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
therefore, that in influenza-pneumonia all of the lung involved in the
early peculiar inflammatory reaction need not pass through those stages
and reactions as we recognize them in pneumococcus lobar pneumonia.
The resolution taking place in the areas of serous and hemorrhagic
pneumonia is accomplished largely by a reabsorption of the fluid,
autolytic disintegration of the red blood cells and a certain amount of
phagocytosis of red blood cells and their debris. This resolution is
quite rapidly accomplished, and the clearing up of such an area may take
place in a remarkably short period of time. The leucocytes and
endothelial cells which are present with every such reaction become
active in phagocytosis of bacteria, and we have repeatedly observed them
crowded with small Gram negative bacilli, whose morphology is similar to
that of the B. influenzæ. These areas contain but few bacteria of other
kinds. The exudate in the alveolar walls is also simple in character and
is readily removed. Slight suffusion of blood, serous fluid, and
migrating cells may occupy portions of the alveolar walls during the
acute reaction, but these, too, are easily removed and the tissue
rapidly resumes its normal character. The vascular and lymphatic
congestion again disappear and the tissues which once were soggy return
to a normal state without leaving behind evidence of the pulmonary
incapacity. The lining epithelium of trachea, bronchi and alveoli is
restored by proliferation from the neighboring less injured parts.
If this early stage in influenza-pneumonia is to be compared with the
early reactions of endemic pneumonia, it is interesting to note with
what ease the resolution may be accomplished in the former, whereas in
the latter a further sequence of stages must apparently be passed
through before the lung is cleared of its inflammatory products. As we
have intimated before, the early exudate in these two types of pneumonia
differs very essentially, the one being accompanied by much fibrin and
leucocytes which are present only in small quantities in the pulmonary
lesion of influenza.
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