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
After our experience in the epidemic of pneumonia in the spring of 1918,
when the disease was also so prevalent in the cantonments, we of course
expected to see many cases of empyæma and lung abscess in the present
epidemic. In this we were agreeably disappointed. Only one case of
empyæma and only one case with abscess of the lung were found up to the
time of collecting our data and the compiling of our statistics. Both of
these were among the civilians. From our experience since the compiling
of our statistics, we are inclined to believe that this low incidence of
empyæma may not altogether represent the real state of affairs, as we
have since received in the hospital several cases of empyæma, as well as
of abscess of the lung, which seemed to have followed an influenzal
infection which had occurred three or four months previously. One of
these cases was a particularly remarkable one, in that the patient had
already been admitted to the hospital twice since his initial attack of
influenza in October for suspected pleurisy with effusion. We were
unable to find any fluid with the needle, though we felt certain of
having demonstrated it a number of times physically and with the X-ray.
About eight weeks after the second admission, however, pus was found
after several needlings in the left chest, axillary space, apparently
along the inter-lobar sulcus. This case was a good example of many we
have seen in which a pneumonia, or possibly, as we see it now, a
pleurisy, or even a localized empyæma, seemed to confine itself about
the sulcus or fissure between the upper and lower lobes of the lung.
Frequently the process began posteriorly, apparently at the apex of the
lower lobe, and traveled forward and downward across the axillary space
until it appeared in the anterior part of the chest. In most cases we
interpreted our signs as those of a consolidated lung, and scarcely knew
whether the consolidation was in the upper part of the lower lobe or in
the lower part of the upper, or in both. In some cases we suspected a
localized empyæma or an abscess in the sulcus, but in none did we find
pus after exploring with the needle until this recent case occurred. The
passage of the needle in this case, which was done several times before
pus was found, always gave the impression that it was going through
dense fibrous tissue for some distance before the abscess was finally
found. From this experience, and from the extensive and irregular
invasion of the pleura which we have seen demonstrated at autopsies,
there can be no doubt that the clinical history of the complications of
influenza in this epidemic is not a closed chapter.
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