Chapter VI (1)

THE EPIDEMICS OF TYPHUS FEVER IN CENTRAL EUROPE FOLLOWING UPON THE
RUSSIAN CAMPAIGN AND DURING THE WARS OF LIBERATION (1812–14)

1. GENERAL OBSERVATIONS REGARDING TYPHUS FEVER

Typhus fever, as a specific disease, was well known to the military physicians during the age of Napoleon, since, as set forth in the previous chapter, it regularly appeared during the numerous Napoleonic wars in the form of widespread epidemics. In France the simple word ‘typhus’ was often used to denote the disease, and the custom still prevails there. In Germany the disease was called infectious nerve fever, war plague, lazaret fever, &c.

At the beginning of the nineteenth century it was generally believed that great hardships, colds, lack of the necessaries of life, and the consequent consumption of spoiled foodstuffs give rise to fevers, and that these fevers, in accordance with the epidemic character of the year and of the season, and also in accordance with the severity of the hardships undergone, might develop into dysentery and typhus fever. At all events, even the eminent physicians of the day, men like Hildenbrand of Vienna[106] and Hufeland of Berlin, who in the course of two decades had abundant opportunity to study the disease, assumed that it is possible for typhus fever to break out spontaneously. It was believed that this fever, originating spontaneously, gradually developed the power of infection. Hufeland’s position was self-contradictory, for he assumes that the disease can break out spontaneously and yet that it can be warded off by means of isolation.[107] He says: ‘A proof of the fact that this disease can spread only through infection is offered by the stronghold of Küstrin, which, being closed up tightly during the entire year of 1813, was free from disease, whereas all the surrounding country, even the army of the besiegers, suffered terribly.’ Whereupon Hufeland immediately adds: ‘The war carried on among us and by us with such unheard-of exertion and hardship caused the disease to break out several times anew throughout our country, and hence it could but become general.’ That it is possible for typhus fever to break out spontaneously and subsequently spread by infection was everywhere believed, even by French physicians. It is hardly necessary to say, however, that the theory of the spontaneous origination of the disease does not accord with modern views. The severe hardships undergone, the hunger and cold, the effluvium of gangrenous wounds, the moral depression, and the many other bad effects which characterized this war more than any other, necessarily decreased the soldiers’ power of resistance and increased their susceptibility to infection. Incidentally, all sorts of telluric and meteorological phenomena, volcanic eruptions, earthquakes, the great heat and dryness of the year 1811, the meteors of that year—all these things were at the time brought into causal connexion with the war pestilences of the years 1813–14.

‘Many people stated positively’, says Hufeland,[108] ‘that they contracted the disease almost immediately after they had occupied small, narrow rooms in company with infected French soldiers, or after they had washed their clothes or waited upon them. This frequently happened in small houses that undertook, for a small profit, to shelter invalid soldiers quartered upon the wealthier citizens. Many asserted that they contracted the disease by passing the night in small inns in the towns and villages around Berlin, and on the roads from Königsberg, Danzig, and Frankfurt, and by sleeping on beds or straw which had shortly before been used by infected Frenchmen or Russians. A certain number of men contracted typhus fever by serving as attendants, in order to earn a little money, in the local French military hospital. In this way many of the servants and attendants employed there, as well as numerous surgeons and apothecaries, contracted the disease and subsequently infected the members of their families who brought them home and took care of them, and who, in turn, infected the other inhabitants of the house and of the neighbouring houses.’ Further on, Hufeland adds that only those inmates of the hospital contracted the disease who, as servants and attendants, had been in close and constant contact with the patients.

In the years 1813–14 a large number of physicians were carried away by typhus fever; it was estimated at that time that some 500 of them throughout Germany (excluding the surgeons) fell victims to the disease—in Silesia alone 63 physicians died, in Leipzig 17, in Württemberg 17, and in Baden 35.[109]

Emphasis was always laid upon the fact that the clothes and other effects of people who had succumbed to typhus fever were highly infectious. The wide prevalence of the disease among the Jewish inhabitants of Vilna was attributed to ignorance or disregard of this fact; for when orders were issued to destroy such clothing, the Jews, out of sheer avarice, disobeyed them. The persons who acquired such effects in this cheap and illicit manner usually paid the penalty themselves; in addition, they did a great deal toward spreading the disease.

The military hospitals were also largely responsible for the dissemination of typhus fever; Parenteau-Desgranges[110] called them outright ‘centres de contagion’. The cities in which military hospitals were erected were always severely attacked by the disease. It was generally complained, even by the French physicians, that the French hospitals were poorly arranged and badly managed—even simple cleanliness and competent attendants were lacking. Patients suffering from infectious disease were placed together with others suffering from some mild form of sickness or from a wound, thus giving the infection the best conceivable chance to spread. Let us read how a French physician describes the conditions in Verdun during the severe epidemic of typhus fever that raged there in the years 1792–5:[111]

‘The disease spread with no less severity from other sources of infection, such as the temporary hospitals established in the Convent of Canons of Saint Nicholas, in the Monastery of Saint Vannes, and in the barracks. The unfortunate patients, thrown in heaps on the damp stone and earth floors, scarcely having under them a few mats, or perhaps some dirty straw, filthy with their excrement, three of them often sharing a single blanket of coarse wool, presented the most dismal picture one could possibly imagine. At least three-quarters of the patients died. They were buried in huge ditches dug in the vicinity of the ramparts, and in the gardens surrounding the abbeys of Saint Vannes and of Saint Nicholas.’

The German Central Hospital Management, which was founded in the latter part of November 1813, and from which Bavaria and Württemberg held aloof, sought to introduce certain improvements into the military lazaret system, but it was unable to accomplish a great deal, owing to the lack of hospitals, physicians, and all the means necessary for the treatment of sick and injured people.

Very dangerous for the dissemination of the disease was the belief that the placing of typhus fever patients together with other invalids did no harm, but rather that the congregating of numerous typhus fever patients by themselves caused the contagion to develop with especial severity. The Saxon staff surgeon Neumann, for example, writes in regard to this question:[112] ‘Anybody who lies in a bed to which the poison is still clinging will without fail contract the disease; on the other hand, I have often seen people suffering from other forms of sickness lie alongside of typhus-fever patients and escape infection, provided they had nothing in common, did not touch one another, or make use of one another’s linen. Hence I draw the conclusion that the poison of typhus fever, like the poison of bubonic plague and small-pox, cannot enter the system from a distance, not even from a very short distance, and can be communicated only by close and direct contact. This seems to contradict our experience that the intensity of the poison is greatly increased when several patients lie side by side. Accordingly, I warn all military physicians not to congregate all their typhus fever patients in a single room by themselves; for few would come forth from such a room alive, while the poisoned atmosphere of the room would pervade the entire lazaret, infect the physicians and attendants, and finally spread throughout the immediate neighbourhood. People think that they can prevent the disease from spreading by congregating and isolating the patients, but as a matter of fact this has the opposite effect. This is clear when we consider that the mere being together of unhealthy people causes the poison to develop, and that not only the people themselves, but also the very exhalations from their bodies, are sufficient to spread the infection. For example, if a considerable quantity of dirty clothes or linen is allowed to accumulate in a pile, and after a short time is picked up, the usual result is that the people who do the work experience a severe attack of typhus fever.’

Very often conditions made segregation impossible, even when it was desired, or else the French generals refused to permit it. Consequently, infection was so frequent in the hospitals that the disease at a very early date acquired the name ‘hôpital fever’ (fièvre d’hôpital).

The fact that the weather conditions exerted some influence was not to be overlooked; in the year 1813, when the warm weather began, the disease abated a little, whereas in the year 1814 it ceased altogether at the beginning of the warm weather. The reason for this was that the cold weather forced people to huddle together in houses, and that bathing and washing, particularly among the soldiers and poor people, was less frequently and profusely indulged in; another reason was that the heavier clothing worn in winter facilitated the breeding of vermin.

Failure to take measures of precaution, if the disease once broke out in a neighbouring place, also contributed greatly toward the dissemination of it. ‘If typhus fever was present in any military halting-place, frequently nothing was done to prevent it from infecting the next place, where it had not yet made its appearance; or, if anything was done, it was often merely to issue an order which was not complied with.’[113] At the same time, to be sure, one must take into account the fact that sheer ignorance rendered useful measures impossible. If this ignorance prevailed in the highest places, nothing better was to be expected of the small cities and towns.

That the ‘contagious typhus’ prevalent during the Napoleonic wars was the same disease which we call typhus fever is very certain. The physicians of the middle of the nineteenth century, when views of typhus and typhoid fever had cleared up somewhat, have confirmed this fact.[114] The descriptions of the disease are almost invariably reproductions of the same picture, the sole difference being that it was much more severe and fatal among the half-starved soldiers on their return from Russia, and among soldiers packed together in strongholds, than it was among people who were less afflicted by the war and who lived at a distance from the military routes.

As a rule, the disease broke out eight or nine days after infection. It began with a general indisposition, which lasted several days, or, if this indisposition failed to appear, with a chill, great languor, loss of appetite, and weakness in the limbs; frequently brain disorders also manifested themselves, at first in the form of a mild stupefaction, singing in the ears, violent headache, somnolence, or wild delirium. The exanthema usually appeared between the fourth and the seventh day. Hufeland describes it as ‘an outbreak of red spots, covering most of the body; they were mostly of a violet tinge, but were not sharply defined, and often gradually merged into the colour of the rest of the skin’. It was frequently asserted that the petechiae now and then failed to appear at all, even in severe cases. Jörg says expressly:[115] ‘Sometimes they broke out sparsely, one here and one there, and in such cases it was easy to overlook them.’ After the disease had progressed for two or three weeks the patient’s temperature went down, and there were few fatalities after the twenty-first day. Convalescence was of short duration, provided the outbreak had not been preceded by exhaustion due to hardships. In regard to abdominal and intestinal symptoms, great dissimilarity was observed; Hufeland states that when there were no complications, an autopsy revealed not the slightest change in the intestinal organs, and Horn says that ‘the colour of the intestines was often almost natural.’ The severity of the disease varied greatly; it was particularly fatal among the soldiers homeward-bound from Russia, more than half of whom died. It is frequently asserted that the majority of those who were thus directly infected succumbed to the disease, and that it carried away some ten per cent of the civil inhabitants who contracted it.

Of course it would be a mistake to say that all the epidemics of that time were epidemics of typhus fever; undoubtedly typhoid fever carried away large numbers of people, since it is to be assumed that the disease was endemic in many cities. But owing to the inaccuracy of the descriptions and the lack of autopsies, it is usually impossible to distinguish the diseases with certainty. Even when the results of autopsies were made known, the condition of the intestines was often described so inaccurately that we cannot even make out whether or not there were intestinal ulcers, which are the most important pathological-anatomical symptoms of typhoid fever. But the initial chill, the short duration of the disease (three weeks), the presence of petechiae, the rapid fall of temperature, and the shorter convalescence, all of which are ever-recurring symptoms, enable us to distinguish the epidemic of the years 1812–14 with certainty from typhoid fever.

Through the influence of the works of Hildenbrand and Hufeland the larger part of the medical world of that time came to look upon contagious typhus as a specific disease; other views, however, were vigorously supported, for example, by Markus of Bamberg, who held it to be an inflammation of the brain. The difference of opinion regarding the character of the disease was important, not only theoretically, but also practically, in view of the therapeutic practice of the time; for those who regarded the disease as an inflammation of the brain had naturally, in accordance with the methods then in vogue, to resort to bleeding. But all unprejudiced observers came to the conclusion that bleeding was harmful, and that it killed all the patients upon whom it was frequently practised. Very soon the beneficial influence of fresh air and cold came to be recognized, and the latter was often provided by means of cold-water baths and douches. ‘It was a universally confirmed principle, derived from experience, that the warmer the patients were kept, the more severe was the disease, and the colder they were kept, the milder the disease.’ How beneficial fresh air was for the patients was shown by the fact that those who were kept out in the open air withstood the disease much more easily than those who were kept shut up in houses and hospitals, and that it was much less dangerous to transport patients from place to place in the open air, than to keep them shut up in overcrowded hospitals. ‘Thousands of patients’, says H. Häser,[116] ‘survived even the most severe forms of the disease without human help of any kind. Many, especially physicians, attributed their recovery to the fact that for weeks at a time they were constantly being transported in the cold winter from one halting-place to another, and were not compelled to lie in overcrowded hospitals, where typhus fever and dysentery raged most terribly.’

In dealing with the epidemic of typhus fever of the years 1812–14 we have a double epidemic to consider. The one was disseminated directly by the returning remnants of the ‘Grand Army’, and after causing terrible devastation in East Prussia it spread, in a relatively milder form, to other parts of Germany. The other epidemic broke out during the great battles in Saxony, which lasted several months, and from there spread virulently over a large part of Germany. In order to avoid repetition, the following account will treat of the dissemination of the two epidemics jointly.

2. THE RUSSIAN CAMPAIGN AND TYPHUS FEVER IN RUSSIA[117]

Napoleon began to make preparations for his Russian campaign as early as the year 1811; troops were assembled in Westphalia, Hamburg, Saxony, Holland, on the Rhine, and near Verona, and several hospitals were founded, as in Danzig. An army of 550,000 men was organized to take part in the expedition into Russia; it consisted of Frenchmen, Germans, Italians, Spaniards, and Poles. How this army was destroyed on its march to and from Moscow, and in what a pitiable condition the remnants of it arrived in Germany, is well known. Since it is our purpose to point out here how that severe epidemic of typhus fever spread abroad from those remnants, we can deal but briefly with the prevalence of the disease in the army itself.

In consequence of the great heat, of the lack of drinking-water and good food, and of the continual bivouacking (the peasants burned and deserted all the villages along the way), the army suffered greatly even on the march to Moscow. After crossing the Polish border the soldiers were severely attacked by dysentery and diarrhoea; Kerckhoffs estimates that no less than 80,000 men were suffering from dysentery at the beginning of August 1812. Typhus fever broke out, very sparsely, to be sure, as early as the latter part of July, when the army arrived at Vilna; there were also cases in the hospitals at Minsk, Vilkomir, Globokie, and Mittau, but the disease was not yet so infectious as it proved to be later. After the battle of Smolensk (August 14–18) large numbers of wounded soldiers (between 6,000 and 10,000 according to various reports) were brought to that city, and from that time on, typhus fever and other diseases (hospital fever, diarrhoea, dysentery, gastric fever, &c.) continued to spread throughout the army. On September 14, Moscow was entered, and on September 15 the city was in flames. The army then had peace until October 19, when the return march began. During their sojourn in Moscow the soldiers were very improperly nourished, eating almost nothing but salted meat and fish, and drinking large quantities of wine and spirits. According to Lemazurier, the number of sick and wounded soldiers in Moscow was 15,000. The most common disease even in Moscow was typhus fever; according to Scheerer, when Napoleon’s army withdrew from the city it left behind several thousand typhus-fever patients, almost all of whom died—only the stronger patients were taken along on wagons.

The horrors of the return march are well known. Thousands froze to death in the extreme cold of November, horse-meat and melted snow were the sole means of nourishment, and any soldier who lay down was irretrievably lost. Between Moscow and Smolensk, which was reached on November 9, one-half of the soldiers who had started out from Moscow died; the number of sick soldiers was enormous, and typhus fever raged more and more extensively. On December 8 Vilna was reached, but there the army was not given a moment’s rest; two days later the Russians advanced and captured 30,000 of Napoleon’s soldiers who could go no further.

In pursuing the French army the Russians also suffered severely from diseases; according to Ebstein,[118] between October 20 and December 14, 1812, they lost 61,964 men, most of whom died of ‘nerve fever’ (typhus fever).

In Vilna, which was greatly overcrowded, typhus fever raged furiously. The large number of sick and exhausted soldiers that were left behind, owing to the extreme cold (the thermometer went down as low as –28° Réaumur) sought shelter, partly in private houses, and partly in hospitals. The latter, for the first few days after the arrival of the Russians, were in a terrible condition; sick men and dead men were packed together in the cold, unheated rooms, the former lying on rotten straw, completely deserted, and without care or nourishment. The corridors and courts were filled with dead bodies and with refuse of all kinds, while in the rooms themselves there was no less filth, since nobody removed the excrements. ‘The courts and corridors of the hospitals’, says Gasc, an eye-witness,[119] ‘were so covered with dead bodies that it was necessary to walk over heaps of them in order to enter the rooms.’

Not until after the Emperor of Russia arrived in Vilna was some semblance of order restored. But it was then too late; almost all the patients in the hospitals were infected with typhus fever, and according to Gasc and Lemazurier the great majority of the 30,000 French prisoners died. For owing to the long series of extreme hardships which the soldiers had undergone, the disease broke out in its most severe form, causing wild delirium, very large petechiae, abscesses, and gangrene. Many patients succumbed within twenty-four hours, and recovery was very slow for those who survived the attack.

In a short time the disease spread throughout the city, not so much because the soldiers were quartered in private houses, as because the Jews got possession of the clothes of the dead. Of some 30,000 Jewish inhabitants no less than 8,000 died. In February and March all classes of society, even the wealthiest people, were attacked. The disease also spread to the surrounding country; Lemazurier says that between the middle of 1812 and the beginning of 1813 some 55,000 bodies were buried in Vilna and vicinity, and that the estimates made in Wittepsk, Smolensk, and Moscow were in proportion. The pestilence spread southward and eastward, and according to Faure, in February 1813 thousands of French prisoners died in the overcrowded hospitals in Orel. The same writer says that all of the French soldiers who fell into the hands of the Russians succumbed to typhus fever.[120] We may safely assume that the civil inhabitants of all places in that part of the country were also attacked, even though we have no figures or statistics to confirm the assumption.

The pestilence also raged extensively in the region of the Baltic Sea; St. Petersburg was severely attacked by it. According to Parrot,[121] in the last months of the year 1812 there were a great many cases of ‘nerve fever’ in Dorpat; in Riga the military hospitals were overcrowded, and out of a population of 36,000 and a garrison of 20,000 there were 5,000 sick. The mortality in the hospitals was very high, since, on account of the extreme cold, two-thirds of the small windows were covered with boards and hay.

Regarding conditions in Warsaw we have more detailed information. According to Wolf,[122] two distinct epidemics raged there after the end of December 1812; the one was an epidemic of typhus fever (probably typhoid) and appeared only among the soldiers; the other was an epidemic of typhus fever, which did not attain to epidemic dimensions until January 1813, although a few isolated cases had been observed in Warsaw in the last months of the year 1812. ‘This disease was almost invariably accompanied by a spotted exanthema, which, if the disease was at first rather difficult to diagnose, often gave the first clue. In the case of many people the eruption was so severe and so general, appearing even on the face, that it resembled measles.’ The comparison with measles was also drawn by other observers. Typhus fever was conveyed to Warsaw by the Austrian auxiliary corps, and it quickly spread to the French hospitals, which were in a wretched condition. Later the Russian army also brought typhus fever to the city. A great many civilians in Warsaw contracted the disease; according to Wolf, the epidemic reached its climax in February, and lasted until the end of the year 1813. The lower classes suffered more than the upper classes from the disease, which, moreover, seems to have raged much more furiously in the vicinity of Warsaw than in the city itself.

3. THE APPEARANCE OF TYPHUS FEVER IN NORTH AND CENTRAL GERMANY

On the return march from Moscow to Vilna the remnants of the army had all taken the same route; for, though all bonds of discipline were loosened as far back as Smolensk, nevertheless the instinct of self-preservation kept all the soldiers from abandoning the common line of march. This was also the case during the march from Vilna to the Niemen, where the extreme cold caused untold suffering. After crossing the river, however, the few unfortunate soldiers who had survived the awful misery of the march, hungry, clothed in rags, with torn shoes, alive with vermin, with frozen and gangrenous limbs, scattered in all directions, some going home, and others to strongholds that were in the hands of the French. Thus typhus fever, with which all parts of the army were infected, was spread in a comparatively short time over a large part of Germany.

At first the eastern provinces of Prussia, through which these remnants of the army passed, were attacked by the pestilence; owing to the fact that so many were infected, measures of precaution were everywhere futile. ‘Adynamic fever’, says Kerckhoffs,[123] ‘spread also among the civilians, who were not only afflicted by the terrible scourge of our passing armies, but also became the victims of a murderous contagion. It was a fatal present which we gave them, and which caused such a high mortality among the inhabitants of the country through which we passed. Wherever we went, the inhabitants were filled with terror and refused to quarter the soldiers.’ In the more distant parts of Germany, in the western provinces of Prussia, in Bavaria, Baden, and Württemberg, where people had perceived the danger, it was easier, in the first months of 1813, to guard against the dissemination of typhus fever, since the number of returning soldiers was small and it was accordingly feasible to enforce orders regarding quarantine. With the approach of spring the disease began to abate a little even in the north and east; in the month of April it had almost entirely disappeared from the French troops there, while in May and June the condition of health among them, according to Kerckhoffs, was very good. But in July typhus fever broke out again, and since the Russian army was also infected with it, the disease became uncommonly widespread throughout Saxony and Silesia during the months of fighting that ensued. After the battle of Leipzig, when southern and western Germany were overrun by French fugitives and prisoners, typhus fever once more broke out in that part of the country with greater severity than ever before; even in the province of Brandenburg and in the adjacent regions the pestilence raged, having been borne thither by French prisoners.

In Lithuania, and East and West Prussia, typhus fever raged extensively in the winter of 1812–13. According to H. A. Göden,[124] who had charge of a large military lazaret in Gumbinnen, the epidemic spread continuously from the border of Russia to Berlin. ‘It appeared most virulently’, he says, ‘in the cities of Gumbinnen, Insterburg, Tilsit, Königsberg, Elbing, Marienwerder, Konitz, and Landsberg; it followed along the military roads, and broke out most severely in the halting-places and in those cities where French military lazarets were established.’ In Gumbinnen typhus fever broke out suddenly in the latter part of November, immediately after the arrival of the fugitives, and spread rapidly. At first it appeared in houses where officers and soldiers were quartered; as a rule, several members of a family contracted the disease simultaneously, and only rarely was one member spared. The pestilence raged most furiously in the months of January and February; the town had some 6,000 inhabitants, and frequently 20, 30, or 40 people, including entire families, died in a single day. In the military lazarets the mortality was considerably higher. In March the pestilence began to abate, and in May it disappeared altogether.

In Königsberg the pestilence began in the month of December 1812 and came to an end in May 1813; excluding the soldiers who died in the military lazarets, the following deaths were recorded there:

December (1812) 430
January (1813) 581
February 802
March 622
April 608
May 327
June 196
July 178
August 157
September 160
October 151

In the year 1812 there were 2,648 deaths in Königsberg, whereas in the following year there were 4,403. In the first part of January, when the city was evacuated by the French, 10,000 people, according to Stricker, were left behind. The entire province of East Prussia, according to Gurlt, lost 20,000 inhabitants by typhus fever.[125]

Danzig, which was besieged by the Russians from January 11 to November 29, 1813, suffered terribly. A French army of 35,900 men, under General Rapp, was in the city, and during the siege it was exposed to all sorts of privations as well as to extreme cold. As early as February typhus fever had become very widespread; from January to May, 11,400 soldiers died in the hospitals (4,000 in March alone), while 5,592 inhabitants succumbed to the disease in the course of the entire year.[126]

Silesia was hit extremely hard. The pestilence was conveyed there in the months of October, November, and December 1812 by transports of Russian prisoners, and it appeared in Trebnitz, Striegau, Krottkau, Friedenwalde, Trachenberg, Breslau, Parchwitz, Quaritz, &c. The officers on duty, the persons who lifted the patients from the wagons, the physicians, and the sick-attendants were always the first to be infected.[127] With the opening of spring the disease disappeared, but broke out anew after the battle on the Katzbach. In Breslau the disease appeared in a very virulent form, since the infected soldiers were housed there in overcrowded lazarets, which in the month of November took in some 6,300 patients daily; numerous physicians (statements vary between 16 and 22) also succumbed to typhus fever. Among the civil inhabitants, to be sure, the disease did not become very widespread; out of a population of 62,789, only 3,055 died in the year 1812, 3,095 in the year 1813, and 3,301 in the year 1814. From the middle of September 1813 to February 1814, 478 civilians and some 1,800 soldiers succumbed in Breslau to typhus fever; the total number of soldiers that died between the middle of September and the beginning of March was 3,400.[128] In the governmental district of Liegnitz, having a population of 600,000, according to Kausch[129] only 13 physicians (excluding the surgeons) died. The disease was borne by transports of infected soldiers into other parts of Silesia, and at the end of the year 1813 all the military lazarets in Silesia were infected. In Waldenburg and vicinity (Obersalzbrunn, &c.) typhus fever broke out after the soldiers had marched through on October 20 and November 25, 1813, and seventeen days later the disease was very widespread, all the members of many families having contracted it. In Bunzlau typhus fever raged with unusual fury; in the military lazaret 12,000 men are said to have died between June 1813 and March 1814.

Presently typhus fever appeared, with the arrival of the remnants of the Grand Army, in regions further away from the Russian border. Häser[130] describes the manner in which the disease spread, always along military roads, as follows:

‘French soldiers returning from Russia’, he says, ‘spread the contagion of various diseases over a large part of Central Europe. Almost naked, or clothed in torn and half-burned rags, without shoes, their feet covered with straw, and their frozen limbs covered with festering sores, they marched through Poland and Germany. Typhus fever and other diseases associated with it marked their course. The inhabitants of the country were forced to house the sick; but teamsters also conveyed the infection to villages which the soldiers did not visit. The disease raged most furiously in the hospitals, which scarcely anywhere were able to meet even the most modest demands made upon them.’

Regarding the appearance of typhus fever in Berlin we are informed by Hufeland and Horn.[131] First to occur there (in the months of February and March 1813) were numerous cases of ‘nervous fever’, which was doubtless typhoid fever. Still it is likely that cases of typhus fever also occurred at that time, for Horn, in writing about ‘nervous fevers’ in the Charité, describes the exanthema with the same words that Hufeland uses in reference to later cases. Among these patients there were already some who had returned from Russia.[132] At all events, in the first part of March 1813 there occurred cases of contagious typhus, which was brought to Berlin by French, and later by Russian soldiers; the observed ways of infection, regarding which Hufeland informs us, are mentioned above. In the middle of April there were 246 typhus-fever patients in the Charité. In order to prevent the disease from spreading in this hospital, Hufeland adopted strict measures of precaution. The patients were all carefully isolated on the second floor, which was shut off by means of a grating. The newly-arrived patients were supplied with clean, fresh linen, their clothing was disinfected for several days in hydrochloric acid, and then washed in boiling water containing lye, while objects of no value were burned. The sick-rooms were constantly ventilated by leaving the windows open, and were thoroughly cleaned every day. The physicians, surgeons, and attendants, before they entered the sick-rooms, had to put on black mantles of glazed linen, and on leaving the rooms they had to wash their hands and faces in cold water and rinse out their mouths. In this way the disease was prevented from spreading in the hospital itself.

After the battle of Leipzig typhus fever broke out anew in Berlin; according to Horn, 144 cases of ‘nerve fever’ were received into the Charité in January 1814, 92 in February, 54 in March, 14 in April, 8 in May, and none in June. Regarding the total mortality in the epidemic of typhus fever in Berlin, which in the year 1813 had about 155,000 inhabitants, the following table, compiled by Gurlt,[133] gives us information; there died in:

1812. 1813. 1814.
_Total _Total _From _Total _From
deaths._ deaths._ Typhus._ deaths._ Typhus._

January 422 500 31 680 170 February 457 544 57 596 118 March 444 740 233 781 85 April 476 719 227 653 55 May 584 752 184 443 28 June 396 518 85 434 19 July 417 460 29 541 14 August 338 551 20 454 5 September 370 467 22 577 16 October 425 621 34 430 13 November 356 555 105 412 11 December 571 585 157 565 11 ————— ————— ————— ————— ——— Total 5,256 7,012 1,184 6,566 545

Typhus fever appeared throughout the entire province of Brandenburg. Maier[134] gives us some information regarding the city of Brandenburg, where ‘infectious nerve-fever’ disappeared in the latter part of May 1813, and where, after the battle of Leipzig, it again broke out, but did not become very widespread. On October 27 prisoners from Baden and Hesse were quartered there; they remained until October 31 and then went on to Ruppin. Among them were some convalescents from a military lazaret in Saxony, who infected the occupants of all the houses in which the prisoners were quartered. Between November 5 and December 6 there were 38 ‘nerve-fever’ patients in the Altstadt and 7 in the Neustadt, a small number of whom died. Typhus fever raged very furiously in Jüterbog after the battle of Dennewitz, carrying away entire families.

After his defeat in Russia, Napoleon had quickly returned to France, and there, by means of new conscriptions, had in a short time assembled an army of very young men, who had never done military service and were therefore not accustomed to the hardships of war and, in particular, were much more susceptible to infectious diseases than the troops that had served under him before. In April, when the army of the Allies had arrived at the Elbe, Napoleon with his newly-gathered army left the Rhine and marched to Saxony, which from then until autumn was the main scene of the war. Since the Russian army was still infected with typhus fever, contracted in the winter campaign, and since, furthermore, isolated cases of the disease were still occurring among the remnants of the French troops that had returned from Russia, the inevitable result was that Saxony was not only completely impoverished by the protracted war, but was also terribly afflicted by war pestilences.

In Saxony typhus fever had already become very widespread in the first few months of 1813; all the places through which the military transports passed were attacked, as Sorau, Guben, Lübben, Görlitz, Leipzig, and Weissenberg; while places in which military hospitals were erected fared even worse, as Schneeberg, Zwickau, Chemnitz, Freiberg, and Augustusburg. The severe epidemic in Annaberg (in the Saxon Erzgebirge), lasting from March to May 1813, has been described by Neuhof.[135] In March a Saxon field-hospital was established there, and presently everybody who came in contact with the hospital contracted typhus fever. In neighbouring Thum, where the patients passed only one night, many citizens succumbed to the disease.

Dresden, in the first few months of the year 1813, was not attacked by the disease, notwithstanding the fact that soldiers and officers returning from Russia were taken sick and died there; only in rare instances were citizens, in whose homes officers had been quartered, attacked, and the disease did not rage at all extensively.[136] On the other hand, typhus fever raged furiously in Dresden after Napoleon’s successful battle at Bautzen (May 20 and 21, 1813), when large numbers of wounded soldiers were brought to Dresden and placed in lazarets, which soon became greatly overcrowded. The less-severely wounded were housed in the homes of citizens, who were compelled to receive them and suffered terribly in consequence of it. The result was that typhus fever spread from the soldiers to the civilians. After the battle of Dresden (August 26, 27), from which Napoleon again emerged victorious, but especially during the short siege of Dresden (from the middle of October to November 11), the epidemic increased in both extent and fury. The increased mortality is shown by the following table, which includes only the residents:

January 184
February 199
March 188
April 194
May 289
June 257
July 264
August 474
September 882
October 659
November 960
December 944

According to Fischer, one person out of every ten that contracted the disease died, while the mortality in the French military hospitals was incredibly high. In the course of the year 1813 no less than 21,090 soldiers died in Dresden, while in the same year 5,194 residents died; 3,273 civilians died in the year 1814, and 1,785 in the year 1815. The average number of deaths per annum among the civil inhabitants was 2,304.

Regarding the terrible conditions in Dresden at that time, a pastor informs us in a letter:[137]

It was a gruesome sight to see the wagons full of naked corpses,
thrown together in the most horrible positions, drive away from the
hospitals and set out for their destination. Many bodies are said to
have been cast into the Elbe. The terrible days began about the
middle of May, when many house-owners were obliged to quarter as
many as two, three, and even four hundred men. Presently persons
suffering from wounds, scurvy, and infectious disease began to
arrive from Bautzen, some straggling along piteously on foot, others
being rolled along in ghastly groups on pushcarts. This
disease-spreading mass was now housed in the homes of citizens,
since the twenty-five hospitals were no longer able to accommodate
them. The houses, yards, streets, and public squares were full of
dirt and refuse. Dearth of food, resulting from the breakdown of
means of supply, added to the general misery. Entire families were
wiped out, and many houses are still standing empty (1814). Wagons
bearing the dead clattered on all the streets, and there were few
inhabitants who did not wear some outward sign of mourning for lost
relatives.

Leipzig suffered even greater hardships. The pestilence was conveyed thither by French soldiers in February 1813, and on the 27th of that month there were thirty-eight fever patients in the Jacobsspital. In the summer of 1813, when the war was going on in Saxony, the disease raged there furiously. After the battle of Dresden a large percentage of the wounded were brought to Leipzig, and more than 20,000 sick and wounded soldiers were kept there for several months. As usual, typhus fever broke out in the city in consequence of it, and carried away large numbers of soldiers and citizens. After the battle of Leipzig upwards of 30,000 wounded soldiers, mostly Frenchmen, were housed in the city. ‘Virulent nerve-fever,’ says Beitzke,[138] ‘which had been prevalent in the city for some time, now broke out with tenfold severity, not only in the city itself, but also in the surrounding country, and carried away large numbers of people. The arrival of the cold weather, which helped to check the disease, was under these circumstances a great blessing.’ In the year 1813 some 80,000 French soldiers, according to the hospital lists, succumbed to wounds, war-typhus, and other diseases, in Leipzig. From February 1813 to January 1814, seventeen young physicians died there of typhus fever. The number of civilians buried in Leipzig in the year 1813 was 3,499, in the year 1814 it was 2,022; the average number of interments in the years 1810–12 was 1,443, and in the years 1815–17 it was 1,187. The number buried (including the still-births, but not the soldiers) was, by months:[139]

1813. 1814.
January 98 450
February 121 276
March 206 244
April 202 152
May 178 159
June 200 120
July 290 85
August 189 107
September 176 118
October 311 111
November 743 96
December 785 104

Most of those carried away were adults; the following table indicates the relation between the age of the victims and the mortality:

_Years of Age._ 1812. 1813. 1814.
1 356 517 456
1–10 161 310 305
10–20 29 174 76
20–30 91 362 157
30–40 87 492 173
40–50 104 559 207
50–60 126 409 208
60–70 124 358 234
Over 70 119 256 155

In reference to the year 1813, in which typhus fever caused the greatest devastation in Leipzig, we see how the mortality among persons between the ages of ten and sixty increased between fourfold and fivefold, while among very young children and very old men, it increased by at most one hundred per cent. In the year 1813 more men than women died (1,900 men and 1,599 women), whereas in the following year the reverse was the case (1,009 men and 1,013 women).

Typhus fever spread throughout all Saxony. In Plauen, which was at that time a city of 6,800 inhabitants, the following number of deaths, according to Flinzer,[140] were due to typhus fever: 4 in 1812, 32 in 1813, 59 in 1814, and 5 in 1815. These figures do not include the foreign soldiers that died. According to Flinzer, the specific disease before the year 1819 was usually typhus fever. In the year 1814 the total number of deaths in Plauen increased to 440.

Numerous sick, wounded, and captive soldiers were quartered in Zwickau after the battle of Leipzig. There and in the surrounding villages, in consequence of the erection of a hospital, typhus fever had already appeared in September, but in Zwickau itself, thanks to timely measures of precaution, it gained no headway. In the year 1812 only 183 civilians died there, 376 in the year 1813, and 260 in the year 1814; 380 soldiers died there in 1813, and 14 in the year 1814.[141]

The pestilences spread all over the country, even into the most remote corners of the Saxon Erzgebirge; Annaberg and the neighbouring towns of Marienberg, Weipert, and Geyer were again attacked, although less severely, according to Neuhof, than in the spring. In March the disease disappeared entirely.

The Saxon strongholds along the Elbe fared worst of all; regarding the terrible devastation caused by typhus fever in Torgau we shall have something to say in the tenth chapter. Magdeburg and Merseburg were also severely attacked; this is evident from the fact that one-half of the physicians in Magdeburg (nine in number) succumbed, according to Roloff, to hospital fever.[142] In Wittenberg, whither typhus fever was borne in February 1813 by infected French soldiers, and where it had subsequently disappeared, the mortality was very high during the siege, which lasted from October 28, 1813, to January 14, 1814; of 6,000 or 7,000 inhabitants, upwards of 4,000 had left the city before the siege began. In the course of seven months (July 1813 to January 1814) 590 people died there, whereas the average number of deaths had been only 300 per annum. When the city was captured by the Prussians the death-rate increased; no less than 331 persons died between January 14 and April 14, 1814.[143]

After the battle of Leipzig the defeated army marched back through Weissenfels, Naumburg, Weimar, and Erfurt to the Main. There was now no active effort made to supply food to the army, which still numbered some 100,000 men; the soldiers had to eat whatever they could pick up along the way. ‘Extreme misery and exhaustion’, says Beitzke,[144] ‘led to great excesses; the places along the route were made to suffer, and worst of all, the region through which the French army hurried back was generally infected with the germ of typhus fever.’ ‘The route of the army, clear to Mayence,’ says Giraud,[145] ‘was again strewn with corpses and débris.’

In Weissenfels some 3,000 soldiers are said to have died in the hospitals, and also 600 civilians, within a year. In Altenburg, which had suffered from typhus fever in the spring of 1813, 1,650 men and 55 officers died between October 2 and December 1 of that year. In Eisenberg (in Saxe-Altenburg), according to Greiner,[146] a lazaret was established in the fall of 1813, but there were but few cases of typhus fever transmitted to citizens owing to the adoption of all measures of precaution. On the other hand, the disease was conveyed to numerous near-by villages, in which large numbers of sick and convalescent soldiers were quartered. ‘The Cossacks did the most toward spreading the disease, for wherever any of them were quartered, one could count with certainty upon an early outbreak of nerve-fever.’ In November 1813, a severe epidemic of typhus fever broke out in Gera, and the mortality in four months was seven times as high as usual. In Zeulenroda (south of Gera) the pestilence was not very severe; it was brought there by sick and convalescent soldiers, who were quartered in the houses.[147] Jena, on the other hand, was very severely attacked: the epidemic began in November 1813, and lasted until March 1814.[148] According to Gurlt, the usual number of deaths in normal years in the districts of Weimar and Jena was from 1,750 to 1,850; but in the year 1813 no less than 3,948 people died there, and in 1814 there were 3,363 deaths.

After the battle of Lützen (May 2, 1813) some 8,000 wounded French and Prussian soldiers came to Erfurt, necessitating the immediate erection of lazarets. After the battles in August, when the scene of the war moved closer to Erfurt, the misery in the city was greatly increased, resulting in a rapid dissemination of typhus fever. In the latter part of August, when 9,000 sick and convalescent soldiers arrived in the city, the citizens were obliged to quarter them; the number of soldiers that succumbed to typhus fever was appalling, while as many as 17 civilians often died in a single day; in the week before the battle of Leipzig 504 soldiers died in the hospitals. On October 20–23 the French lazarets were cleaned out as thoroughly as possible. During the siege, which began on October 25 and lasted seventy-three days, the misery was extreme, and typhus fever raged more and more furiously. From November 1 to November 17 some 400 civilians died, while no less than 1,472 soldiers died in the military hospitals; 143 soldiers died on December 9 and 10. The houses of a few citizens were rendered absolutely tenantless. In the year 1813 Erfurt lost 1,585 citizens, as compared with an average of 554 for the years 1811–12; the number of deaths in the year 1814 was 1,121. Typhus fever also raged so furiously among the Prussian besiegers, that the lazarets were soon overcrowded, and it was necessary to house the troops in other places.[149]

In Fulda, which was forced to take in thousands of sick soldiers, typhus fever soon began to spread rapidly, as it also did in the country surrounding the city. In Giessen, where a Russian field-lazaret for 1,800–2,000 men was erected, the epidemic soon spread to the civil inhabitants.

At Hanau the French retreat was opposed by General Wrede with an army of 50,000 Bavarians and Austrians, a much smaller number than the French had. The two days of fighting that ensued (October 30 and 31, 1813) caused the pestilence to develop murderously. Kopp has given us a good description of this epidemic in Hanau.[150] Since the beginning of the war the city had always had a military hospital, which lay outside the city. During the battles in Saxony the number of sick and wounded increased, so that it was necessary to erect a second lazaret within the city. Many sick-attendants and sub-surgeons contracted typhus fever, which was prevalent in the hospitals, and several cases also occurred in the city, especially among people who quartered soldiers for money in their homes; many soldiers were thus crowded together in small rooms, and among them were a great many convalescents from Saxon hospitals. The infectious nature of the disease and its consequent dangerousness was shown by the fact that as a rule entire families gradually contracted it, although the epidemic was confined to individual houses. The engagement at Hanau, from which the French emerged victorious, resulted in the unfortunate city being stormed and plundered. ‘Even while the battle was going on,’ says Kopp, ‘a corps of the French army scattered throughout Hanau. This corps had brought with it from Saxony the germ of infection; for the region around Dresden could be looked upon as the great breeding-place where, in view of the enormous assemblage of people representing so many nations, and owing to the concurrence of so many unusual factors, the soil was uncommonly fertile for pestilential diseases.’ After the engagement a multitude of French prisoners, greatly weakened by hardships and hunger, came to the city. The dissemination of typhus fever was especially helped along by the fact that many poor inhabitants engaged in looting on the battlefield, and took home with them the knapsacks and other effects of the dead. The clothing of the dead came into the possession of those who were charged with burying them, and later got into the hands of the poorest families in the city and in the neighbouring villages. ‘I often entered the houses of poor people,’ Kopp goes on to say, ‘and found the entire family suffering from typhus fever, and on the walls of the low sick-room the uniforms, shirts, and other effects of the dead soldiers would still be hanging.’ The result was that the number of patients greatly increased after the battle, and in less than two weeks an epidemic began to develop; at first it was rather mild, but later on it carried away large numbers of people, and lasted until the end of February, having reached its climax in December. From December 1, 1813, to January 4, 1814, 248 people died, whereas the normal mortality for the month of December was but 30. The total number of deaths, including the soldiers, between October 26 and March 1 was 613, while in ordinary years only 125 people died, on the average. The middle class suffered worst of all, while of the upper classes three physicians and several clergymen died. Of the 192 typhus-fever patients that Kopp himself treated, 21 died (10·9 per cent), but these figures do not include a rather large number of very mild cases. People of all ages and both sexes were attacked; children suffered less than adults, while old people and heavy drinkers were the most liable to succumb. The disease lasted from two to three weeks; death usually occurred on the fourteenth to twentieth day, often somewhat sooner.