A Doctor's Memories:

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A Doctor's Memories:

Book excerpt

By: Victor C. Vaughan

Date: 1926

Source: Victor C. Vaughan. A Doctor's Memories. Indianapolis: Bobbs-Merrill, 1926.

About the Author: Victor C. Vaughan became dean of the University of Michigan Medical School in 1891. When the Spanish-American war erupted he took a leave from the university to become a surgeon with the Michigan Volunteer Infantry. Immediately after the conflict ended, he worked with Walter Reed to investigate typhoid fever outbreaks in military barracks. After his work on the typhoid board ended, he returned to his position as dean, where he stressed science-based, research-oriented teaching and study of medicine.

INTRODUCTION

In 1898, the United States fought a four-month war with Spain, which began as a result of brutal Spanish policy toward its colony of Cuba. Termed the "Splendid Little War" by John Milton Hay, then U.S. Ambassador to Great Britain, the conflict cost less lives in battle than anticipated at 345 dead, but cost the lives of more than 2,500 men from disease.

In the mid-1890s, Cubans attempted to gain their freedom from Spain by fighting a war for independence. Sympathy for the Cuban cause grew in the United States, especially after the Spanish began using concentration camps that killed thousands of Cuban civilians. Sensationalist American newspapers often distorted Cuban events in their bid for readership, which further inflamed anti-Spanish feelings. Emotions reached a fever pitch on February 15, 1898, when the U.S.S. Maine sank after a mysterious explosion in Havana harbor, killing 260 sailors. Americans blamed Spain for the loss, the yellow press thundered "Remember the Maine," and on April 25, 1898, the United States declared war on Spain.

The conflict was one-sided. The Spanish fleet arrived in Santiago de Cuba on May 19, 1898 only to be blockaded by American forces later that month. When the Spanish ships tried to escape in July, the fleet was destroyed. Meanwhile, 17,000 American troops were sent in to capture Santiago. The Spanish forces, though weak, managed to put up a strong resistance before being overwhelmed. The war effectively ended when Santiago surrendered on July 17, 1898.

Hostilities formally ceased with the Treaty of Paris on December 10, 1898, which gave Cuba independence from Spain, although the island remained under American control. Spain also ceded Puerto Rico, the Philippines, and Guam to the United States. This established an American presence in both the Caribbean and Asia.

PRIMARY SOURCE

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SIGNIFICANCE

Despite its brevity and low casualty rate, the Spanish-American War had a significant impact upon American military medicine. It was one of the first major wars fought after the medical establishment had accepted the germ theory of disease.

After the war, Vaughan, Reed, and their colleagues on the typhoid fever board established the importance of both human contact and flies in the spread of typhoid fever. They developed the concept of healthy typhoid carriers as agents of infection and eliminated "typhomalarial fever" as a diagnosis by identifying the two diseases with distinguishing blood tests. Perhaps of greatest importance for the welfare of common soldiers, they showed that line officers were often responsible for typhoid epidemics that ravaged the army in 1898.

Medical officers, although commissioned, were outside of the military hierarchy and needed the cooperation of regular officers to implement any sanitary procedures. Even though physicians regularly warned that poor sanitation and fecal contamination helped spread typhoid, line officers continued to design latrines as they always had. As a result, typhoid fever killed more men in the war than any other cause, with 20,738 cases reported and 1,590 deaths.

Luckily, physicians did not need line officers' approval to treat the wounded, and they took immediate steps to ensure sanitation. They saved lives and limbs with antiseptic first aid on the battlefield and aseptic surgical techniques in the operating theater. As a result, the mortality of wounded American soldiers was the lowest in military history to date.

After the war, the military establishment enacted a number of innovations to minimize future deaths from disease. The Department of Military Hygiene was established at West Point in 1905 to instruct line officers in the fundamentals of military hygiene and camp sanitation. In 1911, typhoid immunization became compulsory for all U.S. soldiers. With this decision, the U.S. Army became the first in the world to adopt an inoculation against typhoid.