CHAPTER VII

SUMMARY OF THE INVESTIGATION AND CONCLUSIONS REACHED. (BY EUGENE L. OPIE, M.D.) 359

Lobar Pneumonia, 362; Bronchopneumonia, 363; Streptococcus Pneumonia, 365; Staphylococcus Pneumonia, 366; Empyema, 366; Bronchiectasis, 367; Unresolved Bronchopneumonia, 368; B. Influenzæ, 369; Pneumococcus, 372; S. Hemolyticus, 374; Nonhemolytic Streptococci, 376; Staphylococci, 377; Pneumonia of Measles, 378; The Transmission of Streptococcus Pneumonia, 381; Transmission of Pneumococcus Pneumonia, 383; Prevention of the Transmission of Pneumonia, 383.

APPENDIX

EXPERIMENTAL INOCULATION OF MONKEYS WITH BACILLUS INFLUENZÆ AND MICROORGANISMS ISOLATED FROM THE PNEUMONIAS OF INFLUENZA. (BY EUGENE L. OPIE, M.D.; ALLEN W. FREEMAN, M.D.; FRANCIS G. BLAKE, M.D.; JAMES C. SMALL, M.D.; AND THOMAS M. RIVERS, M.D.) 387

Inoculation of the Nose and Pharynx with B. Influenzæ, 389; Introduction of Bacillus Influenzæ into the Trachea, 391; Introduction of B. Influenzæ and S. Hemolyticus into the Trachea, 392; Introduction of B. Influenzæ and of Pneumococcus or of Pneumococcus Alone into the Trachea, 393.

ILLUSTRATIONS

CHARTS PAGE 1. The onset of cases of pneumonia shown by autopsy to be uncomplicated by secondary infection with hemolytic streptococcus and of cases of streptococcus pneumonia 141

2. The date of onset of cases in which autopsy demonstrated lobar pneumonia 161

3. Shows the relation of the epidemic of measles to that of influenza at Camp Pike, and the relations of the pneumonia following measles to both measles and influenza 293

4. Shows the time interval between the onset of measles and the onset of the subsequent pneumonia in the 56 cases of pneumonia following measles at Camp Pike 306

5. Shows the time relation between the identification of hemolytic streptococci in the throats and the development of otitis media in 27 cases shown to be due to hemolytic streptococci 314

FIG. 1. Acute bronchitis showing engorgement of blood vessels of mucosa and elevation of epithelium by serum and blood 146

2. Acute bronchopneumonia with nodules of peribronchiolar consolidation and purulent bronchitis 167

3. Acute bronchopneumonia with peribronchiolar consolidation 169

4. Acute bronchopneumonia with peribronchiolar consolidation 170

5. Bronchopneumonia with hemorrhagic peribronchiolar consolidation 174

6. Acute bronchopneumonia with confluent gray lobular consolidation in lower part of upper lobe and hemorrhagic peribronchiolar pneumonia in lower lobe; purulent bronchitis 180

7. Bronchopneumonia with purulent bronchitis and peribronchial hemorrhage 190

8. Streptococcus pneumonia with massive necrosis 201

9. Abscess below pleura with perforation caused by hemolytic streptococci 202

10. Interstitial suppurative pneumonia; interstitial septa are the site of suppuration and lymphatics are distended with purulent fluid; empyema 211

11. Suppurative interstitial pneumonia 212

12. Suppurative interstitial pneumonia 216

13. Suppurative interstitial pneumonia showing a dilated lymphatic 217

14. Endophlebitis occurring in association with suppurative pneumonia 219

15. Abscesses in two clusters caused by S. aureus in upper part of right upper lobe 227

16. Abscesses in cluster caused by S. aureus at apex of right lobe 228

17. Acute bronchiectasis showing fissures penetrating into bronchial wall and at one place entering alveolar tissue 246

18. Acute bronchiectasis showing fissures in the bronchial wall extending into neighboring alveoli which in zone about are filled with fibrin 247

19. Acute bronchiectasis; the bronchial wall indicated by engorged mucosa shows a varying degree of destruction, fissures extending into and through the bronchial wall 248

20. Acute bronchiectasis with destruction of bronchial wall exposing alveoli filled with fibrin 249

21. Bronchiectasis with fissures extending through the bronchial wall into alveolar tissue which is site of fibrinous pneumonia 251

22. Regeneration of epithelium over fissures which have been formed in the wall of a bronchus 252

23. Squamous epithelium growing over the defect in the bronchial wall 253

24. Acute bronchiectasis with fissures extending through bronchial wall which is marked by great engorgement of blood vessels 255

25. Advanced bronchiectasis throughout lower left lobe 258

26. Unresolved bronchopneumonia with tubercle-like nodules of peribronchiolar consolidation best seen in lower lobe; bronchiectasis 268

27. Unresolved pneumonia with peribronchial formation of fibrous tissue; bronchiectasis 270

28. Unresolved pneumonia with bronchiectasis showing new formation of fibrous tissue about a greatly dilated bronchus of which the epithelial lining has been lost 271

29. Lobar pneumonia following measles 338

30. Unresolved bronchopneumonia with measles showing new formation of fibrous tissue about a bronchus and in immediately adjacent alveolar walls 342

31. Unresolved bronchopneumonia with measles showing a nodule of chronic fibrous pneumonia surrounding a respiratory bronchiole 343

32. Unresolved bronchopneumonia with measles showing chronic pneumonia about a respiratory bronchiole and alveolar duct 344

33. Experimental lobar pneumonia in the stage of gray hepatization produced by injection of Pneumococcus III into the trachea of a monkey 395

EPIDEMIC RESPIRATORY DISEASE

THE PNEUMONIAS AND OTHER INFECTIONS OF THE RESPIRATORY TRACT ACCOMPANYING INFLUENZA AND MEASLES