The incidence of Diplococcus pneumonia Weichselbaum in a group of individuals at Montana State
College
by Elizabeth M Carter
A THESIS Submitted to the Graduate Committee in partial fulfillment of the requirements for the
degree of Master of Science in Bacteriology at Montana State College
Montana State University
© Copyright by Elizabeth M Carter (1941)
Abstract:
During the school years of 1958 to 1940,, a Survey to determine the carrier incidence of Diplocoacus
pneumoniae in the throats of a group of individuals at Montana State College was carried out. Various
methods of obtaining cultures were tried.
Using the results of this work and the suggestions received from other investigators as a guide, a more
comprehensive survey was carried out from October 1940 through April 1941 on a group of 54
individuals.
The group was composed of some members of the college faculty, some members Of the clerical staff,
but mostly it was made up of college students. Two methods, the gargle and the swab methods with
modifications developed by the author, of obtaining cultures of Dlplocpccus pneumoniae were used in
order that the relative merits of each might be determined.
Of the 54 individuals tested, 75.9 per cent (41) were carriers of Diplococcus pneumoniae at one time or
another during the survey.
Experimental evidence is presented which indicates that neither the gargle nor the swab method can be
depended on to secure cultures from 100 per cent of the carriers, and that both methods should be used
simultaneously when determining the carrier incidence. Evidence is also presented which shows that
beef heart infusion broth enriched with beef serum gives a much higher per cent of positive cultures
than does the unenriched broth.
The individuals tested in this survey were grouped using the classification of the author.
Nineteen specific types of DiplococCus pneumoniae were found during this survey. Type 5 was the
most common; types 1 and 2 were never found. " . . . I t is- ^ s y t o make m is ta k e s i n t h i s f i e l d o f in v e s tig a tio n ; ^
e asier# , perhaps# than, t o acknow ledge th em , M d b e lie v in g # a s I do# i n
human f a l l i b i l i t y # I have no h e s i t a t i o n i n q u e s tio n in g t h e c o n c lu s io n s
o f th e m ost i l l u s t r i o u s w orkers i n th e f ie ld , -of. m icro b io lo g y # i f th e y a r e
i n c o n f l i c t w ith my own o b s e rv a tio n s ,. On t h e o th e r h a n d / if* upon f u l l e r
in v e s tig a tio n # I am convinced t h a t I have b e en m is ta k e n i n re g a rd t o t h i s
o r any o th e r q u e stio n # X s h a l l f e e l no h e s i t a t i o n i n fo llo w in g th e
example o f P a s te u r i n making a p u b lic announcement o f my e r r o r , *
— S te rn b e rg (1895)
ITH f I
THE INCIDENCE OF DIPLOCOCCUS PMfflONIAE OTICBSELBAUM IN A GEOUP OF
INDIFIDUAIS AT MONTANA STATE COLLEGE
by
ELIZABETH M. GARTER.
A THESIS
S u b m itted t o th e G rad u ate Committee
in
p a r t i a l f u l f i l l m e n t o f th e re q u ire m e n ts
f o r th e d eg ree o f
M aster o f S c ie n c e in B a c te rio lo g y
at
Montana S ta te C o lle g e '
-^C hairm an
G raduate Committee
Boseman» Montana
May, 1941
Bot.
BacL
X 37?
C Z-l-o*
-
2-
TABLE OF CONTENTS
A b stra ct.....................................................................................
3
In tro d u ctio n ...................................................................
4
H is t o r ic a l..................................
4
M a te r ia ls........................................................................................................................... 12
Methods.........................................................................
R e s u lts .......................................... ..............................................................................
D iscu ssio n o f Methods and R e s u lts ........... ..........................
.33
C on clu sion s...........................................................................................
Acknowledynents............................................................................................................. ..
B ib liograp h y..................................................................
&=r—
4
05
CO
6 0 1 0 ?
48
-S a
ABBgRflCg
D uring th e sc h o o l y e a r s o f 1958 t o 1940, a su rv e y t o d eterm in e th e
c a r r i e r in c id e n c e o f D inlococcus pneumoniae i n th e t h r o a t s o f a group o f
in d iv id u a ls a t Montana S t a t e O o lio g e ^ a F la a r r ie d o u t. V a rio u s m ethods o f
o b ta in in g c u l t u r e s w ere t r i e d .
D sing th e r e s u l t s o f t h i s work and th e s u g g e s tio n s re c e iv e d from
o th e r i n v e s t ig a to r s a s a g u id e g a more com prehensive su rv e y was c a r r ie d
o u t from O ctober 1940 th ro u g h A p r il 1941 on a group o f 54 in d iv id u a ls .
The group was composed o f some members o f th e c o lle g e f a c u l t y , some
members Of th e c l e r i c a l s t a f f , b u t m o s tly i t was made up o f c o lle g e
s tu d e n t s . Two m ethods, th e g a rg le and t h e swab m ethods w ith m o d if ic a tio n s '
d ev elo p ed by th e a u th o r , o f o b ta in in g c u l t u r e s o f D inlococcu s pneumoniae
w ere u sed i n o rd e r t h a t t h e r e l a t i v e m e r its o f each m ight be d e term in e d .
Of th e 54 in d iv id u a ls t e s t e d , 75.9 p e r c e n t (41) w ere c a r r i e r s . o f
D in lo co ccu s pneum oniae a t one tim e o r a n o th e r d u rin g th e s u rv e y .
E x p e rim en ta l e v id en c e i s p re s e n te d w hich in d ic a te s t h a t n e ith e r th e
g a r g le n o r th e swab method c a n be depended on t o s e c u re c u l t u r e s from
100 p e r c e n t o f th e c a r r i e r s , and t h a t b o th m ethods sh o u ld be used
s im u lta n e o u s ly when d e te rm in in g th e c a r r i e r in c id e n c e . E vidence i s a ls o
p r e s e n te d w hich shows t h a t b e e f h e a r t in f u s io n broth e n ric h e d w ith b e e f
serum g iv e s a much h ig h e r p e r c e n t o f p o s i t i v e c u ltu r e s th a n does th e
im dnridhed b r o th .
The in d iv id u a ls t e s t e d i n t h i s s u rv e y w ere grouped u s in g th e c l a s s ­
i f i c a t i o n o f th e a u th o r .
n in e te e n s p e c i f i c ty p e s o f D ip lo co ccu s pneumoniae w ere found d u rin g
t h i s s u rv e y . Type 5 was th e most common; ty p e s I and S w ere n e v er fo u n d .
“4:0*
im-RODUCTIOM
T hig p a p e r p re g e n ts th e r e s u l t s o f a s u rv e y by th e a u th o r o f a
group o f in d iv id u a ls s e le c te d on th e M ontam S ta te C o lleg e campus to
d e term in e th e in c id e n c e o f th e v a r io u s ty p e s o f D iu lo co ccu s pneumoniae
Welckgelbaum i n the, t h r o a t s o f th is , group.
The r e s u l t s sh o u ld th r o w .
some l i g h t on th e in c id e n c e o f DiplOcoccug pneumoniae among th e in d i­
v id u a ls a t t h a t i n s t i t u t i o n .
I t i s a ls o th e o b je c t o f t h i s p a p e r t o compare two d i f f e r e n t
m ethods o f o b ta in in g c u ltu r e s from, th e t h r o a t s o f in d iv id u a ls and t o
show th e r e l a t i v e m e r i t s o f t h e two m ethods.
HISTORICAL
In c id e n c e o f th e c a r r i e r r a t e . —A lthough K lebs (18715) i s g iv e n c r e d i t
f o r f i r s t s e e in g pneum ococci„ i t was S te rn b e rg (1.881) Who f i r s t in o c u la te d
r a b b i t s w ith norm al s a li v a and is o la te d th e c h a r a c t e r i s t i c la n c e t-s h a p e d
d ip lo e o e c i w hich we now re c o g n is e a s D ip lo co ccn s pneumoniae.
S te rn b e rg ,
how ever8 d id n o t a p p r e c ia te th e s ig n if ic a n c e o f th e s e o rg a n ism s, and i t
rem ained f o r F r fe d la n d e r (1884) t o d e s ig n a te th e s e d ip lo e o e c i a s th e
c a u s a tiv e a g e n ts o f pneum onia.
S in c e th e w ork o f Doohez and Avery (1 9 1 5 )8 i t has b e en known t h a t
pneum ococci a r e p r e s e n t i n th e t h r o a t s o f a la r g e number o f h e a lth y
in d iv id u a ls .
These a u th o rs found t h a t , w h ile pneumococci, o f ty p e s I
and I l caused o v e r 60 p e r c e n t o f th e e a se s o f lo b a r pneumonia i n a d u lts ,
th e in c id e n c e i n th e norm al mouth was l e s s th a n I p e r c e n t.
They found
ty p e I I I and group BT t o be re s p o n s ib le f o r SO p e r c e n t o f th e pneumococcus
=eS**
e ase e and t o be found f r e q u e n tly I n th o mouth*
P o w e ll, A tw a te r, and F e lto n (1926) made s e v e r a l su rv e y s d u rin g th e
p e rio d from Septem ber 1928 to March 1924 i n B oston and fo u n d t h e Ineideziee
o f pneumoooeci t o be a s fo llo w s :
(a ) Of 104 la b o r a to r y w orkers 70 (67 p e r c e n t) were c a r r i e r s o f
pneumonia organisms = Type I o c c u rre d i n 3 (1*9 p e r c e n t) o f th o s e
exam ined d u rin g t h e su rv e y ; ty p e I l i n IO (9*6 p e r c e n t) ; ty p e I I I in
14 (1 0 .4 p e r c e n t ) ; and ty p e IT (now r e f e r r e d to a s group IT ) i n 57
(54*8 p e r c e n t )*
(b ) Of 113 h ig h sc h o o l boys 74 (66 p e r c e n t) were c a r r i e r s *
Type I
o c c u rre d i n 7 (6*8 p e r c e n t) o f th o s e examined d u rin g th e su rv e y ; ty p e I I
i n 6 (5*5 p e r c e n t) ; ty p e I I I in 5 (4*4 p e r c e n t) ; and ty p e IT in 66 (58*9
p e r c e n t)*
(c ) Of 112 m e d ic a l s c h o o l s tu d e n ts 74 (66 p e r c e n t) w ere c a r r i e r s .
Type I o c c u rre d i n 4 (5 .5 p e r c e n t) o f th o s e examined d u rin g th e su rv e y ;
ty p e I I i n 5 (2 .6 p e r c e n t ) ; ty p e I I I i n 5 (4+4 p e r c e n t) ; and ty p e IT i n
67 (5 9 .8 p e r c e n t ) .
(d) Of 90 s tu d e n t n u rs e s 48 (55 p e r c e n t) o f th o s e examined d u rin g
th e su rv e y w ere c a r r ie r s *
Type I o c c u rre d i n no o a s e s ; ty p e I I i n I ( 1 ,1
p e r c e n t) ; ty p e H I i n 8 (8 ,8 p e r c e n t) ; and ty p e IT i n 44 (48 p e r c e n t ) .
(e ) Of th e t o t a l group o f 95 p e rs o n s on whom 418 ex am in atio n s were
made, ty p e I o c c u rre d i n 5 ,1 p e r c e n t o f th e ex am in atio n s; ty p e I l in
4 ,8 p e r c e n t; ty p e I I I i n 7 .7 p e r c e n t; and ty p e IT In 56 p e r cent*
M eyer (1920) found no s t r a i n s o f ty p e I o r I l among 100 h e a lth y
in d iv id u a ls ; o n ly 5 s t r a i n s (5 p e r c e n t) o f ty p e I I I ; and 17 s t r a i n s
—6=
( I ? p e r c e n t) o f group I ? o rg a n ism s»
T/ebgJter and Hughes (1951) r e p o r te d t h a t i n an extended in v e s t ig a ti o n
em bracing m onthly ex am in atio n s o v er a p e r io d o f from two m onths to two
and one*4ialf y e a r s , o f 105 c h ild r e n and a d u lts l i v i n g i n Hevr York O ity 8
pneumococci w ere o b ta in e d a t one tim e o r a n o th e r from th e n a s a l p a ssa g es
o r th e t h r o a t o f 80 p e r cent o f t h e p e rs o n s s tu d ie d .
They a l s o n o ted
t h a t th e in c id e n c e o f pneumococci i n a l l o f th e in d iv id u a ls in c lu d e d i n
t h e s tu d y underwent s e a s o n a l f l u c t u a t i o n s c o rre sp o n d in g t o th e changes i n
t h e p re v a le n c e o f coryza and s o re t h r o a t s i n th e same p e rs o n .
T h is' l a t t e r
o b s e r v a tio n was a ls o r e p o r te d by longeope and Hex (1905)»
Ghmdel (1955) r e p o r te d - th a t re p e a te d t e s t s had been made ev ery f o u r
weeks f o r one y e a r on th e u p p e r r e s p i r a t o r y t r a c t o f o v e r 100 norm al
s u b je c ts .
Type I o c c u rre d i n 0 ,8 p e r c e n t o f th o s e te s te d ? ty p e XX i n
0 .4 p e r c e n t; ty p e X II i n 6 ,7 p e r c e n t; and group XY i n 6 0 ,0 p e r c e n t,
S C h le if s te in (1958) made a s tu d y o f 100 norm al in d iv id u a ls in
A lbany, Hew Y ork, who had n o t b e en i n c o n ta c t w ith pneumonia p a t i e n t s
and found 7 3 .0 p e r c e n t t o be c a r r i e r s o f pneum ococci,
B11S8, McOlaskey8 end lo n g (1994) made a atudy o f 80 su b je c ts in
th e John Hopkins U n iv e r s ity M ed ical S c h o o l, on whom 1,016 c u ltu r e s t o
be t e s t e d f o r U in lococcu s pneumoniae w ere ta k e n o v er a p e r io d o f two
y ears.
Of th e s e c u l t u r e s 3 4 ,5 p e r c e n t w ere p o s i t i v e f o r pneum ococci.
A ll b u t one o f t h e s u b je c ts y ie ld e d p o s i t i v e c u ltu r e s o f D ip lo co ccu s
pneumoniae a t l e a s t once d u rin g th e c o u rse o f th e in v e s t i g a t i o n ,
B la ck lo e k and O u th rie (1935) fo u n d pneum ococci i n th e t h r o a t s of
0 8 ,6 p e r c e n t o f t h e h e a lth y c h ild r e n exam ined.
H osesaug F e lto n 9 and A tw a ter (1926) r e p o r te d on th e work o f S a i l e r ,
E a lla m i s o n , and MoOoy (191?) who fo u n d , i n 700 e x a m in a tio n s, 16 p e r c e n t
to be c a r r i e r s o f pneumococci.
In c id e n c e o f m u ltip le -ty p e c a r r ie r s *— In th e s u rre y s w hich have
b e en c a r r ie d o u t t o d eterm in e th e a b i l i t y o f h e a lth y in d iv id u a ls to
c a r r y D ip lo co ccu s pneum oniae i n t h e i r t h r o a t s , some i n v e s t ig a to r s have
fo u n d m ore th a n one ty p e t o be p r e s e n t a t th e same tim e ,
Gundel and O Iw a (1985) in v e s t ig a te d th e o c cu rren ce o f pneumococci
o f more th a n one s e r o l o g i c a l ty p e i n th e same s u b je c t.
Of th e in d iv id ­
u a l s s tu d ie d , 88 p e r c e n t c a r r ie d organism s o f two o r more ty p e s*
The
a p p earan ce o f th e new ty p e s was a t t r i b u t e d b y th e a u th o rs t o in f e c tio n
from w ith o u t o r p o s s ib ly t o t h e developm ent o f a ty p o w hich had been
s u p p re sse d by th e dominance o f t h e f i r s t ty p e fo u n d ,
M acEenzie, Tepperman9 and MeKee (1940) found i n a r u r a l community
t h a t 4 1 ,8 p e r c e n t o f th e 250 p e o p le upon whom seven su rv e y s w ere made
d u rin g 14 m onths co u ld be c la s s e d a s m u ltip le * ty p e c a r r i e r s ,
im portance o f c o n ta c ts , —Doehez In d Avefy (193-8) re c o g n iz e d th a t
t h e e x is te n c e o f th e c a r r i e r s t a t e among h e a lth y persons-: and among th o s e
r e c e n t l y re c o v e re d from pneumonia e s ta b lis h e d a b a s is f o r u n d e rsta n d in g
th e mechanism, by w hich lo b a r pneumonia s p re a d s and m a in ta in s i t s h ig h
in c id e n c e from y e a r t o y ear*
I n a group o f 270 c o n ta c ts w ith 28 c a s e s o f pneum onia, B osenau6
B e lto n , and A tw ater (1926) found a c o n s is te n t ex cess o f c a r r i e r s o v er
th o s e found i n th e . c o n tr o l g ro u p » The e x c e ss ap p eared o n ly i n th o s e
ty p e s w hich w ere p r e s e n t am ong-the 28 c a s e s , namely ty p e s I and I I I ,
-8 -
TJaey fo u n d t h a t c o n ta c ts o f ty p e I c a s e s w ere th r e e tim e s a s l i k e l y to
c a r r y ty p e I organism s a s a r e c o n tr o ls ( 8 .1 p e r c e n t a g a in s t 8 .0 p e r c e n t ) .
O o n ta ets w ith ty p e SIX cages w ere tw ic e a s l i k e l y t o c a r r y ty p e 111 organ­
ism s a s c o n tr o ls (1 7 .8 p e r c e n t a g a in s t 9 .9 p e r c e n t ) .
It-w a s a ls o
p o in te d o u t by th e s e a u th o rs t h a t ty p e 111 organism s .occurred, i n c o n tr o l
p o p u la tio n s more f r e q u e n tly th a n ty p e s I and I l ta k e n to g e t h e r » y e t in
.most y e a rs ty p e I I I c au se s n o t more th a n o n e - s ix th a s much pneumonia i n
th e U n ite d S ta te s a s ty p e s I and I I .
Type I I I a p p a r e n tly s p re a d s from,
b o th c a r r i e r s and e a s e s more r a p i d l y th a n does ty p e I .
Bosenau8 F e lto n 9 and A tw ater (1986) showed t h a t among 880 p e rso n s
exposed t o 88 c a r r i e r s , 9 ( 4 .1 p e r c e n t) c a r r i e r s o f th e homologous
organism were d e te c te d .
They f e l t t h a t t h e ev id en ce p re s e n te d c o rro b ­
o r a te d th e a ssu m p tio n t h a t c a r r i e r s , a s w e ll a s c a s e s , sp re a d
pneum ococci, th o u g h , a s th e y p o in te d o u t , th e o ases w ere more p r o l i f i c
so u rc e s th a n w ere th e c a r r i e r s .
m cK en a ie, Tei#erman, and W Eee (1940) i l l si study o f c a r r ie r s in a
V illa g e o f 880 p e o p le i n w hich 8 c a se s o f ty p e I pneum onia had o ccu rred
w ith in S w eeks, found t h a t th e c a r r i e r r a t e o f a l l ty p e s o f D lplococeus
pneumoniae was 7 3 .4 p e r c e n t .
c e n t.
The c a r r i e r r a t e o f ty p e I was 8 4 .0 p e r
F iv e m onths a f t e r t h e o ccu rren c e o f t h e l a s t case o f pneumonia,
th e c a r r i e r r a t e dropped t o 5 .9 p e r cen to
I d e n t i f i c a t i o n o f ty p e s o f D ip lo co co u s pneum oniae. — Cooper and h e r
a s s o c ia te s (1939 and 1933) succeeded i n showing by a g g lu tin a tio n t e s t s
t h a t D iplocoo cus pneumoniae i n Group IF c o u ld be su b d iv id e d in to 89
d iff e r e n t ty p e s ,
p re v io u s t o t h i s w ork, th e i d e n t i f i c a t i o n o f D iplpoQlCpus
*9*
-pneumoniae i?o ty p e s was made a s f o llo w s :
A l l organism s w hich f a i l e d t o
a g g lu tin a te w ith a n t i s e r a f o r ty p e s I 9 I l 9 o r 111 an d ,w h ich w ere a b le
t o ferm en t ln n lin were p la c e d i n group IT*
Cooper's work g r e a t l y a id ed
th e i d e n t i f i c a t i o n o f p io lo c o c c u s -pneumoniae,
But when SJeufeld and
E tinger-T ulczynska (1955) b ro u g h t f o r t h t h e i r m ethod f o r ty p e determin­
a tio n , i t was p o s s ib le f o r . in v e s t ig a to r s t o p la c e t h e i r organism s in to
th e c o r r e c t ty p e s t o th e number o f 58«
O ccurrence o f " su sp iciou s" c u l t u r e s . —A lthough a n t i s e r a f o r ty p e s
I t o 55 a r e now a v a il a b le f o r ty p in g Diplo co ccu s pneum oniae, seme in v e s t­
i g a t o r s have been u n a b le t o c l a s s i f y a s t o type, a l l o f t h e i r c u ltu r e s w hich
by o th e r t e s t s seem t o be D iplococcu s pneum oniae*
S e h l e i f s t e i h (1958) found t h a t o f 132 s tr a in s , o f pneum ococci o n ly 84
co u ld be c la s s if ie d *
I n 15 in s ta n c e s , a "Q u ellu n g sw r e a c t i o n was o b ta in e d
i n p o o led s e r a , b u t th e pneumococci w ere p r e s e n t i n such s m a ll numbers
t h a t i d e n t i f i c a t i o n was n o t a tte m p te d .
T h i r ty - th r e e c u l t u r e s w ere b i l e
s o lu b le b u t co u ld n o t be c l a s s i f i e d a s t o ty p e .
M acKenzie, Tepperman, and McKee (1940) found t h a t 18 p e r c e n t o f th e
c a r r i e r s h a rb o re d pneum ococci w hich d id n o t r e a c t w ith any o f th e s p e c if ic
s e r a o f ty p e s I t o -58*
p o s s i b i l i t y o f change from one ty p e t o a n o th e r . —T here have b e en ,
from tim e t o tim e , s u g g e s tio n s from v a r io u s so u rc e s t h a t one ty p e o f
B ip lo co ccu s pneum oniae m ight change to a n o th e r ty p e i n v iv o » •However,,
t h e r e seems to be some d iv e rg e n ce o f Opinion*
M e g ra il and E cker (1924) s t a t e d t h a t pneum ococci had a ty p e s t a b i l i t y
/
when p la c e d u n d e r c o n d itio n s w hich cau sed th e ty p h o id and o th e r organism s
-1 0 -
•bo show v a r i a b i l i t y ip. Q g g lu tin a tio n e
B aines and, W right (1956) m entioned t h a t t h e i r s e a rc h o f th e l i t - .
© nature had f a i l e d t o produce d e f i n i t e e v id e n c e t h a t a v i r u l e n t pneumo­
coccus co u ld undergo spontan eo u s c o n v e rs io n from one typ e t o an o th er*
They d id , however® s a y t h a t some o f t h e i r work d id n o t prove,® hut d id
s tr o n g ly s u g g e s t9, t h a t u n d e r c e r t a i n r o u ti n e .c o n d itio n s, a ty p e T
pneumococcus would s p o n ta n e o u sly change in to a ty p e I l o rg an ism .
They
w ere u n a b le t o g iv e an y f a c t o r o r f a c t o r s w hich m ight he r e s p o n s ib le f o r
th is in s ta b ility *
Dawson (1950) made th e s ta te m e n t t h a t i t had n o t b een c o n c lu s iv e ly
d e m o n strated th a t, tr a n s f o r m a tio n o f ty p e s among M n io c o c c u s pneumoniae
a c t u a l l y o c c u rre d under, n a t u r a l c o n d itio n s * .
G undel and o k u ra (1955) b e lie v e d t h a t t h e ap p earan ce o f new ty p e s
M t h e t h r o a t s o f in d iv id u a ls s tu d ie d c o u ld he a t t r i b u t e d t o i n f e c t i o n
from w ith o u t o r p o s s ib ly t o th e developm ent o f a ty p e w h ich had been
su p p re sse d by th e dominance o f th e f i r s t ty p e found®
'i ■ ’
K inds o f c a r r i e r s .- - I t has been fo u n d t h a t th o s e in d iv id u a ls who
c a r r y pneum ococci i n t h e i r t h r o a t s a r e n o t alw ays C o n s is te n t e i t h e r i n
t h e le n g th o f tim e th e y c a r r y th e organism , o r i n t h e 't y p e o f organism,
th e y c a r r y .
S tillm a n (1916) found, th a t 'p e r s o n s re c o v e rin g from pneumonia
. rem ained c a r r i e r s - f o r 7' t o 90 d a y s.
D uring t h a t tim e th e y c o u ld a c t as
f c o n ta c t c a r r i e r s ” .
W ebster and B ighes (1951) found t h a t seme p e o p le w ere pneumococcusf r e e , some were " t r a n s i e n t " c a r r i e r s ( p o s i t i v e on s in g le and s c a tte r e d
o e o asio n s betw een p n e m o o o c c u a -fre e p e r i o d s ) , some "periodic" c a r r i e r s
(th o s e from, whom pneum ococci o f one s e r o l o g i c a l ty p e were o b ta in e d f o r
p e r io d s o f I t o IS weeks betw een pnem aoeoceud-frea i n t e r v a l s ) $ and some
w ere e h ro n id c a r r ie r 's (th o s e from whom pneumococci o f one ^ a e ro lo g ic a l
.
ty p e w ere o b ta in e d f o r p e r io d s o f th r e e m onths to th re e , y e a rs o f m o re )» E vidence was p re s e n te d ' showing t h a t t h e s e : d if fe r e n c e s Were due t o a -v a r­
i a t i o n i n h ost^ reslst'an oe t o th e pneumoooecus 'organisms®
' ..
B l i s s , H ctilaskey, and lo n g (1984) a t t e s t e d a c l a s s i f i c a t i o n of
c a r r i e r s ,b ased ' On re p e a te d b a c te r io l o g ic a l, ex am in atio n s e x te n d in g o y e r -a
p e rio d , o f a y e a r or more, w hich was a s l i g h t m o d ifica tio n , o f th a t:d ra w n
up by W ebster and Hughes (1 9 8 1 ).
A f te r a year«B study o f young: a d u lts
th e a u th o rs d iv id e d t h e s u b je c ts in to n o n - c a r r ie r s and c h ro n ic c a r r i e r s ,
’
.
t h e l a t t e r group in clu d in g th o se' p e rs o n s who in te r m itte n tly e x h ib ite d ■
pneum ococci i n t h e i r th ro a t®
W hile th e s o - c a lle d i n t e r m i t t e n t c a r r i e r s ■
m ight o r m ight n o t y i e l d p o s i t i v e c u ltu r e s on re p e a te d e x am in atio n , th e . c u ltu r e s when p o s i t i v e were c o n s i s t e n t l y o f th e same ty p e o f pneumococcus
i n any g iv e n c a s e , i n d ic a tin g t o th e s e a u th o rs a- c h ro n ic c o n d itio n w ith
c o n s ta n t b a c t e r i o l o g i c a l f in d in g s o n ly a s t o ty p e ,
fu r th e r m o re , the.se
a u th o rs c o n sid e re d t h a t t h e i r d e m o n stra tio n added ev id en ce i n f a v o r o f
th e s t a b i l i t y Of pnetimOeodcal ty p e s i n t h e human body. ■ I t seemed more
l o g i c a l t o t h e s e a u th o rs t o d e s ig n a te h e a lt h y in d iv id u a ls who h a rb o r
pneum ococci in th e nose and t h r o a t f o r s h o r t p e rio d s o f tim e -a s temp­
o r a r y c a r r i e r s , and th o s e i n whom o rg an ism s p e r s i s t e d f o r - lo n g e r , p e rio d s
o f tim e a s c h ro n ic c a r r i e r s .
I t wan s u g g e ste d by th e s e a u th o rs t h a t a
f u r t h e r s u b d iv is io n o f c h ro n ic c a r r i e r s in to " c o n tin u o u s6’ and
17i n t e r m i t t o u t" c a r r i e r s would d e fin e more a c c u r a te ly th e c o n d itio n and
th e p o s s ib le menace o f th e c h ro n ic c a s e ,
M l1BRIAlg
Bor grow ing pneum ococci i t was n e c e s s a ry f o r th e medium u se d to
su p p o rt grow th b u t n o t t o cause r a p id a u t o l y s i s .
B eef h e a r t in fu s io n
b r o th w hich c o n ta in e d 0 .2 p e r c e n t ITagBRO4 a s a b u f f e r and 2 p e r c e n t
p e p to n e was found t o be v e ry s a t i s f a c t o r y ,
fo llo w s ;
She f a t was removed from b e e f h e a r t s and th e m eat ground i n an
o rd in a ry m eat g r i n d e r .
w a te r was ad d ed .
h o u rs .
T his b r o th was p re p a re d a s
To each 500 g , o f m e a t, 1000 Ce, o f d i s t i l l e d
T h is m ix tu re was in fu s e d i n th e ic eb o x f o r 12 to 18
A f te r th e f a t had been skimmed fro m th e to p , th e in f u s io n was
b o ile d f o r ■£ h o u r and th e volume was r e s to r e d , w ith d i s t i l l e d w a te r .
t h e a id o f a m eat p r e s s s t h e l i q u i d was squeezed from th e m e a t.
Q ith
T his
l i q u i d was ru n th ro u g h f i l t e r , p a p e r , and th e volume a g a in r e s to r e d w ith
d i s t i l l e d w a te r .
To each 1000 e c , o f t h i s in f u s io n was added 20 g , o f
B ife o p e p to n e , 5 g . HaOls and B g» HagT O 4 and t h i s m ix tu re was h e a te d to
d is s o lv e th e p e p to n e .
A f te r b e in g t i t r a t e d and a d ju s te d t o pH 9 .6 t o 7 .8 ,
t h e b r o th was b o ile d f o r | h o u r.
I t was then, allo w ed t o c o o l t o SO0 0 «
b e f o r e i t was f i l t e r e d , tu b e d , and s t e r i l i s e d i n th e a u to c la v e a t 18 l b s .
p r e s s u r e f o r 15 m in u te s .
The f i n a l pH was a p p ro x im a te ly 7 . 4 .
To in s u r e th e b e s t grow th o f th e pneumococci, th e b e e f h e a r t
in f u s io n b r o th was e n ric h e d by th e a d d itio n o f a p p ro x im a te ly I p e r c e n t
f r e s h b e e f serum which had p r e v io u s ly b e e n s t e r i l i s e d b y t h e u se o f a
E e rk e fe ld f i l t e r and w hich had I p e r c e n t o f form alin added t o i t .
-IS=
S o d im desoxyeholat© s o lu tio n , was u sed i n th e t e s t f o r s o l u b i l i t y
o f t h e c u l t u r e s (Xdlmer and B o e rn e r9 1938)«
I t was p re p a re d a s fo llo w s i
To e v e ry IOO e c , o f d i s t i l l e d water,,. 10 g . o f c h e m ic a lly p u re sodium
d e so x y c h o la te was ad d ed .
The m ix tu re was shaken and s t i r r e d u n t i l
c o m p le te ly d is s o lv e d and th e n a u to c la v e d f o r 15 minutes®
METHODS
M ethods o f o b ta in in g c u lt u r e s f o r th e 1939 t o 1940. s u rv e y . —i n th e
s u rv e y c a r r ie d o u t d u rin g t h e s c h o o l y e a r 1939 t o 19409 s e v e r a l methods
w ere t r i e d w ith v a ry in g d e g re e s o f s u c c e s s .
The f i r s t ,method was a s fo llo w s :
U sing s t e r i l e sw abs, c u ltu r e s w ere ta k e n from th e t o n s i l a r c r y p ts , '
c a re b e in g ta k e n t o a v o id to u c h in g o th e r p a r t s o f th e m outh.
The swab was
p la c e d i n b e e f h e a r t in f u s io n b r o th e n ric h e d w ith a p p ro x im a te ly I p e r c e n t
b e e f serum and in c u b a te d a t 52
O
LC. f o r 12 t o 24 h o u rs .
th e n s tre a k e d on b lo o d a g a r p l a t e s .
T h is c u ltu r e was
C u ltu re s, were ta k e n from th e naso­
pharynx re g io n and t r e a t e d i n th e same way a s th o s e from t h e t o n s i l a r
r e g io n .
A fte r a 24 t o a 48 hour in c u b a tio n p e rio d a t 32° Co9 c o lo n ie s
w hich resem bled th o s e o f D iploeoeeu s pneum oniae w ere t r a n s f e r r e d t o a I p e r
c e n t d e x tro s e b r o th .
The d e x tro s e b r o th was in c u b a te d a t 32° G. f o r 12
h o u rs and th e Efeufeld fiQ uellungs^ r e a c t i o n c a r r ie d o u t.
T h is method p ro v ed
to. be u n s a t i s f a c t o r y s in c e i t y ie ld e d no pneum ococci.
The second m ethod, w hich proved t o be more s a t i s f a c t o r y th a n th e f i r s t
h u t n o t a s s a t i s f a c t o r y a s th e t h i r d , was a s fo llo w s :
A. swab was ta k e n from th e -n a so p h a ry n x r e g io n and p la c e d i n b e e f h e a r t
in f u s io n b r o th e n ric h e d w ith a p p ro x im a te ly I p e r c e n t b e e f serum and
V
«*14«=
in c u b a te d a t 57° C. f o r 4 t o 6 h o u rs .
One c c . o f t h i s c u ltu r e was in ­
je c te d i n t o th e p erito n eu m o f a w h ite m ouse.
When th e mouse became v e ry
s ic k o r was j u s t on th e .verge o f d e a th , h e was. a u to p s ie d .
b lo o d
A c u ltu re , o f
was ta k e n from th e h e a r t and p laced , i n a tu b e of e n ric h e d b e e f h e a r t
in f u s io n b r o th ,
v is ib le - .
T h is c u ltu r e was in c u b a te d a t 57° 0 , u n t i l grow th became
At t h a t tim e , th e N eufeld tfQ u ellu n g st' r e a c tio n was c a r r ie d o u t,
The th i r d ,, an d m ost s u c c e s s f u l method was a s f o llo w s :
The s tu d e n t t o be examined f o r th e p re s e n c e o f pneumococci was asked
t o r i n s e h i s m outh, e s p e c ia ll y arou n d th e t e e t h , w ith 80 c c . o f p h y sio ­
l o g i c a l s a l i n e s o l u t i o n (0 ,8 5 p e r c e n t ) . • T h is w ashing was d is c a rd e d .
Then SO c c . o f th e s a l i n e s o lu tio n was u sed a s a g a rg le f o r from I to
5 m in u te s and th e n ex p elled , in to a s t e r i l e c o n ta i n e r .
c e n tr ifu g e d a t SOOO r . p , m , f o r one h o u r.
.
T h is w ashing was
.
A ll th e sedim ented m a t e r i a l
was th e n suspended I n I c c , o f s a l i n e s o lu tio n , and in je c te d i n t o th e p e r i ­
t o n e a l c a v it y o f a white.mouse*,
S ix h o u rs a f t e r i n j e c t i o n , a. s t e r i l e
c a p i l l a r y p i p e t t e was in s e r te d ■in to th e p e r ito n e a l, c a v ity o f th e mouse and
some o f th e f l u i d was w ithdraw n.
One drop o f t h i s f l u i d was p la c e d in
b e e f h e a r t in f u s io n b r o th ; a n o th e r drop was sm eared .on a b lo o d a g a r p l a t e ;
and a t h i r d d ro p was sm eared o n ,a s l i d e f o r s t a i n i n g .
A f te r 48 h o u rs in c u b a tio n a t -57° C ,, s u s p ic io u s c o lo n ie s were t r a n s ­
f e r r e d t o s t e r i l e b e e f h e a r t i n f u s io n b r o th .
When growth ap p eared i n th e
t u b e s , I cc» p o r t i o n s w ere p la c e d i n e ac h o f th r e e s m a ll tu b e s .
To t h e
f i r s t tu b e was added f o u r d ro p s o f a 10 p e r c e n t aqueous s o lu tio n o f
sodium d e so x y c h o la te ; t o th e second tu b e was added if c c . o f a 10 p e r c e n t
aqueous s o lu tio n o f B acto o x - g a ll; and th e t h i r d tu b e was u sed a s a c o n tr o l.
=?1 5 -
Smears ( f o r th e H eiifeld 'fQlU e llu n g se? r e a c tio n ) were made on g la s s s l i d e s
o f a l l c u ltu r e s w hich w ere s o lu b le w ith e i t h e r o r b o th o f th e above t e s t s e
Blood a g a r p l a t e s w ere s tre a k e d from a l l p o s i t i v e c u l t u r e s i n o rd e r to
o b ta in a p u re c u ltu r e o f th e pneum ococci.
Those m ice w hich d id n o t d ie were o b serv ed f o r 15 d a y s, a f t e r which
th e y w ere e th e r iz e d , a u to p s ie d , and c u ltu r e s ta k e n from t h e p e r i t o n e a l
c a v it y and from th e h e a r t .
The same p ro c e d u re a s d e s c rib e d above was
c a r r ie d o u t w ith any c u ltu r e s showing g ro w th .
S e le c t io n o f in d iv id u a ls f o r th e 1940 t o 1941 su rv ey . —A l l b u t 14 o f
th e in d iv id u a ls were chosen a t random from th o s e who w ere i n Lewis B a l l
when th e work on t h i s su rv ey began i n O ctober 1940.
The group o f 14 were
g i r l s who liv e d i n a s o r o r i t y house on t h e campus a t M ontana S ta te O o lle g e c
( in d iv id u a ls I to 9 , 11 and 12, 14 to 16 i n T able I )
Methods o f o b ta in in g o u ltu r e s 1& j&e 1940 to 1941 surZSX '--In order
t h a t th e two m ethods, swabbing and g a rg lin g * m ight be com pared, each
in d iv id u a l t e s t e d had M s t h r o a t swabbed f i r s t and th e n was asked to
g a r g le .
The two p ro c e d u re s a re d e s c rib e d below : .
The Swab Method. —With a s t e r i l e c o tto n swab a c u ltu r e was ta k e n
from th e n a so p h a ry n g ia l re g io n o f each in d iv id u a l.
The swab was p la c e d
i n a tu b e o f e n ric h e d b e e f in f u s io n b r o th and in c u b a te d a t 57° 0 . f o r
6 h o u rs .
At t h e end o f t h a t tim e th e b r o th was c e n tr if u g e d a t h ig h speed
(a p p ro x im a te ly 2000 r .p .m .) f o r 45 m in u te s .
The s u p e rn a ta n t f l u i d was
p o u red o f f and t h e sedim ent suspended i n I e c . o f s t e r i l e p h y s io lo g ic a l
s a l i n e s o l u tio n (0 .8 5 p e r c e n t ) .
One c c . o f t h i s s u sp e n sio n was i n je c te d
iA tr a p e r i t o n e a lly in to a w h ite m ouse.
S ix h o u rs l a t e r , by means o f a
"16”
s m a ll c a p i l l a r y p ip e t t e , some f l u i d was w ithdraw n from t h e peritoneum .
A
drop o f t h i s l i q u i d was p la c e d in e n ric h e d b e e f heart in f u s io n b r o th and
in c u b a te d a t 57° <3. u n t i l s u f f i c i e n t c lo u d in e s s was p r e s e n t t o ru n a
s o l u b i l i t y t e s t w ith sodium d eso zy o h o la te.
T h is t e s t c o n s is te d in ta k in g
two I c c B sam ples o f c u l t u r e , addin g 4 drop's, o f podium d e so x y c h o la te
s o l u tio n t o one, and u s in g th e o th e r a s a c o n tr o l tube*
The t e s t was
o b serv ed o v e r a p e r io d o f one hour and th o s e c u ltu r e s from w hich th e
c lo u d in e s s had d is a p p e a re d were c o n sid e re d p o s i t i v e e
Sm ears w ere made on
g l a s s s l i d e s fro m th e s e p o s i t i v e c u ltu r e s = A S e u fe ld ttQlU e llu n g s tt re a c tio n ,
was c a r r i e d o u t on th e s e sm ears.
The G arg le M ethod;-"T he in d iv id u a l was asked t o r i n s e out h is mouth
w ith 35 c o . o f s t e r i l e p h y s io lo g ic a l s a l i n e s o lu tio n (0 .8 5 p e r c e n t) and
t o d is c a r d t h i s washing®
A nother 85 c c . o f s t e r i l e p h y s io lo g ic a l s a li n e
s o l u t i o n was u sed im m ediately a s a g a r g le f o r I to S m in u te s .
T his l i q u i d
was e x p e lle d I n t o 'a s t e r i l e c o n ta in e r and th e n c e n tr ifu g e d a t h ig h speed
(a p p ro x im a te ly 3000 r ,p .m ,) f o r 45 m in u te s .
The s u p e rn a ta n t l i q u i d was
p o u red o f f and t h e sediment suspended i n I cc® o f s t e r i l e s a l t s o lu tio n .
One c c , o f t h i s s u sp e n sio n w a s 'in je c te d in tr a p e r ito n e a lly in to a w h ite
mouse®
The method from h e re was th e same as. t h a t f o r th e swab method? i , e . p
w ith d ra w a l a f t e r 6 h o u rs 9 s o l u b i l i t y t e s t , and H eufeld typing®
As soon a s p o s s ib le a f t e r a n in o c u la te d mouse d ie d , a n a u to p sy was
made®
By means o f a s m a ll C a p illa r y p i p e t t e blo o d was w ithdraw n from th e
h e a r t ® A drop o f t h i s b lo o d was p la c e d i n e n ric h e d b e e f h e a r t in f u s io n
b r o th and in c u b a te d a t 37° G. u n t i l n o tic e a b le c lo u d in e ss developed®
The
c u ltu r e was th en t e s t e d fo r s o l u b i l i t y u sin g sodium desoayoholate and th e
-1 7 “
H eu feld r e a c t i o n was c a r r i e d o u t a s f o r th e o t h e r s „
A f te r 14 t o 15 days t h e m ice w hich d id n o t d ie were chloroform ed and
c u ltu r e s ta k e n from th e h e a r t ’ s b lo o d .
I f growth o c c u rre d i t was ta k e n
th ro u g h th e r e g u la r p ro c e d u re .
The s o l u b i l i t y t e s t u s in g sodium d e so x y c h o la te s o l u t i o n and th e
phenomenon o f c a p s u la r s w e llin g d e s c rib e d by Meufeld (1902) and l a t e r
u se d by Mexifeld and E tin g e r-T u lc a y n sk a (1955) a s a method f o r r a p id ty p e
d e te rm in a tio n o f D iplococcus pneum oniae, a r e th e ones u se d a t th e
p r e s e n t tim e by th e a u th o r f o r t h e i d e n t i f i c a t i o n o f ty p e s o f d ip lo e o e c i,
E o r t h i s M eufeld tU iuellungsn re a c tio n * a n t i s e r a o f ty p e s I t o 52»
a c c o rd in g t o Oooper (1929)» and a n tis e ru m f o r ty p e 55» a r e p la c e d in to
g ro u p s As B9 0 , Bs Be and E*
Each group serum c o n ta in s t h e p o o le d a n t i ­
s e r a f o r c e r t a i n ty p e s o f pneum ococci.
The m ethod f o r c a r r y in g out th e M eufeld nQ uellungsti r e a c t i o n i n t h i s
su n re y was a s fo llo w s s
Two sm ears Of t h e s o lu b le c u ltu r e s w ere p la c e d on
each o f s i x c le a n g la s s s l i d e s ,
A d i f f e r e n t group antiserum , o b ta in e d
from th e L e d e rle L a b o r a to r ie s , was p la c e d on each sm ear.
I n th e group
a n t i s e r a u sed th e r e was a b lu e dye which s ta in e d th e o rg a n ism s.
The smear
was th e n covered w ith a c le a n cover g l a s s and was exam ined m ic ro sco p i c a l l y w ith th e a i d o f th e o i l im m ersion l e n s .
•
A p o s i t i v e r e a c t i o n was
in d ic a te d by a c l e a r , u n s ta in e d a r e a aro u n d th e s ta in e d pneum ococci.
T h is
a r e a has a d e f i n i t e o u t l i n e and i t i s t h e sh arp n ess o f t h i s o u tlin e w hich
i s more im p o rta n t i n ty p e d e te rm in a tio n th a n th e amount o f s w e llin g o f
th e c a p s u le .
H alos may be se e n i n n e g a tiv e p r e p a r a tio n s , due, probably,,
t o th e p re s e n c e o f a s m a ll c a p su le around th e organism o r t o th e r e ­
-1 8 -
f r a c t i o n o f l i g h t whoa a a o b jec t i s o u t o f focus*
Oa changing th e f o c a l
p la n e , th e s e h a lo s w i l l lisa p p ea x -, h u t i n p o s i t i v e c u ltu r e s th e y w i l l
s t i l l he v is ib le *
VJhen th e p o s i t i v e group was d e term in e d , a lo q p fttl o f a
d i f f e r e n t ty p e a n tis e ru m (o f th e ty p e s in c lu d e d in t h e p o s i t i v e group)
was p la c e d on each o f th e rem ain in g sm ears and a lo o p f u l o f m ethylene
b lu e was added t o s t a i n th e organism s*
A C lean c o v e r g la s s was p la c e d
on t h e sm ear, w hich was examined a s d e s c rib e d p re v io u s ly *
A ll sm ears w ere
c a r e f u l l y examined m ic r o s c o p ic a lly t o d e te rm in e w h e th er m ore th a n one
ty p e o f pneumococcus was p re s e n t * A ll n e g a tiv e s l i d e s w ere s e t a s id e f o r
a p p ro x im a te ly one h o u r and th e n checked and rechecked*
l t e b e r o f in d iv id u a ls who ware c a r r i e r s ( ta b le s I and I - a ) . —Of th e
laBSWeieelaeppnapwet- nit**Iflni ■Ii ■! wiTrr'rnfci
*<#**W""* -WnlJiC Wuiiiii«A
*™"*""*™*™*™
54 in d iv id u a ls in c lu d e d t o t h i s su rv e y , from whom a t o t a l o f 690 c u ltu r e s
w ere ta k e n by th e two m eth o d s, 41 (75*9 p e r c e n t) w ere c a r r i e r s o f
D iplocoocus pneumoniae a t one tim e o r another®
Of a t o t a l o f 551 su rv e y t e s t s (e a c h t e s t c o n s is tin g o f th e swab
Sind th e g a r g le made fro m one in d iv id u a l on one d a y ), 140 (59*8 p e r c e n t)
gave p o s i t i v e c u ltu r e s *
lum ber o f c a r r i e r s o b ta in e d by, each m ethod ( ta b le s I I and X l-a)
N inety-tw o (65*7 p e r c e n t) o f th e 140 p o s i t i v e c u ltu r e s w ere o b ta in e d by
th e g a rg le method? 97 (69*5 p e r c e n t) b y t h e swab method? and 49 (35*0 p e r
c e n t ) w ere o b ta in e d w ith b o th m ethods fro m th e same in d iv id u a l on rh e
same day*
O ccurrence
th e month ( t a b l e s I and I-a)*
TABLE I
THE INCIDENCE Of PNEUMOCOCCI IN THE THROATS Of A GROUP Of
INDIVIDUALS FROM MONTANA STATE COLLEGE
(1940-1941)
IndlTld
u a l Nb.
November
December
-
_
/
/
/
/
/
/
/
/
/
-
/
/
/
-
-
-
/
/
/
-
7
/
-
not te s te d
—
January
February
March
A p ril
/
/
/
/
•
/
/
/
/
/
/
Dropped s c h o o l . . . . . . . . . . .
/
/
/
-
not te s te d
-
/
/
/
•
•
•
not te s te d
/
-
-
-
-
-
-
not te s te d
not te s te d
—
-
-
/
-
—
—
H
I
I
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Oetober
not te s te d
/
—
-
-
/
/
/
/
/
-
/
/
-
-
-
-
-
-
-
-
/
/
/
-
—
-
-
/
/
i
not te s te d
not te s te d
—
TABLE I (c o n o id .)
In d iv id u a l No. October
88
89
50
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
/
-
/
•
—
/
/
/
/
/
—
/
—
+
/
/
/
November
/
—
/
/
/
/
/
/
not te s te d
•
/
/
-
—
—
—
/
/
not te s te d
December
/
—
/
not te s te d
-
February
/
-
-
-
—
e.
-
/
/
/
/
not te s te d
/
/
-
/
/
-
-
January
—
+
•
/
-
/
/
not te s te d
—
not te s te d
/
/
/
/
—
means th a t th e ln d lr ld u a l gare a p o s it iv e t e s t .
means th a t th e in d iv id u a l gave a n eg a tiv e t e s t .
/
-
/
/
-
+
-
—
/
/
—
-
March
•
/
«
/
/
/
not te s te d
not te s te d
/
-
/
/
not te s te d
—
-
A p ril
_
nol; te s te d
/
not te s te d
not te s te d
/
/
Tt
/
not te s te d
/
not te s te d
—
not te s te d
I
g
I
-2 1 “
$ABti£ I-a
sxmmm of the
oogxmiehce of
pmoMOcoooi
O ctober 1940 t o M arch 1941
Month
Number p e rs o n s
p o s itiv e
P er cent
p o s itiv e
Number p e rso n s
te s te d
O ctober
27
53
50 .9
November
18"
51
3 5.5
December
19
55
3 5 .9
J a n u a ry
SI
50
42 s O
F e b ru a ry
16
53
30.2-
March
19
■ ' 49
’-58.8
A p r il
' 14
T o ta l
140
.
42'
35*3
'
3 9 .8
551'
T o ta l number p e rs o n s u se d I n th e su rv e y =»»= »«<=«o=O0c,,00 =00»«». » =» =»54
Emaber p e rs o n s g iv in g p o s i t i v e c u ltu r e s a t one tim e
o r a n o th e r , ,1 ».a 0» *.© 8, e « e o e o e , o 8 o o o 8 » o i > o e o 0 ' e o » « 8 . @ » < M » * o e - " o e » e e
0 0
«-©• © •
41
• p e r c e n t o f p e rs o n s showing pneum ococci' a t one time-.
ie»*eee,<Soeeeeu>eeeeeee«ieooo75®9
o r another® .
T o ;ta
a l number o f swab and g a rg le c u ltu r e s 1ta k e n d u rin g
i o
o * c e © o e
t ^ e s u r v e y ,i * , . . . . ' .
0
0
o-oe e - e e e » e o e
8
6 9 9
TABLE I I
A COMPARISON OF THE QAROLE AND THE SWAB TECHNICS IN THE ISOLATION OF
PNEOMOCOCCI FROM THE THROATS OF A OROOP OF INDIVTDOAIS AT MONTANA STATE COLLEGE
(1940-1941)
Individ'
u a l Be.
October
O
S
November
S
O
_
—
*
/
/
/
+
/
/
/
/
/
«
—
—
—
•
•
/
•
/
December
O - S
< me
«.
/
-
-
-*
-
' — •
/
+
_
_
_
_
Dropped sc h o o l................................... ..
/
/
/
/
f.
+
/
/
+
.
f . + +
-
-
—
-
/
not te s te d
/
-
.
/
/
-
January
S
O
February
S
O
March
O
S
/
«»
/
/
-
«•
—
-
—
/
not
/
-
/
/
/
—
-
/
/
/
/
/
/
/
/
Dropped sch o o l
-
-
/
/
—
te s te d
/
+
A p r il
S
O
•
/
/
/
—
not te s te d
/
-
-
not te s te d
/
/
/
not te s te d
/
................................. ......................... .............. ................................
/
not te s te d
/
/
-
/
/
/
/
/
-
/
/
not te s te d
not te s te d
fitte d *
TABLE I I (c o n c l.)
“ “i s s a s s g s s s s s s s s f s s g g g s s e g
27
28
29
30
31
32
October
a
S
—
/
/
/
/
/
/
/
November
O
S
-
December
G
S
-
January
G
S
/
/
February
G
S
/
/
-
—
/
-
/
/
/
not te s te d
/
/
/
/
/
/
/
/
/
/
/
/
/
not te s te d
_____ not t e a ted
means Gargle method was u sed ,
means Swab method was u sed .
/
-
*
•
not te s te d
/
/
2
te s te d
not te s te d
/
not te s te d
not te s te d
not te s te d
not te s te d
/
/
/
/
/
/
/
/
not te s te d
Z
not te s te d
/
/
/
/
/
/
/
-
A p ril
G
S
/
/
/
/
/
-
March
G
S
/
/
7
/
/
-
/
/
/
/
/
not te s te d
/
/
+
/
/
-
e s ite d
means no pnetaaocooci were found.
means pneumococci were found.
not te s te d
/
/
/
/
not te s te d
/
-
-
not te s te d
-SB-
IndIt id u a l No.
TABLE IX -a
A COMPARISON OF TBE HZLATIfE MERITS OF THE GARGLE ANB THE SWAB METHODS FOR
THE ISOLATION OF DIPLOGOCQUS PNEUMONIAE '
(1940 » 1941)
o
Number p e r s o n g iv in g
. p o s itiv e c u ltu re s t
03
Per cent of t o t a l
p e rs o n s t e s t e d w hich
w ere p o s itiv e ?
S1S
P er cent of t o t a l
p o s i t i v e s w hich
each m ethod gave:
w ith
Swab
w ith
Both
;® l3 i A)
®|2 ! 4 s
w ith
G argle
w ith
Swab
w ith
B oth
I
q
1%
: S 1S
v d th
G argle
w ith
Swab
w ith
Both
IO
w ith
G arg le
18
SS
13
37
66*6
51 ,5
.4 8 .1
: 53
33 ,9
4 1 .5
34 ,5
November
. IS
15.
7
18
66.7
7 3 .8 ' 3 8 .2
:V s i
8 5 .5
35 .5
1 3 .7
December
14
IS
7
19
73«, 7
S 3 .S
3 6 .8
* SB
8 6 .4
33 ,6
15 ®3
Ja n u a ry
14
SO
7
37
66.7
7 4 ,1
3 3 .3
t 50
8 8 .0
4 0 ,0
1 4 .0
F e b ru a ry
IS
8
4
16
7 5 ,0
5 0 ,0
8 5 .0
I 55
2 2 .6
1 5 .1
7 .5
March -
13
14
8
19
6 8 ,4
73,7
4 2 .1
:• 49
36.5
3 8 .6
1 6 .3
A p r il
9
8
. 3
14
6 4 ,3
5 7 .1
2 1 .4
: 48
; '
3 1 .4
1 9 .0
7 .1
T o ta l
93
97
49
140
6 5 ,7
69.3
35.0
Month
O ctober
O
E -r A
■9
.
I
By stu d y in g t a b l e X-a th e r e a d e r w i l l n o te t h a t d u rin g t h e p e rio d of
seven, m onths from O ctober 1940 t o A p r il 1941 th e p e r c e n t o f p o s itiv e
r e a c tio n s v a r ie d from 0 0 .8 t o 5 0 .9 .
The lo w e st p e r c en t o c c u rre d d u rin g
th e month o f F e b ru a ry , th e h ig h e s t i n O c to b er.
O ccurrence o f c u ltu r e s w hich d id n o t g iv e a p o s i t i v e H eufeld
r e a c t i o n (t a b l e s 111 and IIX = a) .- - F r e q u e n tly i t was found t h a t a c u ltu r e
a p p a r e n tly a pneum ococcus, w hich was s o lu b le o r p a r t i a l l y s o lu b le when
t e s t e d w ith sodium d e so x y c k o la te s o l u t i o n f a i l e d t o g iv e a p o s itiv e
H eufeld ,fO ,uellungsf? r e a c t i o n .
From t a b l e IXX-a i t can be s e e n t h a t th e
number o f th e s e c u ltu r e s v a r ie d from 14 i n O ctober and December t o 5 i n
March*
K inds o f c a r r i e r s and th e number o f p e rs o n s i n each c l a s s i f i c a t i o n
( t a b l e s Pv and XV-a) .— A f te r having s tu d ie d t h e d iv is io n o f C a r r ie r s a s
made by W ebster and Hughes (1901) and B l i s s , M eClaskey, and lo n g (1 9 0 4 )9
th e p r e s e n t i n v e s t i g a t o r u sed th e fo llo w in g term s and d e f i n i t i o n s f o r
th e p u rp o se o f c l a s s i f y i n g th e pneumonia c a r r i e r s ?
A n o n -c a rr ie r i s a p e rs o n who n e v e r g iv e s a p o s i t i v e c u ltu r e o f
D iploooccus pneum oniae*
A c h ro n ic c a r r i e r i s one who y i e l d s p o s i t i v e c u ltu r e s o f th e same
ty p e o f pneum ococci f o r t h r e e o r more c o n se c u tiv e m o n th s.
An i n t e r m i t t e n t c a r r i e r i s one who y ie ld s p o s i t i v e c u l t u r e s a t
i n t e r v a l s d u rin g th e survey*
T h e - c u ltu r e s , when o f th e same ty p e ,
o c c u r n o t more th a n two c o n se c u tiv e months*
A te m p o ra ry c a r r i e r i s one who y i e l d s o n ly one p o s i t i v e c u ltu r e
d u rin g th e survey*
TABLE I I I
OCCURRENCE OF SOLUBLE CULTURES WHICH DID NOT
GIVE POSITIVE NEUFELD REACTIONS
(1940-1941)
In d iv id ­
u a l No.
October
p .
s o l.
s o l.
-
November
s o l.
-
December
-
p. s o l.
•
•
s o l.
s o l.
-
—
-
s o l.
p . s o l.
-
-
n. s o l .
p . s o l.
p . s o l.
p . s o l.
not te s te d
p . s o l.
p. s o l.
—
p.
p.
January
s o l.
s o l.
February
—
p.
Droooed s c h o o l . .
p. s o l.
p . s o l.
—
p.
-
—
—
—
not te s te d
s o l.
. .....
s o l.
March
A p ril
—
not te s te d
-
•
—
s o l.
p . s o l.
not te s te d
—
—
—
—
p.
s o l.
-
—
—
—
s o l.
not te s te d
not te s te d
Drorrmed s c h o o l ....................
86
27
—
-
—
-
-
-
—
—
-
P • S O le
—
-
-
s o l.
-
—
—
•
•
—
—
-
—
s o l.
ee
_
•
-
not te s te d
not te s te d
TABLE I I I ( c o n c l.)
p. s o l.
—
s o l.
p. s o l.
s o l.
p . s o l.
—
-
-
February
s o l.
p . s o l.
-
p. s o l.
s o l.
-
—
s o l.
s o l.
s o l.
s o l.
p. s o l.
-
-
January
not te s te d
s o l.
p . s o l.
-
not te s te d
p. s o l.
not te s te d
-
s o l.
-
March
s o l.
-
—
s o l.
-
not te s te d
not te s te d
-
-
-
-
-
s o l.
-
-
—
-
s o l.
p . s o l.
s o l.
—
-
-
-
-
-
-
-
s o l.
s o l.
-
-
-
-
—
-
-
-
-
-
s o l.
-
-
-
p. s o l.
-
-
-
not te s te d
not te s te d
s o l.
-
-
p. s o l.
—
-
-
s o l.
not te s te d
s o l.
-
-
-
-
not te s te d
p. s o l.
s o l.
-
-
A pril
-
not te s te d
-
not te s te d
-
not te s te d
not te s te d
-
s o l.
not te s te d
-
not
s o l . means th a t th e c u ltu r e wes com pletely so lu b le w ith sodium d esoxyeh olate s o lu tio n ,
p . s o l . means th a t th e c u ltu re was p a r t ia l ly so lu b le w ith sodium desoxyeh olate s o lu tio n
*
—
*
-
December
I
-
-
November
p
S X 8 5 S S 8 6 6 6 6 8 $ 8 6 t;£ S 8 3 g S ii8
28
29
30
SI
32
October
Cf I
IndiTld
u a l No.
1EftHEB I l l - a
SUWAHY OF THE nSUSPJGIOUSn AM) THE POSITIVE GUITUHES
(O cto b er 1 9 4 0 -A p riI 1941)
F e b ru a ry
March
A p ril
D eem ber
14
11
1$
_ 37
18
19 ,
31
41
89
99
38
33
38
19
55
51
@0
50
53
49
48
7 7 .4
5 6 .9
68.3-
5 6 ,0 ■
4 5 .5
4 5 .0
45>8
T o ta l
nS u sp ie io u e "
•c u ltu r e s
T o ta l
p o s itiv e
c u ltu r e s
J a n u a iy
MOTiaaber
T o ta l
T o ta l p e rs o n s
•' te s te d /m o n tb
G ross p e r
c e n t ^ p o s itiv e ”
3
7
7
'
I*
.
19
5
•
■ 14
>ag-«
O ctober
!BH ggjgF
$BE H&ISMCE m fB S SPBCBFie
Of HME0G0Q01 M TBE TBBB&TS OF
A GRoop OF E m m iD m m #
m a im m s w e m coieege
~
.
'
jE s a tw - .
u a l Ho,. October
I
,2
0:
4
-5
6
'
HofeEflaer
,
'*e
5
' 5
89
25
Sr
--W
•-s
.19
21
,5
IS
15
M
15
IS
I?
4
not te s te d
—
-=>
*=»'
36
“*».
S
'"ea.
" 9
23
15
8 -8
,
.
-jn»
-
A s r il
W
M
fc
"is
8 ,1 8
5
-e*
-S='
20
-**■
. 8
•^
'
.
O
10
25
1
Ila reh
“=-
:6
34
F eb ru a ry
V
.8
19
Faaauary
■
F
80
81
SS
ss:
December
Jrit
..
25
17*24
18
"
-«*r'
88
**
.9
not te s te d
20
20
—
S
■rim
» ,* '
,
-
' 4*8 S
n o t ’t e s t e d .
S
S
5
S
W e g p e d s e h o o i e,»i0^
. (»o, o« aa-p»<
**qo oo »s o-»-oo,»oV.o
.
20
Mt.
"'
•**
-*»•
--
.
-.te-
,
M
K
W
:=
hot te s te d
4
hot te ste d
•*fc
5
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TABLE PF-a
A CmsPJBISOE ffl TBB GARSLB AM THE SWAB TECEMOS- I S THE ISOMTIOS G f THE SPEClfIG
TYPES Gf PMiIvIOGGGGl m TSE TMOATS Of IMSriBXJAlS AT WWSMk STATE COIIEGE
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ss
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not te ste d
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not te s te d
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S means th e S m h m ethod was used=
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-
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=33=
A M u ltip le - ty p e c a r r i e r id one Who c a r r ie d two o r Biore typed sim ul­
ta n e o u sly .
-
'Using th e a u th o r ’ s c l a s s i f i c a t i o n , o f t h e 54- Incij1V id u a ls in c lu d e d
i n t h i s su rv e y 1% (S S .2 p e r c e n t) were n o n - c a r r ie r s o f S io lo c o c c u s
pneum oniae; 14 (25.9 p e r C ent) w ere c h ro n ic c a r r i e r s ; 2? (6,0.0 p e r c e n t)
w ere in te r m itte n t c a r r i e r s ; 5 (9 .2 p e r c e n t) were tem p o rary c a r r i e r s ;
and 9 (1 6 ,6 p e r c e n t ) w ere c a r r i e r s o f more th a n one ty p e d u rin g one
s u rv e y .
F requency o f o c c u rre n c e o f s p e c i f i c B iplo co o cu s pneum oniae ty p e s
( t a b l e F ) . —D uring t h i s s u rv e y , ty p e 3 was fo u n d 37 tim e s ; ty p e 17, 26
tim e s ; ty p e 6 , 18 tim e s ; ty p e 8 , 18 tim e s ; type. 4,. 13 tim e s ; ty p e 18,
13 tim e s ; and ty p e 2 8 , 1 0 tim e s .
The o th e r ty p e s w hich o c c u rre d le s s
th a n 10 tim e s d u rin g th e s u rv e y w ere 80, 19, 15, 3 1 , 84, 1 8 , 38, 25, 9 ,
16, 5 , .and 12.
Types I and 8 w ere n e v e r found i n t h i s w ork. -
■
D lSC U SSm OF WfBDDS M D RESULTS
The m ethods
o b ta in in g c u ltu r e s u sed i n t h i s s u rv e y ,
a)
two
w ere c h o se n .—A s u rv e y was c a r r ie d ou t b y th e a u th o r d u rin g November 1939
t o A p r il 1940 on a s m a ll group o f in d iv id u a ls a t M ontana S t a t e c o lle g e .
A f te r two m onths, when th e r e s u l t s o f th e su rv e y in d ic a te d t h a t th e
c a r r i e r r a t e was f a r below t h a t found b y such i n v e s t ig a to r s a s P o w e ll,
A tv m te r, and F e lto n (1926) ( ta b le VI) th e a u th o r w ro te t o i n v e s t ig a to r s
Who h ad c a r r ie d out s i m i l a r s tu d ie s i n t h i s f i e l d .
s m i l l i e (1940) r e p o r te d t h a t he o b ta in e d th e b e s t r e s u l t s by ta k in g
a c u ltu r e from th e p o s t e r i o r nasoph ary n x , c a re b ein g ta k e n n o t t o to u c h
“ 34:
TABLE T
THE SPECIFIC TYPES OF PMEDMOCOCCI AHRAEGED IN THE ORDER OF THEIR
FREQUENCY DURING- OCTOBER 1940 •- MAROE 1941
Types o f
Pnetimocoeei .
Number o f tim e s
found.
.
Sr
37
17
26
6.
18
8,
1@ .
4
15
13
15
28
10
ap
9
19
8
15
8
51
6
24
4
.18
4
32
4
25
3
9
3
18
I
I .
5
12
-
:
'
I
I
-3 5 -
TABtE VT
a
Month
s u m m Y car the ocgurrehge of mEUMocoooi
HUHBB WVEMBER 1939 t o APRIL. 1940/
Humber
p e rso n s
p o s itiv e
Humber
p e rs o n s
te s te d
.36
3 .8
8 6 ...............
7 .7
Eovember
(s)*
I
December
(s )
2 '
Ja n u a ry
(g )#
F e b ru a ry
'
P er cent
p o s itiv e
6 . .
33
1 8 .3
(g.)
4
%
1 1 .2
M arch
(g)
s'
31
9 .7
A p r il
Ce)
7
33
3 1 .3
33 •
187
1 8 .3
'
T o ta l
*Swab m ethod Iise d 6,
#G-arg3.e method u s e d .
/ Due t o th e la c k o f e x p e rie n c e on t h e p a r t o f th e in v e s t i g a t o r and
t o t h e la c k o f u n ifo rm ity i n th e m ethods u sed t o o b ta in c u ltu re s * th e s e
f i g u r e s sh o u ld n o t he c o n s id e re d in d ic a tiv e o f th e e x a c t number o f
c a r r i e r s o f DItdI ococcus pneum oniae. They a r e , however* s u g g e s tiv e .
-9 6 -
aay p a r t o f t h e mouth c a v i t y . • He s t a t e d t h a t he would e x p ec t a t l e a s t
40 t o 50 p e r c e n t o f norm al p e o p le to c a r r y pneumococci i n t h e summer^
and i n w in te r , e s p e c i a l l y around th e f i r s t o f March, th e p r o p o r tio n
sh o u ld be 70 p e r c e n t.
F e lto n (1940) r e p o r te d t h a t th e swab m ethod was a p o o r te c h n ic f o r
i s o l a t i n g pneum ococci f r o m ,c a r r i e r s o r norm al in d iv id u a ls .
Be su g g ested
th e u se o f th e g a r g le te c h n ic w hich was d e s c rib e d e a r l i e r i n t h i s p a p e r.
There seemed to be a d iv e rg e n c e -o f o p in io n a s to t h e 'r e l a t i v e m e r its
o f t h e two m ethods m en tio n ed and, i n some work c a r r ie d o u t by th e a u th o r
from Bovember 1939 th ro u g h A p r il 1940 ( t a b l e V I), th e r e ap p eared to be a
n o tic e a b le v a r i a t i o n i n th e r e s u l t s o b ta in e d by each method*.- Hence i t
was d e cid e d t h a t a com parison o f th e g a r g le and th e swab m ethods m ight
be o f v a lu e ,
As a r e s u l t , beginning w ith O ctober 1940, a group o f 54 in d iv id u a ls
a t th e Montana S ta te C o lle g e campus was s e le c te d t o be c u ltu r e d each
m onth.
T h is group in c lu d e d s tu d e n ts from v a rio u s d e p a rtm e n ts, some
members o f th e c o lle g e f a c u l t y , and some members o f th e c l e r i c a l s t a f f .
I t was hoped t h a t by ta k in g in d iv id u a ls a t random, th e r e s u l t s o b ta in e d
m ight approxim ate th e c a r r i e r s i t u a t i o n a s i t e x is te d on t h e campus.
b ) The a d v a n ta g e s and th e d is a d v a n ta g e s o f each method o f o b ta in in g
c u l t u r e s . —At b e s t , each o f th e two m ethods u sed had s e v e r a l d is a d v a n ta g e s .
I n .t h e fo llo w in g d is c u s s io n , th e m ost o u ts ta n d in g ad v an tag es and d is a d ­
v a n ta g e s w i l l be m e n tio n e d .
The f i r s t method u sed Cn each in d iv id u a l was t h a t o f th e swab.
A
f l a t , wooden, tongue d e p re s s o r was p la c e d on th e back o f th e tongue t o a id
\
-5 7 -
In g e t t i n g th e s ra b in to th e p o s t e r i o r nasopharynx with, a s l i t t l e chance
o f to u c h in g th e i n t e r i o r o f th e mouth a s p o s s i b l e .
t h a t th e f i r s t 'm a j o r d i f f i c u l t y a r o s e .
I t was a t t h i s p o in t
Some in d iv id u a ls would c o n s tr ic t
t h e i r t h r o a t s so t i g h t l y t h a t i t was alm o st im p o ssib le t o g e t th e swab
v e ry h ig h in to th e p o s t e r i o r naso p h ary n x .
E q u a lly im p o rta n t i n h in d e rin g
t h e m ost e f f e c t i v e u s e o f th e swab was th e gagging which o c c u rre d in a
la r g e number o f th e in d iv id u a ls .
The second d i f f i c u l t y a ro s e when th e swab was in p l a c e .
I t was
p o s s ib le w ith some in d iv id u a ls , t o ru b th e w a lls o f th e p o s t e r i o r naso­
p h arynx w ith th e swab.
W ith o th e r s th e d eg ree o f ru b b in g was much l e s s ,
th e r e s u l t b e in g t h a t th e s u rfa c e co v ered by th e swab was a p p re c ia b ly
l e s s i n some th a n i n o t h e r s .
T h is f a i l u r e to co v er a s much s u rfa c e a s
d e s ir e d w ith t h e swab m ight mean th e d if f e r e n c e betw een a p o s i t i v e and a
n e g a tiv e r e s u l t .
I f th e organism s te n d e d t o be lo c a l iz e d i n th e naso­
p h a ry n x , i t i s q u ite c o n c e iv a b le t h a t th e swab m ight have m issed them .
-The t h i r d d i f f i c u l t y was t h a t d u rin g th e p e rio d o f in c u b a tio n p r e ­
ced in g c e n tr if u g a tio n , t h e r e m ight have b e e n , in some c a s e s , an over­
g ro w th o f th e pneum ococci by some o th e r o rg an ism s.
However, i t seems to
th e a u th o r t h a t th e p r o b a b i l i t y o f t h i s i s v e ry s m a ll.
Due t o th e trI a g fl
p e rio d w hich fo llo w s th e in tr o d u c tio n o f organism s in to a c u ltu r e medium,
i t i s q u i t e l i k e l y t h a t th e danger o f overgrowth by any in tr u d in g o rg an ­
ism i s n e g l i g i b l e when th e p e rio d o f in c u b a tio n i s o n ly 6 h o u rs a t 57° 0 .
I n c o n s id e rin g t h e a d v an ta g e s o f th e swab m ethod, th e r e a r e two
w hich seem worthy o f m e n tio n .
The f i r s t adv an tag e i s t h a t , a lth o u g h th e r e w i l l be some v a r i a t i o n s
-S S i n th e amount o f rubbing and i n th e d is ta n c e t h a t th e swab e n te r s in to
th e nasopharynx* th e method can be more n e a r ly standardized b y th e i n ­
v e s t i g a t o r th a n can th e g a r g le method®
The second ad v an tag e i s t h a t organism s which a re p r e s e n t I n th e
p o s t e r i o r n a a o p h a ry n g Ia l re g io n and w hich may no t be p r e s e n t i n th e back
o f th e mouth may be o b ta in e d by th e u s e o f th e swab method®
A f te r th e in d iv id u a l had b een swabbed* he was asked t o r i n s e h is
mouth w ith s t e r i l e p h y s io lo g ic a l s a l i n e so lu tio n ®
The p u rp o s e o f t h i s
r i n s e was t o re d u c e th e number o f in tr u d in g m icro o rg an ism s ®
Each in d iv id u a l was asked to g a rg le from I t o S m in u te s s b u t v e ry
seldom d id anyone g a rg le lo n g e r th a n 1%- m in u tes.
claim ed th e y w ere u n a b le t o gargle®
Some in d iv id u a ls
As a r e s u l t o f t h i s b e lie f * th e y
w ould n o t t r y t o g a rg le lo n g e r th a n SO seconds®
I n o th e r w o rd s, one o f
th e g r e a t e s t d is a d v a n ta g e s o f t h i s m ethod was th e v a r i a b i l i t y i n th e
le n g th o f tim e each in d iv id u a l g a rg le d *
A nother d is a d v a n ta g e o f t h i s method was t h a t each in d iv id u a l g a rg le d
i n a d i f f e r e n t way from any o th e r person®
I n o th e r words* i f a n in d iv id ­
u a l g a rg le d w ith h i s t h r o a t te n se * t h e s a l t s o lu tio n would n e i t h e r be
a b le t o p e n e tr a te th e c ra c k s and c r e v ic e s o f th e t h r o a t n o r t o come i n
c o n ta c t w ith th e b ack p a r t o f th e t h r o a t » T h e re fo re i t seems to th e
a u th o r t h a t , assum ing m icroorganism s t o be p r e s e n t , th e p e rs o n s g a rg lin g
w ith a re la x e d t h r o a t would be much more a p t to g iv e a p o s i t i v e c u ltu r e
th a n th o s e w ith a te n s e t h r o a t ®
Throughout t h i s s u rv e y , i t was th e aim o f th e a u th o r t o c a l l in
t h e in d iv id u a ls t o be c u ltu r e d p re c e d in g a m eal r a t h e r th a n im m ediately
%
“39-
fo llo v /in g a m e a l.
I t was f e l t t h a t a f t e r an. in d iv id u a l had e a te n , th e
eliances o f g e t t i n g pneumpeoeeus organism s would be m a t e r i a l l y le s s e n e d .
However, s in c e th e tim e when th e in d iv id u a ls c o u ld come i n was governed
t o a g r e a t exbent hy - t h e i r sch e d u le o f c l a s s e s , i t was n o t alw ays p o s s ib le
t o c u ltu r e them j u s t p re v io u s to a m e a l.
I t vjps found t h a t when some In d iv id u a ls g a rg le d , th e amount o f
l i q u i d l e f t from t h e g a r g lin g was red u ced from 85 c e . t o 10 c c .
T h is, o f
c o u rs e , m eant t h a t th e in d iv id u a l had sw allow ed o v er h a l f o f th e S a lin e
s o lu t i o n .
S in c e th e number o f pneumococci i n a sample p ro b a b ly i s v e ry
s m a ll, i t i s r e a d i l y se e n t h a t t h e l e s s t h e amount rem aining, th e le s s
chance t h e r e would be f o r g e t t i n g th e o rg a n ism s.
n o t a s im p o rta n t a s t h e f i r s t t h r e e m entioned*
T h is f a c t o r i s p ro b a b ly
However, i t was b e lie v e d
t h a t s in c e i t was one o f th e v a r ia b le s i n th e su rv ey i t sh o u ld be
m e n tio n e d .
The p o s s ib le re a s o n s f o r p o s i t i v e c u l t u r e s b e in g o b tain ed , by, one
method and n o t by t h e o th e r in th e c ase o f m ultiple^type. ,c a r r i e r s . —
I t was n o t c l e a r i n t h e p a p e rs o f some in v e s t ig a to r s w h e th e r, when th e y
m entioned m u ltip le - ty p e c a r r i e r s , th e y m eant p e rs o n s who h a rb o re d s e v e r a l
d i f f e r e n t ty p e s o f B in lo co o cu s pneumoniae i n th e t h r o a t a t one tim e o r
a n o th e r d u rin g th e su rv e y o r w h eth er th e y m eant p e rso n s who h a rb o re d more
th a n one ty p e i n t h e t h r o a t a t one tim e .
I n t h i s p a p e r , when th e a u th o r
u s e s th e te rm " m u ltip le-ty p e c a r r i e r s " , th e re fe re n c e w i l l be t o p e rso n s
who h a rb o r more th a n one s p e c i f i c ty p e o f D inlococcus pneumoniae, in t h e i r
t h r o a t s a t one tim e .
prom t a b l e XV-o i t c an be se e n t h a t in d iv id u a ls 3 , 7 , 8 , 1 8 , 36,
“4-00*
SS6 45» 4 9 p and 52 had two s p e c i f i c ty p e s o f pneumococci i n t h e i r t h r o a t s
i n th e same s u rv e y .
On c l o s e r in s p e c tio n o f th e t a b l e s 8 i t i s n o tic e d
t h a t b o th ty p e s w ere n o t alw ays found a t th e same tim e w ith th e same
m ethod.
F o r Oxamplea in th e c ase o f in d iv id u a l ? a ty p e 24 was is o la te d
b y means o f th e g a rg le method and ty p e 17 by means o f th e swab method i n
t h e O cto b er su rvey.
M e x p la n a tio n o f such r e s u l t s m ig h t l i e in th e l o c a t io n o f th e
o rg a n ism s.
I f ty p e 17 organism s w ere l o c a l i s e d i n th e p o s t e r i o r naso­
p h ary n x 9 b eh in d th e s o f t p a la te # i t i s q u ite c o n c e iv a b le t h a t th e swab
method would be th e o n ly one t o r e a c h th e organism s*
L ikew ise# i f ty p e 84 organism s w ere lo c a te d on o r aro u n d th e
t o n s i l a r c ry p ts# th e g a rg le method would b e th e one m ost l i k e l y t o o b ta in
th e s e organism s—e s p e c i a l l y s in c e i t was th e aim t o keep th e swab from
to u c h in g t h e m outh.
The q u e s tio n n a t u r a l l y a r i s e s a s t o w h eth er th e r e m ig h t n o t be
members o f ty p e 17 organism s i n th e mouth and members o f ty p e 84 in t h e
p o s t e r i o r nasopharynx.
S in c e P ip lo c o c c u s pneumoniae i s n o t a m o tile organism# i t would
have t o r e l y on a r t i f i c i a l methods o f t r a n s f e r .
As t h e p o s t e r i o r naso­
p h arynx i s n o t i n t h e d i r e c t p a th o f liq u id s # food# o r s a l i v a w hich a r e
swallowed# th e chance o f organism s from th e mouth b e in g tr a n s p o r te d t o
t h a t re g io n seems r a t h e r s l i g h t .
The chance o f organism s b e in g tr a n s p o r te d from th e p o s t e r i o r n aso ­
p h ary n x t o th e m outh c a v ity would p ro b a b ly be g r e a t e r th a n from th e
mouth t o th e nasopharynx f o r th e re a s o n t h a t th e s e c r e tio n s p a s s down-
-4 1 -
m r d more e a s i l y than, upw ard.
There i s a p o s s i b i l i t y t h a t i f th e m ethod o f "blocking" which B l i s s 8
M eGlaskey8 and lo n g (1954) fo u n d to be s u c c e s s f u l had b e en c a r r ie d ou t th e
r e s u l t s m ight have been d i f f e r e n t .
T hese a u th o rs found t h a t b y i n je c tin g
two m ice f o r each in d iv id u a l, one w ith a t h r o a t swab b r o th c u ltu r e a lo n e
and th e o th e r w ith a m ix tu re o f 0 ,5 CO. o f c u ltu r e and 0 ,5 Ce, o f immune
sen n a o f t h e ty p e o f th e predom inant pneumococcus 8 th e y c o u ld a s c e r t a i n
t h e predom inant ty p e , b lo c k i t s l e t h a l e f f e c t w ith antiserum , and re v e a l
a s u b o rd in a te t y p e .
I n th o s e c a s e s where more th a n one ty p e was found d u rin g th e su rv e y ,
a s i n in d iv id u a ls 5„ 4 , 5$, Y8 8» IS 9 18# 85, 89# 35# SS8 40» 45# 4 9 , and
5 2 , had t h e m ethod o f "b lo c k in g " been u s e d , i t m ight have b een p o s s ib le t o
have shown th e p re s e n c e o f a ty p e w h ich was submerged.
p o s s ib le re a s o n s f o r c u ltu r e s n o t ty p in g o u t. —Throughout th e co u rse
o f t h i s su rv e y th e r e w ere q u ite a number o f c u ltu r e s w hich f a i l e d t o g iv e
a t y p i c a l H eu feld 5^ u e llu n g s » r e a c t i o n .
When a c u ltu r e showed C lo u d in e ss,
a s o l u b i l i t y t e s t was c a r r ie d o u t u s in g a 10 p e r c e n t s o l u t i o n Of th e
sodium d e so x y c h o la te (a s d e s c rib e d i n th e s e c tio n on m e th o d s).
Sosae o f
th e s o lu b le o r p a r t i a l l y s o lu b le c u ltu r e s f a i l e d t o ty p e o u t ( ta b le B I ) .
H a tu r a lly 8 re a s o n s f o r such a phenomenon w ere so u g h t.
One o f t h e f i r s t p o s s i b i l i t i e s was t h a t th e s l i d e s w ere n o t t h o r ­
o ughly checked, b u t t h i s co u ld n o t a p p ly h e re s in c e a l l s l i d e s were care-*
f u l l y examined and a l l n e g a tiv e s l i d e s w ere s e t a s id e f o r §- h o u r to one
h o u r and th e n checked a g a in ,
f r e q u e n tly two p e rso n s checked th e s l i d e s
b e fo re p la c in g them i n th e d i s t i n c t l y n e g a tiv e g ro u p .
The second p o s s i b i l i t y m s t h a t t h e number o f pneum ococci was so
s m a ll t h a t th e y would be overlooked when, exam ining t h e s l i d e s .
I t would
seem t h a t i f t h e number o f organism s was s u f f i c i e n t l y g r e a t to show a
n o tic e a b le t o a com plete c le a r in g when sodium d e so x y e h o la te s o lu tio n was
added, t h e organism s would be p r e s e n t i n numbers g r e a t enough t o be fo u n d ,
The t h i r d , and m ost p ro b a b le ex p la n a tio n , i s t h a t t h e r e w ere p re s e n t
members o f th e D iplocoecus pneumoniae group f o r w hich t h e r e was no
s p e c i f i c a n tis e ru m ,
Kauffmaim5 M ^rch8 and Schm ith (1940) i n th e c o u rse o f th e p a s t two
o r t h r e e y e a rs have d e term in e d s e r o l o g i c a l l y SO new ty p e s o f pneum ococci,
so t h a t t h e r e I s a t p r e s e n t a t o t a l o f 50 d i f f e r e n t s e r o lo g ic a l ty p e s
known.
They s a y :
C o n tra ry t o t h e w id esp read id e a t h a t th e d ia g n o s is o f pneumococcus
ty p e s w ith th e H eu feld r e a c t i o n i s a v e ry sim ple m ethod, o u r view i s
t h a t t h e a p p r a i s a l o f t h i s r e a c t i o n i s o f t e n d i f f i c u l t and t h a t i t
depends on t h e s e l e c t i o n and a d a p ta tio n o f th e s e r a em ployed. I n most
c a s e s , i n o rd e r t o make a r e l i a b l e pneumococcus ty p e - d ia g n o s is i t i s
n e c e s s a ry t o employ c e r t a i n a b so rb ed immune' s e r a , a s i n some e ase s i n
p r a c t i c e one m ust make d ia g n o s is tw ic e , l , e . , f i r s t e s t a b l i s h th e f a c t
t h a t th e ty p e b e lo n g s f o r example t o th e 7 g ro u p , and th e n by means o f
o th e r ab so rb ed s e r a make th e m ore e x a c t ty p e - d ia g n o s is .
Assuming t h a t th e s e s o lu b le iand p a r t i a l l y s o lu b le c u ltu r e s were
u n i d e n t i f i e d ty p e s o f pneum ococci, th e p e rc e n ta g e o f in d iv id u a ls who
y ie ld e d p o s i t i v e c u ltu r e s by th e m onth would more ^nearly approxim ate th e
r e s u l t s o f o th e r in v e s t i g a t o r s ( ta b le I l l - a ) .
I t h a s been found by H a lte r , B lo u n t, B e a ttie , and O o tle r (1940) t h a t
ty p e S3 i s r e l a t i v e l y a v ir u le n t f o r m ice and t h a t s t r a i n s o f t h i s ty p e
sometimes r e q u ir e th e u s e o f p a r t i a l l y a n a e ro b ic c o n d itio n s f o r su c c e ss­
f u l c u l t i v a t i o n when f i r s t is o la te d from an in d iv id u a l.
S in c e an ae ro M -
*"4:3®*
o g is was n e v er u sed i n t h i s s u rv e y s i t may he p o s s ib le t h a t c u ltu r e s o f
ty p e S3 pneum ococci w ere m is se d .
The im portance o f c o n ta c t s i n t h i s su rv e y . —U n less a su rv e y i s
C a rrie d o u t i n a m anner d i f f e r e n t from t h i s i t i s alm ost im p o ssib le to
d e term in e th e im portance o f c a r r i e r c o n t a c t s . - I n th e c a s e o f th e 14
s o r o r i t y s i s t e r s p th e r e a r e a few i n t e r e s t i n g o b serv a tio n s t o be made.
Type S ap p eared i n O ctober i n in d iv id u a l 9 and i n November i n h e r
roommate, in d iv id u a l 4«
I n d iv id u a ls 3 and B were a f f e c t i o n a t e roommates
w hich p e rh a p s a cc o u n ts f o r th e f a c t t h a t f o r two months (F e b ru a ry and
M arch) b o th c a r r ie d th e same ty p e o f o rg a n ism s» In d iv id u a ls 7 and 9
w ere f r e q u e n tly to g e th e r w hich m ight p o s s ib ly e x p la in th e o c cu rren c e o f
ty p e 3 organism s i n b o th a t th e tim e o f th e M arch s u rv e y .
However9 in
o th e r in d iv id u a ls where th e same ty p e ap p eared th e r e was no known d i r e c t
c o n ta c t w hich w ould a d e q u a te ly e x p la in t h e s i m i l a r i t y .
The p o s s i b i l i t y o f one d i s t i n c t ty p e o f D iploeooous pneumoniae
ehau&tn^ in to a n o th e r d is t in c t t y p e Throughout th e p a s t few y e a rs th ere
h a s been one q u e s tio n w hich p e rp le x e d many i n v e s t i g a t o r s .
I t was t h is :
"Does one s p e c i f i c ty p e o f D iplocoecu s pneumoniae change i n t o a n o th e r
s p e c i f i c ty p e u n d e r n a t u r a l c o n d itio n s ? 6- From th e work o f M e g ra il and
F e k e r (1 9 8 4 ), B arnes and W right (1936) and Dawson (1930) t h e r e seems t o
be no c o n c lu s iv e ev id en ce t h a t such a tr a n s fo rm a tio n o c c u r s .
T h e re fo re ,
i n t h i s p a p e r , t h e p o s s i b i l i t y o f su ch a change has been d is re g a r d e d .
Com parison o f r e s u l t s o b ta in e d by th e a u th o r w ith th o s e o f o th e r
in v e s t i g a t o r s . —D uring th e -seven m o n th 's su rv e y c a r r ie d o u t by th e w r i t e r ,
a t o t a l o f 551 p e rs o n s w ere t e s t e d .
Of t h e s e 3 9 .8 p e r c e n t (MO) were
found t o be c a r r ie r s o f D ip lo co ccu s pneumoniae e ■
These r e s u l t s w ere low er th a n th o s e o f P o w e llg A tw a te rs and F e lto n
(1936) whose t o t a l r e s u l t s were a s f o llo w s 5
a ) Of 104 la b o r a to r y W orkersg 6? p e r 'c e n t were c a r r ie r s =
b ) Of 113 h ig h s c h o o l b o y s, 66 p e r c e n t were c a rrie rs ®
0 ) Of 118 m e d ic a l sc h o o l s tu d e n t s , 66 p e r c e n t w ere c a r r i e r s ,
d ) Of 90 s tu d e n t n u r s e s , 58 p e r e eiit w ere c a rrie rs ® .
T h is d if f e r e n c e m ight be e x p la in e d p a r t l y by th e f a c t t h a t th e s e
in v e s t i g a t o r s o b ta in e d t h e i r r e s u l t s i n B oston where th e c o n ta c ts o f th e
in d iv id u a ls w ere p ro b a b ly c l o s e r th a n i n M ontana,
The d if f e r e n c e m ight a ls o be due t o t h e c h o ice o f organism s t o be
c a lle d p o s itiv e ,
P o w e ll, A tw a te rb and F e lto n (1936) Say;
We have in c lu d e d a s pneum ococci su ch G ram ^p o sitiv e, e n c a p s u la te d
d ip lo d o e c i a s were b i l e s o lu b le , c a p a b le o f fe rm e n tin g i n u l i n and
w hich, i n t h e c a se o f Types I , I I , and I I I , a g g lu tin a te d s p e c i f i c a l l y ,
b u t, i n th e e ase o f Type IF , d id n o t a g g lu tin a te w ith ty p e s e r a .
The a u th o r d id n o t u s e t h e a g g lu tin a tio n t e s t b u t u se d in s te a d th e
s o l u b i l i t y t e s t and th e E e u fe ld wQlU e llu n g s51 r e a c t i o n .
O nly th o s e organ­
ism s which gave a d e f i n i t e E e u fe ld r e a c t i o n were in c lu d e d a s p o s i t i v e .
I t i s thought that i f typing sera fo r the types which Eauffmann9 Mffrch,
and Sehmith (1940) reported had been Vsed9 the resu lts might have been
higher,
B la ck lo c k and G u th rie (1958) found pneumococci in t h e th r o a t s o f
5 8 ,6 p e r c e n t o f th e h e a lth y c h ild r e n th e y exam ined.
T h is p e rc e n ta g e
i s Q u ite n o tic e a b ly lo w e r th a n t h a t o f th e a u th o r who fo u n d 7 5 ,9 p e r
c e n t o f th e 54 in d iv id u a ls in c lu d e d i n th e su rv e y to be c a r r i e r s .
T h is
O B ^ jg
®9
d if f e r e n c e m ig h t he e x p la in e d by th e f a c t t h a t th e fo rm er i n v e s t ig a to r s
u sed o n ly th e swab m ethod t o o b ta in c u l t u r e s from th e t h r o a t » - la c k o f
in fo rm a tio n c o n c e rn in g th e number o f c h ild r e n examined and th e pro<c e d u re s u se d b y B lh ek lo ck and G u th rie makes one h e s i t a t e t o draw to o
many c o n c lu s io n s a s t o th e re a s o n s f o r t h e d if f e r e n c e i n re s u lts ®
S c h l e i f s t e i n (1958)» in v e s t i g a t i n g 100 norm al in d iv id u a ls , found
73 p e r c e n t t o be c a rrie rs ®
b o th to n s ils ®
.H is method was t o swab th e nasopharynx and
'I n t h i s way he o b ta in e d organism s from t h e same re g io n s a s
d id th e w r i t e r when th e g a r g le and th e swab m ethods w ere used®
He also-
i d e n t i f i e d h i s organism s by u s in g th e b i l e s o l u b i l i t y t e s t and th e H eu feld
reactio n ®
Xt i s g r a t i f y i n g t o n o te t h a t , a lth o u g h h i s group o f in d iv id ­
u a l s was l a r g e r , h i s r e s u l t s a r e v e r y com parable w ith th o s e o f th e author®
T h is m ight ln d ie a te t h a t , had o th er in v e s tig a to r s used !methods which were
more a l i k e , th e r e s u l t s would have been l e s s d iffe re n t®
W ebster and Hughes (1951) found 80 p e r c e n t o f 105 c h ild r e n and
a d u l t s i n Hew Torlc to b e c a rrie rs ®
T hese r e s u l t s were 6 p e r c e n t h ig h e r
th a n th o s e o f th e a u th o r , b u t i t may b e t h a t th e d if f e r e n c e s i n l o c a l i t y
a s w e ll a s t h e d if f e r e n c e s i n m ethods acco u n t f o r t h i s s l i g h t v a ria tio n ®
B l i s s , McOlaskey, and lo n g (19% ) made a study o f 20 s u b je c ts on
whom 1,016 c u l t u r e s w ere ta k e n o v e r a p e r io d o f two years®
A l l b u t one
o f th e s u b je c ts y ie ld e d p o s i t i v e c u ltu r e s o f Dlp lo co ccu s pneumoniae a t
l e a s t once during th e c o u rse o f t h e in v e stig a tio n ®
They o b ta in e d t h e i r
c u l t u r e s by w ip in g th e p o s t e r i o r ph ary n x and th e t o n s i l s o r to n s l i a r beds
w ith c o tto n sw abs.
H e e d le ss t o sa y , t h i s p e rc e n ta g e i s much high er th a n
th e one o b ta in e d in t h i s survey®
S in c e t h e r e does seem t o b e a n o tic e -
*'4:6'=’
a b le f l u c t u a t i o n i n t h e p re v a le n c e o f e a r r i e n s $ i t i s n o t a t a l l improb­
a b le t h a t „ had th e p r e s e n t a u th o r c a r r ie d o u t an. i n v e s t i g a t i o n em bracing
a two y e a r p e rio d s th e r e s u l t s m ig h t have more n e a r ly ap proxim ated th o s e
.o f th e fo rm e r i n v e s t i g a t o r s .
Rosenaus R e lto n s and # w a te r (1986) r e p o r te d t h a t S a i l e r 9 H a ll9
YJllSon9 and McOoy (1917) found 1 6 .0 p e r c e n t o f 700 e x am in atio n s made to
be p o s i t i v e ,
Po make a com parison p o s s ib le * th e r e s u l t s o f t h e p re s e n t
su rv e y m ust be f ig u r e d on t h e same b a s i s .
Of 699 ex am in atio n s made* th e
a u th o r found 27»0 p e r c e n t (189) t o be p o s i t i v e .
These r e s u l t s a re
s l i g h t l y h ig h e r th a n t h e fo rm er ones g iv e n .
I n a f i v e m onth’ s su rv e y on 24 m e d ic a l sc h o o l s tu d e n ts * Powell*
A tw a te r9 and R e lto n (1986) found th e h ig h e s t in c id e n c e o f pneumococci to
be i n O cto b er (83 p e r c e n t ) and th e lo w e st t o be i n Hovember (48 p e r
c e n t).
The o th e r m onths w ere, i n th e fo llo w in g o rd e r i n r e s p e c t t o th e
o c c u rre n c e o f pneumococci i n th e t h r o a t ;
R eb ru ary 9 R anuary9 and December.
T hese p e rc e n ta g e s w ere v e ry much h ig h e r th a n th o s e i n th e p r e s e n t s u rv e y .
The group t e s t e d by th e a u th o r was a lm o st tw ic e a s la r g e and was made up
o f a more h e te ro g e n o u s group o f p e o p le .
The h ig h e s t in c id e n c e found by
t h i s in v e s t i g a t o r was i n t h e month o f O ctober (s o «9 p e r c e n t ) and th e
lo w e st was i n R eb ru ary (0 0 .8 p e r c e n t) w ith t h e o th e r m onths i n th e
fo llo w in g o rd e r;
1 - a ).
J a n u a ry , March* December* Kovember9 and A p r il ( ta b le
H ere a g a in , th e d if f e r e n c e s i n t h e l o c a l i t y and i n t h e m ethods
u se d may e x p la in th e la c k o f s i m i l a r i t y i n th e r e s u l t s .
V a ria b le f a c t o r s w hich may a l t e r t h e r e s u l t s w ith su rv e y s o f t h i s
k in d .—The f i r s t f a c t o r w h ich may in flu e n c e t h e r e s u l t s i s t h e method
used.
I t i s e x tre m e ly d i f f i c u l t and h ig h ly u n s a t i s f a c t o r y t o t r y t o
COHipare t h e r e s u l t s o b ta in e d by th e sw ab -eu itu re-m o u se m ethod w ith th o s e
o b ta in e d by t h e g a rg le - c u ltu r e - c e n tr if u g e - m o u s e m ethod.
As h a s been
p o in te d o u t p r e v io u s ly , t h e way th e c u ltu r e i s ta k e n , w h e th e r swab o r
g a r g le , may a l t e r th e r e s u l t s .
The second f a s t e r i s th e h in d o f c u ltu r e medium u s e d .
A very’s b r o th q u i t e s a t is f a c t o r y .
Some found
O th e rs u sed b lo o d a g a r p l a t e s , and
s t i l l o th e r s used: b e e f in f u s io n b r o th .
The a u th o r u sed b u ff e re d b e e f
h e a r t in f u s io n b r o th d u rin g th e su rv e y from November 19B9 t o A p r il 1940
(ta b le ? I ) .
I n th e survey made from O cto b er 1940 t o A p r il 1941, b u ffe re d
b e e f h e a r t in f u s io n b r o th e n ric h e d w ith b e e f serum was u s e d .
To g e t an
ap p ro x im ate id e a o f th e e f f e c t o f ad d in g serum , th e a u th o r u sed u n e n ric h ed
b e e f h e a r t in f u s io n b r o th d u rin g th e November 1940 survey a lo n g w ith th e
e n ric h e d b r o th .
The r e s u l t s were s ta r tlin g ®
Tw enty-seven ou t o f 53
p e rs o n s w ere p o s i t i v e when, e n ric h e d b r o th was u sed and o n ly 10 o u t o f th e
53 w ere p o s i t i v e when th e u n e n ric h e d b r o r h was u s e d .
T hese r e s u l t s ,
a lth o u g h c a r r i e d o u t on o n ly a v e r y s m a ll number, seem t o in d ic a te t h a t a
medium e n ric h e d w ith serum, w i l l g iv e a much b e t t e r grow th o f pneumococci
th a n w i l l an u n e n ric h e d medium.
A t h i r d f a c t o r w hich may in flu e n c e th e r e s u l t s i s th e p o s s i b i l i t y
Of m is sin g p o s i t i v e c u l t u r e s .
I t h a s a lr e a d y been su g g e ste d t h a t ty p e s
above 3 3, f o r w hich t h e r e w ere no ty p in g s e r a a v a ila b le t o th e a u th o r ,
may have been p r e s e n t and c o n se q u e n tly m is s e d .
T here i s a ls o a p o s s i­
b i l i t y t h a t s v i r u l e n t form s o f P ip lo o o cc u s pneumoniae may have been
p r e s e n t i n numbers s m a ll enough t o have b een s u c c e s s f u lly r e s i s t e d by
*»48«
t h e mouse o r t o have been k i l l e d by an tag o n ism from th e p re s e n c e o f some
o th e r organism w hich a ls o found c o n d itio n s f a v o ra b le f o r grow th i n th e
p e rito n e u m o f th e mouse®
I t i s a ls o p o s s ib le t h a t when a c u ltu r e was ta k e n fro m th e h e a r t o f
a Biouse8 t h e r e m ight have been s e v e r a l organism s p r e s e n t i n th e b lo o d ,
one o r more o f w hich grew f a s t e r th a n t h e pneum ococci ,and th u s masked
t h e i r p re s e n c e .
A fo u r th f a c t o r w hich was n o t known t o th e a u th o r u n t i l n e a r th e
end o f t h e su rv e y was t h a t th e r e a r e d i f f e r e n t s t r a i n s o f w h ite mice
,some Of w hich a r e more s u s c e p tib le t o t h e pneum ococci th a n ethers®
The
m ice u sed i n t h i s su rv ey w ere e i t h e r r a i s e d by th e a u th o r o r were o rd e re d
d i r e c t from a r e p u ta b le r e s e a r c h su p p ly h o u s e .
HO m en tio n was made when
o rd e rin g th e m ice a s t o th e Use t o w hich th e y were t o be p u t .
I t i s f e l t by t h e a u th o r, t h a t a l l o f th e s e f a c t o r s .ishouM be con­
sid e re d when t h e r e s u l t s o f such a su rv e y a r e s tu d ie d .
U n t i l one can
c o n tr o l more o f th e s e V a r ia b le s , th e r e s u l t s o f such a su rv e y w i l l s e rv e
o n ly a s a n in d ic a tio n o f c o n d itio n s a s th e y .p ro b a b ly e x i s t , r a t h e r th a n
a s p i c t u r i n g t h e e x ac t s t a t e o f a f f a i r s .
( I ) I n a. m o n th ly su rv e y from O cto b er .1940 t o A p r il 1941, 41 (75.9
p e r c e n t) o f th e 54 in d iv id u a ls examined were c a r r i e r s o f D iplococcus
pneumoniae a t one tim e o r a n o th e r .
(B) Of a t o t a l o f 551 p e rs o n s exam ined, 140 (5 9 .8 p e r c e n t).w e re
' c a r r i e r s o f p n eu m o co cci.:
'
. -4 9 -
'
'
(3 ) Swo m ethods o f d e ta in in g c u ltu r e s were u s e d , th e g a r g le and t h e
awab m ethod a A lthough t h e p e r d e b t o f p o s i t iv e s w hich each method gave
xifaa v e ry n e a r ly a l i k e s th e p e r c e n t o f p e rs o n s g iv in g p o s i t i v e s w ith b o th
m ethods a t th e same tim e was v e ry low and th e t o t a l p e rc e n ta g e g iv in g
p o s i t i v e s r e g a r d le s s o f m ethod was h ig h e r th a n by e i t h e r one a lo n e ,
(4) Te o b t a i n .t h e b e s t r e s u l t s Xfheri tr y i n g t o d e term in e th e
in c id e n c e o f pneum ococci c a r r i e r s , b o th th e g a r g le and t h e swab methods
sh o u ld be u sed s im u lta n e o u s ly ,
(5) Therec fr e q u e n tly o c c u rre d d u rin g t h i s su rv e y c u ltu r e s which
w ere s o lu b le o r p a r t i a l l y s o lu b le w ith sodium d e so x y c h o la te b u t which d id
n o t g iv e a p o s i t i v e H dufeld r e a c t i o n ,
(6) n in e te e n , s p e c i f i c ty p e s o f B ip lo co o cu s pneum oniae were found i n
t h i s s u rv e y ,
( 7 ) The ty p e s o f pneumococci found i n th e o rd e r o f th e ir - f r e q u e n c y
are. a s fo llo w s : 3 , 17* S9 S 6 4& 13$ SS9 SO9 IO9 15, S I, 04# hBs; 50, SS9
9 , 1 6 , 5 , and I S ,
(8) Types I and 0 were n e v e r found d u rin g t h i s s u rv e y .
■ eaQO”
ACENOMEEDGMEBrS
I t i s th e d e s ir e o f th e a u th o r t o e g r e s s g r a titu d e to th o s e
in d iv id u a ls who h e lp e d t o make t h i s survey p o s s ib le
S in c e work on t h i s su rv e y o f t e n c a l l e d f o r c o n tin u o u s a t t e n t i o n f o r
•
■
24 h our p e r io d s , and s in c e , due t o th e in t e r r u p t i o n o f c l a s s e s , th e
a u th o r was u n a b le t o b e 'p r e s e n t a t a l l tim e s . M iss. S h ir le y Nyman h elp ed
................... ................................. ......................... .■*
• 1'
......................
d u rin g t h e O ctober t o December 1940 p o r t i o n o f th e s u rv e y , and M iss Dee
.
,
,
,
'
' '
'
' Mead h e lp e d d u rin g J a n u a ry t o A p r il 1941«
<
Both o f th e s e g i r l s worked
u n d e r th e d i r e c t i o n o f th e a u th o r and o b ta in e d c o lle g e c r e d i t f o r t h e i r
w ork.
The a u th o r w ish es t o g iv e h e r h e a r t f e l t th a n k s t o th e s e g i r l s f o r
t h e i r c o o p e r a tio n .
To Dean Be B® Sw ingle and to D r. ? . B . C o tn e r, th e w r i t e r owes th a n k s
f o r t h e i r v a lu a b le s u g g e s tio n s and c r i t i c i s m s e
To D re L loyd De E e lto n jl s e n io r su rg eo n in t h e U. S . P u b lic H e a lth
S e r v ic e , and t o D r. We G-. S m illie o f th e C o rn e ll U n iv e rs ity M edical
C o lle g e , goes my a p p r e c ia tio n f o r v a lu a b le s u g g e s tio n s g iv e n by
p r i v a t e c o rre sp o n d e n c e »
»51-
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