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
As soon as the lobes show this gray character and with the progressive
development of an acute interstitial purulent pneumonia, the lung tissue
becomes friable. All gradations of flabbiness may still be obtained and
in the early stages while the cellular exudate is accumulating to change
the color of the lung, little variation from the tough character of the
pulmonary tissues can be recognized. When, however, a true gray
character is assumed by a portion of the lobe, the tissue becomes so
soft that it is handled with difficulty without rupture. The thumb can
be pressed into the gray mass and pus will well up around the invading
phalanx. The consistency in the late stages reminds one of the pulpy
tissues in acute splenitis. In cutting such lobes it is almost
impossible to obtain slices of the tissues, their own weight often
breaking such a segment. When allowed to rest on the table for a few
moments, the cut surface becomes coated with a dirty yellow slime
representing pus and products of disintegration arising from the lung.
The stroma and alveolar tissues are themselves involved in the
inflammatory process and many of them have suffered complete or partial
destruction so that they offer but little resistance to pressure and
serve as a poor supporting stroma to the pulmonary tissues. The reaction
which has taken place within the lung producing both the gray color and
the destruction of the tissues is, indeed, an active suppurative one.
One would not be surprised to obtain not only a purulent lesion wherein
the cellular exudate occupies the air sacs and their walls but also a
further stage leading to a destruction of the tissues to the extent that
abscess cavities are produced. These we have met with in several
instances, some of them being small while others were several
centimeters in diameter. An abscess of larger extent and having a
destructive process which involved the surrounding tissues so that one
would speak of it as a process of gangrene, was observed by Dr. McMeans
in one of his cases. A lobar distribution of the purulent lesion takes
place where multiple involved lobules have fused in their periphery or
where a suppurative flooding of the tissues in this violent late
reaction has taken place.
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