DISTRIBUTION OF PNEUMOBACTERIA. 195 



sometimes along with pyogenic cocci ; but in the broncho- 

 pneumonias secondary to diphtheria it may be accompanied 

 by the diphtheria bacillus, and also by the ordinary 

 pyogenic cocci ; in typhoid pneumonias the typhoid bacillus 

 or the B. coli may be also present, and in influenza pneu- 

 monias the influenza bacillus. In septic pneumonias it may 

 occur associated with pyogenic cocci, but the latter in 

 many cases are the only organisms discoverable. Especially 

 important, as we shall see, from the point of view of the 

 etiology of the disease, is the occurrence in other parts of 

 the body of pathological conditions associated with the 

 presence of the pneumococcus. By direct extension to 

 neighbouring parts empyema, pericarditis, and lymphatic 

 enlargements in the mediastinum and neck may take place ; 

 in the first the pneumococcus may occur either alone or 

 with pyogenic cocci. But distant parts may be affected, 

 and the pneumococcus may be found in suppurations and 

 inflammations in various parts of the body (subcutaneous 

 tissue, joints, kidneys, liver, etc.), in otitis media, ulcerative 

 endocarditis (p. 164), and meningitis. These conditions 

 may take place either as complications of pneumonia, or 

 they may constitute the primary disease. The occurrence 

 of meningitis is of special importance, for next to the lungs 

 the meninges appear to be the parts most liable to attack 

 by the pneumococcus. A large number of cases have been 

 investigated by Netter, who gives the following tables of 

 the relative frequency of the primary infections by the 

 pneumococcus in man : 



( i ) In adults- 

 Pneumonia . . 65.95 per cent. 

 Broncho-pneumon a \ 

 Capillary bronchit s / 



Meningitis 

 Empyema . 

 Otitis . 

 Endocarditis 

 Liver abscess 



13.00 



8-53 

 2.44 



1.22 

 1.22 



(2) In children 46 cases were investigated. In 29 the primary 

 affection was otitis media, in 12 broncho-pneumonia, in 2 meningitis, 

 in i pneumonia, in I pleurisy, in I pericarditis. 



