Entered according to Act of Congress, A. D. 1899, by A. N. BELL, in the office of the Librarian of Congress, at Washington. THE NEW YORK PUBLIC LIBRARY ASTOP LENOX AND TIN FOURDICKM. THE SANITARIAN. JULY, 1899. NUMBER 356. SANITARY LESSONS OF THE WAR.* By GEO. M. STERNBERG, M. D., L.L. D., Surgeon General U. S. Army. ABSTRACT. As compared with the Civil War and with other great wars during the present century the mortality from wounds and disease among our troops during the war with Spain has been low. Our wounded have, to a large extent, had the advantage of prompt treatment with antiseptic dressings, and a very considerable proportion of those who were not killed outright have recovered without any mutilating operation or septic complication. The mortality from disease has also been comparatively low, but, unfortunately, during the first months of the war that scourge of new levies of troops, typhoid fever, prevailed in many of our camps and claimed numerous victims. It is well known to sanitarians and military surgeons that as a general rule more soldiers succumb to disease than are killed by the bullets of the enemy, and our recent war has not been an exception in this regard. The total number of deaths reported in our enlarged army, including regulars and volunteers, from May 1, 1898, to April 30, 1899, is 6,406. Of these 5,438 died of disease and 963 were killed in battle or died of wounds, injuries or accident. During the Civil War the number of deaths from disease was 186,216. The number who were killed in battle or died of wounds was 93,969, or about one-half of the deaths from disease. The total deaths from disease in the Union armies from the commencement of the war to Read before the Section on State Medicine at the meeting of the American Medical Association, Columbus, O. June 8, 1899. the 31st of December, 1862, was 34,326, and in the Confederate armies during the same period 31,238. The following table gives the monthly death rates from disease in our armies from May 1, 1898, to April 30, 1899, and, for comparison, the rates for the same period during the first twelve months of the Civil War : COMPARISON OF MONTHLY DEATH RATES (PER 1,000) FROM DIS In addition to this 24,184 deaths are recorded as from unknown causes, and probably most of these deaths were from disease. In comparing the death rates from disease during the year of the Spanish-American War, May 1, 1898, to April 30, 1899, and the first year of the Civil War, May 1, 1861, to April 30, 1862, note should be taken in the first place that the mean strength in May, 1861, was only 16,161, as compared with 163,726 men in service in May, 1898. The mustering in of volunteer troops progressed more slowly in 1861 than during the recent war, so that it was not until September and October, 1861, that the mean strength assumed proportions equal to that of the months of the Spanish War. Although the number present in the camps of 1861-62 after October, 1861, was largely in excess of those aggregated during the past year, the average annual strength during both wars did not differ greatly. Nevertheless the deaths from disease in 1861-62 numbered 10,522, while in 1898-99 they amounted only to 5,438. The death rate per thousand of strength mounted gradually month by month in 1861-62, and, indeed, it did not reach its acme until February, 1863, when the rate of 6.39 was reached. In 1898, on the other hand, the acme, 5.89, was reached suddenly in September, but owing to the sanitary measures adopted the fall during October and November was as rapid as had been the rise. The same gradual rise is seen in the mortality statistics of typhoid fever during the Civil War. The highest death rate, 2.81, was not reached until May, 1862, the thirteenth month of the aggregation of the troops, when 1,092 men died of this disease, and the fall of the rates was as gradual as the rise. On the other hand, the rise in 1898 was sudden, the maximum rate, 3.57, being reached in September, when 933 men died of this disease; but the fall during the months of October and November was as notable as the rise. This sudden suppression of the disease cannot be attributed to an exhaustion of the susceptibility of the troops to attack from this fever, as they only suffered at the rate of 12.37 per thousand of strength during the twelve months, whereas the troops of the Civil War suffered at the rate of 19.71 per thousand. can be attributed only to the active preventive measures that were instituted, and especially to moving the troops to fresh camp sites and to the greater care exercised in the disposal of excreta. It The average mortality from typhoid fever in our regular army since the Civil War has been for the first decade (1868-1877), 95 per 100,000 of mean strength (.95 per 1,000); for the second decade (1878-1887), 108 per 100,000; for the third decade (18881897), 55 per 100,000. This latter rate compares favorably with that of many of our principal cities. For example, it is exceeded by the typhoid death rate in the city of Washington, which is 78.1 per 100,000 (average of ten years—1888-1897); by that of the city of Chicago, which is 64.4 per 100,000; by that of Pittsburg, which is 88 per 100,000. These figures, however, do not show the entire mortality in the cities mentioned as a result of typhoid fever, for without doubt many of the deaths ascribed to "malarial fevers" were in fact due to typhoid infection. Thus in the city of Washington the deaths reported from typhoid and typhomalarial fever (average of ten years) numbered 78.1 per 100,000 of the population, while 23.4 per 100,000 are recorded as due to malarial fever. In Baltimore the mortality, as recorded, from typhoid fever is 41.5, and from "typho-malarial and other malarial fevers" 18.3 per 100,000. In St. Louis the figures are: typhoid |