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
One hundred and sixty-five cases were admitted to the receiving ward
during the period of study as cases of influenza. Of these, 137 had
influenza; 4 of those with influenza had pneumonia at time of admission,
23 had acute follicular tonsillitis, 3 epidemic cerebrospinal
meningitis, 1 scarlet fever, and 1 Vincent’s angina. Sixty-six cases (40
per cent) showed hemolytic streptococcus in the throat at time of
admission and were sent to the streptococcus wards; 99 cases (60 per
cent) were negative for hemolytic streptococcus on admission, and of
these 91 were sent to the “clean” influenza wards. Twenty-four of these
clean cases subsequently became positive for S. hemolyticus. It is
especially noteworthy that 14 of them acquired a hemolytic streptococcus
during the short period that they were held in the receiving ward
awaiting the report of the culture taken at time of admission, the first
culture taken shortly after admission to the “clean” wards being
positive. This result was undoubtedly due to the fact that these cases
were unavoidably associated in the receiving ward with many carriers of
hemolytic streptococcus. It is evident that cases which were supposedly
free from streptococci but which in reality had picked up the organism
in the receiving ward were constantly being sent to the “clean” wards.
It is furthermore evident that if the precaution had not been taken of
reculturing all clean cases on day of admission to the “clean” wards and
daily thereafter these wards would soon have become saturated with
hemolytic streptococci. Even under these conditions, 10 cases, after
varying periods in the “clean” wards, acquired the organism in their
throats. When it is stated that it required the full time of two men
under very special conditions to carry out this work in a very limited
number of cases and that it failed to keep “clean” wards free from
hemolytic streptococci, it is only too apparent that the efficient
separation of carriers from noncarriers in the presence of an epidemic
of influenza is an impossible task.
The segregation of pneumococcus pneumonias following influenza according
to type of infection is obviously impossible, since they are caused by
an almost unlimited variety of immunologic types as far as present
knowledge goes.
Even the efficient separation of streptococcus pneumonias from
pneumococcus pneumonias would require a considerable team of workers and
the closest cooperation between laboratory and ward staffs, so that no
case of pneumonia would be sent to a pneumonia ward until the
bacteriologic diagnosis had been made. In our experience this is rarely
considered feasible even under ordinary conditions, and in the presence
of an epidemic is nearly impossible because of the volume of work
involved and the delay necessitated by bacteriologic methods. It is,
nevertheless, absolutely essential if highly fatal ward epidemics of
streptococcus pneumonia are to be prevented.
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