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used by pathologists and have proved of distinct value in establishing a correct diagnosis as well as assisting in the establishment of the reliability of the Wassermann test.

One of the greatest aids to the physician in the diagnosis of syphilis is the so-called Wassermann reaction. This is an extremely interesting laboratory procedure and one which has assisted greatly in the proper diagnosis and treatment of the disease. In 1901, Bordet and Gengou, while studying complement observed that under certain conditions the complement became fixed and was thereby made unavailable for further reaction with the materials which they were using. Wassermann and Bruck took advantage of this particular phenomenon for the diagnosis of syphilis. They observed that the blood or spinal fluid of persons suffering from syphilis contained a so-called antibody. This antibody, when brought in contact with an antigen, served to fix the native complement present in the serum. Owing to the fact that complement is readily destroyed or made inac-. tive by heat they concluded that if a known amount of complement could be added to an inactivated serum and its specific antigen also introduced, the three substances would unite, fixing the known amount of complement. By introducing a second amboceptor and by also adding washed blood corpuscles, it could be easily ascertained as to whether the complement had been fixed or not. This reaction while appearing to be very simple, is quite complicated, as the various reagents used must be carefully prepared and standardized, and the conditions under which the test is made must be accurately controlled.

Since Wassermann first presented his serum diagnosis for syphilis many modifications have been suggested. At present a large number of antigens are in use, some being preferred by one observer and some by another. Other details of the method have also been modified to correspond with the experiences of various observers. In general, however, the original method of Wassermann is still in use.

Here again we are confronted with the problem as to the relative merits of the various methods of diagnosis. The physician must understand the limitations of the laboratory worker and should familiarize himself to as great an extent as possible with the methods in use at the laboratories where he submits specimens. With this knowledge at hand he will be much more able to interpret the results furnished him and correlate his clinical findings with the laboratory results. As has been so often pointed out, it is only by such correlation that the greatest benefits can be secured. The physician certainly must realize his limitations of diagnosis, but at the same time he should not base his conclusions entirely upon the laboratory findings.

Quite frequently a physician is unable to establish a definite history of syphilitic or gonorrheal infection; at the same time the condition of the patient is such that he is unable definitely to establish a diagnosis. He is reasonably positive that the patient is suffering from either one or the other of these two diseases. I have in mind at the present time a case which was under observation by an Ohio physician who was unable definitely to establish a diagnosis. Repeated examinations of the blood and spinal fluid gave negative results.

for syphilis nevertheless the physician was reasonably certain that the difficulties were caused by a syphilitic infection. After consultation with the patient he decided to try the syphilitic treatment, to which the patient responded very satisfactorily. Such cases as these are bound to arise but should not detract from the value of having the blood tested for syphilitic infection. It is also possible to secure false positive results by the Wassermann test. The physician, however, should become familiar with those conditions which may cause a false positive and be particularly careful not to collect blood from persons who are suffering from diseases or other conditions which may influence the examination. By co-operation between the attending physician, who has an opportunity to study the patient, and the laboratory, very satisfactory results, and results which should be of distinct value to the physician studying the case, should be secured.

FIVE PERCENT OF MEN

IN U. S. HAVE SYPHILIS It is certainly a conservative estimate, in the face of such statistics as we have, to place the percentage of syphilitics among the adult male population of the United States at more than five percent.

If syphilis is five times as frequent among men as among women, more than one percent of the women are syphilitic, and more than three percent of the entire population are syphilitic. That is, there are now approximately 1,200,000 adult syphilitics in this country. And these figures probably considerably underestimate the facts. This gives some intimation of the widespread extent of syphilis, and of its enormous importance.

It means that as a result of its late manifestations it causes in the aggregate an enormous wreckage of human life.-W. A. Pusey, "Syphi lis as a Modern Problem."

RESOLUTIONS PASSED AT U.S. HEALTH CONFERENCE

State and territorial health officials, meeting in their sixteenth

annual conference with the United States Public Health Service, at Washington in June, passed resolutions as follows:

Urging extension of Federal aid to states for improving rural sanitary conditions.

Advocating a Federal system of supervision of health in war industrial centers, to be established by co-operation of the Public Health Service with state and local health and labor authorities.

Congratulating the State of Arkansas on having its compulsory vaccination law sustained by the state supreme court.

Endorsing the Chamberlin-Kahn bill providing Federal aid for venereal disease prevention work of the

states.

Recommending that the surgeongeneral of the Public Health Service appoint a committee to study the problem of sanitary disposal of human excreta in unsewered communities.

Recommending that the Public Health Service ascertain by questionnaire the number of public health workers in the states who have left for Federal service and the number who probably will leave in the next few months, the results to be used as the basis of a statement by the proper authorities on the Government's attitude toward such depletion of state health organizations.

REHABILITATION OF DISEASED AND INJURED SOLDIERS DUE TO THE WAR*

T

MAJOR ELLIOT G. BRACKETT, M. R. C., Washington, D. C.

HERE has been rather an unusual plan in reference to this war in that the aftermath has been taken care of, or is being taken care of, even before it has begun. Usually the soldiers who have come back from war disabled and diseased have been cared for only by the emergency which they themselves have created. The Surgeon-General, however, this time has already anticipated that and has taken very elaborate steps toward the control and caring for these men who, we know, are coming back sometime after our part of the war begins.

It is the object and policy of the Department to consider that these men are taken into the Army and are wards of the Government. The men are taken out of civil life where they are well and wageearners in normal civil capacities, and in the service which they are giving to the country, they are disabled. Therefore, it is the duty and the privilege of the Department of the Army to care for these men until they are put back into civil life as nearly restored phys:cally and industrially, as possible. This means that they are to be kept under the control and under the guidance of the Army until all of this is accomplished.

To do that, plans have been laid for the early care of these men, almost at the time of the injury. Therefore, for the physical care of these men, special hospitals already have been ordered and are under

*Delivered before the American October 19, 1917, Washington, D. C. Health.

way, so that these men who are injured shall promptly have the care of those specially trained physicians and surgeons, in order to avoid the disabilities that come and have come always in wars from delay. This means an elaborate preparation for this kind of work overseas, particularly in France, and there are over there now, a large number of men who are under training and who are working with those in the English government, not only helping them out in their work, but at the same time getting the training which can be of use when they are sent over to France to work among our own American boys. When the disabled arrive in this country, there will be special hospitals to be known as Reconstruction Hospitals.

Here the men will be restored to the greatest potential degree of physical efficiency. An important factor in this work will be the supply of a very large number of artificial limbs, and steps are already under way to provide for these in sufficient numbers. It has been found that in England, where it has been more definitely studied by our people, that they are able to restore for service of those who have been sent back for repair, nearly 70 per cent to 80 per cent. When once this has been done for the soldiers, the enthusiasm that is awakened is, as they tell us, very encouraging. One of the most encouraging phases of this war is that they not only want to get back into serv

Public Health Association, General Session,
Reprinted from American Journal of Public

ice but do get back. There are many men over there, supplied with artificial limbs, who have become aviators and many others physically disabled have gone back to the front and have taken part in actual service which is practical for them even with physical handicaps.

The physical repair is not difficult; the important element is bringing many of these men back industrially so that they can return. to their civil life and still be wageearners. This means a new aspect entirely, because with it means the passing of the word "crippled." These men who have been brought back usually have been sent into the community practically as cripples and have not been able to take part in their life again because returned really handicapped.

These men can very easily, as has often been said, be put back into places where they can fill now vacant positions, but they necessarily will be positions far less important and less to their satisfaction to maintain than those they had left. It would not be fair to take a man who had been a good mechanic, earning good wages, and ask him to take the place of a messenger or possibly an elevator man, or as some one suggested, a floorwalker. The opposite idea is exactly the one that is being followed out. That is, when a man comes back, it will be the endeavor to put him into a degree of efficiency higher than previously, so as to be returned to industrial life again to earn at least the same wage or better than before. This will result in putting the man who will be sent to an employer on a purely business basis able to earn his pay. That is the fundamental part of this plan. To do this, associated with all the hospitals, there are to be established and already are being made

some form of industrial occupation.

In the larger ones abroad there are so-called industrial workshops, and for this the better term is really "curative" workshops than industrial, because it has been found that these men can be put back into these simpler forms of industrial occupation and that used as the means of bringing them back into their life and into their health. For a simple illustration - an injured man has returned with a stif- · fened joint that needs a certain amount of activity to get back its strength and mobility. Instead of applying it entirely by therapeutic means, he can be given some kind of a machine that not only develops him physically but at the same time allows him to use that joint a little more each day.

In this way there is accomplished that therapeutic purpose by means of an industrial occupation which is the foundation work of industrial repair. Each one of these hospitals will be equipped with means of teaching these men the different forms of occupations, and associated with that will be facilities for employment bureaus, so that the disabled can obtain occupation in the line which he has taken up to learn. For example, if a man should come into a hospital in this part of the country and he himself lived in a place in the Western part or in the South, and it was the object to return these men as nearly as possible to their homes, we must be able to say to that man "if you will learn a certain trade, there is a place waiting for you in your town or near your town." Therefore, it is the intention to ask all of the boards of commerce and the large business men to aid the government in this portion of the work. There is one other element of this that is very important, and

perhaps the most important of all. For two or three years, or more, the importance of the re-training and bringing back of men into industrial occupations, of those who are injured, in the ordinary industrial lines, has been very apparent. The value of this military work is going to be permanent, for it is hoped it can be used or adapted to link on with this very large industrial problem which has already begun to loom up as a prominent problem in the horizon. The very shops and the very, methods which will be established and can be established should be continued and carried on in the community as an industrial problem, so that, when this war is over, that part will be practically solved. Therefore, at the end of this war, it is hoped that we shall be able to hand over to the civil communities the solution of this very large problem.

It makes this work, then, not only that of meeting a very great emergency now, but it means that there will be a permanent work which will be turned over to the country at large. This is, in a few brief words, the plan which is being made to take care of these men who we know are coming back to us. The details, of course, are very elaborate, and I do not need to mention them here. I think we should bear in mind two conditions in the first place, we hope to wipe out the idea of having cripples after this war. We are going to give all these men a fair chance to go back into their old life again. Having given part of life and body to the country, we are not going to send them back into the community as dependents, relying upon the compensation given them and the charity and good-will of the community, but as efficient and inde

pendent citizens as before. The other point is that we are going to try to solve this problem so that the work will be of lasting benefit for industrial reconstruction.

NEW ARMY POLICY ON

DISABILITY DISCHARGES

A new and more liberal policy has been adopted by the war department in reference to determining when a soldier discharged for disability shall be regarded as having suffered the injury or contracted the disease "in line of duty." This policy is announced in General Order No. 47, paragraph 2, as follows:

"Hereafter any soldier who shall have been accepted on his first physical examination after arrival at a military station as fit for service shall be considered to have contracted any subsequent determined physical disability in the line of duty unless such disability can be shown to be the result of his own carelessness, misconduct, or vicious habits, or unless the history of the case shows unmistakably that the disability existed prior to entrance into the service. The same rulings shall apply in the cases of officers who have been passed as fit for service on physical examination upon entrance into the service."

This order modifies the ruling adopted by the surgeon general's office on September 11, 1917, which provided in part that "a case of chronic tuberculosis in which the length of service is three months or less shall be considered to be not in the line of duty; cases of acute tuberculosis shall be considered to be in the line of duty in all cases, irrespective of length of service."

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