The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The lungs are extremely voluminous (12, 17) due in part to an
accumulation of liquid within them. This finds its way into the trachea
and completely fills the latter structure with blood-stained, syrupy
fluid, with purulent material, or with a mixture of these (2, 90, 107,
157, 162). At first the pleural surface is smooth and often quite even,
but on closer inspection, a minute granulation is suggested. In many
cases even close examination does not allow the conclusion that an
exudation of anything but serum has occurred through this membrane,
except in localized foci. These foci more frequently involve the
interlobar pleura and that of the lower lobes (112, 143). The volume of
the lungs, often great enough to obliterate the pericardial area, is one
of the two most characteristic features of the external examination. The
other feature is their color. Small, bright red hemorrhages may occur
anywhere. The larger patches are the most striking. Violet, purple, or
dark brown areas, irregular in shape and distribution, are more
frequently found on that portion of the pleura over the lower two-thirds
of the lung. Between the deeply colored zones, there are pale pink areas
which involve the lowermost edge to the least degree, the anterior
margin somewhat more, and the apex of the lung most of all. The darker
portions just referred to may project above the surface and may be
circumscribed, resembling huge, fresh hemorrhagic infarcts (41, 108).
The alveolar walls are not seen through the pleural surfaces in these
darker zones. The pale pink areas, usually at the level of the more
intensely colored zones, may be elevated and the dilated air sacs are
distinctly made out through the pleura (Fig. XIII). At the hilum, the
lymph glands are large and soft. When cut, fluid escapes and is often
blood-stained. The cross section may present a distinct, diffuse,
hemorrhagic appearance (162). At the hilus, too, the lymphatics,
distended here and there over the surface of the pleura, are most
affected. The congested bronchial mucous membrane and the exudate in
these structures has been described.
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