Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
For most of these autopsies there is a record of the date of onset of
the illness, namely, influenza, which finally resulted in pneumonia and
death. Comparison of the number of cases of influenza which developed on
any day with the number of fatal cases which had their onset on the same
day will determine the mortality of influenza at different periods of
the epidemic. Chart 1 shows the number of cases of influenza which had
their onset on each day from September 1 to October 31 and the number of
fatal cases with autopsy which had their origin on corresponding days.
The comparison by weeks between autopsies and total number of deaths
shows that the autopsies represent with considerable accuracy the
deaths. If there is any error it occurs at the height of the outbreak of
pneumonia from September 29th to October 5th and not at its beginning,
or end. The chart shows that the highest mortality occurred among cases
of influenza which had their origin at the beginning of the epidemic
from September 21 to October 1, whereas after October 1, though the
maximum number of cases of influenza occurred on October 3, very few
developed fatal pneumonia.
=Mortality from Pneumococcus and Streptococcus Pneumonias.=—By referring
fatal cases of streptococcus pneumonia back to their date of origin it
is possible to determine what proportion of the cases of influenza,
which developed on any day, died with infection by hemolytic
streptococcus. The accompanying chart (Chart 1) shows that infection
with hemolytic streptococci has been very frequent at the beginning of
the epidemic of influenza (shown by area with double hatch in chart)
that is, from September 20 to 30 and subsequently has gradually
diminished so that few cases have had their onset in the second half of
the epidemic from September 30 to October 15.
Pneumococcus pneumonia uncomplicated by streptococcus infection (shown
by area with single hatch in chart) pursued a course which more closely
conformed to the curve representing influenza. The cases of influenza
which resulted fatally bore a fairly constant ratio to the total number
of cases of influenza from the onset of the epidemic until October 1,
but subsequently few cases of influenza developed fatal pneumococcus
pneumonia.
These charts arranged with reference to the onset of fatal pneumonias
dissociate very clearly the outbreak of streptococcus pneumonia, which
reached its height at the beginning of the influenza epidemic, from the
uncomplicated pneumococcus pneumonia which reached its maximum at the
midpart of the influenza epidemic and then abruptly abated.
[Illustration:
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