The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
As might be expected from the gross appearance, the alveoli vary in
size. At times slightly collapsed and at other times overdistended,
their lumina are still the seat of the inflammatory exudate, although
the mechanical change may allow of some variation in the appearance of
their walls. As a rule, however, the alveolar wall is prominent and owes
its conspicuousness to the tortuous, engorged vessels within. These
vessels contain red blood cells almost exclusively, and on account of
the partial, occasionally complete, loss of the lining epithelium, the
alveolar wall appears as a huge, dilated arteriole (101) separating the
lakes of coagulated material in the spaces (Fig. XXIII). There are
areas, as indicated above, where the alveolar content may be more
definitely arranged in the form of beaded or homogeneous strands of
different caliber; the smallest resemble delicate threads. They tend to
converge toward the alveolar wall like wheat in a sheaf, and often pass
through this wall by way of the so-called pores of Cohn; as soon as the
body of the neighboring alveolus is reached, they again present a
fan-like expansion into innumerable, fine strands (Fig. XXII). Where the
exudate is more fibrinous, the alveolar wall is less likely to be
distended, its vessels are not so prominent, and their content of red
blood cells is definitely decreased. Still this is not the most extreme
type of alveolar exudate met with at this stage. Perhaps, the most
striking, although not the most frequent, exudate has a superficial
resemblance to a huge, red blood clot, and it may be difficult to make
out the alveolar walls separating the masses of well preserved red blood
cells that fill the alveolar spaces. These areas are indistinguishable
from infarcts and may be associated with thrombotic arteritis in near-by
pulmonary vessels (47) (Figs. XXIV and XXV). Among the red blood cells
an occasional strand of fibrin, a desquamated alveolar epithelial cell,
and rarely a polymorphonuclear leucocyte may be encountered. The
alveolar wall itself varies in the definition of its outline. When its
vessels are greatly distended, when its alveolar epithelium is gone, and
when its content consists largely of red blood cells, it is difficult to
distinguish from the exudate which it encloses. However, when it is more
compressed or when its epithelial lining cells are still more or less
intact, it may be seen as a blue-staining strand under the low power of
the microscope, for the well preserved nuclei lend it prominence.
[Illustration:
FIG. XVI. AUTOPSY NO. 112. BACTERIA DEVELOP IN THE HYALINE NECROTIC
EPITHELIUM OF THE TERMINAL BRONCHIOLES. HERE THEY FORM CIRCUMSCRIBED
MASSES THAT SIMULATE NUCLEI. COMPARE FIGURES V, VIII, XV, AND XVII.
HELIOTYPE CO. BOSTON
]
[Illustration:
FIG. XVIII. AUTOPSY NO. 155. ILLUSTRATES A MILD FORM OF PULMONARY
INTERSTITIAL EMPHYSEMA.
]
[Illustration:
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