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
The distinction which was made by the gross examination of the trachea
between the acute tracheitis with serous exudate, subacute tracheitis
and mucopurulent tracheitis was not so readily distinguished in the
microscopic sections. In the gross the character of the exudate lying
upon the surface was the main guide suggesting the nature and intensity
of the inflammatory reaction. In the microscopic sections this exudate
was largely wanting, or was not sufficiently characteristic to confirm
the gross findings. On the other hand, differences in the nature of the
injury were to be found mainly in the reaction of the submucosa. As we
have indicated above, the early inflammatory reaction of the trachea is
mainly evident in an intense congestion accompanied by an inflammatory
œdema of the submucosal tissues, hemorrhage sometimes accompanying this
response. In the later stages of the reaction a cellular deposit takes
the place of the inflammatory œdema and usually consists of lymphocytes
and plasma cells. It is only in those cases where the intensity of the
irritant continues to act over a longer period of time that a
superficial necrosis with leucocytic infiltration makes its appearance.
The epithelial layer of the trachea is desquamated early in the acute
reaction, and hence a denudation of the surface is to be found in all
stages of the acute lesion. The mucous glands have not been found to
show any particular involvement in the inflammatory process, and in the
majority of instances they were found to have escaped entirely the
damaging effect of the virus. Their response in an over-secretion of
mucus may be the outcome of a stimulation by toxins or soluble
irritants; but on the other hand, may also probably be a reflex response
to the injury of the mucosal surface, which being bared of its covering
is highly sensitive. The increased discharge of mucus from the deep
glands may well be a protective response to such injury.
_Bronchi_
The lesions in the bronchi were in every way comparable to those in the
trachea. The main bronchial tubes differ in no material way from the
structure of the trachea, and the extension of the inflammatory process
from above downwards leads to a reaction in their walls similar to what
has been above described. As we follow the subdivisions of the bronchi
we gradually lose some of the characteristics contained in the larger
tubes. The mucous glands gradually become fewer and eventually
disappear. The cartilage rings become smaller and no longer completely
encircle the bronchus, and with the further diminution in the size of
these structures disappear entirely. A relatively greater amount of
muscle tissues takes the place of the cartilage rings. This change in
the anatomy of these structures has a certain influence in modifying the
character and distribution of the inflammation.
TABLE V
BRONCHITIS AND TRACHEITIS
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