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
The pulse was relatively slow in rate as compared with the degree of
temperature elevation, running between 90 and 100 beats per minute in
the large majority of cases. At the height of the disease it was full
and easily compressed. No irregularities were noticed. With recovery it
fell promptly to normal. The respiratory rate showed only moderate
elevation, being between 20 and 26 in most cases. In a few instances a
rate as high as 32 was recorded at time of admission to the hospital,
but this promptly fell with rest in bed. A respiratory rate rising above
26 after the third or fourth day of the disease nearly always indicated
a beginning pneumonia. With recovery the rate promptly fell to normal.
Cyanosis did not occur in the absence of pneumonia.
Aside from the manifestations of a profound toxemia, influenza was
preeminently characterized by symptoms of respiratory tract infection.
The appearance of respiratory symptoms occurred at varying intervals
after the onset of the disease, being well developed by the end of
twenty-four hours in most cases. A progressive attack upon the mucous
membranes of the respiratory tract was universal, beginning with coryza
and pharyngitis and progressing to tracheitis or _vice versa_. Further
extension of the infection to the bronchi, however, was by no means
universal, 49 cases in the group studied recovering without developing
evidence of bronchitis. Sore throat was rarely complained of, and
laryngitis, possibly due to secondary infection, occurred only once. The
progress of the infection was marked subjectively by sensations of
irritation, stinging, and a feeling of tightness. A profuse, thin,
mucoid exudate appeared; the pharyngeal walls and the soft palate showed
a characteristic deep red granular appearance. The onset of tracheitis
began with a sense of burning and tightness beneath the sternum
accompanied by a harassing cough, at first nonproductive, later with the
outpouring of an exudate becoming productive. The sputum varied in
character between a scanty, thin, mucoid sputum and a profuse, frankly
purulent sputum in cases subsequently developing an extensive
bronchitis. Hemorrhage from the mucous membranes was common. Epistaxis
occurred in 12 per cent of the cases and was often profuse. The sputum
contained fresh blood in varying amounts in 24 per cent of the cases; 51
per cent of the cases developed signs of bronchitis. In 15 of these the
bronchitis was mild, probably limited to the larger bronchi, physical
examination showing only inconstant sibilant and musical râles. The
sputum in these cases was neither profuse nor frankly purulent; 36 cases
developed a fairly extensive purulent bronchitis as manifested by more
or less diffusely scattered moist râles and by moderately copious
mucopurulent or frankly purulent sputum. This bronchitis was not
accompanied by an increase in the respiratory rate or by cyanosis unless
pneumonia subsequently developed.
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