Epidemic Respiratory Disease / The pneumonias and other infections of the repiratory tract accompanying influenza and measles

by Eugene L. Opie; Francis G. Blake; Thomas M. Rivers; James C. Small

Case 714, W. H. Onset of measles, Oct. 26; admitted to hospital, Oct. 28; otitis media, Nov. 8; onset of bronchopneumonia, Nov. 9; of empyema, Nov. 17; convalescent in pneumonia ward.

Bacteriology.—1. Throat cultures for: S. hem., Oct. 28, −; Nov. 4, −; 12, +; 23, +; 30, +; Dec. 7, +; 12, −. 2. Sputum: Nov. 10, Pneumococcus II atypical, S. hem. and B. influenzæ.

Case 730, W. S. Autopsy No. 491. Onset of measles, Oct. 26; admitted to hospital, Oct. 29; onset of bronchopneumonia, Nov. 10; of empyema, Nov. 11; of cervical adenitis, Nov. 5; died, Nov. 15.

Bacteriology.—1. Throat culture for: S. hem., Oct. 30, −; Nov. 4, +. 2. Sputum: Nov. 10, S. hem. 3. Pleural fluid: Nov. 11, S. hem. Autopsy bacteriology: Heart blood, S. hem.; right main bronchus, B. influenzæ, B. coli; right lung, S. hem. and B. influenzæ; right pleura, S. hem.; peritoneum, S. hem.

Case 751, P. B. Autopsy No. 492. Entered hospital, Oct. 19; onset of measles, Oct. 30; of bronchopneumonia, Nov. 5; of right empyema, Nov. 12; died, Nov. 16.

Bacteriology.—1. Throat cultures for: S. hem., Nov. 1, −; 4, +; 15, +. 2. Sputum: Nov. 13, B. influenzæ and S. hem. 3. Autopsy cultures: Heart blood, S. hem.; right lung, S. hem., Pneumococcus IV, B. influenzæ, B. coli; pericardium, negative; right pleura, S. hem.; peritoneum, S. hem.

Case 880, B. McN. Autopsy No. 507. Onset of measles, Nov. 30; entered hospital, Dec. 3; onset of bronchopneumonia, Dec. 11; of empyema, Dec. 14; died, Dec. 14.

Bacteriology.—1. Throat cultures for: S. hem., Dec. 3, −; 5, −; 12, +. 2. Cultures from pleural fluid, Dec. 14, S. hem. 3. Autopsy cultures: Heart blood, S. hem.; right main bronchus, S. hem., B. influenzæ, staphylococcus (a few); left lung, S. hem.; left pleura, S. hem.

The average period in the hospital before the development of the streptococcus pneumonia is about two weeks. Cases 98 and 285 were in the hospital thirty and twenty days respectively before the onset of pneumonia. There is a record of from one to four negative throat cultures on each case before streptococcus was found in the throat. This enables us to fix the onset of the pneumonia with reference to the appearance of the streptococcus in the throat.

Case 141 stands alone as representing a class in which S. hemolyticus was implanted upon a pneumococcus pneumonia during its course. In this instance two throat cultures on alternate days after the onset of the pneumonia were negative for hemolytic streptococci. Unfortunately the last record of a throat culture is for one taken ten days before the fatal termination of the case, and it can only be stated that the S. hemolyticus infection was implanted within the last ten days of the course of the pneumonia, perhaps on or about October 12 when bilateral otitis media developed.