THE GREAT WAR IN THE ZONE OF THE ARMY. 325 



result that there were only 7,700 cases of a strength of 2,000,000, 

 throughout a period of 40 months of campaigns. Compare this with 

 their record in the South African War when, of a force of 100,000 

 men, and very few vaccinations, there were 56,000 cases and 8,000 

 deaths, and with the record of the first American Army of one mil- 

 lion men, which according to its Chief Surgeon, Colonel Alex. 

 Stark, had only 17 cases of typhoid and 10 of para-typhoid to Janu- 

 ary I, 1919. With tetanus in 1914 there were 32 cases per 1,000 

 wounded; in 1917, a small fraction of i per cent., the favorable 

 change being due to strict orders that all wounded should be given a 

 preventive dose of the antitoxin. 



In the first British Army in 191 5-16, 3,311 cases of trench foot 

 were evacuated; in 1916-17, only 395. In the fourth French Army 

 in 1916-17, 2,861 were treated for trench foot. As a result of the 

 clear enunciation, in time, of the preventive measures to be taken, 

 practically no cases developed in the American Army. 



Availing ourselves of their knowledge, plus the proof by Strong, 

 of our Army, on suggestive evidence presented by the British that 

 trench fever was carried by lice, plus the experience of both French 

 and British that the destruction of insect life in clothing would 

 enormously reduce morbidity, the American Army, with its own 

 enlightened medical corps, reinforced by the frank testimony of the 

 Allied troops, was able to produce a record for preventive medicine 

 in war the like of which the world has never before seen. 



All of these precautions above noted being in force and all of the 

 special sanitary appliances for this war in function, there remains a 

 general statement to be made : The chief cause of sick wastage, 

 when sanitary science has already yielded its utmost, is reduced 

 vitality from overwork, little sleep, poor food and constant cold. 

 Many of these undesirable conditions are inseparable from certain 

 military necessities, but it is an ill-conceived idea of a commanding 

 officer that troops to be efficient should do arduous service and at the 

 same time be deprived of possible comforts and prime necessities 

 " in order to harden them," such as sleep. In such a war as the one 

 through which we have just passed, this is not the time nor the 

 place to weed out the men with slight imperfections capable of 

 gradual remedy. The wise commanding officer will endeavor, where 



