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INFLUENZA
224
CORRESPONDENCE two rabbits, all of which escaped disease. The day after inoculation, also, there was no difference between To the Editor of THE LANCET the two monkeys. On the next day, however, whereas one monkey was well, the other appeared to be having of the for view desire informaSIR,-In widespread tion of practical value concerning the aetiology of a typical attack of influenza with other symptoms influenza it is perhaps a little rash to broach this suggestive of encephalitis. It remained in that state The affected matterat all. Nevertheless, I do venture to ask for five days and then recovered. whether your leading article in THE LANCET of monkey was the one that had received the unheated Jan. 21st, p. 149, admirable it be as a summary filtrate : the other escaped illness. This is, of course, merely a single experiment, but it of recent work on colds, is not too pessimistic on the could easily be repeated if the opportunity occurred subject of influenza7 Consider, for instance, the illuminating experiments of obtaining material at the onset of an outbreak in a, made in Japan on 52 doctors and nurses who volun- hospital with an adequately equipped bacteriological teered for this purpose at the time of the pandemic department, where rhesus monkeys happened to be of 1918, and reported in THE LANCET (1919 i., available, as in this particular instance. In view of 971) by Yamanouchi, Sakahami, and Iwashima. the steady progress that is being made in our knowThe sputa of 43 cases of influenza were emulsified in ledge of the viruses, I would submit that the outlook Ringer’s fluid. This emulsion was injected into the as regards influenza is one of confident hope rather At its worst, the position is far nose and throat of 12 healthy persons, and the than anything else. Berkefeld filtrate into 12 more. The results were very better than the state of affairs as regards small-pox striking: among the subjects were 6 who had before the work of Edward Jenner. I am. Sir. vours faithfullv. recently had influenza, and these escaped; the 18 all after an influenza incubadeveloped remaining M. H. GORDON. London, W.C., Jan. 21st, 1933. tion period of two to three days. A filtrate of the blood of influenza cases was now injected into the nose and throat of six more healthy persons : the results EFFICIENT MEDICAL SERVICE were precisely the same as in the previous experiments. They next tried the subcutaneous route : four healthy To the Editor of THE LANCET persons received filtered sputum, and four filtered SiR,-The subject of your leading article of blood; all, with the exception of one who had Jan. 7th concerns a large part of the population. It had the after influenza disease, developed previously an incubation period of two to three days. On the affects not only those included in the National other hand, a pure culture of Pfeiffer’s bacillus and a Insurance scheme but many persons with small mixture of Pfeiffer with pneumococci, streptococci, incomes, and also those who are earning what may considered a comfortable salary but have no taphylococci, and diplococci from the sputum of be influenza patients was sprayed into the nose and reserve to fall back upon in case of incapacity from An increasing number of such persons are. throat of 14 healthy persons, but no symptoms and no illness followed. Yamanouchi and his colleagues compelled to seek hospital treatment. They desire concluded that influenza is due to a filtrable virus to have specialised treatment but cannot afford the which is present in the sputum and blood of influenza cost. is often necessary to remove patients, and can infect either by implantation on to I Specialised treatment disease ; it is also true that when disease is the mucous membrane, or by inoculation, and that Pfeiffer’s bacillus and other bacteria found in the generalised and severe, if anything can be done at keeping up the patient’s strength, specially sputum are not the cause of influenza. They point all skilled is needed. People when they fall who or who the had out that all influenza, subjects do not soon recover often believe that their received the sputum emulsion or its filtrate became sick own doctor has not the skill necessary to diagnose immune. their complaints ; or if he has, that he has not These human experiments could be repeated, if In necessary, provided that a sufficient sum of money adequate means of treatment at his disposal. cases methods of illumination which require special for the was set aside necessary accommodation, equipment, and, possibly, compensation. But it to see the affected organ the public are probably would be desirable first of all to see if the main points right. No practitioner who sees only occasional cases. could be worked out on the lower apes or other animals, has the opportunity of becoming so adept in maniand here the following experience may be of interest. pulating the instruments and so skilled in recognising When a sharp outbreak of influenza occurred among what is visible as the doctor who confines himself to the nursing staff at St. Bartholomew’s in January, the sort of practice requiring them. With regard to the second assumption-namely, 1922, and material could readily be obtained during the first 24 hours of the attack, a number of nurses that he has not as a rule adequate means of treatwho were warded in the acute stage were asked to ment at his disposal-the public is again often right. blow their noses into small pads of cotton-wool. These If we leave out the large group of temporary ailrecover pads were at once dropped into a flask containing ments-coughs, colds, inaigestion, &c.-which about 200 c.cm. of normal saline, and were shaken. quickly with meaicine and directions, there are a The fluid was then taken to the laboratory, passed great number of cases of physical disability which through an ordinary Berkefeld filter, and one half ofmight be temporary but may become permanent. the filtrate was heated to 56° C. for 30 minutes. A Such are disability of the feet, as a result of tempair of guinea-pigs, rabbits, and rhesus monkeys were: porary ill-health or of a period of malnutrition, now injected intracerebrally with the filtrate, one ofweakness of the abdominal walls, and displacement each pair receiving the raw material, the other the of the abdominal organs following childbirth or an heated. The result was as follows : There was noI acute illness and imleifect convalescence ; and rheudifference in the effect on the two guinea-pigs or the matic changes, neuritis, or neuroses following an INFLUENZA
though
illness.
localised
beyond treatment and
"
.
CORRESPONDENCE two rabbits, all of which escaped disease. The day after inoculation, also, there was no difference between To the Editor of THE LANCET the two monkeys. On the next day, however, whereas one monkey was well, the other appeared to be having of the for view desire informaSIR,-In widespread tion of practical value concerning the aetiology of a typical attack of influenza with other symptoms influenza it is perhaps a little rash to broach this suggestive of encephalitis. It remained in that state The affected matterat all. Nevertheless, I do venture to ask for five days and then recovered. whether your leading article in THE LANCET of monkey was the one that had received the unheated Jan. 21st, p. 149, admirable it be as a summary filtrate : the other escaped illness. This is, of course, merely a single experiment, but it of recent work on colds, is not too pessimistic on the could easily be repeated if the opportunity occurred subject of influenza7 Consider, for instance, the illuminating experiments of obtaining material at the onset of an outbreak in a, made in Japan on 52 doctors and nurses who volun- hospital with an adequately equipped bacteriological teered for this purpose at the time of the pandemic department, where rhesus monkeys happened to be of 1918, and reported in THE LANCET (1919 i., available, as in this particular instance. In view of 971) by Yamanouchi, Sakahami, and Iwashima. the steady progress that is being made in our knowThe sputa of 43 cases of influenza were emulsified in ledge of the viruses, I would submit that the outlook Ringer’s fluid. This emulsion was injected into the as regards influenza is one of confident hope rather At its worst, the position is far nose and throat of 12 healthy persons, and the than anything else. Berkefeld filtrate into 12 more. The results were very better than the state of affairs as regards small-pox striking: among the subjects were 6 who had before the work of Edward Jenner. I am. Sir. vours faithfullv. recently had influenza, and these escaped; the 18 all after an influenza incubadeveloped remaining M. H. GORDON. London, W.C., Jan. 21st, 1933. tion period of two to three days. A filtrate of the blood of influenza cases was now injected into the nose and throat of six more healthy persons : the results EFFICIENT MEDICAL SERVICE were precisely the same as in the previous experiments. They next tried the subcutaneous route : four healthy To the Editor of THE LANCET persons received filtered sputum, and four filtered SiR,-The subject of your leading article of blood; all, with the exception of one who had Jan. 7th concerns a large part of the population. It had the after influenza disease, developed previously an incubation period of two to three days. On the affects not only those included in the National other hand, a pure culture of Pfeiffer’s bacillus and a Insurance scheme but many persons with small mixture of Pfeiffer with pneumococci, streptococci, incomes, and also those who are earning what may considered a comfortable salary but have no taphylococci, and diplococci from the sputum of be influenza patients was sprayed into the nose and reserve to fall back upon in case of incapacity from An increasing number of such persons are. throat of 14 healthy persons, but no symptoms and no illness followed. Yamanouchi and his colleagues compelled to seek hospital treatment. They desire concluded that influenza is due to a filtrable virus to have specialised treatment but cannot afford the which is present in the sputum and blood of influenza cost. is often necessary to remove patients, and can infect either by implantation on to I Specialised treatment disease ; it is also true that when disease is the mucous membrane, or by inoculation, and that Pfeiffer’s bacillus and other bacteria found in the generalised and severe, if anything can be done at keeping up the patient’s strength, specially sputum are not the cause of influenza. They point all skilled is needed. People when they fall who or who the had out that all influenza, subjects do not soon recover often believe that their received the sputum emulsion or its filtrate became sick own doctor has not the skill necessary to diagnose immune. their complaints ; or if he has, that he has not These human experiments could be repeated, if In necessary, provided that a sufficient sum of money adequate means of treatment at his disposal. cases methods of illumination which require special for the was set aside necessary accommodation, equipment, and, possibly, compensation. But it to see the affected organ the public are probably would be desirable first of all to see if the main points right. No practitioner who sees only occasional cases. could be worked out on the lower apes or other animals, has the opportunity of becoming so adept in maniand here the following experience may be of interest. pulating the instruments and so skilled in recognising When a sharp outbreak of influenza occurred among what is visible as the doctor who confines himself to the nursing staff at St. Bartholomew’s in January, the sort of practice requiring them. With regard to the second assumption-namely, 1922, and material could readily be obtained during the first 24 hours of the attack, a number of nurses that he has not as a rule adequate means of treatwho were warded in the acute stage were asked to ment at his disposal-the public is again often right. blow their noses into small pads of cotton-wool. These If we leave out the large group of temporary ailrecover pads were at once dropped into a flask containing ments-coughs, colds, inaigestion, &c.-which about 200 c.cm. of normal saline, and were shaken. quickly with meaicine and directions, there are a The fluid was then taken to the laboratory, passed great number of cases of physical disability which through an ordinary Berkefeld filter, and one half ofmight be temporary but may become permanent. the filtrate was heated to 56° C. for 30 minutes. A Such are disability of the feet, as a result of tempair of guinea-pigs, rabbits, and rhesus monkeys were: porary ill-health or of a period of malnutrition, now injected intracerebrally with the filtrate, one ofweakness of the abdominal walls, and displacement each pair receiving the raw material, the other the of the abdominal organs following childbirth or an heated. The result was as follows : There was noI acute illness and imleifect convalescence ; and rheudifference in the effect on the two guinea-pigs or the matic changes, neuritis, or neuroses following an INFLUENZA
though
illness.
localised
beyond treatment and
"
.