conditions, such as inflammation of the upper respiratory tract, harbor the meningococcus in a more or less virulent form. The co-existence of measles, coryza and bronchitis with cerebrospinal meningitis is more than accidental, playing an important role in the infectivity of the meningococcus, and the establishing new foci of the disease. The removal of the carriers is usually followed by a decrease in the incidence of the disease.

Of the organizations affected through cerebrospinal meningitis 29 were also affected with measles, 10 with mumps, 7 with pneumonia, 2 with influenza, while bronchitis was fairly prevalent throughout the camp.

While the removal of the healthy carrier is of great importance in controlling the spread of the disease, little definite knowledge has been gained as to the best methods for freeing the carrier of the meningococcus. The use of the dichloramine-T spray as well as other antiseptic solutions no doubt eliminate the organism for a time, so that it is impossible to detect them. by culture. Sooner or later, however, when the preventive spraying is discontinued, the meningococcus may again be recovered from the nasopharynx by culture. The following culture record illustrates this:

F. L. K., Pvt., Hdq. Co, 318 F. A., Dec. 24, 1917. pos. Dec. 31, neg. Jan. 7. neg. released from carrier camp, found again pos. Feb. 13, 1918, and readmitted to carrier camp.

The duration of the period of incubation has been variously placed by the different observers. Wright placed this period from one to ten days, Sophian from one to five. Our observations are in accordance with those of Wright in the Glasgow epidemic, as the following cases indicate:

1. Z. L., Sgt., Hdq. Co., 323 Inf., worked in office with B. A. who was cultured, found positive Jan. 16, 1918, and removed to the carrier camp the same date. Z. was admitted to the Base Hosp. Jan, 25, diag. Fever undetermined. The period Diag. C. S. M. established Jan. 26. of incubation in this instance is nine days. 2. L. F. R., Pvt., Remount Depot, admitted to Hosp., Jan. 25, 1918, diagnosis influenza. On the same date diagnosis C. S. M. was established. This patient boasted of having slipped by the sentry for the purpose of visiting the 317 M. G. Bat., Co. B. about one week before his admission. B,

On Jan. 20, McK. of the 317 M. G. B. Bat., Co. B.

was admitted to the Base Hospital, diag. C. S. M. In this instance the period of incubation was about 5 days.

3. That the incubation period may be still

shorter is indicated by the following case: C. T. B., Pvt., Co. 13, 156 D. B., cultured Jan. 11, found neg., recultured Jan. 13, a gram-neg. Diplococcus, morphologically meningococcus was isolated. The organism did not agglutinate. Jan.

14, C was admitted to the Base Hospital, diag. Fever undetermined. Diag. C. S. M. established Jan. 15, 1918. The probable period of incubation in this case is two days.

The onset of the symptoms probably marks the time when the meningococcus gains entrance into the system from the nasopharynx, where it has existed from time of infection.

The small percentage of carriers who contracted the disease raised the question as to their immunity to the organism they harbored. The problem had a wider application, for if there existed a demonstrable immune body in the serum of the carrier, an immunity might possibly be induced by the use of suspensions of killed meningococci in healthy individuals as a prophylactic measure.

It became apparent that results of the agglutination experiments depended in a large measure upon the strain of meningococci used. The suspensions of meningococci used for agglutinations were made from hemolysed blood glucose agar slants. The growth was washed off with salt solution, the suspension filtered through gauze and placed into the incubator at 56 degrees C. for several hours to destroy the bacteriolytic ferment.

The agglutinations were also incubated at this temperature.

In view of the negative findings in the above experiment strain No. 5 isolated from the spinal fluid Dec. 15, 1917, was chosen, because this strain had been under transplantation for one month.

Table 6 indicates the results of this experiment.

TABLE VI.

The agglutinations in table 6 were carried out Jan. 19, 1918, with the same sera as used for the previous experiment (Table 5). The positive findings in three of the carriers would indicate that the results obtainable are dependent on the strain of meningococcus used in preparing the suspension for agglutination.

In all 160 sera of carriers from the Carrier Camp were tested by agglutination with strains No. 5 and No. 168 obtained from the spinal fluid. Aside from the three positive agglutinations of Carriers Nos. 10, 11, 13 of Table 6 no additional sera of carriers agglutinated either of the above strains. In comparing our results with those of F. L. Gates, it seems possible that our initial dilution of the sera (1:10) was too high.

To determine whether agglutinations occurred in the blood of cerebrospinal meningitis patients early in the disease blood was obtained from the following cases on admission and agglutinations carried out with No. 5 and 168.

3. Jour. of Exp. Med. Vol. VIII, No. 4, pp. 449-474. Oct. 1, 1918.

6.

0 1:400 1:400+

Patients 6 and 7 were carriers and were admitted to the hospital from the Carrier Camp on the dates their sera were taken. The sera of these patients gave no agglutination except in one instance (5) when strain 168 was used while agglutinins were demonstrable in onehalf the number of sera used when a strain of meningococci was used which agglutinated readily. Aside from the polyvalent serum and salt solution controls a normal horse serum control was used in all agglutination experiments. Case 2, although giving an agglutination of 1:20 with strain No. 5 died from the disease. lowest serum dilution employed was 1:10. It is probable that a greater number of sera might have given agglutinations in still lower dilution.

The

1. G. S., 316 F. A., Bat. D. 12-24-17 2. Th. F., 156 D. B., Co. 13 12-11-17 3. A. L.. 316 F. A., Bat. A. 12-14-17 4. B. Th.. 371 Inf., Co. C. 12-16-17 5. D. R., 316 F. A., Bat. A. 1-6-18 6. A. Cl., 156 D. B.. Co. 15 12-29-17

Jan. 22, 1918 No. 168

Diag. No.of Jan. 19.1918 made days strain strain in in No. No. Lab. Hosp. B.W. 5

due to the agglutinins introduced with the therapeutic serum is demonstrated by the findings in the blood of patients 1, 3 and 4, who were treated intraspinally only, the amount of serum given hardly exceeding 40-50 c. cm. at any one treatment while patients 2, 5, and 6 received from 100-125 c.cm. of serum at one time. That the agglutinins are formed by the patient was brought out in the agglutination test with the serum of case 3 C. Ch. Pvt., 156 D. B., Co. 19, whose serum agglutinated both. strains No. 5 and 168 in a dilution of 1:320. This patient, a meningitis suspect, received no serum treatment, because the laboratory findings of his spinal fluid were negative.

We were unable to demonstrate agglutinins in the spinal fluids of a large number of patients, both during their period of active treatment and after their spinal fluid had become free of organisms, and the pathological excess of cells.

Aside from a few cases of cerebrospinal meningitis among the civil population of Columbia, S. C., who for one reason or another could not be transferred to the Base Hospital, Camp Jackson, the majority of civilian patients received their initial treatment at Columbia and were then transferred to the Base Hospital. It is of interest to note that not all the civilian patients thus admitted suffered from cerebrospinal meningitis traceable to contact with enlisted personnel or the proximity of the camp to the city. For one of these, a negro, became ill with cerebrospinal meningitis while serving an extended term in jail, the other, Hayward Trezeverant, admitted Jan. 31, 1918, had never been near the camp and had just arrived from Ft. Mott.

The prophylactic measures taken by the Board of Health of the city consisted in the prompt isolation of all suspicious cases and those who had been in contact with them. The later were cultured for meningococci of the naso-pharynx and kept under quarantine until found free. Public schools, churches and places of popular amusement were closed and the use of street cars by children discouraged for about six weeks during the height of the epidemic. Throughout the epidemic there was the closest co-operation between the Division Surgeon and the health authorities of the city and state. The

prophylactic measures agreed upon for those desiring to visit the city have been indicated in the earlier part of this communication.

I take pleasure in acknowledging the assistance given me by Drs. A. H. Bunce, G. C. Brunelle, J. S. Fleming, G. F. Klugh, E. H. McLean and A. V. Solomon, members of the laboratory Staff, Base Hospital, Camp Jackson, S. C.

MICHIGAN TRUDEAU SOCIETY. RESOLUTION ON THE DEATH OF

DR. V. C. VAUGHAN, JR.

The death of the late Doctor V. C. Vaughan, Junior, of Detroit removes from the Michigan Trudeau Society one of its charter members. The loss is a great one to our Society, to the City and State, and to the medical profession at large.

Be it resolved, therefore, that we deeply mourn his death and extend our sympathy to the various members of his bereaved family; that we request that these resolutions and the accompanying biographical sketch by Doctor Guy L. Kiefer be spread upon our minutes and printed in the Michigan State Medical Journal; and that a copy sent to the members of his family and to each member of this society.

TUBERCULOSIS WORK.

be

Previous to the year 1905 the tuberculosis work of the Detroit Board of Health was confined to an attempt to educate the public in the need of preventive measures. So-called "non-spitting signs" were placed in street cars and other public places forbidding spitting as a general precautionary measure. Pamphlets along similar lines were printed and distributed and knowledge of the disease and its method of spread was disseminated in various ways-through articles in the daily newspapers, in medical and public health journals, and by means of public lectures whenever, such were possible.

FIRST T. B. CLINIC.

In the fall of 1905, a new departure was inaugurated-The first "Tuberculosis Clinic" was at that time established in Detroit. A new force entered into the work, a new personality, Dr.

V. C. Vaughan, Jr. work, charitable and kindly disposed to the afflicted poor and conscientious to a fault in the performance of public duty, Dr. V. C. Vaughan, Jr., took charge of this department and the success of the Board of Health's efforts for the prevention and restriction of the great white plague was assured. The clinic was open daily, except Sundays, from 5 to 6 in the afternoon with Dr. Vaughan in attendance. Here the patients were examined and advised in the prevention of the disease and in the care of their individual case. The homes of the patients were visited by nurses from the Visiting Nurses Association and the members of the family instructed in the details of the prevention of tuberculosis. Each house was provided with one or more folders on "How to Prevent Consumption" and "How to Cure Consumption." The beginning was difficult. It was early in the campaign against tuberculosis, and not only the people at large but even the physicians were not keen in their support. By untiring efforts and everlasting perseverance Dr. Vaughan succeeded in getting patients to apply for advice. The first comers were consumptives in the advanced stage of the disease, almost unable to climb the stairs that lead to the clinic. The kind treatment and careful examination that they always received at the hands of the physician, lead them to tell their friends and acquaintances about it and the opportunity for the Board of Health to reach the public was established. In the summer of 1906 the Exhibit of the National Association for the Study and Prevention of Tuberculosis was brought to Detroit. While the Exhibit was being shown at the Museum of Art, daily from July 30th to August 5th, interesting and instructive lectures on the prevention of tuberculosis were given every evening by speakers from various parts of the country. A large committee of local physicians had charge of this undertaking but Dr. Vaughan was again the moving spirit. Thousands of people visited the exhibit and heard the lectures, and the interest in the prevention of tuberculosis received a new impetus.

Sincerely devoted to his

Today, when such large appropriations are being allowed for preventive measures, it will be interesting to note that during the year 1907, the sum of $600 was appropriated to be used as a fund for furnishing food (proper). The amount was increased $1,200 the following year.

TENT HOUSE ERECTED.

After the tuberculosis clinic had been established a comparatively short time, the need of hospital or sanitorium facilities for some of the patients, became very apparent. Consequently in the winter of 1908, the open air treatment of tuberculosis was begun under the auspices of the Detroit Board of Health. A tent house was

erected on the grounds of the old smallpox hospital on Hamilton Boulevard (part of the grounds now occupied by the Herman Kiefer hospital), and the first patient was taken there for treatment on February 21st. It was a bitter cold winter day as I well remember because I accompanied Dr. Vaughan to call on his first city hospital patient. The consumptive had been living in a couple of dark dingy rooms in a tenement on Congress street east and it was difficult for our nurses to persuade him to open a window at "home" where he sat beside the kitchen stove After his first night in the open, the patient told Dr. Vaughan that it was the first night he had slept well in months. When the patient was returned to "his apartments," somewhat improved in health, he took the windows out altogether as he said he could not breathe in that stuffy place.

The small tuberculosis sanitorium grew by the addition of another tent house donated by the Tau Beta Alumnae Association shortly after the start had been made. The Tau Beta girls not only presented the tent to the city but paid an amount sufficient for the care of one patient annually for several years. At this point allow me to quote from the report of the health officer for the year 1907-1908:

"It is the intention to keep patients about two months, teach them every detail in the prevention of the disease, give them the best possible care and food during their stay at the hospital and then send them out trained consumptives who will be willing and able to preach the gospel of the prevention and cure of tuberculosis to their friends and acquaintances. If we can in the course of a year increase our facilities so as to admit fifty cases into our training school hospital at one time and change the patients every two months we will be able to educate 300 consumptives a year. In our clinic we will reach at least 300 more who will be given instructions by the physician and nurse in charge. In this way we would be instructing 600 patients a year in the methods of preventing the spread of tuberculosis, and in a comparatively short time our campaign of education will have reached every consumptive in the city of Detroit and the results obtained should then be manifest in the decrease of the number of cases and the reduction of the mortality."

Dr. Vaughan was always strong for this training school as was the health officer with whom he worked so faithfully-but unfortunately the plan did not work out because so many of the patients remain for too long a time and are so far advanced that they can not be taken back to the insanitary houses from which they are usually brought.

In the fall of 1908, six additional tent houses were erected and the north wing of the old building which stood on the grounds, unoccupied, was remodeled and arranged for an administration building and an open air ward for the reception of nine patients. By putting two patients in each tent house, the total capacity was now raised to 25 patients.

One of these tent houses was the gift of Mr. Adolph Finsterwald in memory of his wife, Eva Finsterwald. The generous donor also paid the expense of the care of one patient annually for a number of years.

RED CROSS COTTAGE.

Before the end of the fiscal year of 1908-1909, the Michigan Branch of the National Red Cross Society presented the Detroit Board of Health with most of the proceeds obtained from the sale of "Christmas Stamps" and an open air cottage for the care of eight patients and nurses' apartment was erected and is known as the "Red Cross Cottage." A similar cottage was donated by the Detroit Society for the Study and Prevention of Tuberculosis and is known as "The Blue Star Cottage." All of these improvements have changed the Sanatorium from a single tent house with accommodations for two patients in February, 1908, to a group of buildings with accommodations for forty-one patients within a

year.

On Christmas Day a very pretty celebration was arranged for the patients. A small club of ladies consisting of the following: Mrs. Carl Bonning, Mrs. Guy L. Kiefer, Mrs. A. E. Kiefer, Mrs. R. S. Melchers, Mrs. A. H. Steinbrecher, Mrs. William E. Henze, and Mrs. Morse Rohnert, made arrangements for the festive day. They provided an individual present for each patient, the women being furnished with woolen bonnets, the handiwork of the members of the club above referred to, and the men receiving heavy woolen mittens. A Christmas tree was nicely trimmed for the occasion and the administration building decorated with evergreens and holly. All of the decorations were donated by Mr. Samuel T. Douglas, President of the Board of Health, and many beautiful flowers were added to the decorations, the gift of the Tau Beta Alumnae Association. Grinnell Brothers loaned the use of a music box which added greatly to the pleasure of the day. A similar Christmas festival was arranged each year for several years and was under the supervision of the same group of women.

T. B. REPORTS COMPULSORY. Besides these improvements at the Sanatorium, the work of the Prevention of Tuberculosis was given considerable aid this same year by an act of the State Legislature. A specific law was

passed declaring Tuberculosis an infectious disease and making it compulsory on the part of physicians to report the cases under their care together with certain necessary details to the Board of Health. This is a step decidedly in advance and one for which the Board of Health of Detroit together with the State Board of Health had labored for a long time.

Let us revert now to our Tuberculosis clinic. During the year ending June 30, 1909, four hundred and fifty-nine persons presented themselves to the clinic for examination and the total number of visits made to the clinic by all patients was 2,008.

During the first year of the existence of the Tuberculosis hospital one hundred and one patients were admitted and received attention. These were classified by Dr. Vaughan as follows: Early or incipient cases, 27; moderately advanced, 34; advanced 40. The patients remained in the hospital for periods varying from a few days to twenty-one weeks. In a report' made by Dr. Vaughan during that year the cases and the results obtained were all tabulated and the conclusion as best expressed in his own words.

"From an examination of the above tables we see that among the first stage cases 24 out of the 26 patients remaining in the hospital for an interval of at least one week showed improvement in weight, this improvement in weight being in all cases accompanied by a corresponding improvement in their general condition. In other words 92.6 per cent. of the early stage cases did well during their hospital residence. Among the the 34 cases classified as moderately advanced, 24 showed improvement in weight and general condition, a percentage of 70. Out of 40 advanced cases 17 showed improvement in weight and general condition during their hospital stay. In other words 42.5 per cent. of the advanced cases showed temporary improvement during their stay in the hospital.

"While it is too early to state whether the early and moderately advanced cases which have gained during their stay in the hospital have acquired a permanent arrest of their disease process, those individuals which have been under observation for from 3 to 4 months s.nce their residence in the hospital have held the ground which they gained in a most satisfactory manner. Moreover these cases if they follow the instructions which have been given them during their stay in the hospital will cease to be sources of danger and infection to the community in which they live."

DR. VAUGHAN, T. B. PIONEER. During the following year further improvements were made at the hospital and the capacity was enlarged to fifty-nine patients. The Red