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INFLUENZA.
Having occasion to lecture early in 1922, I made the following statement of
opinion on the influenza epidemic which occurred during and after the war.
The disease was the result of one, two, or three of the catarrhal bacteria
acting alone or in concert.
If the B. Influenzae were associated with the pneumococcus, " Trench Pneumonia,"
was the clinical type of average case ; if with the Streptococcus Haemolyticus
the cases presented the signs of corpuscular destruction and ran a more acute
course.
Either of the infections alone in its most virulent form or in a non-reacting
person was capable of causing death, much more so any two of them acting together.
On the other hand, even a mixed infection in a person of natural immunity or
resistance often produced only very mild symptoms, not even as great as attend
a " cold."
The bacteria of the infections became so commonly associated that, being
passed from person to person by identical mode of infection, chiefly the " droplet,"
the association was very long in breaking and it became common that two diseases,
sometimes three, ran concurrently in the same person. Whether true symbiosis
occurred with an alteration of type and virulence due to the long continued association
can only be a matter of conjecture. The association of the influenza bacillus
with others is sufficient to explain every phenomenon I saw or read of in connection
with the epidemic.
The eventual world-wide distribution of the epidemic of this mixed infection
had its source—
1. In the great aggregation of men.
2. In the world-wide dispersal of individuals who broke down under infection,
into a number of small hospital centres.
3. In the removal of groups of the aggregate from place to place in the seat
of war after infection in any group so moved had begun.
In 1917, as its original name " trench pneumonia " implied, and before the
influenzal element was found to be constant, influenza was a trench disease.
Influenza is still rife in various parts of the world, but whether in the rather
deadly associated form, I do not know.
As a frequent and easy misdiagnosis in various diseases it is still of considerable
interest in port work.
ss. " Caledonia " arrived from Bombay on the 27th October, having had
about 80 cases of " influenza " during the voyage, a few of whom were ill at the
time of arrival. A curious feature of the outbreak was that it had been practically
confined to those of the crew occupying quarters on the starboard side of the ship.
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