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PRIMARY FRIEDLÄNDER PNEUMONIA: Title and subTitle BreakREPORT OF THIRTY-TWO CASES

SAUL SOLOMON, M.D.
[+] Author Affiliations

The author received advice and encouragement from Dr. Theodore J. Curphey during this investigation, was given assistance by Dr. E. A. Greenspon of Montreal in correcting the manuscript, and received technical assistance from Miss Katherine Bleckerman.


NEW YORK

From the Fourth Medical Division of Bellevue Hospital, Dr. Charles Nammack, director, and the Simon Baruch Foundation for Research.


JAMA. 1937;108(12):937-947. doi:10.1001/jama.1937.02780120007002
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Carl Friedländer1 in 1882 described an organism which he found at necropsy in several cases of croupous pneumonia. He expressed the view that it was the chief etiologic agent of lobar pneumonia, thus precipitating a controversy which was not settled for many years. It is now generally agreed that Friedländer's observations were correct but that his deductions were too sweeping and based on insufficient data. For, soon after this, Talamon,2 Fraenkel3 and Sternberg4 showed conclusively that the common cause of lobar pneumonia was Diplococcus lanceolatus or pneumococcus. It was their view that the organism described by Friedländer was not a true cause of pneumonia at all but merely a secondary invader. This swing of opinion regarding the pathogenicity of Friedländer's bacillus appears to have been as extreme and erroneous as Friedländer's original conclusions. Weichselbaum5 approximated more closely to the truth as the result of a

REFERENCES

Friedländer, Carl:  Ueber die Schizomyceten bei der acuten fibrösen Pneumonie , Virchows Arch. f. path. Anat. 87:319, 1882;.
Talamon, D.:  Coccus de la pneumonie , Bull. Soc. anat. de Paris 7:475, 1883;.
Fraenkel, A.:  Weitere Beiträge zur Lehre von den Mikrococcen der genuinen fibrinösen Pneumonie , Ztschr. f. klin. Med. 2:437, 1886;.
Sternberg, Y. M.:  The Pneumonia-Coccus of Friedländer , Am. J. M. Sc. 90: 106 and 435, 1885;.
Weichselbaum, A.:  Ueber die Aetiologie der acuten Lungen- und Rippenfellentzündungen , Med. Jahrb. 1:483, 1886;.
Zander, A.:  Ausgendehnte Endemie von Lungenentzündungen durch Infektion mit Friedländerschen: Pneumobazillen unter Zivilarbeitern , Deutsche med. Wchnschr. 45:1180, 1919;.
Curphey, T. J., and Baruch, H. B.:  A Practical Method for the Immunization of Horses by Type Specific Pneumococcic Pleural Exudates , Proc. Soc. Exper. Biol. & Med. 26:687 ( (May) ) 1929;.
Miss Sylvia Barteau, record librarian of Bellevue Hospital, was helpful in obtaining these records.
Julianelle, L. A.:  A Biological Classification of Encapsulatus Pneumoniae (Friedländer's Bacillus) , J. Exper. Med. 44: 113 ( (July) ), 683 (Nov.) 735 (Dec.) 1926;
 The Distribution of Friedländer's Bacilli of Different Types , J. Exper. Med. 52:539 ( (Oct.) ) 1930;.
Personal communication to the author.
Toenniessen, E.:  Untersuchungen über die Kapsel (Gummihüle) der pathogenen Bakterien , Centralbl. f. Bakt. I abt., orig. 85:225, 1921;.
Avery, O. T., and Dubos, R.:  The Protective Action of a Specific Enzyme Against Type III Pneumococcus Infection in Mice , J. Exper. Med. 54:73 ( (July) ) 1931;.
Francis, Thomas; Terrell, E. E.; Dubos, R., and Avery, O. T.:  Experimental Type III Pneumococcus Pneumonia in Monkeys , J. Exper. Med. 59:641 ( (May) ) 1934;.
Goebel, W. F.:  The Soluble Specific Substance of Friedländer's Bacillus , J. Biol. Chem. 74:619 ( (Sept.) ) 1927;.
Etienne, G.:  Le pneumobacille de Friedländer: son rôle en pathologie , Arch. de méd. expér. 7: 124, 1895;.
Kalkstein, Mennasch: Personal communication to the author.
Ferguson, J. A., and Tower, A. A.:  Pneumonia in Infants Due to Bacillus Mucosus-Capsulatus , Am. J. Dis. Child. 46:59 ( (July) ) 1933;.
Webster, L. T.:  The Mode of Spread of a Friedländer Bacilluslike Respiratory Infection of Mice , J. Exper. Med. 47:685 ( (May) ) 1928;.
Cecil, R. L.; Baldwin, H. S., and Larsen, N. P.:  Lobar Pneumonia: A Clinical and Pathological Study of Two Thousand Typed Cases , Arch. Int. Med. 40:253 ( (Sept.) ) 1927;.
Belk, W. P.:  Pulmonary Infections by Friedländer's Bacillus , J. Infect. Dis. 38:115 ( (Feb.) ) 1926;.
Weichselbaum.5 Howard, W. T.:  The Importance of Bacillus Mucosus-Capsulatus (Bacillus of Friedländer) as the Cause of Acute and Chronic Infections , Philadelphia M. J. 1:336, 1898;.
Etienne.14 Ferguson and Tower.16 Comba, C.:  Setticemia de bacillo del Friedländer in un neonato, le sperimentale , Archivio di Biologia 50: 112, 1896;.
Bhatnagar, S. S., and Singh, K.:  Bacteriological Studies in Acute Lobar Pneumonia Due to Pneumococcus and B. Pneumoniae Friedländer , Indian J. M. Research 23:337 ( (Oct.) ) 1935;.
Schlapper, K.:  Ueber Friedländer-Pneumonien , Beitr. z. Klin. d. Tuberk. 78: 741, 1931;.
Sabin, A. B.:  The Microscopic Agglutination Test in Pneumonia , J. Infect. Dis. 46:469 ( (June) ) 1930;.
Apelt, F.:  Ueber die durch den Bacillus pneumoniae: "Friedländer" hervorgerufene Pneumonie , München. med. Wchnschr. 55:833, 1908;.
Solomon, Saul, and Curphey, T. J.:  Streptococcus Septicemia Complicating Pneumococcic Lobar Pneumonia , J. A. M. A. 108:187 ( (Jan. 16) ) 1937;.
The serum employed contains 800 units per cubic centimeter (one unit being ten times the amount that will protect a mouse against a fatal dose of antigen) and was obtained from the New York Health Department through the courtesy of Dr. William H. Park and Miss Georgia Cooper.
Beco, L.:  Recherches sur la fréquence de septicémies au cours des infections pulmonaires , Rev. de méd. 19:461, 1897;.
Thiroloix. M.:  Pneumonie due au bacille de Friedländer , Bull. Soc. anat. de Paris 72:152, 1897;.
Smith, W. H.:  A Case of Lobular Pneumonia Due to Bacillus Mucosus-Capsulatus , J. Boston Soc. M. Sc. 2:174, 1897;.
Kokawa, I.:  Zur pathologischen Anatomie der Kapselbazillen Pneumoniae , Deutsches Arch. f. klin. Med. 80: 39, 1904;.
Sisson. W. B., and Thompson, C. B.:  Friedländer Bacillus Pneumonia with Report of Cases , Am. J. M. Sc. 150:713 ( (Nov.) ) 1915;.
Fremmel, F.: Henrichsen, K. J., and Sweaney, H. C.:  Pulmonary Infections by the Friedländer's Bacillus , Ann. Int. Med. 5: 885-94 ( (Jan.) ) 1932;.
Stengel, A.; Kornblum, K., and Collins, L. H., Jr.:  Friedländer's Pneumonia , Tr. A. Am. Physicians 43: 326, 1928;.
Olcott, C. T.:  Pneumonia Due to Friedländer's Bacillus , Arch. Path. 16:471 ( (Oct.) ) 1933;.
Stoichita, N. N., and Jonnesco, D.:  Abscès au poumon et septicémie à pneumobacilles de Friedländer , Arch. méd-chir. de l'app. respir. 8: 534, 1933;.
Abrami, P., and Worms, R.:  Septicémie à pneumobacilles de Friedländer avec localization pulmonaire , Bull. et mém. Soc. méd. d. hôp. de Paris 54:479 ( (March 31) ) 1930;.
Baehr, G.; Schwartzman, Gregory, and Greenspan, E. B.:  The Rôle of Bacillus Friedländer in Infections , Tr. A. Am. Physicians 48: 353, 1933;.

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Friedländer, Carl:  Ueber die Schizomyceten bei der acuten fibrösen Pneumonie , Virchows Arch. f. path. Anat. 87:319, 1882;.
Talamon, D.:  Coccus de la pneumonie , Bull. Soc. anat. de Paris 7:475, 1883;.
Fraenkel, A.:  Weitere Beiträge zur Lehre von den Mikrococcen der genuinen fibrinösen Pneumonie , Ztschr. f. klin. Med. 2:437, 1886;.
Sternberg, Y. M.:  The Pneumonia-Coccus of Friedländer , Am. J. M. Sc. 90: 106 and 435, 1885;.
Weichselbaum, A.:  Ueber die Aetiologie der acuten Lungen- und Rippenfellentzündungen , Med. Jahrb. 1:483, 1886;.
Zander, A.:  Ausgendehnte Endemie von Lungenentzündungen durch Infektion mit Friedländerschen: Pneumobazillen unter Zivilarbeitern , Deutsche med. Wchnschr. 45:1180, 1919;.
Curphey, T. J., and Baruch, H. B.:  A Practical Method for the Immunization of Horses by Type Specific Pneumococcic Pleural Exudates , Proc. Soc. Exper. Biol. & Med. 26:687 ( (May) ) 1929;.
Miss Sylvia Barteau, record librarian of Bellevue Hospital, was helpful in obtaining these records.
Julianelle, L. A.:  A Biological Classification of Encapsulatus Pneumoniae (Friedländer's Bacillus) , J. Exper. Med. 44: 113 ( (July) ), 683 (Nov.) 735 (Dec.) 1926;
 The Distribution of Friedländer's Bacilli of Different Types , J. Exper. Med. 52:539 ( (Oct.) ) 1930;.
Personal communication to the author.
Toenniessen, E.:  Untersuchungen über die Kapsel (Gummihüle) der pathogenen Bakterien , Centralbl. f. Bakt. I abt., orig. 85:225, 1921;.
Avery, O. T., and Dubos, R.:  The Protective Action of a Specific Enzyme Against Type III Pneumococcus Infection in Mice , J. Exper. Med. 54:73 ( (July) ) 1931;.
Francis, Thomas; Terrell, E. E.; Dubos, R., and Avery, O. T.:  Experimental Type III Pneumococcus Pneumonia in Monkeys , J. Exper. Med. 59:641 ( (May) ) 1934;.
Goebel, W. F.:  The Soluble Specific Substance of Friedländer's Bacillus , J. Biol. Chem. 74:619 ( (Sept.) ) 1927;.
Etienne, G.:  Le pneumobacille de Friedländer: son rôle en pathologie , Arch. de méd. expér. 7: 124, 1895;.
Kalkstein, Mennasch: Personal communication to the author.
Ferguson, J. A., and Tower, A. A.:  Pneumonia in Infants Due to Bacillus Mucosus-Capsulatus , Am. J. Dis. Child. 46:59 ( (July) ) 1933;.
Webster, L. T.:  The Mode of Spread of a Friedländer Bacilluslike Respiratory Infection of Mice , J. Exper. Med. 47:685 ( (May) ) 1928;.
Cecil, R. L.; Baldwin, H. S., and Larsen, N. P.:  Lobar Pneumonia: A Clinical and Pathological Study of Two Thousand Typed Cases , Arch. Int. Med. 40:253 ( (Sept.) ) 1927;.
Belk, W. P.:  Pulmonary Infections by Friedländer's Bacillus , J. Infect. Dis. 38:115 ( (Feb.) ) 1926;.
Weichselbaum.5 Howard, W. T.:  The Importance of Bacillus Mucosus-Capsulatus (Bacillus of Friedländer) as the Cause of Acute and Chronic Infections , Philadelphia M. J. 1:336, 1898;.
Etienne.14 Ferguson and Tower.16 Comba, C.:  Setticemia de bacillo del Friedländer in un neonato, le sperimentale , Archivio di Biologia 50: 112, 1896;.
Bhatnagar, S. S., and Singh, K.:  Bacteriological Studies in Acute Lobar Pneumonia Due to Pneumococcus and B. Pneumoniae Friedländer , Indian J. M. Research 23:337 ( (Oct.) ) 1935;.
Schlapper, K.:  Ueber Friedländer-Pneumonien , Beitr. z. Klin. d. Tuberk. 78: 741, 1931;.
Sabin, A. B.:  The Microscopic Agglutination Test in Pneumonia , J. Infect. Dis. 46:469 ( (June) ) 1930;.
Apelt, F.:  Ueber die durch den Bacillus pneumoniae: "Friedländer" hervorgerufene Pneumonie , München. med. Wchnschr. 55:833, 1908;.
Solomon, Saul, and Curphey, T. J.:  Streptococcus Septicemia Complicating Pneumococcic Lobar Pneumonia , J. A. M. A. 108:187 ( (Jan. 16) ) 1937;.
The serum employed contains 800 units per cubic centimeter (one unit being ten times the amount that will protect a mouse against a fatal dose of antigen) and was obtained from the New York Health Department through the courtesy of Dr. William H. Park and Miss Georgia Cooper.
Beco, L.:  Recherches sur la fréquence de septicémies au cours des infections pulmonaires , Rev. de méd. 19:461, 1897;.
Thiroloix. M.:  Pneumonie due au bacille de Friedländer , Bull. Soc. anat. de Paris 72:152, 1897;.
Smith, W. H.:  A Case of Lobular Pneumonia Due to Bacillus Mucosus-Capsulatus , J. Boston Soc. M. Sc. 2:174, 1897;.
Kokawa, I.:  Zur pathologischen Anatomie der Kapselbazillen Pneumoniae , Deutsches Arch. f. klin. Med. 80: 39, 1904;.
Sisson. W. B., and Thompson, C. B.:  Friedländer Bacillus Pneumonia with Report of Cases , Am. J. M. Sc. 150:713 ( (Nov.) ) 1915;.
Fremmel, F.: Henrichsen, K. J., and Sweaney, H. C.:  Pulmonary Infections by the Friedländer's Bacillus , Ann. Int. Med. 5: 885-94 ( (Jan.) ) 1932;.
Stengel, A.; Kornblum, K., and Collins, L. H., Jr.:  Friedländer's Pneumonia , Tr. A. Am. Physicians 43: 326, 1928;.
Olcott, C. T.:  Pneumonia Due to Friedländer's Bacillus , Arch. Path. 16:471 ( (Oct.) ) 1933;.
Stoichita, N. N., and Jonnesco, D.:  Abscès au poumon et septicémie à pneumobacilles de Friedländer , Arch. méd-chir. de l'app. respir. 8: 534, 1933;.
Abrami, P., and Worms, R.:  Septicémie à pneumobacilles de Friedländer avec localization pulmonaire , Bull. et mém. Soc. méd. d. hôp. de Paris 54:479 ( (March 31) ) 1930;.
Baehr, G.; Schwartzman, Gregory, and Greenspan, E. B.:  The Rôle of Bacillus Friedländer in Infections , Tr. A. Am. Physicians 48: 353, 1933;.
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