
*~ 
‘ 
May 12, 1923] 
containing 25 per cent. of atta, were found valuable. 
After May 1917, following the report of Misses Chick 
and Hume, germinated dhall was used in outlying 
districts, when fresh vegetables or fruit could not be 
_ obtained. 
A remarkable feature of medicine in the War was the 
_ stimulus given by war to scientific investigation. The 
instance already given is in point; and many other 
investigations were successfully carried out under the 
compulsion of urgent necessity. The pathogenesis 
of trench fever unfortunately was only fully revealed 
_ towards the end of the War ; otherwise disinfestation 
of soldiers would have formed an even larger part of 
army sanitary work than it did. For details of a 
valuable investigation of energy expenditure in relation 
to food by Dr. E. P. Cathcart, chap. iv. in the second 
volume should be consulted. In the prevention of 
trench foot, success was at once attained so soon as 
compliance was secured with the army routine order 
that every man should remove his boots at least once 
in twenty-four hours, drying and rubbing his feet and 
putting on dry socks in place of those discarded. 
___ In view of the large part borne by flies in conveying 
infection in the South African War, the prevention 
of flies in all divisions of the Army was vigorously 
promoted in the Great War, and the chapter devoted 
to this is a useful summary of the subject. The 
chapter on the prevention of infestation by lice, 
which is written by Sir W. H. Horrocks, is a masterly 
presentation of this important subject, including the 
biological facts, on knowledge of whicheefficient pre- 
ventive measures must be based. The sixty-one pages 
devoted to this subject do no more than represent its 
relative importance in military hygiene, when we recall 
that Colonel Horrocks estimates that in the War 50 
per cent. of the admissions to hospital from troops in 
the field armies were attributable to lack of personal 
cleanliness and to vermin. The great sanitary lesson 
_ of the South African War was that of fly prevention 
and satisfactory conservancy methods; the great 
_ sanitary lesson of the Great War has been that probably 
one-half of the disablement of our armies in the field 
is due to pediculosis and scabies. 
Scabies was made the subject of accurate investiga- 
tion at Cambridge, civilians volunteering for this 
purpose. These investigations showed that the in- 
fection of scabies could be conveyed by sleeping in beds 
previously occupied by heavily infested soldiers or by 
wearing their clothing. Perhaps the least satisfactory 
disease prevailing among soldiers, from the point of 
view of control, was cerebro-spinal fever ; and although 
very specialised efforts were made to prevent its dis- 
semination, it may be doubted whether these were 
successful, apart from the diminished prevalence which 
NO. 2793, VOL. 111] 
NATURE 
627 
' 
was secured when barracks became less crowded and an 
approximation towards open-air conditions became 
possible. There does not appear to be any justification 
for the belief that the segregation of contacts with cases 
of the disease or the chemical spraying of the throats 
of contacts, which was practised on a large scale, 
greatly influenced the course of events. 
There are but few statistics of disease in these two 
volumes ; but it is significant that whereas in the South 
African War, with an aggregate personnel of 530,000, 
8000 men died of typhoid fever, only 266 deaths from 
this disease occurred in the Great War in the Western 
Front among British and Dominion troops, with an 
average strength of 1} millions and an aggregate of 
three or four times that number. The relative share 
of prophylactic vaccines, of purification of water, and 
of the sanitary disposal of waste-products in securing 
the remarkably low incidence of typhoid and of 
dysentery in the War is not discussed in these 
volumes ; but we hope that in some other volume of 
the history of the War it will be possible to give details 
of any experiences in which one or other of these factors 
of prevention was absent, with the view of assessing 
their relative value in actual experience. 
Attention is directed in Sir W. G. Macpherson’s 
preface to the fallacious illogicality of estimating the 
healthiness or otherwise of troops by the ratio of deaths 
from disease to deaths from wounds. This ratio is 
evidently one between two variables: in particular 
the number and extent of the battles may vary. Asa 
permissible limit of inefficiency due to sickness in an 
army in the field, o-3 per cent. of strength had been 
accepted as a permissible limit; and this empirical 
standard was found in experience to be most useful 
in directing attention to the need for special inquiry 
in any unit. 
The details of sanitary organisation given in vol. 1 
are of importance to all practical workers, and this 
volume will for years form a valuable source of informa- 
tion. The success of the sanitary work of the Army in 
circumstances involving a manifold multiplication of 
existent machinery is one of the most striking features 
of the War. Some of the factors rendering this rapid 
addition to sanitary staffs practicable are not stated 
in these volumes ; but it is noteworthy that the health of 
the troops sent abroad depended primarily on the 
condition of the rapidly improvised camps which were 
scattered throughout this country; and that the 
sanitary safety of these camps depended in large 
measure on the sanitary provisions in the districts in 
which they were placed, and on the active co-operation 
between local and central sanitary authorities and the 
Army authorities. The records of the Local Govern- 
ment Board and of local authorities show that their 
