Studies on Influenza in the Pandemic of 1957-1958: II. Pulmonary Complications of Influenza [open pdf - 5MB]
"Influenza presents a paradox. To the clinician practicing medicine in 1918, influenza was a fearsome disease attended by frequent and often fatal pulmonary complications. To the student of interpandemic influenza in the last quarter century, the disease is an acute, temporarily incapacitating infection of the upper respiratory tract which is benign except on the rare occasion when bacterial pneumonia supervenes. This contrast in the manifestations of influenza has led to speculation that the disease of 1918 was either a different disease entity or caused by an agent of greater virulence than influenza viruses now encountered. The microbiologic and pathologic evidence accumulated during the 1918-19 pandemic established the probable bacterial etiology of most influenza fatalities. There were, however, many clinicians who insisted that certain patients died of fulminating illness unassociated with known bacterial pathogens. This impression received support in the studies of Goodpasture who presented pathologic evidence of a diffuse hemorrhagic pneumonia in two patients which was unassociated with the demonstrable presence of bacteria."
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