| Table XXXVII | ||||
|---|---|---|---|---|
| PNEUMOCOCCUS | HEMOLYTIC STREPTOCOCCUS | STAPHYLOCOCCUS | B. INFLUENZÆ | |
| Bronchus | 44.0% | 64.0% | 44.0% | 72.0% |
| Lung | 31.6% | 57.9% | 26.8% | 52.6% |
| Blood of heart | 25.0% | 52.1% | 0% | 0% |
Pneumococci have been found in the lungs (31.6 per cent) and blood (25 per cent), somewhat less frequently than with peribronchiolar pneumonia (43.9 and 40.3 per cent respectively), and hemolytic streptococci have been found in the blood more frequently (52.1 per cent) than with the latter (36.8 per cent) but otherwise the bacteriology of the two lesions corresponds closely. The low incidence of B. influenzæ in the bronchi (72 per cent) with hemorrhagic peribronchiolar pneumonia is perhaps incorrect as the result of the relatively small number of bacteriologic examinations (namely, 25), but the incidence of the same microorganism in the lung has been higher (52.6 per cent) than with nonhemorrhagic peribronchiolar lesion (43.9 per cent).
In some instances infection with hemolytic streptococci has occurred after the onset of pneumonia. The following list compares the results of bacteriologic examination of the sputum made after the onset of pneumonia with that of blood, lungs or bronchus after death:
| SPUTUM | IN BLOOD, LUNGS OR BRONCHUS AT AUTOPSY | ||
|---|---|---|---|
| Autopsy | 237 | S. hem. | S. hem. |
| 242 | Pneum. atyp. II, B. inf. | Pneum. atyp. II | |
| 247 | Pneum. IV, B. inf. | Pneum. IV | |
| 266 | S. hem. | S. hem., B. inf. | |
| 346 | Pneum. IV, B. inf. | S. hem., B. inf. | |
| 376 | (No. S. hem.) | S. hem., staph., B. inf. | |
Instances of secondary infection with hemolytic streptococcus occur in the list, namely, Autopsies 346 and 376.
From the foregoing studies of the bacteriology of peribronchiolar and hemorrhagic peribronchiolar pneumonia the following conclusions may be drawn: (a) B. influenzæ is found in most instances of these lesions in the bronchi and in about half of all instances in the lungs, but does not occur unaccompanied by other microorganisms. (b) In a considerable number of autopsies pneumococcus is the only microorganism that accompanies B. influenzæ; from the lungs it penetrates into the blood from which it is obtained in pure culture. (c) In a considerable number of instances S. hemolyticus accompanies B. influenzæ, and in some of these instances (representing a large proportion of the relatively small number of cases examined during life), examination of the sputum has demonstrated that infection has been secondary to a pneumonia with which no hemolytic streptococci have been found in the sputum.
Lobular Consolidation.—Consolidation of scattered lobules or groups of lobules has occurred in nearly all instances, namely, 71 of 80 autopsies with bronchopneumonia unaccompanied by lobar pneumonia or by suppuration. When death follows shortly after the onset of pneumonia, patches of consolidation have a dull deep red color; blood-tinged fluid escapes from the cut surface which is almost homogeneous or finely granular. The consolidated tissue seen through the pleura, which is raised above the general level, has a bluish red color. Isolated lobules or groups of lobules which have undergone consolidation may be scattered throughout the lungs, but not infrequently there is confluent consolidation of the greater part of lobes, of whole lobes or of almost an entire lung. Such lungs are very heavy and may weigh 1,400 or 1,500 grams; bloody serous fluid exudes from the cut surface. The lesion resembles the red hepatization of lobar pneumonia, but confluent patches of pneumonia are usually well defined by lobule boundaries. The tissue is soft and the granulation of lobar pneumonia is absent. In many instances the lobular or confluent areas of consolidation are reddish gray; in some instances consolidated tissue is in places red and elsewhere gray, and in a smaller group of autopsies there is gray consolidation only (Fig. 6). Red lobular consolidation is often seen in those who have died within the first four days following the onset of pneumonia, but is almost equally frequent after from five to ten days; the average duration of pneumonia in these cases was 5.5 days. Combined red and gray consolidation was more frequently found when pneumonia had lasted more than five days, the average duration of pneumonia being 7.3 days. The greater number of instances of gray consolidation were found after seven days of pneumonia, the average duration of the disease being 10.0 days. These figures are cited to show that lobular, like lobar, consolidation passes gradually from a stage of red to gray hepatization, but the change occurs more slowly and is often long delayed.
Lobular pneumonia, which occurred 71 times among 80 cases classified as bronchopneumonia, may be regarded as an almost constant lesion of the disease. It is found not only in association with other lesions of bronchopneumonia, but with lobar pneumonia of influenza as well.
The bacteriology of this lesion shows no deviation from that of the slightly larger group of bronchopneumonia (p. [163]). All types of pneumococcus have been found in association with the lesion, Pneumococcus I in 2 instances, Pneumococcus II in 1 instance; atypical Pneumococcus II and Pneumococcus IV have been found much more frequently. Pneumococci have been found in more than a third of these autopsies (42.9 per cent in the lungs, 33.3 per cent in the blood); hemolytic streptococci in less than one-third (28.5 per cent in the lungs, 30.2 per cent in the blood).
