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. [Illustration: