398 THE TREATMENT OF DISEASES. 



unlikely to be set up in the course of other diseases, and it is a complication for 

 which we must always be on the look-out. In Bright's disease, for example, it is 

 not of unfrequent occurrence. 



Pneumonia is commonly ushered in by restlessness with general febrile dis- 

 turbance. At the end of from one to three days there are rigors, soon followed by 

 nausea, cough, pain in the side, distressed breathing, a pulse reaching 140 or even 

 160 beats in the minute, burning heat of the skin, thirst, loss of appetite, prostra- 

 tion, headache, and sometimes even transient delirium. Not unfrequently the 

 patient describes the succession of his symptoms as shivering, fever, cough, and 

 breathlessness. 



The onset of pneumonia is most commonly marked by rigors, which are usually 

 severe, their frequency and intensity being greater in this than in almost any other 

 disease. Pain in the side appears to exist only in those cases in which the inflam- 

 mation of the lung is accompanied by some degree of pleurisy. This, however, is of 

 frequent occurrence, the pain being commonly felt on a level with or a little 

 below one or other breast, but it may be experienced in almost any other part 

 of the chest. Generally it is most severe at the beginning, and declines by degrees, 

 ceasing altogether for some time before the pneumonia terminates. It is aggravated 

 by cough, by a deep breath, and often by sudden changes in posture, or by pressure 

 made on the ribs. Shortness of breath is also of constant occurrence, although it 

 varies greatly in degree. Sometimes it is so slight that the patient is not conscious 

 of it, and even the physician scarcely perceives it. Sometimes it is so extreme that 

 the patient, entirely regardless of what is going on about him, seems wholly occupied 

 with respiring, is unable to lie down, and what with the shortness of breath, cough, 

 and pain in the side, can scarcely speak. The number of respirations in a minute 

 is seldom less than thirty, often thirty-five to forty, and they may even reach sixty 

 or seventy. The cough, which is one of the earliest symptoms, is short and hacking, 

 and rarely comes on in paroxysms. It is usually dry at the outset, but in a few 

 hours is accompanied by a peculiar expectoration, which constitutes one of the most 

 certain indications of the presence of pneumonia. The expectoration consists of 

 transparent and tawny or rust-coloured sputa, uniting in the vessel containing it 

 into a jelly-like and trembling mass of such viscidity that the spittoon may be turned 

 upside down and shaken without spilling its contents. This characteristic appear- 

 ance may perhaps not be noticed for the first day or two, but it is almost always 

 present at some period in the course of the disease. One of the most marked 

 features of pneumonia, and one that will often suffice to distinguish it from other 

 complaints, is the sudden and considerable rise of temperature which marks its 

 invasion, and is usually maintained until the occurrence of the crisis. It is not 

 uncommon for the thermometer to mark a temperature of 103 or 104 degrees within 

 a few hours of the first feeling of illness. 



In the majority of cases pneumonia ends in complete recovery. Usually a 

 marked crisis takes place, th temperature falling rapidly to the normal, while the 

 pulse and respiration diminish' in frequency and the other symptoms abate, con- 

 valescence being soon established. This happens usually from the third to the 

 eleventh day, most commonly about the end of the first week. It is often marked 



