A "BAG" OF RATS FROM THE FRENCH TRENCHES
VOLUNTEERS FOR EXPERIMENTAL INFECTION WITH TRENCH FEVER, AND
THEIR NURSES.
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Soldier’s heart
Of the cases of so-called “soldier’s heart” - which is not true heart disease but is often treated as such - about 60 per cent returned to duty as the result of a system of physical training
April 2, 1917
Some remarkable views are expressed in the “Report Upon Soldiers returned as Cases of Disordered Action of the Heart or Valvular Disease of the Heart” just issued by the Medical Research Committee. The report is the result of the work carried out at the Hampstead Military Hospital at the instance of Sir Alfred Keogh, who appointed Sir Clifford Allbutt, Sir James Mackenzie, and Sir William Osler consultants to the hospital. Dr Thomas Lewis, the head of the clinical staff of the Medical Research Committee, was placed in control of the research work. A number of officers specially selected by the War Office, and including two officers of the Canadian Army Medical Service, composed the staff, and a vast amount of highly specialized scientific work was carried out.
The report makes a protest against medical examinations in these cases founded on the detection of so-called abnormalities while the patient “is at rest”. The test of a hearts capacity, certain forms of gross disease having been eliminated, is its power to do work. Of the cases of so-called “soldier’s heart” - which is not true heart disease at all but is often treated as such - about 60 per cent returned to duty as the result of a system of physical training. The usual stay in hospital,too, was cut down by about half. This was an immense saving of time and money and it proved that the test of capacity is the true test in these cases, for nearly half of the men who returned to duty had “systolic murmurs” which, by older standards, might have gained for them the diagnosis of “heart disease”.
The fact was that the men with these supposed disability signs did just as well as the men without them. “Rest in bed”, says the report, “is harmful, and should be avoided at all stages of treatment except in instances of severe praecordial pain, severe headache, or severe giddiness”.
The ordinary symptoms of “soldier’s heart” are breathlessness, pain, exhaustion, giddiness and fainting, with palpitation, lassitude, and irritability. Having established the test value of capacity to do work as against sounds heard with a stethoscope and the value of physical training as against rest in bed, the report goes the length of stating that “auscultation” (ie, the use of the stethoscope) “is the least valuable method employed in sorting soldiers suffering from cardiovascular derangements the sorting can almost always be effected without its aid.”
This again is a very striking view, for the use of the stethoscope is universal and the respect paid to its findings often reverent. The report appeals to common sense against exaggerated fears “of overlooking early heart disease” by the dictum: “It may be taken as an axiom that no soldier who is free from symptoms on duty has an affection of the heart which incapacitates him, and this axiom may be adopted irrespective of any unusual sign found in the heart. Now actual heart disease in young soldiers, in the absence of a history of rheumatic fever or of syphilis, is a comparative rarity.”
It is recommended that attention should not be called to “heart trouble” in these cases at all, as thereby undue fears are aroused. A further recommendation which is of value at present is that men from sedentary occupations should be very carefully scrutinized and trained “by tenderer methods in the initial stages than those in vogue for conscripts as a whole.”
The choice of the Hampstead Hospital for this work was a very happy one. The fine air and good surroundings have certainly played an important part in helping soldiers towards recovery and so in promoting the success of treatment. The hospital has from the beginning been under the able command of Colonel T More Reid, who recently conducted the King and Queen over it.
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To the Editor of The Times
Sir, Two years ago you warned the public of the danger of flies, and as a result a campaign against these pests was organized throughout the country. Today an equally serious and immediate danger threatens in the shape of lice, and therefore I venture to hope that once again you will use your influence to arouse the public. So far as the Army is concerned the matter is clearly very serious indeed. It has recently been stated by high scientific authorities that louse-borne diseases now account for half of the total sickness rate from the Western front. Moreover, apart from sickness, the incessant scratching robs a man of sleep at a moment when sleep is vital.
Sir David Bruce’s Committee on Trench Fever has recently reported that, thanks to the work of Major Byam, louse excreta have been identified as the carrier agents of trench fever - one of the worst scourges of armies. It is recognized that typhus fever - which wrought such havoc in Serbia - and relapsing fever are both louse-borne. The present lousy state of the trenches would certainly result in a fearful epidemic. were typhus to break out in France. Over and above this, skin diseases are set up by scratching.
The fact was that the men with these supposed disability signs did just as well as the men without them. “Rest in bed”, says the report, “is harmful, and should be avoided at all stages of treatment except in instances of severe praecordial pain, severe headache, or severe giddiness”.
The ordinary symptoms of “soldier’s heart” are breathlessness, pain, exhaustion, giddiness and fainting, with palpitation, lassitude, and irritability. Having established the test value of capacity to do work as against sounds heard with a stethoscope and the value of physical training as against rest in bed, the report goes the length of stating that “auscultation” (ie, the use of the stethoscope) “is the least valuable method employed in sorting soldiers suffering from cardiovascular derangements the sorting can almost always be effected without its aid.”
This again is a very striking view, for the use of the stethoscope is universal and the respect paid to its findings often reverent. The report appeals to common sense against exaggerated fears “of overlooking early heart disease” by the dictum: “It may be taken as an axiom that no soldier who is free from symptoms on duty has an affection of the heart which incapacitates him, and this axiom may be adopted irrespective of any unusual sign found in the heart. Now actual heart disease in young soldiers, in the absence of a history of rheumatic fever or of syphilis, is a comparative rarity.”
The choice of the Hampstead Hospital for this work was a very happy one. The fine air and good surroundings have certainly played an important part in helping soldiers towards recovery and so in promoting the success of treatment. The hospital has from the beginning been under the able command of Colonel T More Reid, who recently conducted the King and Queen over it.
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Lice and disease
Louse excreta have been identified as the carrier agents of trench fever - one of the worst scourges of armies
June 12, 1918
To the Editor of The Times
Sir, Two years ago you warned the public of the danger of flies, and as a result a campaign against these pests was organized throughout the country. Today an equally serious and immediate danger threatens in the shape of lice, and therefore I venture to hope that once again you will use your influence to arouse the public. So far as the Army is concerned the matter is clearly very serious indeed. It has recently been stated by high scientific authorities that louse-borne diseases now account for half of the total sickness rate from the Western front. Moreover, apart from sickness, the incessant scratching robs a man of sleep at a moment when sleep is vital.
Sir David Bruce’s Committee on Trench Fever has recently reported that, thanks to the work of Major Byam, louse excreta have been identified as the carrier agents of trench fever - one of the worst scourges of armies. It is recognized that typhus fever - which wrought such havoc in Serbia - and relapsing fever are both louse-borne. The present lousy state of the trenches would certainly result in a fearful epidemic. were typhus to break out in France. Over and above this, skin diseases are set up by scratching.
The evil does not stop here. Men on leave stay at YMCA huts, hostels, and other places, travel in trains and public conveyances, and in a variety of ways mingle with the civil population; their clothes and kits are often lousy and almost always contain louse excreta, which, as Major Byam proved (vide report in The Times), retain their virulence after prolonged exposure to air and sunlight and even after heating to 55deg Centigrade.
A very few lice will cause the disease, and men who have been very lousy are apt not to notice a few lice. Further, a man not obviously ill with trench fever can infect lice in this country, and these then become actively dangerous. So much impressed has the Local Government Board become by the danger of a spread of malaria in this country, that specialist inspectors have been appointed and attempts made to segregate infected persons. Yet the louse is thousands of times more plentiful here than the anopheles mosquito, and the number of trench fever dases far greater than the number of malaria cases. Moreover, the possible remote effects of trench fever, heart troubles and neurasthenia, are much more crippling to a community than those of malaria.
Trench fever is a most difficult disease to recognize, unless doctors have been specially trained to recognize it; in its early febrile stages it is apt to be called “influenza,” and in its chronic stage “myalgia “ or “rheumatism.” Thus, because the doctors of this country are apt to consider that this disease can arise only in the trenches - on account of its unfortunate name - and because there is no specific individual sign by which it may be known, cases go unrecognized.
Happily, the weapons of war against lice have been forged to some extent already. Early in the day the Lister Institute of Preventive Medicine, of which Sir David Bruce is chairman, provided funds to assist the investigation of trench fever and enable the necessary experimental work to be carried out, thus helping to secure the valuable information about the exact method of spread of the disease. Any campaign against lice should therefore, it is suggested, centre round the Lister Institute, and should be informed by the store of scientific knowledge there available. Further funds should be provided for an extended investigation into insecticides, so-called “preventive clothing”, and other means of checking the pest. The Local Government Board meantime should take measures to destroy lice in schools and elsewhere, and should provide that experts specially trained to recognize trench fever be appointed as administrators and instructors. Finally, the Royal Army Medical Corps should be given a free hand in the matter of destroying lice both at home and in the war zone. Civil and military administrators should work in close touch with the scientific staff at the Lister Institute.
Unless measures of this kind are taken at once, I fear that the louse will bring such havoc upon us as flies and mosquitoes would have brought had not the danger in their case been recognized and dealt with, for louse excreta may be carried anywhere by a breath of air, and are in almost all the clothing of soldiers returning from France to this country.
I am, &c,
ENTOMOLOGIST
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Dr Woods Hutchinson gave his second Chadwick Lecture yesterday on Hygiene in the War at the Robert Barnes Hall, Wimpole-street. He dealt with his experience of the light against disease on the British, French, and Italian fronts.
An army camp, he said, used to be a hotbed of epidemics. The soldier’s worst enemy enlisted with him, for what killed most men in war was not bullets, but “bugs”, not the sword but the streptococcus. Whenever a thousand men were called to the colours at least twenty billion tubercle bacilli, ten billion typhoid, five billion pneumonia, and a couple of million dysentery germs were called with them.
The first thing an army in the field did was to foul its own water-supply and the second was to infect its food by the swarms of flies, bred in its refuse heaps. If the old ratios of disease per 1,000 soldiers had run in this war, we should have had 300,000 cases of typhoid with 75,000 deaths in the British Army in France alone. We had had barely 2,000 cases with fewer than 200 deaths.
A very few lice will cause the disease, and men who have been very lousy are apt not to notice a few lice. Further, a man not obviously ill with trench fever can infect lice in this country, and these then become actively dangerous. So much impressed has the Local Government Board become by the danger of a spread of malaria in this country, that specialist inspectors have been appointed and attempts made to segregate infected persons. Yet the louse is thousands of times more plentiful here than the anopheles mosquito, and the number of trench fever dases far greater than the number of malaria cases. Moreover, the possible remote effects of trench fever, heart troubles and neurasthenia, are much more crippling to a community than those of malaria.
Happily, the weapons of war against lice have been forged to some extent already. Early in the day the Lister Institute of Preventive Medicine, of which Sir David Bruce is chairman, provided funds to assist the investigation of trench fever and enable the necessary experimental work to be carried out, thus helping to secure the valuable information about the exact method of spread of the disease. Any campaign against lice should therefore, it is suggested, centre round the Lister Institute, and should be informed by the store of scientific knowledge there available. Further funds should be provided for an extended investigation into insecticides, so-called “preventive clothing”, and other means of checking the pest. The Local Government Board meantime should take measures to destroy lice in schools and elsewhere, and should provide that experts specially trained to recognize trench fever be appointed as administrators and instructors. Finally, the Royal Army Medical Corps should be given a free hand in the matter of destroying lice both at home and in the war zone. Civil and military administrators should work in close touch with the scientific staff at the Lister Institute.
Unless measures of this kind are taken at once, I fear that the louse will bring such havoc upon us as flies and mosquitoes would have brought had not the danger in their case been recognized and dealt with, for louse excreta may be carried anywhere by a breath of air, and are in almost all the clothing of soldiers returning from France to this country.
I am, &c,
ENTOMOLOGIST
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Health in the field
When it came to typhus a clean undershirt was a better life-protector than any shirt of mail
November 9, 1917
Dr Woods Hutchinson gave his second Chadwick Lecture yesterday on Hygiene in the War at the Robert Barnes Hall, Wimpole-street. He dealt with his experience of the light against disease on the British, French, and Italian fronts.
An army camp, he said, used to be a hotbed of epidemics. The soldier’s worst enemy enlisted with him, for what killed most men in war was not bullets, but “bugs”, not the sword but the streptococcus. Whenever a thousand men were called to the colours at least twenty billion tubercle bacilli, ten billion typhoid, five billion pneumonia, and a couple of million dysentery germs were called with them.
The first thing an army in the field did was to foul its own water-supply and the second was to infect its food by the swarms of flies, bred in its refuse heaps. If the old ratios of disease per 1,000 soldiers had run in this war, we should have had 300,000 cases of typhoid with 75,000 deaths in the British Army in France alone. We had had barely 2,000 cases with fewer than 200 deaths.
MODERN SANITARY SCIENCE
Our Army in Flanders and Northern France last winter, in open trenches In some of the vilest and sickliest weather troops ever had to face, had less sickness and fewer deaths from pneumonia and other diseases than it used to have in barracks in times of peace, and far less than the general civil population at home. Inoculation protected them against typhoid; splendid feeding, with plenty of meat and fat, against pneumonia and consumption, fly-campaigns against dysentery and diarrhoea, shower baths and clean underwear against spotted typhus, and quarantine against all the mild infectious measles, summer diarrhoea, diphtheria. and influenza. The old plagues of army camps, cholera, Black Death, and spotted typhus, all lifted their heads in Italy, in Serbia, and in Russia, but all were promptly stamped out by modern sanitary science. “There is no armour against fate”, but when it came to typhus a clean undershirt was a better life-protector than any shirt of mail.
TRENCH TROUBLES
Only three new diseases had appeared in this war - trench fever, trench nephritis, and trench feet. The two first were still a puzzle as to causation, but all three had been brought down to comparatively slight proportions by properly drained trenches, loose, comfortable foot and leg-wear, washing and greasing of the feet every night, and clean socks and plenty of them. Trench fever seemed also closely associated with lice-infestation.
The mental damage inflicted on the soldier by the horrors and strains of this war has been just nothing at all. The total number of cases of serious or lasting “shell shock,” so called, and mental disturbance, during 1916, was 2,600, less than one per 1,000 of the armies in the field and less than half of the ordinary insanity rate in men of military ages in times of peacc. Modern nerves had stood the fearful strain of this war superbly. None so well as those of the highly civilized white races. Among the steadiest, stanchest, and most “shell-proof” of all stood the highly “citified and neurotic” Cockney.
VENEREAL DISEASE
As for the ancient and classic plague of armies, venereal disease, in spite of the disgraceful solicitations to which a silly sentimentalism and ostrich-like Puritanism permitted them to encounter in London on leave, the figures for the British Army were: 1903, 12 per 100; 1913, 6 per 100; 1916 (at home), 3 per 100; 1916 (in France), 2-4 per 100. In other words, the average incidence of venereal disease in the British Army in Franeo was no higher than that believed to exist among men of military ago in time of peace. The American Army in France, by treating it like any other contagious disease, it had been brought down to less than 1 per cent. If, Dr. Woods Hutchinson added, we would stop preaching and exhorting about venereal disease, as a moral problem, and treat it strictly as a sanitary one, for the duration of the war, we could soon bring it well below its former prevalence ii times of peace. If the soldier on leave were systematically provided with easy, abundant opportunities to meet and dance and go sightseeing with nice girls and women, he would never miss the bad ones, for the minds of young men were cleaner than those of most of the middle-aged who exhorted them.
Dr Woods Hutchinson will deliver his third lecture next Wednesday, at 3.30 pm, on “Food, Nutrition, and Nutritional Disease in an Army.”
Our Army in Flanders and Northern France last winter, in open trenches In some of the vilest and sickliest weather troops ever had to face, had less sickness and fewer deaths from pneumonia and other diseases than it used to have in barracks in times of peace, and far less than the general civil population at home. Inoculation protected them against typhoid; splendid feeding, with plenty of meat and fat, against pneumonia and consumption, fly-campaigns against dysentery and diarrhoea, shower baths and clean underwear against spotted typhus, and quarantine against all the mild infectious measles, summer diarrhoea, diphtheria. and influenza. The old plagues of army camps, cholera, Black Death, and spotted typhus, all lifted their heads in Italy, in Serbia, and in Russia, but all were promptly stamped out by modern sanitary science. “There is no armour against fate”, but when it came to typhus a clean undershirt was a better life-protector than any shirt of mail.
Only three new diseases had appeared in this war - trench fever, trench nephritis, and trench feet. The two first were still a puzzle as to causation, but all three had been brought down to comparatively slight proportions by properly drained trenches, loose, comfortable foot and leg-wear, washing and greasing of the feet every night, and clean socks and plenty of them. Trench fever seemed also closely associated with lice-infestation.
The mental damage inflicted on the soldier by the horrors and strains of this war has been just nothing at all. The total number of cases of serious or lasting “shell shock,” so called, and mental disturbance, during 1916, was 2,600, less than one per 1,000 of the armies in the field and less than half of the ordinary insanity rate in men of military ages in times of peacc. Modern nerves had stood the fearful strain of this war superbly. None so well as those of the highly civilized white races. Among the steadiest, stanchest, and most “shell-proof” of all stood the highly “citified and neurotic” Cockney.
VENEREAL DISEASE
As for the ancient and classic plague of armies, venereal disease, in spite of the disgraceful solicitations to which a silly sentimentalism and ostrich-like Puritanism permitted them to encounter in London on leave, the figures for the British Army were: 1903, 12 per 100; 1913, 6 per 100; 1916 (at home), 3 per 100; 1916 (in France), 2-4 per 100. In other words, the average incidence of venereal disease in the British Army in Franeo was no higher than that believed to exist among men of military ago in time of peace. The American Army in France, by treating it like any other contagious disease, it had been brought down to less than 1 per cent. If, Dr. Woods Hutchinson added, we would stop preaching and exhorting about venereal disease, as a moral problem, and treat it strictly as a sanitary one, for the duration of the war, we could soon bring it well below its former prevalence ii times of peace. If the soldier on leave were systematically provided with easy, abundant opportunities to meet and dance and go sightseeing with nice girls and women, he would never miss the bad ones, for the minds of young men were cleaner than those of most of the middle-aged who exhorted them.
Dr Woods Hutchinson will deliver his third lecture next Wednesday, at 3.30 pm, on “Food, Nutrition, and Nutritional Disease in an Army.”
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