Symptoms.—The attack usually commences with fever, preceded in adults by severe shiver ings, and sometimes in children by an attack of convulsions. The fever is sometimes very high, running to and Within a short time, 24 hours or so, the nature of the disease is in dicated by pain in the chest, rapid, shallow breathing, and cough, at first dry, but after wards attended by a characteristic spit. The pulse is rapid, but not so much quickened as the breathing. The face is flushed, perhaps livid, the skin is dry and hot; the tongue is furred ; appetite is lost ; there is headache; and the urine is scanty and highly coloured. The patient should be made to spit into a dish. What is put up is at first rust-coloured, and so thick and gelatinous that it sticks to the dish and will not fall out though the vessel be turned upside down. This indicates that the disease is in what has been described as the second stage. In a few days the spit becomes more fluid and yellowish. Sometimes, however, there is little spit. Delirium is an occasional symptom, and is rather a serious one if marked. A common symptom is an eruption of watery blisters on the lips. The condition of the lung can be readily ascertained by an examination such as described on p. 358. At the onset of the disease a fine crackling sound is heard, which soon disappears, the usual sound of air entering and leaving the air-cells being no longer heard, and a dull sound being produced by tapping the chest over the affected part, because that part is solid. When the matter begins to be expelled, the return of air is sig nified by the return of the crackling sound, and progress to recovery is indicated by the gradual restoration of the healthy sounds.
Recovery should begin about the fifth or seventh day by a disappearance of the fever. In about a fortnight the disease runs its course, though it may last only a few days or may be much prolonged.
Gangrene is indicated by the spit being fetid.
Treatment. —The person must be strictly confined to bed in a room kept moderately warm, but having a due supply of fresh air. A dose of castor-oil or seidlitz-powder should be given to open the bowels freely, and an ordinary motion should be obtained daily. Light but nourishing diet is to be adminis tered, milk, beef-tea, &c., and water to quench thirst should not be denied. Occasional large poultices to the affected side, or flannel cloths sprinkled with turpentine, and covered with thick folds of warm flannel, will help to relieve the pain and difficulty of breathing. This is the kind of treatment, and in ordinary cases is sufficient with careful and attentive nursing. The acetate of ammonia mixture may be given (PRESCRIPTIONS—FEVER MIXTURES). In CAMS of exhaustion or weakening of the heart, stimu lants are required, the carbonate of ammonia and senega mixture (STIMULANT MIXTURES), or wine, brandy, or whisky. These are not to be given without occasion. The disease, however, is so serious a one, and the details of treatment depend so much upon the individual affected, that no delay should be permitted in summon ing a physician.
During recovery nourishing food, eggs, ani mal food, &c., are required, and quinine and iron tonic, cod-liver oil, &c., are advisable. For some time after the attack the person ought to exercise great care, since the lung cannot be supposed to recover its ordinary condition for a very considerable time after all signs of dis ease have disappeared.
Chronic Pneumonia (Fibroid Phthisis (con sumption)—Cirrhoth) consists in a growth of fibrous tissue round the bronchial tubes and air-cells, gradually encroaching on them till the lung tissue is converted into dense, hard material. This newly-formed material in time shrinks, and in this way still further destroys the lung substance. It may also in parts break down, and cavities are thus formed.
Its causes are occasionally preceding acute pneumonia, bronchitis, &c. Inhalation of solid particles, such as miners, mill-stone grinders, colliers, flax-dressers, knife-grinders, stone cutters are exposed to, may also produce it. It is thus known as knife-grinder's consump tion, stone-cutter's consumption, &c.
The symptoms are chiefly gradually increas ing weakness, loss of flesh, more or less diffi culty of breathing, and cough, with or without spit, which is often considerable, however. Sometimes spitting of blood occurs, and dropsy arises from the weakened condition of the heart which the disease produces.
The disease may be prolonged for many years.
Treatment consists in good food, fresh air, removal to a warm and equable climate, and tonics, such as quinine and iron, cod-liver oil, &c.
Congestion of the Lungs is a term in very common use, being often employed where in reality inflammation of bronchial tubes or air cells is present. Of course congestion is always present in inflammation, the vessels being en gorged or congested with blood before the proper features of inflammation have deve loped. Doubtless in some cases the state of congestion passes off without actual inflamma tion being developed. But a state of conges tion independent of actual inflammation does occur, specially in diseases of the heart and during the progress of fevers. Thus where there is valve disease (p. 319) of the left side of the heart, in particular mitral-valve disease, the blood does not pass onwards into the arteries with due rapidity, and becomes blocked in the auricles. The overfull condition passes back wards along the pulmonary veins (p. 302) till the lungs are reached, and there the vessels in turn become overfull, so that the pulmonary blood-vessels are engorged. Fluid escapes from them and pervades the lung tissue, which be comes dark, empty of air, and dropsical. This is apt to lead to active inflammation or to gan grene (death) of parts of the lung. Blood vessels may burst and bleeding occur, the blood being partly expelled by the mouth, and partly poured out among the lung tissue, forming pulmonary apoplexy. Such congestion is not active but passive, the blood simply collects because it cannot pass onwards. In fevers, especially exhausting fevers like typhoid, the heart shares in the general weakness, and may become unable to propel the blood with suffi cient vigour, so that congestion arises through enfeebled circulation. Old persons, or persons of weak condition of body, if kept lying in bed on the back for any length of time, as for example with a broken leg, &c., are liable to congestion, simply because the weight of the lung itself, with the person in the recumbent position, prevents due circulation. Such per sons ought to be propped up occasionally to avoid this.