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
Shortly following the development of the serous exudate in the
submucosal tissues, the epithelial lining is found to suffer from the
reaction. The serous exudate does not remain confined to the
interstitial tissues, but is poured out through the mucosa into the
trachea. It would appear that the amount of this clear exudate may
become greater than can be dealt with by the mucosa, with the result
that an accumulation of this serous fluid takes place between this
epithelial layer and its basement membrane. We have repeatedly seen
considerable stretches of the mucosa lifted from the basement membrane
and shed in large plaques into the lumen. These mucosal cells at the
time of their desquamation retain fairly well their morphological
characters, and do not show evidence of necrosis prior to their removal.
Disintegration of these cells naturally occurs while lying in the
secretion of the trachea, and a variable cellular mass in stages of
disintegration may often be found both in smears and sections. When the
epithelial cells are lifted in wide plates, a type of bleb develops
which is easily broken and then disintegrates.
The desquamation of the lining membrane is a fairly constant occurrence
in the cases coming to autopsy. In the majority of those which we have
examined the greater portion of the trachea was completely denuded, save
for small islands lying in the recesses near the mouths of the mucous
ducts. In one case this lesion was accompanied by a process of
ulceration, due in all probability to the invasion by other
micro-organisms. The denuded tracheal surface usually shows a further
inflammatory reaction in which a cellular exudate then makes its
appearance. This reaction is mainly one in which lymphocytes and plasma
cells infiltrate the spaces previously occupied by the serous fluid. The
reaction is limited to the submucosa and does not extend into the
tissues beyond the cartilages. We have found only occasional
polymorphonuclear leucocytes lying close below the surface. During this
period, however, varying grades of degeneration may occupy the upper
layers. The basement membrane particularly seems to suffer by losing its
characteristic outline and staining qualities. This membrane becomes
swollen, softened and indefinite. At times a homogeneous precipitate
occurs along its free surface giving rise to an appearance resembling a
false membrane. This deposit is, however, distinctively different from
the diphtheritic membrane of other infections. It is interesting,
however, that where such deposits and degeneration occur in the basement
membrane more or less degeneration and necrosis also occur in the
connective tissues immediately neighboring to it. These tissues show a
peculiar granular destruction and alter their staining qualities.
Moreover, and what is more important, under these conditions the dilated
blood vessels are found to suffer from the injuries taking place in
their neighborhood. We have repeatedly found partially or completely
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