Pre-eruptive Stage Research Articles

HUMAN CONVALESCENT SERUM IN THE PREVENTION AND MODIFICATION OF MEASLES

Measles is possibly the most prevalent, the most contagious and one of the most fatal diseases of early childhood. Practically all human beings are susceptible, regardless of their age or race or the climate in which they live, but young children furnish the greatest number of cases and the highest mortality. Ninety-seven per cent of the cases occur before the age of 15 and over one-half during the first five years of life. It is difficult to prevent exposure to the disease because of its highly contagious character in the prodromal period, during which the symptoms are not diagnostic and its nature remains unrecognized. The period of highest infectivity is in the preeruptive stage. Few persons die of the disease itself, but, contrary to the popular conception, measles is a disease to be feared because of the high mortality due to complications from secondary invading organisms. The death rate from

SUCCESSIVE ROENTGENOGRAMS OF THE CHEST OF CHILDREN DURING MEASLES

The frequency of symptoms in measles that are referable to the respiratory tract is generally recognized. Little or nothing is known of the roentgenologic changes that occur in the chest during the various stages of the disease. Our purpose in this study, therefore, was to determine by roentgenologic methods the frequency of changes in the lung, the character of these changes and, finally, their progress. The study is based on the examination of 130 children who were admitted to the Willard Parker Hospital because of measles. Only children admitted during the preeruptive or eruptive stage are included in this series. In a subsequent study, we shall report further data on the roentgenograms of these patients, made from four to eight months after their discharge from the hospital. METHOD Successive roentgenograms of the chest were taken every two or three days during the child's stay in the hospital. In all, 388

AN AID TO THE EARLY DIAGNOSIS OF MEASLES AND POSSIBLY VARIOUS OTHER ERUPTIVE DISEASES

In treating a child, aged 8 years, who had recovered from measles with a complete disappearance of eruption five days before, we decided, for several reasons, to give her some general ultraviolet radiation. On exposure to the rays in a darkened room, we were surprised to see what appeared to be an ordinary generalized eruption covering the torso, face and legs. Thinking that possibly the rash of measles was followed by a small amount of pigmentation, we decided to try exposure during the preeruptive stage. In the first case so treated, a boy, aged 6 years, a brunet, the eruption showed beneath the epidermis exactly forty-eight hours before it made its appearance macroscopically. Becoming interested, we began trying this on a number of patients of various ages. In some of these cases we were called only a few hours before the eruption appeared. In our list we timed the development of

THE ETIOLOGY OF MEASLES

It is generally accepted as a proved fact that the contagium of measles is present in the blood stream during the late preeruptive and early eruptive stages of the disease. This was first conclusively demonstrated by Hektoen,1who produced clinical measles in two adults by injecting them with ascites broth which had been inoculated with blood from a measles patient. Experiments with monkeys2have confirmed the correctness of this view. The epidemiologic evidence indicates with great probability that the contagium is present in the throat and nasal secretions just before the fastigium and at the height of the eruption, disappearing or becoming noninfectious with the fading of the rash. While both of these facts have been apparent for some time, and attempts to cultivate the specific organism from the blood and throat secretions had been made, little had been accomplished until Tunnicliff,3in 1917, isolated a green,

Observations on the Etiology of Measles

Recently Ferry and Fisher 1 have described a small, gram-positive, aerobic, green producing streptococcus which they isolated from the blood of measles patients in the early stages of the disease. In obtaining this organism 10 cc. of blood were added to flasks of Hibler medium and any resulting growth was plated on sheep's-blood agar. They state that this organism forms a soluble toxin, which on injection into horses or rabbits is capable of producing an immune serum showing antitoxic properties. Further, by using proper dilutions of the toxin, they have elaborated a skin test similar to the Schick test and Dick test, which can be used in determining individual susceptibility to measles. In a series of papers published between 1918 and 1926 Tunnicliff2 and her associates describe a gram-positive micrococcus which they believe to be the etiologic factor of measles. This organism, which can be cultivated only under strict anaerobic conditions in the first generation, grows, when transplanted upon suitable mediums, as an aerobic greenproducing diplococcus or short chain streptococcus in subsequent generations. They have recovered this organism from the blood, sputum, nasopharyngeal secretions and the aural discharge of measles patients in the pre-eruptive stage and in the early period of the rash. They believe that they have produced a modified form of measles by inoculating susceptible animals with this organism. The serums of these inoculated animals possess the biological properties of immune sera. These workers have not as yet reproduced the disease in man. Caronia 3 isolated an anaerobic gram-negative diplococcus from the blood, bone marrow, nasopharyngeal secretions and cerebrospinal fluid of measles patients using the Tarozzi-Noguchi culture technic. This organism is agglutinated in high dilution by the serum from convalescent measles patients. He states that he reproduced the disease in young

Agglutination in Measles

In a previous article1 I have described a small, gram-positive diplococcus, which was isolated in anaerobic cultures from the blood of measles patients, during the pre-eruptive and early eruptive stages of the disease. Similar diplococci were also isolated from the throat, nose, eye, and in one instance from the ear. During the acute stage of measles, I found that the serum showed a diminished opsonic power for this organism,2 followed by a marked increase as the symptoms subsided and the rash began to fade. This increase in opsonins occurred generally on the third or fourth day after the appearance of the eruption and was specific for the measles diplococcus. The serum of measles patients gave slight complement fixation for the diplococcus,3 at the time corresponding to the height of the opsonic reaction. Measles serum was found also to agglutinate this diplococcus, but when first isolated the organism often agglutinated so much spontaneously that no satisfactory experiments could be made. Later, when studying the serum of rabbits immunized with diplococci isolated from measles, it was found3 that strains about one year old grew diffusely in dextrose broth and did not agglutinate spontaneously, but were agglutinated distinctly by immune rabbit serum. Hence it seemed worth while to study again agglutination reactions in measles. The new experiments were made at Camp Meade, Md. The serum of 10 measles patients was examined, generally daily, for agglutinins by the macroscopic method. A strain, isolated from the blood of a measles patient a few hours before the appearance of the eruption, was used in the experiments. Another blood strain isolated at the same time of the disease, was also tested from time to time and found to correspond closely in its agglutinative reaction. The diplococci were transplanted from human blood agar to dextrose (29fc) broth and incubated 24 hours. The mixtures of diluted serum and broth culture

AN EXPERIMENTAL DEMONSTRATION OF THE PRESENCE OF THE VIRUS OF MEASLES IN THE MIXED BUCCAL AND NASAL SECRETIONS

In our previous communications¹we have shown that the monkey (<i>Macacus rhesus</i>and<i>Macacus cynomolgus</i>) is susceptible to the infection of measles when inoculated with the blood obtained from a human case late in the preeruptive stage or within twenty-four hours after the first appearance of the eruption. Following such an inoculation,²at least 50 per cent. of the animals react in a characteristic manner. After a variable incubation period of not less than five days there is a more or less marked rise in temperature with or without catarrhal symptoms referable to the respiratory passages, such as sneezing and cough, and with or without an exanthem. About half the animals inoculated fail to present definitely recognizable symptoms. In other words, the disin the monkey is subject to great variation, the variations corresponding to those that have been described in the human subject and presenting in some respects

Is Small-Pox Contagious before the Eruption Appears?

To the Editor: —A man afflicted with small-pox walked our streets one day last week, causing no small degree of popular and journalistic agitation. A prominent physician who had examined the case is reported as saying: I do not know that small-pox is contagious in the first three or four days, before the eruption comes out. I can assure the profession that this malady is contagious in the pre-eruptive stage, and will now adduce a case in point: One night during the year ending July 1, 1872, a young German clerk sought admittance to the Long Island College Hospital, Brooklyn, N. Y. The Superintendent, William V. Blower, arose from his bed to admit the patient, but although not a medical man himself, upon seeing and questioning him he suspected the malady might be a contagious one, and as such were not admissible, he awoke me for advice. Although