DISTRIBUTION OF PNEUMOBACTERIA 205 



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, and the pneumococcus may be 

 found in suppurations and inflammations in various parts of the 

 body (subcutaneous tissue, peritoneum, joints, kidneys, liver, etc.), 

 in otitis media, ulcerative endocarditis (p. 188), 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 : 



(1) In adults- 

 Pneumonia . ...... 65 '95 per cent 



Broncho-pneumonia) -IK QK 



Capillary bronchitis/ - 

 Meningitis . -. 13 '00 



Empyema 

 Otitis 



Endocarditis 

 Liver abscess 



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 1 

 pneumonia, in 1 pleurisy, in 1 pericarditis. 



Thus in children the primary source of infection is in a great 

 many cases an otitis media, and Netter concludes that infection 

 takes place in such conditions from the nasal cavities. 



As bearing on the occurrence of pneumococcal infections 



