War fever

“ With the beginning of the modern period we come to more frequent pandemics, not of plague, but of minor or milder forms of pestilential infection. On the continent of Europe these were in part related to the state of war, which may be taken as beginning with the invasion of Italy by Charles VIII. of France in 1494. Typhus-fever, or war-fever with famine-fever, now begins to be a familiar form of sickness—in 1498, 1505, 1510, 1528, and so on. Other forms are putrid sore throat, dysentery, and varieties of fever included under influenza. ”

“ The causes of the fever above mentioned, as shall be more fully illustrated hereafter, are chiefly connected with the circumstances occurring in the beginning of a war, when men of all descriptions are mixed, without proper precautions being taken to guard against the infection imported from jails or guardships. The sickness in the French fleet was still greater in the beginning of the war than in the British ”

“ A man in good condition should be able to withstand the wettings and exposures that lower the system, but in a winter campaign, pneumonia causes a large amount of sickness and is one of the serious enemies of the soldier.
"Above all others one disease has proved most [212] fatal in modern warfare—enteric, or typhoid fever. Over and over again it has killed thousands before they ever reached the fighting line. The United States troops had a terrible experience in the Spanish-American War. ”

“ Why, if the yellow fever be derived from the West-Indies, was it not imported every year before 1791, and before the existence, or during the feeble and partial operation of quarantine laws? It is no answer to this question to say, that a war is necessary to generate the disease in the islands, for it exists in some of them at all times, and the seasons of its prevalence in our cities have, in many instances, [250] had no connection with war, nor with the presence of European armies in those and in other sickly parts of the globe. ”

“ It is called trench fever. It is not a fatal disease, but it is slow and painful, and it is so common as to be almost an epidemic. Its ravages are so great that it actually hampers the allies in their struggle to win the war. Something like five hundred thousand men a year are temporarily pulled out of armies because of trench fever. ”

“ It is bitter enough to lose thousands of the best of our young men in a hideous war, but it adds terribly to the tragedy to think that more than one half of the losses may be [210] due to preventable disease. Typhus fever, malaria, cholera, enteric, and dysentery have won more victories than powder and shot. ”

“ 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. ”

“ So after this trip we shall be three again, which is a blessing, as there are not enough wards for four, and no one likes giving any up. It also gives us a spare bunk to store our warehouses of parcels for men, which entirely overflow our own dug-outs. As soon as you've given out one lot, another bale arrives.
We have had every kind of infectious disease to nurse in this war, except smallpox. The Infectious Ward is one of mine, and we've had enteric, scarlet fever, measles, mumps, and diphtheria. ”

“ And although the city was strictly quarantined, the disease spread throughout Lorraine and northern Alsace.
In the year 1528 an epidemic of typhus fever occurred in connexion with warlike events. This pestilence broke out in Upper Italy and spread to Lower Italy, where a war was going on between French troops on the one side and German and Spanish troops on the other. The loss of human life was uncommonly large, 30,000 French soldiers and twice as many non-belligerent inhabitants are said to have died. And the pestilence was also borne from Italy to Germany. ”

“ 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. ”

“ 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. ”

“ The belief in the autochthonic origin of diseases continued to prevail until the first half of the nineteenth century. Hecker upheld it in a discussion of the plague-epidemic that occurred during the Russo-Turkish War of 1769–70; he believed that the intermittent fever prevalent in the Danube countries passed over into putrid fever, with or without petechiae, that carbuncles and buboes gradually developed, and that putrid fever was thus converted into bubonic plague. ”

“ It is impossible, however, to prevent our soldiers billeted in France from occasionally contracting communicable diseases from the French civilian population, and it is obvious that as there were from 3 to 5 per cent. of the soldiers uninoculated against typhoid fever, we would get some cases of typhoid fever.
Besides this, unless further precautions were taken, the army would be susceptible to disease such as cholera, dysentery and the like should there be cases of these in the war zone. ”

“ None of the other infectious diseases developed very extensively during this war; of the Prussian army, which numbered some 280,000 men, only 379, all told, succumbed to typhoid fever, and dysentery did not appear at all. A rather mild epidemic of small-pox spread throughout a considerable part of Germany in the year 1865, and lasted until the year 1866; whether or not the war helped the disease to spread, which is not unlikely, we cannot state with certainty owing to a lack of bases of comparison. ”

“ The comrades who have rendered them this last service move onward to bury others, and leave them to vitiate the air and to form a terrible herd of infection. Thus it is that a country which has already been devastated by war is again brought to the verge of despair by the appearance of 130typhus fever, dysentery, and other equally serious maladies. ”

“ There were 6,000,000 cases of disease in the Federal armies, which meant that, on an average, every man was sick at least twice.
The diseases most prevalent were dysentery, typhoid fever, malaria, pneumonia, arthritis, and the acute diseases of childhood, such as measles and malnutrition.
The principal weapon of the war and the one by which 80 per cent of all wounds were produced was a single-shot, muzzle-loading rifle in the hands of foot soldiers. ”

“ In many cases of fever, however, there is no poison in the blood; thus, the local irritation of a boil or other inflammation [Pg_203] may cause what is well termed "irritative fever." The way in which this is produced is by an indirect, and not a direct, action upon the inhibitory heat-centre.
The casualties of the late war proved but too abundantly that a man may be wounded in one part of the body and suffer from paralysis of voluntary motion in another part. Thus, a soldier struck in the neck fell unconscious, and on awaking was astonished to find his right arm powerless at his side. ”

“ Of the former the most powerful of all are those influences which lower the health of a community, especially overcrowding and poverty. Hence this fever is most frequently found to affect the poor of large cities and towns, or to appear where large numbers of persons are living crowded together in unfavourable hygienic conditions, as has often been seen in prisons, workhouses, &c. Armies in the field are also liable to suffer from this disease; for instance, during the Crimean War it caused an enormous mortality among the French troops. ”

“ BY AN ARMY SURGEON.
No disease causes such havoc in modern campaigns as typhoid or enteric fever, and it becomes the duty of every one having authority to impress this fact upon the men committed to their charge. ”

“ Of course, we have had no big battles, as we have not the men or guns, but we have had constant patrols and skirmishes, nearly always losing men killed or wounded, or both. We have also suffered very heavily with fever and dysentery, and all our hospitals are full. ”

“ Something will have been done for the cause of this better method of civilising the lower races, if we forewarn and forearm ourselves against the symptoms of hostilities with them by a thorough understanding of the conditions which render such hostilities probable. For as an outbreak of fever is to some extent preventable by a knowledge of the conditions which make for fevers, so may the outbreak of war be averted by a knowledge of the laws which govern their appearance. ”

“ Inflammation of the chest has been hitherto considered as accompanied by inflammatory fever as an essential character, but this is by no means always the case. In large cities, and among troops after hard service, in which they have been subjected to much privation, and in certain epidemics, the accompanying fever often partakes of a low or typhoid character, and becomes infinitely more dangerous. ”

“ But in December, when large bodies of troops marched through the highlands, the southern part of Württemberg, these fevers followed the soldiers’ lines of march. At first it was the French prisoners who carried lazaret-fever with them wherever they went, and a very severe form of the disease too; later on, these fevers always broke out wherever the Russian soldiers went, although very few of the soldiers themselves were infected with them. Frequently persons contracted the disease who had no sick soldiers in their homes. ”

“ Chemnitz, small-pox epidemic 1871, 255 f. Chenu, 171, 173, 183. Cholera, 6 f.; Balkan War, 300 ff.; Crimean War, 170 ff.; France 1853, 170 ff.; German War of 1866, 184 f.; Tripolitan War, 299 f. 336Civil War, American, 5; dysentery, 178 f.; malaria, 180; measles, 179; small-pox, 179; typhoid fever, 177; typhus fever, 178. Cless, 260. Colin, 203. Cologne, small-pox epidemic 1870, 247 f. Concentration camps, South Africa, 292 ff. Constantinople, cholera epidemic 1912, 301. Copenhagen, pestilence 1710, 85. Crimean War, cholera, 170 ff.; dysentery epidemic, 172; scurvy epidemic, 172 ”

“ After the death of Bernhard von Weimar and of Banner, all centralized warfare in Germany ceased, and there began an endless series of futile marches across the country. The great depopulation of Germany, the difficulty of properly nourishing the few that had survived, and the wide prevalence of camp-fever, made it impossible to carry out any more large enterprises. Severe pestilences scarcely ever occurred, for the simple reason that there were so few people to contract and spread diseases. Typhus fever had become epidemic everywhere. ”

“ The men have to leave the fighting line, go to hospitals and lie there suffering and helpless for weeks on end. One fever does not give positive immunity from others, and it is a fact that many men have recurrent [126] attacks. Trench fever is worst in Flanders, where the British hold the front, but the French, Belgian and Serbian soldiers also suffer from it. When the American army gets here in great numbers we shall undoubtedly see thousands and thousands of our soldiers go under from this disease. Before our men come we want to know what the cause of trench fever is, and how to prevent it. ”

“ Everything the brutalized soldiers could not consume themselves or take with them, they destroyed or burned. There was an absolute dearth of farm-workers, and in addition to that, the year 1635 was dry and unproductive. Horrible are the descriptions of the hunger and misery which the people in all parts of Germany experienced at that time. Under such conditions pestilences could spread unhindered; to be sure, they relaxed a little after the year 1638, but by no means ceased entirely. Whenever real plague disappeared, typhus fever, which was prevalent in all parts of the army took its place ”

“ The Turkish army, in consequence of inferior nourishment, was badly infected with intermittent fever, dysentery, and typhus fever when it set out from Constantinople in March 1769. When the Russian troops advanced, the Turks retreated after an engagement near Galatz. Since the disease had been conveyed on ships from Constantinople to Galatz, where many Russians succumbed to it, the city was evacuated. On the way to Jassy every trace of the pestilence disappeared, and in Jassy the soldiers were quartered in the houses of the citizens. ”

“ Regarding the number of plague patients in the Russian army, which was also attacked by several other diseases, especially malaria, diarrhoea, dysentery, and fever, no information is available; the Russian army numbered 150,000 men, and, according to Seidlitz, 134,882 men were received into the lazarets and 75,226 men into the regimental sick-rooms up to the end of February 1829; thus 210,108 men contracted disease in a period of ten months. ”