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Volume VI     January, 1918 - October, 1918


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I3IRml? OF THE IYORFL I?? !mE BOSPITAXL
      Dr. Cole.

Durirq the past quarter investigation lmr been tip& hzmdloapped owing

the ftult t&at osjw of the norIcer have left to engage in a.nny aotivitler.   Moot

theBe men rsr??$o~qJsd in the actual cbxe of mtieata, and with the opening of

u peumonia seaoan it boome evident that it would be neoerruy to obtain aorm

. ..i of mbstltutor to oaray on this part of the k4t.  It slm reemed of import~s

,l - ua to iaetruot ar mung army msdiop1 offiosrr u poraible in the methadr of wwwr~

rdatment in pneumonia.

Ccmoequently, wtiSJ upon #e authority of the Both of Soientifia Dire&cm,

! Invited the Burgeon Generti of the Axmy to mnd to the horpitrl `a lbulteb muiber
                                                                           3'

bf medical off icerr to arrirt in the tre&mnt of. patientr with lob- ha, b

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ordur that the offiurrr. ouuld beooao: ,tho~; fmllir;r withlthe
                                           2.         i..   method,~of t&t-
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                                   e

.

Six to eS@tt hemmen hem been rerident in the hospital met of the time.
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                          Itham : y,;

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of atlologic dJm&naoir aad 80ruEi tatmant.  Axt l,qQorfmt prrt of the mSk h88   `. `. .;
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been to teeoh them how to avoid merum reaction8 and to recognlos them when they

OOCIIT.  Most of the offioarm rent havm been Oapblm young men and we feel that

the plan haa worked out ratirfsctorily, both for the hompital and the army.  mng

the part qusrter, 99 patient8 rufferlng fram pruunonir have besa treated in the

horpltrl.  TM8 ir 8 mush larger nunbor than wm har8 ev8f treat8d bdorm in tb

as'88 tim8.  lrighty Of ths.8 potientm ???? o 01di0r0, twenty-three OiVfliaXl8.   Moat

0f the roldlera wure from Cmp blillm-  Thlm aaq ham now bean praetioally abandon&.
                               .

corurqumtly the xwmbmr of o oldler8 baing rant hero ham boon groatlJ redtxmd and

for a 8orpply of mat~1m.l we are atgain depimllng upon uirlliul 8OurO.8.

!Cho rmmultr from the rtudy of the p&noni~ Oa808 aumng the o oldlerm bsr8

been of interest u throwing light on thm mitt&ion in the amy 0-8 wrkure

pos~naaia im prmileat, but it irn obrfoum that our 8xperiezuu ha8 been mtmh too

             _... ./. ;
meagre to per& Uy; `fl&1:`*&iulrpioa8 I
                          to be drawn.

different type8 of p2mmoooeal.  Of the 23 aamem o~pnmmonls, 6 were due to Type I

pnm~~ooo~i, 6 to Type XI,%3 to Typa 11x; '2 to`- III, ad 2 td!Typa I?.   a     ,'
                                                                           I

butinthim 8UUd1


serimm of Oame8 thim mfght.well be due to uhmae.  In addition to theme 21

caesc, all of whiah were ahamaterietioally lobar gmeumonir, there were two uBme8

Of pin8IXOOZlia in &tdt8 Whbh Weed rBBOOi&ted with the PrOBeMe Of  nOn-hscrmplyfit3

ctrepto0oooi and 8t~~bOOC4Oi reqaOtir01p.  The 8ta~yloowoum Oamo died on thi

7th d&y but ILO 8tltOpB~ -8 obttid.   !the 2!iOYldAO8KblyfiO 8tr~tOOOWtl8 OcI8@

recovered.  Both of theme 0~01 oouurrod in previo~rlyheilthyman 63 and 62

J-O=. of age n.pootive1y.  In both 08.e. tail0 OIl88t W88 fairly abn@t, thou& io. .

neither ln8tanuowa8 there aohlll.  In both of the.0 0Iu.8 the proO~88 in the    '

lungmayverywellhavebe&rbr~naho qmmmla, thotl$h in the 8t8~tOOWOtl8

oame there warn wall marked oonmtdttlon at one bore, with                           
                                 , however, txunmma

ralem In th8 other 1~.

Suoh uaaem, bo;edOr , have not only omurred thim pw - there hav8 be& "

dr rare bb88 i `cud `on &`oth& ban&; in .&at4 lobar pnmnis, there im not

infrepntly a ooaqpl~orting~brmOhiti8 in other part8 of the hngm.   !f!he


Among the eawr.in soldierr, ?Owero due to pmmmaocai.   Of theme 26

6 to Tm II, 16 to atgpial Type II

sere dne to Type I,,ppmmo~ocui, 1 to TypIII, and 22 to Type IV pr.munoooaoi.

The only stri.Idng t&hag about thir dlrtrlbution of oaaaa ir the large rnmbr of

OQBO~ dpe to atyploal Tw If pmmmxmi.  Thaw organiaw, hummer, were

dlotrlbuted throu&out the ae~@rlj. wb-grcmpr.  Our experhknoo , tharefors, hu

not given 8ny lndioation of an o piAumiO ouuurm0 Of PsMpmDnir of rrnp on8 typ8.

ITU~~ c&888 In our ~rlOaO0 for thir qmrter.   of the88 OUO8 fOtW WOPO dU0 to

hnrmlytio 8tZ?O~tOOOWi &Z-Id tW0 WOXW dJl0 t0 8tawlWWi.  fi1 Of th8 8tX'OptOOON

09808 were umcmlated with QIppprmr aad two of than died.  h UQtO~8y Wa8 obttid

                              1 :

on one of thue.  The l-8 in thi8 ofi80 &awed aa i~%'.@abrly dl8tributed Q&C&~

The two 0~88 of 8taphglooo0eu8 infeotion of the long. al80 dlod urd srrtopriar were

mrformed on both.  In 0136 o&m there wu all irregularly d.lrtributeb patoby


formation, however, were 88OZl.  The other also ahowbd a diffum purulsnt bronehitia

and bronuho-pneumonia,

Atmng8t the 76 a~881 of pneumonia aopng eoldierr, therefore, there were

G rrhich 8hould probdaly be oonaidored a8 b~naho-pneumonia in type.

.

During the tiim theme ptirntr were being rant to the hospital IlI8uh8

were prmabnt in th8 O~IQ, but ii1~30 we did not d88ir8 t0 Admit patient8 EUffer-

ing from !l%b(LI108, M attempt was mai8 on the gart of the umy oniobrr to 68Xld ll8

.

no pathntr that war0 mafiaring from mrarlrr or were in early oonval8mance.

::cvarthdf38S, thb.3 of the patient6 w'twe Imad to have ?ud meeeles very recently.

!ho of them had typiaal lob- pkeurmnia, one dw to gaimm0oa0~8 Tp IIT and one

to ?* o ??????? Ty~w 11 -00cP8, the Other 0I8. W&a On8 with 8 8ta~ylWOWU8

bronaho-prmmxmia, and thir pltitmt died.

prevalent in Cemop Wheelor, I add for md obWned permlrrion prom the Burgeon

General to wnd Dr. Stllrlrmn thar@ to x&e @uaW ob8erva~ionr.  Aooordingly, Dr.

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Stillsmn went to Camp Wheeler On ITovwiber 10, but the oondiflonr were not suitable


for meking acaurate rtodler; It wu ovidant that the problm wu 8 mwh more ooqpl~

one than had been aatlolpatod a and he theraf ore remmined only IL week.  Eowever, fm

the rhrdier made th8ra end from the study of the maf8rlal he bruu&t home with him, .

it ha8 b8sn parrib t0 pltgb Otlo&&3 diagna888 on CL 8Orle8 of Oa808, though in th8

valu8 u th8ywodd otheml8e bo.

ldoreover, awing to twhnioal diffititier, determiartionr W8r8 not

coqplrtod on a o~nriflemable ms&er of 8p8eiorn8 obtained 80 that tha fi.guror do not

reprorent tb mtual oondltlon8 la a uontlauow &lo8 of patlontr.  me 8pullmnr

of sputum rkudbd ware obtalnod from 0~88 oomfdand frank lobar pmamnia, the

xuuibar ofthamthatw8ra OOrlvalo8aontfromma8le8 i8XkOthUUL

Spwimgnr of sputum wen obtained from 98 oama of pmnmnla.   In thuo

8p0Oim+n8 EoumpoO~wi were lrolrtad'and $h@ !i!JpO ddbrddkl 51 k48tUM8.       :`..

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`hen wooooi were distributed irr the rrrioor groups &a follows :                  
                                                                           
                                                                           
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      -1 a0 .-'. 59$ ;                                ',
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"II '6 -,ll

= XII      3 - 5!

= Iv      10   * 19

In thlr brlof rtudy no attention w(u paid to the qouurzwzw 0 Of 8fSOJ&O-

couous pslsum~nia, and it ie quite pO88iblO that a nUIdbOr Of th8 08808 euffered


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from this form of infection.

~a Decsmber 4 Capt. Dochez wae ordered to Cm Bowie, Fort worth, Tm,

to aeslrt In etiping the gmmnmnia rituation ther8.  H8 wa8 joined there by Dr.

Jobling Who brou&t with him one of the Red Crorr laboratory care.   Dr Douh82'8

mrk aoneirted in daterrmiaing the type8 of pammoaoouur rerpon8iblO for the 1oba.r

pnsuwnla prevalllng in thir o&m@, in trying out in the field the mathod devised b)

PAvery for dOt8larining tm8 of ~OOUOUI, 8nd In lnhod~ing Into th8

laboratory the method8 of mkiag Iwh type dotorrninationr.

hbOr&tOry w8re all %TI8trUSt@d kr it8 080.

l?yp8 brt8rminatiOn8 w8re m8da b?Dri Ikahar on 78 018a8 of lobar pkOUnOni&

88 fOllOW8t

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ma88 in whloh tbs olinio& dl4$~?8i8 (1181 defiaitaly e8fabli8h&, over bli w8re

&mmnsttsrt8d to be due to m 1,


In addition to tfssee uase8 there prwsiled at the 04~~) I; large Imib8r Of

oe8e8 of bronaho~nla or oa8em of prumnmnla runn* an atyplaa.lo0ur8e.  M8q

of tham were M8OUiatOd with or followed mm8108, but in mum no much arroolatioa

was present.  hUtOp8i88 WeZ-8 perforrmd On 27 8U& 088tr#, aZid in 22 8lIQv Ua8

prssent.  BaPterlologioel examlnat ion8 of 16 fluid8 mhmed in 13 the prorena of

& hEWOlyti0 8tlYI~tOCiOW3U8.

It 18 ObTtOU8 thBt dl Of OtW 8YidOIlUO 18 80 fBr Very frrgmbnt-$`, - 18

alao that obtaiasdby Dr. Zlmrar at Cusp Wheelw, tio8e r8prt I have h&the

Op~rtanity Of 808ing.

It 10 quit@ oortaln, however, th&t in the O-8 rlhere ptIau8Wir ir

pr8YBhnt , Bt ' hUt two kind8 of -nary infO~tiOn8 Oxi8t ; f ir8t, miorl lobar

broadhoqummnh dru td 8traptOOOOOi~ did po88ibiy u80 t0 p&&0001.   tilao8t

of both then forma of pnlrmawy lnfwtion or only of the b%miho~~~.

2.  ?* ?? ??? ?? ?? ???????? o ???????? With aPsMh8 18 thi


3.   Ia aontaot infection of lmportanas in the spread of acute lobar     <fb>
                                                      t. `..[,    , 1'

pmU8onie in the oampr or 18 8xpoeur0, with consequent antoganom Infection, the

chief faator.

In ardor that these queetlons tmy bo rolvod, our experienae, whiuh I

haYe relat8d, iXldiC~t88:

.

1.  That all ca8eo of amtr pulmonary lplootion should rsaelvs an accurate

clinical dlagno@iiB.   To make this ~osrlbla IL thotbogh ollnieal 8tUdy MU careN

patho10g1c  inY88tigatiOn of th8 C&s88 Onding frttilp i. I16C88UFy.

       2.  So far aa possible the etiolodo weat oonasrned in o v8x-y case shotid

ha d8trrmind'd.

3.   The usoclationwith measlor or th8 aba8IX_8 of 8t%3h areociatlon

should be 88tabllrh8d In all aa800 of aauto pulmonary disease.

lbn much knowl@p (avk In one oamp) la obtained - epidemiologic studies

to 88t&l%8h tkm apooirtion of OBI68 of riudhr etiOlogy with oath other, the
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oauurronoo of hadthy Oki8t8 Of iZlf8CtiOn, 8fCo; aan bo carried out with moma
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hOp8 Of 8900888.

'It mag b8 expected thk& 80 far a9 amate labar pnetaadnio due to the

s~~Clfi0 tyP88 18 eonc8rn8d, it8 Ooourronoe i8 largel? lIAd8p8ndent Of outride
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fme,orr and that oontaut lnfeotlon lo of, Very gmat ilnpOrtMC8 as it Is in civilian

,

life, though dlroot evl&~e @hotid be obtain& to 88tabli8h thir.

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treated in ihe horpital and in oaoem under our imediate lugenirion oontimu to

be axusllent.  Ix the hoqital during the pmt cpnrter 29 uaaea have been treated

and all ham raoorardl but one.  In moat cmuba the rffeot of admlnlatratlon of

the mrmn ham been proxpt and uamirtUle.

In o nuubr of the army oampr treat&t la bolng aarried out, but in an

unfmient iii0 and unntiafbc4or;l nmnner.  until `prompt atld acaurata olinlo8l and

:vill aof yield lxpotturt iaforaprtioa u to tha value of this method.   The

,

conalt ionr, however, are impraring and it ir hoped that during the winter auah

i.nfonnation rrry be obtr(nrd.  So fu tbr mmultr reported to DY have all been

fworable, some of them brilliant, but moat of kaa muat be acoopted with reeeme. 1

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inoculation of certain meniberr of the otaff have ihown the oeooins to be more toxic

tti W86 UQOUted.   The method therefore will have to be modified before It uan be

ert earively emplOyOd.  It ie hoped and believed. that thir oan be done ?ithout

destroying the effect@.

IJew method for the dsterminstion of Typsr of pnemococoua perent in

SFUttmL  The rwity of mice has been a oeri0118 matter, M It bar made the general

apy;liurtion of the fomer method of rtlologic diagnoalr in pneunonls difficult.

Cr. Avery hrr rweeodod in &wiring a modiun ad a method which renAerr the tue of

mice unneCoumuy.  5% fact that pnetmococcus grow8 very luxuriantly and rapidly

in sugar aoatrirdng mediun, o rpeoially if blood bo premnt, is IU&I two of.   A

portion of rpatun ie added %v a 1 per oat glmose broth containing S per cent of

blood.  In five how@ the g~UIlOCOC~i havs trrually grown profwdy while the other

                           The m&ad he48 proved
with any of the sera It lr kaown that the`pm9po0000i uo of thr eorreopoziding type. A


of great value and in most oases a diagnosis can be mada more rapidly thsn by tha

older method.

Dr. Dsmhp has been working in the chemical laboratory determining the

optlmnm hydrogsn ion conoentration and optIrma salt oontsnt of msdlum for the

growth of ~oooai.  !l!hs pregaration of I very favoribls medium fori ths growth

of thssd organisms is a prsatlail nnd inpprtsnt matter.   This work is still In

pro& 88.

Dr. Cc&&,

At the request of the lhvti Reotiting Station ln New York, dnd of the

British Beorriiting Mimion, I undertook to axsmim aortain oandldatas for the

U. S. Tavy 6nd for the Bilt itih Royal Flyhg Corps.   The men referred here are

those who present dlffioulty in estimating the condition o`i the heart and
                                                          .

would not m&r ocUna.ry oirmmstmaom bo rejeotad; but who showed ~l~t~osrbiogr

whioh would no+ bo regudad (LO sibnonml.  an mrves of thou mbn are ,brfag

oollretod for skdy.  !L!hou f iabinga shuuld, if posslblo , later bo reviewed Ii

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the light of the service those man have been able to reader.


Stlmlated also by the needs of the war we have wor'ked out a nw form of

eleatrode for use ln sleotroaardiogra@y.   The new form Is rmmh 1088 mmborsoms

than the old ons md uonsmss muah less tlm In It a eme md in its adJu.stmsnt .

In aon,junat ion with Dr. B. A. Hatohsr of Corn11 University, we are

making rtudles on the &sags of h preparation of the tinoture of digitalis, designed

for use ln ths uwy , In the hops that ths new prspamtion may be sub at itutrd for

the unsatlsfsotory prspwrtions no- in uss.  Oar put of thw work oonsists In

compulng Dr. Hataher' a preparation with the one (dlglpurtum) we have ussd, In

Its effeot on ths oleotrooudlogran In nonad lndivida+ls 8nd In -nib.   Ilr
                                                                  .

the result of this study we should bo tile to glvq Its do~gs as peuisely as we

are now able to give that for dlglporrtun.

Dr. Allsn has oon$immd the st&iss previously mmtied as in progrsss.

These studlas me being

for thatmsnt and stydy. .

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