Changes in Personality after Cerebrospinal Fever
Authors: M. N. Pai
Journal: BMJ (1945)

the nursing staff to administer.For these reasons it is prob- ably wiser to reserve sulphonamides for therapeutic purposes. SummaryThe results are recorded of two investigations made among measles patients admitted to the North-Western Hospital during the epidemic of 1942-3.1.In Investigation A an intensive study of the bacteriological and clinical conditions in one ward for a period of 12 weeks showed that: (a) 72% of the 65 patients at risk became cross-infected with Type 6 haemolytic streptococci; (b) as a result of Type 6 streptococcal cross-infection 12 patients (18.5%) developed middle- ear suppuration-of these 12, 4 underwent mastoid operations;(c) 26% of the patients developed skin infections, mainly impetigo;(d) allowing 14 days as the normal stay for an uncomplicated measles case, excess stay in hospital amounted to two and a half years.2. In Investigation B an analysis was made, in accordance with a set scheme, of the middle-ear-suppuration cases among all the measles patients admitted to the hospital from Dec., 1942, to May, 1943, inclusive.This showed that: (a) Among the 496 patients 3.6% suffered from "early" (i.e., on or before the 5th hospital day) middle-ear suppuration, and 13.3 % from " late " (i.e., on or after the 6th hospital day).In view of the findings in Investigation A, it could be assumed that the great majority of the late middle-ear complications were due to cross-infection.(b) Among children under the age of 9 years the percentage incidence of late middle-ear suppuration did not vary greatly in the three age groups.Under 3 years of age the incidence was 14.3 %, in the 3-to-5-year group 13.9%, and in the 6-to-8-year group 18.6%.Among patients of 9 years or over the rate was much lower, being 3.2%.(c) The late middle-ear-suppuration rate was considerably lower among patients admitted in April and May than among those admitted in the winter months.(d) The incidence of late middle-ear suppuration did not vary greatly in the three " open " wards of the hospital, being in Ward A 18.8%, in Ward B 17.2%, and in Ward C 17.9% (corrected figure).(e) The percentage incidence of ear complications was not higher among children under 3 years of age, but the seriously damaging effects of cross-infection fell most heavily upon them.Of the 238 children in this group, 11 (4.6%) underwent mastoid- ectomy, and one of these died.Infants under 1 year of age suffered particularly severely; 6 of the 45 infants admitted to the hospital developed late middle-ear suppuration, and in 4 cases this was followed by further complications-namely, in one by retropharyn- geal abscess, in one by extradural abscess and mastoidectomy, in one by bilateral mastoidectomy, and in the last by orbital cellulitis, bronchopneumonia, and mastoidectomy.3. In view of the high complication rate due to cross-infection, treatment at home rather than in hospital is advocated for patients with uncomplicated measles.4. For the protection of measles patients who must be admitted to hospital, recommendations are made for the control of cross- infection and for improvements in administrative and nursing procedures.I wish to thank Dr. W. Gunn for his advice, and for access to