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 chief attention was given to the study of the autopsy material and
we concentrated on the isolation of B. influenzæ. At the same time we
did not neglect the other bacteria making up the flora of the bronchi,
lungs and pleural cavity in these cases. The various types were isolated
and most of them fully identified.
_Technique_
Direct smears were made on sterile slides of all material studied and
stained by Gram’s method. The counterstain was always alcoholic fuchsin
diluted 1-20 in distilled water. Direct cultures were made on a human
blood agar plate containing 5 per cent. blood, which was further smeared
just before use with defibrinated blood. This latter procedure was later
discarded, as it did not appear to assist to any marked extent the
growth of B. influenzæ. Blood broth containing a few drops of
defibrinated blood and blood agar slants smeared with blood were also
used. Heated blood agar (2-3 c.cm. of defibrinated human blood added to
100 c.cm. of ordinary agar at a temperature of from 90 to 100° C., or as
the agar comes from the sterilizer) was used in the last nine cases to
replace the blood agar slant in the direct cultures and as the medium of
choice for transfers of the B. influenzæ.
I prefer the ordinary blood agar plate to the heated blood plate because
the former gives readings which are very helpful in distinguishing
colonies of various types. B. influenzæ appears as clear, tiny,
pinpoint, inert colonies. B. xerosis or the pseudodiphtheria group gives
more opaque but often rather similar colonies. Gram negative cocci as M.
pharyngis siccus have dry, raised, soon becoming wrinkled, inert
colonies, varying greatly in size; M. catarrhalis, more moist, inert
colonies. The cocci of the streptococcus viridans group appear as very
small colonies with greening, or are not infrequently inert, while thin,
flattened colonies with central thickening may sometimes be noted. Those
of the streptococcus hemolyticus group occur as small, frequently
nipple-like colonies with clear, wide zones of hemolysis; pneumococci as
moderately small, moist, dewdrop-like colonies with center collapsing
early and with greening; streptococcus or pneumococcus mucosus as
larger, watery, sticky colonies with greening and frequently an early
clearing near the colonies.
TABLE I.
BACTERIOLOGY OF THIRTY-TWO AUTOPSIES FROM INFLUENZA CASES.
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