But while typhoid fever and dysentery in the Franco-German War attacked the civil population only in those parts of the country in which the fighting took place, and nowhere acquired epidemic dimensions, and while it is probable that typhus fever did not appear at all at that time, there occurred in connexion with the war a very severe epidemic of small-pox, which raged more extensively and furiously than any other epidemic in the course of the entire century, and spread not only throughout the belligerent countries, but also throughout all Europe.
Everybody knows how severely Europe suffered from epidemics of small-pox in the last part of the eighteenth and first part of the nineteenth centuries, and how the ravages of that disease were first checked by Jenner’s wonderful discovery. Nevertheless, small-pox did not entirely disappear from Central Europe until the year 1870. The reason for this is found in the fact that compulsory vaccination was introduced in only a few states, and even in them was not properly enforced, and also in the fact that people did not until later begin to realize that vaccination insures immunity only for a period of 12–15 years at most. Consequently new recruits, if they had already been vaccinated once, were not revaccinated when they began to serve. But since sporadic outbreaks of small-pox continued to occur in the Prussian army, orders were issued in the year 1834 that all recruits must be vaccinated. The result was that from that time on, the Prussian troops were very rarely attacked by the disease. The same measure was adopted in Württemberg in 1833, in Baden in 1840, in Bavaria in 1843, in Brunswick in 1858, in the Kingdom of Saxony in 1868, and in the Grand Duchy of Hesse in 1869. Compulsory vaccination did not exist in Prussia or Saxony before the Imperial Vaccination Law was passed in the year 1874; the result was that large numbers of children were never vaccinated. The anti-vaccinationists, especially in the ‘sixties, carried on a vigorous agitation, and this had the effect of increasing the number of unvaccinated persons; the number of revaccinated persons had always been small. In South Germany compulsory vaccination for one-year-old children was introduced in the first part of the nineteenth century—in Bavaria and Hesse in 1807, in Baden in 1815, in Württemberg in 1818—but revaccination was not enforced until 1874, when the Imperial Vaccination Law was passed.
The small-pox mortality in Prussia prior to the year 1870 is indicated by the following table, which shows the number of deaths per 10,000 inhabitants:
| 1831–40 | 2·6 |
| 1841–50 | 1·7 |
| 1851–60 | 2·1 |
| 1861–5 | 3·5 |
| 1866–7 | 5·2 |
| 1867–8 | 1·8 |
| 1868–9 | 1·9 |
| 1869–70 | 1·7 |
In the year 1864 an epidemic of small-pox had broken out, and the war of 1866 had helped it to spread; but in the year 1868 the disease began to abate, so that by the middle of the year 1870 almost all of Prussia was free from small-pox, as will be set forth in greater detail later on. In South Germany the small-pox mortality was even lower; in Bavaria it was 0·85 in the years 1861–70, in Württemberg it was 0·9 in the same years, and in the Grand Duchy of Hesse it was 1·9 in the years 1866–70.[250]
In the ‘sixties small-pox had not been very common in France, but no detailed reports regarding its prevalence there are available; the reports which the prefects were supposed to hand in are either entirely missing, or else very incomplete. According to the statistics compiled by Vacher,[251] the death-rate increased a little in the years 1864–5, then began to decrease, and in 1869 increased again. The figures which Vacher compiled, and which the Académie de Médecine in Paris has on file, are:
| 1860 | 1,662 |
| 1861 | 1,740 |
| 1862 | 1,813 |
| 1863 | 1,440 |
| 1864 | 3,290 |
| 1865 | 4,166 |
| 1866 | 593 |
| 1867 | 2,081 |
| 1868 | 3,900 |
| 1869 | 4,164 |
Vacher says in regard to these figures: ‘As far as the actual number of persons who contracted and succumbed to small-pox are concerned, they express only a small part of the truth. The reports submitted to the Academy of Medicine are rarely complete; it is even necessary to say that about one-quarter of the Departments never send in reports on the epidemics at all, although the ministerial instructions render the submission of these reports obligatory, and although the Academy never ceases to protest against the negligence of the prefectoral administrators.’ Vacher then goes on to say that in the years 1860–9 only 59 out of every 100 infants born were vaccinated, and that at the outbreak of the war about one-third of the French population was unvaccinated; in many Departments, indeed, as many as four-fifths (Aveyron, Corsica, &c.). Small-pox was much more prevalent in the French army than in the German army; according to the German Health Report,[252] the number of deaths caused by the disease was:
| Prussian Army. | French Army. | |||
|---|---|---|---|---|
| Total No. | Per 10,000 men. | Total No. | Per 10,000 men. | |
| 1866 | 8 | 0.30 | 46 | 1.37 |
| 1867 | 2 | 0.08 | 70 | 1.82 |
| 1868 | 1 | 0.04 | 169 | 4.28 |
| 1869 | 1 | 0.04 | 95 | 2.27 |
The reason for this lies in the fact that a larger proportion of the Prussian soldiers were vaccinated. Since the year 1806 all French recruits who had never been vaccinated were supposed to submit to the inoculation when they presented themselves for service, but this regulation was for years at a time very laxly enforced; consequently in the year 1857 a new order was issued, introducing compulsory vaccination for all recruits. But even this order does not seem to have been everywhere carried out with the necessary strictness, and complaints regarding the partial success of vaccination were frequently made by military physicians.
As stated above, there was a noticeable increase in the small-pox mortality in the year 1869; this increase lasted into the beginning of the year 1870, but was confined to certain localities. Chauffard’s[253] report on epidemic diseases in France is more incomplete for the years 1869–70, on account of the war, than for previous years; it was supplemented, partially at least, by the later reports of Vernois[254] for the year 1871, and also by the comprehensive report of M. Delpech[255] for the years 1870–2. According to these, epidemics of small-pox occurred in the year 1869 in North-west France (Bretagne), in North-east France (Departments of Aisne, Pas-de-Calais), and in South-east France (Departments of Gers, Ariège, and Pyrénées-Orientales.) In the winter of 1869–70 the epidemic continued to spread, and by the end of the year 1870 it included almost the whole of France. The incomplete reports give us no idea as to which Departments were attacked before the outbreak of the war and which after. According to Vernois, the disease appeared that year in 42 Departments, including 132 arrondissements and 539 parishes. But, as stated above, the reports are all very incomplete; a later report submitted by Delpech adds 11 more Departments to the 42. The total number of deaths caused by small-pox in France in the year 1871 is unknown; Vernois reported 14,425 deaths in 39 Departments, but this does not include the figures for Paris, where 10,539 persons succumbed to the disease, or for the Department of Finistère, or for the Department of Sarthe (in regard to which it is merely observed that there were ‘beaucoup de morts’), or for several other Departments.
It is a fact that small-pox raged severely among the civil inhabitants of all regions in which the second half of the war was waged (to the south, east, and north of Paris), and that the war itself helped the disease to spread in the eastern Departments (Jura, Doubs, Saône-et-Loire, Haute-Saône). The wide prevalence of the disease among the soldiers is attributed by many French physicians to the fact that the army as a whole had been inadequately vaccinated. If this was true of the regular troops, lack of time made it absolutely impossible to vaccinate all the men that were afterwards assembled in such a precipitate manner. The movements of the soldiers in the cold season of the year (in December there was some bitterly cold weather) made it necessary for friends and enemies to share whatever shelter they could find, regardless of whether the house had previously been occupied by small-pox patients, or whether such patients were actually lying in it at the time. The result was that the disease became very widespread throughout all France. Says Laveran:[256] ‘The army, being composed of men who had been in service for a long time, and who had been vaccinated and revaccinated, suffered very little, but the events which took place after the declaration of war altered this state of affairs. The regiments of the Departments on their way to Paris were quartered in the homes of civilians, where they contracted small-pox. The disease spread easily among the young people who, owing to lack of time, had not been revaccinated, and many of whom had perhaps never been vaccinated at all. During the first part of the siege of Paris it was these regiments which suffered the most from small-pox, but later on the epidemic became more general and spread to all the corps. The number of soldiers infected with small-pox during the siege was about 6·76 per 100, or 68 per 1,000.’
Small-pox raged very extensively in besieged strongholds. In Paris an epidemic of small-pox began in November 1869, and the number of deaths caused by the disease there was:[257]
| October (1869) | 39 |
| November | 93 |
| December | 119 |
| January | 174 |
| February | 293 |
| March | 406 |
| April | 561 |
| May | 786 |
| June | 914 |
| July | 1,072 |
| August | 713 |
| September | 700 |
| October | 1,361 |
| November | 1,722 |
| December | 1,837 |
| January | 1,503 |
| February | 763 |
| March | 230 |
In the middle of the summer the disease was not very prevalent in the garrison; most of the cases were among the civil inhabitants. This condition changed in September, however, when the newly-organized mobile guard arrived in the city, consisting of young men who had not been revaccinated for lack of time, and many of whom had never been vaccinated at all. A severe epidemic now began to rage throughout the garrison; between October 1870 and March 1871 no less than 7,578 men suffering from small-pox were taken to the Hôpital Bicêtre, where the majority of the small-pox patients in the garrison were housed, and where 1,074 (14·17 per cent) of them died. Colin reports that the total number of small-pox patients taken there from the garrison (the total number of men in which he estimates at 70,000 regular troops and 100,000 guardsmen)[258] was no less than 11,500, and that the number of deaths was 1,600. In November, owing to the rapid dissemination of the disease in the garrison, the number of cases among the civil inhabitants also began to increase.
Small-pox also raged in Metz, but not so extensively as in Paris; the following table indicates the number of men in the garrison carried away by small-pox:
| August (15–31) | 6 |
| September | 40 |
| October | 51 |
| November | 58 |
| December | 21 |
| Total | 176 |
The surrender of the stronghold, on October 27, led to the discovery of 200 small-pox patients in a tobacco factory. The epidemic among the civil inhabitants came to an end in March 1871.
Belfort, where the garrison consisted mostly of national guards, also experienced a severe epidemic during the siege; likewise Strassburg, Nancy, Toul, and Verdun.
In Strassburg, where cases of small-pox had repeatedly been observed, the disease became more widespread in the summer of 1870, and during the siege the number of cases increased considerably; not until August 1871 did the epidemic come to an end. According to Kriesche and Krieger,[259] the number of civilians that succumbed to small-pox in Strassburg, the population of which in the year 1871 was 77,859, was:
| 1869. | 1870. | 1871. | |
|---|---|---|---|
| January | 2 | 4 | 81 |
| February | 3 | 5 | 52 |
| March | 3 | 9 | 20 |
| April | 13 | 14 | 15 |
| May | 1 | 19 | 14 |
| June | 2 | 23 | 4 |
| July | 6 | 22 | 3 |
| August | 5 | 33 | 1 |
| September | 2 | 66 | |
| October | 92 | ||
| November | 2 | 72 | 1 |
| December | 3 | 92 | |
| Total | 42 | 451 | 191 |
Langres was attacked with especial severity. The garrison there was composed of freshly enlisted troops (mobile and national guards), and averaged 14,629 men. The epidemic began in September 1870, and was not yet over by March 1871. The following table gives the number of cases and deaths according to Claudot.
| No. cases. | No. deaths. | |
|---|---|---|
| September | 81 | 10 |
| October | 145 | 12 |
| November | 301 | 34 |
| December | 598 | 41 |
| January | 621 | 91 |
| February | 402 | 93 |
| March | 186 | 53 |
| Total | 2,334 | 334 |
The disease raged very extensively in the French provincial armies that were organized to relieve Paris—thus in the south-western, northern, and south-eastern scenes of the war, small-pox had already made its appearance among the civil inhabitants of those parts of the country in consequence of the continual passing through of soldiers, many of whom had never been vaccinated. Orléans, Chartres, and Le Mans, were the main centres of the pestilence; in the north Amiens, Bois-Guillaume, Rouen, and other places; in the south, besides the strongholds of Belfort and Langres, the cities of Dijon, Besançon, Pontarlier, and several other places. The disease raged furiously throughout this entire region, but the exact number of deaths is not known.
In south-eastern France, small-pox did not become very widespread until after the outbreak of the war; in Lyons, for example, the epidemic began in the second half of October. To be sure, small-pox had appeared in several places in the year 1868, but by the winter of 1868–9 this epidemic was over, although individual cases continued to occur. Regarding the cause of the small-pox epidemic that broke out in Lyons in the autumn of 1870, Fonteret[260] gives us the following information: ‘Two causes could not help favouring the outbreak in our city; the movements of the troops that took place at that time, and the emigration of numerous Parisians, who since the beginning of September, that is to say, since the time when the epidemic began to rage furiously in Paris, passed through our city on their way to Switzerland.’ Regarding the course of the epidemic, no statistics covering the entire city are available, but we are able to see from the following table, compiled by Perroud, the number of small-pox patients taken in by the Hôtel-Dieu and the number that died there:
| Patients. | Deaths. | |
|---|---|---|
| January-June (1870) | 126 | 9 |
| July-September | 101 | 15 |
| October | 29 | 8 |
| November | 94 | 26 |
| December | 160 | 37 |
| January (1871) | 148 | 31 |
| February | 147 | 37 |
| March | 135 | 29 |
| April | 124 | 25 |
| May | 84 | 12 |
| June | 45 | 7 |
| July | 38 | 5 |
| August-December | 44 | 6 |
In the other cantons of the Department 935 deaths were officially recorded in the years 1870–1. It was observed in Lyons, as in other places, that not only the number of persons who contracted small-pox, but also the virulence of the disease itself, increased; whereas only 10.6 per cent of 227 sporadic cases resulted fatally between January and September, out of 1,004 persons who contracted the disease between October 1870 and July 1871 no less than 21.7 per cent died.
In the year 1871 small-pox did not spare a single Department in France, although many of them failed to send in reports. Vacher estimates the number of deaths due to the disease in the year 1871 at 58,236, but he adds that the estimate is too small. No report, for example, was sent in by the Department of Sarthe, where in the city of Le Mans alone there were 1,181 deaths, nor by the Department of Haute-Garonne, where there were 1,328 deaths in Toulouse. The total number of unreported deaths, therefore, must have been at least 20,000. It is almost impossible to estimate the number of deaths that occurred in the year 1870. From the available statistics Vacher estimates the number of deaths caused by the disease in the two years 1870–1 at 89,954, a figure, as he himself says, ‘which represents only a part of the reality.’ Another estimate made by Vacher, putting the number of deaths caused by small-pox in the years 1869–70 at 200,000, is in all probability not an exaggeration.
In the year 1872, to be sure, small-pox appeared in the form of epidemics in numerous parts of France, but nowhere did it spread so widely as in the two previous years. According to a report worked out by Delpech for the years 1870–2, no less than 42 Departments failed to make any report at all in the year 1872, while only 18 of the remaining 41 Departments sent in reports regarding epidemic outbreaks of small-pox. The epidemic lasted until 1873, in which year reports regarding small-pox epidemics came in from 10 Departments; but only in the Departments of Morbihan and Pyrénées-Orientales was the epidemic apparently somewhat more intense.[261]
Thanks to the well-vaccinated condition of the German troops, the army suffered comparatively little from small-pox. In the field army 4,385 men (61·3 per 1,000) contracted the disease, and 278 of them (3·5 per cent of those who contracted it) died. Including the officers, physicians, and officials, the number taken sick was 4,991 and the number that died was 297. The number of men in the individual army corps that contracted the disease varied greatly according to the nature and place of their activity; particularly hard hit were the army divisions in the south-western and northern scenes of the war, where the military operations were carried on in fearfully cold weather, and where it was impossible to quarter the infected soldiers in isolated places by themselves. The French army was attacked much more severely by small-pox, although there are no accurate reports available regarding the prevalence of the disease. According to a report found in the Vienna Medical Weekly,[262] the total number of French soldiers that succumbed to small-pox was 23,469[263]; but the accuracy of this number, to be sure, is questionable, since, assuming that there was a very high mortality, it would mean that some 120,000 troops contracted the disease. At all events, the French army, taken as a whole, was badly infected with small-pox, and it was inevitable that among the French prisoners brought to Germany there should be numerous small-pox patients, some in the incubation stage, and some in the convalescent stage of the disease, and that they should infect other people there.
The number of French prisoners taken to Germany in the first few months of the year 1871 was no less than 372,918; the prisoners who at the very beginning, but especially after the surrender of Metz, were transported in large numbers to Germany, had to be distributed throughout the entire Empire, clear over to the eastern boundary. Owing to the fact that new transports of French prisoners were constantly arriving at the German frontier, which, in consequence of severe hardships and privations, they reached in such a weak physical condition that they could not be taken very far inland, it became necessary to transfer some of the earlier arrivals to other places of detention, and this, of course, favoured the further dissemination of the disease. This transference was rendered particularly necessary by the arrival of large numbers of prisoners after the battle of Sedan (September 1), after the capitulation of Metz (October 27), and after the battles of Orléans and Le Mans (December and January respectively). Small-pox occasionally broke out among these prisoners while they were on their way to Germany, rendering it necessary to leave them behind, or else the disease made its appearance when they reached their destination; as a rule, however, the first cases of the disease were observed a few days after their arrival at their place of detention, where they soon infected the other prisoners. The further dissemination of the disease among them was checked by means of wholesale vaccination.
Of the prisoners, 14,178, all told (38 per cent of the total number taken), contracted small-pox, and of these 1,963 (5·26 per cent) died. The statistics in the German Health Report indicate distinctly the number of prisoners in the various states and provinces that contracted and succumbed to the disease; but the total number of prisoners taken is known only in the case of the larger states in the Confederation, since the statistics in the Report are compiled on the basis of the army-corps districts, which do not coincide with the political divisions. The figures for the larger states are as follows:
| Maximum no. prisoners. | Patients. | Deaths. | Patients per 1,000. | Deaths per 100 cases. | |
|---|---|---|---|---|---|
| N. Germany, excluding Kingdom of Saxony | 283,750 | 10,547 | 1,527 | 37·2 | 14·5 |
| Kingdom of Saxony | 10,234 | 248 | 18 | 24·2 | 7·3 |
| Bavaria | 40,083 | 1,607 | 196 | 40·0 | 12·2 |
| Württemberg | 12,958 | 390 | 28 | 38·1 | 7·2 |
| Baden | 12,083 | 512 | 21 | 42·4 | 4·1 |
| Grand Duchy of Hesse | 13,810 | 874 | 173 | 63·3 | 19·8 |
| All Germany | 372,918 | 14,178 | 1,963 | 38·0 | 13·8 |
The number of people who contracted the disease varied greatly in the different territories, depending upon the locality whence the prisoners came. Accordingly, the figures in the case of the Grand Duchy of Hesse were rendered large by the fact that a severe epidemic of small-pox broke out in the stronghold of Mayence on the occasion of the arrival there of prisoners from Metz. The number of prisoners that contracted and succumbed to small-pox in the larger military prison-dépôts is shown by the following table, which covers only those places in Prussia and the Grand Duchy of Hesse in which the maximum number of prisoners held in confinement exceeded 5,000:
| Maximum no. prisoners. | Patients. | Deaths. | Patients per 1,000. | Deaths per 100 cases. | |
|---|---|---|---|---|---|
| Spandau | 6,856 | 77 | 25 | 11·2 | 32·5 |
| Jüterbog | 5,002 | 196 | 23 | 39·2 | 11·7 |
| Danzig | 9,189 | 188 | 24 | 20·5 | 12·8 |
| Königsberg | 7,324 | 221 | 22 | 30·2 | 9·9 |
| Stettin | 21,000 | 1,303 | 194 | 62·0 | 14·9 |
| Erfurt | 12,400 | 203 | 28 | 16·4 | 13·8 |
| Magdeburg | 25,450 | 1,902 | 271 | 74·7 | 14·3 |
| Torgau | 9,359 | 603 | 128 | 64·4 | 21·2 |
| Wittenberg | 9,753 | 51 | 10 | 5·2 | 19·6 |
| Posen | 10,303 | 191 | 29 | 18·5 | 15·2 |
| Glogau | 13,621 | 1,198 | 170 | 88·0 | 14·2 |
| Neisse | 12,801 | 385 | 117 | 30·1 | 30·4 |
| Minden | 5,071 | 98 | 13 | 19·3 | 13·3 |
| Wesel | 16,299 | 1,042 | 127 | 63·9 | 12·2 |
| Cologne | 13,774 | 175 | 24 | 12·7 | 13·7 |
| Coblenz | 15,011 | 571 | 111 | 38·0 | 19·4 |
| Lockstedt | 5,000 | 47 | 7 | 9·4 | 14·9 |
| Mayence | 14,669 | 759 | 165 | 51·7 | 21·7 |
In the case of the Kingdom of Saxony and of the South German States no figures for the individual places are available. We see from the above table that of the large prison-dépôts, Glogau, Magdeburg, Torgau, Wesel, Stettin, and Mayence had the most cases of the disease; generally speaking, the smaller places were less severely attacked, although there are a few exceptions to this statement; in Stralsund, for example, there were 78·2 cases of the disease per 1,000 prisoners, in Papenberg and Hanover 63·4, in Colberg 53·9, and in Münster 52·8.
The occurrence of small-pox in the immobile German army was closely related to its prevalence among the prisoners, and it attacked the immobile troops much more severely than the field-troops. The latter, to be sure, were no less exposed to the infection, but the former, taken as a whole, were not nearly so well vaccinated; for it was impossible in the short time available to see to it that all the reserves were vaccinated, since the troops designated for the field were given the precedence. Thus between conscription and vaccination there was more or less of an interval, during which a large number of the reserves were not protected against the disease. The total number of men in the immobile army that contracted small-pox was 3,472 (excluding Baden and the Grand Duchy of Hesse, regarding which we have no statistics). Assuming that the average number of reserves in the immobile army was 300,424, this means that about 11·6 per 1,000 contracted the disease. The number of cases among the immobile troops in the individual states of the Confederation varied greatly, as indicated by the following table:
| Average no. reserves. | Patients. | Deaths. | Patients per 1,000. | Deaths per 100 cases. | |
|---|---|---|---|---|---|
| N. Germany, excluding Kingdom of Saxony | 238,040 | 1,703 | 92 | 7·15 | 5·4 |
| Kingdom of Saxony | 17,628 | 506 | 30 | 28·70 | 5·9 |
| Bavaria | 34,634 | 1,183 | 39 | 34·16 | 3·3 |
| Württemberg | 10,122 | 80 | 1 | 7·90 | 1·3 |
In the larger Prussian garrisons, and in Mayence, the following number of men contracted and succumbed to small-pox:
| Average no. men. | Patients. | Deaths. | Patients per 1,000. | Deaths per 100 cases. | |
|---|---|---|---|---|---|
| Berlin | 9,110 | 57 | 4 | 6·3 | 7·0 |
| Danzig | 7,376 | 45 | 5 | 6·1 | 11·1 |
| Königsberg | 6,426 | 101 | 11 | 15·7 | 10·9 |
| Stettin | 7,000 | 74 | 5 | 10·6 | 6·8 |
| Magdeburg | 11,296 | 84 | 8 | 7·4 | 9·5 |
| Posen | 9,482 | 113 | 6 | 11·9 | 5·3 |
| Breslau | 8,029 | 20 | 2·5 | ||
| Wesel | 7,284 | 117 | 7 | 16·0 | 6·0 |
| Cologne | 9,207 | 19 | 1 | 2·1 | 5·3 |
| Coblenz | 8,710 | 83 | 4 | 9·5 | 4·8 |
| Mayence | 9,046 | 122 | 9 | 13·5 | 7·4 |
Wherever, as in Breslau, there were few prisoners, the small-pox percentage in the immobile army is low. Regarding the above figures, it must be remarked that those pertaining to the garrisons were compiled on the basis of the average number of troops, whereas in the case of the French prisoners the maximum number was used as a basis. The relative number of small-pox cases in the latter table, accordingly, is somewhat too low. Among the prisoners and among the immobile troops, the climax of the pestilence was in January, as indicated by the following table:
| French Prisoners. | Immobile German troops. | |
|---|---|---|
| July (1870) | 2 | 16 |
| August | 27 | 9 |
| September | 85 | 47 |
| October | 273 | 49 |
| November | 1,041 | 128 |
| December | 3,107 | 358 |
| January (1871) | 4,139 | 802 |
| February | 3,151 | 719 |
| March | 1,521 | 457 |
| April | 586 | 451 |
| May | 209 | 291 |
| June | 36 | 145 |
The number of French prisoners taken to Germany in the month of July 1870 was small. Of the sixteen immobiles who contracted the disease during that month, nine belonged to the Ninth Army Corps, most of them having been infected inland before the outbreak of the war. That the month of July did not constitute the starting-point of the subsequent epidemic is evident from the fact that the prevalence of the disease decreased in August, as well as from countless individual observations.
In the summer of 1870 Germany was almost free from small-pox. Later on, thousands of French prisoners, almost all of them hailing from infected localities, were within a short time scattered throughout the entire German Empire, and since the inhabitants of many parts of the country, as stated above, were very insufficiently vaccinated, it was inevitable that epidemics of small-pox should break out everywhere. The disease was disseminated in several ways: by prisoners who had contracted it on their way to Germany, or who had to be transported from an infected to an uninfected locality, by persons into whose systems the infection had entered but had not yet revealed its presence, and by uninfected persons who had come in contact with infected persons; numerous persons, moreover, contracted the disease by handling the clothing, blankets, and other effects of small-pox patients.
‘The dissemination of the disease,’ says the German Health Report,[264] ‘which broke out simultaneously in various parts of Germany, was helped along in numerous ways. From the lazarets and from the prisons it was communicated by nurses and guards, and by working men and tradesmen, to the civil population and to the local garrison, and from there it spread to the surrounding country. It was conveyed from place to place, often considerable distances, by the moving population itself, not infrequently by marching troops, and particularly by the removal of prisoners from one place of detention to another; the latter measure had to be adopted in order to make room for the fresh transports of prisoners that were constantly arriving, many of them in such an exhausted condition that it was necessary to spare them the long and trying journey to the far East. Thus the prisons at Mayence, Coblenz, Wesel, Minden, &c. became the foci from which the disease was transplanted into hitherto uninfected places.’
The result was that there broke out in Germany an epidemic of small-pox which raged more furiously and extensively than any other epidemic in the course of the nineteenth century. Whereas among the prisoners-of-war and among the immobile German troops (who were particularly exposed to the infection) the disease reached its climax as early as January 1871, among the civil inhabitants of the country this climax did not come until later in the year; in the more out-of-the-way regions, moreover, where there was less intercourse, the height of the epidemic was not reached until the year 1872.
After the prevalence of small-pox in Prussia had again increased somewhat in the years 1864–7, in the following years the number of cases of the disease grew steadily smaller, so that around the middle of the year 1870 the country was practically free from it. Its prevalence again increased in the first months of the year 1871. The following table indicates the number of deaths caused by the disease in Prussia in the course of twelve years:
| Total no. deaths. | Deaths per 10,000 inhabitants. | |
|---|---|---|
| 1862 | 3,894 | 2·1 |
| 1863 | 6,250 | 3·4 |
| 1864 | 8,904 | 4·6 |
| 1865 | 8,403 | 4·4 |
| 1866 | 11,937 | 6·2 |
| 1867 | 8,500 | 4·3 |
| 1868 | 4,510 | 1·8 |
| 1869 | 4,655 | 1·9 |
| 1870 | 4,200 | 1·7 |
| 1871 | 59,839 | 24·3 |
| 1872 | 66,660[265] | 26·9 |
| 1873 | 8,932 | 3·6 |
In the year 1874 only one person per 10,000 inhabitants succumbed to the disease. Among the French prisoners small-pox usually broke out very soon after their arrival at their place of detention, while among the inhabitants of the places in which the prisons were located it usually did not make its appearance until several months later. Guttstadt,[266] in his excellent work on the Epidemic of Small-pox in Prussia in the Years 1870–1, has compiled a table of statistics indicating in a number of places when the disease first made its appearance among the prisoners and among the civil inhabitants. We reproduce this table below, with a few small alterations. In some of the places mentioned there was no military prison; only prisoners suffering from small-pox were taken to them, usually resulting in an epidemic of the disease among the civil inhabitants. The table clearly indicates the connexion between the small-pox epidemics among the civil inhabitants and the outbreaks of the disease among the prisoners; regarding the manner of dissemination in the case of the individual epidemics we shall have more to say further on.