Notes on preventive medicine for medical officers, United States Navy / Department of the Navy, Bureau of Medicine and Surgery.

  • United States. Navy Department. Bureau of Medicine and Surgery.
Date:
1918
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Licence: Public Domain Mark

Credit: Notes on preventive medicine for medical officers, United States Navy / Department of the Navy, Bureau of Medicine and Surgery. Source: Wellcome Collection.

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    ONFIDENTIAL. [M. & S. No. 129655—1.] Preventive Medicine for Medical Officers, United States Navy. oles On DEPARTMENT OF THE Navy, Bureau OF MEDICINE. AND SURGERY, Washington, D. C., May 10, 1918. NOTES ON THE EPIDEMIOLOGY OF DIPHTHERIA. The epidemiology of diphtheria is better understood, perhaps, than that of any other acute communicable disease of the respiratory type. Probably local and State boards of health have had more practical experience in its suppression than that of any other disease because of its wide prevalence, because the principal facts in its etiology have been well known for many years, and the comparative simplicity of its bacteriological technique has made possible in almost all communities the scientific application of measures for its prevention and control. It is well known that diphtheria is frequently spread by healthy carriers as well as by per- sons ill with the disease. Much work has been done to determine the ine¢idence of carriers, both in the presence of epidemics and at times when the disease has not been g generally preva- lent. The percentage of carriers found among actual contacts varies from.10 per cent, where precautions are taken to isolate the cases, to 50 per cent, or even 100 per cent, mire no precautions are taken. Rosenau states that 1 per cent of 4,500 school children in Boston at the beginning of the school year when the disease was not prevailing were carriers of morphologically typical diphtheria bacilli. Among 4,098 healthy individuals in Detroit shortly after a time of greatly increased prevalence of the disease, Goldberger found 38 or 0.9 per cent to be carriers of morphologically typical diphtheria bacilli. Of these, however, only 0.097 per cent were virulent. His figures are low, perhaps, in comparison with those of other observers who have found between 2 and 5 per cent under similar conditions to be carriers of diphtheria organisms, with virulent bacilli in 0.1 per cent to nearly 2 per cent of the cases. Cold weather, density of population, overcrowding, prevalence of tonsillitis and acute catarrhal infections of the upper respiratory tract are all factors. which greatly increase the percentage of carriers who may be found. They also tend to increase the incidence. of the disease. Investigations have shown repeatedly that only a small percentage of the carriers detected harbor virulent organisms.’ The percentage will necessarily vary, depending wpon whether the disease is epidemic, or merely sporadic in the community, and upon whether the carriers have actually been in contact with a case of diphtheria. Unless these facts are recognized and given consideration it is possible to interfere seriously with naval routine and important naval activities by isolating great numbers of carriers who harbor nonvirulent organisms incapable of causing Aiphthteien: eed can not be determined with certainty without a guinea-pig test and therefore avy under war conditions it will ordinarily be permissible to limit the isolation of car- ; ose who have been in intimate contact with a known case of diphtheria. This Sanet Ait M vide te ee