PNEUMONIA. 
251 
to be in a condition of inflammatory oedema, heavy pitting on 
pressure and crepitating when cut. 
The second stage is that of pulmonary hepatization or red 
hepatization. The affected portion is bulky, heavy, solid to 
feel. On section the lung is firm and dry, presenting a red 
granular surface which is readily broken and sinks in water. 
Third stage is that of resolution or gray hepatization. This 
is marked by falling of temperature. The exuded product 
now rapidly undergoes molecular degeneration, the fibrinous 
element becoming completely emulsified, and the corpuscles 
more or less broken down by fatty changes. 
Termination .—Resolution is a most favorable and common 
termination. Abscess, gangrene and chronic pneumonia may 
arise. 
Symptoms .—The general aspect and symptoms of pneu¬ 
monia on the third or fourth day of attack are usually such as 
to leave but little room for doubt at to the nature of the case. 
But in the early stage I have been frequently at a loss to 
know if it was going to be a case of pneumonia or pleurisy, a 
point of much importance from a therapeutic standpoint. 
The disease is usually ushered in with a chill, staring coat, 
anxious expression, febrile symptoms, cold extremities. 
Thirsty as a rule, patient retains standing posture, legs separ¬ 
ated as if to give room for lungs to expand. Temperature rang¬ 
ing from 104° to 106 0 . Pulse accelerated and very variable, 
numbering from 70 to 90. The artery is hard and full or may 
be soft and full, owing to plethoric condition of patient. Mu¬ 
cous membrane congested. Appetite and secretions dimin¬ 
ished. 
PJiysical Signs .—Dullness on percussion over hepatized 
portion and a loss of respiratory murmur. Just before hepati¬ 
zation sets in you get the crepitant rales. In the second stage 
bronchial breathing, which is very characteristic. In the 
third stage the bronchial breathing gives place to crepitations 
of a moist, coarse character. Pleural friction is heard if com 
plicated with pleurisy, which I think is in most cases. 
Treatment .—Pneumonia being a self-limiting disease, the 
only form of treatment indicated is to try and assist nature 
