A text-book of the practice of medicine.

Anders, James M. (James Meschter), 1854-1936

Date:: 1913

Credit: A text-book of the practice of medicine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

132/1390 page 124

$[a) Primary Lobar Pneumonia. Acute Pneumonic Phthisis. Physical signs, as a rule, first referable First referable to apex. to base of lung. Usually limited to one lobe or the lower Usually extension from apex to base. segment of one lung. Signs of consolidation, followed by reso- Signs of consolidation, followed by cavity- lution. formation, with large gurgling r^les at apex. Apex of opposite lung not involved. Apex of opposite side generally in- vaded. Prognosis not hopeless. Hopeless. Tuberculous disease of other organs does Often does, not follow as a rule. [h] Typhoid pneumonia must be diagnosed from p)neumo-typ1ioid., and the blood in the two conditions may be of service in the discrimination. Leukocytosis usually exists in pneumonia, and there is hypoleukocytosis in typhoid; but this fact is only of value when there is marked increase or decrease of the leukocytes, since figures about normal may occur in either condition. In pneumo-typhoid, after the end of the first week, hoAvever, undoubted symptoms of typhoid fever arise, and often before this period the Widal test will clear the diagnosis. On the other hand, typhoid pneumonia is characterized especially by great physical prostra- tion, feeble heart-action, and other symptoms of the typhoid state. {e) 3Ieningitis is sometimes mistaken for pneumonia, and particularly when the latter occurs in children. The initial symptom of pneumonia in the very young is often a convulsion ; whereas, though in meningitis this symptom is not uncommon, it is more apt to manifest itself later. When headache occurs in pneumonia it is frontal. It is almost invari- ably complained of in meningitis, but is occipital, and is associated with rigidity of the cervical muscles. Before the occurrence of pressure- symptoms in the latter disease the patient is very restless and m-^rose; his reflexes are exaggerated and there is marked hyperesthesia. The temperature-range is lower, more irregular, and there is no crisis, while the pulse is more variable and often irregular in meningitis. In pneu- monia with latent local symptoms the pulse-respiration ratio is greatly altered and the type of respiration peculiar (vide ante). The important rule, to examine for the physical signs in doubtful cases, must not be neglected, and if the subject be young the apex region in particular. The differential diagnosis between pneumonia and broncho-pneumonia and pleurisy with effusion will be found on pages 558 and 592. Prognosis.—The mortality from pneumonia in hospitals averages about 25 per cent. It is less in private practice—about 15 per cent. The death-rate, however, is greatly modified by the type of the indi- vidual epidemic; hence a precise statement as to the percentage of fatal cases cannot be ventured. Wells collected 22o,730 cases, which gave a mortality of 18.1 per cent. The elements that enter into a correct prognosis are in the main identical with those in other acute infectious diseases, and concern (1) the severity of the type of infection, (2) the presence or absence of complications, and (3) circumstances peculiar to the individual. (1) Severity of the Type of Infection.—In sthenic cases this is shown by (a) the temperature-range, (b) the degree of heart-power, (c) the in- tensity of the nervous symptoms, and to some extent by {d) the size of$

A text-book of the practice of medicine.

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