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
A few words as to “forms” or varieties of influenza might be helpful
before suggesting a classification of symptoms. In former epidemics of
influenza considerable importance was attached to the early
manifestations or first symptoms as characterizing the “form” of
influenza which was in evidence in the individual patient. These were
reported as a “respiratory form,” a “nervous form,” a “gastro-intestinal
form,” and other forms—circulatory, renal, psychic, etc. In the epidemic
of 1889 and 1890 particularly these types were noted, and they have been
described in the subsequent small epidemics, practically characterizing
them as being of one or the other, and frequently as being without any
respiratory symptoms. In the study of our group of cases in the present
epidemic every effort was made to recognize the non-respiratory cases,
but we were unable to find a single case which did not have definite
respiratory symptoms, either early or late, in addition to any other
symptoms present. Only occasionally were nausea, vomiting and diarrhea
or tachycardia, or certain neuroses or psychoses, the leading symptoms.
The respiratory symptoms in some cases seemed to be at the onset
primarily of the lower respiratory system—that is, without the
preliminary coryza. These usually ran a rapidly fatal course,
characterized by marked cyanosis and confusingly irregular chest signs.
We would say, therefore, in so far as our experience goes in this
epidemic, we are not justified in speaking of any particular forms
except the respiratory form, and whenever pronounced manifestations
occurred justifying a characterization of any other form they could more
easily be interpreted as a complication, or the manifestation of a
coincident disease, or of a severe toxæmia.
The classification of the symptoms, therefore, takes into consideration
largely those symptoms arising from the respiratory system. We are of
the impression that the pathology demonstrated by Dr. Klotz and
described by others justifies the following classification. Clinically
we would recognize two distinct groups of epidemic cases.
The first includes those _without lung involvement_ having symptoms
arising from the upper respiratory tract, including the trachea and the
larger bronchi. These were practically without any chest signs except
for the rather indefinite signs of an acute bronchitis, and the only
symptoms referable to the respiratory tract were a coryza, soreness of
the throat, hoarseness and a cough of varying degree and character. If
to these symptoms are added those of Leichtenstern just mentioned, one
will have a good description of a so-called simple, uncomplicated
influenza.
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