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
A similar divergence of opinion prevails with respect to the
bacteriology of influenza. There is fairly general agreement that the
members of the pneumococcus and streptococcus groups and to a less
extent other organisms are responsible for a large proportion of the
secondary pneumonias, and but few observers hold that they possess any
etiologic relationship to influenza. No such uniformity of opinion
exists, however, with respect to the relation of B. influenzæ to
influenza and to the complicating pneumonia. By some it is considered
the primary cause of influenza, by others it is regarded as a secondary
invader responsible for a certain proportion of the secondary
pneumonias, and by still others it is not considered to bear any
relation either to influenza or its complications.
A limited number of references to the extensive literature of the recent
pandemic will amply serve to illustrate the various points of view that
have developed.
Keegan[32] regards pneumonia as a complication and considers that B.
influenzæ, the probable cause of influenza, is the primary cause of the
pneumonia which may or may not be still further complicated by
pneumococcus or streptococcus infection as a terminal event.
Christian[33] states that epidemic influenza causes a clinically
demonstrable bronchitis and bronchopneumonia in the larger proportion of
cases, and lays particular emphasis upon the fact that it is quite
incorrect to consider fatalities in the epidemic as due to influenza
uncomplicated by bronchopneumonia. Blanton and Irons[34] speak of
influenza as an “antecedent respiratory infection” of undetermined
etiology, and believe that pneumonia when it occurs is due to autogenous
infection by a variety of secondary invaders, principally of the
pneumococcus and streptococcus groups. Hall, Stone, and Simpson[35]
regard pneumonia strictly as a complication and quite distinct from
influenza itself. Synnott and Clark[36] believe that the infection is
characterized by a progressive intense exudative inflammation of the
respiratory tract often terminating in an aspiration pneumonia with a
variety of conditions found at autopsy and a multiplicity of secondary
organisms responsible for the fatal termination. B. influenzæ was
usually found but always with other organisms. Friedlander and his
collaborators[37] speak of a fulminating fatal type of influenza with
acute inflammatory pulmonary edema, but regard true bronchopneumonia as
secondary, due to infection with pneumococcus or S. hemolyticus. B.
influenzæ was not found more frequently than under normal conditions.
Brem[38] and his collaborators present a clear cut clinical picture both
of influenza and the secondary pneumonia to which it predisposes,
regarding the latter as definitely due to secondary infection with
pneumococcus, streptococcus or B. influenzæ, the virus of influenza
being unknown. Ely[39] and his collaborators make no distinction between
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