Excerpts on the Influenza and Pneumonia Pandemic of 1918
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SECTION OF COMMUNICABLE DISEASES
With a view to making a more intensive study of infectious diseases, a section of communicable diseases was established January 1, 1918 in the division of sanitation. At that time epidemics of measles, pneumonia, and meningitis were raging extensively in the various camps and cantonments, and special interest attached to the relationship existing between pneumonia and measles, which then appeared of primary importance, although at a later date this relationship became less marked. In the fall of 1918 the severe epidemic of influenza, with the succeeding high incidence of pneumonia, claimed first attention of the section. Both in the earlier period and during the influenza epidemic, the section became particularly
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impressed with the importance of contact and droplet infection in the spreading of communicable diseases, and with the necessity of treating pneumonia as an infectious disease. The division of sanitation took steps to prevent overcrowding in barracks and tents, and to minimize in hospitals the danger of droplet infections by requiring the use of cubicles for the patients and masks and gowns for the attendants. Memoranda emphasizing the communicability of pneumonia were circulated to all concerned. More recently the importance of careful dishwashing in the prevention of respiratory disease has received particular attention. On recommendation of the Surgeon General two circulars were issued in October, 1918, by the War Department with reference to the necessity for the sterilization of dishes. Based on experience with the operation of these circulars, recommendation was made to the Adjutant General on May 24, 1918 that this subject matter be embodied in Special Regulations 28 in the following words:
CLEANING MESS EQUIPMENT AND DISHES.
Individuals who are ill, or are becoming ill, with diphtheria, scarlet fever, pneumonia, measles, mumps, meningitis, tuberculosis, typhoid fever, dysentery, or cholera are very likely to have their hands and mess kits more or less soiled with the discharges from their noses, mouths, and intestines. These discharges contain the germs of the above-mentioned diseases: When soldiers individually wash their mess equipments in receptacles used in common, and dry them with dish towels used in common, there is danger of transmitting the germs of these diseases from the hands and mess equipment of one soldier to the hands and mess equipment of another. This transmission may take place through soiling the hands with the dishwater contaminated by previous users, or by smearing the hands with the moisture from the dish towels similarly contaminated. From the infected hands and mess equipment of an individual the germs of these diseases may readily be transferred to his mouth and nose, thereby causing the soldier to develop the malady in question. These matters are of particular and extreme importance at times when respiratory or intestinal diseases of a serious nature are prevalent. To guard against these dangers, the following instructions will be strictly adhered to. The importance of taking these precautions is particularly great in hospitals.
(a) When practicable to assemble the mess equipment of a company or detachment, or when dishes other than the mess, equipment are used, all such mess equipment or dishes, immediately after each meal, will be thoroughly washed with soap and warm water, then carefully rinsed in hot water, and finally actually boiled or steamed in a boiler, galvanized-iron can, or other suitable receptacle. After boiling or steaming, the dishes should be rapidly removed, drained, and allowed to dry in the air while still hot. If not practicable to completely air-dry the dishes, they maybe dried with dish towels, an ample supply of which should be provided. After each meal, dish towels should be thoroughly boiled with soap, washing powder, ammonia, lye, or other suitable cleansing material, then thoroughly rinsed and hung out to dry in the sun.
(b) When the cleansing of mess equipment by each individual soldier is necessary, one of the following two methods will be used. The first method is much the better.
First method: When facilities therefor are available, mess kits will be washed with soap under running water, preferably warm water, in such manner that the mess kit and hands of one soldier do not come in contact with the mess kits and hands of other soldiers, nor with the water which has come in contact with the mess kits and hands of another soldier. The mess kits will then be shaken and air-dried. Under no circumstances will a common dish towel he used in this method, but there is no objection to each soldier having an individual dish towel, provided he uses it exclusively for his own mess kit. Boiling of the mess kits is not necessary if this method of washing is in force.
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Second method: In this method three suitable containers such as galvanized iron cans or boilers are necessary, and provision must be made for maintaining the water in one of these containers constantly at a boiling temperature during the entire period the cleansing process is going on. Generally in camps and cantonments this can not be accomplished; unless a trench, or suitable rock or brick device, is provided, in which a small fire is kept burning under the receptacle for boiling water. The first two receptacles will contain hot, soapy water. Each soldier will thoroughly wash his mess kit in the first receptacle of soapy water, rinse it in the second receptacle of soapy water, and finally rinse it again in the receptacles containing water which is actually boiling. During the washing and rinsing, in the first and second receptacles, each soldier must take care that he does not soil his hands with the wash water which may have been contaminated by preceding users. The use of the swabs, previously advised has been found to be undesirable because their handles quickly become wet with dish water and so soil the hands of the soldier using them. After the final rinsing in boiling water, the mess kits will be immediately well shaken and air-dried. Under no circumstances will a common dish towel be used in this method, but individual dish towels, may be used under the conditions laid down in the preceding paragraph. After completing the washing of their mess kits by this method each soldier should at once thoroughly wash his hands.
(c) After they have been cleansed, mess equipment and dishes will be protected from the access of flies, roaches, dust, and dirt.
(d) In this regulation all reference to dishes and mess equipment will include cups, saucers, drinking glasses, platters, vegetable dishes, knives~ forks, spoons, and other utensils.
(e) The use of common drinking cups is prohibited.
With a view to increasing the efficiency in handling communicable diseases at the large camps, steps were taken to station at each an officer with special training in epidemiology, who was assigned as "epidemiologist" to assist the camp or division surgeon and the sanitary inspector in making an intensive study of epidemiological problems and in carrying out measures within the camp for the prevention of communicable diseases. Such officers were assigned early in January, 1918, and their work has been generally most satisfactory. They have been given ample authority, through the sanitary inspectors, to make effective their recommendations.
It was early recognized by the Medical Department that in the control of communicable diseases in camp it was essential that incoming drafted men should be received in detention camps and kept in small groups during the first two weeks of their service, instead of being domiciled in barracks accommodating several score of individuals. No such detention camps were provided in the original plan of the cantonments, but these, and also quarantine camps were improvised at many stations. Ultimately authority was obtained from the War Department to construct permanent detention and quarantine camps, consisting of frame huts, each of which would hold eight men on the basis of 50 square feet of floor space per man, These detention and quarantine camps were nearing completion when the signing of the armistice put a stop to this work.
The epidemics of measles, influenza, meningitis, and pneumonia, together with the occurrence of other diseases of less importance, has furnished a wealth of material for study. Many monographs on these subjects have been prepared by the section of communicable diseases and some of these have already been published in current medical journals.
