penmalipe* pH83 E xTas 'ij- k /. j_ I* / From the Atlantic Monthly for October, 1862. THE SANITARY CONDITION O F The Army of ihe United States, BY EDAYARD JARYIS, M. D., OF DORCHESTER, MASS. Book J 3 Q 1862.] Sanitary Condition of the Army. 463 SANITARY CONDITION OF THE ARMY. The power and efficiency of an army consist in the amount of the power and efficiency of its elements, in the health, strength, and energy of its members. No army can be strong, however numerous its soldiers, if they are weak ; nor is it completely strong, unless every member is in full vigor. The weakness of any part, however small, diminishes, to that extent, the force of the whole ; and the increase of power in any part adds so much to the total strength. In order, then, to have a strong and effective army, it is necessary not only to have a sufficient number of men, but that each one of these should have in himself the greatest amount of force, the fullest health and energy the human body can present. This is usually regarded in the original creation of an army. The soldiers are picked men. None but those of perfect form, complete in all their organization and functions, and free from every defect or disease, are intended to be admitted. The general community, in civil life, in- cludes not only the strong and healthy, but also the defective, the weak, and the sick, the blind, the halt, the consumptive, the rheumatic, the immature in childhood, and the exhausted and decrepit in age. In the enlistment of recruits, the can- didates for the army are rigidly examined, and none are admitted except such as appear to be mentally and physically feound and perfect. Hence, many who of- fer their services to the Government are rejected, and sometimes the proportion accepted is very small. In Great Britain and Ireland, during the twenty years from 1832 to 1851 inclusive, 305,897 applied for admission into the British army. Of these, 97,457, or 32 per cent., were rejected, and only 208,440, or 68 per cent., were accepted.* In France, during thirteen years, 1831 * Report on the Sanitary Condition of the British Army, p. 498. to 1843 inclusive, 2,280,540 were offered for examination as candidates for the army. Of these, 182,664, being too short, though perhaps otherwise in possession of all the requisites of Ijealth, were not examined, leaving 2,097,876, who were considered as candidates for examination. Of these, 680,560, or 32.5 per cent, were rejected on account of physical unfitness, and only 1,417,316, or 67.5 per cent., were allowed to join the army.* The men who ordinarily offer for the American army, in time of peace, are of still inferior grade, as to health and strength. In the year 1852, at the sev- eral recruiting-stations, 16,114 presented themselves for enlistment, and 10,945, or 67.9 per cent., were rejected, for reasons not connected with health: — 3,162 too young, 732 too old, 1,806 too short, 657 married, 2,434 could not speak English, 32 extremely ignorant, 1,965 intemperate, 106 of bad morals, 51 had been in armies from which they had deserted. Total, 10,945 All of these may have been in good health. Of the remainder, 5,169, who were subjects of further inquiry, 2,443 were rejected for reasons connected with their physical or mental condition : — 243 mal-formed, 630 unsound in physical constitution, 16 unsound in mind, 114 had diseased eyes, 55 had diseased ears, 314 had hernia, 1,071 had varicose veins, Total, 2,443 Only 2,726 were accepted, being 52.7 per cent, of those who were examined, and less than 1 7 per cent., or about one- * Report on the Sanitary Condition of the British Army, p. 499. 464 Sanitary Condition of the Army. [October, sixth, of all who offered themselves as candidates for the army, in that year.* In time of peace, the character of the men who desire to become soldiers dif- fers with the degree of public prosperity. When business is good, most men obtain employment in the more desirable and profitable avocations of civil life. Then a larger proportion of those who are will- ing to enter the army are unfitted, by their habits or their health, for the occu- pations of peace, and go to the rendezvous only as a last resort, to obtain their bread. But when business falters, a larger and a better class are thrown out of work, and are glad to enter the service of the country by bearing arms. The year 1852 was one of prosperity, and affords, there- fore, no indication of the class and char- acter of men who are willing to enlist in the average years. The Government Reports state that in some other years 6,383 were accepted and 3,617 rejected out of 10,000 that offered to enlist. But in time of war, when the country is en- dangered, and men have a higher mo- tive for entering Its service than mere employment and wages, those of a better class both as to character and health Hock to the army ; and in the present war, the army is composed, in great degree, of men of the highest personal character and social position, who leave the. most desirable and lucrative employments to serve their country as soldiers. As, then, the army excludes, or intends to exclude, from its ranks all the defective, weak, and sick, it begins with a much higher average of health and vigor, a greater power of action, of endurance, and of resisting the causes of disease, than the mass of men of the same ages in civil life. It is composed of men in the fulness of strength and efficiency. This is the vital machinery with which Governments pro- pose to do their martial work; and the amount of vital force which belongs to these living machines, severally and col- lectively, Is the capital with which they in- tend to accomplish their purposes. Every * Medical Statistics of the United States Ar- my, 1839-54, p. 625. wise Government begins the business of war with a good capital of life, a large quantity of vital force in Its army. So far they do well ; but more is necessary. This complete and fitting preparation alone is not sufficient to carry on the martial pro- cess through weeks and months of labor and privation. Not only must the living machinery of bone and flesh be well se- lected, but its force must be sustained. It must be kept in the most effective con- dition and In the best and most available working order. For this there are two established conditions, that admit of no variation nor neglect: first, a sufficient supply of suitable nutriment, and faithful regard to all the laws of health ; and, sec- ond, the due appropriation of the vital force that Is thus from day to day creat- ed. A due supply of appropriate food and of pure air, sufficient protection and cleans- ing of the surface, moderate labor and refreshing rest, are the necessary con- ditions of health, and cannot be disre- garded. In the least degree, without a loss of force. The privation of even a single meal, or the use of food that is hard of digestion or innutritious, and the loss of any of the needful sleep, are fol- lowed by a corresponding loss of effective power, as surely as the slackened fire in the furnace is followed by lessened steam and power In the engine. Whosoever, then, wishes to sustain his own forces or those of his laborers with the least cost, and use them with the greatest effect, must take Nature on her own terms. It is vain to try to evade or alter her conditions. The Kingdom of Heaven is not divided against itself. It makes no compromises, not even for the necessities of nations. It will not consent that any one, even the least, of its laws shall be set aside, to advance any other, however important. Each single law stands by itself, and exacts complete obedience to its own requirements : it gives Its own rewards and Inflicts its own punishments. The stomach will not di- gest tough and hard or old salted meats, or heavy bread, without demanding and 1862.] Sanitary Condition of the Army. 465 receiving a great and perhaps an almost exhausting proportion of the nervous en- ergies. The nutritive organs will not cre- ate vigorous muscles and effective limbs, unless the blood is constantly and appro- priately recruited. The lungs will not decarbonize and purify the blood with foul air, that has been breathed over and over and lost its oxygen. However noble or holy the purpose for which human power is to be used, it will not be created, except according to the established con- ditions. Tlie strength of the warrior in battle cannot be sustained, except in the appointed way, even though the fate of all humanity depend on his exertions. Nature keeps an exact account with all her children, and gives power in pro- portion to their fulfilment of her condi- tions. She measures out and sustains vital force according to the kind and fitness of the raw material provided for her. When we deal liberally with her, she deals liberally with us. For everything we give to her she makes a just return. The stomach, the nutrient arteries, the lungs, have no love, no patriotism, no pity ; but they are perfectly honest. The healthy digestive organs will extract and pay over to the blood-vessels just so much of the nutritive elements as the food we eat contains in an extractible form, and no more ; and for this purpose they will demand and take just so much of the nervous energy as may be needed. The nutrient arteries will convert into living flesh just so much of the nutritive ele- ments as the digestive organs give them, and no more. The lungs will send out from the body as many of the atoms of exhausted and dead flesh as the oxygen we give them will convert into carbonic acid and water, and this is all they can do. In these matters, the vital organs are as honest and as faithful as the boiler, that gives forth steam in the exact ratio of the heat which the burning fuel evolves and the fitness of the water that is sup- plied to It ; and neither can be persuaded to do otherwise. The living machine of bone and flesh and the dead machine of iron prepare their forces according to VOL. X. 30 the means they have, not according to the ulterior purpose to which those forces are to be applied. They do this alike for all. They do it as well for the sinner as for the saint, — as well for the traitorous Secessionist striving to destroy his country as for the patriot endeavoring to sustain it. In neither case is it a matter of will, but of necessity. The amount of power to be generated in both living and dead machines Is simply a question of quality and quantity of provision for the purpose. So much food, air, protection given pi'o- duce so much strength. A proposition to reduce the amount of either of these necessarily involves the proposition to reduce the available force. Whoever determines to eat or give his men less or poorer food, or impure air, practically determines to do less work. In all this management of the human body, we are sure to get what we pay for, and we are equally sure not to get what we do not pay for. All Governments have ti-Ied, and are now, in various degrees, trying, the ex- periment of privation in their arinies. The soldier cannot carry with him the usual means and comforts of home. He must give these up the moment he enters the martial ranks, and reduce his appa- ratus of hving to the smallest possible quantity. He must generally hmit him- self to a portable house, kitchen, cook- ing-apparatus, and wardrobe, and to an entire privation of furniture, and some- times submit to a complete destitution of everything except the provision he may carry In his haversack and the blanket he can carry on his back. When sta- tionary, he commonly sleeps In barracks; but he spends most of his time in the field and sleeps in tents. Occasionally he is compelled to sleep in the open air, without any covering but his blanket, and to cook In an extemporized kitchen, which he may make of a few stones piled together or of a hole in the earth, with only a kettle, that he carries on his back, for cooking-apparatus. In all cases and conditions, whether in fort or in field, in barrack, tent, or open air, he is limited 466 Sanitary Condition of the Army. [October, to the smallest artificial habitation, the least amount of furniture and convenien- ces, the cheapest and most compact food, and the rudest cookery. He is, there- fore, never so well protected against the elements, nor, when sleeping under cover, so well supplied with air for respiration, as he is at home. Moreover, when lodg- ing abroad, he cannot take his choice of places; he is liable, from the necessities of war, to encamp in wet and malarious spots, and to be exposed to chills and mi- asms of unhealthy districts. He is neces- sarily exposed to weather of every kind, — to cold, to rains, to storms ; and when wet, he has not the means of warming himself, nor of drying or changing his clothing. His life, though under martial discipline, is irregular. At times, he has to undergo severe and protracted labors, forced marches, and the violent and long- continued struggles of combat ; at other times, he has not exercise sufficient for health. His food is irregularly served. He is sometimes short of provisions, and compelled to pass whole days in absti- nence or on short allowance. Occasion- ally he cannot obtain even water to drink, through hours of thirsty toil. No Govern- ment nor managers of war have ever yet been able to make exact and unfailing provision for the wants and necessities of their armies, as men usually do for themselves and their families at home. SUPPOSED DAXGERS TO THE SOLDIER. From the earliest recorded periods of the world, men have gone forth to war, for the purpose of destroying or overcom- ing their enemies, and with the chance of being themselves destroyed or over- thrown. Public authorities have gen- erally taken account of the number of their own men who have been wound- ed and killed in battle, and of the casu- alties in the opposing armies. Gunpow- der and steel, and tlie manifold weap- ons, instruments, and means of destruc- tion in the hands of the enemy are com- monly considered as the principal, if not the only sources of danger to the soldier, and ground of anxiety to his friends ; and the nation reckons its losses in war by the number of those Avho were wounded and killed in battle. But the suflering and waste of life, apart from the combat, the sickness, the depreciation of vital force, the withering of constitutional en- ergy, and the mortality in camp and for- tress, in barrack, tent, and hospital, have not usually been the subjects of such careful observation, nor the grounds of fear to the soldier and of anxiety to those who are interested in his safety. Conse- quently, until within the present century, comparatively little attention has beeu given to the dangers that hang over the army out of the battle-field, and but little provision has been made, by the combatants or their rulers, to obviate or relieve them. No Government in former times, and few in later years, have taken and published complete accounts of the diseases of their armies, and of the deaths that followed in consequence. Some such records have been made and printed, but these are mostly fragmentary and par- tial, and on the authority of individu- als, officers, surgeons, scholars, and phil- anthropists. It must not be forgotten that the army is originally composed of picked men, while the general community Includes not only the imperfect, diseased, and weak that belong to itself, but also those who are rejected from the army. If, then, the conditions, circumstances, and habits of both were equally favorable, there would be less sickness and a lower rate of mor- tality among the soldiers than among men of the same ages at home. But if in the army there should be found more sick- ness and death than In the community at home, or even an equal amount, it is mani- festly chargeable to the presence of more deteriorating and destructive influences In the military than in civil life. SICKNESS AND MORTALITY IN CIVIL LIFE. The amount of sickness among the people at home is not generally recog- 1862.] Sanitary Condition of the Army. 467 nized, still less is it carefully measured and recorded. But the experience and calculations of tlie Friendly Societies of Great Britain, and of other associations for Health -Assurance there and else- where, afford sufficient data for deter- mining the proportion of time lost in sickness by men of various ages. These Friendly Societies are composed mainly of men of the working-classes, from which most of the soldiers of the British army are drawn. According to the calculations and ta- bles of Mr. Ansel, in his work on " Friend- ly Societies," the men of the army-ages, from 20 to 40, in the working-classes, lose, on an average, five days and six-tenths of a day by sickness in each year, which will make one and a half per cent, of the males of this age and class constantly sick. Mr. Nelson's calculations and tables, in his " Contributions to Vital Statistics," make this average somewhat over seven days' yearly sickness, and one and ninety-two hundredths of one per cent, constantly sick. These were the bases of the rates adopted by the Health -Assurance com- panies in New England, and their expe- rience shows that the amount of sickness in these Northern States is about the same as, if not somewhat greater than, that in Great Britain, among any definite num- ber of men. The rate of mortality is more easily ascertained, and is generally calculated and determined in civilized nations. This rate, among all classes of males, between 20 and 40 years old, in England and Wales, is .92 per cent. : that is, 92 will die out of 10,000 men of these ages, on an average, in each year ; but in the health- iest districts the rate is only 77 in 10,000. The mortality among the males of Massa- chusetts, of the same ages, according to Mr. Elliott's calculations, is 1.11 per cent, or 111 In 10,000. This maybe safely as- sumed as the rate of mortality in all New England. That of the Southern States is somewhat greater. These rates of sickness and death — one and a half or one and ninety-two hundredths per cent, constantly sick, and seventy-seven to one hundred and eleven dying, in each year, among ten thousand hving — may be considered as the pro- portion of males, of the army-ages, that should be constantly taken away from active labor and business by illness, and that should be annually lost by death. Whether at home, amidst the usually favorable circumstances and the average comforts, or in the army, under privation and exposure, men of these ages may be presumed to be necessarily subject to this amount, at least, of loss of vital force and life. And these rates may be adopted as the standard of comparison of the sanita- ry Influences of civil and military life. SICKNESS AND MORTALITY OF THE ARMY IN PEACE. Soldiers are subject to different in- fluences and exposures, and their waste and loss of life differ. In peace and war. In peace they are mostly stationary, at posts, forts, and in cantonments. They generally live in barracks, with fixed hab- its and sufficient means of subsistence. They have their regular supplies of food and clothing and labor, and are protect- ed from the elements, heat, cold, and storms. They are seldom or never sub- jected to privation or excessive fatigue. But in war they are In the field, and sleep in tents which are generally too full and often densely crowded. Sometimes they sleep In huts, and occasionally In the open air. They are liable to exposures, hard- ships, and privations, to uncertain sup- plies of food and bad cookery. The report of the commission appoint- ed by the British Government to inquire Into the sanitary condition of the army shows a remarkable and unexpected de- gree of mortality among the troops sta- tioned at home under the most favorable circumstances, as well as among those abroad. The Foot-Guards are the very elite of the whole army ; they are the most perfect of the faultless In form and in health. They are the pets of the Govern- ment and the people. They are station- ed at London and Windsor, and lodged in 468 Sanitary Condition of the Army. [October, magnificent barracks, apparently ample for their accommodation. They are cloth- ed and fed with extraordinary care, and are supposed to have every means of health. And yet their record shows a sad difference between their rate of mortal- ity and that of men of the same ages in civil life. A similar excess of mortality ■was found to exist among all the home- army, which includes many thousand sol- diers, stationed in various towns and pla- ces throughout the kingdom. The following table exhibits the annual mortality in these classes.* DEATHS IN 10,000. »^ a O o o > <_ o B cr? ^ 6 1 ? BS != > P » •-1 "-J B ^ '< 20 to 25 84 216 170 25 to 30 92 211 183 30 to 35 102 195 184 35 to 40 116 224 193 Through the fifteen years from 1839 to 1853 inclusive, the annual mortality of all the army, excepting the artillery, engi- neers, and West India and colonial corps, was 330 among 10,000 living; while that among the same number of males of the army-ages, in all England and Wales, was 92, and in the healthiest districts only 77.f There is no official account at hand of the general mortality in the Russian army on the peace-establishment ; yet, ac- cording to Boudin, in one portion, con- sisting of 192,834 men, 144,352 had been sick, and 7,541, or 38 per 1,000, died in one year. % The Prussian army, with an average of 150,582 men, lost by death, during the ten years 1829 to 1838, 1,975 in each year, which is at the rate of 13 per 1,000 living. § The mortality of the Piedmontese ar- * Report on the Sanitary Condition of the British Army, t Ibid. X Traite de GeograjMe et de Statistique Medi- cnles, Tom. II. p. 239. § Ibid. p. 286. my, from 1834 to 1843 inclusive, was 158 in 10,000, while that of the males at home was 92 in the same number living. From 1775 to 1791, seventeen years, the mortaUty among the cavalry was 181, and among the infantry 349, out of 10,000 living ; but in the ten years from 1834 to 1843 these rates were only 108 and 215.* Colored troops are employed by the British Government in all their colonies and possessions in tropical climates. The mortality of these soldiers is known, and also that of the colored male civilians in the East Indies and in the West- India Islands and South-American Provinces. In four of these, the rate of mortality is higher among the male slaves than among the colored soldiers ; but in all the oth- ers, this rate is higher in the army. In all the West-Indian and South- American possessions of Great Britain, the average rate of deaths is 25 per cent, greater among the black troops than among the black males of all ages on the plantations and in the towns. The soldiers are of the healthier ages, 20 to 40, but the civil- ians include both the young and the old : if these could be excluded, and the com- parison made between soldiers and labor- ers of the same ages, the difference in fa- vor of civil pursuits would appear much greater. Throughout the world, where the ar- mies of Great Britain are stationed or serve, the death-rate is greater among the troops than among civilians of the same races and ages, except among the colored troops in Tobago, Montserrat, Antigua, and Granada in America, and among the Sepoys in the East Indies, f In the army of the United States, during the period from 1840 to 1854, not including the two years of the Mexi- can War, there was an average of 9,278 men, or an aggregate of 120,622 years of service, equal to so many men serv- ing one year. Among these and dur- * Traite de Geoc/raphie etde Statistique Medi- cates, Tom. II. p. 284. t Report on the Sanitary Condition of the Bntish Ai-my. 1862.] Sanitary Condition of the Army. 469 ing this period, there were 342,107 cases of sickness reported by tlie surgeons, and 3,416 deaths from disease, show- ing a rate of mortality of 2.83 per cent., or two and a half times as gi-eat as that among the males of Massachusetts of the army -ages, and three times as great as that in England and Wales. The attacks of sickness average almost three for each man in each year. This is manifestly more than that which falls upon men of these ages at home.* SICKNESS AND MORTALITY OF THE ARMY IN WAR. Thus far the sickness and mortality of the army in time of peace only has been considered. The experience of war tells a more painful story of the dan- gers of the men engaged in it. Sir John Pringle states, that, in the British armies that were sent to the Low Countries and Germany, in the years 1743 to 1747, a great amount of sickness and mortality prevailed. He says, that, besides those ■who were suffering from wounds, " at some periods more than one-fifth of the army were in the hospitals." *' One regiment had over one-half of its men sick." " In July and August, 1743, one-half of the army had the dysentery." " In 1 747, four battalions," of 715 men each, "at South Beveland and Walcheren, both in field and in quarters, were so very sickly, thatj at the height of the epidemic, some of these corps had but one hundred men fit for duty ; six-sevenths of their numbers were sick."f "At the end of the cam- paign the Royal Battalion had but four men who had not been ill." And " when these corps went into winter -quarters, their sick, in proportion to their men fit for duty, were nearly as four to one." % In 1 748, dysentery prevailed. " In one regiment of 500 men, 150 were sick at the end of five weeks ; 200 were sick af- * Medical Statistics U. S. Army, 1839-54, p. 491, etc. t Observations on the Diseases of the Army, p. 51. \ lb., p. 53. ter two months ; and at the end of the campaign, they had in all but thirty who had never been ill." " In Johnson's reg- iment sometimes one-half were sick ; and in the Scotch Fusileers 300 were ill at one time."* The British army in Egypt, in 1801, had from 103 to 261 and an average of 182 sick in each thousand ; and the French army had an average of 125 in 1,000, or one-eighth of the whole, on the sick- list, t In July, 1809, the British Government sent another army, of 39,219 men, to the Netherlands. They were stationed at Walcheren, which was the principal seat of the sickness and sufiering of their pre- decessors, sixty or seventy years before. Fever and dysentery attacked this sec- ond army as they had the first, and with a similar virulence and destructiveness. In two months after landing, Sept. 13, 7,626 were on the sick-list. " 19, 8,123 " " " 21, -6,684 » •" " 23, 9,046 " " In ninety-seven days 12,867 were sent home sick ; and on the 2 2d of October there were only 4,000 effective men left fit for duty out of this army of about 40,000 healthy men, who had left England within less than four months. On the 1st of Feb- ruary of the next year, there were 11,513 on the sick-list, and 15,570 had been lost or disabled. Between January 1st and June of the same year, (1810,) 36,500 were admitted to the hospitals, and 8,000, or more than 20 per cent., died, which is equal to an annual rate of 48 per cent, mortality. The British army in Spain and Portu- gal suffered greatly through the Penin- sular War, from 1808 to 1814. During the whole of that period, there was a con- stant average of 209 per 1,000 on the sick- list, and the proportion was sometimes swelled to 330 per 1,000. Through the * Observations on the Diseases of the Army,. p. 59. t London Statistical Journal, Vol. XIX. p. 247. 470 Sanitary Condition of the Army. [October, forty-one months ending May 25th, 1814, "vvith an average of 61,511 men, there was an average of 13,815 in the hospitals, Tvhich is 22.5 per cent. ; of these only one-fifteenth, or 1.5 per cent, of the whole army, were laid up on account of injuries in battle, and 21 per cent, were disabled by diseases. From these causes 24,930 died, which is an annual average of 7,296, or a rate of 11.8 per cent, mortality.* No better authority can be adduced, for the condition of men engaged in the actual service of war, than Lord Welling- ton. On the 14th of November, 1809, he wrote from his army in Spain to Lord Liverpool, then at the head of the British Government, — " In all times and places the sick-list of the army amounts to ten per cent of all." f He seemed to consid- er this the lowest attainable rate of sick- ness, and he hoped to be able to reduce that of his own army to it : this is more than five times as great as the rate of sickness among male civilians of the army- ages. The sickness in Lord Wellington's army, at the moment of writing this de- spatch, was fifteen per cent., or seven and a half times as great as that at home. In the same Peninsular War, there was of the sick in the French army a con- stant average of 136 per 1,000 in Spain, and 146 per 1,000 in Portugal. Mr. Ed- monds says, that, just before the Battle of Talavera, the French army consisted of 275,000 men, of whom 61,000, or 22.2 per cent., were sick.J Lord Wellington wrote, Sept. 19, 1809, that the French ar- my of 225,000 men had 30,000 to 40,000 sick, which is 13.3 to 17.7 per cent. The French army in Portugal had at one time 64 per 1,000, and at another 235 per 1,000, and an average of 146 per 1,000, in the hospitals through the war. The British army that fought the Bat- tle of Waterloo, in 1815, had an average of 60,992 men, through the campaign of four months, June to September ; of these, " * Edmonds ia London Lancet, Vol. XXXVI. p. 143. t Despatches. X Edmonds in London Lancet, Vol. XXXVI. p. 145. there was an average of 7,909, or 12.9 per cent., in the hospitals.* The British legion that went to Spain in 1836 consisted of 7,000 men. Of these, 5,000, or 71 per cent, were admit- ted into the hospitals in three and a half months, and 1,223 died in six months. This is equal to an annual rate of almost two and a half, 2.44, attacks for each man, and of 34.9 per cent, mortality, f " Of 115,000 Prussians who invaded Turkey in 1828 and 1829, only 10,000 or 15,000 ever repassed the Pruth. The rest died there of intermittent fevers, dysenteries, and plague." " From May, 1828, to February, 1829, 210,108 patients were admitted into the general and regi- mental hospitals." "In October, 1828, 20,000 entered the general hospitals." " The sickness was very fatal." " More than a quarter of the fever-patients died." " 5,509 entered the hospitals, and of these, 3,959 died in August, 1829, and only 614 ultimately recovered." " At Brailow the plague attacked 1,200 and destroyed 774." " Dysentery was equally fatal." " In the march across the Balkan, 1,000 men died of diarrhoea, fever, and scurvy." " In Bulgaria, during July, 37,000 men were taken sick." " At Adrlanople a vast bar- rack was taken for a hospital, and in three days 1,616 patients were admitted. On the first of September there were 3,666, and on the 15th, 4,646 patients in the house. This was one-quarter of all the disposable force at that station." " In Oc- tober, 1,300 died of dysentery ; and at the end of the month there were 4,700 in the hospitals." " In the whole army the loss to the Russians in the year 1829 was at least 60,000 men."$ CRIMEAN WAR. In 1854, twenty-five years after this fatal experience of the Russian army in * Edmonds in London Lancet, Vol. XXXVI. p. 148. t Ih., p. 219. { Boudin, Traite de Geographie et de Statis- iique Miidicales, Tom. II. p. 289, etc., quoted by him from Major Moltka. 1862.] Sanitary Condition of the Army. 471 Bulgaria, the British Government sent an army to the same province, where the men -were exposed to the same diseases and suffered a similar depreciation of vital force in sickness and death. For two years and more they struggled with these destructive influences in their own camps, in Bulgaria and the Crimea, with the usual result of such exposures in the waste of life. From April 10, 1854, to June 30, 1856, 82,901 British soldiers were sent to the Black Sea and its coasts ; and through these twenty-six and two- thirds months the Bi-itish army had an average of 34,559 men engaged in that " War in the East " with Russia. From these there were furnished to the gen- eral and regimental, the stationary and movable hospitals 218,952 cases: 24,084, or 11 per cent, of these patients were wounded or injured in battle, and 194,- 868, or 89 per cent., suffered from the diseases of the camp. This is equal to an annual average of two and a half at- tacks of sickness for each man. The published reports give an analysis of on- ly 162,123 of these cases of disease. Of these, 110,673, or 68 per cent., were of the zymotic class, — fevers, dysenteries, scurvy, etc., which are generally sup- posed to be due to exposure and priva- tion, and other causes which are subject to human control. During the two years ending with March, 1856, 16,224 died of diseases, of which 14,476 were of the zy- motic or preventable class, 2,755 were killed in battle, and 2,019 died of wounds and injuries received in battle. The an- nual rate of mortality, from all diseas- es, was 23 per cent. ; from zymotic dis- eases, 21 per cent. ; from battle, 6.9 per cent. The rate of sickness and mortality varied exceedingly in different months. In April, May, and June, 1854, the deaths were at the annual rate of 8.7 per 1,000 ; in July, 159 per 1,000; in August and September, 340 per 1,000; in December, this rate again rose and reached 679 per 1,000 ; and in January, 1855, owing to the great exposures, hardships, and privations in the siege, and the very imperfect means of sustenance and protection, the mortal- ity increased to the enormous rate of 1,142 per 1,000, so that, if it had continued un- abated, it would have destroyed the wholo army in ten and a half months.* AMERICAN ARMY, 1812 TO 1814. We need not go abroad to find proofs of the waste of life in military camps. Our own army, in the war with Great Britain in 1812-14, suffered, as the Euro- pean armies have done, by sickness and death, far beyond men in civil occupa- tions. There are no comprehensive re- ports, published by the Government, of the sanitary condition and history of the army on the Northern frontier during that war. But the partial and fragmen- tary statements of Dr. Mann, in his " Medical Sketches," and the occasional and apparently incidental allusions to the diseases and deaths by the commanding- officers, in their letters and despatches to the Secretary of War, show that sickness was sometimes fearfully pi-evalent and fatal among our soldiers. Dr. Mann says : " One regiment on the frontier, at one time, counted 900 strong, but was reduced, by a total want of a good police, to less than 200 fit for duty." " At one period more than 340 were in the hospitals, and, in addition to this, a large number were reported sick in camp." f " The aggre- gate of the army at Fort George and its dependencies was about 5,000. From an estimate of the number sick in the gen- eral and regimental hospitals, it was my persuasion that but little more than half of the army was capable of duty, at one period, during the summer months":!: of 1813. "During the month of August more than one-third of the soldiers were on the sick-reports." § Dr. Mann quotes Dr. Lovell, another army -surgeon, who says, in the autumn of 1813 : "A morn- ing report, now before me, gives 75 sick, out of a corps of 160. The several regi- ments of the army, in their reports, ex- * Report on the Sanitary Condition of the British Army, p. 524. t Medical S/cetches, p. 39. t ]b., p. 204. § lb., p. 66. 472 Sanitary Condition of the Army. [October, liibit a proportional number unfit for du- ty." * Dr. Mann states that " the troops at Burlington, Vt., in the winter of 1812- 13, did not number over 1,600, and the deaths did not exceed 200, from the last of November to the last of February." j- But Dr. Gallup says : " The whole num- ber of deaths Is said to be not less than 700 to 800 in four months," and " the number of soldiers stationed at this en- campment [Burlington] was about 2,500 to 2,800." t According to Dr. Mann's statement, the mortality was at the annual rate of 50 per cent. ; and according to that of Dr. Gallup, it was at the rate of 75 to 96 per cent. This is nearly equal to the severest mortality in the Crimea. General William H. Harrison, writing to the Secretary of War from the borders of Lake Erie, Aug. 29, 1813, says: "You can form some estimate of the deadly effects of the immense body of stagnant ■water with which the vicinity of the lake abounds, from the state of the troops at Sandusky. Upwards of 90 are this morning reported sick, out of about 220." This is a rate of over 40 per cent. " Those at Fort Meigs are not much bet- ter." § General Wilkinson wrote from Fort George, Sept. 16, 1813: "We count, on paper, 4,600, and could show 3,400 com- batants " ; that is, 25 per cent, and more are sick. " The enemy, from the best in- formation we have, have about 3,000 on paper, of whom 1,400," or 46.6 per cent., " are sick." || MEXICAN WAR. There was a similar waste of life among our troops in the Mexican War. There is no published record of the num- ber of the sick, nor of their diseases. But the letters of General Scott and General Taylor to the Secretary of War show that the loss of effective force in our ar- * MecKcal Sketches, p. 119. t Jb., p. 199. J On Epidemics, p. 70. § United States Documents, 1814. II lb., 1814. my was at times very great by sickness in that war. General Scott wrote : — " Puehla, July 25, 1847. " May 30, the number of sick here was 1,017, of effectives 5,820." " Since the arrival of General Pillow, we have effectives (rank and file) 8,061, sick 2,215, beside 87 officers under the latter head." * Again : — " Mexico, Dec. 5, 1847. " The force at Chapultepcc fit for duty is only about 6,000, rank and file; the number of sick, exclusive of officers, be- ing 2,041." -f According to these statements, the pro- portions of the sick were 17.4 to 27.4 and 24.7 per cent, of all in these corps at tho times specified. General Taylor wrote : — " Camp near Monterey, July 27, 1847. " Great sickness and mortality have prevailed among the volunteer troops in front of Saltillo." % August lOth, he said, that " nearly 23 per cent, of the force present was disabled by disease." The official reports show only the num- ber that died, but make no distinction as to causes of death, except to separate the deaths from wounds received in battle ' from those from other causes. During that war, 100,454 men were sent to Mexico from the United States. They were enlisted for various periods, but served, on an average, thirteen months and one day each, making a total of 109,104 years of military service ren- dered by our soldiers in that Avar. The total loss of these men was 1,549 killed in batde or died of wounds, 10,986 died from diseases, making 12,535 deaths. Be- sides these, 12,252 were discharged for. disability. The mortality from disease was almost equal to the annual rate of 11 per cent., which is about ten times as * Executive Documents, U. S., 1847-48, Vol. VII. p. 1013. t Ih., p. 1033. t 11., p. 1185. 1862.] Sanitary Condition of the Army. 473 great as that of men in ordinary civil life at home. SICKNESS IN THE PRESENT UNION ARMY. There are not as yet, and for a long time there cannot be, any full Govern- ment reports of the amount and kind of sickness in the present army of the Unit- ed States. But the excellent reports of the inquiries of the Sanitary Commis- sion give much important and trustwor- thy information in respect to these mat- ters. Most of the encampments of all the corps have been examined by their in- spectors ; and their returns show, that the average number sick, during the seven months ending wifeh February last, was, among the troops who were recruited in New England 74.6, among those from the Middle States 56.6, and, dunng six months ending with January, among those from the Western States 104.3, in 1,000 men. From an examination of 217 regi- ments, during two months ending the middle of February, the rate of sickness among the troops in the Eastern Sanitary Department was 74, in the Central De- partment, Western Virginia and Ohio, 90, and in the Western, 107, in 1,000 men. The average of all these regiments was 90 in 1,000. The highest rate in Eastern Virginia was 281 per 1,000, in the Fifth Vermont ; and the lowest, 9, in the Seventh Massachusetts. In the Cen- tral Department the highest was 260, in the Forty-First Ohio ; and the lowest, 1 7, in the Sixth Ohio. In the Western De- partment the highest was 340, in the Forty -Second Illinois; and the lowest, 15, in the Thirty- Sixth Illinois. On the 22d of Febi-uary, the number of men sick in each 1,000, in the several divisions of the Army of the Potomac, was ascertained to be, — Keyes's, 30.3 Sedgwick's, 32.0 Hooker's, 43.7 McCall's 44.4 Banks's, 45.0 Porter's 46.4 Blenker's, .... 47.7 McDowell's, . . 48.2 Heintzehiiaii's, . 49.0 Franklin's, . 54.1 Dix's, 71.8 United States Regulars, . . 76.0 Sumner's, .... 77.5 Smith's, .... . 81.6 Casey's, . . . . . 87.6* Probably there has been more sickness in all the armies, as they have gone far- ther southward and the warm season has advanced. This would naturally be ex- pected, and the fear is strengthened by the occasional reports in the newspapers. Still, taking the trustworthy reports hei'ein given, it is manifest that our Union army is one of the healthiest on record ; and yet their rate of sickness is from three to five times as great as that of civilians of their own ages at home. Unquestionably, this better condition of our men is due to the better intelligence of the age and of our people, — especially in respect to the dan- gers of the field and the necessity of prop- er provision on the part of the Govern- ment and of self-care on the part of the men, — to the wisdom, labors, and com- prehensive watchfulness of the Sanitary Comnnssion, and to the universal sympa- thy of the men and women of the land, who have given their souls, their hands, and their money to the work of lessen- ing the discomforts and alleviating the sutferings of the Army of Freedom. OTHER LIGHTER AND UNRECORDED SICKNESS. The records and reports of the sick- ness in the army do not include all the depreciations and curtailments of life and strength among the soldiers, nor all the losses of effective force which the Govern- ment suffers through them, on account of disease and debility. These records con- tain, at best, only such ailments as are of sufficient importance to come under the observation of the surgeon. But there are manifold lighter physical disturbances, which, though they neither prostrate the * MS. Letter of Mr. Elliott, Actuary of tlie Sanitary Commission. 474 Sanitary Condition of the Army. [October, patient, nor even cause liim to go to the hospital, yet none the less certainly unfit him for labor and duty. Of the regiment referred to by Dr. Mann, and already ad- duced in this article, in which 700 were unable to attend to duty, 340 were in the hospital under the surgeon's care, and 360 were ill in camp. It is probable that a similar, though smaller, discrepancy often exists between the surgeon's records and the absentees from parades, guard-duty, etc. It is improbable, and even impossible, that complete records and reports should always be made of all who are sick and unfit for duty, or even of all who come under the surgeon's care. Sir John Hall, principal Medical Officer of the British army in the Crimea, says that there were "218,952 admissions into hospitah" * " The general return, showing the pri- mary admissions into the hospitals of the army in the East, from the 10th April, 1854, to the 30th June, 1856, gives only 162,123 cases of all kinds." f But an- other Government Report states the ad- missions to be 1 6 2,6 73. t Miss Nightin- gale says, " There was, at first, no system of registration for general hospitals, for all were burdened with work beyond their strength." § Dr. Mann says, that, in the War of 1812, " no sick-records were found in the hospital at Burlington," one of the largest depositories of the sick then in the country. " The hospital-records on the Niagara were under no order." || It could hardly have been otherwise. The regi- mental hospitals then, as frequently must be the case in war, were merely extem- porized shelters, not conveniences. They were churches, houses, barns, shops, sheds, or arky building that happened to be with- in reach, or huts, cabins, or tents sudden- ly created fur the purpose. In these all the surgeons' time, energy, and resources * Report cm the Sanitary Condition of the Brit- ish Army, p. 180. t lb., 525. I Medical and Surgical ITistory of the War in the East, Vol. II. p. 252. § Report on the Sanitary Condition of the Brit- ish Army, p. 377. II Medical Sketches, p. 246. were expended in making their patients comfortable, in defending them from cold and storm, or from suffering in their crowded rooms or shanties. They were obliged to devote all their strength to taking care of the present. They could take little account of the past, and were often unable to make any record for the future. They could not do this for those under their own immediate eye in the hospital ; much less could they do it for those who remained in their tents, and needed little or no medical attention, but only rest. Moreover, the exposures and labors of the campaign sometimes diminish the number and force of the surgeons as well as of the men, and re- duce their strength at the very moment when the greatest demand is made for their exertions. Dr. Mann says, " Tlie sick in the hospital were between six and seven hundred, and there were only three surgeons present for duty." " Of seven surgeons attached to the hospital depart- ment, one died, three were absent by rea- son of indisposition, and the other three were sick."* Fifty-four surgeons died in the Russian army in Turkey in the sum- mer of 1828. " At Brailow, the pestilence spared neither surgeons nor nurses." f Sir John Hall says, " The medical offi- cers got sick, a great number went away, and we were embarrassed." " Thirty per cent, were sometimes sick and absent" from their posts in the Crimea. $ Seven- ty surgeons died in the French army in the same war. It is not reasonable, then, to suppose that all or nearly all the cas- es of sickness, whether in hospital or in camp, can be recorded, especially at times when they are the most abundant. Nor do the cases of sickness of every sort, grave and light, recorded and un- recorded, include all the depressions of vital energy and all the suspensions and loss of effective force in the army. When- ever any general cause of depression * Medical Sketches, p. 66. t Boudin, Traite de Geographic et de Sta- tislique Medicales, Tom. II., p. 289. I Report on the Sanitary Condition of the Brit- ish Army, p. 180. 1862.] Sanitary Condition of the Army. 475 ■weighs upon a body of men, as fatigue, cold, storm, privation of food, or malaria, it vitiates the power of all, in various de- gi'ees and with various results ; the weak and susceptible are sickened, and all lose some force and are less able to labor and attend to duty. No account is taken, none can be taken, of this discount of the general force of the army ; yet it is none the less a loss of strength, and an imped- iment to the execution of the purposes of the Government. INVALIDING. The loss of force by death, by sickness in hospital and camp, and by temporary depression, is not all that the army is sub- ject to. Those who are laboring under consumption, asthma, epilepsy, insanity, and other Incurable disorders, and those whose constitutions are broken, or with- ered and reduced below the standard of military requirement, are generally, and by some Governments always, discharged. These pass back to the general communi- ty, where they finally die. By this pro- cess the army is continually sifting out its worst lives, and at the same time it fills their places with healthy recruits. It thus keeps up its average of health and diminishes its rate of mortality ; but the sum and the rates of sickness and mor- tality in the community are both there- by increased. During the Crimean War, 17.34 per cent, were invalided and sent home from the British army, and 21 per cent, from the French army, as unable to do military service. By this means, 11,994* British and 65,069 f .French soldiers were lost to their Governments. The army of the United States, in the Mexican War, dis- charged and sent home 12,252 men, or 12 per cent, of the entire number engaged in that war, on account of disability. The causes of this exhaustion of per- sonal force are manifold and various, and * Medical and Surgical Ilistory of die British Army in the East, Vol. II. p. 227. t British and Foreign Medical and Surgical Journal, Vol. XXI. SO generally present that the number and proportion of those who are thus hope- lessly reduced below the degree of effi- cient military usefulness, in the British army, has been determined by observa- tion, and the Government calculates the rate of the loss which will happen in this way, at any period of service. Out of 10,000 men enlisted in their twenty- first year, 718 will be invalided during the first quinquennial period, or before they pass their twenty-fifth year, 539 in the second, 673 In the third, and 854 in the fourth, — making 2,784, or more than one-quarter of the whole, dischar- ged for disability or chronic ailment, be- fore they complete their twenty years of military service and their forty years of life. It is further to be considered, that, dur- ing these twenty years, the numbers are diminishing by death, ancf thus the ratio of the enfeebled and invalided is increas- ed. Out of 10,000 soldiers who survive and remain in the army in each succes- sive quinquennial period, 768 will be in- valided in the first, 680 in the second, 1,023 in the third, and 1,674 in the fourth. In the first year the ratio is 181, in the fifth 129, in the tenth 165, in the fifteenth 276, and in the twen- tieth 411, among 10,000 surviving and remaining. The depressing and exhaustive force of military life on the soldiers is gradual- ly accumulative, or the power of resist- ance gradually wastes, from the beginning to the end of service. There is an ap- parent exception to this law in the fact, that, in the British army, the ratio of those who were invalided was 181 in 10,000, but diminished, in the second, , third, and fourth years, to 129 In the fifth and sixth, then again rose, through all the succeeding years, to 411 In the twentieth. The experience of the Brit- ish army, In this respect, is corroborated by that of ours in the Mexican War. From the old standing army 502, from the additional force recently enlisted 548, and from the volunteers 1,178, in 10,000 of each, were discharged on account of 476 Sanitary Gondiiion of the Army. [October, disability. Some part of this great dif- ference between the regulars and volun- teers is doubtless due to the well-known fact, that the latter were originally en- listed, in part at least, for domestic train- ings, and not for the actual service of war, and therefore were examined with less scrutiny, and included more of the weaker constitutions. The Sanitary Commission, after in- specting two hundred and seventeen reg- iments of the present army of the United States, and comparing the several corps with each other in respect of health, came to a similar conclusion. They found that the twenty-four regiments which had the least sickness had been in service one hundred and forty days on an average, and the twenty-four regiments which had the most sickness had been in the field only one hundred and eleven days. The Actuary adds^ in explanation, — "The difference between the sickness of the older and newer regiments is probably attributable, in part, to the constant weed- ing out of the sickly by discharges from ' the service. The fact is notorious, that medical inspection of recruits, on enlist- ment, has been, as a rule, most imperfectly executed ; and the city of Washington is constantly thronged with invalids awaiting their discharge-papers, who at the time of their enlistment were physically unfit for service."* In addition to this, it must be remembered, that, although all re- cruits are apparently perfect in form and free from disease when they enter the army, yet there may be differences in constitutional force, which cannot be de- tected by the most careful examiners. Some have more and some have less power of endurance. But the military burden and the work of war are arranged and determined for the strongest, and, of course, break down the weak, who retire in disability or sink in death. GENERAL VITAL BEPRESSIOX. Two causes of depression operate, to a considerable degree in peace and to a * MS. Letter of Mr. Elliott. very great degree in war, on the soldier, and reduce and sicken him more than the civilian. His vital force is not so well sustained by never-failing supplies of nutritious and digestible food and reo-u- lar nightly sleep, and his powers are more exhausted in hardships and exposures, in excessive labors and want of due rest and protection against cold and heat, storms and rains. Consequently the ar- my suffers mostly from diseases of depres- sion, — those of the typhoid, adynamic, and scorbutic types. McGrigor says, that, in the British army in the Peninsula, of 1 76,007 cases treated and recorded by the surgeons, 68,894 were fevers, 23,203 diseases of the bowels, 12,167 ulcers, and 4,027 diseases of the lungs.* In the Brit- ish hospitals in the Crimean War, 30 per cent, were cholera, dysenterj', and diar- rhoea, 19 per cent, fevers, 1.2 per cent, scurvy, 8 per cent, diseases of the lungs, 8 per cent, diseases of the skin, 3.3 per cent, rheumatism, 2.5 per cent, diseases of the brain and nervous system, 1.4 per cent, frost-bite or mortification produced by low vitality and chills, 13, or one in 12,000, had sunstroke, 257 had the itch, and 68 per cent, of all were of the zymot- ic class,f which are considered as prin- cipally due to privation, exposure, and personal neglect. The deaths from these classes of causes were in a somewhat sim- ilar proportion to the mortality from all stated causes, — being 58 per cent, from cholera, dysentery, and diarrhoea, and 1 per cent, from all other disorders of the digestive organs, 19 per cent, from fevers, 3.6 per cent, from diseases of the lungs, 1.3 per cent, from rheumatism, 1.3 per cent, from diseases of the bcain and ner- vous system, and 79 per cent, from those of the zymotic class. The same classes of disease, with a much larger proportion of typhoid pneumonia, prostrated and de- stroyed many in the American army in the War of 1812. * Medico- Cliirurgical Transactions, Vol. VI. p. 478, etc. t Report on the Sanitary Condition of the British Army, p. 525. — Medical and Surgical History of the War in the East. 1862.] Sanitary Condition of the Army. 477 In paper No. 4^, p. 54, of the Sanitary Commission, is a report of the diseases that occurred in forty-nine regiments, while under inspection about forty days each, between July and October, 1861. 27,526 cases were reported ; of these 67 per cent, were zymotic, 41 per cent, diseases of the digestive organs, 22 per cent, fe- vers, 7 per cent, diseases of the lungs, 5 per cent, diseases of the brain. Among males of the army-ages the proportions of deaths from these classes of causes to those from all causes were, in Massachusetts, in 1859, zymotic 15 per cent., diseases of di- gestive organs 3.6 per cent., of lungs 50 per cent, fevers 9 per cent, diseases of brain 4.6 per cent.* According to the mortality-statistics of the seventh census of the United States, of the males between the ages of twenty and fifty, in Mary- land, Virginia, North Carolina, South Carolina, and Georgia, Avhose deaths in the year ending June 1st, 1850,and their causes, were ascertained and reported by the marshals, 34.3 per cent, died of zy- motic diseases, 8 per cent, of all the dis- eases of the digestive organs, 30.8 per cent, .of diseases of the respiratory organs, 24.4 per cent of fevers, and 5.7 per cent, of disorders of the brain and nervous sys- tem. In England and Wales, in 1858, these proportions were, zymotic 14 per cent, fevers 8 per cent, diseases of di- gestive organs 7.9 per cent., of lungs 8 per cent, and of the brain 7 per cent, f If, however, we analyze the returns of mortality in civil life, and distinguish those of the poor and neglected dwellers in the crowded and filthy lanes and alleys of cities, whose animal forces are not well developed, or are reduced by insuffi- cient and uncertain nutrition, by poor food or bad cookery, by foul air within and stenchy atmosphere without, by im- perfect protection of house and clothing, we shall find the same diseases there as in the army. Wherever the vital forces are depressed, there these diseases of low * Calculated from the Eir/litcentk Registra- tion Report. + Calculated from Twenty-First Report of Registrar General. vitality happen most frequently and are most fatal. Volumes of other facts and statements might be quoted to show that military ser- vice is exhaustive of vital force more than the pursuits of civil life. It is so even in time of peace, and it is remarkably so in time of war. Comparing the English state- ments of the mortality in the army with the calculations of the expectation of life in the general community, the difference is at once manifest. Of 10,000 men at the age of twenty, there will die before they complete their fortieth year, — British army in time of i)eace, .... 3,058 England and Wales, English Life-Table, 1,853 According to tables of Amicable and Equitable Life-insurance Companies, 1,972 New England and New York, accord- ing to the tables of the New-England Mutual Life-insurance Companj-, . 1,721 DANGERS IN LAND-BATTLES. This large amount of disease and mor- tality in the army arises not from the battle-field, but belongs to the camp, the tent, the barrack, the cantonment ; and it is as certain, though not so great, in time of peace, when no harm is inflicted by the instruments of destruction, as in time of war. The battle, which is the world's terror, is comparatively harmless. The official histories of the deadly struggles of armies show that they are not so waste- ful of life as is generally supposed. Mr. William Barwick Hodge examined the records and despatches in the War-Office in London, and from these and other sources prepared an exceedingly valua- ble and instructive paper on " The Mor- tality arising from Military Operations," which was read before the London Statis- tical Society, and printed in the nine- teenth volume of the Society's journal. Some of the tables will be as interesting to Americans as to Englishmen. On the following page is a tabular view, taken from this work, of the casualties in nineteen battles fought by the British armies with those of other nations. 478 Sanitary Condition of the Army. [October, CO O O C5 0-(< 05 O — O '-I O lO «D'T-rr-ri-T;o ■*"-^to of of-*" t£i^ o s s oocoooooooo OOOOOO: lOOr-lCOCOlQ05CD05"^iO COO ^ "rt hn c B Tl 5 a c m o "Xj ^ bri cS a c M ^ 5 «DrH OCJtMCOr-lr-ltMOOCNro coh-irai--iccooo50ooo»^'ra-»omo5co CO (NO'frHCOCOCOt-OOr^"- OJi-Jt^Ot- OOlOO 00rHCO(MO5 03*1-1 -^ to 00-^(MCOr-li— IC5-i*C;GOC->C^COiOOiraO:00 1-1 (M 1-1 _0 O C^ O J- CO^O_ I^-* I-^IO rH o Oq_ T-T C0~ i-Tr-Tc^' S^'ofoO r-ri-rr-rr-roo'rH r-T C3 1-1 i-( i-l r-i :0 Tji r-ll- COlOiOOO^CO(MOl7100T-l03h-0(MCD«DTOC ^^ ^ ~ I! > be • • >- o r-l i^t^o osio-ri^coiocoo-^oioo OO r^ . TO^«>(Mt^00C0T-ll~--H lO IXJ CQ CI 1^ C' O -f r-( CO -fi 00 ^- 00(XJCi-COCCOiiO'M CO T-l CO 1- i-{ C-l J^ Ph c« a; t3 -o OCOCO-+*lCCO-t*CDirS c\ (N r-1 CO '^ (M (N O -;^ 3 T-l W ;^ « O lO ^ O (M CO CI CO lO t- COCOl^OOCCt^Cll^CO -«; r-l -* -* r-l CO T- rH 1< 00 y S (N r; » S. . '3 ■< CO 05 OO 00 O lO o rH OO t- g-S CM (J» (N r-l IN rH r^ a\ 1— rH O o P3 ^' • -2 3 ■ ct ci:^.— ^ 3-I-;^q^^ocj3 i Pi, rt >-: Ph c/: 0, ec; t) XO IC iC ITj 00 CI rH ■* ■* in '-'S-033 33^ aj C3 Q Sj-?;5 S o S !=jDhc3 ■< 03 O S fi< 1-5 ■< -^ r. d CO ■* in 00---'00"'"0000 r-l rH rH rH 1862.] Sanitary Condition of the Army. 481 Mr. Hodge's second table shows the conditions and casualties of thirteen bat- tles between fleets and squadrons. This is condensed and quoted on the preced- ing page. His third table includes thirty-five ac- tions with single ships on each side, be- tween the years 1793 and 1815. 8,542 men were engaged, and 483, or 56.5 per 1,000, were killed, and 1,230, or 144 per 1,000, wounded. Twenty-six of these actions were with French ships, which are here omitted, and nine with American ships, which are shown in the second table on the preced- ing page.^ Thei-e is a very remarkable difference in the loss which the British suffered in naval and in land battles : — 6 rt Vessels. Killed. One in Wound- ed. One in 13 Fleets 64.0 17.7 19.8 12.7 30.0 20.4 35 26 9 19 Single ships French single ships. American do. do. Land battles 6.9 10.6 4.4 11.0 The danger both of wounds and death in these contests was three times as great in the single ships as in fleets, and about five times as great in battles with the Americans as in fleet-battles with oth- er nations. The dangers in fleet-battles were about half as great as those in land- battles, and these were but little more than half as great as those in fights with single ships. COMPARATIVE DANGER OF CAMP AND BATTLE-FIELD. These records of land-battles show that the dangers from that cause are not very great ; probably they are less than the world imagines ; certainly they are much less than those of the camp. Of the 176,007 admitted into the regimental hospitals during the Peninsular War, on- ly 20,886 were from wounds, the rest from diseases ; fourteen-fifteenths of the bur- VOL. X. 31 den on the hospitals in that war, through forty-two months, were diseased patients, and only one-fifteenth were wounded. In the Crimean War, 11.2 per cent, in the hospitals suffered from injuries in battle, and 88.8 per cent, from other causes. 10 per cent, of the French patients in the same war were wounded, and 90 per cent, had fevers, etc. In the autumn of 1814, there were 815 patients in the great mil- itary hospital at Burlington, Vermont. Of these 50 were wounded, and the rest had the diseases of the camp. In the Crimean War, 16,296 died from disease, and 4,774 from injuries received in battle! In the Peninsular War, 25,304 died of disease, and 9,450 from wounds. During eighteen years, 1840 to 1857, 19,504 were discharged from the home, and 21,325 from the foreign stations of the British army. Of these, 541, or 2.7 per cent, of those at home, and 3,703, or 17.3 per cent, abroad, were on account of wounds and fractures, and the others on account of disease, debility, and ex- haustion. NATIONS DO NOT LEAUN FROM EXPE- RIENCE TO PREPARE FOR ARMY- SICKNESS. Nations, when they go to war, pre- pare to inflict injury and death on their opponents, and make up their minds to receive the same in return ; but they seem neither to look nor to prepare for sickness and death in their camps. And when these come upon their armies, they seem either to shut their eyes to the facts, or submit to the loss as to a disturbance in Nature, a storm, a drought, or an earth- quake, which they can neither prevent nor provide for, and for which they feel no responsibility, but only hope that it will not happen again. Nevertheless, this waste of life has followed every ar- my which has been made to violate the laws of health, in privations, exposures, and hardships, and whose internal history is known. The experience of such dis- astrous campaigns ought to induce Gov- ernments to inquire into the causes of the 482 Sanitary Condition of the Army. [October, suffering and loss, and to learn -whetlier they are not engaged in a struggle against Nature, in -which they must certainly fail, and endeavoring to make the human body bear burdens and labors which are beyond its strength. But Governments are slow to learn, especially sanitary les- sons. The British army suffered and died in great numbers at Walcheren and South Beveland, in the middle of the last century. Pringle described the sad con- dition of those troops, and warned his nation against a similar exposure ; yet, sixty years later, the Ministry sent anoth- er army to the same place, to sink under the malarious influences and diseases in the same way. The English troops at Jamaica were stationed in the low grounds, where, " for many generations," "the average annual mortality was 13 per cent." " A recommendation for their removal from the plains to the mountains ■was made so far back as 1 791. Numerous reports were sent to the Government, ad- vising that a higher situation should be selected"; but it was not until 1837, af- ter nearly half a century of experience and warning, that the Ministry opened their eyes to this cost of life and money in excessive sickness and mortality, and then removed the garrison to Maroontown, where the death-rate fell to 2 per cent., or less than one-sixth of what it had been.* . The American army, in the war with Great Britain fifty years ago, suffered from the want of proper provision for their necessities and comfort, from ex- posures and hardships, so that sometimes half its force was unavaihible ; yet, at the present moment, a monstrous army is col- lected and sent to the field, under the same regulations, and with the same idea of man's indefinite power of endurance, and the responsibility and superintendence of their health is left, in large measure, to an accidental and outside body of men,