PNEUMONIA WITH CENTRAL LESIONS shows some modification of the usual symptomatology. While subjective symp toms may be marked, it will be readily understood that the physical signs are in definite, so that the diagnosis depends mainly upon the former manifestations. Pain, however, is usually absent, as in volvement of the pleura, upon which this symptom usually depends, does not occur. Apical pneumonia, or those cases in which the lesion begins at the apex, is often extremely grave and attended by marked nervous phenomena, particularly delirium. It is to this class of cases that the term cerebral pneumonia is some times applied.
Pneumonia occurs with great fre quency as an intercurrent affection in a large group of chronic diseases, and is thus encountered during the course of chronic nephritis, diabetes, locomotor ataxia, and other chronic diseases of the nervous system. Under these circum stances it frequently constitutes the ultimate cause of death. In chronic pul monary diseases, also,—as chronic tuber culosis and emphysema,—the disease at times occurs, and when associated with the latter affection is often of difficult diagnosis, owing to the indefinite char acter of the physical signs, due to the failure of the inflammatory exudate to completely fill the greatly distended air vesicles, so that complete consolidation of the involved area does not take place.
Three forms of pneumonia have been described in accordance with the dis tribution of the local lesion: (1) migra tory, or wandering, pneumonia, a form in which one lobe after the other is suc cessively invaded; (2) double pneumonia, in which one or more lobes of both lungs are involved, but which otherwise shows no special modification of symptoms; and (3) crossed pneumonia, already referred to as that form in which the lower lobe of one side and the upper lobe of the other are involved.
Bilious pneumonia is that form in which marked jaundice is an associated symptom, and is probably due to a mixed infection.
Diagnosis.—The diagnosis of croupous pneumonia is usually unattended with difficulty. The sudden onset with chill, a temperature-curve corresponding to a more or less distinct type, the character of the sputum, the occurrence of herpes, the physical signs, and the sequence of events in general constitute a clinical picture in typical cases that admits of but little difficulty in diagnosis.
In children up to ten years there is often found an absence of the patellar reflex. It can frequently be elicited be fore auseulation or percussion gives evi dence of the disease. In very young in fants the phenomenon could not be observed; in the other patients it seemed to make no difference where the process was located or how much of the lung was involved. Most children with positive sign were strong and well nourished and were seriously ill with the disease, showing especially cerebral symptoms with the onset, but no varia tion during the course. M. Pfaundler (Miinch. med. Woch., July 22. 1902).