CHAPTER II PERSONAL HYGIENE (Part 1)

CHAPTER II PERSONAL HYGIENE Though much can be accompb'shed by suitable orders concerning hygiene their value can be greatly enhanced by intelligent co-opera- tion on the part of the men. To this end they should receive from the Surgeon certain elementary instructions concerning the care of their persons and their habits. The importance of an adequate supply of fresh air at night is not fully appreciated by most troops. Men tend to burrow for warmth, and in trench warfare this is unavoidable. If the weather be cold, they close the inlets of fresh air in huts and tents. The resultant re-breathing of contaminated air both lowers resistance to disease and impairs mental and physical energy. The smaller the shelter the better it should be ventilated. Adequate fresh air is especially necessary if there occur an epidemic of any infectious disease of the respiratory organs. The troops in the Punitive Expedition were required in the dead of winter to provide adequate ventilation at night, though they had but scanty bed covers and suffered some- what from cold. The use of braziers was prohibited as they devel- oped injurious gases. The fact that in but two instances did pneu- monia attack two men in the same tent in the El Paso district where fifty thousand men were encamped is attributed largely to the fact that free ventilation of tents was enforced. In the trenches men warm and dry themselves in dug-outs sepa- rated from the main trench by low clay partitions. These are heated by coal braziers. Lack of ventilation is necessitated by military conditions at many points near the front. Exercise is essential to health. Marching troops are healthy, not only because of occupancy of new camp sites, but because of the exercise they perform. The value of setting up exercises is quickly manifest in recruits. The best form of exercise is that indulged in 6 PERSONAL HYGIENE 7 as recr^tion because of the psychological element it introduces. For this reason, athletic sports in which all men participate should be encouraged. Americans as a people prefer to watch games, as did the Romans, rather than to participate in them. Games not only increase the vital fimctions of organs but their mental effects are stimulating and keep men contented. Rest is as important as exercise. Men should have eight hours work, eight hours recreation, and eight hours rest. So far as pos- sible, habits of exercise, recreation, and sleep should be regular. It is particularly desirable that men get adequate sleep and that this be as refreshing as possible. Young men require more sleep than older ones. To secure a maximum of benefit men should sleep in loose underwear and have adequate bed covering when in the field. Paper blankets for troops in fixed camps where supplies are limited may be extemporized by sewing a few layers of newspaper between layers of bed ticking, burlap, etc. When these become soiled, they are opened, the paper removed and burned, and the fabric cleansed. Bedding should be aired and bed linen changed weekly. Bathing promotes the physiological functions of the skin by clear- ing the openings of the sweat glands which discharge from ij^ to 4 pints of sweat daily and are a most important regulator of body tem- perature. It also frees the mouths of the sebaceous glands whose secretions oil the skin and prevent it from becoming unduly hard- ened and rough. Bathing also removes dirt and the germs which may abound on the skin. Forty thousand have been counted on a square centimeter. They may give rise to boils, carbuncles, cellulitis, etc. Also any wound contracted through a skin that is dirty is very liable to become infected. The influence of dirty clothing and dirty skin in causing gas gangrene has been very noticeable in this war. Almost all wounds are infected. The introduction of adequate bathing facilities in our army was fol- lowed by a fall in morbidity of about 20 per cent. Many of our most dangerous camp diseases such as typhoid fever, cholera and dysentery are disseminated by dirty hands. Bathing also prevents fouling of the air by emanations from the body due to the accumula- tions of the excretions and fluid on the skin. Cold baths act as a tonic and have a stimulating effect. Warm baths are sedative. Bathing facilities are discussed in the chapter on camps. 8 FIELD HYGIENE AND SANITATION Men should wash the face, head, neck and hands every morning in cold water. The scalp should be washed twice a week. The hands should be washed with soap whenever soiled, before each meal, and after each visit to the latrine. Good soaps for use in hard waters are the Physicians* and Surgeon's, Sayman's, Walke's, "Coal Oil Johnnie" and Palm Olive. Soap is a good disinfectant. The nails should be. kept short and cleaned frequently. When cholera is present basins of two per cent, phenol should be provided near the latrines. Nostrils and ears can be kept clean by the insertion of a little vaseline which is then removed by the corner of a towel or handkerchief. Sticks should not be introduced into the auditory canal or nose. It is best that no beard be worn in fixed camp, but if worn it should be trimmed short; daily washed and brushed. In the trenches it is impossible for soldiers to shave themselves daily. Many troops habitually wear beards when on active service in time of war. Excessive or offensive sweating is treated by painting on the af- fected area a ten per cent, solution of formalin every other day. Five or six applications may be necessary. Since cleanliness is even more necessary among men crowded in camps and in cantonments than it is under other circumstances, appliances must be devised and facilities developed whereby it may be obtained. These are considered in the chapter on camps. In the absence of adequate bathing facilities, however, a sponge bath may be used, or the body rubbed with a coarse fabric, e.g.j a gunny sack. This expedient gives an unexpected amount of satis- faction. Men should use their own toilet and smoking articles. By toilet articles especially, a number of infections may be transmitted, e.g.y ^ itch, ringworm and other skin diseases, body vermin, gonorrheal infections, syphilis, smallpox, typhoid fever, etc. . Any irritation about the mouth or throat should be treated promptly as it may give rise to ulcerations, abscesses, etc. Espe- cially should attention be given to decayed teeth and to pyorrhea. The importance of this disease is only beginning to be generally appreciated. It is responsible for certain acute and chronic general infections. Many of the latter are usually attributed to "rheuma- tism." Teeth should be examined at least every six months by a PERSONAL HYGIENE 9 dentist. They should be cleaned with a soft brush and some tooth powder or ordinary soap twice daily. As the tooth brush is easily infected it should be washed after each using and kept in a container. Indiscriminate spitting should be discouraged strongly as if trans- mits many infectious diseases. Proper care of the feet of marching troops is a matter of prime importance. Nails should be cut short and square. Corns should be attended to promptly. After a march especially in hot weather the feet should be sponged, clean socks put on, and those removed, washed and dried. Wet or wrinkled socks especially, should be replaced. Exposed parts should be protected by adhesive plaster or greased with vaseline or tallow. The entire foot and ankle should be anointed if the soldier has to stand in much water, as in the trenches. Tender feet may be hardened by bathing in alum, form- alin or alcoholic solutions. Soap or grease applied to the feet or socks before the march will lessen friction. The foot powder issued by the Medical Department prevents abrasions and blisters, and gives excellent results. It consists of 87 parts talcum, 10 parts starch and 3 parts salicylic acid. Soaking the feet does more harm than good as it softens the skin. Blisters that develop on the march are usually treated by pricking them, expressing the water and covering with adhesive plaster. A better method followed by Capt. R. C. Hefflebower, M. C, is the following: The blister and the surrounding skin are painted with tincture of iodine, then a small fold of the raised epidermis is caught between the blades of a pair of scissors and excised leaving a small oval opening about KeX J^ inch in diameter. In large blisters additional openings are made. After the fluid has escaped, the area is again iodined, dried and covered with adhesive plaster. The strips of the latter are narrow and over- lap so as to conform exactly to the foot surface. Their ends are always brought up over the sides of the foot to prevent rolling and curling. This practice of treating blisters on the feet gives better results than any other yet devised. Woolen socks are best. Food should be masticated thoroughly and eaten slowly. Large quantities of liquids should not be drunk at meals. Too many arti- cles of poor quality especially fruits and pastry are eaten at the re- freshment booths that spring up around camp. The practice of making regular visits to the latrine should be followed. Procrastina- lO FIELD HYGIENE AND SANITATION tion is a common cause of constipation. Natural processes should be promoted by exercise and the use of bulky food. Alcohol is now rightly regarded as a poison and its use is meeting with increasing opposition. When none is obtainable, the discipline and morale of troops is immeasurably improved. In the Punitive Expedition, many old soldiers who had been frequent soiurces of trouble rendered impeccable service and the effects of total absti- nence were apparent both in guard house and hospital reports. Smoking if practiced to excess may cause various nervous dis- orders—headache, giddiness, insomnia, tremor, arrhythmia of the heart, etc., but in moderate quantities, its effect upon those habitu- ated to its use is soothing and its use should not be interfered with. The practice of inhaling, however, is deleterious because of the large amount of nicotine absorbed. Sexual intercourse is not essential to health. Attempts to excul- pate its indulgence by lusty young men, removed from domestic restraint, are far too frequently based on the assumption that the reverse is the case. Emissions are an evidence of vigor and not of its loss. The indiscriminate gratification of sexual desire usually eventuates in contraction of a'venereal disease, since most prosti- tutes are infected. To reduce the prevalence of such diseases among those who are unable to control themselves, the following procedure is practiced in several services. After urination, the penis is washed with soap and water, lo c.c. of a two per cent, solution of protargol are injected and retained for three minutes. The head, neck and shaft of the penis are rubbed with 33 per cent, calomel ointment in 20 per cent, lanolin and 47 per cent, vaseline. To be effective this pro- phylactic treatment should be employed not more than an hour after exposure. In order to control venereal disease, troops are in- spected twice monthly, once before the 15th and again before the 30th by a medical officer accompanied by an officer from the respec- tive company. Men found diseased are required to take appropri- ate treatment. Also a record is kept of the prophylactic given, show- ing the name of the person taking it, date and hour of exposure, date and hour of administration and signature of the Medical Department man administering it. Facilities for the administration of the pro- phylactic and for keeping this record are provided at the regi- mental infirmary. Acute cases, other than uncomplicated gonor- PERSONAL HYGIENE II rhea, are transferred to the hospital. Men who fail to take the prophylactic are brought to trial under the provisions of General Orders 17 W. D. 1912, G. O. 31 W. D. 1912, and G. O. 45 W. D. 1 9 14. A record for syphilitic cases is also kept showing the treat- ment given and progress in each case. It is also necessary to keep a record of the number of venereal cases undergoing treatment in order that any increase in these infections may be detected promptly and controlled. Prophylactic personal treatment against typhoid and paratyphoid fevers, smallpox and cholera, and personal prophylaxis against malaria, etc., are discussed in the chapter on transmissible diseases. Clothing should be well fitted, comfortable, with few constrictions, and should not hamper movement, particularly of the chest and abdomen. Shoes should be broad, at least two-thirds inch longer in- side, than the foot, as the foot spreads and lengthens on the march. Socks should be well fitting, not too tight, and free from holes. In cold weather in trench warfare, it is especially necessary to have loosely fitting shoes which will accommodate easily two pairs of socks. Shoes should be hob-nailed and made impervious to water by rubbing with neatsfoot oil or castor oil. The best type of foot wear for officers in the field is a high waterproof boot which laces up the front. For the enlisted man the Munson shoe is much more com- fortable than the new field marching shoe though not so durable. In the march of the i6th Inf. out of Mexico 12.15 per cent, of the men who used the Munson shoe and 65.13 per cent, of those who wore the marching shoe developed blisters or abrasions (Hefflebo wer) . The best type of foot wear for the soldier is believed to be a loose • shoe, on a Mimson last with a heavier sole than the latter, hob-nailed, and lightly dressed with neatsfoot oil. Men require different amounts of clothing and there should be some latitude allowed in the amount of underwear worn. Exposure to heat or cold lowers bodily resistance and should thus be controlled as far as possible. Underwear should be changed if possible weekly in winter or twice weekly in summer and aired nightly in hoi weather. Men should not lend their clothing to each other as some of the most dreaded camp diseases may be transmitted in this way. In the absence of adequate warm clothing, comfort may be pro- 12 FIELD HYGIENE AND SANITATION moted by a folded newspaper placed underneath the shirt, or a paper or chamois skin vest. Loss of gloves may be prevented by tying these to the end of a cord which passes up the sleeves and across the back. Laundering presents many difficulties in the field, especially in trench warfare, but its necessity is indicated by the fact that laundry water contains more bacteria than ordinary sewage. The disposal of such water should therefore be practiced with great care and the laundering place for troops on a stream should be that point down stream from which water is obtained, — ^if possible at a distance from camp. A good plan in semi-permanent camps is for men to boil their clothing in discarded oil cans. If piped water is plentiful and facilities for drainage ample, bath houses may be so constructed as to provide a place where clothes can be washed. Under the usual conditions in camp, however, movable tables or benches should be provided. These should be placed in the rear of each company street, but moved to a new spot every two or three days. Under no circumstances should they be located in shady places. (Lewis and MiUer.) Laundrymen may be employed by the several companies, or other camp followers under adequate supervision may do the laundering by personal agreement with individuals. At Dublan, in Mexico, a laundry employing 120 Chinamen was established by private parties under the supervision of Colonel Glennan, the Divi- sion Surgeon, and rendered excellent service at low rates. In fixed camp, company or regimental bath and laundry houses are usually provided. In European services laundries that can handle as high • as 5000 pieces a day, are mounted on trains of auto trucks which move to selected points near the firing line. The machinery is actuated from the motors. Bath trains similarly equipped with laundry facilities also operate near the front in the services of the central powers. These organizations are accompanied by a personnel which repairs damaged clothing. Most men are cleanly and do not harbor vermin. Lice are seldom seen except on recruits or among troops deprived of bathing and laundry facilities, as in time of war. But the men themselves are the main source of infestation by these insects. Experiments in detail and on a large scale, carried on among PERSONAL HYGIENE 13 soldiers in billets and trenches, by A. D. Peacock go to prove that the measures suggested below are of -great benefit. 1. Whenever possible, and as regularly as possible, the clothing should be thoroughly searched for both lice and the "nits" or eggs. If the removal of the white patch which binds the seams at the fork of the trousers does not interfere with comfort, it is well to remove it. Special care during the searching for the lice and eggs should be paid to this region. Men should be afforded set times for inspecting their clothes. There should be a general inspection by company and medical officers each week. 2. The great source of danger is the presence of eggs on the cloth- ing. These hatch in about a week. It is necessary, therefore, that the trousers should be ironed and brushed at least once a week. 3. Against the lice themselves, whenever necessary, the remedies mentioned below are recommended. Powders, as a rule, should not be used at the fork, but down the shirt and trousers. Care should be taken to see that any powder which falls from the shirt to the fork should be small in amount, as too much is liable to cause smarting. A man in each unit should be responsible