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Typhoid and the Army

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Typhoid and the Army is an article published in The Times on 13 november 1901.

Report of speech at the Royal United Service Institution on 12 november 1901 where Arthur Conan Doyle made a speech about sanitary questions in South Africa.

Typhoid and the Army

The Times (13 november 1900, p. 10)

Before the Royal United Service Institution, yesterday, Dr. Leigh Canney read a paper entitled "Typhoid, the Destroyer of Armies, and its Abolition." The attendance was good, and the meeting was presided over by Sir William Broadbent.

Dr. LEIGH CANNEY, in the course of his paper, said the great destroyers of armies in war and in peace were the diseases typhoid, dysentery, and cholera. They were mainly water-borne, and all were alike excluded by the measures he proposed. Although there was some difference of opinion as to the relative efficiency of air and water to spread typhoid, the great body of medical opinion was in favour of the view that the main channel was water. There was evidence to show that if all the water avenues of typhoid to an army or camp were closed the other avenues would cease to be effective. This was proved to be the case in the vast civil camps of European and native workmen at Assuan, and in other instances, such as in the prisons at Pietermaritzburg, Lucknow, and lately at Ahmenagar; whereas the soldiers and civil population, having access to unapproved water, suffered severely. These three water-borne diseases, if allowed their natural incidence, as had largely been the case in the present and all recent wars on any large scale, seriously and often disastrously affected the efficiency of an army. The paralysis of an army produced by water-borne disease was often so complete that the army failed to accomplish the work set before it. During the Civil War in England neither of the opposing forces moved for many months on this acconnt, though encamped in adjoining counties. From this cause in recent times the first army went to the Crimea was practically wiped out by a death-rate exceeding that of the Great Plague, and led "ultimately to the enforced abandonment of part of the enterprise the army was designed to accomplish." Still later, the Russians in Western Asia had to abandon their projected policy by the paralysis of their mobilized army, produced by enteric fever. In Madagascar the slightest serious resistance would have practically annihilated the whole French army, paralysed and decimated as it was from this cause. In connexion with the present war, he drew attention to two instances in which the incidence of enteric fever led, in the one case, to grave disaster and delay, and, in the other case, to the very verge of one of the greatest disasters that the reputation of the Army could have been called upon to receive. He referred, in the former case, to Paardeberg and Bloemfontein, and, in the latter case, to Ladysmith. In the case of the Bloemfontein epidemic, no one could deny that the delays involved in transporting all the food, hospitals and equipment required by a division of bed with typhoid or other water-borne disease and that by their staff of attendants must have had a disastrous effect in delaying many days the subsequent advance and the delivery of effective blows. The view taken by the House of Commons on this question was expressed by Mr. Balfour in the statement "that the whole question is one of transport, avowedly one of transport." If this were true, then it would be seen that there was no escape from the adoption of the scheme he proposed. The scheme started on the assumption that all water in was to be regarded as contaminated. He had adopted the method by boiling or heat sterilization. This was the most practicable, least liable to errors in method, and required less expert skill than filtration or chemical processes. The apparatus consisted of a cylindrical copper boiler with large heating surface below, arranged in wedge-shaped pockets which could be easily cleaned. It held 50 pints (6 1/2 gallons) of water. An iron stand was provided, under which a petroleum lamp was placed, with rapid and complete combustion under air pressure. The whole weighted 38 1/2 lb., and measured 33 in. in height by 17 in. in diameter. In cases of urgency the men of the water section would only raise the water to 180 deg. Fahr. This would be reached in nine minutes, and cooled sufficiently to drink as soup or meat-extract in two minutes. The fuel used was petroleum , and must be as constantly at hand as ammunition. Further to ensure continuity of action, the transport of this water section must be made very independent of the general transport, and must march with the regiment or unit. To ensure the system working, a system which asumed that no water would be drunk in war from the day of embarcation to the day of return which was not "approved" by the water section, it was evident that much attention to detail was necessary, and that success depended on insisting that there should be no man in the Army who was not directly interested in the scheme was a sound one and could be relied on. All officers must be trained and examined in the elements of sanitary science, as it concerned the management of camps, disposal of excreta, technique in force for providing "approved" water, selection of camp sites, &c. Whilst all officers of the R.A.M.C. were to be, as at present, trained in military hygiene, that they might be able to advise combatant officers and instructions to the greatest advantage, a special number of R.A.M.C. officers, who had either distinguished themselves in this branch in the Army or had been passed into the Army on this account, must be reparded as saniatry officers, in the proportion, perhaps, of one to a division. The men of the water section should be specifically recruited for intelligence and trustworthiness in the proportion of 2 per cent. of strength. Every effort must be made, by offering disctnction or reward to officers or men of either Navy or Army, or to civilians, to obtain suggestions as to any suitable modificationof the methods at any time in force, which should render the work of this corps more simple, rapid, or effective. The advantages of this scheme were:— (1) Total immunity from water-borne disease, which amounts to four-fifths of the mortality and invaliding of armies; (2) absence of discomfort and inefficiency on the march from minor illness; (3) diminished thirst and discomfort by accessible tea, meat-extract, soup, &c., several times a day, in place of foul water, a biscuit, and late transport; (4) enormous reduction of transport; (5) great increase in effective strength; (6) liberation of the R.A.M.C. officers and men for care of the wounded, by emptying the typhoid and dysentery hospitals; (7) acceleration of the war and saving of enormous expense; (8) the placing of responsibility in the proper quarter for the future, making such subterfuges as "Hospital Commissions" or inquiries an impossibility. The essentials in the scheme were:— (1) A trained water section of 2 per cent. of the strength; (2) the training and education of all officers in sanitary methods; (3) the education and training of the men in the advantages to themselves and their comrades; (4) the appointment of expert sanitary officers; (5) the responsibility of all non-medical officers for the executive sanitary work of camps or units; (6) responsability of the same officers for the incidence of water-borne disease — enteric, dysentery, and cholera — in their units; (7) the transport of this water section to be sacred, used for no other purpose whatever largely independent of all other transport; the transport of reserved fuel, &c., to take precedence, if required, of everything except one day's ammunition; (8) the establishment of a tradition that it is dishonourable and a crime to use any water for drinking purposes not "approved" or allowed.

The CHAIRMAN said all were agreed that typhoid fever was the great scourge of armies, especially on active service, and they had almost confessed their impotence to deal with this fatal disease. Dr. Canney's scheme was at any rate well thought out, but whether it was practicable he was not in any wise in a position to speak. They must look to the Royal Army Medical Corps and the men engaged in the administration of military work for their opinion. The most important part of the scheme, to his mind, was the education in peace times of officcers and man in the importance of drinking pure water only, and enlisting their sympathy, so that they might be trusted in the field to carry out the instructions necessary for the safety of themselves and their comrades.

MAJOR FIRTH, professor of military hygiene at Netley, expressed his cordial sympathy with the scheme as a whole, and thought that with further consideration something might be made of it. There would be no difficulty in getting a sufficient number of capable officers in the R.A.M.C., but hitherto there had been a certain lack of sympathy for this class of work in high places. If the suggested water section ever came into existence, he hoped the men of that section would be taught not only the sterilizing of approved water by boiling, but by every means known to science. The success of the scheme depended on the whole-hearted sympathy and co-operation of every officer, otherwise it would break down. In the hands of a sympathetic War Minister a great deal could be done to evolve in war a sound sanitary service.

MAJOR-GENERAL LORD DUNDONALD said his experience in South Africa led him to the belief that it was impossible to make water safe for drinking purposes by filtration only. It could only be done, in his opinion, by boiling, sterilizing it by heating. With that object in view on his return to this country he devised a means of carrying water in vessels which could be used for boiling purposes. What he devised, no doubt, was not perfect, but since then he had had it perfected. When the war broke out in South Africa the arrangements for the water were, of course, in accordance with the Regulations, but every mind must feel that they were not in accordance with the period of 1900, and if those in power would attend to the advice of men like Dr. Canney thousands of lives would be saved in future wars. The rations of the men were another very important matter. A long continuance of bully beef and biscuit rendered men susceptible to the easy assimiliation of the germs of disease (Hear, hear.) He had noticed that officers who drank the same water as the men were not so liable, because their food was more varied. In his opinion no site of a standing camp covered by bell tents could remain for any length of time in a sanitary condition. If it was found necessary to form a standing camp, either for refugees or soldiers they should asphalt the floor space all over the portion of the camp that was not enclose by wire fencing, so that the asphalted portion might be cleaned out periodically. He did not think it was possible to over-estimate the importance of instructing every officer in the Army in sanitary work and in the maintenance of camps in a cleanly state. They could not expect the company officer and the colonel of a regiment alone to take an interst in this matter. It must be forced upon them from above. (Hear, hear.) If those in positions of responsibility would only take a proper and thorough interest in sanitary matters they would see the juniorofficers and men soon following suit. (Cheers.)

Dr. WASHBOURNE, C.M.G., showed how flies and dust only spread typhoid under certain circumstances, which would be largely controlled by Dr. Leigh Canney's methods. WAter was the main agent by which enteric fever was spread. They had to provide a pure water supply, and to see that sewage excreta were properly disposed of. For that purpose there ought to be a sanitary corps to see not only to the water but also that all other sanitary camps and that corps should be a branch of the R..M.C. In that way a great deal could be done, and at little trouble and expense, to prevent this terrible scourge.

Dr. RIDEAT advocated the use of a chemical bisulphate of soda, which required 15 minutes to do its work.

Dr. A. CONAN DOYLE, as one who had witnessed the horrifying results of the neglect of the most ordinary precautions among the soldiers in South Africa, without the slightest remonstrance from anybody, said he had listened with the greatest interest to the paper, because it seemed a practical and bold method of combating a fell evil. He hoped the paper and discussion would be brought to the notice of the authorities. If it was not stretching red tape too far, why should not Dr. Leigh Canney be sent straight out now to South Africa with his apparatus? (Cheers.) Let him be attached to one single column and see whether the results would turn out better than in any other column. And why should not sent out too, and let them compare the results one with the other? (Cheers.) This was not a time for academic discussion. the house was on fire and it was time they were taking some practical step to put it out. His only fear was that when they got the thirsty private soldier into such a state of discipline that he would look on water without drinking it the whole human race would have been educated past all knowing. The private soldier took a perverse delight in doing what he should not the moment the eye of his superior officer was turned away. He did not quite see how the young regimental officer, with sporting proclivities, could always be on the spot, but allowing that our soldiers could only rise to such heights, the scheme was a most admirable one.

BRIGADE SURGEON LIEUT.-COL. MYERS wished to known what was to be done with a body of water-bearers, half a mile in front of the army and 1 1/2 mile behind the scouts, if the enemy suddenly came upon them? Men parched with thirst would drink anything. In the Suakin campaign he had seen men drinking water in which their own dead comrades were rotting. To abstain from water was a matter of education. He could go a whole day in the hottest part of Africa without drinking.

MAJOR H. A. CUMMINS, R.A.M.C., pointed out that in Ashanti water had been boiled and cooled for the soldiers. He also alluded to the difficulties of obtaining fuel oftentimes in connexion with Lord Roberts's advance, and of dealing with the men in the advance trenches and the pickets on the hills?

CAPTAIN DANCE, R.E., chief surveyor, metropolitan fever hospitals, suggested that the pioneers of the ordinary Line battalion should be specially trained in the first principles of sanitation. He also stated that the medical and other officers of the Metropolitan Asylums Board, the greatest central authority in the metropolitan area, had arrived at the conclusion, from their large experience, that boiling was the best deterrent against enteric.

After a prolonged discussion, Dr. LEIGH CANNEY replied.

COLONEL LONSDALE HALE, who had taken the chair meantime, Sir W. Broadbent having been obliged to go away, then summed up. He rather regretted that there was not a stronger element of opposition present, the general tone of the discussion being in support or Dr. Leigh Canney's views. Living near a military centre he had spoken to officers returned from the front on this subject of boiling water for thirsty men with their tongues hanging out, and the reply he got was, "D——d rot." Officers and men had not taken proper precautions to guard against typhoid, and therefore the public were beginning to think that these terrible casualties from enteric could not be prevented, whereas he maintained that in many cases they should really be classed under "regrettable incidents."

This concluded the discussion.