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November 23, 1918


Author Affiliations

Shelby, Ohio

JAMA. 1918;71(21):1766. doi:10.1001/jama.1918.02600470064027

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To the Editor:  —For the past month I have been on epidemic duty with the United States Public Health Service. Most of the cases that I have seen that have developed pneumonia have been complicated with a most rebellious cough. This has been so common in my own experience and with those with whom I have discussed this epidemic that it has occurred to me that this cough might be one of the causative factors of the pneumonia, either by producing trauma in some part of the respiratory mechanism which acts as an infection atrium, or by so lessening the resistance of the patient through loss of sleep, pain and exertion that he readily picks up the pulmonary infection.The cough at first seems to be only irritative, for the patient expectorates but little; usually, however, after coughing almost incessantly for two or three days, he begins to spit up

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