The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
Physical examination showed a markedly emaciated white woman with a
high degree of arthritis deformans. Dullness and fine râles were
present at the left apex. The temperature was but slightly elevated
until three days before death, when it rose to 101°F. and slight
dullness developed at the right base with bronchial breathing and
fine râles. The white blood count, which on admission had been 9,200
cells per cubic millimeter, rose to 15,000 per cubic millimeter. She
died after a seven-weeks’ illness.
At necropsy, with the exception of the joints, little of interest
was found outside the thoracic cavity. On the posterior and
diaphragmatic surfaces of both lungs fibrous adhesions were present
binding the visceral to the parietal pleura. The right lung was
moderately voluminous and grey in color over the upper lobe, but had
darker red areas over the surface of the lower lobes. Patches of
increased consistency were found in the lower part of the upper
lobe, in the middle lobe, and at the base. On section there was a
slight, red, serous exudate. The surface over the more solid areas
was somewhat translucent, grey or light red, and was firm and not
friable. The bronchi of the lower lobes were conspicuous, and at the
extreme base so dilated as to give almost a honeycombed appearance.
From them yellow pus exuded. The left lung was less voluminous and
showed some increase in consistency throughout. In the lower lobe
this was more uniform, but the upper had a shotty feeling. On
section the upper lobe showed many hard or caseous nodules, with
occasional patches of grey, gelatinous pneumonia. One small cavity
was present about 3 centimeters from the apex. The lower lobe showed
no gross evidence of any tuberculous process. Many pseudotubercles
projected from the red surface, but from each pus could be expressed
exposing the slightly congested wall of a bronchiole. At the extreme
base two small cavities filled with yellow pus were present (Fig.
L).
Sections from the left upper lobe showed, microscopically, both a
chronic and acute tuberculous process. Tubercles with a definite
wall were present, but there were also large areas of caseation. The
tissue between showed interstitial organization with mononuclear
infiltration and occasional groups of leucocytes. The bronchial
epithelium exhibited no marked change, but the bronchi were filled
with pus cells.
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