Chapter 13 - The World War

As I have already said, more than once, I was impatient for our nation to get into the war. I felt that our tardiness was a national disgrace. Reared in the midst of the Civil War, war has always been to me abhorrent. The trappings of war and its displays never had for me any fascination. The nearest I ever was a convert to Freudism was when a medical colleague put me through its catechism. After he had asked me many questions and had me fill out partial sentences, he inquired if in childhood I had ever been frightened by a soldier. I had to admit my experience with the pistol in my face. He said that I had hesitated whenever I came upon the word “soldier” in his inquisition. With the other members of my family feeling as I did, it is not surprising that my five sons and I had our commissions in 1917 as soon as they could be obtained. I was promoted from a lieutenant in the reserve corps to the rank of major and assigned to duty with the medical division of the Council of National Defense in Washington.

During my first weeks in khaki my duties were many and diversified. Questions pertaining to every phase of the preservation of the health of our soldiers were referred to me. Some of these had already been determined in the National Research Council and only awaited official sanction. Daily, men and women with suggestions, some wise and many otherwise, filed through my office; some were prompted by patriotic motives and sought no personal gain; others were seeking a financial return; some protested vigorously against vaccination; some wanted the soldiers prohibited from smoking, with special emphasis against cigarettes. All kinds of curealls and preventives were offered the government; some free, but most of them on the payment of a substantial reward. The number of nostrum manufacturers and vendors was large, heavily fortified by testimonials. It was a great opportunity to study psychology. I listened to all courteously and decided nothing, but said to each that his proposition would be referred to a board. In all instances in which there was doubt in my own mind this was done. My wide acquaintance among physicians and other scientists enabled me to refer most things to one or more experts and of these all were willing to serve. There were more methods of purifying drinking water than I had ever heard of and I thought myself fairly well posted on this line. Frauds and exaggerations were easily detected. For instance, one man had a new and wonderful method of purifying drinking water. He mentioned a dozen places in the United States and Canada where his method was in successful operation. He had hardly got out of the building before telegrams were on their way to the health officers of these places and on his return a few days later, all I had to do was to show him the answers. The baseless lies told me must have kept the recording angel busy.

Within a few days such men as Colonels Lyster and Darnall of the regular medical corps, with such experts as Whipple and Sedgwick of the Massachusetts Institute of Technology, and Phelps of the Hygienic Laboratory, had formulated every detail for the purlfication of drinking water in cantonments, small and large, on the march and in the field, and these were officially sanctioned. After this if a man came with a new method I told him that his process might be the best in the world but that the matter had already been settled and was in operation and no change would be made. One poor fool came with a horrible story of the injuries being done the British soldier by wearing brass buttons. According to him brass buttons on the blouse were killing more British soldiers than German shells. I asked him to disclose this important and dreadful fact to Colonel Goodwin of the British Army who was in the next room. According to another, certain insects were feeding upon French soldiers and he had a wonderful insecticide. He described bugs unknown to the most learned entomologist. Colonel Dercle and Major Rist were informed of the great injury and the immediate danger to their soldiers. I may say here that our liaison officers were of untold value to us; they brought to us the experiences and observations which they had accumulated during more than two years of the war. The stream of would-be benefactors through my office ceased as abruptly as it had begun and my occupation in this line terminated.

Simultaneously with the above and continuing longer, applications for commissions from physicians in civil life were coming in by the hundreds and the thousands. Each of these had to be scrutinized, accepted or rejected, and suitable rank and special duty suggested. A committee consisting of Colonels Noble, Miller and Caldwell of the regular corps with Doctors Welch, Mayo, Simmons, Martin and myself had this task. The only ranks then open to such applicants were lieutenant, captain and major. I never knew of but one man who thought that the rank assigned him was too high, but I may say, in honor of my profession, that audible dissatisfaction was rare. Moreover, I record with most satisfaction that political influence was seldom brought to bear. There were a few shameful exceptions, but these were rare. In the Spanish-American War I served with Major Reed and Shakespeare on a similar committee, and nearly every man whom we rejected was soon back with a letter from my friend, then Secretary of War, saying that Senator so and so or Congressman so and so asked that the applicant have another examination; then the examination was written and such that no man in this group passed. If this occurred in the World War, I do not know it. When I am asked if politics in Washington is improving I cite this example and give an emphatic affirmative answer.

In the World War a physician from Ohio wanted a commission and would not be satisfied with anything but the highest rank. I had my suspicions as to his personal character and professional standing and put him off from time to time while I was endeavoring to get more exact information. One day he came to me with a look of triumph on his face, saying, “I have a letter from my Congressman.” For a moment I wondered if we were dropping back into the customs of 1898, He handed me a sealed envelope which I opened, and read the following: “Dear Colonel: This man is from my district. >He claims that he voted for me and probably he did. He thinks that he should have a commission and he wants to be a major. Do not let him bulldoze you but do as you think wise in the matter.” I informed the applicant that the letter was eminently satisfactory and with this information he took his departure. I never saw him again.

No age limit for medical officers was fixed, though sixty-four was supposed to be the limit, but the honored dean of American surgery, Doctor W. W. Keen, in his eightieth year, looked like a boy in khaki and at my solicitation wrote a valuable handbook on War Surgery, up to date in every particular.

When in 1916 President Wilson, by congressional authority, appointed a Council of National Defense, as a member of this important organization he named a medical man, Doctor Franklin Martin of Chicago. This selection proved to be a wise one. Soon after his appointment Doctor Martin, aided by Doctor Frank Simpson of Pittsburgh, began organizing the medical profession of the country. At that time there were in the United States about one hundred and forty thousand legally qualified physicians of both sexes and of all ages. About half of these were believed to be fit personally and professionally for military service of some kind. State committees classified and graded all of these, giving the special fitness of each. These lists were in the possession of the Surgeon General by December, 1916. In this work Doctor Martin had the hearty cooperation of the American Medical Association, the College of Surgeons and all their component organizations. In short, the medical profession of the United States was mobilized for war, so far as the law permitted, by the close of the year 1916. I may add, since I will not return to this subject, that nearly forty thousand physicians enlisted in the army and navy and quite as many more served on draft boards or were engaged in other government services. The medical profession was not altogether unprepared for war when it was proclaimed, and if any other profession enlisted or served in proportionate numbers I do not know it.

After war was proclaimed the Medical Division of the Council of National Defense, under the direction of Doctor Martin, continued and amplified its work. The executive committee, of which I was fortunate enough to be a member, had frequent meetings in which propositions were presented and discussed with the greatest freedom. This committee consisted of the three Surgeons General, Gorgas, Braisted and Blue, and Doctors Martin, Welch, Simpson, Grayson, Mayo and Vaughan. General Gorgas presided at the executive meetings with the same gentleness with which he had ministered to me when I had yellow fever in 1898, I never knew another man who could receive the highest honor without any facial evidence of emotion or face criticism without the slightest sign of embarrassment. I knew him as Captain Gorgas in Cuba; worked with him as Major General Gorgas, and can testify that the acquisition of stars made not the slightest difference in him. I stood by his side when at Atlantic City the American Medical Association decorated him with a medal, the gift being accompanied by a most laudatory speech by Doctor Reed of Cincinnati. As we left the platform I said: “I do not see how you could go through this ordeal without emotion.” He replied, with a twinkling in his eyes: “You do not see what is going on within.” I was with him when a United States Senator asked why he did not commission osteopaths. He replied: “Because the laws which you make do not permit; will you change the law?” On an inspection tour he decided to stop and visit a camp unannounced. We alighted from the train, he with two grips, I with one. I picked up one of his. “No,” he said, “you forget that I am younger than you.” On reaching the street, he said, “You watch the grips and Willie will find a cab.” One day we were walking along Pennsylvania Avenue when we met Senator McKellar of Tennessee. The Senator put his finger on the “R” on my collar and said, “We are going to take that off.” I replied: “Pray, do not; it confers many privileges on me; I can be saucy to a superior officer, who seeing the ‘R.’ says to himself, ‘Oh, well, he is only a reserve man and does not know better.’ Here I am walking on the right side of General Gorgas when I should be on his left. We have met several line officers and I have noticed disapprobation on their faces until their eyes fell on the ‘R.’”

When we entered the World War the highest rank that a reserve officer could have was that of major. This was true in all corps. General Gorgas determined to remove this restriction in the medical corps. With this purpose he appeared before congressional committees. This awakened resentment not only among his own regular officers but in the whole army. General Gorgas was summoned before the Secretary of War and accused of violating a regulation which forbade all army officers lobbying before Congress. He pleaded guilty, but in perfect candor said that the heads of other departments could do as they saw fit, but that the good of the medical corps justified his action, pointing out that in the hospitals and on the battlefields of France our medical majors would have to consult with brigadier and major generals in the European armies, and although their professional equals, could not be treated as such by their European confreres. His candor and the justice of his claim won over his accusers, and the restriction in regard to promotion was removed in all corps. Mrs. Gorgas and Mr. Hendrick have told of this episode in their most admirable biography of General Gorgas. I should add that in this contest General Gorgas had no difficulty in winning the approval of congressional committees. He plainly stated-that most of his regular officers would, during the war, be needed in administrative work while reserve officers would be in the hospitals and on the firing line.

Before the War College his reception was not so pleasant, but Congress makes the laws, and even the War College has to obey them. Thus the “R’s” were removed and volunteers and regular officers stood on equal ground. Truth, however, demands that I record the fact that in the medical corps at least this benefited the regular officer more than it did the volunteer. This new law provided that ‘in the newly constituted corps there could be a certain per cent. of colonels, we will say three. In 1918 there were less than one thousand regular medical officers and quite thirty thousand volunteers; now three per cent. of thirty-one thousand is more than three per cent of one thousand and it can not be denied that promotions were not proportionately distributed. However, this is a small matter. To the regular officer, rank is of great importance; to the volunteer, it is of only temporary value in so far as it enables him to do better work.

I have only one grievance concerning the rewards conferred on medical men during the war. When we entered the conflict and Mr. Balfour and General Joffre came over, their first request was that we send them medical men. It was decided to call for one thousand picked doctors under thirty-five years of age and send them to the British army as a training school with the promise that as soon as our soldiers reached France they would be transferred. With others I was sent out to drum up these, and I am not unduly boasting when I say that no one could have been better acquainted with the life conditions of the recent medical graduate than one who had been dean of a large medical school for twenty-six years and still occupied that position. All these young men had recently finished years of costly college and professional training; were just establishing themselves in practice; those who were not married intended to be; many had one or more children and were anticipating more; many had purchased homes on credit, had established hospital connections which must be broken, and so forth. It has always been a consolation to me that I presented no false hopes. I said to these young men: “You can not afford to refuse this invitation. Some time in the future your son will ask if you were in the World War and if not, why. However, you should not accept without full knowledge of the price you will pay. You will leave your practice and it will take you a long time to recover it. When the war is over the man who goes must be content to live on a side street, while the man who stays at home lives on the avenue. The former will be fortunate if he can make small deposits in a bank in which the latter is a director. Those of your colleagues who stay at home will pass a resolution pledging the members of the local medical society to send fees collected from your former patients to your wife, but if she is dependent on this income she and her children will live in poverty.” These things and many others along the same line I said to them.

Many of these young men called at my Washington office on their way to the port of embarkation. They were handsome in khaki. It was only by direct questioning that I was permitted to see the mental burdens some of them were carrying. A few were ordered back home; more were temporarily assigned to camps in this country; but they went more than nine hundred strong to the British Army and were forgotten. The British could not promote them; they did confer decorations on some. Most of them were a credit to our country, but when the Armistice was signed, all were lieutenants still. After the war was over an attempt to right this grievous wrong was made, but promotion in rank is of but little service to a volunteer when the war is over. No one paid more dearly for his patriotism than the young medical man and I dare say that if a like emergency arises in the next generation his sons will follow his example. I must admit that the young men among my former students who shirked the call to war and stayed at home for profit lost my esteem. I am glad to add that they were but few.

General Gorgas was fond of driving a car, and in our official journeyings in and about Washington he frequently performed this function. We dubbed him our chauffeur, criticized his driving and had much merriment about it. He detested war but would have led a corps in battle with the same calm with which he managed the largest medical corps ever created, providing as it did for the lives, health and comfort of more than five million men. He was anxious to have the war done with, when he could take up his life work, the eradication of yellow fever from the world. The day after the Armistice was signed his term as Surgeon General expired and soon thereafter he was on his way to West Africa to continue his yellow fever studies. He died in London after having been knighted by the king in person.

In the early spring of 1917, before a barrack had been erected, General Gorgas, Doctors Martin, Welch and I were granted an audience with Secretary Baker. Our purpose was to offer suggestions concerning the ventilation, floor space, cubic capacity, and so forth, of the barracks in the cantonments. The other gentlemen had spoken, basing their arguments on what we know of the epidemiology of cerebrospinal meningitis. Lighting his pipe, the Secretary turned to me and said: “Doctor Vaughan, what have you to say about this matter? All I know about hygiene I learned from you. When I was a boy, my father was a health officer in West Virginia. When he found something you had written he brought it home and asked me to read it aloud to him. Now, as I understand it, the disease these gentlemen have been talking about is one of infancy. What has it to do with soldiers ?” The opportunity for a little humor was irresistible, so I said: “Mr. Secretary, permit me to take up my rôle as your instructor. It has been thirty years or more since it was interrupted.” Good naturedly he said, “Go ahead; you will find me a willing pupil.” I told him that he was thinking of infantile paralysis while my colleagues had been talking about cerebrospinal meningitis, a disease most prevalent among young adults and especially among recently recruited soldiers in crowded barracks.

The Secretary, after hearing us, called for the chief of staff and gave orders that all barrack plans should have our approval; of course this was not done. I did not come in contact with Secretary Baker frequently or intimately, but when I did he listened attentively and answered sympathetically. I once suggested that the cantonment hospitals should be built more permanently and preserved after the wards sanatoria for different diseases. The Secretary seemed quite pleased with the idea and promised it serious attention; more pressing demands doubtlessly drove it from his mind. I never drive through a wrecked cantonment without recalling this conversation and wishing that the suggestion had been given more consideration. We wrecked our cantonment hospitals and then proceeded to build hospitals for veterans, but at the cost of millions, to say nothing of national scandals. In my opinion, Secretary Baker has had to bear much undeserved criticism. We have had great Secretaries of War in times of peace but none in war, if the critics of the times be right. In the Civil War the first Secretary, Cameron, held his position but one year. His successor, Stanton, was criticised by the people and had other troubles. In the Spanish-American War Secretary Alger bore the brunt of criticism and Mr. Baker has met with a like fate.

One afternoon I was called to the office of the Secretary of War and on arriving I was directed to a certain room. On entering I found Assistant Secretary Keppel in the chair. In front of him were several men in longtailed coats and one man wearing the uniform of a major in the quartermaster’s department. This man greeted me and said that he was glad to see another uniform. Mr. Keppel asked one of the long tails to explain the purpose of the meeting to me. He said that he and his colleagues represented the “Purple Cross,” that this organization supplemented the Red Cross, and that the latter looks after the soldiers during life, while the former looks after them when dead. He and his friends were asking for an order turning over all soldiers that should be killed or die from any cause in France to the “Purple Cross” to be embalmed and returned to their homes. He went on to say that the “Purple Cross” had a board of supreme directors, made up of the most eminent scientific and medical men in the country. This board supplied the directions for preserving the dead. He held a paper in his hand and said: “Here is a list of our directors.” I asked to see the list and near the head was my own name. I said, I fear with some warmth, that since entering the room I had learned much. I had never before heard of the “Purple Cross.” Now I find that I have the honor of being one of its directors. I ended with pronouncing it a fraud. Failing to get the desired order from the Secretary of War these men had a bill introduced into Congress with a like result. I have been told that the official organ of the “Purple Goss” roasted me brown, but I was never conscious of going through the process.

During the early summer of 1917, Doctor Martin very wisely called the most prominent men in the medical profession for consultation in Washington. Topics for consideration at these gatherings were carefully considered and were presented for general discussion. Every visitor was encouraged to speak plainly and without restraint. The topics brought before these assemblies were of varying importance I will mention here only one. The conservation of food was then a most important matter. The United States had been for two years feeding Belgium, England and France, the first-mentioned gratis and the others to the profit of the American producer. It was universally believed that starvation was proving to be a most important factor in determining the result of the war. The price of wheat was fixed by the Federal Government as a’ war measure. First helpings at table were scant and a second discouraged. It was urged that the daily consumption of sugar should be brought down to the lowest limit compatible with health and the rapidly advancing price of this article contributed to compliance with this suggestion. The American people were complying with these requests with wonderful unanimity. Elaborate dinners were discountenanced. Simple two or three course dinners were, even among the wealthy, the rule. Our soldiers must be fed without stint because we must rely upon their strength in the great struggle. But civilians must be moderate in eating.

To-day those of us who lived through that period can but feebly recall the intense interest taken in food conservation, especially by the better-to-do and more intelligent classes. We look back upon it as a kind of hysterical display of patriotism; but then it was a question of pare. mount importance. We must feed our soldiers and those of our allies even if we must deprive ourselves of a certain amount of gustatory pleasure. At that time we were not demanding that France back our loans by a mortgage on its shell-torn acres or wantonly ruined cities and cathedrals. Thousands of moderately well-to-do women among us were each feeding and clothing at least one French orphan. Then we recognized that France, England and Italy had been fighting our battles as well as their own. We read with horror, backed by hatred, how French mines were being dynamited after the machinery had been shipped to his own country by the barbarous Hun. We cried to our allies: “You can have all our surplus food, all our wealth, yea more, even the blood of our sons; persevere in your courageous contest; we are coming to your aid with our great resources.” Men are brothers when they face a common danger; alas, this statement is true only under the condition therein given!

The above is a feeble and inadequate statement of the psychology of our nation when on a Sunday morning in June, 1917, the wisest men in the medical profession assembled in one of the large rooms of the Willard Hotel. The subject was food conservation; the discussion was strictly scientific; nothing was said about the degrading effects of alcoholic drinks. The chief speaker was Doctor Alonzo Taylor, now of Stanford University, California. He had recently been in Germany as a food expert. His audience was to have first-hand and exact information. Indeed, there was then and there is now, no one more competent to speak on the subject of foods. His words came clothed in the unsurpassed virility characteristic of the man. He showed that in the conversion of carbohydrates, starches and sugars, into alcohol there is a marked loss in food value. He calculated this loss mathematically. The figures stood before his auditors and convinced them. I can not speak for others but in my mind his speech was much as follows: “We need to conserve our foods; an efficient way in which this may be done lies in the prohibition of the conversion of carbohydrates into alcohol.” Probably many in the room were fully aware beforehand of the truth of Doctor Taylor’s statement but it had, as presented by him, a telling effect. Add to this the following facts which must have been in the mind of everyone in the audience: alcoholic drinks must not be permitted our soldiers; civilians must be equally patriotic; therefore the latter must willingly deny themselves what they forbid the former. I, at least, and I believe all others in the room, was convinced that a national prohibition law was not only justified but, for the time at least, necessary.

At the close of the meeting Doctor Martin appointed a committee to draw up resolutions expressive of the sentiment of those present. These resolutions were formulated and presented to the Council of National Defense the next day. We never thought of what effect a prohibition act might have on the nation after the war. When one is held up by a highwayman in a dark alley or on a lonely road and is fighting for his life or his pocketbook or for both, his mind is not likely to be occupied in planning what he will have for breakfast the next morning. About the same time the American Medical Association, at an annual meeting in New York, passed a resolution favoring prohibition. How much these movements, inaugurated in medical organizations, had to do with the enactment of the eighteenth amendment I can not say. I have heard the profession accused; I have never heard it praised in this connection. I have given the details as they came under my observation and in which I participated. It is not within my province to approve or disapprove of the eighteenth amendment as it has operated or failed to operate since the World War.

In my opinion, another hysterical move inaugurated during the war was the undue and unjustified importance attached to the so-called “Intelligence Test” as used in the promotion of officers. I had a small part in the introduction of this procedure, but in my opinion it ran beyond bounds and secured unwarranted commendation. I thought that it might be an aid in the selection of those who might be entrusted with rank and increased responsibilities, but I never dreamed that it would become a dominant factor in these matters. The test, as applied in our army, was a rude measure of mental alertness, but this is only one factor in intelligence. It was not used in any other army and of those in our army to whom it was applied, but few if any ever participated in battle. It is one thing to be a model officer in a cantonment and another thing to perform the same function on the firing line. The so-called “Intelligence Test” as employed in our mobilization camps in the World War will need to be subjected to more crucial trials before it can justly deserve the high encomiums then and later bestowed upon it.

In the extension of his office force General Gorgas was kind enough to put me in charge of the division of communicable diseases. This post was the one for which I thought myself best fitted. General Gorgas must have had the same idea, since no word passed between us concerning it either before or after the assignment. On going to my desk one morning I found a sign bearing the words “Communicable Diseases” hanging over it. The tables of all my assistants had been moved to that part of the room and on my desk were the reports from all the camps on the prevalence of communicable diseases. I made no remark but went to work.

Writing as I am of the experiences of an epidemiologist of the World War it would be criminal in me not to mention the mistakes which, in my opinion, were made in my own department. I leave it to the heads of the other sections and divisions to do as they please. I will trespass on their fields only so far as it is necessary for me to do in discussing my own problems. When this is necessary I will go as far into other fields as I deem necessary, “with charity for all and malice towards none.” It is now generally admitted that the conservation of the health of troops is a matter of prime importance. I had nothing to do with battle casualties, the care of the wounded nor even with diseases which are noncommunicable. When can one consider the health of a military organization, so far as communicable diseases are concerned, satisfactory? The answer to this question, which my helpers and I formulated, was: When the morbidity and mortality rates from these diseases are no higher among the soldiers than they are in the same age group at home. This is a high standard, one seldom reached, and one less frequently maintained for a long period. We did reach it in some camps, but in most we fell below it; in a few, far below. The more densely people are packed together the more difficult is it to control the spread of infection. There are no other conditions under which men are so closely and so continuously in contact as in an army camp. In the field men are not so crowded and consequently infection is less prevalent. From September 29, 1917, to March 29, 1918 (six months), five out of twenty-nine great camps complied with the standard named in both the morbidity and the mortality rates. Three others were satisfactory in mortality but with an excessive morbidity. Taking the twenty-nine great camps together the death rate from pneumonia during the six months mentioned above was twelve times as great as in the same age group of the civilian population of this country. Only one other disease, cerebrospinal meningitis, showed a higher case mortality than pneumonia, but the cases of pneumonia far outnumbered those of meningitis. So far did pneumonia overshadow all other diseases that the history of this disease is the medical history of our cantonments. The typhoid fever of the Spanish-American War was practically negligible.

The procedures followed in the mobilization of our soldiers in the World War brought into every cantonment every infection then existent in the areas from which the men came. Drafted men were assembled at some point in each state. They came from every community; they came in their ordinary clothing; some clean, some filthy. Each one brought many samples of the bacteria then abounding in his own neighborhood. They brought these organisms on and in their bodies and on and in their clothing. They were crowded together at the state rendezvous and held here for varying periods of time, long enough to pass through the stages of enlistment. Then they filled troop trains and were transferred to their respective cantonments. On the trains the men from the first to the last car mingled freely. Not a troop train came into Camp Wheeler (near Macon, Georgia) in the fall of 1917 without bringing from one to six cases of measles already in the eruptive stage. These men had brought the infection from their homes and had distributed its seeds at the state encampment and on the train. No power on earth could stop the spread of measles through a camp under these conditions. Cases developed, from one hundred to five hundred a day, and the infection continued as long as there was susceptible material in the camp. It is true that measles is not in and of itself a deadly disease, but it predisposes to pneumonia and increases the death rate from pneumonia. These facts are stated in my work on epidemiology as follows: (1) Of every one thousand. men with measles, forty-four had pneumonia and fourteen died; (2) of every thousand men without measles, seventeen had pneumonia and two died; (3) a person who has recently had measles is ten times more likely to die from pneumonia than is the person who has not recently had measles.

In armies, measles is a disastrous and dreaded disease for two reasons. In the first place, the number attacked by it simultaneously is overwhelming. For instance, all susceptible individuals, on the troop trains mentioned, came down practically on the same day or within two days. The period of incubation in this disease is more definite and fixed than that of any other. This has been demonstrated in more than one instance in which measles has been introduced into communities from which it has long been absent or has never been known. The following are illustrations from my work on epidemiology:

In 1781 measles disappeared from the Faroe Islands and did not reappear until 1846. During this period of sixty-five years there was not a case of this disease anywhere on any of the seventeen islands constituting the inhabited parts of this group. On the reappearance of measles the total population of the seventeen islands was 7,782. These were gathered for the most part in small villages of from twenty to two hundred persons. Thorshavn, the administrative capital, was the only village with a population of more than two hundred, and it numbered only eight hundred. Measles was brought into the islands by a cabinet maker who left Copenhagen March 20 and reached Thorshavn on the 28th in perfect health. From this case it was easy to trace all subsequent cases. It was found that every individual who had not had the disease sixty-five years or longer before acquired it. When a man visited a village in which the disease prevailed and returned to his home everybody with whom he came in contact developed the eruption fourteen days later. Age and sex had no influence upon susceptibility. The man of sixty succumbed quite as promptly and as certainly as the boy of six.

So far as is known measles never touched the inhabitants of the Fiji Islands until 1875. At that time the king of these islands visited Sydney in New South Wales preparatory to turning over the government of his islands to the British. During this visit the king’s son and one of his servants developed measles. When they landed on the island the king called a conference of prominent men from all parts of his country. It is estimated that the population of the Fiji Islands at that time numbered about one hundred and fifty thousand. Practically all acquired the disease and forty thousand died. This instance is frequently quoted by authors who hold that it is evidence of the deadliness of this disease when introduced among a people who have hitherto not known it. It is more likely that the high death rate was due to the fact that all the people came down simultaneously, or nearly so, and consequently the sick were left without care. There was a small detachment of natives, one hundred and forty-seven strong, under English military discipline. Every one of these developed the disease but were well cared for and the death rate was only six per cent. while among those uncared for it was about twenty-six per cent.

Study epidemics of measles wherever they appear and you will find that the mortality rate is influenced by the care and attention given to the sick more than to any other agency. Measles when the sick are ideally cared for is a disease of low mortality; when the sick are inadequately taken care of, this disease may rank in its fatality among the great plagues of the world. When introduced into a population with a susceptibility of one hundred per cent. it strikes down so many at practically the same time that adequate care for the sick is impossible. The resistance of the body already reduced to a minimum by the virus of the disease is easily overcome by secondary infections (especially pneumonia)’, by exposure to cold, by thirst and by hunger. This is true of measles, whether it appears for the first time in a virgin population as it did in the Fiji Islands in 1875 or whether it appears as it did in the camps in the United States in the winter of 1917-18.

In the second place, the large number attacked by measles simultaneously overwhelms hospital facilities, breaks down the most ample provision for the care of the sick and renders successful isolation impossible. What is true of measles is largely true of mumps. In civil life mumps is negligible because only a few are attacked simultaneously; among soldiers it may temporarily render an efficient army helpless.

In Missouri and Kansas and in South Carolina, cerebrospinal meningitis had been known to be endemic for some years before we entered the World War. This disease is spread by carriers, who personally remain well, but transmit the infection to more susceptible individuals. It required no prophetic gift to predict outbreaks of this disease in the cantonments to which the quota from these states were sent. The records from Camp Funston, Kansas, and Camp Jackson, South Carolina, show just what did happen.

The dangers in the mobilization procedures followed by us in the World War were pointed out to the proper authorities before there was any assembly, but the answer was: “The purpose of mobilization is to convert civilians into trained soldiers as quickly as possible and not to make a demonstration in preventive medicine.

No time is gained by hurrying sick men or the bearers of infection into camp. They simply fill the hospitals and lower the effective strength. The line officer has advanced greatly in his appreciation of preventive medicine since the Spanish-American War but I hope that his education in this direction may be greatly extended before the next mobilization of troops will be necessary.

We recommended that the drafted men should be assembled in groups of not more than thirty in places near their homes. There they should be cleaned, bathed, barbered, clothed in clean garments, subjected to their vaccinations, held in isolation for from ten to fourteen days, examined for carriers, tagged with the infectious diseases they have had, sent to the cantonment in locked cars and there restricted to barracks holding not more than thirty men for some days. During all this time they should be exercised or drilled by officers. That thousands of young men may be assembled without suffering from infectious diseases is demonstrated annually on the campus of each of our great universities. The most insane procedure carried out in 1918, from the viewpoint of an epidemiologist, was the sudden and complete mobilization of the students in our universities in the Students' Training Corps. How many lives this procedure sacrificed I can not estimate.

In some of the cantonments the last building completed was the hospital. This, with its diagnostic laboratory, should be the first. The epidemiologist with his assistants should be the first officers on the ground in the preparation of a training camp. They should have medical supervision of the workmen engaged in the construction. There were cases of cerebrospinal meningitis in Camps Funston and Jackson before a soldier arrived. The mobilization of an army is a medical as well as a military problem.

It can not be denied that there was a deficiency in heavy clothing and bedding at some of the camps in December, 1917. I never came so near freezing as I did at Funston at that time. I shivered at Doniphan (Oklahoma) and I felt a norther at Bowie (Texas). In each of these camps I saw shivering guards. The winter of 1917-18 proved to be the coldest on record east of the Rocky Mountains.

During the World War pneumonia from the beginning to the end continued the most potent cause of death. Taking the calendar year of 1917 there were in our army 8,479 cases, with 952 deaths, a fatality of eleven and two-tenths per cent. It will be understood that mobilization of the new army did not begin until October, 1917. During the winter months of 1917-18 (September 29, 1917, to March 29, 1918) the cases numbered 13,393 with 3,11O deaths, a fatality of twenty-three and one-tenth per cent. During the summer months of 1918 (April 5 to August 30) the cases were 8,912 with 1679 deaths, a fatality of eighteen and eight-tenths per cent. During the autumn months of 1918 (the influenza period) the number of cases was 61,198 with 21,053 deaths, a fatality of thirty-four and four-tenths per cent.

When we had charted the pneumonia morbidity and mortality in each of the large camps, one thing stared us in the face most strikingly. This was the astonishing difference in the number of cases in the several camps. Camp Hancock, located near Augusta, Georgia, showed a morbidity of six and seven-tenths and a mortality of one and one-tenth; while Camp Wheeler, near Macon, Georgia, showed a morbidity of ninety-five and a mortality of twenty-three and six-tenths per thousand. Good and bad camps were mixed in nearby locations. Then we made other charts, placing the camps not where they were, but in the states from which their soldiers came. Then all the good camps, with the exception of Lewis near Tacoma, Washington, were in that portion of the United States east of the Mississippi River and north of the Ohio and Potomac Rivers. Next we determined the incidence of pneumonia among urban and rural men. It was found invariably low among the former and high among the latter. Now we had the key to the situation. The area from which the men of the good camps came is the most urban, or densely populated, part of the country. City dwellers acquire some degree of immunity to respiratory diseases because they live in an atmosphere frequently or constantly bearing these infections. Country boys are more highly susceptible to the respiratory diseases. This suggested that we increase the resistance of the rural soldiers by vaccinating them with dead cultures of the bacteria of the respiratory diseases. This was attempted during the summer months of 1918, notably by Major Cecil and Captain Vaughan at Camp Upton on Long Island and at Camp Wheeler in Georgia, but this work was overwhelmed by the great and deadly epidemic of influenza. I am glad to say that in all this study of the ‘distribution of pneumonia throughout the camps I had the valuable assistance of Captain George T. Palmer.

Attempts to secure artificial immunity to the pneumonias have been continued by many of the best men in the profession. The problem is a difficult and complicated one because so many bacteria may cause pneumonia, but I have no doubt that it will be solved in time.

In August, 1918, Colonels F. F. Russell, William H. Welch, Rufus Cole and I made an inspection trip through the camps in the Southern States. With the memory of the visit to Asheville, North Carolina, in 1898, in mind, I proposed that we stop in that region for a few days, which we did. But there I contracted a most severe coryza. We reached Washington one Sunday morning and I went directly to the Surgeon General’s office, where General Richard was officiating, as General Gorgas was in Europe. Scarcely looking up from his papers the general said, as I entered the door: “You will proceed immediately to Devens. The Spanish influenza has struck that camp.” Then, laying aside his papers and looking into my suffused eyes, he said: “No, you will go home and go to bed.” I took the next train for Camp Devens and arrived early the next morning. I am not going into the history of the influenza epidemic. It encircled the world, visited the remotest corners, taking toll of the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face of science.

Soon the Huns were slowly but stubbornly retreating and in November the Armistice was signed, but there can be no armistice between medicine and disease. The conflict will continue as long as man walks the earth and the victory will ultimately be won by death. But as I see it, man’s mission on earth is not to seek immortality either for himself as an individual, or for his race, but to strive for wisdom. To what heights he may lift himself in this effort I can not say. I do know that if he ceases to strive for wisdom he will sink into ignorance to which there is no bottom. Man has by long effort acquired a degree of intellectuality which enables him to serve as a co-worker with his creator. The wheels of evolution are never standing still; they are constantly moving; they may go forward or backward. We are concerned with the things of this life, not with the possible or probable hereafter.

The war brought to my wife and myself the greatest sorrow of our lives. As I have said all of our five sons enlisted. Our eldest (Victor C. Vaughan, Jr.), with his brother Walter, went to France in June, 1917, where he served in the hospital at Chaumont until the Armistice. After this, General Ireland assigned to him the duty of working up the typhoid statistics in our expeditionary forces. He did this work at Dijon and then went to St. Aignan preparatory to starting for home. He was to leave the next morning when he and a comrade, late in the evening, went bathing in the Cher River and he was drowned. He began practice in Detroit in 1905 and, instead of waiting for patients, he, with the permission and assistance of Doctor Guy L. Kiefer, health officer, opened the first tuberculosis clinic in that city. He continued this work and in 1923 the Detroit Board of Health dedicated the infirmary of the new municipal hospital at Northville to his memory. He served the poor so efficiently that the well-to-do began to seek his advice, and when he went to France, he had a well-established reputation as an expert in tuberculosis. He married the splendid woman who had been his assistant in his early work. He was an ideal practitioner, devoted to and beloved by his patients, always bringing to them the best skill acquired by experience and study. He made several contributions of scientific and practical value. There was apparently before him a bright and useful career. I shall not discuss the sad emotions awakened in his parents by their great and irreparable loss. These are too sacred to trust to words.