Pneumonia attacks people of all ages ; but affects more men than women.
It is more frequent during winter and spring than in summer and autumn ; and it has occasionally occurred epidemically in some dwellings, towns, prisons, barracks, schools, convents, etc. The disease is largely due to a special form of bacteria—the Pneitmococcus of Weichselbaum ; the Diplococcus pneumonia' of other authors. Colds, which formerly were held responsible for the disease, are now looked upon merely as occasional causes. By injuring the mucous membrane of the lungs they enable the bacteria to enter the tissues, there to begin their harmful activity. Contusions of the chest may also be regarded as occasional contributory causes. Instead of acquiring an immunity by one attack of pneumonia. the disease seems to show a tendency to recur. Some patients may have as many as four or five invasions.
In the treatment of the disease the physician usually restricts himself to combating the particularly annoying disturbances. He endeavours to ameliorate the pain in the sides, to reduce the fever, to lessen the cough, to keep the conditions of excitement (delirium) within moderate hounds, and to further the loosening of the sputum. But his main attention is directed to the heart. The great danger in pneumonia does not come from the lung involvement, hut from the heart. If this organ grows weak and threatens to relax, it must he relieved by proper means, and must be stimulated to a more vigorous activity so that the patient may be able to stand the crisis. This careful watching of the heart is one of the most important tasks of the physician, because his timely interference in case of threatening danger mat- save many patients Nvho otherwise would have succumbed. Such a responsible task, however, requires an exhaustive knowledge of the disease„ of its course, and of the methods of examination ; and this is possessed only by a physician.
Until the fever subsides the diet should consist of plain, pure water, or mineral water, bland soups, and milk which may be stirred with the yolk of an egg or prepared with easily digestible Hours. Preserved fruits, stewed apples, oranges. etc., are also permissible. The prescription of alcoholic stimulants is essential for habitual drinkers, but unnecessary in many other casts. The sick-room must not he too dark, and should he frequently ventilated. Pure, fresh air is of great importance. The fear that ventilation exposes the patient to the danger of catching cold is without foundation. Draught or cold air can become harmful only %Olen the fever has receded and recovery begun. Warmer covers and the placing of a screen in front of the bed during the airing of the room will then afford sufficient protection.
The sputum should be caught in a glass receptacle tilled with a disinfecting solution.
The peculiar course of pneumonia suggests some important practical explanations. It occasionally happens that it is not the nature of the disease nor the constitution of the patient that is held responsible for the steady progress of the affection until the crisis sets in, but the physician. The doctor's inability to " check " the disease arouses unjust criticism, especially in families whose members are disturbed by the agitations of opponents of " old school medicine." And it often happens that during the worst period of the disease (shortly before the crisis) the regular attendant is dis missed, and another called, possibly a " natural healer." If the crisis has taken place in the meanwhile, the new-comer has the satisfaction of having the patient appear as if he were transformed, and free from all danger. The members of the family ascribe this result to the " immediately successful " treatment of the new helper, without considering that the favourable turn had been due to the previous treatment during the anxious and important days preceding the crisis. They thus greatly wrong the physician whose careful supervision and treatment, although unable to check the progress of the disease, enabled the patient to overcome the crisis. The layman should, therefore, beware of erroneous and hasty conclusions.
If the course of the disease be unfavourable, it leads rapidly to a fatal termination. In rare cases suppuration, gangrene, or shrinking of the lungs may supervene. Since a healthy heart is of great importance in the battle with pneumonia, it follows that drunkards, persons with weak hearts, the obese, and the aged are in great danger.
In addition to the classical type of pneumonia, other forms develop in the course of certain diseases, such as typhoid fever, influenza, etc. There is, moreover, a so-called catarrhal variety of pneumonia, which occurs most frequently in children and in the aged, in connection with bronchitis (in measles, whooping-cough, smallpox, and diphtheria). This type, which is called broncho-pnenntonia, does not run as regular a course as ordinary pneumonia. It is of longer duration, lasting several weeks or months, and it does not improve suddenly, but gradually. The sputum, which is usually absent in cases of small children, is never admixed with blood. Treatment consists in warm baths with cool to cold allusions, chest-packs, medicines, and proper food. Bronchopneumonia is a very serious affection in small children.