The American Plague: The Untold Story of Yellow Fever, the Epidemic that Shaped Our History - Molly Caldwell Crosby (2006)

Part III. Cuba, 1900

Chapter 10. Siboney

The rains started in Cuba, falling lightly at first, then in heavy, gray panels, drumming against the blades of palmettos and muddying the camp. In the afternoon, the temperature might reach 120 degrees, but during the night, it dropped into the 60s, and rain fell steadily, soaking the soldiers in their dog tents. Camped outside the village of Siboney on a narrow mesa between steep hillside and jagged, coral-rock shoreline, the Thirty-third Michigan and Seventh Massachusetts awaited the Battle of Santiago.

Dr. Victor Clarence Vaughan, dean of the medical school in Michigan, chose to sleep in a hammock. It was a good way to prevent the crabs that scratched their way across the sparse mesa from crawling over him in his sleep. With his poncho and blanket hanging in the boughs of the tree to protect against the rain, he could reach the blanket when the temperature fell and wrap up inside the wet wool while waiting for morning and the swarms of mosquitoes that came with it. When the mosquitoes were too much, Vaughan would strip down and head toward the water pipe that pumped fresh water from the mountains outside of Siboney into Santiago. The troops would drive holes into the pipeline to drink water, or even better, get a morning shower, before plugging them closed again. After his pipeline shower, Vaughan would make his way to the mess hall for coffee—freshly made by the cook, who pounded the grains in a tin pan with a bayonet.

The army needed a place to unload supplies, but the treacherous road from the American-held Guantanamo Bay to Santiago was riddled with tangled jungle and tropical fever, so transports— including a large number of medical supplies—were sent to the coastal hamlet of Siboney under the command of General W. Rufus Shafter. Vaughan and the other Michigan volunteers had arrived there on board the Yale on June 27, 1898.

Vaughan had already seen things in Cuba he never expected to see—some were innocent observations like the fact that the locals feared the soldiers’ toothbrushes. The soldiers kept them in the bands of their caps, and the locals, having never seen a toothbrush before, thought it might be some sort of weapon. Other observations were more disturbing. The Cuban insurgents, so romanticized in the U.S. as revolutionaries, were nothing more than a collection of withering men, women and children. “It was the first time I had seen a starving people, and I could hardly believe what I saw,” wrote Vaughan. “My mental picture of starving people had consisted of individuals uniformly emaciated from head to foot, but the first impression made upon me by these people was that they had eaten too heavily. The limbs and the chest were greatly emaciated, while the abdomen was markedly protruding.”

Vaughan and the troops were at their new camp less than a week before the Battle of Santiago. A few miles away, Teddy Roosevelt and his Rough Riders rode toward Kettle Hill in the San Juan Heights. In the next six days, 12 surgeons—Vaughan among them—would treat 1,600 wounded men from the battle. They operated throughout the day and by lanterns swinging from posts in the night, listening to the sound of Spanish bugles in the distance and smelling smoke rising from the sea. Since most of the bullets and shrapnel passed directly through the body, the surgery was fairly simple. Vaughan chose a barber as his surgical assistant to help him clean wounds with Lysol soap and apply iodoform gauze at the flesh points of entry and exit.

When all of the men had been treated and the wounds dressed, Vaughan went back to his hammock exhausted, convinced he could sleep anywhere under any conditions. Exotic birds called from the treetops, and the smell of rotting mango and approaching rain was in the air. Cloudbursts would fall by the afternoon. As he reached his hammock, another stretcher arrived. The patient was very sick, but sleeping soundly at the moment, so Vaughan asked the men to place the stretcher underneath his hammock where the patient would be shaded while he slept, and then Dr. Vaughan drifted off to sleep.

He awoke to the sound of retching.

Leaning over the side of his hammock, Vaughan saw ink stains of black vomit on the man’s face, clothing and blankets. He sprang out of the hammock and ran into the camp.

“Come, doctor, we have a case of yellow fever,” Vaughan shouted at Dr. Guitéras, the well-known yellow fever expert and professor who had served on the 1879 Yellow Fever Commission.

They did what they could for the fever patient, then quickly set out to find a site for a yellow fever hospital, far from the other sick wards. Their haste was critical in the case of a yellow fever outbreak.

Guitéras and Vaughan rode a handcar up the mountain railroad east of Siboney. The place they chose was more than a hundred feet above sea level along the northern slope of the mountain range overlooking a huge valley and the Sierras beyond. For reasons unknown to them, high ground seemed the best place to treat and prevent the spread of yellow fever. Tents and supplies were set up immediately, and before nightfall, there were already three patients in the new hospital.

General Shafter wrote to Washington, “There are now three cases of yellow fever at Siboney, in Michigan regiment, and if it gets started no one knows where it will stop.” That number grew to thirty the next day, then hundreds. By the end of the epidemic, close to fourteen hundred cases would be seen in the makeshift hospital overlooking a valley of royal palm trees and mountain peaks; the village of Siboney would be evacuated and burned to the ground.

The epidemic presented another problem: American soldiers could not return home until the fever could be contained. Instead they waited, like men anticipating execution, as yellow jack moved through the troops. One all-black regiment was ordered to Siboney to care for the fever patients; by the time they left, they had lost one-third of their men. Yellow fever quarantine camps had been set up in New England to accommodate returning soldiers, but a handful of senators from that area called the war department with objections. It was decided to keep the soldiers in Cuba until they could be certain yellow fever could be controlled. Even letters out of Santiago had to be thoroughly fumigated in the U.S. before delivery.

In what would be known as the “Round Robin” letter, General W. R. Shafter and Colonel Theodore Roosevelt devised a plan to write a letter signed by the officers under Shafter’s command that would be leaked to the press to force public opinion. Public pressure would surely drive McKinley to bring his troops home rather than leave them to the ravages of yellow fever. Although typhoid and dysentery had been far more damaging to the troops, the officers feared the onset of the fever season would be disastrous for the already sickly troops. “All of us are certain,” wrote Roosevelt, “that as soon as the authorities at Washington fully appreciate the condition of the army, we shall be sent home. If we are kept here it will in all human possibility mean an appalling disaster, for the surgeons here estimate that over half the army, if kept here during the sickly season, will die.”

Roosevelt’s letter as well as the Round Robin letter signed by Roosevelt and Shafter’s other officers were given to a reporter from the Associated Press. The plan worked beautifully, and the next day, the New York Times headlines blared: “War Department Spurred to Activity by News from Santiago: Col. Roosevelt Declares 90 Per Cent of the Army Is Incapacitated and That Men Will Die Like Sheep If Left in Cuba.”

The situation had been gravely misrepresented from the beginning. Shafter had neglected to give accurate reports to Surgeon General George Sternberg and Secretary of War Russell Alger. Most likely, Shafter was fearful of news of sick soldiers spreading to the Spanish; but he also worried that camp surgeons were confusing cases of typhoid and malaria for yellow fever. The Round Robin letter published by the press came only three days after Sternberg and Alger first knew the full extent of the epidemic spreading among the Fifth Army Corps.

The administration was furious. McKinley was in the midst of negotiations for peace with Spain, and the Round Robin letter, he argued, damaged his position. Why would Spain negotiate if they knew biding their time during yellow fever season would wipe out half of the U.S. Army in Cuba? But the Spanish undoubtedly had their own concerns to contend with; in the previous four years, 16,000 of their troops had been stricken by yellow jack. In the end, the Round Robin controversy was a moot point. Orders had already been placed, even before the publication of the letter, to return the troops to the U.S.

Troops were sent to Montauk Point, a cool, high ground, to wait out the yellow fever quarantine. In all, 20,000 soldiers would land at Montauk Point in the space of three weeks. Conditions at that camp and elsewhere were notoriously bad. Surgeon General Sternberg had warned the administration that disease would be devastating to the army; he had been right.

Bald, with a white walrus moustache, Sternberg was a lifelong army man: straight backed, square shouldered, stout, a look of purpose in his face. He was a product of Lutheran ideology and German descendents. He was described by some colleagues as stiff and even egotistical, but he had real ambition, and it had taken him far. After his service on the Havana Yellow Fever Commission in 1879, Sternberg had continued his work on yellow fever, searching for the pathogen in the blood that caused the fever. He had even put forth one theory that bacteria he discovered, called Bacillus X, were the culprits. By 1893, Sternberg had been named surgeon general, and he opened the Army Medical School in Washington, D.C. But that ambition had also led to some disappointments. As “America’s Bacteriologist,” Sternberg was a forward-thinking man who had made important discoveries, but not before the great successes of France’s Louis Pasteur and Germany’s Robert Koch. His place in medical history was in no way secure, and what he needed now was his own definitive discovery.

George Sternberg was in a tough position as the Spanish-American War escalated. The military was wary of medical officers, seeing them most often as obstacles, or even annoyances, during war. As the surgeon general, the medical officers beneath him often saw Sternberg as a part of beaurocratic machinery. An editorial in the New York Times accused Sternberg of lacking the nerve and force of character necessary for a wartime authority figure. Another New York Times writer remarked, “Surgeon General Sternberg is unfit for the position he holds and that to his inefficiency is chiefly due the complete breakdown of the medical department in this war.”

Nonetheless, Sternberg had advised against sending troops to Cuba during the wet season when yellow fever was predominant, and he went so far as to refuse sending nonimmune army medical officers into fever-ridden Cuba. Sternberg also published concerns for the unsanitary conditions of camps and rapid enlistment of nonimmune men. There were simply too many men crammed into too many camps to keep up any sort of acceptable hygiene.

One week after the first case at Siboney appeared, Dr. Vaughan was walking the grounds of the camp when he felt a severe pain in the small of his back—he could barely stand or walk, and he knew immediately what was happening. He limped back to his tent to write a letter to his wife. His guilt mounted as he put pen to paper and wrote that he had been ordered into the interior of Cuba for the next two weeks, and she would not hear from him. Surely the lie would be more comforting than no word at all, or worse, the truth. After that, Vaughan went to see the chief correspondent of the Associated Press, asking him not to mention his name or his condition in dispatches home. Then, Vaughan entered the white hospital tent that had housed surgical patients: Long rows of empty cots, over fifty of them, spread out before him in two straight columns. He asked an orderly to change the sheets on one and fell into it.

That night, Dr. Guitéras examined Vaughan. “Only a little malaria. You will be all right in a few days. Tomorrow I shall give you quinine.” Guitéras told the nurses to keep Vaughan comfortable and see that he has everything he needs; then he left.

Throughout the night, Dr. Guitéras returned to Vaughan’s bedside—half a dozen times. Vaughan kept his eyes closed and pretended to sleep each time Guitéras entered, but he could always feel the doctor’s touch on his wrist and hand on his brow.

As Guitéras came into the hospital tent the next morning, he was swinging his arms and whistling a tune; he gave the impression of a man who had a long night’s sleep and nothing in the world to worry about.

“Only a little malaria,” Guitéras repeated. “Don’t you think that the air up at the yellow fever hospital on the mountain side is much better than it is down here on this low wet ground?” Defeated, Vaughan said that he was ready to go to the yellow fever hospital and tried to rise from his cot, but Guitéras gently pressed him back down into the bed.

“Your temperature is above one hundred five degrees; your pulse is below forty; a change in position, even the sudden lifting of an arm, might stop your heart. You will not move on any account. Men will come, lift your cot, place it on a flat car, and you will be carried to the yellow fever hospital. I shall go with you.”

Vaughan spent the next week in the yellow fever ward, his stomach painfully contracting and shrinking, only to suddenly burst again with black vomit. He was treated with calomel and a local lemonade made from Epsom salt, lime juice and warm water. One afternoon, another yellow fever patient offered Vaughan a ginger ale. The thought of the carbonated drink was overwhelmingly appealing, but Vaughan cautioned the man to wait another few days. The patient insisted, trying to rise from the bed to find a corkscrew for the bottle.

“Do not move,” Vaughan whispered. “If you must drink the ginger ale, call the orderly and have him pull the stopper. Your heart is crippled and a change in position may kill you.”

The man laughed, rising from the bed, and then fell dead across Vaughan, breaking the cot beneath them. Vaughan called for the orderly, and the body was removed.

Another day, a yellow fever patient bribed an orderly to bring him solid food when he was under orders not to eat. He died within a few hours of the meal. Though his hunger grew intense, Vaughan adhered to his liquid diet of warm lemonade. He also suffered from delusions, believing that he was at once the patient and at other times just observing the patient—a “double consciousness,” he called it.

His temperature climbed toward 106, and he watched the clouds gather over the Sierras. He began to see gods and demons standing on the mountaintop. The clouds grew wilder and thicker, eclipsing the sun and swallowing the world. Each day, those lightning storms and clouds gathered in the mind of Victor Vaughan, until finally, they parted and disappeared suddenly and completely. Vaughan’s fever had broken, though he was now sixty pounds lighter and considerably weaker.

His superior officer prepared orders to send him home by transport, but Vaughan refused, arguing that his new immune statuswould enable him to do even greater work in the hospitals in Cuba. Rather than simply order Vaughan to return, the officer instead told Vaughan to stay as long as he liked and set up a tent for him—just a few feet away from the mess hall. Vaughan could smell the food from the mess, and several times he attempted to get out of his cot and walk there. He was too weak to manage even the short distance and had to crawl on his hands and knees. Vaughan’s superior officer visited him every hour.

“Tomorrow morning a transport leaves for the United States with convalescent soldiers, and I haven’t a doctor to send with them,” complained the officer. “I do not know what to do.” It was a thoughtful and effective tactic.

“Major, do you want me to go on that transport?” Vaughan asked.

Without answering, the superior officer called to a captain, “Bring a stretcher with bearers and put Vaughan on the transport.” On the long journey home, Vaughan recovered fully from his bout with yellow fever.

Victor Vaughan arrived back in New York in August of 1898, where orders from Surgeon General Sternberg awaited him. He would be part of the Typhoid Commission to investigate disease rampant among the American camps, and the head of the board would be Major Walter Reed.