536 



NATURE 



i] 



UNE 24, 1920 



3000 men. per day prior to their embarkation. The 

 absence in the community at home of any noticeable 

 incidence of trench, relapsing, or typhus fevers goes 

 to show the justification of the claim to success of 

 the sanitary officers and personnel concerned in these 

 works. 



There were other insect-borne infections to 

 be guarded against in different parts of the world 

 where, the military situation required our troops to 

 serve. In some of these cases hygienic control was 

 necessarily subservient to military urgency, and out- 

 breaks of sickness occurred, the more readily so, 

 perhaps, in the light of the unprepared soil which 

 our young troops offered on first entry into tropical 

 and sub-tropical zones. There is not time to detail 

 the various minor hygienic campaigns, but the vast 

 amount of anti-malaria work carried on in the various 

 overseas war zones justifies notice. Being carried out, 

 often with most complete success, from the point of 

 view of mosquito elimination, there were at the same 

 time areas where enemy action almost entirely forbade 

 active measures of drainage, canalisation, or oiling. 

 Even in these circumstances, however, it was not un- 

 common for certain of our officers, accompanied by a 

 guard of two or three men, to push out into No Man's 

 Land to oil certain stagnant waters known to be 

 mosquito-breeding places. As to the extent of work 

 carried out in draining, ditching, fiUing-in, etc., exact 

 figures are scarcely procurable, but in the aggregate 

 the efforts made must rank among the major schemes 

 of the world, and be of incalculable value both by the 

 improvement made and as an example to the in- 

 habitants of the various areas concerned — Egypt and 

 Palestine, Macedonia, Lower Mesopotamia, etc. In 

 addition, however, to these offensive measures, defen- 

 sive action against malaria was generally and 

 thoroughly carried out by means of the provision of 

 quinine, of netting of different forms, of special 

 clothing, gloves, head-nets, etc., and of repellent sub- 

 stances, as also by the treatment of infected natives 

 and various schemes for the isolation and removal of 

 infected men who would otherwise act as foci for 

 fresh cases. 



From another aspect altogether the sanitary sec- 

 tions rendered valuable service ; I refer to the 

 economies effected. These economies were both direct 

 and indirect. In the latter category may be placed 

 the saving effected by tlie adoption of destruction of 

 excremental matter by unit incineration which other- 

 wise had to be disposed of with considerable expense 

 by contract removal. Even of greater interest, how- 

 ever, was the direct saving resulting from the adop- 

 tion of improved sanitary technique. In this category 

 may be mentioned, first of all, the saving of fat. 

 One of the most difficult waste-matters to get rid of 

 in a cleanly way is greasy water — wash-up water, 

 kitchen swill, etc. In seeking for better methods of 

 disposal of this sullage the special cold-water grease- 

 trap was devised, and soon pointed the way to an 

 obvious economy. By the careful collection of all 

 such wash-up fat, and of the scrap-fat and bone-fat 

 rendered in cookhouses, a bulk of crude fat _ was 

 obtainable which proved of immense use in aiding 

 the national resources. A campaign of fat-saving was 

 first initiated by the sanitary sections, and later 

 developed and organised by the Quartermaster- 

 General's Department. It was so successful that 

 many of the war zones were able to make all their 

 own' soao locally, and, furthermore, to send home 

 many tons of fat for making givcerine, then so neces- 

 sary for the manufacture of munitions. _ As an 

 instance, the saving of an average battalion was 

 some 60 lb. of fat per day at a time when fat fetched 

 at least 40Z. per ton. 



NO. 2643, VOL. 105] 



Another very useful economy was the collection of 

 the solder from the sealing of the myriad tins used 

 as food-containers. Nothing could be more striking 

 than the picture presented by an up-to-date unit 

 destructor consuming in cleanly fashion all the 

 waste matter from a large camp, and at the same 

 time melting out from improvised receptacles streams 

 of solder, which dripped into cold-water receivers, 

 while the heat of the furnace was utilised to heat 

 large tanks of water, of value both for ablution and 

 for the various washing-up processes so constantly 

 required. 



During the war many scientific investigations were 

 carried out, both at home and in the actual theatres 

 of war, for the elucidation of disease and the deter- 

 mining of the best modes of prevention. In some 

 cases this necessitated the investigation of certain 

 diseases which were either unknown in former 

 campaigns or had been little studied in the past. 

 Very valuable aid was given by the labours of the 

 Trench-fever Committees at home and in France, and 

 also by the War Nephritis Committee and Medical 

 Research Committee in France. It having been 

 clearly established that trench fever is conveyed by 

 the louse, and diagnosis having been made possible, 

 a great impetus was given to general measures of 

 personal hygiene in the field, and also to improve- 

 ment in methods of bathing and disinfestation. 

 Trench fever was made notifiable in consequence, and 

 a very great improvement resulted from the increased 

 attention to precautionary measures. At the ter- 

 mination of the war the diseases had greatly declined, 

 and no infection was conveyed to England on 

 demobilisation. 



By the labours, in short, of the united profession, 

 all doing that work which was required of them and 

 W'hich local authority considered most immediately 

 necessary, the troops were served as few armies have 

 ever before been served. 



In France, for instance, in 19 18, out of a mean 

 strength of 1,250,000 men of all races, the typhoid 

 admissioji rate amounted to only 0-2 per thousand 

 per annum, whereas in the case of the war in South 

 Africa the admission rate reached the high figure of 

 130 per thousand. 



In the case of dysentery the total number of deaths 

 from this disease in France during the whole war was 

 fewer than 200. These figures in themselves are a 

 sufficient and lasting tribute to that branch of the 

 Army to which so many of our profession have 

 belonged, and from which we hope they have taken 

 something in exchange for the much they brought 

 to it. 



An inevitable result of the war has been the recogni- 

 tion by everyone engaged of the value of "preventive 

 medicine." This has led, on one hand, to the definite 

 recognition of the Sanitary Service in the Army as 

 an organised department, and has aroused, on the 

 other, an increased interest among thoughtful 

 members of the civil community into their own state 

 — an interest which provoked the demand for an 

 organised national effort, and ultimately led to the 

 formation of the Ministry of Health. 



In summing up my views, I would say that, in my 

 opinion, the future prosperity and success of our 

 nation depend to an incalculable extent on the im- 

 provement of the physical and mental standard of all 

 members of the community; it must not merely be 

 — as I am afraid it has been to a considerable extent 

 in the oast — a case of the "survival of the fittest,!' 

 but rather a perfection of every method by which 

 mortality mav be decreased, by which the production 

 of "unfits "mav be diminished, and by which the 



