Another variation in the character of the lesion is doubtless referable to variation in the severity of primary bronchial injury. Alveoli immediately surrounding small bronchi are filled with dense plugs of fibrin. The alveoli which besot the walls of the bronchioles contain fibrin, but the alveolar duct and its tributary alveoli are filled with polynuclear leucocytes.
The bacteria which have been cultivated from the lung in autopsies with peribronchiolar pneumonia are as follows:
| Pneumococcus | 5 |
| S. hemolyticus | 8 |
| B. influenzæ, pneumococcus | 5 |
| B influenzæ, S. hemolyticus | 7 |
| B. influenzæ, staphylococcus | 1 |
| Pneumococcus, staphylococcus | 2 |
| S. hemolyticus, staphylococcus | 2 |
| B. influenzæ, pneumococcus, S. hemolyticus | 2 |
| B. influenzæ, pneumococcus, staphylococcus | 1 |
| B. influenzæ, S. hemolyticus, staphylococcus | 2 |
| Pneumococcus, S. hemolyticus, staphylococcus | 3 |
| No organism | 3 |
| Total | 41 |
The following list which shows the bacteria found in the blood is an index to the pathogenicity of pneumococci and hemolytic streptococci:
| Pneumococcus | 22 |
| S. hemolyticus | 20 |
| Pneumococcus, S. hemolyticus | 1 |
| No organism | 14 |
| Total | 57 |
The percentage incidence of pneumococcus, hemolytic streptococcus, staphylococcus and B. influenzæ in bronchus, lung and blood, given in Table XXXVI, is inserted to indicate with what readiness each one of these microorganisms passes from the bronchus through the lung into the circulating blood.
| Table XXXVI | ||||
|---|---|---|---|---|
| PNEUMOCOCCUS | HEMOLYTIC STREPTOCOCCUS | STAPHYLOCOCCUS | B. INFLUENZA | |
| Bronchus | 39.4% | 57.7% | 60.6% | 84.8% |
| Lung | 43.9% | 61.0% | 21.9% | 43.9% |
| Blood | 40.3% | 36.8% | 0. % | 0. % |
B. influenzæ is present in the bronchi in a very large proportion (84.8 per cent) of those in whom this type of bronchopneumonia has been found at autopsy; it is much less frequently recovered from the lungs. Staphylococci, in part S. albus and in part S. aureus, are less frequently found in the bronchi and are recovered from the lungs in a relatively small proportion of autopsies. The percentage incidence of pneumococci and streptococci in lungs and blood demonstrates the pathogenicity of these microorganisms, for whereas pneumococci and hemolytic streptococci are found in the consolidated lungs in 43.9 and 61.0 per cent of instances of the lesion respectively, they make their way into the blood in 40.3 and 36.8 per cent of instances.
Coexisting infection with pneumococci and hemolytic streptococci has been not uncommon e. g., Autopsy 275 in which both were in the blood; in 2 instances (Autopsies 333 and 378) in which pneumococci were obtained from the blood, hemolytic streptococci were found in the lungs and bronchi; in 3 instances (Autopsies 258, 273 and 445) in which hemolytic streptococci were present in the blood, pneumococci were obtained from the lungs.
In the group of autopsies under consideration, examination of the sputum was made during life and after onset of pneumonia in 11 instances. The microorganisms found in the sputum and at autopsy were as follows: