RESULTS OF SANITARY REFORMS.
The errors and losses which have been adverted to are not all constant nor universal: not every army is hungry or has bad cookery; not every one encamps in malarious spots, or sleeps in crowded tents, or is cold, wet, or overworked: but, so far as the internal history of military life has been revealed, they have been and are sufficiently frequent to produce a greater depression of force, more sickness, and a higher rate of mortality among the soldiery than are found to exist among civilians. Every failure to meet the natural necessities or wants of the animal body, in respect to food, air, cleanliness, and protection, has, in its own way, and in its due proportion, diminished the power that might otherwise have been created; and every misapplication has again reduced that vital capital which was already at a discount. These first bind the strong man, and then, exposing him to morbific influences, rob him of his health. Perhaps in none of the common affairs of the world do men allow so large a part of the power they raise and the means they gather for any purpose to be lost, before they reach their object and strike their final and effective blow, as the rulers of nations allow to be lost in the gathering and application of human force to the purposes of war. And this is mainly because those rulers do not study and regard the nature and conditions of the living machines with which they operate, and the vital forces that move them, as faithfully as men in civil life study and regard the conditions of the dead machines they use, and the powers of water and steam that propel them, and form their plans accordingly.
But it is satisfactory to know that great improvements have been made in this respect. From a careful and extended inquiry into the diseases of the army and their causes, it is manifest that they do not necessarily belong to the profession of war. Although sickness has been more prevalent, and death in consequence more frequent, in camps and military stations than in the dwellings of peace, this excess is not unavoidable, but may be mostly, if not entirely, prevented. Men are not more sick because they are soldiers and live apart from their homes, but because they are exposed to conditions or indulge in habits that would produce the same results in civil as in military life. Wherever civilians have fallen into these conditions and habits, they have suffered in the same way; and wherever the army has been redeemed from these, sickness and mortality have diminished, and the health and efficiency of the men have improved.
Great Britain has made and is still making great and successful efforts to reform the sanitary condition of her army. The improvement in the health of the troops in the Crimea in 1856 and 1857 has already been described. The reduction of the annual rate of mortality caused by disease, from 1,142 to 13 in a thousand, in thirteen months, opened the eyes of the Government to the real state of matters in the army, and to their own connection with it. They saw that the excess of sickness and death among the troops had its origin in circumstances and conditions which they could control, and then they began to feel the responsibility resting upon them for the health and life of their soldiers. On further investigation, they discovered that soldiers in active service everywhere suffered more by sickness and death than civilians at home, and then they very naturally concluded that a similar application of sanitary measures and enforcement of the sanitary laws would be as advantageous to the health and life of the men at all other places as in the Crimea. A thorough reform was determined upon, and carried out with signal success in all the military stations at home and abroad. "The late Lord Herbert, first in a royal commission, then in a commission for carrying out its recommendations, and lastly as Secretary of State for War in Lord Palmerston's administration, neglecting the enjoyments which high rank and a splendid fortune placed at his command, devoted himself to the sanitary reform of the army."[75] He saw that the health of the soldiers was perilled more "by bad sanitary arrangements than by climate," and that these could be amended. "He had some courageous colleagues, among whom I must name as the foremost Florence Nightingale, who shares without diminishing his glory."[76] Both of these great sanitary reformers sacrificed themselves for the good of the suffering and perishing soldier. "Lord Herbert died at the age of fifty-one, broken down by work so entirely that his medical attendants hardly knew to what to attribute his death."[77] Although he probed the evil to the very bottom, and boldly laid bare the time-honored abuses, neglects, and ignorance of the natural laws, whence so much sickness had sprung to waste the army, yet he "did not think it enough to point out evils in a report; he got commissions of practical men to put an end to them."[78] A new and improved code of medical regulations, and a new and rational system of sanitary administration, suited to the wants and liabilities of the human body, were devised and adopted for the British army, and their conditions are established and carried out with the most happy results.
These new systems connect with every corps of the army the means of protecting the health of the men, as well as of healing their diseases.
"The Medical Department of the British army includes,—
"1. Director-General, who is the sole responsible administrative head of the medical service.
"2. Three Heads of Departments, to aid the Director-General with their advice, and to work the routine-details.
"A Medical Head, to give advice and assistance on all subjects connected with the medical service and hospitals of the army.
"A Sanitary Head, to give advice and assistance on all subjects connected with the hygiene of the army.
"A Statistical Head, who will keep the medical statistics, case-books, meteorological registers," etc.[79]
Besides these medical officers, there are an Inspector-General of Hospitals, a Deputy Inspector-General of Hospitals, Staff and Regimental Surgeons, Staff and Regimental Assistant-Surgeons, and Apothecaries.
The British army is plentifully supplied with these medical officers. For the army of 118,000 men there were provided one thousand and seventy-five medical officers under full pay in 1859. Four hundred and seventy surgeons and assistant-surgeons were attached to the hundred regiments of infantry.[80]
It is made the duty of the medical officer to keep constant watch over all the means and habits of life among the troops,—"to see that all regulations for protecting the health of troops, in barracks, garrisons, stations, or camps, are duly observed." "He is to satisfy himself as to the sanitary condition of barracks," "as to their cleanliness, within and without, their ventilation, warming, and lighting," "as to the drainage, ash-pits, offal," etc. "He is to satisfy himself that the rations are good, that the kitchen-utensils are sufficient and in good order, and that the cooking is sufficiently varied."[81]
Nothing in the condition, circumstances, or habits of the men, that can affect their health, must be allowed to escape the notice of these medical officers.
In every plan for the location or movement of any body of troops, it is made the duty of the principal medical officer first to ascertain the effect which such movement or location will have upon the men, and advise the commander accordingly. It is his duty, also, to inspect all camp-sites and "give his opinion in writing on the salubrity or otherwise of the proposed position, with any recommendations he may have to make respecting the drainage, preparation of the ground, distance of the tents or huts from each other, the number of men to be placed in each tent or hut, the state of cleanliness, ventilation, and water-supply."[82] "The sanitary officer shall keep up a daily inspection of the whole camp, and especially inform himself as to the health of the troops, and of the appearance of any zymotic disease among them; and he shall immediately, on being informed of the appearance of any such disease, examine into the cause of the same, whether such disease proceed from, or is aggravated by, sanitary defects in cleansing, drainage, nuisances, overcrowding, defective ventilation, bad or deficient water supply, dampness, marshy ground, or from any other local cause, or from bad or deficient food, intemperance, unwholesome liquors, fruit, defective clothing or shelter, exposure, fatigue, or any other cause, and report immediately to the commander of the forces, on such causes, and the remedial measures he has to propose for their removal." "And he shall report at least daily on the progress or decline of the disease, and on the means adopted for the removal of its causes."[83]
Thus the British army is furnished with the best sanitary instruction the nation can afford, to guide the officers and show the men how to live, and sustain their strength for the most effective labor in the service of the country.
To make this system of vigilant watchfulness over the health of the men the more effectual, the medical officer of each corps is required to make weekly returns to the principal medical officer of the command, and this principal officer makes monthly returns to the central office at London. These weekly and monthly returns include all the matters that relate to the health of the troops, "to the sanitary condition of the barracks, quarters, hospitals, the rations, clothing, duties, etc., of the troops, and the effects of these on their health."[84]
Under these new regulations, the exact condition of the army everywhere is always open to the eyes of medical and sanitary officers, and they are made responsible for the health of the soldiers. The consequence has been a great improvement in the condition and habits of the men. Camps have been better located and arranged. Food is better supplied. Cooking is more varied, and suited to the digestive powers. The old plan of boiling seven days in the week is abolished, and baking, stewing, and other more wholesome methods of preparation are adopted in the army-kitchens, with very great advantage to the health of the men and to the efficiency of the military service. Sickness has diminished and mortality very greatly lessened, and the most satisfactory evidence has been given from all the stations of the British army at home and abroad, that the great excess of disease and death among the troops over those of civilians at home is needless, and that health and life are measured out to the soldier, as well as to the citizen, according to the manner in which he fulfils or is allowed to fulfil the conditions established by Nature for his being here.
The last army medical report shows the amount and rate of sickness and mortality of every corps, both in the year 1859, under the new system of watchfulness and proper provision, and at a former period, under the old régime of neglect.
THE NUMBER OF DEATHS IN 100,000.[85] Annual Average for
10 years, 1837 to 1846. 1859.
Household Cavalry 1,039 427
Dragoon-Guards 1,208 794
Foot-Guards 1,872 859
Infantry Regiments 1,706 758
Men in healthy
districts of England 723
The Foot-Guards, which lost annually 1,415 from diseases of the chest before the reform, lost only 538 in 100,000 from the same cause in 1859.[86]
Among the infantry of the line, the annual attacks of fever were reduced to a little more than one-third, and the deaths from this cause to two-fifths of their former ratio. The cases of zymotic disease were diminished 33 per cent., and the mortality from this class of maladies was reduced 68 per cent.[87]
The same happy accounts of improvement come from every province and every military station where the British Government has placed its armies.
Our present army is in better condition than those of other times and other nations; and more and more will be done for this end. The Government has already admitted the Sanitary Commission into a sort of copartnership in the management of the army, and hereafter the principles of this excellent and useful association will be incorporated with, and become an inseparable part of, the machinery of war, to be conducted by the same hands that direct the movements of the armies, ever present and efficient to meet all the natural wants of the soldier, and to reduce his danger of sickness and mortality, as nearly as possible, to that of men of the same age at home.