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Perspectives in Biology and Medicine 48.2 (2005) 293-300
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Military Medicine in the Spanish-American War
Alfred Jay Bollet
The Spanish-American War of 1898 was brief, with relatively few battle casualties, but epidemic disease, especially typhoid fever, devastated the volunteer troops. Post-war investigations and commissions generated better understanding of the problem of asymptomatic carriers and a series of recommendations that greatly improved military medicine. The new practices, including the development of a typhoid vaccine, saved thousands of lives during World War I. Studies that established the role of the mosquito in yellow fever spawned preventive measures that ended the huge epidemics of that disease in the Western Hemisphere; this in turn made possible successful construction of the Panama Canal. This well-written book, Bullets and Bacilli: The Spanish-American War and Military Medicine by Dr. Vincent J. Cirillo, describes the military and medical events of the war and tells the story in satisfying detail.
The bacterial etiology of most of the major epidemic diseases of the time had been elucidated during the revolution in medical thinking that occurred in the decades immediately preceding the war with Spain. The "germ theory of disease" became widely accepted after Robert Koch's demonstration of the role of the tubercle bacillus in the etiology of tuberculosis in 1882. Concern about surgical cleanliness, along with early aseptic techniques originally inspired by Joseph Lister, were already improving the outcome of major surgical procedures. As a [End Page 293] result, the fatality rate following surgical treatment of battle wounds during the Spanish-American War was much lower than during the Civil War four decades earlier. Indeed, statistically it was the lowest percentage mortality of the wounded of any of our wars, before or since, but the number of casualties was infinitesimal compared to our other wars. Epidemic disease, especially typhoid fever, remained the main killer of soldiers as it had been in the Civil War and would be again in the Anglo-Boer War of 1899 to 1902.
The experiences of the Civil War and the acceptance of germ theory had stimulated major improvements in the sanitation of cities, cutting the frequency of some devastating epidemic diseases. But these developments had little influence on the thinking of military leaders, who ignored the advice of medical officers. Basic sanitation was largely ignored by both officers and men; as in the Civil War, line officers accepted that "a military camp is supposed to smell that way."
Bullets and Bacilli recounts the story of the epidemics of typhoid fever very well. Regular army troops experienced little typhoid, probably because they were almost all immune from prior exposure to the disease, although Cirillo suggests that the rarity of the disease among them was because of better discipline and therefore better sanitation in their camps. However, the disease became epidemic as soon as volunteers arrived in the training camps. Most of the deaths occurred while the volunteers were still in the United States, but after the fighting ended deaths from disease continued to decimate the troops in Cuba.
The gravity of the problem led the Surgeon General of the Army, George Sternberg, to appoint an army "Typhoid Board," and after the war President McKinley appointed a War Investigating Commission (the Dodge Commission) that also focused principally on the problem of disease among the troops. The Typhoid Board had three members, one of whom, Major Edward Shakespeare, died shortly after beginning the task. The head of the Board was Major Walter Reed, who was also asked to investigate the problem of yellow fever in Cuba. therefore, most of the work of the Typhoid Board fell to the third member, Major Victor Vaughan.
The Board concentrated on the problem in the training camps in 1898, focusing on the fact that the disease became epidemic quickly in volunteers when they reported to the training camps...