Part 2 — THE BACTERIOLOGY OF EPIDEMIC INFLUENZA WITH A DISCUSSION OF B. INFLUENZÆ AS THE CAUSE OF THIS AND OTHER INFECTIVE PROCESSES (continued 2)
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It is my opinion, as expressed above, that practically all of the population are rapidly infected during such a pandemic as we have had. The resistant have escaped, and it would appear to be very difficult to break down this resistance. The human experiment carried out by Pettenkofer on himself and his assistant 199with vibrion choleræ is an example, but we have numerous others demonstrating the same kind of phenomena in most of our diseases of established bacterial origin. In diphtheria we have an explanation in the varying antitoxic content of the sera, but we really know very little of what are the actual factors in preventing or determining infection among exposed individuals in the natural history of most diseases. The reports of Leonard Hill and Gregor are well worth reading in this connection, as well as the editorial in the same number of the British Medical Journal. We are not in a position to be very dogmatic on the causes of epidemics. The mere presence of the bacteria or any other living virus is not in itself sufficient to explain the phenomenon, and one of the chief objects of this paper is to indicate from the collected facts, that in the words of Flexner, “the case against the influenza bacillus is not proved.”
Conclusions
1. B. influenzæ is one of a group of hemophilic bacteria and there are probably strains of this organism which may be differentiated which will lead to further subdivisions of the group.
2. B. influenzæ as we understand it today, is distinguished by its morphological and staining characters; its requiring hemoglobin in some form for its development; its showing symbiotic reactions with other bacteria which stimulate its growth; the production of a toxine and its usual low pathogenicity for animals.
3. The media found most favorable for its growth are those containing blood with the hemoglobin content altered in certain ways, (1) by heating, (2) the addition of various chemicals, (3) by the action of other bacteria or their products. The heated blood agar I have found to be a most efficient and readily prepared medium.
4. Since B. influenzæ is so difficult to isolate, it is necessary to be very cautious in interpreting results unless the greatest effort has been made to demonstrate the presence of this organism.
5. B. influenzæ should be considered, from the evidence at hand, as the bacterial causative agent in epidemic influenza, and it should be recognized that secondary infections following the 200primary attack by this organism are both frequent and important. This view I believe the logical one, unless much more convincing evidence than we have today may demonstrate another more probable living virus as the cause.
6. B. influenzæ is a frequent etiological factor in purulent and chronic bronchitis, broncho-pneumonia and other acute and chronic respiratory infections, in meningitis, endocarditis, sinusitis, conjunctivitis and other conditions, as well as in complications of many other diseases.
7. There are many carriers of the bacillus among our population, both in apparently normal individuals and in those suffering from chronic infections of bronchi, sinuses or other parts.
8. The problem of what constitutes resistance or susceptibility to this infection are as far from solution as they are in most other respiratory diseases, and the attempts to explain the reasons for epidemics have been as futile as they are for meningitis and many other respiratory epidemics.
9. It would not appear that the immunological reaction against this infection has been discovered, but the possibility of its being of an antitoxic nature opens an interesting field for investigation.
BIBLIOGRAPHY
Abrahams, Hallows and French Lancet., 1919; i, p. 1.
Abrahams, Hallows, Eyre and French Lancet., 1917; ii, p. 377.
Abstract of Foreign Literature on Influenza Jour. A. M. A., 1918; lxxi, p. 1573.
Adrian Quoted by Tedesko, q. v.
Allen Lancet., 1910; i, p. 1263.
Averill, Young and Griffiths British Med. Jour., 1918; ii, p. 111.
Avery Jour. A. M. A., 1918; lxxi, p. 2050.
Babes Deutsch. Med. Wochen., 1892; xviii, p. 113.
Batten Lancet., 1910; i, p. 16.
Basile Baumgarten Jahresb., 1907; xxiii., p. 284.
Beall Jour. A. M. A., 1906; xlvi, p. 1442.
Bernstein and Loewe Jour. Infect. Dis., 1919; xxiv, p. 78.
Besancon and Griffon Quoted by Scheller, q. v.
Besson Text-book, translated by Hutchens, 1913.
Blanton and Irons Jour. A. M. A., 1918; lxxi, p. 1988.
Boggs Amer. Jour. Med. Sci., 1905; cxxx, p. 902.
Brem, Bolling and Casper Jour. A. M. A., 1918; lxxi, p. 2138.
201Brentz and Frye Woman’s Med. Jour., 1908; xviii, p. 73.
Brown and Orcutt Jour. Exper. Med., 1918; xxviii, p. 659.
Bruschettini Cent. f. Bakt. Abt. i., 1892; xi, p. 412.
Bruschettini Cent. f. Bakt. Abt. i., 1892; xii, p. 34.
Bruschettini Cent. f. Bakt. Abt. i., 1893; xiv, p. 253.
Bujivid Cent. f. Bakt. Abt. i., 1893; xiii, p. 554.
Canon Die Bakteriologie des Blutes bei Infektionskrankheiten Jena, 1905.
Canon Deutsch. Med. Wochen., 1892; xviii, p. 28.
Cantani Zeit. f. Hyg., 1896; xxiii, p. 265.
Cantani Cent. f. Bakt. Abt. i., 1897; xxii, p. 601.
Cantani Cent. f. Bakt. Abt. i., 1900; xxviii, p. 743.
Cantani Zeit. f. Hyg., 1901; xxxvi, p. 29.
Cantani Cent. f. Bakt. Abt. i., Orig., 1902; xxxii, p. 692.
Cantani Zeit. f. Hyg., 1903; xlii, p. 505.
Capaldi Cent. f. Bakt. Abt. i., 1896; xx, p. 800.
Clemens Munchen. Med. Wochen., 1900; p. 925.
Cohen Annales de l’Instit. Pasteur., 1909; xxiii, p. 273.
Cohen and Fitzgerald Cent. f. Bakt. Abt. i., Orig., 1910; lvi, p. 464.
Cohn Arch. f. Gyn., 1907; lxxxii, p. 695.
Cohn Cent. f. Bakt. Abt. i., ref., 1906; xxxviii, p. 23.
Cole and MacCallum Jour. A. M. A., 1918; lxx, p. 1146.
Cornil and Chantemesse Cent. f. Bakt. Abt., i., 1893; xiii, p. 489.
Couret and Herbert Report at meeting of Amer. Assoc. Path. and Bact., 1919.
Coutant Jour. A. M. A., 1918; lxxi, p. 1566.
Davis, D. J. Jour. Infect. Dis., 1907; iv, p. 73.
Davis, D. J. Arch. Int. Med., 1908; ii, p. 124.
Davis, D. J. Jour. Infect. Dis., 1910; vii, p. 599.
Davis, D. J. Amer. Jour. Dis. Child., 1911; i, p. 249.
Davis, D. J. Jour. A. M. A., 1915; lxiv, 1814.
Davis, D. J. Jour. Infect. Dis., 1917; xxi, p. 392.
Delius and Kolle Zeit. f. Hyg., 1897; xxiv, p. 327.
Dever, Boles and Case Jour. A. M. A., 1919; lxxii, p. 265.
Dick, G. F. Jour. A. M. A., 1918; lxx, p. 1529.
Dick, G. H. and Murray Jour. A. M. A., 1918; lxxi, p. 1568.
Dujarric de la Riviere Jour. Med. Res., 1918; xxxix, p. 39, review.
Dunn Jour. A. M. A., 1919; lxxi, p. 2128.
Ecker Jour. A. M. A., 1918; lxxi, p. 1482.
Ely, Lloyd, Hitchcock and Nickson Jour. A. M. A., 1919; lxxii, p. 24.
Eyre Jour. Path. and Bact., 1909; xiv, p. 160.
Eyre and Lowe Lancet., 1918; ii, p. 484.
Ferry Jour. Path. and Bact., 1915; xix, p. 488.
Fichtner Cent. f. Bakt. Abt., i, Orig., 1904; xxxv, p. 374.
Fichtner Baumgarten’s Jahresb., 1906; xxii, p. 207.
Finkler Cent. f. Bakt. Abt., i, 1896; xx, p. 807.
Fleming, A. Lancet., 1919; i, p. 138.
202Fleming, J. S. Jour. A. M. A., 1918; lxxi, p. 2137.
Fraenkel Quoted by Howard, q. v.
Friedberger Cent. f. Bakt. Abt., i, Orig., 1903; xxxiii, p. 401.
Friedlander, McCord, Sladen and Wheeler Jour. A. M. A., 1918; lxxi, p. 1652.
Ghedini and Breccia Cent. f. Bakt. Abt., i, Ref., 1911; lvii, p. 567.
Ghedini and Fedeli Cent. f. Bakt. Abt., i, Ref., 1910; xlvii, p. 358.
Ghedini Baumgarten’s Jahresb., 1906; xxii, p. 207.
Ghedini Cent. f. Bakt. Abt., i, Orig., 1907; xliii, p. 407.
Ghon and Preyss Cent. f. Bakt. Abt., i, Orig., 1902; xxxii, p. 90.
Ghon and Preyss Cent. f. Bakt. Abt., i, Orig., 1904; xxxv, p. 531.
Giani and Picchi Cent. f. Bakt. Abt., i, Ref., 1906; xxxvii, p. 239.
Gioelli Cent. f. Bakt. Abt., i, 1898; xxii, p. 853.
Goodpasture Jour. A. M. A., 1919; lxxii, p. 724.
Gotch and Wittingham British Med. Jour., 1918; ii, p. 82.
Grassberger Zeit. f. Hyg., 1897; xxv, p. 453.
Grassberger Cent. f. Bakt. Abt., i, 1898; xxiii, p. 353.
Greenwood British Med. Jour., 1918; ii, p. 563.
Gregor British Med. Jour., 1919; i, p. 242.
Guiral Reviewed Jour. A. M. A., 1919; lxxii, p. 80.
Guizzetti Reviewed Jour. A. M. A., 1919; lxxii, p. 1111.
Hammond, Rowland and Shore Lancet., 1917; ii, p. 41.
Harris Lancet., 1918; ii, p. 877.
Heyrovsky Wien, Klin. Woch., 1904; xvii, p. 644.
Hicks and Gray Lancet., 1919; i, p. 419.
Hill, Leonard British Med. Jour., 1919; i, p. 238.
Holman Jour. Infect. Dis., 1914; xv, p. 293.
Holman Jour. Med. Res., 1916; xxxv, p. 151.
Horder Lancet., 1918; ii, p. 871.
Horder 36th An. Rep. Loc. Govt. Bd., 1906; p. 279.
Howard and Ingersoll Amer. Jour. Med. Sci., 1898; cxv, p. 520.
Huntoon Report at meeting of Amer. Assoc. Path. and Bact., 1919.
Hurley Letter. Boston Med. Surg. Jour., 1918; clxxix, p. 691.
Huyghe Quoted by Scheller, q. v.
Influenza Committee Advis. Bd. to the D. G. M. S. British Med. Jour., 1918; ii, p. 509.
Jacobsohn C. r. Soc. Biol., 1901; xix, p. 553.
Jehle Quoted by Madison, q. v.
Jochmann Cent. f. Bakt. Abt. i, Ref., 1906; xxxviii, p. 661, and quoted by Scheller, q. v.
Jordan Jour. A. M. A., 1919; lxxii, p. 1542.
Keegan Jour. A. M. A., 1918; lxxi, p. 1051.
Keeton and Cushman Jour. A. M. A., 1918; lxxi, p. 1962.
Kinsella Jour. A. M. A., 1919; lxxii, p. 717.
Kitasato Deutsch. Med. Wochen., 1892; xviii, p. 28.
203Klein British Med. Jour., 1892; p. 170.
Klieneberger Quoted by Scheller, q. v.
Koch Quoted by Davis, 1915; q. v.
Kossel Quoted by Ritchie, q. v.
Kotz Jour. Lab. Clin. Med., 1919; iv, p. 424.
Krage Baumgarten’s Jahresb., 1910; xxvi, p. 1063.
Kraus Jour. A. M. A., 1919; lxxii, p. 292. Medical News.
Kretz Cent. f. Bakt. Abt., i, 1898; xxiii, p. 24.
Krumbhaar Lancet., 1918; ii, p. 123.
Lacy Jour. Lab. and Clin. Med., 1918; iv, p. 55.
Lamb and Brannin Jour. A. M. A., 1919; lxxii, p. 1056.
Latapie C. r. Soc. Biol., 1904; lv, p. 1272.
Latapie Jour. Med. Res., 1918; xxxix, review.
Levinthal Zeit. f. Hyg., 1918; lxxxvi, p. 1.
Libman Trans. Assoc. Amer. Phys., 1912; xxvii, p. 157.
Lindenthal Wien. Klin. Wochen., 1897; x, p. 353.
Little, Garofalo and Williams Lancet., 1912; ii, p. 34.
Longo Baumgarten’s Jahresb., 1908; xxiv, p. 660.
Lord Boston Med. and Surg. Jour., 1902; cxlvii, p. 662.
Lord Boston Med. and Surg. Jour., 1905; clii, pp. 537 and 574.
Lord Jour. Med. Res., 1908; xix, p. 295.
Lord, Scott and Nye Jour. A. M. A., 1919; lxxii, p. 188.
Luerssen Cent. f. Bakt. Abt., i, Orig., 1904; xxv, p. 434.
MacCallum Monog. of Rockefeller Instit. for Med. Res., 1919; No. 10.
Macdonald and Lyth British Med. Jour., 1918; ii, p. 488.
Macdonald, Ritchie, Fox and White British Med. Jour., 1918; ii, p. 481.
Madison Amer. Jour. Med. Sci., 1910; cxxxix, p. 527.
Madison Jour. A. M. A., 1910; lv, p. 477.
Mann, Rainaford and Warren Med. Surg. Rep. of Roosevelt Hosp., 1915.
Martin, C. J. . British Med. Jour., 1918; ii, p. 281.
Matthews Lancet., 1918; ii, p. 104.
Medalia Boston Med. Surg. Jour., 1919; clxxx, p. 323.
Menko Quoted by Scheller.
Menschikow Cent. f. Bakt. Abt., i, Ref., 1906; xxxvii, p. 490.
Meunier Cent. f. Bakt. Abt., i, 1897; xxi, p. 689.
Meunier La Sam. Med., 1898. Quoted by Lord and Scheller, q. v.
Minaker and Irvine Jour. A. M. A., 1919; lxxii, p. 847.
Mix New York Med. Jour., 1918; cviii, p. 709.
Moon Quoted by Davis, 1915; q. v.
Moszkowski Cent. f. Bakt. Abt., i, Ref., 1902; xxxii, p. 272.
Munro British Med. Jour., 1919; i, p. 338.
Muir and Wilson British Med. Jour., 1919; i, p. 3.
McMeekin Reviewed Jour. A. M. A., 1919; lxxii.
204McPhedran Canadian Med. Assoc. Jour., 1913; iii, p. 548
Nastjukoff Cent. f. Bakt. Abt., i, 1895; xvii, p. 492.
Nichols and Stimmel Jour. A. M. A., 1919; lxxii, p. 174.
Norris and Pappenheimer Jour. Exper. Med., 1905; vii, p. 450.
Nuzum, Pilot, Stangl and Bonar Jour. A. M. A., 1918; lxxi, p. 1562.
Odaira Cent. f. Bakt. Abt., i, Orig., 1911; lxi, p. 289.
Oertel Canadian Med. Surg. Jour., 1919; ix, p. 339.
Opie, Freeman, Blake, Small and Rivers Jour. A. M. A., 1919; lxxii, pp. 108 and 556.
Orticoni and Barbie Reviewed Jour. A. M. A., 1919; lxxii, p. 228.
Orticoni, Barbie and Leclerc New York Med. Jour., 1918; cviii, p. 730.
Paltauf Wien. Klin. Wochen., 1899; xii, p. 576.
Paranhos Cent. f. Bakt. Abt., i, Orig., 1909; l, p. 607.
Park Reported at Meeting of Amer. Assoc. Path. and Bact., 1919.
Parker Jour. A. M. A., 1919; lxxii, p. 476.
Patrick Lancet., 1919; i, p. 137.
Pfeiffer Deutsch. Med. Wochen., 1892; xviii, p. 28.
Pfeiffer Zeit. f. Hyg., 1893; xiii, p. 357.
Pfeiffer and Beck Deutsch. Med. Wochen., 1893; xviii, p. 465.
Pieliche Berl. Klin. Wochen., 1894; xxxi, p. 534.
Poliak Wien. Klin. Wochen., 1908; xxi, p. 973.
Pritchett and Stillman Jour. Exper. Med., 1919; xxix, p. 259.
Rapaport Jour. A. M. A., 1919; lxxii, p. 633.
Richards and Gurd Montreal Med. Jour., 1907; xxxv, p. 541.
Richter Cent. f. Bakt. Abt., i, 1894; xxxi, p. 832.
Ritchie Jour. Path. and Bact., 1911; xiv, p. 615.
Rivers Bull. Johns Hopkins Hosp., 1919; xxx, p. 129.
Robertson, H. E. Jour. A. M. A., 1918; lxx, p. 1533.
Robertson, W. F. British Med. Jour., 1918; ii, p. 680.
Rosenow Jour. A. M. A., 1919; lxxii, p. 1604.
Rosenthal These. Paris., 1900.
Rucker and Wenner New York Med. Jour., 1918; cviii, p. 1066.
Saathoff Munch. Med. Wochen., 1907; p. 2220.
Sacquepee Paris Med., 1913; xxxv, p. 208.
Sahli Reviewed Jour. A. M. A., 1919; lxxii, pp. 686 and 111.
Scheller Cent. f. Bakt. Abt., i, Orig., 1909; l, p. 503.
Scheller Kolle and Wassermann, 1912; v, p. 1257.
Schlagenhaufer Quoted by Scheller, q. v.
Schofield and Cynn Jour. A. M. A., 1919; lxxii, p. 981.
Schultes Quoted by Scheller, q. v.
Slatineanu C. r. Soc. Biol., 1901; xxix, p. 850.
Slatineanu Cent. f. Bakt. Abt., i, Orig., 1906; xli, p. 185.
Slawyk Zeit. f. Hyg., 1899; xxxii, p. 443.
Smith, F. J. Lancet., 1908; i, p. 1201.
Smith, W. H. Jour. Boston Soc. Med. Sci., 1899; iii, p. 274.
205Smith, Theobald Jour. Med. Res., 1913; xxix, p. 291.
Soper Jour. A. M. A., 1918; lxxi, p. 1899.
Soper Jour. Lab. Clin. Med., 1918; iii, pp. 560-567.
Spat Berl. Klin. Wochen., 1907; xliv, p. 1173.
Spooner, Scott and Heath Jour. A. M. A., 1919; lxxii, p. 155.
Stone and Swif Jour. A. M. A., 1919; lxxii, p. 487.
Strause and Bloch Jour. A. M. A., 1918; lxxi, p. 1568.
Susswein Wien. Klin. Wochen., 1901; xiv, p. 1149.
Synnott and Clark Jour. A. M. A., 1918; lxxi, p. 1816.
Tedesko Cent. f. Bakt. Abt., i, Orig., 1907; xliii, pp. 322, 432, 548.
Thalhimer Bull. Johns Hopkins Hosp., 1911; xxii, p. 293.
Thalhimer Cent. f. Bakt. Abt., i, Orig., 1914; lxxiv, p. 189.
Thursfield Quart. Jour. Med., 1910; iv, p. 7.
Tunnicliff Jour. A. M. A., 1918; lxxi, p. 1733.
Tunnicliff and Davis Jour. Infect. Dis., 1907; iv, p. 66.
Vagede Baumgarten’s Jahresb., 1903; xix, p. 244.
Voges Berl. Klin. Wochen., 1894; xxxi, p. 868.
Weil Cent. f. Bakt. Abt., i, Ref., 1910; xlvii, p. 359.
Wittingham and Sims Lancet., 1918; ii, p. 865.
Wolbach Bull. Johns Hopkins Hosp., 1919; xxx, p. 104.
Wollstein Jour. Exper. Med., 1906; viii, p. 681.
Wollstein Jour. Exper. Med., 1911; xiv, p. 73.
Wollstein Jour. Exper. Med., 1915; xxii, p. 445.
Wollstein and Goldbloom Amer. Jour. Dis. Child., 1919; xvii, p. 165.
Woollacott British Med. Jour., 1918; ii, p. 530.
Wright, J. H. Boston Med. Surg. Jour., 1905; clii, p. 496.
Wynekoop Jour. A. M. A., 1903; xl, p. 574.
207