Chapter XI: The Diseases of Soldiers at Home and Abroad

The soldier is liable, like other members of the community, to various diseases due to his occupation and surroundings, although at the present day the hygienic conditions of barracks and military duties are so carefully supervised that he is, when on home service, placed under much more favourable circumstances than men of his own class in civil life. It is, therefore, somewhat disappointing to find that under these circumstances, knowing soldiers to be more or less picked men, they are not, judging from tables of mortality, more healthy than their civilian brethren of the same age. It is a matter of common observation that the army ages a man quickly; the old soldier of a regiment, who is looked upon more or less as a privileged individual, and generally given some sort of employment which relieves him from “sentry go” and the more arduous duties of his profession, is seldom over forty years of age, and ought to be therefore at his best; but partly from the monotony of his existence, and partly from excessive smoking, drinking, and night duty, the private of twenty years’ service is, as a rule, a worn-out machine, his mental faculties blunted, and his body, if not the seat of actual disease, aged and almost useless. These effects are still more marked when a man, as is generally the case, has spent a great part of his service abroad, for to the effects of hot climates and the diseases incidental thereto must be added, in a greatly enhanced degree, the enforced ennui and idleness which are the bane of the soldier’s existence in all stations in times of peace, and especially in the tropics. We all know how much more likely we are to rust out than wear out, and the enforced idleness which the soldier, especially in the infantry, has to encounter, leads to sluggishness of the functions of the body, while in many, drunkenness, increased smoking and debauchery, exercise an injurious influence upon health, apart altogether from the actual diseases to which they may give rise. An old soldier, for these reasons, can seldom eat his rations, and his system seems to be in that receptive condition that he readily falls a victim to epidemic disease prevalent in the neighbourhood, and this the more owing to his tendency to haunt the lowest and most insanitary parts of the town near which he may be quartered. This is seen more particularly abroad, where the native quarters are in marked contrast to the clean and sanitary military cantonments, so that medical officers have come to regard it as almost certain that the soldiers will soon suffer when an epidemic breaks out among the civil population. Statistics prove that the longer soldiers serve, the greater is the proportional mortality among them.

After these preliminary remarks we will proceed to discuss the peculiar health conditions under which soldiers exist, and their effects as regards their duties, habits, surroundings, and dress: firstly, at home; secondly, abroad, with special reference to hot climates, both dry and damp, and the diseases from which they suffer in such climates; thirdly, the special dangers to health incidental to active service.

The peculiar conditions of military as contrasted with civil life are that the soldier must perforce (in most cases) remain unmarried, that his daily wants are all provided for by the State, so that his pay, though small, is practically all pocket money, which may, if he is so inclined, be all spent on drink and debauchery; that his personal liberty is a good deal restricted, tending to irritability and low spirits in many temperaments; that he has no privacy, living as he does in rooms common to him and many others; that he has to dress in clothes in which hygienic principles are sometimes overruled by the necessity for ornamentation and smartness; and that his duties frequently entail great exposure to varieties of temperature and loss of sleep.

As regards the first of these points, it is known from statistics that married men, as a rule, live longer than the unmarried, apart altogether from the dangers of venereal diseases. This is not difficult to understand, seeing that the married man has more solid comforts, and is not tempted to spend his evenings abroad, also that he has that incentive to steady work and moderation in all things which the celibate has not. Again, the average soldier has undoubtedly more pocket money than the average civilian of his class; he has no incentive to save; he is tempted by numerous companions of both sexes to excess of all kinds, and spends most of his evenings abroad, consuming more drink and tobacco than is good for him. Vanity and desire to be smart frequently cause him to dress in garments much too thin for the state of the weather. Discipline has, no doubt, a very depressing effect upon the health of some men. Restraint and the petty tyranny of superiors exercise a bad effect upon their spirits, causing loss of sleep, and often leading to drinking. In spite of the great improvement in the treatment of the men which has been effected in our army in recent years, suicides are still too common, though not nearly so frequent as formerly, or as they are in other armies.

As regards the herding together of men in barrack rooms, this is an evil which is almost unavoidable without great increase of expense, but if it could be altered it would certainly make the army more attractive to the better class of men. Formerly there was great overcrowding and consequent sickness, but at the present day, in almost all barracks, each man has at least 600 cubic feet of space, a larger amount than men of that class usually enjoy in civil life. Before the need for fresh air was so fully recognised as it is now, there was great mortality in the army from chest complaints, especially from consumption, as also in the navy; but now the regulations are very strict, the number of men to be accommodated in each room, so as to give each his 600 cubic feet, is painted on the barrack-room doors, and any overcrowding, beyond the regulated numbers, must be reported upon and explained by the officers, regimental and medical. The public are now, generally speaking, fully alive to the need for fresh air and ventilation, but disregard of the necessity is still a very fertile cause of disease in civil life, especially when to lack of fresh air is added the fact that such air as there is is laden with dust or other solid matter, as in mines or workshops. In former years the large amount of lung disease in the army and navy was in exact proportion to the amount of overcrowding, but now the soldier and the sailor do not suffer more from these diseases than do the civil population. In the first ten years of the late Queen’s reign, the deaths from lung diseases in the army per 1000 of strength were at the rate of 7.82, but in 1898 there were only 2.5 cases per 1000 admitted to hospital, of whom a very small proportion died, the majority being invalided or cured. Apropos of this I need only remark that the latest plan of treating consumptives is to keep them day and night in the open air. Cold fresh air is no longer so much dreaded as formerly. That it is not the cause of consumption can be abundantly proved from army statistics. From these statistics one may learn how, in the old days of overcrowding, pulmonary consumption was much more prevalent among the troops serving in the delightful climate of the West Indies than in England, or in Canada, owing to the scandalous manner in which the barracks in those islands used to be kept overfilled. Now, except when yellow fever appears and carries off the men, the West Indian station is the healthiest quarter of the British army, not excepting even the home stations.

As regards the dress of the soldier, there was formerly in the army a good deal of disease of the heart and great blood-vessels. This was undoubtedly caused by restriction to the circulation from tight clothing, and from the pressure on the chest of the straps which supported the knapsack and accoutrements. At the present day the tendency is to do away with everything tight: the stock has disappeared, the tunic is made to fit more loosely, and the weight to be carried is so arranged that there is no pressure on the chest. The dress for hard work is made of light material, serge or drill, allowing free transpiration from the skin, and even the stick-up collar of the tunic is being done away with, at all events for the campaigning dress, and is being replaced by a turned-down collar, as may be noticed in pictures of officers on active service in South Africa. One wonders that any men survived the active service in India in the old days of the tightly-fitting, thick cloth clothes, insufficient head-dress, and straps supporting the knapsack and ammunition pouches crossing over the chest. The fighting at the Alma was in full-dress uniform, and there is no doubt that there was a great deal of unnecessary suffering and mortality from this cause. Instinct and common sense alike urge against doing hard work and long marches in tight clothes, which overstrain the heart. We still hear every now and then of serious consequences, both in England and on the Continent, from holding fatiguing field days in hot weather. Doubtless we must attribute part of the trouble to excessive smoking and drinking. “Soldier’s irritable heart” is attributed to the uniform and to men having to stand for long periods in a constrained attitude; but I am disposed to blame beer and tobacco for part of the mischief: tobacco especially, I believe to be a cause of heart trouble among soldiers, though many authorities doubt it, seeing that Continental soldiers smoke more than ours do and suffer less. Our men, however, as a rule, smoke and chew much stronger tobacco than other people; they indulge in it in the early morning on an empty stomach, and at all other times, and I have known a man who was anxious to be invalided out of the army produce the most marked cardiac symptoms by the surreptitious use of strong cake tobacco. The men of the navy, who have always had a looser and more workmanlike dress than the army men, do not suffer to the same extent from heart troubles. Such complaints are more prevalent in that corps of the army which has the hardest work and the tightest clothes, viz., the Artillery. With more rational ideas prevailing at the present time, the amount of heart complaint has diminished, and there is now proportionally only one-third the amount which existed about the time of the Indian Mutiny. In making this statement we must, however, bear in mind that our soldiers are younger than the men of those days, and in such the effects of these diseases are less likely to manifest themselves. However, there is no doubt that not only in respect of cardiac, but of all other maladies, the army is much healthier than it used to be since reforms in dress and the general treatment of the soldier have been instituted. Old medical officers say that they never see the same class of diseases they used to. Walks round military burial-grounds, especially abroad, tell terrible tales of mortality among troops in former years. In the “Happy Valley” in Hong Kong may be seen a monument erected to over 500 men of one regiment who perished there from disease.

Of the duties of the soldier that have a prejudicial effect upon his health, the most injurious is night guard. The medical authorities are charged to make representations to the authorities whenever in their opinion the turn of men for this duty is becoming so frequent as to be liable to cause illness. To the civilian mind it may seem a trifle that each man should come on guard not oftener than say once in five days, but when we consider the long hours of monotonous standing or walking about in the cold and darkness, perhaps too in rain, which this duty entails, one can understand how this prematurely ages the soldier, and can sympathise with the latter’s ambition to get a billet which gives him all his nights “in bed.” This is altogether apart from the great risks of inflammation of the lungs or rheumatic fever caught in this way, especially as the intervals of “sentry go” are, in the winter, usually spent in a superheated guardroom, from which the soldier passes to his cold and solitary vigil. I have known among cavalry in cold weather an immense amount of sickness caused by the men, after getting very hot while grooming their horses in the hot stables, leading them out to water in their shirt sleeves. Either from lack of time, desire to save their clothes, carelessness or reluctance to appear “molly coddles,” the neglect to put on their jackets frequently resulted in attacks of pneumonia, quinsy, etc., etc., which the distribution of woollen jerseys subsequently did much to prevent. Those who imagine that soldiers lead a lazy life little realise how hard a young cavalry or horse artillery soldier has to work before he becomes master of his craft. What with learning to use his weapons, his drill, riding and the care of his horse, clothes, and accoutrements, the recruit, if not well fed and cared for, is very prone to break down under hardships.

To turn now to causes of sickness among soldiers abroad. This is so largely a consideration of the whole question of the effect of hot climates on the European constitution, that I can only briefly treat of it here. The first points to note are that, owing to the impossibility of the troops working in the sun, and to the provision of native servants to do many of the things which the soldier does himself at home, the men have much more spare time; the climate causes a great craving for drink, and the great activity of the skin renders the system more liable to sudden chills. It is a curious and remarkable fact that whereas most severe illnesses at home are due to chest troubles, the abdomen is that part of the body which suffers most severely in the tropics; hence it has been well said that tropical disease generally “hits below the belt.”

Let us consider first the conditions of life in a hot, dry climate, such as Egypt and India in the warm weather, and next, in a moist climate like Ceylon or the West Coast of Africa. The great difference between Egypt and India is in that in the former the nights are comparatively cool owing to the rapid radiation of heat from the sand as soon as the sun goes down in the cloudless sky, while in Northern India in hot weather, the nights are almost as hot as the days. Only those who have had experience can realise the power of the sun in those climates; to go out into the sunlight without a hat, even for a few minutes, is to be struck down, or to get a splitting headache for the remainder of the day; the skin is burned, and the lips cracked by the hot wind, so that even when driving at midnight one turns away his face as from the open door of a furnace; while to sleep, except under a constantly waving punkah, is almost an impossibility for most Europeans. Bungalows are kept closed up to exclude the hot wind except at one or two windows, where it is allowed to enter through grass mats kept constantly saturated with water. The air is only changed by throwing the house open for an hour or so at dead of night, after which all openings are again closed so as to bottle up, as it were, a supply of comparatively cool air before sunrise. Hence exercise in the open air is an impossibility except before sunrise and after sunset. In the military stations in India soldiers can be seen sitting all night about the cantonments, unable to sleep in their beds on account of the heat of the barrack bungalows, which, like all buildings, retain the heat of the sun far into the night. When we think of the effect of such a life on the private soldiers, without a taste for reading or other resources within themselves, can we wonder that their health suffers, and their spirits become depressed, or that the raging thirst such heat engenders should lead to drinking? If the temptation to indulge in alcohol be yielded to, the liver, already in an irritable condition from the heat, and from the digestion of a diet of meat much too heating for the climate, soon becomes congested, or even suppurates; or the nerve centres which control the temperature of the body, already over-worked, break down completely, and heat apoplexy supervenes. It is a remarkable fact that a temperate man rarely suffers from heat apoplexy, for the body in health can adapt itself to enormously high temperatures. On the other hand, I have been much struck by the distress caused by the heat among beer-drinking soldiers, compared with the immunity experienced by the more temperate officer, doing the same work on a march. The measures to mitigate the effects of such a climate are to get as much exercise as possible during the comparatively cool hours of the morning and evening, and to be as much in the open air as possible at night; to have a diet as cooling as possible--fruit, vegetables, fish, etc. (all of which are unfortunately very difficult to procure at that season), and to try to interest the men with books, lectures, and indoor occupations, such as woodcarving, bootmaking, etc. Also to let them have plenty of temperance drinks--tea, lemon juice, etc., etc. Sleeping in the open air is the pleasantest at these times, but unfortunately sudden storms are apt to arise in the night which cause annoying breaks in one’s rest, and again one has to retire indoors at break of day, just when the air is coolest and sleep most refreshing. The alternative is to sleep under a punkah indoors, but the punkah-pulling in soldiers’ barracks is frequently most unsatisfactory, and the broken rest from the heat and mosquitoes is a serious cause of deterioration of health in the soldier. To the educated officer with books, and perhaps music and painting to while away the long, hot hours, the life in the hot weather is not unpleasant, dinner is not taken till perhaps 9 P.M., and social intercourse passes the time till long past midnight, then a few hours of sleep in the coolest time of the twenty-four hours, supplemented by a siesta in the daytime. All open-air work is over by 9 A.M. The more closely the life of the soldier is made to resemble that of his officers, the better will be his health. A word of warning is necessary about the swimming-bath, which, though it gives the most delightful form of exercise, is somewhat dangerous, for the bath being generally under cover, the water is much colder than the outer air, and lengthened immersion is very apt to cause liver and other internal congestions, the commencement of grave tropical disease.

Contrast with the above description that of a moist, hot climate. The air, instead of being hot and dry, is ladened with moisture, the slightest exertion causes profuse perspiration, which renders all the garments damp and clinging; the moisture of the atmosphere renders evaporation from the body and consequent lowering of the temperature much slower; there is experienced a total lack of energy, but as there is no hot wind, the houses can be kept open all day long; there are frequent showers, and vegetation is abundant, and affords plenty of shade for those who care to remain out-of-doors all day. There is not, therefore, in a climate like this the same amount of confinement indoors, but the constant heat and perspiration are very enervating, and soon lead to marked pallor in Europeans. The great danger in such a climate is from the damp clothing; the skin being so active is full of blood, and a sudden cooling from sitting in a draught in damp clothes drives the blood to the internal organs, causing congestion of the liver and spleen, dysentery, etc. To avoid this it is most important always to wear flannel next the skin and to change after exercise. By doing this the risks of such a climate are much mitigated. In two years in Ceylon I never had a day’s illness, and the good health of the army in the Ashanti expedition of 1895–96 must in a great measure be attributed to making the men carry a dry shirt on the march, into which they changed at once on arriving at the halting place. The most important disease of those climates is malaria, due to a minute organism in the blood, now proved to be generally communicated by the bites of mosquitoes. The obvious preventatives are to avoid being bitten by mosquitoes, to destroy the breeding places of these insects by draining the pools in which their larvæ develop, to avoid going out at night, when these insects are most active, and to keep them off by mosquito curtains. Smearing the exposed parts of the body with carbolic oil will repel these pests. There is no reason why soldiers in tropical barracks should not be supplied with mosquito curtains, when it is not hot enough to demand the use of punkahs, which also keep off the insects; and I have no doubt this will be done in all feverish stations as the result of recent teaching.

In sleeping under a punkah, and in fact at all times in the tropics, where the individual retires to bed bathed in perspiration, one of the best means of avoiding chill of the abdominal organs is to wear a long silk scarf (kummerbund) or a flannel “cholera belt” round the body.

One of the older theories about malaria was that it was due to some miasma arising from the ground, and especially from ground which had been recently disturbed. However erroneous this idea may be in theory, in practice many instances are on record of its apparent truth. I can never forget the results of sending men to a so-called sanitorium which had been made in the far East by levelling the top of a mountain and building barracks thereon. Almost every man who went got an attack of malarial fever, and this is in accordance with the experience and superstition of the Chinese. They say that the “Fung Shui,” or genius loci, of a place is a dragon who lives in the ground, and if you disturb the soil you irritate him, with the result that he avenges himself by spreading fever among his aggressors. Therefore the soil about barracks and encampments should be disturbed as little as possible, and all shallow pools of water should be drained or treated with a small quantity of paraffin oil to kill the larvæ of mosquitoes.

Other scourges of the tropics which cause sickness and mortality among our soldiers are liver disease and dysentery (generally due to chill as above described); and those diseases due to contaminated water, _e.g._, enteric or typhoid fever, cholera, and some forms of dysentery. This is so large a subject that I cannot say more on it than to indicate that the germs of the disease may, while almost invariably matured in water, be taken into the system with milk, water, or food, and the best precautions are rigid prevention of adulteration of the milk (to be secured, if necessary, by having the cows milked before a responsible European), boiling suspected drinking water, and the most perfect cleanliness in the preparation of all food. Notwithstanding the greatest care and expenditure in obtaining the best water for our large Indian stations, enteric fever seems rather to increase than diminish, but that is due, I fear, to the carelessness of the soldiers in drinking from contaminated sources in the bazaars, or in their walks abroad. The well-water of India and the native made aerated waters are almost invariably open to suspicion, and ordinary filters are, I fear, only a delusion and a snare. I am acquainted with at least one terrible outbreak of cholera distinctly traced to the use of filters. The bacterial filters of Berkfeld and Pasteur-Chamberland are reliable, but are so difficult to work and keep in order that it is much better to trust to boiling the water. In a tropical climate, when soldiers on the march acquire an intense thirst, it is practically impossible to make them wait till water can be boiled and cooled before quenching their thirst, and we have had recently a terrible example of the effects of foul drinking water in the outbreak of enteric fever among our troops in South Africa. My own practice in India when out shooting was to carry boiled water or cold tea, but to slake my thirst as much as possible by sucking a lemon or lime, a practice which most travellers and (generally) soldiers also could follow with advantage. Another use of these fruits is to squeeze a little of the juice into water which is not above suspicion, as it is known that acids kill the germs of cholera, and also possibly of enteric fever. I may add that limes are very abundant and cheap in most tropical climates, and could generally be served out to the troops.

I have already stated that heat apoplexy is most likely to attack those addicted to alcoholic excess, and is not likely to be prevalent among temperate men in the airy dwellings of Europeans in the tropics; but any great overcrowding, such as occurred in the Black Hole of Calcutta, would be likely to cause fearful mortality. Great and sustained exertion in the hot sun of Egypt or India might cause heat apoplexy or sunstroke in the most temperate. It is marvellous, however, what an amount of exercise temperate men can take when “pig-sticking,” for instance, in the hottest weather in India, with impunity.

The Europeans in India, who live in roomy and clean dwellings, suffer remarkably little from the plague, which is now threatening our shores, but has so far not obtained a foothold owing to rigid sanitary precautions.

A very troublesome complaint among soldiers in the tropics is “Dhobie itch,” a form of ringworm locating itself under the arms and between the legs, where the skin is always moist from perspiration. In one regiment I had charge of, about 75 per cent. of the men had it, causing a considerable amount of suffering and inefficiency. The disease is spread by inoculation from dirty clothes, or such as have been washed in impure water, and the best preventative is the use of clean and frequently changed underwear.

By the adoption of the measures above indicated it is possible for Europeans to enjoy good health in the tropics, but in war it is impossible to observe many of these precautions. It is well known that in all climates the ravages of disease are infinitely more fatal than the weapons of the enemy. The existence of hostilities, with the hard work and privations thereby entailed, usually puts all health considerations into the background. In the Crimean war three times as many of our men died of sickness as at the hands of the Russians, and the proportion will be found even greater in the present war in South Africa, in spite of the deadly accuracy of modern weapons and of the fact that the theatre of operations is one of the most salubrious regions in the world. And it is not difficult to understand why this should be so when we reflect upon what active service means--the prolonged and intense exertion, the loss of rest, deficiency of food, which at the best is coarse, unpalatable, and badly cooked--in a word, starvation; the bad water, the fouling of the camping grounds by the excreta of thousands of men and animals, the heat by day and the cold by night, the clothes alternately saturated by perspiration and frozen by the bitter night wind, also the clothes becoming dirty and infested by vermin owing to their wearers being unable to change them for weeks. In the stress of campaigning men have become ill from want of time and opportunity to secure the daily evacuation of the bowels, which is so necessary to health. These are a few of the conditions incidental to active service, and when we reflect it is not difficult to understand that not only are there many diseases induced by campaigning proper, but that if a man have one weak point about him, such hardships are bound to find it out. We have only to glance at the casualty lists published in the newspapers every morning, to see how various are the causes of death among our men at the front. So well is this recognised that every man is medically examined before going on active service, and all with any defect of constitution are rejected. Here I may incidentally remark that the prevention of venereal diseases in the army is a matter of national importance, for the men who are thereby unfitted to endure the privation of a campaign are many, and all reasonable measures for the prevention of such diseases should therefore have the support of patriotic people.

It is well known that excessive fatigue alone will cause a feverish condition of the body, leading to weakness and loss of appetite, and when that is induced the body is in a favourable condition for the reception of the germs of specific diseases. Service conditions obviously predispose to such diseases as pneumonia, rheumatism, quinsy, frost-bite, etc., etc., and in hot countries to heat apoplexy and sunstroke.

The commonest specific diseases of campaigns are dysentery, enteric fever, cholera, and malarial fevers. Dysentery has always been the great scourge of armies in the field in almost all climates, and the causes may be briefly summed up as bad food, bad air, bad water, and chills. The unwholesome food may cause disease in two ways: owing to its coarseness and being badly cooked, it may give rise to inflammation and irritation of the bowels, or it may be deficient in those still imperfectly understood constituents which are necessary to prevent scurvy. It is unnecessary to dilate further on the food question, the points of which are obvious, but as regards scorbutic dysentery I may say that it is very liable to appear among soldiers in the field, and our authorities endeavour to ward it off by giving, whenever possible, rations of fruit, vegetables, jam, and lime juice. As regards bad air, the condition of camping-grounds whereon large numbers of men and animals have lived even for a few days must be seen to be realised, and when to that is added the stench of dead bodies of men, horses, and cattle, as on a battlefield, it can be easily understood how frequently the air which men have to breathe on active service must be such as to give rise to bowel complaints. Again, in some countries where our troops have to operate, such as in the West African jungles, the air reeks with the smell of decaying vegetation in the stagnant depths of the primeval forest, and such air is most unwholesome.

Bad water is the principal cause of dysentery, but whether a man can acquire true dysentery thus, unless the water has been fouled by the discharges of a previous case of the disease, is not quite certain. Generally, such fouling is not difficult to establish. The drinking of water in which are immersed the rotting carcases of men and animals, and other nameless abominations--such water as our soldiers drunk at Paardeberg--is, as might naturally be expected, likely to cause diarrhœa running into dysentery, especially when all the other causes of that disease exist also. Chill I hold to be an exceedingly common cause of dysentery, having contracted the disease myself from that cause alone after leaving the tropics. It is most important to avoid sudden cooling of the surface of the abdomen by changing into dry flannels immediately on halting, and keeping that region warm, especially at night, by a thick woollen or silk covering. Unfortunately such precautions are generally impracticable on active service.

Enteric or typhoid fever has only been recognised as a distinct disease apart from typhus fever since the researches of Sir Wm. Jenner in the late Queen’s reign, and therefore, whether it used formerly to be as great a scourge in the past as it is now, it is impossible to say. At the present day it is without doubt by far the most fatal disease to which our soldiers are liable either in peace or war, and experience in Egypt, India, and South Africa, where it seems to become more and more fatal in spite of all that science can do to check it, almost causes us to despair.

Protective inoculation on the same principle as vaccination is the latest plan, tried extensively in South Africa, but the reports to hand so far do not show that it has had any marked success as a preventative, though it is hoped that it will prove to mitigate the severity of the attack. The disease is most prevalent and fatal among young men, which is a strong argument against the employment of very young soldiers; but on the other hand many middle-aged men, whose deaths the country is even now deploring, have lately succumbed. There is little doubt that in England and other temperate climates this disease is almost invariably due to bad water, but in India and other very dry climates, where it has continued to spread in spite of the most rigid precautions, the opinion is gaining ground that the germs may often be spread by the wind carrying them about into food and drink from the dry excreta of previous sufferers, deposited on the ground. Flies also are suspected of bringing about the same effect. Even in India and South Africa, however, it is remarkable how often epidemics are associated with contaminated water--for instance, Paardeberg and Bloemfontein (where the enemy cut off the regular water supply), and when one has had experience of the way in which the ground is fouled by the natives of Africa and India, there is little wonder that the water supply suffers. It seems certain that people can drink sewage contaminated water with comparative impunity, but the germs of enteric once admitted into the water, an epidemic is almost certain. The Hindoos always wash their buttocks after defecation, and hence generally perform that act near water, and in the hills in India often when I have been tempted to drink from an apparently pure mountain stream, I have noticed, just in time, the evidence of this disgusting practice. Again natives generally build their huts near a water supply, and hence nearly every rivulet is contaminated. In a hot country it is therefore most difficult to prevent men quenching their raging thirst with obviously polluted water. The Boers are reported to be very filthy in their habits, and as enteric fever is rife among them, it is not difficult for us to understand how so many of our men have contracted the disease in such a thirsty land, where I am informed even doctors, well aware of the risks, could not resist the temptation of drinking the dirty water by the roadside. The only safeguard with suspicious water is to boil it; filters only give a false sense of security, but wells can be purified with Condy’s fluid and acids, and of course rain water, if carefully collected and stored, or a stream, if guarded from its source, may be trusted, as also wells sunk at the time by the Royal Engineers. Many observers think that enteric fever may be caused by excessive fatigue and exposure to the sun, with absorption of poisons from the bowels, especially if they are overloaded with decomposing excreta due to constipation from heat, hard work, unwholesome food, and want of time and opportunity to secure a regular evacuation. In the navy, where condensed water is largely used for drinking purposes, enteric fever is rare, except when contracted ashore; but as soldiers cannot, as a rule, be supplied with condensed water, we must rely on the above precautions as regards water, cleanliness in the preparation of food, care in the disposal of excreta (and it is important to remember that enteric urine is as dangerous as stools), and constant supervision of natives and camp followers.

Cholera is like enteric fever, generally a water-borne disease, and much the same remarks apply to both. On active service, tea, coffee, and cocoa should be drunk in preference to water, as far as time and the supply of fuel will allow, and all drinking water should, if possible, be boiled. When green cocoanuts can be procured each will furnish nearly a pint of deliciously cool and perfectly wholesome “milk.”

I have said enough to show what a vital point the water question is on active service, how the health of an army in the field is largely dependent upon obtaining pure drinking water; and while all officers, regimental and medical, must never weary in their endeavours to secure such a supply, the men themselves ought to be instructed and exhorted to exercise the necessary vigilance and self-restraint, and, if necessary, punished when they fail to do so.

Malaria is always a great danger to soldiers on active service, not only in tropical regions, but also at times in our own latitudes, as was seen in the Walcheren Expedition. Though our theories as to the cause of the disease have lately been altered by the discovery as to the agency of mosquitoes in disseminating it, the old rules of not disturbing the ground, sleeping on raised platforms (as was done in the Ashanti Expedition of 1895–96), avoiding the neighbourhood of marshes and jungly ravines, preventing chill by changing into dry flannels on halting, never starting off in the morning without a cup of cocoa or something of that kind, and taking a daily dose of quinine, should on account of their proved utility still be followed. To keep off mosquitoes in the absence of curtains and punkahs, the face and other exposed parts of the body should be smeared with carbolic oil.

Sunstroke and heat apoplexy are causes of mortality on active service, and even at home in hot weather we have had lamentable results from overworking our soldiers in improper clothing and head-dresses. The obvious precautions are, the avoidance of overcrowding and overloading the men, the wearing of a suitable head-dress, loose porous clothing, the provision of plenty of non-alcoholic drinks, and marching in as open order as possible, so as to give every man enough fresh air. The greatest precaution of all, viz., avoidance of work in the sun, cannot, of course, be generally adopted on active service.

Sore and tender feet cause a great deal of inefficiency on active service, though our army boots are generally very good, with plenty of room and low heels, but a less rigid sole would be an improvement. The socks should be woollen and not too thin or loose, the feet should be kept clean and well soaped immediately before putting on the sock, and blisters should be carefully treated.

Many of the above suggestions may appear incapable of being carried out in the stress and hurry of active service, but, of course, anything which will prevent disease contrives “a double debt to pay”; it keeps the men in the fighting ranks, and prevents their becoming not only useless but a burden and trouble to their healthy comrades. Every soldier is said to cost the country about £150 before he can be placed in the field as efficient, therefore sickness entails very heavy pecuniary loss to the country, and all reasonable precautions will ever receive the earnest attention and support of capable leaders. In fact, without due regard to many of them it would be impossible in some countries for white men to remain in the field at all, and the Ashanti Expeditions of 1873 and 1895 have well been called “doctors’ wars.”

In conclusion, if my remarks have given rise to the impression that the soldier is a drunken or unreliable creature, such is far from my intention. He only presents, and that in a degree mitigated by discipline and respect for authority, the faults of his class. My experience of the average working man, which is large, is that the majority cannot refrain from drinking so long as they have money in their pockets, regardless of the consequences to themselves and their families, and that to offer a man drink is their ordinary way of showing kindness and good-fellowship; while their general want of self-restraint is very disappointing, considering the educational advantages they have enjoyed compared with their fathers.

J. R. DODD.