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
Complement fixation tests were carried out by Odaira but his results
were much less satisfactory than those he obtained by means of
agglutination. Rapaport made an extensive study of this test, using the
sera of patients in various stages of convalescence. Three hundred and
fifteen convalescents showed 54.5 per cent. positive while 300 controls
only gave 9.5 per cent. positive results. Most of the positive cases
were in patients three to five days after their illness, but the
reaction was found in convalescents after from 1 to 45 days. Sera from
acutely ill patients at times showed negative or slightly positive
reactions but these same sera after keeping for some days and retesting
often gave strongly positive results. This would appear to be a
promising field for investigation.
_Anaphylaxis_
Hypersensitiveness was noted by W. F. Robertson in chronic infections
with B. influenzæ. Wollacott in a letter to the British Medical Journal
suggested that the severity of the recent outbreak of influenza may
possibly be due to the development of a state of anaphylaxis. There
would seem to be at least some evidence in favor of such a view in the
fact that the severe outbreak was preceded by epidemics of a milder form
of influenza and that the influenza bacillus was probably widely spread
during this time. Greenwood, as quoted above, noted that primary cases
always precede the mass attack. Of course, the term anaphylaxis has been
used to explain almost everything. Nevertheless, the theory is
interesting. The skin tests which we did for hypersensitiveness were, as
I have noted above, negative but there is a possibility that the failure
of the reaction may indicate a higher resistance or even an antitoxin,
now that the bacillus can be classed as a toxicogenic one.
Anti-influenza sera have been produced by a few investigators (Latapie,
Wollstein) but have not found any practical application during this
pandemic. Vaccination is discussed elsewhere in these studies.
_Experiments on the Human_
There has never been in the history of medicine so many experiments on
human beings as have been carried out in the attempts to discover the
etiological factor in the recent pandemic of influenza. Davis has called
attention to a successful human inoculation with pure cultures of B.
influenzæ which he performed in 1906. During the present investigation
at least 200 men have volunteered as experimental subjects, and the
results of many different methods of attempting to transmit the disease,
have been disappointing and inconclusive. I will not attempt to review
the reports at present available, as a great deal of the work done has
not yet appeared in print. The important point is that the results do
not affect the various views held as to the causative agent in pandemic
influenza nor the massive evidence for transmission of the disease under
natural epidemic conditions.
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