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
Of the more unusual reactions observed in the lungs an infarct was found
occupying a considerable part of the lower left lobe in one case. There
was a marked softening of the lung tissue with reddish, mucky-looking
lung substance arranged about small irregular cavities. This reaction
extended into the lung for a distance of 4.5 cm. Bordering close on
these softened areas there was a dry mottled yellowish gray and deep red
lung tissue. Surrounding this area again were noted a number of small
blood vessels in which there were found yellowish granular plugs. One
plug in a vessel was found at a distance of 3 cm. from the base of the
lobe, and another was found at a distance of 8 cm. from the apex of the
lobe. On further examination it was observed that the base of this
softened area was situated on the pleural surface and that the apex was
directed inward about a distance of 6 cm. from the pleura. Bathing the
cut surface there was a glairy and very sticky material of a reddish
yellow color. Near the apex of this softened area in the lung there was
found a vessel about the size of a goose-quill in which there was a
grayish yellow granular plug. This plug was adherent to the vessel.
Within the small bronchioles there were plugs of a soft yellowish brown
material. The striking feature in addition to the softening of the lung
in a number of places was the glairy material of a sticky nature which
bathed the cut surface. A white infarct was present in the spleen. The
lung described above as well as another showed gangrenous change. In the
second of these two abscesses had formed, and there was a communication
between the lung and pleural cavity in which there was a large amount of
sanguino-purulent fluid and a pyopneumothorax.
In a description of these reactions it must be added that the early and
late changes were not always observed independently, but in most cases
occurred together, giving the lung a peculiar mottled red and yellow
glassy appearance. More frequently the congested œdematous reaction was
observed singly, while the purulent alteration usually was in
combination with the former type. The acute serous pneumonia was noted
13 times, 6 times in combination with the purulent reaction and 7 times
alone, while the acute purulent pneumonia was found in 9 cases, 3 times
alone and 6 times with an acute serous process. In all but 3 of 18 cases
there was evidence of a bronchial distribution. Two of these three cases
showed a massive œdematous lung with in one case an extensive
hemorrhage, while the third presented an advanced purulent reaction with
marked necrosis and softening. An acute bronchitis which varied in
character from a hemorrhagic to a purulent one was present in all the
cases. The reaction observed within the bronchi in the individual cases
corresponded closely to the picture found in the lungs.
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