Studies of influenza in hospitals of the British armies in France, 1918.

Date:
1919
Catalogue details

Licence: Public Domain Mark

Credit: Studies of influenza in hospitals of the British armies in France, 1918. Source: Wellcome Collection.

    13/142 (page 11)
    From records at my disposal it would seem that out of 965 patients of the autumn outbreak questioned as to a previous attack, only 248, or about 26 per cent., stated that they had had influenza during the summer ; and a considerable number of these had had the disease so mildly that they were not sent to hospital. It is definitely stated by Major J. W. McNee, D.S.O., that, out of 500 patients questioned, only 20 per cent. had suffered from influenza in the summer. The severe cases, without exception, stated that they had had no previous attack. Allowing a margin for errors of diagnosis, these figures appear toe suggest that some degree of immunity had been acquired. The following quotation froma letter received from Lieutenant-Colonel Elser, Medigal Corps, U.S. Army, points in the same direction: ‘In July about 80 per cent. of the Command at one of the Base hospitals (numbering approximately 228) suffered from “3-day fever’, while in this present epidemic very few cases developed in this Command, and those almost invariably among individuals who had jomed this organization recently.’ It cannot be claimed that these records are final or conclusive, but they point, with considerable weight, to the production of some amount of immunity. This‘is what might be expected, as it is difficult to believe that an epidemic can owe its cessation entirely to a diminution of virulence of the causative agent, and it is, on the whole, more simple to explain the cessation of an outbreak in terms of the production of a relative immunity in the population concerned. Ill. Freeuency or HAEMORRHAGE. Nothing is more striking than the unanimity with which all observers mention haemorrhage as a prominent feature of the disease in the autumn epidemic. This point is hardly mentioned in reports received durmg the summer, but records of the more severe cases show, nevertheless, that a tendency to haemorrhage existed then as later. In the post-mortem notes included in the Report by the Committee of the Director-General’s Advisory Council (B. M.J., November 9, 1918), it is stated that ‘ sub-pleural and interstitial haemorrhages were seen in 18 cases (out of 89 examined), but only as small localized areas’. Other post-mortem records of the same period afford similar information. In reports on the autumn outbreak, on the contrary, constant reference ig made to haemorrhage, blood being noted in the sputum and faeces, and epistaxis being often recorded. Notes kindly fur- nished by Dr. L. Stewart Sandiman, Chief Medical Superintendent, Q.M.A.A.C., show that menstruation is very frequently precipitated by attacks of influenza. The report by Captain T. H. G. Shore, R.A.M.C., lays much stress upon the constancy with which haemor- rhages were noted post mortem and suggests their importance as a factor in the inception of the pulmonary complications of the disease. The numerous pathologists who have sent in reports are almost unanimous in noting haemorrhages in the lungs, and mention made of bleeding in the suprarenals, the brain, the pericardium, the pleura, and other situations. Haemorrhage in the rectus muscle is frequently reported. An interesting note by Captain Murray