Autopsy 504.—G. R. C., white, aged twenty-eight, farmer from Alabama, had been in military service three months. Onset of illness occurred six days before death, and two days later he entered the hospital with fever (103.4° F.), pains in the abdomen and vomiting. Consolidation at the bases of the lung was recognized on the day following admission and on the day before death 900 c.c. of greenish brown fluid were aspirated from the left pleural cavity.
Anatomic Diagnosis.—Interstitial suppurative pneumonia with consolidation in left lower lobe; purulent pleurisy on both sides; purulent pericarditis; purulent peritonitis; parenchymatous degeneration of kidneys; acute splenic tumor.
The body is that of a large well-nourished man. The left pleural cavity contains 975 c.c. of creamy, yellow fluid; right pleural cavity contains 425 c.c. of purulent fluid thinner than that on the left side. The left lung is collapsed; the posterior and lower half of the lower lobe is consolidated, flabby, deep red and fleshy in appearance. The interstitial septa are yellow, thickened with bead-like enlargements and contains creamy purulent fluid which flows away and leaves small cavities. This interstitial suppuration is more advanced below the outer surface of the lobe than elsewhere.
The pericardial cavity contains 25 c.c. of creamy, yellow, purulent, fluid; the epicardium is dull, covered in a few places by a small amount of fibrin and below it are ecchymoses.
The peritoneal cavity contains 100 c.c. of thick, yellow pus; the peritoneal surfaces are injected and between the liver and diaphragm is fibrin.
Bacteriologic examination shows the presence of S. hemolyticus in pure culture from the blood of the heart, the lower lobe of the left lung, pericardium and peritoneum. The right main bronchus contains the same microorganism, B. influenzæ and a few staphylococci.
General serositis has been caused by hemolytic streptococci which in one instance have entered the pleura from a subpleural abscess, and in the other from the suppurating interstitial tissue of the lung. In one of these cases the patient entered the hospital with symptoms suggestive of acute peritonitis.
Bronchiectasis
Acute dilatation of the bronchi is a common result of the bronchitis of influenza, and its frequent occurrence is an index of the severity of the changes in the bronchial wall. In some instances the smaller bronchi in well-localized areas are uniformly dilated; in other instances, large cavities, several centimeters in diameter, are formed and all transitions between the two extremes occur.
The occurrence of bronchiectasis following influenza is mentioned by Leichtenstern[[86]]. He states that evidence of bronchiectasis can persist for weeks or months and nevertheless end with complete restitution of the lungs to normal. Lord[[87]] has described instances of bronchiectasis occurring in association with infection by B. influenzæ and Boggs[[88]] has recorded similar observations.