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
We would again emphasize the value of careful nursing to conserve the
patients’ strength. They should be kept warm, well covered, with plenty
of fresh air. Water should be given regularly and abundantly. The diet
should be light, one depending a good deal upon the severity of the
case. We believe it is safer to limit the diet to fluids while the
infection is still pronounced, but as soon as the crisis has passed one
may increase the diet freely and fairly rapidly.
Regular elimination from the bowel should be helped by the use of castor
oil every other day, the dosage made to comply with the patient. We
noticed much less abdominal distention in this form of pneumonia than
one is accustomed to see in the ordinary lobar pneumonia. If distention
were present, plain soap enemas with turpentine gave very satisfactory
results. Turpentine stupes also are of considerable value. Rest at night
is needed. When a hypnotic was necessary we gave morphine (gr. ⅙), and
repeated if the desired results were not obtained.
The day is coming when we are going to isolate our pneumonia cases. This
was almost an impossibility during the stress of the past epidemic, but
we know that temporary and fairly satisfactory methods can be applied.
Many hospitals provided for a type of isolation. In a pneumonia ward
sheets stretched between the beds keep the fine spray which a heavy
cough always produces from spreading over the next two or three beds.
This method is simple and can be easily carried out. We feel almost
certain of having seen convalescent influenza cases develop pneumonia
from the adjacent pneumonia patients. As much as is physically possible,
the uncomplicated influenza and the pneumonia cases should be separated.
Further, it is to be kept in mind that reinfection by another group of
pneumococcus is quite possible, even in a ward containing only pneumonia
patients.
We did not observe any special effect of quinine, salol, salicylates
after the pneumonia had developed and, therefore, these drugs were
discontinued. Digitalis in the form of the tincture was at first made a
routine measure, but toward the middle of the epidemic we stopped this
routine usage and gave it only as it appeared to be indicated. Our
impression was that the heart was not involved as it is in ordinary
pneumonia. A slow, full pulse, as was so often the rule, did not seem to
require digitalis. For more rapid action of the drug one of the
hypodermic digitalis preparations or strophanthin was given.
Caffein sodium benzoate or salicylate seemed to be of considerable value
given hypodermically every two or three hours, the last dose at 4 P. M.
Its action as a respiratory stimulant and also as a diuretic was what we
desired to obtain. The drug was used fairly early in the pneumonia, and
although it was never prescribed routinely we gave it frequently.
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