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
The extremely tiny colony of B. influenzæ on ordinary blood agar makes
it particularly difficult to detect, and one is apt to get the wrong
impression of its numbers from the macroscopic appearance of the plate.
In attempts at isolation there must be a liberal use of media in picking
colonies, as many suspicious ones will turn out to be immature growths
of B. xerosis, M. pharyngis (or M. catarrhalis), streptococci, or more
rarely pneumococci and other organisms. Replating from such picks is
frequently necessary, and further plates, from the original culture on
heated blood agar, must often be made before the B. influenzæ can be
isolated. The care required in all stages of the isolation of this
organism, the unstinted use of media for plating and for picks, the
number of stained smears to be studied, and the further transfers
necessary to verify results, all these limit the amount of material
which can be studied with any degree of accuracy. If further the
streptococci, the pneumococci, the Gram negative cocci, the capsulated
Gram negative bacilli and many others are to receive any attention, it
can readily be appreciated that a few cases carefully studied are of far
more value than a large number hurriedly examined in an uncertain
routine.
The pathological study of the same cases on which I have done the
bacteriology will be found in Dr. Klotz’s paper in these communications,
and I will merely refer to some of the bacterial findings in the
sections of the lungs and bronchi. The more inclusive methods which have
been used in attempts to determine the etiological factor in influenza
we have been unable to attempt, but I will refer later in this paper to
the findings of the investigations of others. Immunological studies have
been limited to a few investigations on the presence of agglutinins,
complement binding substance, skin reactions and the amount of
complement present in the sera of certain patients. The epidemiological
and clinical studies are reported by Drs. Johnston and Lichty in this
series of reports.
_Material Studied_
The material used in the study I am reporting included swabs from the
large bronchi and fluid from the lungs and pleural cavities of 32
autopsies, as well as blood cultures from 22 patients and swabs from the
nasopharynx of 31 individuals. Fifteen sera were tested for fixation of
complement with an antigen made from several strains of B. influenzæ.
Fourteen other sera were tested for agglutinins. Complement content was
determined in the sera of 25 patients. Skin tests after the Von Pirquet
method were done on 14 convalescents, and carefully stained
nasopharyngeal smears without cultures were studied from 48 patients.
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