Syiiiiitonis. 



183 



croupous pneumonia, or lobular bronclio-pneumonia, but the 

 definite differentiation of these forms is only in rare cases 

 possible because the latter also has a very aciite development 

 and a rapid extension. 



In some cases the pneumonia develops in a manner similar 

 to genuine croupous pneumonia (see Fig. 36). Accordingly 

 the sjanptoms consist of difficult, costal-abdominal breathing*^; 

 first a tympanic, later a dull sound on percussion over the lower 

 parts of one or both sides of the thorax, which later changes 

 into a tympanic and finally into a normal sound. On asculta- 

 tion rales may be heard, later bronchial breathing or the ab- 

 sence of any respiratory sound. This may be again followed 



Fig. 36. Fever curve in ^icctoral influenza. Type of the croupous pneumonia: 



recovery. 



by moist rales. In numerous cases there is a saffron, or rust- 

 colored nasal discharge (for detailed information see Vol. 2, 

 Chapter IV). On the other hand, if the affection of the lungs 

 develops as a lobular pneumonia the symptoms of hepatization 

 (dullness, bronchial breathing), may be entirely absent, or they 

 may be established only over small irregular areas, so that 

 the existence of pneumonia is suggested only by the marked 

 respiratory difficulties, the high fever and possibly the rust- 

 colored nasal discharge. 



The pleurisy which frequently develops in association with 

 the pneumonia is manifested by a sensitiveness of the thorax, 

 and also by superficial abdominal breathing, later by double 



