The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
In this series of cases lesions elsewhere in the body are not
sufficiently constant or important to merit emphasis.[13] Hemorrhages
have been found occasionally in other structures, especially the testes.
The usual cloudy swelling of the parenchymatous organs is, of course,
marked, and in many cases has been associated with actual cellular
necrosis both in the liver and the kidney. Such necroses are usually
focal, and occasionally mitotic figures in the cells of the renal
convoluted tubules or in the liver may be a similar expression of
previous damage. Acute nephritis was not found in our series.[14] The
swollen liver cells often show the bile canaliculi clearly, and this
appearance may be associated with a variable degree of jaundice which
has been found frequently, although the explanation of the jaundice is,
in all probability, an hemolysis of the red cells caused by the
infecting microorganisms. The only other lesion encountered and of
sufficient importance to mention, has been the congestion of the
membranes of the brain and a swelling of the cerebral substance, in all
probability dependent upon edema. One example of purulent meningitis was
encountered.[15] The dilatation of the right side of the heart with a
greater or lesser degree of splanchnic engorgement is such a common
feature in acute pulmonary diseases that it is hardly worthy of detailed
discussion.
[Illustration:
FIG. XXXVI. AUTOPSY NO. 133. A SMALL ABSCESS IN AN EDEMATOUS BAND OF
INTERLOBULAR CONNECTIVE TISSUE.
]
[Illustration:
FIG. XXXVII. AUTOPSY NO. 114. ILLUSTRATES AN UNUSUAL ANATOMICAL
PICTURE IN INFLUENZA—AN EXTENSIVE FIBRINOPURULENT PLEURISY. THE
BRONCHIAL LYMPH GLANDS ARE PROMINENT ON ACCOUNT OF THE HEMORRHAGIC
INFLAMMATORY PROCESS WHICH HAS INVOLVED THEM.
]
A striking feature of influenza is the occurrence of abortion in cases
complicated by pregnancy. Of the ninety-five cases included in this
report, twenty-seven were women of whom three died undelivered (three
months, six months, term), three had suffered complete abortion (one,
three months, and two, six months), and one (six months) was in process
of abortion. It is not our purpose to discuss the relation between
pregnancy and this complication. Here it is desirable simply to point
out that, although in the non-complicated cases of influenza, pregnancy
does not influence the course of the disease, if pneumonia supervenes,
the mortality for the mother, as well as for the child, is definitely
increased (57, 148, 164).
A specific placental lesion would be difficult, indeed, to establish
since hemorrhage is a part of the normal process of placental
separation. However, the hemorrhagic lesion of influenza seems a
plausible explanation for the frequency of abortions in this disease.
_Summary._
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