Some Remarks on Typhoid Fever Among 
our Soldiers During the Late War 
with Spain. 
BY 
VICTOR C. VAUGHAN, M.D., 
OF ANN ARBOR, MICH. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
July, 1899. Extracted from The American Journal of the Medical Sciences, July, 1899. 
SOME EE MARKS ON TYPHOID FEVER AMONG OUR SOLDIERS 
DURING THE LATE WAR WITH SPAIN. 
By Victor C. Vaughan, M.D., 
OF ANN ABBOR, MICH. 
In August, 1898, Surgeon-General Sternberg appointed a board con- 
sisting of Major Walter Reed, U. S. A., Major E. O. Shakespeare, 
XL S. V., and the writer to study the causes and the spread of typhoid 
fever among the troops in the various camps within the United States. In 
accordance with this order the members of the board have been and are 
still engaged in this investigation. Although our work is as yet incom- 
plete, and our conclusions may be somewhat modified after we have 
collected and compared more figures, we are apparently justified at 
present in formulating certain conclusions which may be of some in- 
terest to the profession. With the approval of the Surgeon-General 
and of my colleagues on the board I am permitted to present to you 
some of the facts that we have learned, with conclusions, which, in our 
opinion, are justified by these facts. 
It may be well, in the first place, to say something concerning the 
methods which we have pursued in our investigation of this subject. 
In accordance with the instructions given us by the Surgeon-General 
we visited and carefully inspected ail the larger encampments in the 
United States, including Camp Alger, the camps at or near Fernandiua, 
Fla.; Jacksonville, Fla.; Huntsville, Ala.; Chickamauga Park, Ga. ; 
Knoxville, Tenn.; Wycoff, N. Y., and Meade, Pa. In making this 
inspection, to which we gave about six weeks of time, we endeavored to 
ascertain by direct personal observation the conditions under which the 
soldiers lived. We visited nearly every regiment at each of these camps, 
made ourselves acquainted with the water-supply, the quality and quan- 
tity of the food, the preparation of the food, the nature of the soil of the 
camp, the space alloted to regiments, the arrangement and size of the 
tents and the number of men occupying each tent, the location of sinks 
with reference to the mess tents, the disposition of fecal matter and gar- 
bage, the thoroughness with which the camps were policed, etc. We 
visited regimental, division, and other hospitals, and ascertained the 
methods of disinfection practised in these hospitals. In short, we 
endeavored to see for ourselves everything that might have a bearing 
on the origin and spread of typhoid fever. While making this inspec- 2 
VAUGHAN: TYPHOID FEVEE AMONG SOLDIERS. 
tion we took the testimony of medical and other officers. We hoped to 
be able to interview at least one medical officer in each regiment, but 
this was not always possible. However, the information that we 
obtained in this tour of inspection was considerable and some of it of 
much value. 
Since finishing the inspection we have been engaged in studying the 
records in the office of the Surgeon-General. In this study also we 
have regarded the regiment as the unit; following, however, the details 
of the course of the epidemic in each company constituting the com- 
mand. We have endeavored to ascertain when typhoid fever first 
appeared in each regiment and how it afterward spread. How many 
cases there were in each company; if one dr more companies furnished 
an unusually large number of cases; we have endeavored to ascertain 
whether or not the men in these companies have lived under unusual 
conditions. Thanks to the courtesy and intelligence of some of the 
regimental medical officers, we know how many men in each tent had 
typhoid fever and the initial date of each case. In our complete report 
we hope to give all these data, but in this paper I must content myself 
with general statements, substantiated by a few details. 
We had not finished our first day’s work at Camp Alger before we 
saw that one factor in the problem must be thoroughly dealt with before 
we could hope to reach a satisfactory solution. Fortunately we promptly 
took steps to acquaint ourselves with this factor. It cannot be denied 
that scientific medicine would have gained much had this factor been 
provided for at an earlier date. I refer to the question of the scientific 
diagnosis of typhoid fever. In the division hospital at Camp Alger we 
found most of the febrile cases diagnosed as malarial. We believed 
that they were typhoid fever, but the surgeons in charge had diag- 
nosed them malaria. We requested that competent men, properly 
equipped for making blood examinations for the malarial plasmodium 
and the Widal test, should be sent to each of the larger camps. The 
Surgeon-General acted promptly on this suggestion. Drs. Gray and 
Carroll, of the Army Medical Museum, went to Camp Alger for this 
purpose. Subsequently Hr. Carroll continued this work at Jackson- 
ville. Hr. Hock, of the University of Michigan, made investigations at 
Chickamauga, Knoxville, aud Meade. Acting Assistant Surgeon Craig 
also spent several weeks in making blood examinations at Sternberg 
Hospital, Chickamauga Park. Hr. Curry, acting assistant surgeon at 
Fort Meyer, has made many hundreds of blood examinations upon sick 
soldiers sent from Camp Alger, Jacksonville, and other camps. As a 
result of the work done by these men we are able to state that malaria 
was a very rare disease among those troops who remained in the United 
States. Among the hundreds of blood examinations made on soldiers 
from Camp Alger the plasmodium was not found among the troops at VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
3 
this place. .Dr. Dock found one case at Chickamauga and one at 
Meade. The one at Chickamauga was a private of the Second Arkansas 
Volunteer Infantry, who stated that he had had chills and fever at 
home in the spring of 1898 before he enlisted. The malarial case 
at Camp Meade belonged to one of the Pennsylvania regiments. Two 
weeks before the examination of the blood this man came, so he 
stated, from a camp on the banks of the Potomac, It will be seen, 
therefore, that in each of these cases the plasmodium was probably 
introduced into the system elsewhere than at one of the large camps. 
Malaria was probably more frequent than these figures indicate, but 
that the long continued fevers diagnosed as malaria in nearly all the 
field hospitals were typhoid fever, there can be no doubt. The sick 
reports contain evidence in themselves that malaria was not a prevalent 
disease among the troops. The 158 th Indiana, Sixth Ohio, and First 
West Virginia constituted at Chickamauga Park one brigade, and were 
encamped side by side. From the sick reports it appears that malaria 
prevailed in the Indiana regiment from May throughout the summer. 
There were no cases in the Ohio regiment in May, three in June, eleven 
in July, 103 in August, and 203 in September. In the West Virginia 
regiment malaria does not appear on the records until August, when 
108 cases are reported. That there should have been malaria in the 
Indiana regiment in May and not a case in either of the other regi- 
ments in the same brigade, is not probable; and that it would have 
taken this disease two months, had Chickamauga been the fearfully 
malarious place it is said by some to be, progressing slowly through the 
Ohio regiment to reach the West Virginia regiment, is not in accord 
with any known epidemiological facts concerning this disease. Pushing 
our inquiry further, we find that in the Ohio regiment 273 individuals 
are recorded as having had malaria. Sixty-six of these were sick 
only a few days. Among those there may have been a, few cases of 
malaria, but the probabilities are that even for these a diagnosis of 
febricula would have been quite as scientific. Of the 207 cases of pro- 
tracted malaria, 148 were still sick when the last report consulted by 
us was made (October 31, 1898). This leaves fifty-nine cases of com- 
pleted malaria, among which there are quoted twelve deaths. A death- 
rate of more than 20 per cent, in “ mild, remittent malaria,” as the dis- 
ease is designated by one of the surgeons, is, to say the least, unexpec- 
tedly high. 
To summarize concerning the so-called protracted malarias reported 
by the regimental surgeons, we will say that, in our opinion, practically 
all of these were typhoid fever, and the following are our reasons for 
this opinion : 
1. The uneven distribution of the so-called malaria among regiments en- 
camped side by side gives us cause to suspect that these were not malaria. 4 
VAUGHAN; TYPHOID FEVER AMONG SOLDIERS. 
2. Some of the surgeons who failed to record their cases as typhoid 
state in their comments that typhoid fever prevailed in the regiment. 
One illustration of this may be of interest. From April to November 
there were in the Sixth Ohio, according to the recorded diagnoses in the 
monthly reports, only two cases of typhoid fever. Notwithstanding this 
fact, the acting assistant surgeon in charge at that time wrrites in the 
October report the following statement: “ The health of the command 
is improving. The prevailing disease that has caused the sickness we 
have had is typhoid fever.” And yet the September report showed 
only one cases of typhoid fever, and the October report showed only 
one case, and this one case was one and the same patient carried from 
the August report on to the reports for September and October. 
3. The results of several hundred blood examinations show that 
malaria was a very rare disease among the troops that remained in the 
United States. 
4. Malaria as it exists in this country is easily controlled by moderate 
doses of quinine. All the so-called protracted malarias in our camps 
were treated with large doses of quinine and were not improved thereby. 
Consequently, we must conclude that the diagnosis given these cases was 
erroneous. 
5. The mortality of the so-called protracted malarias corresponds with 
the mortality of typhoid fever, and furnishes most positive proof that 
these cases were not malarial. 
When we began to study the regimental sick reports we found that, 
in order to obtain satisfactory information, we must endeavor to ascer- 
tain how many cases of typhoid fever there were in each regiment, and 
it soon became evident that the regimental sick reports did not give this 
information. Of two regiments in the same brigade, one had more than 
200 cases of recognized typhoid fever, as shown by the regimental 
reports, while the other regiment on like evidence had only two cases, 
but the records of the second regiment show more than 200 cases of 
protracted malaria, and these furnished a mortality as high as that of 
the typhoid fever in the first regiment. For the reasons already given, 
we have included all the protracted malarias among our list of the 
typhoids. It may be asked how long we have considered it necessary 
for a so-called malaria to run in order to make it a probable typhoid. 
In answer to this I will state that we have regarded all so-called mala- 
rias of ten days or more in duration as possible cases of typhoid fever. 
We think that the great rarity of true malaria and the readiness with 
which these rare cases have yielded to quinine, and the fact that quinine 
was so generally administered, justify us in this conclusion. Practi- 
cally, however, the number of doubtful cases is exceedingly small. 
Typhoid fever was not only diagnosed malaria, but it was covered 
up by many other names. In one regiment the death-rate from pro- VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
5 
longed indigestion amounted to 15 per cent, of the completed cases. In 
another regiment at Chickamauga dengue is a frequent diagnosis of 
many cases which undoubtedly were typhoid fever. That dengue should 
have prevailed in one regiment only among the 60,000 troops at Chick- 
amauga is too absurd to receive serious attention. By tracing all doubt- 
ful cases to the hospitals we have been able to reach a positive opinion 
concerning the nature of most of them. In some regiments we have 
made an alphabetical list of all the sick. In others we have taken only 
those who are recorded as having had some intestinal disorder, malaria, 
or some form of continued fever. In some regiments many cases were 
diagnosticated simply continued fever. In others the surgeons seemed 
to regard enteric fever as distinct from typhoid fever. The belief of 
some of the medical men in “ typho-malaria ” is evident by their reports. 
The origin of typhoid fever in all the larger encampments is easily 
determined. Many of the volunteer regiments and some of the 
regular regiments were infected with typhoid fever before they 
reached the national camps. A few illustrations may be interesting. 
The Sixth Ohio reached Chickamauga Park on May 18th with a 
case of recognized typhoid fever. This patient was kept in the regi- 
mental hospital until he died, May 24th. The Ninth New York 
arrived at Chickamauga May 25th. There was a suspiciously pro- 
longed case of diarrhoea on June 10th, and one of enteric fever three 
days later. The Thirty-first Michigan arrived May 17th, and fur- 
nished a recognized case of typhoid fever June Ist. The First Arkan- 
sas reached Chickamauga May 27th. and sent a probable typhoid case 
to the division hospital June 2d, and a recognized case of typhoid 
fever June 3d. The Fifty-second lowa came May 31st, and the sur- 
geon recognized a case of typhoid fever June Bth. The First Missouri 
went into camp at Chickamauga May 21st, and had a suspicious case 
May 31st. The Fifth Missouri came May 27th, and furnished a suspec- 
ted case June 6th. The Second Kentucky arrived May 26th, and, so 
far as the records show, had no typhoid fever until June 26. The 
Second Missouri arrived May 20th, and furnished a probable case May 
26th. The Twelfth New York came May 20th, and the first suspected 
case had its initial date ten days later. The First New Hampshire 
arrived May 22d, and two days later entered on its sick report a case 
that was most probably typhoid fever. The Eighth New York arrived 
May 25th, and did not show any evidence of the existence of typhoid 
fever until June 24th. However, as this patient died July Ist, it is 
probable that the true initial date was earlier than is indicated. The 
Second Ohio arrived May 18th, and two days later a case diagnosed 
as “ gastro-enteritis,” and which may have been typhoid fever, was 
treated in the regimental hospital. These are not selected regiments, 
but these data were taken from a bundle of records at hand at the time 6 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
of this writing, and each record in the bundle was examined. It is safe 
to say that more than 90 per cent, of the volunteer regiments that went 
to Chickamauga Park reached that place infected with typhoid fever. 
So wide-spread is typhoid fever in this country that in assembling a 
regiment of volunteers the probabilities are that one or more men in 
the regiment will be found to be infected with this disease at the time of 
enlistment. Medical officers might do well to bear this in mind and be 
on their guard for the detection of the first case of typhoid fever. 
Instead of doing this, many medical officers will refuse to recognize 
typhoid fever until it assumes epidemic proportions, and the records 
that we have studied show us that often when typhoid fever has become 
an epidemic some medical officers still refuse to give the disease its right 
name and prefer to call it something else. This aversion to calling 
typhoid fever by its right name seems to exist among medical officers 
in all armies. The German medical officer often calls the disease 
“gastric fever,” and this term appears now and then in our records 
when the surgeon happens to be a German. The French call it 
“ manoeuvre fever.” lam inclined to the opinion that medical officers 
often are led to suppress the diagnosis of typhoid fever for fear of the 
alarm that it will give the patient and others. This, however, is a 
mistake. We will not eradicate this disease from our camps unless we 
early recognize its presence and take proper steps to prevent its spread. 
Typhoid fever in a camp should be reported to medical headquarters and 
to the medical officers of other regiments as diphtheria in a school should 
be reported. 
It may be well to emphasize the fact that our troops frequently car- 
ried in their own persons the typhoid infection to the national encamp- 
ment. Some acquired the disease at the State encampments and others 
brought it directly from their homes. In one of the Alabama regi- 
ments typhoid fever was at first confined to one company, and this 
company came from a town where there was an epidemic of the disease 
at the time when the men enlisted. From this company the disease 
spread through the regiment. 
The next question, How did typhoid fever spread among the 
troops ? In answering this inquiry we quite naturally first direct our 
attention to the drinking water. So far as our studies have been car- 
ried up to the present time, the evidence concerning water infection 
in the camps visited is, for the most part, negative. There is no evi- 
dence that the general water supply at the larger encampments was 
infected with typhoid fever. At Jacksonville the general water supply 
to all the regiments was from artesian wells a thousand feet deep, 
and infection of this water seems well-nigh impossible. Moreover, in 
round numbers there were at Jacksonville last August and September 
30,000 soldiers and about the same number of residents. Both soldiers VAUGHAN: TYPHOID FEYEE AMONG SOLDIERS. 
7 
and citizens used the same drinking water, and yet there was a wide- 
spread epidemic of typhoid fever among the soldiers and only a few 
sporadic cases among the citizens. At Knoxville the soldiers and citi- 
zens used drinking water from the same source, and at the time of our 
inspection, September, 1898, there were hundreds of cases of typhoid 
fever among the soldiers, and the records of the health officer of the 
city showed no evidence of the existence of the disease among the citi- 
zens. Some of the regiments at Chickamauga drank water from the 
creek, which might have been contaminated. These regiments suffered 
from typhoid fever, but other regiments which had no water from 
Chickamauga Creek and which brought their supply a long distance 
from mountain springs, the contamination of which is highly improb- 
able, had typhoid fever just as badly as did those who drank water 
from Chickamauga Creek. There is another very interesting point in 
this connection. The three regiments of a brigade are encamped side 
by side; water from the same pipes is distributed alike to all these 
regiments; and yet typhoid fever has prevailed for twenty days and 
has become an epidemic in one of these regiments, while one of the 
others remains wholly free from the disease. A similar condition is 
observed when we study the distribution of the disease among the 
companies in a regiment. I think that we have found evidence of 
water infection at some of the minor camps, and it is probable that 
soldiers while off duty and out of camp drank from infected wells, but 
we are quite confident that the general water supply of the larger 
camps was not infected, and that water infection played a very subor- 
dinate role in the spread of typhoid fever among the soldiers in the 
camps in this country. 
All know that the specific bacterium of typhoid fever is eliminated 
from the bodies of those sick with this disease in the urine and feces, 
especially in the latter, and that the disease is transmitted from one 
person to another by the transference of some part of the feces from 
the sick to the alimentary canal of the well. It follows that the spread 
of typhoid fever will depend upon the disposition of the excretions of 
those infected. On this point we have some interesting information. 
The first division of the Seventh Army Corps had during its stay at 
Jacksonville water carriage for its fecal matter. Each company was 
supplied with a galvanized iron trough, the lower end of which was 
connected with the sewer. The connection between the trough and 
sewer was closed by a cylindrical plug, which could be raised whenever 
it was desired to discharge the contents of the trough. The other end 
of the trough was connected with the water hydrant. The trough was 
partially filled with water, and in this condition received the excrement. 
The contents of the trough were discharged at will. 
The second division of the same army corps was furnished with tubs 8 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
or half-barrels. The fecal matter and urine were received in this with- 
out the addition of lime, dirt, or anything else. When these tubs were 
filled they were carted away by scavengers, emptied, cleaned, and 
returned. The fecal matter in the tubs was always exposed to flies, 
the contents were often spilled about the camp and slopped out along 
the road. 
The third division disposed of its fecal matter in pits, as is ordinarly 
done in camps. Orders were issued that the contents of the pits should 
be covered once, twice, or three times a day, differing in the different 
regiments. In some regiments attempts were made to compel each indi- 
vidual to cover his stool as soon as deposited. 
It will thus be seen that in the three divisions there were three dis- 
tinct methods of disposing of fecal matter. The men in these divisions 
were supplied with the same water, the same rations, lived in the same 
kind of tents, in the same climate, and, in fact, the only difference was 
in the method of disposing of the fecal matter. In August and Sep- 
tember there were more cases of typhoid fever in one regiment of the 
second division than in all the six regiments then constituting the first 
division, while the third division furnished an intermediate number. 
It will thus be seen that when the feces were swept out of camp with 
a minimum possibility of camp contamination, typhoid fever was less 
prevalent. 
The most potent factor in the spread of typhoid fever at most of the 
camps was camp pollution with infected fecal matter. This was true 
at both the large and small encampments. It was equally true of the 
smaller State camps, usually of one regiment, in the Northern States, 
and the large national encampments of one or more corps in the South. 
The Fifteenth Minnesota at St. Paul and Fort Snelling, the Thirty-fifth 
Michigan at Island Lake, and the 203 d New York at Camp Black 
became quite as badly infected as did any of the regiments at Chicka- 
mauga, Jacksonville, or Camp Alger. The epidemic of typhoid fever 
was not due to sending Northern men to Southern camps; nor was it 
due to the massing of many regiments together, but it was due to camp 
pollution. In most of the camps fecal matter was deposited in pits. 
Flies swarmed over the infected fecal matter and then walked over the 
food at the mess-tents. In many of the regimental camps fecal matter 
was deposited about the camp on the ground. There were pieces of 
woodland at Chickamauga Park through which one could not walk 
without soiling his shoes with fecal matter. In some of the regimental 
camps at Tampa the sinks were overflowed by the rains, and fecal 
matter floated through the companies’ streets. In many regiments 
paper soiled with fecal matter was blown about the camp. In a few 
instances it happened that, when a regiment was compelled to occupy 
a site vacated by another regiment, in digging the sinks for the newly VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
9 
arrived command the men found themselves in the filled sinks of the 
regiment that first occupied the ground. In at least one company, 
a New York regiment, a small cesspool was dug in front of each tent, 
and this received the wash-water and probably at night the urine. In 
one of the Pennsylvania regiments the men of one company dug a 
shallow well for drinking water in a location where the water was in 
all probability contaminated, and this company had an unusually large 
number of cases of typhoid fever. At Chickamauga a soldier was found 
attempting to run the guard by getting into one of the barrels on the 
wagon on its way to the spring to bring drinking water for the regi- 
ment. We walked through the regimental camp to which this soldier 
belonged, and we can testify to the fact that, although we picked our 
way, the soles of our shoes were soiled with fecal matter before we 
finished the round of inspection. In this way men carried fecal matter 
into their tents; and clothing, blankets, and tentage undoubtedly 
became infected in many instances. These are some of the ways in 
which the infection of typhoid fever was spread. 
We have considered the question of milk-supply in all the camps 
visited, and can state that there is no evidence that milk was a general 
or frequent vehicle for the distribution of typhoid fever. 
We are convinced from our observations that, when water carriage 
for the disposition of fecal matter cannot be secured, the complete 
sterilization of all fecal matter is necessary to prevent the spread of 
typhoid fever in camps occupied for three weeks or longer. For this 
purpose we have recommended that each company be furnished with 
a specially constructed galvanized iron trough. This trough is to be 
partially filled with a saturated solution of milk of lime, and is to be 
emptied daily by means of an odorless excavator. In large camps one 
odorless excavator will serve a brigade, and the cost of each trough 
will not be more than $l5. 
It must be evident to all by this time that the prevention of disease 
is the most important duty of army medical officers. We think that it 
is cheaper and no less humane to prevent sickness than it is to care for 
the sick. Moreover, prevention of sickness conserves the fighting force, 
keeps the men in good spirits, renders good discipline more easy, pre- 
vents that demoralization that comes with every epidemic, and in every 
way renders an army more efficient. The success of many a campaign 
depends as much upon the hygienic measures enforced as it does upon 
the military skill of the line officers. The medical officer needs special 
training in military hygiene, and should be selected with more care than 
has been exercised in the past. He should be given more authority, 
and then more should be expected of him. 
To what extent did typhoid fever prevail among the troops encamped 
in this country during the summer of 1898 ? Owing to the aversion 10 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
shown by medical officers to diagnosing this disease correctly, as has 
already been mentioned, it is difficult to answer this question exactly. 
The following figures show the extent to which typhoid fever pre- 
vailed among twelve regiments belonging to the First and Third Army 
Corps : 
Name. 
Time. 
No. of 
recognized 
cases. 
No. of 
probable 
cases. 
No. of deaths 
among com- 
pleted cases. 
Total 
deaths. 
12th New York . . . 
May to November 
157 
490 
10 
17 
1st Arkansas . . . 
May to September 15 
81 
228 
13 
22 
8th New York . . . 
May to September 9 
190 
425 
16 
21 
2d Missouri.... 
May to November 
180 
268 
17 
13 
2d Ohio 
May to October 
184 
403 
14 
14 
1st New Hampshire . 
May to September 12 
211 
297 
7 
29 
52d Iowa 
May to September 
175 
345 
20 
35 
1st Missouri. . . . 
May to September 8 
45 
216 
5 
17 
5th Missouri.... 
May to October 
47 
212 
8 
16 
31st Michigan . . . 
May to October 
84 
239 
7 
9 
2d Kentucky . . . 
May to September 15 
89 
286 
14 
27 
9th New York . . . 
May to September 12 
141 
323 
21 
41 
Total 
1584 
3732 
152 
261 
Some explanation of this table may be desirable. The first column 
gives the name of the regiment; the second column indicates the period 
of time covered by the reports from which the data are taken. Some 
of the regiments were mustered out early in September, while others 
continued in service throughout November and even later. The third 
column gives the number of recorded typhoid cases in each regiment; 
the fourth column gives the number of cases of typhoid fever in each 
regiment, according to our estimate, after going over the regimental and 
hospital reports; the fifth column gives the number of deaths among 
the completed cases of probable typhoid fever ; the sixth column gives 
the total number of deaths from disease in the regiment as reported to 
the War Department up to December 2, 1898. It will be seen from 
this table that twelve regiments furnished 3732 probable cases of typhoid 
fever, and we are quite thoroughly convinced that in this list of prob- 
able cases there are very few if any doubtful ones. This gives an aver- 
age of a little more than 300 cases per regiment. In this list the smallest 
number of cases is furnished by the Fifth Missouri, which had 212, and 
the largest number by the Twelfth New York, which had 490. 
We have tried to ascertain the mortality among the typhoid fever VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
11 
cases, but at present we are not able to give any exact figures. The 
fifth column in the above table shows the number of deaths among the 
completed cases of typhoid fever. It must be understood that many 
of these deaths occurred among so-called malarial cases. This column 
foots up 152 deaths among the completed cases in the twelve regiments ; 
there were 3732 probable cases in these regiments. This gives a mor- 
tality of a little more than 4 per cent. It must be understood, however, 
that this is altogether too low, because there is in this computation no 
data concerning the deaths among the incomplete cases. We have 
attempted to get the total number of deaths from the records in the 
War Department, and the sixth column gives us figures for the total 
number of deaths up to December 2, 1898, These figures indicate the 
total number of deaths from all diseases. That these figures are too 
low is shown by referring to the record for the Second Missouri in the 
above table. According to the figures furnished us by the War Depart- 
ment, there was, up to December 2, 1898, a total of thirteen deaths in 
this regiment, but the regimental and hospital records show us that up 
to November, 1898, there were seventeen deaths among the probable 
typhoid fevers only. Supposing that the deaths reported to us from the 
War Department were all due to typhoid fever, we would then have 
among the probable cases of typhoid fever a death-rate of a little less 
than 7 per cent. All that we can say, then, at present is that the death- 
rate among the probable typhoid cases at Chickaraauga, as shown by 
these twelve regiments, was somewhere between 4 and 7 per cent., with 
the probabilities very much in favor of it being much nearer 7 than 4 
per cent. Our general impression during our inspection of the regi- 
ments and hospitals was that the death-rate among the typhoid fevers 
was very low; but 7 per cent, or 6 per cent., or even 5 per cent., is not 
a low mortality for typhoid fever among soldiers. In civil practice we 
have a right now to expect a death-rate of not more than 7 per cent. 
This death-rate should be much less among men who are picked on 
account of their physical perfection. We will endeavor to get more 
exact data concerning the mortality. 
It is a striking fact that the majority of the men who had typhoid 
fever had no preceding disease. We went into this work with the pre- 
conceived idea that diarrhoea and other intestinal disorders rendered 
men more susceptible to typhoid fever, and therefore we fully expected 
to find that typhoid fever prevailed more largely among those who had 
some form of intestinal trouble. Our studies thus far have shown us 
that this is not true, and that more than 80 per cent, of the typhoid 
fever cases do not appear upon the sick reports until they are taken 
with typhoid fever. As illustrating the relation between preceding 
intestinal disorders and typhoid fever, we will take the following from 
our history of typhoid fever in the First West Virginia. There were 12 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
260 cases of probable typhoid fever in this regiment. Five of these 
had the date of their illness in November, and four others did not belong 
to any company. Deducting these, the twelve companies furnished 251 
cases of typhoid fever. Supposing that each company had its full quota 
of 106 enlisted men and three commissioned officers, then 1308 men 
furnished 251 cases of typhoid fever. There are 585 individuals in this 
regiment who are reported as having had some intestinal disorder, and 
apparently 723 escaped disease of this kind. The 585 persons furnished 
82 cases of typhoid fever—l to 7.13 ; the 723 individuals furnished 
169 cases of typhoid fever— Ito 4.6. However, these figures do not 
represent the facts. Of the eighty-two cases of typhoid fever, forty-two 
were not preceded by any intestinal disorder. Therefore, 543 persons 
who had intestinal disorders of some kind furnished forty cases of 
typhoid fever—4 to 13.7; and 765 persons who had no intestinal dis- 
order furnished 211 cases of typhoid fever—1 to 3.64. A little more 
than 84 per cent, of the typhoid fevers in this regiment were not pre- 
ceded by any recorded intestinal disorder. It seems to us that only one 
conclusion can be drawn from these facts. Many of the diarrhoeas must 
have been due to or at least accompanied by a typhoidal infection. 
Another interesting thing about the typhoid fever cases is that in 
a considerable number of those preceded by some disorder, whether 
malaria, diarrhoea, or indigestion, the disorder occurred in such close 
connection with the typhoid fever as to cause us to believe that it 
was due to or accompanied by typhoid infection. The following cases, 
taken from the records of the Sixth Ohio, illustrate this point. It 
should be stated that in this regiment all the cases of typhoid fever, 
with two exceptions, were diagnosed as malaria or indigestion. 
No. 1.—Indigestion, August 24th to 25th; malaria, August 31st to 
October Bth. 
No. 2.—Diarrhoea, August 16th to 17th ; malaria, September 20th to 
October Bth. 
No. 3.—Indigestion, September 11th to 13th; malaria, September 
24th ; died October Bth. 
No. 4.—Diarrhoea, September sth to 6th ; malaria, September 10th ; 
still sick, October 31st. 
No. s.—lndigestion, September 4th to Bth; indigestion, September 
15 to 16th; .malaria, September 20th; still sick, October 31st. 
No. 6.—Diarrhoea, August 14th and 15th; malaria, August 18th to 
October 19 th. 
No. 7.—Continued fever, September 7th to 9th; malaria, September 
10th and 11th ; continued fever, September 26th ; still sick, October 
31st. 
No. 8.—Continued fever, August 12th to 16th ; malaria, August 19th 
to September 21st. 
No. 9.—Diarrhoea, August 22d and 23d ; malaria, August 25th to 
October 25th. 13 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
No. 10.—Diarrhoea, August 13th to 16th ; malaria, August 18th ; 
still sick, October 31st. 
No. 11.—Indigestion, September 15th and 16th ; continued fever, 
September 24th; still sick, October 31st. 
No. 12.—Diarrhoea, August 12th and 13th; malaria, August 19th to 
September 21st. 
No. 13.—Indigestion, August sth and 6th ; malaria, August 18th to 
October 28th. 
No. 14.—Diarrhoea, September 12th to 14th ; indigestion, October 
14th to 16th; continued fever, October 18th ; still sick, October 31st. 
No. 15.—Indigestion, August 16th and 17th; malaria, August 17th 
to September 23d. 
No. 16.—Diarrhoea, August 14th to 16th; malaria, August 18th to 
September 21st. 
No. 17.—Diarrhoea, September 6th and 7th; malaria, September 
12th ; died September 22d. 
No. 18.—Indigestion, August 22d to 27th; malaria, August 29th ; 
still sick, October 31st. 
No. 19.—Diarrhoea, September 2d and 3d ; malaria, September sth ; 
still sick, October 31st. 
No. 20.—Remittent malaria, Sepember 6th to Bth; continued fever, 
September 10th; still sick, October 31st. 
No. 21.—Indigesion, September 9th to 11th; malaria, September 
14th ; still sick, October 31st. 
No. 22.—Diarrhoea, September 14th to 16th; continued fever, Sep- 
tember 19th; still sick, October 31st. 
No. 23.—Diarrhoea, August 20th and 21st; malaria, August 29th to 
September Ist; malaria, September 2d and 3d ; malaria, September 
sth and 6th ; continued fever, September 29th ; still sick, October 31st. 
No. 24.—Diarrhoea, September 21st and 22d ; indigestion, September 
30th to October 3d ; continued fever, October 6th ; still sick, October 31st. 
No. 25.—Diarrhoea, August Bth and 9th ; diarrhoea, August 13th 
and 14th ; malaria, August 20th to October 31st. 
No. 26.—Indigestion, August 19th to 21st; continued fever, August 
29th to October 24th. 
No. 27.—Diarrhoea, August 4th and sth ; diarrhoea, August 7th and 
Bth ; malaria, August 19th ; still sick, October 31st. 
No. 28.—Diarrhoea, September 12th to 14th; malaria, September 
15th to 17th ; continued fever, September 19th ; still sick, October 31st. 
No. 29.—Indigestion, September 15th and 16th ; continued fever, 
September 25th ; still sick, October 31st. 
No. 30.—Simple fever, July 14th to 22d ; diarrhoea, August 2d and 
3d ; continued fever, August 21st; still sick, October 31st, 
No. 31.—Malaria, August 13th and 14th; malaria, August 19th to 
September 21st. 
No. 32.—Indigestion, August 21st and 22d ; malaria, August 29th ; 
still sick, October 31st. 
No. 33.—Simple fever, August 9th to 21st; malaria, August 26th to 
September 30th. 
No. 34.—Diarrhoea, August 21st and 22d; continued fever, August 
to September 24th. 
No. 35.—Diarrhoea, August 13th and 14th; malaria, August 29th to 
September 25th. 14 
VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
No. 36.—Diarrhoea, August 14th and 15th; diarrhoea, August 17th 
and 18th ; malaria, August 29th ; still sick, October 31st. 
No. 37.—Simple fever, August 12th to 15th ; diarrhoea, August 20th 
to 24th ; malaria, August 29th ; still sick, October 31st. 
No. 38.—Malaria, September 10th and 11th; indigestion, September 
14th to 16th ; malaria, September 16th ; still sick, October 31st. 
Hundreds of cases of this kind are recorded on the sick reports. In our 
opinion, the preceding illnesses in many of these cases were connected 
with the typhoid fever infection. The most rational explanation, so far 
as we can see, is that in the majority of these cases the infection was a 
mixed one, in which saprophytic germs greatly predominated in num- 
bers. The preceding illnesses are believed to have been due to the 
action of the saprophytic micro-organisms. 
In our studies we have had frequent occasion to observe that among 
the soldiers typhoid fever was often far advanced before it was recog- 
nized. That this was a potent factor in the spread of the disease in 
camps must be evident. With many unrecognized cases of typhoid 
fever defecating in the pits and on the ground over which men walked, 
drinking from the same water receptacle, eating from the same mess, 
and occupying tents in common with others, the chances of the trans- 
mission of the specific infection was great. This is illustrated in the 
Eighth New York. Many cases sent from this regiment to the New 
York hospitals were found to be convalescing from typhoid fever when 
they reached the hospital, and the disease had been diagnosed malaria 
prior to this time. 
In military experience typhoid fever is often apparently an intermit- 
tent disease. The following cases illustrate this : 
No. 1.—Intermittent malaria, August 10th to 15th ; diarrhoea, August 
19th to 21st; remittent malaria, August 21st to 25th ; advanced typhoid 
fever recognized in hospital, September 9th. 
No. 2.—Diarrhoea, July 30th to August sth; intermittent malaria, 
August 17th to 22d ; remittent malaria, August 22d ; granted sick leave, 
August 27th ; sent to Presbyterian Hospital, in New York City, Sep- 
tember 9th, with advanced typhoid fever. 
No. 3.— Intermittent malaria, August 13th to 18th; remittent mala- 
ria, August 18th; granted sick leave, August 31st; sent to St. Luke’s 
Hospital, in New York City, September 9th, with advanced typhoid 
fever. 
No. 4.—lntermittent malaria, August 13th to 18th; remittent mala- 
ria, August 18th to 23d; granted sick leave, August 29th; sent to St. 
Luke’s Hospital with advanced typhoid fever, September 9th. 
No, s.—Diarrhoea, July 10th and 11th ; diarrhoea, July 22d to 25th ; 
diarrhoea, July 30th to August 4th; intermittent malaria, July 6th to 
20th ; remittent malaria, August 23d to 24th ; granted sick leave, 
August 27th; sent to Mt. Sinai Hospital, New York, September 9th, 
convalescing from typhoid fever. VAUGHAN: TYPHOID FEVER AMONG SOLDIERS. 
15 
Hundreds of other cases might be given to illustrate the apparently 
intermittent character of many cases of typhoid fever. We have stated 
that these are “ apparently” intermittent. We do not intend to state 
that these apparent intermissions were afebrile. It is probable that 
a temperature-record would show that this was not the case. We 
mean that there were periods when the patient felt better, and for this 
reason was returned to duty. 
The influence of change in location of camps upon the continuance 
of typhoid fever is exceedingly interesting. We have not investigated 
this subject as thoroughly as we hope to do. At present, however, I 
think that we can give the following conclusions; 
(a) A regiment thoroughly infected with typhoid fever does not lose 
the disease when it changes its locality, even when it goes to a perfectly 
unobjectionable site and leaves all its sick behind. Evidence of this is 
shown in the history of the whole of the Second Division of the First 
Army Corps when it moved from Chickamauga to Knoxville. At 
Chickamauga Park this division became thoroughly saturated with 
typhoid fever. After reaching Knoxville, and notwithstanding the 
fact that the camp site was probably as fine as any in the world, the 
water-supply unobjectionable, the nature of the soil suitable for the 
digging of sinks, surface drainage good ; notwithstanding all of these 
advantages, typhoid fever prevailed more largely than it did at Chicka- 
mauga. It is altogether probable that the clothing, blankets, and tent- 
age of the men became thoroughly infected with the typhoid bacillus. 
When a regiment becomes saturated with typhoid fever, change in loca- 
tion alone is not sufficient to get rid promptly of the disease. We 
believe that it will be necessary in such a case thoroughly to disinfect 
clothing, blankets, tentage, etc. 
(6) If a regiment be moved before the infection has become marked, 
typhoid fever may disappear or at least decrease. 
(c) Apparently a sea voyage of some days or weeks might rid a com- 
mand, not widely infected with typhoid fever, of the disease. We have 
some illustrations of this in the troops that went to Cuba. For intance, 
about half of the First Volunteer Cavalry went to Cuba, while the 
other half remained at Tampa. Before the departure for Cuba, and 
while the regiment was all together, typhoid fever appeared, and its 
prevalence was confined to those companies that went to Cuba. Appar- 
ently this part of the regiment lost its typhoid fever on its way to Cuba, 
while the part that remained behind became badly infected. 
(d) A regiment thoroughly infected with typhoid fever does not lose the 
disease or lessen the number of cases after a short voyage at sea. This was 
illustrated by the Nineteenth Infantry, which, after becoming thoroughly 
infected with typhoid fever, was transported to Porto Rico. The progress 
of the disease apparently was not in the least retarded by this voyage. The Medical News. 
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