REFERENCES

(1) Keefer, F. R.; Friedberg, S. A.; and Aronson, J. D.: A Study of Diphtheria Carriers in a Military camp. The Journal of the American Medical Association, Chicago, 1918, lxxi, No. 15, 1206.

(2) Neal, M. P., and Sutton, A. C.: Diphtheria in the A. E. F. The Military Surgeon, Washington, 1919, xlv, No. 5, 521.

(3) Blanton, W. B. and Burhans, Chas. W.: A Report of Diphtheria at Camp Custer, Mich., from September, 1917, to March, 1919. The Journal of the American Medical Association, Chicago, lxxii, No. 19, 1355.

(4) Barron, Moses, and Bigelow, Geo. H.: Diphtheria at a Hospital Center. The Journal of Infectious Diseases, Chicago, 1919, xxv, 58.

(5) Nichols, H. J.: Carriers in Infectious Diseases. Williams and Wilkens Co., Baltimore, 1922, 72.

(6) Circular Letter, S. G. O., January 1, 1918.

(7) Weaver, Geo. H.: The Value of the Face Mask and other Measures in Prevention of Diphtheria, Meningitis, Pneumonia, etc. The Journal of the American Medical Association, Chicago, 1918, lxx, No. 2, 76.

(8) McCord, C. P.; Friedlander, A.; and Walker, R. C.: Diphtheria and Diphtheria Carriers in Army Camps. The Journal of the American Medical Association, Chicago, 1918, lxxi, No. 4, 275.

(9) Capps, J. A.: A New Adaptation of the Face Mask in Control Contagious Disease. The Journal of the American Medical Association, Chicago, 1918, lxx, No. 13, 910. (10) Haller, D. A., and Colwell, M. C.: The Protective Qualities of the Gauze Face Mask. The Journal of the American Medical Association, Chicago, 1918, lxxi, No. 15, 1213. (11) Schorer, E. H., and Ruddock, A. S.: Detection of Carriers and Missed Cases of Diphtheria in Embarkation and Debarkation of Troops. The Military Surgeon, Washington, 1919, xlv, No. 3, 319.

(12) Weaver, Geo. H., and Murchie, J. T.: Contamination of the Hands and Other Objects in the Spread of Diphtheria. Observations on Secondary Infections in Hospitals

for Contagious Diseases. The Journal of the American Medical Association, Chicago, 1919, lxxiii, No. 26, 1921.

(13) Simmons, J. S., Wearn, J. T., Williams, O. B.: Diphtheria Infections, with Particular Reference to Carriers and to Wound Infections with B. diphtheria. The Journal of Infectious Diseases, Chicago, 1921, xxviii, 327.

(14) Hartsell, J. A., and Morris, M. L.: A Report of Sixty Cases of Wound Diphtheria. The Journal of the American Medical Association, Chicago, 1919, lxxii, No. 19, 1351. (15) Simmons, J. S., and Bigelow, G. H.: Diphtheria Bacilli from Postoperative Empyema Wounds. The Journal of Infectious Diseases, Chicago, 1919, xxv, 219.

That venereal diseases were responsible for great noneffectiveness and economic waste to the Army during the World War is shown by the fact that, of the total primary admissions to sick report on account of diseases only, numbering 3,500,000, venereal diseases were the direct causes in 357,969 admissions, or 10.2 per cent of the whole. If to this number be added cases reported as concurrent with other diseases, the total reported venereal incidence would be 383,706.

For admission to hospital, solely on account of venereal disease, there was a loss of 6,804,818 days from duty. Loss to the service is not entirely represented in the above figure, principally due to the fact that it was the practice to return men to their organizations and to a duty status as soon as their physical conditions would permit, further treatment being carried on in the organization while the soldier was on duty status. Inevitably time was lost for treatment, but was not officially charged as such; and in the case of salvarsan treatment for syphilis, carried out during convalescence, more especially in the United States, men were returned to the hospital or dispensary at regular intervals as out-patients, treated and sent back to their organizations, usually with a loss of about one-half day per case.

Venereal diseases, as a class, stood second among the most common diseases as a cause of admission to sick report for the Army as a whole, and exceeded the total number of men killed and wounded in action by approximately 100,000. As a cause of loss of time from duty, disregarding the additional time unaccounted for, as explained above, the venereal diseases stood second only to influenza, the greatest scourge of the war.

As a cause of permanent disability, requiring discharge from the service, venereal diseases ranked fourth among the most common diseases, being exceeded in this respect by, first, tuberculosis, (5.52), second, valvular heart disease (2.59), third, mental deficiency (2.58). For venereal diseases (2.53), the discharge rate was 49.4 per 1,000 strength for total diseases.

There was a marked difference in the discharge rates for white and colored enlisted men, as shown in Table 41. The former had a rate of 1.41 and the latter 18.36 per 1,000 per annum. The highest rate for any troops in the entire Army and serving in any country was 35.57 for colored enlisted men serving in the United States. The highest admission rate for American enlisted men was among the 21,000 stationed in the Philippine Islands. The rate was 192.12 per 1,000 strength. The second highest admission rate for enlisted men was in the United States (134.33) and the lowest in Europe (34.64).

• Unless otherwise stated, all figures for the World War period are derived from sick and wounded reports sent to the Surgeon General.-Ed.

The admission rate for the total Army during the war period was 86.71, based upon total primary admissions. Venereal diseases were approximately five times more common among colored than among white enlisted men. Among the former there were 95,026 primary admissions (331.62), as compared with 250,597 (69.62) among the latter.

TABLE 41.-Venereal diseases (all). Primary admissions, deaths, discharges for disability, and noneffectiveness, officers and enlisted men, United States Army, by countries of occurrence, April 1, 1917, to December 31, 1919. Absolute numbers and ratios per 1,000

Venereal diseases, at least during their acute stages, are not among the common killing diseases. Therefore the number of deaths attributed to these. causes in the Army during the World War is relatively small. The duration of the war and the length of service were too short for the most fatal type, syphilis, to show its effects. Table 41 shows that 173 deaths were attributed to venereal diseases in the total Army during the war. Among these, 5 were officers, 106 white enlisted men, and 56 colored enlisted men. Three cases were charged to native troops, and 3 to enlisted men whose color was not stated. For a number of years prior to the World War, venereal diseases constituted a cause for the rejection of applicants for enlistment in the Army. Since this cause for rejection obviously could not obtain, in so far as the World War Army was concerned, from the first practically all cases of venereal diseases were deemed acceptable.' The number of cases discovered among the inducted men on their physical examination after their arrival at Army camps gives a very excellent measuring stick as to the incidence of these diseases among the young adult male population of the United States.

From the beginning of hostilities, in 1917, until May 1, 1918, about 1,000,000 men were inducted into the Army. This is spoken of as the first million and is referred to in Table 42 as P1. The physical examination blanks used at the time that these men were being inducted provided but one space for the notation of defects and only the major defects were noted; therefore, other defects, including venereal diseases, if not considered the major defect, were not listed. During the same period, organization was taking place with the draft boards. and within the camps. Under these circumstances, it is to be supposed that the records do not show the occurrence of venereal disease as fully as was the case subsequently. The second million men, referred to as P2 was called between May 1, 1918, and November 11, 1918. On the physical examination blanks used for the second million men, two spaces were provided for major defects. Local boards and camp examining boards were well organized and running smoothly. The records, therefore, are more complete. This second million was in reality 1,780,000 men, and, as notations shown on the original table2 are based upon 1,000,000 men only, figures used in Table 42 are raised by multiplying those in the original table by 1.8, in order to estimate the total number of cases.

TABLE 42.-Defects found in drafted men-Venereal disease (all) ■ b

• Source of information: Defects Found in Drafted Men. War Department, 1920, 424. A-Men selected for full military service. B-Accepted for remediable treatment. C-Accepted for special or limited service. D-Rejected at camps. Vg-Rejected by local boards. Pi-First million men. P2-second million

men and others.

279
54

291
54

24 24 1,458 1,482

1, 501 2,745
35
198
490 4,333

4,246 233 4,823

8,787
353
5,958

27, 140

3, 714 102, 334

31 36 1,791 1,827

2, 026

7,276