the  infectious  organism  is  itself  rarely  found  in the  wound. Tetanus occurs worldwide. Occurrence is un- common and sporatic in industrial countries, and it  is  more  common  in  agricultural  regions  and underdeveloped  countries. The infectious agent is the bacillus  Clostridium tetani.  The  reservoir  is  the  intestinal  tract  of animals and man and soil contaminated with their feces.  The  incubation  period  averages  about  10 days and ranges from 1 days to several months. Transmission is by introducing tetanus spores into the  body  through  a  wound,  usually  a  puncture wound.   Tetanus   is   not   communicable   directly from  man  to  man. The  specific  treatment  includes  tetanus  im- mune  globulin,  administered  intramuscularly  or intravenously,  and  intensive  medical  support. Preventive  measures  are  based  on  appropriate immunizations. Immunization with a basic series of  tetanus  toxoid,  with  a  booster  at  10-year  in- tervals, is required of everyone. Tetanus prophy- laxis  for  patients  with  wounds  requires  careful determination  and  assessment  of  whether  the wound  is  clean  or  contaminated,  in  addition  to the   appropriate   use   of   tetanus   toxoid   and/or tetanus immune globulin, wound cleansing, and surgical  debridement.  The  proper  use  of  anti- biotics  is  also  needed.  The  public  should  be educated  concerning  the  need  for  proper  wound care and active and/or passive prophylaxis after significant  injury  to  the  skin. International travelers should maintain an up- to-date  immunization  for  tetanus. Tuberculosis Although  tuberculosis  may  affect  many  or- gans, it is primarily a pulmonary bacterial disease that may result in death and disability. The in- fection  usually  causes  pulmonary  lesions  that  heal within  a  few  weeks  without  being  noticed.  The only evidence of this invasion may be lymph node calcifications in the lungs or chest. In some cases, the initial invasion progresses to pulmonary tuber- culosis   with   symptoms   of   weight   loss,   fever, cough,  chest  pain,   and,   in   advanced   stages, hoarseness,  and  bleeding  from  the  lungs.  Less  fre- quently,  extrapulmonary  tuberculosis  occurs  when the bacillus is disseminated to other parts of the body  through  the  lymph  and  blood  systems. Tuberculosis  infection  is  inferred  when  the tuberculin skin test is equal to or greater than 10 mm  of  induration.  A  presumptive  diagnosis  is made  by  demonstrating  acid-fast  bacilli  in  stained 11-23 smears of sputum or other body fluids, and is con- firmed  by  isolation  of  the  tubercle  bacilli  on culture. Tuberculosis  occurs  worldwide.  The  infectious agent  in  humans  is  primarily  Mycobacterium tuberculosis.  The  most  important  reservoir  is  man and, in some areas, cattle. The incubation period from  infection  to  primary  lesion  or  positive  tuber- culin  skin  test  reaction  is  about  2  to  12  weeks. Tuberculosis  may  be  communicable  as  long as tubercle bacilli are discharged in the sputum. Extrapulmonary  tuberculosis  is  generally  not  con- sidered  communicable.  Susceptibility  to  tuber- culosis  is  general.  Children  under  3  years  old, adolescents, and young adults are at greatest risk. Susceptibility  to  disease  is  increased  in  the  under- nourished   or   underweight   and   in   those   with chronic   conditions   such   as   diabetes   and alcoholism. NAVMEDCOMINST  6224.1  series  provides guidelines  on  the  control,  screening,  follow-up and   treatment,   and   reporting   of   tuberculosis among  Navy  and  Marine  Corps  personnel  and dependents. Control and screening are primarily with the use of purified protein derivative (PPD) intradermal injections. High risk personnel who require  annual  screening  are  all  medical/dental personnel  or  fleet  personnel.  Individuals  whose PPD skin test show them to be positive for a past or  present  infection  are  placed  on  a  1-year  pro- gram of antituberculosis medication and periodic evaluations. Active  tuberculosis  cases  are  treated  with specific drugs under the direction of a medical of- ficer. Respiratory isolation precautions are used for  hospitalized  patients.  Contacts  of  active cases—whether in a household, office, or ship— are evaluated with situational PPD skin testing for  evidence  of  infection. Typhoid Fever Typhoid fever is a serious systemic bacterial disease characterized by symptoms of fever, loss of appetite, malaise, headache, cough, red spots on  the  trunk,  and  constipation,  or  diarrhea. Typhoid  fever  occurs  worldwide.  In  the  United States  and  other  areas  with  developed  sanitary facilities, most cases are imported from endemic areas. The infectious agent is Salmonella typhi,  the typhoid  bacillus.  The  reservoir  is  man.  The  in- cubation period is from 1 to 3 weeks. Transmis- sion  is  through  food  or  water  contaminated  by the feces or urine of a carrier or patient. Shellfish