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BIOLOGY
LIBRARY
XFORD PAMPHLETS
1914
Ibacilli and
BULLETS
BY
SIR WILLIAM OSLER
REGIUS PROFESSOR OF MEDICINE
One Penny net
OXFORD UNIVERSITY PRESS
HUMPHREY MILFORD
LONDON EDINBURGH GLASGOW
tW YORK TORONTO MELBOURNE BOMBAY
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OXFORD : HORACE HART
PRINTER TO THE UNIVERSITY
BACILLI AND BULLETS
AN ADDRESS TO THE OFFICERS AND MEN IN
THE CAMPS AT CHURN
I HAVE been asked to say a few words on the question
of health in war-time, that you may reahze its importance.
Formerly an army marched on its belly ; now it marches
on its brain. Only by utilizing existing knowledge, in
all grades from Commander-in-Chief to private, is the
maximum of success available. To put the largest
number of the enemy out of action with a minimum of
loss to his own men is the aim of every general. While
in one way modern war merges the individual in a great
machine, on the other hand the intelligent action of
the unit has never been so important a factor in making
the machine work smoothly and efficiently. After all,
it is the man behind the gun who wins the victory.
What I wish to urge is a true knowledge of your foes,
not simply of the bullets, but of the much more important
enemy, the bacilli. In the wars of the world they have
been as Saul and David — the one slaying thousands, the
other tens of thousands. I can never see a group of
recruits marching to the depot without mentally asking
what percentage of these fine fellows will die legitimate
and honourable deaths from wounds, what percentage
Avill perish miserably from neglect of ordinary sanitary
precautions ? It is bitter enough to lose thousands of
the best of our young men in a hideous war, but it adds
terribly to the tragedy to think that more than one -half
of the losses may be due to preventable disease. Typhus
2iicsbV7
4 .BAOJLLI AND BULLETS
feyer, malaria, cholera, enterjc, and dysentery have won
more victories than powder and shot. Some of the
diseases I mention need no longer be dreaded. Typhus
and malaria, which one hundred years ago routed a
great English army in the Walcheren expedition against
Antwerp, are no longer formidable foes. But enough
remain, as we found by sad experience in South Africa.
Of the 22,000 lives lost in that war — can you believe it ?
— ^the bullets accounted for only 8,000, the bacilli for
14,000 ! In the long arduous campaign before us more
men will go into the field than ever before in the history
of the Empire. Before it is too late, let us take every
possible precaution to guard against a repetition of such
disasters. I am here to warn you soldiers against
enemies more subtle, more dangerous, and more fatal
than the Germans, enemies against which no successful
battle can be fought without your intelligent co-opera-
tion. So far the world has only seen one great war
waged with the weapons of science against these foes.
Our allies the Japanese went into the Russian campaign
prepared as fully against bacilli as against bullets, with
the result that the percentage of deaths from disease
was the lowest that has ever been attained in a great
war. Which lesson shall we learn ? Which example
shall we follow, Japan, or South Africa with its sad
memories ?
We are not likely to have to fight three of the greatest
of former scourges, typhus, malaria, and cholera, though
the possibility of the last has to be considered. But
there remain dysentery, pneumonia, and enteric, against
two of which we should be able to bring to bear success-
fully resources of modern science.
Dysentery, an inflammation of the large bowel, has
been for centuries one of the most terrible of camp
r
BACII.LI AND BULLETS
diseases, killing thousands, and, in its prolonged damage
to health, one of the most fatal of foes to armies. So
far as we know, it is conveyed by water, and only by
carrying out strictly, under all circumstances, the
directions about boiling water can it be prevented. It
is a disease which, even under the best of circumstances,
cannot always be prevented ; but with care the incidence
should be reduced to a minimum, and there should never
again be widespread outbreaks in the camps themselves.
Pneumonia is a much more difficult disease to prevent.
Many of us, unfortunately, carry the germ with us. In
these bright days all goes well in a holiday camp like this ;
but when the cold and the rain come, and the long
marches, the resisting forces of the body are lowered,
the enemy, always on the watch, overpowers the guards,
rushes the defences, and attacks the lungs. Be careful
not to neglect coughs and colds. A man in good con-
dition should be able to withstand the wettings and
exposures that lower the system, but in a winter cam-
paign pneumonia causes a large amount of sickness and
is one of the serious enemies of the soldier.
Above all others one disease has proved most fatal in
modern warfare — enteric, or typhoid fever. Over and
over again it has killed thousands before they ever
reached the fighting line. The United States troops
had a terrible experience in the Spanish- American War.
In six months, between June and November, inclusive,
among 107,973 officers and men in 92 volunteer regiments,
20,738, practically one-fifth of the entire number, had
typhoid fever, and 1,580 died. Fortunately, in this
country tjrphoid fever is not prevalent in the districts
in which camps are placed. The danger is chiefly from
persons who have already had the disease and who carry
the germs in their intestines, harmless messmates in
6 BACILLI AND BULLETS
them, but capable of infecting barracks or camps. You
can easily understand how flies lighting on the discharges
of such typhoid carriers could convey the germs far and
wide. It was in this way probably, and by dust, that
the bacilli were so fatal in South Africa. Take to heart
these figures : there were 57,684 cases of typhoid fever,
of which 19,454 were invalided, and 8,022 died. More
died from the bacilli of this disease than from the bullets
of the Boers. Do let this terrible record impress upon
you the importance of carrying out with religious care
the sanitary regulations.
One great advance in connexion with typhoid fever
has been made of late years, and of this I am come
specially to ask you to take advantage. An attack of
an infectious disease so alters the body that it is no longer
susceptible to another attack of the same disease ; once
a person has had scarlet fever, small -pox, or chicken-pox,
he is not likely to have a second attack. He is immune,
or has what is called immunity. When you expose a solu-
tion of sugar to the air, or if you add to it a pinch of yeast,
a process goes on which we call fermentation, accom-
panied by a growth of little germs of the yeast in the fluid,
and by an increase in temperature (in fact the solution
has a fever), and the composition of the fluid alters, so
much so that you can inoculate it afterwards again and
again with the same germ, but no further change takes
place. Now this is what happens to us when bacilli
make a successful entry into our bodies. They over-
come the forces that naturally protect the system, and
grow just as the yeast does in the sugar solution ; but
the body puts up a strong fight, all sorts of anti-bodies
are formed in the blood, and if recovery takes place,
the patient afterwards has immunity, for a time at least,
from subsequent attacks. The body has mobilized its
BACILLI AND EULLEt^^ ^ : ,f^ f>,; . /:n
forces, and is safe for a* few years at least against that
disease. It was an Englishman, Jenner, in 1798, who
found that it was possible to confer this immunity by
giving a person a mild attack of a disease, or of one very
like it. Against small-pox all of you have been vacci-
nated— a harmless, safe, and effective measure. Let me
give you a war illustration. General Wood of the United
States Army told me that, when he was at Santiago,
reports came that in villages not far distant small-pox
was raging and the people without help of any kind.
He called for volunteers, all men who showed scars of
satisfactory vaccination. Groups of these soldiers went
into the villages, took care of the small-pox patients,
cleaned up the houses, stayed there until the epidemic
was over, and not one of them took the disease. Had
not those men been vaccinated, at least 99 per cent, of
them would have taken small-pox. Now what I wish
to ask you is to take advantage of the knowledge that
the human body can be protected by vaccination against
typhoid fever. Discovered through the researches of
Sir Almroth Wright, this measure has been introduced
successfully into our own regular army, into the armies
of France, the United States, Japan, and Germany.
I told 3^ou a few minutes ago about the appalling inci-
dence of typhoid fever in the volunteer troops in America
during the Spanish- American War. That resulted
largely from the" wide prevalence of the disease in
country districts, so that the camps became infected ;
and we did not then know the importance of the fly as
a carrier, and other points of great moment. But in the
regular army in the United States, in which inoculation
has been practised now for several years, the number
of cases has fallen from 3-53 per thousand men to
practically nil. In a strength of 90,646 there were in
^'""'"^ 1913 only three cases of typhoid fever. In France the
enteric rate among the un vaccinated was 168-44 per
thousand, and among the vaccinated -18 per thousand.
In India, where the disease has been very prevalent, the
success of the measure has been remarkable. In the
United States, and in France, and in some other countries
this vaccination against the disease is compulsory. It
is not a serious procedure ; you may feel badly for
twenty-four hours, and the site of inoculation will be
tender, but I hope I have said enough to convince you
that, in the interests of the cause, you should gladly
put up with this temporary inconvenience. If the
lessons of past experience count, any expeditionary
force on the Continent has much more to fear from the
bacillus of typhoid fever than from bullets and bayonet...
Think again of South^Africa with its 57,000 cases of
typhoid fever ! With a million of men in the field, their
efficiency will be increased one -third if we can prevent
enteric. It can be prevented, it must be prevented ; but
meanwhile the decision is in your hands, and I know ic
will be in favour of your King and Country.
S^l^^^i^nmmEs
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