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
Undoubtedly during the subsidence of the inflammatory process within the
bronchi the gradual restitution of the tissues with little or no
fibrosis is accompanied by a reproduction of the lining membrane arising
from the epithelial remnants in the small mucous crypts. In a few cases
lately coming to autopsy where the patients had suffered an influenza
five or six weeks previously, the mucosa of the trachea and bronchi had
assumed its normal appearance and was fully clothed by a normal
epithelial covering.
_Lung—Early Stage_
We have just discussed the importance of the inflammation of the trachea
and bronchi in the cases of influenza. It is our belief that every case
of influenza has some tracheitis, and a great many have both tracheitis
and bronchitis. This is true in the absence of localizing signs and
symptoms, as was evident even in these cases in which the simple
influenza passed into its more severe type with its pulmonary lesions.
In many of these instances clinical evidences of an inflammatory
reaction in the respiratory tubes were wanting, while the reactions
observed at autopsy were often astounding.
Just as we feel that simple influenza and inflammation of the
respiratory tubes go hand in hand, or better that these respiratory
localizations are the all-important ones in every case of simple
influenza, so, too, we are of the belief that the pulmonary lesions bear
the same relation to all cases of severe and fatal epidemic influenza.
We hold that no case comes to his death through acute epidemic influenza
without having a lesion in the lung. The pulmonary condition, therefore,
is of first importance and its analysis is imperative for a proper
understanding of this disease. There has been divided opinion as to the
part played by the pulmonary lesion in epidemic influenza, some holding
that it is to be looked upon as a part of the disease and others that it
must be viewed as a complicating lesion. Complications of various kinds
are very common, and there are a number of conditions arising in the
lung (abscess, gangrene, necrosis) which must be viewed as
complications. There is, however, a type of pneumonia, and here I use
the term in its broad sense, which is not in truth a complication but
merely a wider extent of involvement of the respiratory tract by the
same virus which is always present to cause lesions in the respiratory
tubes. The reaction within the lungs is distinctive and differs from the
pneumonias which are met with under other conditions and with various
bacterial agencies. Nor are our findings in this matter unique for this
epidemic. They have been described and discussed in the past. True it is
that, like in the epidemic which has just passed us, the incidence of
clinical and pathological pneumonia varied quite widely in different
communities, so, too, the reports of past epidemics do not give a
uniform description of a pulmonary lesion. Where, however, the analysis
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