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
=Relation of Lobar Pneumonia to Influenza.=—Some writers have suggested
that lobar pneumonia, heretofore observed during the course of epidemics
of influenza, is an independent disease with no relation to influenza,
both diseases being referable perhaps to similar meteorologic or other
conditions. Chart 2, which shows by weeks from September 1 to October 31
the relation of deaths from lobar pneumonia (indicated by double hatch)
to deaths from all forms of pneumonia, disproves this suggestion. The
two curves follow parallel courses; that representing lobar pneumonia
reaches a maximum approximately one week after the outbreak of influenza
had reached its height. Lobar pneumonia, like other forms of pneumonia,
was secondary to influenza. When a chart is plotted to represent the
dates of onset of fatal cases of lobar pneumonia (indicated by single
hatch in Chart 2), it becomes evident that the greatest number of these
cases of pneumonia had their onset at the beginning of the influenza
epidemic, approximately one week before it reached its height. Fatal
lobar pneumonia developed less frequently in the latter part of the
epidemic; to obtain an explanation of this relation it is necessary to
chart separately cases of lobar pneumonia with secondary streptococcus
infection, for we have already learned that streptococcus infection was
the predominant cause of death in the early period of the influenza
epidemic. Exclusion of these instances of secondary streptococcus
infection makes no noteworthy change in the character of the chart.
Fatal lobar pneumonia, like all forms of fatal pneumonia (p. 140), was
more frequent in the first half than in the second half of the epidemic.
This difference is referable either to greater virulence of the virus of
influenza or to the greater susceptibility of those first selected by
the disease or, as more probable, to conditions such as crowding
together of patients with influenza, favoring the transmission of
microorganisms which cause pneumonia.
Bronchopneumonia
For the purpose of the present study it is convenient to group together
instances of bronchopneumonia which have been unaccompanied, on the one
hand, by lobar pneumonia (p. 155) or, on the other hand, by suppuration,
which with few exceptions is caused by hemolytic streptococci or by
staphylococci. A group of cases in which lobar and bronchopneumonia have
occurred in the same individual have already been considered. In many
instances, bronchopneumonia is accompanied by abscess formation or by
some other form of suppuration; these lesions will be discussed
elsewhere.
Bronchopneumonia unaccompanied by lobar pneumonia or by suppuration
occurred in 80 autopsies.
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