CROUPOUS PNEUMONIA. 1ft 



This rigor is important both in a diagnostic and hi a prognostic 

 point of view. In no other affections, excepting intermittent fever 

 and septicaemia, do we encounter chills of equal violence ; and in the 

 latter disorders the paroxysms are repeated, while the rigor which 

 ushers in pneumonia is almost always the only one throughout the 

 entire course of the illness. It is from this chill that we calculate, in 

 counting the duration of the disease. In children, convulsions often 

 occur instead of a chill. 



The elevation of temperature, which rises to 103 or 105 Fahren- 

 heit (rarely higher), even on the first day, is accompanied by accelera- 

 tion of the pulse, and by increase of thirst. The countenance is red ; 

 the patient complains of pain in the back and loins, and of a distressing 

 soreness of the limbs. There is great prostration and muscular debility. 

 The tongue is coated, and the appetite entirely gone ; occasionally there 

 is vomiting. As these symptoms often precede the local manifestations 

 by one and even two days, they used formerly to be attributed by many 

 to the accumulation of fibrin in the blood (hyperinosis). Some have 

 even gone so far as to ascribe a critical significance to pneumonia (Dietl), 

 and to declare that the disorder only disappeared after the elimination 

 of the superfluous fibrin from the blood. All these symptoms, however, 

 appertain to the fever, and are more or less pronounced in all febrile 

 diseases, whether the fibrin of the blood be increased or diminished in 

 quantity, or whether its quantity remain unchanged. We need not 

 demonstrate more fully, that every fever, by increasing the rate of trans- 

 formation and consumption of the tissues, must thereby alter the com- 

 position of the blood, and that the products of the interchange of ma- 

 terials are mingled with the blood in greater quantity. This febrile 

 crasis and the elevated temperature of the blood sufficiently account for 

 the perversions of nutrition and function, which take place in febrile 

 affections constitutional disturbance of fever. 



Although fever and derangement of the general health are of earlier 

 occurrence than the symptoms of nutritive derangement which the lung 

 has suffered, yet we may often observe the same thing in febrile catarrhs 

 and other inflammatory fevers. We may assume in such cases that the 

 inflammatory disturbances of nutrition commence quite as soon, at least, 

 as the fever, but that for a while they do not betray themselves by 

 causing pain, cough, or dyspnoea, but remain latent. In other instances, 

 symptoms of functional disturbance appear in the lung either simulta- 

 neously with the chill or immediately afterward. 



The first of these is shortness of breath, a constant accompaniment 

 of pneumonia. Assuming the normal rate of breathing of adults to be 

 twelve, sixteen, or twenty breaths a minute, we see it augmented in 

 pneumonia to forty and even fifty breaths, and find it to attain a still 



