Tlutroops were without tents for some weeks after landing, their packs were not returned to them for nearly two months after the establishment of the siege, and their sjiiad bau's not having been forwarded from > uri, " the soldier was left during the interval almost in a to vermin, and without a change of any kind " (Tulloch), all this while undergoing great fatigue and much exposure. Thus, then, I have rapidly sketched the progress of tin- expedition up to the sitting down of the army before Sebastopol, and indicated the leading circumstances which exrrcised an influence on the health of the troops. Let me now shortly inquire what were the diswhich resulted from these circumstances, and from those r conditions that came int t a later period alre; d iii a previous chapter which all combined to destroy 10,000 men of our army in seven and to delay the fall of the fortress for a year.
It is a n-rnark of all times, that disease thins the ranks of an army far more than is done by the arms of an rant and dwell more upon those events which arc of unusual occurrence, while they pay but little attention to the effect of those causes with whose aetioii they are familiar. Thus it i the iinthiiikin.ir observer, the ravages of battle present with greater force than the more obscure hilt more deadly influences of disease. proportion in which the victims of disease will M of battle, varies with the country and the season in which the campaign is waged, as well as with the resources of the army engaged. It was a saying of Frederick the Great, that fever alone cost him more men than seven pitched battles, and it has been an axiom with most commanders, that " more campaigns are decided by sickness than by the sword." At Walcheren, in 1809, our army, numbering 40,000, lost in the thousand by disease, and only 16'7 by wounds.
In the Peninsula, from January, 1811, to May, 1814, during which period the battles of Albuera, "the most desperate and bloody of the whole revolutionary war," Salamanca, Vittoria, the Pyrenees, Nivelle, Xive, Orthes, and Toulouse were fought; and Badajos, Ciudad Rodrigo, and San Sebastian stormed, besides many lesser encounters, in an effective force of 61,500 men, only per 1000 were lost by wounds, while were lost by disease. In Burmah, again, under a less propitious climate, in the first war 35 per 1000 were lost by wounds, and 450 per 1000 by disease; and in the following year per 1000 were lost by battle, and 300 per 1000 by In the Indian campaigns, in the wars of the Empire, and in the Russian campaign against Turkey in 1828, the difference is still more marked.
To multiply examples would be of little use, but sufficiently easy, as the same is the teaching of almost all campaigns. In the Crimea the proportion of those lost by sickness to those lost by wounds, was, if we take the whole war, Bauden's Hygiene Militaire compared. The experience of the French in Egypt is an exception. There they lost 4,157 by disease, and 4,758 by wounds and accidents, in an army of 30,000, and in a period of three years and a half. DISEASES OF THE ARMY. to ami we calculate merely the period from October, 1854, to April, 1855. then, in a mean: 23,775 men, we 9,248 lost by sicki to place against 608 lost by wounds;f or we extend tin- period, and number the!4, up till the conclusion of in 1856, then the contrast becomes yet more marked and decided.
In the French and Russian d during the war, I believe the proportion of disease to wounds to have been even higher than in ours; but the want of accurate details prevents any close approximation to their loss being made. M. Scrive tells thai in December and January, 1854-5, their admissions into the Crimean ambulances were 15,500, of whom 14,000 were for disease, and wounded; that of the whole number 1.700 died; and tli;--t during the last six months, in which the tinal assaults that led to the taking of the city were made, the French wounded, and, 1 cases of disease. It has been calculated, that during a campaign, an average of 10 per cent, sick may be looked for: but in th'(;e was very much above this. r, 1854, to April, IS-" i though army was stationary, in a comparatively healthy climate, having its communications open, and a miles of the sea, the per-centaire of sick to strc J9 per cent, for the whole body of ln p.-r cent, tor the troops serving in front, and for corps to the unheard-of nnmbrr of per cent.
The entage of sick to strength the whole. cannot be ascertained with precision. how killed in action, f Tulloch's Crimean ( The diseases which chiefly affected our troops were cholera, diarrhoea, dysentery, typhus, and typhoid fevers. It is true that some of these were often so mingled, so confounded in their manifestations, and so modified by their mutual reactions, that it was not always easy, nor sometimes possible, to detect their individual influences, or their mutual correlations and interdependence on one another; yet in many cases the distinctions were well marked at first, or their individuality was shown during treatment. The scurvy poison was the fusing medium, if I may so express myself, which blended the one disease into the other, and modified all; and as the affection was more developed amongst the French than amongst us, I believe the confusion of nosological diseases to which I have referred was more striking with them than even with This curious confounding of affections often put one's previous notions of disease completely at fault, rendering the diagnosis uncertain, the indications for treatment curiously at variance, and combining the pathological results in unaccustomed synthesis.
The intermediary position which the Crimea occupied between Europe and Asia, seemed to have caused that correlation of disease from which our troops suffered. The typhoid fevers of European armies, and the violent dysenteries of Asian and African, there met and struggled for the ascendancy; while the omnipresent cholera ravaged our ranks; and scurvy, the product of no particular clime, but of man's own improvidence, prepared the way for their several assaults. My friend Professor Tholozan has given a very able exposition of this mixing in his paper read to the Academy of Medicine in September, 1856. 'I.KUA deaths appear from 4, and the other in.May, 1855.
This was the -e which chiefly attacked the new drafts, among whom, however, it was not so deadly, in proportion to those I it was among the old campaigners. >d wlu-n the disease was at its greatest height in the Crimea was iu December, 1854, when 888 cases, in an average strength of 29, appeared, and -irivmir 2'9 per cent, cases of the whole force, and 71'6 per cent, deaths on admissions. In the June mie the French had 5,450 cases of cholera, of which L'.T-'l" died. Its n- belliousness to treatment was always marked during the period of intensity, and its manau-eablcness during its retrocession. There seems good reason to suppose that the cholera which appeared - introduced from Marseilles, where it was then prevalent; and while for considerable periods it remained quiescent, it never wholly e-vised in the camp, until its disaj I in the en 1 of
Scurvy was the great age; -t which it was difficult to mnl which, th<>u-h but little h- by its usual Ngnfl thougb >t't.-u carefully dug it, pretence behind s.m,Other ailment yet intb.:ise, and touched u ith its poll These numbers do officers, of whom ill. 1 during the war of sickness, and 86 of wounds. linger every wound. Sometimes breaking out witli a malignancy which recalled the graphic descriptions of the early voyagers, or the masterly delineations of Lind, but more commonly declaring its presence by a more negative, though not less baneful, influence, in preventing or retarding cure. Wasting fluxes, occurring during the treatment of an injury and defying cure; hemorrhages of frequent repetition and difficult suppression; fractures refusing to unite; sores unaccountably slow to heal, were its most ordinary indications to the surgeon.
With us it was not often the immediate cause of death; but with our allies it very frequently was. During the cold weather they lost many scorbutic patients rapidly, from effusion into the lungs, and suffered far more from scurvy than we did. The sloughing bubos in the axilla and groin which they had to contend with, were among its worst complications. M. Scrive says, that its outbreak was most marked in the regiments newly landed, in the proportion of 25 per cent, to 10 per cent, among the older regiments, and that it was less in the besieging than in the observing army in the valleys in the rear. With us, the earlier and most usual symptoms of the scurvy were a weariness of body which indisposed to exertion; a feeling of despondency; some degree of dyspnoea; stiffness in the limbs increased by rest, and relieved, in a great measure, by exercise; hardness of the muscles of the calves of the legs, the integuments of which were discoloured so, that they looked as if peppered with gunpowder; and at times, puffiness of the extremities.