“Sanitation standards in the 18th Century were almost non-existent. Soldiers were in the habit of relieving themselves wherever they wished, including outside their own tents, turning encampments into mucky breeding grounds for dysentery.”
By George Yagi Jr.
18TH CENTURY MILITARY camps were hotbeds for communicable diseases. Often, more soldiers on campaign died from illnesses like typhus, smallpox, typhoid and malaria than were ever felled in battle. Interestingly enough, the overcrowded and unsanitary garrisons of the era provided trailblazing doctors remarkable opportunities to learn about how germs spread.
At the forefront of these studies was Sir John Pringle, often referred to as the founding father of modern military medicine. While traveling with the British Army during the War of the Austrian Succession and the 1745 Jacobite Rebellion, Pringle had the opportunity to observe first-hand both the living conditions of the troops as well as the diseases that regularly afflicted soldiers. Among the more prevalent illnesses he witnessed was dysentery, also known as the “bloody flux.”
Dysentery is characterized by nausea, fever, severe abdominal pain and explosive bouts of diarrhea. Easily transmittable and frequently fatal, the infection could decimate an army before it ever went into battle. While today we understand bacteria and amoeba to be the cause of dysentery, during the 18th Century these concepts of contagion were not understood. Doctors believed illnesses were brought on by an imbalance of the four humors, which consisted of black bile, yellow bile, phlegm and blood. Despite such antiquated notions, Pringle still managed to discover the connection between dysentery and hygiene and was able to lessen the effects of the disease on armies in the field.
Sanitation standards in the 18th Century were almost non-existent. As a result, soldiers were in the habit of relieving themselves wherever they wished, including outside their own tents, turning encampments into mucky breeding grounds for dysentery. The shigella dysentery bacteria or the amoebic Etamoeba histolytica variant are both transmitted through infected feces. Thanks to lax attitudes towards even the most basic tenets of sanitation or personal hygiene (such as hand-washing) soldiers easily spread the disease among their comrades. Sewage and waste running off into nearby creeks and streams also contaminated water, further increasing the likelihood of infection. As water provides dysentery with a means of transport, Pringle noted that when soldiers encamped on damp ground during hot weather, the illness would wreck havoc upon the men.
After British forces emerged from their victory at the Battle of Dettingen on June 27, 1743 he recorded:
On the night following, the men lay on the field of battle, without tents, exposed to a heavy rain; next day they marched to Hanau, where they encamped in an open field, and on good ground; but it was then wet, and for the first night or two they wanted straw. By these accidents, a sudden change was made in the health of the army. For the summer had begun early, and the weather had been constantly hot; but the free and uninterrupted perspiration; attending those heats, had as yet prevented any general sickness. Now, the pores were suddenly stopped, and the humours tending to putrefaction were turned upon the bowels, and produced a dysentery, which continued a considerable part of the season. In the space of eight days after the battle, about 500 were seized with that distemper; and in a few weeks, near half the men were either ill, or had recovered of it.
While the army suffered from the effects of the disease, Pringle noticed one group of soldiers who for some reason had been spared. On their condition he noted:
They encamped for the first time at a small distance from the ground that was afterwards occupied by the army. These men had never been exposed to rain, nor had lain wet; by this separation from the line, they were also removed from the contagion of the privies [latrines]; and having pitched close upon the river, they had the benefit of a constant stream of fresh air. By means of such favorable circumstances, it was remarkable, that while the main body thus suffered, this little camp almost entirely escaped; though these men breathed the same air, the contagious part excepted, used the same victuals, and drank of the same water.
These fortunate soldiers, however, would not enjoy good health for long. After joining the main army, many of their number contracted dysentery too. After witnessing numerous similar situations during his travels, Pringle began his efforts to confront the disease before it occurred.
Pringle was unaware of the role of bacteria, as he ascribed the appearance of dysentery to “putrid air.” These he classified into four categories:
“The first arising from the corrupted water of the marshes; second from human excrements lying about the camp in hot weather, when the dysentery is frequent; the third, from straw rotting in the tents, and the fourth kind is that which is breathed in hospitals crowded with men ill of putrid distempers.”
As for combating the ‘bloody flux,’ Pringle had specific advice on establishing encampments to prevent outbreaks. As he believed putrid air played a key role in the spread of the illness, he recommended the daily opening of tents to provide ventilation.
Concerning the straw used as bedding, he advised that it be changed regularly, but if that were not possible, that it be aired out and dried to prevent dampness from accumulating.
As wet ground also proved problematic in his diagnosis, he also advocated the digging of trenches to drain off moisture and carry away rainwater to maintain dry living quarters.
While these measures were effective for maintaining the health of the army, the best method for combating dysentery he argued was to keep an army moving. Latrines he reasoned were a major source of the infection.
“Make frequent removes; for by shifting [camp]… men will have more exercise, and the old privies will be left behind, which in camps are particularly noxious on account of the frequency of dysentery.”
Aware that human waste played a major role in the spread of the disease, Pringle was particularly concerned about the establishment and use of latrines. He specifically instructed:
In order… to preserve a purity of air in the dysenteric season, let there be some slight penalty, but strictly inflicted, upon every man that shall ease himself any where about the camp, but in the privies. Further, from the middle of July, or upon the appearance of a spreading flux, let the privies be made deeper than usual, and once a day a thick layer of earth thrown into them, till the pits are full, which are then to be well covered, and supplied by others. It may also be proper to order the pits to be made either in the front or rear, as the reigning wind of the season may best carry off their effluvia from the camp.
While Pringle had yet to grasp the concept of bacteria, he did understand that human waste was a source of contagion, which justified the use of punishment if the latrines were not used and feces were found outside the tents of the soldiers. In addition, the location of the latrine pits and the daily application of dirt in the belief that the air was infected, would have helped prevent flies from spreading the disease.
Although his suggestions were simple, and at times arrived at for the wrong scientific reasons, they were effective in combating dysentery. Despite this good advice, until the appearance of antibiotics in the 20th Century, the disease continued to ravage armies where soldiers carelessly refused to use the latrines.
In modern times, dysentery continues to infect soldiers in distant regions where sanitation is poor, but not with the high mortality rates witnessed during the 18th Century. This success today would not have been possible without the pioneering work of Pringle.
Dr. George Yagi Jr. is a historian at California’s University of the Pacific. To learn more of Sir John Pringle and his contributions to the field of military medicine, see his latest book, The Struggle for North America, 1754-1758: Britannia’s Tarnished Laurels. Follow him on Twitter @gyagi_jr