Certain conclusions readily flow from this table. All causes of death may be classified in the groups, (1) much commoner in the Army than in civil life; (2) much less common in the Army than in civil life; (3) of nearly equal commonness in the Army and in civil life.

To the group of causes of death that are commoner in the Army than in civil life belong the following: Measles, 219 times relatively more important in Army than in civil life; meningitis, 14.7; scarlet fever, 9.5; broncho-pneumonia, 9.3; lobar pneumonia, 3.9.

THE FRUITS OF PREVENTIVE MEDICINE

BY MAKING USE OF OUR INCREASING KNOWLEGE OF MEDICINE AND SANITATION SINCE CIVIL WAR TIMES IT HAS BEEN POSSIBLE TO PREVENT HALF A MILLION CASES OF DISEASE AND SAVE THE LIVES OF TEN THOUSAND SOLDIERS IN THE FIRST HALP YEAR OF MOBILIZATION

In this group the diseases are characterized by their communicableness. The hypothesis suggests itself that their high death rate) in the Army is due to the crowding of men at the cantonments.

To the group of diseases much less common in Army than in civil life belong: (Class I) Tuberculosis, cancer, epilepsy, acute endocarditis, organic diseases of the heart; (Class II) typhoid fever, diarrhoea, and enteritis, traumatisms; (Class III) diabetes, alcoholism, cirrhosis of liver, intestinal obstruction, hernia, rheumatic fever, ulcer of the stomach, Bright's disease.

The rate of Class I is low in the Army because liability to these diseases is selected against at the time of physical examination. Class II is low because of superior protective public sanitation in the Army. Class III is low chiefly because of superiority of personal hygiene and of medical care in the Army.

The third group does not show a very different rate in Army and civil life. It includes some of the less common diseases of the Army age-diphtheria, syphilis, apoplexy, pleurisy, simple peritonitis, acute nephritis. It includes also appendicitis and suicide which are about three-fourths as common in Army as civil life.

To summarize: The greatest defect in the defense of the Army against death by disease lies in inadequate protection against communicable (especially contagious) diseases. The crowding of camp. life brings special dangers which must be met by special precautions beyond those necessary in civil life. These precautions are particularly necessary when the troops come from rural States.

It is the function of the Surgeon General's Office to fight microorganisms in order that the General Staff may have live and effective men to fight for democracy.

While the record of diseases described in the foregoing pages may make disheartening reading, still the record must be made the facts must be faced, and our limitations must be overcome by research that shall lead to knowledge. Yet in this record of disease there is ground for encouragement rather than pessimism. A comparison with other American wars shows how great has been the advance of preventive medicine and how much it has increased the Army's effectiveness. Instead of the hundreds of deaths from typhoid during the Spanish-American War, the Army in 1917 suffered only 18 deaths from this disease. The first six months of the mobilization of the Federal Army during the Civil War, July to December, 1861, are nearly comparable as to season with the period July to December, 1917. Let us compare the morbidity for certain common diseases in the two Armies, 56 years ago and last year.

Table No. 136 shows the relative admission rate of certain common diseases in the Army July to December, 1861, and July to December, 1917. Figures denote actual number of cases of disease reported in the entire Army, of white troops. As the strength of the Army in 1917 was about three times that of the Army of 1861, the actual number of cases in 1861 has been multiplied by three.

TABLE NO. 136.---Admissions, first six months Civil War and present war compared (white troops).

This table, represented graphically in Chart 69, speaks for itself. Aside from gonococcus infection (which is probably commoner now than formerly, and is almost certainly more carefully diagnosed) none of the diseases of the list show an important increase over 1861. Measles and mumps apparently show a slight increase. The great reductions in disease are those brought about by improved sanitation. Diarrhea and dysentery are reduced from 244,000 to 11,000, due to treatment of feces and fighting the fly. Typhoid fever is reduced from 10,000 to 225 by keeping down the fly and especially by protective inoculation; typhoid, the former great scourge of armies, has become as negligible as smallpox. Malaria has been reduced from 167,000 to less than 2,000, due to elimination of mosquito breeding areas.

Mouth and throat infections have been cut in third by better ventilation, preventing of crowding and spitting, and the isolation of carriers. The result for the various diseases amounts to a saving during this half year of mobilization of about half a million cases of sickness and the rescuing of the lives of ten thousand soldiers. Of deaths in 1917 there were 2,984 in Army enlisted men in the United States. For the same strength in the Civil War there were 13,959. Thus the advance in sanitation and preventive medicine since 1861 has saved in the first half year of the war over 10,000 lives.

F. FRACTURES.

The total number of fractures occurring in the Army for 1917 was 6,469, of which 89.6 per cent were simple, 7.4 per cent compound and 3.1. per cent comminuted.

I. SIMPLE FRACTURES.

Two thousand and thirty were caused by falls, 2,006 by agents not stated, 498 by crushing accidents, 430 by automobiles, and 320 by animals. Other agents as motor cycles, railroad accidents, machinery, etc., caused a lesser number. Only 39 simple fractures were caused by aeroplane accidents.

The metacarpals, radius, rib, clavicle, tibia, and fibula were the most common locations and comprised 58.8 per cent of all cases.

The metacarpals were not divided into individual groups to determine the proportion of fractures of the various bones.

There were 674 fractures of the radius; 76.8 per cent were of the lower, 7.1 per cent the middle, and 3.7 per cent the upper third. This does not include 43, or 6.4 per cent, of cases in which the location of the fracture was not stated; 36, or 5.3, per cent through the head; and 4, or 6 per cent through the neck. The total number of days lost was 14,292.

There were 2 cases of fracture involving the first rib, 15 the second, 27 the third, 17 the fourth, and 37 the fifth, 40 cases with one rib fractured, 122 with two, 17 with three, and 8 with four. In 50 per cent the location or number of ribs fractured was not stated. In two cases the patient died, 1 with two and 1 with three ribs fractured. The days lost were 6,214.

Fracture of the clavicle occurred in 526 cases; 21, or 4 per cent, were of the inner; 194, or 36.9 per cent, the middle; and 138, or 26.2 per cent, the outer third. In 173, or 32.9 per cent, the location was not stated.

Fracture of the tibia occurred in 490 cases, of which 207 were accompanied by fracture of the fibula, 1 the astragalus, and 1 the radius. In cases without an associated fracture of the fibula, 137, or 48.7 per cent were of the lower; 73, or 26 per cent, the middle; and 32, or 11.4 per cent, of the upper third. This does not include 32, or 11.4 per cent, without associated fracture in which the location was not stated and 7, or 2.5 per cent, in which the fracture was through the head of the bone. Of the fibula fractures, 115 were of the lower, 57 of the middle, and 8 of the upper third. The location was not stated in 26 cases and in 1 the fracture occurred through the neck. The total days lost in fracture of the tibia alone were 10,799, and in cases where both tibia and fibula were fractured, 10,867 days.

The fracture of the fibula alone occurs in 466 cases; 371, or 79.6 per cent, being of the lower; 30, or 6.4 per cent, through the middle;

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