This report is based upon a series of investigations carried on during
the epidemic of influenza at Pittsburgh. This epidemic reached
Pittsburgh about the last week of September, 1918, rapidly spreading
through the community during the first days of October. Pittsburgh had
been warned of its coming through the experience of Boston, where the
epidemic made its appearance during the late days of August. To a
certain extent the warning from the East permitted the making of
preparations to control its ravages. But even with the attempt for the
protection of public health the epidemic advanced with all its
virulence, rapidly picking out the susceptible individuals and leading
to a high death rate.
At the time of the coming of the epidemic there were stationed at
Pittsburgh two military camps, comprising about 7,000 men. It was with
the presence of the disease among these men that our investigations were
chiefly concerned. The men at their respective camps (on the campus of
the University of Pittsburgh and at the Carnegie School of Technology)
were housed in barracks which had been erected only a short time
previously. These barracks contained large dormitories, in which the
individuals freely mingled with each other. In them there was no
opportunity of complete isolation, and by this means of housing good
opportunity was available for the propagation of any communicable
infectious disease. The ordinary sanitary arrangements for these groups
were well provided. The first cases of recognized influenza made their
appearance on October 2. On this day two men were found with the disease
and were isolated. On the following day there were four, and on the
third day eight. It was soon recognized that the increasing number of
the infected cases was growing so rapidly that definite arrangements for
their segregation and care had to be undertaken. This was provided for
on October 4, when the Elizabeth Steel Magee Hospital was in part taken
over by the military authorities and wards were rapidly adapted for the
coming epidemic. For the foresight in making the adequate arrangements
for its control and management we shall always remain indebted to Major
E. W. Day. His indefatigable work in the early days of the epidemic will
always be remembered, and the fact that the epidemic was kept within
reasonable bounds of control was the result of his stringent quarantine
regulations along with the organization of his medical forces. Working
under his direction, Capt. H. H. Hendershott undertook the management of
the hospital and rendered most efficient service. The capacity of the
hospital was soon overburdened, so that from a normal 150–bed
institution it was on the sixth day of its conversion into an emergency
hospital carrying more than 300 cases of influenza. This hospital in
itself was unable to accommodate all of the cases falling ill, and
provision for these had to be made in some of the municipal
institutions. On October 5, 1918, the Medical School of the University
of Pittsburgh undertook to provide the laboratory facilities for the
emergency Military Hospital. It was at first intended to equip only
those laboratory departments which were deemed essential for the
clinical care of the patients in the wards. Inasmuch, however, as the
epidemic of influenza was spreading with alarming rapidity throughout
the city, it was deemed advisable to close the Medical School and to
place at the disposal of the Military Hospital all the laboratory
facilities which could in any way be of use in the care and study of the
influenza patients. This permitted the establishment of departments in
pathology, bacteriology, physiology, physiological-chemistry and
clinical microscopy. The following workers partook in the investigations
which were here carried out: Dr. Oskar Klotz, director of laboratories;
physiology, Dr. C. C. Guthrie (chief), Dr. A. Rhode, Dr. M. Menten, Mrs.
C. C. Macklin, Miss S. Waddell and Miss M. Lee; bacteriology, Dr. W. L.
Holman (chief), Miss A. Thorton, Miss C. Prudent and Miss R. Jackson;
pathology, Dr. Oskar Klotz (chief), Mr. A. D. Frost, Mr. J. L. Scott and
Miss A. Totten; clinical microscopy, Miss R. Thompson, Mr. M. Marshall
and Mr. H. Mock; records, Miss H. Turpin. Intensive work was undertaken
by each over a period of about five weeks, when the epidemic was again
on the road to disappearance and few new cases were being admitted.
These laboratories discontinued their work at the Military Hospital on
November 9.
The clinical observations which are contained in this report were made
at the Mercy Hospital. This institution set aside upward of 100 beds for
the care of the overflow which could not be accommodated at the Military
Hospital. It is unfortunate that the clinical observations and the
laboratory findings contained in this report were not made upon the same
cases. With the number of cases suddenly thrust upon the medical staff
of the army, it was not possible for them to devote detailed attention
to clinical investigation. Furthermore, during the progress of the
epidemic these medical officers were transferred to new posts, so that
it was impossible to obtain a summary of the clinical findings at the
Military Hospital by any of the officers who had but recently been
detailed to the work. We were fortunate, however, that the clinical
investigations were carried out on a similar group of cases to those
studied by the laboratory, and it might be said that their clinical
findings on the patients housed at the Mercy Hospital are parallel with
those observed in other institutions. Necessarily the researches carried
out during such an epidemic were intensive, and all the workers in the
various branches feel that if they had to live through another such
plague they would be much better prepared to approach their problem.
During the heat of such investigations valuable time is often lost in
perfecting methods of technique, and one sorrowfully finds oneself
without available material when the technical work has been accomplished
but the epidemic has passed by. In the studies in bacteriology we were
fortunate in having some of the technical difficulties for the isolation
of the B. influenzæ previously solved. It may be that this in part
explains the broad success which Dr. Holman has had in isolating the B.
influenzæ from so many cases. In other fields the road was less broken,
and it was not until late in the course of the epidemic that results
were obtained in the investigation which seemed to point to valuable
leads.
Dr. S. R. Haythorn, director of the Singer Memorial Laboratory, early in
the epidemic became interested in the protection of individuals against
the infection. In certain quarters much was claimed for the immunity
which could be conferred by vaccination, either by the inoculation of
pure B. influenzæ vaccines or by mixed vaccines. Hoping for some results
by the use of such vaccines, Dr. Haythorn undertook the preparation of
these materials. The value of this procedure could only be estimated
after the lapse of some time and at a period when the epidemic was again
waning.
The clinical work at Mercy Hospital was carried on under the direction
of Dr. J. A. Lichty, and assisted by Dr. W. W. G. Maclachlan, Dr. P. I.
Zeedick, Dr. F. Klein and Dr. W. J. Fetter. By the close co-operation of
the members of this group it was possible to put the clinical findings
of one or other member to severe test, so that the recorded observations
and deductions are of the greater value and less flavored by the
personal element. This is of the more value, since, with the great
amount of work which had to be done at the time of the height of the
epidemic, it was often not possible for the same individual to bestow
the amount of time upon each and all cases as he desired.
We are much indebted to Dr. Ogden M. Edwards, dean of the School of
Medicine, for making available the facilities for carrying out the work,
and for encouraging the publication of the reports.