The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The advent of red blood cells where grossly the exudate is red can
hardly be explained by the simple process of diapedesis. Indeed, there
is ample evidence that they escape by rhexis through lesions of the
vascular wall. This phenomenon cannot be demonstrated in areas where a
compact mass of red cells obliterates the alveolar space (Fig. XXV), but
in the less firmly consolidated alveoli where red blood cells
predominate (Fig. XXVI) the picture of the alveolar wall is very
instructive. The capillaries may be prominent and contain red cells
almost exclusively. Often the epithelium of the air space is exfoliated
so that there is nothing to minimize the prominence of the engorged
vessels. These capillaries, covered by such a delicate wall that rupture
seems imminent, may protrude like saccular aneurysms (101) into the
alveolar space (Fig. XXVI). In all probability, these sacs do rupture
and this result would be one explanation for the escape of large numbers
of red blood cells. In several instances such a picture was encountered,
where with little reaction at the point of rupture, red cells within the
vessel were continuous with an accumulation of similar cells in the
alveolus. Further evidence for such rupture is offered where the vessel
is collapsed. Here there is accumulation of polymorphonuclear leucocytes
in the area of destruction in contrast to the well preserved red
corpuscles in the remainder of the vessel (Fig. XXVI). The above
pictures may be utilized in the interpretation of the outspoken foci of
red hepatization which may assume infarct-like proportions. As has been
said, it is impossible to conceive that these hemorrhagic areas where
the alveoli are packed with red cells ever change to a grey type of
consolidation. Consequently, it seems more probable that the color of
red hepatization in the usual types of pneumonia depends upon the marked
engorgement of the vessels seen through a relatively acellular,
transparent, serofibrinous, alveolar mass and not upon the number of red
cells in the exudate.
C. THE APLASTIC EXUDATE
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