June 24, 1920] 



.NATURE 



535 



1915, and (2) the influenza outbreak of 1918. In both 

 these instances a populace, largely non-immune, was 

 unavoidably — by military and national necessities — 

 concentrated, with a resultant reduction in the 

 spacing-out, and an opportunity arose for " mouth-to- 

 mouth " or "droplet" infection. It is scarcely 

 necessary to say that the pressure of hygienic advice 

 was sufficient to represent the needs of the problem 

 in each case. In the cerebro-spinal meningitis out- 

 break immediate spacing-out of the affected troops 

 produced a rapid fall in the case and "carrier" 

 incidence; in the same way, strong representations as 

 to the need for drastic reductions in the number of 

 troops carried in confined areas, such as ships, or of 

 the methods of slinging hammocks in respect of the 

 head positions, were latterly effective in reducing the 

 unfortunately high incidence of influenza on its last 

 appearance as a pandemic. 



It may be of interest to note thafthe experience of 

 the war had led to a reconsideration, and still further 

 enlargement, of the cubic space allowed the troops, 

 particularly overseas ; and also of the correlated ques- 

 tions of pharyngeal and pulmonary disinfection. The 

 importance of the former point — pharyngeal disinfec- 

 tion—was early recognised, and all transports were 

 provided with means for dealing with the personnel 

 aboard in special inhalation chambers. It is intended 

 that these shall be a permanent feature. of transports 

 in the future, and it is of interest in this connection 

 to note the recent encouraging reports from indus- 

 trial works of the value of certain gases, inhaled in 

 insensible but definite amounts, in inhibiting the 

 incidence of influenza and allied respiratory disorders. 



So much, then, for questions affecting all the 

 troops. Now we come to the more special problems 

 affecting particular groups of soldiery, and perhaps 

 the most important is the control of outbreaks of 

 infectious disease. 



Epidemic disease, with the exception of the influenza 

 pandemic, was noticeably absent, and the care taken 

 to filter off "unfits" on the lines of communication 

 went far to explain the remarkable freedom from 

 disease of the men in the line. In respect of the 

 excremental diseases, with their evil record of 

 morbidity in past wars, and particularly of Enterica, 

 the problem was approached in two ways : First, 

 by the general inoculation of the troops so as to 

 provide a relatively high immunity, and, secondly, 

 by the careful disposal of all infected matter — in other 

 words, by good conservancy methods. Inoculation 

 during the early part of the war was carried out with 

 typhoid vaccine, and a very large proportion of the 

 troops was protected in this way. Later, in 1915, a 

 triple vaccine was used — "T.A.B." — while troops pro- 

 ceeding East were provided also with cholera vaccine. 



The sanitary sections were chiefly responsible for 

 the constructional, advisory, and inspectorial duties 

 involved in providing fly-proof field latrines of the 

 deep-pit type, food larders, and safes for units other- 

 wise unprovided, for the continued and varying 

 problems connected with the reduction of the fly 

 population, and for the supervision of large water 

 schemes. The fly question, especially in Eastern 

 theatres, is a vast and difficult one in view of the 

 quantity of horse-litter inevitably associated with the 

 Army, and frequently of the tactical or climatic im- 

 possibility of burning such fertile breeding matter. 

 The Army was fortunate in being able to utilise expert 

 advice oii the problems raised from prominent ento- 

 mologists, and in having officers and men who set 

 themselves enthusiastically to carry out the methods 

 adopted or tested. 



But while the more serious diseases were largely 

 defeated, it was found that there was a very cOn- 

 NO. 2643, VOL. 105] 



siderable wastage in all theatres of war from insect- 

 borne diseases of different types. In France a very 

 great deal of the minor sickness of the troops was 

 traceable to louse infestation, either as the cause of 

 various septic skin conditions or from trench fever, 

 which was early recognised as a new clinical entity, 

 and has now been clearly proved to be a louse- 

 borne disease. This question of the infestation of 

 troops with lice is one of the most difficult problems 

 of the sanitary officer, particularly in the case of 

 troops crowded together or living under unnatural 

 trench conditions. To this question the energies of a 

 very considerable personnel were directed, and to it 

 all the support of the military authorities was lent. 

 The sufferings of our Allies the Serbs, and since 

 then of a majority of the population of Eastern 

 Europe, from another louse-borne infection, typhus 

 fever, also emphasised the necessity for a vigorous 

 campaign of disinfestation. The problem was met 

 largely by the simultaneous provision of facilities for 

 bathing at intervals not exc<^<;ding a week or ten days, 

 and by the increase in facilities for disinfecting per- 

 sonal clothing and blankets at one and the same 

 time. 



At this point it appears suitable to mention the 

 development in methods of disinfection by steam. In 

 the early days the troops in the field were dependent 

 on the few box-disinfectors available, while the rear- 

 ward units were supplied with Thresh disinfectors. 

 With the provision of divisional sanitary sections, 

 portable Thresh machines were also supplied to each 

 division. It was soon apparent, however, that for 

 the regular treatment of clothing required by the anti- 

 louse campaign this was not sufficient. The ultimate 

 development which resulted was the Foden-Thresh 

 apparatus, comprising two large Thresh disinfecting 

 chambers mounted on, and operated under slight pres- 

 sure by, a Foden steam lorry. In this way the ap- 

 paratus could be rapidly moved to any area in which 

 it was required, at once commence operations by 

 turning the steam into the chambers, and then be 

 driven to a fresh centre for operations. 



The disinfestation centres were of immense value, 

 but were often inadequate to eradicate the louse 

 plague entirely owing to the escape of certain 

 individuals or articles. To meet the needs of men 

 in such circumstances, general issues were made of 

 certain repellent substances of proved value, but more 

 reliance was placed on the regular treatment of 

 clothing and blankets ; and the experience gained in 

 this connection will be of lasting value, for there has 

 developed, as one profoundly valuable result, the use 

 of hot air as a practical method of disinfestation — a 

 method even simpler, cheaper, and more rapid than 

 steam, and one destined, it is hoped and anticipated, 

 to hold a permanent place in the larger schemes of 

 control of insect infections of the future. It is of 

 interest to note that flour-millers in Canada are now 

 utilising this method for the destruction of moths in 

 preference to the older and more dangerous "H.C.N." 

 method. The latest " Orr hot-air huts" are models 

 of efficient disinfectors. The subject, however, 

 remains one for further study and co-operative 

 methods of control. The problem to be met during 

 the demobilisation of 20,000 men daily from France 

 (and of smaller numbers from elsewhere), was no 

 easv one, but of the utmost importance in order to 

 avoid the dissemination of infective disease among 

 the civil community. Careful personal inspection 

 was, of course, required in every case, combined with 

 bathing, disinfection, and the issue of fresh clothing, 

 and this colossal undertaking was carried out to com- 

 olete satisfaction at a series of stations — at base ports 

 in France each capable of dealing with no fewer than 



