ï~~i''! j' i 11! ' i f,' I; ( ii,: 'll i,;:, ',,1' j. 1 f '; is,;,,.,.: I' I is C iii;{;';, 'i ',' II j j i9,.,. ij 3,, S i. ti i.!{ i! I' '~ 11. 1,,a: 1 Ij; ',Iii., II I I_. I: IllI, f i;::,, t, i -; -, } ',!;;t,,31.% '}$4 5 Sillt 1I I 1 I 1652 INFLUENZA-FRIE APPARATUS FOR ADMINISTERING ARSPHENAMIN AT TEMPERATURE OF BLOOD* S. R. THOMPSoN, M.D., CHARLOTTE, N. C. This apparatus was suggested on account of severe reaction and sometimes death after the administration of arsphenamin intravenously. Physicians are realizing more and more the necessity of introducing solutions that will be free from all possible sources of irritation. The reaction called "chills and fever" following intravenous injections of arsphenamin is due, we believe, to injecting arsphenamin intravenously below the normal temperature of the blood. In giving ten or more doses of arsphenamin within from one to four hours we discovered that the patients receiving treatment when the solution was hot, or at the temperature of the blood, had no reaction or chill. Those receiving the last doses of the solution, which had cooled below the normal temperature of the blood, nearly always had more or less reaction. We have given more than a thousand doses by this method in dosages of from 0.3 to 0.6 gm. Solutions of from 30 to 150 c.c. have been given with chills or severe reaction in less than 5 per cent. of the cases., The apparatus consists of a glass container practically closed with a wooden cover - to prevent the entranceof cold air. In the center is a regular arsphenamin graduate. In the air chamber " around this there are three 10'watt incandescent lights and a thermometer, registering in Centigrade and Fahrenheit. The lights may be attached or on separate switches. The_ rubber tubing, mixing jar, needles, etc., may be of any type desired.: These are not included in the illustration. Before the injection is begun the solution in the rubber tube can be brought to the proper Apparatus for administering arsphentemperature by being amin at the temperature of the blood. allowed to. run back into the graduate. Solution left in the apparatus will remain at the desired temperature, depending on the number of lights used. The simplicity, practicability and economy of this apparatus have commended it to us, and it has become indispensable in our.clinic. * Presented before the Mecklenburg County Medical Society, May" 5; 1918. * From the Crowell Urological Clinic and United States Public Health Clinic. Venereal Diseases in Army and Civil Life.-In these five camps (Dix, Lee, Upton, Meade and Pike) there were about nineteen times as many cases contracted before enlistment as afterward. It is, therefore, the disease contracted by civilians before enlistment, under civil conditions, which is responsible for the disability due to venereal disease in the Army. To reduce the small amount of venereal disease contracted after enlistment is the problem of the Army. To cut down -the vast amount brought in from civilian life is the problem before the state and local health officers throughout the United States. There is no greater or more urgent health problem before them today. To solve the whole problem, the Army and the health officers will need to exercise the closest cooperation.-Major W. A. Sawyer, M. C., U. S. Army, Am. Jour. Pub. Health; September, 1918. 'L DIANDER ET AL. Joua. A: M. A. Nov. 16, 1918 Military Medicine and Surgery THE EPIDEMIC OF INFLUENZA AT CAMP - SHERMAN, OHIO ALFRED FRIEDLANDER, M.D. (CINcINNATI) Major, M. C. U. S. Army; Chief of Medical Service CAREY P. McCORD, M.D. (DETROIT) Major, M. C., U. S.- Army; Chief of Laboratory Service FRANK J. SLADEN, M.D.. (DETROIT) Captain, M. C., U. S. Army; Assistant Chief of Medical Service AND GEORGE W. WHEELER, M.D. (NEW YORK) Lieutenant, M. C., U. S. Army; Bacteriologist, Laboratory Service CAMP SHERMAN, CHILLICOTHE, OHIO At the time the prevailing epidemic of influenza was at its height in New England, numerous cases of coryza and bronchitis appeared at Camp Sherman. The picture was not characteristic of influenza, but the condition was so frequently noticed among the patients of the base hospital that isolation was instituted and special wards'set aside for this purpose. The absence of the usual features of influenza led to considerable TABLE 1.-PNEUMONIA AT CAMP SHERMAN * Date Admissions Pneumonia Deaths Sept. 24.................. 80 0 0 Sept. 26..................... 216 8 Sept. 27......................321 10 1 Sept. 28......................314 9J 3 Sept. 29...................... 303 27 2 Sept. 30...................... 732 97 7 Oct. 1................ 1,157 26* 15 Oct. 2...................... 644 278 22 Oct. 3......................633 55* 45 Oct. 4.............957 - 461 52 Oct. 5.............. 711 214 104 Oct. 6....................449 152 119 Oct. 7..-.'...'..'.....- 444 160 110 Oct. 8.....................169 73* 125 Oct. 10...................... 227 160 86 Oct.' 11............. 78 - 51 53 -Total....... 7,618 2,001 842 * Marked irregularity exists in these figures, but the variations in the daily occurrenee of' pneumonia are apparent and not real, being due to the system of reporting diagnoses. comment as to the justification of such a diagnosis. This uncertainty was abruptly and definitely terminated by the sudden appearance of large numbers of patients exhibiting characteristics of clinical influenza. Unlike the simple -syndrome of the earlier cases, the new group was featured by sharper onset; prostration, aches and p'ains, and high temperature. By September 24 the transition had occurred, and this date marks the beginning of a definite epidemic of clinical influenza. At this time the population of the camp was 33,044 Of this number, 24,513 were white, and 8,52 were colored. The larger numbers of these me ere inducted into military service from Ohio, but tller groups from Pennsylvania, West Virginia, Ak ina, Tennessee and Louisiana. Of the total population, -15,493, or 46.8 per cent., had been in service one month or less.. From the nature of the examinations and procedures incidental to induction into service,-it followed that these men were more closely and frequently grouped than the other men of the command., An analysis of the first 4,269 cases of influenza reveals that 2,944, or 69 per cent., occurred in men who had. been in service one month or less. In other worde two thirds of these cases occurred in a group, of 15,493