The history of war-pestilences has shown how severely belligerent armies are attacked by infectious diseases, how seriously their operations are hampered by them, and what loss of life such diseases cause by spreading to non-combatants. If we start from the time when more or less accurate descriptions enable us to determine the nature of the epidemics, we find that plague and typhus fever were the two diseases which, until a few decades ago, most commonly attacked the soldiers; the latter disease, which made its appearance in almost every war that was waged between the beginning of the sixteenth and the middle of the nineteenth century, consequently acquired the name ‘war-plague’.

For a long time nobody knew just how to combat these pestilences, and nowhere were rational measures adopted aiming to prevent them from spreading. We have seen the bitter truth of this statement in connexion with the endless Napoleonic wars. One reason for the neglect of preventive measures was the belief that these pestilences broke out spontaneously when large numbers were crowded together under miserable living conditions. The physicians of that time, in their efforts to explain the sudden appearance of these pestilences, arrived at the conclusion that they were autochthonic. But modern medical science, realizing its limitations, contents itself with the hypothesis that the original cause of these diseases is not to be ascertained, and with the knowledge that the infective agents in the case of almost all of them have been discovered, and that an outbreak of any infectious disease in any specific locality signifies that the germ of that disease must in some way have been deposited there. It was precisely the belief in the spontaneous origination of pestilences that led people to neglect watching for and isolating, with all possible dispatch, the first cases—a measure which is to-day looked upon as the most important means of preventing the dissemination of a disease.

The belief in the autochthonic origin of diseases continued to prevail until the first half of the nineteenth century. Hecker upheld it in a discussion of the plague-epidemic that occurred during the Russo-Turkish War of 1769–70; he believed that the intermittent fever prevalent in the Danube countries passed over into putrid fever, with or without petechiae, that carbuncles and buboes gradually developed, and that putrid fever was thus converted into bubonic plague. ‘It is therefore in all probability true’, says Hecker, ‘that the outbreak of plague in the Russian army in the year 1770, as well as in the year 1828, was not caused by direct infection from the Turkish troops, but was merely an independent development from intermittent fever and spotted fever.’

Recent investigations in the field of medicine turn over to the other sciences all questions regarding ultimate causes, and confine themselves to what is actually observed. We know that the agents responsible for infectious diseases are specific minute organisms which must be present in the system to produce the disease in question, and that these micro-organisms are conveyed from place to place by infected persons, by intermediaries, on articles to which they have attached themselves, in contaminated food, in drinking-water, and in many other ways. Investigators have studied the conditions in which these infective agents live and the manner in which they are disseminated, they have discovered methods of determining the nature of the disease in a very short time, and they have come to recognize the danger of coming in contact with germ-bearers, that is, with persons, healthy or convalescent, who have these micro-organisms in their systems without being themselves sick. Medical science is now endeavouring, by means of systematic procedure and splendid organization, to guard soldiers against the danger of infection; good drinking-water is provided, the men and the rooms in which they live are kept clean, persons suffering from infectious diseases are isolated, all rooms and articles used by patients are disinfected, infected divisions of troops are quartered by themselves, germ-bearers are watched for and discovered, &c. The success of such measures is well known. The knowledge gained and profited by in times of peace is also applied in times of war, and to-day we are able to confine pestilences within much narrower limits than was formerly possible. In order to do this, however, we must have, in addition to an efficient system of transporting and feeding troops, physicians who are well informed in regard to hygiene and bacteriology.

As early as the eighteenth century, successful efforts were made to prevent, by means of energetic measures, the reappearance of plague in Europe; the Russo-Turkish War of 1828–9 was the last war in which it broke out. On the other hand, typhus fever continued to be the Nemesis of belligerent armies, while a new infectious disease, cholera, entered upon the scene and played a very important rÔle in the Crimean War, and a by no means minor rÔle in the war of 1866. Along with these diseases, typhoid fever advanced into the foreground about the middle of the last century, and it soon turned out to be one of the most dangerous diseases that occur among soldiers. This appearance of typhoid fever has led some to think that the disease has prevailed extensively only in comparatively recent times. Hirsch, however, ably defends the opposite view; he maintains that typhoid fever was in many instances confused with the febres pestilentes, malignae, putridae, and nervosae, with the mucous fevers, bilious fevers, putrid fevers, &c. In discussing the typhus-fever epidemics that occurred in the course of the Napoleonic wars, we have several times called attention to the fact that typhoid fever probably broke out in the form of epidemics; but it could be diagnosed with certainty only after post-mortem examinations began to be more frequent. At all events, typhoid fever is to-day prevalent all over the world, and there is always danger that field-armies will be infected with it, either in their own land or in the land of the enemy. All the wars of the last few decades have clearly demonstrated this fact.

For a successful battle against war-pestilences, it is a fortunate coincidence that the civil as well as the military authorities are equally interested in their prevention. Every military leader knows how important it is for the soldiers to keep healthy, since their efficiency is otherwise seriously impaired. It is not our task to describe the particular measures that are to be adopted; the manuals of military sanitation give us accurate information regarding these matters. We merely mention the fact that it is of great value and importance to have physicians, who are well acquainted with hygienic problems, make a preliminary examination of sanitary conditions in the territory through which the soldiers will be required to pass in order to reach the scene of hostilities.

Very great difficulties, to be sure, confront the efforts made in war times to prevent the outbreak of infectious diseases. If the struggle is carried on in an infected region, the troops are often compelled to seek shelter in infected houses; thus during the battles of OrlÉans and Le Mans in the Franco-German War the troops, in order to protect themselves against the severe winter cold, had to live in houses which small-pox patients had shortly before occupied or were actually occupying at the time. Circumstances frequently arise which render impossible the adoption of the most effective measure calculated to prevent the dissemination of a pestilence, that is, the isolation of infected divisions of troops; one can readily imagine how difficult this would be in the case of an army re-forming after a lost battle. Furthermore, even if one of the belligerent armies is doing all it can to prevent diseases from spreading, its efforts must be seriously handicapped if the enemy’s army does not include an equally diligent sanitary corps and does not devote the same amount of energy to the prevention of the outbreak and dissemination of infectious diseases. For even if a sanitary corps is successful in warding off a reaction upon its own troops, nevertheless this reaction is sure to take place with respect to the civil inhabitants of the country in which the war is waged.

During a war, the civil authorities must also do their part in preventing diseases from spreading to the civil population. The local administrations of a region in which fighting is going on are powerless. The generals care very little whether or not a city or village in the enemy’s country is infected by their troops, whom they quarter in whatever house or place best suits their purpose. On the other hand, the communities in which military prisons are located are confronted with a very difficult problem, since these prisons, if infected men are confined in them, easily develop into centres of infection; this fact was observed a hundred times in the year 1870. If a disease breaks out in a community in consequence of the fact that a military prison has been established there, in my opinion it is incumbent on the central government of the country to support the local authorities in their efforts to check the disease, and to give them financial help as well as scientific advice. Unfortunately, it is not to be denied that, in many small cities and in almost all rural communities, absolutely no provision is made for the isolation of persons suffering from infectious diseases; the authorities justify themselves with the reflection that in case of emergency barracks can quickly be erected for the purpose, but at the same time they fail to remember that working-men are not always available in the storm and stress of war times, that building materials in the general scarcity of supplies cannot always be procured with sufficient promptitude, and that pestilences, if the isolation of the first cases is delayed, usually spread with great rapidity.

In future wars we must expect the military authorities to do all they can, just as soon as the prisoners are taken, to segregate as carefully as possible all known and suspected cases of infectious diseases. The difficulties confronting the military authorities, when it is necessary to remove large numbers of prisoners with all possible dispatch away from the scene of the war, are, to be sure, very great.

Finally, we must also call attention to the danger to which the civil inhabitants of a country are exposed, when the soldiers return home after the termination of a campaign in an infected region. It must be demanded under all circumstances that divisions of troops among whom infectious diseases have made their appearance, before returning from the enemy’s country, shall be subjected to a medical examination, isolated, and disinfected, just as was done on such a large scale, for example, by the Japanese after the wars with China and Russia. This also applies to all other persons who have had anything to do with infected divisions, particularly to teamsters.

All preparations designed to prevent the outbreak and dissemination of infectious diseases must be made in times of peace; barracks and lazarets must be erected, physicians who are well acquainted with methods of hygienic investigation must be available, and an adequate number of nurses and sick-attendants must be prepared for immediate service at the very first appearance of an infectious disease. For the military authorities, who can scarcely perform all the duties that the beginning of a war imposes upon them, it will facilitate matters greatly if in future campaigns the Red Cross devotes its attention, not only to the care of the wounded, but also, on a larger scale than it has heretofore, to the prevention of the outbreak and dissemination of war-pestilences.