CROUPOUS PNEUMONIA. 18} 



sounds arise in the chest (from commencing paralysis of the muscles 

 of the bronchi) and the patient dies with the symptoms of oedema of 

 the lung. 



With regard to the termination of pneumonia, we have already seen 

 that recovery is often rapid, where the exudation liquefies, and is reab- 

 sorbed after completion of the stage of hepatization. Complete resto- 

 ration may also take place from the stage of purulent infiltration, only, 

 as the patients are exhausted by weeks of fever, their convalescence is 

 extremely tedious. 



Death, during the first and second stages of pneumonia, usually pro- 

 ceeds from hyperaemia and collateral oedema, by which the uninflamed 

 air-vesicles are rendered incapable of carrying on respiration. Much 

 more rarely it depends upon the excessive extension of the pneumonic 

 infiltration alone. The intense dyspnoea, profuse frothy or liquid sputa, 

 moist rdles in the uninflamed parts of the lung, the sudden sinking of 

 the patient, the drowsiness, the vomiting, the coolness of the skin, arc 

 all signs of insufficient respiration, and of imminent danger of carbonic- 

 acid poisoning. Unless aid be at hand, the symptoms of palsy soon pre- 

 vail, and the patient succumbs under symptoms of oedema of the lung, 

 palsy of the bronchi, and of suffocative effusion. 



A fatal issue, during the stage of red hepatization, resulting from 

 engorgement of the cerebral veins, with consequent effusion, is of far 

 rarer occurrence. Simple blueness of the face need not lead us to fear 

 cerebral congestion ; nor are even the headache and the delirium sufficient 

 to warrant such apprehension, neither do they require the active treat- 

 ment imperatively demanded by that condition. If, however, the pa- 

 tient fall into somnolence which cannot be ascribed to the embarrass- 

 ment of respiration, or if he complain of a sense of formication, or of 

 numbness of his limbs, or should slight convulsions occur, life is un- 

 doubtedly threatened by oedema of the brain, and death may ensue with 

 the symptoms of coma. 



The. third and most usual cause of death, during the stage of red 

 hepatization in pneumonia, is exhaustion. From this cause a compara- 

 tively slight attack of this disorder is extremely dangerous where the pa- 

 tient is old or debilitated, or where he is a drunkard whose nerves are 

 in constant need of stimulus, who trembles until he has his dram, and iu 

 whom the privation of the supply, added to the prostration produced by 

 the fever, soon brings on paralysis. In like manner, a complication with 

 intestinal catarrh and icterus tends to hasten the exhaustion ; or, finally, 

 the longer duration of the fever, and the magnitude of the exudation in 

 a protracted pneumonia, may expend the strength of a person previously 

 vigorous and healthy. In all these cases the obtuseness of the senso- 

 rium increases to stupor, the pulse becomes smaller and smaller, the 



