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• Title: Studies on Epidemic Influenza
• Author : Various
• Release Date : January 09, 2019
• Genre: Medical,Books,Professional & Technical,
• Pages : * pages
• Size : 18801 KB

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This report is based upon a series of investigations carried on during the epidemic of influenza at Pittsburgh. This epidemic reached Pittsburgh about the last week of September, 1918, rapidly spreading through the community during the first days of October. Pittsburgh had been warned of its coming through the experience of Boston, where the epidemic made its appearance during the late days of August. To a certain extent the warning from the East permitted the making of preparations to control its ravages. But even with the attempt for the protection of public health the epidemic advanced with all its virulence, rapidly picking out the susceptible individuals and leading to a high death rate.

At the time of the coming of the epidemic there were stationed at Pittsburgh two military camps, comprising about 7,000 men. It was with the presence of the disease among these men that our investigations were chiefly concerned. The men at their respective camps (on the campus of the University of Pittsburgh and at the Carnegie School of Technology) were housed in barracks which had been erected only a short time previously. These barracks contained large dormitories, in which the individuals freely mingled with each other. In them there was no opportunity of complete isolation, and by this means of housing good opportunity was available for the propagation of any communicable infectious disease. The ordinary sanitary arrangements for these groups were well provided. The first cases of recognized influenza made their appearance on October 2. On this day two men were found with the disease and were isolated. On the following day there were four, and on the third day eight. It was soon recognized that the increasing number of the infected cases was growing so rapidly that definite arrangements for their segregation and care had to be undertaken. This was provided for on October 4, when the Elizabeth Steel Magee Hospital was in part taken over by the military authorities and wards were rapidly adapted for the coming epidemic. For the foresight in making the adequate arrangements for its control and management we shall always remain indebted to Major E. W. Day. His 

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indefatigable work in the early days of the epidemic will always be remembered, and the fact that the epidemic was kept within reasonable bounds of control was the result of his stringent quarantine regulations along with the organization of his medical forces. Working under his direction, Capt. H. H. Hendershott undertook the management of the hospital and rendered most efficient service. The capacity of the hospital was soon overburdened, so that from a normal 150–bed institution it was on the sixth day of its conversion into an emergency hospital carrying more than 300 cases of influenza. This hospital in itself was unable to accommodate all of the cases falling ill, and provision for these had to be made in some of the municipal institutions. On October 5, 1918, the Medical School of the University of Pittsburgh undertook to provide the laboratory facilities for the emergency Military Hospital. It was at first intended to equip only those laboratory departments which were deemed essential for the clinical care of the patients in the wards. Inasmuch, however, as the epidemic of influenza was spreading with alarming rapidity throughout the city, it was deemed advisable to close the Medical School and to place at the disposal of the Military Hospital all the laboratory facilities which could in any way be of use in the care and study of the influenza patients. This permitted the establishment of departments in pathology, bacteriology, physiology, physiological-chemistry and clinical microscopy. The following workers partook in the investigations which were here carried out: Dr. Oskar Klotz, director of laboratories; physiology, Dr. C. C. Guthrie (chief), Dr. A. Rhode, Dr. M. Menten, Mrs. C. C. Macklin, Miss S. Waddell and Miss M. Lee; bacteriology, Dr. W. L. Holman (chief), Miss A. Thorton, Miss C. Prudent and Miss R. Jackson; pathology, Dr. Oskar Klotz (chief), Mr. A. D. Frost, Mr. J. L. Scott and Miss A. Totten; clinical microscopy, Miss R. Thompson, Mr. M. Marshall and Mr. H. Mock; records, Miss H. Turpin. Intensive work was undertaken by each over a period of about five weeks, when the epidemic was again on the road to disappearance and few new cases were being admitted. These laboratories discontinued their work at the Military Hospital on November 9.

The clinical observations which are contained in this report were made at the Mercy Hospital. This institution set aside upward of 100 beds for the care of the overflow which could not 

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be accommodated at the Military Hospital. It is unfortunate that the clinical observations and the laboratory findings contained in this report were not made upon the same cases. With the number of cases suddenly thrust upon the medical staff of the army, it was not possible for them to devote detailed attention to clinical investigation. Furthermore, during the progress of the epidemic these medical officers were transferred to new posts, so that it was impossible to obtain a summary of the clinical findings at the Military Hospital by any of the officers who had but recently been detailed to the work. We were fortunate, however, that the clinical investigations were carried out on a similar group of cases to those studied by the laboratory, and it might be said that their clinical findings on the patients housed at the Mercy Hospital are parallel with those observed in other institutions. Necessarily the researches carried out during such an epidemic were intensive, and all the workers in the various branches feel that if they had to live through another such plague they would be much better prepared to approach their problem. During the heat of such investigations valuable time is often lost in perfecting methods of technique, and one sorrowfully finds oneself without available material when the technical work has been accomplished but the epidemic has passed by. In the studies in bacteriology we were fortunate in having some of the technical difficulties for the isolation of the B. influenzæ previously solved. It may be that this in part explains the broad success which Dr. Holman has had in isolating the B. influenzæ from so many cases. In other fields the road was less broken, and it was not until late in the course of the epidemic that results were obtained in the investigation which seemed to point to valuable leads.

Dr. S. R. Haythorn, director of the Singer Memorial Laboratory, early in the epidemic became interested in the protection of individuals against the infection. In certain quarters much was claimed for the immunity which could be conferred by vaccination, either by the inoculation of pure B. influenzæ vaccines or by mixed vaccines. Hoping for some results by the use of such vaccines, Dr. Haythorn undertook the preparation of these materials. The value of this procedure could only be estimated after the lapse of some time and at a period when the epidemic was again waning.

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The clinical work at Mercy Hospital was carried on under the direction of Dr. J. A. Lichty, and assisted by Dr. W. W. G. Maclachlan, Dr. P. I. Zeedick, Dr. F. Klein and Dr. W. J. Fetter. By the close co-operation of the members of this group it was possible to put the clinical findings of one or other member to severe test, so that the recorded observations and deductions are of the greater value and less flavored by the personal element. This is of the more value, since, with the great amount of work which had to be done at the time of the height of the epidemic, it was often not possible for the same individual to bestow the amount of time upon each and all cases as he desired.

We are much indebted to Dr. Ogden M. Edwards, dean of the School of Medicine, for making available the facilities for carrying out the work, and for encouraging the publication of the reports.

Oskar Klotz.

Pittsburgh, June, 1919.

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