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CHAPTER I INVESTIGATIONS PURSTJED AND CONCLUSIONS REACHED Introduction.-Importance of the establishment of the method of transmission of trench fever. Prevalenee of the disease. Organization and plan of the research. Co-operation between British and American authorities. The obtaining of volunteers from the American Army ; their medical examination. Planning of a field research under war conditions. Problems studied. Conclusions reached. Acknowledgements. Introduction.-After several montlis' study of the problems relating to the prevention of infectious diseases oecurring in the Allied Armies on the Western front, it became evident to the writer 1 that the subject of the method of transmission of trench fever was one of the most important for investigation in bonnexion with the loss of man-power already occurring in somé of these armies, and likely to increase in other armies. The method of transmission of this clisease was at this time unknown, and although there had been much speculation on the subject, very little scientific investigation had been under - taken regarding it and no conclusive results obtained. Moreover, the problem of transmission seemed more urgent for study in connexion with the prevention of trench fever than that of the etiology of this disease, which had already been investigated extensively, although the causative organism remained unknown. Discovery of the methocl of- transmission of a number of the most serious of the infectious diseases has led often to extremely successful results in their prevention, and one cannot refer to a more brilliant example in Preventive Medicine than the results obtained from the introduction of sanitary measures based upon the knowledge of the discovery by Reed and his colleagues of the method of transmission of yellow fever, even though the etiologieal factor of this disease is ultra-microscopic. Therefore, it was hoped that if the method of transmission of trench fever could be proved and the method demonstrated in a thoroughly conclusive manner to the military authorities concerned, the enormous wastage among the troops from this disease could be reduced to a minimum. Prevalenee ofthe disease.-It is not appropriate and no attempt will. be made to give accurate statistics as to the extent to which trench fever has prevailed among the different armies, and indeed no such statistics are available at this time. However, it may be stated that no other infectious disease during the past two years has occasioned so much sickness among the troops in Francé. Grieveson, Muir, McNee, and Byam2 have all published articles in which the grave importance of the disease from a military standpoint is emphasized. Grieveson 3 points out that trench fever förmed 40 per cent. of his hospitál evacuations, and at one time 60 per cent. of all cases of sickness. He further says that the morbidity rate of trench fever can only be equalled by such plagues as typhus, typhoid, or malaria. Muir 4 showed that m