178 DISEASES OF THE PARENCHYMA OF THE LUNG. 



often during the forenoon (hence during the sixth day) as in the after- 

 noon or seventh day. 



The symptoms continue with constant or increasing intensity until 

 the critical day, which generally arrives toward the end, less commonly 

 about the middle, of the first week of the disease ; and while the con- 

 dition of the patient, from the dyspnoea, the thirst, and the intense con- 

 stitutional disorder, is beginning to awaken an earnest solicitude, a 

 striking change takes place, often within a few hours. The temperature 

 and the frequence of the pulse often sink rapidly, the dyspnoea abates, 

 the patient feels easier and more free. In course of twenty-four hours 

 convalescence is often fully established. The patient sleeps, calls for 

 food, and merely complains of extreme debility. -From this time the 

 recovery of many patients progresses steadily. The temperature not 

 unfrequently falls below the normal standard, and I repeatedly have 

 seen the pulse sink to forty beats a minute, although the patient had 

 not taken a grain of digitalis. The blood disappears from the expecto- 

 ration, sometimes gradually, sometimes with suddenness. The sputa 

 become somewhat more copious, but generally to so slight a degree that 

 we are compelled to suppose that the greater parts of the exudation 

 must be absorbed, and that but little of it is expectorated. The tena- 

 city and transparence of the sputum disappear with the blood ; it 

 becomes yellowish sputa cocta. The yellowness depends upon an 

 admixture of young cells, which show more or less trace of fatty 

 metamorphosis. Besides slightly granular pus-corpuscles, cells filled 

 with oil-globules, fat granule-cells, and collections of granules and of 

 free oil-molecules, and black pigment-cells in greater or less numbers, 

 are found in the expectoration. Although reabsorption commences very 

 soon after exudation is complete, yet a considerable period of time usu- 

 ally elapses before auscultation and percussion show that the pneumon- 

 ic infiltration has disappeared. Yet, as the smallest particles of pneu- 

 monic exudation are enclosed in their own net-work of capillaries, the 

 conditions for their reabsorption are more favorable than for the absorp- 

 tion of a pleuritic effusion with but one capillary surface opposed to it. 



In subjects previously healthy, the course of the vast majority of 

 pneumonias is as above described. Indeed, with the exception of the 

 infectious diseases, there are few maladies whose average course is so 

 remarkably uniform. That we should not, until recently, have perceived 

 its evidently cyclical character, is owing to the active manner in which 

 we used formerly to attack the disease whereby its typical course be- 

 came deranged, One must bear in mind that not very long ago it 

 would have been thought a crime to treat a pneumonia without blood- 

 letting, and even without repeated venesection. 9 



In some cases the crisis does not occur at the end of the first week. 



