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 all of our cases we have been struck with the excellent physique of
the individuals succumbing to this epidemic. All were youths in the best
of health, of good muscular build and strong bony frame-work.
Post-mortem rigidity set in fairly rapidly after death. Where this
rigidity had “set” for six or more hours it required much force to
change the position of the muscles. The voluntary muscles of the thorax
and abdomen were always carefully observed, and in a number of instances
the muscles of the thigh were also examined. It was not possible
routinely to dissect the muscles of the extremities, so that we are
unable to give an accurate account of the occurrence of degenerations in
these structures. We have, however, observed the reactions taking place
in the pectorals, psoas and muscles of the abdominal parietes. Changes
were observed with greatest frequency in the recti of the abdomen.
Degeneration occurred in these muscles in 14 instances, while the same
tissues suffered rupture, in part or completely with hemorrhage, in six
instances. It was not uncommon to find marked degeneration in the lower
segment of the rectus muscle on one side, while degeneration and
hemorrhage had occurred in its fellow on the opposite side. In four
cases rupture of the entire belly of the muscle had taken place, so that
a considerable space had occurred between the broken ends and a large
clot of blood filled the intervening space. This degeneration, which was
seen only in the voluntary muscles, was quite interesting and in its
milder degrees was rather difficult to detect. All gradations of loss of
muscle color were seen. In some instances the muscle simply seemed to
have lost its meaty lustre, while again in the more severe instances the
muscle color had changed from the bright red to an insipid yellow or
clay color. The most marked degeneration occurred in the midportions,
while the ends of the muscle masses at the points of attachment were
less involved. Complete rupture of the rectus always occurred in the
lowermost segment, a short distance above the insertion into the pubic
bone. At times the distribution of the degeneration within the muscle
was quite patchy, and irregular islands of yellow about 2 cm. in
diameter were splashed through the muscle masses, which in themselves
were paler than normal. Where the muscle degeneration was advanced the
tissue was soft and at times even buttery. It resembled the character of
the degeneration observed in typhoid fever, although I have no
recollection amongst many enteric cases of having seen the degeneration
of the muscle occur so acutely. Recklinghausen claimed that these
hemorrhages were most unusual in influenza. This is contrary to our
findings.
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