The left pleural cavity contains 75 c.c. of yellowish gray turbid fluid. Over the left lower lobe there is a layer of fibrin. The upper half of the lobe is firmly consolidated, pinkish gray and coarsely granular; the bronchi contain plugs of fibrin. The lower and posterior part of the lower lobe is consolidated deep red and edematous. The left upper lobe is edematous and a layer in the lowermost part in contact with the lower lobe is deep red and consolidated. The left lung weighs 1,490 grms. The lower half of the right upper lobe and the posterior border of the lower is consolidated deep red and edematous; the lung weighs 970 grms.
Bacteriologic examination shows that the blood of the heart contains Pneumococcus II atypical.
The foregoing autopsy is of interest because typical lobar pneumonia appears to have spread from the left lower lobe, where consolidation is firm and gray, to the adjacent part of the upper lobe where consolidation is red and edematous.
The second instance of pneumonia following typhoid fever is an instance of suppurative pneumonia caused by S. aureus.
Autopsy 329.—J. B., white, aged twenty-two, laborer, resident of Oklahoma, had been in military service two days before onset of symptoms of typhoid fever. He was admitted to the hospital on August 27 and B. typhosus was found in cultures from the blood on September 2 and 3. Acute bronchitis appeared on September 26 when the epidemic of influenza had almost reached its height. A diagnosis of bronchopneumonia was made on the day preceding death, which occurred forty-one days after onset of typhoid fever and eleven days after onset of bronchitis.
Anatomic Diagnosis.—Typhoid ulcers of ileum; acute splenic tumor; acute bronchopneumonia with red hemorrhagic peribronchiolar and lobular consolidation in right lung; multiple abscesses forming a circumscribed group in left upper lobe; purulent bronchitis.
The pleural cavities contain no excess of fluid. The lungs are voluminous and there is interstitial emphysema. Below the pleura are bluish red spots of lobular consolidation; in the right upper lobe is a large patch of red consolidation marked by yellowish gray spots in clusters. In the external and upper part of the left upper lobe is a patch of gray consolidation within which, beneath the pleura, there are small abscesses grouped to form a cluster 1.5 cm, across.
Bacteriologic examination demonstrates no microorganisms in the blood of the heart; of two cultures from the left lung one contains S. aureus in pure culture, the other S. aureus and a few colonies of Pneumococcus IV. Cultures from the left main bronchus and from the mucopurulent exudate in a small bronchus both contain B. influenzæ, S. aureus and Pneumococcus IV.
In the foregoing case bronchitis has appeared thirty days after onset of typhoid fever on September 26, immediately preceding the height of the epidemic of influenza. In association with hemorrhagic bronchopneumonia there is suppurative pneumonia with small abscesses forming a circumscribed group below the pleura; there is no empyema. The lesion has the characters of the staphylococcus abscesses following influenza, and S. aureus is found in association with the lesion; B. influenzæ is identified in two cultures from the bronchi.
In 2 instances pneumonia was associated with parotitis which was diagnosed mumps.