Popular Science Monthly/Volume 48/December 1895/Health Experiments in the French Army
By STODDARD DEWEY.
THE report made to the French Parliament in April of this year by General Zurlinden, Minister of War, discloses a new aspect of that life in barracks to which the armed peace of Europe condemns all her young men for a period of their best years. It is nothing less than an experimenting on a giant scale with the health and resistance to epidemic disease of French youth under military regimen.
The first and most fatal enemy has always been typhoid fever.
In 1887 the annual number of cases reached eight thousand, with a death-rate of about eight hundred, for much less than five hundred thousand men. This gave an average of deaths from this single disease very nearly equivalent to two out of every thousand men, while the total mortality of the army was only 8·43 per thousand. In the mortality of French civil life, which remains at eleven per thousand, the destructiveness of typhoid fever is still greater, at least in a large number of towns and cities.
Doctors have long known the cause of the prevalence of this disease; but it is not easy to persuade the ordinary citizen of the necessity of precaution in the use of so common a thing as water. Jules Simon tells a story, good by way of illustration, of the alarming typhoid epidemic in Paris a few years ago. Both doctors and Government had warned the people that the germs of the disease were contained in the water of the Seine, and that only filtered and boiled water could be used safely. One day a cafe waiter was discovered replenishing the drinking decanter of his customers from the common spigot giving forth the river water in its unadulterated impurity. When reproached with his deed, he answered indignantly:
"My father and my grandfather drank this water, and they lived to be old men. I have no time to bother with doctors notions."
During the last month of March there was a sudden outburst of a strange and fatal disease among the old men in the city poorhouse at Nanterre. It was accompanied by tetanoid symptoms (lockjaw), and was attributed by the physician in charge to the ergot of which he discovered traces in the very bad rye bread furnished to the inmates. The director, when asked about the reason assigned, is reported to have answered comfortably, "Doctors' humbug!"
It is the good luck of the army that an intelligent service of hygiene can be enforced whenever the authorities wish. The will began with M. de Freycinet, who was Minister of War through so many changing administrations. He set about substituting spring water or filtered water in place of the water from wells or rivers, which had previously been used by garrisons. By 1890, in comparison with 1887, the number of typhoid cases had diminished in the proportion of thirty-six per cent. By 1891 the decrease was forty-nine per cent. In the single military jurisdiction of Paris it reached seventy-five per cent. This astonishing and satisfactory change followed immediately upon the change of the water supply.
The record of the last three years only confirms this brilliant demonstration of the real work which can be accomplished by rational hygiene. There were five hundred and forty fewer cases of typhoid fever in the army posts in 1894 than in 1891, though the percentage of deaths to cases was slightly higher. But the most striking facts are found in the statistics of particular places like Paris, which has always had the reputation of being a center of this special disease.
Among the soldiers under the military government of the city there were eight hundred and twenty-four typhoid cases in 1888. The following year the number increased to eleven hundred and seventy-nine. At that time the water of the Vanne was substituted for the contaminated Seine water. The cases of the next four years numbered, respectively, only two hundred and ninety-nine, two hundred and seventy-six, two hundred and ninety-three, and two hundred and fifty-eight. Last year the Vanne itself became contaminated through an accident, the history of which has been traced conclusively. The result was an increase of typhoid cases in the Paris garrison to four hundred and thirty-six, of which three hundred and ten occurred in the three months of February, March, and April. During January and February of the present year (1895) there were only eight cases in all.
The fact that typhoid fever comes and goes with impure drinking water could hardly receive a more striking demonstration. Yet the possibility has been realized in the experience of Melun, a garrison town of about twelve thousand inhabitants, situated on the Seine, twenty-eight miles above Paris. Here, in 1889, there were one hundred and twenty-two cases of typhoid fever among the soldiers. The Chamberland filters (Pasteur system) were then introduced, and the cases of the following years numbered, respectively, fifteen, six, two, seven, and seven again for 1894. Suddenly, during the severe weather of February of this year, twenty-eight dragoons, one after the other, came down with the fever. The infantry battalion, living in the same barracks, had not a single case. The secret was soon out. The filters had been allowed to freeze and the soldiers were ordered to drink only the weak infusion of tea furnished them, in which, of course, the water was boiled. The dragoons had simply not obeyed, but had helped themselves to the Seine water from the hydrants.
At Lorient, as in other districts of the coast of Brittany, typhoid fever has long been endemic and still remains so among the civil population. In the garrison, until 1889, there was an average number of one hundred and seventy cases yearly. In 1890 filters were set up, with the result of a decrease in the cases to fifty-eight for that year, while the three following years numbered only two, one, and one, respectively. In 1894 water was brought into the barracks from a spring supposed to be pure. In a short time eleven cases of typhoid fever declared themselves. On examination it was discovered that the spring was contaminated, and the garrison ceased using it for a water supply. The disease has now all but disappeared again.
Similar facts in connection with typhoid fever have been verified in more than twenty widely separated garrison towns. Of the cases which still appear where filtered water is used, the cause has invariably been found, when investigation was possible, to be some accidental use of contaminated water. Thus at Nantes, in Brittany, endemic typhoid fever was reduced by the use of filters to isolated cases. In 1893 there were seventeen, and in 1894 there were thirty cases needing explanation. It was soon remarked that nearly all were among orderlies, who have the habit of taking their meals in certain restaurants of the town. In each of these places it was discovered that the water used was polluted by infiltrations from privies. In four other garrison, towns the same fact was reported.
A final instance, which is also one of the most remarkable, is that of Auxerre. Here one hundred and twenty-nine soldiers were down with typhoid fever in 1892. Filters were set up, and there was one single case in each of the two following years.
Only one objection has been urged against this triumph of the theory that pure water is a preservative against typhoid fever. It is probably more apparent than real. It concerns the attendants on the sick in the military hospitals. These men can hardly be exposed to the danger of drinking contaminated water, and yet many of their number fall victims to each typhoid epidemic. In their case the disease seems to have a real contagion. But it should be remembered that the permanence of their service with the sick undermines their strength until the system no longer resists the action of the morbid germs, to which, moreover, they are exposed in a thousand ways. Their case is no exception to the rule that, under ordinary conditions of life, typhoid fever is propagated only by impure drinking water.
With dysentery—that other enemy of the soldier, both in garrison and during campaign—French military hygiene has not proved itself so successful. Until 1892 there was even a steady increase of cases, though not of deaths. Since that time there has been a diminution of cases and, in a measure, of deaths. So far, the only amelioration seems to result from a constant supervision of the daily disinfecting of privies, and from a provision of conveniences which spare the soldier the necessity of suddenly exposing himself to the chill of night in crossing an open yard.
With cholera, on the other hand, the most encouraging progress has been made. The epidemic of 1893 cruelly tried the civil population of Lorient. The garrison had but a single case. This was a soldier who contracted the disease in Vannes, where he had been in attendance on his mother, who died of it. The same experience was repeated at Brest, where the civil population suffered for months together. In the garrison only two cases declared themselves from first to last. In Marseilles, out of nineteen cases there were only three deaths.
For measles and scarlatina the French army has found neither remedy nor preventive. These diseases come to the barracks from the civil population, among which they exist permanently. Both have gone on increasing in the garrisons since 1887—measles with spasmodic intermittences, scarlatina steadily.
The most disquieting progress has been made by that strange malady—la grippe. This alone, from the first months of the present year, will give a high rate of mortality to 1895 among the military as well as the civil population. Only one conclusion can. so far be drawn from the experience of the army. This is the simple fact that the disease is a permanent danger which military physicians have henceforth to foresee as they do cholera, cerebrospinal meningitis, and diphtheria.
The latter disease, formerly so rare among adults, has also made alarming progress since 1888 among soldiers. It is now hoped that the antitoxine (serum) of Dr. Roux will be as successful in dealing with the dangerous microbe in garrisons as it has been in children's hospitals.
Vaccination continues to give satisfactory results against smallpox. Certain attendant dangers, which are often alleged against it, are avoided by the establishment of what are called centres vaccinogènes, where military physicians supervise the preparation of suitable vaccine. This, in the form of a glycerinated pulp, has been distributed to the Madagascar expedition in quantities sufficient for the revaccination of all the men during the voyage out, and of all the porters and coolies that may be needed after the arrival on the island.
In typhus, the lesson of the barracks confirms what has long been thought to be the only safeguard against its spread. This is the total isolation of cases. The disease, which is so peculiarly contagious, seemed to have abandoned France (excepting certain remote parts of Brittany) after the wars of the first Napoleon. Two years ago it broke out among tramps in the workhouse of Amiens, and soon appeared in Paris. It afterward spread among 'the same class of the population, in and out of prison, through different parts of the country. In the following year, 1894, it broke out again, to the despair of the medical profession. It seemed to have come back to stay, though the present prospect is more favorable. During both these years there were only six cases in the army. Of these, two occurred among military infirmarians who had volunteered their services for the civil hospitals, and one was that of a gendarme whose duties brought him in close contact with tramps already attacked by the disease.
Certain lessons of hygiene, which have been learned from harsh experience by the army, are not yet appreciated by the general public. One of these is the necessity of keeping in hospitals those who are undoubtedly convalescent from epidemic or contagious diseases. This is sorely against the will of families, and often of the patients themselves, who demand permission to complete the cure at home. Formerly, when this was granted, a frequent consequence was a relapse, and, oftener still, a communication of the disease to a new circle of the population. This has been especially observed of typhoid and eruptive fevers, dysentery, and the grippe.
The French army also profits by all the recent discoveries in destroying the germs of disease. Disinfecting apparatus has been indulged in to such an extent that the health service is ready even for an unusual epidemic. What the French oddly call "coaltarisation" is applied constantly to the woodwork of barracks. Methods of permanent ventilation have also been adopted. Each garrison is now being provided with a suitable hospital, and the separate barracks have infirmaries well fitted up.
The final result of all this solicitude for the health of the soldiers, who are the choice youth of the entire nation, is twofold:
First, the steady lowering of the mortality among them is of itself an increase of strength to the army and the country. Thus, during the last five years, on the score of typhoid fever alone, hygiene has saved to France the lives of twelve hundred and sixty-five soldiers. In the seven years from 1880 to 1886 the annual death-rate was 8·43 per thousand. In the seven following years it sank to 6·63, and in 1894 to 6·20 per thousand. Meanwhile, the mortality among people who have not the advantage of living under enforced hygiene remains at eleven per thousand.
Secondly, the compulsory military service, with all its disadvantages, gives the younger generation a strong training in practical hygiene. All able-bodied Frenchmen now learn, during a term of years, the practice of bodily cleanliness and what constitutes the health of habitation. These acquired habits they bring back to civil life.