1918 Journal of the American Medical Association (JAMA)  
Dr. H. W. Loeb, St. Louis : It seems to me that Dr. Wilson has gone even farther than Fraser in establishing some sort of organic basis for all of these conditions. I notice that in referring to the work of Bourgeoise and Sourdille, they claimed that when the shell explosion is in the open, unilateral deafness results, whereas if it is in an enclosed space, as in the trenches, it is likely to be bilateral. I would like to ask Dr. Wilson what he knows about this. Dr. Samuel D. Higgins, Milwaukee
more » ... Higgins, Milwaukee : I think it might be interesting to report a case of unilateral deafness that occurred in Milwaukee a few years ago when the McNamara brothers blew up a large coal bin. This man was injured by the explo¬ sion; only one membrane was ruptured, however. He had no deafness and no difficulty in the ear which was apparently not affected. The ear in which the drum was ruptured suppu¬ rated, but only for about two weeks. His main difficulty was shock. He was frightfully nervous and the best aid was the first aid which was given to him six hours after the explosion occurred. Dr. J. Gordon Wilson, Chicago : The ear protector I have shown will soon be on sale. All at present made have either been sent to the ordnance department or to France. Rubber or some plastic material such as wax molded into the external ear undoubtedly hinders concussion deafness, but these also block the entrance to sound waves and the soldier is thereby prevented from hearing orders. Regarding the benefit to be anticipated from ear protectors in the prevention of some forms of shock I can give no opinion, though I believe that very possibly they will be of use. Last autumn little attention was given to pneumonia as a probable menace to our newly formed army. The reports of only moderate or slight incidence of pneumonia among the French and English armies gave a feeling of security concerning this disease. We were not without warnings, however, for even in times of peace pneumonia had been the most fatal of the acute infections among soldiers, as it is among the civilian population. The experience of the troops along the Mexican border during the preceding year had also given some indication of the danger of this disease. With the onset of colder weather, in October, the prevalence of pneumonia among the troops became serious. During November and December it became alarming, and in certain camps it reached epidemic proportions. Its prevalence among the soldiers has not yet entirely ceased, even with the coming of warm weather. Previous experience, however, indicates that it will probably become less during the summer, but unless preventive measures are found and properly instituted, we run the risk of a repetition next winter of the experience of this. It is very fitting, therefore, that we devote a short period to the discussion of the measures for prevention of this disease. Time will not permit a review of all the details of preventive measures, and I shall therefore limit my remarks to a consideration of the principles involved. A year ago, a discussion of this subject would have embraced only a consideration of the prevention of acute lobar pneumonia due to pneumococcus. War causes rapid and unexpected changes. During the past few months, the experience in our army camps From the Hospital of the Rockefeller Institute. has entirely changed our point of view. Today, in considering this question, not only must we consider acute lobar pneumonia, but we must also include in our discussion broncho or lobular pneumonia having an entirely different etiology. The fact that two distinct diseases existed in our camps was not at once generally recognized, and even in the camps where this knowledge has existed, it has not always been possible clearly to differentiate the cases of the different kinds. Consequently, the rela¬ tive incidence of the two varieties of pneumonia dur¬ ing this first year of the war will never be known. Both kinds of pneumonia have prevailed in most of the camps, frequently simultaneously. Fortunately knowl¬ edge concerning the methods of differential diagnosis is now much more widespread than it was last winter, the laboratories are better equipped and better organ¬ ized, and in the future the different kinds of acute pulmonary infection will undoubtedly be better dif¬ ferentiated, with a corresponding gain in our knowl¬ edge of epidemiology and mode of distribution. Our consideration of the prevention of pneumonia will probably be rendered more clear by an independent consideration of the two diseases, for they must be considered such, at least from the standpoint of prevention. ACUTE LOBAR PNEUMONIA DUE TO PNEUMOCOCCUS The pneumococcus is a widely distributed organism in the mouths of healthy individuals, and since it sur¬ vives for considerable lengths of time in dust, great opportunities exist for its widespread distribution, especially when persons live in close association. A most important question, therefore, is, do persons acquire the disease because they receive the bacteria into their mouths, or on their respiratory mucous sur¬ faces, or is the important etiologic factor something antedating this, something which causes a change in susceptibility of the host either local or general? Does infection then occur with those organisms in the mouth which have the greatest tendency to grow parasitically ? It is obvious that the answers to these questions are of great importance as regards prevention, for in the one case, the chief attention must be given to measures for preventing the distribution of the infectious agent, and in the other, this is of little importance, and the chief attention must be given to the factors influencing resistance. So long as all pneumococci were considered identi¬ cal, we indeed had little justification for attempting to limit pneumonia by preventing the spread of the infec¬ tious agent itself, but were driven to the conclusion that the only factor of importance was the resistance of the individual. The demonstration, however, that pneumococci are not all identical, that the types respon¬ sible for two thirds of the cases, and these the more severe, are found only in the mouths of those sick of the disease, in the dust in their immediate environ¬ ment, and in the mouths of a very limited number of healthy carriers who have been in close association with these patients, at once justifies attempts to pre¬ vent pneumonia by limiting the distribution of these more parasitic types of pneumococci. So far as pneu¬ monia due to these types of organism is concerned, the conditions do not differ essentially from those in diseases like diphtheria or cerebrospinal fever, in which the acquiring of the infectious agent is con¬ sidered of primal importance. Healthy carriers of
doi:10.1001/jama.1918.02600340027007 fatcat:zpidonm7prd6jonyto2h3oshtu