Bullets and Bacilli: The Spanish-American War and Military Medicine (review)

Historians of medicine have paid insufficient attention to the Spanish-American War of 1898, a regrettable circumstance that Vincent Cirillo seeks to redress in this well-researched study. Based on his doctoral thesis and focusing chiefly on the medical history of the U.S. Army at home and at war in the Greater Antilles in 1898, Bullets and Bacilli offers a view of the first major conflict fought after the establishment of the germ theory of disease and of the diagnostic value of X-rays. Cirillo frames his study of this "little war with big consequences" in terms of such technical developments, noting also the lessons that were not learned during the American Civil War (p. 1).

He begins with valuable background histories of the war itself and the organization and administration of the U.S. Army before and during the conflict. With supply shortfalls, army medical officers hamstrung by their superiors, and little if any attention to camp hygiene and sanitation, at the outset of hostilities America was woefully unprepared medically and militarily "for the demands of a modern war against a European power in a tropical climate" (p. 3). Such circumstances contributed to disease taking many more lives than combat wounds: The ratio of battlefield deaths to deaths from disease was one to seven (p. 30). The fact that wounded soldiers stood a better chance at survival than their diseased comrades (and especially so relative to their wounded Civil War counterparts) was due to the effective introduction of medical knowledge and procedures that emerged after the Civil War, including first-aid packets, radiology, and antiseptic/ aseptic surgery.

As a defining event of the Spanish-American War—with over 20,700 cases, 1,590 deaths, and a 7.7 percent mortality rate—the typhoid fever epidemic occupies a central place in Cirillo's story. The disease wrought such damage despite identification of the etiologic agent and the mode of transmission and the deployment of effective preventive measures. Cirillo concludes that the structure of the U.S. military was to blame for the tragedy that played out among its soldiers. "Scientific knowledge was not enough to alter military culture," he writes. "It had to be translated into practice. Medical officers required the cooperation of line officers, who had the ultimate authority to implement effective sanitary procedures. That cooperation was not forthcoming. Despite continuing protests from medical officers, line officers and recruits neglected sanitation" (p. 57). The subsequent work of the Typhoid Board and Dodge Commission drove key organizational and educational reforms in the army and its Medical Department. Cirillo examines several of these reforms in the chapter "Outcomes of the War," including the Army Nurse Corps, Departments of Military Hygiene at the U.S. Military Academy, and Army Medical Reserve Corps, and the vast literature produced for and written and consumed by individuals associated with these projects and related endeavors. Cirillo also offers a comparison to the Anglo-Boer War (1899–1902). Here, too, military culture—namely, that set by British line officers— stood in the way of implementing the lessons already learned to save soldiers stricken with typhoid.

Bullets and Bacilli is a superb study that sets the groundwork for further research on the period, particularly with regard to the contributions of voluntary aid organizations, such as the Red Cross; experiences of soldiers in key sites of care giving, such as hospital ships; and medical material culture, such as radiographs and antiseptic first-aid packets. Students and scholars of American and British medical history, especially those who wish to contextualize contemporary intersections of war and disease, military and civilian culture, and medical knowledge and practice, will find Bullets and Bacilli an invaluable book that suffers only from insufficient proofreading, one assumes on the part of the publisher. Numerous citations in chapters 4 and 5 appear inconsistent because endnotes and parenthetical citations are both used. More than several note numbers are also half...