The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
Hemorrhages in the mucosa of the alimentary canal, including the stomach
and intestines, similar to those so common at the post-mortem table in
many different types of acute infectious disease, are, of course, common
in influenza; but, in one case especially, a lesion was encountered
which adds significance to these hemorrhages (47). Here areas of mucosa,
usually round or oval and varying from one-half to two centimeters in
diameter, often with ulceration in their centers, show, microscopically,
bacterial emboli in the vessels of the mucosa with a hemorrhagic
effusion which obliterates the architecture of this coat and extends at
some points into the submucosal and muscular layers (Fig. LVI). Here,
the occurrence of bacterial emboli in association with the lesion
suggests that they may be etiologically related to similar processes in
other parts of the body.
The above example of hemorrhage in the mucosa of the alimentary canal
has seemed of especial interest, not only for its possible value in
explaining the etiology of the lesion here and elsewhere, but as an
interpretation of the findings in Autopsy No. 185, an abstract of which
is appended below. There a hemorrhagic lesion in the wall of the urinary
bladder led to rupture and brought the patient to the surgical clinic of
the hospital.
_Autopsy No. 185._
A white female, aged 46 years, was admitted to the New Haven Hospital on
January 4, 1919, complaining of “cough and headache.” Five days
previously she had a “cold” that she was able to “break up” with quinine
and aspirin. The “cold” recurred two days ago, and since then she has
had “frequent chills, aches all over, and feels weak.” Her family and
past histories were unimportant.
Physical examination on admission showed congestion of the pharynx.
Below the inferior angle of the scapula on the right, there was
dullness, bronchovesicular breath sounds, and a few fine râles. The
examination was otherwise negative. Three days later the signs in the
lungs disappeared. The next day, after an attack of coughing, she
complained of something having “burst” within her abdomen and of
generalized abdominal pain. A diagnosis of ruptured bladder was made and
1,400 cubic centimeters of bloody urine were withdrawn by catheter.
Immediate operation was decided upon and the bladder was found a hand’s
breadth above the symphysis pubis; the posterior wall was very thin and
presented a tear extending from the trigone upward in the mid line for 7
centimeters. Fully 500 cubic centimeters of clotted blood and urine were
removed from the pelvis, but there was no marked evidence of
peritonitis. A permanent mushroom catheter was placed in the urethra,
and the tear was sutured. The abdomen was closed with provision for
drainage. The patient was returned to the ward in doubtful condition.
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