Proceedings of conference on rheumatic fever : Washington, D.C., October 5-7, 1943.

  • Conference on Rheumatic Fever (1943 : Washington, D.C.)
Date:
1945
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Licence: Public Domain Mark

Credit: Proceedings of conference on rheumatic fever : Washington, D.C., October 5-7, 1943. Source: Wellcome Collection.

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    By using common sense and by making sure that no known contaminants are added to the general air space, I think one can be reasonably safe in caring for rheumatics in institutions. . I should just like to say in closing that while I am firmly convinced of the close association of streptococcal infections and rheumatic fever, I feel very strongly that they follow epidemic patterns, rheumatic fever being associated with streptococcal epidemics. We had one very discouraging, but also possibly enlightening, experience this spring. We have a good many children who have heart failure, some of whom have been sick from 1 to 3 years. At the begin- ning of March, five or six such children simultaneously got worse. There was no change in the throat flora of any of these children or of the hospital person- nel at any time; there was no immunological change in any of these children or of the hospital personnel at any time. ‘There were no temperature rises. Yet they all had a definite, real increase in heart failure and one died. Simultaneously with that, two children in a radiated ward who had no streptococci or throat infections developed large livers. In addition to that three or four children developed signs of typical chorea. As far as I am aware, that is the first time in 3 years such a thing has happened. We have had children that waxed and waned but never simultaneously in these three types of manifestation. Nevertheless, the best I can say is that although pro- tecting patients from streptococcal infections is of major importance, there may be additional unknown factors. Dr. Jackson. Dr. Hollaender, I believe you have had some special experience with ultraviolet irradiation. Dr. Ho.iaenper. I am very sorry to say that many installations that have been put in children’s hospitals are very inadequate. Ultraviolet irradiation is not a substitute for cleanliness. I think one should pay very much attention to the control of dust and lint, and only then to ultraviolet irradiation. Exposing one-third of the room to irradiation may not be sufficient. We now recommend irradiation of the floor in children’s wards or hospitals. We feel that ultraviolet radiation can be used successfully in fixtures that can be placed on the under side of beds and the amount of irradiation can be increased sufficiently to reduce considerably the microorganisms attached to dust and lint. Upper-air irradiation alone may not be enough. One result of irradiation in many children’s hospitals in which children are exposed to excessive amounts of ultraviolet is tanning of their foreheads and conjunctivitis. We found that frequently no measurements had been made of the amount of ultraviolet irradiation children were exposed to, in spite of the fact that there are definite rules for the amount of irradiation that can be safely used. If ultraviolet lamps are to be installed in any children’s hospital or in chil- dren’s wards, it is extremely important to make a careful survey of the air currents, dust control, and the proper amount of ultraviolet that would be necessary to control bacteria. In regard to the glycol studies that have been going on, it had been reported that glycol is not effective in killing micro- organisms in dust and lint. It will kill only free, floating microorganisms. Floor dust and lint have to be mixed with chemicals that are more effective in killing microorganisms. Returning to the value of irradiation, I should like to recommend that persons planning installations get in touch with people who have experience with them. Otherwise there may be harmful results. Dr. Jackson. Would anyone else like to make a comment on bacterial con- trol in institutions? If not, we shall recess for a few minutes. [Short recess. ]