188 DISEASES OF THE PARENCHYMA OF THE LUNG. 



a later period it often accompanies exhaustion, so that, when it is per- 

 sistent and intense, it may be regarded as a sign of an adynamic condi- 

 tion, and hence may furnish grounds for alarm. The same is true of the 

 entire train of symptoms which we are in the habit of calling " ner- 

 vous" (typhoid). It has already been stated that drowsiness, transient 

 twitchings, or palsy, are dangerous signs. 



Finally, the prognosis depends upon the sequelae of pneumonia. A 

 transition from the stage of hepatization into that of purulent infiltra- 

 tion is of far more unfavorable augury than the termination by liquefac- 

 tion and absorption. The formation of an abscess, caseous infiltra- 

 tion of the exudation, and gangrene, make the prognosis more and 

 more grave. 



TREATMENT. The indicatio causalis cannot be met in the ma- 

 jority of cases, inasmuch as almost every pneumonia arises from 

 unknown atmospheric or telluric influences. Indeed, it would be 

 highly injudicious to treat a patient with pneumonia by dia- 

 phoresis, under the assumption that he had "taken cold." Ex- 

 perience teaches that in many instances when the sweating is 

 abundant throughout the attack, the course of the disease is espe- 

 cially severe. 



With regard to the indicatio morbi, we must not forget, in the first 

 place, that the natural course of pneumonia is more decidedly cyclical 

 than that of almost any other disease, and that, left to itself, in a vigor- 

 ous patient, if uncomplicated, and of moderate intensity, it almost always 

 ends in recovery. This fact has not been known until recently. We 

 have to thank the so-called expectant mode of treatment of the Vienna 

 school and the success of the homoeopaths for this important discovery, 

 from which the following rules are to be drawn. Simple pneumonia 

 attacking persons previously in good health requires no more active 

 treatment than does erysipelas, small-pox, measles, or other diseases of 

 cyclical course, provided only that the extent of the disease be mod- 

 erate, and that there be no complication. Indeed, it has been proved 

 that, unless warranted by special indications, active interference has an 

 unfavorable effect upon the course of pneumonia ; and Dietl is right in 

 affirming that this disease, when treated by bleeding, more often termi 

 nates fatally than where no venesection has been employed. It is quite 

 a different matter to compare the cases in which we bleed, not because 

 of pneumonia ', but in spite of pneumonia, and for fear of certain com- 

 plications, with those cases in which, upon principle, blood-letting is 

 never practised. 



The number of bleedings which used to be practised by JBouillaud 

 and other disciples of the " saignee coup sur coup " school, likewise 

 tends to support the experience of Louis, Dietl, and others, that bleeding 



