Walter Reed, Edward O. Shakespeare, and Victor C. Vaughan

Walter Reed

The Department appointed three army surgeons recommended by the Surgeon-General: Major Walter Reed, designated President of the board, and Majors Edward O. Shakespeare and Victor C. Vaughan. The appointment order directed the three men to uncover the cause of the disease’s prevalence. At each stricken training-camp they would draw attention to any unsanitary conditions and recommend corrective measures.

Reed was America’s leading military expert on the scientific diagnosis of typhoid. In 1896, as curator of the Army Medical Museum and Professor of Bacteriology and Clinical Microscopy in the Army Medical School, he “repeatedly exercised” students in an adaptation of the newly developed Widal method, the first effective serodiagnostic test for the disease. Using blood samples solicited from military hospitals throughout the nation, Reed also performed a broader demonstration of the Widal test’s high degree of accuracy, a demonstration that Sternberg promptly publicized in his report for fiscal year 1897.

Shakespeare was a bacteriologist and ophthalmologist who had uncovered the origins of an especially baffling typhoid epidemic in Pennsylvania. Vaughan, a public-health innovator, had investigated typhoid outbreaks throughout the upper Midwest.

Victor C. Vaughan. From the U.S. National Library of Medicine

Typhoid in Stateside Army Training Camps

The Typhoid Board’s members began their work by visiting the Army’s training camps at Huntsville, Alabama; Fernandina and Jacksonville, Florida; Chickamauga, Georgia; Montauk Point, New York; Middletown, Pennsylvania; Knoxville, Tennessee; and Falls Church, Virginia. Between August 1898 and June 1900, when the Board disbanded, it also issued a host of sanitary recommendations and evaluated the medical histories of 92 regiments, basic organizational components of about 1,300 men each and containing collectively over 100,000 men.

Typhoid Board Issues Reports

With the assignment of Reed to other investigative bodies and the subsequent deaths of Shakespeare and Reed, in 1900 and 1902 respectively, Vaughan emerged as the Typhoid Board’s chief publicist. In a May 1899 presentation to the Association of American Physicians, he issued what was essentially the Board’s preliminary public report. One year later Vaughan and his colleagues delivered to Sternberg a report composed of nearly 3,000 manuscript pages and 100 maps and charts. The War Department published an abstract in 1900 and a more complete version, Report on the Origin and Spread of Typhoid Fever in U.S. Military Camps during the Spanish War of 1898, edited by Vaughan, in 1904. That final report, like the abstract of 1900, offered 57 “general statements and conclusions.”

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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. The Sixth Massachusetts Regiment passing in review on May 19, 1898, on the eve of its departure from Boston. From Folio No. 8, Chicago Times-Herald, War Pictures (1898)

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 military camp near Civil War battlefields at Chickamauga, Georgia, 1898.  At the time of this photo, roughly 40,000 men were in the camp. According to the original caption, “sanitary service is being perfected.” 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.

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Deficiencies in Management of Urine, Feces, and Contaminated Objects

“…pollution of the soil, of the feet, clothing, tentage, bedding, etc.” 2nd Corps soldiers in 1898. Courtesy of Noel G. Harrison

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.

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Soldiers’ Continued Recalcitrance to Typhoid Prevention Measures

Engraving of a medical examination. From The Story of the War of 1898 (1898) by William Nephew King, p.39

Many soldiers, however, demonstrated that they were as unimpressed by the Board’s post-war recommendations as by the Surgeon-General’s early-war guidelines. Although the rate for stateside typhoid-admissions per 1,000 soldiers dropped from more than 85 in 1898 to less than 6 in 1900, the latter figure nearly doubled in 1901 and remained high in 1902. Rising through 1901, the 1900 rate for stateside typhoid-deaths per 1,000 soldiers had likewise doubled by 1902. Although the impact of the 1902 statistics was softened somewhat by an awareness that they reflected greater diagnostic accuracy than those of previous years, it was exacerbated by the fact that both admission and mortality rates that year were worse for soldiers stationed stateside than for their countrymen stationed overseas.

Sternberg’s successors in the Surgeon-General’s Office soon encountered site-specific evidence that the Board’s work was often ignored. Shortly before Walter Reed’s death in 1902, he investigated a typhoid outbreak at Fort H. G. Wright, New York. In traveling spatially to Fort Wright, Reed also traveled temporally to late 1898, arriving amidst the predictable devastation wrought by infected soldiers. Reed then reconstructed a familiar history of exposed excrement, human contact, flies, and pathogen-conveyance to no less than three additional military installations.

Robert M. O’Reilly. U.S. National Library of Medicine

In the wake of Reed’s work at Fort Wright, Surgeon-General Robert M. O’Reilly initiated the issuance of Adjutant-General’s Circular No. 62, presenting “in language simple enough to be understood by every enlisted man, rules of personal hygiene.” In 1905, however, new attacks by pathogen-carriers prompted O’Reilly to issue a circular letter to the Army’s chief surgeons, asking them to reiterate the importance of the “details of disinfection” to the medical officers under their supervision. Yet for the fiscal year spanning 1906 and 1907, O’Reilly reported typhoid’s presence in all the camps of instruction and a “decided increase” in its army-prevalence overall.

The attempts of the post-Sternberg Surgeon-General’s Office to instill discipline in people were accompanied by a reduced faith in the technical systems endorsed by Sternberg and the Typhoid Board. In 1905, O’Reilly concluded reluctantly that the “objectionable” privy-pits remained not only the sole means of waste-disposal at many stateside camps but also provided the sole practicable means of such disposal for troops engaged in practice marches and maneuvers. By that year he had also determined that the Forbes-Waterhouse Sterilizers were no less “objectionable” as soldiers refused to provide “the degree of care necessary to prevent them from becoming culture beds for bacteria.”

Civilians’ Continued Menace as Typhoid Carriers and Renewed Interest in Water

In his Report of 1908, Surgeon-General Robert O’Reilly noted that the War Department planned to expand dramatically the acreage devoted to “permanent maneuver camps.” The project lent new urgency to the search for prophylaxis that was “as perfect as possible.” Typhoid fever, he wrote, remained “the disease which in time of war most seriously threatens the efficiency of the Army.”

Jefferson Randolph Kean, who shared Walter Reed’s frustration with typhoid fever as well as assisting him in the triumph over yellow fever. From the Hench-Reed Collection, Historical Collections & Services, Claude Moore Health Sciences Library, UVa

Contract Surgeon James Carroll and Major Jefferson R. Kean, allies of Walter Reed in the war on yellow fever, had in 1902 investigated a new typhoid outbreak in the Army’s Chickamauga, Georgia camp. The two surgeons traced the fever to the neighboring village of Rossville, where they found “unusually favorable conditions” for the disease. Surgeon-General O’Reilly reacted to the Carroll/Kean report with yet another indictment of dirty, indifferent civilians. As in 1898, the Army was “so exposed to typhoid fever that no matter how perfect the sanitation … an occasional case is unavoidable and in the majority of cases can be traced to a neighboring community.” O’Reilly concluded his warning by announcing the publication of what would become the 1904 edition of the Typhoid Board’s report. “The experience of the last few years,” he opined, “strengthens all the conclusions of the Board.”

Evidently, O’Reilly and Victor Vaughan determined that the Abstract of Report on the Origin and Spread of Typhoid Fever of 1900 lacked sufficient emphasis on water. For the edition of 1904,  Report on the Origin and Spread of Typhoid Fever, Vaughan replaced Reed’s “Etiology” essay with appendices that focused solely on waterborne pathogens and offered more extensive and more statistical evidence than Reed’s essay. Publication of the 1904 edition coincided with a surge of typhoid articles in the popular press, coverage that shifted prescriptive emphasis from personal discipline to broad prophylaxis through political reform and improved waterworks and sewers.

Civilian pathogen-carriers in Washington, D. C. lost little time in mocking the renewed attention to water. Typhoid rates that had long hovered at endemic levels assumed epidemic proportions there in 1906. Compounding the embarrassment created by such conditions in the nation’s capital and the Surgeon-General’s headquarters city, the Army’s Corps of Engineers had overseen installation and activation of a state-of-the-art water filtering plant for Washington in 1905. By 1908, investigators concluded that personal contact and inadequate disinfection of typhoid patients’ excrement had largely negated the city’s adequate sewers and new waterworks.

Through a series of articles in 1907-1909, Mary “Typhoid Mary” Mallon provided a specific, nationally recognized face for the phenomenon of contact-infection. She personified no less than three concepts identified by the Typhoid Board: the civilian carrier, the recalcitrant carrier, and the chronic carrier. Ironically, Victor Vaughan may have inadvertently accentuated Mary Mallon’s novelty and consequent impact. In excising Reed’s “Etiology” essay before issuing the 1904 Report, he also excised most of the Board’s discussion of the chronic-carrier state.

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A 2nd Corps regiment in 1898, in the midst of one of the several camp-abandonments necessitated by typhoid fever. Courtesy of Noel G. Harrison

During the Spanish-American War soldier carriers of typhoid bacilli emerged abundantly and powerfully equipped, encountered only divided and uninformed opposition, and ‘recruited’ reinforcements at an exponential rate. By disabling thousands of fellow soldiers in the process, carriers prompted the War Department to order the abandonment of most of the major training camps it opened at the outset of war.

Relocation of Army Training Camps

The United States Army consequently undertook a series of mass-retreats and attempted evasions. Two divisions of the 1st Army Corps moved from Chickamauga, Georgia to Lexington, Kentucky and Knoxville, Tennessee. The 2nd Army Corps moved first from Falls Church, Virginia to Dunn Loring, Virginia and Thoroughfare, Virginia, and then to Middletown, Pennsylvania. The 3rd Army Corps moved from Chickamauga, Georgia to Anniston, Alabama. In Florida the 4th Army Corps journeyed from Tampa to Fernandina.

In evaluating this dramatic response the Typhoid Board determined that the carriers proved as adept at transporting bacilli, in and on their bodies and on their possessions, between states as between neighboring regiments. The inhabitants of some camps found peace only after their assailants finished infecting all susceptible men, numbering in the Board’s estimation as much as one-third of a “thoroughly saturated” regiment’s strength. When attacked by pathogen-carriers, retreat alone was futile.

Strict Typhoid Prevention Measures: Latrine Policy, Disinfection, and Camp Relocation

Company B, 7th Regiment Illinois Volunteers, after a medical examination. From Medico-Surgical Aspects of the Spanish American War (1900) by Nicholas Seen, p.21

The Board concluded that only one of the five army corps stricken with epidemic typhoid succeeded in suppressing the disease actively. In the wake of two fruitless relocations and months of casualties, commanders of the 2nd Corps finally managed to impose an effective latrine-policy, described as “tyrannical” by one of the Board’s interviewees. Next, the Corps’ officers ordered disinfection of the clothing, blankets, and tents of the entire organization, numbering some 15,000 soldiers. Immediately thereafter they oversaw a third relocation, from Pennsylvania to Georgia and South Carolina.

Armed with the Board’s preliminary report, Surgeon-General George Sternberg concluded in 1899 that undisciplined and discipline-resistant soldiers carried typhoid from civilian society, where the disease was “endemic,” and transformed the stateside training camps into battlefields. The men stationed there, he wrote, suffered “all the privations and exposures of troops in actual conflict with an enemy … excepting only the danger from gunshot injuries.” Elaborating on this interpretation, the Board’s final report traced the course of the civil war from the mobilization stage through the pathogen-carriers’ lopsided victories first at the tactical level and then at the strategic level. In that final report Victor Vaughan declared that, “the commanding officer who needlessly and ignorantly sacrifices his men to disease is as unworthy of his position as one who makes a like sacrifice in the face of the enemy.”

The 2nd Army Corps’ three-part strategy of draconian defecation-management, mass-disinfection, and flight received the Typhoid Board’s imprimatur as the principal, recommended method for suppressing existing epidemics. In future wars, however, commanders who initiated such a battle would thereby hinder their ability to fight a conventional enemy simultaneously. Not surprisingly, then, Surgeon-General Sternberg was as eager to employ the Board’s members in a preventative capacity as he was to employ them in a suppressive capacity.

Typhoid Board Promotes New Equipment to Manage Urine and Feces and to Sterilize Water

Plans for the Typhoid Board’s Reed Trough and the building that housed it. From Report of the Surgeon-General of the Army (1899), p.212

Amid mounting evidence of soldier recalcitrance, the Typhoid Board condemned the use of surface tub-latrines and sub-surface privy-pits. Sternberg reached similar conclusions around the time the three surgeons completed their camp tour and returned to Washington, D.C. In October 1898, he proposed a new policy to the War Department: when wartime exigencies delayed or precluded the installation of sewers, delegate excrement-management largely to portable or easily assembled technical systems, rather than to people.

Two months later the Typhoid Board submitted plans for a structure, eventually dubbed the “Reed Trough,” that featured a long urinal; a multi-seat latrine; and a fly-excluding, enclosed metal-trough where disinfecting solutions treated all waste. The Board also drafted specifications for a six-wheeled, pump-and-tank wagon—the “Odorless Excavator”—that allowed its operators little opportunity for spillage while emptying the trough.

The Odorless Excavator, designed by the Typhoid Board to empty the Reed Trough. From Report of the Surgeon-General of the Army (1899), p.211

The Board’s ambivalence towards waterborne transmission of typhoid balanced its members’ certainty about the roles of contaminated people and flies. Although the three surgeons determined that “infected water was not an important factor,” they qualified this conclusion by reporting that some water supplies became “specifically infected” and, at Chickamauga at least, water was a prominent means of transmission if not its “chief” means. Reed devoted no less than six pages of his “Etiology” essay to prose illustrations, drawn partly from Shakespeare’s and Vaughan’s pre-war experiences, of the waterborne pathogen’s resilience and insidiousness. Sternberg agreed that water had proven itself a menace “frequently” before 1898 and directed the Typhoid Board to “consider and report upon the best method of sterilizing water for troops in the field.”

The Forbes-Waterhouse water sterilizer, as modified to meet the Typhoid Board’s specifications. From Report of the Surgeon-General of the Army (1899), p.221

The Board solicited proposals from six manufacturers, tested initial designs, suggested modifications, and then tested the revised designs. In late 1899, at about the time the War Department authorized the Reed Trough and the Odorless Excavator for field trials, the Board’s members recommended one of the six devices—the Forbes-Waterhouse Sterilizer, which likewise received the Department’s approval.

The Surgeon-General and the Typhoid Board’s members declined to extend their experimental approach to vaccination, or at least consideration of it at the published level they granted sterilizers and latrines. In December 1896, Reed had attended a meeting chaired by Dr. William S. Thayer of Johns Hopkins Hospital. Another attendee, Dr. Simon Flexner, suggested testing a promising new anti-typhoid vaccine “in barracks and army corps, where, as is well known, large and destructive epidemics sometimes occur.” Sternberg, however, viewed such prophylaxis as no substitute for sanitation; his reports and those of the Typhoid Board were silent on the subject of anti-typhoid vaccination for humans.

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Anti-typhoid vaccination in the United States Army, c. 1915. Courtesy of Noel G. Harrison

In 1908, the staff of the Surgeon-General’s Office worried that the maneuver-camp expansion program might enflame what they perceived as a lethal psychological condition. George Sternberg had identified the malady in his Report of 1898. Most army personnel, he reasoned, “having no experience of military life in the field, assumed that the deplorable condition in which they were living was the usual mode of life of soldiers … and that their duty as true soldiers was to endure, not only without complaint, but with a certain pride.” In the Surgeon-General’s Report of 1908, Robert O’Reilly likewise noted that “in the past officers … assuming that epidemic diseases are inevitable in war, have argued that troops going into camp should, as a part of their training, be subjected to what they [officers] call service conditions,” or marching conditions.

Voluntary Vaccination for Typhoid

O’Reilly responded to the deadly combination of military romanticism and civilian infection by embracing anti-typhoid vaccination officially. The Surgeon-General’s Report of 1908 announced that his bureau was studying European nations’ attempts “to render their soldiers immune” with that technology. A new American Typhoid Board reviewed the study and recommended the distribution of a vaccine that conferred limited immunity. The United States Army accordingly initiated voluntary vaccination in 1909.

The Mexican Revolution and Mandatory Vaccination for Typhoid

In early 1911, at the outset of the Mexican Revolution, the War Department mandated anti-typhoid vaccination for United States Army personnel dispatched to the southern border. Surgeon-General George Torney, O’Reilly’s successor, subsequently reported that a vaccinated division of 12,800 men suffered one case of and no deaths from typhoid fever while encamped at San Antonio, Texas. Torney compared these statistics to those compiled by the first Typhoid Board for a 10,700-man division that encamped in 1898 “in nearly the same latitude for about the same length of time”: 2,693 cases and 248 deaths. Torney added that a unit that camped outside Galveston, Texas in 1911 lacked “sanitary plumbing” but suffered no typhoid casualties, while the city’s population sustained 192 cases during the same period and despite possession of that very amenity.

James Carroll, another veteran of the yellow fever triumph who found himself mired in the frustration of typhoid fever. From the Hench-Reed Collection, Historical Collections & Services, Claude Moore Health Sciences Library, UVa

Vaccination now topped the Army’s hierarchy of anti-typhoid weapons. In June 1911, the War Department designated such prophylaxis as compulsory for all troops entering federal service. One scientist later estimated that, “had the rates of the Spanish-American War been in effect,” the nation’s armed forces would have suffered half a million typhoid cases during World War I, when they actually suffered 1,572, and two million cases during World War II, when the real figure barely exceeded 600.

In 1904, two years after Sternberg’s retirement from the Army, Surgeon-General Robert O’Reilly granted James Carroll permission to test an oral vaccine on himself and 12 other soldier-volunteers. Seven of the men quickly developed the disease, and Carroll determined that the laboratory personnel who prepared the vaccine had failed to kill all the pathogens. As those were isolated from a soldier who succumbed to typhoid in 1898, Carroll had unwittingly converted a victim into a carrier and staged a literal re-enactment of that year’s pathogenic civil war. All the victims of his study survived, but the Surgeon-General’s Office neither publicized its results nor authorized a replacement trial in the immediate aftermath.

In Conclusion: Vaccination Trumps Discipline and Sanitary Engineering for Typhoid Prevention

Spanish-American War soldiers in a hospital on the Civil War battlefield of Chickamauga, Georgia, scene of the Army’s worst typhoid epidemic in 1898. Courtesy of Noel G. Harrison

Many soldiers rejected the typhoid-fever prophylaxis that Walter Reed helped devise in the wake of the training-camp epidemics, much as they had resisted the measures recommended previously by Surgeon-General George Sternberg. These setbacks notwithstanding, the historical work of Reed, Sternberg, and the Typhoid Board was stunning in its contention that the United States had waged a civil war semi-consciously in 1898. Civilians attacked soldiers or soldiers-to-be, and soldiers attacked one another. Fearfully anticipating this story’s repetition, the successors of Reed and Sternberg subordinated cherished notions of discipline and sanitary engineering to prophylaxis that appeared independent of both.

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This exhibit was written by Noel G. Harrison, a graduate student in The Corcoran Department of History at the University of Virginia and an intern in Historical Collections and Services at the Claude Moore Health Sciences Library, University of Virginia during the fall of 2002. The Web exhibit was prepared and designed by Mike Wilson and Sara Huyser. Special thanks to Bart Ragon, Joan Echtenkamp Klein, and Hal Sharp for their assistance.

For permission to reproduce any of the text or images owned by Historical Collections and Services or to make comments or suggestions, please contact a member of Historical Collections.

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A map of Cuba. From the title pages of An Illustrated History of Our War with Spain (1898) by Henry B. Russell

At the onset of the Spanish-American War in 1898, America’s military planners were less concerned with typhoid fever than with yellow fever, Spain’s military forces, and most of the other major challenges they anticipated. Much of the typhoid-related optimism originated with Brigadier-General George M. Sternberg, a leading bacteriologist and Surgeon-General of the United States Army. On April 25, the day the Congress of the United States declared war on Spain, he issued a series of etiological explanations and sanitary recommendations in Surgeon-General’s Circular No. 1.

George Miller Sternberg

Waterborne Typhoid

The Circular noted that typhoid fever was contagious and identified specific means for its transmission. In accordance with the findings of pioneering typhoid-investigator William Budd, Sternberg emphasized the danger of polluted water and prescribed boiled or filtered supplies for troops who lacked a source pronounced pure by a medical officer. He urged their commanders, moreover, to avoid waterborne typhoid by selecting only those campsites possessing effective drainage. In subsequent guidelines Sternberg tutored medical officers on the supervision of water filtering, in devices the War Department issued on his recommendation, and water testing.

Latrine Use and Flies as Typhoid Vectors

Although Budd, author of Typhoid Fever: Its Nature, Mode of Spreading, and Prevention, had overlooked flies as typhoid vectors, Sternberg’s Circular noted that countering their propensity to “swarm around fecal matter” was as powerful a justification for “strict” sanitary measures as avoiding polluted water. Those measures included officers’ obligation to favor previously unoccupied sites when locating camps. The Circular recommended that their subordinates dig latrines, also known as “sinks” or “privy-pits,” as the first step in camp-establishment and dig  replacement pits when the contents of the originals came within two feet of the ground’s surface. Sternberg added that soldiers who declined to use latrines “should be punished.”

Disinfection of Latrines

No less an optimist than Surgeon-General George Sternberg, the manufacturer of this patriotic cover assumed that sectional amity and reconciliation would represent the principal, domestic by-products of the Spanish-American War mobilization. The cover’s actual user, however, enclosed a letter detailing the stateside ravages of typhoid fever. Courtesy of Noel G. Harrison

Disinfection lay at the heart of Sternberg’s waste-disposal technology: he stipulated that soldiers should cover the contents of latrines thrice-daily with earth, quicklime, or ashes. Army medical personnel should treat the excreta of all fever patients immediately with a solution of carbolic acid, chloride of lime, or with milk of lime made from quicklime.

Typhoid Mortality Rates

Sternberg’s faith in “progress” notwithstanding, in the Spanish-American War’s fourth month the United States Army’s typhoid mortality rate surpassed that of its fourth-month Civil War counterpart. To make matters still more vexing for Sternberg, typhoid statistics were especially bad in the Army’s stateside training camps, situated far from what were understood to be the sites of combat operations.

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Walter Reed. Burnished by Yellow Fever but Frustrated by Typhoid Fever. Bronze sculpture by Hans Schuler, 1905. Historical Collections, Claude Moore Health Sciences Library, University of Virginia.

Walter Reed

Walter Reed’s professional experiences with typhoid fever stand in marked contrast to his professional encounters with yellow fever. In the case of typhoid, he was more a messenger than a conqueror. Typhoid fever remained defiant during a career that oversaw the rout of yellow fever. Through a humanizing story that shows how fate brought Reed continuing frustration as well as talent and success, this exhibit seeks to render him a more accessible role model for students of medicine and history.

The post Introduction: Illuminating a Different Civil War in the Fight against Typhoid Fever appeared first on Walter Reed and Typhoid Fever, 1897-1911.