s 



IVERS1TY J 



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THE DIPl.'n < , t x ,,/.- /'YAT.UOA7.1 355 



predominant in the pneumonia.- With pneumococci the exudate is 

 usually moderate and of a fibrinous character, but may be more abun- 

 dant and of a serofibrinous or purulent character. When the pleurisy 

 is marked it is more apt to continue after the cessation of the pneu- 

 monia. Pleurisy due to pneumococci is more apt to go on to sponta- 

 neous recovery than that due to streptococci or staphylococci. 



The most frequent pneumococcic infections next to pleurisy, following 

 a pneumonia, are those of the pericardium, endocardium, and meninges, 

 and these not infrequently arise together. Pneumococcic inflammations 

 of the heart valves are apt to be followed by extensive necrosis and 

 growth of vegetations. In these cases pneumococci can sometimes 

 be found in the blood for many weeks. Pericarditis due to pneumo- 

 cocci is a frequent complication, but is usually very slightly developed. 

 Meningitis due to pneumococci may be either fibrinous or purulent or 

 both. Arthritis and periarthritis are rarer complications of a pneu- 

 mococcic pneumonia. Besides moderate parenchymatous inflammation 

 of the kidney, which occurs in most cases of pneumonia, well-marked 

 inflammation may occur in which pneumococci exist in the kidney 

 tissues in large numbers. Osteomyelitis and otitis media are not very 

 infrequent. 



How is the pneumococcus conveyed from its original seat in the lungs 

 to distant internal organs? Chiefly by means of the bloodvessels and 

 lymphatics, in both of which it has been found in great numbers. Proof 

 enough of its conveyance through the lymphatics is afforded by the 

 frequent occurrence of inflammations of the serous membranes com- 

 plicating pneumonia; but two cases in particular have been reported 

 by Thue of pleurisy and pericarditis following pneumonia in which 

 the lymph capillaries have been found to be filled with diplococci, as if 

 injected. Their presence in the blood after death has been amply proved 

 by numerous investigations. In many instances they have been recovered 

 from the blood during life. Lambert, as a rule, found them in all fatal 

 cases twenty-four to forty-eight hours before death. This examination 

 has considerable prognostic value, as nearly all cases in which the pneu- 

 mococcus is found end fatally. This micrococcus has been shown ex- 

 perimentally to be capable of producing various forms of septicaemia- 

 local phlegmonous inflammations, peritonitis, pleuritis, and meningitis. 

 A further proof of the transmission of this organism by means of the 

 blood is given by Foa and Bordoni-Uffreduzzi in their investigations 

 into intrauterine infection in pneumonia and meningitis. These inves- 

 tigators have demonstrated the presence of the micrococcus lanceolatus 

 in fetal and placental blood and in the uterine sinuses in maternal 

 pneumonia. There being no question, therefore, as to the possibility 

 of the conveyance of the infective agent by means of the blood and the 

 lymph to all parts of the body, we need not wonder at the multiplicity 

 of the affections complicating a pneumonia, which are caused by this 

 micrococcus; and not only the secondary, but also the primary diseases, 

 as of the brain and meninges, may be explained in the same way. 

 Knowing that the saliva and nasal secretions under normal conditions 



