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

Vaccination: A More Effective Way to Prevent Typhoid Fever

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.