The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The sequelæ after exposure to gas may be markedly delayed. They occur,
not only in animals which have exhibited characteristic acute symptoms,
but also, and especially with phosgene, where no serious immediate
clinical effects followed exposure to the gases. They are dependent upon
the fact that the pneumonic process has a very striking tendency to
undergo organization, a process which involves not only the exudate in
the alveoli, but also that within the bronchioles. The organizing
process may be present in both these portions of the lung or may be
confined to the bronchiole alone, and lead to a progressive interference
with the ingress and egress of alveolar air, so that atelectasis and
emphysema become permanent, and in turn lead to narrowing of the
vascular bed, ultimately producing right-sided cardiac decompensation.
Bronchiectases also occur; they may be tubular, associated with
organization of the pneumonic process in their vicinity, or saccular if
death has not followed the destruction of the bronchiolar wall.
Compare this picture with that of influenzal pneumonia and its sequelæ;
in both there is, first the acute diffuse involvement of the lung,
initiated by, or occurring simultaneously with, an acute
tracheobronchitis and presenting clinically dyspnœa, cyanosis,
blood-stained, abundant sputum, and even interstitial emphysema; next,
the tendency for the pneumonic process to localize and to necrotize; and
finally, if the acute period is survived, organization of the pneumonic
and bronchiolar exudates with resulting bronchiolitis and
bronchiectasis. With even more minute comparison, the resemblance is
sustained. The initial or early dilatation of the ducti alveolares, so
characteristic in gas poisoning, also occupies the foreground of the
histological picture in influenza. These dilated structures are the more
prominent on account of the red, ribbon-like strands that cover the
surface and often involve the walls. Similar necrotization, varying in
its depth even to involve the whole of the alveolar walls, occurs in
both of these conditions. Similar hemorrhages in the early stage,
rupture of the alveolar wall with interstitial and subcutaneous
emphysema, necrotization, gangrene, and organization in the same
localities, characterize the two lesions, and are not found with the
same uniformity in any other type of respiratory disease.
D. THE IMPORTANCE OF THE TRACHEA AND ITS RAMIFICATIONS AS A PROTECTIVE
MECHANISM AGAINST INFECTION OF THE PULMONARY PARENCHYMA
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