R. Gordon Douglas

Respiratory Syncytial Virus Infections within Families

To examine intrafamily spread of respiratory syncytial virus infections and their associated illnesses, 36 families with 188 members were studied during an outbreak of such infections. Nurses visited every three to four days to obtain specimens for viral isolation and interview household members. The virus infected 44.4 per cent of families, and 21.9 per cent of all members. All age groups had appreciable attack rates (with a range of 16.8 per cent in adults to 29.4 per cent in infants). In infected families, 45.9 per cent of members became infected, including 10 of 16 infants. Secondary attack rate for all ages was 27 per cent, and that for infants 45.4 per cent. An infants older sibling appeared most likely to introduce the virus into the family. Associated acute respiratory illnesses occurred in 94.9 per cent of cases, and appeared more severe than those not associated with respiratory syncytial virus. When the virus was introduced into a family the high attack rate produced an illness of age-related severity.

Successful treatment of naturally occurring influenza A/USSR/77 H1N1.

Forty-five university students with proved influenza A/USSR/77 H1N1 infection were randomly treated with either amantadine hydrochloride (14 students), rimantadine hydrochloride (19 students), or placebo (12 students). By 48 hours after initiation of therapy, amantadine and rimantadine recipients had significantly less fever and greater improvement compared with subjects given the placebo. Minor reversible CNS side effects at the end of the five-day course of therapy were observed in one third of the amantadine-treated subjects. However, both amantadine and rimantadine recipients returned to classes earlier and shed smaller amounts of virus than placebo recipients. Thus, both drugs exerted a notable therapeutic effect. Hence, during an influenza outbreak, five days of empirical therapy with amantadine or rimantadine for persons with an influenza-like syndrome should ameliorate clinical symptoms and might decrease spread of virus.

Clinical assessments as predictors of one year survival after hospitalization: Implications for prognostic stratification

In clinical trials measuring the short term survival of patients, prognostic stratification is important to avoid susceptibility bias. Demographic and disease specific clinical features are commonly used to established similarity, but these may not insure prognostic comparability. To identify the generic predictors of one year survival after hospitalization, a cohort of 559 patients admitted to the medical service at New York Hospital was studied. Among all of the clinical and demographic information available at the time of admission, only three were independent predictors of the time until death: functional ability, severity of illness and extent of comorbid disease. The overall one year survival rate was 66%. Six subgroups composed of patients with different combinations of the predictors of prognosis had mortality rates ranging from 97% to 14%. Illness severity was a predictor only in the less functional patients, and only severe comorbidity was associated with a decreased survival after taking into account functional ability and illness severity. Prospective estimates of severity of illness, functional ability and extent of comorbidity can be used to stratify a diverse group of patients according to their probability of one year survival after hospitalization.

Respiratory Syncytial Virus and Influenza: Practical Community Surveillance

Concurrent and sequential outbreaks of infection with respiratory syncytial virus (RSV) and influenza A virus were studied, utilizing a local surveillance system for infectious diseases that involved weekly reports from primary care physicians. The patterns of illness in the community and in hospital admissions were relatively specific for these two viruses, and differed according to whether RSV and influenza A virus occurred together or separately. This surveillance system appeared to be a practical and accurate indicator of the activity of RSV and influenza A virus in the community. Such a system may serve as a valuable means of relatively early detection of the local arrival of these viruses, and recognition of these illness patterns might aid the physician in diagnosis.

Exposure to Cold Environment and Rhinovirus Common Cold

Abstract The effect of exposure in a 4°C room and a 32°C water bath on experimentally induced rhinovirus Type 15 infection was studied in 44 antibody-free volunteers. Volunteers were exposed to cold at selected intervals: at inoculation; during incubation; during maximum illness; and during recovery. Infectivity, illness severity, quantitative virus-shedding patterns, antibody response, leukocyte response and bacteriologic flora of the upper respiratory tract were evaluated in subjects exposed to cold and in a similar number of controls. Although exposure to cold abolished the characteristic increase in neutrophils during illness, there were no significant changes in the other findings. Thus, this study demonstrated no effect of exposure to cold on host resistance to rhinovirus infection and illness that could account for the commonly held belief that exposure to cold influences or causes common colds.

Pregnancy and diabetes

Abstract A review of 106 patients with 131 pregnancies complicated by diabetes has been presented. Past history of the multigravid patients indicated that the infants of the prediabetic mothers tended to be larger than average. The pregnancy of 75 per cent of the patients terminated after thirty-six weeks. Weight gain was not excessive in general for those patients who registered in the first and second trimesters, but was excessive in two-thirds of the patients who registered in the last trimester. Toxemia was present in 46 per cent of the pregnancies, keto-acidosis in 16.8 per cent. The diabetes was treated by the clinical technique. There was no constant diminution of insulin requirements observed during pregnancy. Labor was prolonged in 26 per cent of our primigravid patients and in 1.3 per cent of our multigravid patients. Incidence of forceps was 10 per cent, of cesarean section, 9.9 per cent. The sections were performed for obstetrical indications. Maternal mortality was 1.5 per cent, represented by 2 patients, in neither of whom was the diabetes the initiating cause of death. Maternal morbidity was 17 per cent. The infants were routinely sent to the pediatric premature nursery where incubation, oxygen, suction, and dehydration formed the initial regimen of treatment. Thirty and six-tenths per cent of the infants weighed over 4,000 grams. The infant mortality rate was 21.4 per cent, the total fetal loss was 30 per cent * Errors were often made in estimating the size of the infant and death resulted from the traumatic delivery of impacted shoulders. We believe that delivery should be accomplished at the first sign of developing toxemia, if the pregnancy is past thirty-two weeks. Further, the patient who has been poorly controlled and has had bouts of keto-acidosis should be delivered prematurely. Delivery should be effected by induction of labor when conditions are ideal, otherwise by cesarean section. In the patient with a large infant, or in the case where there is some question as to the size, cesarean section is the procedure of choice.

Oxytocin and milk ejection.

Abstract 1. 1. Oxytocin isolated from the posterior pituitary gland free of any detectable amount of vasopressin and by available physical and chemical criteria essentially a pure chemical compound has milk-ejection activity in recently parturient women who have milk in their breasts. 2. 2. A synthetic octapeptide amide, in so far as has been tested, indistinguishable from naturally occurring oxytocin in other properties, has milk-ejection activity in similar puerperal women indistinguishable from the naturally occurring oxytocin, thus affording conclusive proof that oxytocin has both oxytocic and milk-ejection activities inherent in its molecular structure. 3. 3. Milk ejection occurs consistently in these women when approximately 0.5 unit of oxytocin is administered intravenously, or when 2 units of oxytocin are administered intramuscularly.

Retinal changes in the toxemias of pregnancy. I. History, vomiting of pregnancy, mild and severe pre-eclampsia, and eclampsia.

Abstract The etiological factors responsible for the toxemias of pregnancy have not been revealed despite extensive researches during the past century. Most workers in this problem agree that the maternal vascular bed is extensively involved in this condition. Because of these changes, either gradual or sudden, in the arteriolar system, many of the symptoms and findings of toxemia make their appearance. The vessels may be readily observed by direct visualization of the fundi oculi. Since the New York Lying-In Hospital opened at its present location in 1932, a careful examination of the retinal vascular findings in all patients with toxemia has been recorded. This was possible because of close collaboration between the departments of Obstetrics and Ophthalmology. The purpose of this communication is to review these observations and correlate them with the other findings in the toxemias. Some of the more pertinent reports concerning retinal abnormalities in the toxemias, present standards for retinal changes, and the classification of the toxemias will be briefly reviewed. It is hoped that certain refinements in the management of the toxemias may result following the evaluation of these data.

Bacteriologic findings in the uterus during labor and the early puerperium

Abstract The bacteriologic findings in the uterine lochia in 171 consecutive uterine cultures is described. The patients were divided into four groups: Group 1: 37 patients who had afebrile puerperia or had low grade fevers, the temperature never exceeding 37.8° C. Group 2: 47 patients with spontaneous deliveries and no repair. Group 3: 42 patients with spontaneous deliveries who also had a perineal repair. Group 4: 45 patients who had operative deliveries with or without repair. In each of the last three groups the temperature reached 38° C. on one or more occasions, not including the first twenty-four hours postpartum. In each of the four groups it was noted that anaerobic streptococci were the most frequent organisms found. Anaerobic gas bacilli were recovered only in patients who had operative deliveries. The colon bacillus was found in the uterine lochia more frequently in patients with operative deliveries than in those with spontaneous deliveries. In the latter instance it is often associated with the same finding in the bladder urine. Staphylococcus aureus was recovered in only one uterine culture in the entire series. Staphylococcus albus was recovered eight times. A group of organisms is classified as anaerobic, gram-negative bacilli. They vary considerably morphologically but were not isolated in pure culture. They grew better in liquid media, and were very difficult to grow anaerobically on the surface of rabbit blood agar. No growth was obtained under aerobic conditions. Some members of this group resemble morphologically the Actinomyces pseudonecrophorus described by Harris and Brown. 7

The Common Cold — Relief at Last?

So far, common colds have not yielded to advances in modern science. Nothing we do seems to prevent their regular occurrence or alleviate the annoying symptoms — and we try hard. The 1985 over-the-...