United States army guidelines for troop living space: A historical review

The Army Medical Department has consistently recommended the separation of troops to limit the spread of infectious disease agents. However, convincing evidence supporting the existence of a minimal or an optimal amount of space for each soldier has never been obtained. The inability of military medical personnel to soundly defend space standards should not be taken as reason for considering these standards unimportant and rejecting them. As was pointed out during World War II, infectious disease outbreaks may occur as a result of multiple factors. These factors relate not only to the environment but also to the individual and the disease agent. Designing a study to evaluate the impact of a single environmental factor, living space, is a challenging undertaking even today, when more advanced investigative techniques are available. Currently, the benefits which might be derived from enforcing space standards are not impressive. This is due, at least in part, to success in controlling by immunizations, meningococcal disease and acute respiratory disease due to adenoviruses. However, space allocated could again become a prominent issue. Limited resources and mobilization requirements could force a reduction in the current standards, and there are agents capable of causing severe disease for which vaccines or prophylactic drugs are not available. Therefore, we should now ask whether it is reasonable to again attempt to define the roles of multiple variables, including living space as causes of infectious disease outbreaks.