A Text-book of Military Hygiene and Sanitation

Front matter

to make the world's books discoverable online.

Il has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one thai was never subject

to copy right or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books

Preface

The chapter on Physical Training has been written for this book by Captain H. J. Koehler, U. S. Army (Director of Physical Training at the United States Military Academy, West Point, and an expert of international repute).

The majority of the illustrations not otherwise credited were prepared by Mr. Stockbridge, of the Department of Drawing, U. S. M. A., through the courtesy of the head of that Department.

In the discussion of "Alcohol and other Narcotics," the aim has been to enable pupils to form an intelligent opinion upon the whole subject and especially to distinguish between mere assertion and scientific evidence. While certain of the data in this chapter cannot be accepted as wholly proved, they yet represent the views of the ablest investigators everywhere. With a clear comprehension of the matter, each one may then determine for himself what his personal relations with these substances shall be.

To save the time of the pupil and to avoid the necessity for a- dictionary, a glossary of technical terms used herein is appended.

Frank R. Keefeb.

DotzerlbyGOOgle

Chapter I The Care Of Troops

Definitions. — Hygiene is a science whose laws have to do with the preservation of the health. Sanitation is an art whereby man endeavors to carry out the laws of hygiene. Health is a normal condition of body and mind. Disease is any departure from a state of health. Military hygiene — sometimes referred to as the "care of troops" — embraces hygiene and sanitation in their relations to an army. In modern military usage the adjective sanitary is applied not only to hygienic procedure, but also to troops and organizations of the Medical Department.

Scope of Military Hygiene. — The practice of military hygiene covers all points which relate to the public health of a civil community — and something more. Public health concerns itself with everything which may unfavorably affect the physical condition of individuals in such a community; in other words, it has to do with man and his environment. This involves a consideration of soil, air, water, climate, habitations, ventilation, heating, care of the person, food, clothing, exercise, occupation, habits, parasites, communi cable diseases, disinfection, disposal of refuse, sanitary laws, and vital statistics. The "something more" is the set of conditions incident to the march, the camp, and battle, which greatly modify the circumstances and increase the difficulties met in the application of sanitary procedures. A knowledge of public health thus falls far short of the requirements for the military service, and physicians called from civil life in time of war, without previous military training, find themselves not qualified properly to safeguard the health of the troops entrusted to their care.

Functions of Medical Officers. — Misconceptions as to the functions of the Medical Department are not uncommon even in the army. Since, in time of peace, the medical officer is best known through his relation to the sick, his more important duties may be overlooked. His prime function is, in peace or war, not the cure, but the prevention, of disease. In war time the evacuation of the sick and wounded to the rear, that they may not encumber the army, is next in importance. The care of the sick, essential though it is from ethical and political considerations, thus assumes relative insignificance from the military standpoint.

Military Failure Due to Preventable Diseases. — In all the wars of history (with the doubtful exception of the Russo- Japanese conflict) much more disability and many more deaths have resulted from disease than from wounds. Campaigns which should have succeeded have frequently failed because of the utter breakdown of armies from preventable diseases, such as cholera, plague, typhoid, typhus, small-pox, malaria, dysentery, and yellow fever. The invasion

THE CARE OF TROOPS 19

of Canada by Montgomery and Arnold in 1775 was unsuccessful because of the enormous percentage of losses from small-pox and dysentery. Napoleon's plan to found a colonial empire in what is now the Southern United States failed because 15,000 men of his fine army, sent out for that purpose in 1802, perished in Santo Domingo of yellow fever and other tropical diseases. The British in the Crimea lost twenty-five times more men from disease than from wounds. Brief as was the war with Spain, deaths from sickness in our army were over seven times more numerous than were those from injury. Even in the Balkan War, recently terminated, the Bulgarian campaign {carried on at first with such fiery vigor and astonishing success) broke down largely because of epidemic disease. The occurrence in one day of about 30,000 cases of a choleraic dysentery was a more vital factor than was the Turkish resistance in the check of the Bulgarian Army at Chatalja and its failure to capture Constantinople. Results of Prophylaxis. — Up to recent years a high percentage of disease and death during war time has been accepted as unavoidable, and but little effort made to prevent the one or to lessen the other, but the great increase in knowledge of the causes of disease has given us weapons with which to fight these, and the application of sanitary principles has resulted in a marked diminution in many affections now shown to be preventable. The annual death-rate for that half of the United States which keeps reliable statistics has decreased nearly 20 per cent, in the last generation. The average length of life at present is about forty-five years, and it is estimated that methods of disease prevention (so-called prophylaxis), if properly applied, can add fifteen years to this. The sanitarians of our army have kept pace with advances along this line and, since the Spanish War created opportunities for- them, have been pioneers in blazing trails through uncharted wildernesses of disease. The conquest of yellow fever in Cuba, of hookworm disease in Porto Rico, of pernicious malaria in Panama, of beriberi among Philippine scouts, of typhoid fever in the army itself, are but a few examples of the marvelous results of the application, to great problems met, of the principles of disease prevention. More recently it has been shown in the large camps along the Mexican border that troops can be maintained under canvas in one place for prolonged periods without an increase in sickness beyond the rates usual in garrisons. As a matter of fact, in time of peace at least, sick rates from preventable diseases are .now much less in military than in civil communities.

The Soldier and Disease Prevention. — Soldiers are specialists in a certain branch of human endeavor, the practice of which entails additional risks and creates the necessity for care in avoidance thereof. The risks of battle cannot be avoided, but those of the march and the camp can, as will be shown, be entirely escaped or greatly lessened by the exercise of reasonable caution. The prevention of disease is of supreme importance to officers of the line because the efficiency of the troops they command is dependent upon health. The vital military factor is the soldier himself, and the avoidance of wastage in this particular needs no emphasis. A trained soldier is of more value than are several raw recruits,

THE CARE OF TROOPS 21

If such soldier can be kept in the ranks, or returned thereto promptly after sickness or injury, the system is a great asset to the company commander and to the army. But such a system can be instituted and maintained only by full and hearty co-operation between line and sanitary officers, in association with a high state of discipline. That elusive something, known to us under the French term esprit, is engendered and fostered in troops chiefly by confidence in their officers, and one of the best ways to gain that confidence is by letting the men see and feel the active interest taken in their welfare.

Enforcement of Sanitary Regulations. — When sanitary regulations are promulgated for the guidance of enlisted men, it is often desirable to let them know the reasons therefor. Most of our men are intelligent, thinking individuals, and if their reason is appealed to, compliance is apt to be more thorough than when a mere command is given, without explanation. On the other hand, the issuance of an order by no means ensures compliance. Every order must be followed up, to see that it is carried out promptly and habitually. For this purpose inspections must be made early and often. If a disposition to shirk is observed, delinquents must be punished. Unless the system of inspection and responsibility is thorough and complete and duties of subordinates dftvetail or overlap, work will be neglected, because certain things are nobody's business. A medical officer is on the staff of his commander in an advisory capacity. This relation should not be lost sight of. Recommendations of sanitary officers should be heeded and enforced by commanders.

That one who promptly and firmly supports his sanitary adviser soon finds the sanitation of his camp or garrison maintained at a high standard by those most directly responsible, namely, the company commanders.

Improvidence of Soldiers. — Experience teaches us that we cannot expect the enlisted man to care for himself, so we must be "guide, philosopher, and friend" to him. A Confederate leader (Wise) has well said, "To appreciate fully the truth that 'men are but children of a larger growth,' one must have commanded soldiers. Without constant guidance and governance and punishment they become careless about clothes, food, ammunition, cleanliness, and even personal safety. They will at once eat or throw away the rations furnished for several days, never considering the morrow. They will cast aside or give away their clothing because today is warm, never calculating that the next day they may be suffering for the lack of it. They will open -their cartridgeboxes and dump the contents on the roadside to lighten their load, although a few hours later their lives may depend upon having a full supply. When they draw their pay, their first object is to find some way to get rid of it as quickly as possible. An officer, to be really efficient, must add to the qualities of courage and firmness those of nurse, monitor, and purveyor for grown-up children, in whom the bumps of improvidence and destructiveness are abnormally developed."

Digitzedty GOOgle

RECRUITS AND RECRUITING Mistaken Views of Public— Not every man is suitable for a soldier. The public — including many members of the medical profession in civil life — has the idea that any male over seventeen years of age and not enfeebled by senility or disease may be enlisted and perform efficient service. Nor is every able-bodied man suitable for military purposes. He may be undesirable as to character, mentality, habits, education, or temperament. Furthermore, though the individual may be museularly strong, he may possess some physical defect which, though negligible in his ordinary vocation, is almost certain to develop into a disqualifying defect in the military, service. Thus, when we read the boastful utterances of Jingo orators about "a nation in arms," "ten millions of men will rise to repel the invader," and the like, we must realize that, from the standpoint of physical fitness alone, the vast majority of these millions is totally ineligible. A man may be a good insurance risk and yet be entirely unfitted for a soldier.

Small Percentage Qualified. — In time of peace a sufficient number of applicants ordinarily present themselves, so that our small army may be recruited out of good material. The number of men rejected for one reason or another, but chiefly on account of physical deficiencies, greatly exceeds those accepted. Only 1 in 3 or 4 is taken by officers on recruiting duty in cities, and this percentage is still further reduced by a rigid medical scrutiny at reeruit depots, to which provisionally accepted applicants are sent prior to taking the oath of enlistment.

High Motives, Special Abilities.— The motive actuating an applicant for enlistment — such as a spirit of adventure, a desire to wear the uniform, or even a strong sentiment of patriotism— is not a satisfactory substitute for physical fitness. While it is true that some weedy individuals may develop to an adequate degree, or may even exhibit a rare courage or marked endurance under strain, experience shows overwhelmingly that such is the exception and not the rule. Exceptional recommendations as to character, ability, or knowledge of useful trades should be allowed to influence us only where such relative defects as slight deficiencies in height or weight are concerned. And it is important to bear in mind that there must be not merely the absence of disease or abnormality, but also freedom from any tendency thereto.

Lowered Standards.— At times of special urgency there is apt to be great pressure directed to the lowering of the standards. Militia organizations may desire to be transferred to the volunteer service intact; officers of newly organized regiments are anxious to fill the ranks; or, a real emergency exists. Even at such times, unless the emergency be acute, the pressure should be resisted, for the inferior material is unlikely to reach the firing-line. The defective men break down at the first strain and, never having rendered real service to their country, are promptest to demand pen-

• RECRUITS AND RECRUITING 25

sions. Woodhull quotes Vegetius (a celebrated Roman military writer) as follows: "An army raised without due regard to the choice of recruits was never yet made a good army by any length of service."

Regulars, Volunteers, Militia, Conscripts. — In our military system recruits may be considered under four heads, namely, Regulars, Volunteers, Militia, and Conscripts. Recruits for the first three are all volunteers, in the sense that they apply for enlistment of their own free will. Those for the last are compulsorily chosen in the absence of a sufficient number of voluntary applicants. Regulars are carefully selected by trained officers of the line and medical staff. Volunteers are picked in like manner, but, owing to the inexperience of examiners or pressure to lower the standards somewhat, the material is not always equal to that of the Regulars. This is shown by the fact that in the Civil and Spanish wars deaths from disease and discharges for disability were nearly twice as great among the Volunteers. In the widest sense the militia is the whole number of males of the country who are competent and available for military service. Specifically, the term is applied to the organised militia, these being the men who form the military organizations in the service of the several states. As these organizations — now known as the National Guard — are not ordinarily liable for hard field service, some states do not require a very high standard of physical fitness. When, therefore, in conformity with existing law, the organized militia may be called into the service of the United States, it will be found that from one-half to two-thirds of certain regiments are physically ineligible. It is an interesting but readily understandable fact that, whereas voluntary applicants for enlistment endeavor to conceal defects, conscript,* try to escape service by magnifying existing defects or feigning non-existent ones. In the examination of conscripts, therefore, a skeptical attitude of mind should be maintained toward alleged disabilities,

System of Examination. — Up to 1907 the physical examinations were made largely by civilian physicians, employed under contract, at recruiting stations in cities. Under this system great losses of men occurred as a result of disabilities discovered after the recruit had been sworn in. At the same time the government spent much money for the transportation and clothing of these defectives, while company commanders became dissatisfied on account of the poor quality of the material sent them. As a result of these undesirable features a system has been developed whereby line officers make a careful preliminary examination at their recruiting stations, and forward likely candidates to depots. At the latter points army medical officers examine these candidates, weed out the defective ones, and enlist those qualified. The Surgeon General reports that "the present recruiting system operates in a highly satisfactory manner and furnishes to the army recruits of far better quality than when they were examined under the former system."

Principal Defects. — The physical deficiencies which cause the greatest number of rejections for our army are: venereal diseases, heart abnormalities, defective vision or hearing, foot deformities, and poor physique. While it is not to be expected that line officers on recruiting duty shall be able to

RECRUITS AND RECRUITING 27

detect obscure affections of the internal organs, there are many grosser defects which are readily apparent to them. Such are: deformities, skin eruptions, pallor, emaciation, inebriety, venereal disease, defective development of parts, lice, dirty person, rupture, piles, stiff joints, varicose veins, flat feet, indecent tattooing, etc. Furthermore, internal disease may be suspected from shortness of breath, a thumping heart, dimness of vision, or irregular pulse following moderate exertion.

Character. — The character of the applicant should be determined as accurately as possible. He may satisfy all the physical requirements, but when the recruiting officer asks himself the question, "Would I be willing to have this man in my company?" there is often a decided negative. And this test is a useful one to apply with respect to the intelligence of the applicant, his knowledge of English, and his general appearance. The moral qualifications may be guessed from his features and gaze (open, frank or averted), his manner (direct or furtive and hang-dog), his person and clothing (clean or dirty). He may present the well-known appearance of a drunkard or a tramp. Drug habits may be indicated by numerous marks of the hypodermic needle or very dilated or contracted pupils. A marked disproportion of features or limbs may be indications of degeneracy, or his body may be much tattooed, some of the subjects being of an obscene or otherwise offensive nature.

Mental and Nervous Condition. — The mental and nervous condition is important. Many defectives — especially among the foreign born — pass the initial observation and some even the medical examination, for no class of cases is so difficult to determine without an extended observation. Nevertheless, a nervous, shifty, or excitable manner; wandering attention; defective memory; inability to give prompt or direct replies to questions; sudden, jerky movements, will frequently indicate an unstable nervous system or defective mentality.

Age. — Youth is a serious physical defect. We sometimes read the erroneous statement that the Civil War was fought by boys, but in that war, as in all those of history, undeveloped, immature youths succumbed to the fatigues and privations of campaign in vastly greater proportion than grown men. Prior to the age of twenty-one the bones are not fully formed, the muscles lack endurance, and the heart is unduly susceptible to overstrain. On the other hand, men over thirty, unless thay have led an active, alert life, are apt to be muscle-bound and mentally slow. The limits of age for our service are, in time of peace, eighteen to thirtyfive. It is, therefore, to be seen that minors may be legally accepted in spite of the knowledge that great commanders have, for centuries past, protested against the recruitment of boys for their armies. From a physiologic standpoint the truly desirable minimum is twenty-two years.

Height, Weight, Chest. — In the absence of actual disease conditions, the physical attributes which chiefly determine the acceptance or rejection of an applicant for enlistment are the height, the weight, and the chest measurements. In normal individuals these bear a fairly definite relation to each other, which relation is set down in official tables. Men

RECRUITS AND RECRUITING 29

whose chest circumference, at rest, is below 32 inches, should not be accepted, for such a chest has not sufficient air capacity. The present minimum of height is 5 feet 4 inches. The question of height is not quite so important now as in the days of shock action. Other things being relatively equal, the smaller man is generally quicker in his movements and has more endurance. In these days of specialism we might well accept vigorous men who are a little shorter than the present requirement for special service, thus releasing others of standard height for the fighting line. With respect to weight, men of the "wiry" type may be accepted when they are but a few pounds under the standard, but the mistake must not be made of confusing these with eases of defective or arrested development. In these latter, deficiency in weight, pallor, flabby muscles, a flat chest, sloping shoulders, and generally poor physique denote a feeble constitution.

Records. — It is essential, for the protection of the government, that careful records be made: (a) of all departures from the normal, including minor ones which are not considered disqualifying, and (b) of means of identification. The first is needed as a defense against unjust claims for pension. The second leads to the detection of criminals, deserters, bounty jumpers, and dishonorably discharged men who enlist fraudulently.

Depots. — Owing to the widespread derivation of recruits, depots for their collection and training are frequently afflicted with one or more kinds of contagious diseases, brought by some who have contracted them elsewhere. It has sometimes happened that measles, mumps, or other communi-

DMzeclbvGOOgk cable disease' has developed in parties of men sent from depots, during the trip or shortly after arrival at their destination. Army posts have thus been frequently infected, while the health of the traveling public has been endangered. If, therefore, such a disease exists at depots, the men who have been exposed to contagion should be isolated, in separate squads, until the period of incubation of that particular disease is past. If a case develops in any one squad, none but members of that squad have been exposed to it and the others may safely be forwarded. A similar procedure is advisable in camps.

Vaccinations. — One of the first requirements after the enlistment of a man is to have him vaccinated against small-pox and typhoid fever. This is a very important procedure, looking to his future health and that of the army.

General Order No. 66.— The remarks in this chapter are intended to emphasize the importance of sound recruits and sound methods of recruiting. The most important part of the whole subject, namely, the physical examination of the recruit, is not dealt with herein, for the reason that War Department General Order No. 66, series of 1910, is an excellent presentation thereof.

If in Doubt, Reject. — Recruiting is a highly important duty, for upon those to whom it is entrusted rests the responsibility for the physical, mental, and moral standard of the whole army. Officers assigned to this duty should keep in mind constantly the maxim, // in dmibt, reject.

Chapter III Personal Hygiene

Nature and Importance. — Personal hygiene means preservation of health by attention to the care of the body. It is obvious that such care is essential to keep the physical character of the soldier up to the proper standard. Napoleon is reported to have said, "The most important quality of the soldier is his ability to support fatigue and privation; physical courage is only second." Whether or not this be true, it must be apparent to any thinking individual that personal merits, including courage, are of little avail to the military man if he has not bodily vigor.

Formation of Correct Habits. — Military efficiency in an individual, then, rests upon certain considerations, chief among which are health, strength, and activity. To secure and keep these qualities it is essential for every man to form such habits as experience has shown to be necessary. These habits are: personal cleanliness; regulation of diet; avoidance of excesses (particularly in eating, drinking, and sexual matters); wearing suitable clothing; keeping the bodily processes at work (kidneys, bowels, skin); taking sufficient exercise, preferably in the open air; devoting a proper part of each day to rest of body and mind, with recreation for the latter; maintaining the surroundings in which one lives, in a cleanly state.

Anatomy and Physiology .—In the discussion of this branch of our subject, an elementary knowledge of anatomy and physiology must be assumed, as the scope of this work does not permit of instruction in these topics.

Personal Cleanliness. — The maintenance of personal cleanliness is even more necessary in the military service than in civil life. This is due in part to the violent exercises required of the soldier, with the resultant dirt and sweat, but especially because so many live together within a small space.

Baths and Bathing.— The most important requirement to insure cleanliness is bathing. Baths are necessary partly to rid the skin of external impurities, but chiefly to keep open the "pores," which are the mouths of the sweat-glands, whose product carries away large amounts of waste and poisonous matters from the blood. Each man has a preference for a certain temperature of the water in which he takes his bath; this varies from freezing to hot. A cold bath is stimulating and is to be preferred for a vigorous man, provided he "reacts" well and feels a glow on emerging from the bath and rubbing down. The cold bath is not suited to elderly men nor to those whose circulation is poor. The proper time for cold bathing is on arising in the morning, not at bedtime, as sometimes indulged in.

It is worthy of mention that the practice of cold bathing often breaks up the habit of "taking cold," to which certain people are liable.

Hot and warm baths are soothing and best remove surface dirt; they are grateful means of reducing muscular s

PERSONAL HYGIENE 33

after exertion, and will often induce sleep in a restless, wakeful person.

The most desirable means of bathing is perhaps in a tub in which the whole body may be immersed ; in default of this and particularly in barracks, the shower-bath is very satisfactory. If means for complete bathing are not available, careful attention should, in any event, be given to the daily cleansing of the armpits, crotch and feet, as well as the hands and face. The hands should be washed after defecation and urination, lest they convey disease germs. The nails must be well kept and clean. On the march, if no water is available, a vigorous "dry rub" with a coarse towel will be found refreshing as well as cleansing. The scalp should be washed at least once or twice a month and should be stimulated daily by brisk rubbing with a brush or the fingers.

Care of the Teeth. —Every man should own a good tooth brush and use it with a tooth powder or mild antiseptic (listerine for instance) at least twice a day. If no tooth powder is available, wood ashes or wood charcoal make efficient substitutes. •

Clothing. — Since clothing (especially the underwear) when soiled with sweat and dust is irritating to the skin and gives off disagreeable odors, it is necessary to keep this -as clean as the body. The soldier cannot keep his person clean if his garments are filthy. Therefore, whenever possible, the soiled clothing should be washed (and with soap if it can be had). If the articles are of wool, they should be washed in cold water and dried without wringing. On the march a man should have two suits of underclothes to wear on alternate days, thus ensuring cleanliness if the garments are regularly washed. If, at the end of the day's march, water is not available for this purpose, the garments should be dried, then beaten or well rubbed, and hung up in the air.

Skin Diseases.— In campaign, skin diseases due to animal parasites — especially lice and the itch mite — usually make their appearance and cause much disgust and discomfort. They must be watched for and report of their presence promptly made to the medical officer.

Diet. — In the soldier's life the diet is, of course, regulated as far as possible by the authorities, who design and issue the ration and train the cooks by whom the articles composing it are prepared. In campaign, military considerations may necessitate cutting away from the base of supply, so that soldiers are obliged to live on the resources of the country in which they are operating or even to subsist for a few days upon the emergency ration. Every soldier should be required to learn how to prepare his individual field ration, since the necessity for this frequently occurs in field service.

The character of the food taken should vary in accordance with the conditions of bodily vigor, occupation, climate, and food values. A vigorous man, doing heavy work, requires more nourishment than one of delicate physique following a sedentary pursuit. Climate is an important factor. Men serving in Alaska need a large amount of fats to serve as fuel in maintenance of the temperature balance. Those on duty in the Philippines require a large proportion of sugars and starches.

"Fletcherizing," that is, the chewing of food until it is

w DO! zed

PEBSONAL HYGIENE 35

completely disintegrated, makes eating a bore. Other food fads, such as strict vegetarianism or eating only when the sensation of hunger is felt, usually result in digestive disorders or loss of strength.

Dietary Dont's. — A few general dietary principles follow, which may perhaps best be expressed in the form of prohibitions:

Don't eat hurriedly.

Don't swallow a morsel till it is thoroughly broken up and mixed with the saliva by chewing.

Don't overload your stomach, but get up from the table feeling that you could eat a little more with relish.