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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 


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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 


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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. 


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