Influenza at the United States Naval Hospital, Washington, D.C.
By R.M. Kennedy, Rear Admiral, Medical Corps, United States Navy.
This hospital received its first case of influenza on September 1, 1918, and pandemic proportions were assumed very rapidly. The admission rate soon rose to 25 to 30 cases daily.
From its first appearance in this hospital the disease was of an unusually severe type. Those cases complicated by pneumonia showed marked prostration, early asthenia, and exhaustion of the cardio-vascular system. A few cases promptly died within 48 hours following the onset of the disease.
A great majority showed a leucopenia and a red cell reduction.
The ordinary methods of treatment were most unsatisfactory. Despite the very best nursing and other therapeutic measures, the death rate assumed startling proportions.
After giving the usual methods of treatment a trial with unsatisfactory results, they were abandoned, and the employment of "immune serum" was resorted to with happy issues, manifested by a marvelous reduction in the death rate. In fact, but three deaths have occurred in this hospital since the serum treatment has been employed.
The serum employed was obtained by bleeding patients recovering from influenzal pneumonia during their first week of convalescence. It was taken in 0.2 per cent sodium citrate solution to prevent clotting and allowed to stand until the cells settled. Then the serum was taken through a pipette and kept in a container until needed.
It was given intravenously in 100-mil dosage every eight hours until the temperature was normal or other satisfactory signs of improvement appeared. Some cases promptly returned to normal temperatures within 12 hours following the injection. Others had two doses administered, and a very few required three.
The marked change in these serumized patients form the prostration and toxemia which characterized the pneumonic state to general improvement has been most remarkable and satisfactory.
At one time there were eight serumized pneumonic cases from two to five days old in the disease, and all of them with normal temperature and no subjective symptoms of the disease.
During the epidemic 568 cases were admitted. One hundred and fifty-seven of them developed pneumonia, of whom 31 died, a percentage of 20. Of those cases of pneumonia not treated with serum, 28 died, a percentage of 25. Forty-six cases were treated with serum and 3 died, a percentage of 6.5.
Source: Kennedy, R.M. "Influenza at the U.S. Naval Hospital, Washington, DC." United States Naval Medical Bulletin 13, no. 2 (1919): 355.