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