“In July, 1918, a replacement unit consisting of 248 men from Camp Cody, N. Mex., reached England with typhoid prevailing extensively; 98 men, or 39.5 per cent., had typhoid, and the case death-rate was 8.42 per cent. “It was evident from the investigation that the men were exposed to infection through contaminated drinking water while en route to the port of embarkation in the United States. The unit had been vaccinated a few months prior to the occurrence of the epidemic. Most of the patients presented the typical clinical features of typhoid.” “In August, 1916, a small but severe epidemic occurred in a detachment of Engineer troops stationed at Bazoilles. In this unit fifteen cases of typhoid occurred, with a death-rate approximating ten per cent.” “Following the offensive in the Argonne sector, typhoid and paratyphoid began to be reported from practically all divisions engaged in that offensive. It is quite evident that the initial cases were due in large part to drinking infected water.” “More than 300 cases of typhoid-paratyphoid may be attributed to the Argonne offensive. Eight hundred and seventy-four typhoids and paratyphoids have been reported in the American Expeditionary Forces since October 1, 1918.” “A small but severe epidemic occurred in the Joinville concentration area in December and January. In a group of Medical Department units (evacuation and mobile hospitals and sanitary trains) concentrated there seventy-five cases occurred, with a case death-rate of approximately twenty per cent.” “The records of this office show that patients with typhoid have passed successively through camp, field, evacuation, and base hospitals without any documentary evidence that typhoid or paratyphoid was even suspected. There are records of a stay of two weeks or more in a single base hospital without diagnosis, and not a few records are on file showing that it remained for the pathologist to make the diagnosis at the autopsy table.” “The vaccinated individual protected against general systemic infection may still act as a carrier of typhoid infection, and frequently shows clinical manifestations of local disease of some portion of the gastrointestinal tract, while the characteristic symptom complex of typhoid fever due to general infection, namely, continued fever, rose spots, and enlarged spleen, may be wholly absent.” “Many cases originally diagnosed as influenza in the American Expeditionary Forces have subsequently proven to be typhoid.” “Intestinal types of supposed influenza should always be considered as possible typhoid until proven otherwise.”