CONTA(;iOUS PNEUMONIA. 19I 



limp. Some, however, appear much less depressed, and in entire 

 horses erections occasionally occur. 



During the period of hepatisation most of the preceding symptoms 

 subside. Respiration, however, becomes more and more rapid, is 

 painful, difficult, and sometimes moaning; when pleurisy occurs as a 

 complication, inspiration and expiration are separated by a distinct 

 pause. The cough and discharge usually disappear. In one of our 

 patients I noted on three occasions discharge of blood from both 

 nostrils, due undoubtedly to pulmonary haemorrhage ; but this is a rare 

 occurrence. The pulse is very rapid, small and feeble, occasionally 

 irregular or intermittent ; sometimes there is a venous pulse. The 

 temperature usually remains stationary except as regards the afore- 

 mentioned daily oscillations, but it may rise to 41*8° or even to 42° C* 

 (io7'2° F. to io7'6° F.) ; sometimes it is very irregular, and shows varia- 

 tions of 1° to 2° C. within twenty-four hours. After the fourth day 

 pulmonary changes can usually be readily detected, though, as you have 

 seen in one of our cases, they may remain concealed until the fifth day. 

 Some months ago a colleague asked me to examine one of his horses 

 which had been very ill for several days, and which he thought was 

 suffering from endocarditis. On auscultation I certainly detected 

 cardiac disturbance, but I also noted absence of the vesicular murmur 

 on the right side, and slight crepitation at several spots. The diagnosis 

 was clear. Next day there was a tubal murmur; the pneumonia had 

 been in existence for six days. 



Depending on whether pneumonia is lobular or lobar, the signs 

 recognised on auscultation and percussion differ very greatly. In the 

 lobar type the stethoscopic sounds are those of simple pneumonia ; in 

 the lobular the vesicular murmur is at several spots replaced by a 

 crepitant rale ; but if the centres of lobular pneumonia become con- 

 fluent the signs noted are those of extensive hepatisation, a tubal 

 murmur being heard with more or less complete dulness in the lower 

 region of one or both sides. 



At this period, if at all, pleurisy sets in. Its onset is insidious, and 

 it remains unrecognised until exudate becomes abundant. Physical 

 examination then reveals bilateral dulness extending to a varying height, 

 and limited towards the centre of the chest by a horizontal line ; loss of 

 the vesicular murmur over the whole of this region ; existence of a tubal 

 sound ; and disturbance in the respiratory movements of the chest and 

 flank. When these phenomena coincide with diminution in the pneu- 

 monia symptoms, as you saw in one of our last patients, pleurisy is 

 clearly indicated. 



* M. Brun obeerved a rise in temperature to 42' C. in a horse which afterwards re- 

 covered. Professor Cadiot had a similar case where the temperature rose to 41 '9' C. 



