Relapses in pneumonia are of rare occurrence. A fresh pneumonia sets in one or more days after the crisis has taken place.
An abortive type of pneumonia is spoken of whenever the disease sets in like an ordinary pneumonia. but in which the temperature be gins to drop on the fifth day, an event which occurs more frequently in children than in adults. A duration of only two or three days is not at all uncommonly observed. Even cases of only one or two days' dura tion have been definitely established. debarring eases in which death occurred as early as the first clay (v. Dusch). I, myself, have seen a pneu monia lasting only one day in a seven-year-old girl, in which the diag nosis was confirmed by the rusty colored sputum brought to light by vomiting. In cases where the crisis takes place after only a few days, the signs of consolidation often appear only later, and may last for clays. In contradistinction thereto are the remarkable cases observed by Henoch in which the physical signs in the lungs had already- disappeared before the crisis. The abortive pneumonias permit the conclusion that the process of inflammation may come to a standstill at any stage of the disease, even at the stage of engorgement. The cases of pulmonary congestion described by C'adet de Cassicourt arc probably abortive forms of pneumonia.
A type of pneumonia frequently seen in children, and described by Hi!het and Barthez as cerebral pneumonia, is characterized by marked cerebral symptoms at the beginning or during the subsequent course of the disease. An eclamptic and a ineningeal form are distinguished. The eclamptic form is chiefly seen in children during the first two years of life. General convulsive seizures occur not onlv as initial symptoms, but iire also common during the subsequent course of the disease. Spasm of the muscles at the back of the neck, apathy, and somnolence, are usual accompaniments. The meningeal form is more apt to appear in children from three to seven years with headache, violent vomiting, stupor and coma, rigidity of the neck, delirium, and hyperxsthesia of the skin. The pulse is not slowed, nor are the pupils dilated. Such cases are more apt to mislead one into accepting the presence of a gen uine cerebral affection, for the reason that these symptoms are produced by a central pneumonia, the evidences of which become manifest only towards the crisis. According to Schlesinger, cerebral pneumonia is
seen just as frequently in pneumonia of the lower lobe as in apical pneu monia; while according to the statements of most authors it is found mostly in apical pneumonia. As a rule, the prognosis is good, but the course is apt to be severe. Otitis media is relatively- frequent in these cases, and probably is partly also responsible for the cerebral manifesta tions. Furthermore, a gastric and a typhoid pneumonia have been dis tinguished. But the distinction is of little value, ancl simply goes to show that the pulmonic symptoms in children frequently step into the background and are followed by those from the stomach or general symptoms, in this way dominating the clinical picture.
In this connection, splenie pneumonia, also called massive pneu monia, may be mentioned for &agnostic reasons. It was first described by Grancher in 1883. Until the present time it has received considera tion only in French literature. I, myself, am lacking in personal ex perience regarding this peculiar disease, which is characterized by the fact that it presents a form of acute inflammation of the lungs, but bears the marks of an exudative pleurisy'. According to Queyrat the disease occurs not uncommonly in children, mostly in boys, chiefly dur ing tuberculosis and grippe, and usually follows a cold. High tempera ture, moderate dyspncea, and violent cough without expectoration even in older children, rapidly set in. Absolute flatness is found mostly at the lower portion of the left lung, with disappearance of vocal fremitus, marked bronchial breathing, and fegophony, symptoms which, there fore, point to pleurisy with effusion. In favor of this view also is the frequent disappearance of the apex beat. But symptoms against pleu risy are fine crepitant rftles, exemption of Traube's space, and absence of displacement of the sternum to the affected side. The pulmonic symptoms disappear very- gradually, only after 8 or 10 or even after 15 day's. The disease almost always terminates in recovery. As long as no definite etiological and anatomical findings are submitted in this remark able disease it must be accepted with a certain amount of skepticism.