Читать книгу Epidemic Respiratory Disease - Thomas M. Rivers - Страница 22

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.

Ward 1 was opened on September 24. From that date until October 2 no cubicles were in use and few precautions were taken against transfer of infection. On October 2 cubicles were installed and ordinary precautions to prevent transfer of infection were instituted. On October 6 the ward was closed to further admissions. The data presented in Table XX are divided into two periods, because on September 29 and 30, 4 patients with streptococcus pneumonia were admitted to the ward.