Table XXXIV shows the percentage incidence of pneumococcus, hemolytic streptococcus, staphylococcus and B. influenzæ in the bronchi, lungs and blood and is inserted for comparison with the similar table (Table XXX) showing the incidence of these bacteria in lobar pneumonia.
| Table XXXIV | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| NO. OF CULTURES | PNEUMOCOCCI | HEMOLYTIC STREPTOCOCCI | STAPHYLOCOCCI | B. INFLUENZÆ | |||||
| NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | ||
| Bronchus | 37 | 19 | 48.6 | 13 | 35.1 | 22 | 59.5 | 28 | 75.7 |
| Lung | 47 | 20 | 42.6 | 14 | 29.8 | 13 | 27.7 | 23 | 48.9 |
| Blood | 70 | 22 | 31.4 | 24 | 34.3 | ||||
Table XXXIV shows that pneumococci have a less important part in the production of broncho than of lobar pneumonia; with lobar pneumonia this microorganism was found in the lungs in 77.3 per cent of instances and in the blood, in 65.5 per cent, whereas with bronchopneumonia it was found in the lungs in 42.6 per cent and in the blood in 31.4 per cent. Hemolytic streptococci (in lungs and blood) and staphylococci (in lungs), on the contrary, were more common with bronchopneumonia, and doubtless have a part in the production of the lesion. Streptococcus viridans, B. coli and M. catarrhalis, which are not infrequently found in the bronchi (p. [151]), occasionally enter the lungs with bronchopneumonia but are rarely found with lobar pneumonia. B. influenzæ has been found in less than 80 per cent of instances in the bronchi and in about half of the lungs, maintaining an incidence approximately the same as that with lobar pneumonia.
Table XXXV shows the types of pneumococci found in association with bronchopneumonia and is inserted for comparison with the similar table (Table XXXII) showing types of pneumococci with lobar pneumonia.
With broncho as with lobar pneumonia pneumococci commonly found in the mouth, namely, atypical II, and Types III and IV, have a more important part in production of the lesion than the so-called fixed types, I and II. Atypical Pneumococcus II has been less frequently encountered with broncho than with lobar pneumonia.
| Table XXXV | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| NO. OF CULTURES | PNEUMOCOCCUS I | PNEUMOCOCCUS II | PNEUMOCOCCUS II (Atyp.) | PNEUMOCOCCUS III | PNEUMOCOCCUS IV | ||||||
| NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | NO. POSITIVE | PER CENT POSITIVE | ||
| Bronchus | 37 | 1 | 2.7 | 3 | 8.1 | 14 | 37.8 | ||||
| Lung | 47 | 2 | 4.3 | 2 | 4.3 | 2 | 4.3 | 2 | 4.3 | 12 | 25.2 |
| Blood | 70 | 1 | 1.4 | 1 | 1.4 | 5 | 7.1 | 4 | 5.7 | 11 | 15.9 |
Peribronchiolar Consolidation.—In many instances of bronchopneumonia, usually in association with lobular or confluent consolidation, small firm nodules of consolidation are clustered about the bronchioles (Fig. 2). These nodular foci of consolidation are usually 1.5 to 2 mm. in diameter, being sometimes slightly smaller or slightly larger. They are usually gray and occasionally surrounded by a red halo; sometimes they are yellowish gray. They are clustered about the smallest bronchial tubes to form groups which are from 0.5 to 1 cm. across. A group of nodular foci of consolidation occupies the central part of a lobule of lung tissue. When pneumonia has been of short duration these foci are fairly soft and not sharply defined, and in many instances this form of bronchopneumonia is first recognized by microscopic examination. When the disease has lasted from ten days to two weeks, the consolidated nodules are very firm and sharply circumscribed, closely resembling tubercles. When they have assumed this character, microscopic examination shows that chronic changes indicated by new formation of interstitial tissue have occurred.
The lesion may be designated peribronchiolar consolidation. It has occurred usually in association with other types of pneumonic lesion in 61 instances, being recognized at autopsy in 18 and by microscopic examination in 43.
Fig. 2.—Acute bronchopneumonia with nodules of peribronchiolar consolidation and purulent bronchitis. Autopsy 429.