The foregoing instance is an example of the chronic fibroid pneumonias with bronchiectasis which occur as sequelæ of the epidemic of influenza. It is not improbable that a considerable number of those who suffer with chronic bronchitis and bronchiectasis following influenza have less extensive lesions similar to those which have been described.
Bacteriology of Unresolved Bronchopneumonia.—Bacteria found in the bronchi in 10 instances of chronic bronchopneumonia have been as follows:
| Bacteria in Bronchi with Chronic Bronchopneumonia | |
|---|---|
| B. coli | 1 |
| B. influenzæ and pneumococcus | 1 |
| B. influenzæ and S. hemolyticus | 2 |
| B. influenzæ and staphylococcus | 1 |
| S. hemolyticus and B. coli | 1 |
| B. influenzæ, pneumococcus and staphylococcus | 3 |
| B. influenzæ, S. viridans and M. catarrhalis | 1 |
Bacteria found in the lungs in 17 instances of chronic bronchopneumonia were as follows:
| Bacteria in Lungs with Chronic Bronchopneumonia | |
|---|---|
| B. influenzæ | 1 |
| Staphylococcus | 1 |
| S. viridans | 1 |
| B. influenzæ and pneumococcus | 1 |
| B. influenzæ and S. hemolyticus | 3 |
| B. influenzæ and staphylococcus | 3 |
| Pneumococcus and S. hemolyticus | 1 |
| S. hemolyticus and B. coli | 2 |
| B. influenzæ, S. hemolyticus and staphylococcus | 3 |
| No organism found | 1 |
A noteworthy feature of these lists is the multiplicity of microorganism found, namely, B. influenzæ, S. hemolyticus, pneumococcus, staphylococcus, S. viridans, B. coli, and M. catarrhalis. More than one microorganism is usually found in both bronchus and lung. In the one instance (Autopsy 472) in which B. coli alone has been found in the bronchus, B. coli and S. hemolyticus have been found in the lung and hemolytic streptococcus in the blood; it is evident that B. coli alone has not been responsible for the lesion. In one instance (Autopsy 487) B. influenzæ alone has been found in the lung but hemolytic streptococci have been found in the bronchus, pleura and blood of heart; with S. aureus alone in the lung (Autopsy 370), S. aureus, Pneumococcus IV and B. influenzæ have been found in the bronchus. With S. viridans alone in the lung (Autopsy 473), Pneumococcus III has been found in the pleura and in the blood of the heart and has doubtless had an important part in the production of pneumonia; S. viridans, M. catarrhalis and B. influenzæ have been found in the bronchus in this instance.
No single microorganism is associated with the lesions but combinations of B. influenzæ with hemolytic streptococci or staphylococci are common (over 50 per cent). In Autopsy 422 B. influenzæ and Pneumococcus atypical II have been present in the lungs. Among 10 instances in which cultures have been obtained from the bronchus B. influenzæ is found 8 times, and in the 2 instances in which it has not been identified B. coli has been present. B. influenzæ has seldom been found (Table XXVII) in the presence of B. coli, and it is not improbable that B. coli outgrows and obscures the presence of B. influenzæ.
Table LIV shows the per cent incidence of pneumococci, hemolytic streptococci, staphylococci and B. influenzæ in the bronchus, lung and heart’s blood with chronic bronchopneumonia and serves as an index of the readiness with which each of these microorganisms passes from bronchus to lung and from lung to the blood in this disease.
| Table LIV | ||||
|---|---|---|---|---|
| PNEUMOCOCCUS PER CENT POSITIVE | HEMOLYTIC STREPTOCOCCUS PER CENT POSITIVE | STAPHYLOCOCCUS PER CENT POSITIVE | B. INFLUENZÆ PER CENT POSITIVE | |
| Bronchus | 40.0 | 30.0 | 50.0 | 80.0 |
| Lung | 12.5 | 56.2 | 37.5 | 68.7 |
| Blood | 16.6 | 55.6 | 0 | 0 |
Comparison of Table LIV with the analogous figures for acute bronchopneumonia shows little noteworthy difference. Pneumococci are less frequently found in the lung (12.5 per cent) and in the blood (16.6 per cent) with chronic bronchopneumonia than with acute bronchopneumonia (lung 43.9 per cent; blood, 40.3 per cent). Hemolytic streptococci and staphylococci are not more frequently found with unresolved than with acute bronchopneumonia and failure to resolve cannot be referred to either or to both microorganisms, for bronchopneumonia not infrequently remains unresolved in their absence. B. influenzæ is present in the bronchi in at least 80 per cent of instances and perhaps in all; it is usually combined both in the lungs and in the bronchi with one of the pyogenic cocci.