Division of Disease Control and Health Protection

As preparation for war began it was decided that Tampa would be the port of embarkation for Cuba…As a consequence the largest number of troops in Florida were encamped there awaiting transportation to Cuba. Lesser numbers were camped at Jacksonville(Camp Cuba Libre), Fernandina, Miami and Lakeland…As in all wars, in this "splendid little war" as styled by the Secretary of State, John Hay, disease killed many more than bullets. The generally accepted statistics in this matter are those of the Surgeon-General. The period covered is May 1,1898 to April 30, 1899. Deaths from disease were 5,438 and deaths from battle wounds, injuries and accidents 968.

Perhaps the single most operative factor in this high disease rate was the haste with which the troops were assembled and encamped. There was simply not enough time to prepare for them. This was especially true for the estimated 100,000 men who streamed in the Florida encampments...major problems

…were provision of adequate food supply, water supply and human waste disposal…

Providing adequate quantities of safe and palatable water to troops in Florida was a major problem…early in the mobilization Surgeon-General Sternberg sent out a directive that all water used for drinking or cooking purposes should be boiled; however this directive was largely ignored by the line officers and soldiers alike…

Far and away the most difficult problem, the problem that was never satisfactorily solved, and the problem that caused most disease was the matter of human waste disposal. The rapid influx of troops precluded provision for adequate sewage disposal in most of the camps. The thin layer of surface soil at Tampa and Miami and the high water table in these areas made the standard Army latrine system largely unworkable…

Except in a very few instances the Army hospital in Florida were tent hospitals…The tent hospital consisted of multiple "wards," operating tents, mess tents and kitchen tents as well as tents housing the medical officers, nurses, hospital corpsmen and other personnel…Ideally such wards were floored with a wooden platform raised off the ground. At times because of haste to provide for the flood of sick soldiers or the delay in obtaining lumber, the wards were not floored. Indeed sometimes sufficient cots were not immediately available and the sick were forced to lie on the ground…

The complement of a division hospital was one surgeon and two assistant surgeons. Early in the campaign all nursing was performed by members of the Hospital Corps (all male) and soldiers detailed on a daily basis from the line… as the number of cases of typhoid fever mounted in the camps throughout the country, the need for the well-trained female nurse was evident. Trained female nurses were then hired as contract nurses for general hospitals, division hospitals, post hospitals and regimental hospitals. In all, contracts were made with 1,563 female nurses; 140 contracted typhoid fever and 12 died...the services rendered by these ladies and their outstanding performance played a large role in the establishment of the Army Nurse Corps…

..Many of the diseases encountered in the Florida Camps were those common to all armies…measles, mumps, chickenpox and whooping cough. Catarrhal jaundice (Hepatitis Type A or Type non-A/Non-B) was present among the troops in Miami and Jacksonville. Smallpox vaccination had been the custom of the Army since 1812 but it was not always carefully performed and vaccinia was not uncommon…Venereal disease was very common…

…the most frequent diagnoses to appear on the sick reports were diarrhea and dysentery…By far the most frequently fatal disease of the Florida camps was typhoid fever. In 1898 typhoid was endemic throughout the United States and the troops brought it to the encampments. Army medical officers were slow to recognize this disease and mistook it for malaria, typhomalaria, dysentery and other diseases….

When the Reed Commission came to Fernandina and Jacksonville as part of its nationwide investigation into the cause of the typhoid in the Army camps…They found in more than 90% of the volunteer regiments and all the regular Army regiments cases of typhoid fever developed within eight weeks of encampment. About one fifth of the soldiers in the national encampments developed typhoid fever. Of the typhoid cases the mortality rate was 7.61% and deaths from typhoid accounted 86.2% of the total deaths in the national encampments.

Many lessons were learned from the disease experience in Florida and camps elsewhere during the Spanish-American War that were to serve the nation well 18 years later with onset of World War 1. Among these lessons were the need for a more adequate Medical Corps with greater authority in sanitary matters, the value of trained female nurses to the Army, and the importance of compulsory typhoid vaccine innoculation…However by far the greatest lesson learned was the importance of adequate camp sanitation.