A typical attack of influenza usually begins as a rhinitis and spreads from the nasal mucosa throughout the respiratory tract. As the chief symptoms are produced by the involvement of the bronchial tree, attention is naturally directed to the lungs and bronchi as the most important foci for the infection. However, in studying acute cases one is often impressed by the fact that the severity of the disease, best evidenced by the general prostration of the patient, is out of all proportion to the physical signs. Tracheobronchitis with abundant mucopurulent sputum, a particularly distressing and often spasmodic cough, and moist râles uniformly present in both lungs, almost exhaust the positive findings for the respiratory tract. It becomes difficult to understand why a vigorous, previously healthy young adult, should succumb to an infection which in many cases appears to be almost wholly confined to the tracheobronchial mucosae. It might even be
ROBERTSON HE. INFLUENZAL SINUS DISEASE AND ITS RELATION TO EPIDEMIC INFLUENZA. JAMA. 1918;70(21):1533–1535. doi:https://doi.org/10.1001/jama.1918.26010210010008c
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