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®Rtgtnal (Tomllluntcattons. Protected by Copyright J R Army Med Corps: first published as 10.1136/jramc-64-01-01 on 1 January 1935. Downloaded from VOL. LXIV. .. JANUARY;' ,1935., - ,,,:.: No. 1. Authors are. alone responsible for the 8ta:te~ents made and the opinions' expressed in their' papers. ~~tlurnal---' of t~, ®rtgtnal (tOmllluntcattons. Protected by copyright. SOME MILESTONES OF ACHIEVEMENT IN AR1\i&z~~:RYGIENE AND A FEW SUGGESTIONS FOR FU RTHERJ;>RQGRESS.l '. .-.~, By MAJOR-GENERAL P. H. HENDERSON, C ..1?':"';.D.S.O., i~;H;P~ ,: . I REGARD the charter of the Army Hygiene specialist to be ~h~c(;n.li!e'):'Vation of the man-power of the Army through the maintenance and promotion o(Be'alth and the prevention of disease. The charter, therefore, embraces everythi~g ~hich affects the health and well-being of the soldier and also of his family, for, if the married eoldier has not got a well-housed, well-fed, happy and healthy family, his morale http://militaryhealth.bmj.com/ and health, and with them his work, will suffer. I propose to confine myself chiefly to those'milestones in hygiene which affect the soldier's environment and life in barracks and, to a less extent, in the field. The marked success of certain other measures in preventive medicine, such as -i.noculation, have received more public notice in the past, although the ~ubjects with which I will deal are of equal importance, but, because they are constantly before us, __ any progress in regard to them is apt to be taken Jor granted. I should like to say that such pr()gress as has been made in regard to Army Hygiene is very largely due to the initiative of hygiene officers and to the close co-operation maintained between the Hygiene Directorate. (which embraces the on October 2, 2021 by guest. hygiene specialists in Commands, Districts· and Educational establishments) and other branches of the Army, and more particularly with those branches concerned with Engineer Services, and the feeding and housing of the troops, 1 Reprinted from the Proceeding8 oj the Royal Society of Medicine, vol. xxviii, p: 1 (United Services Section, p. 1), by permission of the Honorary Editors. 1 J R Army Med Corps: first published as 10.1136/jramc-64-01-01 on 1 January 1935. Downloaded from 2 Some Milestones oj Achievement ~n Army Hygiene MILESTONES (1) Education.-Since I joined the Army some thirty-five years ago, education in regard to matters of hygiene and sanitation has improved in a very marked degree. Most of this improvement has taken place \lince the World War, largely as the result of the formation of the Hygiene Directorate which was created under Army Council Instruction No. 545 of September 16, 1919, and the valuable support this Directorate receives from the Army Hygiene Advisory Committee. Since the formation of this Directorate, not only has the teaching of hygiene and sanitation at the R.A.M. Oollege and Army School of Hygiene been re-organized on up-to-date and thoroughly practical lines, but Oommands and Districts are now supervised by fully qualified specialist officers, and £200 is at the disposal of the Director of Hygiene annually for purposes of research-some of the valuable fruits of this research will be referred to later. Under the duties for which the R.A.M.C. is maintained, first place is given in the R.A. M.O. "Training Manual" to" maintenance of health and prevention of disease," and prevention of disease is also given priority in the general duties of the Medical Services in the Army Regulations. That is as it ought to be, and it is pleasing to note that in civilian life there is a strong movement afoot to follow our good example Protected by copyright. in this direction, and thus bring the practice of medicine throughout the country into its true perspective. The education of officers and other ranks of the Medical Services of the Army in hygiene and sanitation is carried out at the R.A.M. Oollege and Army School of Hygiene, and that of officers and other ranks of other arms at the Army School of Hygiene.' The education of the combatant branches is also carried .out in all stations by means of lectures delivered during the individual training season, and­ perhaps most important of all-by 'practical demonstrations during inspections of barracks and camps by properly trained hygiene specialists. What is the result of all this? It, is that the majority of combatant officers, who, when I' first joined the Service, took little interest in matters affecting the health and well-being of their men, now take a genuine and live interest in all these problems with gratifying http://militaryhealth.bmj.com/ results. In testimony of this it was claimed a short time ago by that eminent biographer, Sir George Arthur, that the recent improvements in the soldier's environment, particularly in regard to messing and accommodation, were due solely to the personal efforts and initiative of the present-day commanding officers of units. Now, while a scrutiny of the official files would probably reveal the fact th~t these 'improvements originated in recommendations made by hygiene officers, it is a great satisfaction to know that the new interest taken in such important matters by combatant officers should induce this well-known writer to make such a claim, and it is certain that, because of the greatly increased knowledge of hygiene possessed on October 2, 2021 by guest. by staff and other officers, ib is essential, if medical officers are to continue to be in a position to give advice on this subject to these officers, that they should keep themselves thoroughly up to date. (2) The housing of the troops.-Up to the middle of the nineteenth century the housing of the soldier was deplorably neglected, and inquiries instituted just before and after the Orimean War showed that the high mortality from pulmonary diseases J R Army Med Corps: first published as 10.1136/jramc-64-01-01 on 1 January 1935. Downloaded from P_ H_ Henderson 3 prevailing at that time was due to the overcrowding of men in insanitary barrack­ rooms. To give but two examples: in England in 1820 the beds were arranged in double tiers, and in Jamaica the men slept in hammocks touching each other. It was not until 1851 that a definite cubic space of 450 cubic feet per man in barrack rooms at home was fixed. In 1855 Lord Monck's committee investigated the conditions then prevailing, and it is interesting to note that the motive of tbat committee was identical with ours to-day, namely, a desire not only to raise the standard of health and well-being of the soldier, but also to improve the tone in the barrack room, and thus produce better fighting material. The chief recommendations of that and later committees were to increase the cubic and superficial areas allotted to each soldier, al?d the construction of separate married quarters, although they also made other suggestions for improving the environment of the solUier which were not acted upon until much later. In 1857 a Royal Commission was assembled under Sidney Herbert, and this Commission found that the death-rate among soldiers in peace time was twice as high as among the civilian populations of the same ages, the Army death-rate being then recorded as 17-5 per 1,000. In 1933 the death-rate for the Home Army was 1-87 per 1,000 and that for the whole Army at home and abroad 2-15 per 1,000, Protected by copyright. while the civil death-rate for England and Wales during the same year was 12-3 per 1,000. As the result of the Royal Commission's recommendations in 1857, the space per man was raised to 600 cubic feet at home and 800 cubic feet abroad. A survey of the barracks in the United Kingdom at the time showed that, based on this allowance, they fell short of the necessary accommodation by about one-third. The important factors of floor space and the space between beds were not definitely laid down until a much later date. Although not regarded so at the time, a most important recommendation of the Royal Commission was the utilization of medical assistance in the selection of sites for barracks and in other matters affecting the soldier's environment. The Barrack and Hospital Improvement Commission was next formed to http://militaryhealth.bmj.com/ consider in detail the recommendations of the Royal Commission and in 1862 was constituted a Standing Committee. In 1865 their title was changed to that of "The Army Sanitary Committee," which remains a very active body to-day under the title of " The Army Hygiene Advisory Committee," presided over by the Director of Hygiene. The duties of this Committee in regard to barracks are as originally laid down: viz. (1) To report on new sites and on block plans of new barracks-making whatever inspections may be necessary; (2) to report on all type plans, especially with reference to sanitary details; (3) to report on all new principles of construction or fitments from the hygienic aspect. The recommendations of this Committee in regard to housing are later dealt with by the Barrack Synopsis Committee on which on October 2, 2021 by guest. the Directorate of Hygiene has a representative. When we reflect on the conditions under which the soldier was housed in the past, of which I have given you but a brief summary, and when we inspect some of the barracks and huts still iil existence which were erected at the time of the Crimean War or a little later, we can congratulate ourselves that, as a result of close cooperation between the Hygiene Directorate and the Engineer Services, we have definitely reached a milestone of achievement in the latest barrack design.
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