(b) One hundred and sixty-six contact “carriers” are included in Groups II to VIII. Eighty-two of these passed from observation after their initial positive culture and 14 appear as “irregular.” The cases with repeated throat cultures after the initial positive are summarized in Table LXX.
| Table LXX | |||
|---|---|---|---|
| NO. PATIENTS CULTURED | NO. BECOMING NEGATIVE | PER CENT BECOMING NEGATIVE | |
| Recultured after one week | 70 | 26 | 37.1 |
| Recultured after two weeks | 22 | 9 | 40.9 |
| Recultured after three weeks | 5 | 5 | 100.0 |
| Recultured after four weeks | 4 | 4 | 100.0 |
These records indicate that contact carriers in great part harbor hemolytic streptococci during short intervals. A longer period of observation after the disappearance of hemolytic streptococci would have been desirable in many instances. Some patients were followed with consistently negative cultures during three, four and five weeks after hemolytic streptococci had disappeared.
It is difficult to explain those instances in which negative cultures are interposed between positives. Where one negative interrupts positive cultures, it is possible that the throat culture failed to demonstrate hemolytic streptococci which were present. Such cases in this series fall within the limits of the percentage error of throat culture identification. Where two or three, or even four negative cultures intervene, reinfection is not impossible.
Relation of S. Hemolyticus “Carriers” to the Complications of Acute Respiratory Diseases.—In the present study of measles it has been shown that pneumonia following measles has been no more common in “carriers” than in “noncarriers.” Nevertheless, pneumonia occurring in badly infected wards has been modified by streptococcus complications.
More cases of otitis media have appeared in “carriers” than in “noncarriers.” The possibility that mild otitis media, which would ordinarily pass unnoticed, might become evident as the result of streptococcus invasion must be considered. Levy and Alexander have made an important contribution to our knowledge of the rôle of hemolytic streptococci in measles. They find that “carriers” of hemolytic streptococci among measles patients are especially predisposed to complications following measles.
Their cases were drawn from a camp population highly saturated with S. hemolyticus “carriers.” In the organization from which 89 per cent of their patients with measles came, there were 83 per cent hemolyticus “carriers” among men on duty. Among patients with measles, throat cultures were positive for hemolytic streptococci on admission in 77 per cent. It is evident that all patients with measles have been exposed to hemolytic streptococci during the first day or two after admission. Failure to carry streptococcus would appear to be dependent upon ability to resist it rather than upon lack of opportunity for acquiring it. Of 388 cases observed by Levy and Alexander only 79 were “noncarriers” of hemolytic streptococci on admission, and of these, 27 became positive while under observation; only 52 remain as “noncarriers” of hemolytic streptococci. This small group must be regarded as a highly selected one, composed of individuals more than ordinarily resistant to hemolytic streptococci and perhaps to all complications of measles. The chances are that these 52 cases placed under any circumstances might very well have been among the large number of measles cases in which no complications develop.
Furthermore, it is not unlikely that any complication of measles may be modified by a streptococcus secondarily when about 85 per cent of the cases show S. hemolyticus in the throat. The complications in the cases of Alexander and Levy appear to have been caused in large part by streptococcus, but a complete bacteriologic study of them is not recorded. Complications among streptococcus “carriers” are not identical with complications due to the streptococcus, and it is desirable to know what percentage of complications actually due to hemolytic streptococci occurred among the 85 per cent of patients with measles who carried hemolytic streptococci.
Summary.—No hemolytic streptococcus complications occurred in 112 cases of measles observed at Ft. Riley, among which streptococcus “carriers” rose from 2.6 per cent on admission to 24.1 per cent before discharge from the hospital. The percentage of “carriers” of hemolytic streptococci among normal men in the camp supplying these cases was about 25.5 per cent.
The influenza epidemic and a small epidemic of measles occurred in part simultaneously at Camp Pike during September and October, 1918. The complications following measles at Camp Pike were to a considerable extent dependent upon the combined effects of influenza and measles.