Excerpt from The American Journal of the Medical Sciences, 1919, Vol. 158
Depending upon the locality, the etiological factors producing pneumonia may be expected to show variation. From experience in army base hospitals, two facts of importance have been rather universally recognized. The first fact refers to the general preva lence of the streptococcus (normally one of the hemolytic varieties) in pneumonia following measles. The second fact refers to the prevalence of the streptococcus, likewise one of the hemolytic varieties, as an organism associated in many localities with the pneumococcus in the production of epidemic pneumonia not pre ceded by measles or inﬂuenza, but as a distinct type in which the pneumococcus has appeared to play but a minor role. In certain localities, during the recent epidemic of influenzal pneumonia, the pneumococcus as the prevalent type of infection both in the acute disease and in the subsequent empyemas. In other localities the pneumococcus and streptococcus have been associated, while in others streptococcus pneumonias have been more frequently encountered than had been heretofore generally recognized.
In the series of empyema here reported only those are included which required treatment by aspiration or operation. There were available for this report 35 empyema patients who recovered by repeated aspirations alone, while came to Operation. Those patients were not included who died within a few days of admission with an established diagnosis of empyema or those who died during the course of aspirations designed for their relief, but who, because of activity of the pneumonic process, acute bilateral empyema, purulent pericarditis, meningitis or other serious complications, were not considered reasonable operative risks.
Because of the interest attached to variations of treatment, with increasing experience, these empyema patients have been grouped, depending largely upon three-time intervals, as follows'
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