You no doubt have health problems. Well, hopefully not you yourself, but at any rate your wargame armies. Let me explain:
Some time ago I acquired a fistful of old copies of LW, a.o. issues 39 and 40 with a very interesting article by Rod Robinson on sickness in armies in earlier eras. I proposed to our editor that he should reprint those articles, but the dear fellow [?] answered back that I better write something myself on the subject, using whatever inspiration I could find. Sorry, I have few qualifications for doing so, so what follows is mainly a compilation from the references below.
Historically the Assyrian and Roman armies had excellent health systems including advanced surgery, but this was practically forgotten in the West in the Dark Ages. When “professional” military medicine was re-invented in the 16th century most doctors and surgeons were of an extremely low quality, but maybe still a little better than the women that accompanied the mercenaries of an earlier day - then considered the soldiers’ only chance to get any medical care at all.
Thus the following is mainly about the military health in western armies between the fall of Rome, and the end of the 19th century when matters finally improved decisively, but it does not consider the health - or lack of it - of camp followers, prisoners of war etc. The statistics available to me are almost all British; however, things were hardly much better elsewhere. I’ll try to point to what were the problems, and how can they be demonstrated in wargame campaign rules.
Before starting to look at the health of your army in the field we must investigate which percentage of your soldiers are at all fit for active duty. Around 1880 Furse wrote: “When a battalion is placed under orders for service in the field, experience has shown that a deduction of very nearly 25 per cent. has to be made from the paper strength for young soldiers, insufficiently drilled recruits, men who are absent, sick, or physically unfit.” (You maybe should not have painted all those figures that have to remain in the drawer.)
Some basic health questions are: Which percentage of the troops must be expected to be sick at any time, which percentage of them would die from non-battle causes each year, and which percentage must be invalided out of the army per year. Then come the effects of the irregularly but rather frequently occurring epidemics, and finally one possible way of building all of it into any set of rules that pretend to be realistic. (If you think that your figures are too well-painted to fall sick, or you just consider the whole matter too offensive, please stop reading here and forget about realistic rules). What I write concerns - more or less - civilized armies; the locals will often be resistant against much sickness that is a result of permanent local circumstances; for them different rules may be necessary, or the losses under the rule proposals below could be reduced with some factor.
Some examples are given to illustrate circumstances referred to, but in most cases scores of other examples could have been used. Battle casualties are no part of this article.
Sickness
Apart from epidemics the matters imposing health risks on soldiers in the main seem to be the area, the location, the time of the year or any rough weather, humidity (marshes are dreadful in almost any weather), the quality of housing, crowding of soldiers, animals and followers in a limited space, the quality of drinking water, the sufficiency of food and other supplies, lack of rest and other fatigue, stress from fighting, the general quality of the army’s medical services, the transportation facilities for the sick (river boats and hospital ships are a lot better than pack animals, carts or wagons), the quality of the regimental doctor and surgeon, and of the unit’s CO.
Until the beginning of the 20th century it is a clear picture in almost all campaigns that the losses from sickness were far higher than the losses from combat. On average the yearly hospital admissions seem to have been above 200 % of the force, meaning that each soldier was admitted to hospital more than twice a year.
A rule-of-thumb seems to be that, albeit with wide variations between different locations and circumstances, the number of sick mostly varied between 6 and 10 % of the force - a result supported by evidence from the Imperial Roman army and from the Danish army in its German Wars in the middle of the 19th century. It seems as if 2 % sick would be about the top of medical efficiency possible in the best of circumstances; the less lucky like, say, the American forces in 1776 could have one quarter of the men sick. For a moment forgetting epidemics it seems possible that we in normal times should calculate the number of sick as being somewhere between 2 and 25 % of the force.
Furse noted on service in India, a medium dangerous area: “On the score of health alone men should not be sent to India under twenty years of age.” And “the sickness is as a rule greatest in the first and second years spent there, the average health then improves in the third, fourth and fifth years, and is thus maintained up to the eight year, after which the rate of mortality and invaliding rapidly increase.”
In France 1944-45 the American forces still suffered 44 % of their losses from non-battle causes, and Dupuy estimates that without fight in a temperate climate during WW II, 0.2 % of a force would be lost every day, in wintertime only 0.1% (Seemingly not much, but try to add up for a month - or a year).
In general main part of the sick men recovered, but if their unit had moved on they must try - in the best case - to catch up with it with normal marching speed. Robinson proposes that recovery from sickness should last two weeks; as I have not seen this period substantiated anywhere I am more bent to believe in three weeks before men who had been hospitalized were able to march to their units with normal army speed.
Death from Sickness
In the Seven Years War 1756-63, 135,000 of the 185,000 men recruited into the Royal Navy died of disease, i.e. 73 %. The average yearly deaths as a consequence of sickness or injury in the British Army in India between 1817 and 1856 were almost 7 %, and during the Mutiny it suffered 16 deaths from disease for every man killed in action. In 1839-53 the worldwide yearly mortality rate from disease in the British Army was 3.3 %; in 1889-98 it had dropped to 0.9 %. The last decades of the 19th century saw on one hand enormous advances in nursing and the treatment of sickness and on the other hand significant advances in the supply of food like the use of canned meat, dried milk powder, and evaporated milk.
The yearly death rates from disease in the US Army was in 1846 = 10 %, in the 1860s = 7.2%, in 1918 = 1.3 %, and in the 1940s = 0.6%.
Invalids
We have so far looked at sickness and loss of life from non-combat causes. But a number of men suffering from these causes never recovered and would have to be invalided out of the army, transported back to their area of origin and probably lousily, pensioned. Here the statistics do not help much, as I only know that 20 % of the Spanish hospital admissions in the Netherlands 1596-99 were invalided, that around 1865 the British Army in India yearly invalided 8-9 % of its force, and that at the end of the Second Boer War 17 % of the British raised for the war had been invalided out of the force. Based on this, and that Florence Nightingale’s activities only showed massive results on a global basis from around 1870, I would guess that the average yearly number of men invalided would be about three times the deaths from non-epidemic diseases.
Epidemics
The possibilities for epidemics were manifold, and more than one epidemic could hit a force at a time. Thus in the Ashanti War of 1873-74 there were 1,145 sick among the British troops; of them 737 with Malaria and 153 with Dysentery. But epidemics mostly remained a matter of Chance.
Epidemics are transferred by different means that are of little relevance here. Robinson gives the following percentages of death risks among the military from disease during an epidemic: Typhus 30-50 %, Malaria 10-70 %, Smallpox 40 %, Bubonic Plague 50-90 %, Typhoid up to 20 %, Cholera 50 %, Dysentery 30 %, Tuberculosis up to 8 %, and Syphilis immediately after it had arrived in Europe up to 25 %, later much less. (Although hardly politically correct to mention venereal diseases counted from 1808 to the end of WW II up to half the hospital admissions of the British army overall and in India. It hit probably on average between 4 and 20 % of the men each year, but in India 1895 it was 50 %).
The “risk areas” for epidemics are according to Robinson besides besieged towns, and a ten mile radius around them, places like ports, marshes, and locations where there had been an epidemic during the last ten weeks.
Rule Proposals
When it comes to proposed wargame rules one should notice that Robinson calculated bounds in campaigns as having a duration each of one week and that he used as one of his instruments of chance a deck of cards. Personally I would have preferred campaign bounds of 5 days (giving a more realistic sequence of necessary rest for the armies), but in this respect I stay with his system. Instead of cards I propose the use of percentage dice - 2 D10 - giving some clearer mathematics. The purposes of the rules below are to give realistic losses from health problems, induce the players to invest resources to reduce these problems, and to be prudent in choice of marching routes and places of action.
Normal Disease
Count any negative factors for each unit among the following: The area in general (say India) - the location (say Peshawar) - pre-1550 - an unhealthy time of the year or any unusually rough weather - humidity, being in or bordering to marshes counts double - the quality of housing - crowding of soldiers, animals and followers in a major camp - marching or fighting in hilly or mountainous areas - having force marched for several days without a rest day between the marches - being stationed in a port - being besieged by or besieging an enemy - the quality of the drinking water - the sufficiency of food - lack of rest - lack of clothes or shoes - having been transported on high sea by ship - stress from fighting, where having been in a battle counts double - the quality of available sanitary installations - insufficient personal cleanliness, i.e. the soldiers have had no possibility during the last week to bathe and change uniform - the general quality of the army’s medical services - the transportation facilities for sick and wounded. Divide the number of negative factors with two; now you have the basic percentage of sick men this week, but this percentage can neither be less than 2 nor more than 10.
If the regimental doctor/surgeon is average, double the basic percentage; if he is bad, triple it. The regimental doctor/surgeon is bad if he has 01-25 on percentage dice, average if 26-95, and above average if 96-100. If the doctor/surgeon is above average, divide the basic percentage of sick by 2, still respecting 2 % sick as a minimum. Use your normal system to see whether the unit’s CO is above average; if so, reduce the effect from the doctor/surgeon being bad to being average.
As can be seen the player has quite some influence on the risks; other rules must decide the cost for him of, say, good sanitation, supplies, medical services, etc. (It would be a lot simpler each week to set the percentage of sick in a unit to 2 plus 1 Dl 0, but then the result would be an effect of Chance only.)
After 3 weeks of illness men have recovered and will start marching to their units with normal marching speed, taking one day’s rest in five.
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