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. prisoners. | Patients. | Deaths. | Patients per 1,000. | Deaths per 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. prisoners. | Patients. | Deaths. | Patients per 1,000. | Deaths per 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. reserves. | Patients. | Deaths. | Patients per 1,000. | Deaths per 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 no. men. | Patients. | Deaths. | Patients per 1,000. | Deaths per 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 infected persons. | Maximum no. | First Case. | No. Patients. | First Outbreak. | No. Deaths (1870). | No. Deaths (1871). | ||
| 1. | East Prussia | |||||||
| Königsberg | Aug. 15 | 7,324 | Aug. 15 | 221 | Aug. (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. | Brandenburg | |||||||
| Berlin | Aug. 20 | 24 | Nov. | 170 | 5,212 | |||
| Frankfurt-o.-t.-O. | 756 | Nov. 12 | 8 | Jan. | 3 | 117 | ||
| Küstrin | Aug. 7 | 2,204 | Aug. 17 | 9 | End (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 | Jan. | 1,376 | Feb. 3 | 5 | Aug. (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. | 1,065 | Dec. (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 | 5,000 | Oct. | 47 | End 1870 | ||||
| Rendsburg | Nov. | 2,590 | Nov. 26 | 44 | End 1870 | 0 | 114 | |
| Schleswig | Dec. 3 | 1,570 | Dec. 13 | 17 | End 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. (end) | 2,709 | Jan. (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 | 981 | Aug. 15 | 13 | Oct. (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 district. | Schwarzwald district. | Jagst district. | Donau 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 German Confederation. | Population Dec. 1, 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 compulsory. | Vaccination not compulsory. | |||
|---|---|---|---|---|
| Bavaria. (1870–5). | Hesse. (1870–2). | Saxony. (1872). | Netherlands. (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.