direct the course of reëducation so that the maximum beneficial results can be obtained. The direction of his energy and knowledge to this end will redound largely to the happiness of the individual who can be transformed from a helpless burden to a more or less useful existence, as well as prove an enormous economic saving to the nation as a whole. The knowledge gained in improved methods of surgical treatment during the world war will result in better results in the treatment of industrial accidents in peace time. No XIX PREVENTIVE MEDICINE AND THE WAR1 VICTOR C. VAUGHAN O educated man, civilian or military in his training and life, now questions the importance of keeping the soldier free from infection. That health is at all times a nation's greatest asset and disease its greatest liability has become a recognized truism. Never in the history of the world has preventive medicine had so great an opportunity to demonstrate its value in the service of mankind and that it has not failed in this demonstration all admit. From all parts of the earth, bearing every known infection, millions of men have been assembled and disease has at no time and in no way become a deciding factor in any military enterprise. The mobilization of raw untrained men,and their hurried transformation into effective soldiers, has always been accompanied by marked increase in morbidity and mortality. The assembly of young men in camps acts like a drag-net bringing to a central point all infections prevalent in the areas from which these men come. The wider the area, the larger the number of those brought together, the greater the susceptibility of the individuals constituting the assembly, the more closely they are crowded together and the more intimate their contact, the larger the number of bearers of infections, the more virulent the disease-causing organisms brought into the camps, the greater will be the morbidity and 1 For the scientific details upon which this Chapter is founded see papers by Col. Victor C. Vaughan and Capt. Geo. T. Palmer in the "Journal of Lab. and Clinical Medicine," August, 1918, and July and August, 1919. mortality from communicable diseases. Our Government assembled within less than two years nearly four million untrained, undisciplined men, most of whom were unacquainted with the details of personal hygiene and without experience in caring for themselves under conditions of army life. That the morbidity and mortality from communicable diseases among these should show an average above that in the civilian life from which they came was to be expected by one familiar with the science of epidemiology. The purpose of this writing is to ascertain to what extent preventive measures succeeded in holding down the death rate from communicable diseases among our soldiers, especially in the camps in this country. In doing this it will be best to divide the period covered by our active military operations into three seasons: (1) From Sept. 29, 1917, to March 29, 1918. On the first of these dates the camps were fairly well developed and this period covers the winter months and our findings can be compared with the summer months with reference to the seasonal influence on the character and spread of infections. (2) From March 30, 1918, to August 31, 1918. Under usual conditions the month of September would have been included in this "Summer Season," but the appearance of the pandemic of influenza early in September led to the division here indicated. (3) From September 1 to December 31, 1918. These four months we have designated as the "Autumn Season" or the "Influenza Period." THE WINTER OF 1917-18 The death rate in the army should be compared with that for the same age period in civil life. The comparison should be made on the records for the same year and the same season. Through the help of the Health Commissioners of certain cities we are able to do this. Most enlisted men in the army were between 21 and 31 years of age. The period nearest this available in civil statistics is the age between 20 and 29 years. comparing these figures there is a slight disadvantage to the In army on each of the following points: (1) The death rate in the group from 20 to 29 years of age is lower than that of the draft age from 21 to 31 years. (2) The death rate in these ages is greater among males than among females. (3) The army includes more men above 31 than below 21. (4) The population of cities is as a rule overestimated and a slight overestimate in the population lowers the estimated death rate markedly. With these explanations a comparison of the army death rate with the rates in certain cities, expressed as annual rates, is given for this period in Table 1. TABLE I Annual Death Rate per 1000. (Age 20 to 29 Yrs., Time, Oct., Nov., Dec., 1917; Jan., Feb., Mar., 1918.) It is seen that the average death rate in the camps is higher than that of any city with the exception of New Orleans. As is true of cities the death rate varied widely in different camps, as is shown in Table 2. By comparing tables 1 and 2 it will be seen that 13 camps had a lower death rate than New York and St. Louis for the age group of 20 to 29 years and in some this rate was about one-half that of these cities. The diseases responsible for the greatest number of deaths in the army during the period now under consideration are the acute respiratory diseases. These are named in the order in which they caused death as follows: pneumonia, meningitis, measles, scarlet-fever and diphtheria. With the addition of tuberculosis these caused 77 per cent. of all deaths. Sixteen per cent. were due to other diseases and seven per cent. to mechanical injuries. Assuming the conditions in the registration area for 1915 to be fairly representative of other years we may express the relative fatality between civilian and army life during the six winter months as follows: Pneumonia was 12 times greater in the army. The low tuberculosis rate is due to the elimination of those in the active stage of this disease and most of the deaths from |