HOW TO KEEP WELL. The Chicago Record’s HYGIENIC MANUAL :f pr.ltMed 'irfthe'Fieid: By - Colonel Charles--Smart, Deputy Surgeon-General United States Army. “We read the war news in the other pa- pers, then we turn to The Chicago Record to see how much of it is true.’’—Urbana (III.) Daily Courier. HOW TO KEEP WELL The Chicago Record’s HYGIENIC MANUAL Fer, United Sfehes-Sekhefs “in the riela By Lie jtenant-Colonel Charles Smart, Deputy Surgeon-General United States Army. [Copyright, 1898, by The Chicago Record. ] THE CHICAGO RECORD’S HYGIENIC MANUAL General orders issued on Decoration day, 1898, from the head- quarters of the army by the major-general commanding require that “every officer of whatever grade will, as far as may he in his power, guard and preserve the health and welfare of those under his charge.” The importance of this requirement can he fully understood only by those who have had ex- perience in the camps of large armies and who are aware that usually it is disease and not gunshot injury which scores the heavier death rate. Those who are killed in battle or who die of wounds received in conflict have rarely exceeded in number the victims of disease. In our civil war two men per- ished from disease for every man who died from gunshot injury, and the diseases which carried them off were preventable diseases, or such as would not have affected them had they been properly protected against the harmful influences to which the soldier is Disease More Fatal Than the Enemy’s Bullets 3 THE CHICAGO RECORD’S more or less exposed during the progress of an active campaign. In our army in times of peace the number of deaths occurring from disease in a year is only about 4 in every 1,000 men, or 1 death among 250 men, while during the years of the civil war it was 1 death in 18 or 19 men, and in 1863 it ran as high as 1 death in every 16 men. This great difference between the death rates of soldiers in time of peace and in time of war explains why the major-general com- manding considered it necessary to remind officers of all grades that one of their first duties is to guard and preserve the health of the men under their charge. The power of an of- ficer to preserve the health of his men is materially increased by a thorough knowledge of the harmful in- fluences which affect soldiers on active serv- ice and of the causes of the diseases usually spoken of as camp diseases; but his power for good is limited unless his instructions are obeyed and his advice followed intelli- gently. No matter how well informed he may be or how earnest in his endeavors on behalf of his command, his efforts can effect but little unless his men appreciate his ob- ject and co-operate with him. This booklet Officers’ Re- sponsibilities 4 HYGIENIC MANUAL is intended to present to both officers and men the principles of self-preservation in camp, that disease, disability and death may be lessened and the command kept always at its highest point of health, strength and efficiency. Protection from dis- ease is, in a general way, effected by keep- ing the men always in good physical condi- tion, by attention to the person, the shelter, clothing and diet, and the avoidance of all unnecessary exposures and fatigues. When a soldier is, from any cause, below par in his physique he breaks down under influences which otherwise would have but little effect on him. Importance of Keeping in Good Physical Condition But a special protec- tion can be given against smallpox. The volunteer soldier should be vaccinated by the medical officer, if, on inspection, he is found to be insufficiently protected against this disease, which is now prevailing both in certain parts of the south and in Cuba. This should be done immediately after muster-in, to prevent outbreaks of the disease and dis- ability from hurried vaccination during ac- tive service. Vaccination 5 THE CHICAGO RECORD’S The shelter provided by the government in camps of organization may consist of temporary wooden barracks or tents of various patterns, such as the wedge or common tent, the wall tent, the Sibley tent or the conical wall tent. These tents are of no account in active field service, because, as they require wagon transporta- tion, the number of wagons would impede the movements of the army, and on account of the activity of these movements the tents would never be where the men were who wanted them. They would be miles away in the wagon train. For shelter in active serv- ice each man has, therefore, to carry his shelter canvas over his shoulder with his blanket roll; but from the sanitary point of view this is no disadvantage, for the men have their shelters always with them and are thus saved from many exposures, and in mild or warm weather the shelter tent is a healthier habitation for two men than the large tent for its ten or twenty inmates. Slielter Canvas Blanket Roll anil Haversack Before starting on ac- tive service the sol- dier should be fully- equipped for the cam- paign. The lists that have appeared in some of the newspapers lately of articles to be carried by the volunteer on a campaign were 6 HYGIENIC MANUAL evidently made up by persons who know nothing personally of service in the field. In his blanket roll the soldier should have a spare flannel shirt, undershirt, pair of draw- ers and handkerchief, with two pairs of socks, his shelter canvas and a rubber blanket, poncho, pommel slicker or other waterproof garment, as a protection from rain during the march or on guard and as a damp-proof flooring for his bed. His haversack contains his regulation plate, knife, fork, spoon, etc., and has attached to it his cup. Besides these and his arms, ammunition and can- teen, he should carry nothing but a first aid packet, needle book containing thread and a few safety pins and spare buttons, match box, towel, soap, pocket comb and looking glass. His shoes and socks should be care- fully selected to fit. It is well to start on a march in shoes that have already been broken in by several days’ usage in camp. The un- dergarments should be light-weight woolen mixtures, not too coarse or irritating to the skim The color of the shirt is usually blue, to preserve the military appearance when worn without the blouse, but lighter colors reflect heat better and are cooler. As the blouse for field service is to be light brown, the shirt should correspond in color. The blouse in hot weather or hot climates is used only as an overcoat in the chill or mists of night or early morning. 7 THE CHICAGO RECORD’S Lunches on ilie March At the end of the first half-hour of a march the command is usu- ally halted for ten minutes to permit the various regiments to close up and allow the men to readjust their packs and prepare for the real work of the day. After this there is a rest of five or ten minutes at the end of every hour (unless halts for other purposes render these un- necessary) to rest the men and permit any who have dropped out to regain their places in the column. X from any cause. The wearing of a flannel binder or abdominal belt is practiced in many hot Abdominal Belts 23 THE CHICAGO RECORD’S countries as a protection against intestinal troubles from surface chills. Typhoid Fever The camp fever that under ordinary condi- tions is most to be feared by new regiments is typhoid fever. This was the fever which, in the first year of our civil war, struck down about 80 and killed 20 out of every 1,000 men serving with the army. Young men of the military age are particularly susceptible to the disease. It is propagated mainly by excremental filth getting into the water supply. A sin- gle regiment in a camp by itself may be able to preserve the purity of its water supply, but when twenty or thirty thousand men are camped in the same locality it is difficult to prevent the drainage of one regiment or brigade from contaminating the water sup- plies of other parts of the command. The disease is propagated also by contact with soiled blankets and clothing. Dysentery and cholera are propagated in the same way. Cleanliness of the person, of the clothing, of the shelters and of the camp surface is es- sential to protection from these diseases. The exclusion of filth from the water supply is also essential, but on account of the diffi- culty of effecting this, the infection possibly present in a doubtful water should be de- stroyed by boiling the water. Infection can be removed also by filtering the water 24 HYGIENIC MANUAL through a special filter of porous earthen- ware, for which arrangements, as already stated, have been completed. No doubt typhoid fever, diarrhea and probably yellow fever are often communi- cated to soldiers in camp by the flies which swarm about fecal matter and filth of all kinds and convey infectious material to the food while it is bedng prepared or served. If for no other reason than to lessen the annoyance and danger from this pest of flies a strict sanitary police is important. When a case of these infectious diseases occurs the medical department becomes charged with the responsibility of preventing its spread. Infection Car- ried l»y Flies. In hot climates ma- larial fevers are more frequent in their oc- currence and more dangerous than in tem- perate or cold climates. During our civil war these fevers constituted one-fourth of all the cases of sickness, but the death rate caused by them was much lighter than that of diarrhea, dysentery or typhoid fever. Malarial Fevers Malaria is something which is generated in soils having enough of moisture and warmth to foster the growth °f vegetation. For practical sanitary pur- Malaria 25 THE CHICAGO RECORD’S poses it may be regarded as a something on which plants live and thrive. If there be not enough of vigorous plant life on the sur- face to use up all that is produced in the soil the excess will escape into the atmosphere to the detriment of the persons who breathe it. Thus, places are dangerous at night when vegetation is asleep that are not so in the daytime, when plant life is awake and active. In temperate climates fevers occur in the spring before vegetation has attained its vigor, and in the autumn when the annual vegetation is wilted and dying. Correspond- ingly in the tropics, fevers appear at the be- ginning of the rainy season, but are most prevalent at its end, when vegetation decays. Grounds where the vegetation has been in- jured by inundation become dangerous during the subsequent period of draining and drying up. Lands exposed to occasional salt water overflow are specially insalubrious, as the land plants are quickly injured by the salt water. Camps should not be pitched in the imme- d i a t e vicinity of marshes, bayous, lagoons, ponds or dams where the water rises and falls, nor on recently inundated grounds, bottom lands with rank vegetation or sands with little or no vegetation when the subsoil water is only a few feet below the surface. Should there Marshes 26 HYGIENIC MANUAL be a swamp or other unhealthy ground in the locality the camp should be pitched on its windward side or separated from it by a rising ground or a belt of trees or shrub3. Vegetation a Foe to Malaria Places that are healthy when the natural veg- etation is growing on their surface become unhealthy when this vegetation is destroyed by the breaking in of the ground for agri- cultural purposes, or when the soil is up- turned in the construction of engineering or other works. During our civil war the cut- ting down of trees for firewood or for the building of corduroy roads, breastworks, bombproofs, abatis, etc., was frequently fol- lowed by outbreaks of malarial fevers. Hence, in forming a military camp the natural vege- tation in its immediate vicinity should be in- terfered with as little as possible. Grass, leaves, branches and brushwood used as mat- tresses, awnings, hedges, etc., exhale no ma- laria in their gradual decay. It is the ground from which they were removed that becomes dangerous. Fatigue to Be Avoided in Malarious Dis- trict Malarial fevers attack by preference those who are already more or less broken down by fatigues, expo- sures or poor diet. Hence, in a malarious country not only should forced and night 27 THE CHICAGO RECORD’S marches be avoided, but also exhausting work or exercises during the day. In the early morning hot coffee should be issued im- mediately after roll call, and men mounting guard at night should be furnished with a lunch and coffee. Chill Chill to the surface from insufficient clothing should be avoided. At sundown the soldier should put on his blouse, for radiation from the body into the clear skies of warm climates takes place quickly. The body clothing and blan- kets should be thoroughly dry before turning in for the night. In unhealthy localities even bathing should be indulged in with caution, on account of the danger from chill. The bunks of the men should always be raised at least two feet from the ground, and in dangerous lo- calities the campfires should be kept bright at night. It ii ii Us It is advisable to carry a piece of mos- quito netting in the blanket roll, not only to protect the sleeper from flies and mosquitoes, but to filter the air, for there seems ground for the belief that malarious air thus filtered is to some extent deprived of its noxious qualities. Mostiuito Netting- 28 HYGIENIC MANUAL Boil the Water A belief in the prop- agation of malarial fevers by impure sur- face water is generally entertained. Boil- ing or filtering the water destroys its in- fection. Deep well waters are pure in this regard. ii ill i ue Quinine, arsenic and other medicines are sometimes used ad- vantageously to protect the system against malarial diseases when troops are exposed in particularly dangerous localities, but this should be left in the hands of the regimental medical officer. • Yellow Fever Much unnecessary alarm has been caused in this country by newspaper discussion of the danger to our troops from yellow fever in Cuba. Our peo- ple appear to have forgotten that the dis- cipline and sanitary administration of a mil- itary camp afford the very means for pre- venting the occurrence of the disease or stamping out the infection if it should be introduced. When the city of Memphis suf- fered so severely in 1879 those of the inhab- itants who moved into camp at a distance of a few miles were preserved, although the discipline of the camp was not so strict as it should have been. A system of medical 29 THE CHICAGO RECORD’S inspection and disinfection has kept the dis- ease out of the United States for many years hack. This same system can keep it out of our camps in Cuba. Outside of certain in- fected cities there is in Cuba no more dan- ger to our troops than in any of our south- ern seaports. While operating in Cuba every suspicious case of fever should be isolated by our medical officers and all precautions should be taken to prevent the spread of infection from a first case. Should a first case oc- cur, the troops ought to change camp, leav- ing the infection behind them. When, how- ever, the military necessity renders such a change impossible, a guard should be placed around the infected command to cut off all unauthorized communication, and quaran- tine restrictions should be imposed on the infected localities from which the first case was derived. No person should be received within the lines of the camp without under- going medical inspection, and no baggage or supplies without being disinfected or passed by the quarantine officer. Water sup- plies should be boiled or filtered, unless from deep wells, and all general police regula- tions should be scrupulously carried, out. With the exception of fruit protected by an outer rind, no food should be eaten that To Prevent Its Spread 30 HYGIENIC MANUAL has not been thoroughly cooked. There should be no unnecessary exposure to sun, rain or night air, no drills nor fatigue duties other than to furnish needful relaxation and exercise, and no active operations unless called for by the imperative military neces- sity. In fact, when the military conditions permit, a camp sur- rounded by infection should be regarded as engaged in a cam- paign against the disease, and the energies of every officer should be devoted to super- intending the conduct of his men with special reference to this view. Fig’ht It as an Enemy It is hardly neces- sary in these pages to say anything of the harmful effects of in- toxicating liquors, for every soldier knows something of this in a general way. He knows that when a man is intoxicated his brain is so befogged that he is unable to pro- tect himself from accidents and exposures. He knows that disability and death are often a consequence of intoxication in civil life and that serious results would be relatively more frequent among troops on a campaign because of their greater liability to accidents and exposures. He probably knows also that Intoxicating Liquors 31 HYGIENIC MANUAL for days after a so-called indulgence in liquor the system is more or less broken down and the individual less able to withstand fatigues, exposures or wounds that would have affected him but slightly when at his best. It may be well, however, for the young soldier to re- member that it is not a manly thing to get drunk. It does not prove him to be the very deuce of a fellow. It merely proves that however intelligent, bold and brave he may be, he has taken one step downward toward worthlessness. General officers sometimes promulgate regulations excluding whisky from camp. This is well, but it would be better if every soldier promulgated such a law on his own behalf and appointed himself provost-marshal to see to its fulfillment. Uncle Sam Distributed more copies of The Chicago Record through the mails during the year 1897 than of any other single daily newspaper in the United States. $6l,2l5.77 are the official government figures for the amount of postage paid by The Chicago Record for the trans- mission of papers through the mails in 1897. Comparison with the official government figures for the sums paid by other newspapers show that the mail circulation of The Chicago Record greatly exceeds that of any other news- paper in the United States. The total paid circulation of THE CHICAGO RECORD averages from 250,000 to 300,000 copies a day. War News That is really news is the sort you get in The Chicago Record—not the “yellow” dreams of sensational cor- respondents. The Chicago Record prints the news— —all the news, all the time—and tells the truth about it. Its reputation rests upon the solid rock of reliability. It is the only newspaper in the United States outside New York city that has its own ex- clusive dispatch boat serv- ice and its own staff cor- respondents and artists at the front in both hemi- spheres. Form 137 A.