182 DISEASES OF THE PARENCHYMA OF THE LUNG. 



skill is bedewed with clammy sweat, and the patient dies from passive 

 hypersemia, passive oedema, and suffocative effusion. 



Death takes place with symptoms quite like these in the third stage, 

 that of purilent infiltration, when the strength proves insufficient to 

 withstand the duration and intensity of the fever. Sometimes the 

 asthenic symptoms, which may arise during pneumonia, are accom- 

 panied by another group of symptoms of a different kind. The pulse 

 grows small and irregular, a slight jaundice appears, which manifestly 

 does not depend upon biliary obstruction ; the urine becomes albumi- 

 nous, the mind of the patient is much disturbed, the delirium being vio- 

 lent at first, afterward settling into stupor. When there is much jaun- 

 Juce, this description corresponds nearly with that of the bilious pneu- 

 monia found in many of the ancient pathologies. * In these cases we 

 probably have to do with a parenchymatous degeneration of the heart, 

 liver, kidneys, brain, and blood. In their appropriate sections we shall 

 consider in detail the subject of parenchymatous degeneration of these 

 organs, as well as the relation of icterus to parenchymatous degenera- 

 tion of the liver, and then dependence of this degeneration upon an 

 increase of the animal heat, and upon intensity of the febrile crasis. 



With regard to the rarer sequelae of pneumonia, we may have good 

 reason to suspect the formation of an abscess, when the slight shiver- 

 ing fits, which accompany purulent infiltration, change into violent 

 rigors; and when a yellow-gray discharge, containing more or less 

 pigment, begins to be expectorated in large quantities ; but the diag- 

 nosis is only sure, when, by means of the microscope, we can discover 

 elastic fibres, which, from their structure, are recognizable as belonging 

 to the lung, or when physical exploration shows the existence of a 

 large cavity in the chest. When a pulmonary abscess ends fatally, 

 death takes place under conditions similar to those which accompany 

 death from purulent infiltration. If the abscess heal, the expectoration 

 loses its yellow color, little by little, as the cavity gradually becomes 

 enveloped in a capsule of connective tissue ; and when the abscess is 

 completely closed the sputa cease entirely. Should a permanent cavity 

 remain behind, lined with a pyogenic membrane, and surrounded by in- 

 durated connective tissue, it affords the same symptoms, runs the same 

 course, and gives rise to the same danger as do the bronchiectatic cavi- 

 ties of which we have to treat in Chapter XI. The formation of new 

 connective tissue and its contraction in the regions about the cavity 

 also give rise to those depressions of the thorax which we shall describe 

 by-and-by. Gangrene a very rare sequel to pneumonia is character- 

 ized by most intense collapse, by the expectoration of a blackish sputum 

 of a most foul, putrid odor, together with the physical signs of a cavit\ 

 in the lungs (see Chapter XIL). 



