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
A much better appreciation of the muscle degeneration was obtained in
the _microscopic_ studies of these tissues. The various gradations of
tissue change could be followed, which was not possible in the naked-eye
examinations. Some points respecting this degeneration were quite
noteworthy. Firstly, the process of degeneration in its early stages and
advancing through the acute destructive periods was not accompanied by
any inflammatory reaction. Evidence of inflammatory exudate was obtained
only when the degeneration had proceeded to a degree permitting of
rupture with hemorrhage, or in the late stages when the areas of marked
muscle dissolution were undergoing repair. We have no evidence to
indicate that bacteria were present during the beginning of the
degenerative process. Bacteria could not be demonstrated in section. The
appearance of the tissue suggested a purely toxic process which was
selective in its action, picking out voluntary striped muscle tissue and
attacking certain muscle groups in preference to others. It was also
interesting to observe in the early stages of the degeneration that
individual fibers lying amidst healthy and unchanged muscle elements
would show degeneration in many of its stages. This appearance was often
unique, particularly when in the early stages of the process the
involved fiber would still retain its normal position and shape though
markedly altered in its staining and chemical qualities.
The degeneration as observed in these cases showed many of the
characters like that of waxy degeneration seen in typhoid fever. Similar
appearances to these have also been described in connection with the
toxic degenerations which occur in the vicinity of infections by the gas
bacillus. In fact, all the stages observed in the one can be seen in the
other. They differ, however, only in the degree to which final
destruction takes place and in the speed with which the degeneration is
accomplished. The character of the degeneration is well studied in
sections stained with hematoxylin and eosin, eosin-methylene blue, and
best of all in the phosphotungstic acid hematoxylin. By the latter
method one is able to follow clearly the grade of degeneration as it
effects the muscle striations. On the other hand, the peculiar waxy
appearance of the early degenerating fibers is best seen in sections
stained with eosin or fuchsin, where the striated muscle fibers are
found to be changed to a more intensely staining red body of homogeneous
character and devoid of all evidence of their original internal
architecture. These bland waxy fibers were often of the size and shape
like the normal. On the other hand, the fibers are also not uncommonly
swollen, stretching the sarcolemma to almost the bursting point.
Following this primary bland degeneration the fiber takes on irregular
shapes, becoming constricted and collapsed at irregular intervals, so
that islands of the waxy contents lie within the sarcolemma, being
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