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MEASLES AND PNEUMONIA IN OUR
VICTOR C. VAUGHAN, M. D., Ann Arbor, Mich.
Measles and pneumonia are so closely associated in military camps that it is well to consider them together. Measles is one of the most infectious diseases and its restriction in camps seems well nigh impossible except under exceptional conditions when the soldiers can be scattered over large areas. This requires so much housing in the form of tents or barracks. and interferes so greatly with drill and other military activities, that measles is justly greatly dreaded.
The soldier who has had this disease in childhood is fortunate, and a command made up of immunes is doubly so. One attack seems to give life-long protection. It is true that oc
casionally a soldier, who is sure he has had measCase D, Step No. 3.
les, develops this disease; but it is more than probable that the former attack was due to some other eruptive disease. Organizations recruited from sparsely settled districts are more prone to this infection than those from urban or more thickly settled communities, on account of the larger number of susceptible individuals.
Measles, among our people at least, is seldom fatal so long as it remains uncomplicated and without more serious sequelae. This is so generally true that it has been seriously suggested that all susceptibles should be exposed to it in order to secure immunity, but until the complications and sequelae can be more certainly controlled, this procedure can not be recommended. The control of epidemics of measles is more difficult because it is transmissible before it is recognizable in the individual. This however, should not deter medical officers from the daily inspection of all men under their charge, and especially of all recent additions to
their commands. Case D, Step No. 4.
On the first evidence of the disease, the
soldier should be sent to the hospital and his Dr. William J. Mayo of Rochester, Minn., was tentmates should be quarantined for 14 days. awarded a gold medal by the National Institute This time is believed to cover the period of inof Social Sciences at its annual banquet in New cubation. The contacts may be drilled in a squad York City, on the evening of January 18. The by themselves, but should not be allowed to medal was bestowed in recognition of Dr. Mayo's mingle with others. Their drill master and athumanitarian work.
tendants should be selected from those known
to be immune. No Meeting in March-Members of the Medi
A soldier sick with measles should be imcal Society of the Missouri Valley will please mediately sent to the hospital, with his clothing bear in mind that at the last meeting, a resolu
and blankets. On arrival at the hospital, the tion was adopted to the effect that the March meeting of the society would be omitted during clothing and blankets should be sterilized by the period of the war. All members who are in
steam, rolled in paper, or placed in a paper bag,
labeled and put away awaiting the recovery of the service will have their dues remitted. The
their owner. secretary would be pleased to receive the names of all who have accepted commissions as he * Editorial in The Journal of Laboratory and Clinical wishes to print a list in the Medical Herald soon. Medicine, January, 1918.
In the hospitals, patients with measles should mattresses and blankets. It is claimed by many not be crowded more than is absolutely neces- that exposure for a few hours to the air-we will sary. However, when the bed capacity is doubl- not say to sunlight because this is by no means ed by the number of patients, as has happened in always in evidence—is sufficient to disinfect more than one base hospital recently, overcrowd- bedding which has been occupied by patients ing seems · unavoidable unless additional cot with measles and pneumonia, but some are still space can be secured by the immediate erection skeptical on this point. of hospital tents. When the beds must be
That overcrowding has been a factor in the brought within four feet of one another, an im
spread of respiratory diseases in our camps provised clotheshorse carrying a sheet kept
seems quite evident. The transmission of these moist with a 5 per cent solution of carbolic acid, diseases is in inverse ratio to the distance beor a 1:1000 solution of bichloride of mercury, tween individuals. With men sufficiently scatshould be placed, as a screen, between the cots. tered, even measles-as contagious as it is-is This may seem wholly unnecessary, and it not transmissible. The Surgeon-General, with might be asked why it is necessary to try to his extensive experience with septic pneumonia protect one measles patient against another. The
in the Canal Zone and in South Africa, has purpose of this recommendation is not to pre- recognized the danger from the respiratory disvent the spread of the measles; but some of these eases and has insisted from the first that every patients, experience indicates that many of them,
man in barracks or tents should have a miniare carriers of virulent pneumococci and strepto- mum of 50 square feet of floor space. With cocci, and the purpose of this precaution is to nine men in a tent 16x16, the space is reduced to prevent the dispersion of these virulent organ- 'less than 29 square feet and in some camps the isms. The sputum cups should be burned and
number of men in such tents was as great as the floors should be kept moist and dry sweep- 12. Soldiers have been overcrowded in tents, ing should not be permitted. The patients barracks, and even in hospitals. should be kept warm and given hot drinks. The plates, knives, and forks should be boiled.
The viruses of the respiratory diseases are Drinking cups should not be exchanged, but
transmitted for the most part, at least, through each patient should have his own. Paper nap- the spray present in coughing, sneezing, and kins should be used and should be burned with rapid talking. It is true that a virulent pneuthe sputum.
mococcus has been found in dust, and this canA mistake made in many of our camps is
not be omitted from the list of distributing
agencies. Some of our camps have been very the too early return to duty of soldiers recovering from measles. They should be placed in dusty, and how greatly this has contributed to convalescent hospitals and kept at rest for a
the prevalence of the respiratory diseases can period of ten to fourteen days before returning
not be accurately determined. to duty. While uncomplicated measles seldom Medical officers should be awake to the or never kills, it lowers the resistance to infec- danger of overcrowding and should do what tion with pneumococci and streptococci. Too they can to avoid it. Line officers have ceroften it has happened that a soldier returned to
tain valid reasons for preferring compact organiduty after recovery from measles is sent back to
zations. It favors administrative purposes. the hospital within two or three weeks or earlier However, there should be no unreasonable conwith pneumonia. On the other hand, in those flict on this point among intelligent men, all of camps in which the convalescents from measles whom must recognize the fact that the strength have had proper care, the number of cases of of an army lies in its effective men and is in pneumonia is relatively low. It should be im- inverse ratio to those on sick report and in pressed upon every medical officer that a con
hospital. The medical officer is supreme in valescent from measles is especially susceptible the hospital, and still some wards have been to pneumococcic and streptococcic infection, and
overcrowded while others are vacant. Because in order to protect him from these infections, he a ward is intended, in the construction of the should have proper and prolonged professional hospital for surgical cases, is no reason why it supervision.
should remain vacant for weeks while pneuWhen a soldier recovers from measles and
monia wards are carrying twice the number of leaves his bed in the hospital, the bedding should patients they were built for. If the sterilization be sterilized by steam before it is occupied by of bedding is secured by a few hours' exposure another patient. The absence of any provision to out-of-door air, a ward should be safe after for this procedure is, up to the present time, a
the removal of all the beds and a few days' striking feature of most of our base hospitals. exposure with open windows and doors. Sterilizers, we are told, have been ordered, but In our base hospitals in this country, with up to the early part of December we found no no wounded, the greater part of the space, base hospitals fitted with facilities for sterilizing which means the greater number of the wards, should be used for medical cases and especially were constructed by the aviation corps, not by for respiratory diseases.
the quartermaster's department. The construcIt should not be forgotten that overcrowding tion cost more in money, but, so far, has cost in sleeping quarters is determined, to some ex- much less in sickness and deaths. tent, by the position of the cots with reference A great sin has been committed in sending to one another. So far as the spread of respira- troops from a camp known to be badly infected, tory diseases is concerned, men may be over- to one relatively free from infection, without crowded in the open air. It has not been un- proper precaution. At Camp Wheeler, Macon, usual to find men sleeping in cots so arranged Georgia, and at Camp Beauregard, Alexandria, that four heads are brought close together. Louisiana, the statement is made that their inThe medical officer should see to the arrange- fection came from Camp Pipe, Little Rock, ments of cots in tents and barracks. On account Arkansas. At the last mentioned place, the of the shortage of blankets and the absence claim is made that their infection came from of heating facilities, it is not rare to find two Camp Funston, Fort Riley, Kansas. Indeed, cots brought close together so that the same the charge is openly made that one camp inblankets may cover two men.
tentionally emptied its hospitals into another It seems to have been assumed by those who camp. While this undoubtedly is a gross exhad supervision of the housing of our soldiers. aggeration, there is some truth in these statethat camps and cantonments in the southern ments. Men have arrived at their destination states did not need to be warm, and has prob- actually ill with measles, pneumonia, or menably been a contributing factor in the greater ingitis, and have been sent directly from the prevalence of pneumonia in the southern camps train to the hospital. Such procedure would not compared with those located in the north. More- be permitted by civil health authorities. Moreover, it is an old and well certified medical ob- over, this is not the worst of it. Men coming servation that pneumonia is not only more com- from an infected camp have been immediately mon. but more fatal, in the south than in the distributed among the different organizations northern states. While the average winter tem- at the place of arrival. In this way, the infecperature in Michigan is lower than that of tion has been planted and scattered widely in a South Carolina, one may suffer from the cold most fertile soil. Under no condition, except quite severely in the latter state. The same gen
under the stress of actual warfare, should troops eral idea seems to have prevailed among those be sent from one camp to another without isolawhose duty it was to provide winter clothing. tion for a period under medical supervision both This was distributed last in the southern camps,
before departure and after arrival. This preand as late as early December many of the
caution should be taken on all transfers of soldiers at Fort Worth, Texas, were not pro
troops from one camp to another occupied camp. vided with woolen clothing. By one who has
When the movement is from an infected camp, experienced the chilling effects of a Texas north- extra precautions should be taken. New arer, this defect will be appreciated.
rivals, whether they come from another camp, Another mistake in the construction depart- or from recruiting stations, or directly from ment was to leave the base hospital for the last their homes, should be quartered apart and building to be erected. At Fort Worth, early in inspected individually and daily before disDecember, the base hospital was without run
tribution among organizations. . The trasfers ning water and sewers, and all bed pans had of troops should be under the supervision of to be carried a long distance-in some wards as medical officers, and these should report to the far as a quarter of a mile. There were abso- medical officers at the place of destination all lutely no bathing facilities in the base hospital. infections which have appeared among the arAt Fort Sill, the base hospital was in process
rivals or to which they have been exposed. of construction, and some of the wards, par
These precautions might not be necessary among tially built, were crowded with patients. There well-seasoned troops who have been in the field were no trained nurses, and the soft coal used for months and possibly for years, but with raw in the small stoves was tracked over the floor soldiers they are absolutely necessary if infecand the dust was deposited on sheets and pillow
tion is to be reduced to a minimum. Within a cases. In camps and cantonments in this coun
few months, we should have a constant stream try, the base hospital should be completed, and of troops moving from their homes through furnished with every facility, before troops are
one camp and another to points of embarkamoved in.
tion across the ocean to the battlefields of EuThe excellence of the barracks of the avia
rope. To protect these millions from infection.. tion corps, and the relative freedom from dis- or to reduce infection among them to the miniease among those occupying them is shown mum, will require the constant attention and when comparison is made between them and care of our most experienced epidemiologists. the division housing. It is said that the former We can not hope to avoid loss from infection