Studies on Epidemic Influenza: Comprising Clinical and Laboratory InvestigationsUniversity of Pittsburgh. School of Medicine
History
Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations
University of Pittsburgh. School of Medicine
Influenza; Influenza Epidemic, 1918-1919
(a) Rigid quarantine for all persons suffering from the disease and all
contacts. During the epidemic quarantine was advocated by many people.
It was pointed out that the disease spread most rapidly in camps, in
ships, and in quarters generally where large numbers of persons were
closely associated; that it was quite as contagious and more rapidly
fatal than most diseases which are regularly quarantined; that while it
was admitted that there is no laboratory method to make certain the
diagnosis, and no method of telling how long convalescents are capable
of transmitting the disease, as there is, for instance, in diphtheria,
still there is no question of the value of the arbitrary quarantine used
in measles, scarlet fever and smallpox, all of which are diseases in
which the parasitic causes are not known. Further, the opinion was
expressed that complete isolation and quarantine would not only protect
the community from influenza, but that it would also in a measure
protect the patient from contact with numerous outside strains of
pneumococci and streptococci, and so lessen secondary infection and
reduce the general mortality.
There are many reasons why quarantine is not applicable in epidemic
influenza. Most important of all is probably the inability to make
certain the diagnosis, especially during the early stages in light
cases. This would work detrimentally in several ways. Really ill
patients would delay calling a physician until late, for fear of
unnecessary quarantine. Many needless and unjust quarantines would
result when the diagnosis was uncertain and the physician anxious to
carry out quarantine measures efficiently. Many patients would have
contacts running about and infecting their neighborhoods while a delayed
diagnosis was being made. Influenza was so contagious during the
epidemic that it would have necessitated general quarantine not only of
all infected persons but also of all contacts to have obtained any
favorable results, and since nearly everyone was either a patient or a
contact, all lines of business would literally have been paralyzed by
the procedure. If it is true that the infected person is most dangerous
to others before he has developed symptoms himself, he is a carrier
impossible of detection and control. Points in favor of the hypothesis
that infected persons spread the disease before they develop symptoms
are found in the following facts. As the disease passed from community
to community officials became alert for the appearance of the first
case. In army barracks and in large institutions it was often possible
to determine the first case at its development. The case was, in many
instances, removed at once and isolated, but I have seen no instance in
which such a measure was successful in curbing the disease. As
subsequent cases appeared they were likewise immediately removed, but
the cases continued to spread just the same. Bloomfield (38) cited the
Public-domain text, read in full here on John Shaqi.
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