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
In two instances slight hemorrhages were observed into the conjunctival
tissues. In each case they were unilateral and occupied the tissues
contiguous to the inner canthus. In one case there was well-marked
icterus with yellow coloration of the scleræ and skin. In this case the
icterus was associated with degenerative changes in the liver, there
being no recognizable obstruction to the bile passages. The icterus had
come on quite acutely and without any special clinical manifestations.
In the epidemic of 1890 jaundice was present in a considerable number of
cases (Medical Record, 1890, xxxvii, 473). Cole made similar
observations in the epidemic of influenza amongst the Canadian soldiers.
Œdema of the skin was not met with in any of our cases. This point is
worthy of comment, inasmuch as some authors have been impressed with the
serious damage taking place in the kidney and the resulting incapacity
of these organs. Although, as we shall point out later, the kidney
tissues in these cases showed a decided toxic degeneration, there was no
evidence that a glomerular damage of serious degree ever occurred. The
urinary excretion, as is pointed out in a report by Dr. Zeedick, varies
considerably with the intensity of the disease. It is unusual to find
derangement of kidney function to a degree to reflect seriously upon the
general bodily state. At least this has been our experience in the
present epidemic. Even where subsequently we were able to demonstrate a
considerable tubular degeneration in the cortex of the kidney the change
in the kidney function was not of sufficient magnitude to lead to a
water-retention to be recognized in an anasarca. I wish to distinguish
clearly at this point the difference in finding an œdema in certain
involved tissue structures in various parts of the body and arising
through an inflammatory reaction due to the presence of peculiar focal
irritation, as compared with the accumulation of fluid in many and
irregular situations as it occurs through retention and faulty excretion
by the kidneys. Various organs as we have found—as, for instance, the
lung, heart and liver—showed a condition of œdema which was not to be
reconciled with an inadequate circulation because of a cardiac or renal
incompetency. These œdemas, which we will discuss later, are local and
are the result of damaging influences inducted in and upon the tissues
where they are found.
_Muscle_
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