occurred
have
many of
to
our
readers to
much
less satispneumonia and a prognostic factoiy, both from a diagnostic point of view. We used to see pneumonia the fifth, seventh or case cease abruptly on ninth day suddenly, as is said by crisis, just is the text-books taught us, but this is no longer the case. In our own experience of find
their
cases
within the past 5 or 6 years, we have found it the exception to meet a straightforward case ; we have found much more com-
pneumonia
monly cases of broncho-pneumonia pneumonia, than the old stereotyped tion.
Pleurisy
have found
we
an
accompaniment with or without the side, and in fatal cases we
or
lobular-
lobar affecinvariable
pain in have very freTo what extent severe
met with pericarditis. influenza has really been present in India within the past 3 or 4 years, it is difficult to say. Cases have been pretty freely returned under this
quently
heading,
as
missioner's
may be
Report,
seen
both
in the in
Sanitary
Com-
the British
and
Native
Army and among prisoners. In our experience, though we have hesitated to
own use
the term
"
Influenza" in the returns, yet
have had little doubt that a great number of the cases of bronchitis, broncho-pneumonia, we
and pneumonia met with influenzal
nature.
consolation difficulty has beset of
a
It to our
were really of an is, therefore, something
find
that
professional
the
same
brethren at
may be learned from an admirable lecture by Professor Whitla of Belfast, in a recent issue of the Dublin Journal of Medical Science. The fact is, we must recognise pneumonia to be, as Dr. J. W. Moore has said, a "multiple infection." A true pneumonia may occur in erysipelas, influenza, tuberculosis, enteric fever, and, we may add, in
home,
PNEUMONIA SINCE THE INFLUENZA EPIDEMIC.
student-days of most of us, there was so satisfactory as Lobar Pneumonia. No disease was, to use Tennyson's expression, so of careful of the type even if so careless the individual life. But since the days of the great pandemic of influenza, no disease has In the
no
disease
"
"
been
more
erratic
or
"
less orthodox.
"
It must
as
in each of the
case
due to the
cerebro-spinal fever,
localisation
specific micro-organism
in the
of the
lung primary
disease or a toxin derived therefrom. We have also learned from the researches of our Bombay
Medical confreres, and
especially Major Childe,
that there is a true plague-pneumonia. Dr. Thompson of the Bellevue Hospital, Belfast, has pointed out that of late years lobar pneumonia often fails to follow a definite course, and, in his opinion, it departs widely from its characteristic clinical symptoms, and notably in its duration ; and he is, writes Dr. Whitla, probably correct in surmising that these alterations are
THE INDIAN MEDICAL GAZETTE.
338
in some way depending upon the advent of influenza ten years ago. Ley den of Berlin found three types of influenzal pneumonia, i.e.,
simple streptococcic, the which, Frankel's diplococcus the
mixed forms, the latter ofteu
true croupous was
present),
(in and
with
complicated
pleural inflammation. There
little doubt of its clinical Its onset is often sudden; the
also
is
characteristics.
temperature may bound up with alarming rapidity ; there may be no marked pleural pain, or herpes or rusty sputum, and for three or four days no physical signs of pulmonary mischief. Fine crepitus when it comes, is soon followed by tubular breathing, indicating consolidation, but this is not lobar; it is rather confined to islands of pulmonary tissue separated by healthy lung or
by patches of bronchial catarrh. The conspreads in a mean and treacherous
solidation
very different from that of honest pneumonia. The expectoration is seldom rusty, manner,
but often
profusely purulent or more ofteu muco-puruleut; dulness on percussion is seldom well
marked,
and shifts
confidence in one's
so
much that
loses
one
previous observations,
even
if noted down at the time. The duration of the is indefinite and usually longer than the 7
cases
8 days of old fashioned orthodox pneumonia. Cases have often been noted within recent years at home in which there was strong susor
picion of contagiousness. pneumonia with which in
This is we
are
a
feature of
familiar with
India; and many such cases used to be reportregiments on the N.-W. Frontier a decade
ed in
ago. It is probable that the mortality of this unorthodox pneumonia is somewhat less than of the old lobar form ; at least, this is home or more
experience,
but in
India,
in 1897, the
case
death-
was fully up to the average, e.g., 1G 'per cent. for British Troops, 15 per cent, for prisoners and 22 per cent, for native troops (many of the
rate
latter
were
however much
exposed during
We had thus
the
frontier campaigns). briefly cated a change in the pneumonia of the present doubt that our views coinda}r, and have little cide with the experience of many of our readers.
indi-
[Sept.
1899.
have
many of
to
our
readers to
much
less satispneumonia and a prognostic factoiy, both from a diagnostic point of view. We used to see pneumonia the fifth, seventh or case cease abruptly on ninth day suddenly, as is said by crisis, just is the text-books taught us, but this is no longer the case. In our own experience of find
their
cases
within the past 5 or 6 years, we have found it the exception to meet a straightforward case ; we have found much more com-
pneumonia
monly cases of broncho-pneumonia pneumonia, than the old stereotyped tion.
Pleurisy
have found
we
an
accompaniment with or without the side, and in fatal cases we
or
lobular-
lobar affecinvariable
pain in have very freTo what extent severe
met with pericarditis. influenza has really been present in India within the past 3 or 4 years, it is difficult to say. Cases have been pretty freely returned under this
quently
heading,
as
missioner's
may be
Report,
seen
both
in the in
Sanitary
Com-
the British
and
Native
Army and among prisoners. In our experience, though we have hesitated to
own use
the term
"
Influenza" in the returns, yet
have had little doubt that a great number of the cases of bronchitis, broncho-pneumonia, we
and pneumonia met with influenzal
nature.
consolation difficulty has beset of
a
It to our
were really of an is, therefore, something
find
that
professional
the
same
brethren at
may be learned from an admirable lecture by Professor Whitla of Belfast, in a recent issue of the Dublin Journal of Medical Science. The fact is, we must recognise pneumonia to be, as Dr. J. W. Moore has said, a "multiple infection." A true pneumonia may occur in erysipelas, influenza, tuberculosis, enteric fever, and, we may add, in
home,
PNEUMONIA SINCE THE INFLUENZA EPIDEMIC.
student-days of most of us, there was so satisfactory as Lobar Pneumonia. No disease was, to use Tennyson's expression, so of careful of the type even if so careless the individual life. But since the days of the great pandemic of influenza, no disease has In the
no
disease
"
"
been
more
erratic
or
"
less orthodox.
"
It must
as
in each of the
case
due to the
cerebro-spinal fever,
localisation
specific micro-organism
in the
of the
lung primary
disease or a toxin derived therefrom. We have also learned from the researches of our Bombay
Medical confreres, and
especially Major Childe,
that there is a true plague-pneumonia. Dr. Thompson of the Bellevue Hospital, Belfast, has pointed out that of late years lobar pneumonia often fails to follow a definite course, and, in his opinion, it departs widely from its characteristic clinical symptoms, and notably in its duration ; and he is, writes Dr. Whitla, probably correct in surmising that these alterations are
THE INDIAN MEDICAL GAZETTE.
338
in some way depending upon the advent of influenza ten years ago. Ley den of Berlin found three types of influenzal pneumonia, i.e.,
simple streptococcic, the which, Frankel's diplococcus the
mixed forms, the latter ofteu
true croupous was
present),
(in and
with
complicated
pleural inflammation. There
little doubt of its clinical Its onset is often sudden; the
also
is
characteristics.
temperature may bound up with alarming rapidity ; there may be no marked pleural pain, or herpes or rusty sputum, and for three or four days no physical signs of pulmonary mischief. Fine crepitus when it comes, is soon followed by tubular breathing, indicating consolidation, but this is not lobar; it is rather confined to islands of pulmonary tissue separated by healthy lung or
by patches of bronchial catarrh. The conspreads in a mean and treacherous
solidation
very different from that of honest pneumonia. The expectoration is seldom rusty, manner,
but often
profusely purulent or more ofteu muco-puruleut; dulness on percussion is seldom well
marked,
and shifts
confidence in one's
so
much that
loses
one
previous observations,
even
if noted down at the time. The duration of the is indefinite and usually longer than the 7
cases
8 days of old fashioned orthodox pneumonia. Cases have often been noted within recent years at home in which there was strong susor
picion of contagiousness. pneumonia with which in
This is we
are
a
feature of
familiar with
India; and many such cases used to be reportregiments on the N.-W. Frontier a decade
ed in
ago. It is probable that the mortality of this unorthodox pneumonia is somewhat less than of the old lobar form ; at least, this is home or more
experience,
but in
India,
in 1897, the
case
death-
was fully up to the average, e.g., 1G 'per cent. for British Troops, 15 per cent, for prisoners and 22 per cent, for native troops (many of the
rate
latter
were
however much
exposed during
We had thus
the
frontier campaigns). briefly cated a change in the pneumonia of the present doubt that our views coinda}r, and have little cide with the experience of many of our readers.
indi-
[Sept.
1899.
