Among the diseases that broke out in the field-armies during the war of 1870–1, dysentery (epidemic dysentery) played an important rôle, especially in the months of October and November. Prior to the year 1870 it was a comparatively rare disease in Germany, whereas in France it was quite common. This is indicated by the fact that in the years 1863–9 the number of deaths due to dysentery in the French army (home stations) was twelve times as large as in the Prussian army. Particularly hard hit were the troops in and around Metz, where dysentery raged continuously and with considerable severity,[[245]] as well as in Strassburg and Sedan; in the city and vicinity of Paris the disease, owing to the advanced season of the year, raged less furiously. As a rule it was an open question whether the places in which the German troops contracted the disease were already infected beforehand, or whether the disease had been brought there for the first time by infected divisions of the French army.
Of the German field-army, 38,975 men, all told, contracted dysentery (47·8 per 1,000 of the average number of troops under arms), and of these 2,405 died. Of the average number of French prisoners taken to Germany 41·7 per cent contracted the disease; nearly all the cases of the disease were among the prisoners themselves, who brought the germ with them, and the result was that the number of cases soon began to decrease. It was, of course, inevitable that numerous prison-guards should contract the disease, but nowhere did it spread in a serious way to the civil population.
Of very great importance, as far as the war operations were concerned, was the fact that typhus fever, which in former years had played such a fatal rôle, did not make its appearance among the troops; according to most observers, the disease did not break out at all during the war. The Prussian troops along the Russian border were never entirely free from typhus fever; according to the German Health Report, 91 soldiers contracted the disease in the year 1867, 99 in the year 1868, and 37 in the year 1869. France itself had apparently been free from the disease for a long time, but there was always a possibility that it would be conveyed into the country from Algiers, where in the year 1868 a severe epidemic had raged in consequence of a great famine the year before; of the army in Algiers the disease had carried away 252 men (3·94 per cent).[[246]] Consequently both the Germans and the French watched very carefully any outbreaks of a disease involving symptoms of typhus fever. Cases of a disease held by the authorities to be typhus fever were reported from Nancy, Châlons-sur-Marne, Lunéville, and Metz, but careful investigations by von Niemeyer indicate that they were merely cases of typhoid fever exhibiting unusually well developed roseola. Several French physicians (Chauffard, Léon Colin, Kelsch) likewise testify to the fact that typhus fever did not appear in the French army during the entire war. Grellois, to be sure, asserts that typhus fever broke out about the middle of the siege of Metz and then suddenly disappeared. But even this assertion may fairly be questioned; at all events there was not a single soldier in the garrison suffering from the disease at the time of the capitulation, as Grellois himself admits.
According to Michaux,[[247]] a former chairman of the Medical Society in Metz, a small epidemic of typhus fever raged among the civil inhabitants of that city during the siege. The correctness of this statement, however, is doubted, as no post-mortem examinations were made. It seems that fifty-five children and nine nurses in two orphan asylums contracted the disease, and that twenty-eight of the former and one of the latter succumbed to it; the first cases of the disease were reported early in October, and by the end of November the epidemic was over. This sudden disappearance of the disease was attributed by Michaux to the termination of the siege, a conclusion also upheld by Méry, who studied the disease in the Crimean War. Viry,[[248]] who until a few days before the siege had charge of the field hospital in Vallières (near Metz), where he treated some 250–300 patients every day, performed autopsies on all supposed victims of typhus fever, but in all cases found only the evidences of typhoid fever. Nevertheless, he believes it possible that typhus fever occurred there, and holds the view that the overcrowded condition of the city favoured a spontaneous outbreak of the disease. Laveran,[[249]] who was also present in Metz during the siege, disputes the correctness of Michaux’s diagnosis, as does the German Health Report, on the ground that the disease attacked children almost exclusively, that it caused such a high mortality, and that it disappeared so suddenly. He seems to think that it was some acute exanthema, probably haemorrhagic measles. This leaves unexplained the fact that a large number of nurses contracted the disease.
III. The Great Epidemic of Small-pox caused by the Franco-German War
But while typhoid fever and dysentery in the Franco-German War attacked the civil population only in those parts of the country in which the fighting took place, and nowhere acquired epidemic dimensions, and while it is probable that typhus fever did not appear at all at that time, there occurred in connexion with the war a very severe epidemic of small-pox, which raged more extensively and furiously than any other epidemic in the course of the entire century, and spread not only throughout the belligerent countries, but also throughout all Europe.
Everybody knows how severely Europe suffered from epidemics of small-pox in the last part of the eighteenth and first part of the nineteenth centuries, and how the ravages of that disease were first checked by Jenner’s wonderful discovery. Nevertheless, small-pox did not entirely disappear from Central Europe until the year 1870. The reason for this is found in the fact that compulsory vaccination was introduced in only a few states, and even in them was not properly enforced, and also in the fact that people did not until later begin to realize that vaccination insures immunity only for a period of 12–15 years at most. Consequently new recruits, if they had already been vaccinated once, were not revaccinated when they began to serve. But since sporadic outbreaks of small-pox continued to occur in the Prussian army, orders were issued in the year 1834 that all recruits must be vaccinated. The result was that from that time on, the Prussian troops were very rarely attacked by the disease. The same measure was adopted in Württemberg in 1833, in Baden in 1840, in Bavaria in 1843, in Brunswick in 1858, in the Kingdom of Saxony in 1868, and in the Grand Duchy of Hesse in 1869. Compulsory vaccination did not exist in Prussia or Saxony before the Imperial Vaccination Law was passed in the year 1874; the result was that large numbers of children were never vaccinated. The anti-vaccinationists, especially in the ‘sixties, carried on a vigorous agitation, and this had the effect of increasing the number of unvaccinated persons; the number of revaccinated persons had always been small. In South Germany compulsory vaccination for one-year-old children was introduced in the first part of the nineteenth century—in Bavaria and Hesse in 1807, in Baden in 1815, in Württemberg in 1818—but revaccination was not enforced until 1874, when the Imperial Vaccination Law was passed.
The small-pox mortality in Prussia prior to the year 1870 is indicated by the following table, which shows the number of deaths per 10,000 inhabitants:
| 1831–40 | 2·6 |
| 1841–50 | 1·7 |
| 1851–60 | 2·1 |
| 1861–5 | 3·5 |
| 1866–7 | 5·2 |
| 1867–8 | 1·8 |
| 1868–9 | 1·9 |
| 1869–70 | 1·7 |
In the year 1864 an epidemic of small-pox had broken out, and the war of 1866 had helped it to spread; but in the year 1868 the disease began to abate, so that by the middle of the year 1870 almost all of Prussia was free from small-pox, as will be set forth in greater detail later on. In South Germany the small-pox mortality was even lower; in Bavaria it was 0·85 in the years 1861–70, in Württemberg it was 0·9 in the same years, and in the Grand Duchy of Hesse it was 1·9 in the years 1866–70.[[250]]