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DAY OF DISEASE ON WHICH DEATH OCCURRED │ NUMBER OF CASES
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Third │ 1
Fourth │ 3
Fifth │ 4
Sixth │ 4
Seventh │ 4
Eighth │ 5
Ninth │ 3
Tenth │ 4
Eleventh │ 3
Thirteenth │ 1
Fourteenth │ 1
Twentieth │ 1
Twenty-third │ 1
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The time as indicated in the above table has no relation to the length
of time that the patients were ill of pneumonia, but refer to the period
of illness from the beginning of the influenza. The duration of the
pneumonia is indicated in another table.
Of the 35 fatal cases 32 came to autopsy. Facilities were available to
do the work very satisfactorily, in that the hospital was well provided
with a modern post-mortem room and its accessories. The notes on the
autopsies were taken immediately and fully, and the materials for
subsequent study were collected in different types of preserving fluid.
Portions of tissue were collected from all of the organs for
microscopical study, while fluids from the chest, lungs, bronchi and
heart were obtained for bacteriological investigations and for some
chemical analyses.
Added to the above material we also had the opportunity of reviewing and
studying the lesions of 18 autopsies performed by Dr. J. W. McMeans.
These cases were very similar to our own series, in that they were cases
of epidemic influenza amongst soldiers who were being cared for at the
St. Francis Hospital. The disease processes were quite alike in the two
series, and the analyses made by Dr. McMeans are comparable in our own
and serve as a means of checking our results obtained in another
institution. The similarity of the lesions in the lungs and other organs
serve to indicate that what is reported in this paper is an index of the
nature of the lesions of epidemic influenza as it occurred in the
Pittsburgh district. In a few instances the autopsies performed by Dr.
McMeans revealed more advanced pulmonary lesions with abscess and
gangrene than were noted in the cases autopsied at the Military
Hospital. The process, however, in the two series of autopsies was
identical.
_General External Features_
There were no external characteristics of the bodies which were
autopsied by us which were constant. Some features were more commonly
present than others. Of these the cyanosis of the face, head, neck and
shoulders, and in a few instances of the upper extremities, attracted
our attention more than any other. This cyanosis was present in over
one-half of the number of cases, and it was confined almost always to
the upper part of the body. The face, ears and neck were always more
affected than other parts. This cyanosis bore no relation to the length
of time after death when the body was viewed, as we found that when it
was present during life it maintained its prominent appearance for a
long time after death.
The cyanosis differed from the bright hue or flush as it is at times
observed in ordinary pneumonia, the color in these instances being of a
dark purple, or better a purplish blue. The lips and ears showed the
most intense color. The cyanosis was not associated with any evidence of
œdema. The capillaries of the tissues were filled with blood which was
of a very dark character. Cyanosis could also be seen in the finger tips
about the nails. This was more marked in the upper extremities than in
the lower. The skin of the body rarely showed any cyanosis, these
tissues being quite pale, or at times showing a slightly yellowish
tinge. In one instance the cyanosis of the head and neck was accompanied
by a slight purplish rash upon the upper portion of the chest. This rash
was of a petechial kind, there being slight hemorrhage into the tissues.
The lesion, however, was not of the blotchy purpuric type which has been
observed by others during this and past epidemics (Cole). This single
case is the only one where we had evidence of superficial hemorrhages
into the skin.