PNEUMONIA. 67 



It has been asserted that the upper pulmonary lobes are scarcely 

 ever attacked with inflammation. This statement is not correct ; 

 those lobes are often affected, but not so frequently as the lower lobes. 

 Morgagni, Frank, and Broussais, who draw their conclusions from 

 dissections, state that the upper lobes are most frequently the seat of 

 Jnflammation ; Laennec and Andral, on the other hand, who included 

 cases of recovery in their calculation, found the lower lobes to be 

 most commonly inflamed. This discrepancy may be reconciled, as 

 Dr. Williams observes, by assigning as the cause of it the fact, that 

 injiammatio7i of the upper lobes is the most frequently fatal. 



The disease, as it generally occurs, presents the following cha- 

 racteristic symptoms : — pain, more or less marked, in one of the 

 sides of the chest ; dyspnoea, viscid and bloody sputa, dull sound, 

 and modification of the respiratory murmur. The patient lies on 

 the back ; the pulse accelerated, but variable in its character ; the 

 fever is generally of the inflammatory kind, but is occasionally 

 typhoid. 



Of the pain, — The pain is generally on the level of, or a little 

 below, either breast ; more rarely it is seated either below the cla- 

 vicles or entirely at the lower part of the ribs, and even in the hypo- 

 chondria, or, in fine, over all the extent of the thoracic parietes of one 

 side. In some cases it precedes, by several days, the appearance of 

 the other symptoms ; being then neither accompanied by fever, 

 cough, nor dyspnoea, it simulates a pleurodynia, or simple rheumatic 

 pain. The pain is increased by coughing, by the movements of in- 

 spiration, sudden changes of position, and intercostal pressure and 

 percussion ; it is principally exasperated by lying on the side on 

 which it exists. M. Andral says, " In all patients who presented this 

 pain to us, we found the pleura inflamed, and covered with membra- 

 niform albuminous exudations." 



Of the dyspnoea. — The dyspnoea, in pneumonia, is generally in 

 the direct ratio of the extent of the inflammation, of its seat, and of 

 its intensity in each of the points which it occupies. To this rule, 

 however, many exceptions occur ; for, owing to some peculiar idio- 

 syncrasy, there are some individuals a very small portion of whose 

 lung is in the first stage of inflammation, and whose respiration is 

 nevertheless much embarrassed ;. there are others, on the contrary, 

 in whom a much more extensive inflammation of the lung in the 

 second or third stage exists, and yet the dyspnoea is compara- 

 tively slight. It appears, cseteris paribus, that inflammation of the 

 upper lobe gives rise to greater dyspnoea than an equally extensive 

 and equally advanced inflammation of the lower lobes. 



The dyspnoea in pneumonia presents > various grades or degrees. 

 In the mildest form, the patients are not aware of its existence ; in 

 a greater degree still, the patient may not feel any oppression, but 

 the inspiratory movements are short and frequent ; in a still higher 



