Читать книгу Epidemic Respiratory Disease - Thomas M. Rivers - Страница 20

During the period from September 6 to 15, just prior to the outbreak of influenza in epidemic proportions, the ward had an average population of 18.6 patients. The total number of new patients admitted was 11, of whom 3 died, a mortality of 27.2 per cent. All these cases were pneumococcus pneumonias as determined by bacteriologic examination of the sputum at time of admission. The 3 fatal cases showed pneumococcus infection at autopsy. During the second period, from September 16 to 25, with the outbreak of the epidemic of influenza, the ward rapidly filled with new cases of pneumonia, attaining an average population of 46.1 patients. Of the 52 new cases admitted 16 died, a mortality of 30.7 per cent. Again all the cases admitted during this period in which bacteriologic examination of the sputum was made, were found to be pneumococcus pneumonias with one exception. This case, admitted on September 21 and dying two days later, had a hemolytic streptococcus pneumonia. Fortunately, though quite by accident, he was placed in a bed at one end of the porch and no transmission of streptococcus infection to other cases in the ward took place. At autopsy 13 cases showed pneumococcus infection; the foregoing case, hemolytic streptococcus. During the third period from September 26 to October 5 the ward became even more crowded, having an average of 58.6 patients; 23 new cases were admitted, 8 of whom died, a mortality of 34.7 per cent. Autopsy showed that 5 of these were pneumococcus pneumonias and 1 was caused by hemolytic streptococcus infection. It is noteworthy that the death rate from pneumonia gradually increased as the ward became more and more crowded. This may possibly be attributed in part to the increasing severity of the pneumonia during the early days of the influenza epidemic. That it was in part directly due to secondary contact infection with pneumococcus will be shown when the transmission of pneumococcus infection is discussed. In spite of the overcrowding of the ward the introduction of 2 cases of streptococcus pneumonia did not cause an outbreak of streptococcus infection. Whether this was due to precautions taken against the transfer of infection or was merely a matter of good luck is difficult to say, in view of the fact that a considerable amount of transfer of pneumococcus infection from one patient to another did occur.

Ward 8 had long been used for the care of colored patients with pneumonia. As in Ward 3 cubicles were in use and ordinary precautions against the transfer of infection were used. The data are presented in Table XVIII.