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
Finally we would mention the peculiar epidemic which has been observed
apparently over the world, encephalitis lethargica. We do not for a
moment put ourselves on record as regarding this disease as a
post-influenzal affair, but no one will deny that it has a peculiar time
relation to the epidemic; and further, that its distribution is
apparently identical. Its bacteriology seems to be unknown. Its local
pathology in the mid-brain is not peculiar or at variance with
encephalitis produced by known organisms. We have seen five cases; three
of whom had had undoubted influenza, while the other two were entirely
free from even the slightest suggestion of any type of illness previous
to the attack. All of these cases recovered. It has been stated that
following the 1890 epidemic a clinical condition was observed in Europe
which bears a close resemblance to what has been termed at the present
time encephalitis lethargica.
_Prognosis and Mortality of Influenza_
In giving a prognosis of influenza one has to take into consideration
the peculiar manifestations of the disease, especially the possible and
sudden changes which are liable to take place in the lungs. The points
which lead one to feel that the outlook is grave occur in about the
following order, which is also about the order of the severity of the
symptoms. First, _cyanosis_. This usually appeared quite early and was
considered a forerunner of definite lung infection. It may have been a
symptom only of the “wet lung,” to which reference has been made, but it
was usually followed with definitely recognized pathology in the chest,
and it immediately made the outlook unfavorable. Second, _continuation
of elevated temperature_. If the temperature fell to normal in three or
four days, the outlook was, of course, good; but if it went up again, or
if the temperature did not fall in that time, the chances were that
there was a lung involvement, even though the chest signs were negative
or only those of an acute bronchitis. Strange to say, however, when
definite chest signs were once recognized, the height of the temperature
or the continuation of fever was not so important a prognostic factor.
Third, _increase in pulse rate_. The pulse, as was noted before, was
unusually slow, even though the patient seemed desperately ill; when,
however, it began to increase in rate the condition was usually very
grave. Fourth, _the extent of lung involvement_. This was of very little
prognostic value. Both lower lobes might be solid, and yet if there was
no cyanosis and the pulse and respirations were satisfactory, the
outlook was rather good. On the other hand, there might be the slightest
involvement of the lung, and if the pulse were rapid and cyanosis
present the outlook was grave. Fifth, _depression and stupor_, or loss
of so-called “morale.” If the patient remained clear in his mind, bright
and hopeful, no difference how extensive the involvement or how grave
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