coccus, while eighty-seven percent of the sputum revealed the same organisms. Examinations of both swab cultures and sputum showed that one hundred percent of the patients were infected with streptococci of the hemolytic type. An examination of the pleural exudates of forty-one lobar pneumonia cases at necropsy, showed fifty-nine percent to be pure hemolytic streptococcus, while pneumococci were found in forty-one percent of the cases. Of seven broncho pneumonia specimens eighty-six percent streptococcus and fourteen pneumococcus. Death was classed as apparently due to hemolytic streptococcus in ninety-four per

were

cent of the total cases and the conclusion was drawn that the streptococcus is the causative organism in this complication following measles; moreover, it was the cause of death even in a large percentage of the cases of lobar pneumonia.

Dr. Rufus Cole, a member of the commission which made a study of pneumonia existing at Fort Sam Houston, is of the opinion that broncho pneumonia following measles is due to one organism, a hemolytic streptococcus and that reports of the findings of nonhemolytic strains which have been made from some camps need to be verified.

Distribution of Organism.

The hemolytic streptococcus does not appear to be such a widely distributed organism as the pneumococcus. It has been found in a small percentage of normal individuals. Swab cultures taken from the throats of healthy individuals at Fort Sam Houston showed that only six percent harbored this organism. At Camp Zachary

Taylor, on the other hand, fifteen percent of one contigent were found to be carriers of the hemolytic streptococci on arrival in

camp.

While it is true that hemolytic streptococci are often found in milk, all the evidence at hand in

dicates that these are of a different type and are not pathogenic. For reasons at present unknown, hemolytic streptococci prefer to select a measles patient for their host. It may be that the organism of measles prepares the way for the streptococci. In any case the respiratory passages of the patient suffering from measles make a good culture medium for the organism and, the resistance of the patient having been broken down by the disease, streptococci invade infection. An examination of 291 the lungs and produce a severe swab cultures from measles cases at Fort Sam Houston showed Type III hemolysis in 104. It is significant to note that thirty-three percent of the patients giving positive findings developed strepto pneumonia. Similar results have been obtained in other camps. Patients in the same wards with streptococcus carriers soon become carriers themselves and as these organisms rapidly gain in virulence by passage from one host another a serious epidemic is the result.

to

As a preventive measure all measles patients should be examined for the presence of the streptococcus hemolyticus and those found to be carriers should be rigidly isolated. Such measures have been taken in our Army hospitals. All persons coming within the immediate neighborhood of such patients should be protected by face masks. These measures

have proved highly valuable in combating serious epidemics.

Protective Serum.

Numerous attempts have been made to produce anti-serum against streptococcus infections and several such serums are being sold by commercial firms. At the present time, however, no striking results have been obtained in the majority of streptococcus infections. These unsatisfactory results. have been due to the fact that there exist a great many strains of streptococci, differing from each other in their cultural reaction and immunity tests. Today streptococci are divided into two main groups, those that possess the power to lake red blood cells, called the hemolytic group, and those that produce no hemolysis in blood, called the non-hemolytic, or sometimes streptococcus viridans. The later class is a heterogeneous group of organisms which show little relation to each other, either culturally or in their immunity reactions. On the other hand, recent researches have proved that the streptococcus hemolyticus is a more homogeneous group. Although the different members of the group show some variation in their fermentative reactions, there is little difference in their immunological reactions as indicated by the complement fixation test. Much work remains to be done, but the future looks promising for producing a satisfactory immune. serum against the group, provided its members are closely enough related. At present there is also no conclusive evidence of the usefulness of vaccine therapy in streptococcus infections for the same reasons which apply to serum therapy.

At Fort Sam Houston the experiment has been carried out of

vaccinating one group of streptococcus carriers and injecting another with anti-pneumococcic serum. The report on this work has not yet been made public.

For the country doctor who has no available laboratory facilities, the determination of the causative agent of pneumonia offers serious. difficulties. difficulties. It is out of the question to send a specimen of sputum any distance to a laboratory because of the time consumed. It is essential that a diagnosis be made in the shortest possible time, as pneumonia is a treacherous and uncertain disease. For such cases some authorities advocate that both a polyvalent pneumococcus serum and streptococcus serum be administered at once, as such a serum has exactly the same specific action against the type of organism causing the infection as its own immune serum, only in this case a larger dose of the serum must necessarily be given. Although such a procedure may prove of great value, there is at present no conclusive evidence for its adoption.

RABIES IN ENGLAND AGAIN.

England has recently experienced cases of rabies after being entirely free from the disease for fifteen years. Cases have been reported from Devonshire and the Isle of Man. A quarantine established twenty years ago against the importation of dogs from abroad, and strictly enforced despite objections by a large part of the public, gradually reduced rabies prevalence among animals in England from 672 cases in 1895 to none in 1903 and succeeding years up to the present. The cases this year are attributed to dogs smuggled in from France by returning soldiers.

MPERFECT disinfection of a

I portion of Xenia's public

water supply was responsible for the typhoid fever outbreak of forty-four cases in that city during the last few days of August and the earlier half of September, according to investigations made. by representatives of the State Department of Health. The fault, it was found, lay with a defective supply of bleaching powder, the substance used as a disinfecting agent.

All epidemiological evidence disclosed by the investigation pointed to the water supply as the source of infection. Cases were widely distributed over the city and city water was used at home by all but one patient, who used it only at her place of business. A study of the occupations of the patients revealed no similarity in this regard. Milk, ice cream and fresh vegetables were used in varying quantities and obtained from many sources. None of the patients had eaten any raw shellfish recently before falling ill. No public gatherings had been attended by patients recently enough to be suspected as sources of infection. Contact infection as an important. cause is ruled out by the facts that only eleven patients resided in homes where other cases developed either before or after the case in question and that only two households had as many as three cases each.

The Xenia water supply is furnished by a private company. It is derived from two sources

a

system of drilled wells southwest of the city and a combined surface and ground water supply obtained from reservoirs, springs and dug wells north of the city. The surface and ground water supply was installed in 1887 and remained in use after the drilled wells were installed in 1896, because the latter source was insufficient to supply the city. Water from the drilled wells has always appeared satisfactory from a sanitary standpoint. That pumped from the station north of the city has been shown at several times to be unsatisfactory, in consequence of which a hypochlorite disinfection plant was installed in 1914. On the average two-thirds of the city's water comes from the drilled-well source and one-third from the disinfected supply, the amount pumped from the drilled wells becoming relatively smaller in dry weather. This variation makes it impossible to determine just what part of the city is being supplied from each source at a given time, but the presence of a large amount of iron in the drilled-well water makes a reasonable degree of differentiation possible.

Disinfection of the water at the north pumping station had been carefully conducted, according to the report of the Department investigators, who found that bleaching powder had been added in definite, prescribed quantities for two and one-half years. Analysis. of water samples collected in the city, however, demonstrated that the water from this station was

of doubtful and unsatisfactory quality, while that from the other station was satisfactory. This led to an analysis of the bleaching powder, which was found to be of one-fifth the guaranteed strength.

"Since this substance was guaranteed to be of proper strength,' says the report of the investigation, "it follows that the undertreatment of the city water was purely accidental; nevertheless, it is significant that such a possibility

always exists when disinfection of a public water supply is necessary to render it safe for domestic use. In order to avoid the recurrence of a polluted water being supplied the consumers at Xenia, the water company should abandon the existing supply at the Springfield Pike station (the surface and ground water source) and procure water of satisfactory sanitary quality from another source. In the meanwhile, it is advisable that the company abandon its hypochlorite method of disinfection and employ the more dependable and up-to-date method using liquid chlorine."

NEW TREATMENT FOR
EMPYEMA IS DEVISED

BY ARMY SURGEONS Means of treating empyema, the lung disease which caused many deaths in the army camps and cantonments last winter, have been devised by the army medical department. The plan followed by the army surgeons is to draw off the pus which forms in the pleural cavity by means of aspiration (a needle and suction apparatus) at frequent intervals, following this by operation after the patient has begun to improve and the exudate has become reduced in virulence.

The civilian practice in empyema has been to operate immediately after diagnosis. The type of disease prevailing in the army has been found to be widely different from that met with in civil life, and the medical officers have felt that early operation may involve great risks without compensating benefits.

Empyema was one of the complications which frequently followed measles in the army hospitals last winter. This infection attacks the membrane covering the lungs or the membranous lining of the chest, producing a fluid or pus which remains between the two membranes and, as it increases in quantity, tends to fill the pleural cavity and reduce the air space in the lungs, frequently witn fatal result. The form of the disease observed in the army last year was found upon investigation to be due to the streptococcus.

GOVERNMENT ISSUES

1916 BIRTH STATISTICS. The birth rate in the birth registration area of the United States in 1916 was 24.8 per 1,000 population, according to the Census Bureau's report for the year, just issued. The death rate in the same states was 14.7 per 1,000 population.

The birth rate was .I below that for 1915 and the death rate was 7 higher than in 1915.

The death rate of infants under one year old was 101 per 1,000 living births in 1916, as against 100 per 1,000 living births in 1915.

The birth registration for 1916 included the six New England states, New York, Pennsylvania, Maryland, Michigan, Minnesota and the District of Columbia. Ohio has since been admitted.