| Table LXIV | |||||||
|---|---|---|---|---|---|---|---|
| Complications Developing in 867 Cases of Measles at Camp Pike. Distribution of Complications Between 242 “Carriers” and 625 “Noncarriers” of Hemolytic Streptococci from September 15 to December 15, 1918 | |||||||
| NAME OF COMPLICATION | NUMBER OCCURRING IN | TOTAL NUMBER | PER CENT IN | ||||
| “CARRIERS” OF HEM. STREP. | “NONCARRIERS” OF HEM. STREP. | CASES WITH INCOMPLETE RECORD OF THROAT CULTURES | ALL CASES | HEM. STREP. “CARRIERS” | “NONCARRIERS” OF HEM. STREP. | ||
| Pneumonia | 12 | 44 | 0 | 56 | 6.4 | 5.0 | 7.0 |
| Otitis media | 31 | 11 | 6 | 48 | 5.5 | 12.8 | 1.8 |
| Mastoiditis (following otitis media) | 15 | 4 | 4 | 23 | 2.6 | 6.2 | 0.6 |
| Local meningitis (extension from mastoid) | 2 | 0 | 0 | 2 | |||
| Frontal sinusitis | 1 | 0 | 0 | 1 | |||
| Ethmoidal sinusitis | 0 | 1 | 0 | 1 | |||
| Suppurative arthritis | 1 | 0 | 0 | 1 | |||
| Cervical adenitis | 1 | 0 | 0 | 1 | |||
| Acute bronchitis | 4 | 2 | 0 | 6 | |||
| Acute tonsillitis | 4 | 1 | 0 | 5 | |||
| Acute laryngitis and aphonia | 1 | 0 | 0 | 1 | |||
| Acute pleurisy | 2 | 1 | 0 | 3 | |||
| Erysipelas of face | 0 | 1 | 0 | 1 | |||
| Epidemic meningitis | 0 | 1 | 0 | 1 | |||
| Note.—The percentages of incidence of pneumonia and otitis media in the “carrier” and “noncarrier” groups are at direct variance. It would appear from these findings that streptococci very readily invade the middle ear from the throat and set up grave disorders. The invasion of the lung from the throat occurs with less frequency. Hemolytic streptococci perhaps never initiate the pneumonic processes and can be regarded as more or less accidental secondary invaders. | |||||||
The relation of these pneumonias following measles, to the influenza epidemic has been discussed. The time relations between the onsets of measles and that of the subsequent pneumonia vary widely. There appears to be nothing constant in the length of time between the onset of measles and that of the pneumonia. In 30 of the cases this period is less than ten days; in the remaining 26 cases, it ranges from ten to thirty-two days (Chart 4).
In the ward treatment of these cases of pneumonia, they were divided into three groups according to their clinical characters and according to the results of throat and sputum cultures.
| (a) | Streptococcus pneumonias | 9 cases |
| (b) | Pneumonia with hemolytic streptococci in the throat without symptoms referable to the streptococcus | 13 cases |
| (c) | Pneumococcus pneumonias not carrying hemolytic streptococci | 34 cases |
The streptococcus-free cases were treated in a separate ward. Cases were admitted to this ward directly from the “clean” measles wards, but only after a throat culture taken prior to their transfer had been negative for the hemolytic streptococcus.
The other two groups were treated together in another ward, but in strictly separate compartments of it. This precaution was carried out on the assumption that patients with an acute streptococcus pneumonia were real sources of danger in the ward because of a heightened virulence of the organism causing the grave symptoms. The pneumonias subsequently developing hemolytic streptococci in their throats, without their presence modifying the course of the pneumonia, came to be regarded as being in the same class with uncomplicated cases of measles carrying hemolytic streptococci, in so far as their being potential sources of danger in a ward is concerned.
Chart 4.—Shows the time interval between the onset of measles and the onset of the subsequent pneumonia in the 56 cases of pneumonia following measles at Camp Pike. Each case is represented by one of the small blocks measured along the ordinate. The onset of measles in all cases is represented by the line at the extreme left of the chart. The onset of pneumonia in each case is indicated by the limit of the block marked off in days to the right of this line.
(a) Streptococcus Pneumonias.—Nine cases of streptococcus pneumonia developed. Of the 867 cases of measles studied, 242 showed throat cultures positive for the hemolytic streptococci at some period of their stay in the hospital. It appears then that 3.7 per cent of the patients carrying hemolytic streptococci in their throats developed streptococcus pneumonia. Thirty-seven cases had positive throat cultures when first observed on admission to the measles wards. It is significant to note that not a single case of pneumonia of any kind developed among these cases.
MEASLES PNEUMONIA; STREPTOCOCCUS GROUP