CROUFOUS PNEUMONIA. 189 



is no specific, and that it does not even cut the process short. In fact, 

 die bleedings had to be repeated and continued until the third, fifth, or 

 seventh day that is to say, until the terminal day arrived when the 

 cycle of the pneumonic process was complete. 



Whichever one of the current theories upon inflammation we maj 

 adopt, none of them even partially upholds the efficacy of venesection 

 in pneumonia. The fact is, unfortunately, forgotten, that the most in 

 tense hyperaemia, by itself, cannot occasion croupous inflammation ; that 

 the enlargement and dilatation of the capillaries, which we see in valvulai 

 disease of the heart, although they may cause splenification and oedema, 

 never produce croup of the air-vesicles. The subject of venesection 

 can be more appropriately discussed while considering the symptomatic 

 indications for treatment, under which head it, strictly speaking, belongs. 



I have made extensive employment of cold in the treatment of 

 pneumonia, and, relying upon a large number of very favorable results, 

 can recommend this procedure. In all cases I cover the chest of the 

 patient, and the affected side in particular, with cloths which have been 

 dipped in cold water and well wrung out. The compresses must be 

 repeated every five minutes. Unpleasant as this procedure is in almost 

 all cases, yet even after a few hours the patients assure me that they 

 feel a material relief. The pain, the dyspnoea, and often the frequency of 

 the pulse, are reduced. Sometimes the temperature goes down an entire 

 degree. My patients often retain this surprising condition of improve- 

 ment throughout the entire duration of the attack, so that their outward 

 symptoms would hardly lead one to imagine the grave internal disorder. 

 The relatives of the patient, too, who do not fail to perceive the im- 

 provement, now readily assist in the treatment to which at first they 

 were opposed. In a few cases, and only in a few, the use of cold affords 

 no relief, and the troublesome manipulation for its application increases 

 the distress of the sufferers so much that they refuse to keep it up. In 

 such cases I have not insisted upon the further application of cold. 



In the hospital at Prague every pneumonia is treated with cold com- 

 presses, and, according to the statements of Smoler, it is exceptional for 

 a patient not to feel material relief from this treatment. As, however, 

 I have never succeeded in cutting short a pneumonia by means of cold 

 applications, I should only ascribe a palliative influence to their use, 

 had not the duration of the disease in many instances been decidedly 

 shortened and the convalescence hastened by means of their energetic 

 and methodical employment. In fact, in but few cases have we seen 

 the disease delay its departure until the seventh day. Many have im- 

 proved on the fifth, and a very large number as early as the third day ; 

 nay, I have repeatedly found it impossible to keep patients with recent 

 pneumonia in hospital for a longer period than a week. Cold is rightly 



