Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
A comparison of Tables LXII and LXIII gives some indication of what
might have been expected if the carriers had not been removed from the
treatment wards at weekly intervals. With the carriers removed from the
“clean” cases and segregated in a separate ward so as to be removed
effectively as sources of spread of the S. hemolyticus infection to
clean cases, the percentage incidence with all cases considered rose to
a point nearly twice as high as that ever reached in the wards where
clean cases alone were allowed to remain. Had these carriers not been
separated, and remained in contact with cases free from hemolytic
streptococci, they would have served as just so many more sources of
infection, and an incidence of at least twice that recorded for all
cases combined, or four times that of the treatment wards, might have
been expected. These results indicate that the weekly separation of
carriers from clean cases did, to a considerable extent, lower the
individual’s danger of acquiring S. hemolyticus infection while in the
hospital.
Complications of Measles
In Table LXIV the complications developing in the measles patients under
observation at Camp Pike are tabulated. In the division of the
complications developing in “carriers” and “noncarriers” of the
hemolytic streptococci, reference is made only to the records of the
throat cultures. The division is therefore not dependent upon the
bacteriology of the complications. For example, only 9 of the 12 cases
of pneumonia developing in “carriers” were streptococcus pneumonias. On
the other hand, the cases of mastoiditis following otitis media were
almost invariably due to hemolytic streptococci. Of the 10 otitis cases
occurring in “noncarriers,” 4 developed mastoiditis and 3 of these
showed hemolytic streptococci on culture from the mastoid cells at
operation. Missed cases of identification of S. hemolyticus by throat
culture in cases which develop S. hemolyticus complications may arise
from a number of causes. It is desired here only to direct attention to
these discrepancies.
=Pneumonia Following Measles.=—Fifty-six cases of pneumonia following
measles occurred during the period of observation in this group of 867
cases of measles. Of these, 9 were streptococcus pneumonias. This gives
an incidence for streptococcus pneumonias of 1.04 per cent, while that
for all the pneumonia is 6.4 per cent. There were 8 cases of lobar and
48 cases of bronchopneumonia. Seventeen fatal cases occurred giving a
mortality rate of 30.4 per cent for the group. Five of these fatal cases
occurred among the 9 streptococcus pneumonias. The mortality rate for
the streptococcus pneumonia thus was 55.5 per cent; that for the
nonstreptococcus group was 25.5 per cent. All 9 cases of streptococcus
pneumonia developed empyema. In 7 cases it was diagnosed clinically; in
2 at autopsy only. No cases of empyema developed in the group of
nonstreptococcus pneumonias.
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