Chapter VIII (1)

THE FRANCO-GERMAN WAR OF 1870–1, AND THE EPIDEMIC OF SMALL-POX IN THE
EUROPEAN STATES CAUSED BY IT

I. SIZE OF THE ARMIES

In the Franco-German War of 1870–1, a larger number of troops were assembled within a short time upon the field of battle than in any previous campaign. On the German side 33,101 officers and 1,113,254 men took part in the war; the average number of men in the German field-army was 815,000. The total number of French soldiers under arms is not definitely known; that it was enormous is evident from the fact that the number of prisoners taken (including the garrison in Paris and General Bourbaki’s army) amounted to no less than 21,500 officers and 702,000 men. At certain periods of the war huge bodies of troops were congregated within comparatively narrow limits; at the battle of Gravelotte (August 18, 1870) some 180,000 to 200,000 men faced one another on either side; at the siege of Metz the average size of the German investing army was 240,000 men, while the French army in the city numbered 173,000 men at the time of the capitulation. At the battle of Sedan (September 1, 1870) 124,000 French soldiers were opposed to nearly twice that number of Germans. The garrison in Paris amounted to about 250,000 men, while the German besiegers averaged 240,000 men.

II. DYSENTERY, TYPHOID FEVER, AND TYPHUS FEVER

Despite the fact that these enormous congregations of men were often exposed to very unfavourable weather conditions, and were much of the time scantily fed, the number of German field-troops that contracted and succumbed to infectious diseases was comparatively small. The total loss sustained by the German army in consequence of injuries and diseases amounted to 43,182 men and of these 14,648 died of disease. The following table indicates the percentage of deaths caused by the various diseases:

_Disease._ _Per cent._
Typhoid Fever 60·0
Dysentery 16·2
Small-pox 1·9
Intermittent Fever 0·1
Other infectious diseases 0·3
Other diseases 21·5

Typhoid fever and dysentery were most prevalent, for the reason that the troops were often quartered in places where these diseases were already endemic. Regarding these matters we are accurately informed by the ‘Health Report relating to the German Armies in the War of 1870–1 against France’, an exhaustive account published by the Medical Division of the Prussian War Department.[238]

A total of 74,205 men in the German field-army contracted typhoid and gastric fever, and 8,904 succumbed to them. The eastern Departments of France, especially the city and vicinity of Metz, were constantly afflicted with typhoid fever. This explains why both the German besiegers and the French defenders suffered so severely from that disease, the dissemination of which was helped by the contamination of the springs and water-courses, partly through excessive use, and partly in consequence of the burial of dead men and horses in close proximity to them. And while drinking-water was for that reason brought from a distance, the water used for other purposes was obtained in the immediate neighbourhood. It is obvious that typhoid fever must have raged extensively among the inhabitants of the villages surrounding Metz, the mortality in which during the siege was three times as high as normal. This is evident from a compilation of figures in the German Health Report,[239] indicating how the death-rate in these villages rapidly decreased after the withdrawal of the Germans; per 100 inhabitants, there died in:

_Inhabitants._ _Nov._ _Dec._ _Jan._ _Feb._ _March._ Verneville 672 2·39 1·34 1·04 0·30 0·74 St. Privat 480 2·70 1·20 1·68 0·84 0·42 Gravelotte 708 2·14 0·71 0·55 0·71 — Ste. Marie aux 1·17 0·59 0·59 0·29 0·59 Chênes 340 Rezonville 587 1·87 0·87 0·68 0·68 0·85 Gorze 1,774 1·45 0·73 0·56 0·22 0·39

Typhoid fever and dysentery were chiefly responsible for this high mortality. As at Metz, so also at Sedan and Paris, the troops suffered severely from typhoid fever.

Large numbers of typhoid-fever patients were taken to lazarets in Germany; the Prussian lazarets alone took in 30,507, of whom 1,376 died.

Typhoid fever raged furiously among the French prisoners of war, who usually brought the germ of the disease with them from the scene of the hostilities. ‘Most observers’, we read in the German Health Report,[240] ‘agree that the disease was most prevalent during the first three weeks after the arrival of large transports of prisoners at their place of detention; after that it gradually abated, and finally appeared only sporadically.’ The military prisons, however, while they often formed new sources of infection, did not help to disseminate the disease, owing to the advanced season of the year.

It made considerable difference from what part of the scene of the war the prisoners came; those coming from Strassburg and Toul were much less severely infected with typhoid fever than those from Sedan and Metz. This applies particularly to General Bourbaki’s men, who manifested the least power of resistance to the disease. In Rastatt, for example, there were at one time sixty prisoners suffering from typhoid fever; of those who had come from Strassburg, Neubreisach, and Schlettstadt 13·3 per cent died; of those from Metz 14·5 per cent died, and of those from Bourbaki’s army 40·6 per cent died. Of the French prisoners confined in Germany (the maximum number was 374,995 and the average number 262,496) 15,020 contracted typhoid fever and 3,835 succumbed to it. The prevalence of the disease among the German troops, as compared with its prevalence among the French prisoners, is indicated by the following table:

_No. per 1,000 that _No. that died per 100
succumbed to typhoid treated._
fever._
Mobile German army 11·2 12·0
Immobile German army[241] 3·0 4·1
French prisoners 14·6 25·6

The immediate vicinity of the places in which all these French prisoners suffering from typhoid fever were confined was necessarily unsafe to live in; and while the epidemics that were brought about by people contracting the disease there and conveying it abroad were always kept localized, they were by no means confined to the very narrow limits indicated, on the basis of scattered communications, in the German Health Report. The reason for this moderate dissemination is clear; at that time typhoid fever was rendered much less prevalent throughout Germany by the introduction of extensive sanitary measures (sewers, aqueducts, refuse removal, &c.), which prevented the disease from constantly spreading from place to place. In Frankfurt-on-the-Main the mortality due to typhoid fever was not increased; the number of deaths per 10,000 inhabitants was:

1867 4·3
1868 7·1
1869 4·2
1870 5·8
1871 5·8
1872 6·1

In many cities, on the other hand, an increased number of deaths due to typhoid fever was observed; whether this was attributable to a transplantation of it from France, or to a spontaneous outbreak of it among the many people in these cities who already had the germ in their systems, it is impossible to ascertain. From the statistics we are scarcely ever able to make out the proportion of soldiers and civilians that died. The number of deaths due to typhoid fever per 10,000 inhabitants was:

_Berlin._ _Munich._ _Elberfeld._ _Strassburg._ _Erfurt._ _Plauen._ [242] 1867 6·9 6·0 8·1 8·5 10·6 2·4 1868 10·0 8·0 5·3 9·0 9·4 3·3 1869 6·7 13·0 5·3 9·6 6·7 1870 7·8 14·0 9·3 17·8 21·8 1871 8·9 14·0 9·4 14·2 33·1 2·5 1872 13·9 24·0 8·8 7·8 5·3 4·9

In the case of Strassburg the increase caused by the war is clear; of the civil inhabitants alone, 74 died in the year 1869, 137 in the year 1870, and 110 in the year 1871. In the case of Elberfeld the increase began in the year 1870. In Munich the increase began as early as the year 1869, although the very high mortality did not commence until 1872, as in Berlin; in these two cases the increase cannot be said to have been caused by the war. The same is true of Plauen, where the increase also began in 1869. In the case of Erfurt, unfortunately no statistics are available for the year 1870; in the year 1871 the increase there is very marked. To be sure, it is not expressly stated that prisoners of war are excluded, but as they were not included in the total mortality, or in that due to small-pox, we may safely assume that they were excluded in the case of typhoid fever.[243]

A marked increase in the prevalence of typhoid fever is to be noted in the stronghold of Ulm on the occasion of the arrival there of numerous prisoners from France; the following table indicates the number of people who succumbed to the disease in that city:[244]

_Garrison._ _Prisoners._ _Civil population._
1867 10 25
1868 3 8
1869 4 7
1870 10 150 15
1871 15 25 28
1872 6 20
1873 2 5

Since in the case of typhoid fever it is very often impossible to trace the source of infection, it is not surprising that in many instances it is difficult to prove that the disease broke out in any specific locality in consequence of the arrival there of a person, or group of persons, from an infected locality. This applies, for instance, to the epidemic of typhoid fever that occurred in Meiningen in the year 1871. In many places the disease, being prevalent among the prisoners detained there, undoubtedly spread to the civil population, but nowhere did this occur to such an extent as to attract the attention of the authorities.

Among the diseases that broke out in the field-armies during the war of 1870–1, dysentery (epidemic dysentery) played an important rôle, especially in the months of October and November. Prior to the year 1870 it was a comparatively rare disease in Germany, whereas in France it was quite common. This is indicated by the fact that in the years 1863–9 the number of deaths due to dysentery in the French army (home stations) was twelve times as large as in the Prussian army. Particularly hard hit were the troops in and around Metz, where dysentery raged continuously and with considerable severity,[245] as well as in Strassburg and Sedan; in the city and vicinity of Paris the disease, owing to the advanced season of the year, raged less furiously. As a rule it was an open question whether the places in which the German troops contracted the disease were already infected beforehand, or whether the disease had been brought there for the first time by infected divisions of the French army.

Of the German field-army, 38,975 men, all told, contracted dysentery (47·8 per 1,000 of the average number of troops under arms), and of these 2,405 died. Of the average number of French prisoners taken to Germany 41·7 per cent contracted the disease; nearly all the cases of the disease were among the prisoners themselves, who brought the germ with them, and the result was that the number of cases soon began to decrease. It was, of course, inevitable that numerous prison-guards should contract the disease, but nowhere did it spread in a serious way to the civil population.

Of very great importance, as far as the war operations were concerned, was the fact that typhus fever, which in former years had played such a fatal rôle, did not make its appearance among the troops; according to most observers, the disease did not break out at all during the war. The Prussian troops along the Russian border were never entirely free from typhus fever; according to the German Health Report, 91 soldiers contracted the disease in the year 1867, 99 in the year 1868, and 37 in the year 1869. France itself had apparently been free from the disease for a long time, but there was always a possibility that it would be conveyed into the country from Algiers, where in the year 1868 a severe epidemic had raged in consequence of a great famine the year before; of the army in Algiers the disease had carried away 252 men (3·94 per cent).[246] Consequently both the Germans and the French watched very carefully any outbreaks of a disease involving symptoms of typhus fever. Cases of a disease held by the authorities to be typhus fever were reported from Nancy, Châlons-sur-Marne, Lunéville, and Metz, but careful investigations by von Niemeyer indicate that they were merely cases of typhoid fever exhibiting unusually well developed roseola. Several French physicians (Chauffard, Léon Colin, Kelsch) likewise testify to the fact that typhus fever did not appear in the French army during the entire war. Grellois, to be sure, asserts that typhus fever broke out about the middle of the siege of Metz and then suddenly disappeared. But even this assertion may fairly be questioned; at all events there was not a single soldier in the garrison suffering from the disease at the time of the capitulation, as Grellois himself admits.

According to Michaux,[247] a former chairman of the Medical Society in Metz, a small epidemic of typhus fever raged among the civil inhabitants of that city during the siege. The correctness of this statement, however, is doubted, as no post-mortem examinations were made. It seems that fifty-five children and nine nurses in two orphan asylums contracted the disease, and that twenty-eight of the former and one of the latter succumbed to it; the first cases of the disease were reported early in October, and by the end of November the epidemic was over. This sudden disappearance of the disease was attributed by Michaux to the termination of the siege, a conclusion also upheld by Méry, who studied the disease in the Crimean War. Viry,[248] who until a few days before the siege had charge of the field hospital in Vallières (near Metz), where he treated some 250–300 patients every day, performed autopsies on all supposed victims of typhus fever, but in all cases found only the evidences of typhoid fever. Nevertheless, he believes it possible that typhus fever occurred there, and holds the view that the overcrowded condition of the city favoured a spontaneous outbreak of the disease. Laveran,[249] who was also present in Metz during the siege, disputes the correctness of Michaux’s diagnosis, as does the German Health Report, on the ground that the disease attacked children almost exclusively, that it caused such a high mortality, and that it disappeared so suddenly. He seems to think that it was some acute exanthema, probably haemorrhagic measles. This leaves unexplained the fact that a large number of nurses contracted the disease.

III. THE GREAT EPIDEMIC OF SMALL-POX CAUSED BY THE FRANCO-GERMAN WAR

But while typhoid fever and dysentery in the Franco-German War attacked the civil population only in those parts of the country in which the fighting took place, and nowhere acquired epidemic dimensions, and while it is probable that typhus fever did not appear at all at that time, there occurred in connexion with the war a very severe epidemic of small-pox, which raged more extensively and furiously than any other epidemic in the course of the entire century, and spread not only throughout the belligerent countries, but also throughout all Europe.

Everybody knows how severely Europe suffered from epidemics of small-pox in the last part of the eighteenth and first part of the nineteenth centuries, and how the ravages of that disease were first checked by Jenner’s wonderful discovery. Nevertheless, small-pox did not entirely disappear from Central Europe until the year 1870. The reason for this is found in the fact that compulsory vaccination was introduced in only a few states, and even in them was not properly enforced, and also in the fact that people did not until later begin to realize that vaccination insures immunity only for a period of 12–15 years at most. Consequently new recruits, if they had already been vaccinated once, were not revaccinated when they began to serve. But since sporadic outbreaks of small-pox continued to occur in the Prussian army, orders were issued in the year 1834 that all recruits must be vaccinated. The result was that from that time on, the Prussian troops were very rarely attacked by the disease. The same measure was adopted in Württemberg in 1833, in Baden in 1840, in Bavaria in 1843, in Brunswick in 1858, in the Kingdom of Saxony in 1868, and in the Grand Duchy of Hesse in 1869. Compulsory vaccination did not exist in Prussia or Saxony before the Imperial Vaccination Law was passed in the year 1874; the result was that large numbers of children were never vaccinated. The anti-vaccinationists, especially in the ‘sixties, carried on a vigorous agitation, and this had the effect of increasing the number of unvaccinated persons; the number of revaccinated persons had always been small. In South Germany compulsory vaccination for one-year-old children was introduced in the first part of the nineteenth century—in Bavaria and Hesse in 1807, in Baden in 1815, in Württemberg in 1818—but revaccination was not enforced until 1874, when the Imperial Vaccination Law was passed.

The small-pox mortality in Prussia prior to the year 1870 is indicated by the following table, which shows the number of deaths per 10,000 inhabitants:

1831–40 2·6
1841–50 1·7
1851–60 2·1
1861–5 3·5
1866–7 5·2
1867–8 1·8
1868–9 1·9
1869–70 1·7

In the year 1864 an epidemic of small-pox had broken out, and the war of 1866 had helped it to spread; but in the year 1868 the disease began to abate, so that by the middle of the year 1870 almost all of Prussia was free from small-pox, as will be set forth in greater detail later on. In South Germany the small-pox mortality was even lower; in Bavaria it was 0·85 in the years 1861–70, in Württemberg it was 0·9 in the same years, and in the Grand Duchy of Hesse it was 1·9 in the years 1866–70.[250]

1. _The Small-pox Mortality in France in the Years 1870–1_

In the ‘sixties small-pox had not been very common in France, but no detailed reports regarding its prevalence there are available; the reports which the prefects were supposed to hand in are either entirely missing, or else very incomplete. According to the statistics compiled by Vacher,[251] the death-rate increased a little in the years 1864–5, then began to decrease, and in 1869 increased again. The figures which Vacher compiled, and which the Académie de Médecine in Paris has on file, are:

1860 1,662
1861 1,740
1862 1,813
1863 1,440
1864 3,290
1865 4,166
1866 593
1867 2,081
1868 3,900
1869 4,164

Vacher says in regard to these figures: ‘As far as the actual number of persons who contracted and succumbed to small-pox are concerned, they express only a small part of the truth. The reports submitted to the Academy of Medicine are rarely complete; it is even necessary to say that about one-quarter of the Departments never send in reports on the epidemics at all, although the ministerial instructions render the submission of these reports obligatory, and although the Academy never ceases to protest against the negligence of the prefectoral administrators.’ Vacher then goes on to say that in the years 1860–9 only 59 out of every 100 infants born were vaccinated, and that at the outbreak of the war about one-third of the French population was unvaccinated; in many Departments, indeed, as many as four-fifths (Aveyron, Corsica, &c.). Small-pox was much more prevalent in the French army than in the German army; according to the German Health Report,[252] the number of deaths caused by the disease was:

PRUSSIAN ARMY. FRENCH ARMY.
_Total No._ _Per 10,000 men._ _Total No._ _Per 10,000 men._
1866 8 0.30 46 1.37
1867 2 0.08 70 1.82
1868 1 0.04 169 4.28
1869 1 0.04 95 2.27

The reason for this lies in the fact that a larger proportion of the Prussian soldiers were vaccinated. Since the year 1806 all French recruits who had never been vaccinated were supposed to submit to the inoculation when they presented themselves for service, but this regulation was for years at a time very laxly enforced; consequently in the year 1857 a new order was issued, introducing compulsory vaccination for all recruits. But even this order does not seem to have been everywhere carried out with the necessary strictness, and complaints regarding the partial success of vaccination were frequently made by military physicians.

As stated above, there was a noticeable increase in the small-pox mortality in the year 1869; this increase lasted into the beginning of the year 1870, but was confined to certain localities. Chauffard’s[253] report on epidemic diseases in France is more incomplete for the years 1869–70, on account of the war, than for previous years; it was supplemented, partially at least, by the later reports of Vernois[254] for the year 1871, and also by the comprehensive report of M. Delpech[255] for the years 1870–2. According to these, epidemics of small-pox occurred in the year 1869 in North-west France (Bretagne), in North-east France (Departments of Aisne, Pas-de-Calais), and in South-east France (Departments of Gers, Ariège, and Pyrénées-Orientales.) In the winter of 1869–70 the epidemic continued to spread, and by the end of the year 1870 it included almost the whole of France. The incomplete reports give us no idea as to which Departments were attacked before the outbreak of the war and which after. According to Vernois, the disease appeared that year in 42 Departments, including 132 arrondissements and 539 parishes. But, as stated above, the reports are all very incomplete; a later report submitted by Delpech adds 11 more Departments to the 42. The total number of deaths caused by small-pox in France in the year 1871 is unknown; Vernois reported 14,425 deaths in 39 Departments, but this does not include the figures for Paris, where 10,539 persons succumbed to the disease, or for the Department of Finistère, or for the Department of Sarthe (in regard to which it is merely observed that there were ‘beaucoup de morts’), or for several other Departments.

It is a fact that small-pox raged severely among the civil inhabitants of all regions in which the second half of the war was waged (to the south, east, and north of Paris), and that the war itself helped the disease to spread in the eastern Departments (Jura, Doubs, Saône-et-Loire, Haute-Saône). The wide prevalence of the disease among the soldiers is attributed by many French physicians to the fact that the army as a whole had been inadequately vaccinated. If this was true of the regular troops, lack of time made it absolutely impossible to vaccinate all the men that were afterwards assembled in such a precipitate manner. The movements of the soldiers in the cold season of the year (in December there was some bitterly cold weather) made it necessary for friends and enemies to share whatever shelter they could find, regardless of whether the house had previously been occupied by small-pox patients, or whether such patients were actually lying in it at the time. The result was that the disease became very widespread throughout all France. Says Laveran:[256] ‘The army, being composed of men who had been in service for a long time, and who had been vaccinated and revaccinated, suffered very little, but the events which took place after the declaration of war altered this state of affairs. The regiments of the Departments on their way to Paris were quartered in the homes of civilians, where they contracted small-pox. The disease spread easily among the young people who, owing to lack of time, had not been revaccinated, and many of whom had perhaps never been vaccinated at all. During the first part of the siege of Paris it was these regiments which suffered the most from small-pox, but later on the epidemic became more general and spread to all the corps. The number of soldiers infected with small-pox during the siege was about 6·76 per 100, or 68 per 1,000.’

Small-pox raged very extensively in besieged strongholds. In Paris an epidemic of small-pox began in November 1869, and the number of deaths caused by the disease there was:[257]

October (1869) 39
November 93
December 119
January 174
February 293
March 406
April 561
May 786
June 914
July 1,072
August 713
September 700
October 1,361
November 1,722
December 1,837
January 1,503
February 763
March 230

In the middle of the summer the disease was not very prevalent in the garrison; most of the cases were among the civil inhabitants. This condition changed in September, however, when the newly-organized mobile guard arrived in the city, consisting of young men who had not been revaccinated for lack of time, and many of whom had never been vaccinated at all. A severe epidemic now began to rage throughout the garrison; between October 1870 and March 1871 no less than 7,578 men suffering from small-pox were taken to the Hôpital Bicêtre, where the majority of the small-pox patients in the garrison were housed, and where 1,074 (14·17 per cent) of them died. Colin reports that the total number of small-pox patients taken there from the garrison (the total number of men in which he estimates at 70,000 regular troops and 100,000 guardsmen)[258] was no less than 11,500, and that the number of deaths was 1,600. In November, owing to the rapid dissemination of the disease in the garrison, the number of cases among the civil inhabitants also began to increase.

Small-pox also raged in Metz, but not so extensively as in Paris; the following table indicates the number of men in the garrison carried away by small-pox:

August (15–31) 6
September 40
October 51
November 58
December 21
———
Total 176

The surrender of the stronghold, on October 27, led to the discovery of 200 small-pox patients in a tobacco factory. The epidemic among the civil inhabitants came to an end in March 1871.

Belfort, where the garrison consisted mostly of national guards, also experienced a severe epidemic during the siege; likewise Strassburg, Nancy, Toul, and Verdun.

In Strassburg, where cases of small-pox had repeatedly been observed, the disease became more widespread in the summer of 1870, and during the siege the number of cases increased considerably; not until August 1871 did the epidemic come to an end. According to Kriesche and Krieger,[259] the number of civilians that succumbed to small-pox in Strassburg, the population of which in the year 1871 was 77,859, was:

1869. 1870. 1871.
January 2 4 81
February 3 5 52
March 3 9 20
April 13 14 15
May 1 19 14
June 2 23 4
July 6 22 3
August 5 33 1
September 2 66
October 92
November 2 72 1
December 3 92
—— ——— ———
Total 42 451 191

Langres was attacked with especial severity. The garrison there was composed of freshly enlisted troops (mobile and national guards), and averaged 14,629 men. The epidemic began in September 1870, and was not yet over by March 1871. The following table gives the number of cases and deaths according to Claudot.

_No. cases._ _No. deaths._
September 81 10
October 145 12
November 301 34
December 598 41
January 621 91
February 402 93
March 186 53
————— ———
Total 2,334 334

The disease raged very extensively in the French provincial armies that were organized to relieve Paris—thus in the south-western, northern, and south-eastern scenes of the war, small-pox had already made its appearance among the civil inhabitants of those parts of the country in consequence of the continual passing through of soldiers, many of whom had never been vaccinated. Orléans, Chartres, and Le Mans, were the main centres of the pestilence; in the north Amiens, Bois-Guillaume, Rouen, and other places; in the south, besides the strongholds of Belfort and Langres, the cities of Dijon, Besançon, Pontarlier, and several other places. The disease raged furiously throughout this entire region, but the exact number of deaths is not known.

In south-eastern France, small-pox did not become very widespread until after the outbreak of the war; in Lyons, for example, the epidemic began in the second half of October. To be sure, small-pox had appeared in several places in the year 1868, but by the winter of 1868–9 this epidemic was over, although individual cases continued to occur. Regarding the cause of the small-pox epidemic that broke out in Lyons in the autumn of 1870, Fonteret[260] gives us the following information: ‘Two causes could not help favouring the outbreak in our city; the movements of the troops that took place at that time, and the emigration of numerous Parisians, who since the beginning of September, that is to say, since the time when the epidemic began to rage furiously in Paris, passed through our city on their way to Switzerland.’ Regarding the course of the epidemic, no statistics covering the entire city are available, but we are able to see from the following table, compiled by Perroud, the number of small-pox patients taken in by the Hôtel-Dieu and the number that died there:

_Patients._ _Deaths._
January-June (1870) 126 9
July-September 101 15
October 29 8
November 94 26
December 160 37
January (1871) 148 31
February 147 37
March 135 29
April 124 25
May 84 12
June 45 7
July 38 5
August-December 44 6

In the other cantons of the Department 935 deaths were officially recorded in the years 1870–1. It was observed in Lyons, as in other places, that not only the number of persons who contracted small-pox, but also the virulence of the disease itself, increased; whereas only 10.6 per cent of 227 sporadic cases resulted fatally between January and September, out of 1,004 persons who contracted the disease between October 1870 and July 1871 no less than 21.7 per cent died.

In the year 1871 small-pox did not spare a single Department in France, although many of them failed to send in reports. Vacher estimates the number of deaths due to the disease in the year 1871 at 58,236, but he adds that the estimate is too small. No report, for example, was sent in by the Department of Sarthe, where in the city of Le Mans alone there were 1,181 deaths, nor by the Department of Haute-Garonne, where there were 1,328 deaths in Toulouse. The total number of unreported deaths, therefore, must have been at least 20,000. It is almost impossible to estimate the number of deaths that occurred in the year 1870. From the available statistics Vacher estimates the number of deaths caused by the disease in the two years 1870–1 at 89,954, a figure, as he himself says, ‘which represents only a part of the reality.’ Another estimate made by Vacher, putting the number of deaths caused by small-pox in the years 1869–70 at 200,000, is in all probability not an exaggeration.

In the year 1872, to be sure, small-pox appeared in the form of epidemics in numerous parts of France, but nowhere did it spread so widely as in the two previous years. According to a report worked out by Delpech for the years 1870–2, no less than 42 Departments failed to make any report at all in the year 1872, while only 18 of the remaining 41 Departments sent in reports regarding epidemic outbreaks of small-pox. The epidemic lasted until 1873, in which year reports regarding small-pox epidemics came in from 10 Departments; but only in the Departments of Morbihan and Pyrénées-Orientales was the epidemic apparently somewhat more intense.[261]

2. _Small-pox among the French Prisoners_

Thanks to the well-vaccinated condition of the German troops, the army suffered comparatively little from small-pox. In the field army 4,385 men (61·3 per 1,000) contracted the disease, and 278 of them (3·5 per cent of those who contracted it) died. Including the officers, physicians, and officials, the number taken sick was 4,991 and the number that died was 297. The number of men in the individual army corps that contracted the disease varied greatly according to the nature and place of their activity; particularly hard hit were the army divisions in the south-western and northern scenes of the war, where the military operations were carried on in fearfully cold weather, and where it was impossible to quarter the infected soldiers in isolated places by themselves. The French army was attacked much more severely by small-pox, although there are no accurate reports available regarding the prevalence of the disease. According to a report found in the _Vienna Medical Weekly_,[262] the total number of French soldiers that succumbed to small-pox was 23,469[263]; but the accuracy of this number, to be sure, is questionable, since, assuming that there was a very high mortality, it would mean that some 120,000 troops contracted the disease. At all events, the French army, taken as a whole, was badly infected with small-pox, and it was inevitable that among the French prisoners brought to Germany there should be numerous small-pox patients, some in the incubation stage, and some in the convalescent stage of the disease, and that they should infect other people there.

The number of French prisoners taken to Germany in the first few months of the year 1871 was no less than 372,918; the prisoners who at the very beginning, but especially after the surrender of Metz, were transported in large numbers to Germany, had to be distributed throughout the entire Empire, clear over to the eastern boundary. Owing to the fact that new transports of French prisoners were constantly arriving at the German frontier, which, in consequence of severe hardships and privations, they reached in such a weak physical condition that they could not be taken very far inland, it became necessary to transfer some of the earlier arrivals to other places of detention, and this, of course, favoured the further dissemination of the disease. This transference was rendered particularly necessary by the arrival of large numbers of prisoners after the battle of Sedan (September 1), after the capitulation of Metz (October 27), and after the battles of Orléans and Le Mans (December and January respectively). Small-pox occasionally broke out among these prisoners while they were on their way to Germany, rendering it necessary to leave them behind, or else the disease made its appearance when they reached their destination; as a rule, however, the first cases of the disease were observed a few days after their arrival at their place of detention, where they soon infected the other prisoners. The further dissemination of the disease among them was checked by means of wholesale vaccination.

Of the prisoners, 14,178, all told (38 per cent of the total number taken), contracted small-pox, and of these 1,963 (5·26 per cent) died. The statistics in the German Health Report indicate distinctly the number of prisoners in the various states and provinces that contracted and succumbed to the disease; but the total number of prisoners taken is known only in the case of the larger states in the Confederation, since the statistics in the Report are compiled on the basis of the army-corps districts, which do not coincide with the political divisions. The figures for the larger states are as follows:

_Maximum
no. _Patients _Deaths per
prisoners._ _Patients._ _Deaths._ per 1,000._ 100 cases._
N. Germany,
excluding
Kingdom
of Saxony 283,750 10,547 1,527 37·2 14·5
Kingdom of
Saxony 10,234 248 18 24·2 7·3
Bavaria 40,083 1,607 196 40·0 12·2
Württemberg 12,958 390 28 38·1 7·2
Baden 12,083 512 21 42·4 4·1
Grand Duchy
of Hesse 13,810 874 173 63·3 19·8
——————— —————— ————— ———— ————
All Germany 372,918 14,178 1,963 38·0 13·8

The number of people who contracted the disease varied greatly in the different territories, depending upon the locality whence the prisoners came. Accordingly, the figures in the case of the Grand Duchy of Hesse were rendered large by the fact that a severe epidemic of small-pox broke out in the stronghold of Mayence on the occasion of the arrival there of prisoners from Metz. The number of prisoners that contracted and succumbed to small-pox in the larger military prison-dépôts is shown by the following table, which covers only those places in Prussia and the Grand Duchy of Hesse in which the maximum number of prisoners held in confinement exceeded 5,000:

_Maximum no. _Patients _Deaths per prisoners._ _Patients._ _Deaths._ per 1,000._ 100 cases._ Spandau 6,856 77 25 11·2 32·5 Jüterbog 5,002 196 23 39·2 11·7 Danzig 9,189 188 24 20·5 12·8 Königsberg 7,324 221 22 30·2 9·9 Stettin 21,000 1,303 194 62·0 14·9 Erfurt 12,400 203 28 16·4 13·8 Magdeburg 25,450 1,902 271 74·7 14·3 Torgau 9,359 603 128 64·4 21·2 Wittenberg 9,753 51 10 5·2 19·6 Posen 10,303 191 29 18·5 15·2 Glogau 13,621 1,198 170 88·0 14·2 Neisse 12,801 385 117 30·1 30·4 Minden 5,071 98 13 19·3 13·3 Wesel 16,299 1,042 127 63·9 12·2 Cologne 13,774 175 24 12·7 13·7 Coblenz 15,011 571 111 38·0 19·4 Lockstedt 5,000 47 7 9·4 14·9 Mayence 14,669 759 165 51·7 21·7

In the case of the Kingdom of Saxony and of the South German States no figures for the individual places are available. We see from the above table that of the large prison-dépôts, Glogau, Magdeburg, Torgau, Wesel, Stettin, and Mayence had the most cases of the disease; generally speaking, the smaller places were less severely attacked, although there are a few exceptions to this statement; in Stralsund, for example, there were 78·2 cases of the disease per 1,000 prisoners, in Papenberg and Hanover 63·4, in Colberg 53·9, and in Münster 52·8.

3. _Small-pox in the Immobile German Army_

The occurrence of small-pox in the immobile German army was closely related to its prevalence among the prisoners, and it attacked the immobile troops much more severely than the field-troops. The latter, to be sure, were no less exposed to the infection, but the former, taken as a whole, were not nearly so well vaccinated; for it was impossible in the short time available to see to it that all the reserves were vaccinated, since the troops designated for the field were given the precedence. Thus between conscription and vaccination there was more or less of an interval, during which a large number of the reserves were not protected against the disease. The total number of men in the immobile army that contracted small-pox was 3,472 (excluding Baden and the Grand Duchy of Hesse, regarding which we have no statistics). Assuming that the average number of reserves in the immobile army was 300,424, this means that about 11·6 per 1,000 contracted the disease. The number of cases among the immobile troops in the individual states of the Confederation varied greatly, as indicated by the following table:

_Average
no. _Patients _Deaths per
reserves._ _Patients._ _Deaths._ per 1,000._ 100 cases._
N. Germany,
excluding
Kingdom
of Saxony 238,040 1,703 92 7·15 5·4
Kingdom of
Saxony 17,628 506 30 28·70 5·9
Bavaria 34,634 1,183 39 34·16 3·3
Württemberg 10,122 80 1 7·90 1·3

In the larger Prussian garrisons, and in Mayence, the following number of men contracted and succumbed to small-pox:

_Average _Patients _Deaths per no. men._ _Patients._ _Deaths._ per 1,000._ 100 cases._ Berlin 9,110 57 4 6·3 7·0 Danzig 7,376 45 5 6·1 11·1 Königsberg 6,426 101 11 15·7 10·9 Stettin 7,000 74 5 10·6 6·8 Magdeburg 11,296 84 8 7·4 9·5 Posen 9,482 113 6 11·9 5·3 Breslau 8,029 20 2·5 Wesel 7,284 117 7 16·0 6·0 Cologne 9,207 19 1 2·1 5·3 Coblenz 8,710 83 4 9·5 4·8 Mayence 9,046 122 9 13·5 7·4

Wherever, as in Breslau, there were few prisoners, the small-pox percentage in the immobile army is low. Regarding the above figures, it must be remarked that those pertaining to the garrisons were compiled on the basis of the average number of troops, whereas in the case of the French prisoners the maximum number was used as a basis. The relative number of small-pox cases in the latter table, accordingly, is somewhat too low. Among the prisoners and among the immobile troops, the climax of the pestilence was in January, as indicated by the following table:

_French Prisoners._ _Immobile German troops._
July (1870) 2 16
August 27 9
September 85 47
October 273 49
November 1,041 128
December 3,107 358
January (1871) 4,139 802
February 3,151 719
March 1,521 457
April 586 451
May 209 291
June 36 145

The number of French prisoners taken to Germany in the month of July 1870 was small. Of the sixteen immobiles who contracted the disease during that month, nine belonged to the Ninth Army Corps, most of them having been infected inland before the outbreak of the war. That the month of July did not constitute the starting-point of the subsequent epidemic is evident from the fact that the prevalence of the disease decreased in August, as well as from countless individual observations.

4. _The Epidemic of Small-pox in the Civil Population of Germany in
1871–2_

In the summer of 1870 Germany was almost free from small-pox. Later on, thousands of French prisoners, almost all of them hailing from infected localities, were within a short time scattered throughout the entire German Empire, and since the inhabitants of many parts of the country, as stated above, were very insufficiently vaccinated, it was inevitable that epidemics of small-pox should break out everywhere. The disease was disseminated in several ways: by prisoners who had contracted it on their way to Germany, or who had to be transported from an infected to an uninfected locality, by persons into whose systems the infection had entered but had not yet revealed its presence, and by uninfected persons who had come in contact with infected persons; numerous persons, moreover, contracted the disease by handling the clothing, blankets, and other effects of small-pox patients.

‘The dissemination of the disease,’ says the German Health Report,[264] ‘which broke out simultaneously in various parts of Germany, was helped along in numerous ways. From the lazarets and from the prisons it was communicated by nurses and guards, and by working men and tradesmen, to the civil population and to the local garrison, and from there it spread to the surrounding country. It was conveyed from place to place, often considerable distances, by the moving population itself, not infrequently by marching troops, and particularly by the removal of prisoners from one place of detention to another; the latter measure had to be adopted in order to make room for the fresh transports of prisoners that were constantly arriving, many of them in such an exhausted condition that it was necessary to spare them the long and trying journey to the far East. Thus the prisons at Mayence, Coblenz, Wesel, Minden, &c. became the foci from which the disease was transplanted into hitherto uninfected places.’

The result was that there broke out in Germany an epidemic of small-pox which raged more furiously and extensively than any other epidemic in the course of the nineteenth century. Whereas among the prisoners-of-war and among the immobile German troops (who were particularly exposed to the infection) the disease reached its climax as early as January 1871, among the civil inhabitants of the country this climax did not come until later in the year; in the more out-of-the-way regions, moreover, where there was less intercourse, the height of the epidemic was not reached until the year 1872.

_(a) The Dissemination of Small-pox in Prussia and in the smaller North
German States_

After the prevalence of small-pox in Prussia had again increased somewhat in the years 1864–7, in the following years the number of cases of the disease grew steadily smaller, so that around the middle of the year 1870 the country was practically free from it. Its prevalence again increased in the first months of the year 1871. The following table indicates the number of deaths caused by the disease in Prussia in the course of twelve years:

_Total no. deaths._ _Deaths per 10,000 inhabitants._
1862 3,894 2·1
1863 6,250 3·4
1864 8,904 4·6
1865 8,403 4·4
1866 11,937 6·2
1867 8,500 4·3
1868 4,510 1·8
1869 4,655 1·9
1870 4,200 1·7
1871 59,839 24·3
1872 66,660[265] 26·9
1873 8,932 3·6

In the year 1874 only one person per 10,000 inhabitants succumbed to the disease. Among the French prisoners small-pox usually broke out very soon after their arrival at their place of detention, while among the inhabitants of the places in which the prisons were located it usually did not make its appearance until several months later. Guttstadt,[266] in his excellent work on the _Epidemic of Small-pox in Prussia in the Years 1870–1_, has compiled a table of statistics indicating in a number of places when the disease first made its appearance among the prisoners and among the civil inhabitants. We reproduce this table below, with a few small alterations. In some of the places mentioned there was no military prison; only prisoners suffering from small-pox were taken to them, usually resulting in an epidemic of the disease among the civil inhabitants. The table clearly indicates the connexion between the small-pox epidemics among the civil inhabitants and the outbreaks of the disease among the prisoners; regarding the manner of dissemination in the case of the individual epidemics we shall have more to say further on.

THE APPEARANCE OF SMALL-POX AMONG PRISONERS-OF-WAR AND AMONG THE CIVIL
INHABITANTS IN THE GERMAN CITIES IN THE YEARS 1870–1

────────────────┬─────────────────────────────────┬───────────────────────
_Cities._ │ FRENCH PRISONERS. │ CIVIL INHABITANTS.
────────────────┼─────────┬──────┬───────┬────────┼───────┬───────┬───────
〃 │ _First │ │ │ │ │ │
│ arrival │ │ │ │ │ │
│ of │_Max- │ │ │_First │ _No. │ _No.
│infected │ imum │_First │_No. Pa-│ Out- │Deaths_│Deaths_
│persons._│ no._ │Case._ │tients._│break._│(1870).│(1871).
────────────────┼─────────┼──────┼───────┼────────┼───────┼───────┼───────
1. _East │ │ │ │ │ │ │
Prussia_ │ │ │ │ │ │ │
Königsberg │ │ │ │ │Aug. │ │
│Aug. 15 │ 7,324│Aug. 15│ 221│(end) │ 74│ 558
2. _West │ │ │ │ │ │ │
Prussia_ │ │ │ │ │ │ │
Danzig │Aug. 25 │ 9,189│Aug. 28│ 188│Sep. 16│ 5│ 709
Graudenz │Aug. 5 │ 1,437│Aug. 28│ 9│Fall │ 0│ 11
Thorn │Aug. 21 │ 2,001│Aug. 27│ 11│Fall │ 8│ 147
3. _Branden- │ │ │ │ │ │ │
burg_ │ │ │ │ │ │ │
Berlin │ │ │Aug. 20│ 24│Nov. │ 170│ 5,212
Frankfurt- │ │ │ │ │ │ │
o.-t.-O. │ │ 756│Nov. 12│ 8│Jan. │ 3│ 117
Küstrin │ │ │ │ │End │ │
│Aug. 7 │ 2,204│Aug. 17│ 9│(1870) │ 1│ 32
Landsberg- │ │ │ │ │ │ │
o.-t.-W. │Nov. │ 133│Nov. │ 1│Nov. 20│ 0│ 97
4. _Pomerania_ │ │ │ │ │ │ │
Colberg │Nov. 4 │ 3,246│Nov. 14│ 175│Jan. 7 │ 0│ 27
Greifswald │ │ │Oct. 18│ 3│Dec. 13│ 1│ 109
Schivelbein │Jan. 24 │ 603│Jan. 26│ 24│Feb. 20│ 0│ 43
Stettin │Aug. 12 │21,000│Aug. 22│ 1,303│Dec. │ 13│ 422
Stralsund │Dec. 4 │ 2,991│Dec. 9 │ 234│Jan. 7 │ 0│ 366
Stolp │ │ │ │ │Aug. │ │
│Jan. │ 1,376│Feb. 3 │ 5│(1871) │ 0│ 16
5. _Posen_ │ │ │ │ │ │ │
Bromberg │- │ │Dec. 15│ 14│Feb. 10│ 0│ 280
Posen │Oct. 4 │10,303│Sep. │ 191│Feb. │ 79│ 466
Schneidemühl│Nov. │ 940│Jan. │ 5│Jan. │ 0│ 40
6. _Silesia_ │ │ │ │ │ │ │
Breslau │ │ │Nov. │ 4│ │ 28│ 742
Glatz │Oct. 12 │ 2,284│Oct. 6 │ 96│Feb. │ 2│ 38
Glogau │Sep. 1 │13,621│Sep. 16│ 1,198│Oct. 7 │ 10│ 114
Görlitz │ │ 326│Nov. │ 5│Jan. │ 0│ 164
Oppeln │Nov. 6 │ 1,027│Jan. │ 23│Jan. │ 0│ 38
Schweidnitz │Jan. 28 │ 1,821│Jan. │ 75│March │ 0│ 52
7. _Saxony_ │ │ │ │ │ │ │
Aschersleben│Dec. 2 │ 1,618│Jan. │ 12│Dec. │ 0│ 53
Erfurt │Sep. 12 │12,400│Sep. 14│ 203│Dec. │ 18│ 235
Halberstadt │Jan. │ 619│Jan. 28│ 6│Feb. │ 0│ 29
Halle- │ │ │ │ │ │ │
o.-t.-S. │ │ │Nov. 1 │ 28│March │ 0│ 195
Magdeburg │Aug. 30 │25,450│Sep. 15│ 1,902│Nov. 18│ 22│ 646
Mülhausen │ │ │Dec. │ │ │ │
│Dec. │ 1,065│(early)│ 57│Feb. 1 │ 4│ 25
Nordhausen │ │ │Sep. │ 8│Jan. │ 0│ 233
Quedlinburg │ │ 927│Nov. 27│ 29│Nov. │ 1│ 3
Torgau │Sept. │ │ │ │ │ │
│(end) │ 9,359│Oct. 4 │ 603│Nov. │ 0│ 67
Wittenberg │Aug. 27 │ 9,723│Sep. 5 │ 51│Oct. 3 │ 5│ 100
8. _Schleswig- │ │ │ │ │ │ │
Holstein_ │ │ │ │ │ │ │
Lockstedt │ │ │ │ │End │ │
│ │ 5,000│Oct. │ 47│1870 │ │
Rendsburg │ │ │ │ │End │ │
│Nov. │ 2,590│Nov. 26│ 44│1870 │ 0│ 114
Schleswig │ │ │ │ │End │ │
│Dec. 3 │ 1,570│Dec. 13│ 17│1870 │ 10│ 38
9. _Hanover_ │ │ │ │ │ │ │
Stade │ │ 2,284│Jan. 28│ 32│1871 │ 0│ 3
10. _Westphalia_│ │ │ │ │ │ │
Hamm │ │ │Oct. │ 12│Nov. 22│ 9│ 114
Minden │Sep. 10 │ 5,071│Sep. │ 98│Nov. 2 │ 5│ 114
Münster │Jan. │ │Jan. │ │ │ │
│(end) │ 2,709│(end) │ 143│Feb. 12│ 2│ 67
11. _Hesse- │ │ │ │ │ │ │
Nassau_ │ │ │ │ │ │ │
Cassel │ │ │Nov. │ 13│Nov. │ 6│ 99
Frankfurt │ │ │Dec. │ 8│Jan. │ 23│ 125
12. _Rhine │ │ │ │ │ │ │
Province_ │ │ │ │ │ │ │
Düsseldorf │ │ │ │ │Oct. │ │
│ │ 981│Aug. 15│ 13│(1870) │ 6│ 524
Coblenz │Sep. 15 │15,011│Sep. 23│ 571│Nov. 2 │ 0│ 81
Cologne │Sep. 1 │13,774│Sep. 1 │ 175│Sep. 12│ 65│ 418
Wesel │Sep. 9 │16,299│Sep. 20│ 1,042│Nov. │ 9│ 84

The book contains a survey of the small-pox mortality in Prussia in the year 1871 according to Governmental Districts and Communities. The figures for the year 1872 have not been published; they were placed at my disposal, in manuscript form, by the Royal Prussian Bureau of Statistics. ──────────────────────────────────────────────────────────────────────────

The small-pox mortality varied greatly in the different Prussian Governmental Districts; particularly noteworthy is the fact that it was considerably higher in the eastern provinces, especially in the year 1872, than in the western provinces, notwithstanding the fact that the latter were exposed to the infection much sooner and much more frequently in consequence of the arrival and passing through of French prisoners. The only plausible explanation of this is the fact that the inhabitants of eastern Prussia were not so thoroughly vaccinated as those in the west; this, however, was not because the anti-vaccinationists were more influential in the east, but because the eastern provinces had fewer physicians than the western provinces, where medical advice and help were far more accessible, and where the population was more enlightened. The effect of vaccination is clearly revealed in those Governmental Districts in the west which introduced compulsory vaccination before they were incorporated into Prussia; Schleswig-Holstein did this in 1811, Hanover in 1821, the Governmental District of Wiesbaden in 1820, and the Governmental District of Cassel in 1828. All these parts of the country had fewer cases of small-pox. The Governmental Districts in which large military prisons were located, and those in which, owing to a higher industrial development, there was more intercourse of all kinds, were attacked earlier by small-pox than the others. Of the western provinces only the two highly industrial districts of Arnsberg and Düsseldorf, and the district of Trèves, were very severely attacked. The living conditions among the working people were not so good at that time as they are to-day, and the close quarters must necessarily have favoured the dissemination of small-pox; furthermore, the constant moving about of the working inhabitants, many of whom did not live where they were employed, helped to spread it. Thus it was observed in the vicinity of Leipzig, that the villages inhabited by working people were much more severely attacked by small-pox than those inhabited by farmers, with their stationary and settled population. The high figures in the case of the Governmental District of Trèves may be explained by the fact that its location made it necessary for a large proportion of the French prisoners that were taken into Prussia to pass through it. The number of deaths per 10,000 inhabitants in the various Governmental Districts of Prussia is indicated by the following table (the districts which introduced compulsory vaccination in the year 1870 are designated with an asterisk):

_Governmental District._ 1870. 1871. 1872.
Königsberg 3·5 24·5 37·8
Gumbinnen 4·1 9·7 40·0
Danzig 2·8 42·4 67·6
Marienwerder 3·7 17·7 76·2
Berlin 2·1 63·1 31·4
Potsdam 1·8 25·8 28·7
Frankfurt 0·1 18·6 40·0
Stettin 1·6 29·9 21·4
Köslin 2·2 12·2 36·7
Stralsund 0·2 34·0 3·9
Posen 6·0 48·3 58·0
Bromberg 5·3 24·1 86·6
Breslau 3·1 27·5 33·6
Oppeln 1·7 22·5 42·1
Liegnitz 0·5 11·2 16·8
Magdeburg 0·6 27·5 16·3
Merseburg 1·0 28·8 20·2
Erfurt 1·4 25·3 14·4
Schleswig-Holstein* 0·2 18·0 5·0
Hanover* 0·3 5·3 8·8
Hildesheim* 0·1 13·8 19·6
Lüneburg* 0·2 7·8 6·5
Stade* 1·3 5·6 4·9
Osnabrück* 0·3 6·0 0·8
Aurich* 0·0 5·4 1·1
Münster 0·3 11·6 10·8
Minden 0·2 13·4 8·9
Arnsberg 0·4 39·1 33·8
Cassel* 0·5 9·0 6·2
Wiesbaden* 1·7 9·7 2·5
Coblenz 1·2 22·8 6·6
Düsseldorf 0·3 32·9 20·5
Cologne 1·4 14·6 2·8
Trèves 2·5 34·0 3·1
Aix-la-Chapelle 0·8 14·5 7·8
Hohenzollern 1·7 19·9