Intrafamilial contagion in chronic sino-respiratory infections.

The problem of chronic sino-respiratory infections which includes sinusitis, bronchitis, bronchiectasis and infective asthma is of great magnitude. Although these illnesses do not immediately endanger the life of the patient they seriously affect the health of many individuals. I t is estimated that approximately 2,000,000 people in this country suffer from chronic bronchitis and 1,250,000 from sinusitis.l With asthma due to infection included, approximately 3,000,000 to 4,000,000 are sufferers of chronic broncho-pulmonary disease. Bronchitis alone is responsible for the largest average absenteeism in industry and exceeds the common cold in terms of time lost from productive work.2 For the past eight years the author has concerned himself with the problem of infection in the respiratory tract, in view of the frequency of these infections in allergic patient^.^ At first, attention was paid to the use of antibiotics in combating infection; preferably this was administered in aerosol form to achieve maximum concentration within the respiratory tract, although secondary absorption and systemic action could be demonstrated with penicillin and streptomycin. A method of administering long-lasting aerosols, utilizing open and closed methods of treatment, and a tent and closed chamber (bathroom) for treatments of infants and children, was developed.' Subsequently, to achieve more specific therapy with the antibiotics, bacteriologic methods were introduced which included the use of cultures, and the performance of in vitro inhibition tests.= This unquestionably improved the results of the treatment. Nevertheless, it soon became apparent that the problem was not the control of specific incidents of infection but how to prevent the recurrence of infection, since this seemed to be inevitable in most patients. At times it was noted that despite adequate therapy with specifically-selected antibiotics, cultures taken revealed the presence of the. offending organisms in the respiratory tract. This was particularly true for the hemolytic staphylococcus and some strains of streptococci. In others it was noted that these organisms were apparently eliminated as a result of therapy, only to be isolated again with a recurring infection. Then again, when several members of a family were treated simultaneously, and cultures were taken from them, it was frequently noted that there was a commonality of potentially pathogenic organisms. Attention was, therefore, focused on contagion as an important