FIG. LV. AUTOPSY NO. 146. ACUTE HEMORRHAGIC ENTERITIS ASSOCIATED WITH MULTIPLE BACTERIAL EMBOLI IN THE CAPILLARIES OF THE INTESTINAL MUCOSA.
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[1]. The history of the epidemics of influenza cannot but impress one with the difficulties of medical progress. Beyond the fact that the descriptions of the epidemics are such that the disease is recognizable as being the same, there is little of real value in the literature until the beginning of the 19th century.
In the 18th century the infectious nature of the malady had been recognized. The results of study in the first half of the 19th century are shown in the literature of the epidemic of 1847–49. In it, exceptionally good clinical descriptions and epidemilogical studies are published. In the next forty years great strides were made in Pathology and in the essentially new science of Bacteriology. With those two aids in the study of infectious disease, it is only reasonable to expect an increase in knowledge of influenza after the epidemic of 1889–90. Such is the fact and a comprehensive review of both the Bacteriology and Pathology of this disease is offered in Nothnagel’s Specielle Pathologie, 1896, Bd. IV, by O. Leichtenstern.
[2]. Early in the epidemic, Nicolle (106) and his co-workers described a filterable virus as the probable etiological agent in influenza. Several investigators have corroborated this work. Chief of these are: Gibson, Bowman, and Connor (46); Bradford, Bashford, and Wilson (16). The latter investigators independently isolated a filterable virus which may be cultivated by the Noguchi method and which, when inoculated into monkeys, produces a general reaction with specific respiratory lesions which, they think, are comparable to those of man in influenza. While these results must be confirmed, they offer greater promise than any other.
[3]. A marked fibrinous exudate in the lower trachea with the formation of a pseudomembrane was noted by Oberndorfer (108), Lubarsch (19), Coray (28), Borst (15), and Schmorl (128). Schmorl studied the bacteria from the trachea and found in sections streptococci, pneumococci, and staphylococci, but not B. influenzæ or B. diphtheriæ.
[4]. Simmonds (131), Bernhardt and Meyer (19) note that perichondritis may be present, but do not give a detailed description of the lesion. Gruber and Schädel (50) found this perichondritis to be associated with abscess formation.
[5]. Two examples of fresh endocarditis are reported by Malloch (95) and one by Dietrich (34), all of which were due to B. influenzæ. Acute myocarditis was observed by Blanton and Irons (12) and Gruber and Schädel (50). Glaus and Fritzsche (47) report a case with multiple hemorrhages, necrosis, and leucocytic infiltration of the heart muscle and also one of Zenker’s degeneration of the myocardium. Cases of both myocarditis and endocarditis are included by Leichtenstern (82) in a review of the epidemic of 1889–1890.
[6]. The picture is not unlike that of the interstitial pneumonia after measles as described by MacCallum (93).