By DAVID WARK, M.D., 9 East 12th Street, New York.

Pneumonia

During the past winter inflammation of the lungs has destroyed the lives of many persons who, although they were in most cases past the meridian of life, yet still apparently enjoyed vigorous health, and, I have little doubt, would still have been alive and well had the preventive means here laid down against the occurrence of the disease from which they perished been effectively practiced at the proper time.

The most important anatomical change occurring during the progress of pneumonia is the solidification of a larger or smaller part of one or both lungs by the deposit in the terminal bronchial tubes and in the air cells of a substance by which the spongy lungs are rendered as solid and heavy as a piece of liver. The access of the respired air to the solidified part being totally prevented, life is inevitably destroyed if a sufficiently large portion of the lungs be invaded.

This deposit succeeds the first or congestive stage, and it occurs with great rapidity; an entire lobe of the lung may be rendered perfectly solid by the exudation from the blood of fully two pounds of solid matter in the short space of twelve hours or even less. The rapidity with which the lungs become solidified amply accounts for the promptly fatal results that often attend attacks of acute pneumonia. If recovery takes place, the foreign matter by which the lung tissue has been solidified is perfectly absorbed and the diseased portion is found to be quite uninjured. The only natural method by which the blood can be freed from the presence of foreign matter is by the oxidation - the burning - of such impure matters; the results being carbonic acid gas that escapes by the lungs and certain materials that are eliminated chiefly by the kidneys. But when these blood impurities exist in the vital fluid in unusually large quantities, or if the respiratory capacity be inadequate, the natural internal crematory operations are a partial failure.

But nature will not tolerate the presence of such impurities in the vital fluid; if they cannot be eliminated by natural means they must by unnatural means; therefore such material is very frequently deposited in various parts of the body, the point of deposit being often determined by some local disturbance or irritation.

For instance, if a person whose blood is in fairly good condition takes a cold that settles on his lungs, he either recovers of it spontaneously or is readily cured by means of some cough mixture; but if his blood be loaded with tubercular matter, the latter is extremely liable to be deposited in his lungs; the cough that was excited in the first place by a simple cold becomes worse and persistent, in a few months his lungs show signs of disorganization, and he has consumption of the acute or chronic type, as the case may be.

On the other hand, if the impure matter by which the blood is loaded be of the kind that causes the pulmonary solidifications of pneumonia, the latter disease is very likely to be developed if a cold on the lungs be caught.

The liability of any individual to attacks of acute pneumonia is therefore determined very largely by the presence or absence in his blood of the matter already alluded to. If his blood be free from it, no cold, however severe, is competent to originate the disease.

There can be no question but that good living and sedentary habits have a strong tendency to befoul the blood; the former renders effective respiration all the more necessary for the removal from the blood of whatever nutritive matter has been taken beyond the needs of the system, and the latter inevitably diminishes the respiratory motions to the lowest point consistent with physical comfort. From these conditions originates the active predisposing cause of pneumonia, to which we have already alluded.

The disease is more fatal in the very young and in the aged; the mortality seems to bear a direct ratio to the respiratory capacity; in young subjects the breathing powers have not been fully developed like the other physical capacities, while in the old the respiratory volume has been diminished by the stiffening of the chest walls and of the lungs by the senile changes already detailed.

There can be no question but that protection from cold and judicious attention to the health generally, by suitable exercise and diet, has a powerful tendency to prevent that overloaded condition of the blood to which I believe acute pneumonia to be chiefly due; still I have no doubt but that the most active preventive measure that can be adopted is keeping up the respiratory capacity to the full requirements of the system, a precaution which is specially necessary to ease-loving and high-living gentlemen who are past the prime of life. I am of the opinion that if such persons would cultivate their breathing powers by the simple means here recommended, their liability to pneumonia would be notably reduced.