Lobar or fibrinous pneumonia is caused in most instances by the Diplococcus lanceolatus (pneumococcus) and rarely by the Diplococcus mucosus, the staphylococcus, or the streptococcus. The infection is effected as a rule through inhalation of the pathogenic microorganism by way of the upper respiratory tract. It is stated that the diplococcus reaches primarily the lymph nodes at the hilum of the lungs, wherefrom it spreads toward the pulmonary parenchyma. However, this opinion is contradicted on the following ground: Since the hilum, one argues, is the point of convergence of the lungs with the lymph flowing thereto from the periphery, the spread of the microorganism should be then a retrograde one, which is thought to be unlikely.The clinical and pathological aspects of the disease are likewise matters for debate. Thus it is not understood why the pneumococcus will cause in instances a bilateral, patchy, or lobular bronchopneumonia with its gradual onset, while in the pneumonia the object for discussion in the present report, the onset is sudden and the lesion is lobar and unilateral.The brusqueness in the development and the rapid spread of the inflammatory processes in one lung in cases of lobar (genuine) pneumonia has led to the suggestion that the disease is probably an expression of an altered sensitiveness of the lung toward the Pneumococcus pneumoniae, or that one is dealing in this condition with an allergic phenomenon.
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