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12
Written instructions were issued to the District Nurses for
their guidance in going in and out amongst patients. The
medical practitioners of the District were communicatid with,
and invited to send sputum for bacteriological examination to
my laboratory at King's College, London,
Clinically and bacteriologically the Harrow cases were
identical with cases which I had the privilege of studying
elsewhere in Surrey and Kent. From the middle of October
till the end of December I investigated bacteriologically 55
cases. In every case a mixed infection was found—a combination
of two or more of the following four organisms:
Frankel's pneumococcus,
A streptococcus,
Pfeiffer's bacillus,
M. catarrhalis.
The sputa were all taken after the third day of the disease.
Frankel's organism (the Gram-positive diplococcus responding
to the carbohydrate fermentation tests generally
received as characteristic of it) was isolated in 28 cases; the
streptococcus in 10 cases; Pfeiffer's bacillus in 20 cases; and
M. Catarrhalis in 18 cases.
In ten fatal cases investigated the dominant organism in
the sputum was either Frankel's diplococcus or the streptococcus.
In one of these cases pus aspirated from the pleural
cavity contained this streptococcus in pure culture. It
clots milk, ferments saccharose, lactose, and raffinose; and is
pathogenic to mice, Probably it is a modification of
Frankel's diplococcus.
Clinically the Disease presents a diminution of arterial
tension with a pulse irregular and variable in amplitude;
weakening of first sound of heart; early cyanosis of nails and
fingers and in fatal cases of whole body; enlargement of
spleen and occasionally of liver; delirium when temperature
is high frequently persisting and increasing when temperature
falls ; irritability combined with mental torpor; increasing
difficulty in the coordination of ideas occompanied by sadness,
fits of tears, and forebodings of death. Persistent sleeplessness
cocurs in many cases.