June 24, 1920J 



NATURE 



533 



of 400,000 men ; he reached Moscow on September 14, 

 the retreat began on October 19, and on December 13 

 he recrossed the Niemen, and of his great army more 

 than four-fifths had meked away. • 



Probably one of our most disastrous campaigns, 

 from a hygienic point of view, was the Walcheren 

 Expedition of 1809. where our mortality from disease 

 amounted to 3469 per thousand of strength of troops. 



Regarding the Crimean campaign in 1854 I shall 

 say but little ; we have all read of the trials and 

 hardships of the troops in that campaign, in which 

 the mortality from disease amounted to 230 per 

 thousand of the strength. 



In the Afghanistan War of 1878-80 the mortality 

 was 937 per thousand, which appeared to be an im- 

 provement compared with the terrible figures which 

 we have just considered. 



Bad as these figures are, yet those of other nations 

 are even more unfavourable ; for example, in the 

 French Sudanese campaign of 1888-89 the mortality 

 from disease amounted to 280 per thousand — worse 

 figures than those of our own Army in the Crimean 

 campaign thirty-five years previously. 



I think that perhaps the most striking example of 

 the havoc which may be wrought by disease on an 

 armv in the field is that furnished by the French 

 Army in Madagascar in 1895, where the mortality from 

 disease amounted to 300 per thousand of strength. 

 In this campaign 7 men were killed by the enemy 

 and 94 wounded, while the deaths from disease num- 

 bered 5600. The actual admissions for sickness 

 amounted to more than 15,000, or 85 f>er cent, of the 

 whole force. 



The evils in the past were mainly due to lack 

 of co-ordination and of real knowledge on which 

 concerted action could be based. Nevertheless, ad- 

 vances were made, and, as an example of the steady, 

 progressive improvement in the health conditions of 

 the soldier and the increased success in disease pre- 

 vention, it is interesting- to note that in India during 

 the five years 1878-82 the following were our sickness 

 and mortality rates per thousand of men serving 

 among European troops : 



Constantly sick Deaths Malaria Dysentery Cholera 



1878-82 68-1 20-5 569 42-8 57 (4-2 deaths) 



Compare these figures with those for 1912 : 

 1912 28-8 4-6 82 5-2 0-3 (02 deaths) 



As regards conditions in the civil community, 

 probably the first really important step towards an 

 improved condition of afi'airs in England dates from 

 the passing of the Public Health Act in 1875. Two 

 hundred years ago the annual death-rate in London 

 was 80 j3er thousand ; I think it is now about 18 per 

 thousand. 



Military hygiene differs little in theory from that 

 relating to the public health of a civil community, 

 and in times of peace is closely allied to that 

 ordinarily carried out in all branches of the Public 

 Health Services. 



There are, however, certain considerable advantages 

 in military hygiene which find no counterpart in civil 

 life. The measures which the sanitary officer recom- 

 mends, when accepted, are carried out with all the 

 power of military organisation and discipline behind 

 them, and insanitary conditions and disease are sub- 

 ject to a far greater control than can usually be 

 obtained with a civil population ; so that, before the 

 South African War, great advances had been made in 

 the status and training of the Medical Service 

 generallv, but there were still many defects, the chief 

 of which were lack of organisation in the Sanitary 

 Service, deficient education and training in hygiene 

 of the officers and men of all branches of the Service, 

 NO. 2643, VOL. 105] 



and lack of co-ordination between the Medical Service 

 and the rest of the Army, 



Now let us consider the South African War. From 

 what I have said you will realise that we entered on 

 that war fairly equipped with knowledge, but with a 

 deficiency of organisation as regards the hygienic 

 requirements of an army in the field. It is true that 

 affairs improved very considerably during the course 

 of the war, but the unpreparedness at the outset bore 

 its inevitable harvest. During this campaign some 

 14,000 men died from disease as compared with about 

 7000 killed. As regards enteric fever, we had 57,684 

 cases with 8022 deaths. Dysentery alone accounted 

 for 86 admissions per thousand of the strength, and 

 from all diseases we suffered 843 admissions with 

 24 deaths per thousand of the strength ; while wounds 

 in action accounted for 48 admissions with slightly 

 less than 3 deaths per thousand. 



South Africa saw the dawn of the organised 

 scientific study of disease as regards its actual in- 

 cidence in thfe field. Much of the success achieved 

 by field hygiene and sanitation in the recent war 

 may be traced to experience gained in the war in 

 South Africa. 



The Army Medical Service emerged from the South 

 African War convinced of the absolute necessity for 

 improving the sanitary organisation on certain 

 definite lines. It was, in fact, at last generally 

 realised throughout the Army that in war nothing is 

 so costly as disease. The main requirements were, 

 first, the education of the troops themselves — officers, 

 non-commissioned officers, and men — in the aims and 

 methods of hygiene. The second necessity indicated 

 was the allocation of certain officers and personnel 

 for sanitary work alone, and for their special training, 

 in addition to the continued training of all medical 

 officers, in the very latest scientific work. The third, 

 and perhaps the most important, requisite was 

 organisation for war. 



This organisation was so arranged as to compass 

 a thorough sanitary control of the lines of communica- 

 tion in order to filter off unfit men suffering from 

 contagious or infective disease, and at the same time 

 to maintain a freedom from disease of all personnel 

 passing through the various channels and fixed estab- 

 lishments comprising the lines of communication. In 

 France, for example, during the past war, it may be 

 said that, beyond an outbreak of dysentery at one 

 training centre, clearly traced to an influx of 

 "carriers" from the East, the lines of communication 

 during the whole period were maintained almost free 

 from outbreaks of epidemic disease of any serious or 

 extensive nature. 



How very different were the conditions under which 

 the Army took the field in 1914 from those of former 

 wars ! The scientific investigations of the preceding 

 years had stabilised to a very large extent the hygienic 

 environment of the soldier. Careful work on his food- 

 stuffs as regards quantity, variety, and quality assured 

 him a sound basis on which to wage war. 



Undoubtedly much of the low incidence of infectious 

 diseases enjoyed by the troops in the field during the 

 whole war was due to a high resistance maintained 

 by the ample and excellent condition of the food- 

 supply. In the same way the equipment, clothing, 

 and personal hygiene of the troops had all been en- 

 visaged on the soundest lines ; while the method and 

 practice of sterilising water-supplies and safeguarding 

 foodstuffs, as well as the disposal of waste products, 

 had been carefully thought out and generally in- 

 culcated. 



Now let us consider the three main essentials to 

 life, namely, food, water, and air. The food of the 

 troops and its intimate relation to that important organ 



