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 _stomach_ and _intestines_ the lesions were of two kinds, (1)
hemorrhage and (2) erosions. Petechial hemorrhages were present in the
stomach 15 times, in the intestines 4 times. These small dots of blood
extravasation, lying in the mucosa and submucosa, differ in no way from
those observed in other acute infections and intoxications, save that
the tendency for the leakage of blood into the lumen of the viscera was
more pronounced. Often we could observe the presence of free and more or
less altered blood in the stomach and intestines, and in 12 cases the
amount was considerable, sufficient to be spoken of as melena. It is
probable that the oozing of blood takes place not only from the areas
visible to the eye as petechial hemorrhages, but also from the more
normal-looking mucosa of stomach and bowel. The tendency to hemorrhage
was not necessarily accompanied by visible alterations in the epithelial
layer of the mucosa, though at times erosions were found. When
hemorrhage could be observed, the extravasation of blood occupied the
superficial layers of stroma, causing a separation of the tissues
beneath the epithelial layer. At times the submucosa was also
infiltrated, and in one instance the musculature. The lesions were
isolated and sporadic, but always about small capillary loops. It
appeared to us that the damage was primarily upon the vascular tissues
and particularly upon the endothelial walls of the fine channels.
Inflammation was not present, and the hemorrhage was more or less
passive—that is, a slow oozing rather than acute hemorrhage by rhexis.
The second type of lesion of the gastro-intestinal canal was erosion.
This was of the nature of a defect in the mucosa, usually multiple,
small and well circumscribed. The tissue loss was superficial. In their
appearance these lesions were similar to those encountered in these
parts in other infections, and also as described by McMeans in
experimental infections of animals. The erosions appear to arise in a
process of bland necrosis, limited in the periphery by healthy tissue
and not tending to enlarge. It is probable that these erosions are
associated in their development with the petechial hemorrhages, being a
sequel to the vascular disturbance of the mucosa and subsequent
digestion of the injured tissue. Multiple lesions of the stomach were
found 10 times and twice in the intestine. The largest was 1.25 cm. in
diameter. They are more common on the posterior than anterior wall, and
usually toward the lesser curvature. It is probable that these defects
are limited in their progress and heal readily.
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