Culture from heart’s blood remained sterile. S. hemolyticus was grown from right pleural cavity, and S. hemolyticus and B. influenzæ were grown from the right lung. Culture from the left lung contained S. aureus and contaminating microorganisms.
Microscopic examination shows the presence of peribronchiolar patches of pneumonia in which there are few polynuclear leucocytes and many lymphoid and plasma cells; the alveolar walls are thickened and infiltrated with mononuclear cells. In some sections the tissue is wholly consolidated and the site of advanced organizing pneumonia. Interlobular septa and connective tissue about blood vessels are thickened and cellular. Small bronchi have lost their epithelial lining, their walls are thickened and there is peribronchial organizing pneumonia. In some sections the lymphatics are immensely dilated and distended with polynuclear leucocytes. There is necrosis of the walls of the lymphatics and of the polynuclear leucocytes within the lumen.
In the discussion of acute bronchopneumonia it has been shown that S. hemolyticus is not infrequently a secondary invader of a pneumonic lesion perhaps caused by pneumococci. With progress of the disease hemolytic streptococci persist. In the autopsies with unresolved pneumonia just described, hemolytic streptococci have found their way into the lymphatics and produced suppurative lymphangitis with inflammation of the interstitial septa of the lung.
CHAPTER V
SECONDARY INFECTION IN THE WARD TREATMENT OF MEASLES
James C. Small, M.D.
A study of 979 cases of measles was made in the base hospitals of Camps Funston and Pike from July to December, 1918, with the purpose of establishing any existing relation between the prevalence of the hemolytic streptococci and the incidence of the graver complications of measles, especially the pneumonia following measles. The greater number of these cases occurred at Camp Pike coincidently with the influenza epidemic, so that the picture is modified during this period by a summation of the after effects of the two diseases.
The work undertaken includes:
(a) Routine throat cultures on admission of all patients with measles.
(b) Separation and treatment in separate wards of the patients harboring hemolytic streptococci and those free from such streptococci.
(c) Investigation of the bacteriology of all cases under treatment, by weekly throat cultures during the period in the hospital.