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
Degenerations of a similar kind as those of the abdominal recti were
found in both pectorals. In the chest region, however, the degeneration
was less frequent and less severe. We observed it only twice, and in
neither instance had the degeneration led to a rupture and hemorrhage of
the muscle bundles. Kuskow observed a single case of degeneration and
hemorrhage of the pectoral muscles. In the psoas muscle we observed
degeneration on two occasions, in one of which the lesion was associated
with a partial separation of the muscle fibers and hemorrhages into its
substance. In one case clinically, but not coming to autopsy, a lesion,
which from its character we presume to have been a degeneration,
occurred in the sterno-mastoid, being accompanied by hemorrhage and the
development of a firm clot the size of a hazel nut. In the subsequent
history of this case the lesion passed through an aseptic process of
organization with contracture so that the patient has recently been
developing a “wryneck.” Kohts in 1890 reported the finding of muscle
degeneration and abscesses in the arm. The condition arose as a late
complication of influenza.
From our experience at the autopsy table in observing the relative
frequency with which muscle degeneration occurs in the severe cases of
epidemic influenza, we feel convinced that numerous cases which recover
pass undiagnosed of this condition. Furthermore we have evidence, as
illustrated in a case observed by Dr. McMeans, wherein a lesion which
occurred in the gluteal muscles was followed by a localizing infection
at this site that these muscle degenerations and hemorrhages may have
serious consequences. There are a number of instances in which
post-influenzal complications of the nature of deep-seated abscesses of
the extremities, thorax, and abdomen may have their explanation for the
localization in a primary muscle damage accompanied by hemorrhage and
followed by an infection of variable type. Cole also comments upon the
development of abscess in the deep muscles where degeneration had taken
place. In illustrating some of our findings to Dr. J. Anderson he
immediately recognized such a condition in the pectoral muscles of a
patient in which he was unable to arrive at a conclusion of the
pathological events which had taken place. It is one of the noteworthy
features in this disease that the voluntary muscles of certain regions
are apt to suffer severe damage, while the heart and the various
unstriped muscular tissues are little if at all affected by a similar
process. It would be interesting to know whether the lack of response
and the delayed functional recovery on the part of the muscles of the
extremities in so many patients who have suffered influenza is the
result of the damaging influence of a peculiar intoxication present in
this disease. One of the features in influenza is the prostration of the
patient, and with it there is definite muscular weakness. We have been
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