Copyright
P. M. (Percy Moreau) Ashburn.

The elements of military hygiene : especially arranged for officers and men of the line online

. (page 1 of 22)
Online LibraryP. M. (Percy Moreau) AshburnThe elements of military hygiene : especially arranged for officers and men of the line → online text (page 1 of 22)
Font size
QR-code for this ebook


UNIVERSITY OF CALIFORNIA, SAN DIEGO



3 1822 01947 0202



^ LIBRARY



~N



V_



UNN6RSITY OF
CAUFORNIA

SAN oicao



UNIVERSITY OF CALIFORNIA SAN DIEGO



3 1822 01947 0202






\f



C^'^



THE snrrvsc!: nc?:ooL, w. v. M.
130 ccLur.'.::-.':; Avirrjs

B03T0:i



MILITARY HYGIENE



THE ELEMENTS OF
MILITARY HYGIENE

ESPECIALLY ARRANGED FOR OFFICERS
AND MEN OF THE LINE



BY



y'Lc



p. m;>shbuen

MAJOR, MEDICAL CORPS, U. S. ARMY




BOSTON AND NEW YORK
HOUGHTON MIFFLIN COMPANY

1909



COPYRIGHT, 1909, BY PERCY M. ASHBURN



ALL RIGHTS RESERVED



PREFACE

There can be little or no doubt that the sanitation of
the army would be greatly improved if line officers
and enlisted men should become more interested in the
subject, and cooperate more freely and intelligently
with medical officers in the efforts to promote it.

This book is written in the hope that it may both
inform and interest them and so gain for the medical
officer the sympathy and cooperation that he always
needs, but now too seldom has. It is also hoped that
medical officers themselves, especially those of the
volunteer service and militia, may find the book useful
in their dual capacities of administrators and teachers.



CONTENTS

PART I. — THE RECRUIT AND HIS ENVIRON-
MENT

I. The Recruit 3

n. Persoxai. Htgiexe 20

III. Foods and their Preparation . . .33

IV. The Hygiene of the Barracks . . 54
V. Camps 73

VI. The Hygiene of Moving Troops . . 101
VII. The Hygiene of Hot and Cold Climates 120

PART IL — THE CAUSES OF DISEASE

VIII. The Remote or Predisposing Causes of

Disease 141

IX. The Immediate or Exciting Causes of

Disease ....... 156

X. Disease Carriers 180

PART III. — THE PREVENTION AND
CONTROL OF EPIDEMICS

XI. The Defenses against Disease in General 199
XII. Typhoid and other Water-Borne Diseases 213

XIII. Air-Borne and Fomites-Borne Diseases . 239

XIV. Insect-Borne Diseases .... 257
XV. Venereal Diseases 281

Index 301



PART I

THE RECRUIT AND HIS
ENVIRONMENT

"Health and a good constitution are better than all gold; and a
strong body than wealth without measure."

EccLESiASTicus 30 : 15.



MILITAKY HYGIENE



CHAPTER I

THE RECRUIT

One of the principal factors in military hygiene is
the individual soldier, or, as he comes from civil life,
the recruit. If he enters the service in good physical
condition, in good health, and with sufficient intelli-
gence to apprehend and apply the instruction he re-
ceives in military hygiene, the problem is almost half
solved. The final acceptance or rejection of recruits now
rests almost entirely with medical officers ; but in cer-
tain ways line officers exercise a considerable influence
in the matter : in the acceptance at the recruiting station,
and in requesting special authority to enlist because of
special qualifications. For these and other reasons it is
important that they should keep well informed as to the
requirements necessary and the qualifications desirable in
recruits. We will therefore briefly consider some of these.
The age limits for first enlistments are from eighteen
to thirty-five years. Preferably men should be chosen
between twenty-three and thirty years. Be-
fore the age of twenty-three years most °
men are immature, their muscles are not hardened, their
hearts not so strong, their minds not disciplined by expe-
rience, their appetites and emotions not under control ;
while their susceptibility to impressions from their en-
vironment is such as to make it undesirable to limit
their associations exclusively to adult unmarried males.



4 THE RECRUIT AND HIS ENVIRONMENT

After the age of thirty years the man's habits of body
and mind are fixed, he takes instruction less readily,
his body may have begun to deteriorate, particularly if
it has not been well cared-for, and, in many instances,
he seeks the service as a refuge, after failing in other
walks of life. Many good men may be obtained before
the age of twenty-three and between the ages of thirty
and thirty-five, but in general the case is thought to
be as stated.

The size of the recruit is not a matter of the great-
est importance, provided that the development is nor-
mal and the man strong and active, except
as it applies to assigning him to duty. It
is obvious that a very large and strong man is better
suited for coast-artillery work than for the cavalry, and
that a small, wiry man is in that respect better for the
cavalry. The proportions of weight and chest measure-
ments to height are published from time to time in
general orders, and those proportions usually represent
very well those of strong, well-developed men. An in-
crease of weight, if associated with great breadth of
shoulder and large chest measurement, is not necessarily
harmful, being usually indicative of strength and en-
durance. The sturdy, stocky Japanese coolie exemplifies
this. Obesity, whereby the man is burdened with his
own weight, is of course objectionable.'

^ The following table copied from the Medical Eecord of September
5, 1908, and compiled from the data of the Mutual Life Insurance Co.
of New York, by its Chief Medical Director, is interesting as indicat-
ing somewhat " the influence of overweight and underweight on vitality."
The weights considered normal by the insurance company are some-
what in excess of those prescribed by the War Department, the in-
orease averaging about 10 pounds at the ages 25-29, and for heights



Chest



THE RECRUIT 5

The chest should be freely mobile, that is, both sides
should move freely, symmetrically, and equally, in ex-
panding and contracting. The measured
chest expansion should generally corre-
spond with the figures published in the general orders ;
yet it should be remembered that one man with very
ordinary lung capacity may, by use of the shoulder and

below 70 inches. A weight 20 per cent below the average is considered
" underweight," and 20 per cent above the average, " overweight."

Table showing the Percentage of Deaths in all Classes, and some Indi-
vidual Diseases, among Overweights and Underweights, and the
General Experience of the Mutual Life Insurance Company.



Causes of Death.


Over-
weights.


Under-
weights.


General
Experience.


Claes I. General Diseases — Acute . .

Typhoid fever

Malarial fever

Influenza

Class II. General Diseases — Chronic

Tuberculosis

Cancer

Diabetes

Class in. Diseases of the Nervous System

Cerebral Congestion and

Hemorrliage, Cerebral

Softening, Paralysis . .

General Paralysis and other

forms of mental alienation

Class IV. Diseases of the Circulatory

System

Organic diseases of the heart
Class V. Diseases of the Respiratory

System

Fiieumonia

Class VI. Diseases of the Digestive Sys-
tem

Cirrhosis of Liver ....
Class VII. Diseases of the Genito-urinary

System

Bright's Disease and Nephri-
tis

Class IX. Diseases of Skin and Cellular

Tissue

Class XI. Old age

Class XII. Violent causes

Casualties

Suicides

Class Xin. ni-defined


9.67
4.00
1.27
1.47

13.07
2.93
4.40
3.40

19.08

14.14

1.80

10.01
12.94

8.54
6.87

lO.Gl
3.47

12.01

11.07

1.20

None

7.07

4.20

2.87
2.G0


9.28
3.0G
1.21
2.04
24..59
16.98
5. .57
0.G5
.12.16

8.47

0.84

11.69
8.54

15.78
12.34

8.54
0.65

7.42

5.30

0.47
2.04
5.57
3.43
2.14
2.50


8.90

3.94 j

1.24

1.00
19.56
12.42

4.18

1.25
17.44

12.32

1.30

1185
10.76

11.86
9.03

10.19
1.00

8.78

6.66

0.50
1.50
7.42
5.21
2.20
3.98



6 THE RECRUIT AND HIS ENVIRONMENT

back muscles and retraction of the abdomen, show an
apparent expansion of 3^ inches, while his companions
with a capacity as great, may, through ignorance of
tricks or of what is desired, show only 1| inches. It is
desirable that the chest be fairly large, to afford amjtle
room for the free working of the heart and lungs, as on
such finally depend both strength and endurance. A
generally well-developed and strong man will show
well-developed and prominent chest muscles.

Certain types of chest frequently indicate a predis-
position to, or the actual existence of, disease, and de-
mand careful consideration even when not constituting
actual causes for rejection. The long, narrow chest, with
prominent or " winged " shoulder-blades, depressed or
flat below the collar-bones, and forming an acute
angle at the divergence of the ribs below the breast-
bone, frequently marks a predisposition to consumption.

A large, barrel-shaped chest, as deep from front to
back as transversely, and showing a relatively small
movement, is often associated with emphysema and
asthma.

A chest more prominent on one side than on the
other is apt to be associated with curvature of the spine,
or old or chronic pleurisy.

Marked prominence or depression of the breast-bone,
especially if associated with "beading," or lumps on
the ribs near the breast-bone, frequently results from
rickets, and may be accompanied by other bone de-
formities.

The abdomen should be well muscled, and firm when

. , , the applicant is standing. It should move

easily and naturally in respiration, should

not be pendulous, and should be firm, particularly in



THE RECRUIT 7

its lower parts, just above the groin. Weakness here
will be indicated by a bulging if the patient strains, as
at stool, or if he stands on his toes and coughs hard.
Such bulging, especially if it be marked or shows a
tumor-like swelling, indicates a predisposition to, or
the actual existence of, a hernia.

The umbilicus or navel is another frequent site of
hernia, and should be noted in that connection, as
should any abdominal scars resulting from operations,
as for appendicitis. Another, though less frequent, site
of hernia is the femoral. This is shown by a fullness
or swelling in the lower part of the groin, in the high-
est part of the thigh rather than in the lowest part of
the abdomen.

Large masses or tumors that can be felt through the
abdominal wall, or that can be seen to produce in-
equality or fullness, are causes for rejection.

Distention or prominence of the veins on the sur-
face of the abdomen, or a varicose condition of them, is
generally an evidence of impaired circulation or liver
disease, and should cause rejection.

Hemorrhoids, or piles, while apparently not con-
nected with the abdomen, are the result of distention
of the rectal veins, and may be due to liver disease, to
abdominal tumors, to constipation, or other intra-ab-
dominal conditions. They are manifested as tumors,
usually of a bluisli color, within or about the anus, which
vary in size from that of a small pea to that of a man's
thumb. Of themselves they are not a cause for rejection
unless of large size or producing symptoms, but their
presence should always be noted. Internal piles are not
visible, and usually make their presence known by burn-
ing or irritation in the rectum, or by the passage of



8 THE RECRUIT AND HIS ENVIRONMENT

blood in the stools. In examining for them, note should
also be made of other abnormal conditions of or about
the anus, such as fissures or cracks in the skin and
mucous membrane ; fistulas, little openings near the
anus from which there may be a slight discharge of pus
or fecal matter ; or abscesses or boils. Any of these
conditions may so disable the man as to unfit him for
service.

A history of abdominal trouble, such as severe indi-
gestion, gallstone colic, vomiting of blood, should cause
rejection.

The examination of the head is very important, as
revealing defects in most of the special senses and as
_, J offering important evidence as to the man's

character, habits, and abilities. The evi-
dence on the latter points is to be gained largely from
the shape of the head and the expression of the features,
and, while such evidence is not always reliable, certain
heads and faces are so distinctly indicative of stupidity
or vice that there should be no hesitation in rejecting
their possessors. Then, too, hideous or disgusting de-
formities should at once cause rejection, for the sake
both of the victim and those with whom enlistment
would associate him, even though they are not of a
character to incapacitate directly. The vision and hear-
ing should be tested in strict accordance with the regu-
lations governing the subject, and failure to meet the
requirements is cause for rejection.

In addition to the test for vision, however, the eyes

should be examined for any signs of inflammation, red-

_ ness, watering, drooping of the lids, scars

or deformities, granulations, styes or boils,

undue prominence of the eyeball, inability to move the



THE RECRUIT 9

eyes in all directions, and discoloration or blurring of
the cornea-

The ears, in addition to the tests for hearing, should
be examined for any discharge, whether
watery or purulent, and if present it should
be a cause for rejection.

The nose should be examined as to its freedom from
obstruction, by having the applicant close first one side
and then the other with his fingers and then
breathe and blow through the free side. In-
cidentally this may call attention to a foul-looking dis-
charge or a foul-smelling breath, either of which may
justify rejection. A sunken or much scarred nose is
often an indication of syphilis, while a red, bulbous
nose, even if not indicating alcoholism, is sometimes an
indication of indigestion. It should be noticed that the
man habitually breathes through his nose.

The mouth and throat should always be _, ^,
» ,, . J •' Mouth

careiully exammed.

The condition of the teeth is the first point to be
noted here. It is desirable that all should be pre-
sent and good, but there must be at least
enough to permit of proper mastication of
the food, and for this purpose at least four grinders
are demanded, two above and two below, and so dis-
posed as to permit their effective use. Enough of the
front teeth should also be present to permit of the bit-
ing of food and to preserve the symmetry of the face.
At times men are accepted with no upper teeth, but
wearing plates. This should only be done by special
authority and in special instances. Insufficient or poor
teeth are apt to produce digestive disturbances, partic-
ularly on campaign, when hard bread may be issued,



10 THE RECRUIT AND HIS ENVIRONMENT

and when the preparation of the food in general may
not be as good as in garrison. The examination of the
teeth should not only relate to their presence and the
presence or absence of cavities, but also to their state
of cleanliness. Neglected, filthy teeth and gums may
seriously menace the general health, while they cer-
tainly predispose to loss of teeth, and, in many instances,
indicate general carelessness or filthiness. Sores or
ulcerations on the lips, tongue, gums, or inner sides of
the cheeks should be carefully noted, as they may in-
dicate syphilis or other general disease, and should at
least lead to further and more careful search for syphi-
lis. The same remark applies to milk-white patches,
seen especially on the tongue.

In ill-kept mouths the gums may be spongy and bleed

spontaneously or on pressure, or pus may exude from

_, between them and the teeth ; or they may

be greatly retracted and expose tjje roots

of the latter.

In these and other cases the teeth may all be present,
yet in such poor condition as to forbid proper mastica-
tion, or to threaten their early loss.

The most common and easily detected throat trouble
is enlargement of the tonsih. This condition usually
_, indicates a liability to frequent attacks of

sore throat, and should always excite in-
quiries as to this, and while not necessarily a cause for
rejection, unless very marked, should be noted as a
point against desirability. Ulcers, white patches, mem-
branes, and an appearance of acute inflammation in
the throat, should cause rejection.

Hoarseness, or loss of voice, or cough, should at least
delay, and if persistent prevent, acceptance.



THE RECRUIT 11

Numerous scars on the tongue, lips, and cheeks, unless
clearly and certainly accounted for other- _
wise, should cause rejection as being prob- °

ably due to bites during epileptic fits, or to syphilitic
or other ulceration.

Too much importance should not be attached to a
coated tongue, but a raw-looking, bright red, or tremu-
lous one should direct careful scrutiny to the general
condition and the habits.

Enlarged lymphatic glands, or "kernels," are most
frequently noticed in the neck or under the jaw. They
are frequently indicative of inflammation or -
ulceration in other nearby regions, espe-
cially the mouth or throat, and their pre- *^
sence should lead to careful examination for such con-
ditions ; but at times their presence is indicative of a
general infection, such as syphilis. Usually, if the en-
larged glands are numerous, or the enlargement great,
they constitute a proper cause for rejection. When the
enlargement is localized at one part of the neck only,
it points to an infection entering at a part near it.
Thus such a gland at the angle of the jaw may be due
to inflammation of a tonsil of the same side ; one under
and near the jaw to a bad tooth, etc.

The scalp should be carefully examined as to its
cleanliness and general care, for the presence of lice,
which may be seen as such or may be re-
vealed by the " nits " or eggs, little whitish '^

bodies attached firmly to the hairs ; for ringworm,
scabbiness or scald-head, patchy baldness, wounds or
scars, etc. The presence of vermin is a cause of rejec-
tion in two ways, as indicating a lack of personal care,
and as a danger to be introduced into crowded barracks.



12 THE RECRUIT AND HIS ENVIRONMENT

Superficial suppurative scalp diseases should generally
cause rejection, as being contagious or as being caused
by scratching excited by lice. Patchy baldness, if the
patches are sharply defined and the skin is smooth,
clean-looking, and not scarred, is apt to be harmless.
If the skin is inflamed and scarred, and stumps of
broken hairs are present, it should cause rejection. Ir-
regular and incomplete baldness occurring in patches
or tracts, giving at times a " moth-eaten " appearance,
is most apt to be due to syphilis, and should cause care-
ful examination for other signs of that disease.

The upper limbs should be examined as to their de-
velopment and musculature, their free mobility in all
joints and in all directions, the presence of
all bones and joints, and a reasonable
amount of dexterity and strength. Atrophy or wasting
of a group of muscles or a part, inability to bend or
make free use of a joint, and similar defects, should
be carefully looked for, as they may otherwise be
missed. Loss of one or more joints of a finger, swelling
and deformity of a joint (baseball finger), or stiff con-
tracted fingers are not uncommon, and, if in the fourth
or fifth fingers, are not serious matters, though they
should be noted. If in the second or third fingers, the
matter is more serious, yet the applicant will usually
be able to handle a gun and perform his other duties.
Loss of a thumb is a serious defect, and in most instances
would justify rejection. All deformities from badly
united fractures or 'other causes should be noted, and
should cause rejection unless the applicant can demon-
strate his ability to execute the movements necessary
in the performance of his duties.

The legs should likewise be examined as to their



THE RECRUIT 13

development, musculature, size, mobility, etc. The ap-
plicant should be required to move all the - ,
joints, to jump, hop, and otherwise demon-
strate his ability to use his limbs. Marked
deformities, such as clubfoot, shortening of one leg,
stiffness, marked swelling or marked limitation of mo-
tion in a knee or hip, should at once cause rejection.
Less marked deformities, such as knock-knee, bow-legs,
crooked shins, etc., need not cause rejection unless man-
ifestly interfering with the free use of the limbs, or
rendering the subject's appearance ludicrous or unmili-
tary. Here, again, marked wasting of a part or of a
group of muscles will often be found due to a joint
lesion, a paralysis, or other nervous trouble, that would
serve to disqualify the applicant. In addition to these
defects, common to both arms and legs, the lower ex-
tremities are subject to other affections rarely or never
seen in the upper.

Varicose or dilated veins are often seen. They usu-
ally show as swollen, bluish, and more or less tortuous
vessels beneath the skin, and may be individually as
large as a man's finger. They are most commonly seen
on the lower legs, but are not very rare in the space be-
hind the knee, and may extend up the inner side and
front of the thigh to the groin. If marked, they should
cause rejection. If only slight, and in otherwise desira-
ble applicants, they may be passed, but should always
be noted. At times they cause the appearance and per-
sistence of very chronic ulcers, which occasionally bleed,
pain, or otherwise disable the man. Such ulcers are es-
pecially apt to show on the front or to the inner side of
the lower half of the leg. They are long in healing, are
apt at any time to break open again, and when healed



14 THE RECRUIT AND HIS ENVIRONMENT

usually present brownish, discolored scars. Such ulcers,
or such scars if accompanied by varicose veins, should
cause rejection. The legs are especially prone to chronic
ulcerations^ which may be caused by syphilis, tubercu-
losis, leprosy, and other infections. In general these are
causes for rejection.

A rough, nodulated, tender shin-bone is not an un-
usual sign of syphilis.

The feet require particularly careful examination, as
on their integrity, usefulness, and strength (or what we
might call their durability) depends a large part of the
man's capacity for " soldiering." The best known and
probably the least important of the foot-ills is corns.
They are best known because most persons at some time
have at least one, and they are one of the least impor-
tant ills because in most instances they cause not even
serious inconvenience, and they usually disappear with
the use of properly fitting shoes and ordinarily good
care of the feet.

If numerous and painful, however, or if soft corns,
situated between the toes, they may justify rejection.

Sweating feet, which soften, blister, redden, and burn,
may cause rejection, as they are not apt to stand much
marching.

Stinking feet may justify rejection in most instances,
as constituting a nuisance in barracks.

Bunion, an inflammatory and deforming joint-affec-
tion, usually at the base of the great toe, will, if very
marked, disqualify.

Hammer-toe, a condition in which a toe is flexed and
the end presses on the floor, while a knuckle projects
above, is very apt to cause lameness and may justify
rejection.



THE RECRUIT 15

Overlapping toes may disqualify in a somewhat simi-
lar manner.

Deformities of the arch of the foot are very impor-
tant. It may be too high, so that the weight is borne on
the ball of the foot and the heel, the intermediate parts
remaining clear of the ground. This is a relatively rare
condition, but may disqualify. A common condition is
the opposite, ov flat foot, wherein the whole length and
breadth of the foot touches the ground and the arch is
almost or entirely obliterated. Such a foot in a white
man is usually a poor marching foot, and, unless the
applicant is a desirable man and states that he is a good
walker, and that the foot never gives him trouble, it
should cause rejection. When passed, its existence
should always be noted, in case the man should be dis-
charged for it later. The condition is more common but
less important in negroes, but it may cause trouble in
them also, particularly in the course of long marches.

Another type of weak foot is not really flattened but
tends to rotate outward, thus bringing the inner margin
of the foot nearer to the ground and more directly
under the weight of the body, where a greater weight
comes upon it, causing it to tire and eventually to break
down and become flat. It may justify rejection.

The genitals should be well-formed and normal.
Both testicles should be present and in the scrotum ;
it should be possible for the applicant to .

retract his foreskin, and the penis should
not show gross deformities, such as the opening of the
urethra being placed far back from the end. Scars on
the penis should prompt investigation as to their na-
ture, whether syphilitic, chancroidal, or otherwise. The


1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Online LibraryP. M. (Percy Moreau) AshburnThe elements of military hygiene : especially arranged for officers and men of the line → online text (page 1 of 22)