The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
However, in such areas of slight change, the bronchi and bronchioles may
be distended and filled with polymorphonuclear leucocytes, exfoliated
epithelium, and bacteria (Fig. X). It is, of course, possible that
infection of the parenchyma may recur from these sources. Here the
extent of involvement of the bronchiolar wall is variable and analogous
to those described previously. Occasionally, too, where the alveolar
change has subsided, the interstitial tissue, particularly that which
divides groups of neighboring lobules, may retain its increased size
with fibrous tissue framework spread apart by exudate and punctuated
with an occasional circumscribed purulent mass (92, 95, 110, 156) (Fig.
XXXVI). Such a miliary abscess within the lymphatics of the interstitial
tissue may compress the neighboring air sacs, themselves entirely free
of inflammatory involvement. That these strands of interstitial tissue,
the conduits for the lymphatics, are important barriers against the
spread of an inflammatory process from lobule to lobule by direct
extension, is evidenced by the extreme variation in the amount and type
of involvement in neighboring lobules (Fig. XXX). This variation is
repeatedly encountered and the band of interstitial tissue, often
prominent on account of its edema, separates these lobules the more
clearly. In all probability, the sharp demarcation of the lobular
consolidation as described in the gross picture depends upon the change
in the interstitial tissue which tends to localize the infection (93).
This fact suggests that the process within the pulmonary parenchyma
spreads along the bronchial tree rather than from lobule to lobule.
Sections from those areas of the lung where the involvement is more
marked may show a histological picture not unlike that described for the
aplastic stage, but, in addition, there are groups of lobules where the
exudate is typically purulent and pus cells not only form the greater
part of the exudate in the lumen, but are prominent in the distended
vessels of the alveolar wall (Fig. XXIX). Often these leucocytes are
multilobed and frequently their protoplasm is granulated with
phagocytized bacteria. The bacteria are also encountered free in the
alveolus along with other elements; namely, red blood cells, strands of
fibrin, or precipitated albumin (Fig. XXI). The bacteria, however, are
not particularly conspicuous, for generally they are either single, in
pairs, or in chains; and it is only when they become clumped to form
large masses, often larger than any normal tissue cell, that they
attract attention. When this appearance is encountered, the alveolar
wall is no longer distinct and well preserved. Although the wall may
still be made out, it often stains rather homogeneously and much of the
finer architecture is lost in the thrombo-necrotizing process that has
been instituted (Fig. XVII).
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