(a) A culture from the throat made on admission to the observation ward (first day in hospital).
(b) A culture made on the first day in the treatment ward (third day in hospital).
(c) A culture made one week later (tenth day in hospital).
If the ward incidence of hemolytic streptococci reaches 10 per cent, especially in a filled ward, the cultures should be repeated on the thirteenth day in the hospital. If the incidence of “carriers” of hemolytic streptococci increase rapidly, cultures on alternate days should be made so that “carriers” may be removed from the ward. Wherever possible, culturing of the treatment wards as units should be practiced.
5. Patients developing acute symptoms in any way suggestive of infection with S. hemolyticus should be immediately isolated; culture from the throat should be made at once and final disposal of the patient should depend upon its result.
Carriers of Hemolytic Streptococci
During the winter of 1917–18, with the establishment of the army camps, it very soon became evident that in many of the serious and fatal complications of measles and other respiratory diseases, hemolytic streptococci were playing a very important rôle. The epidemic prevalence of hemolytic streptococci among hospital cases, and later among men on duty in the camps, was established by bacteriologic studies. Prior to this time in civil life, hemolytic streptococci under epidemic conditions had been studied in milk-borne epidemics of septic sore throat, such as are reported from Chicago in 1911–13[[92]]; from Boston in 1911[[93]]; and from Baltimore in 1911–12[[94]]. Contact air-borne infection has not been emphasized in considering the dissemination of hemolytic streptococci. Smillie[[95]] reports a few cases of hemolytic streptococcus throat infections which he attributes to contact infection. Conditions within the army camps were such as to suggest the dissemination of hemolytic streptococci by contact air-borne infection. Some knowledge of the percentage of individuals showing positive throat cultures became desirable at the very beginning of studies of contact dissemination of hemolytic streptococci.
Smillie found that only one of 100 normal throats harbored the Beta hemolytic streptococci of Smith and Brown. Levy and Alexander[[96]] report the presence of hemolytic streptococci in 83.2 per cent of healthy men at Camp Taylor, and hemolytic organisms (not definitely identified as streptococci) in 14.8 per cent of recruits arriving at Camp Taylor. Irons and Marine[[97]] found hemolytic streptococci among 70 per cent of healthy men at Camp Custer.
Among measles patients on admission to the hospital at Fort Sam Houston, Cole and MacCallum[[98]] report 11.4 per cent and Cummings, Spruit and Lynch,[[99]] 35 per cent of throat cultures positive for hemolytic streptococci. At Camp Taylor, Levy and Alexander report 77.1 per cent positive among 388 cases of measles on admission to the hospital.
The spread of hemolytic streptococci in measles wards was shown by Cole and MacCallum when on admission 11.4 per cent of cases had positive throat cultures, 38.6 per cent after from three to five days, and 56.8 per cent after from eight to sixteen days in the ward. In our study of hemolytic streptococci with measles at Camp Funston, 2.6 per cent of the cases had positive throat cultures on admission, 12.8 per cent after three to ten days, and 24.1 per cent after eight to twenty-three days in the hospital. In a similar study at Camp Pike we found 1.7 per cent positive on admission; 10.9 per cent after one week; 22.8 per cent after two weeks; 26.2 per cent after three weeks; and, 33.1 per cent after four weeks in the hospital.