214 INFLAMMATORY AND SUPPURATIVE CONDITIONS. 



may supervene and lead to destruction of large portions of the 

 lung. In these a great variety of bacteria, both aerobes and 

 anaerobes, are to be found. 



In ordinary broncho-pneumonias also, Fraenkel's pneumo- 

 coccus is usually present, sometimes along with pyogenic cocci ; 

 in the broncho-pneumonias secondary to diphtheria it may be 

 accompanied by the diphtheria bacillus, and also by pyogenic 

 cocci ; in typhoid pneumonias the typhoid bacillus or the B. coli 

 may be alone present or be accompanied by the pneumococcus, 

 and in influenza pneumonias the influenza bacillus may occur. 

 In septic pneumonias the pyogenic cocci in many cases are the 

 only organisms discoverable, but the pneumococcus may also be 

 present 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 neigh- 

 bouring 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, for from the blood stream 

 both in the early and later stages of pneumonia, pneumococci 

 have been isolated by Prochaska and Cole, thus explaining why 

 the pneumococcus may be found in suppurations and inflam- 

 mations in various parts of the body (subcutaneous tissue, peri- 

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

 endocarditis (p. 197), 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 prim- 

 ary infections by the pneumococcus in man : 



(1) In adults 



Pneumonia . . 65.95 per cent Empyema . . 8.53 per cent 

 Broncho-pneumonia | Otitis . . . 2.44 ,, 



Capillary bronchitis i * 5 5 " Endocarditis . . 1.22 

 Meningitis . . 13-00 Liver abscess . . 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. 



