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
Occasional reports have been made upon the occurrence of thrombosis
immediately following an attack of influenza. These thromboses have
occurred in diverse regions, the brachial, femoral, the mesenteric, and
other arteries. It is possible that the development of the deep
hemorrhagic lesions of muscles in the extremities are associated with
thrombosis. It is impossible, however, to demonstrate within such blood
masses the presence of thrombosed vessels which had preceded the
hemorrhagic state. It was, however, possible to demonstrate capillary
thromboses through the lung and in the submucosa of bronchi and trachea.
In these instances the damage to the vascular walls was brought about by
the action of the infection immediately surrounding them, and was not
associated with a process beginning within the lumen of the channel. The
type of thrombosis within the lung to which we have referred in a
previous discussion is interesting in that it does not show the usual
type of fibrin clotting, but in place of fibrin threads a gummy
homogeneous material is deposited upon the vessel walls within which the
red blood cells soon undergo dissolution. It would appear that these
thromboses within the lung are dependent upon a toxic action on the
vessel wall and its plasma content.
Thromboses within venous channels are met with more often than in
arteries. The veins of the lower extremities are most frequently
affected, and yet amidst the many cases of influenza it is an unusual
occurrence. The various thromboses of larger vessels usually occur as
post-influenzal complications rather than as accompaniments of the acute
disease. It is possible that factors other than those present during the
acute stage play an important part, and that the virus of influenza is
not directly the cause of the thrombosis.
_Lymphatics of Lung and Mediastinum_
One of the prominent reactions which was almost constantly present as
the inflammatory reaction involving the lymphatic system of the chest.
The lymph glands within the chest responded to a marked degree in
hyperplasia and commonly showed enlargement quite out of proportion to
what is usually observed in lobar pneumonia. These reactions were in
direct relation to the inflammatory processes of the lung and appeared
to be involved in proportion to the inflammation occupying the tissues
drained by them. Elsewhere in the body the lymph glands responded but
slightly, and often no change was observed in the lymphatics of the
abdomen, axilla and lower extremities. The systemic intoxication thus
had no effect upon distant lymph glands, and even the presence of
micro-organisms in the circulation did not appear to cause responses in
these tissues other than in the neighborhood of the chest. Within the
chest the lymphatic system became involved through the presence of the
various bacteria migrating along the lymphatic channels as well as
through its activity in removing products of inflammation.
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