CHAPTER I MILITARY HYGIENE AND SANITATION- GENERAL CONSIDERATIONS
Hygiene is both the art and the science of preserving and improving health. It pertains especially to the individual. Sanitation or public hygiene considers both the principles and apparatus employed for the purpose of promoting the health of communities.
The keynote of both hygiene and sanitation first, last, and all the time, is cleanliness, — cleanliness of both mind and body, cleanliness of thoughts and habits, of association and environment; cleanliness of both the exterior and tissues of the body, for the latter should be free from all noxious materials. The essential end of both hygiene and sanitation is to promote cleanliness.
Military hygiene and sanitation consider the parts of these sciences which are of a special value to armies, more particularly when they are in the field. Circumstances then existing are, to a degree, peculiar and peculiar measures must be adopted for the preservation of health. The successful sanitary service of groups of men living close to nature, unprovided with many of those refinements of civilized life developed for static community service, presents problems, often unique, which require prompt and resourceful solution.
Congregation of troops in such close contact as exists in camps, facilitates the transmission of disease among them, while exposure to the elements and the privations inseparable from the military service tend to lower their powers of resistance. The prime duty of the Medical Department is not the care of the individual, harsh as they may seem, but the preservation of the health of the command in order that its numbers and vigor may be unimpaired.
The sanitary service of troops is not an imposition or a necessary evil. It is an effort to assist the commander in preserving the health and thus the number and morale of his troops. It is an essential and integral part of the military organization. Though expensive, sanitary measures are worth more than they cost. Carrell estimates that on a cold business basis each healthy soldier is worth $6000 to the state. A sick soldier is not only useless but requires the services of able-bodied people, is a constant source of expense, perhaps a focus of infection, and later burdens the state through the pension list.
Discipline is essential for the proper enforcement of orders affecting health. The sanitary adviser can do nothing if his recommendations are not enforced by the commanding officer. Under similar circumstances the morbidity of those commands whose discipline is lax, is invariably higher than is that of those whose discipline is strict. An increased sick report is only one of the several ways in which the demoralizing effects of lax discipline manifest themselves.
Important as are hygiene and sanitation they sometimes must be ignored. Armies exist in order to win battles and sanitary measures must ever be ancillary to the prime efforts to obtain that end. Military exigencies must dominate before an engagement, during it, and perhaps after it.
History abounds with instances when sickness either caused or aggravated military failures; e.g., the fall of Athens, in the Peloponnesian War and the defeat of the Prussians at Valmy, a conflict which made possible the fruition of the French Revolution. Many other failures of lesser importance may be cited.
Though it is impossible to over-emphasize the view that the essential aim of the medical service is maintenance of fighting efficiency of the troops at the front, the great importance of sound sanitation on the lines of communication must be noted. 'However satisfactory the civil sanitary organization in the zone of active operations may have been prior to hostilities, it is inevitable that a certain amount of disorganization and inefficiency must result from the increased demands and stress of war. An advancing wave of units, fully officered, equipped and organized, should leave in its wake few insanitary conditions, but the matter is very different when detachments subsequently use the line of communication. These detachments lack equipment, trained personnel and organized medical supervision, and consequently the routes tend to become progressively more insanitary. The consequent potential danger becomes an actual menace when the routes still later are traversed by returning infective patients. The ultimate result is that the lines of communication which should serve to maintain the fighting strength by a stream of healthy reinforcements, may prove a source of weakness by passing into the firing line men who have been infected en route to the front, where they become foci of infections which may be spread through the ranks.' (Lelean.) It is thus evident that there can be few more important duties for the medical officer in the field than those which deal with the maintenance of sound sanitation upon the lines of communication.
The conditions surrounding the soldier in time of war render him, until he has been hardened, more susceptible than the civilian to certain diseases. The ailments most prevalent in armies in time of peace differ from those in war. During campaigns troops suffer from inclement weather, extremes of temperature, lack of proper shelter, crowding, unsuitable or badly cooked food, overstrain, excitement and anxiety. Sanitary conditions are then often of subsidiary importance and are comparatively neglected with the result that almost invariably disability and death from disease rapidly increase.
The commonest diseases among troops are infections (which as a rule are spread chiefly by contact), digestive disorders, rheumatism, affections of the respiratory and nervous systems and of the heart. In the United States Army the most prevalent infections in time of peace, are venereal diseases, tonsillitis, bronchitis, diarrhea, influenza, pneumonia, rheumatism, measles, mumps, tuberculosis and malaria. The most common causes of death from disease in former wars were cholera and typhus, both of which have invaded armies in Europe during the present conflict. In our war with Mexico the commonest disease was a severe diarrhea, probably an anomalous form of dysentery. In the Civil War the commonest diseases were diarrhea, dysentery, malaria, typhoid fever, rheumatism, respiratory and venereal diseases; in the Spanish-American War and Philippine War, malaria, typhoid fever, dysentery, and diarrhea.
The sick rate is highest for young soldiers under 20 years of age. These men are especially subject to typhoid fever. The disability rate then falls after this age up to the age of 45 when it begins to rise. The death rate is highest in young soldiers 19 years of age and under. It reaches its minimum between 25 and 30 years, rises slightly up to 40 and rapidly thereafter. Rates for both morbidity and mortality are highest during the first year of service; they then gradually diminish, to rise again after 10 years service. The death rate is lowest in the third or fourth year. In the tropics, young soldiers are even more liable to sickness than they are in the United States. The lowest rates of admission, disability, and non-effectiveness in the tropics are among soldiers past 40, though these men furnish the highest death rate.
The healthfulness of an army is not indicated by a comparison of the number of deaths from disease with the number of deaths from wounds. This popular standard of comparison is quite fallacious. The two causes of disability cannot be compared. It would be as reasonable to attempt to determine the salubrity of a community by comparison of the number of deaths from disease to the number of deaths by accident as to determine the healthfulness of an army by similar standards.
<Callout type="important" title="Importance of Sanitation">Sanitation is crucial for maintaining military efficiency and preventing disease spread among troops. Proper hygiene practices can significantly reduce morbidity rates.</Callout>
<Callout type="risk" title="Risk of Infection">Infections, especially those spread by contact, pose a significant risk to troop health in close quarters. Measures such as handwashing and proper sanitation are essential.</Callout>
<Callout type="tip" title="Promote Discipline">Strict discipline is necessary for enforcing hygiene orders. Officers must ensure that their recommendations are enforced to maintain low morbidity rates.</Callout>
Key Takeaways
- Sanitation and hygiene are critical for maintaining military efficiency.
- Proper sanitation on lines of communication is essential to prevent disease spread.
- Young soldiers under 20 years old are particularly susceptible to typhoid fever.
- Discipline in enforcing hygiene orders significantly impacts health outcomes.
- Comparing deaths from disease with those from wounds does not accurately reflect a unit's health.
Practical Tips
- Implement strict handwashing protocols among troops to prevent the spread of infections.
- Ensure that all soldiers are educated on basic hygiene practices, especially in close quarters.
- Regularly inspect and maintain sanitation facilities to ensure they remain clean and functional.
- Prioritize discipline and enforcement of hygiene orders to minimize disease transmission.
Warnings & Risks
- Lax discipline can lead to higher morbidity rates among troops, compromising their effectiveness.
- Neglecting sanitation on lines of communication can result in the spread of infections through returning soldiers.
- Comparing deaths from disease with those from wounds is misleading and does not reflect true health outcomes.
Modern Application
While the specific techniques described in this chapter are historical, the principles of maintaining hygiene and sanitation to prevent disease remain relevant. Modern survival preparedness can benefit from these lessons by ensuring that basic hygiene practices are prioritized during emergencies or when living in close quarters with others.
Frequently Asked Questions
Q: What is the most important factor for maintaining military health according to this chapter?
The most important factor is cleanliness and proper sanitation, as emphasized throughout the text. Sanitation is crucial for preventing disease spread among troops.
Q: How does discipline affect the health of a military unit?
Strict discipline in enforcing hygiene orders significantly impacts health outcomes. Lax discipline can lead to higher morbidity rates among troops, compromising their effectiveness on the battlefield.
Q: What are some common diseases that affect soldiers during wartime according to this chapter?
Common diseases include infections (spread by contact), digestive disorders, rheumatism, respiratory and nervous system affections, and heart conditions. Specific examples mentioned are typhoid fever, malaria, and pneumonia.