Re: Medical articles from 1832, 1889 and 1918
This is yet another interesting article. They took samples from the livers of people in Egypt who had died rapidly from Spanish Flu and they injected them in rabbits, and then continued to transfer samples from one rabbit to another, resulting in faster and faster death. They thought it was pneumococcus they were dealing with, obviously, but we know what else was lurking in the broth.
Lancet
June 28, 1919
Pathogenic properties of the Diplococcus
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? In view of the increased virulence of the disease in October, the experiments were repeated with rabbits. 0.5 cubic cm of nutrient broth culture were injected intraperitoneally, the diplococci having been isolated in pure culture from the liver of fatal cases. Some 12 to 14 hours after inoculation, the rabbit began to show signs of distress; the temperature gradually rose, it suffered from diarrhea, and gradually became more and more lethargic, finally dying in from 22-28 hours in a state of coma. ? In every case, the pleural cavities contained a hemorrhagic exudate? By passage through three or four rabbits the virulence of the organism can be still further increased and a fatal result obtained in from 15-20 hours.
Interesting?note the nephritis (kidney infection)
Lancet
March 15, 1919
The Influenza epidemic in British Guiana
The recent influenza pandemic appears first to have made itself manifest in Georgetown, the capital of the colony, in November 1918. Clinically the symptoms do not appear to differ from those characteristic of the disease in other centres which have suffered its ravages. The disease has taken a fearful toll, more particularly of the lower classes of the community, the poor East Indian and black, generally already debilitated by the ravages of chronic malaria or filarial infection. Death has been due, in the vast majority of cases, to a rapidly fatal broncho-pneumonia, and the purpose of this article is to give a short account of the pathology and bacteriology of the disease in this country.
Post-mortem findings are based on examinations carried out on 24 fatal cases of influenza at the height of the epidemic. Generally marked cyanosis was present externally. Internally the pathological changes appear to center in the respiratory tract; nasopharynx, pharynx, larynx, trachea, and bronchi show congestion of the mucous membrane with exudate varying to a certain extent in character, but generally tenacious and sometimes stained with blood. Pleurisy was rare, only being present in two cases and then of the acute fibrinous variety.
The heart and pericardium showed no particular change. The lungs showed generally a broncho-pneumonia of the diffuse variety. If only a portion of the lung were involved, it was invariably the base, and a constant feature was the intense congestion of the lungs; the broncho-pneumonic areas on section are hard and reddish-gray in color.
The brain was involved in only one case ? An acute parenchymatous nephritis was present in a few cases. The liver frequently showed some fatty change.
Jan 4th, 1919
Lancet
The Influenza Scourge
Commencing in late September, Canada has passed through a terrible epidemic of influenza. It is yet impossible to give any figures for the whole country, but the deaths in Toronto reached as high as 150 on one dya. In Canada the disease has not been made reportable or notifiable and no quarantine has been practiced, but isolation has been put into force to some extent by private practitioners and in hospitals. Toronto grappled with the epidemic by rapidly preparing two emergency hospitals, one of which has not been used. Toronto?s health officer claims that that city reached the crest of the epidemic much earlier than other Canadian and American cities (think Sars?). Some physicians used a prophylactic vaccine and speak well of it, and the Ontario Board of Health participated in the making of such vaccine. That board discussed reporting, isolation, and quarantine in regard to influenza before the epidemic invaded the province, but concluded that these measures were impracticable. There was much disruption of business and educational life, but speaking generally, each municipality was left to its own resources in fighting the disease. Evidence is strong that the mass of the people still cling to alcohol in the treatment of influenza. In Prince Edward Island, clergymen were empowered to write prescriptions for alcoholic liquors (funny stuff), and temperance laws were in general more plastic than at other times. In Toronto there are two licensed vendors of liquors under the Ontario Temperance Act and the long lines of waiting citizens testified to the number of prescriptions written by physicians. The Montreal Board of Health had prepared a circular advising the public to take to bed and send for the physician at the first sign of the disease. In regard to vaccines, the public was informed that the treatment was still in an experimental stage, and that no body of medical opinion was prepared to endorse their use as a prophylactic measure. The opinion has been widely expressed that the epidemic of influenza ?has taken a terrible fall out of? preventive medicine. It is scarcely understandable how medical officers simply waited for the inevitable. {WHO repeating history)
January 4th, 1919
Lancet
?The Symptoms?
The onset has generally been sudden and acute. There have, of course, been many quite mild cases, but again and again a perfectly healthy man may be taken ill in the street or on duty with a sense of general malaise; he feels chilly, suffers from aches in his back, limbs and head, and rapidly develops such a sense of prostration that wherever he is he has to lie down. He may rally sufficiently to be able to himself back to his quarters with some difficulty , or he may be so bad that he has to be carried.
He gets to bed and is only too glad to stay there. He is nauseated at the sight of food and ?feels rotten?. Though drowsy, often he cannot sleep. His temperature is raised, generally as high as 104 degrees, or more. The pulse is full and firm, its rate isas a rule not raised proportionately to his temperature, and his respiration rate is between 18 and 30. Many cases have red injected palate and anterior fauces and complain of severe throat, but many have no such complaint, and on examination of the chest, physical signs are absent. The tongue is almost invariably coated with a thick fur, superficially yellowish-brown at the back and on the dorsum, pale yellowish-white beneath the darker surface and often with no fur on the margins and tip.
Epistaxis, sometimes of almost alarming degree, has been an unusually common phenomenon in this epidemic, sometimes at the beginning, more often after the patient has already gone to bed, and in quite a number of cases, the hearing has become much impaired, a few cases having become temporarily stone deaf (this was noted in 1890 too). Quinine prophylaxis may be factor in this, but that there is middle-ear catarrh in at least some of the cases has been shown by subsequent ear discharge, and in one or two cases by considerable bleeding from each ear.
Vomiting has not been usual, but it has occurred often enough to attract attention. Diarrhea to the extent of six or seven loose motions on the first day or two has been rather less uncommon.
Abdominal pain has not been a pronounced feature although occasionally it has existed of sufficiently severe character to lead to a provisional diagnosis of appendicitis, and even to some solicitude as to differentiation from an acute abdominal condition urgently needing operation.
?(fascinating stuff on the severe symptoms?I will hopefully get a chance to type this up some time). On the ?smell? of influenza patients, hemorrhages, hematemis, hemoptysis, color of the patient, cough, parotitis, interesting rashes, and nephritis (actually I might copy a sentence from the nephritis paragraph in light of the kidney failure patients in India we are reading about this week.)
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Large, red blood-oozing kidneys of the type seen in acute scarlatinal uremia have been almost constant at the autopsies of the fatal cases, and the occurrence of this acute nephritis is further evidence of the infecting agent, or at any rate its toxins, being widespread throughout the body, the ?pneumonic? part of the disease being but a portion of the whole.
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But I didn't look at the 1831 one.
