Sir John Pringle was born in 1707 into a Scottish baronetcy. As a young man, he went to the Netherlands and studied medicine at Leyden, received his M.D. in 1730, and four years later was made a professor of Pneumatics and Moral Philosophy at the University of Edinburgh. He became involved in the War of Austrian Succession when the Earl of Stair, who was leading a British force through Flanders in 1742, appointed him to lead the general hospital. The professor brought to the army an expertise on diseases and hygiene previously unknown. He also changed the political face of war, as this excerpt from Walker (p16) illustrates:

It was through Pringle's agency that the practice of regarding hospitals in the field as exempt from attack by the enemy was first established. The Earl of Stair made the proposal to the Duke of Nottilles, who commanded the enemy (French) forces, and from that date a custom, by which many men were lost, of removing the sick on the approach of the enemy to a point beyond the camp was discontinued, and the hospitals were regarded as neutral territory.

This agreement was part of a document known as the Frankfurt Cartel. Unfortunately, before long each side was accusing the other of breaking it. At*Fontenoy, Cumberland accused de Saxe of mistreating the British wounded, and de Saxe accused the British of violating another section of the Cartel, that dealing with ransom (Skrine pp215-219). Nevertheless, the concept had been established, and descendant conventions can look back upon the Frankfurt Cartel as a forerunner.

Pringle soon gained reknown for the hygenic and dietary improvements he introduced to the British army, and as a reward, in 1745 the Duke of Cumberland made John Pringle "Physician General to his Majesty's Forces in the Low Countries and beyond the seas."

After the war, Pringle went to London, where he wrote Observations on the Diseases of the Army in Camp and Garrison. This wonderful work went through many editions and languages, and was being printed at least as late as the l790's.

A recurring theme in Pringle's book which he proves again and again through careful observation is that damp, marshy, low-lying areas breed disease faster than high and dry ground. The fighting ground in Flanders and The Netherlands were just such damp places - called the "Low Countries" - areas that had previously been marsh or even intrusive saltwater bays, but which had been diked off into farmland.

Everything north of the river Dys in Flanders was considered Lowlands (see map in SWYA Journal Vol. VI, no. 3, p10) as well as the coastal lands in the Dutch Brabant and United Provinces. In these low environs, the epidemic would start in July or August, decline at first fall, and cease at first frost (Pringle p7).

Epidemics, as "virulent" of easily spread diseases, were often intermittent or remittent fevers, and the troops thus afflicted would have intense thirst, increased body temperature, nausea, vomiting, and other foul symptoms. Additional epidemic diseases were the fluxes-namely Cholera and Dysentery. Both of these fluxes, as well as the fevers, were often accompanied by worms exiting the anus, mouth, and nostrils, driven out by the heat of fever (Monro). It was taken for granted that these worms already existed in the men's bowels as a matter ofcourse.

The non-epidemic and non-seasonal yet persistent diseases, or the "chronics," scurvy was the most common, existing throughout the year. Itching was also a continual problem. However, in June 1742, when 16,000 British troops under Lord Stair landed in Flanders, none of these diseases, except itching, were present. The men were in good health.

Headquarters was set up at Ghent, situated right on the border between the Lowlands and the Uplands. Here were stationed three Foot Guard batallions, most of the cavalry, one line foot regiment, the train and the general hospital. Ghent was to become the perfect place in which to observe the different effects of the Lowlands and Uplands on troop health. For example, of the Ist Foot Guards, two companies were stationed on the high and dry St. Peter's Hill, whereas eight companies were billeted in the lowest, dampest part of town. By July, 138 men from the eight lower companies were sick, versus 2 men from the two higher companies (Pringle p14), representing a 17-fold difference.

During this same period in cantonments (quarters), the highest number of sick for any of the other British foot regiments was 70, and for a dragoon regiment was 40. These reports included all accidents, so the actual number at this point was only three times that for home duty (Pringle ppl5-16). Dr. Pringle notes at this point that a complete battalion consisted of 813 men, but commissioned officers were not counted in the sick returns, the rates must be figured at a battalion strength of 780. The dragoon regiments mustered 474 enlisted men each, divided into three squadrons.)

During the headquarters stay in Ghent, the rest of the army was stationed in numerous towns where the sick rates varied from three times those of Ghent, to almost no sick at all. The dragoons outside of Ghent enjoyed such good health that not a single man was left behind when they decamped.

In November, the mild Autumnal epidemics ceased and the Winter diseases began. These consisted of "...colds in various shapes..." including pleurisy, hard coughs, stitches, rheumatism, inflammation of the lungs, and other ailments. The soldiers, unused to the weather and very poorly clad, fell quickly to the "colds". Additional but less chronic Winter diseases suffered by the troops included dropsy and consumption, and lastly, the dreaded Malignant Fever. This hit the general hospital that Winter, sparing few whom it afflicted. The source of the terrible distemper was eventually traced to the decayed limb of a soldier. (Pringle p19).

Early in February 1743 the troops headed for Winter quarters at Julius and Aix-la-Chapelle in Germany. The soldiers were still in fine condition, though 600 sick were left behind at the general hospital at Ghent. Soon after settling into quarters, the Influenza of 1743 swept Europe, luckily sparing most of the British except for some in Brussels (Pringle p20).

The Winter of 1742-43 was extremely cold. In March, a 17 day snowstorm started in Germany, during which the British troops left their Winter quarters and crossed the Rhine (the Dettingen campaign). "The march was long and the roads deep, but the men had warm houses to stay in at night and good provisions, so that very few were lost" (Pringle ppl9-20). On March 17th the troops encamped at Hoechst, which was a dry and healthful country.

In May, when the ground was still wet and the nights were still cold, the diseases of Spring began. A flying (ambulatory) hospital was opened at Nied to receive the men who were falling to the Spring inflammations. These diseases were caused by the troops having to sleep in tents without covering and by exposure to rain, with no way of drying out clothes- freezing conditions which would send most modern backpackers scurrying back to town in defeat.

Interestingly, the cavalry, as always, had a lower proportion of sick in camp. This was because of the extra exercise that they received while caring for their horses, and also because they were issued cloaks to keep them dry or to use as bed-clothes. The officers enjoyed perfect health . and always do in the first part of campaign. " (Pringle). On the 22nd of June, the army marched to Aschaffenburg, leaving behind 500 sick, or a ratio of 1:29.

The nights were now becoming warmer and the rains ceased. The troops were starting to enjoy better health, when, in the evening of June 26th, the tents were struck and the men began a night march to Dettingen, that famous field of carnage. The night after the battle, which the British won, the victors lay in the open field without tents in a heavy rain. The next day, the 28th, the army marched off to Hanau, where they made a field camp: "by these accidents, a sudden change was made in the health of the army." (Pringle p24). Epidemic dysentery struck, knocking down 500 British within eight days of the battle, and nearly half of the army were similarly afflicted within the next few weeks. Even so, some of the officers became ill.

The dysentery abated in August as the weather turned warmer and dryer, and the army crossed the Rhine to make for Worms. But it was at this time, just as the dysentery was dissipating, that the Autumnal fever reappeared. By mid October 800 men were in the hospital at Worms. On October 25th, camp was broken and the troops returned to The Netherlands in various divisions, leaving behind 3000 sick in Germany (Pringle p30), which constituted a sizeable portion of their army.

One of those hospitals retaining the sick was in a small town called Feckenstein, whose sad memory attests to the dangers civilians faced when having hospitals placed in their villages; although half of the patients were lost, nearly all of the villagers died, first from the Bloody Flux and then from the malignant fever.

By mid December, all of the sick in Germany were moved back to Ghent on river transport. As Dr. Pringle relates:

"So that , in this tedious voyage, the fever having acquired new force by the confinement of the air, mortifications and other putrid Effluvias, it was raised to such an extraordinary pitch of virulance, that above half the number died by the way, and several more soon after their arrival. (p30).

Of 23 healthy workers assigned to unload the tents packed on this ghastly barge of death, 17 died shortly afterwards. Thus by the end of the campaign of 1743, there were three British soldiers in the hospital for every thirteen in quarters. Just as in the previous year, the remittant fevers lasted until about December, to be replaced by the coughs and colds during the Winter.

In the Spring of 1744 no epidemics hit the army. The campaign started in May, and on the 3lst of July the army crossed the Scheldt, encamping in Lisle, where they remained for almost the rest of the campaign. This campaign saw the addition of five fresh foot batallions, plus new recruits and additions to the dragoons, bringing the British Army upwards to 10,000. The year turned out to be relatively healthful, and when in late Fall, camp was broken, only 1500 sick were left behind and 300 dead, all from disease. The army was becoming hardened by the campaigning and the Winter remitting fevers were mostly confined to recruits that year (Pringle pp35-40).

The Flanders campaign of l745 began on April 25 for the British, which is when the army took to the field, encamping at Anderlecht. On the 9th of May they came up to Brifford, where the weather was fine and the sickload light, with only a few cases of fever. After a while, smallpox began to be felt, though it did not spread much, and seemed to have been brought over by the new recruits. Pringle states that at no time was it known to be of consequence in the campaigns.

The eleventh of May saw the tremendous battle of Fontenoy, in which the British , though ultimately forced to retire from the field, consigned a host of good Frenchmen to the ground via an unbelievable eruption of firepower. The weather was fine on that infamous day, and:

"... the following night so dry and mild, that tho' most of the men lay without cover, and all had been extremely fatigued, yet no sickness occurred. (the) next day an hospital was made at Ath, in the cuzernes of St. Roe, which took in about 600 wounded (Pringle p43).

After the battle, the army moved on to Leffines, where it stayed until the end of June. May was warm and dry, but June proved to be cold and wet, prompting a return of the Summer agues and fluxes. "...tho little affecting the old and hardened troops, (the diseases) were severe on Price's and Mordaunt's regiments..." (Pringle p43) Good health finally returned when the troops moved in Autumn, so that when camp was broken on October 24th, and the troops dispersed into Winter quarters, they were in fairly good health.

The exceptions to this were the five British battalions which had surrendered at Ostend, where disease struck many during their forced march to barracks at Mons. Another exception was Handy's regiment, which spent the campaign in the moist citadel of Antwerp, where they suffered grievously from dysentery. By the end of the campaign of 1745, only 1000 men were left behind in Dutch Brabant, along with 200 dead from disease, which was a great improvement over the previous year (Pringle p47).

1745 saw the bulk of the British army embark for England in order to defend the monarchy from the Stuart uprising. By early December, two battalions and three cavalry regiments had assembled under the Duke of Cumberland at Litchfield, where "the Quakers had made a present of under-waistcoats to the men; which was a seasonable provision for a Winter campaign." (Pringle p50).

By late December, most of the troops had settled into Winter quarters, except for 1000 foot and a force of cavalry marching on Carlisle. As men in this small detachment fell ill, they were left in towns and houses along the road and entrusted to the care of local surgeons and apothecaries (pharmacists). By the time Carlisle was taken in early January, only one man in the expedition had died from sickness. This low flgure was a result of the mild weather and nice billets along the way. The rest of the corps, in Winter quarters, suffered only 600-700 sick and 40 dead from disease (Pringle p52).

On February 10th, the Duke's army marched from Edinburgh toward Perth. There were plenty of provisions, but the quarters were poor, and many began to succumb to Winter inflammations. From then until April, the diseases took their usual Winter course. As Spring advanced, the distempers slackened as in past years.

Following the battle of Culloden, fought on April 24, 1746, the troops encamped at Inverness, which proved to be a very tragic place indeed. A hospital for the British wounded was set up in two malt-barns after the battle, 270 being admitted. Pringle states that there were many broadsword wounds, but these proved some of the easiest to heal. Besides the malt-bam hospital, a sick infirmary was set up in two houses. In addition, the jails in towns were literally crammed with the rebel wounded, whose corpses were hauled out as they died.

The people of Inverness had just recovered from a scourge of smallpox and measles before the troops arrived. An army market had been set up in town, and it was a crowded dirty place with "morbid air". All of theselactors combined (the wounded, sick and the state of the town) made the physicians and surgeons fear for the worse, so every precaution was taken to have the wards aired-out and the men kept clean. The jail was thinned out by putting some of the prisoners on board a couple of ships laying port. (Pringle pp5556).

The precautions seemed to work, for the month of May passed with no unusual infections among the troops. All went to naught however, when the malignant contagion struck. It was brought in by Houghton's regiment, which had just joined the army at Inverness in late May. That regiment alone had six officers and two hundred men struck by the malignancy, and the regiment soon passed it on to several hundred men in other regiments. The final death toll would reach three hundred. (Pringle pp56-64).

In April 1747, the British army again took to the field in the Dutch Brabant, encamping at Gilsa, near Breda. They now had with them some fifteen battalions and fourteen squadrons. The distempers of 1747 took their usual course, that being the Summer bilious and remitting fevers. In August, a dysenery epidemic struck, with more than half of the soldiers succumbing as well as most of the peasants in the adjoining villages. Few soldiers died from this flux because of their well-aired hospital in Maastricht, but many of the peasants passed away. Later in October, when the rains began, the usual Autumnal fevers appeared just as the army was going into Winter quarters.

Due to the peace accord, the campaign of 1748 was a short one and entirely unnoteworthy from a medical point of view. Camp was broken on the ninth of July. The British Medical Service could now rest for seven years until the outbreak of the Seven Years War. It was now Donald Monro's turn to lead the men to better health.

Influence of Disease on the Mid-18th Century British Expeditions Flanders and Germany

Introduction
Sir John Pringle
Donald Monro