UBPARY 
 
 085702 
 
(SfarneU Utiineroitg ffiibrarg 
 
 Strata, ^tta l^atk 
 
 THE LIBRARY OF 
 
 EMIL KUICHLING, C. E. 
 
 ROCHESTER. NEW YORK 
 
 THE GIFT OF 
 
 SARAH L. KUICHLING 
 
 1919 
 
Cornell University 
 Library 
 
 The original of tiiis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924004993196 
 
THE HYGIENE 
 
 Olf 
 
 ARMIES IN THE FIELD. 
 
 BY 
 
 SIR ROBERT RAWLINSON, C.B. 
 
 CIVIL ENGINEER, CHIEF ENGINEER INSPECTOR LOCAL GOVERNMENT BOARD, 
 MEMBER OF THE ARMY SANITARY COMMITTEE. 
 
 READ AT THE PAEKES MUSEUM, JUNE, 1883. 
 
 LONDON : 
 
 WYMAN & SONS, 74-76, GREAT QUEEN STREET, 
 
 lincoln's-inn fields, w.c. 
 
 1883 
 
THE 
 
 HYGIENE OE AEMIES IN THE EIELH. 
 
 THIS subject is so vast, special, and complicated, that I 
 can only promise to touch the fringe of it, and this 
 in a roundabout sort of way. I will not presume to lay 
 down hard and fast rules by which armies in the field 
 may be regulated in sanitary matters in the future, but 
 rather describe, in narrative form, some of my own ex- 
 perience, gained during the time I acted as the Engineer 
 member of the Sanitary Commission sent out to the Army 
 in the Crimea in the spring of 1855 ; and, that it may be 
 clearly understood under what conditions that Commis- 
 sion was sent out, I insert the Instructions. 
 
 The Instructions to the Sanitary Commissioners on 
 leaving England for the Crimea : — 
 
 " Wae Dbpaetment, I9th Fehrumy, 1855. 
 
 " Gentlemen, 
 
 " Her Majesty having been pleased to assent to your 
 proceeding on a sanitary mission to Constantinople and 
 the Crimea, you are instructed to obey the directions 
 which follow. 
 
 " The utmost expedition must be used in starting on 
 your journey, in the journey itself, and in the execution 
 of all that is necessary at the place of your destination. 
 
 A 2 
 
"On your arrival at Constantinople and Balaklava, 
 you will put yourselves instantly into communication 
 with Lord W. Paulet, Admiral the Hon. F. Grey, and 
 Lord Raglan respectively, and you will request of them 
 forthwith (according to the oflB.cial directions they will 
 have received) full powers of entry into every hospital, 
 infirmary, or receptacle of whatsoever kind for the sick 
 and wounded, whether ashore or afloat. 
 
 "You will inspect every part of such infirmaries, 
 ascertain the character and sufficiency of the drainage 
 and ventilation, the quantity and quality of the water 
 supply, and determine whether the condition of the whole 
 is such as to allow, by purity of the air and freedom from 
 overcrowding, fair play and full scope to medical and 
 surgical treatment for the recovery of health. 
 
 " You will call to your aid for this purpose, whether as 
 witnesses or as guides, any of the officers or attendants 
 that you may require. 
 
 " The result of your inspection and opinions, together 
 with a statement of all that is necessary should be done, 
 whether in the way of arrangement, of reduction of 
 numbers in the wards, cleansing, disinfecting, or of actual 
 construction, in order to secure the great ends of safety 
 and health, must be laid, as speedily as possible, before 
 Lord W. Paulet, Admiral Grey, or Lord Raglan, as the 
 case may be, or such persons as may be appointed by 
 them to that special duty, and you will request them to 
 give immediate directions that the works be completed. 
 
 " As no time is to be lost, you may reserve your 
 detailed and minute reports, and give, in the first 
 instance, a statement only of the things to be done 
 forthwith. 
 
 " The Engineer Commissioner will be expected to 
 conduct the inspection along with his colleagues, and to 
 
devise, and to see executed, all such structural arrange- 
 ments as may be declared indispensable. 
 
 " You will examine the modes whereby the sick and 
 wounded are conveyed to the transports, or to the 
 hospitals, ashore or afloat. 
 
 " You will take care that, as far as possible, all evil 
 influences from without be removed, so that the air 
 inhaled by the inmates of the hospitals be not con- 
 taminated. It is reported, for instance, that the hospital 
 ship in the harbour of Balaklava is much surrounded by 
 dead carcases. 
 
 " As a necessary consequence, you will order that the 
 dead be interred at a sufficient distance from the hos- 
 pitals. You will lay down rules both as to the time and 
 mode of interment, consulting, of course, the convenience 
 of the constituted authorities. 
 
 " Should any other hospital or receptacle for the sick 
 be decided on while you are on this expedition, you will 
 examine it, and state all that must be done for health, 
 decency, and comfort. 
 
 " You will not interfere in any way with the medical 
 and surgical treatment of the patients, nor with the regu- 
 lations prescribed to the nurses and attendants. 
 
 " Upon your arrival at Constantinople, you will de- 
 termine among yourselves in what way you can best 
 carry out the objects of your mission. 
 
 " It is important that you be deeply impressed with 
 the necessity of not resting content with an order, but 
 that you see instantly, by yourselves or by your agents, 
 to the commencement of the work, and to its super- 
 intendence, day by day, until it be finished. 
 
 " It is your duty, in short, to state fully, and urge 
 strongly for adoption by the authorities, everything that 
 you believe will tend to the preservation of health and life. 
 
"The camp must also come under your immediate 
 and anxious attention. 
 
 " You must consider and apply, with the least possible 
 delay, the best antidotes or preventives to the deadly 
 exhalations that will be emitted from the saturated soil, 
 whenever the warmth of spring shall begin to act on the 
 surface. 
 
 " You must consider how all decaying substances, 
 present and future, may be removed speedily, or other- 
 wise disposed of with safety. Also in what way the 
 feculent matter of the camp may be rendered innoxious. 
 
 " You will pay special attention to the harbour of 
 Balaklava, and state your opinion as to the best mode 
 of cleansing it, and of keeping it clean from the accu- 
 mulations of filth floating on the surface. It will be 
 desirable to ascertain, not only for the convenience of the 
 transport of the sick, &c., but also for the removal of all 
 kinds of nuisances to the outside of the harbour, whether 
 jetties might not be easily constructed. 
 
 " As stated in your instructions relating to the hos- 
 pitals, so here you will, with the utmost possible despatch, 
 lay your plans before the proper authorities, in order that 
 they may be carried into execution. 
 
 " I have the honour to be, Gentlemen, 
 
 " Your obedient humble servant, 
 
 (Signed) " Panmube. 
 
 "Dr. Sutherland. 
 "Dr. H. Gavin. 
 " Mb. Eawlinson." 
 
 Note. — The Right Honourable The Earl of Shaftesbury, K.G., selected 
 the Commissioners ; and probably had the principal share in drawing up 
 he above Instructions. 
 
If General Orders could, in all cases, have been made 
 applicable and could have been obeyed, outside comment 
 might have been unnecessary, and the aid of a specially- 
 appointed Sanitary Commission during the Crimean War 
 might not have been needed. It may, however, from 
 experience, be assumed that there never will be General 
 Orders framed suflicient to cover all contingencies ; and 
 we may also assume that there will be neglect now and 
 then, from various causes. Some of the links in the 
 chain of regulations will break, and confusion will follow. 
 The General Orders for the army under the command of 
 the Duke of Wellington in the Peninsula, in the Low 
 Countries, and in France, 1809 to 1815, cannot probably 
 be improved upon, and Lord Raglan was Secretary to 
 the Duke. He must, consequently, have been acquainted 
 with the Duke's General Orders ; and yet we see the utter 
 confusion into which affairs drifted in the Crimea. The 
 siege of Sebastopol had not been provided for; and, 
 consequently, became exceptional. 
 
 No finer body of men ever left England than 
 composed the army of the East, 1854. Their equip- 
 ment was supposed to be perfect, and the provision 
 for their maintenance was also supposed to be 
 ample; and yet the results soon declared deplorable 
 failure.* To whom that failure was due it is impossible 
 now to say. It was not, however, to any individual, but 
 rather to the absence of an independent Sanitary depart- 
 ment with the Army, and to the want of one home depart- 
 ment to direct and control, having also power to order all 
 extra stores, and to inspect their shipment, and to see that 
 the several stores were so arranged in the transports that 
 
 * The Crimean War was, no doubt, in some degree a surprise. The 
 country " d/ri/ted into it," and the siege of Sebastopol was an after-thought, 
 for which the army was not prepared. Hence, when winter came, thera 
 were no special provisions to meet it. 
 
8 
 
 they should be available in the order of their necessity, 
 and not to have surgical appliances and medicines placed 
 beneath a massive bulk of ammunition, as was said to 
 have been the case in the Crimean War. Blunders of this 
 class do not appear to have been avoided even in the 
 recent Egyptian campaign, because past experience had 
 been forgotten, or deliberately set on one side. 
 
 A letter by Captain Douglas Galton, R.E., C.B., &c., 
 on the recent Egyptian Army Medical Inquiry sets forth 
 in the clearest words how both past experience and model 
 regulations based on that experience have been set aside. 
 Captain Galton states : — 
 
 " It will be in your recollection that, after the Crimean 
 War, a Royal Commission was appointed at the instance 
 of Lord Panmure, under the presidency of Lord Herbert 
 of Lea, to inquire into the sanitary state of the Army. 
 That Commission exposed the defective condition of 
 military hospitals, the absence of any efficient organisa- 
 tion of general hospitals in time of war, the want of any 
 method by which the improvements then recently intro- 
 duced for the protection of health in civil life could be 
 rendered available in barracks, camps, and hospitals ; and 
 it showed the great loss of life arising from these defects 
 during the war with Russia." 
 
 Captain Galton further states that : — 
 
 " A careful perusal of the report and evidence in the 
 Egyptian Blue-book containing the results of the inquiry 
 just concluded will satisfy any impartial reader that Lord 
 Herbert's regulations would have provided against the 
 evils which have arisen under these new arrangements 
 which have superseded them. Lord Herbert's regulations 
 provided that, in order to secure the health of the troops 
 in the field, a sanitary officer should be attached to the 
 Quartermaster-General's staff, to whom, on appointment, 
 the Director-General of the Army Medical Department 
 
9 
 
 was to issue a code of instructions to meet the specialities 
 of the campaign on all matters connected with rations, 
 clothing, shelter for troops, sanitary arrangements, and 
 precautions for preventing disease. The sanitary oCBcer 
 was to accompany the Quartermaster-General, or such 
 ofi&cer as he might appoint, in selecting buildings for 
 occupation by troops, whether as hospitals, quarters, or 
 stables. He was to examine into their sanitary condition 
 and into all matters connected with such buildings as 
 were likely to affect the health of the troops or of the 
 sick ; and he was to advise the Quartermaster-General 
 or his deputy on all such subjects ; he was to examine 
 into the sanitary condition of towns or villages about to 
 be occupied, and their neighbourhood, and to make recom- 
 mendations for organising a proper sanitary police to 
 preserve cleanliness and for the removal of nuisances, as 
 well as for the execution of such sanitary measures as he 
 might consider necessary for protecting the health of 
 troops in occupation. Corresponding sanitary instruc- 
 tions were also issued to the Quartermaster-General's 
 department." 
 
 It will be seen, on carefully reading this letter, that 
 practical lessons, however well taught, and also that 
 subsequent Official Inquiries, however ably conducted, 
 have led up to very little that has proved to be really 
 useful when the country again enters upon war. The 
 army medical arrangements had drifted back into the 
 old groove, the old forms of blunders and the old stories 
 are repeated, and yet the existing regulations are officially 
 supposed to be, if not perfection, all that is requisite. 
 
 But officials never own to a mistake : everything 
 done and said must, therefore, be assumed to be cor- 
 rect. This rule the Sanitary Commission found in full 
 force and fully believed in by the heads of the Medical 
 Department on the Bosphorus and in the Crimea. 
 
10 
 
 With filthy, overcrowded hospitals, full of sick, and a 
 terribly high rate of mortality, some of them asserted 
 that all had been done and was being done that was 
 required or practicable ; and that, consequently, for the 
 Home Government to have sent out a Sanitary Com- 
 mission was an insult to the Army Medical Department. 
 The army, they admitted, was no doubt sufi'ering under a 
 high rate of mortality, but then there was full and ample 
 precedent for this state of things during war; not only in 
 the British army, but also in Continental armies of old ; 
 as is shown by the returns relative to the rates of 
 mortality in the armies of France, after the retreat from 
 Russia, when 40,000 men around Paris are recorded to 
 have died of typhus in six weeks ; one-fifth of the remain- 
 ing force being sick. Army Medical Officers, therefore, 
 knowing this fearful loss of life to have been the common 
 fate of men in war, in all armies, could see nothing ex- 
 ceptional in the mortality of the British soldiers on the 
 Bosphorus. 
 
 As the Government of the day learned more from 
 newspaper correspondents than from official returns, 
 let us see an independent description of the condition 
 of the camp in November, 1864. Letter by Times cor- 
 respondent : — 
 
 " Rain kept pouring down — the skies were black as ink 
 — the wind howled over the staggering tents — the 
 trenches were turned into dikeS' — in some of the tents 
 water was sometimes a foot deep — our men have neither 
 warm nor waterproof clothing — they were out for twelve 
 hours at a time in the trenches — they were plunged into 
 the inevitable miseries of a winter campaign— and not a 
 soul seemed to care for their comfort, or even for their 
 lives. These were hard truths, which, sooner or later, 
 must have come to the ears of the people of England. 
 It was right they should know that the most wretched 
 
11 
 
 beggar who wandered about the streets of London in the 
 rain led the life of a prince, compared with the British 
 soldiers who were fighting for their country, and who, we 
 were complacently assured by the home authorities, were 
 the best appointed army in Europe." 
 
 This description, bad as it shows things to have been, 
 indicates nothing more than a necessity for vigorous 
 scavenging ; and if there had been a properly organised 
 staff of scavenging inspectors, and the Commander-in-Chief 
 could have ordered the bringing in and the employment 
 of labour, the road to the front and the camp might have 
 been cleansed from mud in a week and have been 
 preserved clean. 
 
 The Government at home, having had some experience 
 of the benefits to be derived from sanitary operations, 
 ultimately saw this, and then appointed and sent out the 
 Army Sanitary Commission. 
 
 In Government departments I am sorry to say that 
 there is not, on all occasions, due respect shown to the 
 feelings of permanent officials, and, in our case, we were 
 not put into communication with the heads of the per- 
 manent Medical Department before leaving London, 
 nor in the Crimea; which, no doubt, gave offence, but for 
 which the members of the Commission were in no sort of 
 way answerable. 
 
 In my opinion, this is not the best way of using men, 
 but it is a subject outside of my province to settle. We, 
 the members of the Sanitary Commission, were selected 
 to undertake important duties under new and strange 
 conditions. We were informed that instructions would 
 be sent out to the heads of departments, to the British 
 Minister at Constantinople, to Lord Baglan in the 
 Crimea, and to the Admiral on the Bosphorus, with an 
 earnest request that they would facilitate us to the fullest 
 
12 
 
 extent in our labours. We, however, had no introduction 
 to the heads of the Medical Department. 
 
 To show how it was anticipated the Sanitary Com- 
 mission would be received, I give the very charac- 
 teristic extract and letter from the Life of the late 
 Lord Palmerston : — 
 
 Extract from the " Life of Viscount Palmerston" 
 1846-65, by the Son. Evelyn Ashley. Vol. II. 
 
 Spring of 1855. 
 
 No time was lost by the reorganised Cabinet in 
 remedying some of the most pressing evils which had 
 borne down our Army in the Crimea. Lord Palmerston, 
 in announcing to the House of Commons the formation 
 of his Government, detailed also some of his new adminis- 
 trative measures. The ofl&ce of Secretary of War was 
 to be amalgamated with that of the Secretary of State in 
 the person of Lord Panmure ; a Bill was immediately to 
 be introduced for the enlistment of older men on short 
 service ; the Admiralty was to establish a special Board 
 to superintend the transport service ; lastly, a Sanitary 
 Commission was to be sent to the Crimea, and another, 
 under Sir John McNeil, to superintend the commissariat. 
 I append Lord Palmerston's letter to Lord Eaglan 
 accompanying the Sanitary Commission : — 
 
 " Downing Street, February 22, 1855. 
 
 "My deab Lord Baglan, 
 
 " This will be given to you by Dr. Sutherland, 
 Chief of the Sanitary Commission, consisting of himself. 
 Dr. Gavin, and Mr. Bawlinson, whom we have sent out 
 to put the hospitals, the port, and the camp into a less 
 unhealthy condition than has hitherto existed, and I 
 request that you will give them every assistance and 
 
13 
 
 support in your power. They will, of course, be opposed 
 and thwarted by the Medical Officers, by the men who 
 have charge of the port arrangements, and by those who 
 have the cleaning of the camp. Their mission will be 
 ridiculed, and their recommendations and directions set 
 aside, unless enforced by the peremptory exercise of your 
 authority. 
 
 " But that authority I must request you to exert in 
 the most peremptory manner for the immediate and 
 exact carrying into execution whatever changes of 
 arrangement they may recommend; for these are matters 
 on which depend the health and lives of many hundreds 
 of men, — I may, indeed, say thousands. It is scarcely to 
 be expected that officers, whether military or medical, 
 whose time is wholly occupied by the pressing business 
 of each day, should be able to give their attention or 
 their time to the matters to which these Commissioners 
 have for many years devoted their action and their 
 thoughts. 
 
 " But the interposition of men skilled in this way is 
 urgently required. The hospital at Scutari is become a 
 hotbed of pestilence, and if no proper precautions are 
 taken before the sun's rays begin to be felt, your camp 
 will become one vast seat of the most virulent plague. 
 I hope this Commission will arrive in time to prevent 
 much evil ; but I am very sure that not one hour should 
 be lost after their arrival in carrying into effect the 
 precautionary and remedial measures which they may 
 recommend. 
 
 '• My dear Lord Baglan, 
 
 " Yours sincerely, 
 
 " Palmekston." 
 
 Something of the opposition anticipated certainly met 
 us, but not in any form seriously to retard our work. 
 
14 
 
 as with this we commenced and went steadily on. We 
 soon noted that the Barrack Hospital must have main 
 sewers ; as Dr. Gumming, the chief medical officer on the 
 Bosphorus, remarked, not in the most pleasant manner, 
 that he did not know what a Sanitary Commission could 
 do there to prevent disease, as the wind from the Sea 
 of Marmora would make the wards doubly foul and 
 aggravate fever cases. 
 
 This remark led me at once to ask the engineer officer 
 in charge if the building was sewered ; when he replied 
 that " he did not know." Upon this an orderly in 
 attendance said : " Yes, sir, the building is sewered." 
 I then said : " How do you know ? " He replied : " If 
 you will come with me, I will show you the sewers." 
 There they were, with their ends fully open towards the 
 Sea of Marmora. I at once knew the cause of the excess 
 of fever when the wind blew in and drove the concen- 
 trated putrid sewer-gas back into the sick wards. How 
 this state of things was remedied will be described in 
 another part of this paper. 
 
 The Army Sanitary Commission, having landed at Con- 
 stantinople, on the following day crossed the Bosphorus 
 and inspected the Great Barrack Hospital, — a compara- 
 tively new building, and much finer in design and in 
 construction than any barracks in Great Britain. This 
 and the other military buildings had been designed and 
 constructed by European engineers. 
 
 A description of these buildings by Miss Florence 
 Nightingale must be of general interest and have special 
 value, as she occupied one corner of the Barrack Hospital 
 during the winter of 1854-55, and witnessed the destruc- 
 tive effects of overcrowding, excessive dirt, and defective 
 ventilation. 
 
15 
 
 Miss Nightingale states in notes upon her experiences 
 at Scutari as follows : — 
 
 " The Scutari disaster was a separate problem, and must 
 be considered by itself. It was the case of thousands 
 of sick removed 300 miles from the causes which had 
 occasioned the sickness, and exposed to another class of 
 risks in the buildings into which they were received. 
 
 " The buildings were spacious and magnificent in ex- 
 ternal appearance ; far more so, indeed, than any military 
 buildings in Great Britain, and several of them were, 
 apparently, better suited for hospitals than any military 
 hospitals at home. 
 
 " This merely external appearance was, however, fatally 
 deceptive. Underneath these great structures wei-e 
 sewers of the worst possible construction, loaded with 
 filth ; mere cesspools, in fact, through which the wind 
 blew sewer-air up the pipes of numerous open privies, 
 into the corridors and wards where the sick were lying. 
 
 " The wards had no means of ventilation, the walls were 
 very dirty, and required lime-washing. The number of 
 sick crowded into the hospitals during the winter of 
 1854-55 was disproportionately large, especially when 
 the bad sanitary state of the buildings is taken into 
 consideration. The population of the hospitals was in- 
 creased, not only without any sanitary precautions having 
 been, taken, but while the sanitary conditions were 
 becoming daily worse ; for the foul sewers were getting 
 more and more dangerous, and the dirty walls more and 
 more saturated with organic matter. 
 
 " Some slight improvements were, however, made in the 
 beginning of March, 1855. But it was not till the 7th 
 March that effectual measures were initiated for removing 
 the causes of disease in the buildings, viz., through the 
 aid of the Civil Sanitary Commission. By the month of 
 
16 
 
 June the improvements were nearly completed, and the 
 proportion of sick had fallen off, and the hospitals had 
 by this time become healthy. 
 
 " This is a brief sketch of the history of the frightful 
 Scutari calamity. Even from the very beginning of 
 the occupation of these buildings in October, 1854, and 
 before the sufferings of the winter had begun, the 
 mortality was very high, although the number of sick 
 was small, indicating the unhealthy state of these build- 
 ings even then. Nothing, however, was done to improre 
 them. But fresh shiploads of sick were passed into them. 
 The mortality, of course, continued to rise. Still nothing 
 practically useful was done. Then came the great 
 Crimean catastrophe, and ship after ship arrived with 
 sick in so exhausted a condition that the foul air of these 
 hospitals was almost certain death to them, and accord- 
 ingly they died, in the month of ^February, 1855, at a 
 rate of 415 per cent, per annum. So that in twelve 
 months, at such a rate, the whole sick population of the 
 hospitals would have perished four times over. In 
 February two out of every five cases treated died in the 
 hospitals of the Bosphorus, and at Koulali one out of 
 every two. Well may this incredible mortality teach us 
 a terrible lesson ! 
 
 " The reduction in the mortality, after the sanitary works 
 were begun, is most striking, as it falls eventually to less 
 than a sixth part of what it was when the Barrack and 
 General Hospitals were occupied together in October, 
 1854, and to a nineteenth part of what it was in 
 February, 1855. Our general hospitals have been so 
 deplorably mismanaged in all our wars, that the question 
 has been raised as to whether it would not be better to 
 do without them altogether. The experience of Scutari 
 proves that general hospitals may become pest-houses 
 
17 
 
 from neglect, or may, by proper treatment, be made as 
 healthy as any other buildings. 
 
 " These are the facts of Scutari hospitals during the first 
 year of our occupation. Nothing in the sanitary recom- 
 mendations we have been analysing (that is, the army 
 medical sanitary arrangements), unless it be some sug- 
 gestions made when it was too late, would have led us to 
 suppose that there was anything seriously wrong in these 
 hospitals ; or, that their defects had any share in the 
 destruction of the British sick, who have given a name 
 to these buildings in history." 
 
 Further to illustrate the condition of these buildings 
 and their surroundings, the following extracts from the 
 Report of the Sanitary Commission are given, com- 
 mencing 7th March, 1855 : — 
 
 " On entering the Great Barrack Hospital, the first 
 thing that attracted our attention was the fearfully dirty 
 state of the ground around the buildings used as hospitals, 
 and the defective state of the ventilation. 
 
 " Excepting a few small openings here and there, there 
 were no means of renewing the atmosphere within this 
 hospital, the large cubic space above the tops of the 
 ward windows always retaining a considerable amount of 
 hot and foul air for which there was no escape. There 
 was not even an open fireplace connected with the 
 building; the wards were, therefore, heated by stoves, the 
 pipes of which passed through a small hole at the top of 
 one of the windows in each room. 
 
 " The communication between the wards and corridors, 
 in the majority of instances, was by doors ; and hence, 
 as these doors were shut, that free circulation and 
 
 B 
 
18 
 
 perflation of the atmosphere so necessary in military 
 hospitals was impossible. 
 
 " The upper parts of the windows in the privies, and in 
 the galleries connecting them with the corridors, were at 
 once removed or broken, so as to allow the emanations to 
 escape into the external atmosphere.* 
 
 " The rooms are large and lofty, and have generally 
 three windows each, but much too small for their cubic 
 contents ; and the heads of these windows do not reach to 
 within five or six feet of the ceiling. The window space 
 in the corridors is considerable, and the heads of the 
 windows came up much closer to the ceiling. The 
 different flats of the building communicate by large and 
 roomy stone staircases. 
 
 " To remedy the defective ventilation, the Commission 
 recommended that the upper portion of the windows 
 should in all cases be opened, and the current of air 
 modified by the insertion of perforated zinc plates, louvre 
 boarding, or otherwise ; that adequate space for the escape 
 of foul air should be provided as near as possible to the 
 ceiling of each ward ; and that the staircases should be 
 used for ventilating-shafts, by large square openings being 
 made through their ceilings and through the roof." 
 
 The ventilation in the General Hospital was much 
 less objectionable. This building had sash-windows. 
 
 * The windows were not casements but fixtures, and could not con- 
 sequently be opened from the top. The only remedy immediately avail- 
 able was, therefore, to break out all the top squares, and this was at once 
 done, and so permitting foul air to escape and fresh air to enter by tens of 
 thousands of cubic feet each hour. Peat-charcoal was scattered twice a 
 day over the putrid excreta. The open ends of the large sewers were 
 covered with old tent-cloth and large ventilating-shafts broken outside the 
 Barrack walls. The results were almost magical. 
 
19 
 
 '• Both wards and corridors were, however, used for the 
 sick, but the disposable means of ventilation were such 
 that this hospital could hardly be said to be over- 
 crowded. 
 
 " Permanent and independent ventilating arrange- 
 ments, by perforated zinc panes in the windows and 
 ventilating openings at the ceilings, were here also 
 directed to be introduced for the wards — the same as 
 those for the Barrack Hospital. 
 
 " The upper window sashes in the privies and galleries 
 were directed to be removed, so as to let out the foul 
 air and prevent, as far as practicable, dangerous eflluvia 
 from entering the corridors. 
 
 " The General Hospital, like the Barrack Hospital, is 
 divided longitudinally, all round, into wards and corridors ; 
 the wards facing outwards, and the corridors facing 
 towards the courtyard. But it differs from the Barrack 
 Hospital in one important particular — namely, that the 
 rooms and corridors communicate, not only by the doors, 
 but also by numerous large and lofty sash-windows 
 situate in the division-walls, so that by proper manage- 
 ment of the windows, and by the introduction of per- 
 forated zinc-panes, and also by suitable ventilating open- 
 ings at the ceiling of each ward, a thorough ventilation 
 could be at all times secured." 
 
 With regard to the ill effects of defective drainage, 
 so much has been said, that a few extracts from the 
 diary of the Sanitary Commission may be necessary. 
 
 "We found the sewerage belonging to the Barrack 
 Hospital in a most defective condition. The sewers and 
 drains were large, badly formed, rudely constructed, 
 irregular in invert gradient, untrapped, and impeded with 
 putrid refuse. 
 
 B 2 
 
20 
 
 " It may be here stated generally that all the buildings 
 used as Hospitals were sewered. Turkish sewers are 
 made of rubble-stone or coarse brickwork, the largest 
 sewers having a sectional area equal to 6 ft. in height and 
 4 ft. in width, arched over ; smaller sewers square on 
 section, about 3 ft. by 3ft., covered with rough flat stones. 
 The bottoms are flat, rough, and uneven ; there were no 
 means of external ventilation, no means for cleansing or 
 flushing, and the ends or mouths of the sewers at Scutari 
 opened above the level of the sea, and were exposed to 
 the action of the winds, which, in certain directions, blew 
 into the sewers' ends, and carried the foul emanations from 
 the deposits within them through the pipe-drains to the 
 Turkish privies, and thence into the corridors and wards 
 where the sick were placed. It was stated to us by Dr. 
 Gumming that a change of wind had been observed to be 
 attended by an accession of fever cases among the sick, 
 and that existing fever cases put on a more aggravated 
 form. We found that the winds to which these results 
 were attributed blew in the direction of the open, mouths 
 of the large sewers. These sewers were, in fact, elongated 
 cesspools of the most dangerous description, through 
 which, and through the Turkish privies, the wind forced 
 putrid sewer-gases directly into the wards of the Hospital. 
 
 " The exhalations escaping through the defective walls 
 and covers of the sewers, where they happened to pass 
 close to or underneath occupied rooms, could, in some 
 instances, be distinctly observed within the rooms, and 
 there is reason to believe that fatal cases, both of fever and 
 cholera, arose from this circumstance among the inmates. 
 
 " In order to diminish, as far as practicable, the in- 
 jurious emanations proceeding from these sewers and 
 Turkish privies, it was directed that the outfall-sewers of 
 the Hospital should be extended, and a canvas cover 
 
21 
 
 placed over their mouths to prevent the wind driving the 
 eflfluvia into the Hospital ; that three openings for ven- 
 tilation should he made in each main-sewer between the 
 Hospital and the outfall, with a water-trap at each sewer 
 ventilator, and a man-hole for subsequent cleansing : 
 water-tanks for flushing the sewers were also directed to 
 be placed immediately outside the walls of the building. 
 These tanks consisted of hogsheads, each having a large 
 wooden valve covering a pipe communicating with the 
 head of each sewer. The Inspector was directed to see 
 that these flushing-tanks were filled with water three 
 times a day, and the valves opened suddenly by himself. 
 
 " All the privies, sewers, and drains were directed to be 
 thoroughly cleansed, and their contents deodorized and 
 removed. It was further directed that peat-charcoal 
 should be freely used as a deodorizer for these purposes. 
 
 " The privies of this large building (the General 
 Hospital) are situated in four square towers, built on the 
 outside of the Hospital, instead of being within the square, 
 as in the Barrack Hospital. One of the towers is situated 
 at each angle of the main building and communicates 
 with the interior by means of a gallery opening into each 
 corridor. The windows of these galleries were all closed 
 at the time of our first examination, and as the structure 
 of the privies and the arrangement of the drainage were 
 essentially the same as in the Barrack Hospital, the 
 effluvia entered the corridors and could be easily detected 
 within them at some distance from the doors. 
 
 " This constituted the main sanitary defect of the 
 General Hospital ; but it was a very dangerous one, and 
 neutralised, to a great extent, the advantages possessed 
 by the building. 
 
 " On several occasions, both in the Barrack and other 
 
22 
 
 Hospitals, we saw the excreta of patients in utensils 
 under the bed, instead of having been at once removed. 
 
 " The effluvia from the privies had free access to the 
 corridors, and so added materially to the impurity of the 
 air. 
 
 " The first step taken by the Commissioners was to 
 examine carefully the outskirts of the Barrack Hospital, 
 to ascertain whether there were any external causes likely 
 to aflPect the purity of the surrounding atmosphere. 
 
 " The site of the Hospital, as already stated, is open 
 and airy, overlooking the Sea of Marmora on two sides, 
 and on the third side facing the open country ; on the 
 fourth side it is contiguous to one extremity of Scutari, 
 which, like all Turkish towns, we found to be in a bad 
 sanitary condition. The paving was rough and badly laid, 
 and the channelling very defective. The surface, in 
 many places, was filthy, and had putrefying mud lying in 
 hollows, and there were nuisances among the houses. 
 The ravine to the south-east of the Hospital contained 
 offensive deposit, which tainted the air on that side of 
 the building. There was some refuse and several dead 
 dogs lying close to the Hospital walls. 
 
 " The surface of the inner square of the Barrack 
 Hospital was uneven, badly formed, imperfectly drained, 
 and very dirty. 
 
 " Pour detached buildings within the court-yard, one 
 at each angle of the square and communicating with the 
 corridors, contain the Turkish privies : these buildings 
 open into each line of corridors by two large doors, one on 
 each side of the angle. By this arrangement each 
 corridor in the circuit of the building communicates with 
 the privies by eight doors. The privies consist merely of 
 
23 
 
 a xnarLle slab with a circular opening at the surface, com- 
 municating with a vertical pipe of red tile, carried down 
 into a drain at the basement of the building. These 
 privies, and the galleries between them and the corridors, 
 are lighted by a number of glazed windows, which we 
 found were all closed, so that there was a direct com- 
 munication between the sewers, which were loaded with 
 putrid filth, and with the corridors and wards of the 
 Hospital. 
 
 "The Turks, as it is known to those who have travelled 
 in the East, are remarkably decorous in their habits, and 
 the privies on the side of these long corridors were 
 separated from each corridor by an ante-room : the door 
 leading into the ante-room was, however, not opposite 
 to that which led to the privies, so that it was impossible, 
 even if the door had been opened, for any one to obtain a 
 view of those places. The Turks use water, and therefore 
 the soil-pipes were very small ; and there were (as it is 
 a part of their religion to wash after using these neces- 
 saries) small water-taps on the left-hand side for the 
 purpose. When the army was at the Barracks in the 
 summer, these taps were, by the soldiers, broken off ; and, 
 in consequence, the supply of water was stopped. When 
 the Barrack was re-opened as an Hospital, no suGBcient 
 pains were taken to repair those pipes, or to secure a flow 
 of water, and the drain-pipes choked up ; and the liquid 
 faeces, the evacuations from those affected with diarrhcsa, 
 filled up the drain-pipes and floated up over the floor, 
 coming into the room in which the privies were, flowing 
 into the ante-room, where the foul matter was more than 
 an inch in depth ; men suffering from diarrhoea who had 
 no slippers nor shoes, as this flood of filth advanced, came 
 less and less near to the privy openings, and nearer and 
 nearer to the door, till, at last, excreta was within a yard of 
 
24 
 
 the ante-room ; and, in consequence, the smell from this 
 place was such as not fully to be described. 
 
 " Connected with this question of overcrowding, we 
 may state that we found a considerable portion of the 
 Barrack Hospital in use as a dep6t. We considered that 
 the presence of so many soldiers and other persons not 
 necessary for the treatment of the sick was a source of 
 danger, from their occupying cubic space within the 
 building and increasing the impurity of the air from the 
 defective privy drainage ; of the truth of which opinion 
 we had subsequently two striking confirmations. 
 
 " All the hospitals had a water-supply. That for the 
 Barrack Hospital was found to be hardly sufficient in 
 amount for so large a number of sick. The water was not 
 so pure as could have been desired, and it was received 
 into tanks within the Barrack square. 
 
 " Speaking generally, we were of opinion that the walls 
 of the wards and corridors were not so clean as they 
 might have been, 
 
 " There were false-floors in the wards which had been 
 used for sleeping-berths for the Turkish soldiers, and 
 which had the bedsteads of the sick placed on them. 
 There were also box-seats along the walls of the wards 
 for the use of the soldiers. We were of opinion that 
 there ought to have been no such enclosed spaces capable 
 of collecting dirt and foul air within the walls, and that 
 it would have been advisable to have removed the whole 
 of this useless woodwork before the sick were put into 
 the wards, had there been time and means for doing so. 
 
 " We directed the frequent use of quicklime- wash for 
 the purpose of cleansing the walls and improving the 
 
25 
 
 atmosphere in the wards and corridors. This we con- 
 sidered one of the most important sanitary precautions 
 which could be adopted. Experience has shown that all 
 jjorous substances, such as the plaster of walls and 
 ceilings, and even woodwork, absorb the emanations pro- 
 ceeding from the bodies and breath of the sick. After a 
 time, the plaster becomes saturated with organic matter, 
 and is a fresh source of impurity to the air of the ward. 
 It hence follows that, unless the walls and ceilings of 
 hospitals be constructed of absolutely non-absorbent 
 materials, it is necessary, at short intervals, to use some 
 application capable of neutralising or destroying the 
 absorbed organic matter. Of all known materials, 
 quicklime-wash is the best and cheapest for this purpose. 
 Its effect in freshening the air in crowded wards and 
 rooms is immediate, and it is one of the most efficacious 
 agents for mitigating the virulence of epidemic disease." 
 
 The following is a summary of the work done during 
 the period of Mr. Wilson's inspectorship about five 
 months : — 
 
 Hand-cart or large basketfuls of filth removed ... 5,114 
 Sewers and latrines flushed (times) ... ... 466 
 
 Carcasses of animals buried .., ... ... 35 
 
 Weekly abstract of Mr. Wilson's Scavenging Diaries. 
 
 Week ending March 24. 
 
 " Thirteen men, on an average, employed in cleansing 
 the surface of the ground in the vicinity of the Barrack 
 Hospital and at Kulali, in removing the refuse, burying 
 animals, &c, During the week there were collected and 
 removed from the vicinity of the Barrack Hospital 202 
 hand-cart or basketfuls of filth, rubbish, and offensive 
 
26 
 
 matter. Two tons of filth were removed at Kulali. The 
 carcasses of fifteen dogs and two horses were buried, and 
 the sewers of the Barrack Hospital were flushed three 
 times. 
 
 Week ending March 31. 
 
 " The cleansing operations were extended to the 
 General Hospital and Palace Hospital this week. The 
 number of men employed was twenty on the average. 
 The ground about both Hospitals, and that portion of the 
 village nearest the Barrack Hospital, was swept clean. A 
 large sewer within the barrack square was opened by 
 order of the Commissioners, and forty-two hand-cartfuls of 
 putrid filth removed from it. The sewers connected with 
 the privies were opened and cleansed, and twenty-six 
 hand-cartfuls of filth removed from tliera. A sewer at the 
 General Hospital was also opened and cleansed, and 
 fourteen hand-cartfuls of filth were removed from it. Water 
 was carried to the flushing tanks, and the sewers at the 
 Barrack Hospital were flushed nineteen times in the 
 course of the week. The total filth and refuse removed 
 from the vicinity of Barrack, General, and Palace 
 Hospitals, during this week, was 354 hand-cart or 
 basketfuls, and the carcasses of seven dead animals were 
 buried. Peat-charcoal was used in the cleansing 
 operations. 
 
 Week ending April 7. 
 
 " The ground about the Barrack, General and Palace 
 Hospitals was swept as usual, also part of the Village of 
 Scutari ; an offensive sewer at the Barrack Hospital was 
 cleansed. The average number of men employed during 
 the week was twenty-five. There were 297 hand-cart or 
 basketfuls of filth removed. Water was carried to the 
 flushing tanks, and the sewers and privies at the Barrack 
 
27 
 
 Hospital were flushed twenty-one times. The Hospital 
 at Kulali was inspected. Peat-charcoal was used for 
 deodorizing the privies. The ground round the Hospital 
 was cleansed and the privies flushed. 
 
 Week ending April 14. 
 
 *' The average number of men employed this week was 
 twenty. The ground about the Hospitals was swept as 
 usual and 215 hand-cart or basketfuls of filth were 
 removed. Water was carried to the flushing tanks, and 
 the sewers at the Barrack Hospital were flushed nineteen 
 times during the week. The carcasses of two horses, a 
 cow, and four dogs were buried. 
 
 Week ending April 21. 
 
 *' Several large foul sewers were opened at the Barrack 
 Hospital, by order of the Commissioners ; peat-charcoal 
 was applied to deodorize their contents, and above 100 
 hand-cartfuls of filth were removed from them. The ground 
 around all the Hospitals cleansed. The filth and refuse 
 collected and removed during the week amounted to 417 
 hand-cart or basketfuls. Water was carried to the 
 flushing tanks, and the sewers and privies at the Barrack 
 Hospital were flushed out twenty-four times. Peat- 
 charcoal was applied to the privies every day. A dead 
 horse was buried. The average number of men employed 
 during the week was 26." 
 
 Similar cleansing works were carried out to the end 
 of the war. 
 
 If this paper does not serve some other purpose than 
 detailing scavenging work done by the Sanitary Commis- 
 sion, it will have been written in vain. It is, however, my 
 intention to show how surface-filth may accumulate under 
 
28 
 
 neglect of scavenging in camps, villages, and hospitals, 
 and how little, comparatively, is required to prevent much 
 misery and loss of life. Take the case of Balaklava, as 
 described by the Times correspondent, as an example ; it 
 was so utterly neglected on its first occupation in the way 
 of scavenging : — 
 
 Balaklava. — "As to the town itself, words could not 
 describe its filth, its horrors, its hospitals, its burials, its 
 dead and dying Turks, its crowded lanes, its noisome 
 sheds, its beastly purlieus, or its decay : all the pictures 
 ever drawn of plague and pestilence, from the work of the 
 inspired writer who chronicled the woes of infidel Egypt, 
 down to the narratives of Boccaccio, De Foe, or Moltke, 
 fall short." 
 
 The harbour of Balaklava was also in a sad state of 
 filth, even as late as April, 1855, The Sanitary Commis- 
 sion, however, arranged with Admiral Boxer to have two 
 flat-bottomed boats manned, to act as scavengers' carts 
 act in towns, — going round, morning and evening, from 
 ship to ship, to receive any refuse, take it outside, and 
 discharge it in the sea into deep water. 
 
 AH carcasses floating in the harbour were also towed out 
 to sea and cut up so as to sink. Cattle steamers were 
 ordered to "bank fires," and discharge cargo; then to fire 
 up, go out to sea five or six miles from shore, clean decks, 
 and come in and wait orders. 
 
 The Sanitary Commission does not pretend to claim 
 credit for all the improvements which took place in the 
 camp from the spring of 1855 to the end of the war, 
 because the example set by them was followed. Lord 
 Raglan interpreted the instructions issued to the Commis- 
 sion liberally, and promptly seconded each report issued by 
 the Commission with a supplemental order that works of 
 cleansing should be carried out over the entire camp. The 
 
29 
 
 French, however, though seeing these improvements in 
 British hospitals and camp, took no corresponding 
 measures to scavenge and cleanse, and suffered for their 
 neglect. 
 
 In the spring of 1855 other great improvements took 
 place : huts had been sent out with warm clothing ; and 
 sheep, as also preserved and potted meats, arrived in 
 abundance. The weather became genial, the mud dried, 
 and roads had been repaired. Some of the huts had, 
 however, been improperly pushed into the hillside (occu- 
 pied by the Highland Brigade), where the strata 
 happened to be clay, and these became a sort of cellar 
 dwelling. The roof being of impervious felt, prevented 
 ventilation. The earth around and beneath the huts 
 became sodden with wet, and, as a consequence, fever 
 prevailed. These huts were ordered to be removed, and 
 were taken down, but only after doing much mischief. 
 
 The Blue-book Report (1883) on the organisation of 
 the Army Hospital Corps in Egypt reveals many blunders 
 of a type as old as the service, such as confusion in 
 transmitting materials for use ; and something worse 
 than confusion in contract supplies, both of materials and 
 of provisions. Can there be no better service in future ? 
 
 War is, no doubt, a blundering, extravagant, and 
 destructive business under any aspect, and the best 
 framed regulations come to be disregarded ; and even 
 where adhered to they may, at times, bring about the 
 worst possible forms of extravagance. The Egyptian 
 report most fully sets forth the confusion into which 
 the regulations fell, and the suffering which resulted. 
 Detachments of the army had, however, to be removed 
 suddenly, and the impedimenta necessary for use could 
 not follow as rapidly. Then provision was made for 
 contingencies which never happened, and, most fortunately 
 
30 
 
 for the men, the war came to an abrupt and unexpected 
 termination. 
 
 Men on the march, we must remember, are loaded like 
 beasts of burthen. They have to march under their im- 
 pedimenta, so that the whole body may be bathed in 
 perspiration, feeding must be irregular, and water may 
 be absent or may be polluted, and then in one night's 
 bivouack the body may be chilled, so that fever to a large 
 proportion of the men must be the result ; and that there 
 must necessarily be great loss of human life in actual 
 war will be self-evident to any one who knows the least 
 possible about the subject, the elements for which no 
 previous calculation which shall be reliable can be made 
 being by far the most destructive. No forethought can 
 fully guard against excessive changes in weather, and 
 excessive wet and excessive cold are far more destructive 
 than any results brought about by fighting. Indeed, the 
 fighting portion of a soldier's life is usually of short 
 duration. It is not in battle that armies are destroyed, 
 but on the field, in camp, and in foul hospitals. 
 
 Where an army in the field is either advancing or 
 retreating, there must be exposure to the elements ; but 
 even under these conditions a properly-organised sanitary 
 staff may be most useful. Temporary sheds may be quickly 
 erected, and some form of bed be provided to raise sick 
 men out of the mud, and not to allow them, as in the 
 Crimea during the first winter, to be laid on the bleak 
 ground on the side of Balaklava Harbour all the night 
 through, rain or fair, frost or snow, without the least 
 shed-protection, until the poor emaciated sick could be 
 taken on board some transport, but in many cases only 
 that the body might be thrown overboard the first thing 
 in the morning. 
 
31 
 
 Any buildings to be used by sick or by broken- 
 down and wounded men should, as taught by Sir John 
 Pringle, at once have the windows removed to prevent 
 injury by polluted air, and any improved apparatus pro- 
 vided for water-supply be brought into use. Pood, in a 
 concentrated and portable form, may now be served out, 
 and the horrible salt junk and ration-pork be in future 
 dispensed with. A spirit - ration is liable to be most 
 injurious in several ways, and should not be used except 
 as a medicine. 
 
 In the question of shoes and clothing, these should 
 be the best in make, and of the best material ; and as 
 to food, England could afford to feed her troops in the 
 field on turtle-soup, if this would reduce the mortality, 
 as men will now ever be the dearest commodity. We 
 have not conscription, neither do I think it is likely to 
 again be available. There had better, then, be no stint in 
 feeding. 
 
 For water-supply, light carts of steel, similar in form 
 to watering-carts in towns, may be of great utility, as 
 one horse or one mule would easily draw to a distance of 
 one or two miles from. 100 to 200 gallons of water, to be 
 served out to the men in the positions occupied. Portable 
 water-filters can also be easily arranged, to be similar in 
 form to the light steel water-carts ; so that water for 
 hospital purposes may be filtered even in its transmission. 
 "Water, which weighs 10 lb. to the gallon, is heavy to 
 carry, and would be carted much more readily. Good 
 water, to be supplied rapidly, will be as useful as good 
 and wholesome food, and a prompt supply of both will 
 ever, in war, be of the utmost importance. 
 
 In the army of Sweden, the men's shoes and feet are 
 specially attended to ; and as Napoleon's remark, that he 
 depended as much upon the legs of his soldiers as upon 
 
32 
 
 their arms, is a truism, it will be self-evident that con- 
 tract boots and shoes, with absorbent soles, ought to 
 be avoided. The old ditty, — " For want of a nail, the 
 shoe was lost ; for want of the shoe, the horse was lost ; 
 and for want of the horse, the man was lost," — is ap- 
 plicable to military operations in actual war. 
 
 Where an army for a time becomes stationary, a 
 sanitary corps will find ample work to do in improving 
 roads, in surface-draining, in scavengering, and in ven- 
 tilating any permanent buildings used as hospitals ; and, 
 if the service will permit of a use of working parties, 
 enormous benefits may be secured to the entire force in 
 the field. Any arrangements which will preserve the 
 men in better health will be for the advantage of the 
 entire force. During the late Russian war with Turkey, 
 some of the correspondents gave descriptions of remov- 
 able filth even in the vicinity of the Emperor's quarters, 
 which indicated clearly that no sanitary staff had been 
 appointed with the Russian army. The lessons which 
 might have been learned from Crimean and Sebastopol 
 experience had been of no avail. 
 
 A skilled sanitary officer will be a man of many 
 expedients springing from close and intelligent observa- 
 tions; and, in his works, he will strive to save labour. 
 Every country has its character impressed on its surface 
 contours, and these the geologist and engineer will read 
 at a glance. Wide and flat areas will indicate, as a rule, 
 a soft subsoil ; a steep gradient will indicate a subsoil of 
 some hard material, such as gravel ; rock will generally 
 show above the surface; where there are mountains, 
 there will usually be at the base mounds of material, — 
 particles weathered from the rock and admirably suited 
 for road-forming, as it may be excavated and sorted so 
 as to save the labour of quarrying and breaking for road- 
 
33 
 
 making. This was the case in the Crimea on the margin 
 of the road from Balaklava to the front. This road, the 
 first winter, was (in the lower part of the valley) by the 
 wheel traffic worn into almost impassable mud. To 
 repair this road we found the Eoyal Engineers were 
 blasting rock at a distance to break into road material, 
 when at the foot of the mountain, and close to the road, 
 there were hundreds, if not -thousands, of tons of stone 
 ready broken — that is, the "talus" weathered and 
 washed down during untold years from the mountain. 
 Much of this material the Sanitary Commission caused 
 to be removed to cover the graves of the soldiers and 
 camp-followers buried at the head of the harbour. If 
 this material had been used from the first to preserve 
 the road to the front in order, there need have been no 
 railway, much suflFering would have been prevented, and 
 many lives have been saved. How the roads and the 
 camping grounds in the Crimea came to be in the sad 
 condition they were in is, even now, to me a mystery. 
 Let any one read the graphic letters of the Times 
 correspondent, as quoted in this paper, to see what 
 was their condition. Ammunition - wagons broke 
 down, commissariat carts broke down, horses broke 
 down, and men broke down in this terrible mud. 
 Horses lay down in it, were frozen to the ground, and 
 broke their backs in attempting to rise out of it. 
 
 In the Crimea there were wells and natural springs of 
 water which were not made the best use of, either for 
 the men or for the horses. The wells were broken down, 
 and the water from the springs, when not actually drawn 
 for use, flowed to waste. All wells, in future, should be 
 under the charge of an orderly. All springs shoiald be 
 impounded, and watering-troughs for horses should be 
 filled separately, and the approaches be paved to prevent 
 
34 
 
 the ground being trampled into deep mud, as I saw it.* A 
 sanitary engineer officer will know something of meteor- 
 ology ; and where there are streams or rivers, he will see 
 at a glance if these are liable to floods (as each river 
 writes its own history on its margins), and will take care 
 that troops and stores, when stationary for any period, 
 are placed out of the flood-lines. This was not done in 
 the Crimea above Balaklava, and resulted in the loss of 
 stores and of human lives also. Even the Sardinian 
 engineers committed this blunder. 
 
 A railway was constructed from Balaklava to the camp, 
 which was certainly used for some purposes. But, at the 
 time this railway was in progress, there were hundreds of 
 mules and horses standing idle in the mud at the head 
 of the harbour, without nosebags, and hundreds more at 
 Sinope, on the opposite side of the Black Sea. These 
 animals were subsequently used by the Land Transport 
 Corps, when it had been organised under General McMur- 
 doch. The railway was ridiculed in the Crimea. 
 
 We learn that materials to construct railways had been 
 shipped with the expedition to Egypt, but that, as usual, 
 things were wrongly placed — sleepers were below the 
 rails; but as neither sleepers nor rails were required, 
 this did not much matter. This idea of railway-making 
 seems to have grown into a mania with our generals. 
 Materials, we know, were sent out to the Coast of Africa, 
 at a cost, it was said, of about £90,000, to make a railway 
 during the Ashantee War. These materials, however. 
 
 * The Commission, in inspecting the camp, pointed out to certain 
 Engineer officers the absolute necessity there was to construct dams to 
 impound the spring-water, and to arrange for drawing water without 
 wasting and slopping so as to cause mud. Work of this sort was done 
 S!ubsequently. 
 
35 
 
 were never used for the purposes intended. If future 
 wars are to be concentrated on one spot, and armies are 
 to be stationary, as before Troy, for months and years, 
 temporary railways may be useful, but not otherwise. 
 
 In future wars it is admitted that picks and spades 
 may require to be used as much, if not even more, than 
 rifles. All officers will, therefore, have to learn something 
 of engineering ; and if soldiers can use pick and spade to 
 provide earthwork shelter from rifle-bullets, they may 
 also use these implements for sanitary purposes. A 
 working army will be more contented if they find that 
 their labour tends to their safety and comfort. Idleness 
 is an incentive to vice, and leads to insubordination. 
 
 A modern army will be a very different body of men to 
 those forming the Peninsular army under Wellington, 
 and must be treated very differently. Elogging is for 
 ever done with, and it is most disgraceful to have any 
 attempt at its renewal. 
 
 War ever has been, and ever will be, a destructive, 
 wasteful, and rough process ; and he is the best general 
 who moves his army most rapidly with the least loss of 
 men, and with the least cost in material. And to accom- 
 plish these ends there must be aptitude and intelligence, 
 not only in the commander-in-chief, but also in his gene- 
 rals. They must be ready to turn everything available 
 at once to account. It will not do to work by routine, 
 regulations, and requisitions written out on "foolscap 
 paper, half margin, one side only." 
 
 I suppose the General Orders of the Duke of Welling- 
 ton are considered good examples; but the Duke, in the 
 Peninsula, ever did something more than unceasingly 
 refer even to his own General Orders. His personal 
 observation was incessant, his perceptions rapid ; and 
 
 c 2 
 
36 
 
 consequently his instructions, outside any order-book, 
 were practical, being suited to the conditions and 
 requirements of place and time. Take the instances 
 here quoted : — 
 
 CiRCULAE, Letter. 
 " To the Officer Commanding. 
 
 "Frenda, 2%thNov.,\%\2. 
 
 " I have ordered the army into cantonments. . . . 
 The discipline of every army, after a long and active 
 campaign, becomes in some degree relaxed, and requires 
 the utmost attention on the part of the Generals and 
 Officers to bring it back to the state in which it ought to 
 be for service; but I am concerned to have to observe, 
 that the army under my command has fallen off in this 
 respect, in the late campaign, to a greater degree than 
 any army with which I have ever served, or of which 
 I have ever read. Yet this army has met with no 
 disaster ; it has suffered no privations which but trifling 
 attention on the part of the Officers could not have 
 prevented. . . ." 
 
 This letter is full and severe, and must have wakened 
 up the officers to fuller attention to their duties. But 
 the Duke points to minute details worthy of adoption 
 now, as, for instance : — 
 
 " In regard to the food of the soldiers, I have frequently 
 observed and lamented in the late campaign the facility 
 and celerity with which the French soldiers cooked in 
 comparison with those of our army " 
 
 Again, as to water-supply and cooking : — " Certain men 
 of each company should be appointed to cut and bring in 
 
37 
 
 wood, others to fetch water, and others to get the meat 
 and vegetables to be cooked ; and it would soon be found, 
 if this practice were daily enforced, and a particular hour 
 for seeing their dinners, and for the men dining, named, 
 as it ought to be, equally as for the parade, that cooking 
 would be more regular and better." 
 
 The suggestions of the great Duke point to something 
 to be done by commanders of regiments outside of cut-and- 
 dried formal regulations. But with the Duke's General 
 Orders and letters to study and learn, how did our army 
 in the Crimea, 1854-55, fare before Sebastopol? The 
 men were encamped in a bare and bleak country, without 
 means to make fires for cooking, with salt beef and pork, 
 raw coffee berries and ration rum, undue exposure to the 
 elements, and no change of clothing. Officers and men 
 became emaciated, their clothing swarming with vermin, 
 and yet, at a few miles distant, in the harbour of 
 Balaklava there was the finest transport fleet of steamers 
 in existence available, with the richest country in the 
 world open to be drawn upon, and yet, in that first dread 
 winter, November 1854 to April 1855 — six months — out of 
 31,333 men, some 10,283 died of disease — one out of three, 
 nearly. The officers did not superintend cooking, they 
 had nothing to cook with, there was not an organised 
 water-supply service. Some colonels of regiments did 
 more than others, but, as the results show, there was 
 terrible mismanagement somewhere. We know that in 
 the spring of 1855 the Government of the day sent out 
 two Commissions to inquire and report as to the cause 
 of the terrible disasters. And some of us know the sort 
 of reception their reports had accorded. 
 
 I think it may be gathered from my remarks that 
 the purport of this paper is to show that to preserve an 
 army in health, either in hospital, in barracks, or in the 
 
38 
 
 fleldj will, as in the past, so in the future, require active 
 intervention on the part of the Commander-in-Chief, of 
 the Generals, and of the Colonels and officers, outside 
 any printed regulations, however full and ample. As the 
 Duke of Wellington explained on one occasion to the 
 House of Lords : that martial law was no law, other than 
 the will of the Commander-in-Chief; so, in future, the 
 Commander-in-Chief, during a state of war, must have the 
 power to relax any published General Order or regulation, 
 if necessary to make better provisions for the army. A 
 sanitary staff, as provided for by the late Lord Herbert, 
 distinct and separate from both Commissariat and Army 
 Medical Departments, should be with and part of the 
 army, under the direct control of the Commander-in- 
 Chief, who should have power to order and expend in this 
 service as he might think necessary. That is, that any 
 amount of extraneous labour might be provided and paid 
 for which he might deem necessary, and the country in 
 which he might be could supply. 
 
 The army in the Crimea was most materially benefited 
 by voluntary efforts from home, by relations, and by the 
 general public shipping out warm clothing, by Florence 
 Nightingale and her lady nursing, by distribution of food 
 suited to sick men in hospital, and by extra voluntary 
 furnishing of medical comforts ; then there were the works 
 and labours of the Army Sanitary Commission. The 
 expenditures by all these parties were, however, mere 
 fractions in the gross costs of the war, which were some 
 hundred millions sterling. The total money value of all 
 the extra distributions of clothing, food, nursing, and 
 sanitary appliance did not, I suppose, reach half a million 
 sterling ; so that, if these entire extras had been provided 
 for, it would only have amounted to about half a week's 
 expenditure of the cost of the war. 
 
39 
 
 Sanitary science, in its fulness, is a science of modern 
 growth. There must, however, have been wise men and 
 generals in olden times, and the great generals of an- 
 tiquity must have been good sanitarians, or Alexander 
 the Great could not have marched an army of Greeks 
 through Asia Minor on to India and back. Hannibal 
 could not have crossed from Africa to Italy, neither could 
 the emperors of Rome have made the conquests they 
 accomplished. 
 
 I confess that it put a blush on my face when I left 
 the Crimea, and passed from Sinope on to Trebizond in 
 Asia Minor, knowing and feeling what had occurred to 
 the British army in the Crimea, and then to reflect that 
 it was on through this country I then looked upon, with 
 vride and rapid rivers, that Alexander marched his army 
 hundreds of miles, crossing mountain ranges in mid- 
 winter breast-deep in snow — as it is recorded, — then on 
 to India, fighting great battles, and returning safely ; 
 whilst England — the richest nation in the world — had, 
 in a few months of the first winter, lost the finest army 
 that ever left her shores, and that within seven miles 
 of the most complete base of operations any general ever 
 had established for him. It did not need much reflection 
 to learn that there must have been many sad deficiencies 
 in our army arrangements for the field. As the Army 
 Sanitary Commission have fully set forth in their Report, 
 there were, on the Bosphorus, dirty hospitals exposed to 
 sewer air, malaria; a dirty and polluted harbour at 
 Balaklava, and in the Crimea absence of proper roads ; no 
 scavenging ; and a neglected water-supply in the camp. 
 
 Howard drew attention to the neglected state of 
 prisons in his day; and now, in consequence of his 
 exposures, these places have been improved until the 
 safest place for health is in a British prison. The late 
 
40 
 
 Lord Herbert drew attention, in the Barrack and Hos- 
 pital Reports, to the state of barracks and military 
 hospitals in Great Britain, and both barracks and hos- 
 pitals have been improved, though by no means, in all 
 cases, to a state so perfect as prisons. The urine-tub of 
 the night is, however, no longer the only ablution-tub of 
 the morning ; and men in barracks may have their meat 
 cooked other than by boiling; and the Herbert and 
 Netley Hospitals are improved examples of hospital 
 accommodation. Let us hope that the science of Hygiene 
 for Armies in the Field will meet with due and equal 
 improvements. 
 
 If Professor De Chaumont is consulted, as he ought to 
 be, or whoever is at the head of the School of Military 
 Hygiene, there will not be the breaks down now com- 
 plained of. 
 
 In touching on this question of army hygiene, even at 
 this day, I know that I, as an outsider, am venturing on 
 disputed ground. But that enormous improvement took 
 place in the British army in the Crimea, from some cause 
 or causes, after the advent of the Sanitary Commission 
 cannot be disputed; but, ofi&cially, the credit has never 
 been accorded to that Commission, The one great fact 
 was, however, made unmistakable — namely, that from the 
 spring of 1855 the health and condition of the British army 
 began to improve, until, by the autumn of that year, the 
 entire force in the field was in a state of health, and was 
 under a less rate of mortality than when in barracks at 
 home ; and this continued until the close of the war. The 
 [French, the Sardinians, and the Bussian soldiers, how- 
 ever, knew of no such abatement of camp and hospital 
 sickness, the destruction of life having gone on up to the 
 close of the war. Details may be found in the Reports, 
 as also in the Army Returns of the several nations, and 
 
41 
 
 in a pamphlet by SurgeoQ-General T. Longmore, entitled 
 "The Sanitary Contrasts of the British and French 
 Armies during the Crimean War," published 1883, as 
 well as in other Reports and papers. 
 
 Surgeon-General Longmore (page 19) states : — " The 
 root of the evils which led to the lamentable condition of 
 the British troops in the hospitals no less than in the 
 camps, during the first part of the war, was, undoubtedly, 
 the neglect of the old maxim, ' to be prepared for war in 
 time of peace.' 
 
 " This neglect existed in all departments of the army, 
 in none more so than in the medical department. Nothing 
 was ready for a state of war." 
 
 The contrasts between the earliest and later states of 
 health of the British troops is shown by returns as 
 under : — 
 
 First winter, 1854-55, strength of force (average) 31,333. 
 Losses from disease from November, 1854, to April, 1855, 
 10,283 ; second winter, 1855-56, strength of force, 50,166. 
 Losses from disease, from November, 1855, and April, 
 1856, 551. 
 
 The total number of deaths from disease during the 
 whole campaign was 16,297. Out of each 100 of this 
 total number of deaths, 63 occurred during the first 
 winter, and 3'38 per 100 the second winter. 
 
 Without giving the full details furnished by Surgeon- 
 General Longmore, I may state, from page 17-18 : the 
 British Army, in the first winter, had 2,286 deaths from 
 fevers of all kinds ; second winter reduced to 129. Under 
 typhus, from 164 to 16. Amongst the French troops, 90 
 the first winter, 10,278 the second winter. The French 
 had no sanitary commission, the hospitals remained 
 unscavenged, unventilated, and their hospital drains 
 
42 
 
 unimproved, the result being excessive overcrowdingj 
 until men and doctors alike perished ; the British 
 hospitals being absolutely free from typhus cases. Taking 
 these results into account. Surgeon- General Longmore 
 states : " It is well that the practical lessons in sanitary 
 science afforded by the events of the Crimean War should 
 not be allowed to pass out of mind." In these remarks I 
 most cordially agree. 
 
 This paper ought to teach one simple lesson, — namely, 
 that scavenging should be provided for, and practised 
 whenever an army is in camp. If buildings are occupied 
 for hospital or barrack purposes, their condition should at 
 once be brought under the attention and operation of the 
 engineer sanitary ofl&cer, that he may see to any sewering, 
 draining, privy accommodation, water-supply, and, above 
 all, ventilation ; as where buildings are occupied there 
 will be a liability to crowd them, and if there is not ade- 
 quate ventilation, foul air will kill more certainly and 
 swiftly than the elements. If the great buildings on the 
 Bosphorus which were used as British hospitals had been 
 dealt with on their first occupation as they were dealt 
 with in the spring of the second year of occupation, very 
 many lives would have been saved. 
 
 With respect to ventilation of buildings, there is a 
 prevailing fear of outside air, especially if this is cold. 
 In civil life some people sleep in rooms with fireplace flue 
 closed, and doors and windows tight shut up ; others, 
 more sensible, — even delicate ladies — never have their 
 bedroom window closed, frost or snow, fog or rain, all 
 through the year, as they know that lung-tainted air 
 within a room is far worse for health than any outside air 
 can be. 
 
 Extravagance in estimates and in expenditure should 
 not be tolerated : but there may be two definitions of 
 
43 
 
 extravagance. A British soldier has a certain money- 
 value, which is high as compared with the value in some 
 Continental armies ; he ought, therefore, to be cared for 
 and provided for so as to preserve this value to the 
 purposes of the nation. A soldier, to be efficient, must 
 be sound " wind and limb," or he can neither march nor 
 fight when required. In the matters of shoes and 
 clothing, if cheap shoes or boots cripple the men's feet, 
 they are very dear, and it will be cheaper to have the best- 
 made and best-fitting shoes at double the price of the 
 bad and cheap ones. The same may be said of clothes, 
 of food, and of hospital and barrack accommodation. 
 Soldiers and sailors ought to be as much cared for as 
 criminals, and when the Government has attained to this 
 knowledge, and will develope it in practice, the lives of 
 our soldiers and sailors will also be developed to their 
 utmost capacity, and, according to all experience, the 
 results will warrant the money expenditure and extra 
 care. 
 
 The following extracts will show that, until very recently, 
 there was not much comfort nor safety to health for 
 soldiers in barracks. If the evidence were not so 
 unmistakably clear and distinct, few people would have 
 credited the fact that the urine-tub of the night was the 
 ablution-tub in the morning. But so it was, and it is 
 some satisfaction to know that this abomination has been 
 done away with. 
 
 Barrack - rooms were also overcrowded and under- 
 ventilated. Regulation space was 450 cubic feet per 
 man, with little ventilation ; 1,000 feet per man, with 
 abundant ventilation, is provided in cells for prisoners. 
 
u 
 
 Bxtracts from the Report of the Commissioners ap- 
 pointed to inquire mto the Regulations affecting the 
 Sanitary Condition of the Army, the Organisation of 
 Military Hospitals, and the Treatment of the Sick 
 and Wounded. Evidence of Major- General Sir 
 E. AiEET, K.O.B., 2mh May, 1857. 
 
 Question 1564. — Report of Barrack Committee, Ser- 
 geant Brown is asked : — 
 " Have you often gone into the men's rooms in the 
 morning before the windows were open ? Yes. 
 
 " In what state did you find the atmosphere ? In a 
 very thick and nasty state, especially if I came in out of 
 fresh air. 
 
 " If I went in out of my own rooms sometimes, 
 I could not bear it till I had ordered the windows to be 
 opened to make a draught. 
 
 " I have often retired to the passage, and called to the 
 orderly man to open the windows. The air was offensive, 
 both from the men's breath, and from the urine-tubs in 
 the room." 
 
 3060. How are the men's rations cooked ? A company 
 is generally provided with two boilers, in one of which 
 the soldiers boil their meat, and in the other they 
 boil their potatoes ; they have nothing else. A man goes 
 on with it from the day that he enlists till he is discharged. 
 He lives upon boiled meat for twenty-one years. 
 
 3061. Do you believe that is distasteful to the men ? 
 I am persuaded, having commanded a regiment for 
 fourteen years, that the men are perfectly sickened 
 with it. 
 
 3062. Has it come under your notice that they do not 
 consume the rations ? Constantly. I have seen the 
 
45 
 
 meat, after it has been boiled down to shreds, thrown 
 away — the men would not look at it. 
 
 3063. Do you think that that arises from the ration 
 being larger than is necessary for the men's subsistence ? 
 The meat ration is insufficient. I do not think that the 
 soldier gets enough. I think that three-quarters of a 
 pound of meat, including bone, is quite insufficient for 
 the soldier. 
 
 3064. Even if you had a sufficient weight of meat, do 
 you tliink that it could be made more available than it is 
 now, and more agreeable to the soldier, if he had better 
 means of cooking ? Certainly, if the soldiers had the 
 means of roasting, baking, and frying their meat. Inde- 
 pendently of the diversity of diet, which T am very much 
 in favour of, I am sure it would be much more tasteful to 
 the soldier. 
 
 7S ^ ¥p ^ ^ 
 
 3073. Mr. Staflfbrd : How would you improve the 
 cooking ? I should give them the means of baking, the 
 means of roasting, and the means of frying ; they should 
 have roasting grates, ovens, and frying-pans. I should 
 have in every barracks a sort of small batterie, so that 
 the men might have stew-holes, and fry upon them — the 
 same as they do in the French army. 
 
 3074. Would that add very much to the expense ? 
 No ; very little. 
 
 3075. Would you not gain it in the fuel ? Yes ; they 
 have them in the French barracks, and the men are 
 using their stew-pans aU day long ; they make stews — 
 they stew vegetables — and improve their diet, and 
 diversify it very much. 
 
 3076. If you give them this increased ration, you must 
 have an increased stoppage, must you not ? Not actually 
 
46 
 
 out of the soldier's pocket — perhaps less than he now 
 pays. At present it is done by messes. One man from 
 the mess goes out with a non-commissioned ofB.cer with 
 the men's mess money, which generally amounts to from 
 about 2^d. to 3d. a day in excess of what he pays for his 
 regular ration; they go out and purchase their coffee, 
 sugar, pepper, salt, potatoes, or anything else they can get. 
 
 3077. Is that compulsory upon them ? Yes ; that is, 
 the commanding officer is allowed to expend a certain 
 sum upon the dieting of his men, and he apportions that 
 as he chooses. 
 
 3078. It is not to exceed a certain sum ? No. 
 
 3079. 7d. or 8d. ? It comes generally to S^d. a day. 
 
 3080. Including washing ? Yes ; one halfpenny is 
 allowed for that. The Guards pay more, as they hare 
 extra clothes. 
 
 3081. You conceive that an ample ration for three 
 meals, with variety, would not cost the soldier more than 
 he is now compelled to pay in the stoppage for his ration 
 and the stoppage for his additional messing ? Certainly 
 
 not. 
 
 * * * * * 
 
 3158. Sir H. K. Storks : The lavatories are very bad in 
 the barracks, are they not ? Very bad indeed. 
 
 3159. President : They have urine-tubs in the barrack- 
 room, and they are very offensive, are they not ? Very 
 bad. 
 
 3160. Sir H. K. Storks : AVhat means have the men of 
 making water at night ? They have urine-tubs. 
 
 3161. Do you recollect an order being issued, calling 
 the attention of the commanding officers to men washing 
 themselves in the urine-tubs ? It was the general practice 
 throughout the army ; they had no other means. 
 
47 
 
 3162. Since when ? Since I have been in the Army. 
 
 3163. President : What are those urine-tubs made of ? 
 Of wood. 
 
 3164. Do not they necessarily stink ? Most offensively. 
 
 3165. "Why do they not give them chamber-pots ? It 
 is not one of the barrack utensils ; it is not barrack 
 furniture. There will be no difficulty in having the same 
 pewter chamber-pots as they have in the hospitals, I 
 think that every barrack ought to be provided with proper 
 utensils. 
 
 3166. Mr. Alexander : The privies are nothing more 
 than cesspools ? They are abominable, and extremely 
 offensive. The system was to empty them by contract ; 
 but latterly it is improved very much indeed, because it 
 is all bought for maniire. 
 
 Is it to be wondered at that soldiers died under these 
 defective arrangements at more than twice the rate due 
 to life under more healthy conditions ? 
 
 In all new barracks there are improved latrines for the 
 men, proper urinals for both day and night uses, and 
 water-closets for the officers. Barracks and hospitals, both 
 in Great Britain and abroad, have been improved; but in 
 certain cases new barracks and new hospitals on fresh sites 
 are required, as safe and satisfactory improvements are 
 not always possible, — as., for instance, in Dublin. The 
 excuse for not building new barracks is a plea of cost. 
 If, however, an estimate were put forward, and were 
 vigorously supported with truthful and legitimate reasons, 
 showing that sickness would be lessened, and deaths 
 reduced to an extent producing both a direct and indirect 
 
48 
 
 saving of money, more than an equivalent to the interest 
 on the capital expended, I think the most rigid economist 
 in the House of Commons would give way. 
 
 Since the Crimean War great improvements have been 
 made in Army Hygiene, — as, in improved hospitals, in 
 improved ambulance arrangements, and in sanitation 
 generally. 
 
 Enormous improvements have also been made in British 
 India, and at all stations within the tropics, — as, in the 
 West Indian Islands, at Singapore, and at Hong Kong. 
 
 Her Majesty the Queen has also established the Royal 
 Red Cross decoration, so that sanitary nursing service wiU 
 become popular. 
 
 Miss Florence Nightingale has published her " Notes on 
 Hospital Construction," and "Notes on Nursing," which 
 will prevent the mistakes and mal-arrangements of former 
 periods, — as, hospitals on the Pavilion Plan, which she 
 advocates, will alone be erected in the future : and, where 
 space can be obtained, only of one story in height, so as 
 to secure both window and roof-ridge ventilation. 
 
 To show that the work of the British Army Sanitary 
 Commissioners has met with approval at home and abroad, 
 and also with imitation in America, the following extracts 
 are given from the " History of the United States Sanitary 
 Commission," from Kinglake's " History of the Invasion 
 of the Crimea," and also from a paper by J. N. RadcliflFe, 
 M.R.C.S. :— 
 
Copy of a Letter from the UNITED STATES SANITAET 
 COMMISSION.'— 
 
 "Historical Bureatt, 21, West Twelfth Street, 
 " New York, Mwreh 27, 1867. 
 
 " My deae Sie, — I have the pleasure to transmit herewith a copy 
 of the ' History of the United States Sanitary Commission : being 
 the General Report of its Work during the "War of the Rebellion'; 
 and beg to ask your acceptance of the same in the name of the 
 Commission and in recognition of your claim upon our grateful 
 regard as a distinguished friend of our National cause. 
 
 " With assurances of the highest esteem, — I am, dear Sir, very 
 truly your obedient servant, 
 
 (Signed) " JNO. S. BLATCHPORD, 
 
 " General Secreta/ry. 
 
 " Robert Eawlinson, C.E., Governmeiit Act Office, 
 
 " No. 8, Kichmond Terrace, Whitehall, London, England." 
 
 D 
 
50 
 
 Extract from the HISTOEY OF THE UNITED STATES 
 SANITARY COMMISSION: BEING THE GENERAL 
 REPORT OF ITS WORK DURING THE WAR OF 
 THE REBELLION. By Chaeles J. Stille. Pages 26 to 33. 
 Published by J. B. Lippincott Sf Go., Philadelphia, 1866. 
 
 The American Government had no official Army Sanitary 
 Commission when the war commenced. Neither^ indeed, did the 
 Government ever establish such a commission, but after the disas- 
 trous battle of Bull-run a Civil Sanitary Commission was formed, 
 as may be seen, on the lines of the British Army Sanitary Commis- 
 sion, and was supported throughout by voluntary subscriptions to 
 the extent of millions of pounds sterling. 
 
 Abstract from the Report by the Secretaries to the Civil Sanitary 
 
 Commission. 
 
 The President (Lincoln) and General (Scott) had repudiated the 
 idea of an official Army Sanitary Commission, which repudiation 
 brought the Civil Sanitary Commission into existence. 
 
 " This strange infatuation pervaded all ranks of the people j 
 Apprehen- and as it seemed a foregone conclusion that discipline, 
 r°°th^^* such as that which existed in other armies, could not be 
 result. enforced in ours, of course little effort was made to 
 
 introduce it among the volunteers. The effect of this absurd theory 
 soon became apparent. The ignorance of the officers concerning 
 their duties was manifest at the very first test. The injury to the 
 health of the troops, and therefore to their morale and efficiency, 
 mainly due to the ignorance, incompetency, and carelessness of 
 their officers on their arrival at Washington, is now known to have 
 been absolutely disastrous. Experienced military officers looked 
 with dismay on the prospect of making an active campaign with 
 such troops, while those who were more sanguine, only because 
 they were more ignorant, could not fail to be oppressed with 
 an anxious fear lest the best strength of the nation should be 
 uselessly sacrificed. But before the actual shock of arms took 
 place, leading minds throughout the country, who saw most 
 
51 
 
 clearly the deep-seated cause of the evil, were thoroughly studying 
 the whole subject, and anxiously searching for a remedy. 
 
 " At that time the experience of the Crimean War was fresh in 
 the memory of all. That experience was a complete chapter by 
 Experience itself on sanitary science. It taught the great truth that 
 Crimean *^® ' Cause of humanity was identified with the strength 
 "War. of armies.* We were left to no vague conjecture as to 
 
 the causes which produced the fearful mortality among the allied 
 troops before Sebastopol — a mortality which, as has been truly 
 said, has never been equalled since the hosts of Sennacherib fell in 
 a single night. Public opinion in England, indignant and horror- 
 stricken at this frightful result, long before the war closed, called 
 loudly for investigation and remedy. The result has been a con- 
 tribution of inestimable value to our knowledge of everything 
 which concerns the vital questions of the health, comfort, and 
 efficiency of armies. The results of these investigations, both in 
 regard to the causes of the evil and the wonderful efficiency of the 
 remedies which were applied for its removal, had been recently 
 given to the world in Parliamentary reports, in the works of pro- 
 fessional men, and especially in the invaluable testimony of Miss 
 Nightingale ; so that all the conditions of the problem were per- 
 fectly known, and its solution could be arrived at with the exact- 
 ness and certainty of a scientific demonstration. The description 
 of the causes which had produced a mortality in the British army 
 so fearful that, had it continued at the rate which was maintained 
 in January, 1855, it would in ten months have destroyed every man 
 in it, was so accurate, and bore so wonderful a resemblance to evils 
 already known to exist in our condition, that the lesson seemed 
 prepared specially for our warning and benefit. Earnest men who 
 loved their country, and who had some humane consideration for the 
 health and lives of those who were defending it, determined that 
 something should be done to avoid a similar catastrophe here. 
 They knew that the British people had been able only to investigate 
 and deplore the causes which had led to so direful a result. They 
 felt that here a wise, thorough, and persistent effi^rt should be made 
 at the outset of the war, guided by the Crimean experience, to 
 forestal the insidious march of those diseases which, if unchecked, 
 would inevitably overwhelm our army and, with it, our country in 
 ruin. 
 
 D 2 
 
52 
 
 " The experience of the Crimean War taught those who consulted 
 it the nature of the terrible dangers which encompass all armies 
 "What was outside of the battle-field, the possibility of mitigating 
 that e^J- *^®™^ ^^^ ^^^ sanitary measures which, in strict accord- 
 rienoe. ance with the general laws of health, should be adopted 
 to provide for the safety of an army. But it taught many other 
 things, which were far from encouraging to the zeal of those who 
 suppose that the ease of applying a remedy has in actual practice 
 any due relation to the undisputed magnitude of the evil to be 
 abated. They found, in the first place, a certain inflexible military 
 routine in the management of everything connected with the 
 administration of the Medical Department of an army, the preserva- 
 tion of which in all its integrity was considered as essential to the 
 very existence of the troops who might be perishing through its 
 adherence to regulation and precedent, as any part of the military 
 system. They found, too, that the medical stafi", however much it 
 might deplore the evil, was helpless to efiect a remedy, for under 
 the existing system it had no power to initiate, order, and execute 
 sanitary works. While the evidence was overwhelming that the 
 plainest teachings of modern science had been neglected, not only 
 in the construction of hospitals, but in the adoption of suitable 
 precautionary measures to insure the health and comfort of the 
 soldier in camp, it was also evident that the natural jealousy which 
 is the result of a certain esprit de corps in any thoroughly organised 
 administrative body, always manifests itself with a most determined 
 spirit against any plans which seek to infuse new life into that body 
 even through the regular channels, and especially against any extra 
 official effort to render its machinery less cumbrous and more 
 efficient. While the experience of the Crimea, therefore, clearly 
 proved the cause of the evil and the nature of the remedy, it no 
 less clearly proved the practical difficulty of applying that remedy 
 outside and independent of Government agencies, and the almost 
 insurmountable obstacles of transferring to such agencies a portion 
 of that zeal and enthusiasm for the welfare of the soldier which, in 
 modern times at least, to the credit of the civilisation of the age 
 let it be said, is the strongest and most characteristic impulse of 
 the people towards an army which is fighting its battles. Still, the 
 success of Miss Nightingale's efforts in the hospitals at Scutari, 
 and the astonishing results which were produced in the improve- 
 
53 
 
 ment of the health of the troops by the adoption of the measures 
 recommended and enforced by the Government Sanitary Commis- 
 sion which was sent out to the Crimea in February, 1855, led those 
 to persevere who clearly saw the nature of the difficult task before 
 them. Thus encouraged, they sought to initiate some methods 
 which should anticipate and guard against, and not follow, as in 
 the Crimea, the fearful havoc caused by the neglect of sanitary 
 laws. 
 
 " The importance, therefore, of rousing public opinion to the 
 absolute necessity of forcing upon the Government 
 ence of such *^^ adoption of precautionary measures to insure 
 teaohiBgsin the lives and safety of our troops in camps, in 
 BimUar barracks, and in hospitals, was the practical lesson 
 
 measures which was taught by the Crimean experience to those 
 who had studied it with a view of rendering it 
 applicable to our needs. Some of these earnest - minded men 
 became afterwards active members of the United States Sanitary 
 Commission, but that organisation bore no resemblance whatever, 
 except in name, to the body which was sent out by the British 
 Government in February, 1855. The latter was invested with 
 plenary powers to do anything and everything which could im- 
 prove the sanitary condition of the troops, whether in the camps 
 or the hospitals. It will appear hereafter that our Sanitary Com- 
 mission in its organisation, methods, operations, and results, 
 was wholly original and peculiarly American in its characteristics. 
 The occasion of its existence was, unquestionably, an emergency 
 which might prove, and did prove in many respects, similar to that 
 which occurred in the Crimean War, but that war only taught the 
 necessity of precautionary measures, and shed no light whatever 
 upon the practical question how far it was possible to adapt those 
 measures to our American system. Indeed, it will be seen, as we 
 proceed, how our peculiar condition and circumstances embarrassed 
 the action of those among us who sought to base the care of our 
 army upon a system deduced from the positive results of experi- 
 ence. It will, perhaps, be found that it was almost as difficult to 
 make our Government believe in the necessity of taking such pre- 
 cautionary measures as it became afterwards to convince those 
 whose immediate duty it was to enforce them, that supplemental 
 
54 
 
 aid and tte advice of an unofficial organisation might be so giren 
 as not to impair military efficiency and discipline. 
 
 " The powers conferred on the British Sanitary Commission were 
 wholly unexampled in the history of the administrative system of 
 Great Britain. The results of its labours have been^ on the whole. 
 The func- perhaps the grandest contribution ever made by science 
 taons of the ^q ^Jjq practical art of preserving health among men 
 Sanitary required to live together in large masses. Its existence 
 Commission, ^g^g ^^g^ ^^ ^^ have Said, to the horror which was 
 
 inspired by the accounts of the perishing army before Sebastopol, 
 and to the wide-spread conviction that this result was attributable 
 to causes which might be removed by wise sanitary measures. 
 Three gentlemen, each distinguished for his practical acquaintance 
 with the laws of hygiene and the principles of sanitary science — 
 Dr. Sutherland, Dr. Hector Gavin, and Mr. Eawlinson — were 
 appointed in February, 1855, by the Minister of War, Lord 
 Panmure, Commissioners to proceed at once to the Crimea 
 (subsequently, on the death of Dr. Gavin, Dr. Milroy was appointed), 
 and there, on the spot, to reform the abuses to which the evil was 
 due. They were told expressly, in the letter which announced 
 their appointment and defined their duties, that in the prosecution 
 of their labours they were not to be content with merely issuing an 
 order, but that 'they should see instantly that the work they 
 ordered was commenced, and superintend it day by day until it 
 was finished. They were further directed to use all diligence in 
 ascertaining whether any and what removable causes of disease 
 connected with the camps and hospitals existed, to represent such 
 defects to the military and naval authorities, to issue instructions 
 for their removal, and to see that their instructions were complied 
 with.' Thus it will be seen that, in all matters within the scope 
 of their instructions, they were supreme, overriding all considera- 
 tions of rank, and introducing for the first time into the English 
 system the practical heresy of breaking through all the solemn 
 formalities of regulation, precedent, and red-tape, upon the strict 
 observance of which the safety of the country — to the mind trained 
 in official habits — absolutely depends. The result justified this 
 extraordinary — almost revolutionary — departure from the ordinary 
 methods of administration j the rescue of thousands from impending 
 death will be its justification in history, while perhaps the stoutest 
 
55 
 
 defender of routine and precedent will now admit that this was one 
 of the emergencies of that necessity which knows no law. No such 
 extraordinary powers as were conferred upon these Commissioners, 
 and fully exercised by them when it was necessary to accomplish 
 their object, were ever granted by the Government of the United 
 States to any body of men outside of the regular military organisa- 
 tion ; but perhapSj many will recall periods during the war when 
 such a despotic authority, wisely exercised by such a Commission 
 as that sent to the Crimea, would have saved thousands of lives to 
 the country aiud millions of dollars to its treasury." 
 
 Extract from " THE INVASION OP THE CRIMEA," by 
 A. W. KiNGLAKE. Pages 440 to 449. 
 
 " With the same righteous object at heart, and at nearly the 
 very same time,* our males also passed into action j but how did 
 their brain-power work ? They formed and sent out a Commission 
 to inquire into the then existing ' conditions and wants ' of our sick 
 and wounded troops in the Bast, and also into the ' hospital accom- 
 modation ' provided for them, and into the adequacy of such accom- 
 modation for subsequent ' contingencies ' j and they were to carry 
 their investigations to the point of attaining ' the full and complete 
 truth,' and enabling themselves to present to the War Minister 
 ' the most comprehensive Report, and the most desirable sugges- 
 tions,' ' with a view to the correction of any deficiencies which 
 might exist or arise in the conduct of the hospital establishments,' 
 or generally in the measures adopted for the care, of our troops, 
 sick or wounded. After conducting inquiries which, for intricacy 
 and probable tediousness, might rival whole clusters of old- 
 fashioned Chancery suits, the Commission was to report home to 
 
 * The latter end of October. It was then that the ladies sailed, and then — 
 the 23rd-^that the males took their step. 
 
56 
 
 the Duke of Newcastle;* and in completing instructions which 
 ensured such a loss of time as to make discomfiture certain, our 
 male rulers ordered their tortoise to gallop as fast as it could. They 
 gravely enjoined despatch. 
 
 " The inquiries directed were such as might well enough 
 occupy a good number of months, if not, indeed, one or two years ; 
 but supposing them by some magic vigour to be finished within a 
 few weeks, how soon did any male hope that they could be brought 
 to result in that actual ' correction of deficiencies ' which, of 
 course, was the object in view ? The hospitals were many, and 
 some of them were divided from others by hundreds of miles of 
 sea. Bach one of them, however imperfect, was still a complex 
 organism ; and although its faults might be glaring, the cause of 
 them might well be obscure, whilst besides, over every step that 
 led towards improvement, there always impended the danger of 
 exciting antagonism in the minds of public servants who, when 
 disturbed in their work by this ugly search after faults, might 
 easily throw up defences obstructive to prompt reformation ; and, 
 upon the whole, it was scarcely imaginable that Commissioners 
 reaching the Bosphorus in the first week of November would be 
 able to complete their inquiry and make their report before the 
 middle of the following month. 
 
 " Allowing from that time one fortnight for the mail to take 
 home the report, another for deliberation in Whitehall and the 
 construction of remedial plans, another for the eastward-bound mail 
 bringing out the decrees of the Government, with — superadded 
 at last — yet one other fortnight for carrying them into effect, 
 we find interposed for preparations a period of some thirteen 
 weeks — that is, a quarter of a year — and the time of expected 
 fulfilment stands — not, as was bitterly needed, before the beginning 
 of winter, but almost, indeed, at its close, so that any of our 
 soldiery stricken in the direst time of trial, who were only to be 
 saved through the measures advised by the Commission, would 
 
 * " Oh, good gracious ! How like ' them ! ' " If remembering and admiring, 
 as I do, Mrs. Oliphant's delightful " Chronicles of CarUngford," one can almost 
 hear some such comment on the masculine " them " from the lips of her charming 
 Miss Majoribanks. 
 
57 
 
 then be at rest in their graves. But, in truths no such speed as 
 this computation implies could well have been realised ; and few 
 will gainsay the tribunal which described this Commission as a 
 ' form of proceeding suited to redress grievances at home, or to 
 become a basis for legislative measures,' but ' ill adapted to relieve 
 the pressing wants of 5,000 men suffering under mismanagement 
 and neglect.'* 
 
 " The Commissioners were at their post in good time 1 5 and, 
 though hampered for a while by an error on the part of the 
 Government,! they conducted bhe inquiry as quickly as they very 
 well could without neglecting their orders, and came also, on the 
 whole, to conclusions which appear sound enough in themselves ; 
 but how was it possible that, whilst acting under instructions which 
 compelled them to report to the War Department at home, they 
 could promptly effect any good ? Mr. Sidney Herbert, seeing this, 
 and acting, unless I mistake, under the impulsion of his letters 
 from the Lady-in- Chief, took upon himself to suggest in a private 
 letter that, without waiting for the approval of their report, the 
 Commissioners should themselves see ' the evil corrected as far as 
 possible,' but their actual instructions at that time allowed them 
 no manner of warrant for taking any such course ; and it was only 
 on the 6th of January, 1855, that the Government enjoined the 
 Commissioners to make suggestions to Lord William Paulet. 
 
 " Eeceiving that warrant on either the 22nd or 23rd of January, 
 they so far obeyed it as to make some recommendations to Lord 
 William Paulet on the 26th, and some more on a later day ; but 
 these pointed to what may be called the command and disposition 
 of troops in connexion with our Scutari hospitals, and did not 
 
 * The Sebastopol Committee Kep., pp. 6, 7. 
 
 t The first week of November, 1854. The Commission at first consisted of 
 Dr. Camming, Dr. Spence, and Mr. Maxwell. 
 
 X The Government detached Dr. Spence on a mission to the Crimea without 
 providing that his two colleagues might act as a " quorum," and the powers of the 
 Commission were thus thrown into abeyance. Dr. Spence being on board the 
 Prince, ofl' Balaklava, on the 14th of November there lost his hfe, and Dr. Sidney 
 Laing was appointed to fill his place. The Commission recovered its competency 
 on the 27th of November. 
 
58 
 
 embrace the main subject.* The Commissioners (as expressly 
 directed) addressed their report, — not to any authority on the 
 spot, but — to our War Department in London. It was at Scutari 
 on the 23rd of February f that they made their report, and it pro- 
 bably reached Whitehall about the 9th of the following month, so 
 that Ministers in the second week of March might at last under- 
 take to found beliefs or opinions upon the knowledge obtained, 
 might frame their measures accordingly, might send out their 
 decrees to the Bast, and perhaps hope to see them beginning to 
 take some effect in the middle or latter part of the spring, — a time 
 later by three or four months than that at which Sir George Browne 
 saw perfection in our hospital wards, and ascribed it to womanly 
 energies. 
 
 " Thus sorrily lagged the males in their undesigned trial of speed 
 and power with what proved not only the swifter, not only the 
 more agile mind, but also the higher capacity for executive 
 business^ and even the more intent will. 
 
 " If regarded as only concerning the internal administration of 
 the Scutari hospitals, this apparent approach to perfection was 
 thoroughly real, and already, as some would imagine, must have 
 carried the reward of success to the heart of the Lady-in- Chief . 
 She herself, however, was one who disdained to look with com- 
 placency upon any result of her efforts which imported no real gain 
 of ground, and would hardly, indeed, acknowledge that from 
 The mortality November even to February substantial good had 
 in our hospitals been done, when, in spite of all the care lavished, and 
 ever forced concurrently with the admiration excited by an almost 
 down. magic improvement in the efiBciency of the hospital 
 
 management, stern columns of figures showed death to be more 
 than ever rife in the wards. 
 
 * The principal change recommended to Lord William by the Commissioners 
 had been previously submitted to Lord Raglan himself by the Lady-in- Chief. 
 
 + Even then they had not had time enough to complete the whole inquiry 
 directed, but the Government pressed them to end their task, because one of them 
 (Dr. Cumming) had become the chief medical oflScer at Scutari, and his services 
 ■were there greatly needed. 
 
59 
 
 V. 
 
 " Brought about, as we saw, by those wholesale, encompassing 
 poisons which were only to be conquered by engineers and labourers 
 undertaking what we call 'Public Works,' the mortality in our 
 Bosphorus hospitals maintained its appalling height throughout 
 the whole winter, and continued its ravages into the month of 
 March.* 
 
 " Science then interposed. Taught at last by observing the 
 The Sanitary impotence of orders framed by a Minister who forgot 
 Commissioners, tg ^.^^^^ rpijj^Q ^^ j^jg reckoning,t the Government— 
 now newly constituted — took care to avoid his mistake; and, 
 having wisely determined that they would attack the foul poisons 
 surrounding our Levantine hospitals with the weapons of the skilled 
 engineer, they resolved that the Sanitary Commissioners despatched 
 for this purpose should — not merely go inquiring, but — act, and 
 should not only act, but be prompt. Urged by orders conceived in 
 this spirit, the Commissioners, Dr. Sutherland, Dr. H. Gavin, and 
 Mr. Rawlinson, went off to the Bast without seemingly losing 
 a day. 
 
 " They soon found that our Levantine hospitals were suffering 
 under rank poison — not poison of such a kind that it can be 
 annulled or counteracted by domestic management, but of that 
 grosser sort that can only be combated by engineering works ; 
 and propelled by wholesome instructions which ordered them 
 ' to see instantly ' to the commencement of the necessary work, 
 and to its superintendence * day by day until finished/ J they 
 
 * See ante, p. 214. 
 
 t The instructions to the Hospital Commissioners stated, antei p. 441. 
 
 t These instructions, given by the War Department on the 19th of February, 
 ] 855, were so well devised, and produced such signal effect, that they deserve to 
 be carefully remembered by our army administrators ; and, if I do not find room 
 for them in the Appendix, I trust that the above-given date may be used as a clue 
 for finding them in the official archives. The tone of the instructions is very 
 peculiar, and such as to make one believe that, whether directly or otherwise — 
 perhaps through the wholesome intervention of Mr. Sidney Herbert— they owed 
 much to feminine impulsion. The diction of the orders is such that, in house- 
 keepers' language, it may be said to have " bustled the servants.'' 
 
60 
 
 passed into action with admirable promptitude. In the second 
 week of March they had already made some progress, and on the 
 17th had advanced their works so far as to be in a state for 
 producing at once some part of the intended effects. Then came 
 The change 0° ^ change which, if only it had been preceded by 
 they wrought, mummery, instead of ventilation and drainage and 
 pure water supply, would have easily passed for a miracle.* 
 Down went the rate of mortality. Having already gone down 
 from the terrible February rate of 42 per cent, to 31, it descended 
 in the next fortnight to 14; in the next twenty days to lOj in 
 the next, to 5 ; in the next, to 4 ; and, finally, in the next twenty 
 days, — days ending on the 30th of June, 1855, — to scarce more 
 than 2,f — a rate so low as to be touching the very goal for which 
 sanguine toilers were striving, because brought down to a level 
 with the rate of mortality in our military hospitals at home. J 
 
 " And now, passing from the mortality in our Bosphorus hospitals 
 to that of our Eastern hospitals generally, I may say that the deaths 
 were — for January, 1855, 3,168 ; for February, 2,523; for March, 
 1,409 ; for April, 582 ; for May, 594; and for June, 1,042 ;§ but, 
 besides, if consenting once more to glance beyond the bounds of 
 this History, I may say that from the end of June, 1855, to the 
 time, twelve months later, when our army bade farewell to Grim 
 Tartary, the mortality invading our hospitals grew less and. less 
 almost constantly, and that the monthly return, which for January, 
 
 * When afterwards he went to the Crimea, Mr. Rawlinson, the engineering 
 member of the Commission, who had achieved such vast good, had himself a sort 
 of escape which popular diction is still apt to call " miraculous." He was struck 
 by a 42-pounder steel shot, without being permanently, or indeed, very seriously, 
 injured. 
 
 t Ibid. Stated more exactly with their appendant fractions, the above numbers 
 are 42-7, 31-5, 14-4, 107, 5% 4-3, and 2-2. 
 
 X That is, with the average rate in such of them as were in or near London. 
 In those, it seems, the average rate of mortality was 2'9 per cent, 
 
 § Being deaths to force per 1,000 per annum : — 
 
 For January, 1855 1173-6 
 
 „ February, „ 9792- 
 
 „ March, „ ...,,. 561'6 
 
 For April, 1855 22-32 
 
 „ May, „ 202-8 
 
 „ June, „ 318- 
 
61 
 
 1855, had recorded 3,168 deaths, showed for June, in the following 
 year, deaths numbering only six.* 
 
 "But, whilst dwelling on those happy changes which raised our 
 Thouehts that liospital management to an almost unknown height of 
 memory ought excellence, it less becomes our people to harbour a 
 sense of complacency than to think of the lives — the 
 lost lives — that timely care might have saved. A sustained though 
 painful remembrance of those trials, those wants, under which our 
 troops suffered and died, would, perhaps, afford some ground for 
 hoping that, in wars yet to come, the dire penalties of State 
 incapacity may not again have to be borne. 
 
 VI. 
 
 " Nor ought our people to fly from the memory of this winter 
 Problema Campaign without bending their thoughts to some 
 
 raised by the problems which tasked men's minds at the time, and 
 the winter have Only in part found solution. The still unsolved 
 
 campaign. problems are many, yet fuse well enough into one : 
 
 How to make our mixed polity furnish an Executive Government 
 which at once, on the call to arms, and without needing yet further 
 lessons in the cruel school of adversity, may be equal to the business 
 of war." 
 
 Extract from " The Hygiene of the Turhish Army," 1854-55. By 
 J. N. Eadclifpe, M.R.C.S, Bug., Late of the Staff of E.H. 
 Omar Pasha, 
 
 The cleanliness of a camp is a subject of peculiar importance, 
 and the methods of attaining cleanhness merit more attention than 
 they have yet received on the part of military officers. 
 
 * Ibid. The ratio of these six deaths " to force per 1,000 per annum " is 
 expressed by the figures which we before saw expressing the ratio for June, 1856 
 (see note, ante, p. 406), i.e., by the figures 2'4 
 
62 
 
 Cleanlinessj so far as the neat aspect of a camp is concernedj is 
 highly gratifying to the eye ; but this may be, and, indeed, often 
 is, attained, and yet some of the worst sources of atmospheric 
 pollution, from a misapprehension of their effects, are allowed to 
 remain. 
 
 The continued inhalation of an atmosphere tainted by decom- 
 posing organic matter, such as is usually rife in a camp, is one of 
 the most powerful predisposing causes of those terrible epidemics 
 which ravage armies. It insidiously deteriorates the health, and 
 lays the foundation necessary for the development 6f fever, cholera, 
 and other cognate diseases ; and inasmuch as it is less palpable in its 
 effects than bad diet, excessive fatigue, intemperance, and other 
 potent predisposing causes of disease, which are apt to affect an 
 army in the field, and as it is more generally, nay, is invariably, 
 present in a greater or less degree, it requires more constant and 
 watchful attention. Remove the predisposing causes of an 
 epidemic disease, and the exciting causes become, as a rule, 
 inoperative j diminish the former in degree, and the latter will be 
 proportionately diminished in effect. For many years the 
 experience of civil life has shown that the emanations from 
 decomposing substances act most powerfully in predisposing the 
 system to the development of fever, dysentery, diarrhoea, and 
 cholera. The experience of the allied armies during the war in 
 the Crimea has shown that, in the camp, the effluvia from putrescent 
 matters were equally powerful agents in the development of diseases 
 among the soldiers, and that the diseases thus developed were 
 similar in character to those witnessed under the same circum- 
 stances in civil bfe. 
 
 To diminish the sources of atmospheric vitiation in a camp, it is 
 requisite that proper receptacles should be provided for all ejected 
 matters whatsoever ; that it should be imperative upon the soldier 
 to use these receptacles ; that measures should be had recourse to 
 for the destruction of such rejected matters as cannot be readily 
 and deeply buried; that a systematic watchfulness should be 
 observed on the part of the officers ; and that special regulations 
 should be adopted for the general guidance of the men. Nothing 
 can be done effectually without a properly- organised scheme 
 of action, equally affecting the superior and inferior grades of 
 officers, and the men. The sanitary state of a camp is a matter of 
 
63 
 
 too great importance to admit of the measures necessary to secure 
 the conditions most favourable to the preservation of health being 
 left to the option of one man or another. 
 
 Not unfrequently the site of an encampment was insufficiently 
 prepared, the drainage in particular being defective ; and when the 
 soil happened to be naturally moist, the air within the tents was 
 rendered damp, and this condition operated as a powerful localising 
 cause of zymotic disease. 
 
 Notwithstanding the want of any definite or special hygienic 
 laws in the British army in the Crimea, the general good sense 
 both of officers and men led to an avoidance of all the more glaring 
 sources of filth, and to an adoption of measures of cleanliness which 
 were characteristic. Even so early as the month of April, 1855, 
 when the men had barely been relieved from the harassing and 
 incessant duties which had devolved upon them during the winter, 
 the nose at once pointed out the distinction between the French 
 and Turkish and the English camps, the atmosphere in the two 
 former camps abounding with pernicious effluvia ; and, subsequently, 
 the Sardinian camp might equally be distinguished from the British 
 camp by a superfluity of foul odours. In none of the allied camps 
 were the essentials of cleanliness attended to so much as in the 
 British camp. 
 
 The Sardinian soldiers equalled, if they did not exceed, the 
 Turks in the filthiness of their habits ; and the polluted condition of 
 the outskirts of their encampments, and even of the immediate 
 vicinity of their hospitals, was astounding. Moreover, there was 
 a neglect in the removal or burial of carrion within the bounds of 
 the French, Sardinian, and Turkish camps, which was never 
 witnessed in the British camp. 
 
 Bach of the allied armies suffered more or less from the neglect 
 of hygienic measures.* 
 
 * The British Army Sanitary Commissioners landed in the Crimea in April, 1855, 
 and took up quarters in Balaklara (temporary huts of timber). The day after 
 landing, — ^in company with General Sir Colin Campbell, — the camp of the fiighland 
 Brigade was inspected, where much fever existed. Some temporary huts then 
 occupied were partially buried in the hill-side, which was wet shale. The roofs of 
 
64 
 
 In the spring, summer, and autumn of 1 855, fever and scurvy 
 prevailed extensively among the Turkish troops at Eupatoria, in 
 consequence of the foul hygienic condition of the town and en- 
 trenched camp, and the imperfect rations of the soldiers. During 
 the same period the sick rate of the Turkish force before Sebastopol 
 was comparatively low, the camp being rarely fixed for more than 
 six or eight weeks upon one spot, and the men being fully fed; but 
 zymotic diseases, particularly fever, diarrhoea, and cholera, con- 
 stituted the principal portion of the sickness which occurred, and 
 attention to the most ordinary hygienic precautions would have 
 diminished the amount of those diseases. 
 
 The sanitary state of the French Oamp and army during the 
 winter of 1855-56 formed one of the saddest episodes of the war. 
 " The earth within and without the dwelling-places of the men was 
 saturated with the products of human and bestial bodies buried 
 lightly. Throughout the winter, carcasses were left to rot 
 uncovered close to the tents, while soldiers in huts and tents 
 
 the huts were of felt, but water and air tight, — no provision existing for ventila- 
 tion. The floors were not only damp, but from below most of the huts water 
 oozed out, — the subsoU being as foul as a cesspit. The causes of the fever were 
 consequently soon made evident to the General. A plan for freeing the huts from 
 the subsoil wet by clearance round the huts and by drains, with full ridge ventila- 
 tion by a louvre opening the length of the ridge, and by removing the inside sub- 
 soil for a depth of 12 inches, and substituting quicklime and charcoal, soon 
 rendered the huts operated upon wholesome. As many of the men as it was 
 possible to remove to a site on dry rock higher up were so removed, the result 
 being a cessation of new fever cases, and recovery of the sick. 
 
 As rapidly as possible the Commissioners reported to Lord Raglan on the 
 condition of the village and harbour of Balaklava, the cavalry camp, and the camps 
 of the divisions at the front generally ; embodying suggestions for the formation 
 of latrines, the draining and ridge ventilation of the huts, and the disinfection 
 of the subsoil within them. We had reason to know that Lord Raglan must have 
 had the recommendation as to scavenging, cleansing, and improving the means of 
 water-supply copied during the night, as we found the works actually commenced 
 the next morning. Mr. Radcliflfe apparently did not know this. He, however, 
 saw that the British portion of the camp soon put on an improved appearance, and 
 that this improvement was continued up to the end. The Commissioners laid 
 down this rule, — namely, that scavenging and surface cleansing should not cease 
 so long as troops occupied the ground. The huts, also, once ventilated, remained 
 ventilated to the end of the war. — R. R. 
 
65 
 
 closely shut against frest air, constantly wet^ the enclosed area 
 sankj and loaded with aU sorts of impurities. Personal cleanliness 
 was impracticable in such habitations, and the alentours showed an 
 utter disregard of aU English notions of decency. To these local 
 evils must be added the too close packing of huts and tents, both 
 for the healthy and sick.'' * The tents, also, were old and much 
 worn ; the food of the soldiers was, and had been for some months, 
 scanty and unwholesome ; the supply of wood for fuel was deficient; 
 and the clothing was bad, and not fitted for winter. 
 
 Developed and fostered by these conditions, and by the neglect 
 of even the commonest hygienic rules, sickness prevailed to so great 
 an extent in the French army, that it was placed in a very critical 
 position. At one time the aggregate number of sick amounted to 
 40,000. Typhus raged in the camp and hospitals with the 
 virulence of a pestilence, and the mortahty was enormous. M. 
 Baudens declared that, of the typhus patients in hospital in 
 February, 1856, two-thirds were devoted to certain death. Forty- 
 six surgeons died from typhus alone, and scarcely one escaped an 
 attack of the disease. The medical staff became so crippled by its 
 losses, that it was unable to meet the exigencies of the period ; and 
 on the Minister of War being urged to send out as many surgeons 
 as possible, he declared that he had no more surgeons at his dis- 
 posal, and that he could not procure any, — " II n'en avait plus a 
 sa disposition, et le recrutement ne repondait pas aux besoins." — 
 (Baudens.) The French hospitals in the Crimea and on the 
 Bosphorus were insufficient for the fitting accommodation of the 
 immense amoun^t of sickness which inundated them ; and while the 
 French camp in the Crimea paralleled the horrible scenes which 
 occurred in the British camp during the first winter of 1854-54, 
 the French hospitals on the Bosphorus paralleled the wretchedness, 
 misery, neglect, and mortality which reigned in our hospitals at 
 Scutari during the same period.f 
 
 Inordinate fatigue had contributed greatly to the excess of sick- 
 ness which prevailed among the British troops in the winter of 
 
 * " England and France before Sebastopol, looked at from a Medical Point of 
 View." By Charles Biyce, M.D. London, 1857. Page 84. 
 t Dr. Bryce, Op. cit. passim. 
 
 E 
 
66 
 
 1854-55, but this important source of disease had little or no 
 influence in the development of the maladies which ravaged the 
 French army in the winter of 1855-56 ; for the duties of the French 
 soldiers at that period did not exceed in severity those performed 
 by the British soldiers, and the health of the latter was good. 
 The position which was occupied by the French army was also 
 almost inoperative in the causation of zymotic diseases j for the 
 experience of the army, in the earlier part of the campaign, had 
 shown that, with the exception of that portion of the position 
 which was on the Tchemaya, the ground over which the camp 
 extended was healthy; and the divisions of the French army 
 which were encamped on the plateau of Sebastopol suffered equally 
 from disease with the rest of the army, although the British 
 divisions encamped on the same plateau had good health. 
 
 The causes of the extraordinary amount of sickness and exces- 
 sive mortality which prevailed in the French army are to be found 
 alone in the foul sanitary condition of the camp and the miserable 
 state of the half-fed soldiers. The typhus epidemic was nursed and 
 disseminated by the over-crowded and filthy hospitals; every 
 hospital was a centre of infection, and in the camp "typhus 
 overflowed the hospitals, and was found in the regimental tents " 
 (Baudens). 
 
 The Sardinian army did not escape the baneful consequences of 
 a polluted camp, but the extensive hospital accommodation pro- 
 vided, and the completeness of the medical staff, sufficed to keep 
 the outbreaks of zymotic disease which occurred more or less in 
 subjection, or to nip them in the bud. 
 
 The care devoted to the removal of noxious agents in the 
 British camp had considerable influence in causing that high state 
 of health and freedom from disease which prevailed among our 
 troops towards the close of the war ; but, when the sanitary state 
 of our army was at the best (May, 1856), and the sick-rate 
 averaged only 5 per cent, of the whole force, 25 per cent, of the 
 total admissions into hospital and 37 per cent, of the deaths were 
 from zymotic disease. In May, 1855, zymotic affections consti- 
 tuted 64 per cent, of the cases of sickness admitted into hospital, 
 and occasioned 90 per cent, of the deaths from disease ; but, 
 notwithstanding the great diminution in the amount both of the 
 
67 
 
 sickness and mortality from zymotic disease in May, 1856, tte 
 Sanitary Commission despatched to the seat of war in the Crimea 
 has expressed the opinion that, most probably, " a still further 
 diminution of zymotic cases might have been obtained" had 
 sanitary measures been more thoroughly and systematically 
 carried out in the camp, and the drinking of ardent spirits 
 greatly diminished, if not prevented.* 
 
 During the twelve months preceding the evacuation of the 
 Crimea the average proportion of zymotic disease to the total 
 sick of the British army, exclusive of wounded, was rather more 
 than 49 per cent., and the average proportion of deaths from 
 zymotic disease to the total mortality from sickness was 51 per 
 cent. From October 1, 1854, to April 30, 1855, fevers, cholera, 
 and scurvy formed one-third, and diseases of the stomach and 
 bowels one-half of the total admissions into hospital, exclusive of 
 wounded. It may be roughly estimated that zymotic diseases 
 constituted two-thirds of the cases of sickness admitted into 
 hospital during that period. 
 
 This testimony of Mr. J. M. E-adcliffe to the superior 
 condition of the British Army, both in hospital, in the 
 Bosphorus, and in camp in the Crimea, has an inde- 
 pendent value, which may be set against opinions ex- 
 pressed by some of the Army Medical Officers, who would 
 not acknowledge any merit in the work done by and 
 under the orders of the Army Sanitary Commission, 
 although the results before them were so palpable. 
 
 The statements set forth in this papermay therefore again 
 
 * Report of the Proceedings of the Sanitary Commission despatched to the 
 Seat of War in the East. Blue Book, p. 196. 
 
 £ 2 
 
68 
 
 be reiterated, namely, that the works as described to have 
 been executed for the British Army at the hospitals on 
 the Bosphorus and in the Crimea were exceptional, and 
 were not imitated by any of the other army authorities. 
 The deadly effects of the foul sewers and drains found to 
 exist at the large Turkish buildings occupied by British 
 soldiers and sailors were entirely removed ; the barrack 
 and hospital rooms occupied by the sick had almost 
 immediately the fullest possible means for ventilation 
 provided ; the change of air amounting to millions of cubic 
 feet each hour of each day ; the sick had, in fact, during 
 the summer as much fresh air to breathe in the wards 
 as if they had been in the open air, but protected from 
 direct drafts ; the sewers and drains were incessantly 
 flushed ; the wards were cleansed and lime-washed, which 
 processes were continuous to the end, and removal of 
 surface refuse of all sorts was equally continuous, with 
 the most ample and perfect scavenging. The Commis- 
 sioners paid strict attention to their instructions, obeying 
 them both in the letter and in the spirit. General Lord 
 William Paulet at first, and General Storks subsequently, 
 both seconded the efforts of the Commissioners to the 
 fullest possible extent. 
 
 It formed no part of our duty to interfere with the 
 buildings occupied on the Bosphorus by the [French, and 
 if any members of the French army, military or medical, 
 ever inspected the works done by the British Sanitary 
 Commissioners to the buildings occupied by the British, it 
 never came to our knowledge. It, however, is clear from the 
 statements made by Mr. J. N. Badcliffe that no such 
 inspection, leading to any practical purpose, ever was 
 made by the Erench, by the Sardinians, or by the Turks. 
 
 The voluminous evidence taken by the Commission 
 presided over by Lord Morley as to the results of the 
 
69 
 
 Egyptian campaign is not pleasant reading. Hospital 
 orderlies were in some instances brutal (almost as 
 bad as those described in " The Surgeon's Daughter "), 
 and in many instances they were apathetic and careless. 
 If the evidence of General Lord Wolseley stood alone 
 it would be the severest condemnation possible of the 
 defective sanitary organisation and arrangements ; but 
 this evidence is not exceptional. All the old Crimean 
 blunders appear to have been repeated. Medical and 
 other stores could not be obtained when needed, pro- 
 visions ran short, and the cooking was abominable. 
 The camping - grounds occupied were swampy and 
 offensively dirty. Egyptian buildings were used as 
 hospitals, without alteration, cleansing, or ventilation. 
 The results being, as usual under such conditions, disease 
 in excess, — 7,039 men in hospital, 463 only being 
 surgical cases. The work of the Sanitary Commission 
 in the Crimea, and the results obtained, formed no 
 precedent for the Army Medical Department in Egypt. 
 The regulations, as established by Lord Herbert, had 
 been subverted. The climate was blamed, — a climate to 
 which invalids are ordered to recover health. 
 
 Is it too much to hope that the Government may in 
 time recognise the necessity for a Sanitary Depart- 
 ment, — independent of the doctors ? A department 
 having a sanitary engineer at its head, with a staff of 
 sanitary inspectors under him. This Sanitary Depart- 
 ment to be immediately under the orders of the 
 Commander-in-Chief for the time being, who shall have 
 power to strengthen the service as needed. The engineer 
 to see to all structural works and arrangements. The 
 sanitary inspectors to be placed at the head of a 
 scavenging department, and to assist with supplies of 
 water. Where outside labour can be obtained this to be 
 
70 
 
 made available, and day by day, or week by week, be 
 paid for. If there had been a sanitary engineer with the 
 army in Egypt he would at once have removed the 
 windows from any buildings occupied as hospitals, so as 
 to have secured full means for ventilation ; would have 
 cleansed the wards or rooms ; would also have had lime- 
 washing where practicable ; have seen to any sewers or 
 drains, where such existed ; and have made provision for 
 water-filtering. These duties form no part of the 
 education of a medical oflScer, and it is better they 
 should not do so. A sanitary engineer undertaking 
 surgical operations would not be more out of place 
 than a medical officer presuming to undertake and 
 execute sanitary engineering works. 
 
 A long experience with the devising and executing 
 of sanitary works has led me to the following con- 
 clusions ; — 
 
 Eirstly, as to Hospitals ; that, as a rule, hospitals 
 in all countries and in all climates are under-venti- 
 lated ; that lung-and-skin-tainted air is the most 
 deadly enemy the sick have to endure ; and that 
 two and three storied hospitals never are sufficiently 
 ventilated. 
 
 Secondly, sewers, drains, and water - closets 
 should never be beneath the basement or within 
 the wards of any hospital, but should be external, 
 and independently ventilated. 
 
 Thirdly, that cleansing within and without 
 hospital wards should be immediate, rigid, and at 
 short intervals, ventilation being by windows opening 
 up to the ceiling, or by ridge-louvre ventilation for 
 
71 
 
 single-story wards. Some of the finest hospitals in 
 Europe, in plan and in cubic space, are sadly neglected 
 in their sanitary arrangements. It should therefore 
 never be forgotten, that unceasing care and cleansing 
 will be requisite to preserve the best arranged 
 hospitals in a wholesome condition. 
 
 Fourthly, that the ground-floor of any hospital- 
 ward should be raised from the ground to admit of 
 full and free ventilation beneath ; and that the 
 entire site should have a layer of concrete not less in 
 thickness than six inches. 
 
 Fifthly, that for camps, either in peace or in 
 war, scavenging should be thorough and unceasing, 
 so long as the ground is occupied ; and that all refuse 
 which can be burned should be so destroyed. 
 
 Sixthly, that food, water, and clothing should 
 be wholesome and sufficient, as fever is ever the 
 scourge of men in masses, living in the midst 
 of accumulated filth, under-fed, and defectively 
 clothed. 
 
 Seventhly, an army should have a full sanitary 
 staff at command, and the Commander-in-Chief 
 should be under the instructions issued io the 
 Army Sanitary Commission of 1856, and have 
 similar authority to order, to see executed, and 
 to pay for the work done. The extravagance of 
 war is enormous, but the cost of the fullest and 
 most effective sanitary arrangements will only be 
 fractional. 
 
 Eighthly, each man should have shoes of the 
 best make which he can wear without being made a 
 
72 
 
 cripple after tlie first day's or week's marching, if even 
 they cost three times the price of contract boots and 
 shoes, as a crippled soldier is an encumbrance. If a 
 regiment has ten men lamed by bad or misfitting 
 boots or shoes, as each man is valued at £100, a 
 capital sum, equal to £1,000 sterling, is, for the time, 
 lost to the service. 
 
 Ninthly, the issue of spirits as a ration has been 
 an unmitigated evil and should be discontinued. 
 Men wet, exhausted, and miserable, will drink 
 spirits in excess if available ; and during war, and 
 under such conditions as prevailed in the Crimea 
 during the winter of 1854-55, the spirit ration was 
 sent in excess, and tended to destroy those who 
 consumed it. Many of the men were too sick to 
 take it. Some were dead for whom the ration was 
 sent ; and the living, to soften their misery, drank 
 to excess as opportunity served. 
 
APPENDIX No. I. 
 
 On the lOth of June, Sunday morning, I was riding 
 with some officers of the E,oyal Artillery who were going 
 to their duties in one of the batteries, and, in a ravine 
 termed "the Valley of the Shadow of Death," I was 
 struck down by a 42 lb. round shot, and was carried to a 
 temporary hospital in the Light Division. Lord Raglan 
 came u.p to see me as soon as he heard of it, and on the 
 Wednesday following sent his carriage to take me down 
 to Balaklava. From thence I wrote to him, stating that 
 the Doctor had recommended me to go home at once. 
 The letter as under is his Lordship's reply : — 
 
 "Before Sebastopol, June 22nd, 1855. 
 
 " SiE, — I have received your letter of tte 20tli instant, and regret 
 to learn tliat you continue to suffer from your wound, and that it 
 is considered necessary that you should return to England without 
 delay. This being the case, you are quite right to take advantage 
 of the first opportunity to leave this country. 
 
 "You will take my best wishes with you, and I beg to be permitted 
 to express my hope that you will experience no permanent bad 
 effects from what befell you in the ravine leading to the trenches, 
 
 " It is a mercy that your life has been preserved. Few have had 
 such an encounter with a 68 lb. shot and have escaped so well. 
 I hope you will take the shot home with you. 
 
 " I have the honour to be. Sir, 
 
 " Your very faithful servant, 
 
 (Signed) " RAGLAN." 
 
 "Robert Kawlinson, Esq." 
 
74 
 
 The shed-hospital I was placed in was at the extreme 
 front. A hospital orderly was appointed to attend 
 upon me, which he did with the greatest care. But 
 at midnight he was seized with cholera in its most violent 
 form, and died at ten o'clock the next morning. At about 
 two o'clock in the same morning the officer I was with 
 when wounded came to me direct from the batteries, and, 
 seeing the condition I was in, had me, with my bed, 
 carried to his tent, where I stayed up to the Wednesday 
 following. His servant, in the mean time, who said he 
 knew where the shot was which had struck me, as he got 
 hold of it and it burned his fingers, went down and brought 
 it up from where it had buried itself in the side of the ravine, 
 and placed it on the floor of the tent (the Russians were 
 firing 68-lb. shot that day, and it was assumed this was 
 that weight). I wrote to Lord Raglan, as he had 
 requested me to do, to say I wished to move down to 
 Balaklava, when he at once sent his carriage up with one 
 of his aides-de-camp, who, seeing the shot on the tent-floor, 
 named it to his Lordship : hence his notice of it, and the 
 mistake as to its weight. The shot is of steel, forged, 
 not cast. When taken down to Balaklava and seen by 
 an Ordnance officer he detected this at once, and said it 
 was new to him, as it was the first shot of " swaged " 
 steel he had ever seen. I have it at home now. 
 The shot crossed in front, cutting the reins, the pomel 
 of the saddle, and driving a steel purse on to the crest of 
 the pelvis, making a large flesh-wound, and seriously 
 bruising the bone. I had that moment raised my hat, to 
 wish the officers good morning, saying I was going back, or 
 my right arm must have been taken ofi', as the shot per- 
 forated my coat beneath the arm. The pelvis-bone 
 exfoliated for months after my return, until the eminent 
 surgeon, Mr. Perguson, scraped away all the injured 
 parts, when the wound healed, leaving, however, a deep 
 hole in the place. 
 
APPENDIX No. II. 
 
 Extract from the " SURGEON'S DAUGHTER." 
 Waverley Novels, XLYIII. 
 
 A NOVEL is not, perhaps, the best source from which to 
 extract grave facts descriptive of Army Hospital mis- 
 management during the last century, but we have other 
 records, not so graphic, but equally revolting and painful. 
 It is also admitted that most of the incidents in the 
 "Waverley Novels are historical, and this description of 
 the state of this military hospital is not one whit more 
 terrible than the dry details of the state of the prisons of 
 the period, as related by John Howard : — 
 
 " The eflfect of the liquor displayed itself, as usualj in a hundred 
 wild dreams of parched deserts, and of serpents whose bite inflicted 
 the most intolerable thirst, of the sufiering of the Indian on the 
 death-stake, and the torments of the infernal regions themselves ; 
 when at length he awakened, and it appeared that the latter vision 
 was in fact realised. The sounds which had at first influenced his 
 dreams, and at length broken his slumbers, were of the most 
 horrible as well as the most melancholy description. They came 
 from the ranges of pallet-beds, which were closely packed together 
 in a species of military hospital, where a burning fever was the 
 prevalent complaint. Many of the patients were under the influence 
 of a high delirium, during which they shouted, shrieked, laughed, 
 blasphemed, and uttered the most horrible imprecations. Others, 
 sensible of their condition, bewailed it with low groans and some 
 attempts at devotion which showed their ignorance of the 
 principles, and even the forms, of religion. Those who were con- 
 valescent talked ribaldry in a loud tone, or whispered to each other 
 in cant language, upon schemes which, as far as a passing phrase 
 
76 
 
 could be understood by a novice, had relation to violent and 
 criminal exploits. 
 
 "Eichard Middlemas's astonishment was equal to his horror. 
 He had but one advantage over the poor wretches with whom he 
 was classed, and it was in enjoying the luxury of a pallet to himself, 
 — most of the others being occupied by two unhappy beings. He 
 saw no one who appeared to attend to the wants or to heed the 
 complaints of the wretches around him, or to whom he could offer 
 any appeal against his present situation. He looked for his clothes 
 that he might arise and extricate himself from this den of horrors ; 
 but his clothes were nowhere to be seen, nor did he see his 
 portmanteau or sea-chest. It was much to be apprehended he 
 would never see them more. 
 
 " Then, but too late, he remembered the insinuations which had 
 passed current respecting his friend, the Captain, who was sup- 
 posed to have been discharged by Mr. Lawford, on account of some 
 breach of trust in the Town Clerk's service. But that he should 
 have trepanned the friend who had reposed his whole confidence in 
 him ; that he should have plundered him of his fortune, and placed 
 him in this house of pestilence, with the hope that death might stifle 
 his tongue, were iniquities not to have been anticipated, even if 
 the worst of these reports were true. 
 
 " But Middlemas resolved not to be awanting to himself. This 
 place must be visited by some oflScer, military or medical, to whom 
 he would make an appeal, and alarm his fears at least, if he could 
 not awaken his conscience. "While he resolved these distracting 
 thoughts, tormented at the same time by a burning thirst which he 
 had no means of satisfying, he endeavoured to discover if, among 
 those stretched upon the pallets nearest him, he could not discern 
 some one likely to enter into conversation with him, and give him 
 some information about the nature and customs of this horrid place. 
 But the bed nearest him was occupied by two fellows who, although 
 to judge from their gaunt cheeks, hollow eyes, and ghastly looks, 
 they were apparently recovering from the disease, and just rescued 
 from the jaws of death, were deeply engaged in endeavouring to 
 cheat each other of a few halfpence at a game of cribbage, mixing 
 the terms of the game with oaths, not loud, but deep ; each turn of 
 luck being hailed by the winner as well as the loser with execrations 
 
77 
 
 which seemed designed to blight both body and soul^ now used as 
 the language of triumph, and now as reproaches against fortune. 
 
 "Next to the gamblers was a pallet, occupied indeed by two 
 bodies, but only one of which was living, the other sufferer had 
 been recently relieved from his agony. 
 
 " ' He is dead ! he is dead ! ' said the wretched survivor. 
 
 " ' Then do you die too, and be d d,' answered one of the 
 
 players, ' and then there will be a pair of you, as Pugg says.' 
 
 " ' I tell you he is growing stiff and cold,' said the poor wretch ; 
 ' the dead is no bedfellow for the living. For God's sake, help to 
 rid me of the corpse.' 
 
 " ' Ay, and get the credit of having done him, — as may be the 
 case with yourself, friend, — for he had some two or three hoggs 
 about him.' 
 
 " ' You know you took the last rap from his breeches-pocket 
 not an hour ago,' expostulated the poor convalescent. ' But help me 
 to take the body out of the bed, and I will not tell the jigger-dubber 
 that you have been beforehand with him.' 
 
 " ' You tell the jigger-dubber ! ' answered the cribbage-player, 
 ' Such another word, and I will twist your head round till your eyes 
 look at the drummer's handwriting on your back. Hold your 
 peace, and don't bother our game with your gammon, or I will 
 make you as mute as your bedfellow.' 
 
 " The unhappy wretch, exhausted, sank back beside his hideous 
 companion, and the usual jargon of the game, interlarded with 
 execrations, went on as before." 
 
APPENDII No. III. 
 
 List of Official Reports referred to in this Paper. 
 
 The extent to whicli the work of the Army Sanitary 
 Commission has extended, directly and indirectly, may be 
 partially gathered by a glance at the list of oflBcial 
 inquiries, reports, and publications appended, bearing on 
 the questions of barrack and hospital improvement, 
 hospital nursing, and ambulance arrangements. Every 
 European army has been more or less influenced by the 
 improved results obtained in the British army, as revealed 
 in these reports. When the sickness and death-rates 
 came to be critically examined, it was found that im- 
 provements tending to great reductions must take place, 
 especially in British. Inida, or its occupation must be 
 given up, A mortality amongst soldiers, ranging as high 
 as 69 in the 1,000 per annum, could not be endured, and 
 it was confidently anticipated that this mortality could 
 be reduced to, or even below, 20 in the 1,000. Professor 
 de Chaumont, in a paper recently read at the United 
 Service Museum, has shown that there has been, and now 
 is, a reduced death-rate in every branch of the Service ; 
 though further improvements require to be made, both in 
 barracks and in hospitals, which will e£Fect a further 
 saving of life when carried out, — the great retarding 
 influence being in the Estimates. 
 
79 
 
 I am aware that there is a large amount of printed 
 matter relative to Military Hygiene, — as, for instance, 
 a volume by Dr. Pringle, the volume by Dr. Partes, The 
 Soldier's Pocket Book, by Lord Wolseley ; and, besides. 
 General Orders, Barrack and Hospital Regulations ; to 
 which may be added a mass of Blue-Book inquiries as to 
 Army Regulations both at home and abroad, the following 
 being an imperfect list : — 
 
 No. 
 
 Date. 
 
 Name of Report. 
 
 1 
 
 1854-55 
 
 Eeport on Britisli Army Hospitals in the 
 Crimea and Scutari. By 
 Alexandee Gumming, Esq., M.D. 
 Thomas Spence, Esq., M.D. 
 P. B. Maxwell, Esq. 
 
 Ordered by the Duke of Newcastle. 
 
 2 
 
 1854-55 
 
 Eeport on Inquiry into Supplies of the British 
 Army in the Crimea. 
 Sir John McNeill, G.CB., and 
 Colonel TuLLOCH. 
 
 Ordered by Lord Panmuee. 
 
 3 
 
 1855-56 
 
 Report by Army Sanitary Commission on 
 Work done at the Hospitals on the 
 Bosphorus, and at the Camp in the 
 Crimea. 
 John Sutheeland, Esq., M.D. 
 Hectoe Gavin, Esq., M.D. 
 EoBEET Eawlinson, Esq., Civil Engineer. 
 Gavin Mileot, Esq., M.D. 
 
 Ordered by Lord Panmuee. 
 
 4 
 
 1857 
 
 Eeport on Eegulations afifecting the Sani- 
 tary Condition of the Army. 
 Eight Hon. Sidney Heebebt. 
 
80 
 
 No. 
 
 Date. 
 
 Name of Eeport. 
 
 6 
 
 1863 
 
 Report on the Sanitary Condition of Bar- 
 racks and Hospitals^ with Suggestions 
 for Improvements. 
 John SdtheelanDj Esq., M.D. 
 W. H. BuEEELLj Esq. 
 Capt. Douglas Galton, E.E. 
 The Eight Hon. Lord Heebeet, Secretary 
 of State for War. 
 
 6 
 
 1863 
 
 Eeport of Eoyal Commission on the Sani- 
 tary State of the Army in India. 
 Vols. I. and II. 
 
 Stanley. 
 
 Peobt T. Cautlet. 
 
 J. E. Maetin. 
 
 J. B. Gibson. 
 
 E. H. Geeathead, 
 
 W. Faee. 
 
 John Sutheeland. 
 
 7 
 
 1863-64 
 
 Eeport on Barrack and Hospitals on the 
 Mediterranean Stations, with Sugges- 
 tions for Indian Stations. 
 Capt. Douglas Galton, E.B., E.E.S. 
 John Sutheeland, Esq., M.D. 
 The Eight Hon. Sir Geoege Coenewall 
 Lewis, Bart., M.P., Secretary of State 
 for War. 
 
 8 
 
 1869-70 
 
 Eeport on Measures for Sanitary Improve- 
 ments in India. 
 
 9 
 
 1871 
 
 Eeport on Sanitary Appliances Introduced 
 into Barracks. 
 T. A. L. MuEEAT, Deputy Director of Works. 
 John Sutheeland, Esq., M.D. 
 
81 
 
 No. 
 
 Date. 
 
 Name of Report. 
 
 10 
 
 1863 
 
 Report of a Committee appointed by tlie 
 Secretary of State for War to inquire 
 into the Organisation of the Army 
 Hospital Corps, Hospital Management, 
 and Nursing in the Field, and the Sea 
 Transport of Sick and Wounded; 
 Together with Minutes of Evidence. 
 Appendix and Index. 
 
 Signed — 
 
 M OELBT. 
 
 W. R. Mends, Admiral. 
 
 R. B. Hawlby, Majors General. 
 
 R. LOTD-LlNDSAT. 
 
 Redvees Butlee, Colonel. 
 William MacCoemac. 
 T. Ceaweoed, D.G. 
 C Laws ON. 
 Dissent by — 
 
 R. B. Hawlet, Major-General. 
 
 R. LoTD-LlNDSAT. 
 
 Remarks by — 
 
 William MacCoemac. 
 
 11 
 
 1858 
 
 Notes on Matters affecting the Health, 
 Efficiency, and Hospital Administration 
 of the British Army. Pounded chiefly 
 on the Experience of the late War. By 
 Floeencb Nightingale. Presented by 
 request to the Secretary of State for War. 
 
 12 
 
 1815 
 
 The General Orders of Field Marshal the. 
 Duke oe Wellington, &c., &c., &c., in 
 Portugal, Spain, and France, 18,09 to. 
 1814; and 
 
 The Low Countries and France, 1815. By 
 Lieut.-Col. John Guewood, 
 
82 
 
 No. 
 
 Date. 
 
 Name of Eeport. 
 
 13 
 
 1882 
 
 The Soldier's Pocket Book. For Field Service. 
 
 By 
 
 Lieut. -General Sir Gaenet I. Wolselet, 
 
 G.G.B., G.O.M.G. (nowLordWolseley). 
 
 Fourth Edition, revised and enlarged, with 
 
 illustrations. 
 
 14 
 
 1878 
 
 Parkes's Practical Hygiene. 
 De Chaumont. 
 
 Fifth Edition. 
 
 15 
 
 1866 
 
 History of the United States Sanitary Com- 
 mission ; being the General Report of its 
 Work during the War of the Eebelhon. 
 
 By 
 
 Chaeles J. Stille. 
 
 Twenty-three gentlemen, with the Rev. 
 
 H. W. Bellows, D.D., of New York, at the 
 
 head, constituted the American Sanitary 
 
 Commission. 
 
 16 
 
 1880 
 
 The Invasion of the Crimea ; its Origin, and 
 
 an Account of its Progress down to the 
 
 Death of Lord Raglan. By A. W. 
 
 KiNGLAKE. Vol. 6. 
 
83 
 
 No. 
 
 Date. 
 
 Name of Report. 
 
 17 
 
 1882 
 
 Suggestions in regard to Sanitary Works 
 and Measures required for Improving 
 Indian Stations and their Vicinity. 
 Prepared and revised by the Army 
 Sanitary Commission. 
 
 President .- 
 Hbebeet, Gen. Sir A. J., K.C.B. 
 Members : 
 
 Dawson Scott, Col. R. M. 
 
 Maeston, Dap. Surg.-Gen. J. A.j M.D. 
 
 K.C.S.I.,M.D.,Q.H.P. ) ^'''^'^• 
 SuTHEELAND, J., Esq., M.D. 
 Galton, D., Esq., C.B., late Captain Royal 
 
 Engineers. 
 Bawlinson, R., Esq., C.B., C.B. 
 
 18 
 
 1883 
 
 The Sanitary Contrasts of the British, and 
 French Armies dm-ing the Crimean War. 
 
 By 
 
 Surgeon - General T. Longmoee, C.B., 
 Q.H.S., E.R.C.S. 
 
 &c., &c., &c.