Kitabı oku: «The Atlantic Monthly, Volume 10, No. 60, October, 1862», sayfa 13

INVALIDING

The loss of force by death, by sickness in hospital and camp, and by temporary depression, is not all that the army is subject to. Those who are laboring under consumption, asthma, epilepsy, insanity, and other incurable disorders, and those whose constitutions are broken, or withered and reduced below the standard of military requirement, are generally, and by some Governments always, discharged. These pass back to the general community, where they finally die. By this process the army is continually sifting out its worst lives, and at the same time it fills their places with healthy recruits. It thus keeps up its average of health and diminishes its rate of mortality; but the sum and the rates of sickness and mortality in the community are both thereby increased.

During the Crimean War, 17.34 per cent, were invalided and sent home from the British army, and 21 per cent, from the French army, as unable to do military service. By this means, 11,994⁴³ British and 65,069⁴⁴ French soldiers were lost to their Governments. The army of the United States, in the Mexican War, discharged and sent home 12,252 men, or 12 per cent, of the entire number engaged in that war, on account of disability.

The causes of this exhaustion of personal force are manifold and various, and so generally present that the number and proportion of those who are thus hopelessly reduced below the degree of efficient military usefulness, in the British army, has been determined by observation, and the Government calculates the rate of the loss which will happen in this way, at any period of service. Out of 10,000 men enlisted in their twenty-first year, 718 will be invalided during the first quinquennial period, or before they pass their twenty-fifth year, 539 in the second, 673 in the third, and 854 in the fourth,—making 2,784, or more than one-quarter of the whole, discharged for disability or chronic ailment, before they complete their twenty years of military service and their forty years of life.

It is further to be considered, that, during these twenty years, the numbers are diminishing by death, and thus the ratio of enfeebled and invalided is increased. Out of 10,000 soldiers who survive and remain in the army in each successive quinquennial period, 768 will be invalided in the first, 680 in the second, 1,023 in the third, and 1,674 in the fourth. In the first year the ratio is 181, in the fifth 129, in the tenth 165, in the fifteenth 276, and in the twentieth 411, among 10,000 surviving and remaining.

The depressing and exhaustive force of military life on the soldiers is gradually accumulative, or the power of resistance gradually wastes, from the beginning to the end of service. There is an apparent exception to this law in the fact, that, in the British army, the ratio of those who were invalided was 181 in 10,000, but diminished, in the second, third, and fourth years, to 129 in the fifth and sixth, then again rose, through all the succeeding years, to 411 in the twentieth. The experience of the British army, in this respect, is corroborated by that of ours in the Mexican War. From the old standing army 502, from the additional force recently enlisted 548, and from the volunteers 1,178, in 10,000 of each, were discharged on account of disability. Some part of this great difference between the regulars and volunteers is doubtless due to the well-known fact, that the latter were originally enlisted, in part at least, for domestic trainings, and not for the actual service of war, and therefore were examined with less scrutiny, and included more of the weaker constitutions.

The Sanitary Commission, after inspecting two hundred and seventeen regiments of the present army of the United States, and comparing the several corps with each other in respect of health, came to a similar conclusion. They found that the twenty-four regiments which had the least sickness had been in service one hundred and forty days on an average, and the twenty-four regiments which had the most sickness had been in the field only one hundred and eleven days. The Actuary adds, in explanation,—"The difference between the sickness of the older and newer regiments is probably attributable, in part, to the constant weeding out of the sickly by discharges from the service. The fact is notorious, that medical inspection of recruits, on enlistment, has been, as a rule, most imperfectly executed; and the city of Washington is constantly thronged with invalids awaiting their discharge-papers, who at the time of their enlistment were physically unfit for service."⁴⁵ In addition to this, it must be remembered, that, although all recruits are apparently perfect in form and free from disease when they enter the army, yet there may be differences in constitutional force, which cannot be detected by the most careful examiners. Some have more and some have less power of endurance. But the military burden and the work of war are arranged and determined for the strongest, and, of course, break down the weak, who retire in disability or sink in death.

GENERAL VITAL DEPRESSION

Two causes of depression operate, to a considerable degree in peace and to a very great degree in war, on the soldier, and reduce and sicken him more than the civilian. His vital force is not so well sustained by never-failing supplies of nutritious and digestible food and regular nightly sleep, and his powers are more exhausted in hardships and exposures, in excessive labors and want of due rest and protection against cold and heat, storms and rains. Consequently the army suffers mostly from diseases of depression,—those of the typhoid, adynamic, and scorbutic types. McGrigor says, that, in the British army in the Peninsula, of 176,007 cases treated and recorded by the surgeons, 68,894 were fevers, 23,203 diseases of the bowels, 12,167 ulcers, and 4,027 diseases of the lungs.⁴⁶ In the British hospitals in the Crimean War, 39 per cent. were cholera, dysentery, and diarrhoea, 19 per cent. fevers, 1.2 per cent. scurvy, 8 per cent. diseases of the lungs, 8 per cent. diseases of the skin, 3.3 per cent. rheumatism, 2.5 per cent. diseases of the brain and nervous system, 1.4 per cent. frost-bite or mortification produced by low vitality and chills, 13, or one in 12,000, had sunstroke, 257 had the itch, and 68 per cent. of all were of the zymotic class,⁴⁷ which are considered as principally due to privation, exposure, and personal neglect. The deaths from these classes of causes were in a somewhat similar proportion to the mortality from all stated causes,—being 58 per cent. from cholera, dysentery, and diarrhoea, and 1 per cent. from all other disorders of the digestive organs, 19 per cent. from fevers, 3.6 per cent. from diseases of the lungs, 1.3 per cent. from rheumatism, 1.3 per cent. from diseases of the brain and nervous system, and 79 per cent. from those of the zymotic class. The same classes of disease, with a much larger proportion of typhoid, pneumonia, prostrated and destroyed many in the American army in the War of 1812.

In paper No. 40, p. 54, of the Sanitary Commission, is a report of the diseases that occurred in forty-nine regiments, while under inspection about forty days each, between July and October, 1861. 27,526 cases were reported; of these 67 per cent. were zymotic, 41 per cent. diseases of the digestive organs, 22 per cent. fevers 7 per cent. diseases of the lungs, 5 per cent. diseases of the brain. Among males of the army-ages the proportions of deaths from these classes of causes to those from all causes were, in Massachusetts, in 1859, zymotic 15 per cent., diseases of digestive organs 3.6 per cent., of lungs 50 per cent., fevers 9 per cent., diseases of brain 4.6 per cent⁴⁸. According to the mortality-statistics of the seventh census of the United States, of the males between the ages of twenty and fifty, in Maryland, Virginia, North Carolina, South Carolina, and Georgia, whose deaths in the year ending June 1st, 1850, and their causes, were ascertained and reported by the marshals, 34.3 per cent. died of zymotic diseases, 8 per cent. of all the diseases of the digestive organs, 30.8 per cent. of diseases of the respiratory organs, 24.4 per cent. of fevers, and 5.7 per cent. of disorders of the brain and nervous system. In England and Wales, in 1858, these proportions were, zymotic 14 per cent., fevers 8 per cent., diseases of digestive organs 7.9 per cent., of lungs 8 per cent., and of the brain 7 per cent⁴⁹.

If, however, we analyze the returns of mortality in civil life, and distinguish those of the poor and neglected dwellers in the crowded and filthy lanes and alleys of cities, whose animal forces are not well developed, or are reduced by insufficient and uncertain nutrition, by poor food or bad cookery, by foul air within and stenchy atmosphere without, by imperfect protection of house and clothing, we shall find the same diseases there as in the army. Wherever the vital forces are depressed, there these diseases of low vitality happen most frequently and are most fatal.

Volumes of other facts and statements might be quoted to show that military service is exhaustive of vital force more than the pursuits of civil life. It is so even in time of peace, and it is remarkably so in time of war. Comparing the English statements of the mortality in the army with the calculations of the expectation of life in the general community, the difference is at once manifest.

Of 10,000 men at the age of twenty, there will die before they complete their fortieth year,—

DANGERS IN LAND-BATTLES

This large amount of disease and mortality in the army arises not from the battle-field, but belongs to the camp, the tent, the barrack, the cantonment; and it is as certain, though not so great, in time of peace, when no harm is inflicted by the instruments of destruction, as in time of war. The battle, which is the world's terror, is comparatively harmless. The official histories of the deadly struggles of armies show that they are not so wasteful of life as is generally supposed. Mr. William Barwick Hodge examined the records and despatches in the War-Office in London, and from these and other sources prepared an exceedingly valuable and instructive paper on "The Mortality arising from Military Operations," which was read before the London Statistical Society, and printed in the nineteenth volume of the Society's journal. Some of the tables will be as interesting to Americans as to Englishmen. On the following page is a tabular view, taken from this work, of the casualties in nineteen battles fought by the British armies with those of other nations.

TABLE 1.–NINETEEN LAND-BATTLES.

TABLE 1.–NINETEEN LAND-BATTLES. (cont.)

BRITISH. (cont.)

TABLE 1.–NINETEEN LAND-BATTLES. (cont.)

Of those who were engaged in these nineteen battles one in 51.6, or 1.93 per cent., were killed. The deaths in consequence of the battles, including both those who died of wounds and those that died among the missing, were one in 30, or 3.3 per cent. of all who were in the fight. It is worth noticing here, that the British loss in the Battle of New Orleans was larger than in any other battle here adduced, except in that of Albuera, in Spain, with the French, in 1811.

In the British army, from 1793 to 1815, including twenty-one years of war, and excluding 1802, the year of peace, the number of officers varied from 3,576 in the first year to 13,248 in 1813, and the men varied from 74,500 in 1793 to 276,000 in 1813, making an annual average of 9,078 officers and 189,200 men, and equal to 199,727 officers and 4,168,500 men serving one year. During these twenty-one years of war, among the officers 920 were killed and 4,685 were wounded, and among the men 15,392 were killed and 65,393 were wounded. This is an annual average of deaths from battle of 460 officers and 369 men, and of wounded 2,340 officers and 1,580 men, among 100,000 of each class. Of the officers less than half of one per cent., or 1 in 217, were killed, and a little more than two per cent., or 1 in 42, were wounded; and among the men a little more than a third of one per cent., 1 in 271, were killed, and one and a half per cent., 1 in 63, wounded, in each year. The comparative danger to the two is, of death, 46 officers to 37 men, and of wounds, 234 officers to 158 men. A larger proportion of the officers than of the soldiers were killed and wounded; yet a larger proportion of the wounded officers recovered. This is attributed to the fact that the officers were injured by rifle-balls, being picked out by the marksmen, while the soldiers were injured by cannon- and musket-balls and shells, which inflict more deadly injuries.

DANGERS IN NAVAL BATTLES

It may not be out of place here to show the dangers of naval warfare, which are discussed at length by Mr. Hodge, in a very elaborate paper in the eighteenth volume of the Statistical Society's journal. From one of his tables, containing a condensed statistical history of the English navy, through the wars with France, 1792–1815, the following facts are gathered.

During those wars, the British Parliament, in its several annual grants, voted 2,527,390 men for the navy. But the number actually in the service is estimated not to have exceeded 2,424,000 in all, or a constant average force of 110,180 men. Within this time these men fought five hundred and seventy-six naval battles, and they were exposed to storms, to shipwreck, and to fire, in every sea. In all these exposures, the records show that the loss of life was less than was suffered by the soldiers on the land. There were—

Comparing the whole number of men in the naval service, during this period, with the mortality from causes incidental to the service, the average annual loss was—

TABLE II.–BATTLES BETWEEN FLEETS OR SQUADRONS BRITISH.

TABLE II.–BATTLES BETWEEN FLEETS OR SQUADRONS (cont.)

TABLE III.–BATTLES BETWEEN BRITISH AND AMERICAN SHIPS.

TABLE III.–BATTLES BETWEEN BRITISH AND AMERICAN SHIPS. (cont.)

Mr. Hodge's second table shows the conditions and casualties of thirteen battles between fleets and squadrons. This is condensed and quoted on the preceding page.

His third table includes thirty-five actions with single ships on each side, between the years 1793 and 1815. 8,542 men were engaged, and 483, or 56.5 per 1,000, were killed, and 1,230, or 144 per 1,000, wounded.

Twenty-six of these actions were with French ships, which are here omitted, and nine with American ships, which are shown in the second table on the preceding page.

There is a very remarkable difference in the loss which the British suffered in naval and in land battles:—

The danger both of wounds and death in these contests was three times as great in the single ships as in fleets, and about five times as great in battles with the Americans as in fleet-battles with other nations. The dangers in fleet-battles were about half as great as those in land-battles, and these were but little more than half as great as those in fights with single ships.

COMPARATIVE DANGER OF CAMP AND BATTLE-FIELD

These records of land-battles show that the dangers from that cause are not very great; probably they are less than the world imagines; certainly they are much less than those of the camp. Of the 176,007 admitted into the regimental hospitals during the Peninsular War, only 20,886 were from wounds, the rest from diseases; fourteen-fifteenths of the burden on the hospitals in that war, through forty-two months, were diseased patients, and only one-fifteenth were wounded. In the Crimean War, 11.2 per cent. in the hospitals suffered from injuries in battle, and 88.8 per cent. from other causes. 10 per cent. of the French patients in the same war were wounded, and 90 per cent. had fevers, etc. In the autumn of 1814, there were 815 patients in the great military hospital at Burlington, Vermont. Of these 50 were wounded, and the rest had the diseases of the camp.

In the Crimean War, 16,296 died from disease, and 4,774 from injuries received in battle. In the Peninsular War, 25,304 died of disease, and 9,450 from wounds.

During eighteen years, 1840 to 1857, 19,504 were discharged from the home, and 21,325 from the foreign stations of the British army. Of these, 541, or 2.7 per cent. of those at home, and 3,708, or 17.3 per cent. abroad, were on account of wounds and fractures, and the others on account of disease, debility, and exhaustion.

NATIONS DO NOT LEARN FROM EXPERIENCE TO PREPARE FOR ARMY-SICKNESS

Nations, when they go to war, prepare to inflict injury and death on their opponents, and make up their minds to receive the same in return; but they seem neither to look nor to prepare for sickness and death in their camps. And when these come upon their armies, they seem either to shut their eyes to the facts, or submit to the loss as to a disturbance in Nature, a storm, a drought, or an earthquake, which they can neither prevent nor provide for, and for which they feel no responsibility, but only hope that it will not happen again. Nevertheless, this waste of life has followed every army which has been made to violate the laws of health, in privations, exposures, and hardships, and whose internal history is known. The experience of such disastrous campaigns ought to induce Governments to inquire into the causes of the suffering and loss, and to learn whether they are not engaged in a struggle against Nature, in which they must certainly fail, and endeavoring to make the human body bear burdens and labors which are beyond its strength. But Governments are slow to learn, especially sanitary lessons. The British army suffered and died in great numbers at Walcheren and South Beveland, in the middle of the last century. Pringle described the sad condition of those troops, and warned his nation against a similar exposure; yet, sixty years later, the Ministry sent another army to the same place, to sink under the malarious influences and diseases in the same way. The English troops at Jamaica were stationed in the low grounds, where, "for many generations," "the average annual mortality was 13 per cent." "A recommendation for their removal from the plains to the mountains was made so far back as 1791. Numerous reports were sent to the Government, advising that a higher situation should be selected"; but it was not until 1837, after nearly half a century of experience and warning, that the Ministry opened their eyes to this cost of life and money in excessive sickness and mortality, and then removed the garrison to Maroontown, where the death-rate fell to 2 per cent., or less than one-sixth of what it had been⁵⁰.

The American army, in the war with Great Britain fifty years ago, suffered from the want of proper provision for their necessities and comfort, from exposures and hardships, so that sometimes half its force was unavailable; yet, at the present moment, a monstrous army is collected and sent to the field, under the same regulations, and with the same idea of man's indefinite power of endurance, and the responsibility and superintendence of their health is left, in large measure, to an accidental and outside body of men, the Sanitary Commission, which, although an institution of great heart and energy, and supported by the sympathies and cooperation of the whole people, is yet doing a work that ought to be done by the Government, and carrying out a plan of operations that should be inseparably associated with the original creation of the army and the whole management of the war.

CRIMEAN WAR

The lesson which the experience of the Russian army of 1828 and 1829 taught the world of the mortal dangers of Bulgaria was lost on the British Government, which sent its own troops there in 1854, to be exposed to, and wither before, the same destructive influences. But at length sickness prevailed to such an extent, and death made such havoc, in the army in the East, that England's great sympathies were roused, and the Ministers' attention was drawn to the irresistible fact, that the strongest of Britain's soldiers were passing rapidly from the camp to the hospital, and from the hospital to the grave. Then a doubt occurred to the minds of the men in power, whether all was right in the Crimea, and whether something might not be done for the sanitary salvation of the army. They sent a commission, consisting of Dr. John Sutherland, one of the ablest sanitarians of the kingdom, Dr. Hector Gavin, and Robert Rawlinson, civil engineer, to the Black Sea, to inquire into the state of things there, to search out the causes of the sufferings of the army, and see if there might not be a remedy found and applied. At the same time, Miss Nightingale and a large corps of assistants, attendants, and nurses, women of station and culture and women of hire, went to that terrible scene of misery and death, to aid in any measures that might be devised to alleviate the condition of the men. Great abuses and negligence were found; and the causes of disease were manifest, manifold, and needless. But a reform was at once instituted; great changes were made in the general management of the camp and hospitals and in the condition of the soldiers. Disease began to diminish, the progress of mortality was arrested, and in the course of a few months the rate of death was as low as among men of the same ages at home.

This commission made a full report, when they returned, and described the state of things they found in the Crimea and on the shores of the Black Sea,—the camps, barracks, huts, tents, food, manner of life, and general sanitary condition of the troops, their terrible sufferings, and the means and ways of caring for the sick, the measures of reform which they had proposed and carried out, and their effects on the health of the men. This report was published by the Government.

Besides this commission, the Government sent Dr. Lyons, a surgeon and pathologist of great learning and acumen, to investigate the pathology or morbid condition of the army. According to his instructions, he spent four months in the Crimea and at the great hospitals on the Bosphorus. He examined and traced the course of disease and disturbance in the sick and wounded. He made very many thorough examinations after death, in order to determine the effects of vitiating influences upon the organization, and the condition of the textures and organs of the body in connection with the several kinds of disorders. Dr. Lyons's extremely instructive report was published by national authority as one of the Parliamentary folio volumes. After the war was over, Dr. W. Hanbury and Staff-Surgeon Matthew, under the direction of the Secretary of War, gathered, analyzed, and prepared the records of all the surgeons of the several corps of the Crimean army. To these they added a long and valuable treatise on the nature and character of the diseases, and their connection with the condition and habits of the men. These are published in two very thick folio volumes, and give a minute and almost daily history of the life, labors, exposures, privations, sufferings, sickness, and mortality of each regiment. These two works, of Dr. Lyons and Drs. Hanbury and Matthew, show the inseparable connection between the manner of living and the health, and demonstrate that the severe life of war, with its diminished creation of vital force, by imperfect and uncertain nutrition and excessive expenditure in exposures and labors, necessarily breaks down the constitution. It subjects the body to more abundant disorders, and especially to those of the depressive, adynamic type, which, from the want of the usual recuperative power, are more fatal than the diseases of civil life. These works may be considered generic as well as specific. They apply to and describe the sanitary condition and the pathological history of all armies engaged in hard and severe campaigns, as well as those of the Crimea. They should, therefore, be read by every Government that engages in or is forced into any war. They should be distributed to and thoroughly understood by every commander who directs the army, and every surgeon who superintends the sanitary condition of, and manages the sickness among, the men; and happy will it be for those soldiers whose military and sanitary directors avail themselves of the instructions contained in these volumes.

There are several other works on the Crimean War, by surgeons and other officers, written mainly to give a knowledge of the general facts of those campaigns, but all incidentally corroborating and explaining the statements in the Government Reports, in respect to the health and sufferings of the British and French armies. In this view, Dr. Bryce's book, "England and France before Sebastopol," and M. Baudens's and M. Scrive's medical works in French, are worthy of great attention and confidence.

The most important and valuable work, in this connection, is the Report of the British Commission appointed in May, 1854, "to inquire into the regulations affecting the sanitary condition of the British army, the organization of the military hospitals, and the treatment of the sick and wounded." This commission included some of the ablest and most learned physicians and surgeons in the civil and military service, some of the most accomplished statisticians, sanitarians, army-officers, and statesmen in the United Kingdom. They were authorized to inquire into the habits and duties, the moral and sanitary condition of the army, the amount and kinds of sickness, the causes and frequency of death, and the means of improvement. This commission sat for a long time in London. They called before them fifty-three witnesses, among whom were Sir Benjamin Brodie, the leading surgeon of England, Dr. Andrew Smith, Director-General of the Medical Department of the Army, Thomas Alexander, Inspector-General of Hospitals, Major-General Airey, Quartermaster-General, Dr. John Sutherland, late Crimean Commissioner, and one of the leading authorities of Great Britain in all sanitary matters, Dr. William Fair, the chief and master-spirit of the Registry-Office, and the highest authority in vital statistics, Colonel Sir Alexander Tulloch, author of the elaborate and valuable reports on the mortality in the British army, Francis G. P. Neison, author of "Contributions to Vital Statistics," Miss Nightingale, and others, surgeons, officers, purveyors, engineers, soldiers, and medical and sanitary scholars.

The commission put forth 10,070 interrogatories relating to everything connected with the army, the persons and the matériel, to officers, surgeons, physicians, health-officers, soldiers, nurses, cooks, clothing, food, cooking, barracks, tents, huts, hospitals, duties, labors, exposures, and privations, and their effects on health and life, in every climate, wherever British troops are stationed or serve, at home and abroad. The same inquiry was extended to the armies of other nations, French, Turkish, Russian, etc. To these questions the witnesses returned answers, and statements of facts and opinions, all carefully prepared, and some of great length, and elaborate calculations in respect to the whole military and sanitary science and practice of the age. A large part of the inquiry was directed to the Crimean army, whose condition had been, and was then, a matter of the most intense interest. Many of the witnesses had, in various ways, been connected with that war: they were familiar with its history, and their answers revealed much that had not before been known. The result of all this investigation is published in a folio volume of 607 pages, filled with facts and principles, the lamentable history of the past, painful descriptions of the present, and wise suggestions for the future management of the army; and the whole is worthy of the careful attention of all who, as projectors, leaders, or followers, have anything to do with the active operations of war.

The Crimean War has this remarkable interest, not that the suffering of the troops and their depreciation in effective power were greater than in many other wars, but that these happened in an age when the intelligence and philanthropy, and even the policy of the nation, demanded to know whether the vital depression and the loss of martial strength were as great as rumor reported, whether these were the necessary condition of war, and whether anything could be done to lessen them. By the investigations and reports of commissions, officers, and others, the internal history of this war is more completely revealed and better known than that of any other on record. It is placed on a hill, in the sight of all nations and governments, for their observation and warning, to be faithful to the laws of health in providing for, and in the use of, their armies, if they would obtain the most efficient service from them.