Little significance can be attributed to the observation that B. influenzæ was present in pure culture in the lungs from Autopsies 450 and 486, for the presence of Pneumococci IV in the blood of the heart in Autopsy 450 and of Pneumococcus II atypical in the pleura in Autopsy 486 furnishes evidence in view of the occurrence of lobar pneumonia that pneumococci had disappeared from the lungs. B. influenzæ was found both in the lungs and bronchus or in the bronchus alone in 3 of these 4 cases.
The relation of hemolytic streptococci to the lesion is of interest. In 3 of 4 instances of lobar pneumonia this microorganism had entered the bronchi but was not found in the lungs or in the heart’s blood; and gross and histologic examination showed none of the lesions which are usually caused by it. In 1 instance (Autopsy 508) hemolytic streptococci, absent from the throat when the patient was admitted to the hospital with measles sixteen days before death, appeared in a culture made five days later and was subsequently found three times; it had penetrated into the bronchus but failed to reach the lung. Observations made upon lobar pneumonia following influenza have shown the relative insusceptibility of lobar pneumonia with gray hepatization to secondary infection with hemolytic streptococci (p. [160]). Autopsy 508 demonstrates that occurrence of hemolytic streptococci in the sputum of a patient with pneumonia does not furnish conclusive proof of the existence of streptococcus pneumonia.
Bronchopneumonia.—Bronchopneumonia has been found in every instance of pneumonia following measles save 3, namely in Autopsy 486, Autopsy 505 with lobar pneumonia and Autopsy 507 with interstitial suppurative pneumonia. It is not improbable that further histologic study might have demonstrated small patches of peribronchiolar pneumonia, for purulent bronchitis was present in the two autopsies with lobar pneumonia. This small group of cases has reproduced all of the important features of bronchopneumonia following influenza. Hemorrhagic peribronchiolar consolidation characterized by the presence of small gray spots clustered about terminal bronchi upon a homogeneously red background has been found in 5 of 18 instances of pneumonia with measles. Pfeiffer regarded this lesion as characteristic of the pneumonia of influenza. Peribronchiolar patches of consolidation with no surrounding hemorrhage were found in 14 instances, being recognized first by microscopic examination in half of this number. Lobular consolidation occurred in 11 autopsies and peribronchial fibrinous pneumonia was present in a third of the autopsies on patients with pneumonia of measles.
Bronchial, peribronchial and intraalveolar hemorrhage is much more commonly associated with the pneumonias of influenza than with the more familiar types of acute bronchopneumonia. Exuded blood may undergo absorption; and with bronchopneumonia which, persisting unresolved, has assumed the characters of a chronic lesion, it is common to find mononuclear cells often in great abundance filled with brown pigment derived from the hemoglobin of red blood corpuscles.
Autopsy 439 is an example of acute hemorrhagic bronchopneumonia; there are red lobular and confluent lobular patches of consolidation which upon the pleural surface have a blue or purplish color. In the dependent part of the left lung occupying a large part of the lower lobe there is lax, red consolidation marked by gray or yellowish gray spots of peribronchiolar pneumonia and in this lobe bronchi are encircled by zones of hemorrhage. Pneumococcus II atypical was obtained from the lung. In Autopsy 444 the lesion has the same hemorrhagic character although lobular patches are in a stage of grayish red hepatization. Pneumococcus II atypical has been found in the heart’s blood, and with B. influenzæ in lungs and bronchus. Autopsy 441 is an example of the occurrence of conspicuous nodules of peribronchiolar consolidation in some parts of the lungs with the same lesion in other parts on a background of hemorrhage. B. influenzæ and S. aureus have been found in both lungs and bronchi.
Steinhaus[[102]] states that the pneumonia of measles is never lobular inflammation but occurs in small patches several of which may be found in a single lobule.
Chronic fibroid pneumonia following measles characterized by cellular infiltration and proliferation of the interstitial tissue of the lung has been described by Bartels,[[103]] Steinhaus,[[104]] Hart,[[105]] MacCallum[[104]] and others.
Fig. 30.—Unresolved bronchopneumonia with measles showing new formation of fibrous tissue about a bronchus and in immediately adjacent alveolar walls; partially obliterated alveoli occur in the peribronchial fibrous tissue. Autopsy 481.
