In association with bronchopneumonia there have been necrosis and beginning abscess formation with empyema, the suppurative lesions being caused by hemolytic streptococci which had finally entered the blood stream. There was purulent bronchitis, and the lungs had the voluminous character often associated with this lesion; there was beginning bronchiectasis. B. influenzæ was obtained both from the lung and from the bronchus.
In 2 instances (Autopsies 323 and 335) the diagnosis of scarlet fever was made in patients suffering with pneumonia following influenza. These lesions have been included in the list of influenzal pneumonias. In the following instance the patient was admitted with scarlet fever, later developed acute follicular tonsillitis, and finally suppurative pneumonia caused by hemolytic streptococcus.
Autopsy 311.—E. J., white, aged twenty-two, a tinsmith and automobile repairer, resident of Arkansas, had been in military service three months. Onset of illness was on September 18 with headache and sore throat. The patient was admitted September 24 with the diagnosis of scarlet fever; two days later there was acute follicular tonsillitis. Pneumonic consolidation on the right side was recognized October 2, three days before death.
Anatomic Diagnosis.—Acute suppurative pneumonia with three small abscesses below pleura of right lower lobe; acute fibrinopurulent pleurisy on both sides; serous pericarditis.
The right pleural cavity contains 1500 c.c. of turbid, dirty yellow fluid containing masses of fibrin; the left cavity has 500 c.c. of similar contents. The pericardium contains 30 c.c. of turbid fluid containing a small quantity of fibrin; there are ecchymoses below the epicardium. The right lung is collapsed and in the lower lobe contains three small subpleural abscesses, the largest of which is 1.5 cm. across.
Bacteriologic examination shows the presence of hemolytic streptococci in pure culture in the blood of the heart and in the right lung. From the right main bronchus are obtained hemolytic streptococci, B. influenzæ, Pneumococcus IV and a few staphylococci.
In this instance there has been infection with streptococcus which is a common sequela of scarlet fever. In the absence of evidence of bronchopneumonia there has been abscess formation below the pleura with empyema and pericarditis. B. influenzæ has been found in the bronchus.
The pneumonias found in association with measles reproduce the characters of the pneumonias described in association with influenza. Particularly noteworthy is the occurrence of lobar pneumonia, hemorrhagic peribronchiolar pneumonia, interstitial suppurative pneumonia, severe bronchitis with bronchiectasis and unresolved bronchopneumonia. In the presence of an epidemic of influenza attacking more than one fourth of the population of a camp, those suffering with diseases, such as measles, typhoid fever, mumps, etc., are unlikely to escape entirely, and it is probable that the tendency to the occurrence of pneumonia present in association with these diseases will be increased. The close resemblance between the pneumonias which we have found with the diseases mentioned, on the one hand, and the pneumonias of influenza on the other, both being characterized by the occurrence of hemorrhagic, suppurative and chronic pulmonary lesions, indicates that influenza has had a part in the production of the pneumonia found with measles and some other infectious diseases during the progress of the epidemic of influenza.
CHAPTER VII
SUMMARY OF THE INVESTIGATION AND CONCLUSIONS REACHED
Eugene L. Opie, M.D.