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
It would appear that much of the divergence of opinion that has been
formed has depended to a considerable extent upon the conditions under
which cases have been observed. This is clearly brought out by
contrasting the experience of Fantus[39] dealing with private cases in
civilian practice, where pneumonia was relatively uncommon, with that of
others dealing only with cases in large hospitals, where those admitted
have been in large part selected seriously ill patients with a high
incidence of pneumonia, the milder cases comprising from 60 to 90 per
cent of those attacked by influenza never reaching the hospital.
Variations in opinion with respect to the bacteriology of the epidemic,
especially in regard to B. influenzæ, would appear to be due for the
most part to differences in bacteriologic technic, in some degree to
differences in interpretation. Accumulating evidence can leave little
doubt that B. influenzæ was at least extraordinarily and universally
prevalent throughout the period of the epidemic and thereafter, and that
earlier reports of failure to find it were due to the use of methods
unsuitable for its detection and isolation.
The opportunity afforded the commission at Camp Pike to devote their
full time to a systematic and correlated group study of the epidemic
simultaneously from many aspects throughout its whole course made it
apparent that influenza _per se_ is in the large majority of instances,
in spite of the initial picture of profound prostration, a relatively
mild disease which tends to rapid spontaneous recovery. This opinion is
supported by the fact that the disease during the first waves of the
epidemic in this country, which it is now recognized occurred pretty
generally in the army camps during the spring of 1918, was so mild that
it attracted only passing attention, since the disease at that time was
not sufficiently virulent to predispose to any alarming amount of
pneumonia. With the return of the epidemic in the late summer and early
fall, however, the disease had attained such a high degree of virulence
that it predisposed to an appalling amount of severe and often rapidly
fatal pneumonia, which often detracted attention from the real nature of
the preceding disease. Yet even during the fall epidemic from 60 to 90
per cent of the cases of influenza proceeded to rapid recovery without
developing complications. On this ground alone it would seem only
logical to regard pneumonia strictly as a complication of influenza
rather than as an essential part of the disease, irrespective of whether
the pneumonia may be caused by the primary cause of influenza or not.
The complexity of the clinical features, the bacteriology and pathology
of the pneumonias following influenza lend further support to this
opinion.
It seems better, therefore, to consider influenza first as a disease by
itself and subsequently to take up the question of pneumonia and the
relation of influenza to it.
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