192 CLINICAL VETKRINARV MEDICINK AND SURCERV. 



Resolution, anncninced by improvement in the general symptoms, 

 by return of appetite, sinking of temperature, polyuria, and sometimes 

 by the appearance in different parts of the bod}' of " critical abscesses," 

 usually occurs a little later and rather more slowly than in simple 

 pneumonia. As in the latter, the crepitant rale returns in the hepatised 

 regions, and is ever}where gradually replaced b}- the vesicular murmur. 

 For some days the patients have a loose paroxysmal cough, and muco- 

 purulent discharge from both nostrils. Under suitable hygienic con- 

 ditions relapses are rare. 



A serious and unfortunately somewhat frequent termination is gan- 

 grene, produced by tissue-destroying toxins elaborated b}- the pneumo- 

 bacteria alone or in association with other organisms. Gangrene is, 

 therefore, either mono- or poly-microbic. The general symptoms then 

 become still more aggravated, appetite is entirel}- lost, the heart beats 

 tumultuously, the pulse becomes ver}- feeble or is e\en lost, the tempe- 

 rature remains high, but with sudden oscillations, and a greyish stinking 

 discharge sometimes containing fragments of necrotic tissue runs from 

 the nostrils. On auscultation various sounds are heard : tubal murmurs, 

 crepitation, gurgling, amphoric, or cavernous sounds, and sibilant rales. 

 At certain points the percussion sound is dull, at others tympanitic ; 

 sometimes the bruit de pot fclc ("cracked-pot sound") is well marked. 

 As the gangrene and consequent septic intoxication progress, the general 

 symptoms become more and more alarming. Rigors, trembling fits, 

 and sweating occur; the extremities and skin become cold, weakness is 

 extreme, and the face ver}- anxious. At last the patient falls to the 

 ground exhausted, struggles more or less, and speedily succumbs. 

 Though gangrene is not always fatal, recovery is rare. 



Abscess formation in the lung sometimes occurs as an original com- 

 plication, or accompanies gangrene. It may be suspected, towards the 

 end of the hepatisation period, if, while remaining high, the tempe- 

 rature oscillate markedly and be accompanied by rigors, trembling, 

 sweating, groaning, and great loss of strength. So long as the abscess 

 remains closed, auscultation and percussion give little information ; but 

 if one break into a bronchus a cavernous or gurgling murmur ma}- be 

 detected, while on percussion tympanitic resonance or the " cracked- 

 pot sound " is heard. A more or less foetid purulent discharge escapes 

 from the nostrils. Whilst not invariably fatal, pulmonary suppuration, 

 like gangrene, is extremel}- grave. 



Among extra-pulmonar}- complications myocarditis occupies the 

 chief place. Inflammation of the heart muscle occurs secondarily during 

 the course of infectious pneumonia, and is clinicall}- revealed, as I have 

 told you, b}' disturbance of the heart and pulse. The cardiac contrac- 



