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 localization of the inflammatory products not only upon the surface
of the air sacs but also in the stroma of the alveoli; the interlobular
trabeculæ, and about the vascular channels indicates the intense effect
of the virus of this disease. The exudate is largely an indication of
the point of action of the irritant upon the tissues, and in influenza
with its variety of bacteria in the lung this is not limited to the
surface membrane of the air sacs. During this second stage of the
reaction the purulent exudate was found occupying all structures of the
involved area. Damage upon the component tissues was to be seen in the
endothelium of the capillaries, the muscle tissue of the bronchioles and
arterioles, the connective tissues and the epithelium. It was seldom
that bacteria were demonstrated in the interstitial parts, and it would
appear that the damage was the result of their toxins.
Hence, broadly speaking, the end result of the pneumonic process in
influenza is far more complex and indefinite than that in lobar
pneumonia. Resolution may take place early with the clearing up of the
first products of the exudate; or it may be delayed in association with
the secondary purulent process which not uncommonly occupies multiple
lobes. Where the resolution begins in purulent regions the final outcome
is most variable, depending upon the amount of damage which has been
imposed upon the lung tissue during the suppurative inflammation, ending
either in complete restoration or slight fibrosis of the lung, or
passing on to focal scarring of various degrees, sufficient to alter the
pulmonary capacity. In other instances the resolution is delayed by the
development of abscess, infarct and gangrene. Here the final outcome is
determined by the amount of tissue involved in the destructive process,
and the persistency with which the infecting micro-organisms attack the
local tissues and the constitutional resistance of the individual. Those
individuals in whom resolution begins before there is much purulent
pneumonia stand the best chance of having the lung return to its normal
characteristics.
_Pleura_
Public-domain text, read in full here on John Shaqi.
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