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
To a certain degree we were able to analyze the types of the lesions as
they occurred in the different stages and progress of the pulmonary
inflammation. Briefly, these were as follows: the earliest stage of
congestion following rapidly upon the infection from the bronchi was
followed by (1) inflammatory œdema, (2) hemorrhage, (3) cellular exudate
(a. mononuclear cells, b. leucocytes, c. interstitial infiltration) and
(4) resolution or organization, abscess, infarct and gangrene. The
majority of our cases died during the stages of congestion, hemorrhage
or early purulent infiltration. In the early stages the amount of fibrin
was small or entirely absent, later, with the appearance of leucocytes,
some fibrin was present.
For the estimation of the time elapsing between the onset of the
pneumonia and death we are dependent upon the clinician. This is often
quite difficult to do, in as much as with a primary respiratory disease,
such as epidemic influenza represents, it is very difficult to determine
the time when there is a transition from the inflammatory process of the
upper respiratory tubes to that of the pulmonary tissue. In many of the
cases where from the onset there was intense prostration and every
evidence of marked intoxication the clinical manifestations of localized
processes taking place in the respiratory system were very much in the
background and often of insidious progress. In four of our cases it
appeared as if the pulmonary manifestations had made their appearance
with the first sudden and severe onset of the influenza. On the other
hand, also, the clinical signs and symptoms of lung involvement were
different from those of frank lobar pneumonia. We would, from our
experience at the autopsy table, say that where in the cases of epidemic
pneumonia there are present the signs of pulmonary consolidation like
those of true lobar pneumonia, that there has been an antecedent period
of a pulmonary lesion which passed unrecognized by the clinician. To
more clearly state the case, whereas in lobar pneumonia the stage of
congestion preceding the stage of red hepatization gives rise to no
signs whereby the clinician can indicate the time of its onset or
determine the time when it has passed into the succeeding stage, and
moreover, the stage of congestion is of short duration to be measured in
a period of a few hours, this stage in epidemic influenza though equally
indefinite in its clinical manifestations is much prolonged, lasting not
only a period of hours but even a period of several days. It is this
pulmonary state which is difficult or even impossible to recognize in
the living. All gradations of it occur and the clinician can only
broadly suggest from all the evidence at hand, the period when
inflammation with definite exudate began in the lung. In as much as the
total length of illness of a number of cases was only three, four and
five days, whereas there was nothing at the onset to suggest pulmonary
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