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 is my opinion, as expressed above, that practically all of the
population are rapidly infected during such a pandemic as we have had.
The resistant have escaped, and it would appear to be very difficult to
break down this resistance. The human experiment carried out by
Pettenkofer on himself and his assistant with vibrion choleræ is an
example, but we have numerous others demonstrating the same kind of
phenomena in most of our diseases of established bacterial origin. In
diphtheria we have an explanation in the varying antitoxic content of
the sera, but we really know very little of what are the actual factors
in preventing or determining infection among exposed individuals in the
natural history of most diseases. The reports of Leonard Hill and Gregor
are well worth reading in this connection, as well as the editorial in
the same number of the British Medical Journal. We are not in a position
to be very dogmatic on the causes of epidemics. The mere presence of the
bacteria or any other living virus is not in itself sufficient to
explain the phenomenon, and one of the chief objects of this paper is to
indicate from the collected facts, that in the words of Flexner, “the
case against the influenza bacillus is not proved.”
_Conclusions_
1. B. influenzæ is one of a group of hemophilic bacteria and there are
probably strains of this organism which may be differentiated which will
lead to further subdivisions of the group.
2. B. influenzæ as we understand it today, is distinguished by its
morphological and staining characters; its requiring hemoglobin in some
form for its development; its showing symbiotic reactions with other
bacteria which stimulate its growth; the production of a toxine and its
usual low pathogenicity for animals.
3. The media found most favorable for its growth are those containing
blood with the hemoglobin content altered in certain ways, (1) by
heating, (2) the addition of various chemicals, (3) by the action of
other bacteria or their products. The heated blood agar I have found to
be a most efficient and readily prepared medium.
4. Since B. influenzæ is so difficult to isolate, it is necessary to be
very cautious in interpreting results unless the greatest effort has
been made to demonstrate the presence of this organism.
5. B. influenzæ should be considered, from the evidence at hand, as the
bacterial causative agent in epidemic influenza, and it should be
recognized that secondary infections following the primary attack by
this organism are both frequent and important. This view I believe the
logical one, unless much more convincing evidence than we have today may
demonstrate another more probable living virus as the cause.
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