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.

    17/142 (page 15)
    B. Other Organisms as Secondary Infective Agents. (a) B. influenzae (Pfeiffer). Had it not been for these recent observa- tions which have gone so far towards demonstrating the etiological role of a filter-passing organism, the evidence in favour of B. wnfluenzae would probably have been regarded as conclusive. As it is, this bacillus must still be admitted to be the earliest and most constant ‘associate ’, appearing on the scene within the first hours of the attack. To what extent it facilitates the operations of other and more virulent germs still remains to be discovered. Tytler, Janes, and Dobbin, in commenting on their finding of B. wmfluenzae in 90 per cent. of the cases examined, sum up as follows: *° Allowing for errors of technique, unavoidable in a series of this size... this means that the bacillus was constantly present.’ The presence of B. influenzae in a high proportion of cases within the first week of the disease, and at a time when streptococci and “pneumococci were much less frequently found, is well shown in the chart in the paper by Patterson, Little, and Williams. These observers cultivated B. wmfluenzae from sixty-two out of sixty-three fatal cases. Not only is B. wmfluenzae present in nearly every case but it tends to evoke immune responses early in the disease. In confirmation of the work of Captain J. Cruickshank in the summer outbreak, the presence of specific agglutinins for this ~ organism has been demonstrated, during the autumn epidemic, by Captain A. Fleming, Captain H. H. Perry, Major H. G. Gibson, Major I. B. Bowman, and by Captain P. Hartley whose report on this subject 1s included in Part II; but the reaction has not yet been shown to be either so constant or so clear-cut as to serve as a reliable diagnostic method. Its interest lies, rather, in the evidence which it affords of the early presence of B. Pfeiffer as an organism actually evoking immunizing responses in the cases examined. It is worthy of remark that the agglutination was most complete and most constant in blood-samples collected up to and including the seventh day, after which the phenomenon was less frequently demonstrated. B. wnfluenzae has been cultivated from the blood stream on several occasions, though this is rare during the normal course of the disease. That it invades the circulation fairly frequently, as a terminal infection, is shown by the observations of Lieutenant B. A. I. Peters, R.A.M.C., who recovered it from the heart’s blood in nine out of forty-one cases examined by him post mortem. At the same time nothing is more curious, in view of the constant presence of B. Pfewffer in influenza cases in France and elsewhere, than the negative reports by workers of undoubted merit in certain other localities. In the Medical-Supplement of the Daily Review of the Foreign Press of September 1, 1918, negative or inconclusive findings of the B. influenzae are recorded by Gruber, Friedmann, Uhlenhuth, Kolle, and even Pfeiffer himself. The technique for the isolation of B. influenzae has been much improved of recent months, and it becomes a question of interest as to how frequently this organism will be found present in the sputum of chest cases other than influenza during times when this