NATIVITY State of occurrence Fla Tex La Ala Miss. Ga. Calif SC. Ark Okla NC. TennNMexAriz Va Ore Wash Md Del. Ky WVå NJ Ohio Ma M 186 2 12 31 196 86 55 64 61 30 14 96 17 30 57 6 22 6 6 11 3 35 10 20 4146 56 SUM 2 QUADRANTS 942 CHART NO. 59. SUM UPPER QUADRANTS 1140 Ind Pa Kars RI. Utah Conn Colo Nev Mass Ida Mich III. Neh la Wyo Me. NH. Vt. Wis SD Mont Minn ND DC. Elsewhere of broncho-pneumonia from troops who were natives of warm States and were located in warm States. There were 252 cases from troops born in cold States and located in warm States. There were 54 cases among troops that were born in warm States and were located in cold States and 105 cases among troops born in cold States and located in cold States. Putting the total strength at 1,325,000 and making assumptions as in the case of broncho-pneumonia and by means of similar calculations, we reach the following rates of incidence per 100 men of admissions for broncho-pneumonia. If all these approximations are warranted, the following conclusions seem to be justified: Broncho-pneumonia affected troops in the following order of susceptibility: Comparing the distribution of lobar and broncho-pneumonia by States of occurrence, it appears that lobar pneumonia was relatively the commonest in the Gulf States and Arkansas and least common in the New England and Middle States and West Virginia. It is also low in Wyoming and Washington. The incidence of broncho-pneumonia (which is less common and more fatal) is somewhat different. Alabama no longer falls in the class of heaviest incidence of this disease. New England falls into three grades. Still the warmer States are clearly those of greatest incidence of the disease. In respect to the territory from which camps draw there is a smaller difference between lobar and broncho pneumonia. Whereas the natives of Coastal States are little affected by lobar pneumonia, this is not true of broncho-pneumonia. In general, the occurrence of lobar pneumonia seems to be more dependent upon meterological conditions than is that of broncho-pneumonia. 3. MEASLES AS PRIMARY TO PNEUMONIA. Pneumonia, primary, either lobar or bronchial, is a dangerous disease, both because of absolute number of admissions to sick report and because of its absolute mortality; but these diseases become much more dangerous when they occur as complications to measles. Thus, of 1,354 admissions on account of broncho-pneumonia complicating measles in white troops 45.6 per cent died, and of 680 admissions on account of lobar pneumonia complicating measles, 38.7 per cent died. The colored troops did not suffer relatively as much as white troops from these complications; though primary lobar pneumonia was relatively more numerous and relatively more fatal with the colored troops than with white troops. The relation of measles to the pneumonias is not so much that pneumonia depends on measles for admission to the body, since there are nearly four times as many cases of primary pneumonia as of pneu rmonia following measles. Also, only a small proportion of cases of measles are followed by pneumonia; out of 47,573 cases of measles in the United States only 2,075 were followed by pneumonia. The striking fact is that when pneumonia does follow measles it is so often fatal. Measles diminishes resistance. It is to be noted, moreover, that when pneumonia follows measles, pneumonia is thrice as frequently of the bronchial as of the lobar type, though in primary pneumonia the lobar type is five times as common as the bronchial; and when broncho-pneumonia does complicate measles, it is fatal in 45 per cent of the cases, though when primary it is fatal in only 14 per cent of the cases. This is probably because the antecedent measles has diminished resistance or else has permitted a more virulent organism to enter into the tissues, namely streptococcus haemolyticus, which produces the so-called interstitial broncho-pneumonia. In negroes this especial morbidity of broncho-pneumonia complicating measles is striking. Thus, primary broncho-pneumonia is less fatal in that race than primary lobar pneumonia, but, as a complication of measles, broncho-pneumonia is nearly one and three-quarters more apt to end fatally in that race than lobar pneumonia. The colored race resists lobar pneumonia following measles, but it is relatively unresistant to broncho-pneumonia complicating measles. Also, this relative predominance in the mortality of broncho-pneumonia over lobar pneumonia complicating measles is greater in the colored than in the white troops. TABLE NO. 93.-Complications of primary lobar pneumonia, enlisted men in United States, 1917. |