EPIDEMIC RESPIRATORY DISEASE The Pneumonias and Other Infections of the Respiratory Tract Accompanying Influenza and Measles BY EUGENE L. OPIE, M.D. COLONEL, M. R. C., U. S. ARMY; PROFESSOR OF PATHOLOGY, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE FRANCIS G. BLAKE, M.D. MAJOR, M. R. C., U. S. ARMY; ASSOCIATE MEMBER OF THE ROCKEFELLER INSTITUTE FOR MEDICAL RESEARCH JAMES C. SMALL, M.D. FORMERLY FIRST LIEUTENANT, M. C., U. S. ARMY; BACTERIOLOGIST, PHILADELPHIA GENERAL HOSPITAL THOMAS M. RIVERS, M.D. FORMERLY FIRST LIEUTENANT, M. C., U. S. ARMY; ASSOCIATE IN BACTERIOLOGY, JOHNS HOPKINS UNIVERSITY _ILLUSTRATED_ ST. LOUIS C. V. MOSBY COMPANY 1921 COPYRIGHT, 1921, BY C. V. MOSBY COMPANY _Press of C. V. Mosby Company St. Louis, U. S. A._ INTRODUCTION Death from lobar pneumonia, bronchopneumonia and measles, fatal with few exceptions in consequence of complicating pneumonia, constituted in 1916 approximately one-sixth (16.8 per cent) of the mortality in the army,[1] whereas in 1917 the same diseases were responsible for nearly two-thirds (61.7 per cent) of all deaths. During the first half of 1918 the incidence of pneumonia steadily increased and in some army camps there were extensive outbreaks of unusually severe pneumonia. In July, 1918, the Surgeon General assigned a group of medical officers to the study of the pneumonias prevalent in the army and stationed them at Camp Funston, Kansas. At the base hospital of this camp all cases of pneumonia occurring among troops assembled in the camp were studied, but during the month of August there were few cases of pneumonia and these were of mild type. Pneumonia which occurred at Camp Funston during August was almost wholly limited to recently recruited colored troops from southern states (Louisiana, Mississippi). There was a low rate of mortality, and few complications. This pneumonia exhibited a noteworthy difference in etiology from that usually seen in civil life, for it was associated with a high incidence of those types of pneumococci which occur in the mouths of healthy men, namely, Pneumococcus atypical II,[2] Type III, and the group of microorganisms represented by Type IV. Pneumococcus Type I was encountered in only a few instances and Type II was not found, although these two microorganisms are responsible for two-thirds of the lobar pneumonia which occurs in civil life.