The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
Gradually this phantom architecture, spotted only here and there with
disintegrating polymorphonuclear leucocytes, ends in a ragged compressed
border of a shaggy pink material which has no identifying qualities
(Fig. XXXV). In the inner zone of pink an occasional vessel or, at
times, a bronchiole more resistant to the process remains; frequently it
is accentuated by the presence of partially destroyed polymorphonuclear
leucocytes at its periphery. Probably these cells invade the necrotic
areas along the sheath of the bronchus or vessel and not across the dead
area. The thrombotic process described in the previous stage (Fig. LII)
associated with an acute arteriolitis, may be associated with these
gangrenous areas as well as with infarcts (82), but more likely gangrene
is preceded by the acute diffuse necrosis of the alveolar wall which
occurs in the fulminating cases. Furthermore, this is suggested where a
typical grey hepatization is associated with marked thinning, but not
actual disappearance, of the alveolar wall. Before concluding the
description of this stage of the disease, mention should be made of the
granular nodules of fibrin superimposed upon the swollen pleural cells
and also of the older pleural exudate, either typically fibrinopurulent
or more homogeneous with broken nuclear fragments (Fig. XXXVIII).
_Summary._
In this stage of the disease the respiratory change is characterized by
a localization of the inflammatory process with cellular invasion of the
exudate. Pneumonia results, varying in extent from peribronchial to
lobar, a pneumonia in which one of the most frequent complications is
necrosis of the lung. Consequently, abscesses, even gangrene, are found.
(3) ORGANIZATION OF BRONCHIOLAR AND PNEUMONIC PROCESSES.
The processes described for the preceding group which involve not only
the alveoli, but also the bronchi and the bronchioles, were predicted
from the extensive hyalinization of these structures—a characteristic
change in the more fulminating and acute phases of the disease.
Likewise, it can be predicted that where death does not terminate the
process such lesions will be followed by organization, which, by
converting the exudate into scar, will produce deformities and offer
serious mechanical interference with the ingress and egress of alveolar
air and similar interference with the flow of blood through the
pulmonary circulation (82).
[Illustration:
FIG. XXIV. AUTOPSY NO. 92. AN ALMOST PURE HEMORRHAGIC ALVEOLAR
EXUDATE. COMPARE FIGURES VI, XXV, AND XXVI.
]
[Illustration:
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