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
In six patients there was a purulent inflammation of the pharynx, larynx
and trachea. It was extensive and produced profound general symptoms,
dyspnœa and profuse purulent expectoration. The lungs were clear, but
the patient seemed for a time in danger of death. The condition was
considered a grave complication. There was only one case of acute
sinusitis, one case of antrum disease, and only four cases of middle ear
infection were recognized. This is in marked contrast to other epidemics
which have occurred to our knowledge in the past fifteen years or more,
and which have been spoken of as influenza or “grippe.” Disease of the
tonsils, middle ear disease, mastoid disease and sinus disease occurred
with great frequency in those sporadic epidemics. This again seems to
show that the deep respiratory tract was more generally and more
severely affected in this epidemic than the upper respiratory tract.
With the exception of the pleura, the serous membranes were remarkably
free from infection. Only one case of acute endocarditis, three cases of
meningitis (all pneumococcic), none of pericarditis, peritonitis or
arthritis were recognized among the 547 cases of influenza.
The kidneys did not seem to be involved in the infection. Albumen was
present in the urine, as might be expected in febrile conditions, but no
evidence of acute clinical nephritis, such as suppression of urine,
general œdema or uræmia, was recognized. The condition of the urine in
this epidemic will be described more in detail in another paper of this
series.
A peculiar pathological process in the muscles was brought to our
attention by Dr. Klotz, who demonstrated a myositis or hyaline
degeneration of the lower end of the recti abdominalis. This lesion is
carefully described in the pathological section. After our attention had
been called to this lesion we recognized several cases clinically having
the same condition. One was in the right sterno-cleido-mastoid muscle
and another was in the left ilio-psoas muscle. This last patient while
he was convalescing developed a severe pain in the left hip, extending
upward into the lumbar region and downward into the thigh. His decubitus
was like that of one suffering with psoas abscess. Every test available
was made to confirm this diagnosis, but all the findings were negative.
The patient rested in the hospital, in bed, for some time, gradually
improved, and eventually made a complete recovery.
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