On the Fringe of the Great Fight Part 11

The methods employed to break these links are simple; the carrying out of the methods is oftentimes very difficult.

It is obviously essential in the first place to remove from the army, at the earliest possible moment after it has been diagnosed, every case of communicable disease. This means the adoption of measures for picking out soldiers who show symptoms of disease, which really comes down to the fact that the medical officers must always be on the alert and carry out the instructions of the director of medical services of the army with despatch. In the British Army this is one of the most important features in the control of epidemics. If a man is suspected of having any communicable disease he is instantly placed under quarantine until the diagnosis has been confirmed, after which he is removed from the army area altogether as a possible focus of infection. The British Army takes no chances, and its wonderful record of freedom from contagious disease proves that it has been absolutely sound in its technique.

This is practically the only way of eliminating diseases, such as measles and scarlet fever which cannot be diagnosed by bacteriological methods, but of course the procedure is employed in all other kinds of epidemic disease as well.

Great Britain has been fortunate above all other nations in this respect that she sent over at first a small army of regular troops, perfectly equipped from the medical standpoint as well as in every other way. Efforts had been made for years to remove typhoid carriers from the regular army, and naturally no soldier was sent into the field who was known to have typhoid, or to be a carrier of typhoid or any other contagious disease germs. Furthermore, the soldiers had practically all been vaccinated against smallpox and inoculated against typhoid fever.

As division after division was sent out to the army in France, they too were completely equipped with sanitary squads, casualty clearing stations, field ambulances, water carts, and other necessary medical equipment. Consequently as the army grew and expanded into a huge force it was thoroughly equipped not only with the necessary apparatus for caring for sick and wounded, but also with the experience acquired by those already in the field. In this way the British Army differed from all of our European Allies who had been compelled to mobilize everything at once and found themselves woefully lacking in medical equipment and personnel, so much so in fact that they had been in the beginning unable to handle all epidemics successfully.

With a realization that the medical equipment of the British Army was complete; that it had been sent into the field free of communicable diseases; that it had been vaccinated and inoculated against two of the most dreaded diseases, smallpox and typhoid fever, and that every reinforcement subsequently sent out had been carefully freed from suspicious cases of disease, it can be readily understood that the British Army began under auspicious circ.u.mstances, and that thereafter its freedom from contagious disease depended to a great extent on the preventive measures adopted.

It is impossible, however, to prevent our soldiers billeted in France from occasionally contracting communicable diseases from the French civilian population, and it is obvious that as there were from 3 to 5 per cent. of the soldiers uninoculated against typhoid fever, we would get some cases of typhoid fever.

Besides this, unless further precautions were taken, the army would be susceptible to disease such as cholera, dysentery and the like should there be cases of these in the war zone.

We therefore arrive at the conclusion that, as there might be some "carriers" and undiagnosed cases of disease among soldiers and civilians excreting disease germs, additional means must be adopted to destroy such germs before they could reach other soldiers. This is the place where sanitation and hygiene steps in, and it is in these matters that the army of Great Britain is unexcelled by any army in the field to-day.

Since the group of intestinal diseases can originate only from the excretions of people who are giving off the specific germs, it would be logical to endeavour to destroy such excreta or render it incapable of contaminating water or food. This is done. All excreta behind the front line and reserve trenches is destroyed in numerous incinerators, which are kept burning night and day. The British Army is the only army which has succeeded in doing this. All excreta which cannot be burned is buried so that it cannot be reached by flies.

As it may happen through accident or carelessness that water supplies have been contaminated, it is the rule to sterilize all water used for drinking purposes, either by boiling, by the use of bisulphate of soda, or by chlorine. The chlorine method is the one in general use in the British Army, as it is in all of the other allied armies.

The possibility of using chlorine in the field was brought to the attention of the British Army authorities by the publication of a method evolved by the writer in 1909. According to this method a stock solution of hypochlorite of lime was added to the water, the amount necessary for any given water being determined by a solution of pota.s.sium iodide and starch. This was particularly useful in the trenches where it was possible to accurately sterilize a pail or a barrel of water if necessary. Small tablets of hypochlorite of lime, each one sufficient to sterilize a pail of water, were also ordered and issued to the first Canadian division, and proved useful.

The great bulk of the water supply, however, is sterilized directly in the water carts by adding one or two spoonfuls of the dry chloride of lime to the partly filled water cart, the mixing being done by the addition of the rest of the water and by agitation during the trip back to the place where the cart is stationed.

In addition to this, large mobile filter units, after a plan draughted in September, 1914, and officially suggested by the writer in 1915 after experience in the field, were built and issued to all the British armies. These mobile filters are capable of filtering and sterilizing large quant.i.ties of water and delivering it to water carts or into stand pipes, ready to drink. A check is kept on the efficiency of the filtration and sterilization by mobile field laboratories.

Standing orders forbid the use of unboiled milk in the army as well as fresh uncooked vegetables, so that there is little danger from these sources. When ones sees the peasants watering their vegetables with sewage, the reason for such regulations are apparent.

As it is possible for flies to carry typhoid bacilli and other disease germs from excreta to food, a constant war is waged against these filthy insects. Flies breed chiefly in manure, and one fly will produce many millions of flies in the course of one summer. The obvious method of keeping down flies is to destroy their breeding places, and therefore it is the duty of everybody concerned to see that all manure piles in the army area are gotten rid of. Some of it is burned, some spread on the fields, some buried, and so forth. On the other hand food is screened from flies whenever possible, and privy pits made inaccessible to them by the same means. On the whole the house fly has not yet, in so far as we know, played any great part in causing epidemic disease in the British Army in France, because so many of the precautions outlined have been carried out.

By getting rid of cases of intestinal disease, and "carriers" of intestinal disease, destruction of excreta and garbage, screening of food, destruction of breeding places of flies, sterilization of drinking water, boiling of milk and vegetables, and in the case of typhoid and paratyphoid fevers, inoculation, the chances of intestinal disease germs getting through from one person to another are comparatively small, as the results would indicate.

To show that these results are not due to accident an example will demonstrate: Early in the war when the British took over from the French a section of the line in the Ypres salient, the Belgian population in the little village of Vlamertinge and neighborhood was being devastated with typhoid fever, and the French troops also had a great many cases. When the British troops took over the line they not only escaped getting typhoid fever themselves, but they succeeded in absolutely stamping it out among the civilian population, and in getting rid of any "carriers" of the disease.

The cases were discovered by a house-to-house investigation by "The Friends' Search Party"--a group of Quakers who had conscientious scruples against bloodshed. This search party notified the medical authorities, particularly the laboratory in the area, of any doubtful cases, and the diagnosis was then made by laboratory methods. In the last six months of my stay in France, near the Belgian border, I do not think that the Friends' search party unearthed a single case of typhoid, and as a matter of fact few cases of the ordinary epidemic diseases such as measles or diphtheria were discovered, although they continued to make house to house investigations and report to us regularly.

The insect-borne diseases in the Western Europe war zone are, as far as we know, carried by flies, lice and mosquitoes. Flies carry disease germs more or less mechanically, and are controlled by the methods outlined above.

Mosquitoes are responsible for transmitting malaria and yellow fever, though the latter never occurs in Europe. Malaria in France is also comparatively unknown, though we found the Anopheles mosquito which is responsible for transmitting the disease elsewhere.

There were also numerous cases of malaria recurring in soldiers from India, Egypt, and other hot countries, so that we had both the infected individual with the malaria parasites in his blood, and the mosquito which was capable of carrying the organisms. Yet in 1915 we had only a dozen cases of malaria develop in men who had never been out of England, and were therefore, presumably, infected in France.

Possibly the chief reason for this was due to the fact that after the mosquito has sucked the blood of an individual infected with malaria, and been infected with the malaria parasite, the weather was not warm enough for the parasite to undergo its necessary transformation in the blood of the mosquito. A continuous warm period of several days'

duration is necessary for this purpose, and in France these time periods never occurred of sufficient duration. Here was a climatic feature which proved to be of very great importance in preventing the spread of a disease most inimical to the health of any army.

Here again, any cases of malaria developing were removed as rapidly as diagnosed, so that mosquitoes did not have much opportunity of becoming infected.

Typhus fever is one of the most dreaded diseases in the army, for it is highly fatal, and both in former wars and in the recent Serbian campaign has proved a terrible scourge. It is quite a different disease from typhoid fever, and is conveyed from man to man solely through lice. In other words, the phrase "No lice, no typhus" is scientifically true.

Every army in the field is a lousy army, and every soldier in a fighting unit is more or less lousy. The louse commonly present is the body louse, and it lays its eggs in the seams of the uniforms and on the underclothes. The eggs hatch out quickly so that when a man once becomes infected the lice multiply with great rapidity.

For typhus to get a grip on an army means that there must be at least one case of the disease, and there must be lice on the case. Some of these lice will fall off, wander away, or be left on the bedding, in the straw, or in the patient's discarded clothes. If these lice have bitten the typhus patient and thereby been infected, it seems to be necessary for a certain length of time to elapse for the organism to develop in the body of the lice before they are able to introduce the virus into uninfected individuals by biting them.

As yet there have been no cases of typhus fever in the British Army in France, though it has occurred to a greater or less extent in Germany, Austria, Russia and Serbia. The quarantine services at the ports of the countries bordering on the Mediterranean have prevented it spreading to any other country.

Typhus fever is known as a dirt disease, and its control is possible through the plentiful use of soap and water. The most difficult thing for a soldier to obtain in the field is a bath. Normally he is in the front line trenches for a week, in the reserve trenches for a week, and in rest for a week. This means that he cannot get a bath for at least two weeks, and he doesn't. So that though a soldier goes back into the trenches clean and free from vermin he is sure to become reinfected from lice left in the dugouts; or some lice eggs on his clothes perhaps have escaped destruction, and he may be as lousy as ever when he comes out of the trenches again. The old straw in the barns and the billets is sure to be infected with lice, and it is very difficult to sterilize the men's blankets. Consequently a persistent continuous fight against this variety of vermin must be kept up, for lice are not only a potential source of danger in transmitting typhus fever and relapsing fever, but they are a great source of irritation to the men and responsible for much loss of sleep.

The greatest luxury at the front is a hot bath, and these are provided in every divisional area on the British front. Three or four miles behind the trenches in the rest areas, in places where a plentiful supply of water can be obtained, the army has established bath houses.

Sometimes a brewery, or part of it, has been taken over for this purpose, because the breweries all have deep wells from which a plentiful supply of water can be obtained. If the bath house is in a brewery they may utilize the large beer barrels cut in two for baths.

These are filled with cold water and live steam turned into the water to warm it. After the bath the men dump the barrels, which are immediately refilled by attendants, for the next group.

Most of the bath houses, however, are in improvised shacks built upon the edge of creeks or ponds. The water is pumped into an elevated reservoir and heated frequently by means of a threshing machine boiler, rented or purchased from some neighboring farmer. One section of the shack is divided off for a bathroom with a number of showers and the other rooms devoted to the receiving of dirty clothing, storing the clean clothing, washing, drying and sterilizing.

As you pa.s.s along the road you will see perhaps a platoon or a section of a platoon marching to the bath house, without belt or equipment, and carrying towels. At the bath house a certain number, say twenty men, pa.s.s into the first room where they undress. Their underclothes and shirts are thrown to one side to be washed; their caps and boots are not treated in any way. The uniforms are hung on numbered racks and placed in the disinfection chamber where they are immediately treated with live steam, or they are taken into an adjoining room where the seams are ironed with hot irons to destroy lice and eggs.

The men then pa.s.s on into the bathroom where they are given about ten minutes to luxuriate with plenty of soap and hot water. As they pa.s.s out of the bath through another room they are given clean socks, underclothes and shirts, and by the time they are dressed their own uniforms, disinfected, are handed back to them. The whole operation takes from twenty-five to thirty minutes, and from a thousand to fifteen hundred men can be put through each bath house in a day.

The discarded clothes are washed by local peasant women paid by the army; in one of these establishments in our area there were 160 Belgian peasant women engaged in this work. Mending is also done by them, while socks and clothes too far gone to be mended are packed in bundles and sent away to be sold.

The waste wash water from the baths and laundries entering the creeks naturally causes trouble from troops down stream who may have to use it. Horses will not touch soapy water, and the brewers object to making beer with it; they say it spoils the beer.

Consequently the sanitary officers have in many cases been compelled to put in tanks to treat this dirty water and purify it. This is usually done by adding an excess of chloride of lime, which precipitates the soap as a curd and carries the dirt down with it. By sedimentation, and filtration through canvas, cinders and sand, the water is clarified and turned into the creeks again clean. So completely can this be accomplished that the experience at one bath house is worth narrating.

This bath house was built on a little pond which acc.u.mulated in winter and was not fed by springs or any other auxiliary source of supply; consequently with the advent of warm weather it would have dried up unless the water had been conserved in some way.

The sanitary officer in charge was equal to the task. With the advice of engineers and the laboratory he built a plant which subsequently worked to perfection. The water used to bath at least a thousand men a day, as well as the wash water from the laundry attached to the bath house, was collected and treated with acid to remove the soap; the sc.u.m formed carried to the top all of the dirt, which was then filtered off by means of sacking, cinders, and sand. The excess of acid was treated with lime which neutralized it, and the excess of lime was removed by soda. The water was all filtered before it was returned to the pond into which it flowed just as clear as it had been before, and with enough hardness present to give it a lather with soap.

The system was operated during the whole summer and gave complete satisfaction. It really did what nature would have done in a much longer time and with a much bigger plant. Had the pond been used to bathe in direct it would have been unfit for use in the course of a few days, whereas by the method employed it was always perfectly sweet and clean.

The common sense and resourcefulness of the British sanitary officer is well shown by this solution of a difficult and apparently hopeless problem. It is indeed a difficult problem which a British officer will acknowledge to be hopeless, and it is this very British quality that the Hun should always keep in mind in thinking of the end of the war and the reckoning afterwards.

As far as we know there has been no plague among the warring armies in Europe. Plague is conveyed from rats having this disease to human beings by means of rat fleas. These fleas become infected by biting the infected rats and subsequently infect human beings by biting them.

There are plenty of rats in the trenches and dugouts, particularly in winter; in the summer they breed along the water courses, and in the autumn are attracted to the trenches where there is plenty of waste food to be had.

Numerous devices are used to destroy them, and it is a common thing to see a soldier sitting patiently in the trenches with his rifle between his knees and a piece of toasted cheese on the end of his bayonet. As Mr. Rat, attracted by the savoury odour, approaches and takes the first sniff, the trigger is pulled and there is one living rat less.

Prizes are sometimes given to the man who can kill the largest number in a week, and bags of 25 and 30 are not uncommon. Sometimes poison is used, and even ferrets have been employed with, however, little success.

In connection with the rat problem, we had an ill.u.s.tration of how impossible it is even for a rat to escape the British army system.

Army routine, the result of many years of experience, once put into operation is as sure and certain as death and taxation.

The regulations are that if any considerable number of rats have been noticed around the trenches sick or dying, some of them shall be sent to the field laboratories for examination. Bubonic plague is a rat disease; consequently if rats are dying in any great numbers, we would conclude that some disease, possibly plague, must be the cause.

In this case the Director of Medical Services of the army had been notified that a rat had been despatched to a laboratory for examination. Consequently he was anxious to know the result of the examination, and when a report was not forthcoming he sent a telegram to the officer commanding the Canadian laboratory asking that a report on the rat be forwarded at once. As we had not received the rat we reported the same to the D.M.S. who put the matter up to the D.D.M.S.

of the corps who had forwarded the rat. The rat had gone to another laboratory, and "the system" to locate the rat was put into operation.

The following is the correspondence upon the subject: