TABLE NO. 120.-Complications of fatal cases of tuberculosis, enlisted men in United States, 1917. Mumps was one of the commonest of the infectious diseases prevailing in our Army camps in 1917. In fact, it was one of the very few diseases which reached greater proportions in 1917 than in the corresponding initial period of our Civil War. Among the enlisted men in the United States mumps was a cause for admission to the sick report in 21,725 cases, or 4.39 per cent of the total admissions were for mumps. Gonococcus infection, measles, diseases of the tonsils, bronchitis, and influenza were the only causes having higher rates. Among our troops in Europe mumps accounted for 11.03 per cent of the total admissions to the sick report, being outranked only by bronchitis and influenza. For the most part, the mumps that occurred was of a mild type and few deaths resulted from it. The most frequent complication reported was orchitis. No discharges from any branch of the service were attributed to mumps. The seriousness and importance of this otherwise relatively unimportant disease lie in the large number of days lost to the service on account of it. Among the enlisted men in the United States 5.62 per cent of the total number of days lost on account of disease were due to mumps. Measles and gonococcus infection alone were more serious from this point of view. Among our troops stationed in Europe mumps leads all other diseases as a cause of lost time and accounted for 13.57 per cent of the total number of days lost. Below is a table showing the number of admissions and deaths due to mumps by armies and by color in the United States and Europe. TABLE NO. 121.-Mumps, enlisted men, 1917. The above table of admissions becomes more significant if we substitute the ratio per 1,000 men for the absolute numbers. Distribution of admissions to mumps, Army in United States, by State of nativity of enlisted men. Charted in four grades. The darkest areas indicate greatest resistance to (least incidence of) the disease. The order of States, together with the limits of percentage of incidence of the disease represented by each grade of shading, is as follows: 1. 0.6, R. I., N. Y., N. J., Conn., N. H., Mass., Pa., Nev., Md., D. C., Me., Del. 2. 0.6-1.0, Mont., Cal., Wash., Ohio, Ill., Colo., Ariz., N. Mex., Vt., Minn., Wis., N. Dak. Wyo., S. Dak., Oreg., Idaho, Utah. 3. 1.0-6.0, Mich., Ind., La., Mo., W. Va., Okla., Nebr., Iowa, Kans., N. C., S. C., Tenn. Ky. 4. 6.0+, Ark., Va., Fla., Miss., Ala., Ga. Tex., and Regular National National Total. Regular National National Total. colored. Army. Guard. Army. Army. Guard. Army. Considering first the distribution by Army, it will be seen that both in the United States and in Europe, among the colored as well as the white troops, mumps was much more prevalent in the National Guard than in either the Regular or National Armies. The above tables show us that mumps was twice as prevalent among our troops in Europe as among those in the United States. This increase prevailed in all three armies and among both colored and white troops. As mentioned before, very few deaths resulted from mumps. A total of nine deaths resulted from 25,472 admissions. The death rate was consistently greater in Europe (0.02 per 1,000) than in the United States (0.01 per 1,000). It may prove of interest to treat in some detail the distribution of mumps by camps of occurrence and State of nativity of the victims of mumps in the United States. Following is a table of the rate of admissions per 1,000 mean strength in the National Army and National Guard camps. TABLE NO. 123.-Admissions per 1.000 mean strength, by camps. This table serves to emphasize the difference in the rates for National Guard and National Army camps. The rates in the National Guard camps are considerably higher. However, in both armies mumps reached epidemic proportions in several camps. Camps Beauregard, Wheeler, Bowie, and Shelby have the highest rates of admissions among the National Guard camps while Camps Lee, Travis, Jackson, and Pike have the highest rates among the National Army camps. Some idea of the size and duration of the epidemic in these camps may be gained from the following list of admissions taken from the monthly reports. TABLE NO. 124.—Admissions, National Guard and National Army. It is very noticeable from the above table that the numbers of admissions in all of these camps increased appreciably from month to month and reached their maximum frequency in December. In this respect the epidemics of mumps differ somewhat from the epidemics of measles which almost invariably reached their maximum in November and were well under control in December. Mumps on the other hand ran well over into January before being checked. The above eight camps having the highest admission rates for mumps, all quartered troops coming from sparsely settled and rural regions. With the exception of Camp Lee they received very few troops from the larger towns and cities. Perhaps somewhat more than a third of the troops in Camp Lee came from the larger towns and cities. On the other hand, the camps showing the greatest immunity from mumps received men from the more densely populated areas. Among these are Camps Dix, Devens, Meade, and Upton of the National Army and Camps Wadsworth, Hancock, McClellan, Logan. and Sheridan of the National Guard. In other words, we find a distribution for mumps very similar to that noted for measles. Being also an infectious disease it seems reasonable to urge the same causative factor of immunity for mumps that was suggested for measles. In the cities mumps are so widespread that practically every child suffers an attack at or before his early school years and consequently grows up immune to mumps. But, on the other hand. in sparsely settled areas many individuals grow to adult life without having become immunized to the disease. The fact that we have at the one extreme a very high rate of admission among troops born in the rural States of Georgia, Alabama, Mississippi, Florida, Virginia, Arkansas, Texas, Kentucky, Tennessee, Kansas. Nebraska, and Oklahoma while at the other extreme we have an apparent immunity among the troops coming from the more densely populated States of Rhode Island, New York, New Jersey, Connecticut, Massachusetts, Pennsylvania, Maryland, Delaware, and District of Columbia seems to indicate that in the case of mumps also the early acquisition of immunity through crowding is an important factor in determining the rate of mumps in the camps. Crowding in camp quarters or in hospitals have also undoubtedly tended to facilitate the spread of the disease among those who were not already immune. VIII. TYPHOID FEVER. 1. GENERAL. Since 1911 the Surgeon General's reports have each year presented an increasing amount of convincing evidence of the value to the Army of compulsory antityphoid inoculation. In 1917 this method of protection was of course tested on a much greater scale than ever before. but the results have justified the previous conclusions as to its value. Substantial protection has been secured not only against typhoid. but also against paratyphoid A and B by use of the triple typhoid vaccine adopted soon after the declaration of war. It will be noted in the statistical part of this report that during the year 1917 there were 297 cases of typhoid; 13 cases of paratyphoid A; 7 cases of paratyphoid B. A large proportion of the cases occurring in this country were in men who were in the incubation period of the disease on their entrance into the military service. The reports |