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 presence of large amounts of exudate within the bronchi brought
these structures into unusual prominence. This was particularly true in
the purulent stage of the reaction when beads of sticky pus would well
up from the cut bronchioles. We were tempted on a number of occasions to
speak of this in terms of bronchiectasis but with the intense
inflammatory reaction occupying the bronchial wall and modifying its
contour on this account we avoided this diagnosis. In one instance,
however, the lesion was unmistakable. This was a case of purulent
pneumonia (764) dying on the ninth day of the disease. The distribution
of his pulmonary lesions was distinctly lobular, apparently following
the course of the bronchial distribution. The bronchi were followed
longitudinally and irregular pouchings of the lumen were very apparent.
The bronchi had suffered marked inflammatory reaction which had also
infiltrated the muscular tissues of the tubes. Goodpasture and Burnett
report finding two cases of acute bronchiectasis associated with abscess
and ulceration of the bronchi. In our case the bronchiectasis was found
bilateral but was more marked in the lower lobes than the upper.
The lymphatic channels within the lung tissue are found active in
establishing an internal drainage to the neighboring thoracic glands.
The lymph vessels were often found filled with leucocytes and variable
amounts of serum. During this late stage only a few of the endothelial
leucocytes were observed wandering to or from the lung with a load of
pigment or cell debris. These wandering endothelial cells, however,
appeared to become loosened from their normal situations and in the
vicinity of lymphatic nodes or communicating channels where these cells
are prone to localize with their carbon pigment, again assumed their
spherical form and took on migratory properties entering into the nearby
tissues and scattering themselves in the looser structures. It is an
interesting point to note that these pigment carrying cells, ordinarily
assuming a latent existence when their cytoplasm has been crowded with
foreign particles will assume all the activities of migrating cells when
the œdema of the tissues alters the physical properties not conducive to
a stationary existence. These cells will then be found to enter the lung
alveoli, often appearing as cells which have only recently picked up
their carbon load. When, however, the conditions of the experiment, that
is, the production of an inflammatory œdema in the lung, are produced in
the tissues of an individual with much anthracosis, he will, during the
period of his pneumonia and for some time during convalescence, bring up
a greater number of these cells in his sputum than are ever obtained
during the times when the lung is not involved. We are convinced that
inflammatory conditions of the lung tend to reduce the total number of
latent pigment bearing cells present in the involved tissues, and in
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