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Chapter XIV

Communicable Diseases, Table of Contents

CHAPTER XIV

GERMAN MEASLES

STATISTICAL CONSIDERATIONS

German measles was not of particular importance to the Army during the World War and did not rank among the 30 most common diseases. There were 17,378 primary admissions for the total Army of more than four million officers and men, giving a ratio of 4.21 per 1,000 strength. (Table 76.) There were 524 primary admissions for officers and 17,039 for American officers and enlisted men. The admission ratios were, respectively, 2.54 and 4.16 per 1,000 per annum. There were 16,192 primary admissions for white American troops and 259 for colored American troops, giving admission ratios of 4.50 and 0.90 per 1,000 strength, respectively. There were 64 primary admissions where the clinical records did not specify color.

aUnless otherwise stated, all figures for the World War period are derived from sick and wounded reports sent to the Surgeon General.-Ed.


464

TABLE 76.-German measles. Admissions, deaths, discharges for disability, and days lost, by countries of occurrence, officers and enlisted men, United States Army, April 1, 1917, to December 31, 1919. Absolute numbers and ratios per 1,000

 


Total mean annual strengths


Admissions

Deaths

Discharges for disability

Days lost (absolute numbers)

Non-
effective (ratio per 1,000 strength)

Absolute numbers

Ratios per 1,000 strength

Absolute numbers

Ratios per 
1,000 strength

Absolute numbers

Ratios per 1,000 strength

Total officers and enlisted men, including native troops

4,128,479

17,378

4.21

82

0.02

1

0

211,645

0.14

Total officers and enlisted American troops

4,092,457

17,039

4.16

82

.02

1

0

209,413

.14

Total officers

206,382

524

2.54

---

---

---

---

4,842

.06

Total American troops:

 

 

 

 

 

 

 

 

 

    

White

3,599,527

16,192

4.50

77

.02

---

---

198,684

.15

    

Colored

286,548

259

.90

4

.01

1

0

4,930

.05

    

Color not stated

---

64

---

1

---

---

---

957

---

         

Total

3,886,075

16,515

4.25

82

.02

1

0

204,571

.14

Total native troops (enlisted)

36,022

339

9.41

---

---

---

---

2,232

.17

Total Army in United States, including Alaska:

 

 

 

 

 

 

 

 

 

    

Officers

124,266

475

3.82

---

---

---

---

4,336

.10

    

White enlisted

1,965,297

15,449

7.86

74

.04

---

---

188,378

.26

     

Colored enlisted

145,826

243

1.67

4

.03

1

.01

4,616

.09

         

Total enlisted

2,111,123

15,692

7.43

78

.04

1

0

192,994

.25

         

Total officers and men

2,235,389

16,167

7.23

78

.03

1

0

197,330

.24

U.S. Army in Europe, excluding Russia:

 

 

 

 

 

 

 

 

 

    

Officers

73,728

31

.42

---

---

---

---

380

.01

    

White enlisted

1,469,656

473

.32

3

.00

---

---

6,998

.01

    

Colored enlisted

122,412

12

.10

---

---

---

---

197

0

    

Color not stated

---

63

---

1

---

---

---

930

---

         

Total enlisted

1,592,068

548

.34

4

.00

---

---

8,125

.01

         

Total officers and men

1,665,796

579

.35

4

.00

---

---

8,505

.01

Officers other countries

8,388

18

2.15

---

---

---

---

126

.04

U.S. Army in Philippine Islands:

 

 

 

 

 

 

 

 

 

    

White enlisted

16,995

16

.94

---

---

---

---

125

.02

    

Colored enlisted

4,456

---

---

---

---

---

---

---

---

         

Total enlisted

21,451

16

.75

---

---

---

---

125

.02

U.S. Army in Hawaii:

 

 

 

 

 

 

 

 

 

    

White enlisted

16,161

46

2.85

---

---

---

---

1,119

.19

    

Colored enlisted

3,319

1

.30

---

---

---

---

71

.06

         

Total enlisted

19,480

47

2.41

---

---

---

---

1,190

.17

U.S. Army in Panama: (White enlisted)

19,688

9

.46

---

---

---

---

82

.01

U.S. Army in other countries not stated:

 

 

 

 

 

 

 

 

 

    

White enlisted

(a)

63

---

---

---

---

---

823

---

    

Colored enlisted

(a)

1

---

---

---

---

---

31

---

    

Color not stated

---

1

---

---

---

---

---

27

---

         

Total

14,232

65

4.57

---

---

---

---

881

.17

Transports:

 

 

 

 

 

 

 

 

 

    

White enlisted

97,498

136

1.40

---

---

---

---

1,159

.03

    

Colored enlisted

10,535

2

.19

---

---

---

---

15

0

         

Total

108,033

138

1.28

---

---

---

---

1,174

.03

Native troops enlisted:

 

 

 

 

 

 

 

 

 

    

Philippine Scouts

18,576

58

3.12

---

---

---

---

700

.10

    

Hawaiians

5,615

24

4.27

---

---

---

---

184

.09

    

Porto Ricans

11,831

257

21.72

---

---

---

---

1,348

.31

aSeparate strength of white and colored not available.

It has long been known that German measles is not a fatal disease; therefore all deaths reported for the Army during the World War were, in all probability, due to some concurrent disease. Table 76 shows a total of 82 deaths charged to German measles, 77 of which were among white American troops, 4 among colored American troops, and 1 color not stated. The death ratio was 0.02 per 1,000 strength. One case was discharged from the service on account of disability following this disease. This was a colored American soldier. The permanent disability was due to some other cause.

From the standpoint of noneffectiveness, German measles was a disease of some importance to the Army during the World War. Based on the comparative number of days lost, it stood forty-ninth on the list of common diseases. For the total Army, there were 211,645 days lost from duty, giving a noneffective ratio of 0.14 per 1,000 strength. By far the greater proportion of the time lost was among the white enlisted men. They lost 198,684 days, as compared with 4,930 days lost by colored enlisted men. The noneffective ratios were, respectively, 0.15 and 0.05 per 1,000 per annum. Table 76 shows 4,842 days lost by officers, giving a noneffective ratio slightly higher than that for colored enlisted men. This ratio was 0.06 per 1,000 strength.

The highest admission and noneffective ratios for the total Army were for native enlisted troops. Among a mean strength of 36,022 native troops


465

(Table 76) there were 339 primary admissions, with a loss of 2,232 days from duty. The admission and noneffective ratios per 1,000 strength were 9.41 and 0.17, respectively. The native troops served in their native countries.

CHART LI

OCCURRENCE IN THE ARMY IN THE UNITED STATES

Table 76 shows 16,167 primary admissions for the Army stationed in the continental United States. This number represents the vast majority of the cases reported during the war, most of which were among white enlisted men. The admission ratio was 7.23 per 1,000 strength. An analysis of these cases shows 15,449 among white and only 243 among colored enlisted men. The


466

ratios per 1,000 strength were 7.86 and 1.67, respectively. This disease was more common among officers than among the colored troops; there were 475 primary admissions for the former, a ratio of 3.8 per 1,000 per annum.

According to the system of recording deaths, 74 deaths among white and 4 among colored enlisted men in the United States were charged to German measles. The death ratios were 0.04 and 0.03, respectively. The number reported was so small that, even if they could correctly be attributed to German measles, they would make this a disease of minor importance to the Army during the war.

The importance of this disease to the Army was principally in the number of days lost from duty. Table 76 shows that the officers and men stationed in the United States lost 197,330 days from duty on account of German measles. As would be expected, this was principally among the white enlisted men, since the disease was much more common among them. The noneffective ratio for the total Army in the United States was 0.24 per 1,000 per annum.

The occurrence of German measles by camps in the United States showed wide divergence. (Table 77.) The largest number of primary admissions was reported from Camp Lewis, Wash., where 1,555 cases were reported during the war, the admission ratio per 1,000 strength being 32.54. Camp Cody, N. Mex., was second, with 1,351 primary admissions, the admission ratio, 59.68 per 1,000 strength, being the highest for any camp in the United States. The average admission ratio for all camps in the United States was 7.81.

Though German measles was reported from practically all camps, there were no areas where it could properly be called endemic. Camp Pike, Ark., reported but 11 primary admissions. This is of special interest, since the endemic diseases at Camp Pike, in many instances, were above the average.

Colored troops contributed less than one-fiftieth of the total admissions of 9,915 from the larger camps, there being only 210 primary admissions among them.


467

TABLE 77.-German measles. Admissions and deaths, by camps of occurrence, white and colored enlisted men, United States Army, with ratios per 1,000 strength, and case fatality rates, April, 1917, to December, 1919

Camps

Average strength for period


White enlisted men

Colored enlisted men

White and colored enlisted men


Admissions

Deaths

Admissions

Deaths

Admissions

Deaths

Case fatality rates (per cent)

Absolute numbers


Ratios per 1,000 strength

Absolute numbers

Ratios per
 1,000 strength

Absolute numbers

Ratios per
 1,000 strength

Absolute numbers

Ratios per
 1,000 strength

Absolute numbers

Ratios per
 1,000 strength

Absolute numbers

Ratios per 
1,000 strength

Camp Beauregard, La.

20,625

18

0.89

0

0

1

2.37

0

0

19

0.92

0

---

---

Camp Bowie, Tex.

26,193

31

1.23

1

.04

0

0

0

0

31

1.18

1

0.03

3.23

Camp Cody, N. Mex.

22,636

1,351

59.68

6

.27

---

---

---

---

1,351

59.68

6

.27

.44

Camp Custer, Mich.

37,631

180

4.96

1

.03

1

.74

0

0

181

4.81

1

.03

.55

Camp Devens, Mass.

47,921

363

7.94

1

.02

12

5.41

0

0

375

7.83

1

.02

.27

Camp Dix, N. J.

49,786

322

7.16

0

0

7

1.45

0

0

329

6.61

0

0

---

Camp Dodge, Iowa

39,032

100

3.01

1

.03

54

9.30

3

.52

154

3.95

4

.10

2.60

Camp Doniphan, Okla.

26,747

208

7.78

4

.15

---

---

---

---

208

7.78

4

.15

1.92

Camp Eustis, Va.

6,780

7

1.11

0

0

0

0

0

0

7

1.03

0

0

---

Camp Forrest, Ga.

8,980

1

.11

0

0

---

---

---

---

1

.11

0

0

---

Camp Fremont, Calif.

15,414

72

4.67

1

.06

---

---

---

---

72

4.67

1

.06

1.39

Camp Funston, Kans.

56,222 

515

10.29

0

0

5

.81

0

0

520

9.25

0

0

---

Camp Gordon, Ga.

44,871

283

7.44

5

.13

31

4.54

0

0

314

7.00

5

.11

1.59

Camp Grant, Ill.

49,256

36

.85

0

0

0

0

0

0

36

.73

0

0

---

Camp Greene, N.C.

29,710

23

.88

0

0

0

0

0

0

23

.77

0

0

---

Camp Greenleaf, Ga.

11,959

33

2.76

0

0

---

---

---

---

33

2.76

0

0

---

Camp Hancock, Ga.

37,994

681

18.71

1

.03

1

.63

0

0

682

17.95

1

.03

.15

Camp Humphreys, Va.

12,836

26

2.67

0

0

3

.97

0

0

29

2.26

0

0

---

Camp Jackson, S.C.

42,011

454

12.31

3

.08

30

5.85

0

0

484

11.52

3

.07

.62

Camp Johnston, Fla.

22,267

48

2.42

0

0

1

.41

0

0

49

2.20

0

0

---

Camp Kearny, Calif.

25,472

456

17.90

0

0

---

---

---

---

456

17.90

0

0

---

Camp Lee, Va.

57,635

549

10.76

9

.18

15

2.26

0

0

564

9.79

9

.16

1.60

Camp Lewis, Wash.

47,792

1,548

32.75

4

.08

7

13.34

0

0

1,555

32.54

4

.08

.26

Camp Logan, Tex.

27,734

217

8.14

2

.08

4

3.74

0

0

221

7.97

2

.07

.90

Camp MacArthur, Tex.

25,271

48

1.97

0

0

0

0

0

0

48

1.90

0

0

---

Camp McClellan, Ala.

28,664

30

1.13

0

0

1

.47

0

0

31

1.08

0

0

---

Camp Meade, Md.

50,033

447

10.65

0

0

29

3.60

0

0

476

9.51

0

0

---

Camp Mills, N.Y.

24,197

313

13.64

0

0

2

1.59

0

0

315

13.02

0

0

---

Camp Pike, Ark.

49,587

11

.27

0

0

0

0

0

0

11

.22

0

0

---

Camp Sevier, S.C.

27,786

61

2.33

1

.04

0

0

0

0

61

2.20

1

.04

1.64

Camp Shelby, Miss.

30,432

36

1.25

0

0

0

0

0

0

36

1.18

0

0

---

Camp Sheridan, Ala.

26,507

367

14.32

0

0

1

1.13

0

0

368

13.88

0

0

---

Camp Sherman, Ohio

42,750

29

.78

0

0

0

0

0

0

29

.68

0

0

---

Camp Syracuse, N.Y.

3,367

1

.30

0

0

---

---

---

---

1

.30

0

0

---

Camp Taylor, Ky.

46,962

307

7.21

5

.12

2

.46

0

0

309

6.58

5

.11

1.62

Camp Travis, Tex.

44,264

26

.69

0

0

1

.15

0

0

27

.61

0

0

---

Camp Upton, Long Island, N.Y.

44,871

174

4.33

1

.02

0

0

0

0

174

3.88

1

.02

.57

Camp Wadsworth, S.C.

31,809

309

10.25

1

.03

0

0

0

0

309

9.71

1

.03

.32

Camp Wheeler, Ga.

25,726

24

1.00

0

0

0

0

0

0

24

.93

0

0

---

Others

339

---

---

---

---

2

5.90

0

0

2

5.90

0

0

---


     Total

1,270,069

9,705

8.37

47

.04

210

1.90

3

.03

9,915

7.81

50

.04

.50

 


468

When viewed by months and seasons of occurrence, the majority of primary admissions were reported in the United States for November-December, 1917, and January-February, 1918, and among white troops. During these months, there were 2,133, 4,313, 2,980, and 1,139 primary admissions, respectively. During the fall of 1918 and the winter and spring of 1919, German measles was of but little importance to the Army.1 It is probable that the occurrence during the winter of 1917-182 was due to the comparatively large amount of nonimmune material in the Army and to confusion in diagnosis.

TABLE 78.-German measles. Admissions, by months, white and colored enlisted men, United States Army, United States and Europe. Absolute numbers and ratios per 1,000, April, 1917, to December, 1919

 Month  and year


White troops


United States

Europe

Mean strengths


Admissions

Deaths

Mean strengths

Admissions

Deaths

Absolute numbers


Ratios per 1,000 strength

Absolute numbers

Ratios per 1,000 strength

Absolute numbers

Ratios per 1,000 strength

Absolute numbers

Ratios per 1,000 strength

1917

 

 

 

 

 

 

 

 

 

 

April

183,758

164

10.71

1

0.07

---

---

---

---

---

May

245,454

359

17.55

---

---

626

---

---

---

---

June

309,205

425

16.49

---

---

12,794

1

0.89

---

---

July

458,817

289

7.56

---

---

28,821

11

4.58

---

---

August

562,714

190

4.05

---

---

50,882

9

2.12

---

---

September

776,466

331

5.12

---

---

70,266

52

8.88

---

---

October

1,032,244

367

4.27

1

.01

92,139

8

1.04

---

---

November

1,061,422

2,133

24.11

8

.09

123,429

49

4.76

---

---

December

1,129,065

4,313

45.84

24

.26

160,178

29

2.17

---

---

     
     Total 1917

479,929

8,571

17.86

34

.07

44,928

159

3.54

---

---

1918

 

 

 

 

 

 

 

 

 

 

January

1,096,434

2,980

32.62

16

.18

193,264

65

4.04

---

---

February

1,095,039

1,139

12.48

6

.07

223,130

11

.59

---

---

March

1,129,223

788

8.37

10

.11

283,268

16

.68

---

---

April

1,168,558

608

6.24

2

.02

388,048

19

.59

---

---

May

1,197,757

500

5.01

2

.02

587,240

24

.49

---

---

June

1,303,746

268

2.47

1

.01

796,427

8

.12

---

---

July

1,328,513

126

1.14

1

.01

1,063,192

4

.05

---

---

August

1,284,247

75

.70

1

.01

1,266,592

13

.12

---

---

September

1,321,440

52

.47

---

---

1,527,793

23

.18

2

.02

October

1,343,933

20

.18

1

.01

1,635,321

7

.05

---

---

November

1,255,195

9

.09

---

---

1,682,836

6

.04

---

---

December

941,219

65

.83

---

---

1,591,692

14

.11

---

---


     Total 1918

1,205,442

6,630

5.50

40

.03

936,589

210

.22

2

.002

1919

 

 

 

 

 

 

 

 

 

 

January

672,937

67

1.19

---

---

1,488,683

22

.18

---

---

February

471,815

62

1.58

---

---

1,310,083

16

.15

---

---

March

406,839

66

1.95

---

---

1,115,693

23

.25

---

---

April

339,836

36

1.27

---

---

853,425

18

.25

---

---

May

291,810

11

.45

---

---

569,842

10

.21

---

---

June

246,903

2

.10

---

---

271,633

9

.40

---

---

July

215,104

1

.06

---

---

111,634

1

.11

---

---

August

156,791

1

.08

---

---

48,006

1

.25

---

---

September

149,360

1

.08

---

---

30,315

---

---

---

---

October

139,877

---

---

---

---

21,055

3

1.71

---

---

November

132,403

---

---

---

---

18,920

---

---

---

---

December

135,441

1

.09

---

---

18,379

1

.65

1

.65


     Total 1919

279,926

248

.88

---

---

488,139

104

.21

1

.002


     Total for period

1,965,297

15,449

7.86

74

.04

1,469,656

473

.32

3

.00

 


469

TABLE 78.-German measles. Admissions, by months, white and colored enlisted men, United States Army, United States and Europe. Absolute numbers and ratios per 1,000, April, 1917, to December, 1919-Continued

Month and year


Colored troops


United States

Europea

Mean strengths


Admissions

Deaths

Mean strengths

Admissions

Absolute numbers


Ratios per 1,000 strength

Absolute numbers

Ratios per 1,000 strength

Absolute 
numbers

Ratios 
per 1,000 
strength

1917

 

 

 

 

 

 

 

 

April

4,870

2

4.93

---

---

---

---

---

May

5,826

3

6.17

---

---

---

---

---

June

5,171

1

2.32

---

---

---

---

---

July

6,675

---

---

---

---

---

---

---

August

8,519

1

1.41

---

---

---

---

---

September

9,409

1

1.28

---

---

---

---

---

October

21,795

---

---

---

---

935

---

---

November

39,225

30

9.18

---

---

2,392

4

20.10

December

36,851

20

6.51

---

---

5,346

---

---

     
     Total 1917

11,529

58

5.03

---

---

723

4

5.50

1918

 

 

 

 

 

 

 

 

January

50,705

37

8.76

---

---

8,673

2

2.77

February

49,955

13

3.12

1

.24

9,664

1

1.24

March

54,814

4

.88

---

---

11,541

---

---

April

59,015

22

4.47

2

.41

12,667

2

1.89

May

87,650

75

10.27

1

.14

28,279

---

---

June

89,305

12

1.61

---

---

33,208

1

.36

July

124,976

2

.19

---

---

47,171

1

.25

August

168,422

2

.14

---

---

78,734

---

---

September

164,846

3

.22

---

---

91,270

---

---

October

182,705

---

---

---

---

138,827

---

---

November

150,587

---

---

---

---

148,679

---

---

December

104,140

1

.12

---

---

148,372

---

---


     Total 1918

107,260

171

1.59

4

.04

63,090

7

.11

1919

 

 

 

 

 

 

 

 

January

68,337

6

1.05

---

---

140,396

---

---

February

66,104

1

.18

---

---

131,219

---

---

March

44,634

5

1.34

---

---

123,152

1

.10

April

29,824

2

.81

---

---

119,801

---

---

May

20,780

---

---

---

---

108,650

---

---

June

18,562

---

---

---

---

64,166

---

---

July

20,058

---

---

---

---

12,508

---

---

August

18,013

---

---

---

---

1,741

---

---

September

11,322

---

---

---

---

1,287

---

---

October

9,084

---

---

---

---

185

---

---

November

8,792

---

---

---

---

83

---

---

December

8,935

---

---

---

---

---

---

---


     Total 1919

27,037

14

52

---

---

58,599

1

.02


     Total for period

145,826

243

1.67

4

.03

122,412

12

.10

aNo deaths reported for colored enlisted men in Europe.

The difference between the primary admissions reported from camps, as shown in Table 77, and the total number of primary admissions reported for the United States as a whole is accounted for by troops who had stations other than in the larger camps. Among these were 6,252 primary admissions.


470

OCCURRENCE IN THE AMERICAN EXPEDITIONARY FORCES

The distribution of German measles among the American Expeditionary Forces was of far less importance, from every point of view, than in the United States. There were 579 primary admissions in the American Expeditionary Forces, with a total mean annual strength of one and a half million men; the admission ratio was 0.35 per 1,000 per annum. White enlisted men contributed most of the cases. There were 473 primary admissions among the white enlisted men, 12 among colored enlisted men, and 63 where color was not stated. Officers contributed 31 primary admissions and had the highest admission ratio for any American troops in Europe. This ratio was 0.42 per 1,000 per annum. The admission ratios for white and colored enlisted men in Europe, respectively, were 0.32 and 0.10 per 1,000 per annum.

From the standpoint of time lost, this disease was of comparatively little importance to the American Expeditionary Forces-there was a total of 8,505 days lost, 6,998 of which were for white enlisted men, 197 days for colored enlisted men.

EPIDEMIOLOGY

Though the exciting cause of German measles is unknown, there is no question as to the identity of this disease or as to its contagious nature. Its infectiousness seems less than that of measles and scarlet fever and to be of but short duration. Table 76 indicates that the negro possesses a relatively high degree of immunity to German measles or that the disease was frequently not accurately diagnosed, since the number of admissions was much greater among white than among colored troops. According to experiences in the United States Army during the World War, the seasonal occurrence of this disease was that of the other exanthematous diseases; in other words, it was most common during the fall, winter, and early spring months. The highest admission ratio, 9.41, was for native enlisted troops. If this is to be taken as an index of immunity, the native troops, particularly the Porto Ricans, are more susceptible to German measles than are even the white American troops.

It is very probable that the infectious agent is contained in the nasopharyngeal discharges of the patient-at least during the catarrhal stage of the disease.

PROGNOSIS

The available records contain no case where death which occurred during the course of an attack of German measles could not be attributed to some other cause.

SYMPTOMS

Patients afflicted with German measles neither appear nor feel very ill. There is a great diversity of opinion as to the duration of the incubation period. Geiger reported the average incubation period among 173 cases studied as 17 days, the shortest being 11, and the longest 21 days.3 Vaughan gave the wide range of from 5 to 21 days.4

Premonitory symptoms are usually present and consist of malaise and mild headache, slight sore throat and, exceptionally, toxic symptoms, such as pain in the joints. Gastrointestinal symptoms are exceptional. There may be elevated temperature with a chilly sensation during this stage, or both may


471

be absent. The duration of this stage is characteristically short, and the skin rash usually makes its appearance within 24 hours. Some authors state that an enanthem is constantly present and consists of a macular rose-red eruption in the throat. It was on this account that German measles was originally regarded as a hybrid, having the sore throat of scarlet fever and the rash of measles. The mastoid and occipital lymph glands are usually enlarged and painful. Although this adenitis usually occurs late in the disease, it is sometimes one of the earliest symptoms and the physician's attention may be attracted to it by the complaint of tenderness and stiffness of the neck.

The eruption may be the first sign of the disease to attract attention. It appears on the face and, unlike scarlet fever, involves the perioral region. In the beginning it is usually discrete, macular, somewhat punctate, slightly elevated, and disappears easily on pressure. Itching is usually not present.

Geiger reported 15 recurrences in a study of 173 cases.3 In 5 cases there were three separate attacks. In 2 cases, the second attack occurred three weeks after the first and was followed by a third attack five weeks later.

COMPLICATIONS AND SEQUELĘ

Geiger reported that complications were not infrequent in his cases, nor were they of a mild type.3 Acute arthritis was noted in 36 of his cases. Recovery was slow. In 4 cases hemolytic streptococcus was obtained in pure culture from the knee joint. In two cases acute nephritis was noted. Endocarditis was a complication in 1 case and otitis media in 8. Neither pneumonia nor jaundice was reported by Geiger.

The statistical records of the Surgeon General's Office for the World War period show 38 cases of German measles reported as concurrent with measles and 32 cases as concurrent with scarlet fever. Conversely, there were 21 cases of measles and 54 cases of scarlet fever recorded as concurrent with German measles, the only difference between these two classes being a question of which disease was reported as the primary cause of admission. There were no deaths among these cases.

DIAGNOSIS

The diagnosis of German measles is based upon the mildness of onset, the mildness of symptoms and signs, the incubation period, special adenopathy, and characteristics of the skin eruption. The differential diagnosis between German measles, measles, and scarlet fever is most important. Measles is differentiated by the following diagnostic points: The incubation period is shorter, and catarrhal symptoms of the respiratory tract are more pronounced. The differential diagnosis between German measles of the scarlatiniform type of rash and scarlet fever is more difficult. The distinctive points in favor of the latter are the shorter incubation period; more severe initial symptoms, as vomiting, sore throat, fever, headache, rapid pulse, "strawberry tongue," greater tendency to complications, and characteristics of the skin eruption.

Toxic and drug rashes at times must be differentiated from the rash of German measles. The former skin rashes are irregularly distributed and they are polymorphous in character. Glandular involvement and catarrhal affections of the respiratory tract are absent in the toxic and drug rashes.


472

Confusion in diagnosis undoubtedly existed in the early part of the war period, more especially in the fall of 1917. This is believed to account for the occurrence of German measles in epidemic proportions in some camps and its practical absence in others. No other explanation can be offered to account for these differences, since the military conditions were the same. The camp surgeon at Camp Lewis reported that German measles was epidemic in November and December, 1917, with a total of 1,203 cases; however, that figure should be considered advisedly, as there was at that time still some confusion as to the diagnosis. This was the camp that reported the largest number of cases. The difficulty seems to have been principally in differentiating measles, which was epidemic in the camps at that time. Table 79, prepared from a selected group of camps, shows that, generally speaking, where the admission rate for measles was above the average for camps in the United States the rate for German measles was lower than the average; and, vice versa, where the rate for German measles was high the rate for measles was below the average. This table shows a close similarity in the trend of scarlet fever with that of German measles when compared as above outlined and would indicate confusion in the diagnosis of these three diseases.

TABLE 79.-Comparative occurrence, measles, German measles, and scarlet fever, in a selected group of camps in the United States, 1917 and 1918. Ratios per 1,000

Camp


1917

1918


Measles

German measles

Scarlet 
fever

Measles

German 
measles

Scarlet 
fever

Beauregard, La.

461.69

1.26

0

26.74

0.33

0.19

Bowie, Tex.

444.72

3.97

.27

2.93

.06

.42

Cody, N. Mex.

41.86

176.18

2.56

12.52

2.67

2.36

Lewis, Wash.

12.67

114.82

8.67

23.67

10.67

12.69

Pike, Ark.

477.47

.12

34.26

74.11

.25

5.71

Sevier, S.C.

371.40

2.94

0

33.66

1.89

2.03

Travis, Tex.

452.65

2.23

.82

19.77

.37

.53

Wheeler, Ga.

508.86

3.30

.35

4.27

.26

.16

Wadsworth, S.C.

.87

9.58

.11

16.63

10.38

1.22


     Total for camps

120.92

21.20

2.69

22.58

3.44

2.48


PROPHYLACTIC MEASURES

There are no known specific prophylactic measures for German measles. Separation of soldiers from their commands and isolation until all evidences of the disease had ceased were the bases of prevention used during the war. The incubation period is the best index for handling contacts.

TREATMENT

There is no known specific treatment for German measles. There is no record of any special work along these lines during the World War. The disease is mild, as a rule, and symptomatic treatment, in general, usually suffices. The treatment of complications is entirely symptomatic.

REFERENCES

(1) Annual Report of the Surgeon General, U. S. Army, 1920, 167.

(2) Ibid., 1919, Vol. I, 877.

(3) Geiger, J. C.: Epidemic of German Measles in a City Adjacent to an Army Cantonment. The Journal of the American Medical Association, Chicago, 1918, lxx, No. 24, 1918.

(4) Vaughan, Victor C.: Epidemiology and Pub]ic Health. C. V. Mosby Co., St. Louis, 1922, 179.

(5) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. I, 878.