University of Virginia Historical Collections at the Claude Moore Health Sciences Library

Findings of the Typhoid Board: Disease Spread by Civilians and Members of the Military

Farewell To Soldier Boys!

Farewell To Soldier Boys!. From Folio No. 6, Chicago Times-Herald, War Pictures (1898)

The Typhoid Board’s work included what could later be described as federally sponsored public history. Along with scientific testing, they undertook tours, documentary research, historical analysis of landscapes, and interviews of civilian and military eyewitnesses.
 

Civilians Transmit Typhoid to Military

As interpreted by the Board’s surgeon-historians, this research showed that the United States had mobilized against itself in 1898. They concluded that typhoid fever was “epidemic” in the stateside training camps, and military society contracted the disease from civilian society. Families, friends, and neighbors infected soldiers-to-be, who then carried the typhoid bacillus, Salmonella Typhi, to comrades in camps. The disease was so “widespread” in the United States, the Board determined, that “one or more men already specifically infected … enlisted in nearly every command.”

Leaving for the Front

Leaving for the Front. From Folio No. 8, Chicago Times-Herald, War Pictures (1898) Men going to stateside training camp 1898. The Typhoid Board and Surgeon-General Sternberg later concluded that some in the cheering crowds attacked the soldiers even as they celebrated their service.

Typhoid Is Misdiagnosed

The Typhoid Board’s members also concluded that the camps attracted lethal concentrations of civilians’ ignorance as well as their germs. Civilian-physicians-turned-army-surgeons diagnosed correctly only about half of the typhoid cases they examined. The Board’s preliminary report noted that typhoid was “covered up by many other names.” Its later reports disputed theories, prevalent among camp doctors, that suggested as stand-alone causes crowding, gastrointestinal disorders induced by dietary imbalances, the “nonacclimatization” of Northerners in Southern camps, gaseous poisons, and the “belief that the colon germ may undergo a ripening process.”

Color lithograph of soldiers and railroad cars, 1898. From The Story of the War of 1898 by William Nephew King, p.31

A Typical Typhoid Carrier Is Asymptomatic But Infectious

One of the Typhoid Board’s maps showing the uneven distribution of typhoid fever cases (hachured tent-symbols) in the camps of 1898. From Report on the Origin and Spread of Typhoid Fever (1904), p.538

The Typhoid Board revealed that the Army’s typical pathogen-carrier possessed an extraordinary ability to conceal his deadly weapons. A man who had contracted but survived the disease before joining the military “may for a long time continue to carry and excrete the specific poison.” A soldier who contracted typhoid fever after reaching camp remained in an asymptomatic but contagious incubation state for about ten days after infection. Before as well as after diagnosis, then, he possessed the capacity to “scatter the infection.” A carrier of the typhoid bacillus, moreover, might exhibit a temporary improvement in symptoms, tempting his regimental surgeon to return the man to duty among the camp’s other inhabitants and, inadvertently, to a new cycle of pathogen distribution.

The infected soldier’s potential arsenal included a weapon even more menacing than the typhoid that hid temporarily. The Board concluded “it is quite certain that an individual may become the bearer and distributer [sic] of the infecting agent…without developing the disease himself.” Walter Reed evidently deserves the lion’s share of credit for discovering this capacity for permanent concealment. His essay,“The Etiology of Typhoid Fever,” published in 1900 in the Abstract of Report on the Origin and Spread of Typhoid Fever in U.S. Military Camps during the Spanish War of 1898, constituted the Board’s principal recognition and description of what was later termed the “chronic carrier” state.

Army hospital on the Civil War battlefield of Chickamauga, Georgia, 1898. From Report of the Surgeon-General of the Army (1898), p. 120

The Typhoid Board derived its knowledge of pathogen-incubation partly from Chickamauga’s female nurses, whose arrival at the camp there coincided with the Board’s. According to Victor Vaughan he and his colleagues began watching each nurse “carefully…the first came down with typhoid fever ten days after her arrival.” While the nurses doubtless possessed as full an awareness of typhoid’s general dangers as any member of their profession, Vaughan’s account made no mention of whether the Board notified them of their impending role in the incubation study. That particular service was perhaps a case of “under-informed consent.”
 
 

Death by Typhoid

Pathogen-carriers’ weapons were as horrific in effect as they were stealthy in operation. At Chickamauga, for instance, Charles Kirk, an 18-year-old musician in the 14th New York Infantry Regiment, entered a hospital on September 9, 1898. The Board’s final report contained an abstract of his subsequent history: “Diagnosis: Typhoid Fever. Temperature moderately high; marked delirium; for three days before death, vomiting and involuntary discharge of watery stools. Died September 15, 1898.” Vaughan would remain tortured by animated memories, mental pictures he “would tear down and destroy were I able to do so,” of the soldier victims he visited in 1898.
 

Camp Conditions Promote Typhoid: More Soldiers Die Stateside Than in Fighting

America’s semi-conscious civil war in microcosm. Of these 11 members of the 1st Connecticut Infantry, at least seven became typhoid carriers, and two died of the disease. From History of Company K, First Connecticut Infantry (1899) by George B. Thayer

The Typhoid Board’s statistics showed that more Spanish-American War soldiers died from training stateside than from fighting overseas. At tented battlefields in the United States one-fifth of the soldiers present, more than 20,000, developed typhoid, and over 1,500 shared the fate of Charles Kirk. More men perished from the disease’s effects during the war than from those of any other agent, including yellow fever and Spanish gunnery.

The Board determined that newly arrived pathogen-carriers often attacked comrades via skin, clothing, or possessions. Camp life afforded countless opportunities for direct or semi-direct contact among soldiers, especially during mealtimes, leisure periods, and the shared occupation of tents. The Board’s members, moreover, found “fearful pollution…in many camps,” noting sub-surface privy pits that frequently flooded, surface tub-latrines that fouled the surrounding ground, and unauthorized latrines that “dotted” the woods adjacent to some tenting areas. Pathogen-carriers unable to achieve indirect transfer via the shoes or clothing of men who traversed polluted ground could enlist the assistance of latrine-visiting flies. Once freighted, the insects found their way to other areas of the camp, alighting on people, their food, and their possessions.

Tented battlefield at Chickamauga, Georgia, 1898. From Folio No. 9, Chicago Times-Herald, War Pictures (1898)

Carriers who failed to spread the infection in tents and at official or unofficial latrines found additional, ample opportunity while languishing in division hospitals. The Typhoid Board found the often reluctant orderlies, usually untrained men detailed from surrounding camps each morning, oblivious to George Sternberg’s mandate for the immediate treatment of patient waste. “Wholly ignorant of the nature of infection and the methods of disinfection,” they simply “went to the hospitals, handled bed pans used by persons sick with typhoid fever, and at night returned,” infected, to their comrades in the camps.

Carriers were often recalcitrant as well as lethal. Circular No. 1 presented not only Sternberg’s recommendations but also his warning that outbreaks of disease would “infallibly follow a neglect of these measures.” Many commanders elaborated upon the Circular, by ordering that each soldier should cover his feces immediately upon deposition, but the Typhoid Board failed to locate a single regimental camp “in which we did not find exposed fecal matter.” The three surgeons concluded that, “It is a very difficult thing to have the soldiers appreciate the necessity of keeping fecal matter covered.”

The carriers’ varied tactics rendered the Board’s historical work especially difficult. Edward Shakespeare prepared detailed maps and charts documenting regimental outbreaks by victims’ names, dates of symptom-appearance, and locations in individual tents. In illustrating the disease’s geographically uneven spread in the camps, he eliminated as prime transmission-candidates those media that underwent geographically even distribution, especially water from central sources. When factored against the ten-day incubation period, moreover, Shakespeare’s symptom-appearance dates revealed myriad infection-routes that led from one soldier to the next and through the tented battlefields.
 

Army Commanders Unprepared to Fight Typhoid

When pathogen-carriers extended their attacks to army units larger than individual regiments, they encountered a final defensive network composed of high-ranking field officers and War Department officials like Surgeon-General Sternberg. The Typhoid Board suggested that most of these men were little better prepared to meet the enemy than the hapless regimental surgeons.

Officers and men of a representative regiment, 1898. Courtesy of Noel G. Harrison

The Board noted that all army surgeons, including Sternberg and Walter Reed, lacked the authority to enforce sanitary directives. Instead, they expressed their views formally as recommendations to the officers who commanded regiments, army corps (numbering in practice between 15,000 and 30,000 men and representing generally the organizational level of a major training camp), or units of other sizes. Those commanders then decided whether to transform the recommendations into binding orders. Fortunately for carriers of the typhoid bacillus, officers generally lacked training commensurate with their roles as managers of camp sanitation. The Typhoid Board found that some camp commanders selected poorly drained or previously occupied tenting grounds, delayed ordering the establishment of new latrines, and suppressed regimental surgeons’ “reasonable” efforts to correct the oversights.