| Table XLIV | |||
|---|---|---|---|
| AUTOPSY | BLOOD | LUNG | BRONCHUS |
| 283 | Pneum. IV | Staph., B. inf. | B. inf., Pneum. IV, staph. |
| 291 | 0 | 0 | B. inf., staph. |
| 398 | 0 | ||
| 419 | 0 | Pneum. II, B. inf. | Pneum. II, B. inf. |
| 421 | S. hem. | Pneum. IV, S. hem. | |
| 422 | 0 | Pneum. II atyp., B. inf. | |
| 425 | S. hem. | S. hem., B. inf., S. alb. | |
| 433 | 0 | S. hem., B. inf., S. aur. | |
| 460 | S. hem. | S. hem., B. inf. | S. hem., B. inf., staph. |
| 463 | 0 | B. inf., staph. | B. inf., staph., Pneum. IV |
B. influenzæ has been present in the bronchi in every instance save one in which cultures have been made, and it is probable that in this exceptional instance cultures have remained sterile because the media employed have been defective. The incidence of B. influenzæ in the lung has been unusually high both with and without organization (66.7 per cent with no organization; 77.8 per cent with organization). Streptococci and staphylococci have been found in a considerable proportion of all instances of peribronchial fibrinous pneumonia, but there has been no notable preponderance of these microorganisms when organization has occurred. Organization has been present in instances in which pneumonia is referable to pneumococcus associated with B. influenzæ and unaccompanied by either streptococci or staphylococci (Autopsies 419 and 422). Wadsworth[[81]] found no organization after inoculation of the lungs of dogs with pneumococcus or with staphylococcus alone, but produced organization when he inoculated animals with both microorganisms.
Injury to bronchi produced in part at least by B. influenzæ exposes the bronchi and lung tissue to repeated infection with a variety of microorganisms; absorption of fibrin and regeneration of alveolar epithelium are prevented, resolution fails to occur and organization of fibrin follows.
Suppurative Pneumonia With Necrosis and Abscess Formation
Three varieties of suppurative pneumonia have occurred in association with influenza.
A. Necrosis and suppuration with formation of one or several abscesses usually below the pleura and almost invariably caused by hemolytic streptococci.
B. Interstitial suppurative pneumonia caused by hemolytic streptococcus.
C. Multiple abscesses in clusters caused by staphylococci.
Suppurative pneumonia with necrosis and abscess formation will be discussed in this section. Pulmonary abscesses which occurred in 43 autopsies may be included in this group; in 4 of these autopsies abscess and interstitial suppurative pneumonia occurred in the same individual. These abscesses were much more frequently situated in the lower than in the upper lobes and more often in the right than in the left lung. In most instances there was one or several abscesses situated below the pleura of one lobe; occasionally abscesses occurred in two lobes of the same lung or in both lungs. The distribution was as follows: Abscess in only one lung occurred in right upper lobe in 6 autopsies; middle lobe, 3; lower lobe, 15; left upper lobe, 2; lower lobe, 16. Abscesses occurred in both right and left lower lobes, twice. The usual situation was at the lower and posterior part of the lower lobe at or near the basal edge, less frequently below the posterior border or upon the basal surface of the lobe. These abscesses in almost every instance were found immediately below the pleural surface, so that they appeared upon the pleura as opaque yellow spots usually surrounded by narrow zones of hemorrhage. In one instance (Autopsy 376) the abscess cavity was separated from the pleural cavity by remains of the pleura which was as thin as tissue paper and in other instances perforation had occurred (Fig. 9). In Autopsy 480 the abscess cavity which had perforated the pleura was in free communication with a bronchus of medium size.
In most instances of suppurative pneumonia there have been associated lesions of bronchopneumonia which have been peribronchiolar, hemorrhagic or lobular and have exhibited no unusual characters. The abscess or abscesses are situated within an area of pneumonic consolidation which is not limited by lobule boundaries and has not the characters of bronchopneumonic consolidation. In some instances this consolidation is limited to a zone immediately about the abscess, but often it involves the greater part of a lobe. The tissue is laxly consolidated and flabby; on section it has a dull, conspicuously cloudy appearance and is grayish red, pinkish gray or gray; it is homogeneous or very finely granular. Turbid gray fluid, which sometimes resembles thin pus, oozes from the cut surface.