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 had treated but a few cases when the report of McGuire and Redden
appeared. These observers working in the Naval Hospital at Chelsea,
Mass., presented very excellent results in the use of immune serum from
convalescent influenza cases in the treatment of pneumonia. They
reported 30 recoveries out of 37 cases, with 1 death, and 6 cases still
under treatment at the time of their report. This form of treatment
began at Chelsea on September 28, 1919. In Texas, on October 15, Brown
and Sweet gave two cases of influenzal pneumonia citrated blood from
convalescent influenza patients. Their two cases recovered. Our
published results, although not showing such excellent figures as from
the Chelsea observers, agree very well with their work.
Since that time a number of confirmatory reports have been brought
forward. Ross and Hund have shown that this method has been of value in
their hands, and recently a further statement from McGuire and Redden
tends to confirm their first views as to the value of immune serum from
convalescent patients. Their last report giving a mortality of 6 in 151
cases of pneumonia cannot be other than positive proof of the value of
this method of treatment.
As the technical side of the work has been given in several articles, we
hardly think it necessary to again review it in detail. A few phases
should, however, be recalled. It would seem that either serum or the
whole citrated blood may be used. Solis-Cohen and his group of workers
believe that whole blood has stronger bactericidal properties than
defibrinated blood or the plasma. But yet one cannot complain, even on a
theoretical basis, against the results obtained with serum by McGuire
and Redden. The use of whole blood increases the detail of the
procedure, in that the agglutination reactions must be estimated.
Unfavorable results in this regard also naturally cut down the supply of
available donors. In a military hospital a dearth of donors does not
arise, but in civilian practice the problem is very different. In our
work we never gave more than 100 cc. of whole blood; usually the amount
varied between 50 cc. and 75 cc. On account of the small amount we felt
that isoagglutination would not be a serious factor, and in more than
200 injections we failed to see any evidence of ill results from this
source. Giving up to 500 cc., as was done by Ross and Hund, is probably
a different affair, and accurate agglutination tests are essential. We
feel that if the case is treated sufficiently early in the disease as
much good can be shown to occur after 50 cc. as after 100 cc. of blood.
We do believe, however, that the pooling of sera, where one is able to
carry out this method, as it means a liberal supply of donors, is really
the method of choice. Syphilis must be ruled out, both clinically and
serologically.
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