Chapter VIII (3)

In the Governmental District of Aix-la-Chapelle only the district of Malmedy suffered severely in the year 1871; being in the south-western part of the governmental district it was, like the border districts in the Governmental District of Trèves mentioned below, exposed to the first onrush of the transports of prisoners. The number of deaths there in the year 1871 was 333 (111·0 per 10,000), whereas in the following year not a single death due to small-pox was reported in the district. At Jülich a Frenchman suffering from small-pox arrived in July, and in November an epidemic broke out among the prisoners; 188 cases of small-pox were reported, and of these only three terminated fatally. In the garrison only one man contracted the disease.

The governmental district of Trèves had a very large number of small-pox cases in the year 1871, since a large part of it bordered directly on the enemy’s country, so that large numbers of sick and convalescent prisoners passed through it. In the year 1872 only a few cases of small-pox were reported, except in the immediate vicinity of Trèves, where the pestilence became quite widespread. The following table indicates the number of deaths per 10,000 inhabitants in the districts mentioned:

1871. 1872.
Daun 3·0 1·9
Wittlich 18·7 1·3
Bernkastel 6·1 0·5
St. Wendel 20·0
Ottweiler 36·2 0·4
Trèves (city) 12·6 4·1
Trèves (district) 17·2 20·6
Prüm 33·2 0·9
Bitburg 23·6 1·4
Saarburg 60·9 1·0
Merzig 51·5 2·8
Saarlouis 80·0 0·2
Saarbrücken 49·5 0·3

The province of Hesse-Nassau suffered very little from small-pox in the years 1871–2, since a compulsory vaccination law had long been in force there. Large epidemics did not occur anywhere. In Cassel a case of small-pox had occurred in the summer of 1870, and after that there were no more cases until November 9; on that day a man was taken sick who had been acting as a sutler among the German troops before Paris and had there been infected. On November 18 a nurse employed in a house in which a field-soldier was quartered contracted the disease, and this case was followed by six more cases among the civil inhabitants; all told, six persons succumbed to small-pox in the city of Cassel in the year 1870, ninety-nine persons (21·4 per 10,000 inhabitants) in the year 1871, and four persons in the year 1872.

In Frankfurt-on-the-Main a few cases of small-pox were reported in the course of the year 1870; the disease was perhaps conveyed thither from Stuttgart. After the commencement of the war it was borne into the city by numerous transports of soldiers and prisoners, and a widespread epidemic soon developed. In the garrison thirty-two cases of the disease were reported. After the Rochus Hospital was opened to small-pox patients, in April, the epidemic reached its climax; the following table, found in the German Health Report, indicates the number of patients received into the above-mentioned hospital and the number that died there:

_No. patients._ _No. deaths._
January 81 13
February 148 16
March 168 17
April 177 25
May
June 36 12

In August the epidemic came to an end. All told, there were 23 deaths due to small-pox in Frankfurt-on-the-Main in 1870, 125 deaths (13·7 per 10,000 inhabitants) in 1871, and 25 deaths in 1872.

In Wiesbaden an epidemic began in December 1870, and reached its climax in February. The population of the city was 35,463, and of these 6 succumbed to small-pox in 1870, 71 in 1871, and two in 1872. Regarding the origin of this small epidemic no information is available.

_(b) The Dissemination of Small-pox in Saxony in the Years 1870–2_

The kingdom of Saxony experienced a very severe epidemic of small-pox in consequence of the Franco-German War. The wide dissemination of the disease is attributed by Wunderlich to the fact that vaccination, in consequence of the wild agitation of the anti-vaccinationists, was insufficiently practised; prior to the year 1874 vaccination was not compulsory in Saxony. Even before the war broke out small-pox had appeared in Saxony in the form of epidemics, e.g. in Chemnitz and Freiberg. The following table indicates the number of persons, all told, that succumbed to small-pox in Saxony:[275]

1871 9,935 (estimate) 38·8 per 10,000 inhabitants.
1872 5,863 22·8 per 10,000 inhabitants.
1873 1,772 6·9 per 10,000 inhabitants.

Of the immobile troops stationed in Saxony, the total number of whom was 17,628, some 506, all told, contracted the disease and 30 succumbed to it.

Regarding the dissemination of small-pox in Leipzig and vicinity we have accurate information.[276] In Leipzig itself small-pox patients were housed only in the city hospital. A small epidemic of the disease had raged there in the years 1868–9. In the year 1870, eighteen patients were committed to the hospital in the months of January-July, after which there were no more cases until October; on the 22nd, 23rd, and 31st of that month a single patient, each time a French prisoner, was taken to the hospital. On November 7 a laundress employed in the hospital contracted the disease; the first case among the civil inhabitants was reported on November 10. In December an epidemic began which spread rapidly and reached its climax in April. The following table indicates the number of patients committed to the hospital in the months mentioned:

March (1871) 384
April 388
May 361
June 231
July 73

The epidemic lasted until the year 1872, and the highest mortality was in the month of May 1871; the number of deaths caused by the disease in the various months was as follows:

October (1870) 1
November 2
December 9
January (1871) 20
February 47
March 117
April 233
May 246
June 205
July 91
August 32
September 24
October 14
November 13
December 10
January (1872) 4
February 5
March and April 4

Among these 1,077 victims of the disease were 21 soldiers and 27 outsiders from the surrounding villages. The disease was very virulent. Of the 1,727 patients treated in the hospital 253 died (14·7 per cent). The population of Leipzig in the year 1871 was 106,922, so that the 1,052 deaths of the year 1871 correspond to a mortality of 98·4 per 10,000 inhabitants. Of 3,726 prisoners, 98 (76·3 per 10,000) contracted the disease and 9 died.

In the district of Leipzig no case of small-pox was officially reported between the months of May and October. When the disease broke out in the city of Leipzig it was of course inevitable, in view of the constant intercourse between the city and the surrounding country, that it should spread rapidly among the working people who were employed in the city and lived in the country, first to the immediate vicinity, and then, following the chief lines of traffic, to the more remote localities.[277] Of 113 places 106 were attacked; only two peasant-villages and five isolated farm-estates were spared. The villages inhabited by working people were much more severely attacked than those inhabited by farmers and peasants. The progress of the epidemic is indicated by the following figures, which Siegel says are incomplete, since not all the cases were reported, and which correspond at best to only one-half of the actual number of cases and deaths:

_Cases._ _Deaths._
October (1870) 2
November 9 3
December 22 5
January (1871) 107 16
February 216 42
March 398 103
April 816 255
May 944 367
June 732 311
July 288 161
August 94 68
September 45 35
October 38 16
November 41 25
December 44 18
January (1872) 26 12
February 28 20
March 18 11
April 6 10
May 5 6
June 2 1
July — —

According to this table the number of deaths in the district of Leipzig, the population of which was 97,100, was eight in the year 1870, 1,417 (145·9 per 10,000 inhabitants) in the year 1871, and 60 in the year 1872. Accurate figures regarding the ratio of deaths to total cases cannot be computed; at all events small-pox raged very severely, owing partly to insufficient vaccination, and partly to the wretched conditions in which the working people lived.

In Dresden, mild epidemics of small-pox had raged in the year 1864 and again in the years 1867–8; between the months of January and August 1870 not a single small-pox patient was taken to the city hospital; the first case was committed to the hospital on September 27 of that year, and after that two more persons contracted the disease in a barrack. The disease spread from there, at first along the streets in the vicinity of the barrack, and then throughout the Antonstadt, Neustadt, and finally the Altstadt. The epidemic reached its climax among the civil inhabitants in April 1871, in the garrison in January. The following table indicates the number of patients committed to the city hospital in the months mentioned:[278]

September (1870) 2
October 12
November 22
December 31
January (1871) 60
February 82
March 95
April 186
May 173
June 148
July 78
August 38
September 18
October 32
November 40
December 62
January (1872) 59
February 57
March 30
April 40
May 13
June 13

All told, there were fifteen deaths due to the disease in Dresden in the year 1870, 570 deaths (32·7 per 10,000 inhabitants) in the year 1871, and 151 deaths (8·4 per 10,000) in the year 1872. Among the prisoners there were 150 cases of the disease, and of these nine were fatal; in the garrison there were 413 cases and twenty-one deaths.

The epidemic of small-pox in Chemnitz, at least the beginning of it, was in no way connected with the war. An exhaustive report made out by Flinzer,[279] who carefully investigated the conditions relative to vaccination in the year 1871, furnishes us the following figures; of 64,255 inhabitants 53,891 were vaccinated, 5,712 were unvaccinated, 4,652 had survived a previous attack of small-pox, and only 1,928 persons had been vaccinated more than once. The epidemic of small-pox began in January 1870, and reached its climax in December of that year. From March 1871 to September 1872, only a few cases of the disease were observed, but after September the number of cases suddenly began to grow larger, resulting in a second severe epidemic, which continued to increase in severity until March 1873. The mortality statistics found in Flinzer’s report are reproduced below; they go only as far as April 1873, but after that the epidemic abated considerably:

1870. 1871. 1872. 1873.
January 1 25 3 43
February 3 15 1 68
March 5 4 5 74
April 8 3 4 37
May 8 3 6
June 8 1 10
July 19 14
August 27 6
September 20 1 6
October 28 1 12
November 28 1 27
December 38 2 32
——— —— ——— ———
Total 193 56 126 222

A particularly good idea of the protection against small-pox afforded by vaccination is given in the Chemnitz statistics for the years 1870–1. Of 53,891 vaccinated persons 953 (1·8 per cent) contracted the disease in those two years and seven succumbed to it, all of whom were more than ten years of age; of 5,712 unvaccinated persons, almost one-half contracted the disease (2,643 or 46·3 per cent, to be precise), and of these 243 (9·16 of those taken sick) died. Of those who died, 102 were less than one year old, 51 were less than two years old, 47 were in their fourth or fifth year, and 20 were from five to ten years of age.

How dangerous small-pox showed itself to be after the Franco-German War is indicated by a report of Geissler[280] regarding the epidemic in Meerane, a manufacturing town of some 20,000 inhabitants. There, between October 1871 and May 1872, no less than 460 persons (434 children and 26 adults) succumbed to small-pox, i.e. 230 per 10,000 inhabitants. Of the children 80·3, and of the adults 26·3, succumbed to the disease in the course of the epidemic.

_(c) Small-pox in Bavaria in the Years 1871–2_

In the year 1866 Bavaria had an epidemic of small-pox, which, although it abated considerably in the following years, did not leave the country entirely free from the disease; it was, however, confined to a very few localities in the year 1870. In Upper Bavaria cases were reported in that year only in Altötting and Friedberg; in Lower Bavaria absolutely no cases were reported; in Upper Franconia a small epidemic raged in August 1870, in the district of Forchheim; in Central Franconia, where in the year 1868 a rather severe epidemic had raged, the disease had almost entirely disappeared by 1870; Lower Franconia and Swabia, finally, had only sporadic cases of the disease. French prisoners and homeward-bound soldiers, away on furlough, caused the pestilence, as was reported from all sides, to break out anew; the rapid dissemination of the disease, according to these reports, was helped by persons coming in direct contact with French prisoners in crowded places, by teamsters returning from France, by German fugitives from France, by persons handling the linen and clothes of patients, and by the sale of woollen blankets and other things which the French prisoners brought with them. The following table indicates the number of people who succumbed to small-pox in Bavaria:[281]

_Total._ _Per 10,000 inhabitants._
Oct. 1, 1865–Oct. 1, 1866 577 1·2
Oct. 1, 1866–Oct. 1, 1867 1,210 2·5
Oct. 1, 1867–Oct. 1, 1868 917 1·9
Oct. 1, 1868–Oct. 1, 1869 487 1·0
Oct. 1, 1869–Oct. 1, 1870 363 0·8
Oct. 1, 1870–Dec. 31, 1870 224
1871 5,070 10·4
1872 2,992 6·1
1873 869 1·8
1874 263 0·5
1875 87 0·2

Munich fared pretty well, and the civil population suffered less than the soldiers.[282] Not a single case of small-pox occurred there during the entire year of 1870. In November an officer suffering from dysentery returned home from France, and shortly after his arrival he was taken sick with small-pox, which later attacked two members of his family. In the first part of the year 1871 small-pox became more and more widespread, and reached its climax in June. The total number of deaths in the year 1870 was 7, in the year 1871 it was 150 (8·9 per 10,000 inhabitants), and in the year 1872 it was 108 (6·4 per 10,000 inhabitants). The following table indicates the number of deaths that occurred in the months mentioned:

November (1870) 2
December 5
January (1871) 18
February 17
March 15
April 17
May 20
June 22
July 7
August 4
September 6
October 7
November 10
December 7
January (1872) 10
February 21
March 20
April 20
May 21
June 11
July-December 5

In Nuremberg[283] sixteen isolated cases of small-pox were observed up to the end of September in the year 1870, and twenty cases from October to December (five in October, four in November, and eleven in December); not a single patient succumbed to the disease in the course of that year. In January the number of people to contract the disease increased rapidly, and the climax of the epidemic was reached in April. The following table indicates the number of deaths caused by the disease in the months mentioned:

January (1871) 1
February 3
March 10
April 18
May 13
June 11
July 6
August 0
September 3
October 1
November 2
December 5
January (1872) 7
February 13
March 6
April 9
May 2
June 2

In the second half of the year 1872 there were two more deaths due to small-pox. The total number of deaths caused by the disease was 73 (8·8 per 10,000 inhabitants) in the year 1871, and 40 (4·8 per 10,000) in the year 1872.

Augsburg was very severely attacked. A Bavarian soldier and two French prisoners succumbed there to small-pox in December 1870. In January the disease spread to the civil population, increased rapidly in severity, and reached its climax in May. After abating a little in September, the epidemic started up anew and did not disappear entirely until May 1872. The number of deaths is indicated by the monthly reports found in the Bavarian _Ärztliches Intelligenzblatt_, a few of which we reproduce:

January (1871) 8
February 14
March 24
April 35
May 42
June 34
July 17
August 14
September 2
October 9
November 14
December
January (1872) 17
February 18
March 11
April 8
May 6
June and July 5

The total number of deaths, some of which are not included in the monthly lists, was 234 (45·7 per 10,000 inhabitants) in the year 1871, and 71 (13·8 per 10,000) in the year 1872.

In Regensburg sixteen persons (eleven prisoners, three soldiers, and two civilians) contracted the disease in the latter part of 1870; in 1871 as many as 123 persons contracted the disease, and of these thirty-three died. In Bamberg the first two cases were reported in December 1870, the disease having been brought there from Würzburg; up to August 1871 some ninety persons contracted the disease, among them twenty-three prisoners and five soldiers; of these, eight died. After a short lull, new cases were reported (between December 1, 1871, and August 1872); there were thirty-one cases, all told (seventeen of the patients being soldiers), and only one death.[284]

_(d) Small-pox in Württemberg in the Years 1871–2_

In Württemberg, where vaccination had been compulsory since 1818, but had been frequently evaded in the ‘sixties in consequence of the agitation of the anti-vaccinationists, an epidemic of small-pox raged in the years 1863–7, causing, all told, 804 deaths. In the latter part of the year 1869 a new epidemic began and carried away many people, particularly in Stuttgart, but also in the rest of the Neckar district. With the arrival of the French prisoners the number of cases increased rapidly, and the disease appeared in many places which had never before been attacked. The following table indicates the number of reported cases and deaths:[285]

_Year._ _Cases._ _Deaths._ _Deaths per 10,000 inhabitants._
1868 559 34 0.2
1869 1,488 133 0.7
1870 5,208 529 2.9
1871 10,848 2,050 11.3
1872 ? 1,164 6.4

But the reports were not always complete, for the reason that many cases were kept secret. The following table indicates the number of deaths caused by small-pox in the various districts:

_Neckar _Schwarzwald _Jagst _Donau
district._ district._ district._ district._
1868 1 19 3 11
1869 77 5 40 11
1870 381 71 40 37
1871 883 570 173 424

In the years 1869–70 Stuttgart[286] was the principal seat of the epidemic; sixty-six cases were reported there in 1866, fifteen cases in 1867, and seventeen cases in 1868; only one case terminated fatally in the year 1868. In the year 1869, after an average of twenty cases per month had been officially reported up to August, the disease raged more and more furiously, so that the total number of cases for the entire year was no less than 744. In the following year the disease continued to increase in severity until February, when it began to abate somewhat, so that in October 1870 only thirteen cases were reported. Then the number of cases steadily increased again until June 1871, when the epidemic once more subsided a little, only to reach another moderate climax in November. In the middle of the year 1872 the epidemic suddenly came to an end. The following table indicates the number of deaths caused by small-pox in the Stuttgart epidemic:

1869. 1870. 1871. 1872.
January 1 21 7 17
February 19 8 14
March 20 10 12
April 2 22 25 6
May 21 22 3
June 1 14 23 3
July 3 2 12 4
August 2 5 15
September 2 2 6
October 5 1 21
November 13 2 19
December 21 5 19
—— ——— ——— ——
Entire year 50 134 187 59

It is impossible to prove that the recrudescence of the disease in Stuttgart in the latter part of 1870 was in any way connected with the arrival of infected persons from France. In the garrison, which numbered some 3,000 men, only four mild cases occurred, inasmuch as all recruits had been vaccinated in Württemberg since the year 1833. But in the latter part of the year 1870 there arrived a battalion of the Landwehr, a third of whom had never done active service, and had therefore never been revaccinated in accordance with the military regulation; after this, numerous cases were reported in the garrison (October 1870 to April 1871), although none of them resulted fatally.

The connexion between the epidemic in the stronghold of Ulm and the war was very obvious. Says Volz:[287] ‘After the summer of 1870 had produced only a few cases of small-pox, and a long pause (August to the beginning of November) had intervened, during which we saw absolutely no traces of the disease, the arrival of French prisoners caused the disease to spread far and wide, constituting a part of the epidemic which raged throughout almost all of Europe. In the latter part of September the first cases of small-pox were observed among the prisoners. But a month and a half elapsed before the disease made its appearance among the civil inhabitants; one of the first cases was traced to the beds in the barracks. In January 1871 the disease was conveyed to Söflingen by a woman from that place who had been employed as a nurse in the military hospital at New Ulm. The constant intercourse between Söflingen and Ulm soon asserted itself through the infection of working-men who were employed in the latter place and lived in the former. At the same time the disease frequently appeared among the laundry-owners, washerwomen, scrubwomen, innkeepers, sutler-women, and generally among persons who were employed in any capacity in the field-hospitals and forts. Then, too, patients kept arriving who had been infected in Baden, Switzerland, Bavaria, North Germany, and in regions which, like ours, had been infected by prisoners and fugitives arriving from France. In the district of Beimerstetten the disease also made its appearance, having been brought there in a carpet which a woman purchased from a Bavarian soldier who had accompanied a transport of prisoners. In addition to this woman, sixteen more persons contracted the disease, and three of them died.’

In the city of Ulm thirty-six civilians (13·7 per 10,000 inhabitants) succumbed to the disease, while in the district of Ulm forty-six persons (21·2 per 10,000) died. The climax of the epidemic was reached in May; after a short lull in August and September it started up again and lasted until the autumn of 1872. The garrison at Ulm was also attacked, but not very severely.

Of the immobile troops in Württemberg, who averaged 10,122 men, 7·9 per 1,000 contracted the disease. Of the French prisoners that were held in Württemberg, 390 contracted the disease (the climax, 199 cases, was reached in December). The maximum number of prisoners was 12,958, and 30·1 per 1,000 contracted the disease and twenty-eight died (7·2 per cent of those taken sick).

In Heilbronn,[288] as in Stuttgart, a small epidemic had raged before the war broke out; from February to July 1870 some forty persons had contracted the disease. From August to October no more cases were reported, but in November a new epidemic began and spread with great rapidity. The following table indicates the number of cases and deaths in the small-pox hospital at Heilbronn:

_Patients._ _Deaths._
November (1870) 2
December 19 2
January (1871) 51 3
February 66 9
March 95 13
April 83 14
May 95 17
June 47 11
July 18 2

In addition to these, twenty-seven cases of the disease were reported in the city, so that the total number of patients was perhaps as large as 1,000. All told, seventy-one persons died in Heilbronn in the course of the epidemic.

_(e) Small-pox in Baden in the Years 1871–2_

In Baden a great many cases of small-pox were reported among the French prisoners; their maximum number was 12,083, and of these 512 (42·4 per 1,000) contracted the disease, and 21 (4·1 per cent of those taken sick) succumbed to it. The largest number of cases (133) was observed in January. Regarding the distribution of the French prisoners among the various dépôts no information is available, while regarding the immobile German troops we know absolutely nothing. Among the civil inhabitants a small epidemic raged as early as the year 1869, particularly in the district of Mannheim. In the latter part of the year 1870 a considerable number of cases was reported, and a rather severe epidemic rapidly developed. According to a written report of the Baden Bureau of Statistics, the number of deaths due to small-pox per 10,000 inhabitants was as follows:

_District._ 1870. 1871. 1872.
Constance 0·6 18·8 3·2
Freiburg im Breisgau 3·5 27·5 2·3
Karlsruhe 3·7 33·1 5·2
Mannheim 1·0 6·5 3·4
——— ———— ———
All Baden 2·4 21·7 3·5

Of those cities which at that time had more than 10,000 inhabitants, Mannheim and Karlsruhe suffered very little; Rastatt, Freiburg, and Constance were the most severely attacked. The number of deaths caused by small-pox was:

_Population._ 1870. 1871. 1872.
Mannheim 39,606 3 33 4
Karlsruhe 36,582 4 25 9
Freiburg im Breisgau 24,668 10 138 17
Heidelberg 19,983 2 37 2
Pforzheim 19,803 2 34 2
Rastatt 11,560 10 99 1
Baden 10,080 4 9 4
Constance 10,061 2 39 2

_(f) Small-pox in Hesse in the Years 1871–2_

Regarding the epidemics of small-pox that raged in the Grand Duchy of Hesse in the course of the nineteenth century, Reissner and Neidhart[289] have published an excellent book. Vaccination, at least once, was made compulsory in Hesse in the year 1807. According to the above-mentioned book, small-pox was prevalent in Hesse all the time; the average number of deaths per annum in the years 1863–8 was O·47 per 10,000 inhabitants. After the year 1868 the statistics read as follows:

_Deaths—Total._ _Per 10,000 inhabitants._
1869 20 0·24
1870 248 2·95
1871 1,028 12·08
1872 167 1·95
1873 3 0·03

The increased prevalence of the disease began in September; the following table indicates the number of deaths in the several months:

1870. 1871. 1872.
January 163 27
February 3 148 30
March 3 136 33
April 9 163 35
May 9 143 22
June 10 105 17
July 5 73 2
August 5 30 1
September 13 21
October 30 15
November 45 15
December 116 14
——— ————— ———
Entire year 248 1,026[290] 167

While small-pox made its appearance here and there in the first half of the year 1870, it did not acquire epidemic dimensions until after the outbreak of the war. In many places, to be sure, it was impossible to prove that the disease was directly connected with the war. Reissner and Neidhart mention numerous cases in which the disease was communicated by field-soldiers who were sent from France to Hessian reserve-lazarets (Pfungstadt, Lampertheim, Crumstadt, and others), by furloughed field-soldiers (Lauterbach, Lorsch, Eschollbrücken, and others), by fugitives from Paris at the beginning of the war (Giessen, Gross-Eichen), by French prisoners who had contracted the disease in camp or during transport, by teamsters returning home from France (Worms, Grossgerau), by military effects—such as carpets, clothing, tent-canvas (three places in the district of Grossgerau), and especially by people who had visited the prisons where the French soldiers were confined (Mayence, Darmstadt, &c.).

Not a single district in Hesse was spared during the epidemic of the years 1870–2. The district of Mayence suffered worst of all; then came Giessen, Offenbach, and Darmstadt, all districts in which moderately large cities were located. The following table indicates the number of deaths per 10,000 inhabitants in the various cities and districts:

1870. 1871. 1872.
Mayence (city) 13·5 37·4 3·2
Mayence (district) 3·2 33·3 0·3
Darmstadt (city) 3·5 12·9 0·8
Darmstadt (district) 2·9 21·7 1·8
Giessen (city) 7·4 9·0
Giessen (district) 11·8 9·6 1·0
Offenbach (city) 0·4 15·9 6·6
Offenbach (district) 0·7 12·7 4·7

In the city of Mayence about thirty cases of small-pox were reported in the year 1870 before the war broke out. ‘Shortly after the beginning of the war,’ say Reissner and Neidhart, ‘numerous prisoners were interned in Mayence, and among them cases of small-pox had not infrequently been observed beforehand. Notwithstanding the admonitions of the military physician, a barrack inside the city was set aside as a lazaret for them. At first in the near-by streets, but later on throughout the entire city, an epidemic now began to rage such as Mayence had never before experienced in the memory of man. It lasted throughout the entire year of 1871 and did not come to an end until the middle of the following year.’ The epidemic reached its climax in Mayence in January 1871, abated a little until March, started up again in April, and then slowly decreased in fury until it finally disappeared altogether. In the garrison at Mayence 190 men contracted the disease in the years 1870–2 and nine succumbed to it; of the prisoners of war 934 contracted the disease and seventeen per cent of them died. The pestilence was disseminated in all directions from Mayence, partly by people from the surrounding country who visited the city, and partly by other means. Thus, for example, the disease broke out with unusual severity in Bretzenheim, a village situated a mile or so away from the barracks where the prisoners were confined; the inhabitants of the village in many instances used the contents of the ditches in which the defecations of the prisoners were thrown to fertilize their fields, and they also bought straw and other waste products in the city.

In the city of Giessen no cases of small-pox occurred in the year 1870 prior to the outbreak of the war. The first cases observed there were in September, but the epidemic, which reached its climax in December, did not become very widespread. In Darmstadt 50 cases of small-pox were reported in the year 1870 prior to the outbreak of the war, and after the war began some 50–60 cases were observed before the end of the year. The epidemic, which became only moderately widespread, lasted throughout the entire year of 1871 and did not disappear until the middle of the year 1872.

_(g) General Observations regarding the Epidemic of Small-pox in Germany
in the Years 1871–2_

In connexion with the Franco-German War an epidemic of small-pox raged throughout Germany, the extent and virulence of which exceeded that of any other epidemic that occurred in the entire course of the nineteenth century. Unfortunately, in the case of a number of small States, we have no statistics relating to the number of deaths caused by the disease. The figures which I was able to obtain I have compiled in the following table. In the case of Alsace and Lorraine, as well as of Oldenburg, the two Mecklenburgs, and the other small North German States, absolutely no figures are available; judging by their population and by the prevalence of small-pox in the States surrounding them, we may safely estimate the number of deaths caused by small-pox in them in the years 1871–2 at some 4,000.

───────────────┬───────────┬───────────────────────────────────────────── _States in the │_Population│ German │ Dec. 1, │ Confederation._│ 1871._ │ _Deaths caused by small-pox._ ───────────────┼───────────┼────────┬────────┬──────────┬──────────┬───── 〃 │ 〃 │ 1869. │ 1870. │ 1871. │ 1872. │1873. ───────────────┼───────────┼────────┼────────┼──────────┼──────────┼───── Prussia │ 24,691,085│ 4,655│ 4,200│ 59,839│ 66,660│8,932 Bavaria │ 4,863,450│456[291]│516[292]│ 5,070│ 2,992│ 869 Saxony │ 2,556,244│ ? │ ? │ 9,935│ 5,863│1,772 Württemberg │ 1,818,539│ 133│ 529│ 2,050│ 1,164│ 55 Baden[292] │ 1,461,562│ 67│ 343│ 3,176│ 511│ ? Hesse │ 852,894│ 20│ 248│ 1,028│ 167│ 3 Brunswick[291] │ 312,170│ ? │ 2│ 269│ 215│ ? Lübeck │ 52,158│ │ 1│ 36│ 15│ Bremen[291] │ 122,402│ │ │ 54│ 41│ 3 Hamburg │ 338,974│ 20│ 83│ 3,647│ 323│ 3 Other States │ 2,439,576│ ? │ ? │4,000[292]│4,000[292]│ ? Alsace-Lorraine│ 1,549,738│ ? │ ? │ ? │ ? │ ? ───────────────┼───────────┼────────┼────────┼──────────┼──────────┼───── All Germany │ 41,058,792│ │ │ 89,104│ 81,951│ ───────────────┴───────────┴────────┴────────┴──────────┴──────────┴─────

The above compilation leaves no doubt that the disease was borne into Germany from France. The contagion was conveyed into Germany by prisoners and field-soldiers, some of whom were infected beforehand and were sick when they got there, others of whom were still apparently healthy, and still others of whom had reached the convalescent stage of the disease, and less frequently by civil persons (teamsters and fugitives); but the prisoners were by far the most active influence in spreading the disease. The dissemination usually took place in the following manner; in the dépôts where the prisoners were confined, small-pox epidemics of varying severity broke out; from all sides the people streamed in to see the prisoners, and when they went away they conveyed the infection wherever they went, at first, of course, around in the immediate vicinity. This is most evident in the eastern provinces, where these dépôts soon came to be dangerous seats of small-pox infection; the near-by districts were very severely attacked as early as the year 1871, whereas the more remote districts did not begin to suffer severely until the year 1872.

The development of a small trade between the prisoners and civil inhabitants in articles belonging to dead soldiers, or in personal effects, also helped to spread the disease; moreover, certain unscrupulous sick-attendants, when they were instructed to destroy such articles, frequently disobeyed the order and secretly sold them, thereby giving an additional impetus to the dissemination of the disease.

The fact that a large part of the population was not vaccinated, and that the necessity of revaccination was not properly recognized (only soldiers were revaccinated), also helped to increase the severity of the pestilence. In all the South German States compulsory vaccination had existed for decades, but its strict enforcement was everywhere hindered by the activity of the anti-vaccinationists; Prussia and Saxony did not introduce compulsory vaccination until the year 1874. Revaccination among the civil inhabitants was rarely practised in either North or South Germany. These differences in the vaccination laws account for the fact that small-pox raged more severely in North Germany than in South Germany; this is also distinctly shown by the tables reproduced in the course of this chapter. The fact that the civil inhabitants in general were more thoroughly vaccinated also explains why the percentage of children that succumbed to small-pox was so much smaller in South Germany than in North Germany.

The number of deaths caused by small-pox in the epidemic of the years 1870–2 was greatly increased by the extremely virulent character of the disease. Of course one cannot estimate the number of deaths caused by small-pox among the civil inhabitants from the number of reported cases of the disease, since the reports sent in were always very incomplete. We know that the mortality of small-pox depends very much upon vaccination; vaccinated persons succumb far less frequently to the disease than unvaccinated persons. This fact explains why among the German field-soldiers, who were constantly subjected to hardships and privations of all kinds, only 5·75 per cent of the patients died, whereas of the French prisoners some 13·85 per cent died. The mortality among the civil inhabitants of Germany was also very high; this was chiefly due to the fact that severe forms of the disease, particularly hemorrhagic small-pox, were of frequent occurrence. As authority for this we can only refer to these reports of the hospitals; but since small children, amongst whom the mortality of small-pox is very high, are less represented in them, and, on the other hand, since mild cases among adults can more readily be withdrawn from hospital treatment, one cannot accept without qualification the experience of the hospitals. According to Wunderlich, of 681 patients treated in the Leipzig hospital between the year 1852 and July 1870, only 29 (4·2 per cent) died, whereas in the years 1870–1, of 1,727 patients treated, 253 (14·7 per cent) died. In Breslau, whereas in former epidemics an average of seven per cent of the patients died, in the epidemic of the years 1871–2 no less than 13·4 per cent died. Guttstadt also states that the mortality in the Berlin hospitals was fifteen per cent, whereas the number of deaths caused by the disease in former years was much smaller. We have seen above that 21·7 per cent of the patients taken to the Hôtel-Dieu in Lyons died. It is unnecessary to adduce further statistics; all contemporary observers agreed that the epidemic involved an extremely severe and virulent form of the disease, and that this same virulence characterized the disease wherever it made its appearance.

5. _The Epidemics of Small-pox that raged in the European, and in a few of the non-European States in connexion with the Franco-German War of 1870–1_

_(a) Switzerland_

Switzerland was exposed to great danger in consequence of the passage of General Bourbaki’s army, which consisted partly of very young soldiers who had suffered great hardships, including cold and hunger, and which contained large numbers of men who were suffering from small-pox. The little country was called upon to take in some 85,000 men; when the latter were examined on the frontier a large number of them were found to be infected with small-pox and were held at Verrière in France. But this did not prevent the disease from being conveyed across the border. Of the French prisoners confined there, 137, all told, succumbed to small-pox.

Unfortunately no mortality statistics giving the cause of death were compiled in Switzerland until the year 1876, so that we have no figures indicating the prevalence of small-pox. The western cantons were most exposed to the infection. In Berne, which at that time had a population of 506,511, no less than 2,637 persons, excluding the French prisoners interned there, contracted the disease between October 1870 and September 1872; in the year 1871 there were 9·6 deaths per 10,000 inhabitants.[293] In the city of Basel, which was attacked as early as November 1870, the epidemic reached its climax in February; the number of deaths there was as follows:[294]

_Total no._ _Per 10,000 inhabitants._
1870 7 1·6
1871 64 14·0
1872 13 2·7

The Canton of Basel (Land) was attacked somewhat less severely; in the year 1871 only 59 persons (10·9 per 10,000 inhabitants) succumbed there to small-pox. In the Canton of Solothurn, which was infected from Olten, a railway junction, 13·9 persons per 10,000 inhabitants died in the year 1871. In the Canton of Waadt small-pox broke out, according to Vogt, in the district of Vivis in November 1870, and 200 persons contracted the disease in the course of that month. In the two small-pox hospitals at Lausanne, 351 patients were treated between November 20, 1870, and the end of 1871, and 62 of them died.

The small-pox epidemic spread very rapidly from the West throughout all the rest of Switzerland, partly in consequence of the distribution of the French prisoners among the other cantons, and partly in consequence of inland intercourse. Of the French prisoners interned in the Canton of Zurich 180, according to A. Brunner,[295] contracted the disease and 31 died of it. The patients were sheltered in the small-pox camp at Winterthur, whence the infection spread to many places. In February 1871 there was a rapid increase in the number of cases; the epidemic reached its climax in March and April, and then steadily abated until June. The statistics for the Canton of Zurich, which had a population of 285,915, were as follows:

_Patients._ _Deaths._
1870 85 6
1871 1,068 137
1872 200 18
1873 22 —

In the Canton of Thurgau, according to Vogt, there were 9·2 deaths per 10,000 inhabitants in the year 1871, in the Canton of Schaffhausen 4·0, and in the Canton of St. Gall 3·3. During the small-pox epidemic that raged in the Canton of Schwyz in the year 1871 the communities of Gersau and Küssnacht were severely attacked; throughout the entire canton 56 persons (11·7 per 10,000 inhabitants) succumbed to the disease. The Cantons of Glarus, Unterwalden, Zug, and Graubünden were also rather severely attacked. In the Canton of Tessin, whither the disease, which first appeared in Locarno, had been conveyed by travellers from Paris, and where 62 cases of it and 6 deaths had been reported up to June, a new epidemic broke out in Personico, resulting in 15 deaths; in the year 1871 there were 11 deaths reported throughout the entire canton. In the Canton of Willis small-pox broke out only sporadically.

_(b) Belgium_

In numerous places throughout Belgium small-pox had appeared in the first part of the year 1870 in the form of widespread epidemics, a fact which we can readily explain when we consider the country’s proximity to France, which was everywhere infected with the disease. Thus, according to Larondelle, a severe epidemic of small-pox broke out in February 1870, in the city of Verviers, which at that time had some 33,000 inhabitants, and lasted until January 1871; in the year 1870 no less than 428 deaths were reported there, and 185 of them occurred in the month of December alone. When the war began French fugitives kept bringing the disease into the country, especially after the battle of Sedan, when more than 10,000 French soldiers were interned on Belgian soil, some in Beverloo and others in the citadel of Antwerp. From these places the epidemic spread throughout all Belgium. In Brussels, for example, no cases of small-pox were reported in July 1870, in August there were two cases, in September two, in October twenty-two, in November sixty-nine, and in December 101. In all Belgium the number of deaths caused by small-pox was:[296]

_Total no. deaths._ _Per 10,000 inhabitants._
1868 843 1·7
1869 1,651 3·3
1870 4,163 8·2
1871 21,315 41·7
1872 8,704 16·8
1873 1,749 3·3

_(c) Netherlands_

In the Netherlands an epidemic of small-pox had raged in the year 1866; in the following year it had rapidly abated, and in the year 1869 had caused only fifty deaths in the three provinces of North Holland, Utrecht, and Limburg combined. In the year 1870 the number of deaths increased considerably, and in the following year reached an appalling height.[297] The following table indicates the annual mortality of the disease:

_Total no. deaths._ _Per 10,000 inhabitants._
1869 50 0·14
1870 706 1·96
1871 15,787 43·55
1872 3,731 10·21
1873 351 0·95

Thus both Belgium and the Netherlands had a very high small-pox mortality in the year 1871; as elsewhere, the cause is traceable to repeated transplantations of the disease, and to the fact that vaccination was insufficiently practised.

_(d) Austria_

In the years 1872–4 Austria suffered severely from small-pox; the total number of deaths per annum caused by the disease is indicated by the following table:[298]

_Total no. deaths._ _Per 10,000 inhabitants._
1870 6,177 3·0
1871 8,074 3·9
1872 39,368 19·0
1873 65,274 31·2
1874 36,442 17·3
1875 12,151 5·7

Although small-pox was usually conveyed into Austria from the East and South (Italy), nevertheless the connexion between the epidemic in Austria of the years 1872–4, and the great German epidemic is too obvious to be overlooked. This is clearly shown by the successive appearances of the disease in the various crown-lands, the number of deaths per 10,000 inhabitants in which is indicated by the following table:

1870. 1871. 1872. 1873. 1874. 1875.
Lower Austria 2·6 5·1 37·0 28·8 15·1 10·6
Upper Austria 1·4 2·5 12·6 19·8 7·4 3·1
Salzburg 4·1 9·8 20·4 18·6 3·1 0·7
Styria 1·3 1·7 7·0 15·1 22·4 8·0
Carinthia 2·6 1·9 2·7 18·3 27·8 5·6
Carniola 1·2 1·2 4·0 21·2 51·1 4·3
Triest 3·2 2·1 72·2 4·1 5·9 2·7
Görz and Gradiska 〃 1·1 5·5 7·6 5·2 1·4
Istria 〃 0·6 18·3 9·5 8·9 3·0
Tyrol 0·9 1·1 1·0 3·3 11·0 14·4
Vorarlberg 〃 1·7 7·2 12·9 3·2 0·7
Bohemia 1·1 1·8 15·7 29·0 4·0 1·0
Moravia 1·8 3·8 21·0 47·0 6·6 2·4
Silesia 0·2 3·6 57·7 25·2 4·7 1·3
Galicia 6·4 6·4 20·9 46·5 33·5 7·3
Bukowina 6·6 12·0 9·0 9·7 44·3 29·2
Dalmatia 4·4 3·6 3·0 9·4 5·8 3·5

These relative percentages were based upon a mean population computed from two censuses, one taken in 1869 and the other in 1880.

We see how the epidemic gradually penetrated into Austria, and how Triest at a very early date became a second focus of the dissemination. In the year 1870 the small-pox mortality was generally low in Austria. The small epidemic in Bukowina in the year 1871 had no causal connexion with the Franco-German War; it was an epidemic such as had often broken out in former years in the countries of eastern Austria, and such as still break out occasionally nowadays. On the other hand, a considerable increase in the number of deaths caused by small-pox is observed in the year 1871 in Lower Austria and Salzburg, and to a certain extent in East Austria, Moravia, Silesia, and Bohemia; in Lower Austria, Salzburg, and Silesia the epidemic reached its climax in the year 1872, whereas in Upper Austria, Bohemia, and Moravia this climax did not come until the year 1873. The same is true of Vorarlberg, while the crown-lands of Styria, Carinthia, Carniola, and Tyrol were most severely attacked by the disease in 1874. In Triest and Istria the climax of the epidemic was reached in 1872, in Görz and Gradiska in 1873. In Galicia, which had always had a high small-pox mortality, the epidemic did not begin until the year 1872; it reached its climax in the following year. In Bukowina the climax did not come until the year 1874.

‘To follow the progress of the disease according to political districts,’ says Daimer, ‘is instructive for the reason that, as was clearly shown at that time, it always spread slowly—a fact which was also repeatedly observed in the case of other epidemics; thus, there was always time enough to adopt appropriate measures aiming to check its progress.’ There is a very marked difference between the epidemic of small-pox in East Austria and the one in Germany; the latter attacked all Germany within a short time, since the war had developed there a very extensive intercourse. And even in Germany it was observed that the disease was a long time in reaching those regions that were less affected by this intercourse.

Vienna was attacked with great severity by small-pox; so also was Prague, though to a lesser extent. The following table indicates the number of deaths caused by the disease per 10,000 inhabitants:

_Vienna._ _Prague._
1869 5·4 1·9
1870 4·8 2·6
1871 7·6 1·5
1872 52·7 39·7
1873 22·0 28·2
1874 14·3 3·0
1875 18·0 1·1

But in these cities the epidemic did not come to an end; epidemic outbreaks of small-pox continued to occur in Vienna until 1885, in Prague until 1893, and in a number of years (for example, 1877, 1880, 1883, 1884, and 1888) the disease underwent some very important exacerbations.

_(e) Italy_

Small-pox is supposed to have been conveyed into Italy by the volunteers who had fought under Garibaldi; they became infected with the disease in the Department of Côte d’Or, where it had raged extensively, and then brought it back with them when they returned home. In Milan 200–300 cases per annum were usually reported prior to the year 1870. In the summer of that year the number of cases greatly increased, terminating in the following year in a severe epidemic which reached its climax in September and October. According to Felice del Agua,[299] there were 1,287 cases and 152 deaths in the year 1870, and 4,467 cases and 866 deaths in the year 1871. In Rome small-pox made its appearance in October 1871, causing 335 deaths between October 10 and December 31, 1871, and 727 deaths in the entire year of 1872. In the case of a large number of individual places we have reports regarding epidemics of small-pox, but I was unable to find a comprehensive account of the epidemic that raged at that time in Italy.

_(f) Great Britain and Ireland_

Owing to the constant intercourse between England and France it was inevitable that small-pox should very soon be conveyed into England; the persons who conveyed it were probably French refugees. As on the continent, so also in England, small-pox was always prevalent; in the years 1869 and 1870, however, it was not very widespread, and it did not begin to gain much headway until the autumn of 1870. The number of deaths caused by small-pox in England was:

_All told._ _Per 10,000 inhabitants._
1868 2,052 0·9
1869 1,565 0·7
1870 2,620 1·2
1871 23,126 10·1
1872 19,094 8·3
1873 2,264 1·0

In the first nine months of the year 1870 there was no increase in the small-pox mortality, but in the last three months, and from January 1871 on, the increase was very marked. The number of deaths caused by the disease was:

1870. 1871.
First 405 4,903
Second quarter 446 7,012
Third quarter 500 4,612
Fourth quarter 1,229 6,380

These figures do not agree with the figures for the years 1870–1 given in the previous table, and the reason for this is not explained in the report. The places where the disease first entered England were London, Liverpool, and the mining districts of Durham and South Wales (Monmouth). The compiler of the reports regarding the movement of the population in England in the year 1871 says:[300] ‘Nearly all the smaller outbreaks may be more or less directly traced to one of these centres; Brighton, for instance, doubtless suffered from its intimate communication with London. There is distinct evidence in many cases of the introduction of the disease into sea-side towns by sailors, and considering its fatal prevalence in Holland, Belgium, and many parts of France, it is not a matter for great surprise that Southampton, Great Grimsby, and one or two other ports suffered from the epidemic. It is indeed very probable that the epidemic in London was due to the large arrivals of French refugees during the latter part of the previous autumn. That the epidemic may to a great extent be traced to our foreign communications is beyond doubt, and it is to be regretted that the steady decline of deaths from small-pox in the six years 1864–9 had induced a certain apathy in the matter of vaccination, and thus left a large portion of the population unprotected from the disease. In times of severe epidemics large numbers of the vaccinated in some way or other also suffer for the neglect which has left so many unvaccinated.’

The number of deaths caused by small-pox in London was:

_All told._ _Per 10,000 inhabitants._
1868 597 1·9
1869 275 0·9
1870 973 3·0
1871 7,912 24·2
1872 1,786 5·4
1873 113 0·3

In the first quarter of the year 1871 some 2,400 persons succumbed to small-pox in London, in the second quarter 3,241, in the third quarter 1,255, and in the fourth quarter 980. The epidemic broke out in the East End of London in the fortieth week of the year 1870, i.e. in the first part of October; the number of deaths caused by it there was 40, and by the end of the year this number had increased to 110.

Of the English counties, those along the north-east coast were most severely attacked; for example, Durham and Northumberland, where the number of deaths caused by the disease was 45·0 and 29·8, respectively, per 10,000 inhabitants. In the cities of Sunderland and Newcastle-on-Tyne, located in these counties, the number of deaths per 10,000 inhabitants in the year 1871 was 86·0 and 54·1 respectively. There was a very large number of deaths in London (24·2 per 10,000 inhabitants), and the counties bordering on London (Middlesex and Essex) also suffered severely (9·3 and 8·0 respectively); next in order come the counties of Monmouthshire and Lancashire with 14·8 and 11·9 respectively. The high mortality in Lancashire was due only to the city of Lancaster, where there were no less than 38·8 deaths per 10,000 inhabitants; in the rest of the county the number of deaths per 10,000 inhabitants was only 6·3.

In Scotland and Ireland the number of deaths caused by small-pox was:

_All told._ _Per 10,000 inhabitants._
_Scotland._ _Ireland._ _Scotland._ _Ireland._
1869 64 20 0·2 0·04
1870 114 32 0·3 0·1
1871 1,442 665 4·3 1·2
1872 2,448 3,248 7·2 6·2
1873 1,126 504 3·3 0·9
1874 1,246 569 3·6 1·1
1875 76 535 0·2 1·0

Small-pox spread very slowly to Scotland and Ireland; whereas in England the maximum number of persons died in the year 1871, in Scotland and Ireland the maximum number of deaths occurred in the year 1872. Both countries, moreover, were less severely attacked than England.

_(g) Denmark, Norway, Sweden, Finland, and Russia_

Small-pox was a long time in spreading to the Scandinavian countries. In Denmark an epidemic had raged in the year 1869, but did not become very widespread until the year 1872. In Copenhagen it began in the year 1871 and reached its climax in February 1872; between January and April 1,220 cases of the disease and 86 deaths were reported there. Regarding Norway we have no statistical information. In Sweden small-pox raged in the years 1865–9, abated a little in the years 1871–2, and started up again with considerable severity in the year 1873. Stockholm was severely attacked; in the year 1873 there were 13·0 deaths per 10,000 inhabitants, and in the following year 79·2. In Finland, where an epidemic had raged in the year 1868, the number of deaths caused by the disease began to increase in the year 1872, and in the two following years the epidemic acquired enormous dimensions. The number of deaths per 10,000 inhabitants was:

_Denmark._[301] _Sweden._[296] _Finland._[296]
1870 1·0 1·8 1·3
1871 0·6 0·8 1·0
1872 2·2 0·8 3·4
1873 0·3 2·6 45·6
1874 0·4 9·4 50·1
1875 2·1 4·6 8·6
1876 0·1 1·4 3·6

L. Colin reports that the pestilence spread to Russia in the year 1872, when it attacked St. Petersburg very severely. More detailed information I was unable to find.

_(h) Non-European Countries_