176 CLINICAL VETEKINARV MEi:)ICINE AND SURCIERV. 



Auscultation of the lower portion of the affected lung re\eals a 

 well-marked moist crepitant rale during inspiration, and immediatel}- 

 after the paroxysms of coughing. At this point partial or almost 

 complete dulness is noted on auscultation ; while in the upper zone, 

 which has undergone no change, the vesicular murmur is increased. 



Hepatisation commences on the fourth or fifth day. The fever 

 persists, the pulse and respiration reach their highest point, at certain 

 moments expiration is sighing ; the pulse is usually strong and full, 

 but sometimes small and soft ; cough is less frequent and discharge 

 disappears, because the exudate collected in the pulmonary alveoli 

 coagulates there. On auscultation over the large bronchi and surround- 

 ing parts one hears during inspiration and expiration, or onl}- during 

 the first part of the latter, an abnormal sound, sometimes strong, 

 sometimes feeble and deep-seated — the tubal murmur. On the 

 diseased side the lower part of the lung is silent, or only abdominal 

 sounds transmitted by the solidified lung are audible ; in the upper 

 healthy part the vesicular sound is increased ; towards the borders of 

 the hepatised zone the crepitant rale often persists. On percussion 

 dulness is complete throughout the entire pulmonary area invaded. 



The constitutional symptoms are usually most marked from the 

 fourth to the sixth day. ^^'hen the disease develops regularl}' and 

 promises a favourable termination, diminution commences from about 

 the seventh day, marking the crisis. The patient is livelier, takes note 

 of its surroundings, shows better appetite, respiration is less rapid and 

 painful, the pulse less frequent, and the temperature falls. The cough 

 returns, or if it has persisted becomes more frequent, and discharge 

 reappears — now usually mucous in character, greyish, sometimes rust}- 

 or streaked with blood. The mouth is cooler, the excretions are 

 moister, occasionally diarrhoea occurs. The urine increases in quantit}', 

 and through it are eliminated certain of the toxic products accumu- 

 lated in the body. In some patients sweating occurs, in others little 

 subcutaneous abscesses, termed critical abscesses, appear in different 

 regions. On auscultation the crepitant rale begins to replace the tubal 

 murmur formerly heard, and gradually advances from above down- 

 wards throughout the entire pulmonary area invaded, being in its turn 

 soon replaced by the vesicular murmur. The percussion dulness 

 simultaneously decreases, and in a few days the sounds again become 

 normal. 



Comparison of a certain number of cases of simple uncomplicated 

 pneumonia shows that in this disease the temperature curve is typical. 

 It steadily rises from the outset, reaches its highest point with con- 

 siderable rapidity, remains for some days with slight morning and 



