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EPIDEMICS RESULTING
FROM WARS
PRINTED IN ENGLAND
AT THE OXFORD UNIVERSITY PRESS
Carnegie Endowment for International Peace
DIVISION OF ECONOMICS AND HISTORY
John Bates Clark, Director
EPIDEMICS RESULTING FROM WARS
BY DR. FRIEDRICH PRINZING
EDITED BY
HARALD WESTERGAARD
PROFESSOR OF POLITICAL SCIENCE IN THE UNIVERSITY OF COPENHAGEN
OXFORD: AT THE CLARENDON PRESS
London, Edinburgh, New York, Toronto, Melbourne and Bombay
HUMPHREY MILFORD
1916
------------------------------------------------------------------------
INTRODUCTORY NOTE BY THE DIRECTOR
The Division of Economics and History of the Carnegie Endowment for
International Peace is organized to ‘promote a thorough and scientific
investigation of the causes and results of war.’ In accordance with this
purpose a conference of eminent statesmen, publicists, and economists
was held in Berne, Switzerland, in August 1911, at which a plan of
investigation was formed and an extensive list of topics was prepared.
The programme of that Conference is presented in detail in an Appendix.
It will be seen that an elaborate series of investigations has been
undertaken, and the resulting reports may in due time be expected in
printed form.
Of works so prepared some will aim to reveal direct and indirect
consequences of warfare, and thus to furnish a basis for a judgement as
to the reasonableness of the resort to it. If the evils are in reality
larger and the benefits smaller than in the common view they appear to
be, such studies should furnish convincing evidence of this fact and
afford a basis for an enlightened policy whenever there is danger of
international conflicts.
Studies of the causes of warfare will reveal, in particular, those
economic influences which in time of peace bring about clashing
interests and mutual suspicion and hostility. They will, it is believed,
show what policies, as adopted by different nations, will reduce the
conflicts of interest, inure to the common benefit, and afford a basis
for international confidence and good will. They will further reveal the
natural economic influences which of themselves bring about more and
more harmonious relations and tend to substitute general benefits for
the mutual injuries that follow unintelligent self-seeking. Economic
internationalism needs to be fortified by the mutual trust that just
dealing creates; but just conduct itself may be favoured by economic
conditions. These, in turn, may be created partly by a natural evolution
and partly by the conscious action of governments; and both evolution
and public action are among the important subjects of investigation.
An appeal to reason is in order when excited feelings render armed
conflicts imminent; but it is quite as surely called for when no
excitement exists and when it may be forestalled and prevented from
developing by sound national policies. To furnish a scientific basis for
reasonable international policies is the purpose of some of the studies
already in progress and of more that will hereafter be undertaken.
The publications of the Division of Economics and History are under the
direction of a Committee of Research, the membership of which includes
the statesmen, publicists, and economists who participated in the
Conference at Berne in 1911, and two who have since been added. The list
of members at present is as follows:
EUGÈNE BOREL, Professor of Public and International Law in the
University of Geneva.
LUJO BRENTANO, Professor of Economics in the University of Munich;
Member of the Royal Bavarian Academy of Sciences.
CHARLES GIDE, Professor of Comparative Social Economics in the
University of Paris.
H. B. GREVEN, Professor of Political Economy and Statistics in the
University of Leiden.
FRANCIS W. HIRST, Editor of _The Economist_, London.
DAVID KINLEY, Vice-President of the University of Illinois.
HENRI LA FONTAINE, Senator of Belgium.
His Excellency LUIGI LUZZATTI, Professor of Constitutional Law in the
University of Rome; Secretary of the Treasury, 1891–3; Prime Minister of
Italy, 1908–11.
GOTARO OGAWA, Professor of Finance at the University of Kioto, Japan.
Sir GEORGE PAISH, Joint Editor of _The Statist_, London.
MAFFEO PANTALEONI, Professor of Political Economy in the University of
Rome.
EUGEN PHILIPPOVICH VON PHILIPPSBERG, Professor of Political Economy in
the University of Vienna; Member of the Austrian Herrenhaus, Hofrat.
PAUL S. REINSCH, United States Minister to China.
His Excellency BARON Y. SAKATANI, recently Minister of Finance; Present
Mayor of Tokio.
THEODOR SCHIEMANN, Professor of the History of Eastern Europe in the
University of Berlin.
HARALD WESTERGAARD, Professor of Political Science and Statistics in the
University of Copenhagen.
FRIEDRICH, FREIHERR VON WIESER, Professor of Political Economy at the
University of Vienna.
The function of members of this Committee is to select collaborators
competent to conduct investigations and present reports in the form of
books or monographs; to consult with these writers as to plans of study;
to read the completed manuscripts, and to inform the officers of the
Endowment whether they merit publication in its series. This editorial
function does not commit the members of the Committee to any opinions
expressed by the writers. Like other editors, they are asked to vouch
for the usefulness of the works, their scientific and literary merit,
and the advisability of issuing them. In like manner, the publication of
the monographs does not commit the Endowment as a body or any of its
officers to the opinions which may be expressed in them. The standing
and attainments of the writers selected afford a guarantee of
thoroughness of research and accuracy in the statement of facts, and the
character of many of the works will be such that facts, statistical,
historical, and descriptive, will constitute nearly the whole of their
content. In so far as the opinions of the writers are revealed, they are
neither approved nor condemned by the fact that the Endowment causes
them to be published. For example, the publication of a work describing
the attitude of various socialistic bodies on the subject of peace and
war implies nothing as to the views of the officers of the Endowment on
the subject of socialism; neither will the issuing of a work, describing
the attitude of business classes toward peace and war, imply any
agreement or disagreement on the part of the officers of the Endowment
with the views of men of these classes as to a protective policy, the
control of monopoly, or the regulation of banking and currency. It is
necessary to know how such men generally think and feel on the great
issue of war, and it is one of the purposes of the Endowment to promote
studies which will accurately reveal their attitude. Neither it nor its
Committee of Research vouches for more than that the works issued by
them contain such facts; that their statements concerning them may
generally be trusted, and that the works are, in a scientific way, of a
quality that entitles them to a reading.
This monograph on epidemics resulting from wars is designed to bring
into light an aspect of international conflict that has never been
adequately appreciated. An examination of the facts here presented will
indicate that until comparatively recent times the most serious human
cost of war has been not losses in the field, nor even the losses from
disease in the armies, but the losses from epidemics disseminated among
the civil populations. It was the war epidemics and their sequelae,
rather than direct military losses, that accounted for the deep
prostration of Germany after the Thirty Years’ War. Such epidemics were
also the gravest consequence of the Napoleonic Wars.
It may appear that a study of war epidemics can have only historical
interest, in view of the progress of modern medical science. Plague,
cholera, and typhus can be brought under control by modern methods of
sanitation. One can point to the fact that in the present great war, the
only serious epidemic that has been reported is the typhus fever
epidemic in Serbia. When the medical history of the war comes to be
written, however, it will be found that the aggregate losses from
sporadic outbreaks of war epidemics have been very considerable. A war
sufficiently protracted to lead to universal impoverishment and a
breakdown of medical organization would be attended, as in earlier
times, by the whole series of devastating war epidemics. And even in the
case of less exhausting wars, the chances of widespread epidemics is far
from negligible. There is much food for reflection in the author’s
account of the small-pox epidemic following the Franco-German War. In
1870 the means of coping with small-pox were as nearly perfect as they
are in the greater part of the world to-day. This fact did not save
Europe from a widespread epidemic, entailing human losses exceeding in
gravity the losses in the field. To-day, as in the past, the
probabilities of increased morbidity in the civil population, not only
among the belligerents, but among neutrals as well, must be entered as a
highly important debit item against war.
JOHN BATES CLARK,
_Director_.
CONTENTS
PAGE
INTRODUCTION 1
CHAPTER I
WAR PESTILENCES 4
CHAPTER II
THE TIME BEFORE THE THIRTY YEARS’ WAR 11
CHAPTER III
THE THIRTY YEARS’ WAR 25
CHAPTER IV
THE PERIOD BETWEEN THE PEACE OF WESTPHALIA AND THE FRENCH
REVOLUTION 79
CHAPTER V
THE PERIOD BETWEEN THE FRENCH REVOLUTION AND NAPOLEON’S RUSSIAN
CAMPAIGN 92
CHAPTER VI
THE EPIDEMICS OF TYPHUS FEVER IN CENTRAL EUROPE FOLLOWING UPON THE
RUSSIAN CAMPAIGN AND DURING THE WARS OF LIBERATION (1812–14) 106
CHAPTER VII
FROM THE AGE OF NAPOLEON TO THE FRANCO-GERMAN WAR 165
1. The Russo-Turkish War of 1828–9 165
2. The Crimean War (1854–6) 170
3. The North American Civil War (1861–5) 175
4. The Italian War of 1859 183
5. The Danish War of 1864 183
6. The German War of 1866 184
CHAPTER VIII
THE FRANCO-GERMAN WAR OF 1870–1, AND THE EPIDEMIC OF SMALL-POX
CAUSED BY IT 189
CHAPTER IX
FROM THE FRANCO-GERMAN WAR TO THE PRESENT TIME 286
1. The Russo-Turkish War of 1877–8 286
2. The Boer War of 1899–1901 290
3. The War in South-west Africa (1904–7) 296
4. The Russo-Japanese War of 1904–5 296
5. The Occupation of Tripoli by the Italians (1911) 299
6. The War between Turkey and the Balkan States (1912–13) 300
CHAPTER X
EPIDEMICS IN BESIEGED STRONGHOLDS 302
1. The Siege of Mantua (1796–7) 304
2. The Siege of Danzig (1813) 306
3. The Siege of Torgau (1813) 311
4. The Siege of Mayence (1813–14) 316
5. The Siege of Paris (1870–1) 320
6. The Siege of Port Arthur (1904) 324
CONCLUSION 328
INDEX 335
INTRODUCTION
In countries which have the misfortune to be the scene of protracted
wars, the mortality regularly undergoes a considerable increase. This is
caused chiefly by the infectious diseases which in war times so often
appear in the form of epidemics. These diseases, moreover, not only
afflict the country in which the war is waged, but are also carried by
prisoners, returning soldiers, and in other ways, into the land of the
victor, where it is possible for them to spread over a large territory.
A report on the loss of human life among that part of a population which
does not participate in a war has not yet been undertaken, writings on
war pestilences usually confining themselves to the losses within the
armies themselves.[1] It is the purpose of the present study to
investigate the losses sustained by the non-belligerent part of the
population in consequence of epidemics caused by wars.
In doing this it seems advisable to select a few war pestilences which
on account of their enormous extent are particularly notable, and to
subject them to an exhaustive discussion. This method has the advantage
that it will enable us to show in individual cases how it is possible
for these pestilences to extend over such a vast territory, under what
circumstances they spread from place to place, and how they enter
regions remote from the scene of war. For this exhaustive discussion the
writer has chosen the pestilences that occurred during the Thirty Years’
War, the epidemic of typhus fever after Napoleon’s Russian Campaign, and
the pandemic of small-pox after the Franco-German War of 1870–1. These
epidemics afford very instructive examples of what horrible losses both
friends and enemies may sustain in consequence of war pestilences.
While the outbreaks of ‘plague’ in the course of the Thirty Years’ War
have already been made the subject of a comprehensive account, strange
to say there are no such accounts of the other two epidemics; to give a
clear picture of these pestilences the writer was therefore constrained
to collect the necessary information from widely dispersed sources. In
gathering his material a number of large German libraries assisted him
most kindly—particularly, the Royal National Library at Stuttgart and
the University libraries of Strassburg and Tübingen.
The other parts of the history of war pestilences are set forth in a
more general way; for an exhaustive treatment of them would have
necessitated several years of preliminary work, which the writer in the
short time at his disposal was unable to undertake.
The writer has drawn as much as possible from original sources; this
applies at least to the pestilences of the Napoleonic Period, and to the
epidemic of small-pox after the Franco-German War. It would have been
impossible to deal with the other wars in the same way without consuming
considerable time. From the bibliographies it will appear what sources
the author has consulted; rarely are quotations given from works which
he has not seen, and in such cases it is indicated whence they were
taken.
The causes of the origin and spread of pestilences during a war are
clear. Every aggregation of people, even in times of peace, at
celebrations and annual fairs, in barracks, and so forth, is necessarily
exposed to the danger of pestilence; but this danger is ten times as
great in large assemblages of troops during a war. The soldiers are then
subjected to all possible kinds of hardship and suffering—lack of food,
or food which is inferior and badly cooked, sleeping out in the cold and
rain, fatiguing marches, constant excitement, and homesickness—and all
these things greatly lessen their power of resistance. When large bodies
of troops are obliged to remain in one and the same place for a
considerable length of time, the additional difficulty presents itself
of keeping the locality unpolluted by the excrement of men and animals,
and by refuse of all kinds. If an infectious disease reveals its
presence in such an aggregation of people, energetic and stringent
measures must be adopted, even in times of peace, to prevent it from
spreading. In war times it is often impossible to take the necessary
precautions, since the attention of the commanders is directed toward
very definite objects, to which all other considerations are
subordinate. Whether the germ of the disease is already in the place, or
whether the soldiers bring it with them, in either case there is danger
that the fighting armies will cause the disease to spread over the
entire scene of the war, and thus seriously endanger thousands of human
lives.
Modern methods of sanitation have done much toward preventing the spread
of army pestilences, not only in peace, but also in war. The last few
decades have evinced that fact. Whatever attitude we may assume toward
the question whether war can ever be wholly abolished, we must all agree
that, if war has once broken out, all possible means must be employed to
prevent the spreading of pestilence within the armies. Here the
interests of the people and of the commanders coincide, since the
efficiency of armies is often seriously interfered with by the outbreak
of pestilence, and not infrequently the success or failure of a war
depends, not upon the outcome of its battles, but upon the appearance or
non-appearance of pestilence.
CHAPTER I
WAR PESTILENCES
All infectious diseases may spread in consequence of war and develop
into epidemics of varying extent. In the next chapter we shall see how
the wars at the end of the fifteenth century favoured the spread of an
epidemic of syphilis. In the Union Army, during the American Civil War
of 1861–5, both measles and typhoid fever were very widespread, and
together they were the cause of 4,246 deaths, or about 1·75 per cent of
the total enlistment. Scarlet fever, influenza, yellow fever, relapsing
fever, and malaria (if the war is waged in countries where this disease
is endemic—especially in the Lower Danube region, in the Netherlands,
Spain, and Italy) have also played an important rôle in many wars. But
we give the name ‘war pestilences’ only to those infectious diseases
which in the course of centuries have usually followed at the heels of
belligerent armies, such as typhus fever, bubonic plague, cholera,
typhoid fever, dysentery, and small-pox; we may also include here
scurvy, the etiology of which has not yet been definitely determined.
1. _Typhus fever_ (spotted fever, exanthematic typhus—called in France
and England simply typhus, in Spain tabardillo[2]—formerly called
contagious typhus, hunger typhus, camp fever, and Hungarian fever) is an
acute infectious disease of cyclic recurrence, which resembles typhoid
fever only in name. From the eighth to the tenth day after infection,
often somewhat sooner or later, it begins with a chill, accompanied by
nausea, vomiting, violent headache, and psychic depression. In the first
few days the patient’s temperature rises rapidly, and on the fourth or
fifth day a rash in the form of dull-red spots, as large as a pea,
breaks out over the entire body. These spots gradually grow larger, and
after two or three days, through the appearance of very small
haemorrhages, change into petechiae. The apathy of which the patient
first gave evidence now gives way to wild delirium. At the end of the
second week the temperature falls rapidly, and in one or two days
becomes normal; often, however, the fall of temperature takes from six
to eight days. The duration of the entire disease, accordingly, is from
two to two and a half weeks. Death usually occurs at the crisis of the
disease—from the tenth to the twelfth day—rarely between the sixth and
ninth days or after the twelfth.
The danger of the disease varies greatly in different epidemics;
statements regarding this point diverge according as we refer to the
statistical records of hospitals or to the private practice of
physicians. With the latter the number of deaths is smaller, since
persons suffering from the disease in mild form less often go to the
hospitals. Epidemics in which a quarter of the patients, and even more,
have succumbed have frequently occurred, especially in war times, during
famines, &c. The cause (infective agent) of typhus fever is not known;
according to recent investigations it is spread by vermin; Ricketts and
others have fixed responsibility for it upon the body louse. The
infection is communicated from man to man, and very often it is
contracted from the clothes, linen, and other effects of typhus
patients. Recovery from the disease usually renders a person immune
against a second attack. Typhus fever frequently appears nowadays in the
eastern and south-eastern parts of Europe, in Hungary and Galicia, and
also in Spain, Italy, and Ireland.
2. _Plague_ appears in two forms, depending upon the place where the
infective agent enters the body: the bubonic plague and the pneumonic
plague. In the case of the former the painful plague-sores (buboes)
develop, usually two or three days after infection, from the lymphatic
glands; these sores,—which appear most often in the region of the groin,
less often in the axilla, on the neck, lower jaw, and in other
places,—soon suppurate. There is either a development of toxins, which
are the cause of the severe general symptoms, or else the _bacilli
pestis_ go from the glands into the circulatory system and cause
septicaemia, which is quickly fatal. Pneumonic plague takes the form of
a catarrhal inflammation of the lungs, causing a profuse and bloody
expectoration, which contains large quantities of bacilli. This form of
the disease almost always ends fatally in a few days. The mortality of
bubonic plague is somewhat lower; the disease has an average duration of
eight days, and carries away from fifty to seventy per cent of its
victims.
In the Middle Ages an epidemic of plague (black death) ravaged all
Europe. At the present time it is still endemic in India, in southern
China, in Egypt, in Uganda, and perhaps in other countries, whence it
frequently develops into general epidemics.
The infective agent in the case of plague is the _bacillus pestis_,
identified in 1894 by Kitasato, and subsequently, but independently, by
Yersin. Rats, which are very susceptible to the disease, play an
important rôle in spreading it; in India the outbreak of a plague
epidemic is always preceded by the dying of large numbers of rats. Their
excrement contains large quantities of bacilli, which may be destructive
to human beings. The rat-flea is also known to carry the infection. The
infection may be conveyed directly by plague patients, when the buboes
suppurate, or when the blood becomes generally infected with the
_bacilli pestis_, which are contained in abundance in the sputum, urine,
and excrement, or when the lungs are affected and the patient charges
the atmosphere by coughing. One who has recovered from the disease is
usually immune for life.
3. _Cholera_, after an incubation period of two to eight days, begins
with frequent (ten to twenty times a day) vomitings of a fluid like
rice-water, and incessant retching. The patient, owing to the great loss
of water, sinks rapidly; he acquires a corpse-like appearance, loses
consciousness, and death may result on the first or second day. If the
attack is survived, the patient frequently dies from sheer exhaustion
afterwards. The mortality of cholera is great—from forty to fifty per
cent of its victims die. In this calculation the numerous cases of
cholerine, that are always prevalent during cholera times, are excluded.
Recovery from the disease does not protect a person against contracting
it again. The infective germ in the case of cholera is the ‘comma
bacillus’, discovered by Robert Koch in 1883. The spread of cholera is
caused by the penetration of the _comma bacillus_ into the alimentary
canal, resulting from contact with objects which have been contaminated
by the evacuations of cholera patients; less frequently it is indirectly
caused by the pollution, from evacuations, of water used for drinking or
washing purposes.
4. _Dysentery_ has always played an important rôle in military
campaigns. To be sure, it is not very dangerous, so far as the patient’s
life is concerned, but in war times, owing to irregular nursing and
scanty nourishment, and the consequent use of unsuitable food, it may
spread over a large territory and be very destructive to large numbers
of soldiers and other people.
There are two distinct forms of the disease—amoebic dysentery and
bacillary dysentery. The latter is caused by the _bacillus pyocyaneus_,
discovered independently by Stiga, Kruse, and Flexner. The disease used
to be common throughout Europe; at the present time it appears in
Central and Western Europe only in small epidemics, whereas in Eastern
Europe it spreads over large territories. It causes frequent, often
blood-coloured, defecations, accompanied by griping pains in the abdomen
and a distressing pressure (tenesmus). The disease lasts from one to one
and a half weeks, but for a long time after recovery the patient’s
alimentary canal is very sensitive to improper nourishment. The disease
is transmitted either by direct contact, since the evacuations of the
bowels contain large quantities of bacilli, or by infected water.
Amoebic dysentery, occurring in tropical countries (Southern Europe,
Egypt, Southern Asia, Central America, &c.), is much more dangerous; it
is caused by an amoeba, carefully studied by Kartulis, and very often
acquires a chronic character, sometimes causing abscess of the liver.
5. _Typhoid fever_ (called in England ‘enteric fever’, in France
‘fièvre typhoïde’, in Italy ‘febbre tifoidea’) in many wars has been
very widespread among the armies; for example, in the American Civil
War, in the Franco-German War (Metz), and in the Russo-Turkish War of
1877–8. The progress of the disease is well known; between the time of
infection and the outbreak of the sickness nine to eleven days usually
intervene, sometimes even as much as three weeks. In the first week
the temperature of the patient rises slowly, during the second week it
remains at about the same height, while in the third week it abates
considerably, becoming normal in the course of the fourth week. The
spleen enlarges a great deal, and in the second week small pale-red
spots (roseola), scarcely as large as a pea, appear on the buttocks
and especially on the belly. The patient’s bowel-movements, at first
normal, now becomes diarrhoeal, while certain psychic disorders also
manifest themselves, usually in the form of a heavy somnolence. In the
third week the patient’s life is threatened by complications in the
intestines—haemorrhage or perforation. Characteristic of the disease
are the anatomical changes of the small intestine—at first
enlargement, and later ulceration of Peyer’s patches. The infective
agent in the case of typhoid fever is a bacillus, identified by Gaffky
in 1882. It lodges in the alimentary canal, and is conveyed by food
that has been touched with hands to which matter containing the
bacillus has adhered, or else in contaminated water used for drinking
or other purposes. From eight to ten per cent of the patients die,
while a single recovery usually insures immunity against a second
attack.
6. _Small-pox_ has an incubation period of ten to fourteen days. The
disease begins with a chill, accompanied by violent headache. On the
third day the eruption appears; little papules develop and quickly
change into pustules, showing themselves first on the face, then on the
back, arms, and hands, and finally on the legs and feet. On the ninth
day the pustules suppurate, and after that gradually dry up; if it
progresses favourably, the disease is over in two or two and a half
weeks.
In the case of small-pox the infective agent is not yet known; infection
is caused by contact with a patient, or with objects which he is using
or has used. It is particularly dangerous to touch things on which the
contents of the pustules have dried, for such articles remain infectious
for a long time. Recovery from the disease usually renders a person
immune for life. The mortality in different epidemics varies greatly;
most dangerous of all is the so-called ‘black small-pox’ (haemorrhagic
small-pox, with bleeding in the pustules and under the skin). The total
number of deaths in an epidemic of small-pox is dependent upon whether
the disease appears in a vaccinated or an unvaccinated community; in the
latter case the mortality may reach thirty per cent, whereas in the
former case only three or four per cent of the patients die. Vaccination
renders a person immune for eight to twelve years, while, if the disease
breaks out anywhere in spite of vaccination, the number of fatal cases
is very few. It should be noted that small-pox was formerly dreaded, not
only because of its danger to life, but also because it frequently
leaves a person disfigured for life, and in rare instances causes total
blindness.
7. _Scorbutus_ (scurvy) used to be a common disease on ships, in
prisons, and in times of famine; it appeared with the greatest
malignancy in besieged cities—Thorn, Nuremberg, Alexandria, Port Arthur,
&c. The real cause of the disease is unknown, although too much food of
one kind, particularly lack of fresh vegetables, together with long
confinement in poorly ventilated and dark rooms, are important causative
factors. Inasmuch as the disease almost always appears in the form of an
epidemic, it is probable that there is a specific infective agent. It
begins with a general feeling of weakness; the skin and mucous membranes
become pale and sallow, the gums become inflamed and ulcerated, and
small and large extravasations of blood take place in the skin and
muscles, and at the joints and knuckles. In serious cases haemorrhages
occur in the intestines, kidneys, bladder, and uterus. A change of diet
and surroundings will quickly cure scurvy; otherwise progressive anaemia
will result in death.