Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
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.
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