Acute Congestion of the Lungs. PulmoJiary Hypercemia. 201 



a mucous rale, or when ligemorrhage has supervened by a loud 

 rattling. Percussion shows a lack of resonance over the whole 

 lung, not so flat and definitely circumscribed as in pneumonia but 

 a partial flatness of sound over the v^'hole chest. In pneumonia a 

 limited area of lung is absolutely solidified (hepatized) while the 

 remaining lung is practically normal, whereas in acute congestion 

 often the whole lung is gorged with blood but for some time no 

 part of it is entirely divested of air. 



Another marked feature is the maintenance at first of the nor- 

 mal temperature with only a slight rise of about 1°. This serves 

 to distinguish congestion of the lungs from sunstroke (heat anhge- 

 matosis) in which the temperature usually rises to 108° or 110° F. 

 or higher. The temperature rises however as the disease advances 

 and merges into pneumonia. Another distinguishing feature 

 from sunstroke is the early pallor of the mucous membranes which 

 in heat apoplexy are strongly congested. In congestion they be- 

 come dark red only with the advance of the disease and the ad- 

 vent of asphyxia. These features serve also to distinguish acute 

 pulmonary congestion from contagious fevers, pneumonia and 

 other inflammations of internal organs. 



Course. Termination. The more acute (fulminant) forms are 

 promptly fatal. In the exhausted system the lungs have become 

 uniformly gorged with blood, which can no longer be forced 

 through the capillaries by the right heart, the heart in turn is 

 overdistended with blood and ceases to beat and death ensues in a 

 few minutes. 



In the less acute cases the patient survives twenty-four hours 

 and upward, the whole lung not being equally implicated but only 

 certain lobules, usually the lower, or the congestion, if uniform in 

 all the lung, being less extreme. 



In favorable cases recovery takes place in one or two days. 

 There is a return of life and appetite, a gradual improvement in 

 pulse and breathing, the respirations becoming deeper and longer, 

 and in a few hours all the more violent symptoms may have dis- 

 appeared. With a more gradual improvement recovery may still 

 be complete in four or five days. 



Lesions. When the subject has died suddenly the appearances 

 are essentially those of uniform engorgement of the pulmonary 

 capillaries with blood. The general aspect is a dark red, varying 



