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Dr. Victor Vaughan’s Witness of Influenza Pandemic, U.S. Army, 1917-1918
Victor C. Vaughan, M.D., witnessed many infectious disease outbreaks, including epidemic measles and pandemic influenza, in the U.S. Army cantonments of World War I, where he served as U.S. Army physician in charge of communicable diseases. He was outspoken about the causes of these outbreaks, placing some responsibility with the policies of the pacifist Woodrow Wilson administration. The United States’ late entry into the World War was a “national disgrace,” he declared, because the U.S. had abandoned its traditional Allies (Great Britain and France). Furthermore, the Wilson administration crammed preparation for entry into the war (mobilizing an army) into a few months (April to September 1917), rather than the few years advocated by Wilson’s adversaries, including former U.S. President Teddy Roosevelt. The haste resulted in undesirable outcomes, including horrific disease outbreaks in the U.S. Army cantonments, declared Vaughan.
Dr. Vaughan was born on October 7, 1851, in Mount Airy, Randolph County, Missouri, about half way between Kansas City in the west and St. Louis in the east. His ancestry was Huguenot (French Protestant), English and Welsh. (1-2) He experienced the savage effects of the Civil War (Missouri was a border state; the Vaughans sided with the Union), which established in him a lifelong abhorrence of war. Vaughan wrote, “[My] father was not a Democrat, but a Conservative or Whig, the platform of which party stated that ‘they recognized no political principle other than the Constitution of the country, the Union of the States, and the enforcement of laws.’” (3)
Vaughan learned to read and write with the wife of a neighboring physician until the physician and his wife moved away. (1) Then he studied at a local academy whose teachers were from normal schools. At sixteen he entered a Methodist college in Fayette, Missouri (Central College). From there he matriculated at Mount Pleasant College in nearby Huntsville where he earned a B.S. degree. He moved to Ann Arbor, Michigan, in September 1874 (age 22 years) to attend the University of Michigan because of its renowned chemistry facilities. There he earned three successive degrees: Master of Science (1875) and Ph.D. (1876) in chemistry with geology and biology minors and an M.D. in 1878. He taught physiological chemistry beginning in 1876 and held the positions of professor of physiological and pathological chemistry and associate professor of therapeutics and materia medica from 1883 to 1887. He spent a year at the University of Berlin in Germany studying bacteriological technique under Dr. Robert Koch. In 1887, he founded a hygiene laboratory at Michigan, and became professor of hygiene and physiological chemistry, as well as director of the laboratory. He subsequently served as dean of the University of Michigan Medical School for thirty years, from 1891 to 1921. (4-5) While he was dean, the Wilson administration asked him to serve on the Medical Division of the Council of National Defense.
Dr. Vaughan at age 66 years and his five sons obtained their commissions in the U.S. Army as soon as they could after the U.S. Congress officially declared war on Germany on April 6, 1917. The U.S. Army promoted Vaughan from a lieutenant in the medical reserve corps to the rank of major and assigned him duty with the Medical Division of the Council of National Defense in Washington, D.C.
President Woodrow Wilson, by congressional authority, had created the Council of National Defense on August 24, 1916, as part of his halting war-preparedness initiative. Wilson’s secretary of war presided over the Council, which consisted of the secretaries of the Army, the Navy, the Interior, Agriculture, Commerce and Labor, as described elsewhere. (6) President Wilson appointed Drs. Franklin Martin and Frank Simpson to the Council in 1916 to begin to organize the medical profession of the country. Dr. Vaughan noted, At that time there were in the United States about one hundred and forty thousand [140,000] 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 [70,000]. 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…[N]early forty thousand physicians [40,000] 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. (7) When Congress declared war on Germany on April 6, 1917, President Wilson officially established the medical division of the Council of National Defense under the direction of Dr. Martin. The executive committee of the medical division consisted of three Surgeons General and five physicians: The names of the other members of the medical board are available elsewhere. (8) Surgeon General, U.S. Army, Gorgas placed Vaughan in charge of the division of communicable diseases of the U.S. Army.
Vaughan’s job entailed “conservation of the health of troops,” a “matter of prime importance. [He] had nothing to do with battle casualties, the care of the wounded nor even with diseases which are noncommunicable.” He continued, 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 [civilian] 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. (9) Indeed, Vaughan recalled, “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 win 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 disease that the history of this disease is the medical history of our cantonments. The typhoid fever of the Spanish-American War was practically negligible. (9) Dr. Vaughan wrote about the measles epidemic from October through December 1917 in U.S. army cantonments, as follows: 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 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. (9-10) “In armies,” Vaughan continued, “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 with 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… 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 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 of 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… 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. That 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. (11) Cerebrospinal meningitis was endemic in Missouri, Kansas and South Carolina for some years before the U.S. entered World War I. The disease may be spread by carriers, who personally remain well, but transmit the infection to more susceptible individuals. “It required no prophetic gift,” declared Vaughan, 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.” (12) Vaughan pointed out to “the proper authorities” “the dangers in the mobilization procedures followed by the [U.S. Army] in the World War…before there was any assembly [of men at the cantonments], 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.’” (14) Vaughan continued, 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…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 [e.g., of the meningococci that cause cerebrospinal meningitis], 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. [Recall that Dr. Vaughan was dean of the medical school at the University of Michigan while serving during the war]. 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. Vaughan noted that 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.”(13) Vaughan also said, “It can not be denied that there was a deficiency in heavy clothing and bedding at some of the camps in December, 1917 [14]. 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). The winter of 1917-1918 proved to be coldest on record east of the Rocky Mountains.” (13) Vaughan wrote, “During the World War pneumonia from the beginning to the end continued the most potent cause of death.” Mobilization of the new army began around October 1917. “During the winter months of 1917-18 (September 29, 1917 to March 29, 1918) the cases numbered 13,393 with 3,110 deaths, a fatality [rate] of 23.1%. During the summer months of 1918 (April 5 to August 30) the cases were 8,912 with 1,679 deaths, a fatality [rate] of 18.8%. During the autumn months of 1918 (the influenza period) the number of cases was 61,198 with 21,053, a fatality [rate] of 34.4%.” (15) What were the root causes of the pneumonia morbidity and mortality? asked Vaughan. He answered, 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 6.7% and a mortality of 1.1%; while Camp Wheeler, near Macon, Georgia, showed a morbidity of 95% and a mortality of 23.6%. [!] 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 [urban] and high among the latter [rural]. 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. Dr. Vaughan recalled, “In [late] 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 my 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 genera 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.” (16) Thus, in his autobiography, Dr. Vaughan chose not to relive the experience of the influenza pandemic in his autobiography.
What did Dr. Vaughan find at Camp Devens? Other sources said, he “saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up blood stained sputum. In the morning the dead bodies are stacked outside like cordwood.” (17) On the September day Dr. Vaughan arrived to Camp Devens, 63 men had perished from the disease. Vaughan also said, “This infection, like war, kills the young, vigorous, robust adults. The husky male either made a speedy and rather abrupt recovery or was likely to die.” (18) A third report states that Vaughan admitted, “The saddest part of my life was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do. At that moment I decided never again to prate about the great achievements of medical science and to humbly admit our dense ignorance in this case.” “In the late autumn of 1918, as the flu cut a deadly path through entire towns and villages, Vaughan’s observation of mortality rates from around the nation yielded a horrifying equation. ‘If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth.’ Then, to Vaughan’s relief and dismay, influenza seemed to slip away as mysteriously as it had arrived. In its aftermath, Vaughan knew that Americans and all citizens of the world were lucky the ‘Spanish Lady’ hadn’t claimed even more victims. Vaughan pointed out that doctors of the day ‘knew no more about the flu than 14th century Florentines had known about Black Death.’” (19)
Dr. Victor Vaughan and other physician leaders associated with the Medical Division of the Council of National Defense of the Wilson administration forewarned federal authorities about the undesirable effects of rapid draftee mobilization into huge hastily constructed camp-cities located throughout the United States (16 in the south and 16 in the north). Disease prevention policies gave way to the perceived imperative to rapidly mobilize a huge American army, even though the Allies (Great Britain and France) explicitly asked the U.S. for money and materials. The Wilson administration had waited so long to begin preparations to enter the war, even against the advice of many people (such as ex-President Teddy Roosevelt and General Leonard Wood) that when it (the administration) finally perceived Germany as a threat to U.S. security, it had to play “catch up.” This meant breathtaking acceleration of the conversion of civilians into soldiers. The Wilson administration staff pushed hard to load up the 32 camps, sometimes before camp hospitals had been completed (minimal heating systems, inadequate clean water and sanitary systems). Green political appointees in the Wilson administration reasoned that hospitals were unnecessary, because the men would not be in camp very long before shipping overseas. The effects of the winter of 1917-1918, one of the most severe in recorded history, wore on the health of the men so rapidly mobilized into the huge camps lacking adequate health care facilities,. The results were ghastly in terms of loss of young men’s lives, mostly from respiratory diseases, which culminated in killing pneumonias. Indeed, 58,119 men died of all diseases during training to become soldiers. Of the 58,119 deaths, 46,992, or 80.85% were from respiratory diseases. (20-21) The galling wastage of life in the U.S. Army camps of World War I is hard to comprehend today. The influenza pandemic of September, October, and November 1918 finished off the sorry saga that began with poor leadership judgment and planning at the highest levels of government, according to Dr. Victor Vaughan and other observers.
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