The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The majority of the fatalities occurred in the acute stage of the
disease, the anatomical aspects of which have been elaborated more or
less completely.[1] Other cases survived for a longer period and in
these, anatomical changes existed, which, as will appear later, were
prognosticated from the acute lesions. Moreover, these findings
suggested that certain progressive anatomical changes occur even when
the disease runs a much less severe clinical course; for example, in
cases where respiratory symptoms persist for a long period before they
are brought to a fatal conclusion.
History, too, suggests such a chain of events; namely, in the record of
the delayed crop of respiratory disorders that followed the harvest of
the epidemic of ’90.
Previous studies of experimental pneumonia in normal and aplastic
animals by one of the authors (160) give a background for the
interpretation of the histology of some phases of this disease, but more
important are the studies of the respiratory inflammatory processes
initiated by the inhalation of toxic gases. This subject, introduced
into human Pathology with the use of poisonous gases in modern warfare,
necessitated elaborate investigations which have just been concluded
(159).
The pathology produced by the inhalation of these poisonous vapors is
analogous to that found in influenzal pneumonia. This is said with a
full comprehension of the criticism that may follow such a statement,
and with the knowledge that a similar analogy has been drawn between
influenzal and plague pneumonia (Symmers, 141). It is, however, a
criticism that is welcomed and which will be met in the body of the
paper.
For the reasons just cited, it has seemed desirable to contribute to the
Pathology of various phases of influenzal pneumonia and to attempt to
correlate this with other types of acute respiratory inflammation, in
the hope that the prognostications which suggest themselves may be of
aid in the prophylaxis and possibly in the treatment of the more
insidious and progressive pulmonary changes that may follow this
disease.
A large part of the text is devoted to a description of the gross and
more minute pathology of the respiratory tract associated with influenza
and its complications, both in the acute and in the subacute or chronic
stages. Incidental lesions of less importance in other portions of the
body that have occurred in these cases are presented briefly, and
emphasis is placed upon a number of special subjects. The order of
discussion will be as follows:—
I. The Pathology of the Respiratory Tract in Influenza.
(A) Lesions of the Trachea and Bronchi.
(B) Lesions of the Lung.
(1) Acute Diffuse Fulminating Type.
(2) Localization and Necrotization of the Pneumonic Process.
(3) Organization of the Bronchiolar and Pneumonic Processes.
II. Influence of the Respiratory Complications of Influenza upon
Tuberculosis of the Lung.
III. Extrarespiratory Lesions in Influenza.
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