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Smoke-control Areas
1165 TABLE LI-SENSITIVITY TO
I
I
ANTIBIOTICS
AND
PHAGE-TYPE OF STRAINS OF INFLL‘F1VZA PNEUMONIA
Staph.
CL2G9’82CS ISOLATED
FRO:ll
CASES
OF
I
1. In 6 cases two strains were 2. P. S, C, A, T, E, penicillin,
isolated. streptomycin, chloramphenicol, aureomycin (chlortetracycline), terramycin (oxytetracycline), erythromycin. 3. 44B, phage adapted by us from phage 44, which has some local importance. 4. );"0. 80, 42E, strains typable by one or combinations of the phages mentioned, No being a phage adapted by us from phage 42E, closely related to phage 80 but not quite the same. 5. yg, non-specific pattern. d. "T, non-typable by routine-phage-dilution ; not yet typed by concentrated phages.
haemolytic streptococci, pneumococci, and Haemophilu. influenza are rarely isolated. In the young age-groups many of the cases compli cated by infection with staphylococci ran a fulminan1 fatal course, with rapidly supervening shock fron toxaemia. and Sensitivity to Antibiotics of Staph. aureica Table 11 shows the results obtained. The reason why the number of antibiotic-resistant strains was greater in the fatal than in the non-fatal cases is not yet known. Perhaps many of the fatal cases had not received adequate antibiotic treatment, or perhaps treatment with antibiotics other than penicillin may be less effective in severe cases. One must remember also that superinfection with a resistant staphylococcal hospital strain is also possible in staphylococcal influenzal pneumonia. Relation of Staphylococcal Influenzal Pneumonia and Staphylococcal Skin Lesions We traced staphylococcal skin lesions either in the patient or in one or more members of his family in 19 cases by phage-typing. This type of investigation is not easy when one has to examine the patient’s relations and friends. Sometimes a small staphylococcal skin lesion had not been noticed by the patient or by a relation or had been considered of no importance. Such a finding is of great practical importance because it may reveal danger to the influenza patient. Influenzal Death in Mitral Stenosis In 252 necropsies there were 10 cases of mitral stenosis and we have been informed of another 6 fatal cases. Many case-reports gave the same description of a severely ill dyspnceic patient, with abundant h2emorrhagic nonpurulent sputum, deteriorating despite antibiotic treatment. From 9 cases Asiatic virus was isolated from the lung, bacteriological culture being negative. Macroscopically the lung resembled that of influenza-virus pneumonia in mice and ferrets. Both patients 2 cases were studied in our hospital. survived. We got the impression from the clinical symptoms and radiography of the lungs that there was no acute congestion of the lungs (with haemodynamic cedema). Radiologically, focal bilateral consolidations of both lungs were seen. Asiatic virus was isolated from the ha-morrhagic sputum, which was bacteriologically sterile. In such cases it is possible that true virus lesions are present in the lungs, but the association with mitral stenosis and chronic pulmonarv congestion remains studies of the unexplained. Careful lung tissue may shed light on this problem. So far we have found in two cases capillary necrosis and thrombosis in the lung tissue. hdhogenecity of Asiatic Influenza Virus Isolated from DUty Tissue for 1’twice V-eisolated 6 strains of Asiatic influenza virus by JIloculating emulsion of lung tissue directly into mice. In
Phage-types
"
histopathological
"
case did fatal virus pneumonia develop in the mice before the 4th passage. One of the mouse-lung adapted strains was cross-tested, after 22 passages, in the haemagglutination-inhibition test with the strain A-Singapore 1/57 (egg line) and A-Asia-Japan 305/57 (which has undergone 3 ferret and 6 mouse passages) and did not show any deviation in antigenic composition, all three strains being identical. The M.L.D. for mice of this strain is 10-3.5 of a 10% emulsion of infective lung tissue, which is not very high. no
We
are
indebted to all morbid
lands for their cooperation.
pathologists
in the Nether-
REFERENCE
Hers, J. F. Ph., Mulder, J. (1951) J. Path. Bact. 63, 329.
Smoke-control Areas The Minister of Housing and Local Government has confirmed five orders for the creation of smoke-control areas under the Clean Air Act, 1956. They are orders made by Bolton, Denton (Lanes), Hayes and Harlington (Middlesex), Ossett (Yorks), and West Bromwich ; they cover a total area of 380 acres and include 920 buildings. The only other order which has been confirmed under the Clean Air Act dealt with the city centre of Liverpool. All the orders come into operation next year. With the exception of the West Bromwich Order, no objections to any of these orders were received. In the case of West Bromwich, whose order covers 25 acres in the town centre and affects 250 buildings, objections were received from householders and were later heard at a public inquiry. The principal objections were : (a) that smoke nuisance from industries and the railways should be reduced before householders were required to burn smokeless fuel ; (b) that coke fumes in houses suffering from downdraught were dangerous to health ; and (c) that the cost of replacing or adapting fireplaces to burn smokeless fuels would cause financial incomes.
hardship
to
persons
on
small fixed
In announcing his decision, the Minister states that, as West Bromwich suffers from substantial smoke pollution to which domestic chimneys are as much a contributory cause as industrial chimneys, he must take the view that the Corporation are entitled to use the powers conferred on them by Parliament to declare smoke-control areas. Dark smoke emitted from industry and the railway will be reduced when the remaining provisions of the Clean Air Act come into operation, and the replacement of steam by diesel trains has already started on the railway-line adjacent to the area. On the question of coke fumes the Minister states that there is no question of these being more harmful than those from coal ; they are virtually the same. As for downdraught, the burning of coke will not increase this and may even improve it because of the higher temperature of the combustion gases. The trouble can often be remedied by the use of fires or stoves with restricted throats. Finally, the Minister points out that the cost of adapting and replacing fireplaces to burn coke ranks for a grant of not less than 70%, and that the Corporation have undertaken to consider sympathetically the payment of more than
70%
in
special
cases.
I
I
ANTIBIOTICS
AND
PHAGE-TYPE OF STRAINS OF INFLL‘F1VZA PNEUMONIA
Staph.
CL2G9’82CS ISOLATED
FRO:ll
CASES
OF
I
1. In 6 cases two strains were 2. P. S, C, A, T, E, penicillin,
isolated. streptomycin, chloramphenicol, aureomycin (chlortetracycline), terramycin (oxytetracycline), erythromycin. 3. 44B, phage adapted by us from phage 44, which has some local importance. 4. );"0. 80, 42E, strains typable by one or combinations of the phages mentioned, No being a phage adapted by us from phage 42E, closely related to phage 80 but not quite the same. 5. yg, non-specific pattern. d. "T, non-typable by routine-phage-dilution ; not yet typed by concentrated phages.
haemolytic streptococci, pneumococci, and Haemophilu. influenza are rarely isolated. In the young age-groups many of the cases compli cated by infection with staphylococci ran a fulminan1 fatal course, with rapidly supervening shock fron toxaemia. and Sensitivity to Antibiotics of Staph. aureica Table 11 shows the results obtained. The reason why the number of antibiotic-resistant strains was greater in the fatal than in the non-fatal cases is not yet known. Perhaps many of the fatal cases had not received adequate antibiotic treatment, or perhaps treatment with antibiotics other than penicillin may be less effective in severe cases. One must remember also that superinfection with a resistant staphylococcal hospital strain is also possible in staphylococcal influenzal pneumonia. Relation of Staphylococcal Influenzal Pneumonia and Staphylococcal Skin Lesions We traced staphylococcal skin lesions either in the patient or in one or more members of his family in 19 cases by phage-typing. This type of investigation is not easy when one has to examine the patient’s relations and friends. Sometimes a small staphylococcal skin lesion had not been noticed by the patient or by a relation or had been considered of no importance. Such a finding is of great practical importance because it may reveal danger to the influenza patient. Influenzal Death in Mitral Stenosis In 252 necropsies there were 10 cases of mitral stenosis and we have been informed of another 6 fatal cases. Many case-reports gave the same description of a severely ill dyspnceic patient, with abundant h2emorrhagic nonpurulent sputum, deteriorating despite antibiotic treatment. From 9 cases Asiatic virus was isolated from the lung, bacteriological culture being negative. Macroscopically the lung resembled that of influenza-virus pneumonia in mice and ferrets. Both patients 2 cases were studied in our hospital. survived. We got the impression from the clinical symptoms and radiography of the lungs that there was no acute congestion of the lungs (with haemodynamic cedema). Radiologically, focal bilateral consolidations of both lungs were seen. Asiatic virus was isolated from the ha-morrhagic sputum, which was bacteriologically sterile. In such cases it is possible that true virus lesions are present in the lungs, but the association with mitral stenosis and chronic pulmonarv congestion remains studies of the unexplained. Careful lung tissue may shed light on this problem. So far we have found in two cases capillary necrosis and thrombosis in the lung tissue. hdhogenecity of Asiatic Influenza Virus Isolated from DUty Tissue for 1’twice V-eisolated 6 strains of Asiatic influenza virus by JIloculating emulsion of lung tissue directly into mice. In
Phage-types
"
histopathological
"
case did fatal virus pneumonia develop in the mice before the 4th passage. One of the mouse-lung adapted strains was cross-tested, after 22 passages, in the haemagglutination-inhibition test with the strain A-Singapore 1/57 (egg line) and A-Asia-Japan 305/57 (which has undergone 3 ferret and 6 mouse passages) and did not show any deviation in antigenic composition, all three strains being identical. The M.L.D. for mice of this strain is 10-3.5 of a 10% emulsion of infective lung tissue, which is not very high. no
We
are
indebted to all morbid
lands for their cooperation.
pathologists
in the Nether-
REFERENCE
Hers, J. F. Ph., Mulder, J. (1951) J. Path. Bact. 63, 329.
Smoke-control Areas The Minister of Housing and Local Government has confirmed five orders for the creation of smoke-control areas under the Clean Air Act, 1956. They are orders made by Bolton, Denton (Lanes), Hayes and Harlington (Middlesex), Ossett (Yorks), and West Bromwich ; they cover a total area of 380 acres and include 920 buildings. The only other order which has been confirmed under the Clean Air Act dealt with the city centre of Liverpool. All the orders come into operation next year. With the exception of the West Bromwich Order, no objections to any of these orders were received. In the case of West Bromwich, whose order covers 25 acres in the town centre and affects 250 buildings, objections were received from householders and were later heard at a public inquiry. The principal objections were : (a) that smoke nuisance from industries and the railways should be reduced before householders were required to burn smokeless fuel ; (b) that coke fumes in houses suffering from downdraught were dangerous to health ; and (c) that the cost of replacing or adapting fireplaces to burn smokeless fuels would cause financial incomes.
hardship
to
persons
on
small fixed
In announcing his decision, the Minister states that, as West Bromwich suffers from substantial smoke pollution to which domestic chimneys are as much a contributory cause as industrial chimneys, he must take the view that the Corporation are entitled to use the powers conferred on them by Parliament to declare smoke-control areas. Dark smoke emitted from industry and the railway will be reduced when the remaining provisions of the Clean Air Act come into operation, and the replacement of steam by diesel trains has already started on the railway-line adjacent to the area. On the question of coke fumes the Minister states that there is no question of these being more harmful than those from coal ; they are virtually the same. As for downdraught, the burning of coke will not increase this and may even improve it because of the higher temperature of the combustion gases. The trouble can often be remedied by the use of fires or stoves with restricted throats. Finally, the Minister points out that the cost of adapting and replacing fireplaces to burn coke ranks for a grant of not less than 70%, and that the Corporation have undertaken to consider sympathetically the payment of more than
70%
in
special
cases.