PNEUMONIA 417 



the organism. In the light of Meltzer's studies one can 

 conceive that through one or another of many causes 

 exudations, non-specific in character, may occur in the 

 lungs, occlude terminal bronchi and, as in the experimental 

 cases, cause small cavities into which pneumococci, gaining 

 access, develop as in a closed space and by the products 

 of their growth bring about progressive inflammation of 

 the tissues surrounding them. The experimental evidence 

 also suggests the view that pneumonia probably always 

 starts as such isolated patches which, by extension, coalesce 

 until finally larger areas or indeed whole lobes of the lungs 

 are involved. When this inflammation of the lung, with its 

 accompanying symptoms, have progressed for about a week, 

 the crisis may be expected, i. e., the distressing symptoms 

 become more or less suddenly relieved, fever begins to 

 decline, respiration is less difficult, and there are beginning 

 signs of changes in the diseased lung tissue, i. e., resolution 

 may set in. 



These sudden changes for the better, so often observed 

 in true lobar pneumonia, and as said, denominated "the 

 crisis," constitute one of the dramatic phenomena of clinical 

 medicine. As if by magic, often within a few hours, a patient 

 apparently in extremis, may be found in comparative comfort 

 and progressing steadily to recovery with little or no return 

 of the distressing symptoms. It is needless to say that this 

 is not the history of every case, but it is so frequently seen 

 in non-fatal cases as to fairly characterize the course of a 

 case destined to recover. 



What are the forces that work this remarkable change for 



the better? It cannot be that the pneumococci causing the 



trouble are suddenly killed off and their hurtful action in 



this way terminated; for we have seen that long after the 



27 



