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MILITARY HYGIENE AND SANITATION 
 
MILITARY HYGIENE AND 
 SANITATION 
 
 BY 
 
 COLONEL CHARLES H. MELVILLE 
 
 M.B. Edin., D.P.H. ' ' 
 
 ROYAL ARMY MEDICAL CORPS 
 
 LATE SANITARY OFFICER, ARMY HEADQUAR'TERS, INDIA 
 
 LATE SECRETARY AND EXPERT IN SANITATION, ARMY MEDICAL ADVISORY BOARD, 
 
 WAR OFFICE 
 
 PROFESSOR OF HYGIENE, ROYAL ARMY MEDICAL COLLEGE 
 
 MEMBER OF COUNCIL, ROYAL SANITARY INSTITUTE 
 
 WITH DIAGRAMS 
 
 LONDON 
 
 EDWARD ARNOLD 
 
 1912 
 
 [A// rights resefved] 
 

 BIOLOGY 
 LIBRARY 
 
 DEDICATED 
 TO THE MEMORY OF 
 
 PEINGLE, JACKSON, FITZPATRICK 
 
 AND MANY OTHER OFFICERS NOW FORGOTTEN, 
 WHO IN THE PAST WITH INADEQUATE MEANS 
 EFFECTED SO MUCH FOR THE HEALTH AND 
 WELL-BEING OF THE BRITISH SOLDIER, IN 
 THE HOPE THAT WE, THEIR BETTER-EQUIPPED 
 SUCCESSORS OF THE PRESENT DAY, MAY, BY 
 FOLLOWING THEIR EXAMPLE, ACHIEVE EVEN 
 BETTER RESULTS, SINCE WE CANNOT HOPE TO 
 SURPASS THEIR MERITS 
 
PREFACE 
 
 This short treatise on " Military Hygiene and Sanitation " 
 is founded on the lectures delivered by me while Professor 
 of Hygiene at the Koyal Army Medical College. 
 
 I have not attempted to deal in detail with all the problems 
 of hygiene, and in particular I have omitted — as, for instance, 
 in the question of house drainage — those which are liberally 
 treated in the ordinary textbooks. 
 
 In considering the prevention of infectious diseases, also, 
 I have limited myself to those which are most important in 
 war. I have not therefore discussed such ailments as 
 Malta fever and Tuberculosis, for instance, with which the 
 army is concerned mainly in peace-time, under conditions 
 not differing materially from those which confront the 
 Medical Officer of Health in civil practice. 
 
 I have to acknowledge much kind assistance from Captain 
 N. Dunbar Walker, Eoyal Army Medical Corps, who has 
 helped me greatly with suggestions and in the preparation 
 of some of the plates. 
 
 I have, further, to thank the Editors of the Journals of 
 the Royal Army Medical Corps and the Council of the 
 Royal Sanitary Institute for permission to make use of a 
 
 28^1759 
 
vi PREFACE 
 
 number of blocks which had previously appeared in the 
 Journals in question. The lower part of Fig. 5 is copied 
 from an illustration in " Royal Army Medical Corps 
 Training" (1911), and the permission of the Controller 
 of His Majesty's Stationery Office has been obtained for 
 its use. Q^ jj^ jyj^ 
 
CONTENTS 
 
 PAGE 
 
 PREFACE - - - - - ... V 
 
 CHAPTER 
 
 I. INTRODUCTORY -.-... 1 
 
 n. SANITARY ORGANIZATION - - - - - 18 
 
 in. PHYSICAL CONDITION OF THE RECRUIT - - - 22 
 
 IV. PHYSICAL TRAINING '- - - - - - 33 
 
 V. MARCHING - - - - - - - 46 
 
 VI. FOOD AND DIETETICS - - - - - - 81 
 
 Vn. THE soldier's RATION - - - - - 112 
 
 Vin. FIELD-SERVICE RATIONS - - - - - 119 
 
 IX. WATER-SUPPLY - - - - - - 139 
 
 X. PURIFICATION OF WATER - - - - - 169 
 
 XI. VENTILATION - - - - - - 196 
 
 Xn. REMOVAL OF WASTE MATTERS - - _ . 207 
 
 xrn. DISPOSAL of waste matters .... 225 
 
 XIV. DISPOSAL OF WASTE MATTERS IN THE FIELD- - - 245 
 
 XV. BARRACKS .--'.--. 272 
 
 XVI. TEMPORARY HABITATIONS OF THE SOLDIER - - - 292 
 
 XVII. CLOTHING ....... 301 
 
 XVin. EQUIPMENT - - - - - - - 313 
 
 XIX. PREVENTION OF INFECTIOUS DISEASES - - - 331 
 
 XX. PREVENTION OF INFECTIOUS DISEASES (continued) - - 365 
 
 XXI. DISINFECTION ....... 385 
 
 XXII. SANITATION OF THE BATTLE-FIELD .... 402 
 
 APPENDICES ------- 406 
 
 INDEX -------. 413 
 
 vu 
 
MILITARY HYGIENE AND 
 SANITATION 
 
 CHAPTER I 
 
 INTRODUCTORY 
 
 Man aims at the prevention of disease by the study of the 
 science of hygiene and the practice of the art of sanitation. 
 Strictly speaking, hygiene and sanitation should concern 
 themselves with the prevention of all diseases, but in prac- 
 tice certain ailments are excluded from their purview. They 
 deal, in fact, only with those diseases which are due to 
 causes originating definitely outside the body, which are, 
 in fact, the result of the interaction between the body of 
 man and his surroundings, whether natural or artificial. 
 Certain ailments — ^for instance, the so-called " diatheses," 
 and the different new growths, malignant or innocent — are 
 at present excluded from this list, though this by no means 
 implies that at some future date they may not be, as a result 
 of greater knowledge, added to it. 
 
 We may, in fact, say that hygiene is the science whereby 
 man studies the physical effect on himself of his surround- 
 ings ; sanitation the art by which he tries to accommodate 
 himself to these surroundings. The distinction between the 
 science and the art is of considerable significance. Hygiene, 
 being a science, is, like all other sciences, ruled by a code of 
 laws which are everywhere and immutably true. This code 
 consists of laws excerpted from among those of physiology 
 which govern the internal economy of man's body, and those 
 of the various natural sciences which regulate the nature 
 and behaviour of his surroundings. On the other hand, 
 sanitation, being an art, is, like all other arts, guided in its 
 
 1 
 
2 ; ;.<MJLITAJIY HYGIENE AND SANITATION 
 
 ■'•••*•. '*r»-. '•» , • . 
 
 practice by rules whicli, though founded originally on the 
 laws of hygiene, vary indefinitely with time and place, with 
 the age, sex, and occupations of the population in question, 
 and with a thousand other considerations of practicability 
 and social polity with which hygiene is in no way con- 
 cerned. This distinction may be illustrated by two very 
 simple examples. 
 
 It is an inevitable law of nature that all dead organic 
 matter shall ultimately be oxidized into the simple forms 
 represented by the oxides of (principally) carbon, hydrogen, 
 and nitrogen. This law, in so far as it concerns the sur- 
 roundings of man — that is, the waste products of his exist- 
 ence, his excreta, remnants of food, and other debris, the 
 dead bodies of his neighbours and his domestic animals — 
 is excerpted and added to the laws of hygiene, with the 
 further addition that during such process of oxidation no 
 possibly infective particles shall be given an opportunity of 
 passing from such waste products to the air, water, or food- 
 supplies of the community. Sanitation, founding its rules 
 on the above hygienic law, disposes of all such dead organic 
 matters by the method and in the manner best suited to 
 the actual nature of the substance in question, the richness 
 or poverty of the population concerned, and innumerable 
 other considerations. The methods which it adopts for the 
 disposal of sewage are not the same as those which it makes 
 use of in destroying household refuse, and, again, the 
 means which it employs for the former purpose are different 
 in the various cases of a rich manufacturing town, a small 
 and poor rural district, and a military cantonment in India 
 or South Africa. 
 
 To take another instance : In accordance with a universal 
 physical law, hot air rises and cold air descends. Since, as 
 a result of human respiration, air is vitiated in various ways, 
 hygiene adopts the above law, and utilizes it for the removal 
 of used air from, and the supply of fresh air to, the habita- 
 tions of man. Sanitation, recognizing the law, formulates 
 in accordance therewith its rules for achieving ventilation, 
 with the significant addition that the necessary changes 
 must be made without causing any sensible "draught," 
 realizing that human nature must be kept in mind when the 
 laws of science are adapted to the needs of daily life. And, 
 
INTRODUCTORY 3 
 
 again, though the physical law quoted above is equally true 
 in all climates and all latitudes, the actual mechanism of 
 ventilation is not the same in the two cases of, say, a house 
 in the north of Scotland and a barrack-room in Madras. 
 
 On occasion the conflict between what hygiene says should 
 be done and what sanitation recognizes as practicable may 
 be so great that we have to neglect the former in order to 
 effect the latter. In civilized communities such situations 
 but seldom occur ; but in military sanitation, which has to 
 work under barbaric surroundings, instances of this conflict 
 are not rare. I may here relate one such instance in which 
 this conflict was brought very obviously to my notice. In 
 the station of Quetta, in the nineties of last century, enteric 
 fever was prevalent every year during the summer and 
 autumn months, the epidemics gradually increasing in 
 severity, until in 1898 they culminated in one of the worst 
 outbreaks — if not the very worst — that ever occurred in 
 India. The European garrison consisted at that time of 
 two battalions of infantry and three batteries of artillery ; 
 one of the infantry battalions had only lately arrived at the 
 station, though it had been some three years or so in India. 
 The remaining units had all been in the station some time. 
 The annual epidemic began rather later than usual, but 
 between the beginning of August and the end of October — 
 when, as usual, it came to an end with the beginning of 
 winter — there were 232 admissions for enteric fever out of 
 A lor ce of EuroDeans numbering onlv 213 and of these 
 
 EKRATDM 
 Page 3, line 27, for " 213 " read " 2188." 
 
 lately arrived m tne station, ana contamea a large amount 
 of susceptible material. The other infantry battalion 
 suffered rather more than the artillery, whose barracks were 
 behind and some little distance from the western end of the 
 infantry lines. 
 
 The outbreak was so severe that in the case of the battalion 
 which suffered most, recruiting in the county from which it 
 came was seriously affected. The situation was undoubt- 
 
5 ;;.»: MILITARY HYGIENE AND SANITATION 
 
 practice by rules wHich, though founded originally on the 
 laws of hygiene, vary indefinitely with time and place, with 
 the age, sex, and occupations of the population in question, 
 and with a thousand other considerations of practicability 
 and social polity with which hygiene is in no way con- 
 cerned. This distinction may be illustrated by two very 
 simple examples. 
 
 It is an inevitable law of nature that all dead organic 
 matter shall ultimately be oxidized into the simple forms 
 represented by the oxides of (principally) carbon, hydrogen, 
 and nitrogen. This law, in so far as it concerns the sur- 
 roundings of man — that is, the waste products of his exist- 
 ence, his excreta, remnants of food, and other debris, the 
 dead bodies of his neighbours and his domestic animals — 
 is excerpted and added to the laws of hygiene, with the 
 further addition that during such process of oxidation no 
 possibly infective particles shall be given an opportunity of 
 passing from such waste products to the air, water, or food- 
 supplies of the community. Sanitation, founding its rules 
 on the above hygienic law, disposes of all such dead organic 
 matters by the method and in the manner best suited to 
 the actual nature of the substance in question, the richness 
 or poverty of the population concerned, and innumerable 
 other considerations. The methods which it adopts for the 
 disposal of sewage are not the same as those which it makes 
 use of in destroying household refuse, and, again, the 
 means which it employs for the former purpose are different 
 
 o± used air from, and the supply of fresh air to, the habita- 
 tions of man. Sanitation, recognizing the law, formulates 
 in accordance therewith its rules for achieving ventilation, 
 with the significant addition that the necessary changes 
 must be made without causing any sensible " draught," 
 realizing that human nature must be kept in mind when the 
 laws of science are adapted to the needs of daily life. And, 
 
INTRODUCTORY 3 
 
 again, though the physical law quoted above is equally true 
 in all climates and all latitudes, the actual mechanism of 
 ventilation is not the same in the two cases of, say, a house 
 in the north of Scotland and a barrack-room in Madras. 
 
 On occasion the conflict between what hygiene says should 
 be done and what sanitation recognizes as practicable may 
 be so great that we have to neglect the former in order to 
 effect the latter. In civilized communities such situations 
 but seldom occur ; but in military sanitation, which has to 
 work under barbaric surroundings, instances of this conflict 
 are not rare. I may here relate one such instance in which 
 this conflict was brought very obviously to my notice. In 
 the station of Quetta, in the nineties of last century, enteric 
 fever was prevalent every year during the summer and 
 autumn months, the epidemics gradually increasing in 
 severity, until in 1898 they culminated in one of the worst 
 outbreaks — if not the very worst — that ever occurred in 
 India. The European garrison consisted at that time of 
 two battalions of infantry and three batteries of artillery ; 
 one of the infantry battalions had only lately arrived at the 
 station, though it had been some three years or so in India. 
 The remaining units had all been in the station some time. 
 The annual epidemic began rather later than usual, but 
 between the beginning of August and the end of October — 
 when, as usual, it came to an end with the beginning of 
 winter — there were 232 admissions for enteric fever out of 
 a force of Europeans numbering only 213 and of these 
 cases 75 died. The infantry battalions occupied a long 
 line of barracks running roughly from north-west to south- 
 east, and the battalion at the westerly end sufl:ered by far 
 the most severely, contributing about two-thirds of the 
 cases and the great majority of the deaths. This battalion 
 was that which I have already referred to as having only 
 lately arrived in the station, and contained a large amount 
 of susceptible material. The other infantry battalion 
 suffered rather more than the artillery, whose barracks were 
 behind and some little distance from the western end of the 
 infantry lines. 
 
 The outbreak was so severe that in the case of the battalion 
 which suffered most, recruiting in the county from which it 
 came was seriously affected. The situation was undoubt- 
 
4 MILITARY HYGIENE AND SANITATION 
 
 edly most serious, and it became imperative to take some 
 steps to prevent a recurrence of such a state of affairs. It 
 will be remembered that in those days enteric fever was 
 universally looked on as a water-borne disease, and the 
 possibility of any other method of dissemination was hardly 
 considered, and, if suggested, derided. The water-supply 
 of Quetta was exceptionally good, and for reasons to which 
 I shall refer later, when discussing the causation of enteric 
 fever in India, the authorities in the station came to the 
 conclusion that the danger lay in the filth trenches. These 
 were situated to windward of the lines, and though, on 
 account of the arid nature of the soil and the absence of 
 water, which was not procurable, they were not properly 
 worked, I have no reason to doubt but that oxidation of 
 the faecal matter was proceeding, though slowly. The 
 decision arrived at was to shift the disposal ground to some 
 safer spot, but this was not easy to find. To go to leeward 
 of the lines was impossible for many reasons, one of which 
 was that the water came from mountains in that direction, 
 and we should have been working in proximity to the pipe 
 line and the service reservoirs. There was ground available 
 situated directly north of the lines, along a good road, but 
 unfortunately it was impossible to go more than half a 
 mile along this road without coming into the line of fire 
 from the infantry ranges. However, as there was no other 
 locality, there was nothing else to be done, and this position 
 was chosen, though it was closer to the barracks than the 
 existing trenches. At the same time, it was impossible to 
 carry out any shallow burial of the excreta — the only method 
 which is at all scientific, since in that manner only can 
 oxidation be hoped for — for the reason that this would 
 result in bringing the plague of flies, already sufficiently 
 dangerous, closer than ever to barracks. It was therefore 
 decided to bury the excreta in deep pits, measuring about 
 30 feet long, by 15 feet deep, and 6 feet broad. It was 
 intended that the filth for each day, after being placed in 
 the pit, should be covered with earth, but as the soil was 
 mainly a very coarse shingly gravel, this sank through the 
 mass of ordure, which was thus brought nearer to the surface. 
 Accordingly, the filth was merely poured into the pits, and 
 allowed to accumulate until within a foot of the top. By 
 
INTRODUCTORY 5 
 
 this time a dense scum had formed, owing to the rapid drying 
 of the topmost layers of sewage, and a septic action took 
 place in the subjacent fluid . There was no percolation through 
 the soil ; this was proved by digging pits close to those 
 already full, and there cannot possibly have been any oxida- 
 tion of the mass of putrescent organic matter. Considerable 
 nuisance resulted in the immediate vicinity of the pits, but 
 as the wind had never been known to blowfrom that direction 
 into barracks, this did not affect the garrison, though it 
 closed for purposes of exercise one of the few roads out of 
 the station. The number of admissions for enteric fever in 
 1899 was a little over thirty, though a fresh infantry 
 battalion which had come from Rangoon, where enteric 
 fever is rare, to replace a battalion that had been through 
 two epidemics in Quetta, was thus introduced. I am quite 
 aware of the danger of arguing on the lines, " Post hoc, 
 propter hoc," and I admit that no point can possibly be 
 proved in that manner ; but, knowing the station as well as 
 I did, I can think of no other cause for the reduction of 
 enteric fever that actually did occur than the extremely 
 unscientific method that we adopted for the disposal of 
 excreta. The original recommendation, for which I was 
 responsible, did not contemplate that this method should be 
 continued longer than would be necessary to institute a 
 more scientific method in a more suitable locality, to which 
 the excreta should be removed by a light railway. As more 
 than a temporary expedient such a method is naturally 
 indefensible, and nothing but the exceptional circumstances 
 of the case justified its adoption, even for a short time. 
 
 The sanitary officer must always remember that his duty is 
 to prevent disease, under the conditions under which he actu- 
 ally has to cope with it. To do this, to escape some emergent 
 and pressing danger, it may be necessary for him to violate 
 some law of hygiene, and thereby incur another, perhaps 
 even a greater, danger in the future. Such a step is only 
 justifiable when the man who takes it does so knowingly, 
 and with his eyes open. Acting thus, he will be able to 
 prepare himself to. meet, and if possible escape, the future 
 retribution which inevitably visits all infringement of natural 
 laws. Such methods must not be adopted to meet trivial 
 situations ; the greatness of the danger must be the measure 
 
6 MILITARY HYGIENE AND SANITATION 
 
 of the excuse ; but the man who is not ready to accept the 
 responsibility of breaking, if necessary, all and every 
 hygienic law, so as to cope with a desperate sanitary situa- 
 tion, will find himself in much the same situation as he who 
 subordinates the instinct of self-defence to the obligations 
 imposed by the sixth commandment. 
 
 The student of hygiene may be judged by his opinions, 
 and these can be tested by the exactness of their agreement 
 with the laws of natural science and physiology. The 
 sanitary officer, on the other hand, can only be judged by 
 the results of his work. The highest ideals of hygienic 
 sanctity are no excuse for an exaggerated sick-list, though 
 one is sometimes tempted to think that they may occasion- 
 ally, in the hands of bigots, form — at least in part — its 
 explanation. 
 
 Scope of Hygiene and Sanitation. — In the widest sense 
 hygiene and sanitation are concerned with all preventable 
 diseases and under all possible situations, and textbooks 
 dealing with these subjects aim, as a rule, at an equal catho- 
 Qcity. In actual practice the medical officer of health 
 concentrates his attention on those more or less limited 
 aspects of the science and the art which affect directly the 
 population under his care. This is more particularly true 
 of the so-called "trade sanitations," in which the popula- 
 tion is limited in numbers, very often in sex, and, of course, 
 always in occupation. This limitation is especially true of 
 military sanitation. Here the population is small, is con- 
 fined to one sex, and to members of that sex between certain 
 narrow limits of age. A population so homogeneous implies 
 a correspondingly restricted range of disease, and in our 
 army this is more particularly the case, since one particular 
 class of disease to which the population in question is, on 
 account of its age and sex, peculiarly liable — namely, 
 venereal disease — is by national choice and custom excluded 
 from the purview of the sanitarian. 
 
 The Military Population. — The military population con- 
 sists of young male adults, specially selected as being free 
 from organic disease, or, in the popular phrase, " sound in 
 wind and limb " ; living in organized communities in 
 specially built houses ; leading a life of moderate physical 
 exertion, free from all immediate anxiety as to employment 
 
INTRODUCTORY 1 
 
 or food ; liable at times, however, to be exposed to vicissi- 
 tudes of climate to which they have been previously un- 
 accustomed, and also to the exceptional strain, both physical 
 and mental, which is implied by the words " active service." 
 The most striking pecuHarity, however, about this popula- 
 tion is that its members no longer lead the individual life 
 of the civilian, but, instead, the communal life of the soldier. 
 We shall find accordingly that the problems of sanitation, 
 as they confront us in the case of the soldier serving in the 
 United Kingdom, are concerned almost entirely with this 
 change from the individualistic to the communal life. At 
 the outset of a soldier's career — as, for instance, in his 
 physical training — allowance is made for individual physical 
 pecuharities, but eventually he must learn to do what his 
 comrades do, and in the same manner and at the same time 
 as they. He must live in the same building, eat the same 
 food, march at the same pace, and share the same hardships ; 
 and eventually he must, if necessary, die with them, for the 
 sake of the community to which they all belong. The com- 
 munal life of the army is, in fact, one of the essential features 
 in that training which is intended to fit the soldier for the 
 performance of that last supreme duty. Its influence is to 
 be traced at every stage of his career, and it modifies all his 
 surroundings. The sanitary officer must therefore never 
 lose sight of this essential fact ; he must remember that his 
 recommendations affect not single individuals or small 
 households, but large aggregates of men. Such recom- 
 mendations, if accepted, will be carried out with the momen- 
 tum of a regimental organization behind them, and there- 
 fore carried out more perfectly than under any other system. 
 At the same time, this power, like all other massive forces, 
 has the defects of its qualities, and lacks the elasticity which 
 is a characteristic of less ponderous agencies, It is most 
 important, then, that it should not be brought to bear on 
 any problem until the sanitary officer is thoroughly satisfied 
 that the line of action he is recommending is the right one. 
 There must be no chopping and changing of plans ; no raw 
 haste, and no vacillation once the work has begun. 
 
 There is one very delicate aspect of the communal life 
 which I must just refer to. The units of which the army is 
 composed have histories going back in some cases for more 
 
B MILITARY HYGIENE AND SANITATION 
 
 than 200 years — histories of which they are justly proud, 
 and which it is the duty of every individual in the unit to 
 know. Linked up with these histories are many small 
 peculiarities and customs, which mean nothing to an outsider, 
 but are full of significance to the members of the unit. It 
 is the duty of the sanitary officer to recognize these, and 
 never on any account needlessly to interfere with such 
 traditions. It rarely happens that there is one way, and 
 only one, of arriving at a desired object ; the longest way 
 round is very often the shortest way home, in administra- 
 tion as well as geography. 
 
 I have already said that sanitation may be called the art 
 by which man adapts himself to his surroundings, since the 
 diseases at the prevention of which it aims are due to causes 
 existing outside the human body. In the case of military 
 sanitation this is more particularly true, since ex hypothesi 
 the population with which it has to deal is at the outset 
 free from all organic disease, " sound in wind and limb." It 
 is worth while, therefore, to devote a short time to consider- 
 ing the nature of these external disease causes. 
 
 All theoretically possible causes of disease existing outside 
 the human body may be divided into two classes — namely, 
 
 (1) those which remain always outside the body ; and 
 
 (2) those which, existing originally outside the body, can, 
 nevertheless, enter into the body, and which, unless they 
 can so enter, are impotent to produce any disease therein. 
 
 Amongst the causes which must be included under class 
 (1) are heat, cold, and the other various conditions which 
 together form what we denominate " climate," hunger, 
 thirst, occupation, etc. It is not more than twenty years 
 ago that almost all the diseases from which the soldier 
 suffered outside the British Isles were attributed to one of 
 these causes — ^namely, climate. The blessed word " Meso- 
 potamia " had never a more consoling eifect in theological 
 circles than " climate " for many years possessed in the 
 region of epidemiology. I have seen in some cases the 
 peculiar infectivity possessed by syphilis in certain parts 
 of the world even attributed to this cause. At the present 
 day climate as a cause of disease has lost all the prestige 
 which it once possessed, and, indeed, it may be said that 
 no one of aU these theoretically possible causes of disease, 
 
INTRODUCTORY 9 
 
 nor even any aggregation of them, can ever cause disease. 
 A man may be hungry, thirsty, ill-clad, and exposed to the 
 extreme of either heat or cold ; he will nevertheless not 
 contract any specific disease thereby, though he may suffer 
 severe injury. Disease, as apart from injury, is attributed 
 at the present day to the second class of external disease 
 causes — namely, those which, existing originally outside 
 the body, can nevertheless enter into it, and produce disease 
 there — in other words, specific pathogenic micro-organisms. 
 But here, again, it is accepted that these alone are not 
 necessarily capable of producing disease, even after effecting 
 an entry. Every man possesses a certain natural power 
 of resisting such an attack, and in military sanitation we 
 have to deal with a population whose powers of resistance 
 are, or theoretically should be, except in respect of one 
 particular disease, at their very highest. We see, then, 
 that, as regards the soldier, disease should be theoretically 
 impossible, unless he is attacked at the same time by some 
 cause belonging to the first class, which, by producing an 
 injury, lowers his powers of resistance, and also by some 
 disease germ which takes advantage of that weakened 
 defence to time its onslaught. Now, the causes which 
 lower a man's powers of resistance to disease are closely 
 connected with the work he does, the quantity and suit- 
 ability of the food that he eats, the sufficiency and otherwise 
 of the shelter provided, and so on. All these things are far 
 more under the control of the sanitary officer in the army 
 than under that of the medical officer of health, who has to 
 deal with a civilian population. The former has, therefore, 
 a double advantage over the latter, since he starts with a 
 healthy population, and the conditions which militate 
 against the maintenance of that state of health are to a 
 very great extent absolutely under his control. 
 
 We may divide sanitation in the army, then, into two 
 main headings — ^namely, the preservation of health, which 
 deals with all those external disease causes, which, as I have 
 said, remain always outside the body ; and the prevention 
 of disease, which is concerned entirely with the attack 
 made on the individual man by disease germs. 
 
 The duties of the medical officer, qua hygiene and sanita- 
 tion, include, then, the maintenance of health and the pre- 
 
10 MILITAEY HYGIENE AND SANITATION 
 
 vention of disease, and of these the former comes both 
 in time and in logic the first. The Report of the Army 
 Medical Department for 1909 shows that only one man in 
 forty was, on any one day, in hospital throughout the- 
 army at home and abroad, and only one man in fifty if the 
 army at home be considered. Again, every medical officer 
 of any experience knows that the sick list is furnished by 
 comparatively few men in any unit ; the great majority 
 never see the inside of a hospital. It is on this majority, 
 which I should feel inclined to put at a strength equivalent 
 to 75 per cent, of the whole army, that the eyes of the 
 medical officer should chiefly be fixed. 
 
 I have been speaking so far of the prevention of disease 
 only, and of the maintenance of health as a part of that 
 system. But it would be a great mistake to limit the 
 importance of the maintenance of health by confining it 
 to so restricted an area of influence. The soldier is essenti- 
 ally a man of action, and it is the duty of the military 
 medical officer to see not only that he keeps clear of hospital, 
 but also that he possesses in the highest degree all his 
 physical powers. It is in this direction that the medical 
 officer can come most prominently forward as taking a 
 part in the active executive work of the army in war. The 
 study of the physiology of the soldier's life, of the effect 
 produced on his constitution by his work in peace and in 
 war, is even more important than a study of the diseases 
 to which he is most usually exposed. Such study will not 
 only help to keep the man out of hospital, but will also 
 make him, to use an old phrase, a better man of his hands 
 whilst he is in the ranks. This side of a medical officer's 
 activities has not so far, I think, received the attention it 
 deserves. The older army surgeons — Pringle and Jackson, 
 and in later years Parkes — recognized its importance. 
 Since the days of the latter it has fallen somewhat into 
 neglect, but the institution of a special course at the Royal 
 Army Medical College directed entirely to this study indicates 
 a great advance in the policy of the Medical Departmenii--^ 
 in this direction. 
 
 As in all other trade sanitations, the work of the sanitary 
 officer in the army is affected by certain conditions and 
 considerations, some of which are common to all trade 
 
INTEOBUCTORY 11 
 
 sanitations, some peculiar to the trade of the soldier alone. 
 I propose to discuss these in detail. 
 
 In the first place come pecuniary considerations. In 
 time of peace pecuniary considerations, questions, that is, 
 of cost, are paramount. To put the matter in the crudest 
 way, the soldier has a certain pecuniary value, of which 
 the State is the responsible owner. Any such value is 
 calculable in terms of pounds, shillings, and pence, and aU 
 such values are liable to depreciation, against which the 
 prudent owner attempts to insure himself. The amount 
 of money to be paid in insurance on any valuable article 
 is readily ascertained by trained actuaries. Sanitation 
 is one form of insurance, and the amount of money that 
 should be expended on sanitation is just that amount which, 
 under ordinary conditions, due regard being had to the 
 capital represented, will safeguard the owner of the valuable 
 article against loss or depreciation ; in other words, will 
 protect the soldier from physical inefficiency and disease. 
 In private life this point is, of course, readily recognized, 
 and every man regulates his expenditure on the sanitary 
 improvement of his own house by this rule. The mere fact 
 that the sanitary officer has not to deal with his own money, 
 but with that of the nation, should make no difference, or 
 if this fact be permitted to affect his point of view, then it 
 ought only to be in the direction of making him balance 
 even more carefully the pros and cons of his recommendations 
 from the financial aspect. It is true that the position occu- 
 pied by the Medical Department in the general scheme of 
 military administration does not throw on the sanitary 
 officer the onus of actually deciding whether or no any pro- 
 posed expenditure should be incurred. His position is 
 merely advisory. His responsibility is, however, in no 
 way lessened by this fact. A sanitary adviser who has 
 no military status or training, may be forgiven if he bases 
 his advice on purely theoretical considerations, since he 
 is not in a position to visualize the situation from any other 
 than the one aspect. The military sanitary officer, however, 
 who aspires to be looked on as an integral part of the army, 
 can allow himself no such latitude. In virtue of his position 
 and experience he is enabled to view all sanitary questions 
 equally from the sanitary and the military side, and his 
 
12 MILITARY HYGIENE AND SANITATION 
 
 advice must therefore be based on a consideration of the 
 position under discussion, not only as it affects the health 
 of the soldier, looked at as a human being, but also as it 
 affects his value regarded merely as a national asset. It 
 is true that improved health and increased value go hand 
 in hand ; the former connotes the latter. But the advisa- 
 bility and practicability of the methods by which it is 
 proposed to attain these ends depend largely, in peace time 
 entirely, one may say, on their cost, and must be so estimated. 
 I have known, and I do not imagine my experience is unique, 
 sanitary officers make recommendations which I feel sure 
 they would have thought twice and oftener over if the money 
 had had to come out of their own official budgets. I have 
 known recommendations made of such magnitude that it 
 would have been cheaper in the long-run to move the 
 garrison concerned than carry out the proposals suggested. 
 Such conduct may be magnificent ; it may even be consonant 
 with the most perfect hygiene ; it is most decidedly not 
 sanitation, which, before all, has to adapt itself to its 
 surroundings. To make recommendations which are im- 
 possible on account of expense is just as foolish as to 
 suggest measures which run cou>nter to some natural physical 
 law. 
 
 There is a particular class of consideration that affects very 
 importantly sanitation as it is practised in the army, for 
 which I will use the term " industrial considerations." 
 These are due to the labour conditions in countries where 
 civilized workmen are not available. In India, for instance, 
 the art of plumbing, on which so much of modern sanita- 
 tion depends, is unknown. Schemes which, for their com- 
 pletion and upkeep, demand the work of skilled plumbers 
 are, therefore, impracticable. I state this merely as an 
 instance — it is not the only example — of the necessity 
 of recognizing the fact that the rules of sanitation can only 
 be applied through the industrial machinery locally avail- 
 able. The ambitious projects of the young sanitary officer 
 fresh from home, with the ink hardly dry on his hard- won 
 diploma of public health, wilt under the cold eye of the 
 native water-carrier and the low-caste sweeper. Not in- 
 frequently in his eyes the senior officer, who realizes the 
 true inwardness of the situation, must seem backward and 
 
INTRODUCTORY 13 
 
 effete. This stage of thought is one which we all go through, 
 and in warning young officers of its existence, I do not do 
 so with any vain hope that they will thereby escape the 
 salutary experience. It is, as it were, a disease from which 
 complete immunity can only be purchased by suffering from 
 a severe attack, sometimes from several attacks. It often 
 takes many years and many rebuffs before one realizes that 
 one cannot put the new wine of modern sanitation into the 
 old bottles of native custom and prejudice. 
 
 The last series of considerations with which the mihtary 
 sanitary officer has to reckon are military considerations. 
 In time of peace these have little or no weight. Speaking 
 from a fairly wide experience of sanitary administration, 
 both in India and at home, I can say confidently that I have 
 never known any important sanitary project rejected as 
 impracticable on purely military grounds, provided only it 
 were well reasoned in conception and clearly stated in 
 argument. I have known sanitary officers complain of 
 their schemes having been refused in this manner, but I 
 have invariably found that the fault lay on their own side. 
 Either the scheme was badly worked out, or the arguments 
 brought forward in its favour were loose and unconvincing. 
 In time of war, and to a less extent on manoeuvres, which are, 
 ex hypothesi, the picture of war, military considerations are 
 paramount, and rightly so. In time of peace the soldier is 
 merely learning his trade, and it is necessary that he should 
 be kept in good health for that purpose. On manoeuvres, 
 too, he is stiU merely learning his work, but now with some 
 approach to experiencing the actual rigour of real war. 
 It is reasonable, therefore, that on manoeuvres he should 
 be called on to undergo, in some modified way, the exposure 
 and hardship that he will inevitably have to suffer when 
 war comes. In war he is no longer learning his work, but 
 actually performing it, and that work is of such paramount 
 importance to the nation that no considerations whatsoever 
 of life or health must be permitted to interfere with its 
 execution or hinder its success. The duty of the military 
 sanitary officer in time of peace is, like that of all other 
 sanitary officers, to preserve the health of the population 
 committed to his charge. The duty of the military sanitary 
 officer in time of war is, like that of every other individual 
 
14 MILITARY HYGIENE AND SANITATION 
 
 in the army in time of war, to defeat the enemy. Since 
 that defeat is the result of certain physical activities on the 
 part of individual soldiers, culminating in the killing of 
 certain individual soldiers on the opposing side, it is obvious 
 that it will be achieved the more surely and rapidly, the 
 higher the level of physical efficiency — that is, health — 
 at which the sanitary officer can maintain the soldiers 
 of the army to which he belongs. Their health is not an 
 end in itself, but only a means, a very important means it 
 is true, but still only a means — ^to an end, and that end is 
 the defeat of the enemy. But the price of success in war 
 is human life and suffering, and it is for the Commander 
 to decide on the terms of payment. He may decide to pay 
 the price in exhaustion and disease, or in terms of bayonet 
 and gunshot wounds. He will choose, presumably, that 
 method of payment which seems to him the most convenient 
 and the cheapest, but in any case the choice rests with him, 
 and not with the medical authorities. 
 
 Two of the chief factors in any strategical problem are 
 time and numbers. The Commander may decide that it 
 is more important to be at a certain spot at a certain date 
 in diminished numbers rather than to be at the same spot 
 two days later in increased strength. A very striking 
 illustration of this point is given by Marlborough's cam- 
 paign in the Low Countries in 1 7 1 1 . He was on that occasion 
 opposed to Marshal Villars, the Commander of the French 
 Army, and it was necessary for him, if he would avoid a 
 desperate assault on a strongly entrenched position, to 
 seize a certain point by a certain time. If successful in 
 this, it would be unnecessary for him to expose his men to 
 further risk of punishment under the fire of the enemy. 
 Calling on his troops for severe exertions, he attained his 
 object, the right wing of his army covering forty miles in 
 eighteen hours. Long before the position was reached, in 
 the words of Mr. Fortescue : " The severity of the march 
 began to tell heavily on the foot. Hundreds dropped un- 
 conscious, and many died there and then, but they were left 
 where they lay, to await the arrival of the rearguard ; for 
 no halt was called, and each regiment pushed on as cheerfully 
 as possible with such men as still survived." As a result, 
 the next day Marshal Villars offered battle under the walls 
 
INTRODUCTORY 16 
 
 of Cambrai, but Marlborough had aheady won the rubber, 
 and decHned to reopen the game. The fortified town of 
 Bouchain surrendered under the very eyes of Villars who, 
 outmanoeuvred by this desperate march, was unable to 
 interfere, and " with its capture the last, and not the least, 
 of Marlborough's campaigns came victoriously to an end." 
 
 Another very striking illustration is to be found in the 
 career of Stonewall Jackson. Colonel Henderson says in 
 his Life of that great General (voJ. ii., p. 482) : " His victories 
 were won rather by sweat than by blood, by skilful 
 manoeuvring rather than sheer hard fighting. Solicitous 
 as he was of the comfort of his men, he had no hesitation, 
 when his opportunity was ripe, of taxing their powers of 
 endurance to the uttermost. But the marches which strewed 
 the wayside with the footsore and the weaklings won his 
 battles. The enemy, surprised and outnumbered, was 
 practically beaten before a shot was .fired, and success was 
 attained at a trifling cost." Jackson himself said : " I had 
 rather lose one man in marching than five in fighting." 
 In other words, he knew that victory was cheaper when 
 bought, as it must be in the first case by suffering and disease, 
 than when purchased by wounds and violent death on the 
 field. 
 
 The sanitary officer who should object to such a method 
 of purchase, because it conflicted with some textbook rule 
 of hygiene or sanitation, would stand convicted of ignorance 
 of the merest elements of his craft. His duty is to acquiesce, 
 and see to it that the coin in which the price is paid rings 
 true, and is full value. It was the footsore and the weaklings 
 who strewed the wayside of Jackson's marches, and thereby 
 not only increased the cost of his victories, but made those 
 victories less certain. It is for the sanitary officer to see 
 that the footsore and the weaklings are as few in number 
 as possible, and that if a man must die from exhaustion, or 
 disease the result of exhaustion, it should be due to no cause 
 which medical science could have obviated. 
 
 I have used Marlborough and Jackson to illustrate my 
 argument, since their worst enemies never accused either of 
 these leaders of being battle shy, and both were conspicuous 
 for their care and solicitude for the comfort of their men. 
 The first named is stated on one opcasion to have taken a 
 
16 MILITARY HYGIENE AND SANITATION 
 
 footsore private into his carriage, and the latter stood sentry- 
 over his weary men on the march to BuU Run sooner than 
 that they should be disturbed. Their plans were not affected 
 either by any aversion to the ordeal by battle or by any 
 indifference to the sufferings of their soldiers. TJiey knew 
 that victory was to be bought only at a price, and they 
 merely chose the currency in which that price should be 
 paid. It is not for the sanitary officer to cavil at the price 
 or the terms of payment ; his duty consists in seeing that the 
 currency is not depreciated. 
 
 The recommendations of the sanitary officer in time of 
 war must then be carefully drawn so as to fit in with the 
 general scheme of the campaign, and with the basic principles 
 of strategy. To enable him to do this it is his duty in peace- 
 time to study those principles by reading not only the 
 textbooks in which they are laid down, but also military 
 history. It is probably true that no guide to knowledge 
 can ever quite replace actual experience, but for individual 
 experience to be really valuable it must be compared with 
 the experience of others, and thus a true parallax for the 
 solution of any problem obtained. Experience and study 
 of history combined will give a man a stereoscopic vision, in 
 comparison with which that supplied by either alone is 
 weak and narrow. But the experience of the man who 
 has never thought over and analyzed his experience, is often 
 the most dangerous and fallacious of guides. Frederick 
 the Great's famous baggage mule still remained a baggage 
 mule in spite of its numerous campaigns, and many a man 
 has had as much experience as that well-known animal, 
 and still remained like it, intellectually, in the position 
 from which he started. 
 
 The reading of the sanitary officer should comprehend 
 not only the systematic treatises, such as Napier's " History 
 of the Peninsular War," or Mr. Oman's later study of the 
 same period, or Mr. Fortescue's magnificent " History of 
 the British Army," but also, and even more importantly, 
 perhaps, memoirs of individual soldiers of aU ranks ; 
 the humbler the rank, the more valuable the memoir. 
 Sanitary officers frequently find themselves in stations where 
 it is difficult to procure scientific works dealing with their 
 own special subject. The stations where military literature 
 
INTRODUCTORY 17 
 
 of the kind I have referred to is not procurable are few 
 indeed. In a fairly extended experience of Indian service 
 I can only remember one such, and in that a circulating 
 library kept up by the Intelligence Department at the 
 headquarter station thirty miles o3 was available. There 
 is, then, no excuse for medical officers who neglect this side 
 of their education. 
 
 In connection with this subject I should like to impress 
 on all students of military sanitation the benefit to be 
 reaped from a study of imaginary problems. I am quite 
 aware that such study is irksome, and many men will probably 
 say, or at least think, that a knowledge of sanitation and 
 of the service combined is quite enough to enable them to 
 meet oShand any problem when it actually does face them 
 in concrete form. They resort, in fact, to the ancient excuse 
 of the amateur actor : " It will be all right on the night." 
 We all know that amateur, and also the dismal failure that 
 usually results " on the night." Most of us know officers 
 whose performance in a crisis has for similar reasons come 
 equally short of their confident promise in advance. 
 
CHAPTER II 
 
 SANITARY ORGANIZATION 
 
 The chief sanitary authority of the army, in peace or war, 
 is the Director-General of the Army Medical Service, and 
 this authority is exercised by him in the form of advice to 
 the Secretary of State for War and the Army Council 
 through the Adjutant-General. The position of the Director- 
 General, and his relation to the chief military authorities, 
 is duplicated throughout the service by the relationship 
 of Principal and Administrative Medical Officers to Com- 
 manders-in-Chief and General Officers Commanding divisions, 
 and again by the relationship borne by medical officers in 
 charge of effective troops to officers commanding individual 
 military units. Every military officer exercising command 
 has at his disposal a medical officer as his responsible 
 sanitary adviser. The medical officer has no executive 
 authority except such as is delegated to him as a staff 
 officer of the commanding officer. The latter is responsible 
 for the due execution of the measures recommended to him 
 by the former, and is also responsible for co-ordinating these 
 measures with the general military situation. It must 
 be obvious that the only person who can really effect this 
 co-ordination is the man on whom the responsibility for 
 the success of the military operations in progress rests, and 
 this is equally true of a subaltern commanding a. company 
 and a Field-Marshal commanding the massed forces of the 
 Empire. 
 
 But though this is true, and an inevitable consequence of 
 rational military organization, it in no way lessens the 
 responsibility that devolves on the sanitary officer, of seeing 
 that the advice he gives is such as will not conflict obviously 
 with strategical or tactical principles. Any medical officer 
 
 18 
 
SANITARY ORGANIZATION 19 
 
 of health could give the commander the necessary advice 
 to meet the sanitary situation considered by itself. The 
 military sanitary officer has no raison d'etre unless he is 
 prepared to envisage the military aspect of the problem 
 as well, and frame his recommendations accordingly. He 
 has no right to throw on the shoulders of a man, already 
 sufficiently burdened with responsibility, the onus of deciding 
 the relative importance of a series of recommendations, 
 concerning a technical department with which he cannot 
 be expected to be thoroughly acquainted. 
 
 Lord Wolseley in his " Soldiers' Pocket-Book " says some 
 very crushing things on this subject, and recommends 
 Generals to leave their sanitary officers at the base, stigma- 
 tizing the whole matter as " a modern fad." If tradition 
 be true, he had some reason for his wrath. Sanitary officers 
 who will not recognize the true inwardness of military 
 sanitation and its position in the military scheme, are far 
 too near the front if they are at the base of operations. It 
 would be difficult, in fact, to find a suitable situation for 
 them consistently with the retention of their names in 
 the Army List. 
 
 Principal and Administrative Medical Officers are assisted 
 in sanitary matters by specially qualified sanitary officers, 
 on whom they rely for the supervision of the details of 
 sanitary administration in the force of which they are in 
 charge, and also, should they feel the need of it, for expert 
 advice. The sanitary officer is a staff officer to the Principal 
 or Administrative Medical Officer, as the case may be, and 
 not to the Commander-in-Chief or the General Officer Com- 
 manding. This position is sometimes misunderstood, and 
 therefore a few words as to the absolute necessity for its 
 existence may be pardoned. 
 
 The responsible adviser of the General in all matters con- 
 nected with the sick is the Principal Medical Officer. The 
 number of sick that will need to be provided for must 
 naturally vary with the extent and efficacy of the measures 
 adopted for the prevention of disease. A very simple illus- 
 tration will suffice. Suppose a force to be operating in an 
 area where the water is known to be bad. The amount of 
 sickness will depend on whether or no sufficient measures 
 are taken for the purification of the water. Clearly, if no 
 
20 MILITARY HYGIENE AND SANITATION 
 
 sterilizing apparatus is taken, a greater amount of hospital 
 accommodation will be needed. The Principal Medical Officer 
 could not logically demand the provision of transport for 
 his sterilizers and at the same time for the increased hospital 
 accommodation necessitated by the fact that the water 
 was bad. If his sterilization is not going to lessen the sick- 
 list, the apparatus may as well be left behind. Obviously, 
 if there is a condition of divided responsibility — if one man 
 is responsible for the prevention of disease and another for 
 the care and treatment of the sick, duplication of the kind 
 I have just suggested will inevitably occur. The only 
 possible way of avoiding such duplication and the resulting 
 inevitable friction is to keep the two — prevention of disease 
 and the care of the sick — under the one man. The principal 
 medical officer may, of course, delegate his sanitary powers 
 very largely to his sanitary officer. He cannot delegate 
 his sanitary responsibility, which is inalienable. 
 
 The divisional sanitary officer is undoubtedly a very 
 important link in the sanitary chain. Speaking of India, 
 where alone I have any personal experience of the work, I 
 know that he can render the greatest possible assistance 
 to his principal medical officer and also to his other brother 
 officers of his own standing in charge of stations in the 
 division. Within the first three months he should know 
 the general topography of every station in it, the general 
 distribution of barracks, and the class and medical history 
 of the troops occupying them. It is far easier to submit 
 recommendations for a station which one has actually seen 
 than for one known only from plans. 
 
 His laboratory work should take a second place. The 
 real workroom of the sanitary officer is the barracks, and 
 unless and until he knows them thoroughly, his advice 
 with regard to them will lack actuality. Ignorance in this 
 direction is the unpardonable sin. 
 
 So far I have been speaking of sanitary administration 
 as it concerns the Medical Department, but it is an error 
 to suppose that the matter ends with that branch of the 
 Service. The executive sanitary officers of the British Army 
 are the squadron, company, and battery officers. It is on 
 them and on the extent to which they realize the assistance 
 that sanitation can afford them in the execution of their 
 
SANITARY ORGANIZATION 21 
 
 military duties that the health of the army ultimately 
 depends. An army that relies on its sanitary officers for 
 its health would be in much the same position as one which 
 relied on its Adjutant-General for its discipline. It is the 
 duty of sanitary officers to try and make regimental officers 
 recognize their responsibilities in this direction, and also 
 to point out to them the very real value that sanitation 
 possesses from the purely business point of view — that it 
 means full ranks and ranks full of healthy men. Just as 
 the executive sanitary officer is the regimental officer, so 
 the actual maintenance of sanitation depends on the rank 
 and file. I do not refer to those men in every unit who 
 are told off for actual sanitary duties, though they play 
 an important role, but the individual warrant officers, 
 non-commissioned officers, and privates, from the sergeant- 
 major to the last-joined recruit. Unless these can be got 
 to recognize the value of sanitation — again from the purely 
 business point of view — there will be no sanitation in the 
 unit. There will be plenty of standing orders, no doubt — 
 probably in direct ratio to the amount of disease in the 
 unit — but there will be no real sanitation. This is, of 
 course, to a certain extent a matter of instruction, but much 
 more a matter of example ; and the sanitary officer is not 
 the person who should be responsible for imparting either. 
 I feel very strongly that in a question so closely linked up 
 with the internal discipline of the regiment, battalion, or 
 battery, there should be no intermediary between the 
 regimental officer and his men. If any such is allowed, the 
 men and officers mil come to look on sanitation as some 
 extra -regimental affair, worthy, no doubt, of the recognition 
 and acceptance due to all such matters ; they will not 
 recognize it as what it really is— an organic part of the 
 regimental life. 
 
CHAPTEK III 
 
 THE RECRUIT 
 
 The first consideration of the sanitarian is the physical 
 condition of the population amongst whom he has to work. 
 It must be, therefore, our first task to discuss the con- 
 ditions under which the soldier enters the ranks before 
 we consider his work and the surroundings in which he has 
 to live. 
 
 Tebms of Enlistment. — The British soldier enlists be- 
 tween the ages of eighteen to twenty-five for two periods of 
 service, which together aggregate twelve years, and which are 
 distinguished as service with the colours and service in the 
 reserve. The relative length of these two periods varies 
 in different arms and also at different times as a result of 
 changes of national policy. The most important classes — 
 viz., the infantry and cavalry of the line enlist for seven 
 years' colour service and five years in the reserve. The 
 sappers of the Eoyal Engineers enlist (in part) for a similar 
 period. The Royal Horse Artillery enlist for two periods 
 of six years. The Brigade of Guards and the Royal Army 
 Medical Corps for one of three with the colours and of nine 
 years with the reserve. 
 
 The period of colour service of the man in a line regiment, 
 though called " short service," is, in fact, long service 
 when we compare our army with any one of the continental 
 armies. This is necessitated by the fact that we have 
 to keep about one-half of the army constantly abroad, and 
 therefore must insure men serving overseas long enough to 
 repay the cost of passage. 
 
 Our army is enlisted on a voluntary basis, and it is interest- 
 ing to note one of the physical effects of this. Since the 
 service is voluntary, and the engagement for a limited period 
 
 22 
 
THE RECRUIT 23 
 
 only, it is too much to expect that men who have already 
 got settled down to a job in civil life will throw up their 
 work for a purely temporary benefit. The men we get 
 are therefore the men not in regular work, very often men 
 who have never been in regular work. According to the 
 Report of the Director-General of the Medical Service for 
 1909, the proportion that were more or less unemployed 
 on enlistment was about 90 per cent. This being so, and 
 the ranks being open to lads of eighteen, it is obvious that 
 we must enlist a considerable number of immature and 
 underfed lads — a point alluded to in the Report already 
 quoted. This is a natural corollary of the voluntary 
 system of enlistment, and from a national point of view the 
 early age at which we take recruits possesses a very distinct 
 advantage. It is far better to take a lad who, morally, is 
 more pliable, and who, physically, has not suffered much 
 from unemployment, than to wait till a later period, when 
 both mind and body have deteriorated as the result of an 
 extra year or so of "loafing." These facts, however, of 
 immaturity and physical poverty must be kept in mind 
 when the effect of the training and work of the young 
 soldier are being considered. This point, also, is referred 
 to by the Director-General in his Report for 1909, as 
 follows : "It should not be forgotten that many of the 
 lads will be incapable of doing the work of a seasoned 
 soldier for at least two or three years." Similar notes have 
 been made in previous Reports, and, indeed, nothing else 
 is to be expected. A lad cannot at eighteen do the work 
 of a man, and we have to pay for the fact that we get the 
 recruit at an age of greater moral and physical receptivity 
 by the comparative disadvantage of having to keep him 
 more back in his training than we would otherwise do. 
 
 In other countries with universal service the age of habihty 
 to service varies from seventeen to twenty-one, but the 
 majority do not take their men tiU at least twenty. This 
 is in part due to the fact that their service is so much 
 shorter than that in our army. It would be impossible 
 to recruit line regiments for two or three years — ^the usual 
 continental period — if men entered at eighteen. As one 
 result our soldier of twenty years of age has two years of 
 training and of good feeding to his credit, as compared 
 
24 MILITARY HYGIENE AND SANITATION 
 
 with the continental recruit of the same age, and the nation 
 retains his services for five years longer with the colours. 
 More than half our men come to us under twenty, and the 
 result is that we possess a class of soldiers of from under 
 twenty-three to twenty-seven with more training and physi- 
 cally better " set " than are available in any other army. 
 
 Physical Standards — Height. — The height of the British 
 recruit averaged in 1909, 5 feet 6^ inches. This was i inch 
 higher than the average for the previous decade. The 
 actual minimum standard varies somewhat with labour 
 conditions, but is fixed at present at a minimum of 5 feet 
 
 4 inches for infantry of the line, and 5 feet 4 inches to 
 
 5 feet 6 inches for cavalry. Departmental corps allow of 
 a somewhat lower standard, whilst the Royal Horse Artillery 
 fix 5 feet 7 inches for all classes (except artificers) ; the 
 Royal Field Artillery 5 feet 7 inches for gunners, and 
 5 feet 5 inches for drivers ; the Royal Garrison Artillery 
 5 feet 8 inches for all classes except artificers. Certain 
 corps d^elite are able to demand special standards. Thus, 
 the Grenadier, Coldstream, and Scots Guards insist on 
 5 feet 9 inches, and the Cavalry of the Household Brigade 
 on 5 feet 11 inches. In mounted corps an upper limit is 
 also fixed : 5 feet 8 inches in the line cavalry, 5 feet 7 inches 
 in the drivers of the Royal Horse and Royal Field Artillery, 
 and 6 feet 1 inch in the Household Cavalry. 
 
 Increased height does not in these days possess the value 
 that it had in the wars of the pre-breechloading era. Tall 
 men had, in the days of close formations, a distinct moral 
 value when it was a question of close quarters and shock 
 tactics. The comparatively small man, on the other hand, 
 is quicker, as a rule more active, gets more value out of his 
 ration, and does not knock himself about to the same 
 extent as the bigger men on rough ground. [" Les petits 
 resistent long-tems, les colosses succombent de bonne 
 heure. La campagne de Moscou est decisive a cet egard " 
 (Coche)]. The minimum height in Germany is 5 feet 
 l^ inches ; Russia, Italy, and Austria, 5 feet 1 inch. The 
 French fix no lower limit for infantry. The Swedes and 
 Norwegians come up to about our figures. Height is 
 essentially a matter of race and breed. Above a certain 
 limit, which yaries with each strain of blood, men are apt 
 
THE RECRUIT 25 
 
 to get weedy, and it is, strictly speaking, unscientific there- 
 fore to fix an absolute standard for men so widely different 
 in race as the Scandinavian of the Border Counties and the 
 Celt of Wales, or some parts of the West of Ireland and 
 Scotland. Where the divergencies are greater, as in the case 
 of the Indian Army, this fact has to be taken into account. 
 It would be absurd to have one ruhng standard for the 
 Gurkha, the Tamil, the Mahratta, the Sildi, and the Pathan. 
 
 Chest Measurement. — The minimum expanded chest 
 measurement in the infantry of the line is at present 
 33-1^ inches for a lad of eighteen under 5 feet 5 inches in 
 height. At the same height, but twenty years of age, 
 34 inches are demanded. In cavalry of the line the 
 minimum is increased by 1 inch at each of the above ages. 
 ArtiUery and special corps £x special figures, which need 
 not be detailed. The important point in connection with 
 chest girth is not the absolute tape measurement, but the 
 range of mobility. This is fixed at a minimum of 2 inches, 
 or 2 J inches in the case of men who are exceptionally tall 
 for their age. As regards the absolute chest measurement, 
 this should always be taken in connection with the height. 
 For medium men the chest girth should be rather over 
 half the height, for smaller men proportionately greater, 
 and for taUer men proportionately less. It must constantly 
 be kept in mind that the chest girth is one of the most 
 uncertain measurements that can be made. Differences in 
 method — as, for instance, in the height at which the tape 
 is placed in different countries, personal differences in the 
 matter of a taut or a slack tape in the technique of different 
 observers, and varying muscularity of the pectoral region 
 in various recruits — all affect this question materially. 
 Our own standards are fairly in accordance with the rough 
 rule laid down above. 
 
 Weight is taken into consideration with age and height. 
 The minimum for infantry of the line is 112 pounds for a 
 lad under 5 feet 6 inches, and eighteen years of age. At 
 the same height, but over twenty, 3 pounds extra are 
 demanded. The cavalry ask the same amount — viz., 
 115 pounds for both the above classes of men. They also 
 lay down a maximum of 147 pounds for men under 
 twenty, and of 154 pounds above that age. Weight 
 
26 MILITARY HYGIENE AND SANITATION 
 
 is a very useful guide to the physique of a man, but must 
 be used with caution. There is, of course, no difficulty in 
 ascertaining the actual weight within the limits of instru- 
 mental error, but it must be remembered that weight 
 varies very considerably, not only from day to day, but also 
 from hour to hour, according to the amount of solid and 
 liquid food ingested and the solid and liquid discharges. 
 It naturally should bear a definite relationship to height, 
 and the standard sometimes laid down, which affords a 
 useful rough rule for guidance, is that the weight in kilo- 
 grammes should be equal to the number of centimetres of 
 height in excess of 100. Thus, for a lad of 5 feet 4 inches 
 (160 centimetres) the average weight should be 60 kilo- 
 grammes, or 132 pounds. For immature lads this is un- 
 doubtedly too high a standard, especially if they are not 
 too well fed. Weight must naturally also be taken into 
 consideration with appearance, and obesity excluded. 
 
 The average age, height, chest measurement, and weight 
 of the recruit in 1909 were as foUows : Age, 19-8 years; 
 height, 66-5 inches ; chest measurement (minimum), 
 33-6 inches, with an average expansion of 2-6 inches ; 
 weight, 130-1 pounds. We see that the chest measurement 
 is greater than half the height, and the weight in Idlo- 
 grammes 7 less than the odd centimetres of height over 100. 
 This points to a man rather under the average in height 
 (which is to be expected at the age), well proportioned, 
 but rather wanting in muscular development. These 
 standards may be compared in another way. A French 
 army medical officer, Pignet, has devised a formula which 
 goes by his name, in which the weight in kilogrammes, plus 
 the chest measurement in centimetres, is subtracted from 
 the height in centimetres. The resulting figure provides a 
 numerical index of physical efficiency, the height of the 
 index being in inverse ratio to the degree of efficiency. 
 Pignet classifies his indices as follows : Under 10, " very 
 strong "; between 10 and 15, " strong "; 15 to 20, " good "; 
 20 to 25, " fair "; 25 to 30, " weak "; 30 to 35, " very weak "; 
 above 35, " useless." 
 
 The average height, weight, and chest measurement of 
 the recruit of 1909 give us the following formula : Height 
 (166-25), minus chest measurement (84), plus weight (59-1), 
 
THE RECRUIT 27 
 
 equals an index of 21-15 — just a little too high to be " good," 
 but certainly to be classed as " very fair." The figures 
 for the previous decade are a little lower all round — viz., 
 height, 66 inches (165 centimetres) ; chest measurement, 
 33-4 inches (83-5 centimetres) ; and weight, 128-1 pounds 
 (58-2 kilogrammes), giving an index figure of 23-3. 
 
 A consideration of these figures shows that the remarks 
 of the Director-General quoted earlier in this chapter are 
 well supported on scientific grounds. 
 
 Apart from actual standards of measurement, recruits 
 have to possess a certain standard of health, or, rather, 
 must be free from certain actual ailments or defects. These 
 defects and the method of ascertaining them are laid down 
 in the instructions for medical officers examining recruits 
 in the Army Medical Regulations, and it is unnecessary to 
 detail them here. A few words may, however, be said 
 about the actual cause of rejection. 
 
 Out of a total number of 50,298 inspected during 1909, 
 15,041 were rejected, or 29-9 per cent. Of these 5-8 per 
 cent, were rejected for deficient chest measurement, 1-1 
 for deficient height, and 0-46 for deficient weight, or a 
 total of 7-4 per cent., for being under standards. Defective 
 teeth accounted for about one-sixth of the total number 
 of rejections ; heart disease for one-ninth ; defects of the 
 lower extremities, including flat-foot, for one-thirteenth ; 
 defective vision for one-sixteenth ; varicocele for one- 
 twentieth ; and varicose veins for one-twenty-fifth. 
 
 The importance of defective teeth is obvious. The ratio 
 of rejections for this cause during 1909 was higher than in 
 the two years immediately previous, but lower than in 
 the years before 1907. The personal equation of the re- 
 cruiting officer comes very strongly into play here. The 
 condition of the teeth, it should be remembered, is only of 
 importance as affecting the general nutrition. A man with 
 a doubtfully sufficient number of teeth in his head, who is, 
 nevertheless, well nourished, is clearly not suffering from 
 the deficiency in his dental apparatus. The two factors, 
 nutrition and number of teeth, should always be taken 
 into consideration together. 
 
 Heart disease plays, as wiU be seen, an important part. 
 It is occasionally said that the standard laid down by the 
 
28 MILITARY HYGIENE AND SANITATION 
 
 military medical officer is too strict in this respect, and that 
 men are rejected on account of functional cardiac disorder 
 in whom there is no organic disease, or at least complete 
 compensation. This is probably true, at least as regards 
 the second part of the indictment. I cannot agree with the 
 first part — namely, that the line is too strictly drawn. The 
 conditions under which a medical officer examines a recruit 
 are very different from those that obtain in a civilian con- 
 sulting-room. The time for examination is limited, since 
 probably a considerable number of men have to be examined 
 in a comparatively short period. Above all, it is impossible 
 to tell the man to go away, and come back in a few days and 
 say how he feels. The decision has to be made at once. 
 It must be remembered, too, that the army is recruited up to 
 a fixed strength. Any doubtful man taken in, means 
 another possibly better man kept out some weeks later 
 owing to the list for that corps, or arm, being closed. 
 Lastly, it is not sound policy to take such a risk on behalf 
 of the State. There is no use in teaching a man the trade 
 of soldiering if there is even a small probability of his not 
 being able to parade with his unit for service. This is, of 
 course, speaking of recruiting only. Once a man has learnt 
 his trade, and can be kept under observation, then it is 
 reasonable to keep him in the ranks, with a cardiac deficiency 
 or apparent deficiency, which would certainly have kept him 
 out as a recruit. 
 
 All recruits can be discharged as unfit within three months 
 after enlistment on the advice of a medical officer. The 
 causes for discharge under these circumstances are much 
 the same as those for rejection of recruits. The total number 
 so discharged during 1909 was 526, or 1 per cent, of those 
 actually appearing for examination. The proportion to the 
 number actually enlisted thus discharged after trial was 
 small, only 1-1 per cent. Loss or decay of teeth was the 
 most important cause. Heart disease and defective vision 
 came next in the list. The total number was less than that 
 for the previous decade, but the same causes were operative 
 in both periods, and in much the same relative proportions. 
 It is interesting to note that this probationary period of 
 three months is a revival of the old Roman custom of 
 probation for recruits. 
 
THE RECRUIT 29 
 
 Social Position of Recruits. — Voluntary enlistment 
 naturally attracts unskilled, or only partially skilled, more 
 than highly skilled labour. Bad times in any one trade will 
 obviously drive more men from that particular employment 
 into the ranks, and the first to go will probably be those who, 
 having just begun to learn their work, have not had time to 
 get settled, or are the first to be turned off on reduction of 
 estabhshment. Out of a total of 45,000 men examined 
 during the year, October 1, 1909, to September 30, 1910, 
 20,000 were classed as unskilled, and 10,000 as skilled. 
 Eleven thousand belonged to "occupations classed separ- 
 ately," such as carmen and carters, general porters, domestic 
 servants, tradesmen's assistants, and clerks." This class 
 cannot be considered, except with regard perhaps to domestic 
 servants and clerks, as being skilled in the same sense as 
 shoemakers and factory workers generally. The remaining 
 numbers are made up by professional classes (400) and boys 
 under seventeen (2,000). (Round figures only are given.) 
 
 Of unskilled labour 11,000 men are shown as general 
 casuals, 9,500 of these being " general casuals, town." Out- 
 door unskilled labour gave 7,700 men, mostly agricultural 
 labourers, and indoor unskilled labour, 2,000. 
 
 The ratio of rejection was 30.46 per cent., taking all candi- 
 dates into consideration. Unskilled labour and occupations 
 classed separately gave a higher ratio of rejection than the 
 average, though the difference is not great. General casuals 
 (town) and indoor imskilled labour gave high ratios, the 
 former especially. In general it may be said, with regard 
 to unskilled labour, that the country is better than the 
 town, and the outdoor worker very distinctly better than 
 the indoor. Thus, of agricultural labourers, only 25 per 
 cent, were rejected, whilst general casuals (town) gave 
 35 per cent. 
 
 As regards skilled labour, the rejections were about the 
 average figure for all classes. 
 
 The social position of the recruit varies naturally with 
 that of the labour market. Any lad who sees a good 
 opening and prospect of steady employment in civil life 
 is extremely unlikely to risk his chances of ultimate success 
 by enlisting for seven years' service, nor does it appear 
 desirable in the general interests of thq nation that he should 
 
30 MILITARY HYGIENE AND SANITATION 
 
 do so. On the other hand, the lad who sees no such opening, 
 and who belongs, by reason of the improvidence of his 
 parents, or for other cause beyond his control, to the general 
 casual class, is benefited by the chance of tiding over a 
 certain period in regular employment, with good food and 
 other advantages, without tying himself down for an un- 
 limited period of years, as used to be the case in the " good 
 old days of eighteen hundred and fighting-time." It is 
 interesting to read the remarks of men of that period on 
 the recruit of those days. 
 
 Dr. Marshall, Deputy-Inspector-General of Army Hos- 
 pitals, in a most useful and interesting treatise, " On the 
 Enlisting, Discharging, and Pensioning of Soldiers," written 
 in 1839, says : " The condition of a soldier is very little calcu- 
 lated to induce an industrious man who can obtain sub- 
 sistence in any other way to embrace it ; consequently those 
 who enter the service are commonly thoughtless youths, 
 petty delinquents, men of indolent habits, persons who are 
 unable to procure work, or who are in very indigent circum- 
 stances " ; and again : " Necessity and not an ardent liking 
 for the profession compels many to enlist, they having lost 
 their character, or contracted habits of idleness or improvi- 
 dence, which more or less exclude them from the better paid 
 walks of civil industry, by which means they are con- 
 strained to devote themselves to a military life." Jackson, 
 many years before, said much the same. 
 
 It would be wrong to leave this part of the subject without 
 saying a few words as to the relationship which the recruit 
 of the present day bears physically to his predecessor in the 
 past. The opinions held on this point are often extremely 
 erroneous, and it is important that the young medical officer 
 should have soimd ideas on the subject. The laus temporis 
 acti is engrained in human nature, and just as a boy leaving 
 school believes that the children just joining can never 
 possibly emulate the feats of the heroes he remembers when 
 he was in their position, so the older generation of soldiers 
 cannot realize that the recruit of the present day is not 
 degenerate when compared with the men he remembers 
 seeing in the ranks when he himself first got his commission. 
 It is permissible to insert here a quotation from the life of a 
 distinguished General, Sir William Butler, which puts the 
 
THE RECRUIT 31 
 
 above belief in better words than I can command. He is 
 writing not long after the Crimean War, and the passage 
 runs as follows : 
 
 " Already the result is visible ; the standard has to be 
 reduced ; men are now taken who would have been rejected 
 with scorn a few years ago ; we get recruits no longer from 
 the rural districts, but from the slums of the cities, and even 
 from these sources we find it difficult to obtain them in 
 sufficient numbers. ... I shall never forget the sorry 
 contrast that presented itself on the bank of the Sittang 
 River at Tonghoo, where one draft of a hundred and twenty 
 men of the new model formed up on the high shore from the 
 boats. The old soldiers had come down from the big teak 
 huts a couple of hundred yards away to see the new arrivals. 
 The contrast between the two sets of men was not flattering 
 to the newcomers. ... I often look now as soldiers pass, 
 and marvel what has become of these old Greek gods, for 
 not only are the figures gone, but the faces have also vanished 
 . . . those clean-cut foreheads, the straight or aquiline noses, 
 the keen steady eyes, the resolute lower jaws and shapely 
 turned chins. What subtle change has come over the race V 
 
 It will probably be accepted that the physical condition 
 of the British soldier was never better than in the thirties 
 of last century, when the low establishment kept up and 
 the length of the soldier's engagement made the demand for 
 recruits lower than it has ever been since the Crimean War. 
 In the excellent little handbook already quoted, " On the 
 Enlisting, Discharging, and Pensioning of Soldiers," tables 
 are given showing the average circumference of the chests 
 of the recruits examined in the London District from 
 October 13, 1838 to January 12, 1839 inclusive, arranged 
 according to the height of the recruits. As regards height, 
 out of 609 town recruits passed during this period, 459 were 
 between 5 feet 5 inches and 5 feet 8 inches, 332 being below 
 5 feet 7 inches. As regards country recruits, out of a total 
 of 391, 310 were between 5 feet 5 inches and 5 feet 8 inches, 
 217 being below 5 feet 7 inches. Taking both classes to- 
 gether out of 1,000 recruits, 769 were between 5 feet 5 inches 
 and 6 feet 8 inches, 549 being below 5 feet 7 inches. It is 
 probable, therefore, that the average height was, if anything, 
 rather below than above 5 feet 6*5 inches, which was the 
 
32 MILITARY HYGIENE AND SANITATION 
 
 average for 1909. As regards chest measurement, the 
 average for men between 5 feet 5 inches and 5 feet 8 inches 
 ranged from 32-54 to 32-53 inches for town recruits, and 
 from 32-66 to 33-13 inches in the case of country lads. The 
 only chest measurement recorded as better than the average 
 for 1909 is 35 inches in the case of country recnlits above 
 5 feet 11 inches, of which there were only two altogether. 
 Weights are not given. The above figures are, of course, 
 small, but since London was the largest recruiting depot at 
 the time, they probably give a fair picture of the average 
 class of recruit taken into the ranks in those days. They 
 certainly afford no grounds for argument as to physical 
 degeneration in the present day. Nor does it appear that 
 a great preponderance of the men were drawn from the 
 country as compared with the town. Judging from some 
 tables given by Dr. Marshall, the numbers actually passed at 
 the Dublin depot between 1826 and 1837 were drawn equally 
 from both classes. This is a less debatable point, however, 
 since the exodus from country to town which marked the 
 latter half of the nineteenth century is above question. 
 
 I think that it is of great importance for the young 
 medical officer to recognize that the material with which he 
 has to deal is not markedly different from that which passed 
 through the hands of his predecessors eighty years ago. 
 The recruits I have just been referring to were the men who 
 fought under Napier and Gough in Scinde and against the 
 Sikhs, and whatever their physique may have been on joining, 
 there can be no doubt as to their performances in the field 
 at a later date. 
 
 It may be justifiable to apply to this matter the well-known 
 remark in regard to a famous periodical : " The British 
 soldier is not as good as he used to be, and he never was." 
 
 The examination of recruits is one of the most responsible 
 duties that a medical officer can be called to perform. 
 Neglect in this respect can more easily cause inefficiency than 
 ignorance of medicine, or lack of surgical skill. It is the 
 more important to recognize this since the actual routine of 
 inspection of the recruit is monotonous and uninteresting. 
 Every young medical officer should remember the motto of 
 Vegetius in this connection : " Nee leve hoc officium putetur, 
 nee quibuscunque mandandum." 
 
CHAPTER IV 
 
 PHYSICAL TRAINING 
 
 The expression " physical training " can be, and is habitu- 
 ally, used to express two totally different forms of activity. 
 In the first place, it is used to denote a system of physical 
 education, and in the second to signify the constant practice 
 of regular muscular exercises, with a view to maintaining 
 a condition of muscular "fitness." The confusion is un- 
 fortunate, since the two forms of physical training are dis- 
 tinct, not only in their aims, but also in the nature of the 
 exercises demanded by each. In this chapter I will use 
 the words " physical education " to denote the first form, 
 retaining " physical training " for the second only. 
 . Physical education is, like all other education, only a 
 means to an end, and not an end in itself. Gymnastic 
 instructors, like aU other teachers, are often apt to forget 
 this, and to think, or rather assume — for the shghtest 
 thought on the subject would convince the most obstinate 
 of his error — that the exercises in the gymnasium possess 
 some peculiar virtue of their own, quite apart from their 
 purely educational value. 
 
 The first step, then, in considering physical education is 
 to decide the object for which the man is educated. In the 
 case of the soldier this is simple enough. The object of the 
 soldier's education is to enable him to utilize to the utmost 
 aU his bodily powers, to the end that he may, with the 
 least physical expenditure, be able to kill his enemy. To 
 enable him to do this he must have complete control over 
 all his muscles of progression, a very high degree of co- 
 ordination of hand, and foot, and eye, so that, even under 
 the stress of intense nervous excitement, his • brain shall 
 be in a condition to take in the orders of his officer, and his 
 
 33 3 
 
34 MILITAKY HYGIENE AND SANITATION 
 
 muscles execute immediately those orders as they are trans- 
 mitted from his brain. For the purposes above mentioned 
 great muscular strength is not required, and therefore 
 exercises which have this as their main object are uncalled 
 for. The qualities chiefly required are agility, an amount 
 of muscular development rather above the average, but of 
 a general and not of a localized nature, together with a 
 knowledge of how to " get over the ground " and surmount 
 obstacles in the most economical and rapid manner, either 
 with or without assistance. To put the matter in a rather 
 brutal but very practical manner, the soldier has to be 
 taught those exercises which will enable him eventually to 
 get into a position of advantage from which he can bring 
 his skill at arms to play on the persons of his enemies, with 
 the greatest economy of exertion possible. 
 
 The object of his physical training should be to keep him 
 constantly in such a condition of bodily fitness that he shall 
 be able to. execute the movements demanded, the most 
 economical method of doing so having been once taught, 
 with the least possible derangement of his circulatory, 
 respiratory, and thermogenetic machinery, and continue 
 doing so for the longest period necessary with the minimum 
 amount of nervous and muscular fatigue. 
 
 To return to the educational side of the subject. Physical 
 education, like all education, is general and special. The 
 general education is that which is taught at the outset to 
 the beginner — that is, the recruit. Once taught, it need not 
 be regularly repeated, though occasionally the memory may 
 require to be refreshed. Special education is the profes- 
 sional superstructure raised on the foundation of general 
 education. Here the elements may be taught once for all, 
 and need not be repeated ; but anything beyond this needs 
 constant instruction, and in one sense this branch of educa- 
 tion never ceases. As regards the physical education of the 
 soldier, the general instruction consists in the simpler move- 
 ments of the gymnastic system, or of drill. The special 
 education includes marching with or without heavy loads, 
 running, jumping, climbing, and the negotiation of obstacles 
 of all kinds, at first without, but later wearing, the full 
 equipment of that arm of the Service to which he belongs. 
 The use of the bayonet and rifle, the sabre or lance, are the 
 
PHYSICAL TRAINING 35 
 
 finishing steps in this special education, and, as every 
 soldier knows, this part of the teaching never comes to an 
 end, since there is always something more that a man can 
 learn. 
 
 The preliminary physical education should occupy the 
 first weeks of the recruit's military life. During this time 
 he will have to undergo vaccination, and in consideration of 
 this, and also of the fact that the lad is often underfed and 
 invariably immature, it is necessary for the medical officer 
 to see that no strain of any kind is inflicted. The move- 
 ments at this stage should be such only as do not demand 
 the overcoming of resistance. On this account I should 
 omit from the earlier part of the course all span bending, 
 heaving, abdominal, or dorsal exercises. Leg, neck, and 
 arm exercises are all suitable, and some of the lateral exer- 
 cises. Balance exercises on the beam, raised very sUghtly 
 or not at all, are excellent as teaching co-ordination. Great 
 use should be made in this period of games, such as skipping, 
 jumping over a weighted string swung round in a circle, 
 and of short slow runs across country. At this stage the 
 greatest possible amount of individual attention is de- 
 manded, and each man must be watched as closely as if 
 he were one of a string of horses under training. I feel 
 confident that a great deal of harm is done by pushing the 
 training of yoimg soldiers before they have had time to 
 get the benefit of the plentiful barrack fare. Consideration 
 must be given at the same time to the source of the recruit 
 and his previous occupation, if any. The town " casual " 
 will, as a rule, be fairly brisk and alert, but under-developed; 
 the country yokel clumsy and heavy, but more muscular. 
 In the latter case much more attention must be paid to 
 exercises at games which produce co-ordination. In the 
 former those which encourage muscular development will 
 obviously occupy more time. The town boy is, I think, 
 more apt to give way under the strain of early training than 
 the country lad, and should be carefully watched. I know 
 of no better way of keeping touch with a man's progress 
 in this respect than that of counting his pulse before and 
 after a measured amount of exertion, and noting the rapidity 
 with which it returns to the normal. If the return grows 
 more rapid as the training progresses, the man is improving. 
 
36 MILITARY HYGIENE AND SANITATION 
 
 Unless it does, there is something wrong somewhere. The 
 ordinary standard measurements should also be repeated at 
 regular intervals. A recruit should increase in height 
 slightly, as a result of natural growth as well as improved 
 carriage, and should also increase distinctly in weight and 
 chest measurement. Measurements of the leg, arm, and 
 abdomen may also be usefuUy made, if care be exercised 
 to secure uniformity of method. With regard to the last- 
 named measurement, it is useful to note that it is best carried 
 out with the subject lying on his back. In addition to 
 measurements, however, the medical officer should study 
 the general bodily aspect and activity of the recruit, and 
 note what, or if any, degree of improvement is manifested. 
 
 By the end of the sixth week of training it should be 
 possible to begin exercises involving moderate strain. I 
 am aware that this seems rather a timid suggestion, but 
 I cannot see what useful object is attained by going too fast 
 in this matter. A few days too late can do no harm, whilst 
 a premature change may have most serious effects. With 
 regard to exercises involving strain, there is one very simple 
 rule which, to my mind, settles absolutely the suitability 
 or otherwise of any particular exercise. No exercise in- 
 volving strain should be taught unless that particular form 
 of movement is one which in the ordinary course of his 
 fighting a soldier may be called on to perform. All acrobatic 
 tricks are absolutely ruled out. On the other hand, any 
 exercise involving strain, no matter how severe the strain 
 may be, is justifiable if it is at all probable that the soldier 
 may be called on to perform such a moyement in the per- 
 formance of his duty. Several exercises, such as climbing 
 on to the shelf, or the heaving exercises on the beam and 
 rope entail severe strain ; but since a soldier may be called 
 on to execute these movements in war, he must be taught 
 how to do them in time of peace. On the other hand, span- 
 bending, fall-hanging, and arch-hanging, are movements 
 which under no conceivable situation is a man likely to be 
 asked to perform, and they cause a considerable amount of 
 strain. They are contortionist work, and, therefore, since 
 they cause strain, unsuitable. 
 
 In this matter of strain I think we might go even farther 
 than we do, and make the soldier climb on the shelf, or on 
 
PHYSICAL TRAINING 37 
 
 the rope or beam, and surmount obstacles, in full marching 
 order. The Swedish, Austrian, and French manuals insist 
 more fully than ours on these points. 
 
 Certain exercises are defended on the grounds that, 
 though not directly useful, they enable a man to execute 
 some other movement which is useful, and which he may 
 be called upon at some time or another to perform. I have 
 heard an instructor, for instance, defend one of the dorsal 
 exercises on the ground that it strengthened the muscles 
 which the man would need for digging. This is a very 
 common form of heresy, and permits of no defence. If it 
 is necessary to teach a man how to do any particular thing, 
 as in this case to use a spade, the quickest and most efficient 
 method of instruction is to make him actually use a spade, 
 and correct him where he works clumsily or uneconomically. 
 There is sound physiological ground for this line of argument. 
 Whenever a man learns a new exercise, he has to establish 
 a definite system of nervous intercommunication controlling 
 the action of the active and antagonistic muscles concerned 
 in that exercise. This system of intercommunication can 
 never be so completely established as by actually per- 
 forming and constantly practising the movement in ques- 
 tion. In this connection there is no valid reason for treating 
 a man differently from any other animal. A horse is trained 
 to jump by being made to jump, and, progressively, to jump 
 more and more formidable obstacles ; and in the same way 
 the soldier should be trained to exercise the numerous 
 activities, on the proper and efficient performance of which 
 the success of the army may at some time depend, by the 
 actual exercise of those activities. 
 
 In this connection there is one class of exercises now 
 banished from the official manual, the so-called " breathing 
 exercises," which must be referred to. The object of these 
 exercises is, apparently, twofold. They are intended to 
 teach a man how to breathe — an operation, it may be 
 observed in passing, that he has presumably been performing 
 efficiently at an average rate of fifteen times to the minute 
 from the moment he first severed his connection with the 
 maternal placenta — and also to expand his chest. In the 
 French " Reglement d'Education Physique " (1910), in 
 which they are still retained, it is said that their object is 
 
38 MILITARY HYGIENE AND SANITATION 
 
 to augment the respiratory capacity by rendering the 
 thoracic cage more supple, and thus improving the oxy- 
 genation of the blood. It is directed that they shall be 
 performed on every occasion on which it is found necessary 
 to restore calm to the system, especially after running, 
 jumping, or games. The recruit is told to stand at atten- 
 tion and take a deep breath, keeping the mouth shut as 
 as far as possible. 
 
 In the model course of physical exercises drawn up by 
 an inter-departmental Committee in 1904, the importance 
 of these exercises is somewhat insisted on, and reference is 
 made to " those exercises, primarily of the upper limbs, 
 which tend to develop chest capacity, or to exercise the 
 muscles involved in the process of respiration." Later, it 
 stated that they " aid in the elimination of the carbonic 
 acid accumulated by the repeated contractions of the 
 muscles during the lesson." These theories seem to me to 
 be founded on a mistaken theory of the physiology of 
 respiration. An increase in the carbonic acid in the alveolar 
 air beyond a certain limit will inevitably cause increased 
 respiration, whatever the subject may do or try to do. A 
 marked reduction of that gas in the alveolar air will result 
 in apnoea, no matter what the subject may do, or try to do. 
 It is possible by forced and repeated inspiration to cause 
 this last condition, simply as a result of washing out about 
 half the carbonic acid in the air of the alveoli, and the con- 
 dition is one which, if pushed beyond certain limits, may 
 have serious consequences. The only scientific breathing 
 exercises are those which cause a slight increase in the 
 carbonic acid in the alveolar air, and thus convey the normal 
 stimulus to the respiratory centre which produces increased 
 depth or rapidity of respiration. If the gas accumulates to 
 any extent, as assumed in the Committee's Report, the 
 subject will automatically breathe deeply to get rid of it. 
 No exercise will be necessary any more than any exercise 
 is necessary to teach a man how to drink water when he is 
 thirsty. Air hunger is the most imperative of all appetites, 
 and insists on being satisfied : nothing short of complete 
 mechanical obstruction to the passage of air will prevent its 
 satisfaction. The defence usually brought forward in 
 support of these deep-breathing exercises is that the majority 
 
PHYSICAL TRAINING 39 
 
 of young people are lazy breathers, and do not use their 
 lungs as completely as they should. Even assuming the 
 premises, the fact that a lad is a lazy breather is due to the 
 fact that he has not been in the habit of accumulating 
 enough carbonic acid in his lungs to give his respiratory 
 centre the necessary stimulus required to produce increased 
 activity, and until that stimulus is given, he will continue 
 to be a lazy breather. In the same way, a horse out at 
 grass is a lazy breather, and to fit him for the hunting 
 season it is necessary to get him out of that habit. This is 
 done very simply by graduated work, not by any round- 
 about system of gymnastics, and what is good for the horse 
 is equally good for the young human adult. The best 
 breathing exercise for the recruit is graduated running, 
 carefully watched, and calculated to produce a degree of 
 dyspnoea far short of distress. This will provide the normal 
 stimulus to increased respiration, and the less the recruit 
 thinks about how he is going to breathe, the more likely 
 he is to breathe physiologically. The respiratory muscu- 
 lature is quite as capable of managing its own affairs in 
 this respect as is the cardiac. 
 
 The general physical education of the recruit should 
 naturally form the bulk of the earlier part of his work in 
 the gymnasium, but it is not necessary to defer his special 
 education till the general is completed. The intercalation 
 of obstacle work and marching, with cross-country running, 
 will help to break the monotony of the course. Once learnt, 
 it should not be necessary for this general education to be 
 repeated, except in the case of particularly clumsy men, or 
 men who have been long in hospital. In this last case the 
 object would need to be, not so much education as gradu- 
 ated exercise, to bring the man into condition. 
 
 Position of Attention. — This position, the teaching of 
 which is one of the first steps in general physical education, 
 has an important aspect from the point of view of the 
 medical officer, since it is certain that considerable damage 
 was inflicted on some men by the old position, which entailed 
 an attitude of forced inspiration, and therefore a danger of 
 strain on the heart and large intrathoracic vessels. The 
 position of attention, as described in the " Training Manual " 
 for 1905, was one of continued strain ; the exact squareness 
 
40 MILITARY HYGIENE AND SANITATION 
 
 of the shoulders to the front was insisted on, the hips were 
 drawn back, and the chest advanced. It is true that the 
 words " without constraint " were added, but the position 
 was essentially one of constraint, as being unnatural. The 
 knees were well braced back, which entailed contraction of 
 the quadriceps extensor muscle, which is not necessary in 
 the erect posture, and the weight of the body was thrown on 
 the forepart of the feet, necessitating a position of unstable 
 equilibrium. The defects of this position were brought to 
 notice by Surgeon-Major Davy in 1876. The present 
 position ("Manual of Physical Training," 1908, p. 26) is 
 a rational position of attention — one, that is, in which 
 attention can be paid to an order, and the same executed 
 without any delay. Any stiff attitude means that the 
 soldier has to undo, as it were, some work he was doing 
 before beginning to execute any fresh order, and is therefore 
 ipso facto not a position of " attention." 
 
 A few words may be said about the anatomy and physi- 
 ology of the erect posture, since these are closely connected 
 with the maintenance of the position of attention over any 
 prolonged period. 
 
 The first point to note is that the human body is sym- 
 metrically disposed on either side of the sagittal plane, but 
 asymmetrical as regards the coronal plane. From this it 
 follows that it possesses greater lateral than antero -posterior 
 stability when in the erect posture. The second point is 
 that the body is composed from above downwards of several 
 segments which are not rigidly fixed to each other. 
 
 The third point is that each of these segments possesses 
 a centre of gravity peculiar to itself, which comes into 
 relation to the point of bearing between that segment and 
 the segment immediately below, and also into relation with 
 the area of support of the body on the ground — ^that is, the 
 space between the outer margins of the feet. 
 
 To maintain an erect posture with the minimum of con- 
 straint, it is necessary that the centre of gravity of each 
 segment should be as nearly as possible vertically above its 
 point of bearing, and also as nearly as possible vertically 
 above the centres of gravity and points of bearing of the 
 segments below. The maximum of stability and the 
 minimum of constraint would be obtained if the various 
 
PHYSICAL TRAINING 41 
 
 centres of gravity and the various points of bearing were all 
 in the same vertical line, and if that line fell immediately 
 in the centre of the area of support. 
 
 The body may be considered as consisting of five rigid 
 segments, which are given in the table below, the point of 
 bearing of each on the segment immediately below being 
 placed opposite. 
 
 The head bears on atlanto occipital joint. 
 ,, trunk „ hip- joint. 
 „ thigh ,, knee-joint. 
 J, leg ,, ankle-joint. 
 
 „ foot ,, ground. 
 
 The most important point of bearing is the hip-joint, 
 since here the weight comes into relation with the supports, 
 and it will be convenient to take a coronal plane running 
 through both hip-joints as a base to define the relative 
 positions of the various centres of gravity and points of 
 bearing. The following table shows this relationship, 
 + standing for in front, - for behind, this plane : 
 
 Centres of Gravity. Points of Bearing. 
 
 Head — 1-0 cm. Atlanto-occipital joint -1*5 cm. 
 
 Trunk -0-6 cm. Hip- joint + 
 
 Thigh -0.4 cm. Knee-joint -I'Oc.m. 
 
 Leg —2-7 cm. Ankle-joint - 5-0 cm. 
 
 Beginning from above, we see that the centre of the 
 gravity of the head is slightly in front of the atlanto-occipital 
 joint. The head would, therefore, naturally tend to fall 
 forward, if not maintained in the erect posture by contrac- 
 tion of the muscles of the neck. The mechanism is that of 
 a lever of the first order, and since the arm of the lever on 
 which the resistance works is very short, but little force is 
 necessary to maintain the position — little more, in fact, than 
 the tonic contraction of the muscles concerned. 
 
 The head being fixed on the trunk, the next point of 
 bearing that comes into consideration is the hip-joint. It 
 will be seen from the table above that the centre of gravity 
 of the trunk is behind the coronal base plane, the centre 
 of gravity of the head, and the point of bearing of the 
 head on the spine being also behind that plane. It is 
 obvious, therefore, that at the hip- joint we have the entire 
 weight of the body behind its main support. The resulting 
 
42 MILITARY HYGIENE AND SANITATION 
 
 tendency to fall backwards is here counteracted by the 
 powerful psoas and iliacus muscles, assisted to a certain 
 extent by those of the abdominal wall. Here, again, the 
 leverage to be counteracted is small in comparison to the 
 muscular power available. Coming now to the thigh, we 
 find that the centre of gravity is behind the coronal plane, 
 but in front of the point of bearing at the knee-joint. The 
 tendency here, therefore, is to fall forwards, and this is 
 prevented by the tension of the crucial ligaments. It is 
 important to note that in the normal comfortable erect 
 posture the quadriceps extensor of the thigh is relaxed, and 
 the pateUa freely movable. Below the knee the point of 
 support shifts even farther back, the ankle-joint being 
 5 centimetres behind the coronal hip-plane. This distance 
 gives the greatest divergence from this plane yet noted, and 
 therefore it is at the ankle-joint that the greatest strain 
 occurs. Equilibrium is here maintained by the active con- 
 traction of the soleus muscle, which, as Richer shows, is 
 the muscle which plays far the most important part in the 
 maintenance of the erect posture. Above this point the 
 variations in front and behind of the different points of 
 bearing and the different centres of gravity are so slight that 
 the muscular work necessary to maintain equilibrium is but 
 little in excess of a purely tonic contraction. At the ankle- 
 joint the divergence is so marked that the soleus muscle has 
 to contract actively to keep the body from falling forwards. 
 The work to be done consists in maintaining the centre of 
 gravity of the entire body immediately over the centre of 
 the area of support. This centre lies on a line joining the 
 heads of the two fifth metatarsal bones, and midway between 
 these points. In the old position of attention the weight 
 was thrown on the front part of the foot, thus increasing the 
 work demanded of the soleus muscle. In both the French 
 and the German positions of attention this same fault seems 
 to be committed. During the time that a man occupies 
 the position of attention he is constantly swaying backwards 
 and forwards, the movement of the vertex being about 
 1-75 inches in the sagittal and about 0-75 in the coronal 
 plane, in the first five minutes. After prolonged standing 
 in this position the movements become much exaggerated. 
 The addition of a load causes a more marked oscillation. 
 
PHYSICAL TRAINING 43 
 
 which increases in amplitude with any increase in the load. 
 The position of attention is one of greater stability laterally 
 than antero -posteriorly, on account of the fact that the 
 body is symmetrically constructed on the right and left of 
 the sagittal plane. This stability can be increased by 
 increasing the area of support, by separating the feet 
 laterally, ag is done in the " stand-at-ease " posture. Here, 
 too, the antero-posterior stability is increased by the fact 
 that the hands are lightly clasped behind the buttocks, 
 thus affording a certain counterpoise to the weight of the 
 trunk. In head-tracings taken in this position, it is found 
 that the weight of the body is systematically transferred 
 from one foot to the other. This position is undoubtedly 
 an improvement on the old lop-sided " stand at ease," in 
 which all the weight was brought on to one leg, whilst the 
 other played a purely passive part. 
 
 It should be kept constantly in mind that all positions 
 except the recumbent are positions of unstable equilibrium, 
 demanding constant muscular effort on the part of the man 
 who has to maintain them. No man, therefore, should 
 be kept in one position for any length of time. 
 
 The essential points in physical education are gradual 
 progression and individual training, more especially at the 
 start. There is no necessity to coddle men, but there is 
 no necessity to break them down by too rapid advance in 
 the course. Eventually, of course, the soldier must be 
 trained to face severe strain if necessary, and there is no 
 reason why this should not be done even in peace-time if 
 each case be watched. 
 
 There is one aspect of physical training which should be 
 remembered, and that is the necessity of some form of 
 exercise, either work or play, if men are to be kept fit. A 
 sedentary army is almost certainly an unhealthy army. 
 Many causes combine, no doubt, to bring this about, but 
 one that is very apt to be forgotten on service is want of 
 exercise. An extract from a letter written by Sir John 
 Moore to Sir Ralph Abercromby is so apropos that I quote 
 it in full. It is dated " Fort Charlotte, St. Lucie, 2nd Sep- 
 tember, 1796," and runs as follows : " Great attention 
 should be paid in this country to the cleanliness and even 
 neatness of the soldier's person, and the regularity of his 
 
44 MILITARY HYGIENE AND SANITATION 
 
 diet ; an addition to the eating part of his ration instead 
 of his rum ; sea or river bathing, constant activity, and 
 movement. In short. General (excuse the pedantry of the 
 expression), but with a Roman, instead of modern, exercise 
 and disclipine, the troops in the West Indies might, I am 
 convinced, be kept healthy. A parade twice a day, con- 
 sisting of a mere inspection of and exercise of arms, is easy 
 for the officers ; it leaves them what they call more time, 
 but it leaves the soldier also to lounge the whole day in a 
 barrack, where the air cannot be good, and where, from 
 indolence, his body becomes enervated and liable to dis- 
 order." 
 
 Pr ingle gives much the same advice. " In fixed camps, 
 as there is always more sickness from inactivity than from 
 fatigue, it would not be amiss to make proper regulations 
 about the exercise at such times ; and the rather that as our 
 soldiers, left to themselves, are naturally too indolent to use 
 what is fit for them "; and he further quotes from the 
 " De Re Militari " of Vegetius the following passage, with 
 which Sir John Moore was also probably well acquainted : 
 " Rei militaris periti, plus quotidiana armorum exercitia ad 
 sanitatem militum putaverunt prodesse, quam medicos, ex 
 quo intelligitur quanto studiosius armorum artem docendus 
 sit semper exercitus, cum ei laboris consuetudo et in castris 
 sanitatem, et in confiictu possit prsestare victoriam." The 
 Japanese paid particular attention to organized exercise, 
 chiefly in the form of games, during intervals of rest in their 
 late war. 
 
 In peace-time there is little danger of this being forgotten 
 by the British officer, but on service, during periods when 
 the troops are from some cause or another stationary, there 
 is often a feeling that the men should not be harassed, which 
 is apt to be carried too far. Even in cantonments there are 
 always some men who need a certain amount of encourage- 
 ment to make them take sufficient exercise in the way of 
 games, etc. 
 
 There is, however, especially as regards the officer, a 
 danger of going too far in the opposite direction. There 
 is no doubt that many young men do themselves serious 
 injury by immoderate exercise in hot climates. There is 
 no more dangerous excess than that of playing oneself to a 
 
PHYSICAL TRAINING 45 
 
 " standstill," as a good many young officers rather exult 
 in doing. It is often remarked in India how often it is 
 the strongest who sujffer most severely from enteric fever, 
 and die from it most frequently. A great deal of this is 
 due, I feel positive, to the fact that it is just these men 
 who carry their exercise too far, and who are also prone, 
 from a feeling of false pride, to go on long after they should 
 have given in to the first signs of approaching illness. 
 
 This danger of excess was also noticed by Pringle, who 
 remarks : " Some caution is necessary with regard to excess, 
 because our common people generally observe no medium 
 between their love of ease and pursuing the most violent 
 
CHAPTER V 
 
 MARCHING 
 
 Marching is undoubtedly the most important form of 
 physical exertion demanded of the soldier, since it more 
 than any other comes into direct relation with strategy. 
 As the German Regulations say : " The march forms the 
 groundwork of all operations. The success of every under- 
 taking depends largely on its proper execution, and the 
 arrival of a body of troops in good fighting trim at the 
 proper time and at the appointed place is frequently decisive 
 of the issue." Or, more briefly, in the old saying of Marshal 
 Saxe : " Victory is a question of legs." 
 
 It is, in fact, a truism to say that every strategical con- 
 ception and every tactical plan is based ultimately on the 
 assumption that the flexors and extensors of the lower 
 limbs of a certain body of men will continue to contract 
 and relax normally for a certain period of time. Accurate 
 timing of movements is one of the essential postulates of 
 all staff work in the field, and such accurate timing can only 
 be justified if it is based on a thorough grasp of the prin- 
 ciples which underlie the actual physical exercise of march- 
 ing and the infiuences which, for good or for evil, affect its 
 economical performance. The question is one primarily 
 of physiology, and must be approached in the first place, 
 therefore, from the physiological standpoint. To begin 
 with, it is necessary to grasp exactly what " marching " 
 means, and for that object I will give the definition which, to 
 my mind, most completely and clearly fulfils that meaning. 
 
 "Marching," then, means walking; wearing certain 
 clothes in a certain manner ; carrying a certain load, dis- 
 posed on the body in a certain manner ; as one of a unit in 
 a body of men ; at a pace regulated by the average physical 
 
 46 
 
MARCHING 47 
 
 conformation of that body, and not by the personal peculi- 
 arities of any particular individual. It is interrupted by 
 periods of rest, termed " halts," the number, distribution, 
 and duration of which are dictated, not by the physical 
 exhaustion of the individual soldier, nor even primarily 
 by that of the body of troops of which he forms a part, but 
 by considerations of a purely strategical or logistic nature. 
 Further, this exertion may be prolonged over periods 
 measured by hours, or even days, and weeks, far beyond 
 any limit that the average man would voluntarily try to 
 attain. In short, in marching we find a communal form of 
 physical exertion, the performance of which is conditioned 
 by no desire or reluctance on the part of the individual, 
 but only by the will of his commander. Seeing that this 
 is so, it is imperatively necessary for that commander to 
 realize what the demands which he makes on the soldier 
 in the ranks by the order to march really are. To arrive 
 at some idea of these, it is necessary to discuss the definition 
 which I have just given in detail. 
 
 Walking is the term used to express the ordinary system 
 of progression, in which one foot is always, and both feet 
 for a short time simultaneously, on the ground. This pro- 
 gression imparts a series of movements to the centre of 
 gravity of the body, the most marked of which is, of course, 
 a forward movement in the direction of progression. This 
 forward movement is not at low speeds necessarily con- 
 tinuous, and is never invariable as regards rapidity. On it 
 also are superimposed movements of translation, vertical and 
 lateral in direction. At the same time the whole trunk 
 undergoes certain movements of torsion round a vertical 
 axis, the most marked of which are the swinging in opposite 
 directions of the shoulders and the hips. There is, though 
 less noticeable, a rocking movement of the body at the waist 
 in the antero-posterior direction, and a swaying from side to 
 side, which becomes more marked in case of fatigue. These 
 secondary movements which I have referred to are none of 
 them very great in extent, especially in well-trained men 
 in good marching condition, but with untrained or tired 
 men, and especially when both these states coincide, the 
 cumulative effects of these secondary movements may be 
 important. The actual amounts are given by Du Bois- 
 
48 MILITAKY HYGIENE AND SANITATION 
 
 Eieymond as follows : The centre of gravity has a forward 
 and backward movement in the line of progression, amount- 
 ing to 12 millimetres (0-48 inch), on either side of a theoretical 
 centre of gravity moving at a uniform rate — ^that is to say, 
 that in one complete pace of 30 inches the centre of gravity 
 moves 24 millimetres (0-96 inch) forward, and the same 
 extent backwards. The lateral movement amounts to 
 1-3 centimetres (0-52 inch) on either side of the line of 
 progression, and the vertical to 2 centimetres (0-8 inch) 
 above and below its position at rest. In the aggregate 
 these movements are of considerable importance, and their 
 significance is increased, especially in the case of the vertical 
 movements, when heavy weights are carried. The move- 
 ments of torsion and rocking are especially concerned with 
 the balance of these weights, though their absolute amount 
 is also to be kept in mind. 
 
 The brothers Weber at one time advanced the theory that 
 walking was almost whoUy due to a pendular movement of 
 the legs, but this theory is now abandoned. All walking 
 is the result of muscular effort, and the muscles chiefly con- 
 cerned are naturally those of the legs. The muscles of the 
 upper part of the body are mainly concerned in maintaining 
 the balance of the trunk on the supporting lower limbs, and 
 the extent to which they are engaged is largely a matter 
 of training and of the weight carried. Here, again, fatigue 
 and want of practice in marching, alone or combined, are of 
 great importance. In the lower limbs the muscles used in 
 walking may be classed as " primary " and " secondary." In 
 the first we have actual propulsive movements. The most 
 important of these in this respect are — (1) The muscles of the 
 calf, aided by those of the anterior aspect of the thigh, and 
 to a less extent by the glutei, during the moment when the 
 posterior foot pushes o£E from the ground, and (2) the 
 quadriceps extensor, which throws the swinging leg forward 
 immediately after it has passed in front of the supporting 
 limb. The secondary muscles of walking are — (1) Those 
 which brace the supporting leg during the time when it alone 
 has to bear the weight of the body, and (2) those which flex 
 the swinging leg so as to enable the foot to clear any irregu- 
 larities of the road. In the former of these the amount of 
 muscular exertion entailed is entirely dependent on the skill 
 
MARCHING 49 
 
 with which the individual manages to keep his centre of 
 gravity immediately over his area of support, and this 
 again is largely a matter of practice, especially when heavy 
 weights have to be carried. The glutei, in addition to acting 
 slightly to reinforce the propulsive movement of the hind- 
 ward leg, also have an important action in maintaining the 
 antero-posterior, and lateral balance of the trunk on its 
 supporting limbs. The fatigue of marching in the case of 
 untrained men is largely due to the work of these secondary 
 muscles, and this is most markedly seen when weights are 
 carried. 
 
 A form of walking, called marche en flexion, has been 
 practised in France which is said by its advocates to enable 
 a man, after a comparatively short period of training, to 
 cover considerable distances at a high rate of speed — that is 
 to say, from five to six, or even more, miles an hour. In 
 this method the legs are kept bent throughout, except just 
 at the moment when the rearmost foot is leaving the ground, 
 whilst the forward foot is planted flat on the ground instead 
 of heel first. The body is bent forward from the hips, but 
 without stooping. This style of walking is imitated from 
 the natural plodding gait of the unshod man, and it is said 
 by its advocates that the individual is dragged forwards by 
 his centre of gravity. " The degree of inclination of the 
 body regulates the pace ; if it is desired to go faster the 
 inclination is increased, the legs follow the movement ; if 
 the individual desires to check his pace he lessens the 
 inclination. In any case it is never necessary to caU on the 
 legs to get an increase in rapidity." The results obtained 
 with picked bodies of men have certainly been extraordinary, 
 and those claimed as possible by the advocates of the system 
 more extraordinary still. It is as weU to remember that 
 no work can be achieved without a corresponding expendi- 
 ture of energy. Energy may indeed be economized, but it 
 can never be created, and it would need very strong proof 
 to substantiate the statement that by merely altering the 
 inclination of the body at the hips it is possible to cover 
 six miles an hour as cheaply as four miles when walking in 
 the ordinary manner. As a matter of fact, a good deal 
 more than this is claimed for the method by its supporters. 
 In reality the system is uneconomical in at least one respect, 
 
 4 
 
50 MILITARY HYGIENE AND SANITATION 
 
 since the quadriceps extensor is kept in a state of tension 
 throughout the entire pace, whereas in the ordinary method 
 of heel-and-toe walking it is alternately contracted and 
 relaxed. Richer sums up on this subject : " We are forced 
 to ask whether the results which Commandant Raoul has 
 obtained are not due to special training conditions which he 
 applied to his subjects. As a matter of fact, further ex- 
 perience has by no means confirmed the hopes that were 
 founded on the results first obtained. I understand from 
 Dr. Laveran that the latest experiments have shown that 
 Commandant Raoul's system leads to fatigue, and occasion- 
 ally to cardiac trouble, and that it has actually been 
 abandoned." 
 
 Mere practice in walking alone is not sufficient to teach a 
 man how to march in the ranks, since he is not compelled in 
 the former case to control those secondary movements of his 
 body which lead in the ordinary careless pedestrian to 
 oscillations of greater or less extent on either side of the 
 straight line of progression ; in the ranks these would, if 
 uncontrolled, naturally lead to collision. Again, mere 
 marching in the ranks, without progressive carrying of 
 weights, is insufficient, since the man has not learnt to 
 economize in the matter of those secondary muscular move- 
 ments which are necessary to maintain an even balance. 
 I have spent some time on these details of the muscular 
 mechanism and the statics of marching, since a good many 
 peopleseemto hold the opinion that walking, andeven march- 
 ing, come, as Dogberry said of reading and writing, by nature. 
 This is not the case even in the matter of walking, much less 
 in that of marching, and of marching with a heavy load. 
 
 So far I have been discussing the physiological mechanism 
 of walking, and it is clear that it consists of a series of com- 
 plicated muscular movements, repeated at every pace. It 
 is, therefore, a monotonous form of exercise, so monotonous 
 that it is the only form of movement that can, in the case 
 of normal men, be performed even during the sleep of ex- 
 haustion. This monotony is accentuated in the case of the 
 marching soldier by the fact that he has to accommodate 
 his movements to those of his comrades, by maintaining a 
 uniform length of pace and a uniform cadence of step. To 
 the trained man this is rather an advantage than otherwise, 
 
MARCHING 51 
 
 since there is no nervous preoccupation necessitated by the 
 constant repetition of the same series of muscular con- 
 tractions. With the untrained man fatigue sets in sooner, 
 since he has not yet arrived at that stage of being able to 
 march without thinking about it, which results from repeated 
 practice. The most important point, however, in con- 
 nection with walking is its effect on the general physiological 
 machinery of the body. 
 
 Walking is the result of muscular exertion, and the extent 
 of that exertion can be definitely measured by the consequent 
 transference of the individual in a certain direction, hori- 
 zontal or vertical, or in both directions combined. The 
 amount of work done being known, it is then possible to 
 estimate the exact amount of energy expended in walking 
 any measured distance. The most exact observations in 
 this direction have been made by Zuntz and Schumburg, 
 utilizing the respiratory exchange as a measure of the 
 internal combustion of fuel during any fixed period. 
 
 According to these workers, the amount of energy ex- 
 pended per kilo of body weight per metre horizontal varies 
 between 0-0006 and 0-0005 Calories, if the pace be 75 metres 
 per minute. The variation in the amount of energy ex- 
 pended in different cases varies with training, and the mean 
 of the above two figures, 0-00055, may be taken as a fair 
 basis for calculation. Any acceleration above this pace adds 
 0-0000024 Calorie per metre per minute. From these figures 
 it is possible to arrive at a very close idea of the actual 
 amount of work expended by a man working on a perfectly 
 level plane. The work expended in climbing is equivalent to 
 0-0075 Calorie per kilo per metre vertical. The following 
 concrete example shows the method adopted for estimating 
 the actual work done on a march. The horizontal distance 
 traversed was 22,032 metres (about 13| miles), and the 
 rate 94 metres per minute. The energy expended per kilo 
 of body weight was therefore : 
 
 22,302 X (0-00055 + 0-0000024 X 19) 
 = 22,302 X (0-00055 + 0-000456)= 22,302 x 0-000596, or 0-0006 
 = 13-4 Calories. 
 
 In addition, the vertical height ascended was 182-4 metres 
 (600 feet), and this, multiplied by 0-0075, gives us 1-4 Calories. 
 
52 MILITARY HYGIENE AND SANITATION 
 
 The average weight of the men performing the march was 
 87 kilos, therefore the total work performed was 1, 1 66 Calories 
 in horizontal, and 122 Calories in vertical work, making a 
 total of 1,288 Calories for the whole march. The following 
 figures may be taken as approximately correct for calcu- 
 lating the work done by the average private of the line 
 (weight in heavy marching order, 87 kilos, 191 pounds) in 
 marching one mile at the gradients noted : 
 
 1 in 100 
 1 in 90 
 1 in 80 
 1 in 70 
 1 in 60 
 1 in 50 
 
 91 Calories per mile. 
 
 92 
 
 93^ 
 
 95 
 
 98 
 
 101 
 
 From a considerable number of measurements, I find that 
 the roads in the South of England, east of Dartmoor, have, 
 over an ordinary length of march, a gradient of 1 in 100. 
 On Dartmoor the average is between 1 in 70 and 1 in 50. 
 The general average for England would probably be about 
 95 calories per mile, but for any particular march the actual 
 figure can easily be calculated. 
 
 The work done is expressed in terms of heat units, and 
 this follows from the fact that the process is one of com- 
 bustion, during which heat is actually produced in the 
 body. From this fact several very important corollaries 
 follow. 
 
 In the first place, if heat is produced in the body, one of 
 two things must happen — either the heat must in some way 
 be dissipated or the temperature of the body must rise to 
 such an extent .that further exertion would be impossible. 
 What actually does happen, in the case of all prolonged 
 exercise, is that the temperature rises to a certain definite 
 point, and there remains stationary so long as the in- 
 dividual under observation is in a normal state of tempera- 
 ture balance. The most important point about this is the 
 fact that the temperature during work is normally raised 
 above the point which in ordinary medical practice is con- 
 sidered tiie normal temperature. In fact, the expression 
 " normal " temperature is a serious misnomer, unless the 
 occupation of the individual at the time of observation is 
 mentioned. The rise in temperature during exercise is 
 
MARCHING 53 
 
 physiological and beneficial, enabling the muscles to do 
 their work more economically, since the necessary chemical 
 changes are favoured by moderate heat. This is a fact 
 that is recognized in practice, in sport, in everyday life, 
 and in common speech. The regular custom of the pre- 
 liminary canter in racing is an instance of the former ; the 
 expression " warming to one's work " is an example of the 
 latter. An exactly parallel case may be cited in the internal 
 combustion engine which, as all motorists know, does not 
 run so satisfactorily " cold " as " hot." From a consider- 
 able number of observations made by officers going through 
 the Physical Training class at the Eoyal Army Medical 
 College, I have come to the conclusion that the optimum 
 temperature for walking is about 100-6° F. This level is 
 reached sooner or later after the beginning of the walk, 
 according to personal idiosyncrasy. 
 
 It would appear that every man has his normal tempera- 
 ture curve for an ordinary walk. In some this curve rises 
 rapidly and then falls slightly to its permanent level. In 
 others the rise is slow but continuous, and the level is 
 attained later. Various causes influence this curve. Thus, 
 a halt by itself slightly lowers it, especially on a cool day ; 
 whilst the ingestion of food raises it ; the actual curve is 
 therefore a resultant of several factors (see Fig. 1). 
 
 In using the expression " normal " curve, it is necessary 
 to appreciate clearly the real significance of this rise in 
 temperature. When we speak of a man at rest having a 
 normal temperature, we mean that his internal body heat 
 is about 98-4° to 98-6° F., and we estimate the importance, 
 pathognomonically, of any rise above that level by the 
 proportion that rise bears to a certain margin of safety, 
 the upper limit of which is marked by a temperature of, 
 say, 104° F. The man still being at rest, we do not con- 
 sider any rise to less than 102° F. as being of itself a matter of 
 serious import, though its actual significance will depend 
 on various conditions, pathological or otherwise, that happen 
 to coexist therewith. Above 103° F. we begin to feel that 
 the temperature itself is probably beginning to have a 
 deleterious effect, though any serious danger is not to be 
 apprehended as a rule, on this account merely, till a higher 
 level is reached. Ordinarily, then, one may say that a man 
 
54 MILITAKY HYGIENE AND SANITATION 
 
 at rest has a safety margin of about 4-5° F., inside of which 
 any temperature variation is not of primary importance. 
 In the case of a man taking exercise, the normal temperature 
 is raised probably about 2° F., and this rise is perfectly 
 physiological, and even, as already stated, beneficial. At 
 the same time, the upper-safe limit of temperature is not 
 pushed, so to speak, farther off, but remains unchanged. 
 
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 Break- 
 fast 
 8. a.m. 
 
 9 am. 
 
 10 a m. 
 
 II. a.m. 
 
 I2.N00N 
 
 Lunch 
 or dinner 
 1 p m. 
 
 3 p.m. 
 
 4- p.m. 
 
 Tea 
 
 betwe 
 5 8i7. 
 
 ;n 
 
 Supper. 
 9 pm. 
 
 10 p.m. 
 
 5 p.m. 
 
 6 p.m. 
 
 7 p.m: 
 
 Fig. 1. — Showing Normal Diurnal Range and Range during a 
 2O.M1LE Walk. 
 
 and in consequence the man at work has a margin of safety 
 of only about 2-5 F., a little more than half that of the man 
 at rest. It therefore becomes most important to study 
 carefully all the causes which may tend to raise the tempera- 
 ture of the man at work above the physiological limit, and 
 thereby diminish to a greater extent the already reduced 
 margin of safety. At any point a man's internal tempera- 
 ture is the resultant of two sets of influences — those that 
 
MARCHING 56 
 
 induce an increased production of heat, and those which 
 favour or impede its dissipation. 
 
 The factors which increase the production of heat are 
 chiefly the actual amount of work done, and the rapidity 
 with which it is done. On the other hand, heat can only 
 be dissipated by radiation, convection, and evaporation, 
 and the factors which influence the dissipation of heat 
 must do so by accelerating or retarding one or other of the 
 above-named physical processes. Taking the first-named 
 factors to begin with, it has already been shown that the 
 amount of heat produced is directly proportional to the 
 actual work done, and that it is increased regularly by 
 the rate of work ; in this case, the pace at which the march 
 is performed. This increase is, however, regular only 
 within certain limits. The experiments of Zuntz and 
 Schumburg show that if the pace of 100 metres per second 
 be exceeded, the amount of heat developed per unit incre- 
 ment of pace is out of proportion to that produced at a 
 slower speed, and as the pace increases to an even higher 
 rate so the disproportion is more marked. In the case of 
 the soldier marching, the regulation pace is about 90 metres 
 per minute, though light infantry go somewhat faster 
 than this. The increase due to increased pace is, therefore, 
 not important under ordinary conditions on the march. 
 The most important bearing of speed in this connection 
 is, however, the fact that the pace has to be that of the 
 average man in the ranks, and therefore men markedly 
 below or above the average suffer by having to step out 
 or step short to keep level. In either case the individual 
 is working uneconomically, and the heat production is 
 therefore enhanced. Running, even when the pace is 
 merely that of the " steady double," raises the production 
 of heat considerably, though here again training has an im- 
 portant effect. If the speed be much increased, the body 
 temperature is raised not only on account of the increased 
 production of heat, but also because the time available for 
 dissipation is reduced. In marching this is not, however, 
 a matter of serious importance. 
 
 The heat produced is also affected by the load carried. 
 Within certain limits the increment of heat is proportionate 
 to each increment of load, being at the rate of 001 Calorie 
 
56 MILITARY HYGIENE AND SANITATION 
 
 per kilo per minute as long as the total is under 30 kilos 
 and the weight is evenly distributed. Any lack of balance, 
 however, may raise the expenditure in respect of any 
 particular portion of the load to three times this amount. 
 This point will be again discussed in speaking of equipment. 
 
 Other factors which lead to an increased expenditure 
 of fuel are want of training, pain, and fatigue. Training 
 has a most remarkable influence in effecting an economy 
 in fuel expenditure, and by training I do not refer to mere 
 general physical " fitness," but to training in the practice 
 of marching as such. It is surprising what a difference the 
 repeated systematic exercise of this apparently simple 
 series of movements makes on their efficient performance 
 in men who are otherwise in sufficiently good condition. 
 Pain has also a marked effect. Zuntz and Schumburg found 
 that in a man who suffered from inflammation of the tendon 
 sheaths of the foot the expenditure of energy was raised 
 about 20 per cent. The reason of this is that as a result of 
 the pain the normal activity of the muscles ordinarily 
 engaged in propulsion is interfered with, and secondary 
 muscles have therefore to be brought into play, which, being 
 untrained, act uneconomically. The instinctive effort to save 
 a blistered foot would have much the same result. Lastly, 
 fatigue increases the expenditure of energy in proportion to 
 work completed, and therefore also the production of heat. 
 In the chart in Fig. 2 the fatigue-rise in temperature, and 
 its long continuance after work had stopped, is well shown. 
 
 As regards the production of heat, therefore, we may 
 conclude that there is a certain normal production of heat 
 for an ordinary amount of work, when a man is fresh and 
 in good condition and practice, that represents for such 
 a man his minimum expenditure of fuel for that particular 
 amount of work. The human engine in its most efficient 
 condition can utilize about one-third of the energy which it 
 actually expends in useful work, showing, as a matter of 
 fact, a much higher degree of efficiency than the best steam- 
 engine yet produced, and one not very inferior to the 
 best internal explosion engine. This ratio of efficiency 
 cannot be improved on, but it may be much diminished 
 by various causes which have already been detailed. Those 
 which are most under our control are training, pain, and 
 
MARCHING 
 
 57 
 
 fatigue. By good training not only is the expenditure of 
 energy minimized during an ordinary march, but the onset 
 of fatigue is postponed. Fatigue can also be minimized by 
 reduction of weight, where this is possible, proper arrange- 
 ment of halts, and other precautions, which it is hardly 
 necessary to enumerate. Pain is chiefly a matter of sore 
 feet. The consideration of this particular point comes later ; 
 it is worth noting here, however, the great importance of 
 
 RECTAL 
 TEMP. 
 C° F" 
 
 On 
 
 rising 
 
 First 
 hour 
 
 Second 
 hour 
 
 Third 
 hour 
 
 Finish 
 
 One 
 hour 
 later 
 
 Four 
 hours 
 later 
 
 Feb. 10 
 
 on 
 rising 
 
 • 5 
 
 
 
 
 
 
 
 
 
 
 >.B.38- 5 
 
 
 
 DB.38 
 
 
 
 
 38-8 102 
 •5 
 
 :| 
 
 •2 
 
 38-3 lo'l' 
 
 38 '■% 
 •3 
 •2 
 
 37- a IO£J 
 1 
 
 •2 
 
 
 
 
 
 WB^° 
 
 
 
 
 
 V* B.3A-5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ' 
 
 ■>.,^ 
 
 
 
 
 
 
 
 
 A 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 / 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 > 
 
 
 
 
 
 
 / 
 
 
 
 k 
 
 
 
 
 
 
 
 
 
 
 
 
 
 / 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 J 
 
 
 
 V 
 
 
 
 
 
 / 
 
 
 
 > 
 
 
 
 
 
 
 
 
 
 
 
 ^^ 
 
 
 
 
 
 \ 
 
 
 
 l-> 
 
 
 
 
 
 
 
 
 T^ 
 
 
 
 
 
 \ 
 
 
 
 '/ 
 
 ""^^ ^ 
 
 . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 //. 
 
 
 
 '- 
 
 
 
 
 
 // 
 
 
 
 
 
 1 
 
 
 
 3 
 
 
 
 
 
 \ 
 
 
 
 9 
 
 
 
 
 
 
 
 
 i 
 
 
 
 
 
 \ 
 
 
 
 1 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 1 
 
 
 
 J 
 
 
 
 
 
 
 
 
 t 
 
 
 
 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 370 :| 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 •3 
 36-6 98 
 
 361 ?7''' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Fig. 2.— Showing Average Temperature Curve of Four Subjects, 
 17-Mile Walk (Unbroken Line) ; Curve of Fifth Subject, Same 
 Walk, showing Fatigue (Dotted Line). 
 
 attending to the feet, not merely with a view to reducing 
 suffering, but also with the object of increasing efficiency. 
 It is the duty of every medical officer in charge of a marching 
 unit to assist by his advice the commanding officer in this 
 direction of economizing energy. 
 
 Heat is dissipated by convection, radiation, and evapora- 
 tion. Taking convection and radiation first, it is obvious 
 that heat can only be dissipated in this manner if the 
 
58 MILITARY HYGIENE AND SANITATION 
 
 surrounding air, or the other bodies in immediate contact 
 with the body actually under consideration, be at a lower 
 temperature than the surface of that body. In the case 
 of a man this naturally means the surface of his clothes ; 
 the uncovered areas of skin come but little into play in 
 comparison. Convection does not come importantly into 
 play unless the air is at a lower temperature than 60° F. ; 
 the effect is greater if it is in motion. Still, cold air, especi- 
 ally if dry, is such a bad conductor that but little heat 
 can be dissipated in this way until a temperature of about 
 50° F. or even lower is reached. If the air be moist and 
 the man at rest, a considerable amount of loss occurs owing 
 to the high specific heat of the moisture in the air. So soon 
 as he begins to move, however, this effect is reversed by 
 the obstruction to evaporation imposed by the high degree 
 of humidity. As regards convection, the movement of the 
 air is the most important factor, within ordinary limits 
 of temperature. Above 65° F. in the shade convection 
 practically ceases under all conditions. 
 
 Radiation can only take place from a relatively hot to a 
 relatively cold body. In the case of the soldier in the 
 ranks it is obvious that the nearest bodies are those of his 
 comrades, who are all at much the same temperature as he 
 himself. Radiation can, therefore, have little effect. 
 Evaporation is, in fact, therefore, the chief means by which 
 the body dissipates the heat generated by work, and to 
 facilitate this process by every possible means is one of the 
 primary duties of an officer commanding a marching column. 
 
 The extent to which evaporation is available is measured 
 by the degree of relative humidity in the air. All air that 
 is only partially saturated tends to take up moisture from 
 any wet surface, and thereby locks up a certain amount of 
 latent heat, which is abstracted from the surface in question. 
 In man the wet surface is naturally the skin, or the sodden 
 clothes, and it is easy to see that evaporation will be more 
 rapid from the smooth surface of the former than from the 
 rough absorbent hygroscopic surface of the latter. All 
 clothing, therefore, limits evaporation, and thus hinders the 
 dissipation of temperature. How important this effect can 
 be may be seen from some experiments carried out by 
 Dr. Pembrey and Captain (now Major) Parker, R.A.M.C, in 
 
MARCHING 59 
 
 1906, in which a difference of as much as J degree was noted 
 as the result of merely opening the drill- jacket on a short 
 march. This simple precaution — ^namely, that of un- 
 buttoning the coats on the march, is but rarely carried out, 
 and it is the duty of every medical officer in charge of a 
 marching unit to see that this important means of widening 
 the man's margin of safety is brought to the notice of the 
 commanding officer. It is not merely a case of greater 
 comfort for the men, or even of the prevention of disease, 
 though both of these are also concerned, but of increased 
 efficiency at the actual moment. The practice of drilling in 
 shirt-sleeves and " shorts," so universal in India, is worthy 
 of the highest praise from the physiological point of view. 
 
 Evaporation can, of course, take place also from the 
 surface of the clothes. The disadvantage here is that the 
 evaporation is delayed in point of time, and when it does 
 happen it is apt to be too late — that is, when the man is 
 halting, or after the march is over, and the increased com- 
 bustion has ceased. The moisture is then evaporated on a 
 falling temperature, and injury — in popular speech " a chill " 
 — is not unlikely to result. 
 
 Evaporation is assisted by the movement of the air, since 
 fresh quantities of non-saturated air are being constantly 
 brought into contact with the free moisture of the man's 
 skin ; still air, or, even worse, a gentle following wind, have a 
 repressive effect on evaporation. I have already stated that 
 all air that is only partially saturated tends to take up 
 moisture from any wet surface, and, conversely, a saturated 
 air can take up no more moisture. Air is able to hold 
 greater quantities of water vapour at high temperatures than 
 low, and, therefore, for the same degree of absolute humidity 
 hot air is more favourable to evaporation than cold. The 
 degree of relative humidity is measured by the difference 
 between the wet and dry bulb thermometers, and for any one 
 fairly uniform climate the reading of the wet-bulb ther- 
 mometer can be taken as a fairly safe criterion of the amount 
 of relative humidity. In England, for instance, a wet-bulb 
 temperature of 75° F. indicates a relative humidity approach- 
 ing so nearly to saturation that evaporation is almost 
 impeded, and exertion very difficult. In India, on the other 
 hand, a wet-bulb temperature of 86° F. is tolerated with 
 
60 MILITARY HYGIENE AND SANITATION 
 
 ease, and exercise can be enjoyed if only the dry bulb is 
 sufficiently elevated to show a reasonably low relative 
 humidity. It is important to remember that the absolute 
 temperature, either that of the wet or dry bulbs, is not the 
 really important point. The capacity of the air to take up 
 additional moisture is the essential consideration, and where 
 this is small or absent, the fact that the air temperature is 
 comparatively low will not prevent the body temperature 
 rising to a serious extent. On the other hand, a dry-bulb 
 temperature of 110° F., or even higher, is consistent with 
 active exertion if only the relative humidity is so low that 
 the air can take up moisture from the body to a sufficient 
 extent. Anyone who has served in India knows the differ- 
 ence between the bracing influence of the heat during the 
 earlier months of the hot weather and the enervating effect 
 of a " muggy " day in spring or autumn in England. It is 
 important, therefore, that officers in charge of troops should 
 watch carefully during the drill season the variations in 
 relative humidity, since on these the amount of work that 
 can be demanded of the men depends. 
 
 Evaporation is affected also by the fact that men have to 
 march in organized bodies more or less close to each other. 
 The evaporation of the moisture from the breath and skin 
 of the men at the head of the column raises the relative 
 humidity of the air breathed by the men farther to the rear, 
 and thus interferes with their heat regulation. This dis- 
 advantage can be lessened, or rather distributed, by opening 
 out the ranks, and changing the order of march. In a 
 hedgerow country like ours the difficulty is greater than in a 
 less enclosed terrain ; still, it is doubtful if advantage is taken 
 as often as might be of open spaces when they do occur. 
 Deep cuttings, such as occasionally occur on chalk and 
 limestone downs, should be avoided by a detour, if possible. 
 It has already been shown that direct radiation and con- 
 vection can play but little part in assisting the dissipation of 
 heat under ordinary conditions. They may, however, work 
 strongly in the opposite direction on occasion. A hot sun 
 shining on the surface of the clothes may heat these to such 
 an extent as to increase actively the internal temperature. 
 Whether rays other than the heat rays do of themselves 
 exert any actinic effect on the constitution is a matter about 
 
MARCHING 61 
 
 which there has been much discussion. A series of observa- 
 tions made lately in Manilla by officers of the United States 
 Army would appear to point to the conclusion that the 
 actinic rays exercise no injurious effect, but the conditions 
 under which the experiments were carried out were, in my 
 opinion, hardly such as to furnish a final answer. The occur- 
 rence of cases of what Weiss terms coup de soleil electrique is 
 sufficient proof that intense light rays have a certain effect 
 on the nervous system, whilst the common experience of 
 " snow blindness " amongst mountaineers, and of " sun- 
 burn " from exposure to the ultra-violet rays, point to some 
 as yet unanalyzed action of these forms of radiant energy. 
 Personally, I feel inclined to maintain a non-committal 
 attitude, and as regards prevention am in favour of, and 
 should personally practise, the use of coloured fabrics in 
 the clothing, more especially in the lining of the head- 
 gear, until more definite proof is brought forward of their 
 inutility. 
 
 The Effects of Profuse Perspiration. — Since, as 
 already stated, the regulation of the temperature depends 
 almost entirely on evaporation of moisture, it is obvious 
 that during severe exertion profuse sweating is necessary to 
 provide the means for this evaporation. A certain amount 
 of evaporation doubtless occurs from the moisture exhaled 
 by the lungs, but the amount of this is constant, and cannot 
 be increased in the same ratio as that exuded from the 
 sweat glands. It is on these last we have therefore to rely. 
 The well-known case related by Zuntz and Tendlau, in which 
 there was congenital absence of sweat glands, and the 
 subject was enabled to work during hot weather only by 
 freely soaking his shirt in water, is the best illustration of 
 their importance. But if this mechanism is to be made 
 use of it is obvious that a considerable loss of water from the 
 body must result. In the experiments of Zuntz and 
 Schumburg on one occasion as much as 3,366 grammes 
 (7 J pounds) of water were lost, of which about seven- 
 eighths were evaporated, and the balance (420 grammes) 
 remained in the clothes. In some experiments carried out 
 by Pembrey and Parker at Aldershot in 1906, the average 
 loss during a seven-mile march was 1,129 grammes, of 
 which 137 grammes remained in the clothes. 
 
62 MILITARY HYGIENE AND SANITATION 
 
 The significance of these two facts is considerable. To 
 take the second first, the retention of a certain amount of 
 water in the clothing is an illustration of the point raised 
 some little while back as to the effect of clothing on this 
 means of regulation of the temperature. It is obvious that 
 this amount of water was on these occasions lost to the body 
 without any corresponding advantage being reaped, and 
 again, that the subsequent evaporation of this amount of 
 moisture would deprive the body of a certain amount of heat 
 at a time when there was no longer increased combustion 
 going on to replace the loss. In a case like that noted above, 
 where 420 grammes of water remained in the clothes, this 
 would represent a loss of over 200 Calories to a body that 
 was already cooling down. 
 
 The actual loss of water is in itself, however, a matter of 
 paramount importance. The total amount of water present 
 in the body of a 10-stone man is equivalent to about two- 
 thirds of his total body weight — 93 pounds, or rather over 
 9 gallons. Of this it is dangerous for him to lose as much 
 as one-tenth, and any loss approaching one-twentieth must 
 be replaced at a fairly early moment if efficiency is to be 
 retained. In the above case, quoted by Zuntz, the limit is 
 nearly reached, and some of Pembrey's figures are not far 
 behind. It is obvious, then, that if a man loses as much 
 water as is recorded in the above observations, he must 
 replace the loss by drinking. This fact has to be very clearly 
 recognized, since it lies at the root of all successful march 
 discipline in warm weather. In the German Regulations 
 this is the case, and it is worth while quoting the paragraph 
 relating to this point in full : 
 
 "The greatest enemy of infantry on the march is heat, 
 and special measures should be taken to protect the men 
 against this, which is one of the most important causes of 
 depletion of the ranks. The best means at our disposal is 
 careful regulation of drinking. Mounted officers or bicycle 
 orderlies should be sent on ahead of a column to warn the 
 inhabitants of villages to turn out and have water ready on 
 both sides of the road for the troops. If possible a halt of 
 short duration may be made for this purpose, otherwise, if 
 time presses, the men must snatch a drink as they pass, and, 
 if possible, fill their water-bottles." 
 
MARCHING 63 
 
 During a twenty-four hours' walking race carried out at 
 the Stadium in 1909 the competitors, following the usual 
 custom, limited more or less strictly their allowance of 
 water. They all suffered somewhat severely from abdominal 
 pain, and in some cases vomiting occurred, owing to the 
 fact that there was an insufficient supply of water in the 
 body to permit of a satisfactory secretion of gastric juice. 
 In an interesting correspondence in the British Medical 
 Journal, which followed the publication of the report on this 
 contest, the necessity of a liberal supply of water during 
 severe exertion was insisted on by several writers, one of 
 them (Dr. Claude Wilson), an experienced Alpine climber, 
 quoting a saying of a secretary to the Alpine Club, to the 
 effect that " the more you drink the further you go." An 
 interesting illustration of the same principle is afforded by 
 the practice of the General Omnibus Company with respect 
 to the watering of their horses in hot weather. The Company 
 has found by practical experience that a liberal allowance of 
 water, both for drinking and washing down, is a remunerative 
 step, and accordingly they supply this at various places on 
 their omnibus routes. At the same time, we must recognize 
 the danger of allowing men to drink from any and every 
 source, and even such a comparatively orderly method of 
 procedure as that already related from the German Regula- 
 tions is not free from objection. 
 
 The key to the solution of the problem lies in " discipline." 
 If discipline is to be enforced in the matter of so imperious a 
 natural appetite as thirst, the conditions must be thoroughly 
 grasped. In the first place, then, we must lay down that no 
 man shall drink water from his water-bottle, or elsewhere, 
 except by the order of his officer. The standing order of the 
 Light Division in the Peninsula is the best guide here ; it 
 runs as follows : 
 
 " Section 2, article Iv., 3 : The officers must be particu- 
 larly attentive to prevent the men going out of the ranks for 
 water ; when this is required the battalion or brigade must 
 be halted." 
 
 If this order is to be obeyed the officer must know exactly 
 when it is necessary to aUow water to be drunk, and this 
 can be ascertained in two ways — either by VQljing on the 
 sensations of the men, or by a scientific calculation. The 
 
64 MILITARY HYGIENE AND SANITATION 
 
 first-named, which is the best, can only be safely used if 
 the men are so trained that their subjective sensations can 
 be relied on as evidence. The subjective sensation of thirst 
 in the untrained man is merely an expression of a parched 
 condition of the mucous membrane of the mouth and 
 pharynx ; in the trained man it is, or should be, the expression 
 of a water-hunger in the active tissues generally. Unless 
 the man is trained to such an extent that he is able to dis- 
 regard the former, which we may call " the thirst of habit," 
 it is impossible for him to know by the evidence of his 
 sensations when the latter stage, the real " thirst of neces- 
 sity," is reached. This training should be carried out 
 naturally in the ordinary course of military instruction. 
 It is, in my opinion, one of the most valuable items of training 
 in the whole course. It is also possible to arrive at a fairly 
 accurate idea of how much water is needed and when, by 
 estimating the probable water loss on scientific grounds. 
 Presupposing that the conditions are such that heat regula- 
 tion can be carried out only by evaporation, we know that the 
 evaporation of 2 grammes of water will abstract about 
 1 Calorie from the body ; therefore, if we know the amount 
 of work done, we know the amount of water that must be 
 evaporated to maintain the body temperature at a constant 
 figure. Taking the average energy expenditure per mile at 
 90 Calories, this infers an evaporation of 180 grammes of 
 water per mile. One litre will therefore be evaporated in 
 about six miles. During the earlier part of the march, how- 
 ever, the heat is allowed to accumulate in the body to raise 
 it to the normal marching temperature, and therefore 
 evaporation will not come into the question until this point 
 is reached. Taking the specific heat of the body as 0-83 
 and the optimum marching temperature as 1-2° C. above 
 the optimum at rest, it is obvious that it wiU take about 
 three-quarters of a mile to raise the temperature of a 10- 
 stone man (63-6 kilos) to this extent. Evaporation will 
 therefore presumably come into play as soon as this distance 
 has been covered. It is not, however, necessary to replace 
 the lost moisture at the very instant of evaporation, and it 
 is permissible to suppose that a man can safely lose about 
 one-fortieth of the water in his body without inefficiency 
 resulting. This gives us a margin of If pints, or 1 litre, 
 
MARCHING 65 
 
 equivalent to a distance of about six miles. The corollary, 
 therefore, is that if temperature regulation is dependent 
 purely on evaporation, then under ordinary conditions a 
 man should not need to touch his water-supply till about 
 seven miles of an ordinary give-and-take road have been 
 covered, and that after this he should be allowed 1 litre, 
 which is equivalent to If pints — in other words, the contents 
 of his water-bottle — every six miles. Under specially harass- 
 ing conditions more latitude should be allowed, but it is a 
 safe rule to lay down that on an ordinary march of fourteen 
 to sixteen miles no man should be allowed to touch his 
 water-bottle till the half-way halt, and should not empty it 
 till within a mile of camp. Such a rule does not make 
 any extraordinary demands on a man's endurance, and is, I 
 believe, enforced in some regiments. That it is not enforced 
 in all I have had ocular proof from watching men on 
 manoeuvres. In short, water on the march should be 
 treated with as much care as ammunition. Just as no man 
 may expend a round of the latter without authority, so no 
 man should expend a drop of the former without the same 
 authority. " Water discipline " is as essential to good 
 marching as " fire discipline " is to good fighting, and I 
 would venture to say that a unit in which the former cannot 
 be enforced (as one sometimes hears it said, especially in 
 this connection, " The soldier won't do this," or "It is no 
 use expecting him to do that ") is a unit in which the latter 
 is unlikely to be observed. After all, whatever prefix one 
 may attach to the word, there is only one " discipline," and 
 that is obedience to orders. 
 
 Pathological Aspects of Heat Production on the 
 March. — If from any cause the production of heat in the 
 body exceeds a certain limit, or the dissipation of heat fails, 
 then the result is a condition of pyrexia. The permissible 
 range is fairly high. The optimum being, say, 100 -6° F., 
 my experience is that no serious effects are likely to result 
 as long as the temperature does not rise above 102° F. Any 
 further rise is pathological. The most marked early effect, 
 is seen when the man is halted. He is unable to stand 
 steady, but sways slightly, and his hand becomes tremulous. 
 The face is flushed, and the eyes inclined to stare. The skin 
 is sensibly hot to the touch, the respiration laboured, and 
 
 5 
 
66 MILITARY HYGIENE AND SANITATION 
 
 the mouth open. Later, the skin may become cold and 
 clammy as the result of exhaustion, the lips being cyanotic, 
 but in strong young adults the usual result is increased 
 flushing, with injection of the conjunctivae. The ultimate 
 stage of this condition is heat-stroke. The causes of this 
 condition have practically all been already detailed. The 
 classification given by Hiller is perhaps the best, just as his 
 study of the subject has been the most complete. He 
 arranges them under three heads, as being connected with 
 (1) the weather, (2) military duties, and (3) individual pre- 
 disposition. Amongst the meteorological causes he places 
 first high-air temperature, the majority of cases being 
 recorded in the months of June, July, and August, and at 
 readings between 77° and 88° F. (dry bulb). A high degree 
 of relative humidity comes next, followed by stiUness of the 
 air, and direct exposure to the sun's rays, heating up the 
 clothing and accoutrements. Causes connected with mili- 
 tary duty are the hour of the march, the formation adopted, 
 omission to open the clothing, the number of halts, weight 
 of accoutrements, and the selection of the force. As regards 
 the hour of the march, he states that 80 per cent, of his 
 cases occurred between 10 a.m. and 3 p.m., and recommends 
 that short marches should be so timed as to finish before 
 the first-named hour. In the case of long marches, a sub- 
 stantial midday halt should be followed by the completion 
 of the march in the cool of the evening. No one who has 
 served in India will need much instruction on this point. 
 It is important, however, to remember that it is possible to 
 fall into the other extreme, and start too early. The pesti- 
 lential old Indian custom of starting at 2 a.m., even in the 
 cold weather, which ruined the men's rest, and exposed them, 
 tired and unfed, to the rays of the early morning sun, striking 
 under the helmet brim, was as irrational as starting too late 
 at the hotter season of the year. As regards the selection of 
 the men, this involves the exclusion of all men who suffer 
 from a personal liability, whether that be individual and of 
 a permanent nature, or the result of antecedent illness, or 
 the nature of the occupation. Individual predisposition 
 includes the influence of the occupation and life of the 
 soldier on his general muscular fitness, and the presence of 
 certain organic abnormalities. 
 
MARCHING 67 
 
 Amongst habits and occupation, the most important place 
 is held by those which tend to produce muscular inactivity. 
 Reservists, men on the active list told off as cooks, or clerks, 
 or who had suffered long terms of imprisonment, or had 
 lately left hospital, supplied the great majority of the 
 cases. The remainder occurred in men whose general bodily 
 constitution was temporarily or permanently weakened, as 
 in the case of hard drinkers, men prone to over-eating, or 
 suffering from digestive disturbance. Insufficient sleep ac- 
 counted for 6 per cent, of the cases, a point worth noting 
 in connection with men employed on picket or guard, or 
 orderlies in attendance on cases at night. Want of food, as 
 conducing to general weakness, also exercises an important 
 effect. Organic disease accounts for a comparatively small 
 number of cases, though the mortality of such as are due to 
 such conditions is exceptionally high. Adhesions of the 
 pleura occurred in 36 per cent, of Killer's post-mortems. 
 Disease of the circulatory and urinary systems were com- 
 paratively rare, probably as being less likely to escape notice 
 during ordinary life. Excess of adipose tissue, whether 
 general or confined to the heart, was present in a large 
 number of cases. 
 
 The prevention of heat-stroke lies in observing, and as 
 far as possible minimizing, the causes which produce it. 
 The only cause which is absolutely beyond control in any 
 way is the high relative humidity of the air. The absolute 
 heat of the day, and exposure to the sun's rays, can be 
 avoided by a judicious selection of the hour of marching, 
 the stillness of the air minimized to a certain extent by 
 opening the ranks. All the other causes above detailed are 
 under the control of the commanding officer, and he and his 
 immediate medical adviser should be held responsible that 
 they are guarded against. 
 
 Effects of Marching on the Respiration, Circula- 
 tion, AND OTHER SYSTEMS OF THE BoDY. — ^Marching, being 
 a form of muscular work, entails, as already shown, a certain 
 amount of combustion proportionate to the energy actually 
 developed in the production of the work. This combustion 
 demands an increased supply of oxygen, and an increased 
 supply of fuel, and leads, therefore, to an increase in the 
 respiratory exchange, and an acceleration of the circulation. 
 
68 MILITARY HYGIENE AND SANITATION 
 
 It therefore affects importantly both the respiratory and 
 circulatory systems. Again, since the regulation of the 
 temperature is effected largely by evaporation from the 
 skin, the composition of the blood and the functions of the 
 urinary system are also interfered with. 
 
 Effects on the Respiratory System,. — The demand for an 
 increased supply of oxygen is met at first by an increase in 
 the number of respirations, and, later, by an increase in their 
 depth, the former change being, however, the most marked. 
 Any cause which leads to greater combustion obviously 
 entails also increased respiratory exchange ; therefore load, 
 pace, and the other factors already detailed when con- 
 sidering the question of combustion need not be again dis- 
 cussed. The most important point to remember is the 
 necessity of keeping the movements of the chest as far as 
 possible unhampered by any constricting bands, which 
 might interfere either with the rapidity or the magnitude of 
 its movements. Here, again, it is necessary to insist on the 
 absence of all straps crossing the chest above the waist. It 
 is impossible, with any form of equipment, to avoid entirely 
 some interference with the chest movements. As long as a 
 man has to carry some of his belongings on his person, and 
 at the same time keep his hands free for fighting and his 
 legs unencumbered, it is obvious that the weights so imposed 
 on him must come into direct relation to his chest waU, and 
 must take part in every movement of that wall. The ill- 
 effects can be minimized by a suitable arrangement of the 
 different weights forming the load, a point that falls to be 
 considered under the heading of Equipment. 
 
 Increase in weight carried diminishes to a serious extent 
 the " vital capacity," and this diminution will affect natur- 
 ally the " complemental air " to the greatest extent. The 
 " tidal air " will also share in the reduction, especially after 
 fatigue, whether general or affecting only the respiratory 
 muscles, has set in. Zuntz and Schumburg give a reduction 
 of vital capacity of about 9 per cent, with a load of 22 kilos 
 (48-4 pounds), of about 11 per cent, with a load of 27 kilos 
 (59-4 pounds), and about 12 per cent, with a load of 31 kilos 
 (68-2 pounds). In individual cases the reduction was much 
 greater, amounting in one subject, with the minimum weight, 
 to 18 per cent., and with the maximum to 25 per cent, of the 
 
MARCHING 69 
 
 vital capacity at rest. Practice in the carrying of loads is 
 most important in this connection. Schwiening recommends 
 the use of breathing exercises (Lungengymnastik) for this 
 purpose. Loath as one naturally is to disagree with such 
 an authority, I cannot help feeling that this suggestion is in 
 direct opposition to sound practice. A man will soonest 
 get accustomed to carrying loads by carrying them. The 
 respiratory system is not the only one concerned in the 
 matter, and though breathing exercises may doubtless 
 strengthen the chest muscles and so enable them to compete 
 with an increased load, the legs and those parts of the trunk 
 which have to bear the actual pressure of the loads will not 
 in any way benefit by these exercises, and will demand some 
 other special form of training. It cannot be too often 
 repeated that the best way to learn how to do a thing well 
 is to do it, and the best way to keep in good condition to do 
 it well is to go on doing it. 
 
 When the embarrassment of the respiratory movements 
 becomes serious, the usual sequences follow — namely, en- 
 gorgement of the bases of the lungs, obstruction to the flow 
 of blood through the right side of the heart, and through the 
 liver. These last are indicated by an increase in the cardiac 
 and hepatic duiness. Zuntz and Schumburg report such an 
 increase in 56 per cent, of cases when the load was 22 kilos, 
 70-4 per cent, when the load was 27 kilos, and 87-5 per cent 
 when it reached 31 kilos. The liver acts, according to these 
 observers, as a safety-valve to the heart, dilatation of the 
 former organ occurring earlier than that of the latter. The 
 dilatation affected the right side of the heart practically in 
 all cases, and in half the left was also affected. It was noted 
 that these phenomena coincided with an increased respiratory 
 rate, ^.nd an increase in body temperature, and were largely 
 due to the constriction imposed on the body by the waist- 
 belt and the weight of the cartridge pouches. They did not 
 appear to bear any relation to the pulse-rate. 
 
 The changes in the outlines of the cardiac and hepatic 
 duiness noted above disappear, as a rule, in a healthy, well- 
 trained man in the course of two or three hours, or at least 
 by the evening of the day on which the exertion was incurred. 
 Occasionally, however, the effects are more lasting, and 
 persist until the next morning. It can easily be understood 
 
70 MILITARY HYGIENE AND SANITATION 
 
 that in cases like these last named important digestive dis- 
 turbance might result, and a man so affected would not be in 
 a condition to repeat the exertion on the following day. 
 The chief practical point in this connection is, in my opinion, 
 the tightness of the waist-belt. In the majority of equip- 
 ments the position of this band depends largely on the 
 balance of the accoutrements. If, as is often the case, it 
 tends to be drawn upwards, the resulting constriction will 
 ajffect the liver very seriously. In the new webbing equip- 
 ment, when ammunition is carried, this is not the case, and if 
 the belt be worn loose no ill-effects need result. Worn tight, 
 with the weight of seventy-five rounds applied closely over the 
 hepatic region, it may exercise a distinctly in jurious influence. 
 In the new American equipment the belt is allowed to 
 sag downwards almost to the line of Poupart's ligament. 
 
 Effects on the Circulation, — The increased combustion, 
 demanding, as it does, increased oxygen and increased 
 fuel, naturally entails an increased acceleration of the 
 cardiac rhythm. This is very marked, the pulse respond- 
 ing almost at once to any alteration in position or pace. 
 The pulse-rate is more variable during exercise than 
 either the respiratory rhythm or the temperature, and can 
 easily be doubled by a smart run. The increase during an 
 ordinary march is from 40 to 100 per csnt. of the rate at 
 rest. It is dependent on, primarily, the same conditions as 
 those which affect the combustion ; these have already been 
 detailed, and need not be again repeated. The essential 
 nature of the relationship is apt to be masked by secondary 
 influences, affecting the lumen of the peripheral circulation. 
 
 When the heart has to beat more rapidly, it shortens the 
 diastole to a greater extent than the systole, so that the 
 ratio between these two periods, which may be taken as 
 being under normal circumstances about 3 to 1, may fall 
 as low as unity, or even below this figure. The corollary 
 of this is that the heart gradually gets less time to become 
 filled with blood, and its driving power is to that extent 
 lessened. That is to say, each successive beat sends out 
 into the systemic circulation a gradually diminishing 
 volume of blood. The effects of this diminished efficiency 
 in the direction of reducing the supply of fuel and oxygen 
 to the muscles need not be dilated on. 
 
MARCHING 71 
 
 The first effect on the blood-pressure is to increase it. 
 This is due to the fact that the vis a tergo of the heart-beat 
 is increased, whilst the resistance of the circulation through 
 the cutaneous capillaries is at first maintained at normal, 
 and that through the capillaries of the muscles increased by 
 their contraction. As the skin becomes warm, the capil- 
 laries and smaller arterioles near the surface dilate, and the 
 pressure may fall to normal or remain but slightly higher 
 than this as long as the exercise persists. Any weakening 
 of the heart-beat will, in consequence, now lead to a fall in 
 the blood-pressure, due to the diminished drive of the heart. 
 In fatigue this occurs, and the pressure may faU so low 
 that the heart can no longer keep the superficial capillaries 
 full. The skin then becomes clammy and pale, and the 
 lips show by their colour the deficient aeration in the lungs. 
 Ordinarily, especially in well-trained men, the changes in 
 the circulation are so transient that they pass off in the first 
 minute or so of halt. They are therefore best investigated 
 by the simple clinical method of palpating, and counting the 
 pulse. It is only in the more serious cases that circulatory 
 disturbances persist for any length of time. 
 
 The effects produced on the blood are an increase in the 
 specific gravity, and also in the number of red and white 
 blood corpuscles. The first named is not great. Zuntz 
 and Schumburg report an average advance of the specific 
 gravity from 1059-6 to 1063. The red corpuscles increased 
 by 9 per cent., and the white by 43 per cent. The rise in 
 specific gravity is ajttributed chiefly to an increased osmosis 
 into the active tissues, the result of the presence therein of 
 metabolites ; loss of moisture from perspiration must also 
 have some effect. The increase in the red corpuscles is 
 probably only relative, but that of the leucocytes is an 
 actual multiplication due to the washing of corpuscles from 
 the walls of the larger veins by the more powerful flow of 
 the blood. The change affects chiefly the large polynuclears, 
 and is more persistent than the others just noted, which are 
 transient in their nature. The increased specific gravity 
 of the blood is of importance as being likely to interfere 
 with the free perspiration demanded if heat regulation is 
 to be satisfactorily maintained. 
 
 Effects on the Urinary System. — The specific gravity of 
 
72 MILITARY HYGIENE AND SANITATION 
 
 the urine may be raised or lowered by the march, and 
 the exact conditions which determine either result seem 
 to be as yet unsettled. Zuntz and Schumburg came 
 to the conclusion that the exertion of the march had 
 a positively diuretic effect, causing the excretion of a 
 more dilute urine even on days when there had been 
 profuse sweating, and but little fluid had been drunk. 
 Albumin occurs not infrequently in the urine after severe 
 exertion, and it is still doubtful in how far this is to be con- 
 sidered pathological. It undoubtedly shows itself amongst 
 even well-trained men. Collier reports its presence in 
 130 out of 156 rowing men actually in training, and in them 
 has been attributed to deficient oxygen-supply to the kidneys 
 during hard work, the demands of the active muscles having 
 first to be met. In all probability the safest line to take 
 in such a case is to judge by the concurrent symptoms 
 present. Albuminuria in a man not previously known to 
 be in the habit of passing albumin should always lead to 
 careful watching of the individual. If persistent, or if 
 accompanied by casts or other signs of disordered meta- 
 bolism, it should undoubtedly be looked upon as a serious 
 condition. In any case, it must be taken as a possible 
 danger-signal until proved to be the contrary. 
 
 Halts. — The proper distribution of halts and their dura- 
 tion exercises a great influence on the marching powers 
 of the men. In Field Service Regulations, part i., p. 47, 
 it is laid down that a short halt will be ordered soon after 
 the column has started, subsequent halts being arranged 
 at the discretion of the commander of the column. The 
 early halt is a general practice, and its object is explained 
 in the German Regulations as being to adjust clothing and 
 accoutrements, and meet the calls of nature. After an 
 early start this halt is extremely important, and should not 
 be curtailed. Subsequent halts must be made according 
 to the condition of the men, the state of the weather, etc. 
 As regards the condition of the men, it is important to 
 remember that the men who count are those at the rear of 
 the column, where the air is saturated and the dust most 
 trying. The duties of the commander naturally keep him 
 at the head of the main body, and he is apt sometimes to 
 forget how very different the air at the farther end of his 
 
MARCHING 73 
 
 column may be from that which he himself breathes. The 
 medical officer in charge of the rearmost infantry unit should 
 be made responsible for notifying the effect of the march 
 on the men he is in charge of to the commanding officer of 
 that unit, and suggesting a halt or change of position if 
 necessary. 
 
 The usual practice is to halt for five or ten minutes at 
 the end of every hour, with a longer halt a little beyond 
 half-way, of, say, half an hour. The French take ten 
 minutes' halt after every fifty on the road, with half an 
 hour after being three hours on the road, or after three- 
 quarters of the total distance has been covered. The Ger- 
 mans seem to be less lavish in this particular. General 
 StonewallJackson ordered a halt of ten minnutes every hour ; 
 the Light Division in the Peninsula took two halts on a 
 twelve -mile march. 
 
 From a physiological point of view, a halt should either 
 be short or decidedly long. Ten minutes is, if anything, 
 too long for a short halt, as with a tired man it gives him 
 enough time to get stiff, but not long enough for a thorough 
 rest. Under ordinary marching conditions, the hourly halt 
 is in reality only necessary to break the monotony of the 
 march, and to mark the lapse of time. It also affords men 
 time to adjust boot-laces, get rid of smaU stones that may 
 have got into their boots, and so on. For this purpose 
 five minutes should be enough. If a longer halt be made, 
 then at least haK an hour should be allowed. The men 
 should take off their accoutrements, and, if possible, lie 
 down. In an enclosed arable country this last may often 
 be impossible, but in open country, or where the bulk of the 
 land is under pasture, there need be no difficulty. Heavy 
 rain and soaking grass might, it is true, prevent it, but the 
 mere fact that the grass is damp need not. If necessary, the 
 men can take their greatcoats out of their packs and put 
 them on, or use them to lie down on. In the Light Division 
 the custom at each of the two halts already aUuded to was 
 to take off packs and lie down, each company resuming 
 the packs only just in time to admit of its marching off at the 
 proper moment. Stonewall Jackson used to say, " A man 
 rests all over when he lies down." 
 
 From a physiological point of view, I think it important 
 
74 MILITAKY HYGIENE AND SANITATION 
 
 to emphasize the difference between the halt that is merely, 
 as it were, a punctuation in the course of a march, and the 
 halt that is a real rest. The former should never be more 
 than ten minutes, and five is better ; the latter never under 
 half an hour, and an hour, if the time can be afforded, is 
 preferable. The place where the long halt is to be made is 
 of importance. In very hot weather shade, unless it be 
 accompanied by fresh air, is not always an advantage, 
 especially in this country. The direct rays of the sun are 
 less likely to hurt than the close, damp air of a wood. 
 Where a road is heavily wooded on both sides it is better 
 to push on and get into the open before halting. The foot 
 of an ascent is a bad place to stop at. Physiologically, the 
 rest will be more appreciated at the top of a hill, when the 
 pulse and respiration are both accelerated ; in addition, the 
 ascent will be less easily tackled immediately on starting 
 after a prolonged rest, owing to stiffness, and the fact that 
 the men need to be warmed to their wock. 
 
 Forced Marches. — This term is applied either to one 
 severe march or to a succession of long marches prolonged 
 over several days. Classical examples of the former in our 
 army are the magnificent march of Marlborough's troops — 
 40 miles in eighteen hours — through Villars' lines, in 
 1710 ; the march of the Light division to Talavera in 1809 
 — 62 miles in twenty-six hours ; and the march of the 
 same body after Sauroren in 1813 — 40 miles over moun- 
 tain-roads in nineteen consecutive hours. 
 
 The two famous marches carried out by Lord Roberts 
 from Cabul to Candahar — 318 miles in twenty-three days — • 
 and from Bloemfontein to Pretoria, during which his central 
 column marched 300 miles in thirty-four days, and that 
 commanded by Sir Ian Hamilton — 384 miles in thirty-seven 
 days — are our best-known modern examples of the con- 
 tinuous forced march. 
 
 These different types of forced march have a very different 
 significance from the point of view of the physiologist, and 
 therefore of the sanitarian. In both cases the human 
 machinery is exposed to a tremendous strain, but whereas 
 in the first case this is concentrated into a few hours, in the 
 latter it is spread over a period of days or weeks. In either 
 case this strain will probably lead to a considerable thinning 
 
MARCHING 76 
 
 of the ranks, but the measures to be adopted to lessen such 
 thinning will differ considerably in the two cases. In the 
 case of the single severe march the demand for energy is 
 rarely greater than can actually be supplied in the form 
 of food, or, in other words, fuel. For instance, in the case 
 of the Light Division marching to Talavera, if we take the 
 average energy expenditure per mile at 150 Calories — that 
 is, more than half as much again as would be needed in the 
 southern counties of England — ^it would be necessary to 
 supply each man for his sixty-two miles with 9,300 Calories 
 of food. It is quite simple to devise a ration which should 
 supply this amount of energy in a weight of 7 pounds, and 
 still contain 50 per cent, of water. There would be no 
 insuperable difficulty in lowering this weight to 4 pounds, 
 by using desiccated food, which the man could easily carry 
 on his person. But, after all, there would be no necessity 
 for supplying so much additional energy as this, since any 
 man can live for a certain time en his own tissues. It would 
 be fair to expect a supply from this source of at least 3,000 
 Calories. The difficulty lies not in the question of fuel 
 in short, but, adhering to the same metaphor, in that of 
 lubrication. The prolonged exertion demands an excessive 
 excretion of water, and unless this is replaced the tissues 
 get blocked by their own products of disintegration, and 
 the machine becomes clogged. 
 
 Napier's description of the men during the march after 
 Sauroren, when many "fell and died, convulsed and frothing 
 at the mouth, while others, whose spirit and strength had 
 never before been quelled, leant on their muskets, and 
 muttered in sullen tones that-they yielded for the first time," 
 answers exactly to the description by Hiller of the dyscrasic- 
 paralytic form cf heat-stroke, which " affects most severely, 
 as a rule, the most trustworthy and stout-hearted men, 
 who would never of their own free-will leave the ranks," 
 and which is characterized, amongst other symptoms, by 
 " severe general muscular spasms, with rigid opisthotonos, 
 clenched jaws, and foaming at the mouth." Such a con- 
 dition can only be guarded against by a free supply of 
 water. All other precautions, lightening the weight carried, 
 opening the jackets, and so on, must also be taken ; but unless 
 the blood is in such a state that it can flush out the working 
 
76 MILITARY HYGIENE AND SANITATION 
 
 tissues, and remove the waste products of exercise, any other 
 measures will be purely palliative. I have already stated 
 the amount of water that a man requires for a short or 
 ordinary march. For a long march he should, in my 
 opinion, be allowed his water-bottle full at every sixth 
 mile after the conclusion of the first eight or so. That is, 
 starting with the water-bottle full, it should be replenished 
 at the fourteenth, twentieth, twenty-sixth mile, and so on. 
 I cannot see that in any civilized country this need present 
 any insuperable difficulty, though it does, of course, demand 
 forethought. In such a case there must be no meticulous 
 haggling over the question of quality — water the men must 
 have, the best that can be procured, but water in any case. 
 
 Before undertaking such a march, staff and medical officers 
 should study carefully on the map the possibilities of getting 
 water on the road, and in this direction a knowledge of 
 geology will be of the greatest value. Success — ^that is 
 to say, the number of efficient men that the commander 
 can place at his objective point — ^will depend on the amount 
 of water that he procures for his men en route more than 
 on any other one physical condition. Deficient water 
 may not mean absolute failure — ^that is to say, with bad 
 arrangements, or even without any arrangements at all, 
 some men will arrive at their destination. They will be 
 fewer in numbers, and less efficient in quality, than if 
 reasonable provision is made. Inefficient lubrication of an 
 engine may go far before actual " seizing " occurs, but the 
 bearings suffer nevertheless, and the case of a badly 
 watered army is precisely similar. 
 
 As already stated, this water is needed to further the 
 processes of metabolism, and also to free the muscles from 
 the waste products that otherwise will accumulate in them. 
 This last object may be materially assisted by the practice 
 of massage at the halts. I am indebted for this hint to 
 Colonel Mark Sykes of the 5th Battalion, Yorkshire Regi- 
 ment (T.F.). It consists in forcible flexion, followed by 
 forcible extension of each leg three times, every joint being 
 moved to the utmost possible extent, after which the legs 
 and buttocks are kneaded firmly. This procedure has a 
 marked effect in reducing cramp at the time and stiffness 
 subsequent to the march. 
 
MARCHING 77 
 
 The continuous forced march stands on a different physio- 
 logical footing to the single severe effort. In this case the 
 exertion on any one day is not peculiarly exhausting. Thus, 
 in the Cabul-Candahar march the average distance traversed 
 each day was only 13-9 miles if the whole period be included, 
 or 15- 14 miles if marching days only are taken into con- 
 sideration. The average daily distance traversed by General 
 Ian Hamilton's force between Bloemfontein and Pretoria 
 was just over ten miles, that of Lord Roberts' centre column 
 eight and a half miles. If only marching days are counted, 
 these figures rise to a little over thirteen, and to sixteen 
 and a half miles respectively. The longest march per- 
 formed by the first-named force was twenty-eight miles, 
 and by the second twenty-two miles. Obviously the actual 
 exertion demanded of the men was not on any one day a 
 serious matter. The effects produced by such a march 
 are not, therefore, due to the severity of the work, but to 
 the constant repetition of a strain that is perhaps just 
 slightly above the average of that to which the bodily 
 mechanism of the soldier is accustomed. This is fairly 
 obvious if we consider the history of such marches in the 
 past. In 1805 the Grand Army which Napoleon had 
 collected at Boulogne for the projected invasion of England 
 marched from that town to the Rhine, 400 miles, in twenty- 
 five days. The men were seasoned soldiers who had been 
 assiduously trained for a great adventure for many months, 
 and their losses were in consequence small. On the other 
 hand, the fore 3 which marched from the north of Germany 
 to Vienna in 1809, composed largely of young men recruits, 
 left a substantial proportion of its numbers on the road. 
 More than one-half the men composing this army were under 
 twenty years of age. In the march to Candahar the only 
 regiment which suffered seriously was the 72nd Highlanders, 
 which contained a large draft of men who had arrived lately 
 from Scotland. The seasoned infantry which followed 
 Lord Roberts to Pretoria lost only 4 per cent, of their 
 strength. Training, then, is the most important factor 
 in the performance of the continuous forced march. Next 
 to training comes food, or, in other words, fuel. For any 
 prolonged exertion of this nature a special addition to the 
 ration is advisable. This addition should consist of some 
 
78 MILITARY HYGIENE AND SANITATION 
 
 easily digested and assimilated foodstuff, and, personally, 
 I consider that sugar is the most suitable form which it 
 can take. The fats, though their energy value is so much 
 higher, are not so easily digestible, and beyond a certain 
 point are not assimilable. Protein is less digestible, and 
 I should be averse to increasing the already high pro- 
 portion of this food principle present in our ration. I 
 would, however, make an exception in favour of including 
 meat extractives in the ration. These have no energy 
 value of their own, but their power of stimulating the 
 digestive powers is very great, and for a tired man a mess-tin 
 of hot soup, even if made from tinned extract, may act as 
 what our Elizabethan ancestors were in the habit of calling 
 a " shoeing horn " to the less attractive but more solid 
 components of the ration. Alcohol might also be more 
 freely used on a march of this nature than under ordinary 
 conditions. The opportunity for its use would arise at the 
 end of any particularly harassing day, to encoura^ the 
 men to make themselves comfortable for the night. The 
 occasions should be carefully chosen, since the issue would 
 lose much of its value if it came to be looked on as a regular 
 custom instead of being an exceptional resource. 
 
 Care of the Feet. — So far I have discussed chiefly the 
 physiological principles on which the performance of the 
 march is based. Anatomically, it is concerned chiefly with 
 the foot of the soldier, and mainly with the skin of the foot, 
 The actual formation of that limb is a question for the 
 recruiting officer, and any defect in that direction must be 
 remedied before the question of marching comes into con- 
 sideration at all. There is only one word that I should like 
 to say here in favour of exercising a certain amount of 
 moderation on the consideration of this point. The modern 
 human foot is the result of the use of artificial foot-gear, 
 lasting over many generations. When we consider the 
 question of walking as it affects civilized man, we must 
 consider the foot as consisting of a foot plus a boot. We 
 can no more leave the latter out of consideration than we 
 can set on one side the man's clothes when we discuss the 
 question of temperature regulation. The naked, bare -foot 
 savage is one person, the civilized man, booted and clad, 
 according to the customs, senseless or otherwise of his race, 
 
MARCHING 79 
 
 is another, and it is the latter with which we have in practice 
 to deal. Whether a reform in the foot-wear of the nation 
 is possible or necessary is not for the army medical officer 
 to decide. He must take the booted foot as he gets it, 
 and make the best of it. The important point for him to 
 consider is the junction between the foot and the boot — • 
 that is, the interaction between the inner surface of the 
 leather of which the former is composed, and the skin with 
 which the latter is covered. This interaction is controlled 
 by the interposition of the sock or other form of foot-covering 
 in use, and the general question of the construction of these, 
 and also of boots, will be touched on under Clothing. 
 Here I wish only to refer to the feet themselves. If the 
 foot be normally shaped, within the usual variations met 
 with in civilized man, the most important condition is 
 cleanliness. A dirty foot is necessarily an unsound foot. 
 The cleanliness of men's feet can be insured by frequent 
 cleansing, and careful drying after cleansing. Any moisture 
 left between the toes, or elsewhere, will encourage putre- 
 factive processes in any dirt, internal or external, that 
 may accidentally be left in such positions. 
 
 After cleanliness comes the actual physical condition 
 of the epidermis. In a man who has been in the habit of 
 taking regular exercise, this will probably be hard and 
 sufficiently resistant to withstand the ordinary friction of 
 the march. In the case of peculiarly soft feet some hardening 
 lotion — e.g., formalin — ^may be used, or a solution of chromic 
 acid, 10 per cent., or weaker if excoriations are present. 
 In the case of men who suffer from hyperidrosis, more 
 drastic measures are necessary. The patient must be 
 detained in hospital for twenty-four hours. All the foot- 
 gear must be sent for. The socks should be soaked for one 
 hour in a solution of corrosive sublimate, 1 in 2,000, then 
 well rinsed in hot water, and subsequently washed. The 
 inside of the boot must be painted everywhere with a 
 solution containing 1 ounce of salicylic acid in 10 ounces of 
 spirits of wine. The feet are then carefully cleansed, and after 
 drying painted over with the same solution. The chief 
 attention should be paid to the red, sodden areas which are 
 characteristic of the complaint. After this a clean pair 
 of socks may be put on, or the foot covered with dry boracic 
 
80 MILITARY HYGIENE AND SANITATION 
 
 lint. The painting is repeated the following morning. 
 The process is, in fact, one of thorough disinfection of the 
 feet and their coverings. 
 
 The most important point is, however, to keep a close 
 supervision over the feet of the men, and this is to a great 
 extent a disciplinary measure. Repeated foot inspection 
 must be made by the medical officer and company officers. 
 In addition, men must be warned that they will be held 
 responsible for reporting the slightest injury to their feet 
 immediately at the conclusion of the march. The man 
 who saves his sore feet till the next morning, and then 
 reports sick, must be made to march, or have the serious- 
 ness of his negligence brought home to him in some other 
 way. In the majority of cases the soldier who suffers from 
 sore feet is as directly responsible for the accident as the 
 cavalry soldier who rubs his horse's back, and should receive 
 the same amount and kind of consideration. In this 
 connection the ingenious invention of Dr. Coindreau may 
 be mentioned. This officer applies a strap round the ankle 
 and instep in a figure of eight, which immobilizes the foot 
 inside the boot. The strap is pulled fairly tight, and 
 fastened off by a buckle, which lies just in front of the 
 external malleolus. In this manner the rubbed surface 
 gets time to heal, and if the wound be in the meantime 
 treated aseptically, recovery may be anticipated, even though 
 the man continues marching. The care of the feet may 
 seem a small thing, and to the medical officer ambitious 
 of surgical or hygienic distinction appear rather below his 
 personal or professional notice. There is, however, no duty 
 more important, or the punctual performance of which will 
 be more readily repaid by the sight of full ranks. 
 
CHAPTER VI 
 
 FOOD AND DIETETICS 
 
 The word " food " in its widest sense must be held to include 
 all substances which man consumes with a view to nourish- 
 ment, though it is more scientifically restricted to denote 
 only those ultimate principles which supply either building 
 material or fuel for the human machine. In the following 
 section I will, where there is likely to be any ambiguity, 
 use the expression " foodstuff " to connote the wider, 
 and " true food " the more limited of the above meanings. 
 
 Selection of Foodstuffs. — The foodstuffs which are 
 used by man, whether civilized or savage, are not selected 
 by him, primarily or knowingly, to meet any physiological 
 requirements, except in so far as these are expressed by 
 the natural longings and appetites. They are selected 
 mainly on sensual or aesthetic grounds, the choice being 
 tempered by the question of cost or pro curability. Briefly, 
 a healthy man eats what he likes and can obtain, with but 
 little conscious thought, in the immense majority of cases, 
 at least, as to whether it is suitable for the work he has to 
 do or even consonant with the preservation of his health. 
 But though it is true that men choose their food, not because 
 it is good for them, but because they like it and can get it, 
 still, it by no means necessarily follows that what they like 
 is not at the same time the best for them. The foodstuffs 
 that men eat are largely a matter of national tradition and 
 custom — ^that is, of an unconscious adaptation of the 
 individuals of a race to their surroundings. A tribe that 
 persisted in consuming an unwholesome or unsuitable food 
 must obviously either die out or deteriorate. It must, 
 no doubt, have repeatedly happened during the course 
 of history, that some particular race has been driven by 
 
 81 6 
 
82 MILITARY HYGIENE AND SANITATION 
 
 a more powerful enemy into a region where the best food 
 was no longer cultivable or obtainable. Such a tribe must 
 either die out or adapt itself to living on the inferior food- 
 stuffs which are still available, and will thus perpetuate 
 and accentuate its inferiority. It, in fact, will remain a 
 poor race because its food is poor, and conversely its food 
 will be poor because it is a poor race. On the other hand, 
 it is hardly consonant with what we know of the process 
 of evolution to suppose that the races which have for 
 centuries dominated their neighbours have done so in spite 
 of the fact that they persisted in living on unsuitable forms 
 of food. In short, for a strong race national usage predi- 
 cates a certain suitability in the dietary. 
 
 The student of dietetics who ignores these national and 
 traditional prejudices will inevitably come to grief sooner 
 or later when he finds that the hard facts of history run 
 counter to his theories. So strong is the sentiment that 
 attaches men to certain foodstuffs that it has on occasion 
 happened that men have died of starvation, not because 
 all food, but only the particular food to which they were 
 habituated has failed. To ignore appetites so strong as 
 these is the negation of science, and the cardinal error 
 into which many so-called food reformers fall is trying 
 to teach people to subsist on foodstuffs, which by national 
 tradition — call it even national prejudice if you will — ^they 
 are not in the habit of considering suitable articles of diet. 
 The definition given by Dr. Johnson of oatmeal — ^namely, 
 " the food of men in Scotland and of horses in England " — 
 is an apt illustration of such a prejudice — one which, in 
 spite of the counter-query, " Where do you find finer men 
 or better horses ?" persists in almost unabated strength 
 amongst the working classes of the South to the present 
 day. There is, in fact, ample physiological justification 
 for yielding to — call it even pandering to, if you will — such 
 national, social, and even personal predilections. Since 
 the soldier leads a communal life, personal appetites have 
 to be levelled up or down to a general regimental standard, 
 but national and social habits are, and very rightly, allowed 
 considerable weight in the arrangement of his messing. 
 
 Classification of Foodstuffs. — The enormous variety 
 of foodstuffs available makes it necessary to adopt some 
 
FOOD AND DIETETICS 83 
 
 general form of classification to facilitate their discussion. 
 That which I adopt is given in the following paragraph, 
 and I will merely preface it by saying that I do not put 
 it forward as being strictly scientific, but merely as a good 
 working arrangement, which permits of all possible food- 
 stuffs being included, and placed each under a heading 
 which denotes its chief dietetic quality, though not its 
 sole dietetic function. 
 
 All foodstuffs may be divided primarily into (1) those 
 which are absorbed, and (2) those which are not absorbed, 
 and these can again be subdivided as follows : 
 
 1. Foodstuffs which are absorbed — 
 
 (a) Those which help to build up tissueslthe true 
 (6) Those which help to supply energy J foods. 
 
 (c) Those which assist in either of the above — 
 
 stimulants and antiscorbutics. 
 
 (d) Those which hinder either of the above — poisons. 
 
 2. Foodstuffs which are not absorbed — 
 
 (a) Those which assist absorption — condiments. 
 
 (6) Those which do not assist absorption, but are 
 
 mechanically beneficial on account of their 
 
 bulk, 
 (c) Those which hinder absorption or cause injury — 
 
 poisons. 
 
 As I have already premised, the above classification is 
 not scientific, since any one food may fall under more than 
 one of the above heads. Thus most of the true foods act 
 both to build up the tissues and to supply energy, whilst 
 any one of them, if taken to excess, or in individual cases 
 even if taken in moderation, may act as a poison. Again, 
 condiments are, as a matter fact, in most cases absorbed ; 
 but their chief dietetic function does not depend on their 
 absorption, and is, in fact, completed before that has taken 
 place. They, too, may, if taken to excess, act as poisons, 
 irrespective of the fact that they have previously had a 
 beneficial effect, or not. Alcohol can supply energy, and 
 therefore might be classed under the true foods. Its true 
 dietetic value does not, however, lie in this direction, but 
 in that of assisting the general processes of assimilation 
 
84 MILITARY HYGIENE AND SANITATION 
 
 and digestion, by the physical and mental excitement 
 which it produces, and it is therefore rightly placed under 
 the heading of " stimulants." Lastly, the complex animal 
 and vegetable substances which form the staple of any 
 diet contain ingredients which may be classed under almost 
 any one of the different headings. Thus, for instance, a 
 mutton chop consists mainly, as regards its solid consti- 
 tuents of protein material, a true tissue builder ; it also 
 contains fat, a true source of energy, whilst under certain 
 conditions the former may supply energy and the latter 
 build up, if necessary, tissue. In addition, there may 
 exist some unabsorbable fascia or cartilage, which, if 
 swallowed, will act to increase the mass of the faeces, and 
 so assist peristalsis. Lastly, a spicule of bone may be 
 ingested, and cause mechanical injury to the gastric mucous 
 membrane, and thus act as a poison. 
 
 With these limitations and provisos, I have found the 
 classification given above a good working arrangement for 
 purposes of discussion. It will be convenient to consider 
 the less important substances first, leaving the true foods 
 for discussion last of all. 
 
 Condiments. — I have defined these as substances which 
 are not absorbed, but which assist absorption. The chief 
 condiments in common use are mustard, pepper, vinegar, 
 various spices, and common salt, this last acting also as a true 
 food. They act reflexly on the digestive secretions through 
 the special nerves of taste, some also — e.g., pepper, curry- 
 powder, -etc. — act on the gastric mucosa, producing free 
 secretion as a result of direct irritation. It is a mistake to 
 look upon condiments as luxuries. They are, in fact, neces- 
 sary, especially in the case of civilized man, to effect satis- 
 factory digestion and absorption, especially in the case of 
 the less sapid vegetable foods. This action is not, however, 
 confined to the actual substances which we know by the 
 name of " condiments." Everything which tends to make 
 the food attractive in appearance or odour, the surroundings 
 in which it is consumed, luxurious table appointments, 
 bright lights, pleasant companionship, all these tend to 
 assist what Pavlov has termed the " psychic stimulus " to 
 digestion. Most important of all is variety in diet. It may 
 be true that hunger is the best sauce, but even hunger 
 
FOOD AND DIETETICS 85 
 
 cannot make a man relish the same food if indefinitely 
 repeated, more especially if, however delightful it may be 
 as an occasional article of diet, it is too cloying for persistent 
 use. The old clause in servants' agreements in many parts 
 of Scotland, protecting them against the issue of salmon on 
 more than a limited number of days in the week, is an 
 excellent instance of the effect of too frequent repetition. 
 On active service it is often impossible to avoid this 
 monotony of diet, sometimes for many days at a time. The 
 corollary is that every effort should be made to take advan- 
 tage of any opportunities for variety that may arise. In 
 this connection the important digestive influence exerted 
 by the soluble extractives of meat must be noted. These 
 substances possess nO inherent tissue-building power, but, 
 as Pavlov has shown, if they are removed from meat by 
 prolonged boiling and compression, the residue exercises 
 but a feeble and purely mechanical stimulus on the gastric 
 mucous membrane. The addition of Liebig's Extract to 
 the sodden meat at once restores its activity. The individual 
 extractives of meat, creatin, etc., do not appear to produce 
 this effect by themselves ; the precise nature of the active 
 substance or substances is therefore uncertain. The later 
 researches of Thompson have furnished further proof of this 
 fact, and there is evidence to prove that certain substances 
 exist in the natural juices of the animal body which exert 
 some direct stimulating effect on the gastric digestion. In 
 the same way as pleasurable surroundings assist digestion, 
 so do the reverse conditions inhibit and interfere with the 
 process. The whole scheme of metabolism is so delicate, and 
 its different parts so closely interwoven, that it would be 
 difficult to say of any one outside influence that it might 
 not produce some effect, for good or for evil, on this im- 
 portant mechanism. 
 
 Articles which are not absorbed, but are Bene- 
 ficial ON Account of their Bulk. — Little needs to be said 
 under this heading. The most important member of this 
 class is cellulose. Its presence is mechanically beneflcial by 
 exciting peristalsis, and when it is lacking, as in the absence 
 of fresh vegetables, constipation is apt to result. 
 
 Poisons. — This expression is used purely in a dietetic sense. 
 I do not refer under this heading to the various forms of 
 
86 MILITARY HYGIENE AND SANITATION 
 
 poisoning that result from putrefactive decomposition of 
 meat, etc. The word in its dietetic sense refers only to 
 substances which form parts of, or, indeed, themselves are, 
 common foodstuffs. Of those which are not absorbed some 
 may cause actual injury to the intestinal wall, such as spicules 
 of bone, or the spines or stones of various plants and fruits. 
 These are of little importance. The actual bulk of a food- 
 stuff, which, as I have just stated, has up to a certain point 
 a beneficial effect, may, after a certain point has been 
 reached, exercise a poisonous action by impeding the absorp- 
 tion of other substances. The researches of McCay on this 
 point, in connection with the diets of prisoners in Bengal, 
 are most valuable. He has shown that with an excessive 
 rice diet the absorption of protein is interfered with as a 
 direct result of the bulk of the foodstuff in question, until 
 with very large amounts the total protein absorbed is not 
 only relatively, but actually, decreased by further additions 
 to the dietary. Dealing with the British soldier, who does 
 not, as a rule, consume large quantities of starchy foods, 
 the point is not perhaps of great importance, but officers of 
 native troops, whether Indian or African, should always 
 keep this fact in mind when suggesting additions to a 
 dietary. Besides the dietetic poisons which are not ab- 
 sorbed, we have to consider those which are absorbed. I 
 do not here refer, as I have already said, to those poisons 
 which are the results of decomposition of foodstuffs, nor 
 to the accidental inclusion in a diet of pharmaceutical 
 poisons, as, for instance, in the case of the substitution of 
 aconitum ferox for horse-radish, or of poisonous fungi for 
 the common edible mushroom. The poisons just mentioned 
 are of comparatively rare occurrence, and therefore of com- 
 paratively slight importance. The substances which I 
 include under this heading, and which are of real importance, 
 are those which under ordinary circumstances, and in 
 moderate amount, are true foods, condiments, or stimulants. 
 I have already shown that the mere bulk of a food, which in 
 moderation is advantageous, can, if pushed to excess, 
 exercise a poisonous action by interfering with absorption, 
 in the same way it is perfectly true that every member of 
 the three classes just named may, if consumed to excess, act 
 as a poison. Thus, excess of sugars and starches may lead 
 
FOOD AND DIETETICS 87 
 
 to dyspepsia and eventually glycosuria, excess of protein 
 foods to albuminuria and uric acid poisoning, excess of fats 
 to diarrhoea. Again, each and all of them may under certain 
 conditions, or in certain persons, acts as poisons — ^that is, 
 causes of illness — even when taken in comparative modera- 
 tion. This is, of course, a mere commonplace. " One 
 man's food is another man's poison." The point of these 
 remarks lies in the fact that certain persons, best termed 
 *' food faddists," insist that the same article cannot at one 
 time act as a food and at another as a poison, and argue that 
 because it occasionally, in their experience, acts, or has 
 acted, as the latter, it can under no circumstances act as 
 the former. This seems to me a very dangerous fallacy, and 
 it must always be remembered that the question whether 
 any foodstuff shall act as a true food, stimulant, anti- 
 scorbutic, or condiment, on the one hand, or as a poison on 
 the other, is merely a matter of quantity in all cases, and of 
 idiosyncrasy in many. 
 
 Stimulants. — These are substances which, being absorbed, 
 primarily assist absorption and metabolism, though one at 
 least of them, and that the most important, alcohol, can and 
 does act as a true food, in respect that its combustion in 
 the body produces energy. Other stimulants are tea and 
 coffee, and to a less extent chocolate or cocoa. The first 
 two are not in themselves foods, though occasionally as 
 actually consumed — ^that is, with milk and sugar — ^they may 
 act as food adjuncts. Chocolate and cocoa, owing to the 
 considerable portion of fat which they contain, are also, of 
 course, true foods. 
 
 On the general question of stimulants and their necessity, 
 it is only necessary to observe that they are universally used 
 by civilized races, and their consumption must be taken 
 therefore as the response to a want felt, if not by all men, 
 at least by all races higher in the scale than the lowest 
 savages. If not necessary in the sense that man cannot live 
 without them, they are at least so in the sense that he will 
 not live without them if he can by any possibility procure 
 them. As to the result of consuming stimulants, the general 
 experience is that in moderation they do no harm, whilst at 
 the same time, as a result of the pleasurable mental or 
 psychic effect produced, they undoubtedly promote comfort. 
 
88 MILITARY HYGIENE AND SANITATION 
 
 and, when taken reasonably with meals, assist digestion and 
 metabolism. In excess they may act as poisons, and in this 
 case more than any other idiosyncrasy plays a large part. 
 The degree of concentration in which they are ingested is 
 also of importance, and this is as true of tea and coffee as of 
 alcohoHc fluids, whilst tea, if badly " made," may, owing to 
 the tannin present, act as an immediate cause of dyspepsia. 
 So far what I have written is equally true of all stimulants, 
 and is probably sufficient on this point. The question of 
 the consumption of alcohol stands on a somewhat different 
 footing to that of other stimulants, and this matter therefore 
 demands somewhat more lengthy treatment. 
 
 Alcohol. — The difference between alcohol and other stimu- 
 lants consists in the fact that, quite apart from its effect on 
 the body as a stimulant, it also exercises an important 
 moral and mental influence. Consumed in excess it cannot 
 possibly have any defenders at the present day, though it 
 may be noted that a little over 100 years ago an eminent 
 Scotch judge declined to accept the fact of drunkenness as 
 a plea, in extenuation of punishment for crimes committed 
 under the influence of alcohol, on the grounds that its 
 effect should be such as to exalt the moral tone of those 
 indulging in it. Other days, other customs. It is safe to 
 lay down as an axiom that the consumption of alcohol in 
 excess is bad in every way, physically, mentally, and 
 morally. The discussion only turns on the point as to what 
 constitutes excess, and whether its consumption in modera- 
 tion is pernicious or not. There are many honest men who 
 sincerely believe that indulgence in alcoholic liquors in any 
 form whatsoever, and in any quantities, however small, is 
 hygienically and morally wrong, and that, in the words of 
 Sir Victor Horsley (" Alcohol and the Human Body," p. 353), 
 " what is commonly described as moderate drinking has a 
 most injurious influence on health and life, and that the 
 best practice, both in the interests of health and morality, 
 consists in the avoidance of all alcoholic drinks as bever- 
 ages." I need hardly say that this is a moderately worded 
 statement when compared with those of many supporters of 
 this view. On the other hand, there are as many, if not 
 more, equally honest men, who sincerely believe that they 
 can lead the lives of useful citizens, none the worse but even 
 
FOOD AND DIETETICS 89 
 
 the better, for the fact that they, as a matter of rule and 
 practice, do habitually indulge in moderate drinking. 
 
 The subject is of such enormous importance, from a 
 hygienic point of view, especially in connection with the 
 population dealt with in military sanitation, that any teacher 
 of that subject is bound to face it, and to point out clearly 
 the position he adopts in regard to it. In the first place, 
 and to clear the ground, it is necessary to define what 
 moderate consumption of alcohol really means. To begin 
 with, no one ever does, as a matter of fact, drink " alcohol." 
 The strongest spirits usually consumed consist of about 
 half and half of alcohol and water. Again, no man who 
 habitually or even frequently consumed raw spirits could be 
 described as a moderate drinker. Therefore, in the second 
 place, the average man takes his alcohol diluted with from 
 about 15 to 95 parts of water, in proportion as he drinks the 
 ordinary whisky-and-soda, or some of the lighter wines or 
 beers. In addition to the water, he adds sugars, colouring 
 matters, bitters, and other flavouring matters to the already 
 diluted alcohol. Again, a man who drinks even this diluted 
 and flavoured alcohol to any great extent on an empty 
 stomach could not well be called a moderate drinker. 
 Therefore, in the third place, this alcohol already highly 
 diluted and flavoured, is mixed in the stomach in the 
 enormous majority of cases with solid food of some nature 
 or other. Lastly, the term " moderate drinker " would not 
 in general be applied to a man who drank spirits, beer, or 
 wine at his morning meal, or, indeed, who indulged in a 
 glass of the same "in the middle of the morning." There- 
 fore, in the fourth place, this diluted, flavoured alcohol is 
 not consumed before a good half of the day's work is pre- 
 sumably done. I think that the majority of my readers 
 would recognize as a moderate drinker a man who drank a 
 moderate amount of wine, or spirits and water, or beer at 
 his meals, with perhaps a whisky-and-soda after his daily 
 game of polo, or what not, and another as a " night-cap " 
 before going to bed, and who was not in the habit of drinking 
 anything at all of this nature before the midday meal. 
 
 Accepting the above definition, is there any evidence that 
 men who follow such a course of life are worse men 
 physically and morally than the men who abstain alto- 
 
90 MILITARY HYGIENE AND SANITATION 
 
 gether ? I think not. The description just given would 
 apply to the great majority of educated, active-bodied men 
 in the British Isles, and, in fact, throughout Europe. Sir 
 Victor Horsley produces statistics to show the great differ- 
 ence in mortality between total abstainers and moderate 
 drinkers, and, indeed, these are the strongest arguments he 
 adduces. But I cannot see that there is any assurance that 
 the numbers returned as moderate drinkers do not in fact 
 include a great many people who had no claim to that title. 
 It i s but rarely that a man will openly acknowledge to being 
 a drunkard, and I therefore pay the less attention to the 
 statistics of this kind. I will venture an attempt to arrive 
 at the truth in another manner. The proportion of tee- 
 totallers amongst the officers of the army is comparatively 
 small ; the immense majority are moderate drinkers — in 
 other words, they habitually consume about the amount of 
 alcohol which I have laid down above a« being the average 
 standard of that class, and would look on any marked 
 excess above that amount as depriving the individual con- 
 cerned of the right to be called a " moderate drinker." 
 Probably 75 per cent, consume less than half that amount. 
 Nevertheless, in spite of the fact that, though the majority 
 of these men indulge in a habit which, according to Sir 
 Victor Horsley, should have " a most injurious influence on 
 health and life," the class to which they belong will compare 
 favourably as regards health, activity, and longevity, with 
 any other in the country, and that in spite of the fact that 
 many of them are handicapped by exposure to trying 
 climates. 
 
 Again, it is often stated that the health of the race is 
 affected by even moderate drinking. Quite apart from the 
 fact that this statement is unsupported by any statistical 
 evidence, it must be remembered that the present living 
 members of the Teutonic and Scandinavian races, which for 
 so many centuries have played a leading, if not the leading, 
 part in the history of the world, are descended from a stock 
 peculiarly addicted to the free consumption of alcohol, and 
 that, speaking for our own race, the British, 100 years 
 ago drunkenness was rife from the Cabinet Minister to the 
 coal-heaver. Whether the race be degenerate at the present 
 day or not is a matter of opinion, which in the absence of 
 
FOOD AND DIETETICS 91 
 
 accurate anthropological measurements, is incapable of 
 proof. It would be rash to apply that term to Nelson's 
 sailors, or the men who followed Wellington, and it seems 
 improbable that what had not been effected by the drunken- 
 ness of the previous 1,500 years should have been caused 
 by the moderate drinking of the comparatively temperate 
 century that has elapsed since then. I wish it to be dis- 
 tinctly understood that I am speaking from the point of 
 view of the student of hygiene, not from that of the teacher 
 of morality. The case for temperance is so overpoweringly 
 strong that it is a pity that its advocates should weaken it by 
 making statements which are contrary to the ordinary 
 experience of mankind. Such statements merely discredit 
 the cause which we all have at heart, those who may be 
 called " moderate drinkers " just as strongly as those who 
 are actually total abstainers. 
 
 Strictly speaking, alcohol must be looked on as a food, 
 since its combustion in the body produces a certain amount 
 of heat, and thus saves for the use of the body an isodynamic 
 quantity of fat or carbohydrate. In actual practice, how- 
 ever, it cannot be used as a food, since in quantities sufficient 
 to produce any substantial supply of energy the effect on 
 the central nervous system would be so great as completely 
 to neutralize any good effects so produced. It occupies, in 
 fact, much the same position qua food in the human body 
 as it does qua fuel outside. A spirit-lamp is an extremely 
 convenient lamp if it is required to boil a kettle in a hurry, 
 but an extremely bad one if it is required to light or heat a 
 room. Alcohol is a bad food if it is required to supply 
 energy for a forced march, but an extremely good one when 
 it is necessary to spur a man to make himself comfortable 
 for the night, instead of collapsing into an unrefreshing sleep, 
 unsheltered or unfed. 
 
 The proper function of alcohol, then, is to assist absorption 
 and metabolism, and in practice in the Service its issue is 
 limited to occasions when, owing to fatigue or exposure, 
 these functions are apt to be interfered with or inhibited, 
 as, for instance, when, owing to the discomfort engendered by 
 inclement weather, the men are not likely to make the best 
 of their evening meal. It should never be issued on 
 occasions when men are expected to make a march, or to 
 
92 MILITAKY HYGIENE AND SANITATION 
 
 men likely to be exposed either to severe cold or the other 
 extreme of intense heat. It should be given at the con- 
 clusion, never before or in the middle of work. Owing partly 
 to its local irritant action on the gastric mucosa, and partly 
 also to its actual combustion, alcohol produces a sensation 
 of warmth, which , in as far as it is due to the former reaction, 
 is, of course, fictitious. The heat actually produced is 
 dissipated by a dilatation of the superficial capillaries, but 
 the rapidity with which this takes place is largely dependent 
 on the amount of clothing worn. The man who comes into 
 camp cold, and drinks his "tot" of rum between the 
 blankets, close to a fire, undoubtedly retains sufficient heat 
 in his body as the result of the combustion of the alcohol 
 to be of serious value. The same man drinking his rum 
 before standing as sentry in an exposed position, on a cold 
 night, will probably suffer a loss of heat greater than the 
 amount actually to be credited to the combustion of the spirit. 
 Antiscorbutics. — The cause of scurvy is as yet unknown, 
 and therefore it is difficult to enumerate exactly the sub- 
 stances which act as antiscorbutics. Lime-juice and fresh 
 vegetables are the foodstuffs which are usually recognized 
 as fulfilling this role, but there have been cases, though 
 few, in which the disease has occurred, in spite of the 
 presence of these articles in the dietary. Still, the experi- 
 ence of the Royal Navy and mercantile marine is fairly 
 conclusive, that in the enormous majority of cases the 
 absence of these is the cause and their addition to the 
 dietary the best remedy for scurvy. It is possible that 
 under the name of " scurvy," which is, in reality, more of 
 the nature of a symptom-complex than a true disease 
 entity, we are in reality including more than one patho- 
 logical condition. Certain it is that we cannot find any one 
 cause that will absolutely cover all the various outbreaks 
 which have passed under this appellation. There is, quite 
 apart from the purely dietetic causation, a strong psychic 
 element occasionally present, as in the case of prisoners of 
 war, who are particularly subject to this complaint. A 
 monotonous diet undoubtedly appears to conduce to the 
 production of scorbutic symptoms, and, indeed, if there 
 can be said to be any one factor common to all outbreaks, 
 then monotony of diet is probably the condition in question. 
 
FOOD AND DIETETICS 93 
 
 Knowing, as we do, the effect of psychic influences on the 
 digestion, it is quite conceivable that one effect of a per- 
 sistently monotonous diet may be to interfere with one or 
 more of the delicate links in the long chain of metabolism. 
 The effects of such a breach of continuity may be the same, 
 even though the breach may not always effect the same 
 links on all occasions. In any case, a complete change of 
 diet, and, if possible, of scene, is necessary if we wish to 
 prevent or put a stop to an outbreak of scurvy. A microbial 
 origin has been suggested, but, though in the later stages, 
 when ulceration has taken place, of the gums particularly, 
 a secondary condition, due to infection by micro-organisms, 
 may complicate the original disease, the balance of evidence 
 still seems in favour of a purely dietetic origin. 
 
 The True Foods. — ^We now come to a discussion of those 
 substances which either go to build up the tissues or supply 
 energy to the body, or perform both these functions. These 
 alone are entitled to the appellation of " true foods." Con- 
 versely, all things whatsoever that can fulfil the above 
 purposes in the human body are foods. They may be bad 
 or unsuitable foods at all times, or only under certain 
 conditions, as when taken to excess, or in a disordered 
 condition of the digestive system, or, again, only to certain 
 individuals. In the same way any matter that wiU burn 
 in a fire is fuel, though it may, under certain circumstances 
 be a bad, or unsuitable, or even a dangerous, fuel. The 
 choice of a food out of all the long list available is a matter 
 to be decided by the individual under the peculiar circum- 
 stances in which he finds himself. 
 
 The true foods are classified as follows : 
 
 1. Inorganic. 
 
 Water. 
 Salts. 
 
 2. Organic. 
 
 (a) Nitrogenous : Protein. 
 
 (b) Non-nitrogenous : Fats. 
 
 Carbohydrates. 
 
 Water. — ^Water is not, as a rule, looked on as a food, but 
 it is, in reality, the most important of aU foods, and may, 
 
94 MILITARY HYGIENE AND SANITATION 
 
 in fact, be looked on as the only indispensable daily food. 
 Its function is to build up the tissues, and since two -thirds, 
 roughly, of the human body consists of water, its importance 
 as a tissue-builder is at once obvious. In addition, its 
 presence is essential to the performance of the ordinary 
 chemical reactions of hydrolysis and oxidation, which con- 
 stitute such a large part of the process which we term 
 " metabolism," and also to the efficient carrying out of the 
 automatic heat-regulating mechanism of the body. The 
 water necessary for the above purposes is furnished in the 
 form of a fluid, or as a constituent part of the ordinary solid 
 foodstuffs, or, again, to a slight extent by the oxidation 
 of hydrogen in the body. The amount necessary depends 
 largely on the work done by the individual, the surroundings 
 under which he lives, and the nature of his food. The 
 smaller the amount of water contained in the solid food- 
 stuffs supplied, the greater is the amount that must be 
 furnished in one or other of the ways just mentioned, and 
 principally, of course, in the form of drinking-water. This 
 fact should always be kept in mind when soldiers are being 
 fed on concentrated foods. It is possible, of course, to 
 increase very greatly the portability of meat by driving off 
 say, 90 per cent, of the water which it contains, and if this 
 is done with care, neither the digestibility, palatability, nor 
 energy value of the food need be interfered with. Under 
 certain conditions such a degree of concentration might 
 solve some difficult problem of supply. But it must be 
 remembered that the water which has been removed to 
 make the food portable must be supplied in some other form 
 if the soldier is to be properly nourished. We carry con- 
 centrated food presumably because it is not available in its 
 natural form in the country through which we are passing. 
 As long as water is available in that country, we are justified 
 in saving transport by carrying only the solid constituents 
 of the meat, but only on condition that water is available. 
 In the last resort, and if a choice had to be made, it would 
 be necessary to leave the solid food and carry the water, 
 not with a view to reducing the discomfort produced by 
 thirst,, but to escape the certain death which would result, 
 and very rapidly, from water-starvation, of which the 
 sensation we term " thirst " is merely a sign. The expendi- 
 
FOOD AND DIETETICS 95 
 
 ture of water during work is directly proportional to the 
 work done and the necessity that arises for regulation of 
 the body temperature by evaporation. It will, therefore, 
 obviously be increased by marching in a hot climate, the 
 very conditions under which scarcity of drinking-water may 
 be anticipated. It must be remembered that a healthy 
 man carries a considerable reserve of fuel in his body to 
 supply energy in the absence of fresh supplies of food, and 
 can subsist, in spite of starvation in this direction, for a 
 period to be measured by weeks. He carries, on the other 
 hand, a very small reserve of water, and his term of endur- 
 ance, supposing this supply to be cut off, is one which may 
 be stated in days, or, if the work be severe, in hours only. 
 This subject has already been referred to when discussing 
 the supply of water on the march. 
 
 Salts. — The body contains about 5 per cent, of its weight 
 of mineral matter. The most important of these salts are 
 the chlorides of sodium and calcium, the carbonates of 
 sodium and calcium, and the phosphates of potassium, 
 calcium, and magnesium. Iron is also present in the haemo- 
 globin, and though the total amount is small, its presence 
 is essential for existence. The only salt that is taken as a 
 foodstuff is chloride of sodium. All the others are provided 
 in the form of by-products, as it were, in a well-regulated 
 mixed diet. If an animal be fed on a food from which all 
 mineral salts have been excluded, it begins to show nervous 
 deterioration in about three weeks, and succumbs in from 
 four to five weeks. The total amount of any one salt re- 
 quired in any one day is, of course, extremely small, when 
 compared with the more bulky organic foodstuffs. This 
 fact is of considerable importance. The amount being so 
 small, its absence is easily overlooked, and many obscure 
 cases of malnutrition, or that condition which is generically 
 termed " scurvy," are probably due to the prolonged 
 omission from the diet of some one salt, though not in all 
 cases of the same salt. Such a condition of affairs is 
 naturally not unlikely to occur when men are placed on a 
 monotonous and restricted diet. The addition of chloride 
 of sodium to the diet is not an absolute necessity, since it 
 may be supplied as a constituent of some of the flesh foods. 
 Carnivorous animals, as is well known, do not seek for 
 
96 MILITARY HYGIENE AND SANITATION 
 
 " salt-licks " in the same manner as those belonging to the 
 herbivorous genera. Still, in the case of civilized men 
 consuming a normal mixed diet such an addition is de- 
 manded, and those who live largely on vegetable foods need 
 an even larger allowance. An excess of salt has been 
 shown by McCay to have a positively deleterious effect, 
 and the researches of Marey and others show that a " water- 
 logged " condition of the tissues may be produced, which 
 is apt to aggravate any inflammatory process and lower the 
 powers of resistance of the tissues in the case of injury. The 
 well-known fact that slight accidents are apt to lead, in the 
 case of scorbutic men fed on a salt-meat diet, to serious tissue- 
 destruction is probably not unconnected with this tendency. 
 In such cases the general scorbutic condition may be due to 
 a defect of some particular salt in the dietary — e.g., phos- 
 phates — ^whilst the local manifestations are due to the excess 
 of some other salts — ^the chloride of sodium and nitrate 
 of potassium. 
 
 Organic Foods. — ^We now come to the consideration of the 
 true foods which are derived from the animal and vegetable 
 kingdoms. Water and salts are, it is true, to a certain 
 extent (in the case of the salts to a considerable extent), 
 derived from these kingdoms ; but since they are partly 
 and — as regards water, at least — ^most conspicuously in- 
 gested as such, I have separated them from the organic 
 foods. 
 
 The organic foods are divided into nitrogenous and non- 
 nitrogenous. 
 
 The nitrogenous foods are derived from both the animal 
 and vegetable kingdoms, though, as a rule, to a greater 
 extent from the former than the latter. These foods are 
 absolutely essential to life, since they alone supply the 
 indispensable nitrogen. Life can, in fact, be supported on 
 protein (with the addition of water and salts alone), as is 
 the case with carnivorous animals, and with a few savage 
 tribes. As a rule, and invariably in civilized man, however, 
 this is not the case, fats and carbohydrates being also used. 
 
 The chemical constitution of proteins is extremely 
 complex, and their molecular arrangement even more com- 
 plex than their chemical composition. 
 
 Their fate in the body may shortly be sketched as follows : 
 
FOOD AND DIETETICS 97 
 
 After ingestion, they pass unaltered to the stomach, and 
 are there at once acted on by the gastric juice and pepsin 
 secreted by the gastric mucosa in response to the reflex 
 stimulation conveyed from the mouth, but largely, if not 
 principally, as a result of the psychic stimuli already 
 referred to. The digestive action does not begin at once, 
 but only when the alkaline reaction of the food, due to the 
 ptyalin of the saliva, has been overcome. The result of 
 this gastric digestion is the production of acid albumins, 
 proteoses, and, finally, peptones. For this transformation 
 to occur it is absolutely necessary that both pepsin and 
 free hydrochloric acid should be present. Under ordinary 
 circumstances the transformation of proteins does not go 
 beyond the stage of proteoses and peptones in the stomach, 
 though, if the passage of the food be artificially delayed, a 
 further breaking up of these still complex bodies can occur. 
 Normally, however, the proteins, now in the form of pro- 
 teoses and peptones, and some, indeed, still unaltered, 
 pass into the duodenum. Here they come under the 
 influence of the ferments contained in the pancreatic juice, 
 bile, and succus entericus. The reaction of the contents 
 of the duodenum is alkaline, which at once puts a stop to 
 any further action of the pepsin, but allows the even stronger 
 ferment trypsin full play. Trypsin, which is the result 
 of an interaction between the trypsinogen of the pancreatic 
 juice and the entero-kinase of the succus entericus, attacks 
 not only the proteoses and peptones coming from the 
 stomach, but also the still unaltered proteins that have 
 escaped the action of the gastric juice, and reduces all 
 these to the stage of amino-acids — bodies that are still of 
 a complex nature, but far less so than the original proteins 
 from which they descend. There is evidence to show that 
 this action of trypsin is more complete when it meets with 
 already altered proteins than with those which have passed 
 through the stomach unattacked. Amongst these amino- 
 acids may be mentioned glycin (or amino-acetic acid), 
 leucin, tryosin, and tryptophane. In addition to trypsin, 
 however, there is present in the succus entericus a ferment 
 named " erepsin," which also acts strongly on the peptones, 
 but is unable to attack native proteins, with the exception 
 of casein, which is feebly digested, T^hile it acts slowly or 
 
 7 
 
98 MILITARY HYGIENE AND SANITATION 
 
 not at all on the first-formed or primary albumoses (Pavlov). 
 This ferment is present not only in the succus entericus, 
 but is widely spread in different tissues, and, amongst 
 others, in the gastric mucous membrane. It is probable 
 that in this last position it acts on any proteoses and pep- 
 tones that are absorbed from that organ, since these sub- 
 stances are never present in the blood. The ultimate 
 absorption of proteins takes place in the form of amino- 
 acids, or even of simpler compounds. 
 
 The protein tissues of the body must obviously be built 
 up from the protein tissues of the food, but the process is 
 not one merely of resynthesis, but of selection plus re- 
 arrangement, followed by the formation of new synthetic 
 compounds. The generally accepted view is that the body 
 appropriates to its own uses such of the different end pro- 
 ducts of protein digestion as are suitable to its needs, re- 
 jecting those of which it is unable to make use. These last 
 are split up into a carbohydrate and a urea moiety, the 
 former of which is stored up in the form of glycogen, the 
 latter excreted as urea by the kidneys. The actual process 
 is not, perhaps, or even probably, so simple as this. It 
 is quite possible that both the glycogen and the urea are 
 built up from debris of protein molecules in an extreme 
 state of disintegration. It is unnecessary here to go into 
 these abstruse points of metabolism. What it is most im- 
 portant for the student of dietetics to remember is that, 
 regarded as a tissue -building food, protein is of value, 
 not merely qua protein, but qua useful protein. The 
 whole question of the amount of protein food that should 
 be consumed hinges on this point, which will be referred 
 to later, when discussing that question. 
 
 The non-nitrogenous foods include the fats and carbo- 
 hydrates. 
 
 The fats are, chemically considered, glycerine esters of the 
 fatty acids, and contain carbon, hydrogen, and oxygen. 
 Considered in the light of fuel, it is important to remember 
 that the oxygen present in the molecule is not sufficient 
 to satisfy the hydrogen which the latter contains. The 
 energy value does not depend, therefore, as in the case of 
 the carbohydrates, purely on the carbon of the molecule. 
 The fats are practically unaffected until they reach the 
 
FOOD AND DIETETICS 99 
 
 small intestine. Here they are emulsified by the action of 
 the bile, and then broken up by the action of the steapsin 
 of the pancreatic juice into fatty acids and glycerine. 
 These are again resynthesized in the intestinal wall, and 
 absorbed by the lymph ducts in the form of the fat originally 
 ingested. This fat is then stored in the body as depot fat, 
 and is available as a store of energy or warmth in emergency 
 — e.g., in starvation. 
 
 There is a certain amount of fat in the body which forms 
 part of the active tissues, and this is peculiar to the body. 
 It is probably made up indifferently from proteins, fats, or 
 carbohydrates. This fat does not entirely disappear, even 
 in extreme starvation. In respect of this " tissue fat," the 
 fat of the diet may be looked on as a tissue builder. 
 The main use of fat, however, is to form a reserve of 
 energy. 
 
 The carbohydrates are, considered chemically, aldehyde, 
 or ketone derivatives of the polyatomic alcohols, and contain 
 carbon, hydrogen, and oxygen, the last two being in the 
 proportions necessary for the formation of water. The 
 fuel value of the carbohydrates depends, therefore, solely 
 on the carbon present, and is thus inferior to that of the 
 fats. The carbohydrates may be divided into the mono-, 
 di-, and poly-saccharides. The two former classes include 
 the ordinary sugars (grape-sugar, cane-sugar, milk-sugar, 
 etc.), the third class the gums and starches. The starches 
 are attacked by the saliva and converted into maltose and, 
 to a slight extent, into dextrose ; but this action does not, 
 as a rule, progress very far, since it is checked as soon as the 
 food reaches the stomach, or as soon, rather, as the reaction 
 is altered from alkaline to acid by the action of the gastric 
 juice. It is important to note that the starches are the 
 only foods which are digested in the act of chewing. Pro- 
 teins and fats are merely mechanically disintegrated in 
 the process. Too prolonged a mastication of protein food 
 would probably exercise an adverse influence on the sub- 
 sequent digestion of these matters in the stomach, owing to 
 the excessive flow of alkaline saliva thus produced. Pro- 
 longed chewing may, owing to the laborious nature of the 
 process, be useful in the case of people who are prone to 
 overeating ; otherwise, except in the case of the carbo- 
 
100 MILITAKY HYGIENE AND SANITATION 
 
 hydrates, there does not seem to be much physiological 
 justification for the practice. The chief digestion of the 
 sugars and starches takes place in the small intestine, as 
 a result of the action of amylolytic ferments contained in 
 the pancreatic juice and the succus entericus. The former 
 converts the polysaccharide, starch, into the disaccharide, 
 maltose, but, as in the case of the saHva, does not carry 
 the action further to any great extent. The succus entericus, 
 on the other hand, attacks starches feebly, but converts 
 maltose into dextrose. Eventually all the carbohydrates 
 ingested are reduced to the dextrose or monosaccharide 
 condition, and absorbed in that form. This is conveyed 
 by the portal blood-stream to the liver, and there again 
 reconverted into glycogen, one of the polysaccharides. 
 This substance, which is the great store of energy in the 
 body, is distributed to the working parts in the form of 
 dextrose by the general circulation. Glycogen can be 
 formed from protein, as already described, and also (almost 
 certainly) from fat. On the other hand, carbohydrates 
 can be converted into fat if necessary. 
 
 Surveying the whole question of digestion and absorption, 
 it is important to note one or two points. The chief 
 digestive organ is the upper part of the small intestine. 
 Here all of the three organic foods are digested. The 
 stomach acts mainly as a reservoir where the diet com- 
 ponents are mixed and, as it were, standardized, certain 
 small portions being ejected into the small intestine as 
 required. A certain amount of absorption of dextrose or 
 amino-acids may, it is true, take place here, but this is not 
 large in amount. At the other end of the chain the large 
 intestine again acts as a regulator, permitting of the accumu- 
 lation and periodic discharge of food waste. The second point 
 is that all absorption is the result of a process of splitting up 
 of foodstuffs into simpler molecular arrangements. Under 
 ordinary circumstances this process follows certain fairly 
 defined lines, which I have endeavoured to sketch above. 
 There is no reason to suppose that ordinarily the body breaks 
 down the different food molecules to any greater extent 
 than is absolutely necessary — ^in fact, such a theory would 
 run counter to the economical principles on which the 
 organism works. To what exact degree it is necessary that 
 
FOOD AND DIETETICS , i ' ;,;' Jv' -Vl^l' 
 
 food protein should be broken down before it can be re- 
 synthetized into body protein depends to a certain extent 
 probably, on the one hand, on the nature of the former, 
 and the actual emergent demands of the body for some par- 
 ticular form of protein on the other. It is reasonable to 
 suppose that, under certain conditions, the chain of me- 
 tabolism may be much shorter and the process of disintegra- 
 tion much less severe than in others. It is, in my opinion, 
 not possible for us to lay down any definite limits to the 
 powers possessed in case of emergency by the body of 
 breaking down complex molecules and building up entirely 
 new rearrangements of their ultimate chemical constituents. 
 If necessary, it will go far to attain its object, but, however 
 roundabout the path may seem, it will in all cases be the 
 shortest feasible under the actual conditions. 
 
 Quantity of Food Needed. — The total quantity of 
 food needed must obviously depend on the demands of the 
 body for fuel and building material. This quantity is 
 usually estimated in terms of energy units — that is, of 
 fuel. The unit in general use in the discussion of dietetics 
 is the large " Calorie." This is equivalent to the amount of 
 heat necessary to raise 1 kilogramme of water at 20° C. 
 through 1° C. The number of units expended in the 
 twenty-four hours depends, of course, on the activity or 
 otherwise of the individual. Zuntz gives 3,000 Calories as 
 the estimated expenditure of a soldier's day in barracks, 
 and this corresponds fairly closely with the general allowance 
 for a life of moderate exercise. 
 
 This amount of energy must obviously be supplied from 
 the proteins, fats, and carbohydrates of the diet, and 
 these various principles furnish this energy in the following 
 net amounts — viz. : 
 
 1 gramme protein furnishes 4-1 Calories. 
 
 1 gramme carbohydrate furnishes 4-1 Calories. 
 
 1 gramme fat furnishes 9-3 Calories. 
 
 Obviously, there is one fallacy in the above method of 
 estimation, since it makes no allowance for tissue building, 
 and, in consequence, it is first necessary to ascertain the 
 amount of protein needed under this heading. If a man be 
 subjected to absolute starvation, it is found that he excretes 
 
102 MILITARY HYGIENE AND SANITATION 
 
 an amount of nitrogen which represents the metabolism of 
 rather more than 1 gramme of protein per kilogramme of 
 body weight. Thus, in a seven days' starvation experiment, 
 conducted by Benedict, the subject, weighing 62 kilo- 
 grammes, metabolized on the different days 73-4, 74-7, 
 78-1, 69-8, 65-2, 64-4, and 60-8 grammes of protein re- 
 spectively. If, however, to a man thus starving an exactly 
 similar amount of protein food be given (all non-nitrogenous 
 food being withheld), it is found that, instead of the intake 
 and output being balanced, the former is unable to keep 
 pace with the latter, and a certain amount of nitrogenous 
 starvation persists. If the quantity of protein food be 
 now slowly increased, it will be found that the output still 
 rises, but less slowly, until a point is reached, which may be 
 placed roughly at 2 grammes per kilogramme of body 
 weight, at which the excretion and ingestion of nitrogen 
 exactly balance each other. This point may be called 
 "the lower limit of nitrogenous equilibrium." Any in- 
 crease in the protein of the food above that amount will 
 result in an increased excretion of urea, and the condition 
 of equilibrium will be maintained until a very high level of 
 intake indeed is reached, which may be called " the upper 
 level of nitrogenous equilibrium." Above this point the 
 excretory organs will be unable to cope with the intake, 
 and accumulation of nitrogenous material in the body will 
 result. Briefly, it may be said, then, that within extremely 
 wide limits the body is capable of maintaining its nitrogenous 
 tissues — in other words, its general framework — at a constant 
 weight, irrespective of the amount of nitrogenous food 
 supplied. 
 
 In an experiment of the above nature the protein food has 
 to furnish not only sufficient material to repair the ordinary 
 daily wear and tear of human existence, but also enough to 
 supply fuel for the production of the energy demanded by 
 the work, internal and external, performed by the indi- 
 vidual. Clearly, then, if this latter can be supplied from 
 any other source, it should be possible to force down " the 
 lower level of nitrogenous equilibrium " to an extent corre- 
 sponding closely to the amount of protein food which had 
 on the restricted diet been hypothecated for the supply of 
 energy. In practice, as we know, no civilized men, and but 
 
POOD AND DIETETICS 103 
 
 few savages, live on a purely nitrogenous diet, and the 
 process of metabolism on the usual mixed diet may be 
 briefly stated as follows : All the protein which is ingested 
 must be disposed of if nitrogenous equilibrium is to be 
 maintained. So much of what is suitable as is needed to 
 replace inevitable waste is built into the tissues, and that 
 which is not needed, or is unsuitable, is broken up, as 
 already described, the urea moiety being excreted, and the 
 carbohydrate moiety stored for use. Any balance of energy 
 that is required is furnished by the fats and carbohydrates 
 of the diet. Prima facie, the above process is wasteful, both 
 in the physiological and the monetary sense of the word. 
 It is wasteful physiologically because the whole of the 
 protein molecule is not utilized. The excreted urea con- 
 tains a certain amount of unoxidized carbon and hydrogen, 
 and the loss on this account of the potential energy present 
 in the protein molecule may be placed at nearly 30 per cent. 
 On the other hand, the whole of the energy present in every 
 molecule of fat or carbohydrate absorbed is transformed to 
 heat or work in the body. From the physiological point of 
 view, therefore, it is much more economical to furnish the 
 necessary energy from fat or carbohydrate than from 
 protein. It is wasteful in the monetary sense, since the 
 protein-furnishing foods are, on the whole, more expensive 
 than those which contain only the non-nitrogenous prin- 
 ciples. A strong case, therefore, exists for those who hold 
 that the amount of protein ingested should be just sufficient 
 to replace the daily wear and tear of nitrogenous tissue, 
 the purely energy demands being met by fats and carbo- 
 hydrates only. The most reliable and extensive laboratory 
 experiments on this point are those of Professor Chittenden 
 of Yale. He has shown that health and strength can be 
 maintained by various individuals (soldiers, students, and 
 athletes) on a diet containing on an average only 
 0-150 gramme of nitrogen (corresponding to 0-94 gramme 
 of protein) per kilogramme of body weight. The facts as 
 recorded by Chittenden are indisputable, and he seems to 
 hold a fairly strong position in urging, as he does, that a 
 rational diet for a civilized man should be based on an 
 allowance of protein food no higher than that stated above. 
 He is, I think, on less sure ground, since he adduces no 
 
104 MILITARY HYGIENE AND SANITATION 
 
 direct experimental proof of his assertion, when he states 
 that " any excess of protein food over and above what the 
 tissue cells really need for their daily repair " entails " un- 
 necessary labour on the part of the organism, and at the 
 same time " exposes " the tissues and organs to the possible 
 deleterious action of this uncalled-for excess of nitrogenous 
 waste products prior to their elimination from the body." 
 Such a statement presupposes a lack of elasticity in the 
 physiological mechanism which is not supported by experi- 
 ence. Still, quite apart from this possibly pathological 
 aspect of the question, the purely physiological arguments 
 adduced by Professor Chittenden in support of his views 
 are undoubtedly very strong. 
 
 On the other hand, if we apply the test of history, we 
 find that the leading nations of Europe, and amongst them 
 more particularly the governing classes, have, for as long a 
 period as we have any record, habitually consumed at least 
 twice as much protein food as Professor Chittenden recom- 
 mends, whenever they have been able to procure it ; and, 
 moreover, that a very fair test of the prosperity of any 
 particular class might be made by observing the amount of 
 protein food, more especially animal food, consumed by its 
 members. There is no proof, as far as I can see, that these 
 races have in any way suffered in consequence of this 
 indulgence. They have led the other nations of the world 
 for many centuries, and amongst them that nation which 
 has always been notorious for its high consumption of protein 
 has been by no means backward in the race. The struggle 
 for existence between the various European peoples has been 
 so keen during the last 500 years that any race which wil- 
 fully handicapped itself by persistent disobedience to some 
 physiological law must have fallen back in the competition. 
 If Professor Chittenden's theories are sound, then the 
 English nation has undoubtedly so handicapped itself 
 in . comparison with the other nations of Europe . It 
 will, I think, hardly be seriously urged that Great 
 Britain is seriously behind the continental nations, or 
 that the people of Europe and North America are far 
 behind the other peoples of the world, be the test what it 
 may. 
 
 So far the historical argument only goes to prove that a 
 
FOOD AND DIETETICS 105 
 
 successlul national life is not inconsistent with a high 
 protein consumption. It does not prove that an equal 
 amount of success might not have been achieved on a 
 smaller allowance of this food principle. On this point also, 
 however, history can throw some light. In the Bengali 
 race we find a people who, for as many years as we have 
 record, have lived on a diet which the researches of McCay 
 show to be, as regards the quantity of protein present, 
 closely in accord with the principles of Professor Chittenden. 
 As regards his physical development. Captain McCay shows 
 clearly that the Bengali is in this respect of an inferior 
 type, being 25 per cent, lighter than the average European, 
 with a smaller chest measurement, though much the same 
 stature. The blood of the Bengali, containing about 25 per 
 cent, less haemoglobin than that of the European, flows at 
 25 per cent, less pressure. As compared with Anglo-Indian 
 and Eurasian students, the Bengali youth shows no progress 
 in development during the years sixteen to twenty, though 
 the several classes live under much the same surroundings, 
 differing chiefly in the fact that the members of the two first- 
 mentioned classes consume about 0-19 gramme of nitrogen 
 per kilo of body weight as compared with the 0-11 gramme of 
 the Bengali. As regards physical endurance and activity, 
 the Bengali labourer is enormously inferior to the European. 
 Insurance offices in Calcutta rate all Bengali lives as being 
 five years worse than European lives ; one large office will 
 accept the policies of well-educated Bengalis of the higher 
 castes only, and even then not beyond the age of thirty-five 
 to thirty-eight years. A very strict medical examination is 
 made, a slight excess measurement round the waist being 
 sufficient to insure rejection. At the same time, renal 
 disease is twice as prevalent amongst native patients in the 
 Medical College, Calcutta, as amongst European patients, 
 though scarlet fever is unknown in India. As regards the 
 position held by the Bengali race amongst the other inhabi- 
 tants of the peninsula, history shows us that they have been 
 consistently for centuries the hewers of wood and drawers 
 of water for their more powerful northern neighbours. They 
 are conspicuous amongst all the peoples of India for the 
 fact that no member of the race has ever served in the ranks 
 of our native regiments. 
 
106 MILITARY HYGIENE AND SANITATION 
 
 The fighting races of India have been those whose food 
 has consisted of the grains richer in protein — e.g., wheat — 
 and whose diet has in most cases included a certain amount 
 of meat. 
 
 Lastly, we have the evidence of men who have changed 
 from the low protein diet of their homes to the higher rate 
 of consumption prevalent in some land to which they have 
 emigrated. On this point the evidence of Dr. Hutchinson, 
 of New York, is very interesting. He states that Japanese 
 labourers coming to the United States increase their working 
 powers, and their corresponding wages, by 50 per cent, when 
 they turn to a full meat diet, and that nearly the same 
 improvement has been noticed in the case of West Indian 
 negroes, employed on the Panama Canal, when placed on 
 Northern Army rations. 
 
 The explanation of the apparent contradiction between 
 the results of experience and experiment lies in the fact 
 that what is needed is not any actual amount of protein as 
 such, but a definite amount of suitable protein. The 
 question is, in fact, one not of quantity, but of quality. A 
 man must eat enough suitable protein to replace his daily 
 wear and tear. To enable him to procure this suitable 
 protein, it may be necessary for him to consume a consider- 
 able bulk of unsuitable protein, the extent to which he is 
 driven in this direction depending entirely on the nature of 
 the foodstuff most conveniently available, and the extent 
 to which the proteins it contains correspond to the actual 
 needs of the body at the time. In Professor Chittenden's 
 experiments the subjects were carefully selected. Especially 
 amongst the soldiers, " many were found unsuited for 
 various reasons, and were quickly exchanged for others 
 better adapted for the successful carrying out of the experi- 
 ment. Several quickly deserted, not relishing the restric- 
 tions under which they were compelled to live." One man 
 was rejected as physically unsuited (no explanation given), 
 another as physically unsuited on account of a high grade of 
 myopia, another as mentally and morally unsuited. Their 
 lives were carefully ordered hour by hour, and " every pre- 
 caution to preserve the health and good spirits of the men 
 was taken." The food had to be carefully selected, since 
 " it was necessary in prescribing the daily diet to see that 
 
FOOD AND DIETETICS 107 
 
 the quantity of the food was such as to completely satisfy 
 the appetite. This necessitated the use of a considerable 
 bulky food of low fuel and low nitrogen value." In such a 
 process of selection there must inevitably have been some 
 notice taken of quahty. Unsuitable or obviously indigestible 
 food would certainly have been rejected. Naturally also 
 the men did not suffer from any particular anxiety as to 
 where the next meal was to come from, or how much they 
 could afford to spend on it. I must decline to accept 
 evidence so procured as a safe guide in laying down a 
 standard dietary even for the well-paid artisan or busy 
 professional man, whose lives are less carefully ordered for 
 them, and whose food is less carefully selected ; much less, 
 then, for men like the agricultural labourer or the country 
 doctor, who have to take their chance of wind and weather, 
 and whose meals and rest have to fit in as best they may 
 among the other claims of a hard-worked life ; even less, 
 then, for the soldier on service, exposed not only to the 
 elements, but also to the intense nervous and physical strain 
 of war, whose food is badly cooked, of such quality and 
 quantity as luck may allow, and to whom a good night's rest 
 is often an impossibility. A man's food must be fitted to 
 the life he leads. As long as he leads a laboratory life he 
 can live on laboratory fare, and Professor Chittenden's rules 
 are then possibly the best he can follow. As long, however, 
 as he leads the rough-and-tumble life of the average wage- 
 earning man, he will find the experience of his forefathers, 
 as embodied in the dietetic practices of the successful 
 members of his race, a safer guide than the experiments of 
 the physiological chemist. 
 
 I cannot do better than close this section with a quotation 
 from Mr. Benedict, which runs as follows : " Dietary studies 
 all over the world show that in communities where pro- 
 ductive power, enterprise, and civilization are at their 
 highest, man has instinctively and independently selected 
 liberal rather than small quantities of protein." For the 
 above reasons I consider that the amount of protein in the 
 diet of a man doing moderate work should be somewhere 
 about 2 grammes per kilo of body weight. For a 10-stone 
 man this will amount to 126 grammes. Since it is 
 more convenient to deal with round numbers, I will. 
 
108 MILITARY HYGIENE AND SANITATION 
 
 for the purpose of the present discussion, fix it at 120 
 grammes. 
 
 The energy value of this amount of protein is 492 Calories, 
 and the residue of, say, 2,500 Calories must be made up 
 accordingly by means of fats and carbohydrates. It is 
 generally held that these can replace each other to a very 
 great extent so long as neither is entirely absent from the 
 diet, and in practice the relative proportions of these two 
 substances are regulated very largely by pecuniary con- 
 siderations. The richer classes eat more fats, and the 
 poorer more carbohydrates. Strictly speaking, however, 
 it is probable that we cannot calculate on the basis of energy 
 value only. It is not, in other words, correct to replace 
 fats by carbohydrates, or vice versa, on a purely isodynamic 
 basis of calculation ; the proper ground of comparison is 
 their power of forming glycogen, and as this is more readily 
 supplied by carbohydrates than by fats, a certain balance 
 must be held to exist in favour of the former. The ratio 
 of fats to carbohydrates observed in actual dietaries ranges 
 between very wide limits, as shown in the following list 
 (the figures in brackets denote the total potential energy of 
 each diet) : 
 
 Ordinary prisoners, Scotland, light work 
 " Hard- worked " weaver, England 
 "Fully-fed" tailor, England 
 " Well-paid " mechanic, Munich 
 Carpenter, Munich 
 Painter, Leipsic 
 Physician, Munich 
 Lawyer, Munich 
 
 (3,115) 1 to 15 
 (3,569) 1 to 14 
 (3,053) 1 to 13 
 (3,085) 1 to 9 
 (3,194) 1 to 7 
 (2,500) 1 to 5 
 (2,762) 1 to 3 
 (2,401) 1 to 1-5 
 
 It is interesting to note that the labouring men noted 
 above, though, generally speaking, doing harder work, eat 
 more of the less economical food principle (using " eco- 
 nomical " purely in its energy-producing sense) than those 
 doing less work, who are probably more affluent. Amongst 
 soldier's peace-time rations we find the following variations : 
 
 British 
 
 . . (3,400) 1 to 3-7 
 
 United" States 
 
 . . (3,536) 1 to 5 
 
 German 
 
 . . (3,205) 1 to 8 
 
 French 
 
 . . (3,426) 1 to 9 
 
 Austrian 
 
 . . (2,886) 1 to 16 
 
 Russian 
 
 . . (3,297) 1 to 18 
 
FOOD AND DIETETICS 109 
 
 The differences here are largely due to the fact that the 
 British and American armies are recruited more largely 
 from townsmen ; the continental armies, on the other 
 hand, to a greater extent from the agricultural classes. 
 Social as well as economical considerations arise, there- 
 fore, in connection with the decision on this point. A 
 ratio of 1 to 8 may be taken as a fair average propor- 
 tion. 
 
 Calculating on this basis, we will allot the remaining energy 
 required to be furnished — ^that is, 2,500 Calories — ^to fats and 
 carbohydrates in the proportion of 1x9-3 to 8x4-1, which 
 gives us roughly 60 grammes fat to 480 grammes carbo- 
 hydrates. The entire ration then stands as follows, viz. : 
 
 Protein . . . . 120 grammes = 490 Calories. 
 
 Fat . . . . . . 60 grammes = 560 Calories. 
 
 Carbohydrates .. 480 grammes = 1,970 Calories. 
 
 Total Calories in round numbers = 3,020 
 
 The above may be taken as a fair standard diet for 
 an ordinary man doing light work and drawing average 
 wages. 
 
 Before going any farther it will be useful to translate the 
 above figures into actual foodstuffs. In doing this it is well 
 to begin with the carbohydrates, since these are procurable 
 from the vegetable kingdom only ; 480 grammes of carbo- 
 hydrates are contained in, roughly speaking, twice that 
 weight of bread, which may be looked on as the staple 
 article of carbohydrate food. The dietary, therefore, com- 
 mences with 960 grammes of bread. This amount, however, 
 supplies not only the total amount of carbohydrate, but also 
 some of the protein and the fat. The amounts of these 
 principles present in the above weight of bread are, in round 
 numbers, 60 and 10 grammes respectively. Coming next 
 to consider the protein, it is clear that the residue 
 (60 grammes) will in most cases be supplied in the form of 
 animal food ; 60 grammes of protein are contained in 
 300 grammes of ordinary " medium fat " beef without bone, 
 or, say, 375 grammes with bone. In addition to supplying 
 protein, however, this weight of beef contains about 1-5 per 
 cent, of fat, or, say, 6J grammes. It only remains now to 
 furnish the residue of the fat, say, 45 grammes, which will 
 
110 MILITARY HYGIENE AND SANITATION 
 
 be supplied by 60 grammes of butter. The whole dietary 
 will then stand as follows : 
 
 Bread, 960 grammes (2 pounds 2 ounces). 
 
 Beef, medium fat, with bone, 375 grammes (13| ounces). 
 
 Butter, 60 grammes (2 ounces). 
 
 (All the above calculations are purposely made in round figures for 
 convenience.) 
 
 Before leaving this subject of a standard diet, I should like 
 to utter a word of warning. The expressions " protein," 
 " fats," and " carbohydrates," are purely chemical, and in 
 no way culinary. They are convenient expressions to use 
 when making the purely chemical calculations on which any 
 scientific dietary must be based. They are extremely 
 dangerous symbols if resorted to under any other circum- 
 stances. The student must remember that man does not 
 eat proteins, fats, and carbohydrates, but meat, butter, 
 bread, and sugar, and, therefore, whilst it is allowable to 
 think in the former terms, he must always be ready to 
 translate these expressions into actual concrete foodstuffs. 
 I have given the above example of such a translation, as 
 I have found it, on the whole, the easiest to follow, but any 
 other will doubtless do as well, with the aid of some table 
 of food values, such as that written by Atwater and Bryant, 
 if only the above caution is kept in mind. 
 
 Since the amount of food consumed must depend on the 
 amount of work done, it is necessary to inquire into the lines 
 on which the demand for an expenditure of energy greater 
 than 3,000 Calories should be met. For this purpose I will 
 take the case of a man performing an amount of work which 
 raises his daily demand for food to 4,50,0 Calories. The 
 readiest way to effect such an increase is clearly to make an 
 addition to the fat ration, since here we get the greatest 
 amount of energy per unit increment of weight. The 
 absolute limit of fat that can be tolerated by the digestive 
 organs is partly a question of idiosyncrasy, and partly one 
 of the severity of the climatic conditions to which the 
 individual is exposed, taken together with the work done. 
 The highest figures on record are 363 grammes and 
 365 grammes consumed by teamsters and brick-makers 
 respectively in Massachusetts. The total energy demand 
 
FOOD AND DIETETICS 111 
 
 in the case of these men was 7,800 and 8,848 Calories respec- 
 tively, and such a demand is, of course, quite exceptional. 
 Ordinarily speaking, few people care to consume more than 
 from 160 to 200 grammes of fat, even when doing as much 
 work as in the case actually under consideration. 
 
 The first step, then, would be to increase the fat to 
 180 grammes, supplying thus about 1,100 Calories additional 
 to the 3,000 in the original dietary. There remain now 
 about 400 Calories to be provided from proteins and carbo- 
 hydrates. Since the carbohydrate ration is already fairly 
 high, it would be reasonable to divide this new increment 
 equally between the two principles, giving 50 grammes of 
 each. The entire scale would then run as follows : 
 
 Protein . . . . 170 grammes = 697 Calories. 
 
 Fat .. .. 180 grammes = 1,674 Calories. 
 
 Carbodydrate .. 530 grammes =2,173 Calories. 
 
 Total . . Rather over 4,500 Calories. 
 
 The additional foodstuffs required might be utilized to 
 add a little variety to the dietary. The additional fat could 
 be supplied in 4 ounces of bacon, 2 ounces of cheese, 4 ounces 
 of oatmeal, and 1 pint of milk. These would also furnish 
 almost all the additional protein required and all the carbo- 
 hydrate. The amount of starchy food in such a dietary is, 
 of course, excessive, and some of the carbohydrate would be 
 usefully furnished in the form of jam and sugar. 
 
CHAPTER VII 
 
 THE SOLDIER'S RATION 
 
 The ration of the soldier is in all armies fixed by regulation 
 at a certain amount. In deciding this amount regard is 
 had, naturally, to the needs of the average man as regards 
 fuel and tissue repair, but all choice of actual articles issued 
 is taken out of the hands of the individual, and vested 
 partly in those of the Supply Department, and partly in 
 those of the regimental or company authorities who super- 
 vise the messing. This is one of the chief manifestations 
 of the communal life led by the soldier, and at the outset 
 no doubt a certain amount of " breaking in " has to be done 
 in the case of individual recruits. This is, perhaps, less 
 the case in the British Army than in the national armies of 
 the continent, since the class from which our recruits are 
 drawn is more homogeneous than is the case with those 
 of other countries. 
 
 Messing. — Some form of joint messing is now universal 
 in our army, even in India. Up till quite lately in the latter 
 country the soldier was allowed to have his individual ration 
 prepared by the native cook, in the manner, and to a certain 
 extent at the hours, which chimed in with his individual 
 convenience. Such a custom is wasteful to the last degree, 
 and from the sanitary point of view is also full of objection. 
 The enormous multiplication of utensils used stood in the 
 way of any satisfactory cleansing, and it is my firm opinion 
 that a great deal of intestinal disease was attributable to 
 the mistake of permitting this individualized form of mess- 
 ing. A combined messing system of some kind or other is 
 necessary, but, though this is generally agreed upon, there 
 is by no means a consensus of opinion as to the scale on 
 which it should be maintained. 
 
 112 
 
THE SOLDIER'S RATION IVA 
 
 Briefly, the choice lies between a company and a battalion 
 system as regards the infantry, and a squadron or regimental 
 system in the cavalry. In the smaller self-contained units 
 of other branches the question does not arise. This is not 
 the place to discuss the arguments pro and con for the dif- 
 ferent methods, in as far as these are of a disciplinary 
 nature. From the purely sanitary point of view the advan- 
 tages are all on the side of the messing by large units as 
 against that of messing by small units. In the first place, 
 from the purely physiological point of view, there is less 
 waste of foodstuffs, and the soldier receives, therefore, more 
 actual nourishment from his ration. From the sanitary 
 aspect it is obvious that the fewer the centres at which 
 food is prepared and consumed, the less trouble there is 
 in insuring that the former of these operations shall be 
 carried out in a cleanly and orderly manner, and that the 
 latter shall take place under the best surroundings as regards 
 table adjuncts, cleanliness of utensils, etc. Lastly, the 
 removal of kitchen refuse and slops is enormously simplified 
 where these accumulate at one centre only, instead of 
 several. This advantage would be most marked in warm 
 climates, where flies are apt to haunt the neighbourhood 
 of the cook-house. The full advantages of a regimental 
 system can only be experienced where, as is the case in 
 the most modern barracks, the battalion or regiment is 
 provided with a common dining-room. Even where this 
 is not the case, however, it is possible to arrange a battalion 
 system of messing if it is really desired to do so ; and I 
 consider that it is the duty of all medical officers to impress, 
 by all means in their power, the sanitary advantages of such 
 a system on commanding officers with whom they come 
 into contact. 
 
 Cooking. — The only point which I should like to em- 
 phasize in this direction is the absolute necessity in foreign 
 stations of excluding all native cooks from any share in 
 handling the food. With a properly constructed kitchen, 
 the British soldier can do the actual cooking in a great many 
 Indian stations all the year, and in almost all (I might say, 
 in reality, all the important stations) for a considerable 
 portion of the year. In those stations where it is too hot 
 for him to take part in the kitchen work, or during those 
 
 8 
 
114 MILITARY HYGIENE AND SANITATION 
 
 parts of the year in which this is impossible, the making up 
 of the various dishes should be carried out by Europeans. 
 The part played by the native cook should be limited to 
 that of fire-boy or stoker. No part of the person of this 
 usually dirty and invariably low-caste individual should 
 ever be allowed to come into contact with any foodstuff 
 before, during, or after preparation. 
 
 Peace Rations. — The peace ration of the British soldier 
 at home consists of 1 pound of bread and | pound of fresh 
 meat, with bone, or 1 pound " nominal " preserved meat. 
 (As this expression " nominal " in relation to the weight of 
 preserved meat is of frequent use, I may as well give the 
 explanation of its meaning here. In the trade preserved 
 meat is sold in tins of a gross weight of one or more pounds, 
 this gross weight including that not only of the meat, but 
 of the tin in which it is packed. In the case of a 1 -pound 
 tin the net weight of the meat supplied is about 13 ounces. 
 The larger the tin, the less the weight of the metal relatively 
 to that of the food which it contains.) The fresh meat is 
 either home-kiUed or imported " frozen," and as a rule the 
 supply authorities stipulate that the latter shall not be 
 issued on more than a certain number of days in the week. 
 Mutton is given once a week ; on other days beef is supplied. 
 Preserved meat is issued occasionally (generally once a 
 month), for the purpose of effecting a turnover of the 
 reserves in store. At stations abroad the fresh-meat ration 
 is increased by 4 ounces, and a similar addition is made when 
 the men are under canvas at home, or (subject to the approval 
 of the G.O.C.) when they are temporarily accommodated in 
 unequipped buildings. 
 
 In addition to the issue of bread and meat in kind a 
 "messing allowance " of threepence a day is given to all 
 European soldiers, other than Maltese, and is drawn for 
 every man, from the day of attestation, for all days on 
 which the soldier draws his pay, except when he is in hospital 
 on account of injuries or ailments not due to active service, 
 or under treatment in a non-dieted hospital, or in quarters, 
 and receiving certain " medical comforts." 
 
 The total amount of food actually supplied to the soldier, 
 therefore, amounts to his share of the pooled rations in kind, 
 plus his share of the extra messing provided by the pooled 
 
THE SOLDIER'S RATION 115 
 
 threepences of his company or battalion. The actual energy- 
 value provided naturally varies, but Pembrey and Parker, 
 after an analysis of the messing-books of several units, came 
 to the conclusion that the average amounts were as follows : 
 viz., Protein, 133 grammes ; fats, 115 grammes ; and carbo- 
 hydrates, 427 grammes — with an energy value of* 3,280 
 Calories. In addition to this most men procure something 
 in the way of supper, on payment, from the regimental 
 institute or elsewhere, which represents a further meat 
 allowance. 
 
 The ration of the man in the ranks may be said to be 
 equivalent to that of a well-to-do artisan doing moderate 
 work. The fat-carbohydrate ratio is, however, higher than 
 is at all usual in the class from which the soldier comes, 
 and the protein allowance is also high in comparison. 
 
 In the American Army the fresh-meat ration is 1 J pounds, 
 and that of preserved meat 1 pound. Fish, dried, pickled, 
 or tinned, can also be substituted for the meat ration, but 
 the weight allowed is only 14, 18, and 16 ounces in the three 
 cases respectively. The usual bread ration is 18 ounces, 
 but apparently a flour ration of the same weight is more 
 usually issued. A special vegetable issue of potatoes 
 (li pounds) and beans (2-4 ounces), with a fair list of 
 equivalent substitutes, is allowed, and in addition coffee 
 or tea, condensed milk, and sugar (3*2 ounces). Various 
 condiments and other adjuncts are also given. The ration 
 of the United States soldier is thus decidedly generous. 
 Its chief merit, however, is its great variability. Thus, by 
 choosing certain articles, it is possible to increase the energy 
 value to over 5,000 Calories, whilst with a different selection 
 it may be allowed to drop to 2,500. The average com- 
 position is given by Havard at — Protein, 157 grammes ; fats, 
 99 grammes ; and carbohydrates, 481 grammes — with an 
 energy value of 3,536 Calories. Extra messing is some- 
 times allowed from the company fund. 
 
 The difference between the British and United States 
 rations is not very great. The greater variety in the scale 
 shown in the latter is an advantage that is more apparent 
 than real. The less a peace-time ration is tied down to 
 definite quantities of definite foodstuffs, the better. Meat, 
 and bread or flour, the most important constituents of any 
 
116 MILITARY HYGIENE AND SANITATION 
 
 dietary, are preferably procured in bulk and issued in kind, 
 on account of economy. All condiments, stimulants, and 
 other accessories, such as tea, sugar, and vegetables, are far 
 better purchased as required by the messing authorities. 
 The regimental messing system has clearly the advantage 
 in this direction over the company system that all large 
 purchasers have over small customers. They are able to 
 exercise more discretion in their purchases, and their custom 
 is better worth the having. 
 
 The German soldier receives a peace ration on two scales, 
 the "lower" and the "higher" (Kleiner-Friedens-Verpfle- 
 gungssatz and Grosser Friedens-Verp/legungssatz). Each of 
 these consists of three portions — the bread, meat, and vege- 
 table ration respectively. The bread ration is the same in 
 both cases — viz., 750 grammes (1 pound 2 J ounces) of bread, 
 500 grammes (1 pound IJ ounces) of field biscuit, or 400 
 grammes (14 ounces) of egg biscuit. The meat ration consists 
 of 180 grammes (6 J ounces) of fresh meat, or 120 grammes (4 J 
 ounces) smoked bacon, or 100 grammes (3 J ounces) preserved 
 meat, with 40 grammes (IJ ounces) of ox-kidney fat, on the 
 lower scale ; and of 250 grammes (J pound) of fresh meat with 
 60 grammes (2 ounces)of kidney fat, or 200 grammes (Tounces) 
 of smoked bacon, or 200 grammes of preserved meat, on the 
 higher scale. The vegetable ration includes a large number 
 of different vegetables — potatoes, lentils, rice, groats, etc. 
 The weight of potatoes allowed is considerable, 1,500 grammes 
 (3-3 pounds). The larger scale allows of more variety, but 
 does not give any extra amount. The total composition 
 is given by BischofE at — Protein, 78-5 grammes ; fat, 54-3 
 grammes ; and carbohydrates, 514-8 grammes — energy 
 value, 2,938 Calories, on the lower scale ; and protein, 89-9 
 grammes ; fats, 80-7 grammes ; carbohydrates, 514-8 
 grammes — ^with an energy value of 3,230 Calories, on the 
 higher. 
 
 The Austrian ration includes 840 grammes (1 pound 
 14 ounces) of bread, of which one -sixth may be replaced by 
 84 grammes (3 ounces) of biscuit, 190 grammes (6| ounces) 
 of fresh meat, and a certain allowance of vegetables — e.g., 
 potatoes, 560 grammes (1 pound 4 ounces) — with salt, 
 pepper, and vinegar. A special fat ration of 10 grammes 
 (J ounce) of lard, or 20 grammes of marrow fat, is also 
 
THE SOLDIER'S RATION 117 
 
 allowed. In addition to these issues in kind, a small sum 
 is allowed (10-5 hellers = about one penny) to provide break- 
 fast and supper. The total ration amounts, according to 
 Bischoff, to — Protein, 96-5 grammes ; fats, 33 grammes ; 
 and carbohydrates, 532 grammes — with an energy value of 
 2,886-5 Calories. 
 
 In the French Army the ration of bread consists of 750 
 grammes (1 pound 2 J ounces) of ration bread, and one- 
 third that amount of pain de soupe. In place of this, pain 
 biscuite may be ordered, in which case the weight of ration 
 bread is only 700 grammes, the allowance of pain biscuite de 
 soupe being 250 grammes. A third alternative is pain de 
 guerre, which corresponds more exactly to our " biscuit," 
 in quantities of 550 and 185 grammes (1 pound 3 J ounces 
 and 6 J ounces) respectively. Pain biscuite is bread which has 
 has been exposed to prolonged baking. It is a good deal 
 drier than ordinary ration bread {pain de munition), the 
 crumb being closer in texture and the crust browner. It 
 can be kept for eighteen to twenty days after issue, but if 
 " leaven " is used in the process of manufacture, this period 
 is shortened to ten days. The meat issue is represented by 
 320 grammes (11 J ounces) of fresh meat with bone, or 
 200 grammes (7 ounces) of preserved meat, or 240 grammes 
 (8 J ounces) of salt pork. Thirty grammes (1 ounce) of rice, 
 or 60 grammes (2 ounces) of dried vegetables, or 30 grammes 
 of preserved vegetables, or 60 grammes of preserved soup, 
 are also allowed, with 30 grammes of lard, or 40 grammes of 
 beef fat. A small issue of salt, sugar, and roast coffee is 
 made, and on occasion J litre (9 ounces) of wine, or 2i ounces 
 of brandy. A special ration of llj ounces of brandy is 
 allowed as a ration hygienique. A very considerable lati- 
 tude is given in the matter of substitutes. Lemoine gives 
 the average composition as being — Protein, 3731 grammes ; 
 fat, 6607 grammes; and carbohydrates, 561-2 grammes — 
 with an energy value of 2,927 Calories. 
 
 In the Russian Army the ration is extremely varied. 
 This is partly due to the enormous number of fast days that 
 are observed by the men. The basis of the diet is. 1,230 
 grammes of bread (2 pounds 12 ounces), with tea and a 
 little sugar. A certain money allowance is^ also made to 
 cover the purchase of meat, vegetables, salt, etc. The 
 
118 MILITARY HYGIENE AND SANITATION 
 
 average composition and energy value are given by Bischoff 
 as — ^Protein, 120-7 grammes ; fat, 39-2 grammes ; and carbo- 
 hydrates, 628 grammes — with an energy value of 3,417 
 Calories. On fast days, by a judicious selection of foodstuffs, 
 the protein is raised to 125 grammes, the fat to 54-9 grammes, 
 and the carbohydrates to 669-8 grammes. The energy value 
 of the ration is raised to 3,770 Calories. The apparent 
 paradox is explained by the fact that the fasting is one of 
 quality only, and amounts to deprivation of meat. As a 
 result, there is more cash left over from the money allowance 
 for the purchase of the cheaper foodstuffs. 
 
CHAPTER VIII 
 FIELD-SERVICE RATIONS 
 
 The ration of the soldier on field service is always and in- 
 evitably a compromise between the amount that he needs 
 and that which the supply authorities can see their way to 
 providing. The latter, again, is also a compromise between 
 the amount that can be furnished from local resources and 
 that which the transport can provide carriage for. These 
 three factors make a graduated scale in which the soldier's 
 needs stand at the top and the capabilities of the transport 
 at the bottom. The actual ration, therefore, that the man 
 in the ranks receives lies somewhere between the two 
 extremes just stated, and mere often below than above the 
 mean of the two. All countries lay down scales of rations 
 for field service, graduated, in some cases, according to the 
 amount of work that the soldier will be called on to perform ; 
 but it is not to be supposed that any commander would 
 recognize this scale as absolutely binding upon him should 
 the local resources enable him to increase, or other exigencies 
 compel him to diminish, the actual amounts prescribed by 
 the Regulations. These scales must be looked on as being 
 merely guides to the average amounts that have to be 
 calculated for, principally with a view to transport, not by 
 any means as Procrustean rules to which the appetites of 
 the army are compelled to conform. 
 
 It may often occur that at the very time when the troops 
 are being called on for extreme exertions the difficulties of 
 transport and supply may be so great that the ration may 
 have perforce to be reduced to a level insufficient to meet 
 the physiological demand. A striking instance of this 
 occurred in the German campaign in South-West Africa 
 (1904-1906), where it was frequently found impossible to 
 supply the movable columns with even a reduced (two- 
 thirds) ration. The condition of affairs in such cases is 
 aggravated by the fact that the difficulty of transport does 
 
 119 
 
120 MILITARY HYGIENE AND SANITATION 
 
 not apply equally to all constituents of a ration. Fresh 
 meat can be driven " on the hoof," and preserved meat is 
 peculiarly portable ; but the carbohydrate foodstuffs do 
 not possess the former advantage, and are, besides, ex- 
 tremely bulky. Under such circumstances the men may 
 be reduced to a ration consisting largely of meat, the 
 amount of which that can be metabolized is strictly limited 
 by the capacity of the digestive organs to supply the 
 necessary ferments. 
 
 Field-service rations may be divided into normal, special, 
 iron or reserve, and emergency rations, and will be con- 
 sidered under the above heads. 
 
 The normal ration is the scale laid down for ordinary field 
 operations. The special ration is designed to meet some 
 special emergency calling for extreme exertion. This may 
 be achieved by the addition of some special articles or the 
 increase pro rata of all the constituents of the normal ration. 
 Some services prescribe more than one such scale. The 
 iron or reserve ration is a ration which is intended to supply 
 a fair amount of energy, not sufficient to meet all demands, 
 but enough to enable the soldier to live and work, while 
 subsisting on the reserve stores of energy contained in the 
 stored-up glycogen and fat or the protein of the less active 
 tissues. Such rations are carried by the man or in the 
 regimental transport, and are not allowed to be consumed 
 without the sanction of superior authority. The emergency 
 ration is an artificial compound, carried on the man, in- 
 tended to keep " body and soul together " when all other 
 forms of nutriment fail. The soldier is net permitted to 
 eat this ration except by order or in dire emergency. 
 
 The Nokmal-Service Ration. — The different scales 
 laid down for the more important armies are shown in 
 the Appendix.* The basis of all such rations is a meat and 
 bread or biscuit issue, supplemented by vegetables, tea, 
 and sugar. This last article is supplied as such and also as 
 a constituent of jam or preserved fruits. Usually a special 
 fat ration is given. 
 
 Field-Service Ration, British Army. — The meat-and- 
 bread basis of this ration appears to have a traditional 
 
 -''■ The tables and plate referred to in this chapter are given in the 
 Appendix for convenience of comparison. 
 
FIELD-SERVICE RATIONS 121 
 
 foundation, the normal issue during the Napoleonic wars 
 being much the same as that in the South African cam- 
 paign. The total value of the ration was fixed empirically, 
 and it does not appear that, till quite lately, a definite 
 experimental trial was made to see exactly how much food 
 was necessary to support the fatigues of a campaign. In 
 the year 1909, however, such an experiment was sanctioned. 
 This was conducted on the following lines : A party, con- 
 sisting of one officer and twenty N.C.O.'s and men of the 
 Loyal North Lancashire Regiment, with three medical 
 officers and some details, was encamped on Salisbury Plain 
 from the Uth to 23rd October. The food was carefully 
 restricted to the issues laid down in allowance regulations, 
 and a certain march, in heavy marching order, carried out 
 every day. A careful record was kept of the actual ground 
 covered, and an estimate of the energy so expended made, 
 on the lines detailed in the chapter on " The March." An 
 estimate of the energy otherwise expended was also made, 
 and this was fixed at 3,000 Calories. This arbitrary figure 
 was arrived at by taking Zuntz's estimate for a purely 
 sedentary life, giving a mean of about 2,350 Calories as a 
 basis, and adding to it an amount considered to be fairly 
 equivalent to the exertion demanded by the ordinary 
 fatigues of camp life, under the peculiar circumstances of 
 the experiment. The men were carefully weighed every 
 morning at the same hour and in the same minimum of 
 clothing. At the commencement, on the middle day, and 
 at the termination of the experiment the measurement 
 round the chest, the abdomen, and calf were also recorded. 
 Taking the purely theoretical calculation first, it will be 
 noted (Table B) that there was a decided deficit of nearly 
 900 Calories per diem. Obviously this calculation is liable 
 to the objection that the extent of the defect is largely 
 proportional to the amount fixed on as representing internal 
 work. The energy value of the food was estimated partly 
 by means of analyses carried out in the Royal Army Medical 
 College and partly from the figures given by Atwater and 
 Bryant in " The Chemical Composition of American Food 
 Materials." A strict watch was kept to see that no food 
 refuse was left unaccounted for. The actual composition 
 of the rations eaten is shown in Table C. The diurnal 
 
122 MILITARY HYGIENE AND SANITATION 
 
 variation in weight is shown by the curve on Plate D. It 
 will be noted that there was a distinct initial rise, lasting 
 over the first four days of the experiment, followed by a 
 marked and much greater fall. The initial rise affected all 
 but two of the men, and cannot be regarded as accidental. 
 It may have been due to a greater retention of water in the 
 tissues, the result of a salt-meat ration, or to the fact that 
 the carbohydrate in the ration was considerably higher than 
 that in the usual barrack ration, or, again, to the stimulus 
 to muscle growth supplied by the regular exercise. This 
 increase in weight was coincident with an increase in the 
 abdominal girth, and the calf measurement, but a decrease 
 in the circumference of the chest. Following on this un- 
 explained rise was an even more marked, and almost equally 
 genera], fall, accompanied by a diminution in chest and 
 abdominal measurements, and a very slight rise in calf 
 circumference. The men at the conclusion cf the march 
 showed a pinched, starved appearance, and signs were not 
 wanting to show that most of them, and more particularly 
 the heavier members of the party, had come close to an end 
 of their reserve stores of fat. Whether the theoretical 
 calculation of the amount of energy expended was correct 
 or not, it was abundantly clear that the amount of food 
 consumed was by no means adequate to the amount of 
 work done. At the same time it was certain that the work 
 done did not in any way come near to the demands that 
 normally must be expected under field-service conditions. 
 The life led by the men was roughly as follows : After rising 
 about 7 a.m., they had their breakfasts, and were then 
 weighed. After putting on their accoutrements, they 
 marched a distance varying from eight to twenty miles, the 
 general average distance covered being about twelve miles. 
 The remainder of the day, after return to camp, was filled 
 up in any way the men chose, so long as they did not leave 
 the camp boundary. At the beginning of the experiment 
 they used to kick a football about, but as they became jaded 
 towards the end of the fortnight, they left off this amusement. 
 The tents had to be pitched on the first day, and were struck 
 moved by hand about 500 yards, and repitched in a mor, 
 sheltered position on the third day. On the eighth day thee 
 were struck, loaded on to a waggon, and then unloaded in 
 
FIELD-SERVICE RATIONS 123 
 
 the forenoon, again loaded in the afternoon, and unloaded 
 and pitched at a new camp in the evening. On the ninth 
 day they were struck and loaded in the morning, unloaded 
 and pitched in the evening. At the first camp-ground 
 the latrines were about one-quarter of a mile distant, and 
 50 feet below the camp. In addition, the ordinary camp 
 fatigues of fetching meals from the somewhat distant 
 kitchen, etc., had to be performed. There was no night 
 duty, no manoeuvring, meals were regular, and consumed 
 under comparatively comfortable conditions, and, generally 
 speaking, the men were not harassed in any way. Clearly, 
 the exertions of a life like the above cannot in any way be 
 held to come up to those of even ordinary campaigning. 
 Whether the theoretical calculations, then, were absolutely 
 accurate or not, it is fairly clear that the ration issued was 
 insufficient under the actual circumstances, and a priori, 
 therefore insufficient to meet the normal demands of war. 
 The food principle the lack of which was most felt was fat. 
 As will be seen, during the first week, whilst tinned beef 
 was issued, this fell as low as 50 grammes. In the second 
 week, as a result of the very high quality of the fresh meat 
 supplied, the amount of this particular ingredient rose to 
 110 grammes ; but even this allowance was insufficient to 
 allay the marked craving which was felt by all, more 
 especially by the officers of the party — a craving that per- 
 sisted in the case of the writer for upwards of a fortnight 
 after a return to normal conditions of life. A marked 
 craving for sugar was also experienced, but not nearly so 
 strongly as in the case of fat. Generally speaking, the 
 carbohydrate ration was held to be sufficient. The officers 
 were unable to consume their biscuit ration, though the 
 biscuits were of excellent quality, and liked by them. 
 Presumably this was due to social dietetic custom. The 
 men ate all of theirs, and preferred them to the bread given 
 in the second week. This was probably due to the fact that 
 the bread could be bolted, and did not, therefore, last so 
 long as the harder biscuits, which demanded a considerable 
 length of time for their mastication. The men described 
 them as being " more filling." There was no general desire 
 for more meat, and towards the end of the first week there 
 was in some cases, especially amongst the officers, a distinct 
 
124 MILITARY HYGIENE AND SANITATION 
 
 loathing for the corned beef. This was probably due to 
 the monotonous nature of the issue and the absence of 
 condiments. The vegetable ration was considered un- 
 satisfactory. The energy value supplied in the case of 
 fresh vegetables is incommensurate with the weight, and 
 since on service these articles are only available for issue 
 in localities where they are actually grown, being unable 
 to stand transport, their inclusion in the energy-supplying 
 portion of a ration seems inappropriate. As a result of 
 this experimental march, a suggestion was put forward 
 that certain additions should be made to the scale, con- 
 sisting of 2 ounces of bacon, 2 ounces of cheese, 4 ounces of 
 jam (making the total ration J pound actual), and 2 ounces 
 of oatmeal. It was calculated that these additions would 
 raise the value of the whole ration to about 4,500 Calories, 
 which, on theoretical grounds, appears to be about the 
 average expenditure per day under field-service conditions. 
 In accordance with this report a second experimental 
 march was ordered to be carried out in August, 1910. The 
 strength of the party was the same as before, taken on this 
 occasion from the Somerset Light Infantry, with an 
 additional officer belonging to the Army Service Corps. 
 The general routine of the march was also much the same, 
 except that, owing .to local difficulties in the matter of 
 suitable camp-grounds, and also to the weather, the tents 
 were not moved after they were pitched on the first day. 
 The men were thus saved a considerable amount of fatigues, 
 and as the kitchen and latrines were more conveniently 
 situated than in the first case, the estimate for internal 
 work was lowered to 2,750 Calories for marching days, and 
 3,000 Calories for days on which no march was performed. 
 Here, again, there is the obvious objection that the ultimate 
 balance of food supplied and energy expended depended 
 very largely on an arbitrary calculation. The same obser- 
 vations were made as before, but the measurements of 
 chest, abdomen, and calf were carried out more frequently. 
 The composition and energy value of the food is given 
 in Table E, and the preponderance in fat over the 
 diet of the first march is very striking. As on the first 
 occasion, all members of the party practically showed an 
 initial rise, but this was more marked on the second than 
 
FIELD-SERVICE RATIONS 125 
 
 on the first occasion. This rise was followed, as before, by 
 a fall ; but here, again, the fall was less in extent than that 
 which marked the second stage of the first experiment. 
 Lastly, the average weight finished off much where it 
 began, the slight gain which was, in fact, recorded, being 
 negligible. The condition of the men exhibited a marked 
 contrast to that of the men who took part in the 1909 
 experiment. There was no sign of wasting, and, in marked 
 contradiction to the hunger experienced at the conclusion 
 of the first march, two of the officers who participated in 
 both complained of loss of appetite. This was probably 
 due to the high protein ration. 
 
 Taken together, the two experiments are very instructive. 
 The conditions were as nearly identical as could be ex- 
 pected under the circumstances. The men were of the 
 same average physical standard as regards weight, age, etc., 
 and no special selection was made as regards habits. In both 
 cases they were taken at random from a considerably larger 
 number who volunteered to share in the experiment. The 
 actual marches were rather harder on the second than on 
 the first occasion, though the average work done per diem 
 (see Table F) was rather less, since one extra day of rest 
 had to be given on account of bad weather. In both 
 cases the weather was extremely inclement, and on the 
 second this fact was aggravated by the situation of the 
 camp, which was on an exposed hillside, at about 1,000 feet 
 elevation. 
 
 Discarding minor differences, it may be said that, the 
 energy expenditure being much the same on both occasions, 
 this was not met by the ration issued during the first experi- 
 ment, whilst it was satisfactorily replaced by that issued on 
 the second. As already stated, the work done was not so 
 severe as that which would be demanded of men under 
 ordinary conditions in the field, but the results obtained 
 furnish us with some basis for argument on this point. 
 The average distance traversed was twelve miles per day. 
 By itself this is not severe exertion, though under the 
 ordinary conditions of a campaign, when the men would be 
 unable, as they were during these experiments, to take 
 their ease after arrival in camp, such a distance would be 
 considered a satisfactory and sufficient demand to make on 
 
126 MILITARY HYGIENE AND SANITATION 
 
 men in the absence of any specially urgent necessity for 
 speed of movement. The addition of another five to six 
 miles per day would, even with the possibility of immediate 
 rest on arrival in Camp, have meant severe work, and I have 
 come to the conclusion, after discussing the question with 
 several staff and regimental officers, that such a distance 
 would about represent the extra work entailed by the 
 ordinary camp duties that devolve on men before starting 
 in the morning and after arrival in camp in the evening. 
 Taking the average expenditure per mile of a give-and-take 
 road at about 90 Calories (see p. 52), a distance of five and 
 a half miles will represent 500 Calories. 
 
 Since in the second march it was found that a ration sup- 
 plying an average net amount of 4,000 Calories was sufficient 
 to meet the energy demands of the occasion, it is a fair 
 inference that one of 4,500 Calories would be needed to meet 
 those of active service, whilst possibilities of expansion to, 
 say, 5,000 Calories should be readily available. 
 
 If Table A be consulted, it will be seen that the nor- 
 mal field rations of the different continental nations in 
 no case, except the Russian, in any way approach the 
 above standard. The reason of this is that the scales which 
 the different authorities fix are intended to lay down a 
 minimum for actual subsistence in a country where other 
 supplies are locally available. In the South-West African 
 campaign the normal German rations for troops on the 
 lines of communication was — Protein, 172 grammes ; fat, 
 123 grammes ; and carbohydrates, 633 grammes — with an 
 energy value of 4,360 Calories. This is higher by about 
 700 Calories than their regulation issue for hard work in a 
 (presumably) European campaign. For troops at a dis- 
 tance from the lines of rail the ration had to be reduced to 
 about two-thirds of the normal issue. The average compo- 
 sition of this reduced ration was 132 to 139 grammes of 
 protein, 76 to 95 grammes of fat, and 41 1 to 490 grammes of 
 carbohydrates. The energy value varied from 2,940 to 
 3,494 Calories. The necessity of allowing a smaller ration 
 to the working than to the stationary troops was unavoid- 
 able under the conditions of the campaign, and it had the 
 advantage that the men on return from the " trek " had 
 the chance of recuperating on a liberal diet. 
 
FIELD-SERVICE RATIONS 127 
 
 From a British point of view, all the field-service rations 
 of foreign armies are lacking in fat, though, as a matter 
 of fact, they all make a special issue of fat or lard. The 
 Russian soldier is peculiarly badly off in this respect. The 
 allowance of protein is also low for men who are exposed to 
 vicissitudes of climate and the general strain, physical and 
 mental, of war. 
 
 Special Rations. — These are rations intended to be 
 issued on the order of superior authority to meet the energy 
 demands of some peculiar emergency. In the German Army 
 the meat or vegetable issues, or both, are increased ; in the 
 French a definite addition of meat, bread, and brandy is 
 made to the normal ration, to make what is termed the 
 ration forte. Either the normal or the " strong " ration 
 may be augmented by a pro rata increase of one-quarter, one- 
 third, or one-half of all its constituents. The above methods 
 are those which strike one at first sight as being those most 
 logically adapted to meet the situation. It is doubtful, 
 however, in my mind if they really do solve the problem in 
 the best way. The conditions under which an increased 
 ration is demanded are often those which render the con- 
 sumption of that ration a matter of difficulty. Either the 
 men are too tired to eat their food, or there are no facilities 
 for its preparation. In my opinion the demands imposed 
 by increased exertion should be met by the special addition 
 to the ration of some foodstuff which needs the minimum 
 amount of preparation, to which the soldier is unaccustomed, 
 and which will possess, therefore, the advantage of novelty. 
 Some form of meat extract would be advisable on such 
 occasions, with good chocolate or toffee, and perhaps 
 something in the nature of a sausage. It is not much 
 satisfaction to a man who has lived on tinned beef and 
 biscuit for a fortnight, when he arrives very tired at the 
 end of a long march to be presented with an extra half-tin 
 of the former and four more of the latter. A mess- tin of 
 hot soup, though it contains no actual nourishment, would 
 be more appreciated than the meat, and the sugar of the 
 sweetmeat would be preferred to the starchy carbohydrate 
 of the biscuit. It is most important, I think, to remember 
 on service — more, even, than at ordinary times — that the 
 thing which really counts is not how much food the man 
 
128 MILITARY HYGIENE AND SANITATION 
 
 receives from the supply authorities, but the amount of 
 that food which he can turn to useful purpose. When the 
 digestive and assimilative powers are depressed, as they so 
 often must inevitably be on service, there is neither sense 
 nor reason in merely piling more food on to the man. This 
 is more especially the case when the additions to the ration 
 are identical with those foodstuffs of which the man is 
 already, in all probability, heartily sick. 
 
 The composition and energy value of some special rations 
 is given in Table G. 
 
 All rations, whether normal or special, must rely for the 
 greater part of the energy which they supply on a basis of 
 meat, fresh or preserved, and bread or biscuit. As regards 
 fresh meat, our issue is greater than that of any other 
 European army. This difference is, in my opinion, entirely 
 in our favour. One pound of fresh meat (IJ pounds in- 
 cluding bone) is not in any way an excessive allowance for 
 an actively employed young man. From the physiological 
 point of view the processes of metabolism should be kept at 
 a high level, to enable the individual to face the mental and 
 physical stress of active service. 
 
 Whatever may be the theoretical advantages of a low 
 protein diet in the case of the sedentary man, I am abso- 
 lutely certain that for the fighting man, exposed to the 
 incessant physical and mental strain of war, the only 
 suitable ration is that which contains a large amount of 
 protein, and, further, I am certain that that protein should 
 be furnished, as far as possible, in the form of fresh meat. 
 Unfortunately, the conditions under which the British 
 Army campaigns are not such as to facilitate the issue of 
 fresh meat, while, when this is possible, the meat supplied 
 is often coarse and tough in fibre, and tasteless. The chief 
 defect is, however, in the direction of fat. The German 
 report on the campaign in South- West Africa allows only 
 1 per cent, of fat in the fresh meat supplied, or about half 
 that given by Atwater for " very lean " side of beef. 
 This defect can be met by a special issue of fat, either as 
 such — e.g., lard, kidney fat, etc. — or in the form of bacon or 
 cheese. The issue of mincing machines will do much to 
 overcome the toughness and coarseness of the fibre, whilst 
 as regards the complaint of tastelessness, this might be well 
 
FIELD-SERVICE RATIONS 129 
 
 met by the issue on such occasions of some preserved meat 
 extract. The important stimulant action exercised on the 
 digestive processes by the extractives of meat has been well 
 shown by Pavlov, and the work of Thompson of DubHn has 
 confirmed these conclusions. They would undoubtedly 
 play a very useful role under the conditions which I have 
 just mentioned. 
 
 The ration of preserved meat is, to a certain extent, fixed 
 for us by trade conditions, since our supplies are procured 
 in the open market. Nations which have their own military 
 preserved-meat factories have a freer hand in the matter. 
 Our ration is, therefore, decidedly larger than theirs, and 
 here, again, I consider the difference is in our favour, for 
 the reasons which I have aheady stated. The ration is 
 issued in 1-pound (nominal) tins, containing about 13 ounces 
 of meat. Certain conditions are laid down as to the pro- 
 portion of fat that should accompany the meat — viz., 
 between 10 and 15 per cent. This corresponds to the 
 amount present in fresh meat classed as "lean," and is 
 probably greater than the proportion found on the fresh 
 meat usually obtainable on service ; it is undoubtedly too 
 low, in the absence of a special fat issue. On the other 
 hand, it is impossible to place it higher, since, with a larger 
 proportion of fat, the meat fibre becomes greasy and 
 nauseating. This is, of course, particularly the case in a 
 hot climate, when the fat becomes liquid. The corollary 
 is the provision of a special fat issue. It is important that 
 the meat should be issued in single rations, since then each 
 man can carry his daily ration on his person. With larger 
 tins, either one man has to carry his comrades' allowance, 
 or else the tin has to be kept open in the haversack for one 
 or more days, according to the size of the tin — an obviously 
 objectionable practice. In the South- West African cam- 
 paign the Germans made a rule that 75 per cent, of the meat 
 should be packed in single, the remainder in triple, ration 
 tins. The French use single ration tins only, except in 
 the case of fortresses, to which larger tins (2 kilos) are 
 issued. 
 
 The German War Department has its own preserved-meat 
 factories, situated at Mainz and Spandau ; but it does not 
 rely entirely on this source of supply, the open market 
 
130 MILITAKY HYGIENE AND SANITATION 
 
 being also utilized. The army factories manufacture two 
 kinds of preserved meat — beef in bouillon, and Gulasch, 
 a sort of stew of beef or mutton, with bacon, vegetables, 
 etc. Beef must be of the first quality only, from animals 
 four to seven years old, and of these only the fore-quarters 
 are used. 
 
 In both the French and German Armies the meat is well 
 cooked before tinning, and the bouillon is added to the meat 
 in the tin, the whole being seasoned ; in the latter case 
 vegetables are included. In the French ration the meat is 
 pressed into the tins and the bouillon concentrated. The 
 French use pork as well as beef for the preparation of a 
 ration of this kind. In these armies the aim seems to be 
 to procure a complete ration, as opposed to the meat portion 
 of a ration only. Under the strict rules that can be enforced 
 in a Government factory this is no doubt feasible, but 
 dealing in the open market the purchaser is often apt to 
 be defrauded in the matter of this class of preparation. 
 The Germans in South- West Africa found that a tin reputed 
 to hold 400 grammes of mixed preserves sometimes con- 
 tained only 100 grammes meat, with a few vegetables 
 floating in 300 grammes of fluid. 
 
 The relation of bread to biscuit is much the same as that 
 of fresh meat to preserved meat. The younger men can, 
 as a rule, consume all their biscuit ration ; but older men 
 and officers find considerable difficulty in doing so. The 
 present ration biscuit, weighing 2 ounces, is an excellent 
 specimen of its kind, but presents the natural difficulty of 
 being hard, and taking time to masticate. The French 
 Army makes use of a pain biscuite, which is simply bread 
 desiccated by prolonged heating. Such a bread has, 
 doubtless, many advantages over biscuit, but possesses 
 one marked disadvantage, and that is its friability. A 
 biscuit can be carried in the haversack, and small pieces 
 broken off at intervals and chewed. Dried bread in the 
 haversack rapidly gets reduced to the condition of pow- 
 dered crumbs, and is then of no further use to anybody. 
 The portability of biscuit is its great recommendation, and 
 though its hardness is a distinct disadvantage, especially 
 to people with bad teeth, still, the fact that it cannot, like 
 bread, be bolted at one meal is a considerable make-weight 
 
FIELD-SERVICE RATIONS 131 
 
 on the other side. In the German and Austrian Armies 
 an egg biscuit is made use of, containing 500 eggs to 100 kilo- 
 grammes (220 pounds) of flour ; 12 kilogrammes of sugar, 
 and 12 litres of milk are also added. Such biscuits possess, 
 of course, a considerably enhanced energy value, owing to 
 the fat present. I should be doubtful of their keeping 
 qualities, especially in respect of the attacks of weevils, etc., 
 and am inclined, on a priori grounds, to suspect that men 
 would soon get tired of them. For prolonged use, there is 
 no doubt that the simpler the food the better. The bread 
 and biscuit issues of the continental armies are considerably 
 larger than our own. The bread ration of the Russian 
 soldier is the highest, and the faculty of disposing of such a 
 large amount of starchy food must be in some way a national 
 idiosyncrasy. 
 
 Vegetables. — ^These are issued either fresh or preserved. 
 The distinction is important. Fresh vegetables are especi- 
 ally valuable on account of their antiscorbutic properties. 
 This is possessed most markedly by the green vegetables, 
 cabbages and the like, though also by onions and potatoes 
 in considerable degree. The class first mentioned, owing 
 to the presence of a large amount of indigestible cellulose, 
 also exercise an important influence on the peristalsis of 
 the intestine. Unfortunately, no fresh vegetables, with 
 the exception of onions and potatoes, keep well, whilst 
 these, owing to the large amount of water that they contain, 
 are disproportionately bulky, when considered in con- 
 nection with the amount of energy that they are able to 
 furnish. When, therefore, it is a case of transport, green 
 vegetables are out of the question, whilst potatoes and onions 
 can be carried just as well dried as fresh, and a great saving 
 of weight thereby effected. Where fresh vegetables are pro- 
 curable, they should be supplied as extra to the ordinary 
 ration, and no account taken of the trifling amount of 
 energy that they contain. Among vegetables with a dis- 
 tinct nutritive value, the most important are peas, beans, 
 and lentils. These keep well when dried, but possess the 
 great disadvantage that prolonged soaking is necessary 
 before cooking to render them digestible. Where travelling 
 kitchens are available, this difficulty can be easily remedied ; 
 but in their absence these leguminous vegetables lose much 
 
132 MILITARY HYGIENE AND SANITATION 
 
 of their value. Potatoes dried in chips are extremely useful. 
 They keep well', and can be easily fried or mashed, and 
 make thus an excellent addition to the meat ration. Great 
 care must be taken in allowing the men to eat uncooked 
 fresh vegetables. The methods of intensive cultivation in 
 vogue in certain countries in respect of these foodstuffs are 
 such that disease is almost certain to result if they are eaten 
 raw. The consumption of salads or of thin-skinned fruits 
 such as strawberries should be forbidden, and the rule as 
 far as possible enforced. 
 
 Some special form of fat ration is the general rule. In the 
 French Army this takes the form of lard or suet ; in the 
 German, of kidney fat ; in the Austrian, of marrow fat or 
 lard. Some such issue is most certainly necessary, since 
 the meat usually procurable on service, whether fresh or 
 tinned, does not furnish nearly enough of this important 
 source of energy. It must be remembered that the common 
 foodstuffs, milk and butter, which in peace-time supply so 
 large an amount of the fat consumed, are rarely procurable 
 in the field, owing to their lack of portability. The best 
 form which the fat issue can take is that of bacon or cheese. 
 These articles have the advantage that the former can be 
 eaten with relish cold, which is hardly the case with lard 
 or suet, whilst the latter, cheese, is also edible raw. At the 
 same time they provide a certain amount of protein. In the 
 case of cheese this protein is different from that of flesh 
 meats, so that with the issue of this substance an important 
 variety is introduced as regards this particular food prin- 
 ciple. The importance of variety, especially in the case of 
 proteins, has already been mentioned. 
 
 Sugar is given in all rations, but, except in the case of 
 our army, in absolutely insufficient quantity. Jam seems 
 not to be allowed by any foreign nation — a remarkable 
 omission, since, in addition to the sugar present, some of 
 the more acid jams have a marked antiscorbutic action. In 
 South- West Africa the German troops found the augmented 
 ration of 40 grammes of sugar too small. There is not the 
 slightest doubt that in this respect our ration is far superior 
 to any other. The advantage of sugar lies in the fact that 
 it can be absorbed with the least possible alteration. There 
 is no necessity for prolonged process of metabolism, as in 
 
FIELD-SERVICE RATIONS 133 
 
 the case of the proteins, or of emulsification, and subsequent 
 spHtting up, as in the case of the fats. Sugar is, however, 
 not only the most easily absorbed ; it is the most rapidly 
 utilized of all the foodstuffs. A fairly large number of 
 experiments have been made on the use of sugar during 
 hard work, the most complete of which are those of Medecin- 
 . Major Joly, with two companies of the 94th Regiment of 
 the Line of the French Army at Bar-le-Duc. It is true that 
 there are not lacking dissentient voices, but I have been 
 unable to find that their unfavourable views are as well 
 founded as those which support the issue of the ration . My 
 personal experience is entirely in favour of a high sugar 
 issue. This foodstuff should, therefore, in my opinion, 
 form a considerable bulk of any special ration, or of any 
 addition to the normal ration, under conditions of peculiar 
 exertion. 
 
 Stimulants. — These are issued by all armies, either as 
 an emergent or as a regular ration. I have already stated 
 my views as to the occasions on which alcohol should be 
 issued. It certainly should not be given as a matter of 
 routine, as was done in the case of the Grerman campaign 
 in South- West Africa. At the outset the allowance on that 
 occasion was 3J ounces a day, and, with a view to con- 
 venience of supply, presumably, the total amount for one 
 week was given out at one time. The possession by each 
 man of 24| ounces of spirits led to aggravated drunkenness 
 and violence. It was said, too, that the regular daily issue 
 of alcohol conduced in some cases to the acquirement of 
 the " drink habit " in men who had not previously suffered 
 from this failing. It cannot be too strongly laid down 
 that a daily issue of spirits is wrong. The value of 
 alcohol on service, which is very great, lies in its being 
 resorted to occasionally only. Constant use robs it of all 
 benefit. 
 
 Tea is issued in our army, but the continental soldier 
 prefers coffee, being more accustomed to it in his home. 
 The British soldier likes tea in moderation, but does not, 
 unfortunately, show any inclination to drinking it to the 
 exclusion of other beverages like his Australasian cousins. 
 If he could be trained to do so, the question of purification 
 of water in the field would be considerably simplified. 
 
134 MILITAEY HYGIENE AND SANITATION 
 
 Coffee is a less convenient article from the supply point of 
 view than tea, since the ration is twice the weight of the 
 tea ration. In addition, the preparation of coffee is a 
 more difficult process. If the berry is issued unground, 
 then coffee-mills must be supplied, as in the French Army 
 The Grermans in South-West Africa found the gun-butt a 
 most ineffectual substitute. 
 
 Reserve Rations. — These are rations which are carried 
 either by the soldier on his own person or packed in the 
 regimental transport. They are intended to be used only 
 by superior order, and when the connection with the normal 
 chain of supply is broken. The conditions under which 
 such rations will be needed are likely to be much more fre- 
 quent in the wars of the future than in those of the past. 
 Forty or fifty years ago the exigencies which demanded the 
 issue of the reserve ration were chiefly due to difficulties of 
 transport and rapid movement of the troops. Such occa- 
 sions will also undoubtedly occur in the future, though the 
 introduction of mechanical transport may be expected to 
 render them less frequent. The increased range of modern 
 armaments and the prolonged nature of modern battles 
 will, however, give rise frequently to situations in which 
 the men at the front may have to depend for all their food 
 during a period of two or three days on the supplies which 
 they carry on their own persons. There is no doubt that 
 the provision of a good reserve ration would facilitate the 
 solution of many strategical and tactical problems. 
 
 The question has a physiological side, and I propose to 
 discuss it briefly from that point of view. The first point 
 to be considered is the amount of energy that will be de- 
 manded of the man and the amount that can be supplied in 
 the ration. The latter will depend, to a certain extent, on 
 the weight which the man can afford to carry, the length of 
 time that the ration is expected to last — in other words, the 
 number of rations that must be carried — and, lastly, on the 
 degree of concentration possible as regards the different 
 foodstuffs. 
 
 The amount of energy required from the man will probably 
 be, for reasons already stated, somewhere about 4,500 to 
 5,000 Calories per diem. Since, by the terms of the problem, 
 the ration is required to meet a brief emergency, some 
 
FIELD-SERVICE RATIONS 135 
 
 assistance may be expected from the tissue reserves of the 
 body, and it will be unnecessary, therefore, to replace com- 
 pletely all the day's expenditure by means of the ration. 
 On the other hand, since the emergency may quite well 
 last as long as three days, it would be unwise to furnish less 
 than, say, two-thirds of the daily output. This will leave 
 the man at the end of three days what one may term " one 
 day short " in his energy account. The ration should supply, 
 therefore, about 3,000 Calories, and should be of such 
 weight that a man can carry three rations, having a total 
 weight of 6 pounds. The reason for settling on this last 
 figure will be given when discussing equipment ; here it 
 need only be said that every ounce of weight that the man 
 can spare will be needed for ammunition. The problem, 
 then, reduces itself to the following statement — viz., the 
 provision of 3,000 Calories in a weight of 2 pounds, or about 
 900 grammes. This means a degree of concentration in 
 which every gramme provides 3 J Calories. 
 
 A few words may here be said as to the exact meaning of 
 the expression "concentration of food." There is only 
 one way in which food can be concentrated, and yet retain 
 all its energy -producing constituents, and that is by evapo- 
 ration. If we drive off all the water from, say, a pound of 
 lean meat, we will have as a residue about 90 grammes of 
 protein ; by stopping short of complete desiccation, and 
 leaving a small amount of residual moisture — say, about 
 one -eighth only of that originally present — we can, if the 
 process be carried out carefully, produce a concentrated 
 foodstuff, perfectly palatable, which will keep without 
 being hermetically sealed almost indefinitely. Such a 
 foodstuff will contain all the energy-providing constituents 
 of the original meat and all its tissue-building elements, 
 with the one important exception of water. As long as 
 water is procurable, such a foodstuff is extremely valuable, 
 and, therefore, on a forced march through a well-watered 
 country much saving of transport might be effected by its 
 issue. Unfortunately, there are many occasions on which 
 a reserve ration is required, such as during a long-drawn-out 
 attack, when it is just as difficult to send forward water to 
 the men as it is to supply solid food. It must be remembered 
 that water is of all foodstuffs the least portable and the 
 
136 MILITARY HYGIENE AND SANITATION 
 
 most bulky. We are, therefore, faced by the difficulty that 
 in one of the emergencies in which, above all, we require a 
 reserve ration we are unable to rely on concentration to 
 help us in the solution of the problem. Concentration must 
 always be carefully distinguished from extraction. There 
 seems a general idea in the minds of the lay public — a 
 belief fostered largely by sensational posters — ^that it is 
 possible, by some abstruse process, to concentrate the 
 entire energy value contained in the carcass of a slaughter 
 beast into one teacup. It is well, therefore, to remember 
 " extraction " means merely the taking out of certain 
 soluble matters from the whole mass of foodstuff available, 
 which have no real food value, though of great importance 
 as digestive stimulants. 
 
 The only foodstuffs which lay themselves open usefuUy 
 to concentration are meat and fresh vegetables. Bread 
 becomes crumbly, and is in this condition best replaced by 
 biscuit. 
 
 Since, however, whatever our reserve ration be, we must 
 meet the energy demands inside the prescribed weight by 
 a certain amount of concentration, it seems fairly clear 
 that our first choice must light on those foodstuffs which 
 we are accustomed to eat in a more or less water-free state 
 rather than on those that normally contain a large pro- 
 portion of moisture. This turns our attention at once on 
 the fats and sugars. The basis of our ration, then, from 
 an energy-forming point of view, must consist of these 
 articles alone or in combination. As between the two, 
 sugars are the more easily digested and absorbed, and, in 
 addition, after absorption, the more readily made use of 
 in the body. On the other hand, fats are to sugars in 
 respect of their energy-producing powers as 2 J to 1. A 
 large allowance of protein is not necessary, since, as a form 
 of energy, this is on a level with the sugars, and at the same 
 time less easily digested. In choosing the various food- 
 stuffs, we must limit ourselves to those that can be eaten 
 raw, or, if already cooked, can be eaten with relish cold. 
 As regards fats, no foodstuff consisting mainly of this 
 substance can be eaten cold, with the exception of butter, 
 which is peculiarly unsuitable for transport, especially if 
 the climate is at all warm. The two foodstuffs which are 
 
FIELD-SERVICE RATIONS 
 
 137 
 
 suitable vehicles of this principle are bacon and cheese, and 
 these should undoubtedly be chosen. In addition to fat, 
 the latter supplies a substantial amount of protein, and the 
 former a little of the same substance. The sugar can be 
 supplied as such, or as chocolate. The ordinary chocolate 
 issued to the Royal Navy contains about 20 per cent, of 
 sugar and 30 per cent, of fat. Substance can be added 
 to the ration in the shape of biscuits, which supply both 
 protein and carbohydrate. As a merely tentative sketch 
 of such a ration, the following scale is suggested. It could 
 be packed in a portable form, and, with salt and tea added, 
 would be well within the necessary limits of weight. I 
 should feel inclined to add some beef extract purely as a 
 stimulant. 
 
 Suggested Scale for a Reserve Ration. 
 
 Substance. 
 
 Weight 
 (Avoir.). 
 
 Protein in 
 Grammes. 
 
 Fats in 
 Grammes. 
 
 Carbohy- 
 drates in 
 Grammes. 
 
 Calories. 
 
 Biscuit 
 Bacon 
 Cheese 
 Sugar 
 
 Chocolate . . 
 Tea . . 
 
 8 oz. 
 4 oz. 
 4 oz. 
 3 oz. 
 3 oz. 
 1 oz. 
 
 37 
 11 
 31 
 
 7 
 
 3 
 76 
 41 
 
 25 
 
 180 
 
 5 
 
 70 
 50 
 
 926 
 756 
 536 
 290 
 450 
 
 Total 
 
 1 lb. 6| oz. 
 
 86 
 
 146 
 
 305 
 
 2,960 
 
 The weight would be brought up to nearly 2 pounds, in 
 all probability, by the metal tins or wrappings in which the 
 various foodstuffs were packed for carriage. It seems to 
 me that it is on lines something like the above that a reserve 
 ration should be built up. 
 
 The composition of the various reserve rations of foreign 
 armies is given in Table J. The haversack ration of the 
 United States is the only one which appears to give an 
 amount of energy at all equivalent to the amount likely to 
 be demanded of the men under the conditions when a 
 reserve ration is likely to be required. 
 
 Emergency rations are rations composed of highly con- 
 centrated foodstuffs, weighing veryiittle, and supplying an 
 
138 MILITARY HYGIENE AND SANITATION 
 
 amount of energy that is not equivalent even to subsistence. 
 They are not used to any great extent. That issued in our 
 army weighs about 9 ounces, together with its enveloping 
 tin, and supplies about 900 Calories. It consists of a mixture 
 of Plasmon and chocolate. 
 
 Conclusion. — However many different scales of rations 
 may be fixed for an army, that one which is of real and 
 preponderating importance is the normal ration. This 
 should be so fixed that a man at ordinary times is getting 
 rather more than he really needs at the time itself. A great 
 deal of war consists of " that important strategical opera- 
 tion, sitting still," and it is during the conduct of this 
 operation that the soldier should be accumulating those 
 reserves of energy which, since they are part of his living 
 tissues, are always at his disposal, need no preparation, 
 and cannot be lost by carelessness in the supervision of 
 equipment. No harm can follow from high feeding if the 
 men are compelled, as I have already said, when speaking 
 of physical training, to keep themselves in good condition 
 by regular exercise during these periods of " sitting still," 
 whether in the form of play or drill. The soldier who is 
 always getting enough, but only just enough, to eat will be 
 so close to the edge of starvation that the first twenty-four 
 hours on short rations will be felt by him. The well-fed 
 man, trained rather big, will be able to tide over several 
 days of starvation if only he has something in the way of 
 a fairly substantial ration to stay the natural cravings of his 
 gastric mucous membrane for occupation. The real solu- 
 tion of the reserve -ration problem lies not in the reserve 
 ration itself, but in a liberal diet at all times when a liberal 
 diet is procurable. 
 
CHAPTER IX 
 
 WATER 
 
 Water, considered chemically, is a compound of hydrogen 
 and oxygen, in the proportion of two volumes of the former 
 to one of the latter. Considered physically, it is a fluid 
 which is incompressible, and seeks to find its own level — 
 points of great importance in connection with sanitary and 
 hydraulic engineering. Further, it is odourless, tasteless, 
 and, except when seen through a considerable depth, 
 colourless. In respect of its reaction on the ordinary senses 
 of sight, smell, and taste, it is, therefore, devoid of special 
 character. Chemically pure water is, however, never met 
 with in Nature in any serious quantity. The sanitarian, 
 in fact, does not deal outside the laboratory with HgO, 
 but with HgO + o;. In the same way he does not deal with 
 the characterless fluid described above, but with one which, 
 in the great majority of cases, does possess some colour, 
 taste, or smell, though perhaps only to a very slight degree. 
 The possession of any such character points to the presence 
 in the water of some substance in addition to the natural 
 constituents, hydrogen and oxygen — ^to some x, in short — 
 which may or may not be harmless, but in any case is an 
 addition which must be identified and its character noted, 
 in case it should be a possible cause of disease. 
 
 Circulation of Water. — ^AU the water in the earth or 
 in the superjacent atmosphere is in a constant state of 
 movement in a circular direction. Starting with its con- 
 densation in the atmosphere, it falls on the earth in the form 
 of rain, dew, snow, or hail ; it then either sinks into the 
 earth, runs over its surface, is absorbed by the vegetation, 
 or is again evaporated into the atmosphere. The great 
 bulk of it after a longer or shorter journey fiows into the 
 sea or the larger lakes, from the surface of which it again 
 
 139 
 
140 MILITARY HYGIENE AND SANITATION 
 
 evaporates, and is taken up into the atmosphere, to be 
 once more condensed into one of the four forms already 
 mentioned. The process may be looked upon as a gigantic 
 and automatic system of natural purification and distri- 
 bution, in which the same mass of water is perpetually 
 furnished for the use of man, and, after pollution as a result 
 of that use, is purified by distillation, and again supplied 
 for fresh use. Man collects the water he needs at any 
 point in the system of circulation that is most convenient, 
 and it is worth keeping in mind that the farther that col- 
 lection-point is removed from the original starting-point of 
 condensation in the atmosphere, the greater is the change 
 that will have occurred in the original, pure, characterless 
 chemical compound, H^O. The larger, therefore, will be 
 the potential number of ic's present, each of which may 
 be a possible cause of disease, whose presence must, in any 
 case, be taken into account, and its significance decided. 
 
 The Uses of Water. — Man uses water in two ways — 
 namely, as drinking-water and as washing-water. Under 
 drinking-water I include, of course, that used in cooking, 
 and under washing-water that used for cleansing the body, 
 clothing, utensils, or the surroundings of man. But to 
 whatever use the water is put, it eventually again rejoins 
 the great cosmical circulation. It is essential to remember 
 this point, because if man withdraws water in any large 
 amount from that circulation for his use, the responsibility 
 devolves on him of facilitating its immediate return to that 
 system. In other words, every water-supply installation 
 demands an equivalent water-removal system. This im- 
 portant point has not always been kept in mind, especially 
 in large stations in India, where Excellent dr in king-supplies 
 of water have been furnished in liberal quantities, but no 
 coincident thought taken as to its removal after use. 
 
 In whatever manner water is made use of, however, it 
 must always be considered under six headings — viz., 
 quantity, quality, collection, storage, distribution, and 
 purification. 
 
 I propose, therefore, to consider water under these various 
 headings in detail, and in doing so will follow the course of 
 water through the circle which it follows in the air and in 
 or on the earth, as already described. 
 
WATER 141 
 
 Quantity. — Quantity comes to be considered logically 
 first, since it is impossible to predicate the quality or con- 
 sider the use of that whose existence has not been abso- 
 lutely proved. This is one of those truisms which is so 
 obvious that its existence is apt to be ignored. In the 
 extreme way in which it is stated above, no sane person 
 would think of disputing it, but the problem as it faces us 
 in actual practice is not so baldly stated. " Quantity," in 
 the sense in which the sanitarian uses the word when 
 dealing with water-supply, means sufficient quantity ; and 
 it is often forgotten that no system of water-supply is a 
 good system, no matter how excellent the quality or how 
 perfect the arrangements for collection, storage, distribution, 
 and, if necessary, purification, unless there is a certainty 
 not only of the water being there, but of its always being 
 there, and always there in sufficient quantity. Between 
 two supplies, one of which is good in quality, but precarious 
 in quantity, and the other plentiful, but dangerously 
 polluted, the choice must always lie in favour of the second, 
 no matter whether it be more difficult to collect and dis- 
 tribute or not. These are engineering questions that can 
 always be solved, and even the most polluted water can be 
 successfully purified. If the wrong choice be made and 
 the decision given in favour of quality as against quantity, 
 then assuredly some day the supply will fail, and the com- 
 munity will be driven, unprepared, to meet the engineering 
 difficulties, and unprovided with an efficient system of 
 purification, to fall back on the plentiful but dangerous 
 source which it previously rejected. 
 
 Quantity of Water Necessary Daily. — The daily needs of 
 man may be divided into personal, domestic, and municipal. 
 For his personal use — ^that is, for drinking, cooking, and 
 personal ablution, he requires about 6 gallons, which 
 admits of the use of a sponge bath. If a large bath be 
 indulged in, then, naturally, the amount may be as high as 
 ten times that allowance. For domestic use — that is, for 
 cleansing of utensils and linen, scrubbing, flushing of 
 water-closets, etc. — it is safe to allow twice the first-named 
 amount — say 12 gallons. For municipal demands — that is, 
 for street-cleaning, fire-extinguishing, and so on — another 
 12 gallons may be allowed, making the total daily demand 
 
142 MILITARY HYGIENE AND SANITATION 
 
 about 30 gallons per head in round numbers. The amounts 
 actually supplied in any town vary considerably in this 
 country — from 15 and 16 gallons at Stamford (1907) and 
 Leicester (1906) to 62 J gallons at Whitehaven (1906)— but 
 the average allowance comes to close on the above figure. 
 In barracks the amounts laid down by regulation are : 
 20 gallons a day for each man, woman, or horse ; and 
 10 gallons a day for each child ; 50 gallons a day are allowed 
 for personnel and patients in military hospitals. The total 
 allowance for an infantry battalion, 950 officers and men, 
 with about 50 families, is laid down in the " Water-Supply 
 Manual " at 30,000 gallons a day, including water for roads, 
 and gardens, and flushing drains. Ten per cent, extra is 
 allowed in the Service reservoirs on account of fire. 
 
 In the French Service a total of 30 litres (6^ gallons) is 
 allowed per head, as follows : 8| pints for drinking, the 
 same for cooking, for the hospital, and for general cleaning ; 
 7 pints are allowed for ablution, and 10 J pints for laundry. 
 A mounted man gets 5 litres (8f pints) more than the above. 
 Lemoine considers this too low, and recommends an increase 
 up to 53 litres (11 J gallons), increasing the lavatory and 
 laundry supply. Kirchner gives the German allowance at 
 50 litres (nearly 11 gallons), and the Austrian at 40 litres 
 (8 gallons 6 pints). 
 
 In tropical stations larger quantities should be allowed, 
 principally on account of the greater amount expended on 
 personal ablution and the washing of clothes. In practice 
 the British officer does use very much more than that 
 above laid down for personal use. It would undoubtedly 
 be well if the soldier could also be supplied with enough for 
 a satisfactory shower-bath daily. This would add 12 gallons 
 to the present amount, and the question of removal would 
 be a serious matter in stations where the gradient is slight. 
 
 The allowance of water on service constitutes a serious 
 problem only in countries where water is scarce, and has 
 to be carried — as, for instance, in the Soudan. The allow- 
 ance then should be about J gallon as a minimum. The 
 amount and nature of the transport available is, of course, 
 the deciding factor. 
 
 The consideration of the quantity of water that should be 
 allowed on the march, depending, as it does, almost entirely 
 
WATER 143 
 
 on the exertions demanded of the men and the weather con- 
 ditions, falls more naturally to be considered under the 
 chapter devoted to the problems involved in " marching." 
 
 Quantity of Water derived from Rainfall. — The amount of 
 water that can be obtained from the rainfall depends 
 primarily on two factors — viz., the depth of the annual 
 rainfall, and the area available for collection. This obviously 
 gives the maximum quantity available under theoretically 
 perfect conditions. In practice many deductions have to 
 be made. Thus, for instance, the distribution of the rainfall 
 in point of time is of the greatest importance. A much 
 larger amount can be collected in stations where the seasonal 
 rains fall continuously and heavily over a short period 
 than in another where a large amount of total precipitation 
 occurs, but in isolated, comparatively light, showers. 
 
 A certain amount may also have to be lost where the first 
 washings of the collecting areas are rejected. In calculating 
 the total area available for collection, allowance must be 
 made for the gradient at which this is sloped. It is not the 
 actual area, but its horizontal equivalent that is of impor- 
 tance. This warning is hardly necessary in the case of 
 house -roofs, since the gradients are so steep that the pre- 
 caution is less likely to be omitted. In the case of pre- 
 pared areas in fortifications, where the slope is less obvious, 
 it is occasionally apt to be forgotten. In calculating in 
 advance the amount of rain that will be available in any 
 station, it is usual to take the average of the three driest 
 years on record. This lies between 70 and 80 per cent, 
 of the average fall. Of this amount about 75 per cent, will 
 be reaUy available. 
 
 Quantity of Water available from the Earth. — If water is 
 not collected as rain or dew, it must be collected after it 
 has reached the surface of the earth. Here one of four 
 things happen to it. It either sinks into the earth, runs 
 over its surface, is absorbed by vegetation, or evaporated 
 back into the air. The proportion which runs over the 
 surface or sinks into the earth is that alone which is naturally 
 available for purposes of water-supply. The ratios which 
 these amounts bear to each other and to the total amount 
 of water that actually reaches the earth's surface vary almost 
 infinitely with the local meteorological, botanical, and 
 
144 MILITARY HYGIENE AND SANITATION 
 
 geological conditions. According to Woodward (" Geology 
 of Water-Supply," p. 52), the amount of water that perco- 
 lates in Britain averages from one-quarter to one-fifth of 
 the rainfall, whilst the " surface run-off " is about one- 
 sixth. Vegetation and evaporation from the surface 
 account for the remaining two-fifths. No such rules can 
 be held to apply to any place but that in which they are 
 formulated. In any new station, if accurate calculations 
 are required, then accurate observations must be made. 
 Ordinarily, however, it is possible to arrive at a reasonable 
 estimate after a careful study of the local conditions. 
 
 The water that runs off over the surface forms streams, 
 rivers, ponds, or lakes, and these are obvious sources of 
 water-supply, providing quantities proportionate to their 
 size, and in the case of moving waters, streams, or rivers, 
 to the rapidity of their flow as well. It is unlikely that the 
 medical officer will ever be asked to give more than a rough 
 estimate of the yield of such sources of supply, and for 
 this purpose the methods described in the " Eield-Service 
 Pocket-Book " are sufficient. Accurate calculations would 
 devolve naturally on the Royal Engineer officer concerned. 
 Dealing, then, purely with quantity, it is unnecessary to 
 dilate farther on the water derived from " surface run-off." 
 That water which percolates into the earth now demands 
 attention. This water sinks into the earth until it reaches 
 a stratum of rock that imposes an impermeable, or relatively 
 impermeable, barrier to its farther progress. When this 
 occur^s, the water in question spreads laterally in the line 
 of least resistance, and forms what is called the " ground- 
 water," or, when very close to the surface, the " sub- 
 soil water." This may occur at any distance from the 
 surface, depending solely on the depth of the first im- 
 pervious, or so-called impervious, layer. At the same 
 time, since no rock is absolutely impervious, and every 
 rock, however impervious in texture, is liable to Assuring 
 and other breaches of continuity, water can descend to 
 even greater depths, and at any one point on the surface. 
 If we descend vertically, we shall find several layers of 
 ground water, each lying in a pervious and on an impervious 
 stratum of rock. 
 
 A "water-bearing"' stratum is one which, being itself 
 
WATER 145 
 
 pervious, allows of the free passage of water in any direction 
 through its substance, the farther downward movement 
 of the fluid being obstructed by some subjacent, com- 
 paratively impervious, rock. The mere power of retaining 
 water does not make a stratum water-bearing. If this 
 property is due to the intimate structure of the rock, as 
 in the case of the London Clay, then the " water-bearing " 
 capacity is in inverse ratio to its " water-holding " power. 
 The water-holding power of a water-bearing rock is con- 
 ferred on it by the presence of the impervious layer below, 
 and is not the result of its own intimate structure. 
 
 In the more superficial strata it is probable that the 
 ground or subsoil water forms a more or less continuous 
 subterranean sheet, but the deeper we descend the more 
 likely it is that we shall find this continuous sheet broken 
 up into discrete lagoons, or even well-defined river-beds 
 whose direction may in no way agree with the lines of the 
 surface drainage. 
 
 The quantity of water held in any water-bearing stratum 
 will depend on four factors. Firstly, of course, on the 
 amount of rainfall ; secondly, on the amount actually 
 percolating to the depth under consideration ; thirdly, on 
 the slope or " dip " of the impervious stratum ; and fourthly, 
 on the retaining power of the water-bearing stratum. It 
 is obvious that, comparing different water-bearing strata 
 in the same conditions as regards locality, the two last- 
 named factors are of paramount importance. The water 
 having penetrated as far as the " impervious " stratum, 
 wiU flow more quickly downwards if that stratum lies at 
 a steep dip, or if the water-bearing rock possesses a high 
 degree of permeability ; on the other hand, it wiU accumu- 
 late to a greater depth if the " impervious " stratum is 
 horizontal, or nearly so, or the water-bearing layer is of a 
 comparatively retentive character. 
 
 The quantity of water that can be procured from any 
 stratum will, naturally depend on the quantity retained, 
 and this naturally varies with the character of the various 
 water-bearing rocks. But it also depends on the freedom 
 with which the water-bearing stratum will part with its 
 water. The net result — i.e., the water-supply — is therefore 
 the product of many factors. For instance, a loose sand 
 
 10 
 
146 MILITARY HYGIENE AND SANITATION 
 
 lying on a horizontal bed of clay will yield a copious supply 
 of water, since it itself imposes just enough resistance to the 
 flow of the ground-water to oppose its escape in a lateral 
 direction, but yet not enough to impede its collection by 
 mechanical means^ — e.g., pumping. On the other hand, a 
 stiff clay — e.g., china clay — may hold as much as 70 per 
 cent, of its bulk of water, owing to the great, though not 
 absolute, resistance that its texture imposes to the passage 
 of the fluid. At the same time this resistance prevents any 
 large supply of water being drawn from the mass present, 
 since it impedes the movement necessary to fill a well or 
 supply a pump. It is impossible in a work of the dimensions 
 of the present one to discuss fully the many relations of 
 the underground water. For such the reader is referred to 
 Woodward's " Geology of Water-Supply," which enters 
 into considerable details on these points, and is an invalu- 
 able handbook to any officer specially engaged in water- 
 supply work. 
 
 Springs and Wells. — If the surface of the ground be sloped 
 at an angle steeper than that at which the impermeable 
 stratum " dips," then it is obvious that the underground 
 water, flowing through the water-bearing stratum which 
 lies on the impervious one, will eventually appear at the 
 surface either as a spring, or a line of springs, or as a diffuse 
 oozing that goes by the descriptive name of " seepage." 
 Various other causes conduce to the formation of springs, 
 but in all the same principle is present. The water 
 comes to the surface, and is there available for the use of 
 man, as the result of the action of gravity acting against 
 and along certain planes or lines of resistance. If the 
 underground water does not come to the surface, then man 
 digs a well, which passes down to the water-bearing stratum, 
 and by purely mechanical means — pumping, etc. — fetches 
 it to the surface. Except for the fact that in the one case 
 the means are what we call " natural," and in the other 
 " artificial," there is no difference in the supply provided by 
 a spring or a well. The quantity to be obtained from a 
 spring or from a well varies, however, in the following 
 manner, supposing the permeability of the water-bearing 
 stratum to be the same in both cases : In the spring the 
 delivery is proportionate to a vis a tergo — to the pressure — • 
 
WATER 147 
 
 that is, the depth of water in the water-bearing stratum. 
 In the well the delivery is due to a vis a f route — the suction 
 of the pump that drags the water to the surface. 
 
 Regularity of Supply from Springs and Wells. — The regu- 
 larity of supply from a spring or well will depend on the 
 distance which the water has had to traverse subter- 
 raneously, or the resistance which it has had to overcome 
 from the time when it first struck the surface of the earth 
 to the time at which it is placed naturally or artificially at 
 the disposal of man. It is easily comprehensible that if 
 the water which falls as rain has only a few feet of earth 
 to pass through before it reaches a weU or spring, that well 
 or spring will vary closely in its output with the daily or 
 weekly supply of rain. The greater the distance which has 
 to be traversed, the less close will be the connection, till 
 after a certain time neither well nor spring is influenced by 
 daily, monthly, or even annual variations in the local 
 rainfall. This distance need not necessarily be vertical — 
 in fact, it is immaterial in what direction the water has 
 travelled. All that is necessary is that the resistance im- 
 posed should have been sufficient to "tail out," so to 
 speak, the various detachments of water, representing the 
 various showers of rain, on their passage through the ground, 
 so that the originally existing distinctions imposed by 
 difference in original date shall be gradually smoothed 
 out, and the intermittent downfall of rain transformed into 
 the steady output of the permanent spring or the reliable 
 well. 
 
 Wells differ from springs as sources of supply in one 
 very important manner. Since the delivery of a well 
 depends very largely on the vis a fronte imposed by the 
 action of pumping, any great variation in that demand 
 — ^especially, of course, in the direction of an increase — 
 may cause a serious disturbance in the water-bearing 
 stratum, and therefore a marked alteration in the amount 
 provided. Supposing a well, for instance, to be pumped 
 for ten hours a day continuously, and to deliver 100,000 
 gallons a day with absolute regularity over a long period. 
 This fact gives us no guarantee that twenty hours' pumping 
 will yield 200,000 gallons a day. Such a disturbance may 
 open up new sources of supply, or may temporarily 
 
148 MILITARY HYGIENE AND SANITATION 
 
 exhaust, or even close, existing sources. Another fallacy- 
 has to be guarded against. I have known it suggested in 
 the case of a failing supply that more wells should be 
 dug. Such a resort may succeed if the scantiness of the 
 output is due to deficient means of collection in the presence 
 of an ample subterranean supply. If the deficiency be 
 due (as in a case which I have in my mind, in which such 
 a suggestion was made) to a failing underground reservoir, 
 then it is as futile to hope to increase your supply by 
 adding to the number of your wells as it would be for a 
 man to increase his income by multiplying the number of 
 his cheque-books. In either case he will be merely in- 
 creasing the draft on a slowly waning balance, and the 
 result will as surely be a water famine in the one case as 
 it will be bankruptcy in the other. 
 
 Artesian Wells. — These are wells in which the water rises 
 to the surface, or even overflows, as a result of subter- 
 ranean hydrostatic pressure. They are, in fact, not so 
 much wells as springs, to which an artificial outlet has 
 been provided. A typical instance of their formation may 
 be noted in the London Basin. Here we have a water- 
 bearing stratum, the Chalk, lying on the impervious Gault 
 Clay, and dipping under the London Clay. Rain falling 
 on the Chalk hills that encircle London sinks down through 
 the pervious Chalk, and is held up in a natural basin by 
 the underlying Gault. A bore driven down through the 
 London Clay gives an outlet to the pent-up supply, which 
 is forced to the surface by its own hydrostatic pressure, 
 since the water-level in the Chalk is higher than the level 
 at which London stands. Artesian wells give supplies 
 which are extremely constant as regards quantity, and 
 from their nature are, after the primary cost of boring, 
 cheap in the matter of working expenses. It is dangerous, 
 however, to suppose that because a copious supply has 
 been procured from one artesian well we can count firmly 
 on duplicating the supply from other borings. The water 
 that is delivered from artesian wells is held chiefly in 
 fissures, and later borings may fail to hit o£E satisfactory 
 reservoirs, or may interfere with previously successful wells. 
 
 Quality. — The quality of a water depends on the matters 
 added to the water subsequently to its condensation in 
 
WATER 149 
 
 the atmosphere up till the time at which it is taken by 
 man for his use. These substances are taken up from 
 the air or the earth, and their real significance, from the 
 point of view of the sanitarian, is that they furnish a record 
 of the path taken by the water under consideration during 
 the time that has elapsed since its first condensation. 
 From this he is able to calculate whether it has undergone 
 any risk of being contaminated by the actual causes of 
 disease. 
 
 Quality of Rain- Water. — The first additions to the water 
 are the various gases existing normally in the atmosphere 
 which are taken up by it in solution. In the neighbour- 
 hood of manufacturing towns various other gases may 
 be absorbed, but from the point of view of the sanitarian 
 these are of the less importance, since rain-water is not 
 collected for drinking purposes in the neighbourhood of 
 such localities. The most important of the gases that 
 are taken up by the falling rain is carbonic acid, on account 
 of the solvent action which it exercises on the alkaline 
 carbonates. In addition to these gases, the rain takes 
 up in suspension floating particles of dust, etc., and a 
 certain number of bacteria. It is extremely doubtful, 
 however, if these particles, even when they happen to be 
 specific micro-organisms, have any sensible effect on the 
 water in the direction of causing disease. I should feel 
 inclined to hold that up to the moment at which the rain 
 touches the prepared collecting surface the additions which 
 have been made to the water are small in amount, and 
 negligible as regards importance. The serious additions 
 are furnished not by the air through which the rain passes, 
 but from the surface on which it falls. It is obvious that 
 in the period that elapses between showers the collecting 
 surface, whether it be a roof or a prepared area in a fortifica- 
 tion, is open to contamination by debris, animal or vegetable 
 in their origin — e.g., bird droppings — and by wind-borne 
 particles of all possible descriptions. This is so obvious 
 that where roof- collected rain-water is used for purposes 
 of supply it is usual to reject automatically the first washings 
 off the roof. 
 
 In Gibraltar and Bermuda the entire water-supply of the 
 garrison is procured from rainfall, collected either on roofs 
 
150 MILITARY HYGIENE AND SANITATION 
 
 or on prepared areas. In the former station the water 
 contains large numbers of Bacillus coli, this micro-organism 
 being present often in samples as small as 1 c.c, and almost 
 invariably in 10 c.c. The supply in Bermuda also 
 contains large numbers of organisms which appear to be 
 related to the Coli group, though of an aberrant type. In 
 neither of these stations, however, have any outbreaks of 
 disease been traced to the water-supply, and it is certain 
 that standards of purity suitable for localities where the 
 water is derived from subterranean or surface sources 
 cannot be held applicable to rain-water supplies. Naturally, 
 collecting areas must not be placed in close proximity to 
 sewage-disposal works or filth trenching-grounds. Unless 
 so placed, there is no evidence at present that the additions 
 made to the water at this stage have any definite sanitary 
 significance. 
 
 Quality of Ground-Water. — The water which sinks into 
 the earth at once begins to take up substances in suspension 
 and solution. Of those which it dissolves some are taken 
 up by the inherent solvent power of water, others by the 
 action of the carbonic acid previously absorbed from the 
 atmosphere or from the soil itself. These last are the 
 alkaline carbonates, of which the most important is car- 
 bonate of lime. These salts render the water " hard," but 
 since their presence depends only on the solvent power of 
 the predissolved carbonic acid, the hardness they produce 
 is commonly called " temporary hardness." Any agent 
 which drives off or is able to combine with this carbonic 
 acid, will immediately rob the water of its alkaline car- 
 bonates, and thus remove the " temporary hardness " 
 which they produce. The farther the water sinks through 
 the earth the greater the amount of substances it will dis- 
 solve, and these, which are not held in solution by the 
 presence of the carbonic acid, constitute the " permanent 
 hardness." The most important are the sulphates of lime 
 and magnesia, but different rocks give up different sub- 
 stances, some of which, as in the case of the saline springs, 
 materially affect the taste of the water, and confer on it 
 various medicinal properties. It is very doubtful whether 
 the carbonates and sulphates which produce temporary 
 and permanent hardness have any serious effect in the 
 
WATER 151 
 
 direction of disease production. Individuals moving sud- 
 denly from a " soft " water to a " hard " water district 
 are apt at first to suffer from constipation and other digestive 
 disturbance, or in some cases from rheumatic symptoms ; 
 but in the majority of cases these effects are purely tem- 
 porary. 
 
 The chief significance of " hardness " is economic. Such 
 waters cause a great destruction of soap, owing to the 
 formation of insoluble oleates, and from this cause alone it 
 was calculated that the city of Glasgow saved £30,000 a 
 year after the introduction of the Loch Katrine water. A 
 considerable waste of fuel also results from the formation 
 of a thick fur deposited on the inner surfaces of kettles 
 and boilers, and also owing to the fact that meat and vege- 
 tables have to be boiled for longer periods in a hard than in 
 a soft water. On the other hand, hard waters are preferred 
 for certain trades — e.g., brewing — as exemplified by the 
 well-known hard water of Burton-on-Trent. Goitre has 
 been attributed to the presence of certain dissolved mineral 
 matters in water, but this disease occurs under so many 
 different combinations of conditions that it has not yet 
 been found possible to identify any one factor common 
 to all. After the salts which produce hardness, the most 
 important of all matters taken up by the water in its 
 passage through the earth is chloride of sodium. This 
 substance does not of itself possess any importance. It 
 causes no disease, even when present in quantities sufficiently 
 large to affect the taste, and therefore the potability, of 
 the water. The significance of this salt lies in the fact 
 that, being a constant ingredient of urine, and therefore 
 of sewage, its presence in water may point to the con- 
 clusion that at some time or other that water was con- 
 taminated by sewage, and therefore potentially by disease 
 germs. But here, again, it is important to note that the 
 mere presence of the salt is of no value as evidence of con- 
 tamination. AU waters practically contain some chloride 
 of sodium ; some of them contain even considerable quan- 
 tities, derived purely from mineral sources, and therefore 
 absolutely devoid of significance from a sanitary point 
 of view. The important point to ascertain is, first, the 
 normal chloride content of the water. If this remains 
 
15^ MILITARY HYGIENE AND SANITATION 
 
 unchanged, then there is no danger to be apprehended, 
 but any marked increase is a warning whose meaning must 
 be elucidated. The usual limit laid down is about 4 parts 
 per 100,000, but such a rule has no validity. Three parts 
 per 100,000 in a water whose normal content was one part 
 would mean danger, whereas seven parts would possess no 
 importance if this represented the usual proportion found 
 by analysis. An excess of chlorine is found in certain 
 geological formations — e.g., the Permian — also in wells near 
 the sea, or in surface-waters in districts exposed to constant 
 strong sea-winds — e.g., Cornwall. 
 
 It should be noted by the military sanitary officer that 
 the chlorine figure is almost invariably high in the well- 
 waters of Upper India. 
 
 In addition to these purely mineral matters, the water 
 in its passage through the earth takes up in solution 
 certain nitrogenous compounds which are entirely of organic 
 origin, and due to the decomposition of organic matter, 
 animal or vegetable, lying on or underneath the surface. 
 The importance of these substances lies in the fact that 
 they not only point to pollution by organic matter, which 
 may possibly be of animal, and therefore, possibly, also of 
 human, origin, but that by the stage of oxidation to which 
 the nitrogen has advanced they also give some clue to the 
 length of time that has elapsed since the organic matter 
 was originally deposited in or on the earth. One of the 
 earliest products of decomposition of organic nitrogenous 
 material is ammonia, which, by process of oxidation, is 
 converted first into nitrous acid, and later into nitric 
 acid, these last being found in the water as nitrites and 
 nitrates respectively. These substances are derived in- 
 variably, it may be said, from organic matter originally. 
 On the other hand, all waters contain a certain amount of 
 ammonia, which may be derived even from the air, and the 
 presence of free ammonia, therefore, in small amounts is 
 not considered of serious importance. The presence of 
 large amounts of ammonia, or of even small quantities 
 of nitrites, is held, however, to point distinctly to organic 
 contamination having occurred at no very distant date. 
 Nitrates represent the ultimate stage of oxidation, and 
 therefore do not possess the same significance, since they 
 
WATER 15^ 
 
 may originate from organic matter of geologic date. Nitrates 
 may be reduced again to nitrites, but in shallow well-waters 
 this is rare, if, indeed, it ever occurs. 
 
 The evidence offered by the presence of these nitrogenous 
 compounds is, therefore, of very great value if properly 
 weighed. Two points only must be kept in mind in 
 estimating the value of that evidence. The first is that 
 the significance of the fact that ammonia, nitrites, or 
 nitrates are present in the water consists in their pointing 
 to contamination by organic matter, which may be, first, 
 possibly of animal origin ; secondly, possibly faecal ; thirdly, 
 possibly human ; and, lastly, may possibly contain the 
 germs of some water-borne disease. The chain is neither 
 short nor direct, and conclusions which would be quite 
 justifiable under conditions such as we are accustomed to 
 in these islands might be extremely unsound in countries 
 where the soil and climate differ very materially from those 
 of Great Britain. The experience of many years has shown 
 that in this country it is safe to connect certain facts at 
 one end of that chain with certain conclusions at the other. 
 That experience is not sufficient to enable us to say that, 
 under all conditions and in all circumstances, the same 
 line of argument will hold. Dealing, as we, the medical 
 officers of the army, often have to do, with conditions 
 which are strange to us, it is necessary to reopen, as it 
 were, the case at every fresh station at which we serve. 
 The second point to be remembered is that these matters 
 are in themselves innocuous. They are not dangers, but 
 only danger-signals. 
 
 Amongst the organic substances taken up from vege- 
 table matter must be mentioned humic acid. This is 
 present in a large number of moorland waters, and where 
 these come into contact with lead, whether in the form 
 of lead ore in the earth or lead piping in the system of 
 distribution, they are apt to dissolve a sufficient amount 
 of that metal to cause poisonous symptoms. Numerous 
 cases of lead-poisoning have been traced to this cause in 
 the North of England ; in Northumberland a great deal of 
 the underground water is rendered unfit for use in con- 
 sequence. A similar action takes place in the case of zinc, 
 and an upland water may dissolve this metal from gal- 
 
154 MILITARY HYGIENE AND SANITATION 
 
 vanized iron pipes or cisterns, especially when these are 
 new. In the case of a new installation at the Cordite 
 Factory in the Nilgiri Hills zinc was present in the water 
 delivered to the factory to the extent of 1 part per 100,000, 
 but has now, after a lapse of five years, disappeared. No 
 bad effects were experienced by the people who consumed 
 this water, though the metal persisted for at least two 
 years. 
 
 In addition to the substances which it dissolves, the 
 water also takes up certain matters in suspension. Just, 
 however, as the amount of dissolved matters increases 
 with the distance through which the water has perco- 
 lated through the earth, so that of suspended matters 
 diminishes. The earth, in fact, acts as a very efficient form 
 of filter. Suspended matters may be divided into animate 
 and inanimate. The latter are of little importance, as a rule, 
 unless present in such quantities as to render the water 
 obviously turbid. In the case of surface supplies or shallow 
 wells it is possible, especially under service conditions, that 
 the water may contain such matter in quantity sufficient to 
 act as a direct mechanical irritant to the mucous mem- 
 brane of the alimentary canal. In India fine particles of 
 mica are sometimes found in the waters of the Himalayan 
 hill-stations, and have been accused of causing that trouble- 
 some disease, hill diarrhoea. This can hardly be held to be 
 proven as yet. Perhaps some cases have this etiology, but 
 many are undoubtedly of microbial origin, and related 
 closely to sprue. In the South African War the suspended 
 matters in the water of some rivers were accused of causing 
 diarrhoea. Other suspended matters are those which 
 originate from human clothing, such as fibres of linen, 
 wool, or cotton, or from the human body, such as scales 
 of epithelium or hairs. The significance of these lies, of 
 course, in the fact that they point to the possibility of 
 contamination by human excreta, either directly or as a 
 result of the washing of soiled clothing. 
 
 By far the most important of the suspended matters 
 belong, however, to the animate class. This class includes 
 the various entozoa, and also, and most importantly, 
 various micro-organisms. These belong to two classes — 
 (1) those which actually cause disease, and (2) the micro- 
 
WATER * 155 
 
 organisms which constitute the normal flora of the human 
 intestine which constantly accompany those pathogenic 
 germs. The entozoa need not detain us. 
 
 The micro-organisms which actually cause disease are 
 those of cholera, enteric fever, and dysentery, and their 
 constant concomitants are the Bacillus coli in the first place, 
 and less importantly the streptococci, and the B. enteritidis 
 sporogenes. I need hardly say that the presence of even 
 a single disease -producing microbe in a water sample would 
 suffice to condemn the source at once. In the case of cholera 
 the specific spirillum can be isolated and identified in water 
 with comparative ease. In the case of enteric fever this 
 is, however, not the case. It is, in my opinion, doubtful 
 whether this micro-organism has ever been isolated from 
 a natural water to which it hsid not been purposely added. 
 In the earlier days of bacteriological research I am aware 
 that this discovery was reported with considerable frequency, 
 but the evidence which was then considered sufficiently 
 strong to decide the question in the affirmative would not 
 be accepted nowadays. The present practice is to limit 
 the search for micro-organisms to the B. coli almost ex- 
 clusively. The presence of this bacillus in any great 
 numbers would, if supported by the results of a chemical 
 examination and of an examination of the source from 
 which the water was drawn, justify us in condemning the 
 water for use. Here, again, as in the case of chlorine and 
 nitrogenous compounds, we are relying not on the actual 
 discovery of the cause of disease, but on the presence of a 
 certain substance in the water, which must inevitably be 
 there if the disease cause exists in the source. The exact 
 number of germs of this species which would justify us in 
 condemning a water cannot be laid down with any certainty. 
 The surroundings must be taken into consideration, and the 
 evidence from all sides carefully balanced. It is not so 
 usual at the present day to search for streptococci and for 
 B. enteritidis sporogenes, as used to be the case some few 
 years ago. Their presence would certainly not weigh 
 against the evidence furnished by the non-discovery of 
 B. coli, though this result might cause grave doubts as to 
 the skill of the analyst. On the other hand, a positive result 
 obtained in an examination directed to discovering this 
 
156 MILITARY HYGIENE AND SANITATION 
 
 last-named micro-organism would be neither strengthened 
 nor weakened by the presence or the absence of the other 
 two. 
 
 If we consider the impurities which water takes up 
 from the air and the earth in its passage through these 
 media, we see that, whilst the alkaline carbonates may 
 in special instances cause dyspepsia or rheumatism, and 
 the acids present in the softer waters may accidentally be 
 the origin of lead-poisoning, the only true disease causes 
 added to the water are the eggs of certain entozoa and the 
 micro-organisms of the water-borne diseases. 
 
 All examinations intended to decide the quality of a 
 water are directed to ascertaining this last point, but in 
 doing so we are guided, as regards chemical and bacterial 
 examinations, by the presence or absence of certain other 
 additions or impurities which are not in themselves patho- 
 genic, but which, since they must be present if the disease 
 cause is present, act as danger signals, showing the possi- 
 bility at least of pollution. It must be remembered that 
 we can only say of these matters that they must be present 
 if the disease cause is present, not, as it would seem, from 
 the use made of such evidence by some that the disease 
 cause must be present because they are present. Our 
 deductions, then, can only be looked on as not unjustifiable 
 inferences, by no means as certain, logically proved facts. 
 
 This brings us to the very important question of the 
 methods to be adopted for the purpose of ascertaining the 
 quality of a water. There are three of these at our dis- 
 posal : (1) An inspection of the source from which the water 
 is derived and its surroundings ; (2) a chemical, and (3) a 
 bacteriological examination of certain small samples of the 
 water itself. If it is desired to give a complete report on 
 any water, all three methods must be made use of ; but 
 if any one is to be dispensed with, then it must be one 
 of the last two. The first method, primitive though it may 
 seem, is absolutely essential. It is worth while to con- 
 sider shortly the nature of the evidence furnished by these 
 different methods of examination. By the first we can 
 learn all the possibilities that exist for contamination 
 of the water ; we may even be able to say definitely that 
 such and such a definite contamination has occurred. If 
 
WATER 157 
 
 contamination be present, we can decide whether it is 
 casual or of a permanent, unavoidable nature, and in the 
 former case, whether any measures of prevention are likely 
 to be successful, and, if so, what such measures should be. 
 We can also decide whether the contamination is due to 
 human or only to animal excreta. In the case of the bac- 
 teriological and chemical examinations we can only say 
 that in a certain small amount of water — say half a gallon^ — 
 we have found, or failed to find, certain chemical substances 
 or certain micro-organisms which would certainly be present 
 if faecal contamination had occurred. We can also lay 
 down roughly the probable date of the contamination. We 
 can give no opinion as to the actual nature of the con- 
 tamination, whether human or animal. In the case of 
 the chemical examination it is not always possible even 
 to distinguish clearly between animal and vegetable, and 
 we can draw no deductions as to whether the contamina- 
 tion is due to some inevitable condition, or merely to some 
 passing accident. Repeated examinations continued over 
 a long period furnish, naturally, somewhat stronger evi- 
 dence ; but a true interpretation of the results obtained 
 can only be derived from an actual inspection of the 
 source. Two instances that I have met with during the 
 course of my service illustrate this point so clearly that 
 I venture to give them at length. In the first the water, 
 which issued from a large spring at the foot of the hills 
 near Chaman, on the Afghan frontier, was found to be 
 chemically and bacteriologically as free from contamination 
 as any water could well be. Ammonia and oxidizable 
 matters were almost absent, and the chlprine figure was 
 low. There were only one or two micro-organisms in 
 each cubic centimetre, and none of the intestinal group 
 were found. On inspection of the source, it was found 
 that a native cemetery was situated within 20 yards of 
 the mouth of the spring, and almost exactly above it. 
 There had been, so I was informed, no burial in the cemetery 
 for many years ; but, by a strange coincidence, one was 
 actually in progress at the time of my visit. The soil was 
 hard and impermeable, though liable to fissures. The 
 temperature was not much above freezing-point in the 
 day, and close to zero at night. It so happened that no 
 
158 MILITARY HYGIENE AND SANITATION 
 
 fissure had developed opening up communication between 
 one of the numerous graves on the hillside and the under- 
 ground channel of the water. At the same time such a rift 
 might at any moment develop, and, naturally, the source 
 was condemned. In the second case the water showed 
 abundant signs chemically of gross organic contamination, 
 and swarmed with B. coli. An inspection of the source 
 showed that the organic matter was largely vegetable 
 in its origin, whilst the fsecal contamination which the 
 result of the bacteriological examination pointed to was 
 due to the excreta of cattle and sheep. In the first case the 
 source could not well be protected, whilst in the second the 
 provision of a few hundred yards of wire fencing would 
 safeguard the supply with absolute certainty. Chemical 
 and bacteriological examinations, when they give positive 
 results, draw attention, it is true, to conditions which might 
 in their absence escape notice. They are, of course, also 
 useful aids in the administration of a water-supply system, 
 once that has been established. For open sources of supply 
 — and it is with these that on service we mostly have to 
 deal — they are by themselves most misleading. Negative 
 results are, of course, absolutely valueless. A great deal 
 of nonsense has, in my opinion, been talked about this point 
 of water examination on service. With fighting troops it 
 is unnecessary, since all water is ipso facto contaminated 
 if it come from open sources in a district which is the scene 
 of hostilities. It may be urged that this statement can 
 hardly hold good in the case of previously uninhabited, or 
 only sparsely inhabited, countries, such as our troops fre- 
 quently have to campaign in. A district may be abso- 
 lutely uninhabited prior to the arrival of an army, but once 
 that has taken place, it is obviously not only inhabited, 
 but, in the immediate vicinity of the force, densely in- 
 habited. The sanitary officer who, on the strength of 
 negative results obtained from a chemical or bacteriological 
 examination, permitted neglect of the usual methods of 
 purification would make a serious mistake. I repeat, then, 
 that it may be accepted as an axiom that on service all 
 open sources of water are ipso facto contaminated, and 
 therefore all equally demand purification. 
 
 The quantity and quality of the water available having 
 
WATER 159 
 
 been determined, it is necessary to consider next its collec- 
 tion, storage, and distribution, in the order named. Purifi- 
 cation comes in, of course, at some period in the series, 
 but will be considered most conveniently last of all. It 
 may be intercalated immediately after collection, in which 
 case the processes of storage and distribution must be so 
 conducted as not in any way to undo the work of the previous 
 process of purification. In any case, of course, it is im- 
 portant that the quality of the water should not deteriorate 
 during these processes, and, also, that there should be no 
 waste. 
 
 Collection. —Water may be collected as rain-water 
 immediately after it reaches the surface of the ground, on 
 specially prepared areas, or on roofs. As already stated, 
 such prepared areas are apt to be exposed to more or less 
 wind-borne contamination, from which it is impossible to 
 protect them. Prepared areas in fortifications and else- 
 where should be protected by means of barbed-wire fencing 
 from any casual trespass by men or animals. In fortifica- 
 tions it is the custom to paint these areas in squares of 
 different colours, so as to render them less conspicuous, 
 and thus avoid attracting hostile fire. It is important that 
 the pigments used should contain no lead or chromium, 
 which might be taken up by the water. Apart from the 
 above measures, but little is necessary or feasible. Where 
 water is collected from roofs, it is usual to reject the first 
 flow, which performs the function of washing the roof. 
 This is done by means of a mechanical contrivance called a 
 " Roberts rain-water separator." In this the first flow is 
 directed to waste, with the exception of a small portion 
 which collects in a canting chamber. When this chamber is 
 full, it tips over, operating a lever which directs the sub- 
 sequent flow to the storage reservoir. Purification of rain- 
 water by filtration should always be carried out, in view of 
 the inevitability of contamination, which may on occasion, 
 though not, I believe, frequently, be of a dangerous char- 
 acter. 
 
 Collection of Ground-Water. — Ground- water is collected 
 either from springs or wells. In the former case not much 
 need be said. The flow of the spring is impounded in a 
 reservoir, and then distributed. In" the case of a well, a 
 
160 MILITAEY HYGIENE AND SANITATION 
 
 few remarks are necessary. In the first place, it must be 
 remembered that when a well is sunk to a certain depth, it 
 is with a view to getting water from that depth. No other 
 water should be allowed to enter the well. This is effected 
 by giving the well an impervious lining, consisting either of 
 a metal tube or of brickwork, bedded in cement, and lined 
 with hydraulic cement. In comparatively loose soils, the 
 brickwork should be puddled at the back with clay. This 
 precaution will prevent water coming from the upper 
 layers of the soil or rock. To prevent surface washings 
 obtaining access to the well, a substantial masonry curb 
 should be built round the edge of the well, and to prevent 
 rain-water or air-borne contamination getting in, the well 
 must be covered over. Both these objects may be attained 
 by hermetically sealing up the well and covering this over 
 with earth. The exact nature of the materials used for this 
 protection and the manner in which those materials are 
 used is a question of detail. In some form or another these 
 three separate possible avenues should be protected 
 against the entrance of casual contamination. When a 
 well is pumped, the level of the water in the well and in 
 the water-bearing stratum in the immediate vicinity of the 
 well is lowered. This depression becomes gradually less 
 and less till at a certain distance the demand made on the 
 well has no particular effect on the subsoil water-level. 
 The line of water saturation within the area affected by 
 the well is, therefore, no longer level, but slopes gradually 
 upward and outward from the water-level maintained in 
 the well. In this way an inverted cone is formed, the size 
 of which depends on two factors — viz., the vis a f route of 
 the pumping operations and the amount of resistance 
 opposed to the flow of the water by the peculiar structure 
 of the water-bearing stratum. The looser the soil and the 
 greater the demand, the wider will be the cone of depression ; 
 whilst with a dense rock and a small demand the cone will 
 be correspondingly narrowed. If the rate of demand on the 
 well be constant, and the rocks do not contain a large 
 proportion of minerals readily soluble in water, the cone of 
 depression will remain constant once the well has got 
 established. A sudden increase in the demand, or the for- 
 mation of a rift or hole in the rock, the result of solution 
 
WATER 161 
 
 of certain of its component minerals, will, of course, alter 
 the dimensions and arrangement of the cone. The im- 
 portance of this lies in the facts to which allusion has 
 already been made. As long as the demand is constant, 
 and the structure of the rock or soil undisturbed, so long 
 it may be anticipated that the quantity and the quality of 
 the water available will also remain unchanged. Given, 
 however, any such sudden alteration in the demand or the 
 structure of the rock as I have just mentioned, it will be 
 necessary to await the collection of new data, as regards 
 both quality and quantity, before any permanent reliance 
 can be placed on the well under its new regimen. 
 
 Wells are divided into deep wells and shallow wells, and 
 it is usual to lay down some definite standard of depth 
 which divides the one class from the other. This is apt to 
 be misleading. The real depth of a well is not the distance 
 measured vertically from the surface of the earth to the 
 well-bottom, but the distance which the water has had to 
 travel through the earth from the spot on which it first fell 
 to the position in which it is found available for use. It is 
 probable that any well that is 100 feet or more in vertical 
 depth may be classed as a deep well, since the vertical 
 distance in itself represents a mass of soil sufficient to 
 deprive the water of any casual impurities by a mere filtra- 
 tion. On the other hand, if this depth be measured through 
 a homogeneous soil, it is possible that a fissure or a series of 
 fissures may communicate between the surface and the 
 subsoil water, and thus rob the well of its apparent ad- 
 vantage. A truer definition, in my mind, of a deep well is 
 one that penetrates through two impervious layers of soil 
 or rock. Such a well, even if only 20 feet deep, possesses 
 the advantage that the water that appears at the bottom 
 must have travelled through a long and circuitous route 
 from the spot at which it first fell. If there be only one 
 impervious layer, then i^is possible for a fissure to develop 
 close to the well, and cause a direct communication with 
 the surface. With two impervious layers, it is unlikely 
 that two fissures, one in each layer, shall develop exactly 
 opposite each other, and afford such direct communication. 
 Naturally, the deeper a weU, measured vertically, the 
 better, other things being equal ; but it must be constantly 
 
 11 
 
162 MILITARY HYGIENE AND SANITATION 
 
 remembered that an apparently shallow well may, when 
 the geological situation has been ascertained, turn out to 
 possess in reality, and to a far greater degree, the essential 
 qualities of a deep well — that is, regularity of output and 
 constancy of quality^ — than another well which the super- 
 ficial observer might class as " deep." 
 
 Water may be collected from that portion of the rainfall 
 which runs off the surface, and is then in general impounded 
 in artificial reservoirs. This is done in the case of certain 
 stations in India — e.g., Bangalore and Secunderabad. In 
 the former case a large lake is formed, some eight miles 
 in length, and averaging three-quarters of a mile in breadth. 
 The questions involved in the construction of such reser- 
 voirs are largely of an engineering nature, but the sanitary 
 officer may be asked to advise on the question of what 
 margin of land should be taken up round the edge of the 
 lake with a view to safeguarding the water against pollu- 
 tion. This is a question in which pecuniary considerations 
 of considerable magnitude are involved, and it is important 
 to take up a reasonable attitude on the subject. The first 
 point to be considered is the size of the lake and the daily 
 demand made upon it. Where the latter is trifling com- 
 pared with the former, it is obvious that the time occupied 
 in the passage of any particular contamination from the 
 farthest extremity of the lake to the outlet must be 
 extremely long, and at any intermediate spot directly pro- 
 portional to the distance from the outlet. Knowing, as 
 we do now, the important purifying effect of sedimentation, 
 and the fact that specific micro-organisms of disease are 
 not favourably placed when exposed to sunlight, and the 
 competition of the hardier vegetative germs, it is obvious 
 that in a long lake such as that just mentioned, the con- 
 tamination due to the presence of a village at the end of 
 the lake farthest from the outlet is practically negligible, 
 and the danger attributable to any other source of pollution 
 is inversely proportional to its distance from the outlet. 
 In the immediate vicinity of the outlet, naturally, stringent 
 steps must be taken, especially in respect of small gullies 
 running down into the lake, which are liable to be used 
 as latrines by the natives. Every such case must be judged 
 on its own merits, and no hard-and-fast line can be drawn. 
 
WATER 163 
 
 The sanitary officer, in dealing with a scheme of this nature, 
 must remember that he is not called on to aim at an ideally 
 perfect reservoir, absolutely and certainly free from the 
 remotest possibility of contamination. Reasonable security 
 is all that can be demanded, and such a degree of security 
 is all that Government is prepared to pay for. Storage is 
 necessary in all cases where the supply is intermittent. In 
 the case of rain-water — as, for instance, in Gibraltar — cis- 
 terns are provided sufficient to hold a supply for a 
 prolonged period of drought. These are closed in, and 
 such cisterns, surrounded as they are by dwellings, must 
 inevitably be so. The disadvantage of this is that it 
 is impossible to see what is happening. Pollution may 
 occur during storage in such cisterns, owing to surface- 
 washings finding entrance through manholes, or through 
 cracks in the walls of the cistern, the result of settlement. 
 The reports from Gibraltar (A.M.D. Reports, passim) 
 touch frequently on these difficulties. From what has been 
 said under the head of " Collection," it will be readily under- 
 stood that in the case of a rain-water supply pollution is 
 practically inevitable, on account of the difficulties attach- 
 ing to collection and storage. An installation of Berkefeld 
 candles was recommended in the Report for 1908, and is 
 gradually being introduced at this station. 
 
 Storage is also necessary in cases where a piped supply 
 of water is in use, whether derived originally from wells 
 or from natural or artificial lakes. This is done in what 
 are called "service reservoirs," holding from one to three 
 days' supply, situated in the immediate vicinity of the 
 station. These permit of any sudden demand being met — - 
 e.g., in the case of fire — and also prevent interruption of 
 the service as a result of injury to the pipe-line. It is usual 
 to roof these over, but I have never been able to convince 
 myself of the necessity or even advisability of this step, 
 especially in India, or any other tropical station. Wind- 
 blown contamination must, of course, be guarded against, 
 but this can best be done by wise choice of position. In 
 any case, it is almost impossible to prevent such con- 
 tamination through the ventilators that are always pro- 
 vided. I have a vivid recollection of seeing the surface of 
 the water in the roofed-in service reservoirs at Quetta 
 
164 MILITARY HYGIENE AND SANITATION 
 
 covered with the floating bodies of dead locusts, which had 
 penetrated through the ventilators. If foreign bodies of 
 such size can penetrate into a reservoir, it is obvious that 
 mere roofing will not keep out contamination by particles 
 of infected dust, etc. If contamination is inevitable to 
 some degree, then it is, in my opinion, infinitely preferable 
 to arrange so that one shall be able to see it. I should be 
 sceptical of the danger from such casual contamination to 
 which an open-service reservoir would be exposed under an 
 Indian sun. 
 
 Storage is sometimes provided for by cisterns in barracks, 
 though it is intended that these should be reduced to a 
 minimum. There has been a good deal of, in my opinion, 
 unnecessary prejudice against such distribution cisterns. 
 A direct supply from the main is theoretically excellent, 
 but in practice it means a great deal of inconvenience. 
 The defects in cisterns lie, not in the apparatus, but in the 
 individuals who design their position in the house. It 
 seems a rule that the water cistern should be placed in some 
 out-of-the-way, dark corner, as if it came into the catena 
 rerum tacendarum. This is not at all necessary. A cistern 
 placed where it can be easily inspected and, if necessary, 
 cleaned out, is a most useful appliance, and need not in any 
 way interfere with the sanitation of the dwelling. In India 
 it is usual to supply galvanized-iron tubs for the storage of 
 water in bungalow verandas. These are a necessity where 
 stand-pipes are situated at a distance from the bungalows. 
 Great care should be taken to see that they are periodi- 
 cally scoured and placed on the cool side of the building. 
 
 Distribution in Barracks. — This presents no peculiar 
 difficulties in military stations at home, or where water is 
 laid on direct to the different barrack buildings. In such 
 cases the soldier has merely to go to the nearest tap to 
 procure a drink, or to fill his water-bottle, and the re- 
 sponsibility for the cleanliness of that receptacle or of the 
 mug he uses rests on him alone. In a considerable number 
 of stations, more especially in India, this is not the case, 
 and the water has to be collected from a few stand-pipes 
 scattered throughout barracks, and conveyed from those 
 points to the various isolated bungalows, and there stored 
 in small cisterns in the verandas, in the manner already 
 
WATER 166 
 
 referred to. The question is complicated when, as is not 
 infrequently the case, it is considered necessary to submit 
 the water to some preliminary process of purification by 
 boiling before actual distribution to the barrack bungalows. 
 The conditions, in fact, approximate somewhat to those 
 met with on field service, and the problem should be tackled 
 in much the same way. In fact, great though the dis- 
 advantages of any system such as I have just sketched 
 undoubtedly are, still, they may be turned to good account 
 if the opportunity is taken of training the men in the 
 regular observance of a methodical ritual of distribution. 
 The essence of this ritual lies in the principle that water 
 should be distributed by certain people only, and at certain 
 times only. The carrying out of this ritual should be en- 
 trusted to responsible individuals who recognize the im- 
 portance of the task, not to natives of the country, even 
 though water-carrying may be their hereditary profession. 
 I am quite aware of the difficulties attendant on such a 
 process. The weight of the drinking-water required by 
 a company 100 strong, allowing half a gallon to each man — 
 no excessive allowance on a hot day in India — is 500 pounds ; 
 for a whole battalion, therefore, close on two tons. System 
 or no system, this has somehow to be transported from 
 the stand-pipes to the bungalows, and it seems to me that 
 the absence of a system is little likely to render the solution 
 of the problem any the easier. Where boiling is resorted 
 to as a method of purification, this transport performance 
 has to be repeated twice over, and the need of method is, 
 of course, thereby doubled. It has often seemed to me 
 that the fact of the water being boiled at some stage on its 
 journey from the stand-pipe to the barracks was looked 
 on as conferring some magical safeguard on the fluid, 
 destroying not only any pollution antecedent to the process, 
 but also extending, as it were, the aegis of its protection 
 over the water during its subsequent wanderings. It is 
 immaterial what the system adopted is in actual detail, 
 but I would like to suggest certain points which seem to me 
 essential if the method adopted is to be successful. In the 
 first place, the entire process should be placed under the 
 supervision of a non-commissioned officer — if possible, a 
 lance-sergeant. He must not be too young, or he will lack 
 
166 MILITARY HYGIENE AND SANITATION 
 
 authority and knowledge ; nor too senior, or he will lack 
 incentive to work. The same man should not be kept at 
 the work too long — a month or two at the outside would 
 be sufficient. In this manner a considerable number of 
 senior sergeants will have been through the mill, and learnt 
 the importance of the subject. This will be of the very- 
 greatest value in time of war. Under this man should be 
 a certain number of privates — say two per company — 
 forming the water party. Any actual handling of the water 
 should be done by these men, and not by natives. The 
 latter may carry the buckets or drag the cart in which the 
 water is transported to its destination ; but they must on 
 no account be allowed to manipulate taps or do any other 
 thing which necessarily brings any portion of their bodies 
 into contact with the water itself. Lastly, there should be a 
 definite time for water distribution — ^preferably, of course, the 
 early hours of the morning. If the water has to be boiled, 
 the same men must supervise this process, and the subse- 
 quent details of cooling, etc. If this system seems too compli- 
 cated, then I would advise that the companies be marched 
 to the nearest stand-pipe and the men made to fill their 
 water-bottles, after morning parade, and again, if necessary, 
 in the evening. In such a case boiling may be dispensed 
 with. This, again, would have an educational effect of the 
 greatest value, as assisting to inculcate restraint in drinking. 
 It is the duty of every medical officer in charge of effective 
 troops in a station such as I have been referring to to impress 
 on the officer commanding those troops, as strongly as he 
 can, the enormous importance of attending to the smallest 
 details of water-distribution, whether in barracks or in 
 the field. A battalion that has been drilled in this respect 
 in cantonments will have the greatest possible advantage 
 as compared with another battalion coming from some 
 station where a proper piped supply was laid on into 
 barracks, and the soldier, finding everything done for him, 
 did not realize the necessity of doing something for himself. 
 In the field, of course, the chances of contamination are 
 multiplied a thousandfold, and care and system are, there- 
 fore, all the more important. If the habit has been learnt 
 in peace, there is at least hope that it will be practised in 
 war. If it has been neglected, or has been unnecessary in 
 
WATER 167 
 
 cantonments, it will certainly be neglected in the first case, 
 and be much harder to learn in the second, when the 
 battalion is on service. This care and system, which are 
 very properly grouped together under the term " water 
 discipline," constitute one of the most important means of 
 keeping the ranks full in war ; and there should be no more 
 difficulty in enforcing it than in enforcing discipline in the 
 purely military sense. I have heard it said fairly frequently 
 that the soldier could not be made to take care as to what 
 water he drank ; that he would drink when he chose, and 
 where he chose — in short, that water discipline could not 
 be enforced. On that point I do not pretend to be able to 
 judge. Of this, however, at least I am very certain. A unit 
 whose officers cannot enforce water discipline cannot be a re- 
 liable unit in discipline generally , and to admit that the soldier 
 will not, or cannot, be made to obey orders in this respect is 
 to admit that he cannot be trusted to obey orders, except 
 under such conditions as are agreeable to him personally. 
 
 Collection and Distribution in the Field. — ^I do not 
 intend to go into much detail as to these points. In civilized 
 warfare each unit will be accompanied by its regulation 
 allowance of water-carts under charge of a specially qualified 
 water party. The source of water is selected by the staff, 
 in conjunction with the sanitary or other medical officer 
 present, and safeguarded, as far as possible, from pollu- 
 tion. That is to say, the best water that can be found is 
 selected, though it is, of course, often necessary to choose 
 an obviously polluted source and make the best of it. On 
 this point I will make only two remarks. Firstly, all 
 water on service, except that which comes from a regular 
 municipal piped supply, must be looked upon as polluted, 
 in the sense that it must not be drunk without preliminary 
 purification. Secondly, in spite of the fact that the water 
 is ex hypothesi, or even obviously, polluted, that affords no 
 reason for increasing the already existing contamination. 
 On these statements certain corollaries hang. If the water 
 is polluted, then, obviously, no individual should be allowed 
 to have access to it until it has been purified. In the " Field 
 Service Pocket-Book " it is laid down that " men must be 
 prevented from drinking water from unauthorized sources." 
 This lacks only one thing — namely, it doe§ not define an 
 
168 MILITARY HYGIENE AND SANITATION 
 
 " authorized source." As a matter of fact, no man should 
 be allowed access to the source at all. He should go to 
 some place where the purification apparatus for his unit is 
 installed, and fill his bottle there. The water parties of 
 the various units are the only people who should be allowed 
 to approach within a certain definite distance of the source 
 itself, and this they should do at regular times and in a 
 regular manner. In the next place, as few even of these 
 men should go to the actual edge of the water as are abso- 
 lutely needed for the proper drawing of the water. If the 
 regulation water-cart is in use, one man only need carry 
 the end of the hose-pipe and place it in the water ; if buckets 
 have to be resorted to, then a line of men must be made to 
 pass the filled buckets up and the empty buckets down. 
 There must be no unnecessary coming and going near the 
 water's edge. No animals should be allowed to come close 
 to the water, and, if necessary, the draught-horses of the 
 water-cart must be unharnessed and taken to some little 
 distance whilst filling is going on. In any case a small 
 catch-water drain must be made, to prevent the trickling 
 of urine or dirty water back to the source of supply. Of 
 course, cases will occur where, owing to the local conditions 
 or the weather, it is practically impossible to do anything, 
 and where additional pollution is inevitable. Cases may 
 even occur where, owing to the hardships of the march, the 
 men must be allowed to drink anything they can get hold 
 of. One cannot legislate for such exceptions. There need 
 be no more difficulty in arranging for a systematic method 
 of distribution in the case of water than there is in the case 
 of ammunition, Both may, under stress of circumstances, 
 break down, but that affords no excuse for neglecting either 
 under ordinary conditions. As I have already said, the 
 whole question is one of discipline, and though the expres- 
 sions "fire discipline," "march discipline," and "water 
 discipline," are convenient ideographs to express certain 
 sides of military activity, still, every soldier knows that there 
 is, in reality, only one discipline, and that is obedience to 
 orders from a superior officer. The officer or soldier who 
 exercises a liberty of choice as to which order he will obey 
 and which he will disregard, at the dictates of his own appe- 
 tites, is no longer disciplined in the true sense of the word. 
 
CHAPTER X 
 
 PURIFICATION OF WATER 
 
 The purification of water consists in the removal from or 
 destruction in the water of those substances which have 
 been added to the water in its passage through the air and 
 through or over the earth, which are either dangerous to 
 health or render the water unsuitable for use, In practice 
 purification is limited to the removal of hardness and the 
 removal or destruction of disease germs and other sus- 
 pended matter. In exceptional cases, where the only water 
 available is undrinkable on account of an excess of saline 
 constituents, as in the case of sea-water, distillation may be 
 resorted to, with a view to purification. Such cases are, 
 however, exceptional in military practice. 
 
 Removal of Hardness. — Temporary hardness is re- 
 moved either by boiling, on the small scale, or, on the large 
 scale, by the addition of milk of lime to the water. This 
 combines with the carbonic acid dissolved in the water, 
 forming an insoluble carbonate of lime. The carbonates 
 which the water was previously enabled to hold in solution, 
 in virtue of the carbonic acid of which it has now been 
 deprived, sink to the bottom, together with the newly 
 formed carbonate. At the same time a considerable 
 number of micro-organisms are removed from the water 
 by precipitation. This process is usually termed " Clark's 
 process." There are various modifications in which the 
 water is strained through cloths, or passed through filtering 
 towers, after addition of the milk of lime ; but the principle 
 is the same in all. Permanent hardness may be removed 
 by the addition of carbonate of soda. 
 
 In military sanitation, however, by far the most im- 
 portant aspect of water purification is that which is directed 
 
 169 
 
170 MILITARY HYGIENE AND SANITATION 
 
 to attacking the disease germs contained in water. These 
 may either be removed from the water or destroyed in it. 
 Removal is effected by sedimentation, precipitation, or 
 filtration ; destruction by the agency of heat, light, or 
 chemicals. 
 
 Sedimentation. — In this process the water is allowed to 
 stand in or flow very slowly through uncovered settling 
 tanks. It is extremely efficacious, especially as regards 
 the specific organisms of disease, which do not, it is prob- 
 able, live long under such conditions. As a preliminary to 
 filtration, sedimentation is undoubtedly useful, but it is 
 seldom relied on alone. Personally, I am not sure that in 
 India sedimentation would not be preferable to sand filtra- 
 tion, with all the inevitable dangers attending on cleaning 
 by native labour. The original expense of construction is 
 the great objection, since a fortnight's sedimentation should 
 be allowed. Upkeep charges are, however, reduced to a 
 miQimum. 
 
 Precipitation is not used (except in the Clark process, 
 already described) on the large scale. On service, the 
 addition of alum to muddy water has a wide range of 
 utility in this direction. A large flocculent precipitate is 
 formed, which sinks slowly to the bottom, entangling a large 
 number of bacteria. As an adjunct to filtration this 
 process is useful, and, in my opinion, gives us the most rapid 
 and efficacious method of clearing grossly polluted water. 
 
 Filtration. — The term " filtration " is applicable to any 
 method in which a mechanical obstruction is placed in the 
 way of the flow of the water, in such a manner as to allow 
 the water to pass through apertures in the obstructing 
 material, whilst holding back a greater or less proportion of 
 the particulate suspended matter. The obstruction may 
 vary in degree from that imposed by a coarse rough cloth 
 to that caused by a close-grained porcelain candle, and the 
 efficacy of the resulting filtration will vary accordingly. 
 Certain rules are, however, applicable to all filtration, 
 whatever its degree, and it is advisable to clear the ground 
 by stating these first. 
 
 The first rule is that the amount of resistance opposed to 
 the flow of the water is inversely proportional to the size 
 of the apertures in the obstructing material or filter. The 
 
PURIFICATION OF WATER 171 
 
 second is that the degree of purification effected is also 
 inversely proportional to the size of the apertures, and 
 therefore directly proportional to the amount of resistance. 
 
 Obviously, the greater the resistance, the greater the 
 power necessary to force the water through the apertures of 
 the filter. But since the degree of purification effected is 
 directly proportional to the resistance, it must also be 
 directly proportional to the power available. And, on the 
 other hand, the power necessary is directly proportional to 
 the degree of purification desired. These constitute the 
 third rule. The fourth rule is that the rate of filtration 
 varies directly with the filtering area available, directly, also, 
 with the power available, and inversely as the resistance 
 offered. 
 
 If a high degree of purification is required, we must inter- 
 pose a great resistance. If that purification is required 
 rapidly, we must either increase the filtering area or the 
 power exerted, or both. As a matter of fact, for purely 
 mechanical reasons, it is impossible to increase the power 
 above a certain limit without damaging the material used 
 for imposing the resistance, so that rapidity is largely a 
 question of increased filtering area, if a high degree of 
 purification is desired. On the other hand, it is possible 
 to increase the rapidity, the filtering area remaining con- 
 stant, by lowering the standard of purification, since in 
 this way we lessen the amount of obstruction necessary. 
 When both the area available and the power are limited, 
 as is the case in the field, rapidity of output means a low 
 standard of purification ; a high standard of purification 
 means a delayed delivery. 
 
 The above statements seem so elementary as hardly to 
 be worth repeating at such length, and so circumstantially. 
 I do so because, obvious as these rules are, they are con- 
 stantly forgotten. Inventors frequently claim that they 
 can achieve purification of a high degree with resistance 
 of a minimal amount, which can be overcome by a minimum 
 expenditure of power, and in the shortest period of time. 
 Sanitary officers must keep constantly before them the fact 
 that filtration is not an esoteric process, but merely straining 
 " writ large "in three syllables instead of two. The rules 
 which regulate straining through a pocket handkerchief 
 
172 MILITARY HYGIENE AND SANITATION 
 
 regulate equally straining (commonly called "filtration") 
 through a sand filter-bed, or a porcelain bougie. 
 
 Filtration on the large scale is carried out most commonly 
 — ^in England, at least — in what are called " sand filter- 
 beds." These consist of large tanks, about 5 feet in depth, 
 which are filled from below upwards with coarse gravel, 
 fine gravel, coarse sand, and fine sand. The thickness of 
 the different layers varies in different installations. Be- 
 neath the lowest layer is placed a series of drains, intended 
 to collect and lead away the filtered water. These beds 
 are intended to remain constantly submerged in water, 
 which slowly filters through them. The force is applied 
 by the head of water in the tank, and is directly relative 
 to this. The resistance is imposed at first by the fine sand, 
 but this is not sufficiently great to bring about any high 
 degree of purification. After the lapse of a short time, the 
 duration of which depends on the impurity of the water, 
 a gelatinous film is formed on and in the upper inch or two 
 of the fine sand, due to bacterial and infusorial growth. 
 This is termed a "zooglcea." The resistance opposed by 
 this is considerable enough to bring about a very satisfactory 
 amount of purification, and since this demands an increase 
 in power, the water on the top of the sand increases in depth, 
 thereby giving a greater head of water. As the zooglcea 
 gradually becomes denser, so the purification increases ; 
 but the filtering area, being constant, the rate of flow 
 diminishes, and as the obstruction demands increased power, 
 the depth of water also increases. Eventually the head 
 reaches a point at which either the tank can contain no more 
 water or the pressure is sufficiently great to injure the 
 filtering film. The bed must now be thrown out of action, 
 the upper few inches of sand skimmed off, and then the 
 cycle begins again as before. Eventually, when the fine 
 sand has been gradually, in the process of successive 
 cleanings, reduced to a layer of about 15 inches in depth, 
 the bed is remade up to the original level. The usual rate 
 of filtration through such a bed is not more than 2 gallons 
 per square foot of surface per twenty-four hours. 
 
 Undoubtedly the greater part of the filtration occurs 
 during the passage of the water through the zooglcea, which 
 removes about 70 per cent, of the micro-organisms present. 
 
PURIFICATION OF WATER 173 
 
 The remainder are retained in the upper 15 inches or so of 
 the fine sand, and it is on this account that, in cleaning the 
 filter, it is advisable to leave at least this depth of that 
 material undisturbed. The lower layers act merely as a 
 support to the filtering layer, and it is important that the 
 materials of which they are composed should be so graded 
 and arranged that all sudden variations in the rate of flow 
 of the water may be avoided. A constant rate of flow is 
 absolutely necessary if satisfactory filtration is to be 
 maintained. 
 
 Such a filter-bed will give a filtrate containing a greatly 
 reduced number of micro-organisms, but absolute sterility 
 is never attained. For this there are several reasons. In 
 the first place, a certain number of the bacteria originally 
 present in the water may find a passage through the filtering 
 medium, but, in addition to these, there are always a certain 
 number of water bacteria living in the depths of the filter 
 which are gradually washed through into the filtrate. The 
 importance of these is considerable when we are dealing 
 with a comparatively pure water. If the number of micro- 
 organisms in the raw water is small (according to Reinsch, 
 below 200,000 per c.c), it is impossible to estimate the 
 filtering efficiency of the bed by a comparison of the number 
 of germs in the raw water and the filtrate respectively, since 
 those present in the latter bear no relation, either as regards 
 number or origin, to those in the former. In such cases it 
 is necessary to lay down a minimum standard of germs 
 actually allowed to be present in the filtrate, which is 
 arbitrarily fixed at 100 per c.c. 
 
 It must be remembered that pathogenic bacteria are some- 
 what peculiarly situated in regard to the possibility of their 
 finding a passage through a filter. It is but rarely that 
 they exist in the water as isolated individuals. More fre- 
 quently they are contained in small particles of faecal 
 matter or mucus, which are easily held back by the zoogloea. 
 From this point of view, Spitta considers urine con- 
 taining typhoid bacilli as a much more dangerous source of 
 water infection than a specifically contaminated stool. 
 On the other hand, it is probable that isolated typhoid 
 bacilli, even if present in large numbers in the water, would 
 have but a poor chance of surviving in the struggle for 
 
174 MILITARY HYGIENE AND SANITATION 
 
 existence with the hardier water organisms living in their 
 natural medium. When a man contracts enteric fever by 
 drinking contaminated water, I should imagine that he does 
 so, not by ingesting numbers of isolated bacilli, but by 
 swallowing one or more small particles of fsecal matter or 
 mucus in which these micro-organisms are sheltering. It 
 is permissible, therefore, to accept as satisfactory a standard 
 of filtration which falls considerably short of absolute 
 sterility, even though that implies a certain number of 
 bacteria which exist in the raw water are actually passing 
 through the filter. 
 
 Owing to the extremely slow rate at which the water 
 passes downwards through the filter-bed, it is at least 
 possible that some biological action comparable to that 
 which is met with in a sewage filter occurs during the pro- 
 cess. Unless the raw water is grossly contammated with 
 organic matter, however, this is not likely to be sufficient 
 to effect any marked change in its chemical constitution ; 
 and it is safe to say, with Proskauer, " that the chemical 
 character of a filtrate is the same as that of the unfiltrated 
 water." It is impossible, therefore, to impose any chemical 
 test of filtering efficiency. 
 
 It is clear that in a filter-bed such as I have described, 
 where the raw water is submitted at once to a filtering 
 resistance capable of keeping back the smallest particles, 
 there is a certain want of economy of effort. A great deal 
 of the suspended matter in water is of, comparatively 
 speaking, a gross nature, and can be kept back by a straining 
 medium of a much less delicate nature than the zoogloea 
 of a sand filter-bed. It is possible, therefore, by submitting 
 the water to a process of rough straining, to diminish the 
 pressure thrown, as it were, on the fine bed. In the Puech- 
 Chabal system an attempt is made to combine such a pro- 
 cess with one of aeration. The raw water is passed through 
 a number of filter-beds, containing material of gradually 
 increasing fineness, and each, in consequence, somewhat 
 larger in area than that preceding it in the series. These 
 are arranged in a descending " stair," and the water is 
 made to cascade from one " step " to the next. By this 
 means a thorough aeration is effected. The last bed of 
 the series is an ordinary sand-filter. It is not necessary to 
 
PURIFICATION OF WATER 175 
 
 clean this bed oftener than once in six months, and the 
 interval may extend even to a year. 
 
 The cleaning of sand filter-beds is undoubtedly the great 
 drawback to their use, and this drawback is considerably 
 magnified when the cleaning process has to be carried out 
 by low-class native labour, as in India and elsewhere. Any 
 means by which this can be done away with or postponed 
 possesses a distinct value from the point of view of military 
 sanitation. 
 
 Mechanical Filters. — In order to simplify the process 
 of cleaning, and also to increase the rapidity of filtration, 
 various forms of mechanical filter have been introduced, 
 principally in America. Of these, the best, in my opinion, 
 is the Jewell system. In this form of apparatus the 
 water, to which a certain amount of alum has been added, 
 is led through sedimentation tanks, and then passed on 
 to the surface of a sand-bed, which is supported on a frame 
 at the top of a high metal or masonry cylinder. A dense 
 film rapidly forms on the surface of the sand as a result of 
 the addition of the alum, and this replaces in function the 
 organic zoogloea of the common sand filter-bed. The for- 
 mation of this film is so rapid that the fiow of water is 
 quickly impeded, and washing becomes necessary. To 
 ejBfect this, the direction of the current is reversed, whilst 
 at the same time the mass of sand is effectively stirred up 
 by revolving rakes. This process, which only occupies 
 a few minutes, may need to be repeated several times in 
 the twenty -four hours. The washing-water is allowed to 
 run to waste. This system has been found to possess a 
 high degree of efficiency, combined with great rapidity. 
 The force employed is that of gravity, acting by virtue 
 almost entirely of " negative head." For countries where 
 a low-class native labour has to be relied on for cleaning 
 filter-beds, I consider the Jewell system most satisfactory. 
 The first cost of erection is high, and a certain amount of 
 skilled supervision is required. These filters are peculiarly 
 efficacious in dealing with water containing extremely fine 
 silt. They should be very useful under conditions such as 
 I have just noted, where difficulties arise in connection 
 with cleaning. 
 
 The Bell filter is constructed on much the same lines, and 
 
176 MILITARY HYGIENE AND SANITATION 
 
 worked in much the same way as the Jewell. There is 
 not, however, the same arrangement for preliminary sedi- 
 mentation. The Bell is a good filter for use in cases where a 
 certain amount of vegetable, and perhaps some animal, 
 pollution has occurred, but where there is no probability of 
 specific contamination by human excreta. It is eminently 
 suitable for use with water from an upland grazing ground. 
 The delivery 7 is gallons per square foot per hour. Washing is 
 effected as in the Jewell filter, by reversed flow. In the 
 Candy filter the water is passed through blocks or layers of 
 magnetic oxide of iron, but before this is done air under 
 pressure is injected into the water. This form of filter is 
 extremely efficacious, especially in cases where the water is 
 heavily tainted with chalybeate matter, or contains foetid 
 gases. An installation at Longmoor, near Aldershot, works 
 well with a water of this nature. 
 
 Lemoine describes, under the appellation " non-submerged 
 sand filter " {flltre a sable non submerge de Miquel et Mouchet), 
 an installation which was adopted in the French Army in 
 January, 1909. The theory on which this filter works is 
 that "purification of water consists in a fixation by the 
 means of the sand grains of all solid particles in the water, 
 as a result of an attraction analogous to that of gravity, 
 or by means of adhesion due to capillarity. This action 
 takes place throughout the entire depth of the sand-mass." 
 Such purification comes into action immediately the water 
 comes into contact with the sand, and it is not necessary to 
 wait for a process of " ripening " to develop, as in the case 
 of the submerged sand filter. The rate of filtration is 
 2 cubic metres of water per square metre of sand surface 
 (22' 6 gallons per square foot). If too rapid a flow is at- 
 tempted, the sand particles are disturbed, and purification 
 does not occur. These filters are composed of layers of 
 sand and gravel of various thickness, with a supporting sub- 
 stratum of bricks, and are built up inside receptacles, made 
 of metal or masonry. The different layers run as follows 
 from above downwards : 
 
 1. Fine sand, 1 millimetre (0-04") gauge . . 1-5 metres (4' 9"). 
 
 2. Coarse sand, 0-3 cm. (O-12'O gauge . . . . 6 cm. (2"). 
 
 3. Fine gravel, 0-5 to 1 cm. (0-2 to 04") gauge 5 cm. (2"). 
 
 4. Coarse gravel, 2 to 4 cm. (0-8 to 1-6") gauge 5 cm. (2"). 
 
PURIFICATION OF WATER 177 
 
 These layers of sand and gravel are supported on two 
 layers of bricks. In the upper of these the individual bricks 
 are laid flat in rows 1 to 2 centimetres (0-4 to 0-8 inch) 
 apart, whilst in the lower the bricks stand on end and the 
 rows are separated by an interval of from 4 to 5 centimetres 
 (1- 6 to 2 inches). The former act as a support for the super- 
 incumbent filtering mass ; the latter serve the purpose of 
 under-drainage. Lemoine shows in his illustrative diagram 
 a thin layer of coarse sand on the uppermost surface of the 
 fine sand, intended presumably to act as a protection to 
 this latter. The thickness appears to be about 1 inch. 
 
 The water, which is first passed through a roughing filter, 
 flows on to the surface of the fine sand through a coiled tube 
 in which small holes are bored ; these average ten or twelve 
 to the square metre of surface. Care must be taken that no 
 jet of water shall impinge on the sand surface within 20 centi- 
 metres (8 inches) of the wall of the chamber, and it is 
 advisable to bank up the uppermost protective layer of 
 coarse sand all round the edges of the filter in order to pre- 
 vent any water that may pond up on the surface from 
 finding a passage between the sand-mass and the retaining 
 walls. The delivery tube for filtered water should be as 
 close to the bottom of the filter as possible, and of such size 
 that there shall be no obstruction of the flow. A tube of 
 1 centimetre (0-4 inch) will allow of a discharge of 4,000 litres 
 (880 gallons) in the twenty-four hours. The surface of the 
 filter should never be less than about half a square metre 
 (say 5 square feet). The size should be such as to give a 
 per capita allowance of 10 litres (2-2 gallons) per day, at a 
 filtration rate of 2,000 litres (440 gallons) per square metre 
 (9-9 square feet) of surface. 
 
 The filter should not be placed so as to be exposed to 
 the action of the direct rays of the sun, which encourage the 
 growth of algae, thus leading to rapid blocking of the appa- 
 ratus. It should stand in a dark place, or, at most, in a 
 diffused light only. It must be protected from frost. 
 According to Lemoine, in the first days of working, the 
 effluent possesses more micro-organisms than the raw water, 
 due to the washing of bacteria out of the filter mass. After 
 a few weeks the micro-organisms found in the filtered water 
 are only those which grow in the lower layers of the sand 
 
 12 
 
178 MILITARY HYGIENE AND SANITATION 
 
 and gravel, their number depending greatly on the amount 
 of nutritive material in the water. Pathogenic bacteria are 
 said to be entirely eliminated, and, according to Miquel, 
 the B. coll does not penetrate farther than the upper half- 
 metre (20 inches) of the fine sand. Good results appear to 
 have been produced in some of the French garrison towns 
 where this system has been installed. 
 
 The non-submerged sand filter has one great advantage 
 over the submerged filter, in that it is not necessary to resort 
 to periodical cleaning, which is undoubtedly the great objec- 
 tion to the latter form. A priori, one would imagine that 
 in filters of any size the difficulty would be the same as in the 
 case of streaming sewage filters — namely, to get complete 
 satisfactory distribution of the water throughout the sand- 
 mass. Where comparative experiments have been made 
 with the two types of filter working under the same condi- 
 tions, as has been done at Marseilles, the older type seems to 
 have been undoubtedly the more efiicacious of the two. 
 
 Filtration on the small scale can be carried out by means 
 of the so-called " domestic filters," which are usually made 
 nowadays of porcelain or a composition of infusorial earth. 
 These " candle filters ^' are of widespread use in different 
 services in the field, and in some places in barracks. 
 
 Individual candles are most efficacious, but experience of 
 battery-filters composed of several candles has not justified 
 the expectations once entertained with regard to them. 
 The great difficulty, especially in the tropics, where they are 
 most likely to be needed, lies in the perishable nature of the 
 rubber washers used. The opinion of Medecin-Inspecteur- 
 General Vallin, quoted by Lemoine (p. 323), is so apropos 
 that it seems worth reproducing in full. " These filters have 
 now been in use in many barracks and hospitals for fifteen 
 years, and have rendered inestimable services. In many 
 cases they have put a stop to obstinate outbreaks of disease 
 — true endemics, in fact. They have reduced by one-half 
 the incidence of typhoid fever in the army. At the same 
 time we have had a long experience of the minute care and 
 the worry entailed by the weekly dismantling, cleaning, 
 inspection, and refitting of 150 fragile candles, and of an 
 equal number of receptacles placed below them. Whenever 
 this supervision is momentarily relaxed, whether as a result 
 
PURIFICATION OF WATER 179 
 
 of the slackness attendant on prolonged effort or other 
 causes, the filters rapidly get out of order ; they may even 
 become sources of danger from the false sense of security 
 they furnish." This sums the situation very well, I think. 
 Filter candles are like many other appliances — excellent 
 when used as units, but unreliable when used in mass. 
 
 In the field, filters are used by us in the form of the filter 
 water-cart, of which a detailed description is contained in 
 " Royal Army Medical Corps Training." In principle this 
 consists of a rough strainer, formed of compressed sponge, 
 from which the water passes to porcelain candles, each dis- 
 charging separately in such a manner that the output of 
 each individual candle can be checked. Experiments are 
 in progress to substitute a strainer, consisting of cloth 
 stretched on a cylindrical wire framework, for the sponges. 
 Using this, and adding 1 grain of alum to the gallon of water, 
 it has been found possible to strain Thames water absolutely 
 clear within a few minutes of starting the pumps. A thick 
 deposit of slimy mud is formed on the outer surface of the 
 cloth, which eventually furnishes so great a resistance to the 
 flow of the water as to produce a high degree of purity. The 
 force used is limited to 40 pounds to the square inch. I 
 have come to the conclusion that bacterial purification is 
 practically impossible, under field service conditions, with 
 any resistance less than the above. Mule-pack and coolie 
 filters have been designed on the same plan as the water-cart 
 filters. 
 
 In the French Service both separate and combined candle 
 filters are used. In the former {fiUre Berkefeld de campagne) 
 a single filter candle is enclosed in a metal tube, and the 
 water forced through by means of a semi-rotary pump. The 
 whole is mounted on a collapsible tripod. This pattern 
 resembles closely a form once in use in our Service, but 
 since discarded. The delivery at the start is at the rate of 
 45 litres (9-84 gallons) per hour, but diminishes after the 
 first fiLfteen minutes. In the larger form {filtre Ohamherland 
 de campagne) twenty-one candles are used. The connection 
 between the candles and the collecting chamber is effected 
 by a special attachment which replaces the usual cemented 
 base, and lessens the risk of fracture, The candles are en- 
 closed in a cylindrical case 14 J inches in height, and 12 J 
 
180 MILITAEY HYGIENE AND SANITATION 
 
 inches in diameter. The weight of the total whole apparatus 
 is 50 kilogrammes (110 pounds). 
 
 In the German Army a small portable filter is used, con- 
 sisting of a candle enclosed in a metal case and a foot-pump, 
 like that used for inflating bicycle tyres. This is carried at 
 the back of the man's knapsack in the place usually occupied 
 by the mess-tin. It weighs 3 kilogrammes (6-6 pounds), 
 and delivers 3 litres (5 J pints) per minute. This discharge 
 would certainly fall off in a very short time. A compound 
 filter is also used, consisting of nine candles in a cylindrical 
 metal case ; to this is attached a lift and force pump, and 
 the whole is mounted on a light wheeled platform. The 
 output of this apparatus is, at the start, equivalent to 
 15 to 20 litres (26 J to 35 pints) per minute. As a matter of 
 fact, however, it cannot, even with a fairly clean water, be 
 calculated to furnish more than about 75 to 125 litres 
 ( 1 6 J to 26 gallons) per hour. Hetsch, in Bischoff 's " Lehrbuch 
 der Militarygiene " (p. 309), states that on service the un- 
 avoidable accidents to which such a piece of apparatus must 
 be subjected would almost certainly cause some leak with 
 consequent chance of danger. In the South- West African 
 campaign this filter rapidly got blocked up. 
 
 In the American Army the Darnall filter is largely used. 
 In this the water, after the addition of alum and sodium 
 carbonate, is siphoned from one bucket to another, passing 
 through a cloth stretched on a cylindrical wire cage. The 
 power employed is very slight, and the resistance that can 
 be overcome low. A high degree of purification in any 
 reasonable period of time is a priori not to be anticipated, 
 and at the Royal Army Medical College our results have not 
 been good. If the descending or delivery arm of the siphon 
 were lengthened, more power would be available. It is 
 only fair to say that in the United States fair results have 
 been achieved — namely, a delivery of 50 gallons an hour, 
 with a bacterial purification equivalent to 98 per cent. If 
 any considerable quantity of water is required, a consider- 
 able extent of filtering area — in other words, a large number 
 of filters — would be needed. 
 
 In the Japanese Army the Ishiji filter was used during the 
 late war in Manchuria. This consists of a simple canvas 
 conical bag, with two lateral arms or spouts. The apex of 
 
PURIFICATION OF WATER 181 
 
 the cone is closed. The spouts are filled with sponge and 
 charcoal, and the water issues through these. Two powders 
 are added — viz. : (1) Containing potassium alum, potassium 
 permanganate, and aluminium silicate ; and (2) aluminium 
 silicate, tannic acid, and hydrochloric acid. The former is 
 added to the water in the filter in sufficient quantity to cause 
 discoloration ; the second powder is then gradually stirred in 
 till the colour disappears. In this filter the power is sup- 
 plied by the head of water in the cone, and depends on this 
 being kept full. The method is simple, and a similar piece 
 of apparatus could easily be improvised. 
 
 Various improvised methods of straining may be used on 
 service with a view to removing gross contamination, the 
 particular appliance varying with the materials available. 
 These are familiar to most officers, and I will not dilate 
 further on them. 
 
 General Remarks on Filtration in the Field. — A water may 
 be free from disease bacteria, and yet demand filtration on 
 account of gross pollution, sand, mud, floating debris, etc. 
 On the other hand, a water may be perfectly clear, and, 
 indeed, of the most inviting appearance, as, e.g., in a chalk 
 stream, and yet be dangerously polluted. The same 
 methods of purification are, obviously, not applicable in 
 both these cases. In the first some form of gross straining 
 is required to make the water sightly, and this is necessary 
 whatever subsequent method of purification be adopted. 
 This can readily be achieved by a thick cloth strainer 
 stretched on a framework. This framework may be either 
 in the form of a cylindrical cage, such as already described, 
 or in that of a long spiral of fine wire. In the latter form 
 a greater filtering surface is available, giving, therefore, a 
 larger output with the same lorce. The cylindrical strainer 
 is, on the other hand, more easily manipulated. Alum 
 should be used to cause a deposition of mud on the cloth, 
 after which the degree of purification produced will gradually 
 increase as the deposit increases in thickness, until at last 
 the power available is no longer capable of forcing water 
 through the clogged meshes of the cloth. In such a case, 
 when the water is obviously polluted, the greater the amount 
 of dirt present, the greater the degree of filtration ; and 
 when the water is extremely foul, sufficient bacterial purifica- 
 
182 MILITARY HYGIENE AND SANITATION 
 
 tion can be effected by this method without recourse being 
 had to any further process. On the other hand, a clear 
 water — e.g., that from a chalk stream — demands no such 
 preliminary straining on the one hand, whilst on the other 
 there is not present, in the water the mud needed to produce 
 a filtering slime on the cloth. The same fact has been noted 
 by Nankivell {Journal of Hygiene, July, 1911) in the case of 
 sand filters. In such a case, if filtration be adopted, some 
 form of candle filter must be used to insure purity. It must 
 be remembered that in the field, or elsewhere, it is not 
 necessary to go as far as absolute sterility of the water for all 
 purposes. For washing, cooking, or making tea, it is only 
 necessary that the water should contain no great amount of 
 visible dirt. To achieve this, straining of the simplest kind 
 is all that is necessary. On the other hand, a clear chalk 
 stream, even if polluted, is extremely unlikely to give rise 
 to disease when used raw for ablution, cooking, or making 
 tea. It can therefore safely be used for these purposes, 
 untouched. It should be a strict order at all filtering in- 
 stallations in the field that no water is to be served out for 
 washing, cooking, or making tea, which has been subjected 
 to candle filtrations ; such water should be reserved to 
 fill water-bottles ; it is too valuable to waste in other 
 directions. 
 
 Filtration is at present, and will probably for some time 
 continue to be, the best means at our disposal for the puri- 
 fication of water in the case of troops on the move. The 
 great advantage possessed by filters is the fact that no extra 
 stores, such as fuel, are necessary for their efficient working, 
 and that they can be set to work at the shortest no 'ice — as, 
 for instance, during a midday halt. The great defect of 
 all filters is unreliability. Whatever form is used, it is 
 almost impossible to avoid having, at some point or other, a 
 joint between the actual filtering material and a metal con- 
 nection. The fact that these materials possess different co- 
 efficients of expansion under heat entails inevitably, sooner 
 or later, the development of flaws in the process of steriliza- 
 tion. These flaws are often difficult of recognition, except 
 as the result of minute and careful examination. Any 
 marked solution of continuity will be revealed by an in- 
 creased flow at the delivery pipe, but it may be permitted 
 
PURIFICATION OF WATER 183 
 
 to doubt whether the perspiring private who is operating 
 the pump-handle against a resistance of 40 pounds to the 
 square inch will be in a great hurry to realize — much less 
 draw attention to — the occurrence of such an accident. In 
 any case, a comparatively small pinhole in the cement of 
 the joint which may let through a considerable number of 
 pathogenic bacteria, will produce no obvious macroscopic 
 effect on the output. Such a minute defect can only be 
 identified by dismounting the candle and immersing it in 
 water. Again, however reliable the filter candle, both as 
 regards the material of which it is made and the permanence 
 of its joints, sooner or later bacteria will grow through the 
 pores of the material. This necessitates periodical dis- 
 mantling, sterilizing, and cleaning. 
 
 All these difficulties can no doubt be circumvented or 
 surmounted, but only at the price of a constant, almost 
 meticulous, supervision. Unfortunately, though a state of 
 war does no doubt encourage the development of many fine 
 qualities, the faculty of continuous attention to minute 
 detail is not on the list. In the case of filtration, more than 
 any other system of purification, the medical officer in 
 charge of a unit must pay particular and personal attention 
 to the condition of the various parts of the apparatus, and 
 the general working of the system. He will after a time 
 realize the difficulty of avoiding a lapse into mere dead 
 routine, and if this is the case with him, how much more 
 must it be so in that of comparatively uneducated men, who 
 are less qualified to realize the importance of the work. At 
 the same time, though it is important to aim at as high a 
 degree of purity as possible, it is at least open to question 
 whether it is necessary to insist on absolute perfection — ^that 
 is, complete sterility. This is an ideal state of affairs which is 
 not achieved, or even demanded, in any municipal installa- 
 tion. Personally, though of course I should like to see 99-5 
 per cent, of the bacteria removed by my filter-carts under all 
 circumstances, and would be inclined to insist on such a 
 degree of success under laboratory conditions, when it is a 
 que^l^ion of actual field service I would be content to put up 
 with a decidedly lower standard — say, 90 per cent of purifi- 
 cation. Perfection is often apt to be the enemy of efficiency, 
 and I think this is just one of those points where we must 
 
184 MILITARY HYGIENE AND SANITATION 
 
 be careful not to ask too much of Fate, in case she may 
 decline to give us anything at all. 
 
 There is a point worth keeping in mind in connection 
 with the filtration of water, more especially on field service, 
 and that is the actual conditions under which the germs of 
 disease are met with. When talking of filtration, the general 
 idea seems to be that we have to deal with individual 
 germs, and that our filtering material must therefore possess 
 a texture sufficiently close to obstruct the passage of these 
 extremely fine particles. Personally, I feel a considerable 
 degree of scepticism on this point. In my opinion, the 
 pathogenic organisms of intestinal disease are in the enormous 
 majority of cases hidden in small masses of mucus or faeces, 
 and that isolated bacilli which get access to water-supplies 
 live a very short time indeed. When a bacteriological 
 count of water sample is made, the masses of baciUi each 
 form a colony, and one colony only — ^that is, one of them 
 counts on the plate exactly the same as the isolated in- 
 dividual micro-organism. A purification of 90 per cent, 
 means only that we have reduced the number of colonies 
 to that extent, not the individual bacteria. If we could 
 count the actual germs present before and after we should 
 probably find the reduction caused by a good candle very 
 much greater than that which the plate-counting method 
 shows it to be. We are justified in my opinion, therefore, 
 in allowing a considerable latitude, and I should feel in- 
 clined to look not so much to the actual number of colonies 
 present as to the size of those noticed after filtration. The 
 question is one demanding considerable further research, 
 and at the present stage we are not, as I have already said, 
 justified in being too meticulous in our requirements. 
 
 If germs are not removed from water by filtration they 
 may be killed in the water, and this is done either by light, 
 heat, or chemicals. Light is used in the form of the ultra- 
 violet rays. These are produced in the lamps at present 
 in use, from mercury vapour, rendered incandescent by 
 means of an electric current. The principle is much the 
 same in all cases. The mercury is contained in bulbs at 
 the two ends of a vacuum tube made of quartz. The tube 
 is rocked so as to cause the mercury to fiow through it, 
 whilst the current is running. The vapour left behind by 
 
PURIFICATION OF WATER 185 
 
 the mercury, as it rushes from one end of the tubes to the 
 other, at once glows with a strong violet light. The steriHz- 
 ing action of these rays is little short of marvellous, as long 
 as the water is clear, but how it operates is not at present 
 known. It may do so by producing ozone in the water, 
 or by a directly lethal action on the protoplasm. The latter 
 seems the more likely, since it is known that if the rays 
 act for any length of time on the skin or conjunctivae 
 serious results may occur. In the Cooper-Hewitt lamp, 
 manufactured by the Westinghouse Company, the lamp is 
 contained in a cylindrical box, through which the water 
 flows, being exposed to the action of the rays while passing 
 over the edge of a conical diaphragm. The lamp is not in 
 actual contact with the water. In the Nogier apparatus, 
 on the other hand, the lamp is immersed in the water, and 
 the same is the case in that manufactured by the Quarz- 
 lampen Gesellschaft of Hanau. 
 
 It does not appear that so far any use has been made of 
 this method for field service, though in the Deutsche Mill- 
 tardrztliche Zeitschrift for June 5, 1910, and again for 
 March 20, 1911, an account is given of two installations 
 suitable for field use. One of these is intended to be self- 
 supporting, manufacturing its own power by means of a 
 small petrol motor and dynamo ; the former, at the same 
 time, actuates the pump. The water is first strained 
 through a roughing filter and then passed through Berkefeld 
 candles. This latter seems a work of supererogation, and 
 indeed the author has omitted this precaution in the later 
 form. The water then passes through a Nogier lamp. The 
 expenditure in power is 10 amperes at 139 volts, and the 
 apparatus is calculated to supply 10 litres (17-5 pints) per 
 minute. The whole is fitted up in a large four-wheeled 
 waggon, total weight 2,420 pounds, at the back of which 
 is a switch-board for controlling the electric attachments. 
 In the second design the sterilizer consists of a roughing 
 filter and Nogier lamp, carried on a small two-wheeled 
 cart, fitted so as to be limber-drawn by either the Field- 
 Rontgen Ray waggon, or the wireless telegraphy waggon. 
 The current necessary in this case is 1-5 amperes at 110 volts, 
 and the dehvery the same as in the other pattern. A 
 more detailed account of these twb installations is to be 
 
186 MILITARY HYGIENE AND SANITATION 
 
 found in the Journal of theE.A.M.C. for May, 1911, under 
 " Current Literature." * It does not appear that either of 
 these installations has been actually built as yet. 
 
 Billon-Daguerre has suggested the use of a lamp in which 
 the rays are produced in highly rarefied hydrogen, and 
 claims for such a lamp more economical work, and greater 
 efficiency at a less expenditure of power (only 2 amperes 
 at 5 to 6 volts) than in any of the mercury vapour lamps. 
 Undoubtedly we have in sterilization by ultra-violet rays 
 the most promising method yet put forward. It is free 
 from all the objections brought against heat and chemicals^ — • 
 namely, that of changing the character of the water in the 
 first, or that of drugging the soldier in the second, case. 
 It appears to be less open to defects than filtration, and is 
 equally applicable whether with troops on the move, or in 
 standing camp. 
 
 Sterilization by Means of Chemicals. — ^Chemicals can 
 be used to destroy the micro-organisms in water in two ways. 
 They may act either as oxidizing agents or as direct proto- 
 plasmic poisons. In the former class are included most 
 prominently ozone and permanganate of potassium ; in 
 the latter the various halogens, chlorine, bromine, and 
 iodine, and also sulphuric acid. 
 
 Ozone is used on the large scale in several forms of appa- 
 ratus of which the Siemens Halske, and those of Frise, 
 Otto, and Abraham and Marmier, are the best known. The 
 ozone is produced as a rule by means of silent electrical dis- 
 charges through previously dried air. The resulting ozonized 
 air is then injected into the water, a thorough admixture 
 being effected by various mechanical means. The different 
 forms of installation vary only in this last respect. In the 
 Frise sterilizer the water flows slowly upwards through a 
 tower about 8 metres (26-4 feet) in height, its passage being 
 obstructed by means of perforated celluloid plates, and the 
 dissemination of the ozone throughout the mass being thus 
 assisted. In the Otto sterilizer the water passes down- 
 wards through a tower into which the ozone is forced from 
 below, thus meeting the flow of water. In the Abraham 
 and Marmier method the same procedure is adopted, the 
 tower, whose height is 7 to 8 metres (23-1 to 26-4 feet), 
 * See also Journal for February, 1912, p. 235 
 
PURIFICATION OF WATER 187 
 
 being loosely filled with gravel. The Siemens Halske 
 method closely resembles this. According to Lemoine the 
 Frise Company are meditating the production of a portable 
 ozone sterilizer for use in the field. 
 
 Permanganate of potassium is the chemical most com- 
 monly used for oxidation of bacteria in water. In India 
 at one time this salt was largely employed. In the absence 
 of other oxidizable matter, in solution or suspension, the 
 salt will inhibit the growth of disease-producing organisms. 
 The action is slow, taking half an hour in the case of Bacillus 
 typhosus, and a considerable dosage is necessary. If sufii- 
 cient is used to make the result certain the taste and the 
 colour of the water are markedly affected. 
 
 Lemoine describes several processes in which perman- 
 ganate of potash or permanganate of calcium are used in 
 combination with alum and other salts, the process being 
 combined with rough filtration. The great objection to 
 all oxidizing processes lies in the fact that the oxygen made 
 use of exercises no selective action. Dealing with a water 
 rich in organic matter, which is naturally often the case in 
 polluted waters, especially in the field, the process of oxida- 
 tion may extend itself on perfectly innocuous materials, 
 allowing the bacteria, at which it is aimed, to escape. 
 
 The halogens are free from this reproach, and therefore, 
 theoretically, more satisfactory. Chlorine can be evolved 
 either from chloride of lime or from salt solutions by electro- 
 lysis. The former method was used with success at Lincoln, 
 and works satisfactorily at Reading with the highly polluted 
 water of the Kennet. In this last-named town the hypo- 
 chlorite which is added to the water is subsequently removed 
 by filtration through gravel and magnetic oxide of iron. 
 The resulting effluent is absolutely free from all objection- 
 able taste. In certain experiments made at the Royal 
 Army Medical College, it was found that if water containing 
 B. coli were pumped through a small receptacle contain- 
 ing bleaching powder (available chlorine 20 per cent.) and 
 then allowed to stand for about five minutes B. coli was 
 completely destroyed. The chlorine was still recognizable 
 chemically at the end of this period, but not perceptible 
 to the taste. The Ontario Provincial Board of Health 
 recommend the use of chloride of lime in the following 
 
188 MILITARY HYGIENE AND SANITATION 
 
 manner : The salt is rubbed into a teacup of water, and the 
 solution further diluted with three cupfuls. One teaspoon 
 of the resultant mixture is added to each 2-gallon pail, 
 and the water allowed to stand for ten. minutes. Un- 
 fortunately this process depends largely on the chloride of 
 lime being fresh and containing a large proportion (30 per 
 cent.) of available chlorine. Used in the conditions for 
 which it is advised by the Board of Health — e.g., by pro- 
 spectors, miners, and campers — this strength is not likely 
 to be maintained. Moor and Hewlett recommend the use 
 of bleaching powders in the proportion of 0-25 parts per 
 million for clear chalk waters. The water should be allowed 
 to stand for an hour. 
 
 Iodine is used by Vaillard, being liberated by the action 
 of tartaric acid on the iodate of soda. After ten minutes 
 the free iodine is absorbed by hyposulphite of soda. This 
 process can only be used in comparatively small quantities 
 of water. The salts are made up into tablets of different 
 colours to facilitate their use in proper sequence. Testi 
 of the Italian Army uses a solution containing free bromine 
 and bromide of potassium, with hyposulphite of soda as 
 a corrective. Schumburg, with a similar procedure, absorbs 
 the excess of bromine with sulphate of iron. 
 
 Of the three haloids it can confidently be said that chlorine 
 is by far the most useful. It is, to begin with, a normal 
 constituent of the human body, and we know that it can 
 be consumed in considerable quantity as chloride of sodium 
 without ill-effects. It is different with the iodides and 
 bromides, which are distinctly depressing in their action. 
 Iodine and bromine should not, in my opinion, ever be 
 resorted to, except in the absence of all other means of 
 sterilization. 
 
 The acid sulphate of sodium is recommended by Parkes 
 and Rideal. It is used in tabloids containing 15 grains for 
 each pint, and imparts a distinct acid taste to the water. 
 This is not unpleasant, and if it is made up as suggested 
 by Firth, in combination with oil of lemon, the resultant 
 liquid is palatable and refreshing. There is one considera- 
 tion that, I confess, gives me pause. A man on service 
 consumes at least half a gallon of water. Supposing half 
 this to be taken in the form of tea, that leaves 2 pints 
 
PURIFICATION OF WATER 189 
 
 which must be steriUzed by the bisulphate. It is a question 
 for how long a period it would be wise to give the soldier 
 30 grains a day of a salt so closely allied to the well-known 
 laxative sulphate of soda. Personally, I should strongly 
 object to its issue for anything but the shortest period. 
 
 The great obstacle to the use of chemical methods of 
 sterilization on service is the difficulty of distributing the 
 agent evenly throughout the water. On the small scale, 
 as in the soldier's water-bottle, of course this is simple 
 enough. On any, even moderately, large scale it is out of 
 the question unless some mechanical means is resorted to, 
 and this at once robs the process of its greatest recom- 
 mendation — namely, the fact that special apparatus is not 
 needed. The objection of drugging 'condemns, in my mind, 
 the use of bisulphate of soda, bromine, and iodine, and per- 
 manganate of potash, for any but the shortest periods. 
 Another paramount objection to many of the chemical 
 methods recommended is the complicated technique neces- 
 sary. An extreme instance of this is shown in the following 
 form of sterilization, recommended by Glaser (Militdrarzt, 
 February 25, 1910) : The apparatus necessary is packed in 
 an aluminium case, 2 inches long by IJ inches in diameter. 
 In this are contained the chemical reagents — viz., calcium 
 permanganate and sulphate of manganese, each in con- 
 centrated solution, besides a number of filtering discs. 
 The case is made so as to screw into the man's water-bottle 
 at one end, the other being closed by a screw cap. The 
 prescribed ritual of purification is as follows : One litre of 
 water having been measured into the soldier's mess tin 
 (the lid of which possesses just this capacity in the Austrian 
 service) 5 drops of the calcium permanganate solution are 
 added to this, and well mixed. The quantity of salt con- 
 tained in this amount is 50 milligrammes. After the lapse 
 of ten minutes 5 drops of the solution of sulphate of man- 
 ganese are added. Ten minutes later a brown precipitate 
 having formed, the aluminium case is screwed on to the 
 mouth of the water-bottle over which a sterile filtering disc 
 has been placed, and the now sterile water is filtered into 
 that receptacle. The Austrian water-bottle only holds 
 500 c.c. of water, so presumably it is intended that the 
 above process shall be carried out by the men in pairs. No 
 
190 MILITARY HYGIENE AND SANITATION 
 
 information is given as to the method by which the filtering 
 discs shall be maintained in a sterile condition in the field. 
 The same vice of complication condemns the processes of 
 Vaillard, Testi, and Schumburg. Such methods may be 
 classed amongst the many other " vain adornments " which 
 encumber all departments of mihtary activity after a few 
 years of peaceful theory, only to disappear when the army 
 " clears for action," or at the latest after a few weeks of 
 warlike practice. 
 
 The officer who expects the ordinary careless man in the 
 ranks to remember the order in which he is to place three 
 different tabloids in his water-bottle, and the intervals he 
 is to observe between the additions, displays a faith in the 
 intelligence and power of self-restraint of the thirsty soldier 
 more creditable to his heart than to his head. On the large 
 scale, if the difficulty of mixing could be got over, this 
 objection would naturally disappear. Ozone is free from 
 all objection, but there is not at present any practicable 
 method for applying it to field-service conditions. In short, 
 I conclude that chloride of lime and bisulphate of soda are 
 the only reliable chemical sterilizers that are at present at 
 our disposal in war. They cannot be considered as being 
 generally useful, but for small bodies of specially selected 
 intelligent men, or small parties under the immediate 
 control of an officer, and (especially in the case of the 
 bisulphate) for short periods they may be of great assistance. 
 Such conditions exist typically in the case of a small de- 
 tached signalling party, or an officer's patrol of mounted 
 troops. 
 
 Purification by Heat. — ^The simple boiling of water is 
 undoubtedly the best way to insure its sterilization. In 
 the case of the isolated individual or the small detached 
 party, as long as fuel is obtainable and fires permitted, 
 the problem presents no difficulty. The mess tin, or the 
 camp kettle, can be used, and the subsequent cooling carried 
 out in the water-bottle. With large bodies of men the 
 affair assumes a certain complexity. In such a case some 
 special form of apparatus is necessary to boil the water in, 
 and some special means must be adopted to cool it subse- 
 quently. In some stations in India large standing boilers, 
 called " Larry more boilers," have been instituted. These 
 
PURIFICATION OF WATER 191 
 
 sterilized the water satisfactorily, but in no way assisted 
 in cooling it. This had to be carried out in some open 
 receptacle, and in the subsequent manipulation it not 
 infrequently happened that aU the benefit conferred by 
 the boiKng was lost. This was even more markedly the 
 case where boiling was effected, as in the majority of cases, 
 in large, open caldrons, from which the water was removed 
 by means of pails dipped into them. 
 
 If it is desired to sterilize water by heat on the large scale, 
 then it is imperative that some means must be provided 
 whereby the process of cooling may be carried out rapidly, 
 without exposing the water to any risk of further con- 
 tamination. In the absence of any refrigerating apparatus 
 this is effected most readily by means of " heat exchange." 
 The principle of this method is that if two masses of water 
 of different temperature are brought into close relationship, 
 being separated only by a thin sheet of some good con- 
 ducting material, they will tend to approximate in tempera- 
 ture, a rough balance being struck between the two. In 
 aU apparatus working on this system the incoming cold 
 water is made to pass on one side of a thin metal sheet, 
 whilst the outgoing hot water passes along the other. As 
 a result the latter emerges from the apparatus not only 
 sterilized, but cooled to a very considerable degree. Co- 
 incidently there is considerable economy of fuel, the cold 
 water arriving at^the boiler'at an aheady'somewhat raised 
 temperature. In the German and French Armies large 
 portable sterilizers of this nature are in use. In the former 
 this consists of a four-wheeled waggon, carrying a boiler 
 and cooler. The water is heated to 110° C, and eventually 
 cooled to within 2° to 3° of its original temperature. The 
 output is 1,000 litres, say, 220 gallons, per hour, and the 
 weight of the entire apparatus 2,450 kilos, about 2 tons 
 8 hundredweights. Such a weight is prohibitive for a 
 moving piece of apparatus, and it could therefore only be 
 used in standing camps or in large forts. A smaller form 
 suitable for pack transport, weighing 90 kilos (190 pounds), 
 is also suppKed. In the South-West African campaign 
 both these steriHzers were found unsatisfactory, and un- 
 suited for the climate. The chief objection to them seems 
 to have lain in their great weight. ' In the French Service 
 
192 MILITARY HYGIENE AND SANITATION 
 
 three different types are in use — the Vaillard and Desmaroux, 
 the Malvezin, and the Maiche-Cartault. These only differ 
 from each other in the means by which the two moving 
 masses of water are brought into relation to each other. 
 In the Vaillard-Desmaroux method {Sterilizateur Salvator) 
 this consists of two metallic sheets, rolled concentrically 
 on each other in such manner as to leave between them two 
 channels, of exactly equal capacity. The output is 1,000 
 litres per hour, and the apparatus is not portable. 
 
 In the method of Malvezin (Sterilizateur Pastor) the two 
 masses of water are separated from each other by thin 
 metallic corrugated plates, made of a specially prepared 
 bronze, covered with a fine enamel. The currents are broken 
 up into thin horizontal films, " which may be compared to 
 two ribbons interlaced in a zigzag fashion, the one moving 
 from above downwards, and the other in the opposite 
 direction" (Lemoine). In the Sterilizateur Maiche-Car- 
 tault the exchange takes place in helically coiled tubes. 
 In all these forms of apparatus the temperature of the water 
 is raised very considerably above that which is necessary 
 to destroy the germs of the ordinary water-borne diseases. 
 This entails an unnecessary expenditure of fuel. 
 
 It has been proved by direct experiment that a momentary 
 exposure to a temperature of 80° C. is sufficient to kill the 
 micro-organisms that cause cholera, enteric fever, and 
 dysentery. In the Griffith sterilizer, used in our army, 
 this fact is made use of. This consists of a boiler and an 
 exchange cooler as in the case of the other patterns, but the 
 passage of the heated water from the former to the latter 
 is controlled by a valve, operated by a small capsule, which 
 contains a mixture of alcohol and ether boiling at 80° C. 
 This guarantees that no unsterilized water can pass through 
 the cooler. The saving on fuel is considerable, and the taste 
 of the water is not affected to the same extent as with the 
 ordinary models. This pattern has not undergone the test 
 of field service, but has worked well in camps in this country. 
 The largest stationary pattern is calculated to deliver 
 100 gallons per hour. A portable form has been made, 
 but so far has not proceeded beyond the experimental stage. 
 
 Sterilization by Heat in the Field. — It is very doubt- 
 ful, in my opinion, if sterilization by heat can ever be of 
 
PURIFICATION OF WATER 193 
 
 practical utility in the field with troops on the move. The 
 apparatus is necessarily bulky, and the method entails the 
 provision of fuel, that is, additional transport. In civilized 
 countries this, of course, would present comparatively less 
 difficulty, though even here the collection and distribution 
 of the necessary coal, wood, or oil, would entail extra duties 
 on the part of the supply authorities. Again, whilst a 
 filter cart can be brought into activity immediately on 
 arrival in camp, any heat exchange apparatus demands a 
 certain lapse of time before it can supply potable water. 
 In uncivilized warfare the difficulties are even greater, since 
 the fuel may have to be transported from the base, and the 
 system would therefore add another weight to the many 
 which hamper the activity of an independent column 
 operating under such conditions. On the other hand, in 
 stationary posts on the lines of communications, or other 
 positions occupied for some length of time, this method 
 presents certain manifest advantages. In the first place it 
 demands much less supervision than any system of filtra- 
 tion, and can be maintained at work for much longer 
 periods, and in the second it is much more certain in its 
 action, when this is continued over a long time. A filter 
 needs constant supervision, and periodical renewal, while 
 flaws of even serious extent may pass undetected. The 
 essential drawback to the employment of heat is the un- 
 pleasant mawkish taste that invariably results. 
 
 The Position occupied by Purification in the Water- 
 SuppLY System. — Since water is at the moment of condensa- 
 tion in the atmosphere free from all possible contamination, 
 the purification of water is a confession of inadequacy or 
 weakness somewhere. This inadequacy may be the result 
 of circumstances beyond our control, as, for instance, in 
 the case of a large town which has to rely for its water on 
 an obviously polluted river. In a great many cases, how- 
 ever — and this applies particularly to stations such as our 
 troops occupy in India and South Africa — ^the demand is 
 so comparatively small that it is, or should be, possible to 
 select a source free from all possible contamination, which 
 should yet be capable of supplying sufficient water for the 
 garrison concerned. It must be remembered that we have 
 to protect ourselves, not against an infinite number of 
 
 13 
 
194 MILITARY HYGIENE AND SANITATION 
 
 possible forms of pollution, but against practically one 
 only — namely, pollution by human excreta. Moreover, we 
 know that the bacteria which constitute the real and only 
 danger are readily removed from the water by passage 
 through a comparatively small thickness of soil or rock. 
 If we can insure — and this is fairly often the case — ^that 
 our water shall be collected off a perfectly pure surface — as, 
 for instance, a fenced-off moorland — or, if from wells, that 
 these are at least half a mile, measuring horizontally, from 
 any polluted soil, and of sufficient depth — ^using the word 
 in the sense defined in an earlier chapter — it becomes a 
 question how far it is necessary to resort to purification 
 at all. Yet I have not infrequently seen measures of 
 purification, of an extremely crude type, resorted to under 
 conditions where the necessity for any measures of the 
 sort was extremely uncertain. It must be remembered 
 that all purification means a certain amount of handling, 
 and any scheme that is not carefully thought out may 
 result in the actual addition to the water of the very germs 
 which it was intended to remove. It is our duty, therefore, 
 in the first place, to see that the source is free from danger 
 (assuming, of necessity, that the amount available from 
 this source is sufficient). The question of purification only 
 arises when the source is obviously dangerous or liable to 
 contamination, and the liability is of a permanent and 
 irremediable nature. The adoption of purification, there- 
 fore, assumes either that one or both these conditions has 
 been proved to exist ; is a proof, therefore, of imperfection, 
 whether unavoidable or not, in our methods of collection. 
 The adoption of duplicate systems of purification is even 
 more illogical. I have seen cases where, after passage 
 through sand filter-beds, the water was, nevertheless, boiled 
 before issue to the troops. Clearly the sand-beds were 
 either efficacious or useless. In the former case boiling 
 was a work of supererogation, in the latter the filters should 
 have been dispensed with. It may be wise to have two 
 strings to one's bow, but it is bad archery to fit them both 
 on to the bow at the same time. Briefly, the adoption of 
 any method of purification assumes that up to that point 
 in our system the water has been exposed to probable and 
 unavoidable contamination. 
 
PURIFICATION OF WATER 195 
 
 If purification is necessary, it should be carried out under 
 some central authority, and not, if it can be avoided, by 
 the individual consumer, nor even by isolated groups of 
 consumers. A centralized system of purification is much 
 more likely to be efficacious, and much less likely to be 
 dangerous, than one which leaves the details of the work 
 to a number of scattered individuals. The inevitable loss 
 of economy resultant on all decentralization of effort leads 
 to inefficiency. I am perfectly certain that the boiling of 
 water "under regimental arrangements," sometimes even 
 "under company arrangements," as it used to be carried 
 out in India in the late nineties, meant the risk, 
 if not the actual certainty, of increased danger. Where 
 purification is necessary, then, it should be carried out 
 by some central station authority, not by individual units. 
 If, however — and such occasionally may be the case — water 
 cannot be purified in any central installation, then the 
 opportunity should be taken to instruct the men in purifi- 
 cation " under field-service conditions," and the methods 
 adopted in peace approximated as closely as possible to 
 those of war. On service, of course, all water is i^so facto 
 contaminated, and must, therefore, be purified. 
 
CHAPTER XI 
 
 VENTILATION 
 
 " Ventilation " means the provision of fresh air to and 
 the removal of foul air from the rooms of a dwelling, with- 
 out the causation of draught. The most constant cause of 
 the fouling of air is human respiration, and though other 
 causes exist, such as emanations from the clothes and 
 bodies of people using the room, or from the bodies of 
 animals, and the products of combustion of illuminants, 
 still, ventilation is considered chiefly in connection with the 
 air needed for and expended in respiration. 
 
 The connection existing between the breathing of foul 
 air and the causation of disease has always impressed itself 
 very strongly on the minds of men. As is well known, the 
 whole class of malarial diseases was at one time connected 
 definitely by name with the inhalation of bad air, and in 
 popular imagination a large number of other illnesses — such, 
 for instance, as gaol fever — were attributed directly to the 
 contamination of the air by some subtle gaseous emanation. 
 This was probably largely due to the powerful impression 
 produced on the imagination by the sense of smell, as is 
 evidenced by the fact that in the Middle Ages the use of 
 strong scents was considered one of the best prophylactics 
 against infectious disease. The study of bacteriology has, 
 of course, explained to a very great extent the part played 
 by the atmosphere in the propagation of epidemics. The 
 actual transference of micro-organisms as such — apart, that 
 is, from fragments of faecal matter, sputa, etc. — is very 
 doubtful, and at the present day I should imagine that 
 few people would credit the air itself with being a vehicle 
 of disease, though its current may furnish the motive power 
 required to transport the particulate matter which contains 
 
 196 
 
VENTILATION 197 
 
 the infective micro-organisms. Still, that the persistent 
 breathing of " bad air " — to use the most convenient 
 popular phrase — is connected with impairment of health 
 is an undoubted fact, and, moreover, this " badness " is 
 undoubtedly largely connected with the alterations pro- 
 duced in the air as the result of respiration. It is logical, 
 therefore, to consider, first, the changes produced in air 
 by this vital process. 
 
 Composition of Air. — ^Air consists normally of oxygen, 
 nitrogen, and carbonic acid. The two former constitute the 
 great bulk of the mixture, but, though the compound gas 
 is present in infinitesimal proportions comparatively (3 to 
 4 parts per 10,000), it must be looked on as being essentially 
 a normal constituent of the atmosphere. Its presence is 
 necessary to the continuance of vegetable life, and thereby 
 to that of the animal kingdom. The nitrogen is present, 
 as far as we know, mainly as a diluent of the oxygen, and, 
 though certain plants possess the power of fixing this gas, 
 the property is rare, and absent entirely in the animal 
 kingdom. The active agent of the atmosphere is, of course, 
 the oxygen, which forms slightly more than one -fifth of the 
 entire mixture. 
 
 Respiration produces certain chemical and physical 
 changes in the air inspired. As regards the former, the 
 oxygen is reduced from 21 per cent, to 16 per cent., the 
 carbonic acid being raised from 003 per cent, to 4 per cent. 
 At the same time the temperature of the outgoing air is 
 raised approximately to that of the body, and it is saturated 
 with moisture. Lastly, certain offensive gases, the result 
 of putrefactive processes in the upper air and alimentary 
 passages, and certain micro-organisms having a similar 
 provenance may be added during the process. 
 
 In addition to the effects produced on the air of a room 
 as the result of respiratory processes, we must include 
 those due to the evaporation of perspiration, which in 
 persons of uncleanly habits may add a very definitely 
 offensive element to the atmosphere. 
 
 The results of breathing air thus contaminated may, if 
 the condition is acute, as in the several cases of historical 
 overcrowding, of which the Black Hole of Calcutta is the 
 classical instance, be extremely serious. In that particular 
 
198 MILITARY HYGIENE AND SANITATION 
 
 tragedy, for instance, in which the conditions were aggra- 
 vated by intense atmospheric heat and moisture, 23 
 individuals only survived in the morning out of 146 
 who had been shut into the room the evening before, 
 whilst the survivors suffered for some time from symptoms 
 of septic poisoning. On the other hand, people exposed 
 to chronic overcrowding suffer from general malnutrition 
 and anaemia, with a high death-rate from respiratory 
 diseases, especially from phthisis. In the majority of cases 
 the situation is complicated by the co-existence of poverty, 
 and often by intemperance and general immorality ; but 
 the connection of chronic overcrowding and pulmonary 
 phthisis is well shown by the diminution in the death-rate 
 from that disease that has accompanied the improvement 
 in the housing of the British soldier since 1860. In the 
 year 1857 a Royal Commission was instructed to inquire 
 into and report on the condition of barracks and hospitals 
 in the United Kingdom. It was found that about one- 
 quarter of the army lived in rooms affording less than 
 350 cubic feet per man ; only about 6 per cent, of 
 the force enjoying a per capita allowance of over 
 550 cubic feet. The death-rate on account of phthisis was 
 far higher in the army than in the civil population of the 
 same age. As a result of their investigations, the members 
 of that Commission recommended that in future the accom- 
 modation in barracks should be calculated on the basis of 
 an allowance ot 600 cubic feet per man. This recom- 
 mendation was gradually carried out, and has now for many 
 years been universally observed. Coincidentally with this 
 improvement in the housing conditions of the soldier the 
 death-rate from tuberculosis has fallen from 2-78 to 0-31 per 
 1,000, whilst the invaliding rate has been diminished by 
 50 per cent. The improvement in this respect in the army 
 has far outstripped the improvement that has also occurred 
 in the civil male population of the same age, and the cause of 
 that improvement has undoubtedly been entirely, or almost 
 entirely, the increased accommodation allowed in barracks. 
 Since the effects of bad ventilation must be due to some 
 one or more of the alterations effected in air by the process 
 of respiration, it is necessary to consider the effects on the 
 human body of these changes individually. 
 
VENTILATION 199 
 
 Effects of Increase of Carbonic Acid. — ^The increase 
 in the proportion of carbonic acid present is so marked a 
 feature of respiration that attention was early directed to 
 this factor as a possible cause of the iU-effects of bad venti- 
 lation. This tendency was strengthened by the fact that 
 the presence and amount of this gas is so easily recognized, 
 and its quantity can be so accurately estimated, that it 
 affords a very ready standard whereby to estimate the 
 actual amount of respiratory impurity present. De Chaumont 
 was the first to fix a standard in this respect, considering 
 that any amount in excess of 6 parts per 10,000 of carbonic 
 acid was associated with a sensation of " stuffiness " readily 
 apparent to the senses. Other later observers have in- 
 creased this somewhat narrow range of permissible impurity, 
 and the Committee on the Ventilation of Cotton Weaving- 
 Sheds prescribed a limit of 12 parts per 10,000, giving a 
 margin of permissible impurity of over 8 parts, or four 
 times that allowed by De Chaumont. This would probably 
 be considered excessive in the case of a room occupied con- 
 tinuously as a dwelling-room, but at the same time we have 
 ample proof that, as long as the carbonic acid present is 
 not due to respiration, amounts much higher than these 
 can be endured, not only without distress, but without the 
 fact being recognized. According to Pembrey, it is quite 
 possible to work in a room where the proportion of carbonic 
 acid is as high as 60 volumes per 10,000, while at the same 
 time this amount is not perceptible to anyone entering the 
 room. This fact is now generally accepted, and though 
 the percentage of carbonic acid is still retained as the 
 simplest and most accurate test of the condition of ventila- 
 tion in an inhabited room, it is recognized that the quan- 
 tities present, even in the worst ventilated rooms, are 
 insufficient to account for the effects produced by bad 
 ventilation. 
 
 Effects of Decrease of Oxygen. — -Since the amount 
 of carbonic acid in expired air is roughly 100 times that 
 in pure air, whilst, on the other hand, the oxygen is decreased 
 only by 20 per cent., it might be anticipated that the effect 
 of bad ventilation on the air of a room would be less obvious 
 in the latter than in the former direction. As a matter of 
 fact, the proportion of oxygen present even in the air of the 
 
200 MILITARY HYGIENE AND SANITATION 
 
 worst ventilated rooms varies but slightly in amount from 
 that in the air of the open country. Angus Smith found 
 in the air of a law-court which was not ventilated in any 
 way 20-65 per cent, of oxygen near the door, and 20*49 per 
 cent, under the lantern just as the court was closing — a, 
 diminution of only at the outside 2-5 per cent, of the average 
 amount present in fresh air. A diminution so small as this 
 can hardly be expected to have any effect, since an equal 
 reduction in the actual amount of oxygen taken in at each 
 inspiration would be effected by a very moderate increase 
 in the altitude at which the sample was taken. 
 
 Effect of Putrescible Organic Matters added to 
 THE Air. — The very obvious effect produced by the air of 
 a stuffy room on the olfactory organs, and the fact that this 
 is in some delicate people accompanied by, and, as a result 
 partly, no doubt, of unconscious suggestion, connected 
 causally with, a feeling of nausea and faintness, has led 
 many people to connect the bad ejBfects of ventilation with 
 the presence of these putrescible organic matters in the 
 expired air. Experiments by Arsonval and Brown-Sequard 
 led these observers to conclude that a poisonous alkaloid 
 was actually present in such air ; but later observers have 
 decisively negatived this conclusion. It may be taken as 
 proved that up to the present no definitely toxic substance 
 has been isolated from air which has been vitiated by human 
 respiration. So great an authority as Rubner, it is true, 
 still adheres to the opinion that harmful matters do, never- 
 theless, exist in expired air, " though their nature, amount, 
 and characteristics are as yet unknown." It is very 
 doubtful if even this modified theory can be maintained. 
 The sense of smell exercises so marked a bias on the mental 
 processes that deductions drawn from it alone are most 
 misleading, and demand support from more exact experi- 
 mental observation. It must be remembered, too, that 
 this sense is the most easily blunted of all, and a very brief 
 exposure to the air of a " stuffy " room would deprive even 
 the most sensitive of the power of recognizing this condition, 
 by the sense of smell alone, in another equally objectionable 
 apartment. 
 
 Effects of the Physical Changes in the Air. — There 
 is no doubt that all recent work goes to show that the effect 
 
VENTILATION 201 
 
 produced by the air of a badly ventilated room is primarily 
 due to the increase in temperature and humidity, and that 
 these conditions are largely aggravated by any want of 
 movement in the air. These changes exert their influence 
 through the heat-regulating mechanism of the body. Under 
 ordinary circumstances the body parts with the heat which 
 it produces by radiation, convection, and evaporation. 
 Radiation and convection can exercise but little influence 
 in an inhabited room, much less in a crowded one, if the 
 air temperature is anything over 65° F. Any motion in the 
 air will, of course, bring ever fresh masses of air in contact 
 with the body, and thus assist in removal by convection. 
 In the absence of such movement heat loss must be effected 
 almost entirely by evaporation, and the extent to which this 
 is possible is entirely dependent on the relative humidity 
 of the air. If this is high, evaporation ceases, or is 
 diminished, and interference with the heat - regulating 
 mechanism at once results. In any particular climate the 
 relative humidity can be fairly well estimated by the 
 reading of the wet-bulb thermometer, but this is an accurate 
 guide under constant conditions only. Thus, a wet-bulb 
 temperature of 74° or 75° is most oppressive in England, 
 since the dry bulb is rarely much higher, and the flgures 
 given, therefore, connote a condition closely approaching 
 humidity. In India, on the other hand, a wet-bulb tempera- 
 ture of 85° F. is compatible with a feeling of absolute well- 
 being, so long as the dry bulb stands as high at least as 
 100° F.. since the amount of relative humidity is then only 
 47 per cent. A high degree of humidity is oppressive, even 
 at comparatively low temperatures, if the air be still ; and, 
 as is well known, a cold, stuffy room is only less objectionable 
 than a hot, stuffy one. Movement of the air not only 
 brings fresh cool masses of air into contact with the skin, 
 but also assists evaporation. In a badly ventilated room 
 the air in the immediate vicinity of the individual may be 
 saturated with moisture, though that at a distance is still 
 comparatively dry. In such a case mere agitation of the 
 air will effect relief up to a certain poin' , even though the 
 air of the apartment as a whole is not changed. There is 
 considerable reluctance in some quarters in accepting the 
 theory that the bad effects of ventilation are entirely due 
 
202 MILITARY HYGIENE AND SANITATION 
 
 to the physical changes produced in the air as a result of 
 respiration, but at present certainly the onus of proof is 
 on the shoulders of those who still adhere, like Rubner, 
 to the suggestion that unknown toxic elements exist in 
 expired air. 
 
 The Effects of Combustion. — The burning of illuminat- 
 ing gases or oils results in the production of carbonic acid 
 and water, as well as in raising the temperature of the 
 room. It has always been recognized that a higher propor- 
 tion of carbonic acid could be allowed to be present in the 
 air of an apartment, when its existence was due — in part, 
 at least — to artificial illumination. Thus, in the Report 
 of the Committee on Humidity and Ventilation in Cotton 
 Weaving-Sheds, the carbonic-acid standard is laid down 
 at 12 parts per 10,000, or 8 parts in excess of the amount 
 present in the outside air, whichever be the greater, at 
 ordinary times, but at 20 parts per 10,000, or 16 volumes 
 in excess of the outside air, whichever be the greater, 
 during the hours when artificial illumination by gas or oil 
 is in use. This position at first seems somewhat illogical. 
 Originally, no doubt, it was assumed, on the grounds that 
 artificial lamps and gas-jets added no putrescible or offensive 
 matters to the air, and that, therefore, the actual amount 
 of carbonic acid thus produced was less significant than 
 that which proceeded from human lungs. This position 
 could not now be logically held. As a matter of fact, 
 however, the proportion borne by the water produced in 
 combustion, say, of coal-gas to the carbonic acid, which is 
 the result of the same process, is very much smaller than 
 the proportion borne by the water exhaled in respiration 
 to the carbonic acid in the expired air. We are still, 
 therefore, justified in being more lenient in laying down a 
 carbonic-acid standard when artificial lighting is used 
 than when this is in abeyance. 
 
 Estimation of the Amount of Air required. — Theo- 
 retically, this should be based on the amount necessary to 
 absorb the moisture produced by respiration and perspira- 
 tion, and would vary, therefore, with every variation in 
 the temperature and relative humidity of the atmosphere. 
 Actually, however, it is much simpler to use the carbonic 
 acid present as a test and fix an empirical standard for 
 
VENTILATION 203 
 
 this. Having done this, it is a simple matter to estimate 
 the amount of air necessary per head of the occupants of 
 a room to be dehvered per hour, if that standard is to be 
 maintained. The amount of carbonic acid exhaled per 
 hour varies with the size, age, sex, and occupation of the 
 individual. For the ordinary sedentary adult an average 
 figure of 0-6 cubic feet per hour is taken. If, now, we take 
 a closed room measuring precisely 1,000 cubic feet in size, 
 we know that this wiU contain about 0-4 cubic feet of 
 carbonic acid. Taking De Chaumont's standard of per- 
 missible limit of impurity — namely, 0-6 parts of carbonic 
 acid per 1,000 — it is fairly clear that the average adult will 
 have raised the percentage of carbonic acid in the room to 
 this amount in the time taken by him to exhale 0-6— 0-4 = 
 0-2 cubic feet of carbonic acid. But since he exhales 
 0-6 cubic feet per hour, he will clearly attain this limit in 
 twenty minutes. Therefore a fresh supply of 1,000 feet 
 must be given at the end of twenty minutes if the standard 
 is to be maintained. This amount will again be expended 
 in twenty minutes, and a third in a similar period. Clearly, 
 every individual will, taking the above arbitrary standard 
 of impurity, expend 3,000 cubic feet of air per hour. Further, 
 too, it is immaterial what the size of the room may be. It 
 does not matter whether the fresh air comes from another 
 room or from another part of the same room. If a higher 
 standard of impurity be taken, as, for instance, that laid 
 down by the Weaving- Sheds Committee — namely, 12 parts 
 per 10,000 — then, clearly, the allowance of air may be 
 much smaller — only about 800 cubic feet per hour. 
 
 It would be undoubtedly more logical to fix on some 
 standard of relative humidity, and to lay down that the 
 air of an inhabited room shall not show a greater difference 
 between the wet and dry bulbs than that shown by the outer 
 air, within a certain permissible margin of variation. So 
 far, no standard of this nature has been fixed. As a matter 
 of fact, in dwelling-rooms no such calculations are made. 
 In rooms such as concert-halls they may be of use, though 
 great allowances have to be made for loss by friction in 
 air-passages, etc. In practice a certain number of aper- 
 tures are constructed to act as inlets and outlets, with 
 reference chiefly to the number of individuals that may be 
 
204 MILITARY HYGIENE AND SANITATION 
 
 expected to use the room. These are supphed, as a rule, 
 by windows, chimney- flues, and other openings, which 
 permit of the free movement of air, and the extent of these 
 is not fixed, in the great majority of cases, by considerations 
 of ventilation, but on aesthetic or other more general grounds. 
 Inlets and Outlets. ^ — These are apertures in the wall 
 of a room, either intentionally constructed with a view to 
 the entrance and exit of air, or at least made use of for that 
 purpose. To effect this various appliances are used — 
 e.g., Tobin's tubes, perforated bricks, and similar devices. 
 Taking inlets into consideration first of all, it is important 
 to consider their actual raison d^etre. This is to admit pure 
 air. It is not to admit pure air mixed with the accumu- 
 lations of dirt and debris that may have collected in some 
 recess or another. All apertures intended for use as inlets 
 which are not easily accessible for thorough cleaning, or 
 which contain corners not readily visible, and whose pur- 
 pose is not obviously marked on them, so that the necessity 
 of such cleaning shall be recognized, are, in my mind, 
 anathema. I am not speaking of public haUs, but of 
 dwelling-rooms, and in these I include barrack-rooms. 
 The only inlet which is always and easily accessible is the 
 window, and I hold firmly to the belief that the only inlet 
 which should be allowed in a dwelling-room is the window. 
 This aperture may be utilized in various ways, as by the 
 Hinckes-Bird system, in which the lower sash is kept per- 
 manently raised by a false sill, and an aperture equivalent 
 to the entire breadth of the window and about 3 inches 
 deep, is available for the entrance of fresh air. The direc- 
 tion of the entering current is by this device deflected 
 upward, and the draught thereby caused is less likely to 
 be felt. A better apparatus still is the so-called " hopper- 
 window," in which a glass hopper is attached to the lower 
 sill of a sash-window, projecting into the room. The upper 
 level of this hopper should be about 5 feet above the floor, 
 and it should be so constructed that it can, when the 
 window is shut, be folded up out of the way. For schools, 
 hospitals, and gymnasia these are excellent. In barrack- 
 rooms they would be too liable to breakage. Outlets may 
 also consist of artificial apertures in the wall of a room, and 
 in this case there is, prinm facie, the less necessity for con- 
 
VENTILATION 205 
 
 structing them in such a way as to faciHtate easy cleansing. 
 In' fact, however, the necessity is just as great in the case 
 of outlets as of inlets. The reason of this is that whatever 
 may have been the original intention of the designer as to 
 the proper course of the air-currents in a room, their actual 
 course will be decided by the relative position of the hot 
 and cold surfaces of the room. Wherever there is a cold 
 surface there will be down draught, and should an opening 
 originally designed as an outlet exist immediately above 
 that cold surface, the direction of the air-current will tend 
 to be inwards through that opening, and not outwards. 
 On the other hand, supposing that there is in the room one 
 main source of heat, all the air in the room will be drawn 
 directly towards that source, entering the room at every 
 available aperture, and will pass directly upwards from it 
 as it can find vent. In any dwelhng-room where there is a 
 fire burning, such an overmastering up-current exists, and 
 it is safe to say that in such a case every opening in the 
 room except the chimney acts as an inlet to supply the 
 demands of the chimney up-current, whatever the original 
 intention with which that opening was constructed. If 
 the fire be considerable, then the draught of air will affect 
 the currents, not only in the original room, but in the 
 passages and other rooms immediately adjoining. 
 
 In short, it may be said that the only outlet of a room in 
 which there is a fire is the chimney. 
 
 During the winter months the outlets and inlets of rooms 
 in which fires are not lit will all become inlets to supply the 
 air demanded by the rooms which possess fires. Thus, in 
 an ordinary villa, where in the day-time there are fires only 
 in the kitchen and in one or two rooms on the ground-floor, 
 there will be a current of air in the house from the upper 
 stories to the basement. Later in the night, as the bed- 
 rooms become warmed and the kitchen and sitting-room 
 fires die out, the current will tend to be reversed. The 
 ventilation of an ordinary dwelling-house, cut up as it is 
 into a large number of rooms and passages, each with sur- 
 faces presenting different conditions as regards tempera- 
 ture, is one of the most complicated problems in sanitation, 
 and it may be safely said that the responsibility of the 
 designer ends when he has provided a sufficient number of 
 
206 MILITARY HYGIENE AND SANITATION 
 
 suitable inlets — ^that is, windows — and safeguarded all un- 
 suitable apertures likely to become inlets as far as possible. 
 The actual course of the air-currents in the house, once it 
 is inhabited, is beyond the wit of mortal man to conjecture. 
 It will vary indefinitely with the manners and habits of 
 the occupiers. What is true of dwelling-houses is, in my 
 mind, equally true of barracks. Here we have to deal, it 
 is true, with fewer rooms, and these of a larger size. I should 
 trust in winter to a fire in an open fireplace, and in the 
 summer to open windows ; and at all times in the year I 
 should insist on all doors and windows, as far as the weather 
 permits, being wide open on all occasions when the men are 
 out of the room. It is in this last resource that I am certain 
 that the proper ventilation of barracks consists. It is 
 important to remember that the private soldier comes from 
 a class the members of which are, to state the case mildly, 
 averse to excess in the matter of fresh air. They do not 
 like open windows, and they will not, if they can help it, 
 have open windows, when they are themselves in the room. 
 The greater the reason, therefore, why the windows should 
 be open as wide as possible when they are out of the room. 
 As a practical point, it is advisable that the windows should 
 be opened and closed by some method of gearing under the 
 control of a N.C.O., and applying simultaneously to all 
 windows on one side of the room. The best form is a sash- 
 window, of which the top can be let down when wanted, or 
 a hopper window, with a hopper at the upper part. In 
 cubicle barracks each cubicle must be separately ventilated 
 in this manner, the different hoppers being controlled by 
 the N.C.O. of the corridor, not by the individual men. 
 
CHAPTER XII 
 REMOVAL OF WASTE MATTERS 
 
 One of the most important of all the problems that the 
 sanitarian has to face is how best to remove and dispose of 
 the waste matters that result from the ordinary daily life 
 of mankind. In military sanitation I confidently place 
 these questions as being the most serious of all that arise 
 in connection with the prevention of disease, since it is my 
 experience that the diseases which we have chiefly to fight 
 against in military practice are caused and propagated 
 more by defective methods of disposal and removal of these 
 waste matters than by any other means. Before con- 
 sidering these in detail, therefore, I should like to lay down 
 certain general principles which seem to me to underlie all 
 systems, and which must be observed carefully if any 
 system is to be satisfactory and efficacious. 
 
 In the first place, then, I will classify these waste matters 
 under two heads — physiological and economic. The physio- 
 logical waste matters are the excreta, liquid and sohd ; the 
 economic waste matters are the various fragments of food 
 and other debris, and the slop and other waters which are 
 the result of the different processes of daily life, eating, 
 cleaning of utensils, and so on. Now, as regards these two 
 classes it is to be noted that the amount of the former is 
 fairly constant for aU classes of men, whether civiHzed or 
 savage, consuming similar diets, whilst the quantity of the 
 latter will vary directly with the extent of civilization to 
 which the community concerned has attained. In any at 
 all civilized community the second class is far more bulky 
 than the first, and the problem of its removal and disposal 
 is difficult in direct proportion to the degree of civilization 
 and the size of the community. Obviously, then, whilst 
 
 207 
 
208 MILITARY HYGIENE AND SANITATION 
 
 the physiological waste matters form a constant factor in 
 the problem, the other class is more or less variable, and 
 under control, both as regards quantity and quality. 
 
 The reasons why these matters have to be removed and 
 disposed of are three in number : (1) Since they are to a 
 great extent of an organic nature, they are putrescible, 
 and in the process of decomposition they produce offensive 
 gases, which, if not in themselves actually the cause of 
 disease, do undoubtedly lower the vitaHty of those exposed 
 to them, and also certainly cause what is legally termed a 
 "nuisance." (2) They afford a favourable breeding-ground 
 for flies ; and (3) in the case of the physiological waste 
 matters they may contain the germs of certain intestinal 
 diseases which, by some means or another, and very largely 
 by the agency of flies, may get access to the air, water, or 
 food-supplies of the community, and thereby give rise to 
 fresh cases of the diseases concerned. 
 
 These evil consequences can be absolutely prevented only 
 by complete disposal of the waste matters, though the risk 
 of actual disease or serious nuisance can be largely mitigated 
 by rapid and distant removal. We must decide first, then, 
 what we mean by the word " disposal." In the case of 
 organic matters this can only mean oxidation, and waste 
 matters of organic origin can only be said to be disposed of 
 completely when their chief component elements — ^nitrogen, 
 carbon, and hydrogen — -are converted into nitric acid, 
 carbonic acid, and water. It is important to note, however, 
 that this process of oxidation need not necessarily of itself 
 affect the vitality of the disease organisms which are — at 
 least, potentially — present in the waste matters. It will 
 only do so with certainty if it is carried out in such a manner 
 as to result in a rapid evolution of heat, as in the case of 
 incineration. Slow oxidation, which is the method most 
 usually adopted, does not of itself destroy disease-producing 
 organisms, and cannot, therefore, be looked upon as, 
 strictly speaking, a complete method of disposal. Now, it 
 is obvious that with any method of oxidation less rapid than 
 incineration, if the waste matters are great in amount, there 
 wiU inevitably be, especially in a warm climate, a certain 
 amount of putrefaction and fly-breeding, and since at the 
 same time the disease-producing organisms will be un- 
 
REMOVAL OF WASTE MATTERS 209 
 
 affected, there will be grave risk of these last getting access 
 to the air, water, or food-supplies of the community. There- 
 fore it follows that this process of slow oxidation must not 
 be carried on in the vicinity of any dwelling, and from this 
 we deduce the corollary that removal is more important than 
 disposal in all cases where incineration in situ is impossible. 
 
 Taking, for instance, an isolated community living in a 
 sparsely inhabited country, it is clear that if by some 
 mechanical means we can contrive to remove at once all 
 waste matters to a distance of several miles, the problem of 
 disposal may, as regards that isolated community, be 
 allowed to stand over for subsequent consideration, as long 
 as the direction chosen is not towards the quarter of the 
 prevaiHng wind, and the locaHty selected for disposal not 
 close to the water-gathering ground. Such a situation is 
 by no means impossible. Any man who has served in 
 India must know many stations in which it would be quite 
 feasible to select a direction and a locaHty fulfilling the 
 above conditions, which at the same time would not inter- 
 fere with the health or comfort of neighbouring native com- 
 munities, and in which, therefore, if only the purely me- 
 chanical problem of complete and rapid removal were 
 solved, that of disposal would present no features of urgency. 
 I want to insist on this preponderating importance of 
 removal as compared with disposal, because men who have 
 been accustomed all their lives to an automatic system of 
 removal are very apt to forget its paramount importance 
 in countries where the efficiency with which it is performed 
 depends on the memory and energy of a low-class native. 
 I would impress most strongly on every young officer going 
 to India that, as regards disease prevention, the removal of 
 excreta is infinitely the most important question that he 
 will have to face. The closer the danger the greater the 
 danger, and with every yard that the excreta are removed 
 from the vicinity of barracks the danger diminishes in 
 inverse ratio to the square of distance. 
 
 As regards this question of removal, it is obvious that the 
 two classes of waste matters stand on a very different 
 footing. The class which I have termed " economic " can 
 only produce a nuisance. If allowed to accumulate for 
 some time, the unpleasant odours evolved may, it is true, 
 
 14 
 
210 MILITARY HYGIENE AND SANITATION 
 
 have a detrimental influence on the general health ; but 
 there is no possibility, as far as we know, of putrefying 
 organic matter producing enteric fever or cholera in the 
 absence of the specific disease germs, which exist only in 
 the physiological waste matters or excreta. In any case, 
 the danger is not so immediate and pressing in the case of 
 the former as it is in that of the latter, and it is on the 
 latter, therefore, that we must concentrate our chief atten- 
 tion. The methods to be adopted for the removal of the 
 two classes also differ. Rubbish is usually bulky, and is 
 always insoluble. It cannot, therefore, be removed in any 
 case except by actual porterage, by hand or cart. On the 
 other hand, the excreta are in great part liquid, whilst the 
 solid matter is small in amount, and readily disintegrated. 
 They therefore readily lend themselves to removal by water 
 carriage, which also solves the question of removal of slops 
 and other waste matters. 
 
 The effect on disease incidence of the introduction of such 
 a system of water carriage, which removes at once and to 
 a safe distance all the specifically dangerous matters, besides 
 a considerable amount of putrescible fluid, has been proved 
 by experience to be so great that in all civilized communities 
 a water-carriage system of removal is installed whenever 
 possible. The reduction in the prevalence of enteric fever, 
 as the direct result of the institution of a sewerage system, 
 is one of the commonplaces of textbooks on sanitation, and 
 need not, therefore, be repeated in detail. In fact, the 
 efficiency of such a system is so great that any community 
 which still retains a more primitive method of removal may 
 fltly be called on to show cause for so doing. Such cause 
 can only be furnished by proof that the difficulties in the 
 way of installing and maintaining a water-carriage system 
 are so great that it would be impossible either in the first 
 place to carry out properly the mechanical laying of the 
 necessary conduits, or, in the second, to insure their fulfilling 
 their necessary function of rapid and complete removal at a 
 subsequent period. 
 
 In certain places such cause can be shown, and here, 
 therefore, it is necessary to fall back on a hand and cart 
 system for removal of all waste matters. The different sig- 
 nificance of the physiological and economic waste matters, 
 
EEMOVAL OF WASTE MATTEES 211 
 
 as I have termed them, now comes at once into play. Since, 
 as I have already stated, it is the former only that are im- 
 mediately dangerous, whilst the latter are merely the pos- 
 sible cause of nuisance, it is clear that the removal of the 
 former is the urgent problem, and the task before us will be 
 simpHfied by keeping the two different classes of waste 
 matters separated. In a hand-and-cart system the great 
 difficulty is presented by bulk of fluid. This, which is a 
 positive advantage in a drainage system, as faciHtating 
 flushing, becomes a positive disadvantage when all dan- 
 gerous or putrescible matters have to be carried away by 
 man, or dragged away by animals. The excreta, liquid and 
 solid, must therefore be kept rigidly apart from all slops ; 
 they must be removed as rapidly and as frequently as 
 possible, and, pending removal, they must be so enclosed 
 that no particle of possibly infectious matter shall be able 
 to find access to the food, water, or air supphes of the com- 
 munity. It is sufficiently clear as a mere matter of principle 
 that if we can dispose immediately in situ of all such pos- 
 sibly infectious matters — as, for instance, by incineration 
 in the actual latrine itself of all the excreta, the problem of 
 removal of the other waste matters loses a great deal of its 
 urgency, and in practice a good deal of its difficulty — a point 
 to which reference will be made later. To sum up on the 
 whole question : 
 
 1. Waste matters consist of two classes, of which one is 
 positively dangerous until disposed of, the other in itself 
 merely the cause of annoyance, though in the presence of the 
 former it may assist in the dissemination of danger. 
 
 2. The disposal of both classes is achieved by oxidation, 
 whether slow or rapid ; but whereas rapid oxidation will not 
 only remove the danger, but also prevent the nuisance, slow 
 oxidation will not affect the former, nor entirely prevent the 
 latter. 
 
 3. Therefore, where rapid oxidation — or, in other words, 
 incineration in situ — is impracticable, it is necessary to 
 achieve early and complete removal, since at any moment 
 both the danger and the nuisance are in direct proportion 
 to the proximity of the waste matters to the habitations of 
 the community. 
 
 4. This early removal is effected in civihzed communities 
 
212 MILITARY HYGIENE AND SANITATION 
 
 by a system of water carriage, and its efficacy as a method 
 of preventing disease has been repeatedly proved. 
 
 5. Where this method of removal by water carriage is im- 
 possible, it is clear that on general principles we should aim 
 at immediate disposal in situ of the positively dangerous 
 waste matters by rapid oxidation, which not only disposes 
 of them qua possible causes of nuisance, but also destroys 
 entirely their power of causing disease. It should be noted 
 here that there is no proof that the methods of slow oxida- 
 tion which are usually adopted for the disposal of waste 
 matters in any way affect the disease-producing organisms 
 that may be, and should always be assumed to be, present in 
 the excreta. They must therefore be looked on from the point 
 of view of disease prevention as theoretically incomplete. 
 
 Water-Carriage Methods of Removal. — The usual 
 systems of water carriage begin with the water closet, are 
 continued through the soil-pipe, the house drain, the branch 
 drain, and the sewer, to their final termination at the sewage 
 works. It is to be noted that we have here a closed system of 
 pipes containing a greater or less quantity of putrescible fluid 
 in more or less rapid motion. The efficacy of such a system 
 depends, in the first place, on the rapidity with which the 
 fluid is carried along the system of piping, since any delay 
 permits of the accumulation of noxious gases which may 
 pass backwards into the habitation. It is essential, there- 
 fore, that the onward flow of the sewage should be facilitated 
 in every way, that there should be no constructional impedi- 
 ment, and that means should be provided whereby every 
 accidental obstruction may be at once cleared away. At 
 the same time, since a certain amount of putrescence, with 
 consequent evolution of gas, is inevitable, there should be 
 complete disconnection between the air of the house and 
 that of the drainage system, and also free communication 
 between the air of the latter and the general atmosphere. 
 
 The various methods by which the above objects are 
 achieved are fully described in general textbooks on sanita- 
 tion, and since the details of a drainage system in a modern 
 barracks differ in no way from those in any civil institution, 
 nor, indeed, except in extent, from those in a private dwell- 
 ing, I do not intend here to touch further upon them, since 
 they possess no distinctively military features. 
 
REMOVAL OF WASTE MATTERS 213 
 
 Hand and Cart Methods. — I will accordingly pass at 
 once to the system of removal by hand and cart which we 
 are forced to adopt in stations where for various reasons a 
 water-carriage system is impossible. 
 
 As I have already said, the advantages possessed by a 
 water-carriage system are so great that the adoption of any 
 inferior method needs defence and the submission of reasons. 
 Obviously these must be grounded on local conditions which 
 either tend to impede the onward flow of the sewage, or 
 favour the evolution of gas in the drains, or produce both 
 these effects. The flow is impeded by deficient fall, or by 
 great length of comparatively narrow branch drains. 
 Neither of these by itseK is insuperable, since the former can 
 be overcome by mechanical means, pumping, suction, etc., 
 and the latter, if the gradient be satisfactory and the quantity 
 of the sewage sufficient, is of comparatively less importance. 
 Combined together, however, they constitute a difficult situa- 
 tion. Long branch drains mean a scattered community living 
 in houses situated at a considerable distance from each other, 
 and this, again, means, as a rule, a community with a small 
 taxable capacity compared with the area that it covers. Pro- 
 pulsion or ejection systems are expensive in construction and 
 upkeep, and, though they can overcome any difficulty the 
 result of insufficient gradient, their efficacy is much dimin- 
 ished if the narrower branches form any considerable pro- 
 portion of the whole drainage system. The evolution of 
 gas is favoured by a high temperature, which, in addition, 
 increases the volume of the gas so formed ; whilst, if an 
 extraction system is to be adopted, free intercommunication 
 cannot be permitted between the open air and thab of the 
 drain or sewer. Clearly, therefore, in a warm cHmate, with 
 a community living in comparatively small detached houses, 
 especially if the general surface be flat, the introduction of a 
 water-carriage system of removal bristles with difficulties. 
 I do not mean to say that they are necessarily insuperable 
 difficulties. They can doubtless be overcome by a free 
 expenditure of money and constant supervision, and with 
 a rich community would probably be overcome. Now, the 
 condition of affairs in the enormous majority pf our Indian 
 stations is as I have stated three sentences above. For 
 these reasons, I have come to the conclusion that to intro- 
 
214 MILITARY HYGIENE AND SANITATION 
 
 duce a water-carriage system in these stations is an impossi- 
 bility. The money for expensive installations does not 
 exist, and the constant necessary supervision could only be 
 applied through the agency of ignorant, low-caste natives. 
 Where such conditions obtain, the only resource is to fall 
 back on a hand-and-cart method of removal, recognize its 
 inevitable dangers, and make the best of the situation. This 
 is just one of those positions where it is essential to remember 
 that sanitation is merely adapting oneself to one's surround- 
 ings. I should like to add one word of warning here as to 
 the danger of introducing civilized methods of hygiene to 
 a population that is unaccustomed to or does not want 
 them, or in places where the actual daily detail must be 
 carried out by cheap native labour. In such cases the old 
 proverb, Corruptio optimi pessima, is more than ever 
 true. It is often better, retrograde though the step may 
 appear, to keep to the ancient ways. 
 
 Accepting, therefore, the conclusion that, under circum- 
 stances such as I have detailed, we are forced to abandon 
 the more efficient and scientific method of water carriage, 
 and rely on a hand-and-cart system of removal, I propose 
 to describe at some length the essential points of this last 
 method, and in doing so shall keep in my mind chiefly the 
 conditions as they have to be dealt with in the great majority 
 of Indian stations, since not only am I better acquainted 
 personally with these conditions, but, as far as the army 
 medical officer is concerned, they constitute a problem with 
 which he must inevitably find himself sooner or later brought 
 face to face. 
 
 The essential distinction between any such system of 
 removal and a water-carriage system is that removal has to 
 be carried out by hand and periodically, instead of being 
 automatic and immediate. For a longer or shorter period, 
 therefore, the excreta, liquid and solid, have to be detained 
 in the more or less immediate vicinity of the dwelling. 
 The entire success of a conservancy system depends on the 
 efficiency with which it prevents, during this period of in- 
 evitable retention, (1) the occurrence of nuisance, and (2) the 
 passage of possibly infective particles of the excreta from 
 the receptacle in which they are contained pending removal, 
 to the air, water, or food supplies of the community. The 
 
REMOVAL OF WASTE MATTERS 215 
 
 prevention of nuisance is, of course, essentially a question 
 of deodorization, and this, again, is largely a question of 
 occlusion and distance. In the case of barracks, therefore, 
 latrines should, to begin with, be at a good distance from 
 the barrack bungalows, and the receptacles should be closed. 
 There is little difficulty about the former, and I would feel 
 inclined to lay down 50 yards as a reasonable distance. 
 The closing of the receptacles is another matter, and here 
 we are brought up against one of the great difficulties of 
 all such systems. Obviously, the excreta must be kept, 
 pending removal, either in the receptacle into which they 
 are passed by the man, or transferred into another. In the 
 former case we have at once the difficulty of closing the . 
 receptacle, which may need to be used by other men ; in 
 the second we have to recognize the emptying of excreta 
 from one receptacle to another, with all its attendant 
 dangers of spillage, difficulty of cleaning, etc. Personally, 
 I consider the danger of the latter procedure greater than 
 the risk of nuisance attached to the first, and I hold strongly 
 that the excreta should remain in the receptacle into which 
 they are first passed until final removal. It is possible 
 to have automatically closing fiap covers to the latrine 
 seats, though I have but little faith in these, or, rather, a 
 well-grounded trust in the capacity of the private soldier to 
 circumvent any such apparatus if it is likely to be in any 
 way irksome to him. If any further deodorant action is 
 required, I would trust to the use of chloride of lime, or an 
 emulsion of crude carbolic acid, or other similar compound, 
 sprinkled freely about the latrine. The difficulty in respect 
 of nuisance, then, can be overcome in the above manner. 
 We have now to consider the danger. This, of course, con- 
 sists in the fact that there is always a possibility of one or 
 more men in a unit being a " carrier " of the germ of enteric 
 fever or some other of the so-caUed intestinal diseases, and 
 therefore a further possibiHty of the germs passed by him 
 obtaining access to the air, water, or food suppHes of his 
 comrades. This can only happen if some means of transport 
 are provided, and there are, as far as I know, only two 
 methods in which this can be furnished. The germ must be 
 carried either on the person of the individual who happens 
 to be in the habit of passing it, or by files. The former is, 
 
^16 MILITARY HYGIENE AND SANITATION 
 
 of course, a very distinct danger, and one that it is difficult 
 to guard against if the man is engaged in the cookhouse, or 
 is otherwise concerned in the preparation of his comrade's 
 food. This point will be again referred to under Enteric 
 Fever. As regards the house-fly, which I consider the 
 greatest danger, most elaborate steps must be taken. In 
 the first place the latrine seat should be closed in round the 
 receptacle, so as to afford as little facility for the access of 
 the fly to its contents as possible. The only difficulty here, 
 again, will be in the case of the lid, and it may be necessary 
 to place a man on duty in the latrine to see that the lids 
 are kept closed after use. I do not place much reliance, 
 however, on any mere mechanical appliance as regards the 
 exclusion of so pertinacious an insect as that which we are 
 now considering. The only measure on which I do place 
 reliance is the use of some strong-smelling chemical which 
 shall be obnoxious to the fly. This must be used freely on 
 the floors and walls of the latrine, and the wooden seats 
 must also be thoroughly scrubbed with it. The under-surface 
 of these seats should also be tarred once or twice a week 
 with the same object. I know by experience that, using 
 such precautions, it is possible to keep flies out of latrines 
 without any mechanical appliances, and I have too little 
 faith in such appliances to trust to them alone. If possible, 
 I would have both, since two strings are better than one ; 
 but if only one is possible, then I should rely on the strong- 
 smelling chemical as the most efficacious method. Whatever 
 means are used, of one thing I am most sure : the efficiency 
 of any method of conservancy at this stage is in inverse ratio 
 to the number of flies in the latrines ; these pests are not only 
 themselves the great danger, they are also the most obvious 
 evidence of its existence. 
 
 Distance has, of course, a distinct importance as regards 
 the danger from the excreta, in addition to its importance as 
 regards nuisance. No latrine should, in my opinion, be 
 within 100 yards of any kitchen, and the greater the distance 
 the better. The recklessness — one can hardly use any other 
 word — with which these structures were at one period dis- 
 tributed throughout barracks is hardly conceivable nowa- 
 days. There is at present in the museum of the Royal 
 Army Medical College a notice-board from the hospital at 
 
REMOVAL OF WASTE MATTERS 217 
 
 Ahmednagar inscribed with the following legend : "No. 23. 
 Cookhouse, Lavatory, and Privy," showing that all these 
 three offices were combined in one structure. And though 
 this is an extreme, it is by no means a solitary instance, of 
 such ineptitude in design. 
 
 Structure op Latrines. — It was the custom at one time 
 in India to build these of brickwork, mud plastered, the floors 
 being also of brickwork, though more frequently of earth, 
 possessing in either case numerous chinks and crevices. All 
 latrines should be constructed of impervious material, either 
 metal, or of some of the modern patent fireproof building 
 compositions. They should be built with double walls and 
 roofs to keep out the heat, and the materials assembled in 
 such manner that the entire structure can be dismantled 
 and transported to another position if necessary. The floor 
 should be of concrete or good masonry, if procurable . Where 
 this is impossible, I would rely on an earthen floor prepared 
 with kerosene oil. This is infinitely better than brickwork, 
 which always wears unevenly, and affords numerous crevices 
 for the accumulation of filth. The seats should be solid 
 wooden slabs resting on iron brackets, but not fastened 
 down : the receptaces, large metal buckets of the dimensions 
 of those in use in standing camps in England. The small 
 earthenware pan, or gumlah, is not, I consider, permissible. 
 These receptacles should fit closely to the seats, and be kept 
 in position by guides fixed either to the under-surface of 
 the seat or built into the floor. They should be removed 
 through an aperture at the back of the seat closed ordinarily 
 by a heavy flap door. Whether this is to be done once or 
 twice a day must depend on the ultimate arrangements for 
 removal to the disposal-ground. If possible, this should be 
 carried out twice in the twenty-four hours, but always by 
 daylight : this last point is essential. The dangers of a hand- 
 and-cart removal system are multiplied tenfold if it is carried 
 out in the dark ; and as the only objections to a daylight 
 method are sentimental, they should be overridden. Im- 
 mediately after removal from beneath the seats, the pails 
 should be closed by means of heavy metal lids fastened down 
 by a solid clamp, and these lids should not be again removed 
 from the pails until they are about to be emptied at the 
 disposal-ground . 
 
218 MILITARY HYGIENE AND SANITATION 
 
 Details are, however, immaterial. The object to be con- 
 stantly kept in mind is that no loophole must be allowed 
 for any particle of potentially infective matter to escape 
 from the pail until it is finally emptied at the trenches or 
 pits for disposal. Such escape is effected either by the 
 agency of flies which have obtained access to the excreta 
 while the pail is under the seat in the latrines, or as the 
 result of splashing during the subsequent inevitable moving 
 about of this receptacle. The first essential is to keep the 
 flies out of the latrines ; the next, to move the pail as little 
 as possible until it is hermetically covered ; and, lastly, 
 never to move it about at all except during the hours of 
 daylight. If any accidental splashing should occur, it can 
 then be at once detected, and suitable steps be taken to 
 counteract the possible danger. 
 
 A greater difficulty than that presented by the removal 
 of the solid excreta is presented by the urine. In the first 
 place, the bulk is enormously greater ; in the second, there 
 is far more danger of splashing during removal ; and in the 
 third, and most important of all, it is almost impossible 
 to induce men to look on urine as being so dangerous a sub- 
 stance as the solid excreta. The best pattern of urinal is a 
 trough discharging into a tub or similar receptacle. This 
 latter should be removed as it stands to the disposal-ground 
 or to a central depot, due care being taken, as in the case 
 of the faeces, to prevent access of flies or splashing. The 
 building in which the trough is placed should be constructed 
 of materials similar to those already mentioned under the 
 head of Latrines, the floor being of impermeable material, or 
 else of earth hardened by the application of kerosene oil. 
 Of the two, I prefer the latter, since it is difficult to get any 
 impermeable flooring to withstand evenly the assaults of 
 the ammunition-boot, and an oiled earthen floor is more 
 easily kept in order and repaired than a chipped or worn 
 concrete floor. Where good paving-stones are available, 
 these may be used. The so-called " Cuddapah slabs " are ex- 
 cellent for this purpose. The trough may be of metal or 
 earthenware, with, if possible, a good glaze. Glazed or not, 
 it should be constantly oiled to facilitate the flow of the 
 urine. I have seen many different forms of trough, but I 
 have never yet seen one which would with certainty prevent 
 
* REMOVAL OF WASTE MATTERS 219 
 
 spilling on the floor, the result of carelessness-, sometimes of 
 drunkenness. It is, therefore, of the greatest importance to 
 keep flies out of urinals, and the use of chloride of lime or 
 some other deodorant is advisable. The receptacle into 
 which the trough discharges should be covered, and I know 
 no better method of doing this than to use a conical wire or 
 wicker basket fitting on to the rim. This basket should be 
 filled with pieces of wood charcoal well sprinkled with mineral 
 oil. This will serve to keep away flies, and at the end of 
 the period of use the charcoal can be burnt and re-used. 
 The receptacle should be of considerable size, and, in my 
 opinion, supported on wheels, so that it can be removed as 
 it stands without any emptying or unnecessary handling, 
 and it should, of course, be provided with a lid. The danger 
 of splashing is great, and this can be obviated in part by 
 using large receptacles, so that they shall never be more 
 than three -parts full, and also by floating leaves or grass 
 on the surface of the fluid. This very simple contrivance 
 is most efiicacious in this direction. The urine must even- 
 tually be removed to the disposal-ground, and there is a 
 great difficulty here. Either each individual receptacle 
 must travel the whole way, or there must be some central 
 depot where the smaller tubs may be emptied into larger 
 tanks. The first method multiplies transport enormously ; 
 the second means splashing. The removal of urine is, in 
 fact, a very serious problem. If we place the average 
 excretion at 2 pints per man, the total weight of fluid that 
 has to be transported in respect of this excretion in the case 
 of an infantry battalion at full strength is well over a ton, 
 with a total bulk of 40 cubic feet. Perhaps some form of 
 travelling vacuum tank would be the most satisfactory 
 apparatus for this purpose. If we remember how compara- 
 tively easy it is for a negligent or lazy sweeper to get rid 
 of his load in any convenient ditch, it is allowable to main- 
 tain a certain amount of scepticism as to the thoroughness 
 with which this amount of fluid is on occasion removed 
 from the vicinity of barracks, especially when this 
 operation is carried out by night in a cart of the usual 
 pattern. 
 
 The removal of excreta from barracks is, I consider, the 
 most important part of the daily sanitary routine in an 
 
220 MILITARY HYGIENE AND SANITATION 
 
 Indian station. No mechanical appliances can possibly 
 insure its being carried out in such a manner as absolutely 
 to preclude all danger. It is therefore essential that the 
 details of latrine and urinal management should be en- 
 trusted to some reliable person, private or non-commissioned 
 officer, and not left to the mercy of the low-caste native 
 sweeper and his ideas of what constitutes efficient con- 
 servancy. The duty need not be by any means unbearably 
 unpleasant, unless the latrines and urinals are allowed to 
 get into bad order. There is no reason why this duty 
 should be given to one selected man — in fact, it would be 
 better if all the men took their turn at it, since all are 
 equally interested in its proper performance. Such a 
 method, too, deprives the selection of a man for this duty 
 of any invidious appearance. 
 
 In addition, company officers should be made to realize 
 the essential importance of this branch of sanitation . Under 
 a well-organized regimental system, there need be no diffi- 
 culty in maintaining satisfactory conservancy with a 
 minimum of offence to any individual. If it is left to the 
 sweepers, there will be no proper conservancy, and a 
 maximum amount of nuisance to everybody will inevitably 
 result. 
 
 Difficult as the problem of removal of excreta from bar- 
 racks undoubtedly is, it is simplicity itself when compared 
 with that which confronts us when we have to deal with 
 the bungalows occupied by officers. A short description of 
 the ordinary bungalow and its surroundings is advisable 
 here for the benefit of those officers who have not yet made 
 acquaintance with Indian surroundings. 
 
 In the first place, the bungalow itself is a large one-storied 
 building, consisting of a larger or smaller number of sitting 
 and bed rooms. The chief peculiarity which distinguishes 
 it from an English house is the fact that there is no general 
 closet, each bedroom being provided with a small annexe 
 or bathroom in which a bath and commode are placed. 
 The excreta are removed from this room by a special low- 
 caste servant, the sweeper, and by him deposited in a metal 
 receptacle placed in an outhouse in the compound, which 
 also officiates as the servants' latrine. The distance at 
 which this is situated from the bungalow depends entirely 
 
REMOVAL OF WASTE MATTERS 221 
 
 on the size of the compound, and this, again, usually on 
 the size of the bungalow. Where a large bungalow is 
 situated close to a small one, it is quite possible that the 
 native latrines of the two compounds may be in extremely 
 close proximity to the latter dwelling, and this condition of 
 affairs is by no means exceptional. The occupants of the 
 bungalow itself are probably from one to four in number, 
 not often as many as six ; but the number of natives in- 
 habiting the compound is limited only by the number of 
 relatives which the caprice of the domestics or the laxity 
 of the masters permits to reside in the servants' quarters. 
 In addition to the human population, there are, as a rule, 
 one or more ponies or horses stabled in the compound. 
 Obviously, therefore, we have in any cantonment a large 
 number of isolated filth -depots, each of which is a potential 
 cause of danger to the community. The larger the canton- 
 ment and the more crowded the bungalows, the greater the 
 danger. 
 
 The supervision of these numerous scattered native 
 latrines is a task of the greatest difficulty. Nominally, it 
 is the duty of the cantonment magistrate and his staff, but 
 in reality it is impossible for any one man, however ener- 
 getic, to carry out this duty. It is essentially incumbent 
 on every occupier of a bungalow to look after the latrine in 
 his own compound, and, indeed, the general conservancy of 
 that area. That the former task is an unpleasant one I 
 readily admit, but the more efficiently it is performed the 
 less unpleasant it becomes. A daily visit to the latrine 
 need not take any long time, and can conveniently foUow 
 the daily visit to the stable, which is part of the ordinary 
 daily ritual. The use of strong deodorants — e.g., chloride 
 of lime or crude carbolic acid — is advisable, not with any 
 idea of destroying possible infection, but merely with that 
 of driving away flies. (I use the word " deodorant," because 
 the killing of smells is one, though the least important, of 
 the objects of the use of these substances, and partly also 
 because I am loath to coin so hideous a word as " muscifuge," 
 which would more accurately signify their real intention.) 
 At the same time, the owner should see that a proper re- 
 ceptacle exists in the latrine, and that the lid is not only 
 in good repair, but in its proper place — namely, on the top 
 
222 MILITARY HYGIENE AND SANITATION 
 
 of the receptacle, and not, as is more usual, propped against 
 the side of it. 
 
 Whilst on this question of native latrines, I should like 
 to say just a few words about that humble but absolutely 
 necessary domestic, the native sweeper. This man is a low- 
 caste Hindoo, using this word in a wide sense, or else a low- 
 class Mohammedan, and his position is best described in the 
 phrase originally attributable, I believe, to the late Miss 
 Nightingale — namely, " a human drain -pipe." This is, 
 indeed, his proper function, and should be his only function. 
 This principle is not, however, always observed, especially 
 in the case of British units lately arrived from home. I 
 have in my mind a distinguished infantry battalion, not 
 long in the country, in which every table servant had the 
 designation " sweeper " written plainly on his face. I 
 know another instance in which two cases of enteric fever 
 occurred amongst some young officers which were traced 
 with great probability to the fact that the early-morning 
 tea was brought from the mess by the bungalow sweeper. 
 Now, there is not the slightest use mincing words in a case 
 like this. To allow a sweeper to come into contact in any 
 way, however indirect, with one's food is as nasty — ^there is 
 no other word suitable — as to eat one's meals in a water- 
 closet. And though this is not a sanitary aspect of the 
 subject, I may add that the better class of native servant 
 looks on any man who allows such contact knowingly to 
 occur much in the same way as we should look on one who 
 was addicted to the other objectionable practice. It is the 
 duty of any medical officer in charge of a newly-arrived 
 battalion to impress on the officers of that unit the danger 
 to which such laxity exposes those who are guilty of it. 
 
 The removal of excreta from the compound latrine is a 
 matter with which the cantonment magistrate is concerned. 
 Here, again, the difficulties are enormous, and they are 
 multiplied a hundredfold when removal is carried out by 
 night. Daylight removal is the first essential towards 
 efficiency in this respect. 
 
 Whether we are dealing with barracks or private bunga- 
 lows, the ultimate removal must be carried out by cart, 
 except in hill-stations. I have no doubt in my own mind 
 as to the pattern of cart that is the best for this purpose. 
 
EEMOVAL OF WASTE MATTEES 223 
 
 In the first place, there must be no emptying of receptacles 
 in barracks, and therefore any tank pattern of cart stands 
 condemned. The cart should be a lorry, with the centre 
 rather higher than the sides, so that the latrine receptacles 
 may be stacked on it in two layers, or rather at two levels. 
 This cart should be solidly built, with stout wheels, and 
 should be dragged by horse -draught. Such a cart was 
 introduced at Quetta in 1899, and acted admirably. Re- 
 moval should be by regular roads, and at certain definite 
 hours. Carts should not be allowed to wander erratically 
 up any back-lane, lurching from one rut into another, but 
 all should be confined to good metalled roads. Horse- 
 draught is not essential, though infinitely better than 
 bullock-draught, because quicker, and in the long-run, I 
 believe, cheaper. I need hardly say that motor-draught 
 would be preferable to either. The distance to which 
 removal should be effected is important, and the only 
 limitation is the expense. It will depend partly on the 
 number of times at which removal is made during the 
 twenty-four hours, partly on the establishment of carts 
 maintained, and the pace at which the draught animal 
 used is capable of travelling. The ideal, in my opinion, is 
 attained by the use of horse-draught lorries for removal 
 to a depot close to, but to leeward of cantonments, using a 
 light railway for the rest of the distance. The receptacles 
 should be transferred direct from the lorries to trucks of 
 any suitable construction on the rails. With some such 
 system removal to three or four miles should^ not be im- 
 possible, and if that is effected, the subsequent question of 
 disposal is one of comparatively less urgency. 
 
 From beginning to end the whole efficiency of any con- 
 servancy system in Indian cantonments depends entirely 
 on supervision by responsible Europeans. The native does 
 not, and will not, understand the importance of the subject. 
 Whether as a result of custom, or education, or merely 
 because of Oriental fatalism, he will not of his own " mere 
 motion " pay that attention to detail which is absolutely 
 essential. The average British officer and soldier, accus- 
 tomed all his life to have removal carried out for him, and 
 to have his responsibility in this matter limited to the 
 pulling of a handle, takes time to realize the alteration in 
 
224 MILITARY HYGIENE AND SANITATION 
 
 his surroundings in this respect. The old tag, Godum non 
 animum, is as true with regard to sewage removal as with 
 regard to any other ingrained habit. 
 
 The difficulties of such a system are, in fact, so great, and 
 the loopholes for danger so innumerable, that I am steadily 
 coming to the conclusion that the solution of the problem 
 lies in some method of incineration in situ, whereby all the 
 difficulties and nine-tenths of the danger are avoided. The 
 consideration of this, however, I defer till I come to the 
 question of disposal. 
 
CHAPTER XIII 
 
 DISPOSAL OF WASTE MATTERS 
 
 In discussing the question of the disposal of waste matters 
 it is necessary to remember the division of these matters 
 — ^to which reference has been made when considering their 
 removal — into two classes — namely, those which can only 
 produce a nuisance, and those which in addition are the 
 possible vehicles of specific infectious disease. 
 
 The meaning which we attach to the word " disposal " 
 varies with the class of waste matter which we happen to be 
 at the time considering. The first class, which produce merely 
 a nuisance, do so because they are in large part organic in 
 their nature and therefore putrescible. This quality of 
 putrescibility persists until all the organic matter is com- 
 pletely oxidized, and therefore the disposal of waste matters 
 in so far as they are the causes of nuisance, consists simply in 
 their oxidation, whether rapidly by fire, or more slowly by 
 natural biological processes. The second class, in addition to 
 being possibly the cause of nuisance, are actually dangerous 
 on account of the fact that they may contain the germs 
 of specific disease, and disposal in their case should, strictly 
 speaking, connote the destruction of these disease germs, 
 in addition to the oxidation of the accompanying dead 
 organic matter. In practice in this country this distinction 
 is not observed except in cases where specific intestinal 
 disease is known to exist. This is partly because of the 
 comparative rarity of diseases, such as enteric fever, 
 cholera, and dysentery, and partly because, owing to the 
 great efficiency of modern systems of drainage, the danger 
 is at once removed to a safe distance. Where water 
 carriage is impossible, and where intestinal diseases are 
 comparatively common, the distinction is a very necessary 
 
 225 15 
 
^26 MILITARY HYGIENE AND SANITATION 
 
 and important one, which needs to be kept constantly in 
 mind. 
 
 It is important to remember, too, that these two methods 
 of disposal — oxidation, which prevents nuisance, and sterili- 
 zation, which destroys danger, are absolutely unconnected 
 with each other, since either can be accomplished success- 
 fully and completely without the other being even attempted. 
 Thus, for instance, it is possible to oxidize completely all 
 the sewage from a large country house by means of a 
 very simple biological installation situated in the grounds, 
 in such a manner that the effluent may be discharged into 
 any convenient watercourse without causing a nuisance. 
 Supposing, however, a case of enteric fever should occur 
 in the house in question, it would, in the present state of 
 our knowledge, at least be impossible to guarantee that 
 the specific poison, supposing it to get access to the sewage, 
 would be with certainty destroyed by passage through the 
 biological installation, whatever the character of this 
 might be. In such a case the distinction between the two 
 lines of disposal would be at once recognized and acted on. 
 Again, it would be simple enough to sterilize even a consider- 
 able bulk of sewage either by boiling, or, in theory at least, 
 by chemicals, without in any way interfering with its 
 putrescibility. The danger would be removed, but the power 
 of causing a nuisance would not be affected, and oxidation 
 would still have to come into play to effect complete 
 disposal. 
 
 Where a water-carriage system of removal exists, the 
 potentially dangerous matters are mixed up with a large 
 bulk of other matters which can do no more than cause a 
 nuisance, and, in theory at least, the whole mass must be 
 looked on as equally dangerous. In practice, however, as 
 already pointed out, the danger is so comparatively small 
 and the nuisance so very obvious that attention is entirely 
 directed to the prevention of the latter. 
 
 Where a water-carriage system does not exist, the mixture 
 of the different classes of waste matters does not occur, 
 the dangerous being kept strictly separate from those that 
 are merely troublesome. Disposal, therefore, can now be 
 carried out in a much more scientific manner, each class 
 being dealt with in a different way, according to its peculiar 
 
DISPOSAL OF WASTE MATTERS 227 
 
 attributes. I have little hesitation, therefore, in saying 
 that on purely theoretical grounds alone it would be 
 correct practice to sterilize in situ all excreta, where these 
 have to be removed by a hand-and-cart system ; even if 
 this latter process were free from all the difficulties which 
 I have attempted to describe in the last chapter, I should 
 prefer, personally, that method of sterilization which in- 
 cludes complete oxidation — in one word, incineration. 
 Under the circumstances as they meet us in military 
 practice, especially in India, the argument for some such 
 method of sterilization in situ is enormously strengthened. 
 
 In the first place, however, I will discuss the disposal of 
 sewage as ordinarily understood in this country, where all 
 the used water of the community is removed by the one 
 process. The subject is an extremely complex one in civil 
 practice, since it is complicated by the addition to the 
 sewage of various forms of trade waste, which interfere 
 with the biological processes employed for the oxidation 
 of the sewage. In military practice, however, these do not 
 occur, and I shall confine myself to dealing with the problem 
 in its simplest form, that of the disposal of a purely domestic 
 sewage, containing human excreta, together with kitchen 
 and wash-house slops. The main point to keep in mind 
 throughout the study of every scheme of disposal is the fact 
 that disposal means oxidation, and that every step which 
 assists oxidation is a step forward, whilst every measure that 
 retards or impedes that process is retrograde. This oxida- 
 tion occurs normally in the case of all organic dead matter, 
 through the agency of minute forms of animal and vegetable 
 life, utilizing the oxygen of the atmosphere. Unless 
 assisted artificially, this oxidation cannot ordinarily be 
 effected sufficiently rapidly to prevent putrefaction, and 
 the whole aim of modern methods of sewage disposal is to 
 supply that artificial assistance. Taking any putrescible 
 fiuid, it is obvious that the simplest way to procure oxidation, 
 on the lines above laid down, is to bring it into contact 
 with the micro-organisms in extremely thin layers, so that 
 as large a surface and as small a total bulk of sewage shall 
 be exposed to the oxygen available. Such an arrangement 
 could be readily supplied by permitting the sewage to flow 
 over any broad flat surface in a thin sheet, but obviously 
 
228 MILITARY HYGIENE AND SANITATION 
 
 this would demand an enormous extent of ground. A 
 more practicable method is to construct a heap of solid 
 material as a framework on which bacteria, etc., can grow, 
 and to allow the sewage to flow through the interstices of 
 this, and, in fact, this method is one of those most frequently 
 adopted. Clearly, however, for such an installation to 
 work satisfactorily the fluid must be as limpid and as free 
 from suspended matters as possible, since these, if present 
 in large amount, will inevitably block the pores or interstices 
 of the framework, and impede the flow of the fluid. The 
 difficulty is increased if the suspended matters be them- 
 selves putrescible, since they will absorb a certain amount 
 of oxygen, and also undergo putrefaction in the substance 
 of the framework, and thereby produce a nuisance. Now, 
 in the case even of a domestic sewage we have a certain 
 amount of suspended matter, both inorganic and organic, 
 present, and before the sewage can be satisfactorily 
 oxidized it is necessary in general to get rid of this. In 
 the case of heavy suspended matters, such as road grit or 
 sand, these are best separated by the intercalation in the 
 flow of the sewer of a detritus or grit chamber, which 
 intercepts all non- floating heavy debris. At the same time 
 a screen or grating holds back the coarse floating matters, 
 pieces of paper, orange peel, corks, fragments of cloth, and 
 so on, that may be present in the sewage. In addition to 
 these gross particles, however, the sewage contains a large 
 amount of fine suspended matter, and this also must be 
 got rid of. 
 
 This may be done in one of three ways. The fine matter 
 may either be allowed to sink to the bottom of the sewage, 
 by simple sedimentation ; thrown to the bottom as the result 
 of adding certain chemical substances to the sewage — that 
 is, by precipitation ; or dissolved by biological action in a 
 septic tank. In either of the first two processes we simply 
 divide the sewage into two parts, one called the " sludge," 
 containing almost all the solid matter, and part of the 
 liquid, the other containing a very little solid matter, but 
 the bulk of the fluid. Each of these has now to be disposed 
 of separately. This problem of the disposal of sludge, 
 however produced, is one which has given much trouble 
 to local authorities. The difficulty consists in the fact that 
 
DISPOSAL OF WASTE MATTERS 229 
 
 we have an extremely bulky and very heavy mass of highly 
 putrescible mud which must be oxidized, but which does 
 not in any way lend itself to easy handling. Attempts have 
 been made to compress the sludge into cakes, the expressed 
 fluid being returned to the main mass of sewage, and the 
 cakes sold as manure. This process has met with a certain 
 amount of success, but owing to the large amount of grease 
 present the manurial value of the sludge is not very high. 
 Lately attempts have been made to recover the grease from 
 the sludge, which is thereby improved as a manure, whilst 
 at the same time the fats obtained have a very considerable 
 market value. This process has met with a gratifying 
 measure of success at Oldham, and is probably the most 
 scientific method yet adopted. Incineration, deposition 
 at sea, and other plans are practised at different places, 
 but these are unremunerative, and in the case of the two just 
 named seriously extravagant. The dissipation into the 
 atmosphere, or the loss at sea, of large amounts of nitrogen 
 is neither scientific nor business-like. The problem of 
 sludge disposal has in the past presented so many difficulties 
 that the idea that it would be possible to get rid of the 
 substances which give rise to it by means of biological 
 action was naturally received with great favour. The first 
 practical application of the idea in this country was made 
 at Exeter by Mr. Cameron, and undoubtedly it has there 
 met with considerable success. In this, commonly called 
 a " septic tank installation," the sewage, after rough strain- 
 ing and passage through a grit chamber, is led into a closed 
 tank, the inflow and subsequent outflow taking place in 
 such a manner as not to cause any disturbance of the 
 surface. In the original plans the tank was completely 
 closed in, all light and air being excluded, and the resulting 
 gas was collected and utilized to light the works. In a 
 very successful installation constructed by Mr. Carkeet 
 James at Matunga near Bombay, the gas was made to drive 
 a small engine, which pumped the effluent on to a high- 
 level filter for further treatment. Subsequently, however, 
 it was found that it was not necessary to close in the tank, 
 and open tanks have been used in many places. Where 
 such tanks work well they undoubtedly work extremely 
 well. The organic solid matters are slowly liquefied by the 
 
230 MILITARY HYGIENE AND SANITATION 
 
 action of anaerobic bacteria, and all that remains in the 
 tanks is a small amount of mineralized humus. On the 
 other hand, they have, more often than not, failed to come 
 up to expectations, producing merely a putrid effluent, 
 deprived of its solids to no greater extent than can be 
 achieved by simple sedimentation. The conditions neces- 
 sary for success seem to include an accurate adjustment 
 of the length of time that the sewage remains in the tank 
 to its strength and composition. Unfortunately no one so 
 far has been able to predicate with any accuracy in respect 
 of any given sewage the period which it is necessary that it 
 should spend in the tank. Clearly the size of the tank 
 depends on this adjustment, and any mistake in construc- 
 tion must influence importantly the subsequent policy, if 
 the expression may be used, of the tank. Any great changes 
 in the amount of flow, or any liability to marked rushes of 
 sewage at certain hours of the day, must obviously affect 
 seriously the question of the installation of a septic tank. 
 Any great increase in the amount will obviously dislocate 
 timing, whilst sudden rushes will disturb the contents of 
 the tank, and lead to equally sudden discharges of unevenly 
 septicized sewage into the other parts of the installation. 
 Briefly, then, the present position with regard to septic 
 tanks seems to be that they act chiefly as sedimentation 
 tanks, and that any biological solution of solid matters 
 that may take place is an accidental advantage that cannot 
 be counted on. Since the sludge difficulty cannot be 
 positively excluded, it is obvious that for purely mechanical 
 reasons, facility of cleaning, etc., it is better to construct 
 these tanks without a roof. 
 
 After the sludge has been removed from the sewage, by 
 whichever of the above methods may be selected, there still 
 remains the comparatively clear putrescible fluid to be dealt 
 with. The way is now, however, open to oxidation in the 
 meshes of a solid framework in the manner to which I have 
 already alluded. 
 
 This is carried out in one of two ways. In the first, the 
 sewage is poured into a tank already filled with clinkers or 
 other suitable material, and allowed to stand there for a 
 longer or shorter period ; in the second, the sewage trickles 
 slowly through a similar mass of material in a continuous, 
 
DISPOSAL OF WASTE MATTERS 231 
 
 unbroken flow. In either case a thick growth of organisms 
 forms itself on the surfaces of the integral parts of the frame- 
 work, and these affect the ultimate oxidation of the putres- 
 cible matters held in solution, and to a less extent in sus- 
 pension, in the sewage. If the sewage is allowed to stand 
 in a tank, the installation is termed a " contact bed " ; if it 
 is permitted to trickle through continuously, it is called a 
 " streaming or continuous filter." 
 
 A contact bed is a tank usually about 4 to 6 feet deep, 
 fiUed with solid matters about 2 inches cube ; clinkers, 
 saggers, road metal, or other convenient material being used. 
 The selection of material depends entirely on the question 
 of cheapness. If cHnkers are available in the immediate 
 neighbourhood for comparatively Httle cost, the fact that 
 they are able to crumble easily, " degrade " in the technical 
 expression, may be overlooked in view of their local cheap- 
 ness. If material has to be brought from a distance, then it 
 is essential that it should resist degradation, and thus post- 
 pone the day of reconstruction of the bed. It must be 
 remembered that the material used acts, no matter what its 
 nature, merely as a framework. Of itseK it possesses no 
 pecuHar virtue beyond supplying a basis for the building 
 up of the active purifying agent — in other words, for the 
 bacterial coating which rapidly grows in its interstices 
 
 A contact bed is worked on the following principle : The 
 sewage, clarified if necessary, is poured on to the surface of 
 the bed until the latter is full ; it is allowed to rest there for a 
 fixed period of time, and then allowed to run off, after which 
 the bed is left standing empty until again required. 
 
 The mechanism may be described as follows : The first 
 effect of pouring the sewage on to the bed is to displace the 
 air already entangled in the framework — a process which 
 does not take place without a considerable amount of dis- 
 turbance of the fragments of which it is composed — the 
 greater in proportion as these last are fighter. During this 
 process a certain amount of oxidation takes place as the air 
 bubbles through the entering fluid. During the period of 
 rest, while the bed is full of sewage, a certain amount of 
 oxidation may take place near the surface of the bed, but 
 in the depths there is probably no such action. On the 
 contrary, a certain amount of anaerobic decomposition 
 
232 MILITARY HYGIENE AND SANITATION 
 
 occurs, more marked in the deepest parts, and proportionate 
 in extent to the length of this period. There is also a certain 
 amount of deposition of the very fine suspended matters 
 still remaining in the sewage, and an extensive separation 
 of colloid matters by adsorption to the material forming the 
 framework. During the period occupied in emptying no 
 chemical action of importance occurs, with the exception, 
 perhaps, of some slight oxidation in the upper layers still 
 in contact with the air. At the same time as the fluid is 
 withdrawn there must be a certain amount of settling down 
 of the framework, as a consequence of the replacement of 
 the heavy fluid by the comparatively lighter air. This 
 furthers the process of degradation. During the period 
 when the bed is at rest empty, all the fine suspended matter 
 left behind, the colloid matter adsorbed to the framework, 
 and the fluid retained by capillary attraction are acted on 
 vigorously by the bacterial flora of the bed. It is during this 
 last period that the real work of the bed as an oxidizing agent 
 is performed. 
 
 The successful working of a contact bed depends on a 
 careful allocation of time to each of the four periods — filling, 
 standing full, emptying, and standing empty — ^which have 
 been already described As regards filling and emptying, 
 it is clear that if these are carried out too rapidly the amount 
 of resulting disturbance of the framework will be unduly 
 great, and the consequent degradation of material unneces- 
 sarily large. At the same time, since these periods are un- 
 important, qua the oxidizing action of the bed, they should 
 not be unduly prolonged. The amount of disturbance will 
 naturally be greater in a deep than in a shallow bed for the 
 same rate of flow ; therefore a broad, shallow bed presents 
 advantages over a deeper bed with a smaller superficial 
 area. The broad, shallow bed will at the same time expose 
 a greater surface of sewage to oxidation than the deeper 
 bed, and therefore presents a definite advantage in con- 
 nection with the work of the standing-full period. This 
 benefit is supplemented by the fact that there will be less 
 anaerobic action in a shallow than in a deep bed, whilst the 
 processes of deposition and adsorption will not be interfered 
 with. The length of time allocated to the standing-full 
 period should be long enough to permit of these last-named 
 
DISPOSAL OP WASTE MATTERS 233 
 
 processes being efficiently carried out, and at the same time 
 not so long as to allow of any great amount of anaerobic 
 action being effected in the depths of the bed. It should be 
 recognized that the second, or standing-full, period is only, 
 as it were, the handmaid to the fourth, or standing-empty, 
 period, during which the chief work of the bed is performed. 
 This last period should therefore be the longest of all. It 
 is impossible to lay down an absolute rule, to be appHcable 
 to all cases, but in practice the length of time allocated to 
 the different periods, beginning with that of filling, is about 
 1 : 2 to 1:4. Coming now to absolute figures, it is con- 
 venient, generally speaking, to give about one hour to each 
 of the comparatively inactive periods of filling and empty- 
 ing, with two hours for standing full and four hours for 
 standing empty. It must be admitted that there is little 
 or no strictly scientific basis for these actual figures, but in 
 practice they have been found convenient, and may be 
 remembered as a safe guiding rule. The timing is regulated 
 in most cases by some form of automatic apparatus. 
 
 It is usual to arrange contact beds in series, the sewage 
 passing from one to the next, and these are generally termed 
 "primary," "secondary," and "tertiary" beds. The 
 working, in theory and practice, is the same for aU. I have 
 ventured to summarize this question of the working of con- 
 tact beds in the above fashion, without claiming that it says 
 all there is to be said about these rather complex structures. 
 The above theory appears to me to satisfy fairly well the 
 facts as we know them, and agrees with actual experience. 
 
 A streaming filter differs from a contact bed in the fact 
 that there is no variation in the flow of the sewage, which 
 runs steadily through the soHd framework of the filter. 
 There are no retaining walls, except in so far as these are 
 necessary to prevent the loose fragments of which the frame- 
 work is composed falling away from each other. The most 
 obvious difference between this arrangement and that of a 
 contact bed is that, since the flow of the sewage is in no way 
 interfered with, there is no force compelling this fluid to 
 distribute itself evenly through the bulk of the framework. 
 The sewage naturally trickles through the mass by the most 
 direct route, and the great crux in all such installations is 
 to insure by mechanical means that all parts of the frame- 
 
234 MILITARY HYGIENE AND SANITATION 
 
 work shall receive an equal supply of sewage. This is 
 achieved by means of tipping trays and revolving sprinklers 
 of numerous forms. Some of these are ingenious in the 
 extreme — such, especially, as the reversible rollers of the 
 Fiddian system — but it is unnecessary to go into detail as 
 regards them. The important point to remember, I con- 
 sider, is that whatever mechanical means are adopted, the 
 process of distribution will be greatly assisted by increasing 
 the depth of the filter at the expense of its superficial area. 
 Theoretically, such an increase in depth need only be 
 limited by the difficulty and expense of constructing suffi- 
 ciently strong retaining walls, and by the crushing efEect 
 produced on the deeper parts of the framework by those 
 above. In a properly constructed streaming filter the action 
 should be purely one of oxidation, and continuous. Theo- 
 retically, therefore, a streaming filter is more efficacious than 
 a contact bed, and the findings of the Sewage Commission 
 are in support of this contention. Grenerally speaking, 
 contact beds should be more satisfactory where the fall is 
 comparatively slight, and where, accordingly, shallow beds 
 would be more practicable from the constructional point of 
 view. This advantage would be lost to a great extent if 
 primary and secondary beds were needed Contact beds 
 are less likely to cause a nuisance, are said to be less likely 
 to encourage the breeding of fiies, and the effluent contains 
 less suspended matter. On the other hand, filter beds are 
 cheaper to construct, the material used need not be so fine, 
 and there is no danger of silting up. They do not need 
 remaking, and they are less sensitive to frost. In any par- 
 ticular case all the circumstances must be carefully con- 
 sidered before coming to a definite decision. For military 
 use the filter is probably, in general, the most satisfactory 
 installation. 
 
 Sewage may be disposed of by direct application to land, 
 and this is still done in some places. Two main methods are 
 resorted to — namely, broad irrigation and intermittent 
 downward filtration. In the first named, which is also 
 called " sewage farming," the sewage is poured on to land 
 more or less continuously, with a view to utilizing its agri- 
 cultural value. In the latter it is poured intermittently on 
 to specially prepared and underdrained plots of soil, and the 
 
DISPOSAL OF WASTE MATTERS 235 
 
 oxidation is entrusted to the soil bacteria. In principle the 
 two methods differ merely in the fact that the former uses 
 the higher forms of vegetable life, which are suitable for the 
 food of men and animals, and the latter relies on the humbler 
 class of micro-organisms. I do not intend to enter into the 
 details of the working of these systems, since the installa- 
 tion of either at the present day as a means of disposing of 
 a crude sewage is unlikely. At the same time, it must be 
 recognized that no system of sewage disposal which does 
 not include the ultimate application of the purified effluent 
 to land can be looked on as complete. The surroundings 
 may be such as to prohibit this application, but where pos- 
 sible it should always be resorted to, not so much with a 
 view to oxidizing the sewage (this should be already com- 
 plete, or nearly so), as with the intention of utilizing the 
 organic nitrogen therein contained. The careless squander- 
 ing of fixed nitrogen into rivers or the sea, or its wasteful 
 conversion into atmospheric nitrogen, is a scientific error of 
 considerable magnitude. 
 
 Both contact beds and filters, though more especially the 
 former, tend in course of time to get blocked up. In the 
 former case this is in great part due to the degradation of 
 the material composing the framework. In both forms of 
 installation, however, there is a deposit of unoxidizable 
 residue from the sewage, and also in the majority of cases 
 an accumulation of more or less putrescent matter in the 
 depths of the framework, the access of oxygen to which 
 has for one reason or another been hindered. In such cases 
 the beds need to be thrown out of work, and in the case of 
 contact beds remade, to enable them to become efficient 
 again. These difficulties are in part due to the comparatively 
 small size of the interstitial spaces of the framework, which, 
 again, is due to the small size of the particles of which it 
 is composed. In order to avoid the necessity of remaking 
 the beds, Mr. Dibdin introduced what are termed " slate 
 beds." In principle these are merely contact beds, but 
 constructed in a more systematic manner than those com- 
 monly in use. Instead of containing a mass of compara- 
 tively small particles arranged at random, the slate bed 
 consists of layers of slate laid regularly one above the other, 
 each layer being separated from those above and below by 
 
236 MILITARY HYGIENE AND SANITATION 
 
 means of slate blocks 1 or 2 inches in thickness, the latter 
 being the size most commonly in use. Such a bed is filled 
 and worked in precisely the same manner as a contact bed. 
 The sewage, after being deprived of its gross solids, is run 
 on to the surface of the uppermost layer of slate and gradu- 
 ally fills the bed. Owing to the great weight of the material, 
 the forcing out of the contained air does not cause the dis- 
 turbance of the framework, which occurs in the ordinary 
 contact bed during this process. 
 
 The action of the bed is probably on the same lines as that 
 of an ordinary contact bed. In course of time a certain 
 amount of humus gets deposited on the layers of slate, and 
 when desired this can be sluiced out with an ordinary hose- 
 pipe. Owing to the large size of the interspaces, the sewage 
 capacity of a slate bed is about twice that of a contact bed 
 of the same dimensions. After treatment on a slate bed, 
 the sewage has to be passed on to an ordinary contact bed. 
 Undoubtedly the great use of these beds is to act as roughing 
 beds. The large size of the interspaces enables them to 
 deal with masses of organic matter of considerable size 
 without getting blocked, and the access of oxygen to the 
 interior of the bed is far less likely to be impeded than in 
 the case of an ordinary bed. It is claimed for them that 
 there is no anaerobic action at any time, but on a priori 
 grounds it is probable that there is a certain amount in the 
 depth of the bed during the period of " standing full." 
 Within limits there is no harm in this, and I see no reason 
 to fear that there need be any over-septicizing of the sewage, 
 which is so apt to occur in a septic tank. 
 
 The disposal of sewage is, as has already been said, purely 
 a matter of oxidation, and any step in a contrary direction 
 is retrograde. This is in practice, however, impossible to 
 avoid. If we could get the organic matter of which we have 
 to dispose in such a fine state of mechanical subdivision that 
 we had only to deal with single molecules of protein, and if 
 we could bring these into close contact with aerobic bacteria 
 in the presence of a free supply of oxygen, the process of 
 oxidation would be rapid and continuous. In practice, 
 however, we have to deal with mechanical aggregations of 
 considerable size, each containing a large number of mole- 
 cules. It is obvious that only those molecules which are 
 
DISPOSAL OF WASTE MATTERS 237 
 
 on the surface of any particular aggregation can be oxidized 
 at once. If the masses of organic matter are of any con- 
 siderable size, or if the free access of oxygen is for any par- 
 ticular reason impeded, then, instead of oxidation, there 
 will be a certain amount of putrefactive decomposition ; 
 that is, the complex molecules of which the organic matter 
 of the sewage is composed will be split up into smaller 
 molecules, but without oxidation. 
 
 The comparatively small size of the interspaces in an 
 ordinary contact bed or streaming filter naturally tends to 
 increase the likelihood of blocking, and of resultant impedi- 
 ment to the free access of oxygen, and accidents of this 
 nature are of constant occurrence, and inevitable. That is 
 to say, that in no case can we definitely say of either in- 
 stallation that oxidation is the only process that is going 
 on in the depths of the framework. Here and there, in 
 isolated areas small or large, anaerobic action is always 
 taking place. If it is small in amount, no notice need be 
 taken of it, as the resultant products of putrefaction are 
 gradually washed into the main flow of sewage and oxidized. 
 
 As the age of the installation increases, such accidents 
 become more frequent of occurrence, partly owing to the 
 gradual mechanical blocking of the interstices of the frame- 
 work by bacterial growth and inorganic debris, and these 
 gradually lead to the necessity of an overhaul of the installa- 
 tion. Obviously, the larger the interspaces in the frame- 
 work, the less likely are such accidents to occur, and the less 
 likely is it that the access of oxygen shall be impeded. No 
 arrangement of this nature can, however, get over the diffi- 
 culty that arises from the presence of large masses of organic 
 matter — as, for instance, lumps of disintegrated faeces. 
 Anaerobic decomposition will occur in the centre of such a 
 mass, whatever the pattern of the installation. With the 
 small interstices of the ordinary contact bed we get the risk 
 of blocking, which aggravates the nuisance ; with the large 
 interstices of the slate bed this is avoided, and the much 
 freer access of air naturally accelerates oxidation. 
 
 The size of the interspaces in a slate bed enables this 
 pattern to deal more easily with an irregular flow of sewage, 
 whether this irregularity affects quantity or quaHty, than 
 either a contact bed or a streaming filter, and therefore such 
 
238 MILITARY HYGIENE AND SANITATION 
 
 an installation may be used for the purpose of standardizing 
 the flow of sewage, and thus facilitating its subsequent 
 treatment. 
 
 Since the ultimate fate of all organic matter is oxidation, 
 and since the object of all disposal systems is to effect this as 
 perfectly as possible, it is obvious that the only test of the 
 efficiency of an installation is the extent to which it oxidizes 
 the sewage passed through it. A sewage that is completely 
 oxidized is completely disposed of, as far as biological 
 methods can dispose of it, and it does not appear to me that 
 any other criterion, such as the total amount of nitrogen 
 present, is of the slightest value. For practical purposes 
 outside the laboratory, one of the best tests of an oxidized 
 effluent is the presence of chlorophyll-bearing plants. If 
 these can grow in the sewage, there can be very slight demand 
 for oxygen on the part of the organic matter in that fluid, 
 and such an effluent can safely be discharged into a river or 
 stream, as far as danger of nuisance is concerned. If, 
 instead of such green plants, a dirty grey flocculent growth 
 is seen, then the sewage is insufficiently oxidized, and the 
 installation inefficient. 
 
 Since the disposal of sewage is a biological process, there 
 can clearly be no quantitative bacterial test for sewage. It 
 is perfectly immaterial from a public health point of view 
 whether a sewage which is completely oxidized contains 
 100 or 1,000,000 bacteria in each hundredth of a cubic centi- 
 metre. A qualitative test is equally difficult. The bacillus 
 of typhoid has never, so far as I know, been isolated from 
 a sewage effluent, though perhaps improved technique may 
 in time achieve this. At present, the only qualitative test 
 that we could apply would be that for the Bacillus coli, which, 
 of course, is useless, since this particular bacillus is the one 
 of all others which must inevitably be present in a sewage. 
 Even, however, if we were able to demonstrate the presence 
 of specific disease germs in the sewage, this would not neces- 
 sarily point to any inefficiency in the disposal installation. 
 B^* -^logical installations are concerned with the disposal of 
 sewage only from the point of view of the prevention of 
 nuisance, not from that of the prevention of specific disease, 
 and the only test of their efficiency is the extent to which 
 they solve the former of these two problems. 
 
DISPOSAL OF WASTE MATTERS 239 
 
 Disposal of Sewage from Barracks. — Barrack sewage 
 differs in several respects from municipal sewage. In the first 
 place, it is purely domestic in its nature ; in the second, it 
 is extremely intermittent in its flow. During the afternoon 
 hours and in the night there is hardly a trickle of fluid 
 in the drains, whilst there is a great rush in the fore- 
 noon, and another, though less marked in amount, in the 
 evening. As regards mechanical composition, the sewage 
 from a barrack contains a large amount of unaltered faecal 
 matter. This is due to the comparatively short run of 
 drain between the barracks and the disposal works. Lastly, 
 especially in the case of cavalry and artillery, there is a 
 relatively large admixture of stable drainage in the sewage. 
 The irregularity of the flow militates against the use of 
 septic tanks or contact beds, and to a less extent against 
 that of streaming filters, unless some method of standard- 
 izing the strength and flow of the sewage is adopted. The 
 presence of large masses of non-disintegrated faeces is also a 
 cause of difficulty in the case of beds of any kind. 
 
 The difficulty with regard to stable drainage consists 
 partly in the presence of a large amount of hippuric acid, 
 which rapidly becomes oxidized into benzoic acid, and exer- 
 cises an inhibitory influence on the biological process, and 
 partly on the large amount of cellulose derived from the 
 litter. This latter clogs the pores of the filtering frame- 
 work, and is more productive of nuisance than any animal 
 organic matter. Personally, I consider Dibdin's slate bed 
 as the most hopeful of all installations for military purposes. 
 It is less liable to clogging, and can be used to standardize 
 the irregular flow of the sewage before it is passed on to 
 contact beds or filters as may best suit the circumstances 
 of the case. The disposal of barrack sewage presents many 
 difficulties peculiar to the task itseK, and those who have 
 had the most experience of it will always be the last to 
 dogmatize about it. Each individual case must be dealt 
 with on its own individual merits. 
 
 The disposal of waste matters in the absence of a water- 
 carriage method of removal is a question of considerable 
 complexity, since each particular class of waste matter has 
 to be considered separately. 
 
 The excreta can be disposed of either by a biological in- 
 
240 MILITARY HYGIENE AND SANITATION 
 
 stallation, by burial in the earth, or by incineration. Of 
 these three, the first two are practically identical in prin- 
 ciple, since in both biological action is involved. They also 
 both necessitate removal to a considerable distance, whereas 
 incineration can be successfully carried out in situ. Bio- 
 logical installations have been tried in India, but so far 
 without very striking success. The difficulty lies largely in 
 the composition of the sewage or rather night-soil. This is, 
 of course, highly concentrated, and contains a large amount 
 of non-disintegrated faeces, differing in both these respects 
 from any civilian sewage in this country, and in the former, 
 at least, and to a certain degree in the latter, from a barrack 
 sewage. The difficulty of concentration can be got over by 
 dilution with water at the site of the works, using for this 
 purpose the water which should in any case be laid on for 
 cleansing the buckets. To approximate in any degree to 
 an English sewage it would be necessary to supply at least 
 15 gallons of water per head of the population concerned — 
 a quantity which in India (and I have that country chiefly 
 in mind in this section) is a serious matter. This water has 
 of necessity to be additional to that already supplied in the 
 station for ablution, etc., which cannot for obvious reasons 
 be carried to the necessary distance in the absence of a 
 drainage system. The water-supply of the station must, 
 therefore, be increased by one-half on this account alone. 
 Given this water, it is possible to get over the difficulty 
 presented by the non-disintegrated character of the faecal 
 masses by means of a mixing tank. A scheme of this nature 
 introduced at Maymyo, in Upper Burma, was distinctly 
 successful. In this an open tank was constructed, into 
 which the contents of the buckets were emptied, the latter 
 being inverted over a powerful jet of water. When the 
 tank was full, the contents were allowed to pass into a 
 septic tank, both dilution and disintegration being thus 
 effected. 
 
 The subsequent disposal, after thorough mixing and dis- 
 integration, can be carried out either by means of septic 
 tanks, contact beds, or streaming filters, or a combination 
 of these. Difficulties will arise in detail from the accidents 
 of climate. Thus, the intense heat and drought of the 
 summer months in the Punjab do not favour biological 
 
DISPOSAL OF WASTE MATTERS 241 
 
 processes, whilst the torrential downpour of the rainy months 
 would affect the ultimate disposal of the effluent. All such 
 difficulties are, however, only made to be overcome, and 
 they can undoubtedly be overcome. They must, however, 
 be expected, and, above all, not minimized in anticipation. 
 Disposal by direct application to land has been carried 
 out for years by the Allahabad system of burial in shallow 
 trenches. The theory of this method is the intimate ad- 
 mixture of the excreta with the superficial, biologically 
 active, layers of the soil. As originally devised, the ^ethod 
 satisfied the conditions but imperfectly, but the improve- 
 ments introduced by Colonel Thornhill, of the Indian Army, 
 were undoubtedly a great advance in technique. In this 
 improved system it was intended that the excreta should 
 be spread out in a thin layer in a shallow trench or pan, the 
 floor of which was covered with loose earth, and then 
 covered with a sheet of pulverized earth. The result was 
 that the excreta were, supposing the details of the system 
 to be carefully carried out, thoroughly mixed with the 
 pulverized earth, and under ordinary circumstances oxida- 
 tion progressed with great rapidity. The method demands 
 careful working and constant European supervision to 
 insure its being successful. Where these are supplied, 
 success is, if not insured, at least in the great majority of 
 cases achieved. On the other hand, without European 
 supervision failure is an almost absolute certainty, and this 
 is undoubtedly the weak point in the system. There is no 
 need to blink matters. It takes a very high sense of duty 
 to support the average British officer in a visit to the filth 
 trenches in the early morning on a hot- weather day. As 
 long as he is feeling well the achievement is possible, but any 
 slight hepatic derangement renders it for nine men out of 
 ten a veritable deed of heroism. A system which depends 
 so importantly on the personal factor is inherently weak in 
 practice, however scientific in theory. On the other hand, 
 it cannot be denied that a biological system is also to a 
 great extent dependent on European supervision. In the 
 trenching method the native labourer is, after all, carrying 
 out an operation with which he is perfectly familiar. He 
 may not always perform his functions conscientiously, but 
 at least he has nothing to learn, and under a strong master 
 
 16 
 
242 MILITAEY HYGIENE AND SANITATION 
 
 he will probably keep up to a fair standard of efficiency. 
 In a biological system all is strange, and though there is 
 comparatively little to be done, still that little has to be 
 taught, and taught as well as supervised, by a British officer. 
 
 In short, no disposal system with which I am acquainted 
 can be carried out in an Indian cantonment without Euro- 
 pean supervision. It cannot be left, as it can in England, 
 to " run itself " under the superintendence of an unskilled 
 labourer, with an occasional visit from a skilled subordinate 
 health official. The choice between one system and another, 
 whether it shall be a biological installation, strictly so called, 
 or an earth- burial method, which is, in fact, as much bio- 
 logical in principle as the other, must depend on local cir- 
 cumstances. It would be Utopian to suppose that which- 
 ever is chosen it can be left to look after itself. Success can 
 only be insured by unremitting attention on the part of the 
 municipal authority — in other words, the cantonment magis- 
 trate and the sanitary officer. The slightest relaxation of 
 vigilance, however intelligible on the grounds of natural 
 human weakness, means failure. 
 
 Such being the case, I consider that the ideal method of 
 disposal in barracks in India is incineration in situ. My 
 reasons for coming to this conclusion are partly the inevitable 
 dangers of removal inherent in any hand-and-cart system, 
 and partly the difficulties in the way of disposal already just 
 alluded to. It must be remembered, too, that in India — 
 and the same is true of all tropical stations — intestinal 
 diseases are of much greater importance than in the British 
 Isles. The weak point of the European in India is his 
 intestinal tract, and disposal must therefore recognize the 
 possible danger as greater than the certain nuisance, and 
 aim first at counteracting the former. It is unnecessary to 
 do more than refer to the difficulties attendant on removal 
 when this is carried out by cart and hand, and the numerous 
 inevitable loopholes which this furnishes for the passage of 
 specific germs from the excreta to the air, water, and food 
 supplies of the community. Any method which can at the 
 same time eliminate these dangers, and do away with the 
 problems attendant on disposal, must necessarily possess 
 strong claims to recognition. Incineration in situ — that is, 
 in the actual latrines — ^seems to me to solve the problem in 
 
DISPOSAL OF WASTE MATTERS 243 
 
 both directions. It has been proved several times over that 
 this can be done without nuisance, using more or less im- 
 provised methods. Accounts have appeared of several of 
 these from time to time in the Journal of the Royal Army 
 Medical Corps, and I do not propose in this book to enter 
 into details of apparatus. It is fairly clear, however, that 
 if it is possible with improvised apparatus, it should be com- 
 paratively easy if some scientific incinerator were introduced. 
 It might be necessary to use some additional fuel, and this 
 is at hand in the ubiquitous kerosene oil of Oriental com- 
 merce, any extra expenditure being more than met from 
 the saving in native establishment, conservancy drivers, 
 hildars, etc. 
 
 The disposal of urine must be carried out by the same 
 process as that used for the disposal of excreta. Supposing 
 incineration to be resorted to, some form of boiler must be 
 attached for the evaporation of the urine. A permanent 
 difficulty is always attached to the disposal of cook-house 
 slops and rubbish. As regards the latter, they should never 
 if possible, be allowed to leave the kitchen. There should 
 be no difficulty in destroying a great deal, if not all, the 
 potato -peelings and similar vegetable debris on the hearth 
 at the conclusion of the day's work. So much as cannot be 
 thus disposed of should be sprinkled with kerosene oil and 
 burnt — in the words of Major Dalgetty, '' Quam primum, 
 and that peremptorie " — in some convenient incinerator. 
 
 Kitchen slops present a great difficulty in consequence of 
 the large amount of fluid grease, which does not, during 
 many months in the year, at least in tropical climates, 
 solidify and facilitate separation from the rest of the fluid. 
 The difficulty is accentuated by the fact that, if cleanliness 
 is encouraged inside the kitchen, in the matter especially of 
 pots and pans, the amount of slops that have afterwards 
 to be disposed of is proportionately increased. Pending 
 removal, these slops must be protected from flies, and this 
 can be done by allowing the discharge-pipe leading from 
 the scullery sink to discharge over a tray filled with charcoal 
 sprinkled with kerosene oil and fitted on to the receptacle 
 as in the case of the urinals already described (see p. 219). 
 In the colder months this arrangement will also act as a 
 grease-trap, and thus assist in solving that difficulty. The 
 
244 MILITARY HYGIENE AND SANITATION 
 
 slops must eventually be disposed of by burial. They must 
 not merely be poured into a pit, but on to a prepared pan 
 in the earth, and then covered over. 
 
 Waste-water from ablution wash-houses must be disposed 
 of by irrigation. It is out of the question to carry away the 
 ablution water of 1,000 or even of 100 men in a climate 
 where personal cleanliness is of such paramount importance, 
 as in most of our foreign stations abroad. Such irrigation 
 must be systematic, and the water utilized for growing 
 plants — e.g., lucerne grass, bananas, etc. If care be not 
 exercised, there may be danger of encouraging the breeding 
 of mosquitoes. This method of irrigation disposal is not 
 always easy, but in my experience it is nowhere — in India, 
 at least — impossible. 
 
 The disposal of waste matters, in the absence of a water- 
 carriage system of removal, must always be fraught with 
 difficulty, and always present the sanitary officer with one 
 of the most difficult problems that he has to face. What- 
 ever can be burnt should be burnt, and burnt at once in situ. 
 A certain amount of nuisance may be expected from smoke, 
 but this must be put up with. Whatever the system adopted, 
 success can only be insured at the price of incessant, un- 
 wearying supervision by the medical and sanitary officers 
 immediately responsible. Here more emphatically, if pos- 
 sible, than anywhere else there is no royal road to efficient 
 sanitation. 
 
CHAPTER XIV 
 
 DISPOSAL OF WASTE MATTERS IN THE FIELD 
 
 The disposal of waste matters in the field is one of the most 
 important and pressing problems in military sanitation. 
 This is more particularly the case with civilized armies, 
 since the men are on the one hand less inured to living in 
 a condition of filth, and on the other more accustomed to 
 having their conservancy managed for them by some im- 
 personal central authority. The responsibility of the in- 
 dividual soldier in barracks for the proper removal and 
 disposal of his waste matters is of the slightest, whereas 
 in the field, with troops on the move or encamped for short 
 periods only, each man has to be made answerable for the 
 due performance of this task. 
 
 The difficulty and urgency of the problem are increased 
 by the fact that removal is, under the conditions that 
 necessarily obtain in the field, impossible. Disposal has 
 consequently to be carried out in situ, and therefore at once. 
 With regard to urine and faeces the point to be kept in mind 
 is that they contain potentially the germs of infectious 
 disease, but that those germs cannot gain access to the water 
 and food supplies of the army unless provided with some 
 form of transport. Immediate disposal can therefore be 
 satisfactorily achieved if they are at once covered up so 
 as to be inaccessible to wind and flies. This can be done 
 in the simplest of all manners, which is at least as old as 
 the Mosaic Law, by burial under a few inches of earth. 
 For troops on the move there is no more efficacious method, 
 and the immediate covering of excreta by earth should be 
 taught to the soldier as an essential part of his field train- 
 ing. Any dereliction of duty in "this should be promptly 
 
 245 
 
246 MILITARY HYGIENE AND SANITATION 
 
 punished, whether on the march or in camp. I am quite 
 aware that the Bacillus typhosus can live in faecally con- 
 taminated soil for a length of time as to whose exact dura- 
 tion no two bacteriologists seen to be able to agree. It 
 is possible, therefore, that the buried excreta may by the 
 next shower of rain be washed into some stream or under- 
 ground water-channel. This danger cannot be ignored, 
 though it is much less insistent than that of air-borne 
 contamination of foodstuffs. It can also be guarded against 
 to a very great degree by a rational selection of latrine 
 sites, and in other ways. It remains obvious to me, 
 therefore, that the immediate danger, which is also the 
 greatest danger, can be most efficiently met by immediate 
 covering over, or protection in other ways from access of 
 flies. 
 
 The danger to be anticipated from any delay in disposing 
 of other waste matters, food debris, etc., is the breeding of 
 flies. The only satisfactory and safe method of disposal 
 in this case is incineration, and, wherever possible, this should 
 be carried out at once and in situ. 
 
 This last rule applies to all camps both standing and 
 stationary. In the former it should be possible to make 
 some more scientific scheme for the removal of excreta 
 to a safe distance before burial. The conditions would, 
 in fact, approximate to those obtaining in a canton- 
 ment where a hand-and-cart system of removal was in 
 vogue . 
 
 Latrines. — There are two patterns of latrine generally 
 used, which may be called the long trench and the short 
 trench respectively. . In the former, which is the old pattern 
 in general use up to within the past few years, a trench 
 was dug 4 feet deep, 3 feet broad at the top, 2 feet broad at 
 the bottom, and 5 yards long for every 100 men. This 
 is a bad pattern ; it inevitably becomes fouled by faecal 
 matter and urine at the edges and the sides, and it is diffi- 
 cult to insure the complete covering up by earth of the faecal 
 matter in the trench. This pattern should, in fact, never 
 be used. In the short trench system a number of trenches 
 are dug, each 3 feet long by 2 feet deep and 1 foot broad. 
 This is the ordinary rule, but I am indebted to Major 
 Caldwell Smith, of the 2nd London Sanitary Company, 
 
WASTE MATTERS IN THE FIELD 247 
 
 for the very useful suggestion that the trenches should be 
 broader at the bottom than the top, say, 1 foot 3 inches 
 at the bottom. As can be seen at once, this protects the 
 sides of the trench from fouling. In loose, sandy soils this 
 is not, however, always possible. 
 
 I am indebted to the same officer for the suggestion that 
 the upper edge of the trench should be, as it were, rebated, 
 leaving a ledge about 6 inches broad and 4 inches on each 
 side of the trench ; this not only prevents the soil at the 
 edge from crumbling in, but gives a certain purchase for 
 the feet when the soldier is in the squatting position (see 
 Fig. 3). The essential point about these trenches is that 
 they shall be used in this position, as by so doing all fouling 
 of the back, front, or sides of the trench is prevented. The 
 earth taken from the trench should be heaped up either in 
 
 Fig. 3. 
 
 front of or behind the trench, on no account at the sides, 
 and will then be available for covering over the faecal 
 matter. In a stiff soil the earth must as far as possible be 
 broken up, or if necessary some drier, more friable soil 
 brought from some little distance. It is rare that even in 
 the stiff est soils the upper 3 or 4 inches are not friable. 
 Close to this heap of earth must be placed the sod removed 
 when the pit was dug, which must be carefully replaced 
 when the trench is filled. In the case where latrines 
 have been dug on arable land this may be impossible. In 
 such a case the earth must be well stamped down and 
 levelled. 
 
 The distance between the trenches is of importance. 
 This should be either 3 or 2 J feet. Personally, I am in 
 favour of the former measurement, which is that most 
 generally allowed. The only objection to this space is the 
 
248 MILITARY HYGIENE AND SANITATION 
 
 total amount of ground taken up by the latrines. The 
 usual rule is to allow one trench for every twenty men — • 
 that is, of course, 5 per cent, of strength. For small numbers 
 this allowance may be necessary, but for any number over 
 200 it is excessive. Some graduated scale should be fixed. 
 Major Caldwell Smith has very sensibly suggested that the 
 factory and workshop standard, as laid down by the 
 Home Office, might be followed. This would give, if the 
 force were less than 500, say, a cavalry regiment, or a half 
 battalion or battery, four trenches for the first 100 men, 
 and one for every additional 40 men, or odd number less 
 than 40. This works out at 7 for 200, 9 for 300, 12 for 
 400, and 14 for 500. For a cavalry regiment with a strength 
 of 526 men 15 might be allowed. Captain Tilbury Brown, 
 who has paid considerable attention to this question, 
 suggests 3 per cent, for 500 and over. For larger units — 
 that is, for infantry battalions, the workshop and factory 
 rules would allow one seat for 60 men or any odd number 
 less than 60. That is, for a battalion, 17 trenches. Person- 
 ally, I should regard this as rather low, and would prefer 
 a 3 per cent, allowance between 500 and 750, and a 2J per 
 cent, allowance above the latter figure. The difficulty 
 about a high allowance is the restricted area available in 
 camp for digging trenches in. The rule is to place these 
 at the rear of the camp, and they cannot of course extend 
 beyond the lateral borders of the camp. In an infantry 
 battalion this allows only 65 yards. If we calculate 4 feet 
 for each trench, 1 for the trench itself and 3 for the interval, 
 that amounts to 200 feet, almost 67 yards for the fifty 
 trenches allowed on a 5 per cent, basis. With a 2J feet 
 interval between trenches one could, it is true, fit the whole 
 fifty in, but naturally there is no object in digging more 
 than are absolutely required. With smaller units, especially 
 those which are mounted, the same difficulty does not 
 arise, owing to the larger camp frontage available. Thus, 
 for instance, in the case of a cavalry regiment 526 strong 
 the frontage is 161 yards, and for a battery 200 strong, 
 75 yards, but here again labour is scarcer than in an in- 
 fantry battalion, so on that account it is necessary to limit 
 the number of trenches to the lowest limit possible. I have 
 given the depth of trenches at 2 feet, and this is the usual 
 
WASTE MATTERS IN THE FIELD 
 
 249 
 
 practice. With'such a depth and good management one 
 set of trenches can be used for as many as four days. If 
 trenches are needed for one night only, 1 foot in depth is 
 sufficient. Personally, I should prefer using each trench 
 for one night only, but with good management they can, 
 if necessary, be used for four days. The question is, to 
 a great extent, one of space available. 
 
 The following instructions, modified from a paper by 
 Captain Tilbury Brown, which appeared in the Journal of 
 the Royal Army Medical Corps in July, 1909, are worth 
 notice, in reference to the laying out of a latrine area. 
 Taking the right-hand rear corner of the^camp area as a 
 
 2 
 
 _i i_ 
 
 3 • O 
 
 i l£ V — 3.' - O -^ , • 
 
 0, 
 
 r j 
 
 1 ! 
 
 1 
 
 r-\- r^ fl r-] r- 
 
 4 ' 
 
 i ; 
 
 L 4 
 
 1 ! : ; 1- 1 ; ■. 1 , 
 3 4 3 4 ■ ! 3 ! 
 
 L_. LJ L_j LJ 
 
 Fig. 4. 
 
 base, fix a tent-peg 3 feet in front of this, and draw a line 
 from it parallel to the base line of the camp. Measure off 
 first, IJ feet along this second base line, and, after that, 
 alternate spaces of 1 foot and 3 feet, till the full number 
 of trenches, minus one, has been marked out. Beyond this 
 mark measure off 1 foot for the last trench, and then 3 J feet 
 beyond that again ; place a peg to show the farthest lateral 
 extension of the latrine area. This will give 3 feet between 
 trenches, with a margin of IJ feet to the right of the first 
 trench, and of 3 feet 6 inches to the left of the left-hand 
 trench. The trenches can then be dug and the screen 
 placed round the latrine area, the two pegs already men- 
 tioned fixing the lateral limits of this screen. The screen 
 
250 MILITARY HYGIENE AND SANITATION 
 
 should be 3 feet clear of the back of the line of the trenches, 
 and at least 6 feet clear in front of them, the total depth 
 of the screened area being thus 10 feet. At the conclusion 
 of the period through which it is intended that the latrine 
 shall continue in use, whether that be one day or four, 
 dig a second row of trenches in the intervals of the first 
 row. The right-hand trench of this new row will be between 
 the first and second trenches of the first row, and the left- 
 hand trench 1 foot to the left of the left-hand trench of the 
 first row. At the end of the second period these trenches 
 must be closed up, and an entirely fresh row dug 1 foot in 
 front (that is, nearer the camp) than the first two rows, 
 corresponding in position exactly with the trenches first 
 dug. It is not absolutely necessary to shift the screen, 
 since there will stiU be 2 feet clear in front of the new rows 
 of trenches, but it can be done if wished, and, for reasons 
 given later, should generally be done. The length of time 
 you can afford to use these various rows of trenches will 
 obviously depend on the space available. Each pair of 
 rows takes up 4 feet in depth, and, in addition, there are 
 3 feet behind the original row of trenches. Thus, in two days, 
 if daily trenches are dug, or in eight, if each trench is used 
 for four days, 7 feet in depth will have been used up ; and 
 in four or sixteen, as the case may be, 11 feet. If the plan 
 of daily trenches be adhered to, in a fortnight the area 
 used up will be 55 feet in depth, say, ISJ yards. As a 
 general rule, the trench system should not be used in 
 camps which it is intended shall be occupied for even 
 this period, and in no case for a longer one. In such 
 cases some pail system of removal should be instituted, 
 and proper wooden latrines erected. I will return to 
 this later. 
 
 There are one or two minor points concerned with the 
 working of trench latrines which I must touch upon. New 
 rows of trenches should always be nearer to camp, and not 
 farther away. Men will not in that case have to tread 
 on dirty ground on their way back to their tents. Trowels 
 or scoops should be provided in the same proportion as 
 trenches are dug, if possible. If this proportion cannot be 
 observed for any reason, then half that number must be 
 furnished. It trowels are not supplied there will be more 
 
WASTE MATTERS IN THE FIELD 251 
 
 difficulty experienced in making the men observe the nde 
 that all excreta should be covered up immediately after 
 being passed. Paper should be provided, and kept in small 
 bags or boxes, fastened to the screens. In addition to the 
 large screen, running round the entire latrine, it is advisable, 
 when possible, to supply smaller screens to run between 
 the individual trenches. It is not necessary to have these 
 at the back of the trench as well, if the large screen is always 
 kept well up to the rear of the line of trenches. When 
 troops are on the move, starting at an early hour every day, 
 and some carelessness is apt to occur, I should like to see 
 the surface of the fiUed-up trench-line scorched with fire, 
 to destroy any possibly infectious matter that may have 
 escaped burial. A little straw and some paraffin oil will 
 effect this satisfactorily. One of the greatest dangers of 
 camp life is due to neglect of troops leaving camp early in 
 the morning, especially when the ground has to be occupied 
 by other bodies of men immediately after. Of course, 
 where there is heather or gorse close at hand, great care must 
 be taken to see that the fire does not spread to a dangerous 
 extent — further, that is, than is absolutely necessary. A 
 thorough burning of the soil is not wanted, merely a short 
 but severe scorching. Officers' latrines should be dug in 
 the same way as men's latrines, and here again individual 
 screening is very necessary. In no case should any form of 
 seat or plank be allowed to be used by the men ; they are not 
 only absolutely unnecessary, but inevitably lead to fouling. 
 If the ground slopes, a catch-water drain should always be 
 dug on the up-hill side of the latrine, and another between 
 the latrine and the camp if the latter be down-hill from 
 the former. 
 
 Whenever a camp is to be occupied as a permanency, 
 then some more permanent form of latrine should certainly 
 be erected. The diagram (Fig. 5) shows such a form. 
 The buckets rest on a concrete platform and are well boxed 
 in, in front, and provided with a hinged lid. This lid 
 should be so constructed that it will close automatically 
 as soon as the seat is vacated, with the object of keeping 
 out flies. A double row of seats is shown, and the roofs 
 are sloped so as to drain on to the concrete platform which 
 is guttered to carry away any washings or leakage. It 
 
252 MILITARY HYGIENE AND SANITATION 
 
 can be swilled or scrubbed down if necessary ; in this case 
 some arrangement should be made for disposing of the 
 washings by means of under-drainage. A box is provided 
 
 L J, (<5 
 
 Side Elevation 
 Destructor : Permanent- 
 
 Latrine : Permanent. 
 
 Fig. 5. 
 
 for dry earth, and one scoop or trowel for each seat should 
 also be issued. Each seat is in a separate stall, but it is 
 not necessary to provide these with doors, and in no case 
 
WASTE MATTERS IN THE FIELD 253 
 
 should full doors covering the entire doorway be provided ; 
 a door covering the middle third is amply sufficient. In 
 the diagram a urinal has been shown under the same roof 
 as one of the rows of seats. This is, of course, not essential, 
 but still very convenient. The disposal of urine in such 
 cases is a matter of very great difficulty. A wheeled tank 
 should, if possible, be provided into which the trough can 
 drain ; the trough may be made of any impervious material, 
 and will be much less likely to become offensive if frequently 
 treated with some mineral oil. This prevents the deposit 
 of urinary salts, and also discourages the presence of flies. 
 It is necessary in all permanent latrines to take very strong 
 measures against flies. In a permanently occupied camp it 
 is extremely difficult to prevent a considerable collection 
 of these insects, but it is possible to prevent their haunting 
 the latrines and urinals, and this must always be done. 
 The principle on which I act is to make the latrines and 
 urinals reek with some smell which is obnoxious to flies. 
 Spraying or swabbing with crude carbolic solution or kerosene 
 oil, with frequent scrubbing of seats and tarring of the 
 under-surface of these, are good measures. It is, however, 
 not a matter of any importance how the flies are to be kept 
 out of the latrines ; the method is nothing, the principle 
 is the important point. I should, if inspecting a camp, 
 judge of the efficiency of the sanitation very largely by 
 the presence or absence of flies in the latrines and 
 urinals. 
 
 Where latrines of this nature are used, some organized 
 system of removal must be instituted. Preferably, this 
 should be carried out in the latrine pails without any 
 preliminary emptying of the contents of these into a cart. 
 If a light rail or tramway can be constructed for the purpose, 
 so much the better. If the pails are protected from flies 
 while in the latrine, and then transported quickly and 
 safely to a distance of, say, one and a half or two miles, 
 the danger of disease from this cause will be largely reduced. 
 Such a method of removal would, of course, entail consider- 
 able initial expenditure. In the majority of cases in a 
 standing camp, even in time of war, the soldier is much 
 more likely to die from disease than from gunshot. Good 
 conservancy is, therefore, even as important, if not more 
 
254 MILITARY HYGIENE AND SANITATION 
 
 so, than fortification, and any money spent on it will be 
 well expended. 
 
 In standing camps disposal should always be by incinera- 
 tion, either in the latrine itself, or preferably, if possible, 
 at some distance from camp. This last method pre- 
 supposes a well-managed and well-thought-out system of 
 removal. As to the pattern of incinerator used, it is im- 
 possible to lay down any law. Some improvised form may 
 be installed, or a proper destructor built. In the latter 
 case it will be unnecessary to remove the excreta to so great 
 a distance. While speaking of this subject, I should like 
 to say one word about the immense value of paraffin or 
 kerosene oil as a sanitary store. All incineration schemes 
 will be greatly assisted by its use, and as a fly deterrent 
 it has no superior. It possesses in addition the advantage 
 that it can be procured almost everywhere, and especially 
 easily in the tropics. 
 
 Excreta in camp can be disposed of by incineration, and 
 this method is, in fact, much practised in America. The 
 most commonly used one is the McCall incinerator. This 
 consists of two combustion chambers placed at right angles 
 to each other, with a common flue or chimney. Each 
 chamber consists of two parts? The lower is of brickwork, 
 and this is built up in a pit 24 inches deep, of which the 
 bricks form the walls. Above the brickwork is a steel box 
 containing two incinerator pans in which the faecal matter 
 is received. Above this again comes a removable wooden 
 seat. When it is desired to incinerate the contents of the 
 pans, the wooden seat is removed and the two incinerator 
 pans closed by two hinged iron lids, which, when the latrine 
 is in use, are raised up and rest against the sides of the 
 wooden seat. The incinerator pans communicate with the 
 common flue and chimney, and in this flue a grate is placed. 
 In this last a coke fire is lighted, and after this has been 
 thoroughly started a wood fire is lit in the brickwork 
 chamber underneath the incinerator pans. The coke fire 
 in the grate acts as a secondary combustion chamber for 
 the destruction of unpleasant fumes. Urinals are con- 
 structed in connection with these incinerators, and after 
 the combustion is complete, and the faecal matter destroyed, 
 the urine is run into the hot pans slowly, and thus evapor- 
 
WASTE MATTERS IN THE FIELD 255 
 
 ated. Though primarily intended for use in standing 
 camps, a portable form has been made in which the brick- 
 work chamber is replaced by sheet steel firebox lined with 
 asbestos. This weighs 1,800 pounds for four seats — that 
 is, for 160 men at the outside, calculating for the proportion 
 of one seat for 40 men. This adds a weight of 10 pounds 
 per man to the transport. Other forms of incinerator are 
 the Jones, which is practically an extemporized form of 
 McCall, and the Conley. These, like the McCall, are 
 worked on the intermittent plan — that is, the fire is only 
 lighted at intervals. In the Lewis and Kitchen pattern a 
 fire is constantly kept burning and the excreta are from 
 time to time raked into the fire and burned there. An 
 arrangement also exists for the destruction of urine. Ac- 
 cording to Colonel Havard, of the United States Medical 
 Corps, imceasing attention is required to prevent the fire 
 going out or else becoming so brisk as to render the seats 
 uncomfortably hot. The intermittent pattern of incinerator 
 has the disadvantage that the excreta are kept in the 
 vicinity of camp for some hours, and may thereby attract 
 flies. This can be obviated by the use of deodorants. 
 Incinerators have not been received with much favour in 
 this country, but in America they are thought highly of. 
 The possibility of their use in large standing camps should 
 be remembered, as it is easy to understand conditions under 
 which other methods of disposal of excreta might be diffi- 
 cult or impossible. 
 
 In the Journal of the Royal Army Medical Corps for 
 October, 1910, there is an interesting account of a pattern 
 of incinerator used in the 101st Grenadiers, one of the old 
 Bombay regiments of the Indian Army. This aims at 
 providing a portable incinerator, and as it seems to me 
 extremely practical I venture to describe it in some detail. 
 Iron pans of J-inch sheet iron, and intended for the reception 
 of excreta, are provided on a 5 per cent, basis. These are 
 made of various sizes, so that they can be packed in nests of 
 six, the dimensions of the outside member of a nest being 
 1 foot 2 inches long by 5 inches broad and 9 inches deep. 
 Two nests are packed into a large iron box with a lid which 
 serves afterwards as a general receptacle. Of these there are 
 four for a battalion 832 strong, containing forty-eight pans. 
 
256 MILITARY HYGIENE AND SANITATION 
 
 In the inside member of a nest a tin of kerosene (paraffin) 
 oil is packed. The actual destructor or incinerator consists 
 of a truncated pyramid, of which the four sides are hinged 
 to each other, in such a manner that the whole can be folded 
 flat. The material used is ^-inch sheet iron. The dimen- 
 sions of the destructor when complete are 2 feet in height, 
 2 feet square at base, and IJ feet square at top. There 
 are two rows of square apertures in each face of the pyramid, 
 for ventilation, the total number being sixteen. This piece 
 of apparatus is placed over a shallow hole in the ground 
 in which a fire is lit. In practice the various pans are 
 placed in holes dug in the ground made accurately to 
 receive them, any interstices being luted with mud. Im- 
 mediately after use the native sweeper passes one of the 
 pans through a mixture of water and kerosene oil con- 
 tained in the metal boxes already alluded to as carrying 
 the nests, the faeces being retained in this receptacle. When 
 it is decided to burn the excreta this receptacle is placed 
 inside the incinerator and burnt. It is not quite clear to 
 me how the details are managed, whether the water is 
 poured into a hole in the ground or not, and there are other 
 minor points on which I am still in doubt. Still, the 
 principles on which the apparatus is worked seem sound, 
 and I would suggest that one of the sanitary companies 
 at its next camp might make experiments with some 
 pattern of this nature. Indian regiments benefit much by 
 possessing a regular establishment of sweepers who are by 
 caste and training accustomed to dealing with excreta. 
 The total weight is, it is true, considerable — about 453 
 pounds, or three mule loads for a battalion 832 strong, 
 rather over J pound per man. It is not stated in the paper, 
 written by Colonel Betham, of the 101st Grenadiers, if the 
 system works without nuisance, but he evidently has a 
 great opinion, founded on experience, of the efficacy of its 
 working. 
 
 Urinals. — An excellent pattern of urinal is that described 
 by Captain Tilbury Brown in the Journal of the Army 
 Medical Corps for June, 1909. This consists of a pit about 
 4 feet square, which is refiUed loosely with the earth dug out, 
 or with stones. Into this pit run two trenches each 12 feet 
 long and 2 feet wide, with a gradient of 1 inch for each foot 
 
WASTE MATTERS IN THE FIELD 257 
 
 of run. The depth at starting should be sufficient to give a 
 distinct beginning to the trench. This is large enough for 
 a battalion. The earth dug out of the trenches should be 
 thrown to the outside and heaped there, the trenches being 
 themselves lined with small stones. The pit should be 
 guarded with a screen, hedge, or wall, so as to prevent men 
 urinating direct into it. As soon as the trenches show signs 
 of becoming offensive, they must be filled in and new ones 
 dug. A catch- water drain should be dug on the uphill side 
 of the urinal to prevent swamping in heavy rain. In stiff 
 soil there is apt to be some difficulty, as the urine will simply 
 coUect on the surface of the fiUed-in pit. I am much in- 
 debted to Major Caldwell Smith for a very ingenious sugges- 
 tion for use in this case. The pit and trenches are dug as 
 before, and the former is filled at first, and to about one-third 
 of its depth, with old tins and burnt rubbish from the camp 
 destructor ; the neighbourhood of any works where clinkers 
 were procurable would naturally be of great assistance. On 
 the top of this lumps of dry earth are placed, and on the top 
 of these again dry earth broken up ^e. The urine runs 
 along the trench, and is received at the end into a pipe made 
 of empty cylindrical tins without tops or bottoms, which runs 
 diagonally downwards to the bottom of the pit on the oppo- 
 site side (see Fig. 6). The urine now has to filter upwards 
 through the filling-in of the pit before it can appear at the 
 top, and this affords an opportunity for evaporation and 
 oxidation. I consider this model preferable to the original 
 pattern, and should feel inclined to adopt it for any urinal 
 intended to be used through any period longer than two or 
 three days, whatever the soil conditions. The urine, being 
 conducted to the bottom of the pit, is at once protected from 
 flies. A simpler form can be used for a small body of men, 
 or tiU the more elaborate structure can be made. This con- 
 sists of a pit into which a steeply sloped gutter runs, the 
 actual point of junction being the bottom of the pit. The 
 pit is filled in as before, but on the side where the gutter 
 enters a board is placed, at least as broad as the gutter, 
 which closes all access of fluid to the pit except at the very 
 bottom . 
 
 Disposal of urine at night is always a great difficulty. 
 The tendency to be careless in this respect is universal, and 
 
 17 
 
258 MILITARY HYGIENE AND SANITATION 
 
WASTE MATTERS IN THE FIELD 259 
 
 yet urine is no less important a source of disease than faecal 
 matter, more especially in the case of that most serious 
 disease, enteric fever. The proportion of convalescents who 
 act as urinary carriers of this disease is very considerable, 
 and the numbers of baciUi that they discharge per diem 
 simply colossal. In one case in which the numbers of bacilli 
 were calculated over a considerable period by Captain 
 Fawcus, of the Eoyal Army Medical Corps, the daily output 
 amounted on one occasion to 500,000,000 in twenty-four 
 hours. It is important, therefore, to provide special night 
 urinals, since the day urinals will obviously be placed too far 
 away for use in the dark. It is not very easy to do this 
 satisfactorily. The usual method is to place tubs or buckets 
 on mounds of earth of a suitable height, with a lamp hung 
 close by. This lamp is essential in standing camps. The 
 difficulty lies in the fact that if the tub is large there is always 
 a certain amount of difficulty in removing it without spiUing, 
 whilst if it is too small there is a danger of overflow. A large 
 number of small, easily portable buckets is more practical 
 than a smaller number of comparatively large tubs. In 
 carrying these it is worth while remembering that a few 
 leaves of bracken or fern floated on the top of the urine will 
 do a great deal towards preventing splashing. For troops 
 on the move, broad, shallow pans should be dug at the ends 
 of the rows of tents. In loose soil it wiU be sufficient if the 
 turf is merely taken off or the surface turned over, but in 
 heavier soil a cavity must be excavated. 
 
 Where night urine tubs are used, it is necessary to provide 
 a pit into which they may be emptied. For this purpose 
 a special pit may be dug, or the day urinal be utilized. I 
 prefer the former plan, since it allows of the pits getting a 
 rest, and the urine filtering or evaporating away. 
 
 The disposal of urine in standing camps of long occupa- 
 tion must always present great difficulties. Its bulk and 
 weight (2 pints or 2 J pounds per man — ^that is, 250 gallons, 
 about 40 cubic feet, or over 1 ton for a battalion) renders 
 it a most difficult matter to handle. Personally, I think 
 that urine pits as already described are probably the best 
 method. The pit should always be so constructed that the 
 urine shall be conducted to the bottom of the pit, as shown 
 in Fig. 6, not allowed to flow over the surface. 
 
260 MILITARY HYGIENE AND SANITATION 
 
 Clearly, if this course is adopted, the urine is actually kept 
 in the camp, and disposed of in situ — a method which would 
 be impossible in a standing camp in the case of solid excreta. 
 Prima facie, this seems to possess many objections, but I 
 think these are more apparent than real. It is necessary to 
 remember that urine contains only 5 per cent, of solid matter 
 in solution. The enormous bulk of it, therefore, is water 
 which is incapable of causing a nuisance. If it is allowed 
 to penetrate at once to the bottom of a fiUed-in soakage pit, 
 the danger of infection being carried by flies is reduced to a 
 minimum. There remains only the nuisance attributable 
 to the ammonia emanating from the carbonate of ammonia 
 resulting from the decomposition of urea. A layer of lightly 
 rammed earth placed on the top of the pit, or wood ashes, 
 about 9 inches deep, would satisfactorily mitigate this 
 nuisance. I am perfectly convinced that such a measure 
 would be infinitely preferable to attempting to convey 
 the total bulk of liquid away in tubs or buckets, with the 
 liberal splashing of potentially infective urine that would 
 inevitably occur. The daily burning of litter on the surface 
 of the filled-in pit would equally obviate any possible 
 nuisance. In this case kerosene oil should, if available, be 
 freely used. 
 
 The sites of all latrines and urinals must be marked out 
 when a camp is evacuated, and this can best be done, in 
 my opinion, by heaping litter over them and igniting it. 
 This will effectually destroy any infectious particles which 
 may have escaped covering over in the hurry of quitting 
 camp. Additional marks may, of course, be placed, if con- 
 sidered necessary, but the first-named procedure I consider 
 essential. It is the last duty of a medical officer of any unit, 
 when leaving a camp-ground, to see that, as far as possible, 
 the site is left in as good a sanitary condition as it originally 
 was prior to occupation. 
 
 I look on an efficient system of latrine and urinal construc- 
 tion and management as being the keystone of practical 
 sanitation in the field. The medical officer of the unit is 
 responsible for the patterns used, and must see that the 
 details of construction are carefully carried out. He is 
 responsible for the management, too, in so far as it is his 
 duty to see that latrine pits are carefully covered in, and 
 
WASTE MATTERS IN THE FIELD 261 
 
 that both these and urinals are not allowed to be used for a 
 longer period than is proper. But the real management of 
 both these installations is the duty of the men and officers 
 of the unit. The sanitation of any unit is what a mathe- 
 matician would term a function of the discipline of the 
 unit. The better the latter, the better the former. This 
 personal responsibility for the details of conservancy must 
 be impressed on every individual in the unit with the utmost 
 power at the medical officer's command. Some of these 
 details are in themselves necessarily unsavoury, and it is 
 sometimes urged that this unavoidable quality renders their 
 due fulfilment derogatory to the character of the soldier. 
 In this connection I venture to repeat two historical illustra- 
 tions which bear strongly on this particular point — namely, 
 the relation between the true military spirit and the perform- 
 ance of duties which, however necessary they may be, cannot 
 be looked on as other than menial. 
 
 My first illustration is a quotation from the Life of Sir 
 John Moore, and runs as follows : " The streets leading to 
 the citadel being dirty, a battalion was ordered to cleanse 
 them. It was represented that the men might object to 
 this, but the order was peremptory, and obedience was in- 
 sisted on. When the men assembled, and were told what 
 to do, they in anger threw down their shovels and dispersed, 
 saying that they were enlisted as soldiers, not as scavengers. 
 This was passed over, but the battalion afterwards became 
 very troublesome." The second instance is an extract from 
 certain Standing Orders just 100 years old, and this runs 
 as follows : " In towns, necessaries must be dug in the yards 
 of houses, or in the most convenient situations adjoining 
 buildings occupied by troops. They must be covered over 
 daily, and fresh ones made as often as expedient. Fatigue 
 parties will be frequently employed in removing and covering 
 over the filth, which, notwithstanding these regulations, may 
 have so accumulated as to render parts of the town or ram- 
 parts offensive. And if the quarters of any particular corps 
 are found to be dirty, some restraint or additional fatigue 
 duties will be imposed on that regiment. " The incident first 
 related occurred in Corsica, when Sir John Moore served 
 there during the Governorship of Sir Gilbert EUiott. The 
 recalcitrant battaHon was one of Corsican Infantry, which, 
 
262 MILITARY HYGIENE AND SANITATION 
 
 if remembered at all, will probably be remembered only by 
 the disgraceful act of disobedience just related. The Stand- 
 ing Orders from which I quoted are those " given out and 
 enforced by the late Major-Gfeneral John Craufurd for the use 
 of the Light Division." The Light Division in the Penin- 
 sular War was, beyond question, one of the very finest 
 military organizations that have ever existed, and Major- 
 General John Craufurd was a man who, when he gave orders, 
 made no mistakes about their enforcement. There is little 
 doubt that the above orders were literally carried out. 
 What was not beneath the dignity of the Light Division to 
 do is not beneath that of any man in any army, and the 
 question as to whether it is better to be soldiers and scaven- 
 gers with them, or soldiers and not scavengers as the Corsican 
 Light Infantry were, is one the answer to which I feel certain 
 few soldiers would hesitate in making. 
 
 In this connection, the following quotation from an order 
 by the famous Russian General Skobeleff, is of interest. It 
 is dated at Duz-Olum, in Trans-Caspia, November 16, 1880, 
 and runs as follows (after four orders relating to sanitation, 
 and referring to the management of latrines, etc.) : " This 
 does not, however, diminish the responsibihty of command- 
 ing officers, and they must always remember that the good 
 state of a camp is a tolerably just measure of the efficiency 
 of the troops occupying it, of the attention to their duty 
 shown by commanding officers, and even of the preparation 
 of the troops for battle " (Grodekoff, trans. Grierson), 
 
 We now come to the consideration of those forms of waste 
 matter which are not specifically dangerous, but, owing to 
 their putrescible nature, have to be removed to prevent 
 the occurrence of a nuisance. These are tent-sweepings, 
 kitchen refuse, kitchen slops, and ablution water, and litter 
 from the mounted and transport lines. 
 
 Taking tent sweepings and kitchen refuse first, there is 
 only one satisfactory method of disposal, and that is by fire. 
 With regard to the first, in a standing camp it is necessary 
 to have some definite system for collection. Perhaps the 
 best way is to have a bag or tin hung on a pole at the 
 end of each line of tents. The orderly men of the tents 
 then collect the sweepings, paper, odd fragments of food, 
 etc., from their respective tents, and place them in the 
 
WASTE MATTERS IN THE FIELD 26:^ 
 
 nearest receptacle. At a definite time each day, or, if 
 possible, twice a day, the bags are aU taken to the common 
 destructor, and there incinerated. As they are mostly of 
 a dry nature, their fuel value is considerable, decidedly 
 greater than that of the heavier kitchen rubbish ; and if 
 possible they should be thrown into the destructor at the 
 same time as this latter in order to facilitate its complete 
 combustion. The kitchen rubbish must be collected in 
 proper bins if these are available ; if not, empty boxes or tins 
 covered in some way must be utilized. Periodically these 
 must be taken to the destructor and burnt there, and the 
 golden rule is : " Sufficient unto the day is the rubbish 
 thereof." No rubbish should remain overnight in or near 
 a kitchen. 
 
 The next step is the construction of an incinerator. The 
 best form consists of a small enclosure surrounded by a cir- 
 cular or rectangular wall composed of sods, bricks, or " bully- 
 beef tins, " either empty or filled with earth. Good sods are 
 perhaps the most durable, but tins filled with earth, espe- 
 cially if this be clayey in nature, are a very excellent substi- 
 tute. In addition, they are always procurable. When sods 
 are used, they should be 9 inches broad and about 2 inches 
 thick. The walls may be supported by stakes borrowed from 
 the fuel issue or specially cut, or else by heaping up earth 
 round them. The walls should be 3 J to 4 feet high, since 
 this is a convenient height to lift refuse baskets and boxes 
 for emptying. A reasonable size is about 2 feet 6 inches 
 square. Air should be admitted by holes left at the bottom 
 of the walls, and these may be converted into long air-ducts 
 by means of corned-beef tins placed end to end, projecting, 
 as will be seen from the diagrams, to a varying extent into 
 the area of the destructor. It may, especially if the 
 weather be damp, be necessary to use a certain amount 
 of fuel with some paraffin oil to start the fire, but subse- 
 quently, with good management, it should be possible to 
 keep the destructor going by means of the rubbish and 
 sweepings alone. Periodical stoking is of importance, as 
 otherwise the fire may die out, or be choked by sudden 
 overloading. 
 
 With such a destructor, unless rubbish is allowed to accu- 
 mulate to an unmanageable extent, there should be no diffi- 
 
pIR 
 
 264 MILITARY HYGIENE AND SANITATION 
 
 culty in entirely disposing of all the rubbish for a battalion, 
 provided care in management is exercised. 
 
 For purely temporary use, such as in a camp occupied for 
 only one night, a semicircular wall may be made of earth 
 and stones with the opening towards the wind ; the rubbish 
 is then heaped together inside this enclosure and burnt. 
 
 iSiSSIJ^^^^ 
 
 4'*SquARE — PLANS 
 
 Fig. 7. 
 
 4f*^DlAMETEK- 
 
 The function of the wall is simply to allow of the rubbish 
 being heaped up against it. Burial, of course, may also be 
 resorted to in such temporary camps, and the choice of 
 method, whether burial or burning, may be allowed to 
 depend on the nature of the soil and the labour entailed in 
 digging, the time available, etc. 
 
 Colonel Firth suggests a simple pattern of incinerator, in 
 
WASTE MATTERS IN THE FIELD 265 
 
 which two trenches are dug at right angles to each other 
 about 9 inches deep and 5 feet long. A chimney is built 
 over the intersection, and a few pieces of railway iron or 
 other material used to form a grate or grid at the bottom 
 of the chimney. 
 
 The " Arnold "or " rock-pile " crematory has been much 
 used in the United States. It is- made in the following 
 manner : A circular pit is dug measuring about 15 feet in 
 diameter and 3 feet in depth. The whole of the floor of 
 this pit is paved with loose large stones to a depth of 14 to 
 16 inches, and on this pavement is built a circular wall, 
 which acts as a lining to the earth wall of the pit, and 
 projects 1 foot above the level of the surface. Earth is 
 heaped up against this wall on the outside to form a sort 
 of ramp, which provides a sloping access and also prevents 
 surface-water entering the pit. In the centre of the pit a 
 pyramid of stones about 5 feet high is constructed, which 
 thus projects 1 foot above the level of the wall, and 2 feet 
 above the general surface. This last structure is essential 
 to produce a draught. If the contour of the ground permit, 
 it is suggested as an improvement to construct the incinerator 
 close to the edge of a sloping bank, so that an opening about 
 2 feet wide may be dug in the circular wall for the removal 
 of ashes and the provision of increased draught. The in- 
 cinerator is started by lighting a wood fire in it, which heats 
 the stones forming the floor and wall to such an extent that 
 any rubbish subsequently deposited is rapidly dried and 
 burnt ; fluid slops can also be disposed of in this crematory. 
 
 The choice of structure to be adopted must be largely a 
 question of local circumstances. If a camp were amongst 
 sand-dunes near a shingle beach where good sods were not 
 easily procurable, then the Arnold incinerator might with 
 advantage be adopted. Where good sods are available, I 
 feel inclined to plump for the square sod-built incinerator, 
 as already described , and as made by the 2nd London Sani- 
 tary Company. The structure is, however, almost the least 
 important part of the question. The essential conditions 
 for success are system and supervision. Without these, no 
 improvised incinerator can be expected to succeed. Every 
 incinerator should be protected by a catch-water drain in 
 case of heavy rainfall. 
 
266 MILITARY HYGIENE AND SANITATION 
 
 In situations where a more permanent installation is pos- 
 sible a destructor may be built on the lines shown in Fig. 5. 
 This consists, as will be seen, of an oblong furnace with 
 a chimney at one end, the whole being built of brick. 
 The roof of the furnace is made of corrugated iron covered 
 over with excavated material. The hearth is constructed of 
 fire-bars made from corrugated iron cut into convenient 
 strips. If possible, two iron rods should run longitudinally 
 along the furnace to support these bars, and in that case 
 the strips should be cut across the corrugations. This will 
 facilitate removal of ashes. In the absence of this support, 
 it will be advisable to cut the strips parallel to the corruga- 
 tions. The actual dimensions of the furnace must depend 
 on the size of the sheets available locally, and the thickness 
 of the walls on the supply of bricks. In the diagram the 
 walls are only one brick thick, and in such a case it is ad- 
 visable to heap earth against the walls for the purpose of 
 support. A piece of corrugated iron may be used as a half- 
 door to improve draught after the furnace has been filled 
 and lighted. 
 
 The next point to be considered is the disposal of kitchen 
 slops. These also must be disposed of on the spot, and the 
 difficulty consists not so much in their bulk as in the grease 
 present. The problem to be solved is the removal of this 
 grease, after which, in ordinary soils, the cleared water can 
 be disposed of by soaking pits or trenches. The usual type 
 consists of a rough strainer which removes the larger pieces 
 of floating refuse — e.g., potato -peelings, etc. — that may still 
 remain in the slops, from which these pass into the grease - 
 trap. This trap consists usually of a hollow in the ground, 
 or of a tin in which heather, straw, grass, or leaves, are placed. 
 The grease congeals on these, and the purified water then 
 runs into shallow pans or pits, and is absorbed. The greasy 
 heather, or whatever material may have been used in the 
 grease-trap, is then burnt, together with the potato -peelings, 
 etc., which may have remained in the first strainer. This 
 method has the defect of being somewhat complicated, there 
 being two receptacles to clear out. The 2nd London Sani- 
 tary Company have improved on this by constructing their 
 strainer and grease -trap in one. A suitable box is taken and 
 filled at the bottom with stones, above which is placed the 
 
WASTE MATTERS IN THE FIELD 267 
 
 grease-retaining material. An overflow should be made near 
 the top of the box, and an outlet also provided at the 
 bottom (Fig. 8). In the absence of a box, a small sod 
 enclosure could be made similar to that described for the 
 destructor, and it might be possible in this case to use it as 
 such, merely at the end of the day burning the grease- 
 impregnated heather or straw in situ. In the absence of 
 vstones the lower half of the enclosure or box may be fiUed 
 with empty tins. The drain from the grease-trap to the 
 soaking pit or area may be lined with small stones, or even 
 floored with empty tins flattened out. What should be 
 aimed at is either to let the water soak into the ground in 
 the drain-bottom at once or pass without delay to the pit. 
 There must be no ponding of it in the drain. As regards 
 the soakage area or pit, I am indebted to Lieutenant A. J. 
 Martin, of the 2nd London Sanitary Company, for the sug- 
 gestion that the important point in the construction of this 
 is area, not depth, the upper layers of the soil being always 
 more friable and more readily permeable than the lower. 
 The pit should not be circular, as this entails more digging 
 for the provision of surface than any other shape. A series 
 of trenches, into which, if necessary, the water could be 
 diverted on different days, or a broad, shallow pan, are pre- 
 ferable. In very impervious soil it is as well partly to refill 
 the pit which has been dug with old tins, etc., on the top of 
 which a layer of the excavated clay broken as fine as possible 
 should be placed. The sullage -water is thus protected from 
 flies, etc., till it has time to soak away. One or more of these 
 can be made, and their use alternated. 
 
 In connection with this subject the question of washing 
 dishes, etc., must be considered. If the men feed in their 
 separate tents, then all this must be done in the vicinity of 
 the kitchen, where only hot water can be procured. The 
 dirty water should be freed from grease, and disposed of as 
 already described. Even where dining-tents are provided, 
 the washing-up should generally be carried out in the 
 vicinity of the kitchen. In standing camps, if possible, 
 trestle -tables, with or without a central trough, as described 
 later, should be provided. 
 
 An important form of waste water is ablution-water. If 
 care be not taken, the ground in the neighbourhood of the 
 
268 MILITARY HYGIENE AND SANITATION 
 
 nadefom a f7/ ordinary 3o/ 
 
 obtamecffrom rne Cankers ^ 
 
 ^fe 
 
 
 
 Tiba^toTiH from Iksffufpr 
 
 
 pv 
 
 
 1 
 
 
 
 p **' Y^^^^ ''* * ^H^^^^ 
 
 — ^ Mio -FEATHER OR Trap - — 
 
 nac/e^m Ga-r of /Bc^L 
 
 Cross Section « 
 
 ^Ricx Bats 
 
 AlUotNTS run wirti well Bo.(ed TAR^eBTcH , P'-A'^ 
 
 f'^UTERiALS _ Box Pitch Tar. Si^sH • Can 
 Fret S/^w. j^mls. Hammer. _ 
 Str^w, Bats 
 
 Fig. 8. 
 
WASTE MATTERS IN THE FIELD 269 
 
 washing-places may rapidly be converted into a disgusting 
 swamp, especially in a clay soil, and the resulting mud 
 carried into the tents. The first point to be considered is 
 the ablution-bench. These should always be constructed in 
 standing camps, and a good pattern is as follows : A trestle- 
 table is constructed having a V-shaped gutter running down 
 the centre. Above this gutter, and projecting slightly into 
 it, should be a plank running longitudinally along the table. 
 The men wash in their basins on the bench, and then tip 
 the water into the longitudinal gutter. This last structure 
 prevents any splashing of the men standing on one side of 
 the bench when basins are emptied on the other. The place 
 where the men stand should be paved either with concrete 
 or loose stones well stamped in. The gutter discharges over 
 a trench in the ground, which runs to any convenient dis- 
 tance, and then spreads out into a series of short trenches 
 arranged herring-bone fashion, or otherwise, as may be most 
 convenient. The extent of soakage area required will, of 
 course, depend very much on the nature of the soil — whether, 
 that is, it is readily pervious or not. Here, again, the water 
 must either soak in rapidly or run away rapidly. The 
 former may occur in loose soil, but if the soil does not 
 permit of this, then the gutters should be made as im- 
 pervious as possible, and with a good gradient, to prevent 
 formation of puddles. If a bench cannot be constructed, 
 on account of want of material or time, or from any other 
 cause, then a canvas trough may be used, or, finally, the 
 men may wash at the actual source from which the water 
 is drawn. I need hardly mention that this must be below 
 the places marked out for provision of drinking-water, and 
 for watering animals, if the source be a stream, and as far 
 distant as possible from these if the source be a pond or 
 lake. 
 
 In hot weather it is well, if possible, to provide some sort 
 of shower-bath where actual bathing is impossible. This, 
 of course, demands a piped supply of water, and is only 
 feasible in a camp occupied for a considerable time. The 
 Americans provide five such per company in addition to 
 10 feet of washing-trough, made of cast-iron, per company. 
 Every effort should be made to encourage daily washing of 
 the feet, especially, of course, in the case of infantry soldiers. 
 
270 MILITARY HYGIENE AND SANITATION 
 
 To enable a man to do this in any comfort, and without 
 wetting his clothes, it is absolutely necessary to provide 
 him with some sort of seat or bench to sit on while so 
 occupied. It is impossible to lay down any scale for these ; 
 the more the better. With less than 15, or say even 20, 
 per cent., there must inevitably be delay in the process. 
 In all standing camps, special structures should be erected 
 to shelter the men whilst washing, or else marquees or other 
 tents pitched. In cold weather some arrangement for hot 
 baths should be made. In or close to large towns it should 
 be possible to make some arrangements with the local 
 authorities for the use of the public baths for this purpose. 
 Near the sea, or where a large lake or river is available, 
 bathing parades should be held in warm weather, not only 
 for cleanliness, but also for instruction in swimming. 
 
 The disposal of the excrement of horses and other animals 
 is always a troublesome question, on account of the bulk 
 of material involved. It may, of course, be possible to 
 dispose of this waste product to a contractor, who will be 
 glad to take it for manure. If this be done, very stringent 
 conditions as to regularity of removal should be laid down 
 and enforced. Removal should take place at certain defined 
 hours, and in case of delay beyond a fixed period of grace 
 the dung and litter should be burnt. Pending removal, 
 these matters must be kept at a spot some distance from 
 the camp, and, if possible, not in the direction of the pre- 
 vailing wind. As a rule, mounted corps are very apt to be 
 careless in this matter. This is, perhaps, natural with the 
 men from whom a great number of our yeomen are drawn — 
 the farmer class — since they are in the habit of seeing such 
 accumulations of manure close to their dwellings. At the 
 same time, such accumulation must not be allowed in camp, 
 as it inevitably leads to the breeding of flies. 
 
 Latrines, urinals, etc., are arranged in the rear of the 
 camp in a space termed the "sanitary area." Behind 
 everything come the latrines and urinals for day use. A 
 separate urinal should be made for officers. Between the 
 latrines for men and those for non-commissioned officers a 
 separate urine -pit is shown, into which it is intended that 
 the night urine tubs should be emptied, the empty tubs or 
 pails being stacked round this during the day. The in- 
 
WASTE MATTERS IN THE FIELD 271 
 
 cinerator is placed close to the latrines, but it is a question 
 whether it should not be nearer to the kitchens to save 
 carrying about of rubbish and irregular stoking. 
 
 Before leaving this subject of camp conservancy, I should 
 like again to draw attention to that most useful adjunct — 
 paraffin oil. This substance is practically universally pro- 
 curable, it is cheap, and one of the best fly deterrents that 
 I know. In addition, its inflammable nature makes it 
 useful for assisting incineration in unfavourable weather. 
 The only other disinfectant that I should recommend for 
 camp use is chloride of lime, which may be usefully applied 
 round the sites of night-urine tubs or pails. These are the 
 most difficult things to deal with that we meet in camp 
 conservancy. They are a standing danger, but it is difficult 
 to see, human, and especially soldier, nature being what it 
 is, how they are to be avoided. 
 
CHAPTER XV 
 
 BARRACKS 
 
 Barracks are buildings intended for habitation by men 
 leading a communal life under discipline. They diJffer 
 from other buildings to which the same description might 
 be applied, in that the discipline to which the soldier is 
 submitted is not merely a means of restraint intended to 
 restrict his personal liberty, but an important part of that 
 education whose end is to teach him to work in unison 
 with his fellows in the performance of their common duty. 
 A certain limitation of liberty is naturally implied in this, 
 but this restraint is in the nature of a side issue only. The 
 real object of barracks is to enable the men to know each 
 other as the result of living together, and thus to form 
 from a number of isolated individuals that organic whole 
 which we term a regiment, battalion, or battery. 
 
 The life of the barrack is, in fact, one of the great in- 
 fluences which distinguish the regular soldier from the 
 irregular volunteer, who meets his comrades only on parade, 
 whilst all the rest of his life is absorbed in pursuits, and 
 moulded by influences, which are different for every member 
 of the unit. 
 
 The collection of a large number of men under one roof 
 or in a number of contiguous buildings has certain very 
 marked influences on their physical life, and forms one of 
 the most important, probably the most important, of all 
 those " surroundings " to which the recruit has to accom- 
 modate himself ; it constitutes, therefore, one of the most 
 pressing problems of military sanitation. The consequence 
 of such an aggregation may very easily be detrimental to 
 health, and, in fact, many military sanitarians have stig- 
 matized barracks in the words of Boisseau, " as a necessary 
 
 272 
 
BARRACKS 273 
 
 evil the bad effects of which we must endeavour to paUiate, 
 without hoping ever entirely to do away with them." Or, 
 again, as Bard says : " The life of the soldier necessarily 
 entails a certain morbidity and mortality which result even 
 more from the crowding together, and the communal life, 
 than from the fatigues and exigencies of military service." 
 
 That the housing of men in barracks has in the past had 
 a bad effect on their health is beyond dispute. At the same 
 time I am by no means inclined to accept the argument 
 that such consequences are the inevitable result of such a 
 mode of life. I can see no essential reason why the soldier 
 in barracks should not lead, not only as healthy a life as, 
 but one more much healthy than, that of his brother who 
 remains in the ancestral cottage or tenement building. 
 The problems to be faced are no doubt difficult, but they are 
 by no means insuperable, and their satisfactory solution 
 is to be found in a scientific mode of planning and building 
 barracks. 
 
 In the days when barracks were first brought into use 
 the chief idea in the minds of the architects who designed 
 them was to isolate the soldier from the remainder of the 
 population, partly, no doubt, to protect the civilian from 
 the excesses of an undisciplined soldiery, but partly, also, 
 to enable the ruler to overawe the populace by a display 
 of concentrated force. The idea of personal restraint was 
 therefore the leading motive, and this is exemplified in the 
 castellated barrack square attributed to Vauban, but in 
 reality the work of a less-known man, Belidor. In these 
 we have a central square surrounded and completely en- 
 closed by four buildings of two or more stories. The 
 upper floors were reached by staircases placed at the 
 corners of the square. The men were accommodated in 
 small barrack-rooms holding about twelve men each ; some 
 of these rooms looked on to the courtyard and some to 
 the outside. In some plans the rooms were arranged back 
 to back with a central partition wall ; in others this wall 
 was replaced by a dark and badly lighted corridor ; in others, 
 again, the rooms all looked outwards and opened into a 
 long corridor running along the quadrangle, face of the 
 building. This last pattern was the best, as a certain 
 amount of direct through ventilation was provided. The 
 
 18 
 
274 MILITARY HYGIENE AND SANITATION 
 
 rooms were used for all purposes, no extra dining or clean- 
 ing rooms, or even kitchens, being allowed. The latrines 
 and other necessary buildings occupied a certain portion 
 of the quadrangle. These barracks were chiefly objection- 
 able on account of the fact that the aspect of at least two 
 out of the four blocks was bad ; the courtyard was never 
 properly aired, and a considerable portion of it never saw 
 the sun, more especially during the winter months of the 
 year. The paucity of means of access necessitated an 
 undue amount of going and coming along the corridors, 
 and any infectious disease once introduced had thus ex- 
 cellent opportunities of spreading. 
 
 The fact that troops had often to be concentrated in 
 positions where they might be conveniently situated to 
 overawe the more turbulent classes of the populace led 
 to the placing of barracks in the most insalubrious and 
 already overcrowded quarters of large towns. This, again, 
 aggravated the initial defects of the plan on which the 
 barracks were built. All the bad effects which residence 
 in such buildings undoubtedly produced in the health of 
 the army were essentially due to the false theory which 
 appears to have dominated the minds of the men who 
 designed them — namely, that barracks were merely places 
 where the soldier could conveniently be confined until he 
 was needed on parade. 
 
 Rational barrack construction in these islands dates from 
 the appointment by Lord Panmure, in the year 1857, of 
 a " Commission for improving the Sanitary Condition of 
 Barracks and Hospitals." The Report of this Commission, 
 published in 1861, should be read by every sanitary officer. 
 It gives an excellent description, with block plans, of the 
 typical barracks of that period, enumerating their chief 
 defects as follows : As regards general plan, want of sim- 
 plicity in the general arrangements of blocks ; buildings so 
 placed as to interfere with the ventilation of each other, 
 buildings erected around closed courts, or with deep closed 
 angles ; barrack buildings placed too close to the boundary 
 walls, with latrines, urinals, dung heaps, ashpits, etc., 
 placed in a narrow space between the barrack and the wall. 
 In addition they noted the following defects in internal 
 arrangement — viz., placing barrack-rooms back to back, 
 
BARRACKS 275 
 
 with windows on one side only and no through draught ; 
 constructing barrack-rooms over stables ; providing means 
 of access to barrack-rooms by long internal corridors, or 
 by corridors covering one side of the rooms ; omitting to 
 provide proper staircases ; taking space for stairs out of 
 barrack-rooms ; using basements for barrack-rooms. The 
 chief defect, however, was the monstrous condition of over- 
 crowding, which was the almost universal rule. Thus, 
 out of a total force of 76,000 men (in round numbers) about 
 1,300 lived in rooms affording less than 250 cubic feet per 
 man, more than one-half had less than 400 cubic feet, and 
 only 5,000 had more than 550 cubic feet air space per man. 
 Taking the whole force, the deficiency in accommodation 
 was estimated at about 32 per cent. In some rooms it 
 was necessary to remove all the tables and forms before 
 the beds could be folded down, whilst in some there was 
 " hardly 12 inches between the beds in any direction ; and 
 when folded down for the night the beds appear to cover 
 the whole area of the floor." The most important of all 
 the recommendations made by the Commission was that 
 in future every man should be allowed 600 cubic feet in 
 the barrack-room. In planning of barracks they suggested 
 that the simplest arrangement was the best ; squares should 
 be avoided, but where necessary the angles should be 
 left open. The simplest arrangement proposed was a 
 single line of blocks running north and south, so that both 
 sides should be exposed to the sun every day, but this 
 might be broken up into two parallel lines separated by a 
 considerable space to be used for a parade-ground, and on 
 occasion even more lines might be made, as long as these 
 were placed " a sufficient distance from each other to enable 
 the whole outer wall surface to be freely exposed to the 
 sun during the day." The keynote of their scheme was 
 decentraUzation, the unit being the barrack -room with 
 certain appended parts " so that a barrack of any size 
 may be constructed by simply increasing the number of 
 units." The unit of size they placed at twenty to thirty 
 beds, the beds being arranged with their heads to the walls 
 on opposite sides of the room, the height of the room to 
 be between 11 and 12 feet, with a breadth of 19 to 20 feet. 
 The entire unit was to consist of (1) the barrack-room ; 
 
276 MILITARY HYGIENE AND SANITATION 
 
 (2) the sergeant's room ; (3) an ablution-room with fixed 
 basins ; and (4) a night urinal. The latrines and day 
 urinals to be placed at as great a distance as may be con- 
 venient from the men's rooms, and the kitchens under a 
 separate roof from the barrack-rooms, but at a convenient 
 distance to enable the men's dinners to be brought to them 
 hot. Baths and ablution-rooms were to be built in any 
 convenient portion of the barrack enclosure, each bath 
 being in a separate compartment, formed by a high bulk- 
 head or partition, with a door and lock. 
 
 The general principles laid down by the Commission 
 have formed the guiding rules for the construction of 
 barracks since that date, and though advances in the science 
 of building have rendered the decentralization recommended 
 by the Commission no longer necessary, still, the general 
 rules propounded hold as good nowadays as when they were 
 first promulgated. 
 
 General Arrangement of Barracks. — It is clear that 
 if a barrack is to be anything beyond a mere method of 
 confining the soldier under cover, certain needs must be 
 satisfied in addition to the provision only of a shelter. 
 This will necessitate the construction of certain rooms or 
 buildings in excess of the mere living-room, such as dining- 
 rooms, recreation rooms, etc. The arrangement of these 
 will depend largely on the barrack policy pursued. For 
 instance, if decentralization is the ruling principle, the 
 latrines, cook-houses, dining-rooms, etc., will need to be 
 distributed throughout the barrack enclosure, so as to be 
 in convenient proximity to the men. On the other hand, 
 if concentration is to be aimed at, these accessory buildings 
 can be all brought together and placed even under the 
 same roof as the barrack-rooms. Decentralization has 
 many advantages both from the sanitary and the adminis- 
 trative points of view. The responsibility for cleanliness 
 can be more directly brought home to certain individuals, 
 and the sanitation of each company placed under the 
 hands of the captain and other company officers. On the 
 other hand, from the point of view of construction (and 
 especially that most important part of construction — 
 drainage), centralization has much to be said in its favour, 
 whilst administratively the important question of feeding 
 
BARRACKS 277 
 
 the men is much more satisfactorily handled from a central 
 kitchen and a central dining-room than from eight or 
 four such institutions. From the point of view of the 
 comfort of the men, too, in an uncertain climate, it is only- 
 fair that in bad weather the soldier should be able to pass 
 from the dining-room to the library or writing-room without 
 going outside, and that after dark, at the close of day, he 
 should be able to get to his bedroom without having to 
 splash across a muddy barrack square. Modern progress 
 in house construction has simplified the question very 
 greatly and a degree of concentration is possible which 
 was out of the question, or at least difficult, some years 
 ago. 
 
 The reaction from extreme centralization to extreme 
 dispersion was perhaps best marked in France in the 
 Toilet pavilion system, in which the troops were accommo- 
 dated in a number of isolated buildings, each one story 
 high, and covering, consequently, an enormous superficial 
 area. The expense of these, as represented by the ground 
 that had to be acquired, was enormous, and the difiiculty 
 of warming rooms whose walls were all outside walls, the 
 surface in contact with the outer air being as nearly as 
 possible equal to that in contact with the air of the apart- 
 ment itself, rendered them unsuitable for use except in a 
 mild and equable climate. In the "type 1889" a return 
 was consequently made to a greater concentration. Lemoine 
 gives the Vincennes cavalry barracks as a type of this 
 pattern. In these we see three buildings, each of three 
 stories, all with the same aspect. In two of these two 
 squadrons each are accommodated, each of these units 
 being separated from the other by a main party-wall, and 
 having its own sleeping-rooms, staircase, night latrines, 
 lavatories, and dining-room. The fifth squadron occupied 
 the upper part of the third building, the lower part being 
 given up to ofiices, workshops, etc. The block plan of the 
 main barrack buildings is H -shaped, certain accessory 
 structures being disposed between these and the outer 
 barrack boundaries. The barrack-rooms were provided 
 with through ventilation and lighting by means of four 
 windows, two on each side of the room. The cubic space 
 afforded was 612 cubic feet, and the height was 13-2 feet. 
 
278 MILITARY HYGIENE AND SANITATION 
 
 In 1907 a return was made to the more scattered arrange- 
 ment previously in use. 
 
 In the British Army decentralization was not carried to 
 such an extreme as in the French Service, except in the 
 case of the old camps at Aldershot and elsewhere, and by 
 the end of the nineteenth century the half-battaHon system 
 was the general rule. 
 
 The block plan of this pattern may be compared to two 
 capital T's joined together by their stems. The cross of 
 each T was comprised by the barrack-rooms and ablution- 
 rooms of two companies ; the junction of the two shafts 
 by a half-battalion kitchen, whilst company dining-rooms 
 were arranged in pairs on the shafts themselves. The 
 barrack-room must obviously be the first consideration. 
 Even if it is used only as a dormitory, which should be the 
 universal rule, the man must perforce spend a greater part 
 of the twenty-four hours in it than in any other one room. 
 In the plan under discussion each room is designed to hold 
 twelve men ; the cubic space is therefore 7,200 cubic feet, 
 on the basis of 600 cubic feet per man. By a late decision 
 of the Army Medical Advisory Board, the height is not to 
 exceed (for purposes of estimation of the cubic space avail- 
 able) more than 10 feet. This implies a floor area per man 
 of 60 square feet, and the general arrangement of the total 
 720 square feet of floor space is much as follows : The 
 dimensions of the room are roughly 20 to 23 feet in breadth, 
 and from 36 to a little over 3 1 feet in length. If the barrack- 
 room has to be used as a dining-room, the latter breadth is 
 necessary; but in cases where a separate dining-room is 
 provided, the narrower room has certain advantages. The 
 beds, each 2 feet 3 inches in breadth, are arranged along 
 each waU. This wall is broken by three windows, each 
 21 feet in breadth, subtracting thus 7 J feet from the wall 
 space available for beds. These are arranged in pairs 
 between the windows, with one in each corner ; thus every 
 man has a clear space on one side of his bed of about 6 feet, 
 and IJ feet on the other. In the narrower room a central 
 passage of about 6 feet is left, this being increased to nearly 
 9 feet in the broader room. The choice between the 
 narrower and the broader dimensions is almost immaterial 
 from a sanitary point of view. The narrower room is 
 
BARRACKS 279 
 
 somewhat more difficult to heat, and the through ventilation 
 is slightly less efficient ; there is, however, but httle choice 
 in this direction. The real deciding factor is the expense 
 of the roof girders. In the broad room these are more 
 expensive, being not only longer but also stouter ; they 
 thus exercise greater pressure on the walls. 
 
 The rooms are heated by fireplaces placed back to back 
 in adjoining rooms, the doors being at the opposite ends. 
 Thus each pair of rooms opens on to a common landing 
 or passage, at the outer end of which is the ablution-room. 
 Separate rooms for non-commissioned officers, with company 
 store-rooms attached, are provided in the proportion of two 
 to every eight barrack-rooms. The cook-house, as aheady 
 stated, occupies the point of junction of the two T's. It 
 communicates directly with the two double - company 
 dining-rooms, and attached to it also are bath-rooms and 
 drying-rooms. The proportion of baths is four for the 
 men, and one for the sergeants of each half battalion. 
 
 The regimental institutes, canteen, guard-room, etc., 
 were all under separate roofs, so that the concentration 
 had in this case only gone as far as sleeping and feeding 
 accommodation. 
 
 The latrines and urinals were also separate, and no night 
 urinals were provided, a noisome arrangement, called the 
 " urine tub " being placed in the landing or passage between 
 every two barrack-rooms. 
 
 Considerable as was the advance made in these plans 
 in the direction of increased comfort for the soldier, a great 
 deal is still left to be desired. The ground covered by 
 the barracks is considerable. The different buildings, with 
 the parade - ground for one infantry battalion, cover 
 22 acres, of which the parade-ground takes up only a little 
 over 3 acres. The actual buildings, therefore, cover well 
 over 18 acres. The men have to go considerable distances 
 in the open, and in bad weather they are apt to get wet, 
 and introduce dirt into the barrack-room on their return. 
 The bathing accommodation is deficient ; an allowance of 
 four baths for the men of half a battalion does not admit 
 of every man bathing as often as he ought to do, and natur- 
 ally those occasions when a man most wants a bath are 
 Iiot infrequently those when all the men, having beea 
 
280 MILITARY HYGIENE AND SANITATION 
 
 similarly occupied, are smitten by the same need. In- 
 evitably some men go without, and the large number 
 actually using the baths absolutely prevents any proper 
 cleansing of the bath after a man has used it before another 
 does the same. Such a condition of affairs is unpleasant 
 always, and may conceivably be very dangerous. Still, 
 there is no doubt that these barracks were an improve- 
 ment on anything seen previously, when the unit of the 
 barrack was the company barrack-room, as laid down by 
 the Commission before alluded to, and when neither separate 
 dining-rooms, sculleries, nor baths, nor covered ways from 
 the barrack-room to other buildings were provided. 
 
 Latest Barrack Plans. — In the latest plans a return 
 has been made to the principle of concentration, the build- 
 ing being so constructed that all the indoor life of the soldier 
 can be passed under the same roof, and, at the same time, 
 the entire battalion or regiment accommodated in the one 
 building. The only completed barracks of this class are 
 those erected for occupation by the Guards at Windsor. 
 Others are, however, in process of construction at Bedford 
 near Edinburgh, for both cavalry and infantry. 
 
 Windsor Barracks. — These are intended to accom- 
 modate five companies of infantry at night, the remaining 
 three being housed in existing buildings of compara- 
 tively recent date. The dining- and other day-rooms are 
 sufficient for the entire battalion. The buildings consist 
 of two parallel blocks, one three the other two stories 
 high, separated by an open space of 75 feet. This open 
 space is covered by a flat roof with large ventilating lantern 
 lights. The ground floors of each of the two blocks are 
 intended for use by day, the sleeping accommodation being 
 provided in the upper stories. A complete innovation has 
 been made by the introduction of a cubicle system. The 
 cubicles open on either side of a long corridor, and are 
 separated by partition walls 7 feet 5 inches high, leaving a 
 space of 2 feet 7 inches clear up to the ceiling. The partitions 
 do not come right down to the floor, a gap of 6 inches being 
 left to permit of thorough cleaning. Each cubicle is 7 feet 
 6 inches by 6 feet. The bed is placed along one side, and 
 the door is so hung that it can be thrown absolutely open 
 to permit of easy inspection by the company officer. Each 
 
BARRACKS 281 
 
 cubicle has its own window, 2 feet 6 inches broad, the upper 
 half of which is a fanlight, faUing inwards, and controlled 
 by a screw rod operated from the non-commissioned officers' 
 room. A locker is placed in each cubicle, and a steel ward- 
 robe, hanging hooks, and arm-rack are also provided. Heat 
 is supplied from steam radiators in the passages, and light- 
 ing is carried out by electricity. 
 
 The greater part of the central area is taken up by two 
 half -battalion dining-rooms, in direct communication with 
 the kitchen and canteen, which are placed in the ground 
 floor of the two-storied block. In one of these rooms a 
 stage has been erected, and private lockers are placed at 
 the ends of the mess-rooms in which the soldier can keep any 
 personal purchases of food. The dimensions of the dining- 
 rooms are 84 feet in length by 64 feet in breadth. The 
 lavatories and latrines are situated towards either e_nd of 
 the central space. The latrines and urinals are not materi- 
 ally different from the same installations at any good railway- 
 station. The lavatories contain basins, slipper-baths, foot- 
 and shower-baths. The latrine accommodation provided 
 comprises 44 seats, and the 32 urinal stalls.* There are 14 
 sKpper -baths, 10 shower, and 26 foot-baths. For purposes 
 of recreation there is a smoking- and games - room 
 (109 by 20 feet), a reading-room, writing-room, and billiard- 
 room. The various shops, stores, and offices find a place 
 in the ground floor of the southern block. 
 
 The new barracks at Edinburgh, for cavalry and infantry, 
 are on a somewhat different plan to those at Windsor, 
 though the ruling idea is the same. 
 
 The cavalry barracks consist of a front block and two 
 wings ; these latter run back from the front block, the 
 starting-point being about 30 yards from the extremity of 
 each end of the front. The total length of the front is 
 420 feet, and that of each wing 350 feet ; the enclosed area 
 is thus decidedly broader than that at Windsor, being 
 14,700 feet. As before, the ground floor of the different 
 blocks contains the various day-rooms and offices, whilst 
 the central area is mainly taken up with the dining-room, 
 which in this case is regimental. It communicates with the 
 
 * In addition, there are 30 seats and 13 stalls on the corridor floors, 
 for night use only. 
 
282 MILITARY HYGIENE AND SANITATION 
 
 kitchen by means of a service corridor and service-room, 
 and also with the canteen. At one side is a stage with 
 dressing-rooms, etc. 
 
 The latrine accommodation is arranged in two blocks 
 each containing eighteen pedestal closets with twelve urinal 
 stalls, between which come the combined shower- and foot- 
 baths, twenty-four in number. Between these and the 
 dinirg-hall come six slipper-baths and eighty-four hand- 
 basins. All this lavatory accommodation is at the southern 
 end of the central area, the latrines and urinals being as 
 far as possible from the dining-hall. As before, the ground 
 floors of the barrack blocks are taken up with the different 
 day-rooms, recreation-rooms, and regimental offices. The 
 cubicles occupy the two upper stories, there being 96 
 in each of the three blocks on each floor, or 576 in all, . 
 besides rooms for non-commissioned officers. Access is 
 obtained by three staircases in each wing, and four in the 
 front block. The cubicles are separated into blocks of 
 twenty-four by cross doors in the central corridor, and small 
 lavatory annexes are supplied in the proportion of two for 
 each corridor. These contain eight washhand basins, two 
 urinals, and two water-closets for night use. 
 
 The infantry barracks, which have been commenced, are 
 arranged on a block plan resembling a capital E. The 
 length of the front main block is .360 feet, that of the two 
 outer wings (the top and bottom cross-strokes of the letter) 
 is 230 feet, whilst the central block is 110 feet long. The 
 central area is thus broken up by the projection into it of 
 the short central block. The two isolated portions thus 
 formed immediately in rear of the main block are left open, 
 and the remainder roofed in, and utilized for dining-room, 
 kitchen, and lavatory accommodation. It may be objected 
 that the uncovered part of the area would suffer from the 
 same objections as the old barrack square, but as the open- 
 ing of the E faces south this is, in fact, not the case. The 
 small amount shaded by the low roof of the dining-hall is 
 not sufficient to produce a bad effect. The other internal 
 arrangements generally are much the same as those of the 
 cavalry barracks just described . 
 
 That such barracks are an immense advance on anything 
 previously constructed in this country, or any other, for the 
 
BARRACKS 283 
 
 matter of that, there can be no doubt. It is worth noting 
 that disciphne, when considered as a part of the communal 
 life intended to educate the soldier and mould the organic 
 life of the unit, has resulted in a barrack plan not unlike 
 the solid square of Belidor. Break down the end walls of 
 a typical barrack of those times and cover in the central 
 area and you would arrive at an almost absolute imitation 
 of the Windsor Barracks. In the later barracks now under 
 process of construction in Scotland the resemblance of the 
 new to the old is even more striking. From a sanitary 
 point of view the greatest advance is undoubtedly in the 
 dining and lavatory accommodation. The former is quite 
 on a level with that of a good public restaurant, and the 
 close connection between the kitchens and the dining-rooms 
 must make for better serving and better feeding generally. 
 Naturally, any battalion is compelled in such barracks to 
 adopt at least a half -battalion, if not a battalion, system of 
 messing. This particular emphasizes the connection between 
 barrack discipline and barrack construction. The two can- 
 not be considered apart, even when the element of personal 
 restraint is kept as much in the background as possible. 
 
 The provision of shower-baths is a great advance. It 
 implies the possibility of insisting on frequent washing 
 without undue waste of water or time, and it robs the bath 
 of all the dangers which a slipper-bath, used in a short 
 space of time by a large number of men, indubitably pos- 
 sesses. It will undoubtedly be necessary, in my opinion, 
 in the case of a battalion occupying such barracks for the 
 first time, to post a sanitary orderly to see that the water- 
 closets are properly used, to perform, in fact, the duties 
 which are carried out by the attendant that may be found 
 in the lavatory of any of the larger metropolitan termini. 
 It will be necessary for the medical officer in charge of 
 effective troops in such barracks to keep a very close eye 
 on these installations with newly-arrived battalions. The 
 old proverb Corruptio optimi pessima is peculiarly attrib- 
 utable to up-to-date sanitary arrangements. 
 
 The Cubicle System. — The opinions as to the advisability 
 or otherwise of this system are various. The greatest 
 advantage is certainly on the moral side. The possession 
 of even a small private apartment confers on the possessor 
 
284 MILITARY HYGIENE AND SANITATION 
 
 a sense of ownership which has a distinctively moral ejffect. 
 I well remember the famous Edward Thring, once Head- 
 master of Uppingham, insisting on the importance of every 
 boy in a public-school having his own study, very largely 
 on this account. It is sometimes objected that the new 
 system will have a socially disintegrating effect, but this is, 
 I think, an exaggerated fear. It will be quite easy to 
 prevent men going up to their cubicles without good reason 
 in the daytime, or before a certain hour in the evening, or 
 at least exercising reasonable restrictions in this direction. 
 The lavish provision of recreation-rooms on the ground floor 
 may be confidently expected to encourage the men to spend 
 their leisure indoor hours in the company of their comrades. 
 
 From the sanitar^^ point of view the most obvious objec- 
 tion is in the direction of cleanliness. A room is difficult 
 to clean in proportion to the number of corners. A barrack- 
 room for twelve men has four corners, but twelve cubicles 
 have at least twenty-four. The fact that the partitions 
 do not descend actually to the floor has no doubt an im- 
 portant bearing on this objection, but here, again, new 
 battalions will need to be specially educated in the art of 
 each man looking after his own apartment, instead of 
 throwing the responsibility on the orderly man for the day. 
 As regards infectious diseases, the ease with which isolation 
 can be effected is no doubt a great advantage. Ventilation 
 is assured by the falling fanlight in each cubicle, which, 
 as already noted, is not under the control of the individual 
 soldier. 
 
 It might be expected that these new barracks, with the 
 increased luxury which they provide, would be more ex- 
 pensive than those built on earlier plans. As a matter of 
 fact, concentration has effected a saving on account of the 
 lessened area required. The barracks at Windsor cover a 
 total area of a little over 5,000 square yards, those for 
 infantry at Redford, where more space is available, 9,200, 
 and those for the cavalry regiment at the same place, 15,200 
 square yards. These figures are exclusive of married quarters 
 and stables. 
 
 Barracks in India. — In India, speaking of the stations 
 in the plains, dissemination is inevitable. The fact that 
 ground is comparatively cheap permits of this being effected 
 
BARRACKS 285 
 
 without extravagance. In the period immediately follow- 
 ing on the Mutiny of 1857 a considerable number of two- 
 storied barracks were built, but they are not particularly 
 satisfactory, and the usual rule is small half-company 
 bungalows with single verandas. Until lately, in the 
 standard plans each half-company bungalow consisted of 
 two dormitories, each 20 feet high, in which 1,800 cubic 
 feet was allowed per man. Between these dormitories a 
 dining-room, on the scale of 30 square feet per man, was 
 placed. A sergeant's room was provided at either end of 
 the block, and a store-room in the veranda. The lavatories, 
 cook-houses, latrines, and urinals are all in detached 
 buildings. Until lately there was no attempt to combine 
 cook-houses and dining-rooms under one roof, but this is 
 now done, a very distinct advance on previous arrange- 
 ments. In the older barrack plans each company had 
 its own cook-house, and the large number of these establish- 
 ments impeded considerably the removal and collection of 
 rubbish. But the most striking sanitary defect was the 
 enormous multiplication of latrines. In one Lines I counted 
 as many as seventeen different latrines for one infantry 
 battalion. Under circumstances like these it was im- 
 possible for the establishment of native sweepers to cope 
 with its task, which was, in consequence, neglected, with 
 the inevitable result. Not only were there too many 
 latrines ; those that existed were often badly placed. 
 With a view to maintaining control, the company cook- 
 house, wash-house, and latrine were frequently placed too 
 close together. I have elsewhere referred to a notice-board 
 indicating that all these three were housed under one roof ; 
 but though this must, it is to be hoped, be a solitary instance, 
 I have on one occasion seen the cook-house and the latrine 
 so close that to effect a passage between them was difficult. 
 
 In my opinion the cardinal principle in laying out barracks 
 in India, or in any other hot climate, where a water-carriage 
 system of removal is impossible, is to keep the number of 
 latrines and cook-houses as low as possible, and to separate 
 them by as large an interval as can be managed. 
 
 The following is the type plan which I should suggest for 
 an infantry battalion : The men should be housed in half- 
 company bungalows, of the present dimensions, arranged in 
 
286 MILITARY HYGIENE AND SANITATION 
 
 two rows 100 yards apart, the bungalows of each line being 
 in echelon, and not at right angles to the general direction of 
 the line. The distance between the different bungalows 
 in the same line should be equal to one and a half times, 
 or twice, the height of a bungalow, and the angle of the 
 echelon should be about 30 degrees. In the central space 
 should be placed a battalion cook-house with dining-room 
 attached, or else two such buildings, one for each half-bat- 
 talion. In close connection with the cook-house should be the 
 bathing accommodation, consisting only of shower and foot 
 baths. Slipper-baths are unnecessary for cleanliness, and 
 the disposal of the large amount of water that they use is 
 a matter of great difficulty. 
 
 I should prefer to have a single installation of this nature, 
 on account of the great advantages possessed by a battalion 
 system of messing, but a single battalion wash-house might 
 occasion some difficulty. It might on this account be 
 necessary to have two half- battalion buildings, each com- 
 prising, as above suggested, cook-house, dining-room, and 
 wash-house. The day latrines and urinals should be placed 
 at least 50 yards to the outer flank of each line of bungalows, 
 so that there should be a good 100 yards' distance between 
 them and the dining-rooms. The latrine and urinal should 
 be combined under the same roof, with a view to disposing 
 of all excreta in an incinerator, without undue carrying to 
 and fro. It would probably be necessary to have four such 
 buildings, each for a double company, as otherwise the men 
 from the bungalows at the extremities of the lines would 
 have too far to go in the middle of the day in the hot 
 weather. For night use a small combined latrine and 
 urinal should be placed fairly close to the bungalows, one 
 for each company, between the two bungalows occupied 
 by that unit. These should be kept locked between 
 " reveille " and " last post " in the hot weather, and between 
 " reveille " and " retreat " in the cold season. The most 
 careful attention should be paid to these buildings to prevent 
 any fly-borne infection passing to the bungalows. The 
 key should be in charge of a non-commissioned officer, 
 who should see that all excreta are removed from these 
 to the larger latrines at " reveiUe." 
 
 The married quarters should be placed at one end of the 
 
BARRACKS 287 
 
 battalion lines, the regimental institutes and ofl&ces at the 
 other. The latrines for the married quarters should be 
 kept as low in number as possible, and each quarter pro- 
 vided with one or two bath-rooms, in the ordinary Indian 
 fashion, for night use. 
 
 As far as possible the lines of bungalows occupied by the 
 men should run in such a direction that the prevailing 
 wind should get free access to every building in the two 
 lines. The married quarters should be to windward — that 
 is, in Upper India, to the north-west of the barracks, the 
 offices and institutes to leeward. 
 
 Such a type plan naturally could not be applied to every 
 station rigidly ; modifications must be made to suit local 
 conditions, but the general principle, which I have already 
 stated — namely, to limit the number of latrines and cook- 
 houses as much as possible, and to keep them as far apart 
 as can be managed, the former, if possible, outside the lines, 
 and the latter inside — ought to be universally observed. 
 
 The individual bungalows should be of the usual type, 
 and the central day-room should be preserved for use as 
 a sitting-room in the middle of the day in the hot weather. 
 This might — ^though I do not feel sanguine about it — ^lure the 
 private soldier away from his bed-cot for a few hours &,t 
 least of the " long, long Indian day." 
 
 Ventilation should be by clerestory windows and a ridge 
 roof. The former should be built on a cross-frame, so that 
 the opening could be closed with glass or wire gauze as re- 
 quired. These windows should be operated by rods or 
 else by stout wires, not by ordinary string, as is, or used to 
 be, the case. The ridge aperture should also be rendered 
 fly, and if possible mosquito, proof, but in this case the 
 gauze should be so placed as to be visible from the inside 
 of the bungalow, and be easily accessible for swabbing. 
 For hot-weather ventilation electric fans or some mechanic- 
 ally worked form of punkah should be provided, and the 
 punkah coolie done away with. I feel certain that this 
 wretched serf is responsible for a great deal of disease. 
 Heating, if not on any central system, which is impractic- 
 able, in my opinion, should be from two fireplaces in each 
 dormitory, not from one only. With the large cubic space 
 allowed, one fireplace cannot supply sufficient heat for the 
 
288 MILITARY HYGIENE AND SANITATION 
 
 whole room except at the risk of scorching the men closest 
 to it. The difficulty is the greater, since it is impossible to 
 reduce the cubic space in stations where heating is most 
 required in the cold weather, on account of the fact that 
 these are, as a rule, also the stations where the heat is the 
 most intense in the hot weather. 
 
 I have already, in Chapter XII., given my views on the 
 construction of latrines and urinals. 
 
 As regards bathing accommodation I have already said 
 that this should be provided in connection with the kitchen. 
 It might be advisable to build ordinary ablution-rooms in 
 addition, where the men could wash in the ordinary sense, 
 and these should be on the outer flanks. In that case foot- 
 baths might be placed in these buildings. The bathing 
 accommodation should be lavish, so that every man can 
 have a shower-bath every day in the hot weather. This 
 should not be impossible, since at this season battalions in 
 the plains are at their lowest strength. It is impossible 
 in the hot weather to keep the person from offence to one's 
 neighbours with any less frequent ablution. 
 
 Inspection of Barracks. — Paragraph 134 of the 
 Regulations for the Army Medical Service, lays down that 
 " the medical officer (in charge of effective troops) will 
 visit every portion of the barracks at least once a month." 
 This duty is perhaps the most important that the medical 
 officer has to perform, and it is at the same time one of the 
 most difficult of all to carry out efficiently. The chief 
 mistake made, in my experience, by junior medical officers 
 in this respect, is that they do not begin their work in the 
 right way. I will venture to indicate what I consider the 
 right way, and, though I am by no means bigoted in the 
 matter, I venture to think it is at least as good as any other. 
 The first thing to be done is to learn geography. The 
 medical officer should first of all procure a plan of barracks 
 and get the general arrangement of the different buildings 
 into his head. Having done this he must next study their 
 position on the ground. Within one month he should know 
 every building and its object by heart. This does not 
 seem much to ask, but I have known medical officers who 
 after a much longer period than the above have been quite 
 astray in barracks if brought into them from some un- 
 
BAItRACKS 28§ 
 
 familiar direction. After studying th^ map and the 
 barracks themselves, the medical officer should then proceed 
 to study the drainage and water-supply systems, inch by 
 inch. He should personally go into every water-closet, 
 test the flush, trace the connections with the soil-pipe, and 
 of the soil-pipe with the drain. The line of the soil-pipes 
 should be traced, and the position of its upper end relatively 
 to the nearest windows noted. The next step will be to 
 follow the course of each drain, inspecting and noting the 
 position of and reason for every manhole, and having the 
 lid off to see if there are any signs of blocking on the bench- 
 ing. The exact position of all ventilating openings should 
 also be noted. The survey of the drain will proceed till 
 the last disconnecting manhole is reached, and will not be 
 completed till the medical officer has ascertained that the 
 lid is on the opening into the cleaning eye. 
 
 In the same way the medical officer should trace the water- 
 supply from the point of collection through the system of 
 distribution and purification to the stand-pipes in barracks. 
 He should make it his business to know the exact tap from 
 which the men of any particular company are in the habit 
 of getting their water. 
 
 The whole of the barracks should be studied in the same 
 meticulous manner until the medical officer feels that as far 
 as the construction of the barracks is concerned he is 
 thoroughly acquainted with every detail of the soldier's 
 surroundings. Until he is in that position he cannot 
 possibly pretend to know anything about the sanitation 
 of the barracks, since it cannot be too often repeated that 
 sanitation is merely a means of adaptation to surroundings. 
 Such an accurate knowledge of the mere bricks and mortar 
 is the essential basis of all sanitation, and is not beyond the 
 reach of even the dullest officer. Without such knowledge 
 the most brilliant may come to hopeless grief. The closest 
 laboratory acquaintance with the different varieties of the 
 members of the coli group is of little use to the sanitary 
 officer who does not know the position and condition of the 
 barrack manholes, and the possession of the former item 
 of knowledge is no excuse for ignorance of the latter piece 
 of information. 
 
 Having acquired the knowledge of geography already 
 
 19 
 
^90 MILITARY HYGIENE AND SANITATION 
 
 alluded to, the medical officer will be in a position to speak 
 authoritatively with regard to the maintenance of sanita- 
 tion. He should in future make a weekly inspection of 
 barracks, and he will be wise if at each inspection he directs 
 his attention particularly to some one or other main " sur- 
 rounding." One week the drainage, another the water- 
 supply, on a third the ventilation, will occupy his attention. 
 By this I mean that on each of these occasions he will look 
 thoroughly at some one system as a whole, giving a general 
 *' look round " only as regards the remainder of the barracks. 
 In this way he can best avoid falling into the habit of a mere 
 perfunctory stroll round the barracks. As long as every- 
 thing is seen thoroughly once a month, not merely glanced 
 at^four times, he will fulfil not only the letter but the spirit 
 of the Regulations. 
 
 Inspection of Men. — The Regulations lay down that 
 the medical officer in charge of effective troops " wiU also 
 inspect the men under his charge monthly to satisfy himself 
 that their personal hygiene has been attended to." The 
 system that I myself practised in this matter was the 
 following : On being placed in .charge of a unit, the first 
 thing to do is to go through all the Medical History Sheets 
 of all the men of the unit. This will take about five hours, 
 and can be easily managed in the course of a week. A list 
 should then be made of all the men who are the " weak 
 points " of the unit, the men who have had enteric fever, 
 repeated attacks of malaria, bronchitis, venereal disease, 
 dysentery, etc. A separate list should be made out by 
 companies of these men, and this list should include every 
 man who has been in hospital within the last twelve months 
 from any cause whatsoever. The first thing that will strike 
 the young medical officer will be the large number of men 
 who have never been " sick " during their service. He will 
 realize that the real invaHdity of the unit resides in com- 
 paratively few men. These are the men on whom he has 
 to keep his eye. In the same way as he directs his attention 
 to some particular part of barracks on any particular day, 
 so he should make it his business to see and keep in touch 
 with the " weak points " of his unit week by week. 
 
 I would also advise the young officer to keep a private 
 weekly return indicating the condition of his unit. This 
 
BARRACKS 291 
 
 return should show by companies, squadrons, or batteries 
 the actual number of admissions during the week, under a 
 few broad headings only. This should form, in fact, a 
 current account of the health of the unit. The undue 
 occurrence of some particular cause of inefficiency affecting 
 only one portion of the unit may thus be recognized, and the 
 cause perhaps removed. The medical officer should keep 
 constantly in mind that he is " in charge of effective 
 troops," and it is his business to keep in just as close touch 
 with the man in the ranks as with the man in hospital. 
 He should try to look on every admission to hospital as an 
 instance of failure on his part, until it is shown to be the 
 contrary. General and other officers are apt to look on full 
 hospitals as a sign of activity on the part of medical officers. 
 One such, a short time ago inspecting a hospital and finding 
 it almost empty, said to the medical officer in charge, 
 " You don't seem to have much work to do," to which the 
 other replied, " On the contrary, it is because I do so much 
 that there are so few sick to show." A full hospital is the 
 opprobrium medici of the army, and in nine cases out of ten 
 it is full because medical officers fall into the error of thinking 
 that their duty is to the sick man first and the healthy man 
 second. The contrary is the case. The healthy effective 
 man is the most important individual, and the greater the 
 number of these the greater the efficiency of the army. 
 This is of course a commonplace. I do not think, however, 
 that medical officers recognize sufficiently that it is their 
 first duty to see that the number of effective men are kept 
 as high as may be. Sanitary duties are very apt to be 
 pushed into the background, and allotted to any officer 
 " in addition to his other duties." The first duty is that of 
 preventing sickness, the second that of treating it. 
 
 "This oughtest thou to have done, and not to have left the 
 other undone." 
 
 There is plenty of room for the second after the first has 
 been done ; the performance of one by no means involves 
 the neglect of the other. 
 
CHAPTER XVI 
 
 TEMPORARY HABITATIONS OF SOLDIERS 
 
 As opposed to barracks, we have those temporary 
 habitations which are occupied by soldiers when it is im- 
 possible or inconvenient for the authorities to provide 
 them with permanent accommodation ; these are camps, 
 bivouacs, and billets. 
 
 The occasions when such temporary accommodation 
 becomes necessary occur both in peace and war. In peace, 
 in our own army, bivouacs and billets are never resorted 
 to ordinarily, except in the case of bivouacs for short periods 
 on manoeuvres. Billets are commonly used by foreign 
 nations, both on manoeuvres and also during the ordinary 
 movements of troops in peace-time. So far their use has 
 not been practised by us, except occasionally in an ex- 
 perimental fashion, as during the Cavalry Manoeuvres in 
 1910. In the wars which the British Army is accustomed 
 to engage in, the opportunity for this form of accommoda- 
 tion has not as a rule arisen, but in any campaign in a 
 civilized country it would undoubtedly be resorted to. 
 Our knowledge of the conditions is, therefore, drawn entirely 
 from foreign sources, and cannot be regarded as having 
 any first-hand authority. It may be permitted me to point 
 out that where practical knowledge is so entirely lacking, 
 the necessity for theoretical study is all the greater. 
 
 Camps may be either permanent, or, as they are sometimes 
 called " standing camps," or temporary. The former are 
 largely used in time of peace for instructional purposes — 
 e.g., for musketry and artillery practice — and in war at the 
 base and at permanent posts on the lines of communication. 
 The great Napoleon expressed himself very strongly on their 
 dangers, from the sanitary aspect, in the maxim, " Tents 
 are injurious to health ; a soldier is best when he bivouacs." 
 
 292 
 
TEMPORAEY HABITATIONS OF SOLDIERS 293 
 
 This statement contains a considerable amount of truth, 
 though I venture to think it is founded on a similar fallacy 
 to that which hes at the basis of the theory that " barracks 
 are a necessary evil, the dangers of which we may hope to 
 minimize, without expecting ever entirely to do away with 
 them." 
 
 Camps and bivouacs differ from barracks most obviously 
 in that they offer a less amount of shelter from the vicissi- 
 tudes of wind and weather than the more permanent 
 buildings afford. It would appear obvious, therefore, that 
 the attendant evils, if any, would be greater in proportion 
 as the protection was diminished ; greater, therefore, in 
 bivouacs than in camps, since in the latter the man has at 
 least one or more folds of canvas between him and the outer 
 air, whilst in the former the roughest shelter only inter- 
 venes. If we consider the individual man under canvas, 
 there is not the slightest doubt that, given plentiful food, 
 it is just as possible for him to maintain his health in a tent 
 as when living under a roof, even when exposed to consider- 
 able extremes of heat and cold. British officers, who have 
 probably a larger acquaintance with camp life than those 
 of any other army, know that three or even six months 
 spent in an 80-pound tent close under the Himalayan 
 snows conduce in the majority of cases to the very extreme 
 of health and vigour, even in men who start on their trip 
 decidedly on the wrong side as regards their physical 
 exchequer. The dangers of camp life, if such there be, are 
 therefore not connected in any way with the individual 
 life, and we are perforce driven to the conclusion that here 
 again, as in so many other instances, the controlling sanitary 
 factor is the communal life of the soldier. This, in my 
 opinion, is the true solution of the problem, and if we are 
 to minimize the evils of military camp life we must approach 
 the question from this direction. 
 
 If we look at the difference between camp life and barrack 
 Hfe, we see that, from the communal point of view, the 
 chief differences are that in the former case the men are 
 crowded together on a smaller area of ground, and also 
 that there are no organized arrangements for the removal 
 and disposal of waste matters. Let us consider these in 
 the above order. 
 
294 MILITAEY HYGIENE AND SANITATION 
 
 Overcrowding. — ^This affects men in camp in two ways. 
 In the first place they are concentrated in the daytime on 
 a comparatively small superficial area ; and, in the second, 
 during the night hours they occupy tents which give them 
 an amount of cubic space ridiculously small as compared 
 with that which they enjoy in barracks. The former defect 
 applies also to bivouacs, though the latter is absent unless 
 the men are huddled up, as is the rule in foreign armies, 
 in tentes-ahris. The overcrowding in daytime is easily 
 minimized by turning the men out of camp, either for 
 military exercises or recreation. And here I may recall the 
 saying of Sir John Moore, already quoted in the chapter 
 on Physical Training, as to the evil of allowing the soldier 
 to " lounge the whole day in a barrack, where the air cannot 
 be good, and where, from indolence, his body gets enervated 
 and liable to disorder." Lounging in a tent is quite as bad 
 as lounging in a barrack-room. The defect of overcrowding 
 at night is less easily dealt with, especially in cold weather. 
 It is more than anyone has a right to ask of ordinary human 
 nature to expect men to sleep on the ground with the tent- 
 flies rolled up, and it is difficult to ventilate the roof of a 
 tent without at the same time permitting the entry of rain. 
 Honestly, I think the evil must be accepted, and if the man 
 must breathe more or less foetid and foul air for, say, eight 
 hours of the twenty-four (during which, it must be remem- 
 bered, the vital processes are less active than during the 
 remaining sixteen), it is all the- more necessary to see that 
 for the whole of those sixteen, or as many of them as the 
 weather will permit, the tent is aired by being struck, or at 
 the least by having the flies or walls rolled up, and the men 
 made to spend as much of the time as possible in the open. 
 I need hardly say that the nightly overcrowding is enor- 
 mouly exaggerated in bivouacs where tentes-ahris are in use. 
 
 Removal and Disposal of Waste Matters. — ^It is in 
 regard to this department of sanitation that the greatest 
 danger of camp life consists. Obviously, too, the danger 
 is the greater in direct proportion to the strength of the 
 force and the length of time that the camp is occupied. 
 It is far greater, therefore, in standing than in temporary 
 camps. In respect of this matter I should lay down that 
 a standing camp is any camp which it is known will be 
 
TEMPORARY HABITATIONS OF SOLDIERS 295 
 
 occupied for more than a fortnight. That period is the 
 longest during which it is at all justifiable to rely on a 
 trench system of latrines. In all camps occupied for longer 
 periods some permanent form of bucket latrine must be 
 instituted, and the general directions which I have already 
 given for the conduct of such latrines when discussing these 
 installations followed. Removal is also a difficult operation. 
 At a base camp a light tramway should be built to run all 
 solid excreta to a safe distance, where they can be buried 
 or thrown into the sea, or any large river not in use for 
 debarkation purposes. Incineration in situ may be prac- 
 tised, and is probably the best method of all. In fact, the 
 conditions must be assimilated as far as possible to those 
 of a cantonment where a water-carriage system is not 
 available, which are discussed in the chapter devoted to 
 that subject. 
 
 The urine presents an even more serious difficulty. At 
 the risk of repetition it may be stated that the great difficulty 
 is the enormous bulk of fluid present compared with the 
 small amount of putrefiable solid matter. If the former, 
 averaging 40 ounces per man, could be disposed of, the latter, 
 at the outside 3 ounces, would present but little difficulty. 
 At the same time urine is an extremely dangerous fluid, at 
 least potentially, seeing that enteric " carriers " frequently 
 pass the germs of that disease by millions in this excretion. 
 I say at once that, in my opinion, the removal by any 
 purely mechanical means, such as by hand and cart, of this 
 bulk of fluid (^50 gallons for one battalion) without slopping 
 is a practical impossibility. If local incineration is practised 
 in the case of the solid excreta, then the urine can, by means 
 of suitable apparatus, be evaporated and destroyed in the 
 incinerators. The problem is, however, in practice, one of 
 considerable difficulty. If incineration cannot be carried 
 out locally, or if the pattern of incinerator adopted does not 
 permit of the easy evaporation and destruction of the urine, 
 then I see no way out of the difficulty except that of disposal 
 underground in situ. This sounds, I am aware, a most 
 insanitary proceeding, and a defence of this proposal is 
 therefore demanded. 
 
 We have two things to guard against : one is the causation 
 of a nuisance as a result of the decomposition of urea, with 
 
296 MILITARY HYGIENE AND SANITATION 
 
 the formation of carbonate of ammonia, the other the spread 
 of infection. Presuming that leakage into the water-supply- 
 is precluded, which should always be done by the selection 
 of a source of water at some distance from the camp (this 
 step is, of course, imperative for other reasons than that 
 with which we are at present concerned), the only means by 
 which infection can be disseminated from the urine is the 
 common fly. If the urine is made to run at once to the 
 bottom of the pit, as in the pattern of urinal shown in 
 Fig. 6, there should be no possibility of flies getting access 
 to it through the overlying mass of stones, etc., with which 
 the pit is filled in. The water would be disposed of by 
 means of percolation and evaporation, and any possible 
 nuisance could be easily abated by burning a certain amount 
 of rubbish on the surface of the filled-in pit. The ashes 
 resulting from the incineration would act as a further 
 deodorizer. In fact, it would probably not be difficult to 
 combine the urinal and the destructor in one construction, 
 if a little care were taken in the digging of the pit. It 
 would be necessary to protect the pit from flooding by surface 
 water in heavy rain, and in very rainy climates by means 
 of a canopy roof. I am certain that some such arrangement 
 would be far preferable in a standing camp, even if occupied 
 for months, than the inevitable slopping which must result 
 from hand- and cart-carriage. 
 
 All waste matters, other than excreta, if of a dry 
 nature, must be burnt. It will probably be necessary to 
 construct a large permanent destructor to deal with the 
 great accumulation of horse litter, carcasses of animals, 
 slaughter-house offal, etc., that is the inevitable corollary 
 of a large concentration of troops or a permanent camp. 
 In some cases a portable incinerator, such as the Horsfall, 
 may be found convenient. 
 
 The ordinary daily rubbish of units is best disposed of in 
 local incinerators such as are described in Chapter XII. 
 This is far simpler and safer than carrying it to a central 
 installation. Slop-water from ablution benches must be 
 disposed of by irrigation, and, if possible, under-drainage. 
 The keynote of camp sanitation is conservancy. I do not 
 say that, having disposed of your waste matters, you can 
 sit down with folded hands and go to sleep. By no means ; 
 
TEMPOKARY HABITATIONS OF SOLDIERS 297 
 
 there are many other things to attend to. But I do say, 
 with the very greatest emphasis and the firmest conviction 
 of being right in saying it, that unless conservancy is recog- 
 nized as being the most important task, much more if it is 
 allowed to fall into neglect, no other sanitary measures 
 that can be adopted will be anything more than mere 
 tinkering. 
 
 The site of a camp is fixed either by military or sanitary 
 considerations, or by neither. Many a camp has been 
 selected by the mere haphazard choice of a tired commander, 
 because water was handy and his men had done enough 
 for the day. Gradually more units have joined, and 
 eventually a standing camp has grown from the originally 
 chance-selected spot. 
 
 Lord Wolseley lays down, in his " Soldier's Pocket-Book, " 
 that the choice of a camp should be made on sanitary 
 grounds, when contact with the enemy is not expected 
 within forty-eight hours. It not infrequently happens that 
 a site originally selected on tactical grounds is afterwards 
 used for permanent occupation. Unless there is chance of 
 attack, as on the lines of communication, it may often be 
 advisable to change the actual position of the camp from 
 that originally selected. As a rule, the ultimate choice 
 is a compromise. A site should, of course, be dry, gently 
 sloping, but not too steep ; conveniently situated with 
 regard to water, but not too close to any large collection of 
 water, especially in countries where malaria is prevalent. 
 Virgin soil is better than cultivated. The nature of the 
 vegetation is the best guide to the real condition of the 
 soil ; outward appearances are apt to be most deceptive. 
 It is generally laid down that gravel or sandy soil is better 
 than clay, but this is not universally true. It must be 
 remembered that the dampness of the surface does not de- 
 pend so much on the nature of the superficial layers of the 
 soil as on the relation which these bear to the first im- 
 pervious stratum below. A shallow layer of pervious soil 
 lying on a very impervious one is far more likely to furnish 
 a damp site than the impervious stratum itself. It is not 
 infrequently the case that patches of gravel lie on saucers 
 of clay ; the former acts like a sponge, holding the water 
 which is supported by the latter. Such a site may appear 
 
298 MILITARY HYGIENE AND SANITATION 
 
 outwardly dry, and in reality be damp even at the driest 
 seasons. 
 
 Bivouacs. — ^The sanitation of bivouacs is precisely the 
 same as that of camps. They are rarely occupied for more 
 than a few days, and only in the absence of all means of 
 shelter. Maugre the opinion of the great French leader, 
 camps are not essentially worse than bivouacs from the 
 sanitary point of view. It is, of course, quite possible that 
 owing to bad management they may become so, but that 
 is not due to any fault inherent in the system. An army 
 that is unhealthy in camp will be far more unhealthy in 
 bivouac, if it occupies the same ground for the same length 
 of time in both cases. As a rule, when troops bivouac, 
 they rarely stay in one place for two consecutive nights. 
 They therefore march away from the site they have rendered 
 insanitary, and thus escape the consequences of their own 
 bad management. 
 
 Billets. — This term is used to denote the enforced 
 quartering of troops on the inhabitants of the country. 
 The conditions under which a billeting system must be 
 carried on will naturally vary widely with the military 
 position at the time. This will affect the length of time the 
 billets will be occupied, and naturally also the degree of 
 concentration of the men. 
 
 For prolonged occupation the area allotted to any large 
 unit is calculated on the basis of the civil population. The 
 capacity of any such area to accommodate troops will 
 naturally vary with the nature and occupation of the 
 inhabitants. An industrial community has less absorbing 
 power than an agricultural, calculated on a population 
 basis. Again, the number of men that can be quartered 
 on any area will be smaller if subsistence has to be provided 
 by the inhabitants than when it is furnished by the supply 
 authorities. The Field Service Regulations lay down that 
 under the former system, commonly called " billets with 
 subsistence," a given area should be able to support a force 
 equal to twice its normal population for one week. In 
 billeting without subsistence a rich agricultural district 
 can accommodate troops at the rate of 10 per inhabitant, 
 whilst on an industrial district or town only half that 
 number, roughly speaking, can be quartered. As regards 
 
TEMPORARY HABITATIONS OF SOLDIERS 299 
 
 the number of men that can be placed in any house, the 
 " Field Service Pocket- Book " lays this down at two men 
 per yard of length for every room between 15 and 25 feet in 
 breadth, and three men per yard if the room be more than 
 25 feet broad. The French allow about 400 cubic feet per 
 man, or from three to six men per hearth. 
 
 In close billeting, when troops have to be concentrated 
 in the immediate prospect of contact with the enemy, no 
 rule can be laid down. Those men who are unable to find 
 shelter under a roof of some kind must bivouac, but every 
 roof will in all probabiHty be used in emergency, since, as 
 Lemoine observes, " the most detestable biUet provides a 
 better shelter against bad weather than the best bivouac." 
 This rule would undoubtedly be observed, even at the 
 expense of the existing civil population, should occasion 
 and the weather demand it. 
 
 The sanitation of billets must obviously vary indefinitely 
 according to the actual circumstances. In prolonged 
 billeting, such as might be resorted to in the pauses of a 
 campaign, the greatest precautions should be taken. 
 Naturally, the first pre-occupation of the sanitary officer 
 will be the health of the civil population, especially in 
 respect of the prevalence of exanthematous or intestinal 
 disease. The actual procedure to be followed will depend 
 on the exigencies of the case. Theoretically, any locality 
 where enteric fever, scarlet fever, measles, or diphtheria 
 has lately been prevalent should be closed to biUeting. 
 It would but rarely happen that this could be done, and 
 in that case the infected houses only need be avoided. 
 Even this might be difficult as a permanent arrangement, 
 and therefore all such houses should be made available for 
 occupation by thorough cleaning with disinfectants, all 
 unnecessary furniture, hangings, etc., being destroyed by 
 fire. In the case of troops biUeted only for one night in a 
 town, it would be impossible probably, in a foreign country 
 certainly, for the. sanitary officer to ascertain in time all the 
 houses where infectious disease had occurred. He must 
 simply do the best he can. In the case of a campaign in 
 this country it would be possible to rely on the local Public 
 Health medical officers, many of whom are on the a la suite 
 list of the Territorial Force. Such officers should be able 
 
300 MILITAEY HYGIENE AND SANITATION 
 
 to furnish a detailed statement of all infected houses in their 
 district to the commander of any British force moving 
 through it. Water-supply in the case of large municipalities 
 or urban districts would present no difficulty. In smaller 
 areas, where no central supply existed, special arrangements 
 would have to be made, just as in the case of troops under 
 canvas. 
 
 Much the same rule applies to the case of removal and 
 disposal of waste matters. In villages and scattered hamlets 
 it would be necessary to construct extra latrines, outside 
 the local boundary, of a temporary or permanent nature, as 
 might be advisable. It would probably be a necessary, or 
 at least a wise, precaution to place the entire village con- 
 servancy under military authority, especially in the case 
 of prolonged occupation. Local labour would, of course, 
 be used. In large villages or towns supplied with a water- 
 carriage system of removal, it might be necessary to con- 
 struct additional latrine accommodation, and connect this 
 up with the existing drainage system. In all cases the local 
 sanitary machinery should be interfered with as little as 
 possible, and the sanitary officer must keep in as close 
 touch as possible with the local Medical Officer of Health, 
 more especially in this country. It must be remembered 
 that as long as the troops are living intermingled with the 
 civil population the health of the one cannot be considered 
 apart from the health of the other. Any unnecessary dis- 
 location of the regular peace-time machinery can only lead 
 to bad results. 
 
CHAPTER XVII 
 
 CLOTHING 
 
 The object of clothing is much the same as that of habita- 
 tions — namely, to protect the wearer, or in-dweller, from 
 variations in temperature, more especially in the direction 
 of increased cold, and from moisture. An extra complica- 
 tion is, however, introduced by the fact that the outward 
 aspect of the individual is directly affected by his attire, 
 and aesthetic considerations have therefore — unfortunately 
 perhaps, but certainly inevitably — more weight in deciding 
 wherewithal a man shall be clothed than in fixing the type 
 and arrangement of his habitation. This is a point fre- 
 quently overlooked by enthusiasts, and this is the reason 
 why the well-meant efforts of certain would-be reformers 
 inevitably come to grief. Any clothing, however sound the 
 scientific basis of its design, is inevitably doomed to oblivion 
 if it renders the wearer ridiculous or even conspicuous 
 amongst his companions. Dealing with uniforms which 
 have an historical connection, it is above all things necessary 
 to remember that purely sanitary considerations can in no 
 case be allowed to take a paramount position, and this is, 
 of course, more particularly the case with those orders of 
 dress which are intended to be worn on occasions of display 
 or ceremonial, where historical associations are of such great 
 importance. As regards service uniforms, this is not so 
 much the case, but invisibility, which is so valuable in 
 preventing injury, must be looked on as being of equal 
 value with those factors which come into consideration in 
 connection with the preservation of health. I do not 
 propose to discuss here the question of uniform generally, 
 but only of those uniforms which are worn in the field. 
 
 Protection from Cold. — Clothing protects man from 
 cold partly by reason of the non-conducting nature of the 
 
 301 
 
302 MILITARY HYGIENE AND SANITATION 
 
 actual fabric, but even more importantly as a result of the 
 non-conducting nature of the air which is (1) occluded in 
 the actual substance of the material, (2) enclosed between 
 the different garments worn, and (3) which lies between the 
 innermost garments and the skin. 
 
 Materials Used. — The materials most commonly in 
 use for the manufacture of clothing are wool, silk, cotton, 
 and linen. Occasionally the actual skins of animals are 
 used, with or without the hair naturally growing on them. 
 Leather, however, is only used for the lining of special gar- 
 ments, whilst fur hardly enters into considerations in con- 
 nection with uniforms. 
 
 The various materials differ considerably in their relative 
 conductivity. Thus, taking the conductivity of air as 1, 
 that of wool would be represented by the figure 6-1, that of 
 silk by 19-2, while cotton and linen would stand at 29- 1. 
 In other words, wool conducts heat six times as rapidly as 
 dry air, silk three times and cotton and linen five times as 
 rapidly as wool. Clearly the question as to whether a 
 particular fabric will or will not conduct heat rapidly must 
 depend to a preponderating extent on the amount of air 
 in its meshes, and also on the freedom of movement per- 
 mitted to that air. These two factors are decided entirely 
 by the method of manufacture. As between different 
 garments, those which prevent free movement of air and 
 thus imprison layers of that non-conductor will be warmer 
 than others which, whether by reason of their looser texture, 
 or the way in which they are worn, permit of the free circu- 
 lation of that medium. 
 
 The amount of air occluded in any fabric depends, as 
 already stated, on their method of manufacture. It varies 
 from 50 per cent, of the total volume in close-woven clothes 
 to about 90 per cent, in the case of flannels. This capacity 
 of retaining air depends partly on the degree of compression 
 to which the material has been subjected, and partly on 
 the natural elasticity of the fibres of which it is composed. 
 Wool is the most elastic of the fibres in common use, linen 
 the least. Thus a woollen garment is warmer than one made 
 of linen on two accounts : first, because wool is naturally 
 a worse conductor than linen ; and, secondly, because, owing 
 to its elasticity, the resulting fabric is more spongy. The 
 
CLOTHING 303 
 
 power of retaining air is much affected by moisture. The 
 amount of moisture that a material can take up is dependent 
 largely on the hygroscopic nature of the fibre. Wool is 
 more than twice as hygroscopic, as linen or cotton, and when 
 a woollen garment is soaked and then wrung out a large 
 amount of moisture is retained in the actual fibre. The 
 air spaces are thus left free. In the case of the two vegetable 
 materials the water obliterates the air spaces and thus robs 
 the fabric of its chief non-conducting quality. 
 
 The air between the different layers of clothing depends 
 partly on the looseness of the fit and partly on the nature 
 of the surface. Loosely- fitting clothes permit of the free 
 movement of air, and, therefore, unless the various openings 
 —at the neck, wrists, and ankles, for instance — are closed 
 up, such garments tend to be chilly. Here again woollen 
 materials show a superiority over the smoother Hnen and 
 cotton fabrics. Fabrics which hold a great deal of water 
 in their meshes are apt, when wet, to cling to each other, 
 and also to the surface of the body. In this manner not 
 only are the air spaces in the material itself occluded, but 
 the layers of air between the different articles of clothing 
 are also abolished. 
 
 Effects of Moisture. — When any cloth is saturated 
 with moisture, the first effect is, as already stated, to increase 
 its specific conductivity as a result of the occlusion of the 
 interstitial air spaces. A secondary effect is produced by 
 evaporation. Fabrics which are composed of non-hygro- 
 scopic material permit of more rapid evaporation, and 
 therefore of more rapid cooling. This is a disadvantage 
 on all occasions except in very hot dry climates, in which 
 the non-hygroscopic material allows of the rapid evaporation 
 of perspiration, and therefore imparts a sensation of coolness. 
 In hot damp climates the sodden garment is irritating to 
 the skin, and in all cold climates the rapid evaporation in 
 dry weather and the increased conductivity in moist seasons 
 conduce to chill. 
 
 The actual clothing of the soldier consists in part of that 
 which is supplied by the State, and in part of that which he 
 himself purchases. The former includes aU articles of uni- 
 form and the requisite minimum of underclothing, and it 
 is these articles alone that I intend to consider here. Night 
 
304 MILITARY HYGIENE AND SANITATION 
 
 clothing is not supplied except to British troops in Hong- 
 Kong and some other stations. This supply is no doubt 
 highly advisable on grounds of general cleanliness, and there- 
 fore indirectly on those of health. Whether it is imperative 
 that the State should supply such articles at its own charges 
 is a matter of question. The State is bound to supply all 
 such articles as it considers absolutely necessary to effi- 
 ciency, as well as those whose pattern it rigidly prescribes. 
 It does not appear to be obvious that it should be called on 
 to furnish other articles which do not come into the category 
 of "absolutely necessary," but only into that of "highly 
 advisable." In making suggestions as to clothing of troops 
 medical officers should be careful to recognize the distinction. 
 They should also remember that the subject of clothing is 
 just as happy a hunting-ground as that of dietetics for the 
 faddist. The healthy man can observe just as wide a latitude 
 in the one as in the other, and the trade-mark of the valetu- 
 dinarian is a meticulous particularity in either. The soldier 
 is ex hypothesi, and also, in fact, a healthy male adult, and 
 it is absurd to carp at details of his clothing because they 
 do not correspond to the self-imposed dicta of fanatics. 
 
 Underclothing. — This consists of shirt, drawers, and 
 socks. The shirt is in our army a woollen shirt of medium 
 thickness, and the German winter shirt is not dissimilar. 
 The United States enlisted man is supplied with two flannel 
 shirts of very superior quality, but different thickness. 
 They are provided with turn-down collar and breast- 
 pockets, so as to give them a more " dressy " appearance 
 when the jacket is not worn. In the majority of cases, 
 however, the shirt is of cotton and extremely coarse. In 
 India men often purchase cotton shirts made from a material 
 called " twill lining." This is manufactured from the short 
 staple Indian cotton, and, owing to its somewhat rough 
 surface, is free from the ordinary objections of cotton 
 shirts. I have known medical officers object to these being 
 worn, founding their opinions on the well-known drawbacks 
 possessed by long staple cotton garments. This is a 
 mistake. As already stated, the quality of any cloth, qua 
 its powers of retaining air in the meshes of the fabric, 
 depend far more on the method of manufacture than on the 
 material of which it is made. The short staple cotton 
 
CLOTHING 306 
 
 material is considerably looser than the cotton with which 
 we are familiar in this country, and forms an excellent 
 fabric for shirts. They are much less irritating than flannel 
 shirts, unless these are of the very best material, and there- 
 fore beyond the purse of the soldier, and in seasons when 
 prickly heat is rife should always be permitted. 
 
 Socks are issued in our own, the Japanese, and the United 
 States Armies ; but on the Continent the soldier is expected 
 to buy them for himseK. The Japanese sock is heelless, and 
 made of cotton in time of peace ; woollen socks were, however, 
 issued in Manchuria. In some Services, but not all, " foot- 
 cloths " are supphed. Socks are undoubtedly good when 
 they are good, but cheap socks rarely are. There is no 
 fault to be found with our own woollen sock, except those 
 which are common to all footwear of this nature. The 
 chief defect, inherent in the article, is the fact that the 
 same part of the sock is always in contact with the same 
 part of the foot and the same part of the shoe or boot. 
 Certain areas are, therefore, always exposed to pressure 
 and friction, whilst others escape. Wear is in consequence 
 uneven, and the very best socks show breaches of con- 
 tinuity over heels and toes after not many days' continuous 
 wear. A certain amount of relief can be obtained by 
 changing a sock from one foot to another, but though this 
 delays the inevitable end, the ultimate " hole "is all the 
 larger in consequence. For the same reason the same parts 
 of the sock always tend to get sodden and hard, and react 
 on the same areas of skin. " Wearing out " can, no doubt, 
 be postponed if care be taken always to change the socks, 
 and never march two days running in the same pair. Careful 
 kneading of the hardened patches and the removal of dirt 
 after drying can also do a great deal to lengthen the life of 
 the sock ; but the ultimate end is the same : washing 
 will only hasten it. A sock which, even if carefully looked 
 after, can survive a week's continuous " marching " use, 
 or a fortnight's wear on alternate days, is undoubtedly rare. 
 The life of a sock may, in fact, be placed at sixty to seventy 
 road-miles. Even then, if skilfully darned, the sock may 
 still be a serviceable piece of footgear, as most of us know 
 from practical experience. Unfortunately, the soldier does 
 not, as a rule, shine as a mender, and the rough patch that 
 
 20 
 
306 MILITARY HYGIENE AND SANITATION 
 
 is all that the average man is able to achieve is only one 
 degree better than an actual hole. 
 
 On the other hand, a foot-cloth, if made of soft and 
 absorbent material like flannelette, has many advantages. 
 Being a mere piece of cloth about 12 inches square, it is 
 much more easily cleaned and dried than a sock. The wear 
 does not attack repeatedly the same part of the material, 
 since the cloth can be applied to the foot in four different 
 ways for each surface — ^that is, eight in all. There are no 
 crevices, and, greatest advantage of all, in comparison 
 with the cheap sock, there are no loose tags of wool left 
 over in the finishing off. The best foot-cloth is no doubt 
 worse than the best sock, but any foot-cloth at all is better 
 than a bad sock. In the case of the regular soldier at the 
 outset of a campaign there is nothing to be feared. His 
 two pairs of socks should carry him 150 to 200 miles with 
 plenty of care and a little mending. When it comes to 
 replenishing, it is as well to remember that a foot square of 
 flannel or flannelette is a very excellent substitute if fresh 
 stores of socks are not available. I am aware that my 
 opinions on this matter are somewhat at variance with 
 those of military sanitarians generally, and I hold them as 
 the result of personal experience lasting over 600 miles, 
 more or less, on the rough footpaths of the Himalayas and 
 Ladak. I am alive to the fact that ordinarily there are few 
 things more misleading than individual experience when a 
 general rule has to be formulated, but the fact that my own 
 feet are peculiarly tender inclines me to be more confident 
 in this particular instance. 
 
 Boots. — The general rule in all armies is to issue an 
 ankle-boot. The Germans and Russians still adhere to the 
 long knee-boot, which can confidently be stigmatized as 
 the worst infantry footgear in the world. A mere sight 
 of this cumbrous article is enough to remove all surprise 
 at the tremendous list of casualties which the German Army 
 showed from feet injury during the earlier days of the 
 Franco-German War. The best of all military boots is, 
 in my opinion, our own. The American boot is more 
 highly finished, and the leather of the uppers more supple ; 
 it is also, probably, very much more expensive. Having 
 used our own boot on several occasions, I can confidently 
 
CLOTHING 307 
 
 say that for the price it would be impossible to get a better 
 boot for rough walking, where appearance was no particular 
 object. The United States boot till quite lately used to be 
 too long in the ankle, and was provided with lace-hooks, 
 which are anathema. They undoubtedly facilitate lacing 
 as long as they maintain their shape, but they are apt to 
 exercise painful pressure on the ankle. 
 
 It is, of course, an axiom that the boot should be fitted 
 to the foot, and not the foot to the boot. This fitting must 
 be done partly by the bootmaker and partly by the wearer. 
 The former fitting is, of course, a question of manufacture, 
 the latter a question of " breaking-in." The former con- 
 cerns the sole of the boot, the latter the uppers. If the 
 soldier had invariably a normal foot, it would no doubt 
 be possible to build a number of boots aU possessing a 
 normal symmetry of form, and differing only in shape, 
 some one pair of which would fit absolutely some one pair 
 of feet. By having different " sizes " as regards not only 
 length, but breadth, a considerable range on either side 
 of the ideal normal can be accurately fitted. Unfortu- 
 nately, the soldier comes to us with the character of his 
 foot already warped by fifteen or more years of wearing 
 cheap ready-made boots, and it is impossible to do more 
 than fit his feet approximately, unless each man is to have 
 a last specially made and retained for him personally. As 
 regards original .manufacture, the " fitting " consists in 
 giving the man a boot the sole of which is large enough to 
 contain his foot, spread under the weight of his body, 
 with a small margin. The size and shape of this can be 
 ascertained by drawing the outline of the foot on a piece of 
 paper on which the man stands, the cardinal points only 
 being accurately noted. The " breaking-in " of the uppers 
 can only be done by softening these thoroughly with oil 
 (linseed oil or ordinary dubbing can be used for this purpose), 
 and then wearing the boot on short walks or about barracks. 
 It is sometimes recommended that the boot should be 
 thoroughly wetted and worn in that condition, being after- 
 wards packed with straw or oats, or placed on a tree till dry. 
 There is a great difference in military boots in respect of 
 the relative thickness of the heel, of the sole under the 
 instep, and again under the fore-part of the foot. The 
 
308 MILITARY HYGIENE AND SANITATION 
 
 following table shows the above measurements for the 
 more important armies in centimetres : 
 
 
 Heel. 
 
 Instep. 
 
 Front Part 
 of Foot. 
 
 Great Britain 
 
 3 
 
 1-0 
 
 1-3 
 
 Germany . . 
 
 3-5 
 
 0-3 
 
 1-0 
 
 United States (old) 
 
 3 
 
 1-2 
 
 14 
 
 United States (new) 
 
 2-7 
 
 0-7 
 
 0-7 
 
 Italy 
 
 30 
 
 0-7 
 
 1-0 
 
 Japan 
 
 25 
 
 0-5 
 
 1-0 
 
 Russia 
 
 2-0 
 
 0-5 
 
 1-0 
 
 Austria 
 
 30 
 
 0-5 
 
 1-0 
 
 France 
 
 3-0 
 
 04 
 
 1-0 
 
 The obvious objection to the thick instep of the British 
 and old United States boot is the fact that it makes them 
 unyielding when first used. On the other hand, the support 
 given, especially after fatigue has set in, is considerably 
 greater than in the thin-soled German and French boots. 
 I am strongly of opinion that it is the want of support to 
 the instep, combined with the undue raising of the heel in 
 the continental boot, that accounts for the prevalence of 
 the condition known as Fussgeschwulst in the German 
 Army, in which it seems peculiarly common. This con- 
 dition, which is, in my experience, unknown in the British 
 Army, and is not referred to by Havard, WoodhuU, or 
 Munson, as occurring in that of the United States, is, in 
 the majority of cases, due to fracture of the heads of one 
 or more of the metatarsal bones, though some cases may 
 be attributed to periostitis, the result of concussion. The 
 actual cause is, in the great majority of cases (131 out of 
 186, according to Tiedemann), overmarching. According 
 to Casarini, the injury is due to loss of muscular support 
 to the vault of the foot, the result of fatigue. Obviously, 
 this condition would be aggravated by any mechanism 
 which tilted the foot, thus bringing the weight of the body 
 more over the front of the foot, and transmitting the shock 
 directly along the axes of the metatarsals. 
 
 The boots supplied to some of the continental infantry- 
 men have large hobnails in the soles. This is a mistake. 
 
CLOTHING 309 
 
 The hobnail inevitably " draws " out of the leather, and 
 the resulting hole gives free access to moisture. 
 
 An ingenious suggestion was made in the Journal of the 
 Royal Army Medical Corps, January, 1910, by Captain 
 Bridges for the manufacture of boots with replaceable outer 
 soles and heels. As soon as the original parts begin to show 
 signs of severe wear they can be detached, and fresh heels 
 or soles fitted. In addition, heels which are apt in the case 
 of the majority of men to wear unevenly can be changed 
 from side to side. 
 
 Gaiters of some kind or another are the general rule. 
 The object of these is — partly, at least, to prevent the 
 access of small particles of grit into the boot — a very im- 
 portant function. They also support the calf to a certain 
 extent, and save the knee from the drag of the trouser, 
 which, if that garment is wet, may cause considerable 
 discomfort. We were for long alone in issuing the puttie, 
 but Japan and the States have now adopted them. 
 A gaiter is better than a puttie, if well made and fitted, 
 and as long as it is new ; but, on the other hand, putties are 
 better than cheap gaiters, which do not answer to the above 
 description, as is generally the case with those issued to 
 the rank and file. 
 
 Jacket. — ^The ordinary short jacket is universally used. 
 As a rule, it is made too tight ; the more it resembles a 
 loose blouse the better. Pockets should be large and roomy, 
 and the skirt come well down over the hips. The collar 
 is usually single, but in our army a roll collar is fitted. 
 The chief point of importance is that the collar in front should 
 not rise much above the sternal notch. If protection is 
 desired above this level, a loose neckcloth is the most suit- 
 able garment. Buttons are, in the majority of cases, con- 
 cealed behind a " fly," and this is certainly the best method. 
 The colour of this garment varies from our own khaki to 
 the German blue-grey. This, however, is almost entirely 
 a military question. The jacket is the normal fighting 
 garment, but in the French and Italian Armies the 
 greatcoat, with buttoned back -skirts, is still used. 
 In their present campaign in Tripoli the latter Service 
 have adopted the short khaki jacket. It is understood 
 that the French contemplate a similar change in the near 
 
310 MILITAEY HYGIENE AND SANITATION 
 
 future ; at present khaki is used by them for colonial service 
 only. 
 
 Trousers. — ^These are made, as a rule, to match the 
 jacket, the French still adhering — for the present, at least — 
 to the well-known red breeches In India these garments 
 are commonly cut down to the shape of "shorts," leaving 
 the knee bare. For a warm climate these are undoubtedly 
 the most rational form of nether garment, as soon as the 
 man has got his skin hardened to sunburn, and to contact 
 with thorns and stones when working in rough ground and 
 taking cover. It must be remembered that the High- 
 landers in South Africa suffered considerably from blistering 
 in the popliteal space, as the result of having to lie in the 
 prone position for hours under a fierce sun. It might be 
 possible to build the trousers in such a manner that a flap 
 could be turned down over the knee except when the man 
 was actually marching. From a physiological point of 
 view the kilt is the best method of covering the thighs on 
 the march. The large open space left free for evaporation 
 is of the utmost value in regulating the body temperature, 
 and preventing an undue rise. 
 
 Greatcoats. — The Norwegian Army is the only one 
 which entirely dispenses with a greatcoat, whilst the 
 French and Italian Services rely on this garment as a 
 general Service dress. These may be taken as representing 
 the two extremes of opinion, whilst the ordinary practice 
 of using the greatcoat as an emergency article of wear 
 for cold or wet weather only constitutes the mean. The 
 United States supply a poncho for service, but otherwise 
 the general pattern in peace is similar to the civilian great- 
 coat. Personally I do not look on the greatcoat as a 
 necessary garment in its present form. My reasons for 
 holding this opinion are given under the heading of " Equip- 
 ment," and need not be repeated here. The Norwegian 
 substitute of a thick knitted woollen " sweater " seems to 
 me much more workman-like. 
 
 He ad-Dress. — The question of a suitable head-dress 
 is one which has agitated the minds of military adminis- 
 trators since when the memory of man goeth not to the 
 contrary. The question of aesthetics comes more promi- 
 nently forward in connection with this portion of attire 
 
CLOTHING 311 
 
 than with any other, in consequence of the close proximity 
 which it naturally bears to the face. From a sanitary 
 point of view the object of any head-dress is to protect 
 the head from cold and damp, and in warm cHmates to 
 ward off the direct rays of the sun, and also to shade the 
 eyes. Protection from direct injury by sword or rifle-butt 
 is also considered in some cases, notably in the German 
 Pickelhaube and our own helmet, which is a bad imitation 
 thereof. Helmets are, however, the exception, and the 
 general pattern is that of a soft cap, with or without a peak, 
 such as the French and Italian kepi, or the Austrian feld- 
 Jcappe. The Swedes stiU adhere to the old three-cornered 
 cocked hat, whilst the American soldier wears a wide- 
 brimmed soft felt hat of the type which the South African 
 War made so familiar under the name of the " smasher " 
 hat. This last head-dress is probably the best from all 
 points of view for use in a temperate climate, since it affords 
 sufficient protection from wet, cold, and glare, without 
 being in any way objectionable in appearance. Like all 
 other portions of the equipment of the United States soldier, 
 it is of excellent quality. The question of the proper head- 
 dress for tropical campaigning is one chiefly of protection 
 from the direct rays of the sun, and of ventilation of the 
 space between the scalp and the inner surface of the hat. 
 Any such hat must be so fitted that it comes down at the 
 side to a level with the external auditory meatus, and 
 sufficiently low in front to shade the eyes without obstruct- 
 ing the vision. Behind, it must project well outwards and 
 downwards to about the level of the coat collar. The rim 
 of the hat where it rests on the head should be a false rim, 
 separated from the real rim by a definite gap of about 
 i inch. In the substance of the canopy of the hat one or 
 more ventilating apertures should be made. The head- 
 dress should be as light as possible, and cork is probably the 
 best material for this purpose. The weight of the hat 
 should be taken by cross-straps running from front to 
 back and from side to side, so as to avoid pressure on the 
 temples. If the inside is lined with cloth, which it should 
 be, this had better be yellow or red in colour. It is true 
 that the actinic theory of sunstroke is not now widely sup- 
 ported, but, still, if only on the same principle as the French 
 
312 MILITARY HYGIENE AND SANITATION 
 
 Marquise said her prayers, it appears a reasonable precaution 
 to take. The problem of a tropical head-dress is well 
 solved by the present pattern of helmet issued to the British 
 soldier abroad. This has had the best compliment — that 
 of imitation — paid to it by the Grerman Army, though the 
 authorities have " improved " on the original pattern by 
 the addition of a hinged " tailpiece," with a dependent cloth 
 flap. It would be safe to predict that a few weeks' cam- 
 paigning, especially in the rainy season, would effectually 
 " dock " these helmets of their additions. For extra- 
 ordinary heat, such as might be experienced in India during 
 the hot weather, there is undoubtedly no headgear to 
 compete with the Cawnpore Tent Club solah topi, made of 
 thick pith. The cloth cover should be artificially water- 
 proofed, or, if this is impossible, the pith itself should be 
 painted over with Aspinall's enamel, to protect it from 
 rain. 
 
CHAPTER XVIII 
 
 EQUIPMENT 
 
 By the term " equipment " we mean all those articles and 
 appliances which the soldier has to carry to enable him to 
 perform the duties of his profession in the field. The 
 nature, number, and weight of these articles will depend 
 on many factors. First to be considered is weight. The 
 soldier cannot carry more than a certain load and remain 
 at the same time a fighting man ; he degenerates into a 
 pack animal. At the same time he must carry a certain 
 amount, since, owing to the exigencies of strategy and 
 tactics, occasions will arise when the possibiHty of a certain 
 movement or manoeuvre will depend on whether the in- 
 dividual soldier can make himself self-supporting as regards 
 ammunition, food, and shelter during the time spent in 
 the execution of the proposed plan. As regards this point, 
 then, the weight of an equipment must be a compromise 
 between what the commander needs and what the man can 
 carry. In setthng the total weight, the absolute and 
 relative necessity of different articles must be taken into 
 account ; the material of which they are made will also be 
 of importance. The soldier who can carry most, or he 
 who can be content with least, will have a great advantage 
 over the less capable or the less hardy. Again, those armies 
 which, by the exercise of ingenuity, are able to devise an 
 equipment that will supply the greatest number of needs 
 at the least weight will also have an advantage over those 
 whose authorities make the least use of modern invention 
 in the application of new discoveries to the manufacture of 
 ever lighter and fighter material. From the sanitary point 
 of view the most important equipment is that of the in- 
 fantry soldier, since he alone is directly affected by the 
 weight it represents. 
 
 313 
 
314 MILITARY HYGIENE AND SANITATION 
 
 The question of the equipment of the infantry soldier, 
 as it at presents exists in the majority of European armies, 
 may be said to date from the era of the Napoleonic wars. 
 Up till that time the importance of strategical mobility was 
 not so clearly recognized, as later, under the influence of 
 Napoleon, it came to be. The kit that the soldier carried 
 appears to have been to a great extent his own business, 
 and the baggage waggons carried as much as they could to 
 supplement deficiencies. With the commencement of the 
 new era, however, it became important to make the infantry 
 soldier as far as possible independent of wheeled transport, 
 the more so that the means of communication, in the end 
 of the eighteenth and the beginning of the nineteenth 
 centuries, were certainly no better, and probably not so 
 good, as under the Roman Empire in the second and third 
 centuries of our era. At the same time, owing to the com- 
 paratively short range of ballistic weapons in the old 
 muzzle-loading days, tactical mobility — that is, rapidity 
 and ease of movement on the battlefield — ^was by no means 
 so serious a problem as it is now that the range of the rifle 
 and the gun have so enormously increased. It was possible, 
 therefore, to load the infantry soldier fairly heavily for the 
 march, without hampering him excessively when he came to 
 actual contact with his enemy on the field of battle. 
 
 The progress of later years has, however, brought a great 
 change. Communications have improved more in the last 
 hundred years than in all the previous history of mankind 
 prior to the introduction of steam and railways. Strategical 
 mobility has become largely a mechanical question. On 
 the other hand, the demand for tactical mobility has in- 
 creased enormously. The infantry soldier can no longer 
 reserve his fire till his officer has had time to settle with the 
 commander on the opposite side the dehcate question of 
 etiquette, as to who should have the honour of receiving the 
 fire of the other, much less can he advance in parade forma- 
 tion till he can see the whites of the eyes of his opponents. 
 
 Already, at 3,000 yards, he comes under effective artillery 
 fire, and at 1,400 yards under effective infantry fire. Conse- 
 quently, from within a mile and a half to a mile of the 
 position attacked all movements must be made with the 
 utmost rapidity, and from one piece of cover to the next. 
 
EQUIPMENT 315 
 
 Nor is this all. The enormous size of modern armies entails 
 extraordinary exertion on those troops which are far back 
 on the column of route, if it is intended that they shall be 
 present at the decisive moment. It may be necessary on 
 occasion to place more than one army corps on the same 
 road, so that the most distant troops will be from twenty- 
 five to thirty miles in rear of those in touch with the enemy. 
 This distance will have to be made up at the last moment 
 in one forced march, or at the best in a march and a half, 
 the troops from the rear perhaps having to go into action 
 straight from the march without having any rest. Again, 
 since the decisive battle or battles will probably take place 
 in the opening weeks, or even days, of the campaign, the 
 reservists who have been called up to fill the ranks wiU not 
 have had time to get hardened, as in the old days, by a long 
 period of route marching to the enemy's frontier. The clerk 
 or the shopman will be called, untrained and soft, from the 
 desk or counter, and thrust straight, with 50 pounds or 
 60 pounds weight on his back, to march to the sound of the 
 cannon. 
 
 The problem of equipment is obviously one the solution 
 of which cannot fail to have an important effect on the 
 conduct of the campaigns of the future. The first point 
 to be considered is the maximum weight that the ordinary 
 man can bear ; the second, the different articles which he 
 must carry in the order of their relative importance ; 
 thirdly, the weight which each of these represents ; and, 
 lastly, which of these can or must be dispensed with, to 
 enable the soldier to carry out the wishes of his commander 
 without undue physical suffering or deterioration. 
 
 Total Weight that a Man can Carry. — Every addi- 
 tional increment of weight added to the load of a marching 
 man increases the expenditure of energy per unit of distance. 
 Up to a certain limit — about 66 pounds — the increase of 
 energy expended is regular per unit increment of weight, 
 so long as the load is distributed in such a manner as not 
 markedly to interfere with equihbrium. This increase 
 equals 4-5 small Calories per pound per minute. Any 
 increase beyond 66 pounds entails a disproportionate ex- 
 penditure of energy. Thus between 66 and 88 pounds the 
 increase is about 6 Calories, and above 88 pounds 10 Calories 
 
316 MILITARY HYGIENE AND SANITATION 
 
 per pound per minute. These figures, which are taken from 
 Zuntz and Schumburg's "Physiology of the March," must 
 be taken as minimal, since want of training, fatigue, or 
 injury, such as lameness, may cause an excessive expenditure 
 of energy. In addition, if the weight be carried asym- 
 metrically, the expenditure is multiplied threefold. It must 
 be remembered that the soldier must keep his hands free for 
 fighting and his legs unencumbered for active movement, 
 while at the same time the respiratory movements of his 
 chest must be interfered with as little as possible. This 
 entails the placing of all the weight on the trunk, and the 
 greater bulk of it posteriorly — that is, more or less asym- 
 metrically in the sagittal plane. In addition, the most 
 important weight of all, and the heaviest individual weight, 
 the firearm, must be carried in one hand or on one shoulder. 
 This weapon weighs about 4 kilos (about 9 pounds) as a 
 rule, and in comparison with other weights must be held to 
 represent three times that amount. 
 
 Clearly the total load should not go beyond that which 
 fixes the limit of regular increase — that is, Q6 pounds. But 
 if we are to consider the rifle as making a threefold demand 
 on the energy of the soldier in consequence of its asym- 
 metrical position, obviously we must reduce this limit by 
 17 J pounds. This places the total weight which the soldier 
 should carry at 48 J pounds^ or, in round numbers, say 
 50 pounds. The above method of calculation is a rough one 
 only, but it tallies fairly well with the limit laid down by 
 Kirchner, and is in accordance with the observations of 
 Zuntz. This load is rather over one-third the weight of 
 the average infantry soldier. 
 
 It next remains to consider what articles the soldier 
 actually must carry, and their relative importance. The 
 following list gives the former information : 
 
 {a) Armament, including rifle, side arm, ammunition 
 and pouches, cleaning materials for rifle, and entrenching 
 tool. 
 
 (b) Personal clothing, including shirt, drawers, and 
 socks, coat, trousers, putties or gaiters and boots, neck- 
 cloth, abdominal belt, head-dress, handkerchief, identity 
 disc, and first field dressing. 
 
 (c) Food, including unexpended portion of ration last 
 
EQUIPMENT 317 
 
 issued, reserve rations and water, together with the appliances 
 for carrying or consuming these — viz., mess-tin, water- 
 bottle with cup, haversack, and cutlery. 
 
 {d) Accoutrements, including knapsack, with belt and 
 braces. 
 
 (e) Shelter, including greatcoat and shelter-tent, or 
 tente-ahri. 
 
 (/) Personal necessaries, including small book, spare linen, 
 personal cleaning materials. 
 
 I have classed the above in the order of their relative 
 importance, as that appears to me. Clearly clothing and 
 fighting tools must come first. I am not aware that, except 
 at the assault on Lungtungpen, the former has of late years 
 been dispensed with, and the importance of the latter 
 needs no explanation. The average weight of the clothing 
 worn is about 13 J pounds. This cannot be reduced. The 
 soldier has but the one suit, and it would be as dangerous 
 to lower the weight — which could only be done at the 
 expense of the thickness of the fabric — as it would be out 
 of the question to increase it by supplying thicker material. 
 The weight of the rifle, bayonet, and entrenching tool is also 
 a constant, and these total up to 12 pounds S^ ounces. The 
 British soldier carries 150 rounds of ammunition, weighing 
 9 pounds 13 J ounces. Some of the continental authorities 
 are in favour of reducing the number of rounds carried by 
 the man, and placing a greater number in the regimental 
 transport. As Major von Schreibershofen points out, the 
 number of days in which the soldier is occupied in emptying 
 his pouches with the greatest rapidity are few compared 
 with those on which he is marching with no chance of firing 
 a shot, and since a portion of his ammunition is already 
 carried for him in the regimental transport, it is merely 
 going a step farther in a direction already to a certain 
 extent taken. I do not understand that the opinion of our 
 own Staff is at aU likely to trend in this direction, and, 
 speaking as an onlooker in this respect, it seems to me that 
 this suggested reduction is merely one of those proposals 
 so common in peace-time which fade so rapidly in war, aU 
 of which aim at increasing celerity of movement at the 
 expense of striking power. 
 
 Taking the necessary clothing and fighting equipment 
 
318 MILITARY HYGIENE AND SANITATION 
 
 alone, we see that a definite and irreducible load of about 
 36 pounds must be placed on the soldier before he starts 
 on a march. 
 
 After armament and clothing the next most important 
 item in the load is food and water. These must be carried 
 in certain receptacles, and these again must be fastened 
 to the soldier's body in some manner, so that they can be 
 laid aside whenever not absolutely needed. For this purpose 
 accoutrements are necessary. 
 
 Taking water first, I explained in the section on marching 
 that the soldier should be supplied on a long march with 
 about 1 litre of water for every six miles after the completion 
 of the first seven. The rational size of a water-bottle is 
 therefore a litre, or If pints. This amount of water weighs 
 over 2 pounds, and together with the water-bottle 3 pounds 
 10 ounces. The rations carried at present are the un- 
 expended portion of the last day's ration (say 1 J pounds) 
 and the emergency ration weighing 9 J ounces. The former 
 is a nebulous quantity, but in all probability the entire 
 amount of food altogether wiU not come to more than 
 2 pounds, if as much. To this we must add the weight of 
 the mess-tin and haversack, etc. The total of food and 
 water, together with the weight of the receptacles in which 
 they are carried, will then amount to about 8 pounds. 
 
 As already stated, the soldier must be provided with 
 certain accoutrements, consisting of belt and braces, to 
 which the various weights that he has to carry may be 
 attached. These weigh in our equipment 2 pounds 
 13 ounces, the weight of the pack being for the present 
 excluded. The haversack is also indispensable and weighs, 
 with nec3ssary cutlery, 1 pound 5 ounces. 
 
 If we take the soldier, then, with merely his ordinary 
 clothes, his armament, and his food for the day, we find 
 that the weight he must carry is as follows, in round 
 figures : 
 
 (a) Armament . . . . . . . . 22^ pounds. 
 
 {b) Clothing . . . . . . ..13^,, 
 
 (c) Food, water, and necessary receptacles ..8 ,, 
 
 (d) Accoutrements . . . . . . 3 „ 
 
 forming a total of 47 pounds. It is true that, by using 
 aluminium instead of block tin or enamelled iron for the 
 
EQUIPMENT 319 
 
 mess-tin and water-bottle, we could save about IJ pounds, 
 but it is clear that even with this reduction it is impossible 
 for a man to be self-supporting for one day as a fighting 
 man unless he carries a load of at least 45 pounds. 
 
 The German and French soldiers carry less weight when 
 reduced to this absolute minimum of fighting weight, the 
 former carrying about 38 pounds and the latter 44 pounds. 
 In either case the number of rounds carried is less, since the 
 German soldier carries 30 of his 150 rounds in his knapsack, 
 which, for the present hypothetical calculation, is supposed 
 to be left behind. 
 
 Deahng with round numbers only, it may safely be said 
 that the soldier must, to make himself supporting as regards 
 food and ammunition, carry for one day's fighting at least 
 40 pounds weight. This includes no shelter for the night, 
 no warm clothing (greatcoat, jersey, etc.), and no food 
 beyond the remains of the ration issued the day before. 
 
 This leaves us with, at the outside, 10 pounds to provide 
 for the above comforts, for any extra food and ammunition, 
 and for those matters that are included under the head of 
 " personal necessaries." There is not the slightest doubt 
 in my mind that the extra food and the extra ammunition 
 should be recognized as having the first claim on this 
 margin of weight. It can be at once recognized that the 
 limit of 6 pounds already laid down as the weight of three 
 successive rations (see Chapter VIII.) errs if at all on the side 
 of liberality. 
 
 The solution of the problem lies in distinguishing between 
 the equipment that is absolutely necessary for fighting and 
 that which is merely convenient on the line of march. 
 This is to a large extent done in our new webbing equipment, 
 and that of some Native regiments in India who have 
 adopted the rucksack. The newly-sanctioned equipment 
 of the United States, however, solves the problem in the 
 most scientific and complete manner. In this, by merely 
 undoing a few straps the soldier can free himself from the 
 more cumbrous portion of his " kit," and go into action 
 with merely his weapons, ammunition, food, and water. 
 
 Such a method, of course, anticipates that the soldier 
 shall at certain times suffer considerably from exposure. 
 This fact must be faced and the hardship minimized as far 
 
320 MILITARY HYGIENE AND SANITATION 
 
 as possible by keeping him well fed at ordinary times when 
 no especial strain is inflicted on him. 
 
 The problem will present itself in its most difficult aspect 
 in the opening movements of a great campaign. The soldier 
 in the ranks is capable, on the one hand, of carrying his full 
 load on the march if desired, and on the other of bearing 
 the hardship of a few nights without shelter in the open, 
 since he starts the campaign well fed and in good training. 
 The reservist, who will almost certainly not be in good 
 training, and may possibly, in some cases at least, be not 
 too well fed, will neither be able to carry the load easily nor 
 undergo the process of " roughing " with such equanimity 
 as the serving soldier. Later, no doubt, he will acquire both 
 faculties, but the general feeling seems to be that the 
 decision will be arrived at in the first weeks, if not days, of 
 the campaigns of the future, and it may well be that he will 
 learn his lessons too late. 
 
 Method or Carrying Equipment. — The method of carry- 
 ing the equipment varies in different armies, and is regu- 
 lated by different factors. The most important, from a 
 physiological point of view, is the extent to which the new 
 load displaces the centre of gravity of the soldier's body. 
 A load should therefore be arranged primarily as far as 
 possible with regard to this aspect of the question : the 
 only consideration that claims priority being that those 
 parts of the soldier's equipment which directly concern 
 his fighting activities, should be so placed as to be readily 
 accessible when wanted. It would naturally be absurd to 
 place his ammunition in such a position as to interfere with 
 his getting ready access to it whenever needed. Again, the 
 load must be so arranged that the movements of the soldier, 
 especially those of actual fighting, whether with bullet or 
 bayonet, shall be as little hampered as possible. 
 
 Arrangement of Armament. — The rifle is, of course, 
 carried in the hand, either clear of the body as at the " trail," 
 or at the " slope " on the shoulder. In some armies, as, 
 e.g., in the Austrian, special facilities are given for slinging 
 this weapon on the shoulder, a small roll being placed on 
 the outer end of the shoulder-strap to prevent the sling 
 from sliding off. In the new French equipment this 
 arrangement is, I believe, to be imitated. This slight 
 
EQUIPMENT 321 
 
 slight addition to the coat is, in my opinion, distinctly work- 
 man-like. The bayonet is carried almost invariably on the 
 belt close to the left mid-axillary line. In the latest 
 American equipment it is placed, during the march, on the 
 left side of the combined haversack and pack, the upper 
 end of the scabbard being level with the shoulder-line. 
 In this case it can, however, though not very readily, be 
 detached from this position and hung on the belt. This 
 seems to me an unnecessary refinement. The weight of 
 the side-arm is so small that the usual " hip position " 
 appears to me free from objection. The ammunition is 
 almost always carried in pouches. The bandolier was in 
 use until lately in our own army, and still is in that of Russia. 
 This method of carrying ammunition is the worst possible, 
 from the physiological point of view. It hampers every 
 respiration, and greatly impedes evaporation from the chest. 
 Pouches are either rigid as in the Grerman, Austrian, and 
 Russian armies, or soft as in our own, and those of Norway 
 and the United States. The objection to rigid pouches is 
 that they press severely on the abdominal walls in the 
 prone posture. The German pouch, carried in front, is, 
 for instance, 3 inches in antero-posterior measurement. 
 The leather of which the pouch is made is of excellent 
 quality, but the whole apparatus is so extremely hard and 
 thick that I cannot but think that in a prolonged fire-fight, 
 as, for instance, occurred at the Modder River, when men 
 were compelled to lie for many hours on their faces, serious 
 injury to the abdominal organs might result. The Austrian 
 and Russian anterior pouches are 2 inches thick, and are 
 shaped so as to exercise less pressure. The French soldier 
 carries two leather pouches in front, made of rather thick 
 leather, and semi-rigid in construction ; they are only 1 inch 
 thick. The Norwegian pouch, of which two are carried in 
 front, is made of soft, well-dressed leather of exceptional 
 quality. It seems to me the best leather pouch in use. 
 In our own and the United States Army, webbing is used, 
 and we differ only in the arrangement. Thus, in our case 
 the pouches are arranged in two "patches" of five, two 
 above and three below, covering each hypochondriac region. 
 (These "patches" are called "carriers," and are attached 
 to the braces of the equipment, as^ well as to the belt ; they 
 
 21 
 
322 MILITARY HYGIENE AND SANITATION 
 
 assist materially in taking the weight of the pack — see p. 328). 
 In the United States' equipment the ten pouches are attached 
 directly to the belt, five on each side. They thus lie more 
 symmetrically with regard to the centre of gravity than 
 our own. The difference is slight from the physiological 
 point of view, the elevation of the weight above the horizontal 
 plane in which that centre lies being comparatively small 
 in the case of our upper pouches. The advantage, slight 
 as it is, is, however, on the side of the United States' soldier. 
 In case of extreme fatigue and consequent hepatic engorge- 
 ment, the pressure of the thirty rounds carried in the upper 
 pouches on the right side in our equipment might cause 
 distress and hamper respiratory movements. From the 
 military point of view leather is perhaps preferable to web- 
 bing, being less likely to alter its shape on account of wet. 
 The rigid pouches of the chief continental armies can be 
 defended on no other grounds. The pain that the rigid 
 pouches of the Germany Army will inevitably inflict on the 
 man who has to lie, for perhaps a long summer day, in the 
 prone position on hard ground, will amount to exquisite 
 torture, and lead inevitably to unnecessary movement and 
 exposure. The Austrian soldier carries a large pouch on 
 the centre of the belt behind. This is essentially connected 
 with his knapsack, and assists materially in relieving the 
 pressure of the braces on the axillae. The French also have 
 a posterior pouch (shortly to be abolished), and the Germans 
 have dispensed with theirs. From the physiological point 
 of view these pouches are good, as placing the weight much 
 closer to the centre of gravity than is the case in the anterior 
 pouches. The ammunition is, however, in an inaccessible 
 position. The Germans have placed the thirty rounds 
 which used to be carried in this pouch in two small pockets 
 on each outer edge of the flap of the knapsack, in this way 
 raising it above the centre of gravity, without placing it in 
 a more convenient position. 
 
 The ammunition should be carried so as to be independent 
 of all other loads, as, e.g., in the ingenious arrangement of 
 the Austrian Army, which renders it possible for the man 
 to get rid of his knapsack, and all the accessories which 
 that entails, without losing a round of single cartridge. 
 Those of the Norwegian and German infantries, which make 
 
EQUIPMENT 323 
 
 such a rearrangement extremely difficult, seem to me on 
 all grounds most un workman-like. 
 
 The entrenching tool is slung on the belt in some cases 
 (German, French), in other cases carried on the knapsack 
 or pack (Norwegian, United States). In the former case 
 the man is apt to be annoyed by the constant swinging of 
 this heavy and cumbersome implement ; in the other the 
 position of so much weight so high above the centre of gravity 
 is objectionable. On the whole it is better, I think, to 
 have a comparatively heavy weight fixed than movable, 
 even though the position may in a mechanical sense be 
 somewhat faulty. 
 
 Food and Water. — The unexpended portion of the last 
 ration issued is carried either in the haversack or the mess- 
 tin ; the reserve rations in the knapsack. The packing of 
 these leaves a good deal to be desired in most cases, the 
 United States only having adopted a really sensible method. 
 In their new equipment, the hard bread is made up into 
 " cartons," each measuring 7 J by 2 J by 2 J inches, wrapped 
 in paraffined paper. The bacon is packed in tins of approxi- 
 mately the same size, each tin containingtwo rations of bacon. 
 Another tin, the condiment tin, also of the same shape and 
 size, but with rounded edges, contains three rations of coffee, 
 salt, and sugar. In this manner packing is considerably 
 facilitated. In some Services the different items of which 
 the ration is composed are carried loose in small cotton 
 bags. Such an arrangement I cannot but look on as most 
 unsatisfactory. The reserve rations are always carried in 
 the knapsack. This arrangement makes it still more diffi- 
 cult to dispense with this weighty encumbrance, should the 
 situation demand it. The problem is not an easy one to 
 solve. If the rations are placed in the haversack, the weight 
 is asymmetrically and clumsily placed, but I think that 
 even this would be preferable to running the risk of the man 
 losing his ration on account of the packs having to be left 
 behind in a hurry. At least, as regards one ration, this 
 should be placed in the haversack . Where travelling kitchens 
 are in use, one or more reserve rations per man are carried 
 in these. The water-bottle is usually carried suspended 
 on the belt, but in the French equipment it hangs over the 
 shoulder by a diagonal strap — a b^d arrangement. In the 
 
324 MILITARY HYGIENE AND SANITATION 
 
 Austrian Army it is carried inside the haversack. The size 
 of the water-bottle varies a good deal. Our own, containing 
 1| pints (1 litre), is the largest. The shape does not as a 
 rule vary much from that of the ordinary flask, but the 
 French hidon is quite distinctive in this respect. In 
 addition to the usual opening for filling and drinking from, 
 it possesses a secondary opening, of a calibre about equal 
 to that of a quill pen, which is intended to facilitate the 
 exit of water from the main aperture by permitting the 
 free entrance of air. The material in use is in most cases 
 aluminium, but the Italians still adhere to the old-fashioned 
 wooden barrel-shaped bottle. There is a certain saving 
 in weight in using aluminium, as compared, for instance, 
 with enamelled iron, or block tin, and where, as in this case, 
 every ounce is of importance, no saving, however small, 
 can be despised. Using still our present shape of bottle, it 
 should be possible to reduce the weight by about 14 J ounces. 
 At the same time it must be remembered that the chief 
 weight in the case of the bottle is the water it contains, 
 not the metal of which it is composed, and in that direction 
 I can see no opening for reduction. 
 
 Objection is sometimes made to aluminium on the grounds 
 that these bottles cannot be used to hold cold tea. As a 
 matter of fact, in some bottles this is the case, but the blame 
 does not rest with the aluminium, but with the other metals 
 with which it is alloyed, principally iron and copper. Pure 
 aluminium, and aluminium and magnesium alloys, are not 
 affected in this way. 
 
 In some cases the water-bottle is carried attached to the 
 back of the knapsack or similar article of equipment. This 
 is the case in some Native Indian regiments. As a result a 
 weight of about 2 J pounds is suspended 8 to 10 inches behind 
 the centre of gravity. The reason for this faulty position is 
 that the bottle is out of reach, and cannot be used by the 
 man except by order. In my opinion this excuse is not 
 sufficient to cover the error in design. 
 
 In our army each man carries an individual mess-tin, 
 and this is now the general rule. In some armies there are 
 certain utensils common to several men, but carried, of course, 
 by one only of the number. This seems to me an unnecessary 
 complication, and the practice seems likely to be soon 
 
EQUIPMENT 325 
 
 universally abandoned. Individual mess-tins are usually 
 made of aluminium, and always should be so. The only 
 drawback to the use of the metal in this connection is the 
 impossibility of using any alkali for cleaning purposes, and 
 also the liability of the utensil to become indented. This 
 last defect need no longer exist in view of the numerous 
 hard aluminium alloys now procurable. The individual 
 mess-tin is usually carried on the knapsack, strapped to the 
 outside or on the top. 
 
 Shelter. — This consists in all armies, except the French, 
 Norwegian, and Italian, of the greatcoat, and in all armies 
 but our own of the shelter-tent as well. The French and 
 Italians wear a greatcoat with buttoned-back skirts at all 
 times, whilst the Norwegians issue a thick knitted jersey, 
 called an "Icelandic jacket," together with a roomy 
 canvas sleeping-bag. The Norwegians use in addition in 
 winter a short jacket, called a Vindjakke. It is made of 
 canvas, and is said to afford excellent protection against 
 cold. There is little to choose between the different great- 
 coats in use. The German coat has a small linen hood 
 attached to and folded inside the collar. This can be pulled 
 over the head under the helmet, and thus keeps the collar 
 in position to protect the back of the neck. AU the great- 
 coats that I have seen are unsatisfactory. As long as a 
 man is up and about they protect both his body and, tant 
 Men que mal, his lower limbs as well. Immediately he lies 
 down his legs are absolutely without any cover, and he 
 benefits no more from the use of this cumbersome garment 
 than if he had on merely the well-known " British warm " 
 so much used in India. It is extremely suggestive, I think, 
 that the Norwegians, who habitually manoeuvre in snowy 
 weather, have discarded the greatcoat in favour of a sleep- 
 ing-bag. The chief objection to the latter would, I imagine, 
 be on military grounds — the inevitable hampering of the 
 soldier's movements in case of a night attack. I fancy that 
 few commanding officers on the Indian frontier would care 
 to have their men's legs shackled in this manner. A stout 
 pair of overalls, such as are used for motor-cycling, or such 
 as are worn by policemen on point-duty, would hamper the 
 man's movements to the least extent, and, if combined with 
 a thick pea-jacket, would afford sufficient protection. 
 
326 MILITARY HYGIENE AND SANITATION 
 
 The shelter-tent, or tente-ahri, is carried in every army 
 except our own. It consists as a rule of a rectangular-shaped 
 piece of light canvas with hooks or buttons so arranged that 
 two or more pieces can be fastened together to form a tent 
 for a corresponding number of men. It is carried attached 
 to the knapsack, either separately or, as in the German 
 Army, rolled up with the greatcoat. In addition to the 
 cloth, a certain number of small pegs, and in some cases 
 sections of a jointed wooden pole, are also carried. In the 
 Austrian and United States Armies it is intended that the 
 rifle (with the bayonet fixed in the former case) shall per- 
 form the function of a tent-pole. This arrangement hardly 
 seems workman-like, and might cause confusion in the case 
 of an unexpected night alarm. The total weight of the 
 tent with pegs and pole is considerable, and it is doubtful 
 whether full value is received for this additional impost on 
 the soldier. Our own experience, which as regards climatic 
 exposure is greater than that of any other nation, decidedly 
 points to the shelter-tent as being a luxury. The German 
 Army did not use them in the Franco-Prussian War, in spite 
 of the fact that the climatic conditions during that campaign 
 were extraordinarily severe. On the whole, I think that 
 the tent is rather more of an incumbrance than an advantage, 
 and I find that I have the support here of General von 
 Billow, who says in his " Criticisms of the Campaign in 
 Germany, 1806 to 1808," that "the protection against the 
 weather which a linen roof affords is of less value as regards 
 the health of the soldier than plenty of good food." 
 
 Necessaries. — Under this heading come the various 
 odds and ends, such as change of shirt, etc., cleaning 
 materials, small book, and in the German Army song-book, 
 which are necessary to a certain extent to the soldier's 
 comfort, but by no means so necessary as to justify their 
 weight being placed on his shoulders. With the exception 
 of a spare pair of socks, his toothbrush, and his small book, 
 all the other articles classed as necessaries can be better 
 carried in the transport. At such periods as the army is 
 engaged in sitting still, or when the movement is one of 
 little urgency, the soldier can have the benefit of these 
 extra comforts. During the concentration before a great 
 battle, or while actual fighting is going on, he must learn to 
 
EQUIPMENT 327 
 
 go without anjrthing but the real necessaries — ammunition, 
 water, and food. These alone will lay as great a weight on 
 him as he can manage to carry, and still retain the activity 
 which his task demands. These so-called necessaries are in 
 themselves individually of little weight. The encumbrance 
 which they entail is due to their number, and the fact that 
 their presence entails that of a cumbrous receptacle — the 
 knapsack, in which they are carried. 
 
 The Knapsack. — ^This still in the generality of cases 
 retains the form of that carried in the Napoleonic wars — 
 namely, a square, flat box, consisting of a wooden framework 
 covered over with leather or canvas. This is supported 
 either on braces which are connected both in front and 
 behind to the belt, or else by leather loops which pass 
 round the axillae. The latter, the original form, persists, 
 as far as I know, only in the French Army. The great 
 drawback of this pattern is that the comparative shortness 
 of the leather strap forming the loop entails danger of con- 
 striction of the large vessels and nerves of the axilla, with 
 consequent oedema of the hand, and occasionally temporary 
 paralysis of the muscles of the arm. It is on this account 
 that it was condemned in our army about forty years ago. 
 In the German pattern the knapsack is fastened by its 
 upper edge to the shoulder-brace, while its lower edge is 
 connected to a guy-strap, which leaves the brace about the 
 level of the nipples. With a fairly deep knapsack all danger 
 of the constriction complained of above is avoided, and in 
 the Austrian knapsack this is minimized to an even greater 
 extent by leading the guy-strap to the lower edge of the 
 posterior ammunition pouch, which is itself an adjunct of 
 the knapsack. At the same time this guy-strap, by throw- 
 ing a portion of the weight on to the brace in front of the 
 shoulder, reduces the backward drag of the knapsack, which 
 would be much greater if it depended on the back of the 
 brace only. In the Swedish Army a supplementary support 
 is furnished by a strap attached to the middle of the upper 
 part of the knapsack. The free end of this can be grasped 
 in either hand, and by pulling on it the man is able materially 
 to relieve his shoulders : an excellent device. 
 
 In the Norwegian Army a rypersack, or rucksack, is used 
 instead of a knapsack. This sack, which is triangular in 
 
328 MILITARY HYGIENE AND SANITATION 
 
 plan, is supported on a wooden framework (meis) which fits 
 to the back. The weight comes much lower down on to 
 the loins than is the case with the knapsack, and the inter- 
 vention of the framework prevents the pack from coming 
 into close contact with the back, and thus obstructing the 
 evaporation of moisture. Physiologically this rucksack 
 has the advantage of bringing the weight closer to the centre 
 of gravity, as well as of causing less interference with tem- 
 perature regulation. In some Indian regiments (Gurkha 
 more especially) a rucksack is used without a framework, 
 and is highly approved by the men of these units. In this 
 case the rucksack can be thrown off with the greatest ease 
 if no longer required, but in the Norwegian equipment the 
 lower part of the sack is connected to the belt in such a 
 manner as to prevent this. Where the sack is simply sus- 
 pended from the shoulders it is very apt to jump about at 
 " the double." For hill- work, however, it is thought very 
 highly of, and, indeed, is the natural method of carrying 
 a load practised by the Tyrolean and Alpine guides. 
 
 In the new webbing equipment which is in process of being 
 issued to our Army the knapsack is replaced by a square 
 canvas sack, which differs from the knapsack chiefly in not 
 possessing any rigid framework. This is attached to the 
 general framework of the equipment in two ways. At the 
 upper corners of the pack are two suspension-tabs, which 
 pass through sliding buckles on the braces behind the 
 shoulders. From each lower corner a narrow supporting 
 strap passes forward, to be attached by a buckle to a narrow 
 " end- piece " connected with the posterior lower corner of 
 the cartridge-carrier of the same side (see p. 322). 
 
 The essential point to remember is that the weight of the 
 pack is, in the first instance at any rate, carried by the 
 narrow end-pieces attached to the carriers, and not by the 
 suspension-tabs at the top of the pack. The function of 
 these latter is to keep the pack from falling away from 
 the body. After a short time the weight of the pack 
 slightly stretches the narrow end-straps of the carriers, the 
 weight then becoming partly transferred to the suspension- 
 tabs. If the whole or even the greater portion of the 
 weight be allowed to be transferred to the suspension-tabs, 
 the essential merit of the design is sacrificed. 
 
EQUIPMENT 329 
 
 The pack is easily removed from the rest of the equip- 
 ment without removing the latter or undoing any essential 
 portion of it. 
 
 The new equipment just sanctioned for the United States 
 is a complete departure from anything previously used. 
 The knapsack is replaced by a pack, which is supported on 
 the braces at the back. When the shelter-tent, blanket, 
 and poncho are not carried, this carrier or haversack forms 
 an oblong pack lying along the spine from the level of the 
 shoulders to that of the upper edge of the belt. Its con- 
 tents are the reserve rations and mess-tin, with knife, etc., 
 these latter being placed in a flap-pocket that closes the 
 upper end of the carrier. When the tent, blanket, and 
 poncho have to be carried by the man, they are rolled up 
 in the shape of a thick sausage, which is fastened into the 
 lower end of the above carrier. The whole now forms a long 
 pack extending from the shoulders to the gluteal fold. The 
 tent, poncho, and blanket can be readily detached from the 
 rest of the equipment. It is intended that the man shall 
 detach these articles immediately before becoming engaged, 
 the only weight remaining being then his food and water, 
 feeding-utensils, and armament. The entrenching tool lies 
 vertically on the back of the pack. It must be admitted 
 that this form of pack is the most satisfactory from the 
 physiological point of view that has as yet been invented. 
 The disturbance of the centre of gravity is minimal, and 
 the area of skin occluded from evaporation by the pressure 
 of the pack also made as small as possible. This is true, 
 however, only of the fighting reduced pack. The full 
 equipment, with poncho, blanket, and tent, has at first 
 sight a cumbersome appearance. This may in part be due 
 to its novelty, and experience obtained by actually carrying 
 the load would be necessary before pronouncing finally on 
 this point. Undoubtedly very careful packing would be 
 needed. An early start from a wet bivouac would render 
 this a matter of considerable difficulty. 
 
 The Russians do not as a rule carry a knapsack, their 
 effects being placed in a large and cumbersome haversack 
 slung diagonally across one shoulder. This practice, which 
 has nothing to recommend it, was till lately the rule in the 
 United States. In the Guard, however, a long black canvas 
 
330 MILITARY HYGIENE AND SANITATION 
 
 pack is issued, resembling somewhat in shape the new pack 
 of the United States soldier. It does not possess any frame- 
 work, and its position is physiologically better than that of 
 the usual continental knapsack. 
 
 Necessity of the Knapsack. — ^Napoleon laid down the knap- 
 sack as one of the five indispensable articles from which the 
 soldier should never be separated, the other four being his 
 musket, ammunition, rations for four days, and entrenching 
 tool. In the face of such authority it seems somewhat rash 
 to question the absolute necessity of this article of equip- 
 ment. The great drawback to the knapsack is the fact that 
 it must be carried on the back, and, since the weight must 
 be supported on the shoulders, high up on the back. The 
 disturbance of the centre of gravity caused by the knapsack 
 is greater than that due to any other portion of the equip- 
 ment, partly on account of its absolute weight, and partly 
 on account of its distance horizontally and vertically from 
 the centre of gravity. The raison d'etre of the knapsack is 
 the necessaries, and, if these could be dispensed with, the 
 knapsack could either be done away with or replaced by 
 some such smaller article as, for instance, the fighting-pack 
 of the American soldier. There is not space to discuss 
 what the shape and size of such a pack should be, though 
 the United States equipment gives a very valuable indica- 
 tion. It must be carried at the back, and supported on the 
 braces ; it must be as little conspicuous as possible, so as 
 not to attract fire ; and it must cover as small an area of 
 the back as possible, so as not to interfere with evaporation 
 of the sweat to a greater extent than inevitable. 
 
CHAPTER XIX 
 
 PREVENTION OF INFECTIOUS DISEASES 
 
 An infectious disease is a disease due to a micro-organism 
 which is capable of being transferred from an infected to a 
 non-infected man, directly or indirectly, every fresh case 
 of such disease being traceable, directly or indirectly, to a 
 previous case of the same disease. 
 
 In every infectious disease, then, we have to consider 
 three individuals or entities — namely, the infected man, the 
 disease germ, and the non-infected man. These three form 
 a chain, continuity of which is necessary for the occurrence 
 of any fresh case of the disease, whereas prevention consists 
 in severing that continuity. 
 
 The chain is continuous when the germ is able to pass 
 from the infected to the non-infected man, and prevention, 
 therefore, consists in preventing that passage. We have, 
 therefor^, to consider in the case of any infectious disease, 
 the method in which the germ leaves the infected man, the 
 means of transit by which it passes from him to the non- 
 infected man, and, lastly, the method by which it obtains 
 access to the body of the non-infected man. The above 
 general principles are true of all infectious diseases whatso- 
 ever, and therefore the prevention of all such diseases must 
 consist of action along similar, if not identical, lines. More- 
 over, since in a great many cases different disease germs do, 
 as a matter of fact, use the same means of exit from and 
 entry to the bodies of the two men concerned, prevention in 
 these will be on identical lines. I will return to this point 
 later. 
 
 Before going into these points it will be advisable to 
 discuss the characteristics of the three different links in 
 the chain of causation. 
 
 331 
 
332 MILITARY HYGIENE AND SANITATION 
 
 The Infected Man. — -This individual, the first link in 
 the chain, may be defined as " a man who harbours in his 
 body, and continuously or at intervals sets free, the germ 
 of an infectious disease." It is to be noted in the first place 
 that the "infected man " need not be a " diseased man," 
 using that word in the ordinary sense. He need not, that is, 
 show any visible signs of the disease, and, moreover, he need 
 not necessarily ever have shown such signs, or even ever 
 have suffered from, or had, the illness himself. Under the 
 term " infected man," then, we include not only the man 
 in hospital or under treatment from the disease, but a large 
 number of other men. 
 
 We may, however, divide all men answering to the defini- 
 tion given above into five classes as follows : 
 
 1. Men actually under treatment for, and recognized as 
 suffering from, the disease. 
 
 2. Men who are suffering from the disease in a purely 
 technical sense, the symptoms being so trivial that they 
 pass unnoticed, and the presence of the disease is not recog- 
 nized. These are commonly called " ambulatory " cases. 
 
 3. Men who, having had the disease, either in its recog- 
 nized form, as in 1, or unrecognized, as in 2, continue for 
 an indefinite period to harbour and set free the disease 
 germs continuously or at intervals. 
 
 4. Men who, having never themselves suffered from the 
 disease, have been in contact with men of any of the above 
 classes, either as attendants or commensals, and, as a conse- 
 quence, harbour and discharge the disease germs continu- 
 ously or at intervals. The term " carrier " is usually 
 applied to members of this and the previous class. 
 
 5. Men who are in the early stages of a typical attack 
 before definite symptoms have developed, and in whom the 
 disease is therefore not yet recognised. Ordinarily the 
 period during which these men remain in this class is short, 
 as they quickly develop into members of Class 1. It is 
 recognized now, however, that men may harbour disease 
 germs for periods much longer than those which are usually 
 laid down as the " days of incubation," and as a result of 
 some accidental lowering of their resisting powers, or some 
 sudden access of virulence on the part of the germ, develop 
 the disease. 
 
PREVENTION OF INFECTIOUS DISEASES 333 
 
 The above classification is of importance from the point 
 of view of prevention, since the members of the different 
 classes differ considerably in the amount of danger which 
 they represent. Obviously the danger from members of 
 Class 1 is, or should be, very small, because it is known, 
 and can be met. The same applies to members of Class 3, 
 who have originally belonged to Class 1, and to members 
 of Class 4, who have been in attendance on, or in close 
 contact with, members of Class 1. Men who belong to 
 Class 5 in the majority of cases rapidly develop typical 
 symptoms, and the danger is thus limited in point of time. 
 Obviously the most dangerous of all are the men who belong 
 to Class 2, the ambulatory cases, or those " carriers " who 
 have developed from being originally ambulatory cases, 
 or, as a result of having been in close contact with them. 
 
 In the Service this is more true than in civil life, since our 
 system of personal records enables us to keep track of all 
 men who have suffered typically from, or been in close 
 contact with, typical cases of any infectious disease, whilst 
 our administrative powers enable us to control their move- 
 ments. The danger in our case should therefore be only 
 from the developing case and the ambulatory case. 
 
 One of the first steps, then, in scientific prevention of 
 disease is early recognition of these cases, and in this respect 
 a great deal of help may be anticipated from improved 
 laboratory methods, especially in time of peace. I should 
 like to point out, however, that it is not entirely a question 
 of test-tubes and microscopes, useful as these undoubtedly 
 are as aids to the solution of the problem. A very great 
 deal will depend, more especially during war, on the personal 
 equation of the medical officer in charge of the unit concerned, 
 and the amount of confidence he is able to inspire in the 
 men who come sick, and even more importantly into those 
 who never come sick if they can help it. 
 
 The personal equation of the soldier is also important, 
 especially on active service. A good-hearted man will 
 bear up against an attack to which his less resolute comrade 
 may succumb . He may complain of ' ' being a bit off colour, 
 to use a familiar and convenient expression, or may com- 
 plain only of slight diarrhoea or headache. The problem 
 of deahng with such men is one of the most difficult which 
 
334 MILITARY HYGIENE AND SANITATION 
 
 the young medical officer will be called on to face. Too 
 stringent rules will defeat their own object, and merely 
 encourage the faint-hearted and malingerer. At the same 
 time they will deter the good man from seeking that assist- 
 ance which might, by tackling the comparatively trivial 
 complaint that affords the micro-organism of serious disease 
 its loophole, ward off an attack. 
 
 The object of sanitation in the army is to keep the ranks 
 full, and that work cannot be done in the laboratory only, 
 working with test-tubes and microscopes ; it can be done 
 by keeping in touch with the man in the ranks, and no 
 appliance, mechanical or scientific, can replace that touch. 
 
 In peace-time there are two men in particular that the 
 medical officer should keep his eye on. These are the 
 aspiring young non-commissioned officer, and the regimental 
 athlete. I remember more than one fatal case of enteric 
 fever where the patient was a young lance-corporal or 
 lance-sergeant, who kept away from treatment till too late, 
 on account of that extra stripe he was so afraid to lose. 
 On the other hand, the first case in one of the worst epidemics 
 I was concerned with occurred in the champion football 
 forward of his battalion, who died late in the third week of 
 an attack. The actual cause of his reporting sick was a 
 severe contusion in the buttock, which became gangrenous, 
 the result of a kick received in a match played when the 
 disease must have reached its tenth day or thereabouts. 
 
 Second to be considered of the three links of the chain 
 concerned in the spread of a disease is the disease germ. 
 This, as I have said in the opening definition, must have 
 the power of passing from the infected to the healthy man 
 directly or indirectly. It passes directly when it does not 
 utilize the agency of an intermediate host, indirectly when 
 it is carried by such a host — e.g., the mosquito in malaria, 
 or the glossina in sleeping sickness. The direct passage 
 postulates one condition, and that is that the germ shall 
 be able to maintain its existence during the period through- 
 out which that passage lasts. It is of importance, then, to 
 ascertain for how long the disease germ can retain its 
 vitality and virulence outside the human body. The amount 
 of experimental work which has been done on this point is 
 enormous, and it is hardly an exaggeration to say that the 
 
PREVENTION OF INFECTIOUS DISEASES 335 
 
 results have been almost as varied as the researchers. 
 Certainly so far no absolute facts have been arrived at. 
 It is impossible, for instance, for us to state definitely that 
 any particular germ can certainly live so many days and 
 can certainly not live so many more days, outside the human 
 body. At the same time the balance of evidence appears 
 to me to go to prove that the period is short ; in other words, 
 that the natural habitat of a human disease germ is the 
 human body, and that the duration of its Hfe outside the 
 body depends largely on the extent to which the conditions 
 to which it is normally accustomed inside the body are 
 there reproduced. As a basis for practical sanitation, I 
 feel justified in holding : (1) That when infective material 
 leaves the body of an infected man it is dangerous, (2) that 
 the danger is greatest at the moment at which it leaves the 
 body, and (3) that it gradually diminishes as time elapses. 
 Obviously, therefore, dealing with any potentially infectious 
 material which we cannot destroy, the first thing to be done 
 is to remove it as far as possible from the neighbourhood of 
 the healthy man, or, if this is impossible, so to hide or cover 
 it up that the egress of germs shaU be mechanically pre- 
 vented. The immediate danger is thereby guarded against, 
 and we have time to think about how we shall deal with 
 the more remote. It is on these grounds that I consider 
 that the immediate removal of waste matters is so much 
 more important than their ultimate disposal, and the 
 immediate burial of excreta the keystone of camp sanita- 
 tion. Taking the last case as an illustration, I am quite 
 prepared to admit that where infective stools have been 
 buried in a shallow latrine trench, it is possible that the 
 specific germ may be brought to the surface at some later 
 date, in a worm casting or by other such means. Person- 
 ally, I think such danger is remote, but I would be the last 
 to deny its possibility. The real danger, however, is present 
 in the interval that elapses between the time that the germ 
 leaves the body and the moment at which it is covered over 
 with dry earth. The germ is never more virulent than it 
 is at that moment, and the purely mechanical obstruction 
 of the earth covering is sufficient to guard against the danger 
 when it is at its greatest. It may be necessarj^ to take more 
 active steps later, as by burning litter on the surface of 
 
336 MILITARY HYGIENE AND SANITATION 
 
 the covered-in trench, etc., but it would be a fatal error 
 to neglect the immediate covering-up with earth, because 
 the more stringent measure was going to be carried out some 
 hours afterwards. 
 
 Closely connected with the vitality of the disease germ 
 outside the body is the question of its immutability. The 
 generally accepted theory at the present moment is that a 
 disease germ is a specific entity, and retains its specific 
 pathogenic properties as long as it retains its vitality. 
 Every fresh case of an infectious disease can, on this theory, 
 be traceable back to a previous case of the same disease. 
 To put a concrete case, if A suffers from enteric fever, 
 he does so because he has ingested a sufficient number of 
 enteric germs, which, in the last instance, came from B, 
 suffering also from enteric fever, the descent of the germs 
 which infected A being in an unbroken line from those 
 which infected B. This is undoubtedly the accepted 
 and orthodox view at the present day, but a certain number 
 of bacteriologists have always held that the theory was not 
 absolutely proven, and that disease germs could lose, and, 
 again, in the process of generations, reacquire, their patho- 
 genic properties. To return to the concrete case above, 
 according to this view it would be quite possible that the 
 bacilli which infected A were descended from certain 
 harmless members of the same group, probably the Bacillus 
 coli, which, again, might, or might not, be descendants 
 of the virulent enteric bacilli, which originally infected B. 
 My own working hypothesis is as follows : We know 
 that the B. typhosus, if grown on suitable artificial media 
 outside the body, may lose some of its typical cultural 
 reactions, in particular that of the power of fermenting 
 certain sugars. The work of Horrocks has also shown that 
 by passage through experimental animals it may develop 
 into an organism bearing little, if any, resemblance, morpho- 
 logical, cultural, or otherwise to the original stock. We 
 also know that disease germs, if grown for a prolonged 
 period on certain artificial media, do lose their virulence, 
 which they can again acquire by passage through selected 
 animals. There is, however, no evidence, as far as I know, 
 that any germ which has so degenerated can recover its 
 virulence so long as it is grown on artificial media only. 
 
PREVENTION OF INFECTIOUS DISEASES 337 
 
 I accept, therefore, the possibihty that the B. typhosus 
 which leaves the body of B, can, during its hfe in the 
 earth of a latrine trench, develop either into a typical 
 B. coli, or into some organism so closely resembling the latter 
 that the distinction is beyond the powers of any but an 
 expert. I do not beheve that so long as this degenerated 
 B. typhosus remains in the soil it can recover its pathogenic 
 properties, though possibly by repeated passage through 
 human bodies it might, in process of time, do so. In any 
 case, it is fairly certain that the longer the period during 
 which it has been buried, the longer the process necessary 
 for the recovery of its virulence. 
 
 If, as up till lately was the common belief, the only 
 dangerous person was the patient suffering from a typical 
 attack of the disease, and if his dejecta only, as, for instance, 
 in the case of enteric fever, were to be considered dangerous, 
 then undoubtedly the possibility that the common B. coli 
 communis from a perfectly healthy man's intestine might 
 develop suddenly, and assume specific pathogenic properties, 
 would be decidedly disturbing. But we know now that the 
 typical case, and even the carrier which develops from the 
 typical case, are the least dangerous of all. The men we 
 have to protect ourselves against are the concealed carrier, 
 the ambulatory case, and the unrecognized and unrecog- 
 nizable contact, and all evidence now goes to prove that 
 in epidemic periods the number of these is enormous. In 
 practice, therefore, we have to protect ourselves, not against 
 fouling of our food and water with the excreta of the known 
 cases of disease, but with those of the unknown ambulatory 
 case and the unrecognized contact — in brief, all excreta. 
 
 In practice, especially as regards this particular disease, 
 the distinction is not of enormous importance. If water 
 has, to my certain knowledge, been recently polluted by 
 human excreta, or if I have good bacteriological and chemical 
 evidence that this has probably occurred, no amount of 
 negative evidence pointing out the absence of enteric 
 bacilli in that water would lead me to accept it as pure. 
 On the other hand, if the pollution is demonstrably old, 
 and slight in amount, experience shows that the water can 
 be consumed with impunity, whether because all the specific 
 germs have died out, or so far lost their specific characters 
 
 22 
 
338 MILITARY HYGIENE AND SANITATION 
 
 as to have become harmless, except, perhaps, to very 
 exceptionally susceptible people, under very exceptional 
 circumstances. It would be unwise for the practical sani- 
 tarian to take up too uncompromising an attitude on this 
 subject of variability. It is distinctly one for expert 
 bacteriologists to settle. Whichever theory is correct, there 
 is no doubt in my mind that the really dangerous moment 
 is that at which the disease germ leaves the body of the 
 infected man, and that therefore our attack on the germ 
 must be made then. 
 
 As regards the third link in the chain — ^the non-infected 
 man — there is little to be said. I should like to emphasize 
 one point, however. In the same way as it is necessary to 
 distinguish between the " infected " man and the "diseased " 
 man, so it is necessary to discriminate between the " non- 
 infected " man and the "healthy " man. Theoretically, a 
 *' healthy " man should be impervious to the attacks of 
 disease germs, and though this may appear to be, and 
 probably is, an impossible ideal, still there is no doubt that 
 the nearer a man approaches to the condition of perfect 
 health the less liable will he individually be to suffer from 
 the attacks of infectious disease. The first step in the pre- 
 vention of infectious disease is, therefore, the maintenance 
 of health — a point to which I have already sufficiently 
 referred. 
 
 The innate powers of resistance possessed by the healthy 
 man may be artificially increased by what is generally 
 termed " vaccination." This process is, of course, best 
 known in connection with smallpox ; but of late years it 
 has been extended to other diseases, most notably, as regards 
 the army, in connection with enteric fever. In this process 
 a killed culture of the B. typhosus is injected into the 
 body of the susceptible individual, with the aim, and also 
 with the undoubted result, of raising his powers of resistance 
 to the micro-organism in question. 
 
 I do not intend here to go into the question of immunity, 
 or discuss the theories on which the above method of arti- 
 ficially increasing that property is founded. As a practical 
 measure, I consider antityphoid inoculation one of the 
 greatest advances made of late years with regard to the 
 prevention of that particular disease. It is necessary, how- 
 
PREVENTION OF INFECTIOUS DISEASES 339 
 
 ever, to point out that it is only with regard to that par- 
 ticular disease, and no other. Inoculation can, therefore, 
 be looked on merely as an adjunct to any general system of 
 disease prevention, and not in smy way as a substitute for 
 those more widely-reaching measures which strike at the 
 general causes of disease. This caution is necessary, since 
 both administrations and individuals are apt to be fascinated 
 by what appears to them a royal road to the prevention of 
 disease, and neglect the more laborious and commonplace 
 drudgery, without which no true sanitation can be effected. 
 Scientific sanitation should aim at defending the individual 
 as a unit of the community, not at defending the com- 
 munity by protecting each individual unit of which it is 
 composed. We should therefore aim at preventing in- 
 fectious disease by destroying disease germs outside the 
 body, using inoculation only to protect us against those 
 which may escape our efforts. 
 
 The prevention of disease, then, consists in preventing the 
 passage of the micro-organism from the infected to the non- 
 infected man. This we may do at one of three points on 
 that passage — namely, (1) at the time when it leaves the 
 infected man, (2) immediately before it enters the non- 
 infected man, or (3) at some intermediate point. We have, 
 therefore, in the case of any particular disease, to consider 
 (1) how the micro-organism leaves the infected man, (2) how 
 it enters the non-infected man, and (3) the media in which 
 it lives during, or by means of which it effects, its passage 
 from the one individual to the other. 
 
 Disease germs leave the body of the infected man in one 
 of four ways — ^namely, (1) by means of the excreta (that is, 
 the urine or faeces) ; (2) by means of the sputum ; (3) by 
 means of particles of infected skin ; or (4) by means of the 
 blood, through the agency of a blood-sucking insect. 
 
 Disease germs enter the boay of the non-infected man 
 also in one of four ways — namely, fl) by means of some 
 article of food or drink ; (2) by inhalation ; (3) by actual 
 contact of infective material with the unbroken, or more 
 frequently the broken, skin ; or (4) by means of the bite of 
 a blood-sucking insect. 
 
 It will be seen that there is a certain analogy between the 
 different methods by which the germs leave and enter the 
 
340 MILITARY HYGIENE AND SANITATION 
 
 body respectively, and this analogy is maintained in actual 
 fact. Thus, germs which leave the infected body in the 
 excreta usually effect an entry into the non-infected body 
 by means of some article of food or drink. Those which 
 are ejected in the sputum enter by inhalation, and those 
 which are withdrawn from the body in the blood abstracted 
 by some blood-sucking insect enter the non-infected man 
 through the bite of the same insect. It is to be noted, how- 
 ever, that, except in this last case, the germ, after it has 
 left the body, may pass the interval that elapses before it 
 enters another body in any substance whatsoever — that is, 
 in the earth, air, water, clothing, or in any form of foodstuff. 
 I have already discussed the length of time that it can exist 
 in such situations, and stated that I consider that it is in all 
 probability short. Nevertheless, however short it may be, 
 the enormous number of substances that can afford the germ 
 shelter makes it almost impossible to direct our attack 
 against it with any certainty during this period. We are 
 in practice, therefore, driven to concentrate our attention 
 on the moments at which the micro-organism actually either 
 leaves or enters the body. 
 
 Here, indeed, the problem is simpler. Every disease 
 germ has its own particular method of departure and entry, 
 and in the case of any particular disease we can, therefore, 
 concentrate our attention on (Certain definite points. Thus, 
 for instance, tubercle bacilli leave the body in the enormous 
 majority of cases by the expectoration, and enter the body 
 by inhalation. Enteric bacilli leave in the urine or faeces 
 and enter by means of some article of food or drink. It is 
 worth noting, moreover, that in any particular case the 
 vehicles in which the germ leaves the body are less numerous 
 than those through which it obtains an entry. Enteric 
 germs can enter the body in or on any one of the numerous 
 articles of food or drink that a man consumes in the course 
 of the day ; they can only leave in the faeces or the urine 
 (I am not talking here of exceptional cases). Tubercle 
 bacilli effect their exit at longer or shorter intervals in the 
 sputa ; they may contrive an entry in any one of the fifteen 
 inspirations that a man makes every minute of his life. In 
 addition, the infected men are few in number compared 
 with the non-infected. It follows, therefore, that we shall 
 
PREVENTION OF INFECTIOUS DISEASES 341 
 
 find it an easier matter to attack the micro-organism at 
 that point in its career when it is just leaving the infected 
 man than to try and intercept it just before it achieves its 
 entry into the non-infected man. In addition, it is at this 
 moment that we are justified in assuming that it retains, in 
 the greatest sense unaltered, its specific virulence. 
 
 DeaHng, as in the army on service we so largely have to 
 do, with the so-called intestinal diseases — enteric fever, 
 dysentery, and cholera — it foUows that we must concen- 
 trate our attention primarily and chiefly on the disposal of 
 excreta, which I have no hesitation in repeating, even ad 
 nauseam of my readers, forms the keystone of all sanitation 
 in war. 
 
 Passing from the general question, I propose now to 
 discuss those infectious diseases which are of primary im- 
 portance in military sanitation. 
 
 Enteric Fever. — Of these, the most important at the 
 present day is undoubtedly enteric fever. In peace-time 
 this disease is of rare occurrence in the army at home. 
 The average admission-rate per 1,000 in the quinquennium 
 1905-1909 was 0-6, representing a total number of only 347 
 cases in the five years. In the Mediterranean stations it is 
 comparatively rare, and, in fact, we may say that it is only 
 in India and South Africa that it assumes important pro- 
 portions. The large size of the garrison in the former 
 station renders it of paramount importance, and in the 
 following discussion I shall practically limit my refer- 
 ences to the disease as we have to deal with it in that 
 country. 
 
 At the outset I should like to touch shortly on the history 
 of enteric fever in India, since a consideration of the disease 
 from a purely epidemiological point of view throws con- 
 siderable light on its causation. In conducting any investi- 
 gation into the history of enteric fever we are, however, at 
 once confronted by the difficulty of nomenclature. The 
 statistics which are at our disposal go back to 1860, but, un- 
 fortunately, the expression " enteric fever," as used by army 
 medical officers in the sixties, seventies, and eighties of last 
 century, does not bear by any means the same significance 
 as it does at the present day in the mouths of their successors. 
 There is not the slightest doubt that many cases which are 
 
342 MILITARY HYGIENE AND SANITATION 
 
 now returned as enteric fever would, on account of the 
 obscurity of the cHnical symptoms, have in that earher 
 period which I have referred to been returned as remittent 
 fever, ague, febricula, or simple continued fever. A few 
 cases, possibly, in which the febrile symptoms were less 
 prominent than those referable to the intestinal system, 
 especially those in which haemorrhage occurred at an early 
 stage, may have been shown as dysentery. These, however, 
 were not probably many in number. 
 
 If we take the period between 1860 and the present day, 
 and class together all febrile diseases (excluding the exan- 
 themata, which, fortunately, have always been rare), we 
 shall be certain of including practically all the cases of true 
 enteric fever in the numbers furnished. In the appended 
 chart, I have constructed a curve (adapted from one 
 originally drawn out for the Army Medical Department 
 Report of 1906) showing the admissions per 1,000 of strength, 
 and the deaths per cent, of cases treated, for this combined 
 class of " all fevers " from 1860 onwards. It will be noticed 
 at once that between 1860 and 1885 the death-rate per cent. 
 of cases treated remained fairly steady between 0-5 and 9, 
 never reaching as high as 1. After 1879, the year of the 
 Afghan War, the admission-rate fell steadily, but, on the 
 other hand, the case mortality showed a persistent rise, cul- 
 minating at the end of last century. Since then there has 
 been a fall, at first slow and not regular, but latterly rapid 
 and continuous. It will be noted that whereas between 
 1860 and 1885 the case mortality never attained to 1 per 
 cent., between 1886 and 1907 it never fell below that figure. 
 During the latter period this ratio was on three occasions 
 higher than 2 and on thirteen as much as 1-5 or higher. 
 In 1908 the death-rate for " all fevers " was 0-9 — a higher 
 figure than was ever noted prior to 1886, whilst in 1909 it 
 was still as high as 0-7, pointing to a mortality higher than 
 that noted in seventeen out of the twenty-six years between 
 1860 and 1885. In 1910, for the first time since 1876, the 
 " fever " death-rate for our troops in India fell to below 
 0-5. The contrast shown on the table below between the 
 admission and death rates for the years corresponding to 
 the Afghan War (1879-1880), and those for 1897 and 1898, 
 the years of the Tirah Expedition, and the concentration 
 
1000 
 
 900 
 
 4-5 
 
 
 4-4 
 
 
 4-3 
 
 
 4-2 
 
 
 4-1 
 
 800 
 
 4-0 
 
 
 3-9 
 
 
 3-8 
 
 
 3-7 
 
 
 3-6 
 
 700 
 
 3-5 
 
 
 3-4 
 
 
 3-3 
 
 
 3-2 
 
 .600 
 O 
 O 
 O 
 
 cc 
 
 LU 
 0. 
 CO 500 
 
 2 
 O 
 
 Q400 
 
 H31 
 O 2-9 
 
 q:2-8 
 
 ^2-6 
 H2-5 
 
 H2.3 
 §2.2 
 2 2-1 
 III 2-0 
 
 CO 1-9 
 
 1-8 
 
 1-7 
 
 
 
 1-6 
 
 300 
 
 1-5 
 
 
 1-4 
 
 
 i-3 
 
 
 1-2 
 
 
 11 
 
 200 
 
 10 
 
 
 0-9 
 
 
 0-8 
 
 
 0-7 
 
 
 0-6 
 
 100 
 
 0-5 
 
 
 0-4 
 
 
 0-3 
 
 
 0-2 
 
 
 01 
 
 
 
 
 
 , , — 1 — — 
 
 1 
 
 
 i 
 
 
 \\ 
 
 ! \ 
 
 
 \\ 
 
 J~\ 
 
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 T " 
 
 1 I 
 
 -\z zji J i " 
 
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 ^^ ri^ t i^- 
 
 
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 I r r^i r 
 
 4 L VJ L 
 
 -t ^ ir- 
 
 \ 
 
 ^ ^ 1^+1 
 
 r 4 si^3n± 
 
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 ^3--;. S 
 
 ^T r 
 
 v 
 
 
 
 
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 1 
 
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 I 
 
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 ^^ v'^iT^ S 
 
 5 t ^^'^^^^^ 1 La , 
 
 \,'- "^ ^ ^ — ^^7 V^y 
 
 ts* *. *^ 
 
 
 
 
 1 
 
 C4 CO ^ lO CO C« 00 
 
 Chart showing Admissions per 1,000 of Sti 
 
 IM 
 
i- 
 
 — 
 
 
 
 r- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 hIifWiT t.\ ITV ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 A rMl/lir>OI/~vMO 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ADMISSIONS."^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 N 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 k 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 I / 
 
 
 
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 A 
 
 hJ 
 
 
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 V' 
 
 
 
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 • 
 
 
 
 u 
 
 
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 L 
 
 
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 n 
 
 1 
 
 A 
 
 k 
 
 
 y 
 
 
 
 
 
 
 
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 \ 
 
 
 
 
 
 / 
 
 V 
 
 
 V 
 
 
 •• 
 
 
 
 
 
 
 
 \ 
 
 
 
 V 
 
 \ 
 
 
 V 
 
 
 
 r 
 
 X 
 
 4 
 
 
 • 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 A 
 
 
 
 \ 
 
 
 
 / 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 k 
 
 
 r 
 
 
 
 
 f 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 V 
 
 Tv 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I 
 
 
 
 \ 
 
 IV 
 
 
 / 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 "^v 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 n ^ >o CO c« 00 
 
 « CO ^ n CD t» 00 
 
 OrHCSIW 'i<t«tOC«.00 9>0 
 
 GTH AND Case Mortality per Cent, for "All Fevers 
 roiA, 1860-1910. 
 
 [To face page 342. 
 
PREVENTION OF INFECTIOUS DISEASES 343 
 
 of troops on the frontier that followed that campaign, is 
 peculiarly interesting : • 
 
 Ratios for " All Fevers " during Two Contrasted Periods. 
 
 
 Admitted per 
 
 1,000 of 
 
 Strength. 
 
 Died per 1,000 
 of Strength. 
 
 Case Mortality 
 per Cent. 
 
 1878 
 1879 
 1880 
 
 Average 
 
 1897 
 
 1898 
 
 Average 
 
 635 
 940 
 790 
 
 440 
 515 
 
 5-2 
 51 
 54 
 
 94 
 10-8 
 
 0-82 
 0-54 
 0-68 
 
 0-68 
 
 214 
 
 2-10 
 
 212 
 
 To my mind the conclusion is fairly clear that the 
 " fevers " with which we have had to deal in the last twenty- 
 five years are different in nature from those with the treat- 
 ment and prevention of which our predecessors were con- 
 cerned in the quarter of a century immediately preceding. 
 If we were dealing with one disease only we should be justified 
 in saying either that the disease had become much less 
 amenable to treatment, or the population more susceptible 
 to the disease. Dealing with a mixed class of diseases, 
 linked together only by one common symptom, pyrexia, 
 we are, I think, justified in concluding that the more severe 
 members of the group have increased, whilst the less fatal 
 have diminished or remained stationary. Now, there is 
 not the slightest doubt that the fatal fever of India, as 
 regards the British soldier, is enteric fever. The deaths 
 attributable to malarial fevers, or to simple continued fevers, 
 are neghgible in comparison. 
 
 I conclude, therefore, that the fatal member of the com- 
 bined group — in other words, enteric fever — was undoubtedly 
 more prevalent in the years between 1886 and 1910, than it 
 had been in the years prior to 1886, as far back as our 
 statistics go. The change occurred subsequently to the second 
 Afghan War, and may be supposed to have commenced 
 somewhere between 1883 and 1885, though it did not show 
 itself prominently till 1886. This change coincides with 
 
344 MILITARY HYGIENE AND SANITATION 
 
 the final passing away of the long-service soldier, and the 
 introduction of the present shorter period of service. It 
 also coincides rather interestingly with the period of the 
 Egyptian campaigns lasting from that of Tel-el-Kebir, in 
 
 1882, to that of the 
 Nile Expedition in 
 1885. It is at least 
 conceivable that the 
 troops coming on to 
 India after sharing in 
 those campaigns in- 
 troduced it into the 
 latter country, or, 
 rather — for it has 
 always, I believe, been 
 to a certain extent pre- 
 sent — increased the 
 number of foci from 
 which it subsequently 
 spread. The culmin- 
 ating point of enteric 
 fever was in the years 
 1897 and 1898. In 
 the former we had 
 the great concentra- 
 tion of troops in the 
 north of the Punjab, 
 in connection with the 
 Tirah Campaign, and 
 in the latter the occu- 
 pation of the Khyber 
 Pass, coinciding with 
 two appalhng out- 
 breaks at Agra and 
 Quetta. In 1899 there 
 was a marked fall, 
 partly, perhaps, due to the protection afforded by the 
 numerous attacks of the preceding years, but partly also 
 to the fact that the outbreak of the South African War 
 put an end to the arrival of young drafts from England. 
 This last influence persisted during the next two years, 
 
 I WW ..I »2 HS HJ 05 mi 07 .)8 f).) Il.t..) 01 •,)!. ,,5 » n,r, OHilw 
 
 Fig. 9. — Admissions and Deaths per 1,000, 
 Enteric Fever in India. 
 
PREVENTION OF INFECTIOUS DISEASES 345 
 
 which also coincided with a marked improvement in 
 sanitary administration in India. The appointment of 
 sanitary officers at the headquarters of the army, and 
 at the headquarters of the four commands, had a most 
 important effect in consoHdating and co-ordinating sani- 
 tary work throughout the army. It is to this, and also to 
 the introduction of anti-enteric inoculation, that I attribute 
 the present improved state of affairs. As regards this last 
 measure, I consider that the history of enteric fever in India 
 is of very great significance. I believe, as I have already 
 said, that one of the most important causes of the great 
 prevalence of enteric fever during the closing fifteen years 
 of last century was the presence of the great mass of highly 
 susceptible material in the country, represented in the 
 persons of the young soldiers of which the army was com- 
 posed. This increased susceptibility, due to age, should 
 logically be combated by an artificially increased power 
 of resistance, and this power is furnished by inoculation, 
 and can be furnished to the same extent in no other way. 
 
 There is one more point in connection with the history 
 of enteric fever which seems to me to point a valuable lesson. 
 As all who served in India during that period know, the 
 years 1 880 to 1 900 were years marked by continuous 
 improvement in the matter of water-supply. (I will refer 
 to this again when discussing cholera.) New piped supplies 
 were introduced into many stations, and, where this was 
 not done, great and continually increasing attention was 
 paid to the details of water-supply in barracks throughout 
 the country. This was even more marked in the years 
 after 1895, in consequence, partly, of the fact that some 
 weak points in the systems then in force were brought to 
 light by the cholera outbreak at Lucknow in that year. 
 
 During just those years when enteric fever was at its 
 worst, and seemed every year to be getting more out of 
 control, the energies of every medical officer were being 
 daily, almost hourly, directed to safeguarding the water- 
 supply. By some irony of fate those stations where the 
 water-supply was best seemed to be those specially selected 
 by this disease to deal its hardest blow. In no case was 
 this more marked than at Quetta. The water-supply in 
 this station was, and is, drawn from a mountain source, as 
 
346 MILITARY HYGIENE AND SANITATION 
 
 free from danger of serious contamination as any source 
 could well be. It was piped for about fifteen miles to a 
 service reservoir, placed as far as possible from any obvious 
 source of danger, and thence delivered to stand-pipes in 
 the barracks. If any contamination had occurred at the 
 source, or in the service reservoirs, the resulting outbreak 
 should have been general in its character, and marked by 
 the well-known features that distinguish such outbreaks. 
 If, on the other hand, contamination had occurred during 
 distribution from the stand-pipes, then this would have 
 been local, and given rise to localized outbursts, following 
 no general rule, in different years. As a matter of fact, 
 however, the outbreaks were general in their character, 
 and year after year showed a very definite resemblance. 
 Thus they always began at a certain part of the infantry 
 lines, were always worst in that part and the immediate 
 vicinity, and spread from thence to the remainder of the 
 station. The spot from which they started was that nearest 
 to, and directly to leeward of, the filth trenches, and the 
 direction in which the epidemics spread was always down 
 the wind. Owing to lack of water, and the nature of the 
 soil, the trenches were absolutely arid, and the miniature 
 whirlwinds or sand-spouts, well termed " devils " by the 
 natives of the country, swept straight from these trenches into 
 the lines, carrying clouds of dust and swarms of files with 
 them. The inference, to my mind, at the time, was clear, and 
 I have never yet seen any reason to doubt it — namely, that 
 the dust and flies carried into the barracks originated, 
 and assisted in the subsequent spread of, enteric fever in 
 the station. The trenches were closed, and deep pits dug 
 at a place somewhat nearer to barracks than the point 
 where the trenches were previously situated, but in a direc- 
 tion from which the wind rarely or never blew. At the same 
 time certain improvements were instituted in the system 
 of removal then in force, with the result that admissions 
 for enteric fever, which in 1898 were 232, in 1899 were only 
 26, though the garrison remained at the same strength, 
 and a new battalion was substituted for one that had 
 been protected to a certain extent by the previous severe 
 outbreak. I occupied at the time the position of sanitary 
 ofiicer at Quetta, and was in a favourable position to study 
 
PREVENTION OF INFECTIOUS DISEASES 347 
 
 the local conditions. This experience, coming as it did at 
 the close of my second tour of Indian service, confirmed 
 in my mind conclusions to which my experience of twelve 
 years in that coimtry had been progressively leading me. 
 During those years enteric fever had been steadily in- 
 creasing in India, and I had had the fortune to be brought 
 into close touch with many outbreaks, none of which 
 showed any of the features that characterize a purely 
 water-borne epidemic. The conclusion to which I came 
 was that flies and dust, combined with faulty methods of 
 removal and disposal, were the chief causes of enteric fever 
 in Indian cantonments. A further experience of four years 
 as sanitary officer, first at the headquarters of a command, 
 and later at those. of the army, did nothing to lessen, but 
 the rather strengthened, my conclusions. Water can, and 
 does doubtless, cause sporadic cases, and even isolated and 
 circumscribed outbreaks ; it is not, I hold most strongly, 
 concerned in the continuation of epidemics such as those 
 with which the eighties and nineties of last century made 
 us who then served in India so familiar. 
 
 Enteric Fever in Cantonments. — -In considering the pre- 
 vention of enteric fever in cantonments we must begin 
 with the infected man. Of the man actually under treat- 
 ment in hospital, little need be said. The dejecta of all cases 
 of enteric fever will naturally be received into a bed-pan 
 containing disinfectant, and they should after that be either 
 incinerated or boiled. The latter process should, in my 
 opinion, always be selected, since, in carrying it out, the bed- 
 pan can, at the same time, be sterilized. It is occasionally 
 forgotten that the washings of a bed-pan are as dangerous 
 as the actual excreta. Reliance should never be placed 
 on mere chemical disinfection, whether for excreta or utensils. 
 Even in the smallest hospital it should be possible to fit 
 up a large caldron in the immediate vicinity of the ward, 
 which should be kept full of water, to which a certain amount 
 of washing soda has been added. In this the bed-pan with 
 its contents should be immersed. With several cases it 
 may be necessary to keep the caldron always simmering, 
 in which case the bed-pan need not be left, in the water 
 more than a few minutes. The soda wiU assist to saponify 
 any fatty matter that may be present, and cleanse the pan. 
 
348 MILITARY HYGIENE AND SANITATION 
 
 Where only a single case is in question, the water must be 
 brought to the boil and maintained at that temperature 
 for two or three minutes. If the bulk of water be large 
 compared with the stool, there will be no nuisance ; if such 
 be complained of, the addition of sanitas or crude carbolic 
 acid to the water will counteract it. In large hospitals 
 some more elaborate apparatus should be supplied with a 
 view to economizing fuel and labour, but it is a mistake to 
 suppose that elaborate apparatus is necessary. The stools of 
 all doubtful cases of fever should be treated in the same way. 
 
 The infected man out of hospital may belong to any of 
 the four categories already described. The actual " carrier " 
 is nowadays easily recognized and isolated, and the danger 
 from him should be infinitesimal. Since every man who has 
 had enteric fever is examined on several occasions to ascer- 
 tain if he is a " carrier " or not, it is probable that but few 
 escape the net. In case, however, any such should elude 
 our vigilance, I lay down as a hard-and-fast rule that no 
 man should be allowed to handle the food of his comrades 
 for one year after he has returned to duty subsequently 
 to an attack of enteric fever. He must, therefore, not be 
 employed in the kitchen, regimental dairy, soda-water 
 factory, or coffee shop, or on any duty which would entail 
 his handling food during that period. At the end of it, if 
 it is desired so to employ him, he should be again examined 
 on, say, three separate occasions, with a week's interval 
 between each, to see whether or no he is a " carrier." In 
 the case of men who have returned to duty after being 
 orderlies in an enteric ward, I should make a similar rule, 
 but limit the period to six months. I do not pretend for 
 one instant that there is any particular virtue in, or any 
 scientific justification for, the periods I have stated. In 
 such a case I decline to take risks, and, as a matter of 
 administration, it is always a sound step to lay down some 
 definite rule. The instances in which any hardship would 
 be inflicted would be extremely few, and the hardship very 
 small in any of them. 
 
 Dealing with the case in the early stage of the disease, 
 and with the ambulatory case is a difficult matter. In nine 
 cases out of ten, however, in typical attacks, men report 
 sick about the fourth day "of disease : the danger here is 
 
PREVENTION OF INFECTIOUS DISEASES 349 
 
 therefore limited. I have aheady spoken of the two men 
 whom it is the duty of the medical officer in charge of a unit 
 specially to keep his eye on — the keen young N.C.O. and 
 the regimental athlete. 
 
 In respect of enteric fever there is one other class of indi- 
 viduals demanding particular notice, and that is the member 
 of the last draft. Every medical officer in charge of a unit 
 should make it his duty to see, and by that word I mean not 
 merely look at, but speak to, and question, the men who 
 composed the last draft from home, periodically, at frequent 
 intervals during the first six months of their Indian service. 
 These men are not only the most susceptible, on physical 
 grounds, but they also suffer from ignorance of the country, 
 and of the dangers of the bazaar. Undoubtedly some of 
 them contract the infection on their journey up country. 
 One such case which I remember was the starting-point 
 of a rather important outbreak. He had no pronounced 
 symptoms, and was not recognized until a thorough over- 
 haul of the " last draft " was made, when it was discovered 
 that he had been suffering from malaise and intestinal 
 trouble ever since his arrival in the station, and acting as 
 a focus of the disease all that time, more than six weeks. 
 Detached parties of men coming from another station, 
 where enteric fever has been prevalent, should also be 
 carefully watched, to prevent their introducing the disease 
 into a station which has been previously free from it This 
 is particularly likely to occur in the case of stations where 
 special courses of instruction — for instance, signalling, 
 musketry, and mounted infantry classes — are carried out. 
 
 The next point to be considered is the direct attack on 
 the disease germ. From what I have already said, I think 
 I have made it fairly clear that this attack must be made 
 at the moment when the germ leaves the body of the infected 
 man. And, since we are dealing with the infected man 
 outside hospital, that means that we must concentrate 
 our attention on the latrines and urinals in barracks. I have 
 already dealt with the question of the removal and disposal 
 of excreta in the absence of a water-carriage system, and it 
 is unnecessary to repeat what I have already said on that 
 matter. In my opinion the conservancy problem is the 
 key of the enteric problem in India. The method which 
 
350 MILITARY HYGIENE AND SANITATION 
 
 I consider the best is incineration in situ, with the most 
 stringent precautions to prevent the access of flies to the 
 excreta during the interval that must inevitably elapse 
 between the moment when they leave the body and their 
 ultimate destruction. Where incineration in situ is im- 
 possible, then the precautions as regards flies must be 
 extended to the entire period during which the excreta are 
 retained in the latrines, and also during their transfer to 
 the disposal-ground. I firmly beHeve that if there are no 
 flies in barracks there will be no epidemics of enteric fever. 
 Isolated cases contracted in the bazaar may occur, occasion- 
 ally even a small outbreak of the water type. In the absence 
 of flies the disease will not " get hold " of the station, and 
 you will not have the type of outbreak with which all those 
 who served in India during the nineties of last century are 
 so well acquainted, persisting, week after week, and month 
 after month, one year with another, sometimes more severe, 
 and sometimes less, but never absent from the station. 
 
 As regards the passage of the germ from the infected man 
 to the non-infected man, the fly is, therefore, the object of 
 our attack. Flies must not only be kept out of latrines ; 
 they must not be allowed to breed anywhere in the vicinity 
 of barracks. Here we are concerned with the destruction 
 of rubbish, more especially with that of horse-litter. Mounted 
 units naturally are the most important in this connection. 
 Apart from the fly, there is one other agent that must not 
 be forgotten, and that is the low-caste native servant. 
 Fortunately, of late years the number of these allowed in 
 barracks has been considerably diminished, and with that 
 much -to -be -desired consummation, the introduction of 
 electric fans or punkahs, it may be hoped that they will 
 almost completely disappear. There is, in fact, not the 
 slightest reason why any native should ever enter a barrack- 
 room or ever manipulate food. Cleaning-boys and parasites 
 of that class should be absolutely forbidden. The number 
 of natives allowed to enter barracks, as apart from barrack- 
 rooms, should be strictly limited, and everyone so authorized 
 should either wear some sort of uniform or a conspicuous 
 badge. 
 
 With regard to the non-infected man, our defence must 
 consist in protection of his food and water supplies. With 
 
PREVENTION OF INFECTIOUS DISEASES 351 
 
 regard to the former, we have to think firstly of the kitchen. 
 It is becoming more and more the practice in India for the 
 soldier to do his own cooking. With the introduction of 
 proper cooking-ranges this is possible in some stations all 
 the year round, and in a great number of the larger stations 
 for considerable periods of the year. Where and when it is 
 impossible, the role of the native cook should be that of a 
 fire-boy. He should on no account be allowed to manipu- 
 late the meat or prepare it for cooking. This can and 
 should always be done by a trained soldier cook. As regards 
 kitchens, we have again to think of the ubiquitous fly. 
 There should be no flies in kitchens, and the only way to 
 insure this is by having no breeding-grounds in or near 
 barracks. One cannot in this case use strong-smelling 
 chemicals to drive out the fly, as in the case of latrines. 
 Wire gauze doors are provided in all cook-houses, and are 
 always shut on the occasion of the arrival of an inspecting 
 officer, if this is known of in advance. I am with good 
 grounds sceptical of their being closed at any other time, 
 except by accident. It has always seemed to me that the 
 old-fashioned split bamboo curtain, or chick, was more 
 efficacious than the modern automatic closing door. In 
 either case, I have little faith in any automatic appliances. 
 The only way to insure the absence of flies in cook-houses 
 is to see that there are no breeding-grounds in or near 
 barracks. The prompt removal and disposal of cook-house 
 rubbish and slops is, of course, important in this connection. 
 
 The soldier's food is derived from three sources. The 
 first is the supply branch of the Supply and Transport Corps, 
 which provides the main articles composing the regulation 
 ration ; the second comprises the various regimental insti- 
 tutes — viz., coffee-shop, supper-bar, and dairy, etc. ; and 
 the third includes various extraneous sources, native and 
 European. 
 
 As regards the official suppHes, little fault can as a rule 
 be found, and, if found, can at once be remedied. As 
 regards the second, there is as a rule, except in an abso- 
 lutely raw regiment, little amiss. If there is trouble, it is 
 uually in connection with the dairy, and consists in the 
 fact that the supply of milk from the regimental herd has 
 faUen short, and has had to be supplemented from ex- 
 
352 MILITARY HYGIENE AND SANITATION 
 
 traneous sources. In nine cases out of ten regimental 
 dairies are under-capitalized, and have no reserve of stock. 
 The difficulty lies in the fact that a regimental dairy has, 
 or should have, no market outside the regiment. It must, 
 therefore, either produce more milk than it needs for its 
 own customers, or some of these must occasionally go short. 
 Rarely one sees a good regimental dairy, still more rarely 
 a good one which limits its market to the regiment only. 
 The milk-supply of the garrison should either be from a 
 Government dairy, or, better still, from a large civilian 
 dairy under skilled European management. Any licence to 
 sell milk in barracks should be conditional on the dairy being 
 open to inspection by military medical and veterinary 
 officers. The amount of milk consumed by the ordinary 
 soldier is so small — about IJ ounces per diem — that I am, 
 I confess, sceptical as to its influence as a cause of enteric 
 fever. The women and children who do drink milk do not 
 suffer from the disease to anything like the same extent. 
 
 Supplies from extraneous sources consist largely of fruit 
 and vegetables sold by native hawkers. Every unit should 
 establish a central market for the sale of these commodities. 
 No native should be allowed to hawk foodstuffs of any 
 description whatever promiscuously through barracks. 
 Some convenient spot should be selected, and the fruit, etc., 
 exposed for sale on clean tables or stands properly protected 
 from dust and flies. A plentiful supply of good fruit and 
 green food is an absolute necessity in a hot climate, and if 
 the men are not given this in barracks they will inevitably 
 procure it in the bazaar. Soldiers' gardens should be en- 
 couraged with this view, but they rarely, if ever, produce 
 enough to meet the demand. Every native hawker should 
 be provided with a conspicuous badge, and also a signed 
 pass, supplied by the Quartermaster. 
 
 An extraneous source of supply which occasionally gives 
 trouble is the unauthorized Soldiers' Home. The large 
 Soldiers' Homes established at many stations under the 
 management of responsible persons have been productive 
 of great good, and of nothing but good, and it is not these 
 that I here allude to. In addition to these, in various 
 stations smaller so-called homes have been started, often 
 of a sectarian character, as a rule inadequately financed, 
 
PEEVENTION OF INFECTIOUS DISEASES 353 
 
 being, in fact, nothing more than restaurants of a poor 
 class. In my experience these are more common in the 
 south of India than in the north. Such estabhshments 
 should be placed out of bounds unless they submit to 
 inspection by military medical authorities, and abide by 
 certain rules. Inside cantonment limits effective control 
 is simple enough, but where a municipal form of govern- 
 ment exists, unless some sort of fixed rule like the above 
 is enforced, trouble will undoubtedly ensue. 
 
 I have already given my reasons for believing that water- 
 supplies do not play, and have not as a rule played, an 
 important part in the production of enteric fever in India. 
 That on occasion water outbreaks do occur I am well aware, 
 and naturally attention should be paid to the water in 
 investigating or combating any epidemic. The ideal water- 
 supply in India would be one in which the water was laid 
 on to every barrack-room, so that the man should be able 
 to fill his own bottle or mug straight from the main. In 
 the majority of stations this is not the case, and some 
 method of storage in the veranda has to be adopted. Great 
 harm has been done in India by over-meddling with the 
 water-supply. Where a water is originally drawn from a 
 good source, and delivered to barracks in stand-pipes, the 
 chances of contamination en route to the barracks being 
 guarded against as far as is humanly possible, then the less 
 that water is handled on its passage from the stand-pipe 
 to the consumer the better. I have already touched on 
 these points when talking of water-supply, and merely 
 recall the principle here. 
 
 Prevention of Enteric Fever on Service. — The prevention 
 of this disease in the field must proceed on exactly the same 
 lines as in cantonments. We must consider the same chain 
 of individuals, and attempt to break up that chain in pre- 
 cisely the same manner. The first object of our attention, 
 then, must be the infected man, and from that it follows 
 that our first line of defence must be the care of latrines 
 and urinals. I am not so optimistic as to expect that even 
 with the best disciplined and the most highly educated army 
 we shall ever escape the dangers incidental to promiscuous 
 defsecation and urination, more especially the latter. But 
 this may be reduced to a minimum, and must be reduced. 
 
 23 
 
354 MILITARY HYGIENE AND SANITATION 
 
 With soldiers, the difficulty will not be nearly so great as 
 with civilian camp-followers, especially natives. The most 
 stringent disciplinary measures may be necessary in the 
 case of these gentry. I need hardly repeat here the im- 
 portance of the destruction of all rubbish, so as to dis- 
 courage the breeding of flies. 
 
 Whatever you do, and however hard you work, you will 
 still have a certain amount of scattered filth and a con- 
 siderable number of flies. I want to warn young, officers 
 from getting into that mental attitude which leads to a 
 passive acquiescence in this state of affairs. The next stage 
 is the "What is the good of anything ?" stage, and that 
 is fatal. Half a loaf is much better than no bread in this 
 case, and he is the best sanitary officer who makes that 
 half into as big a fraction of the entire loaf of perfect sani- 
 tation as he can. 
 
 The same remarks apply to water-supply, though here 
 it is much easier to approach perfection, since the super- 
 vision of the collection and distribution of water is a simpler 
 matter than that of the prevention of promiscuous defaeca- 
 tion. Here, again, however, I do not lay as much stress 
 on water-supply as on conservancy in the causation of 
 enteric fever in the field. Exposed excreta and flies are 
 the main causes of the disease. Our defence against these 
 must necessarily be imperfect, from causes which, if not 
 beyond human control, are sometimes very nearly so. I 
 conclude, therefore, that the main line of defence must be 
 to increase the resisting-powers of the non-infected man — 
 in other words, the practice of anti-enteric inoculation. 
 This is the logical method of counteracting the increased 
 susceptibility of the young soldier, of whom all modern 
 armies are so largely composed. I hold, in fact, that a 
 battalion or other unit must, as far as enteric fever goes, 
 be considered as being fit for service in exact proportion to 
 the number of protected men in the ranks. 
 
 Dysentery. — This disease has in the past played an 
 important part in the medical history of the British Army 
 both in peace and war. At present, except in a few small 
 stations, its influence in peace-time is negligible, whether 
 considered as a cause of sickness or of mortality. In India, 
 for instance, during the year 1909 the admission-rate was 
 
PREVENTION OF INFECTIOUS DISEASES 355 
 
 11-2 and the death-rate 0-25 per 1,000, the averages for the 
 quinquennium immediately preceding being 13-4 and 0-44 
 respectively. In the older days this was not the case. 
 Certain stations, and even certain barracks — as, for instance, 
 the old European infantry barracks in Secunderabad — ^had 
 a peculiarly evil reputation for dysentery. In South Africa 
 it caused a considerable amount of disability, and some 
 mortality, but was in no way comparable with the disease 
 as we read of it in history — as, for instance, in the earlier 
 period of revolutionary wars in France. In the Middle 
 Ages dysentery appears to have occupied, as regards cam- 
 paigns, very much the position which enteric fever occupies 
 at the present day. In aU probability scurvy played a 
 large part in its production ill those times, aggravated by 
 the alternate starvation and excess which regulated the 
 commissariat of med|ieval armies. The descriptions of the 
 disease given by Donald Monro fortify this opinion. 
 
 Under the term "dysentery" are included at least two 
 severe specific diseases, and in all probability a large number 
 of minor complaints . The two former are bacillary dysentery 
 and amoebic dysentery, each of which is due to a distinctive 
 micro-organism. It is possible, however, that there may 
 be more than one form of bacillary dysentery. In addition, 
 we have included under this heading all the various forms 
 of colitis or diarrhoea, marked by bloody stools, or by coHc 
 and tenesmus, which are usually shown under the same 
 heading. Some of these are undoubtedly of a non-specific 
 and temporary nature, due to chiU, or the mechanical irrita- 
 tion produced by the presence of sand or grit in the water. 
 Others, again, which are sHght and temporary, may be 
 related to or be quasi-ambulatory cases of the more typically 
 severe forms. 
 
 As regards prevention, the question is comparatively 
 simple, since there is no doubt that in the specific bacillary 
 and amoebic dysenteries the infection leaves the infected 
 man in his excreta, mainly, if not solely, in his faeces ; whilst 
 in all cases it enters the man by the mouth in or on his water 
 and food. The chain connecting the infected and the non- 
 infected man is precisely similar to that existing in enteric 
 fever or cholera, and the whole mechanism of prevention is, 
 therefore, absolutely identical. It is unnecessary to repeat all 
 
356 MILITARY HYGIENE AND SANITATION 
 
 that has already been said about the strict attention to con- 
 servancy and water-supply that is necessary during service 
 in the field. The possibility of a scorbutic factor existing 
 must also be kept in mind and properly guarded against. 
 
 The three diseases — enteric fever, cholera, and dysentery 
 — may from the point of view of prevention be considered 
 as forming a circumscribed and well-marked group. In all, 
 the mode of departure from the infected man is in the 
 dejecta ; in all, it enters the non-infected man in drink and 
 food, and in all three the common 
 
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 II flv nrovides a link between the two. 
 
 
 
 
 
 
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 one time one or other member of the 
 
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 group may occupy our attention more 
 
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 tha.Ti thp othpr thp 0"pnpral lines on 
 
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 i 
 
 
 which we work are identical. In pre- 
 
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 venting one we prevent at the same 
 
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 time the other two. Ihis statement 
 
 
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 r:^ ± JZ 
 
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 f^ t 5 i 
 
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 «co«i 67 65 «4 4!i 66 6^ £« 69 10 Ti ^1 ^J -[+ -]5 16 Tf -j* 79 «o ti 8x 13 »♦ 15 «c ^^ «t «9 <}o c)i 91 ^3 <j+ gs gt 91 99 
 
 Fia 10. — Cholera in India : Admissions per 1,000. 
 
 il 3 4 f « 
 
 prevent only one disease, and though this is a great and 
 useful help, it must not be supposed that it can in any 
 way replace the more general methods of sanitation, con- 
 servancy, and water-supply. 
 
 Cholera. — This disease has practically never attacked 
 the British Army in peace-time except in India, though 
 occasional outbreaks have occurred under semi-service 
 conditions in other countries, as well as in Turkey before the 
 invasion of the Crimea, and in Egypt in 1883. The history 
 of cholera, however, as far as we are concerned, is its history 
 in India only, and wiU, therefore, be so considered. 
 
PREVENTION OF INFECTIOUS DISEASES 357 
 
 The curves on Figs. 10 and 11 illustrate this history, 
 showing the admissions and deaths per 1,000 of strength 
 from the British Army in India since 1860 on account of 
 this disease. The most striking point about these curves 
 is their closeness to each other, emphasizing the enormous 
 proportionate mortality that is distinctive of cholera. 
 
 If we divide the period covered by these curves into the 
 different decades of which it is composed, we shaU find that 
 in the sixties cholera was always present, and that, roughly, 
 every alternate year was marked by an appalling epidemic. 
 In the seventies cholera was still constantly present, but the 
 outbreaks were less severe and less numerous than before. 
 In the eighties and nineties the disease gradually decreased 
 til], at the present day, it is only* of 
 occasional occurrence. The change is, 
 in reality, more marked than appears, 
 especially in late years, from the curves. 
 Twenty-five years ago, to go no farther 
 
 « 6163 64 6» 66 47 6« 6« 70 -[i -fl 7S -]* 7S 76 77 7* -jg 80 
 
 »3 a* IS ti rj »» »9 qo 91 91 q-s 94 qi St 97 q» q<)l9»« 1 13+567 
 
 Fig. 11. — Cholera in India : Deaths per 1,000. 
 
 back, cholera was a constant visitant to all the up-country 
 stations in India towards the end of the rainy season. 
 The troops might escape, but the disease was always 
 hovering round barracks as it were, and the medical 
 authorities were constantly on the qui vive to meet 
 attack. This is no longer the case. The disease, from 
 being a great probability, has dwindled to a mere possibihty. 
 The explanation is, to my mind, clear, and I think there 
 will be few dissentients amongst those who have studied 
 the facts. Cholera has disappeared because water-supplies 
 have improved, and for no other reason. The connection 
 of water-supply with cholera was not generally recognized 
 in the sixties. In the seventies the teachings of Parkes bore 
 fruit, and during that decade and the next increasing attention 
 was paid to water, as the essential nature of the connection 
 
358 MILITARY HYGIENE AND SANITATION 
 
 between it and the disease became more and more clearly 
 recognized. The culminating-point was reached in 1894, 
 when an outbreak in the East Lancashire Regiment at 
 Lucknow demonstrated in the clearest possible manner that 
 water, and water alone, was the vehicle by which the 
 cholera vibrio was communicated to man. Since that time 
 we have had no outbreak of serious importance. Sporadic 
 cases have occurred, and probably always will occur as 
 long as cholera continues to be endemic among the natives 
 of certain parts of India. It should not, and it may be con- 
 fidently prophesied will not again ever, in peace-time, appear 
 in the form which it assumed in the sixties and seventies. 
 
 In war it is difficult to be equally optimistic. Even in 
 our last frontier campaign, the Mohmand expedition of 1908, 
 the disease appeared, and though limited in extent caused 
 considerable trouble. Fortunately the campaign was not 
 sufficiently long, nor the force employed sufficiently large, for 
 much harm to be done. This might not always be the case, 
 and with any large army keeping the field for a prolonged 
 period close to any of the great Asian trade routes, it would 
 be necessary to keep a very careful lookout for this disease. 
 
 Enteric fever is the standing menace of armies in all 
 climates, but in tropical and subtropical countries cholera 
 will still have to be reckoned with as a serious possibility. 
 The difference between the two diseases in their relationship 
 to military operations is rather important. An epidemic 
 of enteric fever, however prolonged, would have an effect 
 on the advance of an army similar to that produced by the 
 " snipers " of an enterprising guerrilla foe. It might delay 
 for a time, but would not eventually stop, the forward 
 movement. The outbreak at Bloemfontein in 1900 is a 
 good illustration of this. An outbreak of cholera, on the 
 other hand, even if it lasted only ten days, might produce 
 an effect comparable only to a crushing defeat by an over- 
 powering enemy. Such an outbreak, for instance, as struck 
 the army in the Khyber Pass on its return from Afghanistan 
 in 1879, might, if it coincided with an important strategical 
 concentration, alter the course of a campaign, and change 
 the current of history. He would be, indeed, a bold man 
 who would say that such an accident was impossible at 
 the present day. 
 
PREVENTION OF INFECTIOUS DISEASES 359 
 
 The prevention of cholera on service has, therefore, a 
 strategical importance greater than that attached to the 
 prevention of any other disease. 
 
 In studying the prevention of this disease, we have, of 
 course, to consider the same chain as in all other infectious 
 diseases. 
 
 As regards the infected man, we do not know so much 
 as in the case of enteric fever The " carrier " — that is, 
 the man who has passed through a typical attack of the 
 disease and continues to discharge the vibrio in his stools — 
 is probably less common in the case of cholera than in 
 that of enteric fever, for the grim reason that the percentage 
 of recoveries is less. The ambulatory case is possibly 
 more common than generally supposed, and many of the 
 cases of mild diarrhoea that occur during an epidemic are 
 probably of this nature. The vibrio leaves the body only 
 in the stools, at least, in the early stages of the disease, 
 and it is to the immediate destruction of these that we must 
 aim as the first step. On service on the Indian frontier, 
 where the necessity is most Hkely to arise, this would entail 
 the carriage of fuel, since nothing short of incineration 
 would suffice. Again, though it might be possible to insure 
 the incineration of aU excreta -passed in the case of the 
 regular soldier, those of the inevitable crowd of transport 
 and other followers would present enormous difficulties. 
 A certain amount of illicit def aecation would occur, especially 
 on the line of march, and this would be particularly likely 
 to happen at the onset of symptoms of the disease. StiU, 
 attempts should be made to burn as much as possible, and 
 the ubiquitous kerosene oil of the East should be utilized 
 in the filth trenches for this purpose. In all standing camps 
 or posts on the lines of communication, some permanent 
 method of incineration should be adopted. 
 
 The vibrio of cholera is very sensitive to desiccation, and 
 the danger of dust-borne infection is, I consider, less than 
 in the case of enteric fever. Still, this method of dissemina- 
 tion, and also that by means of flies, should be kept in mind. 
 
 As regards the non-infected man, the prevention of cholera 
 resolves itself into the provision of a pure water-supply. 
 If cholera is present, or even threatening, the most minute 
 and meticulous precautions must be taken in the matter 
 
360 MILITARY HYGIENE AND SANITATION 
 
 of water-supply, both as regards collection, purification, and 
 distribution. In camp, whether during peace or war, the 
 source should be guarded by an armed sentry, and there 
 should be no ambiguity in his mind as to the reasons for 
 which he is armed, nor should there be in the minds of 
 others any room for imagining that he will not justify those 
 reasons. 
 
 For purification I would trust nothing except heat, if 
 it can be applied, and if the water can be satisfactorily 
 cooled afterwards. This last would present great difficulties 
 on service in the hot weather, with troops on the move. 
 If heat is not available the next best method under the cir- 
 cumstances would be the use of chemicals . The acid sulphate 
 of soda would undoubtedly be most useful in this case, 
 and would probably be effective in doses considerably smaller 
 than those usually recommended, owing to the extreme 
 sensitiveness of the vibrio to acids. I have never yet seen 
 the filter which I should trust in the actual presence of 
 cholera. 
 
 I have already, when speaking of the general question of 
 water-supply, stated what I consider should be the procedure 
 adopted for collection and distribution. If formality and 
 care are necessary under ordinary field service and manoeuvre 
 conditions, they are ten thousand times more important in 
 the presence, or under the threat, of cholera. I need hardly 
 add that it will be too late to insist on that formality and 
 care, when the disease is already imminent. Practice and 
 instruction in peace are as essential in the details of water 
 discipline as in those of fire discipline. The commanding 
 officer who expects his men to adopt suddenly, in the presence 
 of disease, a rigorous self-restraint in the question of drinking 
 without previous training in the art, is as likely to be dis- 
 appointed as he who expects his men to husband their fire 
 in action, when they have been allowed to squander it on 
 manoeuvres. 
 
 In cantonments, if cholera should appear, I would stop 
 the issue of any water except that which had been boiled 
 and aerated at the regimental soda-water factory. The 
 cost of such a procedure would be infinitesimal, and the 
 protection afforded complete. In hot weather I would go 
 even further, and have the soda-water iced. I need hardly 
 
PREVENTION OF INFECTIOUS DISEASES 361 
 
 say the ice should not be issued to the men, but used in 
 chests, where the soda-water should be stored. 
 
 Personally, however, I still believe, archaic as it may 
 seem, in the old precaution of moving into cholera camp. 
 By so doing the connection between the troops and the actual 
 source of the infection is cut, and, almost as important, the 
 melancholy associations of the barrack-room are removed. 
 In making this move it would be necessary to insure that 
 no water vessel that had been used in barracks should 
 accompany the unit under canvas, with the single exception 
 of the individual water-bottles . These should all be sterilized 
 by pouring in J ounce or 1 ounce of acid, sulph. dil., rinsing 
 well round, and then emptying. This done, the man should 
 be made to fill his bottle with still hot boiled water, and 
 pending the cooling of this, he must not be allowed to 
 drink anything but tea, or regimental aerated water. This 
 sterilizing process must be carried out under the immediate 
 supervision of an officer, preferably the company officer. 
 It must on no account be left to the non - commissioned 
 officers ; not in any way because these men are not to be 
 trusted, but because the man in the ranks will estimate 
 the importance of the procedure entirely by the rank of 
 the individual superintending it. The bottles of all men 
 who have been actually admitted to hospital should be burnt 
 at once. It would probably be necessary to take out into 
 camp certain large receptacles for the storage of water near 
 the tents. Ordinarily these stand in the verandas of the 
 barrack bungalows. If possible, new clean receptacles 
 should be obtained from store to accompany the unit, but 
 if this is impossible, those in use should, after being emptied, 
 be disinfected, either by the use of acid, or more simply by 
 laying a layer of paper and straw in the bottom of the 
 receptacle and setting fire to it. This wiU not damage the 
 tub, and will effectually destroy any lurking infection. 
 
 In camp water will probably have to be drawn from a well, 
 and here all the precautions I have already mentioned should 
 be observed, the armed sentry, the formal drawing and 
 distributing of water by a special party, and so on. If 
 the camp be near cantonments, say within twenty miles 
 by road, free soda-water should be issued. 
 
 As regards other supplies, I should lay down at once that 
 
362 MILITARY HYGIENE AND SANITATION 
 
 none of any kind, sort, or description, should come into 
 camp except those coming from official sources. No native 
 hawker should be admitted into camp, and as few natives 
 of any kind as possible. The consumption of fruit and 
 vegetables should be carefully controlled. Such as are 
 intended to be eaten raw must be limited to thick-skinned 
 fruit that can be thoroughly scrubbed. It would be 
 advisable to prohibit the use of salads, though these can 
 be rendered practically safe if a good supply of vinegar is 
 issued with them. AU restrictions applied to the men in 
 these respects should be made equally applicable to the 
 officers' mess. 
 
 Naturally, particular care should be paid to conservancy ; 
 the filth trenches should be covered with straw, or dry litter, 
 and the latter burnt, at least once in the twenty-four hours, 
 and preferably twice — ^namely, in the forenoon and at 
 "retreat." 
 
 I should like to impress on any medical officer who may 
 have to accompany troops into cholera camp, the necessity 
 of paying particular and personal attention to all the 
 details of sanitation all the time he is in camp. Generally 
 speaking, meddlesome sanitation is a mistake and is apt to 
 cause friction. But when an actual crisis occurs, such as 
 an epidemic of cholera, the medical officer must take personal 
 charge of the situation, and by so doing emphasize the 
 importance of the sanitary precautions he insists on. He 
 should himself see the water drawn, the trenches fired, etc. ; 
 he must himself see all supplies brought into camp, and 
 satisfy himself of their fitness. If the private soldier sees 
 that the medical officer considers the special rules he has 
 made are of sufficient importance for him to sacrifice his 
 own comfort and leisure to insure their efficient observance, 
 that astute individual will accord to those rules a respect 
 which, in course of time, he will probably extend to their 
 promulgator. If, on the other hand, he sees that the medical 
 officer, having engineered a few more additions to the 
 Regimental Order Book, considers his own recommendations 
 of so little real value that their ultimate fate can safely 
 be left to the quartermaster's establishment, he will label 
 those rules " doctor's fads," and view them with a contempt 
 which he will later inevitably extend to their author. 
 
PREVENTION OF INFECTIOUS DISEASES 363 
 
 In connection with the prevention of cholera there is one 
 line of action, the importance of which is not, I think, suffi- 
 ciently recognized, and that is the advisability of being pre- 
 pared in advance. When cholera does come, it is apt to 
 come with but little warning, and after only short notice. 
 This disease is peculiar, above all those with which we are 
 commonly brought into contact, in the moral effect it pro- 
 duces, even on those who might be expected to be, for pro- 
 fessional reasons, least liable to such influences. A sudden 
 outbreak is not unlikely to cause a quite natural mental 
 perturbation in the minds of the military authorities. At 
 such a time they look to the medical officer for guidance, 
 and I need hardly say that they have every right to expect 
 and receive it. The man who has a scheme already sketched 
 out in his mind will be able to meet the sudden demands 
 made on him better than the man who leaves everything 
 to be settled at the last minute. 
 
 There are master-minds, no doubt, who can face any 
 situation on the spur of the moment as it arises. As Athene 
 from the head of Zeus, so from their teeming brains elaborate 
 schemes leap forth complete to cope with any emergency. 
 The ordinary man is not so blessed, and would do well to 
 reahze the fact in time. I would impress, therefore, as 
 strongly as lies in my power, on all medical officers in charge 
 of stations the advisability of drafting for private reference, 
 as soon as possible after taking over charge, some plan of 
 action in case of such an emergency arising. Just as every 
 commanding officer has his defence scheme cut and dried, 
 so every senior medical officer should have his sanitary 
 defence scheme ready in advance and available for immediate 
 use. 
 
 There is but little excuse for being taken by surprise, 
 since some warning at least, if only short and slight, is as 
 a rule given. To be taken both by surprise and unprepared 
 is inexcusable. 
 
 I have not spoken about anti-cholera inoculation, since 
 the present comparative rarity of the disease has rendered 
 the necessity of such a precaution, taken generally, unneces- 
 sary. The method, however, exists, and the experience of 
 Powell in Assam is strong evidence of its utiUty. In the 
 case of troops compelled to keep the field in an endemic 
 
364 MILITAEY HYGIENE AND SANITATION 
 
 area it might be necessary. Circumstances might even 
 demand this precaution in the case of a large force operating 
 on an infected trade route. 
 
 Here, however, it may be permitted to draw attention to 
 an essential weakness of " prevention by inoculation." To 
 protect against one disease, smallpox, is essential, against 
 two, smallpox and enteric fever, reasonable. This we at 
 present do as regards the single, and as far as possible as 
 regards the double event. It would be possible, no doubt, 
 to add a third to the list on emergency, but a further sequence 
 might well make the soldier wonder with Macbeth, " What ! 
 Will the line stretch out to the crack of doom ?" and conclude 
 with him, " I'll see no further," which might have a serious 
 effect on recruiting. 
 
CHAPTER XX 
 
 PREVENTION OF INFECTIOUS DISEASES {Continued) 
 
 Malaria. — Malaria may be taken as the type of that class 
 of infectious diseases which are communicated from the 
 infected to the non-infected man by the agency of a biting 
 insect. As regards the British Army at the present day, it 
 may be said to be the only member of the class with the 
 prevention of which we are in any way concerned, yellow 
 fever, the other important representative of the group, having 
 long since ceased to be an important factor in the health of 
 the army. 
 
 History of Malaria in the British Army. — Malaria played 
 an important part in the history of every campaign in which 
 the British Army took a share up till the end of the Napole- 
 onic wars, even in Europe, and is still of importance both 
 during peace and war in tropical climates. As far as the 
 army is concerned, indigenous malaria has not been seen in 
 the British Isles for many years, the last occasion being in 
 Tilbury Fort in the year 1873. Since, however, these fevers 
 are still said to lurk in remote nooks on the Eastern coast 
 and in the Romney Marshes, and malaria-bearing anopheles 
 are known to breed in the New Forest and Cheshire (New- 
 stead), it might be necessary to take precautions against 
 them in the case of any large concentration of troops in 
 those districts. Rare, however, as malaria has now become 
 in England, to the point of being a natural curiosity, it is 
 important to remember that it was not always so. It is 
 probable that the marshes on the Surrey side of the Thames 
 were a couple of hundred years ago almost as deadly in this 
 respect as the West Coast of Africa is at the present day. 
 Occasionally, when the question of the suitability for occu- 
 pation by troops of some station or other is being discussed, 
 
 365 
 
366 MILITARY HYGIENE AND SANITATION 
 
 objections are raised on the ground of its being inside what 
 is called the " fever zone," which is defined as being below 
 4,000 feet or thereabouts. It is worth remembering that in 
 1710 Lambeth and Southwark were undoubtedly in the 
 fever zone, and that if that zone were a purely orographical 
 phenomenon they should still be in it. 
 
 The most important epidemic of malaria in the history of 
 the British Army is that which occurred in the Walcheren 
 Expedition. The size of the force implicated and the 
 proximity of the locahty to our own shores impressed, as 
 was only natural, the public opinion of those days in an 
 unprecedented manner. Nearly one-quarter of the 17,000 
 men employed died, ajid at one time two-thirds of the total 
 strength was in hospital, the death-rate being twenty-five to 
 thirty a day. The locality selected for debarkation was 
 notoriously malarial, the season of the year the most un- 
 healthy of the four, and there was no selection of the men. 
 Other mistakes in plenty were made, but the three cardinal 
 errors just noted should be remembered, because they 
 furnish useful danger-posts for future guidance. The chief 
 historical interest, however, centres around our numerous 
 tropical campaigns, and of these I will only refer to those 
 in Ashanti in the years 1864 and 1874. As regards the 
 former, Surgeon-General A. A. Gore writes in his " Medical 
 History of West African Campaigns ": "It can hardly be 
 called a war, as an enemy was never seen or a grain of powder 
 expended. Our troops were defeated by disease, much of 
 which was preventable." It may be said briefly that the 
 entire force either died or was invalided, and the same fate 
 overtook the reinforcements. In the 1874 expedition, on 
 the other hand, the death-rate was 18-2 per 1,000, including 
 thirteen killed in action. The campaign was, in a military 
 sense, a striking and complete success. The force was care- 
 fully picked, local preparations were carefully made in 
 advance, the best season of the year was selected, and the 
 blow, when it was struck, was sent clean home'without any 
 delay. This expedition, in spite of the fact that it took 
 place before the true cause of malarial fevers was known, 
 or the foundations of the science of tropical medicine laid, 
 might be taken as a model for the planning of all other 
 campaigns in tropical countries. It is an excellent iUustra- 
 
PREVENTION OF INFECTIOUS DISEASES 367 
 
 tion of the value of a knowledge of military history in the 
 practice of military sanitation. Twenty-one years later, 
 observing the same rules, a second successful expedition into 
 Ashanti was made, whilst in the very same year a French 
 force in Madagascar — a not particularly unhealthy climate 
 — through neglect of these rules, met the same fate as that 
 which overwhelmed our troops in 1864. Malaria has also 
 played a great part in our Indian campaigns, especially those 
 in Arracan and Burma, but it would exceed the bounds of 
 this work to discuss these. The campaigns I have already 
 mentioned I have selected as furnishing certain useful data 
 for prevention in war, and I wiU refer to these again later. 
 
 Prevention of Malaria. — In this, as in all infectious 
 diseases, we have to consider the infected man, the germ, 
 and the non-infected man. The connection between the 
 three is, however, much simplified by the fact that a fourth 
 factor is introduced, and that the path followed by the germ 
 from the first to the second human being implicated is 
 extremely narrow, being limited to the body of a certain 
 species of mosquito, and to the female only of that species. 
 
 The infectivity of the infected man does not depend on 
 any innate quality residing in him, or on any voluntary act 
 of his own, but purely on the possibility of his being bitten 
 by a particular species of insect. The danger to the non- 
 infected man is similarly conditioned. The work of preven- 
 tion is directed, therefore, entirely towards eliminating aU 
 possibility of the insect in question biting any man at all, 
 either by destroying the insect, which is obviously the best 
 method, or by interposing some mechanical obstruction 
 between the man and the insect which will prevent the 
 latter biting the former. Lastly, if for any reason these 
 measures fail, we can by the use of drugs render the blood 
 of the non-infected man an unsuitable habitat for the 
 disease germ. This procedure possesses, however, the same 
 essential defect as does prevention by inoculation, since it 
 aims at protecting each individual separately, and not at 
 protecting the community as a whole, and, therefore, all the 
 individuals of which it is composed. In addition, as far as 
 we know, it protects the individual against only one mos- 
 quito-borne infection, and if there are objections to the 
 multiplication of inoculations, there are infinitely more 
 
368 MILITARY HYGIENE AND SANITATION 
 
 objections to prevention by polypharmacy. Lastly, whilst 
 the protection afforded by inoculation lasts for a term of 
 years, that supplied by drugging can be measured in hours. 
 
 Mechanical Protection against the Bites of Insects. — This 
 can be supplied by surrounding the individual with an im- 
 pervious screen composed either of metal or some textile 
 material, which will allow free circulation of air, and at the 
 same time place an insuperable barrier in the path of flight 
 of the insect. It is, in fact, a method of filtration, and just 
 as in the case of filtration of water, it is impossible to keep 
 back the suspended particles without to some extent ob- 
 structing the free passage of the water, so here it is im- 
 possible to keep out the mosquito without to a greater or 
 less extent interfering with the motion of the currents of air. 
 
 The materials used are either mosquito-curtains, which 
 protect the individual during repose, or mosquito-proof gauze 
 windows and doors, which protect him at all hours during 
 which the insect is active. Curtains are in common use in 
 all tropical and subtropical climates where mosquitoes are 
 numerous. They are so familiar that any lengthy descrip- 
 tion is unnecessary. They should be large enough to have 
 a sufficient margin to tuck in under the mattress, and it is 
 advisable that the lower part, which may come into contact 
 with the body of the sleeper, should be made, not of netting, 
 but of calico, or else, as Ross advises, with a valance of 
 netting in addition, to prevent the mosquito pushing its 
 proboscis through the apertures. Before arranging the net 
 in position for the night, search should be made in the angles 
 at the top for any insect that may have taken shelter there 
 after feeding during the previous night. Ross advises that 
 there should be no opening in the net, and this is most im- 
 portant. Nets, as purchased, frequently have a flap-door 
 which it is practically impossible to close completely. The 
 mesh of the net is usually eighteen threads to the inch. 
 
 I would strongly recommend any officer living in a roomy 
 bungalow to have a small mosquito-proof room built inside 
 his bedroom — say 12 feet by 10 feet by 8 feet — ^large enough 
 to hold his bedstead, an easy-chair, a bedside table, and a 
 small bookcase. The walls and roof of the room should be 
 either of netting or wire gauze on a wooden framework. 
 With a small electric or hot-air fan he will be more com- 
 
PEEVENTION OF INFECTIOUS DISEASES 369 
 
 fortable in this room than under a mosquito-net, and he 
 can spend the hotter hours of the "long, long Indian day " 
 in comparative comfort. 
 
 Buildings may be rendered entirely mosquito-proof by 
 the use of wire gauze in the doors and windows. The 
 material may be either tinned iron, copper, or brass, the 
 latter being somewhat more expensive. The suggestion of 
 Wurtz, quoted by Ross, for the substitution of netting 
 painted over with silicate of potassium for metal gauze is 
 well worth remembering. In this case the mesh should be 
 larger than that recommended above. 
 
 By any of the above methods it is possible for the indi- 
 vidual or the household to secure mechanical protection 
 against the bites of mosquitoes. 
 
 When we come to the question of protecting the soldier, 
 the matter is less simple. The use of mosquito-curtains in 
 barracks is absolutely out of the question in the hot weather 
 in India. The inevitable obstruction to ventilation and the 
 impossibiHty of using net frames of sufficient size at the 
 same time as punkahs decides me definitely against them. 
 In certain stations, no doubt, and at certain seasons of the 
 year, they might be possible, but in those cantonments 
 where the bulk of our army is stationed they would, except 
 as an occasional method of protection, be out of the ques- 
 tion. Mosquito-proof doors and windows would be less 
 objectionable, but the former would be constantly left open, 
 and the latter would be apt to be broken. During the hot, 
 dry weather of Upper India gauze has the great disadvantage 
 of collecting and holding dust. If the gauze were fixed in 
 detachable frames this objection would be to a great extent 
 removed. In any case, if gauze doors and windows are used, 
 it would be necessary to introduce some more efficient form 
 of fan than the common hand-pulled punkah. 
 
 A good current of §;ir is, in fact, one of the best mechanical 
 protections against the mosquito, and I think that the 
 introduction of electric fans would be justified on this 
 account alone. 
 
 The use of essential oils is occasionally resorted to with 
 a view to keeping mosquitoes at a distance. To most people 
 the sensation of heat that results is intensely uncomfortable, 
 but for sentries and others who are necessarily exposed in 
 
 24 
 
370 MILITARY HYGIENE AND SANITATION 
 
 the open, and whose hands must be left unencumbered, this 
 method of protection should be useful. The ordinary kero- 
 sene oil, which is everywhere obtainable in the East, acts 
 very well in this direction. 
 
 Gauntlet gloves and veils were used by the Japanese in 
 Formosa, and on occasion might be resorted to. They pos- 
 sess the very distinct disadvantage from the military point 
 of view of obscuring vision and interfering with the manipu- 
 lation of the firearm. Officers will do well to remember 
 that the Wellington boot affords in evening dress a protec- 
 tion that the more strictly fashionable " pump " and thin 
 sock fail in providing. 
 
 As regards the patient in hospital, the first step is neces- 
 sarily isolation. This is now universally carried out. The 
 next is protection by mosquito-netting or wire gauze screen- 
 ing over door and windows. The latter should be provided 
 in all fever wards, to exclude flies as well as mosquitoes ; 
 but the window gauze should be, if possible, in removable 
 frames, so that the windows may be taken out when neither 
 of the insects noted is in marked evidence. The objections 
 to mosquito curtains in hospital are very great. They 
 obstruct ventilation, and are an intolerable nuisance from 
 the nursing point of view. They should only be used where 
 proper screening is impossible. Wire gauze is not open to 
 the same objections in hospitals as in barracks, since there 
 is not the same coming and going, and nurses and orderlies 
 are more careful in the matter of closing doors than is the 
 healthy soldier in barracks. In dusty weather all gauze 
 should be wiped with a cloth soaked in weak disinfectant 
 solution once in the twenty-four hours. 
 
 The Attack on the Mosquito. — All these precautions, with 
 the exception of wire screening of doors and windows, are 
 open to the objection that they aim at individual, not com- 
 munal, protection. The latter is only. effected by attacking 
 the insect directly, and destroying it, either in its aquatic 
 or its aerial period of existence. 
 
 I do not intend here to go into detail as regards the cycle 
 of the mosquito's life. Suffice it to say that the stages of 
 egg, larva, and pupa are passed in the water, that of imago 
 in the air. During the stages of larva and pupa the insect 
 needs not only water, but also air, and is, therefore, naturally 
 
PREVENTION OF INFECTIOUS DISEASES 371 
 
 most vulnerable at these periods. Its movements are also 
 considerably less free than when it exists in the fully- winged 
 form, and, therefore, attack is more easily directed. 
 
 It is necessary to remember, as an item in general know- 
 ledge, that only mosquitoes belonging to a certain genus, 
 Anopheles, are capable of acting as hosts for the malarial 
 Plasmodium, that not even in this genus are all the species 
 so endowed, and that in any case only the female sex possess 
 the quality. At first sight, then, it would appear that our 
 destructive measures should be directed only against these 
 special species, and in most textbooks a certain space is 
 devoted to a consideration of their habits, especially as to 
 the nature of the water, clear or turbid, running or stagnant, 
 in which they prefer to live. I cannot myself see the neces- 
 sity for such a meticulous differentiation. The mosquito, 
 whether Culex or Anopheles, whether merely an annoyance 
 or a danger, is assuredly under every condition hostis humani 
 generis, and deserves so to be treated. Personally, I should 
 incline to a cold scepticism if any officer assured me that he 
 had destroyed all the malarial-bearing mosquitoes in a 
 station wherein I suffered at all seriously from the bites of 
 the common Culex. 
 
 These remarks apply, of course, only to the current anti- 
 malarial work of the station, and the class of operations that 
 can be undertaken by the local authorities without incurring 
 serious expense. When it is a question of permanent im- 
 provements and large outlay, naturally the identity and 
 habits of the local " malaria-carrier " need to be carefully 
 studied. 
 
 The object, then, to be kept in view is the destruction of 
 all collections of water in which mosquitoes can breed, and 
 where this is impossible, the rendering of such collections 
 uninhabitable as regards the insect. 
 
 The first method applies naturally only to such small col- 
 lections as are contained in empty tins and bottles, casual 
 rain-puddles, etc. ; whilst the latter step must be taken in 
 the case of larger permanent sheets of water — irrigation 
 channels, storage cisterns, and so on. To begin with, how- 
 ever, it is necessary to get a large scale-map of the station — 
 on a scale, say, of 25 inches to the mile — on which every 
 road, building, watercourse, and pond should be clearly 
 
372 MILITARY HYGIENE AND SANITATION 
 
 shown. A careful survey must next be made of the station, 
 and any other fairly obvious breeding-grounds — e.g., borrow- 
 pits, rain-water cisterns, etc. — recorded on the map by any 
 convenient conventional sign. If the season of the year be 
 dry, then it is as well to take advantage of any casual rain- 
 storm to identify localities where the water is apt to hang. 
 Patches of wet cultivation, if allowed to remain, should also 
 be noted. In many stations breeding-grounds peculiar to 
 the station exists. Thus, at Bangalore, where large bosses 
 of granitoid rock exist, it will be found that water collects 
 in niches in the rock left by the partial removal of ex- 
 foliating layers. Stand-pipes often give rise to breeding- 
 grounds in consequence of the drip of water from an 
 imperfect valve. 
 
 The breeding-grounds having been as far as possible 
 identified, the station should be divided into sanitary areas, 
 corresponding most conveniently to the lines of the different 
 units, and placed under the medical officers in charge of 
 those units. It should be the duty of these officers to keep 
 the map-sections relating to their various areas up to date, 
 noting carefully any new temporary or permanent breeding- 
 grounds that may come into existence. It will also be 
 necessary to allot to each sanitary area a gang of workmen 
 under a foreman, the establishment being proportioned to 
 the size of the area. It will, perhaps, be necessary to take 
 on extra hands during the rainy season, but the permanent 
 cadre must be sufficient to deal with the permanent water. 
 Some system of work must be laid down, but the details of 
 this will vary with the station concerned. It is necessary 
 to remember that the insect takes about ten days to develop 
 from the egg to the imago, and spends a week in the larval 
 stage, so that every breeding-ground should be dealt with 
 once a week, but need not be visited oftener. The keynote 
 of the whole campaign is intelligence first, and system next. 
 Given these, the arranging of practical details is a task 
 demanding only common sense and money. The former of 
 these must be supplied by the officers concerned, the latter 
 is a matter for the consideration of higher authorities. 
 These last may or may not see their way to the necessary 
 expenditure ; that is, after all, their affair. They most cer- 
 tainly will not see their way if they think the money is 
 
PREVENTION OF INFECTIOUS DISEASES 373 
 
 going to be wasted in aimless and unsystematic fiddling 
 with the problem. 
 
 In an Indian cantonment there is no great difficulty in 
 the case of the barracks or the ground in their immediate 
 vicinity. The trouble really arises in connection with 
 private compounds, native bazaars, and the lines of fol- 
 lowers. As regards the former, I have no doubt at all in 
 my mind that the occupier or owner, if the house be un- 
 occupied, should be made personally responsible for the 
 breeding-grounds in the bungalow compounds. Some para- 
 graph like the following should be inserted in Station Stand- 
 ing Orders (copied from the draft regulations drawn up for 
 Mauritius by Ross) : " It shall not be lawful for any owner 
 or occupier to aUow mosquitoes to breed in his premises, or 
 to allow the presence on such premises of any receptacle in 
 which water is kept or may coUect, unless such receptacles 
 are properly protected from access of mosquitoes, or unless 
 the water they may contain is treated in such a way as to 
 prevent the breeding therein of mosquitoes, nor shall such 
 owner or occupier allow on his premises any conditions 
 which may in any way be favourable to the breeding of 
 mosquitoes." The " civil " language used above may fitly 
 in a miHtary order be made somewhat more peremptory. 
 
 With regard to the better-class native there will always 
 be a great deal of tact necessary, as in all other sanitary 
 matters ; but in the followers' lines it should be fairly 
 easy to enforce the rule as to the abolition of stagnant 
 water. 
 
 One of the most usual breeding-grounds in private bunga- 
 lows is the earthenware jar, or ghurrah, which is used to 
 collect the outflow from the bathroom. This is usually 
 emptied out inefficiently by the gardener for the sake of the 
 flowers, but a scanty residue is always left, which is as a 
 rule crowded with mosquito larvae and pupae. The garden 
 well, rarely covered over, is also troublesome. Some form 
 of insecticide is probably the best thing here if the well is 
 used for irrigation. All unused wells should be covered over. 
 " Pot-gardening " being the rule throughout India, numerous 
 loopholes are given here for the mosquito, whicli need watch- 
 ing. The accumulation of large pot plants in or along the 
 edges of verandas is a mistake, as they not only encourage 
 
374 MILITARY HYGIENE AND SANITATION 
 
 mosquitoes, but obstruct the passage of air, whilst the 
 moisture of their frequent waterings is sufficient only to 
 make the atmosphere close. Whilst on this subject, it may 
 be as well to lay down that no high trees or dense shrubbery 
 should be allowed near a house in India. The amount of 
 protection which the former afford against the rays of the 
 sun is more than counterbalanced by the closeness they 
 engender. 
 
 Storage cisterns are rare, but when they exist should be 
 netted over or oiled. A piece of wood or metal, heavily 
 tarred and placed in the water, is a fairly efficient means of 
 maintaining a scum on the surface of the small masonry 
 cisterns which often exist in Indian gardens. 
 
 Large Ponds and Lakes. — -These exist in many Indian 
 stations, and when of considerable size add greatly to the 
 amenity of the locality. When small — ^what would be called 
 in England horse-ponds — they should be filled up or drained. 
 The larger lakes are usually formed by artificially blocking 
 up some natural drainage channel. One side, therefore, 
 shows a steep bank, usually protected by a cement or 
 masonry revetment. The water here is usually deep, except 
 in very dry weather, and mosquitoes do not breed as a rule 
 along this side, owing to the constant disturbance by the 
 wind-fret of the ripples, and also the fact that fish and 
 other aquatic foes are able to pursue them to the edge. A 
 considerable extent of the margin, however, consists of a 
 sloping foreshore, muddy, and poached by cattle when the 
 water is low, or grass-covered during the wet season. In 
 either case, mosquitoes are at liberty to breed freely in 
 amongst the grass-roots or in the small puddles left behind 
 by the retreating water in small inequalities, more especially 
 in the hoof -marks. Dealing with the latter first, it is im- 
 portant to limit, as is done in Panama, the access of cattle 
 to the water except at certain definite places. Here, the fore- 
 shore should be paved with cobbles (these are better than 
 cement, which invariably gets broken up) for a sufficient 
 distance. Throughout the rest of the margin of the tank 
 the endeavour should be made to keep the water as deep as 
 possible up to the edge. This may be done by building out 
 the bank or else cutting it back. When the water recedes 
 from the artificial bank it should leave only a flat, not a 
 
PREVENTION OF INFECTIOUS DISEASES 375 
 
 shelving bottom, and this can be managed by cutting 
 terraces in the bottom of the tank during the dry weather. 
 In stations where the subsoil is either clay or laterite (and 
 this in my experience in India covers the majority of cases 
 that demand treatment) there need be no difficulty in the 
 above. When the water in a very dry season retreats 
 beyond all the artificial safeguards that have been arranged, 
 then probably the surface will have got so small that oiling 
 or other measures will have become practicable. Looking 
 back on my Indian experience, I can only remember one 
 station where it would be impossible to carry out measures 
 on the above lines, and that is Meiktila, in Upper Burma. 
 The Hoossein Sagar, in Secunderabad, the Ulsoor Tank in 
 Bangalore, and the tanks in Umballa, to name a few in- 
 stances, are too far from barracks to come into considera- 
 tion. 
 
 Irrigation Channels. — In some stations irrigation is a 
 necessity of human existence. I remember visiting the 
 station of Meean Meer (now Lahore Cantonment) in 1905, 
 when irrigation had been cut off. Malaria was no doubt 
 very prevalent in that station prior to that change, but at 
 least life was possible. Speaking quite deliberately, I feel 
 justified in saying that the clouds of dust and the persecu- 
 tions of sand-flies made life barely worth living under the 
 new conditions. Irrigation, then, being a necessity, the 
 question remains — How is it to be carried out ? Personally, 
 I am of opinion that in such a case well irrigation is the 
 solution of the problem. Irrigation from canals and irriga- 
 tion from wells differ considerably from each other. In the 
 former, extraneous water is brought into the station. The 
 cultivator, it is true, pays a certain tax proportioned to the 
 amount of water that he receives, but without casting any 
 undue slight on the honesty of the native sub-subordinate 
 who arranges these matters, I am under the impression that 
 no extraordinary strain is placed either on his conscience 
 or the pocket of the gardener in arranging an additional 
 allowance. The inevitable consequence is flooding of the 
 garden plots. On the other hand, if well irrigation is re- 
 sorted to, every drop of water has to be dragged laboriously 
 to the surface by bullock-traction, which necessitates a 
 decidedly greater amount of personal labour on the cul- 
 
376 MILITARY HYGIENE AND SANITATION 
 
 tivator. Flooding is therefore prevented. But more im- 
 portant even than this, the water which is used for irriga- 
 tion is no longer extraneous. It is merely shifted vertically 
 from one part of the station to another, and very quickly 
 finds its own level again. If irrigation is necessary, then 
 let it be well irrigation. If canal irrigation is demanded, 
 then constant watch should be kept to see that it is care- 
 fully regulated, and that any patch flooded is allowed to 
 dry completely before another allowance of water is supplied. 
 At the same time, every water-lead must be carefully 
 watched, and all places, such as small backwaters below 
 culverts, or other places where mosquitoes may find a 
 breeding-place, well stirred up with a paddle or other 
 implement once or twice a week, so that all collections of 
 floating leaves, under and amongst which mosquitoes might 
 breed, shall be satisfactorily disturbed. 
 
 I have mentioned merely a few points which my experi- 
 ence in India has shown me to be important. Every station 
 has its own weak points, and it is the business of the senior 
 medical officer to realize these, and see that the resultant 
 danger is met. 
 
 Working on a system, and with a map, he need be no 
 genius to effect this. Without a system and without a map, 
 all his efforts wiU be useless. I except those Napoleonic 
 geniuses who are so frequent in theory (their own) and so 
 rare in experience (mine, and I venture to say that of their 
 brother officers), who, by the mere light of nature, and that 
 automatic grasp of the conditions which their intellects 
 confer, are able to tackle any situation as it arises. I admire, 
 I regret I am unable to imitate their success, and I fear I even 
 retain a certain ungenerous scepticism as to its existence. 
 
 However energetic and systematic an officer may be, 
 he need never hope to eliminate all the malaria-bearing 
 mosquitoes, nor even all the harmless individual members 
 of that family, in his station. It may be some consolation 
 to such to realize that at least two species of Anopheles 
 capable of bearing malaria still exist in considerable numbers 
 in this country, and that even whilst writing this chapter 
 within eighteen miles of London, I have had to repel the 
 too urgent attentions of various members of the Culex 
 tribe. A station can be malaria free without being mosquito 
 
PREVENTION OF INFECTIOUS DISEASES 377 
 
 free, and life can be easily supported even where the gnat 
 occasionally winds his sleepy horn, as long as the music is 
 not too insistent. 
 
 The ingenious calculations of Ross have shown very 
 clearly that if the disease-bearing anopheles are reduced 
 below a certain proportion, malaria must inevitably die out, 
 and the fact that these insects still breed in a considerable 
 number of places in England is eloquent additional proof 
 of the theory. 
 
 Malarial Records. — It is most important that a record 
 should be kept of all cases of malaria occurring in the 
 station, and their incidence noted on a map. A check can 
 thus be kept on the operations of the various mosquito 
 gangs, and any unrecognized breeding-ground traced. 
 
 Destruction of Adult Mosquitoes. — ^This is neither so 
 easy nor so efficacious as destruction of the larvae, partly 
 because of the nimble flight of the winged insect, and partly 
 on account of the fact that our efforts have to be directed 
 largely to killing individual insects, and not to mass destruc- 
 tion, as when we deal with the breeding-places of larvae. 
 
 Ross advocates the use of a small hand-net, and where the 
 numbers are small a great deal can be effected in this 
 manner. In hospital wards such a method of killing the 
 stragglers that have passed the first defences of netting or 
 gauze would undoubtedly be extremely useful. 
 
 Fumigation by means of sulphur, pyrethrum, or camphor 
 and carbolic acid may be used, and would be advisable in 
 the case of taking over a previously unoccupied bungalow. 
 Barracks, which have been left empty during the hot 
 weather, might conveniently be so treated before being 
 occupied by troops coming down from hill-stations. 
 
 Mosquito traps were first suggested by Nuttall, and have 
 been used in Dahomey by French officers. These consist 
 either of holes dug in the ground, and so placed as to be 
 sheltered from the direct rays of the sun, or else, in bunga- 
 lows, of small boxes, painted black inside, or lined with 
 black cloth. AU such measures must, however, be looked 
 on as merely palliative and secondary to a well-considered 
 campaign directed against the larvae. 
 
 Prophylactic Administration of Quinine. — • This may be 
 resorted to with advantage when other measures, such 
 
378 MILITARY HYGIENE AND SANITATION 
 
 as the destruction of the larvae or adult insects, are impos- 
 sible, or only applicable in an imperfect manner. It is 
 most unscientific to rely on it as the main basis of prophy- 
 laxis in peace-time. I have already discussed this matter, 
 and need not repeat what I have already said thereon. 
 Personally I prefer the occasional administration of quinine 
 in large doses to the constant taking of small amounts of 
 the drug. Opinions are, however, about equally divided 
 on the subject. In the former case 10 to 15 grains on Monday 
 and Tuesday of every week ; in the latter 5 grains every 
 morning should be given. Men going out to shoot in 
 specially malarious localities should certainly, if the ex- 
 posure is to be for a short time only, start with a couple of 
 good doses, followed either by a periodical repetition of 
 the same, or the smaller daily dose. 
 
 Malaria in War. — • The consideration of malaria in war 
 resolves itself practically into a discussion of the conduct 
 of a tropical campaign. Of these the Ashanti expedition 
 of 1874 should be taken as a model. The keynotes of this 
 campaign were careful preparation, followed by rapid execu- 
 tion, the actual striking of the blow being effected by a 
 carefully selected European force, of which no other duty 
 except that of marching and fighting was demanded. In 
 all tropical campaigns the human enemy consists of savages, 
 who, whatever their bravery, can be fitly encountered by 
 men of their own race as long as these have the benefit of 
 the superior arms and organization of a civilized nation. 
 All the hard work and drudgery should be performed by 
 locally raised levies, under the immediate supervision of 
 European officers and a few non-commissioned officers. 
 This rule would apply to all the non-combatant services — • 
 engineering, transport and supply, and medical to a very 
 great extent. The proportion of natives to white men in 
 the Ashanti expedition was as two to one ; in the first ex- 
 pedition the numbers were about equal ; whilst in the French 
 campaign in Madagascar the proportions were reversed, the 
 white force numbering 11,000, the native 3,800 only. 
 
 In selecting men for such an expedition all those with 
 a bad malarious history, or with the plasmodium in their 
 blood, should be excluded. In the case of officers it would 
 be necessary to balance the advantages furnished by the 
 
PEEVENTION OF INFECTIOUS DISEASES 379 
 
 possession of some special qualification, against the possible 
 danger to the other members of the staff of an infected 
 individual in their midst. 
 
 The actual base of operations and the line of advance 
 should be selected very largely on medical grounds, pre- 
 mising, of course, that there is any choice in the matter. 
 A specially selected medical officer should be deputed to 
 coUect intelligence as to the health conditions of the locality, 
 and to draft a scheme for antimalarial measures at the base. 
 He should reconnoitre as far as possible along the intended 
 line of advance, selecting the positions for permanent and 
 temporary posts on the lines of communication. 
 
 It must be remembered that in a campaign of this nature 
 the superiority of the civilized force on the purely military 
 side is so great that it can afford to give away even consider- 
 able tactical advantages, whilst it cannot afford to take 
 any chances as regards disease. This is more particularly 
 the case as regards the base, which, in the case of the British 
 Army, is almost invariably on the sea coast, where, therefore, 
 the guns and searchlights of the fleet can be made available 
 for local defence. Posts on the lines of communication 
 should never be in proximity to a native village. Where, 
 however, such a site is imperative on military grounds, the 
 village must be destroyed by fire, the inhabitants, if friendly, 
 being compensated appropriately. 
 
 The actual prevention of malaria must proceed on pre- 
 cisely the same lines as in peace — ^that is to say, the sick 
 must be isolated, the healthy man protected from the bites 
 of mosquitoes, and these destroyed wherever such a course 
 is feasible. At the base itseK, and to a less extent at the 
 permanent posts on the lines of communication, the steps 
 taken must approximate as closely as possible to those 
 adopted in cantonments. In proportion as service con- 
 ditions prevail, the measures adopted must also be modified. 
 Night duties must be made as light as possible, and sentries 
 reHeved frequently. Every advantage should be taken 
 of artificial aids to strengthen defences, and so limit as far 
 as possible the service of security. 
 
 For troops continuously on the move the prophylactic 
 use of quinine must be the main resource, and it is as 
 weU to remember that even when troops are halted it is 
 
380 MILITARY HYGIENE AND SANITATION 
 
 unnecessary to take active antilarval measures if the period 
 during which they are intended to remain stationary is less 
 than one week. 
 
 The Exanthemata. — ^The diseases included under this 
 heading are not of frequent occurrence in the army in time 
 of peace. They are, with the single exception of smallpox, 
 rare in the tropics. At home occasional outbreaks of 
 measles and scarlet fever occur, but the total amount of 
 disability resulting from these diseases is not important. 
 Thus, in the year 1909 there were only 575 admissions from 
 measles and scarlet fever combined, with six deaths in the 
 whole army at home and abroad, the ratios per thousand 
 being 2-6 and 0-02 respectively ; 494 of the admissions 
 and all the deaths occurred in the United Kingdom, and 
 45 of the former in India. Smallpox accounted for 28 cases 
 and 2 deaths ; 19 of the cases were in India, and the rest 
 in Egypt, the deaths being equally divided between the 
 two. The figures for the quinquennium (1904 to 1908) do 
 not differ appreciably from the above. 
 
 It is possible in time of war that an army consisting 
 largely of young reservists, and collected from all regions 
 of any European country, might show a considerable number 
 of cases, especially immediately after mobilization. The 
 evidence of the past is, however, inconclusive on this point. 
 Thus, in the North and South War the Federal troops 
 returned 77 cases of measles per 1,000 of strength in the 
 first year of the war, whilst the Confederates had over 
 8,000 cases out of a strength of 58,000 men during the 
 months of July, August, and September of 1861. In both 
 armies the disease became less common as the war pro- 
 gressed, and the number of protected men increased. 
 Scarlet fever was rare on both sides. In the Franco-German 
 War these two diseases played apparently a comparatively 
 unimportant part, no special notice being made of them 
 in the official German report. In the South African War 
 there were only 338 cases of scarlet fever, and 1,218 cases 
 of measles during the whole of the campaign, a number 
 which is quite negligible considering the length of the period 
 included. On the other hand, the Boers suffered rather 
 severely, which shows that there was no climatic protection. 
 
 In the case of war in Europe it is probable that the 
 
PEEVENTION OF INFECTIOUS DISEASES 381 
 
 relatively greater age of our reservists would be in our 
 favour, in comparison with other armies. There would, 
 however, always be a danger from young soldiers of the 
 regular army returning from furlough shortly before the 
 outbreak of hostihties. It is not unHkely that any concen- 
 tration of territorial troops might show a considerable 
 number of cases, since their age would render them more 
 susceptible, and the force would consist of men drawn from 
 a large area of the country. Some existent infection might 
 be expected to be present, and should always be anticipated. 
 
 The prevention of these diseases (apart from smallpox, 
 which is largely, of course, a question of vaccination) must 
 be conducted on the same lines as that of any other in- 
 fectious disease. The chain — infected man, micro-organism, 
 healthy man — must be assumed to be the same, though the 
 actual causa causans has not so far in any case been satis- 
 factorily isolated. The mechanism of infection, whether 
 direct by contact of the two individuals, by ingestion or 
 inhalation, or indirect by the intermediate action of some 
 insect, is, of course, still unsettled. This fact renders the 
 actual procedure of prevention more difficult. We can 
 only rely on early recognition of cases, and isolation of 
 patients and possibly also contacts, and thorough dis- 
 infection of all clothing and bedding. 
 
 Early recognition is, of course, the most important of 
 these steps, and here we are at once confronted with the 
 difficulty that bacterial methods are not at our disposal 
 in the present state of our knowledge. We must, therefore, 
 rely on previous history. We do not know yet whether the 
 " carrier " case is as common in these diseases as in those 
 of which our knowledge is more extensive and complete. 
 It is probable that " carriers " are not common, since fresh 
 outbreaks due to the return to duty of men who have 
 suffered from either scarlet fever or measles, and gone 
 through the usual period of quarantine, have not been 
 noticed. The history of contact, or possible contact, is, 
 then, of chief importance. 
 
 As far as the regular in the ranks is concerned, we are 
 fairly safe here, but not in the case of the reservist or the 
 territorial soldier. The former is usually protected by age, 
 but each man might be asked, on examination for fitness, 
 
382 MILITARY HYGIENE AND SANITATION 
 
 whether he has been lately in contact with the disease ? 
 It would be too sanguine to expect a truthful answer to the 
 query. The good soldier would not admit the possibility, 
 the bad one might use it as a loophole whereby to escape 
 the performance of his duty. Information as to the exist- 
 ence of any serious amount of such disease in any depot 
 town or any large centre from which many men were likely 
 to come might be procured by the military authorities from 
 the Local Government Board, and units so affected might 
 be quarantined for, say, a week, supposing this not to inter- 
 fere with mobilization arrangements. It would be un- 
 necessary to quarantine for longer than the minimum 
 incubation period, since in the case of widespread infection 
 the disease would be certain to appear amongst the most 
 susceptible individuals who had been exposed to it. A 
 certain risk would, of course, have to be taken. In no case 
 must the smooth progress of mobilization be interfered with. 
 With regard to territorial troops, the danger will, I 
 believe, be greater than with regulars for the reasons already 
 given, but chiefly because of the enormous number of possibly 
 infected areas from which the men will have been drawn. 
 One of the earliest duties of the medical officer of a terri- 
 torial unit on mobilization will be to verify the vaccination 
 of his unit. Every man who cannot show signs of successful 
 revaccination, or a record of the same, should be revaccinated 
 or discharged as unfit for service. As regard scarlet fever 
 and measles, the difficulty is greater. At the same time that 
 the medical officer is satisfying himself as to the vaccination 
 of his unit, he should inquire as to previous diseases so as 
 to know the number of men protected by previous attacks. 
 He should also try to get into touch with the medical officer 
 of health for the district from which his unit is recruited, 
 and ascertain whether either of the above diseases (or any 
 others of the same class) have been lately prevalent in any 
 part of the district. Men coming directly from any part 
 known to be seriously affected must, if military considera- 
 tions permit, be isolated. I say " if military considerations 
 permit " because, once mobilization is ordered, these become 
 paramount. The responsibility for the decision does not 
 rest with the medical officer, but the officer commanding 
 the unit, or the General commanding the brigade or division. 
 
PREVENTION OF INFECTIOUS DISEASES 383 
 
 It is incumbent on the medical officer to place the facts 
 clearly before such superior authority, stating exactly the 
 degree of danger that he considers to exist ; the gravest error 
 that he can fall into is over-stating the case so as to make 
 things safe for himself. That is, of course, a very easy course 
 to follow, but it is a grave dereliction of duty. The medical 
 officer is the only man who can really appreciate the extent 
 of the risk, and he must not shirk the responsibility that 
 lies upon him, of stating it accurately and without exaggera- 
 tion to the commanding officer. 
 
 If isolation is impossible, then the medical officer must 
 make a point of seeing all men coming from infected districts 
 every day. The first symptoms of coryza, or of sore throat, 
 will justify him in sending such men into isolation for 
 observation, and all such cases must at once, from that 
 moment, be treated as actually infectious. Isolation in 
 such cases means absolute isolation, not the partial isolation 
 that I referred to in speaking of suspected " carriers " of 
 enteric fever. 
 
 AU sanitary officers, a la suite, should make a point of 
 warning officers commanding units of the presence of disease 
 of an infectious nature in any villages, towns, or farms in 
 their district. This would naturally be done through the 
 divisional sanitary officer, who should, in fact, himself make 
 it his business to ask for such information. 
 
 I have been speaking of these being carried out imme- 
 diately after mobilization, because the Territorial Army 
 does not exist as a permanent force until that occurs, but 
 I need hardly point out that every medical officer who is 
 in charge of a unit should be possessed of the information 
 as to vaccination and previous diseases long before that day 
 arrives. The fact that the regimental system, under which 
 medical officers actually belong to combatant units, still 
 exists in the territorial army, makes this easy of accom- 
 plishment, and it is for these officers to justify their position, 
 by recognizing that these duties exist not only in time of 
 war, but also in time of peace. 
 
 The problem of how to deal with an outbreak of exan- 
 thematous disease amongst troops composing a part of a 
 fighting force actually engaged in military operations is 
 one of extreme difficulty. Looking at the question broadly, 
 
384 MILITARY HYGIENE AND SANITATION 
 
 it seems to me that we can come to one definite conclusion 
 at least. The affected unit must on no account be kept at 
 the base or on the lines of communication. Such a step 
 would be more certain than any other to lead to dissemina- 
 tion of infection throughout the army. The conditions 
 which obtain at the front are those least favourable of any 
 to the spread of these diseases, since the men are to a great 
 extent in the open. During a prolonged halt the unit 
 concerned should be encamped as far apart from the rest 
 of the force as can be managed, and all mingling with the 
 rest of the troops restricted as far as possible. Suspicious 
 cases should be isolated in a separate camp, and contacts 
 carefully watched. Once the force begins to move, isola- 
 tion of any one unit, especially of an infantry battalion, 
 would be practically impossible, and the risk must simply 
 be run. It would be out of the question to immobilize a 
 whole battalion because one company had shown cases of 
 disease. Whether it would be worth while to immobilize 
 the peccant company is a question that must be settled on 
 the merits of the actual case. The intercommunication 
 between the different companies of a battalion* is, of course, 
 far greater than that between the different battalions of a 
 brigade, and, logically, if a company were immobilized, the 
 whole battalion should suffer the same fate. The line of 
 separation should be drawn between the battalion and other 
 battalions, not between one company and another. It 
 would need a very serious outbreak to justify the with- 
 drawal of a whole battalion from the fighting line : it could 
 not be used on the lines of communication, therefore it 
 seems to me clear that the fighting line is the best place for 
 it. Actual cases must be isolated and treated in a special 
 hospital, and on no account sent back along the ordinary 
 route of evacuation. Medical officers in charge of effective 
 troops must spare no pains in the endeavour to recognize 
 incipient cases. All men with sore throat or coryza must 
 be watched with the greatest care for any rise in tempera- 
 ture or access of other confirmatory symptoms. 
 
CHAPTER XXI 
 
 DISINFECTION 
 
 During the passage of the disease germ from the infected 
 to the non-infected man, it passes its interim existence in 
 certain matters, some of which are, so to speak, accessible, 
 and others inaccessible. Amongst the former are the clothes 
 and bedding used by the infected man, and the air and 
 surfaces of the room which he has occupied during his period 
 of infectivity. Amongst these also may be included his 
 discharges, faecal and otherwise. Clearly, in preventing the 
 passage of the germ from one man to another, it is necessary 
 to attempt at least to kill it during the period that elapses 
 when it is, so to speak, extra-corporeal, and this is accom- 
 plished by disinfection. Clearly, also, this can only apply 
 to those matters which are, as I have said, accessible. In 
 a great number of instances it is possible that the germ 
 may take up, as it were, an unassailable position, and in 
 such a case we are helpless. 
 
 The process of disinfection, then, aims only at killing the 
 germ in the clothes and bedding, or on the utensils used by 
 the infected man, or in the room occupied by him during 
 his period of infectivity, but it aims at nothing less than this. 
 Nothing short of killing can be called disinfection. This 
 process of killing is effected in various ways, principally 
 either by the operation of heat or the use of some chemical 
 solution or other ; but whichever class of process be used, 
 it is necessary to remember that the object of our attack 
 is not the matter in, or on, which the germ rests, but the 
 germ itseK. It is, for instance, no use to raise the tempera- 
 ture of an article of clothing to that point which we know 
 to be the death-point of the germ unless we insure that 
 the germ itself shall be heated to that point ; in other words, 
 
 385 25 
 
3$6 MILITARY HYGIENE AND SANITATION 
 
 that the heat shall penetrate to every portion of the article 
 concerned in which it is possible that the germ may be 
 concealed. Similarly it is useless to attempt to disinfect 
 a mass of faecal matter by immersion in a disinfectant 
 solution if we are unable to guarantee that the active 
 chemical particles shall in reality penetrate into all the 
 recesses of the mass, and thus come into contact with the 
 micro-organism. This is often forgotten, and it is not 
 infrequently the case that agents, particularly of a chemical 
 nature, are used whose action on the surroundings of the 
 germ is such as, in fact, to prevent their coming into intimate 
 contact with the germ itself. The disinfection of organic 
 discharges presents a case very much to the point. Any 
 agent which depends for its lethal action on its power 
 of coagulating albuminous matter may, if brought into use 
 for the disinfection of sputum, fseces, and so on, act in 
 reality as a protective instead of a destructive agent by 
 causing the formation of a defensive coating of solidified 
 albumin round the germ. It is true that in practice we do, 
 quite justifiably, use such solutions for the temporary 
 disinfection of the external surface of such masses of organic 
 matter pending a more complete process, in order to prevent 
 dissemination of infective particles from that surface during 
 transport to the apparatus where the true destructive 
 operation of disinfection shall be carried out. This pro- 
 cedure is only justifiable on the understanding that it is 
 a purely temporary expedient adopted ad hoc, to be followed 
 after the shortest convenient interval by a complete opera- 
 tion of disinfection. 
 
 Agents of Disinfection. — The agents used for the 
 complete destruction of germs are chemical solutions and 
 heat. Cold may also be used to render micro-organisms 
 temporarily inactive, and in Nature this actually may occur 
 when epidemics of infectious disease cease with the advent 
 of cold weather. As a matter of fact, this result may 
 equally well be due to the fact that the low atmospheric 
 temperature numbs and makes torpid the insects, flies, etc., 
 which are the efficient transporting agents of the germ. 
 
 Chemical Disinfectants.— These may be divided into two 
 classes : (1) Those which act on the germ in virtue of its 
 possessing vitality, in other words, the true protoplasmic 
 
DISINFECTION 387 
 
 poisons ; and (2) those which depend for their efficiency on 
 the fact that they are able to produce certain changes, as 
 of oxidation, reduction, or coagulation on all organic or all 
 albuminous matter indifferently of the fact whether it 
 possesses vitality or not. The distinction between these 
 two classes is of great importance. The true protoplasmic 
 poison exercises a selective influence, and acts on living 
 tissues and on them alone ; moreover, in so doing it does not 
 to any material extent expend its powers. Having killed 
 a certain mass of living organisms, it is still capable of further 
 activity, in apparently undiminished strength. 
 
 On the other hand, an oxidizing agent acts as a dis- 
 infectant purely in virtue of the fact that it possesses a 
 certain amount of readily dissociable oxygen, which can enter 
 into combination with the tissues of the germ, and having 
 parted with its oxygen during this process, it is ipso facto 
 rendered inert, and useless for further action. In addition, 
 it possesses no selective action, and is forced to part with 
 its oxygen to the first oxidizable matter with which it comes 
 into contact. This may be dead and harmless organic 
 matter, or even some incompletely oxidized inorganic 
 mineral ; in either case the oxidizing agent is once for all 
 reduced and rendered ineffective. The essential qualities 
 which a chemical disinfectant should possess are that it 
 shall be capable of penetrating to the inmost recesses of 
 the material to be disinfected ; and, secondly, that it shall 
 be able to effect that penetration without losing its essential 
 disinfective lethal powers. Oxidizing, reducing, and co- 
 agulating agents are, therefore, useless in the case of faeces, 
 sputa, or any similar organic infective matters, except for 
 surface disinfection. In selecting the class of disinfectant 
 to be used, we should therefore be guided by the nature of 
 the material that we wish to disinfect. The protoplasmic 
 poisons are those which are most generally efficacious. 
 
 The most important of these are the phenol derivatives, 
 carbolic acid, cresol, etc., which possess the additional 
 advantage of a strong odour, and in warm climates of dis- 
 couraging the presence of flies. In choosing any substance 
 of this class for the disinfection of linen, it is important to 
 select one'that will not leave a stain. 
 
 Various patent preparations are on the market which 
 
388 MILITARY HYGIENE AND SANITATION 
 
 consist of emulsions of tar oils with soap or glue. The 
 former have the advantage that they attack any greasy 
 matter enveloping the germ, and thus enable the disinfec- 
 tant particles actually to penetrate to the micro-organism 
 which it is desired to destroy. At one time they were sup- 
 posed to be immiscible with sea-water, or with strongly 
 saline fluids, such as urine. It has been discovered, however, 
 by Major Wanhill, that this difficulty may be overcome if 
 the soapy emulsion is first mixed with about four times its 
 bulk of fresh water. The effect produced is, of course, a 
 merely mechanical one on the arrangement of the globules, 
 of which the emulsion is formed. The soapy disinfectants 
 are far more stable than those made up with glue. The 
 latter separate out into layers after a very short period if 
 allowed to stand in contact with air — as, for instance, in a 
 half-emptied bottle or drum. Heat appears to accelerate 
 the change. Very considerable agitation is needed to effect 
 the formation of a satisfactory emulsion in these cases. 
 The strength of a disinfectant is usually stated as what is 
 termed its "carbolic coefficient." The figure of the co- 
 efficient denotes that one unit of the disinfectant in question 
 possesses a disinfectant strength equivalent to that of a 
 stated number of units of pure carbolic acid. As a rough 
 guide to the original strength of the preparation, this co- 
 efficient is not without a certain value, but it must not be 
 pressed too far. A difference of two or three in the figure of 
 the coefficient is practically negligible. This arises from the 
 fact that it is impossible to standardize with any degree of 
 accuracy the organism used in the test. Different strains 
 have different powers of resistance, and the same strain shows 
 a different power according to the length of time during 
 which it has been grown under artificial conditions. Again, 
 though the broth culture is supposed to be grown under 
 similar conditions and an equal amount of it taken on all 
 occasions, there is no possible guarantee that the bacilli in 
 the different specimens are in the same state of aggregation. 
 One loopful may take up several clumps of organisms, while 
 the next may take up comparatively few. 
 
 Accepting, then, the fact that the coefficient is valuable 
 only as a rough method of grading disinfectants in relation 
 to each other, there is the further objection that all phenol 
 
DISINFECTION 389 
 
 emulsions for some reason or other gradually lose their 
 strength in course of time, and this want of stability appears 
 to affect more markedly those which possess the highest co- 
 efficients. A high coefficient glue preparation has the 
 further drawback that the consistence is much more viscid, 
 and that, in consequence, it is more difficult to effect a satis- 
 factory mixture with water. In some cases a partial mixture 
 only takes place, the cloudy effect produced at the surface 
 of the receptacle used for mixing completely obscuring the 
 fact that the greater bulk of the disinfectant has sunk to 
 the bottom. It may be anticipated that in the hands of 
 careless or ignorant subordinates a great deal of the dis- 
 infectant would be wasted in this way. A preparation 
 having a moderately high coefficient — say, one of 10 — ^is, 
 on the whole, more easily handled and more reliable for 
 service use than one with a coefficient of, say, 18. It 
 must be remembered that the efficacy of a disinfectant 
 depends not only on strength, but on the power which its 
 ultimate molecules possess of penetrating to, and coming 
 into close contact with, the micro-organism. This demands 
 a state of very minute mechanical subdivision, which, with 
 the higher coefficient preparations, it is difficult to obtain, 
 or at least to guarantee. 
 
 Formaldehyde also acts as a direct protoplasmic poison. 
 It is used either in the shape of liquid formalin, which 
 contains 40 per cent, of pure formaldehyde, or in that of 
 paraform tablets. The vapour may be evolved either by 
 heating the tablets in one of the many forms of lamp in the 
 market, or by the chemical interaction of formalin and per- 
 manganate of potash. The latter method possesses the 
 advantage that no special form of apparatus is necessary, 
 and also that all risk of fire is avoided. Liquid formalin 
 is also used for spraying walls and other room-surfaces. 
 The great drawback to the use of formalin is the extreme 
 instability of the aldehyde and its liabilty to polymerization 
 with the formation of inert solid paraformaldehyde. In 
 addition, the vapour is extremely irritating to the eyes and 
 nose, rendering the operation of " spraying " extremely 
 irksome. When used as a vapour it is essential that the 
 relative humidity of the air in the room should be about 
 70 per cent., and the temperature about 70° F. — conditions 
 
390 MILITARY HYGIENE AND SANITATION 
 
 not always easy of realization. It coagulates albumin, and 
 therefore is apt to form a protective coating when used to 
 disinfect faeces and sputa. 
 
 Amongst this class of poisons may be included those sub- 
 stances which, on account of their powerful acid or alkaline 
 reaction, destroy bacteria. Of these, the most important 
 is milk of lime, which is useful in the disinfection of foul 
 drains, discharges, and garbage generally. Chloride of 
 lime, which is of utility under much the same conditions, 
 owes a part of its activity to the lime which it contains, 
 though, when fresh, the chlorine which it evolves is the 
 really important ingredient. Where a powerful deodorant 
 is required, as in foul urinals, stagnant drains, etc., it is 
 peculiarly useful. 
 
 Perchloride of mercury is an extremely powerful disin- 
 fectant, acting chiefly by its power of coagulating albumin. 
 Unfortunately, its use is much restricted on this very 
 account, and it is therefore useless for the purpose of disin- 
 fecting stools or other discharges. It fixes any stains of 
 blood, etc., that may happen to be on linen, and it 
 attacks unprotected metal surfaces. In military practice 
 it should never be used outside the hospital. The absence 
 of any distinctive odour or appearance renders it an ex- 
 tremely dangerous substance for use in latrines in barracks 
 or elsewhere, and though I am quite aware that it has been 
 used in many stations in India to add to the stools in 
 barrack latrines without any accidents occurring, the prac- 
 tice is, I consider, one fraught with the greatest danger. 
 
 The drawback to the use of all chemical disinfectants is 
 the impossibility of insuring complete penetration to the 
 innermost recesses of the substance to be disinfected. 
 Where heat cannot be applied — as, for instance, in the dis- 
 infection of room-surfaces — or where the proper apparatus 
 for its adoption in the case of clothing, etc., is absent, then 
 chemicals must be used. They may also justifiably be em- 
 ployed for the temporary disinfection of bed and body linen 
 or excreta, pending the application of heat. They should 
 never be used for the ultimate disinfection of any discharges, 
 faeces, pus, etc., since heat in the form of incineration or 
 boiling is practically always available for this purpose. 
 
 Disinfection by Heat. — Heat may be employed either in 
 
DISINFECTION 391 
 
 the form of dry or moist heat. In the former we trust to 
 incineration or dry air, in the latter to steam or boiling 
 water. The applicability of dry air is limited, owing to the 
 fact that it is an extremely bad conductor. If the substance 
 to be disinfected is bulky it is impossible to guarantee that 
 the entire mass shall be raised to the thermal death-point 
 of the disease germ without heating some parts of it to such 
 an extent as to char or even set fire to them. It cannot, 
 therefore, be used for the disinfection of clothing and 
 bedding in bulk, and its utility is limited, in fact, to the dis- 
 infection of certain small articles. 
 
 Incineration should be used for the disinfection of all 
 matters whose destruction is a matter of no moment — e.g., 
 old clothes, soiled rags, etc. — or for that of faeces or other 
 discharges whose destruction is on general grounds advis- 
 able. This is undoubtedly the most complete form of dis- 
 infection, since it insures the destruction of the germ by 
 effecting that of the matter in which it is resting. On 
 service it should be practised extensively in the disinfection 
 of clothing of men admitted to hospital with infectious 
 disease, especially of an intestinal character. 
 
 Moist heat is used most simply in the form of boiling. 
 Where it is inconvenient to incinerate excreta or sputa, etc., 
 in the immediate vicinity of a ward, or where it is desired 
 to disinfect at the same time the bed-pan, spittoon, etc., in 
 which they are contained, boiling in the ward annexe may 
 be advantageously resorted to. The receptacle, with the 
 infective matter still in it (to which some convenient chemical 
 disinfectant may be added with a view to minimizing 
 nuisance), should be immersed in boiling water, and the 
 whole left there for fiYe to ten minutes. Washing-soda 
 added to the water will materially assist in cleansing the 
 utensil. Linen clothing may be disinfected by boiling, in 
 the absence of any more convenient form of steam disin- 
 fector, but woollen materials shrink in the process. In 
 general, however, and where the proper apparatus is avail- 
 able, moist heat should be used in the form of steam. 
 
 Steam may be applied either as current steam or under 
 pressure, according to the apparatus available. It may also 
 be used as saturated steam or superheated sibeam — terms 
 which demand a short explanation. 
 
392 MILITARY HYGIENE AND SANITATION 
 
 Saturated steam is steam at such a temperature and under 
 such a pressure that the slightest decrease in temperature 
 or increase in pressure will cause condensation. Thus, steam 
 as it issues from the spout of a boiling kettle is saturated, 
 and the decrease in temperature resulting from its contact 
 with the outer air immediately causes condensation, and 
 the visible appearance of what is commonly known as 
 " steam." Condensation would equally occur if the steam, 
 though still kept at its original temperature of 212° F., were 
 submitted to a pressure greater than that of the atmosphere 
 at the time and place of its generation. 
 
 Superheated steam is steam which, having been produced 
 at a certain pressure, is artificially heated without the pres- 
 sure being at the same time raised in corresponding degree. 
 If, for instance, the steam issuing from a kettle were led 
 through a pipe heated in a flame to, say, 215° F., the steam 
 would be superheated to that degree, and could not con- 
 dense, the pressure remaining constant, until these 3° of 
 superheat were removed. The steam would, however, 
 remain saturated if at the same time as the superheat was 
 added the pressure were correspondingly raised. It would 
 then condense at once if the temperature were diminished to, 
 say, 214° F., the pressure remaining constant. Superheated 
 steam in the presence of water always tends to become 
 saturated by taking up moisture. 
 
 Saturated steam, whether current or under pressure, pos- 
 sesses enormous penetrative power, owing to its power of 
 condensation. When any volume of steam passes into the 
 form of water by the process of condensation its bulk is 
 reduced in the proportion of 1,500 to 1, and this occurs, as 
 already stated, on the slightest decrease of temperature. 
 Thus, if steam is passed into the interstices of a blanket, 
 say, it immediately condenses, and the resulting diminution 
 in bulk permits of the entry of more steam until the entire 
 fabric is saturated with water. At the same time, more- 
 over, as it condenses the steam parts with its latent heat to 
 the blanket, until eventually by the time that the blanket 
 is saturated with water its temperature is raised to that of 
 the steam — viz., 212° F., at which point it can be main- 
 tained by simple artificial means. This is, in fact, the 
 process of disinfection by means of current steam, and there 
 
DISINFECTION 393 
 
 is no more efficacious method of disinfection, considered 
 simply as a means of killing disease germs. For small 
 quantities of clothing it can be used with great advantage 
 in the simple form of a Koch's steam sterilizer. 
 
 The great disadvantage, however, of this method is that 
 the clothing is completely saturated with water, which may 
 cause shrinking in the case of wooUen materials, and in any 
 case, if many articles of bedding or clothing have to be 
 dealt with, great difficulty in handling. To avoid this last 
 it is necessary to employ some means whereby the disin- 
 fected clothing shall be dried inside the apparatus, and this 
 can be done by the passage through it of dry hot air or 
 superheated steam. Either of these wiU take up the mois- 
 ture still remaining in the material, but the latter is the 
 more generally used, as being less likely to injure the fabric, 
 and more easily manipulated. 
 
 The Thresh disinfector shows such an apparatus in a very 
 simple form. In this disinfector steam is evolved at atmo- 
 spheric pressure from an aqueous solution of chloride of 
 calcium, with a boiling-point of 220° F. The slight amount 
 of superheat present is readily got rid of either by convec- 
 tion or by the taking up of moisture from the clothing, etc., 
 which has to be disinfected. The steam, now having become 
 saturated, condenses, and this process continues until the 
 entire mass is raised to a temperature of 215° F., the heat 
 of the steam given off. The steam, being now no longer 
 able to condense, is turned off, and dry hot air used to take 
 up moisture from the saturated clothing, and thus graduaUy 
 to dry them. The apparatus is handy, needs no skilled 
 supervision, and is easily worked, but the process is, com- 
 paratively speaking, a lengthy one. For dealing with small 
 parcels of clothing or bedding it is extremely convenient. 
 A portable form is made, which would be useful under 
 certain conditions of field service where good roads were 
 available. 
 
 Where larger amounts of infected material have to be 
 dealt with, some form of pressure disinfector must be used, 
 of which several types exist. The general plan of construc- 
 tion and working is much the same in all, and the following 
 account merely gives the main lines of one such as the 
 Washington Lyons, without reference to mechanical details : 
 
394 MILITARY HYGIENE AND SANITATION 
 
 The disinfecting chamber consists of a jacketed cylinder 
 constructed to resist a pressure which may amount in the 
 largest patterns to 32 pounds to the square inch. The 
 material to be disinfected is run into the cylinder on a 
 travelling carriage, and the door firmly clamped. The 
 jacket is filled with steam at a temperature of, say, 130°, 
 whose function is merely to heat the walls of the cylinder 
 and its contents. The cylinder chamber is then filled with 
 saturated steam at a temperature of 120° and a pressure of 
 1 22 pounds to the square inch. The pressure must naturally 
 correspond to the temperature, since the condition of satura- 
 tion depends on the balance of these two being maintained. 
 In order to facilitate the penetration of the steam into the 
 interstices of the material, it is usual to create a partial 
 vacuum in the cylinder by the action of a steam jet, and 
 this process may be repeated more than once . The saturated 
 steam naturally condenses on the clothing in the cylinder, 
 which is at a lower temperature, but the walls being at a 
 higher temperature, the steam in the immediate contact 
 with these becomes gradually superheated. In the course 
 of a few minutes the entire mass of clothing is raised to the 
 same temperature as the incoming saturated steam, which 
 is therefore no longer able to condense. The jacket, how- 
 ever, being heated to a greater temperature than this, the 
 entire mass of steam in the cylinder becomes gradually 
 superheated, and therefore takes up from the clothing the 
 water resulting from the condensation of the saturated 
 steam. When the process is concluded the material in the 
 cylinder is not only disinfected but dried, and can then be 
 removed. 
 
 In actual working the different steps are not separated 
 from each other as clearly as above described, since different 
 portions of the mass to be disinfected may at any one time 
 be at different stages of the process. The essential principle 
 to be kept in mind is that the saturated steam is used to 
 procure penetration and disinfection, and is then super- 
 heated to complete disinfection and effect drying. 
 
 In the Equifex apparatus the pressure is only about 
 10 pounds to the square inch, and drying is effected by dry 
 hot air. 
 
 The selection of one type or the other depends on the 
 
DISINFECTION 395 
 
 amount of work to be done, the amount of money available, 
 and the presence or otherwise of skilled artificers. High- 
 pressure boilers are only needed for large installations, are 
 expensive, and need trained supervision. Where the amount 
 of work to be done is comparatively small, where money is 
 an object, and skilled workmen are not available, then a 
 low-pressure or current steam apparatus must be resorted to. 
 
 It must be remembered that the disinfection of — ^that is, 
 the killing of disease germs in — clothing by the means of 
 steam is just as feasible with simple apparatus as with 
 the most complicated. The latter, no doubt, saves labour, 
 and facilitates the process, but that is all. Its absence is 
 no excuse for neglecting the operation in some simpler 
 form. 
 
 Steam disinfection in the field is always a difficult matter. 
 An excellent portable form of steam disinfector is described 
 in the Journal of the Royal Army Medical Corps for July, 
 1911, by Lieutenant-Colonel C. R. Aldridge. In this the 
 clothing is packed in a box, which communicates by means 
 of a pipe with a simple steam generator. This apparatus 
 has given good results on trial at Aldershot, and possesses 
 the advantage of being suitable for pack transport. 
 
 Room Disinfection. — It is usual to disinfect the rooms 
 that have been occupied by persons suffering from infectious 
 diseases, and since for such a purpose the use of heat is 
 practically out of the question, we have to resort to chemical 
 solution or vapours. The use of vapours, or fumigation, is 
 a custom so sanctioned by practice that it seems almost 
 sacrilegious to question its necessity or efficacy ; but, never- 
 theless, before discussing its use, it seems advisable to con- 
 sider what it really is that we wish to disinfect when we 
 disinfect a room, or, in other words, in what part of the 
 room do we expect to find the germs which we wish to kill. 
 Clearly the germs may either be floating in the air of the 
 room or resting on the different surfaces — that is, on the 
 furniture, hangings, walls, ceiling, or floor. When the germ 
 theory of disease was first introduced, and before the actual 
 particulate nature of the poison was clearly recognized, it 
 was believed, and justifiably so, considering the state of our 
 knowledge at the time, that the miter ies morhi actually 
 floated in the air of the sick-room, and fumigation was 
 
398 MILITARY HYGIENE AND SANITATION 
 
 logically practised with a view to destroying that poison in 
 the air. Such a theory can hardly now be supported. It 
 is well known that in a closed room, free from draughts, all 
 bacteria present in the air will, after a very few hours, have 
 either fallen to the floor or come to a rest on the furniture 
 or the walls. 
 
 It is clearly unnecessary, therefore, to disinfect the air of 
 a room which has been closed for even a short time. The 
 surfaces are the parts of the room which demand disinfec- 
 tion. Now, obviously those parts of the surfaces which are 
 the most likely to be dangerous are the corners of the room, 
 the crevices in the floors, or the furniture, since these afford 
 shelter to the germs. The least dangerous areas are the 
 open surfaces of the walls, etc., exposed to the light and 
 air, and in the case of the floor to the mechanical attrition 
 of human traffic. Unfortunately, it is just these nooks and 
 corners which are the least accessible to the action of 
 vapours. If one tries to imagine the condition of a room 
 in which a large amount of disinfectant vapour has been 
 evolved, it is easy to understand that whilst the open sur- 
 faces of the walls, etc., will be freely exposed to the action 
 of the chemical there will be numerous dead angles to which 
 the fumes will not penetrate. These may be many or they 
 may be few ; their number will be largely a matter of acci- 
 dent. They will depend also on the humidity of the atmo- 
 sphere, the heat developed during the evolution of the fumes, 
 and the air-currents thus engendered, and other factors. 
 
 He would be a bold man who in any particular case would 
 venture to say there was no such inaccessible spot in a room. 
 Disinfection of the surfaces of a room by means of fumiga- 
 tion is, therefore, in my opinion, not even in theory possible, 
 since it must inevitably be incomplete. In actual practice 
 it is, I believe, almost useless, since it leaves untouched 
 those parts of the room which need the most special atten- 
 tion — in other words, the nooks and crannies. 
 
 There is even a further difficulty in the way. It is very 
 doubtful if isolated bacteria — separated, that is, from any 
 sheltering adventitious organic matter — would survive long 
 on the surfaces of a room. Even if they were able to do so, 
 it is practically certain that what we have to deal with are 
 not isolated individual micro-organisms, or even aggrega- 
 
DISINFECTION 397 
 
 tions of such, but small masses of dried sputa, pus, faeces, 
 etc., in which bacteria are lodged, and by the substance of 
 which they are sheltered. The disinfectant has not, there- 
 fore, to attack the naked germ, but to penetrate to the inter- 
 stices of these small particles of organic matter, and kill the 
 germ therein embedded. In the absence of moisture this 
 is practically impossible, and one of the conditions precedent 
 for fumigation is, therefore, the maintenance of a high degree 
 of humidity in the atmosphere of the room. 
 
 In fumigation with a chemical vapour we are, therefore, 
 not using the disinfectant chemical in the form most suitable 
 for the purpose which we desire to effect. In view of this 
 fact, and of the almost absolute certainty that the vapour 
 cannot penetrate into the corners and crevices where the 
 infective matter is most likely to lodge, I believe fumigation 
 to be in practice useless as a method of disinfection. 
 
 Coming next to consider the surfaces of a room, it is im- 
 portant to decide which of these really need disinfection. 
 Pathogenic germs are, as we know, in some cases, though 
 not in all, endowed with a certain amount of motility. 
 This word can only, however, be applied to them in the 
 microscopic sense, and it is hardly conceivable that any 
 germ should of its own mere motion travel from the bed of 
 the sick-room to any distant part of the room. The sur- 
 faces which demand disinfection are, therefore, those which 
 are close to that part of the room occupied by the infected 
 man, and, briefly, it may be said an area equivalent to 
 about 2 yards all round the bed, and about 6 feet up the 
 wall. In a small room this, of course, includes the entire 
 floor-space, but in a large apartment — e.g., a barrack-room 
 — only a comparatively small portion of the floor is affected. 
 
 What we have to disinfect, therefore, in a barrack-room 
 from which a case of infectious disease has been removed 
 is the floor under and for 6 feet all round the bed of the 
 man concerned, and also any furniture included in that 
 area, together with a corresponding extent of the wall to 
 the height of 6 feet. To effect the disinfection of this area 
 we must employ some agent which shall insure that the dis- 
 infectant chemical used shall penetrate into every corner 
 and cranny in a form in which it can actually reach and 
 come into contact with the individual germ, not merely 
 
398 MILITARY HYGIENE AND SANITATION 
 
 with the outside surface of the dried mass of organic matter 
 in which it is contained. To attain this end I know no 
 means more efficacious than hot water, in which some 
 suitable disinfectant has been dissolved in sufficient quantity, 
 a plentiful supply of soap, and a scrubbing-brush, the whole 
 applied with what housewives term "elbow-grease." In 
 short, if the floor and walls to the extent noted above are 
 thoroughly scrubbed in the above manner, I believe we shall 
 have disinfected all the surfaces of a barrack-room that 
 demand disinfection, and we shall have done it in a thorough 
 manner. 
 
 A barrack-room differs from other rooms in the fact that 
 it is not only much larger, but also much freer from super- 
 fluous furniture and hangings. Whatever aesthetic ad- 
 vantage these may possess, they certainly do not facilitate 
 disinfection, and the proverbial bareness of a barrack-room 
 gives it in this respect a great advantage. 
 
 In the case of married or officers' quarters, we are 
 dealing with small rooms, containing furniture and hangings, 
 and these last demand separate treatment. All curtains, 
 carpets, etc., should be sprayed with formalin, and then 
 taken away from the room for further disinfection. The 
 furniture should be scrubbed with disinfectant before being 
 removed, care, of course, being taken in the case of inlaid 
 or polished articles not to cause any injury. The room 
 having been cleared should then be thoroughly scrubbed, 
 as already descri.bed. In short, the quarter should be 
 thoroughly " spring cleaned," to use a well-understood and" 
 familiar phrase. 
 
 It would probably be advisable in the case of a bedroom 
 to repaper the space immediately behind the bed, or in the 
 case of a small room to repaper throughout. The use of 
 paper in sleeping apartments should, however, be strongly 
 deprecated, and that of some washable distemper substi- 
 tuted. 
 
 I would impress on every young officer in charge of effec- 
 tive troops the importance of supervising in person this 
 process of disinfection. It is laid down in regulations that 
 it shall be carried out by men of the Royal Army Medical 
 Corps, so that the responsibility for its execution is no 
 longer divided, as it used to be, between the Medical, 
 
DISINFECTION 399 
 
 Engineer, and Barrack Departments, but it will be done 
 much more thoroughly if an officer is present. 
 
 The best disinfectant to use for this work is one of the 
 phenol group, the regulation substance being saponified cresol. 
 
 Disinfection of walls can be carried out by means of a 
 formalin spray if it is desired to reach to a higher level than 
 7 feet or thereabouts. A spray possesses, however, no par- 
 ticular advantage over a mop, and is considerably more 
 tedious in manipulation. It has, however, an " up-to- 
 date " appearance, which doubtless produces a corre- 
 spondingly good moral effect. 
 
 In cases where it is desired to use fumigation, either 
 formaldehyde or sulphurous acid may be used. 
 
 Formalin vapour can be evolved either from tablets or 
 some patent preparation, of which a large number exist in 
 the market, by means of a lamp. The number of these is 
 legion, and they all doubtless possess considerable efficacy 
 — ^that is to say, they evolve a vapour which will inevitably 
 destroy any bacillus with which it comes into contact, if it 
 can effect that contact. They all possess the drawback that 
 their use entails the leaving in a closed-up room of a lighted 
 lamp. The danger of accident is no doubt small ; still, it 
 exists. A safer and more easily carried out process, de- 
 manding no special form of apparatus, is the evolution of 
 vapour as the result of the chemical interaction of formalin 
 and permanganate of potash. These can be simply mixed 
 in any ordinary earthenware basin, and allowed to stand in 
 the room. This method should always be used, in my 
 opinion, in the Service. 
 
 Formalin vapour will not exercise its disinfectant action 
 except under certain conditions of moisture and tempera- 
 ture. The air must possess at least 70 per cent, relative 
 humidity, and be at 70° F. This at once places it out of 
 court for general use in barracks. An ordinary barrack- 
 room, built to contain twelve men, possesses a cubic capacity 
 of 7,200 feet. All windows and doors must, of course, be 
 tightly closed, and in addition the chimney must be blocked 
 up. The problem of how to maintain a temperature oi 
 70° F. for four hours in such a room without a fire would 
 tax the resources of the most ingenious during at least nine 
 months of most years in this country. 
 
400 MILITARY HYGIENE AND SANITATION ' 
 
 Formalin may be used to disinfect clothing, in stations 
 where a steam disinfector is not available, in the following 
 manner : The articles should first be well sprinkled with 
 water, and then hung up in a wardrobe, paper having first 
 been pasted over all chinks and openings. The wardrobe 
 should be placed in a room near a brisk fire, and formalin 
 vapour evolved inside the cupboard by pouring commercial 
 formalin on to crystals of permanganate of potash. In a 
 warm climate on service it might also be used to disinfect 
 tents and ambulance waggons, the canvas of the tent 
 or that of the waggon tilt being first thoroughly wetted 
 with water. Thorough swabbing with a solution of any 
 of the phenols would in all probability be equally 
 efficacious. 
 
 Sulphurous acid can be evolved from the combustion of 
 sulphur, but is more commonly supplied in the compressed 
 form in cylinders. The atmosphere must be completely 
 saturated with moisture, but temperature conditions are 
 immaterial. The process is simple, and in the latter case 
 free from danger of fire. 
 
 In extreme cases heat may be used for the purpose of 
 room disinfection, but the process is not applicable to any 
 but the rudest habitations. In the case of native huts 
 which it is considered necessary to occupy on service, this 
 method might be employed to destroy fleas or ticks. The 
 floor should be strewed with any cheap fuel, such as cow- 
 dung cakes, litter, etc., and this material set fire to. If care 
 be taken it is possible to disinfect even thatched huts in this 
 way with but slight danger from fire, though, of course, this 
 danger must be guarded against. Since resort to such 
 shelter is only likely to be necessary as a protection against 
 heavy rain, the very conditions which necessitate the process 
 will tend to render it safe. 
 
 Conclusion. — Disinfection is distinctly one of those 
 operations which are at once simple and difficult. The 
 simplicity consists in the facts that the object is merely to 
 kill a definite living organism, and that the agents at our 
 disposal for that purpose are almost infinite in number. 
 The difficulty lies in the fact that it is often very hard to 
 bring the agent into actual contact with the organism, and 
 even more so to be certain that none of the germs which we 
 
Disinfection 40i 
 
 desire to destroy have managed to escape the action of the 
 disinfectant process. 
 
 In any one case the sanitary officer must satisfy himself 
 as far as he possibly can that all the germs have been sub- 
 jected to the lethal process. He must on no account assume 
 that because he has gone through some elaborate method 
 of procedure or satisfied the requirements of some com- 
 plicated ritual he has therefore necessarily effected his 
 object. 
 
 26 
 
CHAPTER XXII 
 
 SANITATION OF THE BATTLE-FIELD 
 
 The difficulties which beset the path of the sanitarian in 
 the field are naturally enormously increased when the army 
 is in immediate contact with the enemy or actually engaged 
 in one of those long-drawn-out battles that it is to be ex- 
 pected will characterize future wars. 
 
 The immediate vicinity of a hostile force, with the inces- 
 sant vigilance and extra strain that it entails on the troops, 
 must inevitably play havoc with any complicated schemes 
 of sanitation. It is on such occasions that the benefit of 
 previous training comes into play. An army, the individual 
 officers and men of which have been taught the importance 
 of sanitation, will undoubtedly have a great advantage over 
 an army whose members are careless or untaught in this 
 respect. More especially will this be the case when the 
 force is either stubbornly holding a defensive position, or 
 engaged in a prolonged siege, or in an attack on such a 
 position held by the enemy. In either case it will be prac- 
 tically out of the question to expect the individual soldiers 
 to do much in this direction. In a besieged town or defen- 
 sive position the civilian population that still remains must 
 be encouraged, or if necessary forced, to undertake the 
 execution of sanitary fatigues. The same may be done by 
 the attacking force, though it would be unwise to allow 
 members of a local and possibly hostile population to pene- 
 trate to the more advanced lines of the attack. In any case, 
 however, much must be left undone, and the conditions 
 under which a force closely engaged with the enemy, and 
 fighting with modern weapons, will have to live, must in- 
 evitably be such as practically to prevent sanitary work 
 being carried on. As a result, after a battle the state of 
 
 402 
 
SANITATION OF THE BATTLE-FIELD 403 
 
 affairs will be such that very active steps will have to be 
 taken if illness is not to break out, not only amongst the 
 civil population, but also amongst the sick or wounded, 
 whose condition is such as to prevent their removal from 
 the vicinity of the engagement. In this country it is fairly 
 certain that if the conduct of the operations remained in 
 our own hands, the supervision of the necessary work would 
 be entrusted to the local authorities, sanitary and otherwise. 
 Sanitary officers on the a la suite list would undoubtedly 
 find a considerable field for activity here. The matters to 
 be disposed of would be not only the dead bodies of men and 
 horses, but also the accumulation of excreta, broken meats, 
 etc., the result of the continued occupation of a compara- 
 tively contracted space by a population perhaps a hundred 
 times the size of that which ordinarily inhabits that area. 
 Since the inhabitants of the locality would naturally be the 
 people most interested in the cleansing of the battle-field, 
 they could very fitly be called upon to assist. Trained 
 soldiers, whether officers or men, would be too valuable to 
 be spared on such an occasion from their duties at the front, 
 and a well-organized sanitary service under the locaji 
 authorities would constitute a distinct national asset. The 
 first step would be to tell off the ground in definite areas, 
 and entrust the work to definite parties of men under some 
 locally recognized leader. Their duty would be to bury all 
 accumulations of filth or garbage in situ. Time would not 
 allow of these matters being collected for cremation, and 
 shallow burial would be quite sufficient. They would also 
 have to collect the bodies of the dead in groups for burial or 
 cremation. 
 
 Undoubtedly the best method is cremation, and it is 
 probable that in the case of the dead of an enemy fighting 
 in this country we should, where possible, adopt this measure. 
 As regards our own men, sentiment would probably prevent 
 any such course, and the only resource then would be burial 
 in large graves. Military trenches might be used where 
 present. Pits should be dug about 10 feet deep and 7 feet 
 broad, so that the corpses may be laid across the trench. 
 Before placing any bodies in the grave some brushwood 
 should be put down to facilitate drainage, and the corpses 
 laid on the top of this to a distance of 3 feet, but not less, 
 
404 MILITARY HYGIENE AND SANITATION 
 
 from the surface. The earth should then be carefully heaped 
 over the mass, a record being kept of the numbers and 
 other particulars of the men buried in each spot. These 
 duties will devolve very often on medical officers of stationary 
 and other hospitals, and I need hardly remind you that 
 every care should be taken as regards identification of 
 bodies. Every soldier in a civilized army is provided now- 
 adays with an identification disc, and these should be care- 
 fully kept until they can be forwarded to the proper 
 authorities — presumably in case of war in this country, to 
 the Adjutant-General at the War Office. These are not, it 
 is true, strictly sanitary duties, but since they will so often 
 devolve on medical officers and sanitary officers, especially 
 those on the a la suite list, who will certainly be entrusted 
 with the sanitation of any battle-field in their particular 
 neighbourhood, the divergence is justifiable. 
 
 When burning is feasible — and in the case of a thickly 
 populated country like ours it may be absolutely necessary 
 in the case of the bodies of the enemy — it may be practised 
 in various ways. One method is to make a large pyre of 
 wood and brushwood or other fuel, in which are hidden 
 layers of corpses. This method was adopted by the French 
 in the wars of the Napoleonic era. 
 
 After Sedan, in 1870, cremation was resorted to with a 
 view to destroying the corpses already buried, but not suffi- 
 ciently covered over. The following procedure was adopted : 
 The earth was first removed until a dark foetid layer in 
 immediate contact with the dead bodies was reached. This 
 was watered with a solution of carbolic acid, and then the 
 mass of putrefaction was completely uncovered. This was 
 then sprinkled with chloride of lime, after which tar was 
 poured over it and allowed to penetrate in between the 
 different layers of corpses. The tar was set alight by means 
 of straw moistened with petroleum, and as a result of the 
 use of this last ingredient the fire was enabled to spread 
 through the entire accumulation of corpses. The heat 
 rapidly became so great that it was impossible to approach 
 within 15 feet of the furnace, and in a little over an hour 
 the contents of the most crowded trenches were reduced to 
 about one-quarter of their original bulk. This, of course, 
 would be largely due to evaporation of moisture. The residue 
 
SANITATION OF THE BATTLE-FIELD 405 
 
 consisted of calcined bones contained in a resinous magma. 
 The earth forming the walls of the trench, having been ex- 
 posed to such an elevated temperature, was freed of all 
 cadaveric odour. A dense smoke was formed, which pro- 
 duced blisters on the exposed skin surfaces of the workers. 
 Gloves and veils should therefore be provided to people 
 engaged in this operation. The flies which infested the 
 ditches were all destroyed at the same time. 
 
 The Americans at Santiago, in 1897, used cremation to 
 dispose of the bodies found unburied when the town was 
 occupied. They adopted a plan similar to that used by the 
 French in the Napoleonic wars already alluded to. In- 
 cineration is not, therefore, impossible, even using primitive 
 means, and this possibility should always be kept in mind, 
 especially in cases where burial has been inefficiently carried 
 out, and a serious nuisance is likely to be caused. With 
 regard to cremation, one word of warning must be issued. 
 Incomplete cremation — ^that is, cremation undertaken with- 
 out very careful preparation — and an abundant supply of 
 fuel — is worse than useless, both on sanitary and sentimental 
 grounds. 
 
 The bodies of animals present considerable difficulty, 
 owing to their greater bulk. The usual plan, if burial or 
 complete cremation is impossible, is to eviscerate the body, 
 bury the entrails, and then light a fire in the cavity of the 
 corpse. Fighting in civilized countries, one has always the 
 advantage of a considerable supply of civilian labour, and, 
 since the l«cal inhabitants are the people most interested 
 in the proper cleansing of the battle-field, they can, as already 
 said, fairly be impressed into the service. 
 
APPENDIX 
 
 A.— SCALES OF FIELD-SERVICE RATIONS. 
 
 Army. 
 
 Protein. 
 
 Fat. 
 
 Carbo- 
 hydrate. 
 
 Calories. 
 
 Great Britain (biscuit and tinned meat) 
 
 180 
 
 49 
 
 510 
 
 3292 
 
 „ ,, (bread and fresh meat) . . 
 
 179 
 
 50 
 
 501 
 
 3255 
 
 Germany (ordinary) 
 
 101 
 
 79 
 
 489 
 
 3147 
 
 „ with increase of compressed 
 
 
 
 
 
 vegetable portion . . 
 
 108 
 
 82 
 
 537 
 
 3401 
 
 , , with increase of meat portion 
 
 117 
 
 101 
 
 489 
 
 3413 
 
 ,, with increase of both meat 
 
 
 
 
 
 and vegetable portions . . 
 
 120 
 
 104 
 
 537 
 
 3667 
 
 ,, South- West African Cam- 
 
 
 
 
 
 paign 
 
 172 
 
 132 
 
 651 
 
 4602 
 
 France {normale) 
 
 124 
 
 64 
 
 518 
 
 3340* 
 
 „ {forte) 
 
 141 
 
 72 
 
 560 
 
 3651* 
 
 Russia 
 
 173 
 
 29 
 
 964 
 
 4929 
 
 Austria 
 
 (108 
 
 42 
 
 458 
 
 2702t 
 
 (123 
 
 39 
 
 426 
 
 2620t 
 
 America . . 
 
 167 
 
 110 
 
 608 
 
 4199 
 
 i 
 
 * Including energy- value of spirit ration. 
 
 t Difference depends on nature of vegetable issue. 
 
 406 
 
APPENDIX 
 
 407 
 
 B.— TABLE SHOWING THE COMPARATIVE VALUE, TOTAL FOOD 
 CONSUMED, AND TOTAL ENERGY EXPENDED: FIRST EX- 
 PERIMENTAL MARCH. 
 
 Day. 
 
 1st 
 
 1 
 
 Total Food Consumed, | 
 
 Total Calorie 
 
 Value of Food 
 
 Consumed. 
 
 Total Calorie 
 
 Value of Energy 
 
 Expended, 
 
 Remarks. 
 
 i^ir 1 "=x'- ., 
 
 2 Cheese sandwich 
 
 71900 
 
 84403 
 
 
 2nd 
 
 3 
 
 Nil 
 
 58600 
 
 83507 
 
 
 3rd 
 
 
 
 59260 
 
 69066 
 
 
 4th 
 
 
 
 59260 
 
 86155 
 
 
 5th 
 
 •*• 1 »> 
 
 59260 
 
 88636 
 
 
 6th 
 
 1 1 Rum ration 
 
 63660 
 
 83547 
 
 
 7th 
 
 4 Nil 
 
 62020 
 
 60000 
 
 
 8th 
 
 A ! 
 
 4 ' >> 
 
 62020 
 
 66924 
 
 
 i 9th 
 
 ^ >) 
 
 62020 
 
 83948 
 
 
 i 10th 
 
 
 Whisky ration 
 
 66580 
 
 90533 
 
 
 nth 
 
 
 Nil 
 
 62020 
 
 84108 
 
 
 12th 
 
 
 
 62020 
 
 87316 
 
 
 13th 
 
 Nil 
 
 »» 
 
 Nil 
 
 Nil 
 
 
 Total 
 
 748620 
 
 968143 
 
 
 Average per man 
 
 37431 
 
 48407 
 
 
 Average per man per day 
 Deficiency per man . . 
 Deficiency per man per day . . 
 
 3119 
 
 IOC 
 
 4034 
 >76 
 >15 
 
 
 The days are counted from 9 a.m. on Monday, October 11th, to 9 a.m. on 
 Saturday, the 23rd. All work, internal and external, done and all food 
 eaten during the period of twenty-four hours between 9 a.m. on the 11th 
 and 9 a.m. on the 12th are included under the first day, and so on. The 
 march performed on the 23rd is not included, as this was carried out after 
 9 a.m. on that day, at which hour the terminal weighing was recorded. 
 
408 MILITARY HYGIENE AND SANITATION 
 
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APPENDIX 
 
 409 
 
 DIAGRAM SHOWING VARIATIONS IN WEIGHT IN TWO 
 EXPERIMENTAL MARCHES. 
 
 65 
 
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410 MILITARY HYGIENE AND SANITATION 
 
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APPENDIX 
 
 411 
 
 Summary of Ration Scales. 
 
 
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 Net Energy Value of Above (deducting 10 per Cent). 
 
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 No. 2 
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 F.— CALCULATIONS SHOWING ESTIMATED TOTAL ENERGY EX- 
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INDEX 
 
 Ablution : benches in field, 269 ; in 
 standing camps, 270 
 
 Accommodation to surroundings, 1, 8 
 
 Accoutrements: items composing, 317; 
 weight of, 318 
 
 Air : allowance in barracks, 198 ; 
 amount required, 202, 203 ; changes 
 produced by combustion, 202 ; com- 
 position of, 197, 199 ; currents, 205 ; 
 inlets, 204 ; organic matter in, 197, 
 200; outlets, 204, 205; physical 
 changes in, and heat regulation, 
 201 ; significance of wet bulb tem- 
 perature, 201 
 
 Albuminuria, significance of, 72 
 
 Allahabad system, 241 
 
 Aluminium, advantages of, 319 
 
 Ammunition : how carried, 321, 322; 
 inaccessible pouches, 322 ; physi- 
 ological effect of arrangement, 322 ; 
 pouches, 321, 322 ; question of re- 
 duction, 317 ; and water, 65 ; 
 weight of. 317 
 
 Animals, disposal of bodies in the 
 ' field, 405 
 
 Armament, arrangement of, 320 ; 
 items composing, 316 ; weight of, 
 317 
 
 Artesian wells, definition of, 148 
 
 Ashanti, 366, 367, 378 
 
 Attention, position of, 39 
 
 B. cdi in water, 155 
 B. enter itidis sporogenes, 155 
 Bandolier, disadvantages of, 321 
 Barrack-room : accessory buildings 
 279 ; advantages of half-battalion 
 280; dimensions of, 278, 279 
 heating of, 279 
 Barracks : arrangement of, 276-282 
 baths, 276, 279, 281, 286; de 
 centralization, 277, 288, and con 
 centration, 276 ; definition, 272 
 early plans, 273, 274 ; Edinburgh 
 281, 282; effect on health, 272 
 273 ; false ideals, 274 ; half-batta 
 lion, 278, 279 ; inspection, 282-290 
 
 night urinals, 276, 279, 282, 286 ; 
 storage of water, 164 ; ventilation, 
 206 ; V. hospitals, 291 ; Windsor, 
 280 
 
 Barracks, India : bathing accommoda- 
 tion, 288 ; decentralization neces- 
 sary, 284, 285 ; half-company, 285 ; 
 heating arrangements, 287 ; sug- 
 gested plan, 286 ; two-storied, 285 ; 
 type of bimgalow, 287 ; ventilation, 
 287 
 
 Barracks, modem type, 280-284 
 
 Bathing parades, 270 
 
 Battle-field, organization of sanitation, 
 403 
 
 Bayonet, how carried, 321 
 
 Belidor, 273, 283 
 
 Bell-fitter, 175 
 
 Billets, 298-300; French regulation, 
 299 ; rarity in England, 292 
 
 Biological installations, difficulties of : 
 in barracks, 239 ; in India, 240 ; 
 Maymyo, 240 
 
 Bivouacs : Napoleon's opinion on, 
 292 ; sanitation of, 298 ; shelter 
 provided by, 293 
 
 Bloemfontein to Pretoria, 74 
 
 Blood-pressure, effect of marching on, 
 71 
 
 Boiling, disinfection by, 391 
 
 Boots, 306-309; Austrian, 308; 
 British, 308; French, 308; Ger- 
 man, 306, 308 ; Italian, 308 ; 
 Japanese, 308 ; Russian, 306, 308 ; 
 United States, 306, 307, 308 ; thick 
 V. thin soled, 308 
 
 Bouchain, 15 
 
 Breathing exercises, fallacy of, 37 
 
 Burial in the field, formalities of, 404 
 
 Butler, opinion on recruits, 31 
 
 Cambrai, 15 
 
 Camps, 293-297 ; Napoleon's opinion 
 
 of, 292 
 Candy filter, 176 ' 
 Cardiac rhythm and increased rapidity, 
 
 70 ' 
 
 413 
 
414 MILITAEY HYGIENE AND SANITATION 
 
 Carriers, 332 
 
 Chest measurement, 25 
 
 Chloride of lime, 390 
 
 Cholera carriers, 359 
 
 Cholera flies, 359 
 
 Cholera : history of, 356 ; on service, 
 358 
 
 Cholera, prevention of : in camps, 361, 
 362 ; inoculation, 363 ; native 
 followers, 359 ; use of chemicals, 
 360 ; water-supply, 357, 360 
 
 Circulation, effects of marching on, 
 67, 70 
 
 Classification of disease causes, 8 
 
 Cleanliness of feet, importance of, 
 78 
 
 Clothing, 301-304; effect on con- 
 vection of heat, 58 ; on evapora- 
 tion, 57 ; weight of, 317 
 
 Coat, British, warm, 325 
 
 Collection of ground water, 159 ; 
 from wells, 160 
 
 Commander, decision of, 14 
 
 Commission on barracks and hospitals, 
 274, 275, 276 
 
 Communal life of the soldier, 7 
 
 Conservancy : conditions essential for 
 success, 214, 223 ; correct pattern 
 of cart, 223 ; daylight, 217, 222 ; 
 duty of officers and men, 261 ; 
 light railway, 223 ; officers' bunga- 
 lows, 220 ; question of incineration, 
 224. See also Waste matters 
 
 Conservancy, field, 260, 261 ; Skobe- 
 leff's orders, 262 
 
 Considerationsrindustrial, 12 ; military, 
 in peace negligible, 13 ; military, 
 in war paramount, 13 ; pecuniary, 
 11 
 
 Contact beds, 231-235 
 
 Convection, 57, 58 
 
 Cotton : conductivity of, 302 ; peculi- 
 arities of short staple, 304 
 
 Country and town lads, 35 
 
 Cremation in the field, 403, 404, 405 
 
 Cubicles, 280-284 
 
 Defeat, how caused, 14 
 Dibdin's slate beds, 235 39 
 Discharge under three months, 28 
 Disciplinary control over feet, 80 
 Discipline and sanitation, 21 
 Disease : classification of causes, 8 ; 
 dealt with by hygiene, 1 ; preven- 
 tion of, 9, 339, 364 
 Disease germs, 334-339 
 Disinfectants, 386-390 ; in field, 271 
 Disinfection : definition of, 385 ; diffi- 
 culty of, 400 
 Disinfector : methods of, 391-394 ; 
 
 selection of, 395 
 Disposal of waste matters. 8ee 
 Waste matters 
 
 Dissipation of heat, 55, 57 
 
 Duty of medical officer on march, 
 57 
 
 Duty of sanitary officer, 5, 9, 15 ; 
 in peace, 13 
 
 Dysentery : history of, 354 ; preven- 
 tion of, 356 ; types of, 355 
 
 Education, physical : essential points, 
 43 ; importance of individual 
 attention, 35 ; nature of, 34 ; 
 preliminary, 35 ; progress in, 35 
 
 Efficiency, ratio of, 56 
 
 Energy expended in walking, 51 ; 
 affected by increase in load, 316 
 
 Enlistment, terms of, 22 
 
 Enteric fever, 341 ; Afghan War, 342, 
 343 ; ambulatory cases, 348 ; danger 
 to young soldiers, 344, 349 ; dust 
 and flies, 346 ; value of inoculation, 
 345 ; and water-supply, 345, 347, 
 353 
 
 Enteric fever in India : history of, 
 341 ; increase in, 343 ; Quetta, 345 
 
 Enteric fever, prevention of, 347 ; 
 flies, 350 ; incineration, 350 ; la- 
 trines and urinals, 349 ; manage- 
 ment of carriers, 348 ; milk, 352 ; 
 native servants, 350 ; supervision 
 of food, 351, 352 
 
 Entrenching tool, how carried, 323 
 
 Equipment, 313; Austrian, 321, 322, 
 324, 327 ; French, 319, 321, 323, 
 324, 325, 327 ; German, 319, 321, 
 
 322, 325, 326, 327; Norwegian, 321, 
 
 323, 325, 327, 328 ; United States, 
 319, 321, 322, 323, 329, 330; weight 
 of, 313, 315, 316 
 
 Equipment, infantry : advantages of 
 light, 320 ; classification of, 316 ; 
 division of, 319 ; effect on asym- 
 metry, 316 ; history, 314 ; irre- 
 ducible minimum, 318 ; Kirchner's 
 limit, 316 ; maximum load, 315 ; 
 method of cariying, 320 ; packing 
 of food, 323 ; Zuntz on, 316 
 
 Erect posture : mechanism of, 40, 
 41 ; movements in, 42 
 
 Evaporation, 57, 58 ; and march 
 formations, 60 
 
 Examination of recruits, importance 
 of, 32 
 
 Exanthemata : chain of infection, 380- 
 384 ; history of, 380 
 
 Excreta, removal of : duty of company 
 officers, 220 ; supervision, 220. See 
 also Conservancy 
 
 Exercises : breathing, fallacy of, 37 ; 
 fallacy of subsidiary, 37 
 
 Experience v. study, 16 
 
 Fatigue and production of heat, 56 
 Feet, care of. 78-80 
 
INDEX 
 
 415 
 
 Field service : physical exercise of, 44 ; 
 
 purification of water on, 179 et seq. 
 Fighting v. marching, 15 
 Filters, streaming, 233-235 
 Fire discipline and water discipline, 
 
 65 
 Foot-baths, 281, 282, 286 
 Foot-cloth : advantages of, 306 ; issue 
 
 of, 305 
 Forced marches, 74-77 
 Formalin : fumigation by, 399 ; limita- 
 tions of, 389, 399 ; vapour for 
 
 clothes disinfection, 400 
 Fortescue's History of the British 
 
 Army, 16 
 Frederick the Great, 16 
 Fumigation, limitations of, 396, 399, 
 
 400 
 Fussgeschwulst, 308 
 
 Gaiters, 309 
 
 Geology of water-supply, 144, 146 
 
 Greatcoat : disadvantages of, 325 ; 
 French, 309, 310, 325 ; German, 
 325; Italian, 309, 310, 325; not 
 used in Norwegian Army, 310 ; 
 ordinary pattern, 310 
 
 Ground-water, 144, 145 ; quality of, 
 150 ' 4 J' 
 
 Habits and occupation, effect on heat- 
 stroke, 66 
 
 Halts, 72, 73, 74 
 
 Hamilton, General Sir Ian, 74 
 
 Head-dress : aesthetic considerations, 
 310; object of, 311; various 
 patterns, 311 
 
 Head-dress in tropics : British, 312 ; 
 German, 312 ; make of, 311 
 
 Health, preservation of, 9 
 
 Heart disease, 27 
 
 Heat : dissipation of, 55 ; production 
 of, 55 
 
 Heat production : pathological as- 
 pects of, 65 ; in walking, 52 
 
 Heat - stroke : causes of, 66 ; and 
 Hiller, 66, 75 ; prevention of, 67 
 
 Height, importance of, 24 
 
 Henderson, Colonel, 15 
 
 Hiller on heat-stroke, 66 
 
 Histories, importance of regimental, 8 
 
 Horse-litter, disposal of, in field, 270 
 
 Humidity, importance of relative, 201 
 
 Hygiene, definition of, 1 
 
 Hygiene and sanitation : distinction 
 between, 2 ; scope of, 6 
 
 Imaginary problems, study of, 17 
 Incineration, 208, 209, 224, 227; ad- 
 vantages of, 242 ; disinfection by, 
 391 ; fuel necessary, 243 
 Incinerator, semi-permanent, camp, 
 266 
 
 Incinerators : field, 263-265 ; Arnold, 
 265; Betham, 255, 256; Conley, 
 254 ; Firth, 264 ; Jones, 255 ; Lewis 
 and Kitchin, 255 ; McCoU, 254 
 India : absence of plumbing in, 12 ; 
 barracks in, 284 et seq. ; enteric 
 fever in, 341 
 Industrial considerations, 12 
 Infected man, classification, etc., 332- 
 
 334 
 Infectious diseases, 331 ; principles 
 
 for prevention, 331, 339 
 Inoculation, correct position of, 339 
 Inspection, 290, 291 ; of feet, 80 
 Irrigation, canals v. wells, 375 
 
 Jacket : fit of, 309 ; usual pattern, 
 
 309 
 Jackson, Stonewall, 10, 15 
 Jewell filters, 175 
 
 Kabul to Kandahar, 74 
 
 Kilt, advantages of, 310 
 
 Kitchen slops, disposal of : in India, 
 243 ; in the field, 266, 267 
 
 Knapsack : advantages of Swedish, 
 327 ; how carried, 327 ; necessity 
 of, 330 ; usual pattern, 327 
 
 Latrines : barrack, 274, 276, 277, 279, 
 
 281, 282, 285, 286 ; management of, 
 
 215 et seq. ; receptacles, 215, 216 ; 
 
 situation, 215, 216 ; structure of, 
 
 217 ; supervision of native, 221 
 Latrines, field : allowance, 248 ; 
 
 arrangement, 247, 249, 250, 251 ; 
 
 extent of ground covered, 248 ; 
 
 marking, 260 ; measurements, 247 ; 
 
 patterns, 246 ; semi-permanent, 
 
 251-253 
 Lead -poisoning from water, 153 
 Light division : conservancy of, 261 ; 
 
 regulation for halts, 73 ; standing 
 
 orders, 63 
 Linen, conductivity of, 302 
 Load : practice in carrying, 69 ; and 
 
 production of heat, 56 
 Long and short service, 22 
 Loss of water, 62 ; and reduction of 
 
 temperature, 64 
 Low Countries, 14 
 
 Madagascar, 367, 378 
 
 Madras, 3 
 
 Malaria : chain of infection, 367 ; 
 Great Britain, 365 ; history of, 365 ; 
 in war, 378-380 
 
 Malaria, prevention of, 367 ; electric 
 fans for, 369 ; essential oils, 369 ; 
 gloves and veils, 370 ; hospitals, 
 370 ; mosquito nets and rooms, 
 368 ; records, 377 ; system neces- 
 sary, 376 ; use of quinine, 377 
 
416 MILITARY HYGIENE AND SANITATION 
 
 March : amount of water on, 65 ; 
 formations and evaporation 60 
 
 Marching, effect: on blood-pressure, 
 71 ; on circulation, 67, 70 ; on 
 composition of blood, 71 ; on 
 respiration, 67, 68 ; on urinary 
 system, 71; fatigue in, 49; Ger- 
 man regulations, 46 ; importance 
 of training, 50 ; monotony of, 50 ; 
 V. fighting, 15 
 
 Marche en flexion, 49 ; opinion of 
 Laveran on, 50 ; opinion of Richer 
 on, 50 
 
 Margin of safety : at rest, 53 ; walking, 
 53 
 
 Marlborough, 14, 74 
 
 Measurements, relation between, 26 
 
 Medical officer, duty of : in connection 
 with water, 166 ; on march, 57 
 
 Mess-tin, 324 
 
 Military memoirs, value of, 16 
 
 Miquel et Mouche filter, 176 
 
 Moore, Sir John, on physical exer- 
 cises, 43 
 
 Mosquito destruction : by fumigation, 
 377 ; hand nets, 377 ; in native lines, 
 372 ; in private bungalows, 373 ; 
 irrigation, 375 ; scheme of, 371, 
 372 ; traps, 377 
 
 Mosquito nets, 368, 369 
 
 Mosquitoes : stages of life, 370 ; 
 varieties, 371 
 
 Napier, 16 
 
 Necessaries, personal, items included 
 
 in, 317, 326 
 Normal temperature, 52 ; curve in 
 
 walking, 53 
 
 Officers' bungalows, conservancy of, 
 
 220, 221 
 Oman, Professor, 16 
 Optimum temperature in walking, 
 
 53 
 Organization, sanitary, 18 
 Overalls recommended, 325 
 
 Pace and production of heat, 55 
 Pack : Russian, 330 ; United States, 
 
 329 
 Pain and production of heat, 56 
 Paints for rain-water collecting area, 
 
 159 
 Paraffin oil, uses of, 271 
 Parkes, 10 
 Peace, duty of sanitary officer in, 
 
 13 
 Peculiarities of military population, 
 
 6,7 
 Pecuniary considerations, 11 
 Perchloride of mercury, 390 
 Perspiration, effects of profuse, 61 
 Phenols, 387 ; strength of, 388 
 
 Physical education : essential points, 
 
 43 ; importance of individual atten- 
 tion, 35 ; nature of, 34 
 
 Physical exercise : dangers of excess, 
 
 44 ; on field service, 44 
 
 Physical training, definition and ob- 
 ject, 33 
 
 Physiology, study of, 10 
 
 Plumbing, absence of, in India, 12 
 
 Position of attention, 39 
 
 Posture, erect, 40, 41, 42 
 
 Preservation of health, 9 
 
 Prevention of disease, 9, 20 
 
 Pringle, 10 ; on danger of excess, 45; 
 on physical exercise, 44 
 
 Problems, study of imaginary, 17 
 
 Production of heat, 55, 56 
 
 Progress and education, how tested, 
 35 
 
 Puttees, 309 
 
 Quetta, 3, 4, 5, 345 
 
 Radiation, 57 ; limits of, 58 
 
 Rain : quality of water, 149 ; quantity 
 
 of water, 143 
 Rain-water, collection of, 149, 159 
 Rangoon, 5 
 
 Ratio of efficiency in man, 56 
 Rations carried by soldier, weight of, 
 
 318 
 Recommendations : impossible, 12 ; 
 
 of sanitary officer, 16 
 Recruits, present and past, 30, 32 
 Regimental histories, importance of, 
 
 8 
 Regimental officer and man, sanitary 
 
 duties, 20 
 Rejection, causes of, 27 
 Resistance to disease, 338 
 Respiration : effect of marching and 
 
 equipment on, 67, 68 ; embarrassed, 
 
 69 ; normal stimulus, 38 
 Rest, margin of safety at, 53 
 Roberts, Field -Marshal Lord, 74 
 Rock : water-bearing, 145 ; water- 
 holding, 145 
 Room disinfection : barracks, 398; 
 
 object of, 395, 396 ; use of heat in, 
 
 400 
 Rubbish, collection and disposal in 
 
 field, 262 
 Rucksack : Gurkha, 328 ; Norwegian, 
 
 327, 328 
 
 Sanitary area, 270 
 
 Sanitary officer : duty of, 5, 9, 13, 15; 
 position of, 11, 19 ; recommenda- 
 tions of, 16 
 
 Sanitary organization, 18 
 
 Sanitation : definition of, 1 ; and 
 discipline, 21; and insurance, 11 
 
 Sauroren, 74 
 
INDEX 
 
 417 
 
 Saxe, Marshal, on marching, 46 
 Scotland, 3 
 Septic tanks, 229, 230 
 Sewage : advantages of slate beds, 
 239 ; anaerobic action in installa- 
 tions, 237 ; composition of bar- 
 rack, 239 ; disposal of, 227, 228, 
 234, 238, 239; oxidation of, 227, 
 228, 230 
 Shelter : items included in, 317 ; 
 
 various forms, 325 
 Shelter-tent, 326 
 Shower-baths, 281, 282, 286 ; in 
 
 field, 269 
 Short and long service, 22 
 Siege, sanitation during, 402 
 Silk, conductivity of, 302 
 Site, selection of, for camps, 297 
 Slate beds : advantages in barrack 
 sewage, 237, 239 ; construction of, 
 235 ; mechanism of, 236 
 Sleeping-bag, disadvantages of Nor- 
 wegian, 325 
 Slipper-baths, 281, 282, 286 
 Sludge, 228, 229 
 Social position of recruits, 29 
 Socks : advantages and disadvantages, 
 
 305 ; Japanese, 305 
 Soil, selection of, for camps, 297 
 Specific heat of body, 64 
 Springs, 146, 147 
 Stability, 143 
 
 Standing camps, destructors far, 254 
 Steam : saturated, 392, 394 ; super- 
 heated, 392, 393, 394 
 Stonewall Jackson, 15 ; rules for halts, 
 
 73 
 Strain, justifiable and unjustifiable, 36 
 Streptococci in water, 155 
 Study V. experience, 16 ; imaginary 
 
 problems, 17 
 Subsoil water, 144, 145 
 Success in war, price of, 14 
 Sun, direct rays of, 60 
 Sweater, Norwegian, 310 
 Sweeper, duty and limitations, 222 
 
 Talavera, 74 
 
 Temperature, normal, meaning of, 52 
 
 Tente d'dbri. See Shelter-tent 
 
 Thirst, 64 
 
 Thomhill's system, 241 
 
 Town and country lads, 35 
 
 Trade sanitations, 6 
 
 Training and production of heat, 56 
 
 Trousers : advantages and disadvan- 
 tages of short, 310; usual pattern, 
 310 
 
 Uniform : historical associations, 301 ; 
 
 invisibility of field service, 301 
 Universal service, physical effects of, 
 
 Urinal : barrack, 274, 276, 279, 281 
 
 282, 285, 286, 288; receptacle 
 
 218, 219 
 Urinals in field, 256 ; construction of, 
 
 257 ; marking, 260 ; night, 259 
 Urinary system, effects of marching 
 
 on, 71 
 Urine, disposal of, 218, 219; best 
 
 method in standing camps, 260 ; 
 . difficulties in field, 259 
 
 Vauban, 273 
 
 Vegetius on physical exercise, 44 
 
 Ventilation, 2 ; definition of, 196 ; 
 
 in barracks, 206 
 Villars, Marshal 14 
 Voluntary enlistment, effects of, 22 
 
 Walcheren, 366 
 
 Walking : energy expended in, 51 ; 
 energy expenditure per mile, 52 ; 
 heat production on, 52 ; margin of 
 safety, 53 ; nature of, 47, 48 ; tem- 
 perature, 53 
 
 War, duty of sanitary officer in, 13 
 
 " Warming to one's work, " physiology 
 of, 53 
 
 Wash-house water, disposal of, in 
 India, 244 
 
 Washing-water, disposal of, in field, 
 269 
 
 Waste matters : classification, 207 ; 
 disposal of, 208 et seq. ; — , by 
 burial, 245 - 251 ; — , danger of 
 delay, 246; — , incineration, 227; 
 — , in field by incineration, 254-256 ; 
 — , in India, 240-242 ; — , meaning 
 of term, 225 ; — , Thomhill's sys- 
 tem, 241 ; — , V. removal, 209 ; effect 
 of oxidation, 208 ; nuisance due 
 to, 208. See also Conservancy 
 system 
 Water : absorbed by vegetation, 144 
 B. coli in, 155 ; B. enteritidis sporo 
 genesin, 155; characteristics of, 139 
 chloride of sodium in, 151 ; circula 
 tion of, 139 ; collection of, in field 
 168 ; discipline, 63, 167, 168 ; dis 
 tribution of, 164, 167 ; evapora 
 tion, 144 ; geology of supply, 144 
 146 ; ground, 144 ; hardness, 150, 
 151, 169 ; humic acid in, 153 
 impurities in, 156 ; lead -poisoning. 
 153 ; micro-organisms in, 154 
 nitrogenous compounds in, 152 
 quality of, 148, 149, 150, 156, 157 
 quantity allowed, 141, 142, 143 
 regularity of supply, 147 ; reser 
 voirs, 162 ; reservoir service, 163 
 — , covered or open, 164 ; — , pro 
 tec tion of, 163; on service, 158 
 storage in barracks, 164 ; strepto 
 cocci in, 155 ; subsoil, 144 ; supply 
 
418 MILITAEY HYGIENE AND SANITATION 
 
 and removal, 140 ; surface supply, 
 144 ; suspended matters in, 154 ; 
 uses of, 140 ; zinc in, 154 
 
 Water, bearing capacity, 145 
 
 Water filtration : area available, 171 ; 
 Bell's system, 175 ; candle filters, 
 178 ; candy filter, 176 ; cleaning of 
 filters, 175 ; efiEect on micro-organ- 
 isms, 173 ; in the field, 181, 182, 183 ; 
 — .American, 180; — , British, 179; 
 — , French, 179; — , German, 180; 
 — , Japanese, 180 ; Jewell system, 
 175 ; large scale, 172 ; Mi quel et 
 Mouche, 176 ; principles regulating, 
 170, 171 ; Puech-Chabal system, 174 
 
 Water-holding power, 145 
 
 Water, purification of, 169 ; by 
 chemicals, 186 ; in the field, 185, 
 189, 190, 193 ; filtration, 170 ; 
 general considerations, 193 ; halo- 
 gens, 187 ; by heat, 190 ; cool- 
 ing, 191 ; Griffith's principle, 
 
 192 ; ozone, 186 ; permanganate of 
 potash, 187 ; precipitation, 170 ; 
 sedimentation, 170 ; sulphate of 
 sodium, 188 ; ultra-violet rays, 184, 
 185 
 
 Water, rain : collecting area, 143, 159 ; 
 quality of, 149 
 
 Water-bottle : aluminium, 324 ; dif- 
 ferent patterns, 324 ; how carried, 
 323, 324 ; rational size of, 318 ; 
 weight of, full, 318 
 
 Webbing, equipment, 328 
 
 Weight, 25 
 
 Wells, 146 ; deep, 161 ; variations in 
 quality, 161 ; variations in quantity, 
 147, 161 ; regularity of supply from 
 147 ; shallow, 161 
 
 Wet-bulb reading, importance of, 59 
 
 Windows as air inlets, 204 
 
 Wolseley, Lord, opinion on sanitary 
 officers, 19 
 
 Wool, conductivity of, 302 
 
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