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patient, nor even cause him to go to the hospital, yet none the less certainly unfit him for labor and duty. Of the regiment referred to by Dr. Mann, and already adduced in this article, in which 700 were unable to attend to duty, 340 were in the hospital under the surgeon's care, and 360 were ill in camp. It is probable that a similar, though smaller, discrepancy often exists between the surgeon's records and the absentees from parades, guard-duty,

etc.

It is improbable, and even impossible, that complete records and reports should always be made of all who are sick and unfit for duty, or even of all who come under the surgeon's care. Sir John Hall, principal Medical Officer of the British army in the Crimea, says that there were "218,952 admissions into hospital."* "The general return, showing the primary admissions into the hospitals of the army in the East, from the 10th April, 1854, to the 30th June, 1856, gives only 162,123 cases of all kinds." But another Government Report states the admissions to be 162,673. Miss Nightingale says, "There was, at first, no system of registration for general hospitals, for all were burdened with work beyond their strength."§ Dr. Mann says, that, in the War of 1812, "no sick-records were found in the hospital at Burlington," one of the largest depositories of the sick then in the country. "The hospital-records on the Niagara were under no order." It could hardly have been otherwise. The regimental hospitals then, as frequently must be the case in war, were merely extemporized shelters, not conveniences. They were churches, houses, barns, shops, sheds, or any building that happened to be within reach, or huts, cabins, or tents suddenly created for the purpose. In these all the surgeons' time, energy, and resources

* Report on the Sanitary Condition of the British Army, p. 180.

† Ib., 525.

Medical and Surgical History of the War in the East, Vol. II. p. 252.

§ Report on the Sanitary Condition of the British Army, p. 377.

Medical Sketches, p. 246.

were expended in making their patients comfortable, in defending them from cold and storm, or from suffering in their crowded rooms or shanties. They were obliged to devote all their strength to taking care of the present. They could take little account of the past, and were often unable to make any record for the future. They could not do this for those under their own immediate eye in the hospital; much less could they do it for those who remained in their tents, and needed little or no medical attention, but only rest. Moreover, the exposures and labors of the campaign sometimes diminish the number and force of the surgeons as well as of the men, and reduce their strength at the very moment when the greatest demand is made for their exertions. Dr. Mann says, "The sick in the hospital were between six and seven hundred, and there were only three surgeons present for duty." "Of seven surgeons attached to the hospital department, one died, three were absent by reason of indisposition, and the other three were sick."* Fifty-four surgeons died in the Russian army in Turkey in the summer of 1828. "At Brailow, the pestilence spared neither surgeons nor nurses."† Sir John Hall says, "The medical officers got sick, a great number went away, and we were embarrassed." "Thirty per cent. were sometimes sick and absent" from their posts in the Crimea.

Seven

ty surgeons died in the French army in the same war. It is not reasonable, then, to suppose that all or nearly all the cas es of sickness, whether in hospital or in camp, can be recorded, especially at times when they are the most abundant.

Nor do the cases of sickness of every sort, grave and light, recorded and unrecorded, include all the depressions of vital energy and all the suspensions and loss of effective force in the army. Whenever any general cause of depression

*Medical Sketches, p. 66.

Boudin, Traité de Géographie et de Statistique Médicales, Tom. II., p. 289.

Report on the Sanitary Condition of the Brit ish Army, p. 180.

weighs upon a body of men, as fatigue, cold, storm, privation of food, or malaria, it vitiates the power of all, in various degrees and with various results; the weak and susceptible are sickened, and all lose some force and are less able to labor and attend to duty. No account is taken, none can be taken, of this discount of the general force of the army; yet it is none the less a loss of strength, and an impediment to the execution of the purposes of the Government.

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, 11,994* British and 65,069 † 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

Medical and Surgical History of the British Army in the East, Vol. II. p. 227.

↑ British and Foreign Medical and Surgical Journal, Vol. XXI.

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 twentyfirst 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 the 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." 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 MS. Letter of Mr. Elliott.

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 regu lar 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 depres sion,- 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.* In the British hospitals in the Crimean War, 39 per cent. were cholera, dysentery, and diarrhea, 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,† 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 diarrhœa, 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 ner vous 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.

* Medico-Chirurgical Transactions, Vol. VL p. 478, etc.

↑ Report on the Sanitary Condition of the British Army, p. 525.- Medical and Surgical History of the War in the East.

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 cent. 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 cent. †

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

Calculated from the Eighteenth Registration Report.

+ Calculated from Twenty-First Report of Registrar General.

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,

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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.

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