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
The blood picture in uncomplicated influenza is a normal one for the red
cells and the hæmoglobin, but the white cells are characteristically
altered. We have made many observations on the red blood cells, and from
all aspects the picture appears to be normal. Similarly, there is
nothing significant about the hæmoglobin estimations. Where we have
slight alteration in the red count and in the hæmoglobin it is probably
safer not to attribute the change to the epidemic. We have no records
showing a secondary anæmia due to the initial epistaxis.
A leucopenia or a normal count is what one should see in most of the
uncomplicated influenzal cases. We are almost ready to say that any
estimation above normal limits means secondary bacterial invasion. The
count may remain low throughout the illness, rising to the normal
rapidly as the temperature falls. We do not regard a leucocytosis at the
end of an epidemic case as part of the blood picture. Our experience is
that with convalescence the normal count returns and remains within
normal bounds. Very often hidden sinus infection is responsible for some
of the post-influenzal leucocytoses. The leucopenia may vary from a
slightly subnormal count to a point well below 2,000. Most of the simple
epidemic cases showed some degree of leucopenia. As far as we have been
able to estimate, we are led to believe that one should not lay any
special stress on the grade of leucopenia as being of prognostic
significance in uncomplicated influenza. Many of the mildest clinical
types showed very low counts, and _vice versa_. There is, however, a
prognostic relation to be noted with reference to a falling white count
in the pneumonia, but this we shall mention again later. The onset of
the leucopenia corresponds to the onset of the disease. It was present
with the earliest cases we examined, and remained fairly stationary,
although we have records of its fluctuating slightly one way or the
other. But one must remember in this regard the personal error in blood
counting, and also particularly the error of the apparatus. For careful
work only those counting chambers and pipettes should be used that have
a Bureau of Standards certificate. The duration of the leucopenia was
fairly close to the duration of the disease.
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