10 



SCIENCE 



[N. S. Vol. L. No. 1279 



of this country exceeded those of the camps. 

 Subtracting the death rate caused by pneu- 

 monia from the total death rate by disease in 

 the recent war we have 2.2 per thousand for 

 the entire army on both sides of the water, 

 which is practically a peace-time death rate. 

 Meningitis has caused, in this war, ten times 

 as many deaths as typhoid fever; pneumonia 

 has caused two hundred times as many. 

 Mumps and scarlet fever, of the infectious 

 diseases of the young men, remain as yet to 

 be controlled, but they are not of great import 

 in the armies in war. The disabling type of 

 disease coming under the head of venereal 

 disease has, in this war, been so controlled 

 that the number of cases brought from civil 

 life was greater than the number occurring in 

 the American Expeditionary Forces in France, 

 which was reduced to twenty-two per thousand 

 per year, a rate only one eighth as high as the 

 incidence among recruits coming from civil 

 life, and only one third as high as the best 

 that ever had been accomplished in the army 

 before. 



Influenza, measles and pneumonia, in the 

 respiratory group, still stand as baffling prob- 

 lems, and their control has not been accom- 

 plished. Measles appeared and spread until 

 it no longer had material on which to spread, 

 as one attack confers immunity to a second. 

 Pneumonia, following influenza or originating 

 as a primary disease, still eludes control. 

 But the knowledge which we have gained in 

 this war of the methods of its spread, of the 

 various infectious organisms which produce it, 

 and their various types and varying virulence, 

 of its occurrence as a secondary complication 

 to measles and influenza, has enormously in- 

 creased. The value of the facts thus learned 

 are incalculable, and belief is justified that 

 the problem is better understood than ever 

 before, and that we soon shall see the solution 

 of these problems. 



The occurrence in the camps of meningitis, 

 another disease of the respiratory group, as 

 far as its portal of infection is concerned, has 

 been forty-five times as frequent in the army 

 as its occurrence in civil life among the same 

 age group. This has been due to overcrowd- 

 ing and the diminution of air space allowed 



the individual soldier in badly ventilated bar- 

 racks. The responsibility for these sanitary 

 sins rests on the General Staff and not on the 

 Medical Corps. 



Wliat then are the lessons that we can draw 

 for future action? There is no question but 

 that the salvage of human beings, the pro- 

 tection of troops from disease in an army, re- 

 news and saves the fightipg forces. Until 

 recently, until medical science could control 

 disease during war time, armies had been 

 more decimated and injured by disease than 

 through battle casualties. Now that, except 

 for epidemic spread of respiratory diseases, 

 the communicable and epidemic spreading 

 diseases can practically be controlled, the 

 medical corps of an army has become an es- 

 sential part of the fighting organization. 

 Whole nations must now go to war. 'So 

 longer can they mobilize a selected portion 

 of volunteers and send them to fight the war 

 and defend the nation. Since all the youth 

 of the nation must mobilize and turn to war, 

 it becomes the duty of a general staff to save 

 its man power and to salvage it to the greatest 

 extent possible. The history of the Crimean 

 War, of our Spanish-American War, and our 

 experience in the recent war have clearly 

 shown that only through proper representa- 

 tion on the general staff by those men trained 

 in such salvage, and by experts in such knowl- 

 edge of sanitation, can this duty be per- 

 formed. When the General Staff of the 

 United States Army comes to realize this 

 fully, one can not conceive that it will fail to 

 give proper representation in its councils and 

 organization to the Medical Department. The 

 practical necessity for this was finally recog- 

 nized in the A. E. F. by General Pershing 

 and three medical officers were detailed at 

 General Headquarters as substantive members 

 of the General Staff. Eesponsibility and au- 

 thority can not be separated, and only by such 

 organization can adequate authority equal the 

 inevitable responsibilities. 



In the mobilization of the industrial forces 

 of the nation by the Council of National De- 

 fense, the health of the nation and the pro- 

 tection of both nation and its armies was 

 regarded of such importance that it demanded 



