Bacilli And Bullets

Sir William Osler, one of the greatest medical men in the world, told
the soldiers in the English training camps that he wanted to help them
to get a true knowledge of their foes. The officers had impressed the
soldiers with the truth that it was always necessary to find out where
their enemies were and how many they were. But Sir William Osier told
them of other invisible enemies which they should most fear, and fight
against. "While the bullets from your foes are to be dreaded," he said,
"the bacilli are far more dangerous." Indeed in the wars of the world,
the two have been as Saul and David,--the one slaying thousands, the
other tens of thousands.

He continued, "I can never see a group of recruits marching to the
depot without asking what percentage of these fine fellows will die
from wounds, and what percentage will perish miserably from neglect of
ordinary sanitary precautions. It is bitter enough to lose thousands of
the best of our young men in a hideous war, but it adds terribly to the
tragedy to think that more than one half of the losses may be due to
preventable disease. Typhus fever, malaria, cholera, enteric, and
dysentery have won more victories than powder and shot. Some of the
diseases need no longer be dreaded. Typhus and malaria, which one
hundred years ago routed a great English army in the expedition against
Antwerp, are no longer formidable foes. But enough such foes remain, as
we found by sad experience in South Africa. Of the 22,000 lives lost in
that war--can you believe it?--the bullets accounted for only 8000, the
bacilli for 14,000. In the long, hard campaign before us, more men will
go into the field than ever before in the history of the Empire. Before
it is too late, let us take every possible precaution to guard against
a repetition of such disasters. I am here to warn you soldiers against
enemies more subtle, more dangerous, and more fatal than the Germans,
enemies against which no successful battle can be fought without your
intelligent coöperation. So far the world has only seen one great war
waged with the weapons of science against these foes. Our allies, the
Japanese, went into the Russian campaign prepared as fully against
bacilli as against bullets, with the result that the percentage of
deaths from disease was the lowest that has ever been attained in a
great war. Which lesson shall we learn? Which example shall we follow,
Japan, or South Africa with its sad memories?

"We are not likely to have to fight three scourges, typhus, malaria,
and cholera, though the possibility of the last has to be considered.
But there remain dysentery, pneumonia, and enteric.

"Dysentery has been for centuries one of the most terrible of camp
diseases, killing thousands, and, in its prolonged damage to health, it
is one of the most fatal of foes to armies. So far as we know, it is
conveyed by water, and only by carrying out strictly, under all
circumstances, the directions about boiling water, can it be prevented.
It is a disease which, even under the best of circumstances, cannot
always be prevented; but with care there should never again be
widespread outbreaks in camps themselves.

"Pneumonia is a much more difficult disease to prevent. Many of us,
unfortunately, carry the germ with us. In these bright days all goes
well in a holiday camp like this; but when the cold and the rain come,
and the long marches, the resisting forces of the body are lowered, the
enemy, always on the watch, overpowers the guards, rushes the defenses,
and attacks the lungs. Be careful not to neglect coughs and colds. A
man in good condition should be able to withstand the wettings and
exposures that lower the system, but in a winter campaign, pneumonia
causes a large amount of sickness and is one of the serious enemies of
the soldier.

"Above all others one disease has proved most fatal in modern
warfare--enteric, or typhoid fever. Over and over again it has killed
thousands before they ever reached the fighting line. The United States
troops had a terrible experience in the Spanish-American War. In six
months, between June and November, among 107,973 officers and men in 92
volunteer regiments, 20,738, practically one fifth of the entire
number, had typhoid fever, and 1580 died. The danger is chiefly from
persons who have already had the disease and who carry the germs in
their intestines, harmless to them, but capable of infecting barracks
or camps. It was probably by flies and by dust carrying the germs that
the bacilli were so fatal in South Africa. Take to heart these figures:
there were 57,684 cases of typhoid fever, of which 19,454 were
invalided, and 8022 died. More died from the bacilli of this disease
than from the bullets of the Boers. Do let this terrible record impress
upon you the importance of carrying out with religious care the
sanitary regulations.

"One great advance in connection with typhoid fever has been made of
late years, and of this I am come specially to ask you to take
advantage. An attack of an infectious disease so alters the body that
it is no longer susceptible to another attack of the same disease; once
a person has had scarlet fever, smallpox, or chicken pox, he is not
likely to have a second attack. He is immune. When bacilli make a
successful entry into our bodies, they overcome the forces that
naturally protect the system, and grow; but the body puts up a strong
fight, all sorts of anti-bodies are formed in the blood, and if
recovery takes place, the patient is safe for a few years at least
against that disease.

"It was an Englishman, Jenner, who, in 1798, found that it was possible
to produce this immunity by giving a person a mild attack of the
disease, or of one very much like it. Against smallpox all of you have
been vaccinated--a harmless, safe, and effective measure. Let me give
you a war illustration. General Wood of the United States Army told me
that, when he was at Santiago, reports came that in villages not far
distant smallpox was raging, and the people were without help of any
kind. He called for volunteers, all men who showed scars of
satisfactory vaccination. Groups of these soldiers went into the
villages, took care of the smallpox patients, cleaned up the houses,
stayed there until the epidemic was over, and not one of them took the
disease. Had not those men been vaccinated, at least 99 per cent of
them would have taken smallpox.

"Now what I wish to ask you is to take advantage of the knowledge that
the human body can be protected by vaccination against typhoid.
Discovered through the researches of Sir Almroth Wright, this measure
has been introduced successfully into our own regular army, into the
armies of France, the United States, Japan, and Germany. I told you a
few minutes ago about the great number of cases of typhoid fever in the
volunteer troops in America during the Spanish-American War. That
resulted largely from the wide prevalence of the disease in country
districts, so that the camps became infected; and we did not then know
the importance of the fly as a carrier. But in the regular army in the
United States, where inoculation has been practiced now for several
years, the number of cases has fallen from 3.53 per thousand men to
practically nil. In a strength of 90,646 there were, in 1913, only
three cases of typhoid fever. In France the typhoid rate among the
unvaccinated was 168.44 per thousand, and among the vaccinated .18 per
thousand. In India, where the disease has been very prevalent, the
success of the measure has been remarkable.

"In the United States, and in France, and in some other countries, this
vaccination against the disease is compulsory. It is not a serious
matter; you may feel badly for twenty-four hours, and the place of
inoculation will be tender, but I hope I have said enough to convince
you that, in the interests of the cause, you should gladly put up with
this temporary inconvenience. If the lessons of past experience count,
any expeditionary force on the Continent has much more to fear from the
bacillus of typhoid fever than from bullets and bayonets. Think again
of South Africa, with its 57,000 cases of typhoid fever! With a million
of men in the field, their efficiency will be increased one third if we
can prevent typhoid. It can be prevented, it must be prevented; but
meanwhile the decision is in your hands, and I know it will be in favor
of your King and Country."

* * * * *

The soldiers in the American army are also inoculated against measles,
scarlet fever, and the pneumonia germ.

Tetanus, or lockjaw, is one of the grave dangers faced by the wounded
soldiers; for the germ of this disease has its home in the earth, and
during a battle, soldiers with open wounds often lie for hours in the
fields and trenches. Antitoxin treatment has reduced the death-rate.

Two new diseases have been produced by the World War,--spotted typhus
and trench fever; both are carried by vermin. This was proved by
soldiers who volunteered to permit experiments to be made upon them. By
preventing and destroying the vermin, these diseases are being
conquered.

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Bacilli And Bullets