The sweating which usually takes place at the tinie of the crisis is usually less severe than in adults, though sometimes causing severe sudamina of the trunk, often followed by mild desquamation.
Otitis media is a rather frequent complication, and often assist, in the presentation of the picture of a cerebral pneumonia. It readily leads to suppuration and perforation of the tympanic membrane. ing a grippe epidemic it is very apt to complicate croupous pneumonia.
Purulent osteomyelitis and arthritis (Hagenbach-Burekhardt and their pupils Meyer and Pfisterer) develop not very infrequently as true metas tases in connection with croupous pneumonia, usually during the first two weeks, and are more apt to affect young infants, frequently, in addi tion to a purulent pleuritis. Most frequently, the larger joints (shoul der, knee) are affected. Abscesses in the skin are frequent. The course of these affections, which contain the pneumocoecus in pure culture, is relatively benign and recovery often takes place after simple incision. Analogous purulent metastases also often develop from a primary pneumococcus Temperature Curve and typical cases of croupous pneumonia in children, the temperature is high and continuous from the beginning. It ranges from 39.5-40° C. (103°-104° If.), increases towards the end of the week, and, between the fifth and ninth day of the disease (see Fig. 83), drops within 12-24 hours to normal or somewhat below (crisis). Ziemssen found the beginning of the crisis to occur mostly in the second half of the seventh day, or occasionally on the fifth day, less often on the third, ninth, eleventh day, seldoni on days of even numbers.
A remission often occurs on the fifth day, less often on the third. With relative frequency, a rapid decline of the temperature to as low as normal may occur the day preceding the crisis (pseudo-crisis). This Baginsky has designated as pro-critical decline (see Fig. 84). Following the crisis the temperature frequently remains subnormal for several days, and may show one or two evening exacerbations.
From this typical temperature curve there are many departures. The duration of the fever may in exceptional eases last only one or two days. At times it may extend over a period of 12-14 days, or even as long as three weeks, in which case either an upper lobe is usually involved, or it is due to an involvement of another lobe. Pneumonia affecting the
upper lobe is frequently characterized by an excessively high tempera ture. In younger children the course of the temperature is often com paratively reinittent or intermittent, most frequently in pneumonia of the lou-er lobe. Not so very infrequently, a seeming crisis is followed by a moderate or high elevation of temperature lasting several days, after which the definite crisis takes place. In a nurnber of eases the fall of the temperature occurs by lysis (12 per cent. Schlesinger). But the decline by lysis is often suspicious of pleuritis as a complication.
Seat of the Pneumonia and Peculiarities of Course.—Croup ous pneumonia often affects a lobe in its entire extent. Frequently, however, it involves only a portion of the same, and permits other parts (especially the anterior) to remain free. At times it extends to one or two lobes of one or both sides.lore frequently than in adults, pneumonia is limited to a single central area, According to three extensive statistics (1-tilliet and Barthez, Baginsky,Comby) each embracing more than 300 cases, there is a remarkable coincidence in regard to the localization and participation of the individual lobes. The upper lobes are affected as frequently as the lower. Most frequently affected are the right upper lobe and the left lower lobe,—the right upper lobe at least twice as often as the right lower lobe. Quite frequently also the middle lobe is affected; not uncommonly both lungs ure involved. During the first years of life, the upper lobes are more often attacked. Before the crisis takes place in the one lobe, the inflammation at times extends to another lobe, and from here sometimes to a third lobe by which the disease may be pro longed by fourteen days or even longer. Such migratory- pneumozdas are not uncommonly observed in grippe. One readily falls into the error of assuming that a migratory pneumonia is present whenever a pneumonia attacks two lobes simultaneously, which however is not apparent in both situations at the same time. Croupous pneumonia complicating grippe, often several days after the disappearance of fever, coryza, and bronchitis, has the peculiarity that it is very apt to appear as an apical pneumonia, producing a varying temperature which usually drops by lysis to the normal in two or three days (see Figs. 85-.S6).