Remarks on the Treatment of the Sick and Wounded in War
Authors: B. Hill
Journal: BMJ (1870)

THE present moment, when all minds are engrossed in the contem- plation of the fearful drama passing through its weary stages on the other side of the channel, appears to me an appropriate occasion for comparing the modes of succouring the sick and wounded in military services during the present and recent wars, with those employed before science had made its several important changes in the conduct of -warfare.In this examination, we must consider in what way the modes of re- ceiving and treating the sick and wounded in battle have been altered from the means employed during the wars of the last, and even of the commencement of the present, century.Frederick the Great, we are told, experienced such insuperable difficulties in the way of adequately providing for his wounded, that he suggested that all wounded should be recognised by belligerents as neutrals (such, indeed, was the agree- ment between Earl Stair, commanding the English forces, and the Duc de Noailles, on the French side, in I743); or, failing this mutual con- cession, it would be not only a more convenient, but a more humane practice, to abandon the wounded on the field of battle; arguing that, with the means at command in those days, any care that could be be- stowed on the sick and wounded rarely did more than stave off death for a time, and so uselessly prolong their sufferings.But other views have prevailed.The physicians wvho attended the forces engaged in these very struggles, in the middle of the last century, laid down, and sufficiently defined, most of the main principles of mili- tary hygiene, which, nevertheless, did not until recently receive much attemlton.Thec milit-ry quthorities of this country neither copied the improvements of other nations, nor, during the peace subsequent to WVaterloo, did they profit by the experience gained in the wars againstNapoleon.The true advance for this country in the practice of mili- tary hygiene began when the English nation learnt, through their press, the ravages that death and disease from preventible causes were inflict- ing on the fine troops sent to the Crimea.This discovery at once aroused the national sympathy, and created the determination to compel the authorities to make the necessary exertion; which, supplemented by an abundant supply from private means, quickly converted a miserable exhausted remnant of a gallant force into an army complete at all points, and in the highest state of health and efficiency.The English expedition to the East landed in the Crimea almost en- tirely destitute of transport and hospital supplies.This destitution and the disastrous wrecks at Balaclava caused nearly ten thousand men to die from preventable disease in the first winter.In the second winter, on the contrary, the loss by death was but six hundred;scurvy, typhus, and other diseases originating in hardship and neglect, were unknown.Indeed, through the wise and successful exertions of the Government and of the nation, during the second winter, the health of the British forces in the Crimea was as good as, or even better tltan it is at home in time of peace.(.Medical and Sn-grical Ihistory of tihe British Army in Tuirket and the Crinmea ins i854-5-6.Presented to Parliament, i858.Vol.ii, p. 43.)On tlhe other hand, the French army, tlhrough their preparations for war, imperfect though they were, suffered less from disease during the first winter, sending in that period, from sickness alone, 8iooo cases to hospital, with a mortality of 1o,ooo; but in the second winter they sent o6,o000, with a mortality of 2i,000, or twice as large as that of the first winter.Let us now consider the consequences of neglecting or observing one or two of the most important principles of army hygiene.One of the most incontestably proved principles of military hygiene is seg,-Gt io, or avoidance of overcrowding, either of the sick or of the healthy.Still, this important condition of health not ensured to our troops until the middle of the Crimean war, since which time it has been up- held in every campaign of first-rate importance.For instanlce, Sir John Pringle, who described the campaign of the British forces in Ger- many, under George II, in 1742-43, and in Scotland and the North of England in 1745-46, gives the plainest possible examples both of the effect of overcrowding in producing disease, and of isolation in arrest- ing its progress when at its worst.He tells us that, after the battle of Dettingen, in 1743, which, you may remember, was the last occasion of an English king being present on the field of battle, nearly half the English forces, of about i6,ooo men, fell sick of (lysentery.The vil- lage of Feckenheim was employed as a hospital.In it 1500 sick were lodged; hospital fever soon broke out, and spread even to the doctors and attendants, causing great mortality throughout the army.At lust the camp was raised, and the disease at once rapidly abated.But 3000 sick were left behind; of these, nearly half died, and with them the unfortunate inhabitants of the village were almost wholly destroyed.So, again, in the campaign against the rebellion of 1745, the sick of the army under the Duke of Cuniberland suffered most severely from typhus, or "jail fever", as it was then called, through the sick men being crowded into the workhouse at Lichfield; yet Pringle says that, at all other places where there was no common hospital, and the sick could not be collected together, the jail fever was unknown.