November 30, 1905 J 



NA TURE 



105 



expressed in the prefatory quotation from Sir J. F. W. 

 Herschel : — " To the Natural Philosopher there is no 

 natural object that is unimportant or trifling'; from 

 the least of Nature's works he may learn the greatest 

 lessons." J. A. T. 



THE WASTAGE IN ARMIES BY DISEASE. 

 'I "HE recent utterances of Sir Frederick Treves on 



1 the subject of the Army Medical Service (see 

 Nature, November 2, p. 15), and the discussion on 

 enteric fever in the army which has appeared in the 

 columns of the Times, have again directed attention 

 to the inadequacy of the means taken in our army to 

 prevent the incidence of enteric fever and other filth 

 diseases. The crux of the matter is this : we have to 

 provide hospital accommodation for 10 per cent, of 

 our forces in the field, the Japanese for but 2 per cent. 

 Why this difference? In the South African campaign 

 no less than 746 per 1000 of the fighting forces were 

 admitted into hospital for disease which is mainly 

 preventable. In this war there were something like 

 450,000 admissions to hospital on account of sickness 

 and some 22,000 admissions on account cf wounds or 

 injuries received in action. 



" Among those admitted to hospital on account of 

 disease alone, there were 14,800 deaths during the whole 

 war; further, so far as can be estimated at present, 42,741 

 of the total admissions to hospital on account of disease, 

 and 7998 of the deaths from disease, were due to enteric 

 fever, while 31,363 of the admissions and 1248 of the 

 deaths were from dysentery. In other words, no less than 

 one-tenth of the admissions on account of disease were 

 for enteric fever, and one-fourteenth were for dystentery, 

 or these two diseases alone were the cause of practically 

 one-sixth of the total admissions and about two-thirds of 

 the total deaths on account of disease; these two diseases 

 also accounted for nearly one-half of the total losses by 

 death from all causes during the war. As we know that 

 both enteric and dysentery belong to the group of diseases 

 which are largely the outcome of faulty environment, the 

 sanitary significance of these figures needs no argument." 1 



How does the Japanese Army deal with the preven- 

 tion of disease? The following record sufficiently 

 answers this question : — 



" The care of the sick and wounded occupied but a 

 small share of the time of the medical officers. The solu- 

 tion of the greater problem of preventing disease by the 

 careful supervision of the smallest details of subsistence, 

 clothing and shelter was their first and most important 

 duty. Nothing was too small to escape their vigilance, 

 nor too tedious to weary their patience, and everywhere' 

 in the field with the scouts or in the base hospitals at 

 home, the one prevailing idea was the prevention of disease 

 I he medical officer was to be found both in the front and 

 in the rear. He was with the first screen of scouts with 

 his microscopes and chemicals, testing and labelling 'wells 

 so that the army which followed should drink no con- 

 taminated water. When scouts reached a town, he imme- 

 diately made a thorough examination of the sanitary 

 conditions, and if cases of contagious or infectious disease 

 were found, he put a cordon around the quarter where 

 they were. A medical officer accompanied foraging parties 

 and with the commissariat officers, sampled the various 

 food, fruit, and vegetables sold by the natives before the 

 arrival of the army. If the food were tainted, or the fruit 

 over-ripe, or if the water required boiling, notices to that 

 effect were posted in suitable places. So strict was the 

 discipline from commanding officer to rank and file that 

 obedience to the orders of the medical officer was absolute, 

 the medical officer also supervised the personal hygiene 

 of the camp. He taught the men how to cook, how to 



"nmh 7- t0 dean u Ae finger nai,s so as to fre e them 

 7™ bact f"a, as well as how to live in general a healthy 



ro Trr* V ,? nd '-' WaS a part of the soldier ' s ^tine 

 to earn out these instructions in every particular. As a 



1 Lieut.-Col Firth. R.A.M.C, Jour* of Hygiw, Sep,., 19 o 5 ,p. 543 



NO. 1883. V OL. J?,] 



result of this system the medical officer was not obliged 

 to treat cases of dysentery and fevers that follow the use 

 of improper food and the neglect of sanitation. During 

 six months of terrible fighting and exposure in a foreign 

 country there was only a fraction of 1 per cent, of loss 

 from preventable disease." 1 



It may be true that vehicles other than water, par- 

 ticularly dust and flies, convey the infection in enteric 

 fever, diarrhoea, and dysentery, but much can be done 

 by safeguarding the water supplies. 



Diminish the incidence of these diseases by any 

 means whatever and the subsequent incidence of the 

 disease will naturally be lessened — cases beget cases. 



It may or may not be practicable to sterilise the 

 drinking water for a big army in the field, but in 

 camps and in small campaigns such as our " little 

 wars " on the Indian frontier, and in Africa, a great 

 deal more could be done than has been done. Thus 

 in the Tochi Valley, in 1897, a force of some 4000 men 

 was condemned to inactivity and suffered severc'y from 

 diarrhoea, dysentery, and enteric. The British troops 

 averaged an annual strength of 622, and among them 

 there were 59 cases of enteric with 30 deaths, 371 

 cases of dysentery with 65 deaths, and 211 cases of 

 diarrhoea with 10 deaths. Here was an ideal instance 

 in which _ sterilisation of the water or distillation 

 for the sick (as the water was verv saline) could 

 have been carried out, as there was "plenty of fuel, 

 and the extra cost involved would probably have been 

 more than covered by the saving in pensions, &c. 

 Lieut. Nesfield, I. M.S., in the Tibet campaign used 

 his iodide iodate tablets (see Nature, July 27, p. 303, 

 and August 31, p. 432), with the result that of 700 

 men who drank water sterilised with them, none con- 

 tracted cholera, while of other batches of men passing 

 through the same region a few days later an average 

 of 3 per cent, contracted cholera. 



There can be no question that the medical officers, 

 of our army are a devoted body of men, highly trained, 

 and fully alive to what should be done, but they are 

 too few adequately to cope with the problem of pre- 

 vention, and what is more they receive little encour- 

 agement in this direction from those in authority. In 

 addition, a body of intelligent trained non-commis- 

 sioned officers and men, a sanitary corps, is required 

 to carry out the policy of the medical officers. At 

 present guards for the water supply and similar pur- 

 poses are drawn from the ordinary strength of the 

 regiments, with, of course, no special training. In 

 the China Relief Expedition in 1900 the Japanese 

 provided three skilled men to take care of their sick 

 and wounded for every two provided by the other 

 armies. In olden times it was thought cheaper to 

 obtain a new soldier than to cure a sick or wounded 

 one; the reverse is the case nowadays if the authorities 

 would but appreciate it, and prevention is even better 

 than cure. R. t. Hewlett. 



NOTES. 



We announce with deep regret that Sir J. S. Burdon 



Sanderson, Bart., F.R.S., late Regius professor of 



medicine in the University of Oxford, died at Oxford on 



November 23. 



Prof. Emil Warburg, president of the Reichsanstalt in 

 Charlottenburg, and Prof. Henri Moissan, of the University 

 of Paris, have been elected corresponding members of the 

 Academy of Sciences of Miinich. 



The twenty-first anniversary of the Royal Scottish 

 Geographical Society was celebrated by a dinner in Edin- 

 burgh on Monday, November 27. Prof. J. Geikie, the- 

 president of the society, presided. 



1 B,it. Med. Jour,,., 1904, ii. p. ,332. 



