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
In the late purulent lesions of the lung we have encountered dilated
lymphatic channels whose yellow contents could be recognized by the
naked eye. At times this could be followed for short distances along the
bronchi as narrow yellow cords, or when cut transversely appeared as
small dots close to the bronchi or vessels. On pressure small droplets
of pus may be evacuated, or again where fibrin has led to a coagulation
of the exudate a yellow plug can be withdrawn from the channel. These
small plugs resembled the thick exudate seen within the bronchi and
often were misleading when first viewed. The distribution of the
purulent lymphatic masses was most irregular occupying only local or
patchy fields in the lung, particularly associated with the purulent
confluent pneumonia. In one instance such a lymphatic appeared to be
associated with the development of a small abscess lying close to the
bronchus.
Too much stress cannot be placed upon the importance of the lymphatics
in all forms of pneumonia. They play an important role in the drainage
of the lung during inflammation. In the normal lung we hardly appreciate
the lymphatic distribution except in our observations upon anthracosis.
But even under these conditions when much carbon is deposited in
conjunction with the lymphatic system we do not gain a true appreciation
of the activity of the lymph channels and nodes during an acute process.
Bacteria may be demonstrated in acute infections of the lung within the
fluid and cells of the lymph channels. Less easily may we demonstrate
bacteria in the lymph nodes under similar conditions, although when
abscess has occurred their presence is readily recognized. The transport
of bacteria is accomplished not only by a passive migration of
micro-organisms in the fluid as it drains from the lung, but organisms
are also found within the leucocytes as they travel with the current.
Only occasionally have we demonstrated bacteria within the wandering
large mononuclear cells, although we have observed them in a few
instances within the cells lining the sinuses of the nodes.
Whether the inflammation of the pleura is directly related to the
involvement of the pleural lymphatics we have not been able to
determine. In our series of cases pleurisy has not been a prominent
feature of the disease, and in many instances the grade of involvement
was so slight that it was not easily recognized by the naked eye and
showed only a slight reaction microscopically. That the presence of
bacteria within the intricate plexus of lymphatics beneath the pleura
may be responsible for the development of an inflammation of this
membrane may well be the case, and in this way simulate the mode of
transmission of the infection as seen in lobar pneumococcus pneumonia
and in the streptococcus type of infection.
_Abdominal Viscera_
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