Autopsy 403.—C. T., colored, aged twenty-five, a laborer, resident of Arkansas, had been in military service one month. Illness began September 27 with swelling of face behind jaw and difficult mastication; the patient was admitted to the hospital on the same day with the diagnosis of mumps. Pneumonic consolidation was recognized on October 8. Death occurred October 13, sixteen days after onset of illness and six days after recognition of pneumonia.
Anatomic Diagnosis.—Acute lobar pneumonia with red and beginning gray hepatization of lower and parts of upper and middle right lobes; acute bronchopneumonia with lobular consolidation in left lung; purulent bronchitis; bronchiectasis in left lung.
The lower lobe of the right lung with the exception of the anterior and basal edge is firmly consolidated; the posterior part of the middle lobe and a small corner at the posterior and lower part of the upper lobe is similarly consolidated. The consolidated tissue is gray and coarsely granular on section. The remainder of the lung is dry and voluminous, and the bronchi contain purulent fluid. The left lung contains red and gray patches of consolidation, from 0.2 to 3 cm. across. Bronchi contain purulent fluid and in the lowermost parts of both upper and lower lobes are moderately dilated.
Bacteriologic examination shows that the blood of the heart contains Pneumococcus III.
It is noteworthy that there was in this case, as in many instances of influenza, both lobar and bronchopneumonia. Purulent bronchitis was present and there was bronchiectasis throughout one lung.
In the following case the diagnosis of mumps may be questioned since the lesion of the parotid has characters of terminal suppurative parotitis.
Autopsy 417.—H.W.D., white, aged twenty-four, a farmer, resident of Oklahoma, had been in military service one month. He said that he had had pneumonia four times. He was admitted to the hospital delirious and the diagnosis of lobar pneumonia was made. Parotitis regarded as mumps appeared five days before death and suppuration occurred on the right side of the face. Death of the patient occurred thirteen days after admission to the hospital.
Anatomic Diagnosis.—Acute bronchopneumonia with lobular consolidation in both lungs; suppurative pneumonia with necrosis and beginning abscess formation in left lung; purulent pleurisy in left side; purulent bronchitis; bronchiectasis; acute parotitis.
The left pleural cavity contains 100 c.c. of purulent fluid of creamy consistence. The left lung is voluminous and bound to the chest wall in places. There are numerous patches of lobular consolidation. At the apex of the lung there is a large area of consolidation, 7 cm. across, where the tissue is cloudy gray and soft in consistence. In the upper lobe is a well-defined patch of grayish yellow color, 6 by 2 cm., with opaque yellow edges; purulent fluid escapes from the cut surface. Bronchi throughout the lung are widely dilated and contain purulent fluid. The right lung is voluminous and contains lobular patches of consolidation; bronchi of this lung are widely dilated.
Bacteriologic examination shows the presence of hemolytic streptococci in the blood of the heart; hemolytic streptococci and B. influenzæ in the lung, and hemolytic streptococci, B. influenzæ and S. aureus in a main bronchus.