CASE HISTORY

On admission on 31.12.36. patient had been ill for 6 days, the illness having started with shivering and general malaise. In the last few days there had been pain in the back and in the right side of the chest and much cough; this pain was worse on breathing and was stabbing in character. On examination the tongue was furred and patient looked flushed and ill. The mouth was dry and the chest showed dullness all over the right middle zone, with distant bronchial breathing and aegophony. No pleural rub was heard, but there was a definite catch on breathing. Culture yielded Str.pnemoniae Group IV, from the sputum. There was no abdominal rigidity. Temp 101.2, P.118, R.32. Patient developed broncho-pneumonia at the left base also and die on 4.1.37 and came to autopsy with a diagnosis of influenzal pneumonia (bilateral) and heart failure.

PATHOLOGY

The specimen consists of the posterior part of the uppermost and lowest lobes of the right lung. The whole lung at autopsy weighed 1620g. The pleural surface of the lower lobe shows fibrino-purulent exudate and haemorrhages, with pus distended lymphatics. The whole lower lobe is bulky and consolidated almost throughout, somewhat resembling grey hepatisation in lobar pneumonia. The colour is largely yellowish and there is abscess formation in many areas. Small haemorrhagic areas can be distinguished particularly near the base of this lobe. The bronchi are intensely inflamed. The upper lobe is intensely congested and oedematous, but there are no definite foci of consolidation.