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
It has been clearly shown that treatment of influenza and pneumonia in
overcrowded wards even with the use of such precautions to prevent
transfer of infection as cubicles, masking of attendants and patients,
etc., is attended by serious danger of contact infection and that such
infection will almost inevitably occur. This is not at all surprising
when it is remembered that we are treating in the same ward, in the case
of pneumonia, a group of what are in reality entirely different
diseases, all of which may be transmitted from one patient to another,
and in the case of influenza a group of individuals who carry a variety
of potentially pathogenic bacteria. No one would expect to treat cases
of scarlet fever, measles, and diphtheria together in a hospital ward
without having contact infection result. Among patients ill with
influenza and postinfluenzal pneumonia, certainly streptococcus
pneumonia and to some extent pneumococcus pneumonia may be transmitted
quite as readily as any of these diseases. In view of these
considerations it must be apparent if ward treatment of these diseases
is to be continued without respect to type of bacterial infection, not
only that overcrowding is absolutely contraindicated but also that much
wider separation of patients than has hitherto been regarded as
necessary is imperative. Furthermore, beds should be separated by
permanent cubicles that cannot readily be displaced. Patients should be
confined to their cubicles until thoroughly convalescent and when up and
about should not be allowed to enter cubicles occupied by patients still
sick. Medical officers, nurses and attendants who come into contact with
the patients should use the same rigid precautions that are used in the
care of patients with typhoid or erysipelas or meningitis with the
additional use of means to prevent droplet infection of the patients,
always bearing in mind that the respiratory tract in patients with
influenza or postinfluenzal pneumonia is as susceptible to secondary
infection as the postpartum uterus or an open surgical wound. In other
words, the most rigid aseptic technic should be maintained. The
recognition of a case of streptococcus pneumonia in a ward should be an
indication for immediate quarantine of the ward until it has been shown
by bacteriologic examination that there is no longer danger of spread of
streptococcus contagion. This is done in the case of meningitis or
diphtheria, neither of which diseases is comparable with streptococcus
pneumonia in rapidity of spread or in resulting fatality.
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