180 DISEASES OF THE PARENCHYMA OF THE LUNG. 



resemblance to typhus than to pneumonia of vigorous adults, Mid hav 

 ing neglected to make a physical exploration of the chest. 



Asthenic fever may also develop, sometimes, in subjects previously 

 healthy and vigorous, where pneumonia is complicated with acute 

 gastric or intestinal catarrh. True, such cases, which are not rare, 

 differ from the pneumonia of old persons, inasmuch as the pain, cough, 

 and characteristic sputa are not at first absent ; but the depressing effect 

 of the complication as well as the fever, which is usually of great inten- 

 sity, soon result in an extreme prostration and in other symptoms, which 

 create the terrifying impression upon the minds of the laity that the 

 malady has become " typhoid" ("nervous"), or " that a nervous fever 

 has set in " The disease is further disguised, and the diagnosis ren- 

 dered doubly obscure, by the thickly-coated tonge, which afterward often 

 becomes incrusted with black scabs, by the distended abdomen and 

 by the watery discharges from the bowels, and if the intestinal catarrh 

 have also involved the ductus choledochus by the jaundiced hue of 

 the skin, and sclerotica. Here, too, physical examination is our sole 

 safeguard against error and mortifying post-mortem disclosures. Pneu- 

 monia is apt to assume very peculiar characteristics when it attacks per- 

 sons of intemperate habits. The beginning of the attack seems rather 

 to be a fit of delirium tremens, and the symptoms of perverted cerebral 

 action are so prominent that the pulmonary affection is liable to escape 

 notice. The patient can hardly be kept in bed ; he is exceedingly 

 loquacious, does not complain, but declares that he is perfectly well. He 

 is in a most cheerful humor, and his delirium and illusions are of that 

 peculiar kind which is almost pathognomonic of delirium tremens. He 

 sees small animals, especially mice and beetles, picks with great industry 

 and persistance at his bed-clothes, or executes all the manipulations of 

 his avocation in pantomime. Even though a patient in this condition 

 have no cough, no expectoration, and complain of no pain, yet his chest 

 should be explored with great care, especially if he have fever. Many 

 a patient has died in a strait-jacket with a diagnosis 01' delirium tre- 

 mens, whose real disease has been pneumonia. At a later period the 

 scene changes. It is a well-known fact that drinkers are equally inca- 

 pable, or even still less capable, of bearing an increase of calorification 

 and an augmentation of their animal heat than aged or debilitated per- 

 sons, and that a fever of very moderate intensity and brief duration 

 exercises an exceedingly depressing and exhausting influence upon the 

 vigor of the heart, the action of the brain, and upon all other functions. 

 In a very few days the pulse, originally full, grows small and weak, 

 the extreme excitement and bustling demeanor give place to a deep 

 apathy, and to rapidly-increasing somnolence, the skin is bathed 

 iii sweat (from incipient palsy of the cutaneous muscles), gurgling 



