PREFACE.

The UNITED STATES NAVAL MEDICAL BULLETIN was first issued in April, 1907, as a means of supplying medical officers of the United States Navy with information regarding the advances which are continually being made in the medical sciences, and as a medium for the publication of accounts of special researches, observations, or experiences of individual medical officers.

It is the aim of the Bureau of Medicine and Surgery to furnish in each issue special articles relating to naval medicine, descriptions of suggested devices, clinical notes on interesting cases, abstracts of current medical literature of special professional interests to the naval medical officer, reports from various sources, historical essays, notes and comments on topics of medical interest, and reviews or notices of the latest published medical books.

The bureau extends an invitation to all medical officers to prepare and forward, with a view to publication, contributions on subjects of interest to naval medical officers.

In order that each service contributor may receive due credit for his efforts in preparing matter for the BULLETIN of distinct originality and special merit, the Surgeon General of the Navy will send a letter of commendation to authors of papers of conspicuous merit and will recommend that copies of such letters be made a part of the official record of the officers concerned.

The bureau does not necessarily undertake to indorse all views or opinions which may be expressed in the pages of this publication. E. R. STITT,

Surgeon General United States Navy.

NOTICE TO SERVICE CONTRIBUTORS.

When contributions are typewritten, double spacing and wide margins are desirable. Fasteners which can not be removed without tearing the paper are an abomination. A large proportion of the articles submitted have an official form, such as letterheads, numbered paragraphs, and needless spacing between paragraphs, all of which require correction before going to press. The BULLETIN endeavors to follow a uniform style in headings and captions, and the editor can be spared much time and trouble and unnecessary errors can be obviated if authors will follow in the above particulars the practice of recent issues.

The greatest accuracy and fullness should be employed in all citations, as it has sometimes been necessary to decline articles otherwise desirable because it was impossible for the editor to understand or verify references, quotations, etc. The frequency of gross errors in orthography in many contributions is conclusive evidence that authors often fail to read over their manuscripts after they have been typewritten.

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The BULLETIN intends to print only original articles, translations, in whole or in part, reviews, and reports and notices of Government or departmental activities, official announcements, etc. All original contributions are accepted on the assumption that they have not appeared previously and are not to be reprinted elsewhere without an understanding to that effect.

U. S. NAVAL MEDICAL BULLETIN

VOL. XIX.

DECEMBER, 1923

SPECIAL ARTICLES.

No. 6

SOME OF THE FUNCTIONS OF THE NAVAL MEDICAL PERSONNEL SERVING IN THE FIELD, WITH SPECIAL REFERENCE TO FIELD SANITARY MEASURES.1

By W. L. Mann, Lieutenant Commander, Medical Corps, United States Navy.

FIELD HYGIENE AND SANITATION.

Value of field hygiene.-One of the prime requisites for victory is health. "Health is necessary in war, and can not be replaced by anything else."

An army in order to fight has literally and figuratively "to take the field," consequently field hygiene and sanitation is one of the most important subjects for military sanitarians, as, at this time, the laws of preventive medicine are made applicable to war, and this adaptability to war-time conditions is the supreme test of all military efficiency.

The functions of a medical military organization may be roughly divided into (a) prevention of disease and (b) treatment of disease. Prevention of disease is of vast importance to the military personnel, and this function only will be considered in this paper.

The comparison of the mortality rate in modern armies with the following figures graphically demonstrates the recent advance of field sanitation:

To a well-informed person the laws of field sanitation may appear so elementary that a study of them would seem unnecessary and probably a waste of time. But when one stops to consider, for example,

'Prepared for the naval medical officers' correspondence course, 1922-23, Marine Corps Schools, Marine Barracks, Quantico, Va.

that the simple measures of mosquito control alone made the building of the Panama Canal possible, one may obtain a slight idea of the vast economic importance of such a preventive procedure. Also, it is not improbable that the World War would have terminated by reason of epidemic diseases in the second year had not certain apparently simple sanitary measures been observed.

The simple method of exterminating the body louse undoubtedly saved hundreds of thousands from death by typhus during the late

war.

Still further, should 1,000,000" trained citizenry spring to arms," we should expect that no less than 100,000 would soon be incapacitated for duty with preventable foot injuries unless the responsible authorities give detailed attention to shoe fitting and foot care.

Qualifications of a successful sanitarian.-Tact and a certain amount of technical ability are necessary requirements for a successful sanitarian. Sanitation is so closely interrelated with cleanliness that you will find that the major portion of the duty of a sanitary officer consists in the supervision of the cleanliness of others.

To cause efficiently other individuals to maintain their persons and premises in a clean condition without arousing a certain amount of friction and antagonism is not always an easy matter, hence the modus operandi should vary with the circumstances. As a rule you will find that friction is exceedingly rare and that there is complete cooperation of the combatant forces in enforcing all necessary sanitary recommendations.

However, if cooperation is not as prompt as you may wish, do not quibble over details, but cultivate a receptive attitude and remember that some of the functions of the sanitary officer are considered purely advisory in nature, and that here his responsibility may cease.

As a general rule reduce all sanitary recommendations to a minimum and make them as concise as possible. All recommendations should be carefully considered, and those which are not of essential importance should be omitted. If practicable, preface your recommendations with an explanation, as commanding officers as a rule like to know the why and wherefore, and rightly so.

Preventive medicine is not an exact science nor is it possible to obtain 100 per cent efficiency. However, if by watching the minor details we are able to increase military efficiency from 96 per cent to 98 per cent, we have not gained a mere increase of 2 per cent as it may seem, but have effected a gain of 50 per cent—that is, we have reduced the noneffective note from 4 per cent to 2 per cent. It is this little difference which sometimes may cause the balance to vary between victory and defeat.

Field sanitation contrasted with sanitation of garrisons.-The difference between field sanitation and sanitation of garrisons is marked. (a) Field sanitation is easier to institute.

For example: The devices used for the disposal of waste in the field are of simple construction, whereas the installation of a watercarriage sewerage system requires expert engineering knowledge.

(b) Constant attention is required to maintain field sanitary devices in proper sanitary condition.

In garrison life the running water and the water-carriage sewerage system usually and automatically maintain themselves in a sanitary condition, with relatively little worry or attention from the sanitary officer. Whereas in field sanitation the conditions are such that the field sanitary devices require constant, alert, and daily personal attention from both the line and medical officers in order that there may not be a weak link in the chain of sanitary measures.

Barracks life may give us comparatively little concern, but when we take the field vigorous sanitary methods must be instituted and maintained and, if possible, improved upon from day to day.

Sanitation versus congregation.-Almost without exception, it is characteristic of all animal life to show a gregarious tendency. And as this gregarious tendency increases, nature attempts to limit excessive multiplication by the reaction of infectious or autogenous toxic products upon the mass. According to mathematics, any species, increasing as it does by geometrical progress, would in a short period of time, relatively speaking, tend to inhabit the earth to the exclusion of all other species.

The danger of infection is in direct ratio to the size and degree of density of the aggregation. Imagine, for example, that a number of men take the field and make no attempt to enforce the laws of sanitation, then the possibility of infection of the various organizations would vary, approximately, directly according to the number and concentration of men. In other words, under conditions in which the measures of preventive medicine were not employed the possibility of an individual soldier acquiring an infectious disease in an army of 1,000,000 men would be approximately one thousand times greater than in a regiment of 1,000 men acting independently. Various other factors enter into consideration that tend to render these statements not mathematically exact; however, they are sufficiently accurate to serve for the purpose of illustration.

ures.

The greater the crowding the greater will be the possibility of infection and therefore the greater will be the need of sanitary measBut man, by gradual attainment, study, and application of the laws of hygiene, has reached a stage in his development in which he is able to assemble a million men in the field and defy nature in her attempt at decimation by disease. It is interesting to note that this