PNEUMONIA, LOBAR.
Synonyms. — Croupous pneumonia; fibrinous pneumonia; pneumonitis; lung fever.
Definition. — Pneumonia is an acute infectious disease with a characteristic pulmonary lesion, due to the outpouring, into an extensive portion of the alveolar structure of the lung, of an hEemorrhagic fibrinous exudate.
Symptoms. — The symptoms of acute pneumonia are dependent both upon the local and upon the general infection. The former, however, usually, though not always, predominate. The onset is usually sudden, with a pronounced chill, which is frequently severe and prolonged. Ordinarily it occurs abruptly without any previous warning, but in some instances it is preceded by a day or two of ill health.
In children the chill may be replaced by headache, nausea, marked vomiting, delirium, or convulsions. Less fre quently the onset of the disease is grad ual, with a prodromal stage lasting from a few days to a week. These prodromes are indefinite, and may be such as accom pany any infectious disease, or may be constituted by symptoms pointing to the lungs, such as cough, pain in the chest, or slight dyspmea. These symptoms, how ever, may be due to a pre-existing bron chitis, which in itself may predispose to croupous pneumonia; even in these cases the onset of the pneumonia may be at tended with a chill or some marked tho racic symptom. In other cases, however, pneumonia may supervene gradually upon a pre-existing bronchitis, the point of demarkation between the two not be ing evident.
The fever rises rapidly and lasts from five to seven days, exceptionally termi nating earlier and frequently later. Its decline is usually by crisis, and is at tended with great prostration; rapid im provement in the condition of the lungs ensues and convalescence quickly follows. Subjective symptoms occur early in the first day, and pain of a distressing char acter is frequently a prominent symptom. A dry, half-suppressed cough soon occurs, which aggravates the pain and much in creases the patient's suffering. Pain is usually referred to the site of the lesion. Respirations are accelerated and some what irregular and shallow, being re stricted by the pain caused by a deep in spiration. Later in the course of the dis ease the respiratory movements become very rapid and shallow, owing to the re striction of air-space due to the lesion. The dyspmea is frequently so great that the auxiliary muscles of respiration are brought into use, while the nasal aim are distended with each respiratory move ment; the face is cyanosed, the cheek upon the affected side is often especially flushed, and the conjunctim are suffused.
There is usually an expression of great anxiety.
The expectoration upon the second day of the disease becomes characteristic. It is viscid, airless, extremely tenacious, and possesses a peculiar rusty discoloration. Upon the second or third day the erup lion of an abundant crop of herpes about the lips and ahe of the nose is to be ob served: a symptom often of great diag nostic value in obscure cases. Nervous symptoms present themselves early and in severe cases are never absent. Head ache, sleeplessness, and delirium are com mon manifestations of the disease. Nau sea and vomiting, especially at the onset, are of not infrequent occurrence. Diar rhoea occasionally occurs, but constipa tion is the rule.
The course of the disease varies greatly, being influenced by the age of the pa tient, his habits and previous condition, as well as by the virulence of the infec tion. This accounts for the variation in type resulting in the different forms of croupous pneumonia about to be de scribed. These variations are also to be ascribed to differences in the pathological anatomy, and in the character of bac terial infection. As a rule, cases of frank croupous pneumonia are clue to infection by the pneumococcus, while the asthenic varieties of the disease are associated with other forms of bacteria, such as the bacil lus typhosus, the bacillus of Pfeiffer, or with staphylococcic or streptococcic in fection. In sthenic cases fever is in variably present and active, and in un complicated cases conforms more or less closely to a distinct type. The pulse is full and bounding and in frequency cor responds to the intensity of the fever.
Statistics of 150 cases of croupous pneumonia. Of these, 80 per cent. pre sented the characteristic chill, fever, and other symptoms, the disease lasting from 6 to 11 days. The right lung was in volved in 60 per cent., the left in 24 per cent., of the eases; both lungs in 16 per cent. In 12 the apex was involved, but in these no cerebral symptoms were present. The initial chill was absent in 14 per cent. of cases occurring in adults. In three cases in old subjects the tem perature remained low, never rising above 100.1°. In 3 cases sudden death occurred, probably due to the action of the toxins upon the heart. Leucocytosis was found in 22 of 30 cases, a marked increase occurring immediately before the crisis; in the cases examined within thirty-six hours after the crisis there was no further evidence of leueocytosis. Elsner (Med. News, Jan. 8, '98).