Hospital trials on the control of dust-borne infection by oiling blankets, ward linen, garments, and floors were carried out in scarlet fever and measles wards in this hospital during the spring of 1942 and of 1943. The work in a scarlet fever ward, while on the whole encouraging, awaits the result of further tests before being recorded. The results of a controlled test in two measles wards are now reported.The haemolytic streptococcus has for many years been recognized as a predominant secondary invader in measles and as an important cause of its serious complications-e.g., otitis media, mastoiditis, and bronchopneumonia. The virus-damaged mucous membrane of the respiratory tract, the catarrhal nature of the primary infection, and the overcrowding of patients in hospital at epidemic times all combine to favour the acquisition and spread of streptococci. 1917and 1918(Michie and Lull, 1928. Its most serious consequences were pneumonia, empyema, and otitis media, which in the majority of cases were due to haemolytic streptococci. Cole and MacCallum (1918) found that a haemolytic streptococcal throat-carrier rate of 11.4% among measles patients on admission to hospital had risen to 38.6% after 3 to 5 days in the wards and to 56.8%,b after 8 to 16 days. They concluded that the chance of developing post-measles streptococcal infection was increased by residence in hospital, and that the high incidence of pneumonia, and the resulting high mortality, were due in part to infection occurring within the hospital. The sequence of events has become clearer since Griffith (1934) extended his method for the seiological typing of Str. pyogenes. Allison and Brown (1936) were thus enabled to make a survey in a measles ward. They took nose and throat swabs from 43 patients once weekly from admission to discharge, and appropriate swabs on the occurrence of any complication. By typing the strains of Str. pyogenes which they had isolated they showed that cross-infection with these organisms occurred in 22-i.e., 51.2%-of the 43 patients; and that of the patients thus cross-infected 13 developed complications as a result (7 otitis media ; 1 scarlet fever with otitis media ; 1 rhinitis; 4 rise of temperature only). In other words, 19% of the measles patients developed otitis media consequent upon crossinfection with streptococci. investigated possible measures for the control of dust-borne infection in wards. The dust-laying effect of spindle oil when applied to floors was tested in field trials by Thomas, who found that the method produced a prolonged and marked reduction in the number of bacteria in the air during sweeping. Since, however, the main source of the bacteriacarrying particles lay in the bed-clothes, van den Ende and co-workers devised methods for the -treatment of woollen and cotton materials with technical while oil, which reduced by 990% the number of micro-organisms liberated during bedmaking. The method of oiling ward articles by the use of oil-in-water emulsions (van den Ende and during the laundering process ...
Allison and Brown (1936) showed that haemolytic streptococci may spread in measles wards as a secondary transmissible infection superimposed on the primary viruscaused disease. Their findings were confirmed by Wright, Cruickshank, and Gunn (1944), who showed in addition that dust particles are possibly an important mneans of streptococcal carriage in measles wards. They found that the oiling of blankets, bed linen, garments, and floors in a measles ward resulted in a 98 % reduction in the numbers of haemolytic streptococci in the air during bed-making, when compared with the numbers in the air of an unoiled control ward; and that the streptococcal cross-infection rate among the patients fell from 58.1 % during a preliminary period with oiled floor alone to 18.6% when, in addition, oiled bed-clothes, garments, and ward linen were in use. The comparable cross-infection rates for the same periods in the unoiled ward were 53.3 % and 73.3 % respectively. The method of laundry oiling was described by Harwood, Powney, and Edwards (1944).Research on the control of air-borne infection was stimulated during the recent war by the occurrence if respiratory infection among men in barracks and other establishments. British workers demonstrated a great increase in numbers of dust-borne streptococci and other bacteria in the air of Army quarters and hospital wards during bed-making and sweeping, and successfully controlled dust-spread bacteria by the application of dustlaying oils to textiles and floors (van den Ende et al., 1940(van den Ende et al., , 1941 van den Ende and Thomas, 1941;. American workers confirmed these observations and introduced new methods of oil application (Robertson et al., 1944; Commissions on Acute Respiratory Diseases and on Air-borne Infections, 1946;Loosli et al., 1946;. In field trials they secured evidence that oiling floors and blankets reduced the incidence of haemolytic streptococcal infection among troops (Commission on Air-borne Infections, to be published).Scope of the Investigation Although the good results of dust control in a measles ward recorded by Wright, Cruickshank, and Gunn (1944) appeared clear-cut, it is notoriously difficult to make strict comparisons between one hospital ward and another. It seemed important, therefore, to repeat the experiment during another measles epidemic and in another hospital. At the same time nursing techniques and other matters, the importance of which had emerged dulring the first experiment, were standardized so far as possible. The investigation was undertaken during 19 consecutive weeks in 1945 in two first-floor measles wards of identical size, design, and aspect. Each ward had a side-room for two cots. In the oiled ward (opened on Jan. 28 and closed on June 7) the following dust-suppressive measures were taken: The floor of the main ward, which was of wood, was treated with spindle oil immediately before the start of the investigation and monthly thereafter (the floor of the side-room, sanitary annexes, and passages could not be oiled, as they ...
SIR,-Workers interested in the isolation of measles virus from patients may like to hear, before the present epidemic closes, of some investigations now in progress. A main object of the work has been to use for culture tissues which are readily available everywhere and thus to obviate the use of human or monkey kidney cultures, which, it may be recalled, were employed by Enders and Peebles' in their original investigations on the isolation and cytopathogenicity of measles virus.In the present investigation cultures of human chorion and human amnion' were inoculated with nose and throat swabs taken from measles patients on the first or second day of the rash. The swabs were inoculated, within 20 minutes of taking them, direct into the nutrient fluid (medium 199+ 20% ox serum) of the cultures. Fluid changes were made shortly before inoculation, on the day following, and thereafter at 3-4-day intervals. Culture tubes were incubated in the stationary position throughout. Cytopathic changes followed the inoculation in all of five chorion cultures and eight of nine amnion cultures.In both types of culture the lesions were usually first detectable on the 3rd or 4th day after inoculation. Development of cytopathic changes differed in the two tissues. In the chorion cultures they were diffusely distributed; little necrosis occurred and, on staining, large numbers of nuclei containing eosinophilic inclusions in various stages of development were seen. These were present in many individual cells as well as in the multinucleate syncytia which developed, more particularly, in the marginal areas. In the amnion cultures, on the other hand, the affected areas were discrete, large, and round, and could in fact be seen as " plaques " with the naked eye or hand-lens. They varied in number in individual cultures from one to about twenty. Vacuolation was conspicuous. With continued incubation the lesions increased in size but apparently not in number; the margins of the syncytia became more sharply defined and necrosis developed early. On staining, large eosinophilic inclusions were seen in the nuclei of the multinucleate cells of the affected areas.The relative merits of the two tissues for serial propagation of virus following isolation in them has not yet been assessed. The widespread invasion of the cultured chorion suggested that this might prove the better tissue, and the few experiments which have as yet been undertaken supported this view. The chorion had an advantage in that it was hardier in withstanding any deleterious influences during placental delivery and subsequent collection; it proved a uniformly reliable tissue with which to prepare cultures. On the other hand, an advantage in isolation in amnion lay in the ease with which the discrete plaque-like lesions could be detected in the living unstained cultures; in the chorion the full extent of the cytopathic changes was only revealed by staining. The results suggest that both these tissues, in culture, may find a place in the clinical and epidemiological investigatio...
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