Part 21

Footnote 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.

Footnote 6:

The picture is not unlike that of the interstitial pneumonia after measles as described by MacCallum (93).

Footnote 7:

Pneumothorax as a complication following influenzal pneumonia is mentioned in association with marked emphysema in the epidemic of 1889–90 by Leichtenstern (82). It has been found by X-ray examination in two cases of interstitial emphysema by Berkley and Coffen (8) and also has occurred at Camp Dix according to the report of Synnot and Clark (143).

Footnote 8:

The rarity of empyema has been commented upon by LeCount (78) and Torry and Grosch (149). The condition was found in a small number of cases by Wegelin (156), Malloch (95), Lyon (90), Chickering (25), and Thomas (146), while Goodpasture (48) described it in eleven out of sixteen cases of streptococcus hemolyticus pneumonia.

Footnote 9:

Fibrinopurulent pericarditis has been described by Simmonds (131), Stone and Swift (138), Lyon (90), Fildes et al (40), Jaffé (66), Glaus and Fritzsche (47).

Footnote 10:

The types of consolidation described as having been encountered at the post-mortem table apparently vary somewhat with the locality and the interpretation of the observers. The lobar type has been frequently found by Opie et al (110), Wollstein and Goldbloom (164), Stone and Swift (138), and others. The pseudolobar pneumonia has been mentioned by Abrahams et al (2), Keegan (67), and Speares (135), while the peribronchial type has been well described by Hubschman, Glaus and Fritzsche (47), and MacCallum (92). Lobular pneumonia has been noted by all observers. The type of consolidation in this series has been tabulated in relation to the inflammatory reaction.

Acute Fulminating Pneumonia Necrotization Organization Total Lobar 0 2 3 5 Pseudolobar 2 4 3 9 Peribronchial 0 1 4 5 Lobular 42 32 2 76 ———— ———— ———— ———— Total 44 39 12 95

Footnote 11:

No particular search was made for such lesions until the epidemic was nearly half over. At that time word was received from Camp Devens that hemorrhagic lesions in the rectus muscle were being found. Thereafter, the recti were examined with care.

Footnote 12:

Abscesses supervening upon the rectus hemorrhages are reported by Beals, Blanton and Eisendrath (7), and by Glaus and Fritzsche (47). Generalized abscesses are reported by the latter and by Dietrich (34). Abrahams, Hallows and French (2) report subcutaneous abscesses; Beals, Blanton and Eisendrath, abscesses of the kidneys.

Footnote 13:

The sinuses of the head and middle ears were examined in a number of cases with negative findings. Suppuration of these areas is, however, reported by others.

Stone and Swift (138) found pus in the sphenoidal sinus in 68 per cent of their cases with pneumococci, streptococci and B. influenzæ present. Wolbach (162) found twenty cases of infection of the sphenoid sinus from twelve of which B. influenzæ alone or combined with pneumococci or streptococci were isolated. Lacy (74) reports four cases of influenzal sinusitis.

Footnote 14:

Acute nephritis has been reported by many observers, but the histological descriptions have been so meager that judgment regarding it must be suspended.

Footnote 15:

This condition has been met with more frequently in other localities. Stone and Swift (138) report it in a high percentage of their cases. Lamb and Brannin (77) encountered it seven times, and Blanton and Irons (12) report two cases. Borst (15) and Jaffé (66) also have found this complication.

Footnote 16:

Cheesman and Meltzer (24) demonstrated as early as 1898 the importance of primary injury for the localization and development of secondary infecting bacteria.

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