Military medicine, 175, 8: 118, 2010 118 military medicine

EDUCATION FORFEITED 
Victories in military hygiene are slow to come, but not 
because the factors that infl uence the performance, endur-
ance, and resistance of service members are unknown. Over 
the past century many have been described and studied and 
a number of effective interventions developed to improve 
them. Victories in military hygiene are slow to come because 
many lessons observed go unlearned by both line and medical 
offi cers. The physical injury and mental fatigue generated in 
the overloaded soldier was revisited by S. L. A. Marshall in 
The Soldier’s Load and the Mobility of a Nation in 1950. But 
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Military Hygiene Enters the 21st Century
MILITARY MEDICINE, Vol. 175, August Supplement 2010 123
33 years later soldiers and marines in Grenada
27
contended 
with heavier loads than Marshall had warned against and in an 
article in the Washington Post in February 2009 the travails of 
the continually overloaded infantryman in Afghanistan were 
described.
28
In September 2003, Marines in Liberia sustained 69 cases 
of Plasmodium falciparum malaria, 4 of them with cerebral 
symptoms, and 44% of the landed force were affected because 
malaria discipline was completely ignored by line and medi-
cal offi cers.
29,30
In fact, medical offi cers reviewing the prob-
lem considered requiring unit commanders to directly observe 
people taking antimalarial medication impractical or unneces-
sary. Moreover, the criminal neglect of line and medical offi -
cers was passed on to the troops.
29,30
Military medical history 
unlearned, education forfeited.