Influenza on a Naval Transport

By W.F. McAnally, Lieutenant, Medical Corps, United States Navy.

During the past six months we have treated over 100 cases of influenza and pseudo-influenza. These occurred in the proportion of about 30 per cent of the former and about 60 per cent of the latter. At no time did the disease tend to assume an epidemic form, which fact is possibly due to the thorough prophylaxis which is insisted upon. A typical case of influenza occurs after an incubation period of one to three days. The attack is generally marked by a chill of greater or less severity, followed by fever ranging from 101° to 104° or higher. The patient complains of aching pains in the trunk and extremities, headache, and general malaise. He looks and feels sick. Upon examination, in practically every case of our series, there has been found a more or less severe inflammation of the nasal mucous membrane and tonsillar rings; in some few cases there has been a distinct streptococcic tonsillitis, which was generally very obstinate to treatment and persisted even after the original influenza had cleared up entirely. These symptoms generally appeared on the third or fourth day of the disease.

The treatment has been generally very satisfactory and was practically the same in all of our cases, i.e., rest in bed, free catharsis, Dobell's solution or a 1 per cent solution of chlorazene as a gargle every two hours, aspirin grs. x and sodium bicarbonate grs. xx t. i. d., together with the subcutaneous injection of influenza bacterin mixed (Mulford), a primary does of 1/2 c.c. being given upon admission and followed at four-day intervals by two or three secondary doses of 1 c.c. each.

Following one, or in some cases two, injections of influenza bacterin and the general treatment as outlined, most of the typical cases were generally discharged to duty in three or four days. Injections of 1/2 c.c. of the bacterin upon admission, followed at four-day intervals by injections of 1 c.c. has been productive almost invariably of exceedingly good results. From one to six hours after the primary

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injection there is a more or less severe exacerbation of the symptoms, but we have yet to see a case in which a serious reaction occurred.

In the second type of cases, which we have called pseudoinfluenzal for want of a better name, our treatment has not given such good results, although they were seemingly the result of a much milder infection. The following case illustrates this type:

C-- Frank, admitted to the sick bay July 15, 1918, complaining of sore throat, slight headache, and muscular pains; temperature, 100.4°; there was a slight inflammation of the nasal and pharyngeal mucous membranes; heart and respiration normal.

Treatment: Bed; magnesium sulphate, oz. 11/2, aspirin, grs. x, sodium bicarbonate, grs. xx t.i.d.; Dobell's gargle; silver nitrate (10 per cent) locally to throat t.i.d. Influenza bacterin 1/2 c.c. was given subcutaneously upon admission. There was apparently no reaction after the bacterin injection.

July 16, 1918: There is very little change; temperature, 99.8°; patient still feels badly, with aching pains in legs and headache.

July 19, 1918: Improving slowly; temperature ranging from 99.8° to 100.2°; tonsillar rings and tonsils inflamed; influenza bacterin 1 c.c. injected s.c.; no reaction; no muscular pains nor headache.

July 23, 1918: Discharged to duty. No symptoms other than a slight redness of the tonsillar rings; slight variations in temperature from normal to 99.3°. Treatment continued.

This case was mild throughout; there were never any severe muscular pains nor headache; fever was low, and the respiratory symptoms were not marked. It and all the cases of this type resembled influenza very closely, except in the severity of the symptoms; furthermore, all these case of pseudoinfluenza give very little or no reaction to the influenza bacterin, and the course of the disease has not been influenced by it.

In our series of over 100 cases careful records were kept in only about 25 instances. While this number is entirely too small to be a basis for any definite statements, and while the cases were not worked out bacteriologically in the laboratory, it seems that we are justified in the following conclusions:

1. There are two varieties of infection giving practically the same train of symptoms, the only difference being in the severity of the process, one of these being influenza, with the classical symptoms and due to a specific infection. The other, pseudoinfluenza, seems to occupy a position midway between a "cold in the head" and influenza and is not due to the same infectious agent.

2. That for the treatment of influenza we have a specific bacterin, which in our hands and when given in a primary does of 1/2 c.c. subcutaneously, followed by one to three secondary doses of 1 c.c. each, has given very satisfactory results, patients rarely remaining

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in the sick bay over three to five days. Also, that this specific bacterin has no appreciable effect upon cases of pseudoinfluenzal type.

The above results would have been more satisfactory had we been able to follow up our cases bacteriologically, and it is hoped that some one will report a series of similar cases in which this data will be available.

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Source: McAnally, W.F. "Influenza on a Naval Transport." United States Naval Medical Bulletin 13, no. 1 (1919): 168-170.