CONTAGIOUS PNEUMONIA. 1 93 



tions are at first violent and palpitating, afterwards becoming more and 

 more feeble in proportion as the muscular fibres are rnore numerously 

 affected with fatty degeneration. Intermittency is often observed. On 

 auscultation a doubling, rolling, or prolonged first sound may be heard, 

 or in exceptional cases a trifling systolic or diastolic murmur. The 

 pulse is irregular, intermittent, and almost imperceptible. 



Like the heart muscle, the endocardium ma}- be injuriously affected 

 b}- microbes suspended in the blood, or b}- toxins emanating from the 

 pulmonary centres. Sometimes endocarditis accompanies myocarditis, 

 sometimes it develops singly. It usually affects the mitral or aortic 

 valves, and is generally accompanied by stethoscopic signs permitting 

 of diagnosis. But too often during an attack of pneumonia the state 

 of the heart is neglected, and this complication altogether escapes notice, 

 being only recognised long afterwards when the valvular insufficiency 

 produced by contraction of the injured valves, or by vegetations deve- 

 loped near their free borders causes gra\e functional disturbance. 



Exudative inflammation of the pericardium is much rarer than that 

 of the endocardium. Its presence is indicated by the usual signs. 

 When trifling in quantity the exudate is only discovered on post-mortem 

 examination, but \\hen abundant it ma}- be recognised b}- the increased 

 area of precordial dulness and by the diminution or absence of the 

 cardiac sounds. 



Nephritis is another fairly common complication, marked by colic, 

 restlessness, difficulty in moving the hind limbs, and sometimes by 

 hematuria. The urine contains red blood-corpuscles and renal casts 

 in which microbes may be detected. When double, nephritis usually 

 kills rapidly, though in occasional instances death is long deferred. 



Enteritis first produces dull colicky pains, which gradually become 

 more severe and are accompanied by diarrhoea, sometimes b}- blood- 

 stained evacuations. 



Meningo-encephalitis is rare. It gives rise to excessive excitement, 

 convulsions, and epileptiform attacks, which may or may not alternate 

 with periods of coma, and usually proves fatal in a few days. You saw 

 this complication in a patient which died rapidly from bulbar haemor- 

 rhage. 



Meningo-myelitis and various forms of toxic paralysis may be seen 

 affecting among other structures the recurrent and sciatic nerves, the 

 bladder, rectum, and penis. The most frequent is paralysis of the 

 penis ; it almost always appears during the period of resolution ; in a 

 few da}-s the organ ma}- become greatly swollen and entirely beyond 

 control. 



Contagious pneumonia, like the abdominal form of influenza, is 



N 



