The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The consolidated areas vary greatly in size and number;[10] often they
are small and involve only single lobules, which now stand out as
granular, generally elevated patches on the surrounding congested plane.
Their color, as on the pleura, varies. They may be dark, almost
hemorrhagic, fading through the reds, pinks, and greys. They may be
firm, or, at the other extreme, honeycombed by small, often narrow,
cavities, from which a material similar to that described on the surface
wells forth. The latter change is more frequent if the consolidated area
is large. It has occurred most often in the pseudolobar and in the lobar
types of the process. The pseudolobar change is differentiated, not only
by the confluence of more or less definite lobular patches and by its
involvement of portions of contiguous lobes rather than a single lobe,
but also by variations in the color and consistence of the different
lobular foci. This is in contrast with lobar involvement where the
entire lobe is affected by a uniform process usually at the same stage
of development. Although the consistence may vary in different portions,
usually the same color is present throughout. (Compare Figs. XIV and
XXVIII.) In one instance where a solid, yellow lobe was found, its
center contained an irregular, fresh blood clot (Fig. XVIII), which
would be sufficient to differentiate this type of consolidation from
that of respiratory disease in which the initial lesion is less
destructive. Sometimes the softening in a hepatized lobule or group of
lobules is much more evident, and the zone becomes divided by irregular
channels filled with viscid, grey or brown material (108, 149, 162).
When such a condition lies just beneath the pleural surface, it may be
distinctly seen from without (Fig. XXXIII). The pleura bulges, the
normal topography of the local zone is lost, and it appears as a dull,
somewhat projecting, circumscribed patch, two or three or more
centimeters in diameter, the surface of which has a more or less
characteristic brown or brownish black opacity. As soon as this is
sectioned there pours from the cavity the liquefied exudate in which the
destroyed pulmonary parenchyma is mixed (Fig. XXXIV). Occasionally,
strands of tissue still traverse the cavity, but, as a rule, it empties
itself completely, and leaves a brownish black wall. The delicate, sweet
but persistent and penetrating odor is not so marked as with typical
gangrene.
_Histological Picture._
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