EPIDEMIOLOGY OF PNEUMONIA 479 



most careful attention to the cleanliness of the mouth of measles 

 patients, both for the reasons mentioned, as well as in order to dis- 

 courage the lodgment of virulent organisms in the patient himself. 

 Doctors and nurses should wear gauze masks when in close contact 

 with the patient as much for the protection of the patient as for their 

 own. A measles patient should never be allowed to remain in the same 

 ward with pneumococcus or streptococcus cases, and as soon as a 

 measles case develops a severe bronchitis or pneumonia, he should be 

 removed from the measles ward into a separate ward or room, since 

 he has now become an active danger to other measles cases. In the 

 measles ward itself beds should be screened one from the other, and 

 there should be at least five feet between beds. It is of great impor- 

 tance that measles cases should be put to bed and kept warm and pro- 

 tected from catching cold as soon as the suspicion of the disease is 

 definite, and similar care should be taken during the course of con- 

 valescence. 



In the case of influenza the conditions are similar. In the section 

 on influenza it will be seen that this disease, in its pure form, is rela- 

 tively mild and has a very low mortality. During the second and 

 third waves of an epidemic, however, practically all influenza cases 

 show some degree of respiratory infection, and the susceptibility to 

 pneumonia is so great during this stage that not only is the percentage 

 of pneumonias very high, but the mortality is appalling. During the 

 year 1918 when the second great influenza wave struck the American 

 Army, influenza was charged, by the Surgeon General's Report, with 

 688,869 admissions among the American troops for the year, the dis- 

 ease and its complications causing 23,007 deaths. 82 per cent of all the 

 deaths occurring in the Army were due to acute respiratory disease. 

 When we consider, as we shall, in the chapter on Influenza, that all the 

 respiratory deaths chargeable to influenza are really deaths from sec- 

 ondary infection, and not to influenza itself, the appalling importance, 

 and not to influenza itself, the appalling importance of the secondary 

 pneumonias from a sanitary point of view becomes apparent. The pre- 

 ventive measures that can be taken in guarding against secondary pul- 

 monary infection are chiefly indirect ones, but are of great importance. 

 Among the most important are care of the patient himself. Studies 

 by Swift, Harlow Brooks and others during the war have shown that 

 immediate cafe in bed, as soon as the first suspicion of diagnosis of 

 influenza is made, is of the utmost value in preventing the development 

 of secondary infection. The greatest care should be taken of the 



