A STUDY OF DIPHTHERIA CARRIERS IN A MILITARY CAMP
Authors: FRANK R. KEEFER
Journal: JAMA (1918)

Writers on military hygiene have affirmed that diphtheria has never been of serious importance in the Army, for the reason that it is easily controlled.This opinion is not shared by the officers on duty at the Base Hospital, Camp Doniphan, since their experience has demonstrated that, under certain circumstances, an epidemic of the disease is exceedingly difficult to over- come.During the early months of 1918 the control of diphtheria, with especial reference to the carriers of the disease, was a very serious problem, which for a long time seemed but little influenced by the strenuous efforts of the staff.As shown in Chart 1, a few cases were constantly present from October, 1917, but it was not until the latter part of January, 1918, that the disease began to show a marked upward tendency.From that time it persisted, despite the most earnest efforts and carefully devised safeguards, for nearly four months.During the period cited, 461 cases and 686 carriers of diphtheria were observed.In their study, nearly 30,000 cultures were made and examined.By the greatest of good fortune, the degree of viru- lence of the responsible organism was slight.Only three deaths occurred, all as the result of myocardial degeneration, and the individuals concerned were already enfeebled as a result of antecedent disease.The condition, however, was serious militarily, since it compelled the withdrawal, from organizations engaged in intensive training for war, of more than a thousand men.These were separated from their com- mands for long periods, since the vital question was not how quickly a person might be returned to duty, but how long before it would be safe for his organization to receive him.The infection was exceedingly tenacious.The means employed for the control of the epidemic, though in many respects more vigorous than those sug- gested by authorities on the subject, for a long time barely • sufficed to maintain an equality between out- going and incoming cases.The intramural situation gave most concern.At a time when but few cases were under treatment, it was discovered that more than half of the twenty-six wards contained carriers, among patients and attendants.Though cultures were made of all in such wards, and infected individuals removed, the next search, at an interval of from five to seven days, was sure to reveal at least as many more who harbored the organism.The epidemic was finally overcome only when avail- able susceptibles had been segregated, or, in the course of military events, had been transferred elsewhere.STATISTICAL BASIS OF THIS SURVEY • No attempt is made in this paper to discuss the treatment of clinical diphtheria, its complications or results, as that subject has been thoroughly treated by others.We are chiefly interested in the discussion«of the diagnosis, treatment, results and control of the carrier condition and the epidemiology of the outbreak in this camp.The data for this paper were derived from (a) the study of 686 diphtheria carriers and 461 cases of clini- cal diphtheria; (b) the incidence of B. diphtheriae in patients admitted to the head surgery section; (c) the results of operative treatment in 294 diphtheria car- riers; and (d) laboratory investigations.