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
Not uncommonly this stage of inflammatory œdema was accompanied by
various grades of hemorrhage, varying from the presence of small
aggregations of red cells to a complete flooding of the lung tissue
making it look not unlike a red infarct of lung, save that the alveolar
walls still showed an active circulation and living cells. It was
remarkable that even though there was such an intense reaction taking
place in the lung tissue there was little or no evidence of a cellular
exudate during this stage of the process. Where much blood was extruded
into the alveoli occasional fibrin threads were found in the coagulum.
In these early cases the bronchicles and small bronchi were found to
contain an exudate similar to that in the alveoli. Not uncommonly the
vessels from which the red blood was escaping, could be demonstrated in
sections. The appearance of the vascular wall suggested that a definite
opening had occurred in the side of the capillary from which the blood
escaped. We were not able to demonstrate a fatty or other type of
degeneration in the cells of the capillary walls. It is probable that
the process of injury was much too acute to permit of the demonstration
of the products of degeneration within the surviving cells.
The hemorrhagic lesions which had existed for a longer period of time
gradually showed a varying infiltration by wandering cells. The earliest
cells not belonging to those of the hemorrhage or œdema appearing within
the alveoli were mononuclear elements partly arising from the alveolar
walls and partly coming from the circulation. Numerous mononuclear cells
of epithelial type desquamating from the inner surface of the alveoli
accumulated in the œdematous fluid and the hemorrhage within a short
time after their occurrence. These cells either appeared in clusters or
as single elements. Accompanying this were also large mononuclear cells
loaded with different quantities of pigment which had apparently escaped
from the lymphatic channels within the alveolar walls. These latter
cells belong to the wandering endothelial type which are active in
phagocytosis for foreign material and which assist so largely in
inducing the deposit of carbon in the lungs and lymph glands. A third
mononuclear cell appearing early in the reaction was the lymphocyte. The
numbers and extent of distribution of this cell were not constant. We
have seen it in some of the reactions where very few leucocytes were to
be seen, and where it constituted the main infiltrating cell of the
alveolar wall or the air sacs. We have previously mentioned its presence
in the inflammatory reactions of the bronchi. Here we find it in the
early response within the lung tissue and appearing amidst a reaction
which is intensely acute. It is not long after the finding of these
various cell elements that the polymorphonuclear leucocyte wanders in
large droves to numerically overshadow the mononuclear cells.
Nevertheless, the three types above mentioned can be recognized in the
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