|OFFICE OF MEDICAL HISTORY AMEDD REGIMENT AMEDD MUSEUM|
HISTORY OF THE OFFICE OF MEDICAL HISTORY
Colonel Robert L. Callison, MC
In the Army, personal hygiene is defined as the measures each individual must employ to keep in good physical condition and the precautions he must take to protect himself from disease. As such, it includes not only cleanliness of the body, but also proper use of insect repellents, avoidance of unauthorized water and food, and any other measure that the soldier is directed to take to preserve his health. Trenchfoot, which was a major cause of disability in the European theater during World War II and for which care of the feet is a necessary preventive measure, will be fully covered in a separate volume to be published as part of the history of the Medical Department of the United States Army in World War II. Sex hygiene, a part of the educational program for the prevention of venereal diseases, will not be considered in this chapter since it is discussed in detail in the section on venereal diseases in another of the Preventive Medicine volumes.
The basic principle of cleanliness of person and neat appearance of troops is a traditional policy of the Army. Even in the American Revolution, when little was known about transmission of disease, some officers were aware of the hazards from louse infestation. An order of 23 January 1778 issued by Lt. Colonel Marion at Fort Moultrie (S. C.), recommended that each soldier have his hair cut so that it was no longer than the top of the shirt collar in back, and short at the forehead and sides. Otherwise, ". . . those who do not have their hairs in this mode must have them platted and tied up. . . ." Provision was also made to have a certain number of soldiers act as barbers for the regiment.1
Personal cleanliness improved in the Army as it improved in the civilian population. As more became known about the transmission of disease, stress was placed upon particular phases of personal hygiene, such as washing hands after using the latrine, and proper use by the individual of sanitary measures for disposal of waste and purification of water.
By World War I the basic rules for personal hygiene and command responsibility for their enforcement were well established. The Medical Department was taken by surprise, therefore, in April 1918 when it received word from the American Expeditionary Forces that 50 percent of the troops arriving in
France were louse-infested. Although a certain amount of lousiness among troops in combat had been foreseen, facilities for disinfestation at United States camps had not been considered necessary. A quick survey of training camps in the United States showed that some lousiness existed although the percentage of infested persons was very low. A high degree of louse infestation was discovered at the Newport News, Virginia, embarkation point, however. The overcrowding of transports and their inadequate bathing facilities insured the rapid spread of lice among troops. Disinfestation equipment was immediately set up at all large camps in the United States and troops were carefully examined for lice before leaving the country. Conditions in Europe provided no new hazards for which rules of personal hygiene had to be revised. It was impossible, however, to maintain satisfactory levels of personal hygiene under all combat conditions. When facilities were available, rigid compliance with rules was enforced.2
WAR DEPARTMENT POLICY
War Department standards and directives for personal hygiene as contained in Army Regulations (AR) 40-205, 31 December 1942, were in effect throughout World War II. Fundamentally they were the same as in AR 40-205, 15 December 1924, merely rewritten and somewhat expanded. As with all aspects of military sanitation, commanding officers were responsible for enforcement of the provisions concerning personal hygiene. The Medical Department was to conduct inspections and recommend appropriate action to correct deficiencies. It was required that each member of the Army be given a course of instruction in hygiene.
The paragraph of AR 40-205 devoted specifically to personal cleanliness stated:
Unit commanders were instructed to determine that the men of their commands had been properly fitted with socks and shoes and that all foot defects were suitably cared for. An undue amount of foot injury and disability from shoes was to be regarded as evidence of inefficiency on the part of responsible officers.
Precautions for care of feet during marches were specified. Before long or protracted marches, unit commanders were to inspect the bare feet of their
men for defects which might require treatment. While on marches, commanders were to have their men wash their feet each day as soon as practicable after reaching camp, cover blisters or excoriations with a light dressing or zinc oxide plaster, dust the feet with foot powder, and put on clean socks.
Measures that the individual soldier could take for his own protection, as well as measures the Army would take for him, were included in each of the appropriate sections. Under mosquito control were listed the proper wearing of clothing, use of repellents, and use of bed nets. Frequent and thorough bathing was specified as one of the precautions against body lice.
The personal hygiene of men assigned to certain duties was specified in other sections of AR 40-205. Barbers, for instance, were cautioned to wash their hands thoroughly before attending each patron as well as to keep all equipment cleaned or sterilized. All men on duty in kitchens, messhalls, and bakeries were also instructed to bathe frequently, wear clean clothing, and be especially careful to keep their hands and fingernails clean.
TRAINING AND EDUCATION
The policies of AR 40-205 were implemented by a continuing program of training and education. Each soldier was issued Basic Field Manual (FM) 21-100, "Soldier's Handbook,"3 which contained a section entitled "Military Sanitation," consisting of instructions for individual compliance with AR 40-205 and simple explanations of the reasons for each rule. The soldier was instructed to report for sick call at the first signs of illness.
A 1-hour class in personal hygiene was part of basic training for all soldiers. Training Film 8-155, "Personal Hygiene," was used to demonstrate proper application of rules of cleanliness. Because the material included in this instruction contained little that was new to the soldier, the main purpose of the lesson was to provide motivation for careful observance of the rules and to make clear the relationship of individual health to the health and efficiency of the unit.
Field Manual (FM) 21-10, "Military Sanitation and First Aid,"4 a basic field manual, and FM 8-40, "Field Sanitation,"5 a medical field manual, were used as references for the basic training class and were available at company level throughout the Army. Field Manual 21-10 outlined the general groups of diseases and the sanitary measures for their prevention and control. It included a chapter on personal hygiene and also one on the particular problems of march hygiene. Field Manual 8-40 dealt primarily with environmental sanitation, but contained a chapter on factors relative to personal hygiene: care
of the feet, especially for the prevention of dermatomycoses; other skin diseases; scabies; and oral hygiene.
A course in personal hygiene, somewhat broader in scope than that for trainees, was given to cadets of the United States Military Academy, candidates in officer candidate schools, reserve officers in training camps, and commissioned officers in refresher courses. Medical Department personnel received further training in personal hygiene at field service schools or medical replacement training centers, with particular emphasis on the individual measures taken to prevent diseases.6
The soldier's education in personal hygiene did not end with the 1 hour of classroom instruction included in his basic training, although the effectiveness of further training varied considerably from unit to unit according to the degree of interest of the commanding officer and his appreciation of command responsibility for enforcement of proper standards of hygiene. Regular monthly physical inspections by medical officers, and barracks and dress inspections by commanding officers, served as constant checks and reminders of the fundamental rules of cleanliness. Additional applicatory training was carried out at all times on marches, bivouacs, and training problems.
Maneuvers were an important part of the training program for ground troops, and also served to demonstrate both the difficulties of and the necessity for maintenance of personal hygiene under field conditions. Commanders observed that troops often felt, once they were away from base camps, that sanitary regulations should be relaxed. A report of sanitation during First United States Army maneuvers in 1941 noted: "Rubbish, waste paper, fruit skins, discarded sandwiches and food scraps, and, in certain instances, freshly deposited human feces were noted in and around many of the bivouac areas."7 As late as 1944 a report on Second United States Army Tennessee maneuvers stated: ". . . defecation on the ground was not uncommon. . . . Enlisted men obtained food and water from unauthorized sources even though this was strictly prohibited." The report concluded that training in basic medical subjects and military sanitation required continuous emphasis and recommended that instruction be realistic and concurrent with other training.8
Training directives which included elements of personal hygiene were issued by all command headquarters. The Eastern Defense Command, for instance, provided for a minimum of 1 hour per week to be utilized in instruction pertaining to the health of the individual.9 Occasionally, directives pertaining to a local hazard, such as ticks in Virginia, were issued to present appropriate preventive measures.
When units were preparing for overseas, or when replacements were processed through staging areas, further instruction in personal hygiene pertaining to the area of assignment was given. Visual aids supplemented directives and pamphlets which described the environmental conditions to be expected and the diseases prevalent in the overseas theater. For troops destined for the European theater, particular emphasis was placed on louse control for prevention of typhus and care of the feet for prevention of trenchfoot. Troops going to the Southwest Pacific or China-Burma-India theaters were specifically trained in preventive measures against malaria, scrub typhus, and schistosomiasis and warned of the dangers from using unauthorized food and water.
Since the overseas destination was not always known accurately or was sometimes changed, not all personnel leaving for overseas were adequately prepared. In February 1944 a War Department circular
10 established minimum standards of proficiency in sanitation and personal hygiene for enlisted men, noncommissioned officers, and officers. It stated that the probable incidence of disease warranted major consideration in the planning of any operation because reports from all theaters had indicated that malaria, diarrheal diseases, and neuropsychiatric disorders were causing more hospital admissions than all battle casualties. Each major command was ordered to provide such inspections and tests as were necessary to determine and assure the attainment and maintenance of the appropriate minimum standards of proficiency by all individuals and units. At least one inspection and test was to be made within the 6 months preceding a unit's departure for overseas. Refresher courses were to be given in all officer pools, overseas replacement depots, and staging areas. Excessive sick rates from preventable diseases would be investigated and appropriate command action was directed if it was found that reasonable preventive measures had been neglected.
The Training Division, Office of The Surgeon General, had from the beginning of mobilization carried on an extensive program of providing training aids such as posters, films, film strips, and three-dimensional aids. In January 1945 a Health Education Unit was established in the Preventive Medicine Service to produce educational media for a comprehensive continuing program of instruction for the soldier in methods of maintaining his health.11 The organization of the unit was necessitated by the anticipation of the shift of emphasis in the war to the Pacific where troops would increasingly come into contact for the first time with many diseases against which there was no vaccine or other known specific immunization procedure, and the prevention of which was dependent to a very large degree upon the individual soldier's knowledge and application of proper protective measures.
The general educational program for the soldier in the overseas theaters depended principally on unit training. While preparations for the North African invasion were underway, training in the United Kingdom included indoctrination in methods of protection against louse infestation. Again, as the time of the Normandy invasion approached, troops were specifically briefed on the subject of typhus just prior to embarkation for the Continent. Soldiers were issued individual cans of louse powder in all areas where it was considered advisable.
Special discussion hours were held in the United Kingdom for units moving to France. These talks were based on the assumption that troops were familiar with the principles of good field hygiene and were directed at the specific problems to be encountered, particularly continental customs with regard to disposal of human feces. Later, in 1944, the Preventive Medicine Division, Office of the Chief Surgeon, European Theater of Operations, was able to publish information in the Stars and Stripes on individual protection against food-borne infection under combat conditions.
Training in the European theater also emphasized individual measures applicable in the control of respiratory infections. The features of personal hygiene especially stressed by unit commanders and medical officers included the importance of avoiding contact with patients who had common colds or other forms of acute upper respiratory infections; the proper methods for disposal of sputum and nasal secretions, with stress on the dangers of promiscuous spitting; the possibility of contracting infections from common drinking cups, canteens, towels, and other personal items. The importance of personal cleanliness, of thorough hand washing, and of frequent changes to clean fresh clothing were other matters that received attention. (See Fig. 1.)
An intensive theater-wide program to train men in prevention of trenchfoot was begun in November 1944. Replacement depots were instructed to make an entry on the War Department Adjutant General's Office Form 20 of each man who had received instruction in the prevention of trenchfoot, and were not to assign replacements until this instruction had been completed.12
In the China-Burma-India theater greater reliance upon individual personal hygiene measures was necessary than in other theaters. Units were scattered over a wide area and troop movements across country usually involved only small groups. An extensive program of environmental sanitation was therefore considered impractical except in fixed installations. Directives and orientation lectures warned soldiers to protect the skin from prolonged exposure to direct rays of the sun. They were told not to work or exercise strenuously in closed spaces. As in all tropical climates, it was important to
bathe frequently and to drink plenty of cool water.13 It was a rule never to drink any but boiled or chlorinated water, which the individual usually had to supply for himself during travel.14
It was a common experience in India to remain in good health while in a fixed station only to pick up diarrhea or malaria while traveling. Educational literature given to troops prior to train movements outlined specific directions to follow. Troops had to make judicious use of native foods, because quartermaster subsistence was not always available during train travel. Throughout India in the larger stations there were restaurants where clean and reasonably palatable food was served. In small stations a hot curry or vegetable "pilau" could be eaten safely. Soldiers were continuously warned against eating raw fruits and vegetables unless they had been adequately treated.15
A constant educational program was carried on by the China-Burma-India theater antimalaria organization to remind individuals of the dangers of malaria and what they could do to protect themselves. Greatest emphasis was placed on the importance of repellents, protective clothing, bed nets, sprays, and atabrine. The troops were reminded repeatedly that they had all the instruments of protection, it was up to them, as individuals, to utilize them.16
PERSONAL HYGIENE IN OVERSEAS THEATERS
European Theater of Operations
Standards of personal hygiene varied according both to the facilities available and the type of combat the individual was engaged in. Theater preventive medicine officers at all levels realized the necessity for convincing company officers of the importance of command responsibility for enforcing adequate standards of personal hygiene. Trenchfoot became such a serious problem that disciplinary action was initiated against the soldier when it was discovered that he had failed to observe any of the prescribed measures. (See Fig. 2.)
Bathing and Laundry Facilities. In the early period of the United Kingdom Base, troop accommodations were overcrowded and bathing facilities were correspondingly inadequate, or even absent entirely. Baths and showers were usually installed in separate buildings, often inconveniently far from bar-
racks.17 A survey late in 1942 brought out the fact that men were not bathing with the frequency that they should because the bathhouses were unheated.18 Gradually adequate facilities were built and stoves were authorized for each bath and ablution house.
After operations were started on the Continent, local bathing facilities in towns were surveyed and inspected by Medical Department officers. In some areas the Quartermaster Corps operated shower points; in others, existing public baths and showers were used.19 As an example of the assignment of quartermaster fumigation and bath companies in the combat zone, 16 complete companies were allocated to the 12th Army Group. Normally a system of clothing exchange was operated at bath points and sections of the company handled troop laundry for divisions in the vicinity. One platoon operating separately at a bath point could provide baths for 1 division in 4 days if the division was in a temporary noncombat status.20
Bathing facilities were variable depending on the unit's location, but that a shortage existed in combat units is indicated by numerous requests made by various headquarters and units for additional bath equipment. It was recommended that bath facilities be provided organically with all types of divisions.21 The 9th Infantry Division reported, for example, that corps shower units with clothes turn-in privileges provided excellent service, but that the disposition of infantry troops prevented removal of more than 2 to 3 percent of any unit from the front at one time. This allowed only 1 bath per man in a 3- to 4-week period.22
The 2d Armored Division reported that during combat a bathing unit was always available to troops. Troops were rotated to get showers frequently.23 The 35th Infantry Division, on the other hand, reported that during the summer months bathing facilities consisted chiefly of local streams. In October 1944 quartermaster bath units began servicing the division, augmented by unit bath centers generally consisting of heated rooms furnished with GI cans and immersion heaters. Laundry service was erratic, ranging from almost nonexistent to satisfactory.24
An example of the experiences of another unit is contained in a report from the 44th Cavalry Reconnaissance Squadron which stated that bathing facilities were always adequate but not always convenient. During the static warfare on the Roer, men had to be transported at intervals to rear areas where
the shower facilities of coal mines were available. After crossing the Roer and Rhine Rivers, bathing facilities in towns and civilian communities were more adequate and available to the troops. Dirty clothing of units was collected and exchanged for an equal amount of clothing from the Quartermaster laundry service. This resulted in some dissatisfaction with regard to sizes but, in general, was very satisfactory.25
Water Discipline. Water discipline in combat units improved as soldiers became accustomed to field conditions. (See Fig. 3.) Sporadic outbreaks of diarrhea due to individuals drinking water from local sources, without using halazone tablets or other field purification methods, were reported throughout 1944. More untreated nonpotable water was ordinarily consumed by combat troops in the rear Army and communications zone areas than in the forward zone, primarily due to the natural laxity and letdown associated with rest areas and fixed installations, but also, through leave and furlough in municipalities not having approved water supplies.
Many of the units in the communications zone had spent considerable periods in Great Britain or were newly arrived from the United States. The common attitude toward any water coming from a tap was that it was potable and that it was the responsibility of others to see that it was so. Such water supplies were frequently used when not authorized in spite of definitely posted instructions to the contrary.
When the Army occupied Germany, efforts were made to remedy sanitary defects in existing water supplies and bring them to the level of United States Army standards of potability. The general policy was to release troops from the obligation of using field methods of water purification as soon as possible.26
Louse Control. A survey of 1,800 units in December 1944 and 1,500 others in January 1954 showed that about 0.5 percent of units gave some evidence of infestation with body lice, but the total number of individual infestations in all units was less than 100. The infestation usually occurred in combat troops who had slept in quarters recently vacated by German soldiers or civilians. The great value of the educational work on louse control was exemplified by the fact that the few infestations which did appear among combat troops were quickly eradicated and only rarely did the same unit have infestation in successive months.27
Personal Supplies. Because tonnage was extremely curtailed during the summer and fall of 1942, post exchanges could supply only limited quantities of tobacco products, toilet articles, and candies. Transient troops in embarkation areas were issued ration accessory convenience kits. These kits contained a daily allowance of razor blades, shaving cream, tooth powder, toilet soap, cigarettes, tobacco, matches, hard candy, and gum. Just before embarkation each soldier received a week's free supply. When post exchanges were not available on the Continent, United States troops received exchange supplies on a free and automatic basis.28
The barber kit was requested more and more frequently as the campaign progressed. Initial supplies had been inadequate and replacement parts were not available. Many barbers used equipment sent them from home. It was not until the latter part of 1945 that the contents of the kit and Army requirements became standardized and the supply adequate.29
North African, Mediterranean, and Middle East Theaters of Operations
Experience in both North Africa and Italy seemed to indicate that prior to arrival in the theater individuals had not been well indoctrinated in the
importance of food and water sanitation.30 Limited fly control supplies and lack of proper toilet facilities made strict enforcement of sanitary measures a necessity. The methods of transmission in the outbreaks of diarrhea in the spring and fall of 1943 in North Africa and in the fall of 1944 in Italy have not been proved, but inadequate protection against flies, improper cleansing of cooking and eating utensils, improper disposal of human wastes, drinking of unchlorinated water, and infected food handlers all seem to have been implicated.31
At a meeting of medical representatives of Fifth United States Army, 2d Medical Laboratory, II Corps, and IV Corps in the fall of 1944 to discuss intestinal disease rates it was concluded that the chief problem in sanitation lay in the difficulty of maintaining good personal hygiene by frontline troops under existing conditions. Soldiers were known to eat unauthorized food and to drink unauthorized water without the use of halazone tablets even though they were available. A previous investigation of 18 cases of typhoid fever had indicated poor water discipline of the individuals involved.32
Once-a-week laundry service for troops was provided in Oran where clothing salvage operations had been set up. Mobile laundries were in the theater, although they could not be provided in sufficient numbers to meet all the bath and laundry requirements of troops in the field. (See Fig. 4.) Typical of the mobile laundry groups was the 487th Quartermaster Laundry Company which followed the Allied armies through North Africa, the invasion of Sicily, and into Italy. "Always within a stone's throw of the advancing combat soldiers, the 487th nevertheless has continued to break records in laundry production and service to front line troops."33 Individual enterprises also played a role in providing bathing and laundry facilities. In North Africa an officer, a laundryman in private life, created an overseas "branch" of his civilian business by hiring village women and setting up shop with tubs and irons.34 Homemade baths were set up in Italy by a quartermaster service company and many units improvised showers. In 1945 the preventive medicine officer for the theater was able to write: "The units of this theater have achieved a high level of personal hygiene"35
No particular problems in personal hygiene were encountered in the Middle East theater although the potential hazards were very real. Serious discussion regarding the relationship between desert sores and the lack of bathing facilities led the Preventive Medicine Section, Office of the Surgeon, United States Army Forces Middle East, to recommend an increase in ocean bathing.
This recommendation was carried out by furnishing more transportation and more time for personnel to bathe in the sea. Personal hygiene was emphasized in health talks to members of the command by preventive medicine personnel.36
In the early history of the theater it was not unusual for over 70 percent of personnel among newly arriving units to suffer a gastrointestinal upset within a few weeks of arrival, because they had not been adequately informed of the dangers of consuming uncooked fruits and vegetables from native sources. As preventive medicine procedures became better understood, and were more thoroughly enforced, the rates for dysentery and diarrhea approached a reasonable figure.37
The provision of adequate bathing and delousing facilities, the use of anti-louse powder, and the placing of native villages out of bounds helped to
prevent typhus and other diseases prevalent in native quarters from occurring among American Forces.
Southwest Pacific Area
In the Southwest Pacific area the principal efforts were directed toward unit sanitation. Elimination of the insect vectors of diseases such as malaria and scrub typhus with the aim of area control was stressed. Individual protective measures, particularly suppression of symptoms by the use of atabrine, were also important preventive measures.
Reports from Australia and New Guinea show that frequent physical inspections of troops and informal inspections of all units were carried out to determine the status of training and adherence to standards of all phases of medical, sanitary, and personal hygiene matters. Personal hygiene suffered during early months in the theater because only cold water was provided for showers and in many places bathhouses were dark, cold, and offered little protection from the wind.38 One division surgeon attributed the occurrence of fungus infections to the inadequate laundry facilities.39 Personal hygiene was raised to a satisfactory level as hot water systems were installed and construction of bathhouses improved.40 The inadequacy of supplies of some items of clothing, insect sprays and repellents, and screening also presented an early problem for many units.41
Disease Control. Instructional periods for all personnel on mosquito control covered organizational and individual protective measures. The latter included sleeping under mosquito nets, using repellents, and proper wearing of clothing. Atabrine discipline was rigidly enforced but was not considered to take the place of preventive measures.
When the Army moved into the Philippines early in 1945 an intensive training program was carried on to give troops an understanding of the various diseases to be encountered. One of the dangers with which there had been little previous experience was schistosomiasis. Newspaper items, posters, roadside signs, and demonstration vans all warned of the dangers of bathing or swimming in fresh water streams and ponds. The educational program was the main weapon against this disease, and as troops recognized the severity of the illness and understood its mode of transmission, the incidence of schistosomiasis decreased.
Consumption of food and water from civilian sources was forbidden as a protective measure against diarrhea, amebiasis, and intestinal parasites. Dis-
regard of these directives by individual officers and soldiers was a factor in outbreaks of these infections.42
Although personal hygiene was generally considered excellent throughout the command, combat conditions necessarily sometimes had an adverse effect. The Sixth United States Army reported that sanitation and individual hygiene suffered during the second quarter of 1945 because of the fatigued condition of the men after several months of fighting and the terrain conditions imposed by the combat situation. The health record became better when troops reached a stable position and began to improve their personal hygiene.43
Another extremely common hazard of the Southwest Pacific area was fungus infection. Observance of directives concerning care of the feet was especially important in an area where fungus infections might become disabling. Frequent bathing, with thorough drying of the skin and powdering of the body helped to lower the incidence of fungus infections. (See Fig. 5.) Periodic inspection of troops was necessary to assure early treatment.44
Bathing and Laundry Facilities. Bathing facilities were reported as adequate at most times and ranged from mountain streams, ocean, and lakes to improvised showers. Many units improvised hot water systems for showers. In the Philippines, after an immediate problem of water supply, shower rooms were provided for all troops.45
Even hospitals reported laundry facilities as inadequate during 1943. In Australia, civilian establishments were utilized, but were working so far beyond capacity that the quality was frequently substandard. Small handwashing machines and many types of makeshift laundry facilities were utilized in New Guinea. By 1944, quartermaster laundry facilities were being provided, primarily for hospitals. Units, in general, provided facilities for the individual to wash his own clothes.46
As has been indicated, an educational program in individual protective measures was necessary, particularly for small isolated units and individuals traveling between fixed installations or on leave. Reports as late as 1944 indicate that troops continued to arrive in the theater without proper instructions in malaria prevention and demonstrating poor malaria discipline.47
Bathing facilities were in the majority of cases improvised, but adequate. In 1943, it was reported that some of the smaller stations in the Assam area had only washracks with drains; however, by 1944 each company and detachment had provided itself with showers. At convoy camps along the Ledo Road soldiers were permitted to sponge off at the rivers, but river bathing was forbidden because of resulting skin infections. In China, each group of Americans constructed their own showers, based upon directions in the Army field manual on sanitation. For a time no heating units were available, but when closed buildings were constructed, hot water was provided for washing and shower facilities.48
In 1943 the native "Dhobies" did most of the laundry for soldiers and officers in India. Their crude methods of beating out and stamping out the dirt were
not particularly efficient. Soldiers associated the prevalent skin lesions with these laundry methods and called them all "dhobie itch." Many unit facilities and quartermaster laundries were established during 1944. Individual experimentation also created some novel laundries as the following example of a combination of American ingenuity and Indian tradition indicates:49
The relative role of personal hygiene in control of disease varied considerably according to the degree of unit sanitation and area control achieved and according to the degree of specific protection afforded by measures such as immunization. There are few outbreaks of disease in which only one factor can be implicated; it is therefore difficult in most cases to correlate specifically good or bad personal hygiene with disease incidence.
A continuing educational program, combined with frequent inspection by both commanders and medical personnel, was found necessary to keep individual health observance at proper levels. A problem of the Medical Department was to convince line officers of their responsibility in enforcing health precautions, such as water discipline, eating only authorized foods, care of the feet, and proper wearing of the uniform for protection against arthropod vectors of disease. The soldier, too, had to be convinced of the relationship between his actions and his health and the health of his entire unit. Agencies were set up, within the Office of The Surgeon General and at all major command levels, to insure the dissemination of information necessary for the soldier to safeguard his health.
The effectiveness with which personal hygiene measures were applied, both in training situations and in active theaters, varied widely. Experienced observers agree that there were numerous lapses from established minimum standards and that, in future military operations, thorough training in personal hygiene will be necessary. This training must include not only the principles and methods to be applied, but should also serve to motivate personnel of all ranks. In addition, there must be command and medical inspections coupled with provisions for effective corrective actions.