Discussion.—At Camp Funston, where the prevalence of S. hemolyticus in the measles wards did not rise above that among normal men in the camp at large, 112 consecutive cases of measles were treated without a single complication due to hemolytic streptococci.
At Camp Pike, the investigation began at the onset of a small epidemic of measles at a time when hemolytic streptococci were an almost negligible factor. The epidemic of measles was followed throughout its course; and, with the passing of the epidemic, there was an increase in the prevalence of hemolytic streptococci which assumed alarming importance in the production of complications.
The epidemic of measles was in part superimposed upon the epidemic of influenza, so that deductions concerning complications strictly due to measles became impossible. It is evident that influenza played a considerable part in producing the complications of measles at Camp Pike.
The dissemination of hemolytic streptococci through measles wards was controlled only in part by the methods used. This partial control may have served to limit the incidence of streptococcus pneumonia, nine instances occurring among 867 cases of measles.
In the ward treatment of measles effort should be directed to prevent the exposure of patients free from hemolytic streptococci to S. hemolyticus “carriers.” By this means the rate of development of S. hemolyticus “carriers” may be reduced.
Measures which should be adopted are as follows:
1. Adequate wards should be prepared in advance for the treatment of measles. The rather gradual onset of epidemics of measles makes this provision possible.
2. The separation of S. hemolyticus “carriers” from other patients should be enforced. Observation wards, where strict technic to prevent transfer of infection is practiced and where throat cultures are made on admission, are essential. Those wards should be promptly evacuated to wards for the care of S. hemolytic “carriers” on the one hand and for “noncarriers” on the other. As far as possible patients should be admitted to a ward until it is filled and then another ward should receive consecutive cases in the same manner. It is desirable to have all cases in each treatment ward in the same stage of the disease. With this system of ward rotation convalescent wards are necessary, so that cases requiring a period of hospitalization longer than the average may be segregated, thus rendering treatment wards available for another levy of acute cases.
3. Strict ward technic elaborated to prevent transfer of bacterial infection from one patient to another must be employed.
4. Throat culture for identification of “carriers” is laborious but essential. An accurate method for identifying and reporting “carriers” as speedily as possible must be employed. A competent bacteriologist is essential. A twenty-four hour interval between culture and its report is desirable. The following scheme is recommended: