santiago de Cuba, July 7, 1898. 
 The government, the different charitable societies, local, 
 State and general, and the people, have from the very begin- 
 ning of this war vied with each other in adopting and carrying 
 into effect means and measures to provide comfort and efficient 
 treatment for the sick and wounded. A commendable unity 
 and harmony of action prevails throughout the entire country 
 to bring about the best results. Desultory action, so common 
 during the War of the Rebellion and that did so much in 
 retarding the philanthropic work at that time, has largely 
 given way to well organized, systematic efforts which will be 
 sure to result in the greatest amount of good to all in need of 
 such assistance. The patriotism of the people is only equaled 
 by their generosity to those who are now engaged in the 
 defense of the honor and dignity of their country. The out- 
 side world will watch the progress and extent of the humani- 
 tarian work displayed during this war with as keen an interest 
 and degree of admiration as the victories of our army. The 
 collection and distribution of funds, clothing, delicacies and 
 hospital supplies is in the hands of responsible persons, and 
 the liberal donors can be assured that the articles contributed 
 will reach the intended destination. Many of the railway cor- 
 porations have shown a laudable willingness to forward con- 
 tributions of this kind at greatly reduced rates, a concession 
 which will materially increase the usefulness of the various 
 societies which have been or will be organized throughout the 
 land for the distinct purpose of aiding the government in prop- 
 erly caring for those who have been disabled from injury or dis- 
 ease. Efforts in this direction are best calculated to stimulate 
 the patriotism and heroism of our soldiers in the field. One of 
 the noblest undertakings for this purpose is the action of the 
 government in the recent purchase and outfitting of two large 
 ocean vessels for hospital and ambulance use. The Navy has 
 the Solace, and the Relief, now under sail for the seat of war, 
 is intended for the Army. The seat of war makes the use of
 
 51 
 
 these ships an absolute necessity for the proper care of the 
 sick and wounded. Both of these ships are floating hospitals 
 supplied with all the facilities of a modern hospital. 
 
 Tlie Hospital Ship ''Relief.'' — This communication is written 
 on board the hospital ship Belief, on its first trip to the seat 
 of war. The ship started from New York, July 2, and called 
 at Fortress Monroe in the afternoon of the following day for 
 the purpose of taking on board a number of surgeons, inclu- 
 ding the writer. Surgeon General Sternberg awaited her arri- 
 val, and made a thorough inspection before her departure. 
 The name of the ship appears particularly appropriate from the 
 conditions under which we left Fortress Monroe, Sunday, July 
 3. Shortly before leaving Fortress Monroe cable messages an- 
 nounced that fierce fighting was in progress on the third day 
 of the battle of Santiago. They also announced to the anx- 
 ious crowd that gathered around the bulletin boards at the 
 hotel Chamberlin, that the number of killed and wounded on 
 our side had reached the neighborhood of 1200, and that the 
 enemy showed greater strength and resistance than had been 
 anticipated. General Shafter, in command of the invading 
 army, had sent a telegram to New York asking for the imme- 
 diate despatch of the Relief. There can be no doubt but 
 that the appearance of the boat is eagerly looked for at the 
 seat of war, and that upon her arrival she will merit the name 
 she bears. The Ileli'^f was formerly the John Englis, and was 
 purchased by the Government, some six weeks ago, from the 
 Maine Steamship Line, for $450,000. She was the sister ship 
 of Horatio Hall, and was used a year and a half as a coast 
 liner between New York and Portland, Maine. She was built 
 by the Delaware River Iron Ship Building and Engine Works, 
 Chester, Delaware, in 1896. She was well adapted for the 
 coast service, and it was a rare opportunity when she was 
 secured for Government service. The vessel is 300 feet in 
 length, 46 feet in width, draws 15 feet of water forward and 
 161^ feet aft, and has an averafge speed of 14 knots an hour. 
 She carries two masts, one smoke-stack, and is supplied with 
 large ventilators. The latter are of especial importance after 
 her reconstruction into a hospital ship. Major Torrey, Sur- 
 geon U. S., formerly stationed at West Point, is in command 
 of the ship, and had charge of the work of reconstruction in
 
 52 
 
 making the necessary changes in adapting her for hospital use. 
 Many important changes in the interior of the ship had to be 
 made in transforming an ordinary passenger steamer into a 
 hospital ship. The major has spent six anxious, trying weeks 
 in accomplishing this. He availed himself of the valuable ser- 
 vices of Naval Constructor Bowles. The work was done at the 
 foot of Ninth street, New York, and -.vas watched with great 
 interest by the public and the medical profession in that city 
 and surrounding towns. Many of the staterooms had to be 
 removed to make space for five capacious wards. About 650 
 men were employed night and day in pushing the work to com- 
 pletion as rapidly as possible. American pluck and energy 
 were well displayed in completing the herculean task in four 
 weeks. The entire expense of reconstruction will reach nearly 
 8150,000, so that the ship costs the Government about ^600,000. 
 I doubt if any other equal sum for any other purpose will do 
 so much for our army as this floating house for the disabled 
 soldiers. 
 
 The interior of the ship is so arranged that every nook and 
 corner can be utilized to advantage. On the hurricane deck 
 forward is the search-light on the pilot house, the pilot house, 
 pilot's and ship oflBcers rooms. Center and aft are canopied 
 for convalescents, and are well supplied with long wooden 
 benches and steamer chairs. Eight life boats and four rafts 
 constitute the life-saving outfit. There are also two steam 
 launches 28 feet in length with a speed of nine knots an hour. 
 The upper saloon deck is intended for medical wards mainly. 
 Ward No. 1 is forward and has 82 beds. The iron bedsteads are 
 of special construction, securely fastened to the floor. The 
 cots in use are iron framed double-deck beds of single width, 
 with wire spring mattress and adjustable side rails. Cotton 
 mattress, linen sheet, two blankets and two horsehair pillows 
 constitute the bed proper. Each bed has a wire basket attached 
 for dressing material ana medicines. 
 
 This ward is sujjplied with two toilet rooms, a stationary 
 bath tub and sink in middle of ward, with adjustable canvas 
 screen. Provision has also been made here for hot and cold 
 water shower bath. The room is lighted by four reflectors 
 with six incandescent burners to each, and a number of green 
 shaded incandescent burners. Four electric fans will prove a
 
 53 
 
 source of comfort during hot weather. The center of this floor 
 is devoted to state rooms for the female nurses, mess room for 
 ward No. 1, and a large pantry containing tableware and facil 
 ities for preparing special diet. Ward No. 2 aft end of the ship 
 with a capacity of Gi beds is connected by a hatchway with 
 ward No. 4 below. Bath, toilet rooms, electric lighting and 
 fans same as in ward No. 1. Forward on lower saloon deck 
 are the sailor's quarters, offices, sleeping apartments and mess 
 room for the medical officers, medical library and a small 
 ward of 28 beds, well lighted and ventilated. In the center of 
 this deck is the kitchen and mess room for the hospital corps 
 and male nurses. At the entrance of the gangway and in a 
 corner of the large surgical ward with 74 beds is the operating 
 room. This room is large enough for all practical purposes, 
 and contains two operating tables, a high pressure steam ster- 
 ilizer, reagent and dressing cases, stationary wash stand, two 
 instrument cases, two formalin sterilizers and two electric fans. 
 The floor is made of interlocking rubber tiles. The fourth ward 
 is well lighted and ventilated. On one side of this ward are 
 stationed a static and X ray apparatus under the management 
 of Dr. Gray. 
 
 On the lower deck forward is the fireman's forecastle (27 
 beds), an ice machine with a capacity of a ton and a half a day, 
 a refrigerator and an apparatus for manufacturing carbonated 
 water at the rate of 100 bottles an hour, a water condenser 
 (sixty gallons an hour) and a sterilizer (carriage 4 feet, 6 inches 
 by 8 feet, 6 inches, which can be used for the disinfection of 
 large articles by, a, steam under ten pounds of pressure at 
 240 P., b, formaldehyde, c, ammonia). In the center of this 
 deck are the carpenter's and plumber's shop and a steam 
 laundry of ample dimensions. Forward aft on this deck is 
 ward No. 5 with forty beds, mess room and quarters for the 
 hospital corps. A small laboratory for scientific work has 
 been fitted up with many of the modern facilities and has been 
 placed in charge of Dr. Gray of the Army Medical Museum. 
 If Santiago has not been taken by the time we arrive the ship 
 will be anchored at the most convenient point near the shore 
 and the transfer of patients will be made by the use of the two 
 steam launches on board. Arrangements have been made for 
 taking patients aboard by canvas basket, by hoisting boat, or
 
 54 
 
 by stretcher up the stair gang, which for this purpose has been 
 made much wider than usual. The ship is in charge of Capt. 
 Frank Harding, First Officer C. W, Crocker, Second Officer 
 Harksen, Engineer Charlton and a crew of sixty-eight men. 
 Major Tomey is assisted by Major W. C. Gourgas and Major 
 Bradley, both of the United States Army. Lieut. J. T. Crabbs, 
 8th U. S. Cavalry, is quartermaster and commissary, and Rev. 
 George Robinson, U. S. A., and Rev. Father J. N. Connolly of 
 New York, are the chaplains. Thre are sixteen trained nurses 
 on board, ten male and six female, and a detachment of twenty- 
 nine hospital corps men. The names of the female nurses are : 
 Miss Elise H. Lampe, Miss Louise Jones Block, Miss Amy 
 B. Furguhasson, Miss Lucy Ashby Sharp, Miss Amanda J. 
 Armistead, Miss Esther Voorhes Hasson. The following con- 
 tract surgeons have been assigned to duty on the ship: Drs. 
 Myers, Schultz, Tierney, Jr., Williamson, Hartlock and Met- 
 calf. The ship carries a large supply which will meet the 
 immediate demands of the sufifering troops. Every one on 
 board is anxious to reach the destination to lend a helping 
 hand. Th3 female nurses have utilized the time in preparing 
 the wards for the reception of patients. If it were not for the 
 blue ocean, the waves and the motion of the ship, it would be 
 difficult to realize that we are not in a well-regulated, well- 
 equipped hospital on terra firma instead of a floating hospital. 
 Tomorrow (July 7) the doors of this great floating institution 
 will be thrown open for the benefit of those who have become 
 incapacitated for duty in the field, and there is a great proba- 
 bility that every cot will be occupied in less than twenty-four 
 hours after its arrival at the seat of action. The journey so 
 far (July 6, 10 a.m., oS San Salvador) has been a very pleasant 
 and auspicious one. A stiff breeze from the south is fanning 
 every room and cheering and invigorating its inmates. All is 
 in readiness to fulfill the mission for which this messenger of 
 mercy has been sent to the distant seat of war. Thousands of 
 anxious hearts at home and in (>uba are following its course in 
 thought and prayer and will be rejoiced when they know that 
 its anchor has been dropped and its deck cleared for action.
 
 THE MEDICAL DEPARTMENT OF THE ARMY IN THE 
 CUBAN CAMPAIGN. 
 
 On Board the Hospital Ship "Relief," July 31, 1898. 
 In an editorial of the Medical Record of July 30, suspicions 
 are thrown out reflecting on the efficiency, foresight and proper 
 management of the Medical Department of the Army during 
 the Cuban Campaign. The remarks made by the editor are 
 based, as he himself asserts, almost exclusively on a correspond- 
 ence which appeared in a recent issue of the Sun. In com- 
 menting on this article the editorial states : "If the report is 
 true, and there seems to be no good reason for doubting it, the 
 Army Medical Department appears in a very unenviable light. 
 It is said that there was a total lack of everything necessary 
 for the proper care of the stricken soldiers. Why this was so 
 it is hard to explain, especially in view of the fact that the war 
 department has constantly declared, in declining voluntary 
 assistance from charitable organizations, that it was abund- 
 antly able to cope with any possible emergency in the field, 
 and yet this is the result." The correspondent of the Sun 
 made bold in saying: "It was evident that the Medical 
 Department of the Army had failed absolutely to send hospital 
 supplies, or by this time they would have been landed. On 
 the one hand it was pitiful. On the other, it was negligence 
 that could have been the result only of incompetence." I am 
 sure if the editor of the Medical Record had been better 
 informed he would not have been so willing to lend his ear to a 
 newspaper correspondent whose success nowadays consists 
 largely in tinging facts with more or less imagination and sen- 
 sationalism. The medical men inside and outside the army 
 have little, if any, influence over the lay press, but the editor of 
 a medical journal of such high standing with the medical pro- 
 fession throughout the entire country as has been willingly 
 accorded the Medical Record, should take the necessary pains 
 to investigate more thoroughly the circumstances which dic- 
 tated the editorial before casting any reflections whatsoever on
 
 56 
 
 the chief of the medical department. Dr. George M. Stern- 
 berg is no stranger to the medical profession and the American 
 people. He occupies the exalted position of Surgeon General 
 of the United States Army, not by political preferment or 
 gradual ascent by promotion, but by merit. President Cleve- 
 land made a wise selection when he made the appointment. 
 It was a selection that met with the heartiest approval on all 
 sides. General Sternberg knows from long and actual experi- 
 ence what it is to be a soldier in the field. He has been there. 
 He served with distinction during the War of the Rebellion. 
 He has followed the unruly and wily Indians over plains and 
 mountains during many a campaign. He has investigated 
 yellow fever at home and abroad, regardless of his own health 
 and life. Since he has been placed in charge of the Medical 
 Department of the Army he has been tireless in making many 
 much-needed improvements. 
 
 The Army Medical School is one of the many fruits of his 
 labors. He has taken special interest and pride in promoting 
 the intellectual and professional advancement of his young 
 army surgeons, assigning them for temporary duty in large 
 cities, where they could enjoy clinical instruction and labora- 
 tory work. He has taken a deep and active interest in the 
 organization and usefulness of the Association of Military 
 Surgeons of the United States, and served most acceptably as 
 president. Last year he was honored by the profession by 
 election to the Presidency of the American Medical Associa- 
 tion. The earnest devotion to his duties made it impossible 
 for him, to his great regret, to attend the Denver meeting. 
 The name of General Sternberg is often seen on the programs 
 of scientific societies from the Atlantic to the Pacific and from 
 Labrador to the Gulf. He crossed the Atlantic, last summer, 
 to represent his Government at the International Congress, 
 held in Moscow, Russia, and his work there added much to 
 the luster of American medicine. The Surgeon-General, now 
 so unjustly accused of incompetency, not only is accorded a 
 well-deserved place in the front rank of the profession, but 
 his administration shows executive talents which have served 
 him well during the present campaign. He has shown good 
 judgment in the selection of his advisers. Colonels Alden, 
 Greenleaf and Smart, are all men of large experience and
 
 57 
 
 admirable executive abilities, as all can testify who have been 
 brought in contact with them. The charge of incompetence 
 and ignorance certainly lacks foundation in the case of General 
 Sternberg and his administration. Now, as to facts. The 
 correspondent of the Sun who furnished all the material for 
 the editorial referred to goes on to say : " The wounded were 
 carried back from the fighting line on stretchers, and laid on 
 the ground to wait until the surgeons could reach them. Many 
 
 Brigadier-General George M. Sternberg," Surgeon-Gem^ral of the Army. 
 
 were soon beyond the need of surgical treatment. There were 
 four divisions of the army, and each division was supposed to 
 have its hospital ; but as a matter of fact there was but one, 
 the division hospital of the Fifth Army Corps, under Major 
 Wood. There were five surgeons, a hospital steward, and 
 twenty assistants, to care for the wounded— several hundred. 
 They had a number of operating tables, a small supply of
 
 58 
 
 medicines, but few bandages, and no food for sick or wounded 
 men. It was comparatively easy to get supplies from the State 
 of Texas ashore to the hospital here (Siboneyj, but there was 
 no transportation to the front." In the opinion of the editor 
 of the Medical Record and the correspondent of the Sun the 
 Red Cross Association's work was the only redeeming feature 
 of the whole campaign, to judge from the language of the 
 latter : "God knows what we should have done here without 
 the help of the Red Cross— your ship, your surgeons, and 
 your nurses I and there is no other help for us at the front. 
 Our wounded up there must have food, bandages, anything 
 you can let us have in the line of hospital supplies." The edi- 
 torial in the Medical Record brings matters to a focus in the 
 closing extract : " It is right and proper that the Surgeon- 
 General should resent any interference with his prerogatives, 
 but he should not directly invite it by making possible such 
 a condition of affairs as here described." This inference is 
 entirely unwarranted by facts as they existed during and after 
 the battle of Santiago. 
 
 The correspondent and editorial do not even mention the 
 steamer Olivette we found July 7 anchored close to the shore 
 before Siboney. This steamer, in command of Major Appel, 
 U. S. A., was used as a hospital ship. This ship was in place 
 and ready to receive the wounded during the battle. The 
 steamer, at the time mentioned, had on board 300 wounded, 
 who received the best surgical attention and nursing. The 
 next day the steamer left for the United States, the medical 
 staff being reinforced by the addition of Acting Assistant- 
 Surgeon Brown of Chicago from the Relief. General Stern- 
 berg at an early date recognized the importance of hospital 
 ships during this war. The Olivette was chartered for this 
 special purpose, Tas well equipped and reached the seat of 
 war in time. The hospital ship Relief, formerly the John 
 Englis, under the supervision of its commander. Major 
 Torrey, was transformed into an ideal floating hospital in less 
 than six weeks and reached Siboney July 7, a day before the 
 Olivette left for its home port. Do these things show either 
 negligence or ignorance ? Do they not rather demonstrate 
 foresight and an earnest endeavor to better care for the sick 
 and wounded in a w^ay creditable to our country and the chief
 
 59 
 
 of the Medical Department? This question can safely be left for 
 the wounded to answer. The Surgeon-General accepted the 
 legitimate services of the Red Cross Association and had rea- 
 son to expect aid from this source, should pressing emergen- 
 cies present themselves. The medical officers, the wounded 
 and the sick have every reason to be grateful to Miss Clara 
 Barton, for what she did in furnishing ice, delicacies and 
 medical supplies. The State of Texas did excellent work in 
 aiding the Medical Department, but that is no reason why 
 those connected with the Red Cross Association should claim 
 all the credit and undertake to criticise a department of the 
 government which has done all it possibly could in anticipating 
 the requirements of a sudden emergency. It is a source of 
 great regret that there should be any friction whatever 
 between the Medical Department and the friends and sup- 
 porters of the Red Cross Association. It must be clear to 
 every unprejudiced mind that the treatment of the sick and 
 wounded must remain under the direct care, control and man- 
 agement of the Medical Department, and that the function of 
 Red Cross is rather auxiliary to it than as an independent 
 organization if the greatest amount of good is to be realized 
 from it. The hospital ship Relief brought an immense amount 
 of medical supplies, delicacies, cots, pillows and blankets. 
 When we arrived at Siboney we knew our presence was much 
 needed, and looked in vain for some one to inform us where and 
 how to land. The precipitous and rocky nature of the shore 
 and the great depth of the ocean made it unfavorable to secure 
 anchorage for several days. A single lighter attended to the 
 demands of numerous transport ships. I am sure no one 
 could blame the Medical Department for the unavoidable 
 delay in unloading the supplies. The little steam launches did 
 what could be done in bringing to the shore what was most 
 needed. Major Torrey worked night and day in supplying 
 the requisitions made by the surgeons in the field and hospi- 
 tals. There was no red tape here, all they had to do was to 
 inform him what was wanted and it w^as delivered as soon as 
 it could be brought to the shore. The lack of proper transpor- 
 tation facilities from the landing to the front can not be 
 charged to the Medical Department. It took more than a 
 week of the hardest kind of work to land all of the supplies,
 
 60 
 
 and, considering the limited facilities available, it is and 
 always must be regarded as a source of satisfaction that it was 
 made possible at all. The Relief brought 1000 cots and an 
 ample supply of bankets, which reached the hospitals with as 
 little delay as possible. 
 
 Lieut. Crabbs of the 8th Cavalry, showed a creditable degree 
 of ingenuity, energy and often of courage in landing the sup- 
 plies. The complaint that the sick and wounded lacked medi- 
 cines and dressing materials is true only to a certain extent. 
 Some of the medicines were exhausted, owing to the unexpected 
 enormous demand, but they were supplied as quickly as could 
 be done under the existing circumstances. The writer had the 
 privilege to operate in all of the hospitals and was always able 
 to find the essential antiseptics and dressing materials required 
 in military practice, and this was at a time when the supplies 
 were at the lowest. There was no lack at any time of stimu- 
 lants and anesthetics. There is no use in denying the fact 
 that immediately after the battle the tentage and blanket sup- 
 ply were inadequate, but these defects were corrected promptly. 
 War always has had its hardships and discomforts ; it can not 
 be prosecuted in parlor cars and clubhouses. Or soldiers ex- 
 pected deprivations and unavoidable discomforts, but on the 
 whole they were subjected to less actual suffering than they 
 had reason to look for. To the credit of the medical oflBcers it 
 must be said they shared the inevitable hardships with the 
 soldiers. They lived on the same food, drank the same water 
 and made the moist ground their beds. The writer will always 
 cherish the memory of the hardships incident to a campaign 
 in a foreign country, a tropical climate and among a strange 
 people. The Cuban campaign was planned and executed so 
 quickly that some omissions and defects had to be expected. 
 It is a source of gratification to know that the complaints 
 made against the medical department have come from news- 
 paper correspondents and camp followers more than from the 
 soldiers themselves. Among the thousands of sick and wounded 
 with whom I have been brought in contact during the Cuban 
 campaign I have seldom heard a complaint : on the contrary, 
 I have heard nothing but words of praise for the hard-working, 
 self-sacrificing medical officers and the department they repre- 
 sent in the field.
 
 THE QUALIFICATIONS AND DUTIES OF 
 THE MILITARY SURGEON. 
 
 Nearly five months of continuous service with the 
 army in the camp and field has afforded me an excel- 
 lent opportunity to make a practical study of the 
 above subject. This time was spent in Camp Tanner, 
 Springfield, 111.; Camp George H. Thomas, Chicka- 
 mauga, Ga., and the Cuban campaign, the time being 
 about equally divided in the different places. The 
 first four weeks were occupied in Camp Tanner, 
 where I assisted in the capacity of Surgeon- General 
 of the State in the organization of the State troops. 
 This service brought me into closer contact with the 
 National Guard of our State than at any time before. 
 A physical and professional examination in which I 
 took part brought out the shady as well as the sunny 
 side of their qualifications. The result of my experi- 
 ence here convinced me that the average National 
 Guard surgeon is a faithful doctor, with more than 
 average professional ability, but, with few exceptions, 
 lacking the necessary military training in performing 
 satisfactorily his administrative duties. This is a 
 part of his education that has been sadly neglected 
 in the past and should receive more attention in the 
 future. Very few States make provision for physi- 
 cal examination of the medical officers, consequently 
 some of them have entered the service totally dis- 
 qualified for participating in an active campaign. 
 Two of the candidates for the volunteer service from 
 the National Guard of Illinois were rejected on this 
 ground. The four weeks' service at Camp George 
 H. Thomas as chief surgeon of the Sixth Army 
 Corps opened up a wide field for extended observa- 
 tions in making comparisons between the work done
 
 (32 
 
 by the surgeons of the regular army and of the 
 National Guard. The surgeons of the United States 
 Army are all men of superior education, splendid 
 physical development, and those who have been in 
 the service for several years are well versed in the 
 routine work of the Medical Department. However, 
 in all matters pertaining to medicine and surgery 
 the average National Guard surgeon more than holds 
 his own. This superiority of the National Guard 
 surgeon over his colleague of the regular army is 
 no reflection on the latter; it is the natural outcome 
 of circumstances, which made such a difference inev- 
 itable. The young army surgeon has to spend many 
 years at small and often out-of-the-way posts, where the 
 opportunities for clinical experience and intercourse 
 with professional colleagues are necessarily limited. 
 He naturally soon falls into the monotonous and 
 routine work of the post life, with little or no induce- 
 ments to continue his post-graduate, scientific and 
 medical studies. When the time comes to pass an 
 examination he wakes uj) from his lethargy suffi- 
 ciently to go through the different compends to pre- 
 pare himself for the coming ordeal. He breathes 
 easy after he has reached the major's rank, as this 
 promotion forever closes the- door of the much- 
 dreaded green room. From now on he is in the 
 line of slow promotion without any extra exertions 
 on his part. He receives his salary and looks confi- 
 dently for assignments to posts where he can spend 
 the balance of his life in ease and luxury. He has 
 reached a time in life when he feels that he can avail 
 himself of the work of his subordinates without 
 interfering with his emoluments or his position in 
 social and military life. He is conscious of the fact 
 that he has reached a rank and a station in life where 
 it is i^roper for him to look to his assistants to do the 
 drudgery which he had become accustomed to in the 
 past, and begin to enjoy the life before him. It is 
 different with the military surgeon taken from civil 
 life. He emerges from the turmoils of family prac-
 
 63 
 
 tice. From the day of his graduation he has tasted 
 the bitter fruit of active competition. His work has 
 been watched with an envious eye and subjected to 
 sharp criticism by his neighboring colleagues, old and 
 young. He felt from the very beginning of his pro- 
 fessional career that success depended upon his own 
 exertions. The average American practitioner is a 
 hustler. He is willing to work night and day to gain 
 a lucrative practice and the social position which goes 
 with it. With few exceptions he knows that what he 
 has learned in college is but the entering wedge to a 
 comprehensive knowledge of the practice of medicine 
 and surgery. He knows that our profession has 
 become a progressive one. His college education 
 tells him what is new today will be old tomorrow. 
 He looks with pity on his colleagues, advanced in 
 years, whose language and practice convince him that 
 they have fallen into a dangerous rut. He reads the 
 numerous medical journals, the great avenues of 
 recent medical literature. He spends his scanty 
 income in purchasing new books and instruments for 
 scientific investigations. All requisitions are made on 
 himself and are honored only by writing bis own 
 checks. He joins medical societies, large and small, 
 and attends their meetings regularly. He listens 
 intently to the reading of papers and discussions to 
 increase his store of knowledge and returns to his 
 limited field of action better prepared to battle against 
 disease. He mingles freely with the members of his 
 profession, always ready to absorb and digest new 
 ideas. He makes frequent pilgrimages to his alma 
 mater or some post-graduate school to familiarize 
 himself with the most recent advances in medicine and 
 surgery. Social life has no attractions for him ; he has 
 entered the profession for the sole purpose of becom- 
 ing an influential and successful practitioner. This 
 is the kind of material our National Guard surgeon is 
 made of. No wonder he outweighs the professional 
 military surgeon in practical knowledge required in 
 the treatment of injuries and disease.
 
 64 
 
 The exacting and often onerous duties of the mili- 
 tary surgeon in times of war require special qualifica- 
 tions to prepare and fit him for his work. He is not 
 only expected to be well versed in theoretical and 
 practical knowledge of everything pertaining to the 
 practice of medicine and surgery, but he must be 
 endowed with qualities both of mind and body upon 
 which he can rely when engaged under the most try- 
 ing circumstances. In field work he has often to 
 perform the most difficult tasks with very limited 
 resources. In such instances good common sense 
 and deliberate action go much further in accomplish- 
 ing what is desired than the finest scholarship and 
 the most profound logical reasoning. The man who 
 can in a few moments extemporize a well-fitting splint 
 out of the simplest materials and perform with the 
 contents of an ordinary pocket case the most difficult 
 operation will do vastly better work on the battlefield 
 than most professors of surgery and the most brilliant 
 operators in civil practice. The surgeon who under- 
 stands the principles and practice of good cooking is 
 of more service to the troops than the one who can 
 repeat, word for word, the contents of the most 
 exhaustive treatise on materia medica and therapeu- 
 tics. The medical officer with a full knowledge of 
 hygiene and sanitation and endowed with the faculty 
 of making a rational, practical use of it is preferable 
 to the most expert clinician, as in military practice it 
 is more important to prevent than to treat disease, no 
 matter how successfully and scientifically the latter 
 may be conducted. The all-around medical officer 
 must be a good mechanic; he should know how to use 
 the carpenter's and blacksmith's tools, how to row and 
 sail a boat, how to make a raft and occasionally he 
 will have reason to be thankful if he has learned how 
 to pack a mule and drive an ambulance team. His 
 miscellaneous knowledge of matters and things en- 
 tirely outside of his legitimate province will be con- 
 stantly drawn upon from difPerent sources and the 
 more he knows and is willing to impart' the more he
 
 65 
 
 will be useful and popular. The man who enters the 
 medical dei3artment of the army under an impression 
 that he is only expected to treat wounds, set broken 
 bones and prescribe for the ordinary camp ailments 
 makes a serious mistake and will be surely a disap- 
 pointment both to himself and to those he is expected 
 to serve. 
 
 Physical condition. — The ideal military surgeon in 
 possession of the necessary mental and physical qual- 
 
 Transfer of wounded to the hospital ship Relief at Arroya. 
 
 ities to make him so is seldom seen. The most active 
 brains are often found in a frail body. I have often 
 seen in civil life surgeons of great reputation strug- 
 gling with disease or its effects, or the victims of 
 some congenital or acquired defects, who were won- 
 ders in the operating amphitheatre in spite of such 
 disability. I have seen more than once the saddest 
 of all spectacles in professional life — a surgeon, himself 
 the subject of an incurable disease, muster into service 
 every particle of his reserve strength to perform a
 
 66 
 
 critical operation with a view of saving the life of 
 another. Achievements of this kind are possible in 
 private practice but are entirely out of the question 
 in military service. The physical condition of the 
 military surgeon must be as nearly perfect as possible. 
 A physical examination as thorough and as painstak- 
 ing as in the case of a private can only decide upon 
 the necessary physical qualifications of candidates for 
 commission in the medical service. For good reasons 
 this rule is followed in the selection of medical offi- 
 cers for the regular army and there is no ground why 
 the same requirement should not be exacted in the 
 National Guard. During my service at Chickamauga 
 and in the Cuban campaign, I saw more than one 
 volunteer surgeon who ought to have been excluded 
 from the service for physical disability. During a 
 campaign the loss of a single medical officer may 
 prove a great disaster. Of all commissioned officers 
 the surgeon is the most indispensable. The vacant 
 place of a line officer can be filled at a moment's 
 notice without any serious loss to the service: not so 
 with the surgeon. His position is one requiring 
 special training and one that can not be filled without 
 crippling the medical service at some other point. For 
 this, if for no other reason, the medical officer must 
 be in sound health and able to cope successfully with 
 the hardships of a campaign. In battle, and during 
 the prevalence of an endemic or epidemic disease, the 
 medical officer is the one above all others whose 
 strength and endurance are taxed to their utmost 
 extent. His services are required by day and by 
 night. He has no rest, and unless in i)ossession of 
 an iron constitution, his strength fails him and he 
 becomes, if not a fit subject for the hospital, at least 
 a physical wreck, who, if he persists in continuing his 
 work, will often do more harm than good. A number 
 of such instances came to my personal notice during 
 the Cuban campaign. A medical officer should not 
 only be in full possession of health and all that this 
 implies, but he should have been in training to
 
 67 
 
 endure hardships of all kinds from early childhood. 
 He need not necessarily be an athlete, but he should 
 be able to walk twenty miles a day or ride forty with- 
 out fatigue and then be ready to do a night's work 
 should an emergency demand it. The dancing halls 
 and club houses are poor training schools for a suc- 
 cessful military career. The lal^or and hardships 
 encountered in hunting are best calculated to prepare 
 the body for a life of great activity and privation. 
 
 The Spanish military hospital in Ponce, Porto Rico. 
 
 Frugal living will not only prove conducive to the 
 maintenance of health but will be the best means of 
 initiating the surgeon to the uncertainties of the com- 
 missary department when on the march or in the 
 field. 
 
 Let every one who chooses the military career dis- 
 pense with unnecessary clothing and luxuries during 
 early life in order to accustom and adapt himself for 
 his life work, which in time of war will bring the 
 inevitable amount of viscissitudes and even suffering.
 
 G8 
 
 The medical officer must be a good horseman, which 
 here not only implies a good rider, but a knowledge 
 of the usual ailments of horses, the treatment, feed- 
 ing and care of the animals. To sum up, the military 
 surgeon must be a man of vigor, made so by birth and 
 training, with as few requirements in his habits of 
 living as possible, in order that he may resist to the 
 highest degree the influences of climate and disease 
 and prepare himself for the hardships and privations 
 incident to active warfare. 
 
 Mental qiLalifications. — A proper and adequate 
 preliminary education is exacted of every surgeon in 
 the regular army; without it he is not permitted to 
 pass the medical examination. Statistics show that 
 a large percentage of the candidates are dropped at 
 this stage of the examination. This is a reflection 
 on the system of medical education which continues 
 to prevail in our country. About the only evidence 
 of proficiency the National Guard surgeon in most of 
 our States is required to show is his diploma. It 
 makes but little difference when the diploma was 
 obtained. Evidences of a satisfactory preliminary 
 education are not required. In consequence of such 
 an easy entrance into the medical service of our State 
 troops, many of the men who receive commissions 
 are illiterate. By hard post-graduate work they often 
 become good physicians, but they seldom if ever 
 make up for the early defects of their education, 
 which seriously interfere with a successful military 
 career. Is it to be wondered at that when such short- 
 comings are discovered by their colleagues and officers 
 of the line, they do not command the respect their 
 commissions, should entitle them to? The reports 
 made out by such men speak for themselves, and 
 appear as black stains upon the department they rep- 
 resent. The elevation of the standard of medical 
 education by most of the medical schools throughout 
 the country will gradually wipe out this blemish, but 
 it will take many years before all of the diplomas can 
 be accepted as sufficient proof that their possessors
 
 69 
 
 are entitled to recognition by the medical department 
 of the different States. Let us hope that a speedy 
 and radical reform may be instituted in the different 
 States ?7hich will accomplish the desired object, and 
 which will make the commission of a medical officer 
 of greater import in showing a higher degree of pre- 
 liminary and professional proficiency than the diploma 
 of any of our medical colleges. This is a desideratum 
 for the realization of which every one interested in 
 
 Ambulance train on the way to the hospital ship Relief in the harbor 
 of Ponce. 
 
 the success and usefulness of the national guard 
 should willingly use his influence. Fortunately, there 
 are no specialties in military practice. The medical 
 education of a military surgeon must be of the most 
 liberal and broadest kind. His practice is so varied 
 that he may have to be physician, surgeon, oculist, 
 aurist, etc., the same day. The sphere of the regular 
 army surgeon serving at a post includes in addition 
 obstetrics, gynecology and diseases of children. Every
 
 70 
 
 military surgeon must be an expert in physical diag- 
 nosis and examination of the eye and ear. He must 
 know something about dentistry, he must know how 
 to extract teeth and how to put in a temporary filling 
 in a carious tooth that can be saved. He must be 
 familiar with neurology, the use and application of 
 electricity as a diagnostic and therapeutic resource. 
 In camp and field he is limited to his own resources 
 in the diagnosis and treatment of all kinds of injuries 
 and diseases. He must therefore be well equipped 
 with a thorough knowledge of everything pertaining 
 to surgery and medicine, and is often called upon to 
 represent the different specialties. No amount of 
 preliminary and professional education will make the 
 military surgeon an efficient officer unless he is pos- 
 sessed of an inborn aptitude for the profession. He 
 must be able to apply and make use of his knowledge. 
 Many men of great learning never become successful 
 practitioners. Their store of knowledge fails them 
 when they come to apply it, The military surgeon 
 in camp and field must be a man of quick perception. 
 He must be able to recognize malingering as well as 
 disease. In an emergency he must be in readiness to 
 act intelligently at a moment's notice. Hesitation is 
 dangerous both to the patient and the reputation and 
 good standing of the surgeon. Indecision creates 
 mistrust, procrastination disaster. Quick decision 
 and prompt action are the essential prerequisites of 
 successful emergency work. Successful action, how- 
 ever, must be preceded by thoughtful, systematic 
 preparation. The most successful surgeon is the one 
 who adopts and follows the watchword, semper para- 
 tus. He should never be caught napping. Careful 
 preparation makes prompt action possible. The suc- 
 cessful surgeon makes his plans ahead and supplies 
 himself with the necessary outfit, medicine, dressing 
 materials and instruments before the emergency arises, 
 and when it does so he is fully prepared to meet it. 
 A lack of forethought and systematic preparation 
 accounts for many shortcomings of medical officers
 
 71 
 
 in the field and camp, with the necessary evil conse- 
 quences for those entrusted to their care. 
 
 Military spirit. — Any one who enters the medical 
 service of the army as a life avocation will be disap- 
 pointed unless he does so imbued with a proper mili- 
 tary spirit. The military surgeon must be a military 
 man and an integral part of the army, if he wants to 
 do justice to his calling and the department he repre- 
 sents. I fear it is a lack of the proper military spirit 
 
 Litter work in the court of the Spanish military hospital in Ponce 
 
 in some of the medical officers in the regular army 
 that is responsible for a well recognizable cleft 
 between them and the officers of the line and field. 
 If this is true in the regular army, it is only too obvi- 
 ous in the National Guard. The rank of the medical 
 officers and their standing in military and social cir- 
 cles suffer when they are regarded and treated as an 
 ordinary doctor. The West Point graduate, educated 
 at the expense of the government, too often forgets 
 that it takes more hard work and a longer time to
 
 72 
 
 make a good doctor than an officer. The officers of 
 the National Guard, holding commission by the grafce 
 of their governor, do not realize sufficiently that their 
 military surgeons have spent a small fortune and five 
 years in acquiring a knowledge of their i^rofession. 
 They seem to forget, or at any rate often ignore, that 
 when they go into camp or in the field they do so at 
 a great personal and pecuniary sacrifice. Their ab- 
 sence from home, even for a short time, may cause a 
 break in their practice difficult to repair. The medi- 
 cal officer is entitled to recognition as a military man, 
 and if this is not accorded to him voluntarily, he 
 must resort to measures that will enforce it. The 
 lack of military dignity on part of the medical staff 
 is due largely to a lack of the proper military spirit 
 in the members which compose it, and to too great a 
 familiarity between the surgeons and the officers and 
 men. The correction of these evils can not be under- 
 taken too soon, and when accomplished will add much 
 to the dignity, influence and efficiency of the medical 
 department of the army and State troops. 
 
 The medical officer who has enjoyed the advantages 
 of an early military training in a military academy 
 or the national guard, is the one best qualified to 
 enforce military rules and assert the dignity of his 
 position. 
 
 Punctuality. — The busiest men have always the 
 most time to perform a duty or to meet an engage- 
 ment at the appointed time. This rule holds good in 
 all walks of life. The drones are always behind. In 
 military life punctuality means everything and from 
 this exaction the medical officer should never be 
 excluded except for special and well founded reasons. 
 In the regular army there is a way of disciplining the 
 medical as well as other officers in coming to time in 
 the performance of definite duties and in making out 
 the reports. My long experience in the National 
 Guard service has taught me, occasionally in a pain- 
 ful way, that the surgeons are often entirely oblivious 
 to the matter of time, especially in the matter of
 
 73 
 
 making out and transmitting the regimental reports. 
 It is the men who put off for tomorrow what should 
 be done today, and who meet their engagements at 
 one o'clock or thereafter instead of twelve, that ren- 
 der the life of their superior officers one of misery 
 and full of disappointments. The men that accom- 
 plish the most are always ready and on time. The 
 medical officers must be made to understand that a 
 due regard for punctuality in performing their duties, 
 
 Covirt of the Spanish military hospital in Ponce. 
 
 in meeting appointments and in mapping out and 
 forwarding reports is one of the most essential feat- 
 ures of a successful military career. 
 
 Courage. — It is still the general belief that, in 
 times of war the military surgeon is exposed to less 
 danger than the soldiers and officers in command. 
 That this is not so is shown by the statistics of all 
 wars. Although the position of the military surgeon 
 is behind the fighting line, he is usually near enough
 
 74 
 
 to the enemy when serving in the front to be 
 reached by stray bullets and bursting shells. The 
 number of surgeons killed and wounded in the per- 
 formance of their duty in rendering first aid is by no 
 means small in any war of magnitude. In active war- 
 fare, however, the greatest danger to the surgeons is 
 to be found in their constant exposure to contagious 
 and infectious diseases, which follow large armies in 
 all climates and during all seasons of the year. To 
 enter a yellow fever camp, to my mind, calls for more 
 courage than to lead and command the troops in the 
 battlefield. Disease always claims more victims than 
 bullets, and this is especially true of the present war 
 with Spain. The nation worships the heroism of 
 those who fell before Santiago, but much less is said 
 of the vastly greater number stricken down by dis- 
 ease, and who have lost their lives from disease, often 
 after prolonged and intense suffering. To the credit 
 of the medical officers of this and other wars it must 
 be said that they showed no fear, either in facing the 
 enemy or what is vastly worse — disease. When yel- 
 low fever made its appearance among the troops 
 around Santiago, every man remained at his post and 
 faced the danger without flinching. Men from the 
 North who had never seen the disease accepted the 
 detail for duty in the fever hospitals without a word 
 of complaint. The medical officer must be endowed 
 with more than ordinary courage to face the many 
 dangers that surround him on all sides during every 
 campaign. Patriotism begets heroism and I make a 
 well-founded claim for both for the medical profes- 
 sion represented in the army. 
 
 Personal habits. — The old adage that 'Tt is easier 
 to preach than to practice.'' is a familiar one and 
 should be made to apply with the same force to doc- 
 tors as preachers. The first and most important duty 
 of the military surgeon is to prevent disease. This 
 can often be done more effectively by example than 
 by precept. The military surgeon must guard the 
 camp against disease. He is looked upon and must
 
 75 
 
 be regarded by those under his care as the one above 
 all others who can give them advice in matters per- 
 taining to their health. He is expected to do this by 
 example as well as precept. He must become a per- 
 manent object lesson in inculcating the importance 
 of cleanliness in person and in dress. His tent 
 should be the cleanest and most orderly in camp. 
 Temperance in eating and drinking can be taught 
 more successfully by action than by words. A mili- 
 
 Transfer of patients to the lifeboat in the liarbor of Ponce. 
 
 tary surgeon under the influence of liquor will do 
 more harm in encouraging the vice of intemperance 
 than can be undone by weeks of lecturing. Profan- 
 ity is prevalent in every camp and while it is not the 
 duty of the surgeon to supplant the chaplain in sup- 
 pressing it, it should receive no encouragement by 
 his example. In his conduct toward the men the 
 surgeon should be firm and dignified, yet kind and 
 sympathetic, especially to those in need of his pro-
 
 7<^ 
 
 fessional services. An impetuous nature and an irri- 
 table temper create a rebellious spirit, which it is 
 difficult to control by the most energetic measures. 
 Proper questions should be answered willingly and 
 with sufficient clearness and adequate length to fur- 
 nish tlie desired information, and not gruffly and 
 snappishly, as is occasionally done without any 
 reason or provocation. Overwork and a disordered 
 digestion are poor excuses for treating a subordinate 
 in an undignified, ungentlemanly manner. The mil- 
 itary surgeon must be known in camp as a gentleman, 
 not only by the officers but by every man under his 
 charge, if he expects to be respected and to do justice 
 to his high calling and responsible position. 
 
 The mUitarij surgeon in war. — The true qualities 
 of the military surgeon are crystallized and best 
 known during an active campaign. It is in war that 
 his ready resources will come to the surface and will 
 be subjected to the severest tests. It is in battle and 
 during the prevalence of devastating diseases that his 
 moral courage and physical endurance will be most 
 severely tried. It is under such circumstances that the 
 troops will look to him most confidently as their protec- 
 tor and nearest and dearest friend. It is not in peace 
 but in war that the bond of true comradeship becomes 
 tighter and tighter between him and the officers and 
 men. It is on the march, in camp, and on the battle- 
 field that the important function of the military sur- 
 geon receives the recognition to which it is entitled. 
 It is the wounded and the sick in a strange land that 
 look to him for help and restoration to health. It is 
 the surgeon who so often receives the last message of 
 the dying. 
 
 The first and most important duty of the military 
 sur^^eon during active warfare is to prevent disease 
 and unnecessary suffering by giving early advice and 
 resorting to timely precautions. The location of 
 camps, policing of the same, the water-supply, food 
 and clothing are subjects which must receive his early 
 and earnest attention. In this work he should receive
 
 77 
 
 the hearty co-operation of the officers in command 
 and if this is not the case he has the moral and mili- 
 tary authority to demand it. It was not the medical 
 department, but the arrogance or stupidity of the com- 
 manding general of the invading army that is resiDon- 
 sible for the extensive outbreak of yellow fever during 
 the Cuban campaign. This experience is sufficient to 
 teach commanding generals that it is unsafe in the 
 future to follow such an example, as an imprudence of 
 this kind, giving rise to inexcusable slaughter and in- 
 describable suffering, will meet with universal indig- 
 nation. The military surgeon is in reality the family 
 physician of the men placed under his charge. He 
 attends to the little ailments with the same care as 
 though he had been sent for by a wealthy family and 
 expected a handsome fee. To be successful in the 
 treatment of disease he resorts to the simplest medi- 
 cation. Complicated prescriptions are dangerous and 
 absolutely out of question in military practice. The 
 tablets containing drugs in the most concentrated form 
 are a great blessing to field practice and should be 
 relied upon almost exclusively in the treatment of dis- 
 ease. The remedies needed are few, and if well 
 chosen and applied will answer all indications. A 
 liberal supply of quinin, opium, calomel, strychnia, 
 camphor, iron, arsenic, bicarbonate of soda and bro- 
 mid of potassium will leave but little to be desired. 
 Turpentine, castor oil, alcohol and the anesthetics are 
 about the only fluid medicines the military surgeon 
 has any use for. The breakage and waste in dispens- 
 ing medicines in bottles are inexcusable in modern 
 field work. Fancy drugs and preparations should not 
 be tolerated. In the practice of surgery the military 
 surgeon who wishes to attain the maximum success 
 must be conservative. Strict asepsis and conserva- 
 tism are the two things which are destined to make 
 miltary surgery successful. Every surgeon must have 
 special training in emergency work. He must be 
 perfectly familiar with the indications and technique 
 of every operation which may become necessary in
 
 78 
 
 the field. He seldom will have an opportunity to cut 
 for stone, extract a cataract, remove an ovarian tumor 
 or operate for other benign and malignant growths, 
 but he must know how to treat a comi30und fracture 
 in the most modern and approved manner; he must 
 be skillful in the treatment of wounds of all kinds, and 
 he must be a master in performing an amputation and 
 in ligating arteries in any part of the body. He must 
 learn to j^erform all emergency operations with the 
 simplest facilities and fewest instruments possible, in 
 order to adapt himself in time to the exigencies of 
 war. The surgeon who can extemporize an operating 
 table in the field and who can secure asepsis with the 
 use of the camp kettle, soft soap and carbolic acid or 
 sublimate and who can perform the most difficult oper- 
 ations with the simplest and fewest instruments, with 
 little or no assistance, is the one who will accomplish 
 the most and who will obtain the best results in the 
 field. 
 
 Ponce, Porto Rico, Aug. 8, 1898.
 
 THE INVASION OF PORTO RICO FROM A 
 MEDICAL STANDPOINT. 
 
 The occupation of Cuba and the Philippine Islands 
 by our conquering navy and army in such rapid suc- 
 cession seemed to increase the desire of conquest and 
 opportunities to test the strength of our arms. With 
 the destruction of the weak navy of our enemy there 
 was nothing in the way of sending troops to any of 
 the many Spanish possessions. The fall of the heroic 
 Cervera and his faithful little band, off the harbor of 
 Santiago, before the murderous fire of our well- 
 equii^ped fleet cleared the pathways of the ocean of 
 further sources of danger. It was but natural that 
 the beautiful island of Porto Rico, one of Spain's 
 most valuable possessions, should have been selected 
 by the military authorities as the next objective point 
 for contention. Repeated attacks by our navy on its 
 best stronghold, San Juan, had failed to bring about 
 surrender and to gain a foothold on Porto Rican soil. 
 So far the navy had taken the lead in bringing Spain 
 to terms and the army was anxious to do its share in 
 wresting from its greedy grasp another enslaved peo- 
 ple. Major-General Miles, who conducted the inva- 
 sion in person, decided to march upon San Juan from 
 several directions, and, after uniting the forces, attack 
 the city jointly. The experience gained in Cuba had 
 taught us an important lesson in conducting the 
 Porto Rican campaign. General Miles laid his plans 
 wisely and with special reference to gain the desired 
 object with as little suffering and loss of life as possi- 
 ble. Every movement in this camioaign was made 
 with a due regard for the welfare and success of our 
 troops rather than a desire for personal gain and
 
 80 
 
 aggrandizement, which characterized the Cuban cam- 
 paign, as every one knows. He was well aware of 
 the depressing effects of the tropical climate on the 
 unseasoned troops and of the necessity of resorting to 
 timely and efficient precautions in preventing disease. 
 From experience and personal observations, he recog- 
 nized the fact that the unavoidable privations inci- 
 dent to warfare are multiplied many times when the 
 seat of war is a strange and remote country present- 
 ing a climate and environments unaccustomed to by 
 the invading force. His actions were clean-cut 
 admissions that he was in need of a medical adviser 
 and that they were influenced by the frequent con- 
 sultations held with his chief surgeon. The war in 
 Porto Rico was conducted upon the most humane 
 principles, and although no great battles were fought, 
 victory upon victory followed the footsteps of our 
 army and in less than three weeks our flag floated 
 over three of the largest cities of the island. Our 
 troops love and respect their leader and have followed 
 him without fear and grumbling under the scorching 
 sun, full of confidence and trust. The news that 
 peace had been declared reached the headquarters at 
 Ponce, August 14, and the troops are now resting on 
 their arms awaiting the final adjustment of the terms 
 of peace. Eager to fight, yet every soldier in the field 
 received this message of peace with joy and enthusi- 
 asm, fully satisfied that the army had done justice to 
 the flag and country it represents. Col. Charles R. 
 Greenleaf, chief surgeon of the army in the field, 
 accompanied General Miles on his trip from Guan- 
 tanamo to Porto Rico, and has been with the army 
 ever since. He was long enough in Cuba to gain a 
 full insight into the horrors created by infectious dis- 
 eases, which so constantly follow large armies, espe- 
 cially in a war of invasion. He was amazed when he 
 saw to what extent yellow fever had broken out in the 
 few weeks the troops had been in Cuba. There was 
 no difficulty in tracing the disease to a total lack of 
 precaution on the part of the general in command.
 
 85 
 
 have rather been overzealous, judging from the num- 
 ber of insignia displayed and worn. It was a com- 
 mon thing to see men wear a white cap with an im- 
 mense red cross on top, another one in front, besides 
 the brassard. 
 
 Ponce was taken and occupied without any resist- 
 ance whatever. The citizens received our soldiers 
 with enthusiasm and manifestations of joy. General 
 Miles was hailed as a long-looked-for friend rather 
 than a conqueror. The next engagement occurred 
 
 Fever patients in tlie court of the Spanish military hospital. 
 
 between Arroya and Guayama, between a small 
 Spanish force in ambush and General Haines' brigade, 
 and resulted in eleven wounded on our side. The only 
 death following this skirmish was a soldier of the 
 Third Illinois Infantry who was shot accidentally by 
 an unknown man of the Fourth Pennsylvania regi- 
 ment. The bullet caused an extensive non-penetrat- 
 ing injury of the chest, from the eflPects of which he 
 died the next day. Such accidents have occurred too
 
 86 
 
 often during the present war, and to prevent repetition 
 in the future this matter should be investigated, as 
 was done in this instance, by the proper authorities. 
 Among the injured was a man who was shot through 
 the pelvis and another one the subject of a gunshot 
 wound of the elbow joint, both of them doing well 
 four days later when I examined the wounded in the 
 brigade hospital at Guayama. The third skirmish 
 took place between the advance column of General 
 Wilson's division, on the march to San Juan, and a 
 small Spanish force intrenched on the summit of a 
 high and steep hill. Lieut. Haines, the son of Gen- 
 eral Haines, was the only one who was brought on 
 board the Relief August 4. One of the wounded was 
 operated on by Dr. Parkhill in an ambulance. The ab- 
 domen was torn open by a fragment of a shell, the 
 intestines protruded and a resection had to be made 
 of a loop for a tearing injury. It was reported that 
 the patient rallied well from the immediate effects of 
 the operation and that hopes were entertained of his 
 recovery. Another engagement took place between 
 the troops under command of General Schwan, on 
 their way from Ponce to Mayaguez, and about 1000 
 Spaniards ambushed four miles from the latter city. 
 This fight resulted in two killed and eighteen wounded 
 on our side. All of the wounded were brought on 
 board the hospital ship Relief, which called at May- 
 aguez on her way to New York, August 15. Such is 
 a brief account of the casualties sustained by our 
 army during the Porto Rican campaign. The expe- 
 rience here coincided with that gained in Cuba, to 
 the effect of confirming the humane nature of the 
 modem weapon. The pro^Dortion of killed to wounded 
 is even smaller than in the Cuban war, as' well as the 
 number of seriously injured. Thanks to more elab- 
 orate preparations for the campaign, the wounded 
 received prompt and efficient attention. The suffer- 
 ing of the well, sick, and wounded can not be com- 
 pared with what I saw in Cuba. War is a great edu- 
 cator, and should we again be called upon to invade a
 
 87 
 
 foreign country, we shall profit by the experience of 
 the past. 
 
 TYPHOID FEVER IX PORTO RICO. 
 
 The native doctors in Ponce, Porto Rico, gave us 
 the assurance that not a single case of yellow fever 
 had been seen in that city for the last three years. 
 We were informed that in San Juan isolated cases 
 occur from time to time. Malaria is present in all of 
 the valleys, more especially in and around Ponce. 
 
 Fever patients in the court of the Spanish military hospital. 
 
 The large, pendulous abdomen, and the pale faces of 
 the many little naked children in city and country, 
 are the best witnesses in showing the prevalence of 
 malarial intoxication. 
 
 Typhoid fever is endemic in certain localities, but 
 at present Ponce is almost free from this disease. 
 Having seen the destruction of life and the indescrib- 
 able suffering caused by yellow fever in Cuba, Col. 
 Greenleaf naturally turned his attention toward pro-
 
 88 
 
 tecting our troops in Porto Rico against this scourge. 
 The proximity of Porto Rico to Cuba, the many pos- 
 sible sources of infection, made such a course impera- 
 tive. That this fear was not unfounded, and that the 
 Chief Surgeon recognized the danger and made use 
 of timely precautions are but shown by the contents 
 of a letter addressed to the Adjutant-General, Head- 
 quarters of the Army, and Circular No. 1 issued be- 
 fore the army sailed from Guantanamo to Porto Rico, 
 and a copy of the Quarantine Regulations formulated 
 at the same time. 
 
 Headquarters of the Army, 
 On board U.S.S. "Yale," en route to Porto Rico, 
 
 July 23, 1898. 
 To the Adjutant -General, Headquarters of the Army. 
 
 Sir : — I have the honor to submit the following recommenda- 
 tions for preventing as far as possible the introduction of yellow 
 fever into the command now about to land on the island of 
 Porto Rico : 
 
 The assignment of an officer of rank, to be placed in com- 
 mand of the base of supplies, with authority to indicate the 
 sites to be occupied by the various supply depots and the hos- 
 pital, and to enforce the regulations governing the health of 
 the attaches of these departments and the persons who may 
 visit them on business. 
 
 The assignment of a sanitary inspector whose duty it shall 
 be to examine all vessels and persons arriving at our base from 
 seaward ports, and to prepare sanitary regulations for the Gov- 
 ernment of all transportation and persons arriving and depart- 
 ing from the station by land. This officer should have author- 
 ity to quarantine all suspicious persons and means of transpor- 
 tation, and to disinfect their belongings, either by fire or such 
 other means as may be deemed necessary. 
 
 All persons connected with the Army are forbidden to enter 
 any building whatever on the island without express authority 
 from these headquarters, and all buildings in rural districts 
 that may be suspected of harboring the germs of disease should 
 "be destroyed by fire or otherwise thoroughly disinfected. 
 
 As woven goods, particularly those of woolen fabric, are spe- 
 cial carriers of disease, the purchase or acceptance of articles 
 of this kind from stores or inhabitants of the island is strictly 
 forbidden. Any such property found within the lines will be 
 at once destroyed and the holder subjected to punishment. 
 
 That commanders of regiments be instructed to prepare their 
 camping grounds with great care and maintain a rigid police in 
 them ; under no circumstances shall they camp on ground that
 
 89 
 
 has previously been occupied either by troops or by collective 
 bodies of the inhabitants. 
 
 That medical officers be required to make frequent inspec- 
 tions of the commands to which they belong, and that any sus- 
 picious case of fever be immediately isolated and the fact of 
 its occurrence reported to these headquarters. 
 
 Canteens should be filled daily with tea or coffee, and these 
 beverages used habitually instead of water, unless that has 
 been previously boiled. Very Respectfully, 
 
 Chas. R. Greenleaf, Colonel, 
 Asst. Surg-C^enl. U.S.A., Chief Surg. Army in the Field. 
 
 Ward in the Spanish military hospital. 
 
 Headquarters of the Army, 
 Office of the Chief Surgeon, on board U.S.S. "Yale," 
 
 en route to porto rico. 
 Circular No. 1. July 24, 1898. 
 
 1. Medical officers will, upon receipt of this circular, report 
 to the Chief Surgeon of the Army the number of medical offi- 
 cers, hospital stewards, acting hospital stewards and privates 
 of the Hospital Corps on duty with their command. Also the 
 number of ambulances, litters and tents, and if medical sup- 
 plies are insufficient, note the general character needed. This 
 report will be made upon the following form : 
 
 Com- Med. Hosp. Actg. Priv- Lit- Ambu- Hosp. Character of Medical 
 mand. Otfs. Stwds. H. 8. ates. ters. lances. Tents. Supplies Needed.
 
 90 
 
 2. A field hospital will be organized at the Army base as soon 
 as possible after landing, and a depot of supplies will be con- 
 nected with it. As we are widely separated from the source 
 of our supplies a strict economy in their use is necessary ; Sur- 
 geons of Divisions and Brigades will give their personal atten- 
 tion to this important subject. 
 
 3. Extreme vigilance is enjoined upon Medical Officers in 
 the matter of camp sanitation ; errors in this particular being 
 promptly reported to the respective commanding officers. 
 
 L The experience at Santiago has demonstrated the effici- 
 ency of properly applied first dressings to gunshot wounds ; 
 these should be left untouched unti' the patient arrives at the 
 base hospital, unless the condition of the wound absolutely 
 demands a redressing en route from the first dressing station. 
 All diagnosis tags will be marked "Dressing not to be removed" 
 or "Redressing required," as the condition demands. Unless 
 an imperative necessity exists, surgical operations will not be 
 attempted at the front. Chas. R. Greenleaf, Colonel, 
 
 Asst. Surg.-Gen. U.S.A., Chief Surg. Army in the Field. 
 
 QUARANTINE REGULATIONS FOR THE BASE OF THE MILITARY EXPE- 
 DITION TO PORTO RICO. 
 
 1. Every vessel shall be officially visited by the inspector before 
 communication is made with other vessels or with the shore. 
 
 2. A vessel having yellow fever or smallpox on board shall 
 not be allowed to communicate with the shore, or with other 
 vessels, but shall leave the island. 
 
 ,3. Vessels coming from sources of infection shall be detained 
 five days without communicating either with the shore or with 
 other vessels. If at the expiration of this time no cases of 
 fever shall have developed, landing may be made under the fol- 
 lowing precautions : 
 
 All fomites shall be disinfected by one of the following 
 methods : Immersion for one hour in 1-1000 solution bichlorid ; 
 sulphur fuQiigation in a chamber twenty four hours, four 
 pounds of sulphur being used for each 1000 cubic feet of space ; 
 or boiling half an hour with complete immersion. The follow- 
 ing need not be disinfected unless directly exposed to infection : 
 
 All new and dry material unpacked, all iron and steel imple- 
 ments, all goods in new and original packages, not having been 
 broken or packed in an infected locality. Goods other than 
 textile contained in textile material, such as coffee in sacks, 
 bacon, spices, etc., kept dry and not broken in an infected 
 locality do not require disinfection other than the container, 
 which shall be treated as fomites as above. Fruits, sounds 
 unless exposed in an infected locality need no disinfection. 
 Live stock may be admitted. 
 
 Such ships shall be thoroughly cleaned and disinfected by 
 the free use of 1-1000 solution of bichlorid, and by fumigation 
 with sulphur before they may again receive men or supplies.
 
 91 
 
 Ships quarantined shall display the usual flag, and those in 
 detention shall be visited by the inspector daily until the time 
 of quarantine shall have expired. 
 
 4. Vessels carrying passengers or having fomites from local- 
 ities of infection, though they (the vessels) may hail from 
 healthy ports, shall be subject to the same quarantine restric- 
 tions as vessels known to hail from infected localities, 
 
 5. Due precaution shall be taken to prevent infection of the 
 base of supplies through communication with infected localities 
 along the line of march by teamsters and others. As far as 
 possible they should not be allowed to remain at the base 
 
 Ambulance train transporting the sick from the Division Hospital to 
 the Spanish military hospital. 
 
 longer than necessary to load and unload, nor to come in such 
 contact as to communicate infection. Stragglers, prisoners 
 and strangers should be immediately sent away, 
 
 Chas. R. Greenleaf, Colonel, 
 Asst. Surg.-Gen. U.S.A., Chief Surg, Army in the Field. 
 
 Major Woodbury was appointed Sanitary Inspec- 
 tor. He met with the hearty co-operation of the city 
 authorities of Ponce in the performance of his oner- 
 ous and often unpleasant duties. The sanitary con-
 
 92 
 
 ditions of the city underwent a great improvement in 
 a few days. The water-supply was found satisfactory. 
 The absence of a sewerage system threw many ob- 
 stacles in the way. The appearance of smallpox in a 
 village some distance from Ponce made vaccination 
 among the soldiers who were not protected against this 
 disease and the natives necessary. An abundant sup- 
 ply of vaccine virus was on hand and was at once 
 issued and used. When I arrived at Ponce, August 
 7, 1 found typhoid fever raging to an alarming extent. 
 It was desirable to trace the origin of the disease. 
 The absence of typhoid fever this season of the year, 
 its outbreak in all the commands, and the short time 
 that had intervened between leaving the United States 
 and the landing in Porto Rico made it probable that 
 the disease could be traced to the infected camps 
 occupied by the troops before leaving for Porto Rico. 
 General Miles was very anxious to obtain reliable 
 information regarding the origin and spread of the 
 disease. Pursuant to the following order I made an 
 exhaustive and systematic investigation: 
 Headquarters of the Army, Office of the Chief Surgeon. 
 
 Port Ponce, Porto Rico, Aug. 10, 1898. 
 Lieut.-Col. Nicholas Senn, Surgeon U. S. V., Chief of Oper- 
 ating Staff of the Army. 
 
 Sir : — You will proceed to the town of Ponce, visit the mili- 
 tary and other hospitals in that town, and such of the camps 
 in its vicinity as you may deem necessary, for the purpose of 
 investigating and, if possible, determining the cause of typhoid 
 and other fevers now prevailing in this army, and report the 
 results of your investigation in writing to me. Should you 
 find it necessary to have the services of an interpreter, or other 
 civilian, to aid in your work, you are hereby authorized to 
 employ him, sending the bill to this office for payment. 
 Very respectfully, 
 
 Chas. R. Greenleaf, Colonel, 
 AsBt. Surg. Gen. U.S.A., Chief Surg. Army in the Field. 
 
 I obtained accurate information of two hundred 
 fever patients, of which number more than 90 per 
 cent, were well-marked typhoid fever, the balance 
 malaria and the results of sunstroke. I estimated the 
 whole number of fever patients in, and in the imme
 
 93 
 
 diate vicinity of, Ponce at 250. In extending my 
 inquiries to General Brooke's command, with head- 
 quarters at Guayama, I found about 145 additional 
 cases; however, in that locality malaria seemed to 
 predominate. Most of the cases came from Chicka- 
 mauga by way of Charleston and Newport News. 
 The Second and Third Wisconsin Regiments fur- 
 nished the largest contingent. Almost every soldier 
 in the diflPerent hospitals belonging to either of these 
 
 Ambulance unloading the sick at the door of the Club House in Ponce 
 used as a temporary hospital. 
 
 regiments suffered from typical typhoid fever, and 
 what attracted my attention was that the disease 
 appeared to be of a more serious type than in most 
 of the men belonging to other regiments. The local- 
 ity from which these regiments came, when encamped 
 at Chickamauga, must have been badly infected. As 
 the result of my investigations, I reported to Col. 
 Greenleaf the number of cases found, and that in my 
 opinion the disease was contracted in every instance
 
 94 
 
 before leaving the camps in the United States. In 
 view of the fact that most of the cases came from 
 Chickamauga, I suggested at the same time that the 
 Medical Department should recommend immediate 
 evacuation of that camp. In Ponce most of the cases 
 found shelter and care in the Spanish military hospi- 
 tal, then in charge of Major Ten Eyck, U. S. A. The 
 club-house and a school for girls, of the Sisters of 
 Charity, were also placed at the disposal of the chief 
 surgeon and were sooa filled with patients. Miss 
 Chancellor of New York did excellent service as a 
 nurse in the former temporary hospital. A conges- 
 tion which occurred in the military hospital, and which 
 could not be prevented, took place when General Wil- 
 son's division moved forward and unloaded at the 
 door all of the sick in the Division hospital, some 150 
 in number. The overcrowded condition was reme- 
 died the next day, when a large number of the more 
 grave cases were sent on board the Belief, anchored 
 in the harbor of Ponce. Medical supplies were in 
 abundance at all times and were freely issued without 
 any formality.. The Relief, and later the yacht 3Iay, 
 brought an additional supply, with many delicacies 
 for the sick. Milk was bought and freely supplied to 
 the sick. It is the irtention of the chief surgeon to 
 establish an extensive out-door receiving hospital as 
 soon as the tentage arrives, which, according to infor- 
 mation received from the Surgeon -General, is now on 
 the way. The number of new cases of typhoid fever 
 in the Porto Rican army will probably be a limited 
 one, and if the troops are recalled as soon as the treaty 
 of peace has been signed, we need to entertain little 
 fear of the indigenous spread of the disease. 
 Arroya, Porto Rico, Aug. 12, 1898.
 
 TYPHOID FEVER IN THE PORTO RICAN 
 CAMPAIGN. 
 
 In Cuba our army met as its most formidable enemy 
 one of the most dreaded of all infectious diseases- 
 yellow fever. The Cuban invasion was characterized 
 by hasty action, a lack of organization, and inadequate 
 preparation. The last crippled the medical depart- 
 ment and is responsible for the early and extensive 
 outbreak of yellow fever. In less than two weeks 
 after our army landed in Cuba, yellow fever made its 
 appearance, and almost simultaneously attacked the 
 troops from Siboney, the base of invasion, to the 
 trenches before Santiago. In less than two weeks 
 from its appearance nearly 500 fever cases, most of 
 them yellow^ fever, impaired the fighting force and 
 seriously taxed the limited resources of the medical 
 department. Fortunately for the army, that type of 
 the disease was mild, the number of deaths few as 
 compared with some of the epidemics in the past. 
 Under the circumstances, it was fortunate that Santi- 
 ago surrendered in time, as the fighting force was 
 being rapidly reduced by the invasion of yellow fever 
 and the ever-present malaria. In planning the Porto 
 Rican invasion the possible repetition of a similar 
 experience was taken into due consideration, and 
 timely precautions against such an occurrence were 
 adopted and carried into effect. So far our troops in 
 Porto Rico have escaped yellow fever, but soon after 
 their landing, fever cases came into the hospitals at 
 an alarming rate. Many of the soldiers were attacked 
 on the transports or soon after landing. After land- 
 ing in Ponce, August 8, I found at least 250 cases of 
 fever in the different hospitals in the city and the
 
 96 
 
 division hospital near the city limits. Even a super- 
 ficial examination sufficed to prove that most of the 
 cases were typhoid fever. The time which intervened 
 between the departure of the troops from the United 
 States and the appearance of fever, made it more than 
 probable that the infection did not have an indigenous 
 origin. In some of the cases it was difficult, in others 
 impossible, to make a differential diagnosis between 
 malaria and typhoid fever without the use of the 
 microscope, and this invaluable diagnostic resource 
 in such cases was unfortunately not at hand. Another 
 difficulty we had to contend with was the lack of 
 recorded thermometric observations, which, when 
 accurately made and systematically recorded, prove of 
 such signal service in distinguishing between these 
 two febrile conditions. 
 
 Pursuant to an order issued by Col. Greenleaf, chief 
 surgeon of the army in the field, I investigated for 
 two consecutive days all of the fever cases then in 
 the hospitals, for the purpose of locating the origin of 
 typhoid fever. In this work I availed myself of the 
 kind and able assistance of Dr. M. O. Terry, Surgeon- 
 General of the State of New York, and Acting Assis- 
 tant-Surgeon Greenleaf, son of the chief surgeon. 
 We made a careful examination of 200 cases of fever 
 as they presented themselves, noted the principal 
 symptoms and tabulated them (see appended table). 
 
 A careful study of these cases, as well as subse- 
 quent developments, furnished adequate proof that 
 90 per cent, of them were genuine typhoid fever. No 
 further doubt could remain in tracing the infection to 
 the camps occupied in the United States. The great 
 prevalence of the disease among the troops, affecting 
 as it did, more or less, all of the regiments, was a 
 source of uneasiness and anxiety on the part of those 
 who were in charge of the invasion. Measures were 
 taken to secure ample hospital room and facilities for 
 the accommodation and proper treatment of those on 
 hand and such as might be brought in later. The 
 order to General Wilson to take up the march toward
 
 97 
 
 San Juan made it necessary to evacuate the division 
 hospital. All of the patients were transferred to the 
 Spanish military hospital in Ponce, which caused the 
 temporary overcrowding to which I referred in a for- 
 mer communication. The Spanish military hospital 
 is a substantial, square, one-story building with a large 
 court in the center. It is built of stone, the floors 
 being made of cement or brick tiling. It is on a high 
 hill near the city limits, from which a magnificent 
 view of the city, harbor and surrounding country can 
 be obtained. It has a capacity for about 150 beds. 
 It required a good deal of labor to make this building 
 fit for the reception of patients. Major Dooly and 
 his force worked persistently a whole day in removing 
 the dirt and filth which the Spaniards had left, in 
 their haste in evacuating the city, as an undesirable 
 legacy. The hospital was at once supplied with cots, 
 bedding and hospital stores. The club-house of the 
 city, and a school for girls in charge of the Sisters of 
 Charity, were otfered to the authorities for hospital 
 use, and courtesy was promptly accepted. For over a 
 week the sick officers occupied the club-house and 
 about fifty patients found comfortable quarters and 
 excellent treatment in the school-house. Ponce has 
 a large charity hospital, the "Tricoche,'' with 200 
 beds, under the care and management of the Sisters 
 of Charity. The hospital is a model of cleanliness 
 and comfort. Col. Greenleaf made arrangements with 
 the city authorities to open the doors of this excellent 
 institution for sick officers. I am sure that every one 
 who will enjoy the kind treatment and excellent care 
 of the Sisters in these great institutions of charity 
 will have a good word for this ancient and worthy 
 order. Out of the 200 cases of fever examined in the 
 different hospitals in Ponce, and which appear in the 
 table, the following diagnoses were made at the time: 
 Gastric fever, 2; effects of sunstroke, 6; malaria, 9; 
 doubtful, 21; typhoid fever, 162— total, 200. 
 
 I am satisfied that of the doubtful cases a sufficient 
 number developed typhoid fever to bring the whole
 
 98 
 
 number of cases up to 280. In reference to the time 
 the disease developed the following can be gleaned 
 from the table : The first symptoms appeared before 
 leaving the United States, 8; on transports, 86; within 
 ten days after landing, 68, out of a total of 162. 
 
 As regards the place of infection the cases came 
 from: Chickamauga, 90; Tampa, 48; Camp Alger, 23, 
 Newport News, 1 — total, 162. 
 
 The small number coming from Camp Alger, where 
 the disease gained such a firm foothold, which led to 
 the abandonment of the camp, is to be explained by 
 the fact that a large number of fever cases, coming 
 from that camp, were returned to the United States 
 soon after landing, by order of Col. Greenleaf . All 
 regiments were not affected alike by this disease. 
 Among the troops in Porto Rico the typhoid fever 
 cases were distributed as follows: 
 
 2d Wisconsin , 42 
 
 3d Wisconsin 17 
 
 16th Pennsylvania 17 
 
 6th Massachusetts 15 
 
 19th U. S. Infantry 15 
 
 6th Illinois 11 
 
 3d Artillery 10 
 
 4th Artillery. 5 
 
 11th U. S. Infantry 5 
 
 1st Provisional Corps 4 
 
 Hospital Corps 4 
 
 17th U. S. Infantry 3 
 
 2d Cavalry 3 
 
 5th Cavalry 3 
 
 3d Illinois 4 
 
 4th Pennsylvania 2 
 
 Signal Corps. ... 2 
 
 5th Artillery 1 
 
 Total 162" 
 
 In tabulating the symptoms the following facts 
 appear : 
 
 ['Dry, coated, red at tip and margin. 10. 
 I Coated, white fur. 21. 
 I Coated, pale, flabby. 17. . 
 Tongue. ■{ Coated, red tip and margin. 56. 
 I Dry, brown and fissured. 20. 
 ! Moist, glazed, red. 13. 
 l^Sordes, lips and teeth. 12.
 
 99 
 
 f Tympanites. 29. 
 
 ! Tenderness and gurgling right iliac fossa. 71. 
 Abdomen. { Rose spots. 37. 
 
 I Spleen enlarged. 141. 
 
 I Spleen markedly enlarged. 20. 
 
 Epistaxis during prodromal stage 28 
 
 Diarrhea 87 
 
 Intestinal hemorrhage 3 
 
 Bronchitis 20 
 
 Delirium 1 
 
 The absence of delirium in all cases but one is 
 remarkable, but it must not be forgotten that nearly 
 all of the cases were examined during the early stages 
 of the disease. In quite a number of cases this symp- 
 tom appeared later. From the symptoms and the 
 death-rate, ascertainable at this time, it is evident that 
 the disease pursued a comparatively mild course. 
 Nearly 200 of the more grave cases were transferred 
 to the hospital ship Belief, which sailed from Ponce 
 for New York August 35. Of this number fourteen 
 died en route and twelve were buried at sea. In two of 
 these cases death resulted from complications. In 
 one case gangrene of the penis, which assumed a pro- 
 gressive form, was the direct cause of death. In one 
 case a fatal termination threatened during the third 
 week of the disease from laryngitis and lobular pneu- 
 monia. A metastatic abscess of the submaxillary 
 gland, which developed in one case, deserves mention 
 as a rare complication of typhoid fever. 
 
 RETURN OF THE HOSPITAL SHIP " RELIEF " FROM 
 PORTO RICO. 
 
 The Relief sailed from Ponce, Porto Rico, August 
 15, for New York, and called on her way at Mayaguez 
 to complete her precious cargo of sick and wounded. 
 All of the wounded at the last port were taken on 
 board. The entire number of patients on leaving 
 Porto Rico was 255, the full capacity of the floating 
 hospital. It is probably the first time in the history 
 of the world that so many fever cases were treated on 
 a hospital ship and conveyed from a foreign country 
 to their homes. The first day out a brisk breeze
 
 100 
 
 caused considerable rolling and pitching of the ship, 
 which induced some cases of seasickness among the 
 patients, but did not seem to unfavorably influence 
 the disease. The female nurses worked faithfully and 
 proved of the utmost value to the sick. Fourteen of 
 the more severe cases of typhoid fever died on the 
 way to New York. Many of the patients improved 
 rapidly during the voyage. The Relief has done all 
 and more than was expected in serving as a temporary 
 hospital and as an ambulance ship in the treatment 
 and transportation of the sick and wounded. 
 
 New York, Aug. 20, 1898,
 
 
 ii 
 
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 irv : liiil^ri 1-1 1 i"-"- w ^Sagjaa
 
 THE RETURNING ARMY. 
 
 The war is over and the heroes who freed the West- 
 ern Continent from Spanish despotism are returning 
 home. The first war of invasion on our part has been 
 a short, decisive one. Only four months have passed 
 by since the Chief Executive issued the first call to 
 arms, and more than we expected has been accomp- 
 lished. The outside world, which has sneered too 
 long at our fighting strength as a nation, has been 
 convinced that it is dangerous to trifle with Ameri- 
 cans in matters of war. In less than two months after 
 war was declared we had more than two hundred 
 thousand men in the field, eager and anxious to face 
 the dangers of active warfare. Less than one-half of 
 this army took part in the invasion. The enemy's 
 navy was entirely destroyed; not a single ship that 
 came within range of our guns escaped. The proud 
 Spanish fleet is a total wreck in American waters, a 
 source of pride to our navy and a significant object 
 lesson for all foreign nations. Santiago fell before 
 our victorious army; Porto Rico yielded after a few 
 skirmishes and Spain accepted our terms of peace 
 without much argumentation, after the hopelessness 
 of her cause had been demonstrated by our invincible 
 army and navy. Peace has been restored, and the 
 returning soldiers of the volunteer army will soon 
 return to citizenship and resume their ordinary voca- 
 tions of peaceful life. 
 
 What a contrast between the invading and return- 
 ing army! This contrast has reference not only to 
 size but also to appearance. Thousands have died 
 from wounds and disease. Yellow fever, dysentery, 
 malaria and typhoid fever have been and continue to 
 be our most formidable enemies. We had no great
 
 102 
 
 difficulty in silencing the Spanish guns, but we have 
 been less effective in preventing the origin and spread 
 of these, the greatest terrors of camp life. We can 
 calculate with some degree of precision the loss of life 
 sustained in battle, but it is impossible today to esti- 
 mate the ultimate damage inflicted by disease. The 
 naval forces scored the greatest victories with little 
 loss of life; they escaped disease and its consequences, 
 to a large extent, and were subject to little or no pri- 
 vations. The invading armies suffered the brunt of 
 privation and discomforts incident to an active cam- 
 paign. The troops in camps who were denied the 
 privilege of taking part in the invasion of Cuba and 
 Porto Rico had their share of deaths, sickness and 
 hardship. It is safe to say that not half of the soldiers 
 engaged in this short war are in a fighting or working 
 condition on their return home. It is a sad sight, 
 indeed, to witness the disembarkment of a transport 
 arriving from Cuba or Porto Rico. Every one of the 
 vessels brings from fifty to one hundred and fifty dis- 
 abled men requiring medical treatment. All of the 
 men left on the outgoing transports in good health 
 and cheerful mood; all who arrive show the effects of 
 the campaign. Many have died in our new posses- 
 sions, many have been consigned to the sea on their 
 way home, others have reached the shore in a dying 
 condition. The crowded transports, the inadequate 
 provisions for proper food, have made the voyages to 
 and from the seat of war a source of hardship instead 
 of health and pleasure. The emaciated forms, the 
 sunken eye, the hollow cheek, the pale, bronzed faces, 
 tlie staggering gait, show only too plainly what can 
 be done by disease, a tropic climate and improper 
 food in disabling an army in a few weeks. In this 
 respect our experience is a repetition of that of our 
 enemy. It is well known that the Spanish army lost 
 50 per cent, of its fighting force from the same cause 
 in two months after landing in Cuba. The Spanish 
 surgeon I met inside of the lines of the enemy, four 
 days before the surrender of Santiago, when we deliv-
 
 103 
 
 ered to him, under a flag of truce, sixteen wounded 
 Spanish soldiers, informed me that when his part of 
 the army reached Cuba the men were all in good 
 health, and that now many were sick and none well. 
 He drew a sad picture of how^ their ranks were 
 thinned out by yellow fever, malaria and dysentery. 
 The outbreak and spread of typhoid fever in our 
 home camps, so early during the campaign, is respon- 
 sible for more deaths and suffering than any other 
 cause. Many of our soldiers carried the infection 
 with them to Cuba and Porto Rico, and were taken 
 ill on the transports or soon after landing. It is 
 much more difficult to keep typhoid fever out of the 
 army than yellow fever. The yellow fever which our 
 troops in Cuba encountered was of a mild type. 
 Comparatively few died and most of the cases recov- 
 ered after an illness of but a few days. Typhoid fever 
 runs its typic course of three weeks or more, little 
 influenced, as far as time is concerned, by medication. 
 It is a disease which, above all others, requires care- 
 ful nursing. The necessary attention to typhoid- 
 fever patients in nursing and treatment is a matter 
 difficult to obtain, even in a well- equipped hospital 
 with all needful appliances. The management of 
 such cases in field hospitals is necessarily attended by 
 many difficulties which tax to the utmost the experi- 
 ence of the medical staff and nursing corps. Consid- 
 ering the limited resources at our command in the 
 treatment of this disease, in our home camps and our 
 new possessions, it is surprising that the mortality 
 has not been greater. The Sisters of Charity and the 
 trained female nurses from different cities, have done 
 most satisfactory work in our home camps, crowded 
 with typhoid fever patients. Many a soldier on his 
 recovery from the disease will feel grateful for their 
 faithful services. 
 
 CAMP WIKOFF. 
 
 Camp Wikoff is now a great hospital. It is located 
 on Montauk Point, L. I., a narrow strip of land sur- 
 rounded on both sides by salt water. The country is
 
 104 
 
 hilly and treeless and the sandy soil is covered with a 
 scanty growth of grass. Between the hills are cup- 
 shaped depressions with a marshy soil, which after 
 rains are filled with stagnant water. These diminu- 
 tive marshes threaten danger in case of a prolonged 
 encampment. They are undoubtedly, all of them, 
 the natural breeding-places of the plasmodium mala- 
 rise. They will soon become contaminated with the 
 fecal discharge from hundreds of typhoid fever cases, 
 as many of the sinks drain directly into them. I am 
 told that the water-supply from the artesian wells, 
 while not ample, is otherwise satisfactory. The small 
 railroad which terminates here from New York, 
 monopolizes the whole business of transportation, as 
 this exclusive right was made conditional in securing 
 the ground for camp purposes. This is greatly to be 
 regretted, as steamer communication could be readily 
 established, which would facilitate the present 
 unusually large passenger and freight business be- 
 tween the camp and New York. Politics and personal 
 interests have figured conspicuously in the manage- 
 ment of the present war. Departments have been 
 severely criticised, when a thorough investigation 
 would often reveal a power behind the throne. If we 
 had steamer traffic between here and New York we 
 would not have to wait for days for the so much 
 needed supplies. The little railroad has had sufficient 
 influence in cutting oflp competition and in increasing 
 correspondingly the value of its stock, and we here 
 are suffering the consequences of this Judas Iscariot 
 bargain. The whole little peninsula is a tented field. 
 Regiment after regiment is arriving, day after day, 
 seriously testing the quartermaster's department. All 
 the troops that came from Cuba must land here to 
 comply with the quarantine regulations. A detention 
 hospital has been established near the landing, to 
 which all suspects are consigned for the required 
 length of time. Near the hospital a large disinfect- 
 ing plant has been erected. So far no cases of yellow 
 fever have been imported. The general hospital con-
 
 105 
 
 tains at the present time (August 26) nearly one 
 thousand patients and all the sick iu the camp will 
 swell the number to 1500. The landing of so many 
 sick in such a short time has brought about an over- 
 crowding which, with the present facilities and re- 
 sources could not have been prevented. Colonel For- 
 wood, Assistant Surgeon-General, selected the camp 
 site, and was the first man on the ground. His 
 immense military experience, gained during the War 
 of the Rebellion, fitted him in an admirable way for 
 the difficult task imposed upon him. Colonel For- 
 wood is an authority in military surgery and endowed 
 with excellent administrative talents. His work here 
 will be the crowning effort of his life. He has worked 
 night and day since he has assumed his duties here. 
 He is a friend of the soldier and will not leave a 
 stone unturned to be of service to him. He has exclu- 
 sive charge of the hospital construction, and his work 
 was much admired by tw^o staff surgeons of the Ger- 
 man army, Drs. Steinbach and Wildemann, and by^ 
 Lieutenant-Commander Tomatsuri of the Japanese 
 navy, w^ho came from New York to the camp with me. 
 As they expressed themselves, the field hosjDitals here 
 were the best they had ever seen. Colonel Forwood 
 is ably assisted in his arduous duties by Majors Heitz- 
 mann. Brown, Nancrede and Wing and a large staff of 
 acting assistant-surgeons. The writer, on his arrival, 
 was placed in charge of the surgical work. An oper- 
 ating tent w^as erected and placed in working order 
 with the assistance of two Sisters of Charity and 
 Acting Assistant-Surgeon Greenleaf. The tent is 
 floored and divided into four sections. The front part 
 is the operating-room, with two side tables two feet 
 in width the whole length of the room. The tables 
 are covered with rubber cloth. An army operating- 
 table and a few stands constitute the balance of the 
 furnishing of the room. The next section is open on 
 the sides to allow a free current of air and serves as 
 an office. The next compartment is the preparation- 
 room, fitted out with formaldehyde and steam steri-
 
 106 
 
 lizers and sufficient shelf accommodations. The last 
 section is used as a storeroom for dressings, splints, 
 antiseptics and drugs necessary for the treatment of 
 surgical cases. 
 
 Gen. Joseph Wheeler is in command of the camp, 
 and although debilitated by the campaign and disease, 
 he attends to his duties wtth a regularity and devo- 
 tion which have characterized his whole military^ 
 career. The sick are being cared for at the present 
 time by fifty Sisters of Charity and sixty trained 
 female nurses. One of the things that was greatly 
 admired by the foreign military surgeons was the 
 efficient work of the hospital corps. They were 
 charmed with the way in which the patients were 
 handled and the gentlemanly conduct of the litter- 
 bearers. Less praise was bestowed on the military 
 bearing of the men in camp, from the highest officers 
 to the ordinary private. The military spirit seems 
 to have been fully subdued in the enemy's country. 
 The sentries move about sluggishly and seldom deem 
 it worth while to come to a "present arms," no matter 
 who may come within saluting distance. Men walk 
 about in clothes showing only too distinctly the 
 absence of whisk-broom or brush since they left Cuba. 
 Guns, bayonets and scabbards have become rusty and 
 show an entire lack of proper care. All drills are sus- 
 pended and the whole camp presents more the appear- 
 ance of a picnic ground than a military post. Officers 
 and men are evidently impressed with the idea that 
 their work is done, and while away their time in a 
 way requiring the least amount of energy and exertion 
 possible. In this respect our troops form a strong 
 contrast with the German army when it entered Paris, 
 after one of the most bloody wars and after a prolonged 
 siege full of hardship and privations. On that occa- 
 sion every soldier was in a condition to go on parade 
 and to pass with credit the inspection of the most 
 exacting officer. Such looseness of discipline as seen 
 here at this time is not calculated to inspire the out- 
 going army with the proper military spirit that should.
 
 107 
 
 be maintained and cultivated under the most adverse 
 oircum stances. Strict military bearing is also sadly 
 lacking among the medical officers — a source of dis- 
 appointment and surprise to the corps of acting 
 assistant- surgeons, who entered the service with the 
 full expectation that the reverse would be the case. 
 Camp Wikoff, Montauk, N. Y., Aug. 27, 1898.
 
 THE NATIONAL CRY. 
 
 Unrest, criticism and grumbling are the accom- 
 paniments and heritage of every war. These symp- 
 toms of war fever have been unusually well developed 
 during the war just ended, and they will be discussed 
 for a long time after the treaty of peace has been 
 signed. After an uninterrupted reign of peace for 
 more than thirty years, the war cloud that came upon 
 us so suddenly and unexpectedly provoked a commo- 
 tion among the people unparalleled in degree and 
 extent since the War of the Rebellion. All eyes were 
 turned in the direction of the seat of war, and the 
 contents of our enterprising and prolific newspapers 
 were devoured with an eagerness unknown in any 
 other country. It is strange that with all this great 
 national unrest the current of commerce and business 
 pursued its natural course. While our troops were 
 engaged in war in foreign lands, the tilling of the 
 soil, the hum of industry and the ordinary avocations 
 of life continued as though harmony and peace 
 reigned universal. The American never forgets that 
 patriotism is not limited to the battlefield. The con- 
 scientious performance of duties at home, the fireside, 
 the farms, the workshops, the manufacturing and busi- 
 ness places, is one of the things ^essential in the suc- 
 cessful prosecution of a war. This fact was recognized 
 by our people, and the result has been that the pros- 
 perity of our country has suffered little, if any, during 
 our first war of invasion. Criticism is a part of human 
 nature. It is seen everywhere. It affects the educated 
 as well as the ignorant, it extends from the cradle to 
 the grave, it involves one sex as much as the other, it 
 moves the well as much as the sick, it infects the pulpit 
 as well as the stage, and it comes to the surface in the
 
 109 
 
 army from the commanding general down to the lowest 
 of all privates. It is amusing to listen at a camp fire 
 to the remarks made from all sources as to how the cam- 
 paign should be conducted. The average private dis- 
 cusses the most complicated strategic problems with an 
 ease as though he were repeating the multiplication 
 table or the Lord's prayer. The generals high in com- 
 mand ease their conscience by criticising their subordi- 
 nates most unmercifully, if any thing has gone wrong. 
 Wise as well as ignorant men, a thousand miles away 
 from the seat of war, have their convictions as to 
 what should be done and are free to express them. 
 Criticism increases in severity and extent in propor- 
 tion as confidence is weakened and undermined. As 
 we live in a free country criticism finds a fertile and 
 productive soil everywhere and anywhere. The un- 
 bridled liberty of the press encourages and fosters it. 
 Like swearing and other vices it is engendered by 
 environments. Just and wrathful criticism is legiti- 
 mate; criticism the outpouring of impure selfish mo- 
 tives is baneful. Our energetic, ei^thusiastic press is 
 entitled to a great deal of credit in giving to the pub- 
 lic the war news so promptly and completely, often at 
 an enormous expense and severe danger to life. The 
 American reporter has no equal in any country for 
 obtaining news regardless of cost and risk. The 
 reporters not only culled the news, but often took a 
 hand in supplying the sick and wounded with fruit, 
 tobacco, and delicacies. How quickly the reporters 
 sniffed the latest news, I learned in Porto Rico. I 
 arrived from Arroya in the harbor of Ponce, August 
 13. Rumors of peace were rife for a number of days. 
 The Herald dispatch boat, then in the harbor, got 
 up steam at about 3 o'clock in the afternoon. Soon 
 the little craft put to sea, and I watched its course with 
 intense interest. I said to my friends, if the boat, 
 after leaving the harbor, turns in the direction of 
 Arroya, it means war; if in an opposite direction, 
 toward New York, peace has been declared. The 
 proud little steamer turned its nose toward the United
 
 110 
 
 States and made a bee line for New York. It was not 
 until the next morning that the welcome news reached 
 headquarters. This is only one of the many instances 
 in which the reporters came in possession of the latest 
 news before they reached the officials. The rei^orters 
 were also instrumental in exposing many irregulari- 
 ties and defects of the military service from head- 
 quarters in Washington to the seat of war. I have 
 no doubt that many wrongs were corrected under the 
 pressure of the press. 
 
 It is not strange that many of our influential news- 
 papers went a little too far in representing the griev- 
 ances of the soldiers and in criticizing the action of de- 
 partments and officers. A tinge of sensationalism is 
 common more or less to all of our great dailies. Inter- 
 views that never occurred will continue to appear as 
 long as the reputation of a reporter depends largely 
 on his ability to satisfy the cravings of morbid curi- 
 osity. The statements made to reporters are always 
 susceptible to more or less reconstruction. Again, it 
 must be remembered that some men in the army, as 
 elsewhere, are likely to exaggerate the true conditions, 
 believing that by doing so, their services will be the 
 better appreciated. As the result of my own obser- 
 vations, I can say without fear of contradiction that 
 the best soldiers do the least grumbling. The most 
 heroic and patriotic soldiers have the least to say of 
 what they did and in relating hairbreadth escapes. It 
 is the drone that does the complaining, and who rides 
 in ambulances, and overcrowds the hospital, and puz- 
 zles and vexes the hard-working doctor. To the 
 credit of the armies of invasion I must say that I 
 heard but few complaints when the days were darkest 
 and the food scantiest. One day I visited the fever 
 camp near the division hospital of the army before 
 Santiago, where I found two hundred patients liter- 
 ally lying in the mud, with nothing but a wet blanket, 
 most of them under a shelter tent, some of them even 
 without this slight protection against the pouring 
 rains. Food was of the plainest kind, yet little or
 
 Ill 
 
 no complaint here. The men expected hardships, 
 and when they came they were not disappointed. 
 Grumbling became more marked and widespread 
 with the progress of the war, after the men had be- 
 come worn out by the campaign, and homesickness 
 had gained a firm foothold. The severest complaints 
 have originated with camp followers. The Medical 
 Department has been criticized repeatedly, and yet 
 it would be found very difficult to find among the re- 
 turning soldiers any one who would be willing, or 
 who would have reason to complain of the treatment 
 he received at the hands of medical officers. In 
 case of war, the machinery of our government is 
 a very comj^licated one. The executive power of 
 the Surgeon-General is indeed an extremely limited 
 one. Everything of importance has to pass 
 through the hands and by sanction of the Secretary 
 of War. The Secretary of War is a busy man in keep- 
 ing track of what is going in his department outside 
 of the Surgeon-General's office. On the other hand 
 the Medical Department depends entirely on the quar- 
 termaster's department in forwarding and distributing 
 medical supplies. No wonder that many collisions 
 between these departments occurred during the pres- 
 ent war. Our experience has taught us in a most 
 forcible way that the Medical Department should have 
 charge of everything pertaining to the sick and 
 wounded, in order to accomplish that for which it is 
 intended. The Secretary of War is not supposed to 
 have any knowledge of medicine or surgery or other 
 wants of sick and wounded, and yet the Surgeon- 
 General is powerless in the execution of his orders 
 without his co-operation. If the forwarding and dis- 
 tribution of the medical and hospital supplies were 
 directly under the control and management of the 
 Medical Department we would have heard less of well- 
 founded complaints of the scarcity of medicines and 
 hospital supplies. To make a department strong and 
 efficient it must be independent. It was not difficult 
 to foresee when this war broke out that the greatest
 
 112 
 
 danger the troops had to expect was disease and not 
 the Spaniards. The importance of the Medical De- 
 partment was never more keenly apparent than at the 
 present time, and yet what was done? The highest 
 official in the Medical Department is a Brigadier- 
 General, and only five medical officers with the rank 
 of Colonel, and seven Lieutenant-Colonels. For the 
 army major-generals were in abundance, brigadier- 
 generals by the dozen, and colonels were turned out 
 by the hundreds. Many of the brigadier-generals in 
 brand new uniforms and glittering staffs never found 
 a command, but their names remained on the pay 
 roll just the same. Many of our newly fledged 
 colonels could not handle a musket to save their 
 lives and some of them even attempted the unusual 
 feat of mounting the horse from the right side. In 
 the face of all these appalling defects of army service 
 the brunt of criticism continues to fall on the Sur- 
 geon- General and his hard working officers in the 
 field. Much has been said of the mismanagement of 
 Camp Wikoff. Considering the limited transporta- 
 tion facilities, and the fact that in less than three 
 weeks more than 3,000 patients have been cared for, 
 it is a source of gratification that so much has been 
 accomplished, largely through the energy of the Chief 
 Surgeon, Colonel Forwood, and Majors Brown and 
 Heitzman. A corps of more than one hundred female 
 nurses, including fifty Sisters of Charity, do the nec- 
 essary nursing with a will and efficiency that aston- 
 ish the many visitors. The hospital tents go up like 
 mushroons, day after day, and at the present time 
 2000 patients are well sheltered and well cared for. 
 No lack of medical supplies at this time. The sur- 
 gical ward in my charge was completed today and is 
 already crowded with patients. The liberal contribu- 
 tions sent here by different relief societies supply the 
 sick and well with an abundance of delicacies of all 
 kinds. The diet of the convalescents is luxurious, 
 much better than what is furnished by the officers' 
 mess. The Red Cross is doing excellent work here,
 
 113 
 
 as elsewhere, in the distribution of clothing, medi- 
 cines and delicacies. Mrs. A. Tscheppe, who repre- 
 sents a relief society of New York, is a familiar figure 
 among the soldier patients and has been of much ser- 
 vice in adding to their comfort and speedy recovery. 
 Most of the i^atients are suffering from malaria, 
 typhoid fever or dysentery. The number of deaths 
 average from ten to fourteen daily, a small percent- 
 age considering the number of patients in the whole 
 camp. The patients here enjoy fresh air, good nurs- 
 ing and excellent treatment, all of which will be con- 
 ducive to rapid recovery. The conditions here for 
 the successsul treatment of the fever cases are, in my 
 opinion, far better than in any of the large hospitals 
 in cities. It is to be hoped that the entire camp will 
 be vacated in from four to five weeks, as after that 
 time the soil will be thoroughly infected, in spite of 
 all precautions, and the indigenous spread of typhoid 
 fever would follow as an unavoidable sequence. The 
 surgical work consists in the treatment of large 
 abscesses, occurring in patients whose general 
 health has been undermined by disease, or the 
 hardships of the campaign, and operations for 
 hemorrhoids and rectal fistula. Unjust and unnec- 
 essary criticism has a demoralizing effect on those 
 directly or indirectly concerned. It is prone to 
 intimidate and confuse those who are criticised 
 and embolden those who look for undeserved 
 sympathy. In this camp there is no further 
 ground for complaint of any kind. It is gen- 
 erally known that the Medical Department was 
 not consulted in locating the camps. For reasons 
 known only to those in power, the camps were selected 
 regardless of sanitary conditions. Our troops have 
 been exposed to malaria since they left the State 
 camps, and almost every man shows evidences of more 
 or less malarial poisoning. As the essential cause of 
 malaria enters the body by inhalation, malaria could 
 not be avoided as long as the camps were located on a 
 soil which breeds the plasmodium. Typhoid fever
 
 114 
 
 made its appearance in the State camps and followed 
 the army to Chickamauga, Tampa, Alger, Cuba and 
 Porto Rico. It is a repetition of what has happened 
 during all campaigns under similar circumstances. 
 Let the national cry subside now and let the press 
 and people await the results of a thorough investiga- 
 tion by Congress, which will place the responsibility 
 for any mismanagement where it belongs. The Med- 
 ical Department courts such investigation, fully con- 
 fident that the blame will be fixed outside of its legit- 
 imate jurisdiction. 
 
 Camp WikoflF, Aug. 31, 1898.
 
 OUR RELIEF SOCIETIES. 
 
 War, pestilence, famine, floods and other great 
 national calamities, are the most reliable tests to bring 
 out the true philanthropic spirit of individuals as well 
 as of nations. The good Samaritan is to be seen every- 
 where under ordinary conditions on his errands of 
 mercy, following the footsteps of his Master in bring- 
 ing comfort to the poor, the sick, the maimed and the 
 oppressed, but his energies are taxed to the utmost, 
 and his work is appreciated most keenly, when the 
 masses are in distress. The American people are 
 noted for their charitable disposition, and have gained 
 a well-deserved reputation for humanitarian work. 
 Our numerous ideal charitable institutions speak for 
 themselves. Many national catastrophes have demon- 
 strated the liberality and good-will of our people. 
 The War of the Rebellion furnished an interesting 
 object lesson to the outside world of the way in which 
 patriotism is estimated here. During the war just 
 ended many diflPerent relief societies have rivaled with 
 each other in supplying our soldiers, sick and well, 
 with many comforts of life beyond the limit of the 
 government supplies. The government itself set a 
 noble example by sending to the camps and the in- 
 vading armies all kinds of supplies, unparalleled in 
 quantity and quality in the history of the country. 
 I am sure no one regrets more keenly than the gov- 
 ernment officials that these liberal supplies did not 
 always reach their destination in time. The work of 
 the many auxiliaries corrected many of these defects. 
 Individuals as well as organized societies have labored 
 incessantly and faithfully in coming to the aid of the 
 government, in furnishing the troops with under- 
 clothing and delicacies usually beyond the reach of
 
 116 
 
 armies when engaged in active warfare. Miss Ana- 
 bel Clarestes, a little girl in Lagrange, 111., has been 
 busy ever since the war commenced in preparing and 
 sending to camps and the front home-made jellies, 
 the product of her own hand. She had no difficulty 
 in collecting money to purchase the necessary mate- 
 rials, but it was left for her to labor in the humble 
 kitchen to prepare the incomparable delicacies for the 
 soldiers in the field. This little American girl is a 
 heroine worthy of the praise and admiration of the 
 returning heroes who have been benefited by her 
 modest, unselfish work. Many a patriotic woman, 
 unknown to newspaper notoriety, has done her share 
 in minimizing the sufferings of this war. It was not 
 an uncommon thing for officers to receive a box con- 
 taining the contributions of some female friend of 
 the army who sent all she could spare for the allevia- 
 tion of the troops in the field. In many such instances 
 the name of the benefactress remained unknown to 
 those who benefited by her donation. I have opened 
 many such boxes, containing as a rule underclothing, 
 bandages, reading and writing material, towels, hand- 
 kerchiefs, and a few jars of jelly or canned fruit. The 
 soldiers who were made the recipients of these gifts 
 felt that they were remembered at home, an assurance 
 which contributed much in intensifying their patri- 
 otism and in sustaining their courage under the most 
 trying circumstances. The intense interest manifested 
 by the government and the peojDle in the care and 
 comfort of the returning army remains unequaled in 
 the history of our country. Every soldier was met 
 with a reception given to an intimate and long-looked- 
 for friend. The sick received the most tender care 
 from all sides, and the well were given food that re- 
 minded them that they had reached home. The hos- 
 pitals and many private houses threw the doors wide 
 open to receive those who required medical treatment. 
 Transportation home was made easy and comfortable 
 by the active intervention of thousands of friends 
 who were strangers when the troops left for the seat
 
 117 
 
 of war. In all large cities committees were organized 
 to look after the comforts of the returning troops. In 
 short, it may be safely stated that no army ever 
 received a more enthusiastic, kind and cordial recep- 
 tion than the troops that have reached us from the 
 seat of war. 
 
 RED CROSS SOCIETY. 
 
 Miss Clara Barton, President of the American Red 
 Cross Society, has performed her onerous duties dur- 
 ing the entire war with a devotion and earnestness 
 that merit universal recognition at home and abroad. 
 She has been tireless in her efforts to bring comfort 
 to the soldiers at times when her services were most 
 needed. The Texas Siud the little steamer Red Cross, 
 under her command, made their appearance at Sibo- 
 ney at a time when outside help was most appreciated. 
 Ice, medicines, dressings and hospital supplies were 
 freely distributed among the sick and wounded. 
 After the surrender of Santiago the Texas was the 
 first vessel to enter its harbor on its errand of mercy 
 in bringing food for the hungry Cubans and delicacies 
 for the sick of the victorious and vanquished armies. 
 The Red Cross Society established supply depots in 
 all of the large camps and the good work done every- 
 where will live in the memories of all who were 
 engaged in the conflict. Miss Barton has the confi- 
 dence of the American people and she has sustained 
 it through the present war by the thoughtful and 
 timely distribution of the innumerable and liberal 
 donations to the society she so well represents. An 
 appropriate idea of what this Society has done can be 
 gained from the fact that in Camp Wikoff alone two 
 thousand dollars of supplies are distributed daily. 
 Miss Barton has been assisted in her widespread 
 humanitarian work by a large staff of physicians and 
 nurses who came to the relief of the medical officers 
 at times when their services were most needed. After 
 X3eace was declared, Miss Clara Barton immediately 
 sailed for Havana to bring much-needed aid to the 
 starving reconcentrados of the long-besieged city,
 
 118 
 
 while her numerous helpers continued their faithful 
 work in the home camps. The work of the Red 
 Cross received the moral and substantial support of 
 the charitably disposed citizens throughout the 
 United States and liberal donations from abroad. 
 Recent experience has again demonstrated that this 
 society is the most important auxiliary in war as well 
 as other natural disasters in bringing prompt relief to 
 the sufferers. 
 
 women's patriotic relief association, new YORK. 
 
 This benevolent Association has extended its work 
 from the camps to the needy families of soldiers who 
 enlisted and went to the front, leaving families behind 
 them, worthy objects of well-deserved charity. It was 
 founded in the City of New York at the outbreak of 
 the war, at the residence of Mrs. Egbert Gurnsey, 
 with Mrs. Howard Carroll as president and well- 
 organized committees and ad^ -sory board, consisting 
 of prominent business and professional men. The 
 Association has provided food and house rent, as well 
 as medical attendance, monthly, to no less than 2444 
 families. A free eatinghouse was established at 711 
 Eighth Avenue, where these families received food 
 and clothing. Mrs. Charles Carroll, a member of the 
 Association, was made president of the Naval Reserve 
 Relief, and by contributions and a garden party given 
 at her residence in New Brighton, Borough of Rich- 
 mond, the sum of $2500 was secured, which was 
 expended for the benefit of the New York Naval 
 Reserves. This special function of the Association 
 did much for the comfort and efficiency of this other- 
 wise neglected branch of the military service. The 
 hospital work of the Association has been under the 
 management of Mrs. Charles Carroll, Mrs. Adolph 
 Tscheppe and Mrs. Seymore. The ladies of the 
 Association, with Mrs. William McDonald as chair- 
 man, gave an outing to the convalescent soldiers 
 from the different hospitals in Central Park, which 
 proved to be one of the most memorable occasions in
 
 119 
 
 the annals of the history of this famous park. Mrs. 
 Charles Carroll and Mrs. Tscheppe erected a tent in 
 Camp Wikoff when the soldiers from Cuba com- 
 menced to return, and have been busy in distributing 
 without any red tape an enormous amount of most 
 valuable contributions among the sick and convales- 
 cents. Their donations of different stimulants and 
 artificial waters have proved most acceptable and 
 timely. From this tent ice cream has been furnished 
 daily. A special messenger has done excellent service 
 in distributing mail and in looking up soldiers 
 inquired after by anxious relatives. 80 fertile have 
 been the resources of this modest little tent that 
 it has been designated "The Gold Mine." Mrs. 
 Tscheppe represents the ladies of the "Liederkranz," 
 and her popularity among the Germans of New York 
 has brought not only the most liberal donations but 
 likewise cash in large amounts. Only the other day 
 she received from a single source a check for $500, 
 which she was asked to use at her own discretion in 
 the care of the sick and convalescent in the camp. 
 The German press of New York has used its influence 
 in supplying Mrs. Tscheppe with ample means on her 
 errands of mercy. 
 
 ILLINOIS ARMY AND NAVY LEAGUE. 
 
 This relief association was organized soon after war 
 was declared. It is composed of representative men 
 and women throughout the State of Illinois, with head- 
 quarters in Chicago. The secretary. Dr. F. H. Wines, 
 had an extensive experience in dispensing charity 
 throughout the War of the Rebellion, and was conse- 
 quently well prepared in assuming the laborious and 
 trying duties of his office. While it was the principal 
 intention of the association to look after the interests 
 and comforts of the State Volunteers, many of the 
 contributions reached soldiers outside of the Illinois 
 troops. The State of Illinois, and the City of Chicago 
 in particular, have been very activ^e in minimizing the
 
 120 
 
 inevitable sufferings incident to active warfare by 
 sending to the camps and the front large quantities 
 of the most desirable articles of diet, delicacies, under- 
 clothing and medicines. The League made special 
 arrangements for transportation at reduced rates, so 
 that the donations reached their destination promptly 
 and at small expense. The League has had from the 
 very beginning a handsome bank account, and cash 
 was sent to different points for the purchasing of the 
 most necessary articles. The citizens of Illinois will 
 have the satisfaction of showing that by concerted 
 action of the members of the League the work of 
 charity and benevolence has been accomplished in 
 the most satisfactory manner. 
 
 MASSACHUSETTS VOLUNTEER AID ASSOCIATION. 
 
 There has been an impression prevailing among the 
 regular troops, that while the soldiers of the regular 
 army have fought the hardest and have been sub- 
 jected to the greatest privations, they have not re- 
 ceived the recognition to which they are entitled, and 
 have been more or less ignored by the different relief 
 associations. There is undoubtedly some truth con- 
 cerning these statements. The Massachusetts Vol- 
 unteer Aid Association has recognized the validity of 
 this complaint, and has directed its surgeons toward 
 correcting the oversight. The work of this associa- 
 tion in this direction has been particularly notable in 
 Camp Wikoff. A number of ladies representing this 
 Association came to the camp, and have done all in 
 their power to render the soldiers belonging to the 
 regular army comfortable and happy, 
 
 A light diet kitchen was established, provided and 
 equipped at the First Division Hospital, in charge of 
 Major Wood, in conjunction with the Red Cross Soci- 
 ety, under the superintendency of Mrs. M. H. Willard. 
 The kitchen is an ideal one, and is presided over by 
 a competent chef. Mrs. Dininger is the lady mana- 
 ger. The bountiful donation for the sick of the Regu- 
 lar Infantry Division was brought to the camp by
 
 121 
 
 Mrs. Leach, wife of Major Smith S. Leach, of the 
 Engineer Corps of the Regular Army, and was con- 
 tributed by the ladies of New London, Conn., and the 
 Pequot Society. It consisted of a well- assorted col- 
 lection of soups, eggs, lemons, oranges, butter, crackers, 
 sugar, barley, cocoa, farina, beef, ham, corn- starch, 
 codfish, breakfast food, chocolate, gelatin, tobacco, 
 pipes, keg of whisky, writing and reading material, 
 towels, j^ajamas, night- shirts and underclothing. The 
 light-diet kitchen is one of the attractions of the camp. 
 The relief societies that I have mentioned are only a 
 few of the hundreds organized throughout the United 
 States for the same purpose, notably among them the 
 "Daughters of the Revolution" and the "Colonial 
 Dames," all of which did their good share in allevia- 
 ting the sufferings of our army in camp and at the 
 front. The charity that has been practiced so boun- 
 tifully and so generally during the present war, must 
 satisfy our victorious army that the patriotism they 
 carried into the field has been cultivated at home in 
 words and action to a degree and extent unparalleled 
 in the history of the world. War in a just cause be- 
 gets patriotism, and nothing can demonstrate this 
 more clearly and forcibly than our experience in the 
 field and at home during the last five months. 
 
 Camp Wikoflf, Sept. 8, 1898.
 
 THE WOUNDED OF THE PORTO RICAN 
 CAMPAIGN. 
 
 The Cuban and Porto Rican invasions have con- 
 firmed the experience of the past in showing that the- 
 greatest horrors of war are caused by disease and it& 
 consequences rather than the implements of destruc- 
 tion. If the battle-grounds are in the extreme north 
 or south, climate enters as an important factor in 
 decimating the ranks and in increasing the sufferings 
 of the contending armies. A war of invasion requires 
 more preparation, foresight and forethought on the^ 
 part of those who plan and conduct the campaign than 
 one of defense, a fact we have been painfully made 
 aware of during the last two months. The more 
 remote the seat of conflict, the more difficult the task 
 of providing food and clothing for the army, and the 
 more serious becomes the problem of properly caring 
 for the sick and wounded, and the greater becomes 
 the difficulty in returning the survivors to their homes. 
 Nostalgia, a very common affection among unseasoned 
 troops, becomes more prevalent in proportion to the 
 distance between home and the seat of war, as we had 
 abundant opportunities to observe during the late 
 war. The depressing effect of this common ailment 
 has a decided influence in increasing the rate of mor- 
 tality of the sick and wounded, and in impairing th& 
 effectiveness of the fighting line. Nostalgia is a con- 
 tagious disease, not in the sense we use the word 
 contagion ordinarily, but when once established in 
 camp it increases rapidly by suggestion. The onset 
 and spread of this common ailment of camp life are 
 promoted by interruptions of the mail service, the only 
 medium of communication between the soldier in the 
 field and his distant home. Among the many sins of
 
 123 
 
 omission of those in charge of the management of 
 the late war was a glaring neglect to provide for the 
 much-needed and anxiously looked for mail facilities. 
 If those who have the management of this branch of 
 the government service in charge could be made to 
 understand what an occasional letter will do in keep- 
 ing up the spirit of +he citizen soldier, nostalgia 
 would have been less prevalent and its effects less 
 disastrous during the late campaign. From the time 
 I left Fortress Monroe for Cuba, July 3, and until I 
 arrived in New York from Porto Rico, August 19, I 
 received only two letters of the probable two hundred 
 sent to me during this time. In summing up the 
 casualties of the w^ar just ended, it is safe to make the 
 statement that the number of killed and the number 
 of deaths resulting from the immediate effects of 
 wounds will not exceed 280. The number of wounded 
 will in all probability reach 1425. The number of 
 deaths from malaria, dysentery, yellow fever and 
 typhoid can not be estimated at this time, as these 
 diseases are still prevailing and will claim many 
 victims before the troops are recalled. The loss 
 of life and the suffering as well as disability, as a 
 claim for pension, caused by disease and the effects 
 of climate will exceed by far those caused by Spanish 
 bullets. During the Porto Rican campaign no pitched 
 battle was fought. The force of the enemy in all of 
 the skirmishes was small and in ambush. Only a few 
 were killed and not more than forty were wounded. 
 Among the wounded, bone injuries were rare, many 
 of the wounds slight. All of these cases tend to con- 
 firm previous observations to the effect that the small 
 caliber bullet of the Mauser rifle, the one used exclu- 
 sively by the Spaniards, causes wounds of the soft 
 parts, which if left alone under the first dressing, will 
 heal by primary intention in the course of a week or 
 two, unless complicated by serious visceral injuries. 
 All of these cases corroborate the statement previously 
 made that the small caliber bullet does not infect the 
 wound and that it seldom carries with it into the tis-
 
 124 
 
 sues clothing or other infectious substances. This 
 observation, so abundantly supported by substantial 
 facts, is an extremely important one for future field 
 service, as it must satisfy the military surgeons that 
 such wounds will heal promptly if left alone under 
 the first-aid antiseptic dressing. On the other hand, 
 I have seen the evil consequences following meddle- 
 some surgery in the form of unnecessary probing. 
 Such wounds are very susceptible to secondary infec- 
 tion caused by the use of the probe. For the purpose 
 cf again calling attention to the humane nature of the 
 modern weapon, and with a view of showing how 
 rapidly wounds inflicted with the small caliber bullet 
 will heal under the most conservative treatment, I 
 will report briefly the nature of the wounds and the 
 results of those wounded in the Porto Rican war: 
 
 Case :?.— Lieut. J. C. Byron, Troop F, Eighth Cavalry, 
 wounded in the skirmish near Mayaguez, August 10. The 
 bullet passed through the foot from side to side on the dorsal 
 aspect, making a groove on the upper surface of the second 
 and third metatarsal bones without fracturing them. Healing 
 by primary intention under the first dressing. He was in the 
 saddle when injured. 
 
 Case 2. — Lieut. John Haines, Battery F, Third Artillery, 
 was wounded in the attack on Aibonito, August 13, and is 
 probably the last man shot by the Spaniards during the inva- 
 sion of Porto Rico. He was in the advance of the line, with 
 his battery planted on a high hill in full view of the enemy. 
 After firing the number of shots ordered, the gun was turned, 
 and at this moment a bullet struck him in the left lumbar 
 region, postaxillary line, and escaped about the sixth inter- 
 costal space, anterior axillary line, on the same side. No 
 indications of bone injury or penetration of the chest. The 
 wounds were dressed in the field and healed by primary inten- 
 tion. He was conveyed in an ambulance from the front to 
 Ponce, a distance of twenty miles, and transferred to the hos- 
 pital ship Relief. At no time has he suffered much from pain 
 or even a sense of discomfort which could be referred to the 
 wound. The patient must have been in a stooping position the 
 moment the injury was received. 
 
 Case 5.— Lieut. T. H. Hunter, Battery B, Fifth Artillery, 
 was accidentally shot by one of his own men by a Krag- Jorg- 
 ensen bullet, which entered the right side of the ilium, passed 
 downward and backward, emerging from the gluteal region on 
 the same side below the ramus of the ischium. The course of 
 the bullet excluded bone injury in this case. Notwithstand-
 
 125 
 
 ing the length and depth of the tubular wound it healed 
 rapidly by primary intention. The indications are that the 
 patient will recover without any functional impairment of the 
 parts implicated in the injury. 
 
 Case i.— William H. Walcutt, Company E, Fourth Ohio 
 Infantry, was wounded in the skirmish near Guayamo, August 
 8. The bullet entered the plantar surface of the left foot be- 
 tween the first and second metatarsal bones, at the junction of 
 the middle with the distal thirds, and escaped from the dorsal 
 side, at a point a little nearer the distal side. From the course 
 of the bullet it is clear that he was running in a direction op- 
 posite to the enemy when the shot was fired. The wounds 
 were healed a week after the injury was received. 
 
 Case 5. — William J. Edgington, Company A, Fourth Ohio 
 Infantry, was wounded during an engagement, August 8. The 
 wound of entrance was at a point two inches to the left of the 
 median line on a level with the sacrococcygeal joint, the 
 wound of exit at the base of the opposite thigh over its inner 
 and middle aspect, directly over the adductor muscles. No 
 evidence of any serious visceral injury of any of the pelvic 
 organs. The temperature remained normal, the wounds healed 
 by primary intention, and when I examined the patient in the 
 hospital at Guayamo, five days after the injury was inflicted, 
 the patient was free from pain and able to leave his cot with- 
 out assistance. The course of this bullet explains the position 
 of the patient at the time the bullet reached its unwilling, 
 moving mark. 
 
 Case 0. — Noble W. Horlocker, Company C, Fourth Ohio 
 Infantry, was wounded in the same skirmish. The bullet en- 
 tered one inch in front of the right malleolus and escaped two 
 and three-fourth inches below and a little behind the external 
 malleolus. Although the bullet must have passed through 
 the ankle joint and the astragalus, the injury was followed by 
 very little pain, except on moving the ankle joint, and no indi- 
 cation of infection had set in five days after the injury was 
 received. It is reasonable to expect that the wounds will heal 
 by primary intention, and that the patient will recover with a 
 useful, movable ankle joint. 
 
 Case 7.— Stewart J. Mercer, Company E, Fourth Ohio 
 Infantry, was wounded August 5, in a skirmish on the way 
 from Arroya to Guayamo. The bullet made a flesh wound 
 over the inner margin of the left patella, and healed by pri- 
 mary intention in a few days. 
 
 Case ^.—Samuel T. Jones, Company C, Fourth Ohio In- 
 fantry, received a wound above the right patella, August 8. 
 Wounds of entrance and exit one inch apart. Primary heal- 
 ing under the first dressing. 
 
 Case 9,— Edward O. Thompson, Corporal Company K, Fourth 
 Ohio Infantry, was wounded near Guayamo, August 8. The bul- 
 let entered the forearm two-thirds of an inch above the wrist
 
 126 
 
 joint, on radial side, and after passing through the soft tissue 
 in front of the bones, emerged from the inner aspect of the 
 forearm just above the wrist joint. Wound healed by primary 
 intention under the first dressing. 
 
 Case if),— Harry Lee Haynes, Company C, Fourth Ohio 
 Infantry, was lying down in a ditch at the time he was 
 wounded, August 8. The bullet struck the arm two inches 
 above the insertion of the deltoid muscle and emerged over 
 the sternoclavicular articulation on the same side. A third 
 wound was found on a line with the course of the emerging 
 bullet one inch below the mastoid process and in the direction 
 of the sterno cleido-mastoid muscle. A fourth wound, an 
 inch and a half in length, one- quarter of an inch in depth and 
 an inch in width, was found on the dorsum of the right fore- 
 arna an inch above the elbow joint. All the wounds healed 
 rapidly, caused but little suffering, and the patient was in a 
 fair way to recovery when seen a few days after he was 
 wounded. 
 
 Case iJ.— Clarence W. Riffer, Company A, Fourth Ohio In- 
 fantry, was wounded August 8. The bullet entered the right 
 thigh at a point five inches above the knee joint and about the 
 middle of the external surface, passed through the soft tissues 
 making its exit three inches to the left of the point of entrance. 
 It re-entered the left thigh at a point two and a half inches 
 above the knee joint, and an inch and a-half to the right of the 
 posterior median line and emerged on the oposite side an inch 
 and a-half above the knee joint. Both tlesh wounds deep and 
 long as they were healed primarily without suppuration. 
 
 Case ii*.— John O. Cordner, Company C, Fourth Ohio In- 
 fantry, was wounded August 5. The bullet made a flesh 
 wound at the lower border of the patella, the wounds of en- 
 trance and exit being separated by a space an inch and a half 
 in length. Primary healing under first dressing. 
 
 Case J5.— William Rossiter, Company G, Eleventh U. S. In- 
 fantry, was wounded in the skirmish near Mayaguez, August 
 10. He was shot through the inferior maxilla. The bullet 
 entered just below the margin of the bone on the right side 
 about an inch in front of the angle and emerged over the angle 
 of the bone on the opposite side, perforating the soft tissues of 
 the neck in a transverse direction. The bullet appears to have 
 passed through the bone without fracturing it. The only pain 
 the patient complains of is produced when he undertakes to 
 masticate food. Wounds of entrance and exit healed in a few 
 days by primary intention. 
 
 Case 14. — Amos Wilkie, Eleventh U. S. Infantry, was on the 
 march when wounded near Mayaguez, August 10. The bullet 
 entered the right lumbar region just above the crest of the 
 ilium, mid axillary line, and emerged about two inches to the 
 left of the spine and four inches above the left sacro-iliac syn- 
 chondrosis. No indications of intra-abdominal complications.
 
 . 127 
 
 He suffered considerable from cramping pains, which he attri- 
 butes to cold and fever which he contracted by exposure to 
 rain. A week after the injury was received, when the patient 
 was an inmate of the Hospital Ship Relief, his condition war- 
 ranted the hope of an early and complete recovery. 
 
 Cane ir>. — Harry C. Errick, Company C, Eleventh U. S. In- 
 fantry, was wounded August 10, in a charge on the enemy in 
 ambush. Wound of entrance in left leg over the outer aspect 
 of the .middle third ; the bullet passed downward and inward 
 and emerged about five inches above the inner malleolus. 
 Hemorrhage slight, no fracture. Wound healing rapidly under 
 first dressing. 
 
 Case 16. — William H. Wheeler, Company A, Eleventh U. S. 
 Infantry, was wounded August 10, near Mayaguez, when in a 
 standing position with his side in the direction of the enemy, 
 his gun down, ready to reload. The bullet struck the tenth 
 intercostal space, leftside, in the post axillary line and made 
 its exit about four inches from the spine in the lumbar region 
 close to the margin of the last rib. No serious complications 
 followed the injury, and at the present time, August 14, the 
 patient is improving rapidly. 
 
 Case 11. — George Curtis, Company D, Light Battery, Fifth 
 Artillery, received a wound of the chest August 10, being in his 
 saddle at the time. The bullet passed through the chest from 
 the second left intercostal space in front to the middle of the 
 outer border of the scapula on the same side. No hemoptysis 
 or any other serious symptoms indicating the existence of the 
 visceral wound of the lung. The only thing he complains of is 
 a sense of numbness in the left arm. Primary union of both 
 wounds. 
 
 Case i8.— Joseph P. Ryan, Corporal Company A, Eleventh 
 U. S. Infantry, was wounded August 10. The bullet passed 
 through the ankle joint. Wound of entrance over the internal 
 malleolus of left leg, wound of exit two inches below the outer 
 malleolus. No infection or signs of synovitis. Wounds heal- 
 ing by primary intention. 
 
 Case 19. — Samuel Copp, Company A, Eleventh U. S. In- 
 fantry, received a scalp wound, August 10, while he was lying 
 on his abdomen on the summit of a hill. Wounds of entrance 
 and exit about two inches apart, healed under the first dressing. 
 He is suffering from a contusion of his abdomen he sustained 
 by falling over an embankment during the same skirmish. 
 
 Case 20. — Arthur Sparks, Company C, Eleventh U. S. In- 
 fantry, received a wound of the lower third of the left thigh, 
 August 10. Wound of entrance on external anterior aspect of 
 thigh about five inches above patella. The bullet passed 
 directly backward and came out on the opposite side on the 
 same level without injuring the femur. Healing by primary 
 intention. 
 
 Case 21. — George W. Whitlock, Company C, Sixteenth Penn-
 
 128 
 
 sylvania Infantry, was in a kneeling position when wounded 
 near Guayamo, August 9. The bullet entered the thigh near 
 the perineum, over the adductor magnus muscle, passed in 
 an outward and backward course and emerged from the gluteal 
 region near or over the sciatic foramen. Hemorrhage slight. 
 Paralysis of the foot and lower part of the leg points to injury 
 of the sciatic nerve. Healing of wound without complications. 
 
 Case 2^. —James Drummond, Company K, Sixteenth Massa- 
 chusetts Infantry, was wounded near Guayamo, August 9. 
 The bullet entered the neck on the leftside, behind the sterno- 
 cleido- mastoid muscle, two inches below the mastoid process. 
 Wound of exit on the opposite side in front of the trapezius 
 muscle. No immediate or remote complications. Wound healed 
 by primary intention. Patient has suffered from slight attack 
 of malarial fever. 
 
 Case 25.— Paul J. Mytzkie, Company D, Eleventh U. S. 
 Infantry, was wounded in the skirmish near Mayaguez, August 
 10. The bullet made a flesh wound three inches above the 
 external malleolus, which healed in a few days by primary 
 intention under the first dressing. 
 
 Case 24. — Daniel J. Graves, Company M, Eleventh U. S. 
 Infantry, received a gunshot wound of the thigh near Maya- 
 guez, August 10. The bullet passed through the thigh in an 
 antero posterior direction, fracturing the femur at the junction 
 of the middle with the lower third. A week after the injury 
 the patient was in excellent condition, the wounds remaining 
 aseptic and healing rapidly. 
 
 Case 25. — Theodore H. Newbold, Company I, Sixteenth 
 Pennsylvania Infantry, was shot while retreating during the 
 skirmish near Guayamo, August 9. The bullet entered the 
 right arm above the olecranon process and emerged from the 
 extensor side of the forearm between the radius and the ulna. 
 The olecranon process was broken off. The X-ray reveals the 
 presence of a fragment of the bullet, or its mantel, lodged in 
 the wound. Aseptic healing of the wound. 
 
 Case 26.— Clyde C. Prank, Company C, Sixteenth Pennsyl- 
 vania Infantry, was injured near Guayamo, August 9. The 
 bullet entered the inner surface of the middle of the right 
 thigh, passed upward and backward, and in grazing the femur 
 made a groove without fracturing the bone, emerging from the 
 external and posterior aspect of the thigh. Both wounds 
 healed by primary intention. In making a skiagraphic examin- 
 ation of the seat of injury a fragment of the bullet was dis- 
 covered in the groove. The piece of lead, as well as a few loose 
 fragments of bone, were removed August 17 by enlarging the 
 wounds of entrance and exit. Operation by Dr. Shultze. 
 
 Case 27.— John L. Johnson, Company D, Eleventh U. S. 
 Infantry, received a gunshot injury near Mayaguez, August 10. 
 The bullet passed in an antero posterior direction through the 
 middle third of the left leg, going through. the space between
 
 129 
 
 the tibia and fibula. Hemorrhage slight. Healing by primary 
 intention. 
 
 Case 28. — Samuel G. Prye, Company D, Fifth Artillery, was 
 injured by a deflected bullet, as he stood by his cannon, near 
 Mayaguez, August 10. The bullet passed through the soft 
 tissues in the right anterior axillary fold without doing any 
 further damage. The wound healed by primary intention. 
 
 Case 29. — Henry Gerrick, Company E, Eleventh U. S. Infan- 
 try, received a superficial wound over the pronator muscles, 
 near Mayaguez, August 10. The wound healed promptly by 
 granulation. 
 
 Case 30. — John Browning, Corporal, Battery D, Fifth Artil- 
 lery, was wounded near Mayaguez, August 10. The bullet 
 passed transversely through the soft tissues of the right fore- 
 arm on a level with the wrist, in front of the radius and ulna. 
 The bullet evidently cut the ulnar nerve and vein, as shown by 
 the paralysis of the parts supplied by the nerve below the seat 
 of the wound and the free venous hemorrhage which immedi- 
 ately followed the injury. Healing by primary intention. 
 
 Th§ marked contrast in the results of the treatment 
 of the wounded in Cuba and Porto Rico, I attribute 
 entirely to the better preparations made for the last 
 invasion, and not to any difference in the surgical 
 skill of the medical officers. The surgeons engaged 
 in the Cuban war were men exceptionally well pre- 
 pared for their profession, and performed their oner- 
 ous task with energy and enthusiasm. Ambulances 
 were scarce, the fighting line far away from the base 
 hospital, conditions which made it difficult to render 
 timely and efficient first aid. Another circumstance 
 which had its influence in interfering with the prompt 
 and effective first aid to the wounded in Cuba was 
 the large number of men who fell in battle in three 
 days. The war in Cuba precipitated in a pitched 
 battle; in Porto Rico it consisted in a number of skir- 
 mishes in which only a small number needed surgical 
 attention. In Porto Rico the rear of the different 
 armies was supplied with an adequate number of 
 ambulances and Hospital Corps men. The first aid 
 was rendered almost immediately after the wounds 
 were received, after which the patients were conveyed 
 to the hospital at once. A sufficient number of med- 
 ical officers were on hand during each engagement to
 
 130 
 
 take immediate and proper care of the wounded. In 
 most instances the wounds healed by primary inten- 
 tion under the first dressing. The value and impor- 
 tance of early surgical attention, and the first-aid 
 dressing, became apparent in comparing the condition 
 of the wounds, a week after the injuries were received, 
 during the Cuban and Porto Rican campaigns.
 
 ON THE FREQUENCY OF CRYPTORCHISM AND 
 ITS RESULTS. 
 
 Cryptorchism and incomplete descent of the testicle are 
 congenital defects, the frequency of which has never been 
 established by reliable and extensive statistics. Undescended 
 testicle, partial and complete, is frequently seen in infants 
 and children, but becomes more rare with the development of 
 the body to manhood. The writer has recently had an oppor- 
 tunity to make an accurate investigation into this subject by 
 the examination of 9B15 recruits for the Volunteer Service at 
 Camp Tanner, Springfield, 111. The ages of the men varied 
 from 16 to 51. The following is the result of the examination 
 with reference to the incomplete descent of the testicle : 
 
 Cry2)torchis7n.— Right side, 12; leftside, 22; both sides, 1. 
 
 Incomplete descent of testicle.— Right side, 10 ; with hernia, 
 1 ; left side, 14. 
 
 Total number of incomplete descent of the testicle in 9815 
 men, 59. Unilateral incomplete descent, the left side was 
 affected 36 times, the right side 22. Out of 59 cases the 
 defect was bilateral only once. In this case the inguinal canals 
 were found completely obliterated, no trace of the testicle 
 could be found. The man was in excellent health, married and 
 father of several children. In only two instances was the 
 incomplete descent of the organ complicated by a small hernia, 
 in both cases on the right side. Both of these men were 
 rejected. In all cases in which the testicle could be palpated 
 the organ was found atrophic, seldom exceeding the size of a 
 filbert or pigeon's egg, soft and not tender to touch. The 
 testicles were most frequently found just within or below the 
 external inguinal ring ; in the latter location it could be freely 
 moved in all directions without causing any pain. None of the 
 men thus afflicted complained of pain or even discomfort 
 caused by the imperfectly developed and incompletely de- 
 scended testicle. Recent scientific investigations appear to
 
 132 
 
 establish the fact that cryptorchism and incomplete descent of 
 the testicle are attributed rather to an imperfect development 
 of the organ than to a failure to reach its normal destination 
 at the right time. The results of these researches as well as 
 the deductions to be drawn from statistic material utilized in 
 this paper seem to combine in teaching surgeons caution in 
 undertaking early operations for cryptorchism for the purpose 
 of transplanting the organ into its normal position and with a 
 view of maintaining or increasing its functional activity. The 
 congenital hernia which so constantly attends retarded descent 
 of the testicle frequently disappears in the course of time 
 without operative or truss pressure. 
 Chickamauga, June 25, 1898.
 
 THE SEAT OF WAR AND OUR MILITARY 
 SURGEONS. 
 
 At the time I am writing this communication I am at Fort- 
 ress Monroe awaiting the arrival of the battleship Yale from 
 Santiago de Cuba. Waiting is always tiresome, tedious, and 
 often painful, but when it comes to waiting for a ship to take 
 you to the seat of war, it is distressing. It has been the dream 
 of my youth to take an active part in some great war, and now 
 that I am in one, the very thought that I might not get near 
 the fighting line is a source of keen disappointment. I have 
 been in hopes that I would be present during the siege of San- 
 tiago de Cuba, but according to the messages that are being 
 flashed (July 2) from the seat of war to the department in 
 Washington, the stars and stripes will float over the doomed 
 city in less than twenty-four hours. The Yale is expected to- 
 day, but it will take at least two or three days for the troops 
 to embark. 
 
 Our victories on land and sea will teach the crumbling mon- 
 archies of the old world that the American people are not 
 only foremost in agriculture, commerce and the different in- 
 dustries, but that when forced to fight they know how to con- 
 duct a war. The heroic deeds of the American soldier have never 
 been appreciated, except by those who were the means of giv- 
 ing him an opportunity of demonstrating his military quali- 
 ties. England, Mexico and the native Indians, have been 
 made to feel and are satisfied what the American soldiery can 
 do. The proud Spaniards will be humuiliated in the eyes of 
 the world as never before, and will soon plead for mercy and 
 raise the white flag to negotiate for peace on any terms. Our 
 people are now giving the world an object lesson in warfare 
 that will not surely be forgotten. The military spirit is epi- 
 demic in our country ; kindle it and it spreads like a flash of 
 lightning, from North to South and East to West. We have 
 the men, the muscle and the brains to bring into the field, at
 
 134 
 
 short notice, the best army in the world. Only sixty-five days 
 have elapsed since the Chief Executive of the United States 
 issued the first call for troops, and at the present time a fairly 
 well equipped army of 200,000 men are in the field, eager and 
 anxious to face the enemy. Our navy, the laughing-stock of 
 haughty foreign countries, has grown with an astounding 
 rapidity, and its achievements have already challenged the 
 admiration of the world, and have become a source of pride to 
 every loyal American citizen. Statesman and politicians may 
 differ in their views regarding the propriety and advisability 
 of extending our possessions beyond the present limits, but 
 one thing remains sure, that our country — perhaps, less as mat- 
 ter of choice than of necessity — is destined to take an active 
 part in the drama of international politics. The annexation 
 of Hawaii and the present war with Spain — the latter provoked 
 upon the most unselfish and purely humanitarian motives — 
 have furnished the entering wedge into the field of foreign 
 politics. Cuba should and must be owned by the United 
 States. Cuba is the hot-bed, the breeding station of yellow 
 fever, and always will remain so, whether under Spanish or 
 Cuban rule. Yellow fever can be stamped out forever in less 
 than two years after it has come into our possession. Yellow 
 fever, always imported from Cuba, has retarded the prosperity 
 of the South, and has ruined, at different times, the commerce 
 of many of its otherwise flourishing cities, and has claimed 
 the lives of more of our people than will be sacrificed in wip- 
 ing out Spanish rule. Geographically and commercially, Cuba 
 belongs to the United States. Cuban government would be 
 only a repetition of what has always been going on in the 
 neighboring islands and the republics of Central America- 
 misrule and revolution. We want no such neighbors. Cuba 
 must be freed from the Spanish yoke. The Cubans are not in 
 a condition to establish and maintain a wise and prosperous 
 self-government. Any such attempt would be little or no im- 
 provement over Spanish rule, either to its population or the 
 people of the United States. The natural resources of the 
 island are great, and are only awaiting a stable government 
 for their development. The scourge of yellow fever, always a 
 menace to the life and commerce of our people, more especially 
 of the Southern States, must be quickly and permanently re-
 
 135 
 
 moved by effective sanitary measures, which can only be effi- 
 ciently carried into effect by placing the island under the con- 
 trol of the government of the United States. 
 
 OUR MILITARY SURGEONS. 
 
 The medical profession of all countries has always been 
 intensely patriotic in times of war. The doctors always have 
 been and always will be the salt of the population. Their 
 education and training are of a nature to ensure qualities 
 necessary to citizenship of the highest type. The practice of 
 their profession, even in times of peace, is admirably adapted 
 to prepare them for the emergencies of war. In the exercise of 
 their duties they encounter hardships and dangers foreign to 
 the lives of the average citizens. They face epidemics far 
 worse than bullets, as far as danger to life is concerned, with- 
 out fear of death. In cities devastated by the scourge of 
 yellow fever or cholera, when everybody else that can leaves 
 for a place of safety, the doctors remain at their posts and 
 minister to the sick and dying without any expectation of a 
 substantial financial reward, or even the gratitude of the 
 recipients of their services. As the number of their well-to-do 
 legitimate clients diminishes during the inevitable exodus their 
 attention to the poor remains unremitting. Day after day and 
 night after night the familiar modest conveyance with its 
 lonely occupant can be seen in the depopulated streets, wend- 
 ing its way to the hovels of the poor on its errands of mercy. 
 The unselfish work of the doctor has never been properly 
 appreciated. From the most ancient times, when battles were 
 fought hand to hand with the most primitive weapons, medical 
 men were on hand ready to dress the wounded and to heal the 
 sick. None of them have ever attained the fame of the innu- 
 merable heroes who distinguished themselves on the battle- 
 field and whose deeds have been immortalized in prose and 
 poetry. In rank, pay and social position the military surgeon 
 has always been at a disadvantage as compared with the lead- 
 ers of troops. The one that knows how to kill and mutilate 
 has reaped more credit for his work than the one bent on his 
 sole mission to prevent and treat disease and to heal wounds. 
 Fame, influence and public recognition are within easy reach 
 of the successful military commander ; they need not be looked
 
 136 
 
 for, much less expected, by the hard-working, faithful, skilful 
 surgeon. His greatest reward, in military or civil practice, 
 always has been and always will be the consciousness of having 
 performed his duty to his fellow-men. 
 
 During the present war with Spain the medical profession 
 has responded promptly and nobly to the call of the country. 
 The medical officers now in the field can be classified as fol- 
 lows : Surgeons and assistant-surgeons United States Army ; 
 surgeons and assistant surgeons United States Navy; sur- 
 geons and assistant surgeons of Volunteers; acting assistant- 
 surgeons United States Army ; acting assistant-surgeons of 
 United States Navy. The surgeons of the army and navy, 
 after a long, comparative rest, have now found an opportunity 
 to make good use of their special training. Many of these 
 men have taken a course in the Army Medical School and 
 most of them have enjoyed excellent clinical opportunities 
 in the large cities. Surgeon-General Sternberg has taken 
 special pains to stimulate the younger members of his 
 department to improve themselves by stationing them for 
 a year in medical centers, where they had an opportunity 
 to attend lectures and clinics and to do laboratory work. The 
 advantages of instruction of this kind will become obvious 
 in this war. The professional military surgeon is well versed 
 in the executive part of his duties, which is sadly lacking in 
 the less favored volunteer surgeon. To the praise of the former 
 it must be said that he is always ready to impart knowledge of 
 this kind to his colleague from civil life. The volunteer sur- 
 geon represents that portion of the young men of our profession 
 who possess not only a full measure of patriotism, but also a 
 laudable degree of surgery and enthusiasm. Many of them 
 now in the field have left a lucrative practice, and are now 
 giving their services to the country for an insignificant salary. 
 Many of our volunteer surgeons have had hospital experience 
 either as internes or attending physicians, or both. Their prac- 
 tical experience has been such as to prepare them well for their 
 work in the field. Without exception all are anxious to go to 
 the front to assume the hardships of active military life. They 
 are anxious and ready to learn and work. The only complaints 
 I have heard were about the monotony and nothing- to-do of 
 camp life. Every one that goes to the front is envied by those
 
 137 
 
 left behind. They have left their homes, their families, their 
 practice, to sacrifice themselves, if need be, for the good cause. 
 I am sure when the Medical and Surgical History of the Amer- 
 ican Spanish War is written it will be brim full of the good 
 work done by the volunteer surgeons. It will record at the 
 same time many deeds of bravery and heroism on their part. 
 The acting assistant-surgeons, both in the Array and the Navy, 
 are so-called contract surgeons. They are appointed, without 
 examination, by the respective Surgeon-Generals, for the dura- 
 tion of the war, and are given the rank and pay of a first lieu- 
 tenant. They are mostly bright young men, recently from col- 
 lege or hospital, who will do their good share in preventing 
 disease and in relieving the sufferings of the sick and wounded. 
 The Association of Military Surgeons of the United States has 
 done the most during its short existence of eight years in es- 
 tablishing the most friendly relations between the professional 
 and civilian military surgeons, and in preparing the medical 
 service for war. The interest in this association will be greatly 
 enhanced by the present war, and the first meeting after the 
 close of hostilities will be a large and enthusiastic one. 
 
 As I write, an order reaches me from Washington instruct- 
 ing me to be in readiness to leave this evening or tomorrow 
 morning on the hospital ship Relief, which calls here on its 
 way from New York to Santiago. Acting Assistant- Surgeon, 
 Henry S. Greenleaf, son of the Chief Surgeon of the Army in 
 the field, accompanies me, and will be associated with me in 
 
 my future work. 
 
 Fortress Monroe, July 2, 1898.
 
 Headquarters Fifth Army Corps, 
 Before Santiac40, July 12, 1898. 
 
 As the hospital ship Relief came in sight of the seat of war 
 every one of its passengers watched with interest and anxiety 
 the indications of the present status of the conflict. When we 
 sailed from Fortress Monroe, Sunday, July 3, fighting was in 
 progress, and not having received information of any kind 
 since that time we were impatient for news. On reaching 
 Guantanamo we came in sight of a number of warships floating 
 lazily on the placid ocean, like silent sentinels, some six to 
 eight miles from the shore. The little bay was crowded with 
 empty transports, all of which indicated that we were not as 
 yet in possession of Santiago. The pilot of a patrol boat finally, 
 in a voice like that of a fog horn, communicated to us the news 
 that the greater part of the Spanish fleet had been destroyed 
 and that the Spanish loss in dead, wounded and prisoners was 
 great. Among the most important prizes of the naval battle 
 was the heroic admiral of the Spanish fleet, who was then a 
 prisoner on board of one of the men-of-war. The land forces 
 were near the city making preparations for the final attack. 
 A partial, if not a complete victory had been won, and we had 
 the satisfaction of knowing that we had not come in vain. Our 
 captain was directed to bring his ship to anchor near Siboney. 
 When we came in sight of this little mining town we saw on 
 shore rows of tents, over which floated the red cross flag, show- 
 ing us that we had reached the place for which we had been 
 intended. The little engine of a narrow-gauge mining railroad 
 was puffing and screeching up and down along the coast con- 
 veying supplies .from the landing to the camp. On the side of 
 a hill were the shelter tents of a company of infantry on detail 
 for guard duty. On the crest of a number of high hills which 
 fringe the coast could be seen block-houses recently vacated 
 by the Spaniards. A grove of palm trees in a near valley re- 
 minded us that we had reached the tropical climate. The
 
 139 
 
 steamer Olivette, floating the Red Cross, was anchored near the 
 shore. Major Appel, surgeon in charge of this hospital ship 
 was the first person to board our vessel, and gave us the first 
 reliable account of the recent battle. His appearance was 
 enough to give us an insight into his experience of the last few 
 days. He was worn out by hard work and his anxiety for the 
 many wounded under his charge. He spoke in the most flat- 
 tering terms of the services of Acting Assistant-Surgeon 
 Parker of New Orleans. Owing to the depth of the ocean, it 
 was impossible to find anchorage for the Relief on the first day. 
 The sea was quite rough and it was under difRculties that 
 Majors Torney, Appel and the writer were landed on July 7. 
 The first person I met on landing was Major Nancrede, pro- 
 fessor of surgery in the University of Michigan, He reached 
 Cuba at the right time to give his valuable services to his 
 country. Hundreds of wounded had received the benefit of 
 his skill. Slight in figure, and anything but robust, he per- 
 sisted in working night and day, until he was worn out by 
 fatigue and loss of sleep. I found him under a fly-tent, resting 
 on the hot sand. He was making preparations for an early 
 departure, in charge of 301 wounded, on the transport ship 
 City of Washington. The country, and especially those who 
 received his careful attention, owe a debt of gratitude to Major 
 Nancrede that can never be paid. 
 
 On reaching the camp I met my friend of years ago, Major 
 LaGarde, U. S. A., in charge of the hospital at Siboney, which 
 had been made the base of operations of the troops in the field. 
 It would have been difficult indeed to find a better man for 
 this trying and responsible position. By nature and training 
 a perfect gentleman, learned in his profession and experienced 
 in warfare, he was in possession of all the qualities required of 
 a medical officer in charge of such an important post. The 
 difficulties he encountered often appeared insurmountable, but 
 were met successfully by his cool and mature judgment and 
 promptness of action. His kind but dignified conduct com- 
 manded the respect of his subordinates, who were only too 
 willing to carry out his orders. Considering the limited sup- 
 plies within his reach, and the many urgent demands for them 
 from all sides, it is a source of astonishment that so much was 
 accomplished in so short a time. Inadequate preparations had
 
 140 
 
 been made for casualties on such a large scale, but he made 
 the best of the limited resources and used them where most 
 needed, often regardless of prescribed military channels. In 
 less than four days nearly 1000 wounded soldiers sought the 
 shelter of his tents. During this trying time he worked inces- 
 santly, regardless of his own health and personal comforts. 
 When the roll of honor is made out at the close of the war, the 
 name of Major LaGarde deserves a well-merited place at the 
 head of the list. In his arduous duties he was ably assisted 
 by Major McCreary and Captains Ireland and Fountleroy of 
 the United States Army, and a corps of acting assistant sur- 
 geons. The camp is on the shore, on a limited plateau at the 
 base of the mountain rising behind the little mining village. 
 The condition of the wounded men furnished satisfactory 
 proof that good work had been done here, as well as at the 
 front. On my arrival many of the wounded had already been 
 placed on board a transport ship, but more than 100 remained 
 in the general hospital. On the whole, the treatment to which 
 the wounded men were subjected was characterized by con- 
 servatism. Only a very small number of primary amputations 
 were performed. Bullets that were found lodged in the body 
 were allowed to remain undisturbed, unless they could be 
 removed readily and without additional risk. A number of 
 cases of penetrating wounds of the abdomen and chest were 
 doing well without operative interference. Penetrating gun- 
 shot wounds of the skull were treated by enlarging the wound 
 of entrance, removal of detatched fragments of bone, and 
 drainage. Several cases in which a bullet passed through the 
 skull, injuring only the surface of the brain, were doing well. 
 With few exceptions, wounds of the large joints were in a fair 
 way to recovery under the most conservative treatment. 
 
 A study of the immense amount of material collected at this 
 station satisfied the surgeons that the explosive efi'ect of the 
 small caliber bullet has been greatly overestimated. The sub- 
 sequent employment of the X-ray in many of these cases will 
 undoubtedly confirm the results of these observations. The 
 battle of Santiago resulted in 157 killed and 1300 wounded. 
 Nearly all wounds of the soft parts healed rapidly. Suppur- 
 ation in these cases was the exception, primary healing the rule. 
 The deceptive nature of wounds of the soft parts is best shown
 
 141 
 
 by a case of gunshot injury of the knee-joint that came under 
 my care during the first afternoon. The knee-joint was dis- 
 tended to its utmost, painful and tender on pressure. A rise 
 in temperature and corresponding general disturbances indi- 
 cated the existence of infection. A small opening was found 
 over the inner border of the patella on a level with the articu- 
 lations. A careful search for the wound of exit proved negative. 
 During the preparation of the limb for the operation another 
 effort was made to find a second wound with the same result. 
 After the patient was under the influence of the anesthetic 
 the limb was rendered bloodless by elastic constriction made 
 at its base. The knee-joint was opened freely by an incision 
 in line with the wound of entrance. A large quantity of liquid 
 blood escaped. A furrow on the surface of the internal condyle 
 of the femur led to a deep groove in the under surface of the 
 patella, and taking these as a guide the wound of exit was 
 finally discovered with the groove directly over the inner 
 surface of the knee-joint in the form of a small slit. Through 
 this slit-like opening a probe was inserted and advanced into 
 the grooves in a straight line without any difficulty. There 
 could remain no further doubt as to the existence of a wound 
 of exit. The joint contained a large quantity of blood, but 
 no detached fragments of bone. The joint was washed out 
 with a 2 per cent, solution of carbolic acid, the capsule sewed 
 with catgut and the external wounds with silk and, after 
 dressing, the limb was immobilized by the use of a posterior 
 splint, made of the sheath of the palm leaf. The patient was 
 doing well when sent home on a transport, two days later. 
 
 AFTER THE BATTLE. 
 
 The day after my arrival I went to the front, about ten miles 
 from Siboney. A colored orderly was my only companion ; he 
 rode at a respectful distance to the rear. The whole distance 
 the road was crowded with mule teams, soldiers and refugees. 
 The refugees made up a seething mass of humanity from start 
 to finish. At a low estimate, 1 must have passed on that day 
 two thousand souls, including men, women, children and naked 
 infants. The day was hot, and the suffering of the fleeing 
 inhabitants of Santiago, the besieged city, and adjacent villages 
 can be better imagined than described. Indian fashion, the 
 women walked while some of the men enjoyed the pleasure of
 
 142 
 
 a mule- or donkey-ride. Most of them were barefoot and dressed 
 in rags ; children and infants naked. Dudes with high collar, 
 white necktie and straw hat were few and far between. An 
 occasional old umbrella and a well-worn, recently- washed white 
 dress marked the ladies of distinction. Their earthly posses- 
 sions usually consisted of a small bundle carried on the heads of 
 the women, or a worn-out basket meagerly loaded with mangoes 
 or cocoanuts. The color of the skin of the passing crowd pre- 
 sented many tints, from white to jet-black. The women were 
 noted for their ugliness, the men for their eagerness to get be- 
 yond the reach of guns. Little squads of Cuban soldiers were 
 encountered from time to time, apparently anxious to get only 
 as far as the rear of our advancing army. These men display 
 an appearance of courage jusr now that is something mar- 
 vellous. Before the blue coats came here they infested the 
 inaccessible jungles at a safe distance from the Spanish guns, 
 making an occasional midnight raid to keep the Spaniards on 
 the lookout ; now they can be seen on the roads in small groups 
 relating to each other how they cut down the Spanish marines 
 with their national weapon on reaching the shore after their 
 vessels were demolished by our navy. The ragged refugees, 
 fleeing in all directions and mingling freely with our troops, as 
 they do, carry with them the filth of many generations and a 
 rich supply of yellow fever germs, which will ultimately kill 
 more of our men than the Spanish soldiers. On the way to 
 the front Chicago push and enterprise came in evidence by the 
 appearance of a mule of the smallest species carrying a rider 
 all out of proportion in size to the diminutive animal. Sus- 
 pended from the neck and dangling over the breast of the 
 animal, was a piece of pasteboard on which was inscribed, 
 ''The Chicago Record.'' To my question, "How is the Chicago 
 Record?'' the rider answered, "AH sold out." On reaching 
 General Shafters headcjuarters, I reported to Lieut. -Colonel 
 Pope, Chief Surgeon of the Fifth Army Corps. Colonel Pope 
 has worked night and day since the troops landed here. He 
 has done all in his power to make his limited supplies meet the 
 enormous demands. At headquarters is the principal field 
 hospital, in charge of Major Wood, a graduate of Rush Medical 
 College, ably assisted by Major Johnson and a corps of acting 
 assistant-surgeons. At the time of my arrival, 68 wounded
 
 143 
 
 officers and men were under treatment at this hospital. Major 
 Wood kindly invited me to perform an amputation of the thigh, 
 for gangrene caused by a gunshot injury, which had fractured 
 the lower portion of the femur and cut the popliteal artery. 
 The wound of entrance was over the inner margin of the 
 patella and that of exit over the lower and outer agpect of the 
 thigh. The knee-joint and thigh were enormously swollen and 
 the gangrene had extended to within a few inches of the knee- 
 joint. The pulse was rapid and the temperature over 105 
 degrees F, The amputation was made at the seat of fracture, 
 above the condyles of the femur, by making a long oval anterior 
 and a short oval posterior flap. The vessel was tied above the 
 seat of injury. Notwithstanding the extensive edema of the 
 tissues, the wound was in excellent condition three days later, 
 and the temperature normal. Here I found many interesting 
 cases on the way to recovery in which the nature of the injury 
 would have been ample excuse for rendering a very grave prog- 
 nosis — among them a number of cases of penetrating wounds 
 of the chest and abdomen. Four laparotomies for gunshot 
 wounds were made here by a volunteer surgeon, but as all the 
 patients died it was deemed expedient to assign him for duty 
 at a place where he could do more good than harm. 
 
 IN THE CAMP OF THE ENEMY. 
 
 In the afternoon I accompanied Acting Assistant-Sur- 
 geon Goodfellow to El Caney. The trip was made for the 
 purpose of taking charge of sixteen wounded Spaniards we 
 were to transfer to the Spanish Army. On the way to El Caney 
 we found many recent graves and numerous dead horses cov- 
 ered only with a few inches of dirt. The stench from this 
 source in some places was almost unbearable. The little 
 village of El Caney is located on the summit of a hill with an old 
 dilapidated church for its center. The public square and the 
 few streets were thronged with refugees, from 8000 to 10,000 
 in number. Crowds of refugees were also seen in the woods 
 around this village gathering mangoes and cocoanuts, about 
 the only food supply at this time. In the vestry room of the 
 church we found a representative of the Red Cross Associa- 
 tion dealing out hardtack and flour to the hungry multitude. 
 The wounded Spaniards were lying in a row on the floor of the 
 church, one of them in a dying condition. All that could be
 
 144 
 
 transported were conveyed in four ambulances under a small 
 detachment of troops to our fighting line. Here a flag of 
 truce was received, which was carried by an orderly, the 
 detachment was left behind and we passed our line. As soon 
 as the Spanish intrenchments came in sight the signal was 
 given and was promptly answered by the enemy. Two officers 
 with a flag of truce advanced toward us and we were halted at 
 a little bridge very near Santiago and below the first intrench- 
 ment. We were received very courteously by the officers and 
 asked to a seat upon the grass in the shade of a clump of 
 trees. Rum, beer and cigarettes were furnished for the enter- 
 tainment of the callers. The object of the visit was explained, 
 whereupon a hospital corps of about thirty men with sixteen 
 litters, in charge of a captain of the line and a medical officer, 
 made their appearance. The wounded men were unloaded 
 from the ambulances and conveyed on litters to within the 
 Spanish line. The visit was such a cordial and pleasant one 
 that we found it very difficult to part from our newly made 
 friends. After bidding the officers a hearty adieu and mount- 
 ing my horse, I was urged to dismount and say another fare- 
 well, a request which was responded to with pleasure. The 
 two little parties then separated and made their way in a slow 
 and dignified manner in the direction of the respective breast- 
 works. 
 
 ARTILLERY ATTACK. 
 
 The first armistice expired at noon, July 11. In the after- 
 noon a heavy cannonading commenced and was kept up until 
 late in the evening. Next morning it was resumed, however 
 with less vigor. During this bombardment the Spaniards 
 renewed their recently gained reputation as effective marks- 
 men. One of our best cannons was hit and literally lifted into 
 the air. An officer was killed and a number of men injured. 
 During the afternoon, while cannonading was still going on, 
 I went to the front, but on reaching our line bombardment 
 was discontinued, and under a flag of truce the commanding 
 generals met and held a conference. The result of this inter- 
 view remains a secret to this hour. 
 
 GENERAL MILES ARRIVES. 
 
 Major-General Miles and stafi" reached Siboney, yesterday, 
 on the steamer Yale and today he proceeded to headquarters.
 
 145 
 
 The appearance of yellow fever at dififerent places occupied by 
 our army has made our troops more anxious than ever to com- 
 plete their task. The frequent drenching rains and inadequate 
 equipments have also done much to render the men restless 
 and anxious to fight.
 
 RECENT EXPERIENCES IN MILITARY SURGERY 
 AFTER THE BATTLE OF SANTIAGO. 
 
 On Board the Hospital Ship "Relief," 
 July 22, 1898. 
 
 WOUND infections. 
 
 Military surgery is no more no less than emergency surgery 
 in civil practice. The surgeon in daily practice has learned 
 long ago that every accidental wound must practically be 
 regarded and treated as an infected wound. In this respect 
 the military surgeon of today has the advantage over his col- 
 league in civil practice in knowing that the small caliber bullet 
 inflicts wounds which per se are more often aseptic than sep- 
 tic. Our recent experience in Cuba has shown that the small 
 jacketed bullet seldom carries with it into the tisssues clothing 
 or any other infectious substances. Most of the wounds of 
 the soft tissues, uncomplicated by visceral lesions, which 
 in themselves would become a source of infection, healed by 
 primary intention in a remarkably short time. If infection 
 followed it usually did so in the superficial portion of the 
 wound in connection with the skin, and what is more than sug- 
 gestive, the wound of exit was more frequently aifected than 
 the wound of entrance. This can be readily explained from 
 the larger size of the wound and more extensive laceration 
 and tearing of the tissues. In many of the cases ideal healing 
 of the wound did not occur, owing to a subsequent limited 
 superficial suppuration of the wound. The deep tissues were 
 seldom implicated in such cases. I have reason to believe that 
 some of the compound fractures which are now suppurating 
 had such a source of infection, that is the extension of a super- 
 ficial infection to the seat of fracture. Two weeks have now 
 elapsed since the battle of Santiago was fought and we are 
 now in a position to inquire more critically into the manner in 
 which "the wounds became infected. The many failures in 
 protecting the more serious wounds against infection are at- 
 tributable to three principal causes : 1. Inadequate supply of
 
 147 
 
 first dressing. 2. Faulty application of first dressing. 3, Un- 
 necessary change of dressing. The medical officers with the 
 regiments and in the field hospitals were hampered in their 
 work by an insufficiency of proper material. The rapidity with 
 which the invasion was planned and executed, the difficulties 
 encountered in transporting the hospital supplies to the front 
 and the unexpected large number of wounded readily explain 
 the lack of dressing material when it was most needed. 
 Many of the dressings were too small and not sufficiently 
 secured to keep them in place in transporting the wounded 
 from the front to the field hospitals. As a rule not enough 
 attention was paid to the immobilization of the injured 
 part, an important element in securing rest for the wound and 
 in guarding against displacement of the dressings. It is a source 
 of regret that plaster-of-Paris dressings were not more fre- 
 quently employed in the treatment of gunshot fractures of the 
 extremities. Another very palpable evil in causing infection 
 was the too common practice of unnecessary change of dress- 
 ing. The transfer of patients fBom one surgeon to another 
 could not be avoided. Patients brought from the first dressing 
 station to the Field Hospital usually weresubjected to a change 
 of dressing and, when a few days later they reached the Gen- 
 eral Hospital at Siboney, they had to undergo the same ordeal 
 and often not only once, but as often as they came into the 
 hands of another surgeon. Patients not thus treated were dis- 
 satisfied, as the laymen are still laboring under the erroneous 
 impression that the oftener a wound is dressed the quicker it 
 will heal. It is difficult to eradicate such a deep rooted and 
 time-honored belief, and patients will continue to clamor for 
 a change of dressing, and the good-natured, hard-working sur- 
 geons only too often yield to such unreasonable requests. The 
 evil of meddlesome surgery has become very apparent during 
 our brief Cuban campaign and has taught us an important 
 lesson that must be heeded in the future. Our military sur- 
 geons must learn to realize the value and importance of the first 
 aid dressing. In all cases in which the first examination does 
 not reveal the existence of complications which require subse- 
 quent operative treatment the diagnosis tag should convey this 
 important instruction: ^'Dressing not to be touched unless 
 symptoms demand it. Such instruction is significant and must
 
 148 
 
 be followed to the letter by all surgeons in subsequent charge 
 of the patient. 
 
 I am satisfied more than ever of the necessity of including 
 in the first aid dressing package an antiseptic powder. For 
 years I have used for this purpose a combination of boracic 
 acid and salicylic acid, 4 : 1, with the most satisfactory resuits. 
 I am also partial to absorbent sterile cotton for this particular 
 purpose, as it constitutes a more perfect filter than loose gauze. 
 A teaspoonful of this powder dusted on the wound forms with 
 the blood that escapes and the overlj'ing cotton a firm crust, 
 which seals the wound hermetically. Should the primary 
 dressing become saturated with blood, the same powder should 
 be dusted over the wet dressing, and an additional compress 
 of cotton is added to the dressing. After the first dressing has 
 been applied it should not be removed except for good and sub- 
 stantial reasons. Much can be done in the after-treatment in 
 the way of readjusting the bandage and in immobilizing the 
 injured part, but the first dressing must remain unless local or 
 general symptoms set in which would warrant its removal. 
 Malaria and yellow fever, that crept in upon us so insidiously, 
 are responsible for many unnecessary changes of dressing. The 
 appearance of fever in a wounded man naturally leads to the 
 suspicion that there is something wrong in the wound. Many 
 dressings were changed on this ground, nothing abnormal was 
 found in the wounds, and a day or two later the nature of the 
 fever was recognized and the patients were either given quinine 
 or were sent to the yellow fever hospital, in accordance with 
 the diagnosis made. Every change of dressing, more espe- 
 cially in military practice, is attended by risk of infection 
 and must be scrupulously avoided, unless local or general 
 symptoms indicate the existence of complications ichich de- 
 mand surgiccd intervention. In writing the above it is not 
 my intention to cast any reflection on the work of our surgeons ; 
 on the contrary, I willingly bear witness to the ability, faith- 
 fulness and unselfishness with which they have done their 
 duty. A better and more conscientious group of medical offi- 
 cers it would be difficult to select anywhere. The results on 
 the whole are excellent, but I am hopeful that they can be 
 improved in the future by placing more stress and attention to 
 the value and importance of the first dressing, and wish to
 
 ,149 
 
 repeat again and in a most forcible way the language of the 
 late Professor von Nussbaum : ''The fate of the wounded 
 rents in the hands of the one who applies the first dressing.'' 
 If this is true in civil practice, its meaning can not be misin- 
 terpreted in military surgery. 
 
 EFFECTS OF BULLETS ON THE SOFT TISSUES. 
 
 In recent cases the small tubular wound made by the Mauser 
 bullet was surrounded by a narrow zone of contused tissue, and 
 the wound space itself filled either with liquid or coagulated 
 blood. A few days later the wound itself was found surrounded 
 with an area of suggillation, which varied in extent according 
 to the nature of the tissues and the amount of extravasation. 
 In cases in which the bullet passed through the tissues some 
 distance, and not far from the surface of the skin the location 
 and direction of the wound canal was indicated by discolora- 
 tion of the skin a few days after the injury occurred. In a 
 number of cases of aseptic wounds in which the bullet had 
 lodged in the tissues and was removed a week or ten days later, 
 I had an opportunity to study the remote effects of the injury 
 on the tissues. In all cases the swelling of the tissues at this 
 time had nearly or entirely obliterated the tubular wound, the 
 location of which was indicated by a dark discoloration, paren- 
 chymatous extravasation, remains of fluid or coagulated blood, 
 and a limited area of edema and infiltration. These conditions 
 served as a useful guide in following the course of the bullet. 
 The bullet itself was usually found loose in a small cavity filled 
 with liquid blood or bloody serum, while a more extensive zone 
 of infiltration indicated the early stage of encapsulation. I 
 have no further doubt but what the new bullet will become 
 encapsulated and remain harmless in the tissues, as readily or 
 more so than the old-fashioned leaden bullet. In isolated cases 
 late suppuration at the seat of the bullet resulted in the form- 
 ation of a circumscribed abscess, a complication which aided 
 the surgeons in locating, finding and removing the missile. It 
 was a surprise to us all to find that in more than 10 per cent, 
 of all the wounded, the bullet was found lodged in the tissues, 
 a vastly greater number than we had any reason to expect. 
 The reason for this became apparent when we began to study 
 the condition of the bullets removed. A large proportion of 
 the bullets removed were found deformed, showing that they
 
 150 
 
 were deflected bullets, which had struck a hard object or passed 
 through a resisting medium before they reached the final ob- 
 ject for which they were intended. The ground upon which 
 the battle was fought is stony and covered with trees and thick 
 underbrush, furnishing the most favorable conditions for de- 
 flection of the missiles. Some of the firing was done at a great 
 
 n 
 
 u 
 
 Fig. 1. Fig. 2. Fig. 3. 
 
 distance, so that occasionally a spent ball was found in the 
 soft tissues without injury of the bones. Such a bullet is shown 
 in Fig. 1. The bullet is a nickel encased Mauser projectile, 
 natural size, the jacket perfect, and was removed from behind 
 the tibia about four inches above the ankle joint. It entered 
 the calf of the leg below the popliteal space and never touched 
 
 Fig. 4. Fig. 5. 
 
 the bone. Fig. 2 represents the same kind of a bullet, the 
 point flattened and mushroomed, removed from the head of 
 the tibia. This bullet was probably fired from a great distance, 
 and the deformity was produced by the bone. Figs. 3, 4, 5, 
 represent a nickel-clad bullet very much deformed. It was 
 found lodged in the deep tissues of the thigh about two inches
 
 151 
 
 from the wound of entrance, slightly overlapping the femur 
 near the middle of the shaft. The bullet evidently struck a 
 stone behind its point, and was deflected before it entered the 
 tissues. It was much flattened and curved. Fig. 3 shows the 
 convex side point of bullet and jacket perfect. Fig. i shows 
 the edge and curve of the bullet. Fig. 5 represents the convex 
 side, showing a wide rent in the jacket indicated by the dotted 
 lines, the lead exposed between them. Figs. 6, 7, 8, illustrate 
 the deformity of a large caliber brass clad bullet. As the bul- 
 let was removed from the soft tissues from a wound without 
 bone injury, the deformity must have been caused outside of 
 the body. The bullet is flattened on one side from a point near 
 the tip to near the base of the lead core. Fig. 6 shows the 
 convex side ; behind the last transverse groove the lead is ex- 
 
 Fiff. 7. 
 
 posed. Fig. 7 illustrates the flattened side of the dotted line, 
 indicating a defect in the brass jacket. Fig. 8 shows the 
 margin of the bullet, and the location and extent of flattening. 
 As the Spanish army is armed exclusively with the Mauser 
 rifle, the weapon from which this bullet was fired must have 
 been in the hands of a volunteer, or possibly a Cuban, 
 
 THE VALUE OF THE X-RAY IN MILITARY PRACTICE. 
 
 The use of the probe as a diagnostic instrument in locating 
 bullets in modern military service has been almost entirely 
 superseded by dissection and the employment of the X-ray. If 
 from the nature of the injury and the symptoms presented the 
 bullet is located in a part of the body readily and safely acces- 
 sible to the knife and it is deemed advisable and expedient to 
 remove it, this can often be done more expeditiously and with
 
 15-^ 
 
 a greater degree of certainty by enlarging the track made by 
 the bullet than by relying on the probe in finding and on the 
 forceps in extracting the bullet. If, as is often the case, the 
 whereabouts of the bullet is not known, its presence and exact 
 location can be determined without any pain or any additional 
 risks to the patient by the use of the X-ray. All of the bullets 
 removed on board the hospital ship Relief were located in this 
 manner. Dr. Gray, an expert in skiagraphy, who has charge 
 of the scientific work of the floating hospital, has been of the 
 greatest service to the surgeons in enabling them to locate bul- 
 lets and in guiding them as to the advisability of undertaking 
 an operation for their removal. His large collection of skia- 
 graph pictures will also furnish a flood of new light on the 
 effects of the small caliber bullet on the different bones of the 
 body. Dr. Gray's work will constitute an essential and endur- 
 ing corner-stone of a much-needed modern work on military 
 surgery. The skiagraph has enabled us to diagnosticate the 
 existence or absence of fracture in a number of doubtful cases 
 in which we had to depend exclusively on this diagnostic re- 
 source. In fractures in close proximity to large joints the 
 X-ray has been of the greatest value in ascertaining whether 
 or not the fracture extended into the joint. In one case of 
 gunshot wound at the base of the thigh in which the bullet 
 passed in the direction of the trochanteric portion of the femur, 
 opinions were at variance concerning the extent of injury to 
 the bone. Some of the surgeons made a diagnosis of fracture 
 while others contended that there was no fracture but believed 
 that the bullet had made a deep groove in the anterior portion 
 of the bone and had possibly opened the capsule of the joint at 
 the same time. The X-ray picture clearly demonstrated the 
 absence of fracture and the existence of a deep furrow with 
 numerous fragments on each side. The X-ray apparatus also 
 proved of the greatest practical utility in showing the displace- 
 ment of fragments in gunshot fractures of the long bones, 
 which enabled the surgeons to resort to timely measures to 
 prevent vicious union. The fluoroscope has greatly added to 
 the practical value of skiagraphy. In the light of our recent 
 experience the X-ray has become an indispensable diagnostic 
 resource to the military surgeon in active service, and the sug- 
 gestion that every chief surgeon of every army corps should be
 
 153 
 
 supplied with a portable apparatus and an expert to use it, 
 must be considered a timely and urgent one. 
 
 THE WOUNDED OF THE BATTLE OF SANTIAGO. 
 
 It will be of interest to the profession to learn something defi- 
 
 Fig. 9. 
 
 nite of the nature of the wounds and their more remote results 
 on the victims of Spanish bullets in the battle of Santiago. 
 Two weeks have passed away since the battle. A considerable 
 number of the wounded have died since, and many have left 
 for the United States on the Olivette, Solace and transport
 
 154 
 
 ships. Among the 130 wounded now on the way to their homes 
 on the hospital ship, Relief, I have selected a number of cases 
 of more than usual interest, for the purpose of studying the 
 effects of the small caliber bullet, immediate and remote, on 
 the different organs and regions of the body. It is my inten- 
 tion to give the course of the bullets by marking on the dia- 
 grams accompanying the report of each case, the wound of 
 entrance and exit. A study of the diagrams will show that 
 deflection of the bullet in the body is exceptional. Asa rule, 
 the wound canal was in a perfectly straight line from one 
 wound to the other. By following the track of the bullet it is 
 not difficult to determine the organ or organs implicated in the 
 injury. I shall classify the cases so as to embrace gunshot 
 wounds of 1, the head ; 2, the neck ; 8, the spine ; i, the chest ; 
 5. the abdomen ; 6, the extremities. 
 
 C4U>rSHOT WOUNDS OF THE HEAD. 
 
 To my own knowledge, a number of gunshot wounds of the 
 head that survived long enough to be transported to the gen- 
 eral hospital at Siboney, died within twelve days after the 
 receipt of the injury. In all of the cases intracranial infec- 
 tion was the immediate cause of death. Encephalitis and 
 leptomeningitis constituted the fatal complications. The be 
 ginning of the intracranial inflammation was always announced 
 by cerebral hernia, which in size was proportionate to the 
 extent and intensity of the inflammatory process. The surgi- 
 cal treatment resorted to in most instances proved powerless 
 in limiting the infection. If these cases had been studied with 
 a little more care during life, and if postmortem examinations 
 had been made more frequently, valuable material could have 
 been obtained for the advancement of the as yet imperfectly 
 developed science of cerebral localization. 
 
 Case 1. — Fred Shockley, Company D, Tenth Cavalry, 
 wounded July 2. When injury was received the patient was 
 lying on his abdomen with chest and head extended at the 
 base of the ridge occupied by the enemy, which position readily 
 explains the unusual course of the bullet. The bullet struck 
 the occipital base at a tangent, producing a comminuted frac- 
 ture with depression ; it then made a deep groove in the back 
 of the neck and then re-entered the body on a level with the 
 first rib to the left of the seventh cervical vertebra, passed
 
 155 
 
 through the chest and escaped in front through the second 
 intercostal space, a little to the left of the mammary line 
 (Fig. 9). Soon after the injury was received he coughed up a 
 small quantity of blood ; no hemorrhage since or any indica- 
 tions of pneumothorax, pneumonia or pleuritis. The chest 
 wounds healed by primary intention. At first had convulsions 
 for a few moments ; no loss of consciousness, but clonic spasms 
 of both arms. At present intellect is unimpaired ; has some 
 headache and a sensation of throbbing in the head ; some im- 
 pairment of motion and sensation of right leg and complete 
 loss of motion of toes of right foot : has some pain in eyes and 
 slight dimness of vision. 
 
 Case 2. — Patrick Ward, Company I, Third Cavalry, admit- 
 
 ted from hospital at Siboney to hospital ship, Relief, July 11. 
 Injury probably received in the same manner as in Case 1. A 
 large defect in the occipital bone marked the wound of entrance 
 and exit in the skull, the opening enlarged by operation. The 
 linear wound below, and extending as far as the last cervical 
 vertebra, was undoubtedly made in following and removing 
 the bullet. The cranial defect and course of bullet are out- 
 lined in Figure 10. 
 
 A cerebral hernia projects from the opening, and a deep- 
 seated cerebral abscess was recently discovered, opened and 
 drained. In part the hernia is covered by skin. Both parietal 
 bones are the seat of a comminuted fracture. Mental facul-
 
 156 
 
 ties not impaired ; no focal symptoms. The patient is losing 
 strength rapidly and will soon succumb to the intra-cranial 
 lesion. 
 
 Case 3. — Jerome Russel, Company A , Thirteenth Infantry? 
 was wounded July 1. When brought on board the Relief a 
 cerebral hernia about the size of a hen's egg was found over 
 the sagittal suture, an inch in front of the occipital protuber- 
 ance. The wound was suppurating, and digital exploration 
 revealed a small circular opening directly in front of the occip- 
 ital protuberance. This opening was evidently the wound of 
 entrance, and by operation, had been connected with the wound 
 of exit by a channel an inch in length and half as wide. The 
 
 Fig. 11. 
 
 hernia occcupied the wound of exit. A number of loose frag- 
 ments of bone have been removed at different times. There is 
 marked hemiplegia on the left side, the forearm is strongly 
 flexed and in close contact with the cheat. Sensation is not 
 diminished; speech clear, but 'ideas confused; pupils react to 
 light ; incontinence of urine ; extensive decubitus over sacrum ; 
 temperature 100.5 degrees F. ; pulse and respiration normal. 
 
 Case 4. — B. C. Parker, Company C, Fourth Infantry, was 
 wounded July 1. The bullet entered the left temporal region, 
 comminuting the bone in that region extensively, and escaped 
 oyer the left frontal eminence (Fig. 11). The cranial defect 
 was increased by the removal of a number of loose fragments. 
 There had been quite a profuse sero-purulent discharge from 
 the wound. The only focal symptom consists in a pricking
 
 157 
 
 sensation in the right foot or chest when the wound is being 
 dressed. His mind is clear most of the time, occasionally 
 slight confusion and wandering. The absence of cerebral her- 
 nia in this case is the surest indication that the infection is local. 
 
 GUNSHOT WOUNDS OF THE NECK. 
 
 Case o.— Lieut. Albert Scott, Company C, Thirteenth 
 Infantry, on July 1, while standing with his company at the 
 foot of a hill, during the advance on Santiago, received a 
 wound in the neck. The bullet entered the neck on the right 
 side just below the inferior maxillary bone, one inch in front 
 of the angle of the jaw. The wound of entrance is a clean cut 
 hole about the size of a lead pencil. The course of the bullet 
 
 Fig. 12. 
 was backward and slightly downward, emerging at the back of 
 the neck on a level with and to the left of the fifth cervical 
 vertebra (Fig. 12). 
 
 At the moment the injury was inflicted he felt no pain in the 
 wound, but he experienced a sensation as if he had been 
 grasped by the wrists and thrown violently to the ground. 
 The wound of exit is of the same size and appearance as the 
 wound of entrance. Very slight hemorrhage. A few minutes 
 after receiving the injury he was carried from the firing line by 
 members of his company, and was soon transported to the 
 First Division Hospital, where he remained for ten days, after 
 which he was removed in an ambulance to the hospital at 
 Siboney, a distance of seven miles over a very rough road, and 
 a day later was transferred to the Relief.
 
 158 
 
 He first became aware of the existence of the wound on the 
 way from the field to the hospital. At the time he came on 
 board the hospital ship he was voiceless, and made constant 
 efforts to clear his bronchial tubes of mucus. Complete par- 
 alysis of right arm and leg, and partial loss of power in left 
 arm and leg. Respiration normal, but an almost constant 
 spasmodic cough, no control over sphincters, involuntary pas- 
 sages from both bladder and bowels, great debility and profuse 
 sweating ; complains of pain all over the body. Morphia and 
 atropin given to subdue pain. A radiograph taken by Dr. 
 Gray shows an injury of one of the cervical vertebrae, probably 
 the fifth. Injury seems to be to the left of the body of the 
 bone. Has received no treatment other than complete rest 
 
 and a nightly anodyne as noted above, which secures a good 
 night's sleep, and markedly diminishes the sweating. Has 
 regained control of the sphincters, and is able to use bed pan 
 and urinal. 
 
 July 19. — During the past six days there has been a decided 
 improvement in the general condition of the patient. He is 
 brighter in appearance, he can articulate more distinctly, and 
 there is a decided return of power in the right leg. The right 
 hand is still absolutely powerless, but the grip of the left hand 
 is decidedly stronger. Appetite and circulation good. 
 
 July 21. — Improvement in general condition still continues. 
 The external wounds healed by primary intention, and the 
 scars can only be seen on making a very careful inspection.
 
 159 
 
 Trional and eulphonal have been substituted for the morphia. 
 
 Case ^.— Oscar C, Buck, Company P, Second Infantry, was 
 shot by a sharpshooter hiding in a tree, July 11. The bullet 
 passed through the neck from side to side. The first and only 
 evidence the patient had that he was injured was bleeding from 
 the throat, the hemorrhage at first being quite profuse. Stiff- 
 ness of the neck and pain on movement have been the only 
 symptoms complained of since. The bullet entered over the 
 sterno-cleido-mastoid muscle on the left side, about two and 
 one-half inches from the mastoid process. The wound of 
 entrance was circular and very small ; the wound of exit on 
 the same level but about half an inch nearer the spine (Fig. 13). 
 Three days later a small superficial abscess formed in the 
 wound of exit, which was evacuated by dilating the wound. 
 Both wounds were perfectly healed July 20. Judging from the 
 course of the bullet it is difficult to understand how the princi- 
 pal nerves and large vessels of the neck escaped injury. This 
 is one of those cases that require careful watching, as a trau- 
 matic aneurysm may develop later in the throat if the bullet 
 injured the external tunics of either of the carotid arteries. 
 
 Case 7.— Charles F. Flickinger, Company C, Fourth Infan- 
 try, was wounded July 1, while lying down. The bullet 
 entered the left posterior cervical triangle on a level with the 
 spinous process of the fifth cervical vertebra, midway between 
 the spine and the posterior border of the sternocleido- mastoid 
 muscle, and emerged opposite the spinous process of the 
 seventh dorsal vertebra, and equidistant from that point and 
 the posterior border of the scapula (Fig. 14a). The patient 
 complains of severe pain in shoulders on attempting to move, 
 but is free from any symptoms that would indicate any injury 
 to the spinal cord. He was within 100 yards of the enemy 
 when he was wounded. 
 
 GUNSHOT WOUNDS OF THE SPINE. 
 
 All cases of gunshot wounds of the spine in which the cord 
 was seriously damaged have died, or will die in the near future. 
 The immediate cause of death in such cases is either a septic 
 leptomeningitis or sepsis and exhaustion from decubitus. 
 Death from the first named cause takes place early as the 
 result of infection of the wound and extension of the inflamma- 
 tion at the seat of the visceral injury along the meninges and
 
 160 
 
 surface of the spinal cord. The first case of this kind I saw 
 was at El Caney a few days after the battle of Santiago. The 
 patient was a Spanish prisoner. I found hina lying on the bare 
 stone floor of the village church. The bullet had entered over 
 the center of the spine at the junction of the dorsal with the 
 lumbar vertebra^ its course apparently being directly forward. 
 Complete paraplegia below the seat of injury. The bladder 
 was distended, nearly reaching the level of the umbilicus : 
 incontinence of urine. The neck, trunk above the wound, and 
 upper extremities rigid ; fever ; pulse rapid and^small, counten- 
 ance extremely pale. The wound was protected by a small 
 
 Fig. 14a. 
 
 dirty dressing, and was suppurating. I doubt not that 
 the patient died in less than twenty-four hours after I saw him. 
 Wounds of the spine without injury to cord were frequently 
 attended by temporary paralysis varying greatly in degree and 
 duration. 
 
 Case 8. — George Kelly, Company C, Seventeenth Infantry, 
 was shot July 1, while lying in a prone position. The bullet, 
 which was fired from a blockhouse on the summit of a hill, at 
 a distance of about 600 yards, entered the body at a point a 
 little below and at the middle of the right ilium, and emerged 
 from the opposite side about three inches below the crest of 
 the left ilium (Fig. 14b). The patient asserts that he suffered 
 intense pain immediately after he was shot, and that he is now
 
 161 
 
 free from pain except when he attempts to walk. The pain 
 thus caused he refers to the sacrococcygeal articulation. The 
 wounds are healed, and the absence of paralysis is the best 
 evidence that the contents of the spinal canal escaped injury, 
 
 Fig. Ub. 
 
 although the bullet must have passed transversely through the 
 first sacral vertebra. 
 
 Case 9. — John Robinson, Company C, Twenty-fourth Infan- 
 try, The bullet entered the supraspinous fossa of left scapual 
 and escaped from the right lumbar region, having perforated 
 in its long course the lung, spinal cord, diaphragm and liver
 
 162 
 
 (Pig. 15). Wounds healed ia ten days. Expectoration bloody, 
 complete paraplegia. Beginning extensive decubitus over 
 sacrum and spinous processes. 
 
 Case lO.-Otto Derr, Company A, Twenty-first Infantry, was 
 
 Fig. 15. 
 
 wounded July 2. Bullet passed through the chest from side 
 to side from the post-axillary line on the right side to a corres- 
 ponding point on the opposite side, on a level with the seventh 
 intercostal space. Complete paralysis of motion and sensation 
 below the seat of spinal injury. The wounds healed, but life 
 was'threatened at the time from a commencing septic decubitus.
 
 163 
 
 Case :Zi.— Lewis W. Carlisle, Company K, Seventy-first New 
 York Volunteers, was hit by a shrapnel in the back, on a level 
 with the third lumbar vertebra, shattering the spinous and 
 left lateral processes of the same. The missile was removed as 
 soon as the patient reached the Division Hospital. As profuse 
 suppuration set in and continued, the patient was anesthetized 
 July 18, and a number of fragments of bone removed. A large 
 abscess cavity in the right lumbar region communicated with 
 the wound. The cavity was drained by making a counter- 
 opening in line with Simon's incision. Impaired sensation in 
 the right leg was the most important local symptom in this 
 case. 
 
 Case i'>.— Charles J. Reardon, Company C, Sixteenth 
 Infantry, was wounded by a fragment of shrapnel which struck 
 him as he lay on his back with his shoulders raised ready to 
 fire. The wound was directly over the spine, on a level with 
 the fourth dorsal vertebra, the missile evidently opening the 
 spinal canal and injuring its contents. The foreign body 
 remains imbedded in the tissues ; its location so far has not 
 been determined. Paraplegia is complete below the level of 
 the umbilicus. On July 18 the patient was still alive, but an 
 extensive moist decubitus became the direct cause of death in 
 the course of a few days. 
 
 GUNSHOT WOUNDS OF THE CHEST. 
 
 It is well known that during the Civil War men 
 had a better chance for life when the bullet passed through 
 the chest than when the chest was opened and the ball remov- 
 ed. The same remains true now, although not to the same 
 extent, as the small caliber bullet is less likely to carry with 
 it into the chest clothing or other infective material. The 
 number of cases of chest wounds that lived long enough to 
 reach the hospital on the coast is still more astonishing, and 
 what is surprising is the fact that unless the hemorrhage was 
 severe the symptoms were mild, some of the patients being 
 confined to bed only for a few days. All of these cases were 
 treated on the expectant plan, i.e., by dressing the external 
 wound or wounds in the usual manner. In no instance was 
 the pleural cavity opened for the purpose of arresting the 
 hemorrhage.
 
 164 
 
 Case 13. — Wm. A. Cooper, Company A, Tenth Cavalry, was 
 wounded July 1. The bullet entered an inch below the left 
 nipple, and escaped from the body an inch below the costal 
 arch in the mammary line (Fig. 16). It is questionable whether 
 the bullet opened either the pleural or peritoneal cavity, as the 
 
 Fig. 16. 
 
 injury was not followed by any symptoms referable to visceral 
 wounds of the chest or abdomen, although the course of the 
 bullet was such as to give rise to the suspicion that either or 
 both of these cavities might have been invaded. 
 Case 14. — Edward O'Flaherty, Company C, Sixteenth In-
 
 165 
 
 fantry, was wounded July 2 by a 45-caliber ball from a bursting 
 shrapnel. The projectile entered below the angle of the right 
 scapula, passed through the lung, diaphragm and liver, lodg- 
 ing beneath the skin in front, between the seventh and eighth 
 ribs (Fig. 17). Bloody expectoration for some time and slight 
 rise in temperature. 
 
 Fiff. 17. 
 
 July 12.— Temperature normal. 
 
 July 21.— Patient suffers but little inconvenience from his 
 wound. No peritoneal or pleural effusion. General condition 
 promises an early and complete recovery.
 
 166 
 
 Case 15. — John B. Semca, Company G, Twenty-second In- 
 fantry, was wounded July 1, by a bullet which entered his 
 back just below the angle of the left scapula, passed upward 
 through the lung, neck and jaw and emerged through the 
 
 Fig. 1- 
 
 alveolar process of the right bicuspid tooth, cutting the tongue 
 slightly (Fig. 18). All wounds healed in a short time by pri- 
 mary intention. Hemoptysis profuse immediately after he was 
 shot, and slight for the following few days. Left arm at first 
 nearly powerless, with desquamation of skin of the hand. 
 Function of the arm is returning gradually. In three weeks
 
 J67 
 
 the patient was able to sit up for a short time each day. Phy- 
 sical examination of the chest at this time revealed nothing 
 abnormal. 
 
 Case i6'.— Winslow Clark, Company G, First Volunteer Cav- 
 alry, was wounded July 1, by a bullet which entered the chest 
 
 Fig. 18. 
 
 by first perforating the left scapula through the infraspinous 
 fossa, three inches above the angle and a inch from the spinal 
 border (Fig. 19). No wound of exit. The probable course of 
 the bullet was downward and forward. Some hemoptysis and 
 fever. No vomiting of blood. The hemothorax was quite
 
 168 
 
 extensive and was relieved by tapping, a week after the injury. 
 He is now (July 22) convalescing rapidly. 
 
 Case 17. — Arthur Fairbrother, Company C, Third Cavalry, 
 sustained a perforating gunshot wound of the chest July 1. 
 
 The bullet entered the chest just below the middle of the right 
 clavicle (Fig. 20). No wound of exit. Hemoptysis rather pro- 
 fuse, followed by hemothorax. Has had fever, off and on, 
 probably malarial. Patient was admitted to the Relief July 15. 
 Wound not completely closed. On coughing, dark fluid
 
 169 
 
 blood escapes. Nearly the entire pleural cavity filled with 
 blood. Two days later three pints of dark fluid blood were 
 removed by tapping and siphonage. Sputum at this time still 
 bloody. 
 
 Fig. 19. 
 
 July 22.— Patient much improved. No signs of empyema. 
 Hemothorax diminished, but may require a second tapping. 
 
 Case m— Scanlon, Company K, Third Cavalry, was wounded 
 on the second day of the battle of Santiago. The ball entered 
 the^chest through the third rib midclavicular line on the right
 
 170 
 
 side, passed downward and backward and escaped in the gluteal 
 region on the same side, after perforating the ilium (Fig. 21). 
 The ball must have passed through the lung, diaphragm and 
 liver. Hemoptysis slight, but distressing nausea, vomiting and 
 pain. Admitted to the hospital ship Relief July 15. At that 
 time he had a constant temperature ranging between 100 and 
 102 degrees F., vomiting, diarrhea and rapid emaciation. Great 
 pain over the liver and ascending colon. Hemothorax and 
 marked swelling in the region of the liver and abdominal cavity 
 
 on the right side. Examination of urine negative. Owing to 
 the great debility and pronounced anemia it was not deemed 
 advisable to resort to laparotomy. 
 
 Case 19. — Harry Mitchell, Company C, Seventh Infantry, 
 was wounded July 1. The bullet entered over the right acro- 
 mion process, passed through the apices of both lungs and 
 escaped through the second intercostal space above the right 
 nipple (Fig. 22). No hemoptysis at any time, dry cough and a 
 moderate hemothorax on the right side. Has suffered from 
 quotidian form of malarial fever, which is yielding to quinin. 
 A speedy and complete recovery is expected.
 
 171 
 
 Case '^0. — Lieut. John Robertson, Company Ci, Sixth Infantry, 
 received a gunshot wound of the upper third of right thigh 
 about 10 o'clock July 1. The profuse hemorrhage was partly 
 controlled by an improvised tourniquet applied by an officer of 
 the line. He was carried to the rear by the men of his corn- 
 
 Fig, 21a. 
 pany, and while thus conveyed he was shot in the left breast, 
 the bullet entering just below the left nipple and passing 
 through the chest in an anteroposterior direction (Pig. 23). 
 He was wounded a third time, the bullet grazing the inner side 
 of the left knee. The first dressing was applied in the First
 
 172 
 
 Division Hospital. The fracture of the thigh was dressed by 
 the use of a long splint. From here he was sent, on July 9, to 
 the Third Division Hospital, and two days later was brought 
 on board the Relief. At this time both chest wounds were 
 healed. The thigh wounds remained aseptic. A radiograph 
 
 Fig. 21b. 
 
 showed great displacement of the fragments by overlapping. 
 The fracture was then treated by confining the limb upon a 
 double-inclined plane, consisting of a hollow posterior splint 
 made of the sheath of the leaf of the cocoa palm, to which 
 was added an anterior thigh splint of wire gauze. After dress-
 
 173 
 
 ing, the limb was placed in a eliog. No pulmonary or pleuritic 
 complications. 
 
 Case ^i.— Henry T. Darby, Company D, Thirteenth Infantry, 
 received a perforating gunshot wound of the chest July 1. The 
 ball entered on the right side, above the angle and at the outer 
 
 Fig. 22. 
 
 border of the right scapula, passed through the chest and 
 escaped through the fourth intercostal space in front, on the 
 opposite side, two inches outside of the mammary line (Fig. 24.) 
 When the patient came on board the Relief, July 9, he com 
 plained of great difficulty in breathing ; he was pale and greatly
 
 174 
 
 prostrated ; temperature 102 degrees F. The physical signs 
 indicated the presence of a copious pleuritic effusion on the left 
 side. The chest was opened by an incision through the sixth 
 intercostal space, in the axillary line, July 11. About three 
 
 Fig. 23. 
 
 pints of fluid blood escaped. Gauze drainage. The lung ex- 
 panded rapidly and the patient commenced to improve. 
 
 No further doubt can remain in regard to the difference in 
 the mortality of gunshot wounds inflicted with the large and 
 small caliber bullets. The cases related above appear to prove 
 that the danger incident to gunshot wounds of the chest made
 
 175 
 
 by the small projectile, consists in complicating injuries involv- 
 ing the heart and large blood-vessels, and that in the absence 
 of such injuries the prognosis is favorable. It seems that em- 
 pyema is a rare remote result of such injuries. Rib resection and 
 free incision and drainage of the chest in such instances must 
 be reserved for cases in which a positive diagnosis of empyema 
 can be made. The safest and best treatment for hemothorax 
 requiring operative interference is tapping and evacuation by 
 siphonage. 
 
 Fig. 24a. 
 GUNSHOT WOUNDS OF THE ABDOMEN. 
 
 Our recent experience in Cuba has more than ever confirmed 
 my conviction that not infrequently cases of penetrating gun- 
 shot wounds of the abdomen will recover without active 
 surgical interference. For years I have maintained, as the 
 result of clinical experience and experiments on the cadaver, 
 that a bullet may pass through the abdomen on a level and 
 above the umbilicus in an antero posterior direction without 
 producing visceral injuries demanding operative intervention. 
 Elsewhere the results of my experience and experimentation 
 concerning such injuries have been published. If the bullet
 
 176 
 
 traverses the small intestine area it is more than probable that 
 from one to fourteen perforations will be found. 
 
 Four laparotomies for perforating gunshot wounds of the 
 abdomen were performed in the First Division Hospital, the 
 only ones, to my knowledge, during the Cuban Campaign. 
 All of the patients died. This unfavorable experience should 
 not deter surgeons from performing the operation in the future 
 in cases in which from the course of the bullet it is reasonable 
 to assume that the bullet has made visceral injuries which 
 would be sure to destroy life without surgical interference. 
 
 In other cases the employment of diagnostic tests for the pur- 
 pose Oi demonstrating the existence or absence of intestinal 
 perforations will enable the surgeon to decide what course to 
 pursue. Abdominal section is always justifiable in cases of 
 internal hemorrhage sufficient in amount to threaten life. 
 
 A number of cases of gunshot wounds of the abdomen have 
 been related in connection with gunshot injuries of the neck 
 and chest, in which the cavity of the chest and abdomen and 
 their contents were implicated at the same time, and which 
 are on the way to recovery without laparotomy having been
 
 177 
 
 performed. I have seen a number of cases of perforating 
 wounds of the abdomen in the First and Third Division Hos- 
 
 Fiff. 2T>R. 
 pitals that were on a fair way to recovery without operation 
 before they were sent home on transport ships. In most of 
 these instances the bullet wounds were either in the umbilical
 
 178 
 
 region or one of the iliac fosste. The following case presents 
 features of more than usual clinical and surgical interest : 
 
 Case 22. — J. F. Taylor, Company D, Tenth Cavalry, was 
 wounded July 2. At the time the injury was received he was 
 
 \ 
 
 Fif?. 25b. 
 in the ventral prone position. The bullet entered the left 
 shoulder in the infraspinatus fossa one inch below the spinous 
 process of the scapula, and passed downward and inward and 
 lodged under the skin in the median line, two inches above the 
 umbilicus (Pig. 25). Hemoptysis considerable during the first 
 day, when it gradually subsided. He complained of great pain
 
 179 
 
 and tenderness in the right side of the abdomen. No vomiting 
 or symptoms of more than a circumscribed peritonitis. An 
 abscess formed in the abdominal wall, which was opened July 
 20, and the bullet was removed. From this time on the pati- 
 ent improved rapidly. 
 
 K 
 
 GUNSHOT WOUNDS OF THE EXTREMITIES. 
 
 It is a source of gratification to know that very few primary 
 amputations were made for gunshot injury of the extremities. 
 All of the surgeons realized the importance of conservative 
 measures in the treatment of such injuries, and limited ampu-
 
 180 
 
 tation to cases in which the condition of the soft tissues pre- 
 cluded such a course. A number of secondary amputations 
 became necessary to save life in cases of infected compound 
 fractures, usually complicated with injury and infection of the 
 adjacent joint. Two cases of traumatic aneurysm are now on 
 
 // 
 
 Fiff, 26b. 
 board the Relief, one an aneurysmal varix, the other an aneur- 
 ysm of the femoral artery. 
 
 Case -25. — Captain Mosher, Company G, Twenty-second 
 Infantry, received a bullet wound July 1, during the advance 
 on Santiago. Those who saw the patient first assert that the 
 hemorrhage was severe, and that the patient lost conscious- 
 
 I
 
 181 
 
 ness. He was removed to the First Division Hospital and 
 transferred July 10 to the Third Division Hospital, and the 
 following day he was brought on board the Relief. I exam- 
 ined the patient at the front five days after the injury and con- 
 firmed the diagnosis made by the attending surgeons, who had 
 recognized the anatomic nature of the aneurysm. 
 
 The wounds healed by primary intention in less than two 
 weeks. One wound is in the middle of Scarpa's triangle and 
 the other at the level of, and one inch posterior to the great 
 trochanter on the same side. From the fact that there is, as 
 shown by the radiograph, a piece of the jacket of a bullet in 
 the right popliteal space, it is probable that he was wounded 
 by a plunging fire and that the bullet inflicted the latter wound 
 after emerging from the wound in Scarpa's triangle. The 
 wound in the popliteal space is suppurating. Patient is very 
 anemic and weak. In the triangle directly under the wound 
 there is a pulsating swelling in the direction of the femoral 
 vein, which extends to Poupart's ligament. Fremitus and the 
 characteristic bruit extend a considerable distance above and 
 below the communicating opening between the artery and vein. 
 The treatment consists in rest and tonics. General health of 
 the patient is improving, but there is no change in the local 
 condition. The mental condition much impaired since the 
 injury is gradually improving. 
 
 Case 24. — John J. Welch, Company M, Second Massachu- 
 setts Volunteers, was wounded July 1. The bullet entered 
 the middle and back of Scarpa's triangle, three inches below 
 Poupart's ligament, directly over the femoral artery, and 
 escaped at a point corresponding with the gluteal crease and 
 to the outside of the femur on the same side (Figure 26). 
 Not much hemorrhage. A well-marked aneurysm developed, 
 presenting all the physical signs characteristic of such a path- 
 ologic condition. The swelling is somewhat elongated, a little 
 larger than a hen's egg, and has. not increased in size since the 
 patient came on board the hospital ship. The leg is somewhat 
 edematous and painful. A number of gunshot fractures of 
 the thigh and leg have become infected and are now being 
 treated by establishing free tubular drainage and resorting to 
 frequent or continuous antiseptic irrigation. Owing to the 
 want of reliable plaster of Paris, we had to resort to various
 
 182 
 
 kinds of splints, single and double inclined plane, in effecting 
 immobilization. The sheath of the leaf of the cocoa palm has 
 served as an excellent material for this purpose. There is 
 every prospect that most of these cases will utimately recover 
 with useful limbs. 
 
 In conclusion I desire to thank Acting Assistant-Surgeons 
 Metcalfe, Torney, Greenleaf, Hartsock, Morrow and Schultze 
 for valuable assistance in preparing this communication.
 
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 THE SURGERY OF CAMP WIKOFF 
 
 The great national Camp Wikoff has been made the recip- 
 ient of the returning army of Cuba. Three months ago the 
 invasion of Cuba was ordered. Our troops left the different 
 camps in excellent condition and good cheer to meet the Span- 
 ish army in the neighboring island, fully informed and impressed 
 with the events that awaited them. The army of invasion 
 considered it a privilege to be called to the front to represent 
 the military prowess and power of this country. The outside 
 world had no conception of what our army could accomplish at 
 such short notice in a distant tropical country. The authori- 
 ties, and particularly the medical department, were fully 
 aware of the fact that the invasion of Cuba meant more a 
 battle with climate and disease than the weakened, sickly, 
 half starved Spanish forces. The invasion was planned on the 
 spur of the moment, and the corps were rushed to the front with 
 a haste that appeared all out of proportion to the conditions of 
 things as they presented themselves at the seat of war. It was 
 decided that our flag should float over the city of Santiago on 
 the Fourth of July regardless of consequences. The army of 
 invasion was packed on transports days before the final order 
 was given to sail. Here was one of the many causes that 
 impaired the health of our troops. The lack of harbor facili- 
 ties on the coast of Cuba, where our army landed, made dis- 
 embarkment and the landing of supplies exceedingly difficult. 
 Most of the barges intended for this purpose were wrecked 
 during the voyage, a serious loss which could not be remedied 
 in time. Much suffering was caused by the lack of efficient 
 landing and transportation facilities. Our troops were sup- 
 plied with rations calculated for our climate, but not adapted 
 for a tropical country. Our soldiers were exposed at once to 
 malarial infection in all of the camps. Occupation of the 
 buildings in which yellow fever had full sway for years, and 
 the free intermingling of the filthy Cuban refugees and soldiers 
 with our troops could not fail in starting and disseminating
 
 184 
 
 this disease among our soldiers soon after landing on Cuban 
 soil. Typhoid fever, which prevailed in all of our large camps 
 before the army sailed for Cuba, soon gained a firm foothold 
 at the seat of war and did its share in increasing the mortality 
 and in shattering the efficiency of the service. Amebic 
 dysentery and diarrhea, the two greatest enemies of the Span- 
 ish army, thinned out our ranks and crowded our imperfectly 
 equipped hospitals. It was fortunate that the enemy yielded 
 to our arms so early, and made it possible for our troops to 
 return so soon to the invigorating climate of the North for 
 proper care and speedy recuperation. Those who saw the 
 different regiments leave our State and national camps would 
 find it difficult to recognize and identify the soldiers of the 
 Cuban campaign. The men left in excellent spirits. Most of 
 them return as mere shadows of their former selves. The pale 
 faces, the sunken eyes, the staggering gait and the emaciated 
 forms show only too plainly the effects of climate and disease. 
 Many of them are wrecks for life, others are candidates for a 
 premature grave, and hundreds will require the most careful 
 attention and treatment before they regain the vigor they lost 
 in Cuba. The surgery of Camp Wikoff represents cases and 
 pathologic conditions which we would expect to occur in men 
 suffering from the effects of disease, exposure and the debili- 
 tating effects of a tropical climate. Our work has consisted 
 largely in the treatment of abscesses and operations for fistula 
 ani and hemorrhoids. I was ordered to Camp Wikoff on my 
 return from Porto Kico, and reported for duty August 22. The 
 field operating tent and surgical wards, already in construc- 
 tion, were completed in two days. I have been assisted in my 
 surgical work by Major Charles Adams, U. S. V., and Acting 
 Assistant-Surgeon Henry Greenleaf. The Sisters of Charity 
 have charge of the surgical wards, and two of them make the 
 necessary preparations for operation and assist in the operat- 
 ing tent. 
 
 SURGICAL HOSPITAL. 
 
 The surgical hospital at Camp Wikoff is a part of the gen- 
 eral hospital. It consists of nine wall tents, placed end-to-end 
 and supported by a substantial wooden frame and floored 
 throughout, constituting a pavilion of 126 x li feet in extent. 
 The front tent, Xo. 1, facing southeast, boarded at the sides,
 
 185 
 
 with a broad table shelf on either hand, is used as an operat- 
 ing tent. It is equipped with a regulation operating table, 
 iron frame and top. Sterilized dressings, gauze sponges, liga- 
 tures, etc., are kept in steriFized towels in readiness for use at 
 
 Major Hkitzmakx, Surgeon U.S.A. 
 
 any moment. The shelves and tables are covered with white 
 rubber cloth, which is kept scrupulously clean. The instru- 
 ments, after sterilization, are kept in trays containing a 2 per
 
 186 
 
 cent, solution of carbolic acid. Saline and antiseptic solutions 
 are kept ready for use in four-gallon bottles. All surgical 
 paraphernalia not in use are covered by clean white sheets. 
 The second tent, open at the sides for free ventilation and cool- 
 ness, is used for the office of the surgeon in charge. It is sup- 
 plied with a field desk, table and chairs. Section No. 3 is the 
 preparation room. The instruments are kept here under lock 
 and key. Two sterilizers, basins, buckets, pitchers and a table 
 constitute the equipment of this room. A glass irrigator and a 
 number of fountain syringes furnish the facilities for irrigation. 
 A field operating case, a Paquelin cautery, a full set of dental 
 forceps, a complete set of urethral instruments, a case of eye 
 and ear instruments and aspirator have furnished all the instru- 
 ments required. The instruments are sterilized by boiling, 
 the dressings by dry heat. 
 
 Hand disinfection consists in scrubbing for at least five min- 
 utes in hot water and potash soap, washing in absolute alcohol 
 followed by prolonged immersion in a 1-1000 solution of bichlo- 
 rid. Just before the operation is commenced the hands are 
 washed once more in alcohol. The field of operation is disin- 
 fected in the same manner as the hands. Section 5 answers the 
 purpose of a pantry and kitchen for special diet. From here 
 the distribution of food takes place as it is received from the 
 main kitchen of the hospital. Between the supply tent and 
 the pantry is an open passage-way four feet wide, through 
 which the patients and nurses enter and leave the hospital. 
 The four tents remaining are used for wards, having a capacity 
 of 32 beds. This hospital in the course of a few days was filled, 
 when ward A, adjacent, occupied by medical cases, was evacu- 
 ated to make room for surgical cases. The present arrange- 
 ments affords room for seventy-five surgical patients. At the 
 present time, September 10, every bed is occupied. The six 
 Sisters of Charity in charge are assisted by three orderlies from 
 the Hospital corps. Patients are prepared for operations with 
 proper antiseptic precautions, and no pains are spared to give 
 them the benefit of modern surgical methods in every detail, 
 during their stay in the hospital. The nursing and care of the 
 sick are faultless, and the diet is not only ample in quantity 
 and quality, but often luxurious, far exceeding what is served 
 on the table of the officers mess tent. The patients much re-
 
 189 
 
 with cotton saturated with carbolic acid, but in the majority 
 of cases the patients returned and insisted on having the pain- 
 ful tooth extracted. Tooth extraction was a conspicuous and 
 grateful part of the surgery of Camp Wikotf. Hardly a day 
 passed without two or three such operations. A very complete 
 set of tooth forceps furnished by the government did good ser- 
 vice in relieving the victims of toothache of their agonizing suf- 
 fering. Much has been said in favor of attaching a dentist to 
 each regiment to look after the teeth of the men, and the ob- 
 servations made in Camp Wykoff tend to support the propriety 
 of such a much-needed addition to the medical service. It is 
 interesting to know that among these patients there was not a 
 single officer, undoubtedly because the officers were more par- 
 ticular in the care of their teeth than the privates, 
 
 HERNIA. 
 
 The number of hernias that presented themselves in Camp 
 Wikoff astonished us all. In every case the statements of the 
 patients were to the effect that the hernia appeared since the 
 enlistment. It might be surmised that at least in some of the 
 cases this physical defect was overlooked during the examina- 
 tion. This might have been so in isolated instances, in the 
 case of volunteers, but such a view would not hold good in men 
 belonging to the regular army. I saw more^ cases of hernia in 
 men belonging to the latter, than the former branch of the 
 military service. Our army in Cuba was not subjected for any 
 length of time to hard marching or violent exertions of any 
 kind, consequently the causes which led to hernia must be 
 sought outside of such mechanical influences. Careful exam- 
 ination appeared to prove that in most, if not in all cases, the 
 hernia was of recent origin. I attribute the hernia-formation 
 principally to the relaxation of tissue, caused by disease and 
 its effects, aided undoubtedly by the prevalence of intestinal 
 affections which must have often resulted in increased abnor- 
 mal intra abdominal tension. The uncertainty of the duration 
 of the encampment induced me to advise against operative in- 
 terference, and in most cases the general condition of the pa- 
 tients was such as to constitute in itself a strong contraindica- 
 tion to the performance of a radical operation. The patients 
 were fitted with a truss and advised to have a radical operation
 
 190 
 
 performed after their general health was restored, after leav- 
 ing the service or obtaining a furlough. 
 
 VARICOCELE. 
 
 The frequency with which varicocele is met with in men from 
 18 to 1.5 years was shown in the examination of 9901 volunteers 
 in Camp Tanner, Illinois. As a member of the board of exam- 
 iners, I was very anxious to obtain accurate information regard- 
 ing this subject, and accurate notes were kept at the time. 
 We found varicocele, slight, 992 ; medium, 692 ; large, 295. Of 
 the slight cases 10 were double, 7 of the right side only ; of the 
 medium cases, 7 were double, and 4 of the right side only ; of 
 the large cases 4 were of the right side only. The percentage 
 of varicoceles to total number examined was 21.17, Only six 
 were regarded as physical disabilities, and those on account of 
 size and pain. At that time I wrote a paper calling attention 
 to the great frequency of varicocele in men of the age for mili- 
 tary service, and claimed that ordinary varicocele was no valid 
 objection to the enlistment of men for military duty. Of the 
 more than 15000 men who returned from Cuba and were 
 landed at Montauk, only five cases of variococele applied for 
 treatment at the surgical ward. In all of these cases the local 
 symptoms were such as to warrant an operation. The opera- 
 tion was performed by excising through a straight incision, 
 directly over the cord, the enlarged veins between double liga- 
 tures. The veins were carefully isolated by dissection from 
 the spermatic cord and the accompanying artery. After excis- 
 ion the two stumps were brought together by a single catgut 
 suture, and by tying over this a thread of one of the ligatures 
 left long from each side. The stumps were buried by several 
 fine catgut sutures with which the deep layers of the tissues 
 were united. The external wound was always closed with 
 horsehair sutures. Elongation of the scrotum sufficient in de- 
 gree to require attention was corrected by transverse suturing 
 of the external wound. The wound was sealed with collodium, a 
 few narrow strips of iodoform gauze, and a pledget of absorbent 
 cotton over which the usual dressing and bandage were applied. 
 
 Case 1. — John D. Deboer, aged 21, colored ; Troop B, First 
 Cavalry ; has had varicocele for the last eighteen months. En- 
 listed five weeks ago. Marked ectasia of the spermatic veins 
 on the left side with corresponding elongation of scrotum o©
 
 191 
 
 same side. He has had no pain, but much discomfort in hot 
 weather from relaxation and dragging sensation. Operation 
 under chloroform narcosis August 31. (Jeneral health not 
 much impaired. 
 
 Case v.— William Cantwell, age 31, Company B, Sixteenth 
 Infantry ; has been in the service fourteen years. Varicocele 
 appeared eighteen months ago. Since he entered the active 
 service the swelling has often been painful, especially during 
 forced marches and in hot weather. He is much concerned 
 about his condition, and submitted willingly to the operation, 
 which was performed under ether anesthesia September .3. 
 On exposing the varicose veins it was found that the tunica 
 vaginalis had remained patent from the external inguinal ring 
 to the testicle, but contained no tluid. The veins were isolated 
 with some difficulty from the cord and the spermatic artery. 
 After disposing of the vein stumps in the usual way the tunica 
 vaginalis was closed with fine catgut sutures over the cord. 
 The scrotum was shortened by transverse suturing of the 
 wound. 
 
 Case o.—Wm. Reed, age 23, colored : Troop H, Ninth Cavalry. 
 Made its appearance soon after his enlistment two months ago. 
 The varicocele is of large size and gives rise to much pain on 
 riding or walking any distance. Operation under chloroform 
 narcosis September 3. 
 
 Case 4. — Robert Duseman, age 21, Second Volunteer Engin- 
 eers. Entered the service two months ago. Six weeks ago, 
 during drill, he bruised the left side of the scrotum, and 
 attributes the varicocele to this cause. He complains of a 
 dragging sensation in the testicle on the left side, the seat of 
 the varicocele of medium size. Usual operation under ether, 
 September 11. 
 
 In all of these cases the general health of the patients was 
 not much impaired, and the wounds healed rapidly by primary 
 intention. 
 
 HYDROCELE, 
 
 Hydrocele from puberty to the age of 45 occurs much less 
 frequently than varicocele. Of the 9901 cases examined in 
 Camp Tanner, we found only 49 cases of hydrocele of the 
 tunica vaginalis and 18 of the cord. Only one case of hydrocele 
 of the tunica vaginalis came for treatment to the surgical ward 
 of Camp Wikoflf. 
 
 Case J.— John Craigie, Company E, First Artillery, a young 
 soldier whose health had become greatly undermined by malaria, 
 was sent from the medical to the surgical ward, for a painful 
 affection of the left testicle of a few days' duration. Patient 
 very anemic and emaciated. A few days ago, on recovering 
 from his illness for which he had been sent to the hospital, the
 
 192 
 
 left testicle became painful and tender, accompanied by a 
 gradually increasing swelling. He came under surgical treat- 
 ment August 27. Careful examination revealed an acute hy- 
 drocele of the tunica vaginalis on the left side, without any 
 palpable visceral lesions of the testicle or epidydimis. The 
 fluid, straw colored, was evacuated by tapping with a small 
 trocar. One dram of equal parts of alcohol and carbolic acid 
 was injected. The reaction was moderate and the patient left 
 a few days later, the swelling gradually diminishing in size. 
 
 BONES AND JOtN'TS. 
 
 Only a few cases of injury and disease of bones and joints 
 came under observation in the surgical department of the 
 general hospital, but these isolated cases present features of 
 interest sufficient to justify mention in connection with the 
 subject of this communication. 
 
 Case 6. — Gunshot fracture of femur. S. M. Wetmore, 
 age 25, trumpeter, Troop D, First Volunteer Cavalry, was 
 shot through the right thigh at the junction of the lower with 
 the middle third, the bullet passing in the antero posterior 
 direction, the wound of exit being on a higher level than the 
 wound of entrance. The wounds were dressed with idoform 
 and healed by primary intention. Just before he was trans- 
 ferred from the hospital at Siboney to the Relief he became 
 very much debilitated and manifested other and more charac- 
 teristic symptoms of iodoform intoxication. A plaster cast 
 was applied, and he was sent to the fever camp as a case of 
 yellow fever— a diagnosis which was never confirmed by the 
 physicians in charge of the hospital. He suffered from mala- 
 ria, and his present condition indicates to what extent the 
 malarial intoxication has advanced. He is extremely anemic, 
 and emaciated to a skeleton. The spleen is much enlarged^ 
 The fractured limb is shortened two inches and a half ; marked 
 overlapping of fragments ; union fibrous. Plaster of Paris 
 bandage reapplied. Tonic and stimulating treatment. 
 
 Ca^-e 7. — R. Whitington, aged 25, First Volunteer Cavalry, 
 on August 11 was riding bareback, when his horse made a 
 quick turn and in tumbling over an embankment the horse 
 fell upon his left leg, producing an oblique fracture of the 
 tibia about two inches above the base of the malleolus, and of 
 the fibula about four inches higher. For some days the limb 
 was placed in a fracture box, but it was found impossible to 
 immobilize the fragments properly. During this time the 
 patient suffered from pain and loss of sleep. August 27 he 
 was placed under the influence of chloroform, the fragments 
 were properly adjusted and the limb immobilized in a plaster 
 of Paris splint extending from the base of the toes to the 
 knee. Since that time he has been free from pain and has 
 slept without the use of anodynes.
 
 193 
 
 Case 8.— Maj.Cien. S. B. M. Young injured his ankylosed 
 elbow- joint, September 2, and received first aid at the surgi- 
 cal ward the next morning. During the War of the Rebellion 
 he received two gunshot wounds of the right arm. One shat- 
 tered the lower third of the humerus, the other perforated the 
 elbow joint. After a prolonged siege of suppuration he finally 
 recovered with ankylosis of the elbow-joint, in flexion at an 
 angle of about 110 degrees, and in a position of marked pro- 
 nation. September 1 he stumbled and fell, striking upon the 
 hand and elbow. He complains of severe pain in and about 
 the joint. The elbow-joint is swollen and very painful on 
 pressure and manipulation. Ecchymosis over both condyles. 
 There is some motion but no crepitation, indicating the exist- 
 ence of ruptured intra and periarticular adhesions. The patient 
 states that this is the fourth time since the ankylosis occurred 
 that it has been broken by injury of some sort. The limb was 
 padded with a thick layer of cotton from the base of the 
 fingers to the shoulder-joint, over which a light plaster of Paris 
 bandage was applied. The patient was placed in charge of 
 Major Nancrede, his attending physician, who a few days later 
 substituted for the plaster dressing an angular wire splint. 
 In less than a week he reported for duty at Camp Meade. 
 
 Case 9.— Thomas A. McDonald, age 24, Second Infantry. 
 While in action before Santiago the stock of his gun was 
 struck by the fragment of a shell, the arm was violently 
 twisted and the radius fractured. The forearm now presents 
 the characteristic "silver fork" deformity of an imperfectly 
 reduced Colles' fracture. There is swelling of the wrist, ina- 
 ability to use fingers, and pain on attempted pronation and 
 supination. Massage, manipulation and electricity advised. 
 
 Case 10. — Preston Guthrie, aged 31, Company F, Twentieth 
 Infantry, re-enlisted three and one-half months ago. States 
 that he cut his left arm two years ago. The wound was slow in 
 healing and left a scar adherent to the underlying ulna. 
 Nothing in the clinical history would indicate that the bone 
 was affected at that time. A contusion of same region occured 
 while loading a transport in Cuba, which was followed by a 
 complexus of symptoms pointing to the existence of a central 
 osteomyelitis. An abscess which formed later ruptured 
 through the old scar, an occurrence which was followed by 
 prompt relief. A moderate discharge has continued since. 
 Examination made August 26 disclosed two fistulous openings 
 over the posterior surface and center of the ulna, leading into 
 a central osteomyelitic cavity. Ulna at the seat of disease con- 
 siderably enlarged. Through a straight incision the fistulous 
 openings in the involucrum were exposed and the cavity freely 
 laid open by chiselling. A sequestrum lying loosely in the 
 bone cavity was removed and the granulations lining the 
 cavity scraped out by a vigorous use of the sharp spoon. 
 After thorough disinfection of the cavity the periosteum was
 
 194 
 
 sutured carefully, over which the wound was closed in the 
 usual manner, leaving only a small space for gauze drainage. 
 The wound remained aseptic and healed rapidly by primary 
 intention. 
 
 Case 11. — George Oppel, aged 21, enlisted in the Second 
 Infantry one month ago. He was admitted to the surgical 
 ward with a fluctuating swelling over the inner aspect and a 
 little above the left knee joint. Ten years ago he was struck 
 in this region with a brick and suffered from an acute bursitis. 
 The bursa has been enlarged ever since, but has not been pain- 
 ful until recently. There is no tubercular history in his 
 family. The swelling is flat and in circumference is as large 
 as a medium sized orange. On palpation no fluctuations can 
 be felt, the sensation imparted being of a semi-elastic nature. 
 The swelling is somewhat tender to touch and is painful when 
 he attempts to walk. August 31, the patient being under the 
 influence of a general anesthetic, the bursa was punctured 
 with a small trocar in three different directions through the 
 same opening in the skin and was thoroughly injected with a 5 
 per cent, solution of carbolic acid. Pressure was applied over 
 the bursa and the limb immobilized upon a posterior splint. 
 In the course of a week the swelling had almost entirely disap- 
 peared and the patient returned to his command for duty. 
 
 REMOVAL OF ^OREIG^' BODIES. 
 
 Two interesting cases of removal of a foreign body lodged in 
 the tissues presented themselves for operative treatment. 
 
 Case i^.— Benjamin Nelson, age 23, Company F, Third 
 Infantry. Came under observation and treatment September 
 6. Three years ago he fell backward against a window and 
 sustained several cuts of the scalp by fragments of broken 
 glass. The wounds healed rapidly without suppuration. 
 After his recovery he was aware of the presence of a piece of 
 glass which had remained encysted in the pericranial tissues 
 ever since, without giving rise to any inconvenience until 
 recently. A few weeks ago the scalp over the embedded 
 foreign body was bruised, and since that time it has caused 
 irritation and pain. The piece of glass could be readily 
 outlined by palpation. On the day mentioned, without anes- 
 thesia, a straight incision parallel to the long axis of the 
 foreign body was made. Xo suppuration within or outside of 
 the capsule. The piece of glass was found surrounded by a 
 firm capsule of fibrous tisue and measured two centimeters in 
 length and two tenths of a centimeter square at the end. The 
 broken surface was irregular in outline. The wound was 
 sutured with horsehair and union was found complete at the 
 time of his discharge, September 11. 
 
 Case 75.— Sergt. Oscar F. Winter, age 52, Company F, 
 Ninth Infantry, seventeen years in service. On July 2, while
 
 195 
 
 in the act of risiDg just behind the trenches, he was wounded 
 by the bursting of a shell near him. He was confident at the 
 time, from the sensation experienced, that he had received a 
 blow from a large fragment of shell on the crest of the left 
 ilium. He says a large ecchymosis formed at once and he 
 could see no evidence of penetration. He was assured by a 
 medical officer that he had suffered a contusion only, that 
 there had been no penetration. He says, however, on being 
 questioned, that a small rent existed in the clothing over the 
 supposed contusion, but is very positive that he must have 
 been struck by the convex side of a large piece of the burst- 
 ing shell. An abscess developed soon after the injury was 
 received and has discharged at a point near the anterior 
 superior spine of the ilium and the resulting sinus has 
 remained since. The patient has done duty without missing 
 a day since he received the wound, until reaching Camp 
 Wikoff. The existence of an abscess cavity and the history of 
 an opening in the clothing led to exploration for a foreign body. 
 The existing opening was slightly enlarged, under chloroform 
 anesthesia, and exploration of the cavity with the finger located 
 a shrapnell ball at about 3^^ inches downward from the open- 
 ing of the sinus. Counter-opening was made at this point and 
 the ball extracted. Tubular drainage, irrigation with peroxid 
 of hydrogen and 21.3 percent, carbolic solutions and moist car- 
 bolic dressing. Speedy healing of the wounds. 
 
 ABSCESSES. 
 
 We would naturally take it for granted that among the re- 
 turning soldiers from Cuba, owing to their greatly debilitated 
 condition, suppurative affections in different forms, and affec- 
 ting various tissues and organs, would furnish a rich and inter- 
 esting material for the surgical ward of the General Hospital. 
 The sources of infection were many, and the resistance of the 
 tissues to pathogenic microbes in most of the men who returned 
 was at low ebb. A good share of the surgical work consisted 
 in incising and draining abscesses, some of them of enormous 
 size. In the treatment of all of these cases, owing to the pro- 
 nounced anemia and great weakness, special precautions were 
 resorted to to prevent the loss of even as much as a teaspoon- 
 ful of blood in performing the operations. In abscesses in the 
 anal region the Paquelin cautery was usually used in prefer- 
 ence to the knife, in laying open the abscess cavity. In other 
 regions the abscess was opened by making an incision through 
 the skin and underlying fascia large enough to admit the tip 
 of the little finger, when the remaining tissues were tunneled
 
 19H 
 
 with a pair of curved, rather sharp pointed forceps, and the 
 tubular wound enlarged to the requisite extent by expanding 
 the blades of the forceps during the withdrawal of the instru- 
 ment. In most instances a counter-opening was made by 
 plunging the forceps into the abscess cavity, inserted into the 
 first opening, through the tissues from within outward until 
 the tip of the instrument made a cone of the skin which was 
 then incised, not over, but on the side of the instrument, suffi- 
 ciently to permit the easy escape of the instrument when the 
 canal was enlarged by expanding the blades, after which the 
 end of the drain was grasped transversly and by withdrawing 
 the instrument through drainage was established. The drains 
 used were freely fenestrated, the openings being numerous, but 
 never larger than to correspond in size to one-fourth of the cir- 
 cumference of the tube. The opening and counter-opening 
 were made in places where drainage and irrigation would prove 
 most efficient. In several cases in which the counter-opening 
 could not be made by the use of the forceps, the abscess was 
 opened in the usual way, and after evacuation of its contents 
 peroxid of hydrogen was injected until the cavity was well dis- 
 tended, when the second opening was made in the same way 
 as the first. After opening and draining the abscess, irriga- 
 tion with a 21., per cent, solution of carbolic acid, followed by 
 peroxid of hydrogen, and finally again with the carbolized 
 solution. In all abscess cases the dressing consisted of a com- 
 press of gauze wrung out of a 2i., per cent, solution of carbolic 
 acid, over which oiled silk was applied with absorbent cotton 
 around its edges, to act as a filter, and the whole confined in 
 place by a well-applied bandage. In the more serious cases 
 the dressing was removed, the abscess cavity flushed, and a 
 new compress applied twice daily. Whenever it was deemed 
 necessary, the affected limb was immobilized. This treatment 
 proved uniformly successful in preventing profuse suppuration 
 and was always followed by rapid improvement in the general 
 condition of the patient. 
 
 In the medical treatment of these cases quinin was used 
 freely, as well as alcoholic stimulants. Iron preparations and 
 a nutritious diet proved most effectual in improving the con- 
 dition of the impoverished blood and in restoring normal 
 nutrition.
 
 197 
 
 CONNECTIVE TISSUE ABSCESSES. 
 
 The connective tissue was the tissue most frequently 
 the primary or secondary seat of infection. The phlegmo- 
 nous inflammation which led to connective tissue abscesses 
 occurred almost exclusively in men whose general health 
 was shattered. As a rule the patients suffering from 
 this affection presented an anemic, almost waxy appear- 
 ance and were greatly emaciated. The deterioration of 
 health was due to antecedent causes, malaria, yellow fever, 
 dysentery, diarrhea, exposure and improper or insufficient food. 
 The phlegmonous inflammation in most instances pursued a 
 rather insidious process and was clinically not characterized 
 by the complexus of symptoms which ordinarily accompany 
 the inflammation preceding an acute abscess. The pain was 
 often slight, tenderness moderate, and the skin seldom showed 
 the inflammatory blush which so constantly is seen during the 
 development of an acute subcutuneous abscess. A tendency 
 to burrowing was manifest in most cases. The induration of 
 the abscess wall, so common in acute abscess, was lacking in 
 most of our cases. There seemed to be a total absence of a 
 tendency to the limitation of the area of abscess formation. 
 The cases that came under our observation resembled in their 
 symptomatology, pathology and clinical course very closely 
 abscess formation as seen during the latter course of any pro- 
 longed acute infective disease, or during convalescence from 
 such. In opening these abscesses I was always careful to 
 make the openings some distance from the center of the ab- 
 scess cavity, in preference at its margins, and the same loca- 
 tion was selected in case a counter-opening was made. By fol- 
 lowing this method of incising and draining the abscess the 
 skin over the center of the abscess, damaged to the greatest 
 extent by the underlying phlegmonous process was avoided, 
 and complete evacuation and free drainage secured. The 
 same careful preparations were made for the operation as in 
 cases requiring surgical intervention for aseptic conditions, 
 with a view of guarding against secondary infection. 
 
 Under this treatment, the general and local conditions of the 
 patients improved very rapidly. In abscesses of very large di- 
 mensions from two to four incisions were made and as many 
 points of drainage established. As suppuration ceased and the
 
 198 
 
 abscess cavity commenced to shrink, the drains were shortened 
 from time to time to enable the process of healing to proceed 
 without hindrance from mechanical causes. 
 
 Case ii.— Robert Bloedel, age 25, Third Infantry Band, 
 enlisted fifteen months ago. Had chills and fever in Cuba for 
 about a month, followed by dysentery. Is still suffering from 
 the diarrhea which followed the dysentery and the patient is 
 much emaciated and very anemic. Before going to Cuba he 
 noticed a small pimple on his neck. Just before leaving San- 
 tiago, swelling of the neck began in the connective tissue, at 
 the site of the pimple, and has progressed steadily. Examina- 
 tion of the cavity of the mouth does not reveal a source of 
 infection. There can be but little doubt that the minute 
 furuncle, which proved harmless as long as the patient re- 
 mained in good health, became the focus of infection of the 
 underlying connective tissue which was made more susceptible 
 to infection by the effects of disease. A large fluctuating 
 swelling in the neck, just below the angle of the jaw, marks 
 the location and extent of the connective tissue abscess. Pain 
 has never been severe. Edema, but no redness of skin. All 
 of the local symptoms indicate a slow, subacute inflammation 
 of the deep connective tissue. The patient was etherized and 
 through drainage was established, the drainage tube being 
 placed in an oblique direction from the floor of the abscess to 
 a point opposite and behind. A large quantity of creamy pus 
 was evacuated and the cavity thoroughly washed out with car- 
 bolized solution and peroxid of hydrogen. A large moist anti- 
 septic compress covered with oiled silk was applied and held in 
 place by a bandage. Very little suppuration after operation, 
 speedy healing of the abscess cavity accompanied by a marked 
 improvement in the appearance of the patient. 
 
 Case 15. — P. P. Sprague, age 29, Seventh Infantry, Company 
 I, entered the regular service seven months ago. He landed in 
 Cuba July 10. Contracted malaria, lost flesh and strength, 
 but continued to perform his usual duties. About three weeks 
 ago he experienced a sense of soreness in the calf of his right 
 leg in the region of a scar from an injury received during child- 
 hood. The soreness increased slowly in severity, and for a 
 number of days he has suffered from a throbbing pain suSi- 
 ciently severe to prevent sleep. The patient is much enfeebled 
 from the effects of the previous disease, aggravated by the 
 recent attack of phlegmonous inflammation. No local source 
 of infection could be found on the most careful search. It is 
 very probable that the scar tissue furnished the locus minoris 
 resistentia' which determined localization of pus microbes 
 floating in the general circulation sufficient in number and 
 virulence to give rise to a subacute phlegmonous process. The 
 whole leg is swollen from the ankle to the knee, tense and 
 edematous, a circumscribed inflammatory blush over the
 
 199 
 
 lower portion of the gastrocaemius muscle. Fluctuation 
 deep seated, somewhat obscure and diffuse. 
 
 The diagnosis made at the time, was deep-seated phlegmonous 
 abscess, involving the connective tissues between the deep- 
 seated muscles of the leg. August 29, under ether unesthesia 
 the abscess was opened by an incision over the posterior aspect 
 of the leg in the median line, at a point where the muscle ter- 
 minates in tendon ; a large quantity of thin bloody pus escaped. 
 As it was found impossible to make a counter opening in the 
 upper recess of the abscess cavity by the use of forceps, per- 
 oxid of hydrogen was injected through the opening to distend 
 the abscess cavity sufficiently to facilitate incision from with- 
 out. The second incision was made in the usual way over the 
 upper third of the fibula and a counter opening established on 
 the tibial side, effecting in this manner efficient through drain- 
 age below and from side to side. Digital exploration through 
 the three openings located the abscess correctly anatomically. 
 In exploring the interior of the abscess the tibia and fibula 
 could be distinctly felt. The abscess cavity was disinfected in 
 the usual way and after applying the wet antiseptic compress, 
 the patient was returned to his cot and the limb placed in an 
 elevated position. The final recovery of the patient was 
 retarded by several severe attacks of malaria during one of 
 which the mercury reached 106 P. The chills and fever yielded 
 to large doses of quinin. 
 
 Case 16. — Henry H. Mix, age 21, Third Infantry, Company 
 F, enlisted three months ago. On June 6 last, while on parade 
 had an attack of heat exhaustion followed by diarrhea for sev- 
 eral days. At Tampa, June 8, two days later, he was put on 
 sick list for two furuncles behind the left knee. These healed 
 promply. July 10 on reaching Cuba, he suffered from furun- 
 cles on buttocks, also malarial fever and diarrhea. At this 
 time an abscess formed in the right popliteal space, which pur- 
 sued an insidious, chronic course. At the time the patient 
 reached Montauk, he was very anemic and almost reduced to a 
 skeleton, and the abscess had opened at different points. The 
 subcutaneous tissue was extensively undermined, and through 
 the openings the fungous lining of the cavity could be distinctly- 
 seen. Ths abscess cavity discharged profusely and extended 
 from the middle of the thigh to the upper portion of the calf 
 of the leg. August 29, the sinuses were enlarged, a number of 
 counter-openings made and free tubular drainage established. 
 The abscess cavity was thoroughly disinfected and a large moist 
 antiseptic compress applied. As there was some tendency to 
 contraction of the knee joint, the limb was placed in a straight 
 position and immobilized by the use of a well padded anterior 
 wire splint so applied that the abscess could be exposed and 
 treated without disturbing the limb. Malarial fever, which 
 developed on the second day after the operation, retarded the 
 healing process, and for a few days threatened the life of the
 
 200 
 
 patient. After the fever was under control by the administra- 
 tion of large doses of quinin, a satisfactory process of repair set 
 in, which soon effected healing of the abscess and restoration 
 of tisssues lost by the extensive destructive process. 
 
 Case 17. — Joseph McGuire, Ninth Massachusetts Volunteers, 
 Company C, had some febrile attack in Cuba, the nature of 
 which is not known. He was admitted to the surgical depart- 
 ment of the General Hospital, September 7, suffering from a 
 superficial connective tissue abscess over left triceps about two 
 inches below the shoulder joint. He has at the same time an 
 alveolar abscess which is discharging through a carious tooth. 
 The infection in this case evidently took place from the blood, as 
 there are no traces of the existence of a local infection atrium 
 to which the phlegmonous process could be attributed. 
 Through drainage and moist carbolized dressing. 
 
 Case i<S.— James F. Dite, age 21, First Illinois Infantry, 
 Company H, received a severe contusion of anterior surface of 
 right thigh from falling log near Santiago. He was treated by 
 a Cuban doctor for rheumatism, and then sent to the Division 
 Hospital where a swelling which had formed at the site of in- 
 jury was incised, but no pus escaped. The swelling remained, 
 and gradually increased in size. When admitted to the surgi- 
 cal ward his general health was precarious. Marked anemia 
 and emaciation. The anterior aspect of the affected thigh 
 from near the knee to the inguinal fold was the seat of a fluc- 
 tuating swelling. The center of the swelling was occupied by 
 a small granulating area marking the place where the incision 
 was made. The abscess was underneath the quadriceps femo- 
 ris muscle, and evidently the incision had not been made deep 
 enough to reach the pus. As the skin was not broken by the 
 injury, infection was determined by microbes floating in the 
 circulation and their localization and growth in the contused 
 deep connective tissue. Under anesthesia the abscess was 
 opened at the most dependent point and a counter opening 
 made on the opposite side with the aid of distension of the cav- 
 ity by peroxid of hydrogen injection. Through drainage and 
 thorough disinfection of the interior of the abscess cavity 
 completed the operation. Prompt relief and improvement fol- 
 lowed the operative intervention. 
 
 Case 19. — Dennis Riley, age 21, First District of Columbia 
 Infantry, Company E, after passing through a rather severe 
 attack of typhoid fever was admitted to the surgical ward 
 suffering from multiple abscesses, varying in size from that of 
 a pea to a walnut, involving the face and the neck. The largest 
 abscess was above the left eyelid. All of these abscesses had 
 their primary starting point in the subcutaneous connective 
 tissue. Treatment by incision and drainage. Convalescence 
 progressed without any further interruption. The location of 
 these abscesses on the exposed part of the body would indicate 
 that the infection had a local source, probably slight abrasions
 
 201 
 
 inflicted by the patient himself during the course of the 
 fever. 
 
 Case m— Edwin Stockwell, aged 28, Second Infantry, Com- 
 pany I, was well until the day before leaving Cuba, August 10 ; 
 on that day felt very weak and sick. On boarding transport had 
 to lie down, vomited, then felt better for a time, then weak 
 and sick and nausea and vomiting again. He was feverish all 
 the time and slightly jaundiced, but continued on duty with 
 the sick. Some doubt remains as to whether this attack was a 
 mild form of yellow fever or malaria. Since his arrival here 
 he has done duty as a nurse. Five or six days ago a furuncle 
 developed on the middle of the posterior aspect of the right 
 thigh, below the gluteal fold. This opened and discharged 
 slightly, but the swelling has continued to increase in size. 
 On examination, a crater-like defect in the skin marks the site 
 of the primary focus of infection. From this point a red zone 
 of inflammation extends in all directions equally to a distance 
 of two inches. The phlegmonous progressive connective tissue 
 inflammation had its origin from the furuncle. Such a compli- 
 cation would probably not have occurred if the patient's gen- 
 eral health and power of resistance tD general infection had 
 not been impaired by the antecedent attack of fever. The 
 skin around the furuncle was extensively undermined. The 
 cavity was freely laid open by a vertical incision and the 
 necrosed tissue and infectived granulations scraped out with a 
 sharp spoon, and after thorough disinfection was lightly packed 
 with a strip of iodoform gauze, and a large moist compress 
 applied. 
 
 Case 2i.— John A. Johnson, aged 24, Third Infantry, Com- 
 pany H, enlisted eight months ago. Phlegmonous inflamma- 
 tion of middle finger of left hand. Three weeks ago had an 
 attack of malarial fever in Cuba, which was complicated by 
 diarrhea. He was treated four days in one of the hospitals, 
 when he returned to his command for duty. The fever left 
 him in a weakened condition. Ten days ago on leaving San- 
 tiago, he noticed a soreness over the dorsal side of the middle 
 finger of the left hand directly over the middle joint. Cause 
 of infection not known. An acute superficial abscess formed, 
 attended by great pain until it ruptured, A considerable por- 
 tion of the overlying skin sloughed, leaving a ragged surface 
 with edematous red margins. On August 27, the patient was 
 placed under an anesthetic, when a thorough examination 
 showed that the infective process did not extend to the joint 
 or the extensor tendon. With sharp spoon, scissors and for- 
 ceps the infected tissues were removed, the resulting surface 
 disinfected and packed with iodoform gauze and the finger 
 immobilized on a palmar splint. The wound healed promptly 
 and the prospects are that the finger will regain its normal 
 functions. 
 
 Case 2^.— Richter, aged 23, First Illinois Infantry, Company
 
 202 
 
 D, contracted typhoid fever in Cuba five weeks ago. During 
 the fever a copious herpetic eruption made its appearance on 
 the upper lip and about the nasal orifices. The fever left him 
 in a greatly emaciated condition. A swelling formed in the 
 left cheek during the last three or four days and increased 
 rapidly in size. Pain and tenderness not well marked. The 
 patient sought medical treatment at the surgical ward Sun- 
 day, September 11. The left cheek was the seat of a large 
 fluctuating swelling. Diagnosis made at the time — abscess of 
 cheek. The abscess was incised from the mouth and a large 
 quantity of very offensive pus was evacuated. The patient was 
 directed to resort to frequent rinsings of the mouth with a 
 saturated solution of boracic acid and was given a furlough to 
 enable him to return as quickly as possible to his home. Infec- 
 tion in this case undoubtedly occurred through the skin defects 
 left by the herpetic eruption. 
 
 GLANDULAR ABSCESS. 
 
 In the discussion of phlegmonous abscess, infection was 
 traced either to a portio invasionis or local conditions, which 
 determined localization from local causes, in cases in which it 
 was reasonable to suppose that the essential cause of infection 
 existed in the general circulation. Without calling attention to 
 the fact, it is reasonable to suppose that in the first class of 
 patients the essential microbic cause reached the tissues 
 through the connective tissue spaces, that is, that a direct 
 anatomic connection existed between the primary essential 
 infection-atrium and the seat of secondary phlegmonous man- 
 ifestations. In the consideration of glandular infection it is 
 essential to connect the infection-atrium anatomically and 
 physiologically, with the secondary glandular suppurative con- 
 ditions. We are able from the clinical history and the patho- 
 logic conditicns presented in most of the cases to establish such 
 a direct connection between the primary source of infection 
 and the secondary glandular manifestations. I have reason to 
 believe that in most of these cases the essential cause of infec- 
 tion was the streptococcus pyogenes, because it is well known 
 that this pyogenic agent usually follows either the connective 
 tissue spaces or the lymphatic channels in giving rise to a dis- 
 tant infective suppurative process. 
 
 Case ^5.— Patrick Collins, age 28, Company C, Eighth In- 
 fantry, enlisted one year ago. About the middle of July, while 
 in Cuba, had a malarial chill followed by fever. Has had fever 
 and diarrhea, and has been on the sick list ever since. While 
 returning on transport from Cuba he experienced soreness in
 
 203 
 
 the region of the left parotid ^iand ; this symptom has been 
 followed by the usual clinical evidences indicative of the exist- 
 ence of an abscess in that locality. On August 29 he presented 
 himself at the surgical ward, and at that time it was not diffi- 
 cult to diagnosticate the existence of a large abscess in the 
 region of the parotid gland. At that time, under ether anes- 
 thesia, it was easy to recognize a diffuse abscess in the parotid 
 region. It was more difficult to decide whether this abscess 
 was of malarial or typhoid origin. Two incisions were made, 
 an extensive purulent product was evacuated, and efficient 
 through tubular drainage was established. In this instance the 
 whole gland seemed to be surrounded by the suppurative prod- 
 ucts and the through drain was passed underneath the glaod 
 that was the primary seat of the secondary field of infection 
 The patient improved rapidly after the operation. 
 
 Case 24.— John Williams, age 25, Ninth Cavalry, Troop 
 F., colored, enlisted four months ago. Following a strain in 
 hfting and exposure in rough weather, while on duty in the 
 Camp at Tampa, Fia., he became aware of the enlargement of 
 the inguinal glands on the right side. The glands were very 
 painful when he was on active duty. There are no evidences 
 of general infection of any kind and the most scrutinizing ex- 
 amination failed to detect any tangible source of infection in 
 the distal side of the lymphatic circulation. On palpating 
 three or four inguical glands were found distinctly enlarged 
 with plain evidences of beginning perilymphadenitis, but no 
 distinct abscess formation. On August 22 chloroform was ad- 
 ministered and a curved incision made, with the convexity di- 
 rected upward in such a manner as to expose the infected 
 glands freely. The glands, three in number, honeycombed 
 with pus were enucleated. A place for drainage was estab- 
 lished, the wound thoroughly disinfected with iodoform, when 
 the external incision was closed with sutures of horsehair. 
 The wound healed promptly by primary intention. 
 
 Case 1^5.— George A. Roberts, Sixteenth Infantry, Company 
 H., colored, was ill eight days with malaria in Cuba, was af- 
 ter that on duty until his arrival in Montauk, when he again 
 had malarial fever. During this attack a furuncle devel- 
 oped on calf of the right leg and opened spontaneously. From 
 this point a lymphadenitis started, which extends to the deep 
 ymphatic glands in Scarpa's triangle and terminated in a 
 lymphadenitis and perilymphadenitis. The lymphatic glands 
 in this region, being in a state of inflammation, 
 resulted in the formation of a tender and painful 
 swelling four inches in length and about three inches 
 in width. No fluctuation and no inflammatory discoloration 
 of the skin. The patient was confined to his cot with the af- 
 fected limb in an elevated position. A large compress satur- 
 ated with 2,^ per cent, hot solutionof carbolic acid. Applied 
 Cred(^'s silver ointment to be rubbed into the skin over the swell-
 
 204 
 
 ing once a day. Under this treatment the inflammatory process 
 subsided and the prospects are, that the swelling will disap- 
 pear without pus formation. 
 
 Case ^6'.— Frederick Warner, age 37, colored, Ninth Cav- 
 alry, Troop L, contracted chancroid about six weeks ago, while 
 on duty at Tampa. The lymphatic glands in the inguinal 
 region became infected and the suppurative lymphadenitis 
 terminated in the formation of three glandular abscesses, 
 which opened spontaneously. At the time the patient was 
 operated upon, September 1, three fistulous openings were 
 found, and the connective tissue was extensively infiltrated. 
 Xo scars or other evidences of the primary lesion can be de- 
 tected. It was plainly a case of suppurative lymphadenitis, 
 caused by invasion with pus microbes from the external geni- 
 tals. Under chloroform anesthesia the sinuses were enlarged, 
 and the remaining broken down gland tissue and infected gran- 
 ulations removed by a vigorous use of the sharp spoon. The 
 resulting wound was thoroughly disinfected, iodoformized and 
 packed with iodoform gauze and covered with a large moist 
 antiseptic compress of gauze, over which was placed an over- 
 lapping piece of oiled silk, and the whole dressing held in 
 place by a bandage embracing the pelvis and upper part of 
 thigh. The patient left the hospital a week after the opera- 
 tion, at which time the abscess cavities were much diminished 
 in size and lined by vigorous healthy granulations. 
 
 Case 27. — John H. Butler, age 21, Ninth Cavalry, Troop L, 
 colored. Tubercular lymphadenitis of submaxillary gland. 
 Family history negative. Mother and father living ; two chil- 
 dren died in infancy : rest living and in good health. About 
 two months ago began to have pain in right side of neck and 
 submaxillary region, and then noticed a small, hard swelling 
 below the angle of the jaw. Additional glands in the same 
 region became involved. At the time he entered the surgical 
 ward a large glandular mass, composed of several enlarged 
 lymphatic glands, was found in the right submaxillary region. 
 On palpation the swelling was painful, but no distinct fluctua- 
 tion could be felt. Inspection of the mouth failed to reveal 
 anything which could be regarded as an infection-atrium. The 
 tubercular nature of the glandular affection was recognized, 
 and a radical operation for the removal of the glands was per- 
 formed September 6, the patient being under the influence of 
 chloroform. The glandular mass was freely exposed by a 
 semilunar incision with the convexity downward and by reflec- 
 tion of the cutaneous flap in an upward direction. The whole 
 mass was dissected out in one piece, which included not only 
 the tubercular glands, but likewise the infiltrated connective 
 tissue surrounding them. The submaxillary gland was ex- 
 posed, and during the latter part of the operation it became 
 necessary to cut and ligate the facial artery. The gland tissue 
 throughout had undergone coagulation necrosis ; each gland
 
 205 
 
 contained several foci of caseation. The wound was iodo- 
 formized and sutured throughout with horse-hair, provision 
 for gauze drainage having been made by making a button hole 
 near the margin and center of the flap. Healing by primary 
 intention. 
 
 Case V8.— Schuyler C. Black, age 31, Ninth Cavalry, Troop 
 I, colored, enlisted four months ago. Chronic balanitis and 
 bilateral plastic lymphadenitis of inguinal glands. In June last 
 noticed enlargement of inguinal glands on both sides, follow- 
 ing a small sore on the glans penis near the corona. He was 
 treated for primary syphilis, and was given large doses of 
 potassic iodid. At no time was there any induration at the 
 base of the sore, which always presented the appearance of an 
 abrasion rather than an ulcer. At no time have there been any 
 indications of secondary syphilis. The lymphatic glands in 
 other regions of the body are normal. The patient states that 
 the sore has healed repeatedly, reappearing at varying inter- 
 vals in the same place. Examination of the penis reveals 
 slight phimosis, chronic balanitis which has resulted in great 
 thickening of the mucosa lining the prepuce. The sore, which 
 has been a source of great mental distress to the patient, ap- 
 pears in the form of a very superficial abrasion not larger than 
 a split pea with ill defined margins and no induration whatever 
 at its base. Recently the preputial margin became the seat 
 of a herpetic eruption. The lymphatic glands in both groins 
 are hard, not very tender to the touch and vary in size from 
 that of a pea to a hazelnut. September 13, typical circumci- 
 sion was performed under chloroform narcosis. It is expected 
 that the removal of the direct cause of the lymphadenitis will 
 be followed by a speedy reduction in the size of the glands. 
 The essential cause is to be attributed to the entrance of pus 
 microbes into the lymph channels from the local lesions of the 
 glans penis and prepuce which became arrested in the lym- 
 phatic filters, producing an inflammation which came to a 
 standstill short of suppuration. 
 
 Case i-P.— Robert V. Smith, age 21, Tenth Cavalry, Troop 
 E, colored, enlisted June 20. A month ago while in camp in 
 Florida, he noticed a number of small pimples on the scalp on 
 the right side. These small furuncles still exist, and a week 
 ago gave rise to a deep seated lymphadenitis affecting the 
 lymphatic glands in the superior posterior triangle on the cor- 
 responding side of the neck. When the patient came under 
 observation, September 13, a large and somewhat diffuse swell- 
 ing marked the location of the infected glands ; evidently the 
 connective tissue around and between the glands is secondarily 
 implicated in the inflammatory process. The swelling is hard 
 and tender on pressure. No signs of central softening. 
 Evening temperature 102 F., morning temperature 100 F. Di- 
 rections were given to clip the hair short, and to disinfect the 
 entire scalp. Crede's silver ointment to be rubbed into the
 
 206 
 
 skin over the swelling and to apply a hot, moist antiseptic com- 
 press. The patient is anemic, for which condition Gude's 
 pepto mangan was prescribed. There is some prospect that 
 the removal of the source of infection and the local applications 
 will succeed in arresting the process and in effecting resorption 
 of the inflammatory product. 
 
 This hope was not realized, as a few days later, September 23, 
 distinct fluctuation was felt and the abscess was incised and 
 drained, the patient being under the influence of chloroform. 
 Rapid improvement followed the operation. 
 
 ABSCESS FOLLOWING TYPHOID FEVER. 
 
 It is somewhat singular that among the hundreds of cases of 
 typhoid fever, that I had an opportunity to see and examine in 
 Porto Rico and in this great national camp, no cases of perfor- 
 ation have come to my notice. I kept myself in readiness to 
 perform laparotomy at a moment's notice, but my services were 
 never requested for this particular purpose. I have no doubt 
 but that some of the deaths from typhoid fever were due to this 
 cause, and that this fatal complication was either overlooked or 
 the general condition of the patient was so grave when it oc- 
 curred, that the attending physicians did not deem it advisable 
 to send for the surgeon. In this camp we had all the necessary 
 facilities for abdominal operations, and I was hopeful that I 
 should have an opportunity to give surgery a fair trial in such 
 cases, but in this I have been disappointed. The most import- 
 ant, and most frequent complications of our typhoid fever pa- 
 tients have been bedsores and abscesses. The careful and at- 
 tentive nursing our patients here have received, has done 
 much in reducing the mortality and suffering from decubitus. 
 Frequent washing with alcohol of the parts exposed to decu- 
 bitus and the use of rubber pillows, and in the worst cases, of 
 water or air beds, have contributed much in the prevention 
 and successful treatment of this complication. We have had 
 however, an excellent opportunity to study the etiology and 
 pathology of abscesses as a complication of typhoid fever. The 
 material was abundant and interesting. It is a source of 
 regret to me that we did not have at our disposal a well-equip- 
 ped bacteriologic laboratory to enable us to study in a more sat- 
 isfactory manner the contents of those abscesses. Acting As- 
 sistant-Surgeon Ewing brought his own microscopic outfit, in- 
 cluding the different stains, and did good work in the micro- 
 scopic examination of pus and other pathologic products, but
 
 207 
 
 we had no facilities for making cultures. He examined the 
 contents of three abscesses in as many patients, and found as 
 the essential bacteriologic cause the bacillus of typhoid in one 
 and the ordinary pus microbes in the remaining two cases. 
 
 The typhoid or so-called metastatic abscesses are caused 
 by the bacillus of typhoid fever or by pus microbes which find 
 their way into the circulation through some infection-atrium, 
 especially the intestinal ulcers, as the result of a mixed infec- 
 tion. [ have no doubt that in some cases the colon bacillus 
 finds its way into the general circulation and produces the 
 same results. The only case of bone and joint infection that 
 came under my observation, and that could be brought in con- 
 nection with the typhoid infection occurred in the case of a 
 young soldier recovering from a severe attack of typhoid fever. 
 
 Case 30. — William Pairweather, age 22, Company A, Twelfth 
 Infantry, about one week after the surrender of Santiago, 
 was attacked with fever which continued for three weeks. He 
 reached this camp with his regiment, emaciated to a skeleton, 
 and extremely anemic. A week ago, while moving about, he 
 was attacked rather suddenly with a severe pain in the right 
 sacroiliac synchondrosis and extending to the leg on the same 
 side. The pain in the leg subsided after a few days but in- 
 creased in severity at the point where it first commenced. The 
 pain is of a dull, aching, throbbing character. Slight swelling 
 over and in the line of the joint. Evening temperature one de- 
 gree above normal. No redness or edema of the skin. Septem- 
 ber 6, the joint was punctured with the largest needle of an 
 exploring syringe and a 5 per cent, solution of carbolic acid 
 was injected in different directions, so as to reach the infected 
 tissues as far as possible. No difficulty was met with in inject- 
 ing three drachms of the solution. The needle puncture 
 was sealed with collodium and a pledget of cotton. Marked 
 improvement followed the intra articular and parenchymatous 
 injection. The pain and tenderness had nearly disappeared on 
 the third day. Under tonics and stimulants the general con- 
 dition of the patient improved from day to day. There is no 
 reason to fear at this time that suppuration will take place. 
 
 This case represents oae of those rare complications of 
 typhoid fever in which a joint becomes the seat of secondary 
 infection during the latter stages of typhoid fever or during 
 convalescence, in which the inflammatory process often results 
 in great destruction of tissue without pus formation. Whether 
 or not the injection should be credited with having brought 
 about the speedy cessation of active symptoms can not be de-
 
 208 
 
 cided, either way with any degree of positiveness. I have 
 learned to value the therapeutic effect of parenchymatous in- 
 jections of carbolic acid in the treatment of chronic or suba- 
 cute inflammation of a non tubercular inflammation, and I am 
 inclined to attribute to it in this particular and similar cases 
 positive curative properties, the evidence of which in this case 
 appeared so shortly after it was made. 
 
 Case 31. — C. H. Baker, aged 22, Company P, Second Massa- 
 chusetts Infantry, was sick two months in Cuba with fever, 
 malaria, headache, a^norexia, diarrhea, in consequence of which 
 he became very weak. Shortly after boarding the transport, 
 he became delirious and has been sick with typhoid fever for 
 three weeks. A week ago, while convalescent, he was attacked 
 suddenly with violent pain in the right testicle which rapidly 
 increased in size, reaching the dimensions of a small orange in 
 the course of two days. At that time, the temperature in- 
 creased two degrees above normal. On the third day after the 
 attack, the swelling was hard, very sensitive to the touch, the 
 skin red and glossy. No chills. Under applications of lead 
 water and opium the pain has been somewhat mitigated and 
 the swelling slightly diminished in size. September 10, a week 
 after the complication had set in, the patient was transferred 
 to the surgical ward. At this time deep-seated fluctuation could 
 be distinctly felt over the center of the swelling. Lees discol- 
 oration of the skin than a few days ago. Swelling only about 
 twice the size of the normal testicle. The abscess appears to 
 occupy the center of the testicle. Under ether anesthesia the 
 abscess cavity was opened at the most dependent point, and a 
 counter-opening two inches higher up made by tunnelling the 
 tissues from within outward with a curved hemostatic forceps, 
 and through drainage established. The pus was of the con- 
 sistence of cream and whitish in color. No transudation into 
 the tunica vaginalis. The conditions revealed at the time of 
 operation left no doubt regarding the parenchymatous central 
 origin of the abscess. Microscopic examination of the pus 
 removed showed typhoid bacilli in great abundance as the ex- 
 clusive bacteriologic cause of the suppurative orchitis. The 
 patient improved very rapidly after the operation, and was 
 transferred in less than a week to one of the Boston city 
 hospitals. 
 
 Case 32. — L. Gardner, age 38, Company A, Sixth Infantry, 
 went through the Cuban campaign with two days' slight ill- 
 ness. He lost flesh, but felt well until he came on the trans- 
 port four weeks ago, when he was attacked with fever which 
 proved to be typhoid complicated by malaria as shown by the 
 erratic temperature curves. Convalescence was preceded by 
 inflammation of the left parotid gland. Emaciation marked. 
 Spleen much enlarged. The liver dulness extends from the
 
 209 
 
 sixth rib to an inch below the costal arch. Lungs normal. 
 Heart sounds clear and distinct. Pulse strong and regular. 
 Tongue red and glazed. A week after the beginning of the at- 
 tack, a large abscess had formed and fluctuation could be dis- 
 tinctly felt, extending from a level with the external meatus to 
 near the angle of the jaw. At that time, September 7, 
 the patient was etherized, the abscess opened at the lowest 
 and highest points, and through drainage estiblished, a 
 large quantity of thick purulent, curdy pus escaped. The 
 cavity was washed out with a 2.5 per cent, carbolic solution 
 and peroxid of hydrogen, and a large, moist, hot antiseptic 
 compress applied. Improvement followed at once and ended 
 in a slow recovery without any interruptions. 
 
 Case 33. — Patrick Collins, age 26, Eighth Infantry, Company 
 C, has been in the service one year. About two weeks after 
 the fight in Cuba was attacked with malaria, which was fol- 
 lowed by typhoid. The fever has persisted since, attended by 
 diarrhea and other symptoms indicating its nature. While on 
 the transport on his return he complained of a sense of sore- 
 ness in the left parotid region, followed by swelling and red- 
 ness. Patient much emaciated and very feeble. At the time 
 the operation was performed, August 29, the swelling extended 
 from the external ear to near the angle of the jaw, and deep- 
 seated fluctuation was distinct. Incision, drainage, disinfec- 
 tion and after-treatment the same as in the preceding case. 
 Owing to the marked weakness of the heart's action, the pa- 
 tient was given two ounces of whisky before he was placed 
 under the influence of ether. Alcoholic stimulants were admin- 
 istered in large and frequently repeated doses and acted very 
 promptly in increasing the tone of the circulation and in build- 
 ing up the impaired nutrition. The discharge from the abscess 
 in this, as well as the other cases of abscess of the parotid fol- 
 lowing typhoid fever, was very slight after the evacuation of 
 the abscess contents. 
 
 Case 34. — Harold Robinson, age 28, Third Infantry, Com- 
 pany D, contracted typhoid fever in Cuba. He is now in the 
 third week of the fever and has been delirious most of the 
 time. The disease pursued almost from the beginning a very 
 malignant course. About five days ago a swelling was detected 
 in the region of the right parotid gland, which increased very 
 rapidly in size, involving the skin after two or three days. The 
 abscess ruptured on the fourth day into the external meatus, 
 but evacuation was incomplete on account of the existence of 
 several separate compartments in the abscess cavity, which 
 were discovered at the time the operation was performed. The 
 abdomen is intensely tympanitic, the skin of feet, legs and 
 abdomen spotted with dark points of ecchymosis. The con- 
 dition of the patient was critical when the operation was 
 performed, September 10. The operation had to be performed 
 without an anesthetic and in his ward, as he was too feeble to
 
 210 
 
 justify his transfer to the surgical ward. The impoverished 
 condition of the blood made it necessary to make the incision 
 only through the skin, completing the opening with hemostatic 
 forceps. Free tubular drainage was established and the abscess 
 cavity was treated in the usual way. Strychnia and alcoholic 
 stimulants were administered freely, but the heart failed to 
 respond and the patient died the next day. Notwithstanding 
 that the openings were made largely by the use of blunt instru- 
 ments, free oozing of blood followed the operation, which may 
 have contributed in hastening the fatal termination. 
 
 Case 55. — Giles Potter, age 33, Second Massachusetts Infan- 
 try, had chills and fever while in Cuba, but was on duty con- 
 tinuously. Was still weak and ill when he came on board the 
 transport. The parotid abscess began on transport. He is 
 very weak and emaciated, at times delirious ; temperature in- 
 dicates typhoid fever. Conjunctivse slightly jaundiced. Pulse 
 small and thready. Spleen slightly enlarged. The abscess 
 was incised and drained without the use of an anesthetic, in 
 its stead a large dose of whisky was given. The pus in this 
 case was of a green color. Patient improved rapidly after the 
 operation and is now on the way to convalescence. 
 
 Case 56'.— John Simpson, age 28, Troop K, First Cavalry, 
 was admitted to the general hospital August 25, suffering from 
 typhoid fever, with a temperature gradually declining until 
 September 1, when it rose suddenly from 99.4 to 102 and 103, 
 dropping on the 8th to 99. On admission patient had very 
 marked roseolar eruption on abdomen and limbs. During the 
 course of the fever numerous furuncles appeared on the fore- 
 head and back. Delirium has been a prominent feature in the 
 case almost from the beginning. Directly following the sud- 
 den rise of temperature on September 4, soreness and swelling 
 of the right submaxillary gland were noticed. Today, Sep- 
 tember 10, a fluctuating swelling, the size of a small apple, 
 marks the location and size of the abscess. Operation without 
 anesthetic. Incision, counteropening, tubular drainage, irri- 
 gation with peroxid and carbolic solution, wet carbolic dress- 
 ing. Rapid improvement followed the operation and the 
 patient is now, September 13, fairly convalescent ; abscess 
 nearly healed. 
 
 The parotid gland, of all glandular organs, is the most fre- 
 quent seat of secondary infection in typhoid fever. For 
 reasons that remain unexplained the submaxillary is seldom 
 involved, and the sublingual is still more rarely affected. The 
 infective process begins in the parenchyma of the salivary 
 gland but extends rapidly to the capsule and the surrounding 
 connective tissue, leading to a phlegmonous process which in 
 four or five days, as a rule, terminates in a well-marked abscess 
 with the gland as a central point. The physician must be on
 
 211 
 
 the alert in such cases, and resort to the use of the knife in a 
 most cautious manner as soon as fluctuation can be detected. 
 It is advisable to establish through drainage for the purpose 
 of securing free evacuation and thorough disinfection of the 
 interior of the abscess cavity. The openings should be made 
 by cutting only the skin and underlying fascia with the knife, 
 completing them by tunnelling the remaining tissues with a 
 curved hemostatic forceps. Dry dressings should not be em- 
 ployed in such cases ; nothing is more grateful to the patient 
 and more efficient in the after-treatment than the application 
 of a moist, hot, antiseptic compress covered with oiled silk to 
 retain heat and moisture. The safest and most efficient solu- 
 tion for this purpose is a saturated solution of acetate of 
 aluminium, but when this can not be secured, a 2.5 per cent, 
 solution of carbolic acid or a saturated solution of boracic acid 
 answer as excellent substitutes. 
 
 In the next case the clinical history is very defective, and it 
 is impossible to say with any degree of certainty whether or 
 not the parotid abscesses followed in the course of typhoid 
 fever, or whether they were external manifestations of a 
 general septic process that developed independently of that 
 disease. 
 
 Case o7.— Austin Dunlap, age 19, Company H, Third Infan- 
 try, was taken suddenly ill in Tampa, about July 1, with pain 
 in' the back and joints and nausea. The disease was diagnos- 
 ticated at the time as malaria. He was sent to quarters, and 
 after four days returned to duty. On arrival at this camp, 
 August 14, had three severe chills during the first twenty-four 
 hours and has been very sick since. When admitted to the 
 surgical ward with bilateral suppurative parotitis and large 
 bedsores, he was reduced to a skeleton. Extensive herpes 
 labialis which near the left angle of the mouth have caused 
 ulceration ; abscess over elbow joint. Pulse rapid and very 
 small, temperature irregular. When first admitted the case 
 was regarded as a forlorn one and whiskey was given in ounce 
 doses hourly. The swelling in the parotid region, on both 
 sides, was hard and very sensitive to the touch. Crede's sil- 
 ver ointment and hot antiseptic compresses constituted the 
 local treatment. Five days later distinct fluctuation could be 
 detected and one of the parotid abscesses was incised and free 
 tubular drainage effected. Owing to his critical condition the 
 operations had to be performed without an anesthetic. The 
 next day, September 10, the opposite abscess was treated in 
 the same manner. The patient has been placed on a water-
 
 212 
 
 bed and was restless and most of the time delirious. No evi- 
 dences of metastasis in any of the internal organs. Under the 
 stimulating treatment he rallied promptly and at the present 
 time, September 13, his mind is clear and the temperature 
 normal. Discharge from abscess cavities slight. The drains 
 are shortened from time to time to permit early definitive heal- 
 ing of the abscesses. 
 
 I am confident that early operative treatment and the heroic 
 employment of alcoholic stimulants have been the principal 
 means in saving the life of this patient. 
 
 Case 5.9.— Corporal George F. Shilling, age 18, Company G, 
 First D. C. Volunteers. Enormous typhoid abscess of arm. 
 Family history negative. Health excellent before he went to 
 Cuba. On August 15 reported sick at the hospital. Had 
 been feeling ill for some days. He has been delirious most of 
 the time since admission to the General Hospital here. The 
 temperature has been on an average 103 degrees F., with 
 daily variation of a degree and a half from August 19 to Sep- 
 tember 4. Since latter date the temperature at no time has 
 been over 101 degrees F. The pulse is small, rapid and weak, 
 tongue dry, brown and fissured. On arriving here on trans- 
 port there were five large bedsores on back and numerous 
 small abscesses of the skin. He was placed at once upon a 
 water-bed, but the bedsores continued to still further under- 
 mine the skin. Two days ago when the nurse was dressing 
 the bedsores, she discovered a swelling of the right arm on the 
 outer edge of the biceps muscle. This has rapidly increased 
 in size and now presents itself as an enormous abscess extend- 
 ing from the shoulder to the tendon of the biceps muscle. 
 Fluctuation is most distinct over the outer aspect of the arm. 
 On palpation a crackling sensation is felt, and on percussion 
 the swelling was distinctly tympanitic. The presence of gas 
 in the abscess cavity could not be doubted. September 12 the 
 patient was almost pulseless, lips cyanotic, respiration shal- 
 low, and marked twitching of the muscles of the upper extremi- 
 ties. In the afternoon the abscess was cautiously opened 
 above and below and a rubber drainage tube drawn through. 
 A large quantity of an offensive gas and creamy pus was evac- 
 uated. The abscess cavity was freely irrigated withperoxid of 
 hydrogen and 2.5 per cent, of carbolic solution and the moist, 
 hot antiseptic compress applied. In place of an anesthetic 
 the patient was given an ounce of whiskey, which was to be 
 repeated hourly. Hot water bags were applied to relieve the 
 embarrassed peripheral circulation. Contrary to our expecta- 
 tions, the patient rallied under this treatment and presented a 
 much more encouraging condition the next morning, when it 
 was reported that the temperature was nearly normal, mind 
 clear and the pulse full and strong. Microscopic examination 
 of the pus by Dr. Ewing revealed : 1, many cocci resembling
 
 213 
 
 staphyloccus pyogenes ; 2, a few large capsulated cocci ; 3, a 
 few fine slender bacilli staining faintly with methylene blue. 
 There is nothing that resembles the bacillus Eerogenes capsula- 
 tus. The patient is in a fair way to recovery (September 17). 
 Case 40. — Fred Angier, age 23, First Cavalry, Troop I, is un- 
 der treatment for typhoid fever probably during the third 
 week of his illness. Patient is delirious and it is impossible to 
 obtain reliable information as to duration of his sickness. 
 Very recently the right eye became affected by an acute in- 
 flammatory process which appears to involve all of the tissues 
 of the organ. The eyelids are swollen, red and somewhat ede- 
 matous. The edema extends over the whole malar region. 
 Exophthalmus well marked. Pupil contracted and immovable. 
 Conjunctiva in a state of catarrhal inflammation. Hypopion. 
 Sent to the New York Hospital, August 30, for treatment by 
 specialist of the eye complication. This is the only case of 
 secondary infection of eye of a typhoid character that was ob- 
 served in the camp. It was a well-marked case of panophtal- 
 mitis and if the patient recovers it will be with the loss of the 
 affected organ. 
 
 ERYSIPELOID. 
 
 Erysipeloid, an acute inflammatory affection of the skin, 
 described by J. Rosenbach, is a disease of the skin not often 
 recognized. It is usually mistaken for erysipelas. The para- 
 site was described by Rosenbach more than ten years ago, but 
 it has never been classified. Attempts to cultivate it have 
 failed so far. This disease is met with usually among persons 
 engaged in the handling of fish and meat, that is, cooks 
 and butchers. It is attended by very slight constitutional 
 disturbances and its local progression is slow as compared 
 with erysipelas. The starting point is generally a finger, 
 where infection takes place through slight surface defects or a 
 puncture. It consists, pathologically speaking, of a subacute 
 inflammation of the lymphatic channels of the skin. The 
 affected skin presents a bluish color instead of the bright red 
 seen in erysipelas. Another and perhaps more important 
 characteristic sign in the differentiation between erysipeloid 
 and erysipelas is the appearance of the margin of the inflamed 
 area. In erysipeloid the shading from diseased into healthy 
 skin is gradual, the line straight, in erysipelas abrupt and the 
 margin presents well-marked fan-shaped projections instead of 
 a straight line. The thickening of the skin by infiltration in 
 erpsipeloid is slight and the only thing the patient complains 
 of is a sensation of burning or smarting. The disease travels
 
 2L4 
 
 in the direction and against the lymph-current, so that when 
 the point of infection is some distance from the tip of the 
 finger, this is reached in time by extension of the inflammation 
 downward from the point of infection. The disease travels 
 slowly, it usually takes a week or more before the inflamma- 
 tion reaches the base of the finger when infection takes place 
 anywhere near its tip. The lymphangitis seldom if ever 
 extends beyond the elbow joint. The infection may extend 
 from one finger to another when the inflammation travels in a 
 distal direction. The skin soon returns to its normal condi- 
 tion behind the zone of infection. A case of this kind came to 
 the surgical ward for treatment. 
 
 Case 41. — Patrick J. M. McGeoch, age 24, kitchen employe, 
 presented himself September 9, complaining of a burning, 
 smarting pain in the right index finger, which commenced 
 four days ago. Over the radial side of the affected finger, 
 opposite the middle joint, is a small abrasion covered by a thin 
 adherent crust. The skin half as far as the tip of the finger 
 and an inch above this point is slightly swollen and presents a 
 bluish red color. The discoloration is most marked on the 
 dorsal side. At the proximal margin of the zone of inflamma- 
 tion the diseased gradually shades into the healthy skin, both 
 in regard to color and swelling. Patient is able to follow his 
 occupation. The case presents all the characteristic signs of 
 Rosenbach's erysipeloid. An alcohol compress with oiled silk 
 over it was applied. In three days the inflammation had 
 extended to the base of the finger while the distal portion, the 
 seat of the disease when the patient first came under observa- 
 tion, presented a normal appearance, the skin being somewhat 
 shrivelled by the action of the alcohol application, 
 
 AFFECTIONS OF THE RECTUM, ANUS AND ADJACENT TISSUES. 
 
 Rectal affections in some form were very common among the 
 returning troops from Cuba. It is fair to presume that some 
 of the soldiers were the subjects of a mild form of hemorrhoids 
 when they entered the service, but it is equally certain that 
 none of them were affected with fistula or abscess. To show 
 the disproportion of rectal disease between the recruits who 
 applied for enlistment and the soldiers returning from the 
 field, I will state that of 10,000 applicants examined in Camp 
 Tanner last spring the following rectal affections were noted : 
 Hemorrhoids, internal, 2 ; external, 219 ; inflamed, 1 ; fistula, 
 1 ; prolapsus, 2. I attribute the prevalence of rectal diseases 
 among our patients in this camp to the following causes : 1,
 
 215 
 
 intestinal affections contracted in the camps and Cuba ; 2, 
 improper food ; 3, the relaxing effect of a tropical climate ; 4 
 frequent exposure. Few of our soldiers escaped diarrhea or 
 dysentery. The irritation of the rectal mucous membrane 
 could not fail in many instances to produce a catarrhal proctitis. 
 The inflamed mucous membrane became permeable to the 
 passage of pathogenic microbes, which so constantly infest 
 even the healthy rectum. The loose pararectal connective 
 tissue, under the influence of general causes, became more sus- 
 ceptible to infection, it is therefore not astonishing that we 
 should have found so many cases of perianal, perirectal and 
 ischiorectal abscesses and their consequences, fistulas Inflam- 
 matory affections of the rectum play also an important etio- 
 logic role in the development of hemorrhoids. We found in a 
 number of cases a direct connection between an antecedent 
 rectal inflammatory affection and the subsequent appearance 
 of hemorrhoids. The intense tenesmus which attends catarrhal 
 proctitis and dysentery causes muscular changes and lesions of 
 the mucous membrane which often become the principal cause 
 of pararectal inflammation and hemorrhoids. 
 
 PARARECTAL ABSCESS. 
 
 Under this head I will report all cases of suppurative inflam- 
 mation in the vicinity of the anus and outside of the rectal 
 wall that have been operated on in Camp Wikoff. In all cases 
 the suppurative inflammation pursued a very rapid course, 
 The pain, as a rule, was intense, and fluctuation could be felt 
 distinctly in the course of four or five days. In high-seated 
 paraproctitis the general symptoms were usually severe, a high 
 temperature and a rapid bounding pulse. It was in these 
 cases that the affection assumed the most progressive form. 
 The abscess contents were always fetid, otherwise presented 
 the usual appearance of pus as found in acute abscesses in 
 other localities. 
 
 Case 42.— Robert F. Stanley, age 22, Troop (i. Ninth Cav- 
 alry, colored. Perianal and ischiorectal abscess. While in 
 Cuba had diarrhea for eighteen days— August 27 to Septem- 
 ber 1— had chills and fever. Reached Camp Wikoff Septem- 
 ber 3, on which day he had pain about the rectum before and 
 during defecation and on sitting down. He was admitted to 
 surgical ward September 8. By careful palpation a small area 
 of circumscribed induration as large as a pea could be felt on
 
 216 
 
 the right side of the sphincter muscle and about one- third of 
 an inch from the surface. This swelling could not be detected 
 from the rectum. Pain was greatly increased under pressure. 
 A small incision was made and about half a dram of pus 
 escaped. The little cavity was washed out with peroxid of 
 hydrogen and carbolized water and loosely packed with a strip 
 of iodoform gauze. As an external dressing a hot moist anti- 
 septic compress was used and held in place by a T bandage. 
 Immediate and almost complete relief followed the operation. 
 On the ninth, the temperature rose to 100 degrees F., on the 
 tenth to 101. The pain was intense and referred to the oppo- 
 site side of the rectum, September 10, a fluctuating swelling 
 could be felt from the perineum and the rectum. The abscess 
 bulged externally as well as on the rectal side. The patient 
 was again anesthetized and the abscess incised through the 
 perineum to the left of the median line. A large quantity of 
 extremely fetid pus escaped. As the undermining was exten- 
 sive two counter-openings were made, one below and one above 
 the first opening. Two fenestrated rubber tubes were employed 
 in draining the large cavity. The abscess was washed out with 
 carbolized solution and peroxid of hydrogen, and the moist 
 antiseptic compress applied. The pain was relieved at once 
 and the discharge after the operation slight. No tendency to 
 further undermining, on the other hand all indications point 
 to an early and permanent healing of the abscess cavity. 
 
 It is in cases like these that practitioners so frequently make 
 a serious mistake by postponing from day to day opening and 
 draining of the abscess. If we had deferred the operation for 
 another day or two the abscess would have ruptured into the 
 rectum and would have led almost inevitably to the formation 
 of an internal or complete fistula. The horseshoe fistulae fol- 
 lowing cases of ischio rectal abscess, so frequently found in 
 any of the large surgical clinics are the best proof of the neces- 
 ity for early operative interference. The rule should be to 
 open such abscesses early, from the external surface, and if 
 fluctuation can not be felt from this direction but from the 
 rectum, the tissues on the side of the rectum can be tunnelled 
 with forceps after making a superficial incision, until the 
 abscess cavity is reached. The surgeon must so conduct the 
 treatment that the formation of a fistula can be avoided, and 
 this can be done in nearly all, if not all, cases in which the 
 abscess is opened before it ruptures into the rectum. 
 
 Case 43. — Alva J. Vananken, age 27, Troop K, First Cavalry. 
 Perirectal abscess. On his last day in Cuba the patient had a 
 mild fever and diarrhea ; the latter persisted fifteen or sixteen 
 days. For the last ten days has had a throbbing pain in the
 
 217 
 
 post anal region. An abscess found and opened in the median 
 line, between the anus and coccyx. Under ether anesthesia the 
 abscess cavity behind the rectum was freely opened with the 
 Paquelin cautery, taking the fistulous opening in the median 
 line as a guide for the incision. The cavity was thoroughly dis- 
 infected and packed with iodoform gauze, over which the usual 
 moist dressing was applied. Rapid healing of the cavity by 
 granulation. 
 
 Case ii.— Robert Sylvester, age 24, Company (i, Fourth 
 Artillery. Has been ill with typhoid malarial fever while in 
 Cuba. Returned from Cuba on the steamer Le )na, and 
 reached Camp Wikofif about September 1. Soon after his 
 arrival he noticed pain on the left side of the rectum. The 
 pain and tenderness increased rapidly in intensity. September 
 7, he was admitted to the surgical ward and the operation was 
 performed without anesthesia three days later. At this time 
 the abscess was prominent on the side of the anus and the over- 
 lying skin presented an inflammatory blush. Fluctuation 
 very distinct from the rectum as well as from the surface. The 
 abscess was opened by a single incision and tubular drainage 
 established, as the incision was large enough to serve for 
 drainage. After disinfection of the cavity and packing it 
 lightly with iodoform gauze, a moist antiseptic compress was 
 applied. The patient was very weak at the time the operation 
 was performed, but gained sufficiently in strength in a week to 
 warrant his transfer to a hospital in Philadelphia. 
 
 Case 45. — Joseph Barret, age 28, Third Infantry, Company 
 G. Ischio-rectal abscess. About the time of the surrender of 
 Santiago had general malaise, fever, vomiting and diarrhea for 
 which he has since been on the sick list. Several days ago he 
 began to experience pain in the rectum which has increased 
 steadily since, and at the time he was admitted to the surgical 
 ward the ischiorectal abscess had opened spontaneously on the 
 right side just within the anal margin. General health much 
 improved. On August 31, under chloroform anesthesia the ab- 
 scess cavity was distended with peroxid of hydrogen for the 
 purpose of ascertnning its exact size and location. A grooved 
 director was inserted into the fistulous opening and used as a 
 guide in laying open the abscess cavity freely with tjie knife 
 point of the Paquelin cautery. The abscess cavity was disin 
 fected and packed loosely with iodoform gauze over which the 
 moist compress was applied. He improved rapidly after the 
 operation and a few days later was transferred to a hospital in 
 Boston. 
 
 Case 46.— William Head, age 20, Eighth Ohio Infantry, 
 Company G, enlisted two and a half months ago. Admitted to 
 the surgical ward with a history of malarial fever and dysen- 
 tery in Cuba, followed by ischiorectal abscess which discharged 
 itself near the anal orifice on the right side. Discharge con- 
 tinues profuse. The peroxid of hydrogen test was applied to
 
 218 
 
 ascertain the extent of the abscess cavity which was found to 
 extend high up into the ischiorectal fossa. Owing to the 
 marked anemia and general debility a counter-opening was 
 made lower down and thorough drainage secured, in place of 
 opening the abscess cavity freely with the Paquelin cautery. 
 Chloroform was used as an anesthetic. The general and local 
 conditions improved promptly after the operation. 
 
 The spontaneous rupture of a pararectal or ischiorectal ab- 
 scess into the rectum is generally followed by the formation of 
 a fistula. If the abscess communicates with the rectum its 
 existence can be surmised from the intermittent discharge of 
 pus and local symptoms which refer to the rectal lesion. An 
 internal fistula of such an origin is often made complete by the 
 abscess finding eventually an external outlet somewhere in the 
 anal region. An external fistula caused by the opening of a 
 pararectal abscess not infrequently becomes complete by 
 the destructive process penetrating the rectal wall. I have 
 long ago abandoned the probe in differentiating between an ex- 
 ternal fistula and a complete one. Injection of peroxid of hy- 
 drogen into the cavity under pressure makes a positive diagno- 
 sis at once. If the fistula is external the abscess cavity be- 
 comes tense, if complete the peroxid foam enters the rectum and 
 will escape from the anus. The probe is only used after the 
 test has made the diagnosis and then only as an aid in perform- 
 ing the necessary operation. In diagnosticating the existence 
 and location of an internal fistula the rectal speculum is of 
 the greatest importance. Rectal fistula will be less frequently 
 met with when the prof ession as a whole recognizes the import- 
 ance of early operative interference in cases of pararectal abscess. 
 In my surgical work in Camp Wykoff only two cases of rectal 
 fistula presented themselves for operative treatment. 
 
 Case 47. — Lieut. G. W. Goode, Troop i, Ninth Cavalry. 
 Hemorrhoids and fistula. He was admitted to the surgical 
 ward August 24. He has been almost habitually constipated, 
 and has been much in the saddle. He knows of no definite pre- 
 ceding illness to account for present condition. He has had 
 much pain and bleeding on defecation, pain persisting for 
 an hour or two after. Examination reveals large internal 
 and external hemorrhoids and an incomplete internal fis- 
 tula following the rupture of a post rectal abscess, into the 
 rectum through the middle of the sphincter muscle, posterior 
 side. The abscess cavity, the size of a walnut, was freely laid
 
 219 
 
 open upon a grooved director with the knife point of the Pa- 
 quelin cautery. The incision was carried directly backward 
 through the median line. The hemorrhoids, two in number, 
 affecting the posterior segment of the anal ring were removed 
 by clamp and cautery. The abscess cavity was loosely packed 
 with a strip of iodoform gauze. The rectal tampon re- 
 mained for two days, The patient made a rapid recovery and 
 was able to leave the hospital September 13. The agonizing 
 pain attending and following each bowel movement disap- 
 peared immediately after the operation. 
 
 Case 48.— John M. Boyd, age 29, Troop G, Third Cavalry, 
 enlisted four months ago. Admitted to the surgical de- 
 partment of the General Hospital August 27. His health was 
 good until he went to Tampa, June 8. At that time he suffered 
 from diarrhea which was persistent, but did not prevent his 
 doing duty in the saddle. For the past five weeks and following 
 a severe pain in the rectum which continued several days, he 
 has noticed a discharge of pus from the rectum. The pain did 
 not disappear entirely after the abscess ruptured into the rectum 
 and was always aggravated during defecation. August 28, 
 under chloroform anesthesia the sphincter ani was dilated, the 
 internal opening was found, the cavity distended with peroxid 
 of hydrogen, external counter openicg made by the aid of the 
 grooved director and the intervening tissues divided with the 
 Paqueiin cautery. Iodoform gauze packing and dry dressing. 
 The internal opening in this case was just above the sphincter 
 muscle, the abscess on the right side of the rectum. Rapid 
 healing of the abscess cavity. 
 
 HEMORRHOIDS. 
 
 A large number of hemorrhoid cases came to the surgical 
 ward with the desire and expectation of receiving the benefits 
 of a radical operation. I am satisfied that only a small per- 
 centage of those affected were willing or prepared to be sub- 
 jected to an operation. Some of the cases examined perempto- 
 rily declined to receive treatment knowing well that the re- 
 sults would put one claim for pension beyond their reach. In 
 my capacity as operating surgeon of the camp I was very anx- 
 ious to curtail the list of pensioners of this war by performing 
 operations for surgical affections which, if left alone, would 
 furnish a just claim upon the Government. On the whole, I 
 found the colored soldiers much more willing than their white 
 comrades to be benefited by surgery. They proved themselves 
 worthy of their hire in the hospital as well as on the battle- 
 field. Too much can not be said in praise of our colored sol- 
 diers. They showed a staunch faith in their doctors as well
 
 220 
 
 as their commanders, and were ready at all times to follow 
 their advice as well as the commands of their officers. Nearly 
 all of the hemorrhoids operated on ehowed pathologic ap- 
 pearances which demonstrated their recent origin. In a very 
 large percentage of cases the first manifestation of hemor- 
 rhoidal condition was preceded by intestinal disturbances, 
 diarrhea or dysentery. Fortunately, I had two Paquelin cau- 
 teries at my disposal as soon as the operating tent was opened. 
 As I said in the beginning of this paper, my instrumentarium 
 at first was a very scanty one. Instruments, however, began 
 to come, day after day, and finally I had an excellent supply, 
 including a number of cases for special work. The absence 
 of a proper pile clamp from the outfit of the surgical ward at 
 the outset, necessitated the use of something as a substitute. 
 This was found in a curved hemostatic forceps. Except for its 
 lightness, and therefore comparatively inefficient grasping 
 power, this answered the purpose admirably. In fact, the 
 facility and accuracy with which the hemorrhoidal swelling 
 could be clamped and isolated, the small space required for 
 its use, and its general convenience and ease of handling as 
 compared with heavy clamps, now in the market, led to the 
 devising by Major Adams of Chicago, of a hemorrhoid clamp 
 similar to the forceps used, but so constructed as to obviate 
 the defects of weakness and imperfect grasp found in that in- 
 strument. The use of the forceps as a clamp has demon- 
 strated that the amount of pressure and crushing exerted by 
 the old-fashioned instruments are unnecessary and uncalled 
 for ; also that there is no need of ivory plates to prevent the 
 transmission of heat through the metal of the forceps to the 
 underlying mucous membrane, as in no instance was any ill 
 effect observed from this cause. Another advantage of the 
 narrow blade forceps has been demonstrated in the absence of 
 any hemorrhage whatever after operation. The new clamp 
 has blades with a serrated grasping surface 5 cm. long, curved 
 on the fiat, the width of the blades closed is 9 mm., their 
 thickness 6 mm., beveled away from the upper to the outer 
 edge for 1 mm. The object of the bevel is to allow of the oper- 
 ation of the cautery with the least possible contact with the 
 metal of the clamp, to avoid heating. The blades come into 
 contact at the point first, so that uniform pressure is exerted
 
 221 
 
 the whole length of the blades when closed, and the hemor- 
 rhoid can not escape its grasp at the point, as often happens 
 with the ordinary clamp. 
 
 The handles are arranged like those of a needle forceps. 
 With one exception the hemorrhoids were removed with the 
 knife point of the Paquelin at a dull red heat, after clamping 
 the swelling at its base. The hemorrhoid was first grasped 
 with a dissecting or hemostatic forceps, when the base of the 
 cone elevated to the desired extent was grasped and clamped 
 with the forceps and the mass outside of the grasp of the in- 
 strument shaved away with the cautery. The operation of 
 
 LATe^Al_yf£VV 
 
 t/ppsRSt^/^PAce 
 
 TfSAN'SVERSE SeCTIO/V OF^ BlADES . 
 
 Hemorrhoid clamp, devised by Major Adams. 
 
 removal was always preceded by dilatation of the sphincter. 
 The patients were always properly prepared for the operation 
 the day before. The rectum was thoroughly cleared out by 
 the administration of a cathartic and irrigation. The last 
 enema was given on the morning of the operation. As a rule, 
 two or three seizures were made. After dilatation of the 
 sphincter the hemorrhoidal swellings were located and grasped 
 with forceps so that the work of clamping and cauterization 
 could proceed without interruption. Care was exercised in 
 every case not to remove too much tissue ; due allowance was 
 given for subsequent contraction. The anal region was
 
 222 
 
 shaved and prepared in the same manner as for operations in 
 other localities. One of the principal sources of pain after 
 operations for hemorrhoids has been the protrusion and swell- 
 ing of the cauterized surfaces. For many years I have suc- 
 ceeded in preventing this very painful post-operative complica- 
 tion by resorting to drainage and rectal tamponade. This 
 method of dressing rectal wounds after this operation is not 
 sufficiently known and practiced. Those who have not tried it 
 might entertain a fear that it is a source of distress rather 
 than comfort. Quite an extensive experience with this 
 method of after-treatment enables me to make the unqualified 
 statement that the rectal tampon, properly applied, is well 
 borne by the patients and makes the use of anodynes superflu- 
 ous. I never administer opiates after operation for hemor- 
 rhoids. The rectal tampon not only obviates unnecessary pain, 
 but it also is almost an absolute protection against secondary 
 hemorrhage and more than this, it provides for free rectal 
 drainage and constitutes the best possible dressing for the 
 cauterized surfaces. 
 
 When I first used this tampon. I was under the impression 
 that it was something new, but I learned later that Mitchell 
 Banks had used a very similar contrivance before. The tam- 
 pon is made by taking a piece of rubber tubing eight inches in 
 length and inserting into it a glass cylinder three-fourths of an 
 inch in diameter and about 2 inches in length. The glass tube 
 is placed where the gauze tent is tied over the rubber tubing 
 for the purpose of furnishing a support to the string with which 
 the gauze tent is tied upon the tube and to insure patency of 
 the tubular drain. The rubber tube should project well over 
 the glass cylinder on the rectal side. The gauze tent is made 
 of one or two layers of iodoform gauze. After completion of 
 the operation the tent is carefully folded and the upper portion 
 covered with vaseline. The tube is then inserted into the rec- 
 tum to the depth of three or four inches and the space between 
 the tent and tube packed with strips of iodoform or plain sterile 
 gauze. After the required amount of packing is inserted the tam- 
 pon is pushed in the direction of the rectum sufficiently to bring 
 the pressure above the grasp of the sphincter muscle. In doing 
 this the projecting mucous membrane and what may remain of 
 the external hemorrhoids are completely reduced. The gauze
 
 223 
 
 Rectal tampon. Rubber tube 20 cm., glass tube 8 cm.
 
 224 
 
 outside of the anal orifice is then wound around the tube and 
 forms a part of the external dressing. Over the gauze a wide 
 ring of absorbent cotton is applied and the whole retained in 
 place by a T bandage. The tampon should remain for 24 to 48 
 hours. 
 
 In removing it traction is made on the gauze tent sufficiently 
 to bring the packing within easy reach when it is removed be- 
 fore an attempt is made to extract the tube. After the removal 
 of the tampon the patient should be given a laxative and after 
 this has acted the cauterized surfaces now minus the eschar 
 are protected by applying carbolated vaseline or some other 
 antiseptic non irritating ointment. I have made it a rule to 
 keep the patient confined to bed for at least a week, still better 
 two weeks. The cases of hemorrhoids operated upon in this 
 camp with very few exceptions have been men whose general 
 health was much impaired, yet in every case the wounds healed 
 quickly and in the most satisfactory manner under the treat- 
 ment outlined above. 
 
 Case 49.— M. J. McXulty, age 31, Company D, Sixteenth 
 Infantry, enlisted six months ago. Has had small hemorrhoids 
 for two years, causing inconvenience only after heavy drinking. 
 In June, while in Florida, bleeding at stool occurred for the 
 first time. Since he suffered from malarial fever and diarrhea 
 during the Cuban campaign, he has suffered from profuse 
 bleeding on defecation. Septembers, under chloroform anes- 
 thesia, three hemorrhoidal swellings were removed. 
 
 Case .30.— George Morton, age 47, sergeant Ninth Cavalry, 
 Troop A, colored, has been in the service ten years and seven 
 months. Had dysentery two months ago, since then has suf- 
 fered from pain in the rectum and bleeding with each evacua- 
 tion of the bowels. August 26, under chloroform anesthesia, 
 three hemorrhoids, partly external and partly internal, were 
 removed by clamp and cautery. 
 
 Case oi.— Jesse Donaldson, age 30, Troop M, Ninth Cavalry, 
 colored, enlisted three months ago. While in Tampa, patient 
 suffered from malarial fever and diarrhea, the latter continued 
 for three or four days. Has not been well since that time. 
 Since August 1, he has been much inconvenienced by a hemor- 
 rhoidal affection which developed recently. Operation per- 
 formed under chloroform narcosis, September 2. Three inter- 
 nal hemorrhoids, two posteriorly, one at upper right quadrant, 
 were removed in the usual way by clamp and cautery. 
 
 Case 5i'.— Claude F. Hall, age 23, Company G, Sixteenth 
 Infantry, had hemorrhoids about four years ago, but not so 
 severe an attack as the present. Recovered without operation.
 
 225 
 
 Has been in the service since the 17th of September, a year 
 ag:o. Following an attack of malaria and diarrhea in Cuba, he 
 has been suffering from hemorrhoids for the past six weeks. 
 He has no bleeding, but the hemorrhoids have been protruding 
 constantly and are very painful. September 7, under chloro- 
 form anesthesia, three internal hemorrhoids were removed in 
 the usual manner by clamp and cautery. They were located 
 respectively in the posterior right and left quadrant. 
 
 Case 52. — James Jervis, age 19, Compaoy K. Thirty fourth 
 Michigan Infantry, enlisted three and a half months ago. Had 
 diarrhea two weeks, before leaving Cuba. Has had much pain 
 and bleeding with movements of bowels since. Never had rec- 
 tal trouble of any kind before. August 31, under ether anes- 
 thesia, two internal hemorrhoids were removed. 
 
 Case 55. —Ora Keithley, age 23, Troop M, First Vol. Cavalry, 
 first suffered severe pain from hemorrhoids in July, when on 
 duty in Cuba. He had had previously an attack of rheuma- 
 tism from exposure to rough and wet weather and sleeping on 
 wet ground. On September 7, three hemorrhoids, partly ex- 
 ternal and partly internal, were removed. 
 
 Case Ji.— Horace Carden, age 21, Troop M, First Vol. Cav- 
 alry, has suffered off and on for three years from hemorrhoids, 
 the present attack was not preceded by any bowel complaint or 
 other illness. Has had no bleeding, but much pain and itch- 
 ing. Operation under chloroform anesthesia, September 8, 
 when three internal hemorrhoids were removed. 
 
 Coseol.— Silas McGovern, age 28, Troop A, Ninth Cavalry, 
 colored, has been in the service three years. Patient was ad- 
 mitted to the surgical ward September 3, One week ago, 
 directly following an attack of diarrhea, he noticed pain in the 
 rectum on defecation. The mucous membrane of the rectum 
 protruded with each stool. Day after admission the patient 
 was chloroformed and three internal hemorrhoids were re- 
 moved. The appearance of the swellings indicated their recent 
 origin. The mucous membrane was in a state of catarrhal 
 inflammation. The posterior half of the anal ring was princi- 
 pally affected by the hemorrhoids as well as by the catarrhal 
 inflammation. 
 
 Cam 5^,— Joseph Etter, aged 19, Troop I, Ninth Cavalry, 
 colored, has suffered for the past two months from hemorrhoids 
 which he believes were brought on by heavy lifting. Since the 
 supposed "strain" he has experienced severe burning pain 
 with each movement of bowels and profuse bleeding. Pain has 
 been persistent after stools for several hours. September 8, 
 under chloroform, three large, dark-blue hemorrhoids were 
 found, one on right and left side posteriorly, and one on ante- 
 rior left quadrant. The swellings were removed as usual by 
 the use of clamp and Paquelin cautery. 
 
 Case 37.— Lee Shanks, age 26, Troop A, First Vol. Cavalry, 
 has been in the service three months. He has been suffering
 
 226 
 
 from hemorrhoids for the past month with no illness preceding. 
 He has had much pain after defecation, but no bleeding. 
 Under chloroform three external hemorrhoids were removed, 
 September 2. One of the swellings occupied the posterior wall 
 of the rectum to the right of the median line, one to the left 
 of the median line posteriorly, and the third in the anterior 
 left quadrant. The hemorrhoids were disposed of in the usual 
 manner. 
 
 Case 58. — Corporal Samuel H. Edwards, Troop C, First Cav- 
 alry, began to suffer from profuse bleeding on defecation the 
 latter part of July, following an attack of diarrhea while on 
 duty in Cuba. Pain has not been severe at any time. Sep- 
 tember 10, under chloroform anesthesia, four very large inter- 
 nal hemorrhoids were removed by clamp and cautery, two 
 from either side of the median line anteriorly. The hemor- 
 rhoids in this case were distinctly venous, the swellings being 
 composed of ectatic veins almost exclusively. 
 
 Case oS*.— Henri Meuronval, age 4.3, Company F, Second 
 Volunteer Engineers, has suffered from hemorrhoids since 
 puberty, with exacerbations at varying intervals. Recently 
 much pain and bleeding. Examination under chloroform, 
 September 11, revealed a large internal venous hemorrhoid on 
 the right side, which, owing to the fact that the Paquelin 
 cautery did not work that day, was treated by ligature. Before 
 the silk ligature was applied, the mucous membrane at the 
 base of the swelling was incised. An ulcer as large as a dime 
 was detected directly over the sphincter muscle in the median 
 line and posterior surface. This ulcer was evidently the remote 
 result of a retroanal abscess which occurred a year ago. Since 
 that time the pain during and after defecation has been much 
 more severe. Besides stretching the sphincter, preliminary to 
 ligation of the hemorrhoid the superficial fibers of the sphinc- 
 ter muscle were divided, carrying the incision through the 
 center of the anal ulcer. Rectal tamponade as usual. The 
 pain was relieved promptly by the operation. 
 
 Case 6'0.— Capt. Nat Phister, age 44, Company G, First 
 Infantry, has had attacks of hemorrhoidal distress in 1888 and 
 1893 but not so severe as at the present time. He has suffered 
 severely with present attack since August 19, the exciting 
 cause being constipation. The suffering was much aggravated 
 by a long ride in the saddle which he was compelled to take 
 while the hemorrhoids were prolapsed. Since that time has 
 had severe pain and constant muco sanguinolent discharge, 
 necessitating the wearing of a diaper. Under chloroform a 
 medical operation was performed September 8, consisting in 
 the removal of two large hemorrhoids, largely external, and 
 affected by extensive excoriations. The operation afforded the 
 desired prompt relief. 
 
 Case 67. -John M. Dixon, age 40, Company B, First Infan- 
 try, had an operation seven years ago and had no trouble after
 
 227 
 
 that until about the first of August, when after a prolonged 
 attack of dysentery he began to suffer with prolapse of the 
 rectum. He has been in the service seventeen years and when 
 last attack occurred he was in Cuba. He reached Camp 
 Wikoff September 13. He has been greatly debilitated by the 
 dysentery, and the prolapse occurs whenever he assumes the 
 erect position or attempts to walk. Has much constant dis- 
 tress with pain, smarting, itchiog and occasionally bleeding. 
 Under anesthesia operation was performed September 14. A 
 large hemorrhoid was removed from the posterior aspect of the 
 rectal wall and a vertical strip of mucous membrane by clamp 
 and cautery. A smaller swelling and strip of mucous mem- 
 brane were removed from the left quadrant in a similar man- 
 ner. Rectal tamponade. Strict directions were given that the 
 patient should be kept in the recumbent position for at least a 
 week. 
 
 Case 62. — James Skinner, age 28, Troop H, Ninth Cavalry, 
 colored, was sick in Cuba with dengue fever, about twenty 
 days, beginning about July 14. Recovered only partially from 
 this before (beginning August 14) he had an attack of malarial 
 fever lasting fifteen days. During both attacks he had poig- 
 nant diarrhea. During the early stage of malaria the hemor- 
 rhoids appeared, with much pain, prolapses and bleeding. On 
 September 13, under ether narcosis, two internal hemorrhoids 
 were removed from the posterior wall of the rectum middle 
 line, and the right posterior quadrant. Patient's health much 
 impaired, anemia marked. 
 
 Case 63. — John HoUoman, age 22, Troop B, Ninth Cavalry, 
 colored, has always been in good health until the latter part of 
 July, when he had diarrhea for three days while on duty in 
 Georgia. Since then he has had pain on defecation, prolapse 
 of the bowel and sensation of incomplete evacuation, but no 
 bleeding. September 15, the patient was etherized and four 
 internal hemorrhoidal masses removed by clamp and cautery. 
 
 Case 64. — Abraham Hill, Company C, Twenty-fourth Infan- 
 try, colored, has been in the service twelve years. About eight 
 years ago he had hemorrhoids, which were operated on success- 
 fully. For the past three months, while on duty in Cuba, he 
 has been suffering great pain on defecation and slight bleeding. 
 Rectal prolapse at stool, always easily reduced. Has enjoyed 
 fair health and attributes the attack to the heat and dampness 
 of the Cuban climate. Operation under chloroform anesthesia 
 performed September 16. Three very large internal hemor- 
 hoids, located posteriorly and laterally, were removed in the 
 usual way by the clamp and cautery. 
 
 The cases related above are instructive in showing what kind 
 of surgery may be expected among soldiers who have partici- 
 pated in a campaign in a tropical country, subject to its indi- 
 genous diseases and debilitated by its climate, improper food
 
 228 
 
 and exposures. The results obtained must also counsel the 
 military surgeons to practice their art not only on the battle- 
 field, but also for surgical lesions caused independently of 
 wounds and so often overlooked in the field hospitals. I have 
 to record only two deaths, and both patients were operated on 
 in the wards of the general hospital, being too weak to be 
 transferred to the surgical ward. Both of them were low with 
 typhoid fever complicated by large metastatic abscess, in one 
 the parotid, in the other the submaxillary being involved. 
 One died the next day after incision and drainage, the other 
 on the third day. 1 am satisfied that many of our cases of 
 phlegmonous and typhoid abscesses would have died without 
 timely and thorough surgical interference. In many of the 
 other cases, more especially hemorrhoids and fistula, the oper- 
 ations performed will restore the men, with the aid of proper 
 general treatment, to their usual condition, and cut them off 
 from the pension list. In all aseptic cases the wounds healed 
 by primary intention, the best possible proof that good surgi- 
 cal work can be done in an operating- tent in the field, and with 
 very limited facilities for carrying out aseptic precautions. 
 Since writing the above paper, a number of interesting surgi- 
 cal cases have been operated on in the surgical ward, which I 
 will now report under the head of 
 
 MISCELLANEOUS CASES. 
 
 Case 60.— Edward J. Hill, aged 23, Troop I, Ninth Cavalry, 
 colored, enlisted three months ago. Painful tetanoid spasm 
 following gunshot wound of heel. About two months ago, 
 while in Tampa, accidentally shot himself through the left 
 heel with a Krag- Jorgensen carbine (30 cal. ), The bullet passed 
 transversely in an oblique direction through the os calcis. 
 There is no evidence of comminution of the bone, the contour 
 being well preserved and the surfaces smooth. While under 
 treatment for the wound, he thinks he contracted "rheuma- 
 tism in both loins." He has suffered twice from painful teta- 
 noid spasm of the gastrocnemius, the attacks lasting about 
 three hours, then subsiding as suddenly as they came on and 
 leaving the leg painless and useful. He entered the hospital 
 August 28, suffering from a third attack which lasted more 
 than twenty-four hours, subsiding suddenly during the night 
 after his admission. The gastrocnemius is firmly contracted, 
 the heel raised, and any attempt to extend the foot aggravated 
 the pain. No tenderness of heel or scars. 
 
 Case 66. — Wade H. Bell, age 21, Company A, Sixteenth In-
 
 229 
 
 fantry, enlisted May 23. He haubeen troubled with varicocele 
 for the past two months. It causes soreness and pain on walk- 
 ing any distance, incapacitating him for guard duty, and he 
 believes the difficulty is gradually increasing. He first noticed 
 the varicocele when he was sick first with malarial fever for 
 five days. Had three such attacks. Veins nearly the entire 
 length of the cord much dilated and tender on pressure. Oper- 
 ation by excision under chloroform anesthesia, September 5. 
 Transverse suturing of the external wound to shorten the elon- 
 gated scrotum. 
 
 Case 67.— James H. Hebel, age 21, Battery 3. Fourth Artil- 
 lery, enlisted three and a half months ago. Purulent ophthal- 
 mia and perforative keratitis. On Saturday, August 27, he felt 
 sensation of a foreign body in the right eye. The next day 
 profuse purulent discharge. On examination August 31, the 
 conjunctiva was found intensely swollen and vascular, dis- 
 charge of pus profuse, eyelids swollen and edematous, pupil 
 contracted ; beginning of ulceration near the center of the 
 cornea ; beginning pannus, intense photophobia. There is no 
 trace of gonorrheal infection. The treatment consisted of fre- 
 quent cleansing with boracic acid solution and application of 
 ice. Atropin could not be secured for three days. After that 
 time it was used in sufficient strength to dilate the contracted 
 pupil. In spite of all that could be done, the corneal ulcer 
 perforated and the anterior chamber of the eye was partially 
 evacuated. At this time the patient obtained a furlough and, 
 on his own responsibility, undertook the journey to his home 
 in Chicago. He was advised to place himself on his arrival 
 under the care of Professor Hotz. 
 
 Case 08.— George Slate, age 24, civilian. Habitual disloca- 
 tion of the left shoulder joint. This is the sixth time during 
 the last two years the accident occurred. Patient probably 
 under the influence of liquor when injured, as he does not 
 know how it happened. Became aware of the dislocation on 
 waking up in the morning. Several contusions on other parts 
 of the body were discovered. Dislocation of head of humerus 
 downward and forward underneath coracoid process of the 
 scapula. On request of the patient chloroform was adminis- 
 tered, and the luxation reduced very easily by extension and 
 rotation. The arm was immobilized by a Velpeau bandage. 
 Accident September 15, reduction the following forenoon. 
 
 Case (J9. — Peter Hansen, age 32, farrier, Troop L, First Cav- 
 alry, fell from stumbling horse September 15, in such a way 
 that he struck the ground with his left shoulder. He has 
 been unable to raise his arm since. Carries affected shoulder 
 lower than the opposite one. Pain and circumscribed tender- 
 ness over the clavicle about an inch from the acromio-clavic- 
 ular articulation. Patient somewhat obese, so that the distal 
 side of the clavicle can not be readily traced. Fracture of the 
 clavicle near the accromion process was diagnosticated, al-
 
 230 
 
 though no distinct displacement could be made out or crepi- 
 tus elicited. Arm supported in a mitella. 
 
 Case 70. — Edward Conean, age 24, Troop I, Ninth Cavalry, 
 colored. Enlisted four months ago. Admitted to the surgical 
 ward September 7, with swelling and extreme tenderness of 
 anterior surface of the left tibia. Previous diagnosis of osteo- 
 myelitis had been made. Xo history of injury. The swelling 
 is most marked over the central portion of the shaft of the 
 bone. The onset of the disease, the location and character of 
 the swelling and the nocturnal exacerbations of the pain left 
 no doubt as to the syphilitic nature of the periostitis. Inquiry 
 develops a history of primary syphilis four years ago. Has had 
 secondary eruptions and mucous plaques, etc., and at the 
 present time there is hyperplasia of the lymphatic glands in 
 all the principal accessible regions. 
 
 Rest in bed. elevation of limb, hot, moist, antiseptic com- 
 press and the internal use of potassic iodid in 15 grain doses, 
 four times a day constituted the treatment that was directed. 
 Under the iodid the pain and tenderness diminished, as well 
 as the swelling. A few days after his admission a small 
 fluctuating swelling could be felt in the center of the inflamed 
 area, but as no pus was expected the use of the knife was 
 refrained from. This superficial central softening is often seen 
 in gummatous swellings and will disappear under the treatment 
 the patient is receiving now. If absorption of the liquid con- 
 tents of the fluctuating swelling does not take place, tapping 
 and washing out with a 5 per cent, solution of carbolic acid 
 will be resorted to. 
 
 Case 71.— Ij. J. Torney, age '21, Troop D, Sixth Cavalry, has 
 been in the service two years and four months. Pressure paral- 
 ysis of radial nerve. While in Cuba was in the hospital three 
 days for chills and fever. He joined his command after his 
 discharge from the hospital and was quite well for three weeks, 
 when suddenly he became unconscious and was afterward 
 wildly delirious and had to be tied to a litter for safe trans- 
 portation. During this trip he lost the use of the extensor 
 muscles of the right hand. The paralysis remains complete, 
 otherwise the patient is in fair condition, although occasion- 
 ally the temperature rises to 102 F. The patient is not con- 
 fined to bed. The paralysis of the musculo spinal nerve was 
 undoubtedly caused by pressure during the transportation on 
 the litter. Massage and electricity were advised. 
 
 Case 72. — Thomas Clemens, age 21, recruit. Twenty fourth 
 Infantry, enlisted two months ago. Hydrocele of the cord. 
 Came to the surgical ward for diagnosis September 16. Six 
 months ago, while in the act of lifting a heavy box, was taken 
 rather suddenly with pain in the right side of the scrotum. 
 In a few days a swelling developed, the size of a hazelnut, which 
 has remained. The swelling is tender to the touch and is con- 
 nected with the cord about an inch above the epididymis. The
 
 231 
 
 swelling ie circumscribed and fluctuates distinctly. It was 
 diagnosticated as a hydrocele of the cord. 
 
 APPENDICITIS. 
 
 It is somewhat astonishing that, in these days of appendi- 
 citis rage, of the many thousand soldiers who have landed at 
 Montauk, not one case of appendicitis came under my notice 
 that would have justified an operation. We would naturally 
 expect that among such a large body of men, almost all of 
 them at some time during the last five months the victim of 
 intestinal affections, the appendix should have claimed its 
 good share of disease. The climate, the diet, the previous 
 intestinal affections contracted in Cuba, should have, accord- 
 ing to our ideas of the nature of appendicitis, combined in 
 exciting the disease. But such was not the case. The profes- 
 sion is well aware of the fact that surgeons who can see noth- 
 ing else but appendicitis in cases in which the patients com- 
 plain of pain in the right iliac fossa, have performed laparot- 
 omy, and these cases were not few in number, where as an 
 excuse for their error in diagnosis, they have completed the 
 operation by removing a normal appendix. Of the three cases 
 of supposed appendicitis sent to the surgical ward, in only one 
 the diagnosis proved correct, and this case was such a mild one 
 that an operation was not deemed justifiable. One proved to 
 be malaria, and the third typhoid fever. 
 
 Case IS. — Charles W. Dyer, age 19, Company K, Seventh 
 Infantry, has been in the service only six weeks. He was taken 
 sick September 11, and was transferred to the surgical ward 
 three days later. The attack commenced with a chill and 
 some fever, the following day pain in the right iliac region set 
 in. Bowels constipated, no vomiting, loss of appetite. Had a 
 similar attack a year ago, from which he recovered in a few 
 days. On his admission to the surgical ward there was slight 
 tenderness over the appendix and cecum, no tympanites and 
 no palpable swelling or muscular rigidity, temperature only a 
 degree above normal. Catarrhal appendicitis was diagnosti- 
 cated, complicated probably by a similar condition of the 
 cecum. Rest in bed, liquid diet and Ounce doses of equal 
 parts of castor oil and sweet oil, four hours apart, until the 
 bowels move, constituted the treatment, under which the 
 patient recovered in a few days. 
 
 Case 7i.— James Reid, age 21, Company I, Seventh Infantry, 
 has been in the service three months. Was admitted to the 
 surgical ward September 1, with the diagnosis of appendicitis.
 
 232 
 
 The clinical history, as well as his condition at the time of 
 admission, warranted a change in the diagnosis from appendi- 
 citis to typhoid fever. The temperature was erratic, showing 
 malarial complication, but the curve from day to day showed 
 the typhoid part to our satisfaction. The tongue was brown 
 and dry with red tip and margins. Pulse 100 and temperature 
 at that time varied from 101 to 105 F. Abdomen tympanitic 
 and great tenderness in the right iliac fossa. Numerous rose 
 spots appeared on the abdomen next day. Under appropriate 
 treatment the fever subsided gradually at the end of the third 
 week of his illness. .The great tenderness in the right iliac 
 fossa undoubtedly led originally to a wrong diagnosis, but it 
 simply indicated in this case deep typhoid ulcers in the lower 
 portion of the ileum. 
 
 Case 15. — Martin G. Norman, age 27, Seventh Infantry, 
 Company C, enlisted three months ago. On leaving Santiago 
 he began to feel bad with headache, anorexia and malaria ; 
 became worse ; lost sleep and complained of pain in the stom- 
 ach ; most severe on left side under costal arch ; bowels con- 
 stipated, tongue large, flabby, with indented margin. Spleen 
 markedly enlarged. At times has had pain in cecal region 
 which disappeared promptly after the administration of a laxa- 
 tive. Under quinin this patient improved rapidly. 
 
 STRICTURE OF THE URETHRA. 
 
 Case 16. — H. J. Ewing, age 54, Company A, Ninth Infantry, 
 has been in the service twenty-eight years. Admitted to the 
 surgical hospital September 12, and transferred the next day 
 to a hospital in New York, Has suffered from stricture of the 
 urethra for a number of years. Exploration with the olive 
 pointed bougie reveals a small and tight stricture in the mem- 
 branous portion of the urethra. The cause of the stricture is 
 a fall upon the perineum he sustained in 1864. Denies ve- 
 nereal infection of any kind. Of late years he has had at- 
 tacks of stoppage of the urine. The stream is small and mic- 
 turition frequent. Patient transferred to New York for treat- 
 ment. 
 
 Case 77.— Prank Hugh Banks, age 20, Ninth Cavalry, Troop 
 D, enlisted three months ago. Has had several attacks of 
 gonorrhea, the last, two months ago. The stricture for which 
 he was admitted to the surgical ward September 1 involved 
 the membranous portion of the urethra, was an old one and 
 was much improved before he was transferred on the 8th to 
 his command. By carefv' and prolonged attempts a No. 8 
 bougie passed the stricture. The treatment consisted of grad- 
 ual dilatation. 
 
 Case 18. —T. C. Mark, age 29, Thirteenth Signal Corps, en- 
 listed three months ago. Has stricture of the urethra dating 
 back to gonorrhea two or more years ago. Examination made 
 September 14 shows stricture half an inch back of the meatus
 
 238 
 
 A 14; another just in front of the scrotum admitting A 12. 
 Gradual dilatation wa3 commenced, but patient was trans- 
 ferred to a hospital in Boston two days later for further treat- 
 ment. 
 
 The few cases of gonorrhea, syphilis and stricture observed 
 in Camp Wikoflf speak well for the morality of our army. 
 
 ADDITIONAL CASES OF FRACTURE. 
 
 Two cases of fracture of the long bones occurring in men 
 belonging to the Cuban Army are of interest in showing im- 
 paired nutrition as one of the causes of delayed or non- union. 
 
 Case 79. — Hillyard H. Felder, age 44, packer, not enlisted. 
 Five weeks ago, in Cuba, fell from a freight wagon ; jumped 
 to save himself and landed on his feet in a small hole, twisting 
 his legs. He sustained a transverse fracture of the right tibia 
 about an inch above the base of the inner malleolus, and a 
 transverse fracture through the middle of the external malle- 
 olus. He came to the surgical ward September 14, the left 
 limb in lateral splints, the right in plaster of Paris bandage. 
 None of the fractures of the right leg have united, and there 
 are no signs of formation of provisional callus. Fracture of 
 left fibula united with some deformity. Patient is over six 
 feet in height and very much emaciated. Plaster of Paris 
 bandage renewed on right limb ; no dressing for the left one. 
 Operation for non-union of fracture of tibia advised as soon 
 as the patient's general condition is improved. 
 
 Case 80. — John Coleman, age 28, Irish, stevedore, employed 
 at the dock, Montauk harbor. Admitted during the afternoon 
 September 12, to the surgical ward. While handling lumber 
 was struck on right side of face by a crowbar handle set in mo- 
 tion by the slipping of a wrench. The accident occurred an 
 hour before his admission to the hospital. The patient was 
 unconscious and very restless. Right side of face swollen. 
 Two small wounds had been sutured before he entered the hos- 
 pital. Exophthalmos of right eye caused by retro-bulbar hem- 
 orrhage, divergent strabismus and dilatation of pupil, which 
 does not respond to light. Free hemorrhage from mouth ; no 
 hemorrhage or serum discharge from either ear. Through the 
 swollen part of the cheek the malar bone could be distinctly 
 moved and crepitus was distinct. Pulse 60. Xo paralysis. 
 Fracture of the malar and superior maxilla with extension of 
 lines of fracture through the base of the skull was diagnosti- 
 cated. On the second day the patient's condition was very 
 much improved but toward evening a rapid rise in temperature 
 led to a careful search for the cause of the fever. Professor 
 Delafield was called into consultation and found a right lobar 
 pneumonia. 
 
 Since leaving the camp I have been informed by Dr. Green-
 
 234 
 
 leaf that the pneumonia terminated in a typic crisis at the 
 usual time, and that the patient is recovering rapidly from the 
 injury. 
 
 Case 81. — Charles Lubbas, age 44, German, engineer. Frac- 
 ture of the clavicle. A week ago while at work as engineer on 
 the Vigilanc'ia, was struck on the right shoulder by a falling 
 plank producing a fracture of the clavicle at the junction of 
 the outer with the middle third. The fracture was oblique, 
 the internal fragment displaced upward and forward and some 
 overlapping. Reduction and Sayre- Velpeau dressing. Patient 
 was transferred the same day to New York. 
 
 ADDITIO>'AL CASES OF GU>'SHOT I>'JURIES. 
 
 Case 82. — Peter Carr, aged 40, sergeant Company F, Six- 
 teenth Infantry. In service 16 years and nine months. Was 
 wounded July 2 before Santiago. He fell down at once on re- 
 ceipt of the injury, and on trying to arise found that the left 
 leg was paralyzed both as to sensation and motion. He was 
 carried to the First Division Hospital where the wound was 
 dressed and he remained four days, thence to Siboney where he 
 staid three days before being taken on board Hospital Ship 
 Relief. He was landed from the i^e/ie/ at Governor's Island, 
 has had a furlough of thirty days and on Sept. 16 reported for 
 duty at Camp Wikoff, entering the surgical hospital Sept. 18. 
 Examination shows a vigorous looking man with partial paral- 
 ysis of left leg. There is a scar on the left side of the back 2i.2 
 inches from the median line and on a level with the second 
 lumbar vertebra. This marks wound of entrance of the ball 
 there is no wound of exit. The patient says the wound healed 
 very promptly with only slight discharge ; further that four 
 weeks elapsed before he could rest any weight upon the leg, 
 but he has been improving ever since and can now walk with a 
 cane. There is marked wasting of the extensor muscles of the 
 left thigh and marked impairment of sensation of the left foot 
 and leg. He says that occasionally the leg gives way in walk- 
 ing, especially if the toe strikes something above the level of 
 the ground. He can not raise it when flexed and states that 
 with much walking the knee swells. There has been no im- 
 pairment of function of bowels or bladder and no priapism. 
 
 In this case the ball probably passed transversely producing 
 contusion of the cord and bruising the roots of the spinal nerves 
 very near their origin ; it is probably lodged where it will do no 
 further harm. The man says the X-ray was used twice but the 
 result of examination was not reported to him. 
 
 Case 83.— B. F. Frazier, age 24, Company B, Twenty-fourth 
 Infantry, has been in the service eleven months. While in 
 action July 1, before Santiago, he received a wound of the 
 right hand, the bullet entering the web between the index 
 finger and thumb, passing through the ball of the thumb and 
 making its exit at the base of the adductors over the anterior
 
 235 
 
 row of carpal bones. No bone injury. The wound was packed 
 with gauze. The wound of exit healed in two weeks, the 
 wound of entrance has never closed completely and has dis- 
 charged from time to time a small quantity of serous pus. The 
 patient was admitted to the surgical ward July 15. Examina- 
 tion with the probe revealed the presence of a small metallic 
 body. During the preparation of the hand for operation a 
 small triangular fragment of metal was washed out of the fis- 
 tulous opening. Under anesthesia next day the wound was 
 again explored and the probe passed to a point underneath the 
 scar of the wound of exit, detected another piece of metal 
 which was removed by incising the scar, when a fragment of 
 lead much larger than the first was extracted. On scraping 
 out the fistulous tract with a small sharp spoon shreds of 
 gauze were removed. The bullet that inflicted the injury 
 must have been a deflected one, as otherwise no fragments of 
 lead would hsve been left in the wound. The gauze undoubt- 
 edly belonged to the packing used at the first-aid dressing. The 
 wound was dressed in the usual manner ; no provision for 
 drainage was made, with the expectation that it would heal 
 speedily by primary intention. 
 
 Case Si,— John Marks, age 22, Troop D, Sixth Cavalry, 
 enlisted five months ago. He was wounded in the charge on 
 San Juan Hill, July 1. The bullet cut the margin of the upper 
 posterior edge of the right ear, entered the scalp one inch 
 above and one and a half inches behind the right external 
 meatus, and emerged from the scalp three inches in a direct 
 line from point of entrance, probably making a superficial 
 groove in the external surface of the occipital bone. The 
 patient says he was taken to Key West while in an unconscious 
 condition, in which he remained two days. July 6 he was 
 operated on, the wound being laid bare by a curved incision 
 and a small piece of bone is said to have been removed. The 
 wound healed in a month. Scars healthy and not sensitive to 
 pressure. He complains now of attacks of throbbing pains from 
 back of head to eyes, three or four times a week ; the attacks 
 last sometimes half an hour. He does not complain of vertigo 
 or disturbance of any of the special senses. Whether the 
 symptoms are purely of a neurotic nature or whether they 
 depend on the injury must be determined by future observa- 
 tion. Potassic bromid was prescribed. 
 
 From the above report I have excluded minor cases that 
 were treated as out-door patients or inmates of the surgical 
 ward not of sufficient interest to have any material bearing on 
 the subject of this paper. This communication has been 
 written for the special purpose of pointing out to the profes- 
 sion, and more especially to the military surgeons, the nature 
 and sphere of surgical work in field hospitals at the end of a
 
 286 
 
 war. This completes my surgical work of this war, and I 
 return to civil life grateful to the authorities and my colleagues 
 for the kindness and many courtesies I have received at their 
 hands. 
 General Hospital, Camp Wikofif, Sept. 17, 1898, 
 
 1
 
 EMPYEMA IN CAMP GEORGE H. THOMAS. 
 
 The short, decisive campaign with Spain just ended 
 was characterized, from a medical standpoint, by the 
 smallness of the number of those killed in the field, 
 the prevalence of disease and the large number of 
 deaths from this source. The brilliant victories on 
 land and sea which forced Spain to sue for peace have 
 cost us so far over three thousand lives — less than 
 three hundred from the effects of bullets and over 
 two thousand nine hundred from disease. The num- 
 ber of deaths from disease will be increased materi- 
 ally, as the different military hospitals at home and 
 abroad still contain a large number of our sick, many 
 of whom will succumb to the diseases contracted dur- 
 ing the campaign. Even in case the hostilities are 
 not renewed, it is impossible to predict the total loss 
 of life at the present time, to say nothing of the 
 thousands who will never recover the health they 
 brought into the service. The unusual amount of 
 sickness which prevailed among our troops, in our 
 home camps and at the seat of war, can be attributed 
 to various causes. The call to arms came at a time 
 of the year when bronchial affections, pneumonia, 
 pleuritis and rheumatism are prevalent. In the State 
 camp of the Illinois troops cerebro-spinal meningitis 
 made its appearance during the first days of their en- 
 campment. Typhoid fever had its origin in our State 
 camps and followed our army to the National camps 
 and to the seat of war in Cuba and Porto Rico. The 
 accumulation of large armies and the prolonged en- 
 campments in localities which lacked a system of 
 sewerage, could not fail in promoting the local spread 
 of infectious disease. The invasion of Cuba occurred 
 during the rainy season, which had a deleterious effect
 
 238 
 
 on the health of the unacclimated troops, rendering 
 them more susceptible to the effects of the semitrop- 
 ical climate and the prevailing diseases. The trans- 
 portation facilities for the unloading of the transports 
 were utterly defective in furnishing the invading army 
 at the proper time with the necessary supplies. The 
 clothing of our troops was not adapted for the Cuban 
 climate. And, lastly, the necessary precautions to 
 protect the troops against yellow fever, which is always 
 found on the Cuban coast, where the landing was 
 effected, were not carried into effect. The command- 
 ing general had been fully advised by the Chief Sur- 
 geon of the Army in the Field, but the instructions 
 were ignored in the haste and tumult of the brief 
 campaign. A lack of a good knowledge of sanitation 
 on the part of many of the medical officers, and espe- 
 cially the inadequate policing of the camps, had their 
 influence in promoting the local spread of disease. 
 Amebic dysentery and malaria, the two tropical dis- 
 eases to which our troops were exposed in the south- 
 ern camps and in Cuba and Porto Eico figured 
 largely in the sick and mortality reports. The pre- 
 vention of these diseases was beyond the control of 
 the medical department. The ordinary camp diarrhea, 
 from which almost every participant of the war suf- 
 fered to a greater or lesser extent, I am satisfied, did 
 much to increase the receptivity of our soldiers to 
 typhoid fever infection. 
 
 Another matter of the greatest importance concern- 
 ing the health of our troops was the regulation gov- 
 ernment ration. The food selected and furnished for 
 the army in Cuba and Porto Rico was the same as 
 that which had been used in the North. Every one 
 who served at the front for any length of time must 
 be convinced that the emaciated, starved condition of 
 our soldiers who returned from Cuba, and who escaped 
 disease, was largely due to the nature of the food upon 
 which they had to subsist. The purchase of food at 
 the seat of war was out of question. Investigation 
 will undoubtedly prove that many of the canned meats
 
 239 
 
 did not contain the amount of nutriment claimed for 
 them. Fresh meat and black bread furnished the 
 continental armies are not only more palatable, but 
 also more nutritious than the canned meats and hard- 
 tack furnished our army. A careful inquiry into the 
 kind of food our occupation armies should be fur- 
 nished, is one of the most important duties of those 
 who are in charge of the commissary department. An- 
 other subject of special importance is the special diet 
 for the sick. 
 
 It is to be hoped that the medical department will 
 be consulted concerning these matters, and that the 
 recommendations made will receive the well- merited 
 attention of the military authorities. During my 
 service, I met one of our soldiers who served under 
 General Gordon in his advance on Khartoum, who 
 informed me that during that campaign the British 
 troops were supplied, on the whole, with much better 
 food than was the case in Cuba. England has bene- 
 fited by long experience how to conduct a campaign 
 in a tropical climate; we are novices in this kind of 
 warfare, but have learned enough during the last six 
 months to enable us to take better care of our troops, 
 should we again be called upon to conduct a war 
 beyond the limits of our country. 
 
 I have deemed it appropriate and advisable, in 
 accepting your kind invitation to deliver the address 
 at this annual meeting, to discuss briefly and from 
 the most practical standpoint, a surgical affection 
 which I had an opportunity to study in a most satis- 
 factory manner during my service at Chickamauga. 
 It is my purpose to occupy my allotted time by relat- 
 ing my experience with empyema in Camp George 
 H. Thomas. I was on duty as chief surgeon in that 
 camp for nearly four weeks during the months of May 
 and June. During that time the camp was occupied 
 by nearly 40,000 men, representing nearly all of the 
 States east of the Rocky Mountains. With the excep- 
 tion of one company of cavalry on guard duty, the 
 army was composed entirely of volunteers. The days
 
 240 
 
 were hot, the nights cool ; the midday temperature 
 frequently reached 98 to 100 degrees F. The drouth 
 which prevailed at that time rendered the roads dusty, 
 the clouds of dust being only settled occasionally by 
 showers of short duration. Camp diarrhea, dysen- 
 tery, cerebro- spinal meningitis, pneumonia and ty- 
 phoid fever were then the principal diseases we had 
 to contend with. 
 
 It is one of the complications of pneumonia — 
 empyema — as observed in Camp George H. Thomas, 
 that I desire to discuss this evening. Empyema rep- 
 resents the pathologic product of suppurative pleu- 
 ritis. Suppurative pleuritis is always the result of a 
 pyogenic infection of the pleura sufficient in virulence 
 to give rise to pus formation. In the absence of 
 traumatic causes it appears clinically and patholog- 
 ically either as an isolated inflammation of the pleura 
 or as a more or less remote complication of pneu- 
 monia. Bacteriologically speaking, suppurative pleu- 
 ritis can only result from the presence in and the 
 specific action upon, the tissues of the pleura of pyo- 
 genic microbes in sufficient number and virulence to 
 give rise to a suppurative inflammation. 
 
 Non- traumatic, suppurative pleuritis is a compara- 
 tively rare, isolated affection; in the great majority of 
 cases it presents itself as a complication of pneu- 
 monia. Recent investigations tend to prove that the 
 essential cause of pneumonia is either Frankel's pneu- 
 mococcus, Friedlander's bacillus of pneumonia (dip- 
 plo-bacillus) or the streptococcus pyogenes. Strep- 
 tococcus pneumonia, occurring either as a primary or 
 secondary affection, is characterized clinically by the 
 gravity of the disease and pathologically by the 
 tendency to pus formation. The microbes of pneu- 
 monia discovered and described by Frankel and 
 Friedlander are the bacteriologic agents usually 
 found in the inflamed tissues in croupous pneumonia. 
 Both these microbes possess feeble intrinsic pyogenic 
 properties, and when, during the pneumonic process, 
 abscess formation or suppurative pleuritis sets in, the
 
 241 
 
 complication occurs usually as the result of a second- 
 ary or Eoixed infection with pus microbes. Croupous 
 pneumonia is a self-limited disease, and when febrile 
 symptoms persist after a sufficient time has elapsed 
 for the disease to complete its typic cycle, it is usually 
 an indication that mixed infection has occurred, and 
 in this event it becomes the urgent duty of the 
 attending physician to look for, locate and determine, 
 if possible, the nature of the complication to enable 
 him to institute timely, appropriate therapeutic 
 measures. 
 
 In suppurative pleuritis complicating pneumonia, 
 the inflamed lung tissue is seldom involved in the 
 suppurative process. Resolution may proceed in a 
 satisfactory manner at the time and after the suppu- 
 rative pleuritis has set in, a fact which would tend to 
 prove that the parenchyma of the lung is more resist- 
 ant to the action of pyogenic microbes than the 
 tissues of the pleura, or that these microbes find their 
 way more readily to the pleura than into the pneu- 
 monic focus after secondary infection has occurred. 
 The complicating secondary pleuritis manifests itself 
 usually about the time the crisis is expected or a few 
 days later. It is evident that suppurative complica- 
 tions in cases of pneumonia would be likely to appear 
 in cases in which the tissues are rendered suscepti- 
 ble to the action of pus microbes and under circum- 
 stances which would supply the bacteria for the sec- 
 ondary, mixed infection. 
 
 Both these conditions were present and operative 
 in Camp George H. Thomas. The health of many of 
 the men encamped at Chickamauga was impaired 
 soon after reaching camp by the sudden climatic 
 changes, change of food, malaria and camp diarrhea. 
 Nearly all cases of pneumonia were characterized by 
 the gravity of the symptoms and a tardiness with 
 which resolution occurred. Camp Thomas was 
 located on the government reservation ten miles 
 south of Chattanooga. The ground is undulating and 
 in part well wooded. Numerous clearings and open
 
 242 
 
 spaces furnished excellent facilities for the drilling 
 and maneuvering of the troops. The National Park 
 is traversed by a sluggish stream, the Chickamauga. 
 Three regiments of cavalry and a number of batteries 
 were in camp during the month of June, the time 
 the five cases of pneumonia complicated by empyema 
 came under my observation. The ground is inter- 
 sected by numerous roads which during the season of 
 drouth which prevailed at that time, became covered 
 with inches of fine dust, which by driving of innu- 
 merable vehicles of all kinds, the marching of troops, 
 the passage of cavalry and artillery would rise in 
 dense clouds and by sudden gusts of wind would often 
 cover the entire camp. This dust was contaminated 
 by pathogenic microbes of all kinds, which could not 
 fail in finding their way into the air-passages of the 
 occupants of the camp. The dust was most abundant 
 near the roads on which there was the most travel, 
 that is, near headquarters. 
 
 It was not strange that most of the cases of pneu- 
 monia originated in localities where the dust clouds 
 were densest, filling the tents and kitchens and cov- 
 ering the food supplies. The dust had undoubtedly 
 some influence in the causation of pneumonia, and 
 more particularly in determining the frequency with 
 which it was attended or followed by suppurative 
 pleuritis. 
 
 Many of the soldiers left their State camps affected 
 by bronchial catarrh, which constituted a potent iDre- 
 disposing cause to pneumonia. This was particularly 
 true of some of the regiments from Illinois. Natu- 
 rally the first regiments arriving at Camp Thomas 
 were quartered near the great thoroughfares of travel 
 and those arriving later in more remote parts of the 
 camp. It is a noteworthy fact that those regiments 
 farthest away from headquarters were almost free 
 from pneumonia, while those nearest the center of 
 travel furnished the largest number of cases. The 
 cool nights, the lying on the moist ground and the 
 inadequate sui^ply of blankets did their share in serv-
 
 243 
 
 ing as potent exciting causes. Some definite infor- 
 mation in reference to the distribution of the disease 
 can be gained by considering the location of the divi- 
 sion hospitals, and the number of cases of pneumonia 
 treated in each one of them. The division hospitals 
 were located as near the center of the respective divi- 
 sions as possible. 
 
 The First Division Hospital was established on the 
 Lafayette Road, about three-quarters of a mile from 
 the headquarters of the corps. The Second Division 
 Hospital was established about two miles from head- 
 quarters and about one-quarter of a mile from any 
 principal thoroughfare, the Brotherton Road being 
 the nearest one. But few of the regiments of this 
 division were encamped on roads subject to much 
 travel. 
 
 The Third Division Hospital was located at the 
 junction of the Alexander's Bridge Road and the Jay's 
 Mills Road, about two miles from headquarters. Some 
 of the regiments of this division were quartered on 
 roads which were used by the wagon trains hauling 
 water, consequently frequently exposed to clouds of 
 dust. 
 
 During the latter part of May and the month of 
 June forty- six cases of pneumonia developed in the 
 First Army Corps. These cases were distributed 
 among the division hospitals as follows: Hospital at 
 Headquarters, 4 cases; First Division Hospital, 32 
 cases; Third Division Hospital, 10 cases. The Second 
 Division Hospital was not established until the mid- 
 dle of June, and from that time on until the end of 
 the month not a single case of pneumonia was 
 reported. Careful inquiry at the regimental hospi- 
 tals failed in finding a case previous to the establish- 
 ment of the division hospital. This was the division 
 encamped almost entirely away from any of the prin- 
 cipal roads, hence least subjected to dust-infection. 
 It will be noticed that 32 cases, or nearly 70 per cent, 
 of the entire number, occurred in the First Division 
 regiments. Out of these forty-six cases six died, or a
 
 244 
 
 mortality of 13 per cent. The six fatal cases came 
 from the First Division. In three of these fatal cases 
 death was caused by the progressive extension of the 
 septic pneumonia, and in the remaining three death 
 was caused by complications. In one case death was 
 attributed to a typhoid condition; in two to cerebro- 
 spinal meningitis. The septic nature of the cases of 
 pneumonia which developed in the First Division is 
 best shown by the frequency with which empyema 
 attended or followed the pulmonary disease. In this 
 division empyema complicated the pneumonia in nine 
 out of the entire number of thirty-two cases, equal to 
 28 per cent. Four of these cases were treated at the 
 Leiter Hospital and four at the St. Vincent's Hospi- 
 tal, Chattanooga. Five of these cases were operated 
 upon by myself: four at the St. Vincent's Hospital 
 and one at the Leiter Hospital. The following case 
 represents the pathologic conditions found in these 
 cases as well as the surgical treatment which was 
 resorted to in meeting the indications of the empy- 
 emic complication : 
 
 W. F., private, Third Ills. Vols., was taken suddenly ill 
 while on drill, May 30. The attack was initiated by nausea, 
 vomiting, dizziness and a sense of great prostration. On the 
 following day severe diarrhea set in, which, in connection with 
 persistent vomiting and intense headache, influenced his phy- 
 sician to transfer him to the division hospital. At that time 
 physical examination revealed a well-marked bronchitis. In 
 the evening he had a decided chill ; temperature 103. 
 
 June 1 he complained of severe pains in his chest and back, 
 cough dry and hacking, sputum tinged a rusty color. Diar- 
 rhea continues ; slight delirium ; temperature 99 in the morn- 
 ing, 103 in the evening. 
 
 June 2. Chest pains not relieved, sputum more deeply 
 tinged. Temperature varies from 101.5 to 103. 
 
 June 3. Diarrhea under control ; cough and expectoration 
 unchanged ; delirium and temperature about the same. 
 
 June 4. No material change in the condition of the patient ; 
 tongue dry and dark brown. 
 
 Daily examinations of the chest did not reveal any signs of 
 consolidation of the lung until June 6. At this time the mid- 
 dle and a part of the upper lobe of the right lung were found 
 consolidated. Temperature 102. 
 
 June 7. Patient delirious most of the time ; cough narass-
 
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 uJ-Ll. 
 
 lill 
 
 ;ill 
 
 Ml 

 
 246 
 
 ing, and copious expectoration of rusty sputum. Temperature 
 rose rather suddenly to 105, 
 
 June 8. Cough less troublesome, sputum more scanty ; sub- 
 jective symptoms improved. Patient was transferred to the 
 Leiter General Hospital, when on his arrival the temperature 
 was found to be 102.4. The medication at this time consisted 
 of strychnia in small doses, muriate of ammonia 5 grains every 
 four hours, alternated with 3 drops of turpentine. Under this 
 treatment the temperature was reduced Ifo degrees during the 
 first day, 2 degrees the second, and l^.y degrees the third day, 
 becoming normal June 11. Carbonate of ammonia was sub- 
 stituted for the muriate at this time. 
 
 From June 12 to 18 the temperature ranged one degree above 
 and below normal. The pulse, which had been 118 beats per 
 minute and feeble on his admission to the Leiter Hospital, 
 became fuller and stronger and diminished in frequency to 80. 
 
 June 19. Temperature suddenly rose in the afternoon to 
 102, pulse 96. 
 
 June 20. Examination of chest showed absolute dulness on 
 the right side, extending as high as the fourth rib. The 
 appearance of fever after a few days of complete defervescence 
 and the rapid increase of the area of dulness, displacement 
 of the apex- beat to the right, as well as a marked bulging of 
 the lower intercostal spaces, left no doubt of the existence 
 of empyema. The symptoms indicating the presence of 
 this complication were so evident that it was not deemed 
 necessary to resort to an exploratory puncture to verify the 
 diagnosis. 
 
 In all of the cases of pneumonia complicated by 
 empyema that came under my personal observation, 
 the disease pursued a very similar course to the one 
 described. The clinical symptoms were characterized 
 by their severity. The patient's general condition 
 left little doubt as to the septic nature of the original 
 disease. As in the case detailed, the suppurative 
 pleuritis commenced two to thre"e days after the pneu- 
 monic symptoms had subsided, its onset being 
 announced by a rise of temperature and the appear- 
 ance of local and general symptoms, suggestive of the 
 existence of a suppurative affection. 
 
 It is more than probable that in most of these cases 
 the pyogenic microbes, which eventually attacked the 
 pleura and caused the suppurative process, entered 
 the lungs at the same time and in the same manner 
 as the microbes which caused the pneumonia. The 
 
 1 
 
 1
 
 247 
 
 bronchitis and diarrhea which initiated the disease 
 were plain evidences pointing in this direction. In 
 some of the cases in which the pneumonia pursued a 
 more typic course, the subsequent suppurative pleu- 
 ritis was caused by a secondary mixed infection. All 
 cases of empyema which were subjected to operative 
 treatment were characterized pathologically by the 
 presence of an abundant fibrinous exudate, which 
 covered both the visceral and parietal pleurie, and, in 
 the form of large fibrinous masses, mixed with the 
 thick cream-like pus. The purulent accumulation 
 occurred rapidly, filling the pleural cavity in a very 
 few days. Displacement of the heart, enlargement of 
 the chest and bulging of the intercostal spaces were 
 the most significant local signs indicating the pres- 
 ence of a large quantity of pus in the cavity of the 
 chest. The right and the left sides were afPected with 
 about the same frequency. In one case the pleuritis 
 was limited, leading to a circumscribed empyema in 
 the left side. The abscess occupied the lower and 
 posterior part of the chest. In performing the rad- 
 ical operation in this case, a section of the tenth rib, 
 about three inches from the spinal end, had to be 
 excised. The location of the empyema was deter- 
 mined beforehand by systematic exploratory punc- 
 tures, the first two punctures yielding negative evi- 
 dence. As a rule, expansion of the compressed lung 
 followed soon after the operation, showing that reso- 
 lution had occurred before or after the pleuritic com- 
 plication appeared. 
 
 In some of the cases suppuration was scanty after 
 the operation; in others it was abundant. In the 
 former event a process of repair set in promptly ; in 
 the latter case it was retarded. The final process of 
 obliteration of the pleural cavity was accomplished by 
 granulation, cicatrization and cicatricial contraction. 
 Evacuation of the pus and drainage were always fol- 
 lowed by a fall in the temperature to normal, or 
 nearly so, accompanied by symptoms denoting rapid 
 improvement of the patient's general condition. In
 
 248 
 
 two of the cases the physicians in attendance were 
 misled in their diagnosis by the absence of fever. 
 The pleuritis was initiated as usual by a rise in tempera- 
 ture and other febrile disturbances, which subsided in 
 a few days, the patients feeling well with the excep- 
 tion of the complaint of embarrassment of the respi- 
 ration. In one case the respiration was so much 
 interfered with by the copious pleuritic exudate that 
 the lips were blue and the pulse almost imperceptible 
 — conditions which necessitated the performance of 
 the operation without an anesthetic. We relied in 
 this case on strychnia and whiskey to counteract the 
 immediate effects of the operation. In the absence 
 of such contraindications ether was used as an anes- 
 thetic, aided by the administration of some heart 
 stimulants immediately before the administration of 
 the anesthetic. 
 
 OPERATION FOR EMPYEMA. 
 
 The existence of an empyema in the adult is a suffi- 
 cient indication for the performance of a radical ope- 
 ration. Puncture and removal of the pus by aspira- 
 tion may succeed occasionally in mild cases of sup- 
 purative pleuritis in the case of children; seldom, if 
 ever in the adult. Operative treatment should be 
 instituted as soon as a diagnosis can be made. Unless 
 the signs and symptoms are conclusive, the diagnosis 
 should be verified and the pus accurately located by 
 an exploratory puncture, as was done in most of the 
 oases operated upon in Camp Thomas. Nothing is 
 gained and much is lost by postponing surgical treat- 
 ment until the accumulated pus has increased to the 
 extent of producing serious and often irremediable 
 compression of the lung on the affected side. The 
 plastic exudate, which is often copious, as in all the 
 cases forming the basis for this address, is another 
 source of danger in case the operation is not promptly 
 performed, as it creates conditions unfavorable to the 
 subsequent expansion of the compressed lung and 
 extenuates indefinitely the infection.
 
 249 
 
 In view of the pathologic anatomy presented by 
 the cases of empyema which constitute the basis for 
 this paper, it must be admitted that the only rational 
 treatment consists in opening the pleural cavity freely 
 and in establishing efficient tubular drainage. Inter- 
 costal incision and drainage do not enable the sur- 
 geon to remove the large fibrinous masses which play 
 such an important role in maintaining suppuration 
 and in preventing speedy obliteration of the pleural 
 cavity. The fibrinous exudate contains pus microbes, 
 and unless removed at the time the operation is per- 
 formed, serves as a nutrient medium for their growth 
 and reproduction and interferes mechanically with 
 pulmonary expansion and speedy obliteration of the 
 pleural cavity by granulation and cicatrization. One 
 of the important modern indications in the surgical 
 treatment of empyema is to remove the inflammatory 
 product as thoroughly as possible, and this can only 
 be done after opening the cavity sufficiently to remove 
 by mechanic measures the infected exudate. In 
 recent cases resection of two inches of one rib at a 
 point where drainage will be most effectual will afford 
 sufficient room to subject the pleural cavity to a thor- 
 ough removal of the inflammatory exudate. With 
 the exception of the case of circumscribed empyema, 
 we opened the chest in the axillary line where the 
 ribs are nearest the skin and usually resected the 
 seventh rib. With one exception, aspiration was per- 
 formed a day or two before the operation for the pur- 
 pose of securing partial pulmonary expansion before 
 admitting air into the pleural cavity. 
 
 Preliminary aspiration is of special value in the 
 treatment of large empyemic cavities. The surface 
 of the entire chest was thoroughly disinfected and 
 every care taken to carry out full aseptic precautions 
 during the operation. The opening of large pus 
 cavities is attended by great responsibility, and this is 
 more especially true in empyema, as secondary infec- 
 tion is liable to occur unless the operation is per- 
 formed under strictest aseptic precautions. If an
 
 250 
 
 anesthetic is given, the greatest watchfulness is re- 
 quired to guard against accidents. I always prefer 
 to perform the operation under partial anesthesia, and 
 I am very partial to strychnia and alcohol as valuable 
 adjuncts in minimizing its immediate and remote 
 dangers. 
 
 I place the patient partially on the opposite side 
 with the chest slightly raised, and the arm on the side 
 to be operated upon raised to the side of the head for 
 the purpose of increasing the width of the intercostal 
 spaces. I expose the rib to be resected by a slightly 
 curved incision with the convexity directed downward, 
 beginning the incision at a point corresponding with 
 the upper border of the rib, carrying it in a gentle 
 curve to the lower border, and terminating it at the 
 upper border at a point about four inches from where 
 it started. By reflecting the cutaneous shallow, oval 
 flap in an upward direction, the muscular covering of 
 the rib is exposed. A straight incision over the cen- 
 ter of the rib, about three inches in length, is then 
 made down to the bone. With an elevator the peri- 
 osteal envelope with the tissues attached to it is then 
 separated, taking care to lift out from its groove the 
 intercostal artery with the tissues to be reflected. 
 After laying bare the rib to the extent of at least two 
 inches, the rib is lifted forward with the elevator and 
 excised with a strong pair of bone- cutting forceps. If 
 the diagnosis is positive, all that remains is to make 
 an incision with the scalpel in the center of the peri- 
 osteal trough, large enough to admit the tip of the 
 index finger. 
 
 The evacuation of the chest contents should always 
 be done slowly ; this can be done most eflPectually by 
 interrupting the flow of pus from time to time by in- 
 serting the index finger into the pleural incision. After 
 evacuation of the pus and loose shreds of fibrinous 
 material, the pleural cavity should be carefully exam- 
 ined by direct inspection and digital exploration. 
 Plastic exudates attached to either pleura must be 
 removed as thoroughly as can be done with finger and
 
 251 
 
 a small gauze sponge held securely in the jaws of a 
 pair of long, preferably slightly curved, forceps. The 
 membranes should be removed by mopping and not 
 by the use of sharp instruments. Scraping of the 
 pleurae with a sharp spoon is superfluous and occa- 
 sionally detrimental. In acute cases I have often 
 noticed quite free hemorrhage from the pleural sur- 
 faces even after gentle efforts to dislodge the adherent 
 fibrinous exudate. Should troublesome hemorrhage 
 follow the procedure, packing of the pleural cavity 
 with one long strip of plain sterile gauze should at 
 once be resorted to. The space below the drainage 
 opening is packed first, and if the hemorrhage is not 
 arrested, the balance of the cavity is packed from 
 above downward. 
 
 Tubular drainage is the ideal method of draining a 
 suppurating pleural cavity. I use for this purpose 
 two fenestrated tubular drains, the size of the little 
 finger, about four inches in length and securely fas- 
 tend together with a large safety-pin. Drains have 
 been repeatedly lost in the pleural cavity for want of 
 resorting to this simple precaution. After inserting 
 the tubular drain, the external wound is sutured in 
 the usual manner. The curved incision, as described 
 above, not only exposes the ribs more freely than the 
 straight incision, as usually practiced, but it is also 
 much better adapted for prolonged drainage. 
 
 I never irrigate the pleural cavity the day the oper- 
 ation is performed. I do so later, provided suppura- 
 tion continues. In case irrigation of the pleural cavity 
 becomes necessary, care is necessary in the selection of 
 the antiseptic solution ; carbolic acid and corrosive sub- 
 limate in the usual strength are dangerous, and should 
 never be used. I make use of either a saturated solution 
 of the acetate of aluminium or Thiersch's solution. 
 Both of these solutions are efficient as an antiseptic and 
 non- toxic even when used in large quantities. The value 
 of the double drain is made apparent when it becomes 
 necessary to irrigate the pleural cavity. By placing 
 the patient on the opposite side, the fluid which enters
 
 252 
 
 the chest through one tube escapes through the other' 
 as soon as the cavity is full, thus washing it out thor- 
 oughly. By placing the patient on the affected side 
 the cavity is emptied, when the same procedure is 
 repeated until the solution returns clear. The solu- 
 tion used should always be heated to blood tempera- 
 ture, as irrigation with a cold solution is fraught with 
 danger. 
 
 The external dressing should consist of a thick 
 cushion of sterile gauze and absorbent cotton to 
 absorb the fluid as fast as it escapes, and to provide 
 the wound with a filter to prevent post-operative in- 
 fection. The best way of keeping the dressing in 
 place and to prevent the entrance of unfiltered air 
 into the cavity, is to substitute for the ordinary band- 
 age the rubber webbing bandage. Change of dressing 
 and antiseptic irrigation become necessary as often as 
 the dressing becomes saturated. For the purpose of 
 obviating frequent changes, the dressings should be 
 ample. 
 
 As the cavity diminishes in size the drains are 
 shortened from time to time, and sooner or later one 
 of them can be dispensed with. Premature removal 
 of the drain is often followed by relapse. Drainage 
 must not be suspended until the surgeon can satisfy 
 himself by careful examination that the pleural cavity 
 has become obliterated. 
 
 Should the lung fail to expand sufficiently in the 
 course of a few months to place the cavity in a condi- 
 tion for definitive healing, Schede's thoracoplastic 
 operation is the operation of choice, as Estlander's 
 multiple rib resection has not yielded the expected 
 results in the practice of many operators, including 
 my own. It is well for the surgeon to keep close 
 watch of the size of the cavity during the after-treat- 
 ment. It has always been my custom, at stated inter- 
 vals, to place the patient on the opposite side, then 
 fill the cavity with one of the antiseptic solutions used 
 for irrigation, then evacuating the chest by reversing 
 the position and measure the quantity of fluid re-
 
 253 
 
 moved. By recording the results of such measure- 
 ments, we are in a position to judge with mathematic 
 precision the size of the cavity, and determine whether 
 or not healing is possible without further and more 
 serious operative interference. Prompt and progres- 
 sive improvement followed the operation in all of mj' 
 cases of empyema operated upon in Camp Thomas. 
 In most of the cases suppuration was soon under con- 
 trol, followed by speedy pulmonary expansion and 
 permanent healing of the empyemic cavity by granu- 
 lation. In two of the cases a recent examination 
 made by Dr. A. F. Lemke showed that the patients 
 recovered their former health. 
 
 Our limited means of making a satisfactory bacte- 
 riologic examination of the inflammatory product 
 made it impossible to ascertain in each case the nature 
 of the microbic cause of the suppurative complica- 
 tion. In two of the cases, inoculation of proper 
 nutrient media resulted in an abundant growth of the 
 staphylococcus pyogenes aureus. I have but little 
 doubt that in most, if not in all cases, the suppura- 
 tive pleuritis developed in consequence of a secondary 
 infection with pus microbes, probably in most instan- 
 ces with the staphylococcus, as indicated by the clin- 
 ical course of the disease and the nature of the 
 inflammatory product. The etiologic relationship of 
 dust to pneumonia, and especially the pleuritic com- 
 plication, must be regarded as established by the facts 
 related above. 
 
 The influence of dust in the causation of pneumo- 
 nia and suppurative pleuritis acts in two ways in the 
 causation of these diseases: 1. The mechanical irri- 
 tation of the bronchial mucous membrane resulting 
 from the presence of ordinary dust renders the epi- 
 thelial layer of the bronchial mucous membrane more 
 permeable to the entrance of pathogenic microbes. 
 2. Pathogenic microbes, and in this case pus microbes, 
 are suspended in the dust and find with it entrance 
 into the air-passages. 
 
 The importance of early radical operative inter-
 
 254 
 
 vention in the treatment of empyema can not be 
 overestimated. The only efficient treatment in such 
 cases consists in opening the cavity of the chest freely 
 by rib resection, removal of inflammatory product and 
 establishing free tubular drainage, followed by safe and 
 efficient irrigation, should subsequent suppuration 
 demand it.
 
 ESCULAPIUS ON THE FIELD OF BATTLE. 
 
 Esculapius on the field of battle ! What an inspir- 
 ing sentiment at this time and on this occasion! Escu- 
 lapius, the fabled deity of medicine, engaged on the 
 battlefield in directing his faithful disciples in bring- 
 ing comfort to the dying and timely and efficient aid to 
 the wounded, is indeed an idea conveying the loftiest, 
 noblest, soul- inspiring subject. The disciples of Escu- 
 lapius have followed and served every army since man 
 has resorted to contest by force of arms to secure the 
 real or imaginary rights of tribes and nations. Every 
 battlefield bears testimony of their life-saving, human- 
 itarian work. When battles were fought hand-to hand, 
 and by the use of the most primitive weapons of war, 
 the Esculapians were there with their pots of boiling 
 oil with which to stanch bleeding, with their crude 
 instruments with which to extract arrows buried in 
 the flesh of the wounded warriors, and with their 
 bottles of wine and oil with which to dress the wounds. 
 Their practice has kept more than pace with the rapid 
 and wonderful improvements in the implements of 
 destruction employed on the battlefield. 
 
 It is a long time since civilized nations abandoned 
 the catapult for the cannon, and the small-caliber, 
 repeating breech-loader has taken the place of the 
 bow and arrow, but the disciples of Esculapius have 
 more than counterbalanced the increased horrors of 
 war by the marvelous advancements made in the sci- 
 ence and art of surgery. The battlefield has witnessed 
 many changes in the practice of military surgeons. 
 It was on the battlefield that Ambroise Par6 substi- 
 tuted the ligature for the cautery in arresting hemor- 
 rhage. It was on the battlefield that Hans Ryf, Baron 
 Larrey, PirogoflP, Guthrie, Nussbaum, Langenbeck,
 
 256 
 
 Esmarch, Stromeyer, Billroth, and a host of other 
 worthy priests in the temple of Esculapius, achieved 
 lasting fame. 
 
 Conservative surgery is the pride of the modern 
 Esculapian on the field of battle. The stacks of 
 amputated limbs that constituted such a gruesome 
 and constant sight after every great battle during the 
 Civil War, will never be seen again on the field of 
 battle where modern surgery is practiced. Aseptic 
 surgery has driven out of our military hospitals the 
 four greatest enemies of the wounded soldier: hospi- 
 tal gangrene, secondary hemorrhage, pyemia and ery- 
 sipelas. The probe, an instrument of torture, danger 
 and fallacy, has been abandoned for the X-ray in 
 locating bullets lodged in the body. The first-aid 
 dressing properly applied at the right time constitutes, 
 in the vast majority of cases, almost a sure protection 
 against infection of the wound. Under aseptic pre- 
 cautions penetrating gunshot wounds of the large 
 joints heal promptly, often without serious impair- 
 ment of the function of the joint. Many cases of 
 penetrating wounds of the chest and abdomen re- 
 cover without operative interference. Prophylaxis has 
 largely taken the place of operative surgery in the 
 field. Our recent experience in Cuba and Porto Eico 
 has demonstrated that the small-caliber rifle is a most 
 humane weapon. If the wounded survive the imme- 
 diate efPects of the injury the prospects of recovery 
 are good. Most of the wounds of the soft parts out- 
 side the three large cavities healed, with few excep- 
 tions, under one dressing in from ten days to three 
 weeks. What a contrast with the experience of the 
 surgeons during the Civil War only thirty-five years 
 ago! This wonderful improvement in military sur- 
 gery has been brought about through the labors of 
 the disciples of Esculapius during the last thirty 
 years. 
 
 Esculapius is unselfish and impartial in his work. 
 His deeds of mercy are dispensed alike to friend and 
 foe. He knows no creed, no politics. He is on the
 
 257 
 
 side of wrong as well as justice. He is loyal to every 
 flag hoisted on the field of battle. He rejoices with 
 the victorious, he sympathizes with the vanquished. 
 He loves and respects the uniform of every nation. 
 He is not anxious for war, but when war does come 
 he is promptly on the field and remains there as long 
 as a single soldier requires his services. He never 
 sleeps. His thoughts, his actions, are devoted to the 
 welfare and usefulness of the soldier. He is the 
 adviser of the well, the comforter and physician of 
 the sick and the good Samaritan of the wounded. His 
 disciples have always proved worthy of their noble 
 profession when engaged on the field of battle. They 
 have served on every battlefield without any prospect 
 or expectation of achieving undying fame, or even 
 receiving the gratitude due them from those benefited 
 by their services. Our histories of the world bristle 
 with accounts of heroism and daring exploits of fam- 
 ous generals, but how little do we find of praise of 
 the deeds of the disciples of Esculapius who faced all 
 the dangers incident to warfare, besides doing battle 
 daily with the Grim Reaper behind the fighting line. 
 The Esculapians on the field of battle belong to a 
 noble, unselfish, learned profession. It requires years 
 of hard study and a small fortune to acquire the nec- 
 essary knowledge to prepare them for their work. 
 They are men who in civil life would occupy a high 
 social position and enjoy a handsome income from the 
 practice of their profession. But the medical profes- 
 sion of all countries has always been intensely patri- 
 otic in times of war. The doctors always have been 
 and always will be the salt of the population. Their 
 education and training are of a nature to ensure qual- 
 ities necessary to citizenship of the highest type. The 
 practice of their profession, even in times of peace, 
 is admirably adapted to prepare them for the emer- 
 gencies of war. In the exercise of their duties they 
 encounter dangers and hardships foreign to the lives 
 of the average citizens. They brave epidemics far 
 worse than bullets, as far as danger to life is con-
 
 258 
 
 oerned, without fear of death. In cities devastated 
 by the scourge of yellow fever or cholera, when every- 
 body else that can leaves for a place of safety, the 
 doctors remain at their posts and minister to the sick 
 and dying without any expectation of a substantial 
 reward, or even the gratitude of their impoverished 
 clients. Day after day and night after night the 
 familiar modest conveyance, with its lonely occupant, 
 can be seen in the depopulated streets, wending its 
 way to the hovels of the poor on its errand of mercy. 
 
 No military surgeon has ever attained the fame of 
 the innumerable heroes who distinguished themselves 
 on the battlefield and whose deeds have been immor- 
 talized in prose and poetry. In rank, pay and social 
 position he has always been at a disadvantage as com- 
 pared with the leaders of armies. His greatest reward 
 always has been, and probably always will be, the 
 consciousness of having performed his duty to his 
 fellow- men. Will you not agree with me that the 
 doctrines as taught by Esculapius and as practiced by 
 his disciples are akin to the teachings of the Great 
 Master? If you do not, let us follow for one day and 
 one night the work of our Esculapian on the modern 
 battlefield. 
 
 The disciple of Esculapius is on the field before 
 the expected battle. He is a non-combatant and mod- 
 estly takes his place behind the fighting line. He 
 knows what is expected of him during the next day, 
 and makes the necessary preparations. During the 
 night the troops are rushed to the front and the line 
 of battle is completed. A deadly silence attends these 
 preliminary preparations for the next day's conflict. 
 From the commanding general down to the private a 
 sense of responsibility, uncertainty and suspense pre- 
 vails. With the dawn of the new-born day the deadly 
 conflict begins. The batteries furnish the prelude to 
 the impending battle, followed by the irregular firing 
 of the picket lines. The more regular cannonading 
 on both sides and the volleys of musketry announce 
 that the day's bloody work has begun in earnest.
 
 259 
 
 The uproar and tumult of battle has commenced. The 
 line of battle is advancing slowly. Our Esculapian 
 disciple is not idle for any length of time. He is near 
 enough the fighting line to observe the movements of 
 the troops, and within range of the fire. The singing, 
 whizzing bullets do not disturb his calmness. Shells 
 plow the ground around and about him, exploding 
 with a dull but terrific noise and sending their mes- 
 sengers of death in all directions. He takes position 
 in a sheltered place, where his patients will find pro- 
 tection from the fire of the enemy. 
 
 He is hardly ready for his day's work when the first 
 victim arrives. He has been conveyed to the rear by 
 friendly hands. A hasty examination shows that he 
 has been shot through the thigh. The trousers on 
 the injured side are soaked with blood. The garment 
 is removed and a stream of red blood locates the bul- 
 let-wound. The patient's face presents a deadly pallor, 
 his forehead is covered with a cold, clammy perspira- 
 tion. The hands are cold and the pulse at the wrist 
 is almost imperceptible. It is evident that the bullet 
 has injured a large blood-vessel and that life is rapidly 
 ebbing away from hemorrhage. The patient is con- 
 scious, but passive and listless. He does not realize 
 his own danger. All he complains of is a torturing 
 thirst and all he asks for is a drink of cold water. The 
 experienced eye of the surgeon takes in the whole 
 situation at a glance. He knows that prompt action 
 is necessary to ward off impending death. In less 
 time than is necessary to describe it, he applies an 
 elastic constrictor above the wound which arrests the 
 bleeding promptly, makes use of the first-aid package 
 to protect the wound against infection, administers 
 the necessary restoratives, pins the diagnosis tag to 
 the lapel of the uniform, satisfies his thirst by admin- 
 istering the contents of his own canteen, and hands 
 the patient over to the hospital-corps men, who bring 
 him safely to the ambulance station. 
 
 Before he has disposed of his first charge his ser- 
 vices are urgently demanded in his immediate vicinity.
 
 260 
 
 and he hastens to the new scene of catastrophe. A 
 young soldier has been struck down by a fragment of 
 a bursting shell which has almost completely severed 
 both legs just below the knee-joint. The patient lies 
 on the ground, motionless, with his sunken eyes di- 
 rected stolidly toward the overhanging blue sky. He 
 has lost but little blood, but his lips are pale and 
 slightly livid, the nostrils dilated, the skin of the fore- 
 head thrown into deep folds. The hands are cold and 
 the pulse at the wrist can not be felt. . The respira- 
 tions are irregular and sighing ; a long and deep res- 
 piration is followed by a number of shallow, imper- 
 fect expansions of the chest. The mind is clear, but 
 it takes repeated questions to elicit the simplest 
 answer. The unearthly brilliancy of the otherwise 
 expressionless, staring eyes clearly indicates the inev- 
 itable doom that awaits the wounded warrior. His 
 life is but the flickering light of a tallow candle to be 
 extinguished at any moment. The surgeon knows 
 that in this case the terrible injury will result in death 
 from shock. The patient is ignorant of the extent 
 of the injury sustained, and if he should happen 
 to see the cold, mangled, motionless legs, almost 
 detached from the body, he would not realize that 
 his life is in such immediate jeopardy. He makes no 
 complaint and no requests. In an almost inaudible 
 whisper he may ask for a drink of water. Home, 
 relatives and friends have become to him but a pleas- 
 ant dream. His mind is occupied by the experience 
 of the day, his ears are filled with the din and tumult 
 of battle, his eyes are still resting on yonder line of 
 battle he was approaching but a few minutes ago with 
 a firm- hope of victory when he, with several comrades, 
 was mowed down by the bursting shell. 
 
 The conscientious surgeon, recognizing the hope- 
 lessness of the case, feels that he has another mission 
 to perform. He ascertains the name of the wounded 
 and of the nearest relatives, and the address, and then 
 calmly informs his patient of what awaits him. For 
 a moment such information brings the patient's mind
 
 261 
 
 back to realities and, probably with a smile and look 
 of gratitude, he responds calmly to the questions. He 
 is made as comfortable as can be done under the cir- 
 cumstances, but before the setting of the sun his 
 spirit has left the mutilated body and joined the 
 peaceful army beyond the reach of human warfare. 
 The next mail carries with it a letter from the sur- 
 geon, in which he details the date and cause of death 
 of the gallant dead to his distant relatives. What- 
 such letters from the battlefield, conveying the last 
 message of the dying soldier, mean to the relatives, 
 can only be fully realized by those who have received 
 them. 
 
 As the heat of battle rises the number of wounded 
 increases rapidly. At the first dressing station they 
 are lying, sitting, standing, walking, awaiting the first 
 dressing. Our Esculapian is unmindful of the heat, 
 thirst and hunger, and hastens from soldier to soldier 
 to extend to as many as possible, and in the shortest 
 space of time, the blessings of the modern first-aid 
 dressing. 
 
 With the approaching twilight firing gradually 
 ceases, without any definite decision of the fortunes 
 of war on either side. On both sides the soldiers rest 
 on their arms, and under the cover of darkness satisfy 
 hunger and thirst. Tired to death from the day's 
 conflict, sleep overtakes them and the naked earth is 
 coveted as a luxurious couch. The work of the com- 
 batants has ceased for the day; that of the non- 
 combatants now begins in earnest. Many of the 
 wounded still remain on the ground, bleeding and 
 suffering from pain and thirst. The veil of darkness 
 is penetrated in all directions in search of them. The 
 faint voices here and there serve a useful purpose in 
 locating them. The dead remain where death reached 
 them. Many a litter-bearer's steps are made uncer- 
 tain by stumbling over the corpses which cover the 
 field. The crowd of wounded behind the fighting 
 line, at the ambulance station and in the field hospi- 
 tals grows larger and larger, and the cries for surgical
 
 262 
 
 aid become louder and more and more imploring. Can 
 the surgeon who has worked incessantly all day quiet 
 his conscience and satisfy nature's demand for rest, 
 follow the example of his combatant comrades, throw 
 himself on the ground and seek repose by surrender- 
 ing himself to the greatest of all charmers — sleep? 
 No! As long as his brain will do its duty and as long 
 as a single muscle will respond to his determined will 
 power, he will serve the wounded. 
 
 There are cases in which a prompt primary opera- 
 tion will save life. These are the cases who receive 
 his first attention. An operating-table is extempo- 
 rized, assistants are pressed into service, and with the 
 aid of a candle light the most difficult operations are 
 performed in the silence of the night, broken only by 
 the frequent moanings of the numerous wounded 
 waiting their turn for the operating tent, mingled 
 from time to time with the shrieks of those who have 
 become raving maniacs, and the stertorous breathing 
 of the dying. What an awful night for our poor 
 Escalapian who forgets his own wants and strains 
 every nerve to serve his fellow- men, and to do credit 
 to his profession and the country and flag that he 
 calls his own. Throughout the whole night he works 
 faithfully and incessantly, and with the break of day 
 he finds his task still unfinished, and the prospects 
 stare him in the face of a repetition of the previous 
 day's experience. The day work was hard and trying; 
 the night work reached the limits of human endurance. 
 
 Can you give me a more striking example of genu- 
 ine patriotism and heroism than the twenty-four hours' 
 work performed by our disciple of Esculapius on the 
 field of battle? If you can not, I can. It iathe same 
 Esculapian away from the bloody field in the fever 
 camp. It requires courage to face the enemy on the 
 field of battle. It requires courage to stand up in a 
 rain of bullets and in an atmosphere torn asunder every 
 few moments by shot and shell, but it requires more 
 courage to enter the silent fever camp, with its myri- 
 ads of invisible foes. The song of the bullet is sweet
 
 263 
 
 music compared with the silent, invisible microbes 
 that cause yellow fever, typhoid fever, malaria, dysen- 
 tery and camp diarrhea. 
 
 It is a privilege to die a glorious death on the battle- 
 field; no such halo of glory surrounds the death-bed 
 in the fever hospital. It is here that the greatest deeds 
 of heroism are witnessed. It is here where the true 
 manly courage of our Esculapian hero is put to the 
 severest tests. Let me ask you a plain, simple ques- 
 tion to test the correctness of the assertions I have 
 made, a question the significance of which, I fear, is 
 not fully understood: If left to choose for yourself, 
 would you not be more willing to engage in a battle 
 than to live and work in a camp filled with typhoid or 
 yellow fever patients? It would take me or any other 
 disciple of Esculapius not long to decide in favor of 
 the battlefield. 
 
 During the war just ended, the disciples of Escula- 
 pius have taken an important and noble part. Cow- 
 ardice is unknown in our medical department. Our sur- 
 geons have done their duty promptly and well. Escu- 
 lapius has watched their conduct and their acts. On 
 more than one occasion he shook his massive hoary 
 head in disapproval, not because of what they did, 
 but of what they could not do. 
 
 Esculapius has drawn his own conclusions from the 
 lessons of the war, and now suggests to you and to 
 the people of the United States and their representa- 
 tives in Congress the absolute necessity of a complete 
 reorganization of the Medical Department. He insists 
 that the rank of our Surgeon-General should be that 
 of a Major-General, that he should be clothed with 
 more executive power, and that he should have his. 
 own commissary and quartermaster's departments. He 
 is satisfied if these important changes in the organi- 
 zation of the Medical Department are made, that there 
 will be less suffering and deaths from disease should 
 we again be called upon to cross swords with another 
 nation. 
 
 In conclusion, permit me to ask you to listen to the
 
 264 
 
 voice of Esculapius in your efiPorts to efiPect a thor- 
 ough reorganization of the National Guard. The new 
 National Guard is destined to become the bulwark of 
 the fighting force of our country, which will never 
 imitate, much less adopt, the militarism of the totter- 
 ing monarchies of the old world.
 
 NURSING AND NURSES IN WAR. 
 
 One of the grave problems of modern warfare is 
 the proper care and nursing of the sick and wounded. 
 
 Our recent experience during the war with Spain 
 has brought the subject prominently to the attention 
 of the military authorities and the people of the 
 United States. The war just ended has furnished 
 the most instructive and forcible object-lesson, in 
 demonstrating the importance and necessity of making 
 adequate preparation for the proper care and manage- 
 ment of the disabled soldiers in war time. The 
 motives which precipitated the war were of the purest, 
 noblest kind, arising from the desire to bring freedom 
 and liberty to the legitimate owners of our neighbor- 
 ing islands, who, under the iron rule of an effete, bank- 
 rupt monarchy, had been deprived of their liberty, 
 happiness and prosperity for centuries. On our part, 
 the war spirit was aroused by a sense of duty to our 
 neighbors and to advance the cause of humanity on 
 our own hemisphere, and not for gain nor conquest. 
 It is not strange that our liberty-loving people re- 
 sponded so promptly to the call of the Chief Executive 
 for volunteers. It required no special foresight to 
 predict with certainty that a war with Spain, in Cuba, 
 would result in greater loss of life and suffering from 
 climate and disease than from the Spanish bullets. 
 The result of the war has shown that this expectation 
 has been fully realized. 
 
 The short, brilliant campaign on land and sea has 
 taught the outside world the strength of our arms, 
 and resulted in a victory over a foreign foe, which is 
 well calculated to stimulate the pride and patriotism 
 for our government and its various departments and 
 institutions. The war just ended was characterized
 
 266 
 
 by the humane treatment of our vanquished enemy, 
 and the desire on the part of the government and the 
 people to provide the invading army with all the 
 necessities and comforts compatible with active war- 
 fare. The war cloud came upon us so unexpectedly 
 that a certain amount of confusion and un prepared- 
 ness in the management of the campaign had to be 
 expected. Considering what has been accomplished, 
 we have every reason to feel grateful that the prize 
 secured was purchased at no greater cost of life and 
 suffering. It was our first experience in fighting a 
 foreign foe in a foreign land, and the many lessons 
 taught and learned will prove of the greatest value 
 should we again be called to cross swords with a nation 
 beyond the limits of our country. Many of the well- 
 founded complaints of the management of the war 
 arose, not from any dereliction of duty of the heads 
 of the different departments, but were due to a faulty 
 organization, and this is particularly true of the med- 
 ical department, which has been so severely criticised. 
 The executive power of the Surgeon -General is indeed 
 an extremely limited one. Everything of importance 
 has to pass through the hands and by sanction of the 
 Secretary of War. The Secretary of War is a busy 
 man in keeping track of what is going on in his de- 
 partment outside the Surgeon- General's office. Again, 
 the medical department depends entirely on the quar- 
 termaster's department in forwarding and distributing 
 medical and hospital supplies. No wonder that many 
 collisions between these departments occurred during 
 the war with Spain. Oar experience has taught us in 
 a most forcible way that the medical department 
 should have charge of everything pertaining to the 
 care of the sick and wounded, in order to accomplish 
 that for which it is intended. The Surgeon- General 
 should be given higher rank and be clothed with more 
 executive power, to enable him to discharge his duties 
 with credit to himself and greater benefit to those 
 who are now only nominally under his charge. The 
 Secretary of War is not supposed to possess much
 
 267 
 
 knowledge of sanitation, medicine and surgery, or 
 other wants of the sick and wounded, and yet the 
 Surgeon-General is powerless in the execution of his 
 orders without his co-operation. If the forwarding 
 and distribution of the medical and hospital supplies 
 were directly under the control and management of 
 the medical department we would have heard less of 
 criticism regarding the scarcity of medicines and 
 hospital supplies. To ma'ke a department strong and 
 efficient it must be independent, and invested with 
 the necessary power it is expected to wield, and charged 
 with a corresponding weight of responsibility. 
 
 The proper care of the sick and wounded in war is 
 a subject as old as warfare itself. It is a subject that 
 has attracted the liveliest interest of the most famous 
 and successful commanders, and that has taxed 
 severely the ingenuity and mental resources of the 
 most famous military physicians. The soldier who 
 risks his life in the defense of the honor of his coun- 
 try, when disabled from duty by wounds or disease, is 
 entitled to the most humane treatment and the best 
 of care on the part of those in whose charge he is 
 placed. The moment he is disabled from performing 
 his duty he comes under the care of the medical de- 
 partment, subject to its rules and regulations. The 
 transportation and proper care of the sick and wounded 
 are under the management of the medical department. 
 The immensity of the labor which devolved upon the 
 Surgeon-General and his limited staff of assistants 
 during the war just ended must become apparent to 
 the general public, when we consider the enormous 
 number of the sick in an army of 300,000 men dis- 
 tributed from Porto Rico to Manila— nearly one- half 
 the circumference of the globe. Hundreds of the 
 recently enlisted men had to be detailed for hospital 
 duty and were placed in charge of the sick. No won- 
 der that among so many some proved absolutely use- 
 less in performing the trying duties of an army nurse. 
 Nursing in the army in times of war is an occupation 
 which is always attended by many difficulties, and
 
 • 268 
 
 particularly when the seat of war is in a foreign coun- 
 try. The unrest incident to the mobilization of troops, 
 the moving and erection of hospital tents, the limited 
 facilities for cooking and often for working, the occa- 
 sional overcrowding of the allotted hospital space, 
 the uncerta^'nty of supplies, are some of the incon- 
 veniences which the army nurse must expect to 
 meet and correct as far as lies in his power to do so. 
 Patience, obedience, perseverance and devotion to 
 duty are a few of the most essential virtues conducive 
 to satisfactory and successful nursing in war. The 
 army nurse, from the very beginning of his philan- 
 thropic career, places himself beyond the reach of any 
 glory and distinction to be gained on the battlefield. 
 His duties are more arduous and taxing than those of 
 his comrades of the line. Being constantly in contact 
 with infectious diseases he exposes himself to more 
 danger than on the battlefield. It requires more 
 courage to serve in a yellow fever or typhoid fever 
 hospital than to face the enemy on the battlefield. 
 The army nurse, with his inadequate pay and no rank, 
 has little else to expect but a full measure of ingrati- 
 tude. His greatest devotion and best efforts are never 
 fully realized and appreciated. If he is competent 
 and devoted to his work, his greatest satisfaction must 
 consist in the consciousness of duty well performed. 
 He is a Samaritan in every sense of the word, whose 
 sole object is to serve his disabled combatant comrades. 
 Few men are born with intrinsic qualities which con- 
 stitute an efficient successful nurse. A true nurse is 
 born, not made. Most male nurses lack the gentle- 
 ness of manner and touch which exercise such a sooth- 
 ing influence over the fretful, nervous, impatient 
 patient. The male army nurse should know something 
 about cooking to enable him to prepare some special 
 palatable dishes for the sick — an accomplishment 
 which but few can claim. To utilize the ordinary 
 army rations for this purpose requires tact and skill. 
 It is wonderful what can be made out of bacon, beans, 
 canned meat, hard tack, salt, gpices and water in the
 
 269 
 
 hands of one skilled in the preparation of special diet. 
 It is in this department of nursing that women excel 
 men beyond comparison. 
 
 It must be conceded on all sides that the nursing 
 in the field during the last war, as well as during any 
 of the preceding wars, done almost exclusively by 
 male nurses, leaves much to be desired. Many of the 
 men enlisted for this special purpose, others detailed 
 from the line for the hospital corps, lacked entirely 
 the necessary qualifications by nature and training 
 for such an important and responsible position. The 
 haste with which the war was planned and finished 
 precluded the possibility of making a careful selection. 
 The tact to make patients comfortable under the most 
 adverse circumstances is' rarely found in men. To 
 anticipate the wishes and carry out the directions of 
 the attending physicians, requires more knowledge 
 and training than belonged to the average hospital- 
 corps men. The hospital-corps men of the volunteer 
 forces, mostly new men in the service, did the best 
 they could under the circumstances, but their work 
 showed a decided lack of discipline and special train- 
 ing at a time when their services were most needed. 
 With additional experience many of them would come 
 up in a comparatively short time to the standard of 
 requirements. An earnest willingness to learn and 
 improve must be accorded to most of them. It takes 
 months of hard work to make a soldier; it takes a 
 much longer time to make a good nurse. The mem- 
 bers of the hospital corps of the regular army are 
 selected with great care, and are required to undergo 
 a thorough and systematic course of instruction, hence 
 they had an advantage over their comrades of the vol- 
 unteer forces, and acquitted themselves more satis- 
 factorily in the discharge of their duties. But every 
 medical ofiicer is conscious of the fact that even 
 many displayed shortcomings which were too con- 
 spicuous to be easily overlooked. The average male 
 nurse, in private, as well as in military life, works for 
 money, and not for the dignity and good standing
 
 270 
 
 of his profession, or the welfare of his fellowmen. 
 The sunny side of the hospital -corps service was to 
 be found in the transportation of the sick and wounded. 
 No fighting army in the world ever enjoyed better 
 ambulance facilities. No army is supplied more lib- 
 erally and with better litters and ambulances than were 
 in use during the recent war by our troops at home and 
 abroad; and no better or more efficient men could be 
 found anywhere than those who were j)laced in charge 
 of the transfer of our sick and wounded. The manner 
 in which our sick were conveyed from ambulance to 
 hospital and from hospital to ambulance, commanded 
 the attention and elicited the highest praise from our 
 foreign visitors. After my return from Porto Rico, 
 on my way from New York to Montauk, I was joined 
 by Lieutenant Commander Tomatsuri of the Japanese 
 naval medical service and two staff surgeons of the 
 German army, who, upon arrival at the camp, watched 
 with the greatest interest this part of the work of the 
 hospital corps. One of the German surgeons freely 
 admitted that our hospital corps men were far more 
 efficient in this part of their work than those of the 
 German army, and, what commended their work to 
 him the most was the gentleness with which the 
 patients were handled. He was astonished that a 
 hundred or more patients could be transferred with- 
 out hearing a rough or angry word, which he assured 
 me was rather the exception than the rule in the Ger- 
 man army. Hospital construction as witnessed by 
 these distinguished foreign observers of our war, 
 during the early history of Camp Wikoff, was another 
 source of surprise and admiration to them. It was 
 difficult for them to comprehend that in less than 
 three weeks excellent hospital accommodations were 
 furnished for nearly two thousand patients. I doubt 
 if any of the old countries, always in a state of armed 
 neutrality, could repeat what was accomplished by 
 our medical department in this direction. Our for- 
 eign observers will never forget the impressions re- 
 ceived in Camp Wikoff, with special reference to the
 
 271 
 
 transportation, care and treatment of the sick of our 
 returning army from Cuba. Such object-lessons are 
 best calculated to impress foreigners with the magni- 
 tude and resources of our country and the patriotism 
 of our people. 
 
 A new phase in nursing was initiated during the 
 last war by the use of hospital ships. The medical 
 department of the Army and Navy recognized at the 
 proper time the necessity of employing ships adapted 
 for the transportation of disabled soldiers from the 
 seat of war back to their own country, where they 
 could receive better care and nursing and escape a 
 prolonged stay in a malarial, semi-tropic country. The 
 hospital ships Relief, Solace and Missouri were the 
 means of saving hundreds of lives which, without 
 such means of transportation, would have perished in 
 Cuba and Porto Rico. The horrors enacted on some 
 of the transports are more than balanced by the com- 
 forts, and even luxuries the sick and wounded enjoyed 
 on these floating hospitals on their homeward jour- 
 ney. Nothing has done more in saving life and allevi- 
 ating suflPering than these messengers of mercy on 
 their hasty errands to and from the seat of war. It 
 was on these vessels that the nation's patients were 
 in the care of competent female nurses. Ask any of 
 the sick soldiers who returned on any of these ships, 
 and you will find him ready to praise and bless the 
 female nurse under whose care he was placed on his 
 return from the seat of war. He will always remem- 
 ber with gratitude her gentleness and devotion to 
 the sick under her care. During the four trips I 
 made on the hospital ship Relief, to and from Cuba 
 and Porto Rico, I had ample opportunity to compare 
 the work of the male and female nurses, and I have 
 no hesitation in speaking in decided terms in favor 
 of the latter. Nursing is woman's special sphere. 
 It is her natural calling. She is born a nurse. She 
 is endowed with all the qualifications, mentally and 
 physically, to take care of the sick. Her sweet smile 
 and gentle touch are often of more benefit to the
 
 272 
 
 patient than the medicine she administers. The 
 dainty dishes she is capable of preparing, as a rule, 
 accomplish more in the successful treatment of dis- 
 ease than drugs. Her sense of duty and devotion 
 to those placed under her care are seldom equaled 
 by men. The sick soldier, far away from home, rela- 
 tives and friends, realizes keenly the superiority of 
 female over male nurses, and especially so, if his 
 illness is tinged, as is often the case, with homesick- 
 ness. It is under such circumstances that the profes- 
 sional female nurse is greeted in camp, on board ship 
 and in the hospital as an angel of mercy, and every 
 look and move she makes are of the keenest interest 
 to the expectant sick. For the time being she takes 
 the place of the deserted wife, the loving mother or 
 the dear sister at the bedside. She watches the 
 progress of the disease by day and by night, and 
 her heart rises and gladdens with the approach of 
 symptoms denoting improvement: deep sorrow and 
 tender sympathy take possession of her when, in spite 
 of all her exertions, the shadows of death advance. 
 Woman is the natural nurse, and nowhere does she 
 appear grander or nobler than when she is minister- 
 ing to the sick and dying of an army in active war- 
 fare. The American woman, above those of any other 
 nation, is peculiarly well fitted for such a post of 
 duty. She is enthusiastic, energetic, tireless, devoted, 
 and, more than all this, intensely patriotic. Our sick 
 and convalescent soldiers owe a lasting debt of grati- 
 tude to the small army of female nurses who left their 
 homes with no expectations of pecuniary gain and 
 served their country in camp and field, in fever- 
 stricken districts, and in common with them, suffered 
 the privations incident to an active campaign without 
 a word of complaint. 
 
 The demand for trained nurses during the war with 
 Spain came suddenly and rather unexpectedly, owing 
 to the prevalence of typhoid fever in the National 
 camps and later by the return of the sick and wounded 
 from Cuba and Porto Rico. From the very beginning
 
 273 
 
 of the war the Surgeon- General's office was over- 
 flooded by applications for service in the hospitals 
 from all parts of the country. The material to select 
 from was enormous, but the task of making a careful 
 selection proved to be a difficult one. The Surgeon- 
 General was overburdened with the various details of 
 his important office and soon found it impossible to 
 attend to this part of his duties in person or through 
 his assistants. In his desire to supply the sick with 
 competent nurses he assigned this duty to Dr. Anita 
 McGee of Washington, who was commissioned act- 
 ting assistant-surgeon, probably the first time this 
 honor was conferred upon a woman in this country. 
 The services of Dr. McGee proved of the greatest value 
 in selecting from the thousands of applicants a suffi- 
 cient number of trained, competent female nurses for 
 duty in the hospitals at different points. The Amer- 
 ican Red Cross Society did excellent work, not only in 
 furnishing supplies of all kinds where and when they 
 were most needed, but also in supplying nurses when 
 emergencies arose. Miss Clara Barton, the Florence 
 Nightingale of this country, president of the society, 
 has performed her onerous duties during the entire 
 war with a devotion and earnestness that merit 
 recognition at home and abroad. She has been tire- 
 less in her efforts to bring comfort to the soldiers at 
 times when her service were most urgently in demand. 
 The State of Texas and the little steamer Red Cross, 
 under her command, made their appearance at Siboney 
 at a time when outside help was most required. Ice, 
 medicines, dressing and hospital supplies were freely 
 distributed among the sick and wounded. Miss Bar- 
 ton and Mrs. Porter, wife of the secretary of the Pres- 
 ident, went to the front, a distance of eight miles, over 
 one of the roughest roads imaginable, in an army 
 wagon, and extended the work of the Red Cross to the 
 very trenches before Santiago. A female nurse and 
 a number of male helpers ministered to the sick in 
 the Division Hospital in charge of Major Wood. I 
 found representatives of the Red Cross in El Caney,
 
 274 
 
 in the vestry of the old village church, dealing out 
 hardtack and flour to the hungry crowds of refugees. 
 After the surrender of Santiago the State of Texas 
 was the first vessel to enter its harbor on its errand of 
 mercy in bringing food for the hungry Cubans, and 
 medicines and delicacies for the sick of the victorious 
 and vanquished armies. The Red Cross Society 
 established supply depots in all of the large camps, 
 and the good work done everywhere will live in the 
 memories of all who were engaged in the conflict. I 
 was told by a representative of this society that in 
 Montauk alone for a number of weeks, supplies to the 
 amount of $2000 were distributed daily. The Red 
 Cross female nurses at Siboney did heroic work when 
 the sick and wounded of our army were in the great- 
 est distress. Several of these nurses were among the 
 first of the yellow fever victims, and had to be taken 
 to the first hospital for treatment. The sick and 
 wounded Spanish prisoners at Siboney were almost 
 exclusively cared for by the Red Cross. 
 
 Miss Barton has the confidence of the American 
 people, and she has sustained it through the present 
 war by the thoughtful and timely distribution of the 
 innumerable and liberal donations to the society she 
 so well represents. After peace was declared, Miss 
 Clara Barton immediately sailed for Havana to bring 
 much-needed aid to the starving reconcentrados of the 
 long-besieged city, while her numerous helpers con- 
 tinued their faithful work in the home camps. The 
 work of the Red Cross received the moral and sub- 
 stantial support of the charitably disposed citizens 
 throughout the United States, and liberal donations 
 from abroad. Recent experience has again demon- 
 strated that this society is the most important auxil- 
 iary in war as well as other National disasters in bring- 
 ing prompt relief to the sufferers. It seems to me 
 that the Red Cross Society is the proper organization 
 from which to recruit the nursing force should we be 
 confronted by another war. This society should be 
 made stronger and extend its influence to every part
 
 275 
 
 of the country. Under the supervision of its repre- 
 sentatives, educated, trained nurses should receive ad- 
 ditional training preparing them for military service 
 and other emergency work. A list of names of nurse% 
 who had satisfied the proper authorities of their spe- 
 cial proficiency for this kind of work should be kept, 
 and the selection made from it, should a request be 
 made by the medical department for service in the 
 army. Provision for comiDetent male nurses for army 
 duty should be made by a more thorough training of 
 the hospital corps of the National Guard of the States, 
 a much neglected subject west of the Alleghany 
 mountains. In addition to this, it would be advisa- 
 ble to establish training schools for young men in the 
 principal cities of the United States, on the same plan 
 and for the same purpose as the Samaritan organiza- 
 tions in Germany. The training of such men should 
 be of the most practical nature, including the trans- 
 portation of the sick and wounded, first-aid dressing, 
 the art of nursing and cooking, with special reference 
 to diet for the sick. An education of this kind would 
 be of the greatest value and profit to the pupils as 
 well as the respective communities, and would be the 
 means of furnishing desirable material for the hospi- 
 tal corps in case of war and efficient aid in case of ac- 
 cidents and National catastrophies necessitating a sud- 
 den call for competent nurses. It appears to me that 
 such a school of instruction for Samaritans could be 
 made attractive and interesting to the pupils, and 
 would become a reliable source from which to make 
 selections for army nurses and the hospital corps. 
 
 The Sisters of Charity stood in the front rank of 
 volunteer nurses in the Spanish war as well as in 
 nearly all of the great wars during the last two hun- 
 dred years. It is the oldest and best working order 
 in the Catholic church. President McKinley became 
 familiar with their efficient and faithful services dur- 
 ing the Civil War and gladly accepted the offer of the 
 Order to furnish nurses, made soon after the war broke . 
 out. All of the principal hospitals in charge of the
 
 276 
 
 Sisters of Charity sent representatives to the front. 
 They were on duty in nearly all of the National camps 
 in Cuba and Porto Rico. The first six sisters were 
 •ent to the Naval Hospital, Portsmouth, Va., July 16. 
 The whole number of sisters on duty September 24 
 was 232. The annex and the surgical wards and oper- 
 ating tent at Montauk were exclusively in charge of 
 100 members of the order. Their work in that great 
 camp was a source of gratification to and admiration 
 by the medical officers and all of the visitors and 
 relatives of the sick. Several of these brave sisters 
 have gone to their final reward in the service of their 
 country, others are lying dangerously ill in the differ- 
 ent hospitals. Too much can not be said in praise of 
 this noble order, as it has always made itself felt in a 
 modest but most efficient way in all of the great wars, 
 without regard to nationality or creed of the contend- 
 ing armies. 
 
 Among the distinguished lay nurses special men- 
 tion must be made of Miss Chanler of New York.' I 
 met Miss Chanler in Ponce, Porto Rico, where she 
 did most excellent service in the military hospitals. 
 Her numerous patients will always remember with 
 deepest gratitude her arduous, unselfish work. The 
 Misses Wheeler, daughters of Major-General Wheeler, 
 accompanied their heroic father to Cuba, nursed him 
 when he was ill and labored earnestly among the sick 
 of his command. They continued their labor of love 
 at Camp Wikoff, where many a sick soldier owed his 
 restoration to health to their unremitting, tender care. 
 Diet kitchens were established at Camp Wikoff under 
 the supervision of Mrs. M. H. Willard of New York, 
 which proved of the greatest benefit for the sick and 
 convalescent soldiers. I take the liberty to quote 
 from a letter recently received from Mrs. Willard, 
 dealing with this subject: "For six weeks I was at 
 Montauk, representing the Red Cross Society Main- 
 tenance of Trained Nurses, which, together with the 
 Massachusetts Volunteer Aid Association, established 
 diet kitchens in connection with the General and
 
 277 
 
 Division Hospitals. On my arrival at Camp Wikoff 
 I found the kitchen department in a very serious con- 
 dition. The officers, doctors, nurses, orderlies and 
 employees, as well as the patients, were procuring 
 their food from a small wooden building, presided 
 over by an army cook, and everything in and around 
 the mess hall was in a dirty condition. Eice and oat- 
 meal were the principal diet for the sick, and this w^as 
 so often burned and badly cooked that the patients 
 were unable to relish or retain it. The first diet 
 kitchen was established August 27, and those at the 
 three Division Hospitals soon followed, and this, with 
 one at the Detention Hospital, made a system of five 
 kitchens, covering a radius of three miles, with a force 
 of fifteen cooks, several dieticians, ten volunteers and 
 twelve detailed men. These kitchens supplied care- 
 fully and scientifically prepared food for the sick and 
 convalescent, and the physicians and nurses were able 
 to procure for their patients, not only liquid diets, but 
 light and special diets as well. One of our prominent 
 physicians remarked that his patients were better fed 
 at Camp Wikoff than in any hospital in New York 
 City with which he had been connected. The Gov- 
 ernment soon realized the value of the work, and two 
 weeks after the opening of the kitchens they were 
 turned over to the officials, and from that time, with 
 no cost to private enterprise, the sick soldiers of all 
 the hospitals were served, not only with home-made 
 broths of beef, mutton and chicken, but also with 
 oysters, broiled chicken, tenderloin steaks, chops, jel- 
 lies, custards, etc." 
 
 This new enterprise in caring for sick soldiers de- 
 serves to be brought to the attention of the general 
 public and should receive the strongest encouragement 
 in the event of another war. 
 
 The different relief societies, National, State and 
 local, did noble work in aiding the Government in 
 properly caring for the sick and wounded. The names 
 of Miss Helen Gould, Mrs. Ellen Hardin Walworth, 
 and scores of other noble-minded, patriotic women
 
 Z<i 
 
 will always be prominently mentioned in the history 
 of the short, decisive war so gloriously ended. The 
 charity that has been practiced so boautifully and so 
 generally, must satisfy our victorious army that the 
 patriotism they can^ied into the field has been culti- 
 vated at home in words and action to a degree and 
 extent unparalleled in the history of the world. War 
 in a just cause begets patriotism, and nothing can 
 demonstrate this more clearly and forcibly than our 
 experience in the field and at home during the last 
 eventful six months.
 
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