Book Description

Epidemic Influenza –Detailed Clinical and Laboratory Investigations Original Authors : Members of the Faculty of the School of Medicine UNIVERSITY OF PITTSBURGH Edited/Added and Translated By : M. Meenachi Sundaram TABLE OF CONTENTS Epidemic Influenza –Detailed Clinical and Laboratory Investigations. 2 Epidemic Influenza –Detailed Clinical and Laboratory Investigations. 9 PREFACE.. 9 HISTORY AND EPIDEMIOLOGY OF INFLUENZA.. 13 The Epidemic in Universities and Colleges. 27 1918 Epidemic at Pittsburgh. 30 Epidemic Incidents in Institutions and Towns of Western Pennsylvania. 33 Summary. 35 A CLINICAL DESCRIPTION OF INFLUENZA AS IT APPEARED IN THE EPIDEMIC OF 1918–1919 39 Prodromal Stage and Communicability. 41 Duration of the Disease. 43 Forms and Varieties of Influenza. 44 Influenza Without Lung Involvement 45 The Pulse and Respirations. 47 Cyanosis. 48 Leucopenia. 50 Asthenia. 51 Influenza with Lung Involvement 51 Diagnosis of Influenzal Pneumonia. 59 Complications. 61 Pregnancy. 65 Sequelæ... 68 Prognosis and Mortality of Influenza. 71 THE URINE AND BLOOD IN EPIDEMIC INFLUENZA.. 74 TABLE I: URINE ANALYSIS IN CASES OF UNCOMPLICATED INFLUENZA AT THE MERCY HOSPITAL. 75 TABLE II: URINE ANALYSIS IN CASES OF UNCOMPLICATED INFLUENZA AT THE MAGEE HOSPITAL. 76 TABLE III: URINE ANALYSIS IN CASES OF PNEUMONIA (INFLUENZAL) AT THE MERCY HOSPITAL. 77 TABLE IV: URINE ANALYSIS IN CASES OF PNEUMONIA (INFLUENZAL) AT THE MAGEE HOSPITAL. 79 Hematology. 82 TABLE V.. 84 Conclusions. 91 THE TREATMENT OF INFLUENZA.. 92 Acute Influenza. 94 Pneumonia. 97 Complications. 104 THE PREVENTION OF EPIDEMIC INFLUENZA WITH SPECIAL REFERENCE TO VACCINE PROPHYLAXIS.. 110 INTRODUCTION.. 110 History of Prophylactic Vaccination in General 111 Prophylactic Vaccination Against Influenza. 115 The Attempt to Develop a Specific Prophylactic Vaccine by the Use of Pure Pfeiffer Strains 117 Author’s Vaccine. 123 Method of Standardization. 124 Conclusion. 126 The Attempt to Protect Against Epidemic Influenza by the Use of Mixed Vaccines. 127 Data on the Prophylactic Value of Mixed Vaccines. 131 Series I. Those Instances in Which Vaccination Was Completed Before the Epidemic Appeared 134 Series II. Those Instances in Which It Is Possible to Compare the Relative Occurrence in Both Vaccinated and Unvaccinated Groups After Vaccination Was Completed. 137 Series III. Those Instances in Which Vaccination Was Begun After the Epidemic Appeared, and in Which Comparisons of Total Figures Only Are Available. 139 The Attempt to Prevent Pneumonia as a Complication of Influenza Through the Use of Lipovaccine 150 Summary. 153 Conclusions. 153 Part II. General Prophylactic Measures. 154 Methods Proposed for Breaking the Channels of Communication. 156 Partial Isolation by Means of the Cubicle System.. 158 The Use of the Face Mask. 159 General Closing Orders. 162 The Closing of Schools. 163 The Closing of Public Dance Halls. 165 Regulation of Public Eating and Drinking Places. 165 Regulation of Traffic. 166 Enforcement of Anti-Spitting Ordinances. 167 Increasing Natural Resistance by Augmented Healthfulness. 169 General Measures. 170 Public Health Administration. 170 Desirable Laws. 171 Education of the Public. 172 Summary. 173 BIBLIOGRAPHY.. 174 PHYSIOLOGICAL AND PHYSIOLOGICAL CHEMICAL OBSERVATIONS IN EPIDEMIC INFLUENZA 177 Results. 178 Circulation. 178 Respiration. 178 Blood. 178 Comment 184 THE BACTERIOLOGY OF EPIDEMIC INFLUENZA WITH A DISCUSSION OF B. INFLUENZÆ AS THE CAUSE OF THIS AND OTHER INFECTIVE PROCESSES.. 184 Introduction. 184 General Methods of Investigation. 185 Material Studied. 187 Technique. 187 TABLE I: BACTERIOLOGY OF THIRTY-TWO AUTOPSIES FROM INFLUENZA CASES. 188 EXPLANATORY NOTE. 216 Results of the Author 217 TABLE II: BACTERIA SEEN IN DIRECT SMEARS FROM NASOPHARYNX.. 220 Direct Smears from Nasopharyngeal Swabs. 220 TABLE III: AGGLUTINATION TESTS WITH SERA OF CONVALESCENT INFLUENZA PATIENTS 221 Media in Growth of B. Influenzæ... 228 B. Influenzæ as a Pathogenic Bacterium.. 233 Infections of the Respiratory Tract 236 Results of Others During the Recent Pandemic. 239 Chronic Infections. 244 Infections of the Pleura. 245 Sinuses of the Head. 245 Eye and Ear 246 Meninges. 247 Invasion of the Blood Stream.. 247 Endocarditis. 249 Immunity—Phagocytosis. 250 Agglutination. 250 Binding of Complement 251 Anaphylaxis. 252 Experiments on the Human. 252 Conclusions. 253 BIBLIOGRAPHY.. 255 THE PATHOLOGY OF EPIDEMIC INFLUENZA.. 264 Materials. 267 General External Features. 271 Muscle. 275 Upper Respiratory Tract 282 Bronchi 287 TABLE V: BRONCHITIS AND TRACHEITIS.. 288 TABLE VI: EXTENT AND DISTRIBUTION OF PNEUMONIA. 291 Lung—Early Stage. 297 TABLE VIII: Distribution of Pneumonic Lesions and Grades of Severity. 305 Lung—Secondary Stage. 314 Lung—Stage of Resolution. 326 Pleura. 331 Heart 333 Arteries. 337 Lymphatics of Lung and Mediastinum.. 342 Abdominal Viscera. 346 OBSERVATIONS UPON THE PATHOLOGY OF EIGHTEEN CASES OF INFLUENZA 354 Summary. 358 BIBLIOGRAPHY.. 362 EXPLANATION OF PLATES.. 363 ABOUT THE AUTHOR.. 378 Epidemic Influenza –Detailed Clinical and Laboratory Investigations PREFACE This report is based upon a series of investigations carried on during the epidemic of influenza at Pittsburgh. This epidemic reached Pittsburgh about the last week of September, 1918, rapidly spreading through the community during the first days of October. Pittsburgh had been warned of its coming through the experience of Boston, where the epidemic made its appearance during the late days of August. To a certain extent the warning from the East permitted the making of preparations to control its ravages. But even with the attempt for the protection of public health the epidemic advanced with all its virulence, rapidly picking out the susceptible individuals and leading to a high death rate. At the time of the coming of the epidemic there were stationed at Pittsburgh two military camps, comprising about 7,000 men. It was with the presence of the disease among these men that our investigations were chiefly concerned. The men at their respective camps (on the campus of the University of Pittsburgh and at the Carnegie School of Technology) were housed in barracks which had been erected only a short time previously. These barracks contained large dormitories, in which the individuals freely mingled with each other. In them there was no opportunity of complete isolation, and by this means of housing good opportunity was available for the propagation of any communicable infectious disease. The ordinary sanitary arrangements for these groups were well provided. The first cases of recognized influenza made their appearance on October 2. On this day two men were found with the disease and were isolated. On the following day there were four, and on the third day eight. It was soon recognized that the increasing number of the infected cases was growing so rapidly that definite arrangements for their segregation and care had to be undertaken. This was provided for on October 4, when the Elizabeth Steel Magee Hospital was in part taken over by the military authorities and wards were rapidly adapted for the coming epidemic. For the foresight in making the adequate arrangements for its control and management we shall always remain indebted to Major E. W. Day. His 6indefatigable work in the early days of the epidemic will always be remembered, and the fact that the epidemic was kept within reasonable bounds of control was the result of his stringent quarantine regulations along with the organization of his medical forces. Working under his direction, Capt. H. H. Hendershott undertook the management of the hospital and rendered most efficient service. The capacity of the hospital was soon overburdened, so that from a normal 150–bed institution it was on the sixth day of its conversion into an emergency hospital carrying more than 300 cases of influenza. This hospital in itself was unable to accommodate all of the cases falling ill, and provision for these had to be made in some of the municipal institutions. On October 5, 1918, the Medical School of the University of Pittsburgh undertook to provide the laboratory facilities for the emergency Military Hospital. It was at first intended to equip only those laboratory departments which were deemed essential for the clinical care of the patients in the wards. Inasmuch, however, as the epidemic of influenza was spreading with alarming rapidity throughout the city, it was deemed advisable to close the Medical School and to place at the disposal of the Military Hospital all the laboratory facilities which could in any way be of use in the care and study of the influenza patients. This permitted the establishment of departments in pathology, bacteriology, physiology, physiological-chemistry and clinical microscopy. The following workers partook in the investigations which were here carried out: Dr. Oskar Klotz, director of laboratories; physiology, Dr. C. C. Guthrie (chief), Dr. A. Rhode, Dr. M. Menten, Mrs. C. C. Macklin, Miss S. Waddell and Miss M. Lee; bacteriology, Dr. W. L. Holman (chief), Miss A. Thorton, Miss C. Prudent and Miss R. Jackson; pathology, Dr. Oskar Klotz (chief), Mr. A. D. Frost, Mr. J. L. Scott and Miss A. Totten; clinical microscopy, Miss R. Thompson, Mr. M. Marshall and Mr. H. Mock; records, Miss H. Turpin. Intensive work was undertaken by each over a period of about five weeks, when the epidemic was again on the road to disappearance and few new cases were being admitted. These laboratories discontinued their work at the Military Hospital on November 9. The clinical observations which are contained in this report were made at the Mercy Hospital. This institution set aside upward of 100 beds for the care of the overflow which could not 7be accommodated at the Military Hospital. It is unfortunate that the clinical observations and the laboratory findings contained in this report were not made upon the same cases. With the number of cases suddenly thrust upon the medical staff of the army, it was not possible for them to devote detailed attention to clinical investigation. Furthermore, during the progress of the epidemic these medical officers were transferred to new posts, so that it was impossible to obtain a summary of the clinical findings at the Military Hospital by any of the officers who had but recently been detailed to the work.