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
Red blood cells were present in 5 per cent. of the influenza cases, and
in 11 per cent. of the pneumonias. This was always a microscopic
observation, save in the case of a slightly smoky urine. Even
microscopically the red cells were not numerous. We noted them at times
quite early in the disease in some of the severe cases which presented
epistaxis and hematemesis. Possibly one might consider the early
presence of red blood cells in the urine as a condition analogous to
those just mentioned, although we never saw anything suggesting free
hemorrhage from the kidney. It is probably better to regard the red
cells as a manifestation of an acute nephrosis of toxic origin.
Casts were found in 35 per cent. of the cases showing albuminuria. We
are inclined to feel that this observation is somewhat low, but at the
same time we have noted that in uncomplicated influenza one frequently
sees albumin without casts. We were also impressed with the fact that
casts were not as prominent a feature in the influenzal pneumonias as
they are in frank lobar pneumonia of essentially pneumococcic origin.
During the course of routine examinations several transient glycosurias
were seen. Their transient character was the outstanding feature. The
quantity of sugar was very moderate—our figures were never above 1 per
cent.—and the daily amount of urine was always within normal limits.
Acetone and diacetic acid were absent. A few observations on the blood
sugar showed a rise (.2 to .25), which readily came to normal with
treatment. Clinically these cases were not classed as diabetes mellitus,
but rather as a nervous complication of influenza, involving in some way
the carbohydrate metabolism, probably through the central nervous
system. One case of special interest, which is mentioned elsewhere, was
the association of glycosuria with almost total blindness from a very
intense optic œdema. Sugar (1 per cent.) was present on the day of
admission, while only a trace was noted on the two following days, and
from then on the urine was free from sugar. How many days the sugar had
been present before admission to the hospital we cannot say, but we
could trace the failure of vision back to almost the day of its onset,
which was three weeks previous to our first examination. The eye
symptoms were the only complaints. The patient had had a moderately
sharp attack of influenza a little over two weeks before the first sign
of failure of vision had appeared. We may add that the vision returned
slowly to normal several weeks after admission. The urine and blood
sugar were normal, on a general diet, over a period of one month while
in the hospital. Unfortunately, we have had no further record of this
patient regarding the urine, but her vision still remains normal. Cases
of this type were observed in England after the 1890 epidemic, and are
referred to in Allbutt’s “System of Medicine,” vol. i, on influenza. Our
other glycosuria cases did not present changes in the fundus of the eye.
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