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 Chênes | 340 | 1·17 | 0·59 | 0·59 | 0·29 | 0·59 |
| 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 succumbed to typhoid fever. | No. that died per 100 treated. | |
|---|---|---|
| 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.[[242]] | Elberfeld. | Strassburg. | Erfurt. | Plauen. | |
|---|---|---|---|---|---|---|
| 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.