Von Jaksch could find no changes in the blood; Klebs only a slight decrease in the red cells; Pribram only a decrease in hemoglobin during the period of convalescence. On the other hand, Schermer, in the clinic at Freiburg, found in a few cases within a few days a marked diminution of red cells and hemoglobin, while Renzi found a marked diminution of the latter with only a slight decrease in the number of the erythrocytes.
Chiari and Baumler observed in several cases a remarkably large number of the so called "degenerative bodies" in the blood; Klebs attributes to the "granule heaps" found by him a very important role in the influenza process, viz., the formation of capillary thromboses in various organs. (Compare p. 607.)
Increase in the white blood cells-leukocytosis-was regularly observed even in uncomplicated influenza by A. Kollmann, P. Friedrich, Chantemesse, Laveran, Kartulis, Dannecker. On the other hand, Rieger (Munich) could never find leukocytosis in simple influenza even during high fever, nor in catarrhal influenza pneumonia, but he did find it in the true croupous pneumonia. Adhuc sub fudice lis est!
Baumler observed hemoglobinuria in one case-a unique observation in influenza literature.
Microcytes were frequently found by the same author during the febrile attack; they disappeared after it was over.
From these observations-marked decrease in hemoglobin; destruction of many red blood corpuscles; urobilinuria and hemoglobinuria; alleged great frequency of icterus, which he considers to be hematogenic-Baumler comes to the conclusion that "in influenza infection the blood undergoes fundamental changes in a very short time."*
We cannot entirely agree with this too dogmatic statement, and it has not been satisfactorily proved, for influenza in the great majority of cases is a very mild and harmless disease; but we do not wish to ignore the fact that one peculiarity of influenza, well known since the oldest times (Wittich, 1580), namely, a disposition to hemorrhages of various kinds, is very much in accord with this theory. We called attention above to the frequency of hemorrhages from the nose, gums, pharynx, and larynx, to the hemorrhagic bronchitis, the simple intestinal and renal hemorrhages, as well as menorrhagia and metrorrhagia; further, that the inflammatory processes in the serous and other membranes (leptomeningitis hemorrhagica) of the brain (encephalitis hemorrhagica), of the intestine and stomach (gastro enteritis hemorrhagica), in the middle ear and tympanic membrane (myringitis hemorrhagica), had frequently a pronounced hemorrhagic character. We may further mention the frequent occurrence of purpura hemorrhagica, the muscle hematomata found by Kuskow, and the complicated cases described by the same author under the name "hemorrhagic influenza," which were characterized by hemorrhages into various organs (muscles, dura mater, pia mater, bones, endocardium, lungs, stomach, intestines, etc.). Further, we may regard the degenerative bodies and granule accumulations described above, which were found in the blood by Klebs, Chiari, and Baumler, as responsible for the venous and arterial thromboses and also, as Klebs especially points out, for the not infrequent termination of pneumonia in gangrene of the lung.
* Many physicians of the previous century (Rutty, 1762; Fothergill, 17/5) remark on the conspicuous yellow, often saffron yellow, color of the serum in the blood from venesection.
Nevertheless, the hypothesis of primary "deep seated changes in the blood in influenza" still requires considerable additional evidence.
The marked tendency to hemorrhage is simply explained by the "vasomotor" hyperemia which characterizes all the inflammatory phenomena occurring in influenza, and may easily give rise to extravasations without any necessarily severe change in the blood or without the capillary thromboses insisted on by Klebs.
A case of "acute leukemia" following influenza is described by Hinterberger, and a case of "acute pernicious anemia" by Rheiner.
There are but few reports concerning the condition of lymphatic glands in influenza. "Meckel (Nuremberg) regularly found swelling of the cervical glands, and Schroder (Neustadt a. H.), of the cervical and inguinal glands. The German army reports note "lymphangitis" and "swelling of the lymphatic glands." The Swiss report mentions that swelling of the lymphatic glands was not infrequently observed. Zehn (Geneva) often found the bronchial glands swollen at the postmortem examination.
Inflammation of the thyroid, strumitis, followed sometimes by sup- ' puration, occurs occasionally as the result of secondary infection in all acute infectious diseases, especially in typhus and pneumonia, and has also been observed on several occasions after influenza (German army reports, official Swiss report, Holz, and Gaucher).