Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
The process just described is analogous to that which occurs whenever an
unopened abscess heals; mononuclear cells accumulate and act as
phagocytes ingesting polynuclear leucocytes.
The following instance of streptococcus empyema is noteworthy because no
suppurative pneumonia has been found in association with it.
Nevertheless the character of the changes present in the lung indicate
that the organ has been the site of an interlobular inflammation which
has healed.
=Autopsy 499.=—J. H. M., white, aged twenty-four, a farmer from
Arkansas, had been in military service five months. Onset of illness
began two weeks before his admission to the hospital on November 15
with cough, fever, headache and malaise; on admission there was
acute bronchitis. Thirteen days after admission the patient
developed parotitis (mumps?); five days later and five days before
death pleurisy was recognized on the right side and pneumonia was
suspected. Death occurred thirty-six days after onset. The
temperature on admission was 103.2° F. and remained elevated during
one week falling by lysis; from this time until the pleurisy was
recognized it was normal and later it remained approximately 103° F.
=Anatomic Diagnosis.=—Fibrinopurulent pleurisy on right side;
fibrinous pleurisy on left side; fibrinopurulent pericarditis;
chronic interstitial (interlobular) pneumonia in process of healing;
purulent bronchitis; acute splenic tumor; parenchymatous
degeneration of kidneys.
The right pleural cavity contains 1,650 c.c. of grayish yellow fluid
containing an abundant sediment of softened fibrin. Part of this
fluid, more opaque than the remainder is confined in a localized
pocket between the inner surface of the lung and the pericardium.
The apex and anterior surface of the right upper lobe, over an area
about 7 cm. across, is held by fibrinous adhesions to the chest
wall; when this adhesion is broken a pocket is exposed 6.5 x 2.5 cm.
containing fibrin and fluid. The pericardial cavity is distended by
350 c.c. of turbid yellow seropurulent fluid. The pericardial
surfaces are covered by shaggy, tough gray fibrin.
The right lung is collapsed; the lower and posterior part of the
upper lobe is deep red and atelectatic. Throughout the upper lobe
the interlobular septa are thickened, often 1 mm. across and very
conspicuous; in the lower and anterior tip of the lobe is an area
where tissue is firm grayish red and heavier than water. The lower
and posterior half of the right lower lobe is firm and airless, and
the tissue is reddish gray or gray and in places finely granular on
section; interlobular septa are conspicuous. Although the lung is
cut into thin sections, no abscesses are found. Bronchi throughout
the lung contain mucopurulent fluid.
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