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

Typhoid Board Criticizes the War Department Sternberg’s Directives Are Insufficient

The Board’s members were even less complimentary of the War Department. Walter Reed had come to share George Sternberg’s long-held belief that doctors commonly misdiagnosed typhoid as either malaria or the so-called “typhomalaria”; Sternberg’s pre-war publicizing of Reed’s Widal test demonstration represented a warning of as well as a corrective for these errors. With the onset of the Spanish-American War, however, the Surgeon-General placed considerable faith in Circular No. 1’s efficacy and simultaneously found himself constrained by an army-wide emphasis on mobility that discouraged the installation of laboratory facilities in field hospitals. When regimental surgeons disputed the Typhoid Board’s early suspicions of widespread misdiagnosis, Reed, Shakespeare, and Vaughan consequently lacked convenient access to equipment capable of demonstrating their crucial point, either through the Widal method or through means to confirm the presence of malaria. Although Sternberg eventually provided such equipment at the Board’s request, its members opined that “the Government” had denied to “scientific medicine contributions of the greatest value.”

Deficiencies in Management of Urine, Feces, and Contaminated Objects

Additionally, the three surgeons suggested the presence of important deficiencies in Sternberg’s Circular No. 1. That document failed to stipulate measures for managing the urine of outwardly healthy soldiers. The Typhoid Board recognized the menace of urine explicitly and urged the complete removal or disinfection of “all” urine as well as all feces. The Typhoid Board, moreover, noted the unbounded industriousness of flies and thereby vindicated the many commanders who recognized the inadequacy of the Circular’s thrice-daily schedule for excrement covering. That policy had allowed the insects up to eight hours of unobstructed harvesting. Yet the Board also observed that the constant coverage they subsequently ordered would have proven futile even in the absence of recalcitrant enlisted men. Flies “swarmed so numerously” that soldiers’ “first droppings … were often covered with them before the act of defecation was completed.”

The Board’s members also acknowledged their own ignorance. After twenty months of study and reflection, Reed noted in the Abstract of Report on the Origin and Spread of Typhoid Fever of 1900, “our knowledge concerning the chemistry of the etiology of typhoid fever is general and vague.” In the Report on the Origin and Spread of Typhoid Fever of 1904, Victor Vaughan recalled that the Typhoid Board had visited the camp at Falls Church, Virginia anticipating proof of waterborne transmission only to find evidence of some other means “quite as efficient.” The Board’s subsequent observations at the Jacksonville, Florida camp eliminated water as the most plausible vehicle for the epidemics. Yet a comprehensive, alternate theory—“pollution of the soil, of the feet, clothing, tentage, bedding, etc.”—remained elusive until after the three surgeons visited Chickamauga, Georgia.

Sternberg Responds to Typhoid Board Findings in 1899

The Typhoid Board’s findings encouraged Sternberg to expand an ongoing condemnation of nonmilitary practices and habits. Somewhat obliquely, his report for fiscal year 1897 had suggested that civilians’ inability to control disease posed a broad threat to the army. In a paper delivered before the American Medical Association in June 1899, he opined that misdiagnosis was “one of the principal causes” of epidemic typhoid during the Spanish-American War.

Society at large, moreover, was as culpable as the medical profession. Sternberg’s paper observed that, “Sanitarians generally are familiar with the difficulties” of controlling “the ravages of infectious diseases in towns and cities.” Those difficulties included: “ignorance and reckless indifference of a large proportion of the population,” “ignorance and mistaken parsimony of legislative bodies,” and “negligence or perfunctory performance of … agents of the health department.” “Perhaps it was too much to expect,” Sternberg concluded, “that typhoid fever should be excluded from our camps.” His conclusions and those of the Typhoid Board typified the critiques of Progressive-era reformers, prone to identifying Americans as their own worst enemies.