Even before the epidemic, Wellington had a considerable problem by virtue of the number of Talavera casualties. This circumstance did, however, ensure that when sickness broke out steps had already been taken to organize hospitals, notably in the fortress of Elvas. Command of the sick was given to Lt. Colonel Henry Mackinnon, who oversaw the evacuation of the wounded back to Portugal and subsequently took command at Elvas, working alongside James Franck, McGrigor’s predecessor as inspector. But, even with these provisions, the numbers of sick swamped the system, and there was little Mackinnon could do so far as the actual medical care was concerned.48 Provision in this regard was sadly lacking at this stage in the war, and though the Elvas hospital was organized with a main section in a convent and a convalescent hospital in one of the barracks, overcrowding and lack of equipment and trained personnel ensured that conditions were hellish and recovery rates low.49 Cooper of the 2/7th described conditions in the “Bomb proof barracks” at Elvas: “No ventilation, twenty men sick in the room, of whom about eighteen died. In this place there were [sic] one door, and one chimney, but no windows. Relapse again; deaf as a post; shirt unchanged and sticking to my sore back; ears running stinking matter; a man lying close on my right hand with both his legs mortified nearly to the knees, and dying. A little sympathy would have soothed, but sympathy there was none.”50 Unsurprisingly, those who had the choice preferred to remain with their units, one such being Lt. George Simmons of the 1/95th, who, despite three recurring bouts of fever—which he attributed to overexertion in the heat—was “allowed to proceed, by my own wish, with my regiment.”51 No matter how well organized, military hospitals were places to be avoided if at all possible, but for the rank and file the opportunities for private convalescence available to an officer like Simmons did not exist. In November, 5,740 rank and file from the infantry were sick in hospital, as opposed to 2,268 remaining with their battalions, but conditions for the latter can hardly have been improved by the fact that many battalion surgeons were taken from their units to make up for shortages at Elvas.52 Although the eventual move away from the Guadiana was marked by a decline in death rates, it would take far longer for the men on the sick lists to return to their units, as is demonstrated by the lack of correlation between sickness and death rates during the epidemic.
Whilst the Guadiana epidemic was a one-off case insofar as its affecting the entire force was concerned, the trend seen during the initial months of Phase B, of an increase in the sick rate coinciding with the opening of active operations, continued throughout the war. As the army became more acclimatized, the levels of sick became lower, but each break from settled quarters saw a distinct increase. This pattern can be seen in Phase C of figure 8, representing the Busaço campaign; even in this short time, the sickness ratio climbs markedly before dropping off again when the army went into winter quarters behind the Lines of Torres Vedras. It also recurred in Phase D, beginning with the pursuit of Masséna in March 1811 and continuing through to the following December, when the army was again in winter quarters. During this latter period, the army undertook a series of lengthy marches, with elements of the force being shifted between the northern and southern theaters. The debilitating effect of these marches, along with heavy combat casualties, ensured that sickness and death rates remained high. The contribution of attrition through strategic consumption is made clear by the fact that whilst the death rate drops after being forced up by the bloody actions of spring 1811, the sickness ratio continues to climb until active operations ceased.
Whilst the coincidence of active operations and a higher sickness ratio is understandable, with physical exertion and exposure to the elements both being recognized at the time as major contributors, a recent study has suggested an additional cause. The historian Edward Coss has demonstrated that the standard British ration issue during the Napoleonic Wars, composing biscuit, meat, and wine or spirits, compared unfavorably not only with that of the British soldier at earlier points in history but even with the food supplied to Renaissance galley slaves. Quite apart from occurrences of commissariat failures, which naturally made the situation worse still, the rations, even when delivered, are shown to have surprisingly low nutritional value. In particular, Coss’s comparison between the standard ration and modern medical guidelines indicates a very low level of protein being provided. The standard ration was further deficient, wholly or in part, in fifteen of twenty-one major vitamins or macronutrients, with accordingly negative effects. Whilst the collective contribution of these dietary deficiencies was debilitating in itself, they also impeded recovery from other illnesses and wounds. Significantly, for example, the ration contained only 4 percent of what is now the recommended allowance of vitamin K, the absence of which can impede blood clotting and therefore increase both bruising and bleeding from wounds.53
Whilst Coss’s calculations give a valuable insight into the nature of the nutritional problems faced by British soldiers, it should be kept in mind that the sparse nature of the basic ration was essentially down to financial and logistical constraints rather than medical ignorance. Nutritional theory in the early nineteenth century may not have progressed beyond the concept of the “universal aliment,” believed to be present in equal proportion in all foods, but the doctors who treated the British solider of the Napoleonic Wars were fully aware of the advantages to be obtained through a healthy and regular diet, even if terms like “macronutrient” would have meant nothing to them. McGrigor summed up the situation as understood in 1815, asserting,
The health of an army depends, in no slender degree, on the quality of the provisions and on the regular supply of them. Some of the divisions of the army appeared to derive a superior degree of health from attention to these circumstances. Some of them were always supplied with abundance of good meat, wholesome wine, and excellent bread; while others complained of their meat, got spirits instead of wine, biscuit instead of bread, or sometimes had neither bread nor biscuit, receiving in lieu of it a portion of flour, or an additional quantity of meat. It was the duty of the superintending medical officer of a division to see these things, and to report to me whenever they were complained of, or were equal to the production of disease. This was done for my satisfaction: at the same time I must state, that generals of division were usually paternal in their attention to the soldier, as well as most commanding officers of regiments.54
Further emphasizing the importance of effective leadership as essential to a good level of fitness in a unit, and reiterating too the paternal nature of that leadership, McGrigor went on to note, “If left to himself, the soldier would broil his modicum of meat and eat it at one meal, drinking his allowance of wine or spirits at a draught. It is needless to say, how hurtful this must be to a man undergoing great fatigue and requiring much nutriment. The orders of the Duke of Wellington were, that whether in the field or in quarters, the men should be divided into messes, have regular meals, their meat be well boiled, with a portion of vegetables and salt (whenever they could be procured): and under the inspection of their officers.”55 The fact that efforts were clearly being taken to supplement the standard ration, even if those efforts were not always successful, affirms that Wellington, his subordinate commanders, and his medical staff were fully aware of the shortcomings of the standard ration and sought to increase it where possible. This was also the case in other theaters, with Graham in January 1814 requesting that Horse Guards consider the viability of “the sending out of a large quantity of Cocoa ready pounded” in the hope that a warm breakfast would help soldiers retain their health in the viciously cold Dutch winter.56
Despite such measures, it is nevertheless clear that nutritional factors played a considerable role in the rapid increase in sickness figures during active operations. When the army was in billets, less energy was expended and food was more readily available, allowing soldiers to recover their health before another spell of active operations, such that the sickness rate only rose when the army was engaged in sustained active oper
ations over an extended period of time. Attempts were made during quiet moments to keep the men hardened by route marches, but whilst the practice would have been beneficial in keeping feet and backs used to the strains of long-distance marching, and thereby limit the numbers of men who might fall out as footsore once operations recommenced, it did nothing about the problem of insufficient nutrition once the army was on the move again.57 Not only were men then far more physically active, and lacking in ready access to shelter, but a failure or hiatus in supply was far more probable and fewer opportunities existed for obtaining food legitimately from other sources. It may well be that this led to men seeking to obtain food by illicit means, but, equally, the opportunities to do so whilst on active operations would not always have been available. Nor, in well-led units where rations were supplemented where possible, and their consumption supervised, should such recourse have been necessary under ordinary conditions. This is not to deny that plundering and illicit foraging occurred—examples aplenty have already been encountered in these pages—but such occurrences seem to have generally been crimes of opportunity and, crucially, to have taken place when soldiers had the time and energy to engage in them. Large-scale foraging in defiance of orders whilst on campaign is only to be encountered on those occasions when the supply system collapsed under pressure, as in the aftermath of Talavera or during the retreat from Burgos.58
Whilst McGrigor appreciated the problems caused by poor nutrition, there were limits as to what he could achieve in this area. On the other hand, he did have primary responsibility for the peninsular army’s hospitals and is primarily remembered for his reforms of their arrangements, something that was certainly needed as accounts such as Cooper’s recollection of his experiences at Elvas testify. The success of these measures is readily apparent in Phase 2 of figure 8. Here, after being pushed to its highest point by the conditions experienced during and after the Burgos retreat, the ratio of sick drops hugely during the first half of 1813. In part, this decrease was because the army had the opportunity to spend a good six months in relatively settled quarters, but there is no denying that men were now getting better medical care than had been the case three years previously. McGrigor’s primary success was in increasing the role of the regimental hospitals, leaving only the worst cases to be treated in the larger general hospitals; this change was of course extremely beneficial when the army cut loose from its established Portuguese bases prior to the Vitoria campaign. New general hospitals were established as the army advanced, notably at Santander and Pasajes, and, both in these and the older established hospitals, greater care was taken to ensure cleanliness and an adequate supply of food, medicine, and clothing.59 The impact of these reforms is, however, masked in part by the fact that the winter of 1812–13 saw the recurrence of epidemic fever. As we have seen, swift quarantine largely confined this contagion to the First Guards Brigade, but the Guards battalions were not the only units to contract the disease during that winter, and it is a tribute to the hospital reforms at both regimental and army level that, unlike in 1809, only an isolated part of the total force was seriously afflicted.60
In the final winter of the war, the provision of tents for the infantry meant that the problems encountered in 1809–10 and 1812–13, with confined conditions leading to diseases such as typhoid, did not arise. Tents not only provided basic protection from the elements, but also kept the troops out of potentially insanitary billets. Each infantry company was allocated one tent for its officers and a further three for its NCOs and men; known as “Flanders Tents,” these were of a large bell configuration with a central pole. In addition, one tent was allocated to each field officer in a battalion, and to the paymaster, with an additional tent shared by the adjutant and quartermaster and another by the medical staff. Transport space was obtained by replacing the old iron camp kettles with small tin ones that could be carried by individual soldiers; the mules that had previously carried the large kettles were then able to carry the tents.61
That it was possible to issue tents for use in the field is in itself testament to the improvements in logistical organization during the course of the conflict—back in 1810, it had not even been possible to provide sufficient tentage for the troops within the Lines of Torres Vedras—although a shortfall did develop by early 1814 that required the shipping of a further 1,500 tents.62 Poor storage did also cause problems, as George l’Estrange recalled, “[The tents] had come out from England at the beginning of the year; they had therefore been a long time in store, and consequently the tent cloths were rather degraded, which was unpleasant indeed, for when the snow begins to fall on the top of the Pyrenees it comes with a vengeance.”63 Ultimately, matters reached an inevitable conclusion, and the rotten canvas of l’Estrange’s tent gave way under the weight of the snowfall. Such difficulties aside, the provision of tents—in conjunction with efforts at a unit level to construct huts or adapt abandoned civilian dwellings—certainly contributed to the reduction of disease, and this would in turn reinforce McGrigor’s view that camp discipline was being well enforced at a unit level by this stage in the war. Indeed, McGrigor noted that it was amongst the cavalry regiments, billeted in villages well to the rear and thus still exposed to the contagions from which the tented infantry had escaped, that the worst levels of sickness were to be found during the winter of 1813–14.64 The Historian John Elting suggests that for troops not sufficiently “housebroken,” tents could in fact increase the likelihood of disease, but this does not seem to have posed a problem in Wellington’s regiments.65
In his account of the closing months of the war, McGrigor implies that he had all but eradicated serious sickness amongst the troops, but this does not tally with the impression given by the data from the regimental returns, which show that the sickness rate, though falling, remained above 20 percent while active operations continued. However, it needs to be kept in mind that McGrigor’s account was based on the figures kept by his own department and listed the numbers of troops recorded as present in the various hospitals. By contrast, the figures used for this analysis are those kept by the units themselves, and at this stage in the war a distinction is no longer made between those sick men being treated in regimental hospitals and those detached to general hospitals. Alongside this point, two additional considerations serve to reconcile McGrigor’s analysis with the data from the unit monthly returns. Firstly, as we have seen, the quality of reinforcements had deteriorated considerably, leading to high instances of sickness among them due to unfit manpower being sent out without time to fully acclimatize—thus, there was a concentration of sickness in a handful of units. The second issue is more significant and can in fact be applied to the war as a whole, with its effects during the last eighteen months being exacerbated by the movement of the army away from its established depots. This was the problem of getting convalescent manpower back to the front from the base hospitals, which is the point at which strategic consumption through sickness and strategic consumption through absenteeism become linked.
As early as October 1810, regimental returns indicated that there were twice as many men in the base hospital at Belem than the hospital’s own records showed.66 These “Belemites,” or “Belem Rangers,” numbered many malingerers but also included men awaiting the opportunity to return to their units.67 Considering that this problem was already pronounced in 1810 when the theater of war was centered on Lisbon, it is readily apparent how much more complex and problematic matters became as the army moved further from its bases. Convalescents had to be grouped together—usually by increments of twenty—and officers found to oversee their movements.68 Not only was the rate of progress slow, but there was frequently a shortage of superintendence, since many convalescent officers preferred to make their own way back to their units, frequently at a pace to suit themselves; that said, at least one officer landed himself before a court-martial after an out-and-out refusal to superintend convalescents.69 The ease with which it was possible for men to slip out of the system
during transit is emphasized by the fact that in March 1814 it was necessary to strike from the records a total of 1,815 rank and file, eleven sergeants, and eleven drummers who had disappeared between the hospitals and their regiments.70
McGrigor argued that improvements to regimental hospitals by 1813 meant that far more cases could be treated without the sick man leaving the army; this cannot be proven or disproven using the unit returns, but McGrigor’s own analysis suggests that it was so. If McGrigor was indeed correct, then a significant portion of the men being returned as sick by their units after mid-1813 were in fact convalescents in the process of returning to the front, and McGrigor’s statement that “we suffered very little from disease, our hospitals containing few besides the wounded”71 is closer to the truth than the data might imply. Irrespective of these points, additional proof of the efficacy of McGrigor’s policies can be seen in the fact that whilst the overall trend in sickness rates—shown in figure 8 as a dotted line—is upward, the actual figures for the final year of the war remain below the level that the trend line would suggest as typical.
It is in this context that McGrigor’s supporting argument, that his figures were artificially inflated by the fact that sickness remained high in the cavalry, which is otherwise impossible to reconcile with the data from the monthly returns, makes sense. McGrigor’s analysis, being based on hospital records, accordingly ignores the absent convalescents who were artificially inflating the sickness ratios in the infantry. So far as the hospitals were concerned, these convalescents were fit and on their way back to the front, but since they had not yet rejoined their regiments the latter continued to record them as sick. This in turn suggests that, outside of the cavalry where some sickness still needed to be eradicated, many of the men being returned as sick by their regiments were in fact lost in the system, by accident or by their own design. If McGrigor is correct about the success of his reforms, then the primary problem at this stage of the war was not healing the soldier—vital as that remained—but getting him back to his regiment.
Sickness, Suffering, and the Sword Page 29