Influenza : $b An epidemiologic studyVaughan, Warren T. (Warren Taylor)
History
Influenza : $b An epidemiologic study
Vaughan, Warren T. (Warren Taylor)
Influenza
“There is no reason for supposing that the virus of measles is
controlled in any way by our calendar. In order to get anywhere in
determining any law of periodicity in epidemics we must know the
morbidity and mortality of the disease by days, or at least by weeks. In
different parts of a large city there may be, and undoubtedly are,
epidemic waves of measles on the flow or on the ebb at the same time.
The best work that has been done along this line is that of Brownlee,
who has figured out epidemic waves of measles, based on the weekly
numbers of deaths in London between 1840 and 1912.
“The figures presented by Brownlee are of great value, and his theory is
fascinating and has much in its favor, not only in a study of epidemics
of measles, but of the other infectious diseases of infancy and
childhood, especially scarlet fever, whooping cough, and chicken-pox. In
order to solve the problem of periodicity in measles we must have more
exact information than we now possess. Brownlee’s figures pertain to
deaths only. There are, so far as we know, nowhere in the world
satisfactory statistics concerning morbidity in this disease. Deaths
from measles are so largely determined by the care bestowed upon the
sick and upon the extent to which secondary infection is prevented that
we are inclined to hesitate about the acceptance of a death rate or
number of deaths from this disease as an index to the virulence of the
organism causing the disease; in other words, we are not convinced that
the death rate in a given outbreak of this disease is a measure of the
virulence of the organism causing it. This involves the question whether
measles _per se_ is a disease of wide variation in malignancy or are the
widely different death rates observed in different epidemics due to
secondary infections. The streptococcus, a common invader of the body
during the progress of a measles infection, is known to possess a most
variable degree of malignancy. We are inclined to the opinion that if
all cases of measles could be recognized before secondary infection
occurs and could be cared for ideally the death rate from this disease
in different epidemics would be much more uniform than is now shown and
would be low. The greatest danger to life in an attack of measles lies
in the fact that the virus lowers the resistance of the body cells and
opens gateways to more deadly organisms, such as the streptococcus. We
believe that there are demonstrated facts which support these ideas.
Quite uniformly in measles there is a well marked leukopenia. As we now
interpret it, this means a decrease in the number of the forces that
naturally protect the body against the invasion of foreign cells. Again
as we interpret it, the failure of the body cells to respond to the
tuberculin test during a course of measles or soon thereafter is
evidence that the resistance of the body is lowered. If our
interpretation on these points be correct we fail to see how deaths from
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