Studies on Epidemic Influenza: Comprising Clinical and Laboratory InvestigationsUniversity of Pittsburgh. School of Medicine
History
Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations
University of Pittsburgh. School of Medicine
Influenza; Influenza Epidemic, 1918-1919
Occasionally we met with small hemorrhages lying in the upper layers of
the subcutaneous tissue. These lesions were small and could not be seen
from the external surface. Nevertheless, some of them seemed to have
occurred in direct contact with the deep cutis and surrounded portions
of the deep skin appendages. From an examination of our cases there was
no reason at the time of autopsy to lay any particular stress upon the
occurrence of these hemorrhages. Subsequently, it has come to mind, and
since learning of the unusual frequency of boils and deep pustules
making their appearance as post-influenzal sequelæ, that these minute
lesions may have a bearing upon the localization of infection in the
skin tissues. We must appreciate, of course, that other factors of a
constitutional nature probably render the individual more susceptible to
the invasion of the staphylococcus, and that such factors are
all-important in allowing this organism to gain a foothold. Whether the
decreased sugar-tolerance with hyperglycemia, which has been observed in
the late stages of influenza, bears a relation to the increased
susceptibility, as appears to be the case in diabetes mellitus, is an
interesting point for further investigation. Other constitutional states
are also undoubtedly involved in the increased susceptibility to the
infection which the patient suffers. Elsewhere (Dr. Holman) it is shown
that the natural complement content is considerably depressed during the
height of the influenza. With such factors present and with the
available infecting micro-organisms, it is possible that the minute deep
skin hemorrhages bear a relation to the immediate localization of the
infection.
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