The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
Only two examples of hemorrhage in the recti muscles[11] were
encountered in the ninety-five autopsies. In other localities this
lesion has not only been more frequent but also more extensive (2, 47,
50, 128, 140, etc.). However, it has been fortunate that the two
instances in this series represent a fresh hemorrhage and the healing
lesion, respectively. The fresh hemorrhage is quite characteristic of
Zenker’s necrosis involving muscles. Grossly, it is a small lesion and
does not involve the entire width of the rectus muscle, as may happen,
with a resulting rupture of this structure (12, 162). Microscopically,
many of the muscle cells have lost their striation, are irregularly
swollen, and, as fractures in them indicate, are apparently brittle.
Between the muscle fibers and where these are lacking, the predominating
element of exudate is the red blood cell, but there is a considerable
amount of fibrin and also some serum between these cells (Fig. LVI). The
absence of polymorphonuclear leucocytes is noteworthy. The second
example of a muscular lesion occurred in a patient who died on the
twenty-fifth day of the disease. Grossly, this also was a small lesion,
although the muscle fibers at its site were obviously ruptured.
Histologically, the lesion is a healing one. Regeneration of the muscle
fibers (47, 156), as illustrated by the formation of typical spindles,
is handicapped by the rapid development of the fibrous scar (Fig. LVII).
Suppuration had not occurred and this also has been true for the focal,
hemorrhagic, inflammatory processes which were encountered in many
different localities throughout the body.[12]
Perhaps the focal hemorrhagic lesions were most frequent in the adrenal
gland. Generally, they were located in the cortex, although medullary
hemorrhages were encountered. The extent of the process varied from
minute hemorrhages, associated with necrosis of only a few cells, to
extensive ones involving half of the adrenal. The microscopic
examination of the exudate revealed the same elements and in
approximately the same proportions as described for the similar process
in the muscles. Not infrequently, mitotic figures in the adrenal cells
indicated an attempt at repair of a minute damage.
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