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
Atropine was indicated whenever signs of œdema were evident. Its action
was not always successful, but in certain severe cases we believe that
large repeated doses of atropine saved a few lives. One-fiftieth (1/50
gr.) grain hypodermically, repeated every hour for several doses, was
usually well borne. We noticed twice in each of two cases after using
small doses (1/100 every four hours) a peculiar rapid cyanosis not
associated with dyspnœa develop. This reaction remained, however, for
only a short time, about 15 to 20 minutes, but it was rather alarming
while it lasted.
The drug therapy is not very satisfactory in lobar pneumonia, and it is
less so in the form of pneumonia which follows influenza. There is
practically nothing essentially new in the drug and general treatment of
this serious complication over what was shown in 1890, or even in the
earlier epidemics, save that our nursing and hygienic measures are
undoubtedly better.
The addition of an immune serum (anti-pneumococcus serum No. 1) to the
treatment of pneumonia is a milestone in the history of the handling of
this disease, but we must keep in mind that the pneumonia of the past
epidemic was not the usual pneumococcic lobar pneumonia. That the
pneumococcus was present in a great many cases is shown in another
article of this series, but we also know that the B. influenzæ was
present in many, and that it played an active part in the disease is
evidenced by the constant low blood count or actual leucopenia. A
leucopenia in true lobar pneumonia is most unusual in the United States.
The rarity of Type I pneumococcus was noteworthy. We were practically
unable to get any anti-pneumococcic serum which was known to be of value
at the time of the epidemic, so naturally could not apply this method of
treatment as was desired. About half a dozen 50 cc. bottles were in
possession of the army medical officers here, but they unfortunately
could get no further supply after this was used. We would have liked
very much to have combined the anti-pneumococcic serum in Type I cases
with the citrated convalescent blood, as was used by us during the
epidemic. The anti-pneumococcic chicken serum of Kyes should also be
considered. This serum has had but a very localized trial, but from
competent observers who have given it to a considerable extent in some
of the army camps we are led to believe that it has a very definite
value. Major Lawrence Litchfield informed the writer that he had
observed excellent results with Kyes chicken serum during the past
epidemic in the treatment of pneumonia. This serum was not available for
our use. It is to be hoped that further experience with Kyes serum will
be favorable, because from the practical standpoint in the treatment of
pneumonia it has many commendable features. Again, we desire to point
out that the use of anti-pneumococcus sera in influenzal pneumonia may
not be a fair test of their true value.
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