Medical articles from 1832, 1889 and 1918

[Sharpe]

I was studying in the library (Medical Center Library) for an exam, and for a break it occurred to me that there were journal articles there from 1918 and 1889. So, I decided out of curiousity to see what they had said. Sure enough, some of them were interesting. I've decided to take the next few minutes to type a couple of them, with possibly more in the next few weeks.

Keep in mind that in 1918 they still thought that it was caused by bacteria (H. influenza--though they called it B. influenzae at the time), and thus often sound very confused, because the bacteria that they thought it was, such as H. influenzae, could not be found in most patients. They usually refer to finding various species of streptococcus, which we now know are often found in the oropharynx without causing any symptoms. I wish I had time to make a list of the articles that I think are most interesting. It really is fascinating stuff. For instance, in some areas that were experiencing 'epidemic influenza' they were simultaneously experiencing 'epidemic polio'. They report epidemic encephalitis, etc. Anyway, here's the first article.

 

[Sharpe]

Re: Medical articles from 1918

Re: Medical articles from 1918

Provisional Notes: On the Pathology of the Present Epidemic
Nov 23, 1918
The Lancet
---------------------------

The arrival and progress of the influenza pandemic in London appears to have been unexpected among the population and to have caused a certain extent of dismay. The curious isolation of different communities due to the difficulty of travel and the absence of press facilities has put back the distribution of common knowledge to what it was a hundred years ago. It is possible to read about occurrences in South Africa or Bombay, but news from towns in this country only filters through gradually and often in a distorted form. Thus, while the influenza epidemic has been proceeding sporadically or acutely in Portsmouth for months, the fact has hardly been referred to outside.

Here in Portsmouth the disease has been more or less endemic since the outbreak of "Spanish Influenza" in the spring. Pneumonia since that time has been prevalent in the Navy, but since that time, it has been certainly more prevalent than usual and has been the subject of considerable inquiry and study. The number of cases of empyema was remarkable. In these were found not only pneumococci but also in many cases haemolytic streptococci, which gave all the ordinary reactions of streptococcus pyogenes.

The general opinion at that time was that the cases were due primarily to either of these organisms or, indeed, to other "respiratory organisms", since streptococcus viridans and streptococcus mucosus were sometimes met with. It was the general impression that "respiratory" bacteria had taken on an increased virulence, owing to the somewhat unsatisfactory weather and the presence of large numbers of young "new entries" in the barracks. The cases were very largely confined to these "new entries".

The question of influenza as a factor in the disease was discussed and studied, but owing to the complete absence of bacteriological support, the causative importance of this bacillus was discredited.

At the end of August, however, an acute alteration took place in the aspect of the disease. The cases among "new entries" became more and more numerous and the clinical aspect more and more acute. It became obvious that a serious epidemic had broken out. Large numbers of cases of acute pneumonia were admitted to hospital, and among these the death rate was very high. Localizing signs such as empyema became less frequent; indeed death occurred before tehse could develop. The outstanding feature of the disease was an acute septicemia of a particularly fulminating type.

At that time the epidemic was very largely confined to the young naval "new entries" and this fact, together with the unusual symptoms, led to all manner of curious suggestions as to its origin. It was even suggested that the disease might be pneumonic plague.

As the epidemic progressed, the age-incidence became widened and all types of men became affected, and finally as was inevitable, the civil population came under its influence. Clinically, it became more obvious that the acuter symptoms were nearly always preceded by 'catarrh' and the question of influenza as the initial infection again came into prominence. Bacteriologically, however, we were unable to obtain any evidence of this: neither in the sputum nor in throat swabs could we find influenza bacilli. Large numbers of cultures and microscopic examinations, ost mortem, were equally unsuccessful. In the trachea, lungs, and blood we now found almost exclusively the same hemolytic streptococcus pyogenes.

We were therefore inclined to the view that this must be a primary streptococcal pneumonia, although it was obvious that the objections to such a view were serious. On the other hand, we were conscious of the fact that the demonstration of influenza bacilli is at all times difficult, and particularly so under the septic conditions which were before us, and therefore when Dr. John Matthews published his technical method for growing B. influenzae, we at once went into the question further.

Among the first cases examined with a digested blood medium comparable to Matthews's we obtained cultures of B. influenzae mixed with large numbers of streptococci from the tonsil after death. In subsequent investigations, using a medium founded upon that of Levinthal (which we refer to as K medium) we have found influenza bacilli in so many men suffering from influenza without pneumonia, and in the organs of men dying from pneumonia, that we are of the opinion that it is unnecessary to look further than this organism for the cause of the epidemic, the streptococci and the other organisms which have been mentioned being only secondary infections upon lungs already infected by B. influenzae.

The difference in the bacterial flora obtained by the use of these media is so remarkable that we are prepared to admit that our original conclusions were incorrect and that B. influenzae was probably the real cause in most of the cases of pneumonia which have been occurring during the last six months. Under these circumstances it may be an assistance to those who still implicate various streptococci or who are discussing the possibility of an "invisible virus" to have our tentative results so far as they can be carried when half our staff is sick.

[now for the interesting postmortem findings--it's gross, so be warned, but fascinating to see real, peer-reviewed autopsy results from human 1918 H1N1, and comparing them to 2001-2006 H5N1 human autopsy and animal research studies. The similarities are quite breathtaking actually. This past week's reports from Surat, India of young men dying with blood coming out of their mouths come to mind too.]

Post-mortem findings

Macroscopic pathology

The post-mortem appearance of a rapidly fatal case will best indicate the type of disease with which we have been dealing here.

Externally: The body of a well-developed muscular young man, aged 18; marked cyanosis of lips and finger-nails; a quantity of blood exuding from mouth. Thorax: 200 cubic cm fo deeply blood-stained watery fluid in left pleural cavity. A trace of similar fluid in right chest. The parietal pleura on both sides is injected and shows scattered purpuric patches. The pericardium contains a little clear blood-tinged fluid. The heart shows nothing remarkable beyond hemolytic staining of the endocardium; the heart muscle is firm and appears in good condition. Left lung: the lower lobe is a dark purple colour and shows a fine fibrinous roughening in places; it retains its shape on removal and is heavy; it feels soft and jelly-alike, with several firmer areas 2 or 3 cm in diameter scattered about in the lung substance. The upper lobe is similarly affected in its posterior part, but in the anterior portion, it is spongy and feels aerated. On section the lower lobe is dark red colour and airless, being full of a thin hemorrhagic exudate which flows out from the cut surface. In the places corresponding to the firmer portions described above there are found solid, dark red, rather dry areas. Some of these extend to the surface of the lung and resemble infarcts in appearance; others however are more or less spherical masses situated centrally in the lung. The lower part of the upper lobe is similarly infiltrated by a thin hemorrhagic exudate, but the upper part is aerated and shows a congested spongy lung substance. The right lung is less affected than the left, the upper lobe being aerated and showing a red spongy surface. The bronchial tree throughout the lungs is intensely injected and contains bloody fluid which pours out into the trachea. The naso-pharynx, pharynx, larynx and trachea are much injected. This injection is most marked in the trachea. The naso-pharynx, pharynx, larynx and trachea are much injected. This injection is most marked in the trachea, especially in the lower part, which is a dark purple colour. The tonsils are prominent and injected and contain a few beads of pus. The cervical and paratracheal glands are injected, the latter being a dark purple; the gland below the tracheal bifurcation is enlarged and very soft and hemorrhagic [perhaps they're referring to the thymus?], as are the glands at the hila of the lungs [hilar lymph nodes?]. Abdomen: peritoneum and intestines appear normal. Spleen not enlarged. On section slightly swollen red pulp. Kidneys: cortex rather opaque in appearance, slightly swollen, no hemorrhages or other abnormalities detected. Suprarenals show dark plum-colored medullae, the left being the most affected. Bladder: nothing remarkable. Brain: some injection of smaller vessels upon the cerebral cortex. No signs of meningitis. No hemorrhage.

The above is a rapidly fatal case showing no reaction to the infection. The patient appears to have been drowned by the exudate into the lungs rather than killed by the septicemia.

In cases of longer standing there has been, in addition to the hemorrhagic condition, a marked broncho-pneumonia with pus in the smaller tubes [secondary pneumonia], and sometimes areas of grey hepatisation, as seen in lobar pneumonia. In several cases there has been a purulent bronchitis and peri-bronchitis, the lung presenting a marbled appearance owing to the purulent infiltration of the bronchial walls; the purlent infiltration can also be seen on the surface of the lung as a white peri-lobular network. Empyema is very common, there being, as a rule, a thin yellowish opalescent fluid with a sediment of thicker pus in teh most dependent part. Pyopericardium is frequent. The spleen shows evidence of reaction, being enlarged and having a swollen, often difluent creamy or dark-red pulp. The kidneys often show severe parenchymatous degeneration, but in only one case has there been an obvious nephritis. In a few cases dying ten days or so after the onset of the disease, the heart muscle appeared considerably affected, being very flabby and having the appearance of parenchymatous degeneration.

 

[Sharpe]

Re: Medical articles from 1918

Re: Medical articles from 1918

Another simply fascinating article from the Lancet:

Lancet
Sept 23, 1918
Notes on the symptomatology and morbid anatomy of so-called "Spanish Influenza"

The recent outbreak of what appears to be a new form of 'influenza', so-called, has greatly added to the number of cases admitted to the base hospitals with the provisional diagnosis of "PUO" [probably 'pneumonia of unknown origin'], and some months' experience in the medical wards of a large base hospital in France has suggested to me that it would be useful to attempt to classify the chief diagnostic features of some of the principal conditions which are admitted to hospital with this diagnosis.

The term PUO, although useful and in some cases necessary, is too loose to be wholly satisfactory. Moreover, a more exact diagnosis is desirable, both from the point of view of prophylaxis and, if necessary, isolation, and also for the purpose of prognosis as to the probable duration of the patient's unfitness for military service.

Certain of the conditions liable to be included under this heading have but to be remembered to be included under this heading have but to be remembered to be excluded in the majority of cases by appropriate clinical or bacteriological exam. Among these may be mentioned 1) malaria; 2) bacillus coli infections [probably now known as E. coli], and 3) malignant endocarditis. But a smaller group remains, comprising 4) the trench fevers; 5) the enteric group, including typhoid and paratyphoid fevers, which for my purpose may be considered together; 6) the influenzal group, including true influenza, and the recent epidemic, which in the present condition of uncertainty as to its bacteriological causation, may be provisionally termed "Spanish Influenza", and 7) certain aberrant cases of cerebro-spinal meningitis.

Symptomatology

The symptomatology of "Spanish influenza" is characteristic, and in view of the extreme prevalence of this disease at present it will be useful first to consider in some detail the principal features of this complaint as seen in France, considering en passant the various points which serve to distinguish it from other diseases closely resembling it.

The incubation period appears to be short, about 3-4 days. The mode of onset is characteristically sudden. A patient may be at work in his usual health in the morning and in the evening he may be in hospital with a temperature of 102-104 and presenting the appearance of acute illness. The earliest symptoms are usually shivering, pains in the limbs and back and very severe headache--generally, but not invariably, frontal in situation--and sore throat, and in almost all cases an irritating severe cough is also complained of.

The appearance in most cases is quite characteristic. The patient lies curled up in bed in a drowsy condition, with flushed face and injected conjunctiva, but there is little coryza, and physical signs, in the early stages at any rate, are remarkable by their absence. The facies, apart from the absence of coryza, very much resembles that of a measles patient a day or so before the appearance of the rash.

Although severe sore throat may be complained of, little can be seen in the throat beyond some general injection of the fauces, but in some cases edema of the uvula or slight degree of tonsillitis is present. Severe and irritating dry cough is usually present, but there may be no discoverable physical signs in the lungs at first. On the other hand, some coarse rhonchi may be heard all over the larger bronchial tubes, or a few crepitations may be heard at one or both bases. In other cases, there is an early generalized bronchitis, and in some few instances a dry pleurisy, particularly in the left axilla, may make its appearance almost at the onset.

A small percentage of patients develop serious pulmonary complications and the pneumonia arising in these cases presents several distinctive features. It is of a mixed lobar and broncho-pneumonic type. Several large patches of consolidation may be found, but not as a rule at the extreme base of the lung. Favorite situations appear to be in the axilla ... [moving down to the more interesting parts] ...

The heart condition of a very large proportion of these cases of Spanish influenza is interesting. Without any marked alteration in the size of the heart as discovered by physical examination, and with the apex beat little if at all displaced, there is a well-marked reduplication of the first sound at the apex or of the pulmonary second sound, which is also frequently accentuated; not infrequently both sounds are reduplicated. In many cases this probably indicates the presence of some degree of myocarditis. It is noteworthy that in a large proportion of cases eamined postmortem here myocarditis was found, and more or less dilatation of the heart was constant. In cases in which a murmur develops and becomes increasingly musical, with displacement of the apex beat, the question of an early ulcerative endocarditis mucst be considered, and a blood culture and leucocyte count should be done with a view of excluding this condition.

[Interesting paragraph on rash--a reason why I pay some attention to lethal outbreaks of disease with rashes--such as in the last year in rural parts of the Philippines, in which they've been blamed on meningococcal meningitis though in most cases they were never able to find meningococcus in the blood, concluding that the drug wiped out the bug that wiped out the person--the rash is probably caused by the same mechanism--disseminated intravascular coagulation. Note that it is known as the Waterhouse-Friderichson reaction and also involves adrenal insufficiency, which based on the previous autopsy result I copied out, probably was occurring in the patients too.]

In at least four instances I have seen a scarlatiniform rash so closely resembling the rash of scarlet fever that very careful examination was required to decide that we were not dealing with a case of the latter disease. The rash, however, was more markedly patchy in distribution, evanescent and recurrent, and in some cases irritating; and the appearance of the patient's face and throat, together with the absence of the rapid pulse and strawberry tongue of scarlet fever, and also the comparatively low temperature at the time of appearance of the rash, enabled us to exclude the existence of this disease. [the patients were probably switching to hypothermic due to all their internal bleeding.]

One patient, however, who gave a history of another man in his hut having had a rash, was transferred to an isolation hospital, but at a postmortem exam made after his death from broncho-pneumonia a few days later the appearances presented were precisely those found in other cases of deaths from this influenzal form of pneumonia. The tongue of these influenzal cases is lmost invariably dirty and furred, and in some cases there is an offensive almost pathognomonic odor of the breath. [the odor they are referring to is probably the result of the breakdown of hemoglobin by stomach acid--which causes a profoundly foul smell.]

.....

[Now for the meningitis/encephalitis-like paragraph--the reason why it's good to pay attention to Uttar Pradesh and Nepal's large, lethal encephalitis outbreak among children already vaccinated against JE.]

There is a group of cases admitted with occipital headache and pain in the neck closely resembling cases of cerebrospinal meningitis, but, as a rule, the rigidity of the neck is much less marked. In some of these cases the diagnosis is rendered more puzzling by the presence of what I may describe as a "spurious" Kernig's sign--ie., it is impossible to say that Kernig's sign is absent, although it is more of the nature of a "clasp-kinfe rigidity" than a true kernig's sign. Lumbar puncture may, however, be necessary to exclude cerebro-spinal meningitis, when, although the fluid may escape under high pressure it is clear and does not present the characteristic cytological features of the latter disease.

[This is interesting--regarding the blood counts they found in 1918 patients--recall the constant reference to low blood counts in Indonesian patients.]

A blood count is of great value in helping to discriminate between the various causes of PUO [Pneumonia of unknown origin]. The trench fevers are usually accompanied by a moderate leucocytosis [high WBC count]. Malaria, malignant endocarditis, scarlet fever, and cerebrospinal fever, as a rule, show a marked leukocytosis. The enteric group is more usually characterized by a leucopenia. In "Spanish influenza" the leucocyte count usual varies between 5000 and 9000 per cc.

[This number is actually somewhat surprising. It is actually in the range of what we in the medical field consider normal, though for someone infected with something, it is low. That is why they consider it low.]

 

[Sharpe]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

Now for an article from 1889-1890 in the Lancet. What is fascinating about this article is that it is the first time I've ever seen a report that mentions animals (in this case dogs and cats) other than horses dying of pandemic flu until H5N1 reared it's ugly head. It is ironic that we are again talking about northern Egypt here--it's like history repeats itself.

March 1st, 1890
Lancet
Egypt

About Christmas day, the influenza first appeared in Alexandria, and although it has not yet been reported among the 1000 soldiers of the Army of Occupation, it has been very prevalent amongst the civilian population. The cases have been less serious than in Europe, and the few deaths amongst Europeans have taken place in people already enfeebled by previous diseases. Cats and dogs are said to have been affected, but not horses. The average death rate for this time of year among natives in Alexandria is 48.3 per 1000 but for the week ending Jan 23rd it went up to 58.1, and the following week to 70.1, since then falling to 67.3. The number of deaths in the last week has increased from 203 to 245, and the greater part of this increase is due to diseases of the respiratory organs. In Cairo, the influenza was first noticed about Jan 10th, and is still mildly prevalent, though it is only during the last three days that cases have occurred among the 2000 English troops. ....

 

[Laidback Al]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

Yes, fascinating history. Have any of the "unusual" 1918 flu symptoms been identified in confirmed H5N1 patients such as rash, heart problems, headache/neck pain?

 

[Sharpe]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

Another fascinating article, this one from January 4th, 1890. Guess what it's entitled?!
"Influenza or Dengue?"

Sirs--at the time that the article on influenza appeared in your issue of Dec 21st, in which you say it will soon be upon us, we were attending a large number of cases of a disease hitherto unknown to us. We are convinced that the character of the epidemic, so called influneza, is by no means certain. From our observations... it would appear ... that there are, if not actually two different epidemics, at least two distinct types of the same. The one, a short and sharp fever, characterized by a sequence of events identical with those of dengue .... and an almost complete absence of coryza, ophthalmia, cough and those symptoms generally considered diagnostic of influenza; the other by symptoms more strictly analagous to those of the influenza, with which, of a less virulent type, we are familiear as an extraordinarily severe cold. The majority of our cases, which are spread over a wide area, have suffered from all or most of the following symptoms [now it gets interesting]: a severe initial rigor, followed immediately by intense headache (throbbing and frontal [see 1918 symptoms in previous article]), nausea, vomiting (those who vomit getting almost immediately relieved; rapid pulse, at first soft and full, afterwards slow and hard; tumultous action of the heart; rapid rise of temperature to 103 or 104; restlessness, with sleep-walking and mild delirium, or in the case of children a semi-comatose sleep [Ginting]; flushed face, foul breath [recall reason], and dirty, parched tongue; muscular pains in the legs and abdomen; critical hemorrhages, as epistaxis or menorrhagia; sweating, occasionally scarlatiniform or petechial eruptions not followed by desquamation [classic bird flu]; tenderness over both sides of the neck; extremely painful sore throat, with relaxed and congested palate and fauces, and sometimes vesicular ulcerations; slight jaundice and giddiness, and rapid defervescence (in children on the second day and adults on the 3rd or 4th day) and subsequent extreme prostation and anemia, with a marked tendency to relapses, more than one of our patients having had a recent attack when traveling on the Continent. The minority of our cases have exhibited some of the above symptoms in a milder degree plus those of a more than usually severe tracheal, nasal and orbital catarrh. ...

 

[Sharpe]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

Yes, fascinating history. Have any of the "unusual" 1918 flu symptoms been identified in confirmed H5N1 patients such as rash, heart problems, headache/neck pain?

I don't have time to give you a complete answer yet, but the short answer is yes.

 

[Shannon Bennett]

Re: Medical articles from 1918

Re: Medical articles from 1918

Cases of emphysema and polio as well as more than the usual number of cases of pneumonia. We are looking at both lung involvement and neurological symptoms of the flu I suspect. A very sneaky virus that evidently mimics a lot of diseases.

 

[sharon sanders]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

"Cats and dogs are said to have been affected."

This is important to remember as many people treat their pets as family members. I do.

http://www.flutrackers.com/forum/showthread.php?t=6028&highlight=pets

 

[Sharpe]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

I leave you with one last article before I leave the library. This little side-project has taken far more time than I planned, and now I need to go home and study. As you know, in the 19th century, we are aware of several influenza pandemics, apart from 1890, including 1847 and 1831. This library has the entire Lancet collection, amazingly enough, and it is all available to med students to look at, which is just SOO cool. Some of the books are crumbling a bit, and so I had to be very careful with them (thinking to myself while I was turning the pages that there was a remote possibility that doctors with 'bird" flu patients from those years were perusing these same pages 150 years ago. I just hope they washed their hands, if you know what I mean! Anyway, unfortunately I couldn't find mention of 'influenza' in the 1847 or 1831 Lancets, though I'm sure I would have if I looked more closely, but they're hundreds of pages along. One thing did occur to me, while perusing them, that I leave with you as terribly curious. In all three of those years that I looked--1890, 1847 and 1831, there were 'cholera' pandemics discussed in various places that were far worse than they'd ever seen before, they had huge lethality rates, and often frightened the populations, often devastating armies too. I put this out there because H5N1 causes severe diarrhea, and has been misdiagnosed time and again for diarrheal illnesses like cholera, and back then, cholera was simply a name given to a set of symptoms including diarrhea. Most strikingly was the 1890 report I read about Baghdad, in which a large portion of the city died, and the rest ran away. Then there was an 1847 report from the British army in Karachi, which was devastated. And finally, I come to 1831--the reason why I'm going on this massive tangent in the first place. Because the whole year, all they talk about is this "malignant cholera epidemic" and all the types of treatments that they're trying on it. Some of the articles in 1831-2 interestingly talk about pneumonia in dogs, cats, swine, cattle and horses, with one of the writers mentioning that he has known 1/4 of the pigs at a farm to have died of pneumonia suddenly. Curious. Anyway, here is part of the last article. How little the world has changed.

Lancet
September 8, 1832 (exactly 174 years and 5 days ago)

A pestilential disease of strange and overwhelming malignity has raged for nearly a year in various parts of Great Britain, and up to the period at which we write, we find that the ratio of the mortality to the total amount of cases is not diminished, either from a decrease of intensity in the epidemic, or by the practical experience in its treatment which our medical men have yet acquired. Despite the discoveries of specifics daily trumpeted to the world, despite the exulting statements of successes thereby achieved, the reckless, unsparing plague still ravages some of the fairest spots of our once salubrious islands, usurping the place of our older and milder epidemics, and causing a daily amount of sudden mortality, more like the desolation of warfare than the progress of disease.

During the preceding week, it has ben our unhappy task to witness examples of domestic distress such as should urge all men of the least humanity to rack their faculties for the devising of some means of staying the progress of this sad calamity. We have been accustomed to the typhus and dystenteries of Great Britain, we have known tents pitched for the sick on the public commons, and we will not deny that from these diseases we have witnessed full many a scene of bitter domestic woe. But aught to parallel the ruin which the existing malady creates by the sudden annihilation of family ties, we know not, nor have read of, in the progress of any other epidemic, since the cessation of the old "sweating sickness". We do not mean to deny that as yet, comparatively speaking, we have been mercifully dealt with; nevertheless, this comparative mercy but proves the innate malignity of the pest, and, even, as it is there is scarcely a member of society, moving in any extended circle, who has not already felt the loss of some acquaintance, relative or friend.

Under these circumstances we repeat, it becomes an urgent duty for us all to bestow our deepest attention on the subject, and this duty is rendered still more imperative by the fact, that the fatal epidemic has already made its reappearance for the second and third times in the various parts of the continent it first visited last summer; neither can we rationally hope that a few months or years will rid us of the causes of the malady, when we find by the latest arrivals from India, that six months have not elapsed since the garrison of Colombo, in Ceylon [Sri Lanka], was decimated by a sudden irruption of the disease.

It seems then to us, after deep reflection on the subject, that the improvement in the method of treating the malignant cholera, should be the paramount object in our future exertions. Of the remote causes of the disease we know nothing, absolutely nothing. But we confess that the chances of elucidating these causes do not seem to us to present an encouraging field for the investigator. The symptoms of cholera and its pathology, whether anatomical or chemical, are now sufficiently well known; anatomy has scrutinized every fibre and tissue of innumerable bodies, and chemistry has not been idle in the analysis of the blod and various fluids peculiar to the disease. And what is the result? The anatomical pathologist confesses that he can discover nothing; the chemist, although he has made many interesting observations, still is forced to admit that the most remarkable features of the disease remain unexplained by his experiences.

[.... Goes into all the weird treatments that they used back then such as bloodletting...]


And the beginning of a shocking letter named "The Cholera in Paris", dated April 10th, 1832.

Since the publication of the last number of our journal, the capital of France has been the scene of such melancholy events as will form one of the most gloomy pages in the history of pestilential disease. Within ten days from its announcement in Paris, 7000 cases of cholera have occurred, of which number 3,600 have terminated fatally. [!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!] The mails received, as we write, give the last daily report at nearly two thousand cases and eight hundred deaths with the last 24 hours. [!!!!!!!!!!!!!!!}

While it si remembered that this disease and mortality, enormous as they are, are but the amount of what has occurred in the city of Paris alone; and when it is also borne in mind that the scourge is raging with equal violence in all of the immediate suburbs of the town, from which the cases are not reported; and lastly, when it is taken into consideration, that at least one-third of the cases in Paris are not reported, as is the fact, a just idea may be formed of the overwhelming power of this almost unprecedented calamity. [sheesh.]

 

[sharon sanders]

Re: Medical articles from 1832, 1889 and 1918

Sharpe- Thank you for this series. It illustrates the historical cycle of infectious disease.

 

[Sharpe]

Re: Medical articles from 1832, 1889 and 1918

Thx Florida1!

 

[Snowy Owl]

Re: Medical articles from 1832, 1889 and 1918

Thank you very much Sharpe, excellent resources.

 

[prepdeb]

Re: Medical articles from 1832, 1889 and 1918

Excellent reading. Thank you Sharpe for posting these.

Everything old is new again.

 

[hawkeye]

Re: Medical articles from 1889 and 1918

Re: Medical articles from 1889 and 1918

Thank you for taking the time to share the information Sharpe. Absolutely facinating.

Another fascinating article, this one from January 4th, 1890. Guess what it's entitled?!
"Influenza or Dengue?"

 

[Sharpe]

Re: Medical articles from 1832, 1889 and 1918

Everything old is new again.

Well put, Prepdeb. You're absolutely right. The greatest weapon we have to fight this pandemic compared to previous ones is knowledge, the knowledge of what happened before and the wisdom to understand what happened that comes from decades of basic science investigations into epidemiology and virology. Finding parallels is SO important, because it puts everything that's going on now into perspective. Several things are clear, for instance, from what I read yesterday in the Library. The viruses involved evolved. In 1890, cats, dogs and people were being affected in Alexandria, though the lethality rate was not all that severe. Less than double the background death rates. By the time it reached Europe, it was much higher however, and animals aren't mentioned any more. In 1918, the first people affected were people younger than 28--the year of the previous pandemic. It appears quite possible that the 1890 pandemic provided people a significant level of immunity in 1918, but nevertheless, by the end of the 1918 pandemic, it had become severe enough to affect older people too. It appears likely, then, that the virus was circulating at low pathogenic levels between 1890 and 1918, only to erupt and evolve quickly when huge numbers of young men started moving around the world and living in close quarters for WWI.

 

[Dark Horse]

Re: Medical articles from 1832, 1889 and 1918

Many thanks, Sharpe. Very interesting. Good luck on your exams.

 

[Sharpe]

Re: Medical articles from 1832, 1889 and 1918

Thanks Dark Horse and everyone else.
Well I'm back in the Library, and read through a few journals. In a case series of children stricken by 1918 flu written up in late 1918 by a New York doctor in Medical Record, he talks about the occasional child who has severe diarrhea at the onset. He blames it on the bacteria--thinking naturally of course that it was a bacterial disease causing food poisoning-like symptoms. Some of the cases really sound like they came out of a modern Indonesian newspaper. Many of the 1917 and 1918 case reports are quite interesting because they have frequent discussions of epistaxis,followed by death, preceded by an influenza-like illness--but they called it pseudo-leukemia and thought that influenza had been a misdiagnosis (because of leukemia's association with bleeding due to low platelets, etc.), but when they examined the blood, they found leukopenia. Anyway, if I find anything really interesting, I'll share it.

 

[Sharpe]

Re: Medical articles from 1832, 1889 and 1918

An interesting letter indeed. Written on September 29th, 1917, called Purulent Bronchitis. It makes one want to relook at a lot of things in light of the possibility that H1N1 was circulating and becoming more virulent over the previous few years until 1917.

.....

I have been studying closely for nearly 15 years both the clinical aspects and bacteriology of the respiratory tract, and have been much struck by the gradual increase, especially during the last four years, in the severity of these bronchitic and pneumonic attacks, and I can assure the authors that the condition they describe has not been confined to the Aldershot military area nor even to the military as apart from the civilian population. I have had large experience of it in private practice and among the New Zealand troops at Codford and Hornchurch. So certain was I that a culmination would be reached last winter that I strongly advised the DDMS, NZEF in England that a special chest hospital should be established, and predicted a very high rate of incidence among our troops at Codford, which he subsequently informed me had been exceeded. The mortality rate at Aldershot was, I believe, exceeded among the New Zealand troops at Codford. The severe epidemics of pneumonia which have ravaged Guatemala city for years [!!!!] have, I am informed, a mortality rate of 40 per cent. [!!!!!] It is highly probable that the grouping together of large numbers of men in huts and marquees tends both to raise the rate of incidence and mortality rate, but, as I have stated, the condition freely existed before the war and has been quite common among the civilian population.

Pretty interesting, that comment about Guatemala, isn't it? I wonder if I can find something more about that...

 

[Sharpe]

Re: Medical articles from 1832, 1889 and 1918

One other interesting thing I noted. In several of the 1918 articles on Spanish Flu they make the comment that the 1890 Influenza pandemic produced a great deal of deafness. On the other hand, in 1918, they say, it was different, because there wasn't any deafness caused by it. And yet at the same time, there are literally dozens and dozens of articles talking about the soldiers coming back from the war completely deaf--they blame it all on war-noise and shock, but one has to wonder if those weren't the same people that caught that bug...