"LOBAR PNEUMONIA CONSIDERED AS PNEUMOCOCCIC LOBAR ATELECTASIS OF THE LUNG"

To the Editors:  —I have read with a great deal of interest the article on lobar pneumonia by Coryllos and Birnbaum published in the Archives of Surgery of January, 1929, page 190. So radical a theory should not pass without consideration and comment. The authors have based their theory that bronchial obstruction is the important factor in the pathogenesis of lobar pneumonia on certain similarities between this condition and lobar atelectasis. I do not think that they have explained successfully the many differences between the two entities. I should like to call attention to one which, I believe, renders the theory untenable.In atelectasis caused by obstruction of a bronchus supplying a lobe, the physical signs are flatness, absent breath sounds and decreased tactile and vocal fremitus. It has generally been believed that these signs persisted as long as the bronchus remained obstructed. In pneumonia the initial decrease in breath