The autopsy was held one hour after death and the essential findings were as follows:—
The peritoneal cavity contained 100 cubic centimeters of clear, straw-colored fluid and the viscera, particularly the liver, were acutely congested. The right side of the heart was greatly dilated; and on opening the pulmonary artery in situ considerable blood gushed forth under pressure and a huge, tortuous embolus completely filled the vessel and its branches (Fig. [LIII]). The veins of the vesicoprostatic plexus on the right, and the right internal and external iliac veins contained thrombi, and it was evidently from this region that the embolus had been set free. The pleura of the lower third of the left lung over an oval area about 13 × 5 centimeters was bound to the parietal pleura by pinkish-grey, translucent adhesions which were evidently of comparatively recent origin. Here the lung was firmly consolidated, but it was apparently normal elsewhere. On section the consolidated area was silvery grey, with a pink tinge, comparatively dry and smooth. In some areas, especially about the bronchi, delicate, silvery grey, translucent strands could be seen sweeping out into the surrounding lung, which contained no air. The remainder of the lung was air-containing. The trachea showed moderate congestion most marked near the bifurcation. The hilic lymph nodes were enlarged, soft, congested, and succulent, as well as anthracotic.
FIG. XXIX. THE VESSELS OF THE ALVEOLAR WALLS ARE CONGESTED AND CONTAIN A LARGE NUMBER OF LEUCOCYTES. THE EXUDATE IS COMPOSED ALMOST ENTIRELY OF WHITE BLOOD CELLS, IN THE BODIES OF WHICH INNUMERABLE BACTERIA MAY BE SEEN. COMPARE FIGURES [XXI], AND [XXXII].
Microscopic examination of the viscera showed acute congestion and some degree of cloudy swelling in the liver and kidneys. The sections of the lung through the consolidated area showed the pleura replaced by a thick layer composed of large and small mononuclear cells, some red blood cells, a rare polymorphonuclear cell, and great numbers of fibroblasts and budding capillaries. Some of the alveoli contained many red blood cells, a few polymorphonuclear and mononuclear cells, some fibrin, and in many areas fibroblasts were organizing this exudate (Fig. [XLV]). Organization was also present around the bronchi and these contained mucus, pus, and desquamated epithelium. Frequently strands of fibroblasts were seen sweeping through the bronchiolar exudates, and in a few instances they had completely filled the lumina.
II. INFLUENCE OF THE RESPIRATORY COMPLICATION OF INFLUENZA UPON TUBERCULOSIS OF THE LUNG
Thirteen of the ninety-five cases included in this report occurred at the United States General Hospital No. 16, one of the large tuberculosis camps. In five instances the patients had active pulmonary tuberculosis. The remaining eight were members of the detachment and may be added to the eighty-two from the New Haven Hospital, making a total of ninety cases in which there was no clinical evidence of active pulmonary tuberculosis at the onset of the acute respiratory disease. When these ninety cases are analyzed, it is found that only two of them show definite activation of an old tuberculous focus (82). One has already been referred to (Autopsy No. 209); the other, presenting a much more acute exudative and ulcerative tuberculosis, deserves special consideration.
Autopsy No. 194.
A white female, aged 27 years, was admitted to the New Haven Hospital on November 8, 1918, complaining of “cold on the chest, fever, cough, and prostration.”
The past and family histories were unimportant. Her illness began one week before admission with dizziness, headache, vomiting, cough, pains in back and legs, chilly sensations, and fever. She went to bed the day after. The acute onset became definitely worse and pains developed in her chest. On admission she was very weak, had a temperature of 101.4°F., a pulse of 120, and respirations of 40 per minute. The physical examination showed a very well developed and nourished woman who was cyanotic but not dyspnœic. The pharynx and tonsils were definitely injected. There were signs of consolidation at the base of the left lung. The pneumonic process gradually increased in the left, spread to the right, and involved the greater portion of both lungs. Otherwise the physical signs did not change greatly during her stay of thirteen weeks in the hospital. Thrombosis of the left femoral vein was diagnosed about two days before her death. The temperature curve was of interest. During the first two days in the hospital it remained at 104°F. For two weeks it was septic in character, being 102°F. in the morning and 104°F. in the afternoon. Then for thirty days it was practically constant at 102°F., only to become septic again, 98.6°F. in the morning and 103.4°F. in the afternoon, and it remained so until death. The pulse curve ran essentially parallel to the temperature curve, varying from 100 to 140 per minute. The respirations varied between 46 and 64 per minute.