Pneumonia

“ In cases of death from uncomplicated pneumonia a very variable extent of lung is involved. In some cases this result may be ascribed to the weakness of the individual and especially of the heart, but in others the virulence of the micro-organisms and the toxins which they have produced is probably the more correct explanation. The improvement in a patient suffering from pneumonia usually commences suddenly, with a rapid fall in the temperature. ”

“ Labored breathing, which is at once hurried, deep, and without intermission, is seen in severe laryngitis, croup, capillary bronchitis, and pneumonia, in all cases alike from the difficulty experienced in introducing into the lungs the requisite amount of air. It is especially marked in double pneumonia, pleuro-pneumonia, complicated with effusion in the chest, and in old standing broken wind with dilatation of the right heart. ”

“ Formerly medical men treated pneumonia by confining the patient in an overheated room in which steam was generated, with the idea that the lungs would be most helped by an atmosphere of moist heat. Now, a pneumonia patient is supplied with all the fresh air possible, the windows of the sick room, even in winter, being kept continually open, and every effort being made to give the patient fresh air even when every breath means a shooting pain, and apparently untold suffering. ”

“ But modern research has demonstrated that there is no relation whatever between the symptoms and the morbid state of the lung, which it is the object of the well-informed physician to remove. It would be easy to show that there are many cases where all the symptoms of a pneumonia have been present, but 264where a post-mortem examination has proved that there was no inflammation of the lung; and that a still larger number of instances might be cited where fatal pneumonia has occurred without any of its symptoms having existed during life. ”

“ When the practitioner is first consulted he often finds only indications of the crisis period of a localised pneumonia at the base of the affected lung. The symptoms include fever, accelerated breathing, moaning, loss of appetite, cough without discharge, dulness over the base of the lung on percussion, disappearance of the respiratory murmur in the dull area, souffle opposite the inferior bronchi, and normal or juvenile respiration towards the front, i.e., in the anterior lobe, and sometimes in the cardiac lobe. ”

“ If the disease proceeds favorably, at the end of five, seven, or ten days the temperature, breathing, and pulse become normal suddenly, and the patient rapidly emerges from a state of danger and distress to one of comfort and safety. The sudden onset of pneumonia with chill, agonizing pain in side, rapid breathing, and often delirium with later bloody or rusty-colored, gelatinous expectoration, will then usually serve to distinguish it from bronchitis, but not always. ”

“ When an old person has a slight rigor followed by febrile movement, with great prostration, for which no explanation can be found, pneumonia may be suspected, even though all its diagnostic signs are absent.
Intermittent or remittent pneumonia, which is described by some authors as a distinct type, is a form of acute pneumonia in which a malarial element is so pronounced that all the pneumonic symptoms, even the physical signs, undergo distinct intermission, returning each day with increasing severity. ”

“ The struggle for breath in the first stage of pneumonia is frequently alarming to witness. The relative frequency of pulse and respiration is more modified in pneumonia. The stitch-like, cutting pain in pleurisy is characteristic and very circumscribed, whereas in pneumonia, unless the pleura is involved, there is little or nothing beyond a dull soreness. ”

“ Foreign bodies, such as feed accidentally getting into the lungs by way of the windpipe, as well as the inhalation of irritating gases and smoke, ofttimes produce fatal attacks of inflammation of the lung and bronchial tubes. Pneumonia is frequently seen in connection with other diseases, such as influenza, purpura hemorrhagica, strangles, glanders, etc. Pneumonia and pleurisy are most common during cold, damp weather, and especially during the prevalence of the cold north or northeasterly winds. Wounds puncturing the thoracic cavity may cause pneumonia. ”

“ It seems to me that the resemblance of pneumonia to the acute general diseases is to be found for the most part in its nervous phenomena, and that the complications which render pneumonia dangerous are those which interfere directly with the muscular power of the heart or diminish its nerve-supply. ”

“ Hypostatic congestion of the lungs is accompanied by copious, watery, blood-stained expectoration. In pneumonia the sputa, though bloody, are rarely watery. Pneumonia occurs anywhere in the lung, and has well-marked rational symptoms; hypostatic congestion occurs in the most dependent portion of the lung, disappears when the patient sits up, is accompanied by no rational symptoms except dyspnoea and expectoration, and usually can be traced to a long-continued recumbent posture in those who are suffering from extensive blood-changes. ”

“ He demonstrated the presence of the bacilli in the sputa, and showed that the inflammation in the lungs was set up by primary plague infection. The pneumonia is usually lobular, the onset marked by rigors, with difficult and hurried breathing, cough and expectoration. The prostration is great and the course of the illness rapid The breathing becomes very hurried—forty to sixty respirations in the minute—and the face dusky. ”

“ But the porteuse seldom suffers in consequences: she seems proof against fevers, rheumatisms, and ordinary colds. When she does break down, however, the malady is a frightful one,—a pneumonia that carries off the victim within forty-eight hours. ”

“ In pneumonia, as in typhoid fever, so-called walking cases always have a serious prognosis. They occur in very strong patients who resist, not the invasion of the disease, but its {152} weakening influence, and keep on their feet for several days, despite the presence of symptoms that require them to be in bed. When a patient walks into a doctor's office in the third or fourth day of a pneumonia with most of one lung consolidated, exhaustion of the heart and of the nervous system, under these unfavourable conditions, will usually have made his resistive vitality very low. ”

“ Simple fibrinous pneumonia is likely to arise from climatic conditions or from exposure, attacks several at once and none later, has less abrupt rise of temperature, less tenderness of the chest walls, less dyspnœa, less obstinate standing, and after death, less interlobular exudate and marbling, and no presentation of old and recent lesions in the same lung. ”

“ In Pneumonia, the symptoms differ from Pleurisy, yet the difference manifests itself in this, that in Pleurisy there is more pain, and in Pneumonia more difficult breathing. Pneumonia is often a consequence of a cold, bronchitis, or the termination of some disease of the air-passages, and may begin with symptoms of a cold—rough coat, want of appetite, low spirits, etc. In other cases, it begins with a shivering chill; the legs, ears and skin are cold; the coat is rough; the nose pale and dry; quick pulse, which afterwards becomes frequent and full ”

“ The respiratory murmur may be lessened in certain morbid conditions, such as emphysema and congestion of the lung, and may completely disappear in pneumonia or broncho-pneumonia, a fact which is even of greater significance. ”

“ This is the term or terms applied when bronchitis, pleurisy, and pneumonia all exist at once. It is impossible for one who is not an expert to diagnose the state with certainty. The apparent symptoms are the same as when the animal is affected with pleuropneumonia. [Pg 127]
SUPPURATION AND ABSCESS IN THE LUNG.
There are instances, and especially when the surroundings of the patient have been bad or the disease is of an especially severe type, when pneumonia terminates in an abscess in the lung. ”

“ In pneumonia the difficulty of breathing consists in its painfulness; in asthma, in the persistent torpor of the respiratory organs. The patient feels as if the expansion apparatus of his chest were utterly paralyzed, the inhaled breath seems to come to the gate of the lungs and no farther ”

“ If the inflammation is due to one of the various other germs that cause the remaining fifth of the pneumonia cases, still other treatment may be needed. It is clear, then, that your physician should be called promptly when pneumonia is suspected so that he may have the laboratory tests made that will tell him with what kind of germ infection he [4] has to deal. Then he can decide what kind of treatment to employ.
Pneumonia Is Contagious
Pneumonia appears to be spread from person to person by contact, so it is regarded as a communicable disease. ”

“ As regards pneumonic plague the origin of such epidemics is probably from pneumonia occurring secondarily in cases of bubonic plague. Provided the conditions are favorable, particularly as to moisture in the air of the room, the infection spreads directly from man to man as a result of the droplets of heavily infected sputum being sprayed into the air in the act of coughing on the part of the patient. ”

“ Young and vigorous subjects suffer most, but almost always recover soonest.
4. The weak pulse, want of reaction, non-disappearance of the pneumonic consolidation, or its appearance during the progress of exhaustive diseases, are the unfavourable signs of pneumonia.
5. Continued exercise or work after the attack; low diet, large blood-lettings; depressants, such as tartar emetic and sedatives; expectorants, such as squills and ipecacuanha; mercury and violent purgatives, are opposed to the restorative treatment of the disease, and when not fatal, tend to prolong its duration. ”

“ The inflammatory reaction which develops into pneumonia, perhaps necrotizing, perhaps later organizing, can only be explained by the combined action of the corrosive gas and the organisms saprophytic in the normal mouth, but now pathogenic in varying degrees in the lung whose vital reactions have either been inhibited or impaired by the gas. ”

“ Almost any remedy that is used for three or four days in pneumonia will be followed by the crisis with, in most cases, a favorable termination. The crisis takes place some time from the seventh to the tenth or eleventh day, and often we do not see a pneumonia patient until the second or third day of the disease. Just before the crisis the patient runs into a series of acute and more or less alarming symptoms. Often there is much restlessness, difficulty of breathing with complaint of heaviness, and perhaps prostration. The pulse and temperature are high, the skin hot and dry. ”

“ As it is contagious, the spread of infection can be stopped if precautions are taken to prevent the transfer of the infectious material from the sick to the well. The secretions from the nose and throat of persons sick with pneumonia, or convalescing from the disease, usually carry the germs that cause it. The transfer may take place through direct contact with these secretions, or inhaling droplets of moist sputum expelled by the sick person while coughing or sneezing.
Pneumonia is no respecter of persons. ”

“ But with regard to the treatment of acute pneumonia I regard the following axioms as fully established, viz.:—
1. The great end of medical practice is to remove the consolidation of the lungs and restore those organs to their natural condition as rapidly as possible.
2662. To this end everything that diminishes vital strength should be avoided, and nutrients administered as early as possible, to favour the cell transformation necessary for removing the exudation from the lungs.
3. There is no relation between the violence of the symptoms or force of the pulse and the fatality of the disease. ”

“ Among acute affections of the lungs, the several forms of pneumonia are the most frequent causes of pleurisies. Fraentzel states that we always find fibroid pneumonia associated with pleurisy as pleuro-pneumonia, even when the inflammation of the lung-tissue itself does not reach the pulmonary pleura. ”

“ In short, recovery is the rule in simple broncho-pneumonia; but from an economic standpoint there is little reason for keeping the animals alive.
Diagnosis. The diagnosis is not generally very difficult; for if at first the case may be mistaken for one of simple pneumonia, the persistence or prolonged aggravation of the symptoms and the irregularity in position of the lesions revealed by percussion and auscultation enable the condition to be distinguished at an early period from simple pneumonia. ”

“ The pneumonia of a child is not the pneumonia of an aged person. Slight ailments, unobserved or disregarded in the adult, become positive disease in advanced life. Our acute fevers, inflammations, fluxes, etc., are not met with among the aged. ”

“ An influenza pneumonia may show the general prostration and cardiac weakness of plague. In influenza pneumonia we have an onset with the features of ordinary influenza, which, however, in the influenza epidemic in 1918 was often short. In plague pneumonia we have pneumonia from the start. The pulse in plague is early weak and rapid and the tendency to a stuporous state more marked. The early appearance of thin watery sputum, which quickly becomes blood-tinged and always contains plague bacilli is noted in plague pneumonia. ”