A SICKLY LITTLE WAR: EPIDEMIC DISEASE, MILITARY CAMPAIGNS, AND THE SPANISH-AMERICAN WAR By Mark A. Youngren A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of History – Doctor of Philosophy 2016 ABSTRACT A SICKLY LITTLE WAR: EPIDEMIC DISEASE, MILITARY CAMPAIGNS, AND THE SPANISH-AMERICAN WAR By Mark A. Youngren Before the twentieth century, disease killed more people during military operations than enemy action. This was particularly the case when soldiers from the temperate regions of Europe and North America were sent to fight in the tropical regions of the world, where they faced a disease environment filled with pathogens against which they possessed no natural defenses. The fear of epidemic disease was a constant companion for senior commanders down to the lowliest soldier, affecting when, where, and how the war was planned, fought, and supported; it affected who was recruited to fight and the willingness of individuals to go to war; and as epidemics began it greatly increased the burden on supply and transportation systems while requiring more and more recruits to simply maintain the numbers available to fight. Despite this, many histories of conflicts fought during this era have treated disease as merely an environmental factor that reduced the fighting strength of each side, less important than the strategies, tactics, and weapons which have been the focus of traditional histories of war. As medicine improved from the humoral theories of the ancient world to the bacteriological revolution that ushered in the germ theory of disease, military commanders and doctors began to understand the disease threats, but even at the end of the nineteenth century that knowledge was frustratingly incomplete. The Spanish-American War (1898) was one of the last conflicts of this disease era – more than seven men died from a disease for every one killed by enemy action. This research is the first scholarly effort to place as much emphasis on the medical weapons available to fight or avoid disease as on the military weapons used to fight the enemy, combining medical and epidemiological history with military history to evaluate the decisions made by the senior American leadership in light of the new discoveries on infectious disease and the lessons learned from previous conflicts fought in tropical regions. It shows that many of the deaths from that war were avoidable given the information available to the decision makers; furthermore, the country came close to losing the critical Cuban campaign of the war due to epidemic disease and the failure to prepare for the known disease environment on the island. Doctors were still torn between the older theories of miasma and contagion and the newer theories of bacteriology and insect vectors, puzzled by viral diseases that failed to show a disease bacterium visible under the microscope. To the thousands of men that died from typhoid, dysentery, malaria, and yellow fever, the Spanish-American War was not a “splendid little war” but rather a “sickly little war” that found the military and medical leadership woefully unprepared despite the medical and military knowledge available to them. Copyright by MARK A. YOUNGREN 2016 Dedicated to my soulmate and fellow Ph.D. Who put up with 40 years of late-night, part-time schoolwork and more degrees Number six is the last one – I promise. v ACKNOWLEDGEMENTS Professor Thomas Summerhill, for supporting me from Day 1 Professor Michael Rip, for inspiring my research into the history of medicine Professors Kirsten Fermaglich and Peter Knupfer, for their patience with many delays Google Books, for digitizing most of the Spanish-American War vi TABLE OF CONTENTS LIST OF TABLES……………………………………………………………………..… x LIST OF FIGURES……………………………………………………………………… xi PART ONE: DISEASE AND WARFARE……………………………………. 1 CHAPTER 1 INTRODUCTION.………..…………………………………………… 2 CHAPTER 2 EPIDEMIC DISEASE...……………………………………………….. 27 The Evolution of Medical Science on Epidemic Diseases………………………. 27 Immunity – Innate and Acquired…………………………………….… 40 Disease and the Soldier………………………………………………… 45 Disease and Warfare – Effects on Military Planning and Actions..…… 49 Epidemic Diseases Affecting War……………………………………………….. 55 Cholera…………………………………………………………………. 57 Dengue…………………………………………………………………. 59 Dysentery………………………………………………………………. 61 Malaria…………………………………………………………………. 64 Plague………………………………………………………………….. 68 Smallpox……………………………………………………………….. 71 Typhoid / Enteric Fever………………………………………………... 73 Typhus…………………………………………………………………. 75 Walcheren Fever……………………………………………………….. 77 Yellow Fever…………………………………………………………... 78 Crowd Diseases………………………………………………………... 81 CHAPTER 3 INTERRELATIONSHIPS BETWEEN DISEASE AND MILITARY CAMPAIGNS ……………………….……………. 84 Combat Environmental Effects that Increase Disease Susceptibility……………. 87 Location………………………………………………………………... 87 Season………………………………………………………………….. 89 Diet – Food and Water…………………………………………………. 90 Sleep Deprivation and Fatigue………………………………………… 92 Cleanliness and Hygiene………………………………………………. 93 Prior Health and Prior Immunities…………………………………….. 95 Overcrowding………………………………………………………….. 98 Multiple Diseases……………………………………………………… 99 Effects of Disease on Military Campaigns………………………………………. 101 Where and When to Fight……………………………………………… 101 Duration (Length of campaign)………………………………………... 105 Recruitment and Choice of Troops……………………………………. 106 Medical Logistics……………………………………………………… 110 vii Morale…………………………………………………………………. 113 Asymmetry…………………………………………………………….. 114 Mobilization and Demobilization……………………………………… 116 Outcomes………………………………………………………………. 118 Conclusion……………………………………………………………... 119 CHAPTER 4 19th CENTURY MEDICINE AND THE DEVELOPMENT OF MILITARY MEDICINE……………………… 121 Early Imperial Medicine, 1500 – 1850…………………………………………... 122 Nineteenth Century Scientific Medicine and the US Military…………………... 145 Disease and Military Medicine…………………………………………………... 165 The US Army Medical Corps………………………………………………….... 175 Quarantine and the US Marine Hospital Service………………………………… 184 The State of Medical Knowledge in 1898……………………………………….. 188 CHAPTER 5 DISEASE AND MILITARY CAMPAIGNS – CASE STUDIES…...... 196 A Case Study of Failure - the Caribbean………………………………………... 199 General Case Study – The Caribbean, 1740 – 1815…………………… 204 Campaign Case Study – Saint Domingue……………………………… 207 Case Study – Conclusions……………………………………………... 212 A Domestic Case Study – the US Civil War……………………………………. 215 A Case Study of Possible Success – Africa……………………………………… 225 General Case Study – The European Conquest of Africa……………... 226 Campaign Case Study – The Third Anglo-Ashanti War………………. 231 Case Study – Conclusions……………………………………………... 242 Lessons Learned from Military History ………………………………………… 247 PART TWO: DISEASE AND THE SPANISH-AMERICAN WAR……….. 254 CHAPTER 6 THE ROAD TO WAR: THE UNITED STATES ON THE BRINK OF EMPIRE………………………………………... 255 The US Military and the End of the American Frontier………………………… 255 The US Army, 1865 – 1898…………………………………………… 258 The US Navy, 1865 – 1898……………………………………………. 266 The US Military: 1898………………………………………………… 270 War Plans………………………………………………………………………… 273 US Military Planners and Tropical Diseases, 1898……………………………… 284 CHAPTER 7 SPAIN AND THE DECLINE OF THE SPANISH EMPIRE……….... 288 The Spanish Empire ……………………………………………………………. 288 The Antilles……………………………………………………………. 290 Spain in the Pacific……………………………………………………. 291 Control of the Seas…………………………………………………….. 294 Spanish Colonial Insurrections………………………………………………….. 296 The Cuban Rebellions…………………………………………………. 296 The Philippine Rebellion………………………………………………. 313 viii The Road to War -The Cuban Question…………………………………………. 320 CHAPTER 8 AMERICA GOES TO WAR………………………………………….. 331 Mobilization – Navy……………………………………………………………... 333 Mobilization – Army…………………………………………………………….. 336 Potholes in the Road to War……………………………………………………... 357 CHAPTER 9 WAR IN THE CARIBBEAN………………………………………….. 366 The Spanish Fleet Arrives……………………………………………………….. 366 Planning for a Caribbean Land War……………………………………………... 376 CHAPTER 10 THE CUBAN INTERVENTION……………………………………… 388 The Spanish Situation………………………………………………………….... 388 The U.S. Cuban Campaign……………………………………………………..... 396 Disease and the Surrender……………………………………………………….. 417 Dying on a Foreign Shore……………………………………………………….. 435 CHAPTER 11 THE INDIRECT APPROACH: WAR AGAINST SPANISH COLONIES……………………………... 451 The War in the Philippines………………………………………………………. 451 The Manila Campaign…………………………………………………. 454 The Philippine Insurrection……………………………………………. 461 The Puerto Rico Campaign…………………………………………………….... 467 CHAPTER 12 BEHOLD, THE HORSEMAN OF PESTILENCE APPEARS……….. 476 Treating the Survivors – Cuba and Camp Wikoff……………………………….. 476 Evacuation and Recuperation………………………………………….. 491 "The Ghastly Echo of a Thinning and Dying Army Corps"………….... 511 We Also Served – Training and Typhoid in the United States………………….. 523 So bad it was impossible to walk……………………………………… 533 CHAPTER 13 THE END OF THE ERA OF DISEASE………………………............ 543 Ending the War………………………………………………………………….. 543 Walter Reed, William Gorgas, and the Defeat of Yellow Fever………………... 551 Lessons Learned – Disease and the Spanish-American War………………….... 556 The Study of War and Disease………………………………………………….. 569 APPENDICES…………………………………………………………………………… 571 Appendix A Morbidity and Mortality Reports………………………………………..... 572 Appendix B Correspondence…………………………………………………………… 575 Appendix C Bibliographic Essay………………………………………………………. 600 BIBLIOGRAPHY……………………………………………………………………….. 662 ix LIST OF TABLES Table 1: Routes of Transmission