A Doctor's Memories
Victor C. Vaughan, M.D.

Table of Contents

Chapter 11

The Typhoid Commission

In reaching New York on my return from Cuba in August, 1898, I found an order to report to the Surgeon General in Washington. Within a few days the Typhoid Commission had been appointed, instructed and set to work. This Commission consisted of Major Walter Reed of the regular army, chairman, Major Edward O. Shakespeare, brigade surgeon, and myself as division surgeon.

For some days we went every morning to Camp Alger in Virginia nearby Washington, spent some hours in camp and hospital and our evenings in discussing the work assigned to us. It may be well to state the views we then held concerning the epidemiology of typhoid fever. Briefly, they were as follows: (1) Typhoid fever is a specific disease due to infection with the Eberth bacillus; (2) it is disseminated by the contamination of drinking water, or, as we said, it is a water-borne disease. Naturally, milk or other foods or beverages might be vehicles for its transmission; (3) it is not known to be transmitted through other agencies, though flies have been suspected; (4) it can be scientifically diagnosed by the agglutination test during life and by the pathological findings after death; (5) malaria, with which it is most likely to be confounded, can be diagnosed by the finding of the plasmodiumin the blood; (6) typhoid fever will be found to be most prevalent among those who are under par in health, especially among those who suffer from gastrointestinal disturbances; (7) the mortality from this disease will be found to be greatest among those manifesting these disorders. These were the views held by the most competent medical men at that time.

Our visits to Camp Alger gave us much concern. There we saw hundreds of cases which we believed, from the clinical symptoms, to be typhoid fever, but which were pronounced malaria by the majority of the physicians in attendance. Autopsies were not in favor at that time. Therefore we could not expect to get information from the dead. To order autopsies would increase the public furor which at that time was running high among the people. Besides, it would be best, since it could be done, to make the correct diagnosis during life. There was not a microscope in any camp. Indeed, there were but few medical men in this country in 1898 who could make the agglutination test for typhoid fever or recognize the plasmodium of malaria and there were still fewer of these in the army. An army diagnostic laboratory had never been thought of. Plainly the first thing to do was to determine the nature of the disease we had to deal with. We went to Surgeon General Sternberg and asked authority to establish a diagnostic laboratory in each camp. No man could have been more appreciative of this suggestion than the pioneer bacteriologist of this country, and we were given the authority asked. We were told to select the men to operate these laboratories and to spare no cost in equipment.

Doctors Gray and Carroll of the Army Medical Museum soon began diagnostic work at Camp Alger, transferring their equipment to Fort Myer when the troops left Alger. Later, Carroll was established at Jacksonville, Florida, and Assistant Surgeon Curry took charge at Fort Myer. Doctor George Dock of the University of Michigan made investigations at Chickamauga, Knoxville and Meade. Assistant Surgeon Craig took charge of the diagnostic laboratory at Sternberg Hospital, Chickamauga Park, when Doctor Dock left. Naturally it took some days to get these laboratories into operation and in the meantime the Commission must move on. We left Washington feeling that we were proceeding properly in our attempts to secure a correct, scientific and unassailable diagnosis of the disease. We recognized that our evidence when presented must be overwhelming. At Camp Alger some of the medical officers agreed with us that the dominant disease in their hospitals was typhoid fever, but these men were in the minority. The majority held to malaria and there was the bogie of typhomalaria which had come into existence in the Civil War and during the more than thirty years which had elapsed since that conflict had been accepted as a reality by many of the best in the profession. It is needless to say that we read and re-read and discussed time and again the history of the fevers in our armies in the sixties. I have condensed this information in my work on epidemiology.

The seventh army corps under the command of General Fitzhugh Lee was in camp near Jacksonville, Florida. The water supply for the troops and that for the city came from four artesian wells varying in depth from six hundred and thirty to one thousand and twenty feet. These wells were located between the city and the camps. Pipes carried the same supply in one direction to the city and in the other to the camps. The population of the camps and that of the city were each in round numbers thirty thousand. Civilians and soldiers drank water from the same source. We could find only seven cases of typhoid fever in the civil population at a time when each of the three division hospitals was receiving a score or more patients with this disease each day; it was evident that typhoid fever in the seventh army corps could not be water-borne unless the water became infected after leaving the city pumps.

By this time we were informed that our diagnosticians at Fort Myer and at Chickamauga were at work. The medical officers at Jacksonville, like those at Camp Alger, were at variance about the diagnosis of the disease; but the dominant designations were typhomalaria and malaria, the latter for the milder and the former for the graver cases. We explained the matter to General Lee and asked him to provide a commission of three or more from the medical officers of the camp, to instruct this commission to select fifty cases that they believed to be malaria or typhomalaria and to turn them over to us. This caused considerable grumbling which reached the line officers. I heard a division commander protesting against the order to General Lee. He said that three men had come from Washington, and full of conceit had questioned the diagnosis of the prevailing disease as made by the medical officers in charge. These Washington men had been on the ground only a few days and had studied the cases only superficially while the medical men of the corps had watched the development of the epidemic from the beginning and had observed every phase of the disease. His discourse ran along this tenor for some time and as I stood near and heard it I had to admit to myself the truth of much that he said. General Lee heard him with good humor on his face, but ended the monologue by saying that the order would stand.

We put the fifty men, thus selected, on a hospital train and sent them to Fort Myer. Carroll reported every case typhoid; no malaria; then the grumbling became louder. It was hinted that the laboratory men at Fort Myer were our creatures and made a report to suit our views. The first part of this insinuation was true, but the second was not. However, we determined to make the demonstration so strong that no one could question it. Therefore, we asked General Lee to instruct the board of medical officers to select one hundred and fifty more cases. This was done and we distributed them among all the best hospitals in Baltimore, Philadelphia, New York, Boston and Cleveland. From each and all of these came confirmation of Carroll’s report from Fort Myer. By this time Dock and Craig were sending in their findings from Chickamauga and from that time no one questioned the diagnosis of typhoid fever. Typhomalaria disappeared from the morbidity lists, not only in army sick reports but shortly in civilian records.

Another favorable condition for the study of the epidemiology of typhoid fever was evident in the camp near Jacksonville. The first division disposed of its fecal matter by water carriage. The installment for this purpose was crude in construction and faulty in operation, but the number of cases developed in the six regiments of this division was one thousand and thirty. In the second division the tub system of disposing of fecal matter was employed. By this method infected fecal matter was scattered all along the company streets and the roads. The number of cases of typhoid fever in the nine regiments of this division was two thousand six hundred and ninety-eight. In the third division regulation pits served as receptacles for fecal matter. In the seven regiments of this division there were one thousand two hundred and ninety-two cases. The tub system was immediately condemned. Water carriage was recommended. When the latter was not practicable it was urged that all fecal matter should be disinfected with freshly slacked lime, removed in odorless excavators and buried. For some years after the Spanish-American War this was done at many army posts.

It was at Jacksonville, if I remember correctly, that the idea of contact or, as we then called it, comrade infection began to obtrude itself upon us. There were certain companies and even certain tents that supplied more than their proportionate number of cases. Then we began a most laborious research which we did not complete until many months after our return to Washington. I shall go into some detail about this later. About this time also we began to be convinced that flies had some part in the dissemination of typhoid fever.

General Fitzhugh Lee

Our stay at Jacksonville was pleasant apart from our special duties. We were members of General Lee’s staff and enjoyed his mess and his stories, one of which I shall repeat since I have never seen it in print. After the surrender at Appomattox, Fitzhugh Lee on his way home was riding along a dusty lane. Seeing a farmer sitting on the rail fence he stopped and began conversation. General Lee: “The war is over.” Farmer: “I heard that but I don’t believe it.” General Lee: “Yes, it is over; Lee has surrendered.” Farmer: “I heard that too; maybe that little runt, Fitzhugh Lee, has surrendered, but Robert E. Lee, never.”

Among the regiments inspected at Jacksonville was the 3rd Nebraska whose colonel was the late Honorable William J. Bryan. As we were instructed to do, we found our way to the colonel’s tent, presented our credentials and asked him to join us in the inspection of his regiment. I shall only say that we found the sanitary condition no better than in other regiments. When we were through with the inspection Major Reed said to the colonel: “Shakespeare and Vaughan are on this commission because they know something of camp sanitation. I am here because I can damn a colonel,” and he proceeded in plain terms to speak of the responsibility of a commanding officer in looking after the health of his troops, and so forth.

A few days later General Lee reviewed the troops from a platform near the Windsor Hotel. He insisted on our standing on the platform with him. We stood back until a certain moment when Lee signified his wish for us to come forward, saying: “Here comes the 3rd Nebraska; salute the colonel as he passes.” This was the only hint we had that General Lee may have heard of the incident in the camp.

We went from Jacksonville to Chickamauga Park. This had been the largest camp in the country. During June and July, 1898, it had been occupied by two corps, sixty thousand troops, but before our arrival many regiments had been sent away.Some had gone to Porto Rico, some were sent to Newport News, and more recently large detachments had been transferred to Anniston, Alabama, to Lexington, Kentucky, and to Knoxville, Tennessee.

Nature has made Chickamauga Park an attractive place. That it is the stage on which one of the great battles of the Civil War was fought lends it a historic interest. In 1898 there was only one objection to it as the site of a great camp. The rocky surface made the digging of latrines difficult and the scanty soil, when thrown out in making the excavations, soon became hard clods with no absorptive property. There are within and about the park large springs and in 1898 the government might, at less cost than was actually expended, have carried an unlimited supply of pure water to every soldier and washed all his excrement beyond the bounds of the camp. I can not but feel that the engineer corps was largely responsible for the 1898 tragedy at Chickamauga, but the ignorance of camp sanitation at that time displayed by the army engineer was surpassed only by that of the line officer. It is true that the medical officer was not up to the times on this subject, but his recommendations were often regarded as unwarranted suggestions from an inferior and treated with contempt. A corps commander went ostentatiously daily to a well condemned by the medical officers and drank of its water. Fortunately for him he had doubtlessly drunk so much polluted water in his life that he had secured a high degree of immunity.

The frail rip-rap dam which was built to deflect the water of Cave Spring Branch, the open sewer of the camp, as it flowed into Chickamauga River was a travesty on sanitary and engineering skill. Besides, the pure waters of the springs were dipped by hands, often bearing infection, into headless barrels not free from the possibility of infection and hauled in wagons to the troops. Here the barrels were emptied by a repetition of the dipping process. There was testimony that men seeking absence without leave often rode in the empty barrels on their return to the springs. The result was that water supplies for regiments thus provided were always short and frequently exposed to specific infection. Some organizations were supplied with piped water which came from Chickamauga River but the intake was protected from the sewer only by the flimsy rip-rap dam already referred to and this was broken by the first heavy rain. In and near the park are a few shallow wells in a soil-traversed by fissures in the rock and subject to pollution from latrines. Such in brief was the water supply of the camp at Chickamauga Park in 1898. It was fortunate for us that we had studied the camps at Alger and Jacksonville before we came to Chickamauga; we never could estimate the extent to which typhoid was water-borne at this camp.

I have never seen so large an area of fecal-stained soil as that which we looked upon and walked over in Chickamauga Park in 1898. This area was a checker board, marked with woody spots of irregular contour and open spaces, some of which had known cultivation. The woody lands were smeared with alvine discharges. As I have said, most of the soldiers had been removed before our arrival, but even then one could not walk under the trees without soiling one’s shoes with human excrement. Behind every considerable tree it lay in heaped-up cones. The falling leaves and twigs did not suffice to hide it. The gentle winds had not wholly dispersed it; a hot September sun was drying it out. An occasional rain was sinking the pollution below the surface and down into the soil where the typhoid bacilli may retain their vitality and virulence for a long time.

At Chickamauga regiments came and went; many brought the infection; none left without it; no organization lingered within its precincts without contributing to the morbidity and mortality lists. With every considerable accession of new troops the flames of the epidemic flared up, consuming not only the newly added fuel but burning deeper into the charred logs. This phenomenon was noticed especially in certain Pennsylvania regiments, which originally consisted of only eight companies. Those in the park early had experienced-their first epidemic, when the additional four companies arrived. Soon the sick curve began to rise and both the new and the seasoned soldier contributed. This seems to be a frequent occurrence in military organizations. The recruiting of veteran organizations may be accompanied by greater loss than battles, and is always fraught with danger.

Regiments moved out of the park, leaving their grounds not only untidy but highly and dangerously infected. New regiments came in and occupied the vacated areas without attempt to clean up. Tents were in some instances pitched over scantily covered latrines. The rains washed the excrete of certain organizations into the company streets and even into the tents of lower lying ones. Nothing is more conducive to sanitary neglect than the expectation of “moving on” in a few days. What does it matter ? We are going to vacate these grounds to-morrow or next week. There were organizations at Chickamauga Park when we visited it in September that had been on waiting orders since May or June. “We are going to-morrow or at farthest next week to Newport News and embark for Cuba or Porto Rico or possibly for Spain.” It is deadening in every particular for an army to be on “waiting orders,” which never come. It breeds a psychological state of mind which begins in elation and soon settles down into an apathy which is destructive in its effect upon every man from the commander-in-chief to the lowest private in the ranks. The Treaty of Peace had been signed in Paris, August 14, and when our inspection was made, military pride had disappeared and every soldier was brooding over personal grievances. Add to this, the physical and mental effects of the deadly epidemic, prevalent in every camp, and it is not surprising that we found in every military organization a spiritless, despondent gloom covering the whole. There had been no peace treaty with disease and death.

The night after our arrival the commander-in-chief took me into a grove of trees and in a whisper asked if I knew the meaning of the Indian word Chickamauga. I did not. Then he said, “it means the river of death and this disease is not typhoid fever nor malaria. It is Chickamauga fever and is due to a miasma that arises nightly from the river and permeates the camp.”

I can not speak for the other members of my board but I admit, now after twenty-eight years, that I became in a way morbid. I have said something of the morbid fancies that invaded my brain cells in my struggle with yellow fever in Cuba in July. I had lost sixty pounds in this contest. I had been entrusted with the command of a hospital ship when I was too weak to go from one side of the deck to the other, save by crawling on my hands and knees. My experiences in Tampa Bay had not acted as a sedative on my over tense nerves. On the inspection tour I had managed to behave quite normally. At least I am sure that my comrades would not have testified to my insanity. I relished my food as I had never done before-although I have had only rare occasion to complain of the efficiency of my gustatory nerves or my digestive organs. An imperative diarrhea annoyed me and persisted in doing so.

When we were preparing to leave Washington the manager of the Southern Railroad kindly placed at our disposal a private car. It had a kitchen presided over by a most competent cook. His viands were well selected and tastily prepared. There was an obliging porter and we had separate bedrooms. The front end of the car served as our office and reception room and in it sat our competent stenographer. In short, we had every modern comfort in our journey. To me there was but one discomfort. That car had to stand at night at our stopping places in the switch yard with trains passing, bells ringing and whistles screaming throughout the long hours. At Jacksonville General Lee had been kind enough to permit our car to be brought to the vicinity of his headquarters. This gave relief for the time. But never since that time have I ridden on a train through the switch yards at Jacksonville or Chattanooga without a painful shudder.

At Chattanooga our car stood at the switch yard. We left it in the morning after a delightful breakfast and returned in the evening to a more abundant dinner. The first Sunday morning of our stay at Chattanooga I asked permission to rest for the day. I went to the Reed House, secured a room and went to bed swearing by all the gods that I would respond to no call until I had a good sleep. I had but a few minutes in bed before there was a loud knocking at the door. I tried to ignore it but it became louder and more peremptory. With an unspoken oath on my lip I opened the door. In walked William Lasley, who, while a student at Michigan, had gone through a long siege of typhoid fever during which I had served as his physician. I had forgotten that his home was in Chattanooga. He told me that his father’s carriage was waiting and that I was to go to his home. I went to the commodious house on the bank of the river, where my time until morning was divided between chats accompanied by smokes, sleeping and eating. I went back to my work greatly refreshed Monday morning.

But during the following days of our stay at Chickamauga I suffered much in both body and mind. As we rode in an ambulance through the camp, tramped the long corridors of the Sternberg and Leiter Hospitals with the crowded cots on each side, consulted with the officers, both medical and of the line, visited with and received the reports of my good colleague, Doctor Dock, in charge of the diagnostic laboratory, and planned our work, I really envied some of the more comfortable looking patients. Once in passing an empty cot I was sorely tempted to throw off my blouse and drop on it. But I was restrained by seeing the mental picture of my wife in the “cottage in the woods” at Old Mission holding before her the Detroit Free Press bearing on its front page the head line, “Major Vaughan of the Typhoid Board becomes a victim of the disease.”This braced me up and I went on with my comrades. When we had finished with Chickamauga and had spent a few days in getting statistics at the camp at Knoxville, I incidentally suggested to my comrades that we go to Asheville, North Carolina, and spend a few days in getting our papers in shape. They readily assented. By some means we succeeded in having our car parked at or near the Biltmore station. We employed an old, garrulous negro driver with an ancient carryall, and riding over this beautiful region we spent some days before returning to Washington.

In the memory chambers of my brain there hang many pictures. Some are the joy of my life, too sacred and too personal to describe to any save my most intimate friends. But there are also ghastly ones which I would tear down and destroy were I able to do so, but this is beyond my power. They are a part of my being and will perish only when I die or lose my memory. Some of these are hospital scenes. Two were painted on my memory walls during the inspection tour of which I am now writing. By some inscrutable device these pictures, although painted on the microscopic cells of my brain, are full lifesize and each shows hundreds of human figures. They are not pictures of still life, for I see every movement of each figure. Sometimes their eyes turn toward me or toward a comrade. In some, the eyes are full of meaning, bespeaking a brain in action; in others they are dull and staring, indicating benumbed or comatose intellectuality. Some faces show the hectic flush of high fever; some the pallor of approaching death; some of the figures are full and rounded, showing but slight departure from health; others are wasted and skeleton like; some are motionless; others are picking at the bedding or plucking imaginary objects from the air. All are prostrate on cots but some are attempting to rise and unreasonably impatient of restraint.These pictures are not all silent ones; some are gentle in their speech; others are violent and denunciatory; some are muttering in low delirium; others are shouting in wild mania. The pictures of which I am speaking just now are of the Second Division hospital at Jacksonville and the Sternberg Hospital at Chickamauga The colors in which they are painted are indelible, strong in contrast, without harmony; but always painful in their effects upon their possessor. The artist who painted these pictures is typhoid fever.

While I am engaged in describing the horrors of my memory picture gallery I might as well say something of the others, and then I will promise never to touch this grewsome subject again. A third picture is in some respects the most horrible of all. The figures are as numerous as those in numbers one and two, but all are children, mostly from five to ten years of age. Most are paralytic in one or more limbs, but this is not the most distressing feature. The paralysis is gradually extending to the muscles of respiration. Suffocation is advancing slowly but painfully and fatally. The little ones, as they pant for breath, turn their beseeching eyes to the doctor. They utter no word of complaint; but with their eyes they beg for help. The pump that brings the air into the lungs grows less and less efficient and finally stops; the lamp of life flickers, fades and goes out. This picture was painted on my memory walls as I stood in a ward of the Willard Parker Hospital in New York City during the great epidemic of infantile paralysis in 1916.

The fourth canvas is quite as large as the others. I see hundreds of young, stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full and yet others crowd in. The faces soon bore a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood. This picture was painted on my memory cells at the division hospital, Camp Devens, in 1918, when the deadly influenza demonstrated the inferiority of human inventions in the destruction of human life.

Such are the grewsome pictures exhibited by the revolving memory cylinders in the brain of an old epidemiologist as he sits in front of the burning logs on the hearth of his “cottage in the woods.” As he looks, he prays that his successors may be spared this infliction. I am growing sentimental and I have condemned this tendency. When I am detected I am ready to plead peccavi, but confession is not atonement.

At Chickamauga the agencies concerned in the transmission and spread of typhoid fever fairly obtruded themselves on our vision. I will briefly discuss them. It had been suggested that the house fly might be a vector in this disease. I do not know who first suggested this. In Circular Number One, issued by Surgeon General Sternberg under date of April 25, 1898, there occurs the following: “No doubt typhoid fever, camp diarrhea, and probably yellow fever are frequently communicated to soldiers in camp through the agency of flies, which swarm about fecal matter and filth of all kinds deposited upon the ground or in shallow pits and directly convey infectious material, attached to their feet or contained in their excrete to the food which is exposed while being prepared at the company kitchens or while being served in the mess tents.”

Our statistics show that the percentage of typhoid was much less among those who ate in screened tents. We sprinkled lime over the contents of the latrines and soon saw flies with feet whitened by the lime walking over the food on the mess tables. Later Doctor Alice Hamilton demonstrated by cultural methods the presence of typhoid bacilli in flies which had fed upon typhoid dejecta. This has been abundantly confirmed and Musca domestica has been pronounced guilty and is now figuratively dubbed “the typhoid fly.”

Our board estimated that the fly was responsible for about fifteen per cent. of the cases of typhoid fever in our camps in 1898. This was taken up by civilian health authorities, exploited in the press and has done much to reduce the number of these pestiferous insects and to render life more comfortable as well as safer from infection, not only with typhoid fever, but tuberculosis, diarrhea, dysentery, and so forth.

Had a conscious effort been made to demonstrate the epidemiology of typhoid fever it could hardly have been better staged than it was in Chickamauga Park. At first there were practically no trained nurses or hospital orderlies, either males or females. Before us every morning regiments were drawn up and so many men detailed from the ranks to serve in the hospitals as orderlies for the day. We followed these men to the hospitals and saw them handling bed pans in their awkward, ignorant way, often soiling their hands as well as the bedding, floors and the ground. At noon they went to lunch mostly without washing their hands, to say nothing of disinfecting them, handling their food and passing it to their comrades. A like demonstration was repeated at supper. The next day a repetition of this cycle was reenacted. Of course, the Board interdicted this show which had already been running for some weeks.

The men, both when off and on duty, soiled their feet in going through the wooded spaces and tracked the infection into their tents. In this way, the person, the food, the clothing, the bedding, and the tentage became the source of this specific infection. The members of the Board saw plainly that contact or comrade infection was the chief agency in the spread of typhoid fever in our camps in 1898 but they realized that their conviction would need to be verified by voluminous and reliable statistics before they could ask the scientific world to accept it. This meant a sentence for them to hard labor for an indefinite period. I shall return to this.

-Before beginning our statistical studies it was desirable that we have some idea of the minimum period of incubation in typhoid fever. We might be able to figure this out from the sick reports of the Pennsylvania regiments that had come to Chickamauga Park short and had received their additional companies on certain recorded dates, but it might be possible to get the desired information elsewhere. About this time fifty trained female nurses from Chicago arrived at Leiter Hospital. We were compelled to assume that all were free from typhoid infection when they arrived and began their hospital work. Each of these was carefully watched and the first came down with typhoid fever ten days after her arrival. Our conclusion was that the minimum period of incubation in typhoid fever is something less than ten days. This has been repeatedly confirmed. Many accidental infections with pure cultures have been recorded and in one instance, at least, a culture was swallowed with suicidal intent. It is true that the period of incubation in typhoid fever is not so constant as in measles, but the knowledge that it may be shorter than ten days has been of great service in the study of its epidemiology. Of course, with our present knowledge we would have vaccinated these girls and the probabilities are that all would have escaped the disease.

After a few days in Washington our Board went to Camp Meade near Harrisburg, Pennsylvania. Here the medical men, notified of our studies, had begun handling typhoid fever as a contagious as well as an infectious disease. Tents, bedding and clothing were disinfected and under these procedures typhoid fever rapidly decreased in the camps, some of which were continued for months. A short visit to Montauk Point, New York, preceded our inspection of Camp Meade. In the former we studied the diseases prevalent among the soldiers returned from Santiago, Cuba. Here we found not only typhoid fever but tropical malaria and convalescents from yellow fever. Later we studied the sick reports of the Fifth Army Corps, the army of invasion, but we did not include these findings in our final report, since our orders were interpreted as confining our work to diseases acquired in the United States. I admit that I was somewhat irritated by a statement coming from the Surgeon General’s office about the close of the World War saying that we had no medical report on the Spanish American War and not mentioning the work of the Typhoid Commission. I have regarded our report as the medical history of the Spanish-American War with the exception of those diseases acquired in Cuba, Porto Rico, the Philippines, those in our navies and the battle casualties. It is true that these are important omissions, but an official report of our medical histories that makes no mention of the work of the Typhoid Commission is certainly defective, and in memory of Majors Reed and Shakespeare I entered a protest.

Our term of sentence to hard labor began in October, 1898, and continued without intermission until the last of June, 1899. The place of our detention was the Army Medical School at Washington. We had before us the monthly sick reports of one hundred and eighteen regiments. From these, every name with rank and company was copied and arranged alphabetically. Each man was traced to a hospital and to final disposition. The records of twenty regiments were so defective that they were discarded. Of the remaining ninety-eight regiments we charted all of the sick in eighty-four, but some of these had been furloughed and it was impossible to follow the individuals. We appealed to the superintendents of civilian hospitals to which sick soldiers had been sent as shown by our records. Only one large hospital, Cook County, Chicago, declined to give us the information asked. However, we did get the data we wanted from this institution. When the superintendent declined to aid, we appealed to the members of the medical staff, prominent Chicago physicians, and they, at their own expense in both time and money, supplied us with the data. In sixty regiments all cases of typhoid, all short and long so-called malarial, and all diarrheas were charted according to the date of their occurrence. In the remaining twenty-four regiments only cases of typhoid fever were charted. In forty-eight regiments we traced the subsequent history of every man with a short diarrhea or supposed mild malarial attack in order to see whether these individuals afterwards showed an immunity to typhoid fever. Bearing on the theory of contact or comrade infection we located by tents and in the order of their occurrence every case of typhoid fever in a number of regiments, both in isolated, small camps and in the larger camps, both north and south of the Mason-Dixon line. These data were furnished by medical officers and by company commanders.

Having found the first case of typhoid fever we endeavored to ascertain where he acquired the disease and how he transmitted it to others. This necessitated our going back to his enlistment and making inquiries concerning the existence of the disease in the community from which he came. Local health officers and physicians, for the most part, came promptly to our aid. We were able to show that in 1898 typhoid fever was so widely distributed in this country that in the assembling of a volunteer regiment, about one thousand three hundred men, there would be from one to four men already bearing the infection. These brought the infection into the camp. In no case did typhoid fever originate de novo. This effectively killed the theory first formulated by Murchison, defended and strengthened by the teachings of Pettenkofer and accepted and elaborated by Davies and other medical officers in the British army, that typhoid fever originates in a ripening process in normal excrete deposited in the soil. It re-established the theory of Budd that there is no typhoid fever without a preceding infection and that typhoid fever is spread only by introducing the alvine discharges of an infected man into the alimentary canal of another man.Thus, apparently well but infected men brought the seeds of the disease into the camps, deposited these in the latrines or elsewhere in their discharges, soiled their own persons and clothing and thus communicated the disease to others.

War with Spain was declared April 21, 1898, when Minister Woodford was handed his passport at Madrid. At that time our regular army numbered 28,183 officers and men widely distributed in small posts throughout the country. This number was augmented to approximately 275,000, thus making about one regular to ten volunteers. The regulars with but little aid, probably with more detriment, fought the land battle at Santiago, the only big land battle of the war. After Dewey’s victory in Manila Bay there was but little for the army to do but to go in and occupy the country. The greatest contest was with disease. Why was this ? The greatest bacteriologist in the country was the Surgeon General. Why then were our camps without any scientific equipment ? On March 9, 1898, when war was inevitable, Congress appropriated fifty millions of dollars for “national defense.” This sum was placed at the disposal of President McKinley, but he could use it only for defense. It was spent liberally in coast defense, when any fool might have known that a Spanish soldier would never step on our shore save as a prisoner. Not only the medical department but the quartermaster and the commissary did not get a cent of the fifty millions of dollars. We have always boasted that we would fight only a defensive war. We still hear this foolish and hypocritical cry. The nation that prepares only for defense, prepares to lose. The exceptions to this rule are indeed rare.In our War for Independence, John Paul Jones and his comrades did not confine their operations to our own coast. In the war of 1812 we invaded Canada. The Mexican War was wholly aggressive. If the southern troops had followed up the rout at Bull Run, the fate of the Civil War might have been quite different. The Spanish-American War was offensive from start to finish and the nation paid dearly for the foolish congressional procedure. I think that no man saw more of the American soldiery in rank and file than I did, and, in my opinion, it consisted of the flower of the nation. How many potentially great men sleep in the graves of that war no one can estimate. Many of those who survived have demonstrated both in civil and military life their worth to their country.

During our inspections and the continuance of our work there was no lack of wise men who were willing to tell us the cause of the epidemics in the camps. Many said that it was due to the transfer of northern men to the south. To this we had only to point to the high prevalence of typhoid fever in certain regiments that never crossed the Mason-Dixon line.

Some said that it was due to the unwise selection of camp sites. There is no spot on earth so salubrious that man may not convert it into a hotbed for the breeding of disease.

Since Major Reed had many other duties, Shakespeare and I had to do most of the clerical and tabulation work. We spent the working hours of the day in the Army Medical Museum and the evenings in our rooms on K Street. Here we had a commodious workroom with a great table in the center. We spread out our sick reports and continued the work.I am a fair worker when I have a task, but at midnight I want to go to bed and I did so, invariably leaving my comrade at the table. I have never known a more persistent worker than Major Shakespeare.

In June, 1899, Shakespeare and I were informed that the finances of Uncle Sam were so reduced that he could no longer keep us on his pay-roll and we were discharged; I should say honorably. But this did not stop our work; we divided the remaining sick reports and went to our respective homes. We planned a temporary resurrection of the defunct Board at Atlantic City, June 2, 1900. I was on my way when I had a telegram announcing the sudden death of Major Shakespeare. I attended his funeral and returned home. In preparation for this meeting I had prepared an abstract of our report. This was published by the government, but I knew that a bare statement of our conclusions without supporting evidence. would not be convincing. In the meantime, Major Reed was carrying out his brilliant and successful researches on the transmission of yellow fever. Thank God! he lived long enough to see this work accepted and his name written among the great benefactors of his race.

Foreign governments began to ask that the report be published in full. Doctor Christopher Childs of the London Epidemiological Society came over and studied the manuscript with me. I owe much to his suggestions and generous help. In 1903 Congress, largely through the influence of Mr. Root, then Secretary of War, made an appropriation for the publication of the full report which appeared in two volumes, one of text and one of charts, late in 1904.These volumes were sent to the war departments of all nations. Some years later it was announced from Germany that Professor Robert Koch had discovered that typhoid fever is largely distributed by contact, giving the percentage of cases due to this cause at practically the same figures given by us. It is needless to say that this announcement did not mention our work begun ten years, and published four years previously. Since this is my autobiography it is my duty to disclose some of my vices as well as magnify all my virtues; therefore I will admit that I was not greatly depressed when I learned that in the invasion of Belgium in 1914 the German army suffered from typhoid fever more seriously than did the English or French.

In my official report I summarized our findings and conclusions in non-technical language to the lay reader. In the chapter on typhoid fever in volume two of my work on epidemiology I have reproduced the summary in more abbreviated form. It may be of interest, however, to mention some of these briefly and to inquire how far the original views of the Board were modified by its own work. These views I have already formulated on page 369 [Tay Vaughan’s note: see the second paragraph of this Chapter XI]. Our work demonstrated beyond peradventure that typhoid fever is a specific disease. It converted a theory into a demonstrated fact. We greatly modified numbers two and three of our previous beliefs. Before beginning our inspection we believed that typhoid fever was exclusively a water-borne disease. Our investigations showed that waterborne infection played a relatively small part in the spread of this disease; that contact or comrade infection was responsible for sixty-two and eighty-hundredths per cent. of cases; that flies caused fifteen per cent.; that the remaining twenty-two and two-tenths per cent. was due to water or air-borne infection and possibly undetermined agencies. Of course, a given local epidemic may be disseminated exclusively by any one of these agencies. Water-borne epidemics, as in the case of polluted water supplies, are usually characterized by explosive outbreaks, while those due to other agencies are more insidious and gradual in their spread.

Our original views numbers four and five were confirmed; numbers six and seven were found to be quite wrong. In the beginning we had not the slightest doubt that we would find typhoid fever more prevalent among those who were frequently on the sick report than among those in more robust health, but thinking that it would be well to substantiate this, we collected much statistical data. The evidence against our assumption was overwhelming. More than ninety per cent. of those who developed typhoid fever had no preceding intestinal disorder. In other words, the disease was almost wholly confined to the robust and vigorous. Those frequently on sick report for the most part did not develop this disease. The reasons for this are multiple. It had long been known that typhoid fever is more prevalent among men than women, and more prevalent among young adults than in childhood or in advanced age. This fact, well founded, was believed to be due to some inexplainable influence of sex and age. The true explanation is more simple. The husband has a much wider range of activity than the wife and his exposures to inflection are much more frequent. The same is true of the young adult compared with the child and the aged. There are other more technical reasons for the greater prevalence of this disease among young adult males. Many men in more advanced years have had slight unrecognized attacks and have thus secured some immunity.

Doctor Robert Koch

But the results that came from our study of the proportion of deaths among the frail and the robust shocked us. The figures showed that the more robust the patient the more likely was he to die. We went over these figures time and time again. We discussed them from every angle. We did not want to believe them; but there they stood. We could find no error; we were compelled to accept them. Then, we thought that we had made a discovery. I began to delve into the old literature; to my surprise this same thing had been observed in the typhus epidemics in Ireland. Among the half-starved Irish cotters one out of twenty-three of those attacked died; among the doctors, priests and nurses who became infected one out of every three died. Poor, lousy, infested men were haled- from the prisons into court and tried for some misdemeanor. The jailer, the barristers, the jury and complainants would sicken and die while the prisoners would recover. This it was that gave the name “Black Assizes” to these trials. This it was that led the English to establish the first fever hospital and to improve the conditions of their jails. It is frequently said that these reforms were due to the pictures drawn by Charles Dickens; they were wrought by a more potent force, the high death rate among the upper classes when brought into contact with the disease.

One old writer in describing the epidemics of typhus in Ireland and England wrote that the disease went through a community, much as you or I would go through a flock of sheep, picking out the “handsomest, healthiest and lustiest.” So our discovery turned out to be nothing more then the picking up of lost facts. This tendency of certain infections to kill off the most robust was confirmed in the pneumonia and influenza epidemics of the World War. These diseases do not improve the race by killing off the unfit as Herbert Spencer believed, but like war, they destroy the best in the nation. Occasionally we still hear the assertion that the doctors are injuring the race by preserving the lives of the unfit, who were formerly killed off by disease especially in childhood. I believe in weeding out the unfit but disease is not the agent through which this desirable result may be secured.

I ventured to offer a simple explanation of the fact that certain infections are more deadly among the robust than among the weak. When one becomes infected with the bacteria of these diseases the body cells begin to destroy the invading germ cells. The strong man kills his invaders rapidly, at the same time liberating their poisons, and in this conflict the patient either recovers promptly or dies quickly. I have said that nothing more surely fatal to the typhoid patient can occur than the sudden destruction of all the bacilli in his body. Nature often overdoes its work; it is a brave but reckless leader in battle. At first I advanced this theory tentatively and without absolute conviction as to its truth, but I have heard it from so many men and have read it in so many books without reference to. its author that now I am fully convinced of its truth. It is said that one may repeat an imaginary incident so often that he finally believes it actually occurred. From observation among my friends and my own personal experience I believe that this old saying has much truth in it.But nothing can be more convincing of the truth of one’s own story than to hear it repeated by those whose judgment and wisdom one respects as coming within their own experience, or as deduced from their own intellectual processes. It is all the more a compliment to the author because it is not intended as such.

As disgraceful in some respects as they were to our country and to England the Spanish-American and the Boer Wars were necessary preparations for the World War. I am sure that this is true in a medical and sanitary way and I believe that it is true from every military standpoint. I lived through the years between the Spanish-American and the World Wars, grumbling more or less audibly, swearing inwardly, sometimes vociferously, and asserting that our government had learned nothing from the Spanish-American War and that we would enter the next as unprepared as we were in 1898. However, I was not altogether inactive during this interval. I never lost my interest in the medical corps and I kept as closely attached to it as the law permitted a civilian to be. During the Spanish-American War I had come to admire many men in the regular army, especially in the medical corps. I knew something of the handicaps under which they worked, sympathized with their attempts to improve matters and continued to enjoy their personal friendship. In 1908 the medical reserve corps, the first of the army, was authorized and I became a lieutenant subject to orders. The Surgeon General on one or two occasions called men of this corps to Washington in consultation.

The organization of the reserve corps was a wise step which was soon adopted by other chiefs of the army. In the medical corps it was done by Surgeon General O’Reilly with the aid of Majors Kean and Ireland. Every progressive physician in the country wanted a commission. The sanitation of all posts was greatly improved. In 1898 the death rate in the army from typhoid fever per hundred thousand was eight hundred and seventy-nine; in 1899 it was one hundred and seven and continued with some fluctuations to fall, reaching nineteen in I907, the lowest point before the introduction of typhoid vaccination. With compulsory vaccination there were no cases in 1913; three per hundred thousand in 1914; none in 1915; three in each 1916 and 1917. In France in 1918 and 1919 it was five and three-tenths and seven and one-tenth respectively. In 1898 a civilian enlisting in the army was quite sure to have typhoid fever; one in every five did. In 1917 the civilian who wished to escape typhoid fever could find no safer place than the army.

In 1910, twenty per cent. of our troops were vaccinated against typhoid fever. In 1911, thirty per cent.; in 1912, this procedure was made compulsory. This method of increasing resistance to this infection was first practised by Sir Almroth Wright, of the Army Medical School at Netley, but England ignored the discovery of its wise son and went through the Boer War without this protection. The losses from this disease in South Africa were even greater than ours in the Spanish-American War. Ours was the first army in the world in which vaccination against typhoid fever was made compulsory and therefore universal. This was largely due to Colonel F. F. Russell, who recommended it after a thorough study of the optimal procedures in European armies. Of course all nations engaged in the World War made it compulsory. Had typhoid fever been permitted to run riot in the World War, as it did in the Spanish-American and Boer Wars, the loss of life, great as it was, would probably have been doubled.

Our troops went to Cuba in 1898 without hospital equipment. The tents used as hospitals at Siboney belonged to the State of Michigan and not to the Federal Government. In the World War our first assignment to France consisted of hospitals and the first of our soldiers killed in France was a medical man, Doctor Fitzgerald, of Kansas City. Before the World War the Red Cross hospitals in this country, under the direction of Colonel Kean, were made ready for an emergency and were transported to France well-equipped and well-manned.

Before the Spanish-American War medical officers detailed to West Point, Annapolis, Leavenworth and other points of instruction took care of the sick, but gave no instruction to the cadets. This was changed and the graduates from these institutions had opportunity to learn about sanitation, preventive medicine, and their duties concerning the health of the troops who should come under their command. Our nation did profit by the lessons of the Spanish-American War and my grumbling, swearing and forebodings were happily without justification as such things often are.

A Doctor's Memories
Victor C. Vaughan, M.D.

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