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.