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Show GENERA I, INFORM A T I 0 N EPIDEMIC INFLUENZA Spanish Influenza, LnGrinpc i:iMt)IIIO ixkiaji:xza Under uulous nnmos, epidemics corresponding to epidemic Influenza hae occurred at Irregular Intervals I slnco accurate descriptions havo boon mmlo of disease It Is likely that at itslll cnillor times this disease was combined and confused with other epidemic disoiders, and so did no! stand out ns nn entity until n relatively rela-tively modern porlod. Thfthlstoiy of epidemics of Influenza Influ-enza docs not differ so much from that of other diseases spiead by hu- Imnn tntcrcoursa that nro usually called contagious. A widespread epidemic follows tho lutroductlon of n specially virulent virus nnd there 'follows a general Immunity amon those of tho population who havo boon Infected. As tho epidemic dies out tho Infoctlon decreases In viru- ilonco and only sporadic cases occur. From such cases, nnd probnbly cvhronic carriers, local outbreaks occur; oc-cur; but tho general Immunity pro- vents any gonoral epidemic. After a period of years a now susceptlblo population has replaced tho Immuno one, nnd with tho Introduction of a fresh virulent virus n general epidemic epide-mic Is again brought about. This would account for ho great susceptibility suscep-tibility of young persons, and as It Is twenty-eight years since tho last great epidemic, wo should not expect ex-pect many Individuals above 30 years I of age to be now affected. CAUSATION The causative agent of epidemic Influenza has not been certainly recognized. Tho attachment of tho namo "Influenza bacillus" to a small bacillus described by Fleltfer In 1892 has beon followed by Its fro-nuont fro-nuont reception as the actual sped flc 'agent. Thero Is, however, much uncertainty as to its otlologlc rolo. It Is to bo hoped that tho study of the" present epidemic may lead to somo cortaln knowlcdgo, regarding the essential cause of tho disease. This should enable us to dotermlno whether tho edomlc cases and those If limited mild epidemics nro really Idnttcal with tho ones observed in the great periodic outbreaks COURSE OP THE DISKAHR Tho cases In tho present opldomlc begin usually qulto suddenly with pain In tho head, back, eyes, limbs nnd Joints. With tho pains ahero is great prostration, chilliness nnd a fovcr of from 101 to 104 P. Tho pulso dees not become very rapid, and the patient ofton Is drowsy, vomiting may occur. Sometimes thero may bo diarrhoea, but usually hero Is constipation. After tho dls-oara dls-oara has becomo established tho mucous membranes of tho noso and Miroat becomo roddoned and thero 's nncozlng and redness of tho con-lunctlvn. con-lunctlvn. Involvement of tho larynx causing hoarseness, and of tho bron-'hl bron-'hl causing cough, are common. ? hero H tt' assoclnted leukopenia or n normal loukocyto count. A leuko cytosis polnns to como complication. The fever gradually falls to normal ifter a fiw dayn and mmo or loss prostrntlon Is present duiing convalescence. con-valescence. A transient alnumlnuria I- f-c"iucit. Many of tho cases havo hemorrhages of tho mucous me.m-branoa me.m-branoa of Hip noso, some of tho irethiacr bowel. SECONDARY 1'NHUMOXIA Not Infrequently a lobular pneumonia pneu-monia dovclnps after a few days and this Is lc-sponslblo for most of tho fatnlt!03. Tho pneumonia dlffors from the usual picture of pneumonia In that tM t mperatuio may bo very slight and the pulse rate may give '!'. little Indication of tho gravity of tho condition. These caBos, Instead oL ,H subsiding, may come down to prac-- "'' H tlcally normal temperaturo for - HHI twelvo hours when there may be a 'HHI hlinrp rlso In temperature,, not fol- ?. lowed by a chill, backache, boneache . headache or nausea. 'H .About this tlmo thero may also be H expectoration containing bright ' red ' blood. As a rule, twelve or twon- - B ty-four hours after tho second' riso" B In temperature, on physical exatnlh-.- , M atlon In the lowor lung, Is a prepon- H dernnce of cases on the left side, small areas about the size of n silver ' H dollar of typical pneumonia consoll- H datlon are found by auscultaton; ' These areas may becomo marked so that by the second day of tho second rise, scattered through tho lung, M probably both lunga, ten or fifteen of H these small areas may havo appear- B ed. If tho patient did well theso- would .g.adually disappear. Thoy M did not rsolvo as a pneumonia H would resolve. Tho clearing up of M tho lung after this In tho recovered k M putlonts wns remnrknblo an to its M rapidity. Other cases went on to a B typical lobar, massive consolidation, M so far as tho physical signs wo to M concerned, with dullness, Increase In M fremitus, typical tubular volco nnd H bicathlng and nil tho signs, except M that thprc was not n very marked BH Incroaso In tho pulse rate', and the M respirations wcro not up to this time Ql matkcdly Increased. Cases with al- . H most completo consolidation of the SHc lu,nE as to tho lowor lobes, witn i r3m- toiaepraturo or 105 would, havo a K Jf'jij pulso around 100, with rcppi:atloiu 5fi (Con'lnupd on P"3o "i 'r , 'PM |
