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 evidence in clinical influenza would suggest at times a bacteremia
in addition to the severe toxemia, which is such a constant feature of
the disease. Simultaneously with the discovery of B. influenzæ, Canon
reported finding bacilli of similar morphology in blood smears, but was
unable to grow them, and it would appear at least doubtful that he was
dealing with the influenza bacillus. Meunier is probably the first who
grew this organism from the blood. He recovered it from 8 blood cultures
out of 10 in cases of broncho-pneumonia following measles, and in one
other case of broncho-pneumonia. A very full discussion of this question
is to be found in Canon’s book on “The Bacteriology of the Blood in
Infectious Diseases.” Of particular interest are the results of Ghedini,
who made a careful study of 28 influenza patients. B. influenzæ was
grown from the blood in 18 of these at the height of the fever, while in
the 10 negative cases the disease was milder or the blood was taken only
after the temperature had fallen. The amount of blood used was 20-30
c.c., and it was cultured in lecithin broth. In practically all of his
cases several cultures were taken, and in a number of the positive cases
negative results were obtained both before and after the acme of the
fever. He also grew the bacillus from 8 of 14 spleen punctures of these
patients. Madison (1910) reported the recovery of this bacillus from the
blood of a patient with a primary broncho-pneumonia who recovered. This
author also used about 30 c.c. of blood. Thursfield, in 1910, also
reported two cases of B. influenzæ bacteremia in which the organisms
were recovered at the height of the temperature. One had influenza, the
other phlebitis, and both recovered. Tedesko and several others have
found it in the heart’s blood in many cases, more especially in
broncho-pneumonia after measles.
During the present epidemic the positive cultures of this bacillus from
the blood have been rather infrequent. J. S. Fleming had 2; 2 are quoted
in the report of the Influenza Committee of the Advisory Board to the D.
G. M. S. (Peters and Cookson); Medalia had 2 during life and 19 of 34 at
autopsy; Orticoni, Barbie and Leclerc in 5 of 10 blood cultures in one
series, and 7 of 19 in another; Stone and Swift 2 at autopsy; McKeekin,
in Australia, influenza-like bacilli in 4; Blanton and Irons three times
in the heart’s blood, one of these pure; Spooner, Scott and Heath twice
in the heart’s blood at autopsy, and Wollstein and Goldbloom from the
heart’s blood in one child. In the majority of these findings the
bacillus was not found in pure culture. Abrahams and his associates
found the B. influenzæ along with a pneumococcus and M. catarrhalis from
the heart’s blood in one case. In our positive blood culture there was
evidence of the same mixture being present.
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