The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
Post-mortem examination showed little of interest aside from the
thorax. The left pleural cavity contained 75 cubic centimeters of
slightly cloudy fluid. The right was almost completely obliterated
by an organizing fibrinopurulent exudate which bound together the
visceral and parietal layers. The left lung was partially collapsed
and covered by a thickened pleura, bluish purple in color, which at
the base and in the interlobar area was finely granular. Crepitation
was present at the apex, the anterior surface, and the borders of
the lung; elsewhere the consistency was increased. On section there
was a frothy exudate from the apex and extreme base. These were deep
red in color, while the intervening surface of the lung was paler,
but broken by many small, white, elevated nodules which at first
glance resembled tubercles (Fig. XXXIX). On close examination each
of these was seen to have a small, depressed center from which pus
could be expressed, and on dissection this was seen to be the wall
of a bronchiole. The right lung was more voluminous and covered by a
thick, grey, fibrinopurulent exudate except on the upper anterior
border where there were a few small areas of interstitial emphysema.
On section the pleural exudate was seen to be sharply demarcated
from the lung parenchyma by a fine red line. The pseudotubercles of
the other lung were here even more marked and from each exuded a
yellow pus which partially obscured the pinkish-grey translucence of
the surface (Fig. XL). The lumina of the larger bronchi were
distended. The hilic and bronchial glands were enlarged and grey.
Microscopic examination of sections from the lung showed an
extensive bronchopneumonia. The alveoli of an occasional group of
lobules were filled with serum or red blood cells, while still other
areas showed foci of necrotizing pneumonia, actual miliary abscesses
in which there were large clumps of bacteria (Fig. XLI). Throughout
the sections, however, the striking change was an organization of
the exudate, which varied from a few fibroblasts to a well defined
connective tissue almost obliterating the normal architecture (Figs.
XLI and XLIV). The alveolar walls in some areas showed edema only,
in others they were almost replaced by a thin line of fibrous
tissue, and in still others, by a hyperplasia of the epithelium
which almost filled their lumina. The bronchi exhibited similar
changes, their lumina were filled with an exudate of desquamated
epithelium and leucocytes, which in some places was organizing (Fig.
XI), and there was a regeneration of epithelium evidenced by a
piling up of the cells and the presence of mitotic figures in them.
The interstitial tissue showed some edema. The tracheal epithelium
was intact, but a few leucocytes and lymphocytes were scattered
through the submucosa.
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