When fortified cities are subjected to a long siege the death-rate in them increases considerably; if diseases break out during the siege, they spread beyond expectation and carry away large numbers of people. The greatest enemy of the people in a besieged city is hunger. Since the approaching hostile army causes the inhabitants of the surrounding country to take refuge in the cities, the latter suddenly become overcrowded, moreover with people who are generally quite penniless and have to be provided for by the rest. In former years, when warfare was much more cruel than it is to-day, this was especially the case. Furthermore, the size of the garrison must be rapidly increased, or perhaps the whole of a retreating army, as was the case in Metz, must be quartered in the stronghold. Accordingly, the first step taken by the commander of a fortress must be to ascertain the quantity of provisions on hand, and to work out an appropriate plan for the distribution of them. How the quality of the bread becomes more and more unsatisfactory, and finally reaches the point where the product is scarcely worthy of the name bread; how people are obliged to eat the flesh of horses, dogs, and other animals; how the prices of the necessaries of life soar ad infinitum—all this is so well known that it needs no further exposition. Besides the absence of these necessaries of life, the lack of milk, fats, salt, and vegetables is accompanied by various consequences; very frequently improper and badly prepared food gives rise to a large number of severe cases of intestinal catarrh.
Insufficient nourishment is seldom the direct cause of death; on the other hand, it frequently so weakens people that they are much more subject to sickness, or, if they have already contracted some disease, they are much more likely to die, or, if they recover, to convalesce slowly. Thus Vacher[324] states that typhoid fever, which usually results fatally in one out of four cases, during the siege of Paris carried away no less than forty per cent of those who contracted it; tuberculosis, he says, often acquired an acute form and caused death within a few weeks. Little children present slight resistance to famine. ‘In regard to new-born and one-year-old infants I have observed in certain cases that become more frequent every day, that the effects of insufficient alimentation show themselves in the form of a progressive emaciation, which includes all the tissues of the body and almost always has fatal consequences; oedema of the teguments, anaemia, uncontrollable diarrhoea, and continual plaintive crying on the part of the little patients are the characteristic symptoms of that hunger-fever which actually decimates our infant generation.’
Another result of insufficient nourishment, one which has frequently been observed in besieged strongholds, is the appearance of scurvy.
During sieges, the hygienic measures of precaution, which are absolutely essential to the maintenance of health in cities, can no longer be carried out. If spring-water is secured outside the city for the inhabitants, the besiegers cut off the source of supply; if the water of rivers is used, then filtration plants have to be erected. But even filtration does not prevent the appearance of those infectious diseases the germs of which are carried in water, since for washing purposes the river-water is used just as it is found. The removal of refuse constitutes an extremely difficult problem; the cleaning out of privies is often possible only to a very insufficient extent, especially when the besiegers have advanced very close to the city, and the failure to dispose of garbage necessarily causes large accumulations of dirt and filth in the streets; this was especially the case in former times.
The burying of so many dead bodies, of both men and animals, especially horses, has met in many sieges with serious obstacles;[325] if the ditches intended for a large number of bodies are not dug deep enough, the atmosphere becomes polluted; to burn them is impossible, owing to lack of fuel; and if they are cast into the river, this jeopardizes the health of those living further downstream. During certain sieges in the past, hard conditions have made it necessary to leave corpses and carcases lying in the open, with terrible consequences.
If the siege takes place in the winter, it is very difficult to procure fuel for heating purposes, unless sufficient provision has been made beforehand. In Paris, for example, the inhabitants suffered severely from cold, and to meet the emergency artificial fuel was prepared by mixing stable manure with tar and reducing the mass to solid form under the hydraulic press.
In the following pages we discuss a few sieges which were characterized by severe outbreaks of pestilence.