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DISEASE, injury and sickness caused not by physical exter- nal force, but instead by some irritation to the internal organs, were labeled "indirect inflammation" by Civil War physicians. The germ theory was not accepted by the medical profession until later in the 19th century.

Physicians recognized several categories of indirect inflammations. Dr. C. Keith Wilbur, in his 1998 edition of "Civil War Medicine," lists miasmatic, non-miasmatic, and unclassified as three major categories.

Typhus and typhoid fever were classified as miasmatic diseases. Such diseases were thought to originate from bad air, filth and decaying animal and plant matter. Patients of both diseases exhibited a continued fever as opposed to intermittent fevers, as with malaria, or eruptive fevers, as with smallpox or variola. These were the three fevers of miasmatic diseases taught in the medical schools of the day.

Poor sanitation, typhoid fever and typhus were synonymous during the Civil War. According to military records, typhoid took the lives of 29,336 Union soldiers. This is approximately 25 percent of all deaths caused by disease. The South suffered also. For every Confederate soldier killed in battle, three died from disease.

Typhoid is caused by different species of salmonella bacteria in contaminated water and is also carried by flies from privies and latrines to the food soldiers ingested. Typhus is caused by microorganisms called rickettsia, carried by body lice. Unsanitary conditions allow body lice to survive. Because of the symptoms, often the diseases were confused by physicians.

The symptoms of typhoid fever were continued fever, perhaps pink skin-spots on the upper abdomen, enlarged spleen, diarrhea, listlessness and sometimes death. Before antibiotics, 12 percent to 16 percent of patients died.

Typhus begins with chills, fever, rash, convulsions, delirium and perhaps death. After World War I, 30 million cases were reported in Eastern Europe and the Soviet Union. Official Union records reported 850 deaths from 2,501 diagnosed cases of typhus. But the records also list 11,898 cases of continued fever.

Undoubtedly, many were caused by salmonella and/or rickettsia. Both were recognized as camp fevers, as they were common among large numbers of men packed together in camp without proper sanitation and good personal hygiene.