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
It will be impossible to review the numerous reports on the recent
epidemic that have appeared. Many of these can be discounted, as far as
the finding of B. influenzæ is concerned, for the reasons mentioned
above. The often quoted report of Little, Garofalo and Williams, who did
not even use a hemoglobin medium, will serve as an example. Little
attention should be given to others where the large numbers of cases
precluded the requisite time and media necessary for such a difficult
problem. Friedlander and his co-workers in their report from Camp
Sherman made no mention of the number of sputa, throat swabs or
autopsies which they examined bacteriologically. The incidence of
influenza showed a total of 10,979 cases, 2,001 of pulmonary œdema or
pneumonia and 842 deaths. They recorded one culture from the sputum with
pneumococcus predominating which gave two colonies of B. influenzæ, and
this bacillus was grown from the lung exudate at one autopsy. Their
conclusions that “B. influenzæ (Pfeiffer) has not been demonstrated as
the causative organism” is certainly true from their results, but that
“the frequency of its detection has not exceeded the frequency of its
existence under normal conditions” can hardly be considered as
established, if we accept the many results mentioned above as indicating
its presence during inter-epidemic times, unless they mean by normal
conditions practically complete freedom from this organism.
The prevalence of B. influenzæ in various sections of this country may
be indicated by the following reports chosen from many available ones.
Keegan, from the First Naval District Hospital, found B. influenzæ 19
times from 23 in cultures grown from the lungs. In 6 cases these
cultures were pure. Medalia reported from Camp McArthur the following.
Out of 2,279 sputa of influenza suspects, 76.8 per cent. showed “B.
influenzæ” in smears, and 445 sputa from cases of broncho-pneumonia
showed it in 54 per cent. It was found in culture in only 10.6 per cent.
of these last cases. He considered sputum smears of practical diagnostic
help. He further grew B. influenzæ twice from the blood during life,
once with a pneumococcus and once alone. Necropsy cultures gave B.
influenzæ in 2 of 3 cultures from the brain, 19 of 34 from the heart, 19
of 36 from the spleen, 54 of 65 from both lungs, 50 of 62 from the right
pleura and 47 of 62 from the left pleura. The percentage of positive
results ranged from 53 in the spleen to 83 in the lungs. Nuzum and his
associates only found B. influenzæ in 4 of 100 cases from the bronchial
secretions, but it is interesting to note that he grew it in practically
pure culture from both lungs of one case at autopsy. Synnott and Clark
in Camp Dix found streptococci and pneumococci predominating, and,
although making no particular effort to study the B. influenzæ or
determine its frequency, they found it in the majority of cases when it
was looked for. Blanton and Irons reported as follows from Camp Custer.
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