H^', 1 -f V LK^TBE^ '&') SANITARY CONDITION TROOPS IN THE NEIGHBORHOOD OF BOSTON, ADDRESSED TO HIS EXCELLENCY THE GOVERNOR OF MASSACHUSETTS, S. G. HOWE, M. D. MEMBER OF THE UNITED STATES SANITARY COMMISSION. '"Mlrf "HINTED BY REQUEST OF THE ADVISORY COMMITTEE. WASHINGTON: GOVERNMENT PRINTING OFFICE. 1861. • HIS EXCELLENCY GOVERNOR ANDREW. Boston, July 25, 1861. Dear Sir : Some time ago I made, at your request, a hasty inspec- tion of the sanitary and general condition of our troops which were first sent to Washington, and reported to you that it was, upon the whole, satisfactory, considering the ordinary condition of armies in the field, and considering that the march of our men was not only their first march, but a forced one. In that sudden and dire emergency, it was meet that Massachusetts and her troops should accept the sufferings and hardships of war without a murmur. It was not a moment for close criticism. But we are getting into a state of persistent war, and it behooves us to see how it can be vigorously prosecuted with the least suffering and hardship to our soldiers that is consistent with honor. Being prevented from aiding the national sanitary commission, as much as I desired to do, at Washington, I have tried to do something indirectly here by visiting our encampments, and I address to you some reflections suggested thereby. From the moment a man enlists in the army his bodily and men- tal powers belong to the country. He is called upon by honor, duty, and patriotism, to devote his time, strength, and life even, if need be, to her service. These obligations are kept continually before his eyes, and those of the world, in prayer, prose, and verse, to say nothing of army regulations ; but there are others which are apt to be forgotten. Obligations between parties are reciprocal, and the country is bound by as strong ties of honor and duty to the soldier as he is to it. The soldier's health is his capital—his stock in trade. It yields a certain daily income in the shape of bodily strength and activity. All of this the country has a right to; but it has no right to touch the capital unnecessarily, or in any way to diminish it. Nay ! it is bound by moral considerations, if not by army regulations, to increase it, if pos- sible, so that the soldier may be richer when he is mustered out than he was when mustered into service. Any unnecessary fatigue or ex- posure, therefore, any needless lack of wholesome food and clothing, 4 any avoidable violation of sanitary laws, by which the soldier's health is broken, is a fraud upon him. These remarks may seem trite and superfluous, but experience shows that governments do not practically admit their responsi- bility to the soldier for the care and preservation of his health—his stock in trade. That our government ought to admit this responsibility, in part at least, is clear, because it undertakes to provide food, clothing, and lodging. These, especially the latter, are often unnecessarily bad and unwholesome; worse, certainly, than our volunteers from New England are accustomed to at home. Government ought to take as much care of the soldier's health as it does for its personal estate, its implements of war, or its horses, but it does not. For instance, it is well known that the use of straw between the ground and the. soldier's blanket is very important in a sanitary point of view ; it is useful, too, for horses. Now the United States army regulations allow 100 pounds a month for each cavalry horse, but only 12 pounds a month for each soldier. ' These straws show which way the wind blows. The government owns both the capital and the income of the horse's vital force, and economizes both ; but it owns only the income of the soldier's vital force, and neglects the capital. True, a horse needs more straw than a man, but not eight times as much. The point is, that he is provided, whenever it is possible, with all that is needful for his well-being, but the man is not. But if this instance is not well chosen, hundreds of others might be given to show what, indeed, the vital statistics of all modern armies show beyond question, that most governments do (unwittingly, per- haps) act towards soldiers as slaveholders are apt to do towards their slaves when negroes are very cheap—they use them up by hard work and poor fare in eight years, rather than make them last sixteen or twenty years by careful usage. Slaveholders have found out that this is poor policy when the prime cost is very high ; but government has not found out that, to the country, the costliest things are healthy and vigorous men. Let us glance at the imperfect statistics of mortality in our armies. In the Mexican war, 1,549 of our men were killed in battle or died of wounds, while 10,986 died of disease ; that is to say, for every man whom the Mexicans slew, disease slew seven. This, however, does not tell the whole story. A man slain in battle is one man less in our army; but for every man sick enough to be in the hospital there are •5 several others ailing, and only half fit for duty, while every patient requires the care and attention of ethers ; so that 1,000 men on our sick list diminishes our force at least 2,000. Again : To the slain man there is a sad end. If he, does not benefit, he does not cumber the world ; but of your sick men, many are in- valided for life. In the Mexican war, 9,749 were discharged as unable to do iurther military duty. These were young men, and most of them broken down by exposure and fatigue, and many forever ruined in health. The statistics of the war of 1812-'14 are imperfect, but full of sad, though useful lessons. Some of the regiments had one-third of the whole number sick in the hospitals at one time. Dr. Mann says, that from estimation of the number sick in general and regimental hospi- tals, he believes that about one-half of the whole army of Fort George was unfit for duty during the summer months. It is useless, however, to dwell on this matter, because our people begin to understand that the frightful mortality in armies is caused by disease far more than by wounds ; but they do not so well know that most army diseases are preventable, and that sickness and death among soldiers need not be more common than among men at home. Government reduces the mortality in good State prisons below the average in civil life, and they might so reduce it in the army if they would increase the expense. Why not? The soldier lives in the open air. His diet, and his lodging, and his habits may all be wisely regulated. Nay ! the thing has been proved. In consequence of the frightful mortality by disease the British government sent out a sanitary commission to the Crimea; and Miss Nightingale sent her- self. The soldiers had been dying like rotten sheep. Late in 1854 they died at the rate of 33 per cent, a year. The rate afterwards increased so fearfully, and rose so high, that if it had continued, and if recruits had not been continually poured in to fill the dead men's places, the whole army would have perished in less than a year. In consequence of active, wise, and resolute efforts the number of deaths immediately began to lessen, and continued to lessen until, in the first quarter of 1856, the rate of mortality was as low as it is usually among men of the army ages in the most healthy rural districts of England. Let us now look at the condition of the recruits in our encampments. They are said to be in good health. Of course they are, for they are fresh from their various wholesome callings. As time is necessary to 6 form an army, so it is to breed an epidemic ; and the processes for both are in active operation. The main object of these encampments should be two-fold—to train men by drill and manoeuvres, and to raise their physical powers to a maximum. The first is the duty of the officer, the second of the sanitaiian; an actual though lamentable distinction, for a really good officer will be also a good sanitarian. The first duty is everywhere looked after ; the second is almost everywhere overlooked. It ought not so to be. In training men for the ring we not only teach them to hit skilfully, but we at once put them on such diet and regimen as will increase their vital force and make them hit hard. In training soldiers, however, we submit them to such diet and regimen as must decrease their vital force. Who would think of training boxers on salt junk and lodging them in close rooms with foul air ? Yet this is what we are doing while training soldiers ; and it will tell in the coming campaign. There should be a very small percentage of kid glove in an army, We want muscular men who can march fast and far ; who can carry weight, and wheel guns, and use spades, and endure fatigue. In the southern army they have not merely ten but fifty per cent, of kid glove. But most of all we want men of abundant vital force, who can resist destructive agencies of all kinds ; among these are climatic influences ; and it will be found that strong, temperate, well- trained northern men will stand tropical heats better than southern men not so trained. In our encampments there are several things which tend to lower the vital force of recruits. The space allotted is too small, especially at night. A crowd is always unwholesome. Men want room. Packino- hu- man bodies closely together tends to breed disease. Hence comes the well known fact that epidemic army diseases resemble those engendered in closely packed quarters of large cities. But in no city, and no quarter of a city, perhaps, are people so closely packed as our soldiers are, or have recently been, at one of our camps, where accurate measurements show that the population was at the rate of over million to a square mile. A thousand men were encamped on 20 460 square feet of ground. As a general thing, not only at the islands, but in the camps on the mainland, the men are too much crowded. This is especially true of their quarters by night. The able report of the British commissioners on the sanitary condition of the army 7 recommends that each soldier be allowed in his barracks a space contain- ing at least 600 cubic feet of air. A room to contain this should be 10 feet square by 6 feet high. If the ceiling is higher, of course the superficial dimensions may be less ; but it will not do to carry this too far, for we run against a law which seems to require that every human being shall have lateral room and verge enough in order to be healthy. If you raise the ceiling to 10 feet, you may reduce the floor space to 10 feet by 6, but you cannot by raising it 20 feet reduce the floor space to 10 feet by 3 without detriment to the health of the sleepers ; and if they are forced to lie in close contact, no height what- ever, though it be of the whole heaven, will prevent contamination of the atmosphere, and injury by other means besides. With these principles in view, let us look at the lodgings provided for our volunteers. At Forts Warren and Independence some of the men lodge in casemates, some in tents. The casemates are, of course, damp in most weathers, and fires have to be kept up, even in summer, to make them less unwholesome. The following table shows the measurement of these rooms, at Fort Independence, with the number of men occupying them in the latter part of June. No. of Length of room. Width. Height. Floor surface. Cubic space. lodgers. Total. To each man. Total. To each man. Feet. Feet. Feet. Feet. Feet. Feet. Feet. 16 25 13* 10* 344* 12* 3,614 226 16 18 1-6 14 11 254f 16 2,897 181 12 14f 14* 11 212| 17f 2,339 195 12 14| 14* 11 212| 17$ 2,339 195 11 14f 14* 11 212f 19* 2,339 212 14 14! 14* 11 212f 15 1-6 2,339 167 21 23 17 13 391 18f 5,083 242 17 23 17 13 391 23 5,083 299 18 23 17 13 391 21* 5,083 2S2 18 22 18 13 414 23 5,382 299 14 18 H* 13 204 14 4-7 2,652 189 3-7 16 18 1H 13 204 12* 2,652 185$ 22 18 16f 11 300 13 7-11 15 51-59 40* 3,300 45,102 31,538 150 236 3,744* 190 88 27.6 13 60 2,426 525f Here the maximum cubic space of air to each man is less than one- half the minimum recommended by the British Sanitary Commission. The floor space was still more cramped, being less than 16 feet upon an average, and in one room less than 13 feet to a man. This allows 8 only about two feet lateral space upon the floor, so that the men slept in actual bodily contact, packed almost like herring. It could not be otherwise. One company, more fortunate, were lodged in a sort of barn, had over 40 feet of floor space, and 500 feet cubic space per man. The following table gives the measurement of the rooms at Fort Warren: Xo. of Length. Width. Height. Floor surface. Cubic space. lodgers. Total. To each man. Total. To each man. Feet. Feet. Feet. Feet. Feet. Feet. Feet. 12 15 131-6 7 1-6 197.5 19 1,4-23 119 11 16* 11 7 1-6 181.5 17.6 1,267 115 12 16* 10* 7 1-6 176 14.8 1,261 113 60 45 15 16 675 11.25 10,800 180 12 16* 11 7 1-6 181.5 15 1,283 106.6 12 16* 10! 7 1-6 176 14.8 1,261 105 11 16* 10! 7 1-6 176 16 1,261 113 Here, again, the average floor space was less than 15 feet to each man, and the average and cubic space less than 145 feet. I omit from the calculation one room, in which on one night 75 men are said to have slept, with a floor space of only nine feet to a man ; which is hardly credible even by western travellers, who have to sleep three in a bed, or on the floor. It is useless to say that the air in such rooms must be unwholesome even with the port holes and doors open in warm breezy weather ; but when closed in cold nights, or whether closed or open in still nights, the air must become fetid and unwholesome. Breathing it must, of course, continually, and little by little, lessen the stock of vital force. As for those lodged in tents, they fare worse. In the first place, the tents are badly pitched. In some no atten- tion is paid to drainage ; and in none that I have seen is the drainage systematic and thorough. In some, as at Eeadville, a slight ditch is dug around the tent, and the sods and dirt left in a heap or carried away at leisure. A far better way is, supposing the tent to be circu- lar, first, to mark a space equal to its circumference at the bottom, and take off all the sods from the inside of this circle, then dig a trench all around the outer edge and throw the dirt within the circle, then take the sods and put them back again and beat them down firmly. You have then an elevated floor; and if you drive the pegs at the bottom of the trench, and strap down, you can easily keep the tent dry without closing it at the bottom. If the wind blows, throw in a 9 little light straw, hay, or brush, and break the draught without closing the opening. If the ground is well chosen, it is easy to drain all the trenches into one common drain. I was told by many officers when I suggested these precautions that they were not necessary ; that there was not much rain, and the ground being sandy readily absorbed it. But our camping grounds ought to be schools ; and the soldiers ought to be taught to take such measures to secure dry sleeping places as will be necessary in the worst weather. As it is now, a three days' heavy storm, such as we have at some seasons, would make most of our tents very uncomfort- able and unwholesome, if not uninhabitable. In the next place, the tents are too much crowded together. For instance, at Long Island, a regiment was encamped on 20,460 square feet, which gave less than 23 square feet of surface for each man. Moreover, the tents, instead of being in separate rows with wide space between each, were in double rows, with the back ends in con- tact. This may not occur again; but the same error, though in a less de- gree, prevails in many camps, and ought to be corrected. Military considerations, of course, often require a sacrifice of sanitary precau- tions, but they do not in this matter. As for the floor space and the cubic space of air allowed to the men inside the tents, it seems hopeless, with the modern ideas of encamp- ment, to have as much as is absolutely required for health. Of all the impedimenta of an army, tents are among the greatest; and many brilliant campaigns have been made without them. Indeed, I doubt whether, in the long run, men who sleep in the open air, without other covering than a hooded capote or a poncho, suffer more than those who are poisoned by the close and fetid air of tents. In ours the floor surface allowed is so small that the men must lie in contact; while the roof is so low that the cubic space is no greater than that of the black hole of Calcutta. It is true that in dry weather the