Typhoid was a menacing threat to U.S. forces during the war. A study of six recruit departure camps showed that of the 107,973 soldiers, 20,738 would contract typhoid and 1,590 would die from the disease. While the cause and prevention for typhoid was known by 1898, lack of sanitary enforcement in military encampments devastated troops. National outrage and increased public awareness fueled military health reforms. After approval by a U.S. Army medical board in 1908, a typhoid vaccination was introduced as a voluntary measure in the U.S Army.