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Military hygiene and sanitation have become more efficient to prevent casualties during field training and deployments. Influenza was deadlier than combat during the First War in 1918. Hygiene standards for military members increased and guidelines for physicians operating for the US were enacted.

Spanish flu in Close Quarters
World War I (the First War) erupted in 1914 and continued well into 1918, the same year Spanish flu made its mark in the US on an Army base. As the war raged in Europe, the Spanish flu was not well-known to physicians and researchers to combat its effect on both American troops and European soldiers. According to Jen Pinkowski, the pathogen quickly spread to other Army camps, and hundreds of thousands of infected soldiers were subsequently shipped across the Atlantic Ocean. Such an infectious disease was easily spread through camps during the war.

Hygiene and sanitation were not common practices in the field. Large capacity gatherings in trenches and tents allowed the easy spread of influenza. Even as the war continued with multitudes of death by combat, researchers Peter C. Wever and Leo van Bergen confirmed the death of 45,000 American soldiers to the pandemic alone (Kiger).

Policies and Advancements
The cleanliness difference in 1918 to 2023 varied from basic hand washing procedures to complete sanitation station requirements. According to Pinkowski, the public health community at the time had no standardized methods of research or testing, virtually no peer review, and no common protocols for clinical trials to aid in the battle against influenza. Just as communities did with COVID-19 in 2020, the spread of Spanish flu was slowed by identifying cases through surveillance and voluntary and/or enforced quarantine or isolation.

Todays' standards state that military personnel should be provided shower/bathing facilities in the field. All personnel must bathe at least once a week and have a clean change of clothing to reduce the health hazard.

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