Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
During the first three days 40 patients with pneumonia were admitted to
the ward. Of these 40 patients, 27 died, a mortality of 67.5 per cent.
Cultures at autopsy showed that 23 of these died with hemolytic
streptococcus infection, none of pneumococcus infection. In four there
was no autopsy. To appreciate the full significance of these figures it
must be emphasized that these patients at time of admission to the ward
in no way differed from those admitted to Ward 3 during the
corresponding period and were not in any sense selected cases. The type
of infection in 9 of these patients had been determined by bacteriologic
examination of the sputum just prior to or immediately after admission
to the ward before opportunity for secondary contact infection in this
ward had occurred. All 9 were shown to have pneumococcus pneumonia free
from hemolytic streptococci at that time. All 9 died, 7 with secondary
streptococcus infection as shown by cultures taken at autopsy, 1 with a
secondarily acquired Pneumococcus Type III infection—sputum showed a
Pneumococcus Type IV on admission—and in 1 there was no autopsy. In view
of the fact that bacteriologic examination of the sputum in cases of
pneumonia following influenza had shown that the large majority of them
were due to pneumococcus infection, it is probable that most of the
other cases of pneumonia admitted to this ward were pneumococcus
pneumonias at time of admission, and that they acquired the
streptococcus infection after admission.
During the next three days 17 new patients were admitted, of whom 6
died, a mortality of 35.3 per cent. Cultures at autopsy showed
pneumococcus infection in 2, streptococcus in 2. It is noteworthy that
the porch was first put into use on September 29. Of the 12 patients
admitted on this date, 8 were treated throughout the acute stage of
their illness on the porch. Of these 8 patients but one died, of a
Pneumococcus Type IV infection and none became infected with S.
hemolyticus. From October 4 to October 6, 10 patients were admitted, of
whom 4 died. Cultures at autopsy showed pneumococcus infection in 2,
hemolytic streptococcus in 1.
The widespread prevalence of hemolytic streptococcus infection in this
ward as compared with its almost entire absence in Wards 3 and 8 is very
striking. Cultures made during life and at autopsy have shewn clearly
that it was due to rapid spread of contagion throughout the ward. The
almost unlimited opportunities for transfer of infection from patient to
patient, during the first six days the ward was in use, undoubtedly
greatly facilitated this spread. From the data available it is
impossible to state exactly when and by which patients hemolytic
streptococcus infection was introduced into the ward, but it must have
been very early since the death rate was very high from the beginning,
and the first 23 cases coming to autopsy died with streptococcus
infection.
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