On the Fringe of the Great Fight

by George Gallie Nasmith

The first group, which includes practically all the ordinary diseases like measles, mumps, whooping cough, influenza, colds, pneumonia, scarlet fever, diphtheria, etc., is conveyed in most cases by one infected person transmitting directly to another person,—through coughing, spitting or sneezing,—germs present in the nose and mouth secretions.

The second group is conveyed by insects biting people or animals infected with the disease, and subsequently biting people who are healthy. In this way the disease-producing organism is introduced into the body of the healthy person, and beginning to multiply, brings about the symptoms of the disease. Malaria is transmitted in this way by the anopheles mosquito; typhus fever by lice, and plague by the rat flea. These are all diseases greatly to be dreaded in the army.

The third group, including typhoid and paratyphoid fevers, cholera, and dysentery, all of which are intestinal diseases, is largely conveyed from the sick to the well indirectly through contaminated water and food. To develop one of these diseases means that the excreta of somebody who has the disease or who has had it, has been taken into the mouth and swallowed, and the germs finding a favorable medium in the intestines have multiplied and produced the typical symptoms. One of the chief ways in which this type of infection occurs is through drinking sewage-contaminated water or milk; another is through contamination of food by the hands of the person excreting the germs; and the third is through the contamination of the food or eating utensils by flies and other insects which carry filth germs from place to place on their feet and bodies.

With these facts in mind and with some knowledge of sanitation and medicine it is easy to see how most epidemic diseases can be held in check. Put briefly, it means that the sanitary organization must be such that the germs from one infected soldier are prevented from reaching another, or as is sometimes said, some link in the chain of circumstances whereby disease germs can pass from one to another, must be broken.

The methods employed to break these links are simple; the carrying out of the methods is oftentimes very difficult.

It is obviously essential in the first place to remove from the army, at the earliest possible moment after it has been diagnosed, every case of communicable disease. This means the adoption of measures for picking out soldiers who show symptoms of disease, which really comes down to the fact that the medical officers must always be on the alert and carry out the instructions of the director of medical services of the army with despatch. In the British Army this is one of the most important features in the control of epidemics. If a man is suspected of having any communicable disease he is instantly placed under quarantine until the diagnosis has been confirmed, after which he is removed from the army area altogether as a possible focus of infection. The British Army takes no chances, and its wonderful record of freedom from contagious disease proves that it has been absolutely sound in its technique.

This is practically the only way of eliminating diseases, such as measles and scarlet fever which cannot be diagnosed by bacteriological methods, but of course the procedure is employed in all other kinds of epidemic disease as well.

Great Britain has been fortunate above all other nations in this respect that she sent over at first a small army of regular troops, perfectly equipped from the medical standpoint as well as in every other way. Efforts had been made for years to remove typhoid carriers from the regular army, and naturally no soldier was sent into the field who was known to have typhoid, or to be a carrier of typhoid or any other contagious disease germs. Furthermore, the soldiers had practically all been vaccinated against smallpox and inoculated against typhoid fever.

As division after division was sent out to the army in France, they too were completely equipped with sanitary squads, casualty clearing stations, field ambulances, water carts, and other necessary medical equipment. Consequently as the army grew and expanded into a huge force it was thoroughly equipped not only with the necessary apparatus for caring for sick and wounded, but also with the experience acquired by those already in the field. In this way the British Army differed from all of our European Allies who had been compelled to mobilize everything at once and found themselves woefully lacking in medical equipment and personnel, so much so in fact that they had been in the beginning unable to handle all epidemics successfully.

With a realization that the medical equipment of the British Army was complete; that it had been sent into the field free of communicable diseases; that it had been vaccinated and inoculated against two of the most dreaded diseases, smallpox and typhoid fever, and that every reinforcement subsequently sent out had been carefully freed from suspicious cases of disease, it can be readily understood that the British Army began under auspicious circumstances, and that thereafter its freedom from contagious disease depended to a great extent on the preventive measures adopted.