H.—l9b

XV

Review of Outbreak of Illness at Camp. 51. In reviewing the outbreak of serious illness at the camp it is important to consider — (1.) The type and nature of the maladies. (2.) Whether there were any indications in the early months of the year that the maladies might assume dangerous proportions. (3.) If such indications were present, did the authorities concerned realize their significance and prepare ample and sufficient means for treatment and prevention ? (4.) When the maladies had actually assumed large and dangerous proportions, were energetic and effective methods pursued both in treatment and in the prevention of further spread ? The types of sickness prevalent in the Trentham Camp may be grouped under the heads— (a) Measles; (b) colds and sore throats; (c) influenza; (d) cerebro-spinal meningitis; and (c) pneumonia. 52. It can be stated with certainty that the measles, colds, septic sore throats, and influenza ran on concurrently. As the number of measles increased, so did the number of the other groups. As the measles increased in virulence, so did the virulence of the other groups increase. The illnesses that occurred at Trentham Camp were almost entirely of a respiratory character. The respiratory organs and tissues, nose, throat, bronchial tubes, lungs, and pleura were affected in a very marked degree. Measles, influenza, bronchitis, pneumonia, and cerebro-spinal meningitis are all associated with catarrh or inflammation of one or other of these tissues or organs. This camp was singularly free from serious sickness connected chiefly with the alimentary system, such as typhoid fever, dysentery, or epidemic diarrhoea. It is also worthy of note that the respiratory troubles prevalent in camp were all of an infectious or contagious character. From an examination of the medical reports and causes of death, one of us (Dr. Martin) finds that when the outbreak of sickness in the camp assumed the character of the epidemic many of the measles cases took on a " suffocative," a " typhoid," or a " malignant" character. Some died from one or other of this type of measles, and some contracted and died from a rapidly fatal pneumonia. For instance, one man apparently convalescing satisfactorily from measles, and being up and about, became suddenly ill. one afternoon and died the next day of pneumonia. In July some of the patients diagnosed as suffering from influenza, and apparently convalescing well from that complaint, suddenly became ill with cerebro-spinal meningitis, and some of these men died from this disease. For example, Private F , admitted to the kiosk at the racecourse hospital on the 7th July with influenza, apparently progressed well till the 16th July, when he became grievously ill, and died from cerebro-spinal meningitis two clays afterwards. 53. An examination of the sick returns shows that pneumonia was, in many of the patients attacked, of a very serious nature, but that the number of those so attacked was not a large one considering the size of the camp and the fact that there were so many men in it suffering from various forms of respiratory troubles. The pneumonia influence in the illnesses at camp is shown by the following table of admissions to hospital and deaths from this Ca.USe :— Admissions. Deaths. December ... ... ... ... 3 1 January ... ... ... ... 5 February ... ... ... ... 2 March ... ... ... ... ... 0 April ... ... ... ... ... 2 1 May ... 5 June ... ... ... ... ... 14 7 July ... 21 8 A comparison of the death-rate with the total number of admissions in the above list is not of much value, because many of the deaths from pneumonia occurred in patients who were admitted with a diagnosis of influenza or

Questions to be dealt with.

Character of maladies.

Pneumonia.