THE INVASION OF PORTO RICO FROM 
A MEDICAL STANDPOINT. 
BY 
NICHOLAS SENN, M.D., 
LIEUTENANT-COLONEL, U. S. V., CHIEF OF THE OPERATING STAFF WITH THE 
ARMY IN THE FIELD. 
FROM 
THE MEDICAL NEWS, 
September 17, 1893. [Reprinted from The Medical News, Sept. 17, 1898.] 
TH E / N l/AS / 0 N 0 F PORTO RICO FR 0 M A 
MEDICAL STANDPOINT. 
By NICHOLAS SENN, M.D., 
LIEUTENANT-COLONEL, U. S. V., CHIEF OF THE OPERATING STAFF 
WITH THE ARMY IN THE FIELD. 
The occupation of Cuba and the Philippine Islands by 
our conquering navy and army in such rapid succession 
seemed to increase the desire of conquest and opportuni- 
ties to test the strength of our arms. With the destruc- 
tion 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 murder- 
ous fire of our well-equipped 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 se- 
lected 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 give 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 people. Major-General 
Miles, who conducted the invasion 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 
possible. Every movement in this campaign was made 
with a due regard for the welfare and success of our troops rather than a desire for personal gain and aggran- 
dizement which characterized the Cuban campaign 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 observation he recognized the fact that the un- 
avoidable privations incident to war are multiplied many 
times when the seat of war is a strange and remote coun- 
try which presents a climate and environments unfamiliar 
to the invading force. His actions were clean-cut ad- 
missions that he was in need of a medical advisor 
and that they were influenced by the frequent consulta- 
tions held with the 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 an armistice had been declared reached the 
headquarters at Ponce, August 14th, 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. Colonel Charles R. 
Greenleaf, chief surgeon of the army in the field, accom- 
panied General Miles on his trip from Guantanamo 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 diseases which so constantly 
follow large armies, especially in a war of invasion. He 
was amazed when he saw to what extent yellow fever 
had broken out during the[few weeks the troops had been in 3 
Cuba. There was no difficulty in tracing the disease to a 
total lack of precaution on the part of the general in com- 
mand. Colonel Greenleaf had given his advice and direc- 
tions before the army left Tampa, but they were not 
heeded. Owing to want of cooperation on the part of Gen- 
eral Shafter the medical officers found themselves power- 
less in preventing and combating the dreaded disease. 
Colonel Greenleaf’s prompt and energetic action on his ar- 
rival in Cuba did much in suppressing the disease, but it 
was too late to guard against a general outbreak. The 
many recent graves in Cuba containing the remains of 
the victims of this disease are the best proof of what will 
happen when the leader of an army ignores the health and 
comfort of his men. In planning the Porto-Rican invasion 
General Miles availed himself of the invaluable services 
of his chief surgeon. The expedition was well equipped 
with medicines, hospital stores, and medical officers to 
meet all possible emergencies. The result has been that 
the army has been so far singularly exempt from disease 
with the exception of typhoid fever and the effects of heat, 
both beyond the control of medical officers. Since his ar- 
rival in* Ponce Colonel Greenleaf has been the busiest man 
in the army. He has not been content in simply issuing 
his orders from headquarters, but he has attended in per- 
son to the execution of every detail. He has visited the- 
camps, the hospitals, and exercised personal oversight 
over the distribution of hospital supplies, instruments, and 
medicines. Anxious to serve the sick and wounded, im- 
patient when face to face with a slow, hesitating subordi- 
nate, he has more than once performed temporarily the 
duties of an ordinary hospital steward to furnish a much 
needed object lesson. His work justifies the confidence 
imposed when he was appointed to the high and responsi- 
ble position he holds. 
General Miles landed with his expedition, which included 
FIRST SKIRMISH. 4 
a number of war-vessels, at Guanico, Monday, July 25th. 
The harbor was entered by the now famous little gunboat 
“Gloucester,” under the command of Lieutenant-Com- 
mander Wainwright. A landing was effected by thirty 
sailors, the Spanish flag was hauled down and the Stars 
and Stripes raised amid the cheers of the sailors who 
knew well that what they had just witnessed 
meant liberty and freedom for the down-trodden 
people of the island of which they had just 
taken possession. The planting of the flag and 
the deafening cheers which reechoed from the hills of 
the liberated island were followed by a volley from the 
hidden enemy, which was promptly responded to by the 
guns of the “Gloucester” and a Colt rapid-fire gun which 
had been taken ashore. The Spaniards fled in confusion 
and sought shelter among the adjacent hills, leaving four 
killed on the field, while our soldiers escaped without a 
scratch. 
The turn of the infantry came soon after landing 
in the form of a lively skirmish in which we lost one 
killed and fifteen wounded, of whom one died a day or 
two later. Most of the injuries were flesh wounds which 
healed in a remarkably short time. A very interesting 
incident occurred during this skirmish. The day was hot 
and our troops had to ascend a steep hill from the crest 
of which the Spaniards defended themselves. One of the 
volunteer soldiers, outrunning his comrades, advanced 
far ahead of his line, and when he had nearly reached the 
Spanish position was overcome by heat. He fell in a 
semi-unconscious state. A Spanish doctor rushed to his 
aid with a stretcher and two hospital-corps men, admin- 
istered the necessary restorative, and had him conveyed 
at once within our line. This one act alone goes to 
show that the Spaniards have often been unjustly ac- 
cused of being cruel and inhuman. This certainly has 
not been the case during the present war. From my own 5 
observations I am sure that they have respected the Red 
Cross. In fact the Red-Cross people of Porto Rico, com- 
posed largely of Spaniards, have shown the greatest ac- 
tivity and interest in their humane work during the entire 
campaign. If anything, they have rather been over zeal- 
ous, judging from the number of insignia displayed and 
worn. It was a common thing to see men wearing a 
white cap with an immense red cross on top, another one 
in front, besides the brassard. Ponce was taken and oc- 
cupied without any resistance 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 between Arroyo 
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 that of a soldier of the Third Illinois 
Infantry who was shot accidentally by an unknown 
man of the Fourth Pennsylvania Regiment. The bullet 
caused an extensive non-penetrating injury of the chest 
from the effects of which he died next day. Such acci- 
dents have occurred too 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 a few days later when I examined the wounded in 
the Brigade Hospital at Guayama. The third skirmish 
took place between the advance column of General Wil- 
son's Division on the march to San Juan and a small 
Spanish force entrenched on the summit of a high and 
steep hill. Lieutenant Haines, the son of General 
Haines, was the only one who was brought on board the 
“Relief” August 14th. One of the wounded was oper- 6 
ated on by Dr. Parkhill in an ambulance. The abdo- 
men was torn open by a fragment of a shell, the intes- 
tines 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. The 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 
Mayaguez on her way to New York August 15th. 
Such is a brief account of the casualities sustained by our 
army during the Porto-Rican campaign. The experience 
here coincided with that gained in Cuba to the extent of 
confirming the humane nature of the modern weapon. 
The proportion of killed to wounded is even smaller than 
in the Cuban war, as well as the number of seriously in- 
jured. Thanks to the more elaborate preparations for 
the campaign the wounded received prompt and efficient 
attention. The suffering of the well, sick, and wounded 
cannot be compared with what I saw in Cuba. War is 
a great educator and should we again be called upon to 
invade a foreign country, we shall profit by the experience 
of the past. 
TYPHOID FEVER IN 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 in- 
formed that in San Juan isolated cases occur from time to 
time. Malaria is prevalent in all the valleys, more espe- 
cially in and around Ponce. The large pendulous abdo- 
mens and the pale faces of the many little naked children 
in city and country are the best witnesses in showing the 7 
prevalence of malarial intoxication. Typhoid fever is en- 
demic in certain localities, but at present Ponce is almost 
free from this disease. Having seen the destruction of 
life and the indescribable suffering caused by yellow fever 
in Cuba, Colonel Greenleaf naturally turned his attention 
toward protecting our troops in Porto Rico against this 
scourge. The proximity of Porto Rico to Cuba, and the 
many possible sources of infection made such a course 
imperative. That this fear was not unfounded, and that 
the chief surgeon recognized the danger, and made use of 
timely precautions are best shown by the contents of a 
letter addressed to the Adjutant-General, Headquarters 
of the Army, and Circular No. 1 issued before 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 the 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 recom- 
mendations for the prevention, as far as possible, of the in- 
troduction 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 
command of the base of supplies, with authority to indi- 
cate the sites to be occupied by the various supply-depots 
and the hospital, 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 regula- 
tions for the government of all transportation and persons 
arriving and departing from stations by land. The officer 
should have authority to quarantine all suspected persons 
and means of transportation, and to disinfect their belong- 8 
ings either by fire or by 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 
disinfected. 
As woven goods, particularly those of woolen fabric, 
are special 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 
subject to punishment. 
That the commanders of regiments be instructed to 
prepare their camping-grounds with great care and main- 
tain a rigid police in them; under no circumstances shall 
they camp on ground that has previously been occupied 
either by troops or collective bodies of the inhabitants. 
That medical officers be required to make frequent in- 
spections of the commands to which they belong and that 
any suspicious 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, 
Charles R. Greenleaf, 
Colonel, Assistant Surgeon-General, U. S. A., Chief 
Surgeon, Army in the Field. 
Headquarters of the Army, Office of the Chief 
Surgeon, On Board U. S. S. “ Yale,” en route to 
Porto Rico, July 24, 1898. 
Circular No. i. 
i. Medical officers will, upon receipt of this circular, 
report to the chief surgeon of the army the number of 9 
medical officers, hospital stewards, acting hospital stew- 
ards and privates of the hospital corps on duty with their 
command. Also the number of ambulances, litters, and 
tents, and if medical supplies are insufficient, note the 
general character needed. This report will be made on 
the enclosed form: 
2. A field hospital will be organized at the army base 
as soon as possible after landing, and a depot of supplies 
will be connected with it. As we are widely separated 
from our source of supplies a strict economy in their use 
is necessary; surgeons of divisions and brigades will give 
their personal attention 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. 
4. The experience at Santiago has demonstrated the 
efficiency of properly applied first dressings in gunshot 
wounds; these should be left untouched until 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 neces- 
sity exists, surgical operation will not be attempted at the 
front. 
Chas. R. Greenleaf, 
Colonel, Assistant Surgeon-General, U. S. A., Chief 
Surgeon, Army in the Field. 
QUARANTINE REGULATIONS FOR THE BASE OF MIL- 
ITARY EXPEDITION TO PORTO RICO. 
1. Every vessel shall be officially visited by the in- 
spector before communication is made with other vessels 
or the shore. 
2. A vessel having yellow fever or smallpox on board 10 
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 following precautions: 
All fomites shall be disinfected by one of the following 
methods: Immersion for one hour in 1-1000 solution of 
bichlorid; sulphur fumigation in a chamber 24 hours, four 
pounds of sulphur being used for each 1000 cubic feet of 
space, or boiling half an hour with complete immersion. 
The following need not be disinfected unless directly ex- 
posed to infection: 
All new and dry material unpacked, all iron and steel 
implements, 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, bacons, spices, etc., kept dry, 
and not broken in an infected locality, do not require dis- 
infection other than the container, which shall be treated 
as fomites as above. Fruits, sound, unless exposed in an 
infected locality, need no disinfection. Live stock may 
be admitted. 
Such ships shall be thoroughly cleansed and disin- 
fected by the free use of 1-1000 solution of bichlorid, and 
by fumigation with sulphur before they may again receive 
men or supplies. 
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 
localities of infection, though they (the vessels) may hail 
from healthy ports, shall be subject to the same quaran- 
tine restrictions as vessels known to hail from infected 
localities. 5. Due precaution shall be taken to prevent infection 
of the base of supplies through communicating with in- 
fected localities along the line of march, by teamsters, 
and others. As far as possible they should not be al- 
lowed to remain at the base longer than necessary to load 
and unload, nor to come in such contact as to communi- 
cate infection. Stragglers, prisoners, and strangers 
should be immediately sent away. 
Charles R. Greenleaf, 
Colonel, Assistant-Surgeon General, United States Army; 
Chief Surgeon, Army in the Field. 
Major Woodbury was appointed sanitary inspector. 
He met with the hearty cooperation of the city authorities 
of Ponce in the performance of his onerous and often un- 
pleasant duties. The sanitary condition of the city un- 
derwent a great improvement in a few days. The water- 
supply was found satisfactory. The absence of a 
sewerage system threw many obstacles in the way. The 
appearance of smallpox in a village some distance from 
Ponce made vaccination necessary among the soldiers 
and natives who were not protected against the disease. 
An abundant supply of vaccine virus was on hand, and 
was at once issued and used. When I arrived at Ponce, 
August 7th, I found typhoid fever raging to an alarming 
extent. It was desirable to trace the origin of the dis- 
ease. The absence of typhoid fever during 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 oc- 
cupied by the troops before leaving for Porto Rico. Gen- 
eral Miles was very anxious to obtain reliable informa- 
tion regarding the origin and spread of this disease. Pur- 
suant to the following order I made an extensive and 
systematic investigation: 12 
Headquarters of the Army, 
Office of Chief Surgeon, Port Ponce, Porto Rico, 
August 11, 1898. 
Lieutenant-Colonel Nicholas Senn, Surgeon, U. S. V., 
Chief of Operating Staff of the Army. 
Sir: You will proceed to the town of Ponce, visit the 
military and other hospitals of 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 
the army, and report the result 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. 
Charles R. Greenleaf, 
Very respectfully, 
Colonel, Assistant Surgeon-General, U. S. A., Chief 
Surgeon, Army in the Field. 
I obtained accurate information of two hundred fever 
patients, of which number 90 per cent, were well marked 
typhoid fever, the balance malaria and the result of sun- 
stroke. I estimated the number of fever patients in 
Ponce and in the immediate vicinity at 250. In extending 
my inquiries to General Brook’s command, with head- 
quarters at Guayama, I found about 145 additional cases; 
however, in that locality malaria seemed to predominate. 
Most of the patients came from Chickamauga by way of 
Charleston and Newport News. The Second and Third 
Wisconsin Regiments furnished the largest contingent. 
Almost every soldier in the different hospitals belonging 
to either of these 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 locality 
from which these regiments came, when encamped at 13 
Chickamauga, must have been badly infected. 
As the result of my investigation, I reported to Colonel 
Greenleaf the number of cases found,and that in my opinion 
the disease was contracted in every instance 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 rec- 
ommend immediate evacuation of that camp. In Ponce 
most of the patients found shelter and care in the Spanish 
Military Hospital, 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 soon filled with patients. Miss 
Chanler of New York did excellent service as a nurse in 
the former temporary hospital. A congestion which oc- 
curred in the Military Hospital, and which could not be 
prevented, took place when General Wilson’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 remedied the next day when a 
large number of the more gravely ill were sent on board 
the “ Relief,” 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 “May,” brought an abundant supply, with 
many delicacies for the sick. Milk was bought and freely 
supplied to the sick. It was the intention of the chief sur- 
geon to establish an extensive outdoor receiving hospital 
as soon as the tentage arrives, which, according to infor- 
mation received from the Surgeon-General, was then on 
the way. The number of new cases of typhoid fever in the 
Porto-Rican army will probably be a limited one, as the 
victims of this disease were immediately separated from 
their comrades, and if the troops are recalled as soon as 
the treaty of peace has been signed we need entertain 
little fear of the indigenous spread of the disease. The Medical News. 
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