Remarks on the frequency and character of the pneumonias of 1890 : an address delivered before the New York Academy of Medicine, April 17, 1890 / by William Pepper.

Date:
1890
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Licence: Public Domain Mark

Credit: Remarks on the frequency and character of the pneumonias of 1890 : an address delivered before the New York Academy of Medicine, April 17, 1890 / by William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Allusion has already been made to the nervous and cerebral symptoms attending the influenza pneumonia of this past season. I am not aware that the cases of pneumonia which occurred unassociated with influenza presented any marked peculiarities in this respect, but, as should naturally be expected, the pneumonias which occurred during or after influenza proved otherwise. In the first place they were often associated with excep- tionally severe pain about the chest and with pains in different parts of the body. There is much evidence to show that these pains might be considered partly due to general neuritis or perineuritis of varying degrees of intensity. It is not now the time to discuss the question whether this affection of nerve-trunks was of purely in- fectious origin or was due to atmospheric influences acting upon systems relaxed and sensitive to an almost unprecedented degree. It would seem, however, that the view of its infectious origin is strongly supported by many facts. The existence of such neural trouble has been made clear in a number of cases by muscular and sensory sequelae. I refer to it partly in this connection because it has seemed probable to others besides myself that such a condition of the intercostal and respiratory nerves, and possibly of the pneumogastrics themselves, may be invoked to explain not only the chest pains, but the extraordinary weakness of the respiratory murmur noted in so many of our pneumonia cases. Another explanation of this striking phenomenon that has been advanced is the hypothetical enlargement of the bron- chial glands. I do not know anything in direct evidence in support of this view, but merely mention as of interest in connection with the matter that Dr. John Todd, of Pottstown, Pa., reports to me that in the cases of influ- enza occurring in that town there was diffuse enlarge- ment of the lymphatics, even advancing to suppuration. We had no such reports from Philadelphia. The cerebral symptom which attended the pneu-
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