CROUPOUS PNEUMONIA 173 



cases, a peculiar sputum, pathognomonic of the malady, begins to be 

 ejected at an early period. This sputum corresponds essentially to the 

 viscid adhesive fluid which, as we have seen, appears in the air-cells 

 during the period of engorgement. Like that liquid, it almost always 

 contains blood, as pneumonic exudation is almost always attended by 

 rupture of capillaries and extravasation of their contents. The pneu- 

 monia of old people alone forms an exception to this rule. In these, 

 the exudation is often a non-hsemorrhagic one, and the hepatization is 

 not red, but yellow, immediately upon its establishment. At the com- 

 mencement of the attack, the pneumonic sputa are so tough and adhesive 

 that it is difficult to remove them from the mouth, and they are usually 

 wiped away with a cloth. They cling so firmly to the receptacle, that 

 the latter can often be inverted without spilling its contents. The 

 blood which they contain is more intimately mixed than it ever is with 

 bronchial mucus. Their color, which always corresponds to the amount 

 of blood commingled, may be light red, rusty, brick-red, or reddish 

 brown. Microscopic examination usually shows great numbers of intact 

 blood-corpuscles, easily recognizable by their form and color, besides a 

 small number of young cells, and sometimes a few pigment cells from 

 the pulmonary vesicles. Chemical examination shows the existence of 

 albumen, which coagulates upon the addition of nitric acid; and of 

 mucin, which coagulates upon addition of dilute acetic acid, and forms a 

 cloud of mucus upon the surface of the diluted sputa. The fibrinous 

 plugs from the vesicles are not expelled ; but, upon the entrance of the 

 pneumonia into its second stage, small, apparently structureless, lumps 

 are found in the expectoration, which are susceptible of being disentan- 

 gled, and by the employment of a low magnifying power may be recog- 

 nized as repeatedly bifurcated and ramifying coagula. These are fibrin- 

 ous casts of the minuter bronchi. 



While, as a rule, all these symptoms of pneumonia mature until the 

 second day of the disease, when physical examination of the chest leaves 

 no further doubt as to its nature, the fever and constitutional symptoms 

 continue to increase. 



According to the careful researches of Thomas^ of Leipsic, the fever 

 is never a continued fever, but is remittent or subremittent, that is to 

 say, the daily fluctuation in its exacerbations and remissions may be 

 considerable, amounting to 0.75 F. to 1.80 F., or else they may be 

 slight, not exceeding 0.4 F. to 0.5 F. The temperature is at its lowest 

 during the early morning hours, the exacerbation usually beginning in 

 the course of the forenoon, attaining its height usually in the afternoon, 

 when, in bad cases, it may rise as high as 105.8 to 107.7 F. In 

 most cases, a day or two before the occurrence of the crisis, the remis- 

 sion increases. On the other hand, immediately before the fever sub- 



