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                          EPIDEMICS RESULTING
                               FROM WARS


                           PRINTED IN ENGLAND
                     AT THE OXFORD UNIVERSITY PRESS




               Carnegie Endowment for International Peace

                   DIVISION OF ECONOMICS AND HISTORY

                       John Bates Clark, Director




                     EPIDEMICS RESULTING FROM WARS


                       BY DR. FRIEDRICH PRINZING

                               EDITED BY
                           HARALD WESTERGAARD
     PROFESSOR OF POLITICAL SCIENCE IN THE UNIVERSITY OF COPENHAGEN


                     OXFORD: AT THE CLARENDON PRESS
       London, Edinburgh, New York, Toronto, Melbourne and Bombay
                            HUMPHREY MILFORD
                                  1916

------------------------------------------------------------------------




                   INTRODUCTORY NOTE BY THE DIRECTOR


The Division of Economics and History of the Carnegie Endowment for
International Peace is organized to ‘promote a thorough and scientific
investigation of the causes and results of war.’ In accordance with this
purpose a conference of eminent statesmen, publicists, and economists
was held in Berne, Switzerland, in August 1911, at which a plan of
investigation was formed and an extensive list of topics was prepared.
The programme of that Conference is presented in detail in an Appendix.
It will be seen that an elaborate series of investigations has been
undertaken, and the resulting reports may in due time be expected in
printed form.

Of works so prepared some will aim to reveal direct and indirect
consequences of warfare, and thus to furnish a basis for a judgement as
to the reasonableness of the resort to it. If the evils are in reality
larger and the benefits smaller than in the common view they appear to
be, such studies should furnish convincing evidence of this fact and
afford a basis for an enlightened policy whenever there is danger of
international conflicts.

Studies of the causes of warfare will reveal, in particular, those
economic influences which in time of peace bring about clashing
interests and mutual suspicion and hostility. They will, it is believed,
show what policies, as adopted by different nations, will reduce the
conflicts of interest, inure to the common benefit, and afford a basis
for international confidence and good will. They will further reveal the
natural economic influences which of themselves bring about more and
more harmonious relations and tend to substitute general benefits for
the mutual injuries that follow unintelligent self-seeking. Economic
internationalism needs to be fortified by the mutual trust that just
dealing creates; but just conduct itself may be favoured by economic
conditions. These, in turn, may be created partly by a natural evolution
and partly by the conscious action of governments; and both evolution
and public action are among the important subjects of investigation.

An appeal to reason is in order when excited feelings render armed
conflicts imminent; but it is quite as surely called for when no
excitement exists and when it may be forestalled and prevented from
developing by sound national policies. To furnish a scientific basis for
reasonable international policies is the purpose of some of the studies
already in progress and of more that will hereafter be undertaken.

The publications of the Division of Economics and History are under the
direction of a Committee of Research, the membership of which includes
the statesmen, publicists, and economists who participated in the
Conference at Berne in 1911, and two who have since been added. The list
of members at present is as follows:

EUGÈNE BOREL, Professor of Public and International Law in the
University of Geneva.

LUJO BRENTANO, Professor of Economics in the University of Munich;
Member of the Royal Bavarian Academy of Sciences.

CHARLES GIDE, Professor of Comparative Social Economics in the
University of Paris.

H. B. GREVEN, Professor of Political Economy and Statistics in the
University of Leiden.

FRANCIS W. HIRST, Editor of _The Economist_, London.

DAVID KINLEY, Vice-President of the University of Illinois.

HENRI LA FONTAINE, Senator of Belgium.

His Excellency LUIGI LUZZATTI, Professor of Constitutional Law in the
University of Rome; Secretary of the Treasury, 1891–3; Prime Minister of
Italy, 1908–11.

GOTARO OGAWA, Professor of Finance at the University of Kioto, Japan.

Sir GEORGE PAISH, Joint Editor of _The Statist_, London.

MAFFEO PANTALEONI, Professor of Political Economy in the University of
Rome.

EUGEN PHILIPPOVICH VON PHILIPPSBERG, Professor of Political Economy in
the University of Vienna; Member of the Austrian Herrenhaus, Hofrat.

PAUL S. REINSCH, United States Minister to China.

His Excellency BARON Y. SAKATANI, recently Minister of Finance; Present
Mayor of Tokio.

THEODOR SCHIEMANN, Professor of the History of Eastern Europe in the
University of Berlin.

HARALD WESTERGAARD, Professor of Political Science and Statistics in the
University of Copenhagen.

FRIEDRICH, FREIHERR VON WIESER, Professor of Political Economy at the
University of Vienna.

The function of members of this Committee is to select collaborators
competent to conduct investigations and present reports in the form of
books or monographs; to consult with these writers as to plans of study;
to read the completed manuscripts, and to inform the officers of the
Endowment whether they merit publication in its series. This editorial
function does not commit the members of the Committee to any opinions
expressed by the writers. Like other editors, they are asked to vouch
for the usefulness of the works, their scientific and literary merit,
and the advisability of issuing them. In like manner, the publication of
the monographs does not commit the Endowment as a body or any of its
officers to the opinions which may be expressed in them. The standing
and attainments of the writers selected afford a guarantee of
thoroughness of research and accuracy in the statement of facts, and the
character of many of the works will be such that facts, statistical,
historical, and descriptive, will constitute nearly the whole of their
content. In so far as the opinions of the writers are revealed, they are
neither approved nor condemned by the fact that the Endowment causes
them to be published. For example, the publication of a work describing
the attitude of various socialistic bodies on the subject of peace and
war implies nothing as to the views of the officers of the Endowment on
the subject of socialism; neither will the issuing of a work, describing
the attitude of business classes toward peace and war, imply any
agreement or disagreement on the part of the officers of the Endowment
with the views of men of these classes as to a protective policy, the
control of monopoly, or the regulation of banking and currency. It is
necessary to know how such men generally think and feel on the great
issue of war, and it is one of the purposes of the Endowment to promote
studies which will accurately reveal their attitude. Neither it nor its
Committee of Research vouches for more than that the works issued by
them contain such facts; that their statements concerning them may
generally be trusted, and that the works are, in a scientific way, of a
quality that entitles them to a reading.

This monograph on epidemics resulting from wars is designed to bring
into light an aspect of international conflict that has never been
adequately appreciated. An examination of the facts here presented will
indicate that until comparatively recent times the most serious human
cost of war has been not losses in the field, nor even the losses from
disease in the armies, but the losses from epidemics disseminated among
the civil populations. It was the war epidemics and their sequelae,
rather than direct military losses, that accounted for the deep
prostration of Germany after the Thirty Years’ War. Such epidemics were
also the gravest consequence of the Napoleonic Wars.

It may appear that a study of war epidemics can have only historical
interest, in view of the progress of modern medical science. Plague,
cholera, and typhus can be brought under control by modern methods of
sanitation. One can point to the fact that in the present great war, the
only serious epidemic that has been reported is the typhus fever
epidemic in Serbia. When the medical history of the war comes to be
written, however, it will be found that the aggregate losses from
sporadic outbreaks of war epidemics have been very considerable. A war
sufficiently protracted to lead to universal impoverishment and a
breakdown of medical organization would be attended, as in earlier
times, by the whole series of devastating war epidemics. And even in the
case of less exhausting wars, the chances of widespread epidemics is far
from negligible. There is much food for reflection in the author’s
account of the small-pox epidemic following the Franco-German War. In
1870 the means of coping with small-pox were as nearly perfect as they
are in the greater part of the world to-day. This fact did not save
Europe from a widespread epidemic, entailing human losses exceeding in
gravity the losses in the field. To-day, as in the past, the
probabilities of increased morbidity in the civil population, not only
among the belligerents, but among neutrals as well, must be entered as a
highly important debit item against war.

                                                 JOHN BATES CLARK,
                                                             _Director_.




                                CONTENTS


                                                                    PAGE

 INTRODUCTION                                                          1

                                CHAPTER I

 WAR PESTILENCES                                                       4

                               CHAPTER II

 THE TIME BEFORE THE THIRTY YEARS’ WAR                                11

                               CHAPTER III

 THE THIRTY YEARS’ WAR                                                25

                               CHAPTER IV

 THE PERIOD BETWEEN THE PEACE OF WESTPHALIA AND THE FRENCH
   REVOLUTION                                                         79

                                CHAPTER V

 THE PERIOD BETWEEN THE FRENCH REVOLUTION AND NAPOLEON’S RUSSIAN
   CAMPAIGN                                                           92

                               CHAPTER VI

 THE EPIDEMICS OF TYPHUS FEVER IN CENTRAL EUROPE FOLLOWING UPON THE
   RUSSIAN CAMPAIGN AND DURING THE WARS OF LIBERATION (1812–14)      106

                               CHAPTER VII

 FROM THE AGE OF NAPOLEON TO THE FRANCO-GERMAN WAR                   165

    1. The Russo-Turkish War of 1828–9                               165

    2. The Crimean War (1854–6)                                      170

    3. The North American Civil War (1861–5)                         175

    4. The Italian War of 1859                                       183

    5. The Danish War of 1864                                        183

    6. The German War of 1866                                        184

                              CHAPTER VIII

 THE FRANCO-GERMAN WAR OF 1870–1, AND THE EPIDEMIC OF SMALL-POX
   CAUSED BY IT                                                      189

                               CHAPTER IX

 FROM THE FRANCO-GERMAN WAR TO THE PRESENT TIME                      286

    1. The Russo-Turkish War of 1877–8                               286

    2. The Boer War of 1899–1901                                     290

    3. The War in South-west Africa (1904–7)                         296

    4. The Russo-Japanese War of 1904–5                              296

    5. The Occupation of Tripoli by the Italians (1911)              299

    6. The War between Turkey and the Balkan States (1912–13)        300

                                CHAPTER X

 EPIDEMICS IN BESIEGED STRONGHOLDS                                   302

    1. The Siege of Mantua (1796–7)                                  304

    2. The Siege of Danzig (1813)                                    306

    3. The Siege of Torgau (1813)                                    311

    4. The Siege of Mayence (1813–14)                                316

    5. The Siege of Paris (1870–1)                                   320

    6. The Siege of Port Arthur (1904)                               324

 CONCLUSION                                                          328

 INDEX                                                               335




                              INTRODUCTION


In countries which have the misfortune to be the scene of protracted
wars, the mortality regularly undergoes a considerable increase. This is
caused chiefly by the infectious diseases which in war times so often
appear in the form of epidemics. These diseases, moreover, not only
afflict the country in which the war is waged, but are also carried by
prisoners, returning soldiers, and in other ways, into the land of the
victor, where it is possible for them to spread over a large territory.
A report on the loss of human life among that part of a population which
does not participate in a war has not yet been undertaken, writings on
war pestilences usually confining themselves to the losses within the
armies themselves.[1] It is the purpose of the present study to
investigate the losses sustained by the non-belligerent part of the
population in consequence of epidemics caused by wars.

In doing this it seems advisable to select a few war pestilences which
on account of their enormous extent are particularly notable, and to
subject them to an exhaustive discussion. This method has the advantage
that it will enable us to show in individual cases how it is possible
for these pestilences to extend over such a vast territory, under what
circumstances they spread from place to place, and how they enter
regions remote from the scene of war. For this exhaustive discussion the
writer has chosen the pestilences that occurred during the Thirty Years’
War, the epidemic of typhus fever after Napoleon’s Russian Campaign, and
the pandemic of small-pox after the Franco-German War of 1870–1. These
epidemics afford very instructive examples of what horrible losses both
friends and enemies may sustain in consequence of war pestilences.

While the outbreaks of ‘plague’ in the course of the Thirty Years’ War
have already been made the subject of a comprehensive account, strange
to say there are no such accounts of the other two epidemics; to give a
clear picture of these pestilences the writer was therefore constrained
to collect the necessary information from widely dispersed sources. In
gathering his material a number of large German libraries assisted him
most kindly—particularly, the Royal National Library at Stuttgart and
the University libraries of Strassburg and Tübingen.

The other parts of the history of war pestilences are set forth in a
more general way; for an exhaustive treatment of them would have
necessitated several years of preliminary work, which the writer in the
short time at his disposal was unable to undertake.

The writer has drawn as much as possible from original sources; this
applies at least to the pestilences of the Napoleonic Period, and to the
epidemic of small-pox after the Franco-German War. It would have been
impossible to deal with the other wars in the same way without consuming
considerable time. From the bibliographies it will appear what sources
the author has consulted; rarely are quotations given from works which
he has not seen, and in such cases it is indicated whence they were
taken.

The causes of the origin and spread of pestilences during a war are
clear. Every aggregation of people, even in times of peace, at
celebrations and annual fairs, in barracks, and so forth, is necessarily
exposed to the danger of pestilence; but this danger is ten times as
great in large assemblages of troops during a war. The soldiers are then
subjected to all possible kinds of hardship and suffering—lack of food,
or food which is inferior and badly cooked, sleeping out in the cold and
rain, fatiguing marches, constant excitement, and homesickness—and all
these things greatly lessen their power of resistance. When large bodies
of troops are obliged to remain in one and the same place for a
considerable length of time, the additional difficulty presents itself
of keeping the locality unpolluted by the excrement of men and animals,
and by refuse of all kinds. If an infectious disease reveals its
presence in such an aggregation of people, energetic and stringent
measures must be adopted, even in times of peace, to prevent it from
spreading. In war times it is often impossible to take the necessary
precautions, since the attention of the commanders is directed toward
very definite objects, to which all other considerations are
subordinate. Whether the germ of the disease is already in the place, or
whether the soldiers bring it with them, in either case there is danger
that the fighting armies will cause the disease to spread over the
entire scene of the war, and thus seriously endanger thousands of human
lives.

Modern methods of sanitation have done much toward preventing the spread
of army pestilences, not only in peace, but also in war. The last few
decades have evinced that fact. Whatever attitude we may assume toward
the question whether war can ever be wholly abolished, we must all agree
that, if war has once broken out, all possible means must be employed to
prevent the spreading of pestilence within the armies. Here the
interests of the people and of the commanders coincide, since the
efficiency of armies is often seriously interfered with by the outbreak
of pestilence, and not infrequently the success or failure of a war
depends, not upon the outcome of its battles, but upon the appearance or
non-appearance of pestilence.




                               CHAPTER I
                            WAR PESTILENCES


All infectious diseases may spread in consequence of war and develop
into epidemics of varying extent. In the next chapter we shall see how
the wars at the end of the fifteenth century favoured the spread of an
epidemic of syphilis. In the Union Army, during the American Civil War
of 1861–5, both measles and typhoid fever were very widespread, and
together they were the cause of 4,246 deaths, or about 1·75 per cent of
the total enlistment. Scarlet fever, influenza, yellow fever, relapsing
fever, and malaria (if the war is waged in countries where this disease
is endemic—especially in the Lower Danube region, in the Netherlands,
Spain, and Italy) have also played an important rôle in many wars. But
we give the name ‘war pestilences’ only to those infectious diseases
which in the course of centuries have usually followed at the heels of
belligerent armies, such as typhus fever, bubonic plague, cholera,
typhoid fever, dysentery, and small-pox; we may also include here
scurvy, the etiology of which has not yet been definitely determined.

1. _Typhus fever_ (spotted fever, exanthematic typhus—called in France
and England simply typhus, in Spain tabardillo[2]—formerly called
contagious typhus, hunger typhus, camp fever, and Hungarian fever) is an
acute infectious disease of cyclic recurrence, which resembles typhoid
fever only in name. From the eighth to the tenth day after infection,
often somewhat sooner or later, it begins with a chill, accompanied by
nausea, vomiting, violent headache, and psychic depression. In the first
few days the patient’s temperature rises rapidly, and on the fourth or
fifth day a rash in the form of dull-red spots, as large as a pea,
breaks out over the entire body. These spots gradually grow larger, and
after two or three days, through the appearance of very small
haemorrhages, change into petechiae. The apathy of which the patient
first gave evidence now gives way to wild delirium. At the end of the
second week the temperature falls rapidly, and in one or two days
becomes normal; often, however, the fall of temperature takes from six
to eight days. The duration of the entire disease, accordingly, is from
two to two and a half weeks. Death usually occurs at the crisis of the
disease—from the tenth to the twelfth day—rarely between the sixth and
ninth days or after the twelfth.

The danger of the disease varies greatly in different epidemics;
statements regarding this point diverge according as we refer to the
statistical records of hospitals or to the private practice of
physicians. With the latter the number of deaths is smaller, since
persons suffering from the disease in mild form less often go to the
hospitals. Epidemics in which a quarter of the patients, and even more,
have succumbed have frequently occurred, especially in war times, during
famines, &c. The cause (infective agent) of typhus fever is not known;
according to recent investigations it is spread by vermin; Ricketts and
others have fixed responsibility for it upon the body louse. The
infection is communicated from man to man, and very often it is
contracted from the clothes, linen, and other effects of typhus
patients. Recovery from the disease usually renders a person immune
against a second attack. Typhus fever frequently appears nowadays in the
eastern and south-eastern parts of Europe, in Hungary and Galicia, and
also in Spain, Italy, and Ireland.

2. _Plague_ appears in two forms, depending upon the place where the
infective agent enters the body: the bubonic plague and the pneumonic
plague. In the case of the former the painful plague-sores (buboes)
develop, usually two or three days after infection, from the lymphatic
glands; these sores,—which appear most often in the region of the groin,
less often in the axilla, on the neck, lower jaw, and in other
places,—soon suppurate. There is either a development of toxins, which
are the cause of the severe general symptoms, or else the _bacilli
pestis_ go from the glands into the circulatory system and cause
septicaemia, which is quickly fatal. Pneumonic plague takes the form of
a catarrhal inflammation of the lungs, causing a profuse and bloody
expectoration, which contains large quantities of bacilli. This form of
the disease almost always ends fatally in a few days. The mortality of
bubonic plague is somewhat lower; the disease has an average duration of
eight days, and carries away from fifty to seventy per cent of its
victims.

In the Middle Ages an epidemic of plague (black death) ravaged all
Europe. At the present time it is still endemic in India, in southern
China, in Egypt, in Uganda, and perhaps in other countries, whence it
frequently develops into general epidemics.

The infective agent in the case of plague is the _bacillus pestis_,
identified in 1894 by Kitasato, and subsequently, but independently, by
Yersin. Rats, which are very susceptible to the disease, play an
important rôle in spreading it; in India the outbreak of a plague
epidemic is always preceded by the dying of large numbers of rats. Their
excrement contains large quantities of bacilli, which may be destructive
to human beings. The rat-flea is also known to carry the infection. The
infection may be conveyed directly by plague patients, when the buboes
suppurate, or when the blood becomes generally infected with the
_bacilli pestis_, which are contained in abundance in the sputum, urine,
and excrement, or when the lungs are affected and the patient charges
the atmosphere by coughing. One who has recovered from the disease is
usually immune for life.

3. _Cholera_, after an incubation period of two to eight days, begins
with frequent (ten to twenty times a day) vomitings of a fluid like
rice-water, and incessant retching. The patient, owing to the great loss
of water, sinks rapidly; he acquires a corpse-like appearance, loses
consciousness, and death may result on the first or second day. If the
attack is survived, the patient frequently dies from sheer exhaustion
afterwards. The mortality of cholera is great—from forty to fifty per
cent of its victims die. In this calculation the numerous cases of
cholerine, that are always prevalent during cholera times, are excluded.
Recovery from the disease does not protect a person against contracting
it again. The infective germ in the case of cholera is the ‘comma
bacillus’, discovered by Robert Koch in 1883. The spread of cholera is
caused by the penetration of the _comma bacillus_ into the alimentary
canal, resulting from contact with objects which have been contaminated
by the evacuations of cholera patients; less frequently it is indirectly
caused by the pollution, from evacuations, of water used for drinking or
washing purposes.

4. _Dysentery_ has always played an important rôle in military
campaigns. To be sure, it is not very dangerous, so far as the patient’s
life is concerned, but in war times, owing to irregular nursing and
scanty nourishment, and the consequent use of unsuitable food, it may
spread over a large territory and be very destructive to large numbers
of soldiers and other people.

There are two distinct forms of the disease—amoebic dysentery and
bacillary dysentery. The latter is caused by the _bacillus pyocyaneus_,
discovered independently by Stiga, Kruse, and Flexner. The disease used
to be common throughout Europe; at the present time it appears in
Central and Western Europe only in small epidemics, whereas in Eastern
Europe it spreads over large territories. It causes frequent, often
blood-coloured, defecations, accompanied by griping pains in the abdomen
and a distressing pressure (tenesmus). The disease lasts from one to one
and a half weeks, but for a long time after recovery the patient’s
alimentary canal is very sensitive to improper nourishment. The disease
is transmitted either by direct contact, since the evacuations of the
bowels contain large quantities of bacilli, or by infected water.
Amoebic dysentery, occurring in tropical countries (Southern Europe,
Egypt, Southern Asia, Central America, &c.), is much more dangerous; it
is caused by an amoeba, carefully studied by Kartulis, and very often
acquires a chronic character, sometimes causing abscess of the liver.

5. _Typhoid fever_ (called in England ‘enteric fever’, in France
‘fièvre typhoïde’, in Italy ‘febbre tifoidea’) in many wars has been
very widespread among the armies; for example, in the American Civil
War, in the Franco-German War (Metz), and in the Russo-Turkish War of
1877–8. The progress of the disease is well known; between the time of
infection and the outbreak of the sickness nine to eleven days usually
intervene, sometimes even as much as three weeks. In the first week
the temperature of the patient rises slowly, during the second week it
remains at about the same height, while in the third week it abates
considerably, becoming normal in the course of the fourth week. The
spleen enlarges a great deal, and in the second week small pale-red
spots (roseola), scarcely as large as a pea, appear on the buttocks
and especially on the belly. The patient’s bowel-movements, at first
normal, now becomes diarrhoeal, while certain psychic disorders also
manifest themselves, usually in the form of a heavy somnolence. In the
third week the patient’s life is threatened by complications in the
intestines—haemorrhage or perforation. Characteristic of the disease
are the anatomical changes of the small intestine—at first
enlargement, and later ulceration of Peyer’s patches. The infective
agent in the case of typhoid fever is a bacillus, identified by Gaffky
in 1882. It lodges in the alimentary canal, and is conveyed by food
that has been touched with hands to which matter containing the
bacillus has adhered, or else in contaminated water used for drinking
or other purposes. From eight to ten per cent of the patients die,
while a single recovery usually insures immunity against a second
attack.

6. _Small-pox_ has an incubation period of ten to fourteen days. The
disease begins with a chill, accompanied by violent headache. On the
third day the eruption appears; little papules develop and quickly
change into pustules, showing themselves first on the face, then on the
back, arms, and hands, and finally on the legs and feet. On the ninth
day the pustules suppurate, and after that gradually dry up; if it
progresses favourably, the disease is over in two or two and a half
weeks.

In the case of small-pox the infective agent is not yet known; infection
is caused by contact with a patient, or with objects which he is using
or has used. It is particularly dangerous to touch things on which the
contents of the pustules have dried, for such articles remain infectious
for a long time. Recovery from the disease usually renders a person
immune for life. The mortality in different epidemics varies greatly;
most dangerous of all is the so-called ‘black small-pox’ (haemorrhagic
small-pox, with bleeding in the pustules and under the skin). The total
number of deaths in an epidemic of small-pox is dependent upon whether
the disease appears in a vaccinated or an unvaccinated community; in the
latter case the mortality may reach thirty per cent, whereas in the
former case only three or four per cent of the patients die. Vaccination
renders a person immune for eight to twelve years, while, if the disease
breaks out anywhere in spite of vaccination, the number of fatal cases
is very few. It should be noted that small-pox was formerly dreaded, not
only because of its danger to life, but also because it frequently
leaves a person disfigured for life, and in rare instances causes total
blindness.

7. _Scorbutus_ (scurvy) used to be a common disease on ships, in
prisons, and in times of famine; it appeared with the greatest
malignancy in besieged cities—Thorn, Nuremberg, Alexandria, Port Arthur,
&c. The real cause of the disease is unknown, although too much food of
one kind, particularly lack of fresh vegetables, together with long
confinement in poorly ventilated and dark rooms, are important causative
factors. Inasmuch as the disease almost always appears in the form of an
epidemic, it is probable that there is a specific infective agent. It
begins with a general feeling of weakness; the skin and mucous membranes
become pale and sallow, the gums become inflamed and ulcerated, and
small and large extravasations of blood take place in the skin and
muscles, and at the joints and knuckles. In serious cases haemorrhages
occur in the intestines, kidneys, bladder, and uterus. A change of diet
and surroundings will quickly cure scurvy; otherwise progressive anaemia
will result in death.




                               CHAPTER II
                 THE TIME BEFORE THE THIRTY YEARS’ WAR


Numerous as are the historical notices in former years regarding the
destruction of armies by pestilence, correspondingly few are the
detailed reports on the spread of pestilence among the non-belligerent
population. The best-known example from antiquity is the _Plague of
Athens_ (430–425 B.C.), described by Thucydides. The plague began in the
second year of the Peloponnesian War, a few days after the invasion of
the Peloponnesians. That it is famous is due to the classical
description of it by Thucydides, himself a sufferer from the disease.
The Plague of Athens broke out in the Piraeus, a fact which has led to
the inference that it was borne thither by mariners from Egypt. At the
time of the invasion of the Peloponnesians, thousands of country people
fled to the city of Athens, which on the advice of Pericles opened its
gates to them; thus more than 400,000 people were crowded together
within its walls. The first outbreak of the plague lasted two years,
then there was an intermission of a year and a half, whereupon it
commenced anew. The second outbreak, according to Diodorus, carried away
4,400 hoplites, 300 cavalrymen, a large (but uncertain) number of other
soldiers, and 10,000 women and slaves. The plague also penetrated to
other places, sparing, however, the Peloponnesus. The nature of the
sickness described by Thucydides cannot be positively determined; it has
been referred to as bubonic plague (Sprengel), as small-pox
(Krause-Daremberg, Kobert), as typhus fever (Häser, Kanngiesser), as
typhoid fever (Seitz), and even as anthrax. All we know for certain is
that it was some highly infectious disease, recovery from which rendered
a person immune. Krauss and Hecker believe that it was a special disease
(‘antique plague’), which no longer occurs.[3]

The _Plague of the Antonines_, also called the ‘Plague of Galen’, which
ravaged Italy in A.D. 166–8, has also been brought into connexion with
warlike events. Avidius Cassius, who preceded Verus in command of the
army, had been sent to Syria for the purpose of suppressing a rebellion,
and there, after the capture of Seleucia, the plague broke out. It was
borne by the troops back to Rome, where, after the triumphal procession
of 166, it spread far and wide, so that it was necessary to load its
victims on wagons and carry them off for burial. The plague spread from
Italy to Gaul, to the very banks of the Rhine, and a large part of the
province was literally depopulated—decayed and deserted villages were
found everywhere. Häser inclines to the view that it was an epidemic of
small-pox, while Laveran, Hecker, Krause, and Littré believe that it was
neither small-pox nor typhus fever, but ‘antique plague’.[4]

The expeditions of the German emperors to Italy, as well as the
Crusades, offer numerous examples of how large armies may be destroyed
by disease. So, for instance, in 963 or 964 the army of the Emperor Otto
I was attacked by a severe pestilence in Italy—a murderous disease which
was usually fatal in twenty-four hours. The German army of Henry IV in
1081–2, but especially after the capture of Rome on June 3, 1083,
suffered from plagues in Italy; but the same army fared even worse in
1084, when a plague broke out and carried away, for example, the entire
German garrison in Rome. In 1137 Lothair’s army was likewise attacked by
infectious diseases in Italy. But by far the most devastating of all was
the pestilence which broke out in Rome in August, 1167, shortly after
the capture of the city by Frederick Barbarossa, and paved the way to a
catastrophe which culminated in the complete annihilation of the German
army. At that time many eminent men succumbed to the disease, the army
dwindled away in the hands of the leaders, and the soldiers fled in vast
numbers in order to escape certain death. Even after the Emperor
Barbarossa’s withdrawal from Rome the pestilence continued to rage in
his army, and it was a long time before it disappeared from the city. It
was the true (bubonic) plague, and usually resulted fatally on the first
day. In the winter of 1190–1 a pestilence broke out in Lower Italy in
the army of Henry VI; it appeared at the beginning of the siege of
Naples and carried away many eminent men. The king himself contracted
the disease, and had to be taken to Capua.[5]

The armies of the Crusades fared even worse; the mortality in the First
Crusade, before and after the conquest of Antioch (1097–8), was
terrible. The pestilence is said to have broken out first among the
children and women who accompanied the armies, and its dissemination was
favoured by a lack of sustenance and continual rainfall; from September
to the 24th of November the pestilence carried away 100,000. The nature
of the disease is not known, although it is known to have been very
infectious. When a new army of 1,500 Germans arrived, it was quickly
attacked by the disease and in a few days almost completely annihilated.
Several hundred frequently died in a single day, and as the summer of
1099 was very hot and a number of bodies remained unburied, the
pestilence lasted well into that year. In 1100 another pestilence raged
among the crusaders. Again, during the Second Crusade a severe epidemic
broke out in the army of the Emperor Louis VII at Attalia in Asia Minor;
the pestilence spread rapidly among the inhabitants of the city, so that
many houses, even entire streets, were depopulated.[6]

During the Third Crusade, shortly after the death of Frederick
Barbarossa (June, 1190), a severe pestilence broke out in the army that
was besieging Antioch; according to Michaux only 5,000 infantrymen and
700 cavalrymen survived out of the entire German army.[7] At the siege
of Acre (Ptolemais), which lasted from August 1189, to July 1191, there
broke out in the winter of 1191 a terrible pestilence which played havoc
in the pilgrim army; it was caused by an inadequate supply of food, and
its symptoms (enlargement of the limbs and falling out of the teeth)
betoken scurvy. It also appeared in the army of Saladin, but was much
worse in the Christian army, in which from 100 to 200 crusaders died
every day. Duke Frederick of Swabia succumbed to this disease on January
20, 1191.[8]

At the time of the crusade against the heretics a serious pestilence
broke out in Egypt in the army of the crusaders, which had already, on
August 12, 1218, suffered from dysentery; it appeared in December during
the siege of Damietta, after a heavy and continuous downfall of rain.
‘The patients’, says Wilken, ‘were suddenly seized with violent pains in
the feet and ankles; their gums became swollen, their teeth loose and
useless, while their hips and shin bones first turned black and then
putrefied. Finally, an easy and peaceful death, like a gentle sleep, put
an end to their sufferings. A sixth of the pilgrim army was carried away
by this disease, which no medicine could cure.’[9] Only a few patients
who survived the winter were helped to recovery by the warmth of spring.
It was unquestionably a severe form of scurvy. The besieged, too,
suffered from the destructive pestilence, and also from Egyptian
ophthalmia. We read further in Wilken: ‘A horrible sight greeted the
pilgrims when they took possession of Damietta. Not only the houses, but
even the streets were filled with unburied corpses; in the beds dead
bodies lay beside helpless and dying invalids, and the infection of the
air was intolerable. Of 80,000 inhabitants which the city had had at the
beginning of the siege only 3,000 were left, while only 100 of these
were healthy.’[10] Other reports say that 10,000 inhabitants survived.

In 1270, during the Seventh and last Crusade, which strangely enough
passed by way of Tunis, a pestilential disease broke out in Carthage,
carrying away, in addition to many soldiers and men of rank, King Louis
IX of France himself and his son, Jean Tristan. This pestilence was
dysentery, and it spread even to Sicily, whither the king’s body was
conveyed. After the king’s death conditions were even worse, since so
many people died that it was impossible to bury all the bodies. The
disease also attacked the enemy’s army.[11]

The increased prevalence of _leprosy_ in Europe in the Middle Ages is
often attributed to the Crusades.[12] Leprosy was very widespread in
Germany, France, Italy, and other countries of Europe before the
Crusades; according to Hirsch it appeared in the Roman Empire in the
first century before the birth of Christ, but did not become very
prevalent until later. Legal regulations governing the marrying of
lepers date back as far as the seventh century, while the earliest
reports regarding leper-houses come down from the eighth and ninth
centuries. Most leper-houses, however, were built between the eleventh
and thirteenth centuries, and although the reverse opinion has been
expressed, it is nevertheless improbable that the building of these
houses was not due to the increased prevalence of the disease. Inasmuch
as leprosy was very widespread in the Orient, where numerous crusaders
contracted it, as indicated by the fact that institutions were founded
there for its victims, many crusaders doubtless returned with the
disease in their systems. But regarding this matter we shall never have
absolutely reliable information; for it is assumed that many people
suffering from other chronic skin diseases were placed in the
leper-houses. A careful study of the available data, however, leads us
to believe that wrong diagnoses were not so frequent as to account for
the large number of cases of leprosy in the eleventh, twelfth, and
thirteenth centuries. Admittance to leper-houses was regulated by many
precautionary measures, and the diagnosis of the disease was made by
churchmen, even bishops, who without doubt necessarily acquired a good
eye for the disease in the course of time. Not until later, when we may
be certain that leprosy was no longer brought from the Orient, was the
disease probably now and then confused with syphilis.

The notable pandemic outbreak of syphilis at the end of the fifteenth
century was also largely attributable to warlike events. The rapid
spread of the disease throughout Central Europe was due, according to
contemporary notices, to the _Landsknechte_ (common foot-soldiers). The
rough coincidence of this epidemic with the discovery of America has
given rise to the view that the disease did not exist in Europe at
earlier periods, but was borne thither from America. But we can point to
numerous instances in the course of the last century, of how infectious
diseases, hitherto unknown, or existing only sporadically, all of a
sudden became pandemic (cholera, plague, diphtheria, influenza),
although no satisfactory and comprehensive explanation of the phenomenon
has been offered. It is generally known that infectious diseases break
out in a mild form and last for years, and then suddenly change their
character and cause virulent epidemics; this is positively confirmed by
the epidemic of small-pox in 1870–2, which will be discussed later. At
all events we cannot draw the conclusion from the sudden outbreak of an
epidemic of syphilis, that the disease was not present in Europe before.

A serious epidemic of syphilis broke out in the army of Charles VIII of
France during his expedition to Naples. Inasmuch as his advance was
nowhere opposed, he was able to enter Naples on February 12, 1495. There
the French army gave itself over to the most unbridled licentiousness,
and the result was that the disease spread rapidly in both the French
and Italian armies. Italians and Frenchmen accused each other of having
brought the disease, so that the former called syphilis ‘French disease’
and the later ‘Neapolitan disease’. The disbanding of Charles’s army
caused the disease to spread far and wide in Europe. ‘Those who had most
to do with the further dissemination of the disease,’ says Häser,[13]
‘were the Albanian and Roumanian estradiots serving in the Venetian
army, brutal and rapacious adventurers, and also the German and Swiss
_Landsknechte_ returning from Italy, who spread the disease over a large
part of Europe.’

A large number of writers of the beginning of the sixteenth century bear
witness to the fact that the pestilence was borne into Germany by
_Landsknechte_; e.g. Pastor N. Berler (_Ruffachische Chronik_ of 1510),
Heinrich Brennwald (1519), Johann Haselbergk (1533), Valentin Müntzer
(1550), _Nuremberg Chronicle_ of 1580.[14] In the year 1495 the
pestilence broke out in many places in France and Germany; in
Strassburg, for example, the disease was planted by _Landsknechte_ who
had served in, and been discharged from, the army of Charles VIII; Hans
Schott testifies to this fact in his _Weltlich Leyenbuch_ (Strassburg,
1541). The city of Metz tried in vain to ward off the disease; according
to the _Metz Chronicle_, many Burgundians (500 cavalrymen and 700
infantrymen) came to Metz in May 1495, and since the most of them were
suffering from _mal de Naples_, they were not allowed to enter the city.
But the soldiers infected the women in the vicinity, and the disease was
later borne by them into the city, where it prevailed for four years,
not beginning to abate until the year 1500.[15] We also have testimony
to the fact that the outbreak of the disease in Nördlingen (1495) was
caused by the arrival of _Landsknechte_.

In a supplementary way we may add here that later wars also caused
frequent epidemics of syphilis within narrow confines; instances of this
kind are cited by A. Hirsch[16] and H. Schwiening.[17]

In August of the year 1486 _English sweating-sickness_ appeared in
England for the first time; it broke out among the troops of Henry VII
shortly before his victory at Bosworth on August 22, 1486. And when
Henry landed at Milford the disease spread, carrying away many victims
wherever it went. ‘Strong and well-nourished people were particularly
susceptible to it—more so than old men, children, and poor people. From
three to nine, sometimes all the inmates of a house caught it, and it
gradually spread over half the inhabitants of the town. The first
appearance of the disease is said to have caused more devastation in
London (where it broke out on September 21), Bedford, and Cambridge,
than the sword, which had been ruling for thirty years in a fearful
civil war. According to Forest, an incredible number of people died from
it, while Thomas Moore also speaks of the dangerous character of this
epidemic. In many places a third of the inhabitants are said to have
died from it, scarcely one in a hundred of its victims recovering.’[18]
The subsequent appearance of the disease, especially the transplantation
of it to the continent in the year 1529, was not attributable to warlike
events. In the year 1551 it disappeared as suddenly as it had appeared
in 1486.

The disease usually began with a chill, headache, palpitation of the
heart, difficulty in breathing, and later a profuse, very malodorous
emission of sweat from all parts of the body. The patient quickly lapsed
into a state of lethargy. The progress of the disease was uncommonly
rapid; ‘in one day either the disease or the patient came to an end,’
says Fracastorius. Any patient who did not succumb, recovered completely
after one or two weeks.

From the sixteenth century on notices are more abundant; we now hear of
epidemics of typhus fever throughout all Europe, although we do not know
positively where the disease first appeared. ‘At all times,’ says
Hirsch,[19] ‘as far back as historical investigation is able to follow
the course of typhus fever at all, the disease has always been bound up
with the most dismal calamities of the nations. The supposition is
therefore justified that, in the numerous war-pestilences and
famine-pestilences of antiquity and the Middle Ages, regarding which we
have no medical reports and must rely only upon the chronicles, typhus
fever has played a conspicuous rôle.’ By this, however, Hirsch does not
mean to say that the specific disease in all the so-called
war-pestilences was typhus fever; on the contrary, he adds: ‘In saying
this I by no means wish to imply that I always identify
“war-pestilences” and “famine-pestilences” with epidemics of typhus
fever; those pestilences, appearing at epochs of general misery, for the
most part represent a mixture of diseases, especially catarrh of the
stomach, dysentery, scurvy, typhus fever, and frequently malaria and
typhoid fever, which not only by chroniclers, but also by medical
statisticians, have quite often been lumped together as _one disease_.’
It is to-day almost impossible to analyse these accounts, in which we
can distinguish only individual characteristics of those various
diseases. This appears most distinctly in the reports of the chroniclers
and historians regarding the war pestilences and famine pestilences of
antiquity, and it also explains the futile effort of the historians to
reduce to one disease known to us the numerous and complicated symptoms
which they have looked upon as the expression of a single
disease-process—an effort which has led some of them to the somewhat
extravagant conclusion, that they were diseases which are now extinct.
The same backwardness, furthermore, characterizes—though to a lesser
extent—the descriptions which the physicians of the seventeenth and
eighteenth centuries wrote of the epidemics of ‘putrid fever’, ‘bilious
fever’, and ‘mucous fever’ occurring at that time. Here, too, in many
cases it was evidently a question of the simultaneous outbreak of
various diseases, the nature of which even the most expert critic could
not afterwards determine with certainty.

At the end of the fifteenth century typhus fever was prevalent in many
parts of Europe; the first scientific account of it comes from the pen
of Fracastorius, who had an opportunity to observe the disease during
the epidemics in Italy in 1505–8, and who described it as a disease
indigenous to Cyprus and the neighbouring islands and appearing for the
first time in Italy.

The names given to the disease were numerous and cannot all be mentioned
here; the name ‘Hauptweh’ (headache) or ‘Hauptkrankheit’ (head-disease)
was current in Germany, while the additional words ‘ohne Sterbedrüsen’
(without death glands) expressly distinguish the disease from bubonic
plague. T. von Györy[20] mentions a large number of synonyms—Hungarian
disease, lazaret fever, spotted fever, petechial disease, &c.

In 1490 the disease was borne by Spanish soldiers, who had fought in the
Venetian army against Turkey, from Cyprus to Spain, and during the war
of Ferdinand the Catholic against the Moors it spread to Granada and did
more damage to the Spanish army than the swords of the Moors.[21]

In the year 1490 a serious epidemic broke out in Lorraine, which
Maréchal and Didion[22] think was typhus fever; it appeared in that
bitter and indescribably cruel conflict between René, Duke of Lorraine,
and the people of Metz. Despite the armistice proclaimed on June 18, the
pestilence spread far and wide and in August entered Metz, compelling
the inhabitants to take to flight; the nobles retired to their castles,
and the citizens went out into the country. And although the city was
strictly quarantined, the disease spread throughout Lorraine and
northern Alsace.

In the year 1528 an epidemic of typhus fever occurred in connexion with
warlike events. This pestilence broke out in Upper Italy and spread to
Lower Italy, where a war was going on between French troops on the one
side and German and Spanish troops on the other. The loss of human life
was uncommonly large, 30,000 French soldiers and twice as many
non-belligerent inhabitants are said to have died. And the pestilence
was also borne from Italy to Germany.

Well known in history is the great pestilence which in 1552 forced
Emperor Charles V to raise the siege of Metz, which had been going on
for two months (November and December). Maréchal gives us detailed
information about this;[23] the Emperor’s army, he says, which consisted
of 80,000 German, Spanish, and Italian troops, in addition to the
enormous camp-following that always accompanied armies at that time, was
reduced one-third by the end of December through desertion, disease, and
disablement. According to the report of the Venetian physician, Andreas
Gratiolo, the widespread diseases were typhus fever and dysentery. The
appearance of these diseases was favoured by the congregating of such
enormous numbers of people in tents and inadequate places of shelter,
and also by the great dampness and the lack of the necessaries of life.
The extreme cold, which prevented the dispersion and isolation of the
patients, also favoured the dissemination of the disease. More than 200
men died in the barracks every day, while 10,000 men, all told, are said
to have succumbed. It was also observed that the Spaniards and Italians
suffered more than the _Landsknechte_ and other German troops, since
they could not stand the severity of the climate so well. During the
siege, hospital-fever and scurvy raged in the city itself, and after the
siege was raised, in the night of January 1, 1553, typhus fever broke
out there, having been borne into the hospitals by wounded soldiers from
the enemy’s camp, or else brought back by citizens who had been out to
inspect the position of the besiegers. During the siege the surrounding
country had been most terribly ravaged by the enemy’s soldiers, so that
the inhabitants were in the greatest misery, without food and without
any source of help. For the spread of typhus fever this afforded a very
favourable soil, and it raged furiously in the months of June and July
in the villages surrounding Metz.

The battles with the Turks in the east did a great deal toward spreading
typhus fever throughout Europe; for that reason the name ‘Hungarian
disease’ came into existence. Toward the end of the fifteenth century,
hitherto prosperous Hungary, by endless wars with Turkey and by
international strife, was brought to the very verge of ruin. Agriculture
ceased almost entirely, the development of the country came to a
standstill, large tracts of land, such as the Banat region, assumed the
appearance of a vast swamp, while at the same time the alternate cold
nights and hot days, together with the great dampness, were very
unhealthy for the foreign soldiers, who were not accustomed to such a
climate. Partly this, and partly the utter lack of sanitation, increased
the baneful effects of camp-life. Dirt and refuse accumulated in heaps,
vermin multiplied so rapidly that it was impossible to get rid of them,
corpses were inadequately buried, while enormous numbers of flies and
gnats molested the soldiers and did a great deal toward spreading
infectious diseases. The hospitals were in a pitiable condition, and
since the soldiers, after their previous experiences, had little hope of
leaving the country alive, they gave themselves over to a most dissolute
life, in consequence of which the country suffered terribly. Several
contemporaries bear witness to the fact that a large part of the German
troops never once faced the enemy, for the reason that they succumbed
beforehand to ‘Hungarian disease’, which killed more of them than the
swords of the Turks. Hence Hungary was called at that time the ‘Cemetery
of the Germans’.

‘Hungarian disease’ was typhus fever, which manifested certain unusual
characteristics for the reason that the German troops, being
unaccustomed to the local foods, inclined considerably toward intestinal
catarrh and scurvy, while many of them also suffered from malaria, which
weakened their power of resistance. The sudden beginning with a chill,
the appearance of lenticular spots on the fourth, fifth, or sixth day,
the duration of about fourteen days, the sudden fall of temperature—all
these symptoms, mentioned by witnesses, definitely stamp the disease as
typhus fever. If the disease has been identified by many historians with
bubonic plague, the reason is that in serious cases of typhus fever
suppuration of the salivary glands, gangrene of the lower extremities,
of the nose and ears, &c., are not infrequent occurrences.

According to Györy,[24] the pestilence which raged so furiously in the
army of Joachim, Margrave of Brandenburg, when the latter was in Hungary
in 1542, was typhus fever. He assumes that the disease was borne thither
by the Italian troops which the Pope had sent to help fight against the
Turks, although he cannot base his assumption on any argument save that
typhus fever was no rare disease in Italy. It is much more probable,
however, that the disease was already endemic in Hungary at that time,
whether from of yore, or whether the Turks had brought it there. So
much, however, is certain, that the Germans suffered a great deal more
from it than did the Hungarians and Turks, who had probably already
survived attacks of the disease and had thus become immune.

‘Hungarian disease’ acquired greater importance in the year 1566, when
it spread from Hungary over a large part of Europe. It was then that
this name first came into fashion. According to Thomas Jordanus, who
took part in the expedition, the disease broke out on the island of
Komorn during the war of Maximilian II against the Turks; from there it
spread further west and forced the Emperor to conclude a treaty of peace
which favoured the Turks. After the dispersion of the army the
discharged soldiers carried the disease in all directions.[25] Vienna
was hit very hard; not only separate houses, but also entire streets,
were filled with victims of the disease. The returning Italians brought
the disease first to Carinthia, where it broke out severely in Villach,
and then to Italy. In the year 1567 the pestilence carried away 400
people in the little town of Villach, and from there it spread to
Styria. In the same way it was carried to Bohemia, Germany, Burgundy,
Belgium, and Spain.

At the end of the sixteenth century typhus fever appeared in Hungary
with renewed virulence; during the siege of Papa it raged with
particular severity among the Italian troops, and according to Coberus
all the patients in the field-hospital died.




                              CHAPTER III
                         THE THIRTY YEARS’ WAR


At the beginning of the seventeenth century, epidemics of bubonic plague
and typhus fever were frequent occurrences in various parts of Central
Europe, but they were usually kept localized by the strict measures that
were adopted, in accordance with the best scientific knowledge of the
time, to prevent them from spreading; the houses in which the patients
lay were quarantined, strangers from infected places were forbidden to
enter the cities under penalty of death, the clothes and beds used by
the patients were burned, while in the streets and public squares
fumigations took place. But in the storm and stress of the Thirty Years’
War such precautions could be taken only to a limited extent, and even
when they were energetically carried out, they did no good, since
diseases were so frequently borne from place to place. A further
consequence of the long war was famine, which was caused by the
devastation of the fields and the non-cultivation of the land, due to
the lack of workers. This made it easier for pestilences to become
unusually widespread throughout Germany. The fact that the scene of the
war kept changing was also to a great extent responsible for the gradual
dissemination of various diseases, since the regions in which the
fighting was going on were always particularly exposed to pestilential
devastation.

Unfortunately we possess, for the various pestilences, scarcely any
accounts written by physicians, and with a few exceptions must rely upon
the information given by chroniclers. In most cases, therefore, it is
impossible to state with certainty just what the individual diseases
were. Consequently, inasmuch as the word ‘plague’ is used in the
chronicles for any serious pestilence, we have adopted it in this same
general sense in our account, without necessarily meaning thereby
bubonic plague. Certainly one of the most common ‘war diseases’ at that
time was typhus fever, and diseases that were commonly called ‘burning,
virulent fever’, ‘plague’, ‘head-disease’, ‘Hungarian disease’, and
‘Swedish disease’, were undoubtedly nothing else but that. At the same
time real plague, bubonic plague, now and then occurred, and the word
‘plague’ is thus very often used in its proper sense, especially in
reference to the pestilences of the years 1630–6. ‘In the history of
this calamitous war,’ says Seitz,[26] ‘we see typhus fever like a
malignant spectre hovering over the armies wherever they go, in their
camps, on their marches, and in their permanent quarters, and preparing
an inglorious end for thousands of valiant warriors. Its ravages among
the non-belligerent population in town and country caused the
inhabitants of many provinces to remember with hatred and loathing the
departed soldiers, who were usually accused of having planted the seed
of death.’

In general one may say that before 1630 the specific disease was usually
typhus fever, and that after 1630 bubonic plague spread along with this
disease throughout Germany; the death statistics of the larger cities,
adduced at the end of this chapter, lead us to this conclusion. In
addition to these two diseases, we find frequent mention of dysentery,
scurvy, and, toward the end of the war, small-pox.

Innumerable articles, chronicles, &c., have described in detail the
miserable condition of the German countries during the Thirty Years’
War. The following account is largely based upon a notable work by a
physician named Lammert, who offers us a chronological enumeration of
the pestilences of that time, and also an exhaustive bibliography.[27]
Since it is impossible to discuss here thoroughly all the countless
epidemics that occurred, we can merely point out their main features and
indicate their connexion with warlike events. The figures quoted may be
relied upon, if, as is usually the case, they are taken from
church-registers; as regards statements taken from chronicles, on the
other hand, there is more occasion for distrust. For a correct
understanding of the facts, to be sure, we should have to know the exact
population of the cities and towns, and this information is only in rare
instances available. We must bear in mind, furthermore, that the
country-people fled to the cities when armies were approaching, and also
that nearly all cities were surrounded by walls and embankments.

The war began in Bohemia. After the battle on White Hill, near Prague
(November 8, 1620), the soldiers of Count Mansfeld, who were already
infected with typhus fever, marched down the Main to the Palatinate and
to Alsace, devastating the country as they passed and leaving severe
pestilences behind them. In the year 1625 the main scene of the war was
transferred to the north, where numerous epidemics had already broken
out in the course of that year. The disorder caused by the war, and
especially the wild warfare of Wallenstein, who in the fall of 1625,
after mustering his army, had joined forces with Tilly, were
particularly favourable to the spreading of disease. Hence in the years
1625–6 we see precisely in North Germany the ‘plague’ doing the greatest
damage.

The battle of Barenberg (near Lutter, August 1626) gave the Imperialists
the upper hand in North Germany. This ascendancy was taken away from
them, however, with the appearance of Gustavus Adolphus of Sweden, who
won a complete victory over Tilly in the battle of Breitenfeld
(September 17, 1631). After that, Gustavus Adolphus advanced to the
Lower Main (Frankfurt and Mayence), and the following year carried the
war into Bavaria, which now became the principal scene of the fighting.
After the battle of Nördlingen (September 7, 1634), the fugitive Swedish
Protestant army, pursued by the Imperialists, retreated through
Württemberg, Baden, and Hesse to the Rhine, where the war was now
carried on for several years. Both armies were badly infected with
disease, and spread pestilence wherever they went. After the battle of
Nördlingen the war became decentralized, splitting up into a number of
warlike movements throughout all Germany; and everywhere these movements
occurred they added, if possible, to the misery of the people.

In the year 1631 that terrible epoch of plague began which reached its
climax in the years 1634–5 and lasted well into the following year. Its
widespread character was due to the innumerable plundering and
devastating marches of the Protestant-Swedish and Imperialist-Catholic
armies back and forth across the country, and also to the consequent
famine. Everything the brutalized soldiers could not consume themselves
or take with them, they destroyed or burned. There was an absolute
dearth of farm-workers, and in addition to that, the year 1635 was dry
and unproductive. Horrible are the descriptions of the hunger and misery
which the people in all parts of Germany experienced at that time. Under
such conditions pestilences could spread unhindered; to be sure, they
relaxed a little after the year 1638, but by no means ceased entirely.
Whenever real plague disappeared, typhus fever, which was prevalent in
all parts of the army took its place; and thus diseases were borne from
place to place until the very end of that disastrous war.


           I. THE WAR IN BOHEMIA AND THE PALATINATE (1618–24)

The year 1620 saw the first warlike events of any importance; at the
beginning they were confined to Bohemia, where in November 1619,
Frederick, Elector of the Palatinate, had been crowned King of Bohemia.
In the first part of the year 1620 typhus fever broke out in Austria and
Bohemia among the poorly nourished troops of the Catholic League,
carrying away, it is said, 20,000 Bavarian soldiers. After the League’s
successful battle on White Hill (November 8, 1620), the disease was
borne by Bavarian soldiers back to Upper Bavaria and Württemberg; it is
stated that it caused an eruption of red spots over the entire body, and
that headache, dizziness, and stupefaction were prevailing symptoms.[28]
Munich, by adopting strict measures of precaution—isolation of the
patients in houses outside of the city, disinfection of suspected
effects and incoming letters, washing in vinegar of money sent in from
infected localities—managed to exclude the disease from the city limits.
In 1620 the troops of Count Mansfeld conveyed the disease, which was
called ‘head-disease’, to Franconia, where in the following year it
raged extensively. In consequence of their marauding expeditions, typhus
fever also became very widespread in the Upper Palatinate—Neumarkt and
Weiden are mentioned as places where it appeared; in Weiden 250 persons
died, three or four times as many as in normal years. Count Mansfeld
then marched down the Main and along the Neckar to Mannheim, and
everywhere his soldiers went they left behind them the germ of typhus
fever: e.g. in Boxberg (near Mergentheim), in Neckarelz (near Mosbach),
in Eberbach, in Ladenburg and Viernheim (both near Mannheim), and in
many other places.

In the following year Lorraine, the Palatinate, and northern Baden
became the scenes of Count Mansfeld’s predatory incursions. Since the
country-people fled to the cities, the latter became greatly
overcrowded; in Strassburg, for example, whither 23,000 country-people
had sought refuge, a severe pestilence (chiefly dysentery) broke out and
carried away in the course of that year (1622) 4,388 people.
‘Headdisease’ broke out in Wimpfen-on-the-Neckar, after the battle
fought there on May 6, in consequence of the arrival of over 900 hundred
sick and wounded soldiers; the result was that a large proportion of the
inhabitants were taken sick, and a third of them died. In the
Palatinate, through which Mansfeld passed on one of his predatory raids,
the mortality in town and country, in consequence of dysentery and other
diseases, was very great. Again, in Frankfurt-on-the-Main typhus fever
broke out in 1622, and 1,785 people died (as compared with 600–700 in
normal years). In Mayence and vicinity the disease became very
widespread in the year 1624. A plague also broke out in Nuremberg in
October 1624, carrying away 2,487 people that year, and 2,881 the
following year.

The Palatinate suffered terribly in the year 1623 from the continued
marauding of Mansfeld’s army, and in consequence of cross-marches of
Spanish and Walloon troops pestilential diseases were conveyed from
there to Lorraine. In July 1623, according to Maréchal and Didion,[29]
typhus fever or bubonic plague broke out in the village of Lessy and
raged furiously for two months. Despite energetic measures that were
taken to prevent the disease from spreading, neighbouring and even more
or less remote villages were infected, so that in 1624 the entire
country was suffering. In spite of the fact that all strangers were
forbidden to enter the city of Metz under penalty of death, the disease
made its appearance there in May 1625, and in less than ten months
carried away 3,000 people. Of the cities surrounding Metz, all of which
were infected, Verdun had a particularly high mortality. The epidemic
spread from the Palatinate to Württemberg, Baden, Hanau, Nassau, and
down the Rhine; for the most part it was typhus fever.

In the year 1623 the army of the Catholic League spread infectious
diseases throughout Hesse, particularly in the region of the Werra. When
the army withdrew, it left dysentery behind it, for example, in
Witzenhausen, Eschwege, and Hersfeld; in July and August it carried away
many victims. A pestilential disease broke out on June 3, 1624, in
Hersfeld, carrying away from October 4, 1624, to January 1625, 316
persons. In 1625, ‘hunger typhus’ and bubonic plague appeared in Nassau;
the pestilence began in Dillenburg on December 18, 1625, and lasted
until October 30, 1626, carrying away in this time 378 people—about
one-third of the population. The climax of the pestilence came in July.
A plague also broke out among the soldiers in Walsdorf-on-the Ems,
likewise in Idstein, remaining there for several years.


 II. THE WAR IN SAXONY, THURINGIA, BRANDENBURG, AND POMERANIA (1625–30)

The years 1625 and 1626 were bad pest-years; according to Lammert, the
various epidemics that occurred were partly typhus fever, partly bubonic
plague, and partly dysentery. The pestilences spread over Saxony,
Thuringia, Silesia, Eastern Prussia, Posen, Poland, and Moravia, and
carried away large numbers of people. They were not always directly
connected with warlike events, as shown by the fact that many provinces
that were spared by the war were attacked by the diseases. On the other
hand, the incursion of Wallenstein’s troops into Saxony and Thuringia
caused pestilence to become unusually widespread.

From 1625 to the time of the battle of Breitenfeld (1631) Saxony
suffered terribly from pestilences that were caused and prolonged by the
war, though by no means as terribly as in the years 1631–3. Dresden and
Leipzig, comparatively speaking, were but slightly affected. Of 13,000
inhabitants that Dresden had in the year 1626, 341 succumbed to a plague
which began in April and disappeared in December; the disease was called
‘burning fever’, ‘spotted fever’, and ‘pestilential spotted fever’,
while in the records of the town council we find mention of ‘spots,
often the size of a groschen, all over the body’, and also of
‘swellings’. Inasmuch as abscesses and gangrene are often observed in
cases of typhus fever, it seems likely that it was that disease.[30] Of
14,500 inhabitants in Leipzig only 122 succumbed to it, although houses
in all the streets were infected. Here again, accordingly, we see how
slight the danger to life is in the case of typhus fever.

The western part of the present kingdom of Saxony suffered considerably
more than the eastern part. In the year 1625 plagues broke out in the
cities of Plauen, Reichenbach (1,000 deaths), and Zwickau; the
last-named city was revisited in June 1626, and between then and the end
of the year 216 people died there. Pestilence also broke out in the
vicinity of Leipzig in 1626—in Borna (70 deaths), in Grimma (350
deaths), and in Wurzen, where it appeared in August. The following
places nearer Dresden were also the scenes of plagues that year:
Rosswein (near Döbeln—376 deaths), Mitweida (outbreak on April 9,
1626—number of deaths before that day 22, between that day and the end
of the year, 1,000), Frankenberg (581 deaths), Freiberg (752 deaths in
the year 1626—500 of them due to the plague). The village of Dohna,
south of Dresden, is also mentioned; in the year 1626 there were 157
deaths there, as compared with an average annual mortality of 60. In the
Erzgebirge plagues appeared in various places in the year 1625; 134
people died in Annaberg and 323 people in Zöblitz. In 1626 there were
205 deaths in Schwarzenberg, 178 deaths in Gottesgabe, and 81 deaths in
Breitenbrunn. Two towns in eastern Saxony, Bischofswerda and Zittau, are
also mentioned; there were 182 deaths in the former in the year 1625.

All Thuringia suffered severely from pestilences in the years 1625–6. In
the year 1625 the number of deaths in Eisenach had increased to 315,
while in 1626 a plague raged so murderously that 769 persons succumbed
to it; other reports say 2,500, but this number doubtless includes the
refugees. In the following year the number of deaths decreased to 156.
In Ruhla, a neighbouring village, 98 persons succumbed to the plague. In
many Thuringian cities the epidemic had already secured a foothold in
the year 1625, and was then spread over a very large territory by
Wallenstein’s invasion. Schmalkalden was the scene of a plague from June
to August, 1625, and in Gotha one broke out at the end of July, 1625,
carrying away 722 persons that year and 209 the following year. In
Erfurt, which had some 15,000 inhabitants, 3,474 people are said to have
succumbed to a plague in the year 1626, the strict ordinances passed by
the town council on December 25, 1625, being of no avail. The small
communities and cities lying to the north of Erfurt, according to the
reports, were very severely attacked; in the year 1625 Ballstädt, with a
population of 600, lost 365, while in the year 1626 the number of deaths
in Gräfentonna was 510, in Gebesee 275, in Kindelbrück 1,514, in
Straussfurth 367, in Weissensee 500, and Cölleda 1,000. In the region
south of Erfurt the village of Ohrdruf lost 203 inhabitants in the year
1625, and 143 in the following year. In Arnstadt 1,236 people succumbed
in 1625 to ‘head-disease’ and bubonic plague—a number corresponding to
one-quarter of the population. Gräfenroda had 1,630 deaths in the year
1625, and Tambach 400 deaths in 1626. Koburg and Rudolstadt were also
visited by a plague in 1626, while towns in the vicinity of the latter,
Königssee, Schwarza, Tanna, and Schleiz, had 707, 129, 195, and 181
deaths respectively. The neighbouring town of Pössnek in the year 1625
had already lost 1,000 inhabitants. Jena and Weimar both suffered, while
there were 228 deaths in Gera and 1,100 deaths in Zeitz due to
pestilence. Many other places in Thuringia that suffered from plagues
are not mentioned here.

That part of Saxony which corresponds to the modern province of Saxony
fared in much the same way as Thuringia, while those parts bordering
directly on the kingdom of Saxony were relatively less severely
attacked. A plague broke out in Eilenburg in September 1625, and
carried away many persons there and in the surrounding country. At
Delitsch (west of Eilenburg) a dangerous fever (_febris
maligna_—probably typhus fever) spread through the wandering armies,
and before the beginning of autumn carried away 150 persons. In the
winter the disease subsided a little, but broke out again in June
1626, and carried away 880 people—in September alone there were 229
deaths, and numerous families were completely wiped out. A plague also
raged in the vicinity of Halle; not until the following year, however,
did it break out in the city itself, whither it was borne by
Imperialist soldiers, and where it caused, from June to December,
3,400 deaths. In Eisleben (east of Halle) a plague began in May 1626,
and carried away 30 to 50 people daily, so that the total number of
deaths for the year was 3,068. Merseburg lost 341 inhabitants in the
year 1626, and a plague raged in Naumburg in the years 1625–6. The
town of Querfurt (west of Merseburg) in 1625 was for seven weeks the
quarters of 3,000 of Wallenstein’s soldiers; they brought dysentery
with them, and the result was that 200 citizens died. In the second
half of the following year a plague broke out and carried away 1,400
inhabitants of the city (including 200 soldiers) and numerous
inhabitants of the surrounding country. The town and vicinity of
Sangershausen were also severely attacked; the pestilence began in the
town in June 1626, and reached its climax in September with 570
deaths—1,323 deaths, all told, are recorded in the church register for
that year, but the figure is said to be too small. Lammert mentions
sixteen surrounding villages in which a total of 2,960 deaths occurred
in the year 1626. In Sondershausen 54 people died up to the end of
July of that year, 36 in August, 137 in September, and 143 in October;
the mortality then decreased, but not until 466 persons had died, 400
of them in consequence of the plague. In the near-by towns of
Frankenhausen and Langensalza the number of deaths was 915 and 913
respectively, the latter town having been visited by a plague the year
before. Nordhausen, from January 1, 1626, to December 6, 1626, lost
3,283 inhabitants—2,504 natives and 779 refugees from other places. In
Stolberg (north-east of Nordhausen) a plague broke out on June 27,
1626, and caused 623 deaths. Quedlinburg, Aschersleben, and
Halberstadt were also attacked; in Aschersleben a plague broke out on
June 15, 1625, and between then and the end of the year carried away
157 persons. The total number of deaths in the year 1625 was 534, in
the following year 1,800 (1,066 in consequence of the plague), not
including the soldiers; the years 1627–9 had a remarkably low
mortality. In 1626 a plague carried away 549 persons in Gröningen
(near Halberstadt). The cities on the Elbe and the surrounding country
were severely attacked; a pestilence broke out in Dessau on September
3, 1625, and between then and the end of the year 224 persons were
buried—399 in the entire year. The disease reappeared in the summer of
the following year, having caused 662 deaths, while only 39 died in
the year following. In Aiken-on-the-Elbe (below Dessau) 1,000 persons,
including soldiers, succumbed to a plague in the year 1626. In the
cities on the Saale, above its confluence with the Elbe, a plague
raged furiously; in Bernburg it appeared in the second half of the
year 1625, carrying away 1,340 persons in that year (the number of
deaths in the following year being 425); Kalbe was also severely
attacked. A plague broke out in Magdeburg at the end of June 1625, and
lasted well into the next year; the wealthy citizens fled from the
city, but were compelled to return by the approach of the
Imperialists, and the result was that several thousand inhabitants
died. The country to the south-west of Magdeburg, as far as Bode,
suffered severely—Osterweddingen, Wanzleben, Gross-Salze, Förderstedt,
Egeln, Wolmirsleben, and other places. Several soldiers quartered in
Förderstedt had succumbed to a plague in June and July 1626, and had
infected the citizens with the disease, which carried away 155 of
them. A plague broke out in Egeln in October 1625, and reached its
climax in February 1626; from January until August 16 of that year 296
persons died there. In Unseberg, which had been infected in August
1625, some 400 citizens and soldiers were buried in the year 1626, in
addition to many who were secretly buried in gardens, thickets, and
fields. The plague raged with particular fury in August 1626; in
Volmirstadt 246 persons died between July 6 and October 1626—144 in
September alone.

In Lower Saxony, in the region between the Elbe and the Weser, most of
which to-day belongs to Hanover, a plague raged virulently in the years
1625–7. In Osterode, whither numerous country people had fled from the
approaching war, a very severe pestilence broke out; in the Saint
Aegidius community alone 1,500 persons died, among them many outsiders.
In Klausthal 1,350, in Andreasberg 700, in Einbeck 3,000, and in Hameln
1,143 people succumbed to bubonic plague and ‘head disease’. In Goslar,
where the pestilence had appeared in 1625, conditions were rendered
particularly bad by the fact that many wounded Imperialists were brought
there after the battle of Barenberg (near Lutter—August 27, 1626); most
of these soldiers died there, 3,000 deaths due to pestilence having
occurred in Goslar in the years 1625–6. Wallenstein’s soldiers also
brought pestilence with them to Helmstedt (in the region of Brunswick);
here one-third of the citizens died, and 295 houses were rendered
tenantless. The university faculty fled several times to Brunswick, the
students either going home or enlisting in the army. This plague did not
come to an end for two years. The surrounding villages, furthermore,
were severely attacked by it; during the siege of Göttingen by Tilly
(June to August 12, 1626) it became very widespread, since the city was
overcrowded with fugitives. From 50 to 60 persons were buried every day.
In near-by Dransfeld 700 people died, in Wolfenbüttel 1,705. In Hanover,
where a plague had already broken out in the year 1625, a reappearance
of it in March 1626 drove out the garrison. The severity of this plague,
which carried away 3,000 people, was increased by the numerous fugitives
in the city; about one-third of the population survived. In the city of
Nienburg, which was besieged by the Imperialists after the battle of
Barenberg, a pestilence likewise broke out among the inhabitants and in
the garrison. In Lüneburg it lasted from 1625 to 1628, and in Osnabrück
from August 1625 to the end of the year.

In the years 1625–6 Wallenstein’s soldiers carried pestilence into the
region north of Magdeburg; in Neuhaldensleben 76 persons were carried
away between the end of August and the first of the year, not including
those who were buried secretly. The following year it demanded a
considerably larger number of victims—583; the maximum was in June—147.
In the Altmark (north-eastern part of the province of Saxony) dysentery,
bubonic plague, and typhus fever broke out almost everywhere during the
years 1625–8. Dysentery appeared in the Danish garrison at Tangermünde
and carried away 1,600 people, and on June 29, 1626, the Danes withdrew
from the place. Stendal was also visited by a plague after the departure
of the Danes; it broke out in July, and in a few months caused 2,511
deaths, the normal mortality being 280–290. Numerous bodies were
secretly buried, while many peasants who had fled to the city were among
the dead; thus the total number of deaths was estimated at 5,000. In
Osterburg 624 people died in the years 1626–8, and in Bismark 163
persons died in the year 1626. In the city of Havelberg 668 persons
succumbed to dysentery, ‘head-disease’, and bubonic plague, the latter
alone carrying away about 400. A pestilence was conveyed to Gardenlegen
by the soldiers of Count George of Brunswick, who had his head-quarters
there; the number of deaths there in the year 1626 amounted to no less
than 1,514. In Salzwedel 335 persons died in the year 1625, and 451 in
the following year, the plague being responsible for 400 of the latter.
In Seehausen dysentery first appeared, and soon gave way to ‘war-plague’
(typhus fever), which lasted until 1628; some 200 of the soldiers
quartered there died, and as many as 1,100 inhabitants.

Brandenburg also suffered, particularly in the south-eastern part, when
Wallenstein’s army, in pursuit of Count Mansfeld, turned into Silesia;
there were 386 deaths in Luckau, 900 in Kottbus, 500 in Forst, 112 in
Spremberg, and 902 in Jüterbog.

Further north, plagues were considerably less widespread in the years
1625–6. In 1625 typhus fever broke out severely in Lübeck and the
surrounding country, carrying away 6,952 people, while in Bremen, which
had had cases of plague in 1625, a widespread outbreak in 1627 carried
away some 10,000 people, natives and refugees. Mecklenburg, being
further away from the scene of the war, suffered somewhat less. In the
year 1625 bubonic plague, ‘head-disease’, and dysentery appeared in
Rostock, Wismar, Schwerin, Plau, and New Brandenburg. In the following
year a plague broke out in Parchim, reached its climax in May, and
lasted until November, carrying away 1,600 persons. In Flensburg a
plague broke out during the occupation of the Imperialists (1627) and
lasted until their departure (1630).

The pestilences of the year 1627 were not very widespread, and this
applies also to the territory in Saxony and Thuringia which had suffered
so severely in the years 1625–6. On the other hand, the countries in the
northern part of Germany, particularly Pomerania and Schleswig-Holstein,
were severely attacked in those years, owing to the fact that
Wallenstein had transferred thither the scene of the war. In the year
1628 Hamburg had taken in a great many foreign fugitives, and the result
was that typhus fever soon broke out in the city and carried away many
thousands of people. The war brought great misery into North Friesland
and the Frisian Islands; the Imperialists and Danes oppressed the people
by enforced quartering and extortions of all kinds, and the result was
famine and plague, lasting until 1630. In Stade, which Tilly in 1629 had
made his head-quarters, both the inhabitants and the garrison suffered
terribly from a severe epidemic of dysentery. In the city of Schleswig a
plague broke out in September, and again in November, in consequence of
the quartering of Imperialist troops; it devastated the entire city, so
that 211 houses stood absolutely empty on Christmas Day, 1628.
Mecklenburg was revisited in 1629, and on August 13 of that year a
plague broke out in Rostock and Teterow. Imperialist soldiers conveyed
pestilence to the city of Plau, where they passed the night of November
29; but in 1630 it appeared in a much more severe form there and carried
away 600 people. In the year 1630 a plague broke out in Mecklenburg, and
in Gustrow one raged from May 7 to the beginning of September.

In the years 1628–9 Pomerania was ravaged by the Imperialists, with
resulting pestilence and famine. Greifswald suffered for four years from
a pestilence which reached its climax in the year 1631. Grimmen,
Stargard (3,500 deaths in the years 1627–30), Freienwalde, and other
places were also attacked. In Greifenberg, where soldiers had been
quartered in large numbers, it raged with unusual fury; three-fourths of
the city were devastated, and when the Swedes arrived only 42 houses
were uninfected. Kolberg (on the Persante) in six months lost 3,000
inhabitants in consequence of a pestilence. On account of the oppression
caused by the war, many citizens fled from Koslin, which, despite the
decrease in population, lost 919 inhabitants in the year 1630. In Stolp
800 people died in consequence of a plague.

A plague was borne into Silesia in July 1623, and in Bunzlau an average
of thirty persons per week died; of 760 deaths in the year, 640 were due
to the pestilence. Many adults fled to near-by villages and died there.
In the following year a plague broke out again in Bunzlau, but as only
130 people died there in 1625, it seemed as though the pestilence was
over. In September and October, 1626, however, it broke out again, and
of 228 deaths that occurred that year, 149 were directly attributable to
the plague. In July 1624 it appeared in Friedeberg and carried away 51
persons. In Löwenberg it began in September 1624; the citizens fled from
the city and set up tents in the fields, but in spite of this, from
forty to fifty people died every day, and the total number of deaths for
the year was some 3,000. In the year 1625 the pestilence was very
widespread in Silesia—Hirschberg, Löwenberg, Herzogswaldau, Liegnitz,
Neumarkt, Waldenburg, Neisse, and other places were attacked. In Breslau
‘head-disease’ raged from June to the end of that year, carrying away
3,000 people; 1626 was also a year of pestilence for Breslau. In
Neustadt (Governmental District of Oppeln) a pestilence raged with
particular fury from May till September 1625; for the years 1624 to 1627
the deaths were respectively 198, 420, 175, and 472. On August 21, 1626,
an army of 6,000 Imperialists under Count von Merode encamped at
Goldberg; most of them were infected with disease; and after their
departure a plague broke out with such severity that a large part of the
population died.

During this time, from 1625 to 1630, when epidemics were raging almost
everywhere in North Germany, South Germany also suffered, since diseases
were often brought there by Imperialist troops and wandering rabble. In
the year 1626 Württemberg alone lost 28,000 people in consequence of
plagues.[31] A pestilence in Augsburg (1628) became very widespread and
caused 9,000 deaths. In the year 1629 ‘head-disease’ broke out in
Württemberg and Alsace. During the isolation of the city of Hanau (from
December 6, 1629, to March 12, 1630) by the Imperialist commander
Witzleben, a pestilential disease, which the soldiers had brought with
them, broke out and caused many deaths throughout the entire vicinity.


                       III. THE WAR YEARS 1630–40


              1. _North Germany until the Peace of Prague_

In the year 1630 began in Saxony—in the wake of marching troops—that
deadly pestilence which soon spread over all Germany and was chiefly
responsible for the enormous loss of human life there in the course of
the Thirty Years’ War. We may safely assume that bubonic plague was the
most common disease, although both typhus fever and dysentery were of
frequent occurrence. In the years 1630–1 the pestilence was confined for
the most part to North Germany; the Electorate of Saxony suffered the
worst, 934,000 people, according to the reports, having died there in
consequence of the war and of diseases.[32]

The pestilence broke out in Leipzig in October 1630, and carried away
301 persons; it was borne there presumably by two foreign
orange-pedlars. In October of the following year it broke out again,
when the Imperialists, after besieging the city for several weeks, on
September 13 had finally captured it. The number of deaths in the entire
year was 1,754. In the year 1632 Leipzig was once more the scene of
grave warlike events, and was compelled to live through a second siege
by Wallenstein; the plague began in June, became very widespread in
August, and from then till October caused a great many deaths, the total
number for the year amounting to 1,390. In August 1633, Leipzig was
again besieged, and this likewise caused the outbreak of a plague which
lasted until December and carried away 761 persons; in 1634 it was
apparently over, for of 306 deaths that are recorded for that year, only
24 were attributable to the plague. In the years 1636–7, however, it
reappeared with great severity throughout the entire city. The country
surrounding Leipzig suffered a great deal in the year 1633, which was
the worst plague-year that Saxony passed through. In the year 1632
Altenburg was occupied by the Swedes, who were infected with some
pestilential disease, the germ of which they left behind them when they
withdrew on January 13, 1633. The disease spread rapidly, acquired a
virulent character, and carried away 2,104 persons, among them many
foreign refugees. Grimma and Borna were severely attacked in 1633, while
Wurzen suffered less severely.

The country north-east of Leipzig suffered severely from plagues in
1631. After the battle of Breitenfeld (September 15, 1631) most of the
wounded were brought to Eilenburg, where in a few weeks a plague broke
out and spread so rapidly that 300 people died in the month of October
alone. After an abatement during the winter, it recommenced in 1632; the
number of deaths for that year was 670, although only 492 of them were
due to the plague, while the disease did not entirely disappear until
1636. The city of Belgern, after it was plundered by Holk’s troops on
October 1, 1632, was visited by a plague; also Dommitsch, Oschatz (where
563 deaths occurred in 1631, and many more in 1633–4), and Ortrand
(where there were 800 deaths in the years 1631–3). Plagues raged very
frequently in Leisnig, Colditz, and Mittweida, and in the villages and
towns surrounding them. In February 1631, Palatinate, Imperialist, and
League troops quartered in Leisnig, and the result was that
‘head-disease’ and bubonic plague became very widespread; in the
following year they reappeared, causing 443 deaths, while many thousands
are said to have died in the country districts. The same was true of the
year 1633. A pestilence broke out in Colditz in the year 1631, and in
the following year ‘soldier’s disease’ (typhus fever) was brought there
by Swedish troops, while in 1633 bubonic plague caused 567 deaths.
Mittweida suffered from plague in the years 1631–4, 243 persons dying
there in the year 1634. In the year 1630 a very severe plague broke out
in Freiberg; 1,147 people died in the course of the year, 1,000 of them
in consequence of the disease. In the following year there were 124 more
deaths. In the autumn of 1632 pestilence raged so furiously that several
thousand people died in a short time—about one-third of the population.
Most of the bodies were buried secretly, only about 3,000 regular
funerals taking place. In the year 1633 there were 1,632 interments, not
including those buried in secret. The plague affected the entire
vicinity of Freiberg and spared scarcely a single village; many places
were left empty and deserted.

In Chemnitz 1,234 interments for the year 1632 are recorded in the
church register, and in the following year the plague raged even more
furiously: almost every house was attacked, and the number of deaths
amounted to 2,500. In Glauchau and vicinity, as in all Saxony, 1633 was
the worst year; 964 people died there in that year. The plague raged
most furiously from August to November, and lasted until 1634; many
bodies were found in the open fields. In the neighbouring Waldenburg 392
people died in a few weeks in 1633, in Lichtenstein 370, in Thurm 400.
In Marienberg, a village lying at the foot of the mountains, 1,000
people succumbed in the year 1633 to typhus fever; the plague spread
into the Erzgebirge and caused 2,300 deaths in Schneeberg and 157 deaths
in the adjacent Neustädtle. A plague had already broken out in Zwickau
in 1632, and in the first part of 1633 it became so severe that 1,500
people died in two months in the summer of that year. The city was full
of sick people and dead bodies, and the number of reported deaths for
the year 1633 was 1,897; but the total number of deaths, excluding the
soldiers, is said to have been no less than 6,000. Entire streets were
devastated. Many of the inhabitants fled to near-by villages, and thus
spread the infection. Crimmitschau was visited by a plague in 1630 (601
deaths), and again in 1633 (409 deaths); 92 families in the last-named
year were completely wiped out. Many neighbouring places were also
attacked; there were 700 deaths in Werdau, 300 in Steinpleiss, 150 in
Königswalde, &c.

The invasion of Holk caused Vogtland to suffer terribly in August of the
year 1632, while his second invasion in the summer of 1633 resulted in
an even worse outbreak of disease. In Reichenbach and vicinity, typhus
fever, bubonic plague, and dysentery prevailed in the year 1633; at
first it was called ‘soldier’s disease’, and later ‘bright plague’
(_helle Pest_). Of 904 deaths that occurred that year, 785 were due to
the plague. In Plauen the number of deaths in 1633 was 1,748, in
Oelsnitz 325 (217 due to the plague). Holk himself succumbed to the
plague in Adorf on August 30, 1633, while 1,000 of his troops also died.

The eastern part of Saxony was also attacked. In Dresden a plague broke
out in 1632 and carried away numerous people; it continued to rage in
the following year, since the war prevented the adoption of the usual
measures of precaution. In the year 1632 the number of Protestants
buried by the church was 3,129, and in the following year it was 4,585.
Numerous families were wiped out, and many houses were rendered
tenantless. In the year 1634 one half of the inhabitants fell victims to
the pestilence, while a large part of the city was devastated in 1635.
Since the reports of E. J. J. Meyer and of the town council continually
speak of ‘swellings’, the disease was no doubt bubonic plague.[33] In
Dippoldiswalde (south-west of Dresden) it raged so furiously in the
years 1631–3 that entire families were wiped out; in those years there
were 189, 510, and 250 deaths respectively. Pirna is said to have lost
4,000 inhabitants in consequence of the plague in the years 1632–4,
while Dittersdorf (south of Pirna) lost 405 inhabitants in the year
1632. The pestilence was borne by Saxon troops to Sebnitz (south-east of
Dresden). In Stolpen it raged from 1632 to 1634. In October 1631 the
Croats brought pestilence to Bischofswerda, and more than 200 persons
died in consequence of it. In March 1632 another pestilence broke out
there, carrying away 660 persons, so that more than one-third of the
houses stood empty. In the year 1631 there were 1,000 deaths in Camenz.
In Bautzen there was a garrison of 500 men, almost all of whom died in
the year 1631; including the residents that were carried away by the
pestilence, the number of deaths there for that year was about 1,000.
Nor did the pestilence disappear from Bautzen the following year.

Lusatia was also the scene of pestilence; only a few places were spared,
and in Upper Lusatia 40,000 persons are said to have been carried away
by pestilences in the years 1631–3. In the last part of September 1631,
dysentery and bubonic plague broke out in Görlitz, which had a Saxon
garrison, and carried away some 400 persons (excluding the soldiers)
between then and the end of the year. In June 1632 there was a second
outbreak of plague; it reached its climax in October, and carried away
6,105 people (including 106 soldiers) in the course of the entire year.
In the following year 726 inhabitants and 435 soldiers succumbed to the
disease. Zittau suffered severely; as early as 1633 several hundred
soldiers and inhabitants succumbed to typhus fever, while in the year
1632 ‘burning fever’, dysentery, and bubonic plague appeared and carried
away 1,246 persons (according to other reports, 1,642 persons).
Petechial fever and bubonic plague, after a period of inactivity in the
winter, recommenced in the first part of 1633; the latter disease
reached its climax in September, carrying away 1,860 inhabitants in that
year, in addition to many Imperialist soldiers. From October to
December, 1634, Saxon and Brandenburg soldiers, after their return from
Bohemia, encamped near Zittau, where various diseases soon broke out;
the result was that hundreds died, and the entire region became
infected.

The Province of Brandenburg was severely attacked by a plague in the
year 1631, but in the next year suffered considerably less owing to the
fact that the scene of the war was transferred to other parts of
Germany. In Berlin 777 people succumbed to a plague in the year 1630,
while in the following year it reappeared in a much severer form and
carried away 2,066 persons. In Spandau, after the capture of the city by
the Swedes on May 6, 1631, famine and pestilence broke out and caused
1,500 deaths. A plague in Potsdam caused 457 deaths between June and
December, 1631. Neuruppin, in February of that year, after the
occupation of the District of Ruppin by Tilly, suffered from a severe
pestilence. Dysentery and ‘head-disease’ broke out in Rathenow in 1631,
reached a climax in July, and carried away 662 people (not including
those buried in secret). In Prenzlau 1,500 persons, about one-fourth of
the population, died in the year 1631, while Havelberg had 227 deaths,
Lindow 400, and Kyritz (after the soldiers had quartered there) 231.
Frankfurt-on-the-Oder, which had been occupied by the Imperialists, on
April 13, 1631, was captured by Gustavus Adolphus, whereupon a severe
epidemic broke out and carried away entire families in the course of a
few days; the alleged number of deaths was 6,000. Müncheberg (north-west
of Frankfurt), Quilitz, Drossen, and Guben were also attacked; there
were 365 deaths in Quilitz and 2,000 in Drossen. In the year 1634, when
the Imperialists once more devastated the Electorate of Saxony, a severe
plague broke out in Luckau, whither many country people had fled; the
spread of the disease is said to have been favoured by the fact that the
soldiers broke into and robbed the closed houses of the dead. In
Seftenberg (near Kalau) a plague broke out in 1630 and carried away 305
persons that year; it remained there until 1633, and spread to many
near-by villages.

Silesia, after the devastation caused by the pestilences of the years
1624–7, had a few years of rest. In the year 1632, however, infection
was brought there from Saxony, though only to a limited extent. On
August 1, 1632, Lauban was obliged to surrender to the Saxon garrison,
so that for ten days the city and the surrounding country were crowded
with troops; the result was that after their departure a severe epidemic
broke out and between July and December carried away 1,400 persons. In
the very next year severe plagues broke out all over Silesia, when
Wallenstein appeared there for the purpose of driving out the Saxons and
Swedes. The plague raged so furiously in Silesia that the armies were
almost entirely exterminated, and whole communities were wiped out.
Golgau, Bunzlau (and vicinity), Greiffenberg, and Friedeberg were
attacked. An epidemic of typhus fever carried away 500 people in
Hirschberg in the year 1632, and in the following year it became much
more widespread and carried away 2,600 persons. ‘The infected persons
are said to have looked very red, like drunkards, and to have died
suddenly.’ Almost the entire population of Landshut died in the year
1633. Goldberg (south-west of Liegnitz) had been plundered by
Wallenstein’s soldiers on October 4 and 5, 1633, and on October 10
Colonel Sparre quartered 200 ‘badly infected’ soldiers there; the result
was that a severe pestilence broke out in the city. In August of the
year 1633 such a severe pestilence broke out in Liegnitz that it was
impossible to bury the victims in the regular way; deep, broad ditches
were dug, and from 100 to 200 bodies laid in them. From August 14 to
December 22 the number of deaths is said to have been 5,794. Breslau,
which at that time had upwards of 40,000 inhabitants, was visited by a
plague in September 1633; in the Protestant parishes 13,231 people died
in that year, in the Catholic 4,800. Neumarkt (north-west of Breslau)
had 1,400 deaths in the same year, while in Brieg, which had a Swedish
garrison, there were 3,439 deaths. The city of Schweidnitz suffered
terribly; 30,000 soldiers under Wallenstein and 25,000 Swedish soldiers
were encamped there, and the plague was so severe that 8,000 of the
former and 12,000 of the latter are said to have died. In the city
itself, which was harbouring innumerable fugitives from the surrounding
country, sick people and dead bodies soon filled all the streets; on
August 25 alone, 300 people died. The number of the dead, including from
2,000 to 3,000 that were buried secretly, and also the outsiders, was
16,000 to 17,000; more than two-thirds of the population are said to
have succumbed. The pestilence was borne from Schweidnitz to
Peterswaldau and Nimptsch, where from 2,000 to 2,400 persons died. On
May 31, 1633, Wallenstein came with his army to Glatz, bringing
pestilence with him; in Glatz itself 4,284 people were carried away,
while many hundreds died in the surrounding country. Petschkau was
almost completely wiped out. In Neisse the number of victims is
estimated at 6,000; 5,272 are recorded in the church registers.

Generally speaking, Thuringia was but slightly affected by plagues in
the years 1631–3, but suffered terribly in the years 1634–5; for in
those years there, as in all Germany, a great famine prevailed. In
Koburg a plague broke out in the year 1630; in 1632 there was an
epidemic of ‘head-disease’, which carried away 300 persons in October
alone, and in 1634 an epidemic of bubonic plague, rendered even more
destructive by famine, carried away 1,143 victims. Several pestilences
(dysentery and ‘burning fever’) also broke out in the Koburg region,
caused by the quartering and ravaging of Swedish troops; the inhabitants
died by hundreds. Hildburghausen suffered from a plague from June on;
whereas only 106 people had died there from January to May, the number
of deaths in June alone was 215. In the following year 534 people died
there from starvation and pestilence, while 169 died in near-by
Streufdorf. Eisfeld (west of Hildburghausen) in 1632 had been plundered
by Swedish troops, and from that time on suffered from pestilence. In
Meiningen, in the latter part of 1635 and the first part of 1636, 500
people succumbed to a plague (106 in November alone). Suhl, which on
October 16 had been burned by Isolani’s soldiers, and Themar—both near
Meiningen—had 1,634 deaths. In the following year 519 people died in
Schmalkalden and vicinity—250 in Tambach, 300 in Vachdorf, and 1,600 in
Salzungen. In the year 1634 the number of deaths in Eisenach was 1,800,
and in the following year 1,600; in the year 1636 there were only 405
deaths there. Erfurt suffered very little in 1635, while Ohrdruf had
1,065 deaths, Wechmar 503, and Arnstadt 464. In Weimar 1,600 people died
in the year 1635, among them 500 foreigners from Franconia who had taken
refuge there. The cities lying further east in Thuringia had been
severely attacked in the years 1632 and 1633, in consequence of the
pestilences in Saxony; for example, Gera, which had been infected in
1633 by Holk’s troops, the near-by village of Untermhaus, which in the
two years had 211 and 600 deaths respectively, and also many other
villages in the surrounding country. A plague in Schleiz carried away
600 persons in the year 1632.

In Rhineland and Westphalia pestilences broke out only sporadically
in the years 1630–4, but in 1635 they became more general. In the
year 1630 Münster was attacked, in 1631 Arnsberg, and in 1632 a
pestilence raged furiously in the Berg country—in Lennep, for
example, where the Imperialist troops were for a long time
quartered. In Mühlheim-on-the-Rhine a pestilential disease broke out
after the departure of the Nassau-Lorraine garrison in 1631. In the
year 1632 the Imperialist and Swedish armies stood facing each other
in Westphalia for six weeks, and the result was an outbreak of
pestilence; 600 people succumbed to it in Bielefeld. In 1635 a
pestilence raged furiously along the Rhine; in St. Goar 200 people
died in the course of the summer. In that year Westphalia was the
scene of warlike events and pestilences; Arnsberg, the villages on
the Ruhr, Soest, Unna (near Hamm), Horstmar, and Kroesfeld were
attacked. The Governmental District of Düsseldorf (on the left bank
of the Rhine) was severely attacked by pestilence; many people died
in Geldern, while there were 389 deaths in Strälen, 256 in Nieukert,
and 700 in Lobberich.


                           2. _South Germany_


                     _(a) Bavaria and Upper Swabia_

After the battle of Breitenfeld (September 17, 1631) Gustavus Adolphus
passed through Halle and Erfurt to Würzburg, Aschaffenburg, and
Frankfurt-on-the-Main. Tilly had marched through Halberstadt, Fulda, and
Miltenberg to Würzburg, in order to relieve that city, which had been
captured by the Swedes, and then turned south. Thus the principal scene
of the war was transferred to Bavaria, which from 1631 to 1634 suffered
terribly from the ravages of the soldiers passing back and forth. No
part of the country was spared. ‘The Thirty Years’ War’, says
Lammert,[34] ‘was particularly fatal and disastrous to Bavaria from the
year 1632 on; it converted the country into an uninhabited waste,
especially because it was followed by pestilence. Like the Imperialist
army under Tilly in the autumn of 1631, so the Swedish army on its
marches consumed everything it found, and wherever it went in the years
1632–5 it spread ‘hunger typhus’ and ‘war typhus’ and bubonic plague;
all the places along the Main lost at least one-half of their
population.’ In September 1632, when Gustavus Adolphus withdrew from
Nuremberg, Wallenstein turned south, and there on November 6, 1632,
Gustavus Adolphus was killed in the battle of Lützen. After that
Wallenstein returned to Bohemia, while the Swedes under Bernhard von
Weimar marched back into Bavaria. The acme of misery was reached here in
the year 1634. It is impossible to enumerate all the places that were
infected by the brutalized, wandering soldiers; the most out-of-the-way
and indigent regions, such as the Spessart and the Odenwald, were
visited by them, and inasmuch as they brought pestilence wherever they
went, the unfortunate villages were subjected to merciless devastation.

1. The region of the Main. Since Gustavus Adolphus first had Horn occupy
the bishopric of Bamberg, and himself marched through Aschaffenburg to
Nuremberg, while Tilly returned to Ingolstadt and later to Lech, the
region of the Main, and later the region north of the Danube, were the
first to be attacked by typhus fever and bubonic plague; not until
later, from 1633 on, did the pestilences spread more or less extensively
in the country south of the Danube.

In Aschaffenburg and vicinity a plague broke out in the summer of 1632
and almost wiped out several villages; the city of Aschaffenburg itself,
which lost a large percentage of its inhabitants, was revisited in the
year 1635. In Würzburg the pestilence began in August 1632, and in the
last part of July of the following year another serious pestilence broke
out there, in consequence of which 489 bodies were buried in the
cathedral parish alone. The prolonged quartering of troops,
notwithstanding all the precautionary measures that were adopted, caused
the pestilence to rage with extraordinary fury; not until September did
it begin to abate. In the year 1635, when infected soldiers were
transferred from Schweinfurt to the stronghold of Marienburg, it
appeared once more. In 1632 Schweinfurt lost ‘several hundred people’ in
consequence of ‘pestilential purple-spots’ (typhus fever). The total
number of deaths was 1,055. In December of the following year another
rather large pestilence broke out, and again in August 1635; in the
latter year it reached a climax in September and came to an end in
December. In Bamberg many people succumbed in 1632 to Hungarian disease,
which the Swedes had borne thither in the spring. This disease was also
very widespread throughout the entire vicinity. In the year 1634 the
Swedes came several times into the region around Bamberg and plundered
the country, so that famine and plague caused great misery. In the
summer of 1635 Bamberg was once more attacked by an infectious disease
(typhus fever), and only two houses in the city were spared. In Kulmbach
the plague raged extensively in the first part of the year 1633; the
number of the dead was so large that the bodies could not all be buried
in Kulmbach, and some had to be taken to the churchyards of near-by
villages. In the following year the plague broke out anew, carrying away
60 persons in a single day. In Bayreuth 400 persons succumbed to a
pestilence in the year 1632, and in the following year 360 died; it
raged even more furiously after the city was plundered by the Master of
Ordnance, von der Waal, on August 19, 1634. From July to October 1,927
out of 7,000 inhabitants died, while the average number of deaths
amounted to only 167 per annum.

2. The region between the Main and the Danube suffered no less.
Nuremberg and vicinity was severely attacked by pestilence in the year
1632. In the summer of that year Wallenstein encamped near Fürth, and
Gustavus Adolphus near Nuremberg; they watched each other for a long
time without venturing a battle. The country people had all fled to the
city. In the Swedish army and in the overcrowded city, which had some
50,000 inhabitants, scurvy and typhus fever carried away many
thousands.[35] Only 4,522 bodies were buried by the Church, but many
more thousands died. Two weeks after his disastrous attack on
Wallenstein’s camp on September 4, Gustavus Adolphus marched south,
while Wallenstein turned into Saxony. The plague continued to rage in
the vicinity of Nuremberg, and many people contracted the disease by
visiting the deserted camp of the Imperialist army and appropriating the
left-behind implements, weapons, and kitchen utensils. Scurvy was still
raging in Nuremberg in the following year. In the year 1634 the plague
broke out and carried away 18,000 persons. In December 1631 Forchheim
was besieged by the Swedes under General Horn, and the result was that a
pestilence broke out in the year 1632 and carried away 578 inhabitants;
the average number of deaths per annum was 45. In March of that year the
Swedes had deserted the city, and in June 1634, when they reappeared
there, the mortality increased again. In the years 1631–2 Uffenheim
suffered a great deal from the predatory raids of the Swedes and also
from plague, which in the year 1634 became very widespread there as in
all Bavaria, carrying away one-half of the inhabitants of the town.
While the Swedes and Imperialists were establishing their camps near
Nuremberg, many people from Ansbach and other places fled to Windsheim,
which thus became greatly overcrowded; the consequence was that people
died there by the hundred, and their bodies were buried, thirty or forty
at a time, in large ditches. When the Swedes left Nuremberg and appeared
in Windsheim, they left behind them 450 men who were infected with
disease; in the entire year 1,564 bodies were counted. In the following
year the city was besieged by the Imperialists (October 12–23, 1633),
and during this time 360 persons succumbed to a pestilential disease;
the number of deaths in the entire year, including the outsiders, was
1,600. Windsheim also suffered greatly in the two following years; at
the end of the year 1635 there were only 50 inhabitants left. In near-by
Burgbernheim, where typhus fever raged in the year 1630, 155 persons
died in the year 1632, 165 in 1634, and 107 in 1636. In Schwabach, which
had been plundered by the Imperialists in the latter part of July, 1632,
various diseases broke out—‘Hungarian disease, dysentery, and even
bubonic plague.’ In the year 1633 there were 298 deaths in Weissenburg;
in 1634, on the other hand, there were 642. Eichstätt had 494 deaths in
the year 1632, 827 in 1633, and 982 in 1634; in the last year the town
was besieged and captured by the Swedes, and for a few days thereafter
pestilences raged furiously. The country districts throughout Central
Franconia, like these cities, were almost completely depopulated by
flight and pestilence.

The Upper Palatinate was also severely attacked by pestilence (typhus
fever and bubonic plague), which spread far into the Bavarian Forest. In
Amberg an epidemic of typhus fever and dysentery broke out in the year
1633, and in April of the following year bubonic plague appeared; the
latter disease carried away from 15 to 20 persons on many days of that
month, while in July and August as many as 40 people died every day. In
the spring of 1634 Weiden became infected with typhus fever and shortly
after that with bubonic plague; from August 17 to November 6, some 1,800
people died. The bodies were corded up like piles of wood, placed in
ditches in groups of 200 and 300, and covered with quick-lime. In
Schwandorf (north of Regensburg) the Imperialists had encamped in the
summer of 1634; after their departure a pestilence characterized by
‘swellings and large unknown spots’ broke out and carried away almost
one-third of the inhabitants. In Hemau (north-west of Regensburg), after
the Swedes had passed through the town, ‘the malignant pestilence’
(typhus fever) had broken out in the year 1633; and in 1634, after the
devastations committed by the troops of Bernhard von Weimar, bubonic
plague appeared and carried away one-half of the inhabitants.

3. The cities on the Danube. In the year 1632 Neuburg was occupied by
the Swedes; after their departure, on October 18, an epidemic of
Hungarian head-disease broke out and carried away many soldiers and
citizens (more than 900 in eight months). Again in the two following
years pestilence caused great devastation. On April 29, 1632, the Swedes
appeared before Ingolstadt, but in a few days withdrew; there was a
strong garrison in the city, however, and many fugitives had gathered
there. In this overcrowded population typhus fever broke out and carried
away large numbers of people. In the following year the disease became
even more widespread, and 1,039 people succumbed to it before the end of
November. In the first part of the year 1635 the pestilence abated. In
the second half of the year 1634 Regensburg was attacked by bubonic
plague, and despite all measures of precaution it carried away
two-thirds of the population (according to other reports there were
3,125 deaths). The entire vicinity suffered from the plague. The
mortality in Straubing during the siege of the Imperialists (March 1634)
increased greatly; even in the year before it had been very high (294
deaths). The total number of deaths in the year 1634 is not known, but
of three parishes St. Jacob’s alone had 631 burials. Deggendorf and
Passau fared similarly.

4. Upper Bavaria and Lower Bavaria south of the Danube. On May 17, 1632,
Gustavus Adolphus had occupied Munich, and during his short sojourn of
three weeks apparently no epidemic diseases made their appearance among
the Swedes. But since typhus fever had broken out everywhere in the
vicinity, strict measures of precaution were adopted by the city
authorities. According to G. von Suttner[36] 124 people in the
quarantine-house before the Schwabinger Tor succumbed to ‘burning fever
and headache’ between August and the end of the year. According to a
report published in 1632 the poor people suffered in particular, while
red spots, continual headache, and later on diarrhoea, characterized the
disease. A very severe pestilence broke out in Munich in the year 1634.
‘The epidemic was caused’, says Seitz,[37] ‘by the arrival of 4,000
Spanish soldiers in July of the year 1634; they were called there from
Tölz and Weilheim when the Duke of Saxe-Weimar and General Horn were
threatening the city. Although shortly after that, in August, a few
evidences of disease were noticed, it was not regarded as infectious.
Finally, however, a real plague broke out with such fury that four
lazarets and a garden outside of the city had to be made ready for the
care of the sick. It raged most furiously in the months of October and
November, when from 200 to 250 dwellings, among them entire houses, were
quarantined every week. Thus it went on until the end of December.’
Unfortunately there exists no medical description of the disease, the
most important characteristics of which were chills, accompanied by
internal fever, violent headaches, great lassitude, haemorrhage,
plague-spots, and swellings. All told, some 15,000 persons are said to
have died in the year 1634—about one-half of the total population of the
city. The bodies of victims became so numerous that they were piled up
in the streets and houses, without attempt to keep a record of the
names, and buried in ditches forty at a time. Strict isolation of the
patients by closing up the houses was enforced, and the use of the
clothes and bedding of the dead was forbidden under severe penalties;
such effects were burned outside of the gates. Only two gates remained
open, and in front of one of them a garden was made ready to receive
strangers who were denied admittance into the city. In February 1635,
the pestilence had almost entirely ceased, but in September it broke out
anew and did not disappear until February 1637.

In the years 1633–4 typhus fever and bubonic plague were spread
throughout all Upper and Lower Bavaria by the continued marauding of the
Swedes. The Imperialists, no less than the Swedes, helped to devastate
the country, while the Spanish soldiers had the worst reputation of all.
Again in the year 1635, especially in the autumn, the pestilence
appeared. A plague broke out in Freising after the town was plundered by
the Swedes on July 16, 1634 (Landshut had already been captured by them
on May 10, 1632), and after their departure they left behind them an
infectious disease which was diagnosed by the town-physician as
Hungarian fever. A pestilence broke out in the city when it was
plundered by the soldiers under Bernhard von Weimar, on July 10, 1634,
and carried away one-third of the inhabitants; according to a list
furnished by the court the number of deaths was 738, but there were many
more with whose legacies the court had nothing to do. The bodies were
piled up on wagons and conveyed to cemeteries, while the dwellings of
diseased persons were closed. In Dingolfing, which was occupied by the
Swedes from July 22, 1633, to June 1634, a plague raged with such fury
that it was thought the city would be completely wiped out.
Simbach-on-the-Inn and the near-by market-town of Thann suffered greatly
from a plague in the year 1634. In Thann many bodies lay for a long time
in the houses unburied, while entire families among the poorer
population were wiped out of existence. The plague also raged in the
surrounding localities, and many bodies lay in the streets as food for
scavenger birds. A plague raged in the years 1633–4 in Traunstein, which
had already had a few isolated cases of disease in the previous year;
123 people died terrible deaths in the two years mentioned, and also in
the years 1635–6. In the year 1634 a pestilence caused 500 deaths in
Rosenheim, while severe outbreaks of pestilence were reported from many
surrounding places—Aibling, Miesbach, Wasserburg, and Tegernsee.

In Tölz twenty-seven adults succumbed in May and June 1633, to Hungarian
disease; a pestilence also broke out in the spring of 1634 and carried
away hundreds of people in the months of May, June, and July. From July
on, the church-registers contain no more entries; the patients with
black swellings usually had but a few hours to live. In Oberammergau
‘wild headache’ raged in the years 1631 and 1633, and many people
succumbed to it. In September 1634, the town became infected with
bubonic plague, and up to October 28, eighty-four people succumbed to
the disease—about one-fifth of the population. The epidemic caused the
people to vow that they would produce the Passion Play there every ten
years. Murnau, Weilheim, and other places were severely attacked in the
year 1634. In Andechs the mortality was increased in the year 1634 by an
outbreak of dysentery and typhus fever, and on July 27 bubonic plague
also appeared and remained until November, carrying away 200 of the 500
inhabitants of the town. In Landsberg typhus fever broke out very
seriously in the year 1630. ‘All over the bodies of the people who
contracted the disease’, says Lammert,[38] ‘red spots appeared, and then
the victims lost control of themselves and knocked their heads against
the walls. Many who seemed scarcely to have contracted the disease died
suddenly. Dead bodies were found everywhere, even in public squares.’ In
the following year the disease spread even further; the vicinity of
Landsberg was infected by the soldiers, who were constantly marching
back and forth. After the terrible plundering of the city in April and
September of the year 1633, a plague broke out and carried away a large
proportion of the few inhabitants that were left.

5. The governmental district of Swabia fared no better than the
aforesaid Bavarian countries, while the region on the northern side of
the Lake of Constance suffered terribly from the predatory raids of the
Swedes and the consequent epidemics. In Augsburg, which from April 1632
to 1635 was occupied by the Swedes, the suffering began when the city
was besieged by the Imperialists. During a siege of seven months
(September 1634 to March 1635) famine and pestilence did a great deal
more damage among the population than the bullets and swords of the
enemies. Whereas this population numbered from 70,000 to 80,000 in the
year 1624, by October 12, 1635, it had dwindled to 16,422. After the
city had surrendered to the Imperialists, people still continued to die
in consequence of pestilential diseases; the town council therefore gave
orders on July 7, 1635, that all refuse should be removed from the city.
Not until the winter did the pestilence disappear. In Memmingen there
were 1,200 deaths in 1633, and 1,400 deaths in the following year; the
worst year was 1635, when the pestilence is said to have carried away
3,000 persons. The towns surrounding the city were also severely
attacked. In Kempten, which was oppressed by the Swedes and Imperialists
in the years 1632–3, a pestilence broke out in the year 1634 and lasted
well into the next year, carrying away 3,000 people. In the surrounding
country, pestilence raged so furiously that many places were completely
wiped out. In the near-by towns of Kaufbeuren, Immenstadt, Pfronten,
Füssen, &c., the pestilence was likewise very widespread; in 1635 there
were 1,600 deaths in Füssen—about one-quarter of the inhabitants.

The predatory incursions of the Swedes extended even to the Lake of
Constance. In the year 1634 the number of deaths in Lindau was 800; at
the beginning of the year 1633 Weingarten, Wangen, and Tettnang were
occupied by the Swedes, who brought infectious diseases with them
wherever they went. Tettnang, which in 1633 had more than 2,500
inhabitants, in 1636 had but 150. In Ravensburg a plague broke out in
the year 1635, reached a climax in September, and in six months carried
away 3,100 people. In Constance Hungarian disease raged in 1633, and is
said to have carried away its victims within a few hours; in 1635
bubonic plague also broke out and caused 2,000 deaths.


                      _(b.) South-western Germany_

The battle of Nördlingen (September 5 and 6, 1634) was an important
turning-point in the war, important for Bavaria for the reason that it
freed the country from the predatory incursions of the Swedes, and
disastrous to Württemberg, Baden, Hessen, and the Upper and Middle Rhine
region, whither the defeated Swedish-Protestant army retreated, and
where the fighting was now carried on for the next few years. Nördlingen
had been besieged by the Imperialists, who were supported by a Spanish
army; Bernhard von Weimar and Horn tried to relieve the city, but were
completely defeated in the attempt. The Swedes turned and fled to the
Rhine, and in a few weeks the entire south-western part of Germany was
filled with Imperialists who had followed in pursuit.

The sufferings of the inhabitants of Württemberg, partly on account of
the deeds of violence committed by the Imperialists, and partly on
account of pestilences, were frightful.[39] On September 10 the
Imperialists entered Stuttgart, which they continued to occupy until
March 30, 1638. In the year 1631 the city had 8,300 inhabitants, and in
the year 1634 the number of deaths was 936, of which 672 were due to the
pestilence. In the following year the pestilence became more widespread,
being helped along by numerous fugitives from the surrounding country
and by famine; the number of deaths was 4,379, and it was necessary to
dig large ditches and bury a hundred bodies at a time. From January to
July 1636, there were 319 deaths due to the pestilence, which in the
following year raged even more furiously and carried away 945 persons.
The mortality was equally high in the year 1638, when the city was
occupied alternately by the Swedes and Imperialists; the latter, when
they departed in October, left behind them 6,000 diseased and wounded
men. In near-by Cannstatt 1,300 people died in 1635. In Esslingen a
plague broke out in 1634 and in 1635 became more and more widespread in
consequence of the continual marching back and forth of the soldiers. It
made havoc especially among the 12,000 fugitives from the surrounding
country, who were packed together in stables and barns, and in many
cases under the open sky. Owing to the incipient famine the pestilence
spread with great rapidity; 12,000 people are said to have died, among
them 600 out of 1,000 citizens, notwithstanding the fact that various
measures of precaution were adopted (removal of refuse, fumigations on a
large scale, &c.). In Göppingen, which was occupied by Imperialist
soldiers a few weeks after the battle of Nördlingen, pestilence soon
broke out and carried away 656 persons between October 1 and the end of
the year (1634); in the following year there were 904 deaths. In the
year 1636 Gmünd had a very severe pestilence, which on many days carried
away from thirty to forty persons; large graves were dug and from forty
to fifty bodies buried at a time. Aalen, in consequence of the continual
marching back and forth of the soldiers, of quartering, and of
extortions, suffered severely; there, and in the country round about, a
plague raged furiously in the year 1634. Krailsheim and Hall,
comparatively speaking, fared well. In Hall, the parish of St. Michael,
in which the average number of deaths for the years 1621–30 was 112, in
the year 1634 had 1,116 deaths (999 in the months of August-December),
while there were 372 deaths in the year 1635.[40] The fugitives in the
city and the people who died there are not included. In Oehringen, after
the town was plundered by the Imperialists from September 13 to 18, a
very severe pestilence broke out and carried away 1,131 persons. The
neighbouring towns and villages also had a great many deaths due to
pestilence—Neuenstein 1,100, Waldenburg 452, and Künzelsau 900. The
entire Hohenlohe Plateau was severely attacked by pestilence; in the
little town of Grossbottwar, first ‘head-disease’ broke out in 1635,
then dysentery, and finally bubonic plague; between the months of July
and December 692 persons succumbed to these three diseases. In June
1635, there were 775 deaths in Lauffen-on-the Neckar, 1,609 in
Heilbronn, 646 in Weinsberg (out of 1,416 inhabitants), 1,802 in
Vaihingen (only 48 in 1631), and 1,019 in Bönnigheim (among them many
outsiders).

In the towns on the Upper Neckar and on the northern border of the
Swabian Alp a very severe pestilence likewise broke out. Nürtingen was
devastated by the Imperialists after the battle of Nördlingen, and in
the years 1634–5 there were 1,154 deaths in consequence of a pestilence.
The surrounding country also fared badly; for example, Urach and the
near-by Alp villages. In the year 1634 a plague broke out in Tübingen,
and in the following year it spread widely in consequence of famine,
compelling the university faculty to leave the city. The highest
mortality was reached in October (386 deaths), while the total number of
deaths for the entire year was 1,485. The plague raged no less furiously
in Rottenburg-on-the-Neckar. Nor was the Swabian Alp spared; in the
village of Gruibingen there were 90 deaths in 1634 and eighty-six deaths
in the year 1635. Böhmenkirch was almost completely wiped out. In
Gussenstadt, whither many inhabitants of the surrounding country had
fled, the usual mortality per annum was 12 or 14; in the year 1634 there
were 313 deaths up to December 7, while in the year 1635 there were 137
deaths up to September 23. In the months of November and December (1634)
alone there were 157 deaths, and the inhabitants frequently died at the
rate of 4–6 per diem.[41]

After the battle of Nördlingen thousands of the inhabitants of the
surrounding country fled to Ulm, where epidemics had broken out in the
year 1634 and carried away 1,871 persons. In June 1635, the general
misery caused a plague to break out there; in the morning many dead
bodies would be found lying in the streets and in front of houses. In
the course of eight months 15,000 persons were carried away, among them
4,033 fugitives and 5,672 beggars; in the following year only 496
persons died, all told. Even the Black Forest district of Württemberg
suffered in consequence of the war and of pestilence; Tuttlingen in the
year 1635 had 546 deaths, Calw 772, and Freudenstadt 434; Neuenburg,
Nagold, Sulz, and other places were also attacked.

How terrible was the loss of human life in Württemberg in consequence of
the war and of pestilence is shown by the fact that the population of
the city decreased from 444,800 in the year 1622 to 97,300 in the year
1639; the population in 1634 was 414,536. In the short period of five
years (1634–9), in consequence of the invasion of the Imperialists after
the battle of Nördlingen, and of the pestilence and famine caused
thereby, the country lost 300,000 inhabitants, or about three-fourths of
its population.

The northern part of Baden suffered severely in the years 1634–6;
Pforzheim lost at least one-third of its inhabitants in consequence of
famine and pestilence, while Durlach and Mannheim are also reported to
have been attacked.

That part of Hessen lying on the right side of the Rhine was likewise
visited by pestilence. In Wimpfen-on-the-Neckar a plague broke out in
August, 1635, and in the period between August 12 and December 31 there
were 494 deaths there. Bensheim, Zwingenberg, Gernsheim, Babenhausen,
and Seligenstadt fared no better. Darmstadt, with 212 deaths in 1633 and
220 deaths in 1634, had an increased mortality, but in 1635 some 2,200
bodies are said to have been buried there; at first it was
‘head-disease’, and afterwards ‘a poisonous pestilence’.

The Lower Main region suffered terribly in the year 1635 from famine and
pestilence; the Wetterau, the Palatinate, and Alsace-Lorraine were all
attacked. Frankfurt-on-the-Main had been occupied by the Swedes in the
latter part of 1631, and after that the mortality increased; whereas in
the years 1630–2 the average number of deaths was 1,598, in 1633 it
increased to 3,512, in 1634 to 3,421, and in 1635 to 6,943. This
includes all the Protestant population, only a part of the Catholic
population, and none of the Jews. The large number of country-people who
had fled to the city rendered the general condition worse and helped to
spread the pestilence. The worst month was September 1635, in which
1,112 persons died. According to a Frankfurt physician, Hörnigk, the
crisis came on the fifth or sixth day, while many people contracted the
disease not only once, but as many as seven times.[42] We see from this
last observation that the various infectious diseases at that time were
not distinguished, but were regarded as different stages of one and the
same disease.

In near-by Hanau, after it was occupied by the Swedes and Hessians on
October 2, 1634, famine and pestilence appeared; in June 1635, an
epidemic of bubonic plague broke out there, reaching a climax in August,
and gradually disappearing with the beginning of the cold weather. The
mortality among the citizens and fugitives was very great, but the
statement that 21,000 people died in Hanau is perhaps an exaggeration.
Upper Hesse was devastated in 1635 by famine and pestilence; in Giessen,
for example, 1,503 people died (according to the grave-diggers’
records), and in Lich, a small fortified town, there were 1,225 deaths,
including 22 soldiers and 549 fugitives from the surrounding country.

In the Rhenish Palatinate, after it was occupied by the Imperialists,
conditions were terrible; famine and pestilence lasted from 1635 to
1639. In the year 1635 General Gallas retreated from Dieuze to the
Rhine, and in the same year serious diseases broke out there (dysentery,
typhus fever, &c.), so that the streets and fields were covered with the
bodies of his soldiers. Wherever he went these diseases were transmitted
to the local inhabitants, so that many places lost more than half of
their population. Pestilence was also transmitted to other cities and
towns in the Palatinate; in Zweibrücken, which had 3,000 inhabitants,
250 married persons died between August 1, 1635, and April 1, 1636; many
villages in the vicinity were entirely depopulated. In Kaiserslautern,
which on August 17, 1635, was stormed by the Imperialists under General
Hatzfeld, and was thereafter subjected to an inhuman sacking, a severe
plague broke out in the year 1636 and carried away large numbers of
people. In Worms numerous people succumbed that year to dysentery.

In Alsace an epidemic of bubonic plague broke out in August 1636; it had
been brought there by the troops of the Count-Palatine von Birkenfeld
and became very widespread among the fugitives in the overcrowded city
of Strassburg. From thirty to forty bodies were buried in a single day,
and in the entire year there were 5,546 deaths, including 1,000
fugitives and soldiers. The disease continued to reveal its presence
until the next spring, and by that time 8,000 persons are said to have
died in Strassburg. In the year 1635–6, owing to the perpetual condition
of war, which made it impossible to cultivate the fields, there ensued a
terrible famine, and this did a great deal to further the dissemination
of pestilence. Zabern, where there was a strong garrison, and where many
soldiers were quartered, suffered terribly in the year 1634, and again
in the years 1635–6 widespread pestilences broke out; in 1636 the
Imperialists died there ‘like cattle’.

Lorraine also suffered terribly. In the year 1635 Bernhard von Weimar
and Cardinal La Valette were obliged to retreat before Gallas to the
vicinity of Metz, where they arrived on October 1; the troops brought
fever, dysentery, and ‘Swedish plague’ with them; the last-named
disease, which has been held to be typhus fever, became more
widespread in Metz in the year 1636 than it had ever been before—it
was _la plus meurtrière et la plus désastreuse des temps modernes dans
notre pays_.[43] The precautionary measures of the city
administration—cleaning of the streets, isolation of the patients,
closing of infected houses—were of no avail. Many bodies were cast
into the Mosel, and before the gates of the city the streets and
fields were covered with dead men and horses. Also in the neighbouring
cities, especially in Verdun and Nancy, the losses in consequence of
the pestilence were great.

Conditions were equally bad in the adjacent Luxemburg. ‘The French as
enemies,’ says Lammert,[44] ‘the Croats, Hungarians, and Poles as
defenders, committed the most terrible devastations in the country
through which they passed. Famine, poverty, and a furious pestilence
completed the misery. Entire villages were wiped out; in the city of
Luxemburg the churchyards no longer had room for the bodies, and places
for burial had to be prepared within the fortifications. Throughout the
entire province 11,000 persons, one-third of the inhabitants, lost their
lives.’

In the year 1637 Count Bernhard von Weimar transferred the scene of the
war into southern Baden, where, during the siege of Breisach, from July
5 to December 18, 1638, an epidemic of scurvy caused increased misery.
In the year 1639 large numbers of people in the Lörrach district were
carried away by the pestilence, among them Count Bernhard himself.


                      _3. North Germany (1636–40)_

In North Germany the war against the Imperialists was continued by the
Swedes under Banner. On October 4, 1636, the Imperialists were defeated
at Wittstock (province of Brandenburg, district of East Priednitz),
whereupon the Swedes in that very same year overran Saxony and
Thuringia. In 1637, to be sure, they were thrown back into Pomerania by
Gallas, but in 1638 they reappeared in Saxony, and in 1639 won a
brilliant victory at Chemnitz. Thereupon Banner undertook a campaign
into Bohemia, whence, in 1641, he was forced to retire. Shortly
afterwards (May 10, 1641) he died in Halberstadt.

These campaigns spread severe pestilences throughout the above-mentioned
regions of North Germany, particularly the southern part of Brandenburg
and the modern province of Saxony. The largest part of the Altmark
resembled a ‘large lazaret’; in Wittstock itself there were 305 deaths
in the year 1636, in Bismark 163, and in Salzwedel 193; in Werben a
plague broke out after the soldiers had been quartered there and lasted
well into the next year. In Stendal it began in June 1636, and carried
away 1,992 persons in that year, as compared with an average annual
mortality of 120–30; nor does the number include the peasants that had
fled to the city, 3,000 of whom died. The pestilence spread over the
entire vicinity and wiped out whole villages. In Tangermünde a
pestilence broke out even before the battle of Wittstock; it was borne
thither by Imperialists and Saxon artillerymen. In Gardelegen, where
Banner had his head-quarters, 500 people in the parish of St. Nicholas,
and 1,205 in the parish of St. Mary, succumbed in the year 1636 to
bubonic plague and other diseases, among the dead being 195 soldiers. In
Neuhaldensleben, whither many country-people had fled, a plague broke
out in May 1636, and spread throughout the entire vicinity; in many days
in September, thirty and more bodies were counted, while the incomplete
church register records 778 deaths. The total number of deaths is said
to have been 2,560.

Typhus fever and other infectious diseases raged furiously in Magdeburg,
and, as before, the country south-west of Magdeburg also suffered. In
Gross-Salze, which had received many fugitives, 701 persons succumbed in
the year 1636 to dysentery and bubonic plague, among them 329 outsiders;
the climax of the pestilence occurred in July, when there were 162
deaths. In Egeln, as in Gross-Salze, a plague broke out in May 1636,
carrying away 164 persons (134 of them outsiders) in June, 63 natives
and 84 outsiders in July. In Wolmirsleben a pestilence raged from April
to the middle of September 1636, and carried away 130 people. In
Atzendorf typhus fever and bubonic plague broke out in the spring of the
year 1636 and carried away 617 persons, inclusive of outsiders. In
Wanzleben 600 persons succumbed in the year 1636 to bubonic plague, and
300 to other diseases and starvation. In Aschersleben a pestilence broke
out on April 2, 1636, reached a climax in November with 217 deaths, and
carried away, all told, 1,125 persons in that year (including 499
outsiders and soldiers). In Zerbst, where infected soldiers were
quartered, the epidemic was particularly widespread; of the fugitives in
the city 1,500 succumbed. In Wittenberg and vicinity dysentery and
typhus fever broke out in the year 1636, and in the fall of that year
bubonic plague also made its appearance and lasted well into the
following year, carrying away thousands of people. In Merseburg, in the
parish of St. Maximus alone, there were 942 deaths in the years 1636–7,
and in Eisleben there were 1,598 deaths (including the outsiders) in the
year 1636. Halle and vicinity, in the summer of 1636, had an outbreak of
‘spotted fever with dysentery’ and bubonic plague; the number of deaths
was not less than 3,440.

In Thuringia a plague raged extensively in the years 1636–7. In
Hildburghausen there were 648 deaths due to a plague in the year 1636,
in Jena 691 (not including the outsiders), while in the year 1637 there
were 307 deaths in Arnstadt and 525 in Zeitz. In many smaller places
dysentery and bubonic plague broke out, having been borne there by
soldiers and wandering beggars.

In Saxony (present kingdom) pestilences reappeared after the invasion of
Banner in the year 1637. In Leipzig a great many homeless people took
refuge; within three months 2,500 persons died there, and in the entire
year 4,229 out of 15,000 inhabitants succumbed to various diseases.
Pestilences also broke out with renewed strength in near-by cities and
towns; by September 1,000 natives and 2,000 outsiders died in Grimma. In
Leisnig, fever, ‘head-disease’, and diarrhoea appeared. After the
burning of the city by the Swedes, a plague broke out and carried away
2,200 persons in six months, including the outsiders. Colditz, which had
suffered great losses in the last six years, had 352 deaths; the
population so dwindled away that in the year 1638 it amounted to only
28. In Döbeln there were 674 deaths, in Oschatz 2,000 (including the
outsiders), and in Mügeln more than 1,000. The near-by cities, belonging
to the governmental district of Merseburg, also had a very high
mortality; in Belgern there were 765 deaths, in Delitsch 881 deaths,
while in Eilenburg 8,000 natives and outsiders are said to have died. In
Dresden, where in the year 1635 only 79 persons had died in consequence
of plague, there were 1,097 deaths in the year 1637. In the following
years, moreover, cases of plague continued to appear. A high mortality
prevailed even in the Saxon Erzgebirge, caused for the most part by
typhus fever.

In Brandenburg a severe pestilence raged in the years 1637–8. Berlin was
repeatedly attacked in 1637 and again in 1639. In Spandau it raged very
extensively, and lasted well into the following year. In Luckau 500
inhabitants died in the year 1637. The pestilence was conveyed to
Neu-Ruppin by an infected soldier, and in the church register of that
town 600 deaths are recorded. In Gransee a pestilence broke out in May
1638, and in a short time carried away 1,000 persons. Four neighbouring
villages were completely wiped out. In Wittstock 1,599 persons succumbed
in the year 1638 to bubonic plague and other diseases, and in Pritzwalk
1,500 people died (not including the soldiers and fugitive
country-people). In Lychen (district of Templin) numerous fugitives and
two-thirds of the native inhabitants died. In Angermünde, but 40 out of
700 families were left, and in Prenzlau a pestilence likewise raged
furiously.

Pomerania, while the war was going on between the Swedes and
Imperialists, fared no better. In Massow 400 persons succumbed to a
plague. In Ueckermünde, in consequence of a plague caused by the capture
of the city by the Swedes, only eight men and seven widows are said to
have survived the year 1638.

Mecklenburg suffered terribly in the years 1637–8 from the quartering of
Swedish troops there. Thousands succumbed in a short time to dysentery
and bubonic plague, especially in the months of August and September
1638. Güstrow, in the year 1637, is said to have lost 2,000 persons
(most of them doubtless fugitive country-people). Sternberg, the
population of which was completely wiped out by the pestilence, stood
empty for half a year. In New Brandenburg, where many country-people had
taken refuge, 8,000 people died in the year 1638, according to the
church register. Bützow had 261 deaths.


                       IV. THE WAR YEARS (1641–8)

After the death of Bernhard von Weimar and of Banner, all centralized
warfare in Germany ceased, and there began an endless series of futile
marches across the country. The great depopulation of Germany, the
difficulty of properly nourishing the few that had survived, and the
wide prevalence of camp-fever, made it impossible to carry out any more
large enterprises. Severe pestilences scarcely ever occurred, for the
simple reason that there were so few people to contract and spread
diseases. Typhus fever had become epidemic everywhere. ‘In Germany,’
says Schnurrer,[45] ‘where fighting had been going on for twenty-two
years, and where soldier-life had almost supplanted civil and rural
life, a certain war-plague revealed itself in places where there were
soldiers, and where the war had left its vestiges. This war-plague was
characterized by a mucous fever, began with a chill, accompanied by
coughing, diarrhoea, and, in the case of women, by increased and
irregular menstruation; at the same time the tongue became dry, headache
and insomnia ensued, and at the crisis either the brain or the throat
became inflamed, or else petechiae or purpura (then for the first time
observed in Lower Saxony) broke out. Moreover, this war-plague, if it
appeared to have passed a crisis on the fourteenth or twenty-first day,
manifested a remarkable tendency to relapse. It was quite as infectious
as bubonic plague, and was called by several names—Hungarian fever,
head-disease, and soldiers’ disease.’ We distinctly see in this
description a mixture of various diseases (especially typhoid fever,
typhus fever, and others). Schnurrer’s authority was Lotichius, a
Frankfurt physician.

The continuation of the war was disastrous to Austria, for the reason
that the Swedish general, Torstensen, pressed on to Moravia and Lower
Austria. As early as the year 1642 he had undertaken an expedition
through Silesia to Moravia and Bohemia; in the year 1644 he advanced
again, defeated the Imperialists at Jankau in Bohemia in the spring of
the year 1645, and besieged (unsuccessfully) both Vienna and Brünn. In
the year 1645 he was hard pressed by the Austrians and compelled to
evacuate Moravia and Bohemia. Torstensen’s campaigns resulted in the
outbreak of severe pestilences throughout all Austria.

Bohemia had suffered as much as Germany from the hardships of the Thirty
Years’ War, while Austrian Silesia, and at times those parts of Austria
which bordered on Bavaria, had not been spared. Only in the year 1634
was Austria itself attacked by pestilences, obvious consequence of the
fact that both Saxony and Bavaria were badly infected. The incursion of
Banner into Bohemia, in the year 1639, had likewise caused a widespread
epidemic.

As far back as the year 1644, and hence before Torstensen’s invasion of
Austria, severe plagues broke out in Hungary, Croatia, Upper and Lower
Austria, Styria, Carinthia, and Görz. People who contracted the disease
usually died in the first three days. Torstensen’s invasion caused the
pestilence to spread very extensively. In Vienna it broke out in August
1645, having been borne thither by Rakoczi’s troops, and carried away
from thirty to forty people daily. Tuln, St. Pölten, and New Vienna are
also mentioned as places that were attacked. Styria was particularly
afflicted in the year 1646; the district of Cilli is said to have lost
10,000 inhabitants, while the city of Cilli alone had some 400 deaths.
In Graz, as in all Upper Styria, the loss of human life was not so
great.


  V. WAR PESTILENCES IN NON-GERMAN STATES DURING THE THIRTY YEARS’ WAR

1. The Netherlands. In the summer of the year 1623 there raged in
Mansfeld’s camp in East Friesland an epidemic of typhus fever, which
soon spread among the Netherlandish troops and over the Netherlands.
Antwerp, Brussels, Ypres, Leyden, Delft, and Amsterdam were all severely
attacked. In Leyden 9,897 persons died between October 1623 and October
1624. In Amsterdam 32,532 people died in the year 1624, 11,795 of them
in consequence of the pestilence. In the year 1625, Breda, which for
eight months had been defended by Flemish and Walloon troops in
conjunction with the English and French, fell into the hands of the
Spaniards; famine, pestilence, and scurvy had raged so furiously in the
besieged city that 8,000 people died there, whereas the well-nourished
Spaniards did not suffer at all from pestilence.[46]

In the years 1635–7 typhus fever and bubonic plague again made their
appearance in the Netherlands. An epidemic of the latter occurred in
Leyden in the months August-November 1635, and carried away 20,000
people in the course of the entire year. The pestilence caused great
devastation in Nimeguen during the siege of the city by the French and
Dutch; in the summer of 1635 dysentery and typhus fever broke out there,
and in November bubonic plague appeared and slowly extended its area in
the course of the winter. From April to October 1636 it raged furiously,
and spared scarcely a single house; from August 1, 1635, to August 1,
1636, some 6,000 persons died in the city, and the pestilence did not
come to an end until February 1637. It also spread to the country around
Nimeguen, especially to Montfort, where half of the inhabitants
succumbed to it.[47]

2. France. In the years 1620–30 a large part of the country was visited
by pestilence, especially the southern provinces during the war of
extermination that was carried on against the Calvinists. In
Montpellier, after the siege in 1623, a virulent fever (_febris maligna
pestilens_) raged for eight months, and carried away one-third of the
people who contracted it. According to Lazarus Riverius the skin became
covered with red, livid, or black spots, similar to flea-bites; they
appeared between the sixth and ninth days, and developed for the most
part on the loins, breast, and neck.[48] In the years 1628–33 France
experienced some very severe outbreaks of pestilence, which undoubtedly
involved bubonic plague as well as typhus fever. Lyons had 50,000
deaths, Limoges 25,000, while Paris, Angers, Châlons, Aix, Montpellier,
Avignon, Marseilles, Agen, Dijon, Vienne, Villefranche, and Toulouse
were also attacked. In Montpellier, whither the pestilence had been
borne from Toulouse, 5,000 people died between October 1630 and April
1631—almost one-half of the entire population. The city of Digne, where
a plague broke out in 1629, had a terrible fate; it was completely
surrounded by soldiers, in order to prevent the plague from spreading
further, and by April 1630 some 8,500 out of 10,000 inhabitants had
died.

3. Switzerland. The proximity of the scene of the war, which brought
numerous fugitives into the country, and the marching back and forth of
troops through the Grisons, resulted in numerous outbreaks of pestilence
in Switzerland. In the year 1622 some 3,000 soldiers were carried away
by an epidemic of typhus fever in the county of Mayenfeld. Pestilences
raged extensively in Switzerland in the years 1628–9. On August 5, 1628,
a plague broke out in Schaffhausen, reached its climax in October of
that year, and carried away, all told, 2,595 persons; 2,000 people died
in the country around Schaffhausen. In Zug a pestilence broke out in
September 1628 and lasted until December 1629, carrying away 468
persons; in Sursee there were 600 deaths, in Sempach 100, in Frauenfeld
400. In Basel the number of deaths in the year 1629 was 2,656. In the
same year St. Gall, Toggenburg, and Altdorf were severely attacked. In
the year 1635 another pestilence broke out; the constant misery caused
by the war, and the consequent famine, brought swarms of beggars and
vagabonds from South Germany into Switzerland, which they infected with
various diseases. The city of Zürich, for example, on June 14 of one
year was compelled to drive out 7,400 beggars. All Switzerland was
attacked by pestilence at that time, even the most out of the way
valleys.

4. Italy was the scene of severe pestilences in the years 1629–31;
according to Ozanam they were borne there by German troops, and
according to Häser by French troops. At all events the outbreak occurred
in connexion with the war which France was waging in Mantua against
Austria and Spain over the succession. According to a Venetian
physician, Grossi, the specific disease was not bubonic plague;
Häser,[49] however, assumes that both typhus fever and bubonic plague
occurred. Lammert seems to think that camp-fever in Upper Italy had
little to do with the high mortality. Ozanam mentions buboes,
plague-sores, inflammation of the salivary glands, and black and violet
petechiae. Death is said to have occurred in from one to seven days.
Brescia was first attacked; after the battle of Villabona (May 26,
1629), the pestilence, conveyed by retreating Venetian troops, spread
throughout Upper and Central Italy. In Verona the number of deaths was
32,895, in Milan 86,000, in Venice (1630) 45,489, (1631) 94,164, in
Mantua 25,000. In the territory of the Venetian Republic 500,000 persons
are said to have succumbed to various pestilential diseases. Genoa,
Turin, Padua, Bologna, Lucca, Florence, Parma, and other cities were
also attacked. Regarding the outbreak of pestilence in Milan, Ozanam
gives us no further information.[50] In October and November isolated
instances of disease occurred among people who had acquired articles
from German soldiers. Strict measures of precaution (burning of all
effects, and quarantining of all persons who had come in contact with
infected people) prevented the pestilence from spreading. But during the
Carnival these measures were carried out less vigorously, and the result
was that in the latter part of March 1630 a pestilence broke out in
various quarters of the city. Accordingly, two more lazarets and 800
straw huts were erected outside the city, and shelter for relatives of
the sick was provided. Notwithstanding this, the pestilence spread to
such an extent that some 3,500 persons died every day. In Florence,
Grand Duke Ferdinand II adopted energetic measures against the
dissemination of the disease; infected people, with or against their
will, were taken to the Hospital of San Bonifacio, where the physicians
themselves were obliged to remain. Recovered patients were held in
quarantine, and their clothes and other effects were burned. Some 9,000
persons are said to have succumbed to the pestilence in Florence.

5. In England typhus fever repeatedly broke out after the year 1622. In
the spring of the year 1643 it appeared in the parliamentary army and in
the royal garrison during the siege of Reading. The disease, which is
described by Thomas Willis, spread from there to Oxford and the
surrounding country.[51]


  VI. A GENERAL REVIEW OF THE LOSS OF HUMAN LIFE IN GERMANY DURING THE
                           THIRTY YEARS’ WAR

Even if it is impossible to give an accurate numerical account of the
losses due to pestilence in the course of the Thirty Years’ War, we have
seen in a general way how epidemics of dysentery, typhus fever, and
bubonic plague followed at the heels of armies, how they were borne from
place to place, and how the devastation of the country caused by the war
led to an absolute dearth of the necessaries of life, and thereby helped
the pestilences to spread. We have mentioned only those places regarding
which we have specific information, and they can be regarded only as
examples of how these pestilences appeared; as a matter of fact,
however, conditions were very much the same in all parts of the country.
At the same time these examples show satisfactorily that the great
depopulation of Germany during the Thirty Years’ War was chiefly caused
by severe epidemics of typhus fever and bubonic plague.

It will be of interest to assemble the figures (such as have been
recorded) relating to the number of deaths that occurred in a few of the
larger cities during the Thirty Years’ War. We include Basel among those
cities, since, being situated close to the border of that part of
Germany where the war was carried on during two rather long periods, it
was necessarily attacked by the prevalent pestilences. At the same time
Basel affords an example of how quickly these pestilences disappeared
from the cities, even in the seventeenth century, if external conditions
permitted the authorities to take the necessary measures of prevention
and precaution, and if the cities were not constantly being reinfected.
We give the total number of deaths, and merely remark that the
population in all German cities in the course of the Thirty Years’ War
decreased considerably. In the case of Leipzig, Dresden, and
Frankfurt-on-the-Main the still-births are included, but not in the case
of Augsburg, Basel, and Strassburg. As a rule the country-people who
fled to the cities are not included among the dead; only in the case of
Strassburg, and perhaps also in that of Breslau for the year 1633, are
they included.

The total loss of human life in the Thirty Years’ War can be estimated
only approximately. The statement attributed to Lammert, that the
population of Germany, which amounted to sixteen or seventeen millions
before the war, had dwindled down to four millions after the war, is
perhaps an exaggeration. Other estimates state that Germany lost
one-half of its population. In the case of a few states we have more
exact figures, which probably approach more closely to the actual loss.
Thus the electorate of Saxony, which was much larger in area than the
modern kingdom of Saxony, in the years 1631–2 is said to have lost some
934,000 persons. The population of Bohemia is said to have decreased
during the Thirty Years’ War from three millions to 780,000. In Bavaria
80,000 families are said to have been wiped out. The population of
Württemberg decreased from 444,800 in the year 1622 to 97,300. The
population of Hesse decreased by about one-quarter. So much, however, is
sure: that in the regions where the war was carried on for several years
the population decreased by far more than one-half. The most positive
proof of this is afforded by the hundreds of burned-down and unrebuilt
houses found in so many German cities, and the numerous unpeopled, or
almost unpeopled, places which Germany had to show at the end of the
war.

                            DEATHS (1618–48).

 _Year._   _Leip-   _Dres-   _Bres-   _Augs-  _Frank-  _Strass-   _Ba-
           zig._    den._    lau._    burg._   furt._   burg._   sel._
            [52]     [53]     [54]     [55]     [56]     [57]     [58]

   1618        422      400    1,205    1,354      625    1,343      535
   1619        569      332    1,313    1,485      544    1,258      257
   1620        477      472    1,456    1,667      670      996      259
   1621        613      491    1,652    1,517      674    1,019      352
   1622        580      381    1,045    1,959    1,785    4,388      450
   1623        500      421    1,050    1,875      725    1,738      336
   1624        812      411    1,260    1,370      955    1,491      297
   1625        718      481    3,000    1,392    1,871    1,350      297
   1626      1,268      740    1,874    2,440      963    2,590      330
   1627        537      412    1,227    2,494      773    1,669      266
   1628        388      469    1,020    3,611      680    1,513      527
   1629        506      398    1,116    1,265      832    1,786    2,656
   1630        881      480    1,156      909      927    1,425      220
   1631      1,754      844    1,795      859    1,132    1,383      221
   1632      2,789    3,129    1,395    3,485    2,900    2,675      284
   1633      1,445    4,585   13,231    3,364      762    5,546      456
   1634        306      721    1,010    4,664    3,512             2,115
   1635        603      597      949    6,243    6,943               560
   1636      1,218      594      873      790    2,301               600
   1637      4,229    1,897    1,060      823    3,152               424
   1638        552      531      863      638    1,079               527
   1639        955    1,845      928      674      948    1,923      515
   1640        469      935    1,273      586    1,034               239
   1641        482      525    1,088      887      735      713      195
   1642      1,080      601    1,343      593      883      680      242
   1643      1,034    1,041    1,332      638      523               532
   1644        604      489    1,570      659      491      707      337
   1645        458      532    1,133      758      678               220
   1646        331      481    1,042    1,488      774      651      205
   1647        403      471    1,273    1,338      662      573      238
   1648        469      606    1,111    1,208      575      643      235




                               CHAPTER IV
  THE PERIOD BETWEEN THE PEACE OF WESTPHALIA AND THE FRENCH REVOLUTION


                          (_a_) CENTRAL EUROPE

The Thirty Years’ War left Germany for several decades in such a
weakened condition that Louis XIV was able to perpetrate all sorts of
outrages upon the unfortunate country. The result was a series of
protracted conflicts in the countries on the Rhine. The German Emperor,
however, was unable to fight with much vigour, partly because of
disruption in the interior of the German Empire, and partly because the
advancing Turks were gravely menacing its eastern boundary. After Louis
XIV had come to terms with Holland in the Peace of Nimeguen (1679), in
order to secure for his protégé the Archbishopric of Cologne, which was
then vacant, he invaded Germany without declaring war, and his troops
committed horrible devastations in the Palatinate and in northern Baden.
A German army was organized to oppose the French, but it accomplished
very little. Regarding the pestilences of that time not much is known,
although it is certain that typhus fever was present in the armies. Thus
we learn from a physician named R. Lentilius[59] that in November 1689,
‘burning head-disease’ or ‘Hungarian disease’ was disseminated by
Bavarian soldiers who, under Max Emanuel, had taken part in the
successful siege of Mayence (ending on September 11), and who afterwards
returned home to pass the winter. Typhus fever was conveyed by them to
Gundelfingen, Lauingen, Höchstädt, Donauwörth, and Wendingen (all of
them places on the Danube between Ulm and Ingolstadt), causing a great
many deaths. In many places—for example, in Gundelfingen—the epidemic
lasted well into the following year.

In the very first year of the War of the Spanish Succession (1702–14)
Augsburg suffered terribly from camp-pestilences, which also spread
among the non-belligerent population. In the year 1703 the city was
occupied by the French and Bavarians fighting as allies, and was
afterwards besieged by the Imperialists and the English.[60] The number
of deaths in Augsburg (excluding the still-births) was:

                               1701   906
                               1702   900
                               1703 1,245
                               1704 3,113
                               1705   748
                               1706   842

Seitz reports that the troops along the Rhine were again infected with
petechial fever in the year 1712; Metz, on the other hand, expressly
says that no pestilences occurred at that time.

In the year 1733 a conflict again broke out between France and Germany
over the Polish succession. In the year 1734 typhus fever appeared along
the Rhine; in the spring and summer the outbreaks were sporadic, but in
the fall, when troops were stationed along both sides of the Rhine, a
virulent typhus broke out in many places, as in Heidelberg, Heilbronn,
and Germersheim; the disease was borne even to Lorraine by French troops
returning from the siege of Philippsburg.[61]

In connexion with the War of the Austrian Succession (1741–8), which
Maria Theresa waged in conjunction with England and Hanover against
Prussia, Bavaria, Saxony, France, and Spain, we know of several
outbreaks of pestilence. In the year 1742 Bavaria was overrun by
Austrian troops; a severe pestilence broke out in that year in
Ingolstadt and carried away several thousand of the strong French
garrison there. A large number of civilians also died.[62] It is stated
that the French garrison at Amberg lost 1,200 men, and that 400 of the
inhabitants perished; it is very probable that the specific disease was
typhus fever.

An unusually severe epidemic broke out in the year 1742 in Prague; on
November 26, 1741, the city was stormed by the Bavarians and French, and
shortly afterwards it was besieged by the Austrians under the Grand Duke
of Tuscany. The number of men in the French garrison was 13,000, and the
siege lasted until December 25, 1742. Almost all the French physicians
and surgeons died; on the bodies of the inhabitants of the city appeared
petechiae, which, it is stated, were not observed among the French. All
told, 30,000 people are said to have been carried away by the epidemic
in Prague. The high mortality was due to the wrong treatment of the
disease by the French physicians, who held it to be inflammatory and
sought to cure it by means of drastic phlebotomy. ‘Cette grande
mortalité,’ says Ozanam, ‘fut attribuée au traitement suivi par les
médecins français, qui, malgré l’avis de ceux du pays, saignaient les
malades jusqu’à ce qu’ils expirassent sous la lancette, et par l’abus
qu’ils firent de l’émétique qu’ils administrèrent jusqu’au 7^e, 8^e,
9^e, et 10^e jour.’[63] (The high mortality was due to the treatment
given by the French physicians, who, despite the advice of the local
physicians, bled the patients until they expired under the lancet, and
overdosed them with emetics as far along as the seventh, eighth, ninth,
and tenth day.) The Prussian army in Silesia was also infected with
typhus fever, and it was not long before all the corps and the native
population were attacked.[64]

The Austrian and English army, the so-called Pragmatic army, which in
the year 1743 operated in the region of the Main, and which on July 27,
1743, won a victory at Dettingen (near Aschaffenburg), suffered
severely, according to Pringle[65], from dysentery and hospital fever.
The hospital for the English army was situated in the village of
Fechenheim (near Hanau); all the patients sent there, even those who had
some mild form of sickness, were infected with a camp-fever, which
according to the description must have been typhus fever, and almost
one-half of them died. The inhabitants of the village were also
attacked, and nearly all of them succumbed. According to Neuwied, the
disease was brought there in the evacuations of the sick and carried
even to England by returning English soldiers.

The Seven Years’ War was attended by several epidemics of typhus fever.
Notwithstanding the long duration of the war, they did not become very
widespread, inasmuch as the armies were comparatively small, and as the
scene of the fighting, in accordance with the military tactics of
Frederick the Great, who opposed first one and then another Power, kept
changing, and thus caused no one region to suffer for any great length
of time. A severe epidemic of typhus fever broke out in Silesia in the
year 1758; it raged in both the Austrian and Prussian armies, and spread
to many places, for example, to Breslau, Schweidnitz, and Landshut,
where the civil inhabitants also became infected. In Breslau, according
to Grätzer,[66] the number of deaths among the evangelical population
was:

                               1756 1,375
                               1757 1,554
                               1758 4,088
                               1759 1,697
                               1760 1,590
                               1761 1,724
                               1762 2,373
                               1763 1,808

According to Süssmilch,[67] the number of deaths among the Catholics in
the year 1758 was 5,135; thus the total number of deaths in the entire
civil population was 9,223. In addition, the following military persons
were buried: 5,470 Prussian soldiers, 2,153 Austrian soldiers, 18
Swedish soldiers; also 755 wives and children of soldiers, and 953
paupers and outsiders. The total number of interments in Breslau in that
year was 18,572. The great mortality lasted from January to June; of
9,349 military persons buried, there died in:

                            January   1,346
                            February  1,709
                            March     1,246
                            April       940
                            May       1,287
                            June        818
                            July        457
                            August      578
                            September   383
                            October     201
                            November    164
                            December    220

In the year 1757, in which there was a high mortality in a large part of
North Germany that was unaffected by the war, there was an unusually
large number of deaths in Dresden; in the year 1760, when the city was
beleaguered by Frederick the Great, a ‘virulent epidemic fever’ broke
out and again caused a great increase in the death-rate. The number of
deaths in Dresden (excluding the still-births) was:[68]

                               1756 2,432
                               1757 4,454
                               1758 2,603
                               1759 2,631
                               1760 3,514
                               1761 2,127
                               1762 2,008
                               1763 1,975

The increased number of deaths during the Seven Years’ War in the
countries where the fighting took place is shown by the following
figures (which include the still-births) for Berlin and Leipzig:


         _Year._              _Leipzig_[69]           _Berlin_[70]
                          (_total no. deaths_).   (_deaths per 1,000_).

          1755                    1,150                   34·5
          1756                    1,286                   42·0
          1757                    2,600                   49·2
          1758                    2,824                   56·4
          1759                    1,408                   43·5
          1760                    2,025                   41·6
          1761                    2,048                   38·2
          1762                    2,160                   48·0
          1763                    1,614                   50·3
          1764                    1,052                   30·3

Typhus fever also appeared in the western scene of the war, where the
Imperialist and French troops were fighting against the Prussians. When
the united Imperialist and French armies besieged Eisenach for two
weeks, the disease broke out in both military hospitals in the city and
afterwards spread among the inhabitants, causing many deaths.


                          (_b_) EASTERN EUROPE

During the numerous wars that were waged in eastern Europe in the course
of the seventeenth and eighteenth centuries, epidemic diseases
frequently made their appearance. After the siege of Vienna (1683),
typhus fever broke out in various parts of Hungary, particularly in
Pressburg, where many soldiers were congregated. The disease spread from
the soldiers to the civilians, and the pestilence lasted from November
1683 to the spring of 1684. After the return of the Prussian troops from
Hungary, typhus fever broke out in many parts of Germany; for example,
in Minden.[71]

At the beginning of the eighteenth century bubonic plague broke out in
Constantinople and spread from there to the Lower Danube countries and
to Russia, particularly to Ukraine. According to Hecker,[72] this
dissemination was greatly furthered by the adventurous campaign of
Charles XII of Sweden, so that the epidemic included all eastern Europe
and gradually embraced north-western Germany and Sweden. Fleeing Swedish
and Polish soldiers, after the battle of Pultowa (July 8, 1707),
conveyed the disease to Silesia. Danzig was severely attacked in that
year, and a few cases occurred there in the year 1708; but in the
following year a very severe pestilence broke out, reached its climax in
September, and between January 5 and December 7, 1709, carried away
32,599 persons. From Danzig the plague spread to Courland, Livonia,
Pomerania, Denmark, and Sweden. In Copenhagen 20,822 persons died in the
year 1710, in Stockholm 40,000, in Karlskrona 16,000.

In the years 1716–18, when Austria and Turkey once more came to blows
over the Turkish occupation of Morea, which belonged to the Venetians,
bubonic plague broke out in Constantinople and also among the Turks who
were shut up in Belgrade. The Austrian army, which was encamped outside
of Belgrade, was apparently not attacked by that disease, although some
4,000 men succumbed to intermitting fever, head-disease, and
dysentery.[73]

During the war waged by Russia and Austria against Turkey (1736–9),
bubonic plague appeared along the Lower Danube. ‘It broke out there,’
says Häser,[74] ‘first during the war waged by Austria and Russia
against Turkey, and the result was that the war was terminated
unexpectedly, and in a manner unfavourable to the Christian arms. At the
time of its appearance in Ukraine (July 1738) the disease was conveyed
by Austrian troops to Temesvar; from there it gradually spread over all
Hungary, mostly along the banks of the Theiss to the boundaries of
Carniola, Moravia, and Austria, and also along the Carpathian Mountains
to Poland and Bukowina. The devastation caused by the pestilence
continued for seven years, and the measures adopted by the authorities
proved of little or no avail.

The severe epidemic of bubonic plague during the Russo-Turkish War of
1769–72 has been carefully investigated by Hecker.[75] The Turkish army,
in consequence of inferior nourishment, was badly infected with
intermittent fever, dysentery, and typhus fever when it set out from
Constantinople in March 1769. When the Russian troops advanced, the
Turks retreated after an engagement near Galatz. Since the disease had
been conveyed on ships from Constantinople to Galatz, where many
Russians succumbed to it, the city was evacuated. On the way to Jassy
every trace of the pestilence disappeared, and in Jassy the soldiers
were quartered in the houses of the citizens. Since patients suffering
from contagious diseases had not been isolated in the military hospitals
there, in the middle of January typhus fever broke out in them,
accompanied by glandular swellings in the groin. Four weeks later a Jew
and his two children were taken sick in the city and died, the Jew
having bought a fur coat in the hospital. Since the Russian
commander-in-chief did not hold the disease to be bubonic plague and did
nothing to prevent it from spreading, in March 1770 it spread far and
wide in Moldavia and Wallachia. Not until the end of April was the
presence of bubonic plague officially admitted; and then the
well-qualified physician Orraeus was commissioned to make an
investigation.

From Jassy the disease was conveyed to Botoshany, which also lies in
northern Moldavia, and there it soon developed into a severe epidemic
and carried away more than 800 out the town’s 2,500 inhabitants; the
rest fled to Carpathia. ‘The patients,’ says Hecker,[76] ‘lay in tents,
and without care or medical help awaited an almost certain death. The
city itself afforded a sight of complete disorder; the houses were
deserted and stood with open windows and doors, the air was poisoned
with the odour of accumulated refuse, and the general devastation bore
silent witness to the most extreme misery. In addition to that, there
were multitudes of savage, ravenous dogs, which dug up the dead and
menaced the sick.’

Conditions were just as bad in Jassy when Orraeus arrived there on May
10; of the inhabitants and of the Russian garrison more than half had
died, while many streets were entirely depopulated. Since the persons
infected with the disease were placed out in a near-by forest, where
they were left without care, many patients were concealed inside the
houses and their bodies afterwards secretly buried in gardens and
cellars. There was no medical help, since both of the Greek physicians
had fled from the city. On May 20 the Russian troops, at the instigation
of Orraeus, withdrew from Jassy; a convent was converted into a
hospital, and soon after that the pestilence began to subside. By June
22 it had disappeared.

In Wallachia the disease broke out somewhat later than in Moldavia, and
with considerably less severity. In Bucharest it lasted until May.

In Bender, situated in Bessarabia on the Dniester, there was a mild
epidemic of bubonic plague after the city had been stormed on September
16, 1770. The carrying-off of war-booty caused new pestilences in the
army and in the population of Podolia and Little Russia. For a short
time in the last part of September the main army also suffered from
plague in its fixed quarters on the Pruth.

The Turkish army, which passed the winter in Bulgaria, was severely
attacked by plague, but no further information about this outbreak is
available.

In February 1771, Moldavia and Wallachia suffered very little from
plague, although there were occasional outbreaks here and there (for
example, in Bucharest) until the year 1773; but these were always of
short duration.

The transplantation of this disease into neighbouring countries,
especially Russia and its capital, was of particular importance. In
consequence of the widespread occurrence of bubonic plague in Moldavia
and Wallachia when the war broke out in the spring of 1770, large
numbers of fugitives from those parts gathered along the border of
Transylvania, where a quarantine establishment was opened at Törzburg
(south-west of Kronstadt). In Rukur, a border-village of Wallachia,
whither large numbers of people fled daily, a Jewess succumbed at the
end of April to bubonic plague, and in the course of the next eight
weeks 60 more people died. From there the pestilence spread to
neighbouring localities, in which 615 out of 3,000 inhabitants
(including 31 outsiders) died. The climax of the plague was in
September. It gradually spread throughout the border-towns of
Transylvania, but only in occasional instances did it reach the interior
of the country; all told, there were 1,024 deaths from the pestilence in
Transylvania in the year 1770.

Since all the supplies of the Russian army were conveyed to it on Polish
wagons, Polish peasants contracted the disease in the infected
countries, and then spread it throughout Poland. Jewish pedlars, who
purchased clothes, furs, and war-booty in the Russian camp, likewise
helped to spread the disease. In Poland the plague became unusually
widespread, particularly in Podolia, Volhynia, and in the eastern part
of Galicia; 47 cities and 580 villages, according to Chenot, were
attacked, and 275 of the latter were almost completely wiped out. The
total loss in these regions is estimated at 250,000. But the disease
penetrated no further into Poland, and Warsaw did not suffer at all.

Southern Russia was attacked later than Poland—not until August 1770.
Kiev was the first of several cities in which the plague broke out; the
disease, which was borne there on infected wares from Podolia, carried
away 20,000 people, about one-fifth of the population of the city.
Fugitives from Kiev conveyed the pestilence to many cities and villages
in Little Russia, while troops returning from Bender helped to spread it
in the north. In Nieskin, a city in Ukraine, the plague caused horrible
devastation; it broke out there for the second time in the year 1771,
and carried away from 8,000 to 10,000 people.

It was generally believed that the severe epidemic of bubonic plague
which raged in Moscow in the year 1771 was directly connected with the
expedition against the Turks. At that time the city had some 230,000
inhabitants; the streets, full of filth, were narrow, and the houses,
most of which were one-story wooden structures, stood close together.
According to Hecker, the beginning of the plague is obscure; fugitives
from the scene of the war, and wool imported from Poland or Ukraine are
both given as the original means of dissemination, but inasmuch as the
disease was so widespread in the south, it is probable that it was
conveyed to the north in various ways. Schafonsky, writing in Russian,
described the plague in an excellent book, of which Hecker made use; the
description by a surgeon named Samoilowitz,[77] who did good service
during the plague, contracted the disease himself, and was roughly
treated in a revolt, according to Hecker, lacks scientific merit and is
unreliable. In November and December, 1770, there were a few suspected
cases in a hospital in the eastern part of the city; Schafonsky
diagnosed the disease as bubonic plague, while the medical officer of
the city called it typhus fever. By means of strict isolation and other
measures this outbreak was soon entirely checked. As early as January
and February, however, indubitable cases of plague had occurred, but
they were kept secret. The epidemic really began in the Imperial
cloth-manufactory, where 3,000 working-men were employed; not until 130
people had died within eight weeks, was this fact made known on March 9,
1771. Since many of the working-men lived in the city and had meanwhile
conveyed the disease to their homes, the measures of prevention came too
late. The patients were now taken to a convent in Ukresh (near Moscow),
while all the rest of the employees were quarantined. But these measures
merely helped to spread the disease, since many of the working-men, in
order to escape being quarantined, fled and concealed themselves in the
city. When it became known that bubonic plague was present in Moscow,
the nobility fled to the country. The people themselves refused to
listen to any advice; nobody believed in contagion, and in September
there was actually a revolt in the city against the measures that had
been adopted to check the epidemic. The compulsory confinement in
hospitals of infected people and the quarantining of their families led
to numerous concealments. In July the pestilence had already become very
widespread; many houses in the suburbs were empty, the courts of justice
and workshops were closed, and, since nurses and grave-diggers were
dying off rapidly, convicts were employed to do their work. In the
southern part of the city a convent was converted into a hospital, and
at the end of July only one attendant was on hand there to take care of
1,000 patients. The epidemic reached its climax in September, when from
600 to 1,000 persons died every day. By January 1772, the pestilence had
disappeared. From the month of April 1771 on, the number of people that
contracted the disease and the number that died were officially
recorded; the number of deaths (excluding the bodies buried in secret)
was:

        _Months._          _Total no. deaths._   _Deaths in Hospitals._

 April (1771)                                778
 May                                         878                      56
 June                                      1,099                     105
 July                                      1,708                     298
 August                                    7,268                     845
 September                                21,401                   1,640
 October                                  17,561                   2,626
 November                                  5,235                   1,769
 December                                    805                     456
 January (1772)                              330

The number of deaths, which at that time averaged 7,000 per annum in
Moscow, thus increased to 58,000 (including some 1,000 secret burials),
and at least 52,000 were directly due to the epidemic. About 150 priests
were victims of their calling.

During the pestilence there was constant intercourse between Moscow and
the surrounding country, since the necessaries of life had to be brought
to the city, where clothes and household goods were to be bought very
cheaply. Thus most of the villages and cities in the surrounding country
were infected. Some of the latter were almost completely depopulated,
while the estate-owners found protection by shutting themselves up in
their manors. Of the more distant cities Jaroslav-on-the-Volga was very
severely attacked, while Borowsk, Kaluga, and Tula suffered somewhat
less. St. Petersburg was the only city to prohibit outsiders from
entering, and it was consequently spared.




                               CHAPTER V
THE PERIOD BETWEEN THE FRENCH REVOLUTION AND NAPOLEON’S RUSSIAN CAMPAIGN


The twenty years of fighting that followed the French Revolution, and
into which all Europe was drawn, were everywhere accompanied by
outbreaks of pestilence, many of which were very serious. At the very
beginning of the first Coalition War (1792–7) they played an important
rôle. A severe epidemic of dysentery broke out among the Prussian troops
when they were advancing into Champagne, and this was chiefly
responsible for the failure of the invasion. Typhus fever had also
appeared and caused a great many deaths among the Prussians, as well as
among the inhabitants of the Departments of Meuse, Moselle, Meurthe, and
Ardennes.[78] When the badly infected army of the Allies retreated,
after the engagement at Valmy (September 20, 1792), it left behind its
sick in various cities and villages, and thus infected the French army
that followed in pursuit. In Longwy itself (which had remained in the
power of the Allies until October 22), and in the immediate vicinity,
the streets were filled with the bodies of soldiers who had succumbed,
partly to exhaustion, and partly to dysentery.[79]

Verdun suffered terribly during the siege of the Allies, and at the end
of August was obliged to surrender. The chief cause of the widespread
occurrence of disease there was the fearful lack of sanitation; ‘à
Verdun,’ say Maréchal and Didion[80] ‘une des causes les plus puissantes
d’infection était le dépavement de la ville au moment du siège. Tous les
jours on jetait de chaque maison au milieu de la rue des immondices de
toute espèce, des déjections humaines et animales, des débris, des
végétaux, qui se mêlant à la boue se liquéfiaient et se putréfiaient par
l’action des pluies. Les agents de la ferme des boues ne pouvaient rien
contre tel foyer. Il s’en échappait une odeur infecte, quand quelque
voiture venait à passer, et l’on voyait souvent des personnes frappées
de spasmes, prises de vomissements et même asphyxiées en traversant les
rues.’ (One of the most potent causes of the infection at Verdun was the
unpaved state of the town at the time of the siege. Every day refuse of
all kinds was thrown from each house out into the street—the evacuations
of men and animals, rubbish, and garbage—and there it mixed with the
mud, liquefied and rotted through the action of the rain. The officials
in charge of street sanitation were powerless. All this filth emitted a
foul odour when a carriage drove through it, and one often saw people
seized with convulsions and sickness, or even suffocated while crossing
the streets.) There was no more thought of taking proper care of the
sick and wounded in Verdun at that time, than there was in the later
French wars; they lay in numbers on rotten straw, in their own
excrement, two or three of them sharing a single blanket. The result was
that two-thirds of the patients died.

Pont-à-Mousson, where three military hospitals were erected, also had a
severe epidemic, as did Metz; the hospitals could not accommodate the
many patients that came streaming in from all directions. Typhus fever
continued to appear sporadically in the next two years; from 1792 to
1795 as many as 64,413 patients were received into the Metz hospitals,
and of that number 4,870 died.

In the years 1793–4 typhus fever was frequently conveyed into Germany in
consequence of the warfare along the Upper Rhine. In May 1793, it was
brought to Frankfurt-on-the-Main by French prisoners-of-war, whom the
Austrians on their march through the country had left behind. In
addition to the cases of ‘putrid fever’ in the military hospitals, a few
cases were also observed in the city; until November the disease raged
extensively, but in the winter it increased in fury and did not
disappear until the summer of 1794. ‘The descriptions of putrid fever,’
says L. Wilbrandt,[81] ‘while they make no mention of exanthema,
nevertheless positively prove that the disease was none other than
exanthematic typhus, war-typhus. The facts that the disease described
was highly infectious, and that it is expressly stated that diarrhoea
was not observed, lead us to this conclusion.’ In the report of the
health-officer, issued at the end of July 1793, it is nevertheless
asserted that ‘the disease was of a putrescent nature, involving spots
and purpura’. The transportation of French prisoners caused the epidemic
to spread to Günthersburg and from there to Bornheim, but only in a mild
form.

A short article by Canz[82] informs us about the spreading of typhus
fever from the Rhine to the Black Forest. The disease was borne by
French prisoners to Hornberg (near Triberg), where in the autumn of 1793
they spent four weeks. Owing to numerous outbreaks of ‘infectious
nerve-fever’, a war-hospital for such patients was established at
Hornberg, which had some 1,000 inhabitants. In November the first
patients appeared in the town, and the epidemic lasted until the
beginning of June of the following year; scarcely a single house was
spared, especially among the poor, and often entire families contracted
the disease. All told, sixty people died, including eight outsiders who
had been brought to the hospital. According to Canz, infectious
nerve-fever also made its appearance in Kinzigtal, in the Rhine region,
and in several parts of Swabia. ‘In some cases,’ he says, ‘petechiae
appeared between the fifth and eighth days on the breast, arms, and
back; at first they were very small and rose-red, but later they turned
yellow, brown, and finally blue and black, occasionally taking the form
of large blue blotches, like suggilations.’

French prisoners also conveyed typhus fever to Bavaria. According to
Seitz,[83] this was the case, for example in Regensburg, where the
disease raged furiously in December 1793. ‘There is no doubt,’ he says,
‘that the germ of this disease was brought there by French captives,
since many contracted the disease and succumbed to it on the
transport-ships on which they were carried; and Schäffer (a physician in
Regensburg) also saw many people contract the fever who had come in
contact with them.’ Typhus fever was disseminated all along the
Danube—Donauwörth, Neuburg, Ingolstadt, Vohburg, Kehlheim, Donaustauf,
Pfatter, Straubing, Deggendorf, and other places. Kulmbach was also
infected by the French soldiers.

During the Coalition War violent conflicts took place in western France
in the Vendée, where the Royalist population had risen against the new
potentates. When Nantes was besieged by the Royalists in 1793, a furious
outbreak of typhus fever occurred in that city.[84] The prisons and
hospitals were greatly overcrowded, the city was filled with dirt which
nobody took the trouble to remove, and many carcasses were left
unburied. In the latter part of September the disease broke out in the
prison of Saintes-Claires, where the prisoners were very closely packed
together. According to le Borgne, the official inspector said of this
prison: ‘Tout manquait dans cette maison—l’air, l’eau, les aliments, les
remèdes, tout jusqu’aux moyens d’ensevelir et d’enterrer les morts.’
(Everything was lacking in the building—air, water, food, remedies, and
even the means for covering and burying the dead.) Without beds, without
even straw, the prisoners had to lie on the damp ground and be scantily
fed on bad bread and water. Regarding the Le Bouffay Prison, we read:
‘Des morts, des mourants, et des prisonniers nouvellement infectés
gisent sur le même grabat! Les cachots répandent des miasmes putrides,
et les lumières s’éteignent lorsqu’on entre dans ces cloaques empestés!’
(Dead, dying, and recently infected prisoners lie on the same pallet!
The cells reek with putrid miasma, and the lights go out when one enters
these pestilential sewers.) And regarding the L’Entrepôt Prison we read:
‘La maladie était si intense à L’Entrepôt que, de 22 sentinelles qui y
montèrent la garde, 21 périrent en très peu de jours, et que les membres
du Conseil de salubrité, qui eurent le triste courage d’y aller, en
furent presque tous les victimes.’ (The disease was so intense at
L’Entrepôt, that twenty-one out of twenty-two sentinels who went on duty
there died within a very few days, and almost all the members of the
Board of Health who had the sad courage to go there fell victims to it.)
The hospitals were so crowded that three or four persons were obliged to
occupy the same bed. After December the disease also spread to the city;
of 300 grave-diggers employed by the Revolutionary Committee, the
majority were taken sick and many died. The total number of deaths in
the city and in the prisons was estimated at 10,000.

In Italy very severe pestilences spread in a very short time over the
entire peninsula, and even to Sicily, in consequence of the war that had
been going on there since 1796. These pestilences were unusually severe
in both camps during the siege of Mantua (1796–7). (We shall learn more
about this in the tenth chapter.) In the year 1799 the French troops
under Scherer were forced to retreat in disorder before the victorious
advance of Suvarov and the Austrians, and they took refuge in Nice.
There, in the autumn of 1799, a severe epidemic of typhus fever broke
out in the French army and soon spread to the non-belligerent
population, one-third of which was carried away by it.[85] In
consequence of the removal of the patients the disease was conveyed into
southern France, infecting Aix, Fréjus, Marseilles, Toulon, and even
Grenoble.[86]

The disease spread much more widely in the direction of Italy, where it
soon attacked the entire coast of Liguria. A terrible epidemic of typhus
fever occurred in Genoa in 1799–1800, when 14,000 people succumbed
within six months.[87] Rasori had noted the first cases as early as the
summer of 1799; the patients were fugitives from Upper Italy, commercial
travellers and military persons. Not until the end of the winter and in
the spring did the disease become very widespread; it attacked
principally the poorer people. Rasori held the disease to be ‘nosocomial
fever’ (typhus fever), and his description of it makes this diagnosis
seem undoubtedly correct. Regarding the increased prevalence of typhus
fever during war-times, we are informed by the following table of
deaths, compiled by Ozanam:[88]

            _Year._ _Deaths in Hospital._ _Deaths in City._

            1794                      392               812
            1795                      477               911
            1796                      761             1,000
            1797                    1,038               900
            1798                      549               803
            1799                      489               809
            1800                      705             1,100
            1801                      929             1,200
            1802                      519             1,006
            1803                      404             1,036
            1804                      418             1,087

We note the increase in the year 1796, then the decrease when the war
was interrupted in the year 1798, and the renewed increase when it began
again.

Likewise in southern Germany various epidemics of typhus fever broke out
during the second Coalition War (1799–1802), and they too were caused by
the war and the constant marching back and forth of soldiers. Many
places in Bavaria and Swabia were also attacked in the year 1799.[89]

A very severe epidemic of typhus fever broke out in connexion with the
war between France and Austria in 1805; it devastated all Moravia,
Bohemia, Upper and Lower Austria, Galicia, and Hungary. After the battle
of Austerlitz (December 2, 1805) hospital fever appeared among the
wounded in Brünn, and carried away hundreds of French, Russian, and
Austrian soldiers. The pestilence soon spread among the non-belligerent
population, which in the months January-May 1806, suffered terribly.
According to Hain,[90] the number of deaths in Austrian Silesia was:

                         July (1805)     3,965
                         August          3,945
                         September       4,204
                         October         4,735
                         November        4,410
                         December        4,501
                         January (1806) 16,399
                         February       14,588
                         March          14,140
                         May             9,087
                         June            6,292

In Vienna, which on November 13, 1805, had been occupied by the French,
a severe epidemic of typhus fever soon broke out in consequence of the
overcrowded condition of the hospitals. The transportation of so many
prisoners of war, particularly Russians, along the military roads to
Strassburg, caused the germ of typhus fever to be scattered along the
entire route; Landshut, Munich, and Augsburg are three Bavarian cities
that are said to have been attacked.[91] In Augsburg the number of
deaths was:

                               1805 1,189
                               1806 1,840
                               1807 1,165

Epidemics also broke out away from the military roads, as in Ingolstadt,
Hof, and Nuremberg.[92]

In Württemberg, infected prisoners were also transported through
Göppingen, Cannstatt, and Vaihingen. In the months of November and
December 1806 the number of deaths in the French military hospital at
Solitude was rather small, but in January 1807 serious diseases were
brought there by Russian and Austrian prisoners.[93] Regarding
Pforzheim, a town in Baden with upwards of 5,000 inhabitants, we have
more detailed information;[94] in December and January transports of
Russian prisoners arrived there, bringing with them ‘putrid fever’.
‘Curiosity, pity, a sense of duty, and the distribution of food brought
many citizens and servants in contact with them, and they were almost
all infected.’ Military hospitals were erected inside and outside the
city; and it is stated that those who were directly infected by the
Russians suffered much more severely than those who contracted the
disease later on. Diarrhoea was rare, but on the skin appeared ‘red
spots of varying size and shape, usually like flea-bites; they developed
first on the neck and breast.’ The climax of the epidemic was in the
last part of January and the first part of February; in May it
disappeared. Of 183 patients treated, Roller lost 26 by death. The total
number of deaths in Pforzheim due to the pestilence was 130 (civilians),
77 of them being between the ages of twenty and sixty. The total number
of deaths, which in the years 1801–5 had averaged 163, in the year 1806
was 346; in the years 1807–10 the average number of deaths was 196.

Typhus fever also appeared in France in the winter of 1805–6, having
been brought there by prisoners of war; Autun, Semur, and Langres were
attacked.[95]

In Napoleon’s war against Prussia (1806–7) typhus fever broke out in the
provinces of East Prussia, where the second half of the war was waged.
According to Hufeland,[96] the disease appeared wherever the soldiers
went in the fall, winter, and following spring; he diagnosed it as
putrid fever, nerve fever, and typhus fever. Hufeland, to be sure, often
points to the fact that the disease of 1806–7 was in several respects
different from that of 1803; in particular, the disease of 1806–7 was
characterized by a long period of incubation, lasting diarrhoea,
meteorism, blood in the evacuations of the bowels, and a long
convalescence. But since Hufeland expressly says that the disease lasted
twenty-one days, and at the same time mentions petechiae and the fact
that the disease often broke out suddenly, there can be no doubt that it
was typhus fever. The peculiar mixed character of his description can be
explained only by the assumption that epidemics of typhus fever and
typhoid fever appeared simultaneously, and that the two diseases were
regarded as one and the same. Gilbert[97] expressly mentions ‘éruptions
pétéchiales’ in his description of these epidemics in the military
hospitals. In Königsberg typhus fever raged in the hospitals and among
the inhabitants, 6,392 of whom died. In Thorn, Bromberg, and Culm, all
of which had military lazarets, the disease spread from them to the
civil population. In Danzig, which in the spring of 1807 passed through
a siege of seventy-six days, the condition of health was good, whereas
typhus fever raged among the French besiegers. In 1805–6 the disease was
conveyed by Russian troops to Silesia, where it broke out in
Trachenberg, Adelnau, Ostrowo, Wohlau, Neisse, and Leobschütz.[98]
German prisoners brought typhus fever with them to France, where it
broke out in the first part of January 1807, in the Departments of Aube
and Yonne.[99]

Typhus fever raged less furiously during Napoleon’s war with Austria in
1809. After the battle of Wagram it appeared in the overcrowded
hospitals of Vienna, and also in Tyrol. Since the war had first been
waged in Bavaria, the disease had also broken out there (in Landshut and
Augsburg), but had nowhere become very widespread.

Typhus fever broke out in the form of very severe epidemics during the
long struggle of the French in Spain and Portugal in the years 1808–14,
since here the French army suffered terribly in consequence of
unremitting hardships, the scanty supply of food, and the poor hospital
arrangements. While in the Spanish Peninsula the French army is said to
have lost 300,000 men in consequence of disease, and 100,000 men in
consequence of the enemy’s arms. A particularly severe epidemic raged in
Saragossa when that city was besieged by the French in the months of
June, July, and August 1808, and again in the months of
December-February, 1808 and 1809; of 100,000 inhabitants 54,000
succumbed to typhus fever, and of 30,000 soldiers 18,000 fell victims to
the same disease, so that the city was forced to capitulate.[100] In the
year 1810 yellow fever caused great devastation in the southern part of
Spain, attacking Cadiz, Cartagena, and Gibraltar; in 1811 it raged
furiously in the provinces of Murcia and Valencia,[101] but the epidemic
was confined to the coast.

From Spain typhus fever was frequently conveyed by transports of
prisoners to France; the border districts through which the prisoners
passed were the first to be attacked, as, for instance, the town of Dax
(near Bayonne). Ozanam says:[102] ‘La France en ressentit les effets
depuis les Pyrénées jusqu’aux environs de Paris, sur toutes les routes
suivies par les prisonniers espagnols, et l’Angleterre en fut infestée
au retour des débris de ses troupes du même pays. En France la ville de
Dax, frontière de l’Espagne, fut une des premières à éprouver les
ravages des maladies épidémiques, qui accompagnent toujours les armées.
La situation basse et marécageuse, jointe à l’encombrement de son
hôpital par des militaires atteints du typhus nosocomial, ne tarda pas à
favoriser la propagation de la contagion, et elle fut bientôt transmise
aux environs. Les prisonniers espagnols y contribuèrent encore, et le
caractère contagieux de la maladie ne fut pas plus douteux, lorsqu’on
vit les employés au service des hôpitaux et à celui du transport de ces
militaires en être tous atteints.’ (France felt the effects (of the
disease) all along the routes followed by the Spanish prisoners—from the
Pyrenees to the environs of Paris, while England was infected by the
remnants of its troops when they returned from France. The town of Dax,
situated near the border between France and Spain, was one of the first
places to experience the ravages of the epidemic diseases which always
accompanied the armies. Its low, marshy situation, together with the
fact that its hospital was overcrowded with soldiers infected with
nosocomial typhus, greatly favoured the propagation of the contagion,
which soon spread throughout the vicinity. The Spanish prisoners also
helped to spread it, and the contagious character of the disease was no
longer questionable when the attendants at the hospitals, as well as the
men who had charge of transporting the sick, were seen to contract it.)

The Spanish prisoners were sent far into the interior, and caused
outbreaks of pestilence wherever they went. In consequence of the strain
and exertion involved in their transportation, and also of the inferior
food, typhus fever soon became very widespread among them. Diseased and
wounded men were always carried in the same wagons, while it was often
necessary to remain for a considerable length of time in camps, where
sick and healthy men lay side by side on straw; thus many died on the
way. In order to prevent the disease from spreading to the civil
population, it was arranged that the buildings designated for the
prisoners should lie away from the town where the soldiers were
quartered, or that the prisoners should be sheltered in barracks. All
intercourse between the prisoners and the inhabitants was forbidden, and
after their departure the straw used by them was burned, and the
buildings they had occupied were fumigated.[103]

Since, however, it finally became necessary to house the sick in
hospitals, it was absolutely impossible to prevent the disease from
spreading. The result was that the following places in Central France
were attacked: Limoges, Guéret, Châteauroux, Issoudun, Moulins, Nevers,
La Charité, and Bourges.[104] As people everywhere were afraid of
contracting the disease, the prisoners were transferred as soon as
possible to near-by districts, and this merely helped to spread the
disease. According to Boin, Bourges, in the year 1809, became the
rendezvous of all Spanish prisoners, who were housed there in barracks
and in public hospitals; of 653 prisoners of war received in the public
hospitals, 103 died. In the city itself only a few cases of typhus fever
were observed. The highly contagious nature of the disease was well
known to Boin, who says:

‘Les dames religieuses de la Charité, chargées du service des salles,
les élèves en chirurgie, les servans, les gardes de nuit, le casernier,
les gendarmes qui escortaient les voitures remplies de prisonniers
malades, le chapelain, le secrétaire du commissaire des guerres, les
personnes que la charité évangélique a fait imprudemment entrer dans les
salles, ont été frappés de la maladie. Tous ont couru des risques,
quelques-uns ont succombé.’ (The nuns who had charge of the rooms (in
the hospital) at La Charité, the medical students, the attendants, the
night-watchmen, the porter, the gendarmes who escorted the carriages
conveying sick prisoners, the chaplain, the secretary of the War
Commissioner, and the persons who imprudently allowed a sense of duty
and charity to induce them to enter the rooms—all contracted the
disease. They all ran risks, and some of them died.) Nevertheless, Boin
did not hold the disease in Bourges to be typhus fever, but a ‘fièvre
maligne putride’; he also adds that he failed to observe petechiae in a
single instance. The physicians sent by the Government, on the other
hand, diagnosed the disease as ‘hospital fever’. Inasmuch as there is no
doubt expressed anywhere else regarding the appearance of typhus fever
among the Spanish prisoners (Ozanam speaks expressly of the appearance
of petechiae on the second, third, or fourth day), it was undoubtedly
that disease which broke out in Bourges.

Not only the French, but also the English troops were attacked by typhus
fever in Spain and Portugal; they are said to have lost 24,930 men in
consequence of diseases, and 8,889 men in consequence of battles and
skirmishes. The disease was conveyed to England by returning soldiers,
but was confined there to a few houses. After the battles of the year
1808, which went against the English, the badly infected English troops
were transported on ships in stormy weather to Plymouth, where from
January 24, 1808, to January 24, 1809, some 2,427 of them were received
into the hospitals. Of that number 824 were suffering from typhus fever,
and 1,503 from dysentery; all told, 405 died.[105]




                               CHAPTER VI
   THE EPIDEMICS OF TYPHUS FEVER IN CENTRAL EUROPE FOLLOWING UPON THE
      RUSSIAN CAMPAIGN AND DURING THE WARS OF LIBERATION (1812–14)


             1. GENERAL OBSERVATIONS REGARDING TYPHUS FEVER

Typhus fever, as a specific disease, was well known to the military
physicians during the age of Napoleon, since, as set forth in the
previous chapter, it regularly appeared during the numerous Napoleonic
wars in the form of widespread epidemics. In France the simple word
‘typhus’ was often used to denote the disease, and the custom still
prevails there. In Germany the disease was called infectious nerve
fever, war plague, lazaret fever, &c.

At the beginning of the nineteenth century it was generally believed
that great hardships, colds, lack of the necessaries of life, and the
consequent consumption of spoiled foodstuffs give rise to fevers, and
that these fevers, in accordance with the epidemic character of the year
and of the season, and also in accordance with the severity of the
hardships undergone, might develop into dysentery and typhus fever. At
all events, even the eminent physicians of the day, men like Hildenbrand
of Vienna[106] and Hufeland of Berlin, who in the course of two decades
had abundant opportunity to study the disease, assumed that it is
possible for typhus fever to break out spontaneously. It was believed
that this fever, originating spontaneously, gradually developed the
power of infection. Hufeland’s position was self-contradictory, for he
assumes that the disease can break out spontaneously and yet that it can
be warded off by means of isolation.[107] He says: ‘A proof of the fact
that this disease can spread only through infection is offered by the
stronghold of Küstrin, which, being closed up tightly during the entire
year of 1813, was free from disease, whereas all the surrounding
country, even the army of the besiegers, suffered terribly.’ Whereupon
Hufeland immediately adds: ‘The war carried on among us and by us with
such unheard-of exertion and hardship caused the disease to break out
several times anew throughout our country, and hence it could but become
general.’ That it is possible for typhus fever to break out
spontaneously and subsequently spread by infection was everywhere
believed, even by French physicians. It is hardly necessary to say,
however, that the theory of the spontaneous origination of the disease
does not accord with modern views. The severe hardships undergone, the
hunger and cold, the effluvium of gangrenous wounds, the moral
depression, and the many other bad effects which characterized this war
more than any other, necessarily decreased the soldiers’ power of
resistance and increased their susceptibility to infection.
Incidentally, all sorts of telluric and meteorological phenomena,
volcanic eruptions, earthquakes, the great heat and dryness of the year
1811, the meteors of that year—all these things were at the time brought
into causal connexion with the war pestilences of the years 1813–14.

‘Many people stated positively’, says Hufeland,[108] ‘that they
contracted the disease almost immediately after they had occupied small,
narrow rooms in company with infected French soldiers, or after they had
washed their clothes or waited upon them. This frequently happened in
small houses that undertook, for a small profit, to shelter invalid
soldiers quartered upon the wealthier citizens. Many asserted that they
contracted the disease by passing the night in small inns in the towns
and villages around Berlin, and on the roads from Königsberg, Danzig,
and Frankfurt, and by sleeping on beds or straw which had shortly before
been used by infected Frenchmen or Russians. A certain number of men
contracted typhus fever by serving as attendants, in order to earn a
little money, in the local French military hospital. In this way many of
the servants and attendants employed there, as well as numerous surgeons
and apothecaries, contracted the disease and subsequently infected the
members of their families who brought them home and took care of them,
and who, in turn, infected the other inhabitants of the house and of the
neighbouring houses.’ Further on, Hufeland adds that only those inmates
of the hospital contracted the disease who, as servants and attendants,
had been in close and constant contact with the patients.

In the years 1813–14 a large number of physicians were carried away by
typhus fever; it was estimated at that time that some 500 of them
throughout Germany (excluding the surgeons) fell victims to the
disease—in Silesia alone 63 physicians died, in Leipzig 17, in
Württemberg 17, and in Baden 35.[109]

Emphasis was always laid upon the fact that the clothes and other
effects of people who had succumbed to typhus fever were highly
infectious. The wide prevalence of the disease among the Jewish
inhabitants of Vilna was attributed to ignorance or disregard of this
fact; for when orders were issued to destroy such clothing, the Jews,
out of sheer avarice, disobeyed them. The persons who acquired such
effects in this cheap and illicit manner usually paid the penalty
themselves; in addition, they did a great deal toward spreading the
disease.

The military hospitals were also largely responsible for the
dissemination of typhus fever; Parenteau-Desgranges[110] called them
outright ‘centres de contagion’. The cities in which military hospitals
were erected were always severely attacked by the disease. It was
generally complained, even by the French physicians, that the French
hospitals were poorly arranged and badly managed—even simple cleanliness
and competent attendants were lacking. Patients suffering from
infectious disease were placed together with others suffering from some
mild form of sickness or from a wound, thus giving the infection the
best conceivable chance to spread. Let us read how a French physician
describes the conditions in Verdun during the severe epidemic of typhus
fever that raged there in the years 1792–5:[111]

‘The disease spread with no less severity from other sources of
infection, such as the temporary hospitals established in the Convent of
Canons of Saint Nicholas, in the Monastery of Saint Vannes, and in the
barracks. The unfortunate patients, thrown in heaps on the damp stone
and earth floors, scarcely having under them a few mats, or perhaps some
dirty straw, filthy with their excrement, three of them often sharing a
single blanket of coarse wool, presented the most dismal picture one
could possibly imagine. At least three-quarters of the patients died.
They were buried in huge ditches dug in the vicinity of the ramparts,
and in the gardens surrounding the abbeys of Saint Vannes and of Saint
Nicholas.’

The German Central Hospital Management, which was founded in the latter
part of November 1813, and from which Bavaria and Württemberg held
aloof, sought to introduce certain improvements into the military
lazaret system, but it was unable to accomplish a great deal, owing to
the lack of hospitals, physicians, and all the means necessary for the
treatment of sick and injured people.

Very dangerous for the dissemination of the disease was the belief that
the placing of typhus fever patients together with other invalids did no
harm, but rather that the congregating of numerous typhus fever patients
by themselves caused the contagion to develop with especial severity.
The Saxon staff surgeon Neumann, for example, writes in regard to this
question:[112] ‘Anybody who lies in a bed to which the poison is still
clinging will without fail contract the disease; on the other hand, I
have often seen people suffering from other forms of sickness lie
alongside of typhus-fever patients and escape infection, provided they
had nothing in common, did not touch one another, or make use of one
another’s linen. Hence I draw the conclusion that the poison of typhus
fever, like the poison of bubonic plague and small-pox, cannot enter the
system from a distance, not even from a very short distance, and can be
communicated only by close and direct contact. This seems to contradict
our experience that the intensity of the poison is greatly increased
when several patients lie side by side. Accordingly, I warn all military
physicians not to congregate all their typhus fever patients in a single
room by themselves; for few would come forth from such a room alive,
while the poisoned atmosphere of the room would pervade the entire
lazaret, infect the physicians and attendants, and finally spread
throughout the immediate neighbourhood. People think that they can
prevent the disease from spreading by congregating and isolating the
patients, but as a matter of fact this has the opposite effect. This is
clear when we consider that the mere being together of unhealthy people
causes the poison to develop, and that not only the people themselves,
but also the very exhalations from their bodies, are sufficient to
spread the infection. For example, if a considerable quantity of dirty
clothes or linen is allowed to accumulate in a pile, and after a short
time is picked up, the usual result is that the people who do the work
experience a severe attack of typhus fever.’

Very often conditions made segregation impossible, even when it was
desired, or else the French generals refused to permit it. Consequently,
infection was so frequent in the hospitals that the disease at a very
early date acquired the name ‘hôpital fever’ (fièvre d’hôpital).

The fact that the weather conditions exerted some influence was not to
be overlooked; in the year 1813, when the warm weather began, the
disease abated a little, whereas in the year 1814 it ceased altogether
at the beginning of the warm weather. The reason for this was that the
cold weather forced people to huddle together in houses, and that
bathing and washing, particularly among the soldiers and poor people,
was less frequently and profusely indulged in; another reason was that
the heavier clothing worn in winter facilitated the breeding of vermin.

Failure to take measures of precaution, if the disease once broke out in
a neighbouring place, also contributed greatly toward the dissemination
of it. ‘If typhus fever was present in any military halting-place,
frequently nothing was done to prevent it from infecting the next place,
where it had not yet made its appearance; or, if anything was done, it
was often merely to issue an order which was not complied with.’[113] At
the same time, to be sure, one must take into account the fact that
sheer ignorance rendered useful measures impossible. If this ignorance
prevailed in the highest places, nothing better was to be expected of
the small cities and towns.

That the ‘contagious typhus’ prevalent during the Napoleonic wars was
the same disease which we call typhus fever is very certain. The
physicians of the middle of the nineteenth century, when views of typhus
and typhoid fever had cleared up somewhat, have confirmed this
fact.[114] The descriptions of the disease are almost invariably
reproductions of the same picture, the sole difference being that it was
much more severe and fatal among the half-starved soldiers on their
return from Russia, and among soldiers packed together in strongholds,
than it was among people who were less afflicted by the war and who
lived at a distance from the military routes.

As a rule, the disease broke out eight or nine days after infection. It
began with a general indisposition, which lasted several days, or, if
this indisposition failed to appear, with a chill, great languor, loss
of appetite, and weakness in the limbs; frequently brain disorders also
manifested themselves, at first in the form of a mild stupefaction,
singing in the ears, violent headache, somnolence, or wild delirium. The
exanthema usually appeared between the fourth and the seventh day.
Hufeland describes it as ‘an outbreak of red spots, covering most of the
body; they were mostly of a violet tinge, but were not sharply defined,
and often gradually merged into the colour of the rest of the skin’. It
was frequently asserted that the petechiae now and then failed to appear
at all, even in severe cases. Jörg says expressly:[115] ‘Sometimes they
broke out sparsely, one here and one there, and in such cases it was
easy to overlook them.’ After the disease had progressed for two or
three weeks the patient’s temperature went down, and there were few
fatalities after the twenty-first day. Convalescence was of short
duration, provided the outbreak had not been preceded by exhaustion due
to hardships. In regard to abdominal and intestinal symptoms, great
dissimilarity was observed; Hufeland states that when there were no
complications, an autopsy revealed not the slightest change in the
intestinal organs, and Horn says that ‘the colour of the intestines was
often almost natural.’ The severity of the disease varied greatly; it
was particularly fatal among the soldiers homeward-bound from Russia,
more than half of whom died. It is frequently asserted that the majority
of those who were thus directly infected succumbed to the disease, and
that it carried away some ten per cent of the civil inhabitants who
contracted it.

Of course it would be a mistake to say that all the epidemics of that
time were epidemics of typhus fever; undoubtedly typhoid fever carried
away large numbers of people, since it is to be assumed that the disease
was endemic in many cities. But owing to the inaccuracy of the
descriptions and the lack of autopsies, it is usually impossible to
distinguish the diseases with certainty. Even when the results of
autopsies were made known, the condition of the intestines was often
described so inaccurately that we cannot even make out whether or not
there were intestinal ulcers, which are the most important
pathological-anatomical symptoms of typhoid fever. But the initial
chill, the short duration of the disease (three weeks), the presence of
petechiae, the rapid fall of temperature, and the shorter convalescence,
all of which are ever-recurring symptoms, enable us to distinguish the
epidemic of the years 1812–14 with certainty from typhoid fever.

Through the influence of the works of Hildenbrand and Hufeland the
larger part of the medical world of that time came to look upon
contagious typhus as a specific disease; other views, however, were
vigorously supported, for example, by Markus of Bamberg, who held it to
be an inflammation of the brain. The difference of opinion regarding the
character of the disease was important, not only theoretically, but also
practically, in view of the therapeutic practice of the time; for those
who regarded the disease as an inflammation of the brain had naturally,
in accordance with the methods then in vogue, to resort to bleeding. But
all unprejudiced observers came to the conclusion that bleeding was
harmful, and that it killed all the patients upon whom it was frequently
practised. Very soon the beneficial influence of fresh air and cold came
to be recognized, and the latter was often provided by means of
cold-water baths and douches. ‘It was a universally confirmed principle,
derived from experience, that the warmer the patients were kept, the
more severe was the disease, and the colder they were kept, the milder
the disease.’ How beneficial fresh air was for the patients was shown by
the fact that those who were kept out in the open air withstood the
disease much more easily than those who were kept shut up in houses and
hospitals, and that it was much less dangerous to transport patients
from place to place in the open air, than to keep them shut up in
overcrowded hospitals. ‘Thousands of patients’, says H. Häser,[116]
‘survived even the most severe forms of the disease without human help
of any kind. Many, especially physicians, attributed their recovery to
the fact that for weeks at a time they were constantly being transported
in the cold winter from one halting-place to another, and were not
compelled to lie in overcrowded hospitals, where typhus fever and
dysentery raged most terribly.’

In dealing with the epidemic of typhus fever of the years 1812–14 we
have a double epidemic to consider. The one was disseminated directly by
the returning remnants of the ‘Grand Army’, and after causing terrible
devastation in East Prussia it spread, in a relatively milder form, to
other parts of Germany. The other epidemic broke out during the great
battles in Saxony, which lasted several months, and from there spread
virulently over a large part of Germany. In order to avoid repetition,
the following account will treat of the dissemination of the two
epidemics jointly.


        2. THE RUSSIAN CAMPAIGN AND TYPHUS FEVER IN RUSSIA[117]

Napoleon began to make preparations for his Russian campaign as early as
the year 1811; troops were assembled in Westphalia, Hamburg, Saxony,
Holland, on the Rhine, and near Verona, and several hospitals were
founded, as in Danzig. An army of 550,000 men was organized to take part
in the expedition into Russia; it consisted of Frenchmen, Germans,
Italians, Spaniards, and Poles. How this army was destroyed on its march
to and from Moscow, and in what a pitiable condition the remnants of it
arrived in Germany, is well known. Since it is our purpose to point out
here how that severe epidemic of typhus fever spread abroad from those
remnants, we can deal but briefly with the prevalence of the disease in
the army itself.

In consequence of the great heat, of the lack of drinking-water and good
food, and of the continual bivouacking (the peasants burned and deserted
all the villages along the way), the army suffered greatly even on the
march to Moscow. After crossing the Polish border the soldiers were
severely attacked by dysentery and diarrhoea; Kerckhoffs estimates that
no less than 80,000 men were suffering from dysentery at the beginning
of August 1812. Typhus fever broke out, very sparsely, to be sure, as
early as the latter part of July, when the army arrived at Vilna; there
were also cases in the hospitals at Minsk, Vilkomir, Globokie, and
Mittau, but the disease was not yet so infectious as it proved to be
later. After the battle of Smolensk (August 14–18) large numbers of
wounded soldiers (between 6,000 and 10,000 according to various reports)
were brought to that city, and from that time on, typhus fever and other
diseases (hospital fever, diarrhoea, dysentery, gastric fever, &c.)
continued to spread throughout the army. On September 14, Moscow was
entered, and on September 15 the city was in flames. The army then had
peace until October 19, when the return march began. During their
sojourn in Moscow the soldiers were very improperly nourished, eating
almost nothing but salted meat and fish, and drinking large quantities
of wine and spirits. According to Lemazurier, the number of sick and
wounded soldiers in Moscow was 15,000. The most common disease even in
Moscow was typhus fever; according to Scheerer, when Napoleon’s army
withdrew from the city it left behind several thousand typhus-fever
patients, almost all of whom died—only the stronger patients were taken
along on wagons.

The horrors of the return march are well known. Thousands froze to death
in the extreme cold of November, horse-meat and melted snow were the
sole means of nourishment, and any soldier who lay down was
irretrievably lost. Between Moscow and Smolensk, which was reached on
November 9, one-half of the soldiers who had started out from Moscow
died; the number of sick soldiers was enormous, and typhus fever raged
more and more extensively. On December 8 Vilna was reached, but there
the army was not given a moment’s rest; two days later the Russians
advanced and captured 30,000 of Napoleon’s soldiers who could go no
further.

In pursuing the French army the Russians also suffered severely from
diseases; according to Ebstein,[118] between October 20 and December 14,
1812, they lost 61,964 men, most of whom died of ‘nerve fever’ (typhus
fever).

In Vilna, which was greatly overcrowded, typhus fever raged furiously.
The large number of sick and exhausted soldiers that were left behind,
owing to the extreme cold (the thermometer went down as low as –28°
Réaumur) sought shelter, partly in private houses, and partly in
hospitals. The latter, for the first few days after the arrival of the
Russians, were in a terrible condition; sick men and dead men were
packed together in the cold, unheated rooms, the former lying on rotten
straw, completely deserted, and without care or nourishment. The
corridors and courts were filled with dead bodies and with refuse of all
kinds, while in the rooms themselves there was no less filth, since
nobody removed the excrements. ‘The courts and corridors of the
hospitals’, says Gasc, an eye-witness,[119] ‘were so covered with dead
bodies that it was necessary to walk over heaps of them in order to
enter the rooms.’

Not until after the Emperor of Russia arrived in Vilna was some
semblance of order restored. But it was then too late; almost all the
patients in the hospitals were infected with typhus fever, and according
to Gasc and Lemazurier the great majority of the 30,000 French prisoners
died. For owing to the long series of extreme hardships which the
soldiers had undergone, the disease broke out in its most severe form,
causing wild delirium, very large petechiae, abscesses, and gangrene.
Many patients succumbed within twenty-four hours, and recovery was very
slow for those who survived the attack.

In a short time the disease spread throughout the city, not so much
because the soldiers were quartered in private houses, as because the
Jews got possession of the clothes of the dead. Of some 30,000 Jewish
inhabitants no less than 8,000 died. In February and March all classes
of society, even the wealthiest people, were attacked. The disease also
spread to the surrounding country; Lemazurier says that between the
middle of 1812 and the beginning of 1813 some 55,000 bodies were buried
in Vilna and vicinity, and that the estimates made in Wittepsk,
Smolensk, and Moscow were in proportion. The pestilence spread southward
and eastward, and according to Faure, in February 1813 thousands of
French prisoners died in the overcrowded hospitals in Orel. The same
writer says that all of the French soldiers who fell into the hands of
the Russians succumbed to typhus fever.[120] We may safely assume that
the civil inhabitants of all places in that part of the country were
also attacked, even though we have no figures or statistics to confirm
the assumption.

The pestilence also raged extensively in the region of the Baltic Sea;
St. Petersburg was severely attacked by it. According to Parrot,[121] in
the last months of the year 1812 there were a great many cases of ‘nerve
fever’ in Dorpat; in Riga the military hospitals were overcrowded, and
out of a population of 36,000 and a garrison of 20,000 there were 5,000
sick. The mortality in the hospitals was very high, since, on account of
the extreme cold, two-thirds of the small windows were covered with
boards and hay.

Regarding conditions in Warsaw we have more detailed information.
According to Wolf,[122] two distinct epidemics raged there after the end
of December 1812; the one was an epidemic of typhus fever (probably
typhoid) and appeared only among the soldiers; the other was an epidemic
of typhus fever, which did not attain to epidemic dimensions until
January 1813, although a few isolated cases had been observed in Warsaw
in the last months of the year 1812. ‘This disease was almost invariably
accompanied by a spotted exanthema, which, if the disease was at first
rather difficult to diagnose, often gave the first clue. In the case of
many people the eruption was so severe and so general, appearing even on
the face, that it resembled measles.’ The comparison with measles was
also drawn by other observers. Typhus fever was conveyed to Warsaw by
the Austrian auxiliary corps, and it quickly spread to the French
hospitals, which were in a wretched condition. Later the Russian army
also brought typhus fever to the city. A great many civilians in Warsaw
contracted the disease; according to Wolf, the epidemic reached its
climax in February, and lasted until the end of the year 1813. The lower
classes suffered more than the upper classes from the disease, which,
moreover, seems to have raged much more furiously in the vicinity of
Warsaw than in the city itself.


     3. THE APPEARANCE OF TYPHUS FEVER IN NORTH AND CENTRAL GERMANY

On the return march from Moscow to Vilna the remnants of the army had
all taken the same route; for, though all bonds of discipline were
loosened as far back as Smolensk, nevertheless the instinct of
self-preservation kept all the soldiers from abandoning the common line
of march. This was also the case during the march from Vilna to the
Niemen, where the extreme cold caused untold suffering. After crossing
the river, however, the few unfortunate soldiers who had survived the
awful misery of the march, hungry, clothed in rags, with torn shoes,
alive with vermin, with frozen and gangrenous limbs, scattered in all
directions, some going home, and others to strongholds that were in the
hands of the French. Thus typhus fever, with which all parts of the army
were infected, was spread in a comparatively short time over a large
part of Germany.

At first the eastern provinces of Prussia, through which these remnants
of the army passed, were attacked by the pestilence; owing to the fact
that so many were infected, measures of precaution were everywhere
futile. ‘Adynamic fever’, says Kerckhoffs,[123] ‘spread also among the
civilians, who were not only afflicted by the terrible scourge of our
passing armies, but also became the victims of a murderous contagion. It
was a fatal present which we gave them, and which caused such a high
mortality among the inhabitants of the country through which we passed.
Wherever we went, the inhabitants were filled with terror and refused to
quarter the soldiers.’ In the more distant parts of Germany, in the
western provinces of Prussia, in Bavaria, Baden, and Württemberg, where
people had perceived the danger, it was easier, in the first months of
1813, to guard against the dissemination of typhus fever, since the
number of returning soldiers was small and it was accordingly feasible
to enforce orders regarding quarantine. With the approach of spring the
disease began to abate a little even in the north and east; in the month
of April it had almost entirely disappeared from the French troops
there, while in May and June the condition of health among them,
according to Kerckhoffs, was very good. But in July typhus fever broke
out again, and since the Russian army was also infected with it, the
disease became uncommonly widespread throughout Saxony and Silesia
during the months of fighting that ensued. After the battle of Leipzig,
when southern and western Germany were overrun by French fugitives and
prisoners, typhus fever once more broke out in that part of the country
with greater severity than ever before; even in the province of
Brandenburg and in the adjacent regions the pestilence raged, having
been borne thither by French prisoners.

In Lithuania, and East and West Prussia, typhus fever raged extensively
in the winter of 1812–13. According to H. A. Göden,[124] who had charge
of a large military lazaret in Gumbinnen, the epidemic spread
continuously from the border of Russia to Berlin. ‘It appeared most
virulently’, he says, ‘in the cities of Gumbinnen, Insterburg, Tilsit,
Königsberg, Elbing, Marienwerder, Konitz, and Landsberg; it followed
along the military roads, and broke out most severely in the
halting-places and in those cities where French military lazarets were
established.’ In Gumbinnen typhus fever broke out suddenly in the latter
part of November, immediately after the arrival of the fugitives, and
spread rapidly. At first it appeared in houses where officers and
soldiers were quartered; as a rule, several members of a family
contracted the disease simultaneously, and only rarely was one member
spared. The pestilence raged most furiously in the months of January and
February; the town had some 6,000 inhabitants, and frequently 20, 30, or
40 people, including entire families, died in a single day. In the
military lazarets the mortality was considerably higher. In March the
pestilence began to abate, and in May it disappeared altogether.

In Königsberg the pestilence began in the month of December 1812 and
came to an end in May 1813; excluding the soldiers who died in the
military lazarets, the following deaths were recorded there:

                          December (1812) 430
                          January (1813)  581
                          February        802
                          March           622
                          April           608
                          May             327
                          June            196
                          July            178
                          August          157
                          September       160
                          October         151

In the year 1812 there were 2,648 deaths in Königsberg, whereas in the
following year there were 4,403. In the first part of January, when the
city was evacuated by the French, 10,000 people, according to Stricker,
were left behind. The entire province of East Prussia, according to
Gurlt, lost 20,000 inhabitants by typhus fever.[125]

Danzig, which was besieged by the Russians from January 11 to November
29, 1813, suffered terribly. A French army of 35,900 men, under General
Rapp, was in the city, and during the siege it was exposed to all sorts
of privations as well as to extreme cold. As early as February typhus
fever had become very widespread; from January to May, 11,400 soldiers
died in the hospitals (4,000 in March alone), while 5,592 inhabitants
succumbed to the disease in the course of the entire year.[126]

Silesia was hit extremely hard. The pestilence was conveyed there in the
months of October, November, and December 1812 by transports of Russian
prisoners, and it appeared in Trebnitz, Striegau, Krottkau,
Friedenwalde, Trachenberg, Breslau, Parchwitz, Quaritz, &c. The officers
on duty, the persons who lifted the patients from the wagons, the
physicians, and the sick-attendants were always the first to be
infected.[127] With the opening of spring the disease disappeared, but
broke out anew after the battle on the Katzbach. In Breslau the disease
appeared in a very virulent form, since the infected soldiers were
housed there in overcrowded lazarets, which in the month of November
took in some 6,300 patients daily; numerous physicians (statements vary
between 16 and 22) also succumbed to typhus fever. Among the civil
inhabitants, to be sure, the disease did not become very widespread; out
of a population of 62,789, only 3,055 died in the year 1812, 3,095 in
the year 1813, and 3,301 in the year 1814. From the middle of September
1813 to February 1814, 478 civilians and some 1,800 soldiers succumbed
in Breslau to typhus fever; the total number of soldiers that died
between the middle of September and the beginning of March was
3,400.[128] In the governmental district of Liegnitz, having a
population of 600,000, according to Kausch[129] only 13 physicians
(excluding the surgeons) died. The disease was borne by transports of
infected soldiers into other parts of Silesia, and at the end of the
year 1813 all the military lazarets in Silesia were infected. In
Waldenburg and vicinity (Obersalzbrunn, &c.) typhus fever broke out
after the soldiers had marched through on October 20 and November 25,
1813, and seventeen days later the disease was very widespread, all the
members of many families having contracted it. In Bunzlau typhus fever
raged with unusual fury; in the military lazaret 12,000 men are said to
have died between June 1813 and March 1814.

Presently typhus fever appeared, with the arrival of the remnants of the
Grand Army, in regions further away from the Russian border. Häser[130]
describes the manner in which the disease spread, always along military
roads, as follows:

‘French soldiers returning from Russia’, he says, ‘spread the contagion
of various diseases over a large part of Central Europe. Almost naked,
or clothed in torn and half-burned rags, without shoes, their feet
covered with straw, and their frozen limbs covered with festering sores,
they marched through Poland and Germany. Typhus fever and other diseases
associated with it marked their course. The inhabitants of the country
were forced to house the sick; but teamsters also conveyed the infection
to villages which the soldiers did not visit. The disease raged most
furiously in the hospitals, which scarcely anywhere were able to meet
even the most modest demands made upon them.’

Regarding the appearance of typhus fever in Berlin we are informed by
Hufeland and Horn.[131] First to occur there (in the months of February
and March 1813) were numerous cases of ‘nervous fever’, which was
doubtless typhoid fever. Still it is likely that cases of typhus fever
also occurred at that time, for Horn, in writing about ‘nervous fevers’
in the Charité, describes the exanthema with the same words that
Hufeland uses in reference to later cases. Among these patients there
were already some who had returned from Russia.[132] At all events, in
the first part of March 1813 there occurred cases of contagious typhus,
which was brought to Berlin by French, and later by Russian soldiers;
the observed ways of infection, regarding which Hufeland informs us, are
mentioned above. In the middle of April there were 246 typhus-fever
patients in the Charité. In order to prevent the disease from spreading
in this hospital, Hufeland adopted strict measures of precaution. The
patients were all carefully isolated on the second floor, which was shut
off by means of a grating. The newly-arrived patients were supplied with
clean, fresh linen, their clothing was disinfected for several days in
hydrochloric acid, and then washed in boiling water containing lye,
while objects of no value were burned. The sick-rooms were constantly
ventilated by leaving the windows open, and were thoroughly cleaned
every day. The physicians, surgeons, and attendants, before they entered
the sick-rooms, had to put on black mantles of glazed linen, and on
leaving the rooms they had to wash their hands and faces in cold water
and rinse out their mouths. In this way the disease was prevented from
spreading in the hospital itself.

After the battle of Leipzig typhus fever broke out anew in Berlin;
according to Horn, 144 cases of ‘nerve fever’ were received into the
Charité in January 1814, 92 in February, 54 in March, 14 in April, 8 in
May, and none in June. Regarding the total mortality in the epidemic of
typhus fever in Berlin, which in the year 1813 had about 155,000
inhabitants, the following table, compiled by Gurlt,[133] gives us
information; there died in:

                1812.             1813.                   1814.
               _Total      _Total       _From      _Total       _From
              deaths._    deaths._    Typhus._    deaths._    Typhus._

 January             422         500          31         680         170
 February            457         544          57         596         118
 March               444         740         233         781          85
 April               476         719         227         653          55
 May                 584         752         184         443          28
 June                396         518          85         434          19
 July                417         460          29         541          14
 August              338         551          20         454           5
 September           370         467          22         577          16
 October             425         621          34         430          13
 November            356         555         105         412          11
 December            571         585         157         565          11
                   —————       —————       —————       —————         ———
    Total          5,256       7,012       1,184       6,566         545

Typhus fever appeared throughout the entire province of Brandenburg.
Maier[134] gives us some information regarding the city of Brandenburg,
where ‘infectious nerve-fever’ disappeared in the latter part of May
1813, and where, after the battle of Leipzig, it again broke out, but
did not become very widespread. On October 27 prisoners from Baden and
Hesse were quartered there; they remained until October 31 and then went
on to Ruppin. Among them were some convalescents from a military lazaret
in Saxony, who infected the occupants of all the houses in which the
prisoners were quartered. Between November 5 and December 6 there were
38 ‘nerve-fever’ patients in the Altstadt and 7 in the Neustadt, a small
number of whom died. Typhus fever raged very furiously in Jüterbog after
the battle of Dennewitz, carrying away entire families.

After his defeat in Russia, Napoleon had quickly returned to France, and
there, by means of new conscriptions, had in a short time assembled an
army of very young men, who had never done military service and were
therefore not accustomed to the hardships of war and, in particular,
were much more susceptible to infectious diseases than the troops that
had served under him before. In April, when the army of the Allies had
arrived at the Elbe, Napoleon with his newly-gathered army left the
Rhine and marched to Saxony, which from then until autumn was the main
scene of the war. Since the Russian army was still infected with typhus
fever, contracted in the winter campaign, and since, furthermore,
isolated cases of the disease were still occurring among the remnants of
the French troops that had returned from Russia, the inevitable result
was that Saxony was not only completely impoverished by the protracted
war, but was also terribly afflicted by war pestilences.

In Saxony typhus fever had already become very widespread in the first
few months of 1813; all the places through which the military transports
passed were attacked, as Sorau, Guben, Lübben, Görlitz, Leipzig, and
Weissenberg; while places in which military hospitals were erected fared
even worse, as Schneeberg, Zwickau, Chemnitz, Freiberg, and
Augustusburg. The severe epidemic in Annaberg (in the Saxon Erzgebirge),
lasting from March to May 1813, has been described by Neuhof.[135] In
March a Saxon field-hospital was established there, and presently
everybody who came in contact with the hospital contracted typhus fever.
In neighbouring Thum, where the patients passed only one night, many
citizens succumbed to the disease.

Dresden, in the first few months of the year 1813, was not attacked by
the disease, notwithstanding the fact that soldiers and officers
returning from Russia were taken sick and died there; only in rare
instances were citizens, in whose homes officers had been quartered,
attacked, and the disease did not rage at all extensively.[136] On the
other hand, typhus fever raged furiously in Dresden after Napoleon’s
successful battle at Bautzen (May 20 and 21, 1813), when large numbers
of wounded soldiers were brought to Dresden and placed in lazarets,
which soon became greatly overcrowded. The less-severely wounded were
housed in the homes of citizens, who were compelled to receive them and
suffered terribly in consequence of it. The result was that typhus fever
spread from the soldiers to the civilians. After the battle of Dresden
(August 26, 27), from which Napoleon again emerged victorious, but
especially during the short siege of Dresden (from the middle of October
to November 11), the epidemic increased in both extent and fury. The
increased mortality is shown by the following table, which includes only
the residents:

                             January   184
                             February  199
                             March     188
                             April     194
                             May       289
                             June      257
                             July      264
                             August    474
                             September 882
                             October   659
                             November  960
                             December  944

According to Fischer, one person out of every ten that contracted the
disease died, while the mortality in the French military hospitals was
incredibly high. In the course of the year 1813 no less than 21,090
soldiers died in Dresden, while in the same year 5,194 residents died;
3,273 civilians died in the year 1814, and 1,785 in the year 1815. The
average number of deaths per annum among the civil inhabitants was
2,304.

Regarding the terrible conditions in Dresden at that time, a pastor
informs us in a letter:[137]


  It was a gruesome sight to see the wagons full of naked corpses,
  thrown together in the most horrible positions, drive away from the
  hospitals and set out for their destination. Many bodies are said to
  have been cast into the Elbe. The terrible days began about the
  middle of May, when many house-owners were obliged to quarter as
  many as two, three, and even four hundred men. Presently persons
  suffering from wounds, scurvy, and infectious disease began to
  arrive from Bautzen, some straggling along piteously on foot, others
  being rolled along in ghastly groups on pushcarts. This
  disease-spreading mass was now housed in the homes of citizens,
  since the twenty-five hospitals were no longer able to accommodate
  them. The houses, yards, streets, and public squares were full of
  dirt and refuse. Dearth of food, resulting from the breakdown of
  means of supply, added to the general misery. Entire families were
  wiped out, and many houses are still standing empty (1814). Wagons
  bearing the dead clattered on all the streets, and there were few
  inhabitants who did not wear some outward sign of mourning for lost
  relatives.


Leipzig suffered even greater hardships. The pestilence was conveyed
thither by French soldiers in February 1813, and on the 27th of that
month there were thirty-eight fever patients in the Jacobsspital. In the
summer of 1813, when the war was going on in Saxony, the disease raged
there furiously. After the battle of Dresden a large percentage of the
wounded were brought to Leipzig, and more than 20,000 sick and wounded
soldiers were kept there for several months. As usual, typhus fever
broke out in the city in consequence of it, and carried away large
numbers of soldiers and citizens. After the battle of Leipzig upwards of
30,000 wounded soldiers, mostly Frenchmen, were housed in the city.
‘Virulent nerve-fever,’ says Beitzke,[138] ‘which had been prevalent in
the city for some time, now broke out with tenfold severity, not only in
the city itself, but also in the surrounding country, and carried away
large numbers of people. The arrival of the cold weather, which helped
to check the disease, was under these circumstances a great blessing.’
In the year 1813 some 80,000 French soldiers, according to the hospital
lists, succumbed to wounds, war-typhus, and other diseases, in Leipzig.
From February 1813 to January 1814, seventeen young physicians died
there of typhus fever. The number of civilians buried in Leipzig in the
year 1813 was 3,499, in the year 1814 it was 2,022; the average number
of interments in the years 1810–12 was 1,443, and in the years 1815–17
it was 1,187. The number buried (including the still-births, but not the
soldiers) was, by months:[139]

                                   1813. 1814.
                         January      98   450
                         February    121   276
                         March       206   244
                         April       202   152
                         May         178   159
                         June        200   120
                         July        290    85
                         August      189   107
                         September   176   118
                         October     311   111
                         November    743    96
                         December    785   104

Most of those carried away were adults; the following table indicates
the relation between the age of the victims and the mortality:

                   _Years of Age._ 1812. 1813. 1814.
                   1                 356   517   456
                   1–10              161   310   305
                   10–20              29   174    76
                   20–30              91   362   157
                   30–40              87   492   173
                   40–50             104   559   207
                   50–60             126   409   208
                   60–70             124   358   234
                   Over 70           119   256   155

In reference to the year 1813, in which typhus fever caused the greatest
devastation in Leipzig, we see how the mortality among persons between
the ages of ten and sixty increased between fourfold and fivefold, while
among very young children and very old men, it increased by at most one
hundred per cent. In the year 1813 more men than women died (1,900 men
and 1,599 women), whereas in the following year the reverse was the case
(1,009 men and 1,013 women).

Typhus fever spread throughout all Saxony. In Plauen, which was at that
time a city of 6,800 inhabitants, the following number of deaths,
according to Flinzer,[140] were due to typhus fever: 4 in 1812, 32 in
1813, 59 in 1814, and 5 in 1815. These figures do not include the
foreign soldiers that died. According to Flinzer, the specific disease
before the year 1819 was usually typhus fever. In the year 1814 the
total number of deaths in Plauen increased to 440.

Numerous sick, wounded, and captive soldiers were quartered in Zwickau
after the battle of Leipzig. There and in the surrounding villages, in
consequence of the erection of a hospital, typhus fever had already
appeared in September, but in Zwickau itself, thanks to timely measures
of precaution, it gained no headway. In the year 1812 only 183 civilians
died there, 376 in the year 1813, and 260 in the year 1814; 380 soldiers
died there in 1813, and 14 in the year 1814.[141]

The pestilences spread all over the country, even into the most remote
corners of the Saxon Erzgebirge; Annaberg and the neighbouring towns of
Marienberg, Weipert, and Geyer were again attacked, although less
severely, according to Neuhof, than in the spring. In March the disease
disappeared entirely.

The Saxon strongholds along the Elbe fared worst of all; regarding the
terrible devastation caused by typhus fever in Torgau we shall have
something to say in the tenth chapter. Magdeburg and Merseburg were also
severely attacked; this is evident from the fact that one-half of the
physicians in Magdeburg (nine in number) succumbed, according to Roloff,
to hospital fever.[142] In Wittenberg, whither typhus fever was borne in
February 1813 by infected French soldiers, and where it had subsequently
disappeared, the mortality was very high during the siege, which lasted
from October 28, 1813, to January 14, 1814; of 6,000 or 7,000
inhabitants, upwards of 4,000 had left the city before the siege began.
In the course of seven months (July 1813 to January 1814) 590 people
died there, whereas the average number of deaths had been only 300 per
annum. When the city was captured by the Prussians the death-rate
increased; no less than 331 persons died between January 14 and April
14, 1814.[143]

After the battle of Leipzig the defeated army marched back through
Weissenfels, Naumburg, Weimar, and Erfurt to the Main. There was now no
active effort made to supply food to the army, which still numbered some
100,000 men; the soldiers had to eat whatever they could pick up along
the way. ‘Extreme misery and exhaustion’, says Beitzke,[144] ‘led to
great excesses; the places along the route were made to suffer, and
worst of all, the region through which the French army hurried back was
generally infected with the germ of typhus fever.’ ‘The route of the
army, clear to Mayence,’ says Giraud,[145] ‘was again strewn with
corpses and débris.’

In Weissenfels some 3,000 soldiers are said to have died in the
hospitals, and also 600 civilians, within a year. In Altenburg, which
had suffered from typhus fever in the spring of 1813, 1,650 men and 55
officers died between October 2 and December 1 of that year. In
Eisenberg (in Saxe-Altenburg), according to Greiner,[146] a lazaret was
established in the fall of 1813, but there were but few cases of typhus
fever transmitted to citizens owing to the adoption of all measures of
precaution. On the other hand, the disease was conveyed to numerous
near-by villages, in which large numbers of sick and convalescent
soldiers were quartered. ‘The Cossacks did the most toward spreading the
disease, for wherever any of them were quartered, one could count with
certainty upon an early outbreak of nerve-fever.’ In November 1813, a
severe epidemic of typhus fever broke out in Gera, and the mortality in
four months was seven times as high as usual. In Zeulenroda (south of
Gera) the pestilence was not very severe; it was brought there by sick
and convalescent soldiers, who were quartered in the houses.[147] Jena,
on the other hand, was very severely attacked: the epidemic began in
November 1813, and lasted until March 1814.[148] According to Gurlt, the
usual number of deaths in normal years in the districts of Weimar and
Jena was from 1,750 to 1,850; but in the year 1813 no less than 3,948
people died there, and in 1814 there were 3,363 deaths.

After the battle of Lützen (May 2, 1813) some 8,000 wounded French and
Prussian soldiers came to Erfurt, necessitating the immediate erection
of lazarets. After the battles in August, when the scene of the war
moved closer to Erfurt, the misery in the city was greatly increased,
resulting in a rapid dissemination of typhus fever. In the latter part
of August, when 9,000 sick and convalescent soldiers arrived in the
city, the citizens were obliged to quarter them; the number of soldiers
that succumbed to typhus fever was appalling, while as many as 17
civilians often died in a single day; in the week before the battle of
Leipzig 504 soldiers died in the hospitals. On October 20–23 the French
lazarets were cleaned out as thoroughly as possible. During the siege,
which began on October 25 and lasted seventy-three days, the misery was
extreme, and typhus fever raged more and more furiously. From November 1
to November 17 some 400 civilians died, while no less than 1,472
soldiers died in the military hospitals; 143 soldiers died on December 9
and 10. The houses of a few citizens were rendered absolutely
tenantless. In the year 1813 Erfurt lost 1,585 citizens, as compared
with an average of 554 for the years 1811–12; the number of deaths in
the year 1814 was 1,121. Typhus fever also raged so furiously among the
Prussian besiegers, that the lazarets were soon overcrowded, and it was
necessary to house the troops in other places.[149]

In Fulda, which was forced to take in thousands of sick soldiers, typhus
fever soon began to spread rapidly, as it also did in the country
surrounding the city. In Giessen, where a Russian field-lazaret for
1,800–2,000 men was erected, the epidemic soon spread to the civil
inhabitants.

At Hanau the French retreat was opposed by General Wrede with an army of
50,000 Bavarians and Austrians, a much smaller number than the French
had. The two days of fighting that ensued (October 30 and 31, 1813)
caused the pestilence to develop murderously. Kopp has given us a good
description of this epidemic in Hanau.[150] Since the beginning of the
war the city had always had a military hospital, which lay outside the
city. During the battles in Saxony the number of sick and wounded
increased, so that it was necessary to erect a second lazaret within the
city. Many sick-attendants and sub-surgeons contracted typhus fever,
which was prevalent in the hospitals, and several cases also occurred in
the city, especially among people who quartered soldiers for money in
their homes; many soldiers were thus crowded together in small rooms,
and among them were a great many convalescents from Saxon hospitals. The
infectious nature of the disease and its consequent dangerousness was
shown by the fact that as a rule entire families gradually contracted
it, although the epidemic was confined to individual houses. The
engagement at Hanau, from which the French emerged victorious, resulted
in the unfortunate city being stormed and plundered. ‘Even while the
battle was going on,’ says Kopp, ‘a corps of the French army scattered
throughout Hanau. This corps had brought with it from Saxony the germ of
infection; for the region around Dresden could be looked upon as the
great breeding-place where, in view of the enormous assemblage of people
representing so many nations, and owing to the concurrence of so many
unusual factors, the soil was uncommonly fertile for pestilential
diseases.’ After the engagement a multitude of French prisoners, greatly
weakened by hardships and hunger, came to the city. The dissemination of
typhus fever was especially helped along by the fact that many poor
inhabitants engaged in looting on the battlefield, and took home with
them the knapsacks and other effects of the dead. The clothing of the
dead came into the possession of those who were charged with burying
them, and later got into the hands of the poorest families in the city
and in the neighbouring villages. ‘I often entered the houses of poor
people,’ Kopp goes on to say, ‘and found the entire family suffering
from typhus fever, and on the walls of the low sick-room the uniforms,
shirts, and other effects of the dead soldiers would still be hanging.’
The result was that the number of patients greatly increased after the
battle, and in less than two weeks an epidemic began to develop; at
first it was rather mild, but later on it carried away large numbers of
people, and lasted until the end of February, having reached its climax
in December. From December 1, 1813, to January 4, 1814, 248 people died,
whereas the normal mortality for the month of December was but 30. The
total number of deaths, including the soldiers, between October 26 and
March 1 was 613, while in ordinary years only 125 people died, on the
average. The middle class suffered worst of all, while of the upper
classes three physicians and several clergymen died. Of the 192
typhus-fever patients that Kopp himself treated, 21 died (10·9 per
cent), but these figures do not include a rather large number of very
mild cases. People of all ages and both sexes were attacked; children
suffered less than adults, while old people and heavy drinkers were the
most liable to succumb. The disease lasted from two to three weeks;
death usually occurred on the fourteenth to twentieth day, often
somewhat sooner.

Frankfurt-on-the-Main suffered terribly in the year 1813 from enforced
quartering. Even in the spring, after the newly-organized French armies
had passed through the city, the Frankfurt lazarets were overcrowded
with sick and wounded soldiers from Saxony, which was then the scene of
the war. Accordingly it was decided in Frankfurt to build barracks
adapted to the expected requirements; and in order to protect the city
as much as possible from the infection of typhus fever, the barracks
were erected outside the city limits, before the Allerheiligen Tor, and
were situated in the Pfingstweide along the Main. The building of these
barracks was a large and very expensive undertaking, but they
undoubtedly served a very useful purpose by protecting the inhabitants
for a considerable length of time against the infection of typhus
fever.’[151] On September 21 and 22 large numbers of sick and wounded
soldiers came to Frankfurt; they filled all the lazarets, and many of
them had to be quartered in the homes of citizens. From that time on
typhus fever began to spread throughout the city. Fortunately for
Frankfurt, the retreat of the French army from Hanau to Mayence passed
by the city, since the French generals were afraid that they would be
unable to get their troops out of Frankfurt again. On October 29 all the
sick and wounded French soldiers in the Frankfurt hospitals were taken
out and conveyed by boat to Mayence. The hospital on the Pfingstweide,
which had room for 1,480 patients, was immediately cleansed and made
ready for the army of the Allies, who were marching into Frankfurt in
large numbers. Typhus fever now reached its climax. The arrival of the
German and Russian armies almost doubled the number of people in the
city; the soldiers were quartered in the homes of citizens and
immediately infected them with the pestilence. On January 14, 1814,
there were more than 4,000 typhus-fever patients in the city alone,
while in the district their number far exceeded 6,000. How the mortality
among the civil inhabitants was thereby increased is shown by the
following figures, which include only the deaths in the civil
population:

                           July (1813)     86
                           August          83
                           September       93
                           October        103
                           November       328
                           December       289
                           January (1814) 264
                           February       248
                           March          212
                           April          132
                           May            135
                           June            76

Four physicians and seven surgeons succumbed to the epidemic in
Frankfurt. Of 668 typhus-fever patients taken in by the Hospital zum
Heiligen Geist, 100 died. Generally speaking, Frankfurt-on-the-Main
fared pretty well, for the reason that most of the patients were housed
outside the city; the lower classes, particularly servants and maids,
suffered the most. In the city itself the disease was confined chiefly
to the narrow streets of the Altstadt. In March and April the pestilence
began gradually to abate, and in May it ceased altogether.

After leaving Hanau the retreating French army went on to Mayence and
France. The great loss of human life due to typhus fever during the
siege of Mayence will be discussed in the tenth chapter. Wiesbaden[152]
was attacked very severely; 800 men are said to have died in the
military lazaret there, while of the native inhabitants, who numbered
4,000 at that time, 466 contracted the disease and 141 succumbed to it.

From Mayence the pestilence spread and infected the Rheingau; the
outbreak in Oestrich (below Hattenheim on the Rhine) is described by
Thilenius.[153] In October sick and wounded French soldiers were taken
down the Rhine, and in the latter part of that month 500 soldiers on
three boats were held up by a severe storm at Oestrich, where the bad
weather compelled them to remain for twenty-four hours. The patients,
contrary to orders, left the ships and were taken in by the inhabitants
of Oestrich. Before they went away fourteen of them died; a number had
already died on the boats. On November 7 five or six citizens of
Oestrich contracted the disease; before the 9th more than thirty had
been taken sick, and on the 10th there were 93 typhus-fever patients in
the city. All told, 330 people in Oestrich contracted the disease, and
103 succumbed to it. In the latter part of November neighbouring places
were infected by dispersed French soldiers, by the small lazarets of the
troops of the Allies, by visits to the sick, and by participation in
funeral ceremonies. Particularly hard hit was the town of Kiedrich,
where 336 people contracted the disease and 69 succumbed to it.

As in Oestrich, so in Winkel (near Rüdesheim), according to J. B. von
Franque, the pestilence broke out on November 5, 1813, when a boat-load
of infected French soldiers was driven ashore there; sixty or seventy of
the patients entered the village of Winkel, where they were housed in a
schoolroom. Presently a large number of the inhabitants (91 all told)
contracted the disease, and 31 of them died. In the small neighbouring
community of Espenschied the pestilence broke out in a Prussian military
lazaret and spread to all the houses with the exception of one.

Kraft[154] gives us some interesting information regarding the
appearance of typhus fever in Runkel-on-the-Lahn (above Limburg). This
outbreak affords an example of how quickly the pestilence spread in
small places. Shortly after the arrival of the Allies, traces of lazaret
fever revealed themselves there, and in the latter part of November
1813, several sick soldiers were brought there and housed in the homes
of citizens. Presently typhus fever broke out all over the town; in the
first part of December the castle at Runkel was converted into a
lazaret, and it was very soon filled with patients. The poor allowed
themselves to be employed for short periods as sick-attendants, and the
result was that they either contracted the disease themselves or else
conveyed it to their homes; it was not long before the entire town, as
well as the surrounding country, was infected. The convalescents from
the military lazarets were not isolated in separate houses, but taken to
the surrounding towns and villages (for example, Weyer, Villmar,
Münster, and Erfurt), many of whose inhabitants were taken sick. The
pestilence raged far and wide; at the climax of the epidemic (February
to the middle of March) entire families lay sick, and a great many
physicians and surgeons were attacked; the disease disappeared about the
middle of May. In Runkel itself, which had 850 inhabitants, 214
contracted the disease and 70 died; the total number of deaths between
December 1, 1813, and July 1, 1814, was 94, whereas the normal number of
deaths for an entire year was but 17. In the village of Münster, which
had 760 inhabitants, 86 were taken sick and 22 died; and in the village
of Weyer, which had 727 inhabitants, 179 were attacked and 58 died; the
average number of deaths per annum in both villages was 12. As in these
small places, so in all the towns and cities the pestilence broke out
wherever a sick soldier of either army passed.

From October 28 on, transports of half-dead typhus-fever patients for
several days kept arriving at Limburg itself, where they were sheltered
in a convent. In only eight days several inhabitants living near the
lazaret, and also several sick-attendants and their families, contracted
the disease. In consequence of the quartering of Russian and Prussian
troops in the homes of citizens, and also in consequence of the erection
of a permanent hospital in the city, into which hundreds of patients
were received every day, typhus fever broke out with great severity
among the inhabitants; the climax of the epidemic came in January. Of
600 civilians who contracted the disease 76 died.

In the Grand Duchy of Nassau, to which the last-named places (Wiesbaden,
Oestrich, Rüdesheim, Runkel, and Limburg) belonged, and which had some
270,000 inhabitants, the number of people who contracted the disease and
the number who died from it, according to the reports of the church and
town authorities, was recorded for the period between October 1, 1813,
and April 1, 1814. According to von Franque, the following figures were
compiled in reference to the civil population in the Governmental
Districts of that time:

   _Governmental         _Due to Typhus Fever._        _No. Deaths from
    District._                                           all causes._
         〃          _No. Patients._    _No. Deaths._           〃
 Ehrenbreitstein              11,522             2,409             3,680
 Weilburg                      2,173               419               680
 Wiesbaden                    29,349             6,179             8,099
                              ——————             —————            ——————
       Total                  43,044             9,007            12,459

Altogether, fourteen per cent of the population were attacked by typhus
fever, and three per cent succumbed to it; scarcely a single community
was spared.

Epidemics of typhus fever also occurred further down the Rhine; Coblenz,
for instance, was severely attacked. According to Bernstein,[155] a
small epidemic broke out in Neuwied in January 1814, having been borne
thither by a Prussian corps under General Kleist, which left behind
eighty-two sick soldiers, many of them suffering from ‘nerve-fever’. The
disease spread in a rather mild form throughout the city, but lasted
only four weeks.

Typhus fever likewise appeared in North Germany, which was not directly
infected by French soldiers retreating from Leipzig. Hamburg was
attacked with great severity. In March 1813, the Russian colonel,
Tettenborn, by means of a bold _coup de main_ had captured Hamburg, but
he was unable to hold it, and on May 30 the French returned. Marshal
Davoust erected strong fortifications and drove out all the poorer
inhabitants, most of whom had come from the neighbouring Altona, and
thus made ready for a long siege, which did not begin until the end of
the year, although the blockade was complete by the middle of January.
Large quantities of filth accumulated in the streets, since all
working-men were employed at the redoubts and hospitals. Food became
more and more scarce. ‘On such a fertile soil’, says Th. Deneke,[156]
‘typhus fever flourished. The disease spread rapidly from the hospitals
throughout the entire city, since not only were all arrangements wanting
for the isolation of the patients, but half-recovered patients were
actually discharged from the hospital and quartered in the homes of
citizens. Of the garrison, which at the beginning of the siege numbered
some 25,000 or 30,000 men, sixty or seventy, at one time as many as 100,
died every day between the first part of February and the last part of
March, and they were all buried outside the Steintor, close by the
town-moat. No less than 10,700 bodies were interred there, 8,200 people
having succumbed to typhus fever, and 2,500 to wounds; among those
buried were numerous prisoners. Regarding the number of inhabitants that
died we have no information. The condition in the hospitals must have
been terrible; since there was not sufficient room or the proper
facilities to take care of the patients, the physicians and attendants
did their duty only under constraint, and the managing officials in many
instances grossly abused their authority; one of them, the director of
the Legert Military Hospital, for example, ended characteristically by
becoming in 1824 the leader of a band of robbers in France.’ Seven
physicians fell victims to the pestilence in Hamburg. The city did not
surrender until May, after the capture of Paris, whereupon typhus fever
appears to have disappeared quickly.

From Hamburg typhus fever was conveyed by fugitives in all directions;
Altona was attacked with particular severity. As mentioned above,
thousands of the poor driven from Hamburg had been received in Altona.
‘The people, driven from their homes by fear,’ says Steinheim,[157]
‘streamed through our gates and went about seeking shelter. At the same
time the gates of Hamburg were closed, and swarms of unhappy people, the
dregs of Hamburg’s population, straggled with the sad remnants of their
property, bent over more by sorrow than by the weight of their burden,
through our gates and found protection, nourishment, and shelter in our
homes; it was a heart-rending sight.[106] They were housed, partly in
barracks, stables, and barns, and partly in the houses of the
lower-class citizens, whose homes were thereby ‘so crammed full that not
a single corner was left unoccupied by some poor stranger’. More than
17,000 refugees were received in Altona, whose normal population at that
time amounted to some 24,000. At the beginning of January, when the very
cold weather came (the thermometer often went down as low as –20 degrees
Réaumur), all the cracks and openings in the doors and windows were
stopped up to prevent the entrance of the outside air. In the latter
part of December 1813, typhus fever broke out in these overcrowded
quarters and carried away large numbers of people. The exact number is
unknown; according to Mutzenbecher 1,138 fugitives, all told, died in
Altona. According to other reports sixty-eight per cent of the patients
in the hospital succumbed. The epidemic reached its climax in March, and
with the coming spring it began to abate, partly because it became
feasible to house the fugitives in better quarters, and partly because
the warmer weather rendered better ventilation possible.

The disease was also conveyed from Hamburg to Eppendorf, but no
information regarding the number of deaths there is available.

In Lübeck typhus fever broke out in March 1814, among refugees from
Hamburg, and carried away 613 people. According to Gurlt, typhus fever
was conveyed to Bremen, partly by the army of the Crown Prince of
Sweden, and partly by fugitives from Hamburg; the epidemic is said to
have been rather mild.

In Mecklenburg typhus fever began to spread after the erection of a
military lazaret in Malchow (October, 1813), and after the erection of a
second lazaret by the Swedes in Wittenburg (near Schwerin).

In Kiel typhus fever did not appear until the beginning of the year
1814; Weber[158] attributed the outbreak there to the Swedish military
lazaret, in which physicians and nurses frequently contracted the
disease. At first the poorer people were attacked (probably because the
sick-attendants were of that class), and later the well-to-do. The
pestilence, mild at first, soon became very severe. The disease also
broke out in other places in Holstein; Pinneberg was severely attacked,
and the disease was also observed in Schleswig. It is remarkable that,
according to Weber, no exanthema was observed in Kiel; it must, however,
have been present in a scarcely noticeable form, since a rash appeared
on the entire skin of convalescents. The disease always began with a
chill, and was characterized now by obstinate constipation, now by
diarrhoea; no patient who survived the thirteenth day died. And even if
an exanthema was not observed, there can be no doubt that it was typhus
fever which raged in Kiel. Weber himself calls the disease contagious
typhus.


           4. THE APPEARANCE OF TYPHUS FEVER IN SOUTH GERMANY

Typhus fever was conveyed to various places throughout South Germany by
the few soldiers that returned from Russia. Nowhere did it become very
widespread, since the authorities soon realized its dangers and
prevented it from spreading by means of appropriate measures of
precaution. A change took place, however, after the battle of Leipzig,
when large numbers of fugitive and captive French soldiers came into the
country, and when troops, particularly Russians, kept constantly
marching back and forth across the country and spreading the infection.
Another important cause of the appearance of the disease there was the
fact that lazarets were erected in South Germany during the campaign in
France, for the purpose of sheltering the sick and wounded soldiers that
were transported back from France.

Regarding the dissemination of typhus fever in Bavaria we are very well
informed in a dissertation by F. Seitz.[159] As among other divisions of
troops, so also among the Bavarian division, typhus fever raged
extensively. On the march from the Vistula to the Oder thirty or forty
men contracted the disease every day, and some of them also suffered
from diarrhoea, dysentery, and other diseases; so that when
Crossen-on-the-Oder was reached only 113 officers and 2,253 men were
left. During the sojourn in Crossen and during the march through Saxony
in March, the number of the patients increased, and by the middle of
March there were only 1,000 able-bodied men left. Thus they arrived at
the Bavarian border. ‘The rumour of the wide prevalence of nerve-fever
in North Germany,’ says Seitz, ‘and the apprehension that the disease
might be conveyed into Bavaria by soldiers returning from the field of
battle, had preceded the arrival of the first warriors. Nevertheless
people did not wish to forgo the pleasure of sheltering in their homes
the soldiers, who had been exposed to so many hardships and privations,
and of helping them to forget their past troubles; and in performing
this philanthropic duty they lost sight of the necessary caution which
prudence demanded.’

The infection of an entire family in Regensburg by a soldier discharged
from the hospital (in February 1813), and reports regarding infection in
other places, resulted in the adoption of strict measures in the
border-towns. All returning soldiers, if it was suspected that they were
infected with disease, were examined by a commission, and if the
suspicion was confirmed by this commission, they were not allowed to be
quartered in the homes of citizens, but were obliged to find shelter in
barracks and lazarets, or in suitable buildings outside the town.
Patients were sent to the military hospitals of Bayreuth, Bamberg, and
Plassenburg (near Kulmbach); as soon as these hospitals were filled up,
a new one was erected in Altdorf. Strict isolation of the patients was
enforced, and this prevented the further dissemination of the disease
among the civil inhabitants. To be sure, a few people contracted the
disease after coming in contact with soldiers; for example, in Amberg,
Sulzbach, Burglengenfeld, Grafenau, Cham, Nuremberg, &c. On the other
hand, there were a great many typhus-fever patients in the military
hospitals, especially in Bamberg. There typhus fever caused a high
mortality among the soldiers; but, thanks to strict measures of
precaution, only a few civilians were taken sick (about 100 out of
20,000 inhabitants), while of several physicians that contracted the
disease only two succumbed to it. About the middle of the year 1813
typhus fever disappeared in Bavaria, without having demanded many
victims. The ‘nerve-fevers’, which were prevalent during the summer (for
example, in Regensburg from July to September), are not regarded by
Schäfer as contagious, and must be looked upon as cases of typhoid
fever.

In November, on the other hand, after the battles near Leipzig and
Hanau, typhus fever broke out suddenly in many places in Bavaria, and in
December raged furiously. The orders, issued in the spring of 1813,
prohibiting all persons suspected of carrying disease from crossing the
borders could no longer be enforced. Says Seitz:[160] ‘When French
prisoners began to march across the country on their way from Saxony and
Würzburg to Bohemia, the pestilence spread among the inhabitants of the
cities and of the flat lands. Typhus fever raged in its most terrible
form among these poor prisoners of war; many succumbed to it in various
places along the route, and thousands died in the hospitals. That the
disease, which haunted all defeated armies like a ghost, would
necessarily reap an abundant harvest among them, was clear to every
physician who observed the physiognomies of these warriors as they were
being led away in captivity from the vicinity of their fatherland into
remote regions. Their pale faces and emaciated forms bore witness to
hunger and sorrow, to a long deprivation of the usual necessaries of
life and to lack of vital energy, to exhaustion caused by the long
marches from Hanau to Leipzig, when in the ardent struggle to reach
their fatherland they had used up their last ounce of strength.
Whosoever was brought by profession, sentiment, or curiosity into
contact with these unfortunate soldiers sooner or later contracted the
disease. Physicians, police-officers, servants, national guards (who
watched over the prisoners), country-people (who carried the patients),
messengers (who brought food to the soldiers in their quarters), were as
a rule the first to be attacked.’

The Grand Duchy of Würzburg was next attacked. In Würzburg itself, where
there were 2,000 or 3,000 French patients in the hospitals, the
pestilence broke out furiously wherever the soldiers went. In Miltenburg
more than 100 persons contracted the disease in the latter part of
December; in the district of Mellrichstadt the number of typhus-fever
patients was 429 (121 deaths), and in the district of Bischofsheim there
were 1,067 patients and 328 deaths. According to Seitz, the number of
deaths throughout the entire Grand Duchy of Würzburg, which at that time
had a population of 344,500, was 2,500, while no less than 16,000 people
contracted the disease. In Nuremberg the pestilence did not become very
widespread; it broke out in the first part of November and lasted until
the middle of January; 150 persons, all told, contracted the disease.
Dinkelsbühl was severely attacked; in the month of November a large
number of French prisoners suffering from typhus fever and diarrhoea
were housed there in the Carmelite Monastery, and in a short time some
200 of them died. Between the 25th and 30th of November typhus fever
spread to the civil population, and, in a few days, more than 100 people
contracted the disease and 10 died; the number of patients increased
until December 12, and then decreased, until the pestilence disappeared
in the latter part of January; 448 persons, all told, contracted the
disease and 89 succumbed to it. In the middle of November it was
conveyed by a transport of French prisoners to Bamberg, where it spread
with such fearful rapidity in the military hospital there, that twenty
persons died every day and all the sick-attendants and medical
assistants contracted it. The disease soon spread throughout the city,
even infecting people who had in no way come in contact with the sick
prisoners. Epidemics of typhus fever were reported in twenty-one
villages in the surrounding country.

All Upper Franconia, through which transports of prisoners were taken to
the Bohemian border, suffered terribly from the pestilence. The disease
was first observed in the towns and villages lying to the north of
Bamberg, whither it had been conveyed by dispersed troops immediately
after the battle of Leipzig (in Nordhalben, Hof, and other near-by
villages). Later on it also appeared in the districts further south. The
region between Bayreuth and Münchberg was, comparatively speaking, less
severely attacked. On the other hand, typhus fever raged furiously in
the military hospital on the Plassenburg, where at the end of December
there were some 700 persons suffering from the disease. In Kulmbach, a
town lying at the foot of the mountain, more than 100 persons contracted
the disease.

While French prisoners were bringing typhus fever into the country from
the west, Austrian and Russian troops were also bringing it from the
east. To be sure, the authorities were enjoined to restrict the foreign
troops to the use of ten military roads that passed through the country,
but the Austrian and Russian leaders frequently ignored these
instructions. Consequently the pestilence spread over the entire region,
a fact which Seitz confirms with numerous specific instances; regarding
the extent to which it raged in Munich, he gives us no information.

Typhus fever was conveyed to Regensburg by French prisoners. ‘Toward the
end of the month [December],’ says Schäfer,[161] ‘typhus fever was
conveyed to Regensburg by French prisoners, some of them sick and some
of them well, but all of them scantily clad and half-starved. They were
quartered in the dance-halls, and those that were sick were taken to a
convent which had been hastily converted into a hospital. There the
civil inhabitants, owing to the lack of appropriate arrangements, were
obliged to distribute food among the sick, and the result was that the
fever finally became general. Not until then was the advice which the
physicians had given at the beginning heeded; they had urged, namely,
that the patients should be cared for by the hospital-attendants
themselves, that each one should have his own separate attendant, and
that only those persons should be allowed to enter the hospital whose
presence was absolutely necessary.’ By February, according to the
official report, 308 persons, all told, contracted typhus fever in
Regensburg, and 51 succumbed to it.

In Ingolstadt an unusually severe epidemic broke out after the arrival
of the French prisoners. In the first part of December the number of
prisoners that died every day was no less than ninety, but after the
middle of the month the mortality was somewhat lower. On December 18
there were 845 typhus-fever patients in the hospitals, and the number of
deaths on this day amounted to only twenty-seven. From then to the end
of the month only fifteen or twenty persons died per diem. On December
10 several civilians contracted the disease; on December 18 the number
of civilians suffering from the disease was thirty-six, and about an
equal number on December 30. The total number of deaths among the
prisoners of war amounted to 2,000. Typhus fever also appeared along the
Danube on both sides of Ingolstadt.

In the course of the winter, typhus fever was also borne into southern
Bavaria by Austrian troops; it broke out in the towns along the military
road, e.g., in Vöcklabruck, Traunstein, Rosenheim, and Landsberg. Places
which the soldiers did not visit were also attacked by the pestilence.
In Weilheim (west of Lake Starnberg) the disease broke out repeatedly
after soldiers had marched through the place; up to April 8 no less than
885 persons had contracted the disease there, and some 100 had succumbed
to it.

According to Seitz, 18,427 cases of the disease and 3,084 deaths
attributable to it were officially recorded in Bavaria between October
1813 and June 1814; the lists kept by the Governmental Districts were
undoubtedly very incomplete, but on the other hand we must assume that
the contagious and non-contagious ‘nerve-fevers’ (typhus and typhoid)
were not always distinguished. For the several districts Seitz furnishes
us with the following figures relating to the number of people who
contracted and succumbed to typhus fever:

           _The Region of the_ _No. Patients._ _No. Deaths._
           Main                          5,752         1,067
           Rezat                         2,135            32
           Regen                         1,627           290
           Upper Danube                  4,613         1,003
           Lower Danube                  1,338           270
           Salzach                       1,815           259
           Isar                          1,147           163

This does not include the number of deaths among the prisoners of war,
nor among the native and foreign soldiers. For the Main region, Seitz
also furnishes figures relating to the age of the patients; of the 5,752
persons who contracted the disease 453 were children, 1,345 were young
men and women, 3,657 were of middle age, and 297 were old men and women.

As in Bavaria, so also in Württemberg, typhus fever broke out in two
epidemics; the first, which was less extensive and less severe, was
caused by soldiers returning from Russia, and the second broke out in
consequence of the passing of troops through the country after the
battle of Leipzig. According to Elsässer,[162] in the first part of the
year 1813 there were 165 cases of typhus fever and twenty deaths due to
it reported from fifteen different localities. In the month of July the
disease disappeared from Württemberg. At the end of the year 1813,
however, the disease was again borne into the country, partly by French
prisoners, and partly by Russian soldiers. ‘Throughout Württemberg’,
says Lohnes,[163] ‘this fever appeared wherever foreign troops had
tarried. Consequently contagious typhus first appeared in the northern
lowlands, while the region around Tübingen and the southern and eastern
part of the country at the beginning did not suffer at all. But in
December, when large bodies of troops marched through the highlands, the
southern part of Württemberg, these fevers followed the soldiers’ lines
of march. At first it was the French prisoners who carried lazaret-fever
with them wherever they went, and a very severe form of the disease too;
later on, these fevers always broke out wherever the Russian soldiers
went, although very few of the soldiers themselves were infected with
them. Frequently persons contracted the disease who had no sick soldiers
in their homes. As a rule the disease in such cases was mild, but it was
very dangerous wherever patients were left or congregated in large or
small hospitals.’

As early as the month of February, the disease had reached its climax in
Württemberg; in March it began to abate rapidly, so that in the first
part of the summer only 150 patients could be counted in fifteen
Governmental Districts. From then until the end of the year it broke out
only sporadically. Braun,[164] who asserts that more than half of the
physicians in Württemberg contracted typhus fever, mentions the names
and residences of seventeen physicians who succumbed to it; we see from
this list that the disease was prevalent throughout all Württemberg. The
disease was also conveyed to the southern part of Upper Swabia.
According to Dillenius, 1,300 sick soldiers were sent in the first part
of the year 1814 from France (especially from Mülhausen in Alsace) to
the military hospital at Tettnang; twenty-four of them died on the way,
and in the course of the following four months five times as many
succumbed to typhus fever in the hospital.[165]

Baden suffered severely from typhus fever; in Karlsruhe, for instance,
typhus fever raged from October to December 1813. But Baden suffered
particularly, for the reason that all the sick soldiers in the Bohemian
army were sent back there from France. Their number far exceeded all
expectations, since typhus fever was uncommonly prevalent in the field
army in France, and the soldiers arriving from there infected the
hospitals. Even when the Austrian and Russian troops marched through the
country the number of ‘nerve-fever’ patients was very large. Freiburg im
Breisgau, at that time a city of 9,000 inhabitants, suffered very
severely in consequence of enforced quartering; some 210,000 soldiers
were housed in the homes of its citizens. In the garrison lazaret and
university hospital, which together had room for 500 patients, no less
than 1,200 patients were crowded together in December 1813; almost all
of them were suffering from diarrhoea and typhus, and owing to the lack
of linen they were compelled to lie in their own dirty clothes on sacks
of straw. Every morning two large wagonloads of dead bodies were driven
away for burial. As usual, the pestilence spread to the civil
population, carrying away entire families. On October 12, 1813, the
former Abbey of Thennenbach was converted into a military lazaret, in
which two weeks later some 1,200 patients were sheltered, although it
had adequate room for only 700. Between December 27, 1813, and March
1814, 567 soldiers succumbed there, most of them to typhus and
dysentery. The epidemic reached its climax about the middle of January,
when as many as thirty persons died per diem. After the middle of
January the number of deaths rapidly decreased.[166] Northern Baden was
also attacked. In Mannheim the sick and wounded French soldiers who
arrived after the battles of Lützen and Bautzen were led around the city
and taken to Spires. Thus typhus fever did not appear in Mannheim
itself, where the condition of health was subsequently also good. The
statement of the _Rheinische Merkur_, that out of 13,000 patients in the
military lazarets in Mannheim 3,347 died, according to Gurlt,[167] is
incorrect; the number of deaths was no more than 346.

Regarding the total number of deaths due to typhus fever in Baden no
information is available; at all events it was very large. This is shown
by the fact that in the last part of 1813 and first part of 1814 no less
than thirty-five physicians and thirty surgeons of the first class fell
victims to the pestilence.[168]

In November 1813, thousands of scattered French prisoners came to
Darmstadt; many of them were suffering from typhus fever, which soon
spread throughout the city. Many places in that part of the present
Grand Duchy of Hesse which lies south of the Main were severely attacked
by the epidemic; as many as 2,000 or 3,000 inhabitants of many places
contracted the disease. But by July 5, 1814, it had everywhere
disappeared.[169]


 5. TYPHUS FEVER ON THE LEFT BANK OF THE RHINE; FRANCE AND SWITZERLAND

The continued retreat of the French army passed from Mayence through
Metz to Paris, and the route of the retreat was marked by patients left
behind. In this way the epidemic of typhus fever was quickly
transplanted to the north-eastern part of France. Alsace-Lorraine, the
Palatinate, Champagne, and Burgundy were all attacked in succession. The
epidemic raged from Kreuznach to Strassburg; the dispersion of the
retreating army caused even the smallest villages to suffer, so that the
pestilence appeared in Worms, Frankenthal, Spires, Oppenheim,
Neustadt-on-the-Hardt, Dürkheim, Landau, Alzey, Trabach, Zweibrücken,
Weissenburg, Hagenau, Zabern, and in other places. Mörs (near
Frankenthal) was almost completely wiped out.[170] The following places
in France are mentioned as having been attacked by the pestilence:
Saint-Avold, Courcelles-Chaussy, Mars-la-Tour, Sierck, Cattenom,
Pont-à-Mousson, Toul, Nancy, Étain, Verdun, Bar, Longwy, and Sedan.
Thouvenel describes the epidemic of typhus fever in Pont-à-Mousson,
which broke out in December 1813, when transports of sick soldiers
arrived there, and spread to all the surrounding towns and villages; it
increased in severity until the middle of March, and by June had almost
disappeared. He describes in emotional language the endless succession
of wagons that arrived every day:[171]


  Who of us will not remember as long as he lives those harrowing
  scenes, which one cannot describe without shuddering? Who will ever
  forget those hundreds of wagons filled with unhappy wounded men who
  had had no medical care since leaving Leipzig; and packed in with
  them were sick men suffering from dysentery, typhus fever, &c.,
  almost all of them dying of inanition, weakness, and filth, as well
  as of disease. Those unfortunate men piteously begged only for a
  place in a hospital already filled with dying men, only to receive
  in reply a forced refusal. And so they were under the cruel
  necessity of going further to die, with the result that they
  infected all the towns and villages along their route, wherever they
  were granted a generous hospitality.


Strassburg, comparatively speaking, suffered but little. As early as
December 1, the prefect of Strassburg had issued orders that a special
building should be set aside in every town for the reception of sick
soldiers that arrived there, and that they should under no circumstances
be housed in the homes of citizens. In October and November
convalescents had been quartered in the residences of citizens, who had
subsequently been infected. In November the number of typhus-fever
patients, which averaged ten or fifteen per month, increased to
thirty-six, and in December to 100. In accordance with the
above-mentioned decree all newly-arrived soldiers were examined by a
Board of Health; the sick were sent to the hospital, and the healthy
were quartered with citizens. ‘Notwithstanding this,’ says
Reisseisen,[172] ‘the healthy ones infected a large number of
inhabitants through their old woollen overcoats, which were thoroughly
saturated with the miasma of the hospitals. The clothes that were sold
privately were particularly dangerous, so that in the latter part of
December strict orders were issued to keep watch for the old clothes and
burn them. In the first part of January, when the rather lax siege
began, typhus fever spread irresistibly throughout the city; in that
month the pestilence reached its climax with 175 deaths. On January 22
the prefects ordered general fumigations in all public buildings, and
recommended that the citizens should also fumigate their homes. The
result was very successful; in February 112 people died, in March 75,
and in April 27, and then typhus fever disappeared. No foreign troops
marched through the stronghold, and although all the French prisoners of
war passed through the city, no more citizens were infected by them, for
the reason that they were quartered in the fortifications.

The devastation caused by the pestilence in Metz was no less than
frightful. Maréchal and Didion[173] give us a picture of this severe
epidemic. On November 19, 1813, some 5,000 sick soldiers were assigned
to that city; it was necessary to see that they were sheltered, and at
the same time measures were adopted to prevent the disease from
spreading. According to the report of the astute Mayor of Metz, Baron
Marchant, the 5,000 soldiers, all of them suffering from an infectious
disease, arrived, and sixty of them died every day. All the physicians
in Metz contracted the disease, and several of them died. It was
impossible to procure sick-attendants, since those who had performed
this service had all contracted the disease, conveyed it home, and
infected their families. Sick soldiers who were quartered privately, and
particularly convalescents, also helped to spread the disease throughout
the city; more than 150 houses were infected. In the latter part of
December the number of patients greatly increased. On January 1, 1814,
after Blücher had crossed the Rhine, the Germans marched against Metz,
and then an enormous crowd of people from the surrounding country fled
to that city for protection. This caused typhus fever to spread far and
wide throughout the city. Furthermore, sick and exhausted soldiers were
constantly being sent to Metz, and it is estimated that some 30,000 of
them arrived there. The worst month was February, and 7,752 soldiers,
all told, died in six months:

                             November   463
                             December 1,602
                             January  1,360
                             February 2,365
                             March    1,622
                             April      340

1,294 civilians also died, the largest number (371) likewise in
February. In the entire Department of Moselle, which at that time had
some 400,000 inhabitants, no less than 10,329 people succumbed to this
epidemic, and this number does not include the soldiers.

Regarding the wide dissemination of typhus fever in the Departments east
and south of Paris, which formed the scene of the war in the first part
of the year 1814 (the Departments of Haute-Marne, Côte-d’Or, Aube,
Yonne, Marne, Seine-et-Marne), no further information is available.
Troyes, Besançon, Dijon, Avallon, and Auxerre are mentioned as places
that were attacked by the pestilence.

In Paris, cases of typhus fever occurred in February, when the war moved
closer to that city. The sick and wounded soldiers were consequently
obliged to go to the hospitals in Paris; but since these were neither
large nor numerous enough to accommodate so many patients, it became
necessary to open several provisional hospitals in appropriate
buildings. At first all the typhus-fever patients were taken to the
Hôpital de la Pitié, but it soon became necessary to change this policy,
since the disease had spread throughout all the wards of that building.
In the latter part of February the first cases of typhus fever appeared
in the city, in consequence of the return of many soldiers to their own
families. In March more and more people contracted the disease, which
toward the end of the month was raging furiously, though more in the
hospitals than in the city. In the Hospice de la Salpêtrière, which had
been converted into a military hospital and began to be used on February
9, 1814, a small number of persons contracted typhus fever in the latter
part of March, and in the months of April and May the disease spread;
after that, however, it began to abate. A great many nurses and
attendants were taken sick.[174] In April a large number of people in
the city were lying sick with typhus fever. In one boarding-school, from
which several persons visited the hospitals and brought typhus fever
home with them, thirty people contracted the disease and four succumbed
to it. In May cases of typhus fever became more rare, and in August no
more people contracted the disease. The mortality in Paris in the year
1814 was very high; whereas in the years 1812 and 1813 the number of
deaths had been 20,133 and 18,676 respectively, in the year 1814 no less
than 27,778 people died, which number includes 2,559 soldiers that died
in the hospitals. In the year 1815 the number of deaths decreased again
to 19,992. How large the number of deaths due to typhus fever was, it is
impossible to state with certainty, since in the case of only a small
number of the persons who actually died of typhus fever was that disease
recorded as the cause of death. The rubric ‘fièvres putrides et
adynamiques’ increased in the year 1813 from 1,337 deaths to 2,860
deaths, and the rubric ‘fièvres malignes ou ataxiques’ from 804 to
1,376.[175]

Owing to the overcrowded condition of the hospitals in Paris, soldiers
were conveyed upon a number of boats on the Seine to Rouen. Since sick
and wounded men were thus transported together, typhus fever was
conveyed to Rouen, where it carried away large numbers of persons
employed in the hospitals. In the same way, sick and wounded were
transported to points on the Loire, causing typhus fever to spread to
Tours, where 860 soldiers succumbed to it.[176]

The proximity of the scene of the war in January and February 1813
caused typhus fever to break out in the Swiss Cantons lying close to the
French border; for example, in the cantons of Basel-Stadt, Basel-Land,
Neuenburg, Solothurn, and Waadt. The number of deaths in these cantons
was:[177]

 _Year._ _Basel-Stadt._ _Basel-Land._ _Neuenburg._ _Solothurn._ _Waadt._
  1812              442           867        1,041        1,349    3,705
  1813              425           748        1,014        1,072    3,186
  1814              721         1,679        1,335        1,844    3,475
  1815              479           812        1,220        1,240    3,267
  1816              355           710        1,234                 3,720

According to A. Burckhardt,[178] lazaret-fever broke out in Basel with
extraordinary fury when the Allies passed through that city; it raged
particularly among the foreign soldiers, but also attacked the
attendants in the hospitals and the civil inhabitants. The number of
deaths caused by it is unknown.


         6. TYPHUS FEVER IN AUSTRIA IN THE YEARS 1813–14.[179]

The country in Austria which was most exposed to the ravages of the
epidemic of typhus fever was Bohemia, along whose borders the war was
for a long time carried on. As early as February 1813, ‘nerve-fever’,
accompanied by petechiae, was borne by Bavarian and Prussian troops into
the district of Königgrätz, but thanks to energetic and strict measures
of precaution, it did not become very widespread. The principal outbreak
of the epidemic in Bohemia took place in the autumn of the year 1813.
The number of typhus-fever patients taken into the Prague hospital in
September 1813 was 39, in October 77, in November 196, and in December
287.[180] The region along the Saxon border suffered the most: e.g. the
districts of Leitmeritz, Saaz, Rakonitz, and Elbogen. In the Leitmeritz
district typhus appeared in August, and became more severe in September
and October; the places along the military road leading from Dresden to
Prague were particularly hard hit. The epidemic lasted until April. In
the near-by Kaurzim district sick and wounded soldiers of all nations
arrived, after the battles of Pirna, Dresden, and Kulm, causing a
virulent epidemic to break out everywhere; in many places all the
inhabitants contracted it. In the latter part of the year, when the
pestilence seemed to have abated a little, it broke out anew when the
French garrison was being taken from Dresden to its place of detention;
in fourteen days 2,422 persons in sixty places contracted the disease,
which disappeared in May. Typhus fever had spread over 103 localities,
all told, in that region, and of 8,066 people who contracted it, 751
succumbed. In the Saaz district typhus broke out in the last part of
October 1813, and carried away large numbers of people; it raged all
along the military road in the vicinity of the scene of the war. The
highest mortality was in the month of December, and in May the
pestilence disappeared. In the Rakonitz district entire communities lay
sick in the first part of the year, but in April no new cases of the
disease occurred. In the Elbogen district typhus fever broke out in
September 1813 in the city of Eger, in consequence of the arrival of
French prisoners and fugitives; the epidemic soon spread over the entire
district, and lasted until March 1814.

The rest of Bohemia suffered less severely from typhus fever in the
winter of 1813–14. In the Beraun district, lying to the south-west of
Prague, it began in October 1813, when the homes of the citizens became
crowded with convalescing soldiers; the epidemic came to an end in March
1814. The number of people who contracted the disease was 3,807, while
the number who succumbed was 296. The adjacent districts of Pilsen and
Kattau were likewise attacked; in the Pilsen district typhus fever broke
out in October 1813, in consequence of the arrival of French prisoners;
a number of places were infected by them, so that in November and
December it developed into an epidemic, which lasted until April. Of
1,185 people who contracted the disease, 237 died. In the Kattau
district 645 contracted the disease and 132 succumbed.

In the eastern part of the country the districts of Tabor and Czaslau
were severely attacked. ‘In the Tabor district’, we read in the
above-mentioned report,[181] ‘there appeared in the month of August at
Neuhaus, where a field-hospital had been erected, several biliary-mucous
nerve-fevers, which broke out in numerous places along the road to
Prague, soon spread to the Tabor district, and became epidemic. They
quickly revealed their presence in all places where sick soldiers passed
the night, or where the natives took part in the transportation of sick
soldiers.’ The climax of the epidemic was in January, and in the middle
of May it disappeared; of 4,267 people who contracted the disease, 448
succumbed. In the Czaslau district, adjacent to the Tabor district on
the north, the disease was disseminated in November 1813 by transports
of prisoners and troops, by the quartering of convalescents in the homes
of peasants, and by peasants who helped to transport sick soldiers. On
December 16, 1813, no less than 4,313 civilians in thirteen places were
suffering from typhus fever. The highest mortality prevailed in the
vicinity of the hospitals; the epidemic disappeared with the arrival of
spring.

Typhus fever was also conveyed into various parts of Moravia,[182]
partly by Austrian troops, and partly by French prisoners; in the
districts of Brünn, Iglau, Olmütz, and Teschen it broke out in numerous
places. In twelve communities in these districts, having a combined
population of 28,267, some 2,126 people contracted the disease between
December 1813 and the summer of 1814, and 207 persons succumbed. In
March the epidemic disappeared almost everywhere. According to the
figures compiled by J. Hain,[183] the number of deaths in Moravia and
Austrian-Silesia together was:

                          July (1813)    3,818
                          August         3,893
                          September      3,888
                          October        4,059
                          November       4,457
                          December       5,202
                          January (1814) 8,280
                          February       7,249
                          March          7,756
                          April          5,464
                          May            5,541
                          June           4,147

In Lower Austria typhus fever also broke out, particularly in Vienna;
the number of deaths there was:

                    _Due to typhus fever._ _All deaths._
               1813          784              12,971
               1814         1,529             15,309

In the rest of the country few diseases appeared, despite the fact that
troops kept marching back and forth.

Typhus fever was conveyed by marching troops to Styria also; the source
of the pestilence was the seven military hospitals in Graz. We read in
the report:[184] ‘The pestilence, proceeding principally from the seven
military hospitals lying within the city limits as from a focus, was
spread abroad by convalescents, attendants, physicians, &c. The
mortality in these hospitals was extremely high; the buildings set aside
for the purpose could scarcely accommodate the number of sick.
Everything was topsy-turvy; the corps of field-doctors on hand was not
nearly large enough to take even the most necessary care of the large
number of patients.’ The region around Graz, Marburg, and Bruck was most
severely attacked by the disease, which also spread to Carinthia and
broke out in Klagenfurt and vicinity.


     7. SURVEY OF THE EPIDEMIC OF TYPHUS FEVER IN THE YEARS 1813–14

It is impossible to draw an accurate picture of the loss of human life
which typhus fever caused in the years 1813–14. This is due, on the one
hand, to the lack of reliable statistics, and, on the other hand, to the
fact that the several regions suffered to a varying degree, depending
upon the number of troops, prisoners, and refugees that they received.
The number of persons that succumbed to typhus fever in Germany during
the years 1813–14 must be estimated at least as high as 200,000 or
300,000. Assuming that 200,000 people succumbed to the disease, the
number that contracted it would amount to some 2,000,000. Since Germany
at that time had hardly more than 20,000,000 inhabitants, some ten per
cent of them, on the basis of this assumption, contracted the disease.
The size of this number is significant, when we consider that the
stronger and older people manifested particular susceptibility to the
disease.

One of the chief causes of the wide dissemination of typhus fever in the
years 1813–14 was the imperfect development of the lazaret system. If at
first a lazaret for infectious diseases was available, the number of
patients it was called upon to accommodate in a few days became so large
that new buildings always had to be opened for them, and it was
impossible to keep them isolated. The efforts of the various municipal
administrations to have the lazarets erected outside the city limits
were powerless against the brutal obstinacy of the French, and, later,
of the Russian generals. The severity of the penalty which they had to
pay for unceremoniously housing infected French troops in strongholds
together with healthy men, is evident from the fearful devastation
caused by typhus fever in Danzig, Torgau, Mayence, &c. The little
communities were absolutely helpless against the dominating power of the
soldiers. One might reproach the municipal administrations of that time
with failing to adopt measures of prevention against the menacing danger
of pestilence, particularly in places which did not suffer in
consequence of the marching back and forth of soldiers. But one must
take into account the excitement which permeated the entire people at
that time—the hopeful longing to be freed from the national enemy’s long
oppression, toward which all thinking and planning was directed, the
employment of all resources for this purpose, and in particular the fact
that sheer ignorance rendered appropriate measures impossible. If this
ignorance prevailed in the highest places, nothing better was to be
expected of the administrations of the smaller cities and towns. The
population was therefore everywhere defenceless against the intrusion of
the pestilence, which was given an opportunity to become more and more
widespread. This, however, had not been the case in Central Europe since
the Thirty Years’ War.




                              CHAPTER VII
           FROM THE AGE OF NAPOLEON TO THE FRANCO-GERMAN WAR


                   1. THE RUSSO-TURKISH WAR OF 1828–9

On April 28, 1828, Russia declared war against Turkey; the fighting took
place partly in the Balkan Peninsula, in Wallachia and Bulgaria, and
partly in Transcaucasia. In the western scene of the war, the Russians,
after the capture of Varna and the futile siege of Schumla in the
campaign of the year 1828, were obliged to retire to the left bank of
the Danube; in the second campaign (1829) Diebitsch defeated the Turks
at Kulevtchi, marched across the Balkan Peninsula, and appeared
unexpectedly at Adrianople, which the Turks surrendered to him without
resistance.

An unusually severe epidemic of bubonic plague accompanied this
campaign. In the year 1828 plague had spread from Asia Minor to European
Turkey and Wallachia; as early as 1825 and 1826 it appeared in
Bucharest, while sporadic cases of the disease occurred in Wallachia in
the summer of 1827 and in the winter of 1827–8.[185] On April 30, 1828,
the first Russian troops made their appearance in Bucharest; they were
quartered in the city itself and in the surrounding villages. On May 13
seven cases of plague appeared in a private house, but the Bucharest
physicians did not hold the disease to be plague. Orders to disinfect
the houses were issued, but intercourse with the surrounding villages
was not stopped. Some thirty inhabitants succumbed to the pestilence in
May, and at the end of that month three Russian soldiers were allowed to
enter the city. Since the number of cases in the city was increasing,
the troops stationed there were quartered in the village of Fundeni,
where, however, several more people soon contracted the disease. During
the month of May, plague broke out in other villages of Wallachia, and
in the course of the summer and autumn it spread throughout the entire
country. In regard to the origin of this epidemic of plague, Simon[186]
says: ‘All Wallachia was infected from the year 1826; but had it not
been for the war and the consequent afflictions of all kinds, the
disease would not have developed in the year 1828 into such a furious
and extensive epidemic. The arrival of the Russians was responsible for
this widespread outbreak, since they carried the infection contracted
from the inhabitants to a thousand different places.’

The removal of the troops to Fundeni temporarily checked the
dissemination of plague in Bucharest, but in the middle of August it
broke out again, presumably in consequence of the arrival of more troops
from the scene of the war; some thirty or forty villages were attacked
by this epidemic, which lasted until the middle of November. In January
1829, plague was conveyed by troops to Moldau and Jassy, which they were
to make their winter quarters; but the disease, notwithstanding the fact
that it was wrongly diagnosed and declared to be typhus fever, was soon
checked by energetic measures of precaution. Regarding the number of
plague patients in the Russian army, which was also attacked by several
other diseases, especially malaria, diarrhoea, dysentery, and fever, no
information is available; the Russian army numbered 150,000 men, and,
according to Seidlitz, 134,882 men were received into the lazarets and
75,226 men into the regimental sick-rooms up to the end of February
1829; thus 210,108 men contracted disease in a period of ten
months.[187]

In March 1829, plague broke out anew. Surgeon-General Witt, who had his
head-quarters in Jassy, declared that the disease was not plague, but an
endemic fever, and put an end to all measures of precaution in March.
‘After the patients were no longer quarantined,’ says Czetyrkin,[188]
‘the disease, bringing destruction in its train, in the spring and
summer began to make headway and spread over Moldavia, Wallachia, and
Bulgaria; it also accompanied the Russian army across the Balkan
Peninsula and appeared in Rumelia, where it completely wiped out several
hospitals. Those divisions of the army which were kept constantly on the
march and were thus exposed to the fresh air, rain, and dew, suffered
less severely; but the garrisons in the cities and strongholds were more
furiously attacked by the dreaded enemy. The overcrowded condition of
the lazarets, the lack of competent nurses and physicians (most of whom
were exterminated by plague), the uncertainty regarding the nature of
the disease—all this constituted the reason why the pestilence could not
be checked.’

The disease first appeared in March 1829 throughout Wallachia, but after
the middle of May it also revealed its presence south of the Danube;
Galatz, Babadag, Kustendji, Mangalia, Bazardschik, and Kavarna were
attacked in succession.

Varna suffered very severely; according to Petersenn, the first cases
occurred there in May 1829, in the infantry regiment Witepsk. The
patients were housed in tents on the sea-shore outside the city, and
since the number of people who contracted the disease continued to
increase, all the patients in the hospitals were soon taken there. The
city was finally completely evacuated and closed up, after the
inhabitants had been assigned to definite places to live in the open
fields and in a near-by forest. The plague reached its climax in the
latter part of June. ‘There was not a hospital,’ says Petersenn,[189]
‘not a quarter of the city, not a division of troops, not a family, not
a single place, which had escaped infection, and everywhere one came
across victims of the pestilence, some dying and some dead; for it
spared neither sex nor age nor class.’ And in another place the same
physician says:[190] ‘If the inside of the plague-camp afforded a
terrible sight, where sick men tossed about, gasping in the burning
summer heat, between the dead and dying, the conditions outside of the
plague-camp were no more pleasant to witness; for along the roads from
the city to the hospitals, on fields and meadows, behind every shrub, in
every ditch, dead and dying men were stretched out everywhere.’ And
Seidlitz, who visited Varna when the plague was at its height, asserts
that the corpses were piled up ‘like logs’ and carried away ‘by
cartloads’. According to Petersenn,[191] the number of patients that
died in the plague-hospital at Varna was:

                       From June 5 to 30   2,238
                       From July 1 to 31   1,484
                       From August 1 to 26   210

At the end of August there were only a few plague-patients in Varna. Of
forty-one physicians, twenty-eight contracted the disease and twenty
succumbed to it.

Conditions were as bad in many other places as they were in Varna;
Slobodzie, Kustendji, and Mangalia were likewise devastated. In Brailow
the first cases of plague occurred in March; in April 132 persons
succumbed to the disease, in May 150, in June 774, and in July the
pestilence abated.[192]

After the Russians crossed the Balkan Peninsula in the summer of 1829,
Adrianople, which was reached on August 12, 1829, was free from plague,
and it remained free until the end of the war. In the first part of
November, however, the plague broke out there in the large old barrack
which had been converted into a hospital and had become greatly
overcrowded. Patients, especially persons suffering from dysentery, had
been sent there from all sides, so that their number had increased on
August 17 to 1,616, on August 27 to 3,666, and on September 1 to 4,641.
On November 1, when the head-quarters were removed from there, 6,000
sick and healthy persons were left behind, the great majority of whom
fell victims to the plague. According to Rinck, in the latter part of
November ten or twenty soldiers suffering from plague were taken there
every day, and in the middle of December not one of the 300 sick-rooms
was spared; from fifty to sixty plague-patients were taken in every day
at this time.[193] In the middle of January 1830 the fury of the disease
abated a little among the Russians, but it raged more and more
destructively among the civil inhabitants, who numbered some 80,000. In
almost all the army-divisions stationed south of the Balkans, plague
broke out in the winter of 1829–30; the entire army, therefore, before
returning to Russia, had to be quarantined twice for a period of
twenty-one days.

Plague also revealed its presence in Transcaucasia, where fighting was
likewise going on. In Armenia it had broken out shortly before the
beginning of the Russo-Turkish War, as also in Erzerum. The
reinforcements coming from there had brought plague to Kars, where it
spread rapidly in the Turkish army.[194] In June 1828, when the
stronghold of Kars was stormed, the disease was borne by Turkish
prisoners back to the Russian army; but the strict measures of
Field-Marshal Count Paskewitsch prevented it from spreading further in
the army.[195] But the inhabitants of Kars resisted these orders, and
the result was that plague continued to rage there, partly in the
garrison, which in twenty days had 530 plague-patients, and partly among
the inhabitants, until September. The plague was conveyed by Turkish
prisoners to Eriwan, to the region of Tiflis, and to other places. In
the stronghold of Achalzich, situated midway between Batum and Tiflis,
plague broke out in the year 1829; in the latter part of February the
stronghold was besieged by the Turks, who were infected with plague. In
consequence of a sortie of the small garrison on March 6, which resulted
in the withdrawal of the Turks, since at the same time Russian
reinforcements were approaching, the plague was conveyed to Achalzich,
where the first cases occurred on March 10 in the garrison, and shortly
afterwards among the inhabitants. On May 23 that part of the garrison
which had been spared by the plague was marched out into the open
country, and the stronghold was thoroughly cleansed, after which no more
cases were reported. In the fall of 1829 plague completely disappeared
from among the Transcaucasian troops, and from the territory under their
control.


                      2. THE CRIMEAN WAR (1854–6)

The Crimean War plays a very conspicuous rôle in the history of
war-pestilences and of military sanitation; on the one hand, it showed
how severe a penalty an army has to pay if, without measures of
precaution, troops are sent to the scene of the war from infected
localities; on the other hand, it showed that it is possible to prevent
serious outbreaks of pestilence if energetic measures are adopted to
provide good food and shelter for the troops. Whereas the English
soldiers suffered a great deal more from pestilence in the first winter
than the French soldiers, in the second winter, in consequence of great
improvements introduced in the housing, clothing, and feeding of troops,
the English suffered very little, while the French suffered severely.

In the year 1853 cholera made its appearance in several places in
France, and in the following year it spread over the entire country; it
raged most furiously in the southern districts. Since the French troops,
who were embarked at Toulon and Marseilles, were consequently infected
with cholera, those suffering from the disease had to be put ashore from
the first transport ship at Malta, and others at the Peiraeus. When the
troops disembarked at Gallipoli there were thirteen cholera-patients
among them, and these were presently followed by other cases. Sporadic
cases of cholera then began to occur wherever the French soldiers went,
as in Nagara, Varna, Adrianople, &c. The fact that the disease was borne
thither by French troops was frankly admitted by most of the French
military physicians; only a few, for example, Cazalas, assumed that the
disease was already prevalent in Dobrudja.[196]

During the expedition undertaken by the French soldiers to the unhealthy
and deserted district of Dobrudja, cholera broke out in the army like an
explosion, compelling it to return. The English soldiers during the
siege of Varna, and also parts of the English fleet, were likewise
attacked by cholera. Statements made by Scrive and Chenu regarding the
number of French soldiers that succumbed to the pestilence diverge
widely; according to Scrive, the French army, which numbered some 55,000
men, lost 5,183 men between July 3 and August 30, 1854, in consequence
of cholera,[197] while Chenu gives us the following statistics:[198]

                           _No. patients._ _No. deaths._
               July (1854)           8,239         5,030
               August                3,043         3,015
               September               376           239

The English army, which numbered some 30,000 men, also suffered:[199]

                           _No. patients._ _No. deaths._
               July (1854)             449           285
               August                  938           611
               September             1,232           575
               October                 445           273

In September the scene of the war was transferred to the Crimea, but
there again cholera raged furiously in both armies; in the winter of
1854–5, to be sure, it carried away a relatively small number of men,
but in the summer of 1855 it broke out anew with great severity. The
total number of deaths in the French army during the entire campaign was
12,467, in the English army 4,513, and in the Piedmontese army 1,230.
The size of the armies varied greatly; the French army was largest in
the latter part of the year 1855, when it numbered 145,000 men; the
total number of English soldiers was 97,864, and that of Piedmontese
soldiers, 21,000.

According to Häsar,[200] cholera spread far and wide from the scene of
the war—throughout Turkey, around the Black Sea, in Greece, in Smyrna,
along the coast of the Dardanelles, in Constantinople, Odessa, Rumelia,
and in the Danube principalities; the inhabitants of the district of
Dobrudja also suffered severely from the pestilence, which after the war
spread over a large part of Russia.

Scurvy also raged in the French army in the dry summer of the year 1855,
as well as in the severe winter following. In August 1855 there were
2,581 scurvy patients in the army, which was the largest number in the
summer months, and in February there were 4,341, the largest number in
the winter months. The outbreak of scurvy among the English troops, who
also suffered from the disease in the winter of 1854–5, was later
checked by the consumption of better food.

Dysentery was also very common: 6,105 French soldiers suffering from
that disease in the Crimea were taken to the field-lazarets; 2,061 died
there, and 2,792 were removed to Constantinople. No less than 7,883
English soldiers contracted acute and chronic dysentery, and 2,143
succumbed to it.

As early as the winter of 1854–5 a small number of cases of typhus fever
occurred among the French and English soldiers; but not until the winter
of 1855–6, between the months of December and March, did the disease
become very widespread in the French army in consequence of unfavourable
living conditions; the English army, on the other hand, scarcely
suffered at all during that winter. Scrive and Chenu publish the
following statistics relating to the French army in the field-lazarets
of the Crimea:


    _Months._      _Size of     _Typhus       _Taken to         _No.
                    army._       fever     Constantinople._   deaths._
                               patients._
 December (1855)      145,120          734              204          323
 January (1856)       144,512        1,523              320          464
 February             132,800        3,402              925        1,435
 March                121,000        3,457            1,140        1,830
 April                105,000          237                           101
 May                   67,000           38                            17

According to Scrive, 11,124 typhus-fever patients, all told, were taken
into the field-lazarets of the Crimea between September 1854 and July
1856; of these, 3,840 were removed to Constantinople, and 6,018 died in
the field-lazarets.[201] But Scrive says that this number of
typhus-fever patients is too small; it must have been increased by the
number of persons who contracted the disease in the field-lazarets and
hospitals, 4,502 of whom succumbed to it, and the number who contracted
and succumbed to it in Constantinople and France, making 7,000 all told.
According to Scrive, therefore, the total number of deaths due to typhus
fever in the French army was no less than 17,515, from which he assumes
that at least 35,000 men contracted the disease.[202]

In the English army typhus fever appeared only sporadically in the
winter of 1855–6; according to Chenu, 167 men contracted the disease and
62 succumbed to it.[203]

Among the Russian troops typhus fever raged furiously,[204] and
according to A. Hirsch it was also very widespread in southern
Russia.[205]

In Constantinople, typhus fever, although it infected numerous persons
in the military hospitals, apparently did not spread to the civil
population. Baudens, who after the capture of Sebastopol came to the
Orient, says expressly that the inhabitants of Constantinople were
spared by the epidemic during its entire course.[206]

According to Murchison, typhus fever was borne by English troops to
English soil, where in the years 1856–7 it caused epidemics in various
parts of the country. The following table indicates the number of
typhus-fever patients taken into the Fever Hospital in London:

                               1854   337
                               1855   342
                               1856 1,062
                               1857   274
                               1858    15

The increased number in London was not due to the fact that the disease
was brought over from Ireland, since there were only fifty-three
Irishmen among the patients, and only two of them had been in the city
less than three months. On the other hand, the warlike events caused a
famine, resulting in much misery among the poor, and this favoured the
further dissemination of the disease.[207]

When the French troops were transported back to France, energetic and
extensive measures of precaution were adopted; only those troops were
allowed to embark who had for several weeks been entirely recovered from
typhus fever; several stations for the discharge of men who contracted
the disease on the way were located along the coast of the Mediterranean
Sea, and sixty-two patients, all told, were left behind at them;
suspected divisions of troops, before disembarking at Marseilles, were
quarantined for a time on several islands along the coast, on St.
Marguerite (Îles de Lérins), on the Îles d’Hyères, and on others, and
before entering the city they were examined again, bathed, and
reclothed. The result was successful. Laveran says:[208] ‘The further
one went away from the seat of the infection, and the more the soldiers
scattered, the more the miasm seemed to lose strength; in France the
typhus-fever patients gave rise to only a few cases inside the hospitals
where they were being cared for; the disease was never communicated to
the civil population.’

Sporadic cases were observed in Marseilles, Toulon, Avignon,
Chalon-sur-Saône, and in other places. A small lazaret-epidemic also
occurred in Paris in the Val-de-Grâce; according to Godelier,[209]
almost all the patients there belonged to the Fiftieth Regiment, which
on November 30, 1855, embarked at Kamiesch. The condition of health in
the regiment at that time was good, and, in particular, it was free of
typhus fever. Of the two ships on which the soldiers were transported,
the one took only thirty days to get from Kamiesch to Marseilles and had
no cases of typhus fever, while the other, which had a harder voyage,
took fifty days and had numerous cases of typhus fever on the way;
fifteen patients were put into the hospital at Malta and twenty-five in
that at Marseilles. No less than fifty-eight soldiers in this regiment
contracted the disease in the Val-de-Grâce, and they infected five
nurses; eight soldiers and one nurse fell victims to the disease.


                3. THE NORTH AMERICAN CIVIL WAR (1861–5)

At the outbreak of the Civil War almost nothing was done in the two
armies to prevent the outbreak and dissemination of diseases; the
assembling of so many troops rendered severe pestilences inevitable. The
successful activity of numerous voluntary societies did a great deal of
good in the way of improved methods of sanitation; the centre from which
this activity emanated was an officially recognized Sanitary Commission,
founded on June 15, 1861, which made the prevention of pestilences its
principal function. It was enabled to carry on its work by large
voluntary contributions of money. The means which the Commission
employed were: good equipment, food, and shelter for the men, isolation
of men suffering from infectious diseases, burning of the clothes, beds,
and tents used by these patients, erection of clean, well-ventilated
barrack-lazarets, and comprehensive plans for transferring invalid
soldiers from the field-hospitals.[210]

Since upwards of a million men, counting both sides, were gradually
brought face to face with one another, the loss of human life was
necessarily terrible. Regarding the losses sustained by the Northern
States, we are excellently informed by an exhaustive health-report in
six volumes, issued by the United States.[211] The report also contains
some statistics regarding the prevalence of disease among the
Confederates and regarding the prisoners, but no figures relating to the
losses sustained by the Southern States are available.

Regarding the total loss of troops sustained by the Northern States, we
find the following compilation:[212]

     _Cause of death._      _White troops._ _Coloured troops._ _Total._
 Killed in battle                    42,724              1,514   44,238
 Died from wounds, &c.               47,445              1,760   49,205
 Suicide, murder, execution             469                 57      526
 Diseases                           157,004             29,212  186,216
 Unknown causes                      23,347                837   24,184
                                    ———————             ——————  ———————
           Total                    270,989             33,380  304,369

If we divide the deaths of unknown cause proportionally among the other
groups, the total number of deaths among the white troops due to
diseases was 171,806, and among the coloured troops 29,963.

In the statistical table in the first volume of the _Medical History_
the figures relating to the number of deaths are not complete; the total
numbers given there are:

                                _White troops._ _Coloured troops._
     Wounds, &c.                         36,688              1,427
     Suicide, murder, execution             549                 78
     Diseases                           128,937             27,499
     Uncertain                              449                  ?
                                        ———————             ——————
               Total                    166,623             29,004

Typhoid fever demanded the largest number of victims; in the first two
years of the war it appeared in the form of murderous epidemics in the
Northern army, mostly in the Atlantic and central districts, and less
severely in the region of the great ocean. If the common continued
fevers, the typho-malarial fevers, and typhus fever, are combined with
the typhoid fevers and looked upon as typhoid fever, there died from
this cause in the Northern army during the entire war 32,112 white
troops and 3,689 coloured troops. In considering these figures, we must
remember that, as stated above, they are incomplete. On this basis, out
of every 1,000 men there succumbed to typhoid fever:[213]

                       _White troops._ _Coloured troops._
               1861–2            20·75
               1862–3            18·24
               1863–4             8·52              28·50
               1864–5            11·45              19·31
               1865–6             8·98              11·60
                                 —————              —————
               Average           13·58               19·8

As in the case of typhoid fever, so also in the case of other diseases,
the coloured troops suffered the heaviest losses, probably because the
food and shelter they received were not so good, and perhaps also
because they had less understanding of the sanitary measures that were
ordered. Among the Confederate prisoners that were brought north, about
40,875 in number, 18·4 out of every 1,000 succumbed to typhoid
fever.[214]

Regarding the appearance of typhus fever in the American Civil War,
views diverge. Since only a relatively small number of cases of that
disease are recorded, it is probable that those cases were wrongly
diagnosed, since typhus fever is so highly contagious. In the
health-reports of the Northern States, in which the word typhus, as in
England and France, means typhus fever, we find the following figures
relating to the disease:

                 _No. that contracted it._ _No. that succumbed to it._
 White troops                        2,501                         850
 Coloured troops                       123                         108

But there are very few case-histories and absolutely no post-mortem
reports available from which one can draw a positive conclusion. Laveran
doubts the occurrence of typhus fever.[215] According to Niedner, on the
other hand, typhus fever prevailed among the Northern prisoners in the
terribly neglected prisons of Salisbury, North Carolina, and probably,
too, in other places.[216] It is to be surmised that the increased
number of typhus fever patients in New York and Philadelphia, &c., which
Hirsch adduces in accordance with the statements of da Costa and Corse,
was connected with the epidemic among the prisoners.[217] According to
Corse, the number of deaths due to typhus fever in Philadelphia was 37
in the year 1862, 131 in 1863, and 335 in 1864.

Unusually prevalent were diarrhoea and dysentery, so that,
notwithstanding their relatively mild character, they caused a large
number of deaths. The cases of cholera reported were not Asiatic
cholera, but a local form of the disease. In the Northern army the
following figures indicate the number of deaths due to acute and chronic
dysentery and diarrhoea:

                    WHITE TROOPS.                 COLOURED TROOPS.
            _Dysentery._    _Diarrhoea._    _Dysentery._    _Diarrhoea._
             _A-   _Chron-   _A-   _Chron-   _A-   _Chron-   _A-   _Chron-
           cute._   ic._   cute._   ic._   cute._   ic._   cute._   ic._
 June 1861       3       1
 1861–2        338     136     230     501
 1862–3        967   1,090     941   7,556
 1863–4      1,242     931     620   7,868     496     220     503     784
 1864–5      1,248     919     973  10,600     584     255     608   1,788
 1865–6        286     152     159   1,033     412     151     257     706
             —————   —————   —————  ——————   —————     ———   —————   —————
 1861–6      4,084   3,229   2,923  27,558   1,492     626   1,368   3,278

Out of every 1,000 men there succumbed to dysentery and diarrhoea
together:[218]

                      _White troops._ _Coloured troops._
               1861–2            4·17
               1862–3           15·99
               1863–4           15·78              43·54
               1864–5           21·29              36·29
               1865–6           16·00              26·97

Small-pox raged very extensively during the American Civil War; the
coloured troops manifested much more susceptibility to it than the
white. The dissemination of the disease was helped along by the fact
that vaccination, which had been neglected on account of the hasty
mobilization, could not be attended to as rapidly as was desirable.

Measles also broke out in both armies in the form of widespread
epidemics. All told, 67,763 white troops and 8,555 coloured troops
contracted the disease, while 4,246 of the former and 931 of the latter
succumbed to it. Out of every 1,000 men there succumbed:[219]

                   SMALL-POX.                       MEASLES.
         _White troops._    _Coloured    _White troops._    _Coloured
                            troops._                        troops._
 1861–2             1·36                            1·97
 1862–3             1·45                            1·99
 1863–4             3·21           16·52            1·88           12·35
 1864–5             1·75            8·69            1·68            3·75
 1865–6             0·69           14·24            0·11            0·51

Malaria became particularly widespread; on an average no less than 52
per cent of the white troops and 83 per cent of the coloured troops
contracted the disease per annum. It is absurd to say, then, that the
negroes are immune to the disease; on the contrary, they contracted it
much more frequently and suffered a great deal more severely from it
than the whites. The troops in the military districts of Carolina and
Arkansas, and also along the great rivers—the Mississippi, Ohio, and
Potomac—were attacked by it with particular severity. Out of every
thousand men the number that contracted the disease and the number that
succumbed to it is shown by the following table:[220]

                 WHITE TROOPS.                COLOURED TROOPS.
         _No. patients._ _No. deaths._ _No. patients._  _No. deaths._
  1861–2           404·0          2·77
  1862–3           460·1          3·76
  1863–4           584·1          3·19            833·7         15·19
  1864–5           558·4          3·34            750·0          8·77
  1865–6           853·1          5·42            947·0          7·81

The total loss sustained by the Northern army in consequence of the most
important infectious diseases is indicated by the following table:[221]

                             WHITE TROOPS.
           _No.    _Ty-   _Typhus _Dysen- _Chol- _Small- _Mea-   _Ma-
         troops._  phoid  fever._  tery,  era._   pox._  sles._ laria._
                  fever._          diar-
                                  rhoea._
 1861      41,556      17       3       4              1      3       1
 May-
 June
 1861–2   288,919   5,795     201   1,205     34     393    568     800
 1862–3   659,955  11,658     378  10,554     96     950  1,314   2,480
 1863–4   675,413   5,632     123  10,661     56   2,171  1,268   2,152
 1864–5   645,506   7,266     124  13,740     67   1,131  1,082   2,155
 1865–6   101,897     894      21   1,630     22      71     11     552
          ———————  ——————     ———  ——————    ———   —————  —————   —————
 Annual   468,275  Totals     850  37,794    275   4,717  4,246   8,140
 Average           31,262

                            COLOURED TROOPS.
 1863–4    45,174   1,251      60   2,003      7     760    568     699
 1864–5    89,143   1,680      41   3,235     10     775    334     782
 1865–6    56,617     650       7   1,526     13     806     29     442
          ———————  ——————     ———  ——————    ———   —————  —————   —————
 Annual    63,645  Totals     108   6,764     30   2,341    931   1,923
 Average            3,581

In the prisons the mortality on both sides was terrible. Regarding the
conditions among the Confederate prisoners that were interned in the
Northern States we are informed by the following table. The average
number of men in the prisons was 40,815, and of this number 19,060, all
told, died; taking the entire war into account, this gives a mortality
of 230.7 per 1,000 per annum.[222] The figures are divided among the
various diseases as follows:

                                       _Deaths (all    _Annual rate per
                                          told)._           1,000._
 Typhoid Fever, Typhus Fever                     1,109              13·6
 Malaria                                         1,026              12·6
 Small-pox, Measles, Scarlet Fever,              3,453              42·3
   Erysipelas
 Diarrhoea, Dysentery                            5,965              73·0
 Scurvy                                            351               4·3
 Bronchitis                                        133               1·6
 Inflammation of the Lungs and                   5,042              61·7
   Pleurisy
 Other diseases                                  1,729              21·3
 Wounds and uncertain maladies                     252               0·3
                                                ——————             —————
                Total                           19,060             230·7

The conditions among the Northern prisoners confined in the Southern
prisons were still worse. In the Andersonville prison, where in the six
months between March 1 and August 31, 1864, an average of 19,453
prisoners were confined, 7,712 died; this means an annual rate of 792.8
per 1,000 men. The following table indicates the proportional mortality
of the individual diseases:[223]

          _Cause of death._            _Deaths (all    _Annual rate per
                                          told)._           1,000._
 Typhoid Fever, Typhus Fever                       199              20·5
 Malaria                                           119              12·2
 Small-pox, Measles, Scarlet Fever,                 80               8·2
   Erysipelas
 Diarrhoea, Dysentery                            4,529             465·6
 Scurvy                                            999             102·8
 Bronchitis                                         90               9·2
 Inflammation of the Lungs and                     266              27·4
   Pleurisy
 Other diseases                                    844              86·7
 Wounds and uncertain maladies                     586              60·2
                                                ——————             —————
                Total                            7,712             792·8

Since mortality statistics existed in only a few of the Northern States
at that time, and the deaths for the year in question were included
merely incidentally in the census taken every ten years, it is
impossible to adduce any figures relating to the spreading of infectious
diseases from the army to the civil population. But certain it is that
this happened to a great extent in the regions where the fighting took
place. In the case of two States, Massachusetts and Connecticut,
mortality statistics are available; in both we find an increased
death-rate during the Civil War. The figures, which do not include the
still-births, are as follows:

                _Year._ _Connecticut._ _Massachusetts._
                 1860        16·3            18·7
                 1861        16·5            19·5
                 1862        18·0            18·5
                 1863        18·0            22·1
                 1864        19·0            22·8
                 1865        16·0            20·6
                 1866        15·0            18·1
                 1867        14·3            17·0

In the case of Massachusetts, moreover, we have statistics relating to
the cause of death; these statistics show a considerable increase in
deaths due to typhoid fever, small-pox, and dysentery; the mortality of
scarlet fever was also very high there during the war-years, but this
fact was in no way connected with the war. The number of people who
contracted the above-mentioned diseases in Massachusetts was:[224]

           _Year._ _Typhoid Fever._ _Small-pox._ _Dysentery._
            1860                937          334          441
            1861                989           33          532
            1862              1,135           40          479
            1863              1,442           42        1,156
            1864              1,344          242        1,186
            1865              1,694          221        1,548
            1866              1,091          141          949
            1867                965          196          658


                    4. THE ITALIAN WAR OF 1859[225]

The Italian War of 1859, which the French and Piedmontese together waged
against Austria in Upper Italy, was not attended by any severe
pestilences, probably because it was terminated in a comparatively short
time, and the number of troops engaged was not very large. To be sure,
typhoid fever and dysentery carried away many men on both sides, while
an unusually large number of soldiers contracted malaria. Those fevers
which were called ‘Fièvres rémittentes épidémiques d’Italie’, and which,
notwithstanding their frequent occurrence, caused only a few deaths,
according to Niedner were for the most part malaria, and not relapsing
fever. The Austrian army seems to have lost more men in consequence of
pestilences than the French army. Regarding the spreading of the
pestilences on a large scale from the armies to the civil population we
have no information.


                       5. THE DANISH WAR OF 1864

In the war of 1864, which Austria and Prussia waged against Denmark, no
epidemics of wide extent occurred. ‘The small number of men engaged,’
says Knaak,[226] ‘the not particularly unfavourable external conditions,
the constant communication between the fighting armies and their
home-countries, and the non-appearance of large epidemics, all helped to
render the health-conditions of the war favourable.’ The total loss
sustained by the Prussian army, which reached a maximum size of 63,500
men, amounted to 1,048 men; of these 738 died in battle, in consequence
of wounds, &c., 310 succumbed to diseases, 193 of the latter to typhoid
fever. Statements regarding the number of deaths in the Austrian army,
which amounted to 25,000 men, are not available. The Danish army, which
numbered 54,000 men, lost 1,446 in consequence of wounds, &c., and 820
in consequence of diseases.[227]


                       6. THE GERMAN WAR OF 1866

As regards sanitation the German War of 1866 acquired importance through
the appearance of cholera on the scene of the fighting. None of the
other infectious diseases developed very extensively during this war; of
the Prussian army, which numbered some 280,000 men, only 379, all told,
succumbed to typhoid fever, and dysentery did not appear at all. A
rather mild epidemic of small-pox spread throughout a considerable part
of Germany in the year 1865, and lasted until the year 1866; whether or
not the war helped the disease to spread, which is not unlikely, we
cannot state with certainty owing to a lack of bases of comparison. The
German troops were well vaccinated, and the number who contracted the
disease was no larger during the war than in times of peace. It is
undoubtedly true, however, that the war exerted an unwholesome influence
upon the dissemination of cholera throughout Germany and Austria.[228]
Cholera had revealed its presence in Germany for the first time in the
year 1865; it broke out in Altenburg, during its fourth passage through
Europe, having been borne thither from Odessa. In the course of the year
it broke out, in a comparatively mild form, in many places in Saxony. In
the year 1866 it raged very extensively and furiously in the Rhine
province and in Westphalia, whither it was borne from Luxemburg; in May
cases of the disease occurred in several seaport towns of Pomerania
(Swinemünde, Stettin, Cammin, &c.), and in June it broke out in Hamburg,
Berlin, Posen, Silesia, East and West Prussia, and in the kingdom of
Saxony.[229] Thus it came about that some of the troops enlisted came
from infected parts of Silesia and Saxony, and the result was that
individual cases of cholera began to occur in the Prussian army.

The disease was conveyed by soldiers from Stettin to Leipzig, where it
spread to the civil population; from Leipzig it spread throughout Saxony
and Thuringia. When the Prussian army advanced into Bohemia the cases of
the disease began to increase, and after the battle of Königgrätz (July
3, 1866) the dissemination of the disease was helped along by the
crowding together of large numbers of sick and wounded soldiers. The
rapid advance of the Prussian army increased the disease’s rate of
dissemination; on all the army’s lines of march large numbers of sick
soldiers were left behind, for example, in Göritz, Gitschin, Königinhof,
Pardubitz, Czaslau, and Leitomischl. In Prague cases of cholera were
reported a few days after the city was occupied. The pestilence was
conveyed by Prussian soldiers to Moravia, where it appeared in Prerau,
Brünn, Iglau, Klosterbrück, Znaym, and Nikolsburg. The further advance
of the Prussians conveyed it to Lower Austria; in Vienna it did not
break out until August.

Some think that the pestilence was conveyed into Austria from Bukowina,
where it had broken out in May 1866. When the war broke out, it is
maintained, the disease was conveyed by troops to the western
crown-lands of Austria.[230] ‘The truth’, says Niedner, ‘probably lies
half way between; the epidemic in Bohemia was disseminated chiefly by
the Prussian troops, but in the other Austrian countries by Austrian
troops.’ Daimer,[231] one of the best authorities on the history of
pestilences in Austria, says: ‘In the year 1866 an epidemic of cholera
came to an end in Bukowina, where it was looked upon as the continuation
of one that had been prevailing in Turkey and Roumania; it spread
throughout the countries in which fighting was going on at that time,
and was borne by troops to remote regions.’ According to Presl,[232] the
number of deaths due to cholera in the several crown-lands in the year
1866 was:

                           _No. inhabitants          _Deaths due to
                          (Dec. 31, 1869)._             cholera._
 Lower Austria                         1,983,149                  15,114
 Upper Austria                           733,241                     153
 Salzburg                                152,141                       1
 Styria                                1,139,205                     260
 Carinthia                               336,768                      40
 Carniola                                465,463                     930
 Küstenland                              585,467                   1,067
 Tirol and Vorarlberg                    880,985                      25
 Bohemia                               5,151,332                  42,730
 Moravia                               2,016,186                  55,527
 Silesia                                 518,443                   2,919
 Galicia                               5,491,675                  34,857
 Bukowina                                522,481                  11,656
 Dalmatia                                445,201                      13
                                      ——————————                 ———————
     All Austria                      20,421,737                 165,292

In Prussia, too, cholera spread, in consequence of the war, more widely
than ever before; the total number of deaths caused by it in the year
1866 was no less than 114,776, and in the following year it was
6,086.[233] Of the Prussian troops 4,529 (16·2 per cent) succumbed to
cholera, and the total loss due to disease was 5,219; only 4,008 men
were killed on the field or died from wounds.

In the Grand Duchy of Hesse a few rather small epidemics occurred, and a
larger one in Mayence.

In the case of Baden the connexion between the appearance of cholera and
the war has been carefully investigated.[234] The disease broke out in
the region of the Main and Tauber and in the Odenwald, and in regions
which had never before been attacked by cholera. On July 24, 1866,
Wertheim received a Prussian garrison, which on the 26th was joined by
parts of the Hamburg contingent. As mentioned above, cholera had already
broken out in Hamburg in June, and a few days after the arrival of the
Hanseatic troops some of them contracted the disease and were taken,
despite the objections of the local authorities, to the town hospital.
On August 6, cases of the disease appeared in the city, and they
constituted the beginning of a small epidemic which lasted six weeks. On
September 22 the epidemic was over, after the population of 3,383 had
lost 28 persons by death; 64 persons contracted the disease. In near-by
Freudenberg, of 42 people that contracted the disease, 23 died. In
Schönfeld two soldiers of the Hamburg contingent contracted the disease
on July 29; the first case among the civil inhabitants, who numbered
524, was on August 2, and in a few days a small epidemic began; 166
people contracted the disease and 55 succumbed to it. At the same time
the Hanseatic troops conveyed the disease to Gerlachsheim, where 61
persons contracted it and 32 died of it, and also to Ilmspan, where 97
contracted it and 34 succumbed to it. On August 1 the Hamburg soldiers
came to Grünsfeld and brought four cholera patients with them, and the
result was that 177 of the inhabitants, who numbered 1,458 all told,
contracted the disease and 23 of them died. The disease was conveyed to
Dittigheim by cholera convalescents of the Hamburg contingent, and 225
persons contracted it there and 66 succumbed to it. In Gerlachsheim it
appeared after a Saxon ammunition-column, which was supposed to be
absolutely free from the disease, had passed through the city. In the
case of Walldurn, which had a very severe epidemic (the city had 3,339
inhabitants, and of these 827 contracted the disease and 113 succumbed
to it), it was impossible to prove that the disease broke out in
consequence of the arrival of the soldiers. Külsheim, which was infected
from Walldurn, had only a small number of cases. Throughout Baden 1,774
persons contracted cholera and 404 succumbed to it. From these
statements it is very evident that the danger of an extensive epidemic
of cholera in the regions south of the Main would have been very great,
if the war had been carried on there on a large scale, and had thus
prevented the authorities from taking measures to prevent the
dissemination of the disease.

The small epidemic in Uzmemmingen, a village of 700 inhabitants in the
north-east part of Württemberg, was brought about by a chamber-maid, who
on August 25 brought the disease from a Bohemian place through which a
Prussian detachment had passed; 60 persons, all told, contracted the
disease in Uzmemmingen, and 19 succumbed to it.[235]

In the Bavarian Governmental District of Lower Franconia cholera broke
out, as in Baden, in consequence of the operations of Prussian
troops.[236] In the last week of July there were skirmishes between the
Prussians and Bavarians near Hettstadt and Waldbrunn; after the
withdrawal of the Prussians, many of whom were seized with diarrhoea,
cholera broke out in both of those villages. The outbreak in Miltenberg
was also connected with the arrival there of Prussian soldiers.
Presently other places in Lower Franconia were attacked; for example,
Rothenfels, Birkenfeld, Karbach, Stadtprozelten, Tiefenthal,
Waldbüttelbrunn, &c. A Bavarian authority gives credit for the
non-appearance of the disease in Remlingen and among the civil
inhabitants of Uettingen, where Prussian soldiers suffering from cholera
lay, to the care and vigilance of the Prussian military physicians.
Cholera also appeared in the Governmental District of Swabia, breaking
out in the cities along the Danube, in Höchstädt, Dillingen,
Gundelfingen, and Neuburg. But it was impossible to prove that the
disease was conveyed thither from the scene of the war.[237]




                              CHAPTER VIII
 THE FRANCO-GERMAN WAR OF 1870–1, AND THE EPIDEMIC OF SMALL-POX IN THE
                      EUROPEAN STATES CAUSED BY IT


                         I. SIZE OF THE ARMIES

In the Franco-German War of 1870–1, a larger number of troops were
assembled within a short time upon the field of battle than in any
previous campaign. On the German side 33,101 officers and 1,113,254 men
took part in the war; the average number of men in the German field-army
was 815,000. The total number of French soldiers under arms is not
definitely known; that it was enormous is evident from the fact that the
number of prisoners taken (including the garrison in Paris and General
Bourbaki’s army) amounted to no less than 21,500 officers and 702,000
men. At certain periods of the war huge bodies of troops were
congregated within comparatively narrow limits; at the battle of
Gravelotte (August 18, 1870) some 180,000 to 200,000 men faced one
another on either side; at the siege of Metz the average size of the
German investing army was 240,000 men, while the French army in the city
numbered 173,000 men at the time of the capitulation. At the battle of
Sedan (September 1, 1870) 124,000 French soldiers were opposed to nearly
twice that number of Germans. The garrison in Paris amounted to about
250,000 men, while the German besiegers averaged 240,000 men.


             II. DYSENTERY, TYPHOID FEVER, AND TYPHUS FEVER

Despite the fact that these enormous congregations of men were often
exposed to very unfavourable weather conditions, and were much of the
time scantily fed, the number of German field-troops that contracted and
succumbed to infectious diseases was comparatively small. The total loss
sustained by the German army in consequence of injuries and diseases
amounted to 43,182 men and of these 14,648 died of disease. The
following table indicates the percentage of deaths caused by the various
diseases:

                        _Disease._         _Per cent._
                 Typhoid Fever                    60·0
                 Dysentery                        16·2
                 Small-pox                         1·9
                 Intermittent Fever                0·1
                 Other infectious diseases         0·3
                 Other diseases                   21·5

Typhoid fever and dysentery were most prevalent, for the reason that the
troops were often quartered in places where these diseases were already
endemic. Regarding these matters we are accurately informed by the
‘Health Report relating to the German Armies in the War of 1870–1
against France’, an exhaustive account published by the Medical Division
of the Prussian War Department.[238]

A total of 74,205 men in the German field-army contracted typhoid and
gastric fever, and 8,904 succumbed to them. The eastern Departments of
France, especially the city and vicinity of Metz, were constantly
afflicted with typhoid fever. This explains why both the German
besiegers and the French defenders suffered so severely from that
disease, the dissemination of which was helped by the contamination of
the springs and water-courses, partly through excessive use, and partly
in consequence of the burial of dead men and horses in close proximity
to them. And while drinking-water was for that reason brought from a
distance, the water used for other purposes was obtained in the
immediate neighbourhood. It is obvious that typhoid fever must have
raged extensively among the inhabitants of the villages surrounding
Metz, the mortality in which during the siege was three times as high as
normal. This is evident from a compilation of figures in the German
Health Report,[239] indicating how the death-rate in these villages
rapidly decreased after the withdrawal of the Germans; per 100
inhabitants, there died in:

                     _Inhabitants._ _Nov._ _Dec._ _Jan._ _Feb._ _March._
 Verneville                     672   2·39   1·34   1·04   0·30     0·74
 St. Privat                     480   2·70   1·20   1·68   0·84     0·42
 Gravelotte                     708   2·14   0·71   0·55   0·71        —
 Ste. Marie aux                       1·17   0·59   0·59   0·29     0·59
   Chênes                       340
 Rezonville                     587   1·87   0·87   0·68   0·68     0·85
 Gorze                        1,774   1·45   0·73   0·56   0·22     0·39

Typhoid fever and dysentery were chiefly responsible for this high
mortality. As at Metz, so also at Sedan and Paris, the troops suffered
severely from typhoid fever.

Large numbers of typhoid-fever patients were taken to lazarets in
Germany; the Prussian lazarets alone took in 30,507, of whom 1,376 died.

Typhoid fever raged furiously among the French prisoners of war, who
usually brought the germ of the disease with them from the scene of the
hostilities. ‘Most observers’, we read in the German Health Report,[240]
‘agree that the disease was most prevalent during the first three weeks
after the arrival of large transports of prisoners at their place of
detention; after that it gradually abated, and finally appeared only
sporadically.’ The military prisons, however, while they often formed
new sources of infection, did not help to disseminate the disease, owing
to the advanced season of the year.

It made considerable difference from what part of the scene of the war
the prisoners came; those coming from Strassburg and Toul were much less
severely infected with typhoid fever than those from Sedan and Metz.
This applies particularly to General Bourbaki’s men, who manifested the
least power of resistance to the disease. In Rastatt, for example, there
were at one time sixty prisoners suffering from typhoid fever; of those
who had come from Strassburg, Neubreisach, and Schlettstadt 13·3 per
cent died; of those from Metz 14·5 per cent died, and of those from
Bourbaki’s army 40·6 per cent died. Of the French prisoners confined in
Germany (the maximum number was 374,995 and the average number 262,496)
15,020 contracted typhoid fever and 3,835 succumbed to it. The
prevalence of the disease among the German troops, as compared with its
prevalence among the French prisoners, is indicated by the following
table:

                            _No. per 1,000 that   _No. that died per 100
                            succumbed to typhoid        treated._
                                  fever._
 Mobile German army                          11·2                   12·0
 Immobile German army[241]                    3·0                    4·1
 French prisoners                            14·6                   25·6

The immediate vicinity of the places in which all these French prisoners
suffering from typhoid fever were confined was necessarily unsafe to
live in; and while the epidemics that were brought about by people
contracting the disease there and conveying it abroad were always kept
localized, they were by no means confined to the very narrow limits
indicated, on the basis of scattered communications, in the German
Health Report. The reason for this moderate dissemination is clear; at
that time typhoid fever was rendered much less prevalent throughout
Germany by the introduction of extensive sanitary measures (sewers,
aqueducts, refuse removal, &c.), which prevented the disease from
constantly spreading from place to place. In Frankfurt-on-the-Main the
mortality due to typhoid fever was not increased; the number of deaths
per 10,000 inhabitants was:

                                1867 4·3
                                1868 7·1
                                1869 4·2
                                1870 5·8
                                1871 5·8
                                1872 6·1

In many cities, on the other hand, an increased number of deaths due to
typhoid fever was observed; whether this was attributable to a
transplantation of it from France, or to a spontaneous outbreak of it
among the many people in these cities who already had the germ in their
systems, it is impossible to ascertain. From the statistics we are
scarcely ever able to make out the proportion of soldiers and civilians
that died. The number of deaths due to typhoid fever per 10,000
inhabitants was:

      _Berlin._ _Munich._ _Elberfeld._ _Strassburg._ _Erfurt._ _Plauen._
                  [242]
 1867       6·9       6·0          8·1           8·5      10·6       2·4
 1868      10·0       8·0          5·3           9·0       9·4       3·3
 1869       6·7      13·0          5·3           9·6                 6·7
 1870       7·8      14·0          9·3          17·8                21·8
 1871       8·9      14·0          9·4          14·2      33·1       2·5
 1872      13·9      24·0          8·8           7·8       5·3       4·9

In the case of Strassburg the increase caused by the war is clear; of
the civil inhabitants alone, 74 died in the year 1869, 137 in the year
1870, and 110 in the year 1871. In the case of Elberfeld the increase
began in the year 1870. In Munich the increase began as early as the
year 1869, although the very high mortality did not commence until 1872,
as in Berlin; in these two cases the increase cannot be said to have
been caused by the war. The same is true of Plauen, where the increase
also began in 1869. In the case of Erfurt, unfortunately no statistics
are available for the year 1870; in the year 1871 the increase there is
very marked. To be sure, it is not expressly stated that prisoners of
war are excluded, but as they were not included in the total mortality,
or in that due to small-pox, we may safely assume that they were
excluded in the case of typhoid fever.[243]

A marked increase in the prevalence of typhoid fever is to be noted in
the stronghold of Ulm on the occasion of the arrival there of numerous
prisoners from France; the following table indicates the number of
people who succumbed to the disease in that city:[244]

                _Garrison._ _Prisoners._ _Civil population._
           1867          10                               25
           1868           3                                8
           1869           4                                7
           1870          10          150                  15
           1871          15           25                  28
           1872           6                               20
           1873           2                                5

Since in the case of typhoid fever it is very often impossible to trace
the source of infection, it is not surprising that in many instances it
is difficult to prove that the disease broke out in any specific
locality in consequence of the arrival there of a person, or group of
persons, from an infected locality. This applies, for instance, to the
epidemic of typhoid fever that occurred in Meiningen in the year 1871.
In many places the disease, being prevalent among the prisoners detained
there, undoubtedly spread to the civil population, but nowhere did this
occur to such an extent as to attract the attention of the authorities.

Among the diseases that broke out in the field-armies during the war of
1870–1, dysentery (epidemic dysentery) played an important rôle,
especially in the months of October and November. Prior to the year 1870
it was a comparatively rare disease in Germany, whereas in France it was
quite common. This is indicated by the fact that in the years 1863–9 the
number of deaths due to dysentery in the French army (home stations) was
twelve times as large as in the Prussian army. Particularly hard hit
were the troops in and around Metz, where dysentery raged continuously
and with considerable severity,[245] as well as in Strassburg and Sedan;
in the city and vicinity of Paris the disease, owing to the advanced
season of the year, raged less furiously. As a rule it was an open
question whether the places in which the German troops contracted the
disease were already infected beforehand, or whether the disease had
been brought there for the first time by infected divisions of the
French army.

Of the German field-army, 38,975 men, all told, contracted dysentery
(47·8 per 1,000 of the average number of troops under arms), and of
these 2,405 died. Of the average number of French prisoners taken to
Germany 41·7 per cent contracted the disease; nearly all the cases of
the disease were among the prisoners themselves, who brought the germ
with them, and the result was that the number of cases soon began to
decrease. It was, of course, inevitable that numerous prison-guards
should contract the disease, but nowhere did it spread in a serious way
to the civil population.

Of very great importance, as far as the war operations were concerned,
was the fact that typhus fever, which in former years had played such a
fatal rôle, did not make its appearance among the troops; according to
most observers, the disease did not break out at all during the war. The
Prussian troops along the Russian border were never entirely free from
typhus fever; according to the German Health Report, 91 soldiers
contracted the disease in the year 1867, 99 in the year 1868, and 37 in
the year 1869. France itself had apparently been free from the disease
for a long time, but there was always a possibility that it would be
conveyed into the country from Algiers, where in the year 1868 a severe
epidemic had raged in consequence of a great famine the year before; of
the army in Algiers the disease had carried away 252 men (3·94 per
cent).[246] Consequently both the Germans and the French watched very
carefully any outbreaks of a disease involving symptoms of typhus fever.
Cases of a disease held by the authorities to be typhus fever were
reported from Nancy, Châlons-sur-Marne, Lunéville, and Metz, but careful
investigations by von Niemeyer indicate that they were merely cases of
typhoid fever exhibiting unusually well developed roseola. Several
French physicians (Chauffard, Léon Colin, Kelsch) likewise testify to
the fact that typhus fever did not appear in the French army during the
entire war. Grellois, to be sure, asserts that typhus fever broke out
about the middle of the siege of Metz and then suddenly disappeared. But
even this assertion may fairly be questioned; at all events there was
not a single soldier in the garrison suffering from the disease at the
time of the capitulation, as Grellois himself admits.

According to Michaux,[247] a former chairman of the Medical Society in
Metz, a small epidemic of typhus fever raged among the civil inhabitants
of that city during the siege. The correctness of this statement,
however, is doubted, as no post-mortem examinations were made. It seems
that fifty-five children and nine nurses in two orphan asylums
contracted the disease, and that twenty-eight of the former and one of
the latter succumbed to it; the first cases of the disease were reported
early in October, and by the end of November the epidemic was over. This
sudden disappearance of the disease was attributed by Michaux to the
termination of the siege, a conclusion also upheld by Méry, who studied
the disease in the Crimean War. Viry,[248] who until a few days before
the siege had charge of the field hospital in Vallières (near Metz),
where he treated some 250–300 patients every day, performed autopsies on
all supposed victims of typhus fever, but in all cases found only the
evidences of typhoid fever. Nevertheless, he believes it possible that
typhus fever occurred there, and holds the view that the overcrowded
condition of the city favoured a spontaneous outbreak of the disease.
Laveran,[249] who was also present in Metz during the siege, disputes
the correctness of Michaux’s diagnosis, as does the German Health
Report, on the ground that the disease attacked children almost
exclusively, that it caused such a high mortality, and that it
disappeared so suddenly. He seems to think that it was some acute
exanthema, probably haemorrhagic measles. This leaves unexplained the
fact that a large number of nurses contracted the disease.


  III. THE GREAT EPIDEMIC OF SMALL-POX CAUSED BY THE FRANCO-GERMAN WAR

But while typhoid fever and dysentery in the Franco-German War attacked
the civil population only in those parts of the country in which the
fighting took place, and nowhere acquired epidemic dimensions, and while
it is probable that typhus fever did not appear at all at that time,
there occurred in connexion with the war a very severe epidemic of
small-pox, which raged more extensively and furiously than any other
epidemic in the course of the entire century, and spread not only
throughout the belligerent countries, but also throughout all Europe.

Everybody knows how severely Europe suffered from epidemics of small-pox
in the last part of the eighteenth and first part of the nineteenth
centuries, and how the ravages of that disease were first checked by
Jenner’s wonderful discovery. Nevertheless, small-pox did not entirely
disappear from Central Europe until the year 1870. The reason for this
is found in the fact that compulsory vaccination was introduced in only
a few states, and even in them was not properly enforced, and also in
the fact that people did not until later begin to realize that
vaccination insures immunity only for a period of 12–15 years at most.
Consequently new recruits, if they had already been vaccinated once,
were not revaccinated when they began to serve. But since sporadic
outbreaks of small-pox continued to occur in the Prussian army, orders
were issued in the year 1834 that all recruits must be vaccinated. The
result was that from that time on, the Prussian troops were very rarely
attacked by the disease. The same measure was adopted in Württemberg in
1833, in Baden in 1840, in Bavaria in 1843, in Brunswick in 1858, in the
Kingdom of Saxony in 1868, and in the Grand Duchy of Hesse in 1869.
Compulsory vaccination did not exist in Prussia or Saxony before the
Imperial Vaccination Law was passed in the year 1874; the result was
that large numbers of children were never vaccinated. The
anti-vaccinationists, especially in the ‘sixties, carried on a vigorous
agitation, and this had the effect of increasing the number of
unvaccinated persons; the number of revaccinated persons had always been
small. In South Germany compulsory vaccination for one-year-old children
was introduced in the first part of the nineteenth century—in Bavaria
and Hesse in 1807, in Baden in 1815, in Württemberg in 1818—but
revaccination was not enforced until 1874, when the Imperial Vaccination
Law was passed.

The small-pox mortality in Prussia prior to the year 1870 is indicated
by the following table, which shows the number of deaths per 10,000
inhabitants:

                              1831–40 2·6
                              1841–50 1·7
                              1851–60 2·1
                              1861–5  3·5
                              1866–7  5·2
                              1867–8  1·8
                              1868–9  1·9
                              1869–70 1·7

In the year 1864 an epidemic of small-pox had broken out, and the war of
1866 had helped it to spread; but in the year 1868 the disease began to
abate, so that by the middle of the year 1870 almost all of Prussia was
free from small-pox, as will be set forth in greater detail later on. In
South Germany the small-pox mortality was even lower; in Bavaria it was
0·85 in the years 1861–70, in Württemberg it was 0·9 in the same years,
and in the Grand Duchy of Hesse it was 1·9 in the years 1866–70.[250]


       1. _The Small-pox Mortality in France in the Years 1870–1_

In the ‘sixties small-pox had not been very common in France, but no
detailed reports regarding its prevalence there are available; the
reports which the prefects were supposed to hand in are either entirely
missing, or else very incomplete. According to the statistics compiled
by Vacher,[251] the death-rate increased a little in the years 1864–5,
then began to decrease, and in 1869 increased again. The figures which
Vacher compiled, and which the Académie de Médecine in Paris has on
file, are:

                               1860 1,662
                               1861 1,740
                               1862 1,813
                               1863 1,440
                               1864 3,290
                               1865 4,166
                               1866   593
                               1867 2,081
                               1868 3,900
                               1869 4,164

Vacher says in regard to these figures: ‘As far as the actual number of
persons who contracted and succumbed to small-pox are concerned, they
express only a small part of the truth. The reports submitted to the
Academy of Medicine are rarely complete; it is even necessary to say
that about one-quarter of the Departments never send in reports on the
epidemics at all, although the ministerial instructions render the
submission of these reports obligatory, and although the Academy never
ceases to protest against the negligence of the prefectoral
administrators.’ Vacher then goes on to say that in the years 1860–9
only 59 out of every 100 infants born were vaccinated, and that at the
outbreak of the war about one-third of the French population was
unvaccinated; in many Departments, indeed, as many as four-fifths
(Aveyron, Corsica, &c.). Small-pox was much more prevalent in the French
army than in the German army; according to the German Health
Report,[252] the number of deaths caused by the disease was:

                PRUSSIAN ARMY.                   FRENCH ARMY.
        _Total No._   _Per 10,000 men._ _Total No._  _Per 10,000 men._
  1866              8              0.30           46              1.37
  1867              2              0.08           70              1.82
  1868              1              0.04          169              4.28
  1869              1              0.04           95              2.27

The reason for this lies in the fact that a larger proportion of the
Prussian soldiers were vaccinated. Since the year 1806 all French
recruits who had never been vaccinated were supposed to submit to the
inoculation when they presented themselves for service, but this
regulation was for years at a time very laxly enforced; consequently in
the year 1857 a new order was issued, introducing compulsory vaccination
for all recruits. But even this order does not seem to have been
everywhere carried out with the necessary strictness, and complaints
regarding the partial success of vaccination were frequently made by
military physicians.

As stated above, there was a noticeable increase in the small-pox
mortality in the year 1869; this increase lasted into the beginning
of the year 1870, but was confined to certain localities.
Chauffard’s[253] report on epidemic diseases in France is more
incomplete for the years 1869–70, on account of the war, than for
previous years; it was supplemented, partially at least, by the
later reports of Vernois[254] for the year 1871, and also by the
comprehensive report of M. Delpech[255] for the years 1870–2.
According to these, epidemics of small-pox occurred in the year 1869
in North-west France (Bretagne), in North-east France (Departments
of Aisne, Pas-de-Calais), and in South-east France (Departments of
Gers, Ariège, and Pyrénées-Orientales.) In the winter of 1869–70 the
epidemic continued to spread, and by the end of the year 1870 it
included almost the whole of France. The incomplete reports give us
no idea as to which Departments were attacked before the outbreak of
the war and which after. According to Vernois, the disease appeared
that year in 42 Departments, including 132 arrondissements and 539
parishes. But, as stated above, the reports are all very incomplete;
a later report submitted by Delpech adds 11 more Departments to the
42. The total number of deaths caused by small-pox in France in the
year 1871 is unknown; Vernois reported 14,425 deaths in 39
Departments, but this does not include the figures for Paris, where
10,539 persons succumbed to the disease, or for the Department of
Finistère, or for the Department of Sarthe (in regard to which it is
merely observed that there were ‘beaucoup de morts’), or for several
other Departments.

It is a fact that small-pox raged severely among the civil inhabitants
of all regions in which the second half of the war was waged (to the
south, east, and north of Paris), and that the war itself helped the
disease to spread in the eastern Departments (Jura, Doubs,
Saône-et-Loire, Haute-Saône). The wide prevalence of the disease among
the soldiers is attributed by many French physicians to the fact that
the army as a whole had been inadequately vaccinated. If this was true
of the regular troops, lack of time made it absolutely impossible to
vaccinate all the men that were afterwards assembled in such a
precipitate manner. The movements of the soldiers in the cold season of
the year (in December there was some bitterly cold weather) made it
necessary for friends and enemies to share whatever shelter they could
find, regardless of whether the house had previously been occupied by
small-pox patients, or whether such patients were actually lying in it
at the time. The result was that the disease became very widespread
throughout all France. Says Laveran:[256] ‘The army, being composed of
men who had been in service for a long time, and who had been vaccinated
and revaccinated, suffered very little, but the events which took place
after the declaration of war altered this state of affairs. The
regiments of the Departments on their way to Paris were quartered in the
homes of civilians, where they contracted small-pox. The disease spread
easily among the young people who, owing to lack of time, had not been
revaccinated, and many of whom had perhaps never been vaccinated at all.
During the first part of the siege of Paris it was these regiments which
suffered the most from small-pox, but later on the epidemic became more
general and spread to all the corps. The number of soldiers infected
with small-pox during the siege was about 6·76 per 100, or 68 per
1,000.’

Small-pox raged very extensively in besieged strongholds. In Paris an
epidemic of small-pox began in November 1869, and the number of deaths
caused by the disease there was:[257]

                          October (1869)    39
                          November          93
                          December         119
                          January          174
                          February         293
                          March            406
                          April            561
                          May              786
                          June             914
                          July           1,072
                          August           713
                          September        700
                          October        1,361
                          November       1,722
                          December       1,837
                          January        1,503
                          February         763
                          March            230

In the middle of the summer the disease was not very prevalent in the
garrison; most of the cases were among the civil inhabitants. This
condition changed in September, however, when the newly-organized mobile
guard arrived in the city, consisting of young men who had not been
revaccinated for lack of time, and many of whom had never been
vaccinated at all. A severe epidemic now began to rage throughout the
garrison; between October 1870 and March 1871 no less than 7,578 men
suffering from small-pox were taken to the Hôpital Bicêtre, where the
majority of the small-pox patients in the garrison were housed, and
where 1,074 (14·17 per cent) of them died. Colin reports that the total
number of small-pox patients taken there from the garrison (the total
number of men in which he estimates at 70,000 regular troops and 100,000
guardsmen)[258] was no less than 11,500, and that the number of deaths
was 1,600. In November, owing to the rapid dissemination of the disease
in the garrison, the number of cases among the civil inhabitants also
began to increase.

Small-pox also raged in Metz, but not so extensively as in Paris; the
following table indicates the number of men in the garrison carried away
by small-pox:

                           August (15–31)   6
                           September       40
                           October         51
                           November        58
                           December        21
                                          ———
                               Total      176

The surrender of the stronghold, on October 27, led to the discovery of
200 small-pox patients in a tobacco factory. The epidemic among the
civil inhabitants came to an end in March 1871.

Belfort, where the garrison consisted mostly of national guards, also
experienced a severe epidemic during the siege; likewise Strassburg,
Nancy, Toul, and Verdun.

In Strassburg, where cases of small-pox had repeatedly been observed,
the disease became more widespread in the summer of 1870, and during the
siege the number of cases increased considerably; not until August 1871
did the epidemic come to an end. According to Kriesche and Krieger,[259]
the number of civilians that succumbed to small-pox in Strassburg, the
population of which in the year 1871 was 77,859, was:

                                1869. 1870. 1871.
                      January       2     4    81
                      February      3     5    52
                      March         3     9    20
                      April        13    14    15
                      May           1    19    14
                      June          2    23     4
                      July          6    22     3
                      August        5    33     1
                      September     2    66
                      October            92
                      November      2    72     1
                      December      3    92
                                   ——   ———   ———
                        Total      42   451   191

Langres was attacked with especial severity. The garrison there was
composed of freshly enlisted troops (mobile and national guards), and
averaged 14,629 men. The epidemic began in September 1870, and was not
yet over by March 1871. The following table gives the number of cases
and deaths according to Claudot.

                            _No. cases._ _No. deaths._
                  September           81            10
                  October            145            12
                  November           301            34
                  December           598            41
                  January            621            91
                  February           402            93
                  March              186            53
                                   —————           ———
                    Total          2,334           334

The disease raged very extensively in the French provincial armies that
were organized to relieve Paris—thus in the south-western, northern, and
south-eastern scenes of the war, small-pox had already made its
appearance among the civil inhabitants of those parts of the country in
consequence of the continual passing through of soldiers, many of whom
had never been vaccinated. Orléans, Chartres, and Le Mans, were the main
centres of the pestilence; in the north Amiens, Bois-Guillaume, Rouen,
and other places; in the south, besides the strongholds of Belfort and
Langres, the cities of Dijon, Besançon, Pontarlier, and several other
places. The disease raged furiously throughout this entire region, but
the exact number of deaths is not known.

In south-eastern France, small-pox did not become very widespread until
after the outbreak of the war; in Lyons, for example, the epidemic began
in the second half of October. To be sure, small-pox had appeared in
several places in the year 1868, but by the winter of 1868–9 this
epidemic was over, although individual cases continued to occur.
Regarding the cause of the small-pox epidemic that broke out in Lyons in
the autumn of 1870, Fonteret[260] gives us the following information:
‘Two causes could not help favouring the outbreak in our city; the
movements of the troops that took place at that time, and the emigration
of numerous Parisians, who since the beginning of September, that is to
say, since the time when the epidemic began to rage furiously in Paris,
passed through our city on their way to Switzerland.’ Regarding the
course of the epidemic, no statistics covering the entire city are
available, but we are able to see from the following table, compiled by
Perroud, the number of small-pox patients taken in by the Hôtel-Dieu and
the number that died there:

                                   _Patients._ _Deaths._
               January-June (1870)         126         9
               July-September              101        15
               October                      29         8
               November                     94        26
               December                    160        37
               January (1871)              148        31
               February                    147        37
               March                       135        29
               April                       124        25
               May                          84        12
               June                         45         7
               July                         38         5
               August-December              44         6

In the other cantons of the Department 935 deaths were officially
recorded in the years 1870–1. It was observed in Lyons, as in other
places, that not only the number of persons who contracted small-pox,
but also the virulence of the disease itself, increased; whereas only
10.6 per cent of 227 sporadic cases resulted fatally between January and
September, out of 1,004 persons who contracted the disease between
October 1870 and July 1871 no less than 21.7 per cent died.

In the year 1871 small-pox did not spare a single Department in France,
although many of them failed to send in reports. Vacher estimates the
number of deaths due to the disease in the year 1871 at 58,236, but he
adds that the estimate is too small. No report, for example, was sent in
by the Department of Sarthe, where in the city of Le Mans alone there
were 1,181 deaths, nor by the Department of Haute-Garonne, where there
were 1,328 deaths in Toulouse. The total number of unreported deaths,
therefore, must have been at least 20,000. It is almost impossible to
estimate the number of deaths that occurred in the year 1870. From the
available statistics Vacher estimates the number of deaths caused by the
disease in the two years 1870–1 at 89,954, a figure, as he himself says,
‘which represents only a part of the reality.’ Another estimate made by
Vacher, putting the number of deaths caused by small-pox in the years
1869–70 at 200,000, is in all probability not an exaggeration.

In the year 1872, to be sure, small-pox appeared in the form of
epidemics in numerous parts of France, but nowhere did it spread so
widely as in the two previous years. According to a report worked out by
Delpech for the years 1870–2, no less than 42 Departments failed to make
any report at all in the year 1872, while only 18 of the remaining 41
Departments sent in reports regarding epidemic outbreaks of small-pox.
The epidemic lasted until 1873, in which year reports regarding
small-pox epidemics came in from 10 Departments; but only in the
Departments of Morbihan and Pyrénées-Orientales was the epidemic
apparently somewhat more intense.[261]


               2. _Small-pox among the French Prisoners_

Thanks to the well-vaccinated condition of the German troops, the army
suffered comparatively little from small-pox. In the field army 4,385
men (61·3 per 1,000) contracted the disease, and 278 of them (3·5 per
cent of those who contracted it) died. Including the officers,
physicians, and officials, the number taken sick was 4,991 and the
number that died was 297. The number of men in the individual army corps
that contracted the disease varied greatly according to the nature and
place of their activity; particularly hard hit were the army divisions
in the south-western and northern scenes of the war, where the military
operations were carried on in fearfully cold weather, and where it was
impossible to quarter the infected soldiers in isolated places by
themselves. The French army was attacked much more severely by
small-pox, although there are no accurate reports available regarding
the prevalence of the disease. According to a report found in the
_Vienna Medical Weekly_,[262] the total number of French soldiers that
succumbed to small-pox was 23,469[263]; but the accuracy of this number,
to be sure, is questionable, since, assuming that there was a very high
mortality, it would mean that some 120,000 troops contracted the
disease. At all events, the French army, taken as a whole, was badly
infected with small-pox, and it was inevitable that among the French
prisoners brought to Germany there should be numerous small-pox
patients, some in the incubation stage, and some in the convalescent
stage of the disease, and that they should infect other people there.

The number of French prisoners taken to Germany in the first few months
of the year 1871 was no less than 372,918; the prisoners who at the very
beginning, but especially after the surrender of Metz, were transported
in large numbers to Germany, had to be distributed throughout the entire
Empire, clear over to the eastern boundary. Owing to the fact that new
transports of French prisoners were constantly arriving at the German
frontier, which, in consequence of severe hardships and privations, they
reached in such a weak physical condition that they could not be taken
very far inland, it became necessary to transfer some of the earlier
arrivals to other places of detention, and this, of course, favoured the
further dissemination of the disease. This transference was rendered
particularly necessary by the arrival of large numbers of prisoners
after the battle of Sedan (September 1), after the capitulation of Metz
(October 27), and after the battles of Orléans and Le Mans (December and
January respectively). Small-pox occasionally broke out among these
prisoners while they were on their way to Germany, rendering it
necessary to leave them behind, or else the disease made its appearance
when they reached their destination; as a rule, however, the first cases
of the disease were observed a few days after their arrival at their
place of detention, where they soon infected the other prisoners. The
further dissemination of the disease among them was checked by means of
wholesale vaccination.

Of the prisoners, 14,178, all told (38 per cent of the total number
taken), contracted small-pox, and of these 1,963 (5·26 per cent) died.
The statistics in the German Health Report indicate distinctly the
number of prisoners in the various states and provinces that contracted
and succumbed to the disease; but the total number of prisoners taken is
known only in the case of the larger states in the Confederation, since
the statistics in the Report are compiled on the basis of the army-corps
districts, which do not coincide with the political divisions. The
figures for the larger states are as follows:

              _Maximum
                 no.                              _Patients  _Deaths per
             prisoners._ _Patients._  _Deaths._  per 1,000._ 100 cases._
 N. Germany,
   excluding
   Kingdom
   of Saxony     283,750      10,547       1,527        37·2        14·5
 Kingdom of
   Saxony         10,234         248          18        24·2         7·3
 Bavaria          40,083       1,607         196        40·0        12·2
 Württemberg      12,958         390          28        38·1         7·2
 Baden            12,083         512          21        42·4         4·1
 Grand Duchy
   of Hesse       13,810         874         173        63·3        19·8
                 ———————      ——————       —————        ————        ————
 All Germany     372,918      14,178       1,963        38·0        13·8

The number of people who contracted the disease varied greatly in the
different territories, depending upon the locality whence the prisoners
came. Accordingly, the figures in the case of the Grand Duchy of Hesse
were rendered large by the fact that a severe epidemic of small-pox
broke out in the stronghold of Mayence on the occasion of the arrival
there of prisoners from Metz. The number of prisoners that contracted
and succumbed to small-pox in the larger military prison-dépôts is shown
by the following table, which covers only those places in Prussia and
the Grand Duchy of Hesse in which the maximum number of prisoners held
in confinement exceeded 5,000:

              _Maximum
                 no.                              _Patients  _Deaths per
             prisoners._ _Patients._  _Deaths._  per 1,000._ 100 cases._
 Spandau           6,856          77          25        11·2        32·5
 Jüterbog          5,002         196          23        39·2        11·7
 Danzig            9,189         188          24        20·5        12·8
 Königsberg        7,324         221          22        30·2         9·9
 Stettin          21,000       1,303         194        62·0        14·9
 Erfurt           12,400         203          28        16·4        13·8
 Magdeburg        25,450       1,902         271        74·7        14·3
 Torgau            9,359         603         128        64·4        21·2
 Wittenberg        9,753          51          10         5·2        19·6
 Posen            10,303         191          29        18·5        15·2
 Glogau           13,621       1,198         170        88·0        14·2
 Neisse           12,801         385         117        30·1        30·4
 Minden            5,071          98          13        19·3        13·3
 Wesel            16,299       1,042         127        63·9        12·2
 Cologne          13,774         175          24        12·7        13·7
 Coblenz          15,011         571         111        38·0        19·4
 Lockstedt         5,000          47           7         9·4        14·9
 Mayence          14,669         759         165        51·7        21·7

In the case of the Kingdom of Saxony and of the South German States no
figures for the individual places are available. We see from the above
table that of the large prison-dépôts, Glogau, Magdeburg, Torgau, Wesel,
Stettin, and Mayence had the most cases of the disease; generally
speaking, the smaller places were less severely attacked, although there
are a few exceptions to this statement; in Stralsund, for example, there
were 78·2 cases of the disease per 1,000 prisoners, in Papenberg and
Hanover 63·4, in Colberg 53·9, and in Münster 52·8.


               3. _Small-pox in the Immobile German Army_

The occurrence of small-pox in the immobile German army was closely
related to its prevalence among the prisoners, and it attacked the
immobile troops much more severely than the field-troops. The latter, to
be sure, were no less exposed to the infection, but the former, taken as
a whole, were not nearly so well vaccinated; for it was impossible in
the short time available to see to it that all the reserves were
vaccinated, since the troops designated for the field were given the
precedence. Thus between conscription and vaccination there was more or
less of an interval, during which a large number of the reserves were
not protected against the disease. The total number of men in the
immobile army that contracted small-pox was 3,472 (excluding Baden and
the Grand Duchy of Hesse, regarding which we have no statistics).
Assuming that the average number of reserves in the immobile army was
300,424, this means that about 11·6 per 1,000 contracted the disease.
The number of cases among the immobile troops in the individual states
of the Confederation varied greatly, as indicated by the following
table:

              _Average
                 no.                              _Patients  _Deaths per
             reserves._  _Patients._  _Deaths._  per 1,000._ 100 cases._
 N. Germany,
   excluding
   Kingdom
   of Saxony     238,040       1,703          92        7·15         5·4
 Kingdom of
   Saxony         17,628         506          30       28·70         5·9
 Bavaria          34,634       1,183          39       34·16         3·3
 Württemberg      10,122          80           1        7·90         1·3

In the larger Prussian garrisons, and in Mayence, the following number
of men contracted and succumbed to small-pox:

              _Average                            _Patients  _Deaths per
              no. men._  _Patients._  _Deaths._  per 1,000._ 100 cases._
 Berlin            9,110          57           4         6·3         7·0
 Danzig            7,376          45           5         6·1        11·1
 Königsberg        6,426         101          11        15·7        10·9
 Stettin           7,000          74           5        10·6         6·8
 Magdeburg        11,296          84           8         7·4         9·5
 Posen             9,482         113           6        11·9         5·3
 Breslau           8,029          20                     2·5
 Wesel             7,284         117           7        16·0         6·0
 Cologne           9,207          19           1         2·1         5·3
 Coblenz           8,710          83           4         9·5         4·8
 Mayence           9,046         122           9        13·5         7·4

Wherever, as in Breslau, there were few prisoners, the small-pox
percentage in the immobile army is low. Regarding the above figures, it
must be remarked that those pertaining to the garrisons were compiled on
the basis of the average number of troops, whereas in the case of the
French prisoners the maximum number was used as a basis. The relative
number of small-pox cases in the latter table, accordingly, is somewhat
too low. Among the prisoners and among the immobile troops, the climax
of the pestilence was in January, as indicated by the following table:

                     _French Prisoners._ _Immobile German troops._
      July (1870)                      2                        16
      August                          27                         9
      September                       85                        47
      October                        273                        49
      November                     1,041                       128
      December                     3,107                       358
      January (1871)               4,139                       802
      February                     3,151                       719
      March                        1,521                       457
      April                          586                       451
      May                            209                       291
      June                            36                       145

The number of French prisoners taken to Germany in the month of July
1870 was small. Of the sixteen immobiles who contracted the disease
during that month, nine belonged to the Ninth Army Corps, most of them
having been infected inland before the outbreak of the war. That the
month of July did not constitute the starting-point of the subsequent
epidemic is evident from the fact that the prevalence of the disease
decreased in August, as well as from countless individual observations.


  4. _The Epidemic of Small-pox in the Civil Population of Germany in
                                1871–2_

In the summer of 1870 Germany was almost free from small-pox. Later on,
thousands of French prisoners, almost all of them hailing from infected
localities, were within a short time scattered throughout the entire
German Empire, and since the inhabitants of many parts of the country,
as stated above, were very insufficiently vaccinated, it was inevitable
that epidemics of small-pox should break out everywhere. The disease was
disseminated in several ways: by prisoners who had contracted it on
their way to Germany, or who had to be transported from an infected to
an uninfected locality, by persons into whose systems the infection had
entered but had not yet revealed its presence, and by uninfected persons
who had come in contact with infected persons; numerous persons,
moreover, contracted the disease by handling the clothing, blankets, and
other effects of small-pox patients.

‘The dissemination of the disease,’ says the German Health Report,[264]
‘which broke out simultaneously in various parts of Germany, was helped
along in numerous ways. From the lazarets and from the prisons it was
communicated by nurses and guards, and by working men and tradesmen, to
the civil population and to the local garrison, and from there it spread
to the surrounding country. It was conveyed from place to place, often
considerable distances, by the moving population itself, not
infrequently by marching troops, and particularly by the removal of
prisoners from one place of detention to another; the latter measure had
to be adopted in order to make room for the fresh transports of
prisoners that were constantly arriving, many of them in such an
exhausted condition that it was necessary to spare them the long and
trying journey to the far East. Thus the prisons at Mayence, Coblenz,
Wesel, Minden, &c. became the foci from which the disease was
transplanted into hitherto uninfected places.’

The result was that there broke out in Germany an epidemic of small-pox
which raged more furiously and extensively than any other epidemic in
the course of the nineteenth century. Whereas among the prisoners-of-war
and among the immobile German troops (who were particularly exposed to
the infection) the disease reached its climax as early as January 1871,
among the civil inhabitants of the country this climax did not come
until later in the year; in the more out-of-the-way regions, moreover,
where there was less intercourse, the height of the epidemic was not
reached until the year 1872.


_(a) The Dissemination of Small-pox in Prussia and in the smaller North
                             German States_

After the prevalence of small-pox in Prussia had again increased
somewhat in the years 1864–7, in the following years the number of cases
of the disease grew steadily smaller, so that around the middle of the
year 1870 the country was practically free from it. Its prevalence again
increased in the first months of the year 1871. The following table
indicates the number of deaths caused by the disease in Prussia in the
course of twelve years:

             _Total no. deaths._ _Deaths per 10,000 inhabitants._
       1862                3,894                              2·1
       1863                6,250                              3·4
       1864                8,904                              4·6
       1865                8,403                              4·4
       1866               11,937                              6·2
       1867                8,500                              4·3
       1868                4,510                              1·8
       1869                4,655                              1·9
       1870                4,200                              1·7
       1871               59,839                             24·3
       1872          66,660[265]                             26·9
       1873                8,932                              3·6

In the year 1874 only one person per 10,000 inhabitants succumbed to the
disease. Among the French prisoners small-pox usually broke out very
soon after their arrival at their place of detention, while among the
inhabitants of the places in which the prisons were located it usually
did not make its appearance until several months later. Guttstadt,[266]
in his excellent work on the _Epidemic of Small-pox in Prussia in the
Years 1870–1_, has compiled a table of statistics indicating in a number
of places when the disease first made its appearance among the prisoners
and among the civil inhabitants. We reproduce this table below, with a
few small alterations. In some of the places mentioned there was no
military prison; only prisoners suffering from small-pox were taken to
them, usually resulting in an epidemic of the disease among the civil
inhabitants. The table clearly indicates the connexion between the
small-pox epidemics among the civil inhabitants and the outbreaks of the
disease among the prisoners; regarding the manner of dissemination in
the case of the individual epidemics we shall have more to say further
on.

   THE APPEARANCE OF SMALL-POX AMONG PRISONERS-OF-WAR AND AMONG THE CIVIL
            INHABITANTS IN THE GERMAN CITIES IN THE YEARS 1870–1

 ────────────────┬─────────────────────────────────┬───────────────────────
    _Cities._    │        FRENCH PRISONERS.        │  CIVIL INHABITANTS.
 ────────────────┼─────────┬──────┬───────┬────────┼───────┬───────┬───────
        〃        │ _First  │      │       │        │       │       │
                 │ arrival │      │       │        │       │       │
                 │   of    │_Max- │       │        │_First │ _No.  │ _No.
                 │infected │ imum │_First │_No. Pa-│ Out-  │Deaths_│Deaths_
                 │persons._│ no._ │Case._ │tients._│break._│(1870).│(1871).
 ────────────────┼─────────┼──────┼───────┼────────┼───────┼───────┼───────
  1. _East       │         │      │       │        │       │       │
       Prussia_  │         │      │       │        │       │       │
     Königsberg  │         │      │       │        │Aug.   │       │
                 │Aug. 15  │ 7,324│Aug. 15│     221│(end)  │     74│    558
  2. _West       │         │      │       │        │       │       │
       Prussia_  │         │      │       │        │       │       │
     Danzig      │Aug. 25  │ 9,189│Aug. 28│     188│Sep. 16│      5│    709
     Graudenz    │Aug. 5   │ 1,437│Aug. 28│       9│Fall   │      0│     11
     Thorn       │Aug. 21  │ 2,001│Aug. 27│      11│Fall   │      8│    147
  3. _Branden-   │         │      │       │        │       │       │
       burg_     │         │      │       │        │       │       │
     Berlin      │         │      │Aug. 20│      24│Nov.   │    170│  5,212
     Frankfurt-  │         │      │       │        │       │       │
       o.-t.-O.  │         │   756│Nov. 12│       8│Jan.   │      3│    117
     Küstrin     │         │      │       │        │End    │       │
                 │Aug. 7   │ 2,204│Aug. 17│       9│(1870) │      1│     32
     Landsberg-  │         │      │       │        │       │       │
       o.-t.-W.  │Nov.     │   133│Nov.   │       1│Nov. 20│      0│     97
  4. _Pomerania_ │         │      │       │        │       │       │
     Colberg     │Nov. 4   │ 3,246│Nov. 14│     175│Jan. 7 │      0│     27
     Greifswald  │         │      │Oct. 18│       3│Dec. 13│      1│    109
     Schivelbein │Jan. 24  │   603│Jan. 26│      24│Feb. 20│      0│     43
     Stettin     │Aug. 12  │21,000│Aug. 22│   1,303│Dec.   │     13│    422
     Stralsund   │Dec. 4   │ 2,991│Dec. 9 │     234│Jan. 7 │      0│    366
     Stolp       │         │      │       │        │Aug.   │       │
                 │Jan.     │ 1,376│Feb. 3 │       5│(1871) │      0│     16
  5. _Posen_     │         │      │       │        │       │       │
     Bromberg    │-        │      │Dec. 15│      14│Feb. 10│      0│    280
     Posen       │Oct. 4   │10,303│Sep.   │     191│Feb.   │     79│    466
     Schneidemühl│Nov.     │   940│Jan.   │       5│Jan.   │      0│     40
  6. _Silesia_   │         │      │       │        │       │       │
     Breslau     │         │      │Nov.   │       4│       │     28│    742
     Glatz       │Oct. 12  │ 2,284│Oct. 6 │      96│Feb.   │      2│     38
     Glogau      │Sep. 1   │13,621│Sep. 16│   1,198│Oct. 7 │     10│    114
     Görlitz     │         │   326│Nov.   │       5│Jan.   │      0│    164
     Oppeln      │Nov. 6   │ 1,027│Jan.   │      23│Jan.   │      0│     38
     Schweidnitz │Jan. 28  │ 1,821│Jan.   │      75│March  │      0│     52
  7. _Saxony_    │         │      │       │        │       │       │
     Aschersleben│Dec. 2   │ 1,618│Jan.   │      12│Dec.   │      0│     53
     Erfurt      │Sep. 12  │12,400│Sep. 14│     203│Dec.   │     18│    235
     Halberstadt │Jan.     │   619│Jan. 28│       6│Feb.   │      0│     29
     Halle-      │         │      │       │        │       │       │
       o.-t.-S.  │         │      │Nov. 1 │      28│March  │      0│    195
     Magdeburg   │Aug. 30  │25,450│Sep. 15│   1,902│Nov. 18│     22│    646
     Mülhausen   │         │      │Dec.   │        │       │       │
                 │Dec.     │ 1,065│(early)│      57│Feb. 1 │      4│     25
     Nordhausen  │         │      │Sep.   │       8│Jan.   │      0│    233
     Quedlinburg │         │   927│Nov. 27│      29│Nov.   │      1│      3
     Torgau      │Sept.    │      │       │        │       │       │
                 │(end)    │ 9,359│Oct. 4 │     603│Nov.   │      0│     67
     Wittenberg  │Aug. 27  │ 9,723│Sep. 5 │      51│Oct. 3 │      5│    100
  8. _Schleswig- │         │      │       │        │       │       │
       Holstein_ │         │      │       │        │       │       │
     Lockstedt   │         │      │       │        │End    │       │
                 │         │ 5,000│Oct.   │      47│1870   │       │
     Rendsburg   │         │      │       │        │End    │       │
                 │Nov.     │ 2,590│Nov. 26│      44│1870   │      0│    114
     Schleswig   │         │      │       │        │End    │       │
                 │Dec. 3   │ 1,570│Dec. 13│      17│1870   │     10│     38
  9. _Hanover_   │         │      │       │        │       │       │
     Stade       │         │ 2,284│Jan. 28│      32│1871   │      0│      3
 10. _Westphalia_│         │      │       │        │       │       │
     Hamm        │         │      │Oct.   │      12│Nov. 22│      9│    114
     Minden      │Sep. 10  │ 5,071│Sep.   │      98│Nov. 2 │      5│    114
     Münster     │Jan.     │      │Jan.   │        │       │       │
                 │(end)    │ 2,709│(end)  │     143│Feb. 12│      2│     67
 11. _Hesse-     │         │      │       │        │       │       │
       Nassau_   │         │      │       │        │       │       │
     Cassel      │         │      │Nov.   │      13│Nov.   │      6│     99
     Frankfurt   │         │      │Dec.   │       8│Jan.   │     23│    125
 12. _Rhine      │         │      │       │        │       │       │
       Province_ │         │      │       │        │       │       │
     Düsseldorf  │         │      │       │        │Oct.   │       │
                 │         │   981│Aug. 15│      13│(1870) │      6│    524
     Coblenz     │Sep. 15  │15,011│Sep. 23│     571│Nov. 2 │      0│     81
     Cologne     │Sep. 1   │13,774│Sep. 1 │     175│Sep. 12│     65│    418
     Wesel       │Sep. 9   │16,299│Sep. 20│   1,042│Nov.   │      9│     84

 The book contains a survey of the small-pox mortality in Prussia in the
 year 1871 according to Governmental Districts and Communities. The figures
 for the year 1872 have not been published; they were placed at my
 disposal, in manuscript form, by the Royal Prussian Bureau of Statistics.
 ──────────────────────────────────────────────────────────────────────────

The small-pox mortality varied greatly in the different Prussian
Governmental Districts; particularly noteworthy is the fact that it
was considerably higher in the eastern provinces, especially in the
year 1872, than in the western provinces, notwithstanding the fact
that the latter were exposed to the infection much sooner and much
more frequently in consequence of the arrival and passing through of
French prisoners. The only plausible explanation of this is the fact
that the inhabitants of eastern Prussia were not so thoroughly
vaccinated as those in the west; this, however, was not because the
anti-vaccinationists were more influential in the east, but because
the eastern provinces had fewer physicians than the western provinces,
where medical advice and help were far more accessible, and where the
population was more enlightened. The effect of vaccination is clearly
revealed in those Governmental Districts in the west which introduced
compulsory vaccination before they were incorporated into Prussia;
Schleswig-Holstein did this in 1811, Hanover in 1821, the Governmental
District of Wiesbaden in 1820, and the Governmental District of Cassel
in 1828. All these parts of the country had fewer cases of small-pox.
The Governmental Districts in which large military prisons were
located, and those in which, owing to a higher industrial development,
there was more intercourse of all kinds, were attacked earlier by
small-pox than the others. Of the western provinces only the two
highly industrial districts of Arnsberg and Düsseldorf, and the
district of Trèves, were very severely attacked. The living conditions
among the working people were not so good at that time as they are
to-day, and the close quarters must necessarily have favoured the
dissemination of small-pox; furthermore, the constant moving about of
the working inhabitants, many of whom did not live where they were
employed, helped to spread it. Thus it was observed in the vicinity of
Leipzig, that the villages inhabited by working people were much more
severely attacked by small-pox than those inhabited by farmers, with
their stationary and settled population. The high figures in the case
of the Governmental District of Trèves may be explained by the fact
that its location made it necessary for a large proportion of the
French prisoners that were taken into Prussia to pass through it. The
number of deaths per 10,000 inhabitants in the various Governmental
Districts of Prussia is indicated by the following table (the
districts which introduced compulsory vaccination in the year 1870 are
designated with an asterisk):

               _Governmental District._ 1870. 1871. 1872.
               Königsberg                 3·5  24·5  37·8
               Gumbinnen                  4·1   9·7  40·0
               Danzig                     2·8  42·4  67·6
               Marienwerder               3·7  17·7  76·2
               Berlin                     2·1  63·1  31·4
               Potsdam                    1·8  25·8  28·7
               Frankfurt                  0·1  18·6  40·0
               Stettin                    1·6  29·9  21·4
               Köslin                     2·2  12·2  36·7
               Stralsund                  0·2  34·0   3·9
               Posen                      6·0  48·3  58·0
               Bromberg                   5·3  24·1  86·6
               Breslau                    3·1  27·5  33·6
               Oppeln                     1·7  22·5  42·1
               Liegnitz                   0·5  11·2  16·8
               Magdeburg                  0·6  27·5  16·3
               Merseburg                  1·0  28·8  20·2
               Erfurt                     1·4  25·3  14·4
               Schleswig-Holstein*        0·2  18·0   5·0
               Hanover*                   0·3   5·3   8·8
               Hildesheim*                0·1  13·8  19·6
               Lüneburg*                  0·2   7·8   6·5
               Stade*                     1·3   5·6   4·9
               Osnabrück*                 0·3   6·0   0·8
               Aurich*                    0·0   5·4   1·1
               Münster                    0·3  11·6  10·8
               Minden                     0·2  13·4   8·9
               Arnsberg                   0·4  39·1  33·8
               Cassel*                    0·5   9·0   6·2
               Wiesbaden*                 1·7   9·7   2·5
               Coblenz                    1·2  22·8   6·6
               Düsseldorf                 0·3  32·9  20·5
               Cologne                    1·4  14·6   2·8
               Trèves                     2·5  34·0   3·1
               Aix-la-Chapelle            0·8  14·5   7·8
               Hohenzollern               1·7  19·9

In East Prussia small-pox broke out very frequently in the city and
vicinity of Königsberg. According to Guttstadt, small-pox patients, in
consequence of the proximity of the Russian border, kept coming to the
hospital in Königsberg, into which twelve persons suffering from the
disease were received between January 1 and August 1, 1870. The first
prisoners-of-war arrived at Königsberg on August 15, 1870, and among
them was a small-pox patient. Shortly afterwards two more cases of the
disease occurred among the prisoners. The first case among the civil
population occurred in the hospital on September 2. Owing to the
constant intercourse between the prisoners and the civil inhabitants the
epidemic spread very rapidly. The districts surrounding Königsberg were
very severely attacked in the year 1871, while the more remote
districts, especially those along the boundary of West Prussia, were not
attacked until the year 1872. In the districts around Königsberg the
mortality per 10,000 inhabitants was as follows:

                                         1871. 1872.
                   Königsberg (city)      49·8   3·6
                   Königsberg (vicinity)  78·4  13·3
                   Labiau                 42·4  30·6
                   Wehlau                103·1   8·9
                   Insterburg             32·2  47·3
                   Fischhausen            38·7  17·9

In the districts of East Prussia more remote from Königsberg the
following number of deaths per 10,000 inhabitants were reported:

                                     1871. 1872.
                       Memel           5·5  37·0
                       Gerdauen       18·9  53·1
                       Rastenburg     65·9  26·8
                       Friedland      13·7  35·5
                       Eylau          15·2  29·7
                       Heiligenbeil   19·7   8·1
                       Braunsberg      2·9  10·1
                       Heilsberg       6·3  27·2
                       Rössel         25·7  52·2
                       Allenstein      7·4 108·5
                       Ortelsburg     20·6 124·4
                       Neidenburg      1·7  45·6
                       Osterode        4·7  76·5
                       Mohrungen       2·1  36·2
                       Prus. Holland   1·1   8·3
                       Heydekrug            43·3
                       Niederung      23·7  84·6
                       Tilsit          5·4  46·3
                       Ragnit          4·6  51·7
                       Pillkallen      0·7  17·4
                       Stallupönen     0·7  14·0
                       Gumbinnen      17·1  35·8
                       Darkehmen       3·8  25·3
                       Angerburg      10·9  81·0
                       Goldap          2·3  41·2
                       Oletzko         1·0  24·7
                       Lyk             2·4  17·8
                       Lötzen          5·1  28·3
                       Sensburg       13·3  52·1
                       Johannisburg   15·8  12·4

Several of the last fifteen districts (Heydekrug to Johannisburg in the
above table) had relatively few cases of small-pox; the reason for this
was that the governmental district of Gumbinnen had but little
intercourse, that few prisoners were taken there at all, and that there
were no cases of small-pox among the few that were taken there.

Danzig was the chief seat of the pestilence in West Prussia, since large
numbers of prisoners were confined there; per 10,000 inhabitants 79·6
succumbed to small-pox in the year 1871, and 35·9 in the year 1872. Says
Liévin:[267] ‘For a considerable length of time no cases of small-pox
occurred in Danzig, but in the month of September 1870 the beginnings of
an epidemic were observed. Although this happened shortly after the
arrival of the first prisoners, nevertheless the beginning of the
epidemic was probably not connected in any causal way with this
circumstance. For, in the first place, the prisoners were French
soldiers captured in the battles of Weissenburg and Wörth, and were in
all probability healthy men, judging from the fact that not a single
case of the disease occurred among them in the first few months; in the
second place, the disease broke out very sporadically in the first three
or four months, individual outbreaks occurring here and there in the
city, just as has been the case in Danzig almost every year. But during
this indigenous pestilence a large number of badly infected prisoners
arrived from the Metz garrison; this gave rise to an epidemic which, had
the prisoners not arrived, would probably have progressed in the usual,
scarcely noticeable manner; as it was, however, the epidemic attained to
the largest dimensions known to the memory of man.’

According to Liévin, the total number of small-pox cases in Danzig and
its suburbs (including the garrison and the prisoners-of-war) was:

                   1870.                 1871.                 1872.
           _Patients._ _Deaths._ _Patients._ _Deaths._ _Patients._ _Deaths._
 January                                 123        24         245        77
 February                                129        28         222        77
 March                                   201        51         153        75
 April                                   365        70          89        33
 May                                     459       109          34        17
 June                                    442       123          19        12
 July                                    182        71          13         3
 August                                  130        49           8         7
 September           2                   111        37           5         2
 October             4         2         124        57           2
 November           13         2         136        42
 December           34         3         135        39

Of the 9,189 prisoners in Danzig, 188 contracted the disease, and 24
died; the largest number of cases was reported in the month of January.
Of the garrison, which consisted of 7,376 men, only 45 contracted the
disease,[268] and 5 died.

As in East Prussia, so also in West Prussia, only those districts
suffered severely from small-pox in which large military prisons were
located; in the remaining districts the pestilence did not acquire much
severity until the following year. Of the three strongholds, Danzig,
Thorn, and Graudenz, the last two had but few cases of small-pox among
the prisoners; in the districts surrounding them the following number of
deaths per 1,000 inhabitants were reported:

                                       1871. 1872.
                     Danzig (city)      79·6  35·9
                     Danzig (district)  91·2  59·2
                     Prussian Stargard  55·5 105·0
                     Rosenberg          40·5  66·5
                     Thorn              46·0  41·7

In the remaining districts of West Prussia the mortality due to
small-pox was as follows:

                                     1871. 1872.
                       Elbing         18·7  71·8
                       Marienburg     16·0  68·6
                       Berent          6·6  47·7
                       Karthaus        7·7  67·9
                       Neustadt       22·9  89·0
                       Stuhm          21·4  97·8
                       Marienwerder   21·3  62·3
                       Löbau           4·9  88·0
                       Strassburg      6·1  80·7
                       Kulm           25·9  65·5
                       Graudenz        5·4  55·9
                       Schwetz        11·0 118·6
                       Konitz          9·7  79·7
                       Schlochau       6·9  69·5
                       Flatow         23·4  74·1
                       Deutsch-Krone  10·2  92·1

All these districts, especially Prussian-Stargard and Schwetz, which lay
side by side along the Vistula, had an unusually high mortality in the
year 1872.

The Governmental District of Posen, in the Province of Posen, was much
more severely attacked by small-pox in the year 1871 than the
Governmental District of Bromberg, whereas in the year 1872 the
condition was reversed. In the former district cases of small-pox had
occurred even before a transport of French prisoners arrived there in
the middle of September; in that month two of the prisoners contracted
the disease, and these two cases constituted the beginning of a large
epidemic among the prisoners. According to Guttstadt, the epidemic among
the civil inhabitants did not commence until February 1872, and it
lasted until the middle of that year. The districts along the boundary
of Posen (Schroda, Wreschen, Schrimm, Kosten, and Samter) had the
largest number of cases and deaths in the year 1871, whereas in the
remaining, more distant, districts the figures for the year 1871 are for
the most part small, and do not begin to grow large until the year 1872.
The following table indicates the number of deaths per 10,000
inhabitants in the districts mentioned:

                                       1871. 1872.
                      Posen (city)      82·5   4·4
                      Posen (district) 103·2  53·0
                      Schroda          105·6  61·3
                      Wreschen         116·5  63·1
                      Schrimm           61·5  88·4
                      Kosten            75·9  72·4
                      Samter            66·9  83·4
                      Pleschen          17·9  56·7
                      Buk               38·2  42·2
                      Obornik           22·2  76·3
                      Birnbaum          15·4  63·6
                      Meseritz          13·0  53·3
                      Bomst             20·5  34·1
                      Fraustadt         21·5  26·0
                      Gröben            55·8  79·5
                      Krotoschin        22·1  62·0
                      Adelnau           26·3  29·4
                      Schildberg        14·6  91·6

The first prisoners that contracted small-pox in the city of Bromberg
were committed to the lazaret on December 15; the epidemic among the
civil inhabitants began there on February 10, 1871. The figures for 1871
were higher than those for 1872 in only three districts—Bromberg itself,
the adjacent Schubin, and Czarnikau; the last-named district lies in the
west and borders on Samter in the Governmental District of Posen. All
the other districts that are not mentioned had higher figures in the
year 1872. The following table indicates the number of deaths per 10,000
inhabitants in the districts named:

                                    1871. 1872.
                        Czarnikau    47·0  69·8
                        Wirsitz      14·7  65·4
                        Bromberg     89·7  72·3
                        Schubin      59·4  96·5
                        Inowrazlaw   20·4 102·5
                        Mogilno      22·6  96·5
                        Chlodziesen  24·7  79·7
                        Wongrowitz   26·3 153·1
                        Gnesen       32·9  56·0

Of the prisoners in the Governmental District of Liegnitz, those in the
stronghold of Glogau were the most severely attacked. In the garrison,
too, the number of small-pox patients was quite large. The first
prisoners arrived on September 1, and the first cases of small-pox among
them appeared on September 16; the maximum number of prisoners there was
13,621, and of these 1,198 contracted the disease. The first case among
the civil inhabitants was reported on October 7; in December the disease
was conveyed to the surrounding villages, especially by tradespeople who
had visited the markets in Glogau. The adjacent districts suffered
relatively little in the year 1871. In the governmental district of
Liegnitz, with the exception of Glogau, where there were 31·2 deaths per
10,000 inhabitants, only Görlitz and Liegnitz had high figures in the
year 1871. In the city of Görlitz a prisoner was committed to the
lazaret in November 1870, and in December, when a transport of prisoners
passed through the city, one of them was left behind there; the epidemic
among the civil inhabitants began in January 1871. Again in the year
1872 small-pox did not become very widespread except in the districts of
Liegnitz, Jauer, Hirschberg, and Görlitz; Liegnitz, with a mortality of
35·2 per 10,000 inhabitants, had the highest figures.

In the Governmental District of Breslau cases of small-pox were
frequently reported. In the city of Breslau the first case among the
prisoners occurred on November 11, the second on January 27, the third
and fourth in April and May, 1871; the first cases in the garrison
likewise occurred in November; from January on, the number of cases grew
steadily larger. The number of reported cases in the city was:[269]

                            January      33
                            February     68
                            March        90
                            April        68
                            May         134
                            June        235
                            July        287
                            August      271
                            September   361
                            October     699
                            November  1,026
                            December  1,229
                            January   1,311
                            February    790
                            March       462
                            April       242

The epidemic was very severe. Whereas during the previous epidemics
(1856–7, 1863–4, and 1868–9) only about seven per cent of the patients
treated in the hospital died, in 1871–2 no less than 322 out of 2,416
patients (13·4 per cent) taken there were carried away by the disease.
Of the 322 patients, moreover, 182 had hemorrhagic small-pox, and of
these 166 died.

The immediate vicinity of Breslau was very severely attacked; in the
districts lying to the south of the Oder small-pox raged extensively in
the year 1871, whereas those districts on the north side of the river
did not suffer very severely until the year 1872. This may be explained
by the fact that the extensive industrial activity of the districts
south-west of the Oder rendered considerable intercourse with Breslau
necessary. The following table indicates the number of deaths per 10,000
inhabitants in the districts north-east of the Oder:

                                    1871. 1872.
                         Namslau      4·0  48·5
                         Wartenberg  14·0  55·4
                         Oels        22·3  71·0
                         Trebnitz     8·6  27·8
                         Militsch    10·0  37·2
                         Gurau       15·5  20·2
                         Steinau     12·1  34·2
                         Wohlau      41·1  38·4

and in the districts south-west of the Oder:

                                        1871. 1872.
                     Neumarkt            13·5  61·5
                     Breslau (city)      35·7  27·3
                     Breslau (district)  57·3  74·9
                     Ohlau               12·2  23·3
                     Brieg                5·2  17·2
                     Strehlau            30·3  33·8
                     Nimptsch            23·5  37·4
                     Münsterberg         53·0  29·0
                     Frankenstein        34·3  14·3
                     Reichenbach         32·0  19·8
                     Schweidnitz         26·3  13·4
                     Striegau            16·9  48·2
                     Waldenburg          57·7  36·2
                     Glatz               39·1  13·4
                     Neurode             20·2  35·6
                     Habelschwerdt        8·2   7·3

In Upper Silesia the stronghold of Neisse had a maximum number of 12,801
prisoners, among whom there were 385 cases of small-pox and 117 deaths;
in the garrison, which averaged 4,452 men, there were 39 cases and 1
death. The first cases among the prisoners were reported on September
25, and in the garrison in November. The civil inhabitants suffered very
little in the year 1871, and the number of deaths among them did not
begin to grow large until 1872. Only in the district of Neisse and in
the neighbouring district of Grottkau was the number of deaths larger in
1871 than in 1872; in all the other districts there were more deaths in
1872. The districts which were most severely attacked in the year 1872
were—Kreuzburg (78·2 deaths per 10,000 inhabitants), Posenberg (58·6),
Gross-Strelitz (60·0), Beuthen (56·5), and Kosel (62·4).

In the Province of Pomerania the city of Stettin came to be a general
rendezvous for prisoners of war; the maximum number of them, owing to
the continual arrival of new transports, was no less than 21,000. The
first transport arrived on August 12, and the first small-pox patient
among them was committed to the hospital on August 28. Of the prisoners,
1,303 contracted the disease and 194 succumbed to it. The climax of the
epidemic came in January, when there were 462 cases reported. The first
cases in the garrison, which averaged 7,000 men, occurred in October,
the first man to contract the disease being a sick-attendant, and the
second an artilleryman; after that, all the branches of service were
attacked. The epidemic in the garrison, however, was confined to 74 men,
only 5 of whom died. In December the disease spread to the civil
population; the number of cases (including the garrison) was 422 (55·5
per 10,000) in the year 1871, and 113 (14·8 per 10,000) in the following
year. In the Governmental District of Stettin only the communities
surrounding the city of Stettin had high small-pox figures in the year
1871, and these communities were also more severely attacked in the year
1872. The following table indicates the number of deaths per 10,000
inhabitants in the communities mentioned:

                                     1871. 1872.
                       Demmin          1·1   2·6
                       Anklam          4·3  15·8
                       Usedom-Wollin  16·4  16·2
                       Uckermünde     24·7  26·4
                       Randow         70·4  29·3
                       Greifenhagen   37·8  26·3
                       Pyritz         15·3  23·1
                       Saazig         27·8  27·4
                       Naugard        32·4  32·6
                       Kammin         10·3  13·3
                       Greifenberg     4·3  10·4
                       Regenwalde     16·4  27·5

At the stronghold of Kolberg (Governmental District of Köslin) 3,500
prisoners arrived on November 4, and in December and January they were
followed by the arrival of more transports. The first cases among these
prisoners were reported on November 14; all told, 175 of them contracted
small-pox and 24 succumbed to it. On January 7 the disease spread to the
civil population, but did not rage very extensively in the city; 127
civilians contracted it and 24 succumbed to it, and in August 1871 it
disappeared; only two men in the garrison were taken sick. Many of the
prisoners in Kolberg were transported to Stettin, Köslin, and Stolp, and
in all three of these places the disease broke out among the civil
inhabitants. In Schivelbein an infected soldier was found among the
prisoners who arrived on January 24, 1871, and on January 26 he was
committed to the lazaret; in February a working-man contracted the
disease in the same lazaret, and after that the epidemic spread
throughout the city and did not disappear until October 1872; it carried
away a relatively large number of people and spread to two neighbouring
villages. But taking the Governmental District of Köslin as a whole, it
may be said that the dissemination of small-pox was moderate; the
district of Schlawe had the largest number of deaths (22·7 per 10,000
inhabitants). On the other hand, in the year 1872 small-pox caused a
very large number of deaths in the districts of Neustettin, Dramburg,
Schlawe, Rummelsburg, and Stolp.

The number of cases of the disease in the Governmental District of
Stralsund was very large. Small-pox broke out very severely among the
French prisoners in the city of Stralsund, the maximum number of whom
was 2,991; of these 234 contracted the disease and 35 succumbed to it.
The prisoners arrived on December 4, and among them was a small-pox
patient; he was committed to the lazaret on December 9. In the garrison,
which averaged 3,700 men, there were only thirty-one cases of the
disease and one death. The first case among the civil inhabitants
occurred on January 7; the patient was a clerk who lived near the
lazaret and had had more or less intercourse with the prisoners. Of
twenty-three more cases that occurred before January 15, at least six
were shown to be directly attributable to the epidemic among the
prisoners; one of the six was a sick-attendant, two were working-men in
the military lazaret, and the other three were members of the families
of attendants. The epidemic then became very widespread; to the end of
the year 1871 the number of deaths was 366, and the number of reported
cases was 1,807. In Greifswald a French prisoner contracted small-pox on
October 18, 1870, in the military reserve lazaret, another on November
1, and a third on November 16. The first civilian, an attendant,
contracted the disease on December 13, and on January 6, 1871, a
working-man, who had transported the attendant from the military lazaret
to the town small-pox hospital, was taken sick. Until February 14, ten
more cases were reported, and then the epidemic began. Up to the end of
the year 1871 no less than 578 cases of the disease and 111 deaths
caused by it were reported to the authorities. In the year 1872 there
were only a few deaths caused by small-pox throughout the entire
Governmental District of Stralsund.

In the case of the two adjacent confederate states of
Mecklenburg-Schwerin and Mecklenburg-Strelitz no small-pox mortality
statistics are available. On September 20, prisoners from Metz were
taken to the reserve lazaret in Schwerin, and among them was a small-pox
patient who died eight days later. In the same month an assistant in the
lazaret was taken sick, and in October and December two more members of
the lazaret staff contracted the disease. The pestilence spread to the
civil population because the attendants who were commissioned to dispose
of the effects of the dead, instead of destroying them, sold or gave
them to the inhabitants. The epidemic, which spread rapidly throughout
the surrounding country, was quite severe and lasted until March 1871.
In Wismar two cases of small-pox were reported among the prisoners in
December, and these were followed by six more cases in January and
February; in the garrison, which averaged 1,219 men, there were 48 cases
of the disease (5 in January, 32 in February, 9 in March, and 2 in
April); 3 of the 48 were fatal. At Rostock 649 prisoners arrived on
November 11, and these were followed by 544 more on December 14; among
the latter there were two small-pox patients, and in the course of the
next few months forty-one more cases of the disease and six deaths were
reported.

Berlin suffered severely from an epidemic of small-pox in the years
1871–2. The last large epidemic there had occurred in the year 1801, and
had carried away 1,626 out of 176,700 inhabitants. In the year 1864
another rather mild epidemic had broken out, but had quickly
disappeared. In the year 1870 the number of small-pox patients in Berlin
was small; an average of nine persons per month succumbed to the disease
between the first part of August and the last part of November. In the
month of December 1870 the death-rate began to increase, at first rather
slowly; the number of deaths in that month was 22, and in March 1872 it
was 176. The epidemic now began to spread rapidly, and in June it
reached its climax with 648 deaths; during the summer it abated a
little, but in the fall it began to rage more and more furiously until
December, when it reached a second climax with 671 deaths. The progress
of the epidemic is shown by the following table, taken from Guttstadt’s
excellent book. The number of deaths caused by small-pox in Berlin was:

                          November (1870)   9
                          December         22
                          January (1871)   48
                          February         80
                          March           176
                          April           349
                          May             430
                          June            648
                          July            532
                          August          528
                          September       490
                          October         600
                          November        660
                          December        671
                          January (1872)  445
                          February        256
                          March           151
                          April           117
                          May              76
                          June             33
                          July             18
                          August           10

The disease was unusually severe and virulent; fifteen per cent of the
patients died in the hospitals. The total number of deaths[270] in the
year 1871, when the population of the city was 826,341, was 5,212, or
63·1 per 10,000 inhabitants; thus the total mortality, which in the
years 1867–70 had been 31·8 per cent (including the still-births),
reached the prodigious height of 40·4 per cent. The cause of the wide
dissemination of small-pox in Berlin was the fact that large numbers of
people, including children, had never been vaccinated, and only a few
had ever been revaccinated. According to a rough estimate made by
Guttstadt, of Berlin’s total population in the year 1871 some 20,000
people had never been vaccinated, 530,000 had been vaccinated only once,
and only 270,000 had been revaccinated; fourteen per cent of those who
had never been vaccinated, two per cent of those who had been vaccinated
once, and O·5 per cent of those who had been revaccinated, contracted
the disease. In the garrison, which averaged 9,110 men, only 57 cases of
the disease and 4 deaths were reported between July 1, 1870, and June
30, 1871. But few prisoners were taken to Berlin; only 24 prisoners
suffering from small-pox were committed to the lazarets, and of these
only 4 died; the first two cases were in August and September.

In the Governmental District of Potsdam only those districts which
bordered directly on Berlin were severely attacked by small-pox in the
year 1871, e.g. the districts of Niederbarnim, Teltow, Jüterbog,
Luckenwalde, and East and West Havelland; in the following years those
districts bordering on Niederbarnim (as Oberbarnim, Angermünde, and
Templin) also suffered severely. In the city of Potsdam two Frenchmen
contracted the disease on February 6, shortly after their arrival there,
and on February 19 a soldier who had accompanied them was taken sick. In
April an epidemic of rather wide extent was raging in the city; the
number of deaths caused by small-pox in April 1871 was 157 (34·5 per
10,000 inhabitants), and in April 1872 it was 71 (16·2 per 10,000). In
the city of Brandenburg-on-the-Havel an infected French soldier arrived
in February 1871; he communicated the disease to his attendant, and in
that very month cases of small-pox were reported among the civil
inhabitants of the city, although it was impossible to prove a connexion
between them and that of the French soldier. The number of deaths, all
told, was 59. The number of deaths per 10,000 inhabitants in the
Governmental District of Potsdam was:

                                         1871. 1872.
                    Prenzlau               7·5  11·1
                    Templin               17·5  28·4
                    Angermünde            15·0  53·4
                    Oberbarnim            18·2  33·8
                    Niederbarnim          36·5  27·1
                    Teltow                46·4  40·4
                    Beeskow-Storkow       20·6  39·8
                    Jüterbog-Luckenwalde  43·4  38·7
                    Zauch-Belzig          14·6  38·1
                    East Havelland        37·7  14·7
                    West Havelland        32·3  33·4
                    Ruppin                26·8  13·3
                    East Priegnitz        14·9  12·6
                    West Priegnitz        16·8  23·3

In the Governmental District of Frankfurt small-pox raged only to a
moderate extent in the year 1871. In Frankfurt-on-the-Oder itself there
were sporadic outbreaks of the disease every year. On November 12 two
infected prisoners from Metz were committed to the hospital, and before
the end of that month two attendants contracted the disease; a few cases
also occurred in the garrison in the month of November. Of the French
prisoners, whose maximum number was 756, eight contracted the disease
and two succumbed to it; in the garrison, which averaged 1,881 men,
there were 21 cases of the disease and no deaths. Among the civil
inhabitants, on the other hand, a somewhat more severe epidemic raged;
whereas in the year 1870 only 21 cases of the disease were reported, in
the year 1871 there were 19 cases in the month of January alone; until
May some 196 persons contracted the disease, which after that began to
abate. The number of deaths, all told, in the year 1871 was 117, and in
1872 it was 70. In Landsberg-on-the-Warthe small-pox broke out in the
middle of November in consequence of the arrival of an infected
prisoner; the first case among the civil inhabitants was reported on
November 20. The total number of deaths in the year 1871 was 97. At
Kottbus an infected French prisoner arrived on October 1, resulting in a
rather severe epidemic among the civil inhabitants (114 deaths in the
year 1871). Not until the year 1872 did the disease become very
widespread in the Governmental District of Frankfurt; with the exception
of the city of Frankfurt there was no district which suffered more
severely in the year 1871 than in 1872. In most of the districts
small-pox broke out very virulently, the only exceptions being the
districts of Lübben and Spremberg.

Regarding the dissemination of small-pox in the Province of Saxony
Guttstadt gives us very detailed information. In the years 1871–2 the
disease was equally prevalent in all three governmental districts in the
Province. In the city of Magdeburg the last case was reported on May 24,
1870, and from then until November there was not a single case among the
civil inhabitants. The first prisoners arrived at Magdeburg in the
latter part of August, and on September 14 a case of small-pox was
observed among them; this was followed by ten more cases in that month.
Of the prisoners brought to Magdeburg, the maximum number of whom was no
less than 25,450, some 1,092 contracted the disease, and of these 271
died. The largest number of cases was reported in the month of February
1871. Of the garrison, which averaged 11,296 men, there were only 84
cases of the disease (7·4 per cent), and of these 8 died. The first case
among the civil inhabitants was reported on November 18, 1870, and this
was followed by seven more cases in that month, occurring in various
parts of the city. The number of deaths in the year 1871 was 646 (56·4
per 10,000 inhabitants), and in the year 1872 only 45 deaths were
reported. From the city of Magdeburg small-pox spread to the surrounding
country.

On November 25 a transport of prisoners from Metz, after having been
detained for two or three weeks in the badly infected city of Minden,
arrived at Quedlinburg; two days later the first case of small-pox
occurred among them. A second transport, which arrived on January 31,
1871, likewise brought infected men with it. Among the civil inhabitants
small-pox did not become very widespread, and only three civilians
succumbed to the disease in the year 1871. In Aschersleben small-pox
broke out among the prisoners in January 1871, a few days after their
arrival from Mayence, and the number of cases reported in the months of
January and February was only twelve. According to Guttstadt, small-pox
was already prevalent in the civil population in December, when the
disease was given an opportunity to spread to the surrounding country.
According to the German Health Report, on the other hand, small-pox did
not appear in the city until February, when the proprietor of an inn,
which had been converted into a small-pox hospital, contracted it. The
total number of deaths in the year 1871 amounted to 53 (31·6 per 10,000
inhabitants). On January 26 and 27, 1871, some 360 prisoners, four of
them infected with small-pox, arrived at Halberstadt, having come from
Mayence. The number of deaths in the city of Halberstadt in the year
1871 was 29 (11·4 per 10,000 inhabitants). Only those districts in the
Governmental District of Magdeburg which bordered on the city of
Magdeburg were more severely attacked; Kalbe (43·1 deaths per 10,000
inhabitants), Wanzleben (37·7), and Wollmirstedt (29·2). In addition to
these the district of Wernigerode also had a very high small-pox
mortality in the year 1871 (70·5 per 10,000). In those districts further
away from Magdeburg—Osterburg, Salzwedel, Aschersleben, and
Halberstadt—the climax of the small-pox mortality was not reached until
the year 1872, whereas in the other districts it was reached in 1871.

In the Governmental District of Merseburg small-pox broke out very
severely in the stronghold of Torgau, where in the last part of
September and in the first part of December prisoners arrived from
Strassburg and Metz, respectively; in both transports, but especially in
the second, there were infected men. The first cases of the disease were
reported on October 4. Of the prisoners, the maximum number of whom was
9,359, some 603 (64·4 per 1,000) contracted the disease and 128 (21·2
per cent of those who contracted it) died. The epidemic, accordingly,
was unusually severe among the prisoners, and it reached its climax in
January. In the German garrison, which averaged 3,943 men, there were,
all told, 75 cases of the disease (19·0 per 1,000) and five deaths.
Among the civil inhabitants the first persons to contract the disease in
the last part of November and first part of December were a woman, who
was employed as a laundress in the garrison lazaret, her sons, and a
woman who had visited the place where the prisoners were confined. The
epidemic did not break out until December 22, on which day a single case
was reported; on the following day twelve more cases were reported. The
total number of deaths was 67 (61·7 per 10,000). Very soon the infection
spread throughout the entire vicinity of Torgau, which in the year 1871
had a very high small-pox mortality; by 1872 the disease had almost
disappeared from the city.

In Wittenberg, which before the arrival of the prisoners was absolutely
free from small-pox, a transport arrived on August 27, and on September
5 the first small-pox patients were taken to the lazaret. Among the
Frenchmen the disease did not rage very extensively; of a maximum number
of 9,753, only fifty-one (5·2 per cent) contracted the disease and ten
succumbed to it. Of the garrison, which averaged 2,845 men, seventeen
contracted the disease and two died. Among the civil inhabitants the
first case of small-pox was reported on October 3; it was that of a
pastor who had been serving as curate among the prisoners. This case was
followed by several others, most of the victims being persons who lived
in the vicinity of the pastor’s dwelling-place. The pestilence then
began to spread rapidly among the civil inhabitants, finally developing
into a severe epidemic. There were 768 cases reported, distributed as
indicated by the following table:

                           October (1870)  26
                           November        66
                           December       102
                           January (1871) 107
                           February        97
                           March          113
                           April           76
                           May             83
                           June            61
                           July            27
                           August           8
                           September        1

Of those who contracted the disease five died in the year 1870 and 100
died in the following year (86·5 per 10,000 inhabitants). Likewise in
the country surrounding Wittenberg small-pox was very widespread in the
year 1871.

Among the French prisoners in Halle-on-the-Saale there were twenty-eight
cases of small-pox in January and February, and at the same time a few
cases of the disease were reported in the regiment that was transferred
from Halle to Mülhausen. In the first part of March 1871, cases were
reported among the civil inhabitants, and they constituted the beginning
of a large epidemic. In the year 1871 there were 195 deaths due to the
disease (37·0 per 10,000 inhabitants) and in the year 1872 there were
forty-one more deaths.

Generally speaking, small-pox was rather uniformly spread throughout the
Governmental District of Merseburg in the year 1871; the districts of
Torgau and Wittenberg were the only ones that were attacked with
particular severity. In the western part of the governmental district
small-pox raged more furiously in 1872 than in 1871.

The city of Erfurt (Governmental District of Erfurt) in the year 1869
had been the scene of a small-pox epidemic, which lasted well into the
following year. The last cases of the disease occurring in connexion
with this epidemic were reported on August 13, 1870. To be sure, the
disease revealed its presence on September 27 and 30 among the French
prisoners, who had arrived on August 21, and these cases were followed
by many more when a new transport of prisoners arrived from Metz; but of
all the prisoners in Erfurt, the maximum number of whom was no less than
12,400, only 203 men (16·4 per cent), all told, contracted the disease,
and of these only 28 died. In the garrison, which averaged 4,627 men,
there were 25 cases of small-pox and no deaths. On the other hand, in
December there began among the civil inhabitants an epidemic which
spread rapidly and reached its climax in April 1871, with 244 cases.
According to Guttstadt, the number of deaths due to small-pox was 253
(53·9 per 10,000 inhabitants) in the year 1871, and 33 in the year 1872.
The epidemic did not come to an end until June 1872.[271] In Mülhausen,
prisoners from Mayence, where small-pox was prevalent, arrived in the
first part of December, and some of them were already infected with the
disease. On February 1 the pestilence spread to the civil population,
and carried away twenty-five persons in the course of the entire year.
Nordhausen was free from small-pox in the summer of 1870; but the
disease was twice borne into the city, in October 1870 and in January
1871, by prisoners. The first cases among the civil inhabitants were
reported in the latter month, after which they increased rapidly in
number. In the year 1870 there were 233 deaths (109·5 per 10,000
inhabitants) due to the pestilence. Except in these two cities of Erfurt
and Nordhausen the disease did not become very widespread in the year
1871 in any part of the Governmental District of Erfurt.

Regarding the appearance of small-pox in Brunswick, the Thuringian
States, and Anhalt, only a small amount of information is available. In
the city of Brunswick a German soldier, who had come from Carignan,
contracted the disease in September, and in November and January six
Frenchmen were taken sick; two of the latter died. In the garrison,
which averaged 1,389 men, there were four cases of small-pox in March
and June. According to a manuscript report of the Brunswick Bureau of
Statistics, the number of deaths due to small-pox throughout the entire
Duchy was 2 in the year 1870, 269 in the year 1871, and 215 in the year
1872. At Gotha a French prisoner suffering from small-pox was left
behind in January, and another prisoner in the same transport contracted
the disease a few days later; in February there were a few isolated
cases in the garrison. At Weimar a German field-soldier suffering from
small-pox arrived in February; he infected the woman who took care of
him, and presently the disease broke out in the city. In Altenburg two
infected sub-officers of the field-army and two Frenchmen, likewise
suffering from the disease, were committed to the reserve-lazaret, and
shortly afterwards a small epidemic broke out in the garrison. There
were ten cases of the disease and no deaths among the Frenchmen, and in
the garrison, which averaged 1,178 men, there were eleven cases and one
death. Among the civil inhabitants the first to be attacked were a
sick-attendant and a journeyman mason; the latter had removed the soot
from a stove in a room occupied by small-pox patients.

In the Duchy of Saxe-Meiningen, according to a manuscript report of the
local Bureau of Statistics, the number of deaths due to small-pox in the
years 1860–71 was 133, in the year 1872 it was 37, and in the year 1873
it was 47. The figures for the several years before 1871 are not
available. Every transport of sick soldiers from France brought
small-pox patients to the city of Meiningen; five cases, the first in
January, were reported in the garrison, which consisted of 1,663 men,
and in the same month there were cases among the civil inhabitants. It
was impossible, however, to establish a connexion between those in the
garrison and those in the city.

In Dessau, one French prisoner in October and two in November contracted
the disease, which in January appeared throughout the city and became
epidemic. In the garrison, which consisted of 1,228 men, there were ten
cases of the disease, none of which terminated fatally.

Hamburg,[272] after the by no means mild epidemic that raged there in
the year 1864 (19·7 deaths per 10,000 inhabitants) suffered very little
from the disease in the following years; in 1868 there were five deaths
reported, and in 1869 the number increased to twenty. After the
Franco-German War an epidemic of small-pox raged in Hamburg, which was
more extensive and more furious than almost any other epidemic that
Germany had ever experienced. In the years 1870–2 no less than 4,053
persons succumbed to small-pox in Hamburg. Among the French prisoners
there were twenty-two cases of the disease and one death, and among the
German troops there were twelve cases and no deaths. The disease first
made its appearance in the summer of 1870, when there were a few cases
in the city; but in October they began to increase in number, and by the
first of the year the disease was spreading rapidly. The number of
deaths in Hamburg was:

                                       1870. 1871. 1872.
                January                         69   158
                February                       107    74
                March                          163    47
                April                          226    16
                May                            364    17
                June                       2   503     4
                July                       2   554     2
                August                     6   578     2
                September                  5   373     1
                October                   10   311     1
                November                  24   229
                December                  34   170     1
                                         ——— —————   ———
                Entire year               83 3,647   323
                Per 10,000 inhabitants   3·6 154·4   9·5

The figures for 1870 and 1871 include the city and suburbs, and those
for 1872 the entire State—a fact, however, which makes but little
difference. This severe epidemic gave rise to the passing of a law on
January 30, 1872, rendering vaccination compulsory; the enforcement of
this law was greatly facilitated in the following years by the fact that
everybody very soon came to recognize the superiority of animal lymph.

In Schleswig-Holstein the city of Altona, which bordered on Hamburg, was
very severely attacked by small-pox. No detailed information regarding
the epidemic there is available; the population of the city in the year
1871 was 83,177, and in the same year 965 persons (116·0 per 10,000
inhabitants) succumbed to small-pox; in the following year there were
only two deaths. In the year 1871 only three districts were more
severely attacked by the disease than Altona—Rendsburg, Steinburg, and
Stollmarn. The city of Rendsburg was an important seat of the disease,
which broke out there on November 16 among the prisoners, shortly after
their arrival; the epidemic, however, was rather mild, since of 2,590
prisoners only forty-four contracted the disease and only three died.
The garrison, which averaged 2,876 men, was somewhat more severely
attacked; 109 men contracted the disease (37·9 per 1,000), and four
succumbed to it. The epidemic became unusually widespread in the city;
114 inhabitants (98·8 per 10,000) succumbed to small-pox there in the
year 1871.

Of 5,000 prisoners confined in Lockstedt, 47 contracted small-pox, the
first in October, and the rest in February; only a few men in the German
garrison were attacked by the disease. From Lockstedt the disease spread
to the surrounding country, including Itzehoe, where it caused 102
deaths (110·6 per 10,000 inhabitants) in the year 1871. From there
small-pox spread in all directions; it was conveyed to Stollmarn chiefly
by working-men from Hamburg and Altona who lived in the country.

In the city of Lübeck, the population of which in the year 1871 was
52,158, the following number of people, according to the report of the
local Bureau of Statistics, contracted and succumbed to small-pox:

                            _Patients._ _Deaths._
                       1870          24         1
                       1871         315        36
                       1872          99        15

Judging from this table, the city was not very severely attacked by the
disease.

In the province of Hanover, small-pox did not become very widespread in
the years 1871 and 1872, thanks to the introduction of compulsory
vaccination; this is evident from one of the tables reproduced above. In
the year 1871 the districts of Osterode and Harburg had the highest
figures, 32·4 and 18·7 deaths respectively per 10,000 inhabitants, and
in the following year Osterode had 47·4 and Einbeck was second with
24·6. In the city of Hanover the cases of the disease in the garrison
were few and far between; the first cases among the prisoners were
reported in August; their maximum number was 2,299, and fifty-six of
them contracted the disease and three died. In the city seventy-one
persons succumbed to the disease in the year 1871, and eighty-nine
persons in the year 1872 (8·1 and 10·2, respectively, per 10,000
inhabitants). In Hildesheim, cases of the disease, which had been
brought there from France, were reported in March 1871; seven soldiers
in the garrison were taken sick. In Göttingen (Governmental District of
Hildesheim) persons who had contracted the disease in France were taken
to the lazaret in March 1871; whether or not this was responsible for
the communication of the disease to the civil inhabitants, among whom a
severe epidemic had never before raged, cannot be ascertained. At
Einbeck (Governmental District of Hildesheim) several small-pox
convalescents belonging to the field-army arrived in February 1871. In
Osnabrück a soldier belonging to the field-army contracted the disease
in December. In Papenburg (Governmental District of Osnabrück) the dépôt
where the prisoners were confined was very severely attacked; of 993
prisoners, sixty-three contracted the disease and two died. In Lingen
(Governmental District of Osnabrück) there was a rather large number of
Frenchmen suffering from small-pox—fifty-three, all told, of whom three
died. In Stade thirty-two out of 2,284 prisoners contracted the disease
in January and February, and five of them died.

In Bremen the epidemic of small-pox did not become very widespread.
According to a report issued by the local Bureau of Statistics, there
were only twenty-six cases of the disease there in the year 1870 and no
deaths; in the following years the number of deaths was as follows:[273]

                       _Bremen—City._ _Rest of State._
                  1871             45                9
                  1872             20               21
                  1873              3

In the case of the Grand Duchy of Oldenburg the number of deaths due to
small-pox is unknown. In the city of Oldenburg three French prisoners
(two in October and one in November) contracted small-pox, and one case
of the disease was reported in the garrison in March. Regarding the
appearance of small-pox among the civil inhabitants no information is
available.

The governmental districts of Münster and Minden (Province of
Westphalia) were only moderately afflicted by small-pox in the years
1870–2. According to Guttstadt, a few cases of the disease were reported
in the city of Münster in May 1869, and these were followed by seven
more in July 1870. After that no cases were reported until November 9,
1870, when a pastor, who had been ministering to the prisoners in
Lingen, contracted the disease; another pastor fared in the same way.
These were followed by eight more cases in two buildings in Münster
itself, and another two in the community of Überwasser, which bordered
on the city of Münster. In the latter part of the year 1870 no cases
were reported in the garrison. In the latter part of January 1871 some
3,000 prisoners were brought from Wesel, which was badly infected with
the disease, to Münster, and there four of them were immediately taken
sick. This was the beginning of a rather extensive epidemic among the
prisoners, 143 of whom contracted the disease and thirteen died; the
maximum number of cases (107) was reported in February. In the garrison,
which numbered 3,910 men, a small number of cases was reported from
February on; of twenty-one cases reported, one resulted fatally. In the
same month a small epidemic raged among the civil inhabitants, reaching
its climax in May. The following table indicates the number of people
who contracted the disease:

                           November (1870)  2
                           December         8
                           January (1871)   0
                           February        13
                           March           30
                           April           48
                           May             91
                           June            84
                           July            43
                           August           9
                           September        5
                           October          1

The number of deaths in the year 1871 was sixty-seven (26·9 per 10,000
inhabitants), and in the year 1872 it was twenty-two; most of the cases
occurred in the quarters of the city known as Jüdefeld and Lamberti, on
account of the proximity of the prison along the Buddenturm. In the
surrounding communities the epidemic reached its climax in July, and
after that began to abate rapidly. The only other region in the
Governmental District of Münster in which small-pox made its appearance
was Recklinghausen, which borders on the Rhenish-Westphalian
coal-fields, whence the infection doubtless came; in Recklinghausen
there were 28·8 deaths per 10,000 inhabitants in the year 1871, and 46·4
per 10,000 in the year 1872.

In the Governmental District of Minden only the city and vicinity of
Minden were severely attacked; before the war began they were free from
small-pox. On September 10 the first prisoners arrived, and among them
cases of small-pox had already been observed in the first part of that
month; in the course of the next eight days more cases were reported,
and of a total number of 5,071 prisoners 98 contracted the disease and
13 succumbed to it. In the garrison, which numbered 5,071 men, one case
was reported in October, four in December, and fifty-two in the
following months; only two cases terminated fatally. The first case
among the civil inhabitants was reported on November 5; the victim was a
laundress who had done washing for the prisoners. This constituted the
beginning of an epidemic in which 651 persons contracted the disease and
114 succumbed to it; the population of the city was 16,862. The epidemic
spread to the surrounding localities, presumably because the woollen
blankets which the patients had used were sold there. Throughout the
entire district of Minden 391 persons (51·0 per 10,000 inhabitants)
succumbed to small-pox in the year 1871, whereas in the following year
only 34 deaths were reported, all told.

In the Governmental District of Arnsberg the districts of Dortmund and
Bochum, which belonged to the Rhenish-Westphalian coal region, and were
even at that time densely populated, were severely attacked by
small-pox; the districts of Hamm and Hagen, which bordered on the
latter, were likewise very hard hit. The following table indicates the
number of persons per 10,000 inhabitants that succumbed to small-pox in
the districts mentioned:

                                     1871. 1872.
                        Arnsberg      12·7  11·4
                        Meschede       6·5   4·3
                        Brilon        10·0  23·1
                        Lippstadt      2·9   9·8
                        Soest          9·6  26·0
                        Hamm          38·1  30·0
                        Dortmund      55·3  38·4
                        Bochum       123·1  71·8
                        Hagen         13·7  54·2
                        Iserlohn       4·3  16·7
                        Altena        18·5  12·7
                        Olpe          18·8   9·4
                        Siegen         9·2   7·4
                        Wittgenstein  10·1  11·6

In the city of Bochum alone 698 persons (329·0 per 10,000 inhabitants)
succumbed to small-pox in the year 1871; almost one-half of the deaths
that year were caused by small-pox. The city of Dortmund itself was less
severely attacked in the year 1871 than the country surrounding it; in
the city alone 96 persons (21·5 per 10,000) died of the disease, whereas
in the district of Dortmund, excluding the city, there were 661 deaths
(71·4 per 10,000). The near-by city of Hamm was very severely attacked;
114 persons (67·3 per 10,000) succumbed there in the year 1871, whereas
the total number of deaths in the rest of the district amounted to 113
(26·5 per 10,000). According to Guttstadt, a prisoner contracted the
disease there on November 2 and subsequently died. The first cases among
the civil inhabitants were reported on November 22; the victims were an
occupant of a public-house situated near the lazaret, and a Catholic
priest who had visited the patients.

In the Rhine Province the districts of the Rhenish-Westphalian
industrial centre belonging to the Governmental District of Düsseldorf
also suffered severely from small-pox: e.g. the districts of Crefeld,
Duisburg, Düsseldorf, Essen, Mettmann, Elberfeld, and Barmen; later on,
in the year 1872, the districts of Lennep and Solingen were also
severely attacked. The districts in the Governmental District of
Düsseldorf lying on the left side of the Rhine were all, with the
exception of Crefeld, mildly attacked. The following table indicates the
number of deaths per 10,000 inhabitants in the various districts
mentioned:

The districts on the left side of the Rhine:

                                     1871. 1872.
                        Cleve          4·8   1·5
                        Geldern        7·8   0·8
                        Mörs           8·4   8·8
                        Kempen         7·3  13·3
                        Gladbach       1·6   5·5
                        Grevenbroich   1·8   2·3
                        Neuss          9·3   4·3
                        Crefeld       54·7  33·7

The districts on the right side of the Rhine:

                                       1871. 1872.
                      Rees              23·5   4·6
                      Duisburg         100·7  10·2
                      Essen             52·9  37·0
                      Düsseldorf        56·2   3·5
                      Elberfeld (city)  47·5  44·0
                      Barmen            24·8  49·1
                      Mettmann          31·3  36·7
                      Lennep             3·3  31·4
                      Solingen           5·1  36·3

On August 17 and 18, seven infected Frenchmen arrived at the city of
Düsseldorf and were at once isolated in a house outside the city limits;
in November a few more infected prisoners arrived. In the small German
garrison (523 men) no cases were observed until later (April and May).
In December 1870, 20 cases among the civil inhabitants were reported;
they constituted the beginning of an epidemic which developed rapidly,
reached its climax in July with 648 cases, and then quickly disappeared.
In the following year, 524 small-pox patients (75·0 per 10,000
inhabitants) died in the city of Düsseldorf.

In the district of Duisburg eleven cases of small-pox were reported in
December 1870, and here again the epidemic developed rapidly, reaching
its climax (1,549 cases) in May 1871. The city of Duisburg was most
severely attacked; 529 persons (173·2 per 10,000 inhabitants) died there
of small-pox in the year 1871.

In the stronghold of Wesel (district of Rees), where the prisoners were
confined in the stronghold itself on Buderich Island and Spellmer Heath,
persons suffering from small-pox arrived in August and September; and
still more arrived in November with a transport of prisoners from Metz.
Of the 16,299 prisoners, 1,042 (63·9 per 1,000) contracted small-pox,
and 127 (12·2 per cent of those taken sick) died; the largest number of
cases was reported in January. In the garrison, which numbered 7,284
men, there were 117 cases of the disease and seven deaths. Since the
inhabitants of the city of Wesel and of the surrounding country had
continual intercourse with the prisoners, the dissemination of the
disease was inevitable; the epidemic among the civil inhabitants began
in November and carried away nine persons in 1870 and eighty-four
persons in 1871.

In Elberfeld the epidemic did not become very widespread until December
1871. The first fatal case in the city of Essen was reported in January
1871; the epidemic then increased in fury until June 1871 (48 deaths),
when it began to abate. In the following year it revived a little in
May, when 26 cases were reported. All told, 272 persons (53·0 per 10,000
inhabitants) died of small-pox in Essen in the year 1871, and 112
persons (21·0 per 10,000) in the year 1872.[274]

In the Governmental District of Cologne small-pox became more or less
widespread in the years 1871–2 in the city and immediate vicinity of
Cologne; in the few years preceding the war Cologne had had numerous
cases of the disease, and in the year 1866 a small epidemic (223 cases)
had occurred there; in the year 1869 some forty cases were officially
reported. According to Guttstadt, the first transport of prisoners,
among them a small-pox patient, passed through Cologne early in
September. Of the gradually increasing number of prisoners (the maximum
number, including Deutz, was 13,774) 175, all told, contracted the
disease and twenty-four succumbed to it. In the garrison, which numbered
9,207 men, there were only nineteen cases of the disease and one death.
Among the civil inhabitants an epidemic broke out as early as September
12; it reached its climax in April 1871, abated somewhat during the
summer, and in October and November started up again. The following
table indicates the number of people that contracted and succumbed to
the disease in the months mentioned (the population of the city at that
time was 129,000):

                                  _Patients._ _Deaths._
                 September (1870)          24         3
                 October                   65        18
                 November                  80        15
                 December                  97        27
                 January (1871)           194        53
                 February                 336        79
                 March                    434        87
                 April                    510        71
                 May                      318        50
                 June                     159        34
                 July                      75        13
                 August                    35        10
                 September                 16         3
                 October                   66         5
                 November                  34         9
                 December                   7         2

According to this table, 63 persons (4·9 per 10,000 inhabitants) died in
the months September-December 1870, and 416 persons (32·2 per 10,000)
died in the year 1871; in the following year 25 more deaths (1·9 per
10,000) were reported. In the district of Cologne (excluding the city)
212 persons (24·3 per 10,000 inhabitants) succumbed to small-pox in the
year 1871; in all the other districts the number of deaths caused by the
disease was small.

In the Governmental District of Coblenz the city of Coblenz and the
adjacent districts of Neuwied and Mayen, as well as the district of
Kreuznach, which lay in the extreme south and very near the scene of the
war, were most severely attacked in the year 1871. In the stronghold of
Coblenz, according to Guttstadt, a locksmith contracted the disease in
the latter part of August; he had become infected while sitting beside
the body of his brother, who had succumbed to the disease in Casbach, a
village near Lingen, in Hanover. The first prisoners arrived in Coblenz
on September 15, and on September 23 one of them was found to be
suffering from small-pox and was taken to the lazaret; new transports of
prisoners kept bringing more cases of the disease. Of the 15,011 French
prisoners that arrived there, a large number contracted the disease; the
maximum number was in January, when 571 (38·0 per 1,000) were taken
sick, and 111 died (19·4 per cent of the patients). In the garrison,
which consisted of 8,710 men, there were 83 cases of the disease and
four deaths in the month of November. Among the civil inhabitants of
Coblenz 81 persons (24·2 per 10,000) died of small-pox in the year 1871;
in the rest of the district of Coblenz 277 persons (67·1 per 10,000)
died; in the district of Mayen there were 234 deaths (43·9 per 10,000),
in the district of Neuwied 220 deaths (32·3), and in the district of
Kreuznach 129 deaths (21·2). In the year 1872 the epidemic was not at
all widespread in any of the districts.

In the Governmental District of Aix-la-Chapelle only the district of
Malmedy suffered severely in the year 1871; being in the south-western
part of the governmental district it was, like the border districts in
the Governmental District of Trèves mentioned below, exposed to the
first onrush of the transports of prisoners. The number of deaths there
in the year 1871 was 333 (111·0 per 10,000), whereas in the following
year not a single death due to small-pox was reported in the district.
At Jülich a Frenchman suffering from small-pox arrived in July, and in
November an epidemic broke out among the prisoners; 188 cases of
small-pox were reported, and of these only three terminated fatally. In
the garrison only one man contracted the disease.

The governmental district of Trèves had a very large number of small-pox
cases in the year 1871, since a large part of it bordered directly on
the enemy’s country, so that large numbers of sick and convalescent
prisoners passed through it. In the year 1872 only a few cases of
small-pox were reported, except in the immediate vicinity of Trèves,
where the pestilence became quite widespread. The following table
indicates the number of deaths per 10,000 inhabitants in the districts
mentioned:

                                       1871. 1872.
                     Daun                3·0   1·9
                     Wittlich           18·7   1·3
                     Bernkastel          6·1   0·5
                     St. Wendel         20·0
                     Ottweiler          36·2   0·4
                     Trèves (city)      12·6   4·1
                     Trèves (district)  17·2  20·6
                     Prüm               33·2   0·9
                     Bitburg            23·6   1·4
                     Saarburg           60·9   1·0
                     Merzig             51·5   2·8
                     Saarlouis          80·0   0·2
                     Saarbrücken        49·5   0·3

The province of Hesse-Nassau suffered very little from small-pox in the
years 1871–2, since a compulsory vaccination law had long been in force
there. Large epidemics did not occur anywhere. In Cassel a case of
small-pox had occurred in the summer of 1870, and after that there were
no more cases until November 9; on that day a man was taken sick who had
been acting as a sutler among the German troops before Paris and had
there been infected. On November 18 a nurse employed in a house in which
a field-soldier was quartered contracted the disease, and this case was
followed by six more cases among the civil inhabitants; all told, six
persons succumbed to small-pox in the city of Cassel in the year 1870,
ninety-nine persons (21·4 per 10,000 inhabitants) in the year 1871, and
four persons in the year 1872.

In Frankfurt-on-the-Main a few cases of small-pox were reported in the
course of the year 1870; the disease was perhaps conveyed thither from
Stuttgart. After the commencement of the war it was borne into the city
by numerous transports of soldiers and prisoners, and a widespread
epidemic soon developed. In the garrison thirty-two cases of the disease
were reported. After the Rochus Hospital was opened to small-pox
patients, in April, the epidemic reached its climax; the following
table, found in the German Health Report, indicates the number of
patients received into the above-mentioned hospital and the number that
died there:

                          _No. patients._ _No. deaths._
                 January               81            13
                 February             148            16
                 March                168            17
                 April                177            25
                 May
                 June                  36            12

In August the epidemic came to an end. All told, there were 23 deaths
due to small-pox in Frankfurt-on-the-Main in 1870, 125 deaths (13·7 per
10,000 inhabitants) in 1871, and 25 deaths in 1872.

In Wiesbaden an epidemic began in December 1870, and reached its climax
in February. The population of the city was 35,463, and of these 6
succumbed to small-pox in 1870, 71 in 1871, and two in 1872. Regarding
the origin of this small epidemic no information is available.


   _(b) The Dissemination of Small-pox in Saxony in the Years 1870–2_

The kingdom of Saxony experienced a very severe epidemic of small-pox in
consequence of the Franco-German War. The wide dissemination of the
disease is attributed by Wunderlich to the fact that vaccination, in
consequence of the wild agitation of the anti-vaccinationists, was
insufficiently practised; prior to the year 1874 vaccination was not
compulsory in Saxony. Even before the war broke out small-pox had
appeared in Saxony in the form of epidemics, e.g. in Chemnitz and
Freiberg. The following table indicates the number of persons, all told,
that succumbed to small-pox in Saxony:[275]

           1871 9,935 (estimate) 38·8 per 10,000 inhabitants.
           1872 5,863            22·8 per 10,000 inhabitants.
           1873 1,772             6·9 per 10,000 inhabitants.

Of the immobile troops stationed in Saxony, the total number of whom was
17,628, some 506, all told, contracted the disease and 30 succumbed to
it.

Regarding the dissemination of small-pox in Leipzig and vicinity we have
accurate information.[276] In Leipzig itself small-pox patients were
housed only in the city hospital. A small epidemic of the disease had
raged there in the years 1868–9. In the year 1870, eighteen patients
were committed to the hospital in the months of January-July, after
which there were no more cases until October; on the 22nd, 23rd, and
31st of that month a single patient, each time a French prisoner, was
taken to the hospital. On November 7 a laundress employed in the
hospital contracted the disease; the first case among the civil
inhabitants was reported on November 10. In December an epidemic began
which spread rapidly and reached its climax in April. The following
table indicates the number of patients committed to the hospital in the
months mentioned:

                            March (1871) 384
                            April        388
                            May          361
                            June         231
                            July          73

The epidemic lasted until the year 1872, and the highest mortality was
in the month of May 1871; the number of deaths caused by the disease in
the various months was as follows:

                          October (1870)    1
                          November          2
                          December          9
                          January (1871)   20
                          February         47
                          March           117
                          April           233
                          May             246
                          June            205
                          July             91
                          August           32
                          September        24
                          October          14
                          November         13
                          December         10
                          January (1872)    4
                          February          5
                          March and April   4

Among these 1,077 victims of the disease were 21 soldiers and 27
outsiders from the surrounding villages. The disease was very virulent.
Of the 1,727 patients treated in the hospital 253 died (14·7 per cent).
The population of Leipzig in the year 1871 was 106,922, so that the
1,052 deaths of the year 1871 correspond to a mortality of 98·4 per
10,000 inhabitants. Of 3,726 prisoners, 98 (76·3 per 10,000) contracted
the disease and 9 died.

In the district of Leipzig no case of small-pox was officially reported
between the months of May and October. When the disease broke out in the
city of Leipzig it was of course inevitable, in view of the constant
intercourse between the city and the surrounding country, that it should
spread rapidly among the working people who were employed in the city
and lived in the country, first to the immediate vicinity, and then,
following the chief lines of traffic, to the more remote
localities.[277] Of 113 places 106 were attacked; only two
peasant-villages and five isolated farm-estates were spared. The
villages inhabited by working people were much more severely attacked
than those inhabited by farmers and peasants. The progress of the
epidemic is indicated by the following figures, which Siegel says are
incomplete, since not all the cases were reported, and which correspond
at best to only one-half of the actual number of cases and deaths:

                                  _Cases._ _Deaths._
                   October (1870)        2
                   November              9         3
                   December             22         5
                   January (1871)      107        16
                   February            216        42
                   March               398       103
                   April               816       255
                   May                 944       367
                   June                732       311
                   July                288       161
                   August               94        68
                   September            45        35
                   October              38        16
                   November             41        25
                   December             44        18
                   January (1872)       26        12
                   February             28        20
                   March                18        11
                   April                 6        10
                   May                   5         6
                   June                  2         1
                   July                  —         —

According to this table the number of deaths in the district of Leipzig,
the population of which was 97,100, was eight in the year 1870, 1,417
(145·9 per 10,000 inhabitants) in the year 1871, and 60 in the year
1872. Accurate figures regarding the ratio of deaths to total cases
cannot be computed; at all events small-pox raged very severely, owing
partly to insufficient vaccination, and partly to the wretched
conditions in which the working people lived.

In Dresden, mild epidemics of small-pox had raged in the year 1864 and
again in the years 1867–8; between the months of January and August 1870
not a single small-pox patient was taken to the city hospital; the first
case was committed to the hospital on September 27 of that year, and
after that two more persons contracted the disease in a barrack. The
disease spread from there, at first along the streets in the vicinity of
the barrack, and then throughout the Antonstadt, Neustadt, and finally
the Altstadt. The epidemic reached its climax among the civil
inhabitants in April 1871, in the garrison in January. The following
table indicates the number of patients committed to the city hospital in
the months mentioned:[278]

                          September (1870)   2
                          October           12
                          November          22
                          December          31
                          January (1871)    60
                          February          82
                          March             95
                          April            186
                          May              173
                          June             148
                          July              78
                          August            38
                          September         18
                          October           32
                          November          40
                          December          62
                          January (1872)    59
                          February          57
                          March             30
                          April             40
                          May               13
                          June              13

All told, there were fifteen deaths due to the disease in Dresden in the
year 1870, 570 deaths (32·7 per 10,000 inhabitants) in the year 1871,
and 151 deaths (8·4 per 10,000) in the year 1872. Among the prisoners
there were 150 cases of the disease, and of these nine were fatal; in
the garrison there were 413 cases and twenty-one deaths.

The epidemic of small-pox in Chemnitz, at least the beginning of it, was
in no way connected with the war. An exhaustive report made out by
Flinzer,[279] who carefully investigated the conditions relative to
vaccination in the year 1871, furnishes us the following figures; of
64,255 inhabitants 53,891 were vaccinated, 5,712 were unvaccinated,
4,652 had survived a previous attack of small-pox, and only 1,928
persons had been vaccinated more than once. The epidemic of small-pox
began in January 1870, and reached its climax in December of that year.
From March 1871 to September 1872, only a few cases of the disease were
observed, but after September the number of cases suddenly began to grow
larger, resulting in a second severe epidemic, which continued to
increase in severity until March 1873. The mortality statistics found in
Flinzer’s report are reproduced below; they go only as far as April
1873, but after that the epidemic abated considerably:

                             1870. 1871. 1872. 1873.
                   January       1    25     3    43
                   February      3    15     1    68
                   March         5     4     5    74
                   April         8     3     4    37
                   May           8     3     6
                   June          8     1    10
                   July         19          14
                   August       27           6
                   September    20     1     6
                   October      28     1    12
                   November     28     1    27
                   December     38     2    32
                               ———    ——   ———   ———
                     Total     193    56   126   222

A particularly good idea of the protection against small-pox afforded by
vaccination is given in the Chemnitz statistics for the years 1870–1. Of
53,891 vaccinated persons 953 (1·8 per cent) contracted the disease in
those two years and seven succumbed to it, all of whom were more than
ten years of age; of 5,712 unvaccinated persons, almost one-half
contracted the disease (2,643 or 46·3 per cent, to be precise), and of
these 243 (9·16 of those taken sick) died. Of those who died, 102 were
less than one year old, 51 were less than two years old, 47 were in
their fourth or fifth year, and 20 were from five to ten years of age.

How dangerous small-pox showed itself to be after the Franco-German War
is indicated by a report of Geissler[280] regarding the epidemic in
Meerane, a manufacturing town of some 20,000 inhabitants. There, between
October 1871 and May 1872, no less than 460 persons (434 children and 26
adults) succumbed to small-pox, i.e. 230 per 10,000 inhabitants. Of the
children 80·3, and of the adults 26·3, succumbed to the disease in the
course of the epidemic.


             _(c) Small-pox in Bavaria in the Years 1871–2_

In the year 1866 Bavaria had an epidemic of small-pox, which, although
it abated considerably in the following years, did not leave the country
entirely free from the disease; it was, however, confined to a very few
localities in the year 1870. In Upper Bavaria cases were reported in
that year only in Altötting and Friedberg; in Lower Bavaria absolutely
no cases were reported; in Upper Franconia a small epidemic raged in
August 1870, in the district of Forchheim; in Central Franconia, where
in the year 1868 a rather severe epidemic had raged, the disease had
almost entirely disappeared by 1870; Lower Franconia and Swabia,
finally, had only sporadic cases of the disease. French prisoners and
homeward-bound soldiers, away on furlough, caused the pestilence, as was
reported from all sides, to break out anew; the rapid dissemination of
the disease, according to these reports, was helped by persons coming in
direct contact with French prisoners in crowded places, by teamsters
returning from France, by German fugitives from France, by persons
handling the linen and clothes of patients, and by the sale of woollen
blankets and other things which the French prisoners brought with them.
The following table indicates the number of people who succumbed to
small-pox in Bavaria:[281]

                                _Total._ _Per 10,000 inhabitants._
     Oct. 1, 1865–Oct.  1, 1866      577                       1·2
     Oct. 1, 1866–Oct.  1, 1867    1,210                       2·5
     Oct. 1, 1867–Oct.  1, 1868      917                       1·9
     Oct. 1, 1868–Oct.  1, 1869      487                       1·0
     Oct. 1, 1869–Oct.  1, 1870      363                       0·8
     Oct. 1, 1870–Dec. 31, 1870      224
     1871                          5,070                      10·4
     1872                          2,992                       6·1
     1873                            869                       1·8
     1874                            263                       0·5
     1875                             87                       0·2

Munich fared pretty well, and the civil population suffered less than
the soldiers.[282] Not a single case of small-pox occurred there during
the entire year of 1870. In November an officer suffering from dysentery
returned home from France, and shortly after his arrival he was taken
sick with small-pox, which later attacked two members of his family. In
the first part of the year 1871 small-pox became more and more
widespread, and reached its climax in June. The total number of deaths
in the year 1870 was 7, in the year 1871 it was 150 (8·9 per 10,000
inhabitants), and in the year 1872 it was 108 (6·4 per 10,000
inhabitants). The following table indicates the number of deaths that
occurred in the months mentioned:

                           November (1870)  2
                           December         5
                           January (1871)  18
                           February        17
                           March           15
                           April           17
                           May             20
                           June            22
                           July             7
                           August           4
                           September        6
                           October          7
                           November        10
                           December         7
                           January (1872)  10
                           February        21
                           March           20
                           April           20
                           May             21
                           June            11
                           July-December    5

In Nuremberg[283] sixteen isolated cases of small-pox were observed up
to the end of September in the year 1870, and twenty cases from October
to December (five in October, four in November, and eleven in December);
not a single patient succumbed to the disease in the course of that
year. In January the number of people to contract the disease increased
rapidly, and the climax of the epidemic was reached in April. The
following table indicates the number of deaths caused by the disease in
the months mentioned:

                           January (1871)  1
                           February        3
                           March          10
                           April          18
                           May            13
                           June           11
                           July            6
                           August          0
                           September       3
                           October         1
                           November        2
                           December        5
                           January (1872)  7
                           February       13
                           March           6
                           April           9
                           May             2
                           June            2

In the second half of the year 1872 there were two more deaths due to
small-pox. The total number of deaths caused by the disease was 73 (8·8
per 10,000 inhabitants) in the year 1871, and 40 (4·8 per 10,000) in the
year 1872.

Augsburg was very severely attacked. A Bavarian soldier and two French
prisoners succumbed there to small-pox in December 1870. In January the
disease spread to the civil population, increased rapidly in severity,
and reached its climax in May. After abating a little in September, the
epidemic started up anew and did not disappear entirely until May 1872.
The number of deaths is indicated by the monthly reports found in the
Bavarian _Ärztliches Intelligenzblatt_, a few of which we reproduce:

                           January (1871)  8
                           February       14
                           March          24
                           April          35
                           May            42
                           June           34
                           July           17
                           August         14
                           September       2
                           October         9
                           November       14
                           December
                           January (1872) 17
                           February       18
                           March          11
                           April           8
                           May             6
                           June and July   5

The total number of deaths, some of which are not included in the
monthly lists, was 234 (45·7 per 10,000 inhabitants) in the year 1871,
and 71 (13·8 per 10,000) in the year 1872.

In Regensburg sixteen persons (eleven prisoners, three soldiers, and two
civilians) contracted the disease in the latter part of 1870; in 1871 as
many as 123 persons contracted the disease, and of these thirty-three
died. In Bamberg the first two cases were reported in December 1870, the
disease having been brought there from Würzburg; up to August 1871 some
ninety persons contracted the disease, among them twenty-three prisoners
and five soldiers; of these, eight died. After a short lull, new cases
were reported (between December 1, 1871, and August 1872); there were
thirty-one cases, all told (seventeen of the patients being soldiers),
and only one death.[284]


           _(d) Small-pox in Württemberg in the Years 1871–2_

In Württemberg, where vaccination had been compulsory since 1818, but
had been frequently evaded in the ‘sixties in consequence of the
agitation of the anti-vaccinationists, an epidemic of small-pox raged in
the years 1863–7, causing, all told, 804 deaths. In the latter part of
the year 1869 a new epidemic began and carried away many people,
particularly in Stuttgart, but also in the rest of the Neckar district.
With the arrival of the French prisoners the number of cases increased
rapidly, and the disease appeared in many places which had never before
been attacked. The following table indicates the number of reported
cases and deaths:[285]

      _Year._ _Cases._ _Deaths._ _Deaths per 10,000 inhabitants._
      1868         559        34                              0.2
      1869       1,488       133                              0.7
      1870       5,208       529                              2.9
      1871      10,848     2,050                             11.3
      1872       ?         1,164                              6.4

But the reports were not always complete, for the reason that many cases
were kept secret. The following table indicates the number of deaths
caused by small-pox in the various districts:

             _Neckar      _Schwarzwald       _Jagst          _Donau
           district._      district._      district._      district._
  1868                 1              19               3              11
  1869                77               5              40              11
  1870               381              71              40              37
  1871               883             570             173             424

In the years 1869–70 Stuttgart[286] was the principal seat of the
epidemic; sixty-six cases were reported there in 1866, fifteen cases in
1867, and seventeen cases in 1868; only one case terminated fatally in
the year 1868. In the year 1869, after an average of twenty cases per
month had been officially reported up to August, the disease raged more
and more furiously, so that the total number of cases for the entire
year was no less than 744. In the following year the disease continued
to increase in severity until February, when it began to abate somewhat,
so that in October 1870 only thirteen cases were reported. Then the
number of cases steadily increased again until June 1871, when the
epidemic once more subsided a little, only to reach another moderate
climax in November. In the middle of the year 1872 the epidemic suddenly
came to an end. The following table indicates the number of deaths
caused by small-pox in the Stuttgart epidemic:

                              1869. 1870. 1871. 1872.
                  January         1    21     7    17
                  February             19     8    14
                  March                20    10    12
                  April           2    22    25     6
                  May                  21    22     3
                  June            1    14    23     3
                  July            3     2    12     4
                  August          2     5    15
                  September       2     2     6
                  October         5     1    21
                  November       13     2    19
                  December       21     5    19
                                 ——   ———   ———    ——
                  Entire year    50   134   187    59

It is impossible to prove that the recrudescence of the disease in
Stuttgart in the latter part of 1870 was in any way connected with the
arrival of infected persons from France. In the garrison, which numbered
some 3,000 men, only four mild cases occurred, inasmuch as all recruits
had been vaccinated in Württemberg since the year 1833. But in the
latter part of the year 1870 there arrived a battalion of the Landwehr,
a third of whom had never done active service, and had therefore never
been revaccinated in accordance with the military regulation; after
this, numerous cases were reported in the garrison (October 1870 to
April 1871), although none of them resulted fatally.

The connexion between the epidemic in the stronghold of Ulm and the war
was very obvious. Says Volz:[287] ‘After the summer of 1870 had produced
only a few cases of small-pox, and a long pause (August to the beginning
of November) had intervened, during which we saw absolutely no traces of
the disease, the arrival of French prisoners caused the disease to
spread far and wide, constituting a part of the epidemic which raged
throughout almost all of Europe. In the latter part of September the
first cases of small-pox were observed among the prisoners. But a month
and a half elapsed before the disease made its appearance among the
civil inhabitants; one of the first cases was traced to the beds in the
barracks. In January 1871 the disease was conveyed to Söflingen by a
woman from that place who had been employed as a nurse in the military
hospital at New Ulm. The constant intercourse between Söflingen and Ulm
soon asserted itself through the infection of working-men who were
employed in the latter place and lived in the former. At the same time
the disease frequently appeared among the laundry-owners, washerwomen,
scrubwomen, innkeepers, sutler-women, and generally among persons who
were employed in any capacity in the field-hospitals and forts. Then,
too, patients kept arriving who had been infected in Baden, Switzerland,
Bavaria, North Germany, and in regions which, like ours, had been
infected by prisoners and fugitives arriving from France. In the
district of Beimerstetten the disease also made its appearance, having
been brought there in a carpet which a woman purchased from a Bavarian
soldier who had accompanied a transport of prisoners. In addition to
this woman, sixteen more persons contracted the disease, and three of
them died.’

In the city of Ulm thirty-six civilians (13·7 per 10,000 inhabitants)
succumbed to the disease, while in the district of Ulm forty-six persons
(21·2 per 10,000) died. The climax of the epidemic was reached in May;
after a short lull in August and September it started up again and
lasted until the autumn of 1872. The garrison at Ulm was also attacked,
but not very severely.

Of the immobile troops in Württemberg, who averaged 10,122 men, 7·9 per
1,000 contracted the disease. Of the French prisoners that were held in
Württemberg, 390 contracted the disease (the climax, 199 cases, was
reached in December). The maximum number of prisoners was 12,958, and
30·1 per 1,000 contracted the disease and twenty-eight died (7·2 per
cent of those taken sick).

In Heilbronn,[288] as in Stuttgart, a small epidemic had raged before
the war broke out; from February to July 1870 some forty persons had
contracted the disease. From August to October no more cases were
reported, but in November a new epidemic began and spread with great
rapidity. The following table indicates the number of cases and deaths
in the small-pox hospital at Heilbronn:

                                 _Patients._ _Deaths._
                 November (1870)           2
                 December                 19         2
                 January (1871)           51         3
                 February                 66         9
                 March                    95        13
                 April                    83        14
                 May                      95        17
                 June                     47        11
                 July                     18         2

In addition to these, twenty-seven cases of the disease were reported in
the city, so that the total number of patients was perhaps as large as
1,000. All told, seventy-one persons died in Heilbronn in the course of
the epidemic.


              _(e) Small-pox in Baden in the Years 1871–2_

In Baden a great many cases of small-pox were reported among the French
prisoners; their maximum number was 12,083, and of these 512 (42·4 per
1,000) contracted the disease, and 21 (4·1 per cent of those taken sick)
succumbed to it. The largest number of cases (133) was observed in
January. Regarding the distribution of the French prisoners among the
various dépôts no information is available, while regarding the immobile
German troops we know absolutely nothing. Among the civil inhabitants a
small epidemic raged as early as the year 1869, particularly in the
district of Mannheim. In the latter part of the year 1870 a considerable
number of cases was reported, and a rather severe epidemic rapidly
developed. According to a written report of the Baden Bureau of
Statistics, the number of deaths due to small-pox per 10,000 inhabitants
was as follows:

                     _District._      1870. 1871. 1872.
                 Constance              0·6  18·8   3·2
                 Freiburg im Breisgau   3·5  27·5   2·3
                 Karlsruhe              3·7  33·1   5·2
                 Mannheim               1·0   6·5   3·4
                                        ———  ————   ———
                 All Baden              2·4  21·7   3·5

Of those cities which at that time had more than 10,000 inhabitants,
Mannheim and Karlsruhe suffered very little; Rastatt, Freiburg, and
Constance were the most severely attacked. The number of deaths caused
by small-pox was:

                               _Population._ 1870. 1871. 1872.
          Mannheim                    39,606     3    33     4
          Karlsruhe                   36,582     4    25     9
          Freiburg im Breisgau        24,668    10   138    17
          Heidelberg                  19,983     2    37     2
          Pforzheim                   19,803     2    34     2
          Rastatt                     11,560    10    99     1
          Baden                       10,080     4     9     4
          Constance                   10,061     2    39     2


              _(f) Small-pox in Hesse in the Years 1871–2_

Regarding the epidemics of small-pox that raged in the Grand Duchy of
Hesse in the course of the nineteenth century, Reissner and
Neidhart[289] have published an excellent book. Vaccination, at least
once, was made compulsory in Hesse in the year 1807. According to the
above-mentioned book, small-pox was prevalent in Hesse all the time; the
average number of deaths per annum in the years 1863–8 was O·47 per
10,000 inhabitants. After the year 1868 the statistics read as follows:


                  _Deaths—Total._ _Per 10,000 inhabitants._
             1869              20                      0·24
             1870             248                      2·95
             1871           1,028                     12·08
             1872             167                      1·95
             1873               3                      0·03

The increased prevalence of the disease began in September; the
following table indicates the number of deaths in the several months:

                               1870.   1871.    1872.
                   January                  163    27
                   February        3        148    30
                   March           3        136    33
                   April           9        163    35
                   May             9        143    22
                   June           10        105    17
                   July            5         73     2
                   August          5         30     1
                   September      13         21
                   October        30         15
                   November       45         15
                   December      116         14
                                 ———      —————   ———
                   Entire year   248 1,026[290]   167

While small-pox made its appearance here and there in the first half of
the year 1870, it did not acquire epidemic dimensions until after the
outbreak of the war. In many places, to be sure, it was impossible to
prove that the disease was directly connected with the war. Reissner and
Neidhart mention numerous cases in which the disease was communicated by
field-soldiers who were sent from France to Hessian reserve-lazarets
(Pfungstadt, Lampertheim, Crumstadt, and others), by furloughed
field-soldiers (Lauterbach, Lorsch, Eschollbrücken, and others), by
fugitives from Paris at the beginning of the war (Giessen,
Gross-Eichen), by French prisoners who had contracted the disease in
camp or during transport, by teamsters returning home from France
(Worms, Grossgerau), by military effects—such as carpets, clothing,
tent-canvas (three places in the district of Grossgerau), and especially
by people who had visited the prisons where the French soldiers were
confined (Mayence, Darmstadt, &c.).

Not a single district in Hesse was spared during the epidemic of the
years 1870–2. The district of Mayence suffered worst of all; then came
Giessen, Offenbach, and Darmstadt, all districts in which moderately
large cities were located. The following table indicates the number of
deaths per 10,000 inhabitants in the various cities and districts:

                                      1870. 1871. 1872.
                 Mayence (city)        13·5  37·4   3·2
                 Mayence (district)     3·2  33·3   0·3
                 Darmstadt (city)       3·5  12·9   0·8
                 Darmstadt (district)   2·9  21·7   1·8
                 Giessen (city)         7·4   9·0
                 Giessen (district)    11·8   9·6   1·0
                 Offenbach (city)       0·4  15·9   6·6
                 Offenbach (district)   0·7  12·7   4·7

In the city of Mayence about thirty cases of small-pox were reported in
the year 1870 before the war broke out. ‘Shortly after the beginning of
the war,’ say Reissner and Neidhart, ‘numerous prisoners were interned
in Mayence, and among them cases of small-pox had not infrequently been
observed beforehand. Notwithstanding the admonitions of the military
physician, a barrack inside the city was set aside as a lazaret for
them. At first in the near-by streets, but later on throughout the
entire city, an epidemic now began to rage such as Mayence had never
before experienced in the memory of man. It lasted throughout the entire
year of 1871 and did not come to an end until the middle of the
following year.’ The epidemic reached its climax in Mayence in January
1871, abated a little until March, started up again in April, and then
slowly decreased in fury until it finally disappeared altogether. In the
garrison at Mayence 190 men contracted the disease in the years 1870–2
and nine succumbed to it; of the prisoners of war 934 contracted the
disease and seventeen per cent of them died. The pestilence was
disseminated in all directions from Mayence, partly by people from the
surrounding country who visited the city, and partly by other means.
Thus, for example, the disease broke out with unusual severity in
Bretzenheim, a village situated a mile or so away from the barracks
where the prisoners were confined; the inhabitants of the village in
many instances used the contents of the ditches in which the defecations
of the prisoners were thrown to fertilize their fields, and they also
bought straw and other waste products in the city.

In the city of Giessen no cases of small-pox occurred in the year 1870
prior to the outbreak of the war. The first cases observed there were in
September, but the epidemic, which reached its climax in December, did
not become very widespread. In Darmstadt 50 cases of small-pox were
reported in the year 1870 prior to the outbreak of the war, and after
the war began some 50–60 cases were observed before the end of the year.
The epidemic, which became only moderately widespread, lasted throughout
the entire year of 1871 and did not disappear until the middle of the
year 1872.


_(g) General Observations regarding the Epidemic of Small-pox in Germany
                          in the Years 1871–2_

In connexion with the Franco-German War an epidemic of small-pox raged
throughout Germany, the extent and virulence of which exceeded that of
any other epidemic that occurred in the entire course of the nineteenth
century. Unfortunately, in the case of a number of small States, we have
no statistics relating to the number of deaths caused by the disease.
The figures which I was able to obtain I have compiled in the following
table. In the case of Alsace and Lorraine, as well as of Oldenburg, the
two Mecklenburgs, and the other small North German States, absolutely no
figures are available; judging by their population and by the prevalence
of small-pox in the States surrounding them, we may safely estimate the
number of deaths caused by small-pox in them in the years 1871–2 at some
4,000.

 ───────────────┬───────────┬─────────────────────────────────────────────
 _States in the │_Population│
     German     │  Dec. 1,  │
 Confederation._│  1871._   │        _Deaths caused by small-pox._
 ───────────────┼───────────┼────────┬────────┬──────────┬──────────┬─────
        〃       │     〃     │ 1869.  │ 1870.  │  1871.   │  1872.   │1873.
 ───────────────┼───────────┼────────┼────────┼──────────┼──────────┼─────
 Prussia        │ 24,691,085│   4,655│   4,200│    59,839│    66,660│8,932
 Bavaria        │  4,863,450│456[291]│516[292]│     5,070│     2,992│  869
 Saxony         │  2,556,244│   ?    │   ?    │     9,935│     5,863│1,772
 Württemberg    │  1,818,539│     133│     529│     2,050│     1,164│   55
 Baden[292]     │  1,461,562│      67│     343│     3,176│       511│  ?
 Hesse          │    852,894│      20│     248│     1,028│       167│    3
 Brunswick[291] │    312,170│   ?    │       2│       269│       215│  ?
 Lübeck         │     52,158│        │       1│        36│        15│
 Bremen[291]    │    122,402│        │        │        54│        41│    3
 Hamburg        │    338,974│      20│      83│     3,647│       323│    3
 Other States   │  2,439,576│   ?    │   ?    │4,000[292]│4,000[292]│  ?
 Alsace-Lorraine│  1,549,738│   ?    │   ?    │    ?     │    ?     │  ?
 ───────────────┼───────────┼────────┼────────┼──────────┼──────────┼─────
 All Germany    │ 41,058,792│        │        │    89,104│    81,951│
 ───────────────┴───────────┴────────┴────────┴──────────┴──────────┴─────

The above compilation leaves no doubt that the disease was borne into
Germany from France. The contagion was conveyed into Germany by
prisoners and field-soldiers, some of whom were infected beforehand and
were sick when they got there, others of whom were still apparently
healthy, and still others of whom had reached the convalescent stage of
the disease, and less frequently by civil persons (teamsters and
fugitives); but the prisoners were by far the most active influence in
spreading the disease. The dissemination usually took place in the
following manner; in the dépôts where the prisoners were confined,
small-pox epidemics of varying severity broke out; from all sides the
people streamed in to see the prisoners, and when they went away they
conveyed the infection wherever they went, at first, of course, around
in the immediate vicinity. This is most evident in the eastern
provinces, where these dépôts soon came to be dangerous seats of
small-pox infection; the near-by districts were very severely attacked
as early as the year 1871, whereas the more remote districts did not
begin to suffer severely until the year 1872.

The development of a small trade between the prisoners and civil
inhabitants in articles belonging to dead soldiers, or in personal
effects, also helped to spread the disease; moreover, certain
unscrupulous sick-attendants, when they were instructed to destroy such
articles, frequently disobeyed the order and secretly sold them, thereby
giving an additional impetus to the dissemination of the disease.

The fact that a large part of the population was not vaccinated, and
that the necessity of revaccination was not properly recognized (only
soldiers were revaccinated), also helped to increase the severity of the
pestilence. In all the South German States compulsory vaccination had
existed for decades, but its strict enforcement was everywhere hindered
by the activity of the anti-vaccinationists; Prussia and Saxony did not
introduce compulsory vaccination until the year 1874. Revaccination
among the civil inhabitants was rarely practised in either North or
South Germany. These differences in the vaccination laws account for the
fact that small-pox raged more severely in North Germany than in South
Germany; this is also distinctly shown by the tables reproduced in the
course of this chapter. The fact that the civil inhabitants in general
were more thoroughly vaccinated also explains why the percentage of
children that succumbed to small-pox was so much smaller in South
Germany than in North Germany.

The number of deaths caused by small-pox in the epidemic of the years
1870–2 was greatly increased by the extremely virulent character of the
disease. Of course one cannot estimate the number of deaths caused by
small-pox among the civil inhabitants from the number of reported cases
of the disease, since the reports sent in were always very incomplete.
We know that the mortality of small-pox depends very much upon
vaccination; vaccinated persons succumb far less frequently to the
disease than unvaccinated persons. This fact explains why among the
German field-soldiers, who were constantly subjected to hardships and
privations of all kinds, only 5·75 per cent of the patients died,
whereas of the French prisoners some 13·85 per cent died. The mortality
among the civil inhabitants of Germany was also very high; this was
chiefly due to the fact that severe forms of the disease, particularly
hemorrhagic small-pox, were of frequent occurrence. As authority for
this we can only refer to these reports of the hospitals; but since
small children, amongst whom the mortality of small-pox is very high,
are less represented in them, and, on the other hand, since mild cases
among adults can more readily be withdrawn from hospital treatment, one
cannot accept without qualification the experience of the hospitals.
According to Wunderlich, of 681 patients treated in the Leipzig hospital
between the year 1852 and July 1870, only 29 (4·2 per cent) died,
whereas in the years 1870–1, of 1,727 patients treated, 253 (14·7 per
cent) died. In Breslau, whereas in former epidemics an average of seven
per cent of the patients died, in the epidemic of the years 1871–2 no
less than 13·4 per cent died. Guttstadt also states that the mortality
in the Berlin hospitals was fifteen per cent, whereas the number of
deaths caused by the disease in former years was much smaller. We have
seen above that 21·7 per cent of the patients taken to the Hôtel-Dieu in
Lyons died. It is unnecessary to adduce further statistics; all
contemporary observers agreed that the epidemic involved an extremely
severe and virulent form of the disease, and that this same virulence
characterized the disease wherever it made its appearance.


5. _The Epidemics of Small-pox that raged in the European, and in a few
 of the non-European States in connexion with the Franco-German War of
                                1870–1_


                           _(a) Switzerland_

Switzerland was exposed to great danger in consequence of the passage of
General Bourbaki’s army, which consisted partly of very young soldiers
who had suffered great hardships, including cold and hunger, and which
contained large numbers of men who were suffering from small-pox. The
little country was called upon to take in some 85,000 men; when the
latter were examined on the frontier a large number of them were found
to be infected with small-pox and were held at Verrière in France. But
this did not prevent the disease from being conveyed across the border.
Of the French prisoners confined there, 137, all told, succumbed to
small-pox.

Unfortunately no mortality statistics giving the cause of death were
compiled in Switzerland until the year 1876, so that we have no figures
indicating the prevalence of small-pox. The western cantons were most
exposed to the infection. In Berne, which at that time had a population
of 506,511, no less than 2,637 persons, excluding the French prisoners
interned there, contracted the disease between October 1870 and
September 1872; in the year 1871 there were 9·6 deaths per 10,000
inhabitants.[293] In the city of Basel, which was attacked as early as
November 1870, the epidemic reached its climax in February; the number
of deaths there was as follows:[294]

                    _Total no._ _Per 10,000 inhabitants._
               1870           7                       1·6
               1871          64                      14·0
               1872          13                       2·7

The Canton of Basel (Land) was attacked somewhat less severely; in the
year 1871 only 59 persons (10·9 per 10,000 inhabitants) succumbed there
to small-pox. In the Canton of Solothurn, which was infected from Olten,
a railway junction, 13·9 persons per 10,000 inhabitants died in the year
1871. In the Canton of Waadt small-pox broke out, according to Vogt, in
the district of Vivis in November 1870, and 200 persons contracted the
disease in the course of that month. In the two small-pox hospitals at
Lausanne, 351 patients were treated between November 20, 1870, and the
end of 1871, and 62 of them died.

The small-pox epidemic spread very rapidly from the West throughout all
the rest of Switzerland, partly in consequence of the distribution of
the French prisoners among the other cantons, and partly in consequence
of inland intercourse. Of the French prisoners interned in the Canton of
Zurich 180, according to A. Brunner,[295] contracted the disease and 31
died of it. The patients were sheltered in the small-pox camp at
Winterthur, whence the infection spread to many places. In February 1871
there was a rapid increase in the number of cases; the epidemic reached
its climax in March and April, and then steadily abated until June. The
statistics for the Canton of Zurich, which had a population of 285,915,
were as follows:

                            _Patients._ _Deaths._
                       1870          85         6
                       1871       1,068       137
                       1872         200        18
                       1873          22         —

In the Canton of Thurgau, according to Vogt, there were 9·2 deaths per
10,000 inhabitants in the year 1871, in the Canton of Schaffhausen 4·0,
and in the Canton of St. Gall 3·3. During the small-pox epidemic that
raged in the Canton of Schwyz in the year 1871 the communities of Gersau
and Küssnacht were severely attacked; throughout the entire canton 56
persons (11·7 per 10,000 inhabitants) succumbed to the disease. The
Cantons of Glarus, Unterwalden, Zug, and Graubünden were also rather
severely attacked. In the Canton of Tessin, whither the disease, which
first appeared in Locarno, had been conveyed by travellers from Paris,
and where 62 cases of it and 6 deaths had been reported up to June, a
new epidemic broke out in Personico, resulting in 15 deaths; in the year
1871 there were 11 deaths reported throughout the entire canton. In the
Canton of Willis small-pox broke out only sporadically.


                             _(b) Belgium_

In numerous places throughout Belgium small-pox had appeared in the
first part of the year 1870 in the form of widespread epidemics, a fact
which we can readily explain when we consider the country’s proximity to
France, which was everywhere infected with the disease. Thus, according
to Larondelle, a severe epidemic of small-pox broke out in February
1870, in the city of Verviers, which at that time had some 33,000
inhabitants, and lasted until January 1871; in the year 1870 no less
than 428 deaths were reported there, and 185 of them occurred in the
month of December alone. When the war began French fugitives kept
bringing the disease into the country, especially after the battle of
Sedan, when more than 10,000 French soldiers were interned on Belgian
soil, some in Beverloo and others in the citadel of Antwerp. From these
places the epidemic spread throughout all Belgium. In Brussels, for
example, no cases of small-pox were reported in July 1870, in August
there were two cases, in September two, in October twenty-two, in
November sixty-nine, and in December 101. In all Belgium the number of
deaths caused by small-pox was:[296]

                _Total no. deaths._ _Per 10,000 inhabitants._
           1868                 843                       1·7
           1869               1,651                       3·3
           1870               4,163                       8·2
           1871              21,315                      41·7
           1872               8,704                      16·8
           1873               1,749                       3·3


                           _(c) Netherlands_

In the Netherlands an epidemic of small-pox had raged in the year 1866;
in the following year it had rapidly abated, and in the year 1869 had
caused only fifty deaths in the three provinces of North Holland,
Utrecht, and Limburg combined. In the year 1870 the number of deaths
increased considerably, and in the following year reached an appalling
height.[297] The following table indicates the annual mortality of the
disease:

                _Total no. deaths._ _Per 10,000 inhabitants._
           1869                  50                      0·14
           1870                 706                      1·96
           1871              15,787                     43·55
           1872               3,731                     10·21
           1873                 351                      0·95

Thus both Belgium and the Netherlands had a very high small-pox
mortality in the year 1871; as elsewhere, the cause is traceable to
repeated transplantations of the disease, and to the fact that
vaccination was insufficiently practised.


                             _(d) Austria_

In the years 1872–4 Austria suffered severely from small-pox; the total
number of deaths per annum caused by the disease is indicated by the
following table:[298]

                _Total no. deaths._ _Per 10,000 inhabitants._
           1870               6,177                       3·0
           1871               8,074                       3·9
           1872              39,368                      19·0
           1873              65,274                      31·2
           1874              36,442                      17·3
           1875              12,151                       5·7

Although small-pox was usually conveyed into Austria from the East and
South (Italy), nevertheless the connexion between the epidemic in
Austria of the years 1872–4, and the great German epidemic is too
obvious to be overlooked. This is clearly shown by the successive
appearances of the disease in the various crown-lands, the number of
deaths per 10,000 inhabitants in which is indicated by the following
table:

                           1870. 1871. 1872. 1873. 1874. 1875.
         Lower Austria       2·6   5·1  37·0  28·8  15·1  10·6
         Upper Austria       1·4   2·5  12·6  19·8   7·4   3·1
         Salzburg            4·1   9·8  20·4  18·6   3·1   0·7
         Styria              1·3   1·7   7·0  15·1  22·4   8·0
         Carinthia           2·6   1·9   2·7  18·3  27·8   5·6
         Carniola            1·2   1·2   4·0  21·2  51·1   4·3
         Triest              3·2   2·1  72·2   4·1   5·9   2·7
         Görz and Gradiska   〃     1·1   5·5   7·6   5·2   1·4
         Istria              〃     0·6  18·3   9·5   8·9   3·0
         Tyrol               0·9   1·1   1·0   3·3  11·0  14·4
         Vorarlberg          〃     1·7   7·2  12·9   3·2   0·7
         Bohemia             1·1   1·8  15·7  29·0   4·0   1·0
         Moravia             1·8   3·8  21·0  47·0   6·6   2·4
         Silesia             0·2   3·6  57·7  25·2   4·7   1·3
         Galicia             6·4   6·4  20·9  46·5  33·5   7·3
         Bukowina            6·6  12·0   9·0   9·7  44·3  29·2
         Dalmatia            4·4   3·6   3·0   9·4   5·8   3·5

These relative percentages were based upon a mean population computed
from two censuses, one taken in 1869 and the other in 1880.

We see how the epidemic gradually penetrated into Austria, and how
Triest at a very early date became a second focus of the dissemination.
In the year 1870 the small-pox mortality was generally low in Austria.
The small epidemic in Bukowina in the year 1871 had no causal connexion
with the Franco-German War; it was an epidemic such as had often broken
out in former years in the countries of eastern Austria, and such as
still break out occasionally nowadays. On the other hand, a considerable
increase in the number of deaths caused by small-pox is observed in the
year 1871 in Lower Austria and Salzburg, and to a certain extent in East
Austria, Moravia, Silesia, and Bohemia; in Lower Austria, Salzburg, and
Silesia the epidemic reached its climax in the year 1872, whereas in
Upper Austria, Bohemia, and Moravia this climax did not come until the
year 1873. The same is true of Vorarlberg, while the crown-lands of
Styria, Carinthia, Carniola, and Tyrol were most severely attacked by
the disease in 1874. In Triest and Istria the climax of the epidemic was
reached in 1872, in Görz and Gradiska in 1873. In Galicia, which had
always had a high small-pox mortality, the epidemic did not begin until
the year 1872; it reached its climax in the following year. In Bukowina
the climax did not come until the year 1874.

‘To follow the progress of the disease according to political
districts,’ says Daimer, ‘is instructive for the reason that, as was
clearly shown at that time, it always spread slowly—a fact which was
also repeatedly observed in the case of other epidemics; thus, there was
always time enough to adopt appropriate measures aiming to check its
progress.’ There is a very marked difference between the epidemic of
small-pox in East Austria and the one in Germany; the latter attacked
all Germany within a short time, since the war had developed there a
very extensive intercourse. And even in Germany it was observed that the
disease was a long time in reaching those regions that were less
affected by this intercourse.

Vienna was attacked with great severity by small-pox; so also was
Prague, though to a lesser extent. The following table indicates the
number of deaths caused by the disease per 10,000 inhabitants:

                             _Vienna._ _Prague._
                        1869       5·4       1·9
                        1870       4·8       2·6
                        1871       7·6       1·5
                        1872      52·7      39·7
                        1873      22·0      28·2
                        1874      14·3       3·0
                        1875      18·0       1·1

But in these cities the epidemic did not come to an end; epidemic
outbreaks of small-pox continued to occur in Vienna until 1885, in
Prague until 1893, and in a number of years (for example, 1877, 1880,
1883, 1884, and 1888) the disease underwent some very important
exacerbations.


                              _(e) Italy_

Small-pox is supposed to have been conveyed into Italy by the volunteers
who had fought under Garibaldi; they became infected with the disease in
the Department of Côte d’Or, where it had raged extensively, and then
brought it back with them when they returned home. In Milan 200–300
cases per annum were usually reported prior to the year 1870. In the
summer of that year the number of cases greatly increased, terminating
in the following year in a severe epidemic which reached its climax in
September and October. According to Felice del Agua,[299] there were
1,287 cases and 152 deaths in the year 1870, and 4,467 cases and 866
deaths in the year 1871. In Rome small-pox made its appearance in
October 1871, causing 335 deaths between October 10 and December 31,
1871, and 727 deaths in the entire year of 1872. In the case of a large
number of individual places we have reports regarding epidemics of
small-pox, but I was unable to find a comprehensive account of the
epidemic that raged at that time in Italy.


                    _(f) Great Britain and Ireland_

Owing to the constant intercourse between England and France it was
inevitable that small-pox should very soon be conveyed into England; the
persons who conveyed it were probably French refugees. As on the
continent, so also in England, small-pox was always prevalent; in the
years 1869 and 1870, however, it was not very widespread, and it did not
begin to gain much headway until the autumn of 1870. The number of
deaths caused by small-pox in England was:

                    _All told._ _Per 10,000 inhabitants._
               1868       2,052                       0·9
               1869       1,565                       0·7
               1870       2,620                       1·2
               1871      23,126                      10·1
               1872      19,094                       8·3
               1873       2,264                       1·0

In the first nine months of the year 1870 there was no increase in the
small-pox mortality, but in the last three months, and from January 1871
on, the increase was very marked. The number of deaths caused by the
disease was:

                                      1870. 1871.
                       First            405 4,903
                       Second quarter   446 7,012
                       Third quarter    500 4,612
                       Fourth quarter 1,229 6,380

These figures do not agree with the figures for the years 1870–1 given
in the previous table, and the reason for this is not explained in the
report. The places where the disease first entered England were London,
Liverpool, and the mining districts of Durham and South Wales
(Monmouth). The compiler of the reports regarding the movement of the
population in England in the year 1871 says:[300] ‘Nearly all the
smaller outbreaks may be more or less directly traced to one of these
centres; Brighton, for instance, doubtless suffered from its intimate
communication with London. There is distinct evidence in many cases of
the introduction of the disease into sea-side towns by sailors, and
considering its fatal prevalence in Holland, Belgium, and many parts of
France, it is not a matter for great surprise that Southampton, Great
Grimsby, and one or two other ports suffered from the epidemic. It is
indeed very probable that the epidemic in London was due to the large
arrivals of French refugees during the latter part of the previous
autumn. That the epidemic may to a great extent be traced to our foreign
communications is beyond doubt, and it is to be regretted that the
steady decline of deaths from small-pox in the six years 1864–9 had
induced a certain apathy in the matter of vaccination, and thus left a
large portion of the population unprotected from the disease. In times
of severe epidemics large numbers of the vaccinated in some way or other
also suffer for the neglect which has left so many unvaccinated.’

The number of deaths caused by small-pox in London was:

                    _All told._ _Per 10,000 inhabitants._
               1868         597                       1·9
               1869         275                       0·9
               1870         973                       3·0
               1871       7,912                      24·2
               1872       1,786                       5·4
               1873         113                       0·3

In the first quarter of the year 1871 some 2,400 persons succumbed to
small-pox in London, in the second quarter 3,241, in the third quarter
1,255, and in the fourth quarter 980. The epidemic broke out in the East
End of London in the fortieth week of the year 1870, i.e. in the first
part of October; the number of deaths caused by it there was 40, and by
the end of the year this number had increased to 110.

Of the English counties, those along the north-east coast were most
severely attacked; for example, Durham and Northumberland, where the
number of deaths caused by the disease was 45·0 and 29·8, respectively,
per 10,000 inhabitants. In the cities of Sunderland and
Newcastle-on-Tyne, located in these counties, the number of deaths per
10,000 inhabitants in the year 1871 was 86·0 and 54·1 respectively.
There was a very large number of deaths in London (24·2 per 10,000
inhabitants), and the counties bordering on London (Middlesex and Essex)
also suffered severely (9·3 and 8·0 respectively); next in order come
the counties of Monmouthshire and Lancashire with 14·8 and 11·9
respectively. The high mortality in Lancashire was due only to the city
of Lancaster, where there were no less than 38·8 deaths per 10,000
inhabitants; in the rest of the county the number of deaths per 10,000
inhabitants was only 6·3.

In Scotland and Ireland the number of deaths caused by small-pox was:

              _All told._            _Per 10,000 inhabitants._
         _Scotland._ _Ireland._        _Scotland._        _Ireland._
    1869          64         20                       0·2       0·04
    1870         114         32                       0·3        0·1
    1871       1,442        665                       4·3        1·2
    1872       2,448      3,248                       7·2        6·2
    1873       1,126        504                       3·3        0·9
    1874       1,246        569                       3·6        1·1
    1875          76        535                       0·2        1·0

Small-pox spread very slowly to Scotland and Ireland; whereas in England
the maximum number of persons died in the year 1871, in Scotland and
Ireland the maximum number of deaths occurred in the year 1872. Both
countries, moreover, were less severely attacked than England.


           _(g) Denmark, Norway, Sweden, Finland, and Russia_

Small-pox was a long time in spreading to the Scandinavian countries. In
Denmark an epidemic had raged in the year 1869, but did not become very
widespread until the year 1872. In Copenhagen it began in the year 1871
and reached its climax in February 1872; between January and April 1,220
cases of the disease and 86 deaths were reported there. Regarding Norway
we have no statistical information. In Sweden small-pox raged in the
years 1865–9, abated a little in the years 1871–2, and started up again
with considerable severity in the year 1873. Stockholm was severely
attacked; in the year 1873 there were 13·0 deaths per 10,000
inhabitants, and in the following year 79·2. In Finland, where an
epidemic had raged in the year 1868, the number of deaths caused by the
disease began to increase in the year 1872, and in the two following
years the epidemic acquired enormous dimensions. The number of deaths
per 10,000 inhabitants was:

               _Denmark._[301] _Sweden._[296] _Finland._[296]
          1870             1·0            1·8             1·3
          1871             0·6            0·8             1·0
          1872             2·2            0·8             3·4
          1873             0·3            2·6            45·6
          1874             0·4            9·4            50·1
          1875             2·1            4·6             8·6
          1876             0·1            1·4             3·6

L. Colin reports that the pestilence spread to Russia in the year 1872,
when it attacked St. Petersburg very severely. More detailed information
I was unable to find.


                      _(h) Non-European Countries_

Constant emigration to America caused the disease to make its appearance
there, and it gradually spread over the entire continent. The following
table indicates the number of deaths caused by it in the states of
Michigan and Massachusetts:[296]

                        _Massachusetts._ _Michigan._
                   1870              131          11
                   1871              294          75
                   1872            1,029         304
                   1873              668          93
                   1874               26          19

In New York 109 persons succumbed to small-pox in the year 1869, 293 in
1870, and 805 in 1871.

The disease was also conveyed to the West Indies and to Chile.
Lersch,[302] moreover, reports that severe epidemics of small-pox
occurred in the Sandwich Islands and in Borneo, and that 500,000 persons
succumbed to it in the years 1873–5 in British India. But inasmuch as
small-pox frequently breaks out there in the form of large epidemics, it
cannot be assumed that the epidemic in Europe exerted any influence upon
this outbreak.


    6. _The Age of the Small-pox Patients. The Connexion between the
       Epidemic and the War. The German Imperial Vaccination Law_

Thus far very little attention has been called to the fact that the age
of the persons who succumbed to small-pox varied greatly in the
different countries. This depends upon how well vaccinated the
population of the country or countries was. Formerly, when nobody was
ever vaccinated, the first year of life and the following years were by
far the most seriously threatened; after the first few years the
mortality of small-pox gradually decreased as the age of the patients
increased. This also applies to-day to those countries in which
vaccination is neglected. On the other hand, in those countries in which
children are vaccinated in the first year of their lives, the infant
mortality is low, although the same children lose their immunity to the
disease when they grow older. To illuminate these facts let us adduce a
few figures. In estimating the number of deaths, however, we cannot use
the number of the living as a relative basis to work on, since the
prevalence of small-pox varied greatly in the different countries;
consequently we must take the total number of deaths and estimate the
mortality on the basis of age from that alone. But in doing this we can
compare with one another only entire countries in which the various ages
are all about equally represented; if we were to take smaller units, for
example, city and country, or agrarian and industrial districts, and use
them for a basis of comparison, more detailed computations would be
necessary. Of the four states included in the table below, Bavaria and
Hesse introduced compulsory vaccination (the law required everybody to
be vaccinated at least once) in the year 1807; Saxony and the
Netherlands, on the other hand, did not have compulsory vaccination. Of
every 100 persons who died of small-pox the following table indicates
the relative proportion on the basis of age:

                                                  _Vaccination not
                   _Vaccination compulsory._        compulsory._
                    _Bavaria._    _Hesse._    _Saxony._   _Netherlands._
                    (1870–5).    (1870–2).     (1872).      (1870–3).
 0–20 years old            22·4         21·8         76·3           68·3
 20–60 years old           59·0         65·4         21·9           29·6
 Over 60 years old         18·6         12·8          1·8            2·1

This table clearly shows that vaccination protects a person against
contracting small-pox for a number of years, or at least against
succumbing to it, but that this immunity lasts only for a certain length
of time and should be prolonged by revaccination—a fact which the
Prussian military authorities recognized and took into practical
consideration for many decades prior to the year 1870.

Many have contended that the epidemic of small-pox which ravaged a large
part of Europe, from the year 1870 on, was not a consequence of the
Franco-German War, but an independent outcome of unknown conditions that
were particularly favourable to the dissemination of the disease. The
main argument used to uphold this contention is that epidemics of
small-pox had occurred in all the states in the years before the war,
without having gained such irresistible headway, and that the disease
had broken out in the form of epidemics in many parts of Germany and the
neighbouring countries even in the first half of the year 1870. But to
refute this argument it can be clearly shown through Guttstadt’s
instructive compilation of data that the German epidemic was in
countless instances, in the case of Prussia as well as in that of other
states in the German Confederation, brought about by the transplantation
of the disease from France. Whenever small-pox broke out anywhere in
times of peace, it was possible to keep the disease localized, through
isolation of patients and the vaccination of the inhabitants of all
regions in which fugitives from pestilence took refuge. In the year
1870, on the other hand, the contagion of small-pox was spread
throughout all Germany in a few months; the increased intercourse caused
by the war, together with the habit the Germans had of visiting the
prisons where the French soldiers were confined, also helped to spread
the disease in all directions.

For Germany this disastrous epidemic, which throughout the German
Empire, including the Imperial Provinces, carried away upwards of
170,000 persons, had just one good result—it led to the passing of a law
in the year 1874 which rendered vaccination compulsory. ‘Besides taking
thousands of human lives the epidemic also caused considerable economic
loss; the care of the sick and the measures adopted to prevent the
disease from spreading necessitated large expenditures of money, while
large numbers of working-men contracted the disease and were thus
incapacitated for a long time; furthermore, the disease left unnumerable
sickly people, who had to be further supported, and at the same time the
fear of infection interfered with commercial intercourse. Those who
managed to escape infection, or to recover from an attack of the
disease, naturally wished to run no more risks in the future, or to
expose the welfare of their families to danger or destruction.’[303]

In consequence of all this grave suffering, the representatives of the
people petitioned the Imperial Government to provide as soon as possible
for a uniform legislative regulation, making universal vaccination
compulsory. The desire expressed in this petition was soon fulfilled by
the submission of a bill on February 5, 1874; the bill was passed by the
Reichstag on March 14, and received the signature of the Kaiser on April
8, 1874. This law required all persons to be vaccinated in the first
year of their lives, and to be revaccinated in their twelfth year; it
applied generally to all Germany.

The beneficial result of the passing of this law was clearly
demonstrated in the course of the following decades. Notwithstanding the
fact that Germany is almost entirely surrounded by states in which
epidemics of small-pox, in consequence of insufficient vaccination, are
of frequent occurrence, since the passing of the Imperial Vaccination
Law the disease has not once made its appearance on German soil in the
form of a widespread epidemic. Despite the fact that small-pox is
frequently conveyed into the country, especially by foreign working-men,
the efforts to keep it confined within narrow limits have always been
successful. The measures which are so effective in the case of other
diseases—isolation of the patients and of suspected persons living in
the vicinity, disinfection of the room and effects which have been used
by patients—in an insufficiently vaccinated community do not have the
desired rapid success, since the contagion of small-pox clings with
extraordinary tenacity to clothes and articles of general use. This fact
has been abundantly proved in the epidemics of small-pox that have
occurred in Europe in the course of the last few decades.




                               CHAPTER IX
             FROM THE FRANCO-GERMAN WAR TO THE PRESENT TIME


Among the great advances made in the last few decades of the nineteenth
century must be included the successful battle of modern hygiene against
infectious diseases. This struggle was introduced by the development of
practical hygiene in England and by the perfection of scientific hygiene
through the work of Pettenkofer. But a firm basis on which to combat
pestilence was not secured until the brilliant discoveries of Koch and
his successors pointed out to us the cause of these pestilences, and
methods were found to demonstrate in a short time the presence of
disease-germs, even among persons who become ill but slightly, or not at
all, and who for that reason are very dangerous to those about them.

Since even in time of peace the close quarters in which soldiers live in
barracks greatly favour the outbreak of epidemics, the military
authorities constantly watched and profited by these advances in the
field of disease-prevention; and with the success of efforts to decrease
the prevalence of infectious diseases among the soldiers in time of
peace, so also in war-times it became possible to check more thoroughly
than ever before the dissemination of these diseases. Hence the number
of men carried away by epidemics is much smaller in modern wars than
used to be the case.


                1. THE RUSSO-TURKISH WAR OF 1877–8[304]

The Russo-Turkish War of 1877–8, like all former wars with Turkey, was
characterized by severe pestilences, which at both seats of the war, the
European as well as the Asiatic, were responsible for large numbers of
deaths. Typhus fever, which frequently made its appearance in Russia and
in the Balkan Peninsula, was once more the disease which made the
greatest havoc. In the years preceding the war it had raged in the form
of epidemics in several Russian Governments, and it is probable that the
Russian army was already infected with it. Erisman states that cases of
typhus fever were observed among the soldiers in the thirty-fifth
infantry division when it was being assembled in the Government of Kiev;
the disease also revealed its presence among the troops when they were
mustered at Kishinev (Bessarabia) before the war broke out. In April and
May 1877, when the army was advancing toward the Danube under a steady
downpour of rain, the number of sufferers from typhus fever,
intermittent fever, and dysentery increased considerably. During the
siege of Plevna, which lasted 143 days and terminated in the
capitulation of the city on December 10, 1877, the prevalence of disease
increased still more. The march across the Balkan Peninsula in the
winter of 1877–8 made great demands upon the badly nourished Russian
troops. The better conditions anticipated in the Balkan lowlands did not
show themselves; on the contrary, here began, from the standpoint of
sanitation, the most unfortunate part of the campaign, since the
retreating Turks had devastated the entire country. The number of
typhus-fever patients in the Russian army, which numbered some 411,000
men, increased to 18,049 in the month of February 1878, and of these
7,522 had spotted fever and 1,540 died. The pestilence continued to rage
with unbroken severity until May; in June it began to abate. The total
number of fever-patients and deaths in the Russian army during its march
to the Danube is indicated by the following table:

                                 _Patients._ _Deaths._
                 Typhoid fever        25,088     7,207
                 Gastric fever        38,363     1,615
                 Typhus fever         32,451    10,081
                 Relapsing fever      39,337     4,849

The number of men in the army increased from 217,446 in April 1877, to
418,000 in March 1878.

The military lazarets played an important and disastrous rôle in the
dissemination of typhus fever, just as they had done in the Napoleonic
Wars. ‘The lazaret-system adopted by the Roumanians’, says Niedner,[305]
‘proved utterly inadequate for the Russians. Scarcely a third of the
regular division-hospitals and military hospitals were made mobile, and
their number, as well as their equipment, was insufficient. The lazarets
were supervised by the Hospital Department, and consequently lacked all
medical management and were always missing wherever they were needed.
The few available lazarets were overcrowded, and being full of dirt and
refuse they merely constituted an added danger for the patients and for
the inhabitants. Not until after long delay were additional barracks
constructed, and these were so badly arranged that they offered very
little relief from the condition of overcrowding in the hospitals. Above
all, there was a lack of means for disinfection and of clean linen, and
this rendered it inevitable that large quantities of infectious material
should accumulate in the lazarets, and that convalescents discharged
from these hospitals should be more likely to infect other people with
whom they came in contact along the military roads.’ The transporting of
these convalescents back to Russia began in the first part of the
campaign; they not only spread the disease all along the military roads,
but large numbers of them conveyed it back to Russia itself, where it
appeared in countless localities and soon developed into a widespread
epidemic of typhus fever. At the end of the campaign, to be sure,
conditions improved; in the spring of the year 1878 a commission
appointed for the purpose finally succeeded in establishing certain
rules governing sanitation in the lazarets, and in bringing it about
that typhus fever patients were everywhere isolated. When the war was
over the troops were transported back home across the Black Sea, along
the coast of which, in the ports of Réni, Nikolayev, Sebastopol, and
Odessa, health-committees had been appointed to see to it that the sick
soldiers were congregated by themselves.

Typhoid and typhus fever likewise became very widespread in the
Caucasian army. According to Kosloff, typhus fever was not endemic in
Armenia, as was probably the case with typhoid fever; the Russian
physicians think that it was conveyed thither by the Russians themselves
and not by the Turks. The conditions for quartering the Russian troops
were as unfavourable as one could possibly imagine; they were housed in
dirty Armenian villages, where nobody attended to the removal of refuse,
and were badly provisioned and inadequately supplied with clothing;
this, coupled with continuous marching and fighting, greatly reduced
their power of resistance. In October 1877 the main army was infected
with typhus fever, and the overcrowded hospitals merely helped to spread
the disease. Conditions were worst of all in the detachment in Erivan.
After the troops had gone into winter quarters there, typhus fever broke
out with terrible severity and presently the entire government of Erivan
was suffering from the pestilence; particularly hard hit were the cities
of Erivan, Chorassan, &c., where the troops were very numerous and were
exposed to the ravages of the pestilence. The following table indicates
the number of men in the Caucasian army that contracted and succumbed to
the four diseases mentioned:

                                 _Patients._ _Deaths._
                 Typhoid fever        24,473     8,908
                 Gastric fever         9,589     1,044
                 Typhus fever         15,660     6,506
                 Relapsing fever      14,576     3,775

The inhabitants of those regions in Asia in which fighting took place
were not attacked by typhus fever. The Turkish troops, on the other
hand, suffered severely from the disease, though not so severely as the
Russian troops; the reason for this was that the former were better
nourished and their camps were kept clean. The Turkish prisoners fared
no better than the Russian prisoners; of 57,000 prisoners taken, 13,983
succumbed to various fevers, most of them to typhus fever.


                      2. THE BOER WAR OF 1899–1901

In the war which England waged against the free states, Orange and
Transvaal, and which lasted more than two years and necessitated the
transportation, on the part of England, of more than 400,000 soldiers to
South Africa, infectious diseases, particularly typhoid fever, played a
very important rôle. The English army, which averaged 200,000 men,
sustained the following losses:[306]

                           _Died of     _Died in battle
                          diseases._    and of wounds._    _Total._
 From Feb. 10, 1900, to
   the end of that year           7,009           4,088          11,097
 In the year 1901                 4,318           2,337           6,655
                                 ——————           —————          ——————
         Total                   11,327           6,425          17,752

Typhoid fever had always been prevalent in South Africa; the first cases
in the English army were observed during the hurried march to
Bloemfontein along the Modder River, on which the soldiers were
dependent for drinking-water, despite the fact that typhoid fever was
known to be raging in places further upstream. The Berkefeld and Pasteur
filters yielded too little water, for the reason that they soon became
clogged; the soldiers used boiled water with reluctance, for the reason
that it took so long for it to cool. Another source of infection besides
the water was the fine dust that was stirred up by daily wind-storms;
this dust, being full of disease-germs, contributed greatly to the
dissemination of typhoid fever. Furthermore, the crowding together of
soldiers in tents caused many of them to contract the disease by direct
communication.[307]

Jameson, the chief of the army’s medical staff, lamented the fact that
sanitary officers (hygienists), originally appointed to accompany each
division of troops, were dismissed. The regular doctors, who were then
called upon to perform their functions, were fully occupied with taking
care of the wounded, and were probably not well informed as to hygienic
investigations and measures. The results obtained from preventive
inoculation, which was practised on some of the soldiers, were in
general satisfactory.

In other places the conditions were similar to those along the Modder
River; in Paardeberg the available drinking-water was equally bad, and
in Bloemfontein there was an explosion-like outbreak of fever. From the
beginning of the campaign to the middle of the year 1900 there were
13,057 cases of disease in the army, and of those 3,174 terminated
fatally; the total number of cases during the entire war was no less
than 42,741.

The English troops that were shut up in Ladysmith from November 1, 1899,
to February 27, 1900, were very severely attacked by typhoid fever. In
the first part of November the English garrison had consisted of 13,496
men, and by March it had dwindled down to 10,164 men. The number of sick
soldiers committed to the lazaret amounted to no less than 10,668, and
of these 1,766 had typhoid fever and 1,857 had dysentery; 383 of the
former and 117 of the latter died. When the Boers withdrew there were
1,996 patients in the hospital, 708 of them suffering from typhoid
fever, 341 from dysentery, and 189 from wounds.[308]

In the Concentration Camps which the English established in the summer
of the year 1900 for the accommodation of the women and children in the
South African Republics, the pestilences soon gained the upper hand.
Lord Roberts had made arrangements to concentrate the families of the
Boers in camps; since the farms of the Boers were systematically burned,
these camps were supposed to protect their wives and children against
starvation, and at the same time the wives and children served as
hostages for their husbands and fathers. When the location of these
camps was decided upon, not sanitary, but military considerations were
taken into account; it was necessary that they should be controlled from
a near-by fortress. They soon became overcrowded, the supply of water
was inadequate, and there was much uncleanliness. The inhabitants of the
camps were mostly women, children, and old men; thus, for example, in
October 1901, of the people living in the camps in the Orange Free
State, 55 per cent were children under fifteen years of age, 31.9 per
cent were women, and 13.1 per cent were men, mostly old men. According
to the reports submitted to Parliament the condition of health in the
Concentration Camps in Natal and in the Cape Colony was not
unfavourable, but in those in Transvaal and Orange it was very bad. The
following statistics, covering the time between June and September 1901,
relate to the Concentration Camps in the Transvaal:[309]

                                 NUMBER OF INHABITANTS.
    _Month._       _Men._       _Women._     _Children._     _Total._
 June                   8,576        16,078        19,811         44,465
 July                   9,665        20,012        24,462         54,139
 August                10,496        22,036        25,983         58,515
 September             10,581        22,226        26,599         59,406
                                                                  ——————
    Average                                                       54,131

                                 NUMBER OF DEATHS.
  _Month._    _Men._     _Women._   _Children._  _Total._     _Annual
                                                            death-rate._
 June                26          48         310         384        103·6
 July                51         118         748         917        203·2
 August              32         185       1,014       1,231        252·5
 September           75         165       1,014       1,254        253·3
                                                                   —————
  Average                                                          209·8

In regard to the Orange Free State the following statistics, including
the month of October, were compiled:

                                 NUMBER OF INHABITANTS.
    _Month._       _Men._       _Women._     _Children._     _Total._
 June                   5,116         9,646        17,953         32,715
 July                   5,351        11,213        20,132         36,696
 August                 5,826        13,381        24,415         43,622
 September              6,089        14,140        25,118         45,347
 October                5,906        14,471        24,929         45,306
                                                                  ——————
    Average                                                       40,737

                                 NUMBER OF DEATHS.
  _Month._    _Men._     _Women._   _Children._  _Total._     _Annual
                                                            death-rate._
 June                32          75         182         289        106·0
 July                50          69         369         488        159·5
 August              30          82         510         622        171·1
 September           43         153         885       1,081        286·0
 October             58         133       1,329       1,520        402·6
                                                                   —————
  Average                                                          235·6

All told, no less than 19,600 persons (14,894 children and 4,706 adults)
died in the Concentration Camps up to March 1902; that is, about
one-fifth of the total number of inhabitants died in a period of about
fifteen months. As indicated by the above tables, the children suffered
more severely than the adults. The principal causes of the high
mortality among the children were measles and pneumonia; since the
grownup Boers had never experienced an attack of measles in their
childhood, they too, even the very old men, contracted the disease and
many of them succumbed to it. The prevalence of pneumonia can be
explained on the ground that the temperature fluctuated greatly in the
course of the winter, and the nights, in particular, were extremely
cold. Whooping-cough, varicella, mumps, and diphtheria were prevalent in
all the camps, and typhoid fever, which, as remarked above, is endemic
in many parts of South Africa, was very common; so also were diarrhoea
and dysentery.

The chief cause of the high mortality in the prison-camps was the fact
that such large numbers of men, men whose vitality had been reduced by
privations and hardships, were congregated in places which had not been
properly prepared to receive them. The unfortunate prisoners often
reached the place of detention in a pitiable condition—exhausted and
half naked. Furthermore, they were men who had no appreciation of the
order that must be observed, when large numbers of people are
congregated in one place, in attending to the daily requirements of
nature, nor were they willing to be taught. The result was that the
ground became filthy; the open spaces in front of the tents were often
used in place of the latrines; the contents of slop-jars were simply
thrown out in front of the doors, instead of being emptied into
receptacles that were deposited here and there for that purpose. The
mothers had no idea of nursing, and were unwilling to take medical
advice; in order to avoid having to send their children to the hospital,
they kept secret the fact that they were sick, thus giving measles,
diphtheria, &c., the best possible chance to spread. We read in an
English report:[310]


  A large share of the high death-rate in them is ascribable to the
  condition in which the women and children arrive. Often they have
  been half-starved and are broken down in health. It cannot be
  wondered at that under these circumstances measles and other
  diseases are inordinately fatal. The dirty personal habits of the
  Boers, their use of improper and often disgusting remedies, and
  their ignorant errors of dietetics in regard to young children, have
  rendered it extremely difficult to secure favourable results in the
  treatment of cases of sickness among the Boer children. There
  appears to be no doubt, as indicated in our previous special
  article, that the measles which has been prevalent has been of a
  specially malignant type. Its malignancy has doubtless been
  intensified by the dirty condition of the Boer children, and by the
  overcrowding that has been permitted in the camps, as well as by the
  previous bad health of these children. The present reports afford
  abundant evidence confirmatory of the conclusion at which we had
  previously arrived, that dysentery, diarrhoea, and enteric fever in
  a large proportion of the camps have been prevalent as well as
  measles.


And in another report we read:[311]


  Measles of a particularly malignant type has prevailed. Its fatality
  has doubtless been increased by the exhausted and semi-starved
  condition in which many of the Boers and their children have arrived
  at the camps. It has been impossible to isolate such cases in the
  camps; and the crude and ignorant and even mischievous methods of
  domestic treatment adopted by the Boer women have doubtless
  increased the evil, as have also the personal uncleanliness of the
  Boers and their fear of fresh air as well as of clean water. But, as
  previously pointed out, enteric fever and diarrhoea and dysentery
  have claimed a large toll of victims, and for the excessive amount
  of these the deficient sanitary control of the camps must be held in
  a large measure responsible.


With the arrival of the better season, when the Concentration Camps,
under the pressure of public opinion, were thoroughly cleansed, the
condition of health improved. Hönigsberger,[312] who inspected the camp
at Merebank (in Natal) in May 1912, derived a very favourable
impression; notwithstanding the fact that the camp lay on low ground
near the sea-coast, where the soil was necessarily damp, there was no
visible surface water because of an effective system of drainage. The
drinking-water facilities were good. Of some 8,000 refugees sheltered
there only 110 died between the months of February and May 1902.


             3. THE WAR IN SOUTH-WEST AFRICA (1904–7)[313]

In the very first year of the war, typhoid fever broke out with great
severity. The disease first made its appearance in the war against the
Herero nation in the first part of April 1904; it attacked the eastern
division of the army, which was commanded by Major von Glasenapp and
numbered twenty-five officers and 509 men, in Onjatu (midway between
Windhuk and Waterberg), after the soldiers had been exposed to rainy
weather, cold nights, and extreme hardship. On April 6 there were six
cases of the disease reported, and by April 16 the number of cases had
increased to sixty-six; the division was then transferred to
Otjihaenena, where the patients were housed in permanent lazarets and
the healthy men were quarantined. Throughout the remaining part of the
war, typhoid fever played an important rôle; the total number of deaths
in the years 1904–7 was 1,491; of these 689 succumbed to diseases, 439
of them to typhoid fever. The soldiers who fought in the battles against
the Hereros were most severely attacked; of a total of 470 deaths 283
were caused by typhoid fever and only twenty-two by other diseases. In
the three years’ struggle against the Hottentots some 1,200 soldiers
died; 375 of them died of diseases; of the 375 typhoid fever was
responsible for 156.


                  4. THE RUSSO-JAPANESE WAR OF 1904–5

The apprehension that the Russo-Japanese War would be accompanied by
severe outbreaks of infectious diseases turned out to be groundless. The
chief danger that threatened both armies was typhoid fever, which is
endemic in Manchuria, and which, on account of the filthy condition of
the Chinese villages, was given an excellent opportunity to spread. In
the first place, the soldiers were prevented from being infected by the
fact that they were allowed to drink nothing but boiled water, and were
always supplied with hot water for tea; in the second place, when they
were called upon to remain in one place for a considerable length of
time, they were quartered, not in the Chinese villages, but in
earth-huts; or, if they were compelled to live in the Chinese villages,
these were always thoroughly disinfected beforehand. Whenever it was
possible, the Japanese military physicians, before the troops arrived in
a village, investigated the place with reference to hygienic conditions
and subjected the inhabitants to an examination. Notwithstanding all
this, large numbers of soldiers on both sides, in the course of the war,
which lasted twenty-one months, contracted typhoid fever, diarrhoea, and
dysentery. In both summers, which are very hot in Manchuria, typhoid
fever made its appearance, to a greater extent in the second than in the
first, since the troops before and after the battle of Mukden remained
encamped for a long time in one and the same place.[314] According to
the statements of the Russian General Medical Staff,[315] the total
number of deaths in the Russian army (excluding the troops at Port
Arthur and the fleet) caused by diseases was 7,960, and to these must be
added the deaths among the discharged troops; the total number of men in
the Russian army was 709,587. Even if these figures are incomplete,
nevertheless they distinctly show that epidemic diseases, considering
the long duration of the war, were not very prevalent. The reports of
foreigners who accompanied the Russian army agree in pronouncing the
general condition of health excellent.[316] Spotted fever and anthrax
were also observed, but among both the Russians and the Japanese they
appeared only sporadically. According to Follenfant,[317] 56,717 cases
of infectious diseases occurred among the Russians; of these 25,800 were
enterorrhoea, 15,800 were typhoid fever, 8,970 were dysentery, and 4,500
were malaria. Regarding the prevalence of disease in Port Arthur we
shall have more to say in the tenth chapter.

Conditions among the Japanese were less favourable, since, on account of
their rapid advance, sanitary measures could not be carried out as
extensively as was desirable. The total number of men in the Japanese
army carried away by diseases was no less than 21,802; 3,956 succumbed
to beri-beri, 4,073 to typhoid fever, 1,804 to dysentery, and 11 to
typhus fever.[318] All told, 95,572 cases of beri-beri were observed; at
first the disease was very common, but later on, when barley was added
to the rice, its prevalence decreased. The number of Japanese soldiers
killed in battle was very large (47,387), and to these must be added
10,970 who died of wounds.

As to whether or not the war caused typhoid fever and dysentery to
spread among the civil inhabitants of Manchuria, as was probably the
case, we have no specific information; the appearance of other diseases
among the civil inhabitants is improbable, since the troops would
certainly have contracted them had they been prevalent.

No information has been given by either Russia or Japan as to whether
the soldiers brought diseases back home with them. In Japan, according
to the _Year Book of Statistics_,[319] the number of deaths was as
follows:

          _Typhoid._ _Typhus._ _Cholera._ _Dysentery._ _Beri-beri._
     1903      4,585         9        140        7,172       10,783
     1904      5,100         5         51        5,294        9,408
     1905      6,291        10         34        8,763       11,703
     1906      6,338         5         29        5,173        7,766
     1907      5,974         6      1,702        5,872        8,767
     1908      5,824         9        297        8,053       10,786

In order to prevent the transplantation of infectious diseases into
Japan, very comprehensive measures of precaution were adopted by the
Japanese military authorities, as was the case after the war with China.
Infected soldiers, and soldiers suspected of being infected, were not
allowed to join the transports; in order to find them out, three
quarantine stations were established, one in Dairei (near Moji), a
second in Ninoshima (near Ujina), and a third at Wadano Misaki (near
Kobe). When the transports of troops reached their destination, the men
were divided into groups of 60 and sent to disinfection establishments,
where they were bathed and their effects were disinfected. The sick were
committed to the hospital, and suspicious cases were quartered in
barracks under observation. If infected men had been found on a ship,
the entire ship, crew, and officers, were disinfected. The disinfection
establishments received 828,376 men for examination; of these 429,962
were disinfected.[320]


          5. THE OCCUPATION OF TRIPOLI BY THE ITALIANS (1911)

During the battles fought in connexion with the occupation of Tripoli by
the Italians, infectious diseases were confined within narrow limits.
According to Sforza, the army physician in Tripoli,[321] cholera broke
out there in the second half of October 1911, reached its climax in
November, and disappeared entirely in the second half of December. The
disease was spread chiefly by dates, which had been infected by flies;
it first appeared among the native beggars, then spread to the rest of
the population, and finally to the Italian soldiers. The pestilence
raged only in Tripoli, a fact which Sforza regards as a proof that it
was not conveyed thither by the Italians; for had this been the case,
cholera would have revealed its presence in Homs, Bengasi, Derna, and
Tobruk, in which places thousands of soldiers disembarked, but not a
single case of the disease was observed. Typhus fever is endemic in
Tripoli; after the Italian occupation twenty cases of that disease were
observed among the natives and ten cases among the soldiers. In order to
prevent diseases from spreading to Italy, convalescents were not allowed
to return home until there was absolutely no danger of their
communicating the infection to other persons. The same measures of
precaution were used in relation to relapsing fever.


     6. THE WAR BETWEEN TURKEY AND THE BALKAN STATES (1912–13)[322]

Regarding the Balkan war definite information is still wanting. Well
known, however, is the outbreak of cholera along the Tchatalja lines;
but the progress of the disease was soon checked and it did not become
very widespread. It first appeared in the camp of the Turks, whither it
was borne by troops from Asia, where severe epidemics of it had occurred
in Mecca and Tiberias, and where it had made its appearance in several
other places. In Constantinople the first case of the disease was
reported on November 5, 1912; in the first week of December it had
reached its climax, and after January 20 only sporadic cases were
observed. The following table indicates the number of persons who
contracted and succumbed to cholera in Constantinople:

                                      _Patients._ _Deaths._
            Nov.  5–Dec.  2 (1912)            934       441
            Dec.  3–Dec.  9 (1912)            540       229
            Dec. 10–Dec. 16 (1912)            451       244
            Dec. 17–Dec. 23 (1912)            276       158
            Dec. 24–Dec. 30 (1912)            141        74
            Dec. 31–Feb.  1 (1913)            173        99
                                            —————     —————
            Nov. 5, 1912–Feb. 1, 1913       2,515     1,245

Among the Bulgarians cholera did not become very widespread; throughout
the entire territory occupied by the Bulgarians, cases of cholera, to be
sure, were observed, particularly along the Tchatalja lines. But the
Bulgarians fought the pestilence with energetic measures; the troops
were given nothing but boiled water, and careful attention was paid to
what they ate; the railway dépôts were thoroughly disinfected, as were
all places in which large numbers of people congregated. During the
armistice the Bulgarians were forbidden all intercourse with the Turks.
For the troops transported back home quarantine stations were
established. The result of all these precautionary measures was
eminently successful. In Bulgaria itself only sporadic outbreaks of
cholera occurred, as in Sofia, Stara Zagara, and in the district of
Shumla;[323] on January 18, 1913, Bulgaria was entirely free from
cholera.

Typhus fever broke out very frequently in all the armies, but detailed
information regarding its prevalence has not been published. According
to the reports which have thus far been issued, the disease did not
appear in the form of epidemics in any of the armies; on the other hand,
it is stated that it broke out among the Turkish prisoners in Bulgaria
and Servia, as in Tatar-Bazarjik, Ligotin, Zajecar, and Kujazevas.




                               CHAPTER X
                   EPIDEMICS IN BESIEGED STRONGHOLDS


When fortified cities are subjected to a long siege the death-rate in
them increases considerably; if diseases break out during the siege,
they spread beyond expectation and carry away large numbers of people.
The greatest enemy of the people in a besieged city is hunger. Since the
approaching hostile army causes the inhabitants of the surrounding
country to take refuge in the cities, the latter suddenly become
overcrowded, moreover with people who are generally quite penniless and
have to be provided for by the rest. In former years, when warfare was
much more cruel than it is to-day, this was especially the case.
Furthermore, the size of the garrison must be rapidly increased, or
perhaps the whole of a retreating army, as was the case in Metz, must be
quartered in the stronghold. Accordingly, the first step taken by the
commander of a fortress must be to ascertain the quantity of provisions
on hand, and to work out an appropriate plan for the distribution of
them. How the quality of the bread becomes more and more unsatisfactory,
and finally reaches the point where the product is scarcely worthy of
the name bread; how people are obliged to eat the flesh of horses, dogs,
and other animals; how the prices of the necessaries of life soar _ad
infinitum_—all this is so well known that it needs no further
exposition. Besides the absence of these necessaries of life, the lack
of milk, fats, salt, and vegetables is accompanied by various
consequences; very frequently improper and badly prepared food gives
rise to a large number of severe cases of intestinal catarrh.

Insufficient nourishment is seldom the direct cause of death; on the
other hand, it frequently so weakens people that they are much more
subject to sickness, or, if they have already contracted some disease,
they are much more likely to die, or, if they recover, to convalesce
slowly. Thus Vacher[324] states that typhoid fever, which usually
results fatally in one out of four cases, during the siege of Paris
carried away no less than forty per cent of those who contracted it;
tuberculosis, he says, often acquired an acute form and caused death
within a few weeks. Little children present slight resistance to famine.
‘In regard to new-born and one-year-old infants I have observed in
certain cases that become more frequent every day, that the effects of
insufficient alimentation show themselves in the form of a progressive
emaciation, which includes all the tissues of the body and almost always
has fatal consequences; oedema of the teguments, anaemia, uncontrollable
diarrhoea, and continual plaintive crying on the part of the little
patients are the characteristic symptoms of that hunger-fever which
actually decimates our infant generation.’

Another result of insufficient nourishment, one which has frequently
been observed in besieged strongholds, is the appearance of scurvy.

During sieges, the hygienic measures of precaution, which are absolutely
essential to the maintenance of health in cities, can no longer be
carried out. If spring-water is secured outside the city for the
inhabitants, the besiegers cut off the source of supply; if the water of
rivers is used, then filtration plants have to be erected. But even
filtration does not prevent the appearance of those infectious diseases
the germs of which are carried in water, since for washing purposes the
river-water is used just as it is found. The removal of refuse
constitutes an extremely difficult problem; the cleaning out of privies
is often possible only to a very insufficient extent, especially when
the besiegers have advanced very close to the city, and the failure to
dispose of garbage necessarily causes large accumulations of dirt and
filth in the streets; this was especially the case in former times.

The burying of so many dead bodies, of both men and animals, especially
horses, has met in many sieges with serious obstacles;[325] if the
ditches intended for a large number of bodies are not dug deep enough,
the atmosphere becomes polluted; to burn them is impossible, owing to
lack of fuel; and if they are cast into the river, this jeopardizes the
health of those living further downstream. During certain sieges in the
past, hard conditions have made it necessary to leave corpses and
carcases lying in the open, with terrible consequences.

If the siege takes place in the winter, it is very difficult to procure
fuel for heating purposes, unless sufficient provision has been made
beforehand. In Paris, for example, the inhabitants suffered severely
from cold, and to meet the emergency artificial fuel was prepared by
mixing stable manure with tar and reducing the mass to solid form under
the hydraulic press.

In the following pages we discuss a few sieges which were characterized
by severe outbreaks of pestilence.


                  1. THE SIEGE OF MANTUA (1796–7)[326]

During the siege of Mantua, which the French carried on from May 30,
1796, to February 3, 1797, war-pestilences raged with fearful severity
among both besiegers and besieged. The city lay in an extremely
unhealthy region—malaria was ever prevalent and the drinking-water was
bad. The intentional flooding of the region and the great heat of the
summer of 1796 caused malaria to break out with great severity and to
acquire virulent forms that rendered the disease more dangerous than
usual. In the latter part of May 1796, the garrison consisted of 18,000
Austrian troops, whose power of resistance had been greatly reduced by
hard service from November on, and by exposure to rain and cold with
inadequate means of shelter. Besides intermittent fever, both intestinal
catarrh and typhus fever made their appearance in July; the latter, at
least, was probably the ‘nervous fever’ mentioned by Stegmeyer. Thus as
early as the latter part of July there were some 2,000 sick men in the
garrison. In August the investment was not yet complete, so that the
soldiers did not suffer from lack of food. Notwithstanding this fact,
however, the diseases increased in prevalence and caused many deaths;
the number of sick men was no less than 6,000. On September 12 the
Austrian general, Würmser, with about 12,000 men, succeeded in gaining
entrance into the city; he brought with him a large number of disabled
men who had been wounded in recent fighting, and many of whom succumbed
to tetanus and hospital fever. The number of patients now increased to
8,500; as there was no bedding or straw available, the patients were
compelled to lie on the bare ground, and the uncleanliness of the
hospitals grew worse. When the investment was finally rendered complete
in October, it caused a great scarcity of meat, fat, and wine; the
number of patients that month was 9,000 and the number of deaths 2,560.
These figures, however, are not complete, since they do not include the
patients in the houses set aside for troops overcome by exhaustion. Up
to this time the weather had been good, but in November rain set in; and
while intermittent fever then decreased in prevalence, dysentery raged
even more furiously, and typhus fever also broke out in a virulent,
quickly fatal form. The supply of food now ran very low, and although
there was sufficient bread on hand, horse-flesh was the only meat. To
add to the general misery, scurvy made its appearance in November, and
all those who contracted it died. The extreme cold compelled the
patients to keep their clothes on, and they lay without blankets on the
hard floors of the hospital corridors; their number had now increased to
9,500, and 2,400 died in November. In December the misery increased; the
cold became more and more intense, the supply of food was almost
exhausted, and the wine gave out altogether; scurvy raged in an even
more severe and virulent form, being frequently accompanied by copious
hemorrhages from various parts of the body. In the hospitals there were
7,354 patients, and 2,021 died in the month of December. In January the
acme of misery was reached; the scarcity of food was terrible, and the
ravages of scurvy were no less than frightful; 1,968 men in the garrison
were carried away in the course of that month. On February 3, 1797, the
stronghold was surrendered to the French. The number of patients taken
in by the hospitals between September and January exceeded 40,000, and
of the garrison, which numbered some 30,000 men, 10,249 (more than
one-third of the total) died. Fodéré estimates the total number of
deaths in the city of Mantua during the siege at 20,000;[327] regarding
the prevalence of diseases and the number of deaths among the civil
inhabitants Steegmeyer unfortunately gives us no information.


                     2. THE SIEGE OF DANZIG (1813)

Danzig, which in the spring of 1807 had passed through a siege of ten
weeks, was once more, in the year 1813, from January 11 to November 29,
subjected to the horrors of a siege, which for two reasons was even more
horrible than the previous one; in the first place, the garrison was
badly infected with disease, causing a severe epidemic to rage
throughout the city; and in the second place, the defenders of the
stronghold, which was most advantageously located to withstand a siege,
were national enemies of the inhabitants. Consequently the latter were
not only grossly disregarded in the distribution of supplies, but were
actually obliged to turn over all they had to the French and then buy it
back at exorbitant prices. And while the inhabitants, and toward the end
of the siege the soldiers, too, suffered severely from a lack of the
necessaries of life, the higher officers and the military officials
lived in luxury until the day of the surrender.

Napoleon had assigned the defence of the city to General Rapp, who
performed the task with great valour and ability. On the return march
from Russia, some 40,000 men of Macdonald’s corps had congregated in
Danzig, and 5,000 of them were sent away by Rapp; in the middle of
January the total number of men in the garrison, including the military
officials, was 35,934, consisting of Frenchmen, Poles, Bavarians,
Westphalians, Spaniards, Italians, and Dutchmen. While Macdonald’s corps
had fared pretty well, comparatively speaking, in the Russian campaign,
the men were all very much exhausted, and furthermore, typhus fever was
prevalent among them. As early as the latter part of January,
accordingly, the number of sick soldiers was very large; in fact, only
about 10,000 men were healthy and able to bear arms. ‘As there were no
hospitals, beds, or remedies,’ says Friccius,[328] ‘many died from lack
of care, and at the same time infectious diseases broke out and made
great havoc. A heap of dead men and horses was a common sight in the
streets, and in a short time many thousands of the troops, as well as of
the inhabitants, were carried away.’

In January the death-rate remained comparatively low; of the garrison
about 400 men died in the course of that month. But in February, which
was a very cold month, typhus fever spread abroad with great rapidity,
so that toward the end of the month some 130 soldiers died every day; no
less than 15,000 men lay sick, and the total number of deaths for the
entire month amounted to 2,000. When it began to thaw on February 24,
the number of patients and deaths increased still more, so that 4,000
men died in March and 3,000 in April. From April on, the condition of
health in the garrison improved, although the number of deaths in the
month of May was still no less than 2,000.[329]

As early as February typhus fever had spread to the civil population,
which before the siege had numbered some 40,000; a great many civilians,
however, had fled from the city before the investment was yet complete.
In the months of February and March, according to Blech,[330] some
200–300 persons died every week, ‘including representatives of all
classes—physicians, preachers, jurists, merchants, down to the humblest
people.’ The pestilence raged most furiously among the civil inhabitants
in the latter part of March. ‘Almost every family was in mourning, and
many families were wiped out entirely; the best and most estimable young
men were carried away in the prime of their lives. Whole families
perished, especially in certain streets which the pestilence seemed to
have selected for its chief dwelling-place.’[331] These were especially
the streets inhabited by the poorer classes.

It was not long before a lack of the necessaries of life began to make
itself felt in the city. As early as February 27 the Russians had cut
off the supply of water afforded by the Radaune, which fed the wells in
the city, and this necessitated dependence upon rain-water. For the
purpose of obtaining new supplies of food, a sortie along the Nehrung
was undertaken on April 27; and while the enterprise was successful, the
only persons who really derived any benefit from it were the higher
officers and military officials, who sold butter, milk, and corned beef
at exorbitant prices. Thus the well-to-do citizens, at least, were able
to secure food by paying an excessive price for it. In May the
conditions among the poor became a great deal worse; they were obliged
to eat things that were positively disgusting; horse-meat and waste from
the breweries were delicacies, while cats and dogs were also devoured.
The rations of the soldiers grew smaller and smaller, although there was
sufficient grain on hand to keep them supplied with bread. Says
Friccius,[332] in regard to a sortie undertaken on June 9, ‘How hungry
the troops in the garrison were is indicated by the fact that they cut
up every horse that was killed in battle and took the edible parts with
them.’

After the conclusion of the armistice, which became known in Danzig on
June 10, there was a pause in the siege lasting until August 18; during
this time the besiegers brought food to the garrison every five days,
but absolutely no provision was made for the civil inhabitants. During
the armistice many citizens left the city; indeed the French expelled
from the city all persons who were not sufficiently provided with the
necessaries of life. At first the Russians allowed the fugitives to pass
through their lines, but later on they raised objections, so that a
large number of the unfortunate inhabitants were obliged to live in the
open fields between the besiegers and the besieged, where many of them
died of starvation. In the latter part of September General Rapp allowed
some 300 of them, who had managed to keep alive, to return into the
city. Blech asserts that the emigration of beggars and others of the
poor reduced the population of the city by some 16,000.[333]

In October, lack of the necessaries of life reached a climax, so that
rats and mice were eaten. Since the scarcity of provender made it
necessary to slaughter almost all the horses, the soldiers were supplied
with large quantities of horse-meat. On November 1 the granaries, in
which were kept the provisions of the garrison, were destroyed by fire,
resulting in the loss of about two-thirds of the provisions. This made
it necessary to reduce the soldiers’ bread-rations, and the bread with
which they were supplied was made of half-burned flour and of rusks
fished out of the stinking Mottlau; ‘it was so disgusting that only
ravenous hunger could induce anybody to eat it.’[334]

In consequence of hunger and the unnatural food eaten, the mortality
among the civil inhabitants, the number of whom had dwindled down to
16,000, became very high; the number of deaths per week in the month of
October was no less than 50–80, to which, according to Blech, must be
added the deaths among the poor which were no longer reported. In the
first part of November there were some 80–90 deaths per week. On
November 29 General Rapp surrendered the city to the Russians and
Prussians; but since the conditions of capitulation could not be agreed
upon until January 1, 1814, there was an interval of about a month
during which the French garrison, but not the civil population, was
supplied with food; consequently the death-rate among the citizens
remained high. Furthermore, the besiegers, among whom a virulent typhus
had been raging since October, communicated the infection to the
inhabitants, 107 of whom succumbed to it in the last week of November,
133 in the first week of December, and 138 in the following week. On
December 1, permission was obtained to establish a market, and from that
time on, the citizens could once more provide themselves with food in a
regular way.

The loss of human life inside the besieged stronghold was terrible; of
the 35,900 troops in the garrison, 15,736 according to Friccius died in
the lazarets; at the time of the capitulation only 16,532 men were left,
and of these 1,482 were sick and had to be left in the city. According
to Blech, a total of 5,592 civilians died, 1,142 of them in the last
three months (October-December) of the year; the number of deaths in
December alone was 473. Toward the end of the siege some ninety persons
died of starvation.[335]


                   3. THE SIEGE OF TORGAU (1813)[336]

On May 10, 1813, when Napoleon had appeared in Saxony, and the King,
after considerable hesitation, had decided in his favour, the Saxon
garrison of Torgau, at that time a place of 5,000 inhabitants, was
replaced by a French army-corps. In the course of the summer large
transports of sick soldiers from various lazarets arrived at Torgau, and
on July 18 alone 3,000 sick men and 1,000 convalescents came from
Dresden. Consequently the number of sick in the stronghold was very
large even before the siege began; all public buildings had been
converted into lazarets. But even these were not numerous or large
enough to accommodate all the patients, who numbered some 6,000 in the
month of September, so that the occupants of houses along entire streets
were driven out of their homes, which were used for lazarets and
barracks. ‘A virulent, putrid fever’ raged in all the lazarets, and at
least one-third of the persons who contracted it died; the inhabitants
and the Frenchmen quartered in the homes of citizens were at first
spared by the disease.

After the battle of Dennewitz (September 6, 1813) the head-quarters of
the third and fourth French army-corps was transferred to Torgau, where
also numerous fugitives took refuge; at the same time the large French
head-quarters from Dresden arrived, so that the size of the garrison was
increased by 10,000 men and 5,000 horses. After the battle of Leipzig
the stronghold was besieged by the Prussians, and presently the supply
of food ran low and the uncleanliness in the streets and houses grew
incredibly worse. ‘Then the pestilence began to spread at an alarming
rate among the inhabitants and among the Frenchmen quartered in the
homes of citizens, so that the entire city of Torgau came to resemble a
large, overcrowded lazaret.’[337]

‘The regular lazarets now became veritable hot-beds of misery; they were
scarcely able to accommodate the large number of patients, who numbered
at least 12,000, and whom it was necessary to place so close together
that they almost touched one another. There was a lack of straw and of
other necessities, of sick-attendants and physicians, of effective
remedies, and especially of order and proper superintendence.’ The
patients suffered partly from severe, fetid diarrhoea, and partly from
typhus. In the courtyards there were enormous accumulations of dirt and
refuse, and the doors leading into many of the sick-rooms could scarcely
be opened owing to the collections of foul matter which covered the
floor ankle-deep; in order to reach the sick it was necessary to wade
through this and to climb over dead bodies. Absolutely no thought was
given to keeping the rooms warm. ‘Thus it is quite natural that among
these horrible surroundings the slightest wound, the most insignificant
indisposition, could easily have a fatal termination, and that it was
like sentencing a man to death to bring him to the lazaret.’ The number
of deaths exceeded 8,000 in the month of November alone.

Equally terrible were the conditions in the other parts of the city; all
the private houses were overcrowded with patients and filled with dirt.
A sickening odour permeated the atmosphere; in the ditches around the
fortress and in every corner of the city lay dead horses, rotting straw
sacks, ragged uniforms, and even human corpses. Refuse of the worst kind
was piled up in the streets, often as high as the second story. ‘At this
time’, says Lehmann, ‘Torgau looked more like a lazaret than a city
inhabited by healthy persons; for who would have been able to find a
house in which there were no persons suffering from nerve-fever?
Parlours, bedrooms, halls, stables, kitchens, and cellars—all were
filled with patients.’ The barracks and guard-rooms resembled hospitals.
In a few weeks more than 600 inhabitants died; entire families were
wiped out by the epidemic, and there was scarcely one which was not
mourning the loss of one of its members.

Up to the beginning of December the number of patients steadily
increased; in the lazarets alone, 300 soldiers died every day.

The terrors of the bombardment had a very disastrous effect upon the
inhabitants of the city, since it compelled them to live in damp,
unhealthy, infected cellars. Not until the latter part of December did
the epidemic begin to abate and to lose, at the same time, its virulent
character; the arrival of very cold weather, as well as the diminution
of the number of people, and the fact that the infection had practically
run its course among the inhabitants and the garrison, were at least
partly responsible for this abatement; furthermore, there was now less
crowding, and it became possible to establish better order.

The lack of system in the French lazarets is shown by the fact that the
authorities were never once able to give an account of the number of
persons that died in them. From grave-diggers’ records and church
registers Richter managed to compile the following table of statistics
indicating the number of deaths:[338]

                         _French     _Saxon       _Civil      _Total._
                       soldiers._  soldiers._  inhabitants._
 January-August (1813)                                   222
 September                   1,107          64            43       1,214
 October                     4,803          36            66       4,905
 November                    8,209           3           228       8,440
 December                    4,886                       258       5,144
 January 1–10 (1814)           649                        83         732
 January 11–31                 314                        91         405
 February                      400                        79         479
 March                         100                        52         152

According to this table there died, between September and January 10,
19,654 French soldiers, 103 Saxon soldiers, and 678 civilians. But
Richter says in regard to the above figures: ‘There is no doubt,
however, that the figures pertaining to the French soldiers are much too
small, since they include only those that were actually buried by the
grave-diggers in public burial-grounds. All those who died in private
houses, in the _tête-de-pont_, in the various forts, in the lunettes, or
in any of the outworks of the fortress are not included; their number
was by no means small, and many of them were buried unceremoniously by
citizens or by their comrades, while large numbers of bodies were left
lying in the open.’ In the month of May it was impossible to find a
grave-digger to bury the heaps of corpses, which were consequently
thrown in masses into the Elbe; this of course interfered with the
operation of the floating mills along the river. Nor are the bodies
disposed of in this way included in the above table. Accordingly,
Richter estimates the total number of deaths among the French soldiers
at between 29,000 and 30,000 men.

The pestilence continued to rage even after the surrender of the
stronghold, and did not begin to abate until the latter part of January.
Although the Prussian troops were not quartered in the city, and entered
it only in the day-time, the pestilence nevertheless spread to them and
carried away more than 300 men in the course of three months. Not until
the end of February did the pestilence among the civil inhabitants begin
to abate; the mortality was still high in March, but in April it sank to
normal again.

According to Richter, two-thirds of the patients in the military lazaret
were suffering from ‘colliquative, dysenteric diarrhoea’, and only
one-third from ‘true typhus’, whereas among the civil inhabitants the
latter was by far the more common. There were two forms of diarrhoea
observed; it appeared either as an acute attack of dysentery, which
rarely lasted longer than two weeks and then terminated in either death
or recovery, or else as a chronic, dysenteric diarrhoea, which caused
general weakness and finally death.

Typhus fever began always with a frequently recurring chill, and with a
violent headache and general indisposition; this was followed by a stage
of dry fever, accompanied by stupor, dizziness, and often wild delirium;
as a rule the first few days were characterized by obstinate
constipation, and bleeding at the nose was very common. Later on,
somnolence manifested itself, and the original constipation changed to a
copious, fetid diarrhoea. Petechiae appeared frequently, but not
invariably; at first small, bright-red spots showed themselves, and
later on they assumed a darker colour, grew larger, and finally turned
black. Their size varied considerably; sometimes they were the size of a
pin-head, while often they were from one to one-and-a-half centimetres
in diameter. Most of the patients died between the tenth and fifteenth
days; but if the disease progressed favourably, signs of improvement
usually showed themselves suddenly on the fourteenth or fifteenth day;
as a rule, convalescence was of short duration.

The two forms of ‘nerve-fever’ mentioned by Richter doubtless include
various other diseases. That many cases of typhus fever were among the
fever patients may be inferred from the fact that the disease was very
prevalent among the French troops, and also from Richter’s description;
he expressly mentions the sudden appearance of the disease, the initial
chill, the remission of the fever in the third week, and the rapid
convalescence—all of them characteristic signs of typhus fever.
Moreover, typhoid fever doubtless prevailed more or less extensively.
Richter describes ‘a pituitous modification of typhus’, with a lingering
development;[339] the crisis always came late, frequently not until the
sixth or seventh week, and was invariably uncertain, so that
convalescence was very slow and often interrupted by relapses.
Deuteropathic complications were of almost regular occurrence. There can
be no doubt that we have to do here with a good description of typhoid
fever, which revealed its presence chiefly among the newly-conscripted
young French soldiers.

Regarding the enormous loss of life caused by the epidemic in Torgau,
Richter, who was a Prussian military physician, says: ‘The devastation
that it caused among the Frenchmen, and unfortunately among the
inhabitants of the ill-fated city as well, was indeed terrible; in fact
there is happily scarcely a parallel to it in the history of the world.
One may safely say that the misery experienced by the French troops
throughout the entire course of that disastrous war reached its climax
inside the walls of Torgau. The French lazarets in the city represented
scenes of horror such as repel human nature, and such as one must
actually witness in order to appreciate fully their dreadfulness.’


                   4. THE SIEGE OF MAYENCE (1813–14)

The terrible devastation caused by typhus fever in the strongholds along
the Vistula, Elbe, and Rhine, which were so valorously defended by
French generals in the years 1813–14, excited general consternation.
Wittmann[340] furnishes a very accurate description of the misery
undergone in the besieged cities, especially the city of Mayence. First
he comments on the scarcity of supplies, observing that the vicissitudes
of war can never be foreseen; furthermore, he asserts that the
commanders of fortresses, when they anticipated a siege, purposely kept
the inhabitants in uncertainty about it. In the case of Mayence,
Napoleon ordered the city to be provisioned after the battle of Leipzig.
Some 2,000 oxen were collected, and most of them were kept in the
villages surrounding Mayence; but when the Allies crossed the Rhine the
oxen were all quickly driven into the city, where they grew lean owing
to lack of provender, and died of rinderpest in such large numbers that
it became necessary to slaughter them all and salt the meat. This was
done in such a careless way that a large part of the meat was spoiled;
even after the stronghold surrendered, some of this salted meat was
still on hand, and it was so rotten that it had to be destroyed. The
citizens had learned of the danger too late, and numerous unscrupulous
citizens bought up all the important necessaries of life and then took
advantage of the situation by raising the prices so high that only the
wealthy could procure food. Lack of good bread, which had been so scarce
during the previous siege of Mayence (1793), does not seem to have been
so severely felt in the siege of 1813. Particularly noticeable was the
want of fuel, so that many soldiers froze to death in the exposed
guard-rooms of the outworks. Legumes, especially peas, could not be
thoroughly cooked, so that it was frequently necessary to throw them
away. The supply of good fat, as well as of fresh vegetables, soon ran
out, while the great quantity of alcoholic beverages stored up in
Mayence had a very detrimental effect. Very inadequate provision was
made for the sheltering of the soldiers; inasmuch as the siege took
place in the winter, they could not camp in the open, and the barracks
were not large or numerous enough to accommodate them. Consequently the
officers were quartered in the homes of the wealthier citizens, one
officer in each house, while the troops were housed in large numbers in
the often insanitary homes of the poorer people. This of course greatly
favoured the dissemination of infectious diseases.

According to Wittmann, there was not a single trace of an infectious
disease in Mayence in September 1813. In October the field-lazarets of
the army were transferred from Leipzig to the West, and most of them
passed through Mayence; in the first part of November, moreover, the
field-army itself passed through the city on its return march; thus sick
and healthy soldiers conveyed typhus fever into the stronghold. ‘In the
vicinity of the hospitals and churches, where sick soldiers were
congregated, in the streets through which these doomed victims passed,
and in the houses in which they were quartered together with healthy
men, or into which they had crept from sheer inability to go further,
contagious typhus broke out first and with the greatest severity.’[341]
Dr. Petit, the commissary sent out by the government in Paris, did not
have the courage to oppose the will of Marshal Marmont, who was in chief
command, and so he sought to pacify the inhabitants by means of notices
in the papers to the effect that the prevailing disease was neither
epidemic nor infectious, and was only contagious typhus.

After the investment was complete, typhus fever caused terrible
devastation throughout the city. When the siege began, Mayence had a
garrison of some 30,000 men, while the civil inhabitants numbered about
24,500; to the latter, however, must be added a considerable number of
refugees from the surrounding country. The bad hospital arrangements, as
always happened at that time, greatly helped to spread the disease in
Mayence. According to a report made out by two French physicians and
reproduced by Wittmann, the air in the hospitals was terrible; every bed
was occupied by two patients, while the straw under them and the
blankets over them were never changed or washed, so that they must
necessarily have constituted a source of infection. A report by
Kerckhoffs[342] regarding the Mayence hospitals describes even worse
conditions:


  I was appointed to serve in the hospital established in the
  Municipal Octroi Building, and the first time that I went there I
  found the living and the dead, the wounded and the sick, scattered
  in confusion all over the place. The sick were stretched out on the
  floor, without even straw under them, covered with ordure. I was
  obliged to pick my way on tip-toe in order not to sink up to the
  ankles in filth. I saw sick men lying beside the dead bodies of
  their comrades. In effect, there were so many of them that they were
  lying on top of one another. In some of the rooms the windows were
  closed, so that no air could enter; in other rooms there was neither
  glass nor boarding in the doors or windows, notwithstanding the
  extreme cold. The sick men told me that they had been in that same
  position for two, three, and even four days, without having had a
  drop of water.


The soldiers under arrest, who were compelled to clean out the
hospitals, all died, no more sick-attendants were to be found, and a
large number of physicians perished in the performance of their duties;
all the persons employed in the hospital entirely neglected their
duties, and most of them were drunk all the time, since large quantities
of wine were on hand for the patients.

The result was that the epidemic gradually attained to enormous
dimensions. ‘The infection’, says Wittmann,[343] ‘carried away all the
grave-diggers one by one, and it was impossible to find anybody who was
willing to do that dangerous work. Thousands of dead bodies of citizens
and soldiers lay for weeks in front of the Münstertor, where they were
piled up like logs pending burial.’ In December and January the epidemic
reached its climax; after that it gradually abated, but did not come to
an end until May 3, 1814, when the siege terminated and the Allies
entered the city.

In the period between November 1, 1813, and May 3, 1814, 7,000 deaths
among the soldiers are recorded in the civil register of the city;
according to statements of the grave-diggers, some 10,000 or 11,000 more
soldiers were buried, whose names were not entered in the register for
the reason that they could not be ascertained; nor do the above figures
include the number of deaths in the stronghold of Kastel on the other
side of the Rhine. Of the civil inhabitants, 2,445 (about one-tenth of
the population) died; a large number of physicians contracted the
disease, and four physicians and five surgeons succumbed to it.


                  5. THE SIEGE OF PARIS (1870–1)[344]

After the battle of Sedan the Germans immediately began to march toward
Paris; on September 15, 1870, the first cavalrymen appeared before the
capital, and on September 19 the investment was complete.

An exhaustive account by H. Sueur and a large number of other reports
offer us very full information regarding the condition of health in
Paris during the siege, since the administrative apparatus never stopped
running. The approach of the German armies caused numerous well-to-do
citizens to leave the city; some went south, some to Switzerland, and
some to England. Sueur estimates their number from the reports of the
railroad companies at 300,000. On the other hand, a large number of the
inhabitants of the surrounding country sought refuge in the city; their
number is estimated at 180,000. Furthermore, the size of the garrison
was considerably increased; the number of men in the regular army on
November 4, 1870, is estimated at 236,941, and this does not include
8,000 men in the First Division of the First Corps. To the above,
moreover, must be added the number of soldiers who died between the
beginning and the end of the siege. Thus the number of men in the
regular army at the beginning of the siege was some 246,000; of these
some 56,000 were already in the city in the middle of the summer, while
the remaining 190,000 arrived later. Accordingly, the total number of
people in the city shortly before the siege began was increased by
70,000. Legoyt estimated the population of the city on July 1, 1870, at
1,890,000, so that on the opening day of the investment there were
1,960,000 (in round numbers, 2,000,000) people in Paris. The arrival of
the 190,000 soldiers altered the composition of the population, since
the increase augmented only the number of males between the ages of 20
and 40.

A severe epidemic of small-pox raged in Paris, as stated above, even
before the siege took place. In the first part of the siege, moreover,
the disease raged with even greater fury in the city, since most of the
young newly-enlisted mobile guards had never been vaccinated. The
maximum of deaths caused by it were reported between November 6 and
November 27. We have already described the course of the small-pox
epidemic in Paris.[345] It was influenced neither by hunger nor by cold,
but developed chiefly for the reason that it was impossible to
congregate and isolate the large number of unvaccinated and susceptible
persons.

Typhoid fever, dysentery, and diarrhoea, because of the unfavourable
conditions brought about by the siege, became very widespread and
virulent. Whereas in the year 1869 there were 630 deaths caused by
typhoid fever, during the siege of 1870 no less than 3,475 persons
succumbed to that disease. Dupinet[346] thinks that the above number is
too small, because the disease was often not recognized, and pneumonia,
a common complication, was entered as the cause of death. Inasmuch as
typhoid fever was endemic in Paris, and as the native inhabitants had
acquired immunity by recovery from an attack in the early part of their
lives, those who were most severely afflicted by the disease were
chiefly the soldiers in the army and the refugees from the surrounding
country. The largest number of deaths was reported in the twentieth week
of the siege, i.e. between January 14 and 20.[347] No less than 375
persons succumbed to typhoid fever in the course of that week, whereas
in the corresponding week of the previous year only sixteen deaths had
been reported. The largest number of deaths caused by dysentery and
diarrhoea in a single week was reported somewhat later; the limited
prevalence of these diseases during the siege is indicated by the fact
that in the half-year 1869–70 the number of deaths caused by them was
never more than twenty per week. From statistics compiled by Sueur we
have arranged the following table (p. 323), which also includes the
deaths caused by bronchitis and pneumonia, but not the victims buried on
the battle-fields, of whom there were some 3,000.

The table indicates the gradual diminution of the food-supply. In
December the quality of the bread grew worse and worse; white bread
could no longer be baked, and in its place an almost inedible form of
brown bread was made out of bran, wheat, rye, rice, barley, and oats.
Particularly noticeable was the lack of good fats, making it necessary
to prepare foods with a bad-tasting tallow that was sold under the name
of ‘Beurre de Paris’. Since the cattle had to be slaughtered (those that
were not killed died of various diseases), there was very soon a great
scarcity of milk, making it very difficult to feed infants.[348]

Several persons have maintained that the extreme cold exerted
considerable influence upon the death-rate; and a glance at the two
columns in the table indicating the number of deaths caused by pneumonia
and bronchitis would seem to justify this contention. How great the
difference was, as compared with normal years, will be obvious when we
call attention to the fact that, whereas in the twenty-second week of
the siege (January 28–February 3) 627 persons succumbed to bronchitis,
in the preceding year only seventy-six deaths were caused by that
disease between January 30 and February 5, and that, whereas from 465 to
468 persons succumbed to pneumonia between January 21 and February 18,
1871, the number of deaths caused by that disease in the corresponding
period of the previous year varied from 90 to 119 per week.

According to the unanimous verdict of the Paris physicians, typhus fever
did not make its appearance during the siege.

                  MORTALITY DURING THE SIEGE OF PARIS

 ──────┬───────────────┬───────────────────────────────┬────────┬───────
  _No. │_First and last│   _Important ordinances and   │_Average│_Total
 of the│  day of the   │           events._            │  no.   │  no.
 week._│    week._     │                               │ deaths │deaths
       │               │                               │ in the │during
       │               │                               │ years  │  the
       │               │                               │1867–9._│siege._
 ──────┼───────────────┼───────────────────────────────┼────────┼───────
   〃   │       〃       │               〃               │   〃    │   〃
       │               │                               │        │
 ──────┼───────────────┼───────────────────────────────┼────────┼───────
      1│Sept. 4–10     │                               │     889│    981
      2│Sept. 11–17    │                               │     852│   1263
      3│Sept. 18–24    │Sept. 19, investment completed │     821│   1272
      4│Sept. 25–Oct. 1│                               │     766│   1344
      5│Oct. 2–8       │Oct. 8, meat ration fixed at   │        │
       │               │  100 gr. for adults, 50 gr.   │        │
       │               │  for children                 │     754│   1483
      6│Oct. 9–15      │                               │     737│   1610
      7│Oct. 16–22     │                               │     761│   1746
      8│Oct. 23–9      │                               │     754│   1878
      9│Oct. 30–Nov. 5 │Oct. 30, requisition of fuel   │     767│   1762
     10│Nov. 6–12      │                               │     781│   1885
     11│Nov. 13–19     │                               │     780│   2064
     12│Nov. 20–26     │Nov. 21, requisition of        │        │
       │               │  potatoes                     │     793│   1927
     13│Nov. 27–Dec. 3 │                               │     833│   2023
     14│Dec. 4–10      │                               │     833│   2455
     15│Dec. 11–17     │Dec. 15, horse-meat ration     │        │
       │               │  fixed at 50 gr. per head     │     884│   2728
     16│Dec. 18–24     │Dec. 19, reduction of bread    │        │
       │               │  ration to 300 gr. for        │        │
       │               │  adults,150 gr. for children  │     854│   2728
     17│Dec. 25–31     │                               │     856│   3280
     18│Jan. 1–6       │Jan. 4, beginning of           │        │
       │               │  bombardment                  │     838│   3680
     19│Jan. 7–13      │                               │     902│   3982
     20│Jan. 14–20     │                               │     903│   4465
     21│Jan. 21–7      │                               │     936│   4376
     22│Jan. 28–Feb. 3 │                               │     951│   4671
     23│Feb. 4–10      │Feb. 4, armistice. First       │        │
       │               │  supplies brought in          │     955│   4451
     24│Feb. 11–17     │                               │     974│   4103
     25│Feb. 18–24     │                               │     995│   3941
     26│Feb. 25–Mar. 3 │                               │     984│   3500
     27│Mar. 4–10      │                               │    1020│   2993
     28│Mar. 11–17     │                               │     975│   2576
 ──────┼───────────────┼───────────────────────────────┼────────┼───────
       │               │                               │   24148│  75167
 ──────┴───────────────┴───────────────────────────────┴────────┴───────

 ──────┬─────────────────────────────────────────────────────────────────────
  _No. │
 of the│
 week._│
       │
       │
       │             _No. of deaths during the siege caused by_
 ──────┼───────┬────────┬────────────┬────────────┬────────────┬─────────────
   〃   │_Small-│_Typhoid│            │            │            │
       │ pox._ │Fever._ │_Dysentery._│_Diarrhoea._│_Pneumonia._│_Bronchitis._
 ──────┼───────┼────────┼────────────┼────────────┼────────────┼─────────────
      1│    116│      39│           8│          25│          54│           45
      2│    168│      45│          10│          65│          66│           55
      3│    158│      45│           9│          43│          62│           61
      4│    210│      56│          23│          46│          46│           36
      5│       │        │            │            │            │
       │       │        │            │            │            │
       │    212│      54│          18│          69│          50│           56
      6│    311│      54│          26│          72│          64│           55
      7│    360│      55│          23│          76│          66│           70
      8│    378│      62│          49│          99│          71│           77
      9│    380│      61│          32│          87│          69│           72
     10│    419│      62│          39│          91│          79│           82
     11│    431│      94│          25│          91│          73│           92
     12│       │        │            │            │            │
       │    386│     103│          25│          92│          81│           89
     13│    412│     140│          25│          76│          92│           99
     14│    398│     137│          33│          83│         108│          107
     15│       │        │            │            │            │
       │    391│     173│          38│         103│         131│          190
     16│       │        │            │            │            │
       │       │        │            │            │            │
       │    388│     221│          30│          73│         147│          172
     17│    454│     250│          51│          98│         201│          258
     18│       │        │            │            │            │
       │    329│     251│          52│         151│         262│          343
     19│    339│     301│          46│         143│         390│          457
     20│    380│     375│          42│         137│         426│          598
     21│    327│     313│          48│         134│         478│          548
     22│    258│     324│          63│         150│         465│          627
     23│       │        │            │            │            │
       │    225│     260│          57│         144│         468│          593
     24│    174│     298│          59│         158│         471│          539
     25│    134│     301│          52│         181│         410│          557
     26│    147│     260│          50│         190│         338│          424
     27│     85│     258│          60│         142│         267│          379
     28│     98│     229│          49│         104│         188│          301
 ──────┼───────┼────────┼────────────┼────────────┼────────────┼─────────────
       │   8068│    4821│        1042│        2923│        5623│         6982
 ──────┴───────┴────────┴────────────┴────────────┴────────────┴─────────────

Scurvy broke out, but did not become at all widespread; sporadic cases
of the disease were observed among the civil inhabitants, while in the
prisons and hospitals it was somewhat more prevalent. Delpech[349]
attributes the appearance of the disease to the lack of fresh
vegetables, which were very expensive and could not be given out in the
public establishments. Among the soldiers the disease broke out only in
Fort Bicêtre, the garrison in which consisted of 800 marines, of whom
some seventy or seventy-five contracted it. None of them were given any
salted meat, and Grenet[350] contends that the outbreak was caused by
the lack of light and air in the small casemates, and by arduous
service, especially in the night. But here, too, the real cause was
probably to be found in the lack of fresh vegetables, which Grenet does
not mention.

The death-rate in Paris during the siege was about three times as high
as normal. Sueur has estimated that in the years 1867–9 the mortality in
the twenty-eight weeks corresponding with those in the above table was
13·1 per 1,000 inhabitants, whereas in the twenty-eight weeks of the
siege the mortality was 38·6 per 1,000.


                   6. THE SIEGE OF PORT ARTHUR (1904)

Port Arthur was besieged by the Japanese from July 30, 1904, to January
2, 1905—a period of 156 days. Whereas, as stated in the last chapter,
the condition of health in the Russian army was good, the sanitary
conditions in Port Arthur during the siege were very bad, since the
supply of provisions that had been laid in proved to be
insufficient.[351] The offer made on August 16 by General Nogi and
Admiral Togo, granting all the women, children (under 16 years),
ecclesiastics, members of the diplomatic corps and military and naval
attachés of foreign powers permission to leave the stronghold, was
refused by General Stössel. As early as August 5 horse-meat began to be
distributed;[352] from September 17 on the troops were supplied four
times a week with horse-meat, since there was no other fresh or canned
meat available. At this time almost everything in the city was consumed,
though the Chinese secretly brought rice, eggs, and other things, on
boats from Chufoo. After September 28 the soldiers were given meat only
twice a week (one-half of a pound of horse-meat or one-third of a can of
preserved meat). Regarding conditions up to October 20 we are informed
by the report of the Russian General Medical Staff:[353] ‘The supply of
food ran lower and lower; beef gave out very early, only a small
quantity of canned meat was left, and even the portions of horse-meat
had to be dealt out very sparingly, as we had very important use for
horses in transporting ammunition, water, food, &c., to the various
positions. In the city it became more and more difficult every day to
procure food; meat, if by any chance a small quantity was marketed, was
sold in the stores for one and one-half roubles per pound. A chicken
cost twelve roubles, a goose twenty roubles, an egg one rouble, a pound
of onions one rouble, a pound of horse-meat one half-rouble.’

In November all the soldiers were given was horse-meat; only the sick
received canned meat. The supply of food in the possession of private
individuals was exhausted, while garlic and vegetables had given out
altogether.

On September 19 the Japanese captured the redoubts controlling one of
the aqueducts that supplied Port Arthur with water; there was however
another aqueduct, and, furthermore, wells were bored and a plant for
distilling seawater was put into operation. The statement of the Russian
General Staff that there was at no time a serious scarcity of water is
not confirmed in Olga von Baumgarten’s diary, which frequently refers in
plaintive terms to the lack of drinking-water in the lazarets.[354]

During the summer the condition of health among the Russian troops was
comparatively good;[355] on August 26 there were 132 officers and 5,661
men in the lazarets. In the first part of October typhoid fever broke
out in Port Arthur, where it was endemic, and before long an epidemic of
such severity was raging in the city that it was difficult to find
places in which to shelter the patients. There were also a great many
cases of dysentery. Owing to the lack of preserved meat and vegetables,
scurvy also made its appearance; the first cases of the disease were
observed early in October. In the latter part of that month there were
in the lazarets 450 typhoid-fever patients, 855 dysentery patients, and
167 scurvy patients. In addition to these diseases, cases of
night-blindness (inability to see after dusk) were observed; the latter
disease is quite common among Russian country-people, being caused by
bad nourishment.

In December the garrison was completely exhausted. Scurvy had become
more and more widespread, and between the fourteenth and twenty-seventh
of that month 71 officers and 1,790 men had been committed to the
lazarets. On the day of the surrender (January 2, 1905) the number of
men in the Russian garrison was 32,400, and of these 6,458 were lying
sick or wounded in the lazarets.[356] Of the remaining 25,942 men,
13,207 were incapacitated; thus the number of healthy men (besides 2,193
marines) in the garrison at the time of the surrender was only 12,735.
Regarding the loss of life during the siege we find no information in
the report of the General Staff. The number of soldiers in the city
(excluding the officers and officials) was 41,780 at the beginning and
32,400 at the end of the siege. No further information regarding the
condition of health among the civil inhabitants of Port Arthur is
obtainable.




                               CONCLUSION


The history of war-pestilences has shown how severely belligerent armies
are attacked by infectious diseases, how seriously their operations are
hampered by them, and what loss of life such diseases cause by spreading
to non-combatants. If we start from the time when more or less accurate
descriptions enable us to determine the nature of the epidemics, we find
that plague and typhus fever were the two diseases which, until a few
decades ago, most commonly attacked the soldiers; the latter disease,
which made its appearance in almost every war that was waged between the
beginning of the sixteenth and the middle of the nineteenth century,
consequently acquired the name ‘war-plague’.

For a long time nobody knew just how to combat these pestilences, and
nowhere were rational measures adopted aiming to prevent them from
spreading. We have seen the bitter truth of this statement in connexion
with the endless Napoleonic wars. One reason for the neglect of
preventive measures was the belief that these pestilences broke out
spontaneously when large numbers were crowded together under miserable
living conditions. The physicians of that time, in their efforts to
explain the sudden appearance of these pestilences, arrived at the
conclusion that they were autochthonic. But modern medical science,
realizing its limitations, contents itself with the hypothesis that the
original cause of these diseases is not to be ascertained, and with the
knowledge that the infective agents in the case of almost all of them
have been discovered, and that an outbreak of any infectious disease in
any specific locality signifies that the germ of that disease must in
some way have been deposited there. It was precisely the belief in the
spontaneous origination of pestilences that led people to neglect
watching for and isolating, with all possible dispatch, the first
cases—a measure which is to-day looked upon as the most important means
of preventing the dissemination of a disease.

The belief in the autochthonic origin of diseases continued to prevail
until the first half of the nineteenth century. Hecker upheld it in a
discussion of the plague-epidemic that occurred during the Russo-Turkish
War of 1769–70; he believed that the intermittent fever prevalent in the
Danube countries passed over into putrid fever, with or without
petechiae, that carbuncles and buboes gradually developed, and that
putrid fever was thus converted into bubonic plague. ‘It is therefore in
all probability true’, says Hecker, ‘that the outbreak of plague in the
Russian army in the year 1770, as well as in the year 1828, was not
caused by direct infection from the Turkish troops, but was merely an
independent development from intermittent fever and spotted fever.’

Recent investigations in the field of medicine turn over to the other
sciences all questions regarding ultimate causes, and confine themselves
to what is actually observed. We know that the agents responsible for
infectious diseases are specific minute organisms which must be present
in the system to produce the disease in question, and that these
micro-organisms are conveyed from place to place by infected persons, by
intermediaries, on articles to which they have attached themselves, in
contaminated food, in drinking-water, and in many other ways.
Investigators have studied the conditions in which these infective
agents live and the manner in which they are disseminated, they have
discovered methods of determining the nature of the disease in a very
short time, and they have come to recognize the danger of coming in
contact with germ-bearers, that is, with persons, healthy or
convalescent, who have these micro-organisms in their systems without
being themselves sick. Medical science is now endeavouring, by means of
systematic procedure and splendid organization, to guard soldiers
against the danger of infection; good drinking-water is provided, the
men and the rooms in which they live are kept clean, persons suffering
from infectious diseases are isolated, all rooms and articles used by
patients are disinfected, infected divisions of troops are quartered by
themselves, germ-bearers are watched for and discovered, &c. The success
of such measures is well known. The knowledge gained and profited by in
times of peace is also applied in times of war, and to-day we are able
to confine pestilences within much narrower limits than was formerly
possible. In order to do this, however, we must have, in addition to an
efficient system of transporting and feeding troops, physicians who are
well informed in regard to hygiene and bacteriology.

As early as the eighteenth century, successful efforts were made to
prevent, by means of energetic measures, the reappearance of plague in
Europe; the Russo-Turkish War of 1828–9 was the last war in which it
broke out. On the other hand, typhus fever continued to be the Nemesis
of belligerent armies, while a new infectious disease, cholera, entered
upon the scene and played a very important rôle in the Crimean War, and
a by no means minor rôle in the war of 1866. Along with these diseases,
typhoid fever advanced into the foreground about the middle of the last
century, and it soon turned out to be one of the most dangerous diseases
that occur among soldiers. This appearance of typhoid fever has led some
to think that the disease has prevailed extensively only in
comparatively recent times. Hirsch, however, ably defends the opposite
view; he maintains that typhoid fever was in many instances confused
with the _febres pestilentes_, _malignae_, _putridae_, and _nervosae_,
with the mucous fevers, bilious fevers, putrid fevers, &c. In discussing
the typhus-fever epidemics that occurred in the course of the Napoleonic
wars, we have several times called attention to the fact that typhoid
fever probably broke out in the form of epidemics; but it could be
diagnosed with certainty only after post-mortem examinations began to be
more frequent. At all events, typhoid fever is to-day prevalent all over
the world, and there is always danger that field-armies will be infected
with it, either in their own land or in the land of the enemy. All the
wars of the last few decades have clearly demonstrated this fact.

For a successful battle against war-pestilences, it is a fortunate
coincidence that the civil as well as the military authorities are
equally interested in their prevention. Every military leader knows how
important it is for the soldiers to keep healthy, since their efficiency
is otherwise seriously impaired. It is not our task to describe the
particular measures that are to be adopted; the manuals of military
sanitation give us accurate information regarding these matters. We
merely mention the fact that it is of great value and importance to have
physicians, who are well acquainted with hygienic problems, make a
preliminary examination of sanitary conditions in the territory through
which the soldiers will be required to pass in order to reach the scene
of hostilities.

Very great difficulties, to be sure, confront the efforts made in war
times to prevent the outbreak of infectious diseases. If the struggle is
carried on in an infected region, the troops are often compelled to seek
shelter in infected houses; thus during the battles of Orléans and Le
Mans in the Franco-German War the troops, in order to protect themselves
against the severe winter cold, had to live in houses which small-pox
patients had shortly before occupied or were actually occupying at the
time. Circumstances frequently arise which render impossible the
adoption of the most effective measure calculated to prevent the
dissemination of a pestilence, that is, the isolation of infected
divisions of troops; one can readily imagine how difficult this would be
in the case of an army re-forming after a lost battle. Furthermore, even
if one of the belligerent armies is doing all it can to prevent diseases
from spreading, its efforts must be seriously handicapped if the enemy’s
army does not include an equally diligent sanitary corps and does not
devote the same amount of energy to the prevention of the outbreak and
dissemination of infectious diseases. For even if a sanitary corps is
successful in warding off a reaction upon its own troops, nevertheless
this reaction is sure to take place with respect to the civil
inhabitants of the country in which the war is waged.

During a war, the civil authorities must also do their part in
preventing diseases from spreading to the civil population. The local
administrations of a region in which fighting is going on are powerless.
The generals care very little whether or not a city or village in the
enemy’s country is infected by their troops, whom they quarter in
whatever house or place best suits their purpose. On the other hand, the
communities in which military prisons are located are confronted with a
very difficult problem, since these prisons, if infected men are
confined in them, easily develop into centres of infection; this fact
was observed a hundred times in the year 1870. If a disease breaks out
in a community in consequence of the fact that a military prison has
been established there, in my opinion it is incumbent on the central
government of the country to support the local authorities in their
efforts to check the disease, and to give them financial help as well as
scientific advice. Unfortunately, it is not to be denied that, in many
small cities and in almost all rural communities, absolutely no
provision is made for the isolation of persons suffering from infectious
diseases; the authorities justify themselves with the reflection that in
case of emergency barracks can quickly be erected for the purpose, but
at the same time they fail to remember that working-men are not always
available in the storm and stress of war times, that building materials
in the general scarcity of supplies cannot always be procured with
sufficient promptitude, and that pestilences, if the isolation of the
first cases is delayed, usually spread with great rapidity.

In future wars we must expect the military authorities to do all they
can, just as soon as the prisoners are taken, to segregate as carefully
as possible all known and suspected cases of infectious diseases. The
difficulties confronting the military authorities, when it is necessary
to remove large numbers of prisoners with all possible dispatch away
from the scene of the war, are, to be sure, very great.

Finally, we must also call attention to the danger to which the civil
inhabitants of a country are exposed, when the soldiers return home
after the termination of a campaign in an infected region. It must be
demanded under all circumstances that divisions of troops among whom
infectious diseases have made their appearance, before returning from
the enemy’s country, shall be subjected to a medical examination,
isolated, and disinfected, just as was done on such a large scale, for
example, by the Japanese after the wars with China and Russia. This also
applies to all other persons who have had anything to do with infected
divisions, particularly to teamsters.

All preparations designed to prevent the outbreak and dissemination of
infectious diseases must be made in times of peace; barracks and
lazarets must be erected, physicians who are well acquainted with
methods of hygienic investigation must be available, and an adequate
number of nurses and sick-attendants must be prepared for immediate
service at the very first appearance of an infectious disease. For the
military authorities, who can scarcely perform all the duties that the
beginning of a war imposes upon them, it will facilitate matters greatly
if in future campaigns the Red Cross devotes its attention, not only to
the care of the wounded, but also, on a larger scale than it has
heretofore, to the prevention of the outbreak and dissemination of
war-pestilences.




                                 INDEX


 Acre, pestilence, 14.

 Adrianople, bubonic plague epidemic 1829, 168 f.

 del Agua, 277.

 Algiers, typhus epidemic 1868, 195 f.

 Amoebic dysentery, 7 f.

 Amsterdam, pestilence 1624, 72.

 Andersonville prison, 181.

 Anti-vaccinationists, 198, 251, 260, 269.

 Armenia, plague epidemic 1828, 169 f.

 Athens, plague, 11.

 Augsburg, pestilence 1634, 58 f.;
   pestilence 1703, 80;
   small-pox epidemic 1871, 259.

 Austria, small-pox epidemic 1872, 275 f.


 Barbarossa, 12 f.

 Basel, small-pox epidemic 1870, 271 f.

 Baudens, 174.

 Baumgarten, von, 326.

 Bavaria, typhus epidemic 1813, 149 f.

 Beitzke, 122, 129, 132.

 Belgium, small-pox epidemic 1870, 273 f.

 Beri-beri, 298.

 Berlin, pestilence 1637, 69;
   small-pox epidemic 1871, 230 f.;
   typhus fever epidemic 1813, 124 f.

 Berne, small-pox epidemic 1870, 271.

 Bernstein, 140.

 Black Death, 6.

 Blech, 122, 308, 309, 310.

 Boehnke, 195.

 Boersch, 29, 78.

 Boin, 103, 104.

 le Borne, 95.

 Bouchut, 322.

 Bourchardet, 320.

 Brandeis, 12.

 Braun, 151.

 Bremen, small-pox epidemic 1870, 242.

 Breslau, pestilence 1758, 82;
   plague 1633, 47;
   small-pox epidemic 1871, 224 f.;
   typhus epidemic 1813, 123.

 Brunner, 272.

 Bubonic plague, 5; 1707, 85;
   Adrianople 1829, 168 f.;
   Armenia 1829, 169 f.;
   Bucharest 1828, 165 ff.;
   France 1628, 73 f.;
   Italy 1629, 74 f.;
   Netherlands 1635, 72 f.;
   Russo-Turkish War 1769, 86;
   Russo-Turkish War 1828, 165 ff.;
   Thirty Years’ War, 25 ff., 41 ff.;
   Varna 1829, 168 f.

 Bucharest, bubonic plague 1828, 165 ff.

 Bukowina, small-pox epidemic 1871, 276.

 Burckhardt, 78, 158, 272.

 Bürger, 313.


 Cannstatt, 112.

 Canz, 94.

 Cazalas, 183.

 Charles VIII, expedition to Naples, 17.

 Charles XII, 85.

 Chauffard, 200.

 Chemnitz, small-pox epidemic 1871, 255 f.

 Chenu, 171, 173, 183.

 Cholera, 6 f.;
   Balkan War, 300 ff.;
   Crimean War, 170 ff.;
   France 1853, 170 ff.;
   German War of 1866, 184 f.;
   Tripolitan War, 299 f.

 Civil War, American, 5;
   dysentery, 178 f.;
   malaria, 180;
   measles, 179;
   small-pox, 179;
   typhoid fever, 177;
   typhus fever, 178.

 Cless, 260.

 Colin, 203.

 Cologne, small-pox epidemic 1870, 247 f.

 Concentration camps, South Africa, 292 ff.

 Constantinople, cholera epidemic 1912, 301.

 Copenhagen, pestilence 1710, 85.

 Crimean War, cholera, 170 ff.;
   dysentery epidemic, 172;
   scurvy epidemic, 172;
   typhus epidemic, 172 ff.

 Crusades, 12, 13 ff.

 Czetyrkin, 165, 167, 169.


 Daimer, 185, 275, 276.

 Damietta, siege of, 14 f.

 Danzig, pestilence 1709, 85;
   siege of, 306 ff.;
   small-pox epidemic 1870, 220 f.;
   typhus fever 1813, 122.

 Davoust, 141.

 Delpech, 201, 202, 324.

 Deneke, 141.

 Denmark, small-pox epidemic 1871, 280 f.

 Depopulation, Thirty Years’ War, 76 ff.

 Diemerbroeck, 73.

 Dietz, 78.

 Dillenius, von, 151.

 Diodorus, 11.

 Diphtheria, Boer War, 294.

 Dresden, pestilence 1757, 83;
   plague 1632, 44;
   small-pox epidemic 1871, 254 f.;
   typhus epidemic 1813, 127 f.

 Dupinet, 321.

 Düsseldorf, small-pox epidemic 1871, 245 f.

 Dysentery 7 f., 14;
   American Civil War, 178 f.;
   Crimean War, 172;
   Franco-German War, 190 ff., 194 ff.;
   Port Arthur, 326 f.;
   Russian Campaign, 116 ff.;
   siege of Paris, 321 ff.;
   siege of Torgau, 314 f.;
   Thirty Years’ War, 31 ff.


 Elsässer, 150.

 Ebstein, 12, 115, 137.

 England, small-pox epidemic 1870, 278;
   typhus fever 1808, 105;
   typhus fever 1856, 174 f.

 Enteric fever, 8.

 Erfurt, small-pox epidemic 1871, 236 f.;
   typhus epidemic 1813, 133.

 Erisman, 287.


 Feichtmayer, 98.

 Ferenczy, 291.

 Finland, small-pox epidemic 1871, 280 f.

 Fischer, 127, 128.

 Flexner, 7.

 Flinzer, 130, 255.

 Follenfant, 298.

 Fonteret, 205.

 Fracastorius, 20.

 Franco-German War, small-pox epidemic, 197 ff.

 Frankfurt-on-the-Main, pestilence 1633, 63.

 Frankfurt, small-pox epidemic 1871, 250 f.;
   typhus epidemic 1813, 135 ff.

 Franque, von, 137, 138, 140.

 Frederick the Great, 82, 83.

 Friccius, 122, 307, 309, 310.

 Friedländer, 157.

 Fuchs, 17.


 Gaffky, 8.

 Gasc, 117.

 Geissler, 256.

 Genoa, typhus fever 1799, 67.

 Gilbert, 100.

 Giraud, 132.

 Gmelin, 61.

 Godelier, 175.

 Göden, 121.

 Gratiolo, 22.

 Grätzer, 78, 82.

 Gravelotte, 189.

 Greiner, 132.

 Grellois, 196.

 Grenet, 324.

 Grossi, 74.

 Gurlt, 1, 99, 101, 115, 122, 125, 131, 132, 143, 153.

 Gustavus Adolphus, 27 ff., 50.

 Guttstadt, 186, 214, 219, 223, 230, 231, 233, 234, 242, 243, 248, 270,
    283.

 Györy, 20, 24.


 Haga, 297.

 Hain, 98, 161.

 Hamburg, small-pox epidemic 1870, 239 f.;
   typhus fever epidemic 1813, 141 f.

 Hammer, 85.

 Hanau, typhus fever epidemic 1813, 134 f.

 Häser, 12, 17, 72, 74, 81, 85, 92, 97, 114, 123, 172, 306.

 Haurowitz, 176.

 Hecker, 17, 86, 87, 89, 329.

 Heilbronn, small-pox epidemic 1870, 263 f.

 Herero War, 296.

 Hildenbrand, 106, 113.

 Hirsch, 15, 18, 19, 173, 178, 184, 185, 330.

 Holk, 44.

 Höring, 263.

 Horn, 52, 113, 124, 125, 133.

 Hörnigk, 64.

 Hufeland, 100, 103, 106, 107, 108, 112, 113, 124.

 Hungarian disease, 20, 22 ff.


 India, small-pox epidemic 1873, 282.

 Ireland, small-pox epidemic 1871, 280.

 Italy, small-pox epidemic 1872, 277 f.


 Joerdens, 99.

 Jörg, 112.


 Kanngiesser, 12.

 Kausch, 123.

 Kerckhoffs, 115, 116, 120, 318.

 Kiev, bubonic plague 1770, 89.

 Knaak, 1, 183, 287.

 Koch, 7, 286.

 Königsberg, typhus epidemic 1806, 100;
   typhus epidemic 1812, 121 f.

 Kopp, 108, 122, 131, 134, 135.

 Kosloff, 286, 289.

 Kraft, 138.

 Kraus, 301.

 Kriesche, 204.

 Kruse, 7.

 Kübler, 184.


 Ladysmith, typhoid epidemic, 291 f.

 Lammert, 26, 50, 58, 64, 66, 72, 74, 77.

 Larrey, 115.

 Laveran, 1, 12, 73, 100, 118, 158, 175, 178, 197, 202.

 Lehmann, 311, 312.

 Leipzig, pestilence 1630, 41 f.;
   small-pox epidemic 1871, 252 ff.;
   typhus epidemic 1813, 128.

 Lemazurier, 115, 117, 118.

 Lentilius, 79.

 Leprosy, 15 f.

 Lersch, 13, 14, 18, 282.

 Leyden, pestilence 1624, 72.

 Liévin, 220, 221.

 Linstow, 1, 101.

 Littré, 12.

 Löbenstein-Löbel, 132.

 Lohnes, 150.

 London, small-pox epidemic 1871, 279.

 Loth, 194, 237.

 Lotz, 274.

 Louis IX, 15.

 Louis XIV, 79.

 Lübeck, small-pox epidemic 1871, 240 f.

 Lyons, small-pox epidemic 1870, 205 f.


 Magdeburg, small-pox epidemic 1871, 233 f.

 Maier, 125.

 Majer, 258.

 Malaria, American Civil War, 180 f.;
   Italian War of 1859, 183;
   siege of Mantua, 304 f.

 Mansfeld, 29 ff.

 Mantua, pestilence 1630, 75;
   siege of, 304 ff.

 March, 182, 274.

 Maréchal, 18, 21, 30, 92, 109, 155.

 Maria Theresa, 80.

 Martin, 188.

 Martius, 258.

 Massachusetts, small-pox epidemic 1872, 281.

 Matignon, 299.

 Maurin, 196.

 Mayence, siege of, 316 ff.;
   small-pox epidemic 1870, 266 f.

 Mayr, 257.

 Measles, American Civil War, 179;
   Boer War, 294 f.

 du Mesnil, 203, 321.

 Metz, pestilence, 21;
   pestilence 1636, 65 f.;
   pestilence 1792, 93;
   small-pox epidemic 1870, 203;
   typhus epidemic 1813, 155 f.;
   typhus epidemic 1870, 196 f.

 Meyer, 32.

 Michaux, 14, 196.

 Michigan, small-pox epidemic 1872, 281.

 Milan, pestilence 1630, 75.

 Moore, Thomas, 18.

 Moravia, typhus epidemic 1813, 161.

 Mortality, Moscow pestilence 1771, 91;
   Seven Years’ War, 84;
   Thirty Years’ War, 78.

 Moscow, bubonic plague 1771, 89;
   typhus fever 1812, 116.

 Munich, pestilence 1634, 55 f.;
   small-pox epidemic 1871, 258 f.

 Münster, small-pox epidemic 1871, 242 f.

 Murchison, 73, 112, 174.

 Myrdacz, 183, 287.


 Nantes, pestilence 1793, 95.

 Napoleon, 115 ff., 126.

 Nassau, typhus epidemic 1813, 140.

 Netherlands, small-pox epidemic 1871, 274 f.

 Neuhof, 126.

 Neumann, 110.

 New York, small-pox epidemic 1871, 281.

 Niedner, 173, 184.

 Norway, small-pox epidemic 1871, 280 f.

 Nuremberg, plague 1633, 53;
   small-pox epidemic 1871, 258 f.


 Oesterle, 304.

 Oettingen, von, 298.

 Okuniewski, 324.

 Ophthalmia, 15.

 Ozanam, 21, 73, 74, 75, 81, 84, 97, 101, 104.


 Parenteau-Desgranges, 109.

 Paris, siege of, 320 ff.;
   small-pox epidemic 1869, 202;
   typhus fever epidemic 1814, 156 f.

 Parrot, 118.

 Pastau, von, 225.

 Pellerin, 157.

 Peloponnesian War, 11.

 Peninsular War, typhus fever, 101.

 Perroud, 206.

 Pettenkofer, 286.

 Pfaff, 40.

 Physicians, typhus mortality, 123, 129, 131, 135, 137, 142, 145, 151,
    155, 319.

 Plague, 5 ff.;
   Athens, 11;
   Rome, 12.

 Pneumonia, siege of Paris, 322 f.

 Pneumonic plague, 5 f.

 Pont-à-Mousson, typhus fever epidemic 1813, 154.

 Port Arthur, siege of, 324 ff.

 Prague, pestilence 1742, 81;
   small-pox epidemic 1872, 277.

 Presl, 186.

 Pringle, J., 1, 82, 308.

 Prinzing, 199.

 Prussia, small-pox mortality, 198.


 Rabinowitsch, 272.

 Rapp, 260.

 Rasori, 97.

 Reisseisen, 155.

 Reissner and Neidhart, 265, 266.

 Reuss, 260.

 Rhumelius, 29.

 Richter, 311–16.

 Riecke, 313.

 Roetenbeck, 52.

 Roller, 99.

 Roloff, 131.

 Rösle, 78.

 Roth, 297.

 Russia, small-pox epidemic 1871, 280 f.

 Russian Campaign, typhus epidemic, 115 ff.


 Samoilowitz, 89.

 Sanitary Commission, American Civil War, 176.

 Schäfer, 148, 298.

 Schafonsky, 89.

 Scheerer, 115, 116.

 Schinzinger, 152.

 Schnurrer, 12, 21, 24, 52.

 Schön, 60.

 Schopper, 301.

 Schwiening, H., 18.

 Scorbutus, 9.

 Scotland, small-pox epidemic 1871, 280.

 Scrive, 171, 173.

 Scurvy, 9, 14;
   Crimean War, 172;
   Metz 1552, 21–2;
   Port Arthur, 326 f.;
   siege of Mantua, 305 f.;
   siege of Paris, 324;
   Thirty Years’ War, 52 ff., 66.

 Sedan, 189.

 Seidlitz, 166, 167, 168, 169.

 Seitz, 26, 55, 81, 95, 98, 99, 144, 147, 148, 149, 150, 257.

 Sforza, 299.

 Siegel, 253.

 Sigel, 261.

 Silesia, typhus epidemic 1805, 98.

 Simon, 166.

 Small-pox, 9, 17;
   American Civil War, 179;
   Franco-German War, 197 ff.;
   Germany 1865, 184;
   Germany 1870, 212 ff.;
   siege of Paris, 321.

 Small-pox mortality, in France, 199;
   French prisoners 1870, 209 f.;
   Germany 1871–2, 268;
   Prussia, 198;
   Prussia 1862–73, 214.

 Stegmeyer, 305.

 Steiner, 16, 299, 324.

 Steinheim, 142.

 Stemmler, 132.

 Stettin, small-pox epidemic 1871, 226 f.

 Stiga, 7.

 Stockholm, pestilence 1710, 85.

 Strassburg, small-pox epidemic 1870, 204.

 Stricker, 115.

 Stuttgart, small-pox epidemic 1870, 261 f.

 Sueur, 203, 320, 322.

 Süssmilch, 83.

 Suttner, 55.

 Sweating sickness, 18 ff.

 Sweden, small-pox epidemic 1871, 280 f.

 Switzerland, typhus fever epidemic 1813, 158 f.

 Syphilis, 16, 17, 18.


 Takaki, 298.

 Teuffel, 188.

 Thierer, 62.

 Thilenius, 138.

 Tholazan, 169.

 Thouvenel, 154.

 Thucydides, 11.

 Tilly, 27, 50.

 Torgau, siege of, 311 ff.

 Typhoid fever, 8 f.;
   American Civil War, 177 f.;
   Boer War, 290 ff.;
   Franco-German War, 190 ff.;
   Herero War, 296;
   Port Arthur, 326 f.;
   Russo-Japanese War, 297 f.;
   Russo-Turkish War 1877, 288 ff.;
   siege of Paris, 321 ff.;
   siege of Torgau, 315 f.;
   Thirty Years’ War, 71.

 Typhus fever, 4 ff., 19 ff., 106 ff., 149 f.;
   1812, 114 ff.;
   1813–14, 162 ff.;
   Algiers 1868, 195 f.;
   American Civil War, 178;
   Balkan War, 301 ff.;
   Berlin 1813, 124 f.;
   Breslau 1813, 123;
   Coalition War, 98;
   Crimean War, 172 ff.;
   Danzig 1813, 122;
   Dresden 1813, 127 f.;
   England 1622, 75 f.;
   England 1808, 105;
   England 1856, 174 f.;
   Erfurt 1813, 133;
   Frankfurt 1813, 135 ff.;
   Genoa 1799, 97;
   Hamburg 1813, 141 f.;
   Hanau 1813, 134 f.;
   Königsberg 1806, 100;
   Königsberg 1812, 121 f.;
   Leipzig 1813, 128 ff.;
   Metz 1813, 155 f.;
   Metz 1870, 196 f.;
   Moravia 1813, 161;
   mortality 1813–14, 163;
   mortality among physicians, 108;
   Moscow 1812, 116;
   Nassau 1813, 140;
   Paris 1814, 156 f.;
   Peninsular War, 101 f.;
   Pont-à-Mousson 1813, 154;
   Russian Campaign, 115 ff.;
   Russo-Turkish War of 1877, 287 ff.;
   Seven Years’ War, 82 ff.;
   siege of Danzig, 307 ff.;
   siege of Mantua, 305 ff.;
   siege of Mayence, 317 ff.;
   siege of Torgau, 311 ff.;
   Switzerland 1813, 158 f.;
   Thirty Years’ War, 26 ff.;
   Verdun 1792, 109;
   Vilna 1812, 117;
   Wars of French Revolution, 92 ff.;
   War with Moors in Spain, 21;
   War of Polish Succession, 80;
   Warsaw 1812, 119;
   Württemberg 1813, 150 f.


 Uetterodt, L., 1.

 Ulm, pestilence 1634, 62;
   small-pox epidemic 1870, 262 f.


 Vaccination, 200, 201, 202, 207,
 211, 212, 217, 231, 240, 241, 251, 255 f., 260, 265, 269 f., 279, 282,
    283, 284, 285;
   effects of, 197 f.;
   effect on mortality, 9.

 Vacher, 199, 206, 207, 303, 320.

 Varna, plague 1829, 168.

 Venice, pestilence 1630, 75.

 Verdun, pestilence 1793, 82 f.;
   typhus epidemic 1792, 109.

 Vernois, 200, 201.

 Verona, pestilence 1630, 75.

 Vienna, small-pox epidemic 1872, 277.

 Vilna, typhus fever 1812, 117.

 Virchow, 115.

 Viry, 196.

 Vogt, 271.

 Volz, 186, 194, 262.


 Wahl, 247.

 Wallenstein, 27, 50.

 War Pestilence, use of term, 4.

 Warsaw, typhus epidemic 1812, 119.

 Weber, 143.

 Weichselbaum, 185.

 Wendt, 123.

 Westergaard, H., 1.

 Wilbrandt, 94, 136.

 Wilken, 14, 15.

 Wittmann, 316–19.

 Woillez, 207.

 Wolf, 119.

 Wunderlich, 251, 252, 270.

 Württemberg, pestilence 1634, 63;
   typhus epidemic 1813, 150 f.


 Yellow fever, Spain 1810, 101.


 Zenzen, 318.

 Zurich, small-pox epidemic 1871, 272.




                            GENERAL APPENDIX
         PUBLICATIONS OF THE DIVISION OF ECONOMICS AND HISTORY


The Conference which met at Berne in 1911, under the auspices of the
Division of Economics and History of the Carnegie Endowment for
International Peace, appointed three Commissions to draft the questions
and problems to be dealt with by competent authorities in all countries.
The first Commission was entrusted with _The Economic and Historical
Causes and Effects of War_; the second with _Armaments in Time of
Peace_; the third with _The Unifying Influences in International Life_.
Subsequently the suggestions of the three Commissions were considered
and approved by the entire Conference.

The questions are to be discussed scientifically, and as far as possible
without prejudice either for or against war; and their discussion may
have such important consequences that the questions are presented below
_in extenso_.


                     Report of the First Commission
         THE ECONOMIC AND HISTORICAL CAUSES AND EFFECTS OF WAR

The Conference recommends the following researches:

1. Historical presentation of the causes of war in modern times, tracing
especially the influence exercised by the striving for greater political
power, by the growth of the national idea, by the political aspirations
of races and by economic interests.

2. Conflicts of economic interests in the present age:

  (_a_) The influence of the growth of population and of the industrial
  development upon the expansion of States.

  (_b_) The protectionist policy; its origin and basis; its method
  of application and its influence upon the relations between
  countries; bounties (open and disguised, public and private);
  most-favoured-nation treatment; the attitude towards foreign goods
  and foreign capital; the boycott; discouragement of foreign
  immigration.

  (_c_) International loans; the policy of guarantees; the relations of
  the creditor to the debtor States; the use of loans for gaining
  influence over other States.

  (_d_) Rivalry among States with respect to capitalist investments in
  foreign countries:

    1. The endeavour to obtain a privileged position in banking
    enterprises, in the opening and development of mines, in the letting
    of public contracts, in the execution of public works, in the
    building of railways (Siberian, Manchurian, Persian Bagdad Railway,
    Adriatic Railway, &c.); in short, the organization of larger
    capitalistic enterprises in foreign countries.

    2. The hindering of foreign countries by convention from executing
    productive enterprises on their own soil, e.g. from building
    railways in their own countries.

3. The anti-militarist movement, considered in its religious and
political manifestations. (Only opposition to all military organization
is here to be considered.)

4. The position of organized labour and the socialists in the various
States on the questions of war and armaments.

5. Is it possible to determine a special interest of individual classes
making for or against war, for or against standing armies?

6. The influence of women and woman suffrage upon war and armaments.

7. The extension of obligatory military service in the different States,
in times both of war and of peace.

  (_a_) The conditions of military service; the system of enlistment and
  of general obligatory service, the actual position of aliens.

  (_b_) The ratio of the persons obliged to render military service to
  the entire population.

  (_c_) The influence of the present system of military obligation and
  the organization of armies upon warfare and upon its duration.

8. The economic effects of the right of capture and its influence upon
the development of navies.

9. War loans provided by neutral countries; their extent and influence
on recent warfare.

10. The effects of war:

  (_a_) Financial cost of war. The methods of meeting it: Taxation;
  International Loans; External Loans.

  (_b_) Losses and gains from the point of view of public and private
  economic interests; checks to production and the destruction of
  productive forces; reduction of opportunities for business
  enterprises; interruption of foreign trade and of the imports of food;
  the destruction of property; shrinkage of values of property,
  including securities; financial burden caused by new taxes, debts, and
  war indemnities; effects upon private credit and upon savings banks;
  advantages to those industries which furnish military materials;
  advantages and disadvantages to neutral countries.

  (_c_) The effects of war upon the supply of the world with food and
  raw materials, with special reference to those States which are in
  large degree dependent upon other countries for such supplies, e.g.
  Great Britain and Germany; by diversion of capital from those
  countries which produce food and raw materials (especially the
  stoppage of railway building and of new investments in agriculture and
  other industries).

  (_d_) The condition of the victorious State: manner of levy and use of
  contributions and war indemnities; influence upon industry and social
  life.

  (_e_) The manner in which the energy of nations is stimulated or
  depressed by war.

11. Loss of human life in war and as a result of war: influence upon
population (birth-rate, relation between the sexes, ratio of the various
ages, sanitary conditions).

12. The influence of war and of the possibility of war upon the
protective policy, upon banking conditions (especially upon banks of
issue), and upon monetary systems.

13. The influence of annexation upon the economic life of the annexing
States, and upon the State whose territory has been annexed.

14. The annexation of half-civilized or uncivilized peoples, considered
especially from the point of view of the economic interests, which act
as motive powers; the methods through which private enterprises take
root in such regions and through which they bring influence to bear upon
their own governments; the effects of such annexations upon the
development of trade with the annexing State and with other countries,
as well as upon the economic and social life of the natives.

15. The progressive exemption of commercial and industrial activities
from losses and interferences through war.

16. Influence of the open-door policy upon war and peace.


                    Report of the Second Commission
   ARMAMENTS IN TIME OF PEACE. MILITARY AND NAVAL ESTABLISHMENTS. THE
           THEORY, PRACTICE, AND HISTORY OF MODERN ARMAMENTS.

1. Definition. Armaments might be described as ‘the preparations made by
a State either for defence or for attack’. These would include the
provision of food, financial preparations, and also semi-military
railways, canals, docks, &c.

2. Causes of armaments. Motives for increasing or commencing them,
distinguishing the great from the small powers.

3. Rivalry and competition in armaments. Motives and consequences of
rivalry, with the possibilities of limitation.

4. Modern history of armaments, with special fullness from 1872. To be
noted as important landmarks:

  (_a_) The introduction of conscription into Germany, France, Austria,
  Italy, Japan, &c.

  (_b_) Modern inventions affecting war.

  (_c_) The question of privateering and private property at sea.

  (_d_) Duration of military service.

  (_e_) The traffic in arms.

5. Military budgets from 1872 (distinguishing ordinary from
extraordinary expenditures).

6. The burden of armaments in recent times.

  (_a_) The proportion of military to civil expenditure.

  (_b_) Military expenditure per capita.

  (_c_) Military expenditure from loans in time of peace, i.e. a
  comparison of expenditure from taxes with expenditure from borrowed
  money.

  (_d_) Comparative burdens of individual taxpayers in different
  countries and the extent to which the differences are due to
  armaments.

  (_e_) Military pensions.

  (_f_) It is desirable to ascertain where possible the ratio between
  the total income of each nation and the total expenditure on armament
  at various times.

7. The effects of war preparations upon the economic and social life of
a nation:

  (_a_) On the sustenance of the entire population of a country at war.

  (_b_) On railway policy.

  (_c_) On public administration and on social legislation.

8. The economic effects of withdrawing young men from industrial
pursuits, into the army and navy:

  (_a_) Compulsory.

  (_b_) Of non-compulsory service (specially in the case of mercenary
  troops).

    (Allowance being made for the industrial value of military education
    and training.)

9. The influence of changes in the occupations of a people upon the
composition and efficiency of armies, and the influence of the changes
in the composition of armies on the economic life.

10. Loans for armaments (participation of domestic and foreign capital).

11. The industries of war, i.e. the various manufactures and other
industries which are promoted and encouraged by military and naval
establishments, distinguishing between:

  (_a_) Government undertakings (arsenals, dockyards, &c.).

  (_b_) Private undertakings, including the history and working of the
  great armament firms, which sell to foreign customers as well as to
  their own governments.

12. War materials (munitions of war). Their recent development and their
cost. This includes arms, ammunition, armour-plate, warships, guns of
all kinds, military airships, &c. So far as possible the effect of
recent inventions upon offensive and defensive war should be indicated.


                     Report of the Third Commission
             THE UNIFYING INFLUENCES IN INTERNATIONAL LIFE

1. The Conference is of the opinion that the economic life of individual
countries has definitely ceased to be self-contained; and that,
notwithstanding the barriers raised by fiscal duties, it is becoming in
ever-increasing measure a part of an economic life in which the whole
world participates.

2. It desires that this change be studied with the object of
ascertaining to what extent the economic life of individual nations has
ceased to be self-contained, and the causes which are bringing about the
greater interdependence of nations.

3. Special attention should be paid to the following factors:

  (_a_) How far the growth of population is responsible for the changes
  that have occurred and are in progress.

  (_b_) The extent to which the insufficiency of the natural resources
  of individual countries for their own requirements has contributed to
  it.

  (_c_) Whether the increasing economic unity of the world is the cause
  or the result of the rising in the standard of living, and how far the
  increasing welfare of nations has been caused by the growing unity.

  (_d_) In what measure the need of individual countries to obtain
  materials of production from other lands and to find new markets for
  their own products is responsible for the growth of international
  dependence.

  4. The Conference desires that investigations be made into:

  (_a_) The volume of the world’s production of all the many articles of
  food, of the various raw materials, and of the principal manufactures.

  (_b_) The productions of individual countries, and the extent to which
  they are retained for home consumption or are exported.

  (_c_) The consumption of individual countries, and the extent to which
  the various articles are supplied from home productions or are
  imported.

5. The Conference wishes to ascertain to what extent the economy of
production by large units, instead of by small units, has contributed to
the international dependence of nations.

6. The development of this world-embracing economy has taken place in
great measure in consequence of the investment of capital by rich
countries in less developed lands. Through this there have arisen close
relations and a great increase of wealth, not only for the lending and
the borrowing countries, but for all nations. The Conference is of the
opinion that researches should be made into the extent of the
interdependence of the nations in the matter of capital.

7. The Conference desires to institute inquiries into the
interdependence of the financial centres of the world.

8. The Conference desires to make the unifying effects of international
trade, the building of railways, the progress of shipping, the
improvement and extension of all means of communication and the progress
of inventions, the subjects of careful investigation.

9. The Conference is in favour of making a comprehensive study of the
various international unions and associations, in which the social and
economic interests of all classes of society are now either organized or
in process of organization, through official or private action.

-----

Footnote 1:

  This subject is discussed in a general way in the following works: J.
  Pringle, _Beobachtungen über die Krankheiten einer Armee sowohl im
  Felde als in Garnison_. Translation by J. E. Greding. Altenburg,
  1754.—Gurlt, _Zur Geschichte der internationalen und freiwilligen
  Krankenpflege im Kriege_. Leipzig, 1873.—A. Laveran, _Traité des
  maladies et épidémies des armées_. Paris, 1875.—L. Uetterodt zu
  Schaffenberg, _Zur Geschichte der Heilkunde: Darstellungen aus dem
  Bereiche der Volkskrankheiten und des Sanitätswesens im Deutschen
  Mittelalter mit besonderer Berücksichtigung der Lagerepidemien und der
  Militärkrankenpflege_. Berlin, 1875.—Knaak, _Die Krankheiten im
  Kriege_. Leipzig, 1900.—von Linstow, _Kriege, Schlachten und
  Belagerungen, in denen nicht die feindlichen Waffen, sondern
  Krankheiten das entscheidende Moment waren. Deutsche mil.-ärztl.
  Zeitschrift_, vol. xxix, p. 177, 1900.—H. Westergaard, _Die Lehre von
  der Mortalität und Morbilität_. Second edition. Jena, 1901. pp. 223,
  254, 260, 264, 566.—H. Schwiening, _Krieg und Friede_, in Th. Weyl,
  _Handbuch der Hygiene_. 4. Supplement, B. 1904. P. 65.

Footnote 2:

  We must remember that the word ‘typhus’, without further
  qualification, in Germany means typhoid fever, whereas in France and
  England it means typhus fever.

Footnote 3:

  F. Schnurrer, _Chronik der Seuchen_. Tübingen, 1825. Vol. i, p. 38.—H.
  Brandeis, _Die Krankheit zu Athen nach Thukydides_. Stuttgart,
  1845.—H. Häser, _Lehrbuch der Geschichte der Medizin und der
  epidemischen Krankheiten_. Third edition. Jena, 1882. Vol. iii, p.
  4.—W. Ebstein, _Die Pest des Thukydides_. Stuttgart, 1899.—Also an
  article by the same author entitled _Die Pest des Thukydides in the
  Deutsche med. Wochenschrift_. No. 36. 1899.—F. Kanngiesser, _Über die
  Seuche des Thukydides_. _Prag. med. Wochenschrift._ No. 100. 1903.

Footnote 4:

  A. Laveran (note 1, introduct.), p. 653.—H. Häser, op. cit., p. 24.

Footnote 5:

  Information regarding pestilences that attacked German armies during
  campaigns into Italy is taken largely from a book by B. M. Lersch,
  entitled _Geschichte der Volksseuchen_. Berlin, 1896.

Footnote 6:

  See B. M. Lersch (loc. cit.) for statements regarding the First and
  Second Crusades, pp. 80 and 85.

Footnote 7:

  B. M. Lersch (loc. cit.), p. 90.

Footnote 8:

  F. Wilken, _Geschichte der Kreuzzüge_. Leipzig, 1826. Vol. iv, p. 314.

Footnote 9:

  Id., loc. cit., vol. vi, p. 222.

Footnote 10:

  F. Wilken, _Geschichte der Kreuzzüge_. Leipzig, 1826. Vol. vi, p. 290.

Footnote 11:

  Id., loc. cit., vol. vii, p. 561 ff.

Footnote 12:

  A. Hirsch, _Handbuch der historisch-geographischen Pathologie_. Second
  edition, 1881. Vol. ii, p. 4.—II. Schwiening, op. cit., p. 692.

Footnote 13:

  H. Häser, op. cit., p. 256.

Footnote 14:

  H. Fuchs, _Die ältesten Schriftsteller über die Lustseuche in
  Deutschland_. Göttingen, 1843. P. 436.—J. F. C. Hecker, _Die grossen
  Volkskrankheiten des Mittelalters_. Berlin, 1865. P. 218.

Footnote 15:

  F. Maréchal et J. Didion, _Tableau historique, chronologique et
  médical des maladies endémiques, épidémiques et contagieuses qui ont
  régné à Metz et dans le Pays-Messin_. Metz, 1850 and 1861. P. 116.

Footnote 16:

  H. Hirsch (note 10, Chapter II), vol. ii, p. 62.

Footnote 17:

  H. Schwiening (note 1, Introduction), p. 694.

Footnote 18:

  B. M. Lersch (note 3, Chapter II), p. 197.

Footnote 19:

  H. Hirsch (note 10, Chapter 11), vol. i, p. 385. Hirsch uses the word
  typhus for typhus fever.

Footnote 20:

  Tiberius von Györy, _Morbus hungaricus_. Jena, 1901. P. 146.

Footnote 21:

  J. A. F. Ozanam, _Histoire médicale, générale et particulière des
  maladies épidémiques, contagieuses et épizootiques_. Paris and Lyons,
  1823. Vol. iv, p. 157.—F. Schnurrer, op. cit., vol. ii, p. 27.

Footnote 22:

  Maréchal et Didion, op. cit., p. 89.

Footnote 23:

  Ibid., p. 150.

Footnote 24:

  Györy, op. cit., p. 145.

Footnote 25:

  Györy, op. cit., p. 143.—F. Schnurrer, op. cit., vol. ii, p. 112.

Footnote 26:

  F. Seitz, _Der Typhus, vorzüglich nach seinem Vorkommen in Bayern
  geschildert_. Erlangen, 1847. P. 55.

Footnote 27:

  G. Lammert, _Geschichte der Seuchen-, Hungers- und Kriegsnot zur Zeit
  des Dreissigjährigen Krieges_. Wiesbaden, 1890.

Footnote 28:

  J. C. Rhumelius, _Historia morbi, qui ex castris ad rostra, et a
  rostris ad aras et focos in Palatinatu Bavariae superioris penetravit,
  anno 1621, et permansit annos 1622 et 1623_. Quoted from Ch. Boersch
  in his _Essai sur la mortalité à Strassbourg_, 1836, p. 138.

Footnote 29:

  Maréchal et Didion, op. cit., p. 174.

Footnote 30:

  E. J. J. Meyer, _Versuch einer medizinischen Topographie und Statistik
  der Haupt- und Residenzstadt Dresden_. Stolberg and Leipzig, 1840. P.
  122.

Footnote 31:

  K. Pfaff, _Nachrichten über Witterung, Fruchtbarkeit, merkwürdige
  Naturereignisse, Seuchen u.s.w. in Süddeutschland, besonders in
  Württemberg, vom Jahre 807 his zum Jahre 1815. Württ. Jahrbuch_, 1850,
  p. 80.

Footnote 32:

  Lammert, op. cit., p. 114.

Footnote 33:

  E. J. J. Meyer, op. cit., p. 267.

Footnote 34:

  Lammert, op. cit., p. 120.

Footnote 35:

  Joannes Roetenbeck, _Speculum scorbuticum oder Beschreibung des
  Scharbocks in zweyen Traktätlein, abgefasst dem gemeinen Mann zum
  Besten_. Nuremberg, 1633.—Caspar Horn, _Kurzer Bericht von der
  fremden, vordem bei uns bekannten, jetzt aber eingreifenden Krankheit,
  dem Scharbock_. Nuremberg. Quoted from F. Schnurrer, op. cit., vol. 2,
  p. 174.

Footnote 36:

  G. von Suttner, _München während des dreissigjährigen Kriegs_. Munich,
  1796. Quoted from F. Seitz, op. cit., p. 63.

Footnote 37:

  F. Seitz, op. cit., p. 66.

Footnote 38:

  Lammert, op. cit., p. 110.

Footnote 39:

  Th. Schön, _Bilder aus Württembergs Leidensgeschichte nach der
  Schlacht bei Nördlingen. Blätter für württ. Kirchengeschichte._ 1891.
  P. 14.

Footnote 40:

  J. Gmelin, _Bevölkerungsbewegung im Hällischen seit Mitte des 16.
  Jahrhunderts_. G. von Mayr’s _Allg. statist. Arch._ Vol. vi, p. 240.
  1902.

Footnote 41:

  G. Thierer, _Ortsgeschichte von Gussenstadt auf der Schwäbischen Alb._
  Stuttgart, 1912. Vol. i, p. 207.

Footnote 42:

  Hörnigk, _Würgengel_. P. 195. Quoted from Lammert, op. cit., p. 201.

Footnote 43:

  Maréchal et Didion, op. cit., p. 185.

Footnote 44:

  Lammert, op. cit., p. 218.

Footnote 45:

  F. Schnurrer, op cit., vol. ii, p. 181.

Footnote 46:

  Lammert, op. cit., p. 214.—H. Häser, op. cit., vol. iii, p. 410.

Footnote 47:

  Diemerbroeck, _Peste de Nimègue_. Amsterdam, 1665. Quoted from A.
  Laveran, op. cit.

Footnote 48:

  Ch. Murchison, _A Treatise on the Continued Fevers of Great Britain_.
  Quoted from the German translation by W. Zülzer. Brunswick, 1867. P.
  25.—Ozanam, op. cit., vol. iv, p. 173.

Footnote 49:

  H. Häser, op. cit., vol. iii, p. 404.

Footnote 50:

  Ozanam, op. cit., vol. v, p. 18 ff.

Footnote 51:

  Ch. Murchison, op. cit., p. 26.

Footnote 52:

  Figures published by the Leipzig Bureau of Statistics in 1872; prior
  to 1629 they cover the governmental years of the successive
  burgomasters, but from 1630 on, they cover the calendar years.

Footnote 53:

  Only the Protestant population, including sixteen villages annexed to
  Dresden, _Stat. Jahrbuch der Stadt Dresden_, Jahrgang 1902. P. 15.

Footnote 54:

  Dr. J. Grätzer, _E. Halley und C. Neumann_. Breslau, 1883. P. 89.
  Including only the deceased supporters of the Augsburg Confession.

Footnote 55:

  According to a written compilation made out by Dr. E. Rösle in
  Dresden. Taken from the reference material in the Augsburg Archives.

Footnote 56:

  A. Dietz, _Frankfurter Bürgerbuch_. Frankfurt-on-the-Main, 1897. The
  Catholics are only partially included, the Jews not at all.

Footnote 57:

  Ch. Boersch, op. cit., p. 167.—Krieger, _Beiträge zur Geschichte der
  Volksseuchen_. _Stat. Mitteilungen über Elsass-Lothringen_, fascicle
  10.

Footnote 58:

  A. Burckhardt, _Demographie und Epidemiologie der Stadt Basel während
  der letzten drei Jahrhunderte, 1601-1900_. Leipzig, 1908.

Footnote 59:

  Rosini Lentilii _Miscellanea medico-practica tripartita_. Ulmae, 1698.
  Vol. ii, p. 435 ff.

Footnote 60:

  F. Seitz, op. cit., p. 85.

Footnote 61:

  Ibid., p. 105.

Footnote 62:

  F. Seitz, op. cit., p. 110.

Footnote 63:

  Ozanam, op. cit., vol. iv, p. 206.—Häser, op. cit., vol. iii. p. 478.

Footnote 64:

  Ozanam, op. cit., vol. iv, p. 207.

Footnote 65:

  J. Pringle, loc. cit.

Footnote 66:

  Dr. J. Grätzer, loc. cit.

Footnote 67:

  J. P. Süssmilch, _Die göttliche Ordnung u. s. w._ Vol. i, p. 316.
  (Fourth edition. Berlin, 1788.)

Footnote 68:

  _Statistisches Jahrbuch für die Stadt Dresden_, Jahrgang 1902.

Footnote 69:

  Figures published by the Leipzig Bureau of Statistics in 1872.

Footnote 70:

  Year-book of Statistics for the City of Berlin.

Footnote 71:

  Ozanam, op. cit., vol. iv, p. 181 ff.

Footnote 72:

  Häser, op. cit., vol. iii, p. 454.

Footnote 73:

  Ibid., vol. iii, p. 459.

Footnote 74:

  Ibid., vol. iii, p. 481.—Hammer, _Geschichte der Pest, die vom Jahre
  1738 bis 1740 im Temesvarer Banate herrschte_. Temesvar, 1839. (Quoted
  from Häser.)

Footnote 75:

  J. F. C. Hecker, _Geschichte der neueren Heilkunde_. Berlin, 1839.

Footnote 76:

  J. F. C. Hecker, _Geschichte der neueren Heilkunde_. Berlin, 1839, p.
  11.

Footnote 77:

  D. Samoilowitz, _Mémoire sur la peste qui, en 1771, ravagea l’empire
  de Russie, surtout Moscou_. Paris, 1783. (A German translation
  appeared in Leipzig in 1785.)

Footnote 78:

  H. Häser, op. cit., vol. iii, p. 533.

Footnote 79:

  Maréchal et Didion, op. cit., p. 284.

Footnote 80:

  Ibid., p. 287.

Footnote 81:

  L. Wilbrandt, _Die Kriegslazarette von 1792-1815 und der Kriegstyphus
  zu Frankfurt am Main. Arch. für Frankfurts Geschichte und Kunst._
  N.F., Vol. xi, p. 29. 1884.

Footnote 82:

  G. E. F. Canz, _Beschreibung einer Schleim-, Faul-, und
  Nervenfieberepidemie, die im Winter und Frühjahr 1793-4 in der
  Rheingegend und auf dem Schwarzwald unter dem Landvolk gewütet_.
  Tübingen, 1795.

Footnote 83:

  F. Seitz, op. cit., p. 125.

Footnote 84:

  G. le Borne, _Recherches historiques sur les grandes épidémies qui ont
  régné à Nantes depuis le 6^e jusqu’au 19^e siècle_. Nantes, 1852.

Footnote 85:

  Häser, op. cit., vol. iii, p. 536.

Footnote 86:

  Ozanam, op. cit., vol. iv, p. 251.

Footnote 87:

  G. Rasori, _Geschichte des epidemischen Fiebers, das in den Jahren
  1799-1800 zu Genua geherrscht hat_. Translated from the Italian.
  Vienna, 1803.

Footnote 88:

  Ozanam, op. cit., vol. iv, p. 291.

Footnote 89:

  Seitz, loc. cit.—J. N. Feichtmayer, _Beitrag zur Geschichte des in
  einem Teile von Schwaben und auch in unserer Gegend häufiger als sonst
  gewöhnlich herrschenden Nervenfiebers_. Ulm, 1800.

Footnote 90:

  J. Hain, _Handbuch der Statistik des österreichischen Kaiserstaats_.
  Vienna, 1852. Vol. i, p. 78.

Footnote 91:

  Seitz, op. cit., p. 150.

Footnote 92:

  P. G. Joerdens, _Semiotische Bemerkungen über die auch zu Hof im Jahre
  1806 herrschend gewesenen Nervenfieber. Hufelands Journal der prakt.
  Heilkunde._ Vol. xxv. 1807. Third section. P. 58.

Footnote 93:

  E. Gurlt, op. cit., p. 151.

Footnote 94:

  J. Ch. Roller, _Geschichte und Beschreibung der Stadt Pforzheim_.
  Heidelberg, 1816. P. 247 ff.

Footnote 95:

  A. Laveran, op. cit., p. 254.

Footnote 96:

  Hufeland, _Bemerkungen über die Nervenfieber, die im Winter 1806-7 in
  Preussen herrschten. Hufelands Journal der prakt. Heilkunde._ Vol.
  xxvi. 1807. Third section. P. 120.

Footnote 97:

  N. P. Gilbert, _Tableau historique des maladies internes de mauvais
  caractère, qui ont affligé la grande armée dans la campagne de Prusse
  et de Pologne et notamment de celles qui out été observées dans les
  hôpitaux militaires et les villes de Thorn, Bromberg, Fordon et Culm
  dans l’hiver de 1806 à 1807, le printemps et l’été de 1807_. Berlin,
  1808.

Footnote 98:

  Gurlt, op. cit., p. 177.

Footnote 99:

  Ozanam, op. cit., vol. iv, p. 266.

Footnote 100:

  von Linstow, op. cit., vol. xxix, p. 204. Compare also _Der Feldzug
  von Portugal in den Jahren 1811 und 1812 in historischer und
  medizinischer Hinsicht. Beschr. von einem Arzt der französischen Armee
  von Portugal_. Stuttgart und Tübingen, 1816.

Footnote 101:

  A. Hirsch, op. cit., vol. i, p. 238.—Kopp, _Jahrbuch der
  Staatsarzneykunde_. 6. Jahrgang. Frankfurt-on-the-Main, 1813. P. 246.

Footnote 102:

  Ozanam, op. cit., vol. iv, p. 269.

Footnote 103:

  Hufeland, _Journal der prakt. Heilkunde_, vol. xxxvi, 1813, May vol.,
  p. 120.

Footnote 104:

  A. Boin, _Mémoire sur la maladie qui régna en 1809 chez les Espagnols
  prisonniers de guerre à Bourges_. Paris, 1815.

Footnote 105:

  Ozanam, op. cit., vol. iv, p. 275.

Footnote 106:

  J. V. von Hildenbrand, _Über den ansteckenden Typhus_. Vienna, 1810.

Footnote 107:

  C. W. Hufeland, _Über die Kriegspest alter und neuer Zeit, mit
  besonderer Rücksicht auf das Aderlassen in derselben_. _Hufelands
  Journal der praktischen Heilkunde_, vol. xxxviii, 1814, June vol., p.
  55. See also special copy with the title, _Ueber die Kriegspest alter
  und neuer Zeit, mit besonderer Rücksicht auf die Epidemie des Jahres
  1813 in Deutschland_. Berlin, 1814.

Footnote 108:

  Hufeland, _Erster Bericht über das epidemische und ansteckende
  Nervenfieber und dessen Behandlung im kgl. Charité-Krankenhaus zu
  Berlin_. _Hufelands Journal_, vol. xxxvi, 1813, June vol., p. 3.

Footnote 109:

  J. H. Kopp, _Jahrbuch der Staatsarzneykunde_. 1814. Vol. vii, p. 280.

Footnote 110:

  J. Parenteau-Desgranges, _Hommage à la vérité; précis historique des
  événements les plus remarquables survenus depuis la rentrée de la
  Russie jusqu’au passage du Rhin_. Paris, 1814.—_Journ. de méd., chir.,
  pharm., etc._, 1814, Vol. xxix, p. 407.

Footnote 111:

  Maréchal et Didion, op. cit., p. 287 ff.

Footnote 112:

  Neumann, _Ein Wort über die Fieber, die in Lagern und
  Militärlazaretten auszubrechen pflegen_. _Hufelands Journal_, vol.
  xxxiv, 1812, April vol., p. 70.

Footnote 113:

  Kopp, op. cit., vol. vii, p. 292.

Footnote 114:

  C. Cannstatt, _Handbuch der medizinischen Klinik_, vol. ii, p. 578 ff.
  1847.—Ch. Murchison, _Die typhoïden Krankheiten_. Translated by W.
  Zülzer. P. 34. Brunswick, 1867.

Footnote 115:

  J. Ch. G. Jörg, _Das Nervenfieber im Jahre 1813 und eine zweckmässige
  Behandlung desselben_. Leipzig and Berlin, 1814. P. 27.

Footnote 116:

  H. Häser, op. cit., vol. iii, p. 613.

Footnote 117:

  J. R. L. Kerckhoffs, _Observations médicales faites pendant les
  campagnes de Russie en 1812 et d’Allemagne en 1813_. First edition,
  1814. Third edition, 1836. Reproduced in epitome by W. Stricker in his
  _Historische Studien über Heereskrankheiten und Militärkrankenpflege_,
  1743-1814. Virchow’s _Archiv für pathologische Anatomie u.s.w._, vol.
  liii, p. 383. 1871. (The spelling ‘Kerkhove’ is incorrect.)—J. D.
  Larrey, _Mémoires de chirurgie militaire_, vols. i-iv. Paris, 1812-17.
  (Kerckhoffs and Larrey give only indefinite information regarding the
  nature of the diseases; Larrey, in particular, who served as a surgeon
  and general inspector on the Health Staff, had very little
  understanding for the infectious character of typhus fever or for the
  energetic measures that have to be adopted to prevent its
  dissemination.)—M. J. Lemazurier, _De la campagne de Russie in Recueil
  de mémoires de médecine, chirurgie, et pharmacie militaires_, vol.
  iii, p. 161. Paris, 1817. Translated from the French by C. F.
  Heusinger, _Medizinische Geschichte des Russischen Feldzugs von 1812_.
  Jena, 1823. (This book, owing to the clarity of its descriptions,
  constitutes the best source of information regarding the diseases that
  broke out during the Russian campaign.)—Ch. J. Scheerer, _Historia
  morborum, qui in expeditione contra Russiam anno 1812 facta legiones
  Wurttembergicas invaserunt; praesertim eorum qui frigore orti sunt_.
  Tubingae, 1819.—R. Virchow, _Kriegstyphus und Ruhr_. Virch. Archiv,
  vol. lii, p. 1. 1871.—E. Gurlt loc. cit.—W. Ebstein, _Die Krankheiten
  im Feldzug gegen Russland_. Stuttgart, 1902.

Footnote 118:

  W. Ebstein, op. cit., p. 65.

Footnote 119:

  J. Ch. Gasc, _Histoire de l’épidémie observée à Wilna en 1813 après la
  campagne de Moscou_. Reproduced in Gasc and Breslau, _Matériaux pour
  servir à une doctrine générale sur les épidémies et les contagions,
  par F. Schnurrer_. Translated from the German. Paris, 1815.

Footnote 120:

  A. Laveran, op. cit., p. 254.

Footnote 121:

  Parrot, _Über das im jetzigen Krieg entstandene typhöse Fieber und ein
  sehr einfaches Heilmittel desselben_. _Hufeland’s Journal_, vol.
  xxxvi, 1813, May vol., p. 3.

Footnote 122:

  Wolf, _Bemerkungen über die Krankheiten, welche im Jahre 1813 in
  Warschau herrschten, insbesondere über den ansteckenden Typhus_.
  _Hufeland’s Journal_, vol. xxxix, 1813, May vol., p. 3.

Footnote 123:

  Kerckhoffs, op. cit. Kerckhoffs uses the name ‘fièvre adynamique’ for
  typhus fever; occasionally he uses the word typhus.

Footnote 124:

  H. A. Göden, _Erfahrungen und Ansichten zur Lehre vom Typhus_. Horn’s
  _Archiv für mediz. Erfahrung_, 1814, p. 342.

Footnote 125:

  Gurlt, op. cit., p. 217.

Footnote 126:

  A. F. Blech, _Geschichte der siebenjährigen Leiden Danzigs von
  1807-14_. Danzig, 1815.—Carl Friccius, _Geschichte der Befestigungen
  und Belagerungen Danzigs_. Berlin, 1854.—H. Beitzke, _Geschichte der
  deutschen Freiheitskriege in den Jahren 1813-14_. Second edition.
  Berlin, 1859. Vol. ii, p. 604.

Footnote 127:

  Kopp, op. cit., vol. vii, p. 284. 1814.

Footnote 128:

  Wendt, _Über die letzte Typhusepidemie insofern sie den Nichtarzt
  interessiert. Corr.-Blatt der schles. Ges. für vaterländische Kultur_,
  vol. v, 1814, Nos. 17 and 18.

Footnote 129:

  Kausch, _Die auf Selbsterfahrung gegründeten Ansichten der akuten
  Kontagien überhaupt und des Kontagiums des Typhus insbesondere_.
  _Hufeland’s Journal_, vol. xxxix, 1814, July vol., p. 9.

Footnote 130:

  Häser, op. cit., vol. iii, p. 612.

Footnote 131:

  Hufeland, op. cit.—E. Horn, _Über die ansteckenden Nervenfieber,
  welche während der Monate März, April, Mai, Juni, u.s.w. 1813
  herrschten. Archiv für mediz. Erfahrung._ Jahrgang 1813, p. 278.

Footnote 132:

  Horn’s _Archiv für mediz. Erfahrung._ Jahrgang 1813, p. 245.

Footnote 133:

  Gurlt, op. cit., p. 339.

Footnote 134:

  Horn’s _Archiv für mediz. Erfahrung_. Jahrgang 1813, p. 431.

Footnote 135:

  Neuhof, _Geschichte und Beschreibung des im Jahre 1813 und 1814 zu
  Annaberg im sächsischen Erzgebirge allgemein geherrschten
  Nervenfiebers. Annalen der Heilkunst des Jahres 1815_, p. 5.

Footnote 136:

  A. F. Fischer, _Geschichtliche Darstellung der im Herbst 1813 in
  Dresden ausgebrochenen und bis gegen Ende Januars 1814 angedauerten
  Epidemie. Annalen der Heilkunst des Jahres 1814_, p. 82.

Footnote 137:

  Reproduced in Kopp’s _Jahrbuch der Staatsarzneikunde_. 7. Jahrgang.
  1814, p. 286.

Footnote 138:

  Beitzke, op. cit., vol. ii, pp. 460 and 562.

Footnote 139:

  _Ältere Nachrichten über Leipzigs Bevölkerung 1595-1849. Mitteilungen
  des statistischen Bureaus der Stadt Leipzig_, 1872.

Footnote 140:

  F. Flinzer, _Die Bewegung der Bevölkerung in der Stadt Plauen i. V.
  während der Jahre 1800-99. Bericht über die Verwaltung und den Stand
  der Gemeindeangelegenheiten der Kreisstadt Plauen i. V. auf die Jahre
  1899 und 1900._

Footnote 141:

  M. Magaziner, _Über den ansteckenden Typhus In Zwickau, vom September
  1813 bis zum Februar 1814. Annalen der Heilkunst._ 1815. P. 218.

Footnote 142:

  Kopp, _Jahrbuch der Staatsarzneykunde_, vol. vii, p. 413.

Footnote 143:

  Gurlt, op. cit., p. 459.

Footnote 144:

  Beitzke, op. cit., vol. ii, p. 564.

Footnote 145:

  P. F. F. J. Giraud, _Campagne de Paris en 1814_. Third Edition. Paris,
  1814. P. 32.

Footnote 146:

  Greiner, _Das exanthematische Nervenfieber. Annalen der Heilkunst des
  Jahres 1814_, p. 602.

Footnote 147:

  J. G. Stemmler, _Schilderung des vom November 1813 bis Februar 1814 in
  Zeulenroda herrschenden Nervenfiebers. Annalen der Heilkunst des
  Jahres 1814_, p. 97.

Footnote 148:

  Löbenstein-Löbel, _Über das Wesen und über die Heilung des
  Nervenfiebers in und um Jena von Michaelis 1813 bis Ostern 1814.
  Annalen der Heilkunst des Jahres 1814_, p. 217.

Footnote 149:

  Wilhelm Horn, _Zur Charakterisierung der Stadt Erfurt_. Erfurt, 1843.
  P. 318 ff.

Footnote 150:

  J. H. Kopp, _Beobachtungen über den ansteckenden Typhus, welcher im
  Jahre 1813-14 in Hanau epidemisch war. Hufeland’s Journal_, vol.
  xxxviii, 1814, May vol., p. 3.

Footnote 151:

  L. Wilbrand, _Die Kriegslazarette von 1792-1815 und der Kriegstyphus
  zu Frankfurt a. M. Archiv für Frankfurts Geschichte und Kunst._ N. F.
  Vol. xi, p. 96. 1884.

Footnote 152:

  J. B. von Franque, _Die Verbreitung der typhösen Krankheiten im
  Herzogtum Nassau während der ersten Hälfte dieses Jahrhunderts. Mediz.
  Jahrbücher für das Herzogtum Nassau_, fascicles 12 and 13, p. 18.
  Wiesbaden, 1854.

Footnote 153:

  H. C. Thilenius, _Beobachtungen über das im Winter 1813-14 im Rheingau
  epidemisch ansteckende Fieber. Hufeland’s Journal_, 1815, vol. xli,
  October vol., p. 3.

Footnote 154:

  Kraft, _Etwas über den Typhus bellicus und die blaue Nase, eine
  merkwürdige Erscheinung bei demselben. Hufeland’s Journal_, vol. xli,
  1815, July vol., p. 47.

Footnote 155:

  J. Th. Ch. Bernstein, _Kleine medizinische Aufsätze_.
  Frankfurt-on-the-Main, 1814. P. 132 ff.

Footnote 156:

  _Die Gesundheitsverhältnisse Hamburgs im 19. Jahrhundert._ Hamburg,
  1901. P. 273. (Presented to the Seventy-third Congress of German
  Naturalists and Physicians.)

Footnote 157:

  Steinheim, _Über den Typhus im Jahre 1814 in Altona_. Altona, 1815. P.
  12.

Footnote 158:

  Fr. Weber, _Bemerkungen über die in Kiel und der umliegenden Gegend im
  Anfange des Jahres 1814 vorherrschenden Krankheiten, besonders über
  den Typhus_. Kiel, 1814.

Footnote 159:

  F. Seitz, op. cit., p. 157 ff.

Footnote 160:

  F. Seitz, op. cit., p. 174 ff.

Footnote 161:

  J. Schäfer, _Die Zeit- und Volkskrankheiten des Jahres 1813 in und um
  Regensburg. Hufeland’s Journal_, vol. xxxix, 1814, p. 73.

Footnote 162:

  J. A. Elsässer, _Beschreibung der Menschenpockenseuche, welche in den
  Jahren 1814, 1815, 1816, und 1817 im Königreich Württemberg geherrscht
  hat_. Stuttgart, 1820.

Footnote 163:

  J. H. B. Lohnes, _Dissertatio inauguralis medico-chirurgica de
  utilitate Hydrargyri in febre typhoïde inflammatoria_. Tubingae, 1814.

Footnote 164:

  F. E. Braun, _Medizinisch-praktische Ansicht der Jahre 1813 und 1814_.
  Tübingen, 1816.

Footnote 165:

  C. von Dillenius, _Beobachtungen über die Ruhr, welche im Russischen
  Feldzug 1812 in der vereinigten Armee herrschte_. Ludwigsburg, 1817.

Footnote 166:

  F. Schinzinger, _Die Lazarette der Befreiungskriege 1813-15 im
  Breisgau_. Freiburg im Breisgau, 1907.

Footnote 167:

  Gurlt, op. cit., p. 696.

Footnote 168:

  Supplements to the statistics relating to the Grand Duchy of Baden,
  fascicle 2, p. 185.

Footnote 169:

  Gurlt, op. cit., p. 646.

Footnote 170:

  Kopp, _Jahrbuch der Staatsarzneykunde_. Jahrgang 7. 1814. P. 290.

Footnote 171:

  P. S. Thouvenel, _Traité analytique des fièvres contagieuses et
  sporadiques, simples et compliquées, qui out régné dans le Département
  de la Meurthe vers la fin de 1813 et au commencement de 1814_.
  Pont-à-Mousson, 1814.

Footnote 172:

  Reisseisen, _Strassburger Brief vom 22. August 1814. Kopp’s Jahrbuch
  der Staatsarzneykunde._ Jahrgang 7. 1814. P. 425.

Footnote 173:

  Maréchal et Didion, op. cit., p. 298.

Footnote 174:

  B. Pellerin, _Considérations sur les maladies qui ont régné à
  l’hospice de la Salpêtrière dans les premiers mois de 1814 pendant
  lesquels les militaires malades ont été admis dans cet hospice_.
  Paris, 1814.—M. Friedländer, _Notice sur la dernière épidémie du
  typhus. Gazette de santé ou Recueil général et périodique._ Année 42.
  Paris, 1815. P. 89.

Footnote 175:

  _Gazette de Santé_, etc. Année 41. Paris, 1814, and Année 42, 1815.

Footnote 176:

  A. Laveran, op. cit., p. 255.

Footnote 177:

  _Ehe, Geburt und Tod in der schweizerischen Bevölkerung während der 20
  Jahre 1871-90._ Third Part. First half, p. 195. Bern, 1901.

Footnote 178:

  A. Burckhardt, op. cit., p. 48.

Footnote 179:

  Historical Survey of the health-conditions in Austria, Styria,
  Carinthia, Moravia, and Bohemia, in the years 1813 and 1814.
  Information taken from the _Hauptsanitätsberichte der Landesstellen_.
  Observations and discussions by Austrian physicians regarding
  practical therapeutics, vol. ii., p. 1. 1821.

Footnote 180:

  Compare also J. R. Bischoff, _Beobachtungen über den Typhus und die
  Nervenfieber nebst ihrer Behandlung_. Prague, 1814.

Footnote 181:

  _Historical Survey_, p. 84.

Footnote 182:

  J. Steiner, _Über den Gesundheitszustand in Mähren im Jahre 1814.
  Beobachtungen und Abhandlungen aus dem Gebiete der gesamten
  praktischen Heilkunde von österreichischen Aerzten_, vol. i, p. 88.
  1819.

Footnote 183:

  J. Hain, _Handbuch der Statistik des österreichischen Kaiserstaats_.
  Vienna, 1852. Vol. i, p. 78.

Footnote 184:

  _Historical Survey_, p. 132. In _Hufeland’s Journal_ (Jahrgang 1814
  and 1815. Vols. xxxii-xxxiv) there is general survey of the copious
  literature of that time regarding infectious nerve-fever; it comprises
  several hundred numbers. Many publications are only of a theoretical
  nature and deal only with the character of the disease and do not aim
  at offering descriptive data; only a few contain usable information
  regarding the duration and extent of the epidemic in the individual
  localities.

Footnote 185:

  Czetyrkin, _Die Pest in der russischen Armee zur Zeit des Türkenkriegs
  im Jahre 1828 und 1829_. Translated from the Russian. Berlin, 1837. P.
  1.

Footnote 186:

  Seidlitz, Petersenn, Rinck, und Witt, _Medizinische Geschichte des
  Russisch-türkischen Feldzugs in den Jahren 1828 und 1825_. New edition
  by F. A. Simon. Hamburg, 1854. P. 27.

Footnote 187:

  Ibid., p. 38 ff.

Footnote 188:

  Czetyrkin, op. cit., p. 4 ff.

Footnote 189:

  Seidlitz, op. cit., p. 137.

Footnote 190:

  Seidlitz, op. cit., p. 10.

Footnote 191:

  Ibid., p. 180.

Footnote 192:

  Ibid., p. 8.

Footnote 193:

  Seidlitz, op. cit., p. 186.

Footnote 194:

  J. D. Tholazan, _Histoire chronologique et géographique de la peste au
  Caucase, en Arménie et dans l’Anatolie, dans la première moitié du
  XIX^e siècle. Gazette médicale de Paris_, vol. xlvi, p. 458. 1875.

Footnote 195:

  Czetyrkin, op. cit., pp. 6 ff.

Footnote 196:

  G. Scrive, _Relation médico-chirurgicale de la campagne d’Orient_.
  Paris, 1857. Pp. 56 ff., and p. 71.

Footnote 197:

  Scrive (loc. cit.), p. 343.

Footnote 198:

  J. C. Chenu, _Rapport au Conseil de santé des armées sur les résultats
  du service médico-chirurgical aux ambulances de Crimée et aux hôpitaux
  militaires français en Turquie pendant la campagne d’Orient en
  1854-5-6_. Paris, 1865. P. 565.

Footnote 199:

  Chenu (loc. cit.), p. 593.

Footnote 200:

  Häser, op. cit., p. 860.

Footnote 201:

  Scrive, op. cit., p. 345.

Footnote 202:

  Ibid., p. 420.

Footnote 203:

  Chenu (note 14, Chapter VII), p. 595.

Footnote 204:

  O. Niedner, _Die Kriegsepidemieen des 19. Jahrhunderts und ihre
  Bekämpfung_. Berlin, 1903. P. 64.

Footnote 205:

  A. Hirsch, op. cit., vol. i, p. 395.

Footnote 206:

  M. L. Baudens, _La guerre de Crimée, les campements, les abris, les
  ambulances_, etc. Paris, 1858. Taken from the second edition,
  translated by W. Mencke. Kiel, 1864. P. 164.

Footnote 207:

  Ch. Murchison, _Die typhoïden Krankheiten_. Quoted from the German
  translation by W. Zülzer. Brunswick, 1867. P. 43.

Footnote 208:

  A. Laveran, _Traité des maladies et épidémies des armées_. Paris,
  1875. P. 257.

Footnote 209:

  Godelier, _Mémoire sur le typhus observé au Val-de-Grâce du mois de
  janvier au mois de mai 1856. Gazette méd. de Paris_, 1856. Nos. 40-1.
  Quoted from Laveran (loc. cit.), p. 257.

Footnote 210:

  H. von Haurowitz, _Das Militärsanitätswesen der Vereinigten Staaten
  von Nordamerika während des letzten Kriegs_. Stuttgart, 1866.

Footnote 211:

  _The medical and surgical history of the war of the rebellion
  (1861-5), prepared in accordance with acts of congress under the
  direction of Surgeon-General Joseph K. Barnes, United States Army,
  Washington._ Six vols., 1870-88. The work is divided into two main
  parts, each consisting of three volumes. Part I includes the Medical
  History; Vol. I gives the statistical results, Vols. II and III deal
  with the individual diseases (Vol. II only with diarrhoea and
  dysentery). Part II, Vols. I-III, comprises the Surgical History.

Footnote 212:

  Ibid. Part I, p. xxxvii, and vol. iii, p. 1.

Footnote 213:

  _Medical and Surgical History_, part iii, p. 193. The reports for each
  year begin on July 1.

Footnote 214:

  _Medical and Surgical History_, part iii, p. 209.

Footnote 215:

  Laveran, op. cit., p. 258.

Footnote 216:

  Niedner, op. cit., p. 72.—Also _Medical and Surgical History_, part
  iii, p. 323 ff.

Footnote 217:

  Hirsch, op. cit., p. 404.

Footnote 218:

  _Medical and Surgical History_, part ii, p. 67.

Footnote 219:

  Ibid., part iii, p. 624.

Footnote 220:

  _Medical and Surgical History_, part iii, pp. 82-3.

Footnote 221:

  For the white troops, ibid., part i, pp. 636-7; for the coloured
  troops, part i, p. 710.

Footnote 222:

  _Medical and Surgical History_, part iii, p. 47.

Footnote 223:

  Ibid., part iii, p. 35.

Footnote 224:

  L. March, _Statistique internationale du mouvement de la population_.
  Paris, 1907. P. 867.

Footnote 225:

  M. Cazalas, _Maladies de l’armée d’Italie ou documents pour servir à
  l’histoire méd.-chirurg. de l’armée d’Italie_. Paris, 1864.—J. C.
  Chenu, _Statistique médico-chirurgicale de la campagne d’Italie en
  1859 et 1860_. Paris, 1869.—P. Myrdacz, _Sanitätsgeschichte des
  Feldzugs 1859 in Italien_. Vienna, 1896.—O. Niedner, op. cit., pp. 66
  and 118.

Footnote 226:

  Knaak, op. cit., p. 31.

Footnote 227:

  Kübler, _Kriegssanitätsstatistik. Klin. Jahrb._, vol. ix, p. 301.
  Jena, 1902.

Footnote 228:

  Niedner, op. cit., p. 17.

Footnote 229:

  Hirsch, op. cit., vol. i, p. 295.

Footnote 230:

  A. Weichselbaum, _Epidemiologie_. Jena, 1899. P. 399. (In Th. Weyl’s
  _Handbuch der Hygiene_, vol. ix, p. 3.)—Hirsch, op. cit., vol. i, p.
  294.

Footnote 231:

  J. Daimer, _Todesursachen in Oesterreich während der Jahre 1873-1900.
  Das österreichische Sanitätswesen_, 1902. Supplement to No. 37, p.
  150.

Footnote 232:

  Fr. C. Presl, _Die öffentliche Gesundheitspflege in Österreich seit
  dem Jahre 1848. Statist. Monatsschrift._ 1898. Vol. iii, p. 392.

Footnote 233:

  Guttstadt, _Die Choleraepidemieen in früherer Zeit. Hyg. Rundschau._
  1906. Vol. xvi, p. 265.

Footnote 234:

  Robert Volz, _Die Cholera auf dem Badischen Kriegsschauplatz im Sommer
  1866. Amtlicher Bericht._ Karlsruhe, 1867.

Footnote 235:

  J. Teuffel, _Die Choleraepidemie zu Uzmemmingen, O.-A. Neresheim, im
  Jahre 1866. Württ. med. Corr.-Bl._ 1867. P. 129 ff.

Footnote 236:

  _Die Cholera in Unterfranken während des laufenden Sommers. Bayr.
  ärztl. Intel.-Blatt_, 1866, p. 509.

Footnote 237:

  A. Martin, _Die Cholera in Bayern während des diesjährigen Sommers.
  Bayr. ärztl. Intel.-Blatt_, 1866, p. 577.

Footnote 238:

  Most of the statements in this chapter are taken from vols. ii and vi
  of the _Sanitätsbericht über das deutsche Heer im Krieg gegen
  Frankreich 1870-1_. Berlin, 1886.—Compare also H. Westergaard, op.
  cit., p. 223.

Footnote 239:

  Vol. vi, p. 162.

Footnote 240:

  Vol. ii, p. 199.

Footnote 241:

  Including the convalescent German troops from France that were taken
  into the immobile army-corps.

Footnote 242:

  Prior to 1870 the reports cover the year beginning October 1 and
  ending September 30.

Footnote 243:

  Loth, _Der Einfluss der in den letzten 30 Jahren erfolgten
  hygienischen Massregeln auf den Gang der Infektionskrankheiten und die
  allgemeine Bevölkerungsbewegung in Erfurt. Corr.-Blatt des allgemeinen
  ärztlichen Vereins von Thüringen_, November 11 and 12, 1901.

Footnote 244:

  Volz, _Medizinalbericht des Kgl. Oberamtsphysikats vom Jahre 1871.
  Med. Corr.-Blatt des württ. ärztl. Vereins_, November 8 and 9, 1873.

Footnote 245:

  H. E. Boehnke, _Die Ruhrepidemie im Standort Metz im Sommer 1910.
  Deutsche mil.-ärztl. Zeitschrift_, vol. xl, p. 803. 1911.

Footnote 246:

  A. Maurin, _Le typhus exanthématique ou pétéchial, typhus des Arabes_.
  Paris, 1872. Ref. in _Gaz. hebdom. de méd. et de chir._, 1873, vol.
  xx, p. 110.—Grellois, _Histoire médicale du blocus de Metz_. Paris and
  Metz, 1872.

Footnote 247:

  Michaux, _Du typhus exanthématique à Metz dans la population civile, à
  la suite du blocus. Gaz. hebdom._, 1873, vol. xx, p. 38.

Footnote 248:

  Viry, _Du typhus exanthématique à Metz dans la population civile. Gaz.
  hebdom._, 1873, vol. xx, p. 56.

Footnote 249:

  A. Laveran, op. cit., p. 260.

Footnote 250:

  F. Prinzing, _Handbuch der medizinischen Statistik_. Jena, 1906. P.
  383.

Footnote 251:

  Vacher, _L’épidémie de variole en 1870-1. Gaz. méd. de Paris_, 1876,
  vol. xlvi, p. 470.

Footnote 252:

  Vol. vi, p. 80.

Footnote 253:

  M. Chauffard, _Rapport sur les épidémies pour les années 1869-70.
  Mémoires de l’Académie de Médecine_, vol. xxx. Paris, 1871-3.

Footnote 254:

  Vernois, _Rapport général sur les épidémies qui ont régné en France
  pendant l’année 1871. Mémoires de l’Académie de Médecine_, vol. xxx,
  p. 423.

Footnote 255:

  M. Delpech, _Rapport général sur les épidémies pour les années 1870,
  1871 et 1872. Mém. de l’Acad. de Méd._, vol. xxxi. Paris, 1875.

Footnote 256:

  A. Laveran, op. cit., p. 364.

Footnote 257:

  M. Delpech, _Rapports sur les faits de l’épidémie variolique observée
  à Paris depuis l’année 1865 jusqu’au 1^{er} juillet 1870. Ann. d’hyg.
  publ._, 1871, series ii, vol. xxxv.—Léon Colin, _La variole au point
  de vue épidémiologique et prophylactique_. Paris, 1873.—O. du Mesnil,
  _La mortalité à Paris pendant le siège. Ann. d’hyg. publ._, 1871,
  series ii, vol. xxxv, p. 413.—H. Sueur, _Étude sur la mortalité à
  Paris pendant le siège_. Paris, 1872.

Footnote 258:

  According to Sueur, the number of men in the garrison at the beginning
  of the siege was 246,000.

Footnote 259:

  Statistics regarding Alsace and Lorraine, No. 11 (Strassburg, 1878) p.
  133.

Footnote 260:

  A. L. Fonteret, _Étude générale des maladies régnantes et des
  constitutions médicales observées à Lyon de 1864 à 1873_. Paris-Lyons,
  1873.

Footnote 261:

  M. Woillez, _Rapport général sur les épidémies pendant l’année 1873.
  Mém. de l’Acad. de Méd._, vol. xxxi, p. clvii. 1875.

Footnote 262:

  1872, p. 896.

Footnote 263:

  German Health Report, vol. vi, p. 81.

Footnote 264:

  Vol. vi, p. 29.

Footnote 265:

  According to a written communication from the Royal Prussian Bureau of
  Statistics.

Footnote 266:

  A. Guttstadt, _Die Pockenepidemie in Preussen, insbesondere in Berlin
  1870-2. Zeitschrift des Kgl. Preuss. Statist. Bureaus_, vol. xiii, p.
  116. 1873.

Footnote 267:

  A. Liévin, _Die Pockenepidemie in den Jahren 1871 und 1872 in Danzig.
  Viertelj. für öff. Ges.-pflege_, vol. v, p. 366. 1873.

Footnote 268:

  According to the German Health Report. Liévin reports seventy-one
  cases of the disease and nine deaths, since he includes all the German
  soldiers, even the transients in the immobile army.

Footnote 269:

  von Pastau, _Beiträge zur Pockenstatistik nach den Erfahrungen aus der
  Pockenepidemie 1871-2 in Breslau. Deutsches Arch. für klin. Med._,
  vol. xii, p. 112. 1873.

Footnote 270:

  Reports vary; Guttstadt himself gives two figures for 1871—5,212 and
  5,084; for 1872 he gives 1,106, whereas a report, in manuscript, of
  the Prussian Bureau of Statistics, gives the figure 2,598.

Footnote 271:

  Loth, loc. cit.

Footnote 272:

  _Die Gesundheitsverhältnisse Hamburgs im 19. Jahrhundert._ Hamburg,
  1901. P. 161.

Footnote 273:

  The figures have reference to all the deaths that occurred among all
  persons in the city and in the city-state; the older year-books of the
  State of Bremen include only the resident inhabitants, so that the
  above figures do not concur with the figures found in the older
  records.

Footnote 274:

  M. Wahl, _Statistik der Geburts- und Sterblichkeitsverhältnisse der
  Stadt Essen, 1868-1879. Zentralblatt für allg. Ges.-pflege_, vol. i,
  p. 352. 1882.

Footnote 275:

  _Vierter und fünfter Jahresbericht über das Medizinalwesen im
  Königreich Sachsen auf die Jahre 1870-1 und 1872-3._ Dresden, 1874 and
  1875.

Footnote 276:

  C. A. Wunderlich, _Mitteilungen über die gegenwärtige Pockenepidemie
  in Leipzig. Arch. für Heilkunde_, vol. xiii, p. 97. 1872.

Footnote 277:

  Siegel, _Die Pockenepidemie des Jahres 1871 im Umkreise von Leipzig.
  Arch. für Heilkunde_, vol. xiv, p. 125. 1873.

Footnote 278:

  A. Fiedler, _Statistische Mitteilungen und aphoristische Bemerkungen
  über die Pockenepidemie zu Dresden in den Jahren 1870 und 1871, nach
  Beobachtungen im Stadtkrankenhaus daselbst. Jahresberichte der Ges.
  für Natur- und Heilkunde in Dresden._ 1872.

Footnote 279:

  M. Flinzer, _Die Blatternepidemie in Chemnitz and Umgegend in den
  Jahren 1870 und 1871. Mitteilungen des Statistischen Bureaus der Stadt
  Chemnitz_, fascicle 1. Chemnitz, 1873.

Footnote 280:

  A. Geissler, _Einige Bemerkungen über Pocken und Vakzination. Arch.
  für Heilkunde_, vol. xiii, p. 547. 1872.

Footnote 281:

  G. Mayr, _Bewegung der Bevölkerung des Kgr. Bayern im letzten
  Vierteljahr des Kalenderjahres 1870 und im Kalenderjahr 1871.
  Zeitschrift des bayr. stat. Bureaus_, vol. iv, p. 244. 1872.

Footnote 282:

  F. Seitz, _Krankheits- und Sterblichkeitszustand zu München im Jahr
  1870. Ärztl. Intelligenzblatt, 1871._ P. 414.—C. Majer, _Die
  Sterblichkeit in München, Nürnberg und Augsburg während der Jahre 1871
  und 1872. Ärztl. Intelligenzblatt, 1873._ P. 677.

Footnote 283:

  C. Martius, _Die Blatternepidemie zu Nürnberg, 1870-2. Ärztl.
  Intelligenzblatt, 1872._ P. 639.

Footnote 284:

  Rapp, _Ueber den Nutzen der Epidemieenhäuser. Ärztl.
  Intelligenzblatt_, 1872, p. 2.

Footnote 285:

  G. Cless, _Impfung und Pocken in Württemberg_. Stuttgart, 1871.—Reuss,
  _Generalimpfbericht vom Jahre 1869. Württ. ärztl. Corr.-Blatt._ For
  1871, vol. xli, p. 220; for 1870, vol. xlii, p. 61, 1872; for 1871,
  vol. xliv, p. 213. 1874.

Footnote 286:

  Sigel: _Die Mortalität in Stuttgart im Jahre 1870.—Württ. med.
  Corr.-Bl._, 1872, p. 209. For the year 1871, p. 273; for the year
  1872, vol. xliii, p. 313. 1873.

Footnote 287:

  Volz, op. cit., p. 59.

Footnote 288:

  Höring, _Die Pocken in Heilbronn. Württ. med. Corr.-Bl._, 1871, vol.
  xli, p. 189.

Footnote 289:

  Reissner-Neidhart, _Zur Geschichte und Statistik der Menschenblattern
  und der Schutzpockenimpfung im Grossherzogtum Hessen. Beiträge zur
  Stat. des Grossh. Hessen_, vol. xxviii, fascicle 3. Darmstadt, 1888.

Footnote 290:

  Two cases not datable.

Footnote 291:

  Estimate.

Footnote 292:

  According to MS. reports.

Footnote 293:

  A. Vogt, _Die Pockenseuche und Impfverhältnisse in der Schweiz_.
  Berne, 1882.

Footnote 294:

  A. Burckhardt, _Demographie und Epidemiologie in der Stadt Basel,
  1601-1900_. Leipzig, 1908. P. 105.

Footnote 295:

  A. Brunner, _Die Pocken im Kanton Zürich_. Zurich, 1873.—S.
  Rabinowitsch-Tonkonogowa, _Über das Vorkommen der Pocken im Kanton
  Zürich im 19. Jahrhundert_. Karlsruhe, 1903.

Footnote 296:

  L. March, _Statistique internationale du mouvement de la population_.
  Paris, 1907.

Footnote 297:

  _De Pokkenepidemie in Nederland in 1870-3._ Hague, 1875. Quoted from
  Th. Lotz, _Pocken und Vakzination_. Basel, 1880.

Footnote 298:

  J. Daimer, _Todesursachen in Oesterreich während der Jahre 1873-1900.
  Das österreichische Sanitätswesen_, 1902. Supplement to No. 37, p.
  104.

Footnote 299:

  Felice del Agua, _Cenni sul vajuolo e sulla vaccinazione_. Quoted from
  Virchow-Hirsch, _Jahresbericht über die Leistungen und Fortschritte in
  der ges. Med. für 1872_. Vol. ii, p. 267. For 1873, vol. i, p. 310.

Footnote 300:

  Thirty-fourth Annual Report of the Registrar-General of Births,
  Deaths, and Marriages in England and Wales. London, 1873. P. xxxi.

Footnote 301:

  _Befolkningsforholdene i Danmark i det 19. Aarhundrede._ Copenhagen,
  1905. P. 147.

Footnote 302:

  B. M. Lersch, op. cit., p. 437 f.

Footnote 303:

  _Blattern und Schutzpockenimpfung._ Elaborated in the Kaiserl.
  Gesundheitsamt. Second edition, 1896. P. 75 f.

Footnote 304:

  N. Kosloff, _Kriegssanitätsbericht über den Krieg gegen die Türkei,
  1877-8_. St. Petersburg, 1884-6; P. Myrdacz, _Sanitätsgeschichte des
  Russisch-türkischen Kriegs (1877-8) in Bulgarien und Armenien_.
  Vienna, 1898; Knaak, _Die Krankheiten im Kriege_. Leipzig, 1900. P.
  65.

Footnote 305:

  O. Niedner, op. cit., p. 90.

Footnote 306:

  _The British Medical Journal_, 1901, vol. i, p. 160, and 1902, vol. i,
  p. 167.

Footnote 307:

  ‘The Recent Epidemic of Typhoid Fever in South Africa.’ Discussions of
  the Clinical Society of London, on May 8 and 22, 1901. Report in the
  _British Medical Journal_, 1901. Vol. i, p. 642 ff. and 770 ff. Also
  in the _Deutsche Med. Wochenschrift_, 1901. _Vereinsbeilage_, p.
  139.—Ferenczy, _Die Typhusepidemie im südafrikanischen Kriege
  (1899-1901), deren Aetiologie und die Präventivimpfungen dagegen.
  Wien. Med. Presse_, 1906, no. 44.

Footnote 308:

  ‘The Siege Statistics from Ladysmith,’ _Brit. Med. Journal_, vol. i,
  p. 730.

Footnote 309:

  ‘The Rates of Mortality in the Concentration Camps in South Africa,’
  _Brit. Med. Journal_, 1901, vol. ii, p. 1418.

Footnote 310:

  ‘The Working of the Refugee Camps,’ _Brit. Med. Journal_, 1901, vol.
  ii, p. 1631 f.

Footnote 311:

  ‘The Report on the Working of the Refugee Camps’ (loc. cit.), p. 1618.

Footnote 312:

  L. _Hönigsberger, Bericht über das Konzentrationslager Merebank
  (Natal). Münch. Med. Wochenschrift_, 1902. Vol. xlix, No. 36.

Footnote 313:

  _Die Kämpfe der deutschen Truppen in Südwestafrika._ Published by the
  General Staff. Berlin, 1906-7.

Footnote 314:

  E. Haga, _Beobachtungen eines japanischen Divisionsarztes während des
  Russisch-japanischen Kriegs. Deutsche militärärztliche Zeitschrift_,
  vol. xl, p. 945. 1911.

Footnote 315:

  W. Roth, _Jahresbericht über die Leistungen und Fortschritte auf dem
  Gebiet des Militärsanitätswesens_, vol. xxxii, p. 91. 1906.
  _Militärwochenblatt_, 1906. P. 158. _Deutsche militärärztliche
  Zeitschrift_, 1907. Vol. xxxvi, p. 111.

Footnote 316:

  W. von Oettingen, _Studien auf dem Gebiete des Militärsanitätswesens
  im Russisch-japanischen Kriege, 1904-5_. Berlin, 1907.—Schäfer,
  _Mitteilungen über kriegschirurgische Erfahrungen im russischen
  Kriege. Deutsche med. Wochenschrift_, 1905. P. 1337.

Footnote 317:

  Follenfant, _L’hygiène des armées dans les pays froids d’après les
  enseignements de la guerre russo-japonaise. Bull. off. de l’Union
  fédérative des médecins de réserve_, 1906, Nos. 6-7. Quoted from W.
  Roth, op. cit., p. 91, vol. xxxii.

Footnote 318:

  Takaki, ‘_The Preservation of Health amongst the Personnel of the
  Japanese Navy and Army_.’ Lancet, 1906. Vol. i, p. 1369.

Footnote 319:

  _Résumé statistique de l’empire du Japon._ Published annually.

Footnote 320:

  Steiner, _Ueber den Sanitätsdienst der Japaner im Krieg gegen
  Russland. Strefflers österr. milit.-ärztl. Zeitschrift_,
  1906.—Matignon, _La désinfection des troupes japonaises rentrantes de
  la campagne de Mandchourie. Rev. d’hyg. et de pol. san._, 1906, p.
  661.

Footnote 321:

  Sforza, _Bemerkungen über einige Infektionskrankheiten, die in Lybien
  vom Tage der Okkupation an bis März 1912 geherrscht haben. Deutsche
  mil.-ärztl. Zeitschrift_, 1912. Vol. xli, p. 756.

Footnote 322:

  According to newspaper reports and to publications of the Imperial
  Health Office.

Footnote 323:

  K. Kraus, _Über Massnahmen zur Bekämpfung der Cholera auf dem
  bulgarischen Kriegsschauplatze. Wiener klin. Woch._, 1913. P. 241.—K.
  J. Schopper, _Erfahrungen über die Cholera in Ostrumelien während des
  Balkankriegs, 1912. Wiener klin. Woch._, 1913. No. 10.

Footnote 324:

  Vacher, _La mortalité à Paris en 1870. Gaz. médicale de Paris_, 1871,
  p. 9.

Footnote 325:

  O. Oesterle, _Paris und die Hygiene während der Belagerung von 1870
  und 1871. Deutsche Vierteljahresschrift für öff. Ges.-pflege_, vol.
  ix, p. 410. 1877.

Footnote 326:

  F. Stegmeyer, _Bemerkungen über die Krankheiten, welche unter der
  Garnison zu Mantua während der Blockade vom 30. Mai 1796 bis zum 3.
  Februar 1797 geherrscht haben. Abhandlungen der K. K. mediz.-chirurg.
  Josefs-Akademie zu Wien_. Vienna, 1801. Vol. ii, p. 387.

Footnote 327:

  H. Häser, op. cit., vol. iii, p. 536.

Footnote 328:

  Carl _Friccius, Geschichte der Befestigungen und Belagerungen
  Danzigs_. Berlin, 1854. P. 158.

Footnote 329:

  Pringle, op. cit., p. 240.

Footnote 330:

  A. F. Blech, _Geschichte der siebenjährigen Leiden Danzigs von
  1807-14_. Danzig, 1815. Part ii, p. 23.

Footnote 331:

  Blech (loc. cit.), vol. ii, p. 61.

Footnote 332:

  Friccius, op. cit., p. 203.

Footnote 333:

  Blech, op. cit., vol. ii, p. 204.

Footnote 334:

  Friccius, op. cit., p. 284.

Footnote 335:

  Blech, op. cit., vol. ii, p. 296.

Footnote 336:

  F. Lehmann, _Beobachtungen des im Jahre 1813 in Torgau herrschenden
  Typhus. Annalen der Heilkunst des Jahres 1814_. P. 506.—G. A. Richter,
  _Geschichte der Belagerung und Einnahme der Festung Torgau und
  Beschreibung der Epidemie, welche daselbst in den Jahren 1813 und 1814
  herrschte_. Berlin, 1814.

Footnote 337:

  Richter, op. cit., p. 9.

Footnote 338:

  Richter, op. cit., p. 19. The figures do not exactly coincide with
  those published by Bürger. Compare J. C. A. Bürger, _Nachrichten über
  die Blockade und Belagerung der Elb- und Landesfestung Torgau, 1818_.
  Torgau, 1838. Quoted in C. F. Riecke, _Der Kriegs- und Friedenstyphus
  in den Armeen_. Potsdam, 1848. P. 120.

Footnote 339:

  Richter, op. cit., p. 54.

Footnote 340:

  F. J. Wittmann, _Erfahrungen über die Ursachen der ansteckenden
  Krankheiten belagerter Festungen_. Mayence, 1819.

Footnote 341:

  Zenzen, Leydig, and Renard, _Ueber das ansteckende Nervenfieber,
  welches in den Jahren 1813 und 1814 in Mainz herrschte_. _Horn’s Arch.
  für med. Erfahrung_, 1814. P. 449.

Footnote 342:

  J. R. L. Kerckhoffs, _Observations médicales_, etc. Maestricht, 1814.
  P. 68 f.

Footnote 343:

  Wittmann, op. cit., p. 150.

Footnote 344:

  Vacher, _La mortalité à Paris en 1870. Gaz. méd. de Paris_. 42^e
  année, 1871, p. 9.—Bourchardet, _L’hygiène de Paris pendant le siège.
  Gaz. des Hôpitaux_, 1870, No. 46.

Footnote 345:

  Chapter VIII.

Footnote 346:

  Dupinet, _Des principales causes de la mortalité à Paris pendant le
  siège_. Paris, 1871.

Footnote 347:

  O. du Mesnil, _La mortalité à Paris pendant le siège. Ann. d’Hyg.
  publ._ Series II, vol. xxxv, p. 413. 1871.

Footnote 348:

  Bouchut, _Alimentation des nouveau-nés pendant le siège de Paris. Gaz.
  des Hôpitaux_, 1871, p. 35.

Footnote 349:

  A. Delpech, _Le scorbut pendant le siège de Paris. Ann. d’Hyg. publ._
  Series II, vol. xxxv, p. 297. 1871.

Footnote 350:

  A. L. Z. Grenet, _Le scorbut au fort de Bicêtre pendant le siège de
  Paris par les Prussiens, 1870-1. Ann. d’Hyg. publ._ Series II, vol.
  xxxvi, p. 279. 1871.

Footnote 351:

  J. Okuniewski, _Port Arthur. Sanitäre Skizzen, Mitteilungen aus dem
  Gebiete des Seewesens_, 1911, No. 5. (Quoted from _Der Militärarzt_.
  Supplement to the _Wiener med. Wochenschrift_, 1911, No. 23.)—Johann
  Steiner, _Der Sanitätsdienst im Kampf um Port Arthur, 1904-5. Der
  Militärarzt_, 1908, Nos. 11-12.

Footnote 352:

  _Der Russisch-japanische Krieg._ Official account published by the
  Russian General Staff. German Edition by Freiherr von Tettau, vol. v,
  part 2. Port Arthur. Berlin, 1912. P. 224.

Footnote 353:

  Loc. cit., p. 224.

Footnote 354:

  Olga von Baumgarten, _Wie Port Arthur fiel_. Translated from the
  Russian by Lilli von Baumgarten. Strassburg and Leipzig, 1906.

Footnote 355:

  Loc. cit., p. 188.

Footnote 356:

  _Russisches Generalstabswerk_, vol. v. 2, p. 453 f.

------------------------------------------------------------------------




                          TRANSCRIBER’S NOTES


 1. P. 1, changed “Lagerepidemieen” to “Lagerepidemien”.
 2. P. 131, changed “Typhusin” to “Typhus In”.
 3. P. 256, changed “—” to “222” in Totals.
 4. Silently corrected typographical errors and variations in spelling.
 5. Retained anachronistic, non-standard, and uncertain spellings as
      printed.
 6. Footnotes have been re-indexed using numbers and collected together
      at the end of the last chapter.
 7. Enclosed italics font in _underscores_.
 8. Superscripts are denoted by a caret before a single superscript
      character or a series of superscripted characters enclosed in
      curly braces, e.g. M^r. or M^{ister}.