CROUPOUS PNEUMONIA. 177 



nution of the chlorides, as well as the appearance of biliary pigment in 

 the urine, are simply due to the improper quality of the matter conveyed 

 to the kidneys for the production of urea. The appearance of albumen 

 in the urine, which not unfrequently occurs in severe pneumonia, is de- 

 pendent upon other causes. Its presence is sometimes occasioned by 

 engorgement of the emulgent veins. As is well known, albuminuria 

 may be produced artificially in the lower animals by ligation of these 

 veins. The chief source of the albuminuria of heart-disease is obstruc- 

 tion of the venous circulation of the kidney. The presence of albumen 

 in the urine of pneumonia, however, is only to be ascribed to such a 

 cause when it is accompanied by cyanosis, enlargement of the liver, and 

 other evidence of intense venous engorgement of the greater circula- 

 tion. In most cases its source is in the parenchymatous degeneration 

 of the kidneys, of which we shall speak more fully in our second volume, 

 and which consists in a swelling and opacity and molecular destruction of 

 the renal epithelium. This parenchymatous degeneration of the kidney, 

 with its consequent albuminuria, occurs in a great variety of febrile dis- 

 orders, and is apparently a result of excessive elevation of the tempera- 

 ture of the body, or febrile crasis. The more intense the fever, so much 

 the more probably will albumen be found in the urine of pneumonia 

 patients, although there may be scarcely any sign of venous engorge- 

 ment of the systemic circulation. The skin, which, at the commence- 

 ment of the attack, usually is dry and parched, after a day or two often 

 becomes moist, and even bathed in sweat, without, however, affording 

 any material relief to the patient. 



Hitherto we have been describing the stadium inerementi, the form- 

 ing stage of the disease. Its transition into the stadium decrement^ or 

 stage of decline, is not gradual, but takes place with a suddenness with- 

 out parallel in any other disorder. 



In former editions of my book I have asserted with great positive- 

 ness that the crisis of a pneumonia almost constantly arrived either on 

 the fifth, seventh, or, in rare instances, upon the third day, and I believed 

 this assertion to be warranted by the results of a large number of ob- 

 servations. Meanwhile I have become satisfied that the ancient doctrine , 

 that the crisis of pneumonia always occurred on the odd days, is unten 

 able, in spite of the high modern authorities who have pronounced ir 

 favor of its correctness. If, in calculating the duration of the disease 

 we take accurate notice of the hour at which the initiatory chill began, 

 and of that in which the decline of the fever commenced, it will be seen 

 that the critical period of pneumonia takes place quite as often upon 

 the even days as upon the odd ones. For instance, a pneumonia, which 

 begins by a chill on Monday at noon, culminates, no doubt, in many 

 cases, in course of the following Sunday ; but the crisis occurs quite as 

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